by Jean Carper
(From the Huffington Post (Huffington.post.com) , September 3, 2010
Why is the Sunday New York Times running four-month-old news on its front page?
Should we worry that the Gray Lady, now 159 years old, is slowing down?
I am referring to the article, “Years Later, No Magic Bullet Against Alzheimer’s Disease,” by Gina Kolata in the Times on August 29, 2010. The piece rehashes what other news media reported last April—that an outside panel of non-Alzheimer’s experts, convened by the National Institutes of Health, concluded there was not enough reliable evidence to recommend ways to prevent or slow the disease and that much more research was needed. “The jury’s verdict was depressing and distressing,” Kolata wrote.
Distressing indeed, especially to some leading Alzheimer’s researchers and organizations, including the prestigious Alzheimer’s Association, who vigorously disagree with the conclusion; but such controversy was barely mentioned in Ms. Kolata’s article.
A more enlightening account of the NIH conference report appeared on the Alzheimer Research Forum, an online blog (alzforum.org) where experts, primarily from medical institutions, exchange ideas and information about the disease.
A blog post by science writer Madolyn Bowman Rogers on May 7 noted that the NIH panel reviewed 300 studies and concluded that they “consistently associated” a higher risk of Alzheimer’s with diabetes, depression and current tobacco use and “consistently associated” a lower risk of Alzheimer’s with physical activity, a Mediterranean diet (low in saturated fat, high in grains, fruits, vegetables, nuts, fish and olive oil) and high levels of cognitive activity. However, the NIH panel judged the level of the evidence “low” for all of these interventions.
And why the “low” evidence rating? Because not enough studies have been done to prove the interventions work; there is a lack of consistent research, primarily due to under-funding. However, it’s important to point out that a “low” level of evidence does not mean the studies are of poor quality. As Neil Buckholtz, director of the Dementias of Aging Branch at the National Institute on Aging, explained, “We don’t yet have enough information to make specific recommendations.”
In a later blog comment, Dr. John Breitner from the University of Washington School of Medicine, put it succinctly: “Absence of proof is not proof of absence.” In other words, just because we don’t know, doesn’t mean the proof doesn’t exist.
The Alzheimer’s Association applauded the NIH panel’s call for additional research, but disagreed with their conclusion that “current research is inadequate to make health recommendations.” Maria Carrillo, the Association’s representative, underscored the fact that studies do show “brain health can make a difference in our future in terms of Alzheimer’s risk,” and said the Association would continue to make recommendations to stay physically, socially and mentally active and to adopt a brain healthy diet as a possible help in lowering the risk of Alzheimer’s.
Even Dr. Buckholtz of NIH contradicted the logic of the panel’s determination that you can do nothing to save yourself from Alzheimer’s.Their report, he says, “is suggestive that there are some things you can do, in terms of a healthy diet, a healthy lifestyle to maintain a healthy brain.” He recommends physical exercise, social interactions, reducing high blood pressure and high cholesterol, and making lifestyle choices that reduce the risk of diabetes and cardiovascular disease.
Dr. Kenneth Kosik, professor of neuroscience at the University of California, Santa Barbara commented that the NIH panel’s threshold of evidence undermines public health efforts to promote healthy behaviors. He also challenged the advisability of holding recommendations, such as exercise and diet, to the same standards of proof required of potent drugs.
Trying to design a double-blind pharmaceutical-style study to evaluate lifestyle factors involved in Alzheimer’s is absurd, he suggested. It would be unethical to have a control group. “The NIH panel does not seriously believe,” he said, “that we will conduct trials in which subjects will be randomized to a control group and told not to treat their hypertension, follow a poor diet, or refrain from exercise.”
He is correct. Why should the general public remain hopeless while medical bureaucrats fiddle and fuss over how much evidence is enough to merit telling us that healthy endeavors like exercising, eating well, using our brains and taking care of our general health might also lessen our odds of Alzheimer’s? How much larger should the Alzheimer’s toll get before experts speak out in favor of ways to prevent it?
The first alarm that smoking causes lung cancer was sounded as far back as 1950 in both the Journal of the American Medical Association and the British Medical Journal, (4). Both prestigious journals declared that smoking more than doubled the risk of lung cancer. They presented the same type evidence the NIH panel found insufficient—observational or epidemiological studies. British and American medical officials and organizations ignored the evidence as an “association” not a cause. Sound familiar?
Not until the first U.S. Surgeon General’s Report on Smoking and Health in 1964 bucked mainstream medicine and massive tobacco industry propaganda to declare smoking a deadly hazard did smoking rates begin to drop from 42 percent in adults in 1965 to 21 percent in 2006.
That history should warn us to ignore the NIH panel and the depressing, recycled news in the Sunday New York Times and to trust our own survival instincts. As the Alzheimer’s Association and many leading researchers advise, it makes sense to try to cut our risk of Alzheimer’s now, rather than wait for a thumbs up from some future government panel, possibly years from now, when it may be too late to save millions of us and a medical system bankrupted by the disease.