American Dementia: Brain Health in an Unhealthy Society by Daniel R. George and Peter J. Whitehouse, Johns Hopkins Press, 2021, 390 pp.
George and Whitehouse had me turning each page with wonder over topics I know well, to which their insight brought new perspective. I had to think back to the Alzheimer’s Centennial for a similar experience when I attended the official, medically focused meeting in Germany, where Alzheimer’s disease (AD) was discovered in 1906, and another meeting in Cleveland that Whitehouse organized. At the former meeting I found the usual self-congratulations of how much progress had been made, while at the latter the focus was on patients and how much value there is in the lives of the demented: “Alzheimer Lives Matter”. It transformed my view of AD from a hopeless condition to one of a phase of life that has its value to personhood and to family.
This book extends the holistic view as a blueprint for a future, not of “a world without Alzheimer’s disease”, but one without zombies, one with greater justice. We know AD is responsive to social, economic, stress, education, nutrition—and the list goes on. It is already within our grasp to reduce age-related dementia by over half with measures that will simultaneously increase our heart health and wellbeing.
George and Whitehouse link the modern understanding to the neo-liberal (capitalistic) dominance since the 1970s, that transformed a rare disease of middle age to the most dreaded of diagnoses, and one that would soon be cured. They go through the first drugs; where Whitehouse played a critical role in development and now the three-decade dominance of the amyloid cascade/tau toxicity that has left us without an effective therapy, much less a cure. In the quest for a cure, the biological and social context has been neglected, so much that what we know of AD is on weak or nonexistent foundation. Patients are left with false hope and grasping for the recently approved Aduhelm that has no meaningful clinical effectiveness. Historic protection by the FDA of safe and effective drugs has fallen to maintain a façade of success of the medical-industrial complex—little different than the similarly successful military-industrial one.
Socialism may not be a solution to all that ails the health system, but the path they chart does offer more hope than decades of stagnation punctuated by press releases. George and Whitehouse put the AD field in perspective with guidance for a future, embracing patients as revitalizing as Ebenezer Scrooge experiencing Christmas morning. Their perspective will enlighten a lay public, and experts in AD, new and old.
