In Context
Film
From film to philanthropy
What is it like to be diagnosed with an incurable
movement disorder as a young adult? When should you
tell people about your illness? How does the diagnosis
affect your mental state? Or your close relationships?
Still: A Michael J Fox Movie provides an open and
honest insight into these challenges, in the words of
Michael J Fox himself. In Still, Fox relays his original
perspective as someone in the global spotlight, whose
profession relies on controlled movement and speech.
Still starts in Florida in 1990, with a dramatisation of
Fox in his 20s, waking up hungover in his hotel room and
noticing his small finger twitching as he blinkingly looks at
his hand in the sunshine streaming through the curtains.
Fox, who narrates throughout, says the “trembling was a
message from the future”, in reference to both his 1985
film hit Back to the Future and his soon-to-be diagnosed
Parkinson’s disease. The documentary, based on the actor’s
memoirs, charts Fox’s journey from a young child growing
up in Canada, to his school years when he takes his first
drama class, to him moving to Los Angeles to try to make it
in Hollywood, and eventually to him achieving phenomenal
success. Alongside his career trajectory, his journey with
Parkinson’s disease is told, starting with his early diagnosis
in 1991 at age 29 years. Fox’s wife, Tracy Pollan, who he
met on his hit TV show Family Ties (she was his character’s
on-screen girlfriend, before life imitated art), also appears
in the documentary. Their romance is recounted in Still, and
the viewer gets an insight to the couple’s relationship with
their four children. Family life is full of fun and laughter,
amid dealing with the realities of the disease, including
Fox’s injuries following falls. A one-to-one interview with
Fox by director Davis Guggenheim punctuates the film
throughout. But only Fox is shown responding to the off-
screen interviewer, which is fitting; he is the star after all,
and this is his story of stardom and illness. Scenes from
Fox’s screen work are also shown to portray his life, but this
tactic is overused and the viewer might find these scenes
superfluous.
The most powerful parts of Still are when Fox speaks
about his illness and how he coped (or didn’t cope).
He recalls his diagnosis and the haunting words of the
neurologist: progressive, degenerative, incurable. On
screen, Fox would try to hide the tremor in his left hand
by holding an object such as a phone or briefcase. He
became an expert at timing his Parkinson’s medication,
taking it only when he required maximum symptom
control. Off screen, Fox turned to alcohol, and he admits to
becoming an alcoholic at one point. It was 7 years before
Fox went public about his diagnosis. At first, he regrets
this decision, then the viewer sees him start to embrace
www.thelancet.com/neurology Vol 22 September 2023 785
the announcement and consider his disease as a beginning
rather than the end. “I wanted to be in the world and not
take this [disease] in retreat from the world”, Fox tells
Guggenheim.
Reaching this way of thinking about his disease was a
turning point in Fox’s journey and his interest in helping
the Parkinson’s community. In Still, the viewer sees
inspirational archive footage of the actor testifying before
US Congress, asking for an increase in research funding
for Parkinson’s disease. Soon after, in 2000, Fox launched
Apple TV+
the Michael J Fox Foundation for Parkinson’s Research,
and this non-profit organisation has now raised more
than US$1·5 billion for research into the disease. Deborah Published Online
Brooks, co-founder and CEO of the Foundation, tells June 15, 2023
https://doi.org/10.1016/
The Lancet Neurology that in preparation to go before S1474-4422(23)00234-X
Congress, Fox met with many Parkinson’s disease experts Still: A Michael J Fox Movie
and “that really did galvanise his point of view about Director: Davis Guggenheim
where he could make a difference”. Fox quickly realised Release date: May 12, 2023
Running time: 95 mins
that “the science is ahead of the money” and he decided to
For more on the Michael J Fox
launch the non-profit Foundation with Brooks, who has a Foundation for Parkinson’s
background in business. Research see https://www.
The Foundation funds basic, translational, and clinical michaeljfox.org/
research and galvanises patients for advocacy, fundraising,
and research participation. Its staff includes a team of
19 neuroscientists who identify and peer review promising
research ideas or work in the Foundation’s policy team.
Business strategists are also employed by the non-profit
organisation, “to prioritise”, explains Brooks. “They’re
looking for process improvements…They figure out how to
do as much as we can as fast as we can.” Speaking about
the Foundation’s mission, Brooks says “our goal is to do
whatever we can to speed drug development”. As well as
taking on “the toughest” projects in research, Brooks states
that the Foundation “will staff the long-term needs for
the field” and they “will convene key partners”. Regarding
research priorities, Brooks notes that “they evolve…
priorities have to evolve with the state of science, and it has
to be matched to what’s possible”.
Apple TV+
 In Context
For more on α-synuclein seed
amplification see Articles
Lancet Neurol 2023; 22: 407–17
For more on the Parkinson’s
Progression Markers Initiative
see https://www.ppmi-info.org/
786 www.thelancet.com/neurology Vol 22 September 2023
The Foundation has had recent success. In May 2023,
researchers funded by the Foundation reported that the
emerging method—α-synuclein seed amplification—can
classify people with Parkinson’s disease with high accuracy,
provide information about their molecular differences, and
detect prodromal individuals before diagnosis. Follow-up
work includes investigating “the impact of assay results
on long-term outcomes”, comments co-lead author
Andrew Siderowf, Director of the Parkinson’s Disease
and Movement Disorders Center at the University of
Pennsylvania (Philadelphia, PA, USA). Siderowf—a long-
time researcher with the Foundation and co-lead of its
flagship Parkinson’s Progression Markers Initiative—thinks
the “vital difference” the Foundation provides compared
with other funders is that it takes on “higher risk and
potentially more impactful studies” that otherwise might
not have received funding. “It’s really crucial that way”,
he notes.
Looking ahead, Brooks says the Foundation plans “to be
big pictured and open”. She hopes, for example, that “in
scalable tissue systems like blood, we are able to do a lot of
screening of risk factors for neurodegeneration much earlier
in life…perhaps as early as your 40s…One of the things we
want to do is start looking and identify people where the
biology exists and predict symptoms by decades”. The
future for the Foundation looks ambitious and optimistic,
qualities the film Still shows Fox has himself.
For young people growing up in the 1980s, it would be
hard not to be a fan of Michael J Fox’s TV shows and films,
with his impeccable comedic timing and well delivered
one-liners. His screen work will forever be a part of growing
up then. But in the future, his contributions to Parkinson’s
disease research could win him a whole generation of new
fans.
Udani Samarasekera