Connect with us

Science

Inside the plan to diagnose Alzheimer’s in people with no memory problems — and who stands to benefit

Published

on

Inside the plan to diagnose Alzheimer’s in people with no memory problems — and who stands to benefit

In a darkened Amsterdam conference hall this summer, a panel of industry and academic scientists took the stage to announce a plan to radically expand the definition of Alzheimer’s disease to include millions of people with no memory complaints.

Those with normal cognition who test positive for elevated levels of certain proteins that have been tied to Alzheimer’s — but not proven to cause the disease — would be diagnosed as having Alzheimer’s Stage 1, the panel members explained.

Even before the presentation ended, attendees in the packed hall were lining up behind microphones to ask questions, according to video of the event.

“I’m troubled by this,” Dr. Andrea Bozoki, a University of North Carolina neurologist, told the panel. “You are taking a bunch of people who may never develop dementia or even cognitive impairment and you’re calling them Stage 1. That doesn’t seem to fit.”

Under the proposal, tens of millions of Americans with normal cognition would test positive for abnormal levels of amyloid or tau, the two proteins the tests look for, and the majority of them may never be diagnosed with dementia, studies suggest. A 60-year-old man who tests positive, for example, is estimated to have a 23% risk of developing dementia in his lifetime.

Advertisement

Criticism of the plan has intensified since it was unveiled in July at the international conference attended by 11,000 doctors and scientists. But the panel, organized by the nonprofit Alzheimer’s Assn., is continuing its push to extend the diagnosis to people who have no problem recalling events or what day it is — and convince skeptics that Alzheimer’s symptoms aren’t necessary to have the disease.

Panel members argue that the earlier patients get help, the more effective it might be. The availability of new drugs for patients with early Alzheimer’s symptoms has spurred them into action now, they say.

The plan could be approved by the panel and published in a medical journal early this year, association officials said. Such a move is likely to be influential: A similar proposal in 2018 that was put forth to help guide research on experimental Alzheimer’s medications was quickly adopted by the Food and Drug Administration and is frequently cited by doctors, scientists and health insurers.

Standing to benefit are the pharmaceutical and medical testing companies who employ seven members of the 20-person panel. At least seven more members of the panel are academics who receive money from those companies for consulting or research. Panelists reached by The Times said the funding did not influence their decisions.

Four other scientists who are outside advisors to the panel are executives from Eisai and Biogen, the makers of two new medicines for Alzheimer’s patients, and Eli Lilly and Genentech, which are developing similar drugs.

Advertisement

The American Geriatrics Society called the panel members’ financial ties to industry “wholly inappropriate.” In an analysis of the proposal, the society warned the proposal could lead to overdiagnosis of Alzheimer’s and subject people to treatments with “limited benefit and high potential for harm.”

Others said the plan was premature at best.

“I think this is untested, uncharted territory,” said Dr. Madhav Thambisetty, a senior researcher at the National Institute of Aging. “I’m not at that stage where I would be able to make a diagnosis of Alzheimer’s disease in somebody who’s cognitively normal based on the presence of a single biomarker.”

A researcher at Washington University in St. Louis works on a blood test for Alzheimer’s disease.

(Huy Mach / University of Washington via Associated Press)

Advertisement

Under the proposal, people with no memory problems who test positive for abnormal levels of amyloid or tau proteins would be classified as Stage 1. They would move to Stage 2 if they begin to experience “neurobehavioral difficulties” such as depression, anxiety or apathy — symptoms often unrelated to Alzheimer’s — even if the patient’s cognition is unchanged.

Stage 3 would be for those with mild cognitive impairment, while Stages 4 through 6 would describe patients with mild, moderate or severe dementia.

The move to label more Americans as having Alzheimer’s comes amid a decades-long decline in the risk of dementia. Researchers don’t know why the risk is falling, but they say higher levels of education, a reduction in smoking and better treatment of high blood pressure could all be factors.

Dr. Peter Whitehouse, professor of neurology at Case Western Reserve University, is one of several doctors who have noted that the plan could benefit the Alzheimer’s Assn. since the majority of its donations come from people who know one of the estimated 6.7 million Americans now living with the disease and want to help find a cure. If more Americans are diagnosed with the disease under the new definition, the ranks of possible donors would swell, he said.

Advertisement

“This raises the potential for more people to want to give money,” Whitehouse added.

