nnadis-healthcareandpharma

Our Patron: Archangel Michael

Fri, 06 Dec 2024 13:17:33 GMT

Following on from our “Faith & Medicine” article and in keeping with the theme of spirituality, I’d like to announce that the Archangel Michael stands as the patron of Nnadi’s Healthcare & Pharmaceuticals Ltd.

“St Michael the Archangel, defend us in battle, be our protection against the wickedness and snares of the devil. May God rebuke him we humbly pray; and do thou, O Prince of Heavenly host, by the power of God, cast into hell Satan and all evil spirits who prowl about the world seeking the ruins of souls.”

Whilst Nnadi’s Healthcare & Pharmaceuticals remains a company that will always stay true to the principles of evidence-based medicine and “Good Science”, we pledge to utilise the scientific skill, talent and ambition that this company possesses to best serve patients & customers be they in the United Kingdom or abroad.

Our privilege to serve those in need of our goods & services is a commitment we do not take lightly. We are most humbled and grateful to undertake this responsibility, and thus ask for the guidance & protection of St Michael the Archangel in all our endeavours henceforth.

Most Sincerely,

Sonny A. Ume

Founder & Managing Director

Faith & Medicine: How Understanding the Relationship between Faith and Western Medicine to Better Improve Primary Care Health.

Fri, 06 Dec 2024 13:13:23 GMT

In the Western world, and specifically to Western medicine (allopathic medicine), faith commonly tends to meet medicine at the intersect of “last resort”. Sporting analogies vividly depict such dire occasions, the “Hail Mary Pass” of American Football, “The bottom of the ninth” of American baseball or “90 minutes plus stoppage time” in football (soccer). Once the game plans and tactics have been tried and exhausted to no avail, the game of the respective sports take on a more urgent, opportunistic and hopeful complexion for the teams involved. This scenario is very much reminiscent of when medicine has been deployed as the opening gambit to tackle ill health only to find it is yielding little to no dividends towards improving to the patient’s health or condition. In this situation desperate times call for desperate measures and in the face of such desperation faith is sought and clung onto. Faith and medicine enjoy a polarising duality; Spirituality versus Science, “The Unseen” versus “The Proven”, subjectivity versus objectivity, belief versus evidence. Even in the face of this presented incompatibility between Faith and Medicine, there resides a common thread that unifies both. Patients. This article will look at the importance of acknowledging faith in medicine and the role faith plays in healthcare, particularly in primary care.

The opening sentiment of this article on the relationship between Faith and Medicine may appear somewhat flippant and reductive. For some patients, faith does not follow a sense of hopelessness or vulnerability. Rather faith, in their respective religion, is their North Star. Their compass in navigating their day-to-day life of which, their healthcare needs are no different. Faith is central to the identity of an individual and for the collective community and demographic. An understanding of a patient’s faith in the healthcare sector is necessary in a multicultural country like the UK and more so in her multicultural major cities such as London. According to the latest data from the ONS (Office for National Statistics) 2021 Census, Christianity remains the largest religion in London with 40.66%, with Islam, Hinduism, Judaism, Sikhism and Buddhism following in sequential order at 14.99%, 5.15%, 1.65%, 1.64% and 0.99% respectively 1. When making an eyeball comparison of the religions distribution chart from the ONS 2011 Census against the ethnic group distribution chart from the 2021 Census, it provides a quantitative and qualitative insight into where specific demographics are situated across London 2. For instance you will find a majority of the Black Afro-Caribbean demographic in South East London an area with a high number of individuals identify as Christians, Asian-Indian in West London, an area where a large majority identify as Hindus and Sikhs, Asian Pakistanis far West & East London where Islam is the dominant religion and individuals who identify as Jewish are predominantly situated in the North and North West London area.

A majority people who identify within an ethnic group demographic will have some connection to a religion, which plays an integral part to shaping their culture as well as their faith. This is of significance as these individuals then to be those as risk of preventative chronic disease of which the health outcome can be a poor prognosis. The data derived from the charts below will form the basis for strategies that are to be deployed in meeting the clinical needs of the multicultural demographic in London.

Source: Wikipedia , ONS 2011

Source: Wikipedia , ONS 2021

A failure to acknowledge the role of faith in multicultural societies and communities can result in frustrated and unsuccessful primary care engagements with a healthcare message that does not resonate with the intended audience. To avoid the notion that faith may act as a barrier to the delivery of healthcare, it would serve us well to understand the leading religions’ stance on healthcare through respected holy books and central philosophies of practiced religions in the UK.

Sacred scripture and philosophy have provided structure and guidance to the practicing of an individual’s faith. We’ll now look at the leading text across the leading religions. Beginning with Christianity, The Bible in James Chapter 5 verses 14-15 (New International Version (NIV)):

“ 14 Is anyone among you sick? Let them call the elders of the church to pray over them and anoint them with oil in the name of the Lord. 15And the prayer offered in faith will make the sick person well; the Lord will raise them up. If they have sinned, they will be forgiven.”

This passage calls to mind the holy sacrament within Roman Catholicism of the Last Rite, Yet in Luke 5:31 we find the following passage:

“It is not the healthy who need a doctor, but the sick.”

In this former passage we see the affirmation of faith and prayers towards ill health in Christianity, whilst the words of Jesus depict the pragmatic acknowledgement of a doctor for those afflicted with ill health.

In Judaism, drawing upon the Torah it is believed that God makes people sick and only He can heal them. This is found in the following books of scripture:

Exodus: 15:26:

“If you will heed the Lord your God diligently.

Then I will not bring upon you any of the diseases that I brought upon the Egyptians, for I the Lord am your healer.”

And in Deuteronomy: 32: 39:

“I deal death and give life, I wounded and I will heal”

Drawing upon the interpretation of the Talmud (Rabbinic debates and literature from the 2nd-5th Century based upon the teaching of the Torah) this sentiment of God’s central role in health is consolidated in the following interpretation by Rabbis

And Hullin 7b:

“A person does not injure his finger below unless it is decreed above.”

However, in the book of Ben Shira (Sirach, Ecclesiaticus), it is believed that with prayer (God), sacrifice and visiting a doctor as stated in Chapter 38 verses 1-4:

“ 1 Give doctors the honour they deserve, for the Lord gave them their work to do.

2 Their skill came from the Most High, and kings reward them for it.

3 Their knowledge gives them a position of importance, and powerful people hold them in high regard.

4 The Lord created medicines from the earth, and a sensible person will not hesitate to use them.”

The evolution towards the role that doctors play in medicine within Judaism continues with the acknowledgement that doctors were vital in society according to a baraita in Shanhedrin (17b) before arriving to the notion that it is Mitzvah (a good deed) for a doctor to heal people as proposed by the teachings of Maimonides. 1

Within the teachings of Islam, there exists two hadiths of significance. The first is that which the Prophet Muhammed in which he states;

“There are two blessings which many people do not appreciate: Health and leisure.” 2

This is appreciation for the gift of health within Islam is emphasised by the hadith as narrated by Usamah Bin Shareek that encourages the use of medicines to treat ailments:

‘I was with the Prophet (PBUH), and some Arabs came to him asking, “O Messenger of Allah, should we take medicines for any disease?” He said, “Yes, O You servants of Allah take medicine as Allah has not created a disease without creating a cure except for one.” They asked which one. He replied “old age.” 2

In Hinduism, based on Dharma traditions spirituality is dependent on health and wellness and that health and wellness is dependent on spirituality.5 Therefore, Hinduism’s ideology that health and spirituality are interwoven encourages individuals to adopt a preventative approach to maintaining good health by developing good daily habits.6 7 In Sikhism, there is no restriction on taking medicines and in fact it is even encouraged.8 Finally in Buddhism, Buddhists have a positive attitude towards seeking medical advice and taking medicine that helps. This does not breach the fifth precept that forbids the consumption of intoxicating drink or drugs, which cloud the mind. Even if a prescribed medicine that may be intoxicating is administered, Buddhists believe this is acceptable as the objective of the medication is to restore good health.

What we can learn from these major, yet differing religions, is their reverence for their spiritual doctrines and practices, whilst adopting a sense of pragmatism towards Western medicine. This acceptance towards medical advice & intervention dispels the idea, in theory, that religion & faith pose a barrier to accessing healthcare. The significance of these findings regarding the relationship between faith and medicine, can contribute positively to addressing the issues such as health inequality in primary care.

Within the NHS, health inequality is defined as unfair and avoidable differences in health across the population between different groups within society.9 These differences can be attributed to socioeconomic status, which tends to be a determining factor. Looking at health inequality closer, there is ethnicity health, which can be defined as health needs, conditions and trends commonly identified in specific demographic that share cultural factors such as language, diet, religion, ancestry and physical features.10 Within ethnicity health, it is more likely one would come across specific attitudes amongst an ethnic demographic. An ideal case study depicting ethnic health was seen around the disproportionate impact COVID-19 had on black and minority ethnic groups. A Lancet report found that those from ethnic minority groups during the 2nd wave of the coronavirus pandemic were more likely to test positive for COVID-19, become severely ill and die.11 To prevent future outcomes as seen from the above report, primary strategies and campaigns must capitalise on the accepted pragmatism of major religions in order to deliver a message that resonates successfully with the attended ethnic demographic. The message must be one that contains either or both the importance of prevention and adherence.

Prevention and adherence are central concepts behind with key roles to play behind any strategy for a successful primary care campaign. One of the NHS’ objectives as part of their Long Term Plan initiative is prevention.12 Preventative medicine reduces the burden placed on secondary care with avoidable hospital admissions as well as increasing better health outcomes. This approach ties in with ethnicity health and no better example of this can be seen than in the NHS’ efforts towards tackling Type 2 Diabetes, which sees Black Afro-Caribbean and South Asians minorities two to four times more likely to develop Type 2 Diabetes.13. Aside from preventative measures, medicine adherence not only seeks to save NHS London losing £39.4 million a year from unused prescription medicine, it can improve health outcome especially in hard to reach ethnic demographics too.14 This is pertinent as those from a religious background may decide to stop medication (without consulting a healthcare profession) due to their faith and spirituality.15 A consequence of this decision, would most likely result in a person spending longer in primary care (being seen again by their prescriber and taking up time), being admitted to hospital (creating pressure on secondary care resources) or their condition deteriorating. These scenarios place a burden on already stretched NHS resources, something we seek to reduce and avoid. Whilst prevention and adherence are vital in the inclusion of any message there must also be a commitment to restoring confidence in the healthcare system. This includes all stakeholders associated with healthcare in the UK. It is essential that the healthcare sector consistently demonstrates acts of confidence in order to gradually and eventually gain the trust of the public, a vital component in extinguishing hesitancy towards medical intervention.

In conclusion, faith and medicine may be perceived as opposing constructs that are poles apart, however they are indeed drawn to people. This is what unifies them. For those who are religious, faith forms their very identity and failure to acknowledge this result in a frayed relationship between this demographic and the healthcare sector. Knowing there exists a degree of pragmatism amongst major religions towards healthcare and medicine, it is vital for stakeholders like Nnadi’s Healthcare & Pharmaceuticals to gain the public’s trust through consistent confidence whilst delivering a message of prevention & adherence in a manner that aligns with members of a religious demographic. The objective is to not only contribute to address health inequality, particularly seen by ethnic demographics, but also improve health outcomes at the primary care level overall.

Nnadi’s Healthcare & Pharmaceuticals will strive to keep the relationship between faith medicine in mind and with all subsequent engagements and initiatives with the public.

References:

1. Wikipedia: Religion in London: https://en.wikipedia.org/wiki/Religion_in_London [accessed 23rd November 2024]

2. Wikipedia: Demographics of London. https://en.wikipedia.org/wiki/Demographics_of_London [accessed 23rd November 2024]

3. The Schecter Instititues. What is the Jewish Attitude Towards Medicine? – Rabbi Professor David Golinkin. https://schechter.edu/what-is-the-jewish-attitude-towards-medicine-responsa-in-a-moment-volume-1-issue-no-3-november-2006/ [accessed 19th November 2024)

4. Assad S, Niazi AK, Assah,S. Health and Islam. J Midlife Health 2013 Jan-Mar;4(1):65. doi: 10.4103/0976-7800.109645

5. In Hinduism, What is the Relationship between Spirituality and Health?- Suhag Shukla. Hindu American. https://www.hinduamerican.org/blog/hinduism-and-health [accessed 19th November 2024]

6.Ibid.

