Transcript Does activated charcoal work?

Australian Ageing Research Agenda
Priorities and Challenges
David Le Couteur
Professor of Geriatric Medicine
Centre for Education and Research on Ageing
University of Sydney
UNITED NATIONS
http://www.un.org/esa/socdev/ageing/ageimpl.htm
Demographers note a demographic revolution, wherein
the proportions of the young and the old will undergo a
historic crossover...This portrait of change in the world's
population parallels the magnitude of the industrial
revolution - traditionally considered the most significant
social and economic breakthrough in the history of
humankind since the Neolithic period.
2000
All cancer mortality rate
1500
1250
1000
750
Old age is the main risk
500
250
0
80
factor for disease and
0-19
20-49
50-74
75+
disability after 28 yrs
60
(Harman 2001)
40
20
Prevalence of diabetes per 1000
Percent of population with high blood pressure
1750
100
0
20-34
35-44
45-54
55-64
65-74
75+
1 in 5 hospital days are
> 80yrs
80
60
40
20
0
<44
45-64
65-74
Age (years)
>75
Evidence for healthcare
– little evidence for efficacy
• >4% of RCT are older people
– efficacy often absent
– adverse outcomes greater
Future $$ predictions
• Baby boomers graduate to retirement in 2011
• Intergenerational Report, costs associated with ageing
will amount to $84 billion within 40 years
• Health care - $15.5 billion
• Pharmaceuticals - $46.5 billion
• Aged care and pensions - $22 billion
Evidence for health policy
(AHR, Lowe & Kasap, 2002)
“New ways of doing things in health care are usually
introduced with little or no scientific evaluation …
Political and economic imperatives, often seeming to be
based on little other than the whim of State or
Commonwealth ministers results in management
directives to rationalize reformulate and change tried
and tested systems...”
Where is ageing research in
Australia?
• NATIONAL RESEARCH PRIORITY AREAS
• 17 areas covering defence, environment, technology
and health
• “Ageing well, ageing productively”
NHMRC Scoping Study
(CERA, NARI consortium)
• designated ageing/geriatric research poorly funded
• minor NHMRC representation
• productive in terms of publications
• performed by “non-ageing” researchers
neurosciences
immunology
NHMRC Project Grants 2000
4000000
2000000
cancer
endocrinology
NHMRC funding ($)
6000000
gastro-hepatology
geriatrics and gerontology
8000000
Includes 8
grants on
dementia
continuing grants
competing grants
0
0
50
100
150
number of applications in 2000
200
250
NHMRC Australian Biomedical Research
1200
1000
800
600
400
200
es
cien
c
ros
Neu
Imm
uno
log
y
cer
Can
ino
log
y
End
ocr
iatr
ics
0
Ger
Publications supported by NHMRC by ISI category
1998 Butler, Biglia and Bourke
Geriatrics was the lowest of all categories
Total number of Australian publications 1996-2000
PubMed citations
1996-2000
6000
5000
4000
3000
2000
1000
0
A
B
C
D
E
F
G
AGEING
A: AGING OR AGEING OR SENESCENCE OR ELDERLY OR OLDER
PEOPLE NOT NEONATE NOT INFANT
B: GERIATRIC OR GERONTOLOGY OR ELDERLY
C: DEMENTIA OR ALZHEIMERS DISEASE
DISEASE
D: CANCER OR NEOPLASIA OR CARCINOMA
E: IMMUNOLOGY OR IMMUNODEFICIENCY OR HIV OR ALLERGY
F: HEART OR BLOOD PRESSURE OR CARDIAC OR CARDIOVASCULAR
G: BRAIN OR NERVE OR NEURON OR NEUROLOGY OR NEUROSCIENCE
AUSTRALIA = AUSTRALIA OR SYDNEY OR MELBOURNE OR BRISBANE
OR PERTH OR ADELAIDE OR CANBERRA
Survey of Australian ageing
researchers
• N=79
• average age 45
• 42% research degree
• 49% hospitals, 25% university, 20% institute
• 61% medical, 25% science, 14% other
The conclusions of the report
• Ageing research
• Infrastructure needs
– primary focus on ageing
– career development
– multidisciplinary
– ageing animals
– interface with health
– longitudinal studies
care
Ageing research will succeed if
• targeted funding and seeding
– area of extraordinary need vs current orphan
status
• primary focus on ageing
– not disease, gene or methodology
• multidisciplinary
– ageing is complex therefore solutions will be
multifaceted