Maria Shriver asks: Why is Alzheimer's Disease so underfunded? Echoing her late uncle, John F. Kennedy, she calls for a "moon shot" solution to AD.

Maria Shriver has a vision that can truly be called John Kennedy-eseque: She wants to see a cure for Alzheimer's Disease (AD). 

She has been all over the news in the last couple of days, talking about malady  that took the life of her father, R. Sargent Shriver, and also the lives of many others--and many more in the decades ahead, as we Baby Boomers age.  

Tonight Shriver was a guest of Diane Sawyer on "ABC World News," alongside Dr. Richard Besser, who has distinguished himself with his serious and determined coverage of medical issues--and his skepticism of government rationing schemes.   Shriver made the point that AD receives just a fraction of the funding that goes to cancer and heart disease--see screen grab above.  She raises a good point: Why is AD so under-funded?   

When Sawyer asked about AD funding, here's the way Shriver answered:

It's six billion dollars to cancer, four billion to cancer, five hundred million for Alzheimer's.  I think we're sitting at s is an incredibly exciting point in our history.  We can launch an expedition on the brain, much like President Kennedy launched an expedition to the moon.  And we can galvanize all our best researchers and scientists, to uncover the secrets of the brain, to Huntington's, to Parkinson's . . . We've never done that as a nation.  We've  got to find a cure to this disease, otherwise it will bankrupt every family in this country, and it will bankrupt as a nation.

Exactly.  So why aren't we doing more?  A cure--or even better treatment--would save money, for us as individuals, and for us as a nation.   And AD progress could be the key to solving the entitlement crisis, if it were linked to raising the retirement age, as argued here at SMS back in June.  

We can only admire Shriver for her determination and vision, but we can also note that such an effort is obviously good politics.   Good health is at the basis of all ideologies and belief systems.  From left to right, from blue to red, from socialist to tea partier, everyone wants to be healthy.  And so the voters, across the ideological spectrum, stand ready to reward the politicians who help them find a better life and a dignified old age.  

Health vs. Health Insurance: How Mental Silos Blind Us to What Matters Most in Healthcare.

The Drudge Report today linked to an AP story on the spread of cutaneous leishmaniasis, the incidence of which has quadrupled in the past few years.   The parasitic skin disease comes from the female phlebotomine sand fly. There is treatment, but treatment is expensive, and of course, in Afghanistan it can be dangerous to be a caregiver.

It's tragic that this disease is afflicting Afghans, and it will be even more tragic if the disease spreads.  Once again, a reminder: The public health victories of one era can be lost in a subsequent era.

And so once again, we are reminded, health itself is more important than healthcare finance.  As it happens, I am reading Rebecca Costa's new book, The Watchman's Rattle: Thinking Our Way Out of Extinction, in which the author talks about the problem of "silos"--mental walls that keep us from thinking outside of our lane.  More often than not, these silos are self-imposed, and yet even though they are "voluntary," they can be paralyzing, intellectually.

And that's what has happened to the US in the healthcare debate.  We have "healthcare finance" in one silo, and that's been the hot silo for decades.  And in the other silo, we have Serious Medicine, which has been much neglected over the same period.   There is little interchange between the two.

Yet a look at this boy's face should tell us which is is the ultimately more important silo.

"Nemesis" by Philip Roth, recalls the scourge of polio before the vaccine

Philip Roth has written a new novel, Nemesis, about a polio epidemic in Newark, NJ back in 1944.  In the absence of a cure or vaccine--the polio vaccine was 11 years away--Roth's work is necessarily about suffering and stoicism, as opposed to a cure.  

Review Roth's half-century in American letters, New York Times reviewer Michiko Kakutani, recalling one of Roth's most famous books, observes, "Whereas 'Portnoy’s Complaint' was an outrageously comic tale about the throwing off of duty, 'Nemesis' is a pleasantly told parable about the embrace of conscience." 

Read an excerpt here.

The Nancy Brinker Ethos: "When you see someone in need, you give. When you see something wrong, you fix it."

Those words appear in Nancy Brinker's new book, Promise Me: How a Sister's Love Launched the Global Movement to End Breast Cancer, reviewed in The Washington Post this morning.   Brinker, the founder of the Susan G. Komen for the Cure, recalls the words of her mother: "When you see someone in need, you give.  When you see something wrong, you fix it."

