I’ve been keeping up with the exciting new neuroscience developments on the cause (and hopefully treatment) of Alzheimer’s disease. One of the articles that I recently read was from CNET, “The Red Pill of Alzheimer's: Would You Take It?”  The most recent development is that scientists are now able to go beyond your genetic biomarkers for the genetic risks associated with developing Alzheimer's disease – they can now identify whether you will have a slow progression of the disease or a disease that will “spread like wildfire.” The scientific discussion in the article is interesting, but the part that I found most fascinating was the question that this research poses: If this genetic test was available, would you take it?  Would you take the “red pill” and see how far the rabbit hole goes?

If the “red pill” analogy is lost on you, a quick refresher: The red pill/blue pill concept was popularized in the 1999 movie The Matrix. The movie’s premise is that an artificial reality is advanced enough that it is indistinguishable from reality. And in the movie’s beginning, the protagonist (the always-contemplative Keanu Reeves) is presented with a choice—take the red pill, which will free him from “the matrix” and bring him into the real world, or the blue pill, which will allow him to stay contentedly unaware in the artificially constructed reality.  Borrowing from the movie, the terms “blue pill” and “red pill” have become a metaphor for the choice between facing the world’s difficult realities and maintain the blissful ignorance of illusion. 

So, back to Alzheimer’s disease; the real issue is whether or not consumers will avail themselves of these genetic tests. Alzheimer’s disease is really only the beginning—I’m sure that more advanced testing with genetic markers will soon be available for other conditions as well. The ramifications of these tests will take us far beyond medical decisions and treatment options; it is the individual psychological and larger societal implications that will have a monumental impact. Will consumers yearn to know so that they can better manipulate the outcome, choosing to live with the knowledge of their future demise? Or, will they trade in the time that they could gain to prepare for their fate for the bliss of temporary ignorance? 

I think the answer to that question lies in American’s unique “where there’s a will, there’s a way” attitude.  Consumers maintain a belief that, if they have early knowledge and they have access, there will be some treatment, some technology, some breakthrough that will enable them to change the outcome of the disease. And then the problem will become how consumers deal with the outcome once they have chosen to take the “red pill.”

The New York Times recently had a piece, "Patient Money: When Elder Care Problems Escalate, You Can Hire an Expert," on the challenges of getting good advice when it comes to caring for elderly parents. The author recommends families hire a geriatric care manager, and adds that

"you must pay these professionals out of your own pocket. Regular insurance does not cover them, although some long-term care policies do. But a good care manager can buy you time and some peace of mind so you can concentrate on your job, your family and your own health."

In addition, the article comes complete with rates—$100 to $200 for consultation; $500 to $1,200 for assessment; and continuing case management by the hour.

I don't see many of the behavioral health and social service organizations I work with preparing to provide in-home support consultations and management needed by an aging U.S. population. There are so many factors that will assure this is a booming market (both private pay and third-party pay, by the way).

We have an aging population, with predictions that the 50+ population will live to 110 years of age(!). There is the push by financially destitute Medicaid programs to keep people at home and out of state-paid nursing homes, coupled with the increasing amount of service cost that consumers and families must pay out-of-pocket. New technologies allow more people with greater levels of disability to live at home. And, we have a changing consumer demographic—a soon-to-be-aging baby boomer population that wants to remain home as long as possible.

Behavioral health and social service provider organizations that give up the market for in-home services and supports for an aging population risk losing the in-home market altogether. Integration isn't a phenomenon limited to physician offices.