Matt and I are heading up to Salford on the train, it’s pitch black, and dead depressing. This cheered me up somewhat and stirred a long gone memory.

I only just remember my sister being ill when I was about 6. A more distinct memory was her accompanying bear; Peri.  Peri pretty much was present all the way to health. Every now and then Peri is discovered still with his hospital wristband on and much smaller than I remember.  I now know that this little bear was named after a Heath Robinson looking yogurt pot, tube and bag gizmo that provided her with the peritoneal dialysis needed whilst her kidneys took a kicking,

This enterprising inspiring mum took her son’s similar requirement for a cancer companion to the next level. Just after his first birthday, Gabe’s mother, Lu Sipos, made the very first Chemo Duck for him. She thought he could use a companion to take to the hospital, one with whom he could share his journey back to health. Both Chemo Duck and Gabe finished treatment in November 2003 and have remained cancer free since.

Since then Lu along with a board of directors and a newly formed not for profit organisation have taken the chemo duck and made him fly. Chemo duck is now in production and the team are striving to give away 10,000 of these donated friends by Gabe’s 10 year birthday.

More than a companion chemo duck has become a vital part of ‘medical play’, a concept that allows children to communicate with parents and healthcare professionals, offering a window into their world midst the turmoil of cancer. Chemo duck is used time and time again as a powerful therapeutic and teaching tool used in medical facilities to familiarize children with cancer protocol and procedures.

Pretty cool eh?

This article was written by Max G, an account executive candidate as part of a first interview to help us see where his MA in International Relations from LSE and our world of healthcare collide. We are delighted to welcome Max to Hive in January.

This is, to quote Tim, a Darwinian moment. The cusp of a revolution and a moment for new thinking and creative minds. The patient is coming, the power structures are diversifying and it’s the job of folks like us to harness that power and use it to effective ends for our clients. Critically, this will mean truly respecting the conflicting and often contradictory wants of patients, instead of merely seeing digital and all things social as just another channel for vulgar old-ad indoctrination. More than anything else, this will mean actually listening to patients: learning from them and understanding their needs beyond the most basal of levels.

Just for the sake of thinking, it’s fun to draw parallels across disciplines. It can also be genuinely productive.

Take the body of literature surrounding U.S. Public Opinion and U.S. Presidents. At the LSE I took a course that addressed the interaction between Presidents and public opinion and I was particularly fascinated by the moment at which the existing consensus completely broke down. Critically, the power-players – i.e. the President – had absolutely no idea how to handle the new climate. It was akin to Reagan’s Secretary of State, George Shultz, visiting Gorbachev in the Kremlin in the late 1980s and telling him ‘The Information Age will destroy your economy if you don’t afford it the room to breathe’. The powers that be were the ones to lose out.

Think of the drugs companies as the President and the patients as the voters. To take the cast a step further, imagine Carter’s team of experts and his Presidential pollster Patrick Caddell – as the tired old ad man who simply clings to the methods of old.

Prior to the end of the Vietnam War and the election of Jimmy Carter in 1977, political scientists and commentators alike agreed that the ‘bully pulpit’ style of Presidential leadership dominated and that the masses had little to say or think, other than that which they’d already been told. In other words, if the President shouted loud enough, the public generally went along. The people were ignorant and malleable. This was termed the Almond-Lippmann consensus.

Similarly, for years the GP-patient relationship consisted of linear, one directional messaging where the GP told the patient what’s good for him and the patient minded his Ps and Qs. Why, as a patient in this climate, would you engage with a brand that meant nothing to you? You were simply told to take it. The brand name sounded scary and the active ingredient scarier. There was no reason to connect with a brand and more importantly, no one had ever muted it as an option. The President knew what was best for you.

Back in the world of politics, The Vietnam War changed the underlying conditions of public opinion dramatically and new scholarship by the likes of Katz and Witkopf asserted that the public was increasingly ‘activated’ on foreign policy issues. The consumer of policy had suddenly woken up. The trouble was, no one had bothered to tell Carter. Or rather, both him and his top-team wouldn’t listen. In critiquing the failures of Carter, one school of thought argues that Carter’s bold and brazen honesty and New World Agenda was simply too much for a typically Conservative American electorate to consume in one go. Honesty, it is argued, was the cause of his failure. For another school, Carter simply didn’t care about public opinion at all.

