Stopping the reimbursement of Alzheimer drugs leaves sick, families and doctors distraught. Because there is now no therapeutic answer to relieve the natural anguish caused by this disease. Especially since the development of new drugs requires finding patients in the early stages of the disease; an extremely complicated challenge
Preventive medicines have always fascinated doctors ... not the future patients. It is a conflict that could be put on the account of ethics, if modern society did not always demand more research. But the solution is perhaps in a precise information of the stakes. The best known example is that of aspirin. This medicine more than a century has fascinated doctors, before we realize the real danger of its inconsiderate taking. But in the fifties, as a result of the discovery of its preventive effect of myocardial infarction, using its ability to dilute the blood and the hypothesis that it could also prevent polyps, so bowel cancer, The question arose of using it widely among healthy people for a vast prevention operation. In the face of the shields - already in the name of ethics - the American doctors had a courageous reaction in lending themselves to a gigantic study to find out. The results were published after 20 years. Unfortunately negative.
But the envy of those who care, those who plan, remains intact. And the disease that frightens the French most, comes back to the forefront. Faced with the real "epidemic" of Alzheimer's disease, due to the decline in life expectancy and especially the lack of really effective treatment, there is the question of treating those who "could" be at risk of Alzheimer's.
Who is at risk for Alzheimer's?
This is where the problem becomes thorny.
Research may be keen to better understand this scourge, there are few certainties. The genetic track is serious. We know, for example, that there is a very rare hereditary form - 2% of cases - but there is no simple test to know if the threat is real or even serious.
Yet those who try to implement treatment lament that the trials are only for patients at a stage where no improvement can be highlighted. Clearly, the development of a drug goes through a first step in healthy people, only to highlight possible independent side effects of the disease, then after in diagnosed patients, those in whom we know that it is probably already too late.
Doctors need people in good health to prove the early effectiveness of these new treatments.
In good health but at risk of disease
One must imagine the fingering of these doctors to recruit people to whom it must be announced that the probability of suffering from this disease is important. Yet today it is technically possible. Modern medicine knows the threat and we can be surprised by the reluctance of institutions but also the opinion of an inevitable phenomenon. Because the issue may seem simple. Either the person will not develop Alzheimer's and the risks are only those of the drug - perfectly controlled - either she develops the disease but later, if ever, if this new treatment is effective. On the simple logical reasoning it could be considered that finding candidates is not complicated considering the number of people who will develop the disease ... In practice it is not so simple to recruit people who are likely to develop the disease in 10 at 15, because it is this delay that is the most interesting to prove the effectiveness of treatments. Added the eternal problem of living with over the top of his head, the sword of Damocles diagnosis.
The example of Huntington's Chorea
Medicine is familiar with this dilemma with Huntington's chorea.
Even if there is no sympathetic disease, with Huntington's chorea, one gets to the bottom of the horror of a medical diagnosis. Abnormal movements and mental deterioration?
To suffer from Huntington's disease is to suffer from a rare, hereditary disease, which was formerly called the "Saint-Guy Dance" because of the uncontrolled movements that this degeneration of the brain causes. Weird movements, but also progressive intellectual deterioration. First irritability or depression, then gradually, a total disappearance of relations with the outside. Even though specialists do not like comparison, it's hard not to think about Alzheimer's disease. While the causes are different, but the result is often the same. Except that in the case of Huntington's chorea, young adults - 30, 40 years old - are often affected. With this is where the disease is particularly horrible, a significant family transmission, which makes this incurable disease an unbearable lottery. Because we found where the anomaly was on the chromosomes. Which, failing to propose a treatment, makes the screening possible. Imagine the terrible choice in a family where there is a case of this disease. Either ignore what tomorrow will be, or know that one will be inexorably reached ... or be reassured.
The solution in this debate, more personal than ethical, is to give the elements of choice clearly. We can count on the intelligence of the man to make the right decision, provided, let's repeat it to benefit from a complete information.