ALZHEIMER’S ASSOCIATION AND THE NATIONAL INSTITUTE OF HEALTH

What measure can the Alzheimer Association take to give Alzheimer’s an increase in federal

funds from the National Institute of health toward research for a cause of the disease?

Caroline Savage
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Abstract

This research project looks at the financial success of three public non-profit organizations the

American Society of Clinical Oncology (American Society of Clinical Oncology), AHA

(American Heart Association), and the AA ( Alzheimer’s Association) in order to identify a

correlation between their success and the amount of money allocated to disease specific research

from the National Institute of Health (National Institute of Health). If a correlation was found,

conclusions were made to answer the question: What measure can the Alzheimer Association

take to give Alzheimer’s an increase in federal funds from the National Institute of health toward

research for a cause of the disease? A data analysis was used, and data was gathered from each

organizations annual audited financial statements. The data that was gathered included the

annual net income, and the amount of money given to research. These numbers were then

compared to annual funds allocated to each disease from the National Institute of Health. After

conducting a data analysis, no correlation was found and instead a correlation was found with

mortality of each disease and funding. This opens the door for other researchers to possibly look

into what factors the National Institute of Health considers when dividing up their funds.

Keywords: ​National Institute of Health, Alzheimer’s, Medicare and Medicaid

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Literature Review

Introduction

Alzheimer's is a disease that grips the brains of millions of Americans each year.

Alzheimer's deposits plaque between nerve cells in the brain and neurofibrillary tangles on the

interior of the neuron cell. Over time the victims of Alzheimer’s lose their memory as well as

bodily functions. This disease affects the 65 year old demographic, which in the next 15 years

will be the majority of the baby boom generation, and by the year 2050 over 16 million people

could be affected by Alzheimer's (Alzheimer's Association,2016). Despite this projected amount

of Alzheimer’s cases the National Institute of Health has not allocated an adequate amount of

funds to discover a cause and or cure for Alzheimer’s (AD).

If the disease is not controlled, both the United States medicare and medicaid budget will

be swallowed by Alzheimer’s care (Reid, 2015).The increase in Alzheimer's cases will present a

need for an increase in economic aid (in the form of Medicare and Medicaid) and with this

increase in cost for patient care, a cheaper and more effective method of treatment will need to

be researched. I am going to assume that the current funding for researchers from the National

Institute of Health will not be enough to research a more effective method to accommodate the

given projections. The reason that the cost is at a staggering amount is that care for patients lasts

years. One patient alone will need 24/7 care for up to ten years (Reid, 2015). As the amount of

patients rises in the near future, the federal budget allocated for disease care will take a very

large hit.
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Given this information, I will look into the effects that efforts made by public non-profits

have on the amount of funds allocated by the National Institute of Health. More specifically this

research will be analyzing methods the American Heart Association and the American Society

for Clinical Oncology use that possibly grant their respective diseases more money from the

National Institute of Health. From the information that I gather I will develop a proposal that

answer the question : What measures can the Alzheimer Association take to receive an increase

in federal funds from the National Institute of health toward research for Alzheimer’s?

Funding

In 2017, care for Alzheimer's patients cost the United States $259 billion dollars

(National Institute of Health, 2017). Currently Alzheimer's is the most expensive disease in the

United States, topping both heart disease and cancer (Alzheimer’s Association, 2017). The

amount given to Alzheimer care will only grow as the amount of patients increase. Due to the

influx of Americans in the ideal demographic for Alzheimer's (AD), the funding needed to care

for the patients will only increase. By the year 2050, the amount of patients suffering from AD

will quadruple as high as 16 million, which in turn costs the US $758 billion. (Alzheimer’s

Association, 2017). In order to decrease this projected number, it is imperative that researchers

locate a cause and identify effective preventative measures.

