Health News Review

As followers of this site know, we no longer systematically review network TV health news stories on a regular basis.  Instead, we occasionally use this blog to comment on things we see.  When a new report was presented this week on the drug solanezumab for Alzheimer’s disease, NBC’s story caught our attention.  Robert Bazell reported:

“For the first time ever an experimental drug is showing great promise of slowing the progression of Alzheimer’s disease.”

First time ever?  Really?

In a 5-minute web search, we easily found 6 different approaches reported to slow the progression of Alzheimer’s disease in just the past 4 years:

July 17, 2012: New Alzheimer’s Drug Slowing Progression of the Disease (CBS)

March 8, 2012:  Alzheimer’s treatment in late stages of disease does slow progression (The Independent)

October 20, 2011:  Antiviral Drugs May Slow Alzheimer’s Progression (Science Daily)

May 11, 2009:  Can New Drug Slow Progress of Alzheimer’s? (ThirdAge.com)

August 3, 2008:  Drugs May Slow Progress Of Alzheimer’s (NPR on two drugs)

An online summary by NBC was more cautious, but still fell far short of the substance provided by a competing Associated Press story that we reviewed.  Read/listen and compare.

The NBC on-air story would not have fared well on our 10 systematic story review criteria. Those criteria provide questions that you might ask:

Quality of the evidence:

Bazell reported: “At first, the experimental drug…seemed to fail as has every experimental drug to date. But when the manufacturer, Eli Lilly, analyzed the data more closely, it found that in those with mild disease, there was 34 percent less memory loss than those on placebo.”

But what does that mean? How did the company analyze the data more closely?  Is this an example of the old line that “If you torture the data, it will confess to anything”? Could it be, in the end, just a statistical aberration?

How big were the potential benefits?

The Associated Press gave details that NBC did not about what was actually measured – providing absolute data rather than just the relative risk reduction that NBC provided:

“The main measures were two tests _ one reflecting language, memory and thinking and the other, ability to perform daily activities such as eating and grooming. The combined results on the mild disease patients showed a nearly 2-point difference in the roughly 90-point score on thinking abilities. Previous studies suggest that a change of 3 to 4 on the score is needed to show a clinical benefit, like an improvement in how well patients can take care of themselves. “It’s a small difference,” Dr. Rachelle Doody of Baylor College of Medicine said of the drug’s effect.”

How big were potential harms?

The Associated Press story discussed angina, brain swelling, brain bleeds.  NBC mentioned none of these.

So, while NBC framed this as “new hope for effective treatment…showing great promise,” AP reported:

“It’s certainly not the home run we all wanted, but we’re very encouraged by these results,” said Maria Carillo, chief science officer for the Alzheimer’s Association, which had no role in the research.

Dr. Stephen Salloway, an Alzheimer’s expert at Brown University, agreed.

“It’s exciting to see that there may be clinical benefit,” he said, but it is modest and may not make a difference in how well patients live _ what matters most to them and their families, he said.

“I hate to get too enthusiastic … there’s a flicker of a signal” of benefit, but less than what some other once-promising treatments showed, said Dr. Sam Gandy, head of Alzheimer’s disease research at Mount Sinai School of Medicine in New York.

Dr. Ronald Petersen, director of Alzheimer’s research at the Mayo Clinic, called the drug’s effect “subtle” and said it may mean just that “somebody remembers one extra word out of a 15-word list” without any real improvement in how well they live.

The drug, if ever approved, is likely to be expensive, and that means “we need more evidence” of its benefit to justify its use, Petersen said.

Comments

Andrew Holtz posted on October 10, 2012 at 12:02 pm

TV stories always skim over things… but the NBC report misled viewers by combining enthusiastic adjectives (“great” promise) with an absence of vital qualifiers.

As Gary’s note mentions… the claim of a “first” is questionable. One problem is that Bazell failed to explain what the Alzheimer’s Association representative probably meant when she said it was the first time they’d seen a slowing of cognitive decline with “this type of drug treatment.” Bazell failed to tell viewers that she may have been referring only to drugs that are designed to slice up beta amyloid deposits, which may be a cause of the thinking problems in people with Alzheimer’s disease. (Though there are still doubts about this explanation.)

An even greater flaw in the NBC story was the patient example. How many viewers assumed this man is thinking and functioning noticeably better because of the drug? That assumption is wrong… at least based on the reported trial results. Not only is it practically impossible to tell in an individual case whether cognitive decline was slowed by treatment (since each person’s decline occurs at a different rate regardless)… but the difference between the treatment and placebo groups reported by the researchers was so slight as to be practically invisible.

As Gary noted above, the AP story explained that the difference (which needs confirmation and may turn out to be a mirage) was a mere 2-point difference on a 90-point scale… and that generally anything less than a 3 or 4-point difference is too small to be noticeable by patients, family members or even doctors examining patients.

“great promise”… “first”… patient appearing to benefit. These are just three points in the NBC story that served to mislead, rather than inform.

