We’ve written before about some of the new scanning techniques that allow visualization and measurement of amyloid deposits in the brain, and how these might relate to Alzheimer’s disease. We know Amyloid-beta plays a role, but as you also know if you’ve been following this blog for even a short period, the relationship is pretty complex. Now, The Centers for Medicare Service CMS released a statement on July 3 saying that it is proposing coverage with evidence development (CED), which allows use of this scanning technique only for patients in clinical trials addressing the effectiveness of these scans. That is, they are not widely approved, but instead are approved in the context of studies looking at their utility.
As you might imagine, this decision has been met with mixed reviews depending on the stake you hold in this process. Some organizations that advocate for Alzheimer’s patients have loudly assailed this as a “bad” decision, arguing that it will delay diagnosis and treatment, which we know are important even based on yesterday’s blog.
Others, however, support this decision. The rational minds on this side of the argument emphasize that we don’t yet know how to use this new technology, and that many people without Alzheimer’s disease show abnormal levels of amyloid on the scans. Thus, there could be a tendency to over-diagnose or confuse things even further.
What’s our take? Well, as with everyone else, it probably depends on who you ask. Ask this point, though, I think there is still too much uncertainty with the technology for it to be of significant benefit. Most clinicians aren’t going to treat on the basis of a positive amyloid scan, instead deferring to other data that are already available. Now, don’t get me wrong. This doesn’t mean that I think this technology is without merit. I just think that we need to be a bit more thoughtful and let the data become more solid before we use it on a daily basis, and delaying it’s use isn’t likely to change diagnosis or treatment one way or the other.
Just my thoughts on a hot topic.