That’s a cemetery, if it’s not clear.
She’s not a bad crow.
We’re starting off today with an episode of Then and Now/Now and Then, with two stories published in the New York Times 52 years and two months apart.
The Then:
The Now:
The virus is old: archaeologists have found documentary evidence of it dating back nearly 4,000 years, suggesting that 1969 could have been the first year in thousands in which no one on the continent died from it.
If you’re a reader of a certain age you’ll recall the urgency of the vaccination campaigns that continued on into the 1960s after the vaccines were introduced in the mid-1950s, and perhaps the angst around communal summer activities. The Washington Post has a multimedia spread that offers some sense of how the virus affected life during those days.
Fucking polio? Great googly moogly.
As we’ve said before and no doubt will again if only to keep reminding ourselves, we suck at prognostication. We know for sure, though, that even the best jugglers can keep only so many chain saws in the air, for only so long.
On a personal note, the Proud Boy who ran as the Republican candidate for state representative in the district next to ours in 2020 has pleaded guilty to a federal felony charge stemming from January 6, with a potential (but unlikely) sentence of as much as four years.
He claimed to be working as a reporter at the time but the feds didn’t buy it, about which we have mixed feelings. Obnoxious prick, though.
Congressional Democratic leaders think an upcoming spending bill is so vital that their underlings will vote for it despite the fossil fuel sweetheart deal attached to it by Chuck Schumer, apparently as payback for Joe Manchin’s support of the Inflation Reduction Act, which itself contains gifts for the industry, and for the industry throwing hundreds of thousands of dollars at Schumer and Manchin and at Democratic campaign funds generally.
The leaders have a lot of leverage over their members. They control committee assignments, which can affect the amount of goodies members can send back to their states and districts, and they control massive campaign funds that can be directed at or withheld from individual members.
Industries can bribe or sanction elected officials, and legislative leaders can in turn bribe or sanction lesser lights, is what we’re saying.
This isn’t exactly Now, but close enough for jazz. HHS honcho Xavier Becerra announced in May that Medicare Part B premiums would drop next year after a sharp rise in this year’s premiums predicated on fears of massive spending on an outrageously-priced Alzheimer’s drug that doesn’t appear to work but got FDA approval anyway in June of 2021.
However, a large increase in Medicare spending due to Aduhelm did not materialize due to price cuts and policy decisions.
Since Medicare premiums were announced last fall, Aduhelm's price was cut in half and Medicare officials ultimately decided to restrict access to the new drug. Medicare said it would not pay for the drug unless Medicare beneficiaries were enrolled in clinical trials.
The drug costs close to $30,000 annually after the price cut.
The New York Times did a story in October of 2021 about how the FDA came to approve a drug when the agency’s own experts were vociferously opposed.
Two months before the Food and Drug Administration’s deadline to decide whether to approve Biogen’s controversial Alzheimer’s drug, aducanumab, a council of senior agency officials resoundingly agreed that there wasn’t enough evidence it worked.
The council, a group of 15 officials who review complex issues, concluded that another clinical trial was necessary before approving the drug. Otherwise, one council member noted, approval could “result in millions of patients taking aducanumab without any indication of actually receiving any benefit, or worse, cause harm,” according to minutes of the meeting, obtained by The New York Times.
Works, doesn’t work, same-same. “Sordid” isn’t a strong enough word for the affair, and the story goes into great detail. If you can’t get past the paywall, we can give a copy to one lucky winner.
The FDA officials who approved the drug are described as having worked “unusually closely” with the manufacturer, Biogen.
About a week before the approval was announced, a memory care doctor wrote a long and detailed explanation of why he wouldn’t prescribe the drug for his patients even if it were approved, and what that would mean to people who were desperate for help. (The op-ed appeared in STAT, a really valuable source of news and opinion on a broad range of medical-related subjects.)
Biogen had declared the drug DOA in March of 2019, saying the clinical trials results didn’t warrant further investment and study. The memory care doctor, Jason Karlawish, was frustrated by both the cancellation, which he describes as based more on finance than science, and the resumption of trials in October of 2019. He says in the latter instance, the FDA allowed Biogen to skip a “key phase” of clinical trials, leading to confusion about the results of the advanced phase.
None of this had to happen. Skipping a key phase of research and performing a futility analysis weren’t scientific decisions; they were business decisions about the pace of research to discover an effective Alzheimer’s treatment and how much a company will spend to sustain that pace.
Ironically, approval of aducanumab will likely slow the pace of discovery. A person who’s willing to take on risks and uncertainties will likely choose the guarantee of taking aducanumab instead of enrolling in a clinical trial [and possibly receiving a placebo].
People with Alzheimer’s and their families are desperate for effective treatments for the disease. Aducanumab might be that treatment, but we won’t know until Biogen invests the time and money needed to run well-designed trials and complete them. The day such a trial brings home positive results will be a turning point for my practice.
Read the whole thing. It’s tragic.
Elsewhere and -when in STAT, we learn that all of the drug’s most prominent advocates took money from Biogen. The story is paywalled, but what’s readable on the page says that a group of four doctors conducted a PR blitz on behalf of the drug, sometimes not disclosing that they’d recently taken Biogen money.
We have discovered that shouting “aducanumab!’” sounds like the casting of a spell, which appears to be what happened with Aduhelm and the FDA.
This concludes today’s episode of Then and Now/Now and Then.
We’ve been told to end these things on the upbeat, and so we shall.
(Musical contributors to this post include 65daysofstatic, “REPLICR, 2019;” Congotronics International, “Where’s the One?";” Deerhoof, “Mountain Moves;” and Fabrizio Poggi & Chicken Mambo, “Spaghetti Juke Joint.” Got music recommendations? Please leave them in the comments.)
Some of us are old enough to have lived through the polio experience and have friends and acquaintances who were physically disabled by the disease. Most in that generation do not resist vaccines when new diseases threaten such as Covid and its mutations.
A number of House members seem to be resisting the Manchin pound of flesh and Nancy Pelosi may refuse to put it on the floor without a majority.
I remember two kids from elementary school who needed leg braces and/or crutches. Some in high school too. I don't remember being scared about polio, although my mother has since said she was on our behalf, but covid still has me rattled and thoroughly vaccinated.
I always come down on the side of cupidity and fear in broad strokes, but occasionally our federal legislators will surprise me. I do hope you're right.