I agree with so much of this, but you lost me at the commentary on obesity. I implore you to look into the data on that and then reevaluate the groupthink on that topic. The drive to turn obesity into a profit center is higher than ever now too.
If you think prevention is expensive… just wait until treatment. Would be curious to learn what you do to prevent chronic diseases that you may be predisposed to.
Seems we are always playing catch up. A new found disaster, Pharma runs to treat. We can't stay ahead. Thalidomide is a good example. Look at the testing it went through before coming on the market. Sickly sad.
I am surprised that many of these “experts” appear to be totally unfamiliar with the work of Dale
Bredesen MD neurologist and professor at UCLA who has published clinical studies using his protocols where 84% of the Dementia patients showed not just slowing but actually reversal of cognitive decline. He also has helped Alzheimer’s patients who have been reversed and functioning for upwards of 7 years. His work is confirmed by others using his protocols such as Dr Heather Sandison who has recently published in the J. Alzheimer’s Research . Try reading Bredesen’s 2020 book entitled The End of Alzheimer’s Program: the First protocol to Enhance Cognition and Reverse Decline at Any AGE. (Penguin Random House). This treatment is vastly more effective, less expensive and much safer than the expensive drugs pushed by pharmaceutical companies. Time to look elsewhere than big pharma!
You nailed it with "medical-industrial complex" which, a la Eisenhower, implies a corruptive takeover of a sector by the money interests. The profit motive wins out over knowledge and ethics. Few clinicians or agencies are immune, and even the researchers are under pressure. The shift from NIH funding of biomedical research to venture-funded startups and Big Pharma will complete the takeover. Sad.
Surprised aluminum isn't brought up at all here as a potential factor. Some speculate that some of the mysterious longevity in certain regions of the world may be due to their water supply being high in silicate which has been show to increase the amount of aluminum we remove from our bodies. Also has been shown to change how much aluminum can be in water in parts per million without the fish dying. Seems like an avenue to explore.
The way I've been thinking of it lately is that Toxicology probably gets it's ass kicked by Virology when it comes to assessing what is causing harm due to the roles the two fields are slated to play in capitalism. Virology lends itself to creating products. Toxicology lends itself to costly, industry threatening, regulation. So of course our society gives the wider jurisdiction to the science that lends itself to making money. I'd love to read about the history of toxicology if anyone has some good books that would be a great place to start I'd appreciate it.
I shared your article on LinkedIn, Twitter and Facebook. If I had sway with the NYT, Wall Street Journal, Washington Post, NY Post, anywhere in print I would publish it there but alas, I don't, and could only do my best to expand the reach of your message in this small way. Sad but not shocking that the FDA doesn't say, don't use this drug on women. Like no one cares about their mothers, sisters, wives, aunts, cousins. Shame on American drug manufacturer not to say, only risk using this on men.
Excellent commentary. Prevention isn’t sexy, or remunerative. And the western concept of “healthcare “ is more geared towards “sick”-care rather than health promotion.
The problem is that nature abhors a vacuum….and in lieu of rigorous research on health promotion…we get quacks instead….and hence you get the supplements-industrial complex, or chelation, or all manner of other kooks who operate in an evidence-free zone.
A few months ago, I was reading commentary that questioned the amyloid/neurofibrillary tangles concept of Alzheimer’s. I wonder if this recent data on monoclonal antibodies changed that in any way, or serves as proof of concept of the pathophysiology theory itself.
Regardless, as you say, what we need is fair, unbiased, and rigorous parsing of the science….to know that something actually works, and are worth the tradeoffs. Once again, NEJM and their peer reviewers and editors disappoint, in failing to highlight the limitations of the studies, as you have done here. Well done!
