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  • • Prime Minister, Ministers, PMSEIC Colleagues, Ladies and Gentlemen Over the last few months I have had the pleasure of working with a group of eminent neuroscientists to prepare this presentation on the pivotal role their field of science will play in treating and preventing this important group of diseases - the brain and mind disorders
  • • These scientists have spent their scientific careers working towards solutions to the major brain and mind disorders The group representatives here today include Fred Mendelsohn,….. [Presentation by myself and Fred] Brain and mind disorders is a collective term for a range of - neurological disorders - stroke, dementia, Parkinson's, epilepsy - psychiatric disorders: - depression, anxiety disorders, schizophrenia, addiction Our choice to treat them as one group of diseases is not an accident - traditionally it was thought that the ‘mood’ related disorders such as depression did not have a biochemical or physiological basis in the same way as stroke, for example. However, we now know that both neurological and psychiatric disorders have an ‘organic’ basis And they both involve gene abnormalities - Essentially - brain and mind are now coming together, so neuroscience offers great potential for curing both groups of diseases
  • The Brain and Mind disorders stand out as by far the outstanding cause of disability in Australia and indeed, the Western world. We are not saying they are the leading cause of death, but because of their chronic, debilitating nature, they are clearly the major cause of disability.
  • And interestingly, psychiatric disorders such as depression dominate in early life, while in the elderly, the neurological diseases such as dementia and stroke are most prevalent.
  • The impact is enormous: Over 15% of our population - both adult and children - experiences a major brain and mind disorder in any year. Besides the direct effects of illness, the consequences include unemployment, social isolation, dependency, violence and suicide Childhood problems: attention difficulties, anxiety, delinquent behaviour Impact is not just on the sufferer, but also on their families Aboriginals: 10 x more severe
  • The health costs are very high, with over $2 billion per annum in pharmaceutical benefits costs plus disabilitys support pensions.
  • • And the PBS/DSP data do not take into account the costs to business Take this one disease alone - dementia: although there are only 160,000 cases pa, it accounts for over 50% of aged care residents and 2.5% of health costs but costs to business are many fold this amount - because of the effect on families and carers • Most worryingly, the situation is predicted to get worse: If the Intergenerational report is correct the health plus business costs will exceed $20 b pa Clearly this is unsustainable
  • Simply delaying the onset of these diseases, or decreasing the incidence by 25% could save Government and business billion of dollars each year.
  • How are we going to achieve these benefits? Incremental improvements in disease management are not the answer [they could actually increase the cost burden] Early intervention is required to either prevent the disease from occurring, or at least allow people to continue productive lives. Health care alone is not the answer: Research from the Australian Twin Registry: 30% of the cause of anxiety and depression is accounted for by genetic rather than environmental factors - more than half the burden is unavertable - data from Andrews and co-workers at the Univ NSW Currently 14% of psychiatric disorders are treatable with currently available methods If we were to apply evidence based medicine this could be improved by 6% to 20% By focussing on cost effective treatments this could be increased by 13% to 33% However, even given unlimited funds to support all available knowledge we could only gain another 12% (total 45%) and the majority of disorders cannot be averted
  • I would now like to present some of recent discoveries about the brain in the last 5 tears that are revolutionizing the way we understand the brain and that we believe are opening doors for solving some of the problems in brain and mind disorders. This is the 50th anniversary of discovery of the double helix structure of DNA by Watson and Crick and coincides with completion of sequencing of the human genome (10 billion BP) This is the biggest single advance since over half of the know genes are expressed in the brain as shown on this DNA microchip. This is markedly accelerating the discovery of the chemical basis of brain function
  • This is a nerve cell in the brain. There are approximately 100 billion of them in each of our brains, nearly twenty times the number of people on earth. Each nerve cell is intricately connected to many others through these areas called synapses. There are about 100,000 on each nerve cell. We use to believe that this wiring between nerve cells was fixed after early childhood but now we know this is a very dynamic process – during this talk you will have formed about a million new synaptic connections every second. This process underlies learning, and development and continues throughout life. It indicates that there are many possible ways we might intervene to enable the brain to respond to damage or injury or to minimize the impact of disease.
