Category Archives: policy

Quantified-self harm..?

OK. This is purely a rant based on a shallow, n=1 observation.

I lost my fitbit down the toilet in December and chose not to replace it.

Since then, I’ve been maintaining my active habits (walking to work, training for a fun run) without the motivational air cover provided by the device.

Since then, I’ve been eating slightly healthier, primarly reducing meat consumption in favour of vegetables, and also increasing the depth and number of fasting days.

As a consequence, I’ve been losing more weight.

The interesting thing is that the only quantified self metric I’ve been looking at has been my weight.

It’s all a bit zero-sum, but I feel that by no longer monitoring my activity, I’m now focusing more on what matters – weight.

This isn’t to poo poo the tracker. I’m confident that it supported the development of activity habit. It’s just that now I’ve covered that, I need to focus on more salient measures.

It makes me think there’s change management a process that’s required to get healthy:

Firstly, get active using whatever motivational means necessary -trackers, fun runs etc.

Second, perhaps simultaneously, concentrate on diet… fasting, nutrition etc.

For further discussion, no doubt…

Nudging for better health conference

Lissanthea Taylor put me onto this conference that she was at:

PDF: Nudging-for-Better-Health-Conference-Flyer

Nudging for Better Health Conference

Nudging for Better Health decorate image

There is growing enthusiasm in government policy circles for promoting strategies designed to encourage and enable individuals to lead healthier lives. Such strategies draw on behavioural research showing individuals do not always act rationally and are susceptible to a range of influences which impact on the decisions they make. The research suggests that people can be nudged towards making decisions which are better for their health but in such a way that it does not unduly restrict their liberty or freedom to act.

This one-day conference will bring together an interdisciplinary group of scholars and commentators to explore the use of nudge strategies to incentivise better health. Recent developments in relation to the use of such strategies in Australia, NZ, the UK and Europe will be examined, as will case studies in specific areas impacting upon individual and collective health and wellbeing. The conference will be of interest to those working or researching in areas involving health and well being, and public health more generally.

Presenters

  • Dr Rory Gallagher & Mr Simon Raadsma, Behavioural Insights Team, NSW Department of Premier and Cabinet
  • Professor Christine Parker, Monash Centre for Regulatory Studies
  • Assoc. Professor Anne-Maree Farrell, Faculty of Law, Monash University
  • Assoc. Professor Duncan Mortimer, Centre for Health Economics, Monash University
  • Professor Michael Selgelid, Director, Centre for Human Bioethics, Monash University
  • Dr Liam Smith, Director, BehaviourWorks, Monash Sustainability Institute
  • Ms Jane Martin, Cancer Council Victoria
  • Ms Sondra Davoren, McCabe Centre for Law and Cancer
  • Dr Muireann Quigley, Bristol University, UK
  • Dr Elen Stokes, Cardiff University, UK
  • Dr John Kennelly, University of Auckland, NZ
  • Ms Paula O’Brien, Melbourne Law School

Event details

Date: Monday, 17 February 2014

Time: 9am – 5pm

Venue: Monash University Law Chambers, 555 Lonsdale St Melbourne

Cost: Free

RSVP: Limited places are available. Please rsvp by Monday, 10 February, 2014 via e-mail toMeli.Voursoukis@monash.edu

To improve health care, governments need to use the right data

Terrific Economist snippet…

http://www.economist.com/news/international/21595474-improve-health-care-governments-need-use-right-data-need-know

Measuring health care

Need to know

To improve health care, governments need to use the right data

DECIDING where to seek treatment might seem simple for a German diagnosed with prostate cancer. The five-year survival rate hardly varies from one clinic to the next: all bunch around the national average of 94%. Health-care providers in Germany, and elsewhere, have usually been judged only by broad outcomes such as mortality.

But to patients, good health means more than life or death. Thanks to a study in 2011 by Germany’s biggest insurer, a sufferer now knows that the national average rate of severe erectile dysfunction a year after removal of a cancerous prostate gland is 76%—but at the best clinic, just 17%. For incontinence, the average is 43%; the best, 9%. But such information is the exception in Germany and elsewhere, not the rule.

Doctors and administrators have long argued that tracking patients after treatment would be too difficult and costly, and unfair to providers lumbered with particularly unhealthy patients. But better sharing of medical records and a switch to holding them electronically mean that such arguments are now moot. Risk-adjustment tools cut the chances that providers are judged on the quality of their patients, not their care.

In theory, national health-care systems should find measuring outcomes easier. Britain’s National Health Service (NHS) compiles masses of data. But it stores most data by region or clinic, and rarely tracks individual patients as they progress through treatment. Sweden’s quality registries do better. They analyse long-term outcomes for patients with similar conditions, or who have undergone the same treatment. Some go back to the 1970s and one of the oldest keeps records of hip replacements, letting medics compare the long-term performance of procedures and implants. Sweden now has the world’s lowest failure rate for artificial hips.

