Monday, 26 October 2009

NHS Moral Dilemma

More need, less available resources ... the NHS continues to be painted into a corner with a new round of confusion that underscores the inevitabilty of viability problems in the future.

A decision will be made by NICE in two weeks on whether local health authorities will have to fund the cancer drug Nexobar. This drug is touted to extend the lives of people with terminal cancer, adding an optimistically-estimated 6 months to 2 years ... all at a cost of about GBP3000 per month! (Cost shouldn't matter, should it?)

As a result, the NHS has made the decision to spend 1 million GBP over the next three years on a kwango to spell out to NICE, the implications of approving new expensive drugs!

And this, of course, raises a whole littany of issues!

First, for those who stand to benefit from access to a drug of this nature...

The view of one patient interviewed by the BBC was that the NHS is putting cost before peoples' lives, effectively consigning him and others in a similar situation to the "scrap heap". Why spend money on a kwango when peoples' lives hang in the balance?

Good point ... if you raise an expectation level it sets a precedent. And that's exactly what has been done. In an attempt to be all things to all people, the system has become inefficient and the result is that even more people suffer.

Then, what about NHS managers who are given a budget to work with? The money has to come from somewhere, so which initiatives "matter less" and get the axe?

People watching BBC Breakfast were quick to mention a wide variety of supposedly gratuitous beneficiaries, ranging from IVF treatments to the care of those who abuse their bodies and take "unreasonable" risks.

But I thought morality was objective in a civilized world.

Then, there's NICE who is ultimately responsible for the viability of the whole system. Where do they draw the lines without creating anger and disparity? Simple ... screw everybody, just a little.

And then there are the drug companies who create these miracles but need a malleable system to maintain the viabilities of the profit train. That's a lovely tie you have there Sir ... thank you for your cheque.

So ... as this whole scenario is inextricably linked with morality, I thought I'd indulge myself and play agent provocateur for the day. And please, before anyone actually takes me seriously and believes this to be anything more than the harmless musings of a dyed-in-the-wool cynic ... relax!

I am just a mere devil's advocate. And an underpaid one at that!

So, here goes. Reality check!

If you are terminally ill and there is no reasonable chance of cure, expecting the tax payer to fund a life extension drug is completely unreasonable. The drug has no chance of curing you.

Sorry. That's the hard truth. I wish things were different, but money is tight.

Once a precedent is set, drug companies will continue to pressure the system for the opportunity to supply more exensive band aid solutions. And they can get away with that because no-one likes to see people suffer in any situation.

Again, the hard truth. On a clinical (callous) macro level, all these chemicals do is skew the life expectancy statistics exactly as I pointed out in my previous post. I realize it's virtual heresy to say that.

But it's also the truth.

The NHS does not have the money, so why is it even going down the road. You can't make promises you are not in a position to honor.

Get real!

The fact that it needs to blow a million pounds that will add absolutely no value to the quality of anyones' lives in order to effectively lobby for common sense to prevail ... only serves to prove the system is light years away from achieving it's broad objectives.

Why doesn't someone step in and stem the bleeding. Where is the leadership and the fiscal sanity?

Fix it before the cheque is written. Oh, but that would horse up the unemployment statistics and impinge on other budgeted revenue streams.

Why are we perpetuating an environment where drug companies actually have us feeling like we are beholden to them? If we stop indulging them they will quickly change their strategy and develop products that add more value for the bucks available.

Economics 101?

Of course, the real answer is to rechannel our energies into preventative measures that are not profitable, but actually work.

Perhaps even the man on the street may eventually grasp the wisdom of such an obvious soultion.

We are dependant on the drug companies because we have been brainwashed at a profound level to think that they are improving our health and making us all live longer.

Wake up folks!

Of course they aren't. Our health is not declining because of a shortage of drugs. It's because we have no idea how to take care of ourselves or our children and have abrogated all responsibility to a sytem that profits by supplying symptom mitigation, not solutions.

And because we cry for relief, we actually think they are the good guys. That's a brilliant business model!

But it's actually so efficient at creaming money from us that it will be the architect of it's own undoing. Hows that for irony?


Because we will continue to fuel a growing organism with money we don't have. Like the global economy, something has to give. Just do the math. Expectations and reckless promises don't pay the bills.

Kwangos, management mentality and oceans of rhetoric will not make things better. What is needed is true leadership and no-one is willing (or able at this point) to step up to the plate.

What would they even say?

Saturday, 17 October 2009

Health Or Medical?

I decided to visit the BBC Breakfast website this morning for some inspiration.

So I clicked on "Health" expecting to see at least one article about health! As I write this, there's not even one.

Yes, there is an article on fibroids, paracetamol, foetal kick charts, chlamydia and the old standby, swine flu! And a headline announcing that "it is up to doctors to fight for the future of the NHS".

That's "medical" not "health"! All of it. Every single one.

We have successfully conditioned the entire population to see "health" as "a lack of health". Which is quite brilliant because it then means that there is a captive market for all those drugs and all those technological advancements we are so proud of.

This would be perfectly acceptable if the drugs and technology were making us all healthier. But they're not. All the health system does is manage the fallout.

For life!

Then we are told we are living longer and we should be delighted that we are fortunate enough to live at a time in history when all this is possible through the marvels of modern medicine. Strike that ... I mean modern health care.

If "average life expectancy" has increased (and that's what we are told, so it must be true), then why are people getting Alzheimer's in middle age? And why are young kids getting type 2 diabetes?

Was there a shortage of drugs? Or could it be that people are getting sicker, earlier and the powers that be are showing us numbers that are actually misleading?

