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A alternating affair of this blog is to flash a ablaze on what I like to alarm “quackademic medicine.” I didn’t ad-lib the term, but I’ve fabricated it mine. Basically, quackademic anesthetic is a appellation that actual appropriately describes what’s activity on in far too abounding bookish medical centers these days, which is the aggression of pseudoscientific anesthetic and absolute affectation in the anatomy of “complementary and addition medicine” (CAM). Of course, the added contempo appellation for CAM is now “integrative medicine,” which was coined to betoken the “integration” of addition anesthetic with science-based anesthetic as admitting they are equals. Thus, there are bookish medical centers that embrace acupuncture, reiki, and naturopathy, the aftermost of which includes homeopathy as an basic allotment of its class and accomplishment set.

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Among the centers of quackademia, of which there are far too abounding in existence, George Washington University is amid the best arrant aback it comes to all-embracing authentic quackery. The aftermost time I discussed GWU, I acclaimed that the Center for Integrative Anesthetic at the George Washington University Medical Center (GWCIM) offers casework that, charitably, be alleged authentic quackery: acupuncture (of course!), chiropractic, craniosacral therapy, bittersweet ablaze therapies, glutathione infusions, Myers’ Cocktail, naturopathy (again, of course!), reiki, intravenous aerial dosage vitamin C, and abiogenetic contour after-effects that accommodate “customized estimation of abiogenetic contour after-effects with specific emphasis on methylation and detoxification profiles.” Some of these are quackery. Some are “rebranding” affairs interventions as somehow “alternative” (and accordingly abundant added hip). Some becloud the curve amid the two, such as “functional medicine,” a annex of CAM that combines “wholistic” anesthetic with a accomplished lot of lab tests and supplements to actual aberrant lab values. The Cleveland Clinic is abnormally amorous of anatomic medicine.Now I apprentice that GWCIM has afresh added addition ambiguous assay to its already all-embracing account of ambiguous protocols. No, the acceding to which I’m apropos is not homeopathy, craniosacral therapy, or aerial dosage intravenous vitamin C. The kindest way to call it is experimental, alike admitting it seems to be offered to anyone afterwards a analytic trial. As it is experimental, it is unproven. It’s additionally based on appealing attenuate gruel as far as analytic abstracts goes and resembles to me the abortive use of 23andme abiogenetic profiles to adviser affliction afore we alike apperceive what these profiles mean. No, bang that. It reminds me of anatomic medicine:

Muses Labs arise today that it has partnered with the George Washington Center for Integrative Anesthetic (GWCIM) to action the MEND™ Acceding to patients amid in Washington, DC. This acceding allows individuals with pre- and early-symptomatic cerebral decline, as able-bodied as balmy Alzheimer’s ache patients, to account from the MEND Acceding via the Center’s Mental Bloom affairs operated in accord with the George Washington University Anamnesis Clinic.

The MEND Acceding is a abstracts driven, technology enabled, alone alignment to accurately analyze and accompanying amusement the dozens of anatomy drivers of age-related cerebral decline. The MEND Acceding is advised to advice patients who are alpha to accept affection of age-related cerebral decline, those with a ancestors history of dementia and patients with balmy Alzheimer’s disease. The Acceding recommends optimal medical interventions alone for anniversary accommodating and has the abeyant to advance anamnesis and cerebral function. The MEND Acceding is an arising alignment that reflects a new access to acclamation circuitous diseases.

The MEND™ Acceding is a assay for Alzheimer’s ache marketed by Muses Labs. I consistently become actual apprehensive aback I see business abstracts that accomplish claims like this:

MEND™ Acceding accompanying applies assorted medications and affairs changes in a highly-personalized abode to attack to arrest and about-face balmy cerebral crime (MCI) and aboriginal date Alzheimer’s disease. MEND Acceding utilizes absolute FDA-approved drugs, supplements, affairs changes, and medical markers and tests in a atypical manner. Personalization of the acceding depends aloft an individual’s genome, medical assay results, comorbidities, accepted medications, medical history, and added inputs.

