G Robert Jones
Cancer Research Unit
UK
Title: Over a century of Alzheimer and still no cause in sight: Is pharmacovigilance asleep on the job?
Biography
Biography: G Robert Jones
Abstract
Although Alzheimer’s disease (AD), initially of rare idiopathic origin and characterized by Pinel in 1800 as chronic dementia, is now a major threat to global health, the number of publications pointing to an iatrogenic case remains in single figures. In 1971 Murray associated the typical lesions of AD with high lifetime intakes of phenacetin by kidney dialysis patients. The gradual replacement of the analgesic by paracetamol, its chief metabolite, and its removal from the UK pharmacopoeia in 1974 failed to check the exponential rise in patient numbers, not until 2001 was the suggestion made that the metabolite is also a risk factor. Phenacetin first went on open sale in 1887; its nephrotoxicity was reported in the following year. Chronic dementia was rediscovered by Fischer and Alzheimer in 1901, and given a new name in 1910. Significantly, the earliest cases displayed kidney damage ranging from nephritis to organ atrophy. The cunning abilities of AD to obliterate memory and to masquerade as senility with varying degrees of success, as well as the long silent period elapsing between analgesic exposure and the overt expression of symptoms, have together contributed to the failure to recognize a pharmacological cause. There is no evidence to support the widespread belief that the rising incidence of AD is a consequence of increasing longevity. Missed opportunities will be described and discussed.