It’s unclear why there is a news release for this study published in the Journal of Alzheimer’s Disease under the heading, “Conquering Alzheimer’s Disease by Self Treatment.”
There is no new research data in the paper. Four of the eight references in the paper — which reads more like an opinion piece — are from the primary author. The news release emphasizes his credentials and the huge medical and financial impact of Alzheimer’s disease (AD). It focuses on the author’s previous work with using amyloid beta protein 42 (Abeta42) as a potential predictor of AD, as well as his theory that daily ibuprofen — “if started early enough” — may “prevent” the disease.
However, the news release doesn’t let readers know that — to date — there is no proven screening test to identify those who will develop the disease, no proven treatment, and no new data to support the hyperbolic language employed.
Alzheimer’s disease affects roughly 6 million people in the US and approximately 45 million people worldwide. Those numbers are expected to triple by 2050.
Because treatment focuses on slowing the disease, not a cure, and because there is no single test which can reliably predict who will develop the disease, any research which touches on either screening or cure is usually highly newsworthy. This places a premium on rigorous and cautious reporting.
We’ve covered dozens of news releases and stories about both treatments and screening tests for Alzheimer’s disease. Here are some things we’ve learned. First, before anyone can make a conclusion that a screening test is truly accurate, or a treatment is truly curative, it will need to be supported by multiple, large-scale studies. Second, when it comes to screening tests one always has to ask two questions: What is the rate of false positives and false negatives? The emotional consequences of both are substantial.
Also, where does a “truly” positive test leave someone if the disease has no effective treatment? Early detection works best if it leads to an action that actually affects the course of a disease.
This news release mentions both a treatment and a screening test. The treatment is ibuprofen, an over-the-counter, nonsteroidal anti-inflammatory drug that is probably widely known to be quite affordable.
The screening test is measuring levels of amyloid beta protein 42 (Abeta42) in the saliva. The cost of that test is not included in the news release.
This is a major weakness of the news release. Both the headline and the accompanying text strongly suggest that ibuprofen can “prevent” or “ward off” Alzheimer’s disease. However, no data are included to support this.
The news release suggests that the way to diagnose AD early is by looking for elevated levels of Abeta42 in the saliva, thereby allowing early treatment with ibuprofen. However, no data on the accuracy of this screening method is included.
No mention is made of the potential side effects associated with daily use of a nonsteroidal anti-inflammatory drug. Potential harms of ibuprofen taken for years can be substantial and include increased risk of stroke, heart attack, gastrointestinal bleeding and kidney disease.
No mention is made of the potential harms associated with either false-positive, or false-negative, tests for Abeta42.
There is no evidence here. The paper referenced offers no data to back up the author’s claims that this is a “true breakthrough … a game changer.”
The release claims that the lead author has international stature as a researcher and that he feels daily ibuprofen may prevent Alzheimer’s disease.
There is no longitudinal data here showing the saliva test will work in future samples with reasonable positive and negative predictive values, much less a clinical trial involving NSAIDs.
An accompanying review paper repeats data published in the same journal last year. That paper described a small, cross-sectional study showing that those who already have been diagnosed with Alzheimer’s disease have higher levels of a toxic protein thought to be involved in Alzheimer’s pathology, compared with (23) controls, and (all of 6) people who are at risk of Alzheimer’s disease. Some of the people included in the sample are as young as 8 years old (!), so presumably the researchers were looking at people who had the early-onset form of Alzheimer’s, which some think is a different disease than the much more common late-onset. To not make this clear in the scientific paper and in a news release is extremely misleading.
No disease mongering.
However, it’s potentially alarmist to suggest to readers that the presence of elevated levels of Abeta42 inevitably leads to the development of Alzheimer’s disease.
There is no specific trial referenced, just a review of the author’s past work relating to blood and saliva screening tests and his opinions that AD can be prevented through “self treatment by consumption of non-steroidal anti-inflammatory drugs, adhering to a Mediterranean diet, and consuming antioxidants such as quercitin which is contained in coffee.”
The release makes many claims and cites a lot of research, but as readers we have no idea who may stand to gain what. It’s not clear who funded the studies, nor what stake Dr. Greer, the president and CEO of Aurin Biotech, may have in any products that eventually result from this research.
The news release focuses on two things. First, previous research by the lead author focused on Abeta42 which we’re told — when found in high levels — can show “those individuals destined to develop Alzheimer’s disease.” No other screening methods for Alzheimer’s disease are mentioned. It’s not mentioned that there is no screening test that can reliably predict if someone will develop the disease. That’s important context.
Second, we’re told that daily ibuprofen, “if started early enough” can “ward off the disease.” It’s not mentioned that, to date, there are no proven treatments for AD. Again, that’s very important context that would help readers.
Most readers will know that ibuprofen is a widely available, over-the-counter drug.
However, it’s not made clear how available (or accurate) the saliva test for Abeta42 is.
Existing research into screening for AD (in particular Abeta42), and the impact of NSAIDs on the disease are not mentioned. This leaves the reader with no idea regarding how novel this approach is or is not.
No data are included to back up the provocative headline. Stating that daily ibuprofen can “prevent” or “ward off” Alzheimer’s disease is unjustified.
Furthermore, quoting the lead author as calling this unproven therapy a “game changer” and “true breakthrough” — or that “AD can eventually be eliminated” — is hyperbolic.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
Comments (2)
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Elisa Braver
March 28, 2018 at 4:26 pmRandomized controlled clinical trials of anti-inflammatory drugs have not observed differences between treatment and placebo groups in terms of cognitive decline.
Jim Handman
April 18, 2018 at 3:34 pmUnfortunately, it was covered uncritically and poorly by a couple of local outlets: https://thetyee.ca/News/2018/04/04/Cheap-End-to-Alzheimers/
and https://globalnews.ca/news/4105741/daily-ibuprofen-prevent-alzheimers/
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