Through the National Institute of Health , Alzheimer's was allocated $929 million within

the program Accelerating Medicine Partnership (AMP) in 2017, the Alzheimer's research. This

program is a public-private partnership founded in 2014. This program partners with the National

Institute of Health, the Food and Drug Administration (FDA), the Alzheimer’s Association, US

Against Alzheimer’s, Geoffrey Beene Foundation, and the Foundation for the National Institute
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of Health (National Institute of Health,2017). The partners establish what they see has the most

promising method of attack for the disease as well as propose a research plan, and make it public

to the biomedical community. As of May 2017, none of the therapies proposed by

pharmaceutical companies through the AMP have indicated clinical proficiency. This method of

funding for Alzheimer’s will be the basis of this study.

In 2016 the National Institute of Health allocated cancer research (through grants to

universities as well as private research), $5,589 million, compared to Alzheimer’s $929 million

(National Institute of Health, 2016). Cancer care in the United States is proposed to cost $175

billion in 2020 (American Society of Clinical Oncology, 2015),which is a little more than half of

what Alzheimer’s is costing the United States today. So why is cancer being funded more? What

is the American Society of Clinical Oncology (which I will refer to as American Society of

Clinical Oncology) doing that the Alzheimer’s Association is not doing? Or is there a

correlation? How can can I use that information to formulate a plan of action that would allow

Alzheimer’s to receive more funding.

Similarly, Heart Disease was funded by the National Institute of Health $1.289 million in

the 2016 fiscal year. However, this disease cost the US $300 billion dollars in 2017 (American

Heart Association, 2016). In the case of heart disease, it costs relatively the same amount to care

for patients annually but they receive a significantly more amount of funding. Given that

information, I will be looking at the methods used by the American Heart Association to develop

my proposal to the Alzheimer’s Association.

Assumptions and Definitions

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Throughout my research it is understood that this is a gap that has not been studied

before. Furthermore I am assuming that at the current rate of growth as well as the incoming

baby boomer generation, that the federal government will not be able to sustain the cost needed. I

am also assuming that there is still more that the Alzheimer's Association can do that they are not

doing to increase awareness and funds. This is assumed because of the gap between National

Institute of Health funding and the cost of Alzheimer’s to the United Staes

I am using the Alzheimer's Association, American Heart Association, and the American

Society for Clinical Oncology as the organizations that raise awareness for the disease but do not

necessarily receive the funding. It is understood that the funds allocated by the National Institute

of Health is given to a multitude of Universities as well as private researchers for research and

not solely to the listed organizations. For the ease of understanding my research when I refer to

“Alzheimer’s Disease”, I will use the acronym “AD” which is used by medical professionals. I

will also use the respective acronym for organizations but will specify when they are first

introduced.

Methods

Design

This study will take a quantitative approach, using data from public databases,

specifically annual audited financial statements released by each non-profit, and is designed to

measure the correlation between efforts taken by the American Society of Clinical Oncology

(American Society of Clinical Oncology) and the American Heart Association (AHA), and the

amount of funds allocated by the National Institute of Health (National Institute of Health). This

correlation showed if the efforts do or do not have an impact on the amount of funds received.
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Does the National Institute of Health even take the success of the non-profits into consideration

when dividing funds up between them? These organizations were used because they recieved the

most funding in the last fiscal year from the National Institute of Health, for their respective

disease (National Institute of Health, 2016). As it was addressed in the assumptions, the money

from the National Institute of Health is not going directly to each non-profit but instead toward

research and grants for each disease that the non-profits represent. The financial data for each

organization were observed, including the organizations annual net income, and amount of

money going directly toward research. This research also looked at the trends in National

Institute of Health allocation over the past five years. From these specific categories an attempt

was made to identify “core” methods, meaning that the success of these methods positively

impacts the amount of funds received by the National Institute of Health. I also looked into the

same categories done by the Alzheimer’s ASsociation and will compare it to the core methods

that I identified as necessary. If the Alzheimer’s Association (AA) is lacking in any of the core

areas that I identified I will make a conclusion as to what change the AA can take to possibly

receive more funding from the National Institute of Health.

