Latest / Morning Medical with Dr. Chow / Lecanemab Access, Diabetes and Brain Health, and Global Life Expectancy Trends

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Lecanemab Access, Diabetes and Brain Health, and Global Life Expectancy Trends · Morning Medical with Dr. Chow

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Welcome to another episode of Morning Medical with Dr.
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Chow, where we bring you the latest in health and medical news from around the globe.
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I'm your host, Dr.
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Chi-Ming Chow.
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Today, we're diving into some intriguing findings regarding the use of a new Alzheimer's
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treatment, lecanemab, which is raising some important questions about access and equity in
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healthcare.
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A recent analysis of Medicare data has revealed significant disparities in the use of
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lecanemab, a monoclonal antibody approved for the treatment of early Alzheimer's disease.
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This study, published in JAMA Network Open, highlights that this drug is predominantly
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being used by relatively affluent, urban, white men.
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Let's break down what this means.
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The researchers found that among older adults with Alzheimer's disease or mild cognitive
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impairment, the uptake of lecanemab was much higher in patients who were male, white, living
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in urban areas, and socioeconomically advantaged.
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Specifically, the adoption rate of lecanemab was six times higher among white patients
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compared to Black patients, and 24 times higher among those with higher socioeconomic status
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compared to their disadvantaged counterparts.
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These disparities may be partly due to the high cost of lecanemab, which carries a hefty price
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tag of twenty-six thousand dollars annually.
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Additionally, the treatment requires extensive testing and regular visits to specialized
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centers, posing significant access barriers.
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This can be particularly challenging for disadvantaged groups who are already
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disproportionately affected by Alzheimer's disease.
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The study also points out that these findings reflect a broader, historical pattern of
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inequities in access to breakthrough therapies in the United States.
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These barriers are not just financial but also include the logistical challenges of meeting
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the treatment's requirements.
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For instance, patients need to undergo in-person infusions, which can be a hurdle for
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those living in rural areas or without easy access to specialized healthcare facilities.
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It's also worth noting that the study did not include data from Medicare Advantage, and there
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were limitations related to the identification of Alzheimer's and mild cognitive impairment
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through diagnosis codes.
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This means that while the data provides a glimpse into the disparities, the actual number
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of eligible patients might differ.
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This analysis serves as a stark reminder of the need to address inequities in healthcare
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access.
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As we continue to develop new and potentially life-changing treatments, ensuring they reach
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all segments of the population equitably is crucial.
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This is not just a matter of cost, but also about creating systems that support access for
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everyone, regardless of their socioeconomic status or where they live.
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A new study led by the University of Southern California has uncovered a noteworthy link
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between type 2 diabetes mellitus and brain health in older adults from a variety of
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populations.
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This research, published in the journal Alzheimer's & Dementia: Diagnosis, Assessment &
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Disease Monitoring, reveals that individuals with type 2 diabetes mellitus tend to have a
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thinner cortex, particularly in the temporal and parietal regions of the brain.
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These areas are crucial for memory and cognitive functions.
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The study utilized advanced neuroimaging techniques to assess cortical thickness and
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hippocampal volume in participants from the Health and Aging Brain Study-Health Disparities
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cohort.
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This cohort included a diverse sample of Hispanic, non-Hispanic Black, and non-Hispanic
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white adults, providing valuable insights into how diabetes affects brain health across
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different ethnic groups.
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One of the significant findings of the study is that poor glycemic control, which refers to the
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management of blood sugar levels, may be a key factor driving the association between type 2
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diabetes mellitus and cortical thinning.
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The research team found that the link between type 2 diabetes mellitus and reduced cortical
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thickness remained strong even after accounting for socioeconomic factors and common
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comorbidities such as hypertension, dyslipidemia, and obesity.
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Interestingly, the study noted that the strongest associations were observed among
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Hispanic participants, while non-Hispanic Black adults did not exhibit significant effects.
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This highlights the need for targeted interventions to improve diabetes management,
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particularly among minority populations, to mitigate its neurological consequences.
