A thank you for the legacy he leaves to the Great American songbook the. Lets take you through some of the headlines who now just so you are now precious president Vladimir Putin is wanting power. They gain 70 aggression towards bellows earlier will also decided to move troops towards its east. And buddha, off the rushes where the listeners arrives in dollars. Even the most i you, thanks to soviet union like to start pulling got significant amount of lens and the west lens that used to belong to germany. It is so give them less than 10 if there is a full and at the present given by starting to pulse our friends in water for head for a boat, and we will remind them its a the u. N. C. Laboratory in chief is wanting of increasing Global Global hunger on solve ation off the russia pull down to the black sea grain deal since august you and broke the agreements. So 32000000 tons of ukrainian grain reach. International markets, great says believes to be facing its houses july, we can do the almost 50 is rec, hold high temperatures, combined with strong winds of closed wild fires, new the capital athens. Temperatures are expected to sol to 45 degrees by sunday. It is rail thousands of people have been marching from tel aviv to west jerusalem in the latest protest against plan judicial changes and peace the due to votes on monday. On the bill restrict taking the Supreme Courts powers to strike down government decisions. A trial date is being set for form of us president donald trump, of a charges of mishandling classified documents. Federal judges set the case for may next year. Off the republican president ial primaries, 7 of the largest u. S. Companies involved in all of the visual intelligence have agreed to follow safeguards set by the white house, amazon, google meta and microsoft, or among the tech johns making the commitment as the headlights and use continues. Ill just say are off the top to out just sierra or how do states console information . How does the narrative inform Public Opinion . How is this as intended, this and we flaming the story . The listening post, i think the media, we dont cover the news, we cover the way the news is cover. The b mencia. Its a condition that affects 55000000 people worldwide. And its most common for alzheimers makes up about 70 percent of all cases. Dementia is the 7th leading cause of death, and according to the u. S. Most recent data, it cost economies globally, 1. 00 trillion dollars. The largest and most influential International Meetings dedicated to advancing dementia science is health and im to them. This year is particularly controversial. A Pharmaceutical Company has these close details of its trials of a new truck to 9, and that eli lilly expects the us food and Drug Administration to decide by the end of this year later to approve what its calling a breakthrough drug. The of the a recently approved and not a one that came despite concerns about it safety and high cost and 26000. 00 a year. For one patients, treatments every nearly 10000000 new dementia cases are reported. 60 percent diagnosed in low and middle Income Countries have these medications the best way forward, or do they just apply cash flow for pharmaceutical companies on step class and, and im so then on this episode of golf to alexs here, we will explore that by talking to to was needing the mental scientist. 8 of the sar is combining patients here with research into the prevention of the mencia and break. Richey with his job, a Health System and a chest using the institution of the 1000000 patients life changing drugs. And his health is patients this lifestyle guidance. So for the 2nd day of rain, braithwaite, cheese and a shot. So alex is here with the professional and great way to thank you for talking to l. Just sierra alzheimers has become so common that many of us know patients with the disease. And theres always this very scary moment when a person doesnt recognize even their own family members. How does that work . What does it do to a brain . This disease that people even forget their own children. I think the, the biggest tragedy in some ways is that as you describe somebody who 1st has some memory problems and who doesnt recognize people around them, what have you is a symptom of this emerging 1020 years, even after the disease is actually started. And a lot of the research that weve been doing over these last of 1015 years or so. This is clearly pointing to the site and these diseases star pro, being late mid life role, 4050 c a. Yes. And, and, and i think thats where theres a huge opportunity like there is another medical conditions that you can detect the diseases who put it early, but something starts to change in your brain then yes, i mean this, so that, so to what the changes are, we still have to map these i completely, but one of the early changes is a build of a protein called amyloid. And this builds up in the brain outside of the nerve cells. And that triggers if you like a lot of other pathologies, a sequence of events that eventually the naps house stopped working so well. And then after that, the symptoms of marriage, because, or the brain has a lot of resilience. So we can manage a fair amount of this disease before symptoms start to emerge. And when that imagines have symptoms arises because the disease is actually go quite advanced. Yeah, youre very strong competing for early detection. You even quit the n