Procedure

In order to measure the correlation between the National Institute of Health funding and the

non-profits efforts I will be looking at two main aspects of each organization. The organizations

that will be looked at include the American Society of Clinical Oncology, AHA, and AA. The

first category being identified is the annual net income from each organization. Annual net

income is calculated using this equation : total revenue- total costs. This will be calculated by

using each audited financial statement that by law each organization is required to release and
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calculating this number. The second aspect is the amount of money that each organization gives

directly to research. Given that the National Institute of Health allocated money toward research,

if a non-profit themselves gives a significant amount of money to research themselves, the

National Institute of Health may not need to give as much. Seeing as this could impact my

correlations we will also be looking at that as well. On the financial reports each organizations

includes this number under “costs” in a category labeled “Research”. The factors were used to

measure the correlation because each organization is required to release this information by law,

guaranteeing a number to be released that will be used in the data analysis. Furthermore, only

looking at finances creates an even scale, seeing that money has the same value across the board

making conclusions from the data will be even between each organization.

For each category I will be measuring the past five years, to make it a more accurate

conclusion. This would be more accurate because as time goes on I will be able to identify trends

in funding from National Institute of Health and each category. In order to see the correlation

with funding and the financial success of each organization I will create a chart and visual graph

showing the number calculated using what was states above for the past five years. I will then

compare it to the chart and graph created from the National Institute of Health specific

allocations for each year and organization.

Upon the conclusion of gathering the data I will be comparing the graphs of the net

income, the amount of money specifically given to research, as well as the money given to each

disease by the National Institute of Health. If an organization has a high net income in one year

and in that same year their disease received an increase in funds, then it will be concluded that

there is a correlation between the net income in an organization and the funds given to their
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disease by the National Institute of Health. For each year I will measure this correlation and if a

correlation is found with any of the two categories I will apply it to the Alzheimer’s Association

data. For example, if a correlation was found with net income and National Institute of Health

allocation and the Alzheimer’s Association has a low trending net income, then it would be

concluded that they need to implement events or methods to increase significantly their net

income.

Data

Figure 1.1
Funds Allocated by National Institute of Health (National Institute of Health)
Disease (in millions of dollars)
2018
2013 2014 2015 2016 2017 (Estimated)
Cancer 5,274 5,392 5,289 5,589 6,032 4,696
Heart Disease 1,230 1,224 1,262 1,289 1,326 1,042
Alzheimer's 504 562 589 929 1,348 790
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Figure 1.2
Figure 1.1 ​and ​Figure 1.2 ​are the baseline comparisons for this research. The entire

purpose of my research is compared to this trends seen in this chart. The amount of funds

allocated by the National Institute of Health (National Institute of Health) will be compared to

the other data listed below. The amount of money in the chart is not the money given to the

organizations that I am running my methods on. Instead this money is going toward specific

Universities and private research grant projects for each disease listed in ​Figure 1.1 ​and ​Figure

1.2. ​As seen in the chart above, heart disease receives a significantly more amount of money

than both cancer and alzheimer's research. It should also be noted that the amount of funds

allocated for Alzheimer’s has steadily increased in the past three years but is projected to have a
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$500 thousand decrease in the year of 2018. Another change in this data, that should be taken

into consideration when making comparisons to financial categories, is the drop in funding

toward in heart disease from 2017 and the project 2018 National Institute of Health funding.

Overall Mortality
Figure 1.3

Disease Overall Mortality

2013 2014 2015
Cancer 580,350 585,430 589,430
Heart Disease 611,105 614,348 633,842
Alzheimer's 84,767 93,541 110,561

Figure 1.4
Figure 1.3 ​and ​Figure 1.4 ​show the annual mortality of the diseases covered by the

organizations chosen. These numbers were gathered from the annual release by the Center for

Disease Control (CDC) records. The data that was able to be gathered ended in year 2015

because “Final Deaths” are not released until up to a year and half after a year ends. It must be
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noted that one can not die ​from​ Alzheimer’s, instead in this chart the death recorded was of

persons who died ​with​ Alzheimer’s. Each of the three disease’s listed above are in the top ten

“causes” of death in the United States for each year reported.

