For decades, research into Alzheimer’s disease has made painfully little progress. More than 7 million Americans are living with the disease, which is the most common cause of dementia. It’s incurable, and treatments have been hampered by groupthink, as well as by systemic fraud from some of the field’s most famous researchers.

But there are finally signs that the field is turning a corner, including two new drugs, rolled out in the last few years, that can treat Alzheimer’s directly.

“If somebody walks into a clinic right now and is diagnosed with Alzheimer’s disease,” Vox senior correspondent Dylan Scott tells Today, Explained co-host Sean Rameswaram, the drugs “will hopefully have some effect in slowing down their cognitive decline.” 

As Scott says, “The drug development pipeline is also starting to look much more robust” — even “revolutionary,” to quote one doctor he spoke with.

The two talk about why researchers are more optimistic than they have been in years, whether GLP-1 drugs might help prevent Alzheimer’s, and an experimental surgery pioneered by doctors in China that has produced striking — but if unproven — reports of improvement in people with the disease.

Below is an excerpt of their conversation, edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify.

You mentioned two treatments. Tell us what they are, Dylan?

We have two drugs right now that have been approved by the FDA: lecanemab and donanemab. And these are drugs that target the amyloid plaque in the brain that scientists have long thought might be associated with the development of Alzheimer’s disease.

The amyloid hypothesis [the belief that Alzheimer’s is caused by the buildup of deleterious amyloid proteins in the brain] has been very controversial for a while, in part because there were these years and years where we weren’t seeing any progress despite this being the dominant hypothesis about the disease. But we do have these two drugs that in clinical trials have been shown to both clear out the amyloid plaque in somebody’s brain and they do seem to lead to slower cognitive decline for those patients.

And the hope is that this is the ground floor. These are the worst drugs, hopefully, that we’re ever going to have and continued scientific discovery and progress with developing drugs will lead to even better treatments in the future.

“The hope is that five, 10 years from now, we’ve got a much more robust suite of treatments that can help somebody who’s been diagnosed with Alzheimer’s.”

Tell us more about the scientific discovery. You mentioned that there’s promising research beyond amyloid plaques?

It’s not like the amyloid hypothesis has been invalidated, but I think our understanding of the disease has become more complex. 

We’re realizing that there’s probably also a role for a different kind of protein called tau. There may also be a role with chronic inflammation, your vascular health, your body’s ability to just pump blood through your body may also be playing a role in the development of Alzheimer’s disease. And so now we’re starting to see treatments that target these other things. 

The way I’ve been thinking about it is if we used to be putting all of our bets on amyloid, we’re still putting some bets on amyloid, but we’re also putting bets on these other things. And so now there are treatments in the works targeting, for example, these tau proteins.

They’re still in the early stages of clinical trials — really at the stage where they’re just checking the safety of these drugs and making sure that somebody can take them without getting really sick, or God forbid, dying or something like that. But even when they’re doing those safety checks, they do start to collect qualitative data about, well, are we starting to see any effects? 

Some of the preliminary results from some of these tau targeting treatments that are in the works have looked pretty promising. And so that’s encouraging, obviously. It’s possible that we’re moving towards a future where not unlike cancer treatment, there’s not just one drug for Alzheimer’s disease, but maybe you take a combination of different things that work on different mechanisms for the disease and the collective cumulative effect is that it stops the progression or even reverses it. 

The hope is that five, 10 years from now, we’ve got a much more robust suite of treatments that can help somebody who’s been diagnosed with Alzheimer’s.

Five, 10 years from now sounds nice, but is there anything else that’s in the cocktail now that people are discovering could be promising for Alzheimer’s?

There are also, yes, drugs that millions of people are taking right now for other reasons that might also be able to help with Alzheimer’s disease. And GLP-1s in particular are the big ones.

No way!

Yeah, I know. These drugs — it seems like every day you see some new headline about this miraculous thing that they can do.

