"Government Alzheimer's Study Brainwashing British Columbians"

October 4th 2007 our Provincial Government in British Columbia announced spending 78 million dollars (70 from the government and 8 expected from pharmaceutical companies), on a three-year study on cholinesterase inhibitors: Donepezil (Trade Marked Aricept), Galantamine (Trade Marked Reminyl) and Rivastigmine (Trade Marked Exelon).

The program is called: The "Alzheimer's Drug Therapy Initiative" or ADTI - which is a study beginning October 22nd 2007 and lasting three years. Those with dementia that qualify will have their medications covered for the very first time by B.C. PharmaCare through the provincial governments 'Special Authority' process - research framework.

 Let us celebrate! This sounds wonderful! .....AT FIRST GLANCE.....

This is less than it looks on the surface however. Our provincial government merely yielded slightly to public shame and outcry that all of these drugs be added to PharmaCare and have come up with a plan to pacify the multitudes. Would this not make them look more credible and 'caring' as we lead up to our provincial election before the 2010 Olympics?

What is the B.C. Governments criteria for the "ADTI"?

(Please take note of the time periods...)

 (FIRST HURDLE TO JUMP...)

• Initiation of coverage in a cholinesterase inhibitor-naive patient:Coverage will be provided for an initial 6-month period, when the following criteria are met:


• A standardized Mini Mental Examination (SMMSE) score of >10 to <26, AND


• A Global Deterioration Scale (GDS) stage 4, 5 or 6.

(note: Patient to be checked for tolerability in naive patients within the first 1-3 months.)

(SECOND HURDLE TO JUMP...)

Continuation of coverage for 6-months periods: Coverage is continued for patients in 6-month increments when:

• The information provided indicates that the patient remains in the mild to moderate stage of Alzheimer's disease (if repeat SMMSE testing in 6-month intervals results in scores of <10, AND


• A GDS stage of 4, 5 or 6 AND


• There is demonstrated stabilization or improvement during the previous six months of therapy.

(THIRD HURDLE TO JUMP...)

Covering when switching for lack of efficiency to another cholinesterase inhibitor. Coverage of another cholinesterase inhibitor is provided for an initial 6 months if:

• The clinician documents the reason for discontinuing the previous cholinesterase inhibitor on the 'Special Authority Renewal/Switching Form'.

(NOTE: Coverage of another cholinesterase inhibitor is provided in the same manner as the previous one (check for tolerability within the first 1-3 months, coverage to be renewed in 6-months increments of criteria continue to be met.)

WHAT DOES ALL OF THIS MEAN????????

Take special note: The Global Deterioration Scale (or GDS) are the 7 stages of daily function. 1= normal through to 7= severe difficulties.

The >10 (greater than) OR <26 (less than) relating to the Mini Mental State Examination (MME) is the number showing a person's score out of a possible 30 correctly responded to questions and/or requests.

But look closely at the 'more than' and the 'less than'. Outlined in the ADTI this really means 11-25.

A July 31st 2007 article in the Toronto Press stated:

"The six-month study, published Tuesday in the journal Neurology, involved 343 people with severe Alzheimer's disease at 98 clinics in Canada, the United States, France, the United Kingdom and Australia.

The study of Aricept was conducted and Dr. Sandra Black, a neurologist at Sunnybrook Health Sciences Centre in Toronto stated: "So it slows down what we call the symptomatic progression of the disease, Patients in the drug-treatment arm of th study showed cognitive improvement on testing and caregivers noted they functioned better overall" said Black.

"They were more interactive. On the cognitive scale, they remembered things a little better, they were more attentive." "They were able to do some activities. They were able to help themselves being assisted in the bathroom. They recognized names.""

This Toronto study focuses on SEVERE dementia. It makes no mention of the MME or GDS, but our Premier; Gordon Campbell and Minister of Health; George Abbott (is he a Doctor?), are now portraying themselves as Santa Claus offering us a 'study' whilst sneaking the toys back from the needy children. They are concluding that these drugs should ONLY 'be tested' on those not on previously on cholinesterase inhibitors. The current dementia patients on these drugs don't get to be in on the study and so don't get their medications covered under PharmaCare! And for the unfortunate ones who are now diagnosed with dementias, must score between 11 and 25 on the MME for six-months at a time.

Gee, sounds like this is a rather bias study before we even start. If you are at GDS stage 4 for example, but somehow get 26 on your MME, you lose! If you're at 11 on the MME and slip to 10 after 6-months "You're OUT!" How about if you should be a 26 instead of a 25? "Sorry...our brain must deteriorate more!" If you could benefit from these medications, and you are strange 7... "Sorry, you will die soon, so you don't need quality of life!"

