Alzheimer’s drug has Wall Street excited, but some researchers are still skeptical

We ought not be surprised that the Wall Street Journal went all-in with its gush-y reporting about lecanemab, the Alzheimer’s drug from Biogen that has shown promise in clinical trials where other drugs of the same class have failed. Investors are drooling.

The reversal in investor sentiment is nothing short of massive. After so many drugs targeting amyloids had failed in clinical trials in recent years, there was growing skepticism of the “amyloid hypothesis,” the idea that targeting an unusual buildup of the protein in patients’ brains should slow dementia.

The results released Tuesday were unequivocal though. The drug reduced cognitive and functional decline by 27%, compared with a placebo. The data, which haven’t yet been published in a peer-reviewed medical journal, hit all of the trial’s primary and secondary endpoints, with many analysts calling it a best-case scenario. Importantly, while the drug did show safety concerns such as brain swelling, it looked safer than other candidates now making their way through clinical trials, wrote Michael Yee of Jefferies.

The positive data make it likely that the Food and Drug Administration will grant Biogen accelerated approval in January, with full approval coming later next year. The bigger question for investors, patients and society is what the Centers for Medicare and Medicaid Services will do. Biogen’s last approved drug for the disease, Aduhelm, received the FDA nod, but CMS effectively killed its commercial prospects by restricting it due to lack of meaningful improvement in health outcomes.

Biogen’s Aduhelm is the first approved treatment for early stage Alzheimer’s patients that may be able to slow the disease. WSJ explains how the drug interacts with brain cells, and why some doctors aren’t ready to prescribe it yet.

This time will be different, with CMS unlikely to “dig in and refuse coverage” due to the highly successful clinical data, wrote Brian Skorney at Baird. With about 2 million Americans suffering from early-stage Alzheimer’s, the costs to the insurance program could be meaningful, leading to higher healthcare costs for most seniors. Just Tuesday, CMS had announced that premiums and deductibles would be declining next year due to lower-than-projected spending on Aduhelm specifically. Now, the government might find itself paying for another pricey Alzheimer’s drug instead.

Just how pricey will be another important question. Biogen has probably learned some hard lessons from the backlash it got to the Aduhelm launch at $56,000 a year, so expect it to price lecanemab at closer to $20,000.

Still, the costs—and the payoff for investors—are likely to be astronomical.

That last part really jumped out at me. They could cut the annual price by almost 2/3 and still make ungodly profits. That shows you how much money big Pharma makes when nobody is keeping tabs on the price they are charging.

And, as Caitlin Owens article in Axios notes:

Some in the research community continue to question the focus on anti-amyloid cures and say success fighting Alzheimer’s will come in combination therapies like those used for heart disease, cancer and hypertension.

“Amyloid-clearing drugs will provide an incremental benefit at best and there is still a pressing need for the next generation of drugs focused on other targets based on our knowledge of the biology of aging,” said Howard Fillit, co-founder and chief science officer of the Alzheimer’s Drug Discovery Foundation.

This is a nightmare scenario for Medicare: an expensive drug of limited benefit that will mean higher premiums for millions of Americans.

More adult grandchildren are choosing to live with their grandparents as roommates

The New York Times has an article up noting what some see as a definite trend: adult grandchildren living with their grandparents:

Grandchildren and grandparents have their own discrete needs. The grandchildren, still in school or in low-paying, entry-level jobs are looking for deeply affordable housing with very tolerant landlords. The grandparents — not as young as they once were — may be contending with decreased mobility, health challenges and isolation.

Further, both sides of the age divide come to the table armed with their own skill sets. The grandchildren can demystify smartphones, Twitter and paying bills online. “They get to feel useful in the relationship. They can help the person they love,” Dr. Saltz said. In turn, their grandparents can share family lore and recipes, give the grandchildren a sense of their roots — and a sense of perspective.

Those in their early 20s don’t have the experience to know that life will go on, “and older adults can provide that context,” Ms. Butts said. “We’ve survived disasters before. We’ve survived diseases before. We’ve survived recessions before.”

