What is the most important element of a perfect heart health system?

Everyone wants things to be perfect, right? Or even near perfect;  maybe just better than a system that functions to its optimum. Updating and accelerating performance normally means a new piece of kit of a now cliched ‘paradigm-shift’ in healthcare delivery.

Surely technology will cleanse all the misfiring and sclerotic elements of healthcare? Well, better diagnostics and smart therapies all help but the one desire from clinicians, policy makers and everyone involved at the sharp end is that prevention becomes the dominant feature – not funding, not politics, not technology; just good education, guidance and the realisation that our health destiny is, largely, in our own hands.

In a recent article for a Raconteur feature in  The Times I asked senior figures what they would place first in a wish list to create a perfect cardiovascular (CVD) health system; Prevention was the word.

CVD kills 17.9 million people in the world annually according to figures from the World Health Organisation and Professor Sir Nilesh Samani, a distinguished cardiologist and now medical director of the British Heart Foundation (BHF), was swift to state that the ideal system would prevent disease in the first place. He was joined by Jan Kimpen, chief medical officer, of healthcare technology giants Philips who echoed the need to live and eat healthy. They have impressive devices and diagnostics – and lots of them – but getting the basics right is the crucial first step before we can get anywhere near perfection.

Public Health England has just stated that prioritising prevention in the NHS could make a drastic difference to the health of the nation and limit the financial burden on the economy from smoking, obesity and CVD. It estimates that 50 per cent to 80 per cent of CVD cases are preventable.

The NHS health check, a series of checks for people aged between 40 and 74, is one of the biggest prevention schemes in the world has benefitted around seven million people since its inception in 2013. But its uptake needs to be supercharged to meet the growing threat of an ageing population living with multiple conditions and the fast-advancing nightmare of generations embedded with obesity.

Technology and medical discovery will tackle the tsunami of ill-health head on but prevention – taken in combination with every ingenious health innovation possible – has to become society’s by-word for good health.






Prevention is better than cure

UnknownThe NHS just got a 70th birthday present of a funding boost to save the ailing institution which ‘celebrates’ its grand old age on July 5. The gift is welcome but remains wrapped because no-one in the government has said how much, when and for how long. It’s an exercise in pass-the-parcel with multi layers to be stripped off before we get to the prize.
And what will the present be? £5 billion, £50 billion, more? The PM and the Health Secretary are light on detail but in this case the principle is way more important than the small print.
Whatever they give will not be enough if it is a one-off payment. We need to change our relationship with public health funding as much as we need to change public health.
that £50 billion will build the healthcare walls a bit higher but it will do little to stop the rising tide of preventable diseases that will spill over the new heights of funding pretty soon. I’ve long argued for the funding of health to be prised away from polarised party politics – it is way too important to be an idealogical football….the Health and Social Care Act ‘reforms’ of 2012 cost £4 billion and, no matter how much that figure is debated, it did little to change the downward trajectory of the NHS. And the plans of other political parties are hardly visionary.
So, and it’s a big SO, we need to change we as a society address our health, individually and collectively. Change is rarely easy but this has to start from our first steps, first words, first lessons. Health should be as important as the Three Rs in childhood development.
I recently wrote a piece for The Future of Health supplement published in The Times which examined the pressure of an ageing population weighted down by chronic diseases that could be avoided. https://www.raconteur.net/healthcare/preventative-healthcare-tackling-challenges-ageing-population
The Danish think tank, Demos, argues that any solution to this demographic mudslide has to be co-ordinated across health provision, housing, town planning and technology. Its founder, Aleksi Neuvonen, commented: “It will be the biggest social change in history.”
It will be difficult but it is the only game in town if the NHS is to survive. It’s going to be a long road when you consider that hospitals have fast food outlets and junk food is the cheap, easy option.
The hope is in growing realisation that plodding along will not cut it. NICE, the government’s health watchdog, agrees and has set out a series of modelling tools that show the savings that can be made by interventions from alcohol to wellbeing.
We should celebrate the NHS’s 70th and all it stands for but also realise that we are at the difficult birth of a new healthcare challenge that should unite all across the political and societal spectrums.

