Biotechnology and Healthy Ageing « POLICY IMPLICATIONS OF NEW RESEARCH Biotechnology If present trends in fertility and life expectancy continue, between one-quarter and one-third of the population in and Healthy Ageing OECD countries will be over 65 years of age by 2025. The ageing population will have profound social and economic implications. Not surprisingly, countries are searching for ways to promote healthy ageing. The OECD Workshop on Healthy Ageing and Biotechnology, held in November 2000 in Tokyo, brought together POLICY IMPLICATIONS an interdisciplinary group of world experts in molecular biology, geriatrics, epidemiology, health economics, Biotechnology and Healthy Ageing ethics and health policy. Their perspectives are the subject of this book and collectively help provide a better OF NEW RESEARCH understanding of the issues and relative contribution that biotechnological solutions will make to the promotion of healthy ageing. POLICY IMPLICATIONS OF NEW RESEARCH POLICY IMPLICATIONS www.oecd.org cover-e.fm Page 1 Tuesday, November 26, 2002 11:51 AM Healthy Ageing and Biotechnology POLICY IMPLICATIONS OF NEW RESEARCH ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT cover-e.fm Page 2 Tuesday, November 26, 2002 11:51 AM ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT Pursuant to Article 1 of the Convention signed in Paris on 14th December 1960, and which came into force on 30th September 1961, the Organisation for Economic Co-operation and Development (OECD) shall promote policies designed: – to achieve the highest sustainable economic growth and employment and a rising standard of living in Member countries, while maintaining financial stability, and thus to contribute to the development of the world economy; – to contribute to sound economic expansion in Member as well as non-member countries in the process of economic development; and – to contribute to the expansion of world trade on a multilateral, non-discriminatory basis in accordance with international obligations. The original Member countries of the OECD are Austria, Belgium, Canada, Denmark, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, Turkey, the United Kingdom and the United States. The following countries became Members subsequently through accession at the dates indicated hereafter: Japan (28th April 1964), Finland (28th January 1969), Australia (7th June 1971), New Zealand (29th May 1973), Mexico (18th May 1994), the Czech Republic (21st December 1995), Hungary (7th May 1996), Poland (22nd November 1996), Korea (12th December 1996) and the Slovak Republic (14th December 2000). The Commission of the European Communities takes part in the work of the OECD (Article 13 of the OECD Convention). © OECD 2002 Permission to reproduce a portion of this work for non-commercial purposes or classroom use should be obtained through the Centre français d’exploitation du droit de copie (CFC), 20, rue des Grands-Augustins, 75006 Paris, France, tel. (33-1) 44 07 47 70, fax (33-1) 46 34 67 19, for every country except the United States. In the United States permission should be obtained through the Copyright Clearance Center, Customer Service, (508)750-8400, 222 Rosewood Drive, Danvers, MA 01923 USA, or CCC Online: www.copyright.com. All other applications for permission to reproduce or translate all or part of this book should be made to OECD Publications, 2, rue André-Pascal, 75775 Paris Cedex 16, France. This workshop is dedicated to the memory of Mr. Koji Ikeda who died tragically in the summer of 2000 in a car accident in France. Mr. Ikeda was First Secretary at the Japanese Delegation to the OECD, and a gifted young official of the Ministry of Health and Welfare. His energy and enthusiasm, and his deep care for the health care concerns of the elderly, made this workshop possible. Mr. Ikeda was also a dynamic participant in the health and biotechnology activities at the OECD, and his loss is felt deeply both in Japan and in the international community. 3 FOREWORD This book originated at a workshop held on 13-14 November 2000 in Tokyo. The workshop’s objective was to identify the contributions of biotechnology to alleviating major age-related diseases and conditions in OECD countries. It brought together over 150 scientists, epidemiologists, industrialists, physicians and health officials working on research on the elderly and their care. The workshop brought together an interdisciplinary group of over 150 world experts in molecular biology, geriatrics, epidemiology, health economics, ethics and health policy who met for two days of very animated and fruitful discussion. Speakers were asked to identify the fields in which biotechnology is contributing most to the goal of healthy ageing and to discuss the potential social or economic roadblocks to the dissemination and use of these technologies. Their perspectives helped OECD countries understand the relative contribution that biotechnological solutions will make to the promotion of healthy ageing as compared to other possible options for prevention, care and treatment. The workshop was convened by the OECD’s Working Party on Biotechnology. It was generously sponsored by Japan’s Ministry of Health and Welfare (since renamed the Ministry of Health, Labour and Welfare). Support from the European Community for the participation of European experts on healthy ageing is gratefully acknowledged. In addition, the OECD’s Biotechnology Unit wishes to thank the Directorate for Education, Labour and Social Affairs for its active co-operation and support in the preparation of and follow-up to the workshop. The workshop rapporteur was Dr. Marc Weksler, of Cornell University Medical School. His expertise in gerontology was critical in identifying the major age-related diseases and conditions that are benefiting from new research. The initial focus was on scientific contributions to healthy ageing. Promising areas of prevention and therapy include advances in biomaterials to treat mobility and frailty in the elderly, stem-cell therapies to reverse cognitive impairment, and gene therapies for cancers and heart disease. However, the most animated policy discussions at the workshop were about the future burden of disease associated with ageing populations, national differences in establishing priorities for health research and care, and the nature of the social and economic trade-offs that concerted policies for healthy ageing entail. Part I of this publication identifies the concerns that motivated the workshop and the policy recommendations reached by the expert participants. Part II presents different perspectives on the economic impact of the ageing of OECD countries. Part III reviews the epidemiological trends behind the major age-related diseases and conditions and the most promising avenues of research for altering the prevalence of these diseases in our populations. Part IV identifies the social trade-offs that a policy for healthy ageing entail and gives a number of examples of how OECD governments are addressing these trade-offs. Finally, Dr. Salomon Wald, the previous Head of the Biotechnology Unit at the OECD, concludes with reflections on unresolved challenges to the application of biotechnology for healthy ageing. The OECD has now embarked on a major three-year health project, which focuses on measuring and analysing the performance of health-care systems in OECD countries and factors affecting performance. The purpose is to help decision makers formulate evidence-based policies to improve the 5 performance of their health systems. Part of the OECD Health Project looks at the impact of new and emerging health-related technologies and examines ways in which OECD countries can best make appropriate use of health-related technology. One of the case studies envisioned involves a technology associated with an ageing-related disease. This volume is published on the responsibility of the Secretary-General of the OECD. 6 TABLE OF CONTENTS I. INTRODUCTION................................................................................................................... 9 Chapter 1. Key Points from the Workshop on Healthy Ageing and Biotechnology................ 11 Chapter 2. Rapporteur’s Scientific Summary by Marc E. Weksler ................................................................................................ 19 II. THE ECONOMICS OF HEALTHY AGEING ................................................................... 23 Chapter 3. Biotechnology and the Burden of Age-related Diseases by Robert William Fogel......................................................................................... 25 Chapter 4. Healthy Ageing and the Challenges of New Technologies: Can OECD Social and Health-care Systems Provide for the Future? by Stephane Jacobzone ........................................................................................... 37 Chapter 5. Age as a Driving Force of Health-care Expenditure: Some Macroeconomic Evidence by Ernst Buser......................................................................................................... 55 Chapter 6. Speeding Access to Important New Drugs: The Challenge of Developing New Pharmaceutical Products for the Elderly by Kenneth I. Kaitin................................................................................................ 57 III. SCIENTIFIC AND EPIDEMIOLOGICAL TRENDS ....................................................... 63 Chapter 7. Genetics and Genomics of Ageing: