It’s the Forest, Not the Trees

• APOE4
• beta amyloid
• Curing Alzheimer's

Last weekend, a global entrepreneur asked me about the difference between much of the current research and what we’re doing. He cited the example of a particular compound (NAD+), but any number of other compounds could be given as examples. My answer was that most researchers are focused on their one particular tree and can’t see the forest.

Almost all current research narrows itself by looking at results, and ignoring causes. Imagine that I’m treating a patient with diabetic ketoacidosis by only treating one of their many metabolic results, such as a low potassium or an elevated blood acid level. Both of these results are typical in patients with life-threatening ketoacidosis, but neither of them is the cause of the problem. If I treat these results by adding potassium or lowering acid, will it solve the problem? No, not even close. That’s not to say that such narrow approaches don’t have benefits, but they don’t strike to the cause of the problem and they certainly don’t cure the patient. I may raise the potassium to normal levels, but I still haven’t made the patient healthy. In the case of severe diabetic ketoacidosis, giving potassium is fine, but giving hydration and insulin is better, and replacing the insulin-producing cells that made the patient a diabetic in the first place would be best of all.

Cure the cause, not the result.

We make the same error in trying to treat Alzheimer’s disease by thinking that it’s just a problem of beta amyloid deposits or tau protein tangles. What we should be doing is going “upstream” and asking why the deposits and tangles occur in the first place. Never mind the results, what’s the cause? It’s not surprising that all of the hundreds of human trials aimed at beta amyloid in Alzheimer’s disease have uniformly failed to modify the course of the disease. These trials attach results, not causes. We should be aiming at the microglial cell aging that initiates the process. I wish the best of luck to my colleagues who focus the results of disease, but they focus on single trees and they completely ignore the forest.

They go after diseases result-by-result, and tree-by-tree.

In Alzheimer’s disease research, focusing on arginine, tau tangles, APOE4, or beta amyloid is like focusing on specific instruments when we should be looking at the entire orchestra. We need to replace the score, but most current research is aimed at the specific instruments and saying that we need to replace the violin. And then the flute. And also the bassoon. And what about that oboe? And we almost forgot the piano! Oh, and don’t forget the piccolo. And the bass drum while we’re at it. Oh, my god, where’s that cello gone?

The reality is that if they’d just get the conductor (the telomere) to play the right score (the epigenetic pattern typical of a young microglia), then they wouldn’t have to deal with a hundred different instruments one-by-one, piecemeal and — if the truth be told — completely ineffectively. Whether we look at symphony orchestras or forests, the same answer applies. To put it back into the forest metaphor, the cure for Alzheimer’s lies not in a particular lichen growing on the funny-looking root on the northwest corner of one particular beech tree in the 186th quadrant of the forest, but in the entire forest itself.

It’s the forest, not the trees.