Across the long human effort to outrun disease, there are moments when a hopeful idea moves faster than the evidence that might justify it. In Ontario's clinics, a neurologist named William Brown has watched one such moment before, when desperate MS patients chased a vein-opening procedure that promised relief and then faded once careful trials found nothing behind it. Now a similar current runs through dementia, where a Chinese microsurgical operation linking brain drainage vessels to venous outflow is traveling from hospital to hospital on the strength of striking videos rather than proven r
Before Celebrating an Alzheimer's Surgery, a Word of Caution From the Zamboni Era
A stunning absence of evidence
Mark
Why is a neurologist bringing up a failed MS treatment from 2009 in a piece about Alzheimer's?
Mimi
Because Dr. Brown lived through it. He and a colleague managed about 1,500 MS patients in Thunder Bay when the Zamboni procedure swept Canada, and he sees the same ingredients now.
Mark
Which ingredients?
Mimi
Desperate patients, no truly effective treatment, a charismatic idea, and compelling visuals. For Zamboni it was venograms and patient testimonials. For this surgery it's viral videos, like the 80-year-old man who went from slumped in bed to reciting an anthem.
Luke
Worth saying that the video is one case, and Brown's account of it comes through the Nature article. A video shows what happened, not why, and not whether it lasts or would happen to other patients.
Mark
So is the surgery known to fail?
Luke
No. Brown predicts it will probably end like Zamboni's, but that's his opinion. Trials are only now underway, so the outcome is unknown.
Mimi
He also says the surgery is harder than Zamboni's, since it needs microsurgeons working on tiny vessels.
Mark
He also questions the amyloid theory itself. How strong is that claim?
Luke
It's his view that the hypothesis may be wrong. He says both proteins can be reduced by treatment but no drug has meaningfully stopped decline. Others may read the drug evidence differently, and the piece doesn't say.
Mimi
And the piece doesn't say how many patients were harmed or helped. It says hundreds of operations, chiefly in China, with few in proper studies.
Luke
That gap is the whole point: the number of operations is known, the evidence of benefit isn't.
Der Puls
- A surgery that reconnects tiny brain-draining lymphatic-like vessels to venous outflow is spreading across hospitals faster than the evidence can follow.
- Viral videos of an elderly patient reportedly regaining speech and movement have ignited a frenzy that is pulling families and surgeons toward an unproven operation.
- Neurologist William Brown recognizes the echo of the 2009 Zamboni MS craze, when a procedure collapsed once controlled trials failed to confirm its benefit.
- Hundreds of operations have already been performed, largely in China, while formal clinical trials are only now beginning to take shape worldwide.
Across the long human effort to outrun disease, there are moments when a hopeful idea moves faster than the evidence that might justify it. In Ontario's clinics, a neurologist named William Brown has watched one such moment before, when desperate MS patients chased a vein-opening procedure that promised relief and then faded once careful trials found nothing behind it. Now a similar current runs through dementia, where a Chinese microsurgical operation linking brain drainage vessels to venous outflow is traveling from hospital to hospital on the strength of striking videos rather than proven results. Brown's warning is less an accusation than a plea: that hope be given the patience of proof.
In 2009, Canadian patients with multiple sclerosis pressed for a vein-opening procedure devised by Italian surgeon Paolo Zamboni. Dr. William Brown, a McMaster neurology professor working in Thunder Bay, watched that enthusiasm rise with a mixture of sympathy and alarm. Patients were exhausted by drugs that barely slowed their disease, and families paid heavily to chase any chance of help. When trials later failed, the treatment disappeared, leaving behind a cautionary tale about desperation, persuasive images, and too little proof.
Brown now sees the same pattern forming around Alzheimer's disease. Drugs that clear amyloid or tau have not yet shown they can meaningfully halt cognitive decline, and he questions whether the underlying theory is even correct. An August article in Nature described a Chinese microsurgical technique that connects brain lymphatic-like vessels to veins, with the goal of clearing amyloid. It began with a single patient in 2020, whose recovery was captured in videos that spread widely and inspired other surgeons across China and beyond.
