Samir Dawlatly: There is no dementia wonder cure

The daughter of one of my patients booked an appointment to see me*. She often came to see me about her father who had lived alone ever since his wife had died five years ago. He was in the early stages of dementia, probably Alzheimer’s, but was still just about managing to live at home with support from his family and social services.

She sat down and took out a tablet of some sort that her own daughter had encouraged her to buy. She held it in an unfamiliar way.

“Look at this, Doctor,” she tapped the screen and turned the device round so I could see it. It was one of the most popular news clips from last month. A report for a new wonder drug to delay the progression of Alzheimer’s disease. As the graphics of an amazing monoclonal antibody zapping amyloid plaques started whirring behind the excited presenter, the streaming quality dropped and the clip ground to a halt.

“It’s OK,” I said as she started tapping at the screen again, “I have already seen it.”

“And what do you think, Doctor?” she looked at me intently, “Is there any hope for my dad, or do the drug company have to do more tests?”

“That’s a good question,” I battled internally over whether to tell her what I had found out about the so-called wonder-drug or to be kind and evasive, “But if we had managed to watch the rest of the clip it would have said that the drug was 5-10 years away from being available for use in the public. It was just a very early trial.”

Her face dropped as she carefully packed the screen away. She had the same look of lost hope that she had had a few years ago when her father was first diagnosed with dementia.

She left the room, defeated.

I’d already carefully searched for the data that the media outlets were basing their reports on. I had difficulty finding them in a peer-review journal. In fact the drug in question had been proven in two Phase 3 trials, published in the most reputable, high impact journal, to do absolutely nothing to improve cognitive function and activities of daily living of patients with dementia over two years.

I’d eventually come across a press release in which the drug company had highlighted a relatively obscure conference abstract and trial extension, where they had given the drug to those that previously hadn’t had it. They then compared patients who had been treated with same drug but for different lengths of time. A new methodological technique. They noted that very small differences remained statistically, not necessarily clinically, “significant” through 52 weeks.

The press release didn’t appear to say that the drug was clinically effective.

So how does information released by a drug company, that may have a dodgy record of fines for heavy and inappropriate promotion of their drugs, metamorphose from a dry abstract about trial methodology to a “breakthrough” for Alzheimer’s Disease?

I can only guess that it is down to spin, and the thing that makes the world spin (or go round): money. The share price of the drug company jumped with the news reported in the mass media; charities (admittedly with financial links to the company) also put a positive spin on the “news” and perhaps a naive media wanted to give hope to people like my patient’s daughter.

But how would I explain that to her in a few minutes when it has taken me hours to unpick and understand what actually happened? The media aren’t going to, they have already moved on to the next scandal, disaster, cancer scare or wonder-drug.

*this patient, this consultation and his daughter are fictional, though the deception described was not.

Samir Dawlatly is a GP partner at Jiggins Lane Surgery in Birmingham. He combines clinical practice with being a part time house husband and an interest in social media, as well as publishing poems, essays, and blogs. He can be found on Twitter as @sdawlatly.

I have read and understood BMJ policy on declaration of interests and declare the following interests: I am a member of the RCGP online working group on overdiagnosis.