Welcoming Speech and Introductory Remarks
6th International Conference on Alzheimer’s and Parkinson’s Diseases
Your Majesty, Mr. President, Madame Minister of Health, Mr. Mayor of the City of Seville, Messrs. Chairmen, Drs. Israel Hanin and Abraham Fisher, Excellencies, Distinguished Guests, Dear colleagues, friends, ladies and gentlemen:
It is a great honor for me to welcome all of you to Seville. On behalf of the organizers of the 6th International Conference on Alzheimer’s and Parkinson’s diseases I would like to express my most sincere gratitude for your presence in this Opening Ceremony as the gateway to the initiation to our Scientific Program.
We are specially thankful to Her Majesty who, amid her heavy burdens, duties and responsibilities, has traveled from Madrid to Seville to dignify and magnify our meeting here today. Many of the dignitaries who are also sharing their time with us in this event, have also changed previous commitments in their political and professional duties to find time to render stimulation and appreciation to the international scientific community represented here by scientists from 48 different countries from all over the world.
Two years ago, Israel Hanin and Abraham Fisher decided to choose Seville as the location to celebrate the 6th ADPD Conference, and they asked me to collaborate with them in this endeavor. I also want to thank both of you, Israel and Abraham, for putting your trust in this country and in this Spanish colleague to maintain or even improve the high standards of this Conference as demonstrated over the years for almost two decades. It was a very pleasant experience to work together with both of you and with Kenes International to make your idea a reality in this 6th ADPD Conference. The result is an attractive Scientific Program in which we wanted to include the best scientists in the world and current leaders in the fields of dementia and Parkinson’s disease. Most of them are here; and I also want to thank all of you, dear colleagues and fellow-scientists, because our success is the merit of having all of you here to show the results of your excellent daily work which is essential for the scientific progress in dementia and age-related neurodegenerative disorders, and to improve the quality of life of our patients, their caregivers, and their families. You are the real stars of this scientific event, and we, the organizers, are but the instruments to bring together the best minds involved in the research of these medical, multidisciplinary specialties. Therefore, thank you so much for being here despite the danger of the Irak war and the health threat posed by the severe acute respiratory syndrome.
The great British statesman Winston Churchill (1874-1965) used to say: “I am always ready to learn although I do not always like being taught”. I invite you to teach us what you know as the fruit of your experience and the many hours spent in your laboratories in trying to elucidate the mysteries of the human brain and the causes of neurodegeneration. Let us bring back the old spirit of the Scientific Congresses when a Congress was the confrontation of knowledge and the encounter of wisdom rather than a political meeting or a parallel funding strategy for managerial purposes. After all, as the great American physician Charles H. Mayo (1865-1939) said a long time ago, “the safest thing for a patient is to be in the hands of a man engaged in teaching medicine. In order to be a teacher of medicine the doctor must always be a student”. This should be the spirit of a good scientist: to be a permanent student of science; because in science the absolute truths of today are always relative truths of tomorrow. As the Irish dramatist and critic George Bernard Shaw (1856-1950) said, “all great truths begin as blasphemies”. And I would add that sometimes in science it takes more than 10 years for a bright idea to be allowed to become an acceptable truth by the sacred cows of a particular discipline. In this respect, dogmatism and the inflexible defense of personal points of view were never good advisors for the scientist. When delivering our ideas, confirmed or not, we should also be cautious for the sake of prudence. As an ironic example, let me remind you of a phrase written by Sydney Burwell (1893-1967) in an issue of the British Medical Journal in 1956: “My students are dismayed when I say to them, ‘Half of what you are taught as medical students will in 10 years have been shown to be wrong, and the trouble is, none of your teachers knows which half”.
In his famous speech delivered at the Republican State Convention at Springfield, Illinois, on June 16, 1858, when Abraham Lincoln made popular the phrase “A house divided against itself cannot stand”, the great American President also pointed out that “if we could first know where we are, and whither we are tending, we could better judge what to do, and how to do it”.
In epidemiological terms, CNS disorders represent the third greatest problem of health in developed countries, after cardiovascular disorders and cancer. People over 65 years of age comprise 13%-to-20% of the population in Europe, Japan, and the USA. The elderly population is growing at a rate of 2.4% every year. New demographic studies predict with about 85% probability that the world’s population will stop growing at the end of this century. The peak population would be reached by 2070 with 9.0 billion people and a great variability among different world regions. The number of people older than 60 years of age is likely to increase from 10% to 22% in 2050. By the end of this century the aging population will increase to 34%, with extreme levels in Japan and the Pacific OECD where 50% of the population will be older than 60. Of great importance for the elderly population right now and in the future is the capacity of the countries to reduce the disease-disability rate and to improve the quality of life of this population segment. It depends mainly on economic, social, psychological, and biological factors. In some developed countries income inequalities are associated with more unequal distribution of determinants of health. However, this may not be the case in other wealthy nations where there has been more widespread and evenly distributed social investments in public health services. The different levels of health within a country are the result of complex interactions including biological factors, economics, culture, politics, history, health organization, nutrition, and the status of women and ethnic minorities. All these factors also influence the aging of the population and the appearance of age-related brain disorders.
