This story is an interesting twist to the usual health news article reviewed on this site. It comes from a regular column, "The Unreal World," in the LA Times that reviews health issues in prime time TV shows. The story provides an overview of a recent episode of a popular TV show – Boston Legal (ABC, Dec 1) and then addresses the clinical content of the show in a point-by-point manner. The episode continues a story line about a lead character Denny Crane, played by William Shatner, who has been diagnosed with mild to moderate Alzheimer’s disease. Crane/Shatner’s memory loss is progressing so he takes legal action (all the way to the supreme court) to gain access to an experimental drug which has not been approved by the Food and Drug Administration (FDA). The aspects of this dramatization related to Alzheimer’s disease symptoms and stages, PET scans of the brain, the experimental drug Dimebon, and the FDA approval drug approval process are accurate. The article is well organized, raising and summarizing the relevant clinical issues, addressing the medical questions in depth and evaluating their portrayal in the TV show. The column omits some basic information we wish it had included such as quantifying the benefits seen with Dimebon, something on the harms seen with it, and a reminder that available medications for Alzheimer’s can help a small number of people but only for a limited amount of time.
The cost of the drug is not particularly relevant in this case.
This story points out the potential benefits of Dimebon based upon preliminary research, but didn’t quantify those benefits. These include improved cognition, memory and ability to perform activities of daily living. These potential benefits should have been placed in the context of existing medications which have shown a very modest effect in these outcomes, in only one-third of people, and for a short-period of time. Little is know about the long-term use of these medications.
The story references general concerns of experimental drugs which do not have proven effectiveness or safety. Potential harms of Dimebon were not mentioned. However, the research study about the Dimebon published in The Lancet reported that dry mouth was the most common side effect. For reference, there can be gastrointestinal side effects from currently approved medications. These are usually dose related and can be minimised by taking the medications with food and gradually increasing the dose overtime.
This story takes a point-by-point approach to evaluate the medical issues related to Alzheimer’s disease raised in the TV episode. The Premise section provides a good, basic description of PET scan brain imaging and symptoms of mild to moderate memory loss. The story should have clearly noted that PET scans do not provide a definitive diagnosis and that tests to evaluate memory such as questionnaires and neurological examinations, are routinely performed as the first line of evaluation. The piece does provide an appropriate level of depth in its discussion of the experimental nature of Dimebon, results of research conducted in Russia, and the stages of the FDA approval process.
Basics facts about the prevalence of Alzheimer’s disease were not provided, but would have helped readers to understand how many people are affected (about 15% over 70 years old). Given that, Alzheimer’s disease was accurately characterized in the story.
The story includes interviews from an independent medical expert and the chief medical officer for the Alzheimer’s Association (www.alz.org).
This story could have been enhanced by adding that there are currently no cures for Alzheimer’s disease. It should have noted that available medications can help a small number of people but only for a limited amount of time.
This story clearly indicates that the experimental drug Dimebon is not available in the U.S. It also notes that the drug won’t be available for at least three years, pending FDA approval.
The story indicates that Dimebon is a new and experimental drug to treat Alzheimer’s disease.
This story does not rely on a press release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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