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Prevagen: The 21st-Century Placebo

As Tinker Bell said, "You just have to believe!"

Every evening, always just before the national news begins, I am forced to endure 15 seconds of claims about a 21st-century version of snake oil: Prevagen. Apparently, we are still as vulnerable to the same false claims that sold similar magical elixirs to our grandparents and their grandparents. If you think that you can depend upon your government to protect you, you would be wrong. In 2017, a federal judge dismissed a lawsuit against Prevagen. In 2018, the Federal Trade Commission filed an appeal and won. The FTC and others point to statements by the makers of Prevagen that their memory study did not show any significant improvement in the treatment group over the placebo group. Indeed, because their results were so unimpressive and indecisive, the makers of Prevagen required over 30 different post hoc statistical analyses of the results to find a significant outcome of any kind on day 60. You will notice on their TV commercial that they do not show data after day 60 because the participants taking Prevagen actually performed significantly worse after taking this snake oil for more than two months!

Thus, the lawsuits and the false and misleading advertisements continue. The makers of Prevagen do consistently make one true statement about their product: It does not cause bodily harm. This statement is also true about water, however, and no one is charging $90 for a jug of water. Thus, we remain unprotected from the lies that bombard us every evening. Their lies are working; Americans purchased about $165 million of Prevagen between 2007 and 2015.

Why do people still fall for this pseudoscience nonsense? The answer is simple. People turn to these bogus snake oils because science has failed to invent a true brain enhancer. In addition, the purveyors of snake oils learned long ago that their magical elixirs sell better if they originate from an unusual source, e.g. a jellyfish, with unusual names accompanied by vague claims. One thing is still as true today as it was long ago, a few people will always claim that the snake oil worked; they feel much smarter after taking Prevagen.

When it comes to therapies that claim to enhance brain function, never underestimate the power of your own expectations. Your mind plays a major role in how these drugs affect you. We all want to believe that the pills we take will help us feel and function better; fortunately, thanks to the poorly understood phenomenon of the placebo effect, we do sometimes, but only for a while, benefit even from the most bogus of elixirs. Essentially, we want these drugs to do something, anything; so, we fool ourselves into thinking that they do. After all, you’ve just spent a lot of money on this pill!

Prevagen is useless because it is not able to cross the blood-brain barrier. This is the Achilles’ heel of so many drugs that might offer something beneficial to the brain: They never get into the brain. Evolution made certain that our brain rests comfortably behind a series of biological firewalls. Many popular remedies depend entirely upon the placebo effect because they cannot cross the blood-brain barrier. The so-called "active ingredient" in Prevagen® is claimed to be the jellyfish protein apoaequorin. This is an incredibly large, highly water-soluble molecule would never be able to enter your brain. First, large proteins are almost completely metabolized by intestinal enzymes so that the individual amino acids are available for absorption. After all, this is the job of the intestines, i.e. to break down foods into the individual components for absorption. There’s an important lesson here: For a drug to act upon your brain it needs to actually get into your brain.

Unfortunately, there are plenty of other charlatans eager to mislead potential customers with flimsy pseudoscientific evidence in order to make profit. As Tinker Bell once said, “You just have to believe!” At least Tinker Bell didn’t charge so much for her advice.

© Gary L. Wenk, Ph.D. Author of Your Brain on Food, 3rd Edition, 2019 (Oxford University Press)