It is fair to ask this consequential question in the title above since it is seldom, if ever, discussed at dementia or neurology conferences. A follow-up question may be asked: Has medicine and its medical practitioners created a reasonable and consistent plan of action in dealing with an incurable disease such as Alzheimer’s disease (AD)?
This last question has no clear-cut answer but does raise a Pandora’s box of moral, ethical and scientific dilemmas that go well beyond the guidelines of the Hippocratic Oath.
Because effective therapy for Alzheimer’s disease (AD) is presently an unmet medical need, my own soul-searching view of this conundrum was expressed in a previous publication, as follows: “The main goal of medicine is to provide the ill with hope for healing, and when there is no hope, to offer understanding.” [1]
As simplistic as this observation appears, it raises an important issue that modern medicine as yet to resolve. This issue centers on the conduct of medical practitioners in providing not hope for healing, but false hope, by prescribing clinically unproven and ineffective drug medicaments (see below).
There is little need to illustrate examples of this “pseudotherapeutic” cop-out since classically, such ‘false hope’ remedies are standard practice at the present time in any medical setting and have been standard practice for decades.
A medical practitioner’s dubious justification to engage in this practice is often, “hey, no good treatment is available for AD so a useless pill is as good as it gets…”, and even better, “I need to prescribe something or these people will march out of here until they find a prescriber somewhere else,” or finally, “…some top medical professionals report that anti-abeta drugs or passive immunotherapy for AD may provide “modest” improvement of daily living (brushing teeth, feeding, bathing) especially in patients that can tolerate the high side-effects of these medications.” Nonetheless, the word “modest improvement” is seldom measurably defined using evidence-based medicine or meta-analyses of current AD treatments, and instead, slips under type ll error components, trial inaccuracies and data fabrication, making it difficult to ascertain drug-placebo group differences [2].
A word about providing false hope from inadequate remedies. At the present time, only 5 FDA-approved medicines for AD are available in the USA; 4 anticholinesterase inhibitors and one NMDA blocker. These drugs make up a multi-billion dollar market for their manufacturers and shareholders, with the bewildering help of licensed prescribers and primary care physicians.
One wonders, however, whether there is some other way to offer understanding of AD rather than using sham medicines that for the most part don’t work and generally have side serious side-effects that can harm the patient?
The most charitable value-judgment that can be said about these 5 FDA-approved products is that they “may” provide a clinically marginal feeling of temporary symptom improvement, which is neither consistent or sustainable. However, their daily use is not innocuous and may be responsible for the high drop-out rate among its takers [3].
For example, none of the 5 FDA approved AD medicines or anti-Abeta immunotherapy vaccines, given individually or in combination used in numerous human trials have been able to measurably assess AD improvement in behavior or alter the course of neurodegenerative progression characteristics of AD [4].
My thinking of an unremitting trend to overplay the public trust using high- power medical advertisements or questionable conjectures from so-called, paid “experts” that solely subscribe to anti-Alzheimer medications, can backfire by ignoring the progressive neurodegenerative pathology unfolding in AD brain. It also serves little purpose to create understanding when hope vanishes from the therapeutic framework. Such practice and competent application that rejects medical phoniness and charlatanism is what makes medicine and its expert personnel a true and esteemed science.
Understanding a complex disease such as AD can identify the at-risk AD patient who can benefit from tailor-made interventions targeting selective lifestyle factors, such as physical, and mental exercise, a nutritious diet and treatment to manage known AD risk factors, hypertension, diabetes, high body mass index and heart disease. Minimizing these risks is potentially useful in therapeutic strategies that may be effective in delaying AD onset [5]. This approach may require some extra effort by the AD clinician but the satisfaction of not whipping out the prescription pad, underlines the value of William Osler’s dictum: “The good physician treats the disease, the great physician treats the patient who has the disease”. Osler is widely considered the father of modern medicine.
In my judgment, a paradigm shift is needed to replace “false hope” medicaments that are more likely to harm the patient. Instead, preventive strategies must be found and quickly applied before the incurability of AD onset implodes.
References
[1] de la Torre JC (2016) Alzheimer’s Turning Point: A Vascular Approach to Clinical Prevention. Springer AG Switzerland.
[2] Becker RE, Greig NH (2008) Why do so many drugs for Alzheimer's disease fail in development? Time for new methods and new practices? J Alzheimers Dis 15, 303-325.
[3] Rochon PA, Gruneir A (2018) Initial cholinesterase Inhibitor therapy dose and serious events in older women and men. J Am Geriatr Soc 66, 1692-1699.
[4] Salloway S, Sperling R, Fox NC (2014) Two phase 3 trials of bapineuzumab in mild-to-moderate Alzheimer’s disease. N Engl J Med 370 322–333.
[5] Barnard ND, Bush AI, Ceccarelli A (2014) Dietary and lifestyle guidelines for the prevention of Alzheimer's disease. Neurobiol Aging 35 Suppl 2, S7.
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