In the late 19th century, a French obstetrician named Stephane Tarnier figured out how the infant incubator could save the lives of millions of premature babies. It was not an immediate success in this country, however. Physicians in the United States scoffed at the concept and, for years, babies in incubators were literally seen only in carnival sideshows between the bearded lady and the tattooed man. No one can calculate how many lives were lost because an important medical innovation was not made immediately available to patients.
The lesson learned over 100 years ago carries even greater importance today. Humankind will eventually find solutions to its most daunting problems. Breakthroughs are the rule, not the exception. It is society’s responsibility to respond swiftly and decisively to scientific progress so that pain and suffering can give way to health and longevity.
But here’s the $200 billion (the approximate medical costs in the United States from Alzheimer’s and dementia) question: If an effective new Alzheimer’s treatment is approved by the Food and Drug Administration in the next five years, will we be ready to deliver it to every individual who can benefit from it? As of right now, the answer is a distressing NO, but we have time to correct our course and take the steps necessary to avoid an infant incubator reprise. Within the public policy and medical communities, there are a number of priorities that need to be immediately addressed:
Making life-changing innovations affordable for patients. The finger-pointing war over drug prices, heightened by the development of a Hepatitis C cure and major advances in cancer therapies, has to give way to a constructive movement aimed at crafting innovation-friendly payment mechanisms with payers and manufacturers to make sure new therapies are widely accessible. Medicare and private insurers also need to appreciate that not paying for first generation disease-modifying drugs will chill the investment needed in the next generation of products required to realize the health system savings that will accompany continuous innovation in biopharmaceutical preventive drugs.
Fixing the Alzheimer’s diagnostic problem. In our country, there is a little-known disparity when it comes to diagnostic care. If you are diagnosed with cancer, nine times out of 10 your doctor is going to tell you. If you have Alzheimer’s disease, 55 percent of the time physicians keep that diagnosis to themselves. Alzheimer’s is the only one of this nation’s leading causes of death that cannot be prevented, stopped or slowed and, thus, doctors may see it as an act of mercy to refrain from sharing such dismal information. As we move closer to effective treatments, candid and accurate diagnostic care is vital.
Training for front-line physicians to prevent, diagnose and treat Alzheimer’s. Enhancing geriatric workforce education, including within primary care, is of utmost importance. In addition, there are 7,000 geriatricians in the United States. With 10,000 baby boomers becoming Medicare-eligible each day, we will need 30,000 doctors in this specialty by the year 2030 just to keep pace with patient demand. Right now, the trend in medical schools is going the other way. The number of students choosing a geriatric track is in decline, and one reason is because a geriatrics practice is not sustainable financially with a 100 percent Medicare payer mix. Other specialties see a mix of payers.
Exacerbating this problem is the difficulty seniors experiencing cognitive challenges have in seeing a memory care specialist, like a neurologist, with a 35-day lead time to make an appointment, on average. Given the fact that many of the new Alzheimer’s drugs in the pipeline are going to be administered by infusion, we need to focus on building a health care workforce trained to treat our changing – and aging – population.
Those of us who have been involved with UsAgainstAlzheimer’s, devoting years to fight this pernicious, dehumanizing disease, have never witnessed the growing optimism we’re seeing today over the possibility of a disease-altering therapeutic breakthrough. It would be a tragedy if we see medical history made only to repeat the mistakes of the past and not be able to deliver that new therapy to those with or at risk of this cruel disease.
Morgan, a distinguished professor of the College of Medicine and Molecular Pharmacology and Physiology at the University of South Florida, and CEO of the Byrd Alzheimer's Institute, and George Vradenburg, co-founder and chairman of UsAgainstAlzheimer’s.