“Do you ever get in a car and get lost?”
The doctor stares at me from across the desk.
“Apart from being forgetful — and everybody’s forgetful — do you have any transient episodes where your brain’s not working and it scares the heck out of you?
“How do you sleep?
“Do you feel energetic when you wake up in the morning, or do you feel like it’s a chore to get out of bed?
“How fatigued are you during the day? Let’s say you go for an appointment and you’ve got to wait for somebody because they’re late, and you’re sitting in a comfortable chair. Do you nod off to sleep?
“Have you ever suffered from depression?
“Have you ever suffered from anxiety or panic attacks?
“Do you ever wake up at night with cramps in your legs or weird sensations in your legs where it keeps you awake?”
This is the Mini Mental Status Examination, created to see how sharp your “cognition” skills are, and Dr. Joseph Abramowitz, anesthesiologist, internist, tribal physician, prison doctor, rebel, thinks that, as a form of Alzheimer’s triage, it is garbage.
Not only that, but he also thinks he may have discovered a way to pull people in the earliest stages of the incurable disease back from the brink.
Not that the medical establishment has sat up and embraced him or his ideas. Medical journals reject his submissions. Specialists don’t seem to appreciate him bringing his ideas to “their” field.
Abramowitz is not at all surprised by this. “I have no friends in medicine who I call colleagues. I have friends who are doctors. I’m a loner. Because if I wasn’t I’d have to buy into their crap.”
Abramowitz, who comes from a distinguished medical family in South Africa, has had a colorful medical career that has stemmed from half-million-dollar positions as internist and anesthesiologist, to medical director of the Southern Indian Health Council in Alpine and urgent care clinics. He also has his own private practice in Chula Vista.
But all through, he has privately pursued the onrushing tidal wave of Alzheimer’s and early-onset dementia that seems to be turning into the AIDS epidemic of the 21st Century.
I first came across Dr. Abramowitz when he sent this letter. “I am a physician in San Diego who conducts clinical research in Alzheimer’s disease. I have made an interesting discovery which I feel certain is very relevant. I am not claiming to have cracked the case, but I have discovered something very significant which has been ignored by mainstream medicine.... I cannot get anyone to take me seriously....”
I didn’t know it would end with me being put in the hot seat to see if I had any symptoms. I can’t tell you how scary that scenario is.
It began with a meeting on the jungle-like deck of Krakatoa eatery in Golden Hill. He was still in his green hospital scrubs. He had flown down like that from a stint at an urgent-care clinic up north.
He was just as I expected a doctor to be who is claiming to have a handle on the medical world’s biggest mystery. Spikey, with the quick eyes and the lightning intellect of an anti-establishment fighter, capable of drowning you in medicalia and then suddenly swerving off into wild and crazy impersonations.
“NOBODY expects the Spanish Inquisition! Our weapons are surprise. Surprise and fear. Surprise, fear, and ruthless efficiency. Surprise, fear, ruthless efficiency, and an almost fanatical devotion...”
He has Monty Python totally down. He inherited the British-style humor from his South African upbringing.
“I had a very privileged childhood as a second-class white, because being Jewish was not accepted amongst [the white establishment]. My father was an obstetrician and gynecologist who did part of his training in England. My mother’s father was the youngest of 11 children from Russia. About half of them were pharmacists. His brother made a fortune by developing a combination of aspirin and [what was known as] phenacetin, which is now no longer used, and it’s Tylenol and codeine. And the product was called ‘Grandpa’s Headache Powders.’ About 1957, he sold out to Beechams, and they paid royalties to him and his successors for 50 years.
“So, I had no thought about looking at [dementia, Alzheimer’s disease, and thyroid causes], and in my book Patienthood the first case report is about a patient whom I interviewed as a medical student, who had a thyroid so big that he could have turned it around and used it as a pillow in a plane. And I didn’t see it. I looked straight at him for 45 minutes and I didn’t see it. He had a toxic diffused goiter. He had an over-active thyroid. Most goiters are related to under-active thyroid. Hypo. Yet I had looked straight at it for 45 minutes and I had missed it.
“That, I’m afraid, is called training. Or rather lack thereof. That is why people have to train for such a long period of time, when there are so many other things in medicine far more subtle, which have to be recognized intuitively.
