Treating Dementia

I found this to be a heartening story, which brings together my long-standing involvement with Cuba and my more recent concern with Alzheimer’s, after first a cousin and then my brother were afflicted by the disease.

The big pharmaceutical firms in the Global North have spent billions of dollars over several decades trying to develop drugs for Alzheimer’s, with only limited success. Cuba, which is prevented by the blockade from accessing US drugs, set up its own biotechnology institute in the 1980s. Despite the constraints it is under, it has since produced successful vaccines for various cancers, meningitis, and hepatitis B, not to mention COVID-19.

I first learned about the initiative soon after it was set up. During a break in filming a report on Cuba for Britain’s Channel Four, I was taken on a visit. At the time, I was ignorant of biology and ill-equipped to understand what the researchers at the institute did, but I continued to follow their activities from a distance, so the news of the new vaccine did not come as a surprise.

Dementia in its various forms, of which Alzheimer’s is the most common type, presents particular difficulties. The cause of the disease remains unknown, and the effect of the drugs so far developed is small and short-term. Moreover, the drugs only have an impact at all if they are administered in the early stages of the disease, and they also carry the risk of serious side effects.

The trouble is that dementia is difficult to diagnose early enough to make a difference, and the urgency is growing. Alzheimer’s strikes in old age, and the Cuban population is aging, for multiple reasons that include the emigration of younger generations and a low birth rate. As the film shows, to develop a vaccine and test it to international standards under these circumstances is a remarkable achievement.

Documenting Alzheimer’s

Teresita’s Dream also calls attention for its account of the process of the drug’s development. I have been writing a book about the representation of dementia on screen around the world. There are dozens of fiction films, and hundreds of documentaries, short and long, many of them instructional and educational. Some are creative, first-person portraits of individual sufferers, while others, like this one, take the form of investigative reportage.

One learns a great deal from these films about living with dementia, including both the symptoms of cognitive decline and the burdens that fall on caregivers. But they tell us very little about medication and nothing at all about the research and development that goes into it, which is the main focus of Teresita’s Dream.

The new Cuban treatment is one of numerous drugs currently undergoing trials — according to one recent report, as many as 180. Trials follow the stringent protocols laid down by the US Food and Drug Administration, which serve as the international standard. They require three phases that take years to accomplish; few candidates survive to Phase III.

The growing number entering trials is explained by the failure of drugs based on the dominant model. This model goes back to 1906, when dementia was first recognized as a disease and not merely a liability of old age by Alois Alzheimer, after whom the disease is named. Alzheimer discovered rogue proteins in the brain of a patient after her death.

Further research was hobbled until the development of the neurosciences after World War II, which gradually revealed anomalies in the supposed course of the disease (some people had the rogue proteins without showing the symptoms). The pharma industry ignored those anomalies until researchers observed that some drugs developed for other purposes showed neuroprotective qualities.

Teresita noticed one of them, under development in Cuba for brain diseases such as Parkinson’s, whose preliminary trials showed an absence of side effects. She realized it might help Alzheimer’s sufferers like her mother and arranged to join the team.

For three years, she used the drug to treat her mother, of whom she speaks very movingly. She shows us photos, talks of how she saw an improvement in her symptoms, and we even see evidence of this in a snippet of home movie footage that shows her dancing.

This led to clinical trials in Alzheimer’s patients at a care center in a town near Havana involving 174 subjects. Thirty percent were stabilized and 54 percent improved, while no side effects were detected.

As the trials move into the next phase, involving almost 1,500 subjects across the country, the film follows the standard format of the investigative documentary, broadening out to include interviews with Teresita’s colleagues and following Teresita on visits to patients and their families, who speak of remarkable improvements.

Preconditions for Progress

The underlying causes of dementia remain obscure. The new drug is not a cure, and it’s too soon to tell how efficacious it will prove to be in the long run. Yet from what we see in this film, it holds out the promise of relieving a good part of the burden the disease brings to sufferers, their families, and the care system.

This is more than can be said for the latest drugs from the pharmaceutical giants in the United States and other countries to gain final approval. Britain’s National Health Service has not adopted those drugs because they are too expensive, their effects are short-lived and barely noticeable, and they need constant monitoring for side effects.

This is the result of a fragmented system of drug development dominated by commercial interests. Within that framework, scientists set up research labs to siphon off government funds in the hope of selling their efforts to the companies that carry out the trials and then charging exorbitantly if they get through (many are abandoned as futile).

The lesson of the film is that Teresita’s Dream can only come true in a country with a fully socialized and integrated health system free of capitalist interests. At the end of the film, Teresita says she would like to see the vaccine commercialized abroad but wonders who might take any notice.

She doesn’t need to spell it out. Certainly not the United States, however much it could help to relieve a broken care system. On a more optimistic note, I have seen reports of a new cooperative venture in biopharmaceuticals between Cuba and China for the production of innovative drugs for cancer as well as autoimmune and neurodegenerative diseases.