How about this idea for the next NIH challenge?

A project I covered back in June continues to advance. Health and Human Services’ KidneyX is about to award $2.6 million in initial prize money. The project aims in part to revolutionize dialysis,  a dreary and expensive process that hasn’t changed since the 1940s.

Check out my earlier interview with project director Sandeep Patel. Knowing people on dialysis, and the tough life it engenders, I’m hoping this project succeeds. KidneyX represents the best in the way the federal government, as convener, can marshall non-government brains and other resources on something that causes both private distress and high public cost. Federal payouts for dialysis run to the billions each year.

Sandeep Patel

So many medical areas seem resistant to improvement, no matter how much money is thrown at them. Yesterday former Supreme Court Justice Sandra Day O’Connor announced her withdrawal from public life. Her reason: The onset of dementia, the flavor of which O’Connor believes is Alzheimer’s Disease. Alzheimer’s is just one of a dozen types of dementia. They all have the same effect. They rob people of everything but their basic bodily functions. Dementia typically comes on bit-by-bit. If you’ve watched someone progress down this one-way track, it’s horrible at many levels. I had the shock of realization one evening several years ago when my mother, a once-vivacious hostess, began preparing a dinner for five with two frozen lamb chops.

Thus President Ronald Reagan’s lament in his famous letter: “Unfortunately, as Alzheimer’s Disease progresses, the family often bears a heavy burden. I only wish there was some way I could spare Nancy from this painful experience.” At least the Reagans were wealthy, which gave them the means to spare themselves from the physical struggles imposed by dementia. How people without savings cope, I can’t imagine. I read one story last year about a postal employee who personally cared for his mother who had dementia, down to the most intimate details.

By no means is the government uninvolved in dementia and Alzhemier’s. To the contrary. Check out this whole NIH website devoted to the disease and its implications. The government participates in funding a vast amount of research into the brain and how it deteriorates. Research insights come frequently. Just last week a federally-funded Mayo Clinic study showed how clearing out so-called senescent cells from the brain might prevent dementia. At least it did in mice. NIH sponsors clinical trials.

Medical challenges differ. Kidney dialysis is a known and discrete function. It’s not difficult to grasp how electronics, nanotechnology, and materials advances could somehow replace those bulky, slow machines. There’s no real treatment for dementia. Caring for people with it means managing something you can’t control. The process varies little. Decline marked by shrinking boundaries of cognition and ability followed  some period of the living shell. Short if you’re lucky. Expenses don’t end until the life does.

Reagan, while he still had some degree of cognition, reportedly quipped, the great thing about Alzheimer’s is, you get to meet new people every day. The bittersweet comment reflects the fact that as dementia takes its time moving in, you know what’s going on.

Studies show the percentage of old folks with dementia is declining. That’s good. But with the baby boomer generation reaching its older years like a roaring river passing a shore marker, the number of cases will triple in the coming couple of decades. We can calculate the effect on Social Security, Medicare and Medicaid. But the future dollar, social and psychological costs of dementia  those seem incalculable. They could swamp the health-care system while causing social devastation.

Perhaps while the research continues, we could have a project to find revolutionary ways of managing dementia that preserve human dignity, chop expenses, and help maintain normalcy for those close to victims.

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