Nominal Benefits Seen in Drugs for Alzheimer’s: A major scientific conference reviewing the evidence for benefits from the Alzheimer’s medications on the market — Aricept, Exelon, Reminyl and Tacrine — found the benefits to be so modest as to leave most doctors unsure about prescribing them, especially given how expensive they are. In my opinion, there are two types of problems in asssessing the impact of these medications. First, statistically significant effects, which will make the case for FDA approval for a drug, are not the same as clinically significant benefit.

“You can name 11 fruits in a minute instead of 10,” said Dr. Thomas Finucane, a professor at Johns Hopkins and a geriatrician. “Is that worth 120 bucks a month?” —New York Times

More importantly, especially in a results-driven healthcare economy, it is difficult to see the benefit of medications which primarily slow an inevitable decline rather than causing improvement. The studies demonstrating that these medications have any substantial value, which I have examined carefully as the drugs were introduced, are prospective studies which follow patients and matched placebo control patients over several years. In other words, concrete benefits will not be apparent to an Alzheimer’s patient’s treating physician or family, and it takes a great leap of faith and a familiarity with the scientific literature to maintain a patient on such a medication. But surely delaying the need to place a patient in a nursing home for months or years, for example, when their decline becomes so profound that home-based care is no longer possible, is eminently desirable. Analogously, many, if not most, patients with cancer opt for far more invasive treatments to extend their lives at home wtih their loved ones for similar or lesser periods of time. It is important not to promote more magical, unrealistic hopes in either case. Moreover, these drugs are just a first iteration. More specific and more powerful medications working by different medications are in the pipeline; memantine, or Namenda, supposedly the first of these, has just arrived… and, so far, I am reserving judgment. The existing drugs, finally, may be even more useful in pre-Alzheimer’s conditions, i.e. as cognition- or memory-enhancers in more benign age-related cognitive decline (like the ‘senior moments’ I suffer…). [thanks, Jerry]