Susan G. Komen died of breast cancer in 1980, still in her 30s.  Ever since, her sister, Nancy Brinker, has been a dynamo on behalf of fighting breast cancer.  Not just paying for its treatment, but seeking to fix it.  That is, seeking a cure.

The Hebrew words tikkun olam don't mean provide care for the world, they means heal the world.

What do Wounded Warriors with Traumatic Brain Injury now need most? Answer: Serious Medicine--More Serious Medicine.

Startling--and also inspiring--photos of Wounded Warrior Robert Warren appearing in The Washington Post this morning.   The photos accompany a long and detailed article by Christian Davenport, explaining the issue of traumatic brain injury. As the photo above makes clear, Robert Warren received horrible injuries from a rocket attack in Afghanistan, and his recovery will be long, difficult, and incomplete--not only was part of his skull and brain blown away in the explosion, but a piece of shrapnel remains embedded in his cranium.

It's fair to say that up until not long ago, a soldier with Warren's injuries would have died on the battlefield, or, if he had survived, would not be able to resume much of his previous life.   Once again, the variable is Serious Medicine.  But we shouldn't stop with what we have. We own it to Warren, and his family, to go further.  If we really wanted to, we could be working to regenerate his brain tissue, and heal the rest of his numerous injuries.  That would be a great and noble healthcare project.

Federal healthcare rationers called out: ABC News' Dr. Richard Besser repudiates government's breast screening recommendations. And why the government will undoubtedly try to ration care in the future.

Last night on "ABC World News," Diane Sawyer and Dr. Richard Besser delivered a tough critique of those breast-screening guidelines that the federal government pushed late last year.   The ABC report was plenty tough, leading the broadcast, but still not tough enough, because while Sawyer and Dr. Besser refuted the government's effort to ration breast-screening, they didn't go further and tell us why the government wants to ration such care--and why even after this rebuke, the government will likely try again.

Sawyer began: "Less than a year ago, you'll remember a government panel said women do not need regular mammograms till the age of 50."  Now, she continued, a new study of one million Swedish women found that "mammograms in your 40s can dramatically save lives from breast cancer."

Then she turned over the segment to Dr. Besser, who added that he sent the Swedish study to 24 doctors and cancer specialists around the country; 21 of them, he said, were already telling their patients just that--get checked regularly in your 40s, don't wait till age 50.   Besser added that the screenings could cut deaths from breast cancer by 26 percent; saving the life of 1 out of every 1200 women screened.   He concluded, "Today's study flies in the face of those controversial government recommendations last year when a panel found mammograms for women under 50 should be an individual decision, rather than a general recommendation."

OK, so scientific recommendations come, and scientific recommendations go.  That's the flux of science, as scientists push toward the best answer.  Right?  Actually, no.

The original recommendation from a government panel, the US Preventive Services Task Force, which came to light on November 16, 2009, should not be seen as a scientific recommendation--they were a political recommendation, aimed at giving the Obama administration, and the overall cause of healthcare rationing, a boost.   We're spending too much on healthcare, the larger argument went, and besides, much of our healthcare spending is counterproductive--so why don't we spend less and call it a win-win?

Those recommendations caused such a firestorm last year that they were withdrawn--or where they?  In a bureaucracy, nothing ever dies. Bureaucrats wishing to advance a particular position might have to make a tactical retreat every so often, but they never give up.

So the original finding should not be seen as an isolated incident.  There will be more.  The bean counters and rationers--here at Serious Medicine we call them Scarcitarians--will be back.  They have not in any way given up in their efforts to define American healthcare downward.

But there is hope, if the people are made aware of their own interests.   And the media, too.  Interestingly, while the politics of the Mainstream Media are firmly on the side of the Obamacare rationers, the ratings eyeballs are to be found on the opposite side of the argument--the Serious Medicine side.  People want to know about how they can stay alive, and they will reward TV networks that help them in that perfectly understandable goal.  It's real people, after all, who consume all the medical information in the larger culture; it's only a few policy wonks who think just the opposite--that people should have less information, and less access to care, pursuing, as they do, their "less is more" vision.

They are less interested in saving the government money in the shortest of short runs.  In the long run, of course, we would be better off, financially as well as medically, if breast cancer were reduced and then eliminated.

"Health Care: Booster Shot For Jobs"

“Health Care: Booster Shot for Jobs?” is the title of a new post by Michael P. Scott, an associate with the Denver-based urban consulting firm Centro, appearing in NewGeography.com.  I agree with everything about Scott’s title--except the question mark.  As his piece makes clear, healthcare is a booster shot for jobs. 

