Op-Ed: Biogen’s Alzheimer’s drug sets a dangerous precedent
By Ranjan Mukherjee
Published in the Bucks County Courier Times, February 9, 2022.
I am a scientist and have worked in the pharmaceutical industry. I believe in and love science.
I am also a retired senior citizen, dependent on Social Security and Medicare. Hence, costs are important to me, especially that of medicines. Biogen’s antibody aducanumab — marketed as the brand name Aduhelm — for Alzheimer’s disease should not have been approved in the first place.
The approval process was torturous. Two large trials showed no convincing clinical benefit, that is, slowing patient’s cognitive decline. An independent advisory committee voted overwhelmingly against approval. Yet it was approved.
This raises some unpleasant questions. Why was it approved and who benefits? Not the patients. A famous line comes to mind, “Just follow the money.” There is a reason why people are increasingly skeptical about the U.S. Food and Drug Administration, FDA; the Centers for Disease Control and Prevention, CDC; and what doctors say.
It was initially priced at $56,000 per annum, a totally outrageous price. It was later cut back to $28,200 which is interesting in itself. If Biogen can make a profit on this price, how or why did they initially charge $56,000? To fleece patients because they could? Obviously, Biogen is still making a tidy profit at the lower price.
The Medicare Part B premium was increased by $22 this year, of which $11 will be used to create a fund to pay for this drug. This is the first time one pricey drug has led to a premium increase for all Medicare recipients, not just affected patients.
Why? Because Aduhelm is given as an intravenous infusion in the doctor’s office. This has to stop or every pharmaceutical company that develops antibodies as drugs — there are many and it’s increasing — will be tempted to take this route.
I can almost visualize the ads on television. A well-dressed and well-groomed elderly person intoning in a rich baritone, “I can feel my memory improving after I started taking this. It makes me feel sharper and younger. It could do the same for you. Talk to your doctor.”
Very seductive indeed. Naturally, seeing these ads, seniors will rush to their doctors to clamor for it. And that, precisely, is the goal. Biogen makes a lot of money. Benefit for the patients? Very questionable.
And premiums will keep spiraling upward, $22 this year, then $50, maybe $150 the year after. Can retirees on a fixed income afford this increase, especially with inflation running rampant? And can Medicare keep up without raising taxes and/or cutting benefits?
The recent Center for Medicare and Medicaid Services, CMS, decision is to pay only for CMS approved clinical trials with Aduhelm until its efficacy is clearly established is therefore necessary. This plan is nicely explained in Bach and Garthwaite’s (June 17) opinion piece.
Health care costs are bankrupting us. I am constantly amazed at the exhortations from our elected representatives to do something about it and then their inability to follow through. Maybe they cannot or probably will not.
But we can do something. Stay healthy. Fewer doctor visits, fewer medicines to take. We benefit on many fronts. Save money and enjoy a better quality of life.
Ranjan Mukherjee is a resident of Northampton Township. He can be reached at email@example.com
World must stop ignoring the plight of Myanmar’s Rohingyas.
The Philadelphia Inquirer, January 25, 2017.
Myanmar, once known as Burma, is a country of 53 million, and the vast majority of its population is Buddhist. It became part of the British Empire with the subjugation of the Arakan and adjoining kingdoms.
Beginning in the 17th century, the empire imported laborers from Bengal (now Bangladesh), which borders the Rakhine province of Myanmar. The descendants of those workers, and others, are today’s Rohingyas, Muslim by religion and now numbering more than one million.
The Rohingyas are one of the world’s most persecuted minorities and the largest single group of stateless people. They are not accepted as citizens of Myanmar, but rather as interlopers from Bangladesh. But that country doesn’t accept them as citizens either. Read more.
Three Careers across Three Continents. Bengali Immigrants, June 2016
The only constant is change: I have heard it said.
Here is the story of my three careers across three countries in three continents. I started as a student of physics, graduating with a B.Sc. (physics honors), and then completed the physics M.Sc. program from the University of Calcutta. For the M.Sc., I took biophysics as my special subject where I had my first brief contact with molecular biology. The physical and chemical properties of DNA, RNA and proteins and their fundamental role in the mystery of life opened an amazing new world to me. I wanted to do my Ph.D. in biophysics in the USA. Read more
Seeking a rhinoceros from atop an elephant. Philadelphia Inquirer, June 2016
One horned Indian rhino in Chitwan National Park, Nepal
Photo: Ranjan Mukherjee
The safari elephant made her way cautiously through dense tropical undergrowth and halted abruptly. Before us we saw an agitated ripple spread through the tall grass. Must be a very large animal!
