The UK's National Institute for Health and Care Excellence (NICE) recently recommended that primary care doctors should identify people eligible for state-funded slimming classes run by private companies, such as Weight Watchers, an American company that offers various products and services to assist weight loss and maintenance. UK facts Obesity costs NHS England £5.1bn a year 25% of adults in England are obese 42% of men & 32% of women are overweight A BMI of 30-35 cuts life expectancy by up to four years A BMI of 40 plus cuts life expectancy by up to 10 years
Lose weight and save millions NICE suggests that health professionals should raise the issue of weight loss in a "respectful and non-judgmental" way, by measuring their body mass index (BMI) to identify people who are eligible for referral for lifestyle weight management services. BMI is a person's weight in kilos divided by their height in meters squared.
About 25% of UK adults are obese with a BMI over 30 and 74% are overweight with a BMI above 25. Just a 3% reduction in weight could extend life expectancy, and reduce the risk of Type2 diabetes, high blood pressure and heart disease.
NICE argues that the cost of funding private weight loss programs for overweight people would be outweighed by the benefits. For example, preventing just a 1% increase in obesity would save the UK government nearly £100 million a year.
Lifestyle change rather than yo-yo dieting In a recent study published in The LancetDiabetes and Endocrinology, researchers suggest that weight loss at any age in adulthood is worthwhile and even transitory weight loss is beneficial to health.
The research examined the impact of lifelong patterns of weight change on cardiovascular risk factors in a group of 1,273 British men and women, followed since their birth in March 1946. It concluded that the longer a person is overweight the greater their propensity of cardiovascular problems in latter life and the greater risk of diabetes.
According to the lead author Professor John Deanfield from University College, London, "Our study is unique because it followed individuals for more than 60 years, and allowed us to assess the effect of modest, real-life changes in adiposity. . . . Losing weight at any age can result in long-term cardiovascular health benefits, and support public health strategies."
Professor Mike Kelly, the director of the centre for public health at NICE, said the guidelines were about lifelong change rather than yo-yo dieting, when the weight is piled back on after initial success.
He stressed the importance of achievable goals: "We would like to offer an instant solution and a quick win . . . but realistically it's important to bear in mind this is difficult. It's not just a question of 'for goodness sake pull yourself together and lose a stone'; it doesn't work like that. People find it difficult to do . . it takes resolve, it takes encouragement."
mHealth proven support for weight management Scott Lonnee, a bariatric dietitian at St George's Hospital, London echoes Kelly's sentiment, "Sensible lifestyle changes, which include sustained dietary changes and physical exercise can have significant healthcare benefits.Planning is important, and there are simple techniques to help individuals lose weight, which include, setting realistic and achievable targets, keeping diaries of what you eat and what exercise you take."
Research commissioned by Weight Watchers, and recently published in the American Journal of Medicine, suggests that losing weight is significantly easier and more effective when individuals have access to online support, compared to weight loss among those who tried to lose weight on their own.
Takeaways Pro-active mHealth strategies can help to change the way health professionals interact with patients. Information, guidance and support regularly sent to the mobiles of overweight individuals to help them lose weight and engage in lifestyle changes would save lives, prevent the onset of disease and save NHS England millions of pounds. Why is it not being done?
What does the nephew of the 41st American President and the cousin of the 43rd have in common with an Indian doctor?
They're both passionate about using new technologies to provide high quality healthcare at affordable cost.
Bush and Shetty Jonathan Bush, a relative of two former American Presidents, is the co-author of Where Does it Hurt? which calls for a healthcare revolution to give patients more choices, and affordable quality care.
A former Army medic and ambulance driver, Bush is the cofounder and CEO of athenahealth, one of the fastest growing American cloud-based service companies, which handles electronic medical records, billing, and patient communications for more than 50,000 US health providers.
Dr Devi Shetty is a brilliant heart surgeon, and veteran of more than 30,000 operations. However, his growing international reputation rests less on his medical skill, and more on his business brain. He wants to do for healthcare what Henry Ford did for the motorcar: "make quality healthcare affordable."