Elsewhere, individual hospitals are blazing a trail. Germany’s Martini-Klinik uses records going back a decade to fine-tune its treatment for prostate problems. The Cleveland Clinic, a non-profit outfit specialising in cardiac surgery, publishes a wide range of outcome statistics; it now has America’s lowest mortality rate for cardiac patients. And though American politicians flinch at the phrase “cost-effectiveness”, some of the country’s private health firms have become statistical whizzes. Kaiser Permanente, which operates in nine states and Washington, DC, pools the medical records for all its centres and, according to McKinsey, a consultancy, has improved care and saved $1 billion as a result.

Such approaches are easiest in fields such as prostate care and cardiac surgery, where measures for quality-of-life are clear. But some clinics have started to track less obvious variables too, such as how soon after surgery patients get back to work. This is new ground for doctors, who have long focused on clinical outcomes such as infection and re-admission rates. But by thinking about what matters to patients, providers can improve care and lower costs at the same time.

Leeder on outcomes…

 

The 1 February edition of The Economist, in an article entitled Need to Know (about health outcomes), took up the theme. The article observed that in Germany, its biggest insurer made available data in 2011 about outcomes for all to see.

Among the outcomes, the data showed five-year survival after treatment for prostate cancer was uniform across the nation – 94 per cent. But the data collected by the insurer went further: while the national average for subsequent erectile dysfunction was 76 per cent, at the best-performing clinic it was just 17 per cent. “For incontinence, the average was 43 per cent: the best 9 per cent,” The Economist wrote.

Armed with data such as these, prospective patients can choose where to be treated. The same data form the basis for discussion between those who provide and those who pay for health care.

 

https://ama.com.au/ausmed/case-measuring-outcomes-what-we-do

The case for measuring the outcomes of what we do

18/02/2014

Archie Cochrane, the Scottish medical epidemiologist after whom the Cochrane Collaboration that develops the evidence base for clinical medicine is named, came out of the Spanish Civil War and World War Two sceptical about the outcomes of his medical care.

Cochrane said, “I knew that there was no real evidence that anything we had to offer had any effect on tuberculosis, and I was afraid that I shortened the lives of some of my friends by unnecessary intervention.”

He changed career, moving into public health and conducting epidemiological research into TB and occupational lung diseases. He became especially sceptical about screening and, as Wikipedia puts it, “his ground-breaking paper on validation of medical screening procedures, published jointly with fellow epidemiologist Walter Holland in 1971, became a classic in the field”.

Cochrane recalled in his 1972 book Effectiveness and Efficiency: Random Reflections on Health Services being puzzled by a crematorium attendant he met who was permanently serenely happy. Cochrane asked why: the attendant said that each day he marvelled at seeing “so much go in and so little come out”.  Cochrane suggested that he consider working in the National Health Service.
In Australia we assess how much work we do in hospitals through activity-based funding.  Money flows in direct proportion – so many coronary grafts, so many strokes treated. But little attention, at least in routine care, is paid to what we achieve. There are examples that contradict this general assertion, but mainly it is true.
Recently, the Bureau of Health Information in the NSW Ministry of Health made available statewide mortality data for five conditions treated in NSW public hospitals, taking account of variations in severity. Such data begin to fill the blanks in our knowledge about outcomes, and prompt discussion about why these variations occur.

The 1 February edition of The Economist, in an article entitled Need to Know (about health outcomes), took up the theme. The article observed that in Germany, its biggest insurer made available data in 2011 about outcomes for all to see.

Among the outcomes, the data showed five-year survival after treatment for prostate cancer was uniform across the nation – 94 per cent. But the data collected by the insurer went further: while the national average for subsequent erectile dysfunction was 76 per cent, at the best-performing clinic it was just 17 per cent. “For incontinence, the average was 43 per cent: the best 9 per cent,” The Economist wrote.

Armed with data such as these, prospective patients can choose where to be treated. The same data form the basis for discussion between those who provide and those who pay for health care.

Once, clinical trials of new cancer drugs were concerned principally with the survival of patients treated versus those not treated with new medications. But they now measure more than life expectancy.

For over 25 years mortality data have been supplemented by quality of life assessments.

But the excellence in clinical trial outcome measurement has not spread to routine care.

So much goes in, but what comes out?
In the US, health care expenditure is a huge worry for individual citizens, for Government (which spends as much as a proportion of GDP/GNP as ours does on health), and for industry, which pays for a lot of health insurance for employees. In response, comparative effectiveness research – CER – has recently evolved.

Wikipedia advises that “The Institute of Medicine committee has defined CER as ‘the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels’.”

There are many agencies and individuals now in the US committed to CER, including Dr John Wennberg at the Dartmouth Institute for Health Policy and Clinical Practice.

He and his colleagues have studied variations in medical practice across the US with a view to ironing out the wrinkles caused by inferior care.

They claim that 30 per cent of health care costs could be saved by correcting care that falls below expected outcomes.

Australia has not been entirely idle, and we have led the world in aspects of outcome measurement in relation to drugs.

Since 1953, Australia’s Pharmaceutical Benefits Advisory Committee (PBAC) has constructed the formulary of publicly funded medicines. Since 1990, the PBAC has made cost and effectiveness (outcome) assessment a mandatory prelude to listing. Pricing and other political decisions follow, but the solid outcome data are necessary. Others are now following our example.

