In February, a proposal was made to diagnose Parkinson's disease based on the presence of α-synuclein accumulation, even in the absence of specific clinical symptoms. This proposal follows a similar trend observed in other neurodegenerative diseases. Clinically, this approach is somewhat controversial as it would label asymptomatic individuals as diseased. Furthermore, it raises questions about why individuals in good health would seek medical consultation.
This follows a similar trend in other neurodegenerative diseases.
This initiative may be driven by the pharmaceutical industry's frustration over unsuccessful clinical trials. By using molecular criteria, clinical trials could achieve higher success rates, despite the persistence of clinical symptoms. This strategy is already evident in the Alzheimer's field, where several drugs have been approved without significantly alleviating symptoms.
This reflects a situation with disease animal models which are successfully cured by many proposed therapies but when those therapies are applied to humans they fail.
The proposal has not been universally welcomed but is likely to gain approval from regulatory bodies due to pressure from patient associations and the pharmaceutical industry to demonstrate progress.
Here is a small list of readers' reactions and answers by authors:
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(24)00211-4/fulltext
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(24)00212-6/fulltext
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(24)00213-8/fulltext
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(24)00214-X/fulltext
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(24)00215-1/fulltext
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(24)00217-5/fulltext
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(24)00222-9/fulltext
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(24)00225-4/fulltext
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(24)00233-3/fulltext
From a political and economic perspective, this approach is problematic. It would lead to the treatment of healthy individuals in an already overburdened healthcare system. Additionally, these treatments are expected to be very costly while being ineffective on clinical symptoms.
We went too far into a mechanical and technological vision of medicine led by molecular biology.