To everyone travelling to London for the Alzheimer’s Association International Conference (AAIC), safe travels. Europe is the world’s fastest-warming continent, and you are on your way to a city, and a continent, experiencing a summer of heatwaves. Our buildings were built to keep the heat in, not keep it out. Come prepared.
AAIC was last in London in 2017. It was a different time. Under the shadow of the unsuccessful solanezumab trial eight months earlier, the field seemed stuck. Now we have blood-based biomarkers, used in research and in clinical practice, digital biomarkers being developed, and patients for the first time ever are being treated with disease-modifying treatments (DMTs). Today, we live in a different era. It is a moment of celebration.
London has changed too. I have been cycling here for more than 20 years. Back then, it was something done by the brave few. We campaigned, blockading junctions, having die-ins. Infrastructure improved. But public policy changed at a glacial pace.
Londoners’ behaviour took a long time to change too. But it did. There has been a 50% increase in cycling since AAIC last took place in London. Covid helped. But you can’t fail to miss the ubiquity of dockless bikes. It shows the power of innovation but that it takes an ecosystem of innovation to make change happen. The bike wasn’t the innovation. It was mobile phones, digital bank cards, GPS tracking. Innovation drives innovation. Lime bikes arrived in London shortly after AAIC was last here. It is hard to imagine a government developing and delivering dockless cycling. There are downsides to dockless cycling. Bikes get dumped on pavements. And, being generous, some users find it hard to distinguish between the pavement and the carriageway, treating the rules of the road as optional. The cycle helmet is definitely optional too, and given the demographic, there are quite a few users who take to the road after a few drinks. If it was down to government to deliver innovation an inter-departmental group would still be waiting for the working group on road safety to report back.
Innovation produces losers. It took the commercial sector’s willingness to accept that trade-off. But it did take government to create a public policy environment to enable the innovation of dockless cycling to reach consumers. Government could have strangled the innovation by trying to deliver it itself, but it could also have done so by not licensing it. When innovation reaches consumers, it is they that are the biggest drivers of future innovation and policy change. There’s a lot of noise at the moment about dockless bikes left on pavements and so on. But these problems will be ironed out. Many more people are cycling, and a far more diverse (gender, ethnicity and wealth) group of individuals is cycling. That changes the politics of it and that changes the policy environment.
And what are the lessons for our field? What you will hear at AAIC is how innovation is driving future progress: from prevention, to diagnostics, to treatments. The story of the nine years since AAIC was last in London is hope realised, we finally have DMTs. The story of what comes next, looking at the scale and breadth of innovation in the sector, and how it is drawing on innovation from beyond the sector, means the future is better than the present.
But the challenge is getting that innovation to the consumer: the patient. In 2017, here in London, someone with dementia was not getting treatments because there were no treatments. Today someone in London is still not getting treatments but, because our health system will not pay. It is a similar story across Europe. Governments can strangle innovation by stopping products from reaching consumers — innovators and companies will take their money and ideas elsewhere.
Health care regulation is rightly a lot more risk averse than public transport. There are a lot more downsides to mistakes in the health system than getting annoyed that someone has dumped a dockless bike on the pavement. But the public policy landscape is hampering innovation. It is making the pathway from basic science to innovation to delivery more difficult. From basic scientist, to advocate we all have a role in overcoming that.
AAIC will be a story of the progress. A story of how innovation is driving progress. But for that progress to reach consumers it should also be a story of a community demanding that innovation in science reaches the patients who benefit.
And if you are trying to get anywhere from ExCeL London take a dockless bike. It is much quicker than an Uber.