A cheering and optimistic story about dementia at HealthInsightUK.org.When Obhi Chatterjee’s dad was diagnosed, Obhi set about researching the most plausible supplements and diets to help him.
The piece tells you what they are and why they might work and also has useful advice for anyone wanting to follow his example. Two of the biggest obstacles are – shamefully – the Alzheimer’s charities and carers provided by agencies who view supplements and odd diets with suspicion. Obhi describes ways of getting round both of them.
It’s a heartening story because Obhi’s dad is now more alert than he was a year ago. That’s in striking contract to the more familiar story of sad and distressing decline. But it also raises a much wider issue about how do we treat people with chronic diseases when the drugs are either unavailable or don’t seem to work very well.
Just grin and bear it?
If you decide to try a range of non-drug treatments – supplements, a specific diet, alternative therapies – the response from self-styled skeptics is all too predictable. Any form of treatment not stamped with the approval of a pair of randomised controlled trials (RCTs) is dismissed as “woo” or quackery. So your only logical option is to grin and bear it. Or, in the case of Alzheimer’s, to watch a relentless decline. Obhi had already done that with one relative and didn’t fancy a repeat.
The skeptics seem unable to accept that this is not an irrational choice. People do it either because they have tried what is on offer from conventional medicine and it hasn’t worked or because there is nothing else.
If there is evidence for elements of the non-drug approach, it is likely to be variable, not least because the funding available is tiny. So is that the final word? If you want your treatment to come with added science it’s an RCT or nothing?
A revealing irony
That seems wrong for so many reasons, not least because of the many all too familiar failures of the RCT. One of the most important and hopeful elements in Obhi’s tale is that, as someone with a background in statistics, he is all too aware of the issue of evidence and the need to find a way of assessing the overall effect his father’s non-drug package. His report on the opportunities the internet offers to do this is very promising.
The revealing irony here is that the challenge facing Obhi attempting to assess the risks and benefits diet, supplements and the rest is exactly the same as that facing doctors following the official RCT approach to treating elderly people. In both cases there is no proper evidence that what they are doing works. Both are practicing “woo”.
This is because as we get older we are likely to be put on more drugs for prevention as our risk getting ill rises and on more drugs for actual disorders – arthritis, high blood pressure, diabetes and so on. Many people in their seventies are taking a dozen pills or more.
Snake oil in care homes?
But even though each of individual drug will have been tested in RCTs, the actual combination that you, I or anyone else gets won’t ever have been tested. There are no RCT guidelines to help doctors managing polypharmacy, just as there aren’t for non-drug therapists; both have to rely on clinical judgement, experience and a variety of different sorts of evidence.
So if the skeptics were to apply their own narrow principles consistently they would conclud that all the elderly people in care homes around the country were getting a mixture of woo and snake oil. Yet curiously we don’t see them campaigning for homes to be shut down.
Ageing baby boomers will increasingly be facing the challenge of avoiding or treating metabolic disorders such as Alzheimer’s, cancer and diabetes. Drugs have limited effectiveness but we haven’t developed effective ways of assessing the effectiveness of lifestyle diet and supplement packages. Obhi’s optimistic explorations seem greatly preferable to the sneers of the sceptics.