A mental health story where cuts are a good thing!

How can mental health benefit from a cut, any cut, let alone lots of them?!

A group of barbers is providing a way by encouraging clients to talk about themselves and let out some of the stresses and strains that build up in life.

We’re all busy, or pretend to be, so we rarely have time to chat in a neutral setting where judgements aren’t handed out. The barbers – or hairdressers – is one of the few places where that can happen. Often derided for their ‘Going anywhere nice this summer’ depth of chat, barbers are in a rare position to be that escape valve.

And Torquay tonsorial (sorry!) Tom Chapman @HeresTommy is championing a scheme where barbers can spot signs of depression and mental health issues and maybe direct people to helpful organisations or just be comfortable talking about personal themes. It’s not turning them into inquisitors latching onto any comment and squeezing pscyho-analytical meaning from it but more being a listening post.



Tom, who runs Tom Chapman Hair Design,  founded the Lions Barber Collective, a charity dedicated to helping barbers provide that listening post as well as the sharp styling. (http://www.thelionsbarbercollective.com) I wrote about him in this week’s Sunday Express (http://bit.ly/2c3TouC and printed below) and hope his cause gets nationwide appeal. Barbers will get training in how to talk to and engage with clients and to not to razor a furrow in someone’s beautiful hair with shock if they say ‘I’m a bit depressed at the moment mate’.

We all need space to accept that our lives are not Facebook and Instagram perfect and maybe doing it while looking in the barber’s mirror will provide perfect self-reflection. Tom has found that more clients are ‘opening up’ to him since they found out he was happy to talk. He has also found existing clients who said just chatting to him while they were going through difficult times provide a huge relief to their stress.

You could hardly find a more manly arena for mental health stigma shaking: Barbers are now a world of bulging forearms, tattoos and Viking bushy beards so it sets a fantastic example about the need for men to talk.

Tom has big plans to promote the scheme –  NHS England are listening and becoming involved – so that ‘listening’ barbers can declare themselves with an approved sticker in the window.

It deserves to be a big success and it will  help many people keep on an even keel and keep the demons at bay. You can still talk about what you did on your holidays and debate if Jose or Pep is the better football manager but you can talk about anything

The only downside I can see is that men may be having more haircuts than normal as they get used to visiting a barbers for a chat and a snip.




FROM THE SUNDAY EXPRESS – September 9, 2016


Barbers are being encouraged to act as trained listeners to help clients deal with depression and mental health issues.

The move comes as a study reveals that 53% of men are more comfortable talking to their barbers than their doctors about private issues.

They establish trust by visiting the same snipper over the years while they are forced to see different doctors when visiting their GP surgery, it added.

“Listening and talking is something we do naturally as barbers and hairdressers,” says Tom Chapman, an award-winning barber. “We don’t want to turn barbers into counsellers but we want to provide that safe place where guys can open up and talk.

“The family doctor relationship is slowly dying which means men are likely hiding from issues that they should be comfortably discussing with their doctors, such as depression, anxiety, and even PTSD.

“But they do build up huge levels of trust with a barber. It’s not often you get chance to sit down and chat one to one in this busy world so it is an ideal opportunity to talk.”

Tom, who runs a barbers in Torquay, Devon, got training in counselling techniques after a 27-year-old friend took his own life.

“It affected me and thought if only he could have talked to me or any of the 100s of people at his funeral maybe it would have helped,” adds Tom, who formed the Lions Barber Collective charity to provide mental health awareness courses for barbers.

“We see clients more regularly than they see their GPs and, with a bit of training, we will be able to teach guys to recognise the signs and direct them to where they can get more help. It’s not about questioning clients; it’s about making them feel free to talk as often just talking about something can make a difference.

“More people have been opening up to me since I started the campaign and some long-standing clients have revealed that just chatting to me during difficult times had helped them.”

