A colleague sent me the link for a Washington Post article titled, “Risk of dementia is declining, but scientists don’t know why.” It is inspired by another article published in the New England Journal of Medicine, “Is Dementia in Decline? Historical Trends and Future Trajectories.”
Essentially, the NEJM article presents good news and bad news. To this, I’ll add worse news.
The good news is that the risk of getting Alzheimer’s disease (AD) or some other form of dementia has gone down a little. The bad news is that the incidence and cost of dementia are still going up. This isn’t a contradiction—people live longer, so the aged population continues to grow and dementia increases, albeit a little more slowly.
The worse news is that we can’t afford this growing population of the demented. Despite slight reductions in risk, the Alzheimer’s Association predicts that the cost of AD will reach $1.1 trillion by 2050.
Let’s put this in context.
Last year’s federal budget was officially $3.9 trillion. Hopefully, you are aware that the US government borrows almost a third of our annual budget and has amassed a nearly $20 trillion debt, not counting unfunded future liabilities.
Presidential candidates promise to spend even more money. This is theoretically possible if taxes are raised high enough to increase spending and begin paying off the debt. While this sounds simple and attractive to many, it would further slow our already stalled economy by draining the private sector of the resources needed to innovate and create the jobs that generate taxes.
Since we’re already maxing out the national credit card, it will be even more difficult to cover the healthcare costs for a huge number of older people with dementia… unless the economy grows. The economy is slow today, however; partly because the dependency ratio (contributors to dependents) continues to worsen.
In plain English, the number of the older sick and retired (the dependents) is skyrocketing while the number of young people (the contributors) entering the workforce is not.
Already, about 30% of government spending goes to cover transfer payments to the aged. Because a static or shrinking workforce is expected to fund Social Security, Medicare and other entitlements for older people, the problem will continue to escalate as the aged population increases. Eventually—unless we solve the medical problems that shorten people’s health spans—the entire system collapses.
You may think I’m exaggerating, and I wish I were. I’m not.
I am, by the way, somewhat puzzled by the NEJM article. It lists a number of risk factors for dementia but omits any mention of the biggest preventable contributor to dementia: smoking.
I know some of the world’s top Alzheimer’s researchers, and they all agree that smoking dramatically increases the likelihood of dementia, probably more than any other single factor.
The Washington Post’s assertion that scientists don’t know why individual risk has decreased in recent years is true only in the strict sense of peer-reviewed science. That means nobody has done the expensive, time-consuming work necessary to prove that slightly reduced rates of dementia correlate to the fact that the number of smokers in the US today has been cut in half from the early 1970s. The following Gallup chart shows this trend clearly.
Like the scientists referred to in the Washington Post article, I can’t “know” that the recent slight reduction in dementia risk is the result of fewer people smoking… but it’s the result of fewer people smoking.
This is actually pretty good news, despite the fact that we don’t have the peer-reviewed data. In fact, it’s very good news because getting this kind of data is now easier than ever due to revolutions in genomics, digital healthcare records, and mobile health applications.
When it first became possible to sequence an individual’s entire genome, it generated a lot of headlines. The lack of media coverage today doesn’t mean the potential of this revolutionary science is not being fulfilled. Behind the scenes, genomicists are making remarkable discoveries about the nearly infinite factors that interact with our genomes.
I don’t know how many people have had their genomes sequenced at this point, though that is not really relevant. A sequenced genome is of use to scientists only if it is associated with actual patient medical records. They can then connect the dots between specific genetic characteristics, medical conditions, and extraneous factors such as smoking that activate genetic weaknesses. In fact, some chain smokers have the genetic capacity to live more than a 100 years while others will get lung cancer from even occasional smoking. The combination of genomic and medical information lets us pinpoint personal risk factors.
Even better are genomes matched to constantly updated longitudinal electronic medical records, which allows bioinformaticians to correlate environmental influences, from smoking and exercise regimens to drug and supplement use, in real time.
It’s difficult to overstate the importance of these new tools. Until very recently, medicine was based on the disease model for the imaginary statistically average person. Even if a drug candidate produced a miracle cure for 90% of test subjects in clinical trials, it would be rejected if the remaining 10% experienced severe side effects.
This made sense in the old days when we couldn’t determine the genetic differences that cause people to react differently to the same drug. Today, we are entering the era of personalized medicine, allowing us to link specific drug treatments with specific genotypes. The consequences will be enormous.
In a similar vein, we will also be able to clear up the incredible confusion surrounding diet and supplements. I write a lot about nutritional discoveries, but it always bothers me when I recommend something because we know that genetics influences response. Some supplements may be beneficial for most people, but useless or even dangerous for others.
Recently, I’ve been talking to a group of scientists who have spent millions of dollars and many years developing in-silico computer tools that create avatars of patients based on their individual genomes and medical records.
Using artificial intelligence, they test vast numbers of hypothetical drug combinations and treatments for a variety of serious diseases on patients’ avatars. Work that would take years if done by humans is done in seconds by a massively parallel array of computers. Already, this process seems to produce superior prescription recommendations, allowing doctors to dramatically improve treatment outcomes.
But that’s not all. Soon, we will move beyond the disease model and into anti-aging therapeutics. Then these bioinformatics tools will become even more important. Based on your genome, electronic medical records, and information gathered from millions of other people tracking their own conditions via mHealth technologies, AIs will be able to develop regimens of drugs, supplements, and behaviors that will dramatically extend your health span.
This bioinformatics revolution will significantly forestall or prevent the diseases of aging, including dementia. It will also repair the dependency ratio, promoting the economic growth needed to pay off this generation’s profligacy.
If you want to read more in-depth analysis of the coming anti-aging revolution—and get my top stock recommendations in this booming biotech sector—give my monthly newsletter, Transformational Tech Alert, a risk-free try today.
Editor, Transformational Technology Alert
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