Scott starts with a paradox: Why it is that cities and their economic-development officials so often ignore the bird in the hand (the palpable reality that lots of people work in healthcare) in favor of the more speculative, perhaps even non-existent bird in the bush (the jobs to be found by luring in tourist attractions).  As Scott puts it: 

The local medical center complex is often the largest employer in town, it would seem that strong fiscal returns would be rewarded to those cities that strategically aligned their economic development efforts to capitalize on growing this sector. Unfortunately, the health industry has historically been viewed as a local disaster, replete with quality of care issues, bureaucratic inefficiencies and high costs.

As noted here many times at SMS, the dominant policy classes in Washington and New York, plus satellite nodes in Cambridge, San Francisco and elsewhere, have concluded that economic growth is great--but not in healthcare.  In healthcare, as we know, we have to “bend the curve” downward.  To be sure, these “Scarcitarian” elites wrap up their arguments in statistics,  but as far as I can tell, this is basically an aesthetic judgement these elites are making: we spend too much, and so we should spend less.    

But of course, aesthetics often makes for poor economics.   In this case, it means that the policy elites wish to provoke a recession in the healthcare sector even as they seek to “stimulate” the economy out of the recession.  Given that healthcare is one-sixth of the economy, it’s a challenge to shrink such a huge component while seeking to enlarge the overall whole; and, as we have seen, policymakers have not been very successful in this hit-the-healthcare brake-while-hitting-the-macro-accelerator approach.    


But the mantra of cutting healthcare, no matter what the cost, has been heavily programmed into these policymakers, so they keep going, and going, and going, even when they are no longer making policy.

Typical of this persistence is a recent post from Peter Orszag, the former director of the Office of Management and Budget in the Obama administration until last month.  Just a few days ago, he published a blog-post for The New York Times, in which he linked cuts in healthcare to not only the cause of deficit reduction, but also to increases in take-home pay and even improvement in public education:  

Containing health care costs is not just an abstraction central to addressing our long-term fiscal gap. It is also central to raising workers’ take-home pay, because increasing costs for health care are holding down wages.   And perhaps most unexpectedly, slowing the growth of health costs may be among the best things we can do to help the next generation attend a high-quality public college.

But as Scott laments in his post: 

Little attention is given to health care jobs as springboards to enliven local and regional economies. The steady parade of doctors, nurses, technicians and support staff at our medical establishments provide cities with a huge multiplier effect on nearby housing, restaurants and retail businesses. The trickle-down effect spreads outward to hospital manufacturers, suppliers, pharmaceutical companies, and other ancillary firms that serve as the lifeblood of a functioning health care system. The economic activity of the medical business extends well beyond hospital walls; it's a high-octane job engine, with the buying power of health professionals helping to sustain struggling communities.

But unfortunately, as Scott describes, cities with big healthcare complexes ignore those healthcare complexes, the bird in the hand, in favor of speculative new stadiums and museums.  As Scott describes the situation in Cleveland:

Cleveland, Ohio, is a prime example of a city that has undermined its economic potential by permitting dubious redevelopment efforts – centered on sports complexes and museums – to overshadow assets such as the Cleveland Clinic and the University Hospitals Health System, which together encompass 51,000 employees.

Like most Rust Belt cities, Cleveland sorely needs an infusion of jobs outside of the long diminished blue collar sector. It could build collaboratively on its health care niche, creating complementary clusters of medically related firms in the life sciences and health information systems that would bring new opportunities and life to the area. The city's world-class medical establishments could supply the ideal springboard for branding Cleveland as a global medical hub, rather than as the home of the Cleveland Cavaliers and the Rock and Roll Hall of Fame museum.

One Cleveland-area organization, BioEnterprise, is taking the lead in fueling the growth and commercialization of health care companies in the bioscience sector. A collaborative effort between top medical and higher education institutions in the region, BioEnterprise is a promising attempt to alleviate Cleveland's persistent difficulties in generating jobs and economic growth.

Scott further notes that these are good jobs at good wages; nationwide, the average salary is $43,000.   And Scott describes efforts to use health care as an economic engine in cities as different aOakland, Sacramento, and Spokane.  He concludes:

When cities and regions choose to create synergies between their communities and their medical campuses, the prognosis is promising for an economic cure.

And oh, by the way, in addition to the economic benefits of healthcare, there are other benefits, too, that one can’t get from another urban galleria.