2012 may be the year the Mayan calendar ends, but 2050 might be the milestone we should really be afraid of.
According to William Thies—Chief Medical and Scientific Officer of the Alzheimer's Association—that is the year the Alzheimer's disease epidemic is set to reach its zenith and scorch the U.S. health care system into oblivion.
In an effort to avoid this impending health care apocalypse, legislators and health experts recently gathered to take the first steps in concocting a national plan of action to counter the disease.
The best laid plans…
Two weeks ago, the Advisory Council on Alzheimer's Research, Care, and Services met for two days to hammer out the details of a proposed national plan to combat Alzheimer's disease.
Made up of an assortment of geriatricians, Alzheimer's specialists, caregivers, and advocacy group leaders, the committee reviewed the plan, which was centered around the following stated objectives:
- Prevent and effectively treat Alzheimer's disease by 2025
- Enhance care quality and efficiency
- Expand patient and family support
- Enhance public awareness and engagement
- Improve data to track progress
Specific strategies to help reach each goal were included in the framework, which appears solid, but raises a few questions.
Treatment by 2025: Pipe dream or achievable goal?
"My promise is that we will have a means to prevent Alzheimer's by 2020," says David Morgan, PhD, CEO of the University of South Florida Health Byrd Alzheimer Institute. He believes that accomplishing the goal of prevention is more scientifically clear-cut than the goal of effective treatment.
In essence, Morgan says the future path of Alzheimer's treatment is similar to that of heart disease 50 years ago. Both ailments are degenerative and develop slowly over time. And, while we have not been able to "cure" heart disease per se, he points out that preventative measures have dramatically decreased the mortality rates associated with cardiac problems.
Khaled Imam, M.D., director of geriatric medicine at Beaumont Hospital, feels that 2025 may be too optimistic. Though it is a good idea to have an aggressive goal, Imam says that, given where we currently stand with our knowledge of Alzheimer's disease, it's going to take more than 13 years to come up with an efficient treatment method.
The key to preventing Alzheimer's likely lies in decreasing the amount of amyloid plaque build-up in a person's brain before they begin to have symptoms of the disease. Future therapies may also be based around decreasing the mount of tau protein that collects inside a person's neurons.
Part of the problem with Alzheimer's is that a significant portion of damage has already occurred in a person's brain by the time their symptoms emerge.
Show me the money
Other questions on everyone's mind are: How much is this going to cost? Where will the money come from?
Morgan estimates that it will take $2 billion to reach the committee's goal of finding an effective treatment for Alzheimer's and he feels confident that the federal government has the purse strings capable of funding such an endeavor.
Even with the national debt topping out at a little over $15 trillion, Morgan points out that the $2 billion would be more akin to an investment in the future as opposed to a one-sided expense. He says that the potential benefit of staving off a disease that could end up disabling Medicare and Medicaid make the decision to devote federal funds to research a, "no-brainer."
Funding for Alzheimer's disease research has historically been much lower than funding for other major diseases, such as cancer and heart disease.
According to figures from the National Institutes of Health, in 2010, $803 million was poured into cancer explorations while only $79 million was used to investigate Alzheimer's.
Imam suggests that the aging of the Baby Boom generation is beginning to cause the focus to shift more towards Alzheimer's. Indeed, the projected numbers for 2011 and 2012 show Alzheimer's funding rocketing up to $450 and $458 million respectively (though both figures are significantly less than the $2 billion suggested by the Advisory Council).
To screen, or not to screen?
There is a good deal of debate surrounding whether or not people should get screened for Alzheimer's disease even though a cure does not exist yet.
Both Morgan and Imam feel that people suspected of having Alzheimer's should get tested.
According to Imam, the tests currently used are relatively accurate (between 88 and 90%) and either confirming or ruling out an Alzheimer's diagnosis can be extremely helpful for a senior and their caregiver.
Benefits to the senior are relatively straightforward. The available treatments for Alzheimer's disease work best when taken in the earlier stages of cognitive impairment.
For the caregivers, the National Alzheimer's Plan draft includes provisions for developing better ways to support those dealing with a loved one who has the disease. Areas for improvement include: long-term care services, health care planning for the senior, and regular mental and physical check-ups for caregivers.
What if the plan doesn't work?
What if we can't find the money to help caregivers? What if the research hits a dead end? What if the plan fails?
Skeptics and supporters of the proposed plan both turn to former President Nixon's "War on Cancer," as an example of the effect of legislation on a major health epidemic.
40 years have passed since Nixon signed the National Cancer Act of 1971 and we have not succeeded in discovering a "cure" for cancer. But, Morgan points out that there have been numerous improvements in general medical knowledge that have been made since its passage.
The War on Cancer, he says, led to the sequencing of the human genome, and has advanced the field of research in ways that have aided research on other diseases. He also emphasizes the fact that, the amount of people who survive cancer has greatly increased over the past four decades.
There are also some fundamental differences between cancer and Alzheimer's. The biggest difference being that the biological elements involved in triggering Alzheimer's disease are thought to be far fewer than those attributed to cancer.
The way forward appears relatively straight to Morgan, who says, "Personally, I think 2025 is pessimistic."
The first formal draft of the National Alzheimer's Plan is set to be released by the middle of February, with the finalized strategy to be issued sometime in the spring.