Mr. Elson and Ms. David, 25, shared a home office and, occasionally, meals. When her grandparents decamped for a few weeks to their condo in Stuart, Fla., Ms. David sorted the mail and flagged the utility bills. “I came from living with three friends in a rowhouse in Washington, D.C., to living with people who were a lot older,” she said. “Different energy, right?”

Yes, but good energy. “I feel very fortunate and grateful to have had that housing option,” Ms. David said.

“The idea of young adults living with grandparents really solves a lot of social issues,” said Rachel Margolis, an associate professor of sociology at the University of Western Ontario in Canada who studies the demography of grand-parenthood. “Most older adults want to age in place, and they need help to do so.”

June Iseman, 90, shares quarters on the Upper East Side with her granddaughter Ally Iseman. “My granddaughter moving in with me means I’m not alone,” she said. “Even though she sleeps until 11 and goes to work at noon, the fact is, she’s here. Because I’m not 100 percent OK in terms of my health, that’s a good thing.”

The article adds that living with grandparents, sometimes as the sole parental figure, has been much more widespread among many children of color for a very long time.

Gov’t task force recommends wide U.S. screening for anxiety disorders

In a first, a government panel recommends all adults under 65 be screen regularly for anxiety disorders.

Adults under the age of 65 should be screened for anxiety disorders and all adults should be checked for depression, a government-backed panel said, as many Americans report symptoms of these mental-health conditions following the height of the Covid-19 pandemic.

The draft guidance released Tuesday marks the first time that the United States Preventive Services Task Force has made a recommendation on screening adults for anxiety disorders. The move comes months after the task force issued similar draft guidance for children and adolescents.

“This is a really important step forward,” said Arthur C. Evans, chief executive at the American Psychological Association. “Screening for mental-health conditions is critical to our ability to help people at the earliest possible moment.”

The task force said that there wasn’t enough evidence on whether or not screening all adults without signs or symptoms ultimately helps prevent suicide. The group didn’t recommend for or against screening for suicide risk, but called for more research in the area.

The task force, a panel of 16 independent volunteer experts, issues guidance on preventive-care measures. Health insurers are often required to cover services recommended by the task force under a provision in the Affordable Care Act.

More than 30% of adults reported having symptoms of an anxiety disorder or depressive disorder this summer, according to estimates from the federal Household Pulse Survey. The percentage of U.S. adults who received mental-health treatment within the past 12 months increased to 22% in 2021, up from 19% in 2019, according to the Centers for Disease Control and Prevention.

Mental-health screening often occurs in doctor’s offices, where patients fill out questionnaires during routine checkups or other appointments. The goal is to spot at-risk people who might not be showing obvious signs, so that the person can get the correct diagnosis and potentially get connected to care before they reach a crisis point.

As for people over 65, the article notes that “some anxiety-disorder screening questionnaires emphasize issues with sleep, pain and fatigue, which also often increase with age.” So screening older adults for those risk factors might turn up a lot of older people who are, you know, just regular old, tired and creaky.

It does strike me that they ought to come up with different a different screening regimen for older people, rather than just deciding to not issue screening recommendations as all.

Nursing homes are tossing onto the street those patients who cut too much into their bottom line

Have you ever heard of the term “facility-initiated discharges”?

I had not until I read this article in The Bulwark by Bill Lueders, writing about his mother:

Last fall, my then-97-year-old mother, Elaine Benz, was evicted from the senior living facility known as the Regency, in New Berlin, Wisconsin, where she had lived for ten years. My sister, Diane, was told on Thursday, October 28, that our mom would not be allowed to return the following morning, as planned, from a physical rehabilitation center to which she had been sent following a fall. The Regency had decided her needs had gotten too great.

It was a staffer at the rehab center and not someone from the Regency—officially ProHealth Regency Care Communities New Berlin—who broke this news to Diane. As she recalls, the staffer told her that the Regency would turn Elaine “away at the doors” if the center tried sending her back. We needed to find her a new place to live.

