To raise life expectancy, ignore the television and newspapers

With increasing good health, the average human being in the developed world can expect to live a longer life, well into the eighties. This is in contrast to a century ago, where reaching the age of sixty was regarded to be a milestone. And what about the 1800s? Being 50 was an achievement, so much so that people married young and being in their twenties was considered middle aged! Life has certainly changed a lot to enable the average life expectancy to increase.

How has the average life expectancy almost doubled over the last two centuries? This can be said to be due to a few significant reasons.

The first is of course improvements in the medical world. The world of medicine has advanced significantly into the modern area, that it is undeniable that this has been the greatest single factor in the lengthening of human life expectancy. Take a look at the average supermarket medical shelf. On it you will see a mind-boggling range of medical products for a variety of symptoms, a range so wide that you may even start to examine how product A differs from product B. Two products to treat one symptom! Bear in mind that a hundred years ago, this might not have even existed! Feeling under the weather? Got a fever? Take a paracetamol or ibuprofen and sleep it off. Centuries ago the only method might have been to get plenty of rest, dabbing your forehead with a wet flannel. Or to visit the apothecary to get a mixture of powders to mix and grind according to some secret formula. And if you are adverse to medication, that makes you hesitant about taking counter medication, there are herbal remedies to explore.

Certainly the range of available medication has contributed in some way to humans living longer lives. But the range of products that you can see are not just the ones available to humans of course; these are the only ones that be purchased without prescription. For medication to treat more serious ailments such as blood pressure for example, these can be obtained via a doctor’s prescription and a subsequent visit to the pharmacist.

The medical process differs getting country to country. In the United Kingdom, you make an appointment to visit a general practitioner but depending on your practice, this could be a week later. Why make an  appointment if you need help later? It is almost as is you are having to anticipate your illness. More likely though, is the explanation that for minor ailments, you are almost expected to self medicate.

In other countries like Singapore for instance, the availability of appointments in what is termed polyclinics means if people are unwell, they merely turn up on the day to be seen. They can also turn up at any polyclinic rather than the one they normally go to, if they happen to be in another area, because medical records are readily shared – as they have been for over three decades. Ill patients are not expected to self medicate; they also go to a doctor despite illness because as doctor’s note is the only accepted evidence for absence from work.

Pharmacists do not exist in Singapore in the same context as in the United Kingdom. In the UK, patients visit the pharmacist after the doctor, and have to make trips to two separate places. In Singapore, the pharmacist is housed in the polyclinic; a separate unit called the Dispensary handles the prescription so after you see the doctor it is ready for collection within the same building.

Better medication is a reason for longer life expectancy. But improvements in medical surgery and practice have played a role in this too. We know about how to treat patients better because medical practices are shared and what used to be exclusive medical information is now widely available to all. In the previous century, for example, the practice of blood letting, removing blood from a patient, was acceptable despite its unproven results. Patients did not necessary survive when this practice was resorted to. When patients survived, surgeons would proclaim “It worked!” But when blood letting failed, surgeons would say that the patient was so weak to begin with that the process could not even save him. Advances in medical surgery have shown that blood letting, presumed to be a cure, actually weakened a patient at his most vulnerable state. But it is only improvements in medical surgery that have meant that this dangerous practice is no longer used or necessary in many cases.

Advancements in the medical world have been backed by improvements in the world of technology. In the past, when information was written down and filed in large binders and filing cabinets, the sharing was done either by executives travelling from hospital to hospital, in a top-level only way of information dissemination. But now information can be stored electronically, and shared seamlessly and knowledge is no longer the preserve of the privileged few. The advances in medical technology have been accelerated by the ability to share this information, resulting in a knowledge boost within the medical community which benefits those within its umbrella.

The availability of knowledge to the average citizen has also played a part in extending human life expectancy. Knowledge about how our bodies work, and the help and care available have helped individuals take better care of themselves. Continual research about diet, exercise and lifestyle influence how individuals live their life, hopefully positively.

