Some of you might be aware that the Merck Manual is considered the world's premier medical textbook.
For some odd reason a year or two ago they thought that we were past the era of print and decided to
stop paper publication; fortunately the people (through mass protests etc.) were able to convince them
of the foolishness of their ways and the print edition was reinstated. Somehow the chant "Take our money, please!"
was able to correct the misguided policy.
I was interested to see what the online Merck Manual (Professional Edition) might report on Alzheimer's disease. I kid you not, the Manual does not consider Alzheimer's Disease the proper nosological term for er Alzheimer's Disease, apparently the currently woke term is Alzheimer Disease (apostrophes are now so outré). The Manual does a reasonably good job of briefly summarizing the main aspects of Alzheimer's and does an admirable job of integrating multimedia (including video to the webpage). Adding a simple mental status test (perhaps different enough from the MMSE to avoid copyright infringement) would be a nice touch. Nothing overly complicated, perhaps a digit span test and orientation to time and space etc..
Nonetheless, I think they need us. For what can "Also, they do not recommend routine testing for the apo epsilon-4 allele." be other than a cry for help? Um, not recommend testing when effective is now effectively on our doorstep? Considering that the aducan trials are going open label this month with all patients being treated, it would not seem entirely unreasonable to me if the FDA might at some point just throw in the towel and allow for marketing aducan on an as is basis. That is "as is" with reference to the extensive safety information that has already been reported and the substantial evidence for efficacy that has already been reported. This might not be completely realistic in terms of how the regulatory process functions, though from our perspective of Alzheimer's advocates it would seem very appropriate.
Perhaps what we could do is port the Merck page to the forum and then remix and annotate it. The idea is that we could add layers to the basic page in order to expand out the basic presentation. For example, there was no mention of polygenic scoring, or surprisingly the word hippocampus (!). Did they really forget to include the word hippocampus in an article about Alzheimer's? I think a brain map that showed how Alzheimer's Disease affects the brain would be very helpful. As would a karyotype showing the regions that have been associated with Alzheimer's risk. Typically the Merck likes to have brief summaries including only clinically actionable information and not encyclopedic coverage with information of dubious relevance, though there would seem to be a great deal of highly useful information that has been omitted. I think a brief mention of aducan as an essentially proven Alzheimer's therapy would not be out of order. It would seem that we have now already reached the time in which effective treatment for Alzheimer's Disease has largely arrived.
Comments and suggestions please!
https://www.merckmanuals.com/profession ... er-disease
