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Can $2 billion a year cure Alzheimer’s?

Linda Furlini, PhD, research ethicist, McGill University Health Centre, Montreal

Linda Furlini, PhD, research associate, McGill University Faculty of Dentistry, Montreal

The following is a guest post by Linda Furlini, PhD, who works as a research associate at the Faculty of Dentistry, McGill University, in Montreal.

Editor’s note: When Hillary Clinton’s campaign gathered reporters on a conference call recently to announce her plan to devote $2 billion annually to Alzheimer’s research that would lead to a cure by 2025, most of the major news media reported on the announcement. For one day broadcasters, print and online news journalists focused on the story and then attention moved on to other developments. We think this will continue to be a story in 2016 since Alzheimer’s disease affects so many. We asked Canadian researcher Linda Furlini to share some personal and professional insights with journalists on how such a research investment might realistically affect millions of seniors and caregivers.


I am glad that Hillary Clinton is paying attention to Alzheimer’s disease. Age is a risk factor for developing Alzheimer’s and baby boomers are aging rapidly. As Clinton already knows, Alzheimer’s disproportionately affects women. In 2006, I wrote an article documenting not only this poorly known fact, but that women frequently are those that care for someone with this disease.

Both my parents were affected by Alzheimer’s disease simultaneously at age 60, with no known family history of the disease. I was a caregiver for 20 years of my young adult life. I wrote a doctoral thesis in 2005 on the educational needs of family caregivers looking after persons with Alzheimer’s disease. So, my interest in Alzheimer’s disease is at the same time personal and professional.

Dementia disease and a loss of brain function and memoriesIf Clinton were to win the election and could devote funds to Alzheimer’s research, I would hope journalists would hold her feet to the fire and ask if she has taken the time to critically examine the existing evidence on this disease before spending any money. Since the late 1980s I have followed developments in the field and the results are not pretty. Researchers have focused on drug development without enough understanding about the disease. The end result is that pharmaceutical companies have been able to make extravagant profits from drugs of questionable worth, while misleading desperately sick people and their caregivers.  Unfortunately, current directions in drug development are following the same path as those of the past. For over 25 years, the amyloid hypothesis that led to the development of these ineffective drugs has remained the hypothesis of choice. Yet, after all this time, no evidence exists that confirms whether amyloid plaques are a precursor or a result of the disease. In fact, many people who show evidence of amyloid plaques under brain imaging show no evidence of symptoms and conversely, some with symptoms show no evidence of amyloid plaques.

Journalists need to cut through the hype and scientific jargon and ask hard questions. They need to hold Clinton accountable for the types of research she funds so that if new drugs are developed, they make a meaningful difference. They need to ask tough questions, such as, are selected biomarkers for the disease proven before testing drugs? Are we testing people without a diagnosis of Alzheimer’s? How can testing Alzheimer drugs on those who may only suffer from a minor cognitive impairment for a multitude of reasons be considered credible science?

Will there be a breakthrough soon? I sincerely doubt it. More to the point, journalists need to ask what will be done to help those living with the disease and their family caregivers. It is abhorrent that caregivers are providing this care without adequate support and resources. Many empty their savings and/or quit their jobs and most suffer dire physical and psychological health consequences that only compound over the generally long course of the disease. Caregiving for persons with Alzheimer’s and other dementias should be a shared societal responsibility and journalists should ask Clinton how she will ensure this happens.

Addendum:
While many news outlets reported only what was stated by designated speakers in the campaign’s conference call, a few, including the Wall Street Journal and STAT, went further and put the news in context:

Wall Street Journal:

“Experts in the field praised Mrs. Clinton’s proposal, though they said there are no guarantees researchers can find a cure for Alzheimer’s by 2025, the goal Mrs. Clinton has set. Timothy Armour, president and chief executive of the Cure Alzheimer’s Fund, which raises money for disease research, said a cure within 10 years is “a stretch goal.”

“This is a very complex disease and it will take complex answers,” he said. “We probably will not have one white pill to kill the disease. It’s going to be a mixture of different kinds of therapies taken at different times.”

STAT:

“Most scientists, however, caution against promising ‘cures’ for serious diseases — arguing that the most realistic strategy for many conditions is to make as much incremental progress as possible, rather than expecting major breakthroughs.”

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Comments (6)

Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.

Susan Molchan, MD

January 6, 2016 at 8:02 pm

As a former Alzheimer’s researcher, the word “cure” in the context of what is conceived as Alzheimer’s disease makes me cringe as it is not realistic, since “Alzheimer’s” is a combination of many factors, including blood vessel disease, as well as abnormalities in a variety of proteins in the brain. Dr. Furlini makes these points very well and the point that too little is done to help figure out how best to care for people with dementia and without wreaking havoc on caregivers’ lives. I would add that just in the last few years have lifestyle factors and the large impact that prevention could have against Alzheimer’s disease been widely recognized, albeit not widely enough. The money and so the focus is still on a fantasy drug “cure.” http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)00528-0.pdf

    Linda Furlini

    January 7, 2016 at 10:52 am

    I thank Dr. Molchan for her excellent comments. I would only add that not only lifestyle factors be considered. Environmental factors, such as air pollution require attention. We examine environmental impacts on children’s brains, but forget about them at the other end of the life cycle.

      Bonny McClain

      January 8, 2016 at 5:00 pm

      The solution will be investiments in social determinants of health. Period. We are already seeing the research regarding nutrition, shared pathways with chronic disease, metabolic derangements, and the lack of identifiable differentiators of normal senescence, healthy brain aging, and abherrant dementia profiles. Alzheimers disease has emerged as a brand–a marketed disease trying desperately to qualify as an illness. The further upstream we look, the more off target we will be. Imagine what a 2 billion dollar investment can do for nutrition, education, air quality, housing…the list is endless but the outcomes have the potential to last a lifetime..

Andrew DePristo

January 8, 2016 at 4:15 am

As a researcher and executive in biopharma, I applaud this very reasoned letter that, at the core, indicates the need for much more research into the basic biology of Alzheimers. Journalists, politicians and the vast majority of the public have no understanding of science versus engineering (i.e., Alzheimers or Cancer versus a moon rocket). The poster child for journalistic investigations of science is the book, “Why We’re Losing the War on Cancer-and How to Win It”, which attempts to show how unscrupulous managers at NCI have lost the war by not allowing for prevention and cures by groundbreaking new discoveries. Reading the book, I could only be saddened by the misplaced outrage displayed by the author. The real problem is that many diseases are not acute but chronic, and develop over many, many years. The science of such disease development is just not understood at present. I wish someone or some organization would start to educate people about how little is understood about many diseases.

    Gary Schwitzer

    January 8, 2016 at 7:23 am

    Andrew,

    That’s a piece of what we try to do every day on this website.

    Thanks for your note.

    Gary Schwitzer
    Publisher

Caroline Mawer

January 11, 2016 at 8:45 am

All the commenters here seem to be missing one of the author’s main points. As she says, “more to the point” caregivers and people with Alzheimers receive very (very!) limited support. Where is the money / studies into the best ways of providing support? This could have much quicker results for people in real need. Of course, any cost-calculations would need to be broad to include all the so-called indirect burdens of caring or having Alzheimers. But even without doing the most back-of-the-envelope calculations, there could be very positive effects from a tiny portion of $2BN. Come on Hillary! Surely you’re smart enough to work this out!