Imagine what kind of money you could make, if you had a $15,000 device
that could slow the progression of Alzheimer disease. The
following clip is from a Medscape news article. (Free
registration is required to view it, but that is better than the
original journal article, which requires a subscription.)
Vagus
Nerve Stimulation Shows Promise as Alzheimer Disease Treatment
By Will Boggs, MD
NEW YORK (Reuters Health) Sept 28 - Vagus nerve stimulation (VNS) is
safe and beneficial for some patients with Alzheimer disease, according
to a report in the August Journal of Clinical Psychiatry.
"The study primarily showed that VNS is well tolerated and safe in
patients with Alzheimer's disease for up to 12 months," Dr. Magnus J.
C. Sjgren from Karolinska Institute, Huddinge, Sweden told Reuters
Health. "Furthermore, the study gave an indication that it VNS may be
of benefit, as a cognitive enhancing therapy, e.g., in Alzheimer
patients that do not tolerate choline esterase inhibitors."
Dr. Sjgren and colleagues previously reported cognitive-enhancing
effects of VNS during a 6-month pilot study of 10 patients with
Alzheimer disease. This report includes an additional 7 patients with
follow-up for at least 1 year.
VNS was well tolerated, the authors report, and all study patients
chose to continue VNS therapy after 1 year of treatment...
href="http://www.psychiatrist.com/abstracts/200608/080601.htm">J
Clin Psychiatry 2006;67:1171-1178.
About 40% of patients showed either some improvement, or at least no
decline, over a period of one year, on the Alzheimer Disease Assessment
Scale-cognitive subscale (ADAS-cog). Outcome was a bit better
using the Mini-Mental Status Examination (MMSE), which is less
sensitive and less specific. About 70% had some improvement,
or no decline.
The authors appear to have no idea why this would work.
I have mixed feelings about this.
href="http://scienceblogs.com/corpuscallosum/2006/07/vagus_nerve_stimulation_for_de_1.php">VNS
requires surgical implantation of a pacemaker-like device, that sends
pulses of electricity to the vagus nerve. It is rather
expensive, and there is no way of knowing ahead of time if it will
work.
On the other hand, if it turns out to be even moderately effective, the
cost saving could be considerable. Perhaps more importantly,
if it could give us some indication of the pathophysiology of the
disease, and some indication of a less invasive way to halt the
progression, that would be extremely valuable.
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One of the problems we have gotten into is preying upon people's anxiety about Alzheimer's, and not surprisingly, these cultivated anxieties enhance someone's bottom line.
Let's say I put someone on a cholinesterase inhibitor. Neither I nor the patient nor the patient's family can see a difference. So maybe we should just stop it?
Well, we have the drug manufacturer planting the seed that, "Well, even if the person isn't better, MAYBE it's slowing the progression, and MAYBE if you take them off and get they get worse, you can't get them back to where they were again." (And there is literature "support" for these concepts, or they wouldn't be saying it.)
So they play Fear Factor, or if you prefer, Dirty Harry saying, "Are you feeling lucky, punk?"
So the Medtronic thing is likely to be another trap. A trap making people out there wealthy.
Yeah, I've been sitting here, trying to figure out what kind of evidence I'd need to see in order to really believe that this treatment is worthwhile for SDAT. Some of the authors of the paper did disclose a relationship with Medtronic. For one, I would want to see a study by an agency with no vested interest. But how would such a thing be funded? at $15,000 per device, a study with 100 patients would need $1.5 million just for the hardware.