Monday 20 to Friday 24 May is Walk to School Week.

The aim of Walk to School Week, which has been going since 1995, is simple: to encourage all parents, children and young people to make walking to school part of their daily routine.

I know when I was a kid I lived a mile from my junior school and subsequently a mile in the other direction from my grammar school. And I walked to school; in fact for much of the time I came home for lunch so walked about 4 miles a day. (OK, I admit I was a lazy teenager and sometimes got the bus to school, but that depended on being in funds as I didn’t get extra allowance for bus fares.)

Walking is good for us and we almost all walk far too little (guilty as charged!). Far too many children get taken, even short distances, to school by car. Parents get scared (usually unnecessarily) of kids being molested or abducted, parents are in a hurry to get to work themselves, or I’m sure in many cases they’re just plain lazy.

But as always there are many benefits to walking: save petrol — and thus save money and the environment — improve health but getting more exercise; and parents walking children to school are spending quality time with their kids, and maybe even teaching them things about the world around them. Get into the walking habit and hopefully it will stay with you for life.

As always there is more information on the Walk to School website at www.livingstreets.org.uk/walk-with-us/walk-to-school.

This year’s Walk to Work Week runs from 13 to 17 May.

It is generally agreed that in modern society we don’t walk enough (guilty as charged!) because walking is a great way to maintain fitness and helps keep the heart healthy. For those who work outside the home, walking to work also saves on petrol and bus fares, and is better for our planet. OK, walking to work isn’t feasible for everyone so as an alternative why not have a lunchtime stroll in the park or along the river?

You can always use walking to work as a way to raise money for your favourite charity, or just to be like Charles Dickens and Wordsworth who went on walks to get inspiration!

Find more information at www.walkingworks.org.uk.

Back last September I wrote about a Scientific American article which proposed that to reduce the spread of ‘flu we should vaccinate children — because it is children, not the elderly, immuno-compromised etc., who are the super-spreaders.

Imagine my astonishment yesterday to see that the UK government is proposing to do just this! Yes that’s right, they’re going to give every child (aged from 2 to 17) an annual ‘flu inoculation. According to yesterday’s Independent report:

All children aged two will be offered a nasal flu vaccine from this September. The programme will be rolled out to all primary and pre-school children next year, with secondary school pupils starting to be vaccinated in 2015.

OK, it would be good if it could all be rolled out this year, but I guess it may in part depend on the vaccine producers’ ability to ramp up production as well as the ability to get suitably trained staff in place to do the work.

But I’m astonished that the politicians have actually listened. I’m even more astonished that they appear to be willing to find the money. Let’s hope dream turns into reality.

As some of you may know I’ve managed to get myself embroiled (at a local level and from a patient perspective) in some of the health service reforms which are now happening.

Partly as a result of this I’m reading Ben Goldacre’s latest book Bad Pharma: How drug companies mislead doctors and harm patients.

Even if only 25% of what Goldacre alleges in the first quarter of the book is true (and that seems conservatively low) there is a scary, systematic and unethical ethos pervading the whole of the pharmaceutical industry which emanates from both the drug companies and the regulators.

At the end of the first chapter [p.99], where Goldacre has discussed the problem of missing drug trial data, he issues this challenge:

If you have any ideas about how we can fix this [the missing drug trial data], and how we can force access to trial data — politically or technically — please write them up, post them online, and tell me where to find them.

What follows is my small response to Goldacre’s challenge.

— o O o —
As patients there is not a lot we can do to address these issues; they’re just too big for the man on the Chapham omnibus to be able to make, individually, a difference. Given that the drug industry, the academics, the medical professional bodies and the regulators have singularly failed to adequately address the issues, the major thrust of the resolution probably now has to come in the form of primary legislation across all territories — something for which sadly few politicians are likely to have the stomach and no government the priority. However that doesn’t mean we patients can (or should) do nothing. This is what I think we can do, at least in the UK.

1. Through our doctor’s Patient Participation Groups (PPG), and through our local LINk/Healthwatch/Health & Wellbeing Boards, we should be putting pressure on the medical world and specifically the local Clinical Commissioning Groups (CCGs, replacements for the PCTs) to force GPs to act ethically and without bias.

   One way to do this would be for GPs to be given guidance on what patients expect of them. This is likely to be way beyond the minimum acceptable standards required by legislation and regulation. And indeed I’m involved at my local level in drafting just that. I can’t say more about it at present as the work is still in draft form, uncompleted by the authors, unapproved by the sponsoring group and of course not yet delivered to its expected recipients. (That it is being done is in the public domain as it is referenced in publicly accessible meeting minutes.) However we are committed to it being published, and publicly accessible, when completed. With luck this will be before the end of the year, so I hope to return to it in a later column.

   But such guidance could contain clauses like (all my wording will need tightening):

   • Clinicians are expected to behave in unbiased and ethical ways. They must declare annually and publicly on their practice’s website all benefits received (services, goods, money) worth over [[name some modest value like £50]] received from any pharmaceutical company or healthcare provider (public or private). They should demand the same transparency from those who they themselves consult or to whom they refer patients.
   • All clinical trials/research in which a clinician is involved must be publicly registered and defined prior to starting and be referenced by the practice’s website. All clinical trial data (including anonymised patient-level data) and results must be published within 12 months of study completion. Again clinicians should demand the same transparency from those who they themselves consult or to whom they refer patients.

