1. Orphan Diseases & One Patient’s Fight Against Erdheim-Chester Disease

2. Definition of Orphan Disease A disease which has not been "adopted" by the pharmaceutical industry because it provides little financial incentive for the private sector to make and market new medications to treat or prevent it.

3. What is an Orphan Disease? Affects Less Than 200,000 People in US A Doctor in a Busy Practice Would Expect to See Less Than 1 Case per Year 7000 Known Rare Diseases 8% of Population Diagnosed with Rare Disease No Disease is Rare When it Strikes Someone You Love Data Obtained From the National Organization of Rare Diseases (NORD)

4. Orphan Disease Facts 85 to 90% are Chronic, Serious or Life Threatening 80% are Genetic Many Impact Specific Age Groups (e.g., children or over 40’s) Diagnosis Often Takes Years with Patients Shuffled from One Specialist to Another Treatments are Uncertain and Not Always Available Costs Can Be Very High Support Structure May be Non-Existent Data Obtained From the National Organization of Rare Diseases (NORD)

7. How Does the Patient Feel? Totally Alone in a Nightmare Abandoned by the Medical Profession An Exercise in Patience "I just want to know what is wrong with me so I can fight it" - 48 year old, weeks before his death “Some days I wish I had cancer…When you have a disease like mine, you don’t fall through the cracks in the system, you fall through a gaping abyss.” – Mark Screiber, 46 year old with Aplastic anemia Newsweek, April, 2008

8. How Does the Caregiver Feel? Scared, Lonely, Exhausted, Forgotten On Duty 24 hours / 365 days a year Focused Solely on Patient; Nowhere Else You Would Rather Be Family Stress “Having dealt with his diagnosed, and later his undiagnosed, health problems I can say the latter is so much worse and I still find it unbelievable that he died” - 33 year old caregiver, 2 yrs after undiagnosed death of spouse who was a successful lung-transplant recipient

9. What Must It Be Like for a Doctor? Frustrating Time Consuming Humbling They are Trained to Help People, Not Certain What to Do When They Can’t

10. Is There Hope? Yes, But Much Needs to be Done Successful Treatments are Being Developed More Support Organizations Available NORD – National Organization for Rare Disorders www.rarediseases.org Internet Allows Patients to Find Each Other and Share Information New Legislation in Place to Help with Research Funding and Approvals

11. A Little History 199020022008 Total of 10 Treatments Developed for ALL Rare Diseases 19731983 Orphan Drug Act Giving Drug Manufacturers Incentives Safe Medical Devices Act Rare Disease Act Enabling NIH Office of Rare Diseases (ORD) NIH Undiagnosed Disease Program 1800 Products Entered Pipeline; 320 Approved Data Obtained From the National Organization of Rare Diseases (NORD)

12. One Person’s Failed Attempt at a Diagnosis Local Doctors Regional Doctors Well Respected Diagnostic Clinic Transplant and Diagnostic Work Up at Major Teaching Hospital Diagnostic Work Up at Major Cancer Hospital Diagnostic Work Up at 3 rd Major Teaching Hospital Records Reviewed Extensively at 4 additional Major Teaching Hospitals Complete Medical Records Sent to Over 60 Research Physicians

13. What One Patient Endured Procedure2004200520062007 * Dialysis Sessions 930013 Invasive Procedures (sedated/non-sedated) 11/17/28/0 Scans 10272419 Days in Hospital 265111285 Prescription Meds (regular) 61116 Infections 3?13 Times Asked Why Me? 0000 * Until mid 2007 Erdheim-Chester Disease Diagnosed at Autopsy

14. What is Erdheim-Chester Disease? Too Many Histiocytes (cells which normally fight infections) Can Infiltrate All or Some Organs –Bone, Brain, Kidney, Eyes, Lungs, Abdominal Tissue/Organs, Cardiovascular, Skin and More Rarely Others Causes Scar-Like Tissue to Surround the Organs & Arteries Symptoms Vary Between Patients Depending on Which Organs are Involved Can be Extremely Painful; Causes Extreme Fatigue Without Successful Treatment: Organ Failure

15. ECD is an Extremely Rare Disease As of May 2006, Only 240 Cases of ECD had been Reported in the Medical Literature Since 1930 When it Was First Described * Never Even Heard of by Most Doctors Diagnosis is Difficult and Time Consuming, Made Only by Chance in Some Cases More Like “Homeless Orphan” Disease * Julien Haroche, et.al.; Variability in the efficacy of interferon- in Erdheim-Chester disease by patient and site of involvement: Results in eight patients; Arthritis Rheum. 2006 Oct;54(10):3330-6.Variability in the efficacy of interferon- in Erdheim-Chester disease by patient and site of involvement: Results in eight patients

16. What Does ECD Look Like?

17. What is the Status of ECD? VERY Few Doctors Have Treated Multiple Cases Anecdotal Treatments Available –Immunotherapy, chemotherapy, radiation, surgery, hormone therapy, corticosteroids, anti-inflammatory drugs, antimetobolite, new cancer drug which specifically inhibits a particular enzyme Results are Variable Literature says most succumb in 2 to 3 years; There are people who have been diagnosed for 22, 18, and 13 years

18. What is the Status of ECD Support? ECD Global Alliance –www.erdheim-chester.orgwww.erdheim-chester.org –support@erdhheim-chester.org Support Group of Patients and Caregivers Meet Regularly Via Chat Rooms 57 Cases Registered, Representing 7 Countries Promoting Research

19. What I Learned YOU are Responsible Doctors Should be on YOUR Team Get Answers That Make Sense, OR Go Somewhere Else Medicine is an Art, It Only WANTS to be a Science There are Some Amazing People in the Medical Field Don’t EVER Underestimate the Value of Faith, Family, and Friends

20. What Advice Would I Give Another? KEEP RECORDS KEEP RECORDS UP-TO-DATE Communicate Be Persistent Work with Insurance Folks to Ensure You Only Make Payments You are Responsible For Ask for What You Need and Expect It

21. What Can We All Do? Be an Advocate Be Supportive Be Generous Be an Organ Donor

22. Questions? ALL input, suggestions, ideas, etc. are appreciated