On the contrary, Carter failed not because he cared nothing for public opinion, but because he failed to appreciate the changes to the underlying landscape and continued to treat the electorate – or for the sake of this analogy his ‘customers’ – as ignorant drones ready to be led. The contradictions in their views meant nothing; little had really changed. From this rapidly expiring rationale, Carter tried to sell something like his human rights policies as ‘non-ideological’ and one-fit-for-all, as opposed to understanding the complex underlying reasons why different voters supported the very same policy, but for markedly different reasons. Far from pleasing everyone, this linear approach to strategy failed everyone.

Back in the world of health care in the 21st century, almost all major stakeholders now appreciate the degree to which the landscape is changing. They get that choice and patient empowerment is coming and that patients are broadly embracing of it. Worryingly however, many traditionalists see this new medium as broadly compatible with the tired old information dissemination of old. Bully pulpit ring a bell?

That’s where Hive and our team of smart cookies come in. We see the irony in giving a presentation on digital in a room full of stuffy insider types through the medium of an overhead projector. Instead, we actually seek to understand patients in their most complex – and thus natural of underlying forms. We tailor our clients’ products to this end and take power back through the empowerment of others. To some observers, this method might seem like pretension defined. Or to others as a serious challenge to the status quo. To us, it’s a holistic approach to the demands of an entirely new and still-emerging world. Digital isn’t just a corporate buzzword and choice means genuinely listening to and respecting the needs of patients.

The way we see it, you can either come with us for the ride or end up like another Jimmy Carter – as much as we love the old peanut farmer.

Come back with me to February 1, 2002. The isle is burning in a cold storm. A South African disembarks in Durham City. Note the sleet melting into her clothing as she hauls 20 kg of backpack up a cobbled street. Hey Isle, it’s me! Luugging his own baggage up this hill, quite immune to my whining, is my fellow émigré Greg. Here we are in the picture on a Skype chat.

Greg was newly qualified in medicine and had secured a urology house officer post in Durham’s teaching hospital. I was a copywriter with an ancestral visa (4 years – sweet). We were best mates. We rented a stone cottage. I got a job helping farmers claim foot & mouth compensation. I also waitressed and went clubbing with my new friends. Come July, we had to get serious. I had to write, and Greg had to get on the proper rotation scheme. I was going to Ealing. He was going to Croydon for August intake. We divided our cups and spoons and we parted.

Greg is now almost in his consultant brogues and I’m doing pretty well my stuff too. I offer you this story because it frames the August system in a ten year period, a good time to assess whether it is working.

The firmament of the NHS is its focus on the patient. If the patient is dying, there is the rush of reflexive action. If the patient has died, there is, ideally, calm reflection. Studies like this one will now be pulled into many different shapes. The focus spreads to the carers and the cash. You have to keep the doctor on the most effective, least expensive training path. Staggering teaching would be difficult. If it means more red tape, the government probably doesn’t want to know right now.

You can read this training story here and do some reflection of your own. With all the cuts and punches, note that it hasn’t made the mainstream health news. Remind yourself that in 2012, training will be absorbed into the new Health Education England and NHS Trust Development Authority. And watch this space to see how our little Scottish study stands up in the storm.

I was fortunate enough to have been on the UK launch team for Viagra, and we were desperate to ensure that it was promoted ethically and was given enough space to be taken seriously – as a product that met a genuine patient need. One that impacted on the lives of millions of people.

The press went mad, “sex drug” shouted from every red top. Knee jerk Health Secretary Frank Dobson’s fears about rampant demand introduced restrictions, which clamped down treatment provision resulting in only 17% of those men who would benefit getting a prescription. GPs were told to restrict their prescribing to one pill per week. All driven by fears that the NHS would be swamped by demands for the new drug.

It’s all seems ages ago and now strange to think of a Health Secretary wanting to dictate the sex lives of their citizens. ‘Once a week Dobing’ was laughed at by many, but still acceptable.

The category perceptions changed, and ED was forced into the sunlight. Now discussed and treated  in a very different world. Walking in Soho with Debbie I spied this photo, a demonstration that perceptions change, but somewhere some of your audience remains intransient.  How things have moved on!

I saw this poster a little while ago at Maidenhead Station, took a photo to remind me to hunt around and I have finally got around to exploring more.

