An important op-ed piece appeared in yesterday’s New York Times authored by Sandra Day O’Connor (former Justice of the US Supreme Court), Nobel prize winner Robert Pruisner, and Ken Dychtwald, a well-known gerontologist.
They argue that prevention of Alzheimer’s disease hasn’t worked because, as they point out, Ronald Regan got Alzheimer’s even though he was both mentally and physically active. They also argue what we really need is a massive increase in research funding to find drug treatments for Alzheimer’s disease. Click here to see the opinion piece.
Is it possible to agree with someone’s conclusion but think that their reasoning is wrong? I think the answer for me has to be yes.
Their argument reflects a basic misconception about prevention. It’s as though we were saying because Jim Fixx (a famous runner) died of a heart attack we should give up on exercise and only focus on drug and surgical treatments for heart disease. It as thought we are saying, Let’s give up being healthy, because even people who exercise and eat right still get heart disease.
O’Connor and her colleagues argue that a major increase in funding for Alzheimer disease drug development might lead more rapidly to effective treatments, and cite the effort made in the 1980s to develop treatment for HIV infection. A similar effort, they argue, would lead to similar progress in Alzheimer’s.
We don’t know that, but there’s only one way to find out. Even though there have been important advances in understanding the basic pathology of Alzheimer’s, it’s still not clear how well treatments based on those advances will work. Recent drug trials have not panned out. A major advance could happen tomorrow, or not for many years.
An alternative model for understanding potential advances in treating Alzheimer’s might be efforts to treat cancer. While major advances in treatment have occurred since the time of the Nixon administration, reductions in cancer rates for things such as lung cancer are also heavily influenced by public health efforts to reduce smoking.
Maybe what we really need is a targeted effort to evaluate both preventive as well as drug treatment strategies in Alzheimer’s. The op-ed piece neglects promising developments such as Carl Cotman’s work on reducing amyloid load in animals that I wrote about several weeks ago. He showed that diet and exercise actually reduced amyloid (a substance believed to be central in Alzheimer’s disease) in aging dogs. That work can lead to preventive efforts but may also lead to drug therapies for cognitive decline and perhaps Alzheimer’s. (See my earlier post here.)
So give up on brain health? I think that’s a really bad idea. We know that people who are healthy as well as physically, socially, and mentally active are less likely to have cognitive decline. Will brain health prevent all Alzheimer’s? Probably not. But should we give up and throw all of our efforts into drug development? Until we have better treatments for cognitive decline, a brain healthy lifestyle is probably the best strategy for staying mentally sharp.
