How Alzheimer's and Diabetes Will Force Healthcare Transformation

For well over a century, the great story of medicine has largely been about developing drugs that treat and cure illness, even wiping out some of humankind's deadliest and most widespread diseases. A thriving global pharmaceutical industry has been an essential ingredient in this ongoing triumph, taking insights from both basic researchers and clinicians and converting them into drugs.

But as a recent Politico article explores at some length, medicine's and pharma's long streak of churning out new drugs that treat the diseases most burdensome to society has been winding down. The article, written by my friend and sometime colleague David H. Freedman, puts it this way:

....As America looks squarely at the biggest health challenges of the future, there’s reason to worry that the system we’ve built may not be adequate to what’s in front of us. When it comes to the two diseases likely to become our biggest killers—Alzheimer's and diabetes—death rates are relentlessly ticking up, with few solutions on the horizon. Even more alarming, to many experts who look at America’s long-term health future, is that incentives appear to be leading toward more drugs [that are] pricey treatments for small groups of patients, rather than toward drugs to tackle major new chronic killers. And if they ever do succeed against these diseases, the costs could be high enough to threaten the solvency of the whole U.S. healthcare system.

A big part of the problem is that pharma and all of medicine have been so successful at attacking infectious disease, once the single biggest disease risk facing humans. But with infectious disease mostly tamed, chronic diseases have come to the fore as our biggest killers and quality-of-life reducers. Fortunately, medicine has made great progress against heart disease and many types of cancer, thanks largely to heart-disease drugs like statins and to chemotherapy agents. But that same progress has remained elusive when it comes to the more aggressive cancers, and especially for Alzheimer's and diabetes.

The difficult-to-treat cancers are starting to yield bit by bit in the face of new, super-high-tech drugs that can home in on specific genetic characteristics. But the results are usually very expensive drugs--they can run into the many thousands of dollars per month--that work on only a small percentage of patients with a specific cancer.

The picture is even worse for diabetes, where our current blood-sugar-level controlling drugs have mostly failed to provide good long-term outcomes for the disease. And it's worse yet for Alzheimer's, for which there are currently no effective drugs, and none in sight that are seen as good bets. The likely impact of this shortfall on the population, and on the healthcare system, can't be overestimated. As the Politico article notes:

More than 5 million Americans suffer from Alzheimer's; 1 out of 3 of us will eventually end up with Alzheimer's or other dementia. Diabetes is a close second on the increasingly worrisome list. The numbers are expected to grow steeply as the population ages—exacting costs not only on patients, but on a health care system and families carrying the burden of long-term chronic care. As you'd expect, researchers, government funders and pharma companies have tried coming up with new drugs to respond to this growing threat, but aren’t finding answers. In a 2017 report from industry-research service EvaluatePharma, of the 20 most promising future drugs approaching the market, none are aimed at Alzheimer's. The only one that addresses diabetes is a longer-lasting version of an existing drug.

As a hospital executive, I can't do much about the grim prospects for effective treatments for Alzheimer's and diabetes except hope for the best. But what I can do is push for a vision of how healthcare needs to remake itself in order to face the big changes we're facing as the burden of disease increases. What won't work is continuing to operate on a model that expects patients to show up at hospitals and doctors’ offices to have their advanced problems treated--we by and large no longer have good treatments for some of the diseases that most threaten us.

What will work is for healthcare to push itself out into communities, homes and workplaces in order to help people prevent, slow and manage chronic diseases. That means influencing lifestyles to get people to have the healthier habits that have in study after study proven effective in reducing the risks of the major chronic diseases. And it means monitoring patients frequently and on an ongoing basis to spot early signs of problems, when there may be hope of interventions that at least head off the need for later hospitalization.

I join everyone else in keeping my fingers crossed that pharma--in collaboration with basic researchers and clinicians--will somehow come up with the big breakthroughs in drugs that tame Alzheimer's, diabetes, the tougher forms of cancer, and other diseases that so far have been difficult to treat effectively. But I also hope that the healthcare industry won't maintain the status quo while we wait for those breakthroughs, which may well be decades away. We can make great strides against these diseases right now if we start making the big changes needed to foster prevention and the earliest possible types of interventions.

Here's hoping we'll make progress to that end in 2018.