Wednesday, June 2, 2010

Thinking About Deficits, Debt--and Alzheimer's.

"A Family’s Torment as Relatives Slip Away" -- that's the grim headline atop Pam Belluck's series of scary pieces in The New York Times, describing the plight of people developing Alzheimer's Disease (AD) in their 40s. That's right--in their 40s.

Belluck's reporting took her to the Latin American country of Colombia, where scientists think that an unfortunate combination of genetics--and perhaps some inbreeding in an isolated rural area--might be the cause of these extreme cases of early-onset AD.

But the problem is far larger than that--and much closer to home, as the above photo, showing Laura Mercer, of Charlotte, reminds us.   She developed AD at age 46.   Politicos will remember, for example, former South Carolina Governor Carroll A. Campbell, a rising star within the GOP, thought to be presidential or vice presidential timber, was diagnosed with Alzheimer's at age 61, and died at age 65 in 2005.  

As the Times' Belluck observes, little has improved over the past five years:

Alzheimer’s has repeatedly resisted attempts to treat it. Current drugs, for people who are already impaired, show little benefit. Now scientists want to attack earlier. New findings show “the brain is badly damaged by the time they have dementia,” said Dr. John C. Morris, an Alzheimer’s researcher at Washington University in St. Louis. “Perhaps the reason our therapies have been ineffective or mostly ineffective is that we’re administering them too late.”
 With Alzheimer’s afflicting 5.3 million Americans and 30 million people worldwide, numbers that some predict will double or triple by 2050, “we can’t wait to try to do prevention until we are absolutely certain what causes” the disease, said Neil Buckholtz, chief of dementias of aging at the National Institute on Aging. “This public health emergency,” he said, is “just going to get out of control if we don’t do something.”

By coincidence the June issue of Scientific American also features an article on Alzheimer's, "Alzheimer's: Forestalling the Darkness." (subscription required, alas)   In this piece, author Gary Stix draws upon some of the same medical history from Colombia as Belluck, but notes as well that here in the US, the number of Alzheimer's cases is projected to swell, from 5.3 million in 2010 to 7.9 million in 2030, with future increases far beyond that.   And Stix, too, reports that curative and preventive strategies for Alzheimer's are minimal-to-non-existent: "Current drugs treat cognitive symptoms only, not the underlying disease process, and work for a limited time, from months to a few years."

In other words, Buckholtz, of the National Institute on Aging, was correct in telling the Times: AD is, indeed, a "public health emergency."

And if it's a public health emergency, then it stands to reason that we should be doing everything we can to stop AD.   But are we?

The answer is no.  To be sure, we are spending on AD, but nobody thinks that AD research is one of the top 50 priorities of the current federal government. We are being told, these days, that we must reduce the deficit and thus the national debt--after, of course, we wrap up on the BP oil spill.

But let's talk about priorities here.  Is reducing the deficit really a higher priority than keeping our population healthy?   Is that your priority?  Should it be a top national priority?

The Peterson Foundation, to name one blue-chip entity, says "yes."  It says that we are on a "unsustainable path,"and is spending a billion dollars to advance that argument in the public square.   Reacting in large part to pressure from the Peterson Foundation and others, President Obama, earlier this year, announced a deficit-reduction commission.   This commission may or may not have any real effect on the deficit and debt, but it has already won the heart of the DC Establishment--the editorial and op-ed page of The Washington Post.

But are the deficit and debt really an urgent problem right now?   Is red ink really a more problem facing the country than Alzheimer's?   The argument about deficit and debt usually boils down to interest rates--the sign of unmanageable spending being rising interest rates.  But in fact, interest rates are headed down, not up.    

According to the Federal Reserve, 30-year T-bills are at 4 percent, the lowest in decades.  The Wall Street Journal reports that mortgage rates are near 50-year lows -- about 4.8 percent.   The reality of today is that the world is awash in capital, and that it has to go somewhere.  And the US, despite all its problems, still seems like a better bet than just about anywhere else in the world.   Nobody, for example, has much confidence in the Euro.  Thus, the money keeps flowing in to the US, and interest rates here stay low.

These points about the deficit and interest reates are not an argument for spending per se, and they certainly are not an argument for spending on foolish things, or wasteful things.  By any measure of "return on investment," much of what the government--federal, state, and local--does is incompetent, even wasteful and fraudulent.    And so such spending should be pruned back and cut.

But spending on health and medicine that improves our lives does not fall into that category.  Yes, there are spending boondoggles in the medical sphere, but there's also a record of profound improvements in our healthcare system, thanks to medical advance--from smallpox to polio to AIDS.    It's hard to imagine what our collective lives would be like if we still had to worry about mass epidemics of any of those diseases.   It's safe to bet that nobody suffering from smallpox, polio, or AIDS puts deficit reduction as his or her top priority.  

If we had a cure for Alzheimer's--or even significant relief, in terms of delaying its onset--we would be making a major contribution to our own well-being, and to the possible extension of our working career--including a possible extension of the retirement age--but in addition, we would have created a medicine that we could sell to the world.  (We could also give it away, if we wanted to, for humanitarian reasons.)

