Did Pfizer "Hide" a Potential Treatment for Alzheimer's Disease?

Contributed by: Dennis Fortier, President, Medical Care Corporation _______________________________________________
Despite the provocative title, this post is largely a summary of a non-story. However, it is worth discussing because this "non-story" has been widely covered in the general media, often in a manner that leans strongly toward the sensational end of the news spectrum.

The facts are fairly non-controversial. Pfizer, a major pharmaceutical drug developer and marketer, performed an analysis of medical insurance data comprised of approximately 254,000 patients with rheumatoid arthritis or another inflammatory disease. The analysis revealed that, among those patients whose inflammatory disease was being treated with Enbrel, a drug marketed by Pfizer in the US, a slightly smaller percentage also had an Alzheimer's diagnosis compared to those who were not treated with Enbrel. Despite the seeming potential for Enbrel to prevent Alzheiemr's disease, Pfizer conducted further internal review and opted not to initiate a clinical trial for the purpose of measuring the efficacy of Enbrel in preventing Alzheimer's disease.

As far as I can tell, no one is disputing those facts. However, how those facts are interpreted has become a matter of creative reporting. One angle that has created a fair amount of reporting (initially in the Washington Post) suggests that, because Enbrel is nearly off patent, after which the drug will be far less profitable, Pfizer made a greedy decision and opted not to pursue a potentially promising Alzheimer's treatment. Most drug development experts disagree with that suggestion.

The noted statistical evidence of a preventative effect of Enbrel against Alzheimer's disease was far smaller than what the drug development industry would generally require before initiating a trial. Furthermore, the effects of anti-inflammatory drugs in the Alzheimer's space have been thoroughly investigated in other studies to no avail. Given that Enbrel does not cross the blood-brain barrier, it is fairly unlikely that a long and expensive trial (see previous summary here of FDA drug approval process) would yield a favorable outcome. In fact, another major marketer of pharmaceutical drugs (Amgen), who holds the rights to Enbrel outside of the US,  reviewed the same data and also concluded that further investigation was not warranted.

Overall, small statistical patterns are commonly present in large data sets like the one discussed here. However, such patterns are not necessarily indicative of an underlying treatment with a clinically meaningful effect. In the opinion of most knowledgeable scientists (as summarized here by Derek Lowe), Pfizer made a prudent decision not to further evaluate Enbrel as a potential treatment for Alzheimer's disease.

A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible. ____________________________________________________________

World Health Organization Issues Guidelines for Reducing Risk of Cognitive Decline

Contributed by: Dennis Fortier, President, Medical Care Corporation _______________________________________________
As research yields new insights about brain health, and in particular, about medications and lifestyle interventions that preserve cognition in later life, sanctioned guidelines become increasingly important as a means of guiding populations and healthcare systems in a positive direction.

To that end, the World Health Organization (WHO) convened a group of international experts to review the published evidence in support of several commonly discussed approaches to vital brain aging. From a thorough literature review and subsequent discussion, the group unanimously identified several "strong recommendations, and several "conditional recommendations".

The strong recommendations were for physical activity, cessation of tobacco use, and a brain-healthy diet as approaches with supporting evidence of benefits with minimal potential for adverse risks. While the evidence was less clear (in terms of likelihood for reducing risk of cognitive decline), the experts also strongly recommended strict control of hypertension and diabetes; two common chronic conditions that may impair cognition and that can be managed with no known adverse effects to brain health.

The group also made several conditional recommendations that would be appropriate on a case by case basis. These included careful weight management, control of total cholesterol levels, cognitive exercises, and treating alcohol abuse. The group concluded that there was not sufficient evidence to make recommendations about social activity or treatment of depression, although both of those approaches are well supported as beneficial in the larger context of overall health. The full 78-page report, including a concise summary of findings, can be downloaded at the WHO website.

