Prevention of brain disorders: a global priority
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1 Prevention of brain disorders: a global priority Sandro Galea, MD, DrPH Gelman Professor and Chair X X
2 prevention priˈvenchən noun the action of stopping something from happening or arising PHRASES an ounce of prevention is worth a pound of cure proverb it's easier to stop something from happening in the first place than to repair the damage after it has happened. Oxford American Dictionaries
3 . Are brain disorders preventable?. So, can we, prevent brain disorders?. Should we invest in preventing brain disorders?. Can we afford not to try to prevent brain disorders?
4 . Are brain disorders preventable?. So, can we, prevent brain disorders?. Should we invest in preventing brain disorders?. Can we afford not to try to prevent brain disorders?
5
6 Depression in the U.S, 8 Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report. Oct ; 59(8)
7 Depression, NYC, Community Health Survey, NYC Department of Health and Mental Hygiene
8 Autism in the United States,
9 . Are brain disorders preventable?. So, can we, prevent brain disorders?. Should we invest in preventing brain disorders?. Can we afford not to try to prevent brain disorders?
10 Absolutely
11
12 . Are brain disorders preventable?. So, can we, prevent brain disorders?. Should we invest in preventing brain disorders?. Can we afford not to try to prevent brain disorders?
13 Three percent of US health care dollars go to prevention
14 a. A values argument
15 Ask yourself would you prefer To have access to effective treatment for your schizophrenia
16 Ask yourself would you prefer To have access to effective treatment for your schizophrenia or Never to have schizophrenia at all
17 One of [our] most difficult challenges is to ensure that the urgent does not crowd out the important. In health the challenge is especially difficult because urgent matters can be so riveting. McGinnis JM, Foege W. The immediate vs. the important. JAMA ;9():6-6.
18 b. A numerical argument
19 Population
20 Exposure
21 Disorder
22 Should we invest in preventing brain disorders?
23 Yes
24 . Are brain disorders preventable?. So, can we, prevent brain disorders?. Should we invest in preventing brain disorders?. Can we afford not to try to prevent brain disorders?
25 a. Our curative efforts are fixing only one very small bit of a much larger challenge
26 Population health Rose G. Sick individuals and sick populations. International Journal of Epidemiology. 985;:-8
27 Population health Rose G. Sick individuals and sick populations. International Journal of Epidemiology. 985;:-8
28 Population health Rose G. Sick individuals and sick populations. International Journal of Epidemiology. 985;:-8
29 Rose G. Sick individuals and sick populations. International Journal of Epidemiology. 985;:-8
30 A B D C Nondiseased Diseased Total Unexposed A B A+B Exposed C D C+D Total A+C B+D N Rose G. Sick individuals and sick populations. International Journal of Epidemiology. 985;:-8
31 Meigs JB, Shrader P, Sullivan LM, McAteer JB, Fox CS, Dupuis J, Manning AK, Florez JC, Wilson PW, D'Agostino RB Sr, Cupples LA. Genotype score in addition to common risk factors for prediction of type diabetes. N Engl J Med. 8 Nov ;59():8-9
32 Meigs JB, Shrader P, Sullivan LM, McAteer JB, Fox CS, Dupuis J, Manning AK, Florez JC, Wilson PW, D'Agostino RB Sr, Cupples LA. Genotype score in addition to common risk factors for prediction of type diabetes. N Engl J Med. 8 Nov ;59():8-9
33 Pepe MS, Janes H, Longton G, Leisenring W, Newcomb P. Limitations of the odds ratio in gauging the performance of a diagnostic, prognostic, or screening marker. American Journal of Epidemiology ; 59:88-89.
34 b. These elements that might prevent brain disorders are inevitably driving brain disorders
35 An illustration, borrowing from cardiovascular disease
36 Will reducing the prevalence of junk food eating in the population reduce the risk of obesity in the population?
37 Baseline heritability Food environment Junk food eating Keyes KM, Davey Smith J, Koenen KC, Galea S. The mathematical limits of genetic prediction: implications for personalized medicine. Under review. Keyes KM, Galea S. Why a focus on changing health behaviors to reduce obesity prevalence will not work: the mathematical limits of individual risk behaviors. Under review.
38
39
40 Therefore Variation in the prevalence of background causes are med/low inter-individual causes is directly 6 6 associated with the number of obese people only when the prevalence of environmental causes is high/med and
41
42 Observation 5 Prevalence of junk food eating never matters to the effect of junk food eating on obesity in the population
43 Observation When genetic influence is low, the risk of obesity following junk food eating is high only when food environment is adverse
44 Observation Genetic influence obviates environmental influence only under common variant conditions
45 Therefore Understanding prevalence of junk food eating tells us very little about contribution of junk food to risk of obesity without understanding environment
46 Therefore, reducing the prevalence of junk food eating in the population is not particularly relevant to reducing the risk of obesity secondary to junk food eating unless there is a concomitant effort to also improve the food environment Keyes KM, Davey Smith J, Koenen KC, Galea S. The mathematical limits of genetic prediction: implications for personalized medicine. Under review. Keyes KM, Galea S. Why a focus on changing health behaviors to reduce obesity prevalence will not work: the mathematical limits of individual risk behaviors. Under review.
47 It is impossible to predict who is going to develop disorder without understanding the environmental drivers of disease
48 Can we afford not to try to prevent brain disorders?
49 No
50 It is no longer sufficient to expect that reforms in the medical care delivery system alone will improve the public s health. Large proportions of the disease burden are preventable. For the public s health. IOM.
51 . Are brain disorders preventable?. So, can we, prevent brain disorders?. Should we invest in preventing brain disorders?. Can we afford not to try to prevent brain disorders?
52
53
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