Health screening has been around for several decades as a way of investigating everything from a woman’s fertility to her blood cholesterol levels, and along the way it has gathered critics as well as advocates.  Critics of private screening point out the potential for ‘false positive’ test results – that is, being told there is something wrong when in fact there is not – which can place extra pressure on an already-strained NHS, and can cause unnecessary worry in patients. Others argue that some patients given the ‘all-clear’ can become complacent about their lifestyle, rather than making healthy, positive changes. On this latter point, is this really an issue? Health checks are overwhelmingly an opportunity for the individual to take more control of his or her health.

Most people opting for health screening will learn something which they were previously unaware of, or were simply ignoring, such as their weight, blood pressure or cholesterol levels.

Clearly the NHS has a role in keeping us well, as well as treating us when we are unwell. Indeed, Public Health England announced last week that one of its priorities is to “support people to live healthier lives” and is rolling out NHS Health Checks to reach 15 million eligible people in England over the next three years. So really, the ‘public versus private’ issue is academic. The fact remains that screening can and does educate us about our health, and open up choices. Moreover, it can and does save lives.

We read about a particularly compelling case for screening in Andrea Kon’s article in this week’s Good Health (The Daily Mail) and in turn, we were compelled to write.  The article focuses on a patient case study involving a 60 year old man from Cambridge who underwent a full MOT health check four years ago, after which, over a period of three years, subsequent private screening revealed his PSA count (a potential indicator of prostate cancer) steadily rising. He was therefore referred to a consultant urologist, after which he became one of the first Britons to undergo a new, more accurate type of prostate biopsy.

The new technique involves the use of two diagnostic tools, instead of just one: Ultrasound images are superimposed on to MRI images, giving a 3-Dimensional view. The surgeon is therefore better able to target tissues where the cancer could be, and uses needles guided through the perineum rather than the usual route which involves piercing the bowel. (For the patient, this latter factor means less pain and lower infection risk, post procedure.)  The patient in question turned out to have an aggressive form of prostate cancer, so the organ was removed, and he is now free from the disease.  In his words, “I dread to think of where I’d be if it hadn’t been for that new approach.  I believe it saved my life.”

Besides being impressed by the technology aspect of this story, we could not help but wonder what would have happened to this man, had he not opted for the initial health screening. Despite the fact PSA tests provide an indication rather than a diagnosis of prostate cancer, further analysis via this new biopsy technique probably saved this man’s life: A case of simply removing more than just ‘doubt’.

On 24th April, a long-awaited Review of England’s cosmetic surgery industry was published, receiving widespread media coverage, coming as it did not long after the PIP breast implant scandal. Indeed, the Review was set up partly in response to PIP, after many years of allowing the industry to regulate itself, resulting either directly or indirectly in alarming stories of cowboy operators, and permanently damaged patients.

Media reports about the Review raised more than just an eyebrow, with lurid stories and case studies ranging from ‘worst-case scenarios made flesh’, to patients who were in reality simply ‘consumers’ with very little power of redress, left to cope with permanent damage – and to much more than just their wallet. Many of these case studies had been treated by the hands of unethical, untrained, and at the very least, uncaring, practitioners. The common thread which ran through the stories of such casualties was the fact they had mistakenly assumed a certain level of training or certification in the person treating them. This was particularly the case where dermal fillers were concerned.

Sir Bruce Keogh, medical director for the NHS in England – a heart surgeon by trade – led the Review, and described as “bizarre” the fact that, “Anybody, anywhere, anytime, can give a filler to anybody else.” He also highlighted the fact that dermal fillers, which are injected deep into the skin, and – unlike Botox – do not usually disperse after a matter of weeks, but instead last for years, are covered by the same level of regulation as mere toothbrushes. This is despite the fact they could in theory cause lasting harm, especially if administered incorrectly.

Currently, at the European level, medical devices such as breast implants, and medicines such as Botox, are regulated. However, fillers are currently viewed as having ‘no medical purpose’. As such, there as many as 190 fillers on the market available for use in European citizens, versus just 14 which are approved and regulated for use in patients in the USA.