Shetty is the founder and chairman of Narayana Health, and by thinking differently to traditional healthcare providers, he's built, India's largest private hospital group comprised of 23 hospitals in 14 Indian cities.
Shetty practices what Bush preaches Bush suggests that the only way America will provide convenient quality healthcare at affordable cost, is if doctors do what they're trained to do, others perform routine services for less: for example, nurse-intensivists relieve surgeons from ICUs, and most importantly, if healthcare entrepreneurs are encouraged to tap into the transformative power of the marketplace.
For the past 15 years Shetty has been practicing what Bush is now preaching. Narayana Health provides high quality healthcare, with compassion at affordable cost on a large scale. For instance in 2013, its 1,000-bed specialist heart hospital in Bangalore alone, performed a staggering 6,000 operations, half of them on children. By contrast, in the same year, Great Ormond StreetHospital in London performed less than 600.
In addition to hospitals, Shetty has developed a telemedicine practice, which reaches 100 facilities throughout India and more than 50 in Africa. Narayana Health is also India’s largest kidney-care provider. Shetty has started a micro-insurance program backed by the government that enables three million farmers to have health coverage for as little as US$2 in annual premiums. Over the next five years, Shetty plans to grow Narayana Health four times its present size and become a 30,000-bed hospital chain.
Healthcare change will come from developing nations Bush says, the only way to build a flourishing health marketplace that everyone wants and can afford is for Americans to demand more from their health providers, and accept greater responsibility for their own health.
This will not happen, and Shetty explains why.
Shetty argues that the greatest advances in healthcare will not come from wealthy nations like the US and UK, but from developing nations. Rapidly changing technologies provide opportunities for developing nations to leapfrog wealthy nations, which are encumbered by entrenched and aging technologies.
Hospitals in developing countries with few advanced procedures can quickly leapfrog world-class hospitals such as those in the US and the UK, says Shetty. Instead of slowly replacing aging technologies, they can quickly implement innovative operational designs, and state-of-the-art technologies, which gives them a competitive advantage.
Narayana Health City Cayman This is what Shetty has done in the Cayman Islands. Backed by Ascension, the largest private health network in the US, and the Cayman government, which has designated a 200-acre site for the development of Narayana Health City Cayman.
The first phase, which opened in February 2014, is a 104-bed tertiary hospital, which provides surgeries for less than half the average US price, with quality outcomes that match or exceed the very best US hospitals. Narayana Health City Cayman is expected to develop into a 2000-5000-bed conglomeration of JCI accredited multiple super speciality hospitals in a single campus providing affordable healthcare to thousands.
Takeaway Americans will have access to high quality healthcare at affordable cost, but it won’t happen in the way that Bush anticipates. Grand Cayman is only a 30minute flight from Miami.
Health professionals don't effectively use mHealth strategies to proactively engage and support people living with diabetes. This failure destroys the lives of millions and unnecessarily increases healthcare costs by billions. This is a travesty.
Health information online In the UK and US the majority of people living with diabetes and pre-diabetes have smartphones, which they use on a daily basis to send and receive information, purchase goods, bank, educate and socialize. Notwithstanding, 80% of health professionals still provide information for the management of diabetes in paper pamphlets, and the majority of diabetes care information on websites is digitalised paper pamphlets. Such communications strategies, cost millions, and fail to slow the progression of the condition.
Epidemic Here's evidence, which suggests that current healthcare communications strategies are failing. Recent UK data released by the NHS show that people diagnosed with diabetes has increased significantly over the past decade. Today, 6% of UK adults are registered as diabetic, and an estimated 0.85 million people have diabetes without knowing it. In 2013 there were 163,000 new diagnoses: the biggest annual increase since 2008.
A 2014 study reported in the British Medical Journal revealed that the prevalence of pre-diabetes in England has tripled in eight years, from 11.6% in 2003 to 35.3% in 2011, which puts immense pressure on NHS finances. It's projected that by 2025, five million people will have diabetes in the UK.
The situation in the US is similar. Results of a 2014 study published in the Journal of the American Medical Association, show that there was a significant increase in diabetes between 2001 and 2009, and warns of a growing epidemic that could strain the American health-care system.
