The Scandal Of Alzheimer’s

Why is there no cure for Alzheimer’s—or why aren’t there medications that can at least substantially slow or meaningfully ameliorate the disease? It afflicts more than 6 million Americans, with that number on its way to doubling within a generation.

Alzheimer’s is a hideous ailment for both the sufferers and their families and friends. Yet even though the disease was first diagnosed by psychiatrist Alois Alzheimer in the early 1900s, progress in fighting it has been almost nonexistent. What’s scandalous is that for decades research has been almost entirely focused on the wrong hypothesis.

Dr. Alzheimer noted in the autopsy of the patient’s brain with the disease that came to bear his name that it was densely loaded with two proteins called plaques and tangles. Unfortunately, the dominant thesis in research on the disease has been that attacking plaques, and to a lesser extent tangles, would cure the ailment and enable the brain to regain its health.

Alzheimer himself warned about focusing too much on plaques and tangles as causes. In fact, some sufferers of Alzheimer’s have proved to have had little in the way of plaques, while others who had plaques didn’t have the disease.

Nonetheless, despite constant failures—some 20 drugs have been developed that ended up as flops—and the expenditure of tens of billions of dollars, the main thrust of research remains focused on fighting plaques.

The obsession with this dead-end approach has been fanatical, almost cultlike. Researchers who want to pursue more promising avenues have faced serious obstacles. Rarely has chronic failure resisted correction on something so important.

You may have heard of a new drug called lecanemab, which is being heralded as a fantastic breakthrough. But lecanemab is based on the wrongheaded plaques hypothesis. As noted health policy journalist Joanne Silberner sadly points out, “At best, lecanemab might slightly slow a patient’s inevitable decline for a few months.”

This research scandal shows the danger of groupthink, particularly when there’s a powerful government agency such as the National Institutes of Health putting the kibosh on grants for nonconsensus projects.

A classic case of similar groupthink involved the cause of stomach ulcers. The once-prevailing view was that stress and lifestyle were the cause, and drugs and regimens were developed on that belief.

This dogma was challenged by two Australian physicians, Robin Warren and Barry Marshall. They posited that the villain was bacteria and that antibiotics were the answer for a permanent cure. When not ignored, their discoveries were derided. Only after many years and constant, sometimes unorthodox advocacy, especially by Dr. Marshall, did the medical world accept their truths. The two were eventually awarded the Nobel Prize in Medicine.

In the case of Alzheimer’s, the rigid research mentality has begun to soften, but only slightly. To attack this deadly rigidity, Congress should hold hearings on the subject, starting with the leaders at the National Institutes of Health.