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The Obama Administration's War on Alzheimer's
On Monday, a presidential advisory group set a goal to prevent and effectively treat Alzheimer’s Disease by 2025. There is much to like about this proposal, but it should come with a consumer warning: There is a lot less to this plan than meets the eye.
Let’s start with the good news. This initiative is potentially an important step forward as the nation confronts Alzheimer’s and other dementias that currently effect more than 5 million Americans–a number that will nearly triple by mid-century. The Department of Health and Human Services estimates that 40 percent of those 85 and older will suffer from some form of dementia before they die.
The panel identified five specific goals. The aim of enhancing research to develop effective treatment and prevention of dementia by 2025 will get the most attention. But the others, including improving the quality of care of Alzheimer’s patients, supporting their families, enhancing public awareness, and improving data collection are all extremely important.
The draft report also recognized the need to better coordinate medical and long-term care for dementia patients, as well as improving care transitions for this very vulnerable population.
The panel deserves kudos for all of these initiatives, and policymakers should absolutely pursue them all.
But the draft is not perfect. Here is what I don’t like about it:
It seems overly focused on Alzheimer’s. True, Alzheimer’s is by far the most common dementia and there is good reason to lavish attention on it. But there are many other forms of memory disease, such as stroke-related dementia and Lewy Body Disease. These will be treated differently, and drugs that prevent or slow Alzheimer’s are not likely to benefit those diagnosed with other dementias.
Money. There isn’t any. The report does not set a goal for research funding. And it barely acknowledges the tremendous financial cost that families bear for providing the personal assistance dementia patients require–often for many years. Without resources, either public or private, all of the panel’s grand plans are a pipe dream.
And keep in mind the budget background of this initiative: In coming years, there will be tremendous pressure on the Medicare and Medicaid budgets, non-Medicaid government support to all of the frail elderly, and NIH research funding. What will happen to this initiative in an era of constrained government resources? This report does not say dementia will get priority in what will be an ugly battle for funding.
The relationship between government and the drug companies. The payoff for the firm that develops a successful dementia drug will be staggering. It would be great to see a new partnership where, in return for research funding, government receives an equity share of profits from any blockbuster Alzheimer drug that is developed with its support. In an era of budget cuts, plowing that funding back into public research programs could go a long way towards supporting future studies.
I remember President Nixon’s 1971 war on cancer. Four decades later, we still argue about how successful it was. But it accomplished one thing: It raised the profile of a disease that people didn’t even want to talk about. If President Obama runs with this draft framework, he can do the same for Alzheimer’s and other dementias. That itself would be an important contribution. But it won’t be enough.