Lo AW, Ho C, Cummings J, Kosik KS.
Parallel discovery of Alzheimer's therapeutics.
Sci Transl Med. 2014 Jun 18;6(241):241cm5.
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These are personal views of the author and do not necessarily reflect the views of the LEAD Coalition or its member organizations.
I am neither a scientist nor an economist but, based on nearly two decades working in dementia advocacy and policy (and nearly three decades as a voter, taxpayer, and person whose family and friends have experienced dementia's devastation), I am certain that Dr. Lo is spot-on about the urgency of the dementia health crisis, the economic and budgetary toll it imposes, the need for more research targets, the value of parallel discovery, and the opportunities for public-private partnerships. In fact, when I first heard Dr. Lo present an early version of his proposals last autumn, I was deeply encouraged by the visionary business case. I am equally certain that merely being right about all those perspectives may not be enough to cause change to occur. Decision-makers—especially those in government—need to be persuaded that the challenges and opportunities are identified properly just to get the conversation started. Decision-makers still must weigh investing their energy and resources in one set of issues against many others, assessing values such as: likelihood of success and consequences of failure, availability and prioritization of necessary resources now and over time, opportunity costs, and the risks of unintended and often unexpected consequences. If all that wasn't daunting enough to inspire decision-makers into paralysis, many also have to contend with being second-guessed by colleagues, constituents, and investors, particularly when the time-horizon to success is lengthy and almost invariably uncertain. Elected officials in particular often have long memories about the vulnerabilities in their profession and the "what have you done for me lately" syndrome among voters; members of Congress remember Speaker Foley's defeat two decades ago and will remember Majority Leader Cantor's recent defeat two decades from now. So, nearly everything for far too long has favored inaction against enormous, complicated, protracted catastrophes like dementia.
Fortunately, albeit much later than would have been wise, the tide may be beginning to turn. Precisely because dementia has become so much more prevalent over the past two decades—arguably, at least in part due to decision-makers' inertia—many more decision-makers are feeling the consequences personally as friends, colleagues, and loved ones are diagnosed or become caregivers for someone diagnosed with Alzheimer's disease or a related dementing condition. Decision-makers in government and the private sector also are beginning to recognize the budgetary and economic imperatives to bend dementia's unsustainable and downright crippling cost curve. We may now be at the dawn of a period in which decision-makers are more afraid of dementia's status quo and projected trajectory than of the panoply of risks involved with driving changes such as those proposed by Dr. Lo.
The relatively small and heroic cadre of government and private-sector decision-maker visionaries and risk-takers upon whom dementia advocates have relied for decades may be soon joined by a wave of new allies more willing and more committed than ever before to bringing game-changing innovation to dementia science, care, and support. Over the past three years in particular, the signs have been mostly positive. A unanimous Congress passed the National Alzheimer's Project Act; the Obama administration led development of (and is working aggressively to implement) the National Plan to Address Alzheimer's Disease, the first goal of which is to effectively treat and prevent Alzheimer's disease by 2025; the FDA issued its transformative “Guidance for Industry, Alzheimer’s Disease: Developing Drugs for the Treatment of Early Stage Disease”; NIH Director Dr. Francis Collins used his authority to boost Alzheimer's research funding, which otherwise would have been severely eroded by the sequester; the public-private Accelerating Medicines Partnership was launched to fast-track pivotal research and data sharing essential to the dementia drug discovery field as a whole; the 2014 omnibus budget bill included historic increases in Alzheimer's research funding; and the December 2013 G8 Dementia Summit appears to have begun to crack open the door to meaningful international collaboration in addressing dementia science, care, and support. Perhaps next through the door will be decision-makers prepared to act on Dr. Lo's prescription for revolutionizing the landscape of dementia science.