Memorandum 17
Submission from Professor Crawford, London
Metropolitan University
SUMMARY OF
THE MAIN
POINTS
The report does not adequately address research
on prevention.
Author of this comment:
Professor Michael A Crawford, PhD, CBiol, FIBiol,
FRCPath, Director of the Institute of Brain Chemistry and Human
Nutrition, London Metropolitan University.
I have worked in several countries and been
a consultant to the World Health Organisation and Food and Agricultural
Organisations with regard to the links between nutrition and chronic
diseases, especially on the role of fats and oils in human nutrition.
My expertise is on the lipid biology and its relevance to vascular
and neural development. I have published over 290 peer reviewed
papers in the bio-medical literature. I am a trustee of two charities
concerned with neurodevelopmental disorders and maternal and child
health. The Little Foundation and the Mother and Child Foundation.
Factual information the committee should be aware
of:
The UK has the highest incidence of low birthweight
of any Western European country. Although low birthweight is only
a crude marker of pregnancy outcome, none the less lower birthweight
is the single most powerful predictor of ill health, heart disease,
stroke, diabetes, poor learning abilities, mental ill health and
crime. At the extreme end, very preterm, low birtweight infants,
are at high risk to central nervous system disorder such as Cerebral
Palsy.
Lord Warner in a recent reply to a question
from Lord Morris provided data showing that the cost of mental
ill health associated with hospital and institutional care has
escalated over five fold in the last two decades with the latest
estimate at over £5 billion. In a recent reply to a question
by Lord Walton he provided data that the courts had awarded costs
against the NHS Trust Hospitals of £189,000,000 for cases
of Cerebral Palsy in 2004-05. This is only a fraction of the cost
of Cerebral Palsy which in the UK is likely to be of the order
of 4 billion/year. This however, is the tip of an iceberg of many
children not reaching their genetic potential because the conditions
that place the UK high in the ill health league also affect women
during the pregnancy. None the less the evidence on Cerebral Palsy
could be that aggressive litigation may be mistaken as the Little
Foundation's European Cerebral Palsy study has concluded that
few cases are genuinely due to obstetric mishap. The majority
are from adverse prenatal conditions hence are potentially preventable[19]
re-iterating what has been in evidence before.[20]
Moreover, the audit of the burden of ill health
in the EU[21]
estimates that brain disorders have overtaken all other costs
and stood at €386 billion for the 25 member states at 2004
prices.
The Cooksey report whilst praising UK science
does not address these issues and does not address the need for
preventive research. Its graphic representations of costs show
a large section related to mechanisms designed for drug research
and a narrow waste for prevention. Its tenor is of the benefits
derived from research on drugs and high technology to the UK economy.
This strategy is curative. Prevention should come first.
In so far as health is concerned the report
rightly sees that the system to date has largely failed to reduce
the burden of health costs. This is reflected in an editorial
in the Lancet[22]
It ignores the changing panaorama. If brain disorders as predicted
in 1972[23],
continue to rise this century as heart disease rose last (vascular
health is critical to neurodevelopment). The outlook is bleak
in terms of social, educational, mental health and political costs.
Recommendations that you would like the committee
to consider including in its report
Welcome as the curative approach is, the real
cost savings, health, educational and social benefits will not
come from cures but prevention.
A major section needs to be devoted to how to
prevent disorders. Much of this should take into account epigenetics
and developmental processes in which environmental, lifestyle,
infectious and nutritional conditions contribute.
There are some simple initiatives that could
be researched:
1. How to use existing knowledge (what are
the barriers, resistance in decision makers, how to implement
and test efficacy of knowledge, already so extensive and hard
gained, in order to test and improve outcomes).
2. What is the cause of the rise in brain
disorders and how can it be stopped.
3. The same applies to the rise in obesity
(the connections with food production methods are not being investigated).
4. Research on the cause of the rise in heart
disease and several cancers which are at a high level in the UK
and other similar western countries. They were rare at the beginning
of last century and rare in many developing countries and even
developed economies such as Japan and South Korea.
There are of course many more such details but
there shodl be a fundamental change in emphasis towards prevention.
There are implications in the preventive approach
not only for medical research but also food and agricultural research
as pointed out by the 1978 FAO/WHO Expert Consultation[24]. The
approach to a re-design of research needs to be multi-disciplinary.
January 2007
19 Bax M, Tydeman C, Flodmark O. Clinical and MRI correlates
of cerebral palsy: the European Cerebral Palsy Study. JAMA. 2006
Oct 4-296(13): 1602-8. Back
20
Crawford M A, Golfetto I, Bistanis D, Ghebremesle; K, Min Y, Moodley
T, Poston L, Phylactos A, Cunnane S, Schmidt W. (2003) Arachidonic
and Docosahexaenoic Acids in Protection Against Central Nervous
System Damage in Preterm Infants. Lipids 38 (4), 303-315. Back
21
European Journal of Neurology, June issue 2005. Back
22
The Lancet. The catastrophic failures of public health. Lancet
2004; 363: 745. Back
23
Crawford MA, Crawford SM (1972) What we eat today, Neville Spearman,
London. Back
24 FAO-WHO Joint Expert Consultation on the Roel
of Dietary Fats and Oils in Human Nutrition, Nutrition report
No 3, FAO, Rome. Back
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