January 30, 2025 • 31 mins
Can lifestyle choices truly prevent more than 50% of dementia cases? Join Dr. Douglas Beck and Dr. Dung Trinh as we explore this thought-provoking question and uncover groundbreaking insights. Our discussion dives into the 2024 Lancet study, highlighting 14 modifiable risk factors for dementia and the potential to prevent or delay nearly half of all cases. You'll learn about the crucial role primary care plays in managing Alzheimer's amidst a shortage of neurologists and the importance of addressing lifestyle factors like sleep and obesity. We also weigh the benefits and challenges of FDA-approved monoclonal antibodies, exploring their promise and limitations.
In our in-depth conversation, we explore the evolving landscape of Alzheimer's detection and treatment. Hear about the promising potential of biomarkers like P-tau-217 and the role of genetic factors like APOE4. We discuss shifting treatment strategies, moving beyond amyloid-targeted therapies to consider tau proteins and the immune system's involvement. The conversation also shines a light on the flaws in our healthcare system's focus on treatment over prevention, examining the impact of lifestyle industries and Medicare Advantage plans on preventive health measures. Join us for this enlightening discussion that promises to challenge your understanding of Alzheimer's care and prevention.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Blaise M. Delfino, M.S. - (00:19):
Thank you.
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(00:41):
Welcome back to another episodeof the Hearing Matters Podcast.
I'm founder and host, BlaiseDelfino and, as a friendly
reminder, this podcast isseparate from my work at Starkey
.
Dr. Douglas L. Beck (00:56):
Good afternoon.
This is Dr Douglas Beck withthe Hearing Matters Podcast and
once again I have the honor ofworking with my dear friend and
colleague, dr Young Trin h.
Dr Trinh, is a physician inSouthern California, and he
treats diagnoses and worksmostly with Alzheimer's patients
.
Dr Trinh, welcome back to theHearing Matters podcast.
Dr. Dung Trinh (01:14):
Thank you so much, doug.
Good to be back.
Lots of exciting things lastyear in 2024, in the world of
Alzheimer's.
Dr. Douglas L. Beck (01:22):
Absolutely, and we're going to talk about
some of those today, and I'm soglad that you're here because
you are one of the experts inthis and you know some of the
things that come up immediately.
Well, is Dr Trin a neurologist?
And the answer to that is he isnot a neurologist.
There are only about, I want tosay, 10,000 to 12,000
neurologists in the USA, andthere's probably in the USA 8 to
(01:46):
10 million people who have beendiagnosed with Alzheimer's
disease, so obviously theycannot see most of them.
So the actual diagnosis andcare, I think falls to people
like Dr Trinh.
Is that correct?
Or am I way off there?
Dr. Dung Trinh (01:59):
Yeah, I'm an internal medicine physician with
that and I have a special nichein working specific to the
brain because we do Alzheimer'sclinical trials and have done it
for many years, and so internalmedicine docs belong to primary
care.
When you are a generalinternist, of course you can
(02:20):
self-specialize to differentstudies, but the majority of
Alzheimer's and dementia is seenat the primary care level.
Dr. Douglas L. Beck (02:29):
Yeah, and this is very important because
it would be impossible forneurology to see all of them and
many, many cities don't evenhave neurologists, absolutely.
Dr. Dung Trinh (02:39):
I don't know where you're at specific in
Texas, but where we're at inSouthern California, orange
County.
Average wait for neurologiststo be seen six to eight months.
Dr. Douglas L. Beck (02:51):
Which is a very long time when you're
suspected of having dementia.
Dr. Dung Trinh (02:55):
Yes, when you're thinking about dementia and
Alzheimer's time is brain.
I love that.
Yeah, time is brain.
And to wait six to eight monthsto see a neurologist, you're
losing brain cells as time goesby.
Dr. Douglas L. Beck (03:10):
Yeah, and they don't come back.
Even if we are successful withtitrations of different drugs,
right now, nobody has shown anyevidence that memory come back.
Once those memory cells aregone, they're gone, and that's
unfortunate, but that is thestate of the art.
I want to talk to youspecifically now for a few
moments about where we are inpreventing decline.
(03:32):
Based on the Lancet study of2024, now includes 14
potentially modifiable riskfactors, so they're including
high LDL cholesterol as well asvisual loss.
Now it's funny because you andI spoke years ago about, well,
why doesn't the 2020 Lancetstudy include vision?
Because obviously that's a mainsensory pathway to your brain
(03:55):
and I guess they realized thattoo.
We weren't the only ones.
But now they do include that in14.
And what's happened?
Also, rather than the 12previous modifiable risk factors
equaling about 40% of your riskfor dementia, now these 14,
that's about 45%.
So tell me your thoughts onthat, because I know you have a
lot of things to share there.
Dr. Dung Trinh (04:16):
Yeah, absolutely .
My thoughts is that it's notjust 14 modifiable risk factors.
There are many other riskfactors that are modifiable,
that are not on the list yet.
And I say yet, and what'sinteresting is that in 2020,
when the Lancet Commission cameout and published the 12
modifiable risk factors thatwill either slow down or prevent
(04:39):
up to 40% of global Alzheimer'scases, so we move the needle
from 40% to 45% by adding twoadditional risk factors, right
from 12 to 14.
And I can only wonder how highthat needle can be moved as we
add on other risk factors thatare known, such as sleep right,
(05:01):
the importance of sleep.
Dr. Douglas L. Beck (05:03):
And other people have identified sleep and
obesity and other lifestylefactors, and when you and I were
talking offline, you said thatthere was a reasonably good
chance that in the near future,over 50% of dementia cases will
be attributable to choices.
Dr. Dung Trinh (05:18):
Absolutely, absolutely.
I have no doubt we have notlooked at all the risk factors
to add onto that list, but I'msure that the Lancet Commission
is continuing to evaluate.
Absolutely.
Dr. Douglas L. Beck (05:31):
And when you think about this, you know
globally it seems that a lot ofnutrition, a lot of exercise, a
lot of diet, a lot of simple andbasic lifestyle choices
absolutely impact, you know,your later years and this stuff
comes back to haunt you.
So I think this is brilliantand I think it's going the right
(05:53):
way.
And is it fair to say, if youwere to attend to the 14 known
potentially modifiable riskfactors, we would expect to
prevent about 50% of dementiacases.
Dr. Dung Trinh (06:05):
Yes, prevent or delay or slow down up to you
know, 50%, that's remarkable.
Dr. Douglas L. Beck (06:11):
That's absolutely remarkable.
Dr. Dung Trinh (06:12):
Yeah, without taking a pill.
Dr. Douglas L. Beck (06:16):
And when you think about now the pills,
which is one of the areas Iwanted to ask for your thoughts
on, we still have thesemonoclonal antibodies right that
have been FDA approved and youknow they're miraculous, they're
great, they have been shown toreally reduce amyloid plaquing
in the brain, right.
But these are not a pill thatyou take.
These are infusions that takehours to have a complete
(06:39):
infusion.
They're very, very expensiveand tell me the outcomes that
you would expect in a typicalperson who's in early stage
Alzheimer's and they say, doc, Iwant to get one of the Amicams.
Dr. Dung Trinh (06:51):
Absolutely so.
We have three approvedmedication.
One of the three is AccelerateApproval, which is Biogen's
Aducanumab.