When we have a health care system that is fully connected electronically, the task of measuring outcomes and using them to good effect in managing the system will be far easier. Outcome data are critical to achieving real financial efficiency. They can be used to help us stop doing things that achieve nothing, or cause harm, and instead use the resources saved for clinical care with good outcomes.

But assessing outcomes, as the prostate surgery example demonstrates, extends well beyond financial efficiency and, indeed, beyond life expectancy. When we confidently explain what we achieve with what we do – quantity and quality of life gained –  patients are empowered to make choices.

UK government-backed SMS nudges

well, good.

http://www.fastcoexist.com/3026172/how-would-you-feel-about-your-government-texting-you-to-tell-you-to-exercise

How Would You Feel About Your Government Texting You To Tell You To Exercise?

A few overweight residents of this U.K. town are about to find out.

“Maybe walk to the shops or take the stairs more often.” “Aim to eat regular meals and keep a check on snacks and drinks.” “Eat fruit and veg.” These are some of the texts you get when you sign up for a new health program. The sender? The U.K. city of Stoke-on-Trent.

Stoke is starting the controversial project because it reckons that regular reminders are key to changing habits, and because getting people to slim down helps public budgets. “This is all about getting people on board and taking action before they need medical support, which is so expensive and personally upsetting,” a spokesperson told the BBC.

The British public hasn’t been so positive, though. Twitter lit up after the scheme was reported, with many bemoaning the long arm of government and wasted public money. Others said the texts could backfire, giving people a negative self-image (though presumably if they sign up in the first place, they’re not feeling good about themselves).

The program, which runs for 10 weeks, costs $16,000 to taxpayers, including set-up charges. About 500 people will participate voluntarily, all of them above the overweight limit, with a body mass index above 25. Officials say $16,000 is a pittance against the cost of treating obesity-related diseases.

Time will tell if the texts work. Other similar experiments show that it might, if people want to be involved and aren’t forced into anything.

Leeder on Policy and Politics

Brian Head, program leader in policy analysis at the University of Queensland, wrote “Policy decisions emerge from politics, judgement and debate, rather than being deduced from empirical analysis. Policy debate and analysis involves an interplay between facts, norms and desired actions, in which ‘evidence’ is diverse and contestable.”

Policy that works distils evidence from several sources. It includes the kind that supports evidence-based medicine, but there is also the evidence that comes from an assessment of political feasibility and evidence that comes from what we might call experience.

Doctors are often frustrated when the evidence they present, from both basic and clinical science and from professional experience, is trumped by politics. But the nature of a democracy is such that this is to be expected.

In all of these examples, policy served as a vehicle for organising thought and care. It is critical to achieving the best clinical outcomes.

The challenge to our nation is to ensure that our state and federal policies are as sound as we can help make them.

We doctors do not make the policies, but we contribute positively and importantly to them.

https://www.mja.com.au/insight/2014/5/stephen-leeder-policy-pointers

Stephen Leeder: Policy pointers

Stephen Leeder
Monday, 17 February, 2014

Stephen Leeder

THE federal government, less than 6 months old, faces many challenges in health care.

Establishing priorities will be useful if they guide attention and resources towards where they are likely to offer the best yield in promoting health and providing care for sick and injured people, while honouring the principles of efficiency and equity in the way that we do things and to whom we attend.

The MJA has asked six health leaders to suggest policy pointers — matters that, in their opinion, warrant the attention of the new government and about which policy might be developed for effective action.

The first response is by eminent Melbourne health economist and academic Stephen Duckett. Duckett sets out his call for policy under three headings — keeping the Medicare promise, going beyond the provision of services and ensuring good governance. He splits his proposals into what a first-term and second-term government might aspire to do.

His wide experience in health service management makes his recommendations especially pertinent.

Brian Head, program leader in policy analysis at the University of Queensland, wrote “Policy decisions emerge from politics, judgement and debate, rather than being deduced from empirical analysis. Policy debate and analysis involves an interplay between facts, norms and desired actions, in which ‘evidence’ is diverse and contestable.”

Policy that works distils evidence from several sources. It includes the kind that supports evidence-based medicine, but there is also the evidence that comes from an assessment of political feasibility and evidence that comes from what we might call experience.

Doctors are often frustrated when the evidence they present, from both basic and clinical science and from professional experience, is trumped by politics. But the nature of a democracy is such that this is to be expected.

Policy on initial screening for acute life-threatening disease benefits greatly from medical input.

Although, strictly, it is case finding, researchers have evaluated the use of a more sensitive troponin test for more quickly determining the presence of myocardial damage in line with an “accelerated biomarker” strategy for assessing and managing suspected ischaemia and infarction. Their findings validate the use of this strategy, formulated by the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand.

Here, medical evidence informs the policy that governs the interaction between patients and health care provision.

Because enthusiasm frequently runs ahead of utility when it comes to screening, the authors of a Perspectives article advocate for a national framework for newborn bloodspot screening. Such frameworks have proved their worth in other countries, and one is needed here.

