Why the expansion of Alzheimer’s may not be helpful

You probably saw the July press reports: balmy tropical breezes, azure surf, cerebral plaques and tangles, and new criteria for Alzheimer’s.

Who could deny an opportunity to spend some time at the best non-oil-spoiled beaches for those who toil at the benches and bedsides for Alzheimer’s victims — and on taxpayer money yet.

It seems to me like, just as human hip and knee joints and premolars and molars are not preprogrammed to make it much past “three score and 10″ for many, and certainly not to “four score and 10″ for most, neither is a normally functional brain.

From the recent Aloha State gathering, we learn of a commercial race for tools to diagnose Alzheimer’s early. The current leader seems to be a dye and a PET scan to find amyloid plaques, although other imaging and chemical tests are also competing.

The combo of NIH-sponsored folks and the Alzheimer’s special interest group decided that we in medical science should now consider their new classification of preclinical Alzheimer’s (maybe five years); mild cognitive impairment (maybe another five years) and classical dementia (maybe a third five or more years).

This would triple the number of Americans carrying some kind of Alzheimer’s designation.

Of course, the goal of any medical diagnosis and therapy is, first, to prevent a dread disease from beginning, and, second, to cure or at least manage it once it has begun.

This expansion of the Alzheimer’s reach may be a useful concept as a working hypothesis or as a descriptor of the natural history of a disease. But, what good, pray tell, in our action-oriented society, does this concept do any patient as of 2010, since no diagnostic test (except autopsy) or therapeutic procedure has been shown either to ascertain the certainty of diagnosis or to alter the progression of the disease?

Research is terrific; I want to know truth.

So, go ahead and develop the diagnostic tests and create possible therapeutic agents. Then try the most promising agents in clinical trials to ascertain safety and effectiveness. A drug that either delays the onset of dementia or speeds its progression, once established, could be immensely useful.

But please do not unleash such diagnostic tests for clinical use on the public until we have a way to intervene to positively change prognosis or course of the disease.

I greatly fear that the American Medical Marketing Machine (AMMM) will shift into high gear to make big bucks for the company execs, shareholders, physicians, and labs by testing the masses for Alzheimer’s stages 1, 2, or 3. And this without a proven treatment, to no patient’s benefit, but with grievous harm for many afflicted.

Until or unless there are helpful treatments that the average patient and physician can use in response to any positive lab tests, do not do the tests beyond the research setting.

As the Bard so wisely saith, “full of sound and fury, signifying nothing.”

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more neurology news.

email

Comments are moderated before they are published. Please read the comment policy.

  • Ms. Beck

    I think you hit it right on the nose with this paragraph: “I greatly fear that the American Medical Marketing Machine (AMMM) will shift into high gear to make big bucks for the company execs, shareholders, physicians, and labs by testing the masses for Alzheimer’s stages 1, 2, or 3. And this without a proven treatment, to no patient’s benefit, but with grievous harm for many afflicted.”

    And what happens when you over medicate for erroneous positive diagnostic tests?

  • http://evimedgroup.blogspot.com Marya Zilberberg

    So on target! Another pre-disease market expansion opportunity with very little clinical impact!

  • http://www.medicinerevealed.com/doctor-patient-right-diagnosis.html medicine revealed

    Very well said, does not make sense to make the “ealry diagnosis” when there is no way to even confirm the diagnois in a meaningful way. Just another label with no real practical use.

  • Marc Gorayeb, MD

    This post confuses me, because the author doesn’t want to “unleash such diagnostic tests for clinical use on the public until we have a way to intervene to positively change prognosis or course of the disease.” Strikes me as a bit paternalistic.
    Are three independent issues being conflated here?
    (1) is the test valid, (2) who should pay for it, and (3) will it lead to an expansion of ineffective treatments?
    (1) Certainly, no test should be made available to the public unless it is valid and safe.
    If it is valid, it should be available to the public because in a free society, none of us has a right to tell others what information should be available to them.
    (2) On the other hand, no test should be covered by insurance until such time that it can be shown to lead to effective treatment. That’s because insurance has a specific purpose.
    Companies are allowed to make money from individuals who value their products and services enough to be willing to pay for them. There is nothing wrong with that.
    (3) It is up to physicians and researchers to ensure that individual patients do not receive treatments that will not likely change the trajectory of their illness.
    Keeping people in the dark is no way to avoid this important responsibility.