7. Naidoo. T. Health and health care--a Hindu perspective. Med Law. 1989 7(6):643-7

8. Sikhism: A Healthcare Worker’s Guide: https://www.sikhcoalition.org/wp-content/uploads/2021/10/Sikhism-Healthcare-Guide-Electronic.pdf [accessed 21st November 2024]

9.NHS Trust. Weston Area Health. Buddhism. https://www.waht.nhs.uk/en-GB/Our-Services1/Non-Clinical-Services1/Chapel/Faith-and-Culture/Buddhism/ [accessed 21st November 2024]

10. NHS England. Equality, Diversity and Health Inequalities. https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/what-are-healthcare-inequalities/ [accessed 21st November 2024]

11. Mathur R Rentsch CT Morton CE Hulme WJ Schultze A MacKenna B. Ethnic differences in SARS-CoV-2 infection and COVID-19-related hospitalisation, intensive care unit admission, and death in 17 million adults in England: an observational cohort study using the OpenSAFELY platform. Lancet. 2021; 39710286: 1711-1724

12. NHS Long Term Plan: Prevention. NHS https://www.longtermplan.nhs.uk/areas-of-work/prevention/ [accessed 23rd November 2024]

13. Diabetes UK. Type 2 Diabetes Know Your Risk. Prediabetes. https://www.diabetes.org.uk/about-diabetes/type-2-diabetes/prediabetes [accessed 24th November 2024]

14. Waste Medicine Campaign- York Road Surgery, Ilford. . https://www.yorksurgeryilford.nhs.uk/2023/11/09/waste-medicine-campaign/ [accessed 23rd November 2024]

15. Health Experience Insights (hexi). Mental health: ethnic minority experiences. The role faith, spirituality & religion for people with mental health problems. University of Oxford. https://hexi.ox.ac.uk/mental-health-ethnic-minority-experiences/the-role-of-faith-spirituality-religion-for-people-with-mental-health-problems [accessed 24th November 2024]

Investment is a Waiting Game: Mini Update from Managing Director

Mon, 09 Sep 2024 09:50:48 GMT

Dear Reader,

We’d like to apologise for our absence and inconsistency in our posting activities. We had planned for 2023 to be the year to springboard growth for the company. However, by August 2023 our plans were derailed by unapproved amendments to an investment deal, unforeseen operational changes by appointed service partner and the negligent damage to our current stock. Due this catalogues of disruptions, it resulted in the business having to concentrate its efforts on stabilizing and navigating through this thorny period. Sadly the decisive actions we took have impacted our agility and growth for 2023 heading into early 2024. It would be no stretch of the English language to deem 2023 as an annus horribilis for Nnadi’s Healthcare & Pharmaceuticals.

Despite the hurdles of learning and operational obstacles to surmount, we persevere not out of foolishness or folly but out of a sense of duty and determination to contribute something positive to the country. Something positive for the nation’s economy and the health of the population too. Through Fergie’s Sparkling Water®, we have had the opportunity to connect and listen to people. We have come to gain an insight into people’s relationship with their nutrition, GP and the NHS as a whole. Through these conversations with the public, it is apparent there is still much work to do. Aside from these conversations, I would be remiss not to mention and acknowledge the kind words of support and gradual return business we have accrued in spite of all these difficulties since August 2023. We are grateful to these customers and supporters, we shall repay their faith by continuing to make strides towards securing investment.

Our path towards securing investment now adopts a strategy of patience (as much as we can afford). The investment climate in the UK is constricted and conservative to nascent SME science ventures. According to an experienced business advisor, investments in the UK have dropped by 61%. Aside from the slow velocity of investment capital, there seems to be a shortage of courage and patience towards modest & sustainable business model. Investing in STEM ventures is not for the faint-hearted, but it is an investment that pays dividends both financially and socially. In this climate, we have to wait discerningly for the correct investing partner that will pull us out of the vicious cycle of traction against capital. I have full confidence in the company’s potential and mission. I hope this is a sentiment shared by our investors. We shall indeed wait and see.

In the meantime, we shall continue with our daily operational activities and ambitions.

We have come to accept that investment is very much now a waiting game.

Kindest Regards,

Sonny Ume

Founder & Managing Director

Nnadi’s Healthcare & Pharmaceuticals Annual Report of 2022: Letter from Managing Director

Fri, 23 Dec 2022 14:05:14 GMT

Dear Reader,

This year has been a year of marked progess and incremental growth in comparison to the previous year.

Early into Q1, we began officially trading with Fergie’s Sparkling Water ^® and have been garnering sales throughout the year. Between late Q2 and mid Q3 , we encountered challenges and hinderances in involving our marketing campaign impeding us from fully capitalising upon the double heatwave that swept through the UK in the Summer. Due to thte unwelcomed impact, we have parted ways from the responsible marketing firm that oversaw our campaign during the periods of the aforementioned quarters. New marketing partners have been identified for 2023. Despites seeing sales and an increase in social media follwers across all platforms, we have had to contend with difficult macroeconomic factors.

The leading macroeconomic factor has indeed been the steep rise in inflation, exacerbated by the Russia-Ukraine conflict in March of this year leading to soaring commodity prices affecting businesses, families and individuals alike. As a result of this, the UK, amongst other countries in Europe, are enduring a cost of living crisis. In relevance to our sector, for Fergie’s Sparkling Water ^® , grocery shopping (food) inflation currently stands at 14.6% (down 0.1%, 6 Dec 2022), significantly higher than this time last year’s recorded at 4.2%. To combat this inflationary environment we have decided on two courses of action. Firstly, we have opted not to engage in cost-push inflatuion from our end, which would see us pass the additional cost onto the consumer. This is clearly demonstrated by us not levying a delivery charge on the customer’s orders. Secondly, we have offered small sample packs and have revised and reduced our prices across our current SKU (flavours/lines) which now includes multiflavour packs. These practices have created new customers, returning customers and prospective customers. Regarding the later, we have seen an increase in orders left at the basket checkout (a common practice observed by e-commerce merchants and retailers). We would prefer to convert these incompleted orders to sales. We shall indeed concentrate attention and focus on this practice and these prospective customers in the coming year.

Aside from opening achievements and current challenges, we have achieved milestones on a marketing and parternship front this year. In mid Q2 we were part sponsors of a well known health conference with leading dietician and nutritionist . We will explore the possibility of sponsoring this event again. In addition to this come Q1 of 2023 we will be sponsoring a University Netball Team Club for the second half of their season. We intend for this to be a promising promotional endeavour. Whilst forming sponsorship links we enagegd in our first out-of-home (OOH) marketing campaign in a thriving and bustling area within the city of London. This achievement and opportunity allowed us for to showcase our distinctive golden cans and unique and delicious flavours to passers-by in the capital. Again, we aim to incorporate this form of marketing into future marketing campaigns.

Rounding up on positive fronts, the final preparations are being made towards the end of Q4 following the better articulation of our product portfolio and strategy heading into 2023. On behalf of the company I am filled with much confidence and optimism as to what lies ahead for 2023. Overall, 2022 has provided an additional 12 months that have served as an invaluable learning curve. Both in evaluation and identification and better yet, realization. And come the end of this year we realize the necessity and central importance of securing funding in 2023.

I believe my confidence and optimism are not misplaced surrounding the current potential and awaiting achievements of this company. For, if we can successfully complete our next round of funding and secure sufficient capital investment, it would serve as both fuel and vehicle to propel our commercial ambitions and endeavours. Nnadi’s Healthcare & Pharmaceuticals aspires to make its contribution to the gauntlet and satellite challenges that have arisen following the aftermath of the COVID-19 pandemic and subsequent scrutiny of the pharmaceutical industry. Given our stance towards the current perception of the pharmaceutical industry and our intended efforts to a propose remedy to the heightened scrutiny through Nnadi’s Healthcare & Pharmaceuticals’ operating model, hence there has not been a more enticing time to be involved in this sector. Nnadi’s Healthcare & Pharmaceuticals will strive to be among those enterprises, big and small, who wish to use all their efforts in tackling the challenges and seizing the opportunities that lie ahead in this field. Again, our ambition can only be realized with the necessary capital to fortify and grow based on what we have achieved so far.

In closing, and returning to current matters, I would like to take this time to thank you for reading this and subsequent articles we have posted this year. I would like to thank all those who have supported and offered advice to bring us this for. And finally, above all else I would like to thank our customers who have invaluable not just in support through purchase, but in patience too.

I would like to wish you and you a very Merry Christmas and a happy and prosperous New Year. May 2023 be a year of achivements and delivery for you as I hope it will be for Nnadi’s Healthcare & Pharmaceuticals.

Kind Regards,

Sonny Ume
Founder & Managing Director
Nnadi’s Healthcare & Pharmaceuticals Ltd.

Sponsorship Announcement: Unversity of Strathclyde Netball Club x Fergie’s Sparkling Water®

Fri, 23 Dec 2022 14:01:57 GMT

Fergie’s Sparkling Water ^® is delighted to announce it will be a sponsor for the second half of the University of Strathclyde Female Netball Club (USFNC). Fergie’s Sparkling Water ^® can be enjoyed as part of a healthy diet, but as a thirst-quenching healthier alternative after physical activity such as sports. Increasing and encourage physical activity, through the medium of sports, is something we wish to do now and in the future. A club officer and player of the USNC, Oriana Smith said;

“We have chosen Fergie's Sparkling water as one of our sponsors this year because we really believe in their product of a healthy alternative to sugary soft drinks. As a netball team who take our sport seriously, we can't wait to enjoy Fergie's drinks after our games and around Strathclyde Campus. Thanks so much Fergie's for being one of our sponsors this year!”

We will certainly cheering the team on!

The Gauntlet: The Challenges that Lie Ahead for Big Pharma and the Industry as a Whole

Mon, 14 Nov 2022 14:20:10 GMT

The pharmaceutical industry is a force for good!

Our opening remark serves as a reminder and maxim within our company’s mission statement of elevating the patient’s and consumer’s perception of the pharmaceutical industry. Now more so than ever in recent times, this maxim of ours is necessary to recalibrate the perception of our industry. For failure to do so will have far reaching consequences, not just upon the pharmaceutical industry but also on public health. As it stands, Big Pharma and the remaining stakeholders within the pharmaceutical industry must, if not currently are, run through a gauntlet consisting of disenfranchised, incredulous and angry members of the public. This brief will look at the current obstacles and challenges that await Big Pharma and other industry players, whilst proffering solutions that go some way to repairing the strained relationship between pharma and the public. The objective of this reconciliation between both pharma and public seeks to restore the lack of confidence and subsequently the trust that has been broken. The future and integrity of the pharmaceutical industry depends on the mending of this relationship.

Beginning with confidence itself, it is its latter crystalised end product of trust, that has been eroded or completely shattered resulting in the pharmaceutical industry being brought into disrepute. The leading contributing factor has been the lack of transparency in commercial activities and the decisions of Pfizer Inc. surrounding their vaccine. The earliest sense of opacity and perceived artifice involved the non-attendance of Albert Bourla pulling out of an initially scheduled European Parliament’s special committee on COVID (COVID committee). Mr. Bourla was not legally bound to attend nor was he subjected to any criminal punishment, as this was not an inquiry. Mr Bourla was intended to speak off the record. Mr. Bourla’s non-attendance proved irksome and did little to quell the committee’s frustration in the pursuit of answer. Another invitation has been extended to Mr Bourla. In Mr. Bourla’s place Janine Small, Pfizer’s Regional President of International Developed Markets stood in. The committee sought to address their concerns surrounding the heavily redacted vaccine purchase contract and the text messages between the Pfizer CEO and EU President Ursula von der Leyen. French MEP and COVI Committee member Veronique Trillet-Lenoir put these questions to Ms. Small. The purpose of Ms. Trillet-Lenoir’s line of questioning was to establish the relevant components about the operations in the manufacturing and delivery of the vaccines. ¹ To this, Small answered that the information remains confidential for “competition reasons. This answer in the eyes of the COVI Committee ran contrary to Pfizer’s initial claim of transparency.