The panel said it was proposing the changes now because the FDA has approved two drugs — Eisai’s Leqembi and Aduhelm from Biogen — for patients in the early stages of memory decline. While a study of Leqembi’s effects on asymptomatic people has begun, there is currently no evidence that giving it to people without cognitive impairment can reduce the risk of dementia or delay the onset of Alzheimer’s symptoms.

Another reason for the change, the panel said, was the availability of new blood tests that do an “excellent” job of detecting abnormal levels of amyloid and tau in the brain. The blood tests are easier and less invasive than the PET scans and spinal taps that traditionally have been used to measure levels of Alzheimer’s-related proteins.

“The purpose of this initiative is to advance the science of early detection and treatment,” said panel member Maria Carrillo, the Alzheimer Assn.’s chief science officer. “In order to prevent dementia, we need to detect and treat the disease before symptoms appear.”

Thambisetty and other doctors also note that the plan does not address the serious bioethical concerns that come with testing healthy people for signs of Alzheimer’s.

Advertisement

People with no memory problems who learn they are positive for abnormal levels of amyloid or tau proteins can suffer from depression, anxiety and thoughts of suicide, studies have found.

A doctor points to PET scan results that are part of a study on Alzheimer’s disease at a hospital in Washington.

(Evan Vucci / Associated Press)

A positive test can also lead to discrimination by employers and by companies offering life, disability and long-term care insurance. That risk is so real that people with no memory complaints who volunteer for an ongoing clinical trial that requires an amyloid test are advised to consider getting any insurance they’ve been contemplating before taking the test.

Advertisement

“This is an ethically gray area,” Thambisetty said of testing cognitively normal people. “There are many questions that remain to be answered.”

Added Dr. Eric Widera, a geriatrician at UC San Francisco: “If somebody tests positive for amyloid and they are an airplane pilot, do they have to disclose that to the airlines? They are not asking these questions.”

Concerns like these led the panel members to revise the draft to say they were not yet advocating for “routine” testing of those without memory problems. And Dr. Clifford R. Jack Jr., a radiologist at the Mayo Clinic who leads the panel, told The Times the proposal was not an instruction manual to guide doctors in the evaluation, diagnosis and treatment of their patients.

“Should you diagnose Alzheimer’s disease in asymptomatic persons? The answer is no,” Jack said.

The changes did not reassure skeptics.

Advertisement

Widera pointed out that under the revised plan, an unimpaired person who tests positive for an Alzheimer’s biomarker would not be considered “at risk” for the disease because — in the panel’s view — they already have it.

“They are redefining what it means to have Alzheimer’s,” he said. “You no longer need to have cognitive impairment to have this disease. You just need the positive blood test.”

They are redefining what it means to have Alzheimer’s.

— Dr. Eric Widera, a geriatrician at UC San Francisco

Advertisement

That could lead doctors to prescribe the new drugs to people without memory problems, Widera said.

Indeed, interest in testing for Alzheimer’s-related proteins exploded after the FDA controversially approved Aduhelm and Leqembi, which reduce amyloid levels in the brain.

The hypothesis is that finding amyloid early and removing it might avoid irreversible brain damage. But so far researchers have failed to demonstrate that a build-up of amyloid causes dementia — or that removing it alleviates symptoms.

The FDA went against the advice of its independent advisory committee and green-lighted Biogen’s Aduhelm in 2021 even though there was a lack of evidence that it reduced cognitive decline. A Congressional investigation later found that Biogen executives met with FDA officials — including Dr. Billy Dunn, head of the neuroscience office — dozens of times and inappropriately collaborated on a key regulatory document. Dunn did not respond to questions from The Times.

The FDA approved the second drug, Eisai’s Leqembi, in July after a study showed it could slow the progression of Alzheimer’s in people with mild cognitive impairment by less than half a point on an 18-point scale, a finding that some doctors doubt would be noticeable to patients or their families.

Advertisement

The agency requires both drugs to carry warnings that they can cause potentially fatal bleeding or swelling in the brain.

A closeup of a human brain affected by Alzheimer’s disease is on display at the Museum of Neuroanatomy at the University at Buffalo in Buffalo, N.Y.

(David Duprey / Associated Press)

The Alzheimer’s Assn. has been among the most vocal advocates for the two drugs, which each cost more than $26,000 a year. The group deployed hundreds of volunteers to lobby Congress and get Medicare to pay for the treatments.

