In 2011 Heiko Braak and his colleagues did something no one else had done before. He looked at dementia in the brains of young children. By dissecting 2,332 brains ranging in age from one to 100, what he found was to change how we see disease.
Only 10 people had complete absence of Alzheimer’s disease related biology. Every person over 25 years of age had Alzheimer’s disease biomarkers. Without any exceptions. Even among children under 10 years of age, one in five already had the Alzheimer’s disease signs. Every adult is sick with the disease. Braak and his wife Eva are known for their stages of dementia when in 1991 they published the six stages of dementia, known as Braak-Braak stages. So they know a few things about the disease.
The finding that every adult has some of the elements that contribute to Alzheimer’s disease was not much news until this year. In 2018 the United States National Institute on Ageing – an agency set up in 1976 to explore ways to promote the health of older adults – sponsored a new way to define Alzheimer’s disease.
This new framework used the biology of the disease alone, ignoring how the disease is expressed. For the first time in the history of Alzheimer’s disease we are defining it not by how it looks – loss of memory, possibly behaviour changes and mood swings – but by biology alone. The problem, as Braak found, is that using biology as an indicator of the disease shows that we are all suffering from Alzheimer’s.
Similar to the Catholic Church and original sin, where everyone is born with sin that eventually takes away the freedom of will, similarly we are told that Alzheimer’s disease is already in all of us and will eventually take away our freedom of will too. There are a lot of similarities. We are moving science back to religion. But, unlike the original sin where baptism somewhat absolves us from this fate, with Alzheimer’s there is no cure and no way of absolving the disease. We are doomed, whether we show dementia or not. Even healthy adults show the biology of the disease; there is no escaping.
In the US a diagnosis of Alzheimer’s will automatically revoke your driving privileges
This new way of diagnosing Alzheimer’s disease is dangerous. Not only for hospitals and clinics that have to deal with this new definition, but also for the legal aspects. What if a court argues that you are an incompetent witness (say someone stole money from you) because they can prove that you have Alzheimer’s disease and therefore do not have a reliable memory.
There are many other examples, examples in real life today where the diagnosis of Alzheimer’s disease reduces your value as a witness in court. In the US a diagnosis of Alzheimer’s will automatically revoke your driving privileges. You lose your driving licence by the time you leave the doctor’s office (it is a reportable disease that goes directly to the motor vehicle department.). If you have business loans you will likely lose those too. The repercussions of receiving a diagnosis of Alzheimer’s disease might also land you in a nursing home, whether you want to or not. This would be disastrous if all of these negative things happened when the person is still behaving normally, such as you and I reading this now.
The only group to benefit from making everyone an Alzheimer’s disease patient are drug companies. Most of the researchers involved in this new definition of Alzheimer’s disease have investments in and connections with large drug companies. Some of the authors reported working for the drug companies themselves. In 2011 such coflict of interests in France resulted in their guidelines being withdrawn.
Researchers working for the French health authority that issued guidelines for the treatment of type 2 diabetes and Alzheimer’s disease were withdrawn by France’s highest administrative court. The court ruled that the potential bias and undeclared conflicts of interest among the authors “contravened national law on conflicts of interests and the agency’s own internal rules”. According to a Consumer Report in 2102, Alzheimer’s drugs cost a lot and help just a little. None work without side effects and none work long term.
There is a certain attitude of playing God. Telling nature that it made a mistake and then trying to fix it. Perhaps the disease of dementia is not caused exclusively by this biology – as so many researchers have been saying for more than a hundred years.
The brain is the most complex organ in the universe. Many things can go wrong (wrong to us anyway, but perhaps this is nature’s way). The effect of this new method of determining whether someone has Alzheimer’s disease is that we begin to lose trust in our doctors.
Looking at just the biology is not what doctors are trained for. They are trained to look at the expression of the disease. In a way, this biological way of looking at disease sidesteps doctors’ experience and skill at diagnosing and makes everyone a patient for drug companies.
Mario Garrett was born in Malta and is currently a professor of gerontology at San Diego State University in California, US. He will be the plenary speaker at the national conference on ‘Gerontological and dementia care in Malta and Gozo: Present and future challenges’, to be held on December 7 at the Intercontinental Hotel, St Julian’s. The conference is being organised by the UN-International Institute on Ageing and Department of Gerontology, University of Malta.