That was a few years back, 2021.
In 2023, licanumab was approved, which is Lekembe, and last
year, 2024, donanumab wasapproved, which is Kinsula.
(07:14):
So both Lekembe and Kinsula arefully approved monoclonal
antibodies.
What that means is that theseare medications that are
antibodies that are designed togo up to the brain, find the
plaque tag onto it and alertyour immune system to go up
(07:35):
there to clear it.
Dr. Douglas L. Beck (07:37):
And it does to a large extent, right.
Dr. Dung Trinh (07:40):
Yes, yes, so it's been shown to effectively.
These medicines can clearplaque.
The question is, what can theydo to memory by clearing plaque?
So I'll tell you what they cando and what they can't do so
that we can have some realisticexpectations.
What these medications are foris that they're FDA approved for
(08:04):
a certain level of Alzheimer'sdementia, meaning they're
approved for mild Alzheimer'scases, mild Alzheimer's stage.
They're not approved formoderate or severe.
They're also approved for astage which we call the mild
cognitive impairment, which iskind of like pre-Alzheimer's
(08:26):
right before you move over toAlzheimer's you have MCI, right.
So these medications areapproved for MCI and mild AD,
mild Alzheimer's.
They're not approved foranything before MCI, meaning
your memory is fine even if youhave plaque Although those
studies are ongoing now to lookto see if medications are
(08:47):
effective for that and they'renot approved for moderate or
severe cases of Alzheimer's.
So what can these meds do?
They're IV infusions.
In the case of Lekembe it'severy two weeks, through an IV,
you infuse a monoclonal antibodyto tag onto what I call the
(09:09):
protofibrils, which is a stateactually before even the plaque
occur.
You have these different microchanges, yeah, these different
stages as the plaque's buildingup to become plaque.
The one of those stages, theprotofibral, which is what
Lekembe attaches to Sure, and asa result of that, clears the
(09:32):
plaque.
The medication, donanumab,which is Kinsula, it attaches
directly to the plaque itself.
Yeah, and that was the secondone.
Yeah, right, the second oneattaches to the end stage of
that process, which is theplaque.
Both these medications can andhas been shown in clinical
research to slow down theprocess of memory loss, compared
(09:56):
to the placebo group, comparedto the group patients not
getting treatment.
What they cannot do is theycannot bring back.
So we can't make a U-turn onmemory, right, if your memory
decline is like this over time,what we can do with these meds
is slow down the decline right,slow down the slope of decline.
We're not seeing this and thereason we're not seeing this is
(10:20):
because over time, withAlzheimer's, we're losing brain
cells, right, neuraldegeneration.
The brain cells are dying,they're going away and as we
lose brain cells, we're notbringing dead brain cells back,
which is why we're not seeingthis.
This argues for the importanceof early detection, when you
have more brain cells than laterdetection when you have more
(10:40):
brain cells than later detectionwhen you have less brain cells.
Yeah you have more to work with.
More to work with?
Yeah, the other thing we shouldknow is that these medications
are not without side effects.
The top two potential sideeffects is what we call micro
hemorrhage, which is a littleblood that can form, and
(11:03):
cerebral.
Some swelling of the brain arepotential side effects that we
see, as well as the plaques isgetting removed.
These are potential sideeffects.
They sound kind of scary andthey can't be.
Dr. Douglas L. Beck (11:16):
Yeah, it's a brain bleed, and if you have a
brain bleed, we can't just puta Band-Aid on it.
You know it's under control.
Dr. Dung Trinh (11:26):
We can't put a Band-Aid on it.
Statistically, though, thesebrain bleeds microhemorrhage, I
call them, and swelling for themost part they are thematic or
mild, meaning patients don'teven know that they have these
symptoms.
That's what we do know.
We also know that, for the mostpart, they go away.
They're not permanent.
Dr. Douglas L. Beck (11:47):
They resolve by just holding the
medication treatment and theygot a lot of attention about 18
months ago the term brain bleedwas everywhere.
Yeah, it was pretty scary,right, but I like
microhemorrhage.
I think that probably puts itin a more appropriate
perspective, and so go ahead.
So we're talking about howthese can help in patients who
(12:10):
have been diagnosed withAlzheimer's early stage or MCI,
and we're talking about what thedrugs can and cannot do.
And you're saying that inessence, they do slow it down a
bit, but they can't bring back.
And what kind of time would itbuy?
I mean, are we talking about aweek, a month, a year?
What's typical?
Dr. Dung Trinh (12:29):
So, based on the research that's been done the
phase three studies we're buyingprobably about half a year, six
months or so, or plus or minusa few months, depending on how
early you catch it.
If we're treating someone atthe MCI stage, we get better
results than if we're treatingsomeone who's a little bit more
(12:50):
advanced, at the mildAlzheimer's stage.
Dr. Douglas L. Beck (12:52):
Well, let me ask you a question clinically
, because I remember in 2022,there was a paper in the JAMA
that said of people age 65 andolder, about one out of five has
mild cognitive impairment.
And the important thing thereis that of the people with MCI,
which is one out of five peopleover age 65 in the US.
(13:13):
About one out of five of thoseconverts annually to full-blown
dementia or Alzheimer's inparticular.
So the question I would have isif you're trying to treat them
earlier and they're in the MCIstage, how do you know which one
was going to convert, or doesit not matter?
Dr. Dung Trinh (13:31):
So here's something interesting At the MCI
stage, most patients are noteven diagnosed.
Yeah, because at the mildstages, when you have just mild
memory concerns, we all blame iton what?
On aging Right?
Dr. Douglas L. Beck (13:48):
That's just , dad, that's just grandpa.
Dr. Dung Trinh (13:51):
So folks don't even go to the doctor to
complain about it, as plaque isbuilding up.
Yeah, it's a fair point.
Yeah, they don't even go.
So we miss MCI at the primarycare level and we miss it by
over 90% Based on the literature.
We miss it by over 90% becausepatients do not go to complain
about mild symptoms.
Dr. Douglas L. Beck (14:13):
Yeah, that's a huge problem when we
have medications that canaddress Alzheimer's at the mild
stages, at the mild stage, andthat also argues for more
cognitive screenings, because ifwe're not screening, then we're
going to miss more and thepatients are invisible to us.
Dr. Dung Trinh (14:29):
Absolutely.
It argues for early detectionand the need for awareness,
especially now that we have dataon prevention.
We have data on, you know, theLancet Commission's 14
modifiable risks.
It's so important to find outif you're at risk or not.
What I'm excited about arethese new blood biomarkers that
we have been hearing.
Dr. Douglas L. Beck (14:49):
That looks really good Because with a blood
biomarker, when somebody hasthe appropriate anneal the APO4
in particular right, when you'reseeing that from mom and dad,
you're saying that you'vedoubled up on that in your
karyotyping.
You're seeing that from mom anddad.
Dr. Dung Trinh (15:02):
You're saying that you've doubled up on that
in your karyotyping.
Yes, so there's two types.
So when you're looking forgenetics, you're looking at the
APOE4 specific to see who are atrisk.
If you have the genetics, theblood biomarkers look for the
specific protein yeah, that'sfantastic.
The amyloid and the tau right,the leading blood biomarker
(15:22):
today is the P-tau-217,phosphorylated tau-217.
