ARTICLE IN BRIEF
At the first G8 summit on the theme of Alzheimer's disease (AD), world leaders and AD experts discussed the need for global efforts and national plans to support research on AD therapies.
The success of the campaign to conquer Alzheimer's disease (AD), which was announced at the G8 Dementia Summit in London on Dec. 11, will depend on vast infusions of money, researchers agree.
“By the middle of this century, if nothing is done, we'll have three times the number of people with Alzheimer's disease — and that by itself could bankrupt the health care system,” said Ronald C. Petersen, MD, PhD, the Cadieux director of the Mayo Alzheimer's Disease Research Center and the Mayo Clinic Study of Aging in Rochester, MN. “We cannot afford to say we'll increase funding for research when we have the luxury to do so. The cost to individuals, families, and societies is catastrophic now, so it's either pay now or pay later.”
Indeed, attendees noted that AD was the first disorder to be included as an agenda item on the G8 meeting since the 2005 meeting focused on HIV and AIDS. [The G8 summit includes representatives from the US, Canada, France, Germany, Italy, Japan, Russia, and the United Kingdom.]
Dr. Petersen attended the G8 Dementia Summit and heard British Prime Minister David Cameron announce that the Medical Research Council (MRC) of Great Britain would spend £150 million ($245 million) more on clinical infrastructure and genomics in addition to its other G8 commitments. The Prime Minister also described other private investments that would stimulate Alzheimer's research in the UK. “I want Dec. 11, 2013 to go down as the day that the global fight-back (against Alzheimer's) began,” the Prime Minister said.
THE US NATIONAL PLAN
Since 2011, Dr. Petersen has served as the chair of the Advisory Council on Research, Care, and Services, which, as mandated by the National Alzheimer's Project Act (NAPA), advises Secretary of Health and Human Services (HHS) Kathleen Sebelius on the development of a national plan.
[Notes, slide presentations, and video feeds from the last meetings of the advisory council in December are available here: http://1.usa.gov/1eCGvmL.]
“Our continuing task will be to look at the plan each year and revise it,” Dr. Petersen said. “Part of the plan emphasizes the importance of public and private partnerships. This is a national plan, not a federal plan, and as such it is not just the responsibility of the federal government. It's a responsibility of the federal government and the private sector, which means that pharmaceutical and device companies, and advocacy organizations such as the Alzheimer's Association, all need to collaborate.”
Dr. Petersen has suggested that all G8 member nations develop a similar plan. In the December issue of The Lancet, he made that appeal in a commentary co-authored with Nick C. Fox, MD, professor of neurology and MRC senior clinical fellow at the Institute of Neurology at the University College London, and co-chair of the Research Advisory Committee of the Alzheimer's Society.
“Each country needs to take a look at its own situation,” Dr. Petersen said. “Only about 13 countries out of the 194 countries in the World Health Organization have national plans (for fighting Alzheimer's disease), and yet this may be the defining disease of our generation for developed and developing countries.”
The Lancet commentary also recommended that each country commit to Alzheimer's research 1 percent of what it already spends caring for people with the disease.
“In this country, we spend over $200 billion a year caring for people with Alzheimer's, two-thirds of which comes from the federal government,” Dr. Petersen said. “One percent would equate to about $2 billion for research. Yet this country spends only $500 million on Alzheimer's research. One of the Advisory Council's first recommendations was to increase that funding to $2 billion.”
In comparison, the National Cancer Institute has spent an average of $4.9 billion per year on cancer research for the past six years, while the NIH has invested about $2.2 billion on heart disease, stroke, and other cardiovascular diseases.
Committing to spend 1 percent of what they already spend on treating and caring for Alzheimer's patients would be the most important immediate action that nations could take, Dr. Petersen said. “I think more realistically, internationally coordinated research efforts to establish large ‘readiness’ cohorts — groups of individuals who have indicated they are willing to participate in research, and have provided some basic information about themselves would be critical to this effort. Several large cohorts already exist, and I think we need to produce an international inventory of existing studies and assess their common data elements. That way, countries can share knowledge about approaches to the underlying etiology. Many countries are moving toward electronic records that lend themselves to data mining. That alone would help facilitate research.”