Tom has joined forces with grooming brand Bluebeards Revenge (http://www.bluebeards-revenge.co.uk) which commissioned the survey to coincide with yesterday’s World Suicide Prevention Day, to raise awareness of men’s mental health.

It’s managing director David Hildrew, a former Royal Marine Commando, says: ““It’s very encouraging to see that barbers all over Britain are presenting a suitable pillar for men to lean on. As an ex-serviceman, I take male depression very seriously. It’s an illness that many military men suffer with in silence. The Lions Barber Collective charity is the perfect way to break down the barriers that men tend to build themselves and together we hope to help educate barbers around the world and encourage men to man up and talk about their problems.”





The sleek greyhound of progress….in boots

The wonderful world of health technology marches to a peculiar rhythm with a challenging signature tune of massive highs and lows.
Every leap forward seems to be followed by a quicksand moment when progress is sucked down into a gloopy trap that submerges hope.
I’ve lost count of the thoroughbred technology breakthroughs that have been welcomed by the dead-hand of bureaucracy, budget constraint and any procedural leg-iron available; it’s bit like admiring the potential of a sleek greyhound and then asking it to compete in wellington boots.
But there was some recent welcome evidence that the stars can align as a pioneering cancer-bashing ultrasound treatment was revealed at the same as a White Paper lauding the benefits of clinical homecare.
Preventing people being admitted into hospital and making sure their stay is shorter, if the do. Perfect.
The Royal Marsden Hospital is the site of an exciting joint venture between the hospital, the Institute of Cancer Research and Philips who have harnessed the power of ultrasound to treat the corrosive bone pain caused by secondary cancers.
Using MRI scanners to pinpoint the focal point of the pain, the High-Intensity Focused Ultrasound (HIFU) waves – 10,000 times stronger than a pregnancy scan – arrow in and effectively burn away the nerve cells. It works on a similar scientific principle of a magnifying glass narrowing the sun’s rays onto a piece of paper or a leaf which catches fire.
Thankfully, no patients self-combusted during the trials which had incredible results in alleviating pain with the ultrasound passing through skin and tissue without causing any damage. The added bonus is that the precision-guided beam can destroy the tumour as well. Further trials are needed to prove its efficacy but scientists and clinicians believe ultrasound is destined to become a potent weapon in treating primary cancers.
Nine patients have already been treated successfully at the hospital, in Sutton, Surrey, and one woman who could barely walk or sit because of excruciating pain has been able to go on 30-minutes walks and sit on a beach with her family.
This time there are no shackles – trials will be accelerated and more people will be treated.
It gets better as the same week a White Paper underscored the benefits of clinical homecare, a strand omitted from the government’s Five Year Forward health plans.
Homecare must be a vital component in future health as we don’t have the capacity to treat everyone, can’t afford to and, what’s more, there’s an ageing and growing population being factored into the unbalanced equation of NHS care.
Keeping people out of hospital, faster recovery times, fewer readmissions, less bed-blocking and waiting times need to be achieved by more intelligent, connected systems not by the fevered red ink of a faceless accountant torturing the figures.
The paper, funded by Healthcare at Home – (https://www.hah.co.uk) the UK’s largest provider of clinical homecare – was drawn up by a distinguished panel of private health companies, NHS Trusts, academics, charities and industry bodies. The company’s virtual ward model saved 136,000 hospital bed nights across 21 NHS Trusts in 2014.
The evidence from well constructed and delivered schemes is compelling but it is also indicative of the climate that Healthcare at Home felt the need to commission the research. It’s not quite a warning note tied to a brick through the Department of Health’s window but it is more than a polite nudge to government and industry that protocols and thinking are not changing quickly enough.