Yeah, I read about this.
Yeah, it has an accuracy rateof around 90% or so.
We can improve that by addingadditional tests.
Dr. Douglas L. Beck (15:35):
So if the patient has signs and symptoms
of MCI and they've got thisblood biomarker, they're a
candidate for infusion.
Dr. Dung Trinh (15:42):
Yeah, absolutely .
If you've got MCI and the bloodbiomarker shows the presence,
you know you get a positiveP-tau 217, then you can go on.
To confirm how much of it is upthere, you can do a PET scan or
a lumbar puncture to actuallyquantify the amount that's up
(16:03):
there and once you quantify theamount then you can discuss the
options for treatment.
With that, if you get a PTAL217 blood test and it's negative
, you can at least have somepeace of mind that at least for
now you can cross Alzheimer'soff your list for now, right,
(16:23):
and this is one of the issuesthat I'm reading about quite a
bit in the newer literature 2024, 2025.
Dr. Douglas L. Beck (16:30):
So to a large degree, we can attack
amyloid, maybe too late andmaybe after the damage is done,
but there's a lot of literaturenow that's pointing to tau
proteins as the more significantissue, right, and this blood
biomarker talks to that too.
There was a paper I was goingto bring up.
I'm going to have to read thisbecause I haven't memorized it
yet.
This came out by KatherinePosson, jeff Burns and Brent
(16:52):
Forrester and it's in December10, 2024 on the geminetworkcom,
and they talk about monoclonalantibody treatments are approved
by FDA.
And they talk about monoclonalantibody treatments are approved
by FDA lacanumab, as you said,and donanumab, as you said based
on their ability to clearamyloid and slow clinical
progression.
No-transcript somewhat and notsee.
(17:32):
You know, it's got to be theright patient at the right time.
Maybe the pathway is throughtau proteins.
Dr. Dung Trinh (17:38):
Absolutely.
The ultimate pathway iscombination therapy.
Dr. Douglas L. Beck (17:41):
Yeah, tell me about that, tell me about
that, tell me about that, yeah.
Dr. Dung Trinh (17:44):
What's interesting, I've noticed this
past year, like several yearsago, everyone was attacking the
amyloid right, anti-amyloidRight.
Past year there's been morestudies now focused on tau, yeah
, and, as a matter of fact, themajority of studies for
Alzheimer's today are notanti-amyloid studies anymore.
They're looking at differentmechanisms of action dealing
(18:05):
with the immune system.
I've seen vaccination studiesnow for Alzheimer's, studies
that are cutting downinflammation.
Even the weight loss medicinesare being studied for
Alzheimer's right the GLP-1s.
Dr. Douglas L. Beck (18:18):
Yeah, well, it makes sense, because they're
doing something and nobodyknows exactly the limits of what
they're doing.
Dr. Dung Trinh (18:26):
Yes, so the ultimate solution in my view, is
combination therapy combinedwith lifestyle.
Yeah, you got to live thatlifestyle.
Dr. Douglas L. Beck (18:44):
right, you can remove plaque, but if you're
not living a lifestyle toprevent, you know what you're
talking about.
Now harkens back to 20, 25, 30years ago, when we were doing,
you know, cabg procedures, whichis, coronary artery bypass with
a graft, and lots of peoplewere getting this done, but they
never changed their lifestyle.
So you know, eight years laterthey would die of a heart attack
or myocardial infarctionbecause they didn't adapt their
(19:06):
lifestyle, and so they had theprocedure done and so they had
good perfusion through theirheart, but the lifestyle wound
up killing them anyway.
Right, it comes back at you.
Dr. Dung Trinh (19:15):
Absolutely.
Bypass surgery is cleaning theplumbing, but you have to stop
the lifestyle that causes theplumbing to clog up.
Same thing with Alzheimer'sright.
We have to stop the lifestylethat allows production.
Dr. Douglas L. Beck (19:29):
All right, let me just get your thoughts.
I'm going to let you go in afew minutes.
But you and I have often talkedabout we don't necessarily have
a health care system.
We have a sick care system.
That's a quote from you aboutsix months ago and I've heard it
before and I love it.
And I don't love it becauseit's reality.
I love it because it's accurate.
And when you look at thedifferent ratings for the
American healthcare systemwhether it's private pay
(19:50):
insurance doesn't matter we arerated anywhere between number 35
, 36, 37 by the World HealthOrganization, all the way up to
number 65 in the new study thatcame out of the UK, and that
means there are 35 to 60countries that have better
healthcare for their citizens,providing better healthcare.
We have the most expensivemedicines and drugs in the
entire world.
We have the most expensivehealthcare.
We have the most expensivemedicines and drugs in the
(20:10):
entire world.
We have the most expensivehealthcare and I would argue
that the biggest issue is thatwe may have the best physicians,
like you.
We may have the bestaudiologists, like some of my
colleagues, and that's great,but the issue to me is that
people do not have access.
You know you have to go whereyour insurance tells you to go.
You have to call ahead of timeand get pre-approved, and you
(20:32):
know they're not going topre-approve something that cost
them a lot of money, and that'swhat I see as the issue is.
You know, if they can't make alot of money on it, then they
won't approve it, and I thinkthat insurance is a debacle.
It is a mess.
Dr. Dung Trinh (20:46):
We, as you mentioned, we have a sick care
system, not a system that isfocused on prevention, and quite
simply, the system itself issick because prevention does not
pay Right Right.
Hospitals shut down if theirbeds are not full yeah.
Doctors will close theirshingles if nobody walks in the
(21:08):
door yeah.
So we have a system that iskind of backward we pay for
sickness, we don't pay forhealth, and on top of that, we
have industries that arefunneling a lifestyle of poor
health the fast foods, you know,the junk food, the food
industry, cigarettes.
(21:30):
Everything else around us tellsus to live this lifestyle that
leads to chronic disease.
I was reading the other daythat we have thousands of
chemicals in our food that arecurrently banned and not allowed
in Europe and other countriesthat we eat every day.
Dr. Douglas L. Beck (21:51):
Absolutely.
Dr. Dung Trinh (21:53):
And there's a problem with that, isn't?
Dr. Douglas L. Beck (21:55):
there there's a huge problem, and even
down to water bottles.
Right, you're drinking waterbecause you're trying to stay
healthy and not absorbable whileyou're absorbing the plastic.
Dr. Dung Trinh (22:04):
Microplastics, right, nanoplastics Huge, huge
issue.
Now we're seeing microplasticsin the brain.
Yeah, Oregon has microplastics.
Huge, huge issue.
Now we're seeing microplasticsin the brain.
Oregon has microplastics.
Dr. Douglas L. Beck (22:13):
You know, the issue is that nobody knows
the long-term results of any ofthis stuff, and we're doing it
every day and it's frightening,it's scary and I don't know how
to fix it.
I really don't, and I'm notsuggesting that I do, but I
think you know the first step,of course, is recognizing
there's a problem.
And we, you know, we've beenaware of nutrition and exercise
(22:34):
and the need to stay healthy fora long time, but, as you say,
we don't encourage it.
We, you know, doctors are therefor disease, not to encourage
health.
Dr. Dung Trinh (22:42):
Yeah, we used to say knowledge is power, but I'm
questioning that now, becauseknowledge alone is not power.
