Negative Press for Alzheimer's Drug

Contributed by: Dennis Fortier, President, Medical Care Corporation

Reporting the news is a business.  This is why stories with market appeal, even if they have little news value, or may even be misleading, sometimes get broad coverage.  I am sure most editors sincerely want to present the most important stories and filter out the trivial items, but there is always a tendency to promote a compelling headline.

Over the last two days, you may have seen headlines that Namenda, one of the approved Alzheimer's drugs on the US market, does not work for patients with mild AD.  These headlines are based on an article published in this week's online issue of the Archives of Neurology.  In this study, researchers at the University of Southern California, performed no new research on the drug, but reviewed data from three other published studies, and concluded that Namenda is not beneficial for patients with mild AD.

I am not sure why this has been so broadly reported in the press, and I would like to emphasize two points:

1) Namenda is not approved for use in mild stage patients, only for moderate and severe stage patients.  This study reached exactly the same conclusions as the FDA reached when they approved the claims for the drug.  No news there.

2) Namenda has been shown to benefit early stage patients when combined with other approved Alzheimer's medications such as Aricept and Exelon.  To craft an interesting headline based on only half the story is fairly disingenuous.

To be fair to the press,  there may be value in reporting that many physicians prescribe Namenda for early stage Alzheimer's and, if prescribed alone (without one of the other drugs shown to boost efficacy), then the effects are probably minimal for most patients.  In that case, a legitimate framing for the story would convey that the drug is not being used properly, as opposed to conveying that the drug is not effective.

I have no ties to the pharmaceutical industry and I don't wish to sell false hope to the public about drug efficacy against Alzheimer's disease.  However, some people respond better than others to existing treatments, and every one deserves the opportunity to find out how treatment will affect them.  It is a shame to discourage physicians and patients from seeking potentially beneficial therapy just so you can sell more press with an eye-grabbing headline.

Can a Brain Scan Predict Alzheimer's?

Contributed by: Dennis Fortier, President, Medical Care Corporation

There is a lot of recent press suggesting that a brain scan may be useful in predicting Alzheimer's disease.

The excitement has been generated by a new study showing that a good read on the size and shape of particular portions of the brain, can be useful in predicting which patients, among a group with subtle symptoms of memory loss, will develop Alzheimer's disease.

The journalists at MSNBC, provide a good example of how the concept of "predicting" is frequently misused in the press, when they are actually writing about "identifying".  Almost invariably, the confusion between predicting and identifying Alzheimer's, is coupled with the misleading notion that subtle symptoms of memory loss sometimes "progress" to Alzheimer's.

I want to untangle these various notions, and offer a clear summary of what I think these journalists are trying to convey.

Mild Cognitive Impairment
When a person has mild symptoms of memory loss that are more severe than those we expect with normal aging, but not severe enough to qualify as dementia, we describe their condition as "mild cognitive impairment" (MCI).  By definition, MCI is not a part of normal aging.  This means that it is caused by some underlying medical condition such as vascular disease, a  thyroid disorder, depression or a number of other causes.  It might also be due to early stage Alzheimer's disease.

Predicting vs. Identifying
The key point is, if you have MCI due to Alzheimer's disease, then you have Alzheimer's disease.  There is no need to predict, only to identify.  There is no concept of "progression", the disease is already present.

So, the recent study that has generated much press, is a good study with a potentially valuable conclusion.  When a person has mild cognitive symptoms that we call MCI, and a physician must diagnose the correct cause of the symptoms in order to administer appropriate treatment, the ability to identify Alzheimer's disease  as the cause (or not the cause), is very important.  If a scan of brain structure is valuable in this regard, then we have gotten better at diagnosing this terrible disease.

We have not, however, found a new way to predict anything.  Only a new way to better identify a disease that is already present.

5 New Alzheimer's Genes: Is This Big News?

Contributed by: Dennis Fortier, President, Medical Care Corporation

This is definitely big news.  But how do you define "big" as it pertains to news?

If you base your opinion on the amount of press coverage devoted to a story, and the prominence of the media outlets covering it, then the recent announcement that researcehrs have discovered 5 new genes associated with Alzheimer's disease is, indeed, "big" news.

However, it is not always clear why a story is big or important, and this often leads to misinterpretations about what a story might mean.  With regard to the 5 new genes, I think the importance lies in the fact that, every new piece of explanatory data can help us understand Alzheimer's disease.

If you read the story and thought it meant that now we can tell who will get AD, you probably read too much into the discovery.  If you thought it meant that we now know how to treat AD, you definitely read too much into the disovery.

AD is a very complex and poorly understood disease.    Scientists have not yet isolated its cause, nor have they clearly mapped the progression of the multiple biological processes that unfold as the disease advances.  There are some consistent elements, like an accumulation of beta-amyloid protein in the brain, and a falling ratio of amyloid/tau proteins in the blood and spinal fluid.  We also generally see shrinkage of certain parts of the brain relative to others, and cognitive decline that usually begins with deficits in short-term memory.

But where it all begins, and which conditions lead to the next, is not clear.  There may be important metabolic processes, chemical changes, immune responses, and inflammatory mechanisms that all play roles in how Alzheimer's progresses.   Finding 5 new genes, with significant correlations to this disease, opens the door to better understanding which of these processes are most likely playing important roles.

To be clear, the better understanding we hope for, will require further work. The thought is that we can figure out what these 5 genes do, and that will tell us which processes might be most important to study as a means of understanding AD.  As you can imagine, that might be a long road.

I think it is great that we have gained new clarity about the possible genetic underpinnings of Alzheimer's disease.  But this is a big news story because it will help us focus future research toward a better understanding of the disease, not because we have unlocked any immediate secrets for better diagnoses or treatments.