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The disparities observed by ethnic and racial group suggest that more research is needed to
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understand how various risk factors can interact in distinct ways across different
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populations to impact brain health.
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As Dr.
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Meredith N.
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Braskie, the senior author of the study, explains, understanding these interactions is
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crucial for advancing personalized care that effectively protects brain and cognitive health
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for each individual.
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Dr.
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Braskie emphasized the importance of large-scale initiatives like the Health and
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Aging Brain Study-Health Disparities, which is the most comprehensive study of Alzheimer's
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disease and related dementias in diverse communities.
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The study provides invaluable data, including interviews, functional exams, blood draws,
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cognitive testing, brain magnetic resonance imaging scans, and clinical lab work, which can
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lead to significant discoveries in the field.
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Arthur W.
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Toga, Ph.D., director of the Stevens Neuroimaging and Informatics Institute, noted
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that the data from such large-scale studies are crucial for uncovering important links, like
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the one between type 2 diabetes and cortical thickness.
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These findings underscore the need for continued research and the potential for
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longitudinal studies to determine if these brain changes result in accelerated cognitive
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decline over time.
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The research team anticipates further studies exploring the effects of diabetes medications
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and lifestyle interventions, which could help identify strategies to protect brain health in
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individuals living with diabetes.
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This research highlights the potential for managing blood sugar levels to safeguard brain
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health as we age, emphasizing the importance of personalized and targeted healthcare
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strategies.
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In Maine, the topic of universal health care is once again taking center stage as a lawmaker
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revives the conversation amid rising health care costs.
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The state spends a staggering eighteen and a half billion dollars annually on health care,
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which accounts for nearly twenty percent of its Gross Domestic Product.
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This has prompted a legislator to propose exploring a publicly funded universal health
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care system that could extend coverage to over fifty-nine thousand uninsured residents.
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During a recent public hearing, advocates emphasized the urgent need for a more effective
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health care system.
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However, the state's affordable health care office expressed skepticism, stating that there
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is currently "no path forward" for establishing such a program.
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Two bills are at the forefront of this discussion: LD 1269, which calls for a
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comprehensive study on the costs and feasibility of universal health care, and LD
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1883, which outlines a detailed plan for a statewide system known as the All Maine Health
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Program.
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If enacted, Maine would become the first state in the nation to adopt a universal health care
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system.
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Representative AnnMarie Mastraccio, who introduced both bills, pointed out that a
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statewide system has not been thoroughly studied since 2002, emphasizing the need to
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update data and explore options.
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She aims to tackle growing health care challenges, including the closure of rural
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hospitals, uncertainties surrounding Medicaid funding, and escalating health care costs.
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Mastraccio argues that Maine's current health care system is fragmented, inefficient, and
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economically unsustainable, and stresses the importance of data-driven decisions to build a
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sustainable and equitable health care infrastructure.
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Supporters, including health care providers and advocates, testified in favor of the bills,
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highlighting the urgent need for reform.
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They drew attention to issues like the lack of access to providers in rural areas, racial
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disparities in health care access, and the financial burden on patients and providers due
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to the existing patchwork of insurance coverage.
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Lily James from the Maine Women's Lobby highlighted how the inadequate health
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infrastructure disproportionately affects women of color, Black and Indigenous women, and
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low-income and rural women.
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She noted significant disparities in prenatal care access, with a much lower percentage of
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pregnant Black Mainers receiving adequate care compared to their white counterparts.
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The All Maine Health Program, according to its advocates, could be transformative, potentially
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saving lives and significantly improving Maine's health care infrastructure.
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A report from the Maine Center for Economic Policy suggests that the cost of such a program
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would be similar to what Mainers currently spend on health care, ranging between seventeen
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point eight and nineteen point three billion dollars annually.
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James Myall, a policy analyst, testified that unlike the current system, a universal health
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care system could be funded through alternative revenue streams, such as federal grants or
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increased taxes on the wealthiest Mainers.
