decision-making -- decision-making by the books -- drove out curiosity
and judgment and investigational spirit in both of these failures.
to the last item, we are not terribly better dealing with success,
probably because we don't have that much experience.
guide you through a thought experiment. We are about to experience an
explosion of Alzheimer's disease cases. Population statistics, incident
rates and demographic changes indicate that the incidence of AD is
doubling every five years. North America alone is going to have
multiple millions of cases in a few more years, and when you look at the
economic aspect of this, by 2030, the spending on Alzheimer’s disease
will be as much as the total Medicare spending on everything in this
not a stochastic process. This is not a maybe. This is going to happen
plus or minus a little bit. This situation is best compared to
astronomers following a meteor hurdling towards San Diego, aimed to hit
a very precisely calculated place and time. What would we do if we had
such a situation? I think we would take it a little more seriously than
we take the economic meteor that's coming just as predictably our way.
what could we do? Let me postulate a sort of science fiction thought
experiment. The science fiction goes like this -- what if we had a drug
that eliminated amyloids? What if we knew, which parenthetically I
don't think we do, but what if we knew that eliminating amyloids would
have a beneficial effect on halting Alzheimer's disease? And what if we
could controllably open the blood-brain barrier at a location of our
choice sufficiently to allow large molecules to go through? The first
two you can argue about. The third we can actually do. It turns out
when we apply focused ultrasound we can open the tight junctions in the
blood-brain barrier reversibly and predictably. We can take tracers and
inject them intravenously and see the tracers travel through the
openings and form a plume, similar to what we saw in the agar.
The plume is more or less
spherical and happens at the desired place.
What if we could develop
an instrument, an image-guided scanner of focused ultrasound hitting
the right places, where amyloids concentrate and wipe them clean or halt
As I'm dreaming this up
for this talk, I encounter a company that is dreaming about the same
things. The company is in business to do focused ultrasound. They are
actually working on this.
But this is not a cheap
deal. Judging from what this company has spent on much simpler
instruments, I think it's fair to say that the development cost would be
somewhere in the neighborhood of $1 billion dollars.
How would we find a
billion dollars to avoid the meteor?