ACCESS TO OBESITY SURGERY IN NEW ZEALAND HAMPERED BY LACK OF GPS’ UNDERSTANDING

ACCESS TO OBESITY SURGERY IN NEW ZEALAND HAMPERED BY LACK OF GPS’ UNDERSTANDING 

Media Release for OSSANZ

One of the most effective long-term forms of treatment for obesity is being denied to thousands of New Zealanders because of a lack of understanding among family doctors about the procedures available, as well as public and private reluctance to fund bariatric surgery, according to the Obesity Surgery Society of Australia and New Zealand (OSSANZ), which will be holding its annual scientific meeting in Wellington this week (November 20^th -21^st).

The uptake of bariatric surgery in New Zealand is one of the lowest in the world, with less than 900 procedures performed across the entire country last year, which means that around 0.03% of persons who are potentially eligible is having this treatment.

OSSANZ spokesman Dr Jon Morrow, a bariatric surgeon at Auckland’s Middlemore Hospital, says GPs’ lack of understanding about obesity surgery is as much to blame as poor funding for the poor access to bariatric surgery in New Zealand, in spite of the country ranking third in the world for obesity rates.

Dr Morrow explains: `GPs in New Zealand are generally against bariatric surgery even though the evidence is unequivocally in favour of its use. GPs generally tend to be quite traditional in their approach to weight loss, I reckon less than a quarter of GPs here will refer patients for surgery. Diet and exercise are important factors, but there is now a huge amount of data, which demonstrates that for up to 15 years after bariatric surgery people do lose weight and keep it off. Unfortunately in the face of this evidence GPs just continue to do what they have been doing. They see obese patients everyday and just don’t mention it to them because they find it impossible to broach the subject with them.’

Wendy Brown, OSSANZ President and Associate Professor in the Faculty of Medicine, Nursing and Health Sciences at Monash University, Melbourne, adds: `The theme of our annual meeting in Wellington is “working together for the good of our patients”.  We know that when diet and exercise intervention has failed for obese patients, bariatric surgery is an effective treatment with a good evidence base.  It is important that we educate GPs and the community on the role bariatric surgery may play in the treatment of obesity.

‘Surgery is currently one of the only options available that predictably provides substantial weight loss which is sustained when provided in an environment that supports lifestyle change. We hope that we can raise the awareness of this option for obese persons in New Zealand, and that the community can explore ways to improve access to this surgery.

‘However, bariatric surgery is not a magic bullet.  It requires a commitment from the patient to change their lifestyle and to actively participate in long-term follow-up.  Therefore, we need to involve GPs and other health professionals to support patients on this journey.  It is important we have a team approach in the management of this disease so that we can get the best outcomes for our patients.’

Dr Morrow adds: `Most of the surgery performed in New Zealand is gastric sleeve. This procedure involves removing around 80% of the stomach, leaving behind a small tube of stomach.  The part of the stomach that is removed is the area that produces hormones that increase hunger, and on top of this patients are physically not able to eat as much.   It is safe surgery, causes less severe nutritional deficiencies in the longer term, has few longer term complications and requires 2-4 follow up visits per year, making it well suited to our population who are often reluctant, or find it difficult to, attend follow-up appointments. Typically, by four years people lose around 60% of the extra weight that they are carrying. With this we see diseases related to obesity such as diabetes, high blood pressure and sleep apnoea improve or completely resolve.

`Yet even though the New Zealand ministry of health knows that there are huge health and economic benefits from bariatric surgery, public and private funding is limited.  Procedures cost between $18,000 and $20,000 privately, but the insurance companies will only pay a third of the cost up to a maximum of $8,000 even though it is in their economic interest to reduce the long-term economic effects of untreated obesity.’

According to the World Health Organization someone with a body mass index (BMI) of 30 or more is generally considered as obese. Obesity rates in New Zealand as a whole are just under 30% of the population, but among Maori the rates are over 48% and rise to 68% in Pacific islanders.

Now characterised as an epidemic, obesity in children and adults is associated with serious health risks that include hypertension, dyslipidemia, diabetes, fatty liver disease, obstructive sleep apnea, and psychosocial complications.