“During my fourth year in medical school were the Soweto riots. Up till then I had always had an ongoing dilemma about what I would do when I graduated. Whether I would stay and train in South Africa or whether I would leave. And once the Soweto riots came, it was clear what I had to do. Get out. So, I graduated in 1978, and I did an internship at the Grootschuur Hospital in Cape Town and left for London.
“I was only really turned on to this thyroid stuff in the last five years or so. My friend S.K. is one of the top diabetes researchers in the country. He’s up at the Puget Sound V.A. And he doesn’t know squat about the thyroid. He’s so sub-specialized in diabetes. And as an endocrinologist he’s supposed to know almost as much about the thyroid and thyroid issues as he does about diabetes. Because the thyroid is an endocrine gland, just like the pancreas.
“And this is important because this gets to the heart of one of the key reasons why doctors haven’t figured this out. Because they are so specialized. So, the neurologists think of their neurology in a vacuum. And the endocrinologists think of thyroid hormones in a vacuum. And never the twain shall meet. I don’t think that my discovery makes me particularly brilliant. I’m just a smart guy who thinks outside the box, with an IQ just under 130, not particularly high.”
So, how about his theory? He admits he’s not a specialist in endocrinology or neurology. And those are the two disciplines that count. Endocrinology is about hormones, endocrine glands, and especially the thyroid, which controls energy and keeps paths to the brain cleared of amyloid cloggers.
And, of course, neurology is about the brain, so knowledge of the two is vital.
“Here’s what I believe. And I don’t think you’ll find another doctor on the planet to agree with me on this: the Achilles heel of the human race is thyroid hormone under-activity. And if you are a female born into this race on this planet, you have a 90–95 percent risk — at some point in your life — that you are going to develop some symptom, either transiently or permanently, related to low-thyroid hormone function in one or other organ. Brain, muscle, intestines, heart, nerves.
“And if you’re a male, born into this species on this planet, probably your risk is about 80 percent. People have described thyroid abnormalities during pregnancy, both high and low. But nobody has put forward a hypothesis that thyroid hormone aberrations in pregnancy are the rule rather than the exception and that their effects last a lifetime. They’re not just transient. But, yes, this is pure speculation on my part. It’s circumstantial.
“Now, in order to prove this hypothesis, we’d have to take probably 400–500 young women finishing high school, and we would have to get them to consent to a lifetime of thyroid hormone replacement. One group would have it, one group would not. And we’d have to study these women for 20–25 years. So, this study probably will never happen. But it’s just so common. The effects of multiple pregnancies are cumulative. There may be issues in the first pregnancy, but more likely during the second or third. [They can happen] during pregnancy, around the time of delivery, and there’s longer term.
Dr. Abramowitz, thyroid disorder, and Alzheimer's Disease
Dr. Joseph Abramowitz discusses his conception for diagnosing, preventing, and treating Alzheimer's Disease in humans through focusing on thyroid hormone, tri-iodothyronine (T3).
“Any endocrinologist, any doctor will be able to pick this [idea] up and figure out what it is. The problem is when it gets to the most sophisticated levels of having to put things together and figure them out, they can’t do them because their view is so narrow.
“Alzheimer’s certainly needs help. Over five million people are living with it across the country, 11 million unpaid caregivers help look after them, it’s costing the nation $172 billion every year, and numbers are rising: in the first decade of the century, Alzheimer’s deaths rose 66 percent, according to the Alzheimer’s Association, while deaths from other diseases have been dropping (HIV deaths have dropped by one third in the last ten years). San Diego County has nearly 50,000 people living with Alzheimer’s. In California, the number of people suffering from the disease will nearly double by 2030. Worldwide, 135 million people could be suffering from dementia by 2050. And yet while our National Institutes of Health fund cancer research to the tune of 6 billion dollars a year, Alzheimer’s only gets $480 million. One twelfth. And while deaths from some cancers, like prostate, are starting to drop, there’s no such reversal on the horizon for the ‘Baby Boomers’ disease.”
An avocado, which chooses this moment to fall from the tree shading us, just misses my coffee cup and focuses our attention.
