Tuesday, 28 August 2012

Social trends: alemtuzumab vs. CCSVI

In response to a comment yesterday about alemtuzumab being a social phenomenon I did some on-line research using Google Trends to compare alemtuzumab to CCSVI. 

Methods: I used the search terms alemtuzumab, campath, campath-1h and Lemtrada to capture most of the MS-related searches in connection with alemtuzumab and MS and compared it to CCSVI. The graph below compares the search volume index of alemtuzumab to CCSVI. To make the graphs readable I had to do a log conversion of the search volumes, which are given by week. To do the log conversion I simply added 1 to each value and then took the natural logarithm of the converted value. You need to add 1 to convert all the zeroes to 1. If you remember your maths from school you can't take a logarithm of zero. This simple trick of adding 1 to all values simply shifts them up by one, which then allows you to take to logarithm. A logarithmic conversion shrinks the values, or brings them closer together, to allow you to compare them visually. What you have to remember that small differences are in fact large differences.

Results: The search volume index of alemtuzumab is pulsatile and when it does increase it dwarfs that of CCSVI. The peaks in alemtuzumab searches are linked to specific news events. Please note the recent surge in the volume of searches, which is related to the withdrawal of the oncology version of alemtuzumab and the recent FDA refuse to file letter. 

Conclusion: Yes, alemtuzumab is a social phenomenon, but its pattern of interest, as defined by Google Trends, differs to that of CCSVI. The alemtuzumab search volume is occurring at several orders of magnitude greater than CCSVI and the pattern of searching is occurring in bursts.  In comparison CCSVI, had a peak that was actually quite small, which is now waning rapidly. These results are reassuring and it shows that the MS community is much more interested in alemtuzumab than to CCSVI.

"Are you surprised by these results?"

"Google Trends is a wonderful tool and I may start using more than I have in the past!"

Recent posts of interest in relation to alemtuzumab:

14 hours ago
It put back the cladribine application 6 months in the US and delayed the FDA decision until after the EMA decision. I believe the negative EMA decision affected the FDA's decision. Let's hope that Alemtuzumab does not go ...
21 Aug 2012
"Yesterday's post on the withdrawal of alemtuzumab to prevent off-license use of the oncology version of alemtuzumab (Mabcampath) resulted in a flurry of discussion and criticism. With some of the latter occurring off-line.
22 Aug 2012
Alemtuzumab remains in the news. Sanofi pulls Campath to clear way for higher-priced Lemtrada FiercePharma. Genzyme has been developing Campath-slash-Lemtrada for MS, hoping to become a big player in that disease ...
21 Aug 2012
Alemtuzumab is being pulled in the US as well. (Reuters) - Sanofi's rare disease unit Genzyme is pulling leukaemia drug Campath to prepare for its launch under a different dosage and as a multiple sclerosis treatment that ...

20 Aug 2012
This means that alemtuzumab will no longer be available as a licensed product in the UK once existing supplies run out. This action is not being taken for any reasons related to product safety, efficacy or supply, but as part of ...
11 Jun 2012
I see that 74% of alemtuzumab treated patients are CDA free at 2 years, but only 51% are MRI activity free. Would you expect this MRI activity to result in CDA at some later stage, or do you think the MRI activity would reduce ...
21 Aug 2012
When alemtuzumab-treated MSer's immune systems recover or reboot themselves, it begins to attack other parts of their body; most commonly the thyroid gland. Dr Coles, in Cambridge, believes that they can reduce the risk ...
13 Apr 2012
Conversely, mean magnetization transfer ratio was stable in 20 alemtuzumab-treated patients (grey matter: -0.01 pu/year, p = 0.87; white matter: -0.02 pu/year, p = 0.51). The gradient difference in grey matter was 0.25 pu/year ...


  1. how does Google trend (pure noise) fit in the scope of fundamental research?
    Any chance it would influence your treatment advice and selection?
    Less noise = less biase

    Not a CCSVI fan at all - the chart below is of interest from April-12 onwards only btw as a mean of reflection of sustainable social interest (prior to that is purely determined by news announcements)

  2. Would Google trend influence treatment advice.......doubt it

  3. you are a researcher. How would you know?

    Treatment advice is so elusive....

