The Business of Aducanumab

I’ve written before about how the makers of the controversial drug Aducanumab are selling hope for $56,000/year, but after thinking and reading more about the topic, I’ve become even more convinced that whatever hope they are selling isn’t actually for patients, but for cash-strapped medical centres and drug companies.

Consider this article in JAMA Neurology. As far as I can tell, the author is a very decent person and accomplished physician. But I find it painful to consider the mental somersaults required to portray a positive scenario out of an astoundingly bad decision by the authorities:

Even opponents of the FDA’s decision, and there are many, ruefully concede that it could be the solution to our lack of a business model. Its delivery as an infusion means physicians will receive approximately 4% in revenue from the drug’s $56 000-per-patient annual cost. There is also revenue from the imaging studies and visits to evaluate for possible adverse effects. Funds will flow into memory centers.

And later on in the article:

As this happens, we will have support to hire more colleagues. Our work will of course focus on “whether aducanumab is right for you.” We will talk about its risks, uncertain benefits, the co-pay, coordinating the imaging visits, how to watch out for signs of brain edema and microhemorrhages, and APOE testing, but this education can expand to other topics such as how to organize a day that is safe, social, and engaged. That is exciting.

Wow, how exciting!

In particular, that part about how they will (of course!) focus their work on whether aducanumab is right for patients, well, let’s put it this way, if I desperately needed to believe in some nonsense, that’s exactly what I would say to myself in the mirror.

Much better is this follow-up article, again in JAMA Neurology, about ‘What the Aducanumab Approval Reveals About Alzheimer Disease Research’. It focuses on the lack of Black patients in aducanumab trials, but makes a broader point about the need for more inclusive research in general.

Something is horribly wrong with the healthcare system in America. The fact that an unproven drug like aducanumab can be recommended for use shows what happens when you prioritise profits over the welfare of patients.

Christmas Light Festival

The start of any festive season isn’t an exact science. In Malaysia, for example, as we approach the fasting month and Hari Raya Aidilfitri, more and more places start to sell ‘kuih raya’, or play Raya songs or offer Raya-specific discounts for random items like washing machines, curtains, and cars (!).

Here in the UK, I am beginning to see more and more signs of Christmas season, albeit with the threat of ‘storm clouds‘ (according to Boris) following a dramatic rise in Covid cases in Europe.

The Oxford Christmas Light Festival is one such sign. Various events are happening around the city between the 19th and 20th of November (yesterday and today) including a Victorian Christmas Market, light trails & shows, as well as a photography workshop.

Right next to our house, Cutteslowe Park has been turned into its own festival of light. I’ve written before how trees often remind me of neurons (see ‘Neurons in Nature‘, ‘Dendrite‘, and ‘Dendrite Again‘) but yet again, I was reminded of this fact upon seeing the trees illuminated from below. Here are some pictures from our area:

My favourite picture is this one, which I call ‘Ice & Fire’ in honour of George R. R. Martin.

Ice & Fire

Hopefully this will motivate him to finally finish the novels before, you know, the inevitable happens. All the best George! 🧙🏼‍♂️

Oh, and in case you wanted to see some videos of the light trail, I’ve got you covered as well:

One Keyboard To Rule Them All

I have a dream.

In that dream, I am the owner of a house.

And in that house, there is a room which serves as my refuge from the outside world. It is the place where I can work, think, read, and write in peace. On the wall there is a map of the world courtesy of National Geographic, next to some framed pieces of Islamic calligraphy. The walls are lined with bookshelves full of my favourite books.

In the middle of the room is my desk, complete with a top-of-the-line Mac desktop. Why would I need a top-of-the-line computer? God knows, but hey, it’s MY dream, so I can put any computer in it that I want, mmmkayyy?

More importantly, in front of the Mac is this beautiful keyboard from Drop, complete with its Lord of the Rings keycap set:

It’s a nice dream.

Stars #2

Living next to a park has its perks. One of them is being able to get to a relatively dark area to do some astrophotography. I am a complete beginner when it comes to photographing the night sky, but I thought I’d give it a go anyway.

Attempt #1
Attempt #2

The images coming out of the iPhone were a bit too bright for my liking so I’ve darkened them a bit using the Photos app. I’m also experimenting with the tint (colour? temperature?) of the photos, making it slightly greenish and the other more red/purple, to see if that helps to bring out the light from the stars a bit more.

If you look closely at the bit of sky above the goal post in the third picture above, you will be able to see a streak of light in the sky. I’d love for that to have been a comet (or is it asteroid? I’m confused!) but it was probably a plane making its way somewhere exotic while the rest of us carry on with our lives on the ground.

All photos were taken with an iPhone 11 Pro Max fixed to a JOBY GorillaPod; using a tripod allowed me to increase the exposure time to 30 seconds in Night Mode.

The Beauty of Autumn

Autumn is my favourite season of the year.

It’s difficult to put into my own words why I like it so much, so I’m not even going to try. Recently, however, I came across a really wonderful quote on the beauty of autumn in a James Clear newsletter.

The quote itself comes from inventor and writer Lin Yutang:

“I like spring, but it is too young. I like summer, but it is too proud. So I like best of all autumn, because its leaves are a little yellow, its tone mellower, its colours richer, and it is tinged a little with sorrow and a premonition of death. Its golden richness speaks not of the innocence of spring, nor of the power of summer, but of the mellowness and kindly wisdom of approaching age. It knows the limitations of life and is content. From a knowledge of those limitations and its richness of experience emerges a symphony of colours, richer than all, its green speaking of life and strength, its orange speaking of golden content and its purple of resignation and death.”

My Country and My People