Healthcare, medicine & pharmaceuticals

Supersize Me

Poor diet and a sedentary lifestyle will make you fat, but this might not be the only reason that obesity is a growing problem. Many now believe that other things have changed in our environment to precipitate such a dramatic rise in obesity over the past 40 years. A review paper in the International Journal of Obesity by 20 obesity experts has identified the ten most plausible alternative explanations for the epidemic. Many of these alternative explanations relate to our immediate environment: that we are smoking less - as, yes, smokers do tend to be thinner; pollution, given the increasing number of pollutants and industrial chemicals like pesticides, dyes and flavourings that we swallow, inhale and absorb everyday; drugs, in particular antipsychotic medications called neurooleptics that typically add weight - as much as ten kilograms in the long term - to users; and the curious, yet logical proposition that a more moderate climate, as a result of global warming and our use of air conditioners and heaters to moderate our environment means we shiver and sweat less shedding fewer pounds in the process. Social issues are also listed as alternative explanations to the rise in obesity: Prenatal effects - put simply, its in the genes; the idea of like marrying like - fat marry fat, and their offspring will tend to be heavier; plus, fat equals fecund - heavier people have more children. As a race too we're getting older, and older people are more likely to be obese than younger people, plus the composition of the US population (which generates most of the data associated with obesity) is changing - Mexican-American and black Americans account for an increased percentage of the population, and both these groups have a higher tendency to be obese than Anglo-Americans; mothers around the world are getting older, and having an older mother seems to be an independent risk factor for obesity. Finally, some point to the fact that we are getting less sleep - several large epidemiological studies suggest that a shortage of shut eye is making us fat (although the cause and effect relationship here requires further investigation, as it's well know obesity impairs sleep.) Meanwhile, the private sector in Japan is stepping up in the fight against flab and producing smart sneakers and pedometers hooked up to personal computers. Most new products aimed at the health-conscious are digital incarnations of low-tech predecessors, and based on two concepts - fun and ease of use. Now, stop reading this and get some sleep!

Health 2.0

First patients and healthcare consumers used the Net to educate themselves and shake off the medical establishment's 'doctor-knows-best' mentality. Now they're starting to control their own medical spending, moving to 'consumer-directed health plans' and, with a health savings account, typically a healthcare budget from their employer, patients are managing their own expenses, shopping around for good value in existing services and seeking out the next generation of medical services. Online DNA-testing services for instance are growing in popularity; advances in genomics are enabling people to test their DNA against a range of diseases and potential adverse reactions to drugs. DNA Direct is just one of more than two dozen online genetic-testing services springing up to take advantage of a growing group of consumers prepared to conduct such tests over the Internet. In the US, people are also increasingly adding health care to their shopping lists with walk-in medical clinics popping up in supermarkets and shopping malls. Typically staffed with nurse practitioners or physician's assistants, these 'convenience clinics' - there are about 160 of them nationwide in the US - treat routine ailments and perform minor procedures. With the number of Americans without insurance at an all-time high, top companies are not only encouraging employees to visit clinics such as MinuteClinic (their slogan: 'You're sick. We're quick'), but also offering to cover the base cost of such visits. So strong is the trend that some are comparing these clinics to the advent of the ATM. In another trend, patients and insurers are advocating at-home monitoring of patients, saving travel time and inconvenience while putting a lid on the spiralling healthcare costs of common conditions. Analysts estimate that the market for home medical monitoring for chronic conditions could be worth as much as $500 million a year by 2009. Demand will only increase, with the greying of the baby boom generation set to double the elderly population between 2011 and 2030. New tools are also coming to market to help facilitate a second opinion on medical bills. The PC application SimoHealth organises healthcare expenses and uncovers discrepancies among medical bills, healthcare payments and insurance reimbursements. The healthcare industry is a $2 trillion dinosaur in the US - a potential goldmine for entrepreneurs. These are just a few of the ideas coming to market, but as always the real opportunity lies with services not yet invented - like a Priceline for elective surgery or an online reservation system for doctors' appointments a la Open Table.

Moral health hazard?