It would seem that this will change, as will the methods some operators use to market procedures: Sir Bruce slated BOGOF (buy-one-get-one-free) deals on surgery, and described the handing out of free breast surgery as a raffle prize as a “particularly distasteful” way of incentivising people to go under the knife. These examples may be the exception, rather than the rule, and fortunately, the Treatments You Can Trust Register exists to direct the public to reputable practitioners, http://www.treatmentsyoucantrust.org.uk/ However, at present, there are no accredited training courses available to those wishing to practice in this area of health, and for consumers, this makes it harder to ask the right questions. From where ROAD Communications stands, being able to ask the right questions is absolutely crucial.

There’s a line about plastic surgery that lingers in the minds of anyone who has watched Brazil – the 1985 movie directed by Terry Gilliam (of Monty Python fame). The line is delivered nonchalantly with the wave of the wrist by a certain Mrs Terrain, who enters the scene in her wheelchair, a handbag-sized pooch on her lap, her face and eyes covered in bandages: “My complication had a little complication.”

Fast forward nearly 30 years, and although a few cowboy surgeons will undoubtedly have slipped through the lassoo (and probably always will), the USA – far from embodying ‘The Wild West’ – is well-ahead of Britain in terms of regulating its cosmetic industry. Doing the same here is all the more important because this industry is booming. Worth just £750m in 2005, in 2010 it reached £2.3bn, and is forecast to be worth £3.6bn by 2015.  So, why risk cutting off it’s nose despite it’s face?

Lipstick sales were said always to rise during recessions because women were investing in small, yet, highly-visible luxuries. It would seem that today’s lipstick is a shot of collagen in the top lip, for many. Earlier this year, we spoke to an industry leader on the subject of the forthcoming Review, and were fascinated to hear his take on why women (and increasingly, men) are opting for cosmetic procedures such a Botox and laser rejuvenation: “To men, power is about having money, but for women, these procedures make them feel good about themselves, and for them, that’s power.”

Taking the knife to BOGOFs: Sir Bruce’s Review recommends:-
• Legislation to classify fillers as ‘prescription only’
• Formal qualifications for anyone who injects fillers or Botox
• A Register of everyone who performs surgical or non-surgical cosmetic interventions
• A ban on special offers (financial) for surgery
• A formal certificate of competence for cosmetic surgeons
• A breast implant register to monitor patients
• Procedures on patients to be approved by a surgeon not a salesperson
• Compulsory insurance in case things go wrong
• A fund to help patients when companies go bust – similar to that of the travel industry

It’s been a very exciting few months, scientifically speaking, on the HIV front. First, we had news from the USA of a baby being ‘cured’ by early drug treatment, and then a French study showed that rapid treatment after infection with the virus could ‘functionally cure’ around 1 in 10 patients.  With both stories, the key is early diagnosis.

On the policy front, however, news concerning sexually-transmitted diseases and unwanted pregnancies has been underwhelming. The Department of Health finally published its long-awaited Sexual Health Framework – the first initiative aimed at addressing sexual health since its Sexual Health Strategy which ran from 2002 to 2010. The problem is, this is a Framework, not a Strategy, and in short, it lacks teeth – a message ROAD helped to highlight to the media and stakeholders on behalf of the British HIV Association (BHIVA). In the worlds of the association’s Chair, Professor Jane Anderson, “Combating HIV involves almost every discipline and area of government policy, from science through to education, economics and social science. This means a strategy that gets all stakeholders around the table working to a coordinated plan.”  It was a story picked up on in British Medical Journal and elsewhere, and it’s a story which will continue to run.  We just hope that the list of ‘ambitions’ in the government’s Framework translate into joined up action to help boost early diagnosis of HIV.  Only then will it be possible to make exciting scientific breakthroughs an on-the-ground reality.

The Children and Families Bill was announced this week, bringing forward the Government’s plans to improve services for vulnerable children, and support strong families – part of its wider aim to ensure young people succeed, regardless of their background. The Bill addresses adoption, looked after children, family justice and special educational needs. Many in the media focused on the preposterous idea of enabling one childminder to care for 5 toddlers, but we at ROAD were keen to know what the Bill would mean for children with special educational and behavioural needs (SEBN).  A few fairly devastating facts to consider first:-

• Over 60% of children come into care because of abuse and neglect
• Almost a third of children in children’s homes have experienced five or more placement breakdowns before moving into the home
• Only 15% of children in care get good GCSEs compared to 60% of their peers
• Looked-after children are three times more likely to suffer mental health conditions than their peers

The MP, Ed Timpson, summarised the Bill from his own perspective, coming from a family which fostered many children when he was growing up: “I remember coming home from school one day to find two boys I’d never seen before playing with my toys.  Now, I’m sorry to say that my first reaction was to run upstairs, shut myself in my room and refuse to come out until they’d left…. Many of the children who came into our home had been damaged by chaotic, difficult backgrounds…. But over time, as they gradually settled, I came to treasure seeing how love, stability and routine could help even the most troubled youngsters thrive and develop.”