Weight loss, smoking, my poker addiction, and…?

And it might prevent dementia down the road. 

If you step back and think about it, the theory does make some sense. Like I said before, scientists increasingly think there’s an association between your vascular health and your cognitive health, especially as you age. And what do these GLP-1 drugs do? They help people lose weight. 

Losing weight helps to lower your blood pressure, lowers your risk of vascular problems, whether it’s heart disease or pulmonary disease or stroke or something like that. So if more and more people take these, they take them earlier in life, they lose weight, they keep it off, they don’t develop these heart or vascular problems, it does make some sense that that may also reduce their risk of developing Alzheimer’s disease. 

It’s still sort of theoretical, but the Alzheimer’s Association is putting $100 million behind some research projects to investigate this possible link. We may learn five, 10 years from now, as millions of people are now on these GLP-1 drugs — maybe we start to see Alzheimer’s less often. And that would be another reason to be optimistic that the future for this disease is looking brighter.

How about reversing it? Is that still a pie in the sky?

It’s out of reach for now. Certainly some of the scientists that I’ve talked to have said, “In theory, it should be possible. Your brain is really resilient. It’s really good at rebuilding itself if you give it the chance.” It seems like it should be possible to stop the progression of the disease eventually, and maybe ultimately reverse it. 

Now, there has been some really intriguing, but also mysterious developments around reversing Alzheimer’s, not from scientists based out of the United States, but from scientists in China. People may or may not have seen that there have been videos of these patients who underwent an experimental surgery and the before and after of these videos is incredible.

In the before, you’ve got somebody who clearly has Alzheimer’s disease, doesn’t recognize their loved ones, has trouble with their train of thought. In the after videos, it’s like they’re a completely different person. They recognize their loved ones, they’re talking articulately. And so that has, as you can imagine, generated a lot of excitement, also a fair bit of skepticism.

Are these videos real? Do we know?

We don’t know for sure if they’re real or not. What’s intriguing about this surgery is that the theory of it, at least to me as a lay person, makes some sense. 

The gist of this surgery is the surgeons create a drain in the patient’s brain and the drain is supposed to help the brain get rid of these amyloid and tau proteins that we think are associated with Alzheimer’s disease. On a hypothetical level, it makes some sense. And scientists in the United States and Europe and elsewhere have been intrigued enough about these videos and the findings that have been reported in academic journals to set up their own studies to try to replicate these findings. 

Now, it’s a crazy story because this scientist in China who pioneered this idea has actually been arrested by the Chinese government. And as I understand it, he’s currently in detention.

For what?!

The reporting I saw was these seem to be kind of flimsy charges of insurance fraud. The Chinese government has also tried to ban the surgery, at least outside of clinical trial settings. So that’s obviously complicated the story a little bit.

But nevertheless, you do have scientists in the US and outside of China who are like, “Well, we at least want to try this for ourselves and see if it works.”

It does feel like it’s something that could get people’s hopes up who have been waiting for this for decades.

Exactly. I mean, I think this is like the holy grail. Can we find a way, whether through surgery or through pharmaceuticals, to actually reverse these symptoms and restore the person to who they were before Alzheimer’s took over?

Because that’s the thing that I think everybody recognizes but is worth emphasizing, is, as one doctor put it to me, and I’ve never forgotten it, Alzheimer’s is a disease unlike any other because it robs you of your identity. 

To be able to restore people’s identity through whatever means, that is the goal that all of these scientists are chasing.

Editor’s note, September 20, 8 am ET: We’re bringing you some of our best-loved Your Mileage May Vary columns while Sigal Samuel is on parental leave. The one below was originally published last September.

This unconventional advice column offers you a unique framework for thinking through moral dilemmas. It’s based on value pluralism: the idea that each of us has multiple values that are equally valid but that often conflict with each other. Submit your own question here.