Chitwan National Park in Nepal is a World Heritage site and a very popular place for viewing wildlife, especially the one horned Indian rhinoceros. Perhaps the best view is from the back of an elephant. And I had come a long way for this once-in-a-lifetime experience.
We left for the safari early in the morning. We drove a short distance to the boundary of the park and were greeted with an astounding sight. There were about twenty elephants standing in line, swaying gently, patiently waiting for us. They had “howdahs” on their backs, each capable of carrying four passengers. Luckily, there were three tourists besides myself from my hotel. An elephant was selected, her name was Champakali. We climbed onto a boarding platform. She stood next to the platform and the four of us stepped onto her back and sat at the four corners of the square howdah so that our weight was evenly distributed on her. It was a snug fit. The mahout (driver) gave an order and we were off on our elephant safari.
We waded across the river Rapti (shallow in winter) which forms the boundary and entered the reserve. Gradually we penetrated deeper into the forest. All around us were huge trees, we were immersed in a sea of green. We saw the iridescent blue and green of wild peacocks and heard the metronomic rat-a-tat of woodpeckers. We came across several spotted deer, a herd of wild pigs and sambars. The sun finally broke through the mist and the morning chill slowly dissipated. We became aware of the unmistakable buzz and whine of insects and big spider webs close to our faces. I was glad for insect repellent and long sleeved shirt and hat. We plodded on for another hour. The trees seemed to grow closer and denser. We heard rustling in the treetops and looked up to see monkeys jumping from tree to tree or staring at us. Our anticipation heightened; would we see something BIG?
Suddenly, we saw another safari elephant approaching us and her mahout excitedly pointed in the direction of a rhinoceros they had just seen. Champakali was off in flash. In minutes we saw the rhino grazing placidly, totally oblivious of the excited humans and elephants. Our mahout got us as close as possible and we spent some time admiring and filming the magnificent rhino, with its prized horn and coat of armor clearly visible. This truly was the highpoint of the safari and I consider myself very lucky to have seen such a rare animal in the wild. At the end of the trip, I thanked Champakali (a banana for her) and her mahout, posed for some photos and returned to the hotel in excellent spirits. An unforgettable safari!
Ranjan Mukherjee is a freelance writer and lives in Pennsylvania, www.ranjanmukherjee.com
An Encounter with the Tigress of Ranthambhore. Philadelphia Inquirer, March 2015
The Tigress of Ranthambhore. Photo: Ranjan Mukherjee
The warning growl, a flash of orange, tension crackling in the air: a tiger is near!
This is what I had imagined and wanted to experience. Mention the word “tiger” and “India” comes to mind. So, a few years ago, my wife, son and I decided to visit Ranthambhore, a one-time princely hunting ground turned tiger preserve, located 112 miles from Jaipur, the capital of Rajasthan, a state in western India.
We stayed in a luxury tent, once used to accommodate guests during tiger hunts in the last century. This irony did not escape us. That evening we went on a safari. We saw several deer who seemed alert and restless. The forest guide said they sense the presence of a tiger nearby, but we saw no tigers. We returned to camp slightly depressed, had dinner around a blazing campfire under the stars and went to bed hoping for better luck the next day.
Next morning we woke early, had tea and biscuits and left for a second safari. It was still dark and freezing cold. We had sweaters and jackets but were still glad for the blankets that were in the Jeep. Routes in the forest were selected by lottery. I drew a number and we proceeded into the forest. We drove for a while on the prescribed route. We saw fresh pugmarks, a hopeful sign. We came across three Himalayan black bears, a mother with two cubs. They came frolicking down the hillside right in front of our car, saw us, turned and ran. They were hilarious to watch but kicked up so much dust it was hard to get a good photo. Still, no tiger. The sun rose, the temperature started to rise along with our anxiety. We continued driving with a sharp look out on all sides.
Three Himalayan black bears hidden in a cloud of dust.
