In "War" against Alzheimers, we elderly will be collateral damage

The strategy is laid out in this paper, NATIONAL PLAN TO ADDRESS ALZHEIMER’S DISEASE, that from the beginning shows the confusion of using Alzheimers, or AD as the generic term for senile dementia which has many etiologies.  It is broad based and similar to our national wars on Drugs, Terrorism and Poverty; based unfounded optimism and unrealistic expectations.

The "war word" is a quick way of changing our culture-- energize the mass of Ameicans to make sacrifices that usually demolish civil liberties, as is the case with traditional wars against enemies of the state.  In such hot Wars, accuracy is not required as optimistic approaches-- whether it was Hitler claiming victory was just around the corner a few weeks before Berlin fell, or General Westmoreland. claiming to see the light at the end of the tunnel in Viet Nam shortly before we withdrew from that country in defeat-- is a universal element.

From Section 1C of the report linked above:

"Accelerated research will improve and expand the application of biomarkers in research and practice. Such improved expansion of biomarkers have shown that the brain changes that lead to Alzheimer’s disease begin up to 10 years before symptoms. "

This is factual, as such biomarkers can provide more accuracy of the course of senile dementia- as contrasted with the following statement:

"Identifying imaging and other biomarkers in presymptomatic people will facilitate earlier diagnoses in clinical settings, as well as aid in the development of more efficient interventions to slow or delay progression."

This is hypothetical based on assumptions that have been challenged by biologist in the field.  We do know that the brain does shrink with aging, but unlike global warming, there is no evidence that this is "anthropogenic"  since it is ubiquitous in humans and other primates. See Antagonistic pleiotropy for those interested in this explanation of aging   Thus it could be part of the the normal process of senescence that has no possible intervention as it is part of the complex process of conception, maturation, decline and death that is common to our allied species.

Without any public discussion ACA, otherwise known as Obamacare has included the the requirement of a cognitive assessment without the opportunity of opting out, in Annual Wellness Visit that will be fully paid for with no co-payment.  This evaluation by physicians unfamiliar with the latest research in this area,  or even their assistants  will become part of the new electronic records that are part of this law, which have minimal security to invidious inappropriate access.  If a 25 year old doctor's assistant thinks you are slow on the uptake based on his or her own values, it will be in your record.

While there were open discussions of other elements that were proposed for these visits, end of life discussions specifically, this aspect was not brought to the publics attention.   There certainly could be public health advantages for this type of accumulation of data of what is a universal aspect of aging, yet the social costs of this process which has been dealt with by differing cultures since time immemorial has not been brought into the public discussion.   Those who would rather avoid thinking about their declining memory, will now have it harder to pull off.

The medicalization of something that large numbers of seniors do not choose to place in such a context, the serious legal consequences of being deemed mentally incompetent that will occur among large numbers of older people has not been discussed, while proceeding with this program predicated on unproven scientific-medical value.

This article from the Journal of Family Practice, Identifying cognitive impairment during the Annual Wellness Visit: Who can you trust?  aknowledges the mandate to report symptoms of dementia and includes this:

Results of this study demonstrate that patients referred for specialized memory evaluation had virtually no idea of the degree of their cognitive impairment. Patients, on average, rated their function in 5 critical areas of cognition and behavior as “good.” While 80% of these patients demonstrated dementia on formal evaluation, more than 95% rated themselves as having good or very good cognition. Their ratings did not correlate with any objective memory measures or expert clinician opinion.

Please read the above over, and maybe a second time.  Let me paraphrase it :  a group of older people, having been directed to this study by a trusted physician think that they are doing O.K.  They know, of course, that their memory is getting bad, I myself can tell you a dozen jokes we tell each other as we hang out together, maybe after a game of tennis or golf.  Sure, we are getting older, and we know it, and we have learned to cope and to help each other face this reality.  We don't focus on our disabilities, but what we have learned, who we are, and what we can share with each other.

Now they went to this medical setting described above, and guess what, they have found out that 4 out of five of these guys, my guys, my friends have a disease called "dementia."   Maybe they didn't even know that this was what was on the agenda, since nist people don't want to know, because we know what doctors and researchers do not readily acknowledge,  that there is no cure, and won't be in our life times.  Sure, some of us do buy these miracle cures advertised on the Internet, and I personally don't try to tell them it doesn't work, since it makes them feel better and probably doesn't hurt any.

But now these elderly are getting results from physicians, and they are told that they have a "condition"  and perhaps they should sign up for an research experiment, and that maybe there will be some cure.  I actually did some participatory research by going to a dementia screening that I go into extensively in this essay.  The testing was sloppy, and the outcome for those who score poorly is dire.

Not only didn't I enlist in this war against Alzheimers.   I am against it, the same way I was against the War against Iraq in 2003, that by the way has made that country into one of Iran's main allies and whose people are still living in the chaos of internecine battle. And how's our war against poverty and drugs coming along?  Good intentions with little thought and much enthusiasm often cost vast sums and bring unexpected negative consequences.

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