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The Jewish High Holidays are coming up, and that includes Yom Kippur. It’s a holiday that encourages people to reflect on their behavior and make amends. That’s all well and good, but I’m someone who struggles with scrupulosity — constantly worrying about my morality and if I’m doing The Most Possible Good™.

In practice this is far more paralyzing than motivating. Fixating on the ethical implications of all possible decisions makes it harder to take any action, and I’ve lost hours scouring my memories of my past behavior for immorality like a football player watching footage of their games to analyze what they could do differently. Guilt simply isn’t serving me, but I worry that saying to hell with all that means I’ll stop striving to be a better person and become morally complacent.

I’ve observed Yom Kippur for decades, and don’t want to simply avoid the day. But the holiday is a moral scrupulosity trigger. How do you think I should approach this? I want to stop feeling guilty for letting guilt get in my own way.

Dear Scrupulous, 

Have you ever heard the story about what happened when God decided to give the Bible to flesh-and-blood human beings? According to the ancient rabbis, the angels hated the idea. They argued that humans were deeply flawed mortals who didn’t deserve such a holy scripture; only angels could be worthy of it, so it should stay up in heaven. 

It fell to Moses to rebut the angels’ argument. He asked them: What do you angels need the Bible for? The Bible says not to murder, not to commit adultery, not to steal — do you have jealousy or other emotions that could lead you to do those things? The Bible says to honor your father and mother — but you don’t have parents, so how could you ever do that? And the Bible says to sanctify the Sabbath — but you never do any work, so how could you even honor the Sabbath by resting? 

The angels saw that Moses was right. Angels are really great at one thing: being perfect. But perfect creatures are static. They don’t experience painful challenges, they don’t grow, and they don’t make choices that add beauty to the world. We humans do those things. God gives the Bible to humans not to make them into angels — but to make them better at being the unique thing they are: human animals, with feelings, flaws, and all, that can learn to use their capabilities in more beautiful ways.

I think there’s a lot of wisdom in this story. And I want you to notice how far it is from demanding that humans do “The Most Possible Good™.” That language suggests a maximizing ethical theory like utilitarianism, which says that we have to do the action that produces the greatest good for the greatest number. In other words, we have to optimize. 

Moral optimization may be possible for angels, but not for humans. We each hold multiple values, and sometimes those values are in tension with each other, forcing us to strike a balance as best we can. We’re not omniscient beings who can know with certainty how best to strike the balance. 

What’s more, sometimes different kinds of moral good straight-up conflict with each other. Think of a woman who faces a trade-off: She wants to become a nun but also wants to become a mother. She can’t balance between those options — she has to choose. And what’s the better choice? We can’t say because the options are incommensurable. There’s no single yardstick by which to measure them so we can’t compare them to find out which is greater.

Given that this complexity is baked into the human condition, it’s impossible to be a perfect optimizing machine. And the more you try to force yourself to be that, the harder it’ll be for you to actually help others, because you’ll just be so burned out. As you’ve already discovered, the optimizing mindset is exhausting — you end up expending a lot of precious mental resources that you could be spending on something else. It can even lead to paralysis. And a lot of the time, there’s no knowably best decision.

So instead of trying to optimize everything, you can adopt a goal that’s humbler but more realistic: to live in line with your values as best you can. 

I know that can feel scary. Optimizing makes being human feel less risky. It provides a sense of control, and therefore a sense of safety. The unspoken premise is that if you optimize, you’ll never have to ask yourself: How could I screw up that badly? 

But there’s another way to feel safe. It’s about leaning into the fact that we are imperfect and vulnerable creatures and that even when we’re trying our hardest there will be some things that we do not do optimally.

Of course, we should still try to live in line with our values. But in those moments when we fall short, we shouldn’t berate ourselves, thinking, “I sinned!” In Hebrew, the word we typically translate as “to sin” (lachto) actually means “to miss the mark.” It’s the same word we’d use to describe someone with a bow and arrow who’s targeting the bullseye but misses it slightly. This is a useful image, because it reminds us just how normal it is to miss the mark. Just as the archer’s arrow is buffeted around by the wind, we’re buffeted around by all the physical and psychological conditions acting upon us — naturally we won’t always hit the bullseye! And when we do miss the mark, we deserve compassion.