That couldn't happen, could it?

I am not an actuary and I'm too lazy to dig long enough to get to the bottom of all this, but here's what I think.

Hygiene standards have improved over the last 100 years, which means that infant mortality has been reduced. This, I would think, is the major factor.

Added to this, sick people that would have died quicker 100 years ago, are now being kept alive by expensive drugs and expensive life support equipment.

And yes, these two things are good. Of course they are. Good, because we can cheat the grim reaper for longer, which keeps the immediate families a lot happier and the doctors firmly committed to the hypocratic oath.

And good for business too ... dare I say it.

Imagine if those same beautiful people lived longer because they led healthier lives and did not spend their twilight years dependant on a plethora of medications.

Imagine if our health care systems focused on getting people off drugs, outside in the fresh air and sunlight and eating foods that their bodies were actually designed for ... then going to sleep without the assistance of pills or a late night tipple.

But hold on, that would be bad for business.

Thursday, 8 October 2009

Personal Training? No Wonder We are Fat!

I must admit I have been incredibly frustrated over the last 18 months or so.

You see, I qualified as a personal fitness trainer in my mid-40's after a successful career in corporate business. Like every other new trainer, I was convinced I could make a huge impact in other peoples' lives.

But after decades in the entrepreneurial trenches my instincts were quick to prickle!

Something didn't feel right.

And it had nothing to do with the fact that most gym bunnies are paid a pittance for being little more than glorified rep counters.

Of course, everyone around me said "what are you waiting for?" Just get on with it. It's what you love ... isn't it? And to be honest, I've had that same conversation with myself many times over.

I have never been one for half measures and I quickly came to see personal training as a very small part of a much larger equation ... that of optimum health.

So I started to teach myself about other aspects of health and physical fitness. To me it seemed pointless working with someone in a gym for an hour or two every week just because that's what trainers do ... and expecting to make an appreciable difference to their knowledge of how to live a healthy lifestyle.

Come on ... not everyone wants to spent time in a gym. And what's the point if you can't also work with them on their other lifestyle habits? And when I looked at what others were doing to solve this obvious basic system flaw, I became progressively more disenchanted.

Lots of trainers sense that somehow they are near the bottom of the food chain in terms of professional respect and capabilities. So those of us driven to improve start to invest in our continuing education.

And I took courses in anatomy, physiology, body work, Gyrotonics, Pilates, Feldenkrais, fascial tensegrity, more anatomy ...

It just never seems to end. A personal trainer can always keep specializing. And one can always keep paying out money to hear the same stuff recycled in different ways, so we can develop more insight and get another gold star.

That's all well and good, I suppose ... but what's the point if we only ever keep sharpening our lazer focus on a tiny piece of the health puzzle? I also kept my eyes and ears open and one thing became increasingly evident.

No matter how many bootcamps, or celebrity experts, or new grades of qualification the industry came up with ... people were still getting fatter and more unhealthy!

So what was the point? What value were we adding? I always gauge a business by the value it brings to the table. All I was seeing was more and more opportunities to spend money gathering qualifications that gave me alleged credibility.

But where was the real value?

Funny thing, any trainer in the industry who reads this will either agree with me totally ... or get all flustered and defensive. But nothing changes.

So here's proof of what a crock this industry has become. And no, I'm not going to have a go at the "Biggest Loser". The rest of the industry seems to have finally sorted out where they stand on that one. Well done lads!

I received an industry newsletter from a well known and highly respected certifying body. Globally revered, in fact. I will not say who, because that would be unprofessional and of course I wouldn't want to jeopardize my career. But, from what I've been seeing lately, you can throw a dart and pick just about anyone of these industry authorities and they'll all be droning on about the same tired garbage.

Here's what caught my eye ... and got my goat even more than usual!

In amongst all the articles by "Mr PhD this" and "Mrs. clinical specialist that" was a recipe for "marbled pumpkin cheesecake".

This got my attention as I already was well versed in the anatgonistic reciprocators of the rectus chuck norris-imus minor and could always learn more about healthy eating.

Under "nutrition profile" (how's that for the grand-daddy of oxymoronic implication?) ... was a pronouncement of all the benefits. "Healthy weight, low calorie, low cholesterol and low sodium". Wow, hows that for ticking some boxes?

Perhaps some lab has figured out how to improve on mother nature?

So I read on ...

Ginger snap cookie crumbs, canola oil, low fat cottage cheese, softened reduced-fat cream cheese, sugar, egg, cornstarch, salt and vanilla extract!

Unsulfured molasses, dark brown sugar, ... I'll stop now! The list carries on with nutmeg, cloves, ginger, cinnamon and unseasoned pumpkin puree. For taste, I presume.

Oh ... and some lemon juice. Must be for the vitamin C. Wonder if that counts as part of our 5-a-day?

I defy any nutritionist or professional body to stake their reputation on the nutritional value of the ingredients above. But this is being touted as "healthy" by the same respected industry leader that wants an application fee from me just so I can prove that I am continuing to invest in my education ... and am deserving of a professional association with their illustrious credentials!

And this is precisely why I cringe at the thought of paying out more money for the privilege of being insurable for another year. Just in case I want to rush out and show some nervous housewife the finer points of a body building split routine. Or how to "burn calories" with 45 minutes on the treadmill (remember your iPod luv).

Ladies and gentlemen ... this is a shocker!

And it's typical. In fact every day you can pick up a magazine, log on to a website with massive page rank, or listen to another self-proclaimed expert with bogus qualifications.

Until the industry wakes up and realizes it has very little to offer beyond motivation, clients will continue to be woefully short-changed.

And I want no part in that!