Earlier this week I won freelance consumer journalist of the year at the Medical Journalists’ Association awards which was fantastic. You had to send in three features to enter and two of mine each focused on a different non-drug treatment that might help with Alzheimer’s. I mention this because looking at them again I was freshly shocked by the ability of the research community to ignore non-drug options, even when the mainstream is in a seriously deep hole.
This particular hole – 12 drugs targeting the plaques and tangles that are the hallmark of Alzheimer’s that have all failed – is filled with the astonishing and astronomical sum of 48 billion dollars. The amount the companies say that research has cost them. Surely there comes a time when common sense demands you stop digging.
But apparently not. These figures emerged at a recent conference organised by an Alzheimer’s charity in a talk candidly entitled: ‘The cost of drug development (and lack of success) over 15 years’. But the lesson the organisers took from the meeting was not to try a different approach but to ask for yet more money to encourage the companies to do more of the same.
The dream scenario
But if they did start thinking outside the box – or the hole – what might they investigate? The dream scenario for really getting to grips with the Alzheimer’s crisis runs something like this. First you need a reliable test to tell, as early as possible, who might be developing the disease. Then, obviously, you need a treatment that can slow it down or even stop it. Just pushing back the full onset by a couple of years would save billions.
However because Alzheimer’s has a variety of causes you would want some sort of biochemical marker that would tell you which patients, whose memories and cognitive ability was beginning to fail, would benefit from the treatment to make is as targeted as possible. Finally you’d be looking for a treatment that only had a few mild side-effects since people would probably be taking it for years.
It sounds an impossible dream. Certainly not one that is likely to be realised for years and probably cost untold more billions. However what may generate feelings of shock and surprise followed by outrage is that the outline of just such a dream scenario is already a reality.
So why haven’t we heard about it? Well you have if you read one of the articles I entered for the MJA award that was published in the Daily Mail earlier this year. It describes a carefully conducted trial – randomised, doubled blinded and all – that involved giving older people who were just starting to have memory problems, very high doses of B vitamins. The results were remarkable.
Scans showed that their brains were starting to shrink faster than normal but in those who got the vitamins, 90 per cent of that shrinkage was halted. Had that been a drug everyone would have heard about it. The analysis published this year followed on from an original study in 2010 when researchers at Oxford first showed the remarkable effect B vitamins could have.
This is the key element of the dream scenario – a plausible treatment to slow or possibly prevent Alzheimer’s developing. Even better this breakthrough came with its own bio marker that could predict who was going to benefit and who wasn’t.
The vitamins only helped those people who had a high level of an amino acid called homocysteine. The B vitamins work by lowering homocysteine levels in the blood, so if you already have a healthy level extra B vitamins won’t help. That’s two elements of the dream scenario.
The Alzheimer’s charities did nothing
The response by the Alzheimer’s charities to this two-for one possible treatment was astonishing, probably heart-breaking if you are someone caring for a person with the disease. They did nothing. The study raised all sorts of questions, it needed to be repeated with more people for longer to see if it could stop or delay progression to Alzheimer’s.
The cost would be about six million, a vanishingly tiny fraction of those dollars in the hole. But none of the funding bodies in the UK or America could find it.
But maybe there is a problem with the mechanism. Perhaps there isn’t a good reason why having a high homocysteine could cause brain shrinkage? However researchers at Temple University School of Medicine in Philadelphia, have described the chemical chain reaction which links the two.
The way it works is this. Extra homocysteine in the brain damps down a process called methylation which is involved in turning genes on and off. Poorer methylation results in the production of another protein called presenilin, which in turn leads to more beta-amyloid, which causes those plaques to form. Phew!
Final part of the package
So not only does lowering homocysteine slow brain shrinkage right down it could well be doing it by stopping that plaque forming. Precisely what the drug companies has spent 48 billion dollars trying to do with those 12 failed drugs!
The third element of the dream scenario – few side effects – also features in the B vitamins option. You do have to be careful with folate and there could be harmful effects of taking high doses of B12 long term but as far as side-effect risks are concerned vitamins and drug are just not in the same league.
So what about the final part of the package – the test? The original trial was done using standard paper and pencil tests that GP’ use to predict risk. But now one of the team from the Nuffield Department of Medicine at the University of Oxford who worked on the original trial has developed a computer version, which makes it much easier and quicker to do it at home.
Called the Cognitive Function Test it takes 15-minutes online at a site called Food for the Brain that specialises in a nutritional approach to psychiatric disorders A paper just published in the International Journal of Geriatric Psychiatry found that the computer version performed as well as the doctor’s pencil and paper tests .The advice on the site is that if your score is poor then you should talk about it with your doctor and discuss a homocysteine test.
Now of course it is possible the Bvit package, or plan B as it is being called, may turn out to have problems or need modification. But the attempt by the Alzheimer’s establishments to blank it does raise questions about whether their primary commitment is to the patients. Because they don’t just ignore this trial.
The idea that there are various life-style changes that can cut your risk of Alzheimer’s is a truism. But is any research into prevention going on? A search on the Alzheimer’s Research UK website threw up just two projects out of 140 and neither appeared to have anything to do with lifestyle. One is described as ‘developing new drug candidates to prevent the build-up of amyloid protein in the Alzheimer’s diseased brain’. The other involves analysing donated brain tissue.
It’s a point you might bear in mind the next time you are tapped for funds. Better still, what about a campaign to oblige charities who take the public’s money to consult them about what it should be spent on? How about a campaign for the ‘Healthy Slice’ – an obligatory 15 per cent charities research budgets to be spent on nutrition and other non-drug approaches that have plausible mechanism?