Optimism About New Alzheimer's Drugs

Contributed by: Dennis Fortier, President, Medical Care Corporation

A few weeks ago, we wrote about the glimmering ray of hope that had emanated from bad news about potential new Alzheimer's treatments.

Both Bapineuzumab and Solanezumab, the two most progressed new drugs in the development pipeline, had both failed the final stage of their respective clinical trials, and would not be approved by the FDA. However, there was some evidence, and much speculation, that both drugs had shown signs of efficacy in secondary data analyses.

Now, as presented at the American Neurological Association's 2012 annual meeting earlier this week, those secondary analyses have been verified and a newfound optimism has swept the field.

Of course, drug approvals require a massive investment of time and money, and drug companies must always weigh the costs of completing that high risk process, against the benefits they might capture during the few remaining years of the drug's patent life, once the process is completed and the drug is commercialized.

Readers might be surprised to learn that drug companies sometimes abandon effective drugs, if the approval process takes too long and the viable (patent protected) period for recouping their investment is too short. This is the decision that Eli Lilly (Solanezumab) and Pfizer (Bapineuzumab) must now face as they consider the time and cost of next steps to bring these drugs to market.

At this point, there are two encouraging signs that each company might push forward and lobby the FDA for an efficient path to near-term approval.  One is that the Federal government, under the National Alzheimer's Prevention Act, is committed to identifying new treatments for this disease.  The other, is that the Wall Street analysts, ever pessimistic about success of new AD drugs, have pushed Lilly's stock price upwards in the wake of this new information.

Long-Distance Caregiving

Contributed by: Dennis Fortier, President, Medical Care Corporation

An aging population is the macro-driver of the trend toward increased demand for caregiving.  Within that trend, it is cognitie impairment, or declining brain health that is really fueling the growth.  A such, caregiving is a topic we watch closely in this blog.

As the geographically dispersed, sandwich generation is increasingly called upon to provide care for an aging parent or relative, long-distance caregiving is also gaining prevalence.  Performing this role from afar comes with its own set of challenges, and I am pleased to direct today's readers to the an article posted by Medical E-Compare, a marketer of medical insurance products.

The article offer tips for caregiving from a distance and features a set of practical suggestions for those finding themselves in this role, along with links to additional reources.

The Misdiagnosis of Alzheimer's Disease

Contributed by: Dennis Fortier, President, Medical Care Corporation

Yesterday we commented on the common misdiagnosis of Lewy Body Disease, a problem often mistaken for Alzheimer's Disease.  In keeping with that theme, we look today at results from an international physician survey on Alzheimer's diagnoses.

Based on a survey of nearly a thousand physicians in five countries (USA, Japan, UK, France, and Italy), we are not doing a very good job at diagnosing Alzheimer's disease in clinical practice.  In fact, about half of all physicians agreed that the disease is "often misdiagnosed" and that diagnoses are "always or often" made too late to treat in a meaningful way.

None of this is news to regular readers of this blog as late detection of cognitive impairment is one of our frequent themes.  However, the survey revealed an interesting perspective from the physicians, in terms of "why" they feel diagnoses are so commonly late.

According to the physicians surveyed, the major contributing factors to late diagnosis are:

• lack of a definitive diagnostic test;
• lack of communication from patients/caregivers; and
• stigma

Not mentioned among their reasons is the one glaring problem that primary care physicians confess to me on a regular basis.  I hear frequently from physicians that investigating memory complaints takes too much time, and often leads to a diagnosis of a problem they don't feel they can treat effectively.  This perspective often leads them to "just keep an eye on the concern" until symptoms worsen and the need for medical intervention is clear.  As the survey noted, this is "too late".

Managing the cognitive health of an aging population is a complex problem, and a difficult one to approach within the confines of our current "fee for service" healthcare system.  As new models evolve, like the Accountable Care Organizations described in the Healthcare Reform Act, we will have an opportunity to greatly improve our standards of care in this important field.