Source: Medika.lfe. Janine Small address the COVI Committee.

societal instruments such as politics (policies), the media and science during the pandemic. Reflecting back on the pandemic through the eyes of the public, the UK government’s message over seen by the Chief Medical Officer (CMO), of “Stay at Home Saves Lives, Protect the NHS” because the mantra promulgated by 24 hours news media along with the daily statistics of those infected and killed by the coronavirus. With the machinery of politics and the media- fuelled by the science, there was indeed a great sense of fear and concern. Helpless, in the midst of the pandemic, the only light at the end of this dark tunnel was the arrival of the vaccine. It is here where the greatest scrutiny is applied. It is believed that the vaccine costs Pfizer $1.18 to make which they intended to sell to the US government for $20 and then will subsequently sell them on the consumer market at a price of $130 next year. Given the cost to end-users, the vaccine carries a 10,000% mark up heading into 2023. Pfizer yearly revenue in 2021 jumped from $41.6bn in 2020 to $81.2bn of which $36bn was attributed to vaccine sales. ² IIt is the commercial practices that has not only drawn scrutiny, but indignation given that the initial research conducted by Pfizer’s German partner BioNTech, was funded by the German tax payer. ³ From the public’s perception Pfizer has immensely enriched itself off the back of a devastating global tragedy. The challenge now facing Pfizer and the industry as a whole, whether they can adroitly and tactfully allay both questions and concerns around the morality and motive of the pharmaceutical industry. This challenge becomes more complicated when the commercial motive is inextricably affected by the next challenge associated with clinical evidence.

Source: Grocer Kantar 52w/e May 2022

Source: Daily Mail. Pfizer has enjoyed record profits and is projected to enjoy more heading into 2023

Evidence based medicine (EBM) and the ethical principle of autonomy, are the cornerstones of allopathic Western Medicine and during this pandemic, the public witnessed the deviation and erosion of both. Thus, the next challenge facing Big Pharma and the pharmaceutical industry is the public’s disillusionment, specifically, their distrust of the profession’s methodology and expertise. Before a medicinal product is launched on the market and available to the public, the drug candidate (proposed medical product) prior to approval and launch) is extensively tested through a series of clinical phases (Phase I, II & III). The rationale behind the process is to test the safety and therapeutic efficacy for a claimed indication (a condition, illness or disease) as stipulated by the intended marketing authorisation (MA) holder (who tends to be the products proprietor or inventor). During the pandemic a common sound bite in the media was the importance of “flattening the curve”. This meant reducing the r-rate, known as the reproduction rate of the virus through the average number of secondary infections produced by a single infected person. ⁴ The r-rate was an indication of transmission and central to the two lockdowns imposed upon the UK economy and public. A 2021 study revealed that a single dose of a coronavirus vaccine would reduce household transmission of the virus by up to a half. Those given a first dose of either Pfizer or AstraZeneca vaccine- who became infected three weeks later – were between 38% and 49% less likely to pass the virus on than unvaccinated people. ⁵ Therefore, the vaccine was seen as a means to ease restrictions, lift the lockdown and ease into the new normal. However, this did not seem the case.

During the COVI Committee, Janine Small was asked by Dutch MEP Robert Roos, of the JA21 political party, whether Pfizer vaccine was tested on stopping the transmission of the virus before entering the market. Small replied, “No”. She further added:

“…We had to really move at the speed of science to really understand what is taking place with the market.”

This is harrowing. There was no data, no clinical evidence and hence no science for a pharmaceutical product making claims towards halving transmission as part of a vaccine drive. For a profession and industry that prides itself on prudence and clinical evidence, this was nothing short of opportunistic, rash and reckless. This answer was not only injurious to the sector, it brought the whole pharmaceutical industry into disrepute. On the subject of injuries, there have been reports of recipients of the Pfizer vaccine experiencing myocarditis and heart attacks despite having no history of cardiac issues. ⁶ Other vaccines have caused paralysis in a 12 year old girl, concerns surrounding fertility and premature deaths amongst healthy and fit individuals. ⁷ From data collated between 9/12/20 and 20/04/22 for the mRNA Pfizer/BioNTech vaccine and 29 ^th September and 28 ^th September 2022 for AstraZeneca vaccine. The rate of vaccine deaths is now higher than COVID deaths are, with the figures showing 1,227 deaths plus 149 miscarriages. ^{8 9} The sudden death of adults in the last 18 months across the globe is to be covered in an up and coming private documentary entitled “Died Suddenly” streaming 21 ^st November 2022. ¹⁰ The industry must brace itself for the question that are sure to follow.

Aside from the untrialled claims of transmission and the climbing death tolls, as a result of the erosion of EBM, the inherent right of autonomy had been attacked. Those that expressed concern and thus, sought more information to arrive at a position of informed consent were lambasted and labelled as “antivaxxers”, “covidiots”, “flat-earthers” and conspiracy theorists. Again, the combination of the media apparatus and the experts of the pharmacy industry created a toxic and divisive environment. “The Vaccinated” and “The Unvaccinated”. The Clean” and “The Unclean.” Adding to this hostile climate came the truly chilling policy imposed, by the then government and Health Secretary Savid Javid, on NHS staff and other care workers of

“No Jab, No Job!”

This policy was a direct contradiction of the Public Health (Control of Disease) Act 1984 and the Coronavirus Act 2020 and despite the government revoking this policy in February 2022, the damage had already been done. The sweeping disregard for the importance of EBM and ethics has left confidence and trust in the pharmaceutical industry in tatters. Aside, from rebuilding this broken trust, Big Pharma has created a more hostile and premier challenge with immediate consequences.

The final challenge to the pharmaceutical industry and one with immediate consequences is the rebellious spirit and “awakening” within not only the UK, but also the global public. This rebellious stance, fuelled by skepticism, poses a real danger to non-adherence and non-compliance with prescribed medication or the refusal to seek medical treatment all together. This is a trend already visible amongst minority ethnic groups, a group most susceptible to health inequalities. ^{11 12} This rebellious spirit will exacerbate the already poor uptake and falling rate of childhood vaccinations across all programs. ¹³ To tackle this challenge with any means of success there must be an acknowledgment that the leverage within the power dynamic between healthcare sector (including pharmaceutical companies, health institutions and healthcare professionals) and the public is no longer tilted in favour of the healthcare sector. The information age has not only dispelled the mystique surrounding the healthcare sector, it has recalibrated it to be a more even keel. This once lopsided relationship has seen the public question the necessity of the vaccines against that of an approved and generic medicine that is clinically efficacious and cheaper medicine in the form of Ivermectin.

Ivermectin is an oral anti-parasitic agent and across a meta-analyses of 18 randomised-controlled treatment trials, the administration of Ivermectin in COVID-19 patients was statistically significant in the reduction in mortality, time to clinical recovery, and time to viral clearance. ¹⁴ The efficacy of

Ivermectin has been described as miraculous” by Dr. Pierre Kory at a COVID Committee in the US considering the devastation COVID-19 wreaked on the African-American and Latino community. When renowned podcaster Joe Rogan purchased Ivermectin, he was chastised for obtaining Ivermectin (most likely prescribed to him), which the media erroneously and disparagingly labelled as “horse dewormer” and not safe or approved to be used for human use. The perpetuated falsehood has served as casus belli against the perceived corruption and dishonesty of the pharma sector, a stance that in of itself will contribute to the proliferation and continued use of counterfeit medication as a means to gain one up on the “greed” of the pharmaceutical corporations. The furore that the Joe Rogan story created has further raised questions and scrutiny as to the motive and veracity of the pharmaceutical industry surrounding the vaccines and now future therapeutics.

Distrusting pharmaceutical companies, coupled with disinterest and a sense of complacency, will lead to non-adherence, non-compliance and the potential rise in counterfeit medication among members of the public. This would pose not just a public health crisis in the UK, but around the world. As a sector we must act fast to address this.

The new-wave of rebellious scrutiny has been led by the likes of Candace Owens through her “Shot in the Dark” series, available on social media platform Parler, and has further emboldened a leading vaccine researcher and campaigner in Robert F. Kennedy Jr. These voices and others will not be diminished. As it stands, they have laid down the gauntlet for us. From the pharmaceutical industry’s current position here to where we would like the pharmaceutical industry to be, the industry must pass through this difficult corridor and scrutinous passage that makes up the awaiting gauntlet. Therefore, we prose the following solutions for its successful navigation.

The first of our proposed solutions is to address the concerns around transparency. The industry must accept and address the gauntlet’s response to transparency with skepticism if Big Pharma and the pharmaceutical industry are to survive the gauntlet. To achieve successful navigation the industry must show its working and hence, must be willing to present, explain and share clinical data surrounding medicinal products in particularly vaccines. It is imperative that the public has confidence with the medicinal products, public health leaders and drafted government policies. Confidence can only be achieved through effective and correctly practiced EBM. Only through these means can trust be established.

The next solution may be far more challenging and even out of our hands. Nevertheless, it is by no means a reason not to try. The pharmaceutical industry especially Big Pharma, must do all they can to ensure responsible media coverage on matters associated with medicine and public health. For clarity, we use the term media to include not just TV coverage but print, online and social media. Continued misinformation, inaccuracy and politicised sensationalism draw scorn and calls from the public of “propaganda”, ”profiteering” and “fear-mongering”. This is not conducive to the industry and drives a wedge in between the necessary relationship between the pharmaceutical industry and the public. This could be addressed in two ways. One way would be educating the media. This could be through better briefing to any media outlets and channels. The aim would be to set the record straight factually by explaining the medicinal product’s mechanism of action, or the illness or health condition of topic. Attending non-legally binding committee hearings or panels would be a positive and welcomed step in the right direction on this front. Equally, the media too are educators (and many within the media industry would share this notion too) and thus, there indeed exists scope and necessity for sensible unified messaging against medical expertise and statistical evidence. The second option for sensible media coverage is for pharmaceutical companies and pharma stakeholders to be proactive, instead of reactive and hence, control the narrative from the outset. This needn’t be hostile or delivered in a belittling fashion, but using clinical expertise and communicating directly with the public in a manner that restores confidence and subsequently trust from the outset. In a world of decentralised media, led by social media, with many platforms for consumer engagement, a media strategy of this kind would be a welcomed remedy and most effective.

In conclusion, Big Pharma and pharmaceutical industry find themselves at a critical juncture. Given the current public sentiment, the entire pharmaceutical industry faces an existential battle for its future. There will be a need to fight. Specific battles will need to be fought to successfully navigate this gauntlet. These battles will not be fought with money, or through PR, nor l through lip service. Rather this battle will only be won through transparency. Transparency in clinical and scientific data. Transparency in commercial operations that neither obfuscates or injurious to commercial competition in a free market. And above all, transparency in veracity and motive. This battle will need to be won on the recognition and respect of bioethical principle of autonomy, for any acts that threaten the existence or acknowledgment will result in the surrendering of key battlegrounds in the fight for transparency. Adopting these approaches before engaging in these battles within the gauntlet will serve as the only remedy to soothe the current restless and rebellious spirit, whilst mending the eroded bridge of confidence between Pharma and public.

The pharmaceutical industry is a force for good and we, Nnadi’s Healthcare & Pharmaceuticals, shall help to see the industry come out of the other side of this gauntlet to prove it.

