ALS Advocacy

ALS Advocacy
Lou Gehrig's Disease - Motor Neuron Disease - Amyotrophic Lateral Sclerosis
Thought it had been cured by now? Still no known cause. Still no cure. Still quickly fatal. Still outrageous.

Tuesday, August 8, 2017

That Looked A Lot Like The Basset 500

Anyone whose life is blessed with a basset hound knows about the Basset 500.  Occasionally hounds
will break into running gleeful circles.  Sometimes they do big circles outside in the yard.  Sometimes they zoom around a circular floor plan inside.  It's exercise  They have fun.  They get nowhere except right back where they started.

Last week my hound was in the office with me when we watched the CDC ALS Registry annual meeting.  She could relate to what happened.

Every year the paid contractors (ALSA, MDA, and now Les Turner ALS Foundation) come to the meeting without any data to measure their effectiveness.

Every year the group ponders how to increase Registry self-enrollment.  There is lots of discussion of things to do that might increase people with ALS contributing their data.

Every year one of the people with ALS invited to the meeting gives the common-sense advice that you have to measure and you have to set goals.  There are nods, but nobody discusses specific metric goals because nobody establishes the pertinent metrics and nobody comes prepared with a measure of the actual performance.

Every year the meeting concludes with no goals, no targets.

My prediction for 2018:

  • The contractors will come to the meeting without any data that measure their effectiveness. 
  • The government project leaders will insist on calling these paid contractors "partners" again (clouding the true relationship and a need for accountability for paid work).  
  • There will be discussion about all the stuff you can do to increase self-enrollment.  
  • A common-sense person (not paid to work on the project) will suggest that they need to set goals and measure.
  • They'll talk more about stuff.
  • The paid facilitator will never bring them back to the idea of measurable goals.   
  • They will leave for another year.

Every year they get lots of exercise and get nowhere except right back where they started.

The dog wants to know how she can get paid half a mil a year to run in circles.


Saturday, August 5, 2017

Expressing Gratitude

It's not just good manners.  It's important.

Yesterday afternoon I listened to a NEALS webinar about a clinical trial.  A gentleman with ALS spoke about his personal experience in this and other trials.  Listeners received wonderful insights.  At one point he had advice for those in charge of the trials.  It's important to say, "Thank you."  Boy, is he ever right about that.

Every year I sit through a lot of ALS research presentations.  There is traditionally a slide at the end of the deck that thanks the funding agencies.  Seldom is there a slide that thanks the people who volunteered for the research.   It should really be the first one in the deck.

Earlier in the week I listened to two days of presentations that included ALS epidemiology studies funded by the CDC ALS Registry project.  Never did I see all those anonymous people who supplied data (often having to supply the same data multiple times in two or three different studies) specifically thanked for their contributions to a study.

There is a lot of angst over getting people with ALS to participate in clinical studies.  Perhaps researchers could simply stop calling their project volunteers "subjects" and start genuinely thanking them as the most important members of their project teams.

Last evening I was invited to a gathering that really drove this home.

There is a project, Hero's Journey Art, that Eli Lilly and Company has been developing.  People who have participated in clinical trials have been invited to submit wooden bricks decorated with whatever their thoughts are about participating in clinical research.  No rules.  No censorship. No coloring in the lines.  Just express yourself. I did my brick many months ago.  It wasn't hard for me.  Mine wasn't a graphic masterpiece, but it contained the words that made a clinical trial so important to Mom.

Last night one of the three sculptures was (literally) unveiled in a cancer support center in my city. There was a larger crowd than I expected.  There were lots of people who had participated in cancer trials.  It was a good reminder to me that there are a many evil diseases out there that still need so much research so that people, especially young people, can live.

When the sculpture was unveiled, the artist, John Magnan, told us a little about the journey and invited us all to look closely and even touch the sculpture.  And that's when this art touched me in a way I never expected.

People approached it, and as I did, looked for "their" bricks.  But they also looked for their friends' bricks.  And they looked at the messages on bricks of people they didn't know but who shared an unspoken bond of having participated clinical research.  The brick themes were all so different, yet they formed something cohesive about facing disease. It was captivating to meet over 300 important and diverse contributors to research via their bricks.

And a major pharmaceutical company was simply saying, "Thank you," in a remarkable way.

In the next year when I need a quiet moment to boost my faith in the fights against diseases, I'm lucky that I can stop by and soak in that sculpture.

Thank you to everyone who contributed to a clinical trial and told a story in a brick, and thanks, Lilly and John Magnan, for an important expression of gratitude.

Thursday, August 3, 2017

Buy Your Own Lunch

Over the last few days we watched the webstream of the CDC's annual ALS Registry meeting.

I'll never forget one disappointing moment that had little to do with the Registry itself.

In the last session, people chimed in with suggestions for the coming year. Fine.

One world-famous ALS clinical research neurologist suggested that there be a meeting of ALSA and MDA clinic doctors the afternoon before the big ALS MND Symposium in December to speak to the value of the Registry.  Fine.