Healthy Brain Resolutions for 2019

 Image result for healthy brain 2019

Contributed by: Dennis Fortier, President, Medical Care Corporation _______________________________________________
It is that season when it is enjoyable, and in some ways instructive, to pause and reflect on the passing of another year. It is also an excellent time for setting priorities and establishing habits that we will be happy to reflect upon twelve months from now.

With that in mind, this article suggests 5 simple practices with clear “brain health” benefits that you may wish to consider as you embark on a fresh new year. To be sure, there are higher ideals than those I have listed here, toward which we could all strive. However, my intention is to provide readers with some ideas that are relatively easy to pursue but can still yield important benefits; the goal is to offer maximal return for minimal effort and sacrifice.

With that said, here are five considerations for starting fresh in 2019:

1. Improve Cardio-Vascular Health

This suggestion is not new but deserves repeating because it has been proven beyond a doubt that good cardio-vascular health leads to better over all health and lower risks for heart disease, diabetes, and Alzheimer’s disease. What is new is certain evidence about how easy it may be to start moving the needle in the right direction. Improving cardio fitness need not involve strenuous exercise and really doesn’t even require that you sweat. Walking is one of the overall best and most underrated forms of exercise and can often be incorporated into daily errands.

Also, don’t think that because walking is easier than running or swimming that you must do it longer to gain a benefit; a daily 30-minute walk is immensely beneficial to a person with no current routine of physical exercise. Especially if the walk can be augmented with a few trips up and down the stairs in lieu of the usual elevator ride.

In terms of staying motivated to maintain a routine of physical exercise, try to find a quantitative measure that will reveal your progress and keep you looking for more gains. In the past, much emphasis has been placed on body weight, a measure that is easy to obtain but can be difficult to improve. As an alternative, check your pulse rate at the end of your work out and track it for one month of daily walks; you might be surprised to see it fall. When you consider how many beats of your heart you can save over the course of a year by keeping your heart rate low, it can be very motivating.

Also, whether or not you suffer from high blood pressure or high cholesterol, be sure to get these measures from your physician during your next check-up and keep track of them as you exercise. Even something as simple as a daily walk is good for your brain and can produce meaningful improvements in both of these bio-markers as you gain better fitness.

2. Reduce Stress

This suggestion might top the all time list of things that are easy to suggest but difficult to achieve. However, it turns out that for many of us, a high percentage of the daily stresses we encounter are self-inflicted. That’s right; choices we make and attitudes we willingly assume end up creating stress that we could otherwise avoid.

Reducing stress is important because we know how detrimental stress can be to our health. Real physical processes are triggered by emotional reactions to stress and, as far as our science can tell, none of those processes are beneficial while all have harmful side effects.

Here is a simple suggestion for reducing stress that, although it won’t work for all of you, must be tried by the rest of you before you can fully believe its effects. Put simply, you should make a conscious decision to drive with patience and courtesy. Look for other drivers trying to cut traffic and motion them in. Don’t speed up to close the gap when another car wishes to enter your lane; slow down and allow them in. Embrace yellow lights for the opportunity they foretell to pause for a moment – this is certainly less stressful than treating them as a threat to your rapid progress. Don’t tailgate or change lanes incessantly seeking opportunities to move one car length closer to the front of the crawling traffic; it is just not worth it. Instead, accept the pace, listen to some music, and keep an eye out for other drivers who might benefit from your courteous cooperation.

If you are not aggressive driver and cannot benefit from that tip, perhaps you can benefit from becoming a less aggressive “parker”. When visiting an establishment with a large parking lot, rather than seeking the spot nearest to the entrance, subjecting yourself to the anxiety of passing up a mediocre spot for the possibility of finding a better one, all the while monitoring the flow of motorists who might be competing for the best spot, try driving to the far end of the lot and parking in the open expanse of remote spots. It is a stress-free approach with the added benefit of a short cardio workout as you walk to your final destination.

While this might seem silly, it’s a step toward avoiding self-inflicted stress that just might carry over into other realms of your life as well. Get the right attitude, reduce your stress, and enjoy a healthier brain and body.

