 Over the past 20 years or so, Big Pharma has invested more than a half trillion dollars into dementia treatment research, but so far to little avail. In light of this, many have turned to supplements. An AARP commission survey found that 36% of those 74 years and older take a supplement for brain health to the tune of billions of dollars a year. The most commonly marketed brain supplement was one I'd frankly never heard of before Prevagen. Prevagen contains a protein derived from a luminescent jellyfish the company claims has been clinically shown to improve memory. According to the company website, a landmark double-blind and placebo-controlled trial demonstrated Prevagen improved short-term memory learning and delayed recall over 90 days. But when you actually pull up the study, not only did Prevagen fail to improve memory learning or recall over placebo, it failed to show a significant improvement in any of the nine measured cognitive tasks tested. As an inquiry into Prevagen, published by the Center for Science and the Public Interest was titled, how can this memory supplement flunk its one trial and still be advertised as effective? Not just as effective, but the number one pharmacist-recommended brand. Considering the lack of sound clinical evidence, how is that possible? Presumably they're just as blitzed with the same kind of advertising as everyone else. No surprise the supplement didn't do anything since the company's own study showed the jellyfish protein was rapidly digested by stomach enzymes. Of course that didn't stop them from raking in more than $20 million a year. Claiming the marketers of Prevagen preyed on the fears of older consumers experiencing age-related memory loss, the Federal Trade Commission and New York State's Attorney General followed a consumer protection complaint charging the company with making false and unsubstantiated claims. The AARP weighed in, accusing the company of deceiving millions of aging Americans. In a move straight out of the big-form aducanumab playbook, the company went back and conducted more than 30 post-hoc analyses of the data and found a few positive findings on a few tasks for some subgroups. This cherry-picking of subgroups after the fact is a classic example of manipulation sometimes called a pee-hacking or data-dredging that can be described as placing a bet on a horse after watching the race. The makers of Prevagen settled a class action lawsuit in 2020 with the FTC over deceptive business practices and false advertising. Remarkably though, the settlement allows them to continue to market it with a court-approved disclaimer that claims are based on a clinical study of subgroups of individuals. But with the amount of slicing and dicing of data they did, the chances of finding at least one false positive was estimated at 80%. Prevagen made me more than just a waste of money. The manufacturer was cited for failing to report more than a thousand adverse events related by consumers to the Food and Drug Administration. Regulators can't have it both ways, though. I mean, if the jellyfish protein is digested away, how can it pose a safety risk? Because dietary supplements are too often adulterated with contaminants. FDA inspectors specifically cited Prevagen's manufacturing facilities for objectionable conditions or practices. A 2019 survey by Pew found that more than half believed that the Food and Drug Administration required supplements to be tested for safety. But that isn't true. One study of 24 supplements sold as cognitive performance boosters found that most claimed an ingredient on the label that wasn't actually in the supplement, and worse, 38% contained ingredients not allowed in supplements like prohibited drugs. Another study of a dozen so-called brain health supplements simply found 8 out of 12 were misbranded, missing an ingredient promised on the label, and 10 out of 12 were deemed adulterated, containing unlisted compounds. For example, caffeine in a product that explicitly highlighted all caps decaffeinated on the label. Only 1 out of 12 was certified to contain what it said it did. The bottom line for Prevagen? There is no acceptable evidence that it's effective. Patients should be advised not to take it.