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Newt's niche issue: Neuroscience

Candidate advocates for brain health research

Tune into a Republican debate and you'll hear a lot about immigration, taxes and the threat posed by a nuclear-armed Iran.

Pay attention at just the right moment, though, and you'll hear former U.S. House speaker Newt Gingrich throw out a phrase that none of his competitors do: brain science.

It is an umbrella term Gingrich uses to refer to the research and understanding of illnesses ranging from Parkinson's to autism, and it's an issue that hits Gingrich, 68, close to home.

"My mother had bipolar disease, and I'm as interested in the whole issue of mental health, which is all brain-science related," Gingrich said in a recent interview with the Monitor. "You realize, for example, the impact of depression, which is a major undercurrent of our health problems. So if you could just understand depression, biologically, the savings would be enormous."

Gingrich became immersed in the policies surrounding neuroscience in 2007, when he co-chaired the congressionally appointed Alzheimer's Study Group with former Democratic senator Bob Kerrey.

Because of that process, Gingrich now believes addressing not only Alzheimer's, but also Parkinson's and autism is crucial for the medical well-being and financial health of the United States. By spending more money on those three areas, Gingrich believes that treatments for other illnesses would improve, too.

Alzheimer's is the illness Gingrich alludes to most frequently on the campaign trail The disease affects 5.4 million families nationwide, a figure that has doubled since 1980 and is expected to be as high as 16 million by 2050. It costs an estimated $183 billion annually. But its greatest costs are immeasurable: grief, loneliness and confusion.

"As Nancy Reagan said one time, Alzheimer's is a very cruel disease, because the person you're looking at isn't the person you're looking at," Gingrich said.

Gingrich said he first came in contact with Alzheimer's when he taught the "oldest men's class in Sunday school" when he was "very young." Although many of his students at first were "totally okay," after four years they were clearly in the early stages of dementia.

Alzheimer's primarily affects people over 65, and the baby boomers are starting to retire, causing a cost explosion so big it's often referred to as a "silver tsunami." People don't understand the scale of the cost, Gingrich said.

By 2050, the nation will have spent $20 trillion of public and private funds on Alzheimer's alone, Gingrich said.

"That's one and a half times the current federal debt. So people tell you they're worried about the federal debt? Here's a single topic that's 1½ federal debts," he said.

The costs associated with Alzheimer's disease aren't just for treatments. Approximately 14.9 million people in the United States provide uncompensated care, according to the Alzheimer's Association. That forces family members - often elderly spouses and adult children with families of their own - to cut back at work or stop working altogether, which leads to a loss of income. All the while, the person they love is slipping away, gradually losing all mental capacities.

The stress takes a toll.

"You have caregivers who are providing hands-on care, bathing their loved one, lifting them out of bed and onto a toilet," said Susan Antkowiak, vice president of the Massachusetts and New Hampshire chapter of the Alzheimer's Association. "Often the spouse caregiver will predecease the person with Alzheimer's disease."

But the bulk of government spending, advocates said, is on treatment, not prevention.

"For every $28,000 the government spends on care for Alzheimer's disease, it only spends $100 on Alzheimer's research," Antkowiak said.

The financial projections for Parkinson's, which like Alzheimer's tends to affect the nervous system in the elderly, and autism, which is a mysterious condition that hampers the ability to communicate, are intimidating.

About 60,000 people are diagnosed with Parkinson's annually, according to the Parkinson's Disease Foundation, and the direct and indirect annual costs, including treatment, Social Security payments and lost income is an estimated $25 billion.

And the costs associated with autism, which the Centers for Disease Control says affects approximately 1 in 100 children, are projected to be even greater. A 2006 study by the Harvard School of Public Health put the lifetime cost of treating a person with autism at $3.2 million.

"I think you're going to discover that the total cost from now till 2050 of all these things combined is probably something on the order of three federal debts," Gingrich said. "So this is a potentially huge upside, if you get the right breakthroughs and you get them fast enough."

 Four-point plan

In 2009 Senate testimony, Gingrich listed 16 "consensus recommendations" to address Alzheimer's. They included encouraging President Obama to make a "major speech focused on communicating the facts of Alzheimer's to the American people"; selling tax-exempt bonds whose proceeds would support the development of procedures to prevent Alzheimer's; establishing a joint congressional committee on Alzheimer's; and creating public-private partnerships that would address research and treatment.

In a recent interview, Gingrich narrowed the list to four things he thinks need to be done to address the costs of Alzheimer's in particular and brain-related disorders in general. Some of them overlap with points he regularly makes while campaigning.

• Set up a public-private partnership that funds brain science independent of the regular federal budget.

Gingrich said creating the public-private partnership would allow a more effective conversation with researchers to find out "the maximum they can invest practically," instead of the current system, which allocates to scientists only what "the politicians" will give them.

No one affected by or working in the area feels the disorders receive enough research money. The National Institutes of Health spends about $150 million annually on autism and about $160 million on Parkinson's. Compare that to, for example, breast cancer, on which NIH spends more than $700 million annually.

