Public health for people like us

At TEDxAuckland 2015 -two of the most outstanding talks were about health issues. Prof Grant Schofield spoke about putting the public into public health, and Dr Hong Sheng Chiong on Fighting blindness with $20 and a smart phone

Grant told a story about a diabetes project in Tarawa on in Kiribati when he worked with a team of 10 people. Tested them first so they could learn how to do the tests and all 10 of them turned out to have diabetes themselves. Later testing showed that 50% of that community has diabetes – quite possibly the highest rate in the world.

Somehow we have been caught out by relying on experts whose advice may not be correct but clearly on issues of public health the reality is far different. There is public dissonance between what science thinks and how that gets translated into everyday choices.

But his best story was “George” the part time pharmacologist from West Auckland. Somehow in the West we have ended up with a public health system that is less about wellness than it should be.

“We’ve run into this perverse situation where butter is a bit like marijuana; you know most New Zealanders have tried it but you wouldn’t use it on a day to day basis”…

So “George” was very sick and personally incentivised to get well so he started looking at the medical research and engaging with the researchers. What he added was a diversity of opinion and independence to his own personal quest. And now he is part of the research team assisting Grant.

I really liked Grants’ idea that we the public should be more involved in the public health space but it does seem that sorting through all of the media noise around medical research is almost overwhelming as this story by Julia Belluz illustrates.

This is why you shouldn’t believe that exciting new medical study Vox – March 23, 2015.

“In 2003, researchers writing in the American Journal of Medicine discovered something that should change how you think about medical news. They looked at 101 studies published in top scientific journals between 1979 and 1983 that claimed a new therapy or medical technology was very promising. Only five, they found out, made it to market within a decade. Only one (ACE inhibitors, a pharmaceutical drug) was still extensively used at the time of their publication.”

…Julia continues

“It’s a fact that all studies are biased and flawed in their own unique ways. The truth usually lies somewhere in a flurry of research on the same question. This means real insights don’t come by way of miraculous, one-off findings or divinely ordained eureka moments; they happen after a long, plodding process of vetting and repeating tests, and peer-to-peer discussion. The aim is to make sure findings are accurate and not the result of a quirk in one experiment or the biased crusade of a lone researcher.”

….

“We don’t wait for scientific consensus; we report a little too early, and we lead patients and policymakers down wasteful, harmful, or redundant paths that end in dashed hope and failed medicine.

This tendency could be minimized if we could only remember that the overwhelming majority of studies in medicine fail.”

It is not all confusion though.

“The more I do this, the more I realize the truth in what Harvard’s Oreskes, Stanford’s John Ioannidis, and many other respected researchers have reiterated over the years: we need to look past the newest science to where knowledge has accumulated. There, we’ll find insights that will help us have healthier lives and societies.”

Looking at a chart like the one below (from the same Vox article)- note: butter 🙂 it is very difficult to be optimistic about medical research. But this sort of goodnews/ bad news scenario is the reality of what we hear every week and it doesn’t help any one.

Medical_studies-05.0

Her article is well worth reading in full. I wonder is a place to start in decoding public health might be one of the online communities such as Patients Like Me where you can Compare treatments, symptoms and experiences with people like you and take control of your health.

Like many people over the age of 40 – I am on medication for some background conditions. The side effects of taking various medications can take months – if not years to work through. My personal opinion is that that my doctor is working for the drug companies rather than for patients is a common one.

Thankfully the next talk at TEDxAuckland 2015 was more hopeful. Hong Sheng Chiong summarised the challenge of solving preventable blindness like this.

preventable-blindness

And right then it becomes apparent that Hong Sheng Chiongs project is a giant step against inequality and towards improving health outcomes for millions of people who have preventable blindness.

The project is open source and open for business at Ophthalmic Docs.

“OphthalmicDocs Ltd is a social enterprise founded by Dr. Hong, Sheng Chiong and Dr. Benjamin O’Keeffe in 2014 in Wellington, New Zealand.

OphthalmicDocs is quickly becoming the world’s first Kiwi based open-source affordable eye equipment company. The fact that 90% of people with visual impairment are living in the developing nations is just sad. One of the major problem lies in the access to affordable ophthalmic equipment. We aim to transform the ophthalmic instrument industry by creating innovative and affordable ophthalmic equipment. Ophthalmicdocs is also a social enterprise so we are not for profit-distribution or dividends. A profit margin of 10% is capped at all the devices we supply. This will be retained for research and development in order to provide more affordable eye equipment in near future.

PS: OpthalmicDocs is a great idea but I’m wondering how it might impact on the work of the the Fred Hollows Foundation.

“In the last five years, the global network of The Fred Hollows Foundation has:

  • Carried out 993,254 sight-restoring operations and treatments
  • Supported training for 38,088 medical and support staff
  • Examined the eyes of 7,209,615 people
  • Provided $10,131,837 of medical equipment
  • Built or upgraded 119 eye health facilities

Since The Foundation was established in 1992, we have also:
Set up independent and commercially successful intraocular lens (IOL) laboratories in Nepal and Eritrea that have produced over 4 million sight-saving lenses. In doing so we reduced the cost of IOLs from over $200 to just $5, making cataract surgery affordable in some of the world’s poorest communities.
Pioneered modern techniques of cataract surgery in developing countries
Implemented eye health programs in more than 29 countries worldwide”

Hopefully the new technology is complementary and will help increase the capabilities of such projects.