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One criticism was that the 12-month follow-up failed to capture a true clinical picture, and that more time was necessary to demonstrate their worth. The team that carried out this original work have now published 3-year data on 330 individuals detained under section of the Mental Health Act,1 randomised on discharge to CTO or voluntary status via Section 17 leave. No improvements in readmission rates, time to first readmission, or duration of readmissions were found for those placed on CTOs. The findings are even more powerful than the original results; CTOs now exist in various forms in over 75 jurisdictions, but no solid scientific evidence has yet been produced to support them. If there are subpopulations for whom (or specific circumstances in which) they work, such characteristics have yet to be delineated. A ‘least restrictive’ principle underpins the Mental Health Act, and a strong rebuttal is needed to justify ongoing CTO use – so-called ‘revolving-door patients' should not be replaced by revolving-door policy.

It cannot have escaped our readers' notice that there has been a public increase in the awareness of the impact of dementia on people's lives: politicians have raised concerns about a dementia ‘time bomb’ as a greater number of people live to an older age; and even the 2013 G8 summit declared1 that there was a need for international initiatives to tackle this illness. The inevitable call for more research is underscored by the lack of any new licenced medications for Alzheimer's disease since 2002. There has been much interest in a putative role for statins – which inhibit the HMGCR enzyme, the rate-limiting step in cholesterol production – as retrospective epidemiological data have shown that they can reduce the risk of developing Alzheimer's disease by up to 70%; but, frustratingly, administration of these drugs to those with the illness appears to produce little benefit. Recent data have now shown that the gene encoding this HMGCR enzyme is a potent modifier for the age at onset and rate of conversion from mild cognitive impairment to Alzheimer's disease.2 Indeed, this work would indicate that its G-negative allele is second only to APOE2 as the most common and important protective genetic variant for spontaneous Alzheimer's disease.