That’s it! That’s all it took. The facility looked for any excuse to get his mother out the door. Once out the door, they just refused to let her back in.

A 97-year-old woman!

Lueders has had to become an expert regarding this common practice as he fights to protect his mother:

But in general, I learned, there is nothing unusual about it. What happened to my mother happens to elderly people in America all the time. A facility will conclude that a patient has become too much work or is no longer a good deal financially and find a way to get rid of her. Often, as with Elaine, nursing homes and other senior care facilities evict residents while they are temporarily moved to another facility.

Nicole Shannon, a frontline attorney for the Michigan Elder Justice Initiative, told me how this sometimes works: “The nursing home will say, ‘Well, it sure seems like you need a psychiatric consult, we’re gonna send you to the hospital.’ The hospital turns around and says, ‘You know, this person does not require psychiatric care. You can go back to your nursing home now,’ and the nursing home says ‘Nope, no thanks, you’re no longer welcome here.’”

Shannon’s group has seen cases in which nursing home residents have had discharges approved for transfers to a homeless shelter, to the home of an unwilling relative, to a house that no longer existed because it had burned down, and to an apartment the person no longer rented.

On November 18, the day after we found a new place for Elaine to live, the Office of Inspector General for the U.S. Department of Health and Human Services released a forty-page report on problems regarding “facility-initiated discharges.” It noted that “discharge/eviction” was from 2013 to 2019 the single most frequent complaint recorded by the federal Long-Term Care Ombudsman Program, which operates in all fifty states and the District of Columbia.

The report says that several of the ombudsmen surveyed “volunteered that nursing homes have said that they would rather accept a deficiency or enforcement penalty than keep the resident.” Other ombudsmen “opined that stronger enforcement actions could help to reduce these discharges.”

I cannot imagine being 97 years old and essentially being told that, while you were at some bogus pretext appointment somewhere, we’ve locked you out of your home and, good luck, whatever the state can do to us is nothing compared to what it costs us to keep you in your home.

You might also want to see this article from last April detailing how Wall Street private equity has been gobbling up the nursing home industry.

We are all going to end up living in a Wall Street-owned dystopian society because, while the rest of us are wasting our time fighting about the southern border and drag queen story hours, America is being sold to the highest billionaire bidder.

Bill Lueders’ mother, Elaine Benz.

Promising results from initial study of possible new way to stimulate memory in older adults

So, this is interesting news about a possible new way to stimulate memory in older people:

Pulsing electrical currents through the brain for 20 minutes can boost memory for older adults for at least a month, according to a new study.

Around 8 percent of people in the US get diagnosed with Alzheimer’s disease or dementia as they get older — significantly impairing their memory — and an even larger group of older adults has some degree of age-related memory loss. This new study is only a first look at a potential solution. But easy, quick treatments like this one could become even more important as the world’s population rapidly ages — especially if future research shows that it can help with more serious cognitive conditions.

The brain stimulation done in this study, published Monday in Nature Neuroscience, came from a swim cap-like device studded with electrodes positioned to deliver the electric current to specific areas of the brain. The research team was interested in two main areas: one that’s linked with working memory (which holds information temporarily and overlaps with short-term memory) and another linked with long-term memory.

The research team divided 60 participants between the ages of 65 and 88 into three groups: one group wore the device but didn’t get any electrical stimulation; the second received stimulation in the region associated with working memory; and the third received stimulation in the area associated with long-term memory. For four consecutive days, the participants received the treatment (or fake treatment) while performing a memory task where they were read a list of 20 words and asked to recall them. The researchers looked to see how often they remembered the words at the beginning of the list (long-term memory) and the end of the list (working memory).

Both working and long-term memory improved over the course of the four days, the study found. “We watched the memory improvements accumulate over time with each passing day,” said study author Robert Reinhart, a professor in the department of psychological and brain sciences at Boston University, during a press briefing. And participants still had improved memory one month later.

And it might have applications to other neurodegenerative conditions.

Too early to tell, of course.