Advertisement

While prescriptions of Leqembi are now taking off, doctors have hesitated to prescribe Aduhelm. Last month, Biogen said it planned to stop selling Aduhelm and instead focus on promoting Leqembi through its partnership with Eisai.

The Alzheimer’s Assn.’s plan to create a new class of symptom-free Alzheimer’s patients began taking shape more than a decade ago and was included in proposals to update diagnostic criteria for the disease in 2011 and 2018.

The association’s website says the idea came from a meeting of its Research Roundtable, a group that companies pay thousands of dollars to join. The roundtable meets twice a year, often at the luxury Park Hyatt Hotel in Washington, D.C. Current members include Biogen, Eisai, Lilly, Genentech, Prothena and 15 other companies. Selected academics and drug regulators from around the world are also invited to attend.

In its 2023 fiscal year, the Alzheimer’s Assn. received $4.9 million from pharmaceutical, biotech, diagnostic and clinical research companies — more than in any of the previous five years. The association said those corporate donations amount to just 1.3% of its total cash donations of $379 million that year.

Carrillo, the association’s chief science officer, told The Times in a statement that “no contribution from any organization impacts the Alzheimer’s Association decision-making, nor our positions.”

Advertisement

“We make our decision based on science, and the needs of our constituents,” she said.

The association spent $100 million on research in its 2023 fiscal year, including grants to some of the academic scientists on the panel or to the universities they work for. Many of those grants are aimed at creating new strategies for early diagnosis of people without memory complaints.

That message of early detection is echoed by pharmaceutical and testing companies. At a scientific conference in Boston in October, Dr. Mark Mintun, an Eli Lilly executive who is an advisor to the panel, said in a presentation that the company’s experimental medicine donanemab helped younger people and those with lower levels of tau more than it helped older people and those with higher levels of the protein.

“This gives us great urgency in thinking about how to diagnose and prepare patients for treatment,” Mintun told the audience, according to a report on the Alzforum news website.

Among the seven industry executives sitting on the Alzheimer’s Assn. panel are former FDA official Dunn, who is now on the board of Prothena, a company developing anti-amyloid drugs; Dr. Eric Siemers, chief medical officer of Acumen Pharmaceuticals, which is also working on anti-amyloid drugs; and Dr. Philip Scheltens, who heads a venture capital fund that invests in dementia drugs.

Advertisement

They are joined by Dr. Reisa Sperling, a Harvard neurology professor who has received research grants from Eisai and Lilly and consulting fees from 18 other companies, according to the panel’s disclosures.

Sperling has led studies investigating the value of treating people without memory problems. She said in 2013 that she could see a future where “we will treat everybody preemptively, in the same way we vaccinate.”

Other academic panel members include Charlotte Teunissen, a professor at Amsterdam University Medical Centers who conducts research for 25 companies, and Dr. Michael Rafii, a USC professor of clinical neurology, who disclosed work for 11 companies.

Both Teunissen and Rafii said their industry funding has no bearing on their judgment.

“I believe working with a diverse group of pharmaceutical and biotech companies, each with their own therapeutic approaches and strategies, can mitigate against a single company’s influence,” Rafii said.

Advertisement

Sperling agreed that corporate research funding did not affect her objectivity. “I want to figure out the truth,” she said.

But others are not convinced.

“This panel is dominated by those with financial ties to companies that will directly benefit” from a more expansive view of Alzheimer’s, said Widera of UCSF. “And there was no consideration about the potential downsides or risk to the number of people who are going to be now diagnosed” if its definition is adopted.

The proposal — initially dubbed “The National Institute of Aging–Alzheimer’s Association Revised Criteria for Diagnosing and Staging Alzheimer’s Disease” — has received international attention in part because it seemed to have the backing of one of the U.S. government’s premiere research centers.

The American Geriatrics Society and others said the proposal’s name implied that the NIA, which is part of the National Institutes of Health, was a full partner in the effort.

Advertisement

But Dr. Eliezer Masliah, director of the institute’s neuroscience division, said that while he and another NIA scientist attend panel meetings, they are not involved in its decisions. “We’re listening and recording and just keeping track of the process,” he said.

After The Times asked NIH officials about the NIA’s involvement, they said the institute’s name would be removed from the proposal’s title.

