Thread by @Ostaley

When I covered the pharma industry in London, the subject of hard-to-treat diseases came up in an interview with an executive. He mentioned drug companies had essentially abandoned stroke. Curious, I dug in and was stunned by what I found. 1/10
qz.com/1583965/nono-a…

Stroke is the No. 2 killer globally, more deadly than cancer, malaria or HIV. Big Pharma spent decades and billions trying to develop a treatment to protect brain cells after a stroke, but failed repeatedly. Drug companies have since given up, moving onto easier targets. 2/10

They failed because stroke is a uniquely challenging disease. It acts more like a car crash than an illness, and speed is of the essence. The human brain is also extremely complex. It’s very hard to design clinical trials for stroke, and patient recruitment is a nightmare. 3/10

But Big Pharma also failed because it was arrogant and sloppy. It assumed drugs that worked in animals would work in humans. It designed trials with the biggest (and most lucrative) possible market in mind, instead of making sure it worked in any patients at all. 4/10

And it read into clinical trial data results that it wanted to see. The industry tested 1,026 separate neuroprotection candidates in 8,516 separate experiments. None worked. Chastened by its repeated failure the industry walked away. 5/10
onlinelibrary.wiley.com/doi/full/10.10…

Meanwhile, doctors found other ways to help patients. Prevention, better systems of emergency care, and new devices that snake into stroke victims brains to pluck out the clots have all made a difference . 6/10

qz.com/1584025/stroke…

As a result, stroke is leveling or falling off in wealthy countries. But in poorer countries that can't afford interventions, it is soaring. A cheap neuroprotective drug is still urgently needed. 7/10 theatlas.com/charts/SJbpOx2…

As I reported on where such a drug might come from, one name kept coming up: Michael Tymianski, a Canadian surgeon whose tiny company NoNO Inc. might succeed where the pharma giants failed. Without support from industry or VCs, NoNO has a stroke drug in two phase III trials. 8/10

Odds are Tymianski will fail, too. Stroke is really hard. But if he succeeds, it will be because he learned from the errors of Big Pharma. And if his drug works, millions of stroke patients may benefit. 9/10

I’m thrilled I was finally able to tell this story. Many thanks to @elijahwolfson and @xantunesx for their insightful, patient editing and months of support, and to @qz for giving a finance editor a chance to write about stroke. I hope you find the time to read it. 10/10