Don’t slow the greyhound of progress down

cute but not that fast

Stem Cell’s World Cup

UnknownRugby is not an obvious futurepills topic but as the World Cup is upon us it is pushing my health and nostalgia buttons.
Sporting endeavour is daily source of fund-raising and there’s all sorts going on around the 2015 tournament.
But the UK Stem Cell Foundation (www.ukscf.org) is benefitting from a gentle form of the high impact game – table rugby. No flying boots involved in this indoor game which involves coins and a flat table. A ‘world cup’ of table rugby is being organised by http://www.tablerugby.co.uk/ to raise funds for stem cell research, which is worth supporting (http://bit.ly/1UFat2H)
Stem Cell research is crucial part of the future of health and medicine and funds from this charity push will go to two projects including work by Professor Brendon Noble, of the University of St Mark and St John (www.marjon.ac.uk) to derive bone and cartilage-forming cells from human embryonic stem cells and autologuous adult stem cells. The research could lead to new treatments for millions of people worldwide who are affected by conditions such as arthritis as well as having huge implications for cartilage sports injuries.
It’s just one part of a ‘bionic’ feature which is exciting when applied to corrosive conditions that cause misery and cost fortunes to treat.
That’s the health bit; the nostalgia? As a kid we played a game called matchbox rugby which provided hours (well, minutes) of fun back in the dark ages. It’s obviously V1 of table rugby but it had an extra dynamic. In the current Stem Cell Research-boosting new version a player shoves a coin across the table and if it rests over the edge, it’s a try which is followed by a flick over the opponents finger for the conversion.
Back in matchbox rugby days the try rules were the same but the conversion bit was the big fun. The opponent had to make rugby posts by pointing index fingers down on the table and position the thumbs together – the conversion came by angling the matchbox over one hand and finger flicking with the other; the force generated could be impressive and the intention, as well as scoring extra points by clearing the thumb crossbar, was to welly it into the opponents face…very popular pastime pre computer games. Not quite Grand Theft Auto in terms of thrills but it was cheap and cheerful.
I’m sure table rugby complies with health and safety but most important aspect is that its helping raise funds for a very important part of our future.
If you get a chance to have a tournament at work or among friends, you could find a new ‘sport’ that doesn’t involve bone-jarring jeopardy. Get playing!

The blind fate of hiding a condition


The sad passing of Cilla Black was mourned by the nation but one unsung element of her inspiring life was her battle with rheumatoid arthritis. It emerged that, according to close friend Sam Leach, the singer struggled with the RA but preferred to let the show go on rather than make a fuss.

Like many of her generation, she just wanted to get on with life, and work, without a deluge of sympathy but rheumatoid arthritis remains a condition of the margins. Not many chronic conditions make easy dinner party topics but RA seems to have built up a peculiar resistance to public understanding and sympathy.

No-one can blame Cilla for not making a song and dance of her condition but it brings into sharp focus how little we appreciate the damage it can do…to all ages. A misconception is that it is a disease restricted to later life -which may be the prime root of its life in the health margins – yet it strikes at the very young and is a curse of tens of thousands in their early 20s.

It affects 690,000 people in the UK (that’s around one in 100 of us) and the curious thing is that people just don’t talk about it that openly. I’m often amazed that when I raise the subject of RA, someone will know someone with it, often people approach with a quiet word in private about how their wife, girlfriend or brother has the condition. Easy admission here: I didn’t speak about it either until someone very close was diagnosed; harder explanation here: I probably thought it was an older, end of life inevitability, something to do with a physical wearing out of the bones (osteoarthritis) rather than a complex auto immune disease.

The science of the body’s auto immune pathways is fascinating and within them we are finding ways of treating a host of conditions. But RA remains steadfastly in the shadows. It is a modern puzzle.

Ailsa Bosworth, chief executive and founder of the National Rheumatoid Arthritis Society (www.nras.org.uk) reveals that the actress Kathleen Turner, an Academy Award nominee in the 1980s, hid her RA until a few years ago, enduring jibes that she had a drink problem because her face became puffy from the steroids she was on and the condition made her unsteady at times.

“I am only too aware that this propensity to ‘hide’ rheumatoid arthritis as if it is somehow shameful or unacceptable to have such a disease, is common, and not just amongst celebrities,” says Ailsa.