h s, right. The, the, the government Health System because you said they only do something when its too late already when people have symptoms. Yeah. So what can you do to, to detect fit in the early stage . I think, i think theres a, in general terms health care across the world. We, we, we say we have a National Health service. We dont, we have a national illness service. And the thing most Health Care Systems are designed and geared towards waiting for people to get sick, waiting for people to get symptoms, as we know is chronic conditions thats often too late and you cant affect the change. But what do you see, for example, to early detect alzheimers . Is that what youre looking at . We can test on the light in the blood. You know, we can actually look for the presence of this protein in the bloodstream. And then, you know, if its, if its, if its abnormal, then we can save that persons maybe more likely to go on to develop on time is dementia in the, in the years ahead in somebodys even more importantly, if its normal, then the symptoms that concerns of water, they have maybe due to something else, like depression or anxiety or stress. So we, we then focus our attention is doctors to, to look for other causes of their, of, of, of their concerns. So when should someone go to a doctor . What symptoms do we have to look out for as we move forward . I think what were, what were, what were hoping to do is perhaps if people have a kind of a, a lower battery or to seek help. So robin waiting for symptoms become really advanced or to start having, you know, major functional impact memory loss forgetfulness. But its, but its, but its, its the cardinal symptom, the, the one that well talk about his name, he lost his forgetfulness. But of course, we all do that, you know, well forget that. And what were actually asking for people to do is, or practitioners to do like, like g ps or family practitioners, is to maybe do a quick memory test for everybody, maybe over the age of 55 at the Alzheimers Association international conference, the biggest gathering of all time a scientist in the world that has been this exciting news now. Right. That is a new truck, the map that was presented to here and im so them. Yeah. Its as the lease of the progression of the disease by more than 30 percent. Yeah, i saw you were on stage. We have with the company with the Pharmaceutical Company is who has developed and dropped and you seem to be as excited as them. I think i think this is a, the waterside transformative, new chapter color where you will, this is, this is a fresh start for the field. Over the over recent months, weve had 2 or 3 drugs that have had similar, painted out strong results that we saw as we saw with the 9. And my people pointed in the same direction and these, these drugs of what we call them on a recorded line 2 bodies. And what they do is they remove this amyloid protein from the brain and they do that very effectively. Now weve had drugs in the past, theyve done that, but they havent been successful because they didnt have any clinical benefit of. What we saw yesterday with a not in mind was a clear impact on clinical symptoms, both cognition and in the day to day function. But what does that mean for patients . What i mean . What does a patient notice if he takes this medicine thing, but one has to say is that, you know, we, we do as doctors as prescribers have to have a sense of what would have happened had, you know, had a drug. And unfortunately, weve got millions of years of Patient Experience of what happens to people over time. And now what we dissipate with this drug is that will be, be slowed significantly. And so we know from us to, to School Perspective from a child perspective, there was definitely a slight, remember this was an 18 month start is being slow to exec progression. So symptoms so, so you know, we, its not going backwards face, it wouldnt decline as quickly as weve done with our drug. Now, i think the under function is maintained for longer at the 2nd level. So, you know, if, if one were able to drive when they were in this trial and had they not had the drug, they wouldnt been able to drive. And in a years time, because of the slowing, itd be another 6 months if not still being able to drive. And you know, as you can imagine, you know, in an, an older person, you know, those months or years of extend its quality of life. Or obviously precious thing this, this drug is, is heading in a new age. This is the beginning of a new chapter. Its turning the page towards what we have currently, which of symptomatic treatments that make no difference to the overall poconos as they might improve . Well, be in for a short period of time, but now we have drugs which cleared the pathology and have me a longer term benefits. There will be other drugs that follow this. Theyll be other other, other, other interventions. But its also clear that the side effects of this truck are particularly bad compared to 2 previous ones, right . That is brain bleeding and yeah, brain swelling, and even 3 people died during this trial who were using this drop. So it, so i think the, what we have to do is, and you know, safety concerns that also mean that the 1st of the medicine is, you know, is do no harm. But we are dealing with the disease that has inevitably fatal. And this is disease where if youre given that diagnosis, you will die from probably your