Diabetes UK report Governments and charities are good at describing the burden of diabetes, but poor at introducing and promoting effective mHealth strategies to reduce the burden. In a 2014 Diabetes UK report, Barbara Young, the charity's CEO says, "The NHS is spending an eye watering amount on diabetes (£10 billion annually), but the money isn't being used effectively." Those who are diagnosed late or don't receive timely care can suffer complications such as kidney and nerve damage, which costs the NHS billions.
The Report emphasises the importance of better education on how to manage diabetes, and stresses that a staggering 80% of the £10 billion the NHS spends on diabetes goes on treating complications, which may have been prevented if patients had received more effective information about the condition.
If nothing changes, the Report suggests, by 2035 diabetes will cost the NHS £17billion a year, and thousands of diabetics will suffer unnecessary complications.
Online managed care systems Where's the leadership to help change the situation? There's evidence to suggest that when mHealth strategies are used in the management of diabetes, they slow the progression of the condition, propel self-management, and significantly reduce the costs of care.
For example, Professor Shahid Ali, a UK practicing GP and Head of Digital Health, University of Salford, has developed and implemented a mHealth system, which enhances the quality of diabetes care, while substantially reducing costs and increasing the efficiency of health professionals.
In the US, Welldoc a successful technology company, founded in 2005 by an endocrinologist, provides a mHealth solution for people living with diabetes, which coordinates diabetes care, propels self-management and achieves long-term adherence.
Professor Gordon Moore from Harvard University Medical School has developed a managed care system that embeds the clinical, behavioural and motivational aspects of diabetes care into any handheld device. It's like, Moore says, "having your doctor in your pocket".
Notwithstanding, governments and agencies responsible for enhancing the quality of care for people living with diabetes are failing to bring such tried-and-tested mHealth solutions to their attention.
Takeaways According to Diabetes UK's, we, "know what needs to happen":
"More focus on ensuring that people know about diabetes
Provision and promotion of effective self-management
Integrated care planned around the needs of the individual
Effective promotion of lifestyle change."
But, how many more people living with diabetes have to endue unnecessary progression of their condition, and devastating complications, which cost health systems billions, before health professionals abandon their costly and ineffective communications systems and embrace cheaper and more effective mHealth strategies?
Since the early 1970s, there's been significant progress in the survival rates of some cancers, in particular testicular, skin, breast, and prostate cancers where the 10-year survival rates in the UK have increased, on average from 46% to 86%.
However, the UK still lags comparable European countries in cancer survival, and for some cancers, particularly lung, esophagus, pancreas and brain, the 10-year survival rates are only about 10% or less.
Late diagnosis In Britain 50% of cancer patients are diagnosed late. This is the result of GPs misdiagnosing, and patient's reluctance to visit their doctors.
In his book, Malignant, Stanford University professor S Lochlann Jain suggests cancer diagnosis is missed in young adults because, "doctors often work under the misguided assumption that cancer is a disease of older people." For example, 80% of lung cancers are diagnosed at advanced stages.
Cancer survival rates are expected to improve as technology, and self-education develop. This is expected to reduce the role of primary care doctors, increase patient-centered healthcare, and reduce late diagnosis.
British stiff-upper-lip In emerging countries, cancer patients present late because of a lack of education and money. In the UK, where medicine is free at the point of care, the British stiff-upper-lip is often the cause of late diagnosis.
A 2013 comparative study published in the British Journal of Cancer found that there was little difference in the awareness of cancer symptoms among patients, yet the British were less likely to act on them. It concluded that the traditional British 'stiff-upper-lip' means cancer patients are dying unnecessarily because they don't want to waste their GP's time with their symptoms or are too embarrassed to seek help.
Genomic medicine A number of studies suggest that doctor-patient relationships are sub-optimal and based on asymmetry of information.
Such relationships will change when patients have access to information on their own DNA. Genomic medicine is a game-changer because of its potential to personalize patient care.
It only takes a few hours to sequence a person's genome, and costs are low and falling. A recent survey suggests that 81% of all US patients would like to have their genome sequenced. Eventually, this will mean that most people will have their genome sequenced so they can be properly cared for if they get sick.
