Framing a health issue through comparisons to warfare is common
in popular media and medical and research communities. Using war metaphors in reference to Alzheimer's disease should be
replaced with messages of resilience against a complex, age-associated
condition that may not be fully defeatable, suggested a team of
While it can
motivate efforts to deal with the issue, this type of language and
messaging can also create fear and stigma, turn patients into victims
and divert resources from critically important prevention and care, said
Daniel R. George, assistant professor of medical humanities, Penn State
College of Medicine.
‘Using war metaphors in reference to Alzheimer's disease should be replaced with messages of resilience against a complex, age-associated condition that may not be fully defeatable.’
Despite decades of failures in Alzheimer's drug development,
scientific attention continues to focus on drugs that "attack" a
molecular compound called beta amyloid, with the goal of curing the
disease. Amyloid is a key component of the plaques in the brain that are
a hallmark of Alzheimer's disease.
Research, however, shows that the
appearance of amyloid does not correlate with clinical symptoms and beta
amyloid has repeatedly been found in the brains of one-third of
"normal" elderly people. This suggests that amyloid may be a symptom
rather than a cause of damage.
A growing number of researchers believe
that declaring "war" on Alzheimer's by "attacking" amyloid may
ultimately be an exercise in self-harm, particularly if amyloid is
representative of the brain's repair response, and may be channeling
resources away from other drug-based approaches that do not assume
Scholars have argued that metaphors and narratives that treat
disease as something to be attacked can be socially damaging to those
affected. The value of such metaphors may be clearer for infectious
diseases caused by single pathogens. It becomes more problematic when
discussing diverse, age-associated syndromes like Alzheimer's that may
not be fully curable. In this way, war metaphors in medicine can invite
ways of thinking that may not be scientifically or socially productive.
"If applied in a careless manner, war metaphors can delude our
sense of what's possible therapeutically, and give false hope to people
and caregivers who are suffering," George said.
George and his co-authors propose moving toward different types
of metaphors - those that encourage use of words like "slow" or
"postpone" rather than "prevent" or "cure," and emphasize building
"resilience" to aging processes in the brain rather than aiming at
"absolute victory" over a disease.
While "fighting" and "defeating"
Alzheimer's through drug development is important, the authors argue it
may be wiser to acknowledge that Alzheimer's is not a disease
disconnected from the aging process like polio or malaria. The authors
note that Alzheimer's has been classified as a disease for the past 40
They suggest it may be more beneficial to take a
lifespan-oriented approach that includes education about known
biological, psychosocial and environmental risk factors, investment in
societal programs and infrastructure that support brain health, and
ensuring proper care for those affected and their caregivers.
"While not as profitable as drug development, public health
initiatives that reduce vascular risk factors, modulate oxidative stress
and inflammation, guard against traumatic brain injuries, promote
social engagement and lifelong learning, and reduce exposure to
neurotoxins, and other commonsense actions should be an explicit
component of our societal response (to Alzheimer's)," the researchers
wrote in the American Journal of Bioethics
George drew particular attention to the residents of Flint,
Michigan being exposed to lead, a neurotoxin, through the water supply.
"It is inexcusable that we could let our public infrastructure
fail to the point where it becomes a contributor to Alzheimer's disease
risk for socio-economically disadvantaged citizens," George said. "If
we're really serious about addressing the problem of Alzheimer's, we
must start by not poisoning our citizens."
Moving beyond the notion of being at war against Alzheimer's could also serve to humanize cognitive aging.
"There's a widely-accepted myth that people who have Alzheimer's
are sort of non-people, akin to zombies," George said. "There are ways
to construct meaning around memory loss that show greater compassion and
solidarity toward people with cognitive frailty rather than seeing them
as passive victims in our biological war against the disease. We
believe in a more humane message - that even if you have a diagnosis of
'probable Alzheimer's' you can still have a life with deep purpose,
social contribution and meaningful relationships."