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J.A.H.R Claassen

Epidemiology: Friend or Foe? (... the author talks about the challenges of research into Alzheimer's disease as an example of the growth of research involving the elderly.
The author states that Alzheimer's disease is a good example of a geriatric disease that has long been ignored. In the past decade we started a frantic search for clues that might lead to its cure. Since no one really knew where to start, we asked our friend epidemiology for help. Large cohorts of elderly people were studied. Epidemiologists looked for correlations, hoping to identify factors associated with a reduced risk of dementia. And with success. They gave us, among others, hormone replacement therapy in women and two groups of drugs, statins and non-steroidal anti-inflammatory drugs [NSAIDs]. People using either of these types of drug were less likely to have Alzheimer's disease, they said.
All this inspired more research. The gold standard of evidence based medicine, the randomised controlled trial, was applied to confirm the data ... To our surprise, the randomised controlled trials gave us bad news. The drugs had no effect at all on Alzheimer's disease. How can we explain this?
What came next is puzzling. The laboratories started to publish their data. They had discovered that inflammatory processes are involved in the pathogenesis of Alzheimer's and that NSAIDs can modify these. These data were enough to indicate that both drugs do have the potential to reduce the risk of the disease in certain patients.
So, where does this leave us? We started out looking for clues to a cure for Alzheimer's disease. With the help of epidemiology we found several. Unfortunately, not one of them has turned out to be useful, despite lots of research effort. What we are left with is a number of new hypotheses. So how should we judge epidemiology in this case: friend or foe? Other keywords and phrases -- geriatric, geriatrics, HRT -- from the text of the article)

BMJ--British Medical Journal Volume 329, Number 7463 (August 21, 2004): page 467.

**The complete text of the article is available at http://bmj.bmjjournals.com/cgi/content/full/329/7463/467?ct (the Web site of BMJ--British Medical Journal)**

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Added 5:00 p.m. CT August 24, 2004
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