He turned to the CEO of the ALS Association to ask for coordination of such a meeting.  Fine.

He then matter-of-factly turned to a representative of a pharmaceutical company actively involved in ALS research and suggested they "sponsor" the event and even perhaps provide lunch.  Now wait a minute.

These are employed neurologists.  Buy your own lunch. 

This is a Registry project that burns through a budget of $10,000,000 every year.  It can pop for an urn of coffee and some sodas in a hotel meeting room.

Let the pharmaceutical company invest all it can in ALS research.  Expect the pharmaceutical company to invest all it can in ALS research. Treat that relationship in a businesslike and respectful and ethical manner.  Don't treat it like your personal piggy bank or a money tree to be shaken down.

There's no such thing as a free lunch.  Think about it.

Saturday, July 29, 2017

Someone, Please Help Ask Some ALS Registry Questions

Tuesday (August 1) afternoon and Wednesday morning, we hope to hear answers.

We also hope that many will listen in to the CDC's ALS Registry Annual Meeting --
https://www.alsregistrymtg.com/

Attendance at the meeting is invitation-only.

For some background, here is the recently published report from last year's meeting --

Here are some questions that I've written in the margins of my dog-eared copy of last year's meeting report:
  1. Why was last year's meeting not webcast?
  2. Why did we only get a report for the first day of last year's meeting and not the second?
  3. Last year's meeting report told us --  "Another important thing is capture/recapture methodology. Lorene Nelson will be giving you a presentation tomorrow on that, and that will allow us to estimate the number of possible missing cases in the Registry."  This seems like a critical project, especially since you are publishing reports that are asserting the demographics of ALS. In reality, we don't know what you don't know.  Could we get some information on what Dr. Nelson presented last year on that second day regarding the recapture and completeness, please?
  4. In its organizational marketing materials, ALSA continues to assert that they help 15,000 people with ALS annually.  In the past, MDA has published similar numbers.  How do we reconcile those totals to the 15,908 people who were found in the entire nation in the last published report from the Registry?
  5. In last year's meeting report, Dr. Weisskopf made a comment -- "So just thinking about it now, it strikes me that another way to sort of look at this is kind of potentially missing cases, is actually to take the people who respond to the portal that are captured in your other databases and determine who in your other databases those web people 22 are missing; right, and then you can sort of use that to figure out for that 20% that don't show up in your databases how many people they're missing sure. And you can up at that point."  That suggestion ended without discussion in the written report.  Plop.  Did anyone discuss that further?
  6. In this climate of likely CDC budget cuts, is anyone making any contingency plans to save the tissue and data in case this project is not funded in the future?
  7. The 21st Century Cures Act included an integrated neuro-surveillance system for a number of neurological diseases. Scientists and taxpayers don't need redundant systems, and to have more neurological diseases represented in a well-designed database could provide valuable insights.  The Cures neuro-surveillance also included authorizations of appropriations of just $5,000,000 per year.  How can they do so much more on so much less budget?
  8. Last year this comment was made in a discussion --  "But after appropriations and CDC overhead, we're more down toward the 6-7-million-dollar mark."  We advocates were told to ask for and we got you a $10,000,000 appropriation for the Registry for one year.  I'm surprised nobody asked this at the meeting, so I will now:  What in the world is CDC overhead that eats up 40% of a project's $10,000,000 that we thought was necessary for the Registry?
  9. Why have you never invited Stephen Finger, PhD to an annual meeting?  http://www.huffingtonpost.com/stephen-finger/national-als-registry_b_5620631.html
  10. In last year's meeting report, a lot was made of difficulties since ALS is not notifiable. In all the years we were told to advocate for ALS Registry legislation, did anyone designing the legislation ever ask that ALS be made notifiable?
  11. Your past meeting reports often mention that Registry reports are consistent with "the literature" or other published reports and registries.  Are there any results from the Registry that are not consistent with other findings?
  12. Has anyone gathered data on what percentage of people with ALS are in Medicare Advantage plans by state or by clinic (in hopes of better defining the related data problem)?
  13. How many researchers have actually requested data from the Registry?  Tissue?
  14. All the paid contractors on this project should be able to provide some data on the effectiveness of their work and not just all the stuff they do or plan to do.  For ALSA, MDA, and Les Turner:
    1. How many people living with ALS were in your clinic system at the end of 2016?
    2. How many new people with ALS entered your clinic system during 2016?
    3. How many of those new people with ALS in your clinic system also self-enrolled in the CDC's ALS Registry in 2016?
We hope that someone who is invited to the meeting will ask and that we all will learn the answers.  Please.  Thank you.





Thursday, June 29, 2017

Dear Contractors, Please Come Prepared

Dear MDA, ALS Association, Les Turner ALS Foundation,

It's nearing time for the CDC's Annual ALS Registry Meeting (at least we think it is).  You know the date for sure because you are the only organizations allowed to nominate participants for the meeting.

You are also well paid as education-and-outreach contractors on the project.

