Harbinger of Hope or Commodity Fetishism: “Re-cognizing” Dementia in an Age of Therapeutic Agents

Extract

Choices abound while we await that pharmacogenetic fix that will save each one of us from all that is our individual and collective fate, contingent of course upon panopticon surveillance of our genetic susceptibilities and environmental triggers. The past decade has offered hope to those families facing the impenetrable shroud characterizing cognitive decline and dementia. Sufferers and their physicians have a growing compendium of pharmaceutical therapeutic interventions to attempt to stave off the usual, if not necessarily mindful, course of illness progression. In January 2001, the acetylcholinesterase inhibitors donepezil, rivastigmine, and galantamine were made available in the National Health Service in the United Kingdom, and some are on the formulary of five provinces in Canada. Those provincial pharmacare programs still refusing to provide these therapies free to the elderly cite lack of evidence of efficacy, following Cochrane guidelines based upon systematic review of the best evidence available using randomized controlled trials. Advocates for public funding of the pharmaceutical agents, on the other hand, cite a narratively rich, heart felt host of behavioral and affective symptoms stabilized or boosted by these drugs. And so, the two solitudes are drawn between science and humanity, between the cold guardians of the public purse and the caring humanitarians.