Knowledge is free on YouTube.
You can learn anything you want.
What really is power is takingaction.
Dr. Douglas L. Beck (22:58):
Yeah, that's good.
Dr. Dung Trinh (22:58):
And I think there's a big gap, right?
We all know, in theory, how toprevent obesity and diabetes,
and yet two out of three of usare overweight in the United
States, right?
So it's not just knowledge.
We got to find a way forsupport and accountability as
well.
Yet two out of three of us areoverweight in the United States.
So it's not just knowledge.
We got to find a way forsupport and accountability as
well with that.
It's why I have a personaltrainer.
(23:19):
My personal trainer isn't therewaiting for me, I'll never show
up to the gym.
It's kind of sad, right, verysad for a physician.
But yeah, it's theaccountability, along with that
knowledge and it's theaccountability, along with that
knowledge.
Dr. Douglas L. Beck (23:32):
And it is needed.
I just want to talk aboutinsurance for a minute, because
almost 50% of people who areeligible for Medicare are on
Medicare Advantage and I readabout this all the time and
Medicare Advantage programs arecommercial programs, run by
whomever.
But I think it's important forconsumers and patients to
understand how managed careprograms work.
When you sign up for a MedicareAdvantage program, the federal
(23:55):
government gives that commercialentity about $1,000 a month to
take care of you, and what thatmeans is that that commercial
entity will say oh, we're goingto give you this trinket.
Here's a shiny thing that youmight like silver sneakers.
You might get a bad hearing aid.
You might get a free dentalexam with no dental care.
You know they do this sort ofthing.
(24:17):
People sign up and the moneythat they are not spending on
you is their profit, and manypeople think that these things
are free.
Well, it's not.
It's costing the federalgovernment about, you know,
$12,000 a year for everybody whosigns up for Medicare Advantage
.
Now, I may have those numbers alittle wrong.
I'm speaking off the top of myhead, I don't have any sources
(24:37):
in front of me, but my point isthat when you have regular
Medicare, it's more of a fee forservice and you know how much
you have to pay.
They can see on the guideline,the providers can see how much
they're going to get reimbursedand you just do whatever you
need.
So I think this is a part of itas well.
Is that so many people are onMedicare Advantage but they
don't really understand how itworks or who's paying for it.
(25:00):
They just know what they'regetting and what they're getting
.
There was an article in theJournal of the American Medical
Association, I want to say about14 months ago, and the title of
it, I'm pretty sure, was higherprices and less health care,
and I don't think you want toweigh in on that.
Dr. Dung Trinh (25:15):
But if you have a comment on it.
I'd love to I will weigh in onit.
I will weigh in on it, Please.
Yes, because I live.
I have lived in this system fora long time and seen insurance
and insurance processes, so Iwould say there's pros and cons.
The theoretical benefit ofMedicare Advantage is that your
(25:35):
care is managed.
So managed could be a bad wordor a good word right.
Managed can be a bad word whenyour care is controlled.
You can only go to this groupof doctors, that group of
specialists, to contract withthe Medicare Advantage plan.
Managed could be good if you'regetting reminders for your
colonoscopies, your mammograms,your eye exams.
(25:57):
From a prevention side, if youhave pure straight Medicare, no
one's sending you reminders togo get your prevention studies
and things of that sort.
Well, that depends on who yourdoctors are.
The doctor too, yes, depends onthe doctor and the group.
But I know that MedicareAdvantage are incentivized to
(26:19):
offer prevention, notnecessarily because they want
you to be super healthy, butbecause if you can prevent
disease, you spend less money onthe disease, right?
Dr. Douglas L. Beck (26:30):
Yeah, and if you can prevent it, obviously
they don't have to pay for it,which is beneficial for
everybody.
Dr. Dung Trinh (26:36):
Yes, absolutely.
Medicare Advantage does giveyou these supplements that
straight Medicare doesn't payfor, sometimes dental hearing
aids, you know things of thatsort.
So there's pros and cons.
Folks sign up for MedicareAdvantage mainly due to the
supplemental stuff like thesilver sneakers and things of
that sort yeah.
Dr. Douglas L. Beck (26:52):
but then the problem comes in right when
you find out that you had aheart attack and you have to go
to this and you're not at thehospital and you have to get
there.
Yeah, you can't choose yourhospitals.
Dr. Dung Trinh (27:00):
You can't choose your doctor.
You got to be within thatnetwork.
So you're giving up freedom.
You're giving up freedom inMedicare Advantage with the hope
of getting these supplementalbenefits, and the prevention
side is kind of what you'regiving up.
Dr. Douglas L. Beck (27:15):
Yeah, and if prevention works, then you're
in great shape on MedicareAdvantage, right?
But anyway, so it is anindividual decision.
My point was to discuss howit's actually funded, because I
don't think people understandthat and, as you say, you know,
when you sign up for it thereare some advantages and there
are some disadvantages as well.
So it's up to the consumer.
But I got to tell you, you know, I turned 65 a long time ago
(27:38):
and trying to make your waythrough all those programs is a
nightmare.
But listen, before I let you go, I know you have a new YouTube
series and I was actuallywatching it this morning and
it's really good because it'sall very, very brief YouTube
videos.
So what's the name of the ofthe YouTube series?
How do people find it?
Dr. Dung Trinh (27:57):
Well, it's so.
It's sponsored by East side andit's it's unlocking Alzheimer's
with that.
They can probably go to myLinkedIn, I suppose, and find
the link on there.
Dr. Douglas L. Beck (28:07):
Yeah, okay, well, you know we'll do, we'll
do.
We'll put it in the descriptionof this podcast.
We'll add the link.
Dr. Dung Trinh (28:13):
We'll add more content to it.
Short snippets of educationalmaterial over time.
Dr. Douglas L. Beck (28:20):
Right, and the ones I saw were things like
reflections of the real worldand you were talking about.
You know, when we talk aboutAlzheimer's, it's important to
understand who the patientreally is, Because in the
Hispanic community it's one anda half times what it is in the
Caucasian community In the Blackcommunity?
I don't recall, but it wassubstantially greater, yeah,
(28:41):
twice yeah, and so it's a greatdiscussion on things that most
people are not aware of.
And then you talk about in oneof the other ones it was how to
evaluate if a epidemiologicstudy or any study, really is
appropriately compared to yourown personal health or, you know
, appropriately involves you,because a lot of studies you
know they can be longitudinal,they could be random control
(29:03):
trials, they could beprospective, they could be
retrospective, and all thisstuff matters as far as it
doesn't mean any of the studiesare bad.
It just means you have tounderstand what it does mean.
Dr. Dung Trinh (29:13):
A study is not a study.
A study means a whole, wide,different types of studies,
right A whole wide array ofstudies.
They all answer differentquestions.
Dr. Douglas L. Beck (29:23):
That's right, and I think that's why
there's always confusion amongpatients and also among
professionals, because, you know, we can easily find things that
support our viewpoint, but thensomebody can point out other
studies and the question is isthis the same population we're
talking about?
Is this the same treatmentwe're talking about?
Is there a control group?
Is there an experimental group?
You know, in all thesequestions which matter, so I
(29:44):
really enjoyed your recordingson that.
Dr. Dung Trinh (29:47):
Thank you.
There's good science and goodmarketing and they're not always
the same.
