If this helps Alzheimer’s it will be ignored

What’s the best way to cut your risk of developing Alzheimer’s? One bit of advice you see regularly is to keep your  mind active – do things like crosswords and so on. But here’s a new way that raises a lot of interesting questions about the current narrow focus of Alzheimer’s research. 

A new study has found that a sense of purpose can help keeps your mind sharper even when you have got the plaques and tangles in the brain that are a sign you’ve got Alzheimer’s. But how would you test it and how could purpose ever become part of an evidence based protection package?

The problem is this. Most Alzheimer’s research is focused on brain biochemistry, either pinpointing genes or finding ways to stop those plaques and tangles forming. But for a while now post-mortems have been showing that you may have had plaques and tangles without suffering from dementia. And even among people with Alzheimer’s some have lots of them and but function much better than others with fewer. Something else is going on.

How do you do a RTC of a sense of purpose?

This study which involved looking at the brains of over 200 people who had been followed and regularly rested for around ten years before dying found that those who still functioned quite well despite the plaques and tangles were often those who had reported having a sense of purpose in life. Now this makes a kind of intuitive sense but  it raises the problem of how do you do a randomised controlled trial of a sense of purpose? Would it possible to have a sense of purpose without knowing that you had one?

And of course the problem isn’t limited to purpose. Emotional states obviously do have powerful physical effects for good – as in the placebo – or for ill, as in the damaging effects of stress or depression which can raise the risk of heart disease. Stress can also affect your telomeres – those protective caps found at the end of chromosomes that may act as a sort of biological clock tracking how well you are ageing. Research has found that suffering severe stress, such as caring for someone with dementia, can shorten them.

But the way evidence based medicine is practised today would make it hard to make use of any of these preliminary findings. However powerful the purpose effect, who is going to fund research into it? Ideally you’d want to explore its potential as a prevention tool – are there purposes that are more or less potent, is a long-standing purpose better than a newly developed one? Can a sense of purpose actually clear away plaque or does it just reduce its damaging effect, and so on.

Exclude whatever makes life worth living

Because a sense of purpose is not patentable it would be hard to raise the funds to test it. But there is more to it. A purpose occupies similar mental territory to a placebo, which is turn adjacent to some of mental states involved in psychotherapy such as meaning and hope. Now it might be possible to dream up a randomised double blinded trial to test the power of purpose but what exactly would be the placebo?

What this highlights is that when dealing with the brain, which is specifically designed to produce these mental states we are using a form of investigations – randomised controlled trials of a single molecules – that specifically exclude all the mental and emotions states that actually make life worth living. Of course this is just a clearer example of the shortcomings of only relying on drugs and chemical markers – believing that Alzheimer’s is only  a matter of blocking plaque , heart disease means cutting cholesterol, depression is treated with more serotonin and so on.

Medical professionals are intelligent and they know like most of us that  single molecules are not the only things that work. But that a huge variety of commonplace things such as food or exercise or purpose or love or a belief that something will help can all tug at those chemical levers just as effectively and do it without that risks that inevitably come with drugs.

But the profession has signed up to a system that pushes them out to the periphery into the place where things without evidence are sent. And that doesn’t just result in an unbalanced healing system that ignores a major resource, it also means that the really fascinating stuff, the intangible goings on that lie behind placebos or purpose have a fraction of the focus they deserve.