Annual Net Income

Figure 1.5

Non-Profit Organization Net Income (total revenue minus total expenses)

2014 2015 2016 2017
American Society for Clinical
Oncology (American Society N/A
of Clinical Oncology) 13,866,330 623,174 2,570,000
American Heart Association
(AHA) 112,255,210 36,218,743 18,918,530 158,385,000

Alzheimer's Association 8,003,000 18,567,000 7,649,000 (-1917000)

Figure 1.6
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As seen in ​Figure 1.5 ​and ​Figure 1.6 ​each organization's net income is recorded. Net

Income is the Total Revenue - Total Expenses. These numbers were manually calculated from

the annual audited financial statements released to the public at the end of each fiscal year. The

Alzheimer’s Association and the American Society of Clinical Oncology had significantly less

numbers than the AHA. The 2017 American Society of Clinical Oncology audited annual

financial report as not yet been released so for that reason no number was reported or included in

the chart. In 2017, the AHA had a loss of 1,917,000, which was the only loss recorded in the four

year time span that is being used for this research project.

Expenses Paid to Research

Figure 1.7 and Figure 1.8​ is the data gathered from the annual audited financial

statements from each fiscal year and each organization. In the financial statement under the

Expenses category each organization listed an amount of money donated directly toward

research for their given cause. In 2014 and 2015 the American Society of Clinical Oncologys’

annual report did not have category labeled “Research” so in order to keep the integrity of my

methods as well as specificity of the category accurate and comparable, I have written not-

recorded. This does not mean that in those years no funds where directly donated by the

American Society of Clinical Oncology but no that was recorded in the exact way the other

organizations did.

Figure 1.7

Non-Profit Organization Expenses Toward Research

2014 2015 2016

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American Society for

Clinical Oncology (American
Society of Clinical
Oncology) None Recorded None Recorded 4,467,448

American Heart Association

(AHA) 145,276,000 151,211,000 184,676,000

Alzheimer's Association 29,147,000 32,535,000 40,480,000

Figure 1.8

Conclusions
When measuring the correlation on net income each year is considered. Keeping in mind

throughout this analysis that for example the impact of the 2016 net income of each organization

would only correlate with the 2017 funding of each disease. This is due to that fact that the

National Institute of Health does not know the net income of each organization until the year has
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ended, which means they if there was a correlation they would determine the next years fund

allocation on the previous years net income of each public non-profit.

When looking at ​Figure 1.2, ​the AHA specifically, there was a steady increase in funding

from the National Institute of Health between 2014-2017. There was a slight decrease of roughly

$100 million between 2014 and 2015, but was recovered the next year when the funding increase

from 2015-2016 by $300 million. Looking at ​Figure 1.6 ​which shows the graph of annual net

income, the same trend is not seen. There is a dramatic drop in the net income of the AHA,

between 2014-2015 but instead of recovering in 2016 as did the National Institute of Health

funding, it continued to drop. The lack of a similar trend dispels any correlation that could have

been present. The correlation is further disproven after analyzing the American Society of

Clinical Oncology net income. The funding for cancer research from the National Institute of

Health fluctuated by no more than $50 million between 2014-2017. Given the enormity of the

amount of funds given by the National Institute of Health being upwards of $6032 million (for

heart disease) , $50 million is insignificant in terms of that fluctuation. However, when looking

at the net income of the American Society of Clinical Oncology, between 2014 and 2015, their

net income increased by over $20 million dollars, but then decreased in 2016 by $18 million.

Seeing that the National Institute of Health funding remained relatively constant, and the net

income fluctuated by over 50%, there again is seen no correlation between the two factors.

Lastly the correlation between the AA net income and National Institute of Health

funding showed similar results to that of the American Society of Clinical Oncology.

Alzheimer’s funding from the National Institute of Health remained relatively constant up until

the year 2016, where is tok a $4 million jump. Seeing that if there was a correlation between that
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jump and the net income, that would mean that in the year 2015, there was a significant jump in

the net income as well, which did happen to be the case. In 2015, the AA’s net income increase

by roughly $10 million (National Institute of Health,2015). However the National Institute of

Health funding continued the upward trend and increased by $400 million for Alzheimer’s

research, and the net income of the AA did not follow that trend. Instead the net income

continued to decrease and in 2017 that were roughly $2 million in debt. All three organizations

demonstrate that there is no correlation between the net income of their non-profit and the

amount of funds that the National Institute of Health allocates for disease- specific research.