Please prepare some very simple data for the meeting so that we all can measure success.
1. How many people living with ALS were in your clinic system at the end of 2016?
2. How many new people with ALS entered your clinic system during 2016?
3. How many of those new people with ALS in your clinic system also self-enrolled in the CDC's ALS Registry in 2016?
That's it.  Three simple measures will make that meeting a lot more productive.  Please be prepared.

Thank you.

Sincerely,

@ALSadvocacy

p.s. For inquiring minds, the most recent annual payments to the three per usaspending.gov were:
Les Turner ALS Foundation $100,521
ALS Association $376,852
MDA $548,658

Tuesday, June 27, 2017

Watch You Don't Break Your Arm Patting Yourself On The Back

That was Dad's standard line whenever we got braggy at the dinner table or a sporting event or a school activity.  Hubris was never a problem at our dinner table.  Humility was valued by my parents' generation, and we learned lessons about the important distinction between arrogance and self-confidence.

Every time I go to an ALS fundraising event or a scientific meeting, Dad's words go through my mind.

"We have failed" does not make a good fundraising slogan or justification for the next big research grant.  ALS events are celebrations of accomplishments that will give the public the confidence to invest.  But, Dad's words ring true to me when I hear all the "accomplishments" and "promise."

We have failed.  Individually and collectively, we have failed.  Sure, progress has been made, but people are still dying from ALS, and the more we discover, the more complicated we realize the problem is.

The first time I went to an ALS walk many years ago, I followed a man who clearly had ALS.  He struggled walking, but he walked.  As I trailed him, I wondered what he had been doing a year before.  Playing golf?  Skiing?  Running marathons?  And I thought that it was unlikely that he would be at the walk the next year.  That's a stark, ugly reality of ALS.  That gentleman walking directly in front of me helped me understand that we really had failed him despite all the fundraising and balloons.

Some folks on the forum at als.net have been giving me grief about my encouraging people with ALS to apply for the fellowships for the International ALS MND Symposium in December.  What difference does the symposium really make?  What have all those scientific accomplishments that are celebrated every year really achieved?  I understand what my friends there are saying.  I understand 100%.

Sometimes it seems like scientists need my Dad to tell them to watch they don't break their arms patting themselves on the back.

People living the reality of ALS at the symposium could convey that, too, simply by their presence and participation.  Their reality in the midst of the celebrating scientists could add a much-needed dose of realism and humility and perspective.

I think Dad would encourage them to be there.

https://alsmndpatientfellows.wordpress.com






Sunday, June 25, 2017

This Small Step Is A Giant Leap

Over the years I've been critical of the International ALS MND Symposium not embracing patient attendance and participation.  Today, we see a small step forward in a direction to fix that problem.

The Symposium is an old-school scientific meeting.  The ALS topics discussed are broad and very
deep.  https://www.mndassociation.org/research/international-symposium/

In the past, if anyone with ALS has chosen to attend, it has required payment of the substantial registration fee (plus a separate fee for an accompanying caregiver).  Add travel and hotel expenses, and there has been a large financial barrier between people with ALS and the Symposium.

This year there is a new program to help mitigate some of the financial barriers --


This is a giant leap toward having people with ALS in the midst of some important discussions.

Anyone with ALS who is interested in the science now has a chance to be in the center of the newest science in Boston in December.  This is a big meeting typically filled with big players in ALS research and with big announcements.

People with ALS are notoriously bright and high achievers.  Finally, a step has been taken that can make them part of the scientific discourse.

Please apply if you have ALS and are interested in the science.

Saturday, June 3, 2017

The Race To Eureka Needs To Start Now

And people with ALS need to be in charge of the race.

20-20 Hindsight

  • How helpful would it have been if we could have seen individual trajectories for people with ALS who have used riluzole over a number of years?
  • How helpful would it have been if we could have observed data on Americans who have been using generic edaravone with or without riluzole for the past several years?
  • How helpful would it have been to have access to data on ethnicities and genetics and experiences of people with ALS who try any number of things in their journeys?

That's water over the dam, but the massive information loss need not continue. There are a lot of good reasons to start the race to Eureka now!

To Get To Eureka, You Need Data

The promise of precision medicine is to know which potential treatments will work for which people.

And in recent days with the approval of a new ALS treatment, we have seen clinicians suggest that combinations of drugs may hold the most promise for effective treatment for people with ALS.

And there are more promising (yet not blockbusting) drug candidates that may be approved in the next several years.

We're in a world of promise without the data to take us to true Eureka moments that we need.

You Own Your Own Data

There has never been a better time in history to get ALS data out in the sunshine for all kinds of smart people to look for insights.  People with ALS own their own data, the most powerful factor in the race to Eureka.

The old public lithium spreadsheet proved that people with ALS can contribute data that will tell a story in a hurry.  We have better tools now, e.g. www.patientslikeme.com , but the tools only work if people contribute their precious data.