The government hope is that the filtering of health information down to the citizens will incentivise them to manage their own health better. This is one of the aims as it moves towards a sustainable healthcare model. How can a sustainable healthcare help? It would focus diminishing resources on those who need it most, so those who cannot afford healthcare or those whose treatments are more costly, and who would normally not be able to qualify for treatments based on quality adjusted life years, would be in a better position. Theoretically, this would slowly raise life expectancy even further by targeting the more life threatening illnesses.

In a previous post I have mentioned that sustainable health is not as clear cut as it seems, but nothing ever is. But if managed right, it could be another contributing factor towards the extension of average life expectancy.

The average citizen has access to more medical information than ever before. There is so much health advice alone on the internet that if it were all only published in books, you could line them to end to end to circle the planet many times over. There are also helplines available to call for advice. Some of these are government sponsored while others are manned by volunteers. There is of course, everyone’s general practitioner to go with. There are many avenues for health information. For those who are interested to medical issues, periodicals such as the British Medical Journal after available.

Then there is also the media.

I have discussed previously that the news on television and newspapers regularly report on health issues, but as I highlighted also in another earlier post, you should take in these pieces of information cautiously, because the research that is done is often linked to a report with a dramatic headline. The lower the quality of journalism, the more outlandish the headline, and the fancier the font too, it would appear. You should not see the health section of the newspaper as the font of your health information, because what might be a fairly tenuous link, or bordering on common knowledge becomes sensationalised into the something new.

Take for instance, cats. They wander about in all hours and sometimes don’t come back, or get lost. Some have collars, some don’t. What would you feel if your cat went missing? Stressed. Sooner or later some newspaper would report Cat Collars Can Minimise Stress Levels, because if  your cat had one, and went missing, you might feel slightly better knowing someone might find it and call you, than if it had no collar and had no means of being returned to you. When this headline would be resorted to, no one can say; but it would be on a day there is nothing to report and not much going on in the world.

You see, the news and newspapers don’t exist to give you information, they exist to pad out the ads and advertising space. In a fifteen minute time slot in television, twelve and a half is filled with listed programmes, while the remaining two and a half are made from advertising that is linked to the programme. We often think of ads as the things that break up the television programme, but a better perspective is to think of the programmes as binding agents for the advertisements – unfortunately, that is how poor television has become. You can similarly think of the news in the newspaper as bits which hold the advertisements together.

The advertising is where media makes its money. But if the newspapers were little more than an Argos catalogue, they wouldn’t survive. If the ads on television were strung together, no one would watch it.

You can look at it using this similar analogy. A library loans books out. But loaning books out does not allow it to make money. A library makes money by selling advertising space on its noticeboards, renting out DVDs for cash, charging for the hire of rooms and delay in book returns. It tries to attract a user base so that it can sell these numbers to event organisers hoping to hold events on its premises.

News on the television and print media work the same way. So you could probably save a few years of your life by ignoring the headlines you encounter, such as those that say “Pet owners live XX% longer live than non pet owners”. The supposed research is the common knowledge that pets  provide companionship and relieve stress, which lead to owners having less pressures and living longer. The percentage is to lull you into thinking research was done when it was not. It may have been the group of pet owners sampled were already older than the average life expectancy and that the animals had no bearing.

What if the pets were unwanted ones, inherited, or ones that had grown to big or become to cumbersome to look after?

“XX% of pets cause stress to their owners.”

The media periodically comes up with headlines such as “Having a pet may help you live longer” – with a catch. The pet must be a dog, and you must be the one that takes it for walks. It is a way of generating column inches on the basic premise that having to walk to walk a dog means you are having to be more active and likely to live longer. There was no mention of whether active individuals who already went out for a walk got a dog for company, or if a dog encouraged individuals to go out walking.

Another headline that surfaced this year was that Grandparents who babysat tended to live longer. This was again based on the tenuous link that having grandchildren around made individuals more likely to go out more often; for those that sat in chairs watching TV most of the time, any evidence to the contrary was explained away by the “tended” in the headline.

So it would not be unfair to state that there is not anything significantly meaningful you can learn from the media to improve your health. If you wanted to live longer, there are more specialised avenues you can seek information from. The thing with health articles is that they are not time-specific, they can be written or filed away, then brought out on a day where news is fallow, in contrast to current events, where – if not reported today – the opportunity is lost. So if you wanted to learn more about living longer, forget the media; simply keep active, keep an open mind, maintain a healthy diet … and what will be, will be.

