Posts Tagged ‘National Institutes of Health’

Is End-of-Life Care Worthwhile?

Monday, August 27th, 2012

Even in the age of advanced healthcare directives and living wills, Americans still must cope with a dilemma when it comes to end-of-life healthcare for themselves or their loved ones.  Consider the fact that Medicare pays as much as $55 billion annually for physician and hospital bills during the last two months of patients’ lives.  That’s more than the budget for the Department of Homeland Security, or the Department of Education.  Estimates are that 20 to 30 percent of these medical expenses usually have no meaningful impact.  The federal government pays for a majority of the bills with no questions asked.  Medicare spends nearly 30 percent of its budget on beneficiaries in their final year of life.

Given this information, the question is whether extending someone’s life is worth the money it can potentially cost.  The solution potentially could have been a snap for Congress when it passed the Patient Protection and Affordable Care Act (ACA).  Unfortunately, the previously bipartisan issue quickly became a political hot potato.

According to Dr. Ira Byock, it costs as much as $10,000 a day to maintain someone in the intensive-care unit, even if the patient remains there for weeks or even months.  “This is the way so many Americans die. Something like 18 to 20 percent of Americans spend their last days in an ICU,” Byock said.  This discussion raises the philosophical issue of the value of human life.   According to Byock, “While many people question spending a lot of money to prolong the life of an elderly, frail patient, it was perfectly logical for a frail person to value life extension as much as a perfectly healthy person.  With advances in medical care, it can be argued that the value of hope has been increasing along with the statistical odds of staying alive until a cure is found.”

Over-treatment, according to Byock, is an unfortunate side effect of medical advances.   “We have enormous scientific prowess and remarkable diagnostic and treatment,” so that when you are admitted to the hospital, the system “moves you quickly towards the next diagnosis and then the next diagnosis after that for the next component problem in a whole picture that few people will see.  It’s a dysfunctional system that feels like a conveyor belt.  We have a disease-treatment system rather than a healthcare system caring for human beings.”  Byock notes that the same system can lead doctors and patients to regard any reduction in treatment, or even accepting that patients are going to eventually die, as failure.  There are amazing ways to combat disease and extend life.  “That’s all well and good.  The problem is, we have yet to make even one person immortal,” Byock concluded.

Dana Goldman, director of the Schaeffer Center for Health Policy and Economics at the University of Southern California and founding editor of the Forum for Health Economics and Policy, has a difference approach.  According to Goldman, “We think of healthcare as an expense, but we really should be thinking of healthcare as an investment.  We want to invest where we have the greatest return. I would put prevention in that bucket.  But the way we do it now, no one has an incentive to invest in things with a long-term return.”

National Alzheimer’s Plan Launched

Monday, May 21st, 2012

President Barack Obama has thrown down the gauntlet in announcing the first National Alzheimer’s Plan, which sets a deadline of 2025 to find ways to effectively treat — or at least delay — the mind-destroying disease.  The Obama administration is laying out numerous steps the government and private partners can take over the coming years to fight what is poised to become a defining disease of the rapidly aging population.  Families and caregivers with a family member suffering from Alzheimer’s can visit a new website for information about dementia and where to get help in their own communities.

The National Institutes of Health (NIH) is funding new studies of possible therapies, including a form of insulin that is shot into the nose.  “These actions are the cornerstones of an historic effort to fight Alzheimer’s disease,” Health and Human Services Secretary Kathleen Sebelius said.

The National Alzheimer’s Plan comes as leading scientists and researchers are meeting at the NIH to debate what research needs to be prioritize to meet that 2025 deadline.  According to the researchers, the time is right to begin testing potential therapies before people have full-blown Alzheimer’s symptoms, when it may be too late to help.  “There’s a sense of optimism” as a result of some new discoveries, Dr. Francis Collins, director of the National Institutes of Health, said.  But, “we need to figure out exactly where is the best window of opportunity” to battle Alzheimer’s.  Collins noted that cardiologists don’t test cholesterol-reducing drugs on people who have advanced heart failure.