There are several individual patient tracking portals (e.g. ALSTDI PMP, AnswerALS) that could release selected data to a common public place like patientslikeme.com to keep people from ALS from entering data in several portals.

And there are patient organizations that could encourage information sharing but have traditionally avoided it like the plague for some reason.

Who really has the incentives and motivation to figure out what specific subgroups of people respond to an ALS treatment? Think about that. It's the people with ALS.

Do you want to go to Eureka?  The race can start now with people with ALS in command.










Sunday, May 14, 2017

There Are Elephants In The Room


A little over a week ago we got the wonderful news that a drug had been approved for ALS in the US.  Since then we have had multiple news reports and webinars and communication from ALS organizations and MT Pharma America about the drug, Radicava (edaravone).

Don't get me wrong.  I ecstatic about having another tool in the toolkit to treat ALS.  There are just these two elephants bothering me.

Elephant 1 - The Awkward Age Of Precision Medicine

This is a drug that was developed in Japan in the late 1980s and was approved for use in strokes there in 2001.  Based on later ALS studies in Japan, it has been used there for ALS since 2015.

I sensed the first elephant right away.  We've been so conditioned of late to the heterogeneity of ALS and the genetic differences that I wondered how people with ALS in Japan differ from those in the United States.  What are the most common ALS genes in Japan compared to the the US? Is there anything in the Japanese data that will help us predict which people in the United States are most likely to respond?

The elephant sat quietly until I listened to Friday's webinar when Dr. Palumbo from MT Pharma America showed a slide modeling comparable blood levels between people of Japanese ethnicity and Caucasians.  I think that showed us that the drug gets to where it needs to be in both groups, but it really doesn't tell us anything about how the groups responded to the drug, does it?

The concepts of precision medicine today constantly drive us to know more about individual cases of ALS and what interventions are likely to work in specific individuals.  New concepts are to know everything possible that distinguish an individual case of ALS.  Can old clinical trial data shed that kind of light? The elephant emerges. How can we figure out which people in the United States are likely to respond (and as important, not respond) to Radicava?

Elephant 2 - The Price

I'm the person in the room who normally defends drug pricing.  New drugs are expensive to discover and develop into commercial products.  As expensive as pharmaceutical products are, they usually provide results that are both cost effective and beneficial to our lives.  I'm pretty immune to drug price sticker shock.

Right after the Radicava approval announcement when some pricing information was revealed, an ALS caregiver asked me what I thought about the price.  I said that I thought if they had a slam-dunk product and could say that people with specific flavors of ALS would receive significant therapeutic benefit, that the extremely high price was probably in the right ballpark.  Unfortunately, the data that we've seen don't make it likely that this is a slam-dunk product for anyone.  It will be something to consider and try, and it may help, and it may not help, and it may be hard to perceive the difference individually.  Elephant 2, meet Elephant 1.

People with ALS will try it and I'm glad they can.

It's a fact that people who are not going to be responders to this product are going to pay the astronomical price, and we don't have data to minimize the size of that group. It's not like Costco where you get your money back later if it doesn't work.

The webinars we've heard have been great about explaining the process of getting payers to pay for new indications.  If it's likely that Medicare will pay for Radicava and its administration for people with ALS, that will be good.

That doesn't mean that we shouldn't talk about the price elephant.  We absolutely should.  It's not harmless for the government to overpay for something, especially when we may be on the verge of more product approvals for ALS in the US.

Over the past couple of years I have gained huge respect for the way DMD parents advocate for approval of therapies for their kids and then for access to those therapies.  We could learn from them about not ignoring elephants.



Tuesday, May 9, 2017

We Need A Toolkit

Dad was an engineer.

He taught us that you always need a good basic set of Craftsman tools, and every tool has its own use.  Never use a screwdriver when you should use an awl.  Never mess up a bolt with the wrong sized wrench.  Never hammer with anything but a hammer.  And duct tape has no correct application in plumbing.

On Friday we got the wonderful news that MT Pharma America was granted FDA approval for
Radicava (edaravone) for ALS.  There is joy in hearing that there is finally a new tool in a barren toolbox.
We can't stop building a toolkit with one new wrench of unknown size.  We need to figure out for whom Radicava works, and we need to keep complementing the toolkit with new options.  This is one tool.  We need that Craftsman set to address a nasty, heterogeneous disease like ALS.

Edaravone has been used in Japan for a number of years for stroke, and it has been approved and in use there for ALS for almost two years.  I acknowledge that this is fast approval by FDA standards, but two years is a lifetime for many with ALS.  We are grateful for Friday's news.  We must forge ahead more quickly and more aggressively.

We have a toolbox to fill with the right tools for the right people.

Friday, May 5, 2017

It's An Expensive Trip To G12.21

Every person with ALS can tell about an expensive journey to get to the diagnosis.

There are millions of dollars worth of wrong diagnoses along the way.  There are tests.  There are surgeries.  There are physical therapies.  There is lab work. There are speech therapies. There are more wrong diagnoses.  There are MRIs.  There are drugs.  There are scans.  There are psychiatrists.  There are more doctors.  There are braces. There are more wrong diagnoses.  All the while, the person whose ALS is not yet diagnosed continues to decline.

