When I was a medical student, we were taught that you can only diagnose Alzheimer's at death through an autopsy.
And so the availability of these blood tests is like magical. Having access to early detection can be transformative in the lives of the person who's developing dementia and also for their families. There are some things that are good for everybody: better metabolic health, better sleep, sort of cognitive training, which are like your puzzles and things like that. I think there was a 25-year study that the NIH funded that only last year found definitively that those kinds of things can have a profound influence on whether you progress to dementia.
Welcome to Ahead of Alzheimer's. In this program, we look at how scientific breakthroughs are giving Alzheimer's patients and caregivers more options. We're also looking forward to see what's on the horizon as scientists continue learning more about dementia. Thank you for joining us.
Now, I'd like to welcome Dr. Jay Bhattacharya to the show. Dr. Bhattacharya is the current director of the National Institutes of Health. He earned his MD and PhD in economics at Stanford University and previously was a professor at Stanford School of Medicine. Welcome to the show.
One of the things that I love talking to you about comes from this experience that you have looking at both medicine and economics, and you actually studied economics undergrad. I also think so much of what we're dealing with in our current environment, certainly in Alzheimer's but even more at large, is this notion of incentives. And there are economic incentives that are driving a lot of both the research and the outcomes that we're seeing. And I wonder now, having been somebody who really did research the NIH and incentives and the age of people researching and all of these things, now that you're in it, how do you see that differently?
Well, Emily, the economic perspective, the economic way of thinking is that everything is a trade-off. That incentives determine the outcomes. That you have to understand the whole system if you're going to understand why the outcomes are the way they are. And I think that's been very, very useful to me throughout my career, while I was a professor studying the economics of healthcare and also in government. There's a few and understand why people make the decisions they do, and then set the structures right so that they make better decisions or help people make better decisions, you're going to get better outcomes. It's been foundational to the way I think about the world.
And so when you look at this massive budget that you are now responsible for and you think about how to sort of push projects forward, one of the things that occurs to me just in the Alzheimer's realm is how much money families are having to spend caring for a loved one who's diagnosed, you know, unfortunately too late or later in the game and there's not as many options for them. So from a research perspective, of course medicine is a tremendously important part of it, but the goal, the mission of the NIH is to support research that improves health and longevity of people.
Health is a very complicated thing. It doesn't just depend on medical care. It depends on decisions you make, the people you have around you, a whole host of things that have ramifications. In a diagnosis of Alzheimer's, just as you say, Emily, it has ramifications not just for 'okay, I have to go see a doctor,' but for your entire family, for the way that you live your life. It's going to have tremendous effects. We at the NIH, we funded a study a couple years back trying to estimate the cost of Alzheimer's disease to the country, not just the medical care costs, but the time lost from work, the caregiving costs, the whole host of the range of things that happen to you as your Alzheimer's diagnosis progresses. And the estimate is that we as a country are going to be spending $800 billion a year.
With a B. I mean, it's a tremendous amount of money. And it's not just the medical care cost, that's only a fraction of it. This is a study run by actually former colleagues of mine at the University of Southern California. And it's just fascinating because what it means is that if we can actually get ahead of the disease, if we can find ways to prevent it, not only will we have a tremendous impact on the lives of people and their families, but potentially also save the country from financial ruin.
And the individual family. I had heard estimates of $400,000, you know, sort of like out-of-pocket expense for the long-term care and for all the other things. But as an economist, you also, I think it's really the early study that you guys, that NIH did, I think is profound because it really shows the impact.
That's why that hit such a large number, $800 billion a year. I mean, so because it includes the impact on families, on caregivers, on loved ones, right? So people have to take time off from work. They have to make sure that the person that has the memory issues or the dementia is cared for properly. It's oftentimes they have to go to memory care units, which are very, very expensive for families, not often covered by insurance directly, and of course a lot of impact on public health systems as well. So it is a very wide-ranging impact. I think it's like 6 million people have Alzheimer's. So that's the official-ish estimate.
Those have been gone through and gotten the diagnosis.
Yes. But there's so many more that are earlier on in the path. And then Alzheimer's is a very specific diagnosis, but there are other broader sets of dementias as well. It's a big, big deal, and it's really important that an institution like the NIH, which I lead, focus on getting answers for people better. I mean, I believe fundamentally the science can do that. I mean, that's the reason I accepted this job in the first place. So I'm actually hopeful. I think what I've seen at the NIH the last couple of years is a desire to do research in a more broad-minded way than I think maybe we've done a bit in the past. Focus on sort of practical things that people can do to get help for their loved ones when Alzheimer's starts to come into the picture.
So, I think, you know, one of the things that we're really looking at in the show is this idea of early intervention and how you can actually make a big difference if you can catch Alzheimer's early, and that the farther the progression is, there are a few things that are reversing the cognitive decline, but there are things that are slowing the development of it.
I will say, just from a very high level, having access to early detection can be transformative in the lives of the person who's developing dementia and also for their families, right? They can make plans around this. I think the availability of these early detection tests, it includes the mechanism you talked about as one, but I think given that it's likely to be lots of different things happening early on, I'm looking for more like, I'd love to have a sort of a suite of them that capture a lot of these mechanisms rather than just development of amyloid plaques or whatever. It is a big advance. Like when I was a medical student, this is in the '90s, we were taught that you can only diagnose Alzheimer's at death through an autopsy.