Even before the plan has been finalized, one company told investors it was poised to benefit.

In a November call with Wall Street analysts, Masoud Toloue, the chief executive at Quanterix, pointed out that the company’s blood test for tau — called p-Tau 217 — had been recommended by the panel for diagnosing the disease.

“We believe we’re in a strong position to capitalize on these opportunities,” Toloue said.

Advertisement

Science

Cancer survival rates soar nationwide, but L.A. doctors warn cultural and educational barriers leave some behind

Published

on

Cancer survival rates soar nationwide, but L.A. doctors warn cultural and educational barriers leave some behind

The American Cancer Society’s 2026 Cancer Statistics report, released Tuesday, marks a major milestone for U.S. cancer survival rates. For the first time, the annual report shows that 70% of Americans diagnosed with cancer can expect to live at least five years, compared with just 49% in the mid-1970s.

The new findings, based on data from national cancer records and death statistics from 2015 to 2021, also show promising progress in survival rates for people with the deadliest, most advanced and hardest-to-treat cancers when compared with rates from the mid-1990s. The five-year survival rate for myeloma, for example, nearly doubled (from 32% to 62%). The survival rate for liver cancer tripled (from 7% to 22%), for late-stage lung cancer nearly doubled (from 20% to 37%), and for both melanoma and rectal cancer more than doubled (from 16% to 35% and from 8% to 18%, respectively).

For all cancers, the five-year survival rate more than doubled since the mid-1990s, rising from 17% to 35%.

This also signals a 34% drop in cancer mortality since 1991, translating to an estimated 4.8 million fewer cancer deaths between 1991 and 2023. These significant public health advances result from years of public investment in research, early detection and prevention, and improved cancer treatment, according to the report.

“This stunning victory is largely the result of decades of cancer research that provided clinicians with the tools to treat the disease more effectively, turning many cancers from a death sentence into a chronic disease,” said Rebecca Siegel, senior scientific director at the American Cancer Society and lead author of the report.

Advertisement

As more people survive cancer, there is also a growing focus on the quality of life after treatment. Patients, families and caregivers face physical, financial and emotional challenges. Dr. William Dahut, the American Cancer Society’s chief scientific officer, said that ongoing innovation must go hand in hand with better support services and policies, so all survivors — not just the privileged — can have “not only more days, but better days.”

Indeed, the report also shows that not everyone has benefited equally from the advances of the last few decades. American Indian and Alaska Native people now have the highest cancer death rates in the country, with deaths from kidney, liver, stomach and cervical cancers about double that of white Americans.

Additionally, Black women are more likely to die from breast and uterine cancers than non-Black women — and Black men have the highest cancer rates of any American demographic. The report connects these disparities in survival to long-standing issues such as income inequity and the effects of past discrimination, such as redlining, affecting where people live — forcing historically marginalized populations to be disproportionately exposed to environmental carcinogens.

Dr. René Javier Sotelo, a urologic oncologist at Keck Medicine of USC, notes that the fight against cancer in Southern California, amid long-standing disparities facing vulnerable communities, is very much about overcoming educational, cultural and socioeconomic barriers.

While access to care and insurance options in Los Angeles are relatively robust, many disparities persist because community members often lack crucial information about risk factors, screening and early warning signs. “We need to insist on the importance of education and screening,” Sotelo said. He emphasized that making resources, helplines and culturally tailored materials readily available to everyone is crucial.

Advertisement

He cites penile cancer as a stark example: rates are higher among Latino men in L.A., not necessarily due to lack of access, but because of gaps in awareness and education around HPV vaccination and hygiene.

Despite these persisting inequities, the dramatic nationwide improvement in cancer survival is unquestionably good news, bringing renewed hope to many individuals and families. However, the report also gives a clear warning: Proposed federal cuts to cancer research and health insurance could stop or even undo these important gains.

“We can’t stop now,” warned Shane Jacobson, the American Cancer Society’s chief executive.

“We need to understand that we are not yet there,” Sotelo concurred. ”Cancer is still an issue.”

Advertisement
Continue Reading

Science

Clashing with the state, L.A. City moves to adopt lenient wildfire ‘Zone Zero’ regulations

Published

on

Clashing with the state, L.A. City moves to adopt lenient wildfire ‘Zone Zero’ regulations

As the state continues multiyear marathon discussions on rules for what residents in wildfire hazard zones must do to make the first five feet from their houses — an area dubbed “Zone Zero” — ember-resistant, the Los Angeles City Council voted Tuesday to start creating its own version of the regulations that is more lenient than most proposals currently favored in Sacramento.