Finally, one day, often a year or more after the start of the expensive journey, a physician says, "You have ALS."  G12.21 is encoded on a medical record.

Mom had one of those long, expensive journeys. She declined terribly along the way. She didn't get her ALS diagnosis until just four months before the ALS took her life.  But for the initiative of a sharp speech therapist, the diagnosis may never have happened.

Some cases of ALS are fast.  Most cases of healthcare delivery are slow.  They are even slower for people who don't have good insurance coverage.

How many people die from ALS without ever finding out that they had ALS?  I guarantee that problem will get worse if yesterday's AHCA legislation moves forward.



Monday, May 1, 2017

The Path From Gingerbread to Disrespect

Since the CDC launched its ALS Registry website in 2010, it has been fraught with gingerbread.

Early on, they installed a "Service Locator."  At the time I thought it was a poor decision.  They
already had links to ALSA and MDA sites where chapter and clinic locators are available and kept current.  Why would the CDC want to maintain with its own databases of chapters and clinics?

The Service Locator is on the lower left of the main page at www.cdc.gov/als 

Through the years it stopped working for me.  I've asked others to test in their browsers, and nobody I know has been able to make it work for many months.

We went from an unnecessary piece of gingerbread to a broken piece of gingerbread.

People seeking ALS services are typically in the throes of a disease that consumes all of their time and energy.  They don't need to type their zip codes into a trusted site only to find out that nothing happens.

We went from an unnecessary piece of gingerbread to a broken piece of gingerbread that is disrespectful of those who try to use it.

And it's not that hard to make broken gingerbread disappear from a website.

Saturday, April 29, 2017

Why?

Obviously I'm interested in ALS advocacy issues.

I read a lot and try to study them.  Our voices are important as are our ideas, and I believe that we can make a positive difference.

Every year I go the the ALSA ALS Advocacy Conference and Day on Capitol Hill.  I pay the fee and pay my own expenses.

In an email yesterday, I received a nice invitation:


I requested to join on facebook and was accepted. Nice.  I liked the idea of this new dimension to Advocacy Day preparation and discussion.

This morning I submitted four items to post.  Evidently, everything is moderated, so all were pending moderation when I signed off of facebook this morning.

Thank you for providing this area.  It’s a nice addition to let us all discuss substance that has been difficult with the format of the conference over the past few years.  We are all more than just our stories and I feel strongly that policies and our voices and thoughts matter. 
I have three topics related to the Registry that I will post and I hope they will be part of the discussion.
Thank you.
__________

1/3  Last summer’s annual Registry meeting at the CDC was blacked out.  All we have is an “executive summary” report that is not at all substantive.  When I inquired months ago about getting a detailed report, Dr. Mehta said that there would be a recording of the proceedings posted.  When I inquired of ATSDR about an ETA for the detailed proceedings, I got the unhelpful response, “When it’s ready.”

https://wwwn.cdc.gov/als/ALSReportsNew.aspx
 
We are being told to request another $10,000,000 for the project without any substance on who was invited to that meeting, what was discussed, what problems were (or were not) addressed, and what direction the leadership is taking the project.   How can we be responsible advocates without having that information?
__________


2/3  We have never seen a businesslike accounting of how ATSDR spends $10,000,000 per year on the Registry.  One year after we pressed the issue, we got a vague set of percentages in some Powerpoint pie charts at the Advocacy Conference.  It’s not unreasonable for us advocates to know how that budget was or will be spent, in dollar categories (like any good budget analyst would supply).
 
As a friend once said in a motherly way, “I’m not giving you another $10,000,000 until you tell me what you did with the last $10,000,000.”  
__________

3/3  What is the cumulative total that has been appropriated for the Registry over the many years, starting with the so-called building-block appropriations that happened in the years before the 2008 passage of the ALS Registry Act. 
We advocates can’t make good cost/value assessments without having a good handle on the costs. 
__________

This evening I find myself locked out of the group.  I can only assume that my discussion points were never posted.

Perhaps the group is to stick to dinner plans and not substance?

Why, oh, why would you stifle polite, informed discussion on something this important?

Why?






Wednesday, April 26, 2017

ColLABorate, Please, Now!

A young father with ALS is in this clinical trial, on the drug protocol for more than 60 days --
https://clinicaltrials.gov/ct2/show/NCT02437110

He actually has experienced clinically measurable improvements.  That's huge.  Normally an ALS trial success consists of getting worse less quickly than before.  Here, we're talking improvements.

I asked him if he knew if anyone else on the drug was having similar results.  Unfortunately he was the only one he knew of on the drug protocol.  NIH had a very small sample set and found very few HERV K positive people with ALS.

Isn't this the promise of precision medicine?  To test the right therapy on the right patients?  Why aren't we finding the right patients for this clinical trial with some urgency?

