Alzheimer’s Drug Approval Sparks Surprising Impact

NewswiseWhen the U.S. Food and Drug Administration gave controversial accelerated approval to the first Alzheimer’s drug in nearly 20 years, it had a surprising impact on attitudes about research into the disease. A survey by University of California, Irvine neuroscientists has found news coverage of the FDA’s decision made the public less willing to volunteer for Alzheimer’s pharmaceutical trials.

Picture : UCI News

The study was conducted by the UCI Institute for Memory Impairments and Neurological Disorders, known as UCI MIND. It appears in the Journal of Alzheimer’s Disease. (Link to abstract: https://content.iospress.com/articles/journal-of-alzheimers-disease/jad220801)

The UCI team performed the survey in tandem with the FDA’s spring 2021 consideration of aducanumab. The monoclonal antibody reduces brain plaques, an Alzheimer’s hallmark, in people with the condition. A panel of outside experts advised the FDA against approval, saying aducanumab’s ability to decrease plaques hadn’t shown an impact on the disease’s clinical progression. The agency’s controversial go-ahead and further disaccord over the drug’s labeling and price captured widespread media attention.

The UCI MIND researchers conducted their study among people aged 50 to 79 who had expressed willingness to take part in drug research. Two weeks before the FDA’s decision, UCI MIND asked respondents if they would be interested in enrolling in a hypothetical four-year study of a plaque-reducing monoclonal antibody and a plaque-preventing drug known as a BACE inhibitor. Eight days after the FDA gave aducanumab the green light, UCI MIND sent survey participants a similar questionnaire with a new section about the monoclonal antibody and its approval.

“We found those who had heard about the FDA decision before our follow up became less willing to take part in a drug trial,” said neurobiology & behavior graduate student Marina Ritchie, corresponding author of the paper. “The people who learned about it from our materials demonstrated absolutely no change in their willingness.”

UCI MIND Director Joshua Grill added: “This is surprising, because it goes against some of our previous data showing people are generally more willing to take part in studies involving approved drugs compared to investigational ones. We believe it could be evidence of the powerful influence of media coverage of science.”

The survey’s findings may offer important insights for Alzheimer’s disease researchers. “Alzheimer’s is the most important medical condition society faces and we need an army of citizen volunteers to participate in drug trials,” said Grill, a professor of neurobiology & behavior and psychiatry & human behavior. “Anything that diminishes credibility in scientific research impedes our progress. Media coverage has the potential to influence people’s choices. That can hold us back or push us forward.”

The findings also show researchers need to be aware of sample bias. It occurs when people with certain characteristics participate in a study at a higher rate than others without those traits or if some research population segments are not fairly represented.

“It’s crucial for trial participants to reflect the scope of people affected by the disease,” Ritchie said. “One thing we don’t know is whether the impact of media attention may be more or less important for particular groups, especially groups underrepresented in research.”

The UCI MIND team plans to conduct further research into the issue, with emphasis on learning how to better ensure diverse populations are part of Alzheimer’s clinical trials. “We need to understand what barriers to trust may exist and overcome them so our research is inclusive and applicable to everyone,” Grill said. Funding for the project was provided by the UCI Alzheimer’s Disease Research Center.

The Ongoing Urban ExodusTo Impact Home Prices

Newswise — Many employees have come to prefer working from home after being forced to do so more than a year ago when the pandemic started. By some estimates, at least one-quarter of employees will still be working remotely multiple days a week at the end of 2021. For those whose jobs allow it, being untethered from the office might mean moving farther away from it – by a few miles or a few hundred.

The National Bureau of Economic Research recently published a white paper by Jan Brueckner, UCI Distinguished Professor of economics, and his colleagues Matthew Kahn and Gary Lin at Johns Hopkins University considering the possible effects that ongoing remote work may have on housing markets, especially in the more densely populated and pricey urban areas. Brueckner shares his insights here.

You suggest that as more people have the opportunity to work from home, we’ll see people move either farther into suburbia or to entirely different, less expensive cities. Why?                                                                                                       If workers can keep their well-paying jobs and move to a cheaper city, their incomes will go further. However, such a move might entail a sacrifice of amenities (good weather, etc.) that would need to be considered. For those workers who remain in their original city, the reduction in commuting costs due to working from home (going to the office only once a week, say) makes the suburbs – where housing is cheaper on a per-square-foot basis – more attractive than before. As a result, working from home may lead to greater suburbanization.

What cities might we expect to be most affected by these shifts?
We would expect to see impacts in expensive cities with large shares of white-collar jobs that pay well and allow working from home. Such cities would include New York, San Francisco, Boston and Seattle. We expect people to move out of these cities – either into outlying suburban areas or to entirely different cities or even states.

So … it could become affordable to live in San Francisco again?
Possibly.

On the flip side, where do you expect to see people flock to?
We’ve heard in the media about migration from California to Austin, Texas, which is relatively cheap and offers less of an amenity sacrifice compared to coastal locations. The same is true for Boise, Idaho, which is in the news a lot. Migration data a few years hence will give a more complete picture.

Is this going to mean more gentrification in some cities?
In one sense, it’s exactly the reverse. The prediction is that many well-paid residents will be leaving the country’s premier cities, allowing more room for the less affluent. Gentrification may increase in the receiving cities as immigrants arrive, but gentrification pressure is lower in many of these places and thus less of a concern for poorer central city residents.

You mention that “the economy still has a long way to go before reaching the new predicted equilibrium.” What kind of time horizon do you envision?
If our predictions are correct, we’d expect these changes to be complete within a decade. There are a number of caveats, however. Our predictions assume that CEOs will tolerate remote work from another city and not penalize those who do it. The Wall Street Journal, however, recently ran a story that casts doubt on this assumption. The issue partly hinges on whether remote workers can maintain their productivity, a concern discounted by some media reports saying that workers feel more productive remotely. A further question involves integration of new employees into an organization that relies on remote work. New employees may have trouble forging bonds and creating a rapport with their colleagues.

As we approach this new equilibrium, what are some other changes we can expect to see?
Intercity relocation will depress house prices and rents in cities that lose population while raising them in the receiving cities. Intracity relocation will push prices up in the suburbs. These changes will, in turn, affect property tax revenues across and within cities.

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