A new study by the RAND Corporation projects that the cumulative costs of caring for people with dementia could be as high as $215 billion annually in the United States, exceeding the costs of heart disease and cancer.
The RAND study, published in the venerable New England Journal of Medicine, estimates that by 2040, these costs will nearly double.
RAND's research is the latest addition to the growing body of evidence that shows Alzheimer's is poised to become the fiscal nightmare of the 21st century. Perhaps most notably, RAND's work confirms the World Health Organization's bold statement a year ago in which they claimed that Alzheimer's was a "public health priority." The WHO, to be sure, doesn't use this language lightly.
The RAND study also validates the U.S.'s recent launch of its "national plan" to defeat Alzheimer's. And it adds some much-needed vigor to the debate about just how much Alzheimer's will cost. RAND's estimates are lower than those of the Alzheimer's Association, but both organizations agree that costs are shooting straight up.
But a debate about the expenses of Alzheimer's is welcome. Disagreement will attract attention, and for too long Alzheimer's has been relegated to the "back burner."
But there's also a dirty little secret revealed by the RAND study: Alzheimer's is about the children. They're the ones who will have to pay for it. It will no longer be possible -- ethics aside -- to hide behind the fallacy: "Oh, well, they're just getting old and..."
The numbers of Alzheimer's patients will be too overwhelming. What the RAND study tells us, more than anything, is that we must de-link aging and Alzheimer's.
For decades, our budget debates have pitted "guns against butter." But if we allow Alzheimer's to continue to be considered "natural" part of the aging process, it is going to consume so much national and global spending that soon budgetary battles will pit "butter against butter." At upwards of $56,000 of spending per year per dementia patient, and with a 1 in 8 chance of getting dementia after the age of 65 (and a 1 in 2.5 chance after 85), the fiscal balance sheets of the future will be consumed by Alzheimer's caregiving costs.
What can be done today with dementia so it doesn't become the kids' burden?
Number 1: We need to do for dementia what we did for HIV/AIDS. The great lesson from the HIV/AIDS outbreak is that moral outrage, political pressure, and self-interest can spur research and development efforts. In just two decades, HIV/AIDS transformed from a certain death sentence into a manageable condition.
Even though Alzheimer's has a number of notoriously difficult hurdles to clear -- de-stigmatizing early diagnosis, greater understanding even of its basic science -- HIV/AIDS sets the model for success. We must recognize that Alzheimer's is not a natural part of aging, and we must be outraged that we're not doing more to combat it. Then, we can begin to mount the political pressure to generate more funding to find better therapies.
Number 2: We should engage in intense global conversation about dementia, and we should demand the creation of a Global Fund. President Obama has recently pledged $100 million to the BRAIN Initiative to support technologies to map the brain. Across the pond, even in their beleaguered financial state, the Dutch government is going to announce a €200 million investment in research and care improvements - because it will save them €3 billion in future costs.
This is a start. But it's not enough. Other events must be leveraged to intensify the debate.
In June, the OECD will host an Expert Consultation aimed at "unlocking global collaboration to accelerate innovation for Alzheimer's Disease and Dementia" in conjunction with the Global Coalition on Aging and Harris Manchester College at Oxford University. The question there will be how to use "big data" to solve Alzheimer's.
At this year's Milken Conference in Los Angeles, a session on Alzheimer's has been scheduled by the newly formed CEO Initiative, an organization of private-sector leaders who have joined together to provide business leadership to the fight against Alzheimer's.
It is exactly these kinds of events that must spark global dialogue and passion.
Over the generations, RAND has been an intellectual catalyst for big social and economic changes on topics from the environment to nuclear arms control. This could be the biggest of them all. Not least for the children who can live in a world where we no longer accept that Alzheimer's is a natural consequence of aging.
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