Ending Parkinson's Disease by Ray Dorsey & Todd Sherer & Michael S. Okun & Bastiaan R. Bloem

Author:Ray Dorsey & Todd Sherer & Michael S. Okun & Bastiaan R. Bloem
Language: eng
Format: epub
Publisher: PublicAffairs
Published: 2020-03-16T16:00:00+00:00

FIGURE 4. mPower smartphone application, 2015.

Williams gave his talk in the morning. By dinner, more than 2,000 individuals from across the country had enrolled in the Parkinson’s study. By contrast, the largest Parkinson’s disease clinical trial of a drug took three years to enroll 1,741 participants.88 Combining the Parkinson’s Voice Initiative’s approach of citizen-led recruitment with smartphones created a new paradigm for research studies.89

The science continues to accelerate. In 2017, a smartwatch study was launched to screen for abnormal heart rhythms and enrolled over 400,000 people in one year.90 In 2018, Apple publicly announced that the Apple Watch could also track symptoms of Parkinson’s disease.91 That same year, Verily Life Sciences (part of Alphabet, the parent company of Google) partnered with Radboud University Medical Center in the Netherlands and with The Michael J. Fox Foundation to investigate the ability of a watch to assess tremors, activity, and sleep.92 The initial results on adoption are encouraging—hundreds of Dutch patients are wearing the Verily smartwatch for twenty-two hours per day; some have done so for more than a year. Such observations allow insights into how people function in their own environments, which can differ from their performance in artificial clinical settings.

Objective measurement of the effects of new therapies is critical. Current subjective rating scales can lead to ambiguous results. For example, two separate studies of the same drug for Parkinson’s that were conducted with a nearly identical design and outcome measures had completely different results.93 Imprecise measurements have real consequences—they make it difficult to determine whether a new treatment works for Parkinson’s. As a result, clinical trials for the disease and similar disorders end up having to be larger, longer, more expensive, and riskier than for other conditions.94

Because of the risk and cost of clinical trials in conditions like Parkinson’s, large pharmaceutical companies may be reluctant to invest in them. On January 8, 2018, Pfizer announced that it was ending research into new drugs for Alzheimer’s and Parkinson’s.95 High-profile failures to find an effective drug for Alzheimer’s and the absence of substantial therapeutic progress in Parkinson’s disease likely contributed to the decision.96

Smaller companies are filling the void left by larger companies. In fact, about one year after Pfizer’s exit, it formed a spin-off company called Cerevel Therapeutics. Backed by $350 million in venture funding, Cerevel Therapeutics will develop new neurological drugs, including a promising one for Parkinson’s disease that acts on dopamine.97 The new company hopes in 2019 to begin a late-stage clinical trial of the drug, which may not have levodopa’s side effects.98

Many pharmaceutical companies are embracing digital measures for Parkinson’s. Roche used a smartphone application in an early-stage trial for Parkinson’s and found it to be more sensitive than traditional rating scales.99 It is now in use in a subsequent clinical trial. Other pharmaceutical companies are evaluating watches and other sensors with the plan to use them to assess future treatments.100

Cerevel and others will need these and other measures to gain an accurate assessment of whether their drugs work. As

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