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MEND Acceding is advised to abode the alive basal pathways for Alzheimer’s ache including metaic issues, toxicity, inflammation, and mitochondrial damage. Due to the complication of the personalization process, the Acceding is accomplished via bloom administering software. The algorithms are able to absorb argumentation to action a avant-garde ambit of abstracts on an individual’s bloom cachet and acclaim specific interventions akin to the assay of an individual. The recommendations are altered for anniversary alone and change over time.

Ah, yes, “personalized” anesthetic and a “personalized” protocol. Muses Labs affirmation to use these factors to architecture a alone assay for MCI due to aboriginal date Alzheimers:

Based on the accustomed causes of cerebral decline, the MEND Acceding collects alone accommodating biometric and behavioral data, including:

The MEND Alone Assay Plan is provided to both the physician and the patient, so they can assay the after-effects together. The physician prescribes the assay plan as appropriate. Patients are periodically retested and the assay plan is adapted over time.

You know, this acceding smells of ambiguous science. My agnostic antennae alpha absolutely twitching aback I apprehend things like “toxicity,” “inflammation,” and “mitochondrial damage.” It sounds actual abundant to me like “autism biomed” accompanying with an address to genomics and computer algorithms. They alpha twitching abnormally adamantine aback I see images like these on a website:

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SimpleTruth (@SimpleTruth10U) | Twitter – simple truth organic goddess dressing | simple truth organic goddess dressing

Yes, its’ a scientist in a white lab covering allegedly manipulating a DNA bifold braid with his hand, complete with a white ablaze that makes it attending as admitting he’s cutting activity from his fingers. OK, it’s not absolutely that blatant, but it’s close. Star Trek admirers ability bethink a appellation frequently acclimated to call some of the accurate discussions that occurred on the show, namely “technobabble.” Basically, technobabble consists of absorbing and scientific-sounding abracadabra that, aback advised added carefully, turns out to be basically meaningless.

This aing allotment of the description of the MEND acceding ability not be technobabble, but it is authentic woo babble. Its actual name (metaic accessory for neurodegeneration, abbreviated MEND) tells me that. So does this aing bit:

The assay algorithm recommends both pharmacological and non-pharmacological components. For example, if synaptic about-face and aliment is needed, again assorted biological mechanisms may crave normalization, enhancement, or administration. Examples of these basal biological mechanisms include: periodically activating autophagy, blocking prionic tau amplification, accretion beta-amyloid clearance, inhibiting beta-amyloid oligomerization, aspersing inflammation, normalizing neurotrophic factors, abbreviation ApoE Ɛ4- advised signals, abbreviation stress, abbreviation tau phosphorylation, abating cholinergic neuro- transmission, and abandoning anamnesis loss. Assessing the cachet of these biological mechanisms involves quantifying and celebratory hormonal balance, citicoline, C-reactive protein and added inflammation-related markers, diet, exercise, cysteine, omega-3 acids, sleep, and so on. Interventions targeting specific biological mechanisms are again prioritized and assigned to optimize key biological mechanisms. Medication doses are defined to an individual’s needs. Individuals are re-tested periodically and the acceding is adapted as necessary.

What the hell does this alike mean?

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Whenever I see claims like this, my aboriginal aptitude is to go to PubMed. At the actual least, I apprehend to acquisition a account of publications on the aggregation website. So, afore activity to PubMed, I perused the Muses Labs website. All I could acquisition was one publication. Afore I get to that publication, though, let me aloof booty a attending at some things I begin application the absolute Google search. I can’t advice but agenda that all the accessories I begin application Google mentioned the actual aforementioned distinct publication.

As you apparently know, Alzheimer’s ache is a anatomy of dementia, of cerebral decline, accompanying to aging. It isn’t (yet) accepted what causes it. It’s accepted that Alzheimer’s ache is a abiding neurodegenerative disease. It’s accelerating and adamant and the account of up to 70% of cases of age-related dementia. The account of the ache is not able-bodied accepted at all. It is accepted that Alzheimer’s patients tend to accept amyloid plaques (amyloid is a protein) and neurofibrillary tangles in the brain. Currently there are no treatments that stop or about-face its progression, although some can briefly about-face its symptoms. It’s a horrible, abhorrent disease, one that I can’t advice but abhorrence as I get older. Aback I accept a blooper in memory, I accept a addiction to antic about “early access Alzheimer’s,” but it’s no antic at all. Alzheimer’s dementia is aloof about the affliction fate I can imagine.

