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The American Way of Medicine

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A new Alzheimer’s drug has been approved, potentially putting state and federal taxpayers on the hook for hundreds of billions of dollars. If the drug was proven to be effective, or even had a good chance of being effective, this would be fine – Alzheimer’s is a horrible disease and a drug that could effectively treat and attenuate/prevent it would be worth almost anything.

The problem is that there appears to be no real evidence that the drug is effective, or indeed that it even has a net positive benefit:

Earlier this week, the Food and Drug Administration overruled—to much criticism—its own scientific advisory committee and approved the Alzheimer’s treatment Aduhelm. The agency made this decision despite thin evidence of the drug’s clinical efficacy and despite its serious side effects, including brain swelling and bleeding. As a result, a serious risk now exists that millions of people will be prescribed a drug that does more harm than good.

Less appreciated is how the drug’s approval could trigger hundreds of billions of dollars of new government spending, all without a vote in Congress or indeed any public debate over the drug’s value. Aduhelm’s manufacturer, Biogen, announced on Monday that it would price the drug at an average of $56,000 a year per patient, a figure that doesn’t include the additional imaging and scans needed to diagnose patients or to monitor them for serious side effects.

The federal government will bear the brunt of the new spending. The overwhelming majority of people with Alzheimer’s disease are eligible for Medicare, the federally run insurance program for elderly and disabled Americans. If even one-third of the estimated 6 million people with Alzheimer’s in the United States receives the new treatment, health-care spending could swell by $112 billion annually.

To put that figure in perspective, in 2020, Medicare spent about $90 billion on prescription drugs for 46 million Americans through the Part D program, which covers prescription medication that you pick up at your local pharmacy. We could wind up spending more than that for Aduhelm alone.

And this is how you end up with a medical system that spends far more than any other liberal democracy to cover many fewer people.

I will have more about it soon, but Jon Cohn’s new The Ten Year War is strongly recommended.

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