The Economist - USA (2021-07-17)

24 United States The Economist July 17th 2021

Baseball’swaningpopularity

Pastime

S

tandingbehindleftfieldduringMajor

League Baseball’s(mlb) annualHome

RunDerby ismuchlikeloiteringinthe

middleofa moshpitata death­metalcon­

cert.Balls,bodiesandbeersareflying.Ifa

dingerishitinthatdirection,themassof

fansbecomesa tangleoflimbsuntilsome­

oneemerges fromthebottomofapile,

bruisedbuttriumphant,home­runballin

hand.Butenthusiasmforthederby,the

All­Star Game andmlb’s electric young

playersbeliesthefactthatthesportisfac­

inga seriesofchallengesthatputthefu­

ture of the national pastime in question. 

The past year has been a turbulent one

for sports, but especially for baseball. The

league  has  cracked­down  on  the  use  of

“sticky  stuff”,  tacky  substances  pitchers

used to help them grip the ball and throw

harder. A star pitcher from the Los Angeles

Dodgers is being investigated for sexual as­

sault, reminding fans of the prevalence of

assault­related  suspensions  among  mlb

stars.  Rob  Manfred,  mlb’s  commissioner,

says the league suffered operating losses of

$3bn in 2020 because of covid­19.

All these problems—even the covid­re­

lated  ones—seem  manageable  compared

with  the  existential  threat  that  is  young

people’s  lack  of  interest  in  the  sport.  A

Morning  Consult  poll  from  2020  found

that only 32% of Gen zAmericans said they

were “casual” or “avid” mlbfans, compared

with  50%  of  all  adults.  That  is  the  biggest

gap  among  all  sports  considered.  In  fact,

younger Americans are more interested in

e­sports than baseball. The league has tak­

en  notice,  and  is  testing  ways  to  shorten

games  (which  average  over  three  hours)

and pump up the action. 

But many fans assume a defensive pos­

ture  when  it  comes  to  rule  changes  or

adopting  new  technology  to  make  the

game more entertaining. “Baseball has this

extremely conservative culture”, says Jacob

Pomrenke,  of  the  Society  for  American

Baseball  Research.  “The  idea  that  baseball

was somehow better in the past is one we

should  throw  by  the  wayside.  The  golden

era  of  baseball  is  now.”  That  is  easier  said

than  done.  Historical  sluggers  still  loom

large in fans’ consciousness, and there is a

sense that the game played today should be

the  same  game  that  was  played  by  Babe

Ruth  or  Jackie  Robinson.  But  that  would

suggest  that  baseball  has  never  changed,

an idea that baseball historians scoff at.

Even if fans come round to the idea that

thesportneedstoadapttogrow,labour

troublesthreatentogetintheway.Thecol­

lective­bargainingagreementthatgoverns

schedules,salariesandsafetyprecautions

issettoexpireonDecember1st.Therela­

tionshipbetweenplayersandownersisal­

ready acrimonious, thanks tolastyear’s

bitternegotiationsovertheshortenedsea­

son. If the sides cannot agree terms, a

strikeora lockoutlooms.Andifitishard

togetyoungfansenthusedaboutthesport,

itwillbenear­impossibletodoitwhen

thereisnobaseballbeingplayedatall. n

D ENVER

The sport’s fascination with its history

makes changing it difficult

Littlesluggers

Drugprices

Blowing the

inheritance

W

henalong-awaiteddrugforAlz­

heimer’s  was  approved  by  the  Food

and Drug Administration (fda) last month,

controversy  quickly  followed.  In  Novem­

ber ten of 11 members of an fdaexpert pan­

el rejected the treatment, but it received ac­

celerated  approval  anyway.  Three  panel

members resigned in protest. It also has a

large price tag: about $41,000 for year one

and $56,000 for subsequent years. The un­

usual  approval  process  and  high  cost  has

sparked a congressional investigation into

the  developer’s  business  practices.  The

treatment  is  also  becoming  the  focus  of

new legislation which, if passed, would al­

low the government to negotiate drug pric­

es for federal health­insurance plans.

About  6m  Americans  (one  in  nine  old

people) have Alzheimer’s disease, a form of

dementia. Aducanumab, marketed as Adu­

helm, successfully clears the brain of beta­

amyloid,  a  protein  that  clumps  between

neurons  and  disrupts  their  functioning.

Some researchers believe that this protein

causes  Alzheimer’s.  Aduhelm  is  the  first

new drug for Alzheimer’s since 2003, so it

will probably be popular despite its contro­

versial  approval.  “There  are  so  many  peo­

ple  and  their  families  who  are  suffering

from  this  condition  with  no  treatments,

and  that  just  leads  to  an  understandably

desperate situation,” says Meredith Rosen­

thal of Harvard University’s School of Pub­

lic Health. “People are really willing to try

anything, at almost any cost. But of course,

that  cost  isn't  just  borne  by  the  families,

but by all of us.”

The  cost  is  high,  even  for  those  with

health insurance. Patients receive an intra­

venous infusion every four weeks at about

$4,300  each  for  the  average  patient,  total­

ling about $56,000 a year. Since dementia

tends  to  hit  older  people,  many  patients

will  qualify  for  Medicare.  The  Centres  for

Medicare and Medicaid Services, the agen­

cy in charge of Medicare, has not decided if

it will cover Aduhelm nationally yet. A de­

cision  is  not  likely  until  the  spring.  Until

then, coverage will be determined by each

of the 12 local jurisdictions.

If  Aduhelm  is  included,  Medicare  will

probably  cover  80%  of  the  price.  Patients

will  need  to  pay  the  rest.  That  adds  up  to

about  $11,500  per  year  (about  40%  of  the

median  annual  income  of  each  Medicare

beneficiary, according to the Kaiser Family

Foundation,  a  health­research  outfit).

Since Aduhelm is not a cure, patients could

pay  for  years.  Most  Medicare  patients  are

protected  by  an  annual  out­of­pocket

spending limit, but one in ten are not.

The high cost of this drug may raise pre­

miums  for  everyone,  says  Tricia  Neuman

of the Kaiser Family Foundation. Ms Neu­

man  and  her  colleague  Juliette  Cubanski

estimate that if 500,000 Medicare patients

receive Aduhelm, that could cost Medicare

and  its  patients  $29bn  in  one  year  (total

Medicare spending for all doctor­adminis­

tered  drugs  reached  $37bn  in  2019).  And

this  estimate  is  probably  conservative.

Nearly 2m Medicare patients used an Alz­

heimer’s treatment in 2017, and Biogen, in

an  investors’  presentation,  estimated  that

1m­2m will use the drug. If 1m patients are

treated, the cost could rise to $57bn.

That  is  why  two  committees  in  the

House  of  Representatives,  the  Committee

on Oversight and Reform and the Commit­

tee  on  Energy  and  Commerce,  have

launched an investigation into Aduhelm’s

price. Drug pricing has been a political is­

sue  for  years.  hr3,  a  bill  that  would  allow

the Department of Health and Human Ser­

vices  to  negotiate  drug  prices,  passed  the

House of Representatives in 2019 and was

reintroduced in April. Aduhelm, a triumph

for the pharmaceutical industry, is nowal­

so the poster­child for this campaign.n

WASHINGTON, DC

Aduhelm may not cure Alzheimer’s,

but it might help fix drug prices