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This is Jane Pauley. Sunday mornings, Dr. John Lepuch talks with Gates about his very personal reasons why. and about a new treatment breakthrough that could be a game changer. First of all, thank you so much for talking with me.
Your father had Alzheimer's, and it strikes me that Even being Bill Gates didn't protect your family from that. Yeah, my dad in his late eighties um had Uh real effect of Alzheimer's. Those last five years he was Quite limited. He was lucky enough to have 24-hour care, but there was no medicine, no. Uh nothing that could bring uh his cognition back.
Was that one of the incentives for you to get into this? Yeah, I mean I'm Super interested in health, and as we get people to live longer, unfortunately, a lot of those last years can be very low quality. And so, through my dad, the mysteries of why haven't we been able to avoid Alzheimer's, I I got I'm very curious about that. And now the arc of this story is heading towards, well, maybe we can prevent Alzheimer's. Yeah, I'm optimistic.
Yeah, I'm Put money into a number of areas, getting researchers to work together, a data platform. uh really studying what causes the disease. Uh one of the Bigger successes is we now have a blood diagnostic.
So you can see if the amyloid, which predicts You're on your way to Alzheimer's. That can be measured.
So, recruiting people for trials. is going to be a lot easier.
Now this decade if we keep funding the research. We should have some fantastic tools. Possibly not. once you get Alzheimer's, but uh to prevent Some of the prevention tools are the most promising. If we keep funding Alzheimer's, that's a big if.
How much have you already invested personally? I put in a bit over 300 million and I'm going to stay. very involved in this. Uh it's an area the government has been very generous. National Institute of Aging budget has gone up a lot.
Now, for the first time, Uh there's a proposal to cut that fairly substantially. It'll be up to the Congress whether they They go along with that. Where are you spending that money, the more than $300 million?
Well, I saw on the diagnostic side, I was surprised that there wasn't a focus there, and it's kind of amazing. That Over a four-year period, the results of that are far better than I expected.
Now you can go into any lab and get this.
somewhat confusingly named test called P217 beta. Uh tau beta. and it'll tell you your amyloid levels. That's very helpful for recruiting for trials. If it's proven out that taking these antibodies Like LeCambi or Donyumanicab early, there's a good chance that will prevent you ever developing Alzheimer's.
That's the most optimistic thing. My funding is to make sure that happens very quickly. Another part is a basic platform of all the data. You know, when pharmacy companies do trials, they learn a lot. Uh but then if if that drug trial fails.
that data doesn't get transferred into a form. that all the researchers have it.
So we saw a chance. to build a modern platform and then get lots and lots of data into it. for researchers. Both in the US and worldwide. Where does AI come in?
Okay. All of the. That got a smile from you. That's small.
Well, AI is going to impact everything we do. We're just at the beginning of AI accelerating drug discovery. The biology of the brain is so complex that AI's ability to take large amounts of data. And find Meaning in that data Means that this research is going to go a lot faster, understanding the biology of Alzheimer's. And then seeing, okay, is there a drug?
Is there a vaccine? What is it? that you can do to stop. That progression. And so.
You know, that increases my view that over the next five to ten years, we'll come up with tools.
So that this looming cost and tragedy uh can largely be avoided. Have you spoken to either the President or to RFK Jr. specifically about this, about the philosophy of the investment?
Well, I've said how great U.S. medical research is, and I'm surprised they're proposing a cut. Is this to President Trump directly? Not this issue, no.
So you haven't spoken to either of them directly about this? How about RFK Jr.? I said, hey, what about these cuts? And he said, okay, that's an overall administration policy that he wasn't. You know, personally, uh...
And I'm dead. it probably wasn't worth talking about because it it had been a cited elsewhere. You know, I am anxious to have a good relationship with the research money that remains and for all. kinds of diseases, including Alzheimer's. With Federal research money being threatened, what do you see as the potential side effect of decreasing that investment?
It delays the breakthrough. You know, Alzheimer's, we still need the kind of basic research work. That the NIH funds. These incredible centers of excellence, like the one in St. Louis, I think there's eight in total.
They're amazing, you know, and they bring in young people with. new ideas. And because the instrumentation to measure protein levels has gotten so good, The data these young researchers have to consider different ideas is so much better. than even five years ago.
So this is the time where you think, wow, let's double down on this disease. And that's why I find myself surprised there's even a consideration of these research reductions. Have you spoken to economists about what the ramifications might be financially for our country if we don't get this under control? No, the numbers are pretty clear. you know, need a personal conversation.
You know, the government Is Got to provide medical care, and whenever you have an aging society. that you have lots of these chronic diseases. Um That can be a huge drain. on the resources. You know, the group that does The overall disease predictions, international health metrics and evaluation that I fund, they do this thing called the global burden of disease.
And for rich countries, the big chapter is you know, chronic, you're moving away. from acute. to these chronic diseases. What's really hurting people's lives is, yes, they're alive, but they're not doing that well. And so both from an expense and a burden point of view.
uh going after A few diseases where Alzheimer's is number one by quite a bit. the imperative is very, very clear. Can you imagine a time when patients come in Part of the routine physical examination and evaluation, they get a blood test to see if they're at increased risk for Alzheimer's? Yeah, for The broad population, probably once you turn 60 or so, that should be part of the routine blood test. It's a fairly inexpensive test.