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This, he argued, would alleviate the financial stress on Mainers, freeing them from worrying
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about copays, deductibles, and network coverage issues.
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On the other hand, Meg Garratt-Reed, director of Maine's Office of Affordable Health Care,
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expressed concerns about the feasibility of the proposed bills.
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She acknowledged the flaws in the current system but argued that a single-payer program
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would be too costly and complex to implement at this time.
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The proposed system aims to reduce costs by eliminating insurance companies and their
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administrative expenses, but Garratt-Reed warned that these savings might not be
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sufficient to cover the additional expenses outlined in the plan.
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She also highlighted the challenges of moving away from the current cost-control measures and
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the difficulties in negotiating rates with providers.
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Furthermore, the proposal relies heavily on federal funds, such as those from Medicaid and
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Medicare, to finance the new system.
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However, Garratt-Reed pointed out that federal law currently does not permit states to
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reallocate these funds without special permission, which is unlikely to be granted
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given the current political climate.
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Despite the desire to overhaul the health care system, she urged lawmakers to focus on
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solutions that are feasible and have the potential to alleviate suffering under the
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current constraints.
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Today, we're exploring a groundbreaking development in the field of gene editing that
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has given hope to families battling rare genetic disorders.
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A story from CNN highlights the case of a baby named KJ Muldoon, from Clifton Heights,
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Pennsylvania, who was born with a severe and life-threatening genetic disease.
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This condition, known as CPS1 deficiency, affects about one in a million infants and can
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lead to toxic levels of ammonia in the blood due to a lack of a crucial enzyme.
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KJ's parents, Kyle and Nicole Muldoon, faced an agonizing decision shortly after his birth.
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They could opt for a liver transplant, an invasive procedure, or take a leap of faith
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with an experimental gene editing treatment.
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After much consideration and prayer, they chose the novel treatment.
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The team at Children's Hospital of Philadelphia and Penn Medicine, along with their partners,
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quickly developed a personalized therapy for KJ using CRISPR, a revolutionary gene editing
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tool.
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This therapy targeted the specific genetic mutation causing KJ's condition.
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Rather than cutting the DNA, the technique employed, known as 'base editing,' flips a
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mutated DNA base to the correct type, reducing the risk of unintended genetic changes.
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In February, KJ received his first infusion of the gene editing therapy, delivered via lipid
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nanoparticles that target liver cells.
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The treatment was a success, allowing KJ to eat more normally and recover from common illnesses
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more effectively.
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This was a significant milestone, given his initial prognosis.
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Researchers are optimistic, but they also caution that it's still early days.
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KJ's progress will need to be monitored over the years to fully understand the long-term
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effects of the treatment.
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However, his current development is promising, and each small milestone, like a wave or
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rolling over, is a cause for celebration for his family.
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This case is not just a triumph for KJ and his family but also a beacon of hope for the
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millions living with rare genetic disorders.
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It demonstrates the potential of gene editing to offer personalized treatments for conditions
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that previously had no definitive medical solutions.
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The researchers involved hope that the insights gained from KJ's treatment can pave the way for
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similar therapies for other rare diseases.
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The financial aspect of developing such personalized therapies is also noteworthy.
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According to Dr.
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Kiran Musunuru, one of the study's co-authors, the cost of creating KJ's custom treatment was
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comparable to that of a liver transplant.
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As the technology and processes improve, it's expected that these costs will decrease, making
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such treatments more accessible.
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The potential applications of this technology are vast.
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Although significant challenges remain, experts believe that the barriers to widespread use of
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personalized gene therapies will be overcome in the next decade.
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This advancement sets a new precedent in the field of genetic medicine, offering a glimpse
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into a future where rare genetic disorders can be treated effectively and affordably.
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The World Health Organization is sounding the alarm, stating that the world is failing its
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health checkup.
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This stark warning comes as new data reveals that global life expectancy has fallen by
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nearly two years between 2019 and 2021, marking the largest decline in recent history.
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This drop in life expectancy is largely attributed to the COVID-19 pandemic's
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far-reaching impacts.