There are numerous, separate precision medicine projects in the ALS space.  There are even more repositories of tissue of people with ALS.  Cmon, folks, let's screen for HERV K and find some candidates and get this trial filled and completed quickly. Now!

It's not that hard if you really mean it when you say you collaborate.


Saturday, April 22, 2017

We Need A Fact-Checker

This week I listened to several presentations on ALS.

Over many frustrating years in the fight against ALS, I've learned to listen for the devilish details. Sometimes I think we need an ALS fact-checker.

CDC Grand Rounds

First up on Tuesday was the CDC presentation for their Grand Rounds.  The topic was of particular interest to me -- "National Amyotrophic Lateral Sclerosis (ALS) Registry - Impact, Challenges, and Future Directions."

https://www.cdc.gov/cdcgrandrounds/archives/2017/april2017.html

Early in the presentation there was an assertion of the applicability of this project to other conditions. But how?  The basis of using their algorithm to locate cases of ALS was based on the quick entry of people with ALS into government health coverage systems such as Medicare and the VA.  That doesn't happen with other conditions. Sure, this Registry has a mother lode of lessons learned, but how would another disease find value in its basic design?

We heard that the Registry speeds up clinical trial recruitment and expands ethnic and geographic diversity (without any data to back up that claim).  Sending out emails to the patients you located on a small fraction of enrolling trials doesn't necessarily advance any of those noble goals (and might actually have the opposite effect on trial diversity).  Who knows?

And there was the importance of the  "partners."  It seems to me that if there is any flow of money to or from any "partners," that should be transparent.  There are some "partners" in this slide who have been paid millions of dollars in this project. And exactly for what?

There was a mention that the large national organizations cited in the partner list represent a majority of people with ALS in the US.  How do we know that?

There was a vague reference that the Registry is providing biospecimens to scientists. How many scientists are involved and how many patients' specimens have actually been distributed?

Did I hear correctly that there were 60,000 risk factor questionnaires completed for 17 separate surveys (giving an average of 3529 responses per survey)?

A woman in the audience asked what percentage of people in the US with ALS are actually in the Registry.  That most important question wasn't answered.  We got a tapdance about the challenges of completeness and ongoing statistical studies and local studies and that you'll never find them all.  But we ask again, what percentage of people in the US with ALS are actually in the Registry?

The Registry continues to make generalizations about ALS being white guys' disease based on the people with ALS who are in the Registry.  What do the people with ALS who are not in the Registry look like?  And how many are there?


One presenter who has been involved in the project annual meetings made an off-the-cuff reference to ALS as a disease of 30,000 people.  Wait.  What happened to the 15,908 number that the Registry published?



And we had a lot of interesting information from one of the clinicians who has worked with the CDC on the Registry.  He had data citations in his presentation, none of which seemed to come from the CDC Registry. Oh, well.


ALS Research Update


Thursday evening there was an ALS research update directed to some college students.  Naturally it started with some basics about ALS. Take a look at the slide on the left.   But wait, what does "affects" mean?  And "two cases per 100,000?"  Is that prevalence?  How does that jibe with the "5 cases per 100,000" on the CDC's slide?  Are global numbers that much different from US numbers?






We again saw a lot of interesting data, but none of the citations seemed to involve use of data from the obscenely expensive US CDC Registry.







Families dealing with ALS don't have time to deal with devilish details.  And they shouldn't have to.   These mixed and vague messages are not acceptable in a world where data and science are so important.  And when precious resources are poured into projects, we need to get the facts right and make sure that their value is in proportion to their cost.

Wednesday, April 5, 2017

"I'm Smarter Than You Think I Am"

A few months ago a television news show had a feature on a wonderful teacher.  Each year she had an assignment for every student -- Write down something about yourself that I don't know that I should know.

The responses were at the root of her understanding her students, and they told her of family situations or interests or hobbies or pain or joy.

And there was one child who wrote an especially important message to her -- "I'm smarter than you think I am."

Wow.

On an ALS message board I just saw a link to a presentation given by a respected, world-famous
ALS clinical researcher on the importance of clinical trials.  She prefaced her message by talking about the real difficulties of doing clinical research in a world of uncurated information on the internet and fake news.  She used terms like "anti-science," "poor education," "ignorance fighting proper science."

And all I wanted to say was, "We're smarter than you think we are."


Saturday, April 1, 2017

In The Middle Of A Roundabout

"The Patient Is At The Center Of Everything We Do"

But are you really patient-centric?

The process was clever enough.
ALS Clinic Neurologist: You need to see Dr. Specialist.  Debbie will make an appointment for you on your way out. 
Caregiver to Debbie: May I make the appointment with Dr. Specialist, please?  My schedule is a little difficult, sometimes.  I have a meeting at work on Thursdays and Monday mornings are out and my loved one with ALS can't be at an appointment before 10 am, and after 2 pm he gets really weak. 
Debbie:  We'll just call them to make a first-available appointment.  That way Dr. Specialist knows that you are our referral.  Then when you get the appointment notice, you can call them and change it to whenever you want.