Professor Brown points out: `Obesity is a disease with far reaching consequences for health and well-being.  Weight loss has the potential to be one of the most powerful health interventions in our community.  Whilst prevention would be the ideal, preventative programmes just have not worked so far.  Diet and exercise programmes are only successful in the long term for 3% of patients.  It is not that obese people are just lazy and can’t be bothered; it is incredibly difficult to lose weight as your body defends your weight vigorously.  We believe it is time for New Zealand to look at ways to improve access to bariatric surgery.‘

Our client Stephanie Evans talks to NZ Business Magazine

A year ago Oasis Beauty owner Stephanie Evans achieved a significant milestone; she was no longer working for nothing to bankroll the business.
“I get paid every fortnight, just like the other staff members – I probably look forward to payday more than anybody else.”
Evans is the quintessential innovator; she recognised a problem and came up with a marketable solution – in her case creating “a skin cream that could smell, look, perform and feel the way I wanted it to.” It was loads of fun she says, but it was initially just a hobby she did after work and during the weekend.
That was 15 years ago and it was a couple of years before she felt sufficiently confident to expand the market beyond her own bathroom. She began selling in a small way; “I’d have a table at local fund-raising events, I did expos and even a five-year stint selling by party plan. At that stage I was still working full time and making the creams in the weekends.”
Today manufacture is outsourced – but remains in New Zealand – and 16 different Oasis Beauty products sell online and in 250 retail outlets throughout New Zealand.
Key to success was listening, particularly to negative feedback, and making changes to the formulae she was producing. “I was solving problems and over time the negative feedback diminished and women were making repeat purchases. It was then I felt I had created something that had the potential to provide me with a modest living.”
Going to market was a gradual process. “Stepping up from school fetes to lifestyle expos to online selling, then retailers; but now I’m an overnight success!”
The business has evolved as she learnt more, says Evans. “The real challenges have come with the astronomic growth curve Oasis is currently on. This needs to be handled very carefully as I’m not prepared to carry a lot of debt to finance growth.”
She’s a perfectionist but believes sometimes getting to market is better than waiting until all the T’s are crossed and I’s dotted. “You have to make a decision to go for it at some point and deal with unforeseen issues as they arise.”
New Zealand is a small market; particularly for a skin care specialist company. And while Evans has two obvious ways to grow the business – increase the product range or export – neither are currently options, she says.
“About five years ago I went through the process of simplifying the range and deleted a number of products where sales didn’t justify carrying them or they didn’t fit
my strategy.
“It was a good decision. Carrying a smaller range of multipurpose products means we are more focused with our marketing efforts; our raw and finished inventory stockholding is healthier and I’ve been able to improve our GP by negotiating better packaging and manufacturing pricing.” Any future additions to the range will be customer-driven, she says.
Deciding not to export wasn’t easy. “I spent a lot of time going down the track of being export-ready and it’s taken me about three years to decide against it. I believe there is still plenty of scope within the domestic market for Oasis to grow and that’s where my focus is.”
It was a decision based on stress versus reward. “Exporting could deliver big bucks but it would also bring increased stress levels and financial worries. Life’s too short for that and I’m enjoying the journey Oasis is currently on. Saying that, I’ll always look at any opportunities that present themselves, but I’m not actively chasing export business.”
It’s chasing her though; online sales around the globe are growing and Evans would like to see that continue. “Online selling is an area of the business we put a lot of effort into and that’s showing in our growth figures.” She sees e-commerce as supplementary to their other market channels and uses the Oasis website to support and drive business to
their retailers.

Effective online strategy
Evans is a firm believer in the value of an effective online strategy and advises any small business to put aside budget for this. “Whether you sell online or not you need to have a decent website.” It needn’t be expensive. “Ours cost a very small amount and returns that investment every week.”
Most of their online work is handled in-house but professional help is sought when required and they’ve budgeted for a website update
next year.
Oasis spends “a fair amount on online advertising and you can’t use social media platforms such as Facebook nowadays without putting money behind your posts.” (Actual spend is currently around three percent of turnover.) That said, the majority of new business comes from word-of-mouth. “This is testament to the years of R&D I undertook to get the products right and the effort
we put in to providing customers with a really good experience. Nothing beats good service.”
Ten years ago, Evans relocated to Oxford in rural North Canterbury. It’s an idyllic lifestyle, but there are challenges for the business. Initially she had to load orders into her truck and drive to the designated courier pick-up point. “Rain, hail and snow, every day! Once my volumes picked up I threatened the courier company I’d take my business elsewhere if they didn’t pick up.”
Couriers now come to the door – frequently stepping over Tom the pig, sunbathing on the doormat.
Getting round to see customers is another challenge. Evans, who travels the country for face-to-face sales and training calls, says the amount of driving and flying can be tiring. “But it’s worth it to be able to operate the business from the beautiful area we live in. It’s a very stress-free environment and I love getting home at the end of the week.”

