Radical new thinking in the field of Alzheimer's study holds out the hope that literally millions of Baby Boomers could be diagnosed and possibly treated before the disease's devastation takes effect. While this is good news for middle-aged Americans, it's even better news for certain medical-industry companies, which stand to reap significant profits. Unfortunately, though, the byzantine public-private system of health insurance in this country means that insurers aren't likely to spend a penny on these potentially lifesaving actions.
Experts from the National Institute on Aging and the Alzheimer's Association recently proposed significant changes to the diagnostic criteria for Alzheimer's disease, advocating for a sweeping expansion of the way the disease is characterized. The dementia phase is our current criteria, so we're trying to identify people who have the biology in an earlier clinical phase," says Dr. Ronald Petersen, director of the Mayo Alzheimer's Disease Research Center in Rochester, Minn.
In other words, Alzheimer's is diagnosed now only after dementia has struck, and it takes an autopsy confirming the presence of distinctive plaques in the brain to draw a definite conclusion. The two panels want to use what are called biomarkers to identify patients before irreversible cognitive impairment sets in, with the hope that brain damage can be halted before full-blown dementia sets in.
Petersen says this could open up the pool of potential patients significantly. In a study of adults over 70-years-old, 10% already had dementia, but an additional 15% had what researchers termed "mild cognitive impairment." This second group of patients are the ones who would likely be classified as having pre-symptomatic dementia under the new diagnostic guidelines. in a New York Times article about the panel recommendations, the number of potential patients was estimated to increase two or even threefold.
This translates to a potential windfall for a few specific types of health care industry companies. First, scientists have identified a few kinds of biomarkers as potentially illuminating. Some, such as spinal taps, are invasive. Others, like PET scans, hold promise because they could literally give doctors a picture of what's happening in the brain. PET scans are better than CTs or MRIs at showing pockets of memory-robbing plaque in the brain. The brains of those who have succumbed to Alzheimer's often are riddled with plaque, and many scientists think that identifying plaques before dementia manifests could be a key step in warding off the loss of mental awareness.
According to Antonio Garcia, research manager of the medical imaging practice at consulting firm Frost & Sullivan, manufacturers of PET scan machines had recently fallen on hard times due to changes in Medicare reimbursement rates that lowered the amount the government would reimburse a facility that performed a PET scan. New criteria that could identify Alzheimer's based on brain changes detectable only by PET scan would increase demand for the service (and, by extension, the machines). Worried baby boomers - especially those with a family history of Alzheimer's - would want doctors to keep a close eye on their aging brains.
Unfortunately, though, Americans face the prospect of paying out of pocket for such scans, at least until the methodology and its results become mainstream knowledge. " People eventually will gt to the place where they'll demand to have a PET scan if they think they have a risk of developing Alzheimer's," Garcia told WalletPop in a phone interview. "People will expect it as a standard of care."
Health insurance companies are likely to display a similar reluctance to underwrite the cost of drugs that are currently used to treat Alzheimer's for pre-dementia patients. Some scientists think that the limited effectiveness of today's crop of Alzheimer's drugs is due to the fact that patients start them too late, after irreversible brain damage has already taken place. Using tools like PET scans to see who's developing plaques might give them an opportunity to give those patients drugs before their cognitive function becomes impaired. "Those therapies do delay progression so there's potential they could exhibit a greater benefit earlier. I think there'd be a big push for that," says Misty Hughes, research analyst at Frost & Sullivan. It's a good theory, but it's still just a theory at this point -- which means Americans will be forced to dig into their own pockets if they want to try this avenue of preventative medicine.
Les Funtleyder, portfolio manager at investment firm Miller Tabak, is another expert who thinks pharma companies will benefit from an expansion of the diagnostic criteria. "It would almost certainly have the impact of expanding the existing market for drugs," he says. "Some people will take proactive measures, justified or not," he says. He cites the "scary reputation" of Alzheimer's as the reason why people would be willing to take drugs even if their effectiveness is not yet proven.
One piece of good news is that the top Alzheimer's drug, which currently goes by the brand name Aricept, comes off patent by the end of the year, which would make it easier for people to pay out of pocket for the drug. In general, Hughes says, within four years of a drug going generic, 90 percent of users are on the cut-rate version. Pharmaceutical companies are hard at work creating other versions of this drug, such as a patch (similar to a nicotine patch) and a time-released version, for which they could still charge top dollar. If one of these turns out to be significantly more effective, this could significantly boost the fortunes of the company that makes it, just as the cholesterol drug Lipitor contributes significantly to manufacturer Pfizer's bottom line.
Again, though, getting health insurers to cover such name-brand drugs will be an uphill battle. Even if one or more drugs is eventually proven to be successful at preventing dementia, insurers probably won't want to pay, says Sherman Moore, partner at consulting firm Kurt Salmon Associates. The reason has to do with our public-private system of health insurance. By the time most Americans develop Alzheimer's, they're covered by Medicare.
From a strictly financial standpoint, Moore explained in a phone interview with WalletPop, it wouldn't make sense for a private insurance company to keep you healthy if you're just going to switch over to Medicare in a few years anyway. They don't need to pay for preventative care, because chances are that by the time you get the full-blown disease, you'll be the government's problem. "Medicare beneficiaries who have Alzheimer's are around three times more expensive, so rationale to provide preventative care from a public health perspective is clear," he says. From the economic perspective of health insurance companies, though, there's no benefit.
While it's possible for Congress to legislate a solution, Moore says that would require the kind of unified voting more typically associated with the AARP, not their boomer-age siblings. If Boomers were to demand better coverage of Alzheimer's diagnosis and treatment, their sheer numbers would be a factor in their favor. For the message to resonate -- and for any meaningful change to take place -- Boomer-aged Americans would have to present a united front to lawmakers.
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