Yesterday The New York Times reported a medical breakthrough: “the development of a blood test that can accurately diagnose Alzheimer’s disease, and even do so years before truly debilitating memory loss.”
Well, “accurately” may be a bit of a stretch. As the Times explained, the test is about “90 percent accurate in distinguishing the blood of people with Alzheimer’s from the blood of those without the disease” and “about 80 percent accurate in predicting which patients with mild memory loss would go on to develop Alzheimer’s disease two to six years later.”
Then, the Times acknowledged, there is one other problem with the test: “At present, treatments for Alzheimer’s disease are not very effective.”
So why exactly would I want an early warning that would give me two to six years to contemplate what it will be like to observe my mind dissolving? (Of course I could comfort myself with the fact that the test is only 80 percent accurate, but somehow I suspect that would only compound my anxieties.)
“There are people who want to know what their future holds so they can plan their estates and lives,” Dr. Sam Gandy, a professor at Mount Sinai School of Medicine in New York who is chairman of the medical and scientific advisory council of the Alzheimer’s Association, told the Times.
Right, this is an estate planning tool.
No, the “real usefulness of an early diagnostic test would come when
drugs are developed that slow or halt the progression of Alzheimer’s
disease,” the Times explains. “The drugs would be most valuable if
they could be used before cognitive ability had declined too much.”
In other words, drug companies that are trying to develop Alzheimer’s
drugs need subjects who are still able to describe losing their
Does this justify putting those subjects through the nightmare of
dreading their fate for two to six years? I’m not at all sure. I’d
like to know more about just how close we are to finding a drug that
would slow the progress of the disease.
And what about the 20 percent who are screened and told that their
mild memory loss will probably turn into Alzheimer’s, only to discover,
six years later, that the result was a “false positive”?
No doubt, at that point, they would breathe a huge sigh of
relief—assuming that they hadn’t already had a nervous breakdown. I
would guess monitoring yourself for six years, always looking for signs
that your mind is beginning to shut down, would be quite stressful.
This isn’t to say that this breakthrough doesn’t represent a major
scientific advance. I can understand how finding a “biomarker” for the
disease would be very useful for doctors trying to pinpoint what causes
Alzheimer’s. As Dr. Tony Wyss-Coray, an associate professor of
neurology at Stanford and the senior author of the paper describing the
research, points out, “understanding why the levels of the 18 proteins
are different in Alzheimer’s patients might provide a better
understanding of the disease.” This makes sense.
But Wyss-Coray doesn’t plan to keep the test in the lab where
scientists can study the bio-marker. Though "the test initially will be used
in research labs,” the San Francisco Chronicle reports,
Wyss-Coray anticipates taking his product to market soon. Already,
he has founded Satoris, Inc. “to commercialize the technology” the
Patrick Lynn, Satoris’ CEO, outlined the game plan in
an interview with the San Jose Mercury News, saying that he hopes to
begin selling the test to laboratories next year—which won’t require
FDA approval, and then win the FDA’s blessing and begin selling it “for
general use” by 2009.
What does “general use” mean? I suspect it means that any elderly
person suffering “minor memory loss” would be seen as a candidate for
screening, and if the test proved positive, that person would then face
a terrible choice: “Do I want to try an experimental drug for
Alzheimer’s, even though they’re not entirely certain that I have
Alzheimer’s? On the other hand, if I do have Alzheimer’s, maybe this
will be the breakthrough drug. . .”
Perhaps it would be useful to have a simple test for Alzheimer’s.
Perhaps some people would like to know what horrors lie ahead for them
and their families. After losing their motor skills, Alzheimer’s
patients lose their power to speak, and finally the ability to swallow
or eat. It can be a long process.
But why make it longer? If we can’t help patients, what is the point of screening them?
My real concern is that this is another case of the pharmaceutical
industry’s priorities setting the agenda for medical research. The
industry needs a larger pool of patients who have been identified
before symptoms develop–but how this knowledge will affect the patient is
not the industry’s concern.