Alzheimer's | What if dreaded disease isn't really a disease?

"The Myth of Alzheimer's: What You Aren't Being Told About Today's Most Dreaded Diagnosis"

by Peter Whitehouse M.D. with Daniel George

St. Martin's Press, 317 pp., $24.95

Susan Sontag's brief, incisive book "Illness as Metaphor" arrived 30 years ago, and its revelation has stayed with me ever since: Certain diseases — tuberculosis in the 19th century and cancer in the 20th — carry the burden of societal fears, which unfairly tar those who become sick with these culturally freighted illnesses. Sontag wrote this superb piece before the advent of AIDS, but our benighted responses to people infected with that virus underscore her point.

Now, Dr. Peter Whitehouse calls on us to consider "The Myth of Alzheimer's," writing a book that I believe Sontag would recognize and welcome. Whitehouse makes a well-reasoned, radical argument that Alzheimer's disease is a false construct, a 100-year-old mistake, a net thrown over what happens to us all — an aging brain.

In clean, clear prose, Whitehouse, an expert on aging at Case Western Reserve University, and his research assistant, Daniel George, state flatly that "Alzheimer's is not a specific brain disease. It can neither be diagnosed definitively in life or death nor does it have one basic defining pathological feature."

Tell that to Ronald Reagan and Aaron Copland, Sugar Ray Robinson and Iris Murdoch, the reader is apt to think. But the authors insist even these famous cases of failing memory and decline are fixed on a continuum along which we all slide.

"Remember," they write, "some decline of our brains over time is an invariable, some might say an essential, aspect of who we are as mortal human beings; cognitive decline actually validates that each of us is a living person, not that we are ceasing to be one." Talk about a mind-bending assertion.

In his preface, Whitehouse, 58, weighs his own culpability in the "Alzheimer's Empire." He describes the terse diagnosis and quick prescriptions he dispensed early in his career in contrast to the label-averse, holistic medicine he practices now. He discloses that consulting for drug companies earned him "well over a total of a million dollars in personal income over the course of my career."

With this book, Whitehouse stakes his considerable reputation on repudiating the hand that fed him.

He reports from behind the scenes that many doctors express private misgivings about the "monster" they have helped create. The book follows the history and the money, noting that in 1979, the nation spent $4 million on Alzheimer's research. In 2006, federal expenditures reached $700 million, even as a "cure" remains elusive.

"The Myth of Alzheimer's" makes for frank reading. Whitehouse charges that, from the beginning, researchers, pharmaceutical companies and advocacy organizations trafficked in "the politics of anguish" to turn on the public spigot.

"Many of us in the field worry that the pursuit of truth has been eclipsed by the pursuit of raising funds," Whitehouse writes.

Greed may grease the lab equipment, but what makes this book worth reading is its thoughtful consideration of Sontag's thesis — what stigma has done to evoke fear and separation for millions of people given this culturally fraught diagnosis.

In 1990, Janet Adkins, of Portland, was beating her grown sons at tennis when told she had Alzheimer's. She telephoned Jack Kevorkian to set up becoming, at age 54, Kevorkian's first assisted suicide.

"The Myth of Alzheimer's" does a deft job of bridging C.P. Snow's two-cultures divide.

It dips into the observations of William James, Rachel Carson and Anton Chekhov and tours "science and treatment" for 60 eye-opening pages.

Whitehouse reports candidly that he experimented with taking donepezil in 2002, partly because he was curious about reports that it enhanced cognition across the board, and partly because many of his patients were on it. It came to naught.

The authors indulge the academic tic of repetition and slip into advice mode for the final three chapters. The chapter "Preparing for a Doctor's Visit" adds value, but it dismayed me that the publisher is marketing this challenging book under "diet/health."

So skip the advertising and go directly to the first page. "The Myth of Alzheimer's" encourages us to recast our stories about mental decline, to make room for prevention and wisdom and intergenerational care as the true yardsticks of hope.

Karen R. Long is the book editor for The Plain Dealer of Cleveland. She can be contacted at klong@plaind.com.