I’m sitting in an office at the clinical trial location bored out of my mind. The battery on my phone is low so I can’t play a game and the doctor who is supposed to do my physical is late.
I have had the requisite blood draw. Ian is a magician. His shots never hurt.
They did another neuropsych exam to see if my mental functioning is up to par. It’s the same test they do every time. Lucky, considering the human need for novelty, it is not the same test that the longitudinal study administers. In this one, they ask you things like, “Take this paper in your right hand, fold it in half and put it on the floor.” Or they ask you to Draw this complicated shape, then thirty minutes later draw it from memory. They spoke a list of words and asked me to say them back. This is where that memory palace I mentioned in the last post might come in handy but the best I can do is try to construct sentences out of them. Meaningful words are easier to remember.
I want to know the results of the MRI. I have asked questions in the past but only about 50% have been answered. I suppose this is the tradeoff of a clinical trial. I am receiving extraordinary medical care but the doctor’s loyalties are divided among me and the science and the entity funding the study.
I would imagine this is a delicate balance and there were terrible abuses in the past. The Tuskegee syphilis study where black men were untreated for their disease is a particularly egregious example. This is one of the cases that led to laws requiring informed consent, communication of diagnosis and accurate reporting of test results. In other words, in 1972, ethics became a mandate for clinical trials. Whew!
Dr. S finally got away from his previous patient and came to visit me. He’s a nice man who is running several neurological studies, most of them ALZ related. He seems excited about his research. He does a basic neurological workup. Can I follow his finger without moving my head? Can I touch my nose with my right index finger with my eyes closed? Are my muscles equally strong on the right and left side of my body? I’m doing fine.
I asked him about parasites. There is an anthropological study called the Tsimane Health and Life History Project studying the Tsimane people in Bolivia. They have found many interesting things. Remember that pesky Apoe4 gene that qualifies me for this clinical trial? These guys found out that people of the tribe that have the Apoe4 gene and parasite infections are doing just great. Those without parasites get ALZ just like the general population. Where parasites are concerned, Apoe4 seems to be protective.
In an evolutionary sense, the Apoe4 gene may have grown in this population because it benefitted and protected people with parasite infections. Now that we are all so clean and tidy, the gene helps our big immune systems attack our brains. That’s the theory at least.
I asked Dr. S what he thought about me getting a hookworm infection. He was very uncomfortable. Doctors don’t like infecting people with parasites.
We talked so long that I almost forgot to ask him about my MRI. He told me the results were unremarkable. That’s doctor-speak for, “Yay! Everything is normal.”