Is our research about Alzheimer disease wrong?
PSYCHIATRIC VIEWS ON THE DAILY NEWS
Today is my wife’s 75th birthday. I just passed my 76th. We, as most people our age, are wary of developing Alzheimer disease and losing our very sense of who we are and our ability to take care of ourselves.
No wonder, then, that society, especially its elders, desperately wants a “cure” for the increasing prevalence of Alzheimer disease. Psychopharmacology desperately needs some new breakthrough medications in psychiatry. Clearly, psychiatry and the rest of medicine became more of a big business when for-profit managed care emerged in the new millennia.1 All of those factors provide a vulnerable situation for questionable research, and that is what we may have in the plaque theory of Alzheimer disease and the related new medications.
Last year, on an internet broadcast for Talk Ten Tuesday, I presented my concerns about the potential FDA approval of a new Alzheimer medication. Though I am not an expert in this area, the research findings seemed questionable even to me, and the projected costs astronomical. Now, a whistleblower—a neuroscientist at Vanderbilt—has raised more sophisticated and scientific concerns.2
Back in 2006, a study suggested that Alzheimer disease stemmed from a group of proteins causing plaques in the brain. Most of the ensuing drug development followed that theory, though none that emerged in real life seemed particularly effective. The latest has been aducanumab (Aduhelm). Now, the original research has been questioned in that the images of the proteins role in that prior research look like they may have been misleading, intentionally or not.
Goodness knows, psychiatry has been accused more broadly by critics of being misleading about some so-called antipsychotics and antidepressants. Criticism has included ghostwriting of psychopharmacology research results, the strong influence of pharma reps on prescribers, the questionable etiologic theories, the misinterpretation of some outcomes, and unrecognized long-term risks.
Time will hopefully tell if we have been on the wrong etiologic path for the treatment of Alzheimer disease and other neuropsychiatric disorders. However, any misguided research does not reduce the need for better biological treatments, whether medication or other interventions. Shying away from those approaches would be like throwing out the baby with the dirty bathwater.
At a time when science is being questioned and alternative facts embraced by many, it is more important to continue research, but also to be as sure of the veracity of the findings over time.
Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times™.
1. Moffic HS. The Ethical Way: Challenges and Solutions for Managed Behavioral Healthcare. Jossey-Bass; 1997.
2. Piller C. Research backing experimental Alzheimer’s drug was first target of suspicion. Science. 2022;377(6604):363.