John O'Connor
John O’Connor

If you are in the senior living business, dementia care is probably something you spend a fair amount of time thinking about.

And no dementia-related development this year had been bigger than the Food and Drug Administration’s recent decision to approve aducanumab (Aduhelm) as an Alzheimer’s treatment.

In some ways, the FDA’s action is understandable. After all, 6 million people in this country have Alzheimer’s and related dementias. Any option that can help slow or eliminate its spread certainly deserves serious consideration.

Still, there are some aspects of this go-ahead that I find troubling. First, the data used to get the drug approved are sketchy at best. Drug firms should be in the business of selling cures, not hope. The best that can be said about this medication right now is that we hope it works.

Then there is the sticker price: $56,000 a year per patient, or possibly more than $56 billion a year all in. Those are some staggering numbers.

Although I found those realities annoying, Judith Graham convinced me that a better response to the drug’s approval might be outrage.

In case you are unfamiliar with Ms. Graham, she writes an excellent, twice-monthly column on aging and health for Kaiser Health News.

In her most recent piece, she asked several experts how the money that soon could be spent on Aduhelm might be put to better use elsewhere.

The replies, to say the least, were thought-provoking. Among the recommendations:

  • Strengthening eldercare by bolstering the number of direct care workers in skilled care, assisted living residential facilities and other settings.
  • Helping people age in place by funding things such as home renovations and assistive devices.
  • Encouraging lifestyle changes that can delay or prevent the onset of dementia. Nudges here include more responsible alcohol consumption, controlling blood pressure and obesity, managing depression, using hearing aids, smoking cessation, regular exercise, social interactions and spending more time on cognitively stimulating activities.
  • Making a greater investment in social determinants of health, including transportation services, safe housing food and programs that target social isolation.

Those are just the greatest hits. There are a few more excellent ideas in her piece as well.

To be clear, I am not against the development of drugs that target Alzheimer’s. Frankly, I wish a lot more research was being done here.

But what we have with Aduhelm is a dubious option that carries a huge cost. Considering some of the alternatives, I’m far from convinced that bankrupting Medicare for the sake of this medication would be money well spent.

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