Muses Labs itself touts its access thusly:

The access we’re employing relies aloft avant-garde software and big-data analytics, and incorporates decades of medical research. Muses Labs offers a account that utilizes the Internet and advice technology innovations to accomplish the Acceding applied and attainable to individuals with cerebral abatement about the world.

Elsewhere, the aggregation is declared thusly:

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The aggregation says this access to Alzheimer’s ache (AD) is based on the atomic analysis of the academician and the actual systems that abutment it. Decades of accurate analysis from about the apple are brought calm and congenital into MEND. Muses Labs combines medical ability with software algorithms. Its algorithms amount out the optimal alone assay for an individual, and enables their physician to appoint the therapy. Muses Labs software again motivates an individual’s adherence to the assay it recommends.

All of this sounds all actual nice and impressive, and there are absolutely accepted scientists on the Muses Labs beat board, although there is additionally Dr. Mikhail Kogan, who aloof so happens to be the Medical Director and the Integrative Anesthetic Fellowship Director at the George Washington Center for Integrative Medicine, Washington DC. Not surprisingly, he additionally does elderliness and embraces anatomic medicine. Appear to anticipate of it, this accomplished Muses Lab access reeks of anatomic medicine, which I like to characterize as “making it up as you go along,” because of its assurance on lots of lab tests whose estimation is questionable. In this case, we arise to be seeing anatomic anesthetic accretion into genomics.

Still, as abounding red flags as I see in the columnist releases and Muses Labs literature, it is consistently accessible that the aggregation is on to something. It’s not incorrect aback it says that Alzheimer’s ache is actual complicated, nor is it incorrect in its assessments of the accepted “state of the art” that distinct abettor therepeutics accept abundantly bootless to about-face cerebral decline. However, it does not chase from that that the MEND acceding works. We’ve been application systems analysis approaches to try to advance bigger treatments for assorted diseases for at atomic a decade now, and, in blight at least, the after-effects accept been mixed. There was a lot of advertising and achievement at first, but it wasn’t continued afore that advertising and achievement ran beeline into the bank of the cruel analysis of the disease. So what’s the affirmation for the MENDS protocol?

So let’s booty a attending at the advertisement that Muses Labs touts as affirmation that its acceding is so able as a assay for aboriginal Alzheimer’s disease? Accustomed that it’s the alone study. It’s additionally a single-author paper, which is appealing abnormal for any array of case alternation or analytic trial. I apperceive annihilation about the author, Dale E. Bredesen, added than that he is affiliated with the Buck Institute for Analysis on Crumbling and UCLA’s Mary S. Easton Center for Alzheimer’s Ache Research. It’s acutely a pilot study; in fact, it’s a baby case alternation of ten patients advised with the MEND protocol.

This case alternation was badly unsatisfying to read. It’s accessible access; so you can apprehend it for yourself if you don’t accept me. I capital to apperceive more. I capital to apperceive aloof what the heck the MENDS acceding entailed. Unlike best affidavit advertisement the after-effects of case alternation or analytic trials that I read, this cardboard was actual attenuate on the details. For example, this table describes it (click to embiggen):

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The MEND™ protocol: Abiding looks absorbing and science-y, but it it either?

Patient #1 is a 67 year old woman with two years of accelerating anamnesis accident whose mother had developed accelerating anamnesis accident at almost the aforementioned age, become demented, and concluded up in a nursing home, not dying until she was in her aboriginal 80s. This was the dieting she was placed on:

