Jason Karlawish is a physician and writer.
He researches and writes about issues at the intersections of bioethics, aging, and the neurosciences. He is the author of The Problem of Alzheimer’s: How Science, Culture, and Politics Turned a Rare Disease into a Crisis and What We Can Do About It and the novel Open Wound: The Tragic Obsession of Dr. William Beaumont. His essays have been published in The Wall Street Journal, The New York Times, Forbes, The Hill, The Los Angeles Times, The Philadelphia Inquirer, STAT, and The Washington Post. His STAT column Neurotransmissions examines the vast problem of dementia. A Professor of Medicine, Medical Ethics and Health Policy, and Neurology at the University of Pennsylvania, he is co-Director of the Penn Memory Center, where he cares for patients, and executive producer of the Age of Aging, a podcast that examines how to live well with an aging brain. He lives in Philadelphia.
Jason Karlawish writes STAT’s Neurotransmissions column
“Diagnosis is interesting. Treatment is exciting.
I’ve fond memories from early in my career prescribing medications that within minutes relieved patients smothering from congestive heart failure, pulled them back from near death from septic shock, or slowed the progression of their diabetes or heart disease. In my fellowship, my prescription of carbidopa transformed the first patient with Parkinson’s disease I diagnosed. After he went from the “utter misery” of house-bound days to happily walking about the neighborhood with his wife, the couple called me their miracle worker.
My career treating people living with dementia hasn’t been as exciting. Some days, after spending an hour or more with a patient and family, I’d reflect upon the care I’d given. I’d prescribed no medications. The dementia pharmacopeia was a short list of medications to mildly palliate cognitive symptoms and relieve depression and anxiety.
I think this lack of excitement is one reason for, as I recounted in the essay that opened this series, my acquaintance’s quip he’d take a test for Alzheimer’s if it came with a gun license, and why Brian Ameche traveled to Zurich to take his lethal dose of pentobarbital. My friend’s remark and Brian’s death by his own hand are vivid responses to doctors like me. We offer no treatment that can change the relentless chipping away at consciousness that is dementia.
Lack of excitement is also why, for years, our Penn Memory Center fellowship program had just one or two applicants. One year, the solitary applicant recounted in her interview how her career plans baffled her fellow neurology residents. “There’s nothing you can do for the patients,” they pestered.
She, like me, disagreed. Dementia diagnostics — giving facts to help a patient and caregiver make sense of and come to terms with mysterious mental experiences — is intensely rewarding, and as I argued in the second essay in this series, the advances in biomarkers have amplified this reward.
Still, those residents had a point. Patients didn’t want to come to a memory center, and physicians weren’t lining up to train with us. Treatments like the ones I prescribed during my general medical training could change all these sentiments, and in the past two years, that’s exactly what’s happening. We’re prescribing treatments that target one of the pathologies that cause Alzheimer’s disease. All of a sudden, dementia treatment is becoming very exciting.
And this feeling is changing behavior. Last year, nine residents applied to our fellowship program. Each explained the same reason: biomarker-based therapeutics. And they should feel excited because patients and caregivers are excited too. Requests for new patient visits have skyrocketed. My colleagues and I struggle to keep up, but we do.
Because we’re excited...”
To continue reading, click on “READ THE LATEST COLUMN” & for a bonus essay, read “Why at-home Alzheimer’s tests may do more harm than good” in The Philadelphia Inquirer
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