Already some scientists and clinicians have started taking advantage of genomic sequencing, to tailor their approaches to individual differences. In this personalized, patient-centred healthcare environment, primary care doctors are less important, and patients more important. As this transformation occurs, early cancer diagnosis and survival rates are expected to rise.
Technology driven patient-centered health Increasingly, patients are employing the expanding array of mHealth apps to diagnose and treat their own ailments and this will increase as the technology develops and prices fall.
For example, patients have started using mHealth apps to measure activity, and changes in their vital signs and bodily functions. Current devices clipped to a finger can measure heart rates, and blood oxygen levels and these data can be transmitted to smartphones. Increasingly consumers will use these tools rather than visit primary care clinics.
Takeaways Technological developments, self-education, and consumers' increased access to their health records, will help to correct the imbalance in information that now exists between doctors and patients.
As this happens, cancers will be diagnosed earlier, primary care centres will disappear, hospitals will exist only for intensive care, and sick patients with long-term chronic illnesses will be monitored and managed remotely from home.
"The next ˜big thing" in healthcare . . . . is IT, which will dramatically change the way health professionals interact with patients. Every step of a patient's care will be determined by protocols on a hand-held device. This will make healthcare safer and shift many hospital activities into the home," says Dr Devi Shetty, world-renowned heart surgeon, founder and chairman of Narayana Health, India's largest multi-purpose hospital group and the person said to have, "the biggest impact on healthcare on the 21st century".
Shetty also warns that, "Despite the advantages of such technologies, the medical community is reluctant to accept them."
Although doctors and patients have iPads and smartphones and use social networks, the healthcare community, "fights like mad to resist change", and fails to embrace life-saving technologies, which would improve patient care and reduce costs. ld improve patient care and reduce costs.
Open systems In 2012 UK Health Secretary Jeremy Hunt issued a Mandate that by 2015, modern communications technology would play a substantially bigger role in the UK's healthcare system. The NHS remains a near bankrupt, inward looking public monopoly driven by proprietary systems rather than customer needs.
Saving lives didn't invoke change Healthcare professionals invariably refer to privacy and security issues to protect the status quo, but these are equally applicable to other sectors, such financial services, which have embraced change and open standards.
An explanation why healthcare systems resist change is in a 1970 BBC Reith Lecture by Donald Schon, formerly Professor of Philosophy, University of California.
Schon borrowed a story from Elting Morison's 1968 book, Men, Machines and Modern Times, to describe entrenched social systems' resistance to change.
During wartime, a young Naval officer named Sims invented a device that improved the accuracy of guns on ships by 300%, but the US Navy rejected it.
The device, "continuous-aim firing" used a simplified gearing mechanism that took advantage of the inertial movement of a ship. What previously a whole troupe of well-trained men had done, now one person, keeping his eye on the sight and his hands on the gears - could do.
To survive and grow, every major industry in today's network-centric world, except healthcare, has abandoned proprietary systems, embraced open standards and actively licensed technologies.
Rejected on scientific grounds Despite it's obvious advantages especially in a time of war, Sims found it extremely difficult to get his device adopted by the US Department of Navy. When finally the Navy did agree to test his system, they did so by taking it off the moving ship and strapping it onto a solid block on land. Since the device depended on the inertial movement of the ship, it didn't work and the Navy rejected the device on "scientific" grounds.
Eventually, Sims attracted the attention of Theodore Roosevelt, who saw the advantages of the device and immediately insisted that it be adopted in the Atlantic and Pacific war theatres where it achieved a 300% increase in accuracy.
The American Navy's rejection to Sims's lifesaving technology is similar to Healthcare systems' reluctance to embrace technologies, which improve patient care and lower costs.
Improving the quality of healthcare usually means significant cost hikes. Acute kidney injury (AKI), however, which kills between 12,000 and 42,000 people in England each year, can be reduced at little cost, and could save the NHS between £434 million and £620 annually.
Severe dehydration is one of the main causes of AKI. Informing at risk patients of the importance of drinking water could reduce the incidence rate of AKI.
