title: Patient Requests for Off-Label Bioprediction of Dementia.
abstract: In 2012, the FDA approved for the differential diagnosis of Alzheimer's disease a brain-imaging technology, Amyvid-PET (aka florbetapir-PET), capable of non-invasively estimating the burden of amyloid plaques; this approval for one indication renders the technology a candidate for off-label use for another indication according to a physician's judgment. What should a physician do if an educated, pro-active, and concerned patient requests off-label use of Amyvid-PET to help her estimate the likelihood that her mild memory complaints are "just normal aging" or are likely to profoundly worsen? I consider reasons that a physician might justify denial of such a request, including concerns of safety, uncertain benefit, and fair resource allocation, but cautiously conclude that there may be certain cases where off-label bioprediction would be permissible.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Baum
mesh_terms: D000375:Aging; D000544:Alzheimer Disease / Q000000981:diagnostic imaging*; D000814:Aniline Compounds; D001921:Brain / Q000000981:diagnostic imaging*; D003704:Dementia / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005026:Ethylene Glycols; D005260:Female; D005462:Fluorine Radioisotopes; D006801:Humans; D056687:Off-Label Use / Q000941:ethics*; D049268:Positron-Emission Tomography / Q000379:methods*; D016312:Treatment Refusal
chemical_list: D000814:Aniline Compounds; D005026:Ethylene Glycols; D005462:Fluorine Radioisotopes; C545186:florbetapir
keywords: Alzheimers disease; biomarkers; florbetapir-PET; neuroethics; off-label use