Suddenly, as we were driving up the slope of a hill, we saw the silhouette of a tigress against the skyline, right next to the car track. She turned and started walking away from us. The driver drove faster to catch up. We gazed, spellbound. She was a magnificent animal, beautiful and fearless. She paused behind a bush and turned to look at us. Her coat was bright orange with jet black stripes and blended perfectly with the dry leaves of the winter forest. At that moment I truly understood the meaning of camouflage and how tigers became such stealthy, effective hunters. I told the driver to stop, grabbed my camera and took a photo.
We returned to camp with great joy. It is very rare to see tigers in the wild and we were extremely fortunate to see the tigress and the bears. We left with incredible memories and great photos. The picture of the tigress is now the background of my computer desktop. It elicits gasps of admiration from viewers and gives me a chance now and then, to tell the story of our encounter with the tigress of Ranthambhore.
Deer watching out for predators.
My Nepal Trip (Part 1). Du-Kool, May 2015
This article is dedicated to those who lost their lives in the devastating earthquake in Nepal, May 2015.
Annapurna at dawn. Photograph by Ranjan Mukherjee
Nepal, the land of high mountains, secluded valleys and dense jungles, has always held a fascination for mountaineers, trekkers and adventurers seeking an escape from their humdrum daily lives. Geography has indeed blessed this land. It hosts some of the highest peaks in the Himalayas to its north and hot and steamy jungles of the Terai to its south. It has swift clear rivers suitable for rafting, challenging peaks for mountaineering, soaring thermals for paragliding and verdant jungles for wildlife viewing. The recent political upheaval is over and the country is once again, fast becoming a Mecca for tourists. Having a wild, adventurous streak in me, I had always secretly dreamed of a Nepali adventure. On a trip to Kolkata last December, I finally turned that dream into reality. Read more.
My Nepal Trip (Part 2). Du-Kool, July 2015
Photograph: Ranjan Mukherjee
After Pokhara, we were on our way to Chitwan National Park in southern Nepal and I was looking forward to seeing the wildlife and getting some good photos. But the picture of Annapurna at dawn was still haunting me, I was indeed fortunate. The day was clear and I kept turning my head around to see the Annapurna massif slowly receding into the distance. I felt a twinge of regret.
The drive to Chitwan would take 4.5 hours and we would be leaving the cool heights of Pokhara and descending to the warmer confines of the Terai. The temperature progressively got warmer and the vegetation more lush. Read more.
Next for the Displaced: Chill Winds and Snows of Winter. Courier Times, September 2015
Photo: Ted Wendel
News of the devastating earthquake in Nepal has moved off the front pages of our newspapers. But in Nepal, heavy monsoon rains are drenching the country and will be followed in a few months by the chill winds and snows of winter. People need to rebuild, but how exactly? Do they build the same structures as before? Perhaps this disaster gives us an opportunity to build safer houses and improve infrastructure.
Nepal is a small, developing, Himalayan county sandwiched between China and India. Its area encompasses eight of the ten highest peaks in the world. Millions of years ago, what is now the Indian subcontinent plate drifted north colliding with the Eurasian plate forcing the Himalayas to rise skyward. This slow, relentless drift continues and strain builds up continuously along the fault line which passes under Nepal. Occasionally, the strain is released causing earthquakes. There has been a record of large earthquakes in Nepal through the centuries. The latest, on April 25, released some pressure but not enough. Seismologists predict that another, potentially bigger earthquake is in the offing but cannot pinpoint the exact time. Although forewarned is forearmed, this does not allow us to sleep in peace. What can we do? It is clear that we cannot prevent earthquakes which are a result of natural geological forces over eons. But we can certainly minimize the devastation and loss of life.
First, is to rebuild as quickly as possible but with buildings that are more resistant to earthquakes. Modern concrete and brick structures survived the earthquake much better than the more traditional brick, wood and mud structures. The excess cost of a reinforced home (e.g., having concrete or timber supports at the corners of the building that are tied together with horizontal runner beams) is estimated to be only 5 to 10% more than traditional homes, but more flexible and resilient to tremors. The Nepali government should clearly communicate this message and help financially as needed, with loans on easy terms. The Nepal National Society for Earthquake Technology could design simple, low-cost, earthquake resilient houses, train masons and communicate en masse to the entire population with the local government enforcing the new building codes. These activities have begun but momentum needs to increase, time is not on our side.
