The Inadequate War on Alzheimer's
The fight against Alzheimer's disease tallied a small victory last week, when two new drugs were found that possibly slow its relentless attack on brain cells. But the search for a cure isn't moving nearly quickly enough.
Alzheimer's kills about 100,000 Americans every year and undermines the final years of life for some 5 million more. Forgetfulness and disorientation are the first symptoms, soon followed by trouble communicating, cooking and getting dressed. By the end, victims are often unable to recognize friends and family, eat or walk on their own, or understand anything happening around them.
Care for the afflicted accounts for almost a fifth of Medicare and Medicaid spending; by 2030, that's expected to reach almost half a trillion dollars a year. Alone among the most widespread diseases, Alzheimer's has no proven treatment, let alone a cure. Drugs exist to mitigate symptoms once they appear, by stimulating mental activity for patients whose brain cells have already deteriorated, but no new ones have been approved since 2003.
Why has this disease proved so invulnerable to modern medicine? Bad luck may be part of it, as it is with all medical research, and the sheer difficulty of solving the puzzles involved. Researchers are still unclear about what causes the deterioration in mental function: Is it the amyloid beta plaque that builds up between nerve cells in the brain? Or is it the tau protein that tangles the insides of those cells? Or could these effects be symptoms of some other underlying disease process? And what causes some people to get the disease and not others? (One hint: It's not simply heredity.)
But in the case of Alzheimer's, money seems to be an obstacle, too. Considering the severity of the disease, and the number of people who suffer from it, Alzheimer's attracts relatively little research money. This year, the National Institutes of Health, the U.S.'s chief funder for medical research, will spend almost 10 times as much on cancer research as on Alzheimer's -- even though just four times as many people have cancer -- and it will spend five times as much on HIV/AIDS, even though just twice as many people have AIDS as have Alzheimer's.
No wonder the number of deaths from Alzheimer's continues to increase, as deaths from other major diseases decline.
Charitable contributions toward Alzheimer's research also lag those of other causes. For every dollar raised in 2012 by organizations that fund cancer research, groups dedicated to Alzheimer's raised about three cents, according to figures compiled by the Urban Institute's National Center for Charitable Statistics.
The disparity may reflect lingering misperceptions about Alzheimer's: That dementia is simply a function of getting old, rather than a disease that can one day be cured, for example, or that it's nothing to worry about until old age. (Research suggests the plaques may begin accumulating in the brain decades before symptoms appear.)
One way to make Alzheimer's a greater priority is to force Congress to focus on it. That's the idea behind a law passed last year requiring that the NIH send annual funding requests for Alzheimer's research directly to the president and lawmakers, bypassing the usual government-wide budget process.
Lawmakers may also want to consider that taxpayers will end up paying either way. Medicare and Medicaid will spend $153 billion caring for patients with Alzheimer's and other kinds of dementia this year, or about 261 times what the NIH will spend looking for ways to prevent and cure the disease. Until one is found, these numbers are way out of balance.
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