I've seen these big headlinescure for this, cure for that and
you try to find the study andthey may have a study.
And you read the study.
Oh, it's a cure in rats, nothumans.
Yeah, and that's extrapolatedto everyone else.
Dr. Douglas L. Beck (30:02):
So yeah, Absolutely, Absolutely All right
.
Well listen, it's always a joyto talk to you.
I hope we do it again sometimesoon and in the meantime, I wish
you a joyous and healthy newyear and I will look forward to
speaking with you sometime inthe near future.
Dr. Dung Trinh (30:15):
Very good to see you, doug.
Have a great day.
Thanks so much.
All right, bye-bye.
Thank you.
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(00:41):
Welcome back to another episodeof the Hearing Matters Podcast.
I'm founder and host, BlaiseDelfino and, as a friendly
reminder, this podcast isseparate from my work at Starkey
.
Dr. Douglas L. Beck (00:56):
Good afternoon.
This is Dr Douglas Beck withthe Hearing Matters Podcast and
once again I have the honor ofworking with my dear friend and
colleague, dr Young Trin h.
Dr Trinh, is a physician inSouthern California, and he
treats diagnoses and worksmostly with Alzheimer's patients
.
Dr Trinh, welcome back to theHearing Matters podcast.
Dr. Dung Trinh (01:14):
Thank you so much, doug.
Good to be back.
Lots of exciting things lastyear in 2024, in the world of
Alzheimer's.
Dr. Douglas L. Beck (01:22):
Absolutely, and we're going to talk about
some of those today, and I'm soglad that you're here because
you are one of the experts inthis and you know some of the
things that come up immediately.
Well, is Dr Trin a neurologist?
And the answer to that is he isnot a neurologist.
There are only about, I want tosay, 10,000 to 12,000
neurologists in the USA, andthere's probably in the USA 8 to
(01:46):
10 million people who have beendiagnosed with Alzheimer's
disease, so obviously theycannot see most of them.
So the actual diagnosis andcare, I think falls to people
like Dr Trinh.
Is that correct?
Or am I way off there?
Dr. Dung Trinh (01:59):
Yeah, I'm an internal medicine physician with
that and I have a special nichein working specific to the
brain because we do Alzheimer'sclinical trials and have done it
for many years, and so internalmedicine docs belong to primary
care.
When you are a generalinternist, of course you can
(02:20):
self-specialize to differentstudies, but the majority of
Alzheimer's and dementia is seenat the primary care level.
Dr. Douglas L. Beck (02:29):
Yeah, and this is very important because
it would be impossible forneurology to see all of them and
many, many cities don't evenhave neurologists, absolutely.
Dr. Dung Trinh (02:39):
I don't know where you're at specific in
Texas, but where we're at inSouthern California, orange
County.
Average wait for neurologiststo be seen six to eight months.
Dr. Douglas L. Beck (02:51):
Which is a very long time when you're
suspected of having dementia.
Dr. Dung Trinh (02:55):
Yes, when you're thinking about dementia and
Alzheimer's time is brain.
I love that.
Yeah, time is brain.
And to wait six to eight monthsto see a neurologist, you're
losing brain cells as time goesby.
Dr. Douglas L. Beck (03:10):
Yeah, and they don't come back.
Even if we are successful withtitrations of different drugs,
right now, nobody has shown anyevidence that memory come back.
Once those memory cells aregone, they're gone, and that's
unfortunate, but that is thestate of the art.
I want to talk to youspecifically now for a few
moments about where we are inpreventing decline.
(03:32):
Based on the Lancet study of2024, now includes 14
potentially modifiable riskfactors, so they're including
high LDL cholesterol as well asvisual loss.
Now it's funny because you andI spoke years ago about, well,
why doesn't the 2020 Lancetstudy include vision?
Because obviously that's a mainsensory pathway to your brain
(03:55):
and I guess they realized thattoo.
We weren't the only ones.
But now they do include that in14.
And what's happened?
Also, rather than the 12previous modifiable risk factors
equaling about 40% of your riskfor dementia, now these 14,
that's about 45%.
So tell me your thoughts onthat, because I know you have a
lot of things to share there.
Dr. Dung Trinh (04:16):
Yeah, absolutely .
My thoughts is that it's notjust 14 modifiable risk factors.
There are many other riskfactors that are modifiable,
that are not on the list yet.
And I say yet, and what'sinteresting is that in 2020,
when the Lancet Commission cameout and published the 12
modifiable risk factors thatwill either slow down or prevent
(04:39):
up to 40% of global Alzheimer'scases, so we move the needle
from 40% to 45% by adding twoadditional risk factors, right
from 12 to 14.
And I can only wonder how highthat needle can be moved as we
add on other risk factors thatare known, such as sleep right,
(05:01):
the importance of sleep.
Dr. Douglas L. Beck (05:03):
And other people have identified sleep and
obesity and other lifestylefactors, and when you and I were
talking offline, you said thatthere was a reasonably good
chance that in the near future,over 50% of dementia cases will
be attributable to choices.
Dr. Dung Trinh (05:18):
Absolutely, absolutely.
I have no doubt we have notlooked at all the risk factors
to add onto that list, but I'msure that the Lancet Commission
is continuing to evaluate.
Absolutely.
Dr. Douglas L. Beck (05:31):
And when you think about this, you know
globally it seems that a lot ofnutrition, a lot of exercise, a
lot of diet, a lot of simple andbasic lifestyle choices
absolutely impact, you know,your later years and this stuff
comes back to haunt you.
So I think this is brilliantand I think it's going the right
(05:53):
way.
And is it fair to say, if youwere to attend to the 14 known
potentially modifiable riskfactors, we would expect to
prevent about 50% of dementiacases.
Dr. Dung Trinh (06:05):
Yes, prevent or delay or slow down up to you
know, 50%, that's remarkable.
Dr. Douglas L. Beck (06:11):
That's absolutely remarkable.
Dr. Dung Trinh (06:12):
Yeah, without taking a pill.
Dr. Douglas L. Beck (06:16):
And when you think about now the pills,
which is one of the areas Iwanted to ask for your thoughts
on, we still have thesemonoclonal antibodies right that
have been FDA approved and youknow they're miraculous, they're
great, they have been shown toreally reduce amyloid plaquing
in the brain, right.
But these are not a pill thatyou take.
These are infusions that takehours to have a complete
(06:39):
infusion.
They're very, very expensiveand tell me the outcomes that
you would expect in a typicalperson who's in early stage
Alzheimer's and they say, doc, Iwant to get one of the Amicams.
Dr. Dung Trinh (06:51):
Absolutely so.
We have three approvedmedication.
One of the three is AccelerateApproval, which is Biogen's
Aducanumab.
That was a few years back, 2021.
In 2023, licanumab was approved, which is Lekembe, and last
year, 2024, donanumab wasapproved, which is Kinsula.
(07:14):
So both Lekembe and Kinsula arefully approved monoclonal
antibodies.
What that means is that theseare medications that are
antibodies that are designed togo up to the brain, find the
plaque tag onto it and alertyour immune system to go up
(07:35):
there to clear it.
Dr. Douglas L. Beck (07:37):
And it does to a large extent, right.
Dr. Dung Trinh (07:40):
Yes, yes, so it's been shown to effectively.
These medicines can clearplaque.