  • These images show areas of loss of grey matter in patients with onset of schizophrenia in comparison with controls or compared with patients with chronic illness. The most dramatic changes appear to be occurring in the first 2-4 years of the illness. This may be the optimal time to intervene to ameliorate the illness and prevent chronicity. This is work form Associate Prof Pantelis a member of the working party In conjunction with genomic studies by other workers in these brain areas show that there are major changes in synapse formation and function In schizophrenia. Incidentally, the ability to predict mental illness before it is full blown is an important medical and research advance but it raises legal and ethical implications that we could discuss
  • With regard to the ability of the brain to adapt and repair itself has been the remarkable discovery that the adult brain contains stem cells that are capable of forming new nerve cells. Here some pioneering Australian workers have isolated these stems cells and show them producing a new nerve cell here. Clearly understanding how these cells are regulated offers the chance of repairing the injured brain or spinal cord Purification of a pluripotent neural stem cell from the adult mouse brain RODNEY L. RIETZE, HELEN VALCANIS, GORDON F. BROOKER, TIM THOMAS, ANNE K. VOSS & PERRY F. BARTLETT Nature 412, 736-739 (16 August 2001)
  • Of these two sisters in their eighties the one of the left has Alzheimer’s disease. If we were to look at the brain of someone with Alzheimer’s we would find that the brain is shrunken and filled with abnormal deposits of a protein called A beta which damages nerve cells. Pioneering work by an Australian, Professor Colin Masters, and his collaborator, Professor Conrad Beyreuther in Germany, have worked out the detailed biochemical pathways involved in the deposition of this abnormal protein. Although there is some controversy, most scientists working on AD now believe that this abnormal protein causes the disease. Masters group has gone on to develop a novel drug that prevents the deposits in a mouse model of Alzheimer’s and also stops the mice developing the behavioural and memory effects typical of the disease This drug is now in clinical trials in patients. Whether or not this particular drug is successful, many groups around the world are working on ways to block the deposition, or enhance the dissolution,of the abnormal protein We make the bold prediction that a cures, or prevention, of Alzheimer's disease may be achievable within the next decade
  • We have many universities, research institutes and centres with world-competitive neuroscience programs. The strength of this sector was recognised by the award of an MNRF in the last round. There are also a range of support organisations, such as the Mental Health Council. Also, our twin registry and the initiative beyond blue to address depression, have attracted international acclaim You may be surprised to learn of the depth and breadth of our industry sector in neuroscience. The 25 Australian companies have a combined capitalisation exceeding $2 billion. I would refer you to our paper which provides profiles of each of these innovative companies. Most evolved from our public sector research base. We also have a substantial presence of the global phama industry - because of our research capabilities. Finally, there are centres of excellence in a range of frontier and platform technologies that are essential to neuroscience.
  • So - Brain and mind are coming together The targets are huge The science is exciting: How can we leverage Australia’s impressive neuroscience capability to cure some of the really big ticket diseases? Research priorities was an important first step [Health and Well-Being} What is now needed in the means to achieve coherence, focus and linkages
  • Prime Minister, our recommendations are straightforward Australia needs to establish a Brain and Mind Research Alliance as the catalyst and glue to focus our excellent research capability on curing major brain and mind disorders within the next decade Our paper provides considerable detail on the functions of this alliance, the process for establishing it and some important early initiatives.
  • Prime Minister, as a non-neuroscientist I can speak without self-interest. What I have learned over the last few months is very exciting - we have a world-class neuroscience capability on which to build our research priorities. It is highly likely that within a decade, several of the big brain and mind disorders will be cured or treated effectively. The brain and mind alliance will position Australia to make a major contribution to those solutions. It will also help contain the spiralling costs of health care and improve the well-being of those 3 million Australians who suffer from brain and mind disorders.
  • The brain and mind are truly coming together!
  • This is some of the means we can study the living human brain using magnetic imaging or radioactive tracers to follow brain structure and function
  • We can now study how brain activity changes during recovery from injury, for example. The first image shows little activity in the right hemisphere during language generation in a child compared with the left hemisphere in the second image. After injury to the left hemisphere, the language generation capacity in this ten year old is transferred to the right hemisphere as shown in the third image.
  • The insights from brain imaging go beyond disease states. Here, in mathematically gifted children performing a mental rotation task, we see that they engage a much bigger brain network to solve the problem. We don’t know yet wether this represents an innate difference or whether it can be learned. In any case it has major implication for education, since this may reveal a brain strategy that is much more powerful for solving mental tasks.

