Attending to the Worried Well

The news coming from an international conference on Alzheimer’s Disease ongoing in Copenhagen indicates that the research focus is pivoting towards the push for early diagnostics.    A number of stories have come out about non-invasive eye exams and a possible blood test that could indicate problems long before a person begins to show serious cognitive decline.   Several studies are gearing up to look at preventative measures or ways to slow the progression of the disease (see http://online.wsj.com/articles/alzheimers-disease-fight-focuses-on-preventive-treatment-1405396803)

Remarkably – some of the positive preventative measures are our old standbys – diet and exercise.  Some others are likewise treatments designed to help maintain overall health (controlling hypertension, cholesterol, and diabetes).     But one can not help but wonder — is that about a particular disease with a very particular pathology – or is this more about staving off the  cognitive decline of aging and ill-health?

Don’t get me wrong – I am all for studies that will help us age better, remain active, and delay and/or prevent cognitive decline.

But I think while this kind of effort is pursued the advocates and funders  can not let science and medicine be diverted from the effort to treat a serious disease process that is devastating to individuals, families, and society.

I have written about this issue several times — there are these 3 factors that tend to creep in and divert us from hard and real problems:

  1. the Lure of Beauty – this is what we love about studying  aspects of disease in place of disease.    We pull on one single thread – ignoring the completeness of the fabric.    We can do elegant, controlled, replicable, publishable science.
  2. Models of disease rather than disease – similar in some ways to 1.   We create cartoons of disease and then make them the focus of all of the effort – forgetting somewhere along the way that models are often simplistic, artificial, and NOT the disease.
  3. Shifting focus from truly ill to worried well.   Pre-cancer, pre-diabetes, pre-alzheimers.   Of course prevention is always better than trying to cure endstage disease.    But still, there is an obligation to try to relieve the suffering of people who have devastating illnesses.

Advocates should keep the pressure on.