For those sorts of expenditures, we could issue bonds.   And it doesn't look to me that interest rates would be adversely affected, especially as the benefits came into view.

But wait a second--aren't medical entitlement programs careening out of control?  Isn't spending itself an issue, beyond even the issue of interest rates?

Well, let's take a closer look at medical spending.   According to the 2009 Trustees Report on the Status of Social Security and Medicare, Medicare spending is currently less than four percent of Gross Domestic Product, and will not even so much as doubled, to eight percent, by 2040.  See chart below, reproduced from the Trustees Report; the blue line is Social Security, the red line is Medicare:

As we can see, Social Security, as a percentage of GDP, peaks at a little over six percent in 2030, and then actually declines a little bit.   Thats a lot of money being spent, but it's not a crisis, except to those who don't think we should have Social Security.   Now let's look at the red line, Medicare: It is currently less than four percent of GDP, and does not reach eight percent until around 2040.  We can say that Medicare spending is a problem--a threat, even--but we can't say that it's an immediate crisis.   My colleague at the New America Foundation, Michael Lind, calls it a "pseudo-crisis."

Why?  Because a lot can happen in 30 years.  Thirty years ago, nobody except a few scientists had ever heard of the Internet.  Thirty years before that, only a handful of people had ever flown on a jet airplane. Thirty years before that, nobody had ever heard a commercial radio broadcast.  Thirty years before that, nobody, except for Karl Benz and a few of his industrial colleagues, had ever ridden in automobile.  A lot can change in 30 years--everything can change.

We might just consider some of the recent news reports from the world of medicine, as distinct from "healthcare policy."  Just within the last month, Craig Venter announced that he had synthesized life.  We can debate the ethics of what Venter did, but we can't debate the impact.

And as noted here at Serious Medicine--and everywhere else--just a few days ago, we have just received from promising news about a possible vaccine for breast cancer.  Interestingly, last night on his "Countdown" show, MSNBC's Keith Olbermann featured the leader of this effort, Dr. Vincent Tuohy, of the Cleveland Clinic Lerner Research Institute, who said that a vaccine would be "a great way to lower healthcare costs."  And, of course, Dr. Tuohy is exactly right about that.   Prevention is cheaper than treatment, and a vaccine is the surest path to prevention.

And, by the way, vaccines and prevention are popular.  People will pay for such things, and they will vote for such things.  Introducing the segment Olbermann explained to the audience that one reason he cares so much about breast cancer is that his own mother died of the disease.

And to borrow a phrase, we ain't seen nothing yet.   The same issue of Scientific American offers a cover-story glimpse of things to come. (It, too, is behind a pay wall.)

The headline is "12 Events That Will Change Everything," as the editors of Sciam say, some or all of these events might occur, "completely transforming societies."   The list includes some events over which we have no control, such as a big earthquake or alien contact, but lists others that are at least partially within our control, such as a deadly pandemic or an asteroid hit  (in both cases, the survival of millions, maybe billions, depends on our being willing and able to take steps to protect lives.)   And some among the dozen events are completely within our control, such as fusion energy (regarded as "almost certain" by Sciam), room-temperature superconductors, and human cloning (regarded as "less certain," by the way).

By all means, let's have an open and transparent debate about these and other "change everything" events, but let's undertand at least this much: If and when even some of these events do transpire, they will change everything.  And by comparison, even the largest American deficit will look like small potatoes.

1 comment:

  1. Yes, back in the ‘60s I met a Colombian with it. He was 43. I had thought you needed to be in your 80s like my grand pa to get it. Not so!

    Dr. John C. Morris is right on as you cited his opinion. And with the baby boomers coming up, Neil Buckholtz is correct: “This (is a) public health emergency.”

    We need better diagnosis for Alzheimer's Disease (AD). It’s one of the most difficult to pin down.
    Our priority should be to assume all who will live long enough will get AD and work for a vaccine or gene modifier to fix the problem like we are working towards cancer and coronary cures.

    God knows it does run in families, mine ..... and a lot!
    Jim, I would prefer to die from anything else than not know what planet I am on! Or my wife, or daughter or son or their spouses or my grand kids names.

    My Aunt Betty had it in the last 8 years of her life. I was her “Administrator.” She died of CHF. The old age home in the Bronx was run by Orthodox Jews. They took care of her like they were nuns, God bless them. I use to visit her; but, since she didn’t know me; I wouldn’t stay for a long time.
    There was this one time though, and I am crying as I write, that in the middle of our visit Betty became as sane as you or I. For a period of about 2 minutes she was totally aware of her situation. It was one of the saddest, cruelest moments I have ever known a human being to have.

    There are a lot of fancy names for these fogs of old age. I think the kindest description comes from my Irish background. We just say they are doting. The word covers a lot of ground without getting bogged down in the science.

    I am glad you have hi lighted this ever increasing storm that will visit us over the next 30 years.