3. Stay Socially Active

While most of us are not in danger of becoming accidental hermits, making new friends and interacting socially are activities that have been documented to decline as we age. We are most prolifically social as young students, followed by fairly intense socialization in adulthood when our children are students, and we tend to be least active when we are older and our children have grown and moved on.

Much research on the benefits of intellectual stimulation, the act of using our brains in challenging ways, has shown a positive correlation with maintained cognitive health. I will write more on that below but will make a separate point here. Meeting people, learning about them, interacting and cooperating with groups, and cultivating relationships are all activities that require deep and comprehensive cognitive activity. In socializing, especially with persons we are still getting to know, we use memory, verbal skills, and judgment along with a poorly understood melding of emotions and executive function. In the opinion of many scientists, socializing may be the best mental activity we have.

Two great ideas for remaining socially active are club membership and volunteering. While you may or may not have interests that lend themselves easily to club membership, a regular card game or social activity with a committed group brings the same benefits. As for volunteering, hospitals, churches, and many non-profit organizations are begging for help in nearly every community. Incidentally, one of the most meaningful gifts you can offer through volunteering is friendship and interaction with a lonely, usually elder, person. Doing so will yield a double benefit because every interaction will be a work-out for both of your brains, not to mention the good it will do for your hearts.

4. Eat Well

You had to know this one was coming. As I did with the section on cardio-vascular fitness, I will try to present this in a new perspective that might be easier to embrace than those perspectives you have heard in the past. Here is my fresh take on eating well.

You needn’t necessarily deny yourself the junk food you’ve grown to love nor worry too much about your daily intake of calories. You do need, however, to worry about getting proper nutrition first. While consuming empty calories is harmful because it leads to weight gain and poor vascular health, the more damaging impact is that it strips away your appetite and prevents consumption of necessary vitamins and nutrients. A fresh approach to diet in the new year might be to focus first on what you should eat and set, as a second goal, the elimination of foods that you should not.

The good news is that the diet shown to produce the best vascular health was also shown this year to also promote the best cognitive health. One should be sure to consume a diet rich in cruciferous and green leafy vegetables, nuts, fish, and tomatoes and low in red meat and high-fat dairy products. Ideally, you will eventually adopt a diet whereby you take in what you need and avoid what you do not, but an easy place to start is to ensure that you get enough fruits and vegetables prior to filling up on junk; this will offer the best opportunity to keep your brain functioning at a high level in the new year.

5. Seek Intellectual Stimulation

If you have pondered the health of your brain at all, you have likely read or heard about the importance of ongoing intellectual stimulation. While it is not yet completely understood, it does appear that active brains decline more slowly with age than those that are relatively unchallenged.

A potential red herring in the discussion is the value of crossword puzzles, sudoku, and the like. Yes, they are mentally challenging activities but they may not produce the rich neural rewards that other activities, such as socializing, might yield. The key seems to be related to the concept of “learning”. If you don’t know the rules of crossword or sudoku then these may be great activities for your brain. However, if you know how the games are played, then merely working through new forms of each puzzle requires no new learning and may offer few benefits to brain health.

Among the most challenging yet rewarding intellectual activities that you pursue are learning to play a musical instrument and learning to speak a foreign language. Both of these have become much easier in the digital age with the advent of tools and software to aid in the learning process. While this might seem counter-intuitive it is actually quite well-grounded. With better tools, the learning becomes easier so the process yields faster proficiency and remains interesting through time. Despite the ease, the learning is real and the brain builds new circuits in accordance with the new learning. The whole process can be great fun, deeply rewarding, and very good for your brain.

 So there you have 5 good suggestions to start fresh in the new year and keep your brain healthy in the process. Work on that cardio-vascular fitness, reduce your stress, stay socially active, eat well, and challenge your brain with new learning. If you do so, you can expect that twelve months from now you can look back with clarity and reflect on a year when you made a worthy commitment to the health of your brain. Follow Brain Today on Twitter --------------------------------------------------------------------------------
A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible. ____________________________________________________________