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New drug treatment for Alzheimer's disease

BMJ 1998; 317 doi: (Published 03 October 1998) Cite this as: BMJ 1998;317:945

Doctors want to offer more than sympathy

  1. Tom Dening, Consultant psychiatrist*,
  2. Claire Lawton, Consultant psychiatrist.*
  1. Addenbrooke's NHS Trust, Fulbourn Hospital, Cambridge CB1 5EF
  2. *Tom Dening has been reimbursed by Pfizer for attending a symposium and has submitted a research proposal to the company; neither author has an interest in prescribing donepezil or any other drug for dementia.
  3. Institute of Psychiatry, London SE5 8AF
  4. Wirral and West Cheshire Community NHS Trust, Elderly Mental Health Directorate, Clatterbridge Hospital, Bebington, Wirral L63 4JY
  5. Berkshire Health Authority, Reading, Berkshire RG30 2BA.
  6. Academic Department of Psychiatry, Guy's Hospital, London SE1 9RT
  7. Barnsley Health Authority, Barnsley S75 2PY

    EDITOR—Yesterday a woman with Alzheimer's disease greeted me by asking spontaneously whether I had recovered from a cold that I had had at her last clinic appointment three months before. A man with the same condition has started to telephone his family again and is now able to go shopping for clothes. The benefits resulting from these two patients' treatment with donepezil are not trivial as Melzer seems to suggest1 —a clinical trial is scarcely required to show the improvement.

    Much is to be learnt from the way in which donepezil has been launched, but, because of the reaction of health authorities hundreds of patients who would by now have benefited from taking donepezil have been denied access to a properly licensed treatment. There are two pieces of subterfuge at work. Firstly, an economic and rationing argument is presented as being a clinical one, with a campaign to raise doubts about the effectiveness of donepezil. The available evidence shows that the drug is as effective as one might expect it to be; it is, after all, only a symptomatic remedy for a progressive disease. Melzer criticises the instruments used in the trials, but the company has followed the methodological requirements of the Food and Drug Administration, so to take exception after the event is unfair. Secondly, contrary to the principles of evidence based medicine and systematic reviews, which emphasise the importance of unpublished data, in the case of donepezil only published trials may be discussed, even though other data have been available all along.

    News of new treatments and the enthusiasm accompanying them should not be censored. The representation of the debate among psychiatrists specialising in conditions relating to old age is being distorted. Is it reprehensible for us to wish to offer effective treatments …

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