As acclaimed above, and afterward an continued altercation of the apparatus of the ameliorative program, the accommodating began on some but not all of the system: (1) she alone all simple carbohydrates, arch to a weight accident of 20 pounds; (2) she alone gluten and candy aliment from her diet, and added vegetables, fruits, and non-farmed fish; (3) in adjustment to abate stress, she began yoga, and ultimately became a yoga instructor; (4) as a additional admeasurement to abate the accent of her job, she began to meditate for 20 account alert per day; [5] she took melatonin 0.5mg po qhs; (6) she added her beddy-bye from 4-5 hours per night to 7-8 hours per night; (7) she took methylcobalamin 1mg anniversary day; (8) she took vitamin D3 2000IU anniversary day; (9) she took angle oil 2000mg anniversary day; (10) she took CoQ10 200mg anniversary day; (11) she optimized her articulate hygiene application an electric flosser and electric toothbrush; (12) afterward altercation with her primary affliction provider, she reinstated HRT (hormone backup therapy) that had been discontinued afterward the WHI address in 2002; (13) she fasted for a minimum of 12 hours amid banquet and breakfast, and for a minimum of three hours amid banquet and bedtime; (14) she acclimatized for a minimum of 30 minutes, 4-6 canicule per week.

How we get from “systems biology” to yoga, exercise, weight loss, abundant sleep, and a bigger diet is unclear. You don’t absolutely charge systems analysis to advance that these interventions will at atomic advance bloom and ability apathetic cerebral decline. As for activity “gluten-free”? On what account was that action based? I accept the aforementioned questions apropos abnegation and the vitamins. Basically, account the almost ambiguous description of the MEND acceding provided here, I see annihilation that requires all that adorned systems analysis and those computer algorithms accustomed by Muses Labs. How “data-drive” and “big data” do you accept to be to appear up with this protocol?

Another declining of this writeup should be accessible to anyone who commonly reads (and abnormally to anyone who participates in) analytic trials. What were the cold outcomes? Alike in a case series, there are usually some cold outcomes examined. For example, did they do assorted tests of cerebral action afore and after, in adjustment to actuate if there was any cold improvement. How was the analysis of cerebral abatement nailed down. Of the three (out of ten) patients described, accommodating #2 is the alone one whose workup for Alzheimer’s ache was declared in annihilation akin in depth, and there is no address of any followup tests, aloof the accommodating and wife’s letters of his improvement. Basically, nine of ten patients reportedly approved “objective or subjective” improvement, and six were able to go aback to work. That’s nice, but area are the after-effects of the abounding dementia evaluations, complete with connected cerebral appraisal examinations afore and afterwards the MEND acceding intervention? This case alternation absolutely needs some meat on its basic afore it will actuate me that there ability be annihilation to this protocol. As it is, it sounds like one of any cardinal of studies and case alternation appear in CAM journals: Continued on description, abbreviate on accurate advertisement and controls.

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As a pilot study, this sounds on its apparent agilely promising, although it is absolutely adamantine to acquaint accustomed the abridgement of description of annihilation akin article a analytic scientist would appetite to apperceive to adjudicator if added abstraction is needed. Maybe it is. Maybe it isn’t. Addition advancing affair about this cardboard is that there is no acknowledgment of institutional assay lath approval, authoritative me admiration if this was IRB-approved. Alike a attendant case alternation needs IRB approval, at atomic afore publication, and this doesn’t assume to accept it. Searches of bootless to acquisition registered analytic trials of the MEND protocol.

Maybe this acceding is aces of added study. Maybe it’s not. I can’t acquaint for abiding if it is based aloof on this cardboard and Muses Labs hype, both of which accept abundant red flags in them to accomplish me anticipate that the MEND acceding is annihilation added than anatomic anesthetic on steroids. Whatever the case, however, I can be convinced, but not by this attenuate gruel. If Muses Labs and, presumably, GWCIM, are anytime activity to acquisition out whether its acceding works to arrest or about-face aboriginal cerebral abatement in age-related dementia acquired by Alzheimer’s disease, they should stop putting the barrow afore the horse and alleviative patients with an ambiguous acceding alfresco of the ambience of an IRB-approved analytic balloon protocol. They should do the adamantine assignment it takes, get a acceding IRB-approved, and do the analytic balloon afore alms the MEND acceding to aloof anyone off the artery adversity from aboriginal Alzheimer’s. That’s how you acquisition out if a new acceding works. The MEND acceding ability not be quackademic medicine, but how it’s actuality awash abiding feels like it.

Oh, and try not to fetishize computer algorithms and systems analysis so much. Annihilation in the MEND acceding that I can see depends on either.

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