all the time is disease. So basically youre giving them a tiny bit of hope. Well, i think what youre doing, what id like to say were doing is were giving them information because what, itll ultimately decision to start the medicine should be with the patient. Not with the doctor. Mm hm. Well, our job is to say, look, in our experience and with our knowledge, we think its, you take this drug. The benefits are ex, lines at the risk that a, b, and c for use a pass, and then with your goals and your aspirations and your, you know, history, what do you want us to do . And i dont know this to be true, but imagine a lot of people who know theyre going to die about so many disease we. We take that risk and i dont think its for us to be paternal istic and to say we know best, but they buy some time, right . Basically thats what they do. They buy some sign, maybe, absolutely 4 or 56 months. But in the periods they have to take a drug that is very intensive, but is it worth it . Thats the question without, thats not a question for me. Thats a question for a patient. I think one of the other things thats really important with this, with this new medicine is that the patients who would in this trial what we called mind come to impairment from all domains. So they already had quite, you know, significant symptoms. The next trial or the trials are being done now, and people with no symptoms at home. And these are the people where, you know, you might be able to hold people at a symptomatic way. So who knows for years, even decades, we just dont know. We havent done those trials, we dont know, but thats the aspiration. I see expectation all of us that when you do have people who but im a light in their brain but no symptoms, the resilience is still there, the brain is still working otherwise well. And you clear the amyloid you may date i said to or the condition because youre actually getting the difficulties like getting rid of a cancer before it spread. But millions of people right are suffering from alzheimers. Many more are going to suffer in the future. So in the commercial interests are charge and take if youre selling hope or maybe false hope even is this not more like a money maker for the pharmaceutical industry. So i think theres, theres, theres in the one hand, there is maybe you billions of dollars to made by the pharmaceutical industry. But its trillions of dollars being spent on alzheimers disease currently. And its not being spent by, as you know, is not being spent by government. So these beings is being spent by caregivers is being spent by families. And that doesnt have to be spent because of the medicine. Well, who knows . I mean, the Health Economic benefits of this may be substantial. I mean, if you were to mean like that, but it cost 26000. 00 around 26000. 00. Person a patient a. Yeah. And you know, benchmark thats against chemotherapy for cancer benchmark that against all the conditions which would probably go to the bathroom prognosis. And i think its for Health Care Systems is for practitioners for the public to say, how much would we spend on preventing dementia on it. But, but i think point for this will do with, with, with, with the 9 a month and was literally sponsorship renewed sbc. This happening already is theres well over 200 different drugs in development. But is it for everyone . I mean it in the west, they already have approved one of those medicines. But when i go to asia to africa, to europe, for example, theres a lot of people in the developing world suffering from alzheimers in 2 days. Yet a lot of these medications, the better, you know, the better, because i think, you know, we know that low and middle Income Countries are more affected by these conditions. In terms of the price point of the instance where youre going often, they are in fact the instance of dimensions probably dropping in north america in europe because of banter, lifestyle and cardiovascular. Now, success specifically, countries less developed countries need these matters. What a thing less developed countries need as well as new medicines, as ability to, to detect the disease. And so at the moment to take the disease in this trial and we did the pet scott. Now that is super expensive as well. Yeah. If we are able to develop and we will be up to that blood test, which cause pennies for all the and brain scans which costs thousands of thousands of dollars, then that makes these medicines more accessible to much wider communities around the world. You have sad that in the next 20 as a ill time as will be a way of condition. And thats, thats quite a strong statement and very different than what was published in the lancet. This the worlds leading medical journal, which sat in the, in 2050 to will be more than 150000000 people suffering from alzheimers. So do you really believe that kind of, i, im, im very specific. I say outside was dementia will be very rare in 10 years time. Just like age is very rare. Now people still of h i v. But we dont get 8. The same analogy, we will have peoples alzheimers disease. But it will be slowly developing my even on develop any further might be able to go to the alzheimers ease. What will be a failure of our Health Care Systems . Well, it will be people who have all the time it diseases and develops on some anxious to stay with us. We now talk. So clinical neurologist 8 o v shar, will shift his perspective on the ethics