In another Perspectives article, the authors welcome progress in the use of cell-free fetal DNA tests of maternal serum for aneuploidy screening (and the extension of related tests to pregnancy outcome prediction) in the first trimester even though these tests have some distance to travel before sensitivity, specificity and predictive value will be clear.

Ah, the delight of reading an article that describes success in closing a gap — any gap! Gaps so often cause lamentation with no design for a bridge.

Researchers and a linked editorial describe a splendid cardiology network in South Australia that supports patients who have had acute myocardial infarction and who live in places remote from major hospitals in receiving appropriate timely and evidence-based care.

The network involves providing advice from metropolitan hospital specialists to rural health practitioners, carefully stratifying patients into three risk categories to determine who needs reperfusion angiography most urgently, and then organising it. The mortality gap between city and rural dwellers was consequently abolished.

Here, policy built the bridge to bring rural outcomes closer to city ones.

In all of these examples, policy served as a vehicle for organising thought and care. It is critical to achieving the best clinical outcomes.

The challenge to our nation is to ensure that our state and federal policies are as sound as we can help make them.

We doctors do not make the policies, but we contribute positively and importantly to them.

 

Professor Stephen Leeder is the editor-in-chief of the MJA and professor of public health and community medicine at the University of Sydney.

This article is reproduced from the MJA.

John Yudkin: the man who tried to warn us about sugar

Terrific article reprinted in the SMH from the Sunday Telegraph, London…

One of the problems with the anti-sugar message – then and now – is how depressing it is. The substance is so much part of our culture, that to be told buying children an ice cream may be tantamount to poisoning them, is most unwelcome. But Yudkin, who grew up in dire poverty in east London and went on to win a scholarship to Cambridge, was no killjoy.

”He didn’t ban sugar from his house, and certainly didn’t deprive his grandchildren of ice cream or cake,” recalls his granddaughter, Ruth, a psychotherapist. ”He was hugely fun-loving and would never have wanted to be deprived of a pleasure, partly, perhaps, because he grew up in poverty and had worked so hard to escape that level of deprivation.”

”My father certainly wasn’t fanatical,” adds Michael. ”If he was invited to tea and offered cake, he’d accept it. But at home, it’s easy to say no to sugar in your tea. He believed if you educated the public to avoid sugar, they’d understand that.”

”It is not just Big Tobacco any more,” Chan said last year. ”Public health must also contend with Big Food, Big Soda and Big Alcohol. All of these industries fear regulation and protect themselves by using the same tactics. They include front groups, lobbies, promises of self-regulation, lawsuits and industry-funded research that confuses the evidence and keeps the public in doubt.”

 

http://www.smh.com.au/lifestyle/diet-and-fitness/john-yudkin-the-man-who-tried-to-warn-us-about-sugar-20140212-32h03.html

John Yudkin: the man who tried to warn us about sugar

Date

Julia Llewellyn Smith

A British professor’s 1972 book about the dangers of sugar is now seen as prophetic. Then why did it lead to the end of his career? 

Sweet beauty: is sugar aging?Not so sweet: sugar. Photo: Lyndall Larkham

A couple of years ago, an out-of-print book published in 1972 by a long-dead British professor suddenly became a collector’s item.

Copies that had been lying dusty on bookshelves were selling for hundreds of pounds, while copies were also being pirated online.

Alongside such rarities as Madonna’s Sex, Stephen King’s Rage (written as Richard Bachman) and Promise Me Tomorrow by Nora Roberts; Pure, White and Deadly by John Yudkin, a book widely derided at the time of publication, was listed as one of the most coveted out-of-print works in the world.

Pure, White and Deadly.Pure, White and Deadly.

How exactly did a long-forgotten book suddenly become so prized? The cause was a ground-breaking lecture called Sugar: the Bitter Truth by Robert Lustig, professor of paediatric endocrinology at the University of California, in which Lustig hailed Yudkin’s work as ”prophetic”.

”Without even knowing it, I was a Yudkin acolyte,” says Lustig, who tracked down the book after a tip from a colleague via an interlibrary loan. ”Everything this man said in 1972 was the God’s honest truth and if you want to read a true prophecy you find this book… I’m telling you every single thing this guy said has come to pass. I’m in awe.”

Posted on YouTube in 2009, Lustig’s 90-minute talk has received more than 4.1 million hits and is credited with kick-starting the anti-sugar movement, a campaign that calls for sugar to be treated as a toxin, like alcohol and tobacco, and for sugar-laden foods to be taxed, labelled with health warnings and banned for anyone under 18.

Lustig is one of a growing number of scientists who don’t just believe sugar makes you fat and rots teeth. They’re convinced it’s the cause of several chronic and very common illnesses, including heart disease, cancer, Alzheimer’s and diabetes. It’s also addictive, since it interferes with our appetites and creates an irresistible urge to eat.