References:

1.   Clara Bauer-Babef . Pfizer remains discreet about COVID vaccine purchase contracts. https://www.euractiv.com/section/coronavirus/news/pfizer-remains-discreet-about-covid-vaccine-purchase-contracts/ [accessed 01 November 2022]

2. Mansur Shaheen. Pfizer cashes in on pandemic: Pharma giant plans to sell its vaccine with a 10,000% markup — despite revenues tripling and CEO pocketing $50m during Covid crisis. https://www.dailymail.co.uk/health/article-11357661/How-Pfizer-plans-sell-Covid-vaccine-10-000-markup.html [accessed 04 November 2022]

3. Ibid.

4.Gov.uk. The R-value and growth rate. https://www.gov.uk/guidance/the-r-value-and-growth-rate [accessed 05 Nov 2022]

5. BBC News. Covid: One dose of vaccine halves transmission-study. https://www.bbc.co.uk/news/health-56904993#comments [accessed 05 November 2022]

6. Tara Haelle. Why is it so hard to compensate people for serious vaccine side effects? National Geographic. https://www.nationalgeographic.com/science/article/why-is-it-so-hard-to-compensate-people-for-serious-vaccine-side-effects [accessed 05 November 2022]

7. Gillian Jamieson. Covid vaccines, treatments, mental health and the future. Supplementary Written Evidence. https://committees.parliament.uk/writtenevidence/36788/html/ [accessed 05 November 2022]

8. Ibid https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1072043/COVID-19_mRNA_Pfizer-_BioNTech_vaccine_analysis_print.pdf [accessed 05 November 2022]

9. Ibid https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1115342/COVID 19_Vaccine_AstraZeneca_analysis_print_-_26OCT22.pdf [accessed 05 November 2022]

10. Died Suddenly- The Documentary. The Stew Peters Network. https://diedsuddenly.info/ [accessed 05 November 2022]

11. Kadambari S, Vanderslott S. Lessons about COVID-19 vaccine hesitancy among minority ethnic people in the UK. The Lancet Infect Dis. 2021. 21; (9) P1204-1206.

12. Khan S. Rebuilding trust in medicine among ethnic minority communities. BMA. 2022. https://www.bma.org.uk/news-and-opinion/rebuilding-trust-in-medicine-among-ethnic-minority-communities [accessed 05 November 2022]

13. Gov.uk. Parents warned about dangers of children missing vaccines. Press release. https://www.gov.uk/government/news/parents-warned-about-dangers-of-children-missing-vaccines [accessed 05 November 2022]

14. Kory P, Meduri GU, Varon J Iglesias J , Marik PE. Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19. Am J Therap. 2021. 28 (3) pe299-e318

Crying over spilt milk: Are the marketing practices to promote infant baby formula jeopardising breastfeeding?

Wed, 07 Sep 2022 10:35:25 GMT

The role of a mother in the development of an infant is invaluable. Whether it be supporting intellectual development or social development at an early age, there remains and even more crucial form of development. Nutritional development. To mark the significance of nutritional development in the early weeks and months of a babies’ life, the first week of August (1st-7th) is considered World Breastfeeding Week by the World Alliance for Breastfeeding Action (WABA). WABA is a global network of individuals and organisations dedicated to the protection, promotion and support of breastfeeding worldwide. However, it would seem that the message and rationale promulgated by WABA faces much challenge whilst heading towards a collision course with the proprietors of instant baby formula milk (IBFM) a form of breast milk substitute (BMS) and their proliferation over the previous decades.

This article will explore how and whether the marketing practices deployed to promote BMS affects and hence jeopardises breastfeeding. We shall look at the importance and significance of breastfeeding, the current challenges and barriers to breastfeeding. We’ll review the marketing practices used by brand labels of IBFM and rebuttals they propose to these claims. Finally, we shall conclude on the repercussions of these claims on the marketing practices and their impact on breastfeeding and IBFM, before providing a conclusion.

Breastfeeding is one of the earliest and vital acts a mother engages in to support the physiological and nutritional development of her baby. It is for this reason why the World Health Organisation (WHO) recommends solely breastfeeding babies for the first six months of their life. ¹ The WHO’s recommendation stems from the constituents of human breast milk, all of which contain basic essential nutrients such as carbohydrates, protein and fats too. Apart from breast milk being tailor made for a mother’s baby, breast milk is rich in million of live cells (white blood cells and stem cells etc.) that are immune-boosting and help organs develop and heal. Breast milk contains enzymes, growth factors, antibodies known as immunoglobulins (key in protecting the baby from illness and infections) by neutralising bacteria and viruses. In addition to this breast milk includes long-chain fatty acids, which play a pivotal part in the development of a babies nervous system, brain and eye development. Finally, breast milk contains 1,400 microRNAs which are thought to regulate gene expression crucial in preventing or halting disease development, whilst supporting the babies immune system and remodeling of the mother’s breast. ² The development and properties of breast milk occur over three stages; colostrum, transitional milk and mature milk (foremilk & hindmilk).

Source: Very Well

There are numerous research studies attesting to benefits of breastfeeding considering that cognitive development was improved by breastfeeding and as such, breastfed babies performed better on intelligence tests. ³ Though these findings have been challenged, as it remains unclear whether there is a direct relationship or whether other characteristics are associated. ⁴ Irrespective of establishing a correlation, breastfed babies had lower rates of obesity, diabetes (both type 1 & 2), hypertension, cardiovascular disease, hyperlipidemia and some types of cancer. ⁵ Though the benefits of breastfeeding seem numerous and a conclusive option, there remains challenges and barriers to breastfeeding.

For some mothers, the act of breastfeeding is not possible and as such it proves to be a challenge in meeting the nutritional needs of the baby. According to the latest data collated by the NHS, the UK had one of the lowest breastfeeding rates at last count in 2010 with 55% of women breastfeeding at six weeks and just 34% doing so at six months. ⁶ From the latest data, 2016-17, despite a slight increase in the two previous years (2014-15 and 2015-16) breastfeeding prevalence at six to eight weeks afterbirth is 44.4%, a considerably lower rate in comparison to nations like Norway, which achieves rates of 71% at six to eight weeks. ⁷ Furthermore, only 1 in 200, 0.5%, UK women do any breastfeeding after a year in comparison to Germany with 23%, USA with 27% and Brazil with 56%. ⁸ Despite, the above findings, 90% of mothers who stop breastfeeding in the early days do so before they wanted to. ⁹ About 80% of new mothers in England attempt to breastfeed after giving birth, with only 1% of babies being exclusively breastfed until they are six months old, contrary to the recommendations made by the NHS. ¹⁰ Common reasons for prematurely stopping breastfeeding given by mothers, include pain and lack of support as reported in a 2016 survey by 60% of 300 mothers surveyed. ¹¹ Difficulties and challenges in breastfeeding can prove a sensitive topic not to mention a period of greater vulnerability to mothers, especially first time mothers. Social pressures can further compound this feeling and amplifies myths speaking, erroneously, to the quality of the mother and relationship (maternal bonding) she has with her baby. Such angst over this period in motherhood is detrimental psychologically to the mother and nutritionally to the baby. Remedies to these situations arise from the use of BMS, especially IBFM.

IBFM is the leading form of BMS, with the global formula market currently valued at over US$ 52bn (£44bn). ¹² IBFM may indeed be inferior to human breast milk, but it does contain necessary vitamins, minerals, proteins and fats to meet the basic nutritional needs of babies. As a result of this, IBFM is a staple a majority consumer’s shopping basket with a newborn in the household. According to UK consumers data, IBFM grew by 8.6% to £295.8m, up by £23m, a resilient performance considering a challenging year. ¹³ Higher prices have placed pressure on parents, yet they have not served as a deterrent and as such has resulted in own brand labels (supermarket labels) growing a head of branded with own labels growing 6.8% in value against brands 6.2% increase. Irrespective of this, brand labels still outperformed own label 14.1%. ¹⁴ The growth in sales for branded IBFM is a recipient of the economic phenomenon of market demand, equating to value, necessity and in relation to branded labels, confidence, legacy and trust in the eyes of the consumer. However, this booming and bullish growth in revenue has drawn much controversy and scrutiny over the concerning marketing practices used by proprietors of leading brand labels to attain such gains at the expense of breast feeding and human breast milk.

Source: Grocer Kantar 52w/e May 2022

In response to the current marketing tactics deployed by proprietors of IBFM & BMS, the World Health Assembly adopted the International Code of Marketing Breast Milk Substitutes (also referred to as The Code) in 1981. Within this charter, Article 5 states:

“…there should be no advertising or any form of promotion of BMS to the general public.”

Yet despite this article encoded within the charter, the promotion of BMS such as IBFM continues unperturbed and unyieldingly to concerning result uncovered by research undertaken by the WHO. According to the research finding of WHO; 4 million social media posts about infant feeding reached 2.47 billion people and generated more than 12 million likes, shares or comments. Around 264 BMS brand accounts posted content around 90 times per day and reached 229 million users and that social media posts that referenced BMS brands or products reached three times as many people as posts about breastfeeding, with people most likely to share or click on the posts relating to the former. ¹⁵ This is by no means an exhaustive list of the findings. As seen above, the prominent medium used by which IBFM proprietors use to deploy their marketing strategies utilises digital marketing and social media and online channels given than 80% women who reported seeing BMS advertisements reported having seen them online. ¹⁶ In addition to this, WHO’s research disclosed some of the marketing techniques implemented by IBFM proprietors and these included engaging in real time contact with women, joining or having access to virtual groups and “baby-clubs”, the use of social media influencers, the use of user-generated promotions via competitions and resorting to privately messaging and providing professional advice. Again, this is not an exhaustive list. The marketing techniques adopted and executed by IBFM proprietors have culminated into the core concerns surrounding their marketing practices. The findings from the WHO report have shown that:

i) BMS companies buy direct access to pregnant women and mothers in their most vulnerable moments from social media platforms and influencers.

ii) BMS companies are using strategies that aren’t recognised as advertising.

iii) That digital marketing can evade scrutiny from enforcement agencies. This could require the exploration of new approaches to code implementing regulation and enforcement. ¹⁷

To highlight these digital marketing practices is to say nothing of the irresponsible claims made by one BMS brand Danone, who was subsequently found to have broken the rules, by claiming that their Cow & Gate brand was easier to digest than regular cows milk as well as confusing infant formula and follow on formula. ¹⁸ Nestle too, along with Danone, have made dubious claims over the additional benefits of artificially created human milk oligosaccharides (HMO), essential to building a babies immune system, when added to their cow’s milk based infant milk. ¹⁹ With such misleading health claims marred by the backdrop of the controversy surrounding the marketing practices of IBFM proprietors marketing strategies that has seen the likes of articles “Could baby formula be the new tobacco?” it is fitting to find some rebuttal to the concerns and accusations levelled at the BMS brands. To this current perception and zeitgeist surrounding the practices of IBFM brands Olivier Lechanoine, VP of specialised nutrition at Danone UK & Ireland proffers a rebuttal. Mr. Lechanoine's opening gambit to the idea of equating formula milk to cigarettes as:

“…an unreasonable comparison.”

Furthermore, he acknowledges the benefits of breastfeeding, yet remind critics that breastfeeding is not an option for all families and that;

“…it is important that parents can make informed choices about the nutrition options that are right for their baby and situation. We need to support parents with factual, science-based nutritional information. This cannot be compared to cigarette marketing.” ²⁰

Mr. Lechanoine concludes by affirming Danone’s commitment to contributing to sensible debate about the responsible marketing of baby formula and the protection of breastfeeding. As welcomed as these words are, there remain repercussions over the irresponsible claims and current marketing practices of IBFM.

One of leading repercussions is the “discouragement” of breastfeeding that currently costs the NHS £50m a year from preventable childhood illness and the reduction in the risk of developing breast cancer. ²¹ A secondary repercussion is the economic consequences associated with overregulation and fines. The stance to adopt here is not to throw the baby out with the bathwater. Instead, its better to acknowledge that any harsh sanctioning or disproportionate response to the current marketing of BMS brands could result in raised prices for the consumer causing cost-push inflation. The danger here is that some IBFM products may possess a degree of inelastic demand to certain households. To effectively enforce The Code’s charters, regulations or fines must be done in a sensible, equitable and measured fashion that accepts that digital marketing is a more cost effective and efficacious way of marketing than traditional means. After all, these BMS brands have a duty to their shareholders to deliver value or a return on their investment. The finally repercussion we’d put forward, is the concerns surrounding the increased cost of living and escalating inflationary environment that is hitting consumers hard. BMS brands can be vulnerable to food insecurity given the rising cost of constituents and fuel prices. With inflation projected to rise to 18% by early 2023, as of the time of writing, it highlights the concern of dependency on a sub-optimal nutritional product a caveat that human breast milk surmounts (by offering complete food security) and why breastfeeding should be encouraged and promoted. Despite the current climate and existing concerns there are solutions to trying to encourage breastfeeding more amidst the backdrop of BMS brands marketing tactics and pervasive digital presence within the UK.

