Dementia: The worrying ‘rise of pseudomedicine’

Aging
An article, published in JAMA Network this month, attacks what it refers to as pseudomedicine. In particular, the authors are concerned that individuals with dementia and their families are being targeted.
Older adult pharmacy
Is fear of dementia being used to sell pseudomedicine?

Dementia is becoming increasingly prevalent as the population of the United States ages.

Currently, 5.7 million people in the U.S. are living with Alzheimer’s, the most common form of dementia.

Worldwide, an estimated 47 million individuals are living with dementia.

However, to date, there is no cure, and treatments can only relieve certain symptoms for some people.

Added to the millions who already have a dementia diagnosis, there are many millions more who are concerned that they, too, might develop dementia one day.

A rise in quackery?

All of these millions could, potentially, be vulnerable to anyone who claims to have answers, whether they offer improved treatments, preventative methods, or, indeed, cures.

This perfect storm of growing prevalence and concern has, according to a recent article, sparked a steep rise in non-evidence-based treatments for dementia and general brain health.

With today’s unparalleled access to information of all types, some individuals are being duped into investing in medical interventions that are not supported by scientific literature. As the authors summarize:

This landscape of limited treatments for dementia, concern about Alzheimer[‘s] disease, and wide access to information have brought a troubling increase in ‘pseudomedicine.'”

When the authors mention pseudomedicine, they are referring to supplements and interventions that, although entirely legal, are promoted as being beneficial despite a distinct lack of supporting evidence.

The article was written by three scientists from the University of California, San Francisco: Dr. Joanna Hellmuth, an assistant professor of neurology; Dr. Gil D. Rabinovici, a professor of neurology; and Dr. Bruce Miller, who is co-director of the Global Brain Health Institute, among other roles.

A surge in supplements

Pseudomedicine most commonly takes the form of dietary supplements that claim to promote brain health and thinking ability. Many of us will have noticed adverts for supplements — whether via the internet, radio, magazines, or television — claiming that the products will help prevent cognitive decline or dementia.

But, as the authors of the recent article write, “No known dietary supplement prevents cognitive decline or dementia.”

Often, these supplements are promoted using individual testimonies, and although these stories can be compelling, they do not constitute evidence. As the Alzheimer’s Asociation writes on their website:

“Claims about the safety and effectiveness of these products […] are based largely on testimonials, tradition, and a rather small body of scientific research.”

This is concerning because, as the authors point out, dietary supplements are not tested for safety by the U.S. Food and Drug Administration (FDA).

This creates a dangerous situation: Because supplements can be purchased without a prescription, people are more likely to believe that they are relatively safe; yet, they are not tested to the same degree as medicines.

And, importantly, companies that sell these supplements are not required to prove that they work.

In some cases, supplements can be dangerous. For instance, vitamin E, which is widely available, can increase the risk of stroke and, if taken in excess, can increase the risk of death.

Another concern laid out by the authors is that supplements are often promoted with adverts and text that is designed to appear scientific. Pseudomedicine marketers have honed this science-like appearance to such a degree that, for consumers, the products appear entirely legitimate and are almost indistinguishable from genuine medicines.

Aside from the money wasted and the potential damage to a consumer’s health, the authors point to another issue related to supplements, explaining that “discussion of them in clinical settings can subvert valuable time needed for clinicians and patients to review other interventions.”

Beyond supplements

Of course, pseudomedicine is not limited to bottles of pills. A dizzying array of treatments have been marketed as reducing the risk of dementia or relieving its symptoms. These include, but are in no way limited to, personalized detoxification, intravenous nutrition, chelation therapy, antibiotics, and stem cell therapy.

As the authors write, “these interventions lack a known mechanism for treating dementia and are costly, unregulated, and potentially harmful.”

Many people will have heard arguments defending pseudoscientific methods; one common theme is that, if a product can offer hope to someone with an incurable condition, then it cannot be all bad.

The authors of the current article, however, reject this defense because some pseudomedicinal interventions can be dangerous; they can also be expensive.

They note that, in some cases, clinicians might suggest complementary treatments. This, the authors argue, is a different situation — the clinician may not benefit financially and can also ensure that any current treatment that the patient receives will not clash with the new intervention.

The authors hope that changes to the current system can be made. They believe that claims made by manufacturers must be backed up by evidence.

The authors also suggest that doctors should help patients and their families distinguish between genuine, research-based claims and testimony-based claims; they conclude:

While unethical forces promote the existence of pseudomedicine, an educated community of physicians and patients is the starting point to counteract these practices.”

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