Read more http://nzbusiness.co.nz/articles/15-year-overnight-success

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Good Healthcare Communications Vital in a World of Competing Authorities

By Peter Boyes

One of our defining characteristics as a species is the nature of our communications with each other. How effectively we communicate is central to our societies. It’s at the core of how we learn, work and play. But there is one arena in which the quality of communication is vital and that is healthcare.

When it comes to communications about healthcare we’re talking about situations where people feel particularly vulnerable and afraid. Good communication is essential to deliver safe, effective, informed care but it’s a field in which advances in information technology and the internet are making it harder paradoxically to do it well surrounded as we are by a host of competing authorities.

It’s tempting to blame the scientists for doing a such poor job of communicating science to the public and countering the myths about healthcare. I’ve met a lot of scientists and medical experts in my career and generally communications is not their key strength. But by and large the public doesn't learn about science from scientists or medicine from doctors. Scientific, and this includes healthcare information, is mostly transmitted by word of mouth and a host of other non-experts competing authorities including celebrities, teachers, journalists, the authors of pot boilers and, yes, PR people.

There is no doubt we do need to do healthcare communications better. There is a lot of ‘stuff’ out there.  Our audiences are becoming less able to understand information about healthcare at a time when we are awash in raw data from an explosion of media through online access.

In the most technologically advanced western society literacy in science is falling. You might assume that a country that can journey into outer space at will and dominates inner space through Silicone Valley would be at the forefront of scientific understanding. However, the USA has now slipped to 24th among developed nations on the OECD 2012 Program for International Student Assessment (PISA), which ranks the science literacy of 15-year olds.

This at a time when the proliferation of anti-science conspiracy theories is affecting the health and lives of millions. One example is the anti-vaccination movement, an irrational trend of mistrust of vaccines, or their ingredients. Its followers pick and choose bits and pieces of ‘evidence’ to claim vaccination causes a range of illnesses, which current scientific research has not yet fully determined.

People have forgotten that vaccine-preventable diseases have ravaged humanity throughout history. Only in very recent times have vaccines changed this significantly. Most Western societies barely remember the time when diseases such as mumps, measles, smallpox and polio were everyday and often deadly. Yet we are on the verge of allowing some of these diseases to reemerge by failing to communicate the benefits effectively. The UK and New Zealand both rank much higher on the PISA list for science literacy (12^th and 6^th) and yet both have also seen recent measles outbreaks linked to falling vaccination levels caused by ill-informed anti-science debate.

Vaccination levels have fallen in New Zealand, the UK and the US following this often one-sided publicity about vaccine safety and possible side-effects. Among these discredited allegations is one that vaccines cause illnesses such as autism. In spite of the science countering this some alternative healthcare practitioners and prominent celebrities have continued to speak out about the supposed danger of vaccines. Measles can kill children yet people are still given media time to claim that vaccination is more of a danger.

We don’t need to look very far back to see how anti-science positions and a failure to communicate health messages effectively can lead to death and suffering for millions of people. For years many jursidictions refused to accept the scientific evidence that the human immunodeficiency virus (HIV) causes AIDS and so did not provide pharmaceutical treatment to infected people.

Some estimates put the death toll cause by HIV denial at 300,000 people in South Africa alone, with hundreds of thousands more elsewhere. And that damage continues. Disinformation and poor communication about HIV and AIDS continues in many parts of the world with enduring resistance to reducing the spread by advocating for the use of condoms.

Much marketing communications of branded health care products or related benefits promotes its own agenda by undermining the basic scientific method so that our publics no longer understand that systematic logical investigation (science) is the best system we have for gaining knowledge.

Instead the makers of collagen capsules for a wrinkle free face, or powdered deer velvet purveyors for the relief of rheumatic pain, or mineral water packagers and brands promising cures for baldness, better milk, honey, or fat free alternatives, highjack or distort science to suit their own stories.

It leaves us with a public ready to believe all sorts of nonsense. Not just that a snazzy package will make the contents better for you. According to a much quoted 2005 Gallup poll about a quarter of the people surveyed in the USA, Canada and the UK believed that astrology has a real effect on their lives and communication with the dead was an actuality.

People forget facts and need reminding regularly not just about measles and vaccination and HIV and condoms but about the importance and relevance of science itself so that they can come to an informed understanding of their health care needs. But in order for them to do that people need to be able to think about the evidence scientifically so they don’t have to make a choice between faiths in competing authorities.