Hundreds of operations followed, yet few were conducted under rigorous study conditions, and the procedure has reached respected centers such as the Cleveland Clinic. Brown acknowledges that this surgery is technically harder than Zamboni's work, since it demands skill with delicate vessels. Still, the story feels familiar to him. He hopes for clarity and, if the surgery succeeds, a credible explanation for how it works. Whether it earns that place or joins Zamboni's treatment in history will depend on the trials now beginning.
In 2009, patients with multiple sclerosis across Canada began clamoring for a procedure devised by an Italian vascular surgeon named Paolo Zamboni. Dr. William Brown, a professor of neurology at McMaster University, watched it happen from a clinic in Thunder Bay, where he and a colleague managed roughly 1,500 MS patients in northwestern Ontario. He is now seeing the same pattern take shape around a surgery for Alzheimer's disease, and he has written in Niagara Now to urge caution.
Zamboni proposed that MS was caused by obstructions in the veins draining the brain and spinal cord. His remedy was to open those veins with balloon catheters, inflating them from inside. His evidence was before-and-after venograms showing blocked veins that had been cleared, plus patients' reports that they felt much better. Brown writes that this was compellingly impressive to patients, their families and some physicians.
Brown does not blame them. The MS drugs of the day relied on an autoimmune hypothesis of the disease, and they reduced relapses only somewhat while barely touching cumulative disability. Side effects, fatigue among them, landed on people already plagued by fatigue. Some patients traveled abroad and paid high bills to find a surgeon willing to operate. Some provinces paid for the treatment, and some communities raised money for patients. Brown met Zamboni twice and found him convinced he was right and eager to join clinical trials. Those later trials failed to support his hypothesis, and the treatment vanished despite the early enthusiasm and the claims of improvement. Brown calls the episode a perfect storm: desperate patients, a surgeon equally desperate to help his wife and others, no truly effective therapy, and, he adds, more than a little arrogance at some MS clinics that did not grasp how desperate their patients were.
He sees a similar setup now in dementia. Millions of patients and families want something that significantly slows or stops Alzheimer's progression, or, given early enough, a low-risk treatment that prevents it. Brown says that despite pharmaceutical company claims, no drug aimed at clearing beta amyloid, or more recently tau, has been shown to meaningfully slow or stop cognitive decline in all its forms. He suggests the underlying hypothesis, toxic accumulation of those proteins, may be wrong. Both proteins do accumulate, and treatment can reduce both, but he invokes physicist Richard Feynman's point that a promising theory without strong experimental evidence is wrong.
That brings him to an August article in Nature titled "A Controversial Alzheimer Surgery is Getting A Closer Look." Its subhead describes jaw-dropping patient videos and miraculous testimonials igniting a frenzy in China over a technique said to reverse the disease's symptoms, now entering trials worldwide. To Brown, the tone recalls the Zamboni days.
The operation uses microsurgery to connect lymphatic-like vessels that drain the brain to venous outflow, with the aim of improving the clearance of beta amyloid. A Chinese microsurgeon tried it in 2020 on an 80-year-old man. Serial videos showed him slumped in a hospital bed before surgery, alert and recognizing his father days afterward, and by the eighth month walking briskly and reciting a Maoist military anthem from memory.
The videos went viral. Other microsurgeons in China adopted the procedure, and word reached surgeons in the United States, the United Kingdom and elsewhere. Hundreds of similar operations followed, chiefly in China, yet Brown describes a stunning absence of evidence. Few of those patients were part of what would be considered proper studies, and the technique has reached mainstream hospitals such as the Cleveland Clinic. Only now, several years on, are suitable clinical trials underway.
Brown notes one difference: connecting tiny lymphatic vessels to veins is far harder than Zamboni's ballooning of large veins, which is why most operations in China were done by microsurgeons trained to work on tiny vessels in confined spaces. Still, he considers the story amazingly similar and expects probably the same result. His closing wish is for clarity and, should the surgery work, an explanation that makes sense of how. The trials now underway will show whether it earns that or joins Zamboni's treatment in history.
Bemerkenswerte Zitate
The Alzheimer's surgery story is amazingly similar to the Zamboni story, and the results will probably be the same.— Dr. William Brown, professor of neurology, McMaster University
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