The Alzheimer's Strategy We NeedA consensus is developing that Alzheimer's Disease (AD) is the next epidemic to worry about, both medically and fiscally. But unfortunately, there's nothing close to a consensus on what to do about it.
James P. Pinkerton
Medical Progress Today
December 2, 2010
Considerations of AD have been subsumed by the debate over spending and the deficit—although Washington mavens don't yet seem to grasp that a fiscal solution is not possible without a medical solution. Instead, policy chatterers have zeroed in on cutting entitlement spending, ignoring the medical problems of aging, favoring a strictly fiscal solution. Such an approach has a soundbite-worthy appeal, but it disregards outside-the-beltway political reality: If the underlying problem of the disease itself is ignored—the incidence of AD is expected to triple in the next 40 years—then popular pressure to spend commensurately will not be ignored by politicians. Indeed, we can note that if AD triples, it won't matter much whether or not Obamacare lives or dies; either way, by mid-century, healthcare will be ruinously expensive.
In the meantime, others seem to believe we should simply have a partisan brawl, aimed at gaining maximum political advantage going into the 2012 elections. And of course, as soon as the '12 elections are over, fighting over the '14 elections will commence. Yet amidst such see-sawing political opportunism, we will continue to spend enormous sums on AD care—already more than one percent of GDP, and rising fast—without any real prospect for a cost-curve-bending cure.
In August 2010, The New York Times reported on the work of a medical "jury" convened by the National Institutes of Health to evaluate the various treatments for AD. The "verdict" of the NIH panel was discouraging in the extreme: "Currently, no evidence of even moderate scientific quality exists to support the association of any modifiable factor (such as nutritional supplements, herbal preparations, dietary factors, prescription or nonprescription drugs, social or economic factors, medical conditions, toxins or environmental exposures) with reduced risk of Alzheimer’s disease."
To sum up: There's "no evidence" that anything we are doing to forestall or treat Alzheimer's is working. The chair of the NIH panel, Dr. Martha L. Davigulus of Northwestern University, summed up the current state of research as "primitive."[i]
Yet we do see stirrings of a counteroffensive against the AD onslaught. In October, former Supreme Court justice Sandra Day O'Connor, joined by Nobel medical laureate Stanley Prusiner and geriatric expert Ken Dychtwald, argued on the op-ed page of The New York Times for a more proactive strategy against AD and its costs:
As things stand today, for each penny the National Institutes of Health spends on Alzheimer's research, we spend more than $3.50 on caring for people with the condition. This explains why the financial cost of not conducting adequate research is so high. The United States spends $172 billion a year to care for people with Alzheimer's. By 2020 the cumulative price tag, in current dollars, will be $2 trillion, and by 2050, $20 trillion.
In addition, O'Connor, Prusiner, and Dychtwald brought up the benefits of an effective AD treatment:
If we could simply postpone the onset of Alzheimer's disease by five years, a large share of nursing home beds in the United States would empty. And if we could eliminate it, as Jonas Salk wiped out polio with his vaccine, we would greatly expand the potential of all Americans to live long, healthy and productive lives—and save trillions of dollars doing it.[ii]
That same month, another leading figure, California first lady Maria Shriver, made an overlapping argument: The goal should not be treating AD, the goal should be beating AD. Speaking to ABC News' Diane Sawyer, Shriver invoked the ambitious vision of her famous uncle, "We can launch an expedition on the brain, much like President Kennedy launched an expedition to the moon."[iii] Once again, the obvious wisdom: A cure for any malady is cheaper than palliative care. That medical-fiscal reality was true for polio, as well as other diseases that have been mostly or completely eliminated—so why couldn't it be true for AD?
And yet the political establishment has paid little heed to O’Connor and Shriver, nor has it thought constructively about the polio precedent. In the weeks since, two different "blue chip" deficit commissions have released weighty reports; both focused entirely on a "cut" strategy for healthcare, as opposed to a cure strategy.
Why the neglect of the proactive cure-approach? Perhaps Washington officialdom is simply incapable of a complicated "two cushion shot"—that is, hitting the billiard ball of medical research in order to hit the ball of lower costs in the long run. Or perhaps the idea of scientific research, as opposed to writing checks and offering bailouts, is simply out of fashion in policy circles. Or maybe Washington has quietly concluded that medical research—and just as crucially, the translation of medical research into actual medications in the marketplace—is hitting a dead end. Why spend more money on, say, the NIH if nothing tangible is achieved? Why have faith in the pharmaceutical companies when a dozen anti-AD efforts have failed in mid- to late-stage testing since 2003?[iv]
Yet if nothing can be done to rekindle medical progress as a public-policy tool, then we are, in fact, doomed both to go gray and to go broke by the middle of this century—unless, of course, the death panels are called in.
So is there any hope for a better outcome? An outcome that's both more compassionate—and less ruinous? If there is such a hope, it will have to come from medical research. Financial transactions won't get us there; only scientific transformation can do the job.
For their part, politicians can help, not by fighting each other, but by clearing away the legal and regulatory roadblocks to medical progress. The FDA is facing a "crisis of confidence"; critics on all sides agree that the agency is "broken."[v] So the answer, of course, is to fix the agency, as part of an overall cure strategy.
Will such an effort succeed? There's no way to know for sure, but our long national track record on public-private mobilization—from building the railroads to building the Interstates to building the Internet—should give us considerable hope. If, that is, we can distill the right leadership lessons from those past large-scale successes.
The political and economic reward for medical success is monumental. With an effective treatment for AD, we could, of example, begin to think about raising the retirement age for Medicare and Social Security, thus solving much of the deficit problem.
In addition, an AD breakthrough would shift cost calculations on just about every fiscal and economic variable. Today, all those tens of millions—soon to be hundreds of millions—of people around the world suffering from AD are seen as a huge burden. But with a real AD cure, they could become paying customers for whichever country is making the medicine, able to continue working and producing—for the betterment of each country, for the betterment of mankind.
James P. Pinkerton is a senior research fellow at the American Strategy Program, a contributor to the Fox News Channel and a regular panelist on the Fox "News Watch" show, the highest-rated media-critique show on television. He is also the editor of SeriousMedicineStrategy.org.