The research is being funded by grants of $16 million and $7.9 million respectively. Experts predict that unless more effective drugs are developed, the number of Americans with Alzheimer’s will double by 2050 and related healthcare costs could soar to more than $1 trillion.  Alzheimer’s affects approximately 5.1 million Americans today; current treatments address symptoms, but do not prevent the disease or halt its progression.

The 2025 goal was the subject of a long debate in the advisory council tasked with helping to write the national plan.  “We had people saying it was overly ambitious and we had people who said it wasn’t ambitious enough,” said Don Moulds, principal deputy assistant secretary for planning and evaluation at HHS.  According to Moulds, some were concerned that an earlier goal might skew research funding into treatments that might be easy hits, but not game-changing treatments.  The 2025 target was deemed to be the earliest date when an effective treatment could be found.  “It’s a huge initiative and a very ambitious step in the right direction,” Moulds said.

Researchers leading the largest clinical study ever done on Alzheimer’s disease have run into an unexpected hurdle.  With nearly 500 patients undergoing MRI scans, PET scans and even spinal taps, researchers hope to invent the first ever test to find Alzheimer’s before a patient loses any memory — or even knows there’s a problem.  “We may be able to screen and begin treatment even before any symptoms begin,” said Dr. Raymond Turner of Georgetown University Hospital, which is one of 57 centers participating in the study.

“The problem is finding volunteers to join the studies,” Turner said.  “Patients.”  The study of 750 patients is 250 patients short.  Nationally, the deficit is in the thousands, with virtually every clinical trial related to Alzheimer’s short of volunteers.  Alzheimer’s itself is part of the problem.  Patients who don’t know that they have the disease don’t know to volunteer, and patients with mild memory loss are often reluctant to participate.  The lead researcher of the imaging trial, Dr. Michael Weiner, says one answer is to recruit physicians who treat Alzheimer’s patients.  “We definitely could do a better job trying to get physicians to refer patients to our project,” Weiner said.  “The slower our trial goes, the slower the rate of progress.”

Eric J. Hall, president and CEO of the Alzheimer’s Foundation of America (AFA), “This day has been a long time coming. The release of the ‘National Plan To Address Alzheimer’s Disease’ reflects the growing impetus among the public and policymakers to act on a disease that has been in the shadows for far too long.  We commend President Obama, HHS Secretary Kathleen Sebelius and Congress for uniquely recognizing and responding to the implications of the Alzheimer’s Disease epidemic.  Recognition is essential for action, and their courage has forged enormous opportunity.

HHS To Step Up Alzheimer’s Research

Monday, April 9th, 2012

Federal officials have taken another step toward their goal of better treatment for and even prevention of Alzheimer’s disease by 2025, according to Kaiser Health News. A more comprehensive, draft version of the Obama administration’s national plan to address Alzheimer’s is now available. Experts emphasized expanding and better coordinating disease research, primarily through public-private partnerships.  They also stressed improved preparation for the healthcare workforce, enhancing public outreach and providing Alzheimer’s families with financial and other support.  To achieve these goals, President Obama proposed an additional $106 million in federal funds as part of his 2013 budget.

The Alzheimer’s advisory council provides new specifics about how the money will be used.  For example, they propose creating registries to better direct Alzheimer’s patients into clinical trials, as well as establishing a national inventory of research investments.  On the healthcare side, the council proposes working with private partners to develop evidence-based guidelines for Alzheimer’s care and establishing a national clearinghouse to publicize those recommendations.  Additionally, the council advocates that new healthcare models – such as the medical homes and accountable care organizations promoted by the Patient Protection and Affordable Care Act (ACA) – be analyzed for outcomes among Alzheimer’s patients.