Great piece on an important topic that garners a lot of publicity. Unfortunately, critical appraisal of drug trials is severely lacking in most headlines and it often takes a lot of digging through source materials to reach basic conclusions like NNT (number needed to treat) or NNH(needed to harm), let alone comparison with existing therapies. As Dr. Makary alluded, the evidence has suggested that AD is a multifactorial process involving genetic susceptibility, lifestyle and exposures, etc. While disease slowing may be an acceptable clinical endpoint for drug trials, what is less clear is the extent to which it improves clinical outcomes for patients in the long run. What typically drives mortality in AD are the psychomotor progressive disabilities (inability to swallow foods, tripping and falling). Progression to debilitation with AD is non-linear for this reason. A bad fall, broken hip, and subsequent hospitalization in someone with otherwise mild cognitive symptoms can precipitate rapid physical and mental decline. Moreover, many of these side effects are highly concerning in the population affected (many of whom are already taking drugs that reduce hemostasis and predispose them to bleeding events, for example). I’m just not convinced that the answer to Alzheimer’s is going to be found in a miracle drug. As both a physician and someone whose family has been affected by AD, I can attest that these patients require round-the-clock multidisciplinary level care on a near daily basis. Perhaps drugs can help patients maintain their independence for a few more years, and that would be a great improvement. But with patients living longer, and co-morbidities piling up as we age I can’t help but feel that we are trying to treat an amputation by simply giving more units of blood (without doing anything to stop the bleeding).
A) interesting for such a difference in results amongst men and women
B) have you seen those side effects? Crazy
I agree with so much of this, but you lost me at the commentary on obesity. I implore you to look into the data on that and then reevaluate the groupthink on that topic. The drive to turn obesity into a profit center is higher than ever now too.
what is the efficacy for women with penises? that could be enlightening.
"It is ironic that America will spend billions on a drug to treat Alzheimer’s, but pennies to study what actually prevents it."
Not really,
$26,500 a year for a treatment.
How much could pfizer make from a newsletter recommending crosswords and spatial exercises?
There is no money to be made from prevention of disease.
And those who want to prevent disease without a profit......are destroyed/smeared/cancelled by those who want to treat that disease for a profit.
If you think prevention is expensive… just wait until treatment. Would be curious to learn what you do to prevent chronic diseases that you may be predisposed to.
"Vaccine Politics Linked to Excess Republican Deaths During Covid, Study Finds
“It’s one of the most telling metrics I’ve seen in how the politicization of the pandemic has played out in the real world.”"
Seems we are always playing catch up. A new found disaster, Pharma runs to treat. We can't stay ahead. Thalidomide is a good example. Look at the testing it went through before coming on the market. Sickly sad.
Norma Lake Castillo
I am surprised that many of these “experts” appear to be totally unfamiliar with the work of Dale
Bredesen MD neurologist and professor at UCLA who has published clinical studies using his protocols where 84% of the Dementia patients showed not just slowing but actually reversal of cognitive decline. He also has helped Alzheimer’s patients who have been reversed and functioning for upwards of 7 years. His work is confirmed by others using his protocols such as Dr Heather Sandison who has recently published in the J. Alzheimer’s Research . Try reading Bredesen’s 2020 book entitled The End of Alzheimer’s Program: the First protocol to Enhance Cognition and Reverse Decline at Any AGE. (Penguin Random House). This treatment is vastly more effective, less expensive and much safer than the expensive drugs pushed by pharmaceutical companies. Time to look elsewhere than big pharma!
Surprised i have not heard of this. Going to look into it now. Thank you for the recommendation.
You nailed it with "medical-industrial complex" which, a la Eisenhower, implies a corruptive takeover of a sector by the money interests. The profit motive wins out over knowledge and ethics. Few clinicians or agencies are immune, and even the researchers are under pressure. The shift from NIH funding of biomedical research to venture-funded startups and Big Pharma will complete the takeover. Sad.
Surprised aluminum isn't brought up at all here as a potential factor. Some speculate that some of the mysterious longevity in certain regions of the world may be due to their water supply being high in silicate which has been show to increase the amount of aluminum we remove from our bodies. Also has been shown to change how much aluminum can be in water in parts per million without the fish dying. Seems like an avenue to explore.