And so the availability of these blood tests is like magical, so you can see early detection, and I think it will have a huge impact. There are questions around the blood test having to do with, let's say you're completely healthy, that means the probability that you have Alzheimer's is very, very, very low. And so you do the blood test, and even though it might be a great test, every test has some false positives. In a background where very few people have it, the false positive likely means that if you are positive, that doesn't mean that you actually are likely to get Alzheimer's. So you have to be very careful about interpreting them. But I think that's the interplay between medicine and technology, like you get doctors to help you interpret the test and put it in context. So if you're seeing some early signs of dementia, you do the blood test. Okay, yeah, this confirms it. Now I can plan around that. I can make better decisions for me and my family, undertake all the cognitive testing, make metabolic interventions. You have a lot of stuff you've been talking about forever. But I think it's really important to say it doesn't tell you anything about the progression of the disease, right? And so you don't know what your course is going to be, but it's an important risk factor for people to be aware of so that it's on their radar.
Can I just put an exclamation mark on that? Right. The blood test is not your fate. It doesn't say what's going to happen to you. It's a signal that's important to understand in some cases. But it allows you to take actions that can help.
It's not 'I get the blood test, I'm going to die.' No, that's not the way it is. I get the blood test and it helps me understand it's much more important even before than before to undertake some of the actions we know will work, you know, exercise more, sleep better, do cognitive training, whatever that means for you, and undertake those actions in ways that can meaningfully change the path of your life and help your family deal with this fact about you.
Well, and know that because this is a risk factor, it's something to keep on your radar, to think about, to continue talking to your doctors about. We had an incredible couple on the show who are primary care doctors focusing on dementia, and I just loved their approach because they're really taking the primary care element but incorporating in a communication and education specifically about dementia because they were seeing it so much in their communities. So in terms of that, we have this sort of tough environment where people aren't being able to spend enough time with their doctors. So how can the government do a better job about, not that you're not doing a great job, but I think we can all do better in everything really, right? But in terms of this idea of communicating things like risk-reward or what new interventions are available and what they really mean.
Yeah, I mean, the job of the NIH is to support the research, right? So that's a very circumscribed thing. It's very, very important, as we've talked about, helps the scientific infrastructure, allows the ecosystem, allows us to help understand the disease better, get better answers. What you're talking about is something that's like an implementation of those scientific ideas. And so I was acting director of the CDC for like 7 months. And it was illuminating because it's related to science. The mission of the CDC is related to science, but it's to communicate that science in a way that might make a difference in people's lives. That's one of the major missions of the CDC, and for an area like this, which is so complicated, is a very challenging task, right? Because I can go into professor mode and start talking about all the fun science stuff, but by itself that may not be meaningful to people. At the same time, if I talk about things in a very detached way, not rooted in the scientific literature and true scientific understanding, I'm going to mislead people.
And so the government, I think, and the CDC, the task of that is to balance those things so that the communication is clear but not so simplified that it misleads.
Yes. So no such thing as trusted science, but give people tools where, and the government's role, I think, should be to be partners, right? Rather than tell you what to do.
Oh, you got this blood, go get this blood test, go take this drug or whatever. The government shouldn't be doing that. What it should be doing is helping you understand the situation you're in. So what are some options for you? How can you take good actions and make good decisions for you and your family so that you have the best outcome possible. I think when the government and the CDC does that, it performs the best.
So I think, you know, one of the other things that's interesting to me is this idea of we as taxpayers fund the research the government is doing. And it's very hard to try to figure out what percentage of that research is on preventative versus treatment. And yet the goal of the NIH is about maintaining long-term health or longevity of American citizens. And so when we look at things like Alzheimer's, how can you tell us a little bit about some of the preventative research that's going on that you're excited about?
Alzheimer's specifically, we made tremendous investments in trying to understand prevention. And actually there have been some real amazing results of late. So there was a 25-year study that the NIH supported that looked at a huge cohort of people, some of whom had interventions for better metabolic health, cognitive training, a whole host of things. In 2012, there was a National Academy of Sciences report asking, is there good evidence that these kinds of things actually have an impact on Alzheimer's progression? And the answer at that point was no, we didn't know. We don't have the answer to that. But now, you know, 2026, you know, was sort of 14, 15 years on, the answer's come in based on this long-standing investment. The answer is yes. Those kinds of interventions, things that make sense not just for Alzheimer's but for many other things, do have an impact on the progression of cognitive decline. So doctors can go to their patients and confidently say, yeah, it's better for you, not just for your metabolic health, for your obesity or whatever, but also for your cognitive health in the future to intervene, have better diets, sleep better, all that now has solid scientific backing which just 15 years ago it didn't. Because of the long-standing NIH investments, I think those kinds of prevention investments are very, very important. And I completely share the spirit of your skepticism. Like the idea, you have a splashy cure, everyone wants that, right? But equally important is investments in trying to make sure the disease doesn't happen at all. I mean, for me, the NIH, that's what we're about, both.
