“Of concern is a groupthink mentality, both at the institutional level and at granting agencies, such that demonstration of amyloid alteration is a de facto requirement for experimental models, preclinical studies, nearly all clinical trials and diagnosis at autopsy. This could aptly be viewed as a systemic defect in postmodern scientific investigation…

…one that narrows the scientific focus of the broadest of pathophysiological processes—aging and Alzheimer’s disease—to an infinitesimally small, singular, wild-type protein produced in all people throughout life, and involves surrogate processes such as inflammation and oxidative stress, only to the extent that they alter this single protein. As we grapple with the possibility that the amyloid preoccupation has effectively put off disease modification for decades if not longer, thought leaders would do well to avoid settling a science that is by definition unsettled, welcome alternative views when so little is known and confront the empirical fact that the favored therapeutic design performs at or worse than a placebo, coconut oil or marijuana.”, Rudy Castellani, M.D. and George Perry, Ph.D., The Wall Street Journal: Letter to the Editor

“Sounds a lot like the groupthink mentality we had with regard to the real causes of the 2008 financial crisis and doesn’t it seem like it might be occurring with global warming?”, Mike Perry, former Chairman and CEO, IndyMac Bank

Opinion

We Should Have Better Results in the Alzheimer’s Battle

Attempts at targeting amyloid have failed so often that objective science compels us to question why the construct is still being pursued so vigorously.

Regarding David Shenk and Rudy Tanzi’s June 9 op-ed: We are struck by the irony in the title “Misplaced Hopes for Curing Alzheimer’s.” Proof of concept as regards the favored, hopeful paradigm is worth noting. Removal of amyloid from the brains of Alzheimer’s patients has no impact on cognitive trajectory. Indeed, attempts at targeting amyloid have failed so often we question why the construct is still being pursued so vigorously.

Of concern is a groupthink mentality, both at the institutional level and at granting agencies, such that demonstration of amyloid alteration is a de facto requirement for experimental models, preclinical studies, nearly all clinical trials and diagnosis at autopsy. This could aptly be viewed as a systemic defect in postmodern scientific investigation, one that narrows the scientific focus of the broadest of pathophysiological processes—aging and Alzheimer’s disease—to an infinitesimally small, singular, wild-type protein produced in all people throughout life, and involves surrogate processes such as inflammation and oxidative stress, only to the extent that they alter this single protein.

As we grapple with the possibility that the amyloid preoccupation has effectively put off disease modification for decades if not longer, thought leaders would do well to avoid settling a science that is by definition unsettled, welcome alternative views when so little is known and confront the empirical fact that the favored therapeutic design performs at or worse than a placebo, coconut oil or marijuana.

Rudy Castellani, M.D.

University of Maryland

School of Medicine

Baltimore

George Perry, Ph.D.

College of Sciences

The University of Texas

at San Antonio

Much of the science the authors cite existed when I entered the field 45 years ago, so where are the cures? We have failed on cures for both Alzheimer’s and cancer. Lack of money isn’t the cause, and the public should be frustrated.

Medical research revolves around publishing, tenure, peer recognition and thought-leader dominance. This academic enterprise has no organization, accountability or quality control with thousands of charities, institutes, universities and the National Institutes of Health all chasing new science and proceeding in an uncoordinated fashion. This is slow at best and not how we got to the moon, cracked the atom and conquered cyberspace.

New science, while important, should not trump accountability or using existing drugs/combinations and every other treatment/prevention strategy possible in a milestone driven manner. This applied research approach worked to cure leprosy and peptic ulcers (thalidomide and antibiotics, respectively) and the mavericks who did it were marginalized. Imagine if such maverick non-thought-leader-driven innovation were encouraged.

It is time to marshal and coordinate this sprawling infrastructure, remove it from academia and charities and attack this problem with a focused milestone-driven, goal-oriented NASA type approach.

Paul J. Marangos, Ph.D.

Carlsbad, Calif.

While health-care costs for Alzheimer’s victims are currently $200 billion a year, most of this isn’t primarily for health care, but rather for custodial care. Special medications, diet and physical-rehabilitation interventions don’t basically alter the disease progression, although attention to protective measures, good nutrition, exercise and TLC are certainly as important for these victims as they are for elderly individuals who aren’t mentally impaired. By including the enormous custodial maintenance costs, we may be crowding out the much-needed funding of basic research.

Lewis L Hamilton, M.D.

Boca Grande, Fla.

Posted on June 17, 2015, in Postings. Bookmark the permalink. Leave a comment.

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