Healthy Skepticism Library item: 2730

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Cassels A.
Dementia do-nothing meds on www.worstpills.org
Common Ground ( Canada) 2005 Nov 4
http://www.commonground.ca/iss/0511172/cg172_cassels.shtml

Keywords:
Alzheimer's dementia

Notes:

Ralph Faggotter’s Comments:

The main problem with the current batch of Alzheimer medications is that they have been vastly over-sold to the medical profession adn the public alike.
The truth is that they are only effective in a 1/3 of users and then the effect is barely noticable in most.
On the other hand they can have significant adverse effects and drug interactions.

Naturally , desparate relatives will try anything, but the focus on ‘treatment through medication’ usually provides unre4alistic hope and the despair of the loved ones is doubled as they see the false promises turn to nothing.

Instead the focus should be on the provision of adequate nursing and caring services and a realistic acceptance that the great cure has not yet arrived.

Full text: Archive : Nov 2005

Dementia do-nothing meds on www.worstpills.org

by Alan Cassels

Unlike the widely publicized, recent struggle between BC’s teachers and the provincial government, numbers of battles have been fought largely out of sight in BC for years. One I am keenly aware of pits patient-advocates against the government, with both sides arguing over treatments for Alzheimer’s disease. It is a vitally important battle that forces us to profoundly question how we, as a society, evaluate and subsidize key drug treatments for our aging population.
On one side are the patients and their caregivers who desperately need the support of public health dollars as they struggle to cope with the mental degeneration associated with Alzheimer’s that besets much of the aging population. The patient-advocates demand an increase in public coverage to ensure better caregiver support, and they want BC PharmaCare to cover the associated pharmaceutical treatments. (Health Insurance BC is the new name for the administrative operations of the Medical Services Plan and PharmaCare, including Fair PharmaCare.)
The drama arises from the fact that the BC government doesn’t cover the three main drugs used to treat Alzheimer’s: Aricept (donepezil), Exelon (rivastigmine), and Reminyl (galantamine). Known as cholinesterase inhibitors, these drugs inhibit an enzyme that breaks down the brain transmitter acetylcholine, a deficiency of which is believed to play a role in Alzheimer’s disease.
From the government’s perspective, only drugs of proven efficacy should be covered, and BC PharmaCare must act in a way that represents good stewardship of public dollars. That the drugs are not covered under PharmaCare is indicative of the belief that pharmaceutical treatments for Alzheimer’s are largely a waste of money.
It’s a harsh reality, because people hope for treatments that will reduce the devastation caused by Alzheimer’s, arguably one of the more difficult diseases that our aging society deals with. Yet, in this battle, I would say that the weight of evidence lies on the side of the government. The problem is that the three drugs used to treat Alzheimer’s disease show benefits that are small – some would even say non-existent. And for many patients, the side effects are serious.
In fact, a recent study published in the medical journal Lancet showed that Aricept, the world’s top-selling Alzheimer’s drug, had little effect on extending the time that people with the disease could live independently in their homes – a benefit which is considered of primary importance to both the drug manufacturer and patient-advocates.
Much controversy has swirled around the subject of treatments for Alzheimer’s, especially since Aricept arrived on the Canadian market in 1997. One of the most controversial issues is the slippery way the drug’s effects are measured. Early research indicated very modest benefits; to be precise, the drug caused an average improvement of three points on a 70-point cognitive test called ADAS-Cog (Alzheimer disease assessment scale). Scores ranged from zero (no impairment) to 70, corresponding to severe impairment. One would be hard pressed to say that an average of three points actually represents any meaningful change in a person’s functioning capacity, yet lobbying for coverage has been intense.
When Aricept emerged on the market, newspaper headlines across Canada announced “breakthrough” benefits from the drug. The public relations machine and its patient-group surrogates worked hard to convince provincial governments across Canada to cover Aricept. They largely succeeded in allowing the hype to obscure the science; other than BC and Newfoundland, every province in Canada has caved in to the pharma-funded lobbying.
In not covering the drug, BC PharmaCare is saving money – money that could perhaps be put to better use. According to the Alzheimer Society of BC, 41,000 people in BC suffer with Alzheimer’s disease. The pills cost about $5 per day. If BC covered the drugs for every individual diagnosed with Alzheimer’s, it would cost about $75 million annually. That’s a lot of citizens’ tax dollars that could be used for other purposes, including providing better caregiver support for Alzheimer’s sufferers.
But wait a minute. What about the patients who do derive some benefit from taking a drug? Any reasonable person would say that in certain patient-specific situations, the drug should be covered. Luckily, there are innovative ways for the provincial drug plans to sponsor individual patient trials and provide subsidized access to the drug during a trial period to see if it works. These “N of 1” trials could rigorously establish whether a particular drug is of any benefit to a particular patient, and if so, that individual’s drug regime would be subsidized. If the drug were not effective for that patient, coverage would cease. We’d all win, right?
Of course, for an “N of 1” trial to happen, it would require the cooperation of the Alzheimer’s Society, the drugs’ manufacturers, and other groups, who, as far as I can tell, see further research as pointless; they are fully convinced that the government must cover the drugs. The Alzheimer Society of BC’s website even provides pre-written postcards for patient-advocates to fill out and forward to their MLAs.
But, let’s be clear, and here I’m speaking to MLAs who might be the recipients of these postcards; it’s not just big, bad BC PharmaCare putting the kibosh on paying for Alzheimer’s drugs. In its publication Worst Pills Best Pills, the consumer group US Public Citizen has gone even further and proverbially stamped the three Alzheimer’s drugs with a “Do not use!” tag. And they don’t make this kind of pronouncement lightly.
Last month, the consumer group’s newsletter reported on the highest quality research produced to date on the effects of these drugs – a systematic review of all published “gold standard” clinical trials of the three Alzheimer’s drugs. It called the scientific basis for recommending the use of these drugs “questionable.” The review, published in the British Medical Journal, also found that donepezil, rivastigmine, and galantamine “caused a broad spectrum of adverse events: nausea, vomiting, diarrhea, and weight loss were the most common.” Worst Pills concluded: “At this time, there are no safe and effective treatments that substantially alter the progression of Alzheimer’s disease.”
However, there is a ray of hope on the prevention front. The journal Lancet Neurology recently reported the results of a study that found middle-aged people who exercise much less likely to develop dementia or Alzheimer’s disease later in life. It appears that exercise may improve blood flow in the brain and help protect against conditions like high blood pressure that make dementia more likely.
There is a solution to the $75-million dilemma: let’s hold the line on useless treatments and use those savings to make better exercise programs available to a wider array of people.
Note: Good-quality information about drugs is worth paying for. www.worstpills.org is a great resource for factual and objective information. You can subscribe to worstpills.org’s newsletter for $15 US annually. Why do you need to pay? Unlike most drug information available on the web, worstpills.org is not subsidized by the pharmaceutical industry.

Alan Cassels is the co-author of Selling Sickness: How the World’s Largest Pharmaceutical Companies Are Turning Us All Into Patients and a drug policy researcher at the University of Victoria. He has spent most of the last 10 years studying how clinical research about prescription drugs is communicated to policy makers, prescribers, and consumers and has produced several full-length documentaries for CBC Ideas, including Manufacturing Patients, which deals with the subject of selling sickness.