The draft plan, issued by the Department of Health and Human Services (HHS), places top priority on treatment, and focuses on the burden the disease places on families and caregivers.  “Alzheimer’s burdens an increasing number of our nation’s elders and their families, and it is essential that we confront the challenge it poses to our public health,” President Barack Obama said.  The White House plans to divert an additional $50 million this year from HHS projects to Alzheimer’s research, and seeks an extra $80 million in new research funding in fiscal 2013.  “These investments will open new opportunities in Alzheimer’s disease research and jumpstart efforts to reach the 2025 goal,” according to HHS.

Eric Hall, president and chief executive of the Alzheimer’s Foundation of America and a member of the advisory council that has been working with HHS, said the draft proposal addresses many of the panel’s concerns.  “Given the current economic environment that limits much-needed resources and the scientific unknowns of this disease, we believe that defeating Alzheimer’s disease will likely happen in a series of small victories,” Hall said.  He was particularly satisfied that the plan focuses on educating healthcare providers on detecting early signs of cognitive impairment and linking newly diagnosed families with support services.

A differing perspective was offered by George Vradenburg, chairman of USAgainstAlzheimer’s and an advisory panel member, who said the draft plan does not go far enough.  “This first draft fails to present a strategy aggressive enough to achieve the goal of preventing and treating Alzheimer’s within 13 years,” he said, noting that the plan lacks specific timelines and does not hold any high-level officials accountable for meeting the plan’s goals.

More than five million Americans already have Alzheimer’s or similar dementias, a number that is expected to rise to 16 million by 2050, along with skyrocketing medical and nursing home bills, because the population is aging so rapidly.  “They’ve covered the right topics.  What is needed now is more detail,” said Alzheimer’s Association President Harry Johns.  “There’s real recognition at this point that Alzheimer’s is devastating for not only the individual but for the families and caregivers.”

Super Committee’s Failure Raises Questions About Healthcare Funding

Wednesday, December 7th, 2011

Now that the Super Committee has failed to identify $1.2 trillion in cuts from the federal budget, automatic cuts totaling billions for everything from Medicare to biomedical research, start in 2013.  Some healthcare sectors will fare better than others.  The primary health entitlement programs, Medicare and Medicaid, are protected under the law that created the Super Committee.  Automatic cuts will not impact Medicaid, the joint federal-state health program for the poor.  Medicare would be cut by two percent – all from payments to hospitals and other providers.

The bad news is that unless Congress reworks the legislation mandating the automatic cuts, a series of across-the-board reductions will begin in 2013.  The House and Senate appropriations committees must decide how to spread the cuts among various programs.  And some of the larger, better-financed lobbies may be able to influence what is cut and what is kept.

Even though the Medicare cuts are limited to hospitals and other medical providers and would not exceed two percent, they argue that is too much and that they sacrificed plenty in the Patient Protection and Affordable Care Act (ACA).  Rich Umbdenstock, president and CEO of the American Hospital Association, said sweeping cuts would hurt Medicare beneficiaries and their families and “also have an impact on the ability of hospitals to provide essential public services to the communities they serve given the impact that Medicare has on the entire healthcare system.”

Officially known as the Joint Select Committee on Deficit Reduction, the Super Committee was unable to meet its deadline to come up with $1.2 trillion of deficit reduction required by the law that created it, much less the $4 trillion that deficit hawks said was necessary to stabilize the finances of the U.S. government, whose debt has topped $15 trillion.  The failure ensures that the fiscal debate between Democrats who want to protect social programs and increase revenue by raising taxes on the wealthy; and Republicans who want smaller government and have pledged to reject tax increases will be a fundamental choice confronting voters in 2012.

“After months of hard work and intense deliberations, we have come to the conclusion today that it will not be possible to make any bipartisan agreement available to the public before the committee’s deadline,” Representative Jeb Hensarling,(R-TX), and Senator Patty Murray, (D-WA) said.  The co-chairs thanked committee members, staffers and “the American people for sharing thoughts and ideas and for providing support and good will as we worked to accomplish this difficult task.”