Then, once the rubble is cleared, houses are rebuilt and the displaced moved indoors, attention has to focus on improving the infrastructure. In an emergency, supplies need to be moved rapidly often to very remote locations. In the absence of trains in Nepal, roads and air are the two main conduits. There are highways in Nepal but the heavy monsoons with the accompanying floods and landslides renders them impassable at times. Many roads have large potholes that often reduce traffic to a crawl and sometimes lead to severe damage of an axle or two. Better roads are needed. The April earthquake has clearly demonstrated the importance of resupply by air. Many of Nepal’s remote towns and villages could only be reached by helicopter, so more helicopters and heliports are needed. This would also boost tourism. Kathmandu International Airport needs to be expanded. If that is not possible, another airport with more modern facilities should be built. In April, the increased influx of relief supplies caused a veritable traffic jam on the runways forcing some relief planes to turn back, unfortunately, when the need was greatest.
How best can we help? Money, of course, is needed. But, in addition, technical help in designing affordable, earthquake resistant houses using materials readily available in Nepal and planning for emergencies and disaster relief is crucial. I visited Nepal last December and spent many delightful hours among the ancient historic temples in Durbar Square, Kathmandu. These have stood for a very long time. Sadly, they are now a jumbled heap of wood, bricks and tiles. The Nepalis are courageous and resilient and they will surely rebuild as they have done on countless past occasions. Only this time, I hope the use of modern technology makes their new homes safer and minimize the devastating impact of any future megaquake. The scenes from the last one are still vividly etched in our minds. Link to Courier Times
The Winding Road. Science, November 2014
The Winding Road
On a bright July day more than 3 decades ago, I turned up at the University of Delaware (UD) physics department, hoping to meet my new research advisor. I was met instead with quizzical looks: The professor had died some months before. No one had told me.
I had come a long way. Read more
Face to face with the King of the Forest. Philadelphia Inquirer, November 2014
King of the Forest strikes a pose. Photo: Ranjan Mukherjee
To most people, lions are symbolic of Africa. However, in one forest on another continent, the Asian lion has made its last stand. Once upon a time they roamed in large numbers across a vast swathe of Europe and Asia. But hunting and habitat destruction have greatly reduced their numbers. Gir forest in the state of Gujrat in Western India is the last stronghold of the Asian lion. There are only about 200 left in the wild. On a trip to India in January, I decided to visit Gir to see these elusive Asian lions and the deer, wild boars, monkeys and peacocks that inhabit the forest.
I traveled by car from Ahmedabad, the capital of Gujrat, and stayed in a hotel on the outskirts of the forest. The evening was spent talking to the inhabitants of the local villages and making arrangements for a safari the following day. Very early in the morning when the animals are active, I entered the forest in an open Jeep with a driver and a forest guide. It was still dark with a gentle cool breeze. Scent travels far under such conditions, ideal for lions to locate their prey. There was no sound except that of the Jeep engine and the indescribable background noise of the jungle. Every rustle would set our hearts racing. Gradually, the inky darkness yielded to a glorious dawn. Shafts of golden sunlight filtered through the jungle canopy and lit up patches of the forest floor covered with dry brown leaves. Our ears and eyes were straining to catch sound or sight of the elusive lions. After some driving on jungle tracks, we heard muffled roars in the distance. We stopped and listened, ears cocked, senses stretched to breaking point, trying to gauge the direction and distance of the roars.
“Lion,” the guide whispered suddenly, grabbed my arm and pointed to the right. My heart nearly missed a beat. There, about 30 feet from us, a male lion broke through the jungle cover and strode unhurriedly in front of the Jeep towards a waterhole a short distance ahead. We followed at a safe distance. At the waterhole he paused, lapped the water for a couple minutes, stretched out on his side and looked straight at me alternately yawning and blinking. He was relaxed and seemed to be enjoying posing for us. I could not believe my good fortune in being able to see a full-grown Asian lion in its natural habitat.
I left with wonderful memories, mesmerized by the majesty of the king of the jungle. A framed picture of the king hangs in my study.
First published in the Philadelphia Inquirer, November 2014.