The reason for this panel was the Danish ‘Fat Tax’.  This ‘Fat Tax’ has been put in place to drive up the prices of foodstuffs which contain saturated fats, foods that tend to be bought by low-income families, foods that tend to be bought by the obese or overweight.  A logical outcome and hope for this would be that healthy foods become more accessible to beacon communities, an assurance we’re still waiting for the Danish government to make, and that awareness is raised with reference to saturated fats as people start questioning the price hike.

The panel comprised a quick word from a Danish MP, a Danish food manufacturer, a Danish member of the public, a KOL and writer (me) and last, but by no means least, an obese patient from Bracknell, England called Hazel.  The first thing to mention is that was a good representation of the sub-section involved in the debate from the BBC, what was not so good was the lack of time the patient suffering from obesity had to speak about it.   The chance, therefore, was lost to gain a precious and sorely needed insight into this stigmatised condition.

The panel session was only half an hour, with many points of view to put across, which is of course correct in line with freedom of speech.  And freedom speech was most certainly reached by the Danish member public who angrily asked the patient why they should pay for their lack of control.  This was, I felt wrongly, omitted from the podcast by the BBC and summed up the general consensus and on the somewhat pigeon-holed condition of obesity.  Fruitless anger over a lack of control with no view or insight into the psychology or the lack of health literacy pertaining to the condition.

We know that obesity can be purely physiological, with links between Type 2 diabetes and obesity firmly established as one being a totality of the other, infinitely the causal element of the other.  We know obesity can be caused by certain syndromes such as Momo and Cohen Syndromes respectively.  We also know obesity can be caused by lack of health education & literacy, depression, insecurity, addiction and many other psychological conditions.  However, these conditions are very rarely addressed or spoken about, with obese people socially scorned, in some cases met with disgust and as we saw in the BBC panel session, met with a questioning anger.

Please also note that none of the aforementioned have been described as a ‘non-medical’ condition.  Mental health costs the global economy $16 trillion per annum and has finally been addressed by the WEF (World Economic Forum) for the first time ever this year, it’s time to list mental health as an NCD AND a medical condition.  I would also include the discipline of psychology in this even though pharmaceuticals are not always involved in it’s regime.  Why must a medical condition be defined by it’s use of drugs?  Even when the causal element i.e. mental health can cause such tangible, physiological manifestations such as obesity.  A condition which costs the NHS £4 billion a year, a figure set to rise to £6.3 billion in the next four years.

The fact that the most important person, the patient, Hazel, was literally brought in 30 seconds before the end of the broadcast did nothing to dispel or expand on the psychology of this disease.  I, as a specialist, was brought in early to give the argument a balance, the public awareness as to how important health literacy and health education is, how it affects us all in the long run.  How mental health issues are under treated or ignored and are causing a global economic deficit.   How patients find themselves on drug regimes without the support of a palliative or mental health team.  How, without proper social care in place, drugs tend to mask or deflate the problem as opposed to curing or enabling a self management of the condition, giving the patient a ‘sustainable treatment’.

As a specialist I research constantly, I brainstorm, I read white papers, blogs, articles but what is theory without the practical.  What is all this knowledge worth if we can’t speak or listen to the people this knowledge is used and learnt for.  Hazel should have been present in that conversation from the onset to give the angry Danish member of the public some empathy, the worried Danish food manufacturer some responsibility.  Hazel, did however, briefly clarify the lack of health and nutrition education whilst growing up, leading to bad food habits, which in later life when health literacy arrived turned into an addiction.  This clarification was a valuable and important statement.

Psychologists describe obesity as an eating disorder, and are usually called in when patients are morbidly obese whether the cause is physiological or not.  So we see obesity reach a stage where the patient will eat until they literally die and the physicality of any existing, tangible, medical condition is no longer taken into account as a mental health team is set to work to find out why this person will eat until they die.  So why is it listed as an eating disorder?  Why not an addiction?  With support groups and medical teams in place.  With unhealthy food manufacturers held to account.  If we were referring to leisure drugs would we say, well that’s their problem or would we be more accepting of the psychology and physicality of the addiction.  Are the obese so vilified that society will not even give them this avenue of understanding?