Yes, such a shame they shut down Dr Chris Exley. He dissected brains. Second link here.
https://childrenshealthdefense.org/research_category/alzheimers-disease/
https://thehighwire.com/?s=Dr+Chris+Exley
The way I've been thinking of it lately is that Toxicology probably gets it's ass kicked by Virology when it comes to assessing what is causing harm due to the roles the two fields are slated to play in capitalism. Virology lends itself to creating products. Toxicology lends itself to costly, industry threatening, regulation. So of course our society gives the wider jurisdiction to the science that lends itself to making money. I'd love to read about the history of toxicology if anyone has some good books that would be a great place to start I'd appreciate it.
I shared your article on LinkedIn, Twitter and Facebook. If I had sway with the NYT, Wall Street Journal, Washington Post, NY Post, anywhere in print I would publish it there but alas, I don't, and could only do my best to expand the reach of your message in this small way. Sad but not shocking that the FDA doesn't say, don't use this drug on women. Like no one cares about their mothers, sisters, wives, aunts, cousins. Shame on American drug manufacturer not to say, only risk using this on men.
Another home run Dr. Makary; keep the hits coming.
Excellent commentary. Prevention isn’t sexy, or remunerative. And the western concept of “healthcare “ is more geared towards “sick”-care rather than health promotion.
The problem is that nature abhors a vacuum….and in lieu of rigorous research on health promotion…we get quacks instead….and hence you get the supplements-industrial complex, or chelation, or all manner of other kooks who operate in an evidence-free zone.
A few months ago, I was reading commentary that questioned the amyloid/neurofibrillary tangles concept of Alzheimer’s. I wonder if this recent data on monoclonal antibodies changed that in any way, or serves as proof of concept of the pathophysiology theory itself.
Regardless, as you say, what we need is fair, unbiased, and rigorous parsing of the science….to know that something actually works, and are worth the tradeoffs. Once again, NEJM and their peer reviewers and editors disappoint, in failing to highlight the limitations of the studies, as you have done here. Well done!
Making small healthy decisions every single day is inherently not exciting :/
Going to look into monoclonal antibody research now as well
So sad. Medical community has gone crazy - and evil - since covid pandemic emerged. How
Could so many doctors feel ok not to treat patients? How could untested injections get authorized to be delivered to healthy people?
Great piece on an important topic that garners a lot of publicity. Unfortunately, critical appraisal of drug trials is severely lacking in most headlines and it often takes a lot of digging through source materials to reach basic conclusions like NNT (number needed to treat) or NNH(needed to harm), let alone comparison with existing therapies. As Dr. Makary alluded, the evidence has suggested that AD is a multifactorial process involving genetic susceptibility, lifestyle and exposures, etc. While disease slowing may be an acceptable clinical endpoint for drug trials, what is less clear is the extent to which it improves clinical outcomes for patients in the long run. What typically drives mortality in AD are the psychomotor progressive disabilities (inability to swallow foods, tripping and falling). Progression to debilitation with AD is non-linear for this reason. A bad fall, broken hip, and subsequent hospitalization in someone with otherwise mild cognitive symptoms can precipitate rapid physical and mental decline. Moreover, many of these side effects are highly concerning in the population affected (many of whom are already taking drugs that reduce hemostasis and predispose them to bleeding events, for example). I’m just not convinced that the answer to Alzheimer’s is going to be found in a miracle drug. As both a physician and someone whose family has been affected by AD, I can attest that these patients require round-the-clock multidisciplinary level care on a near daily basis. Perhaps drugs can help patients maintain their independence for a few more years, and that would be a great improvement. But with patients living longer, and co-morbidities piling up as we age I can’t help but feel that we are trying to treat an amputation by simply giving more units of blood (without doing anything to stop the bleeding).
Would it be reasonable to be guided by a single trial even for men?
This article is well written and concise about the problems in Alzheimer's research.i so agree and appreciate the information!