This year, Lustig’s message has gone mainstream; many of the New Year diet books focused not on fat or carbohydrates, but on cutting out sugar and the everyday foods (soups, fruit juices, bread) that contain high levels of sucrose. The anti-sugar camp is not celebrating yet, however. They know what happened to Yudkin and what a ruthless and unscrupulous adversary the sugar industry proved to be.

The tale begins in the Sixties. That decade, nutritionists in university laboratories all over America and Western Europe were scrabbling to work out the reasons for an alarming rise in heart disease levels. By 1970, there were 520 deaths per 100,000 per year in England and Wales caused by coronary heart disease and 700 per 100,000 in America. After a while, a consensus emerged: the culprit was the high level of fat in our diets.

One scientist in particular grabbed the headlines: a nutritionist from the University of Minnesota called Ancel Keys. Keys, famous for inventing the K-ration – 12,000 calories packed in a little box for use by troops during the Second World War – declared fat to be public enemy number one and recommended that anyone who was worried about heart disease should switch to a low-fat ”Mediterranean” diet.

Instead of treating the findings as a threat, the food industry spied an opportunity. Market research showed there was a great deal of public enthusiasm for ”healthy” products and low-fat foods would prove incredibly popular. By the start of the Seventies, supermarket shelves were awash with low-fat yogurts, spreads, and even desserts and biscuits.

But, amid this new craze, one voice stood out in opposition. John Yudkin, founder of the nutrition department at the University of London’s Queen Elizabeth College, had been doing his own experiments and, instead of laying the blame at the door of fat, he claimed there was a much clearer correlation between the rise in heart disease and a rise in the consumption of sugar. Rodents, chickens, rabbits, pigs and students fed sugar and carbohydrates, he said, invariably showed raised blood levels of triglycerides (a technical term for fat), which was then, as now, considered a risk factor for heart disease. Sugar also raised insulin levels, linking it directly to type 2 diabetes.

When he outlined these results in Pure, White and Deadly, in 1972, he questioned whether there was any causal link at all between fat and heart disease. After all, he said, we had been eating substances like butter for centuries, while sugar, had, up until the 1850s, been something of a rare treat for most people. ”If only a small fraction of what we know about the effects of sugar were to be revealed in relation to any other material used as a food additive,” he wrote, ”that material would promptly be banned.”

This was not what the food industry wanted to hear. When devising their low-fat products, manufacturers had needed a fat substitute to stop the food tasting like cardboard, and they had plumped for sugar. The new ”healthy” foods were low-fat but had sugar by the spoonful and Yudkin’s findings threatened to disrupt a very profitable business.

As a result, says Lustig, there was a concerted campaign by the food industry and several scientists to discredit Yudkin’s work. The most vocal critic was Ancel Keys.

Keys loathed Yudkin and, even before Pure, White and Deadly appeared, he published an article, describing Yudkin’s evidence as ”flimsy indeed”.

”Yudkin always maintained his equanimity, but Keys was a real a——-, who stooped to name-calling and character assassination,” says Lustig, speaking from New York, where he’s just recorded yet another television interview.

The British Sugar Bureau put out a press release dismissing Yudkin’s claims as ”emotional assertions” and the World Sugar Research Organisation described his book as ”science fiction”. When Yudkin sued, it printed a mealy-mouthed retraction, concluding: ”Professor Yudkin recognises that we do not agree with [his] views and accepts that we are entitled to express our disagreement.”

Yudkin was ”uninvited” to international conferences. Others he organised were cancelled at the last minute, after pressure from sponsors, including, on one occasion, Coca-Cola. When he did contribute, papers he gave attacking sugar were omitted from publications. The British Nutrition Foundation, one of whose sponsors was Tate & Lyle, never invited anyone from Yudkin’s internationally acclaimed department to sit on its committees. Even Queen Elizabeth College reneged on a promise to allow the professor to use its research facilities when he retired in 1970 (to write Pure, White and Deadly). Only after a letter from Yudkin’s solicitor was he offered a small room in a separate building.

”Can you wonder that one sometimes becomes quite despondent about whether it is worthwhile trying to do scientific research in matters of health?” he wrote. ”The results may be of great importance in helping people to avoid disease, but you then find they are being misled by propaganda designed to support commercial interests in a way you thought only existed in bad B films.”

And this ”propaganda” didn’t just affect Yudkin. By the end of the Seventies, he had been so discredited that few scientists dared publish anything negative about sugar for fear of being similarly attacked. As a result, the low-fat industry, with its products laden with sugar, boomed.

Yudkin’s detractors had one trump card: his evidence often relied on observations, rather than on explanations, of rising obesity, heart disease and diabetes rates. ”He could tell you these things were happening but not why, or at least not in a scientifically acceptable way,” says David Gillespie, author of the bestselling Sweet Poison. ”Three or four of the hormones that would explain his theories had not been discovered.”

”Yudkin knew a lot more data was needed to support his theories, but what’s important about his book is its historical significance,” says Lustig. ”It helps us understand how a concept can be bastardised by dark forces of industry.”