Firstly, breastfeeding must be seen as a public health priority by policymakers and it would seem that such an attempt has been made. In 2015, the UK government mandated that every pregnant woman would receive five health checks from a registered health visitor. ²² In May of 2021 a recently updated Public Health England Guidance document entitled: Early years high impact area 3: Supporting breastfeeding was released to support families in breastfeeding and increasing the number of babies who are breastfed.

However, these initiatives and intention devised by public health bodies and policymakers are curtailed by cuts to supportive services. Therefore, the second solution is to reverse those cuts made to supportive services by increasing funding or reallocating ring-fenced capital and resources to help breastfeeding women. According to UK-wide Better Breastfeeding campaign, at least 44% of local authority areas in England and affected by recent cuts to breastfeeding services. These cuts further corroborate with other studies that saw 58% of respondent report that cuts to services (which included health visitors visits) as a barrier to breastfeeding. For completeness, 48% and 47% respondents reported closures of children centre services and cuts to infant feeding support groups irrespectively contributed to increasing the barriers of breastfeeding. ²³ ²⁴

A third solution would involve the true and utter commitment to markedly tackling the long-term issues of socioeconomic implications, specifically health inequalities and cultural stigma within the UK. In relation to the former, the current cost of living and inflationary climate has placed more of an importance upon the influence of socioeconomics and food insecurity upon breastfeeding in a high income. For instance, taking qualitative findings from a fellow high-income country as Canada, suggest food insecurity may be root cause of breastfeeding cessation due to maternal fears of producing milk that is inadequate in quality and quantity. ²⁵ The danger here, as alluded earlier, is the dependency of lower socioeconomic households upon IBFM something that contributes to infant food insecurity. In relation to the latter, point on cultural stigma as a barrier to breastfeeding, 63% of mothers would feel embarrassed breastfeeding in the presence of people they didn't know. A further 59% and 49% felt the same about doing so in front of partner’s family and siblings or wider family members respectively. ²⁶ These figures highlight the need for more breastfeeding-friendly spaces as well as discussions and education, as a nation, on the subject of breastfeeding and doing so in public.

The final solution we propose to support breastfeeding entails the revision and reasonable implementation and enforcement of the codes stipulated within the international code of marketing of BMS. The intended achievement of the codes will most likely come to fruition if they serve as a proportional deterrent to over zealous marketing and the dissemination of unsubstantiated and grossly misleading claims. This must be a collaborative endeavour between public health bodies, policy-makers, charities and of course proprietors of IBFM and other BMS brands.

In conclusion and in answering the question posed we would subscribe to the idea that IBFM and BMS are not jeopardizing breastfeeding, though proportional regulation and enforcement is necessary to support and champion the optimal form of baby nutrition that is breastfeeding. Furthermore, it is worth acknowledging that whilst IBFM is suboptimal to human breastmilk, it remains irrefutably patient-centric. It supports the psychological welfare of the mother and meets the standard nutritional requirement of the baby. Both BMS and human breast milk can indeed “co exist” effectively. However, the current situation must be reviewed. Firstly, there must be a change in narrative towards the “demonisation” of IBFM and other BMS brands that make outlandish associations between IBFM and cigarettes for instance. To achieve a more constructive and productive dialogue on this subject that is conducive to the goal of ideal baby nutrition then a collaborative and reasonable environment must be fostered and maintained. Secondly, accountability and transparency from IBFM proprietors is crucial to ensure that mothers are able to make informed decisions regarding their baby’s nutrition based on scientifically substantiated data. Failing to do so should allow for the appropriate enforcing of the 1981 Code. A lack or lose of credibility is detrimental to the life science industry and in this case the pharma and nutritional companies. Finally, policymakers and health strategist within the UK government, local authorities and NHS must reverse cuts and again ring-fence capital and resources to support mothers with breastfeeding be it through visitations, local groups or educational material. Given the economic benefits of breastfeeding to the NHS and nutritional benefits to babies’, it calls for the continued reevaluation and financial support to be available and ever-present.

Signposting:

LatchAid: https://latchaid.com/app - An informative app designed to t and encourage and support mothers breastfeeding with breastfeeding. There is useful information and statistics of interest too.

Medela: Breast milk composition: What’s in your breast milk? https://www.medela.com/breastfeeding/mums-journey/breast-milk-composition

National Breastfeeding Helpline: https://www.nationalbreastfeedinghelpline.org.uk/ - You can now contact them on Instagram. Contact number: 0300 100 0212.

NHS Breastfeeding Help and Support: https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding/help-and-support/ - The website consists of a host of information and contact numbers and details of organisations that can help with breastfeeding.

Disclaimer : Recommendations made in the signpost are not endorsements nor do we have commercial interest or conflict of interest. We seek not to advertise any third party provider. If you have any questions please speak with your GP, midwife or local pharmacist.

References:

1. World Health Organisation (WHO). Breastfeeding. < https://www.who.int/health-topics/breastfeeding#tab=tab_1> accessed 26th August 2022 .

2. Medela. Breast milk composition: What’s in your breast milk? < https://www.medela.com/breastfeeding/mums-journey/breast-milk-composition> accessed 26th August 2022.

3. Der G Batty GD Deary IJ. Effect of breast feeding on intelligence in children: prospective study, sibling pairs analysis and meta-analysis. BMJ (Clinc. Res. Ed.) 2006 333:945.

4. Oxford Population Health. University of Oxford. NPEU. New study finds evidence that breastfeeding directly supports children’s cognitive development. < https://www.npeu.ox.ac.uk/news/2248-new-study-finds-evidence-that-breastfeeding-directly-supports-children-s-cognitive-development> accessed 26th August 2022.

5. Binns C Lee M Low WY. The Long-Term Public Health Benefits of Breastfeeding. Asian Pac J Pub Health. 2016.

6. Brown R. Could baby formula be the new tobacco? The Grocer. 16th July 2022. William Reed.

7. Royal College of Midwives (RCM): J Griffiths. New Breastfeeding statistics for England. 2017. < https://www.rcm.org.uk/news-views/news/new-breastfeeding-statistics-for-england/> accessed 26th August 2022.

8. LatchAid. Breastfeeding in the UK. < https://latchaid.com/breastfeeding-in-the-uk> accessed 26th August 2022.

9. Ibid.

10. Davis N. Breastfeeding support services ‘failing mothers’ due to cuts. The Guardian. 2018 < https://www.theguardian.com/lifeandstyle/2018/jul/27/breastfeeding-support-services-failing-mothers-due-to-cuts> accessed 26th August 2022.

11. Davis N. Low UK breastfeeding rates down to social pressures over routine and sleep. The Guardian 2016. < https://www.theguardian.com/lifeandstyle/2016/sep/09/low-uk-breastfeeding-rates-down-to-social-pressures-over-routine-and-sleep> accessed 26th accessed 2022.

12. WHO. Scope and impact digital marketing strategies for promoting breast milk substitutes. 2022. < https://apps.who.int/iris/bitstream/handle/10665/353604/9789240046085-eng.pdf?sequence=2> accessed 26th August 2022.

13. Ibid 6, - Kantar 52 w/e 15 May 2022.

14. Ibid 6

15. Ibid 12

16. Ibid

17. Ibid.

18. Ibid 6

19. Ibid

20. Ibid

21. Ibid 8

22. Removing the Barriers to Breastfeeding: A Call to Action. How Removing Barriers Can Give Babies Across The UK The Best Start in Life. Unicef United Kingdom The Baby Friendly initiative. https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2017/07/Barriers-to-Breastfeeding-Briefing-The-Baby-Friendly-Initiative.pdf accessed 01st September 2022.

23. Ibid 8.

24. Ibid 22.

25. Dinour LM Rivera Rodas EI Amutah-Onukagha NN Doamekpor LA. The role of prenatal food insecurity on breastfeeding behaviours: findings from the United States pregnancy risk assessment monitoring system. Int Breastfeeding J. 2020.15:30

26. Ibid 22.

Inflation: The Biggest Threat to Diabetes?

Wed, 08 Jun 2022 14:51:47 GMT

Inflation, defined in simple economic terms, is when prices of goods and services generally increase (along with a rise in demand) whilst reducing the purchasing power of money as each unit of currency buys fewer goods and services. The 40th President of the United States, Ronald Reagan, once quipped, “Inflation was violent as a mugger, frightening as an armed robber and as deadly as a hit man.” And as this perpetrator is very much on the loose and as of the time of writing, poses a clear and present danger to family and households in the West. The global economy, in particularly those of the West, is emerging from the embers and effects of the COVID-19 pandemic and whilst still undergoing a jittery and steady recovery, inflation seems to have stalled and in some cases reverse growth in the West. In the United States inflation has hit an annual rate of 8.3% down from 8.5% in March, but still an inflation rate that remains close to a 40-year high.1 Across the pond, Western European nations are grappling, with inflation across the Eurozone reaching 7.5%.2 In addition to this, the raging conflict between Russia and Ukraine has exacerbated the inflationary pressures on the continent. This article will look at how inflation is impacting the UK population and the dangers towards diabetes prevention and what attainable steps or measures can be taken to tackle this.

Despite the backdrop of the COVID-19 pandemic, the escalation of geopolitical tension between the US, Russia and Ukraine has now regrettably broken out into military conflict as of Thursday 24th February 2022 and has sent commodity prices soaring. As of 2019, Russia and Ukraine exported more than 25% of the World’s wheat.3 Ukraine is considered the breadbasket of Europe, as 71% of Ukraine land is agricultural. Ukraine is also home to a quarter of the World’s “black soil” or “Chernozem”, which is highly fertile.

This conflict poses three dilemmas to the economic situation experienced in the UK. The first dilemma is that the economic sanctions imposed on Russian goods and services. This has impacted oil and gas prices as Vladimir Putin has requested that Russian oil and gas be paid for in Russian Rubles. Furthermore, Russia can place restrictions on the supply of gas and energy into Europe.

The second dilemma has been the disruption to the agricultural season. As the conflict has raged on, no crops to fewer crops have been sown, setting up an eventuality of a harsh harvest for this year.

The final dilemma involves Russia’s naval dominance and thus, control of the Black Sea. Ukraine relies heavily on the Black Sea region as 95% of Ukraine’s wheat and grain flow through and contribute to their export trade. 4 Russia’s demonstration of dominance is seen in the form of a naval blockade that cuts off shipping traffic. With food prices already high due to inflation, imports may seek alternatives. 5 However, as of recent, Russia has allowed the export of grain from Ukraine. Despite this new development by Russia, there still remains the threat and presence of food and fuel insecurity that is currently contributing to the rising cost of living.

The UK’s rate of inflation currently stands at 9% up by 2% from March and is projected to reach 10% (5 times above the Bank of England’s target of inflation) by autumn as projected by the Bank of England (BoE).6 According to the Office for National Statistics (ONS) around 9 in 10 (87%) adults reported an increase in their cost of living. Between the period of 16th March and 27 March 2022, the most common reasons by adult for increased cost of living were an increase in the price of food shopping (88%), gas or electricity bills (83%) and price of fuel (77%).7

These findings, particularly the increase on food bill, are corroborated by the 6.7% price rise in the average UK shopping bill. The governor of the Bank of England warns that the rising global foods are a major worry.8 If not already present, the looming threat of food insecurity will greatly impact the most financially vulnerable members of our communities throughout the country.

