Really, Dr. G?

By Dale Bredesen, M.D., Chief Scientific Officer for Apollo Health

Recently, a Dr. Ghomi, psychiatrist from Montana, shared a LinkedIn post suggesting that our protocol for addressing cognitive decline is relatively simple and should be offered at no cost.

I appreciate his interest in making treatment more accessible. This is a goal we share wholeheartedly. However, I believe his comments present an opportunity to clarify several important aspects of our approach, the evidence accumulated over the past decade, and the resources required to achieve the best possible outcomes for patients.

Dr. Ghomi also wrote, “People have argued about whether the Bredesen protocol works for a decade and the argument has not moved an inch.”

I respectfully disagree. Over the past decade, we have made substantial progress:

A Decade of Progress

Since our initial publication in 2014, our work has expanded considerably. Among the milestones:

• Three clinical trials have demonstrated cognitive improvements, with outcomes superior to those reported for any other treatment for cognitive decline.
• Implementation in three assisted living facilities, beginning with Marama at two locations and subsequently at The Vineyards in Fresno, California, has demonstrated encouraging improvements. An ongoing trial at The Vineyards has already reported significant improvements in overall cognition, memory, insulin sensitivity, and multiple other health parameters. Many participating residents have also been able to discontinue medications, including those for diabetes, hypertension, and arthritis-related inflammation, under appropriate medical supervision.
• Long-term follow-up has shown that cognitive improvements can be sustained for more than a decade in some individuals—an outcome once considered unattainable. Read the published study.
• More than 10,000 patients have adopted the protocol.
• More than 2,000 physicians worldwide have received training, along with neuropsychologists, nurse practitioners, health coaches, and other healthcare professionals.
• Applications to additional neurodegenerative conditions, including corticobasal syndrome and posterior cortical atrophy, have led to the first published examples of reversal of decline in these conditions.
• Four books have been published to explain the scientific foundations of the approach, summarize the laboratory findings, and offer step-by-step guidance.
• Two documentary films have chronicled patients who experienced meaningful cognitive improvements while following the protocol.
• Apollo Health has developed a supportive community, providing educational guides, forums, town halls, support groups, instructional classes, and other resources. We have also collected data to help continually refine the approach. One particularly encouraging observation is that improvements may extend beyond cognition to include depression. Read the published research.
• Alzheimer’s survivors have become advocates for others. Individuals such as Judy Benjamin, Sally W, Julie G, Lucy W, Kat T, Frank M, and several others have established the Alzheimer’s Survivors Foundation and the Alzheimer’s Survivors Support Group. As Lucy W says, “Alzheimer’s Survivors—We Exist.” Judy has walked 2,700 miles across the United States and 650 miles across England to spread a message of hope, particularly the importance of early evaluation and treatment.

These developments represent meaningful progress. If data and trials such as these do not “move the argument”, then the arguers are bloviators, not analyzers. The results also provide a foundation for continued scientific inquiry, independent evaluation, and refinement of our approach.

I welcome thoughtful discussion about the strength of the evidence, the questions that remain, and how we can continue improving outcomes for patients.

Understanding the Different Perspectives

When we first published our findings in 2014, the prevailing message was that nothing could prevent, delay, or reverse cognitive decline.

The initial publication challenged that assumption by demonstrating that cognitive improvement was possible when the multiple contributors to decline were identified and addressed individually.

Since then, we have encountered three recurring perspectives that deserve consideration.

The first is that cognitive decline cannot be reversed.

This perspective has been challenged by our published findings from three clinical trials and hundreds of additional examples of cognitive improvement.

We believe these results warrant continued investigation and broader consideration within the medical community. As with any evolving approach, further research, replication, and ongoing assessment will help strengthen the evidence and clarify which patients benefit most.

The second perspective, reflected in Dr. Ghomi’s comments, is that reversing cognitive decline is relatively straightforward and should not require extensive testing, professional guidance, or substantial expense.

We share the desire to simplify care wherever possible. However, our experience suggests that successful implementation is considerably more complex.

Our approach involves identifying the multiple factors contributing to each individual’s cognitive decline, interpreting extensive laboratory findings, and developing a personalized treatment strategy. Experienced practitioners, health coaches, and nutritionists play important roles in this process, while the ReCODE report helps integrate the findings and guide individualized recommendations.

Our clinical trial data underscore the importance of implementation. Some sites with highly trained and experienced teams achieved improvements in virtually every treated patient, while two sites experienced little success. This same pattern occurs throughout the practitioner network.