The silent killer AKI relates to the rapid loss of kidney function. Often it has no symptoms and frequently goes unnoticed by medical staff. AKI's most common in people over 65, and may affect as many as one in six hospital patients who are admitted as an emergency. If left untreated, the condition can result in permanent kidney damage and death.
AKI usually develops before patients enter hospital, and is often caused by dehydration, or an adverse reaction from seriously ill patients to over-the-counter medicines such as ibuprofen. AKI also can develop after some heart surgeries when the kidneys may be deprived of normal blood flow.
Once in hospital, AKI is easily diagnosed by a standard blood or urine test. After diagnosis, the condition can be treated by ensuring that patients stay hydrated or by changing their medications.
Chronic kidney disease (CKD) Chronic kidney disease (CKD) is a condition in which kidneys are damaged and can't filter blood as well as healthy kidneys. Because of this, wastes from the blood remain in the body and may cause other health problems.
Various chronic diseases have detrimental effects on the kidneys. Rapidly rising global rates of chronic diseases portend a consequent rise in kidney failure and end stage renal disease (ESRD). Over the past two decades, worldwide there has been a 165% increase in dialysis treatments for ESRD.
Despite the magnitude of the resources committed to the treatment of kidney disease and the substantial improvements in the quality of care, kidney patients continue to experience significant rates of mortality and morbidity. Partly, this could be the result of poor delivery of medical information.
Variation in kidney care The 2013 Kidney Care Atlas provides evidence to support this thesis by describing variations in the healthcare that people in England with kidney disease receive.
Some variation is to be expected because CKD is more common in older people and ethnicity is a strong influence on the pattern and prevalence of kidney disease in communities. Some variation, however, is unwarranted, and the magnitude of variation in some instances is large.
The Quality and Outcomes Framework (QOF) The Kidney Care Atlas underlines the importance of GPs providing quality healthcare information to patients in formats they prefer. GPs in England are incentivized by the Quality and Outcomes Framework (QOF), which rewards "good practice".
Under the QOF system, doctors are incentivised to establish and maintain a register of patients with CKD and provide them with information about their condition. Ninety per cent of GPs provide such information in leaflets, whereas increasingly patients prefer healthcare information online and in video format.
Data in the Kidney Care Atlas suggests that kidney patients need to be more effectively informed about readily available, inexpensive therapies that can slow and prevent the progression of CKD. This could be achieved by simply substituting videos for leaflets and integrated into the QOF system.
Takeaways Videos, unlike doctors, never wear out and can be accessed by thousands of patients simultaneously, 24-7, 365 days a year from anywhere, at anytime and on any device. Doctors who use videos to inform patients suggest this relieves pressure on GP surgeries and A&E departments.
Ten short videos could reduce kidney disease by encouraging people at risk of CKD to:
Ensure their blood sugar levels are excellent if they're diabetic
Regularly check and control their blood pressure.
Regularly have blood and urine tests
Immediately treat urinary tract
Control blood cholesterol levels
Maintain a diet that is low in sugar, fat and salt and high in fibre
Patients want health information in ways that doctors are not providing.
Patients want reliable answers to simple questions about the presentation, diagnosis, treatment options, side effects, and aftercare of their conditions. They want answers at speed, and increasingly delivered to their smartphones in video formats.
With difficulties gaining face-time with doctors, patients turn to the Internet. Worldwide, some three billion health-related Internet searches are made each year.
Patients experience difficulty finding reliable answers to their basic questions among more than two billion health websites. According to research published by the American National Institute of Health, 33% of adults who search the Internet for health information become confused by what they find. This frustrates their therapeutic journeys and makes for fraught doctor-patient relations.
Things are changing, however, and now patients have a new free-and-easy-to-use online platform, www.healthpad.net. This provides patients with video answers to their FAQs that can be accessed at speed at anytime, from anywhere on any hand held device.
HealthPad HealthPad was started by doctors and launched in June 2013. It has accrued a growing exclusive healthcare content library of over 4,000 videos that provide patients with premium, reliable answers to their FAQs across 32 therapeutic pathways.
This unique health content library with embedded search facilities, has been contributed by leading health providers from premier North American, European and South Asian medical institutions.
