Dementia Centred

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By Mark Butler

July 21st, 2014

Preventing the Prevention Myth

The latest report from the International Longevity Centre on “Preventing Dementia: A Provocation”, is aimed at raising the ante on prevention of dementia and related cost-saving with policy makers and health professionals. It really boils down to a call for the classic elements of doing nothing whilst appearing to do something strategic – awareness raising, “evidence-gathering” from friendly sources and a new policy vehicle.  

The ILC Report is framed around the levels of prevention of “cases of dementia” that might be possible.  It summons up some figures to show what could be saved (in state and private sector spending) by a more determined preventative approach, setting its sights initially on 6 Risk Factors.  This approach yokes dementia prevention to another set of big-ticket health challenges – diabetes, hypertension, obesity, depression, physical activity and smoking.  These “risk factors” overlap with, but are different from, the recent Cambridge Public Health report in similar territory, which in fact reduced its previous optimism about the impact of a coordinated prevention approach downwards from near a half to a third (a huge change reflecting more research undertaken since 2011).  It too rolled out some large, but largely speculative, figures on impact and cost saving to keep Whitehall interested and maintain a sense of relevance to big policy.

There is a myth at the centre of both these high-profile reports.  Stories of (often false) hope have always been one strand of public coverage of dementia – for example the imminent delivery of a miracle cure by Big Pharma or the stories of brave individuals “beating the odds”.  This is as true of Cancer and Heart Disease as it is of dementia and has to be lived with as an inevitable part of social engagement with large-scale health and social/economic challenges. 

My concern though is that it is just not right to frame what is in fact merely a potential slowing of the onset or progress of dementia as “cases prevented”.  It may well be argued that public health interventions and individual changes in behaviour, such as those described in both reports, may affect the prospects for some people.  This is “delay” not prevention. The actual pattern is either unknown, multifaceted or unknowable. The positive cost of prevention is largely about avoidance of cost to the state and the public purse.  It is about some avoidance and some delay.  This should not be misrepresented as a serious and quantifiable prevention process.  To do so places it in the false hope category.

Would it be too cynical to suggest in part that reports such as these are sponsored by the understandable desire to secure a slice of the research money currently swilling around dementia worldwide (whilst it is around)?  This is at the moment heading much more towards search-for-cure Research and Big Pharma, rather than public health and social/economic impact research.  This motivation is legitimate at one level – more serious research is needed around social impact and response to changes in health and old age. 

However something more rigorous, sophisticated and (dare I say it) honest is surely needed – an approach which does not have to trade in the false hope of prevention.  We have to be careful that things do not fuel an agenda of false hope and mythical saving.  It might be a good first step to be sure that the model of prevention and “Risk Factors” is in fact a productive or relevant one.  If the ILC Report provokes such a response more widely then it is to be welcomed. More likely though will be further work in this area in isolation, perpetuating the myth about prevention.  That would make it another wasted opportunity in relation to moving action on dementia forward.  More dangerously it could become a waste of energy and money and a potential distraction from doing so.