 

 

The quest for fitness may be detrimental to your long term mental state

We are often told how we should aim to have, and maintain, a healthy lifestyle. After all, being physically fit allows your body to function both in physical and mental aspects. Healthy body, healthy mind, right?

The only difficulty, if you can call it that, with exercise is that the first thing that we would normally consider is running, but it is not for everyone. Going forward for a certain distance or time has little meaning for some people, especially children.

The thing about running is that it has to have some appreciable meaning, so unless you have some derivative inner joy of measuring your progress using statistics, it is unlikely to hold your interest for the long term. A better form of exercise is though group sports, as the mental boredom of tracking fitness levels is negated in favour of the social dynamic.

Common group sports such as football  have a large following in England. The football season for example lasts from August to May and provides a welcome distraction during the cold winter months. It is also a simple game that can be improvised using other materials and played on all surfaces. No goalposts? Use bags or some other markers. No football? Use a tennis ball. It is often interesting to see children turn up at a field, establish the boundaries of play using trees and creates goalposts using caps or other loose materials and these are often sufficient for the game; at least until there is discussion about whether the “ball” hit the post or went in the goal after it flies over a set of keys intended to represent the goalpost.

There is increasing concern about the link between dementia and football. The pounding of the ball against a soft surface of the brain, when the ball is headed, over time can cause the destruction of cells and cell function. This is of particular concern in the case of children, whose brains and bodies are developing. This has been of significant interest as members of England’s 1966 World Cup winning squad have found to have developed dementia in their later years. Some of them cannot even remember being there in 1966!

It is not just the impact of ball on head that is concerning, but when the head is moved through a range of motion too quickly. Even though there is no impact on the head externally, internally there is damage as the brain is hitting the sides of the skull supposed to protect it.

It is not just football that we have to be concerned about. There is plenty of head and neck related impact in rugby and American football. In fact, in American football, the head related injuries for offensive and defensive linemen, who every forty seconds start a play by ramming into the player on the opposite side of the line,  and the list of dementia sufferers is growing continually. Some players have even sued the NFL for injuries suffered during the game.

Will the rules of football change so that heading the ball is banned? Don’t bet on it. That would change the fabric of the game so much as to ruin it. When the ball is swung in from a corner, what would you do if you couldn’t head it? The game will not change, but also don’t rule out a consortium of players in the future filing lawsuits for work-related injuries. Perhaps in the pursuit of fitness, it may be wiser to choose less impactful activities for the sake of long term health.

Night time eating? Heart disease coming

That late night snack may be comforting and the perfect end to a day. However, if research is proven to be right, it could be the cumulative cause of heart disease.

Scientists have always known that night shift workers are at greater health risks than workers who work regular patterns. Which is why if you divided the pay shift workers receive by the hours worked, you would find that they have a higher hourly rate compared to those who do the same job during normal hours. That extra pay is to compensate for what is commonly perceived as the extra demand of working during the night, at a time your body is looking to shut down for a rest. The external pressures of going against your body, over a prolonged period, can exert a toll on the body.

Scientists in Mexico researching the links between diet and the human body tested their hypotheses on rats. The rats were fed food at a time when their bodies would normally be at rest, and the results showed that the fats from food remained longer as triglycerides in the body’s bloodstream for longer, because their bodies were at a resting state and not primed to break down food.

Bearing in mind that the research was done on rats, and while some results may have bearing on humans and some may not, what points could we take from these research results?

Having high levels of triglycerides in one’s body means that the risk of cardiovascular diseases such as heart attacks are significantly increased. Hence, if you are eating late at night, you may be at greater risk. Although the research is only at its infancy, they could suggest that the body is better when it comes to the processing of fats, when it is at its most active state, as it comes at more of a natural time.

What can you do if you work shifts? You may not have much control over the food you eat, but you can take steps towards eating a healthier diet and make time for regular exercise so the overall risk of heart disease is lowered. And if you do not work shifts, but work during the day, a big meal late at night is also best avoided for you.

