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genetic make-up (Nutrigenomics). For investors to invest, market exclusivity must be assured. We are already witnessing the banning of natural health products under the guise of consumer protection, and there are indications that we are heading towards a situation where it will be illegal to grow herbs in your own backyard on the basis that they are dangerous. The endpoint for the pharmcos is to capture all the indigenous markets which have used traditional herbs for centuries (Chinese, Indian Ayurvedic, South American, African, etc.), and convert them to patented products that can pass the testing, standardisation and scientific proof required by all drugs." sponsors, researchers, regulatory bodies and the medical community at large, systemise healthcare by defining and controlling procedures including the rules on what can be prescribed for any condition, and control what products can be used accordingly. They will then be able to aggregate the demand and negotiate cheaper prices from pharmcos. The UK government has tapped into the frequent-flyer market of patients with chronic conditions who make the most visits to GPs and hospitals. The Expert Patient Programme,”' an NHS health initiative where a certificate of competence is issued after a six- week course of 2.5 hours per week, simply replicates the self- management advice that self-help and support groups have been offering for decades. However, the NHS, through the formalisation and adoption of the program (20,000 people have already taken part), has been able to indicate measurable improvements in quality of life and cost-savings for the health budget. Tangible results have been demonstrated in reductions of 44-80 per cent in visits to GPs and other health professionals by various groups, and in a 31 per cent reduction in hospitalisation for asthma sufferers.” Clinicians and prescribers offering for decades. However, the NHS, through the formalisation Often referred to as "the priesthood", this highly fragmented group _—_and adoption of the program (20,000 people have already taken of clinicians and prescribers seeks to control the ownership of the _ part), has been able to indicate measurable improvements in quality relationship with the patient, the prescribing of drugs, the procedures _ of life and cost-savings for the health budget. Tangible results have used and the acquired knowledge of their application. Their been demonstrated in reductions of 44-80 per cent in visits to GPs collective stance of non-collaboration (although not shared by all and other health professionals by various groups, and in a 31 per clinicians) in government health initiatives to establish EHRs not cent reduction in hospitalisation for asthma sufferers.” only reflects this desire to control the ownership or copyright of patient records but also an unwillingness to be accountable for Expert health consumers and patients decisions made on behalf of patients. EHRs will enable the auditin; Although there are short-term benefits in shifting the P g g g of all decisions and the tracing of major mistakes in general practice | management of chronic conditions back to the consumer, the long- and hospital management. term implications of endorsing groups of highly motivated people An additional pressure will come from patients who will expect _ have not been factored into the health equation. to have access to, or be advised on, the Under the government and pharmco latest clinical evidence when making model, the "expert patient" is drug- choices about veatmen ee An additional pressure will comprtant and therefore more cost- ray states that whereas "the clinician . . effective and profitable. However, was the driving force in the 20th come from patients who will virtual community groups in increasing century, whe Patient will be the driving expect to have access to, numbers are communicating thelr orce in the 21st century". . views and their own knowledge o At this turning point, clinicians can or be advised on, what works for them over the Internet, either submit and become glorified the latest clinical evidence and with the availability of the new, pill-dispensers (as described by the . . ree, open-source software and tools, then British prime minister, Mrs when making choices these groups will be able to gather, Thatcher) or they can take up the about treatment. store, harvest and share knowledge challenge and use what's left of their themselves and become better credibility and trust to help patients as advocates and assist them in harvesting informed and more responsible for their health—a threat to the system, the knowledge of what works. As attitudes to the profession indeed. With the new emphasis on clinical outcome as opposed to change, the intimidating paternalistic stance that was once its scientific evidence, comparative studies of mainstream and hallmark will no longer be acceptable as patients demand the complementary medicine may be published and present new respect they deserve when making critical health decisions. challenges to conventional healthcare. The driver for this wave in consumer power is the cost of Governments and insurers treatment, the reduction in disposable income, the loss of confidence With health insurance costs set to rise by 6.5 per cent annually and trust in the medical industry and, more importantly, the (an estimated US$1.00 of every US$5.00 spent in the USA is on realisation that public health is spiralling downwards and that not a healthcare), with statistics indicating that more people in the USA cent is being spent on addressing the causes. These well-informed per annum are dying from medical errors (approx. 195,000 in people do not want to be drug-dependent or see their children 2000-2002'*) than from breast cancer, AIDS or motor vehicle suffering chronic conditions. They want to own the right to be accidents,” and with the predicted rise in chronic disease set to healthy, and they will meet with fierce, co-ordinated opposition any affect 50 per cent of populations in developed countries,*” | move by governments or pharmcos to inhibit access to natural foods governments and insurance companies are looking to drive down and health products or therapies that have proven benefits. their costs, increase their profits and get better patient outcomes. Likewise, they will fight strongly for the power to deny consent to Reducing costs means extricating the industry from the any group—government, pharmco or clinician—or even any IT stranglehold of those that control prescribing—the pharmcos and company such as Microsoft and Google which stores health records the clinicians. A rapid deviation from the scientifically based to datamine or de-identifiy those records for on-selling to model of healthcare to one that is clinically based will demote the corporations that seek to control and influence the market. "scientific evidence" mantra that has governed healthcare policy With a growing consensus that failure to address the key causes of in favour of what actually works, whether s ientifically Proven or our decline—environmental pollution and nutritional depletion—will nat With tha DOD An additional pressure will come from patients who will expect to have access to, or be advised on, the latest clinical evidence when making choices about treatment. Governments and insurers With health insurance costs set to rise by 6.5 per cent annually (an estimated US$1.00 of every US$5.00 spent in the USA is on healthcare), with statistics indicating that more people in the USA per annum are dying from medical errors (approx. 195,000 in 2000-2002'*) than from breast cancer, AIDS or motor vehicle accidents,” and with the predicted rise in chronic disease set to affect 50 per cent of populations in developed countries, *° governments and insurance companies are looking to drive down their costs, increase their profits and get better patient outcomes. Reducing costs means extricating the industry from the stranglehold of those that control prescribing—the pharmcos and the clinicians. A rapid deviation from the scientifically based model of healthcare to one that is clinically based will demote the "scientific evidence" mantra that has governed healthcare policy in favour of what actually works, whether scientifically proven or not. With the EHR initiative, governments and insurers will be able to accelerate the diffusion of clinical research information to 24 = NEXUS Continued on page 77 www.nexusmagazine.com DECEMBER 2007 — JANUARY 2008