We have seen the first tissue implants into the brains of sufferers of Parkinson’s disease. The tissue has either been from their own adrenal glands (situated on top of the kidneys) or from aborted foetuses, and contains the cells capable of producing the neurochemical transmitter dopamine (the substance deficient in the disease). The tissue is placed via a thin needle into the brain, with the hope that the cells will ‘take’ and produce dopamine.

Many carers have asked whether or not the same sort of operation will soon be available for sufferers of Alzheimer’s disease. The answer is almost definitely not. Unlike Parkinson’s disease, the deficits in Alzheimer’s disease are multiple and very complex and accompanied by structural changes in the nerve cells. The door cannot be slammed shut, however; tissue brain transplants have a science fiction, fantasy aura about them, but in the case of Parkinson’s disease they have become a reality. As research continues, possibilities concerning prevention, treatment and cure of Alzheimer’s disease may well become realities.

New types of dementia are being discovered almost daily. The latest ones include Prion disease, Cortico-Basal Degeneration and Cortical Lewy Body disease. Some of them are extremely complex microscopic-based changes and their true place in the overall picture is unclear. What is clear, however, is that Alzheimer’s disease may soon have to be called Alzheimer’s diseases. It is beginning to appear that what was once thought to be a single disease is now made up of many sub-types. As the technology advances, we may soon be talking about the various ways in which these sub-types can be treated or even prevented by drugs. As the role of genetics gets bigger and bigger there is now an urgent need for the issue of genetic counseling to be considered. A few of the large research-based memory clinics already provide this service as part of their total work-up of the patient, as important as the history, examination and high technology scans. Genetic engineering has arrived for some diseases, could it have a role in the future in chronic confusion?

Despite the major advances in medicine and science, the reality for most people is of a slow decline into a mental desert, dependent on their loved ones for care and comfort. Carers above all need hope, but even more they deserve recognition of their role and as much practical support as they feel they need. It is a cliche that knowledge is power, but with dementia there are at least two victims, sufferer and carer.

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Medical Specialists

Medical specialists are a close knit group of doctors who have banded together to obviate the laws of supply and demand. Specialist colleges have gained control of the post graduate medical education process. Doctors are not allowed to enter the specialist ranks until a vacancy exists by death or attrition. Some say that medical specialists have devised a system that allows them to make exact clones of themselves. Certainly no Aborigines have risen to the dizzy heights of medical specialization and both women and members of the working class are woefully under represented. One female medical luminary was recently heard to say that only seven per cent of the seven major specialist colleges was made up of women members. Medical specialists have also taken over much of the procedural work once performed by general practitioners. It is ironic to think that only this extraordinarily skilled and highly motivated group of self interested medical professionals stands between the people of this country and the Eastern Europeanization of Australia’s private health sector.

Medicare

As a continuum of structural reforms and changes begun after the Second World War, the edifice of Australia’s national compulsory health insurance scheme owes as much to the Australian Liberal party as it does to the Australian Labor party which claims most of the credit for its creation. Medicare provides excellent cover for people choosing to visit general practitioners or medical specialists in the private sector but it has failed dismally to meet the challenge of universal hospital insurance. 80 per cent of all doctors charges in this country are now bulk billed and this means most people never have to pay any cash at the point of delivery of medical services. Detractors of Medicare claim that medical costs have risen 30 per cent since the schemes introduction in 1983. However, at least 30 per cent of the population could not afford direct access to the health care system before Medicare as it now stands was finally brought into existence. Over the last decade Medicare has managed to restrain spending in the health care sector at roughly seven or eight per cent of Gross Domestic Product. This is more than the five per cent spent by Great Britain and a lot less than the 14 per cent spent by the United States, with at least 20 per cent of their population without any medical insurance at all.

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