The Watchdogs Have Left The Building

By Peter Boyes

Is anyone really surprised that the New Zealand Herald has had to apologise unreservedly to the family and friends of Guy Boyland following the incorrect use of two images in the newspaper paper and on the New Zealand Herald website?

When I trained as a news journalist and TV presenter, some years ago now, the accuracy of the story, the details of the what, where, when, why and how of the piece were vital. As young journalists we feared and hated in equal measure a strange breed known as the sub editor. We, of course, thought our purple prose as perfect in every way. The sub editor knew better.

The seasoned old hacks whose job was to make sure our reports were clear, correct, concise, comprehensible, and consistent often struck fear into an aspiring young Hemingway’s heart as they put a red pen through any suggestion of florid inaccuracy. And any protest would invariably be met with a well rehearsed "make it say what it means, and mean what it says".

Then there was the question of editorial judgement. My first news editor, would apply a simple rule to whether the paper would run a story – she’d hook her thumbs in her dungarees and ask `Is it sexy?’ It was her shorthand for the old BBC Reithian principles of would it educate, inform and entertain.

The news media in New Zealand is often reported as being in its death throes and there is no doubt that in some circles this latest incident will be regarded as the dwindling thrashing of a mortally wounded beast. But before we run through the gamut of the reasons our traditional media is dying and jump up and down and blame the internet, let’s look at something more fundamental that’s changed how we look at news.

In the years since I trained as a journalist, what has happened is that increasingly the first two Reithian elements have fallen by the wayside.  Educate and inform? Don't make me laugh. It's now only about entertainment. Simply put, nothing else matters.

New Zealand media commentator, Colin Peacock has described the process of news degradation in this country as:  `news that's become condensed and morselised, over-dramatised and under-contextualised. And more of it concerns relatively trivial topics.’

Just leaf through the rest of the print media or ponder on the dire state of TVNZ’s excuse for news coverage. Nothing else matters except the question is it sexy, even if Peter Williams sometimes forces himself to ask it through gritted teeth.  When you bring in the accountants and the ratings analysts to monitor your news output, they are inclined to take a book keeper’s approach that has no place for the traditions in journalism, such as factual accuracy, balance and social responsibility.

The focus shifts from news as a product to the bottom-line. And the more common and basic and bottom that bottom line is the better. As Henry Mencken, one of America’s most influential journalists wrote: ‘no one ever went broke underestimating the intelligence of the (American) public.’

New Zealand’s media managers are following in the footsteps of Larry Tisch, the US hotel magnate and financier who took over CBS, overseeing its decline as a news provider. He was sarcastically celebrated on the cover of Esquire with the words, ‘Larry Tisch, who mistook his network for a spreadsheet.’

News is just not a big money maker so it moves to the bottom of list of priorities. And no one complains, so it doesn’t become a political issue. It’s easier for our politicians to deal with short form commercial radio as an entertainment slot rather than an in depth analysis of their policies. When the New Zealand Prime Minister refers to a minor celebrity shock jock by a pet name, it's time to worry about the health of the fourth estate and it's ability to protect the third by holding the others to account. There’s every incentive to keep Radio New Zealand short of funds, pat TVNZ on the head and slap the New Zealand Herald around behind the scenes for impertinence.

In the meantime, local journalists and New Zealand stories are cut. It’s cheaper to fill the space with syndicated reports, which is why we get stories about relatively trivial incidents in the US on our TV. If there happens to be some cheap overseas footage available, well it’s easier than sending a crew to Nelson or even Auckland’s North Shore for something serious.

There is less in depth international coverage, the pieces are shorter and softer and the news becomes bland and McDonalised. A colleague of mine has just been made redundant as a sub editor on the New Zealand Listener after almost thirty years. Have you tried to read it lately?

It’s not just the Listener. The same problems afflict much of the news output.  Factual errors that would have been picked up a good sub editor slip by.  Spell check or an outsourced agency, in somes cases overseas, with no understanding of the New Zealand context have replaced the informed sub editor and we see spelling and grammar mistakes, typos and factual errors proliferate in published pieces.

The new economics of news rooms requires that reporters piece together stories from Google search, which means old errors are perpetuated and multiply. There are no budgets to travel and interview real people so consequently their voices often go unheard.

Not only that media businesses are disinclined to consider stories in which they do not see a financial benefit. TVNZ’s move into advertorial production through its Blacksand subsidiary is a move in a dubious direction which is leading to a blurring of news values.