“It’s painful and life changing and there is no cure, although if diagnosed early and treated appropriately, there is a lot more that can be done today to keep people living a relatively normal life than for people like me and Cilla who were diagnosed a long time ago when treatment was different and we didn’t have access to the range of drugs we have today.
“People in the public eye don’t seem to have a problem admitting that they have cancer, heart disease, diabetes, asthma, dementia and other conditions, all of which have a high profile in the media. Yet with RA,  people prefer to hide their disease from friends, family, employers.

“I would like to make a plea to everyone living with RA. Please don’t hide it. We need the public to understand what RA is and what it means to live with it. In the workplace you are likely to get more sympathy if you sprain your ankle than if you live with RA.”

The drugs do work these days but early diagnosis is essential to getting RA under control before it causes too much joint damage. (RA is when the body’s immune system becomes over active and attacks the lining of the joints causing inflammation) People with the condition can life fulfilling lives but, if it stays hidden, their joints, particularly within the hands and feet, can be irreversibly damaged.

Ailsa adds: “I salute you Cilla and perhaps your battle with RA and yet your huge lifetime achievements will inspire others living with RA to start talking about this disease in the same way as we talk about cancer and dementia.”

It is a common condition. It is now time for RA to come centre stage into the spotlight.


Beauty is skin deep

Commercial beauty is rarely the full picture. We are constantly exposed to images, mainly through advertising and fashion, that set the parameters of perfection.
We probably know they are false, unattainable, yet the daily drip of re-touched, paradise backdropped ‘beauty’ inevitably confusess our senses of rational determination.
But that corruption is being re-calibrated by a fascinating and challenging project that puts people with skin conditions in front of the camera. And it is not just any camera, it is one wielded by celebrated photographer Rick Guidotti, who has worked with towering beauties such as Cindy Crawford and the top fashion houses in Milan, Paris, New York and London.
I met him last week on the campus of pharmaceutical giants Novartis, in Basel, and traditional glamour was the last thing on his mind.
“I was always told who was the model of the day. I was told who was beautiful and I bought it,” he said. “But it was ultimately frustrating. I am an artist and I don’t want to be told what is beautiful.”
A change meeting with a teenager with albinism on the streets of New York changed his focal length outlook on life and work and he started championing diversity through his photographs.
Out went the supermodels, catwalk drones and prescriptive booking agencies and Positive Exposure was born. http://positiveexposure.org/
It is his mission to re-define beauty, strip away the camouflaging gloss and shows us a stigma-challenging reality.
Who photographs people with chronic skin conditions such as psoriasis and chronic spontaneous urticaria? Rick does. And he is passionate.
He is working on a project, supported by Novartis’s Skin to live in campaign http://www.skintolivein.com, that shows these real models for the real people they are. No studio, just natural light and people freed to live in their skin.images
17 people from 11 countries stepped out of the shadows to be photographed by Rick for the campaign. One of them happens to be a ballet dancer from New York, who was struck by psoriasis when she was three-years-old; another is a mum from Brazil. His gallery shows the person beyond the condition and it is refreshing.
He photographed them as beauties; in the past they shunned the camera and were only used as examples in medical textbooks. His work covers all forms of genetic diversity and, with his expert touch, the character not the condition shines through.
Rick’s passion is like a waterfall, check him out on an inspiring TEDX talk https://www.youtube.com/watch?v=yIKM7_rgUXU
We have an easy facility to look away when we see something different and as we are continually bombarded by images of what is and isn’t acceptable the field of ‘normal’ vision narrows….we become less accepting. We also have less time to stop and consider.
I’ve interviewed many people with skin conditions and, although the physical pain and discomfort sound corrossive, the damage to their confidence and self-esteem is evident. They talk about being prisoners in their own skin….stop just a minute to consider that.

Having to itch, scratch and squirm is one (enormous) thing but to have your personality and opportunities compromised is another (equally enormous) thing.
Medical advances have provided relief for sufferers and the work decoding the IL-17A pathway that is a route to debilitating skin conditions is truly game-changing for millions worldwide. But it will take us a bit longer to look and see through eratz beauty.
Rick sums it up perfectly…
Change how you see
See how you change