Doctors have known for a long time that the drugs, developed over a decade ago and marketed with a lot of publicity, probably don’t work. Their non-reimbursement will allow the sum saved to be attributed to those around this disease which is sorely lacking in resources and which continues to increase.
We know that the decision is in the pipes of Health Insurance. Even the pharmaceutical industry no longer believes in it. Even before the announcement is made by the Ministry of Health, one of the manufacturers has just withdrawn one of these drugs from the market… The others are waiting, without fighting, which is a clear sign of abandonment.
However, the market was huge. We do not know the exact number of patients to be treated, because many are not diagnosed and labeled as “dementia of old age”, but the France Alzheimer association declares that “today in France, nearly 3 million people are directly or indirectly affected by Alzheimer’s disease. Day by day, the disease is gaining ground: nearly 225,000 new cases are diagnosed each year. By 2020, our country will probably have 1,200,000 sick people. “
Hope had come, more than 20 years ago, from a new class: acetylcholinesterase inhibitors. They are the ones who are in the hot seat today.
The theory: they inhibit the breakdown of acetylcholine, the substance that allows transmission between neurons in the brain, and which has been shown to be deficient in the brains of people with this disease. A verified and serious hypothesis … But which probably does not explain the genesis of the disease. Initially, the studies showed that, although small, their effects were significantly greater than those of placebo and caused cognitive decline and loss of autonomy to be slowed or delayed. The journal Prescrire wrote: “their effects are modest, lasting a few months, in about 10% of patients”. It is likely that the truth was below this already pessimistic assessment.
Why have doctors continued to prescribe these drugs in the face of so much evidence?
Quite simply because it is a disease that affects the entire universe of the patient. The one who suffers from it forgets it quite quickly but those around them live through difficult times, often with the only psychological support of the family doctor, who is then tempted to alleviate the complaint by a prescription … No one can really blame him … But he will have to face the facts today that it is a sword in the water.
The solutions
It is clear that research in the pharmaceutical industry is blocking this disease. The various therapeutic avenues end in dead ends when we move on to the practical phase of human trials. We know that the circuits of the brain are stuck by a kind of glue, a protein, which gradually extends its action to the neurons of the brain. Preventing it from happening or at worst slowing it down is the solution. Tests are continuing with new hypotheses, on the chemical mechanism of memory for example, but the development of a drug is long, at least on the scale of the life of a diagnosed patient. We must still leave a little time for research which remains mobilized and without being able to give precise dates is resolutely optimistic.
While waiting for drugs, there are several areas for which the mobilization must remain important.
Prevention
Without really knowing how to prevent the disease, we know that we have the means to significantly slow it down. By playing on physical exercise (the evidence is obvious), diet (many substances are toxic to the brain) and especially cerebral gymnastics which comes down to a permanent maintenance of the capacities of the brain, in particular memory, if possible. throughout his life. No miracle solutions and above all requiring an effort for those who implement them, but real proof of effectiveness.
Early detection
Most patients are diagnosed too late and vigorous preventive measures put in place too late. Doctors have made considerable progress over the past 20 years, but the first memory disorders still need to be explored by specialists. Pushing open the door of a memory consultation is not a shameful act. Family physicians must be vigilant and bring up the subject as quickly as possible; just like the entourage who should not hesitate to broach the subject.
Disease management
Dealing with Alzheimer’s is grueling and expensive. It is in this sense that the de-reimbursement of drugs of little use is a way of saving money that can be used to help families of patients, to increase support structures and personnel. It is often only for financial reasons that the exhausted entourage does not appeal to external solutions… Which in the long term increases the bill even further through collateral effects.
Alzheimer’s disease, a real public health challenge in the very short term.
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