The financial considerations of investing in medicine and medical research

BBC News reports that a drug that would reduce the risk of HIV infection would result in cost savings of over £1bn over 80 years. Pre-exposure prophylaxis, or Prep, would reduce infection and hence lower the treatment costs for patients in the long term.

The catch? There is one. It’s the long term.

The cost of the treatment and prevention is such that its provision for the first twenty years – bundling together the cost of medical research and production of medicine – would result in a financial loss, and parity would only be achieved after a period of about thirty to forty years; this period is hard to define because it is dependent on what the drug would cost in the future.

Prep combines two anti-HIV drugs, emtricitabine and tenofovir. The medical trials behind it have concluded it has an effective rate of over one in five when it comes to protecting men who have unprotected sex with men from HIV infection. The exact figure is close to 86%.

Prep can be used either on a daily basis, or on what has been termed a sexual event basis – using it for two days before, during and after periods of unprotected sex.

The research model analysed the potential impact of Prep and found that it could reduce infection rates by over a quarter. The cost of the treatment itself, comparative to the cost of treating infection, would result in a saving over one billion pounds over eight years.

However, it does raise a few ethical questions. If the National Health Service is aiming to be a sustainable one – and one of the aims of sustainability is to empower citizens to take responsibility for their own health –  shouldn’t it be considering less about how it will balance the books, but spend more on education for prevention in the first place? The cost of producing Prep on the NHS would be £19.6 billion over 80 years; while the estimated savings from treatment would be £20.6 billion over the same period. Educating people not to have unprotected sex with those at the risk of HIV arguably would result in a higher saving over a lower time period. Perhaps the NHS should consider ways of reducing cost more significantly, rather than latching on to a cheaper prevention drug immediately. If consumer behaviour is not going to change, symptoms are still going to surface, and the provision of Prep on the NHS may only encourage less self-regulation and awareness.

Pressures faced by the NHS

The good news is that every day, the vast majority of the 63.7 million people eligible to use the NHS, don’t need to. And every day you don’t need to use the NHS, someone else benefits. Most people are very capable of looking after themselves most of the time, self-treating for minor ailments and knowing when and where to seek help for serious illness. 90 per cent of symptoms are self-treated but an estimated fifty-two million visits to general practice each year are still for conditions that would get better with time. Self-care is likely to improve further when those who want it are given access to and control over their medical records and data, and technology is better used to direct you to the right information when you need it. In the meantime, a friendly pharmacist can often save you a trip to the GP.

The bad news is that demand in many areas outstrips both the supply of services and the funding for them. Patients who need care are having to wait longer for it, and too many referrals are rejected as not urgent enough, when the NHS should be doing its utmost to prevent emergencies.

There is a very, very big mental illness iceberg out there and it’s showing no signs of melting.

Life is tough enough for NHS staff, but imagine what it’s like for these children and their carers who can’t get any care at all? The pattern of services struggling – or simply not being able to cope safely – with the demands placed on staff is common across the NHS. Waiting times are creeping up, emergency departments are overflowing, people struggle to get a GP appointment, services are being restricted and rationed and lots of people are having to fend for themselves.The technology and choices patients now face can be very complex, but the strength of the NHS lies in its humanity and the ethos that as a society we should pool our resources to care for and protect the most vulnerable.

The NHS is nearly always buckling under the demands placed on it, partly because it’s a victim of its own success. Improvements in public health, wealth and healthcare since the NHS was founded sixty-seven years ago have been stunning. In 1948, half the population died before the age of sixty-five. Now, the average life expectancy is over eighty. One in three children born today will live to one hundred, but one in four boys born in Glasgow still won’t make it to sixty-five. The UK is still a very unequal society, and the rich not only live fifteen years longer than the poor, but they have up to twenty years more healthy living. Life is very, very unfair, which is why we need to fight poverty and build the confidence, courage and resilience in our children to live well, as well as improve and fund the NHS. Those who pay for it most often use it least. It’s the badge of honour for living in a humane society.