“So,” I ask, “have you got a cure for Alzheimer’s?”
Dr. Abramowitz rifles through his bag, brings out a sheaf of papers, and slaps them down in front of me.
“Application for Utility Patent,” the top page reads.
“Name of Inventor: Joseph Michael Abramowitz.”
“Title of the Invention: Method for Prevention of Alzheimer’s Disease.”
So, he is seeking a patent for his “invention?”
The abstract reads: “The principal cause of Alzheimer’s Disease (AD) is a deficiency at the cellular level of the human brain, of the effects of the active form of thyroid hormone, tri-iodothyronine (T3).”
Then he gets to his idea. “Lifelong T3 replacement, beginning in early to mid life and, in some cases later, overcomes these blocks to T3 production and actions and prevents AD in a majority of the sub-types of AD.”
Impressive. But I don’t understand.
“For starters,” I say, “where is the thyroid?”
It turns out it’s in your neck, right below the Adam’s apple. It controls how fast the body and brain use energy. It produces thyroid hormones (T3) to make this all happen.
So, why this explosion of Alzheimer’s? The Industrial Age? Car exhausts? The pesticides in our lettuces?
“Actually,” says Abramowitz, “it was always there. Just remember, with the human body, we’ve been driving the same model for 100,000 years. So, back in the day, our life expectancy was 37. So, there’d be no prostate cancer, there’d be no Alzheimer’s disease, because we were either young or we were dead. It’s a function of life expectancy.
“But today, we have other stresses — women do, particularly, and it’s mostly women who get Alzheimer’s. I’m guessing pregnancy and repeated pregnancies destroy the thyroid system. I’m only guessing. That has to be studied. We have to study women from adolescence to menopause...a group that never get pregnant, and a group that have multiple pregnancies and live births and compare them. That’ll be the only way to study this. And I don’t think that’s ever been done.”
But curing dementia?
“I’ve been interested in hypothyroidism for the last five, six years,” he says. This is the period when he got out from the hospital world of delivering anesthetics in operating rooms and re-encountered real people, in reservation clinics, urgentcare centers, and his own practice.
“Hypo — meaning under, less than — thyroidism, a low supply of the thyroid gland’s T3 jet juice for the brain, which leaves the tissues of the brain open to colonization by sticky amyloids, is seen as a big cause of AD. I started suspecting that with pregnancies and menopause, women should be getting early boosts of T3, even if their lab tests showed “normal.”
Has he “cured” anybody?
“Well, when I was working as medical director at the clinic in Alpine, I was seeing a woman who was around 52–54 years of age. She was menopausal within the last five years, and one of the things she said to me was, ‘My children tell me I’m losing my memory.’
“So, I did a thyroid panel on her, and hers were in the ‘low-normal’ lab range accepted by the labs. Most doctors would say, ‘This panel says your thyroid’s normal. You don’t have Alzheimer’s.’ But I spoke to her about the thyroid issue. I said, ‘This thyroid hormone treatment may help.’ And I told her there was really no downside. And she was keen to try it. And a month later she came back and she said, ‘I’m back to normal.’
“Part of the problem with the management of that case is that I was not diligent enough in collecting data. Because I didn’t really realize the bigger picture at that point. Once I started seeing the bigger picture, I realized that I couldn’t report this case because I didn’t have enough data.”
But now, Abramowitz leans forward. “Then, about six months later, a patient — let’s call her by her initials, M.D. — a woman of about 69, [became], I believe, the first reported case of early Alzheimer’s on planet Earth to be cured with the active form of thyroid hormone. She is the mother of Jackie, who is the office manager at one of the urgent cares that I work at. One day she said, ‘I’d like you to see my mother.’ She thought her mother was bipolar. Her mother’s not bipolar. But she said she — her mother — was getting in the car and getting lost. She’d drive down the road to Ralphs or Vons and she’d get lost. She wouldn’t know where she was.
“So, dementia? Alzheimer’s? If it quacks like a duck, it’s a duck. The husband described how he’d be having a conversation with her about fairly detailed stuff that she knew very well. Things like estate-planning and intimate details about family matters that only a husband and wife would know, and she’d just get lost in the conversation and not know what he was talking about.
