Should dementia from sports injuries and concusion be subject to “deserts based rationing”?

If the dementia risk rises by 17% when the risk of dementia is 10%, the absolute risk only rises to 11.7%. The article by Kat Lay in the Times chooses to use relative risk calculation, but it is important just the same. NHSreality has been saying since inception that certain sports persons, especially those that “ask” for head injuries, such as boxing, and riding, should always be insured. The insurance should cover their long-term care. But what if they still participate without the cover? NHSreality is against deserts based rationing. It is for wealth based co-payments and rationing overtly, especially the high volume low cost treatments that each individual should be expected to cover for themselves. The health services are “regional mutuals”, less powerful and with less choice than the former “national mutual” (NHS), but there has to be a disincentive to make a claim, for everyone. Deserts based rationing, along with most rationing, will be regressive, as the poor are fattest, least fit, and least informed…. At least means based co-payments would mean the wealthy pay more.

Image result for dementia from head injury cartoon

Dementia risk rises 17% after suffering a single concussion – Kat Lay in the Times 11th April 2018 – Dementia risk rises 17% after suffering a single concussion

A single case of concussion raises a person’s dementia risk by 17 per cent, a major study has found.

Researchers analysed data on 2.8 million people for the study, published in The Lancet Psychiatry. The findings are likely to lead to renewed calls for contact sports such as rugby to be made safer.

The study found that people who had sustained a traumatic brain injury (TBI) were 24 per cent more likely than their peers to be diagnosed with dementia during the 36-year study period. Some 5.3 per cent of participants with dementia had a recorded TBI, compared with 4.7 per cent without dementia. TBIs occur when a bump or blow to the head disrupts the normal function of the brain – for example in falls, car accidents or assaults.

The study found that the younger someone was when they first sustained a TBI, the greater their risk of developing dementia. Those who suffered a TBI in their 20s were 63 per cent more likely to develop dementia in later life than those who did not. The figure for people who suffered a TBI in their 30s was 37 per cent.

The results are likely to be seized on by campaigners who believe that participation in sports such as rugby or American football is putting young people’s brain health at risk, although the study did not address sports injuries directly.

Researchers found that the risk of dementia increased in line with severity of the injury. A single severe TBI increased the risk by 35 per cent, while a mild TBI – a concussion – increased it by 17 per cent. It also rose in line with the number of injuries. One TBI was linked to a 22 per cent higher risk of dementia, rising to 61 per cent after four TBIs. Five or more tripled the risk of dementia.

Image result for dementia from rugby cartoon

Jesse Fann, a professor at the University of Washington in Seattle, who led the study, said: “Our analysis raises some very important issues, in particular that efforts to prevent traumatic brain injury, especially in younger people, may be inadequate considering the huge and growing burden of dementia and the prevalence of TBI worldwide.”

In a linked comment article, Carol Brayne from the University of Cambridge, wrote: “It is likely that prevention needs to be considered at societal, community, and local levels.”

The researchers also looked for a link between dementia and those who had had fractures not involving the skull or spine, and did not see an association. This suggests that TBIs specifically, rather than general trauma, play a role in developing the disease.

Other studies have suggested that TBIs cause some of the same pathological changes in the brain as those seen in Alzheimer’s disease. About 850,000 people in the UK have dementia and numbers are expected to rise to more than a million by 2025.

The researchers used data held in Danish national registries from 1977 to 2013. Over the 36 years, 132,093 people had at least one diagnosis of traumatic brain injury, with 85 per cent being mild. Between 1999 and 2013, 126,734 people aged over 50 were diagnosed with dementia.

Their models took into account factors linked to dementia such as diabetes, heart disease, depression and substance abuse, but they were unable to account for others, including education, smoking and high blood pressure.

Experts said that more research would be needed to tease out which specific types of head injury, such as sports concussions, were implicated.

Image result for dementia from rugby cartoon

Rugby and Dementia pugilistica…. an unfair cost on the health service

Rugby is sleepwalking into concussion crisis. Touch rugby or sevens seems much safer..

Chronic Traumatic Encephalopathy ? Time for a change to rugby tackle laws

Should sports injuries all be covered by the UK Health Services? The brain damaging season of international rugby is about to begin.

Too many Rugby World Cup injuries?

School rugby plan ‘too dangerous’

Politicians need to speak out for or against deserts based rationing. If they don’t it will occur by post-code and by default.

Obese and Smokers could be “punished” by deserts based rationing?

A deserts based approach to bed blocking and obesity? How could we encourage families to take their relatives home?

Which party will embrace any form of deserts based rationing?

Its not news to GPs or the Surgeons: Covert, Post-Coded, deserts based rationing is official policy

Devon Health Board deserts based rationing – and political dishonesty & denial at Cabinet level at PMQs.

Overt (deserts based) rationing? – “NHS to ‘ration’ routine operations for obese people and smokers”.

Interesting suggestion low cost or high volume treatments to be excluded… GPs will take no notice as their job is to put their patient “at the centre of their concern”.

Image result for dementia from head injury cartoon

 

 

 

This entry was posted in A Personal View, Rationing, Retired, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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