3.16.2008

Alzheimer's or Cancer: Which Disease Would you Rather Die From?
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Excerpt From the Times Online:

What kind of person envies someone who is dying from cancer? The bestselling author Terry Pratchett, that's who. Last week, he spoke movingly about living with early-onset Alzheimer's disease, which 'strips away your living self a bit at a time.' The disease, he said, had left him with 'a sense of loss and abandonment.'

The 59-year-old fantasy author appeared at a conference for the Alzheimer's Research Trust, to which he pledged a million dollars (around £500,000). He received his diagnosis in December but revealed that he had been suffering for at least two years. He has lost the ability to touch-type, although he has not yet stopped writing.

He told the conference: "I'd like a chance to die like my father did - of cancer, at 86. Before he went to spend his last two weeks in a hospice, he was bustling around the house. He talked to us right up to the last few days, knowing who we were and who he was. Right now, I envy him."

When Pratchett appeared on the Today programme last week, he acknowledged that dementia does not have the "heroic glamour" of cancer - and that to say so would not make him popular. As he told the ART conference: "It's a shock and a shame to find out that money for [Alzheimer's] research is 3 per cent of that which goes to find cancer cures. Perhaps that is why I know three people who have survived brain tumours but no one who has beaten Alzheimer's."

It might be a controversial point of view but Pratchett is not alone in holding it. Dr. Guy Brown, a biochemist at Cambridge University, also proclaims that too much money is devoted to research into cancer and heart disease, to the detriment of studies into dementia. Brown thinks that lavishing fortunes on these conditions - that extend life span but drag out the years in which people suffer - verges on the immoral.

This is what Brown has to say about the country's 10,000 centenarians, a figure expected to rise to 250,000 by the middle of this century: "Some are in a very bad state cognitively and physically. Why are we creating these people? We are increasing life expectancy beyond what is beneficial."

It is not that being old is inherently wrong; but that the increase in longevity has not been accompanied by an increase in quality of life. There is a gap opening up between life expectancy and healthy life expectancy, and increasing numbers of us can expect to fall into the dementia-filled abyss. It is a long, painful descent that takes a decade to reach the bottom, but the relentless medical focus on postponing death means that the bottom is getting ever farther away. For example, the last decade brought a two-year increase in life span, but we can expect to spend only a quarter of it in good health. In effect, it means that modern medicine has gifted us an extra year and a half of ill-health. As Brown argues in his book, The Living End, we are not facing the consequences. "We are driving up longevity and creating more and more people with a very low quality of life," Brown points out, when we meet in his cosy office at Cambridge University. "A disproportionate amount of funding goes to cancer and heart disease, whereas stroke and dementia get much less. These are skewed priorities. We need to switch dramatically but that would mean stopping government funding for cancer and cardiovascular disease, and that would cause screams in the medical research establishment."

This realisation prompted Brown, 48, to rethink his research; he studies cell death, and shifted his focus from cardiovascular disease to dementia because he believed it would make a more positive contribution to society. To some extent, statistics are on his side. The World Health Organisation calculates that, when it comes to disability in the over-60s, dementia is responsible for about 11 per cent, cardiovascular disease for about 5 per cent, and cancer for 2.4 per cent.

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