“So, I saw her and I did the Mini Mental Status Examination. It’s not a very good test. I believe there are better tests for Alzheimer’s, for cognitive impairment, but I don’t know any of the others. The benefit of the Mini Mental Status Exam is that it can be conducted in a few minutes, in an office setting. ‘What’s the date, what’s the day, where are we, what country?’ And then you get them to perform certain actions... ‘Take this piece of paper in your left hand, fold it in half, put it on the floor.’ And then you get them to copy a diagram of two intersecting pentagons.
“And the interesting thing about Jackie’s mother was that her Mini Mental Status Exam did not change, from the test pre to the test post. It was about 27, 28 out of 30. And I scored the test very strictly, and my interpretation of that was that in fact she was actually normal, according to the test.
“Which shows you how worthless the test is. You need to spot the most subtle cognitive impairments, where they’re early, even if they test normal in the office....
“To me, just talking is much more sensitive than answering set questions. You are going to pick things up you would otherwise miss. If you focus on the most subtle aspects of cognition, which are things like getting lost. Or getting lost in a conversation. Because those people can all test normal in the Mini Mental Status Exam. The symptoms are intermittent, early on. It’s much more valuable to speak to family members, loved ones, roommates, whatever.”
So, Jackie’s mom came back from the T3 treatment. “I diagnosed mild cognitive impairment and offered her a trial of T3 augmentation. I explained this would be an ‘off-label’ use of the drug. She used it for four to six weeks, and...normal cognition was restored.
“The beauty of this case is that there were these symptoms about getting lost and getting lost in conversation. The mini mental status was essentially normal, which meant she ‘didn’t have’ Alzheimer’s disease, according to the test protocol.
“But...the mini mental status results are irrelevant. She does have Alzheimer’s disease, and even though her thyroid labs are ‘normal,’ she has hypothyroidism. And hypothyroidism and Alzheimer’s are the same disease.
“You ask 100 doctors about what I just told you, and 150 will tell you I’m a lunatic. Under those circumstances I’m happy to be a lunatic. They [believe] the Mini Mental Status Exam should trump the symptoms. They consider the thyroid labs being normal trump any suspicion of hypothyroidism. They’re wrong.”
Abramowitz believes there are three classes of Alzheimer’s disease. “Late-onset AD: 80 percent (of all Alzheimer’s, including low testosterone in men, though the role of testosterone is still not understood. But we know that the low testosterone effect is an independent risk factor in men). Early onset: between 50 and 60 years old, 10 percent. It’s a slightly different disease. Same pathophysiology, different cause. And climacteric, which equals menopause, dementia: 10 percent.”
We finish up the coffee and breakfast buns.
“What did Henry Gray of Gray’s Anatomy and Pocahontas have in common?” asks Abramowitz as we leave. I shake my head. “They both died of smallpox. Pocahontas was taken back to England where she contracted smallpox and died, and Henry Gray, who wrote Gray’s Anatomy, was nursing his niece, who had smallpox. And he contracted smallpox and died. And that and $2.50 will get you on Jeopardy.”
A week later, I’m hanging out at Gourmet on Fifth.
“I want you to meet this patient, Cori Landress,” Abramowitz had told me. “She does not have Alzheimer’s disease. She has other thyroid issues. But her case proves that there’s no such thing as a normal thyroid function test. They’re all potentially abnormal. You have to treat symptoms. You have to give them a therapeutic trial of T3. There are probably fewer than a dozen doctors on this continent who would not call me a lunatic on this. But it worked for Cori.”
Cori turns out to be a lively woman who comes striding up and sits down and orders a salad. “I spent a couple of years feeling tired, extremely tired,” she says when we get talking. “This was since about August 2010, for a good two years. I just was extremely tired. Couldn’t make it through the day. I remember telling my children I wish they could drive. I was too tired to drive. Fatigue, hoarseness in my throat. I gained weight. And I never gained much in my pregnancies. Maybe 19, 21 pounds in my two pregnancies. And I was going above that. And I thought, Something is wrong. So, I went to my doctors, had three tests done, and I kept getting, ‘You’re fine. Maybe you’re depressed. Middle age. Maybe it’s pre-menopause. Maybe it’s this...’ I remember just leaving, crying. Like, no one’s going to help me.