But if it’s in Nature Neuroscience, there’s a pretty good chance that some high-caliber reviewers thought it to be interesting enough to publish in that high-impact journal.

You can read the rest of the The Verge article at this link.

Is Florida’s mega-retirement community also the STD capital of America?

“We are more worried about alligators than crabs here”

It’s likely you’ve heard of The Villages, a sprawling Florida retirement community near Tampa made famous for its love of Donald Trump and golf carts.

Wikipedia notes:

The overall development lies in central Florida, approximately 20 miles (32 km) south of Ocala and approximately 45 miles (72 km) northwest of Orlando.

Between 2010 and 2020, The Villages was the fastest growing metropolitan area in the United States, growing 39 percent, from about 93,000 in 2010 to about 130,000 in 2020. The Villages covers an area of approximately 32 square miles, an area larger than Manhattan, and is expanding mostly to the south of the current community.

With those facts in mind, it might also surprise you that this bastion of Republican old people also has a reputation as the STD capital of America.

Residents hear the joke all too often. A Tampa Bay Times inquiry on the 38,000-member Facebook group, “The Villages Word of Mouth,” was revealing.

“My doctor in Ohio even, when he asked where we spend time in Florida, stated ‘Oh, The Villages — the highest STD rate in the country,’” wrote Jan Schweitzer on the post.

“We are more worried about alligators than crabs here,” typed Sean Donnelly.

Roy Rowlett wrote: “It doesn’t matter what the truth is. Some people love gossip about old people and sex.”

A moderator disabled comments on the post within days. It had received more than 300 responses.

Rumors abound about how the STD rumor started.

Some say a disgruntled nurse hurled it as an insult. Others believe it began with a joke on a radio station. But most trace it to a 2006 television news story “Doctors in Retirement Community Seeing Increase in STDs.”

“While statistics aren’t yet reflecting the trend, one physician at the Women’s Center of The Villages said, even in her years working in Miami, she has never seen so many cases,” the since-removed WFTV article reported.

The Women’s Center of The Villages is no longer open. And the doctor was never named.

The myth snowballed from there. It appeared over the years everywhere from the New York Post to the Daily Mail. Often, the stories seized on signs that The Villagers were engaging in casual sex or dating, wielding them as evidence of heavy transmission within the retirement community.

Unless The Villages is also the Viagra prescription capital of the world, I would have been skeptical of this from the start.

And while I don’t want to lean too heavily on stereotypes about old people and sex, I just don’t see people this age having the stamina it takes to seek out or plan granny orgies, if they even existed.

You can read the rest of the article here.

Seniors doing the kinds of things seniors will do that have nothing to do with STDs.

If you are at increased or high risk for COVID, should you want until the expected “bivalent” vaccine boosters become available?

I’m at that age where I know and love a lot of people in the 50-and-older age group, which is also the primary population that is approved for the full round of COVID booster shots.

Yet, according to the good folks at AARP, “[T]allies from the CDC show the vast majority of the 50-plus population is lagging behind on boosters. As of July 20, less than 30 percent of adults 50 and older who were eligible for a second boost had received one.”

Those numbers are not good, and clearly include more than just people who are ignorant or mis-informed about vaccines.

There has been much in the news lately about the fact that the government is in the process of likely approving “bivalent” vaccines, which would provide two-prong protection against not only the original strains of COVID, but also the latest variations like Omicron.

So the question remains: if you have not gotten boosted, should you wait until these new vaccines are approved and widely available?

The consensus view of qualified experts is that you should not wait.

Another reason not to fall behind on your booster schedule: It’s still unclear when, exactly, the next generation of shots will be available. The Health and Human Services Department on July 29 announced that the new vaccines could be here by early fall, but Jha said in previous press conferences that it could be a bit longer before their distribution is more widespread.

Clinical trial data still needs to be submitted. And federal agencies and independent experts need to review and recommend the shots — a process that, even under urgent circumstances, can still take some time. Among those recommendations would be the wait time, if any, to receive a new bivalent booster after receiving one of the currently available COVID vaccines.