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Dr.
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Tedros Adhanom Ghebreyesus, the Director-General of the World Health
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Organization, emphasized the human stories behind these statistics.
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Every data point represents a life cut short—a child who didn't reach their fifth birthday, a
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mother lost during childbirth, or an individual who succumbed to a preventable disease.
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The pandemic has exposed and exacerbated existing vulnerabilities in health systems
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worldwide.
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The World Health Organization's 2025 report highlights some progress, noting that by the
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end of 2024, 1.4 billion more people were living healthier lives than before.
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This achievement was driven by reductions in tobacco use, improvements in air quality, and
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better access to water, hygiene, and sanitation.
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However, these gains are being overshadowed by significant challenges.
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Underinvestment in primary health care, shortages of skilled health workers, and gaps
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in essential services such as immunization and safe childbirth are major obstacles to
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sustaining health improvements.
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The World Health Organization warns that noncommunicable diseases, including cancer and
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diabetes, are on the rise due to population growth and aging.
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These diseases are now the leading causes of death among individuals under 70 years old
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globally.
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Air pollution remains a significant threat to public health, impacting populations around the
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world.
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The World Health Organization's Haidong Wang notes that air pollution continues to harm
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community health, contributing to the growing burden of chronic diseases.
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Despite some encouraging trends, such as a more than 40 percent reduction in maternal deaths
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and a halving of deaths among children under five since 2000, progress has stalled or
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reversed in many regions.
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The decline in maternal and child mortality rates is not happening quickly enough, putting
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millions of lives at risk.
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The World Health Organization stresses the urgent need for governments to act with
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commitment and accountability.
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Without a swift course correction, the organization estimates that an additional
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700,000 maternal deaths and eight million deaths of children under five could occur
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between 2024 and 2030.
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As we close today's episode, let's turn our attention to a topic that's become increasingly
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prevalent in our society: wellness.
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Amy Larocca, an award-winning journalist, recently explored this cultural phenomenon in
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her new book, "How To Be Well: Navigating Our Self-Care Epidemic, One Dubious Cure At A
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Time." She delves into how wellness has transformed into a trillion-dollar industry,
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permeating nearly every aspect of our lives.
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Larocca argues that our society's obsession with optimization and self-care has reached a
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fever pitch.
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The wellness industry promises to enhance everything from how we eat and sleep to how we
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age and think.
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But Larocca asks critical questions about these promises: Who do they truly serve, and who do
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they leave behind?
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Her investigation reveals wellness as a luxury good, often marketed to women, using similar
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tactics as those seen in the fashion industry.
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Larocca suggests that women are sold their own bodies back to them, with the wellness industry
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confronting them daily with the idea that they must be perpetually dissatisfied with their
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natural state.
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This relentless pursuit of an idealized self can be exhausting and, as Larocca puts it,
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dangerous.
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The industry thrives on the notion that there's always a better version of ourselves to strive
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for, feeding into a cycle of self-improvement that demands both time and money.
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Larocca also points to the role of influencers and celebrities in shaping the wellness
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narrative.
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Figures like Gwyneth Paltrow have become synonymous with wellness, leveraging their
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platforms to promote products and lifestyles that may not always be backed by science.
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This can blur the lines between genuine health advice and marketing ploys.
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The book also touches on the influence of modern life, where a lack of faith in
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traditional institutions has led many to seek alternative paths to health and wellness.
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The COVID-19 pandemic further accelerated this trend, as people turned to wellness influencers
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for guidance amid uncertainty.
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Larocca's work sheds light on the complexities of the wellness industry, urging us to question
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its motives and the true cost of its promises.
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As we navigate this landscape, it's crucial to remain critical of the trends and to prioritize
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our well-being in ways that are meaningful and sustainable for us individually.
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That's all for today's episode of Morning Medical with Dr.
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Chow.
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Thank you for joining me as we explored some of the most pressing health stories from around
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the world.
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We'll be back tomorrow with more insights and updates.
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Until then, stay informed, stay healthy, and take care.