of pharmaceutical companies on using dementia drugs. You are one of the most a reno researches on alzheimers in europe, but you didnt attend the largest gathering of scientists on this topic and im so them this week, we are with a lot of excitement, a new medicine was launched in stats. You wrote a very critical opinion article saying that this medicine doesnt work and that the insights presented at the conference are actually not new. Its a difficult issue well effect. Its not that difficult. The medicine work that clearly remove the protein from the brain fairly successfully. But the patients dont benefit from it. They have the effects that are seen on condition on memory are so small, the patients and caregivers will not noticed. And this to me and to many actually does not really come as a surprise. Because weve known for more than 25 years that these proteins, amyloid protein, is present in the brain of older persons. Very often. Also people who dont have dementia and people who never develop dementia. And there have been more than 15 earlier studies trying the same, removing the protein from the brain. Most of them, again being successful at removing the protein. But also most of them showing the patients dont benefits the symptoms of the disease simply continue. And unfortunately, people continue to decline all the way into dementia, but its not the scientist at the conference. They end up with the company says they say it stops the progression of alzheimers by a couple of months, maybe 4, maybe 7 months. So that is a difference in, in memory. Theres a difference in what people still can do if it stops. Thats really, thats what they say. I understand that framing. I think the claims that its really modify the disease scores are not supported by the clinical data. And framing that it slows to disease by a number of months or sometimes even framed as recognizing your grandchildren for 4 or 6 months more. It cannot be understood from these data. This is simply need to leave it with all these the data that theyre present. I believe the data they present and the science was a to a, to a certain extent. They show a very small effect on a cooperative measure. But this is so small, over one and a half year. The patients and caregivers dont notice the difference. And whether this will continue the years afterwards, we absolutely do not know what they investigate. That is what happens with memory and other alternative functions such as execution of problems or problem solving issues. And youll see a very, very small difference of 3 points on a scale from 0 to 144. 00. So thats less than 2 percent of a scale of cognition. And they simply did not use delaying the disease as the outcome of their study. The outcome of the study is the cognitive measure. And on this cognitive measure, there is a very small effect which is statistically significant. But its not clinically relevant. Basically, they are selling false hope. I think the feels not just the study, but the field as a whole is indeed selling false hope to a certain extent. And im bothered by debt because i think people dont benefit from falls help and they hear about this new medicine and they must be very keen to get it, i guess. Yes and well, im not sure most people do read between the lines and they understand that this is not a silver bullet. This is not something that will stop their disease. This is something a drug that needs to be administered every month with an i v treating the fusion which requires a clinic visit and it requires safety monitor wrong with repeated m r i scans. And if you then explain to patients what the expected benefit is, at least in the netherlands, my expectation is that most patients will say, im not sure this is for me. We as doctors and scientists, to be extremely careful when were handling desperate people, people are desperate because there are no effective treatments available right now. And we should be extremely careful not to sell false hope to those who are desperate because they are eager to try anything. But instead of that, we need to have an, almost an open discussion about what can realistically be expected and what that means for their life. Because if you have to visit a clinic, every 2 or 4 weeks of repeat it, memorize guns, there may be at 1st events, it may even lead to hyper vigilance in the caregiver. So if this at 1st event, we need to call the clinic. So theres a lot more to it then simply creating falls hope you can even cause harm by this. You also wrote that to is been investments of 10 billions of dollars of these new medicines and that its has become too big to fail. Can you explain it . Yes. The hypothesis that this go periods, protein amyloid all, is this alzheimers disease. This hypothesis is very dominant, even though the Scientific Evidence stair show in the face that theres more to it than this protein like what, what is what is there right out of cost as well . We dont know, but what we do know is that the relation between the amyloid protein and dementia is not very strong because many older people have the protein and dont have dimensions. I think theres a very thin line between hope and false hope. And most of all, we need to be honest to our patients. And i think with the way the effect of these drugs are presented to the late people is not just creating hope. I think its to a large extent, full time because the expectations