The pharmaceutical industry and dementia: how can clinicians, researchers and industry work together ethically for the betterment of people with dementia and their families?

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If I have seen further it is by standing on ye shoulders of Giants.

Sir Isaac Newton, 1676

The therapeutic advances that have improved the lives of individuals with dementia, most notably Alzheimer’s disease (AD), are the culmination of scientific innovation emanating from very distinct sectors of the scientific community. The successful ‘handoff ’ of scientific information seemed, in a sense, well orchestrated albeit not pre-planned. While academic health-care investigators demonstrated a critical deficiency of the neurotransmitter acetylcholine in the brains of AD patients in the 1970s (Davies and Maloney, 1976; Davies and Verth, 1977), the use of available agents such as choline supplements did not have the potency or suitable drug characteristics to meaningfully improve the lives and memory

of AD patients. In parallel, the pharmaceutical industry, recognizing the importance of the structural and biochemical derangements in the brains of AD patients, was able to produce a class of therapeutics known as cholinesterase inhibitors (ChEIs). Initial reports (Summers et al., 1986) necessitated a standardized approach to evaluation of dementia drugs (Leber, 1990). After successful multicentre randomized trials (e.g. Davis et al., 1992), tacrine was the first drug that was approved in 1993 by the United States Food and Drug Administration (FDA) and heralded a major advance in the treatment of people with Alzheimer’s disease, the ChEIs.