2. All members (medical and lay) of CCGs, Health & Wellbeing Boards, etc. must also make declarations as in 1 above.
3. Is it possible to find an MP who is willing to put down an Early Day Motion (or Motions) in Parliament demanding legislation to:
   • require all clinical trial data and documents (including anonymised patient-level data) be made publicly accessible, without hindrance, within 12 months of the completion of the study, and within 3 months to the appropriate regulatory bodies.
   • make all clinical trial data, whoever performs the studies, funds or sponsors them, subject to Freedom of Information requests at no charge, and with no exceptions, worldwide and retrospectively.
   • make gagging and other “interference” contracts illegal?

   We should then be encouraging our MPs to support the motion.

4. There doesn’t appear to be an e-petition to the government. What about it? The partition should require that the actions outlined in 3. above be passed into primary legislation during the lifetime of the present parliament. I guess this would need someone more skilled than I am at drafting to write the petition effectively and without allowing wriggle room.

   According to the government’s own rules 100,000 signatures on an e-petition should trigger a parliamentary debate. That ought to be achievable if everyone buying Goldacre’s book signs and gets another couple of signatures. Create a Facebook page and it could attract even more signatures.

No that isn’t actually a lot in terms of fixing a worldwide, pervasive problem with Big Pharma. But we have to start somewhere and it is probably as much as we patients can realistically do initially, at least initially. Items 1 and 2 should start a trickle up of activity. Hopefully 3 and 4 will start a hammer down.

Thoughts from anyone?

There’s a big brouhaha going on in NW London at the moment over the proposals to reorganise the way our hospitals work.

Needless to say all the local agitators and pressure groups are out in force, mostly peddling totally inaccurate messages like “Save our hospitals”, “You won’t have A&E services”, “Major cuts to your health service”.

Needless to say most of this is totally fictional and they have not understood the actual proposals, which are contained in an 80 page consultation document. I even wonder if any of them have read it.

I have been to several public meetings recently. I am appalled at the inability of people to understand the proposals, the way in which everything is parochial, angry and internalised, and their inability to step aside from “it might be inconvenient for me” and see the bigger picture. People are being angry and frightened, because they dislike change and they cannot (or will not) make the effort to understand.

Nevertheless, and although my GP is one of the team responsible for the proposals, in fairness I have to say they have not been well presented, in clear and straightforward messages and in a way which Joe Public can understand. Joe Public does not listen to detailed arguments (he never did!) but needs sound bites and simple statements. The NWL NHS team may be excellent clinicians, but they have not got good PR/marketing/presentation skills — and it shows. I’m no expert but a lifetime in business (including training) has put me ahead of the pack.

As a working thinker I have therefore made it my business to get involved. Having read the consultation document a number of times I have now distilled it down into a 10 slide, simple presentation for my doctor’s surgery patients’ group. And I have tried to help the NHS team to hone their messages.

Here is a copy of my presentation slides, which are on Slideshare. If you are in NW London then please read the presentation.

[slideshare id=14342271&style=border:1px solid #CCC;border-width:1px 1px 0;margin-bottom:5px&sc=no]

The bottom line is that this is roughly a 10% change in what the patient will see. In other words for every 10 people who go to hospital, one may go to a different hospital. All these hospitals are within something like an 8 mile radius — it’s not like we have to travel 30, or even 60 miles to hospital as is the case in many other areas of the country.

Now I’m not pretending the proposals are flawless; of course they aren’t. There are currently some big gaps like the lack of appropriate public transport services — something he NHS team are well aware of and are already discussing with Transport for London. However ultimately we have to stand aside from our parochial feelings and do what we know is right. In my mind, and regardless of the business case, these proposals are clinically, logically and logistically the right ones and should have been done years ago.

If you can, please also read the Shaping a Healthier Future consultation document.

When you’ve done that please have your say on the proposals; there is an online questionnaire.

The consultation runs until 8 October.

There’s an interesting short article in the October 2012 issue of Scientific American, which I was reading last night.

Under the banner Target the Super-Spreaders, Kathleen A Ryan proposes that the best way to tackle flu is not by vaccinating the elderly, the immuno-compromised and the pregnant. It is actually by vaccinating all schoolchildren between the ages of about 5 and 18.

The article doesn’t seem to be online, so here are a few key extracts:

[T]he most effective way to protect the elderly, and everyone else, is to target kids … Schools are virus exchange systems, and children are “super-spreaders” — they “shed” more of the virus for longer periods than adults.

Computer-modelling studies suggest that immunizing 20 percent of children in a community is more effective at protecting those older than 65 than immunizing 90 percent of the elderly. Another study suggests that immunizing 70 percent of schoolchildren may protect an entire community (including the elderly) from flu.

Perhaps the best example of the effectiveness of childhood vaccination comes from Japan. The 1957 flu pandemic prompted the Japanese to start a school-located childhood vaccination program. For at least 10 years vaccination against influenza was mandatory for all children. Excess deaths from influenza and pneumonia … fell by half … The study showed that for every 420 schoolchildren immunized, one life was saved, predominantly among the elderly. Once the program ended, immunization rates fell, and death rates rose dramatically over the next few years.

In Alachua County, Florida … a school-located influenza vaccination program has been in full operation since 2009. Implemented as a coalition of schools, health departments and community advocates … the program administers FluMist nasal spray, a live attenuated vaccine, free of charge to students, from pre-K to 12th grade, in public and private schools regardless of insurance status. Immunization rates of elementary students have reached 65 percent — enough to reduce the incidence of influenza in Alachua County during the past two flu seasons to nearly zero.

School-wide vaccinations would require a big conceptual change in immunization strategies, involving schools, communities, paediatricians and health departments. Who will fund and lead such an effort?

Well who’d have guessed it? Kids spread germs. Sounds a sensible strategy to me. But it needs a paradigm healthcare thinking. Just a little something else for the NHS to get its teeth into!