Tense prescriptions? Alzheimer medications and the anthropology of uncertainty.
This article discusses the two major groups of Alzheimer medications, which are hotly debated in the specialized literature because of their doubtful efficacy. Examining this issue under the rubric of an ;anthropology of uncertainty,' this article seeks to address the question: how do doctors prescribe medications given tensions created by uncertainty? A partial answer is drawn from research conducted in Brazil with local psychogeriatricians, which has documented a high degree of certainty regarding Alzheimer drugs and their benefits. I argue that one reason for this certainty is that ;efficacy' has become increasingly non-specific in Alzheimer's disease through the broadening of outcome measures in clinical trials. While such measures previously focused on cognitive symptoms, they now encompass concepts such as functionality, quality of life and activities of daily living. The certainty of the Brazilian psychogeriatricians is further buttressed by three interacting elements: (i) the influence of the pharmaceutical industry; (ii) long-standing arguments for including non-cognitive symptoms in dementia care and research; and (iii) a specific discourse found in geriatrics and gerontology, which recognizes ;the person beyond cognition.'
Leibing
Annette
A
Université de Montréal, Quebec, Canada. annette.leibing@umontreal.ca
D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D000884:Anthropology, Cultural; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001938:Brazil; D002800:Cholinesterase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D004059:Diffusion of Innovation; D004345:Drug Industry; D011307:Drug Prescriptions; D005852:Geriatric Psychiatry; D006801:Humans; D018697:Nootropic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D011788:Quality of Life; D040241:Social Marketing; D016896:Treatment Outcome; D035501:Uncertainty
D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D018697:Nootropic Agents