HealthPad does more than reformat print content into digital words and substitute a website for books and journals. The platform leverages the online communications potential, and is an interactive, multimedia utility, which meets the needs, health status and personal backgrounds of patients and patient groups.
Enhanced communications HealthPad serves the needs of patients by enabling doctors to capture, organize and distribute their medical knowledge more effectively. Doctors can drag-and-drop any type of content into a publishing template: scans, pdf files, ppt. presentations, videos, diagrams, photos, commentaries etc. These data are instantly and automatically re-formatted into attractive rich-media publications. By a click of a mouse, doctors then can choose how they wish to share their publications, ranging from private and secure to public and open.
In addition to publishing health knowledge, doctors can use HealthPad to create, develop and manage any number of bespoke online patient groups.
What doctors say about HealthPad "My HealthPad videos personalize medicine and have positive psycho-social effects. Because of HealthPad patients feel that they know me before we have even met and are less inclined to be swayed by discordant and often incorrect medical information they encounter on the internet that can create misperceptions and fear".Dr. Whitfield Growdon, Onco-surgeon, Harvard University Medical School and the Massachusetts General Hospital.
"My patients now don't always have to attend a hospital for reliable information to help them manage their conditions. HealthPad allows me to reduce valuable face-time with my patients while improving doctor-patient relationships and patient compliance by helping them understand their conditions and treatments better".Dr Sufyan Hussain, an endocrinologist specializing in diabetes at Imperial College, London.
Drivers of change The overwhelming majority of UK doctors provide medical information in pamphlet form, while the overwhelming majority of their patients have smartphones and broadband connections and use online services to find jobs, receive their salaries, pay bills and taxes, learn, conduct business and interact socially.
Technological change combined with the escalation of chronic non-communicable diseases, especially among the over 55s, is expected to increase Internet searches for premium and reliable medical knowledge and this will force health providers to change the way they communicate with patients. According to a recent Deloitte's report, in 2014 UK citizens over 55 will experience the fastest year-on-year rises in smartphone penetration. By the end of 2014, UK smartphone ownership is expected to surpass 50%, and the difference in smartphone penetration by age will disappear. This mirrors the rest of the world.
Takeaways If you're a health provider, HealthPad can significantly improve your online communications, enhance the quality of your services and save you money.
If you're a patient, HealthPad provides you with free and easy access to exclusive, premium and reliable healthcare knowledge in video formats you prefer, at anytime, anywhere, anyhow.
Public smoking bans and eating fibre significantly reduces people attending hospitals for asthma. These are the conclusions of two 2014 studies: one reported in the Lancet and the other in Nature Medicine.
Asthma Asthma is the inflammation of the air passages in the lungs. It occurs when the immune system mistakes harmless triggers, such as dust mites as threats, which cause the airways to become inflamed, leading to symptoms such as wheezing and breathlessness.
Worldwide the economic costs associated with asthma exceed that of TB and HIV/AIDS together.
Prevalence "Asthma affects about 300 million worldwide. The prevalence of the condition has increased following changes to a modern, urban lifestyle. Each year asthma kills about 255,000 people and deaths are related to the lack of proper treatment", says Dr. Murali Mohan, Senior Consultant Pulmonologist, Narayana Institute of Cardiac Sciences, Bangalore, India.
Over the past 40 years, the prevalence of asthma has increased in all countries in parallel with that of allergy. With the projected increase in the proportion of the world's population living in urban areas, there is likely to be a significant increase in the number of people with asthma. By 2025, it's projected that there will be an additional 100 million people with asthma.
Mortality & morbidity Asthma mortality rates vary and don't parallel prevalence, but are high in countries where access to essential drugs is low.
Another measure of asthma severity is hospitalization rates. For most low and middle-income countries, such data is unavailable. Notwithstanding, in countries where asthma management plans have been implemented, hospitalization rates have decreased.
Childhood asthma is an increasing challenge and accounts for many lost school days and may deprive the affected children of both academic achievement and social interaction. This is particularly the case in underserved populations such as India where there are an estimated 15 to 20 million asthmatics.
