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The Clive Ballard energy equation
B=mc2, where B is Ballard’s kinetic energy, c is the speed
of Clive, and m the relativistic mass of a dementia
expert and all the stuff he does. Clive Ballard laughingly
describes himself as a “53 year-old, portly middle aged
man”­—so this equation might just explain why he and
his triathlon team are still winning events! But he is also
the new Pro-Vice-Chancellor and Executive Dean of
the University of Exeter Medical School (UK), as well as
European leader of the Starbeam study (an effort to assess
the effectiveness and safety of gene therapy for cerebral
adrenoleukodystrophy), while heading or being deeply
Published Online involved in another 13 projects investigating new drugs,
April 25, 2018 the use of stem cells, and optimising interventions for
http://dx.doi.org/10.1016/
S1474-4422(18)30148-0 patients with dementia. All of that while sitting on the
See Articles Lancet 2012; advisory board of various pharmaceutical companies, and
379: 528–36, Lancet 2011; trying to make sure he stays in clinical practice. Maybe
378: 403–11, Lancet Neurol 2009; my equation is incomplete. I ask him where he finds the
8: 613–18, and Lancet 2014;
383: 533-40
energy for all of this. “I think I only have two speeds [Aha,
For more on the STARbeam
there’s c]”, he muses, “full on or full off.”
study see http://www. Full off? Except for once, after being sent off in a table
starbeamstudy.com/ tennis match, when did c ever equal 0? Not during a career
For more on online brain that has seen major publications on the (often negative or
training see Nature 2010;
465: 775–78
neutral) effects of memantine on cognitive ability in adults
with Down’s syndrome, of sertraline and mirtazapine
for depression in Alzheimer’s disease, of memantine
in Parkinson’s disease dementia, of pimavanserin for
psychosis in Parkinson’s disease, and even of online
brain-training. And certainly not while performing the
work for which he is perhaps best known: highlighting
the negative long term impact of antipsychotics on
mortality in Alzheimer’s disease. “We started with the
idea that psychotic symptoms had an awful impact on
quality of life, but the data showed that what we were
giving to treat people had an even bigger impact: doubling
mortality, tripling the risk of a stroke, even accelerating
cognitive decline and reducing quality of life”, he explains.
But changing medical culture to reduce their prescription
would require even more energy. “While I was at Kings
[College, London] I was also the Director of Research
for the Alzheimer’s Society, and it was only through
harnessing the power of this campaigning organisation
that we eventually made politicians aware of the problem
and got it onto the Department of Health’s agenda.”
Since 2009, the use of antipsychotics in the context of
Alzheimer’s disease dementia has halved.
Of course, Clive then started researching into
treatments to replace them. “We found people in care
homes might spend just two minutes a day in social
666 www.thelancet.com/neurology Vol 17 August 2018
interaction! Simply increasing the time spent talking
to staff reduced patients’ psychotic symptoms. We also
found people with significant agitation might also simply
be in pain but couldn’t tell anyone. For many people it
turned out that paracetamol reduced their agitation
more than antipsychotics ever did.”
But this wasn’t the only time the Society’s power would
charge Clive’s batteries. He spent years trying to make
cholinesterase inhibitors available to people with dementia
via the UK National Health Service (NHS). “The original
studies suggested these drugs were not cost effective, but
the financial model used assumed people with dementia to
have such a low quality of life that it could not be improved.
But these drugs do improve cognitive function, by the
same amount as you’d decline in about 9 months. In other
words they buy you those 9 months, which can also have a
large, positive effect on caregivers and families.” After years
of the Society campaigning, the NHS approved them.
But even being full on (c2) seems unable to explain all of
his energy; the equation is somehow incomplete; there’s
a missing constant. “It’s having good people around you”,
he affirms (which he reveals is part of his excitement
about his new post at Exeter). “In 2003 I moved from
Newcastle University [where he was Professor of Old
Age Psychiatry] to King’s College, London [where he was
Professor of Age-Related Diseases until 2016], and this
really struck home”, he explains. “I was doing all these
things and getting a slightly self-inflated view of myself;
and then I moved to London without my team—and
suddenly realised who was actually doing everything!
Getting things accomplished is all about building good
people around you, creating a culture that enables them
to be autonomous as much as possible, and to realise that
it’s OK for them to make the occasional mistake.”
Before going, I ask where his energy is being invested
next. He doesn’t have to think much. “Designing and
implementing better training to help staff engage with
patients in care homes and continue to reduce the use
of antipsychotics, designing a multiple arm phase II trial
platform for stimulating the Alzheimer’s drug pipeline,
a phase I trial on neural stem cell implantation for
Alzheimer’s disease, getting my clinical work going again
(though it’ll probably be only half a day), and triathlon
training on Devon’s hills.”
It’s only after leaving that I realise I should have asked
what on earth it is that he eats.
Adrian Burton