Mental health and it’s tangible manifestations are here and affect us all, not just by causing a massive global downturn but also watching loved ones and friends being either too afraid to admit they have a mental health problem or being stigmatised when they do.  So let’s listen to Hazel, let’s not get angry with her for a complex problem we don’t really understand and let Hazel put a human face on obesity, in fact let all patients put a human face on their illness.  Human physiology does not end at the physical, it’s where the complexity of the human psyche begins.  It’s where the totality of your patient begins, it’s where the effect of their illness and treatment lies.  It is the human face of the disease.

For the BBC World Service panel on Danish ‘Fat Tax’ click here.

As with all Healthinnovations articles this is open to discussion and innovation.

As with all Healthinnovations benchmarks, these guidelines are open to discussion and innovation.

At this time the beta-version for brands on google + has not begun but the strategy most certainly should be.  When google designed this platform they had brands in mind, the maximum number of friends, or whatever you want to call people, google + will allow is the same as Facebook which is 5,000.   However, with google + this could be 5,000 per circle with no limit set as yet to the number of circles you can utilise.  It is yet to be seen with larger brands, who may have in excess of 100,000 likes or friends on their Facebook fan pages, on how well this will work.  Pharma, on the other hand, will have an advantage here and be able to jump straight in with friends numbering between 1,000 and 15,000 per Facebook fan page, easily divided between circles of 5,000 people.

The greatest adage here of course is the fact that these ‘fans’ can be divided by interests with different streams being sent to each circle.  This also gives the customer a greater choice, a choice which cannot be given on any single Facebook page or in any single Twitter thread, both of which denote different accounts or pages being set up and not always easy to find for the customer.  These also have a reach unmatched by other platforms.  With the extended circles selection you can share with the circles of people within your circles.  This is like sending a tweet to the followers of your followers, automatic retweets.  You can also make your message public, making it  searchable in the google engine and accessible to its 1 billion a month unique users.

Image showing the reach of circles on google +. For a larger image click on target

With google + you can have circles for pharma company news, for drug safety, for CSR news,  for two-way dialogue, for illness type and awareness, the honing of your customer-base is, for now, limitless.  All encompassed on the same page making life extremely easy for your Marketing Authorisation Holders (MAH) to cover.  On the flip side we see customers with the choice to either follow your stream or form a two-way dialogue with the pharma company by including them in their circles.  A choice not given on the more impersonal pharma Facebook fan pages and more intimate than Twitter threads.  There is also talk of google allowing brands to integrate their company web design into their google + page, mirroring official homepages and becoming more recognisable by consumers.  Not to mention better functionality.

The use of separate feeds are key here, leading to intimacy, personalising the customer reception of  information.   I recommend that google allow brands to give their circles full visibility so customers are aware of their surroundings, so to speak.  This would give each circle of customers more transparency and promote interaction within each key topic, possibly leading to self-governed communities as these circles start to intersect and grow.  How these will play out is anyone’s guess but pharma brands must make sure they take advantage of the freestyle nature of google + and make sure threads are different to any others being published on branded platforms.

We are also witnessing a move by social media thought leaders to survey the general consensus on branded google + pages.  Chris Brogan sent a message out recently asking if people would be happy to receive branded marketing news if he created a circle.  The response was overwhelming with the 500 comment limit per post being broken, responses being mostly positive and too many to list.