Collaboration among nations also would provide a boost in terms of sharing knowledge about the disease, according to Dr. Petersen.
“There's still a lot we don't know about Alzheimer's disease,” he said. “While amyloid plaques and tau tangles are involved, other pathologies no doubt contribute. Countries can share knowledge about approaches to the underlying etiology, share data, and create readiness cohorts.”
The fight against Alzheimer's already has produced cooperation among several nations, according to Michael W. Weiner, MD, principal Investigator of the Alzheimer's Disease Neuroimaging Initiative (ADNI).
“We already have the World Wide ADNI,” said Dr. Weiner, director of the Center for Imaging of Neurodegenerative Disease and a professor of medicine, radiology, psychiatry, and neurology at the University of California, San Francisco. “It involves ADNI in North America, Europe, Japan, Australia, Korea, Taiwan, Argentina, and Brazil. The Chinese are talking about joining too. We meet every year at the Alzheimer's International Congress, and have teleconferences four times a year. There's lots of interaction, lots of sharing of data.”
ADNI, launched in 2003, is a public-private partnership created and managed by the Alzheimer's Association that develops biomarkers for Alzheimer's disease. World Wide ADNI also has created uniform protocols so that participants will produce the same test results, which are freely shared among researchers.
Dr. Weiner agrees that ADNI provides an obvious model of cooperation for G8 member nations, but he believes the success of the project depends largely on sufficient funding.
“I think the biggest limitation to developing effective treatments for Alzheimer's disease is money,” he said. “There's no lack of cooperation among people. There's a very positive spirit among investigators — a lot of good will and sharing of information. I think if countries in the G8 come forward and provide more funding for Alzheimer's disease research, that would be fantastic, but I certainly don't see any signs of increased funding for Alzheimer's research in the United States.”
Dr. Weiner cited a speech given recently by Richard J. Hodes, MD, director of the National Institute on Aging (NIA), who said that NIA funding has declined by more than 20 percent over the past decade.
“An inflationary 3 percent a year increase would have produced a 15 percent increase,” Dr. Weiner said. “Instead they saw a 20 percent decrease, which I take as a 35 percent decrease from what we could have expected if we didn't have a Congress unwilling to spend money on NIH-funded research. I don't think the problem is a lack of people willing to work together. I think the problem is money to do the research we want to do.”
Dr. Hodes acknowledges that funding is indeed a challenge in the US, and cites the recent comments by Francis Collins, MD, PhD, the director of the National Institutes of Health, who warns of “deep long-term damage” to biomedical research in the US as a result of budget cuts that have reduced the percentage of successful grant applications by 50 percent in a decade.
But despite such funding woes, Dr. Hodes believes the G8 Dementia Summit may spur ongoing efforts in this country. For example, in May 2012, the NIH and HHS held an Alzheimer's Disease Research Summit, which brought researchers together to plan strategies. The result was an implementation strategy for the National Plan to Address Alzheimer's Disease.
A similar effort on the part of G8 nations is likely to bolster such efforts.
[The NIA and the Alzheimer's Association have developed an online database, the International Alzheimer's Disease Research Portfolio, which lists publicly available research funding projects for AD in the US and abroad: iadrp.nia.nih.gov.]
“Alzheimer's disease is a complex disorder, and collaboration and sharing of data and samples on an international scale is crucial, especially in light of constrained budgets,” he said. “Five years ago, there was only one known genetic risk factor — apolipoprotein E4. Now, the number of known genetic risk factors is more than 20. This was done by combining the efforts of many nations and developing the massive numbers needed to identify these new genetic risk factors. No one country was able to do this alone.”