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| TX: 11.10.06 - Alzheimer's Disease Medication PRESENTER: WINIFRED ROBINSON |
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| Downloaded from www.bbc.co.uk/radio4 THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY. ROBINSON How will the decision by NICE - the National Institute for Health and Clinical Excellence - to restrict access to dementia drugs play out in practice? As you may have heard in the news NICE rejected an appeal from patient and professional groups and opted to stick with the decision made last summer, to limit the prescription of these drugs to patients in the moderate stages of Alzheimer's Disease. This was Andrew Dillon, the NICE chief executive, on the Today programme this morning, explaining why the drugs won't be offered to people judged to be in the mild stage of the disease. DILLON ON THE TODAY PROGRAMME All licensed drugs have an effect for some patients. What we've got to do with all drugs actually is to look to see where they have the most benefit. We have to do that on behalf of the patients because when we make recommendations that something works and should be used patients ought to be, we ought to be, confident that that's going to be the case for the majority of patients and the majority of patients are going to experience real benefit. But we have to be honest, and it is disappointing for us as well as for everybody else, that in this particular case we can't be confident about those things in the early stage of the disease. ROBINSON Andrew Dillon the chief executive of NICE. Well here on You and Yours we've followed the progress of this appeal closely interviewing doctors, patients and carers. The Royal College of Psychiatrists was one of the organisations involved and Professor Susan Benbow speaks for them. Your reaction then to this decision? BENBOW I think it's unjust, inequitable and quite frankly completely wrong. And I can't think of another illness where we tell people who present in the early stages that they have to go away and deteriorate before they're eligible to have any treatment for their condition. And we have to remember that Alzheimer's Disease is in fact a terminal progressive illness, it's absolutely outrageous. ROBINSON You could of course argue that NICE was set up for this purpose, to make these decisions, we may not like all the decisions but these decisions have always been made and at least now they're transparent. BENBOW Yeah, I think we need to have transparency in decisions. I think it's very difficult. I do feel that older adults with dementia are a group of people who are easy to hit, they're easy to disadvantage and I think ageism in healthcare is still rife. I think it's important that healthcare professionals remember that they have a duty to the patient. The GMC duties of a doctor says that you must make the care of the patient your first concern. And in fact in NICE's own guidance it says that individual responsibility of a healthcare professional has to be exercised and they have to make decisions appropriate to the circumstances of the individual patient. ROBINSON Well I want to move on to that. What then is going to happen when a person comes to you and wants you to prescribe these drugs and you feel that they would benefit? BENBOW I think it's very difficult to know how it's going to work out in practice. I think it's possible that some patients are going to try to get things wrong when they score on the mini mental state because the mini mental state is a very blunt instrument and it's amenable to all sorts of influences. ROBINSON This is the test that you use to distinguish between a patient who has mild and moderate disease and you use a score from that test. We have a recording of one of these tests which might be helpful now, we made it during our dementia series last year and this is Edith Waters being assessed by Professor Clive Holmes at Southampton's Moorgreen Hospital. MEMORY CLINIC HOLMES What I'm going to do now Edith, I'm just going to ask you a few of these daft questions to see how you're getting on, is that okay? We'll see how you go. EDITH WATERS That's right. HOLMES Okay, alright. BILL WATERS Don't let him see that I've wrote the answers on the back of your hand will you? HOLMES Can you tell me what year it is at the moment Edith, what year is it? EDITH WATERS Not really. 1920 something? HOLMES Okay. Can you tell me what month it is at the moment? What month is it? EDITH WATERS Is it January? HOLMES January okay. What I'm going to do now, I'm going to ask you to remember three objects for me, okay? Ready? Apple, table and penny. EDITH WATERS Apple, table and penny. HOLMES Okay. I want you to remember them because I'm going to ask you them in a few moments time okay? Apple, table, penny. In the meantime can you spell the word world for me? EDITH WATERS W O R L D. HOLMES Excellent. Now I asked you to remember three objects, do you remember? Can you remember what they were? Not sure? EDITH WATERS Was it the day? HOLMES No, I said you want you to remember three objects for me. Apple was one. EDITH WATERS Oh yeah. HOLMES Can you remember the other two? EDITH WATERS Peach? HOLMES No. Apple, table … EDITH WATERS And chair. HOLMES Penny it was, penny. Not to worry. Okay. ROBINSON Edith Waters taking the mini mental test to assess the progress of her dementia. Professor Benbow, in practice though, doctors do not have to rely entirely on that test do they? BENBOW Well I think they won't because the problem with the mini mental state is that it gives you a score maximum possible is 30, so it gives you a score out of 30 and NICE is proposing that moderate dementia would be between 10 and 20 on mini mental state score. So that would mean that if you scored above that you could be deemed to be ineligible for drugs. But I think as you could see from that short clip if you got somebody who couldn't read and write or who hadn't had a great degree of education they may well tend to score low on mini mental state. On the other hand if you've got somebody who's highly educated - I don't know I had a patient who was a university lecturer and he scored within the normal range but quite clearly had quite advanced Alzheimer's Disease. ROBINSON So might you then in the privacy of your consulting room fudge this matter somewhat? BENBOW I don't know about fudging it but I can see families coaching their relatives to get the answers wrong, instead of coaching them to get the answers right. So I think there are all sorts of things that might come into play but I think we have to recognise that using the mini mental state, which was actually designed as a screening tool for dementia, it wasn't designed to measure progression of a disease, using that is using a blunderbuss really, it's a very insensitive tool and doesn't take all these other things into account. People whose first language isn't English for example, they'll have difficulty with the mini mental state. ROBINSON Professor Susan Benbow, thank you. Back to the You and Yours homepage The BBC is not responsible for external websites |
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