“Because every doctor said, ‘It’s your thyroid. It’s your thyroid.’ But when they ran the blood work, they were saying ‘No, you’re fine.’
“So, then my girlfriend referred me to Dr. Abramowitz. These other doctors had done some panels, but I don’t think they were to the extent that Dr. Abramowitz did. He spent a good hour and a half if not two hours just talking to me. I had waking problems, eye puffiness, face, really severe edema, severe weight gains, my menstrual cycles were just crazy, I was fuzzy-headed, I couldn’t think, I felt dizzy, too tired, I couldn’t exercise, brittle hair, brittle nails, thirsty, muscle fatigue... it didn’t stop.
“And every doctor — which was interesting — said, ‘It’s your thyroid.’ But then they would look at the test and go, ‘Oh. Well it’s in the “normal” range.’ But as it has been explained to me, you can take blood work but that’s a picture of just that time, not what’s going on.
“So, Dr. Abramowitz started me on a low dose of medication to help. And I’m telling you: within a couple of weeks, it was a miracle! I finally felt like I had hope. Because I’ve always exercised. I’ve always been a runner. I couldn’t exercise. I couldn’t do anything. It wasn’t going away. I was eating healthy...it was weird. The normal things I would do to stay within a healthy range, they weren’t working. And I was just gaining and gaining. And the swelling in my ankles and my legs, it was painful. I’m 44. It started when I was 42. I had my children at 30 and 31. So, I don’t know what triggered it. But then it just seemed to keep going downhill. But after the thyroid hormone treatment, in my diary I put, ‘More energy, better sleep, running errands after work, cooking dinner, exercising, more clarity, feeling more upbeat. Able to plan projects, volunteer, get together with friends... I got my life back.”
Abramowitz, in his case report of MD, writes that “T3 offers the potential to prevent Alheimer’s disease, reverse Alzheimer’s disease in early cases, and freeze progression in early cases which are too advanced to reverse.”
It’s a tall claim, and he recognizes that double-blind tests need to be carried out. But they cost money, take time, and need backing from respectable Alzheimer’s and medical organizations. That hasn’t been forthcoming yet.
But basically, he says, treatment is cheap.
“That’s the beauty in this. T3 is cheap. Of course, if this treatment becomes public, accepted, the price of T3 will go up ten times. But it’s my belief, based on what I see in primary care, in general practice, and even in urgent care and emergency rooms, that somewhere between one in three to one in four patients presenting for primary care has, underlying their symptoms, a medical problem which is directly or indirectly related to low thyroid hormone activity.
“So, we’re wasting money doing nothing, not to mention prolonging suffering. Let’s say one tenth of all patient care [relates to low thyroid hormone activity]. So, if you’ve got a $2.5 trillion budget that’s spent on health care every year in the U.S. alone, and you take a tenth of that, that’s $250 million. Other indirect costs could take it up another $250 billion. That’s a half a trillion dollars a year that could potentially be saved by doctors focusing and getting at the real issues here. But can you tell me who you think wants to take a half-trillion dollars out of the U.S. budget? Nobody. Nobody is going to believe that this is an issue as big as this.”
And, he says, the specialists are too narrowly focused on their specialties to look at a cross-specialty solution like his. “But there are believers in primary care. There are people who are GPs and general internists who believe this... When I say ‘this,’ I don’t mean all of this, and when I say ‘believe,’ I don’t mean they believe with as much fervor as I have, but there are some doctors who are open-minded to this.”
He thinks about it a moment. “But, honestly, there are probably fewer than a dozen doctors on this continent who would not call me a lunatic.”
Why isn’t he trying to arrange some large-scale test?
“I have no interest in the U.S. Because — let’s see how to phrase this diplomatically — I have no respect for any medical research that comes out of the U.S. That’s why I don’t want this study done in the U.S.”
Because of Big Pharma, over-specialization, costs?
“All of the above.”
And my Alzheimer’s test? I confess that I can get lost driving and I don’t sleep that well.
But Abramowitz is kind.
“It would appear that you don’t really have any symptoms.”