Chris Brogan survey on branded news for circles. For a larger image click on target

To conclude branded pages are coming to google + with a honed UI yet to be matched by other platforms.  Early adopters, or adapters as we should be known, are loving it but we are geeks.  It’s yet to be seen how the public will take to this almost austere clinical platform, which may not contain the safety or warmth of Facebook pages and at times can be highly technical.  We now have multiple phone call facilities on Gmail and the high spec hangouts with a 10 person conference call ability.  Great for companies or group calls with followers, patients and customers but will these be used by non-business accounts?  Will regulations allow pharma to be involved in group chats of this nature?

We also have Sparks which could be a wonderful avenue to link the massive user base of google search, but after a few experimental tagged posts from yours truly, looks to be slightly off-kilter with its analytics.  This could also be a great search tool for google + users on illness and health awareness engrained within their social platform but definitely needs some tweaking.  Searching for Key Opinion Leaders (KOLs) or specialists within the health and pharma realm on google + is now possible at plus.google.com.

All the above is a plus for geeks like you and me but for the masses who use Facebook to meet up with mates and look at photos this may end up being a purely branded platform you join to follow as opposed to being followed.  This coupled with the, quite frankly, shocking terms and conditions of google + usage may turn away people now comfortably ensconced in the Facebook nest.  Or are we being highly arrogant in our thinking the populace will not be able to use this polished platform.

Only time will tell but either way social just got more personal with google +.

I would also like to take this occasion to thank all the people I have found on google +, both old and new, in particular Mike Young and Craig Delarge who were there performing trial and error posts with me every day.  It’s been great helping to develop this platform for health with everyone and learning as we all go along, what an experience, a big thank you to you all.

Ken Honeywell described in his post aimed at General Healthcare Practitioners, how QR codes can be used to promote practices and supply patients with information on future procedures.   In a recent article on PSFK describing a protest by Global Exchange, Green America, International Labor Rights, and Oasis, ‘Consumer Action Cards‘ were used against Hershey’s child labour practices.  These small cards were placed on Hershey’s products in local grocery stores, containing a basic headline with a QR code to lead previously unlinked members of  the public to an online campaign site and has proved extremely productive.

We can see from the above reports that QR codes promote interaction at a grass-root level.  Doctors are already using them to interact and market their practice with patients and non-profits are empowering consumers all over the US to print out these tags and place them in community stores.

Let’s talk about doctors first.  It would follow that if doctors are already comfortable using QR codes, shouldn’t they be comfortable receiving them?  The biggest complaint we hear from doctors is their lack of time and the need for pharma to market to them at their convenience, which is fair enough.  This could take the guise of e-detailling, hashtag searches or a google-search type marketing, the commonality being these can all be stored, referenced and viewed at a later, more convenient time.

Why are doctors comfortable with QR codes? Well if you think of it barcodes are used every day in hospitals and practices to check and order medications.  And not just by doctors, nurses will also use barcoded information extensively over the course of a day and may welcome receiving extra QR coded information on medication packaging.  There is also the mobility aspect which doctors have integrated into their every day working lives.  Think about an e-detail that has to be inserted into a desktop or transferred to a mobile device.  Why not send the link via a QR code, one click and the information is uploaded to a smart phone or i-pad and on the road with it’s mobile owner.  An e-detail that might be a bit too long?  Provide a Customer Action Card in the drug info pack that could contain links to whitepapers or any extra information that might not usually be read in the references.

These Consumer Action Cards or CAC’s as they unfortunately abbreviate to, are far from it, they promote interaction and empowerment with consumers born of a barcoded society, everything in their consumer life has a barcode, at the cash till or on the consumables they take home.  The Action in the title is just that.  Extra drug safety information at the pharmacy, here’s your Consumer Action Card containing safety tips, relevent links on your illness, links to the pharma manufacturer and who to call for Adverse Events; feel free to upload this to your i-phone and carry the information with you at all times.