The question is, what can theydo to memory by clearing plaque?
So I'll tell you what they cando and what they can't do so
that we can have some realisticexpectations.
What these medications are foris that they're FDA approved for
(08:04):
a certain level of Alzheimer'sdementia, meaning they're
approved for mild Alzheimer'scases, mild Alzheimer's stage.
They're not approved formoderate or severe.
They're also approved for astage which we call the mild
cognitive impairment, which iskind of like pre-Alzheimer's
(08:26):
right before you move over toAlzheimer's you have MCI, right.
So these medications areapproved for MCI and mild AD,
mild Alzheimer's.
They're not approved foranything before MCI, meaning
your memory is fine even if youhave plaque Although those
studies are ongoing now to lookto see if medications are
(08:47):
effective for that and they'renot approved for moderate or
severe cases of Alzheimer's.
So what can these meds do?
They're IV infusions.
In the case of Lekembe it'severy two weeks, through an IV,
you infuse a monoclonal antibodyto tag onto what I call the
(09:09):
protofibrils, which is a stateactually before even the plaque
occur.
You have these different microchanges, yeah, these different
stages as the plaque's buildingup to become plaque.
The one of those stages, theprotofibral, which is what
Lekembe attaches to Sure, and asa result of that, clears the
(09:32):
plaque.
The medication, donanumab,which is Kinsula, it attaches
directly to the plaque itself.
Yeah, and that was the secondone.
Yeah, right, the second oneattaches to the end stage of
that process, which is theplaque.
Both these medications can andhas been shown in clinical
research to slow down theprocess of memory loss, compared
(09:56):
to the placebo group, comparedto the group patients not
getting treatment.
What they cannot do is theycannot bring back.
So we can't make a U-turn onmemory, right, if your memory
decline is like this over time,what we can do with these meds
is slow down the decline right,slow down the slope of decline.
We're not seeing this and thereason we're not seeing this is
(10:20):
because over time, withAlzheimer's, we're losing brain
cells, right, neuraldegeneration.
The brain cells are dying,they're going away and as we
lose brain cells, we're notbringing dead brain cells back,
which is why we're not seeingthis.
This argues for the importanceof early detection, when you
have more brain cells than laterdetection when you have more
(10:40):
brain cells than later detectionwhen you have less brain cells.
Yeah you have more to work with.
More to work with?
Yeah, the other thing we shouldknow is that these medications
are not without side effects.
The top two potential sideeffects is what we call micro
hemorrhage, which is a littleblood that can form, and
(11:03):
cerebral.
Some swelling of the brain arepotential side effects that we
see, as well as the plaques isgetting removed.
These are potential sideeffects.
They sound kind of scary andthey can't be.
Dr. Douglas L. Beck (11:16):
Yeah, it's a brain bleed, and if you have a
brain bleed, we can't just puta Band-Aid on it.
You know it's under control.
Dr. Dung Trinh (11:26):
We can't put a Band-Aid on it.
Statistically, though, thesebrain bleeds microhemorrhage, I
call them, and swelling for themost part they are thematic or
mild, meaning patients don'teven know that they have these
symptoms.
That's what we do know.
We also know that, for the mostpart, they go away.
They're not permanent.
Dr. Douglas L. Beck (11:47):
They resolve by just holding the
medication treatment and theygot a lot of attention about 18
months ago the term brain bleedwas everywhere.
Yeah, it was pretty scary,right, but I like
microhemorrhage.
I think that probably puts itin a more appropriate
perspective, and so go ahead.
So we're talking about howthese can help in patients who
(12:10):
have been diagnosed withAlzheimer's early stage or MCI,
and we're talking about what thedrugs can and cannot do.
And you're saying that inessence, they do slow it down a
bit, but they can't bring back.
And what kind of time would itbuy?
I mean, are we talking about aweek, a month, a year?
What's typical?
Dr. Dung Trinh (12:29):
So, based on the research that's been done the
phase three studies we're buyingprobably about half a year, six
months or so, or plus or minusa few months, depending on how
early you catch it.
If we're treating someone atthe MCI stage, we get better
results than if we're treatingsomeone who's a little bit more
(12:50):
advanced, at the mildAlzheimer's stage.
Dr. Douglas L. Beck (12:52):
Well, let me ask you a question clinically
, because I remember in 2022,there was a paper in the JAMA
that said of people age 65 andolder, about one out of five has
mild cognitive impairment.
And the important thing thereis that of the people with MCI,
which is one out of five peopleover age 65 in the US.
(13:13):
About one out of five of thoseconverts annually to full-blown
dementia or Alzheimer's inparticular.
So the question I would have isif you're trying to treat them
earlier and they're in the MCIstage, how do you know which one
was going to convert, or doesit not matter?
Dr. Dung Trinh (13:31):
So here's something interesting At the MCI
stage, most patients are noteven diagnosed.
Yeah, because at the mildstages, when you have just mild
memory concerns, we all blame iton what?
On aging Right?
Dr. Douglas L. Beck (13:48):
That's just , dad, that's just grandpa.
Dr. Dung Trinh (13:51):
So folks don't even go to the doctor to
complain about it, as plaque isbuilding up.
Yeah, it's a fair point.
Yeah, they don't even go.
So we miss MCI at the primarycare level and we miss it by
over 90% Based on the literature.
We miss it by over 90% becausepatients do not go to complain
about mild symptoms.
Dr. Douglas L. Beck (14:13):
Yeah, that's a huge problem when we
have medications that canaddress Alzheimer's at the mild
stages, at the mild stage, andthat also argues for more
cognitive screenings, because ifwe're not screening, then we're
going to miss more and thepatients are invisible to us.
Dr. Dung Trinh (14:29):
Absolutely.
It argues for early detectionand the need for awareness,
especially now that we have dataon prevention.
We have data on, you know, theLancet Commission's 14
modifiable risks.
It's so important to find outif you're at risk or not.
What I'm excited about arethese new blood biomarkers that
we have been hearing.
Dr. Douglas L. Beck (14:49):
That looks really good Because with a blood
biomarker, when somebody hasthe appropriate anneal the APO4
in particular right, when you'reseeing that from mom and dad,
you're saying that you'vedoubled up on that in your
karyotyping.
You're seeing that from mom anddad.
Dr. Dung Trinh (15:02):
You're saying that you've doubled up on that
in your karyotyping.
Yes, so there's two types.
So when you're looking forgenetics, you're looking at the
APOE4 specific to see who are atrisk.
If you have the genetics, theblood biomarkers look for the
specific protein yeah, that'sfantastic.
The amyloid and the tau right,the leading blood biomarker
(15:22):
today is the P-tau-217,phosphorylated tau-217.
Yeah, I read about this.
Yeah, it has an accuracy rateof around 90% or so.
We can improve that by addingadditional tests.
Dr. Douglas L. Beck (15:35):
So if the patient has signs and symptoms
of MCI and they've got thisblood biomarker, they're a
candidate for infusion.
Dr. Dung Trinh (15:42):
Yeah, absolutely .
If you've got MCI and the bloodbiomarker shows the presence,
you know you get a positiveP-tau 217, then you can go on.
To confirm how much of it is upthere, you can do a PET scan or
a lumbar puncture to actuallyquantify the amount that's up
(16:03):
there and once you quantify theamount then you can discuss the
options for treatment.