    Check the marketing budgets of the pharmas and you'll see how much importance they give to "trends" setting....

    bad science I say. Pure noise.

  4. In my opinion, the way you interpret Google trend is a little bit biased. I have been looking at the graphics at the google trends webpage. Let's analyze it year by year, starting from 2009 (the year where the CCSVI crazyness blew up).

    2009 Alemtuzumab graph: http://www.google.com/trends/?q=alemtuzumab&ctab=0&geo=all&date=2009&sort=0
    2009 CCSVI graph: http://www.google.com/trends/?q=ccsvi&ctab=0&geo=all&date=2009&sort=0
    2009 review: As you can see, alemtuzumab was barely looked at in google. We know that alemtuzumab's research had already started in 2008. So why almost no searchl in google about it in 2009? On the other hand, starting from late 2009, CCSVI was constantly (with higher or lower frequency) googled.

    2010 Alemtuzumab graph: http://www.google.com/trends/?q=alemtuzumab&ctab=0&geo=all&date=2010&sort=0
    2010 CCSVI graph: http://www.google.com/trends/?q=ccsvi&ctab=0&geo=all&date=2010&sort=0
    2010 review: Alemtuzumab follows the same pattern as in 2009. Just bursts of searches rapidly disappearing. On the other hand, CCSVI remains constantly searched in google (with its ups and downs).

  5. 2011 Alemtuzumab graph: http://www.google.com/trends/?q=alemtuzumab&ctab=0&geo=all&date=2011&sort=0
    2011 CCSVI graph: http://www.google.com/trends/?q=ccsvi&ctab=0&geo=all&date=2011&sort=0
    2011 review: Alemtuzumab follows the same pattern as in 2009 and 2010. The same happens with CCSVI, but it is slowly and progressively being less searched in google.

    2012 Alemtuzumab graph: http://www.google.com/trends/?q=alemtuzumab&ctab=0&geo=all&date=2012&sort=0
    2012 CCSVI graph: http://www.google.com/trends/?q=ccsvi&ctab=0&geo=all&date=2012&sort=0
    2012 review: Alemtuzumab's pattern changes. From march 2012 to (at least) august 2012 (5-6 months) it stops being a sporadic phenomenon and starts being constantly searched. CCSVI follows the same pattern as the year before.

    What does all this information show us? It basically shows that you cannot compare alemtuzumab to CCSVI. It is like comparing chicken's sales to pencil sales. And why do i say that?. Let's make an analogy with MS. Alemtuzumab is like RRMS, it comes and goes. There are times were you don't even know it is there and others in which it is the only thing you can see. CCSVI is more PPMS, it is constantly there, doing it's thing, and everyday you can see some of its effects. Why does this dicotomy exist? Just because alemtuzumab is a drug and CCSVI is, not only a pathology, but a procedure. You just hear about alemtuzumab when a trial is done (that is proven in the graphs). Now you look more for alemtuzumab because, as you can see in the graphs, the volume of news that come out is exponentially higher than before. Why there are more news now than before? Because of all you've been writing the past weeks (alemtuzumab being retrieved from the market, lemtrada, higher price, safety, etc...). Once all this boom disapears, you won't hear again about alemtuzumab until it is FDA and EAE approved. And even then, it won't be as popular as CCSVI for just one single reason. CCSVI is available to everyone. Everyone "might" (or "might not") bennefit from it. Alemtuzumab is not available for everyone. It is a high profile drug, one to be used in agressive cases. The basic reason why Alemtuzumab will never be as looked for in google as CCSVI is because CCSVI's market is (or pretends to be) bigger.
    Talking about CCSVI, for the reasons i already mentioned, and because it is a somewhat revolutionary thing (revolutions are always more of the people than the status quo). CCSVI is a cientific thing, but also a popular one. CCSVI exists as it is now, to certain degree, thanks to the people. CCSVI is talked about by the people, for some of them have had the procedure done. That's why, if not proven fake, and alemtuzumab not approved for all MS patients, CCSVI will always be more popular.

