Monday, November 03, 2014

The UK says: Scare 'em and they'll change their lives

What's the best way to persuade middle-aged people to adopt a better lifestyle, to reduce drinking and smoking and increase exercise?  Well, according to the British government, apparently the best way is to scare the bejeezus out of them by warning them that they have an increased risk for Alzheimer's.

Really.  I couldn't make up this one.  Here's the story by Laura Donnelly, health editor at The Daily Telegraph. Excerpts:

Middle-aged people will be screened by GPs for their risk of dementia and told how their “brain age” compares to their biological age, under new plans to “scare” people into adopting healthier lifestyles. 
It means a man of 40 could be told that he has the brain of a 60-year-old, and a significantly greater chance of diseases like Alzheimer’s, based on his weight, exercise habits, cholesterol levels and alcohol intake.

The new system of screening, devised by Public Health England (PHE) means patients will be told how their brain is ageing, compared to those with healthier lifestyles, in a bid to shock them into changing their ways.

Officials behind the idea say they hope the warning will encourage people to make major changes in their lifestyle, which will reduce their chance of dementia.

Dr Charles Alessi, PHE lead on dementia, will present details of the screening tool being developed with University College London, to a G7 convention on dementia in Tokyo this week. 

He said officials hoped to harness the public’s fear of dementia to make people take action to reduce their risk. 

He said giving people an actual estimate of the age of their own brain [will give] them a "potent health message" to act on. 

Whoa!  This raises a host of issues, as noted:

Critics said the plans were “heavy-handed and intrusive” and would frighten millions of people - without giving them an accurate forecast of their true risk of dementia. 


As noted, the science is apparently unclear:

Dr Richard Vautrey, deputy chair of the British Medical Association’s GP committee said he was not convinced the screening would give an accurate reflection of the chance of developing dementia.

“Giving someone’s brain age in relation to their natural age doesn’t necessarily mean they are likely to develop dementia any earlier,” he said. 

“We’d need to really look at the research evidence and understand if there is any basis for this supposition,” he said. 

And then, look at this related aspect, too.  A bounty for each diagnosis:

Last month health officials introduced a new scheme which means GPs will be paid £55 for every extra patient diagnosed with dementia in the next five months. 

Leading doctors said the initiative was an “ethical travesty” but officials insisted the scheme was necessary to boost low rates of diagnosis in this country, with just half of patients with dementia receiving a diagnosis.

Sorry, but I think the whole scheme is nuts.  Your thoughts?


Minivet said...

Don't, don't, don't trust the Telegraph. They're all about slanting or making up news with an eye toward scaring their demographic.

Mitch said...

Reminds me on the health risk assessment scam in employee wellness programs. Drive misdiagnosis and over-treatment, does not save money. Al Lewis is a great voice of reason on this issue. As he points out, HRA's make sense if you are selling them.......

Richard said...

What comes to mind regarding the incentives for diagnosis of dementia, especially in such a captured, controlled healthcare environment, is the effect of the inevitable inappropriate false diagnosis being hung on the individual’s life. Will his driver’s license be cancelled? Will his pilot’s license be cancelled? Will the military reservist be forced to leave the service short of retirement because of the new disqualifying diagnosis? Will the heavy equipment operator be forced out of the job supporting his family?

How does one fight the diagnosis in this captive, controlled system if they feel they are inappropriately labeled as demented? Is one then forced to go out of the country to obtain an independent evaluation? What if that evaluation is contrary to that assigned to him within his country’s system? Who or what entity does one appeal to? Will independent evaluations even be considered and if so how long will it take to consider reversal of the diagnosis if that’s appropriate? Weeks? Months? Years? Never? Then there is the stigma if it is reversed. If you are the licensing agency or the employer, which evaluation do you believe?

My God, this can’t be true! That allegedly intelligent, thinking people put this in place is a nightmare come true!

Peter said...

Nuts! Did they test themselves??

M.E. said...

Of course, the idea that scaring people into behaving better - whatever that means! - is effective is bunk. Witness warnings on cigarette boxes and all of the education about the dangers of smoking.

Barry Carol said...

It sounds nuts to me. I would be highly skeptical of how credible the predictive value of any such test would be and how likely changing my behavior in the recommended ways would do any good. It looks like a crass ploy to reduce healthcare costs by scaring people in a country that long ago made a political decision to skimp on health spending as a percentage of GDP in comparison to its Western European neighbors.