Ronald Reagan, Margaret Thatcher and detective Columbo … even the rich and famous are not immune from the curse of Alzheimer's, and most of us know at least one person who has been hit by this highly complex disease.
The burden of Alzheimer's – and neurological disorders in general – on society is huge and growing. This was just one of the challenges that experts came together to discuss at Swiss Re's 14th annual CRO assembly, Health Focus, where Swiss Re also launched its 2018 SONAR report on emerging risks.
People are living longer, but not healthier lives, and there will be more and more people affected by age-related neurological disorders in the years to come. In the UK, for example, one-fourth of all hospital beds are now filled by someone with Alzheimer's, and, with current demographic trends, 1.7 million people in the UK will have dementia by 2051.
Case numbers are rising exponentially, and the pharmaceutical industry has spent enormous sums pursuing a cure – but with little success.
"There really are no drugs that have any significant impact on curing Alzheimer's disease," Dr. Nicholas Wood of the University College London said during the conference.
Some blame the complexity of the central nervous system, while others cite the rare access to live brain tissues necessary in order to conduct better research.
Although there are some well-known risk factors for dementia – such as traumatic injury, menopause and neurotoxins – one of the main culprits remains also one of the least controllable: your genes.
But genome editing – an emerging branch of medicine that uses an individual's unique genetic makeup to customise medical care – could change all that. Gene therapy is one of the most promising solutions out there for Alzheimer's.
Antisense oligonucleotides (ASO's), the "anti-message," is a new technology which allows doctors to switch off mutant, disease-causing genes with RNA strands. By injecting these ASO's into the spinal fluid of a patient, you can switch off the gene triggering Alzheimer's like a switch. Therefore, mapping the human genome will be key to curing many neurological diseases.
As beneficial as these technologies might become for patients, they also raise important questions and create new risks and exposures for life and health insurers. There are problems with steaming ahead with gene therapy, both technical and ethical, including issues with data security, and the high cost to both develop in the lab and administer to patients.
On a more fundamental level, how do we know if the trigger for Alzheimer's is genetic or not?
While a few diseases are primarily triggered solely from genetic factors, most others are influenced by the environment. Alzheimer's is one of these, as Christoph Nabholz, Head of R&D Life and Health at Swiss Re explained in his presentation Genomic medicine and the insurance industry. Many of these environmental exposures come down to individual lifestyle choices (drugs, stress, exercise, diet, etc.). Although it's too early to say for sure, Dr. Wood stated that there is evidence that gene therapy may also cure Alzheimer's in cases where the trigger is environmental – and this is most promising indeed.
In conclusion, over the past 15 years, the medical profession has made real progress in understanding the source of neurodegeneration. Perhaps the key to successfully curing Alzheimer's lies not in gene therapy alone, but using it in combination with preventative healthy living – which means that the health insurance industry should be incentivising healthy behaviour whenever it can.
As new gene therapies are introduced, the insurance industry needs to take society along with – for example, by getting people's consent in order to use their data in a responsible manner.
Over time, hopefully people will learn that the pros of genome mapping outweigh the cons, allowing people to live not only longer, but also healthier lives.
Category: Funding longer lives
Location: Zürich, Switzerland