  6. And talking about the big question. Why is CCSVI constantly less searched in google trends? I think it's obviously not because of less people being interested. You just have to look facebook pages like CCSVI in multiple sclerosis (every month with more followers), THISISMS (the biggest thread is still about CCSVI), news, new studies (BRAVE DREAMS is an example). I, for instance, was diagnosed of MS just 6 months ago, and CCSVI is something i closely follow. And i can tell you why CCSVI is less looked for in google. It follows the same logic as to why i don't put "multiple sclerosis research blog" every time i want to see your blog. Because i have you on my favorite pages list (yes, i'm a really weird individual, XD). Google is just a door to enter places you've never been before. At first, you may still use that door. But when you become comfortable with the place, you make it your own, and you don't need google. Do people put "facebook" on google to enter their facebook profile. Some might do, but most don't. Especially nowadays with Explorer, Mozilla, Chrome, and others that redirect where you wanna go even if you don't put all the WWW address.

    So, my own conclusion is that CCSVI is not stopping, but it probably is just the starting point for new and very interesting things to come.

  7. "you are a researcher. How would you know?

    I thought the question was personal i.e. "Any chance it would influence YOUR treatment advice"

    So I can speak for myself on a personal note with confidence and say NO and
    with regard Prof G I DOUBT IT

    I agree with you that they have big advertising budgets to entice neuros and MSers

  8. Moreover, if you do look at the news concerning alemtuzumab (etc...), you'll notice that a certain and not minor amount of them were published in general or bussines newspapers. What that's implying is that a certaing percentage of the people looking for alemtuzumab in google are not patients, nor they are people who have a direct interest in MS (if that was not the case, they would not put alemtuzumab's news in bussines newspapers. Because, why write something that no one is going to read?) They are bussinesmen that do have an interest, but in the drug itself, and its economical consecuences.
    Drugs, as opposed to CCSVI, do not have just a human and medical interest, but an economical one too. You have not differentiated that interest, and it is an interest that should be removed, for it is a variable, by definition, circumstantial.

    Even more, if you start thinking about it, and all the variables that need to be considered, one can safely get to the conclusion that, with all due respect, this comparison makes no sense at all.

    1. "Drugs, as opposed to CCSVI, do not have just a human and medical interest, but an economical one too."

      There is certainly an economic interest in CCSVI for those who have a vested interest in performing the procedure which will produce nothing except anorexia of the wallet for the patient.

    2. I have to agree with you on that. CCSVI is also a money making machine for some.

  9. Anonymous you are great, Mousedoctor you need to stop with your accusations, do you expect IR's to do the procedure for free? It only costs 6-8 thousand dollars unlike MS drugs that cost 25-50 thousand dollars a year, it is not good to point fingers when you live in a glass pharmaceutical house.

    1. Ir's charge for the procedure so they have a vested interest.It may only cost 6-8 thousand dollars for some. I'm sure some will be paying more than this. The point is that this directly comes out of MSers pockets which many can ill-afford for a procedure that certainly has not been anywhere close to being validated and until it is I would suggest that those performing it should be doing it for free until it is if they believe in it so much.
      I'm a mouse doctor so I have no vested interest in the prescribing of pharmaceutical products to Msers.

    2. If they were doing it for free, it would actually be at a cost for them. (Charge for room and equipment used and nurses etc.)

      The BNAC PREMiSe trial unblinded their data and will be presented on next month at the ISNVD conference. Is BNAC considered to have a vested interest? It's an academic institution not a clinic.

    3. It only costs 6-8,000 but if you believe the reports where there is an effect it only lasts about 3 months..before re-stenosis? Therefore you need a repeat treatment so 4 times a year that's 24,000-32,000 so not that different from a DMT. But will this be enough, next venous bypass and the clinic no doubt offers a dose of stem cells whilst you are at it.

      It is obvious the procedure is not for free. I personally cannot believe the costs of the CCSVI trials in Cananda cost millions.

      Good to hear that we will begin to get results so we have a month to
      wait. Maybe it is time for a poll. Should be believe the BNAC PREMise Trial results one way or the other?

      “CCSVI intervention should be restricted to blinded, randomized and controlled clinical trials that will establish the safety and efficacy of these endovascular procedures.”
      Robert Zivadinov, MD, PhD"

      There are certainly some Institutes investigating this that have I believe dubious accademic credibility.


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