Writing for Politico, David Nather speculates on whether the Super Committee’s failure has harmed efforts to reform Medicare and Medicaid.  It would be easy to conclude that the Super Committee’s failure means the big, expensive health care entitlement programs — Medicare and Medicaid — are untouchable.  It also would be wrong.  The timing was off, coming too close to a presidential election.  The co-chairs weren’t powerful enough.  The work came too soon after a summer debt deal that Democrats hated.  Republicans couldn’t give the kind of concessions on taxes that Democrats needed.  And the alternative to a Super Committee deal on healthcare entitlements — the two percent automatic cuts in healthcare payments and defense funding that will now take place in 2013 — wasn’t harsh enough to force a deal on Medicare and Medicaid. In fact, it might even have been the easier way out.  All of which means Medicare and Medicaid are not off the table forever.”

The Hill’s Sam Baker offers a different perspective. “The Super Committee’s demise is a mixed bag for the American Medical Association and other groups that wanted the 12-member panel to tackle Medicare’s payment formula, known as the sustainable growth rate (SGR).  The AMA — with bipartisan support in Congress — pushed hard for the supercommittee to include in its deficit-cutting package a long-term fix to the SGR.  The formula calls for automatic annual cuts in doctors’ payments, which add up as Congress consistently delays each cut from taking effect.  Aspirations of a long-term SGR patch should be put to rest, healthcare lobbyists said. But they questioned whether the supercommittee push was ever realistic, because an SGR fix would add to the deficit.”

“I never once believed that the Joint Select Committee would be the one to do that,” said Julius Hobson, a senior adviser at the Washington, D.C.-based law firm Polsinelli Shughart and a former AMA official.

Foreclosure Is Hazardous to Your Health

Monday, November 14th, 2011

Falling behind on mortgage payments harms more than just finances; the stress and strain can negatively impact physical and psychological health.  In 2009, 2.2 percent of all American homes — more than 2.8 million — were in some stage of delinquency.  Researchers examined data collected in 2006 and 2008 on nearly 2,500 Americans who took part in the Health and Retirement Study, a nationally representative sample of Americans aged 50 and older.  The data included information about general health, psychological health, income and whether the person had fallen behind on paying their mortgage.  People who were behind between 2006 and 2008 reported more depressive symptoms, increased food insecurity and were more likely to not take prescription medications as prescribed because of the cost.

“People are making unhealthy trade-offs when they’re trying to make their mortgage,” said Dawn Alley, an assistant professor of epidemiology and public health at the University of Maryland School of Medicine.  “We think it’s a very serious issue.”  The study was published in the American Journal of Public Health.

Nearly 32 percent of people who were having difficulty paying their mortgages didn’t take medications as prescribed because of costs, compared to the five percent who were able to make their mortgage payments.  “Depression, not taking medications and not spending enough money on nutritious food can exacerbate conditions you already have,” Alley said.

Nearly one-third of the people who were mortgage-delinquent reported fair or poor health compared to 19 percent who were able to pay their mortgages on time.  “The rise in mortgage defaults may have important public health implications that could ultimately prove costly to affected individuals, employers, the healthcare system, and society,” according to the study’s authors.

More than a quarter of people in mortgage default or foreclosure are over 50,” Alley said. For an older person with chronic conditions like diabetes or hypertension, the types of health problems we saw are short-term consequences of falling behind on a mortgage that could have long-run implications for that person’s health,” Alley said.

“This study has pinpointed an issue that until now has been somewhat under the radar, but which threatens to become a major public health crisis if not addressed,” said E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine.  “Through research such as this, faculty epidemiologists and public health specialists provide valuable information and perspectives that are useful for government and private policy makers as they work to meet the health and economic needs of Americans.”

This study was co-sponsored by the National Institutes of Health and was conducted with support, resources and use of facilities from the Philadelphia Veterans Affairs Medical Center.