And so if these tools prove to work and we get the side effect level down. then it would become routine that if you test high. for the amyloid in your blood. Then you'd be uh insured to get those clearing drugs and so for a period of years Ideally, um with self-injection, but worst case going in for infusion. that would prevent you from developing Alzheimer's.
So there's a few steps yet to come together here. But we're The dilemma we had where People were never diagnosed with Alzheimer's because we had no good tools, which meant it was hard to recruit people for Alzheimer's trials. And some of these very expensive trials failed. You know, and I was worried pharma would kind of abandon this area. Fortunately, A number of companies stayed in.
And now if things develop Well, they'll be rewarded for taking that gigantic risk. Let's talk about recruiting patients for trials. That's a huge problem, isn't it? Yeah, so Or I should say, that's a huge challenge, isn't it? A big, I was stunned when I looked into this.
A big part of the cost of why trials are so expensive is that recruitment, the number of years it takes to recruit patients, and you spend. As much as $20,000 per person having them go in because the Way to see their amyloid levels was a PET scan, which both for the patient and for the cost is really. Uh a lot of uh a lot of work. Could be five thousand dollars for an amyloid pen. Yeah, even or even more.
And So You know, that was the way it had to be done. And so, what we did is, we took a lot of people getting that PET scan, and we said, okay, will you give blood? And so then we could make. a correlation that wow does this blood test predict the same thing as that PET scan. was successful uh faster uh and with a uh better result than we we ever ever expected.
To me, that was an enormous step. What was it to you when you found out, wow, this blood test can actually be pretty good at at predicting Alzheimer's?
Well, it's like a lot of things I do in the disease area. It's like, wow, Nobody was doing this before. I mean, geez, this is such a clear tool. And then you find brilliant researchers, you know, people at WashU. There were some Swedish researchers who were just waiting for some money to go and dig into this thing.
People can really go for a long time with Alzheimer's and it can be very expensive, not only economically, but emotionally. No, the care costs. which are, of course, are not the only negative thing, but the care costs alone are hundreds of billions. And so You know, sadly, if a family has somebody with Alzheimer's, they may eventually exhaust That person's savings, and then the government is the one bearing those long-term care costs. And so by avoiding those costs, You can say, wow, Alzheimer's research.
has a big payback. You mentioned the effect on families. Can you talk about the effect on you personally when your dad had Alzheimer's, especially those last years? He was such a Brilliant person, you've talked about that. Yeah, my dad was quite amazing.
you know, a great lawyer, very involved in the community. He was on the board of a company and You know, I said to him, Dad, do you Probably should resign from that board. And he said, no, I think I'm doing fine. I said, no, I think. You have a great reputation, Dad.
You shouldn't put that at risk. And he went to the board and said, Look, Sometimes my son is right and He says I should resign, so I think I'm going to resign. Which at that stage was pretty clear-cut that reading a 10Q, 10K, it was not, the disease had taken away his. the brilliance he had at doing things like that. You know, you always have to laugh about, but it was sad to see a man of such.
uh dignity and thoughtfulness Uh You know go downhill. Because he grew up in the Depression, There was a period where he was just so worried, did he have enough money? And he had, through his own work and through some Microsoft, he had, he had lots of money, but he would call my sister many times a week saying, do I have enough money? Then, sadly, we got to the point where money became too abstract and so that that no longer was the uh It sounds though. That he still had the silhouette of a sense of humor to say, well, sometimes my son is right.
Yeah, no, he, he, he, he. did better than your average Alzheimer patient and still maintaining very friendly, even he couldn't name his caretakers, but he would say, did they get a meal? Always worried about how they were doing. I think probably most of us have had this. feeling of wondering at times.
I can't think of a name. Is that just normal aging or is it?
So many people, when they think, okay, I must be developing this. People should not think that way. That's just giving yourself a hard time. Memory gets. It's never perfect and then you're so aware of when it's not working as you get old.
But no, that's mostly people torturing themselves. As you've taken this journey, has there been something that's especially surprised you? It's amazing that we're living in this golden age of. Of medicine, you know, whether it's HIV or malaria or Alzheimer's. Many people look at some trends in society and they get a little bit negative.
And I say to them, okay, what about a society where? We Can prevent almost all of Alzheimer's. And your 70s, 80s, even if you're lucky, you're 90s. you're fully capable of grandparent or if you want to continue working and they're like, really? You know, they're a little skeptical that something like that.
Is happening, and of course, they've seen progress in heart disease, they've seen progress in cancer. But in those as well, the next 10 years, we are going to get a lot better. Uh and so it's People like wow, that is a very positive thing.
So it's a to be born at this. time period. And to be lucky enough to have resources that I can back these researchers, I can find something that. the pharma money and the the government money is not doing. You know, it's kind of wild that I get the opportunity to work with these people.
And when you talk about people being surprised that, oh wow, I didn't realize we had this kind of advance, it makes me think there's stigma attached to Alzheimer's and dementia that really could be an impediment to people even wanting to go out and find out whether they are at risk. Yeah, I mean it's It's such a tragic thing to be alive, but have your brain. not working.
So people probably don't talk about You know, somewhere in their family they're dealing with that. Um And You know, I It could take a little longer. Then five or ten years. But Wow, we are on... on on the path to having tools of intervention.
Now, streaming on Paramount Plus, it's the epic return of Mayor of Kingstown. Warden, you know who I am. Starring Academy Award nominee Jeremy Renner. Has sway in these walls. Emmy Award winner Edie Falco.
You're an ex-con who ran this place for years. And now.
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