These cards should not be designed to replace legally required literature on a drug ad or medication packaging.  These cards can be designed to further patient empowerment and self-efficacy promoting interaction with an easily scanned code, giving extra information with each medical purchase, each medical ad.  These codes can be uploaded and used in conjunction with speech apps or other media to aid people with a disability, and are already being used in healthcare based Assistive Technology.  These codes could help promote health literacy as it stands today as well as leading to a more convenient and time-saving form of marketing to help doctors in their research into new products.  And the icing on the cake, you will have patients and customers physically interacting with your awareness and marketing campaigns.

There’s alot to be said about CAC’s!

Ah ha the breakthrough. I have just worked out how to hide personal contacts in different circles. I have created a circle of old uni friends who will be receiving a separate fun feed which you will all find incredibly boring considering it encompasses my love of afternoon tea and woollen clothing.

Obviously my uni friends will also find this boring and do not want the added insult of having their details on public display on a platform they are unsure of. So here’s how to do it:

1) Click on your name in the top right-hand corner

2) Click Privacy in the drop-down menu

3) Select Edit Network Visibility

4) A box will automatically pop up saying In Your Circles with a drop-down menu listing your circles

5) Simply untick the circles and contacts they contain that you do not want shown on your profile

6) Don’t forget to click on done editing once finished, simple

Hope this helps with the personal feel of this platform x

The story then start’s to get a little odd.  The local GP consulting lot’s of encyclopaedia’s made the girl bend over, Idiopathic Scoliosis was the cause of the deformity.  And a double curvature of the spine meant corrective surgery was needed immediately.  The girl was whisked out of school and firmly ensconced in Stanmore Orthopaedic, the hub of bone disease research in the UK with it’s marvellous nursing staff.

The girl got to meet other kid’s at the hospital, children suffering, and yes they were, with bone cancer, other kids with scoliosis, children suffering from muscular dystrophy unable to move, wasting as they lay in their hospital bed’s.  Then there were the kids that came in for their chemo treatment.  One girl, Helen, would spend the night with her curtain’s drawn being physically sick even before she had the treatment because she feared it so much.  Then there were the kid’s who were really to young to understand what was happening and of course the parent’s who had lost children that would turn up to talk to the kid’s, nurse’s and consultant’s they had got to know.

The girl and the group she had befriended (The Scoli-ites) had their full spinal surgery, with rib clippings, bone grafting and metal rod’s.  Some found they could walk afterwards, some weren’t so lucky.  They were all stuck on morphine and then all very angrily weaned off of it via strong sleeping pills and tranquilizer’s.  All of which were needed for the chronic pain and to avoid going into shock after surgery.

The girl in the story is me and I haven’t spoken about my surgery or my condition in year’s.  I am a stubborn, determined person who was shaped by this experience.   And these serious surgeries do affect and shape the person you become. It made me realise two thing’s… there are always, ALWAY’S people far worse than you and ALL situations get better over time.  What it also made me realise is how traumatising major surgery is and how disassociated you become from the real world when stuck in hospital for long length’s of time.  And even more so when you get home to find you are now lagging behind in the correct time-line of life whilst battling with chronic pain.

For all the consultation’s and quite frankly excellent nursing care we received not once was I or any other of the kid’s offered counselling or psychological consultations.   This was left to the already overburdened nurse’s who also acted as security guards and mum’s and dad’s at night.

How many people have you read about in my story so far, do you feel really should have been complementing their treatment with counselling.  Was it the parent’s who turned up at their dead child’s old ward because they couldn’t bear to sit in their house without them.  Was it the parent’s watching their dying children toddling around the ward.  Was it the child who felt so stigmatised by her condition she refused all other help and preferred to spend the evening being physically ill before a chemo session.  Was it the kid’s going cold turkey with very strong opioids’.  Was it the absolute trooper Katherine who lay in bed with muscular dystrophy making joke’s all day long aware that she did not have much longer to go.  The children watching friends bed’s empty.   Or maybe the staff themselve’s who had the charge of dying and seriously ill children day and day out.