Another study by Janet Currie of Princeton University and Erdal Tekin of Georgia State University shows a direct relation between foreclosure rates and the health of residents in Arizona, California, Florida and New Jersey.  The researchers concluded in a paper published by the National Bureau of Economic Research that an increase of 100 foreclosures related to a 7.2 percent increase in emergency room visits and hospitalizations for hypertension, and an 8.1 percent increase for diabetes, among people in the 20 to 49 age group.

Writing in the Wall Street Journal, S. Mitra Kalita says that “Each rise of 100 foreclosures was also associated with 12 percent more visits related to anxiety in the same age category.  And the same rise in foreclosures was associated with 39 percent more visits for suicide attempts among the same group, though this still represents a small number of patients, the researchers say.  Teasing out cause and effect can be delicate, and correlation doesn’t necessarily mean foreclosures directly cause health problems.  Financial duress, among other issues, could lead to health problems — and cause foreclosures, too.  The economists didn’t find similar patterns with diseases such as cancer or elective surgeries such as hip replacement, leading them to conclude that areas with high foreclosures are seeing mostly an increase of stress-related ailments.”

Time for a Better Flu Shot

Thursday, November 10th, 2011

As the 2011 flu season gets underway, it is reported that  the vaccines given for this dreaded disease may be far less effective than thought, according to a new study.  Michael Osterholm, an infectious disease specialist at the University of Minnesota, found that the most common flu vaccine is effective for just 59 percent of healthy adults, well below the 70 percent to 90 percent level that is generally quoted.  “We’re stuck with a vaccine that has been around for 60 years and not changed much,” Osterholm said.  He stressed the need for an all-new generation of flu shots, especially in case there is a future pandemic.

“Today’s flu shot is like an iPhone 1.0,” according to Osterholm. “What we need is an iPhone 10.0.”  Scientists are presently working on a “universal flu shot” that would be effective for years.  Francis Collins, director of the National Institutes of Health (NIH), said that such a vaccine could be developed within the next five years.

Health officials recommend that all Americans over six months of age get a flu shot.  Nearly 131 million people – just 43 percent of the population — received the flu vaccine in 2010, according to the Centers for Disease Control and Prevention (CDC).

Although Osterholm does not dispute the need for the current vaccines, he said the common perception that they are “good enough” obstructs the development of improved therapies.  In a study published in The Lancet Infectious Diseases, Osterholm and his colleagues examined 5,707 vaccine studies published over the last 40 years.  They focused 31 studies that tested for the presence of flu in laboratory tests rather than counting an increase in flu antibodies — a speedier method that researchers say overestimates the vaccine’s effectiveness.  Additionally, they concentrated on results to those that used randomized controlled trials or other observational methods that did not have “selection bias,” which could lead to sicker people being excluded from the study. 

“We found a number of differences in how influenza vaccine has performed in different populations of people,” Osterholm said. Because 3,000 to 49,000 Americans die of flu every year – the number varies because the disease is not easily predictable, seasonal and pandemic – its severity differs.  In other words, flu is a unique public health problem.  Because of those variations, each year’s vaccine has some differences.  “It’s clear that what we really need is to develop new and better vaccines,” according to Osterholm.  The holy grail would be a vaccine that is effective against all varieties of flu.

The H1N1 vaccine performs slightly better than seasonal flu shots, preventing infection in 69% of adults under 65.  Nasal sprays do even better, preventing infections in 83 percent of children aged seven or less, according to The Lancet.  One study found that flu shots reduce hospitalizations by eight percent.  That is significant, however, because the flu sends about 200,000 Americans to the hospital every year.  The results should not deter people from getting vaccinated, Osterholm said.  “We have an obligation to tell the public what we know.  We know we need better vaccines.  But 59 percent protection is still better than zero.  To me, that still very much recommends getting vaccinated.”

“There isn’t any doubt that influenza vaccine is a pretty good vaccine, but it’s not an excellent vaccine, like polio or measles,” says William Schaffner, a professor at Vanderbilt University School of Medicine.  “Even in the best of times, it’s not capable of completely eliminating infections.”

