My father had Alzheimer’s. As a journalist and editor, he’d worked with words all his life and had always been impeccably correct about his grammar. But soon after he retired, we noticed that he began to lose and jumble his words. After he died at the age of 77, we found notebooks in which he’d tried time and again to spell words correctly. On a scrap of paper, he’d practised my mother’s name and a birthday greeting. He must have been aware that the words were slipping away, at least in the beginning.
There was no cure for Alzheimer’s then, and there is no cure for Alzheimer’s now. Similarly, apart from surgery, there was nothing effective to offer my younger brother, who died with a brain tumour at the age of 33. Twenty years after his death, the same treatments are being offered to people with his type of tumour: surgery, radiation and chemotherapy, all of which may delay the inevitable, but at a cost. I’m not unusual; most people know or love someone who suffers from a common disease for which there is no cure. In fact, compared with most people, I’ve probably got off lightly so far.
What Makes a Drug a Success?
There was great fanfare recently for a new Alzheimer’s drug, lecanemab (brand name Leqembi), which was shown in a trial to reduce the rate of cognitive decline in people with mild impairment. The drug was hailed as ‘momentous’ and ‘historic’, but it is expensive, has to be administered via fortnightly intravenous infusions and requires multiple MRI scans, due to the risk of potentially fatal bleeding in the brain. Moreover, it’s not even clear whether patients and their families will notice any benefit from the treatment, and there are serious questions about its value for women (a problem, given that women are twice as likely as men to develop Alzheimer’s).1 Can this really be regarded as a success?
Set against the backdrop of the aweinspiring technological advances that we hear about on an almost daily basis, I can’t help feeling shocked that we have so little to offer people with strokes, dementia, most cancers, brain injuries, multiple sclerosis, motor neurone disease, osteoarthritis, Crohn’s disease, Parkinson’s disease … the list goes on. Why has there been so little progress in medicine? After all, these failures come on top of decades and decades of research into these diseases. Why has it been so unproductive?
Unfortunately, most of the research into these diseases has been conducted on animals. In this sort of research, scientists try to reproduce the disease in animals and then test new drugs on these animals. Although we’re used to hearing about new medical breakthroughs as a result of animal research, the sorry fact is that when these apparent breakthroughs are followed up years later, most of them come to nothing.2