When drug giant Pfizer announced earlier this year it was exiting the neuroscience business, including the search for a drug to treat Alzheimer's, doctors involved in the race to find a cure were caught off guard.
"I was surprised, because I knew they had interesting compounds in the pipeline," said Dr. Jeff Cummings, director of the Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas. For Cummings, though, it was ultimately just one more addition to a long record he has maintained, documenting the failure of Alzheimer's treatments. "It is another statement that development of drugs, particularly for neurodegenerative diseases like Alzheimer's and Parkinson's, has proven to be enormously difficult."
In an influential report, Cummings quantifies exactly how "difficult" Alzheimer's drug development has been annually: The drug-failure rate hasn't budged from 99.6 percent in years. And it comes at a time when 1 out of every 5 cancer drugs (or roughly 20 percent) are successful, and as the current $259 billion cost of Alzheimer's care in the U.S. is projected to grow to an "unsupportable" $1 trillion annually by 2050, according to the Alzheimer's Association.
Cummings remains confident that it is only a matter of time — though that time may be measured in decades — before drugs are successfully developed. But the current Alzheimer's clinical research impasse has encouraged more doctors to pursue non-pharmacological alternatives. For most individuals — beyond the up-to-5-percent who are genetically predisposed to early onset Alzheimer's — focusing on lifestyle factors as the key to brain fitness and cognitive function, they say, is wiser than waiting for a breakthrough delivered in a pill.
Dr. Majid Fotuhi, speaking this week on brain fitness at the YPO Edge conference in Singapore, is among the most vocal brain fitness experts. He says the failure to find a blockbuster drug targeting proteins associated with Alzheimer's — in particular, beta amyloid and, to a lesser extent, tau — isn't going to reverse the disease, because it never made sense in the first place.
"The field of Alzheimer's has focused too much on these proteins," said Fotuhi, a doctor at Johns Hopkins Medicine and founder of private practice NeuroGrow, a brain fitness center. "Since the '80s many scientists have been saying, 'If only we can block the protein, we can cure Alzheimer's. And 30 years later the focus is on excuses — from giving the drugs too late to wrong dosages — for why the drugs haven't worked." He added, "Twenty percent of people in the field have similar ideas to mine, except 80 percent are dominating the news. Drug companies don't benefit from setting up cognitive therapy or mediation or telling people to sleep well."