By comparison, just two measles vaccines prevent about 95 percent of infections, and polio vaccines have eliminated polio in most countries.

The bottom line, is that most years, it will prevent illness, it will prevent hospitalizations, and it will prevent deaths.” But, he added, “it won’t prevent them all and it cannot eradicate influenza,” as vaccines have done for certain other diseases such as polio and measles.

The American examination could help public health planners determine how to get the most our of the vaccine while better vaccines are developed, said Dr. Scott Halperin, director of the Canadian Centre for Vaccinology in Halifax.  “A lot of research is going on in the flu vaccine field to get a better vaccine,” Halperin said.  “But having said that, you know 59 or 60 percent is still far better than zero percent.”

Andrew Pavia, M.D., who chairs the Pandemic Influenza Task Force of the Infectious Diseases Society of America, said the study confirms what is already understood about the current flu vaccine.  “Everyone agrees that we need better vaccines and we are making progress in that direction.  We have known for years that the vaccine we have does not provide a first-rate level of protection in the elderly and the very young, but it does provide protection.  It would be terrible if the message to the public was that getting vaccinated isn’t important.”  In fact, the less effective a vaccine is, the more important it is that as many people as possible are vaccinated so that those who are most vulnerable are protected.  “With a vaccine that is less than perfect, which is most of our vaccines, much of the protection comes from having widespread coverage within a community,” Pavia concluded.

Poor Education Can Lead to Alzheimer’s

Monday, August 8th, 2011

As many as 50 percent of Alzheimer’s cases worldwide could be avoided if risk factors such as depression, obesity and smoking were eliminated, either with lifestyle changes or treatment of underlying conditions.  Even modest cuts in the level of risk factors could prevent millions of cases of the memory-robbing illness, the researchers said.  As an example, a 25 percent cut in seven common risk factors – such as poor education, obesity and smoking — could prevent as many as three million Alzheimer’s cases around the world and up to half a million in the United States alone.  The new research is being presented at the Alzheimer’s Association International Conference (AAIC) and published online in The Lancet Neurology.

“The idea here is to get a better bead on exactly how we can start untangling what the risk factors are, so that we can not only treat and modify Alzheimer’s but also start talking about prevention of Alzheimer’s,” said Mark Mapstone, associate professor of neurology at the University of Rochester Medical Center.  “The field is working very hard (to figure out) what these risk factors are so we can start heading this disease off before it starts.”

Led by Deborah Barnes of the University of California San Francisco (UCSF), the researchers revisited earlier epidemiological studies on links between Alzheimer’s and seven vital risk factors: poor education, smoking, low physical activity, depression, hypertension during mid-life, obesity and diabetes.  They estimated that these risk factors account for 17 million cases of Alzheimer’s worldwide (approximately half of the estimated 34 million cases of dementia globally) and three million of the 5.3 million estimated cases in the United States.  Some factors appeared to have a greater impact on Alzheimer’s risk than others.  The UCSF team estimated that worldwide, 19 percent of Alzheimer’s cases can be attributed to low education; 14 percent to smoking; 13 percent to physical inactivity; 10 percent to depression; five percent to mid-life hypertension; 2.4 percent to diabetes; and two percent to obesity.  In the United States, more than 20 percent of cases can be traced to low physical activity; 15 percent to depression; 11 percent to smoking; eight percent to mid-life hypertension; seven percent to mid-life obesity; seven percent to low education and three percent to diabetes.

Dr. Ronald Petersen of the Mayo Clinic said the findings have important public-health implications and will help raise awareness of the need for prevention.  The study offers “an uplifting message for aging and cognition,” he said, insofar as it suggests that lifestyle factors can be modified to alter Alzheimer’s risk, at least at the societal level.  But, with the exception of increasing physical activity, there is scant evidence that interventions are successful in altering an individual’s chances of developing Alzheimer’s.

