Category: Science

Alzheimer's Prevention is the best Treatment

Why We Shouldn’t Focus on Developing Alzheimer’s Treatments

March 10, 2014

Recently, The New York Times announced the creation of a partnership between the National Institutes of Health, 10 pharmaceutical companies and seven nonprofit organizations dedicated to the development of drugs to treat, among other things, Alzheimer’s disease. While at first blush, this five-year, $230 million effort may seem noble, the ultimate motivation for this seemingly ecumenical event is suspect.

Alzheimer’s disease affects some 5.4 million Americans, and according to a recent report from the RAND Corporation, costs Americans in the neighborhood of $200 billion each year to care for those afflicted. To contextualize this figure, it represents about twice what is spent on caring for heart disease patients. But it doesn’t factor in the emotional expense borne by the family members of Alzheimer’s patients whose lives are irreparably compromised by this disease.

Drug companies, as the Times article reported, “… have invested staggering amounts of money in developing drugs to treat Alzheimer’s disease, for example, but again and again the medications have failed in testing.” Just last month the New England Journal of Medicine reported that two of the latest candidates for treating Alzheimer’s disease had failed, miserably, to provide any meaningful benefit.

Even more disturbing was the recent report in the Journal of the American Medical Association  demonstrating that the Alzheimer’s drug memantine, currently FDA approved for the “treatment” of moderate to severe Alzheimer’s disease was not only ineffective, but actually was associated with more decline in Alzheimer’s patient’s functionality when compared to a placebo. Interestingly, those receiving synthetic vitamin E actually showed a positive response.

The reason we should temper our support for this announcement is because it represents a profound perversion of priority. Those who would be most enthusiastic about these seemingly forthright liaisons and monetary expenditures may be focused on the development of a blockbuster magic bullet for the treatment of Alzheimer’s disease for reasons that are less invested in alleviating suffering and more invested in financial outcome.

We need to focus today not on developing future treatments for Alzheimer’s disease, but on raising public awareness of the fact that preventive efforts, well-documented in current peer-reviewed scientific literature, can have a dramatic impact, right now, in terms of reducing its incidence. Medical researchers already have the knowledge base that, if implemented, could cut the number of new Alzheimer’s patients here in America by more than half. And when considering the projection that the number of Alzheimer’s patients in America is predicted to double by the year 2030, public dissemination of this information should be top priority.

Unfortunately, marketplace realities stand in the way. There is no opportunity for monetizing such nonproprietary interventions like diet and exercise, which among other lifestyle interventions, are quite well established as playing important roles in paving the way for brain degeneration – or preservation.

Our best medical journals are replete with citations relating such straightforward metrics as blood sugar elevation to risk for dementia, and, as recently reported in the New England Journal of Medicine, even mild elevations of blood sugar, well below the diabetes range, show significant relationship to increased risk for the development of untreatable dementia. Blood sugar directly reflects dietary choices. This provides a meaningful leverage point that can tip the balance in favor of cognitive preservation.

Just last month researchers publishing in the Journal of Neurology, Neurosurgery and Psychiatry demonstrated that elderly individuals who added more fat to their diets in the form of olive oil experienced a dramatic preservation of cognitive function over a 6 year period when compared to subjects eating a more typical Western diet.

The potential implications of these and so many other  heretofore unrecognized studies is profound. But disease prevention lacks the heroism and brass ring potential of bold intervention. It’s clearly time that we take a step back and validate preventive medicine as it relates to compelling brain issues. We can afford to do no less.

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