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I recently attended a meeting organized by the European Brain Council to discuss how we should highlight the need for further brain research to improve health outcomes for brain diseases. At the end of the day, this is a political exercise. We rely on public money to pay for much of the research we do, and research is arguably one of the least harmful ways in which governments spend taxpayers’ money. In the long term, return on investment from research spending is good and innovation requires networks of highly developed skills and inter-dependent specialist interests which characterize the most economically, socially and environmentally successful societies.
However, brain research suffers from a poor understanding of the cost of impaired mental health in particular. The previous ECNP/EBC joint project on the cost and burden of brain diseases had and continues to have an important impact. The simple magnitude of the burden from brain diseases remains a major reason for increases in research funding on basic, translational and clinical research. Parity with what is spent on other diseases is all we need seek. Why should we value mental illness differently from cancer and heart disease? A lot more people now get the message, but not everyone.
Therefore, there needs to be a follow through. The cost of mental illness is one thing, how we value it is another. Raw numbers of euros or dollars have a limited impact, especially as government debt has now devalued our understanding of scale.
It is less commented on that the cost and burden study also revealed the treatment gap that exists for many of our patients. Even when diagnosed, they often do not receive effective treatment. The enormous opportunity costs of non-treatment are the lost productivity of people with relatively treatable conditions – think bipolar disorder, depression, anxiety. So there is a case to be made around these conditions, but it is sometimes tough to make it because the research data is quite limited. Moreover, it means differentiating between different disorders and there is a risk that it becomes a plea for more services. And that becomes another argument about value, which is not yet won.
By contrast the failure to treat physical co-morbidity is a failure of services that are often supposed already to exist. The chance of a member of the general population reaching 70 is the same as a person with bipolar disorder reaching 50. This deficit is both shocking and yet commonplace for many of our patient groups, not just bipolar disorder and schizophrenia. Moreover, loss of life is a metric everyone can understand. It occurs largely because of physical illness particularly cardiovascular disease and because there is a treatment gap in regard to physical illness in our patients. This is, however, not very well understood. A project to understand why and how it happens could help reinforce the sense of value we attach to the health of patients with brain disease. I think that is one of the small steps we can make to increase the value argument for our patients.
So, will raising awareness about the physical health of patients with brain disease support calls for more research on what causes it in the first place? I cannot see it would harm the argument. It might help a lot. Tell me if I am wrong.
Guy Goodwin
ECNP President |
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