The Politics of Anguish: How Alzheimer’s disease became the malady of the 21st century.

Since 2015, neurological research surpassed cancer research at the National Institutes of Health (NIH). It was with great hindsight that the National Institute on Aging (NIA) managed to champion a disease that was, for all intents and purposes, a neurological disease—Alzheimer’s disease. The NIA and Alzheimer’s disease have a symbiotic relationship from the beginning of NIA’s conception in 1974. This emphasis meant that the NIH/NIA had to diminish the role of social factors in Alzheimer’s disease research. But how effective has this approach been? The final judgment needs to be based on outcomes, and the NIH/NIA outcomes are starkly devoid of substance both in theoretical development as well as in practical applications.  We still do not know the exact role of the plaques and tangles in the brain, and what knowledge we have we still cannot apply to elevate some of the symptoms let alone cure the disease. After a century of false hopes, it is time to re-evaluate our approach. The constant search for a cure is becoming a worthless meme. Perhaps we can learn something from cancer research.

Cancer research continues to evolve, but one lesson learned, is that cancer is not simple and not one drug will cure all cancers. We need a similarly nuanced understanding of dementias. Why such a simple understanding is not embraced might have something to do with the politics of how research funds are managed. In Alzheimer’s research there is a hierarchy, a cabal, a virtual club whose members receive most of the federal research funds and who determine the agenda. It's a powerful club that determines the direction of research and determines how to frame the disease, how to define it for the public and what is prioritized. But the direction this inner sanctum charted has resulted in a research cul-de-sac. For more than a hundred years we have been encouraged to foster a false hope of a pharmaceutical product, a drug, which will cure Alzheimer’s disease. This has not happened and this will never happen. And the reason why this can be said with such apparent gusto is because we still do not know what we are trying to cure. The construct we now call Alzheimer’s disease is so broad that any intervention that shows any diffuse outcome, will be heralded as a cure. But despite these advertisements, the disease remains elusive. There are numerous researchers who have pointed out anomalies in research, stressing that the direction we are taking is incomplete (Ballenger, 2006).

Sixty years ago David Rothschild highlighted anomalies that he optimistically anticipated will “…open(s) up many fields of study—for example, unfavorable hereditary or constitutional tendencies, and unfavorable personality characteristics or situational stress.” (Rothschild, 1953, p. 293) Unfortunately it did not. The science of Alzheimer’s disease remains firmly and reticently rooted in biology and neurology, despite compelling evidence that this mechanistic approach is too simplistic and does not explain observations. Another physician predicted how future researchers might use the knowledge of plaques and tangles as “…a good playground…” (Perusini, 1911, p. 144). The historical context tells us that researchers today keep ignoring the complex facets of Alzheimer’s disease and playing a game of causality—that biological markers translate to behavior. And we are paying for these choices by being denied any progress towards understanding the disease, or being closer to a cure or alleviating the disease.

Science is not a destination but a journey. It is purely a method of epistemology, of assimilating knowledge. It is not scientific “knowledge,” but knowledge that is gathered using “scientific methods.” All scientific knowledge is incomplete (or wrong), since science continues to generate more detailed questions which determine a better methodology, that result in more complex and accurate results.  As a function of this process, science is based on reviewing all information, assimilating all observations in a model and being able to predict outcomes. Despite all the science invested in studying Alzheimer’s disease, there remain numerous anomalies.  Why these anomalies remain unrecognized is not due to ignorance, nor incompetence, but due to a political strategy--it is intentional. There is a way out of this research cul-de-sac but we have to confront the truth that Alzheimer’s research is politicized to the detriment of humanity.

Except (edited for this blog) from the book: The Politics of Anguish: How Alzheimer’s disease became the malady of the 21st century. Mario Garrett. Createspace.

References

Ballenger, J. F. (2006). Self, senility, and Alzheimer's disease in modern America: A history. JHU Press.

Rothschild D (1953) Senile Psyhcoses and Psychoses with Cerebral Arterioscelrosis p289-331 in Kaplan Oscar J (ed) Mental Disorders in Later Life, 2nd Edition. Chapter XI.

© USA Copyrighted 2015 Mario D. Garrett