Lane Simonian posted on October 11, 2012 at 10:48 am

The following two studies, largely ignored by the media and the Alzheimer’s research community in the United States, report siginificant improvements in cognitive abilities in patients with Alzheimer’s disease: :

Effect of aromatherapy on patients with Alzheimer’s disease
Daiki JIMBO1, Yuki KIMURA1, Miyako TANIGUCHI1, Masashi INOUE2, Katsuya URAKAMI1,*Article first published online: 8 MAR 2010

DOI: 10.1111/j.1479-8301.2009.00299.x

© 2010 The Authors. Journal compilation © 2010 Japanese Psychogeriatric Society
Issue
Psychogeriatrics
Volume 9, Issue 4, pages 173–179, December 2009

Keywords:Alzheimer’s disease;aromatherapy;cognitive function;dementia;elderly people;non-pharmacological therapy
Jump to…
Abstract
Top of page
Abstract
INTRODUCTION
METHODS
RESULTS
DISCUSSION
ACKNOWLEDGMENTS
REFERENCES

Objective: Recently, the importance of non-pharmacological therapies for dementia has come to the fore. In the present study, we examined the curative effects of aromatherpay in dementia in 28 elderly people, 17 of whom had Alzheimer’s disease (AD).

Methods: After a control period of 28 days, aromatherapy was performed over the following 28 days, with a wash out period of another 28 days. Aromatherapy consisted of the use of rosemary and lemon essential oils in the morning, and lavender and orange in the evening. To determine the effects of aromatherpay, patients were evaluated using the Japanese version of the Gottfries, Brane, Steen scale (GBSS-J), Functional Assessment Staging of Alzheimer’s disease (FAST), a revised version of Hasegawa’s Dementia Scale (HDS-R), and the Touch Panel-type Dementia Assessment Scale (TDAS) four times: before the control period, after the control period, after aromatherpay, and after the washout period.

Results: All patients showed significant improvement in personal orientation related to cognitive function on both the GBSS-J and TDAS after therapy. In particular, patients with AD showed significant improvement in total TDAS scores. Result of routine laboratory tests showed no significant changes, suggesting that there were no side-effects associated with the use of aromatherapy. Results from Zarit’s score showed no significant changes, suggesting that caregivers had no effect on the improved patient scores seen in the other tests.

Conclusions: In conclusion, we found aromatherapy an efficacious non-pharmacological therapy for dementia. Aromatherapy may have some potential for improving cognitive function, especially in AD patients

Nutr Neurosci. 2012 Jul 9. [Epub ahead of print]
Heat-processed ginseng enhances the cognitive function in patients with moderately severe Alzheimer’s disease.
Heo JH, Lee ST, Chu K, Oh MJ, Park HJ, Shim JY, Kim M.
Abstract
OBJECTIVES: Ginseng has been reported to improve cognitive function in animals and in healthy and cognitively impaired individuals. In this study, we investigated the efficacy of a heat-processed form of ginseng that contains more potent ginsenosides than raw ginseng in the treatment of cognitive impairment in patients with moderately severe Alzheimer’s disease (AD).

METHODS: Forty patients with AD were randomized into one of three different dose groups or the control group as follows: 1.5 g/day (n = 10), 3 g/day (n = 10), and 4.5 g/day (n = 10) groups, or control (n = 10). The Alzheimer’s Disease Assessment Scale (ADAS) and Mini-Mental State Examination (MMSE) were used to assess cognitive function for 24 weeks.

RESULTS: The treatment groups showed significant improvement on the MMSE and ADAS. Patients with higher dose group (4.5 g/day) showed improvements in ADAS cognitive, ADAS non-cognitive, and MMSE score as early as at 12 weeks, which sustained for 24-week follow-up.

DISCUSSION: These results demonstrate the potential efficacy of a heat-processed form of ginseng on cognitive function and behavioral symptoms in patients with moderately severe AD.

There are many people desperately searching for a drug “solution” to this disease, but that desire should not come at the expense of the truth.

Linda Furlini posted on October 15, 2012 at 9:57 am

Thank you Gary for highlighting this shoddy reporting that misinforms and oversimplifies. Promoting statistically insignificant results as significant is eerily similar to the past reporting about ineffective Alzheimer drugs, such as Aricept, etc.. One can only surmise that this type of reporting is meant to promote drug sales. Studies, such as the one reported on, is in all likelihood poorly designed because it focuses on cognitive testing to the exclusion of other types of assessments, such as sequencing (mentioned by the physicist), judgment, insight and abstract thinking. These are important especially at the onset of the disease when symptoms are manifested insidiously. Another worrisome trend in reporting on this disease is the inclusion of people affected by Alzheimer’s. They are asked to make statements about their condition or the drugs that they are taking. This, in itself is fine, except these reports do not include information how people early in the course of the disease often lack of awareness about their abilities and the effectiveness of the drugs that they are taking. At minimum, a family member’s perspective should be included.