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Deconstructing the myth of dementia
In Context
Book Deconstructing the myth of dementia “Intellectual blemishes, like facial ones, grow more prominent with age.” François de La Rochefoucauld
The Myth of Alzheimer’s: What You Aren’t Being Told About Today’s Most Dreaded Diagnosis Peter J Whitehouse and Daniel George, St Martin’s Press, 2008. Pp 319. US$25.95 ISBN 978-0-312-36816-6
776
Imagine a scenario where we are all taken in by a plot perpetrated by pharmaceutical companies and perpetuated by the world’s press and stakeholders in the “dementia business”, all of whom are desperately trying to preserve the cash cow of government-sanctioned funds that will enable them to continue their scaremongering of a fearful and gullible public. You might think this is a plot worthy of this summer’s blockbuster movie or a posting on the blog of a conspiracy theorist’s website. But you could not be more wrong. Instead, this is the essence of the clarion call to action by a respected neurologist with more than 30 years’ experience of treating patients with Alzheimer’s disease. In The Myth of Alzheimer’s: What You Aren’t Being Told About Today’s Most Dreaded Diagnosis, Peter Whitehouse and his research collaborator, Daniel George, set out their treatise for a radical rethink of the way Alzheimer’s disease is perceived and, consequently, how people who have dementia are regarded by their doctors, families, and by society as a whole. Following the centenary anniversary since the discovery of a rare form of dementia by a young psychiatrist, Alois Alzheimer, Whitehouse feels that it is high time that we explode the cultural myths and stigmas, some of which go right to the grassroots, that have been built up around one of the most devastating diagnoses a person could receive. Whitehouse and George expound that we are waging a hollow war against the inevitable consequences of age on our brains; and once we accept this, we can work towards building a “scientifically honest and humanistic framework of brain ageing” and are better able to protect our cognitive function into old age through making lifestyle changes early on. Whitehouse might have the air of poacher-turnedgamekeeper, although he is upfront about the years he spent in the thrall of the pharmaceutical industry and his own gradual disengagement from the promulgation of the “Alzheimer’s myth”. And it is through his engagements with industry that he has acquired his insight into the profiteering from the so-called Alzheimer’s construct: pharmaceutical companies that claw back huge revenues from treatments that are modestly effective, and researchers with carte blanche to millions of dollars in research funding to investigate a disease that, to his mind, is not a disease at all but rather the manifestation of the natural ageing of the brain, which occurs at different rates and to varying degrees in different people. Add into the quagmire the press, which sells copy by preying on the paranoia of an ageing population and publicising the decline of a clutch of high-profile celebrity victims, such
as Ronald Reagan, Rita Heyworth, and Iris Murdoch, and a monster of frankensteinian proportions has been created. In the first two sections of the book, the authors summarise the current state of knowledge of Alzheimer’s disease and explain the science of memory and how it is perturbed in Alzheimer’s disease. The inadequacies of the diagnosis and current treatments and the limitations of the current thinking are also discussed. This section also includes a fascinating potted history of the discovery, and rediscovery in the early 1980s, of Alzheimer’s disease, and from here they explain how and why the Alzheimer’s construct has been created. In the third section, Whitehouse and George set out their criteria for life with an ageing brain, hints and tips on how to interpret the symptoms of brain ageing and the alternative causes, how to make the decision to see a doctor, how to find a doctor, what to expect, and how to prepare for your appointments. The authors suggest lifestyle interventions, including dietary, intellectual, and physical, which might enable people at any age to increase their cognitive reserve. They then set out their nine-point action plan for implementing these changes. This is all good commonsense advice, even if the evangelical and reiterative way it is presented might make the reader feel patronised. As an exposé, The Myth of Alzheimer’s falls short of revelatory: not since the days of the apothecary have pharmaceutical companies been cottage industries that are driven by altruism, and who has unstinting confidence in the probity of the press or the dark practices of government lobbying? This book will particularly appeal to baby boomers, who are the group most likely to ask “Why can’t we be cured?”rather than “What can we do to help ourselves?” And there are many tomes with “dog-whistle” messages that tap into the paranoias of this generation, even if the intent is to change attitudes. Depsite the author’s efforts, it seems unlikely that the Alzheimer’s construct will disappear, and it is, in fact, an essential impetus to the search for more effective treatments. Many people take comfort in being diagnosed with a specific ailment, and such disease classifications underscore the workings of many health-related businesses. Nevertheless, the times are undoubtedly changing: existing treatments might only be symptomatic and have limited effectiveness, but many new drug classes are in the early stages of development; so too are our attitudes undoubtedly changing, and dementia is now regarded as a continuum disorder that merits a change in the tools we use to define it and the vocabulary we use to describe it. Regardless of whether prescience had a role in Whitehouse’s change of heart, he is assured of a place in the new order.
