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OMG! They did spinal taps on subjects twice and they didnt have a big drop out rate?!?!

Here is this 3 inch needle we're going to stick in your lower back... Then do it again in 28 days! Yowza!

This is interesting, and thanks for bringing it up. There are a couple of take homes here, and this is a good exercise.

1) They look at surrogate markers (all those things they list as decreasing). Let's put this another way. Say someone has prostate cancer and their PSA is way up. They get treatment and their PSA goes way down! great, right? well, sometimes these same patients get imaging that demonstrates that disease has spread, despite improvement in biomarkers.

this is why I dislike studies that use biomarkers alone as primary endpoints.

2) Part of the reason why Alzheimers is difficult to study is because timelines are LOOOONG. you treat someone in their 70s. well, you may have to treat thousands with and without placebo for a decade or more in order to show real treatment response. As you could imagine, this is incredibly difficult (follow up is difficult, you have to ensure medication compliance, it would be extremely costly, etc). Because "good trials" like this are difficult, they have to rely on surrogate markers like what we mentioned above, which has its own caveats...

3) Now, biotechs that I do like often have patient oriented outcomes (like, say, survival for the above mentioned prostate cancer example) as their primary outcome, AND a "companion diagnostic" that can be shown / is shown to correlate with the primary patient-oriented outcome (ie, if level ABC starts creeping back up, the disease is getting worse).

Thanks for bringing this up.
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