Next it will be political will and not medical intervention on who gets treated and who doesn't... wait a minute, we already have that now in British Columbia.

How about politicians who think a medication like morphine for example, does not work as well for one person as it does another...perhaps we should have a government rated 'pain scale' inflicted on us to determine how much pain a person should suffer and to measure their discomfort by the bean counters in Victoria? (And I am not referring to taxes).

50% (15/30) of those with dementia (mild and severe) who are tested with the MME are not going to receive PharmaCare paid cholinesterase inhibitors as they will be over 25 or under 11 on the scale.

Many people procrastinate on getting their first diagnosis and may only score within 11-25 on their first MME, however years of precious treatment time is lost regardless given this governments indifference to all stages. The sooner the diagnosis the sooner they should be granted help but our government undermines this. If a person lives with dementia for 12 years for example, the first three may be undiagnosed and the last five may be severe or stage 7. Our B.C. government will only offer to pay for medication through the 'Special Authority process - research framework' temporarily for up to three years out of possibly four or more years those mere 33.3% (who score 11-25), out of ALL persons with dementia. I am stunned!!!

And if our loved ones are lucky enough to have never been given any cholinesterase inhibitors in the past AND fall into the 33.3% scoring 11-25, AND are granted PharmaCare paid medication, it merely takes a clinician to have this medication immediately withdrawn by a stroke of a 'red-tape' pen and dash the lives and hopes of our ill elderly and their families. How cruel!!!

This announcement by our provincial government is laden with hurdles poised by Gordon Campbell and George Abbott. How many families (unpaid Primary Care Givers), who have loved ones with dementia, will embrace this illusion of being helped to find out afte4r six months that they have fallen off the 'Gordy and George' petrie dish to disappear through the cracks in the floor and become mere lab-rat statistics?

So what become of those 66.6% scoring above 25 or below 11 who are incapable of passing Gordon Campbell's spin-doctor testing? Does he throw any of them a morsel of hope? Nope! Only the ones who can score 11-25 and are in stages 4, 5 or 6. Perhaps the odd '10' may squeeze through if they can sit at a table properly, hold a pencil, know who they are and can make an 'X' in the box that says L-I-B-E-R-A-L on the next Provincial Ballot. (I forgot - I probably failed the MME - did I mention the Olympics?)

The reality is, is that the Mini Mental Exam or Global stages are guides but conveniently give out politicians (and perhaps some doctors) the protection of indifference by forcing facts and time frames on a disease that is not as rigid in character as they, but is fluid and ever changing. So, choosing only to spend tax dollars for 33.3% of ALL NEW CASES of dementia and ignoring 66.6% AND eliminating all those who have already been exposed to these medications in the past, makes fiscal sense but I find this to be most ethically immoral and unfair. Our loved ones with dementia at ALL stages are not statistics or guinea pigs but PEOPLE, BRITISH COLUMBIANS, and CANADIANS, with dementia, but NOT on our provincial governments 'to do list'. We can all be dazzled by the 70 million gold offerings (20 more than they are going to spend on a bunch of buses) but the magician's wand can also blind us so we do not notice it is 'fools gold'. Just as easy at the 8, or 10 or 12 or stages can be distorted or challenged if a person is having a bad day or ailment.

Scientific proof demonstrates these medications do not turn those with dementia (as our Provincial Government seems to think) into mental wizards for their disease is debilitating and chronic. What it does offer is the slowing down of the 'symptomatic' progression of these diseases and offer a better quality of life for ALL people with ALL stages and levels of dementia; and their families.

Many cannot eat or dress themselves or do banking like the GDS demand, or 'draw a clock' or spell 'world' backwards like the MME dictates. However with these (many cannot afford) their lives can be enhanced, their quality of life recognized - even a little. We can stand in awe as our loved one recognizes the faces of family members, feel joy, and share love through all stages of dementia. How do we find a stage or rating to measure this? 

What is the price we must pay to deny medication to ALL stages of dementia? What is the cost of being granted our 'rights' to the best quality of life in our sunset years? You see, there is only good medical care and bad medical care. There is nothing in between Mr. Campbell and Mr. Abbott. What 'unhealthy CARE' do we settle for from our Provincial Government in British Columbia? What 'health Care' do we demand for our loved ones (and perhaps ourselves) with ALL stages of dementia?

Get your pens out and your keyboards clicking and write your MLA the Opposition and the newspapers. We must halt the further erosion of 66.6% of our future ill elderly and demand current and future patients be given any of the cholinesterase inhibitors PAID 100% by PharmaCare, just like the rest of Canadians. We ask this for our loved ones; we ask this for ourselves.

Jennifer Sierra