From the Eighties onwards, several discoveries gave new credence to Yudkin’s theories. Researchers found fructose, one of the two main carbohydrates in refined sugar, is primarily metabolised by the liver; while glucose (found in starchy food like bread and potatoes) is metabolised by all cells. This means consuming excessive fructose puts extra strain on the liver, which then converts fructose to fat.

This induces a condition known as insulin resistance, or metabolic syndrome, which doctors now generally acknowledge to be the major risk factor for heart disease, diabetes and obesity, as well as a possible factor for many cancers. Yudkin’s son, Michael, a former professor of biochemistry at Oxford, says his father was never bitter about the way he was treated, but, ”he was hurt personally”.

”More than that,” says Michael, ”he was such an enthusiast of public health, it saddened him to see damage being done to us all, because of vested interests in the food industry.”

One of the problems with the anti-sugar message – then and now – is how depressing it is. The substance is so much part of our culture, that to be told buying children an ice cream may be tantamount to poisoning them, is most unwelcome. But Yudkin, who grew up in dire poverty in east London and went on to win a scholarship to Cambridge, was no killjoy.

”He didn’t ban sugar from his house, and certainly didn’t deprive his grandchildren of ice cream or cake,” recalls his granddaughter, Ruth, a psychotherapist. ”He was hugely fun-loving and would never have wanted to be deprived of a pleasure, partly, perhaps, because he grew up in poverty and had worked so hard to escape that level of deprivation.”

”My father certainly wasn’t fanatical,” adds Michael. ”If he was invited to tea and offered cake, he’d accept it. But at home, it’s easy to say no to sugar in your tea. He believed if you educated the public to avoid sugar, they’d understand that.”

Thanks to Lustig and the rehabilitation of Yudkin’s reputation, Penguin republished Pure, White and Deadly 18 months ago. Obesity rates in the UK are now 10 times what they were when it was first published and the amount of sugar we eat has increased 31.5 per cent since 1990 (thanks to all the ”invisible” sugar in everything from processed food and orange juice to coleslaw and yogurt). The number of diabetics in the world has nearly trebled. The numbers dying of heart disease has decreased, thanks to improved drugs, but the number living with the disease is growing steadily.

As a result, the World Health Organisation is set to recommend a cut in the amount of sugar in our diets from 22 teaspoons per day to almost half that. But its director-general, Margaret Chan, has warned that, while it might be on the back foot at last, the sugar industry remains a formidable adversary, determined to safeguard its market position.

Recently, UK food campaigners have complained that they’re being shunned by ministers who are more than willing to take meetings with representatives from the food industry. ”It is not just Big Tobacco any more,” Chan said last year. ”Public health must also contend with Big Food, Big Soda and Big Alcohol. All of these industries fear regulation and protect themselves by using the same tactics. They include front groups, lobbies, promises of self-regulation, lawsuits and industry-funded research that confuses the evidence and keeps the public in doubt.”

Dr Julian Cooper, head of research at AB Sugar, insists the increase in the incidence of obesity in Britain is a result of, ”a range of complex factors”.

”Reviews of the body of scientific evidence by expert committees have concluded that consuming sugar as part of a balanced diet does not induce lifestyle diseases such as diabetes and heart disease,” he says.If you look up Robert Lustig on Wikipedia, nearly two-thirds of the studies cited there to repudiate Lustig’s views were funded by Coca-Cola.

But Gillespie believes the message is getting through. ”More people are avoiding sugar, and when this happens companies adjust what they’re selling,” he says. It’s just a shame, he adds, that a warning that could have been taken on board 40 years ago went unheeded: ”Science took a disastrous detour in ignoring Yudkin. It was to the detriment of the health of millions.”

Sunday Telegraph, London

Health Miranda: You have the right to keep your health information private, anything you disclose about your health can and will be used against you.

  • The Affordable Care Act now lets employers charge employees different health insurance rates, based on whether they exercise, eat healthful foods and other “wellness” choices they make outside of work.
  • As different phases of the law have taken effect and companies have better understood how to implement it, there basically have been three levels of wellness engagement:
  • Level 1 encourages employees to join a wellness program with exercise and nutrition activities and undergo biometric screenings that check weight, body mass, cholesterol and other health indicators.

    Level 2 trades the carrot for the stick. Employees (and insured family members) who don’t submit to the screening and participate in wellness programs face steep penalties; they may have to pay up to 30 per cent more for their share of health insurance costs.

  • Level 3 in the march towards wellness adopts “outcomes” based programs that can require employees to meet specific fitness goals or pay higher insurance costs.
  • WELLOGRAPH.com looks like an interesting prospect at AUD354

http://www.afr.com/p/technology/wearable_tech_privacy_headed_on_1uDsKFvA5cacLwe6vTKIBN

Wearable tech, privacy on collision course

PUBLISHED: 8 HOURS 48 MINUTES AGO | UPDATE: 4 HOURS 28 MINUTES AGO

Wearable tech, privacy on collision courseThe Zepp Labs wearable sensor on a golf glove … this year’s Consumer Electronics Show was dominated by the next generation of fitness devices. With more advanced sensors and improved hardware.

