The videos are astonishing. In one scene, a senior Chinese woman appears lost in the wilderness of dementia, unable to answer basic questions; in the next, she seems to be lucidly chatting and shucking beans for dinner. By all appearances, years of cognitive decline had been rapidly reversed after the patient underwent an experimental new surgery.<\/p>\n
The only problem is: No one is sure if it\u2019s real.<\/p>\n
It\u2019s difficult to take any video at face value in the age of AI<\/a>, and this experimental procedure happened in China, a country with a recent history of controversial science<\/a> touting extraordinary but questionable claims<\/a>. In the past few years, researchers there have published several papers<\/a> reporting promising results from a procedure that purports to attack Alzheimer\u2019s disease<\/a> in a peculiar way: by connecting vessels from the lymph nodes in the neck to nearby veins in an attempt to drain the brain of harmful waste. But these have been small studies that did not include a control group. The doctor who first pioneered the surgery there has reportedly been placed under arrest,<\/a> and the Chinese government has sought to stop most physicians from performing any more of these operations.<\/p>\n Is that because it\u2019s a scam? Or because it\u2019s dangerous? Or could it be because there have not yet been proper randomized trials, tested against a placebo, to assess the procedure\u2019s safety and efficacy? There are new studies being planned in China<\/a> to more rigorously evaluate the surgery.<\/p>\n But scientists elsewhere in the world have a lot of questions. And now, a small group of researchers in the US and Europe are endeavoring to find the answers. Within the next few years, we should know whether this surgery really could be the miracle that the viral videos make it appear to be \u2014 or another much-hyped treatment that ultimately fizzles out.<\/p>\n Dr. Adnan Siddiqui, a neurosurgeon at the University at Buffalo who is leading an initial US-based study of this procedure, previously helped develop a new treatment for severe stroke patients<\/a>. This gave doctors a valuable new technique for treating patients during an emergency, and he told me he saw it rapidly change the standard of care around the world. In an interview, he cautioned that a lot more work needs to be done to assess this proposed new Alzheimer\u2019s treatment \u2014 but at the same time, he\u2019s optimistic.<\/p>\n \u201cThe whole world\u2019s paradigm changed in literally a blink of an eye. It can happen. And I\u2019m hoping this might be that second home run,\u201d he said. In \u201c2027, we\u2019ll start getting clear signals in one direction or the other. By 2028, 2029, we would know whether this is real or not.\u201d<\/p>\n Why this Alzheimer\u2019s surgery really might work<\/p>\n The promise of this controversial new procedure lies in the lymphatic system, which is essentially the body\u2019s drainage system. According to scientists\u2019 best current theories about Alzheimer\u2019s, the brain\u2019s filtration system gets worse as we age, and as a result, plaque made up of amyloid proteins as well as tangles of tau proteins can accumulate in people\u2019s brains and eventually lead to neurological damage, leading to the severe memory loss of Alzheimer\u2019s disease. Researchers have found evidence that those amyloid and tau proteins also accumulate, not just in the brains, but also in the lymph nodes in older people.<\/p>\n So could a minimally invasive surgery to improve the brain\u2019s drainage have such a dramatic impact on Alzheimer\u2019s disease?<\/p>\n Siddiqui, who also runs the Jacobs Institute at the University of Buffalo, which is focused on new technology for vascular and neurological disease, had been interested in the lymphatic system\u2019s role in Alzheimer\u2019s before he ever heard about this experimental work out of China from a colleague years ago. The colleague had gone to see Dr. Qingping Xie, the surgeon who started performing lymphatic surgery on Alzheimer\u2019s patients about six years ago. To investigate further for himself, Siddiqui went to South Korea to meet a plastic surgeon, Dr. Joon Pio Hong, who was performing a new \u201cmore refined\u201d version of the same basic procedure, as Siddiqui put it. But as in China, these were not proper randomized experiments. There was no placebo.<\/p>\n So Siddiqui wanted to see if he could test it himself. After performing proof of concept operations in 2025 with a new microrobotic tool<\/a> (for a rare disorder involving constricted blood vessels in the brain), he and his colleagues decided to take an even bigger swing: testing this new technology to perform the lymphatic surgery for Alzheimer\u2019s<\/a>.<\/p>\n The researchers applied to the US Food and Drug Administration and received approval<\/a> late last year for five initial procedures; over the summer, they got the green light<\/a> to perform the procedure on 15 patients. Several operations have already been performed, and Siddiqui told me he had four more lined up next week.<\/p>\n Sign up for the Good Medicine newsletter<\/p>\n Our political wellness landscape has shifted: new leaders, shady science, contradictory advice, broken trust, and overwhelming systems. How is anyone supposed to make sense of it all? Vox\u2019s senior correspondent Dylan Scott<\/a> has been on the health beat for a long time, and every week, he\u2019ll wade into sticky debates, answer fair questions, and contextualize what\u2019s happening in American health care policy. Sign up here<\/a>.