He later spoke of the need for stability – the laying down of roots being the best thing about being in care, and moving the worst.  He also spoke of the need for support from local authorities during the period these children leave school and become independent, and spared no criticism for inexcusable delays and drift in the care system which leaves children in limbo – something he witnessed as a barrister.

Interestingly, the Bill ushers in new legislation to promote ‘fostering for adoption’ placements, meaning adults can foster the child they hope to adopt, allowing a bond to develop earlier.  (Appallingly, at present, children wait an average of two years to be adopted – three years in some cases.)

We will have to wait to see how successful new measures will be in bringing the improvements so urgently needed, yet, as Timpson points out, “The one thing children don’t have is time”.  Let’s hope things move in the right direction – fast.

From April 2013, the NHS will no longer be responsible for public health in England: Instead, public health control will pass to local authorities, who haven’t managed this important function since the mid 1970s – a period many readers will fail to remember in great detail.  Part of the local authority remit will be to commission NHS health checks for 20 per cent of the eligible population, as part of wider efforts to reduce health inequalities. 

Public health has always been known as a ‘Cinderella service’ in the NHS – the first to be pushed back if cuts were required or budgets exceeded.  However, public health has an increasingly important role in reducing health inequalities throughout England.  For starters, more needs to be done to boost the average lifespan of a man living in County Durham (77 years) to nearer the 82 years of his counterpart living in The Royal Borough of Kensington and Chelsea. 

The obesity and diabetes epidemics we are now witnessing are a clear case in point.  Currently, ten per cent of the entire NHS budget goes to treat diabetes, many cases of which, had they been prevented, would have meant major cost savings.  Diabetes UK suggests that if the NHS Health Checks programme had been implemented effectively in 2011-2012, 9,500 people could have been diagnosed with Type 2, and started managing their condition to prevent further complications.  When properly implemented, public health policies and actions create tangible health benefits and provide cost savings in the long term.  

NHS health  checks have been available to everyone between the ages of 40 and 74 since 2009, to assess their risk of stroke, kidney disease, diabetes, and cardiovascular disease (CVD). Patients identified as high risk receive medical treatment or are referred to smoking cessation programmes, weight loss groups, and the like.  Obviously, after that, it is up to the patient to take up these options. However, Heart UK estimates that only half of England’s PCTs are offering the checks in GP surgeries, and delivery rates in pharmacy have been disappointingly low. That said, there has been a big push in certain pockets of England, such as the North East, with health checks are offered in non-medical, locally targeted settings such as sports grounds, supermarkets, shopping centres, industrial estates, and so on. 

With socio-economically deprived or ‘hard to reach’ groups (such a travellers) in particular, health checks – but also subsequent help – must be clearly signposted, and made accessible.  Types of help can include ‘Better Health At Work’ schemes, courses for physical activity, smoking cessation and healthy cooking courses.  Behaviour change is key, and there is a strong argument for starting health checks at an earlier age.  Health Diagnostics, a client of ROAD, has helped NHS County Durham provide ‘Mini Health MOTs’ for 16 to 40 year olds, the aim being to ‘catch’ this age group whilst they are still teachable, rather than waiting until they’re older when habits and lifestyles are harder to change.

With  financial cutbacks of around 25 per cent faced by many local authorities in England, sceptics would argue there is limited room for improvement on public health.  However, innovation, thinking outside the box, and local knowledge will all be deciding factors in public health’s success or failure within local authority control.  Fortunately, the digital revolution will mean local knowledge can be woven into health strategy, so campaigns can be tailored and targeted at the local, or even the personal level, through web and social media content, increasing the chance of success. 