I would have to say all of them and also all of those who go through intrusive, life threatening surgery and have to return home and catch up with life or simply start living it at their own pace.  It’s now 25 years on and I don’t really see alot in the healthcare press pushing or even reporting on psychology being used to complement treatments.

The American Heart Association released data on a collaborative medical and psychiatric program on the 8th of March 2011. The AHA had found high levels of depression in cardiac patients receiving medical aftercare and have now introduced counselling which has increased patients quality of life after elective surgery and therefore affected recovery rates.  This was also found to be true in a palliative care study held in four New York hospitals with advanced cancer patients. The palliative care study was first carried out in 2010 with terminally ill cancer patients.  The study not only showed a monetary saving to the hospitals overall but also a prolonged period of  life for dying patients.

The hospitals decided to extend the study to early stage cancer patients and patients suffering from heart failure, offering emotional support and two way conversations about treatment plans, what the patients should expect and what they wanted to do.  The study found that if all four hospitals used a palliative care team for a year they would make a saving of up to $252 million.

I don’t find the fact frustrating that the study is having to use monetary terms to persuade the US Government to build more palliative and emotional support programmes for patients in treatment.  I find it frustrating that it is now 25 years on from my original extensive surgery and thing’s are only just starting to change.  Basically serious surgery is just that, it physically put’s a strain on the body because it is not a natural state.  It is invasive, at some time’s frightening, and traumatising  all at once . Surgery is something usually done out of necessity rather than choice.

So why don’t we give some of this choice back in treatment planning and emotional support for the act of surgery itself.  We don’t question the need for physical recovery after surgery so why do we question the need for psychological recovery after we have been through such a life threatening, and draining experience?

So we now know that obesity is costing all of us a lot of money but obesity is a disease which we should be respectful of further complicated by the fact it can be either a physical or mental illness, so I’m not sure chucking diet pills at people is the best way forward.  And there’s the reason for this blog, diet pills….

Just how dangerous are these weight loss pills? ” In the space of one month Abbott has recalled Meridia due to quote “very modest weight loss” from taking the drug didn’t justify its risk of heart attack or stroke” we had Arena and Eisai falter at the first hurdle with lorcaserin due to quote “the weight loss…..was marginal” oh and the cancer risk as well.  Already we can see how these recalls and quite frankly dangerous drugs are being reported, the risk is not mitigating the cause.

Then we have the newest diet drug Qnexa from Vivus which was unapproved last week due to heart risk AND birth defects but there is a difference here, in studies the marginal weight loss was 14.7 % compared to 2.5% in the placebo group.  So it works, which would explain the next report that the FDA may now clear Qnexa.

The only other medical condition where this level of risk mitigation is put in place is Cancer.  A life threatening condition of course denotes dangerous side effects particularly in later stages of the disease, the drugs themselves simply aren’t there yet.  Watching the word usage in these FDA approval or non approval reports as it were we can see the wave coming. We can see obesity becoming the new cancer of approval systems in government attempts to stem it’s costs on their economy.

Obesity is costing a lot of money, yes, but so do most diseases, we can’t really put a cost on this can we? We are after all human and illness and disease are part of being human.  With diseases such as cancer there is a risk of losing your life, were the patients in these weight loss studies at risk of developing cancer, harming their foetus or did they have existing heart conditions?.  If the answer is yes to all three then by all means give them the drugs, if the answer is no, then I am more inclined to say this is not a life threatening illness and therefore has no place in such a high risk mitigation drug category.

The first thing a psychologist will investigate is the person, this immediately differentiates their illness from the being as you would with someone with a cold or say cancer.  I was also informed that the word illness is not appropriate to describe a persons difficulties in the world of psychology.  The word difficulties is used in preference to labels in what tend to be extremely complex deficits or difficulties in life.

