Sandra Day O’Connor, Stanley Prusiner, and Ken Dychtwald published an Op-Ed in the New York Times on October 27, 2010 titled The Age of Alzheimer’s. O’Connor is a retired associate justice of the Supreme Court. Prusiner, received the 1997 Nobel Prize in Medicine and is the director of the Institute for Neurodegenerative Diseases at the University of California, San Francisco. Dychtwald, a psychologist and gerontologist, is the chief executive of a company that consults with businesses about the aging world population.
Their brief piece recites the grim fact that Alzheimer’s Disease will affect a large portion of our elderly population, a segment that is growing faster than any other. They repeat the well known social, personal, and economic consequences of this devastating phenomenon. They call for a increase in federal funding aimed at finding a cure and/or a prevention for Alzheimer’s Disease. They cite the successful government effort to fight AIDS as an example of what focused government supported research can do. Given the prominence of the authors and that of their platform it’s likely that we will rush out and do what they propose without taking a little time to think about it. A sprint to spend without a modicum of prefatory analysis does not just affect profligate progressives; conservatives have already jumped on the the $2 billion bandwagon – that’s the number O’Connor, et al propose, a figure that will doubtless grow exponentially between now and tomorrow. They justify this spending by citing the potential savings that will accrue when we control Alzheimer’s Disease.
The AIDS analogy is not apposite. There is just one cause of AIDS – the human immunodeficiency virus. The effort against AIDS required only an effective vaccine or effective antiviral therapy. More than a quarter of a century after HIV was recognized as the cause of AIDS we still lack the former. It was successful antiviral treatment that brought the AIDS epidemic potentially under control. The difficulty facing science with Alzheimer’s Disease is much more daunting than that faced by researchers dealing with AIDS a generation ago.
To begin with while O’Connor, et al write about “Alzheimer’s Disease” they really mean dementia. At least half the people afflicted with dementia do not have Alzheimer’s Disease. Dementia is a group of symptoms characterized by a decline in intellectual function severe enough to interfere with a person’s normal daily activities and social relationships. In addition to Alzheimer’s Disease other causes of dementia in older people are multi-infarct dementia which is caused by a series of strokes (as many as 40% of case of dementia are due to this syndrome), Creutzfeldt-Jakob disease, normal pressure hydrocephalus, Pick’s disease, Parkinson’s disease, Lewy body disease, and Huntington’s disease. Symptoms of dementia may also result from depression, drug interaction, metabolic disorders (such as thyroid problems), head injury, vision or hearing problems, tumors, and infection.
Thus declaring war on “Alzheimer’s Disease” means engaging in hostilities against a host of foes. Remember how the War on Cancer is going- 40 years and counting. Consider this from the Op-Ed: Most of the medical researchers who study Alzheimer’s agree on what they have to understand in order to create effective drugs: They must find out how the aberrant proteins associated with the disease develop in the brain. They need to model the progression of the illness so they can pinpoint drug targets. And ultimately they must learn how to get drugs to move safely from the blood into the brain.
A breakthrough is possible by 2020, leading Alzheimer’s scientists agree, with a well-designed and adequately financed national strategic plan. Congress has before it legislation that would raise the annual federal investment in Alzheimer’s research to $2 billion, and require that the president designate an official whose sole job would be to develop and execute a strategy against Alzheimer’s. If lawmakers could pass this legislation in their coming lame-duck session, they would take a serious first step toward meeting the 2020 goal.
Even Dr Mengele would want to rid the world of Alzheimer’s Disease, but is ramming a bill through a lame duck session of congress the right way to do it? Read the bill linked above and you’ll see that it includes the usual suspects corralled when the federal government wants to spend a lot of money without offending a key interest group. The bill even establishes another czar. It doesn’t say anything about all the other causes of dementia besides Alzheimer’s Disease. The proponents of this legislation are not disinterested observers. They have been personally affected by family members with dementia or would benefit from the expenditure of billions of dollars by the federal government which would flow to their labs, universities, and institutes. And make no mistake about the $2 billion price tag; it’s just the first week’s rent.
It’s pure baloney to predict that we’ll have dementia under control in 10 years. This is a formidable problem that likely will require generations of work before we have effective preventions or treatments available. Am I advocating inaction and neglect? Of course not. What we should do is fund the best science that’s available. The problem is that we can’t be sure where this science is. You’d likely start with neuroscience, but many of the causes of dementia do not belong to neuroscience and even those that do may find their solutions in another branch of science.
This argument is not likely to be very appealing to those who sincerely want to do something about Alzheimer’s Disease and its cognates. Appointing a czar and a lot of committees that are politically correct (read the bill it’s only 6 pages) will spend a lot of money trying to do something specific about Alzheimer’s Disease (even if totally ineffective). This targeted approach is much more soothing to the psyche than supporting non-directed research that that may eventually pay off but which before it does may seem unrelated to dementia in general and Alzheimer’s Disease specifically. This is another case of genuinely good intentions taking us on another expensive trip to nowhere. It’s feel good legislation which once in the budget can never be cut. Can’t you hear the cries of “They want to kill old people especially those with Alzheimer’s Disease.”
The Age of Alzheimer’s is another reason why government budgets endlessly increase and why government spending can never be cut. There’s always another good cause that needs more money. Spending this money, we’re reflexively assured, will save money in the long run. Remember what Keynes said about the long run.
Hurrying science is sometimes hazardous. Read Alzheimer’s Drug Trial Reports Nine Deaths, Patients Withdrawn. The drug (ELND005) received fast-track designation by the U.S. Food and Drug Administration in April 2009, a designation that allows for a quicker regulatory review process for new drugs that are seen as necessary for treating serious conditions that have no current treatment available.