To truly fight against Alzheimer’s, pharma must overcome old silos and dare more collaboration

One of my greatest fears is a cruel reality for more than 40 million people worldwide: living with Alzheimer’s. I can only imagine how hard it is to realize that one is slowly fading away, not being able to recognize your own children or best friends. At the same time your relatives must witness how someone they love is slowly becoming fragile, losing independence and control. These thoughts fill me with deep sadness and a sense of powerlessness.

Yet there is still no effective treatment and it seems like no significant advancements have been achieved in the last 15 years.

This statement bears truth and fallacies but I am convinced that the pharma industry can do better in fighting against Alzheimer’s — the disease that is estimated to consume almost a fourth of healthcare budgets by 2040. In this article, I am proposing a more holistic approach to research and collaboration that could lead to better outcomes and could initiate the next era of therapeutic progress.

Let me quickly introduce the topic before raising concrete suggestions:

Numerous companies have invested in clinical trials to discover a cure or at least something that slows progression. In addition, I have personally experienced the dedication of scientists to find a solution. Still, advancement is slow and accompanied by frequent disappointments. So why is there still no significant improvement?

A short answer to this complex question is that a lot of the effort of researchers just did not yield what it promised: tackling the accumulation of amyloid plaques in the brain. These protein aggregates are one of the most distinct symptoms of Alzheimer’s patients. Unfortunately, even when the clumps could be reduced, there was seldom success in stopping dementia. The most challenging problem in curing the disease is that we only recognize it when it has already progressed too far. The diagnosis relies on an assortment of aspects such as observations by family members or a patient’s medical history. Even with brain scans that show clear symptoms, doctors can hardly tell whether a person will progress into an Alzheimer’s patient and how extensive progression will be.

Currently approved drugs only tackle very early symptoms and fail in the long run. While more than 200 clinical trials have addressed the disease since 2001, none has been successful in truly slowing progression.

It’s not like nothing is happening:

Failing repeatedly is devastating but offers the chance to learn from mistakes. In fact, the understanding of Alzheimer’s and its causes is becoming better while new approaches are being taken. Misdirected gene expression, viruses such as herpes and specific cells in the brain’s immune system are being investigated as potential causes, while other research still focuses on amyloid plaques or restoring lost synapses. Specialists predict that the correct therapeutic answer could be a bundle of medications that treat different symptoms in different stages of the disease. Furthermore, there is evidence that the disease starts progressing much earlier than expected and that interventions could theoretically take place when patients are still healthy. This new view on the window of opportunity for preventing the disease bears the chance of changing the status quo sustainably.

How collaboration and the power of new technologies will transform Alzheimer’s R&D

Since the pharma industry is driven by profitability, daring bold approaches require corporate risk appetite and, above that, for corporate investments, a positive expected economic value. With classical approaches this calculation will regularly lead to project downfalls. The hard truth is that there is so much uncertainty in Alzheimer’s research that there is a general hesitancy to allocate resources to it. Thus, tackling the new window of opportunity requires some drastic changes to current standards. Efforts must start considerably earlier and patient profiles must be defined much better. Combinations of novel therapies and new technologies need to be tested. All of this incorporates a great deal of risk and uncertainty. Since there are no incentives for individual companies to take all these risks alone, the pharma industry must dare more partnerships. Only a holistic approach to innovation will promise fruitful investments and will thereby enable the next phase of progress.

There is optimism

In fact, first steps towards more collaborative research have been made. Since 2015, a new syndicate of powerful companies, universities and other researchers, EPAD, has been pursuing “collaborative research to better understand the early stages of Alzheimer’s disease and prevent dementia before symptoms occur”. It is great to see these developments but to truly make a difference, I believe these efforts must be much more driven by corporate initiatives aimed at cooperation, which would fuel the area with bigger investments.

So what?

While pharma companies are highly experienced in entering such partnerships in late stage development, collaborating for early, new and risky approaches is an underutilized concept. A cultural change and a fresh perspective are needed to promote such concepts. A new kind of value-focused thinking, centered around the new window of opportunity, can drive the goals and ambitions of such collaborations that could generate new alternatives to build on the potential of preventive care for Alzheimer’s.

The willingness to change and the courage to collaborate with new players, competitors, technology leaders and other industries (such as MedTech) can make the difference in Alzheimer’s research. This approach must be used early on and must include more strategic partners, especially in complex and uncertain situations.

Let me give you an example of a potential, useful collaboration

Artificial intelligence (AI) is a good example of a surely underutilized power that could be leveraged through better cooperation — in Alzheimer’s, AI can help in two important ways:

A. Enabling early diagnosis: Through AI, traditional approaches such as patterning brain scans will be optimized and new tactics such as monitoring sleep behaviors or movements can be introduced. This can enable early treatment and allows researchers to monitor early developments in disease progression.

B. Optimizing clinical trials: Identifying which patients could potentially experience the greatest advantage from specific drugs has been a major challenge and made trial design extremely difficult. Once patient populations are defined better, treatments can be tailored more appropriately to patient-specific needs.

To use the opportunities of AI, established companies who have the resources for large scale research and development must corporate with emerging technology companies or start-ups. Established players lack speed and know-how in the development of new data and technology systems while the providers of these success factors merely lack the scale to achieve advantageous use.

If more examples like this are applied, I am optimistic that there will be opportunity in uncertainty.

A final note:

There are much more approaches, technologies, and developments that can transform Alzheimer’s research. Let’s advance the discussion!