BRIER DUDLEY

Outrage over NSA spying is nothing compared to how people may react to the upcoming collision with wearable computing, medical privacy and new insurance rules.

You don’t need leaked documents to see it coming, though it took me a while to connect the dots after seeing the bewildering array of new health and fitness-tracking gadgets shown at January’s Consumer Electronics Show.

The show was seen as a turning point for “wearables”, including watches, wristbands, headsets and other gadgets. The most popular wearables monitor physical activity and connect wirelessly to phones, which may then upload the data to online services.

Research firms expect the fitness-wearables category to soar over the next few years, outpacing the growth of smartphones and tablets.

Not everyone wants to have a little computer on the wrist or head keeping track of what a wearer does around the clock. But I wonder if they won’t have much choice in the future, under new insurance laws in the US that invite companies to scrutinise and monitor their employees’ health and fitness.

In the past, medical information was generally none of your employer’s business. It’s still technically private. But the health-care overhaul known as Obamacare is chipping away at this wall.

The Affordable Care Act now lets employers charge employees different health insurance rates, based on whether they exercise, eat healthful foods and other “wellness” choices they make outside of work.

A 2013 survey by Aon Hewitt consulting found that motivating employees to change health behaviours is a “significant focus” over the next three to five years at 69 per cent of employers.

It doesn’t seem like a bad thing because it’s wrapped up in warm and fuzzy doublespeak. This isn’t about saving companies money; it’s about your health. Companies aren’t forcing you to participate, they’re offering rewards. We all want to be healthy, right?

As different phases of the law have taken effect and companies have better understood how to implement it, there basically have been three levels of wellness engagement.

TRACKING HEALTH

 

The first encourages employees to join a wellness program with exercise and nutrition activities and undergo biometric screenings that check weight, body mass, cholesterol and other health indicators.

Level 2 trades the carrot for the stick. Employees (and insured family members) who don’t submit to the screening and participate in wellness programs face steep penalties; they may have to pay up to 30 per cent more for their share of health insurance costs.

The law calls this a “reward” for participation. Flip it around and it’s a penalty for not authorising your employer to manage and monitor how you live outside of work.

Better health overall is in everyone’s best interest. But you can’t help but be cynical when it becomes tied to benefit levels, especially in an era of vanishing pensions, flat pay cheques and longer work days.

It’s too early to say whether wellness programs will make a big difference. In the meantime, they can change the workplace dynamic.

By insinuating that individual choices are the driver of health-care costs, they erode the social contract of group plans in which everyone contributes to coverage that takes care of each other and their families in case something happens.

I’m digressing.

Level 3 in the march towards wellness adopts “outcomes” based programs that can require employees to meet specific fitness goals or pay higher insurance costs.

At this point, when body tracking and measurements are used to adjust benefits, it gets harder to maintain the pretence of privacy. Even if individual records are masked, the data will provide enough insight to assess employees’ potential health costs as well as job performance, enabling a new form of discrimination.

Aon Hewitt’s survey said 64 per cent of employers that offer health-care coverage are using data to find cost savings and as they shift towards health-improvement strategies, they’re relying “more on integrated, dynamic data aggregation tools to laser in on the best opportunities for reduction of unnecessary costs”.

TECHNOLOGY ADVANCEMENTS HELP MONITORING

 

Tech companies are ahead of the game. One is Limeade, a hot start-up in Bellevue that last year doubled sales of its software platform, which employers and insurance companies use to encourage and monitor wellness activities. The platform can sync with dozens of fitness-tracking devices and apps.

Last month’s Consumer Electronics Show was dominated by the next generation of fitness devices. With more advanced sensors and improved hardware, they’re building on the success of activity trackers such as the Fitbit and Nike FuelBand that millions of people — including me — already use. Show organisers gave an “innovation award” to the $US320 ($354) Wellograph Watch, which includes a continuous heart-rate monitor, wellness tracker and running watch in a sleek case.

Fitness tracking may become hard to avoid. Intel unveiled sensors at CES that can be embedded into common devices such as earbuds, which then track physical activity. The data can be relayed to a wellness app on a phone and online wellness programs.

Apple also is chasing this opportunity. With the iPhone 5S, it began using a processor with built-in sensors that can be used by fitness apps.

On January 31, word surfaced that Apple had a big meeting with the Food and Drug Administration, apparently to discuss medical apps and perhaps its own version of a health-monitoring watch. This isn’t too surprising. After years of back and forth with tech companies and others, the FDA in September issued guidelines for health-related apps and gadgets, to clarify which will be considered medical devices and require regulatory approval.

I suggest regulators go a step further and issue privacy guidelines for wellness programs, health apps and wearable devices that may share data with insurers and employers. They could be modelled on the Miranda warnings that police use, informing people of their right to avoid self-incrimination under the Fifth Amendment:

“You have the right to keep your health information private, anything you disclose about your health can and will be used against you.”

