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Prove it works: Alzheimer's conference looks to evidence-based medicine for effective treatments

This article first appeared in the St. Louis Beacon, May 6, 2009 - A decade ago, even a respected physician might have been laughed out of a medical conference for suggesting that a Mediterranean diet could help delay the onset of Alzheimer's disease.

Now that this idea has been subjected to research, the Mediterranean solution is gaining acceptance among doctors and others who might have once considered the diet little more than a fad.

Drs. Abhilash K. Desai and George T. Grossberg cited the diet as they put the final touches on a conference they are co-chairing this weekend on evidence-based methods for preventing Alzheimer's disease. Both physicians work in the Department of Neurology and Psychiatry at the St. Louis University Medical School. The session on Saturday will update participants about research, diet and nutrition, risk factors and drug therapies for helping to prevent the disease.

The conference highlights the growing emphasis on evidence-based research for making medical decisions, a trend embraced by the Obama administration. It argues that the medical industry can help cut health-care costs by moving away from trial-and-error approaches and focusing instead on treatments of proven effectiveness.

An evidence-based model is no easy sell to consumers -- or doctors. For one thing, medicines and other therapies have to be subjected to rigorous research over years to determine the standard of treatment.

"We know that exercise is beneficial to heart disease and the brain," says Desai, "but it took 10 years for everybody to agree that that's important."

It took more than eight years -- and several studies -- for the Mediterranean diet to gain respectability as a potential brake to the onset of Alzheimer's disease. One important study, which involved hundreds of elderly people in Manhattan, found a significant decrease in the rate of Alzheimer's disease among those who exercised and adhered to a strict Mediterranean diet.

"This is considered evidence-based because it is a very well-structured, highly scientific study with a controlled group," says Grossberg. "It's not anecdotal, it's not hearsay, it's not just observation or wild claims that health-food manufacturers can make. It's evidence based on one or more well-done, well-controlled clinical trials, and it's the highest level of evidence we have."

Grossberg notes that the Food and Drug Administration's approach to evidence-based medicine has focused mainly on medications.

"What FDA hasn't done a lot of is try to look at non-pharmacological interventions, lifestyle modifications, dietary issues, exercises, the kinds of things we're talking about at the conference."

One way to make more physicians and others aware of the value of evidence-based research is through conferences like the one Saturday, Grossberg says.

Desai adds that one challenge is to win over well-meaning doctors who are set in their ways about treatment issues.

"Many practitioners did not get trained on practices based on solid evidence," he says, adding that new evidence affecting neurosurgeons occurs so rapidly that doctors would have to devote four hours a week "just to keep themselves up to speed."

As a result, he says, some doctors end up "practicing medicine that might be two to five years old. In this fast-paced life, people tell themselves that this (evidence) is not that important."

Desai predicts that doctors will have to change. First, he says, insurers may eventually insist that treatments be based on evidence showing that they work rather than allowing doctors to experiment.

"Evidence-based medicine is getting more traction now because of knowledgable patients and the cost of health care," he says. "Patients are much more educated, and they are reading up on this before they make their appointments."

Desai suggests the carrot may be the most effective way to persuade doctors to embrace evidence-based medicine.

"I'd rather see insurers give incentives to doctors who practice evidence-based medicine rather than punish those who don't," he says. "Incentives are always a much better, forward-looking intervention."

With its power to influence research decisions, the National Institutes of Health might help speed up the move to evidence-based medicine, says Grossberg.

The NIH has $10.4 billion in stimulus money to award to medical researchers nationwide. The medical schools at both St. Louis University and Washington University are said to have submitted record numbers of grant applications to capture a portion of this research money, and both schools stress the intensity of the competition.

"There will be a lot of people knocking on the door," says Dr. Larry Raymond Tait, SLU's vice provost for research, adding that the university has applied for about $80 million worth of grants. "The needs that we have are mirrored by other schools of medicine."

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.

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