The concern surrounding food insecurity arises from the devastating impact it will have on those of lower socioeconomic status and the widening of health inequality associated with tackling prediabetes and Type-2 diabetes. There exists an association, though not yet understood, between low socioeconomic status and unhealthy dietary habits.9

Low income households tend to consume more energy dense foods as opposed to their higher socioeconomic status counterparts. These findings were confirmed in a Finnish study as part of the National Cardiovascular Risk Factor Survey (FINRISK)10. Though not fully understood yet, we would agree with the proffered notion that people with lower levels of education and income have less healthy dietary habits, partly because of their higher priority for prices and familiarity.11

Looking at domestic data relating to food insecurity it effects ethnicities most at risk of developing Type-2 diabetes; Afro-Caribbean and South Asians. According to data in 2020 and used in a question posed to the incumbent Mayor of London, Sadiq Khan, by Caroline Pidgeon, Leader of the Liberal Democrats in the London Assembly, 9% of ethnic minorities (then termed BAME) used food banks compared to just 1% of White Londoners.12 Ethnic minorities tend to have lower household income than their White British Median counterparts with a Bangladeshi, Pakistani and Black African household seeing household incomes lower by £8,900, £8,700 and £5, 600 respectively.13

This finding may justify why minorities in the UK are 1.5 times at risk of succumbing to food insecurities as opposed to White British counterparts.14

The concern and sounding of the alarm surrounding the current inflationary environment and its creation of food insecurity issues affecting those of lower socioeconomic status and ethnic minorities is much very founded. Given the obesity crisis in Europe and the UK’s standing ( TIPPING POINT: BODY POSITIVTY vs. WEIGHT MANAGEMENT ) , the risk factor being of Afro-Caribbean or South Asian descent in the development of Type-2 diabetes and impact this will have on the currently undiagnosed 1 million people living with Type-2 diabetes or who are prediabetic in the UK, and the projected forecast of 5.5 million living with some form of the condition by 2030.15 There exists as a solution or at least measure that can be implemented to mitigate this economic and public health situation.

The first most obvious, yet complex solution is a matter of macroeconomics and involves the BoE raising interest rates in order to counter the effects of inflation. However, such a move is not with disruption upon lending, spending and the housing markets, for which is beyond the scope of this article. Needless to say, this would pose other challenges to the current economic environment. The more attainable solution and something that most can do to manage with rising food bills is to take measure that allow them to maximise the most of their purchasing power. We propose the following suggestions 16:

Plan meals and stick to shopping budget.
Reduce takeaways and cook more at home
Cook larger meals – saving you time and money.
Buy generic brands – in some cases same or better quality for less.
Buy frozen foods – longer shelf life and versatility of meals.
Use the traffic light system on foods bought (sauces, frozen items etc.)
Buy cheaper cuts of meat.
Replace meat with other sources of protein.
Pack your own pack lunch – save money and utilise leftovers from larger meals.
Use coupons & supermarkets reward points system. Fantastic way to save money, but particularly on items you buy frequently. Money saved can be placed into maximising shopping budget.

To conclude, we have looked into the cause of inflation and the potential contributors to the rise of goods and service and the rising cost of living. We hope we have demonstrated that the association between increasing food prices, food insecurity, poor nutrition, low socioeconomic households, ethnic minorities and the development of Type-2 diabetes. We hope that these points from the list above are of help to you should you find that the current economic climate with the rate of inflation is placing pressure upon you and your family’s diet and nutrition.

Inflation indeed presents itself as a major threat to the prevention from diabetes and the potential development of Type-2 diabetes. However, until there is favourable change or solution to this economic situation we would implore you to make the best financial and nutritional decision to stave off prediabetes and the development of Type-2 Diabetes.

Signposting:

1. The Trussell Trust support a nationwide network of food banks and provides emergency food and support to people locked in poverty, whilst campaigning for change to end the need for food banks in the UK.

The Trussell Trust

2. Joe Wicks: The Body Coach. Very useful recipes for creating inexpensive meals that can be made quickly (15 mins) saving you time and money on gas bill.

Instagram @thebodycoach

References:

1. Rushe D. US inflation rate slows but remains close to 40-year high. The Guardian. https://www.theguardian.com/business/2022/may/11/us-inflation-consumer-price-index-figures accessed 30th May 2022.

2. Allianz SE: Eurozone. Eurozone inflation: How bad can it get? https://www.allianz.com/en/economic_research/publications/specials_fmo/2022_5_04_EurozoneInflation.html accessed 30th May 2022.

3. The Observatory of Economic Complexity (OEC). Wheat. https://oec.world/en/profile/hs/wheat accessed 30th May 2022

4. Duggal H. Haddad M. Infographic: Russia, Ukraine and the global wheat supply. Al Jeezera https://www.aljazeera.com/news/2022/2/17/infographic-russia-ukraine-and-the-global-wheat-supply-interactive accessed 30th May 2022

5.Ibid

6. BBC News. What is the UK’s inflation rate and why is the cost of living going up? https://www.bbc.co.uk/news/business-12196322 accessed 30th May 2022

7. Office for National Statistics (ONS). The rising cost of living and its impact on individuals in Great Britain: November 2021 to March 2022. https://www.ons.gov.uk/peoplepopulationandcommunity/personalandhouseholdfinances/expenditure/articles/therisingcostoflivinganditsimpactonindividualsingreatbritain/november2021tomarch202 2 accessed 30th May 2022

8. BBC News. Bank Governor in “apocalyptic” warning over rising food prices. https://www.bbc.co.uk/news/business-61469532 accessed 30th May 2022

9. Eufic. Lower Socioeconomic Status Linked to an Unhealthy Diet. 2012. https://www.eufic.org/en/healthy-living/article/lower-socio-economic-status-and-an-unhealthy-diet-underlying-food-selection accessed 30th May 2022

10. Konttinen, H. Sarlio-Lähteenkorva, S. Silventoinen, K. et al. Socio-economic disparities in the consumption of vegetables, fruit and energy-dense foods: The role of motive priorities.  Pub. Health Nutr . 2013. 16(5), 873-882.

11. Ibid 9.

12. Mayor’s Question Time: London Assembly. Use of Food Banks by BAME Londoners. https://www.london.gov.uk/questions/2020/3825 accessed 30th May 2022

13. Manchester Central Foodbank. Black, Asian and Minority ethic groups are up to twice as likely to be living in poverty- but it doesn't have to be this way. 2020. https://manchestercentral.foodbank.org.uk/2020/06/18/black-asian-and-minority-ethic-groups-are-up-to-twice-as-likely-to-be-living-in-poverty-but-it-doesnt-have-to-be-this-way/ accessed 30th May 2022

14. Bankuet. Shining a Light on Racial Inequality and Food Insecurity. 2020. https://www.bankuet.co.uk/blog/shining-a-light-on-racial-inequality-and-food-insecurity accessed 31st May 2022

15. Diabetes UK. Diabetes Statistics. < https://www.diabetes.org.uk/professionals/position-statements-reports/statistics > accessed 08th May 2022.

16. Healthline. 19 Clever Ways to Eat Healthy on a Tight Budget. https://www.healthline.com/nutrition/19-ways-to-eat-healthy-on-a-budget accessed accessed 30th May 2022

Tipping Point: Body Positivity vs. Weight Management

Fri, 27 May 2022 13:10:23 GMT

“Be yourself” , “Love who you are” and “Never apologise for being you” are common self affirmations associated with wellbeing but can extend to body positivity. The fashion, beauty and sporting industry are leading the vanguard on the encouragement of body positivity in the name of representation and diversity of body types. This is indeed a good thing and very much welcomed. However, there must be a sense of awareness and caution to the indirect promotion of any health implications, in particularly prediabetes. This article will explore the dichotomy between social norms of body positivity versus clinical (health) concerns surrounding body positivity. This article will cover, to an extent, the relationship and impact of body positivity and body image may have upon mental health, healthy weight management and how best to beat prediabetes and Type-2 diabetes. Finally, we shall cover how a healthy weight is calculated, its significance and metabolic difference between individuals. This article will not cover nor engage in any post-discussion or debate on the topic of body positivity in relation to attraction. From a medical viewpoint, attraction is a subjective, fickle and not germane to this article. Given the sensitivity of the subject it would be appropriate to cover the impact on mental health and psychological well-being.

Body positivity is inextricably linked to our self-image, which is key to our sense of identity. Simply put, how we look equates to how we feel. The perpetuation and desirability in the pursuit of the “perfect body” arises primarily from various forms of consumption. Common sources and outlets of this category include; Hollywood, Reality TV, ITV’s mega-successful Love Island franchise and Meta’s Instagram, all offering a window into innocuous entertainment, whilst showcasing the latest beauty trends that go on to become the societal standard. However, this harmless form of entertainment ceases to be so when the perpetuated trends by A-listers, well-known celebrities or recognised public figures (devoid of malice or agenda on their part), are, perceived as unattainable. It is this realisation that is impactful and leaves a detrimental effect on the most vulnerable members of the public on the uses of body image- teens and adolescents. The data to support this is worrying.

According to UK survey of 11-16 years olds conducted by Be Real found that 79% said how they look is important to them. Over half (52%) often worried about how they looked. 1 In a survey of young people aged 13-19, 35% said their body images cause them to ‘often’ or ‘always’ worry. Research has shown that girls are more likely to be dissatisfied with their appearance an their weight than boys.2 3 In a survey by Mental Health Foundation, 46% of girls reported that their body image caused them to worry ‘often’ or ‘always’ compared to 25% of boys.4 In addition to this UK survey by Be Real, targeted at UK adolescents, it was revealed that 36% agreed they would do whatever it took to look good with 57% saying they had considered going on a diet and 10% saying they had considered cosmetic surgery.5 Disturbingly among secondary school boys, 10% said they would consider taking steroids to achieve their goals.6 Through these surveys, young people have expressed that body image is a substantial concern. Body satisfaction and a pressure to be thin is linked to depressive symptoms such as anxiety disorders (social anxiety or panic disorder) particularly in those children who do not match societal views of the ideal body.7 8 9 Possessing a poor body image may also prevent young people from engaging in healthy behaviours, as studies have found that children with poor body image are less likely to take part in physical activity. Survey data has shown that 36% of girls and 24% of boys avoided taking part in activities like physical exercise/physical education (P.E.) due to worries about their appearance. Body image is a substantial concern identified by 16-25 year olds and is the third biggest challenge currently causing harm to young people behind a lack of employment opportunities and failure to succeed within the education system being the first two.10

Body positivity is a social movement with the rationale of addressing and combating these concerns and issues surrounding body image and their effects on people’s mental health, predominantly young people. Body positivity intends to be an inclusive movement focused on celebrating and welcoming all body types, regardless of size, shape, skin tone, gender, and physical abilities. It is a movement that seeks to rewrite present beauty standards deemed as the norm. This movement has not gone unnoticed by corporations, one of which is the sporting apparel giant Nike. In 2019, Nike introduced a plus-sized mannequin to its London flagship store, NikeTown. This move was not without fierce debate and controversy. One side welcomed the sporting giants decision calling it truly inclusive and dispelling erroneous and outdated preconceived notions about plus-size women being unable to participate in physical activity, whilst the other side argues that it perpetuates a “dangerous lie” encouraging people to deny health risks related to obesity. 11 12 The opposing views held by both camps on the matter of plus size mannequins depicts clearly the contentious dichotomy between social norms versus clinical health concerns. We shall now explore the latter viewpoint.

There currently exists a silent obesity pandemic. Latest figures recorded by The World Health Organisation (WHO) show that obesity has tripled since 1975.13 This observation is far from hyperbole as looking closer to home there exists an obesity crisis across Europe, with the UK being one of the nations suffering the brunt of this crisis. From the data aggregated from the study, the UK is considered a nation at high risk. The UK ranked 3rd for obese adults, 12th for childhood obesity, 8th for obesity in children and adolescents and 4th on a chart of “The fattest nations in the EU”.14 What’s more, the WHO warns that the European obesity crisis is responsible for 1.2 million deaths a year. Obesity and overweight contributes to a myriad of health issues including fatty liver disease, breathing difficulties and mobility issues just to name a few. According to data from Cancer Research UK , obesity and overweight are the 2nd largest cause of cancer behind smoking in the UK. More pertinently, obese or overweight individuals are more likely to be prediabetic and on the cusp of becoming diabetic (Type-2), and heading into, if not already experiencing, metabolic syndrome; a cluster of common pathologies such as insulin insensitivity and hypertension. The link between T2D and heart disease is well-established. The unchallenged acceptance surrounding body positivity, from a medical perspective, is financially detrimental to our NHS due to the cost of treatment and complications that arise from a chronic disease. Furthermore, a chronic illness sweeping amongst a population will undoubtedly affect a nations economy negatively striking directly at our labour force and productivity. We strive for a healthier nation and in order to do so we must promote, support and provide education on the importance of achieving an individuals’ ideal body weight as opposed to an ideal or socially accepted body type.

