From Awareness to Action Tackling the Brain Health Pandemic
Transcriber: chewy jeans
Reviewer: David DeRuwe
Every day on the news,
we hear about the mental illness crisis.
We hear it from athletes;
we hear it from actors.
We’re not, however,
in a mental illness crisis;
we’re in something more dire
with greater consequences.
I would suggest to you
that we are in a brain health pandemic.
The reason that this is important
is it’s a growing pandemic, getting worse,
and we have to get
to the right side of this pandemic
to take the appropriate action.
I, like many of you, may have family
members with depression, Alzheimer’s,
Parkinson’s, or other brain health
diseases like tremor.
We have to get an understanding
of these diseases
as the biologic underpinning
so that we can develop
scalable therapeutic interventions
for these diseases.
Now words matter.
It’s important we talk
about brain health, and we take action.
We need to move away
from mental illness stigma
and understand we’re talking
about brain health.
It’s not your fault.
The brain is an organ with biological
underpinnings that cause these diseases.
If we can understand
these diseases biologically,
we can intervene and scale,
so we can treat millions
of people around the world.
Now, this is critically important
because in addition to the personal family
and societal toll it takes,
there’s been a nearly 100% increase
in the economic cost of brain health
diseases in the US alone.
Brain health is the world’s
largest cause of disability.
Brain health is costing us
about a half a trillion dollars per year
on a global scale, so the economic
consequences are dire,
and they continue to grow.
Now let me set some historical perspective
for you on on how we got here.
This is a picture that could be
your kitchen in the 1970s,
and what we heard in this kitchen
was “She’s got cancer; it was divulged.”
It was whispered. It was
a stigma. Cancer was hidden.
It was talked about in the backs
of the kitchens; it wasn’t out front.
Today we have advocacy groups
with better diagnoses.
We understand the biologic
underpinnings of cancer.
We learned that cancer is caused by cells
that replicate out of control.
We were able to intervene.
We learned that our immune systems
are suppressed with certain cancers.
We were able to intervene
In the last 12 months alone,
there’s been 41 new cancer therapies
approved and available to patients.
There’s thousands of companies
and tens of thousands of drugs
being developed for cancer -
cancer is out in the open.
Now of course, your lifestyle
always matters,
getting cancer is talked about,
and it’s not your fault.
This could be a scene from the 80s
where someone might have whispered:
“He’s got a bad ticker,”
and we talked about the fact
he eats too much, drinks too much,
maybe not exercise, or high stress job.
Of course that matters,
but what also matters is family history,
genetics, and environment.
By looking at the heart as an organ
and understanding the biologic
underpinnings of the heart,
we have been able to develop
drugs for hypertension,
for hypercholesterolemia,
and in the last decade alone,
a disease that was once called
senile systemic amyloidosis
and thought simply to be a disease
of aging that you simply got
was understood to be biology,
that a protein synthesized
in the liver misfolded
and deposited in our periphery,
including our hearts.
That disease has been transformed
with available medication.
It’s called TTR amyloidosis now,
named after the discovery
that it was not caused simply by aging.
We can continue to learn
on the biologic front as well.
Now again, lifestyle matters -
eating and drinking too much.
Of course that matters,
but what also matters here is genetics,
and we talk about cardiovascular disease.
Now, it’s the leading cause of mortality
in the world, so we’re not over it yet,
but we talk about it,
it’s out in the open,
we understand the biology, and we continue
to develop therapeutic interventions.
Now here’s a scene that could be my home.
It could be you home today.
And now what’s whispered
is “She’s got depression,”
and we further talk about the fact
that since she’s been home,
she had her babies, she lost her mom,
she didn’t leave her room, her house,
she’s cutting herself.
It’s hidden. It’s not discussed.
Not discussed because we
think of this as mental illness,
as something that’s your fault
or your parents’ fault.
It’s biology; we have to get
to the other side of this.
Now fortunately, we’re seeing
a decrease in this COVID pandemic,
but we are seeing a massive increase
in the brain health pandemic,
and it’s growing.
The brain is an organ,
and the nervous system
attached to the brain is an organ
that has biologic underpinning of disease,
and by understanding
that biologic underpinning,
we can develop interventions
to treat that disease.
When I take my candesartan
for my high blood pressure,
I’m taking a drug, I’m taking medicine.
If I take Prozac for my anxiety,
I’m getting medical-assisted therapy.
That’s not OK, and it’s not scalable
to the millions of people
around the world suffering from
brain health diseases.
So how did we get to a place
where it’s our fault
and we need to toughen up and get over it?
Well, we need to go back over 2000 years
to the Hippocratic age
where the father of modern medicine
taught us that our personalities
were driven by four substrates or humors,
and your humor drove your personality;
if humors were out of balance,
you got disease.
Fast forward to Freud
father of psychoanalysis,
and he thought there were elements
of your mind that led to your personality
and led to disorder.
These teachings were pervasive in books
and then later in TV, movies, and music.
This has led to a view
that “It’s our fault, toughen up.
This is as good as it gets.
Just get over it.”
Let’s move to the hope.
There are many tools we have today
to understand the pathophysiology
of the brain in far better ways.
We understand brain circuitry.
We understand brain structure.
We understand brain chemistries
better than at any time in modern history.
And this new understanding of the brain
and brain pathways
has led to non-invasive ability
to understand and potentially
predict disease.
Let me give you two examples:
We can take a simple blood test
and measure your inflammatory
and steroid levels in your blood.
We can, as we’re doing here,
look at brain circuitry
and understand if your brain circuitry
is in the normal or not normal range.
These kinds of non-invasive treatments
or non-invasive diagnostics
help us understand whether you’re going
to have a depressive episode
or movement disorder or a seizure,
weeks and months in advance.
That’s real advancement,
and because of that advancement,
we are seeing a significant amount
of investment back into brain health.
My company, Sage, looks
at the brain as an organ.
We’re studying science,
the deep biology of the brain,
and trying to develop drugs a step-change
better than those that we have today,
so that people can live
normal, healthy lives
and everyone has an opportunity to thrive.
There are many pathways in the brain.
I’m going to talk about one:
the GABA pathway.
When disregulated, this pathway
can cause depression and anxiety.
Now, this understanding
of the disregulation
of the GABA receptor pathway
led to a therapy intervention
for moms and their baby
diagnosed with depression
called postpartum depression.
And for those who may have suffered
or know someone that suffered,
postpartum depression could have
dire consequences for generations to come.
Its understanding of the GABA pathways
is being applied
more broadly than depression.
Think about the opportunity
of maybe taking a pill
every night for a couple of weeks
that rewires your brain circuitry
and returns you to a normative state.
These are the kind of therapy
interventions that are coming.
Now, I’ve focused mostly on depression,
but this same discovery is happening
more broadly in brain health -
things like cognates, cognitive memory,
things like essential tremor.
These discoveries are coming down the road
and must be here
as the crisis continues to rise.
So join me in the conversation
about brain health awareness.
Join me in rooting for big science
and big innovation.
And if you or a loved one, anyone in your
family has a brain health disease,
think about it as
a pandemic-like situation.
Talk about it, get out in front of it.
And most importantly, remember that these
diseases have biologic underpinnings
and it’s not your fault.
Thank you.
(Applause)