There’s also the possibility that we’re dealing with another dominant variant this fall, different from the ones the new vaccines are designed to target.

“Given the unknowns that still exist, when it comes to my parents, my advice is still get that second booster. It’s a couple of months [until the new shots are potentially available], we don’t know what’s going to happen in the meantime, and we do know that getting a booster now is going to help,” Closser says.

The AARP article is good. I’ve already shared it with my over-50 friends whom I think might find it useful.

You can read the rest at this link.

New study suggests a fiber supplement — any fiber supplement — will probably benefit you, especially if you eat a low fiber diet

The headline in Science Daily about a new Duke study says it all: “It doesn’t matter much which fiber you choose — just get more fiber!”

That huge array of dietary fiber supplements in the drugstore or grocery aisle can be overwhelming to a consumer. They make all sorts of health claims too, not being subject to FDA review and approval. So how do you know which supplement works and would be best for you?

A rigorous examination of the gut microbes of study participants who were fed three different kinds of supplements in different sequences concludes that people who had been eating the least amount of fiber before the study showed the greatest benefit from supplements, regardless of which ones they consumed.

“The people who responded the best had been eating the least fiber to start with,” said study leader Lawrence David, an associate professor of molecular genetics and microbiology at Duke University.

The benefit of dietary fiber isn’t just the easier pooping that advertisers tout. Fermentable fiber — dietary carbohydrates that the human gut cannot process on its own but some bacteria can digest — is also an essential source of nutrients that your gut microbes need to stay healthy.

“We’ve evolved to depend on nutrients that our microbiomes produce for us,” said Zack Holmes, former PhD student in the David lab and co-author on two new papers about fiber. “But with recent shifts in diet away from fiber-rich foods, we’ve stopped feeding our microbes what they need.”

When your gut bugs are happily munching on a high-fiber diet, they produce more of the short-chain fatty acids that protect you from diseases of the gut, colorectal cancers and even obesity. And in particular, they produce more of a fatty acid called butyrate, which is fuel for your intestinal cells themselves. Butyrate has been shown to improve the gut’s resistance to pathogens, lower inflammation and create happier, healthier cells lining the host’s intestines.

I eat a lot of whole grains, so I probably don’t need a supplement. But I might start one just in case.

Wall Street sinks its blood-sucking fangs into the non-profit hospice industry

Your loved one is dying and the last thing you want to worry about is whether that person’s end-of-life care is going to be short-changed by the greed of private equity and the nameless, faceless billionaires who are now out to make bank gobbling up non-profit hospices and turning them into money machines:

With the U.S. population rapidly aging, hospice has become a boom industry. Medicare — the federal insurance program for people 65 and older, which pays for the vast majority of end-of-life care — spent $22.4 billion on hospice in 2020, according to a Medicare Payment Advisory Commission report to Congress. That’s up from $12.9 billion just a decade earlier. The number of hospices billing Medicare over that time grew from less than 3,500 to more than 5,000, according to the report.

But with limited oversight and generous payment, the industry is at high risk for exploitation. Agencies are paid a daily rate for each patient — this year, about $200 — which encourages for-profit hospices to limit spending to boost their bottom lines. For-profit hospices tend to hire fewer employees than nonprofits and expect them to see more patients.

Many hospice nurses and social workers are booked for 30-minute appointment slots throughout the day, unable to spend more time with patients if needed. For-profit hospices hire more licensed practical nurses than registered nurses, who are more skilled, and rely more on nurse’s aides to further cut costs. One study found patients in for-profit hospices see doctors or nurse practitioners one-third as often as those in nonprofit hospices. The U.S. Government Accountability Office found in an analysis of federal data from 2014 to 2017 that patients in for-profit hospices were less likely than patients in nonprofit hospices to have received any hospice visits in the last three days of life.

“The main way of making the bottom line look good is decreasing visits,” Teno said.