I know what you’re thinking: What if adopting this mindset means you’ll become morally complacent and let yourself off the hook too easily? This is one of the most common objections to practicing self-compassion. But research shows it’s not well-founded. In fact, psychologists have found that more self-compassionate people are better able to acknowledge when they’ve made a mistake. They’re more likely to want to apologize and make amends to others when they mess up. And they try to do better the next time around. Why? Because, to them, mistakes don’t feel so psychologically damning. That allows them to take more — not less — responsibility for their actions.

Yom Kippur can feel terrifying when any mistake you’ve made over the past year seems damning. But according to the ancient rabbis, Yom Kippur is not meant to be a somber day — it’s one of the happiest days of the year! After all, it was on Yom Kippur that Moses descended from Mount Sinai carrying the second set of tablets inscribed with the Ten Commandments, ready to gift them to the people. 

You probably know what happened to the first set of tablets: Moses shattered them after seeing the Israelites engaged in idol worship. What’s less known is that, according to one rabbinic story, God’s response to the shattering of those tablets was to actually congratulate Moses. Why did God think breaking them was the right move? And what was different about the second set? 

While the first tablets had been fashioned by God and God alone, the second tablets were a human-divine collaboration: Moses carved the stone and God inscribed the words. And while the first tablets contained only the words of the Ten Commandments — a black-and-white, rule-based morality — the rabbis tell us that the second tablets contained within them all the stories and interpretations that Jewish sages would later develop.

In other words, God recognized that you can’t just give humans a list of moral rules and call it a day. Maybe that would work for angels, who live in a simplified, disembodied world, but our ethical life is just too messy and multifaceted to be captured by any single set of universally binding moral principles. Yet God chose people over angels anyway, inviting us into the collaboration and embracing our humanness rather than rejecting it.

So, to the rabbis, Yom Kippur was a happy day because they fully expected that God would accept and embrace messy humans. 

Please, don’t try to be more zealous than God.

When you’re taking action, by all means, aim your arrows as true as you can — try to hit the bullseye, the place that captures as much of what you value as possible. But once you’ve released the arrow from your bow, let it be. 

If it turns out that you missed the mark, that you acted suboptimally, I put it to you that that is okay. You are not an angel. You are not a perfect optimizing machine. You do not have access to a magical mathematical formula that can consider countless incommensurable variables and spit out the very best move with certainty. You are human and you do the best you can with what you’ve got. 

The wisdom of these millennia-old stories is that that’s good enough for God. Let it be good enough for you, too. 

Bonus: What I’m reading

• Writing this column reminded me of The Mindful Self-Compassion Workbook, written by the psychologists Kristin Neff and Chris Germer. It really helped me develop a self-compassion practice, which has in turn helped me get a grip on my own scrupulosity. I also strongly recommend the eight-week self-compassion course run out of Neff and Germer’s nonprofit, the Center for Mindful Self-Compassion.

• I’ve always associated the philosopher Thomas Nagel with questions about consciousness, but I recently learned that he’s also super interested in questions about religion. In a great essay called “Secular Philosophy and the Religious Temperament,” Nagel asks: What, if anything, does secular philosophy have to put in the place of religion? More specifically, can it answer the question: What is the underlying nature of the universe, and how can the human individual live in harmony with it? 

• In this Aeon essay, philosopher Elad Uzan argues that AI will not be able to solve ethics for us, despite what some people hope. Drawing on the mathematician Kurt Gödel’s famous incompleteness theorems, Uzan writes, “just as mathematics will always contain truths that lie beyond formal proof, morality will always contain complexities that defy algorithmic resolution.”