The associated film is a hard hitting view on Motor Neurone Disease,  has been banned from TV despite being one of the best eye openers I have seen. It seem a terrible shame when the reality of a disease is shelved for the public good.

Alongside this film and poster  the featured sufferer Sarah Ezekiel has a site showing life post diagnosis and provided me with a great example both of human spirit and inspiration.

My immediate answer was to say, of course they bloody shouldn’t be paid! Treatments are prescribed to make people feel better and help them function in the world, surely that is incentive enough?

Hold on, I thought – it’s plainly not enough. Poor compliance is a fact of mental healthcare. It’s easy to speculate on why these patients would avoid their medication. We need to ask about the conversations they are having with their HCPs. Are professionals helping patients reach an informed decision about treatments?

Well, at least one survey says not really. Here, 59% of patients taking an antipsychotic reported that other treatment options had not been discussed. Almost two thirds said that they hadn’t been given written information prior to starting their medication. And 46% said hey hadn’t been warned about its potential side effects.

The NHS and HCPs need to look at the way they are engaging with patients. How many have read the NICE guidance on patient adherence and choice, published in January? And how is the NHS supporting them in implementing change?

Of course, it’s not easy for anyone. The befuddling thing about informed choice is that patients can refuse medication, and the professional’s obligation is to respect this decision. But what if the individual is antisocial, or a danger to self or others? Why are we paying these guys, really – what are the savings down the line? To make a judgment on this pilot, we need to know more about these patients other than that they are poor compliers.

If the scheme sees the light, bitter laughter will accompany jokes about kids being paid to go to school and likewise to adults for behaving on a night out. No-one’s going to like the idea of a pay-for-peace society. Whatever happens, let’s hope these patients get something positive out of it.

Patientslikeme.com is a privately owned initiative that encourages patients to post details about themselves. This real world, outcome-based data is shared with individuals and organisations who work to improve health outcomes, including pharmaceutical companies, research organizations, and non-profits.

30% of epilepsy patients are refractory to treatment, so this move is good news for patients, HCPs and even competing Pharma. Over 37,000 patients are already registered on the site as well as 3,000 caregivers. Any epilepsy community should include the voice of caregivers, as a significant proportion of epilepsy sufferers are elderly or have learning disabilities.

Patientslikeme.com doesn’t just collect data from patients, it provides quality information and allows them to blog and communicate with peers. It’s a site that really does seem to have patients’ interest at heart. That’s why we like it – and so congratulate UCB for being a part.

The researchers asked more than 700 people to look at outlines of both a male and female body and identify which of several shaded areas was a particular organ. The results are shocking. Less than half the respondents could correctly place the heart, while under one-third could place the lungs in their correct location. Interestingly, even those respondents for whom the organ had a relevance performed poorly – for example, more than half of those with renal problems did not correctly identify the location of the kidneys. These findings don’t exactly fit with the picture of the modern, tech-savvy, informed patient that lives in my head.

The researchers also said their findings raise concerns about doctor-patient communication. No shit. Try having a meaningful conversation with a quantum physicist about string theory, without knowing what strings are or where they live. I tried. It’s difficult. Especially when drunk.

And, with the introduction of patient choice in healthcare, concerns about health illiteracy are only become graver. Should Joe Public, who doesn’t know his prostate from his pancreas, really be at the helm when it comes to his healthcare? Would you let me, a copywriter, service your car? Didn’t think so.

This, by the way, is not an argument against patient choice. But, let’s get realistic. The patient needs advice, information and support before being able to take on the role of ‘healthcare chooser’. Or, at the very least, lessons in basic anatomy.

Researchers at Intel Corp will translate this data into a ‘behavioural baseline’ for Mrs. Smith. Any deviation from the norm could be a signal that something is amiss. Although research is at an early stage, it is hoped that the technology will eventually be able to recognise the patterns of behaviour that are characteristic of certain early-stage diseases, like Alzheimer’s.

It would currently take many years to determine if Mrs. Smith was developing dementia, and this technology shows promise to shorten this timeframe considerably. Early diagnosis translates into improved outcomes, and so intelligent houses may become an efficacious (although expensive) healthcare intervention. However, as with all nascent technology, many people are worried about the potential for abuse. You’d be worried too, if you’d seen Demon Seed.