Aricept

One night in late June, I sat down to read U.S. News & World Report, expecting to read half the issue. Instead, I read one article four times.

My paternal grandmother died more than three decades ago. She had Alzheimer's. Although we know more about it today, and it has become pharmaceutically treatable in early stages, the disease remains unpreventable and incurable. Many of us with aging parents have an up-close-and-personal relationship with dementia-related diseases. Some of us speculate on whether we are tomorrow's victims. Some of us will be.

The article described the Mini Mental State Examination, a commonly used, no-tech memory test that physicians administer to patients to begin assessment for Alzheimer's. The problem is that the test takes 10 minutes. That exceeds the length of the average PCP appointment by two to four minutes, so most physicians are unlikely to administer it. The answer, proclaimed this article, is that researchers have developed three other, equally no-tech test vehicles that take but five minutes or less to administer.

Estimates are that approximately 3 million victims of Alzheimer's cost the U.S. about $50 billion annually to treat and care for, averaging out at $16,667 per person per year. All of those researchable metrics seem to be lowball estimates by my personal calculations and are the tip of the iceberg.

A 2003 MetLife data analysis puts the U.S. baby boomer population at 77,702,865. By 2030, boomers will be ages 66 to 84 and will constitute 20 percent of the U.S. population. If even 5 percent of them are dementia candidates, that's 3,885,143 people who will be afflicted, some beginning tomorrow and many within 10 years.

Legislators in Washington are posturing to put $4 billion on the table so providers can buy, lease, upgrade and implement IT systems. It sounds like a lot. We do our victory dance and publicly herald healthcare IT as an idea whose time finally has arrived at the funding table. If another $4 billion were used to pay for a 10-minute dementia test for 3,885,143 people, the cost would be about $1,000 per person per test. At today's prices, that would provide a dementia patient with considerably less than a year's supply of Aricept.

I'm a huge proponent of EHRs, of funded mandates and of nationwide IT integration, although it takes but a few depressing statistics to dislodge me from my soapbox. I can have diagnostic images of my knee taken here in Florida, sent to a nighthawk radiologist in India and have his diagnosis back to my physician in 24 hours. You can have implanted into your arm a chip containing a sizable chunk of personal health information. Legislators can volley to loosen $4 billion from government coffers so providers can buy, lease and upgrade IT systems to participate in a nationwide network of electronic interoperability. But 3.8 million baby boomers can't receive a 10-minute memory test from their PCPs because 10 minutes is longer than the average doctor's appointment. They can remain at risk for losing two, five, 10 or more years of their lives to a hideous disease, for the sake of five minutes of physicians' time.

What's wrong with this picture? Perhaps we have designed a cart, skipped entirely over the horse and are trying to hitch it directly to a jet engine.

COPYRIGHT 2005 Nelson Publishing
COPYRIGHT 2005 Gale Group