According to the Medicare Payment Advisory Commission, for-profit hospices had Medicare profit margins of 19% in 2019, compared with 6% for nonprofit hospices.

For-profit hospices also enroll a different set of patients, preferring those likely to remain in hospice longer. Most costs are incurred in the first and last week of hospice care. Patients who enroll in hospice must undergo several assessments to develop a care plan and set their medications. In their final days, as the body begins to shut down, patients often need additional services or medications to stay comfortable.

“So the sweet spot is kind of in the middle,” said Robert Tyler Braun, an assistant professor of population health sciences at Weill Cornell Medical College.

That makes dementia patients particularly profitable. Doctors have a harder time predicting whether a patient with Alzheimer’s disease or another form of dementia has less than six months to live, the eligibility criterion for enrollment. For-profit hospices enroll those patients anyway, Teno said, and stand to profit the longer those patients live. They tend to enroll fewer cancer patients, whose prognosis is generally more predictable but who usually die sooner.

Thus far, private equity has been able to run rampant over industry after industry, including nursing homes, mobile home parks and, of all things, the New England fishing industry.

Now they want to take over an industry which deals with people when they are most vulnerable to exploitation: when they are dealing with a dying loved one.

You can read the rest of Markian Hawryluk’s KHN article here.

Read this article before you check anyone you know into a nursing home or assisted living

Let’s say you have a neighbor whom you are not related to, nor are you responsible for any of their bills or living expenses.

Just to be nice you agree to drive them to the assisted living center where they are moving after selling their house.

The nursing home asks you to sign some papers and insists the papers are just a formality. They insist the papers in no way make you responsible for this friend and neighbor to whom you were just giving a ride.

Congratulations. You may have just signed your financial life away for a person to whom you aren’t even related.

Never sign anything — not even the guest list — because it could come back to haunt you.

“I get calls all the time from people who are served with these lawsuits who had no idea that this was even a remote possibility, who call me crying and frantic,” said Anna Anderson, an attorney at the nonprofit Legal Assistance of Western New York who has represented defendants in such suits, including Brooks. “They believe not only that they’re going to lose their own income and their own houses and assets, but also they’re concerned that their loved ones who are still in the nursing home may be potentially kicked out.”

The legal strategy is often rooted in admissions agreements, the piles of paperwork that family or friends sometimes sign, not realizing the financial risks. “The world of nursing facilities is a black hole for most people,” said Eric Carlson, a longtime consumer attorney at the nonprofit Justice in Aging. “This happens in the shadows.”

In most cases reviewed by KHN, the people sued didn’t have an attorney, which can be expensive. In nearly a third, the nursing homes won default judgments because the defendants never responded, a common phenomenon in debt cases. In many cases, lawsuits sought interest rates as high as 18% on top of the debt.

Long-term care officials and attorneys say they must use the courts when bills go unpaid. “It would be a disservice to the hospital’s residents, and to Monroe County’s taxpayers, to allow residents who have assets not to pay what is owed,” said Gary Walker, a spokesperson for Monroe County, which operates Rochester’s largest nursing home, Monroe Community Hospital.

From 2018 to 2021, the county filed 60 debt collection cases, including the lawsuit against Brooks, KHN found.

Nationally, Beth Martino, a spokesperson for the American Health Care Association, the largest nursing home industry group, said lawsuits against families are “not a common occurrence.”

But consumer attorneys in California, Illinois, Kentucky, Massachusetts, New York, and Ohio said they regularly see lawsuits against family and friends.

One person even had the nursing home transfer her signature off the guest register to a contract putting her on the hook for a friend’s nursing home bills.

You can read the rest of Noam Levey’s article here.

If I were helping a friend check into a long-term living facility I would either refuse to sign anything or, if the facility made a fuss, sign an illegible scrawl that could in no way be mistaken for my signature.

In summer 2019, Brooks visited her brother in the county-run nursing home where he was sent after being hospitalized for complications from a diabetes medication. She says no one talked to her about billing, but a year later she was sued for $7,967.05. (HEATHER AINSWORTH FOR KHN)