Our role, stated the psychologist, is to approach the patient as the expert.  They are experts in their own life and we want to learn from them about their life and situation.  Our role is to share knowledge in an attempt to help the patient, to normalise any difficulties being experienced and to of course improve their quality of life.  When asked how they felt their patients were viewed by society the timbre of conversation changes to a more exasperated stance.  ‘People are scared, it’s as simple as that’  ‘People want to keep it as us and them’, ‘the people that can handle life and the people who are weak, this is base prejudice and not acceptable’  And from experience prejudice always stems from fear.

The psychologist also went onto the recent findings of ADHD being linked to genes, ‘society wants a biological basis to mental deficits, the ADHD gene was also found in 8% of children without the condition and the number of children with ADHD found with the gene was so small as to be discounted’  This fact has also been commented on by Ben Goldacre in The Guardian.  My interviewee also went onto say that this need for a biological basis was society’s way of ensuring that it will never happen to them, as people view mental deficit as a weakness, ‘people don’t want therapy or to be depressed, they see it as a slight on their character.  It’s like saying you are lesser than other people and you can’t cope’

They then went onto say that any one of us can have a developmental illness in their lifetime, these mental episodes or deficits are just exaggerations of emotion and cognition i.e. paranoia, everyone get’s paranoid at some point in their life, everyone has been suspicious of others.  Everyone has someone in their family with a mental health issue from depression to psychosis so isn’t time to demystify mental health.  Psychologists as a whole cannot understand why people are happy to spend money on their physical health but when it comes to their emotional well-being are unlikely to go to GP’s for feeling anxious or say anti social.  Why is that when some mental health issues if left can affect everyday life and lead to long spells off work just as if you have a serious muscular or physical condition.  Very interesting questions that if not dispelled will lead to lack of understanding and mis prescribing for overlooked mental deficits.

I asked what happens when someone goes to a GP with an emotional problem and in the next post we will discuss what psychologists feel should be done at the first phase of mental care in the community.  The suggestions may not be what you think……

Henry Termeer

Imagine the theme tune to Soap playing in the background.

Next weeks installment of All Our Pharma Companies….

Will Genzyme accept $69 a share? Why does Sanofi keep on trying to get them to sell at this price?  Does anyone understand why anyone on the board of Genzyme is listening to Termeer when 6 months ago they were trying to oust him.  Will Carl Icahn perform a coup and get himself elected to the Sanofi board? Will Genzyme sell at $45 a share and withhold the Myozyme portfolio? Does the deal include Inkheart film rights? Will Sanofi’s elimination of 25% of their US workforce to free up cash go unnoticed?  Will Pfizer relaunch their original 2007 takeover bid and buy them both?

Who will play Chris Viehbacher in the film?…

Confused you will be…..

I disagree, this is not a nice test for a woman to take, hell when is a medical test ever a pleasure for either sex but as the national target in the UK for breast screening  is only 70% I feel any incentive to get women to screen for cancer is good.  This can be a negative, worrying test for some and I think anything that livens this up and makes you feel better can’t be viewed as irresponsible.

The Chicago Tribune also states that why these incentives are irresponsible is that misdiagnosis is also part of this test.  I fail to see what this has to do with creating a positive, pampered atmosphere to what could be a prelude to extremely bad news, why can’t we make this process, a process that can be eased into, rather than hit in the face with a sack of spuds. Cancer Survival rates are also based on mindset AND CATCHING IT EARLY.  Also figures show that mammograms saved twice as many lives as they over diagnosed so anything that can get women in to breast screenings is a good idea in my books.

According to Cancer Research UK in 2008 one-third of all women in the UK were ignoring breast screening invitations, also there is still a large problem with breast screening in deprived areas in the UK.  This could be down to education, lack of time, not wanting to know and due to the age of women screened not really wanting to go into a room with strangers half nude.  Doesn’t it therefore make sense to have some pampering and to associate the staff providing these incentives with the  strangers in the room where you are half-naked.

Chocolate Fondue?  Food for thought……