The global cost for CNS disorders in the USA, as the most representative country among the Western societies, was about 401.1 billion dollars annually. Approximately 1,200 Americans and also more than 1,000 Europeans suffer strokes daily, of whom 20-30% die and 25% are permanently disabled, with an average cost of 30 billion dollars per year per 1,000 strokes.
Approximately 17 million people, representing 31.1% of the total worldwide mortality, die annually by communicable diseases. In contrast, non-communicable conditions account for 59.8% of total deaths. In this section, the leading causes of death are cardiovascular diseases, malignant neoplasms, cerebrovascular diseases, injuries, and respiratory diseases. However, diabetes, nutritional and endocrine disorders, neuropsychiatric disorders, Alzheimer disease and other dementias, and Parkinson disease, still do not appear as major problems of health in the 191 countries evaluated by the WHO in the World Health Report 2000.
Despite this biased information from the WHO, Alzheimer disease, Parkinson disease, and stroke are the three medical conditions most responsible for neuropsychiatric morbidity and disability in elderly subjects. These three clinical entities exhibit an age-related prevalence. At the present time more than 25 million people suffer Alzheimer disease, and probably 70 million new cases will appear in the coming 20 years unless effective treatments or prevention programs are discovered and implemented. The average annual cost per person with AD ranges from 15,000 to 50,000 dollars, depending upon studies, disease stage, and country, with a lifetime cost per patient over 175,000 dollars according to different estimations. About 15-20% of the total costs of dementia are dedicated to pharmacological treatment, and it is expected that a successful treatment would cut down global costs by 30-40%. However, we are still a long way from achieving this commitment.
The problem of health posed by dementia in the developed world and in many developing societies such as Asian and South American countries is demanding major changes of paramount importance in the mentality, efficiency, and solvency of governments, health systems, and the medical community of many countries. The four pillars on which an efficient health system has to stand to deal with dementia and age-related disorders are the following: (1) The first pillar is a good primary care to satisfy the basic needs of the patients; (2) the second pillar is a mature social organization to help the caregivers and relatives in charge of the patient and to alleviate their psychological, physical, and economical burden; (3) the third pillar is an educated medical community prone to do an early diagnosis and an effective multifactorial therapeutic intervention; and (4) the fourth pillar is a strong research program with scientists motivated to understand the causes of the disease, implementing early diagnostic procedures, and discovering new and effective treatments to slow-down the progression of the disease, to reduce disability and costs, and to increase the quality of life of our patients and their families. In the present, we are also in a favorable position to enter into two new areas of progress, such as prevention, relying on interesting new findings related to the molecular neuropathology and genetics of Alzheimer disease, and also pharmacogenomics, as the most effective manner to optimize drug development and therapeutics, increasing efficacy and safety, and reducing side-effects and unnecessary costs.
During the coming days we will have the opportunity of reviewing the advances in the understanding of AD and PD since our last meeting in Kyoto, and also foreseeing how the progress may evolve in the coming years.
At the same time, all of you will also have the chance to get in contact with a different culture. In Seville you will be able to find the most representative style of Spanish hospitality. The Andalusian people are an example of spontaneous joy, open mind, and cosmopolitan behavior; and I hope that all of you will be able to enjoy the joviality of these people as well as the art, the folklore, and the historical richness of this marvelous city.
As a Spaniard, I feel very proud of our people and would like to highlight the important efforts that the Central Government and the Autonomous Communities of Spain have been making for several years to improve the health care of our patients with AD and PD. There is also a growing interest towards increasing the National Budget for R&D in neurodegenerative disorders.
I would like to praise publicly, and in a very special manner, the sensitivity of the Royal Family, particularly that of Her Majesty the Queen of Spain, for stimulating and motivating our society to obtain the appropriate resources for fighting the disability of the elderly population, and the special interest of Her Majesty to create a National Alzheimer Center with public and private funds to promote R&D programs for AD, to optimize the conditions of our nursing homes, and to disseminate specialized Centers for Dementia throughout our country.
Your Majesty, we feel very proud of this initiative and I am sure that our Royal Family will be able to count on the collaboration and support of the scientific community for this altruistic commitment. After all, as Hippocrates (460-377 BC), the father of medicine, pointed out 400 years before Christ, “A wise man ought to realize that health is his most valuable possession”. In a similar direction, Churchill had said that “healthy citizens are the greatest asset any country can have”. By the same token, the great British statesman Benjamin Disraeli (1804-1881) declared in a famous speech in the summer of 1877 that “the health of a people is really the foundation upon which all their happiness and all their power as a State depend”.
Let me conclude by saying, in the words of our beloved Miguel de Cervantes taken from his masterpiece ‘Don Quixote’, that “a leap over the hedge is better than good men’s prayers”. The privileged mind of Cervantes also left us, scientists, two clever messages which are useful when we are searching for relative truths in the obscure jungle of Nature; one message is of caution, when Sancho told Don Quixote “take care, your worship, those things over there are not giants but windmills”; the other one is somewhat optimistic: “There is a remedy for everything except death”.
Thank you very much for your attention.