are so small. And if you look at all the previous studies trying to remove the m light from the brain which were successful, but with no clinical benefits. And we know so many older people have these proteins and dont have dementia. I think you should simply also accept that this may not be the right way for words. You are also an advisor to the European Drug agency, right . Its a counterpart of the American Drug agency, the f d a, d i. D a has already approved one of these medicines that, that sort of slow down alzheimers. E m a hasnt approved anything yet, but we get an in the quality in what is available to patients, right . If you look at the american market, there are maybe medicines available in europe. Theres nothing, let alone in talking about other areas, auto parts of the world. Were also all time is very rapidly growing. Yeah. Well, yes, there may be in the qualities between countries and at the same time, i am not in the f d a. I dont know exactly what our considerations were at this moment. Its impossible to say what the advice may would be. And then its a group of advisors. Im just one of those advisors and an inmate may decide to follow or not to follow our advice. Just like the f d, a approved the 1st drug i had to count them up in spite of the advice of virtually the full committee to reject the approval. So eventually its the may who will decide. But id like if you allow me to pick up on the point of any one of these on, in equities, because i think thats an extremely important point. Because the trucks that are currently being investigated dont add them up, theyre extremely expensive. So they will be around 25000. 00 per patient for a year. Apart from all the logistics around it, with repeated m arise, guns for weekly infusions, older personnel to the hospitals. So the costs are astronomical. If you understand how many people have to manage this will in fact, increase health, any qualities, and in equities, even within high Income Countries, let alone between high Income Countries and low and middle Income Countries. Where these drugs obviously will not become readily available to all the patients suffering from early cognitive impairments or dimensions. So what is the way out then . A few say, we dont go this way, not this medicine, not the last 3 medicines that have now being developed. What, what is your way of looking at Nice Solutions to help people with alzheimers . Yeah, i think there are 2 ways for over it, for science, at least the 1st one is to look at the other molecular mechanisms. All their mechanisms, inflammation, blocks, facile problems. This is for the basic scientist and the loyalty back to the drawing board leaf, the large protein for a while, and investigate other cool potential costs if this is one way for, but the patient doesnt have time to wait for all thats. Thats extremely unfortunate. But there are no quick wins in dimensional research. So here we have like thousands of scientists researching alzheimers all trying to find a cure. And we have this big division we have on the one side. People really wanted to have this medicine and support all the efforts, you know that to get the medicine. And then people like you are much more skeptical. Isnt the patient at the end losing out if theres such a strong debate going on . Yes. Yes, i think its very difficult for them to understand for late persons that on the one hand, extremely, as soon as the news comes from a conference and then other academic scientists with no relations with pharmaceutical industries are, are very careful. I say, look, this is not the goal. Patients may not understand this. No, this is, this is a i agree with you. And therefore, i think its our responsibility, responsibility, a scientist. But really academic scientist to make sure that what we put in press releases is understandable. And does not create false hope entities. Sure. If the interests primarily of the patients and not of the shareholders of the companies profess a great richie, has written that in 20 years. He says alzheimers is sort of a disease. That is, is not that common anymore. Do you agree with him . I wish i could agree. But exactly 20 actually 25 years ago. We heard here in the netherlands in 5 years, there will be a treatment 5 years later in 5 years that will be treatment. These kind of predictions are not based on scientific facts. So i think we should refrain from this kind of prediction. I hope with my colleagues that we will have these effective treatments of course. But the current state of the evidence, the Scientific Evidence does not support such a statement that a professor either richard, thank you so much for the the stories of determination, enjoying it from my end, you can fix it and is on google. And this of was not for me to come in if you and wanda media amazon, what that as a living. Theyve got your opened up your business, have a term inquiry to and im going to shoot documentary from african filmmakers africa direct on algae 0. Where is the western agenda heading . Thats the g 7. Really even matter anymore. Whos more electable, joe biden . Or donald trump, are journalists in the media undermining our society. Can americans cross their Supreme Court is not corrupt. The quizzical look us pull it to the bottom line. The brushes president waldens polling the games to gretchen towards fellers off the wall. So moves troops to it ceased in buddha. The