Repairing the World

Dr. Stephen Salloway '71, an internationally recognized leader in clinical trials for the prevention and treatment of Alzheimer's disease, has recently catapulted into the spotlight with the recent Food and Drug Administration (FDA) approval of the first new drug therapy for the disease in nearly two decades. He is the Director of Neurology and the Memory and Aging Program at Butler Hospital in Providence, Rhode Island, and the Martin M. Zucker Professor of Psychiatry and Human Behavior and Professor of Neurology at the Warren Alpert Medical School of Brown University. He received his MD from Stanford Medical School and completed residencies in neurology and psychiatry at Yale University. We were honored to have a very personal interview with Dr. Salloway ‘71 this June.

GOVS:
You have degrees from some of the country's top educational institutions, you have published widely, and you win awards for your research nearly every year. You are passionate about your work and finding a treatment for Alzheimer's disease. What led you to this work, and what keeps you interested?

DR. SALLOWAY:
When I was growing up, my grandmother, who lived with us, had dementia, and I saw the disease up close and how it affected my family. My father had it as well, so I witnessed all the stages of this terrible disease, but I think these personal experiences made me a better doctor. I understand that it's a big deal and very hard for families. 

I also grew up in Marblehead, Massachusetts, and attended the General Glover school. There has always been a revolutionary spirit in that town, and it influenced me and made me believe that great things are possible. As a kid, I always wanted to be part of something important. I was interested in history, politics, and brain diseases, and my close-knit Jewish family valued medicine as a career. 

In the Jewish faith, each of us is asked to do our part in repairing the world in some way — Tikkun Olam. It translates to "repair the world." I'm a person of faith, and I do feel the hand of God in my work, especially when I'm talking to patients. I'm so grateful for our study volunteers who made this advance possible — the approval of the new Alzheimer's disease drug. We've made a big step forward. The courage and dedication of clinical trial volunteers who stepped into the unknown, people who were in the study for five to six years, are the real heroes. Without them, we would not be where we are with a new treatment. They are truly altruistic - they are doing this for their families and loved ones who may also eventually face this disease.

GOVS:
Speaking of the new drug, you were quoted in two recent New York Times articles reporting on the recent and somewhat controversial FDA approval of a new drug to treat Alzheimer's disease. Based on the article, you firmly approve of the FDA's decision. So, in layman's terms, why do you support this new drug? 

DR. SALLOWAY:
Progress is often associated with controversy. In the early 1900s, Dr. Alois Alzheimer, for whom the disease is named after, was booed off the stage at a conference when he showed the brain pathology of his patient, specifically the amyloid plaques and neurofibrillary tangles we now know as identifiers of Alzheimer's disease. No one believed him. The physiological hallmarks that Alzheimer presented that day turned out to be true. 

I understand people's concerns — the data set has issues, of course, and it didn't work for everybody. Doctors should use the drug only for patients whose statuses match those in the clinical trials. At this point, there’s no evidence that it could be beneficial for any other stage of Alzheimer’s. However, I'm a passionate supporter of approval. Alzheimer's disease is an epidemic, and it's getting worse. Why? Simply because people are living longer and age is a major factor in developing Alzheimer's. Sure, there are other factors, but that's largely it. This disease is so disabling, and the totality of the evidence favors approval, which will open the door to a new treatment era for Alzheimer's that we can build on. 

GOVS:
Can you give us a little more background on your research and why you feel this is a breakthrough for the future of Alzheimer's treatments?

DR. SALLOWAY:
My research has helped shepherd this clinical development in the treatment of the disease — it is promising. The new therapy was developed from a pool of people who lived a long time but did not get the disease, and we identified several antibodies that help break up amyloid plaques associated with Alzheimer's. The drug is a lab-engineered antibody that gets into the brain, binds to, and lowers the plaques. It's the first clinical trial to show lowering and slowing of cognitive decline. 

A great moment for me was when this research data was featured on the cover of Nature (a weekly international journal publishing the finest peer-reviewed research in all fields of science and technology). We had the most clinical experience on Alzheimer's in the world, with some patients participating for more than five years, and we saw the long-term effects of trials. The majority of people were stable for longer — the first time in over 100 trials, which correlated with our positive findings. 

What makes me optimistic is that this research finding and drug approval will accelerate advances, and there is no time to waste. Alzheimer's is the sixth-leading cause of death in the world — it's at an epidemic level with no other approved treatment to slow it down. I think the FDA made a wise decision. The totality of evidence favored accelerated approval with requisite further study to address concerns. The next thing we need is to get a diagnostic blood test to make testing easier.

GOVS:
Where do you see the future of Alzheimer's research and therapies going? Is there real hope for conquering this disease?

DR. SALLOWAY:
This is just the beginning of a new treatment era — it gives us a biological foothold. Maybe some students at Govs will be inspired to work on this research and learn more about how to promote brain health. For example, along with promoting heart health and lowering your risk for strokes, there's evidence that vigorous exercise, adhering to a mostly Mediterranean diet, and maintaining overall health lowers the risk of developing Alzheimer's and dementia symptoms. But, unfortunately, some of us are at higher risk due to genetics, and we'll need additional treatments that can be started early. 

GOVS:
Looking back to your years as a student at GDA, was there a person or experience during that time that has stayed with you or shaped your life in some way?

DR. SALLOWAY:
I attended GDA during turbulent times: protesting the war in Vietnam, the tragic shooting at Kent State — there was so much going on at that time. I had many discussions with then Headmaster Val Wilkie, and I spent a lot of time up at Mansion House to discuss things with him — he was a terrific guy. He was a POW in World War II, and he didn't agree with half the things I said, but he was a great listener and sounding board. I was sorry to hear that he passed away a few years ago. Val was very forward-thinking — I think he would have been very pleased, interested, and proud of my research work. 

GOVS:
Govs students are encouraged to discover their passions, take risks, and find the courage to be their authentic selves; do you have any advice of your own to pass on? 

DR. SALLOWAY:
Teamwork and collaboration are big themes here at Brown, and I know at Govs, too. So, learn a lot about that because it's critical for success, especially in medicine. And follow your passion. You'll go the distance if you do so, but it takes a lot of dedication, persistence, and resilience. 

In my profession, there are many ways to contribute to solving these problems and contributing to treating Alzheimer's. Students can think more broadly about how they can contribute, from lab work or investing in promising work and supporting it to making drugs accessible for those who can't afford it. Pursue an important mission with a clear vision and create strong teams and partnerships to carry it out, and you will be fulfilled and successful. Our memory and aging team and our study volunteers are like a tapestry, with each strand adding beauty and strength to the design. 

I have worked a long time on this drug approval — I wish this moment in my career would have happened earlier, but life happens. For me, the best part is when you tell patients, especially those at risk, that we now have a drug that could lower plaques to help treat and slow down the disease.