Talking Tau with Dr. Claude Wischik
Executive Chairman and Co-founder of
Gary Barg: I am finding there is a lot of
talk about tau these days. It seems like there is a lot more
acceptance of your work than before. Why do you think amyloid
theory took such hold for so many years?
Claude Wischik: It has much more to do with the
politics of science than the science itself. There is no doubt
that there were important genetic findings in the ‘90s which
certainly gave new clues to the causes of Alzheimer’s disease.
It was found that if you have a mutation in the amyloid gene
then this for sure leads to Alzheimer’s disease, but only in
extremely rare cases. And it was the time of the molecular
biology revolution when people thought, “Fine, the pathology is there in
the brain, the gene has been linked to the pathology:
game, set and match.” That was just the climate. When it became
apparent that you could have lots of amyloid in your brain and
not be demented, that really did not register because, by then,
there was such a commitment to it. There was such a commitment
to it financially and career-wise by people that it just became
impossible to back out. That is where I think a lot of companies
find themselves at the moment.
Gary Barg: You are going to release some
detailed scientific papers reporting your research later this
year. Can you explain to the layman what you have learned so far
from the ongoing tau trial?
Claude Wischik: What I can say is that the
safety profile looks good. There have been no big issues turning
up and the drug seems to be well-tolerated. The dropout rates
are less than we had anticipated, and we are even getting
interesting anecdotes from various principle investigators.
Gary Barg: I understand that you need to be
blind to it at this point; in any appropriate clinical trial,
you should be. I’m actually interested in the anecdotes that are
coming in which are outside the norm of what you have seen for
30 years of doing clinical trials.
Claude Wischik: You’re right – as the trials
are double-blinded, all of this could be placebo-effect, of
course, but some of the comments from the investigators are
encouraging. One investigator said that he has been doing trials
for 30 years and particularly the amyloid trials over the last
10 years or 12 years, but there just were no good anecdotes to
tell. There is a certain expected trajectory that people follow
when they have the disease. Once they are on the downward
trajectory, they do not change course. Whereas, with our trial,
there are stories suggesting some patients may be changing
course, which is exactly what we hope for. We will have to see
the final outcomes of the studies before we can say anything
definitively, but these unsolicited reports from the
investigators are encouraging.
Gary Barg: Could you talk to why a family
caregiver of someone living with Alzheimer’s or FTD
[frontotemporal dementia] should consider a clinical trial?
Claude Wischik: The logic is really easy. On
the one hand, you have got 100 percent certainty that your loved
one’s disease is going to progress. And on the other hand, you
have a chance that A) the drug works and B) your loved one will
be randomized to the active arm. So a zero percent probability
of benefit versus some percent probability of benefit, that is
what should be the driver. Ninety percent of the patients coming
into our AD [Alzheimer’s disease] trial are already on AD drugs.
What that is saying to you is they are on these drugs, but they
are declining and they want something else. The next thing I
would say is: Okay, even if you have the bad luck to be on the
placebo arm, you are no worse off. You still have whatever
treatment you came with, number one, and number two, if you can
stick it out, you will with 100 percent certainty get the active
treatment for free at the end of the study. You will also get a
phenomenally proper, thorough, no-expense workup of the
condition which you probably could not afford to get on your
Gary Barg: What is the most important thing you
want to leave family caregivers with?
Claude Wischik: The most important thing is to
find a good care manager. Find someone to guide you through the
labyrinth. Pay money; find out how to get access to support. My
father just died with dementia so I know about this. The care
manager is precious. And gain access to the support systems that
are out there. Until the breakthrough technologies come, that is