Sadly, with these medical advancements has come a desire for pharmaceutical companies to provide a pill for everything. We want to pop something in our mouth, swallow it and for all our problems, pains, issues and illnesses to magically disappear. We now have pills for weight loss. What about a pill to replace exercise? Many drugs that are prescribed are little more than placebos, yet as a society we still demand more.
We can’t understand that antibiotics are utterly useless at making your average sore throat, cough or cold for an otherwise fit and healthy person any better (and could even make them worse). We just want to take something, anything, so that ‘normal’ life can be resumed as soon as possible, but what happens when their isn’t a suitable pill, it doesn’t work or doesn’t even exist?
Drugs for dementia is a thorny issue. First of all, drugs have not been developed for all forms of dementia. Those that have (licenced for use in early-stage Alzheimer’s) are far from universally effective, and it can be impossible to predict who they will work for. Even in the people they do work for they only alleviate symptoms. No pills currently exist to cure any form of dementia.
Despite this, the UK Secretary of State for Health, Jeremy Hunt, seems to believe that early diagnosis of dementia (that I wrote about here) is vital to provide people with the chance of a prescription for one of these dementia drugs since they can, “Help stave off the condition for several years.” The evidence for this, however, is far from conclusive, with some doctors admitting that while they, “Improve cognitive function a bit,” the consensus seems to be that they may only, “Turn the clock back by about six months.”
I have heard and read stories of people who, having been prescribed Donepezil (Aricept), rivastigmine (Exelon), galantamine (Reminyl) or Memantine (Ebixa), have seen huge improvements in their symptoms, which is great for them and their families. Amongst people who I know personally, however, those who have had these drugs have seen little or no improvement, in some cases decline has continued, and having eventually come off the drugs decline has advanced at an alarming rate and resulted in them dying long before they were expected to.
Dementia drugs really aren’t for everyone. Doctors should not be under pressure to prescribe regardless of looking at a person’s individual history, present symptoms and future wishes. I am actually very thankful that my father wasn’t given dementia drugs. It was bad enough that we had battles over the use of antipsychotics (as I wrote about here), and other drugs like statins that I gather he was only put on because, “Every one of his age should be on them,” and antidepressants, “Because everyone with dementia is depressed.” Wherever these gross and inaccurate generalisations come from they have no place in a healthcare system that should be embracing personalisation.
There is precious little patient care involved if a doctor has lost the ability, or autonomy, to prescribe based on what he or she genuinely believes the individual patient actually needs. Is pressure from pharmaceutical companies causing this approach to our healthcare? Or is it pressure from the government? It is almost certainly about making someone somewhere very rich at the expense of the person who is given these drugs, often at a time of significant vulnerability in their life and by a doctor who they most likely have complete trust in.
To put the effect of common drug treatments into perspective, I currently know of someone in their 50’s, on a cocktail of prescription drugs including antidepressants and sleeping tablets, who myself and others have noticed struggling with significant memory and behavioural problems. Prior to knowing the side-effects of the medication that this person was taking, I seriously wondered if they had the beginnings of early-onset dementia. Long-term, the implications on their brain health from these drugs could mean that sadly I may not always be wrong about that.
For me, the burning question in modern healthcare is what has happened to personal responsibility? Of looking at ourselves, our lifestyles and the choices that we make and changing those rather than expecting a pill to do it all for us. Quick fixes and easy options might be more tempting in the here and now, but what about the future? When all the pills we take stop working, or the side-effects cause long-term damage that more pills can’t fix, what then?
In the case of people with dementia, drug treatments really aren’t the only option. Indeed for many people they aren’t an option at all. There are no quick fixes. In fact ultimately there isn’t a ‘fix’ at all, but what will work for everyone is care that looks at each person as a whole and finds the elements that will help them to live well with dementia. The most effective treatment lies within us, unlocked by those with skill, dedication and compassion, qualities you will never find in a bottle.
Polypharmacy is something that affects many people and a number of common categories of drugs can actually cause cognitive impairment as a side effect. Drugs are one of the useful tools in the box, but there are others. The skill is picking the right combination of tools for each individual person.
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