Dissonance in the face of Alzheimer's disease breakthroughs: clinician and lay stakeholder acceptance, concerns and willingness to pay for emerging disease-modifying therapies.

BACKGROUND: Introducing new disease-modifying therapies (DMTs) for Alzheimer's disease demands a fundamental shift in diagnosis and care for most health systems around the world. Understanding the views of health professionals, potential patients, care partners and taxpayers is crucial for service planning and expectation management about these new therapies. AIMS: To investigate the public's and professionals' perspectives regarding (1) acceptability of new DMTs for Alzheimer's disease; (2) perceptions of risk/benefits; (3) the public's willingness to pay (WTP). METHOD: Informed by the 'theoretical framework of acceptability', we conducted two online surveys with 1000 members of the general public and 77 health professionals in Ireland. Descriptive and multivariate regression analyses examined factors associated with DMT acceptance and WTP. RESULTS: Healthcare professionals had a higher acceptance (65%) than the general public (48%). Professionals were more concerned about potential brain bleeds (70%) and efficacy (68%), while the public focused on accessibility and costs. Younger participants (18-24 years) displayed a higher WTP. Education and insurance affected WTP decisions. CONCLUSIONS: This study exposes complex attitudes toward emerging DMTs for Alzheimer's disease, challenging conventional wisdom in multiple dimensions. A surprising 25% of the public expressed aversion to these new treatments, despite society's deep-rooted fear of dementia in older age. Healthcare professionals displayed nuanced concerns, prioritising clinical effectiveness and potential brain complications. Intriguingly, younger, better-educated and privately insured individuals exhibited a greater WTP, foregrounding critical questions about healthcare equity. These multifaceted findings serve as a guidepost for healthcare strategists, policymakers and ethicists as we edge closer to integrating DMTs into Alzheimer's disease care.

AIDS, Sexual Health, and the Catholic Church in 1980s Ireland: A Public Health Paradox?

Our aim was to explore the paradoxical role of the Catholic Church during the early AIDS era in establishing a policy network committed to the principles of public health, even in instances in which these principles contradicted Catholic moral teaching. This article is rooted in a study that explored the transformational effects of AIDS on Irish sexual health policy during the initial decade of the epidemic; that is, as it unfolded in Ireland between 1982 and 1992. Our source material, consisting of 20 documents that had been unexplored for more than 25 years, was obtained from the Dublin AIDS Alliance Ltd., an Irish civil society organization that supports HIV-positive people. Our archival research was supported by 18 semistructured key informant interviews with contemporaneous politicians, representatives of the Catholic Church, clinical personnel, and AIDS activists. We examined the critical role of a Catholic priest in developing a coherent national policy response that reflected the public health principles advocated by the World Health Organization at a time when the moral authority of the Roman Catholic Church had a significant influence on successive Irish governments. (Am J Public Health. 2018;108:908-913.).