Q&A with Dr. Julie Bynum, Co-Principal Investigator of the NBER Coordinating Center on the Economics of Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias Prevention, Treatment, and Care

Introduction: Welcome to a Q&A with Dr. Julie Bynum, one of three co-principal investigators of the NBER Coordinating Center on the Economics of Alzheimer's Disease and Alzheimer's Disease-Related Dementias Prevention, Treatment, and Care. Dr. Bynum's co-principal investigators are Rhoda Au of Boston University and Kathleen McGarry of the University of Los Angeles. The Center is funded by the National Institute on Aging. Dr. Bynum is the Margaret Terpenning Professor of Internal Medicine in the Division of Geriatric Medicine at the University of Michigan, research professor in the Institute of Gerontology, Geriatric Center Associate Director for Health Policy and Research, and a member of the Institute for Healthcare Policy and Innovation. She received her medical and public health degrees from Johns Hopkins, did her residency and chief residency at Dartmouth, and completed specialty training in geriatric medicine at Johns Hopkins. Bynum has a long record of carrying out and leading research projects funded by the NIH and has received many professional accolades. It's a pleasure to have the opportunity to speak with you today, Dr. Bynum. Thank you for your time.

Dr. Bynum: Thank you for having me, it's a delight.

Question: Of course. Diving right into questions: First, a few about your background, and then we'll move to a few about the Center. What initially drew you down the path of studying geriatrics and gerontology?

Dr. Bynum: Yeah, so I am one of those rare birds who went into my educational pathway really inspired by changing what we do for older adults. Back when I was actually in high school, I recognized that what we do in terms of how we treat, medically and otherwise, older adults and our attitudes toward aging really were in need of some serious repair. We weren't doing a good job by older adults. So that was my very first inspiration and it's continued all the way through. As I've learned more, I've learned the problems are complex, they're deep, they're across many, many areas. So, it's something that's both rewarding on the impact for older adults and families and also something that's complex and tricky and you can spend your lifetime trying to solve.

Question: Thank you. So what role can economic research play in improving the quality of life for both the patients and the caregivers?

Dr. Bynum: I'm a physician, I'm not an economist, but one of the things I recognized very, very early is that this disease in particular relies on systems, systems of both healthcare that are complex and families and caregiving systems. And all of that is really dependent on how we pay for care, what we pay for, and how families and people living with this disease can coordinate their care outside of the healthcare system in their homes and their communities. And really, economics is absolutely key. I used to say to people, I'm the geriatrician who said, you know what, I really need to engage with the economists because these are some of the fundamental problems that are going to drive our inability to fix what's going on for older adults and their families.

Question: What do you see as some of the greatest challenges, be they social, economic, or medical, for the United States as we move forward to a population with a significantly higher share of dementia—that is, an aging population?

Dr. Bynum: Yeah, it's a great question. Is there a single greatest challenge? It is hard to distill because, like I said, this is a complex issue that has both medical complexity, long-term care complexity, legal labor force implications, etc. I think if I wanted to boil it down to one thing that's going to really challenge us looking forward is actually the demographic shift where we have a change in the population [that will affect] the dependency ratio, where people actively working and contributing, sort of, financial work and financial labor to support others, children and older adults, is fundamentally going to change. We're going to switch to an era from where [the population] used to be more children and smaller numbers of older adults, to where we're going to have more older adults and fewer children. So we're sort of flipping the population pyramid a bit. And that creates challenges across the board for who's working, who's contributing financially, what it takes to care for your family and your children. All of that is probably, I would say, the singular structural problem that we have to really grapple with over the next 40 years. It underpins so many of the different challenges we face. It's the pure numbers of people and how that's changing across our population.

Question: That's a great segue to start talking about the Center, which, of course, is aiming to address some of these issues. So can you explain a little bit about the mission and goals of the Coordinating Center?

Dr. Bynum: I think our colleagues at the NIH and NIA recognize these demographic changes and the importance of addressing many of the really fundamental issues in the population and the economic impacts on people as well as the economic drivers of the disease. I think there's also the recognition that, in the case of this disease, we probably haven't tapped fully into the community of scientists and investigators who can help us solve these problems for the future. So, the real goal of this particular grant is to say, how can we engage more people who understand these complex populations and economic issues and health system issues, in helping us solve them?

Frankly, in the past, this disease, Alzheimer's disease and dementia, was really not one that people were terribly interested in studying. It's only in the last several years with infusion of funding and the development of the national plan that people are really grabbing hold with the issues and driving it forward. And this is an area that we think there's a lot more to do. So the goal is to stimulate the field of economics to engage with this disease in particular as a major driver of burden and costs to the population and the economy. That's the overarching goal. You might ask me how we're going to do that, which I'm going to anticipate your next question.

Question: Absolutely. Could you outline some of the topics that are being prioritized as part of the Center?

Dr. Bynum: It's kind of breathtaking how broad it is, and I think people get overwhelmed when they see it. But some of the issues—and there are many—certainly the way that we deliver and how we pay for both the medical care system and the long-term care system are critical issues that have both economic implications for the system and for the individuals paying for those systems. So that's a critical area. We're also interested in the economic impact of caregiving itself for people supporting individuals with this disease. There are all sorts of labor market factors, again, related to caregiving, but also the workforce, the paid workforce that supports this population, which, frankly, are very low paid. The direct care workforce is very low paid, and it is hard to keep people in this field.

There's also a lot of the issues around early life impact of education and wealth and all these other issues that have a life course impact on the risk for the disease and sort of the differential risk across populations for even developing it. So I think from issues of what's the economic impact of prevention and management strategies for individuals, for families, how do we have incentive systems for drug pharmaceutical development that can really address the diverse communities at need and risk for these diseases? So basically I would say many, many areas that economists often engage have real need for science in the field of Alzheimer's disease and dementia.

Question: The field and the Center have their work cut out for them. So, what would success look like for the Center, say, five years from now?

Dr. Bynum: Yeah, great question. You know, you can't get anywhere if you don't know where you're going, right? So we would like to see more people doing high-quality economic studies, the economic impact on this disease and of this disease at the end of five years. That means more people who are established in the field, engaged with NIH-funded research on these topics applying for and getting these grants. In addition, developing the early career people who are going to be the future of continuing to study and build the knowledge base that we need to really impact and reduce the burden of this disease on our communities.

Question: We look forward to following the progress of the Center. Thank you again for taking the time today. It's an absolute pleasure speaking with you. Thank you.

Dr. Bynum: Wonderful, thank you.