This variation is an important finding. It suggests that the quality of implementation, professional training, and clinical experience can substantially influence outcomes.

We often compare learning to implement ReCODE with learning a surgical procedure. Both require specialized knowledge, careful execution, and ongoing refinement rather than simply following a standardized prescription.

When addressing a condition as consequential as Alzheimer’s disease, these differences can have profound implications for patients and their families.

Our responsibility is to determine what works, understand why outcomes vary, and continually improve the quality and consistency of care. We should simplify the process where we can, but not at the expense of the individualized evaluation and treatment that appear essential to achieving the best results.

The third perspective concerns the development and pricing of similar approaches.

We have seen programs emerge that resemble our approach but do not acknowledge the earlier research or provide published outcomes demonstrating their effectiveness. Some also charge substantial fees despite producing very disappointing results.

This raises important questions about transparency, evidence, value, and accountability.

Patients deserve to understand what they are paying for, what evidence supports the treatment they receive, and what outcomes they can reasonably expect.

These concerns lead to a larger question that deserves serious discussion: What constitutes a fair cost for treating cognitive decline, and how can we make effective care available to everyone who needs it?

The Cost of Care and the Need for Greater Access

Ideally, we would have a simple, inexpensive pill that could reverse cognitive decline for pennies a day. Unfortunately, no one has yet achieved that goal.

In the meantime, we must consider what it costs to deliver the most effective care available.

Cardiovascular disease, cancer, and dementia are among the leading causes of death in the United States. In the United Kingdom, dementia is the leading cause of death, with Alzheimer’s disease accounting for most dementia cases.

Consider the costs associated with treating these conditions:

• Coronary artery bypass surgery may cost $45,000 to more than $150,000, with reimbursement generally available.
• Cancer treatment often involves surgery and chemotherapy, with costs frequently exceeding $100,000 and reimbursement available.
• Anti-amyloid antibody treatment for Alzheimer’s disease can cost approximately $50,000 annually when required scans, infusions, and physician visits are included. These treatments modestly slow decline rather than reverse it and carry risks, including brain swelling and microhemorrhages.

By comparison, the cost of implementing our protocol is substantially lower. Therefore, the challenge is not the cost of providing this care, but the lack of adequate reimbursement that would make it broadly accessible.

This is an issue we should all be working to change.

In the United States, an individual who develops Alzheimer’s disease may incur more than $400,000 in lifetime care costs, including memory care, assisted living, physician visits, and home care. These figures do not capture the tremendous emotional, physical, and financial toll on families.

The expense of just one year of memory care could cover about TEN years of ReCODE testing and treatment. Delaying the need for memory care could yield substantial savings — with the ultimate hope of avoiding it altogether. In contrast, the current standard of care has actually been shown to be associated with more severe decline.

Early intervention is especially important. The sooner contributing factors are identified and addressed, the fewer interventions may be necessary, making treatment both more manageable and less expensive.

Furthermore, the initial year generally involves the greatest expense because of comprehensive testing and the development of a personalized treatment plan. Costs typically decrease in subsequent years as treatment is refined and ongoing monitoring becomes the primary focus.

Our objective remains consistent: to improve cognition, prevent further decline whenever possible, and help individuals preserve their independence and quality of life.

Making this approach more affordable, accessible, and reimbursable must be a shared priority.

An Invitation to Work Together

So Dr. Ghomi, you propose to offer your version for nothing, and that’s just what it’s worth, since you have no data and no proof of efficacy. As they say, talk is cheap; action is priceless. You owe it to your patients, Dr. G, to learn, document, and publish reversals of cognitive decline. Please consider ReCODE 2.0 training, since the best results to date have been achieved by those who took this training. Then you can contribute to the goal we all have: to reduce the global burden of dementia.

Where we differ is in our understanding of the complexity involved in achieving successful outcomes. I would welcome the opportunity to learn more about your approach, including any documented patient outcomes and published evidence supporting its effectiveness. Sharing these findings would contribute meaningfully to our collective understanding of how best to address cognitive decline.

Ultimately, this is not about any one physician, program, or organization. It is about the millions of people living with cognitive decline and the families who desperately need better options.

We have made meaningful progress over the past decade, but there is still much work to do.

By sharing data, examining outcomes, improving training, and advocating for broader access, we can continue to advance the field together.

Our shared goal should be to reduce the global burden of dementia and ensure that every patient has access to the best possible care.