Dr. Redfield’s Case for Making Alzheimer’s Screening as Routine as Heart or Lung Exams
Dr. Robert Redfield led the CDC through the height of the HIV/AIDS epidemic, and he says Alzheimer’s diagnosis is running into the same resistance.
In this episode, he explains why he considers early diagnosis a non-negotiable principle of medicine, what Alzheimer’s caregiving actually costs families, and why a Medicare coverage rule is still keeping some patients from FDA-approved treatment.
In This Episode:
Your Host: Emily Kaplan
Our Guest:
Dr. Robert Redfield, former Director of the Centers for Disease Control and Prevention, co-founder of the University of Maryland’s Institute of Human Virology, emeritus professor of medicine at the University of Maryland, distinguished professor of medicine at Georgetown School of Medicine, and senior fellow for Biosecurity and Public Health Policy at the Heritage Foundation
This Episode Explores:
- What can Alzheimer’s diagnosis learn from the early years of HIV testing?
- Why does Dr. Redfield call early diagnosis a fundamental principle of medicine?
- How much does Alzheimer’s actually cost families and the economy?
- What is Coverage with Evidence Development, and how does it limit access to treatment?
- What would it take to make cognitive screening a standard part of care after 50?
What Alzheimer’s Diagnosis Can Learn From the History of HIV Testing
Dr. Redfield says Alzheimer’s is repeating a mistake he watched happen firsthand. In the early years of the HIV epidemic, the medical establishment argued against early diagnosis, reasoning that there was nothing doctors could do for patients anyway.
Starting in 1986, Redfield pushed for routine testing within the Department of Defense, although the broader medical community didn’t follow for years. Redfield says that delay cost lives.
He notes that a person can test positive for Alzheimer’s years before symptoms appear and argues for routine testing for everyone over 50.
Why Redfield Calls Alzheimer’s an Economic Threat, Not Just a Medical One
Families can spend more than $400,000 caring for a loved one with the disease over its course, and that burden falls heaviest on caregivers. They often provide constant supervision rather than simple daily medication management.
Redfield connects that cost directly to innovation: The more people who are diagnosed early, the more reason pharmaceutical companies have to develop better treatments for Alzheimer’s.
He watched that dynamic play out with HIV, which went from a 10-month survival prognosis to a manageable, lifelong condition once enough patients were diagnosed to justify the research. Delaying Alzheimer’s onset by even a few years, he says, would be a “home run” for millions of families.
How a Medicare Coverage Rule Still Limits Access to Approved Alzheimer’s Drugs
Even patients who get an early diagnosis can hit a wall, Redfield says, in the form of a CMS requirement called Coverage with Evidence Development. To get Medicare coverage for FDA-approved anti-amyloid drugs, a patient’s doctor has to enroll them in a formal outcomes-tracking registry, and not every provider participates.
Redfield calls it the only case he knows of where an already FDA-approved drug carries that kind of extra bureaucratic step, and he argues it disproportionately shuts out patients in rural areas without close access to a participating provider.
His fix: Make cognitive screening a standard part of the Medicare wellness exam after age 50, and let a drug’s manufacturer handle outcomes tracking instead of the treating physician.
Watch the full episode to see why Alzheimer’s care should follow medicine’s fundamental principle: early diagnosis.
Key Topics and Questions From Today’s Show
What is Coverage with Evidence Development (CED)?
CED is a Medicare coverage pathway, finalized by CMS in 2022, that requires patients to enroll in an approved outcomes registry to access certain FDA-approved drugs, including anti-amyloid monoclonal antibody treatments for Alzheimer’s. Coverage depends on having a provider willing to participate in a qualifying registry study (CMS.gov).
What are the three stages of early Alzheimer’s disease?
The FDA defines three stages of early Alzheimer’s disease. In stage 1, biomarkers such as amyloid are abnormal, but there’s no detectable cognitive decline. Stage 2 involves subtle cognitive changes without functional impairment. Stage 3 includes mild but measurable functional impairment, before the more familiar stages of clinical dementia (FDA.gov).
How much does Alzheimer’s caregiving cost a family?
The total lifetime cost of care for a person with dementia is estimated at just over $400,000, with about 70 percent of that falling on family caregivers through unpaid care and out-of-pocket spending (Alzheimer’s Association).
When did routine HIV testing become standard in the U.S.?
The CDC recommended routine opt-out HIV testing in all healthcare settings in 2006, roughly two decades after Dr. Redfield first pushed for routine testing within the Department of Defense in 1986. Dr. Redfield points to that gap as a cautionary example of how long Alzheimer’s testing could take to become standard if the same reasoning is followed (CDC.gov).
Why does Dr. Redfield want cognitive screening added to the Medicare wellness exam?
Dr. Redfield argues cognitive screening should be as routine as a heart or lung exam, evaluated annually starting around age 50. He believes making it a standard, covered part of the Medicare wellness visit would remove the financial disincentive that currently keeps many patients from getting tested early.