With that, if you get a PTAL217 blood test and it's negative
, you can at least have somepeace of mind that at least for
now you can cross Alzheimer'soff your list for now, right,
(16:23):
and this is one of the issuesthat I'm reading about quite a
bit in the newer literature 2024, 2025.
Dr. Douglas L. Beck (16:30):
So to a large degree, we can attack
amyloid, maybe too late andmaybe after the damage is done,
but there's a lot of literaturenow that's pointing to tau
proteins as the more significantissue, right, and this blood
biomarker talks to that too.
There was a paper I was goingto bring up.
I'm going to have to read thisbecause I haven't memorized it
yet.
This came out by KatherinePosson, jeff Burns and Brent
(16:52):
Forrester and it's in December10, 2024 on the geminetworkcom,
and they talk about monoclonalantibody treatments are approved
by FDA.
And they talk about monoclonalantibody treatments are approved
by FDA lacanumab, as you said,and donanumab, as you said based
on their ability to clearamyloid and slow clinical
progression.
No-transcript somewhat and notsee.
(17:32):
You know, it's got to be theright patient at the right time.
Maybe the pathway is throughtau proteins.
Dr. Dung Trinh (17:38):
Absolutely.
The ultimate pathway iscombination therapy.
Dr. Douglas L. Beck (17:41):
Yeah, tell me about that, tell me about
that, tell me about that, yeah.
Dr. Dung Trinh (17:44):
What's interesting, I've noticed this
past year, like several yearsago, everyone was attacking the
amyloid right, anti-amyloidRight.
Past year there's been morestudies now focused on tau, yeah
, and, as a matter of fact, themajority of studies for
Alzheimer's today are notanti-amyloid studies anymore.
They're looking at differentmechanisms of action dealing
(18:05):
with the immune system.
I've seen vaccination studiesnow for Alzheimer's, studies
that are cutting downinflammation.
Even the weight loss medicinesare being studied for
Alzheimer's right the GLP-1s.
Dr. Douglas L. Beck (18:18):
Yeah, well, it makes sense, because they're
doing something and nobodyknows exactly the limits of what
they're doing.
Dr. Dung Trinh (18:26):
Yes, so the ultimate solution in my view, is
combination therapy combinedwith lifestyle.
Yeah, you got to live thatlifestyle.
Dr. Douglas L. Beck (18:44):
right, you can remove plaque, but if you're
not living a lifestyle toprevent, you know what you're
talking about.
Now harkens back to 20, 25, 30years ago, when we were doing,
you know, cabg procedures, whichis, coronary artery bypass with
a graft, and lots of peoplewere getting this done, but they
never changed their lifestyle.
So you know, eight years laterthey would die of a heart attack
or myocardial infarctionbecause they didn't adapt their
(19:06):
lifestyle, and so they had theprocedure done and so they had
good perfusion through theirheart, but the lifestyle wound
up killing them anyway.
Right, it comes back at you.
Dr. Dung Trinh (19:15):
Absolutely.
Bypass surgery is cleaning theplumbing, but you have to stop
the lifestyle that causes theplumbing to clog up.
Same thing with Alzheimer'sright.
We have to stop the lifestylethat allows production.
Dr. Douglas L. Beck (19:29):
All right, let me just get your thoughts.
I'm going to let you go in afew minutes.
But you and I have often talkedabout we don't necessarily have
a health care system.
We have a sick care system.
That's a quote from you aboutsix months ago and I've heard it
before and I love it.
And I don't love it becauseit's reality.
I love it because it's accurate.
And when you look at thedifferent ratings for the
American healthcare systemwhether it's private pay
(19:50):
insurance doesn't matter we arerated anywhere between number 35
, 36, 37 by the World HealthOrganization, all the way up to
number 65 in the new study thatcame out of the UK, and that
means there are 35 to 60countries that have better
healthcare for their citizens,providing better healthcare.
We have the most expensivemedicines and drugs in the
entire world.
We have the most expensivehealthcare.
We have the most expensivemedicines and drugs in the
(20:10):
entire world.
We have the most expensivehealthcare and I would argue
that the biggest issue is thatwe may have the best physicians,
like you.
We may have the bestaudiologists, like some of my
colleagues, and that's great,but the issue to me is that
people do not have access.
You know you have to go whereyour insurance tells you to go.
You have to call ahead of timeand get pre-approved, and you
(20:32):
know they're not going topre-approve something that cost
them a lot of money, and that'swhat I see as the issue is.
You know, if they can't make alot of money on it, then they
won't approve it, and I thinkthat insurance is a debacle.
It is a mess.
Dr. Dung Trinh (20:46):
We, as you mentioned, we have a sick care
system, not a system that isfocused on prevention, and quite
simply, the system itself issick because prevention does not
pay Right Right.
Hospitals shut down if theirbeds are not full yeah.
Doctors will close theirshingles if nobody walks in the
(21:08):
door yeah.
So we have a system that iskind of backward we pay for
sickness, we don't pay forhealth, and on top of that, we
have industries that arefunneling a lifestyle of poor
health the fast foods, you know,the junk food, the food
industry, cigarettes.
(21:30):
Everything else around us tellsus to live this lifestyle that
leads to chronic disease.
I was reading the other daythat we have thousands of
chemicals in our food that arecurrently banned and not allowed
in Europe and other countriesthat we eat every day.
Dr. Douglas L. Beck (21:51):
Absolutely.
Dr. Dung Trinh (21:53):
And there's a problem with that, isn't?
Dr. Douglas L. Beck (21:55):
there there's a huge problem, and even
down to water bottles.
Right, you're drinking waterbecause you're trying to stay
healthy and not absorbable whileyou're absorbing the plastic.
Dr. Dung Trinh (22:04):
Microplastics, right, nanoplastics Huge, huge
issue.
Now we're seeing microplasticsin the brain.
Yeah, Oregon has microplastics.
Huge, huge issue.
Now we're seeing microplasticsin the brain.
Oregon has microplastics.
Dr. Douglas L. Beck (22:13):
You know, the issue is that nobody knows
the long-term results of any ofthis stuff, and we're doing it
every day and it's frightening,it's scary and I don't know how
to fix it.
I really don't, and I'm notsuggesting that I do, but I
think you know the first step,of course, is recognizing
there's a problem.
And we, you know, we've beenaware of nutrition and exercise
(22:34):
and the need to stay healthy fora long time, but, as you say,
we don't encourage it.
We, you know, doctors are therefor disease, not to encourage
health.
Dr. Dung Trinh (22:42):
Yeah, we used to say knowledge is power, but I'm
questioning that now, becauseknowledge alone is not power.
Knowledge is free on YouTube.
You can learn anything you want.
What really is power is takingaction.
Dr. Douglas L. Beck (22:58):
Yeah, that's good.
Dr. Dung Trinh (22:58):
And I think there's a big gap, right?
We all know, in theory, how toprevent obesity and diabetes,
and yet two out of three of usare overweight in the United
States, right?
So it's not just knowledge.
We got to find a way forsupport and accountability as
well.
Yet two out of three of us areoverweight in the United States.
So it's not just knowledge.
We got to find a way forsupport and accountability as
well with that.
It's why I have a personaltrainer.
(23:19):
My personal trainer isn't therewaiting for me, I'll never show
up to the gym.
