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The Decade Of The Brain: 25 Years Later

Opinion

Xconomy National — 

My phone rang late in the day on a pleasant fall afternoon.  It was a close friend and business associate of mine and, because we talk often enough about a whole variety of things, I didn’t think for a moment about not answering. I rarely talk about my days as a practicing physician, and it’s been a number of years since I last practiced. So although many people know that I am a critical care anesthesiologist, only a few colleagues and friends in my new world of biopharma (I work for The Medicines Co.) ever do the curbside consult thing with me—they just don’t know me in that way.

But the person calling me was one of the few who did know me in that way, and he also knew that despite the new career, I still fielded calls every now and then for medical advice or guidance. I will admit that I had a brief flash of awareness about this before I answered, not enough to make me ignore the call. So even though I was packing up my things, I answered. Immediately I heard him say, absent any pleasantries or greeting: “Hey J, I am sorry to bother you, but I need some help; my grandmother has had a massive stroke.”  I told him to give me all the details.

The details are not what this post is about. All I will say about my friend and his grandmother are some specifics about what ailed her: she suffered a severe acute ischemic stroke that had undergone a hemorrhagic conversion and she was non-responsive. In plain English: She had a stroke, the dead tissue started to bleed, and the stroke was evolving in such a way that more blood was appearing and large swaths of her brain were dead, dying, or at risk of dying. To put even a more human touch to this, the parts of brain that made that woman who she was were in danger of injury or had already been injured; little by little, “she” was disappearing.

When you lose a liver cell, a kidney cell, or even many heart cells, life generally goes on largely unchanged, and you may never really know it happened. You lose a bunch of neurons (a type of brain cell), however, and you may end up losing the name of your daughter, the face of your husband, or your ability to walk, talk, or remember. And all of this was happening in 2014. “So what?” you may ask. What’s so special about 2014?

In 1989, then-President George H.W. Bush pronounced the 1990s to be the “Decade of the Brain.” That was supposed to be the initiative whereby in 10 years time, we would have unraveled consciousness, got a choke hold on things like Alzheimer’s disease and dementia, and of course, finally put the pesky little issue of stroke and grandmothers and mothers and fathers and sisters and all the rest losing large pieces of who they were and what they liked.

Needless to say, this did not pan out they way that President Bush, the National Institutes of Health, and everyone else had hoped. Did we make progress? Yes, we did. Did we uncover some good science? Again, yes, we did. Did we finish what we started? No, we did not. Which brings me back to this story, and this blog post.

The next morning, it just so happened that I read that another super-cool immuno-oncology company had just had a wonderfully successful initial public offering. Tens of millions of dollars (many tens actually) were raised, and the excitement around the new generation of oncology drugs and science continued to grow.

So there it was. On one hand, we had the “Hot New Next Big Thing,” and all of its future potential and possibility. On the other hand, we had the “Decade of the Brain” 25 years later, offering a glimpse of what all of the excitement might look like many years later after all the buzz dies down. My friend’s grandmother should have been getting all kinds of special ‘new’ drugs, or care options, or something. That was the promise implicit in that NIH initiative. But, what actually transpired, as opposed to all of the promise and potential and excitement, was not even close to being as cool, exciting, and meaningful as I had hoped back in grad school in 1991 when I was getting a PhD in neuroscience. Lots of people still die from stroke, or get Alzheimer’s, and we still haven’t really fixed these things or even begun to understand what consciousness is.

So in 2015, we can look back over the past three years and see over 130 biotech IPOs—most a result of some combination of really good basic science, savvy and brave investors, interesting and exciting clinical (or even just preclinical) data, and of course, great timing. My friend’s terrible misfortune showed very plainly that perhaps we’ve been here before. We should tread carefully, because this is just the beginning of a long journey, which will almost certainly take all sorts of detours, encounter all types of problems, and will almost certainly turn out differently that we expect. Not necessarily worse than we expect, just different. I read a great article on a tech blog recently that is so appropriate here. The author riffed about how in the 1970s we thought the future, 25 to 50 years later, would be full of flying cars and moon bases—and instead we got the iPhone and Fitbit.

The point is that the future is rarely what you think, or hope it will be (just in case the stroke story didn’t already make that point clearly enough). Similarly, back in 1995 when Science featured a cover showcasing the “Decade of the Brain,” I thought in 2015 we’d have stroke treatments which, like heart attack care today, allow people to essentially walk out of a hospital after a needle stick to their groin and wire to place a stent. Instead, we got CAR-T therapy (very cool) and CRISPR-CAS9 gene editing (way cool). None of this is bad! It’s just different—and maybe cautionary.

I am not in any position, nor am I brave enough, to comment intelligently on the timing, data, hype, promise, or anything else about the unnamed, yet very cool oncology company to which I’ve been referring. The phone call from my friend reminded me of something, though, that my 5 years in biopharma had almost made me forget. In the end, all of this—the returns for investors, the hype, the data in one patient, or ten patients and all the clinical trials that are breathlessly reported in the biotech press—is useless unless it ends up helping someone like my friend’s grandmother. Want to move the needle on something? Put “a dent in the universe” (as the over-referenced Steve Jobs once said)? Then by all means make new drugs, do great trials, explore cool science and found, build, and sell great companies.

But I have a suggestion as I ponder the “Decade of the Brain” and its grand predictions and goals which 25 years later turned out quite differently. Let’s keep score in a different way. Let’s mint a statistic on the number of people we help. Instead of tabulating the 130 IPOs in three years, or the quarterly funding levels for new companies, or the M&A activity in the sector, let’s report how many people were treated with all these new drugs, how many of those we helped, how many we may have hurt.  If we do this, we will undoubtedly encounter a day where something in those numbers makes us really smile. And, at that moment, we will know that whatever people say one day about the decade we are in right now, no one will ever be caught suggesting that we didn’t pay attention to what mattered most.