There is every incentive for preference in ‘news’ coverage to be given to a commercial partner. Those singers or television/movie stars appearing on the Breakfast or Good Morning are often there because they are part of an overall commercial relationship, promoting that relationship in an incestous cycle and distorting what we see. 

We hear a fair bit of criticism from ‘professional’ journalists and politicians about bloggers such as Whaleoil and the peripatetic tribe of citizen journalists that inhabit the web, but they are often the only watchdogs capable of keeping what passes for the mainstream media connected with some vestigial news values.

It is this new breed of reporter that increasingly breaks the news first and highlights the mistakes and factual errors littering our media. In this they are starting to set the news agenda, and provide interpretation and analysis of issues and events instead of interviewing each other like the staff at TVNZ or eliciting opposing quotes from pet pundits in the name of ‘objectivity’, which is the flavour of the moment at Radio New Zealand.

I've often said when I speak on media relations that up to sixty per cent of news output in New Zealand is originally generated by public relations people. I argue that this is because the skills exodus from mainstream journalism means that there are more, better qualified news reporters in New Zealand PR consultancies than are left in the media itself.

The most important differentiator of PR from advertising is the power of the third party advocacy represented by editorial independence. If a PR agency can persuade a media outlet of the importance of its client’s story as compelling news, the coverage generated is, because of its ‘independence’, so much more valuable than an advertised message. People believe it because it is on the news or in the paper.

The problem is that if there are no watchdogs left to police the media’s output, making it say what it means, and mean what it says, is likely to be powered by commercial self interest rather than news values.

And as that happens, the news itself becomes devalued and its use as a PR medium ironically becomes less effective as no one believes anything anyone says any more.

CONCUSSION CAN HAVE EFFECT ON SPINES OF YOUNG ATHLETES, WARN NZ CHIROPRACTORS

The New Zealand public is largely unaware that concussion injuries can also affect the spine and this is especially of concern in young athletes, according to the New Zealand Chiropractors’ Association.

In light of the recent death of a young sportsman, the NZCA stresses the potential seriousness of head injury in sport and the need for careful screening.

According to Dr Hayden Thomas, chiropractor and spokesperson for the New Zealand Chiropractors’ Association, concussion, also known as a mild traumatic brain injury, occurs from a blow to the head or violent shaking, with approximately 24,000 cases in New Zealand every year^[1]. It is a common injury in sport, with most individuals recovering in 7–10 days but some have persistent symptoms of dizziness, neck pain and/or headaches following a sport-related concussion.

Dr Thomas explains: `We have had a number of reports lately where chiropractors have seen individuals with head injuries, some of which have been diagnosed with concussion, but our members have been shocked that most of the people affected did not understand the neck and spine were also traumatised by the blow to the head. Many people also don’t realise the link between upper neck dysfunction as a possible cause of headaches and dizziness which often gets passed off as coming from the mild traumatic brain injury but responds well to chiropractic care.

`It is paramount the cervical spine and nervous system are checked with any such injury to the head. We know that concussions occur in all contact sports with the highest incidence in rugby, soccer, hockey and basketball and that youth athletes may have a more prolonged recovery and are more susceptible to a concussion accompanied by a catastrophic injury^[2]. A greater number, severity and duration of symptoms after a concussion are predictors of a prolonged recovery.’

Dr Thomas points out that New Zealand is leading the world in research into the neurological benefits of chiropractic but that work related specifically to the chiropractic management of concussion in sport is a nascent area of investigation in need of more funding.

He notes: `Recent work looking at a combination of cervical and vestibular therapy, which is also carried out by chiropractors trained in sports medicine, shows that there is decreased time to medical clearance to return to sport in youth and young adults with persistent symptoms of dizziness, neck pain and/or headaches following a sport-related concussion^[3].

He adds: `Chiropractors commonly encounter concussed athletes in clinical practice and we encourage our members to understand the importance of using standardised concussion assessment tools and current concussion guidelines.’

Athletes should be aware that chiropractic care to restore the proper function of the spine and nervous system can help in the post-concussive situation and also in the maintenance of spinal function and optimum sports performance.

-Ends-

Further Information:

Dr Hayden Thomas, Chiropractor 027 299 9939

Peter Boyes, 027 554 0500 or peter@boyespr.co.nz

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^[1] http://www.brain-injury.org.nz/html/concussion.html

^[2] http://bjsm.bmj.com/content/47/1/15.abstract?sid=2ea95250-41dd-4de1-a00d-1946feb83a8b

^[3] http://bjsm.bmj.com/content/early/2014/05/22/bjsports-2013-093267.short