Smoking and asthma The Lancet published the first systematic review and meta-analysis examining the effect of smoke-free legislation on asthma. The study examined 250,000-hospital attendances for asthma attacks in the US and Europe between 2008 and 2013. Conclusions show that the rates of hospital attendance for asthma were reduced by 10% within a year of smoke-free laws coming into effect.
Comprehensive smoke-free laws only cover 16% of the world's population, and 40% of children worldwide are regularly exposed to second-hand smoke.
Studies tend to focus on the impact of smoking on adults, but more than 25% of all deaths and over 50% of all healthy years of life lost are due to children being exposed to second-hand smoke.
Processed food Research, undertaken by scientists from the University of Lausanne, Switzerland and reported in Nature, examines the role that different types of dietary fibre play in the gut and its effect on asthma. Findings show that a high-fibre diet reduces asthma.
In recent years, the incidence of asthma has been well documented. Coincident with this have been changes in diet, including reduced consumption of fibre.
The Swiss researchers argue that high and low fibre diets alter the types of bacteria living in the gut. Bacteria, which can munch on soluble fibre flourish on a high-fibre diet, and in turn, produce more short-chain fatty acids, which act as signals to the immune system and result in the lungs being more resistant to irritation.
The opposite happens in low-fibre diets and the mice become more vulnerable to asthma.
The Swiss scientists conclude that a dietary shift away from fibre in favour of processed foods raise levels of asthma.
Takeaway Albert Einstein said that, "Nothing will benefit human health and increase the chances for survival of life on Earth as much as the evolution to a vegetarian diet". Were Einstein alive today, he would have added, "and a ban on smoking".
Cataract surgery, once only for elderly patients, is now increasingly being performed on younger baby boomers.
Facts More than half of the over-65s suffer from cataracts, which are cloudy patches in the lens that make vision blurred or misty. The condition is linked to smoking, poor diet or health conditions such as diabetes.
Cataracts can affect your ability to read, write, watch TV, work at a computer, and drive. Severe cases can affect your ability to wash, dress, cook and work.
According to the World Health Organization (WHO), 285 million people worldwide are visually impaired, 90% of these live in developing countries where cataracts are the leading cause of blindness.
Generational differences in rich countries Baby boomers who have cataract operations are significantly different to previous generations who were more complacent, expected less and typically accepted that with age comes loss of opportunity and function.
Baby boomers are part of a 'fix-it' culture. They seek-out solutions rather than passively hope for them. When they sense a limitation they fix-it with such things as artificial joints, Botox, Restylane, Viagra, anti aging cream and increasingly, cataract surgery: now the most commonly performed surgical procedure in the world.
The reasons are clear. Baby boomers have disposable income, they are more active, working longer and have greater demands on their vision. Also, they're more likely to have taken advantage of surgery to address myopia, hyperopia, astigmatism and even presbyopia, and they know the excellent results they can get.
Treatment Currently, the only treatment for cataracts is surgery. According to the WHO, in 2010, 19 million cataract procedures were performed and by 2020, this number is projected to increase to 32 million per year.
The overwhelming majority of these procedures are performed in developed countries. Currently, in the US, 1.5 million cataract extractions are performed annually, and in the UK about 0.4 million.
Traditional cataract surgery Two decades ago, cataract surgery meant a three-day hospital stay, patients couldn’t move around and it took a while for them to get their vision back.
Traditional cataract surgery requires the use of a hand-held blade to make multiplanar incisions in the cornea to access the cataract. A surgical instrument is then used to manually create an opening in the lens capsule that holds the cataract. The goal is to make the corneal incisions precise; make the opening in the lens capsule as circular as possible, in the right location and sized to fit the replacement lens.
Technical breakthroughs Technical breakthroughs mean that now a 45-minute bladeless, laser procedure is positioned to revolutionise cataract surgery.
"In the 1980s phacoemulsification significantly changed cataract surgery and reduced admission times and complication rates. In 2001, femtosecond laser technology was introduced clinically for ophthalmic surgery as a new technique for creating lamellar flaps in laser in situ keratomileusis (LASIK). In 2010 femtolaser was developed into a new tool for cataract surgery; although it is not generally accepted yet the technique is developing and is likely to become the gold standard in time," says Mr. Hugo Henderson, Consultant Ophthalmologist and Ocuplastic Surgeon, Royal Free Hospital, London.
