The bitter, bitter pill of Alzheimer’s Disease

(PHOTO: Julia Freeman-Woolpert)

A while back, when I was groaning over the crappiness of the Democratic Presidential candidates’ health care plans, I came across an intriguing comment on a blog. The woman basically said that health care is always doled out, controlled and limited - whether that limitation is a waiting list, common in socialized medicine, or by price, where people who can’t afford a treatment can’t get it - the most popular method in America. I’d never thought about it like that and it made me go herm.

I am, of course, a die hard devotee of single payer health care. I like to think of it as Winston Churchill thought about democracy, which according to him is “the worst form of government, except for all those other forms that have been tried from time to time.”

Though its necessary bulk could drown a water buffalo in bureaucracy and budgetary excess, in order for public health care to work at all administrators must also be lean and efficient. They have to be kind of stingy. On principle, they can’t fritter away money on treatment that just don’t work or don’t work that well enough. Sort of like how there is an age cut-off for getting IVF on the National Health Service (NHS) in the UK. Or how most plastic surgery isn’t covered in Canada. Yes, some people will be left out in the cold for a treatment that might do them some good, but that’s how the cookie crumbles.

Today, I think the NHS won a wee victory in the interest of wider public health. UK courts ruled to uphold a decision to stop offering popular Alzheimer’s drugs, including the blockbuster Aricept, to patients with mild cases of the disease. The original decision to pull the drug was made by NICE, the body that decides which drugs are cost effective and provide enough of a boon in quality of life to be covered. Their decision was based on studies of mild Alzheimer’s which showed little increase in cognitive functions by taking the drug early in prognosis. The drug manufacturer, Eisai, challenged the decision and took it to court.

One of the most influential studies on this topic was published in 2005 in the New England Journal of Medicine. It followed 769 people for three years: one third received no treatment, one third got vitamin E supplements and the last third got Aricept (generic name donepezil). After one year, patients on Aricept were less likely to have progressed to clinical Alzheimer’s than the other two groups. They also scored fractionally higher on cognitive function tests, such as the MMSE (Mini Mental State Examination, which scores from 0 - 30 points); Aricept patients lost 0.31 points, whereas control group lost 0.80 points.

These small differences disappeared after the first year of comparison. Assessing this and similar studies, NICE concluded that the small benefit, which vanishes very quickly, doesn’t warrant coverage on the NHS. According to the Times article above, 96,600 people in the UK who have mild AD will now not get medication. For one year, at 2.50 pounds per person per day, that’s a saving of 87.6 million pounds.

From what I can see, NICE made a hard, but defensible call. And, unlike the doctors of the NEJM study, they weren’t paid by the drug company. They are literally the last wall of protection that Britons have against the onslaught of Big Pharma’s direct marketing and their influence over clinical trials. Had the judge found in favor of Eisai, it would have been a devastating blow for NICE in the ability to do their job. I mean HONESTLY. Since when did drug companies make decisions based on what is best for the health of the entire population of 60 million Britons? It’s a shit job, for sure, but that is exactly what NICE does.

Of course it’s a bitter pill to swallow for people with AD and their family members, who, of course, believe their their husband or their Nana will stay themselves for just a little longer if given this wonder drug - even if the studies say it probably wouldn’t do much, if anything at all. Statistics mean absolutely nothing to a grieving person in need of a miracle. But when it comes to keeping a whole country afloat, the cold hard numbers are all you can go by.