While some researchers and advocates interviewed for this story weren't sure they wanted neuroscience funded outside the traditional budget process, they did agree with Gingrich that the way Congress gives out research money is skewed.

"A lot of decisions about allocating research dollars comes from the public media campaigns," said Dr. Tanya Simuni, director of the National Parkinson Foundation's Center of Excellence at Northwestern University.

The result: many illnesses with strong public awareness campaigns - frequently cancer - receive a disproportionate amount of funds.

"We don't have a lot of patients with Alzheimer's that can really speak out," said Dr. Gregory Holmes, chairman of the Department of Neurology at Dartmouth Medical School. "By the time you have Alzheimer's, they're not really useful spokesmen for the disorder."

• Reorganize the National Institutes of Health.

The NIH is the part of the U.S. Department of Health and Human Services charged with medical research and "making important discoveries that improve health and save lives." It spends about $31.2 billion annually, according to its website, but it doesn't dispatch that money effectively enough, Gingrich said.

Those who receive NIH grants agree that they spend too much time filling out paperwork to access the funds and not enough time working in laboratories and clinics.

About 10 percent of proposed projects actually get funding, and that high rate of failure drives talent out of research, Holmes said.

"Once you get the grant, it's worth the effort, but a lot of people get discouraged," said Holmes, who has received NIH money for his research in epilepsy. "A lot of good young people are not going into medical research because of the funding."

The process rewards competition, not collaboration, a situation made worse by the high-stakes academic job market.

• Reorganize the Food and Drug Administration.

With a budget of about $1 billion, the Food and Drug Administration is charged with approving any new drug or other treatment for disorders such as Alzheimer's, autism and Parkinson's. But the process has become too slow, Gingrich said.

"The analogy I use is the iron lung, which disappeared because of the polio vaccine. In 1950, there were 60,000 people who died of polio," Gingrich said. "Now here's the fascinating thing. (Jonas) Salk develops this vaccine, he gives it to his own family to prove it's safe. The following year, (1.4 million) volunteers take the vaccine and the year after that the whole country's vaccinated," he said.

"Now today, that'd be a 20- or 25-year project, costing hundreds of millions to a billion dollars. So I want to model, remodel the FDA to get speed."

Simuni cautions against a too-fast-and-loose system. "Could the process be more streamlined and more efficient? Possibly. But their role is to assure the safety of the compounds that come to the market," she said.

But Simuni said the relationship between innovators, regulators and funders has become too antagonistic.

"I want to have more productive and efficient industry-government collaboration," Simuni said.

• Eliminate the capital gains tax.

Gingrich proposes eliminating the capital gains tax to enable entrepreneurs to invest their profits in ventures that could treat or prevent brain-related illnesses.

And the entrepreneurs don't need to cure the illnesses to be worth the investment, he said.

"This doesn't require a cure to have a huge out year effect," Gingrich said. Just setting a goal to delay the onset of Alzheimer's by five years is probably worth $6 trillion to $10 trillion, he said.

The extra cash for investment would allow for new companies to cure or treat brain-related disorders, Gingrich said, and thus "accelerate the introduction of new ideas in the marketplace as rapidly as possible."

 Quintessential Newt

While health advocates weren't sure if they agreed with the tax policy, they welcomed both the attention of a presidential candidate and any idea that could help the cause.

"We need urgency and we need federal funding. We need private funding, we need creative thinking." Antkowiak said.

Politically, Gingrich's mastery of the issue isn't surprising, said New England College political science professor Wayne Lesperance.

"It requires some thoughtfulness. That's Newt. He wants to be the scholar-in-chief," Lesperance said.

The appeal to reducing a rising economic burden would please Tea Partiers, Lesperance said, but that group would also be wary of the expanded government programs Gingrich proposes.

It is a concern Gingrich dismisses.

"The people who get on their computer to access the internet to send a note to their friends about the dangers of big government are using a device developed by the U.S. government - a computer, with an interface developed by U.S. government grants, what we then called the (Defense Department's) Advanced Research Projects Agency, in order to access a worldwide system (also) developed by the Advanced Research Projects Agency," Gingrich said.

Because he is running for president, it is inevitable Gingrich's intentions concerning neuroscience would be viewed through a political prism, Lesperance said.

But Ralph White, 85, of North Hampton, thinks Gingrich is sincere. White knows well the scope and challenge of dealing with Alzheimer's because his wife, Shirley, was diagnosed in 2002.

Since then, White has become an advocate for increased spending on Alzheimer's. White said he supports Mitt Romney, but he saw Gingrich speak at an Alzheimer's conference and was impressed with his understanding of the challenges of the disease.

"The candidate that would get the economy straightened out soon would, I think, help Alzheimer's," White said.

And getting Alzheimer's straightened out will eventually help the economy, Gingrich said.

"Imagine a world without Alzheimer's," Gingrich said. "People will live longer, with dignity, live independently and actually die fairly inexpensively."

(Molly A.K. Connors can be reached at 369-3319 or mconnors@cmonitor.com.)

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