Successful aging – doesn’t matter when, as long as you do start exercising

  • Those respondents who had been and remained physically active aged most successfully, with the lowest incidence of major chronic diseases, memory loss and physical disability. But those people who became active in middle-age after having been sedentary in prior years, about 9 percent of the total, aged almost as successfully. These late-in-life exercisers had about a seven-fold reduction in their risk of becoming ill or infirm after eight years compared with those who became or remained sedentary, even when the researchers took into account smoking, wealth and other factors.
  • Exercise confers a reduction in mortality approximately the same as smoking cessation.
  • successful aging involves minimal debility past the age of 65 with little or no serious chronic disease diagnoses, depression, cognitive decline or physical infirmities that would prevent someone living independently
  • several, unsurprising factors contribute: Not smoking; Moderate alcohol consumption, and; having money.
  • In Australian men aged between 65 and 83, those who engaged in about 30 minutes of exercise five or so times per week were much healthier and less likely to be dead 11 years after the start of the study than those who were sedentary, even when the researchers adjusted for smoking habits, education, body mass index and other variables.

 

PHYS ED 
Exercise to Age Well, Whatever Your Age
By GRETCHEN REYNOLDS
Jon Feingersh/Getty Images

 

Phys Ed
PHYS ED

Gretchen Reynolds on the science of fitness.

Offering hope and encouragement to the many adults who have somehow neglected to exercise for the past few decades, a new study suggests that becoming physically active in middle age, even if someone has been sedentary for years, substantially reduces the likelihood that he or she will become seriously ill or physically disabled in retirement.

The new study joins a growing body of research examining successful aging, a topic of considerable scientific interest, as the populations of the United States and Europe grow older, and so do many scientists. When the term is used in research, successful aging means more than simply remaining alive, although that, obviously, is the baseline requirement. Successful aging involves minimal debility past the age of 65 or so, with little or no serious chronic disease diagnoses, depression, cognitive decline or physical infirmities that would prevent someone from living independently.

Previous epidemiological studies have found that several, unsurprising factors contribute to successful aging. Not smoking is one, as is moderate alcohol consumption, and so, unfairly or not, is having money. People with greater economic resources tend to develop fewer health problems later in life than people who are not well-off.

But being physically active during adulthood is particularly important. In one large-scale study published last fall that looked at more than 12,000 Australian men aged between 65 and 83, those who engaged in about 30 minutes of exercise five or so times per week were much healthier and less likely to be dead 11 years after the start of the study than those who were sedentary, even when the researchers adjusted for smoking habits, education, body mass index and other variables.

Whether exercise habits need to have been established and maintained throughout adulthood, however, in order to affect aging has been less clear. If someone has slacked off on his or her exercise resolutions during young adulthood and early middle-age, in other words, is it too late to start exercising and still have a meaningful impact on health and longevity in later life?

To address that issue, researchers with the Physical Activity Research Group at University College London and other institutions turned recently to the large trove of data contained in the ongoing English Longitudinal Study of Aging, which has tracked the health habits of tens of thousands of British citizens for decades, checking in with participants multiple times and asking them how they currently eat, exercise, feel and generally live.

For the study, appearing in the February issue of the British Journal of Sports Medicine, scientists isolated responses from 3,454 healthy, disease-free British men and women aged between 55 and 73 who, upon joining the original study of aging, had provided clear details about their exercise habits, as well as their health, and who then had repeated that information after an additional eight years.

The researchers stratified the chosen respondents into those who were physically active or not at the study’s start, using the extremely generous definition of one hour per week of moderate or vigorous activity to qualify someone as active. Formal exercise was not required. An hour per week of “gardening, cleaning the car, walking at a moderate pace, or dancing” counted, said Mark Hamer, a researcher at University College London who led the study.

The scientists then re-sorted the respondents after the eight-year follow-up, marking them as having remained active, become active, remained inactive or become inactive as they moved into and through middle-age. They also quantified each respondent’s health throughout those years, based on diagnosed diabetes, heart disease, dementia or other serious conditions. And the scientists directly contacted their respondents, asking each to complete objective tests of memory and thinking, and a few to wear an activity monitor for a week, to determine whether self-reported levels of physical activity matched actual levels of physical activity. (They did.)

In the eight years between the study’s start and end, the data showed, those respondents who had been and remained physically active aged most successfully, with the lowest incidence of major chronic diseases, memory loss and physical disability. But those people who became active in middle-age after having been sedentary in prior years, about 9 percent of the total, aged almost as successfully. These late-in-life exercisers had about a seven-fold reduction in their risk of becoming ill or infirm after eight years compared with those who became or remained sedentary, even when the researchers took into account smoking, wealth and other factors.

Those results reaffirm both other science and common sense. Anoteworthy 2009 study of more than 2,000 middle-aged men, for instance, found that those who started to exercise after the age of 50 were far less likely to die during the next 35 years than those who were and remained sedentary. “The reduction in mortality associated with increased physical activity was similar to that associated with smoking cessation,” the researchers concluded.

But in this study, the volunteers did not merely live longer; they lived better than those who were not active, making the message inarguable for those of us in mid-life. “Build activity into your daily life,” Dr. Hamer said. Or, in concrete terms, if you don’t already, dance, wash your car and, if your talents allow (mine don’t), combine the two.