<\/p>\n The mechanism makes superficial sense: If Alzheimer\u2019s is the byproduct of amyloid and tau building up in the brain because the body gets worse at filtering them out, bypassing a clogged \u201cdrain\u201d in the lymphatic system could help to clear the proteins and relieve symptoms. It is, by a different method, the same therapeutic target as recent breakthrough drugs that slow down the cognitive decline<\/a> of an Alzheimer\u2019s patient.<\/p>\n But instead of an injection, the procedure involves a small incision in the neck, allowing surgeons to connect lymph nodes to a vein. The hope is that creating this new drainage route will help the brain clear amyloid and tau more effectively and \u201chopefully bypass whatever plugs that might be there in the system,\u201d Siddiqui said.<\/p>\n This first round of US surgeries are part of what\u2019s called an early feasibility study. \u201cYou\u2019re just trying to prove that it\u2019s definitely safe and definitely doable and maybe effective,\u201d Siddiqui said. They\u2019re measuring not only the patients\u2019 cognitive performance but other data points \u2014 such as changes to their gait \u2014 for any sign of benefit or harm.<\/p>\n If results are promising, a second feasibility study will involve a larger number of patients \u2014 50 or so. After that, if the evidence suggests they should move forward, the scientists would start to introduce placebos. In the case of surgery, that means some patients would receive \u201csham\u201d surgeries that wouldn\u2019t actually do anything. Then investigators would compare the experiences of the two groups: the people who received the fake surgery and the people who got the real thing.<\/p>\n If the latter group improves significantly more than the former, that would allow scientists to say definitively: Yes, this surgery actually works to treat Alzheimer\u2019s.<\/p>\n \u201cObviously, this is exactly the kind of disease where there\u2019s so much hype and so much hope,\u201d Siddiqui told me. So it is essential to build out the careful research to substantiate it.<\/p>\n But let\u2019s not get ahead of the science<\/p>\n Siddiqui has been in this position before \u2014 and he\u2019s seen it go both ways. There was the new stroke treatment that proved successful and has since become the standard around the world. But he was also an early investigator of a multiple sclerosis treatment, somewhat similar to the Alzheimer\u2019s surgery. After initial promise, it failed when the randomized trials began.<\/p>\n \u201cI wouldn\u2019t be a neurosurgeon if I was not an eternal optimist,\u201d he said. \u201cHowever, I\u2019m a clinical trialist, and I always respect placebo.\u201d<\/p>\n Placebos are essential<\/a>, but they are also tricky. If somebody thinks they have received an active treatment in a study, they tend to think they\u2019re going to benefit. This goes<\/a> for surgical treatments as well. So following patients\u2019 and their symptoms after the intervention is essential to seeing just how much of the effects can be attributed to the treatment and how much could be placebo effect. The latter of which could also be reinforced by loved ones who are desperate to see their parent or spouse get better.<\/p>\n Alzheimer\u2019s is also a complicated disease that we still don\u2019t totally understand. While scientists think there is a relationship between amyloid and tau proteins and Alzheimer\u2019s disease, other factors, such as inflammation and vascular health, could also have a role. Some prior drug candidates have successfully cleared amyloid plaque<\/a>, but patients didn\u2019t get better. Some people have amyloid build-up in their brains<\/a> but never develop Alzheimer\u2019s disease.<\/p>\n Dr. Bohdan Pomahac, division chief of plastic and reconstructive surgery at Yale School of Medicine, is overseeing studies designed to establish more of the basics of how these proteins pass through the lymphatic system. This research includes investigating whether obstruction actually occurs in Alzheimer\u2019s patients, and if so, where exactly those blockages usually are. Only after they do this work, he said, would his team be comfortable proposing surgeries to relieve the blockage and see if that helps improve Alzheimer\u2019s patients\u2019 symptoms.<\/p>\n He told me about having seen Xie, the procedure-pioneering Chinese surgeon, speak during a plastic surgery conference a few years ago. (Plastic surgeons are experts in the kind of microsurgery necessary for the procedure, and several are involved in the ongoing Alzheimer\u2019s trials.)<\/p>\n \u201cI think most people, including myself at the time, dismissed it as, \u2018This is some sort of a charlatan.\u2019\u201d Pomahac said. \u201cBut he kept coming back to conferences every year and started to show more and more videos. We were not sure. Is it actors? You couldn\u2019t tell what\u2019s going on.\u201d<\/p>\n Which is why he is dedicated to doing more of the foundational research to understand Alzheimer\u2019s first. \u201cRushing to the operating room makes no sense in my mind at this point,\u201d Pomahac said. \u201cI think there\u2019s a lot of work that needs to be done to really identify the site of surgery and what type of intervention would be most effective.\u201d<\/p>\n