Editorials from David Williams (Editor)

Editorials from BL#1 and BL#2
Editorials from BL#4 and BL#6
Editorials from BL#7 and BL#9
Editorials from BL#11 and BL#12
Editorials from BL#13 and BL#17
Editorials from BL#18 and BL#20
Editorials from BL#21 and BL#22
Editorials from BL#23 and BL#24
Editorials from BL#25 and BL#26

The fat is in the fire
Vegetables, fish, meat and fruit are largely overshadowed by beer, crisps, burgers and chocolate.  The supersizing ploy of fast food marketers offers a perceived bargain in quantity of food that, combined with lumbering periods on the sofa, poses a real threat to quality and duration of life. Britons are becoming a nation of fatties prone to heart disease and cancers borne from a wider girth and inactivity. Science and medicine may have made great strides in modern millennia, but the practice of a naturally healthy diet and exercise has regressed.  How much of a threat does being overweight pose to health? A Harvard study a few years ago examined the health impact of body mass index (BMI). Beyond confirming the dreadful impact of obesity and its association with illnesses, the study finds people who are overweight but not obese (BMI 25–29.9) faced an increased risk of several serious illnesses, and men were at an enhanced risk of stroke. The Harvard study concludes that men with BMIs 22.0–24.4 are significantly more likely to develop at least one of the weight-related illnesses than their leaner peers with BMIs 18.5–21.9. Although BMIs of less than 25 are healthy, BMIs below 22 are healthier.
     Men with BMIs of less than 18.5 are underweight; 18.5-24.9 is considered healthy; 25-29.9 is moderately overweight; and 30 or above indicates obesity.  As for what constitutes the ideal diet—it depends on whom you believe. Diet and nutrition books could fill a modest library, ranging from scientific and medical books to populist publications, and even diet books written by doctors have carried a whiff of controversy, notably the lowcarbohydrate, high-protein Atkins Diet.
     The modern consensus is to consume a Mediterranean-style diet rich in fruit, vegetables, whole grains, olive oil and fish, and to combine this with daily exercise, say researchers in a study in the New England Journal of Medicine. They conclude such a programme reduces heart disease and cancer by “at least 25 per cent”.  What the results underscore is the importance of the full Mediterranean diet, rather than one food type. The study enlisted 22,043 adults, aged 20–86, in Greece, who were tracked for an average of four years. Diabetics and those with heart disease were excluded.
     Participants scored a point for drinking moderate amounts of alcohol—about a glass of wine a day for women; two glasses for men—but got a zero if they imbibed more or less. Regularly consuming meat, poultry, sweets and dairy added no points and resulted in a lower overall diet score.  Taken into account were age, sex, years of education, smoking status, BMI, and waist-to-hip ratios, which help determine risk of heart disease and diabetes.  The study finds the higher the healthy diet score, the lower the risk of death.  For every two-point rise—achieved, for example, by eating vegetables, beans and nuts daily—the risk of death drops by 25 per cent.
      Daily physical activity plays a critical role in reducing mortality from heart disease and cancer, the study finds. People who engaged in at least an hour a day of vigorous activity had a 28 per cent reduced risk of mortality compared with their more sedentary counterparts.
Unequivocally, eating fatty foods, supersizing them for a higher intake of unhealthy calories, and protracted inertia are not the building blocks of health. Studies are, of course, intrinsic to the empirical method and advance our knowledge. But one must question whether the problem is intrinsic with modern individuals, who are simply lazy and don’t eat sensibly. Perhaps time could be better spent researching yawning gaps in knowledge that demand more of science to fill in than good, old-fashioned commonsense.

How self-regulation will work by Sally Taber
The independent Healthcare Advisory Services (IHAS) represents the interests of the independent healthcare sector and provides practical information and guidance regarding regulation and policy.
     Approximately 4,000 providers of cosmetic treatments already exist across the UK and such treatments are one of the fastest growing areas of the market. Such fierce competition means the cost of treatments is reducing and are more widely available than ever. But these consumers tend to have little awareness of the associated risks to treatment or who to go to when things go wrong.
     Although there are no registration requirements or health and safety standards for cosmetic treatments, we are working fast to ensure a model is in place as soon as possible. Setting up the self-regulation model is a complex task that the IHAS takes very seriously. Our key objectives are:
• to protect patients by establishing an accepted set of good practice standards for non-surgical cosmetic treatments, and
• to ensure that training courses are producing safe, competent practitioners.
     The key to meeting these objectivesis a set of professional standards for the use of Botox and dermal fillers for cosmetic treatments and standards for organisations registering with the scheme. The standards are underpinned by the Medicines Act and the Health and Safety at Work Act Part 3. These are out for consultation until April 14th and can be downloaded from the IHAS website at www.independenthealthcare.org.uk.
     A further set of high-level principles for training courses—including a broad framework for accreditation of training and competencies flexible enough to accommodate existing high quality training and independently evaluated—will ensure that an injectable cosmetic treatment is carried out by an appropriately trained professional.
     By the summer, there will be a registration scheme for a quality mark. It will not duplicate or gold plate existing local authority GMC, NMC, GDC or other regulatory requirements. It will be easily accessible to the public with information about completion of accredited
training readily available. There will be a variable registration fee structure, which minimises costs overall and is proportionate to the ability of the organisation to pay.
     The scheme will be enforced by an independent inspectorate and a risk-based inspections regime that takes account of evidence of good or bad practice before inspections, as well as random sampling. Financed by registration fees, the inspections system will be further strengthened by a credible and transparent complaints procedure, giving consumers a route through which it escalates unsatisfactory outcomes.
     The self-regulation model and quality mark will be a “brand” with high recognition of name and logo by potential customers. There will be an independent governance regime involving non-industry representation. Customers will know to look out for the quality mark and brand when seeking treatments and will trust organisations who have it. Furthermore the media, government and consumer groups will recognise the distinction between members and non-members of the self-regulation model, thereby reinforcing it. Providers not affiliated will struggle in such a highly competitive market. In 2010, the government will review the model.
     There is a long way to go, but we are confident it will find a model that offers protection for consumers, confidence for providers and an industry that everyone can trust.
Sally Taber is director of IHAS, which is distributing a newsletter to provide regular updates of its progress. Subscribe by emailing IHAS on info@independenthealthcare.org.uk.

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