The question remains, Will Cinderella ever get to go to the ball?  Predicting the answer, as ever, is a complex task, but if local authorities pick up the wand and run with it, the carriage might just get there on time.

The fantasy of romantic British summer being – long, hot, hazy days in the sun, crowded beaches, parched gardens, cricket on the village green, is just that – a fantasy, when in reality we spend our summer days ducking and diving to escape the unpredictable downpours. It is therefore no wonder then that 7 million Brits each year go in search of something hotter and exotic over seas. But with all the great things a holiday brings, there is one unwelcomed nasty which can leave you with a swollen and itchy bite or far worse, can infect people with the potentially fatal dengue fever… the dreaded Mosquito!!

Having just got back from a two week holiday in Spain and Portugal where I was eaten alive I was particularly excited to read this week in The Telegraph that Brazilian scientists have found a way to reduce the spread of dengue fever and reduce the blood sucking population! Luckily I have only suffered with annoying and itchy bites, but occasionally a bite can lead to something more nasty..

Dengue fever affects between 50 and 100 million people in the tropics and subtropics each year causing fever, muscle and joint ache as well as potentially fatal dengue hemorrhagic fever and dengue shock syndrome. Therefore a team of Brazilian scientists have come up with a way to reduce the dengue spreading population by breeding and releasing 4 million male GM mosquitoes per week into mosquito infested areas. These GM males will then breed with females and because the male has been genetically modified any offspring will die before adulthood, reducing the mosquito population and therefore the likelihood or those carrying the dengue virus.

The Brazilian initiative will take place later this week and follows the success of previous test runs where it was tried in two mosquito-infested villages in Bahia, with an overall mosquito population reduction of 90% over a six month period.

It is still early days but we hope that the initiative will be successful and be introduced to other infested areas. Until then… we will be sending one Roadie who is off on holiday tomorrow with a mossie spray, to keep those nasties at bay!

For the full article click here: http://www.telegraph.co.uk/news/worldnews/southamerica/brazil/9388102/Scientists-to-breed-GM-mosquitoes-to-stop-spread-of-dengue-fever.html

It may feel bleak out there this midwinter, but there is nothing like a business win to help boost ‘that’ Christmas Feeling.  ROAD are proud and excited to be working with one of the world’s leading producers of medical diagnostic systems: Esaote.

The firm’s MD for Europe & Benelux at this leading manufacturer of ultrasound devices, Cor van der Flier, explains: “We were impressed with ROAD’s approach to communicating with the stakeholder groups in the NHS, and its understanding of how this might evolve with the emergence of new commissioning groups and the changing health landscape in the UK.”

Louise Stone, a new Director at ROAD, will be heading up the account.  Both she and the rest of the team will be doing what ROAD does best – in this case – boosting Esaote’s profile amongst relevant stakeholders during what promises to be a rapidly changing year for primary care.



Just over a year ago, the 7 year itch struck… My long-term, big-chain gym membership was put on ice in a ‘stress cutting mission’ – or so I dubbed it. It felt good cutting out the guilt earned by paying effectively £30 per visit.  Yet I have been left with a feeling that my long-term health is slipping out of my grip.

And I’m not alone. Last week’s article by Maeve Hosea in Marketing Week revealed that compared to a year ago, 12% fewer UK consumers feel in control of their health, as recorded by The Futures Company.  That’s 5% below the global average. So, are we Brits ‘control freaks’ or are we ‘eating more convenience foods on the run, working longer hours and finding less time to exercise’ as the research suggests? The real issue is highlighted by Radha Patel at The Futures Company: “There is health information out there, but people don’t necessarily know what to do with it.”

PUTTING CONSUMERS IN CONTROL

Patel suggests, “personalised health” will become a big trend in future.  ROAD would counter that, in fact, it’s already here.  We recently helped launch what many would consider the ‘ultimate’ in control – the first over-the-counter paternity testing kit available via Boots.  (Incidentally, the article mentioned above points out that in the USA, DNA is being analysed to create diet regimes based on the individual’s genetic profile.)  Likewise, The Core Wellness Programme was created for the global TENA brand, with messages tailored to the individual subscriber – as with Pfizer’s GoFactor campaign for heamophiliacs. ROAD is currently working with Philips, a true leader in the  healthcare-meets-wellbeing arena, supporting Patel’s view that, “technology that makes personal health become more accessible will continue to lead to change in the future.”