Clever?  Yes.

Patient-centric?  Hardly.

The patient in this case can't communicate easily.  The caregiver is trying to hold down some semblance of employment while being a more-than-full-time caregiver.  Both are dealing with a demanding disease.  Both have very reasonable preferences for all appointments that should be easily accommodated without wasted time and calls.

Sometimes a healthcare delivery system sincerely believes that it is being patient-centric, but to the patients, it's like being at the center of a roundabout with healthcare providers going around them in circles to their own destinations.



Saturday, March 18, 2017

Selective Urgency?

ALS advocates received an email and social media alerts this week:



Urgent, eh?

It was urgent when we discovered that the ALS Registry annual meeting last summer was being blacked out.

It was urgent in December when we asked when we asked for an ETA on a detailed report from that meeting and got an incredibly arrogant "when it's ready" governmental response.

It was urgent weeks ago when we asked the ALS Association, the ALS Registry's chief lobbying organization, for verification of the cumulative cost to-date of the project (and we got crickets).

It was urgent when the second annual report was not published on time and we were kept in the dark.

It has been urgent every year when we have asked how the new proposed appropriation would be spent.  Some details of a budget are urgent for any responsible steward asking for funds. We get none.

It is urgent that we be given the courtesy of information that we need in order to be informed, responsible advocates.

That's urgent.


Thursday, March 2, 2017

Solutions Don't Have To Be Complicated Or Expensive

Goal:  To encourage participation in ALS clinical research.

This morning there are 79 recruiting ALS trials at clinicaltrials.gov. About half of them are interventional.

Solution:

Pay an impecunious college student (preferably one with a parent with ALS) $15 per day to post a daily tweet and Facebook post featuring one of the trials.

That is not hard.  It takes effort and a reliable student and a budget of around $5000 per year.  It provides a precious very part-time work opportunity for a student in need of cash.

This will cycle information about every recruiting trial to those dealing with ALS every 2-3 months.

Simple.


Thursday, February 23, 2017

Partnership, Indeed


From an old ALS Association web page on government partnerships:  http://web.alsa.org/site/PageNavigator/ALSA_research_our_approach_partnerships_government

"The Association also has worked with Congress to secure $58 million for the registry, including $10 million in 2016."

Today ALS Association staff are on Capitol Hill for #ALSHillDay17 requesting $20 million more from our legislators for the CDC ALS registry.



That's a grand total of $78 million.  

$78 million for a project that isn't accomplishing its core mission. 

The CDC blacked out the invitation-only annual meeting and has failed to produce a public transcript or recording of that meeting before this additional appropriation request.  That in itself is revealing.

Think about that.

This "partnership" is out of control.  This is wrong.

Saturday, February 18, 2017

It's Time For Some Hard Facts



If ever a project should be dealing in facts, it's one that is supposed to be gathering data on the prevalence and incidence of ALS -- the CDC's ALS Registry.

The project has not delivered on its core mission well, and in the past few years the claim of success has been in an area of its scope creep.


Let's look at some facts.

This morning there were 76 open, recruiting clinical trials for ALS at clinicaltrials.gov.
Of those, 39 are interventional trials and the rest are observational.

Here is the list of the 25 total trials included in the ALS Registry's email notification in the last four years -- https://wwwn.cdc.gov/als/ALSResearchNotificationClinicalTrialsStudies.aspx .

Fact:  Just seven (9%) of the 76 currently recruiting trials are in the CDC notification.
Fact:  Just two (5%) of the 39 currently recruiting interventional trials are in the CDC notification.

Fact:  This is not a success story.






Tuesday, February 7, 2017

Spirit's Prayer

Spirit’s Prayer

Lord let me be simple, let me be true
A child of God, yes, that’ll do.


Lord let me be - some unblinding light
Colored image, piercing night.


Lord let me be - your hands, your feet
Clapping rhythm, dancing beat.


Lord let me see - your frame, your gold
Smiles singing, stories told.


Lord let me say – Love rules the world!
Amen, I say – “What a wonderful world”.

- Barry Crist -


Today I went to Jerry's funeral (see post below).

Some of his many friends told stories of Jerry that made us smile and laugh and appreciate the gift we had in Jerry.  Sometimes I go to a funeral and really don't recognize the person being eulogized.  That was not the case today.  It was the Jerry we all knew and loved.

Then at the end, his good friend, business associate, and lunch buddy read us his poem, "Sprirt's Prayer." 

A good way to end today.  A good way to start tomorrow.


Saturday, February 4, 2017

What Would Jerry Do?

ALS Advocacy is not fun.  The loss of life is relentless.  The funerals are heartbreaking.  The lack of progress is frustrating.

Usually I'm braced a little when we know that a person with ALS has taken a bad turn.  The grief enters and leaves at its own pace.

Last week a different kind of death and grief entered our lives like a shot out of the blue. We lost one of our most effective advocates.  His death was completely unexpected and did not involve ALS.