Critics of Zone Zero, who are worried about the financial burden and labor required to comply as well as the detrimental impacts to urban ecosystems, have been particularly vocal in Los Angeles. However, wildfire safety advocates worry the measures endorsed by L.A.’s City Council will do little to prevent homes from burning.

“My motion is to get advice from local experts, from the Fire Department, to actually put something in place that makes sense, that’s rooted in science,” said City Councilmember John Lee, who put forth the motion. “Sacramento, unfortunately, doesn’t consult with the largest city in the state — the largest area that deals with wildfires — and so, this is our way of sending a message.”

Tony Andersen — executive officer of the state’s Board of Forestry and Fire Protection, which is in charge of creating the regulations — has repeatedly stressed the board’s commitment to incorporating L.A.’s feedback. Over the last year, the board hosted a contentious public meeting in Pasadena, walking tours with L.A. residents and numerous virtual workshops and hearings.

Advertisement
  • Share via

Advertisement

Some L.A. residents are championing a proposed fire-safety rule, referred to as “Zone Zero,” requiring the clearance of flammable material within the first five feet of homes. Others are skeptical of its value.

With the state long past its original Jan. 1, 2023, deadline to complete the regulations, several cities around the state have taken the matter into their own hands and adopted regulations ahead of the state, including Berkeley and San Diego.

“With the lack of guidance from the State Board of Forestry and Fire Protection, the City is left in a precarious position as it strives to protect residents, property, and the landscape that creates the City of Los Angeles,” the L.A. City Council motion states.

Advertisement

However, unlike San Diego and Berkeley, whose regulations more or less match the strictest options the state Board of Forestry is considering, Los Angeles is pushing for a more lenient approach.

The statewide regulations, once adopted, are expected to override any local versions that are significantly more lenient.

The Zone Zero regulations apply only to rural areas where the California Department of Forestry and Fire Protection responds to fires and urban areas that Cal Fire has determined have “very high” fire hazard. In L.A., that includes significant portions of Silver Lake, Echo Park, Brentwood and Pacific Palisades.

Fire experts and L.A. residents are generally fine with many of the measures within the state’s Zone Zero draft regulations, such as the requirement that there be no wooden or combustible fences or outbuildings within the first five feet of a home. Then there are some measures already required under previous wildfire regulations — such as removing dead vegetation like twigs and leaves, from the ground, roof and gutters — that are not under debate.

However, other new measures introduced by the state have generated controversy, especially in Los Angeles. The disputes have mainly centered around what to do about trees and other living vegetation, like shrubs and grass.

Advertisement

The state is considering two options for trees: One would require residents to trim branches within five feet of a house’s walls and roof; the other does not. Both require keeping trees well-maintained and at least 10 feet from chimneys.

On vegetation, the state is considering options for Zone Zero ranging from banning virtually all vegetation beyond small potted plants to just maintaining the regulations already on the books, which allow nearly all healthy vegetation.

Lee’s motion instructs the Los Angeles Fire Department to create regulations in line with the most lenient options that allow healthy vegetation and do not require the removal of tree limbs within five feet of a house. It is unclear whether LAFD will complete the process before the Board of Forestry considers finalized statewide regulations, which it expects to do midyear.

The motion follows a pointed report from LAFD and the city’s Community Forest Advisory Committee that argued the Board of Forestry’s draft regulations stepped beyond the intentions of the 2020 law creating Zone Zero, would undermine the city’s biodiversity goals and could result in the loss of up to 18% of the urban tree canopy in some neighborhoods.

The board has not decided which approach it will adopt statewide, but fire safety advocates worry that the lenient options championed by L.A. do little to protect vulnerable homes from wildfire.

Advertisement

Recent studies into fire mechanics have generally found that the intense heat from wildfire can quickly dry out these plants, making them susceptible to ignition from embers, flames and radiant heat. And anything next to a house that can burn risks taking the house with it.

Another recent study that looked at five major wildfires in California from the last decade, not including the 2025 Eaton and Palisades fires, found that 20% of homes with significant vegetation in Zone Zero survived, compared to 37% of homes that had cleared the vegetation.