Healthcare brands which can communicate the benefits of their product or service to consumers in as tailored and useful a way as possible – rather than simply giving product or service information – will come out on top. Of course, there are many nuances involved in doing this: Persuading consumers to change their behaviour and so improve their health requires sophisticated research and analysis, plus painstaking message creation.  The joy is that consumers can be persuaded, and the time is now.

So, it’s back to the gym for me…  Something else is going to have to give!

Any busy communications agency deserves to be let loose once in a while –  something ROAD’s MD, Paul Jarman knows well.  So, true to agency tradition, off trooped ROAD to the highly salubrious Chiswick House Festival to hear six scorching hot bands, including Tinie Tempah (presumably playing W4 for the very first time), Noah And The Whale (all the way from Twickenham), the uber-exuberant Plan B, Stereophonics, Eliza Doolittle and Katie B.  Masters of ceremony such as Michael MacIntyre cued the talent, and the evening went from sophisticated garden party to mosh pit mayhem in the space of a single shot of Grey Goose. There were enough lobsters, crabs and prawns to throw a rod at, and house cocktails and celebrities in unlimited supply.  Even the over 40s were dancing.  The rest, as they say, is history. Here are a few happy memories. Till the next one…

Patients with chronic, long-term illnesses require life-long support, management and medication from healthcare providers if they are to live their life to the full. Yet, it’s easy to under-estimate the immense degree of continual self-discipline and ‘faith’ in their treatment required by the patient.

This is bourn out through the statistics, which are strikingly intransigent, and this pattern is similar throughout the developed world, with 20-50% of patients not taking their medicine as prescribed.  These individuals are said to be ‘non-adherent’, and it goes without saying that non-adherence has fairly huge implications all round.

Crucially, evidence shows that the first three months of a patient’s compliancy to medication are critical, as this is the period when behaviour patterns are established.  After the first six months, adherence tends to drop sharply.  So, is pharma doing enough to improve the situation?  For sure, there are both financial and a CSR imperatives at stake.

Certainly, the diversity and sophistication of digital and data tools now available to business means there is simply no excuse for pharma not to be in direct contact with patients.  The advantages? Better educated, supported, engaged and motivated audiences, whose new attitudes and behaviours result in improved personal and commercial outcomes

There are three main options for non-adherence in terms of intervention:-

-         Behavioural approaches

-         Education / providing information

-         Involvement from healthcare professionals

Leading a horse to water is just the first step

The key with all of the above is insuring PSPs reach their audience in a meaningful way. Understanding why a patient stops taking their medication is crucial, but so too is creating a meaning for them to take it.  There is no point leading a horse to water if you don’t let him know that the water is safe, suggest the best way of approaching the water’s edge, how long to drink for, and explain why drinking water is good for him, plus tell his owner know he’ll need reminding again tomorrow. And so on.

What makes for a meaningful PSP?

Understanding what the patient needs is the foundation for any inspirational patient support programme, and requires deep ethnographic research into the targetted patients.  Thinking from an ‘end-user’ perspective will help shape the way PSP will impact upon both patient and healthcare provider.  Successful PSPs also motivate healthcare professionals:  If they understand and believe in what you advocate, they will do all they can to help you reach the patient.

How to ensure your patient support programme is successful

There are four main factors:

1.  Clearly define the change you want to make

2. Define the level of HCP support that can reasonably be expected

3. Engagement: Drive visitors to the initiative site, monitor whether e-communications are read, seek completion of relevant surveys

4. Measure changes in compliance and patient well-being

5. Measure satisfaction via positive perception of the programme and recommendation to others

A note of caution: PSPs can act as a ‘lifeline’ for patients when they most need it, but there’s a fine line between ‘offering’ support and ‘instructing’ patients on how best to live their lives.  Tone, content and information are all vital to reaching the audience in a meaningful way.  Listening to, reacting to and engaging with your patients are actions which need to be fully integrated if a PSP is to be successful in the long term.  It’s important to keep asking, “Is this a two-way conversation, or a ‘push’ only?”

Non-adherence is something which is part ‘human nature’ and part ‘lack of support’. It is an issue which needs addressing urgently: Helping to insure good outcomes and quality of life in patients is something pharmas need to feel proud of.