And we nearly all need it eventually if we want help or treatment. One in two people in the UK will get cancer, one in three will get diabetes and nearly everyone will get heart disease. Many of these diseases will be contained rather than cured. Obesity appears unstoppable. Liver disease, kidney disease, lung disease, musculoskeletal disease, depression and anxiety are all on the increase. Mental illnesses cost the UK over £70 billion a year, one in three of us experiences mental health problems every year and one in three people over sixty-five will die with dementia. Many people with dementia live for many years, even if they haven’t been diagnosed and treated. Dementia alone already costs the economy more than cancer and heart disease put together.

These chronic diseases account for 70 per cent of the NHS budget, although many can be delayed if not prevented by a healthier lifestyle. Those with three or more incurable diseases are usually on multiple medications, the combined effects of which are unknown. Many older patients on multiple drugs struggle to take them properly, and there’s a delicate balance between benefit and harm. Loneliness is often a far bigger problem.

The NHS and social care system is crucially dependent on millions of unpaid volunteers and carers, and many very dedicated but poorly paid care workers. The round-the-clock pressures and responsibilities they face are huge. If carers went on strike, the NHS and social care service would collapse overnight. Keeping it all afloat is a massive, collaborative effort and we are far too reliant on institutionalized care, rather than supporting people in their homes.

More women give birth in hospital than need or want to be there, so those who really need to have hospital births don’t always get safe care. Far too many frail elderly patients, many with dementia, end up in acute hospitals, often the most frightening and disorientating place they can be. Far too many people with mental illness end up in police custody and far too many people die in hospital when they want to die at home. We can change this, if services join up, and patients and carers receive the right training and support. Having chemotherapy or dialysis at home can transform not just your healthcare but your whole life. It doesn’t happen nearly enough.

Fixing the NHS and social care system will not be quick or easy, even if we put more money in. In many instances, it would often be kinder to have less high-tech, expensive intervention than more. If all we ever did in the NHS was capture the ideas and feedback from frontline staff, patients and carers, and use it to continuously improve a stable system that everyone understood, the NHS would be out of sight as the world’s best. We have to spend every available penny supporting and joining up the frontline – the NHS is not about the bricks and mortar, it’s about mobilizing and motivating a brilliant workforce to serve patients and give you as much control as you want over your care. And to do that, you need to find your voice and we need to listen to you.

Research done by the Health Foundation, When Doctors and Patients Talk, found that NHS staff are often as anxious and fearful as you are during consultations. They are anxious and frightened of missing an important diagnosis, not being able to give patients what they are entitled to, not being able to practise the standards of care they’d like to, having to deal with justifiable anger, missing a target they have been ordered to hit, being asked to do something they do not feel competent to do, or having to look after so many patients in such a short space of time they just do not feel safe. The ever-present fear is that they simply cannot cope safely with the demand. Just as we shouldn’t blame people for being ill or old or overweight, we shouldn’t blame NHS staff for not being able to always provide the highest standards of care. Praise, kindness and understanding are much better motivators.

And there’s plenty to be thankful for. The Commonwealth Fund in America compares the health systems in eleven countries and ranks them according to eleven measures: quality of care, effective care, safe care, coordinated care, patient-centred care, access, cost-related problems, timeliness of care, efficiency, equity, and healthy lives. You might expect Austria, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland or America to thrash us. In fact, the 2014 ranking (based on 2011 data) puts the UK top of the healthcare table overall, and first in eight of the eleven categories. It came second in equity to Sweden, and third behind Switzerland and the Netherlands for timeliness of care. The NHS is far from perfect, but we should celebrate and publicize the amazing care it often gives, try to improve the good care it usually gives and quickly address the poor care it occasionally gives, so further harm is prevented.

To improve, the NHS needs to be simplified so that anyone can understand it. We pretend to distinguish between healthcare and social care, but it’s all ‘care’ and it should be joined into one care system, with those with the greatest need treated by one team with one named person responsible for coordinating your care. And we must all do everything we can to live well. In the NHS, the staff spend too much time diving into the river of illness, pulling people out and trying to put them back together that no-one has time to wander upstream and look at who’s pushing you in.