Other studies have shown that increasing physical activity is effective.  But whether taking up crossword puzzles or losing weight impacts the path of Alzheimer’s — the pathology of which seems to begin years before symptoms appear — remains unknown.  Last year, a National Institutes of Health panel concluded – with some controversy — that the scientific evidence on lifestyle factors was negligible and said that intervention is helpful.  Petersen said that, while depression is clearly associated with Alzheimer’s, the causal direction could go either way, especially when the depression comes late in life.  “Is that really a risk factor for, or a function of, the disease?” he asked.  The question is, for the most part, irrelevant from a clinical perspective because depression should be treated anyway, Petersen said.

“Education, even at a young age, starts to build your neural networks,” so being deprived of it means poorer brain development, Barnes said.

“It gives us a little bit of hope about things we could do now about the epidemic that is coming our way.”  Alzheimer’s cases are expected to triple by 2050, to approximately 106 million globally.  “What’s exciting is that this suggests that some very simple lifestyle changes, such as increasing physical activity and quitting smoking, could have a tremendous impact on preventing Alzheimer’s and other dementias in the United States and worldwide,” Dr Barnes said.

The study could be good news for people – usually family members – who are caregivers for individuals with Alzheimer’s. “Throughout the progression, I felt quite helpless…without any cure for (Alzheimer’s disease) yet, I could only watch,” said Rick Lauber, who acted as caregiver to his father, John, who developed the disease in his 60s and died at age 76.  As his father’s caregiver, Lauber had to take on unexpected responsibilities, such as moving him three times, taking him to doctor’s appointments, paying bills and becoming his father’s Joint Guardian and Alternate Trustee.  “As an adult child and a family caregiver, caring for Dad had to one of the hardest things imaginable,” Rick Lauber said.  “Watching him decline from a healthy, active, respected academic to a shell of a man was very challenging.  Dad was changing before my eyes and I could not do anything about this.”

According to the 2011 annual Facts and Figures release from the Alzheimer’s Association, nearly 15 million Americans provide 17 billion hours of unpaid care worth $202 billion every year.

This blog is dedicated to the memory of William A. Alter, the founder of our company who passed away August 8, 2008 of complications of Alzheimer’s disease.  To read about Bill Alter’s amazing career, please click here.

Revised Alzheimer’s Guidelines Help Us Catch It In Time

Wednesday, May 4th, 2011

Will revised guidelines for Alzheimer’s disease diagnosis help physicians identify the illness sooner than was previously possible?  For the first time in 30 years, scientists have created guidelines to advance the diagnosis of Alzheimer’s disease and help doctors identify the earliest signs of the degenerative condition, even before memory loss begins with the goal of helping patients prepare early, and eventually treat, the disease.

The National Institute on Aging/Alzheimer’s Association Diagnostic Guidelines for Alzheimer’s Disease outline new approaches and give scientists more advanced instructions for moving forward with research on diagnosis and treatments.  The revised guidelines also have the potential to more than double the number of people being diagnosed with Alzheimer’s in a given year.  “The new guidelines reflect today’s understanding on how key changes in the brain lead to Alzheimer’s disease, said Creighton Phelps of the National Institute of Health’s (NIH) National Institute on Aging.

Writing in Time, Alice Park says that “Currently, Alzheimer’s disease can be definitively diagnosed only at autopsy, when pathologists can confirm the presence of protein plaques and tangles in the brain of a patient who has shown signs of memory loss and cognitive deficits.  The new guidelines tease apart three different stages of the disease that are meant to help doctors better identify affected patients while they are alive.  The phases also reflect the latest research, which suggests that Alzheimer’s develops in the brain over a long period of time — perhaps years or even decades before the first cognitive deficits are noticeable.”

