Opinion

Industrial Strength Alzheimer’s Disease Policy Prescription

Alzheimer’s disease. Few families are untouched by this terrifying illness. And here’s the hard truth: it’s going to get worse. As life expectancies rise, so do the odds of an Alzheimer’s diagnosis. Today, if you live into your mid-80s, you have a roughly 50-percent chance of developing the brain disease, which has no effective treatment options. One recent study suggests the U.S. population of Alzheimer’s patients will double to 11 million by 2040.

Putting it simply: Dealing with Alzheimer’s disease is an immense challenge for our society. Yet there’s reason to hope we can confront this challenge. Under President Barack Obama, the National Institutes of Health increased its focus on the brain. Bipartisan congressional leadership recently pushed into federal law more funding for basic research. This past fall, the National Institute of Aging launched new prizes for research on how best to validate predictors of Alzheimer’s. Bill Gates dove into Alzheimer’s research with new funding. A seminal report by the Alzheimer’s Association reported that by 2060 there will be 9 million Americans who will need intensive medical care similar to that offered in nursing homes.

To convert these efforts into clinical progress, we need to first understand the obstacles which have held back progress on Alzheimer’s, and then make several smart policy changes.

Prevention

Many assume Alzheimer’s disease is entirely a genetic disease, and that there’s little that can be done to prevent it. This is simply not the case. An expert panel set up by the British medical journal Lancet, found more than a third of dementia cases can be prevented by tackling non-genetic factors like poor education, stress, obesity, and social isolation arising from hearing loss. AD is the most common type of dementia, accounting for 60-70 percent of cases.

A talent gap: diagnosis and treatment

As with other diseases, confronting Alzheimer’s requires the three-legged stool of prevention, diagnosis, and treatment. Right now, we do not have enough people to diagnose and treat Alzheimer’s patients.

Diagnosis of Alzheimer’s is complex. It requires meaningful human intervention and there are simply not enough people to do this work. Currently, there are not enough professionals to screen for further diagnostic and treatment all the millions of people who may have modest cognitive impairment. For example, a recent RAND study argues that if the Alzheimer’s medicines currently in late-stage trials bear fruit, there will be so many people over 55 who will need to be screened that wait times will escalate to over 1 1/2 years by 2020. We can fix this gap by increasing awareness, better infrastructure, and more trained physicians/nurses.

Reimbursement policy

The challenges go beyond talent. We need dramatic changes in setting measured reimbursement policy for diagnosis of cognitive decline. Incentives for development of new diagnostic tools are required from insurers, especially the federal programs of Medicare and Medicaid. They must cover new methods of detecting Alzheimer’s and patient access must be based on affordability.

Infusion capacity

Many of the promising products in late stages of development require regular blood plasma infusions. We are so short of infusion center capacity that up to a million people could progress to full-blown Alzheimer’s due to protracted times waiting for access preventive treatment.

Support for caregivers

Too little attention has been given to the people on the front lines of this complex and devastating disease, many millions of whom are patients’ family members. Most often these family carers, an improved term over the word ‘caregivers’, are not paid and could benefit from publicly financed skill development.

It’s time to recognize the valuable contributions these volunteers make in order increase the number of carers, and to improve patient quality of life by enhancing the skill set of said carers. We must offer a living wage stipend, or universal basic income in exchange for their health care services. This investment would open healthcare career paths for these workers, and help address the talent shortage.

We also need to train and continuously upgrade the skills of health care professionals – not just physicians – who focus on Alzheimer’s. If we are to meet the challenge of increased Alzheimer’s volume, we need to extend the treatment delivery system beyond licensed medical professionals.

Public-private partnership for technology

Finally, we need a partnership between government, private businesses, and the academic sector to develop machine learning tools to accelerate diagnostic and treatment protocols.

A first area for partnership focus is on increasing the utilization rate of key diagnostic tools such as positron emission tomography scanners from the abysmal level of 50 percent by better scheduling. We cannot afford to leave such expensive equipment idle half of the time.

A second area is developing robots who can help health aides and nurses in caring for patients. Other countries – like Japan, with its huge elderly population – have seen marked positive feedback from the increased use of robots in nursing homes.

BOTTOM LINE

We should be heartened by the increased focus from government and the philanthropic sector. But more needs to be done: last year, Alzheimer’s-related costs of care reached $259 billion. To build a sustainable infrastructure for diagnosis and treatment, we need more people with the right skills. We should also be using the full set of modern tools such as AI, machine learning, and robots to augment the increased cauldron of human resources.

We also need to augment human ingenuity by using the new tools of machine learning, artificial intelligence, and robots. Doing so offers us our best shot at helping the many people – and families – facing the darkness of Alzheimer’s disease and dementia.

 

David Beier was chief domestic policy advisor to then-Vice President Al Gore and is managing director of Bay City Capital. Andrew Sullivan is a founding partner of Hudson Pacific, a political and public affairs strategy firm.

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