Running clinical trials is expensive - ask any medical device maker or drug company. Trials can sink the best idea and best laid plans, but contract research company Alquest has an outsourcing service to help medical device start-ups get through clinical trials faster and cheaper. In September, it started offering services to help medical device companies conduct their trials in India. CEO Linda Alexander claims this idea has been available to the pharma industry 'for a long time' but it's a relatively new idea for device makers.When it's time for a company to conduct a pre-pilot study, which essentially amounts to putting their product to use for the first time in people to see if things actually work, many go outside the United States, often to developing countries in South America, particularly Brazil, but also Australia. India offers several key advantages over other regions - including more than 1-billion people with a large cross-section of diseases. Alquest claims it can compress the time to enrol patients in trials along with the wait time leading in to a trial, since all that is required is approval from the Hospital Ethics Committee, as opposed to additional FDA approval and presumably more stringent standards and regulations in the US. The company claims that it can also help firms run portions of later stage trials. Two companies have already signed up for early-stage trials, however, big questions associated with the ethics of this procedure remain unanswered - or even unasked - at this point.

No such thing as stress! Can you deal with that?

Stress has overtaken back pain as the single biggest cause of long-term sickness absence, with stressed-out 'sickies' adding up to 12.8 million lost working days per year in Britain at a cost of 1.24billion. Codswallop! according to Angela Patmore who has taken a swipe at the so-called 'stress epidemic' and the unwieldy and unregulated stress management industry in her book The Truth About Stress. She's been labelled a 'heartless bitch', but calm down and listen to what she has to say - for a start the term 'stress', Patmore reasons, is both bogus and illogical. When she started researching the concept in the 1990s, an analysis of the clinical literature showed that there were literally hundreds of different definitions of stress, some of them opposites, some of them irreconcilable, but all of them felt to be 'the correct one' by one expert or another. Without a definition of 'stress', Patmore suggests the ideology of stress management is misleading and deceitful. Worst still, our preoccupation with stress has helped turn individuals into 'sufferers' rather than encouraging them to confront and overcome routine concerns. The stress management industry - a multi-million-dollar industry that is entirely unregulated - is just making things worse, with hundreds of thousands of therapists, counsellors and healers instilling fear and insecurity in people about perfectly normal coping mechanisms and emotions. The statistics corroborate her theory - between 1991 and 2003 the number of accredited stress counsellors increased by 804 per cent. At the same time more and more people became more stressed; basically, the more counsellors there are, the more stressed people there are. And don't be fooled into believing the 'stress epidemic' can be explained by life becoming harder in the 21st century - think of the London Blitz when everyone lived under daily threat of enemy bombs while worrying about loved ones on the front line, rationing and a Nazi invasion; likewise in the Victorian Age when half of all children in poor families died before the age of five and families lived constantly with bereavement. The UK now has a Stress Awareness Day - you were probably too stressed and missed it, it's on 1 November each year.

Consequences of our online culture

Policy makers and analysts in the UK are arguing the pros and cons of onscreen computer culture. Neuroscientist Susan Greenfield heads a league of teachers, psychologists and novelists as the lofty Oxford Institute for the Future of the Mind (OIFM) in arguing that childhood is being 'poisoned' by a culture of junk food, marketing, video games and school targets. She would like to see a complex set of guidelines on how much time parents allow their children to spend in front of a computer or television brought through the parliament. Meanwhile, the American author of Everything Bad is Good for You: How Today's Popular Culture Is Making Us Smarter, Steven Johnson, argues quite the opposite - that mass culture is ever more intellectually demanding. TV programs have complex narratives, post-modern ambiguity and intertwining plotlines that are far more challenging than the Terry and June TV shows of old. 'Video games are a great teacher of fluid intelligence,' says Johnson. 'The second most popular PC game in the US last year was Civilization IV, where you re-create human economic and technological history. Here you have 12-year-olds trying to figure out whether they should go for an agrarian capitalist society or a monarchy'. Some suggest that screens may in part be responsible for rising IQ scores (known as the Flynn Effect), as we fill our leisure time with cognitively-demanding amusements, such as games that force you to think on your feet. What some are seeing as the harbinger of a Nanny State, the Greenfield camp are arguing our square-eyed youths may be dangerously dumb compared with their book-reading forebears, that '(online) children are likely to go for the most easily available stimulating things, such as speed and noise rather than digesting the text (of a book)'. Greenfield is also ringing the alarm on 'invasive technologies', using the example of the 'Play Attention helmet, which kids can use to manipulate a screen icon by thinking', suggesting, 'In future, manufacturers may be able to use such things to manipulate what is happening in the mind'. We are not a mass of uncritical computer-controlled zombies yet, but the changes are becoming visible in adult society - you can see it in relationships and speed dating, why are we in such a rush? The OIFM wants to explore the scientific basis of these issues and lobby the government in the hope that science will shape policy and not the other way round.