Approximately 5.4 million Americans have Alzheimer’s, which dims memory and other cognitive abilities.  People with Alzheimer’s can undergo dramatic personality changes and ultimately are confused, unable to take care of themselves or recognize family members.  An aging population equals more Alzheimer’s cases.  This has made it more important for scientists to develop early diagnosis and treatment tools, as well means to distinguish Alzheimer’s from other types of dementia.  “At this time, we don’t know enough to be able to advise patients properly about what their risk for later dementia might be,” said John C. Morris of the Washington University School of Medicine.  “Even if we do determine what that risk might be, we don’t have treatment to reduce that risk.”

In 1984, Alzheimer’s was diagnosed based on a single symptom – dementia. The updated guidelines reflect a more advanced understanding of the disease: Alzheimer’s can begin as many as 10 years before signs of dementia.  For clinicians, the guidelines reflect how many doctors already diagnose the disease.  For example, memory isn’t always the initial casualty; vision, literary skills and speech can decline while memory remains intact.  Although Alzheimer’s is unusual in people younger than 40, the disease progresses in the same way as a 90-year-old.  Testing for mutations in three genes can determine whether a patient has early onset of Alzheimer’s (though 10 related genes are known).

According to the new guidelines, Alzheimer’s is recognized as a continuum of stages: Alzheimer’s itself with clear symptoms; mild cognitive impairment (MCI) with mild symptoms; and also the “preclinical” stage, when there are no symptoms but when recognizable brain changes may already be occurring.  Additionally, the revised guidelines use what are known as biomarkers – as an example, the levels of certain proteins in blood or spinal fluid — to diagnose the disease and measure its progress.  “It will not change practice,” said Dr. Guy M. McKhann, one of the guideline authors.

Older adults with this impairment progress to dementia at a higher rate than those with no impairment, but progression is not inevitable,” according to the Alzheimer’s Association. “Not everyone diagnosed with MCI goes on to develop Alzheimer’s,” the association noted.

According to William Thies, chief medical and scientific officer of the Alzheimer’s Association, the new guidelines “will result in little change in current clinical practice of medicine as applied to Alzheimer’s disease.  The new criteria are really extending the range of our ability to investigate this disease and eventually to find treatments that will be so necessary to avoid the epidemic of Alzheimer’s that we see facing us.”

Healthcare Reform Promotes Breast Cancer Awareness Among Younger Women

Wednesday, October 13th, 2010

New healthcare law provides grants to help breast cancer patients aged 15 to 44. One little-discussed provision in the healthcare reform law is designed to increase awareness of breast cancer risk in young women aged 15 to 44.   Under the law, the Centers for Disease Control and Prevention will create educational campaigns to focus on breast cancer risk in young women and to promote prevention and early detection  Additionally, the law provides grants to groups that help young women with breast cancer, and directs the National Institutes of Health to develop new screening tests aimed at enhancing early detection.  The law provides $9 million for these efforts on a yearly basis between 2010 and 2014.

Just 10 percent of the approximately 250,000 women who are diagnosed with breast cancer annually are aged 45 or younger, according to the American Cancer Society.  Breast cancer tends to be more aggressive in younger women, with an 83 percent five-year survival rate, compared with 90 percent for women older than 45.  The lower survival rate for younger breast cancer patients is partly due to deferred diagnoses and a lack of screening because of the low incidence.  Mammograms of younger women’s breasts can be hard to read because the tissue is often too dense to be evaluated effectively by X-ray.

The advocacy group Young Survival Coalition encourages women to act quickly if they notice a change in their breasts.  “Be familiar with the look, feel and shape of your breasts, so that if something develops you’re aware of it,” said Stacy Lewis, the group’s vice president of programming.  “If you see a change, go see a doctor, and if you’re told that it’s probably nothing, go to another provider.”

The healthcare reform law’s most significant provisions related to breast cancer in younger women may be those that encourage research.  Because screening women before age 40 isn’t always practical, identifying young women who are at risk is vital, said Dr. Therese Bevers, medical director of the cancer prevention center at the MD Anderson Cancer Center at the University of Texas in Houston.  “We’ve got to have a way of picking out the right young women,” she said. “Otherwise we’ll miss cases.”