11 Dec 2013 Posted in Opinion By Dr Bina Rawal
There are around 800,000 people in the UK living with dementia, and an estimated 44 million people worldwide. Yet our understanding of how it can be prevented or cured lags far behind some of the other ‘big diseases’ such as cancer and heart disease.¹
This absolutely has to change. Aside from the devastating personal consequences of dementia for individuals and their families, it places an unsustainable burden on our health and social care system.² All of this will be exacerbated as the prevalence of dementia continues to increase because of an ageing population.
Progress in this area has to be multifaceted: from general health measures including changes to diet and lifestyle, to restructuring the social care system to better support people with the disease, to increasing awareness to aid timely diagnosis. However, there is no doubt that the pharmaceutical industry needs to continue to play a critical role in discovering and developing new dementia treatments.
Medicines already play a valuable role in alleviating many of the symptoms of Alzheimer’s disease, a common form of dementia. However, as we are all painfully aware, there is currently no cure. This is in spite of many billions of pounds of investment in dementia research globally by the pharmaceutical industry.
This is due, in part, to the biology of dementia. It is not a single disease and the symptoms often only become apparent a decade or more after changes in the brain first begin to appear. This poses particular challenges for early diagnosis and for identifying patients in whom new approaches can be tested in clinical trials at the very earliest stages of the disease.
However other factors, which are in the hands of the policy makers who will take centre stage at tomorrow’s summit, could also help bring to fruition some of the 198 medicines for dementia which are currently in the development pipeline. The innovation and medicines pricing environment for dementia, and indeed the entire spectrum of neurodegenerative disorders, must be reviewed to ensure it is sensitive to the particular challenges of research in this field.
The slow and progressive nature of dementia means that gathering a sufficient evidence base for research takes many years, and this needs to be commercially viable for companies. In the UK, the Government has a role to play in ensuring that companies are rewarded for their investment in this area, particularly given that it is one of the UK’s stated research priorities.³ For instance, regulation and health technology assessments (HTA) need to be tailored for dementia treatments, given the natural history of the disease.
HTAs often favour treatments which extend life, and improve survival from illness, as opposed to those which improve quality of life. This also needs to be addressed if more innovative dementia treatments are to reach patients and allow them to reap the benefits of greater independence and symptom relief.
We welcome the Prime Minister's announcement today on the Government’s investment in life sciences and commitment to support more research and collaboration into dementia. The Government can also play a really crucial role in the acceleration of the research process by developing, and participating in, innovative funding models and progressive licensing approaches. We hope this will be given due consideration as part of discussions at the Summit this week.
We all know the very real benefits which incremental innovation in medicines can bring. We have seen them first hand in antibiotics, anti-epileptics, anti-retrovirals and cancer drugs. These innovations have made it possible to manage or cure conditions in a way that would have been unimaginable a couple of decades ago. Working together, it may one day be possible to revolutionise the experience of dementia sufferers in the same way.
Dr Bina Rawal
Medical, Innovation & Research Director