Watch: Doctor responds to newly approved Alzheimer’s drug and how it may impact Black patients
The Alzheimer's Association says Black Americans are twice as likely as older Whites to have Alzheimer's or another form of dementia.
TheGrio host Marc Lamont Hill gets insight about the treatment from a family medicine doctor who specializes in treating patients of color. They discuss why Black and brown patients may have been excluded from clinical trials of the drug. The following is a transcript of that conversation:
Marc L. Hill: It’s being called a breakthrough in the fight against Alzheimer’s disease. Before the break, we told you that the Food and Drug Administration recently approved a drug that could slow the progression of the disease. According to the Alzheimer’s Association, this disease kills more Americans than breast cancer and prostate cancer combined. So this is an important step. The associations say that Black and Hispanic adults are increased at risk for Alzheimer’s, but the research virtually ignores them by having little to no black or Hispanic participants. So while it is exciting that this new federal approval means a buy in from Medicare, how helpful will it be for communities of color? Joining me now to answer that question is Dr. Bayo-Curry Winchell. She’s a board certified family medicine doctor. She’s also an urgent care medical director. I want to thank you for joining me, Doctor. Explain to me this, because it’s often challenging for folks to understand how if race is not biological, it’s social as they like to tell us. And if race isn’t rooted in these biological differences, how the heck is it that Black folk end up getting sicker, more dying, more getting illnesses, more. All the things that seem to be bound up in biology happen to us even though our racial differences aren’t biological. So help me understand this. I look at Alzheimer’s, they say we’re at a greater risk for Alzheimer’s. How are Black and Hispanic adults at a greater risk for Alzheimer’s?
Dr. Bayo-Curry Winchell: So we are at a greater risk, Mark, just like you mentioned, because of our race. Now, when we break that down, yes, it’s not biological and it’s a social construct, but what it is, is it’s a barrier that allows us to be seen and really recognize our symptoms that are happening. And so we know that black and brown people are more likely to get Alzheimer’s. But what’s happening is we’re not finding out till later on because they’ve had the symptoms for maybe a year or two. But when they go in and they’re seen, they’re not recognized or addressed. And so that is the the main piece that is causing us to be diagnosed at a disproportionately higher rate and at a later rate.
Hill: So it’s not my Blackness that gives me Alzheimer’s. It gives me worse Alzheimer’s symptoms. It’s how people and how the world responds to my Blackness that that makes sense to me. So even even the the the the the barriers that you mentioned are sort of socially constructed. So help me understand more specifically what those barriers are you say, when people finally get into treatment. Right? There’s all kinds of, I guess, access issues. But also when we get there, there’s also how we get treated, quality of care issues. So talk to me about what barriers prevent Black folk from getting access to the diagnosis and also a good treatment once we get to the doctor.
Winchell: Well, there’s two parts. Number one, when we talk about being able to be diagnosed, education is huge. So we have to invest in having medical students. Doctors understand that this disease is possible in all races. And when you understand that, you can recognize it and you can diagnose it. So that is a huge piece. The other part is when a patient comes in and they’re stating, you know, Doc, I’m having a hard time remembering things, I’m having difficulty with remembering people’s names. All of those things are a part of the diagnosis of Alzheimer’s. But we also need that provider to recognize it. So though part of the barrier is just access, because when you’re there in the clinic, you need that provider to recognize it and as well as to be able to have the information to understand that the symptoms that they are experiencing could be Alzheimer’s.
Hill: Talk to me about affordability, because I feel like that’s another piece of this. The Alzheimer’s Association estimates that Alzheimer’s will cost the nation the nation $348 billion dollars this year. They estimate that number by the year 2050 will be one trillion with a ‘t’. That seems unimaginable to me. Why is it so expensive?
Winchell: Well, unfortunately, when we look at how expensive it is to even produce or have a drug available, a lot of things that have to happen and available. But then you’ve got different barriers, such as insurance companies being able to offer it. We have, you know, Medicare just finally approved this drug. They wouldn’t approve it if it wasn’t fully approved. And so that language in itself is difficult to really think about how it lands in people’s pockets because, yes, you know, we appreciate all of those things that happen so a drug can be available. But for me as a doctor, I want to be able to give it to all my patients that I want to be able to provide a care. So people who come in and see me and have these symptoms, I can help them do something with it and not have it be a financial barrier so you can get help and be able to have a better quality of life for a longer period of time.
Hill: That makes complete sense to me when I think about that cost. I also think about Medicare. For some people, Medicare is how they pay for treatments, how they access treatment. Is Medicare enough for Black folk? If Medicare isn’t enough, should we be thinking about Medicaid as we think about other services, other resources, and how do we pay for this stuff?
Winchell: So we have to really unroot all of the pieces that allow medications to be able to be there for patients. And so when we have all these barriers such as Medicaid, Medicare, Yes, are great for access for all people and specifically those that are underserved. We have to look at why do we have these these barriers in place that prevent us from just getting the medicine to the patient. And so what’s happening is there’s a competition between pharmaceutical companies that, again, prevent us from being able to, especially providers, be able to give that to our patients. So it’s a blend of things that we have to look at, acknowledge and produce change if we really want to move that needle and help people.
Hill: Now, this drug has some concerns about brain bleeding, about swelling, all sorts of stuff. And then there’s also I’m speaking for myself, not any other doctor or not any other researcher to any of the journalists. But I’m also concerned about how this may affect people with particular illnesses or medical histories or co-morbid co-morbidities that are often linked to Black folk. Right. So since they haven’t tested Black folk on this on with this drug enough, you know, how risky is it for us to even take this drug right now?
Winchell: So there’s a lot of unknown. We know that black patients are very unlikely to be part of these clinical trials when we talk about drugs, including this medication. But what we do know is it does improve longevity as far as memory and lessens the symptoms and severity for those patients who qualify. But to your point, Marc, you know, there are those side effects, such as brain swelling and bleeding, and that has been shown in especially those patients who have more of a severe or moderate to severe form of the disease. So it’s it’s still an important piece that I think we have to have it offered to Black and brown patients, but it’s something that we have to invest in having more of us in those trials so we know what to expect.
Hill: Absolutely. Knowing what to expect is key. Knowing how to get our needs met is necessary. And that’s why we’re going to keep advocating and that’s what we’re going to keep learning. And Dr. Bayo Curry Winchell you are part of how we learned. Thank you so much for your expertise.
Learn more about the new Alzheimer’s drug from the clip above, and tune into theGrio with Marc Lamont Hill every weeknight at 7 pm ET on theGrio cable channel.
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