Continue Reading

Science

At 89, he’s heard six decades of L.A.’s secrets and is ready to talk about what he’s learned

Published

on

At 89, he’s heard six decades of L.A.’s secrets and is ready to talk about what he’s learned

Dr. Arnold Gilberg’s sunny consultation room sits just off Wilshire Boulevard. Natural light spills onto a wooden floor, his houndstooth-upholstered armchair, the low-slung couch draped with a colorful Guatemalan blanket.

The Beverly Hills psychiatrist has been seeing patients for more than 60 years, both in rooms like this and at Cedars-Sinai Medical Center, where he has been an attending physician since the 1960s.

He treats wildly famous celebrities and people with no fame at all. He sees patients without much money and some who could probably buy his whole office building and not miss the cash.

Gilberg, 89, has treated enough people in Hollywood, and advised so many directors and actors on character psychology, that his likeness shows up in films the way people float through one another’s dreams.

The Nancy Meyers film “It’s Complicated” briefly features a psychiatrist character with an Airedale terrier — a doppelganger of Belle, Gilberg’s dog who sat in on sessions until her death in 2018, looking back and forth between doctor and patient like a Wimbledon spectator.

Advertisement

“If you were making a movie, he would be central casting for a Philip Roth‑esque kind of psychiatrist,” said John Burnham, a longtime Hollywood talent agent who was Gilberg’s patient for decades starting in his 20s. “He’s always curious and interested. He gave good advice.”

Since Gilberg opened his practice in 1965, psychiatry and psychotherapy have gone from highly stigmatized secrets to something people acknowledge in award show acceptance speeches. His longtime prescriptions of fresh food, sunshine, regular exercise and meditation are now widely accepted building blocks of health, and are no longer the sole province of ditzy L.A. hippies.

Beverly Hills psychiatrist Dr. Arnold Gilberg, 89, is the last living person to have trained under Franz Alexander, a disciple of Sigmund Freud.

(Robert Gauthier / Los Angeles Times)

Advertisement

He’s watched people, himself included, grow wiser and more accepting of the many ways there are to live. He’s also watched people grow lonelier and more rigid in their political beliefs.

On a recent afternoon, Gilbert sat for a conversation with The Times at the glass-topped desk in his consultation room, framed by a wall full of degrees. At his elbow was a stack of copies of his first book, “The Myth of Aging: A Prescription for Emotional and Physical Well-Being,” which comes out Tuesday.

In just more than 200 pages, the book contains everything Gilberg wishes he could tell the many people who will never make it into his office. After a lifetime of listening, the doctor is ready to talk.

Gilberg moved to Los Angeles in 1961 for an internship at what is now Los Angeles General Medical Center. He did his residency at Mount Sinai Hospital (later Cedars-Sinai) with the famed Hungarian American psychoanalyst Dr. Franz Alexander.

Among his fellow disciples of Sigmund Freud, Alexander was a bit of an outlier. He balked at Freud’s insistence that patients needed years of near-daily sessions on an analyst’s couch, arguing that an hour or two a week in a comfortable chair could do just as much good. He believed patients’ psychological problems stemmed more often from difficulties in their current personal relationships than from dark twists in their sexual development.

Advertisement

Not all of Alexander’s theories have aged well, Gilberg said — repressed emotions do not cause asthma, to name one since-debunked idea. But Gilberg is the last living person to have trained with Alexander directly and has retained some of his mentor’s willingness to go against the herd.

If you walk into Gilberg’s office demanding an antidepressant prescription, for example, he will suggest you go elsewhere. Psychiatric medication is appropriate for some mental conditions, he said, but he prefers that patients first try to fix any depressing situations in their lives.

He has counseled patients to care for their bodies long before “wellness” was a cultural buzzword. It’s not that he forces them to adopt regimens of exercise and healthy eating, exactly, but if they don’t, they’re going to hear about it.

“They know how I feel about all this stuff,” he said.

He tells many new patients to start with a 10-session limit. If they haven’t made any progress after 10 visits, he reasons, there’s a good chance he’s not the right doctor for them. If he is, he’ll see them as long as they need.

Advertisement

One patient first came to see him at 19 and returned regularly until her death a few years ago at the age of 79.