Continuing on, the correlation of the amount of funds given directly to research from

each non-profit and the amount of funds given by the National Institute of Health to each disease

will be measured. Keeping in mind that when looking at the data in ​Figure 1.8​, the years

2014-2016 are being measured therefore the data in ​Figure 1.1 ​that it will be compared to is

2015-2017. This is because as stated above, if a correlation did exist it would be shown in the

following years.​ ​Looking first at the AHA, as seen in ​Figure 1.8 ​there is a steady increase in the

amount of money they give to research as an organization. Most notably in 2016, there was a

significant jump from donating $151 million in 2015 to $184 million in 2016. When comparing

this trend to that of the National Institute of Health funding as seen in ​Figure 1.1​, there is a the

same trend. However when thinking of the implication of this topic it was assumed that if the

organization donated more themselves, it would reduce the need of the National Institute of

Health to donate as much. This data for only the AHA shows the opposite, when the organization

donated more themselves, the National Institute of Health gave more as well.
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The American Society of Clinical Oncology did not provide enough data on each

financial report to aid to this correlation search, so in order to sustain the integrity of the data the

American Society of Clinical Oncology will not be analyzed. This is due to the fact that only one

year was reported for the amount of donations to research that they gave, and a proper

correlation can not be measured with only a year of data. Continuing on with the AA however, as

seen in ​Figure 1.8 ​there was a steady increase in funds given to research between the years

2014-2016, roughly an increase of $2 million per year. The same trend was seen in​ Figure 1.1​.

In the years 2015-2017 there was a steady increase in the funds allocated to Alzheimer’s research

as well. The data for both the AHA and the AA show a correlation between the amount of funds

given to research by the non-profit and the amount of funds allocated by the National Institute of

Health.

What this study did not determine however was if this was a direct or indirect correlation.

Correlation does not mean causation, meaning that the two could have nothing to do with each

other. There could be a multitude of other reasons why the National Institute of Health increased

their funds for Azlheimer’s research between the years of 2015-2017, this reason could also be

the same reason that the AA donated more money to the Alzheimer’s in the same year. This does

not mean that one happened because of the other, in those years there could of possibly been a

success in a certain research project, or a new medical discovery that made both the organization

and the National Institute of Health to donate more money. This is an area where a fellow

researcher could look into. They could look into certain events that happened in those years that

could of caused in influx of donations of if the two truly did directly correlate.
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The purpose of this data collection was to answer the question : What measure can the

Alzheimer Association take to give Alzheimer’s an increase in federal funds from the National

Institute of health toward research for a cause of the disease? However, the data gathered

throughout the research process became inconclusive. As stated above, no correlation was found

between the net income of each organization and the amount of funds allocated by the National

Institute of Health. Similary the correlation that was found between the organization personal

donation to research and the National Institute of Health funding, did not show whether is was

direclty or indirectly correlated. Therefore no measures can be taken by the AA to increase

funds, given that this data shows there is no correlation between the two.

Lastly, when doing my preliminary research the topic of disease mortality was often

presented with the amount of funding the National Institute of Health gave to each disease. As

seen in ​Figure 1.4​, the mortality per year of each disease was reported alongside of National

Institute of Health funding within the source that the information was received from (National

Institute of Health,2018). A correlation is seen between both ​Figure 1.1 ​and ​Figure 1.4, ​which

opens doors for other researchers to take this topic even further. This research paper shows that

there is no correlation between financial success of public non-profits and the National Institute

of Health allocates. If it’s not based off of the amount of money the disease is costing America

then then what does the National Institute of Health base their division of money on? Is it

mortality? IS the demographic of those who die with each disease impactful on the amount of

research money the National Institute of Health gives? All of these questions were brought up in

this research, but in order to maintain my methods and the overall question, was not looked into

further, but gives another an opportunity to do so.

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