24 United States The Economist July 17th 2021
Baseball’swaningpopularity
Pastime
S
tandingbehindleftfieldduringMajor
League Baseball’s(mlb) annualHome
RunDerby ismuchlikeloiteringinthe
middleofa moshpitata deathmetalcon
cert.Balls,bodiesandbeersareflying.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 suffered 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 difficult
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 first
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 suffering
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
beneficiary, according to the Kaiser Family
Foundation, a healthresearch outfit).
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 fix drug prices