A controversial Alzheimer's surgery is said to reverse symptoms

I believe it was a mistake to approve anti-amyloid drugs like Aducanumab. Big Pharma threatened to stop research on Alzheimer if they couldn't sell this drug and make bumper profits from it. The FDA should never allow itself to be blackmailed in this manner. If drugs don't show a clear improvement, not just the "slowing of the progression" of the disease (which is infinitely debatable and subject to manipulation), they should be rejected. The amyloid theory is a dead end, a wild goose chase which has led to tunnel vision and wasted three decades of research into Alzheimer disease. We're essentially back to square one save for some interesting data that viruses may be involved. This had led to desperate patients seeking help from charlatans and quacks like the one described in this article.

This article soars from hope to hype to skepticism. I guess that's a consequence of reporting on the fringes of science. In particular, I wish there was more detail on the 100-cohort study where patients experienced "modest improvements" and how that's calculated. Is that average increase of X points on an MMSE, etc. In my experience in my family, dementia is not a linear slide. My 85yo mother with Alzheimer's will sometimes present very well and you have to really get into conversational details to notice the dementia. On other days, she'll pick up a paperback and try to use it as a phone. Some days she's steady on her feet, some days coordinating all of those muscles is just too much. Over the course of a couple years, you can track the decline, but it's not a straight line. "Modest improvements" makes me concerned that they measured a valley to a peak. It's only 6 months since the 100-cohort study.

As an ML engineer, I improve models through trial and error. Sometimes a change improves my metrics, and other times it makes them worse, and I just revert it and try something else. It's scary to think about neurological surgery making progress in a similar way. We may not have a good theoretical understanding of why a procedure works, but we observe positive outcomes in a small number of patients and then start looking into expanding its use. It reminds me of procedures where doctors sever connections between the two hemispheres of the brain to reduce seizures. I've heard they can reduce symptoms, but disrupting connections in the brain can also have unexpected consequences. I hope we can do better than essentially throwing spaghetti at the wall.

Derek Lowe's post on this: https://www.science.org/content/blog-post/new-alzheimer-s-th...

The problem with this stuff is (as the article mentions) is that it’s going to take a while to figure out whether any benefit is just temporary. I would guess that there are a lot of variables to eliminate too - eg is it possible that just having a surgery and recovering from anaesthesia can yield some of these benefits in some circumstances? Given that we don’t really understand how most inhaled anaesthetics fully work