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The slim, young-looking professor of psychiatry and bioethics stunned her audience of donors and doctors at the May 8, 2019 Nathaniel Wharton Fund Research Dinner to support research in consultationliaison psychiatry at Columbia. Tia Powell, M.D., who is Director of the Montefiore Einstein Center for Bioethics, announced that she expected to slip into dementia and would be taking about half of those present with her. Her grandmother became demented and so did her mother, a brilliant woman who had pushed six children to graduate degrees.
Not to put too fine a point on it, there was no hope for a cure, not only for those present but for the baby boomer population bulge (born 1946-64) now turning 65 at 10,000/day. Her book, written in smooth prose both elegant and familiar, so it feels like you are listening to a friend who has to break bad news details this. Hopes for a magic pill are confronted by the 99.6% failure rate for new dementia drugs. Memantine, bapinuzab, and solamezumab are not curative, and the reigning amyloid hypotheses is dead or flying on fumes, with another of aducanumab, failed study a month before her talk. Even if an imaginary wonder drug were found today, the decades for testing and deployment doom us (maybe just about all of the Academy) to the risk of incurable dementia. Would it cure or merely postpone the same trying and expensive end? We could be the lucky ones who die otherwise, and the Academy has had our dazzlingly intact oldsters. But the humanist and ethicist Dr. Powell is unsatisfied with a hopeless choice between the misery of dementia and suicide.
Her book is a wholly original push away from current notions of cure to care, and it is a shock to our entitled, “richest nation” systems, accustomed to replacing iron lungs with inoculations, AIDS with lifetime