Steven Goodrick www.thelancet.com/neurology Vol 7 September 2008
Book Deconstructing the myth of dementia “Intellectual blemishes, like facial ones, grow more prominent with age.” François de La Rochefoucauld
The Myth of Alzheimer’s: What You Aren’t Being Told About Today’s Most Dreaded Diagnosis Peter J Whitehouse and Daniel George, St Martin’s Press, 2008. Pp 319. US$25.95 ISBN 978-0-312-36816-6
776
Imagine a scenario where we are all taken in by a plot perpetrated by pharmaceutical companies and perpetuated by the world’s press and stakeholders in the “dementia business”, all of whom are desperately trying to preserve the cash cow of government-sanctioned funds that will enable them to continue their scaremongering of a fearful and gullible public. You might think this is a plot worthy of this summer’s blockbuster movie or a posting on the blog of a conspiracy theorist’s website. But you could not be more wrong. Instead, this is the essence of the clarion call to action by a respected neurologist with more than 30 years’ experience of treating patients with Alzheimer’s disease. In The Myth of Alzheimer’s: What You Aren’t Being Told About Today’s Most Dreaded Diagnosis, Peter Whitehouse and his research collaborator, Daniel George, set out their treatise for a radical rethink of the way Alzheimer’s disease is perceived and, consequently, how people who have dementia are regarded by their doctors, families, and by society as a whole. Following the centenary anniversary since the discovery of a rare form of dementia by a young psychiatrist, Alois Alzheimer, Whitehouse feels that it is high time that we explode the cultural myths and stigmas, some of which go right to the grassroots, that have been built up around one of the most devastating diagnoses a person could receive. Whitehouse and George expound that we are waging a hollow war against the inevitable consequences of age on our brains; and once we accept this, we can work towards building a “scientifically honest and humanistic framework of brain ageing” and are better able to protect our cognitive function into old age through making lifestyle changes early on. Whitehouse might have the air of poacher-turnedgamekeeper, although he is upfront about the years he spent in the thrall of the pharmaceutical industry and his own gradual disengagement from the promulgation of the “Alzheimer’s myth”. And it is through his engagements with industry that he has acquired his insight into the profiteering from the so-called Alzheimer’s construct: pharmaceutical companies that claw back huge revenues from treatments that are modestly effective, and researchers with carte blanche to millions of dollars in research funding to investigate a disease that, to his mind, is not a disease at all but rather the manifestation of the natural ageing of the brain, which occurs at different rates and to varying degrees in different people. Add into the quagmire the press, which sells copy by preying on the paranoia of an ageing population and publicising the decline of a clutch of high-profile celebrity victims, such
as Ronald Reagan, Rita Heyworth, and Iris Murdoch, and a monster of frankensteinian proportions has been created. In the first two sections of the book, the authors summarise the current state of knowledge of Alzheimer’s disease and explain the science of memory and how it is perturbed in Alzheimer’s disease. The inadequacies of the diagnosis and current treatments and the limitations of the current thinking are also discussed. This section also includes a fascinating potted history of the discovery, and rediscovery in the early 1980s, of Alzheimer’s disease, and from here they explain how and why the Alzheimer’s construct has been created. In the third section, Whitehouse and George set out their criteria for life with an ageing brain, hints and tips on how to interpret the symptoms of brain ageing and the alternative causes, how to make the decision to see a doctor, how to find a doctor, what to expect, and how to prepare for your appointments. The authors suggest lifestyle interventions, including dietary, intellectual, and physical, which might enable people at any age to increase their cognitive reserve. They then set out their nine-point action plan for implementing these changes. This is all good commonsense advice, even if the evangelical and reiterative way it is presented might make the reader feel patronised. As an exposé, The Myth of Alzheimer’s falls short of revelatory: not since the days of the apothecary have pharmaceutical companies been cottage industries that are driven by altruism, and who has unstinting confidence in the probity of the press or the dark practices of government lobbying? This book will particularly appeal to baby boomers, who are the group most likely to ask “Why can’t we be cured?”rather than “What can we do to help ourselves?” And there are many tomes with “dog-whistle” messages that tap into the paranoias of this generation, even if the intent is to change attitudes. Depsite the author’s efforts, it seems unlikely that the Alzheimer’s construct will disappear, and it is, in fact, an essential impetus to the search for more effective treatments. Many people take comfort in being diagnosed with a specific ailment, and such disease classifications underscore the workings of many health-related businesses. Nevertheless, the times are undoubtedly changing: existing treatments might only be symptomatic and have limited effectiveness, but many new drug classes are in the early stages of development; so too are our attitudes undoubtedly changing, and dementia is now regarded as a continuum disorder that merits a change in the tools we use to define it and the vocabulary we use to describe it. Regardless of whether prescience had a role in Whitehouse’s change of heart, he is assured of a place in the new order.
Steven Goodrick www.thelancet.com/neurology Vol 7 September 2008