Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Departments of Psychiatry & Human Behavior and Neurobiology & Behavior, Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine CA, USA.
EBioMedicine. 2024 Oct;108:105291. doi: 10.1016/j.ebiom.2024.105291. Epub 2024 Oct 3.
Advances in treatment are changing not only the therapeutic options for patients with Alzheimer's disease; they're also changing their diagnostic options. Technologies to detect amyloid such as PET imaging and blood or CSF testing now have a central role in Alzheimer's disease care. Notably, this role has been made possible by regulatory approval and coverage by payers of therapies. Access to treatments and the diagnostic tests needed to prescribe them is encourageing but it reveals a problem. These tests are tailored to the needs of the therapies, not to the needs of patients. Patients and families need to understand the causes of their impairments and their prognosis. This requires access to the best available diagnostic tests and this access should not depend on the availability of treatments. These tests should be used to their fullest capacity to inform patients of the causes of their cognitive impairments and their prognosis. Unfortunately, compared to diagnostic testing, treatment options are overvalued. We call this problem the tyranny of treatment.
治疗进展不仅改变了阿尔茨海默病患者的治疗选择，也改变了他们的诊断选择。现在，用于检测淀粉样蛋白的技术，如正电子发射断层扫描（PET）成像以及血液或脑脊液检测，在阿尔茨海默病的治疗中具有核心作用。值得注意的是，这些作用是通过监管部门的批准以及支付方对治疗方法的覆盖来实现的。能够获得治疗方法和用于开具这些治疗方法的诊断检测方法固然令人鼓舞，但也揭示了一个问题。这些检测方法是根据治疗方法的需求定制的，而不是根据患者的需求定制的。患者及其家属需要了解其认知障碍的原因及其预后。这需要患者能够获得最好的、现有的诊断检测方法，而且这种获取不应取决于治疗方法的可用性。这些检测方法应该得到充分利用，以告知患者其认知障碍的原因及其预后。不幸的是，与诊断检测相比，治疗选择被高估了。我们将这种现象称为“治疗暴政”。
