Morning Rounds: Health Care And Alzheimer's: Details Matter

The flurry of news about Alzheimer's disease this week and the blizzard of health legislation news blowing down from Capitol Hill should prompt the same reaction in careful readers. First: Read between the lines. And second: Hold your applause until the end.

For example, on the health care front, Senators Christopher Dodd and Orrin Hatch told Morning Edition's Steve Inskeep that they're committed to working together on health care legislation, though their vote on the bill coming out of their committee yesterday was strictly partisan. This wrestling match is far from over.

As for Alzheimer's:

More than 3,000 brain researchers are gathered in Vienna this week to mull over the latest in Alzheimer's research, and the association sponsoring the meeting has been churning out press releases, which is largely why there's been daily news. One study getting a lot of press suggested that moderate drinking could curb one's risk of getting the illness; another said having combat-related PTSD could increase the risk.

The New England Journal of Medicine published (probably not coincidentally) its own newsy Alzheimer's study today on genetic testing for the disease.

It's been known for years that people who have inherited two copies of a particular variant of a gene linked to cholesterol metabolism — ApoE -e4 — are much more likely to getting Alzheimer's dementia. But doctors have just as long discouraged people from getting the test because a) it's not a perfect predictor and b) there's no preventive treatment for the disorder. Getting tested under such conditions, doctors thought, could prematurely devastate perfectly healthy people who got bad genetic news.

The NEJM study suggests people getting such news actually don't panic. "This has upended those assumptions," Boston University's Dr. Robert Green, who headed the study, told the New York Times.

But before you race out to get the test, there are big caveats to consider.

(Problems with the study detailed after the jump)

Anybody with clinical depression or anxiety — two groups who might be expected to be particularly vulnerable to despair after getting bad genetic news — was screened out of the study. Also, all the 162 people who got tested had close relatives with the illness, and many already (often mistakenly) assumed pre-test that they were destined to get the illness. The extensive counseling they got about pre-test (which doesn't always happen outside a research study) actually settled their nerves that having a sibling — or having the ApoE-e4 gene — doesn't guarantee illness. It was the counseling that calmed them, not necessarily the test results.

There are reasons getting the ApoE test could be a bad idea, as Web MD points out. If the test result is in your medical record, it could preclude your ability to get long-term-care insurance, or life insurance.

Beth Peshkin, a Georgetown University genetic counselor, told AP that her father has Alzheimer's, but she's still not tempted to get tested.

I would be one of those people that the first moment I couldn't remember someone's name, I'd think 'Oh God, here it comes.' I'd rather not know.



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