820,000 dementia sufferers cost the UK £23bn per annum, according to a new report by the Oxford Health Economics Research Centre, commissioned by the Alzheimer’s Research Trust. The report bewails the paucity of spending on dementia research. For every pound spent on dementia research, £26 are spent on cancer research and £15 on heart disease. This is despite cancer costing the UK economy half as much as dementia, and a third of heart disease.
I don’t want to say ‘I told you so’, but NPC harped on about this when we published our research into autism in 2007, another condition where research spend is too low. We did some quick maths, highlighting both autism and dementia as examples of conditions where research spend lags massively behind the enormous costs of care. We questioned that surely it was in the interest of government to invest more in researching these problems? It is, after all, the government which stumps up for most of the care costs.
So its good that a charity has invested in economic research to make the case for more research funding for dementia. Lets hope any future government heeds its findings. The public should take note too, and remember dementia when writing their wills or deciding what to fund.
There is a danger however that a report like this sounds as if reallocating resources from cancer is the solution. It’s not. What the cancer story shows us is that large scale investment in research can achieve real improvements in prevention, treatment, quality and quantity of life. Cancer research is increasingly clinically rewarding, because it builds on previous progress.
Decent investment in conditions like dementia is also likely to be very rewarding in the long term, even if shorter term it may be a bit of a slog to catch up on all the basic science. The economic argument is powerful. If some of the research spend was directed towards prevention, you would only have to avoid a couple of thousand cases of dementia to save the UK £50m—the entire current dementia research budget.
But the research has to be good quality—remember Andrew Wakefield, the scientist whose now discredited paper connected autism with the MRR jab? And it should be a stepping stone to real prevention or clinical discoveries. I’m with Sir David Cooksey on wanting funders (be they government, academic bodies, foundations or charities), to think more carefully about what type of research they fund. If no-one had backed Florey, Chain and Heatley, the Oxford trio who instigated the long journey to producing penicillin in clinically useful quantities, then Alexander Fleming’s famous discovery would have been clinically irrelevant. When Fleming discovered penicillin, he believed it had little application—it took Florey et al to use Fleming’s research to develop a treatment for infection. They are the real heroes of the story. Another of my research heroes is the late Professor Sir Richard Doll, who discovered the connection between smoking and lung cancer. So many lives have been saved through prevention as a result of his excellent research.
Rather depressingly, in his 2006 Review on research funding, Cooksey cited a 2003 study that sampled over 100 published research papers in the top six science journals 1979-1983, all promising clinical applications within the next 20 years. The study found that, two decades later, only five approaches had resulted in clinical applications, and just one had had a major impact on current medical practice. It seems we have an abundance of Flemings and too few Floreys.
The role of medical research charities in this whole conundrum is important. As well as fundraising for research and spending the funds, charities play an important role haggling for increased research spend by government. They represent the affected patients, who are sometimes at odds with scientists on research priorities. But I think they also have an added role, to be vigilant about research quality, usefulness and accessibility. The peer review process can only go so far. Charities can help ensure that the research focuses on producing real benefits for patients.