Cataracts in poorer countries While baby boomers in rich countries can stave off the debilitating effects of cataracts with a 45-minute procedure, in poor countries cataracts remain the world's leading cause of blindness.
Blindness is particularly devastating in the developing world where it has a profound impact on the quality of life for the blind person and his or her community. Life expectancy of the blind is usually less than half that of someone with eyesight the same age.
The desperateness of this situation is augmented by the fact that a blind person is unable to contribute to the family income. Not only does blindness mean a father is unable to work, or a mother cannot collect water or go to market, but someone with eyesight must care for him or her. Effectively two income-producing individuals are lost. This creates a devastating economic impact on the family and the community.
In the developing world, cataract surgery is available for only a small proportion of those in need. This is partly because of low demand - caused by barriers related to awareness, bad services, cost, and distance - and partly because of deficiencies in the supply of services.
Takeaways The annual global economic impact of blindness and poor vision caused by lost economic productivity is immense and affects everyone.
Eighty per cent of all visual impairment can be avoided or cured.
Are we addicted to foods that make us obese and kill?
Why is it hard for obese people to lose weight despite the social stigma and health consequences associated with being overweight? Is it similar to cigarette smokers who continue to smoke even though they know smoking will give them cancer and heart disease?
Is processed food the new tobacco?
Large growing global epidemic Over the past 25 years the prevalence of obesity in England has more than doubled and today, most English people are either overweight or obese. Similarly, in the US more than a third of individuals are obese.
It’s estimated that each year, obesity costs the NHS more than £5bn and the US economy about $150bn.
Global epidemicOnce considered a problem only for rich countries, obesity is a rising worldwide challenge. In 1997 the World Health Organization (WHO) formally recognized obesity as a global epidemic and in 2008, claimed that 1.5 billion adults were obese.
Experts say a couch potato lifestyle and overindulgence in junk food is creating an overweight and obese generation prone to heart disease, diabetes and cancer. In rich countries people have easy access to cheap, high-energy food that is often aggressively marketed.
Call for parents and local authorities to help The press refers to the “obesity time-bomb” and suggests that misguided parents are bringing up a generation of overweight children who gorge on junk food and sugary treats and rarely get any exercise. UK policy makers say that more should be done to support families to help them tackle the obesity crisis in children and young people.
In January 2014, Professor Philip James told the European Congress on Obesity in Antwerp: “Unless we can act firmly and decisively, we will be condemning a huge number of children . . . to becoming a ‘lost generation’.”
Where should we target our concerns? Parents? Municipal authorities? Or, the food and drinks industry?
Changed environment Contrary to popular belief, people have not become greedier or less active, but what they eat has changed. Everyday, people are bombarded by food industry adverts to eat more food. New scientific evidence suggests that industrial processed food is biologically addictive.
The tobacco industry In 1954, the tobacco industry paid to publish a “Frank Statement to Cigarette Smokers” in hundreds of US newspapers. It stated that the industry was concerned about peoples’ health and promised a number of good-faith changes.
What followed were decades of deceit and actions that cost millions of lives. During that time the tobacco industry emphasised personal responsibility and paid scientists to deliver research that triggered doubt and criticised science that found harm associated with smoking.
The food and drink industry
Similarly today, some large food and drink companies fund scientific research to establish health claims about their products.
A 2013 report suggests that scientific research sponsored by the food and drink industry is five times more likely to conclude that there are no links between consumption of sugary drinks and weight gain.
In March 2014, Dame Sally Davies, the UK’s Chief Medical Officer told a committee of MPs that, "research will find sugar is addictive" and that the government, “may need to introduce a sugar tax".
For years the tobacco industry made self-regulatory pledges, aggressively lobbied to stifle government actions and denied both the addictive nature of tobacco and their marketing to children.
Takeaways Food and tobacco industries are different, but there are significant similarities in the actions they have taken in response to concerns that their products can harm.
Because obesity is now a pandemic the world cannot afford to make the same mistake it did with the tobacco industry.
London
10 years, 4 months ago
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