How to Read the News: Part 2 of 5

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The purpose of the Brain Today blog is to distill the daily news about brain health and help the public understand the essential meaning of each article. Through time however, I have found myself clarifying the same themes over and over again. Five of these themes are explored in this five-part series “How to Read the News About Alzheimer’s and Dementia”.

How to Read the News About Alzheimer’s and Dementia - Part 2 
Don’t Be Mislead by Published Data on Treatment Efficacy

I read the “facts” in nearly every article I see about Alzheimer’s treatment. Journalists and academics alike often note the same three bits of information that, while more or less true, can be very misleading. Here are the three things:

1. There is no cure for Alzheimer’s disease
2. Current treatments are approved for managing symptoms but not delaying the disease progression
3. The benefits of current treatments last for about six months to a year

These bits of information lend themselves to a very discouraging picture and are often used to make the case for increased public funding or to sensationalize the story as a means of gaining readership. I understand both of those reasons for arranging the facts in the most negative light possible. The problem is that families who are in the early stages of noticing symptoms are key consumers of such stories and they often are persuaded that there is nothing they can do about the emerging problem. This leads to apathy and a steady decline without the benefit of medical intervention.

Here is a deeper perspective that I encourage you to remember when you encounter these famous three bits of information:

There is no cure for Alzheimer’s disease
This is true; there is no cure. Just like diabetes has no cure. Standard medical practice for diseases with no cure is to manage them as beneficially as possible by reducing risks that accelerate their progression, alleviating symptoms, and keeping the patient as informed and vigilant as possible against changes that should be evaluated by a physician. One should not interpret the term "no cure” to mean "no treatment” but the press seems to equate the two when referring to Alzheimer’s disease.

Current treatments are approved for managing symptoms but not delaying the disease progression
Again, this is true. But don’t confuse “approved indications” with “actual benefits”. The approval process is driven by commercial interests aimed at getting drugs to market as quickly as possible. Drug makers want the broadest possible claims but there is a trade off in that broader claims require longer and costlier clinical trials. The currently approved drugs are indicated to “reduce symptoms” but may also delay disease in some cases. However, because the FDA trials for approving the drugs were not designed to demonstrate disease delay, they are not approved for that indication. Ongoing research shows that there may be a small, but perhaps important, disease delaying effect of current treatments in some patients. To be clear, the disease delaying effect is likely to be small at best but, in terms of switching the tone of an article from nihilistic to optimistic, this is something to bear in mind.

The benefits of current treatments last for about 6-months to 1-year
When making the case that current treatments are all but useless, I see this factoid about duration of efficacy used over and over again. Here is what you need to remember. If the average duration in a population is six months to a year, that figure is comprised from the actual, measured duration in each individual subject. While some subjects, no doubt, saw no efficacy whatsoever; others may have seen a two to three year effect. This means that any given patient may respond quite well with a meaningful impact. Since physicians (and patients) cannot know in advance who will respond to treatment and who will not, everyone deserves the chance to find out. It is not defensible to deny treatment in general because the average effect on a population seems unimpressive. And by the way, even six months is a valuable chunk of time when you know you are approaching the end of your life.

So I encourage you to keep these perspectives in mind when you are reading the news about treatment efficacy. Usually there is an agenda to paint the bleakest picture possible but the facts support a rosier view.

Here are the links to each other part of this series:
Part 1 of 5: Be Aware of the Author's Definition of AD
Part 3 of 5: Common Assertions about Diagnostic Accuracy Hide Truth
Part 4 of 5: The Term "Dementia" Cannot be Interpreted Loosely
Part 5 of 5: "No Cure" Not as Bad as it Sounds