Tuesday, August 10, 2010

More on Predicting Alzheimer's

Here is a followup story to my last post: Spinal Fluid Test is Found to Predict Alzheimer's.

The good thing is that the research is moving quickly on Alzheimer's disease. The number one predictor for developing Alzheimer's is age, with over 20% of women over age 85 developing the disease (2010 Alzheimer's Disease Facts and Figures). And face it, age is not a risk factor we can control. We can eat right, exercise, and do all the crossword puzzles imaginable, but if we're lucky, we'll all age.

I still have qualms, though, about doing spinal taps on people. The article indicates that it isn't as risky a procedure as it once was, but then it goes on to say that most internists and family doctors aren't experienced with the procedure. It was suggested in the article that spinal tap centers could be established, but you know, I have mixed feelings about that. It's just one more silo in an already too fragmented health care delivery system.

The other, probably bigger issue for me is one of ethics. Again, who decides? One doctor in the article suggested it should be a decision made between a doctor and the patient. But can my health plan force or strongly encourage me to have the test? If I want the test, will my insurance company pay for it? If I test positive, will I lose my coverage? Will my provider then pay for early treatment?

If I decide to have the test today, what other kind of ramifications will it have for me? I just purchased long term care insurance, but I'll bet I would have been denied if I had tested positive. Will future employers not hire me?

I think the research is good, but at this point I think that's where it needs to stay--in the realm of controlled research. That's not to say I won't change my mind in the future, I probably will. But I don't want us rushing in to something without really thinking through the long term ramifications for every day people, and making sure that new technology and procedures don't make an already terrible diagnosis even more terrible.