The gold standard for identifying an individual’s body weight is by calculating their body mass index (BMI). The BMI is calculated by dividing a person’s weight in kilograms (kg) by their height in metres squared. An ideal BMI ranges between 18.5 to 24.9. An individual deemed obese would have a range between 30 to 39.9. The choice to use a BMI range is not without its critics and caveats. For instance, muscular and athletic people such as rugby union players and heavyweight boxers fall victim to the irony that their BMI range classifying them as overweight, whilst they are in fact a health weight. The discrepancy arises due to muscle being denser than fat.15 Equally your ethnicity can skew your BMI reading, as some ethnic groups such as South Asians are more susceptible to some health problems such as diabetes with a BMI of 23, which is usually considered healthy.16 Finally, on the theme of caveats, research has shown that a grey zone exists with people who are obese but metabolically healthy, meaning they have healthy cholesterol and blood sugar levels as well as normal blood pressure. Despite the contradictory nature of this finding, medical advice supported by clinical data, suggest losing weight may be more beneficial for you.17 It is for this reason, we encourage all people, men and women irrespective of size to increase their physical activity in a manner that is effective and comfortable to them.

In closing, we have looked at the subject of body positivity its rationale as a social movement, its importance and impact on teen and adolescent mental health. We have looked at this movement that has been gaining traction against the backdrop of an obesity crisis in Europe. We have also presented two polarizing and at times polemic points of views relating to body positivity and the plus-size model debate. Our contribution and stance on this debate comes purely from a medical angle. To reiterate we care not about “attractiveness”. This is a superficial at least and subjective at most. We acknowledge and respect the latter. However, neither is central to our source of concern on the topic. Our concern resides with improving and maintaining physiological well-being and any threat to the quality of life or life itself through prediabetes or the development of T2D. We reject the acceptance, normalisation and at times acquiescence of an individual’s weight being clinically unhealthy, but champion the necessity and ideals for an individual to retain a degree of responsibility and effort in managing their health to give them the best quality of life. This is what we support wholeheartedly. As a healthcare & pharmaceutical company, it would be grossly irresponsible to suggest the opposite. Our responsibility also extends to ensuring we do not criticise or crush any genuine initiative or attempts that may help individuals take their first step to losing that excess weight. Whilst support those individuals we aim to move the conversation towards positive thinking and positive actions towards good health and the awareness of the dangers prediabetes can pose.

Reference:

1. Be Real. Somebody Like Me: A report investigating the impact of body image anxiety on young people in the UK. [Internet]. 2017. Available from:   https://www.berealcampaign.co.uk/research/somebody-like-me  

2. Delfabbro PH, Winefield AH, Anderson S, Hammarstrom A, Winefield H. Body image and psychological well-being in adolescents: The relationship between gender and school type. J Genet Psychol. 2011 Jan 25;172(1):67–

3. Kenny U, Sullivan L, Callaghan M, Molcho M, Kelly C. The relationship between cyberbullying and friendship dynamics on adolescent body dissatisfaction: A cross-sectional study. J Health Psychol. 2018 Mar 5;23(4):629–39.

What is Prediabetes?

Fri, 27 May 2022 12:57:41 GMT

To mark the Diabetes (Type-2) Prevention Week, we shall provide you with a brief overview of what prediabetes is, why it is significant, who is most at risk and what can be done to tackle it.

What is prediabetes?

Prediabetes, also known as non-diabetic hyperglycaemia, is a serious health condition that sees a person’s blood glucose level reside above the healthy range, but reside just below the range required for the person to be diagnosed with Type-2 Diabetes (T2D).

An individual is deemed prediabetic if they have an HbA1c reading of between 42mmol/mol (6%) to 47.9mmol/mol (6.4%) or a fasting plasma glucose (FPG) of 5.5mmol/l to 6.9 mmol/l.

In the UK, statistics suggest that there are 13.6 million people at risk of developing Type-2 diabetes.

Why is prediabetes important?

Yes, prediabetes is indeed incredibly important with a multitude of reasons as to why it is significant. We shall present you with the leading two. Firstly, prediabetes is effectively silent. Prediabetes generally does not present with any symptoms, meaning that the person is unaware they have a clinically high chance of progressing onto developing T2D. An individual deemed prediabetic may also be at risk of developing metabolic syndrome. Metabolic syndrome is defined as a syndrome that includes a cluster of common pathologies: obesity, insulin resistance dyslipidemia and hypertension.1 Sadly, by the time an individual is made aware they are diabetic, specifically T2D, they would have most likely succumb to a cardiovascular event such as a stroke or a myocardial infraction. At this point they may, depending on the severity, experience a marked reduction in their quality of life. The patient’s diminished quality of life also impacts the NHS financially.

The second significant reason is the cost on the NHS to treat a patient now diabetic as a result of no clinical intervention taking place earlier on in the patient’s therapeutic journey. The annual cost of diabetes to the NHS stands at approximately £14bn a year.2 NHS spending on diabetic complications and treatment equates to £2.1bn and £7.7bn respectively.

As of 2019, there were 3.9 million people living with a diagnosis of diabetes in of which, 90% of those are type 2. This is to say nothing of the undiagnosed 1 million people living with Type-2 diabetes or those who are prediabetes. In the UK, it is projected that incidences of diabetes will rise with 5.5 million living with some form of the condition by 2030.

From the current data and the projected forecasts it is vital that we do everything we can both be it individually or as a company to support the reduction of clinical and financial pressure on the NHS as a result of the rising incidences of Type-2 diabetes diagnosis. To protect both patients and the NHS, in particularly primary care, the application of the old adage “prevention is better than cure” is most applicable and welcomed.

Who is most at risk of prediabetes?

You are most at risk of prediabetes and the subsequent risk of developing T2D if:

You’re white and over 40 or over 25 if you’re African-Caribbean, Black African, or South Asian.

You are of South Asian descent and African-Caribbean or Black African descent, as T2D is two to four times more likely in people of these ethnicities.

You have a family history of T2D. You are two to six times more likely to develop type 2 diabetes if you have a parent, brother, sister or child with diabetes.

You’ve ever had high blood pressure.

You are carrying extra weight, especially if this weight is around your midriff & lower belly.

It is estimated that 5%-10% of pre-diabetic patients will become diabetic each year with a similar percent reverting back to normoglycaemia.5

This offers a glimmer of hope and an opportunity to prevent developing metabolic syndrome or T2D by taking the initiative to make the necessary inteventions early on.

To start you journey of prevention today. Consider using the Know your risk Type-2 Diabetes by clicking this link: https://preventing-diabetes.co.uk/Know-your-risk-dtc/

How do you treat Prediabetes, what can be done?

As mentioned above, prediabetes is preventable and reversible if identified early. The first thing you can do if you identify as a high risk patient for prediabetes or T2D is to speak with your GP surgery to arrange for a blood test. This blood test will measure you HbA1c levels for the last two to three months.

Another step you can take to reverse your prediabtes and reduce your chances of developing type to diabetes is to focus on improving your nutrition and increasing your physical activity. With nutrition the aim here is not to strave yourself but to make better choice that are low in sugar (simple carbohydrates) and reasonable portions of complex carbohydrates. This links well into increasing levels of exercise and physical activity. The link and the objective with exercise, is to ensure your level of energy expenditure is greater than your calorific intake.

You can begin to implement these changes yourself, or better yet, for more effective guidance and results ask your GP surgery about the NHS Diabetes Prevention Programme (NDPP). Please see links below for further information.

Signposting:

NHS Diabetes Prevention Programme (NDPP): https://www.england.nhs.uk/diabetes/diabetes-prevention/

Know Your Risk Tool: https://preventing-diabetes.co.uk/Know-your-risk-dtc/ .

Xyla Health & Wellbeing: https://xylahealthandwellbeing.com/contact-us/

Reference:

1.Basciano H, Federico L and Adeli K. Fructose, insulin resistance, and metabolic dyslipidemia. Nutr & Metab. 2005. 2:5, 1-14.

NHS Diabetes Prevention Programme (NDPP): https://www.england.nhs.uk/diabetes/diabetes-prevention/

2. Kanavos, Van den Aardweg and Schurer: Diabetes expenditure, burden of disease and management in 5 EU countries. 2012. LSE.

3. Diabetes UK. Diabetes Statistics. < https://www.diabetes.org.uk/professionals/position-statements-reports/statistics > accessed 08th May 2022.

4. Diabetes UK. Prediabetes. < https://www.diabetes.org.uk/preventing-type-2-diabetes/prediabetes >

5. Twohig H. Hodges V. Mitchell C. Editorial Prediabetes: Opportunity or Overdiagnosis. Brit. J. Gen Pract. 172-173.

Diabetes (Type-2) Prevention Week

Wed, 25 May 2022 15:43:36 GMT

This week, 23 ^rd May-28 ^th May, marks Diabetes (Type-2) Prevention Week 2022. Type-2 diabetes is seems somewhat manageable and at times treated with a “matter of fact” attitude or simple as inevitable. This is far from the case. Type-2 diabetes is indeed a very serious and chronic disease that requires the appropriate amount of respect and discipline in controlling their blood glucose and blood pressure. If not, Type-2 Diabetes can be fatal. The one positive or optimistic angle one can adopt with Type-2 Diabetes is that it can be arrested and reversed if caught early at the prediabetic stage.

This week we shall be posting articles covering:

Prediabetes: What is it?

Tipping Point: Body Positivity vs Prediabetes

Is inflation influential in causing Type-2 Diabetes?

In addition to these articles, we are also running a campaign throughout this week with a discount on Fergie’s Sparkling Water ^® . Use the promo code: DPW10 for “ 10% OFF ” your total order.

We shall also be providing appropriate signposting to direct or support you to the most relevant and sufficient services. We would love for you to be a part of this week!

NEWS: Supporting the IFA Conference

Tue, 24 May 2022 09:55:22 GMT

Nnadi’s Healthcare & Pharmaceuticals was proud, yet humbled, to have been given the opportunity to provide Fergie’s Sparkling Water ® to the International Food Addiction (IFA) Conference hosted by the Public Health Collaboration (PHC). The PHC & IFA conferences welcomes everyone from healthcare professionals to members of the public in order to work together for better public health. Nnadi’s Healthcare & Pharmaceuticals is very much in alignment with improving UK public health, a matter that sits centrally in our longer-term objectives, and will strive to continuing supporting, collaborating and when called upon, to contribute to any discussion or initiative.

Thank you very much IFA & PHC.

Metaverse, Friend or Foe? How the metaverse could potentially lead to addiction & impact mental health

Tue, 05 Apr 2022 12:43:52 GMT

On Thursday 28 ^th October 2021 Mark Zuckerberg, Founder & CEO of Facebook Inc, made an announcement that the social media communication juggernaut that houses the eponymous Facebook, Instagram, What’s App and Oculus was to change its name to Meta (Meta Platforms, Inc). ^[1] The word meta is derived from the Greek “μετα” meaning “after or beyond”, aptly named, given the growth and mainstay of virtual interaction in our daily lives post the lockdowns and the COVID-19 pandemic in the “new normal”. ^[2] Though the name “meta” serves as an apt choice again, given that the word meta is the prefix to the word “metaverse”- the next digital frontier currently in the 21 ^st Century. In this feature we will define the metaverse, the benefits and possibilities the metaverse offers, whilst touching upon the concerns and the perceived risks to health and the measures proposed to mitigate these perceived risks.