.ppt .ppt Presentation Transcript

  • Neuroscience: The future in treating and preventing brain and mind disorders
  • Brain and Mind Working Group Dr Leanna Read CEO, TGR BioSciences Pty Ltd Prof Fred Mendelsohn Director, Howard Florey Institute Prof Max Bennett AO Dept Physiology, Univ Sydney Prof Edward Byrne Centre for Neuroscience, Univ Melbourne Prof Ian Hickie CEO, beyondblue Prof Assen Jablensky School Psychiatry & Clinical Neurosci, Univ WA A/Prof Christos Pantelis Dept Psychiatry Univ Melbourne Prof Peter Schofield Neurobiology Res Program, Garvan Inst Med Res With assistance from Department of Health, and Michael Healy, Office of the Chief Scientist
  • Aims of This Presentation
    • To demonstrate:
      • The impact of brain & mind disorders on Australia
      • The urgent need for solutions
      • The pivotal role neuroscience will play in those solutions
    • To show the way forward
  • Causes of Disability Australia, 1996 Years of Healthy Life Lost (thousands)
  • Psychiatric & Neurological Disorders Depression and Addiction Afflict Our Young, Dementia and Stroke the Elderly Years of Age % Total disability Psychiatric disorders Neurological disorders
  • In any one year, over 3 million Australians experience one or more episodes of major brain or mind disorder
  • Counting the Cost Brain and Mind Disorders Impose High Health Costs and Productivity Losses Annual Costs to Government of Mental Disorders PBS Spend DSP Spend 0.0 0.5 1.0 1.5 2.0 $ Billion p.a.
  • Increasing Costs of Dementia 2001/02 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 $ Billion Health Business 2041/42
  • What If We Could Prevent These Disorders or Control Them Cost-effectively?
    • Eliminating Alzheimer’s disease by 2042 would save over $20 billion pa in health and business costs
    • If the onset of disease was delayed for five years the direct and indirect health savings would be
      • $5 billion pa for Alzheimer’s disease
      • $1 billion pa for stroke
    • If the incidence of schizophrenia was reduced by 25%, we would save $500 million pa
  • Neuroscience research offers a real opportunity to achieve impressive savings
  • Improved Health Care Alone is Not the Answer Current treatments Apply evidence based medicine Invest but focus on cost effective treatments Unlimited support to utilise all available knowledge More than half of the burden of mental disorders cannot be averted by current knowledge … . More research is needed
  • 1. Sequencing the Human Genome
    • Greatest single advance for neuroscience
    • More than half of known genes are expressed in the brain
    • Accelerating discovery of chemical basis of brain function
    • New targets for disease prevention and treatment
    DNA chip microarray
  • 2. Cellular and molecular neuroscience
  • 3. Multidisciplinary Approaches Early Changes Detected in the Brain Pantelis & co-workers, Lancet 10 Dec 2002 Schizophrenia: Brain Imaging plus Genomics Reveal a Fundamental Problem With Synapses New therapy targets
  • 4.Stem Cells in the Adult Brain Rietze & co-workers. Nature Aug 2001. Walter & Eliza Hall and Howard Florey Insts
  • 5. Alzheimer’s Disease Alzheimer’s Sufferer Normal Brain Affected by Alzheimer’s Normal Brain Mouse Model of Alzheimer’s Treated Mouse
  • Recap
    • Brain and mind disorders impose the highest health burden of any disease group
    • Early intervention strategies needed
    • The neuroscience revolution offers great promise: brain and mind are coming together
    • Australia can tap its world-class research capability and growing industry sector
  • Australia’s Neuroscience Capability Neuroscience Capability 6 Professional Bodies
    • Initiatives
    • Twin Registry
    • - beyondblue
    Support Organisations Supporting Technologies Proteomics Genomics Imaging Neuroscience Research Centres >10 Universities >20 Institutes/Centres MNRF Industry >25 Australian Companies Global Pharma Companies
  • How do we optimise this opportunity?
    • Cross-disciplinary research networks - national and international
    • National network funding for neuroscience research
    • Outcome focus through community and industry partnerships
    • Provide the means to identify the big research priorities and to evaluate outcomes
    • Pro-active consideration of ethical issues
  • Recommendation: Establish a Brain and Mind Research Alliance Brain and Mind Research Alliance Policy: Research Priorities Outcome Evaluation Ethics Cross-disciplinary Research Partnerships: National & International Community and Industry Partnerships Cross-Agency National Network Research Funding
  • Outcomes for Australia
    • Curing some major brain and mind disorders
    • A significant improvement in the health and well-being of Australians
    • Retain international leadership in neuroscience research
    • Build an internationally competitive neuro-biotechnology industry
  • Bringing Brain and Mind Together
  •  
  • Positron Emission Tomography (PET) Functional neuroimaging
  • Magnetic Resonance Imaging (MRI) Structural and functional neuroimaging
  • Reorganisation of the Brain Following Injury: Speech Normal Child Left Sided Brain Damage Right Right Left
  • Brain Activation in Mathematically Gifted and Normal Children During a Mental Task Gifted Control
  • Schizophrenia Functional Brain Imaging and Genomics Reveal a Fundamental Problem With Synapses