Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Wonderdrug
- Samuel Chew (20 October 2007)
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Omitting donepezil is hardly a hardship
- Thomas E. Finucane (27 October 2007)
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Samuel Chew, SpR City Hospital B18 7QH
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It says, "Prescribing drugs according to cost effectiveness may be the opposite of the rights based approach: decisions can condemn patients to deteriorate before the drug will be prescribed, as is the case with Aricept [donepezil] for dementia patients." The main thrust of the above statement suggest that cholinesterase inhibitors reverses the underlying pathophysiology of reduced cerebral production of choline acetyl transferase, of which it does not. Statements like "condemn patients to deteriorate before the drug will be prescribed" would only serve to mis-inform the public at large and heath-professionals in particular. Competing interests: None declared |
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Thomas E. Finucane, Professor of Medicine Johns Hopkins University School of Medicine.
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To condemn NICE as ageist when it limits access to donepezil is to fall for the vendor's advertising and sponsored trials. There is really no evidence that donepezil does anyone any good. Have a look at AD2000 in Lancet or Howard RJ et al in the N Engl J Med. 2007 357:1382-92. These are two proper randomized clinical trials that are not sponsored by the vendors; both show there is no benefit whatsoever to this drug. In particular, neither carers nor patients can tell any difference between donepezil and placebo. The tremendous wall of vendor-sponsored RCTs has created a terrible false impression about these drugs, and desperate families seek desperate remedies. Competing interests: None declared |
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