It's kind of sad, right, verysad for a physician.
But yeah, it's theaccountability, along with that
knowledge and it's theaccountability, along with that
knowledge.
Dr. Douglas L. Beck (23:32):
And it is needed.
I just want to talk aboutinsurance for a minute, because
almost 50% of people who areeligible for Medicare are on
Medicare Advantage and I readabout this all the time and
Medicare Advantage programs arecommercial programs, run by
whomever.
But I think it's important forconsumers and patients to
understand how managed careprograms work.
When you sign up for a MedicareAdvantage program, the federal
(23:55):
government gives that commercialentity about $1,000 a month to
take care of you, and what thatmeans is that that commercial
entity will say oh, we're goingto give you this trinket.
Here's a shiny thing that youmight like silver sneakers.
You might get a bad hearing aid.
You might get a free dentalexam with no dental care.
You know they do this sort ofthing.
(24:17):
People sign up and the moneythat they are not spending on
you is their profit, and manypeople think that these things
are free.
Well, it's not.
It's costing the federalgovernment about, you know,
$12,000 a year for everybody whosigns up for Medicare Advantage
.
Now, I may have those numbers alittle wrong.
I'm speaking off the top of myhead, I don't have any sources
(24:37):
in front of me, but my point isthat when you have regular
Medicare, it's more of a fee forservice and you know how much
you have to pay.
They can see on the guideline,the providers can see how much
they're going to get reimbursedand you just do whatever you
need.
So I think this is a part of itas well.
Is that so many people are onMedicare Advantage but they
don't really understand how itworks or who's paying for it.
(25:00):
They just know what they'regetting and what they're getting
.
There was an article in theJournal of the American Medical
Association, I want to say about14 months ago, and the title of
it, I'm pretty sure, was higherprices and less health care,
and I don't think you want toweigh in on that.
Dr. Dung Trinh (25:15):
But if you have a comment on it.
I'd love to I will weigh in onit.
I will weigh in on it, Please.
Yes, because I live.
I have lived in this system fora long time and seen insurance
and insurance processes, so Iwould say there's pros and cons.
The theoretical benefit ofMedicare Advantage is that your
(25:35):
care is managed.
So managed could be a bad wordor a good word right.
Managed can be a bad word whenyour care is controlled.
You can only go to this groupof doctors, that group of
specialists, to contract withthe Medicare Advantage plan.
Managed could be good if you'regetting reminders for your
colonoscopies, your mammograms,your eye exams.
(25:57):
From a prevention side, if youhave pure straight Medicare, no
one's sending you reminders togo get your prevention studies
and things of that sort.
Well, that depends on who yourdoctors are.
The doctor too, yes, depends onthe doctor and the group.
But I know that MedicareAdvantage are incentivized to
(26:19):
offer prevention, notnecessarily because they want
you to be super healthy, butbecause if you can prevent
disease, you spend less money onthe disease, right?
Dr. Douglas L. Beck (26:30):
Yeah, and if you can prevent it, obviously
they don't have to pay for it,which is beneficial for
everybody.
Dr. Dung Trinh (26:36):
Yes, absolutely.
Medicare Advantage does giveyou these supplements that
straight Medicare doesn't payfor, sometimes dental hearing
aids, you know things of thatsort.
So there's pros and cons.
Folks sign up for MedicareAdvantage mainly due to the
supplemental stuff like thesilver sneakers and things of
that sort yeah.
Dr. Douglas L. Beck (26:52):
but then the problem comes in right when
you find out that you had aheart attack and you have to go
to this and you're not at thehospital and you have to get
there.
Yeah, you can't choose yourhospitals.
Dr. Dung Trinh (27:00):
You can't choose your doctor.
You got to be within thatnetwork.
So you're giving up freedom.
You're giving up freedom inMedicare Advantage with the hope
of getting these supplementalbenefits, and the prevention
side is kind of what you'regiving up.
Dr. Douglas L. Beck (27:15):
Yeah, and if prevention works, then you're
in great shape on MedicareAdvantage, right?
But anyway, so it is anindividual decision.
My point was to discuss howit's actually funded, because I
don't think people understandthat and, as you say, you know,
when you sign up for it thereare some advantages and there
are some disadvantages as well.
So it's up to the consumer.
But I got to tell you, you know, I turned 65 a long time ago
(27:38):
and trying to make your waythrough all those programs is a
nightmare.
But listen, before I let you go, I know you have a new YouTube
series and I was actuallywatching it this morning and
it's really good because it'sall very, very brief YouTube
videos.
So what's the name of the ofthe YouTube series?
How do people find it?
Dr. Dung Trinh (27:57):
Well, it's so.
It's sponsored by East side andit's it's unlocking Alzheimer's
with that.
They can probably go to myLinkedIn, I suppose, and find
the link on there.
Dr. Douglas L. Beck (28:07):
Yeah, okay, well, you know we'll do, we'll
do.
We'll put it in the descriptionof this podcast.
We'll add the link.
Dr. Dung Trinh (28:13):
We'll add more content to it.
Short snippets of educationalmaterial over time.
Dr. Douglas L. Beck (28:20):
Right, and the ones I saw were things like
reflections of the real worldand you were talking about.
You know, when we talk aboutAlzheimer's, it's important to
understand who the patientreally is, Because in the
Hispanic community it's one anda half times what it is in the
Caucasian community In the Blackcommunity?
I don't recall, but it wassubstantially greater, yeah,
(28:41):
twice yeah, and so it's a greatdiscussion on things that most
people are not aware of.
And then you talk about in oneof the other ones it was how to
evaluate if a epidemiologicstudy or any study, really is
appropriately compared to yourown personal health or, you know
, appropriately involves you,because a lot of studies you
know they can be longitudinal,they could be random control
(29:03):
trials, they could beprospective, they could be
retrospective, and all thisstuff matters as far as it
doesn't mean any of the studiesare bad.
It just means you have tounderstand what it does mean.
Dr. Dung Trinh (29:13):
A study is not a study.
A study means a whole, wide,different types of studies,
right A whole wide array ofstudies.
They all answer differentquestions.
Dr. Douglas L. Beck (29:23):
That's right, and I think that's why
there's always confusion amongpatients and also among
professionals, because, you know, we can easily find things that
support our viewpoint, but thensomebody can point out other
studies and the question is isthis the same population we're
talking about?
Is this the same treatmentwe're talking about?
Is there a control group?
Is there an experimental group?
You know, in all thesequestions which matter, so I
(29:44):
really enjoyed your recordingson that.
Dr. Dung Trinh (29:47):
Thank you.
There's good science and goodmarketing and they're not always
the same.
I've seen these big headlinescure for this, cure for that and
you try to find the study andthey may have a study.
And you read the study.
Oh, it's a cure in rats, nothumans.
Yeah, and that's extrapolatedto everyone else.
Dr. Douglas L. Beck (30:02):
So yeah, Absolutely, Absolutely All right
.
Well listen, it's always a joyto talk to you.
I hope we do it again sometimesoon and in the meantime, I wish
you a joyous and healthy newyear and I will look forward to
speaking with you sometime inthe near future.
Dr. Dung Trinh (30:15):
Very good to see you, doug.
Have a great day.
Thanks so much.
All right, bye-bye.
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