“He’s had patients that he’s taken care of over the span, and families that have come back to him over time,” said Dr. Itai Danovitch, who chairs the psychiatry department at Cedars-Sinai. “It’s one of the benefits of being an incredibly thoughtful clinician.”

Not long after opening his private practice in 1965, Gilberg was contacted by a prominent Beverly Hills couple seeking care for their son. The treatment went well, Gilberg said, and the satisfied family passed his name to several well-connected friends.

As a result, over the years his practice has included many names you’d recognize right away (no, he will not tell you who) alongside people who live quite regular lives.

They all have the same concerns, Gilberg says: Their relationships. Their children. Their purpose in life and their place in the world. Whatever you achieve in life, it appears, your worries remain largely the same.

Advertisement

When it’s appropriate, Gilberg is willing to share that his own life has had bumps and detours.

He was born in Chicago in 1936, the middle of three boys. His mother was a homemaker and his father worked in scrap metal. Money was always tight. Gilberg spent a lot of time with his paternal grandparents, who lived nearby with their adult daughter, Belle.

The house was a formative place for Gilberg. He was especially close to his grandfather — a rabbi in Poland who built a successful career in waste management after immigrating to the U.S. — and to his Aunt Belle.

Disabled after a childhood accident, Belle spent most of her time indoors, radiating a sadness that even at the age of 4 made Gilberg worry for her safety.

“It’s one of the things that brought me into medicine, and then ultimately psychiatry,” Gilberg said. “I felt very, very close to her.”

Advertisement

He and his first wife raised two children in Beverly Hills. Jay Gilberg is now a real estate developer and Dr. Susanne Gilberg-Lenz is an obstetrician-gynecologist (and the other half of the only father-daughter pair of physicians at Cedars-Sinai).

The marriage ended when he was in his 40s, and though the split was painful, he said, it helped him better understand the kind of losses his patients experienced.

He found love again in his 70s with Gloria Lushing-Gilberg. The couple share 16 grandchildren and seven great-grandchildren. They married four years ago, after nearly two decades together.

“As a psychoanalyst or psychiatrist ages, we have the ability, through our own life experiences, to be more understanding and more aware,” he said.

It’s part of what keeps him going. Though he has reduced his hours considerably, he isn’t ready to retire. He has stayed as active as he advises his patients to be, both personally (he was ordained as a rabbi several years ago) and professionally.

Advertisement

For all the strides society has made during the course of his career toward acceptance and inclusivity, he also sees that patients are lonelier than they used to be. They spend less time with friends and family, have a harder time finding partners.

We’re isolated and suffering for it, he said, as individuals and as a society. People still need care.

Unlike a lot of titles on the self-help shelves, Gilberg’s book promises no sly little hack to happiness, no “you’ve-been-thinking-about-this-all-wrong” twist.

Psychiatrist Dr. Arnold Gilberg, 89, authored "The Myth of Aging: A Prescription for Emotional and Physical Well-Being."

After 60 years working with Hollywood stars and regular Angelenos, Gilberg is ready to share what he’s learned with the world.

(Robert Gauthier / Los Angeles Times)

Advertisement

His prescriptions run along deceptively simple lines: Care for your health. Say thank you. Choose to let go of harmless slights and petty conflicts. Find people you belong with, and stop holding yourself and others to impossibly high standards.

“People have the capacity to self-heal, and I have become a firm believer in that. Not everyone needs to be in therapy for 10 years to figure it out,” he said. “A lot of this is inside yourself. You have an opportunity to overcome the things and obstacles that are in you, and you can do it.”

So what is “it”? What does it mean to live a good life?

Gilberg considered the question, hands clasped beneath his chin, the traffic outside humming expectantly.

“It means that the person has been able to look at themselves,” he said, “and feel somewhat happy about their existence.”

Advertisement

The best any of us can hope for is to be … somewhat happy?

Correct, Gilberg said. “A somewhat happy existence, off and on, which is normal. And hopefully, if the person wants to pursue that, some kind of a personal relationship.”

As it turns out, there is no housing in happiness. You can visit, but nobody really lives there. The happiest people know that. They live in OK neighborhoods that are not perfect but could be worse. They try to be nice to the neighbors. The house is a mess a lot of the time. They still let people in.

Somewhat happy, sometimes, with someone else to talk to.

It is that simple. It is that hard.

Advertisement
Continue Reading
Advertisement

Trending