Alzheimer's Cure by 2025: An Unnecessary Goal?

Contributed by: Dennis Fortier, President, Medical Care Corporation

The National Alzheimer's Prevention Act, signed into law one year ago, calls for a national strategy for defeating this terrible disease. A late-stage draft of the strategy sets a goal to develop a cure by the year 2025.  While many have suggested a timeline with more urgency, say by 2020, others have suggested that this timeline is too ambitious.

On the one hand, given our still poor understanding of the disease, coupled with a dismal track record of success for pipeline drugs over the past decade, it seems unlikely that a cure could be developed prior to 2025.  In fact, against the backrop of recent evidence, it may well take longer than that.

On the other hand, we could stop short of a cure and still have great success.  For example, many chronic diseases like diabetes and hypertension have no cure, but we have effective treatments, and we manage those diseases with high efficacy.  It is likely that new drugs, developed well before 2025, will give us greater treatment benefits for patients with Alzheimer's.

Perhaps of greater importance is the fact that we already have approved therapies that can significantly slow Alzheimer's disease progression.  However, since we commonly detect the disease too late and intervene only after massive brain damage has occurred, the perception among physicians is that treatment is unhelpful.  This nihilistic perception actually perpetuates the cycle of late intervention because, believing that there is no treatment, many MDs don't look for early signs Alzheimer's.

In this regard, a key element to an effective national Alzheimer's strategy would be to update physicians about the benefits of early detection and equip them with the tools and training to proactively monitor the cognitive health of their patients.  When a cure is developed, that will be great.  But in the meantime, we can find the disease early and treat it as effectively as possible with robust therapy (drugs, diet, physical exercise, control of diabetes and hypertension, intellectual stimulation, social engagement, and caregiver education).  Such a comprehensive approach has been shown to significantly delay disease progression in a meaningful percentage of early-stage patients.

The War on Alzheimer's

Contributed by: Dennis Fortier, President, Medical Care Corporation

Declaring war on a disease or social problem is no guarantee that it will be vanquished.  However, the passage of the National Alzheimer's Prevention Act (NAPA) a year ago, and the near ready draft of a strategy to wage such a war, are both good signs.

I am encouraged by the top-level recognition of Alzheimer's as a major social problem, and by the seeming seriousness of the current administration to tackle it.  However, the lack of funding in these fiscally challenging times is concerning.  For perspective, we commit more than $6B annually in federal funds to cancer research compared to about a half a billion for AD research.  Current lobbying efforts are aiming for a $2B budget to implement a strategy under NAPA.

If we are to wage a war against this disease, then research funds to better understand Alzheimer's and to develop a cure must be the center-piece of the strategy.  However, I hope that the planners do not overlook more certain, and more immediate opportunities to win many battles.  Great progress can be achieved with not much more than a dose of pragmatism and public will.  I described those opportunities in some detail in an earlier post "Antidote for the Alzheimer's Epidemic".

Given the fast pace of research in this field over the past decade, coupled with historically slow adoption of new knowledge into clinical practice, there is a large gap between the state of our medical knowledge and the standards of care we commonly practice in the clinic.

So let's commit to a national plan for thwarting Alzheimer's and focus on developing a cure.  But let's make sure we also take care to update clinical practice with all of the new discoveries we have made, and will continue to make, as we race toward that ultimate goal.

A National Strategy for Alzheimer's

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Since the National Alzheimer's Prevention Act was passed into law in November of 2010, the Obama administration has been legally bound to develop a national strategy to fight Alzheimer's disease.  As the first draft of the plan is nearing completion, certain themes have been clearly expressed by the public in terms of what they hope the plan includes.

As described in this Associated Press article published by Time,  the plan should address three elements that have been consistently advocated in public forums:

1. Primary care physicians need better training to make earlier diagnoses of cognitive problems
2. Huge spending discrepancies by the National Institutes of Health need to be adressed as Alzheimer's disease receives a tiny fraction of the support that cancer and AIDS receive
3. More community support programs are needed to help Alzheimer's patients and their caregivers survive at home during later stages of the disease

While it is still unclear what the first version of the strategy will look like, or how detailed it will be, I am pleased to see those priorities rising from the public realm.  Two of them are completely focused on the pragmatic benefits of doing a better job with the scientific knowledge we already have, while only the NIH budget issue seems to be focused on funding new (and probably elusive) scientific breakthroughs.

National Alzheimer's Prevention Act (NAPA) Becomes Law

Contributed by: Dennis Fortier, President, Medical Care Corporation

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Last week, President Obama signed the National Alzheimer's Prevention Act into law. So what does that mean?

We described the basic spirit of the Act in this earlier post when it passed Congress. It is largely a commitment that we will formulate a strategy and coordinate resources at the federal level. Notably, there were no appropriations (funds) written into the act so, in that regard, there is a risk that the new legislation will be largely symbolic.

Nonetheless, it is a sign of progress toward higher awareness, importance at top levels, and urgency on behalf of the nation. Such a move is a common first step on the path to increased federal funding so I do not despair the current lack of committed funds. This is an important step and, most probably, a step that will catalyze even faster progress in the field.