I use twitter a lot.  I'll tweet to pharmaceutical companies and journalists and politicians to try to shine some light on ALS.  Seldom do the pharmaceutical companies bite.  I'm just an individual tweeter, after all.  A few years ago somebody from the Lilly Open Innovation twitter account exchanged tweets with me. That led to some messages.  That led to a meeting to discuss clinical trial enrollment barriers for those dealing with ALS.  That led to many more meetings and chats at Lilly and Starbucks and Medicine X.  And that led to interactions with all kinds of activist-patients with a variety of diseases.

How did this happen?  Meet Jerry Matczak.  Jerry was paying attention that evening a few years ago on twitter and he wasn't afraid to engage in constructive interactions.  He listened.  Oh, how he listened.  He didn't get defensive.  He never said, "But you don't understand."  He really listened.

And Jerry dreamed as he listened.  He saw the potential of social media and technology to improve clinical research by making patients part of the solution. He saw bigger pictures than most of us.

And then Jerry delivered solutions.

Dozens of e-patients in every disease area have Jerry stories to tell.  He listened.  He dreamed.  He delivered.

Jerry was genuine.  Jerry was a real person who experienced his own loss of a brother to AIDS before there were effective treatments.  Jerry grasped urgency, and he knew the potential of his industry to save lives that are being lost today.


And on Thursday afternoon I received an email from another ALS advocate that Facebook was buzzing that Jerry had died.  No.  That can't have been right.  I just saw him tweet a few days ago.  It must have been some kind of mistake.  No, it was right.

The pharmaceutical industry has a gaping hole to fill now.  The man with the extraordinary gift to listen and engage e-patients and figure out solutions is gone.

My comfort moving forward is that we all have the example and the standard to follow. We just need to ask ourselves, "What would Jerry do?"

Friday, January 20, 2017

It Was Twenty Years Ago Today

Twenty years ago this morning we lost Mom to ALS.

She died from ALS.  She did not succumb to it.

In 1997 it was outrageous that people were still dying without any effective treatment, so long after Lou Gehrig's death.

In 2017 it's even more outrageous.  Over 2,500,000 people have died from ALS since Mom.

Not much has changed in two decades.  We raise funds and walk and support research, but the prognosis for a person today is mostly the same that Mom faced and that Lou faced.

Step back and look.  We have failed.  Individually and collectively we have failed.  Do we ever admit that?

A few days ago there was an ALS Association "Listening Tour" conference call.  I appreciate the opportunity to be heard.  Today I continue to be concerned with a large, influential organization not being able to be introspective and candid about problems and failures.  Dad always said, "Watch you don't break your arm patting yourself on the back."

"We have failed" doesn't make a great fundraising slogan, but we have failed.  We must admit it.  We must do things differently.

Twenty years.  It seems like yesterday.  It seems like forever ago.

Wednesday, January 18, 2017

Welcome to the 21st Century, Clinical-Trial Matching

If you've ever shopped for a clinical trial for ALS, you know that the shopping tools have been stuck in the 1980s.  Clunky.  Incomplete.  Passive.  Redundant in their flaws.

If you've ever shopped for a pair of shoes online, you know how shopping tools should work in the 21st Century.  Inviting.  Effective.  Sensitive to my preferences. Active.

We often hear about how it costs a billion dollars to develop a new drug.  Time is money.  Time is life for people with ALS.  Yet we continue to use archaic search tools or email notifications for clinical research projects.  People with ALS have been issued 1980s tools that are inefficient and ineffective for all stakeholders.

A few years ago I crossed paths with some folks whose work has developed into antidote.me . Take a look.  They have a business model that addresses a lot of problems that people face in shopping for the right clinical research opportunity.

Over the years we have talked.  I have complained.  They have listened.  I have suggested.  They have listened.  They have taken an interest in ALS.  I maintain that ALS can be a stress-test for a lot of areas of healthcare that need improvement.  They get that.

Yesterday on the right panel of this blog below the tweets, I inserted a snippet of code that gives everyone a portal into their newest edition of their clinical trial search tool.  I hope that it is helpful.  Give it a try. You might find something interesting.  Use their contact form to let them know what you think.  Perfect?  No.  A step into the 21st Century?  Absolutely.

So today we see that it is completely possible to have online search tools that are kept continuously up-to-date with the newest clinicaltrials.gov data.  That has been a big flaw in many old search tools.  We see a tool that includes all recruiting trials (and not just those from selected sponsors).  We see a tool that unsnarls the clinicaltrials.gov data into something readable and usable.  We see a tool that gives you some control of filters.  We see a tool that is easily sharable.

Yes, I still have suggestions -- more control over filters, yelp-like reviews, information like the number of seats left at a trial site.  I have every confidence that we can get there.  Today we see the giant leap we needed to welcome clinical-trial matching into 21st Century.  Thanks, antidote.me.



Note:  I neither seek nor receive any compensation for my work to improve the fight against ALS.