Alzheimer’s – a study suggests that drugs do work, but only some drugs. Holford offers a very partial summary of this evidence.

Patrick Holford’s May E-Newsletter arrived yesterday. It’s not online yet, as far as I can see – so those poor readers who missed out on the e-mail will have to content themselves with me quoting the e-mail here.

Holford looks at Alzheimer’s disease, arguing that

Medication Prescribed to Alzheimer’s Patients may hasten their decline

In a study of 224 people with Alzheimer’s Disease who were living in the community, those who were taking antipsychotic drugs or sedatives had an almost three-fold higher risk of deterioration than those who were taking none. Even worse, for those taking both antipsychotic and sedative drugs together, their risk of deterioration was almost quadrupled.

This is partly right – but misses out some crucial information and could be extremely misleading.

The study in question actually finds that

Patients who were taking antipsychotic drugs and sedatives had a significantly higher risk of deterioration than those who were taking none…Higher risk of deterioration was observed in those who were taking both antipsychotic and sedative drugs together…Patients taking drugs licensed for dementia, drugs affecting the renin –angiotensin system and statins had a significantly lower risk of deterioration than those who were not taking any of these drugs

In other words, some drugs make deterioration more likely, some drugs appear to bring a lower risk of deterioration. This means that one should be more cautious about prescribing some drugs to Alzheimer’s patients, but the study provides evidence of the potential benefits of some other drugs. When making decisions about serious illnesses like Alzheimer’s, it’s very important to have all the information – and not to rely on the type of very partial summary of the information offered by Holford.

3 Comments

Filed under Alzheimer's, drugs, patrick holford

3 responses to “Alzheimer’s – a study suggests that drugs do work, but only some drugs. Holford offers a very partial summary of this evidence.

  1. Shinga

    Was Holford suggesting a different approach to management of people with a possible diagnosis of AD, Jon?

    I take your point about the partial summary of the paper and I’d need to be able to take a look at the paper to comment. I have a difficulty with Odds Ratios that aren’t calculated alongside Relative Risk Ratios.

    In an observational study, if events (e.g., here, it would be deterioration on the assessment scale) are rare, then there is likely to be a close approximation between the Odds Ratio and the Relative Risk Ratio.

    If the events are comparatively common, however, then an OR of (say) 4 may equate to a RRR of 3 which might be a substantial difference.

    Without knowing how likely a deterioration is, it is difficult to have a feel for the numbers in this paper. So, Holford may be correct when he claims that there is almost a quadrupling of the risk, but without seeing the paper, it isn’t safe to equate the OR and RRR which sounds like what he is doing.

    Did he comment on the seeming impact of some classes of drugs in slowing deterioration?

    As far as I can tell, the group was caucasian, 73% female, mean age of 82.3. ‘Only’ 15% were taking antipsychotic drugs, and 13% were taking benzodiazepines or related. I don’t know how many were taking the combined antipsychotic drugs and sedatives but it’s probably quite a small N.

    So, there is appropriate room for caution when prescribing drugs for AD. Is the over-arching point that Big Pharma doesn’t have an adequate response to AD, that some doctors might be out-of-date in their prescribing practices, or wasn’t there an over-arching point?

    Regards – Shinga

  2. Jon

    Sorry if that wasn’t clear – the quoted text was pretty much the entirety of what the e-newsletter said about Alzheimer’s (I just cut out the full reference to the article). Certainly, when prescribing drugs the risks need to be weighed against the benefit – but the approach Holford took in the e-newsletter (to just mention the negative drug effects shown by the study, without mentioning the benefits seen) is not helpful. By the way, as I type this I’m listening to the midnight news – which is exclusively reporting the trial’s ‘positive’ findings re. certain drugs for Alzheimer’s; oh well…

    Holford’s website offers a plan to ‘say no to Alzheimer’s. He suggests a number of dietary changes for those who want to ‘say no to Alzheimer’s. I probably should look through this at some point to check its evidence-base, but at the moment Holford is sending out e-newsletters faster than I can go through them…

    One more thing (already much too long a comment…) – I would argue that focusing purely on the negative effects of drugs can be damaging. For example, Holford’s work on HIV/AIDS has been heavily criticised, in part because all he says about AZT (and any anti-retroviral) in one section of his New Optimum Nutrition Bible is that “By their very nature these drugs are poison to the body. AZT, the first prescribable anti-HIV drug, is potentially harmful and proving less effective than vitamin C“. This type of partial information is dangerous – AZT (and other anti-retrovirals) have really nasty side effects, but they have also saved countless lives. It is irresponsible for a healthcare provider to only focus on the negative aspects of such life-saving drugs.

  3. Shinga

    Sorry, must phrase my comments better – the questions about ‘over-arching points’ were in relation to PH’s email, not your piece.

    I could see that you were saying that the potential benefit of some drugs might be being overlooked in the rush to condemnation.

    Re: the positive reports on the news v. PH’s negative response. I suppose that it’s a classic example of that old crone/beautiful young woman in a hat – it all depends upon your interpretation.

    Regards – Shinga

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