Map of life expectancy at birth from Global Education Project.

Tuesday, December 12, 2006

Market Failure

That's what economists call it when their Theory of Everything doesn't actually apply after all. Strangely, however, it's a theory of nothing, because markets always fail.

The drug companies spent, I dunno, hundreds of millions of dollars to develop the only two pharmaceutical treatments for dementia which are now available: cholinesterase inhibitors (which work more or less like weak versions of nerve gas); and drugs that block the neurotransmitter glutamate. Unfortunately, they don't do much. The British Institute for Health and Clinical Excellence (NICE), which calculates whether treatments are actually worth it, has decided that cholinesterase inhibitors aren't worth the price. At most, the combination of these drugs can produce a brief interruption in the progression of Alzheimer's disease, after which the course resumes. Of course, we don't have rational health care in the U.S., so they continue to be widely prescribed for people with early dementia.

This new study from the Netherlands, however, finds that occupational therapy -- teaching people with dementia how to cope better with activities of daily living, and working with their caregivers to develop more effective strategies -- has a big effect on both the functional status of the person with dementia, and the sense of competence of caregivers and reduction of their burden. And of course, there are no side effects.

As Jeannette Golden and Brian Lawlor write in an accompanying editorial, "Non-pharmacological interventions in dementia have a long history, but until recently they have not been tested in high-quality controlled trials." In fact this was the very first one, and it was small. Golden and Lawlor go on, "The promising results of this study need to be replicated, and further trials need to be refined and extended. This requires building research capacity and increasing resources and funding to the multi-disciplinary teams that deliver care for dementia in the community." But why hasn't this happened?

Too easy for a hint. There is no gigantic for-profit corporation that stands to gain from such research and infrastructure building. Unlike a mass produced, patented pill, this sort of treatment is produced by innumerable small, non-profit organizations. It can't be monopolized through patents or very high cost of entry. Nobody can possibly get rich from it. So we just shovel out the pills and don't do what actually works.

The new Dutch study, by the way, was financed by the Dutch Alzheimer Association, with extra help from the Dutch Occupational Therapy Association. Obviously the Occupational Therapy Association's members stand to gain business from this, but we aren't talking anything like the financial resources of drug manufacturers. That's why we see so little of this sort of research. Without good evidence, insurers won't pay for such interventions.

Here, take a pill. It's a sacrament in honor of your God, the Free Market.

1 comment:

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