The metaverse is defined as a virtual reality world where users can interact, game and experience things just as they would in the real world through the conduit of current immersive technology such as augmented reality (AR) and virtual reality (VR) headsets. ^[3] There is very much an allure, intrigue and excitement surrounding the possibilities that the metaverse offers. According to a survey conducted by Statista, in which they asked respondents “What is the leading benefit of the metaverse worldwide in 2021?” The leading answer was the ability to overcome obstacles such as disabilities that impede individuals in real life. ^[4] Other benefits include; travelling the world without moving, the creation of new job opportunities as well as providing more possibilities in education. ^[5] Given the potential the metaverse offers in further enhancing the human experience, it is currently estimated to be worth $22bn (approximately £17bn) as of 2021 and is expected to be valued at $800bn (£613bn) by 2024 alone. It is even predicted that the metaverse could be a $10-30 trillion opportunity. ^{[6] [7] [8]}

Leading Benefits of the metaverse worldwide in 2021

Source: Statista

Despite the exuberance of an imminent new digital reality and the bullish valuation and forecast attached to the metaverse, there very much exists a cautious hesitance and concern with this vast technologically immersive world. The metaverse could negatively and significantly impact a user’s mental health and could trigger problems with addiction to greater magnitudes than its primitive predecessor the Internet. The aforementioned problems are very much present with the Internet and to an arguable extent, remain unresolved.

Addiction, as defined by the NHS, is considered as not having control over doing, taking or using something to the point where it could be harmful to the individual. ^[9] . A more specific and encompassing definition, defines addiction as a chronic brain disorder molded by strong biosocial factors that has devastating consequences to individuals and to society. ^[10] The pathophysiology of addiction is underpinned by the delineation of the neurocircuitry that mediate reward and motivation, executive control and emotional processing. There are three regions of the brain that are responsible for the cyclical process of addiction. They are the prefrontal cortex, the basal ganglia and the amygdala and we shall cover their roles very briefly.

The prefrontal cortex is the region that underlies executive functions essential in the process of supporting an individual in making rational and healthy decisions whilst regulating our emotions. ^[11] The craving stage of addiction is associated with the prefrontal cortex as the conditional stimuli (drug/addictive artifact) elicit dopamine in the striatum, triggering the motivation to seek and consume the drug. ^[12] The neurocircuitry includes various regions of the brain, the hippocampus & amygdala, of which, glutameric projections from these regions modulate the sensitivity and reactivity to cues and adverse emotions that trigger the urgent motivation for, and preoccupation with drug taking. ^[13] The second region, the basal ganglia, is responsible for intoxication and the binge use of the stimuli. During this stage “the drug” stimulates large bursts of dopamine in the mesolimbic reward system that reinforces drug taking and establishes a strengthened conditioned associations, between that preceding drug consumption with expectation of reward. ^[14] The final region of the brain involved in the role of addiction is the amygdala, specifically the extended amygdala. The amygdala is responsible for the withdrawal phase, the period in which the intoxicating effects of a drug wear off. This period is associated with the ubiquitous negative moods; ahedonia (inability/loss of feeling pleasure), increased sensitivity to stress, dysphoria (a state of unhappiness, restlessness and frustration). The dopamine reward/motivation system is hypofunctional contributing to ahedonia and the aversive state during withdrawal. ^[15] The circuits underlying the withdrawal phase comprise of basal forebrain areas including the extended amygdala. Increased signaling in these circuits are responsible for continuing the cyclic process of addiction as they trigger aversive symptoms that reverts and renders an individual to succumb to their vulnerability of cravings and preoccupation with taking drugs.

Source: Volkow ND & Boyle M: Neuroscience of Addiction: Relevance to Prevention and Treatment.

The relevance and correlation between addiction and the metaverse resides in the immersive technology projecting a powerful illusion of reality, a testament to the sheer awesomeness and power of the metaverse and the components that contribute to sensory overload that poses a neurobiological risk to the user. The neurobiological risk can be observed and assessed in both youths and adults.

In youth, the neurobiological risk arises from the detrimental impact the metaverse may have on neuroplasticity, given that the adolescent brain has not completed its development and as a result is more neuroplastic than an adult brain. ^[16] In the human brain from early to mid-20s the rate of development differs across neuronal circuits with development growing faster and earlier for reward/motivation than for prefrontal top-down control circuitry (emotional control and decision-making) which develops last. Hence, early exposure to a stimulus of abuse, runs the risk of significantly impairing the development of the prefrontal cortex and subsequently increases long-term risk of addiction as a result of increased neuroplasticity in a youthful brain and explains why addiction develops faster in an adolescent than in an adult. ^[17]

In adults, the neurobiological risk, arises in the form of impaired decision-making and an imbalance in assessing long and short-term consequences against rewards, hence potentially engaging in irresponsible and reckless behaviour. In a brain unaffected by addition, the circuits controlling desire for a drug/stimuli are held in check by the prefrontal cortical region. However, when the prefrontal cortical circuits become hypofunctional as a result of repeated exposure to drug or stimuli, the addicted individual is incapable of resisting the strong motivation that desires the drug or stimuli. This explains the difficulty an addicted individual faces when trying to stop taking drugs even when they experience negative consequences and the drug’s pleasurable effects. ^[18]

Just as addiction from over stimulation from the use of the metaverse can impact the neurobiology leaving an impact on the anatomical and physiological structure on the brain, overstimulation of the metaverse can impart a negative psychological impact upon the mind, compromising the user’s mental health. Given our knowledge to date of social media’s and online gaming effect on the brain, they serve as relatable templates to forecast and examine the potential effects the metaverse may have on mental health.

The potential damage to mental health begins from the activation of the dopamine system that provides temporary pleasure and a form of escapism sought by the user of the metaverse. The negative impacts begin to arise post the binge and intoxication phase, fully manifesting itself through the vicious circle of tolerance and dependence (T&D). Tolerance, in so far as incremental prolonged use for the same level of stimulation and dependence (psychological dependence - emotional and motivational withdrawal), would be the byproducts of an individual’s immersion into a digital world that increases the likelihood of being divorced from reality. ^[19] This risk is greater if the users has a genetic disposition to T&D. It is the discrepancies between perceived reality and actual reality that leads to symptoms of anxiety and major depression, predominant symptoms that impact mental health and well-being when reviewing the effects of long-term use of social media and online gaming. Having illuminated the challenges and concerns surrounding the metaverse, with regards to addiction and mental health, our attention shall now turn to suggestions and possible solutions to safeguarding an individual’s experience in the immersive world of the metaverse.

Dangers of the metaverse according to Internet users worldwide in 2021

Source: Statista

With the impending mainstream adoption of the metaverse and the admission of Meta Platforms Inc’s vice president of augmented reality, that moderating user behaviour at “any meaningful scale is practically impossible”, there indeed exists a race to provide safety measures to protect and improve the users experience, particular if it poses any risk or harm to wellbeing mental or physical. ^[20] One organisation leading the efforts to combat harm to users of online services, such as the metaverse, whilst preserving the safety and wellbeing of society is the Carnegie United Kingdom Trust (CUKT). The CUKT aims to do this through the development of the Online Safety Bill (OSB). The OSB is a proposed Act of Parliament with the intention to improve Internet safety. The responsibility of creating the skeleton and model underpinning the OSB has been tasked to Professor Lorna Woods (Professor of Internet law at University of Essex) and William Perrin (Carnegie UK Trustee). ^[21] Through the work of the aforementioned academics, they seek to eventually create an encompassing piece of legislation with the proposed OSB as a means to increase the scope of liability to ensure technology companies can not use the metaverse to escape regulation. ^[22] The regulation would tackle issues surrounding body dysmorphia and false advertising, which both contribute to mental health disorders as well as the ingredients that lead to addiction as mentioned by a previous Meta Platforms Inc whistleblower Frances Haugen. ^{[23] [24] [25]} Nevertheless, it is immensely difficult to say with any certainty to what extent the metaverse would impact addiction and mental health from its current form today. However, proposed bills, like that of the OSB, and with the oversight of the Carnegie UK Trust, are meaningful attempts to safeguard the wellbeing of the society and its members from the potential effects of metaverse.

To reiterate, this article is not a hit piece or criticism of Meta Platforms Inc. for they are not the only companies exploring the capabilities of the metaverse. Google, Disney, JP Morgan and Microsoft. The metaverse can indeed be a force for good. This has been demonstrated in the therapeutic applications of clinical mental issues such as; anxiety (social), phobias, PSTD, delusions and hallucinations. ^[26] . Aside from the clinical benefits, the metaverse has the capacity to provide us with opportunities and experiences that either compliment or enhance our daily experiences ranging from work possibilities, to live entertainment to education. ^[27]

Main Reasons for Joining the Metaverse, according to Internet users in 2021

Source: Statista

Through, this article we seek not to be alarmists or prophets of doom. We seek not to accelerate the fears of the arrival of a dystopian future here on Earth, depicting isolated and drooling addicts seeking ruinous, though pleasurable escapism, akin to those that frequented the opium dens in the 19 ^th Century. Nor do we wish to be the luddites that obstruct the pioneering and logical pathway towards technological evolution. Rather, we seek to scrutinise and objectively critique caveats in the adoption of the metaverse and the negative impact to societal health and wellbeing. We have an obligation to do so as a means to probe and evaluate our defences in order to establish our level of preparedness, not just in providing a safe user experience of the metaverse, but in supporting a user’s clinical needs and wellbeing should it be required.

To conclude, the metaverse is the next inevitable frontier for the Internet and how we connect with it. The metaverse at this nascent stage, is a source of much hype and conjecture and it is the latter that gives rise to skeptical caution, which can be misconstrued as pessimistic and regressive. Rather, it seeks to highlight genuine concerns of addiction and their effects upon neurobiological development and neuroplasticity, along with the impact upon an individuals perception of fantasy (escapism) and reality and thus on the mental health and wellbeing of users. Nevertheless, there exists much curiosity, excitement and optimism as the metaverse presents a host of opportunities and enhancements, all of which is intended to be delivered within proposed UK regulatory parameters of the OSB to reduce online harm whilst using the metaverse. It is indeed too early to say and near nigh impossible to confidently forecast the impact of the metaverse on addiction and mental health. However, what must remain at the forefront as we head towards the adoption of the metaverse is the collaborative cooperation of healthcare institutions, regulatory institution and technology companies that create and provide the online experience and service of the metaverse to devise a framework that allows for the full capability of the metaverse to be enjoyed whilst safeguarding the health and wellbeing of users. Nnadi’s Healthcare & Pharmaceuticals stand ready to contribute and support these efforts when the opportunity to do so arises.

Reference:

[1] S Rodriguez. Facebook changes company name to Meta. CNBC. < https://www.cnbc.com/2021/10/28/facebook-changes-company-name-to-meta.html > accessed 12 ^th March 2022

[2] Oxford English Dictionary (OED). < https://www.oed.com/oed2/00145066 > accessed 12 ^th March 2022.

[3] A Siu. What exactly is the metaverse and why people are talking about it. The Wrap < www.thewrap.com/what-is-metaverse-explained / > accessed 12 ^th March 2022.

[4] Statista. Leading benefits of the metaverse worldwide in 2021. < https://www.statista.com/statistics/1285117/metaverse-benefits / > accessed 12 ^th March 2022.

[5] Ibid

[6] Global News Wire: Metaverse Market Worth USD 21.91 Billion In 2020 and is predicted to grow at 41.7% CAGR by 2030- Report by Market Research Future (MRFR). GlobalNewsWire < https://www.statista.com/statistics/1285117/metaverse-benefits/ > accessed 12 ^th March 2022.

[7] J Swartz. What is the ‘metaverse’ and how much will it be worth? Depends on whom you ask. Market Watch. < https://www.marketwatch.com/story/what-is-the-metaverse-and-how-much-will-it-be-worth-depends-on-whom-you-ask-11637781312 > accessed 12 ^th March 2022.

[8] S Williams. The Single Biggest Question That’ll Determine the Future of the $30 Trillion Metaverse. The Motley Fool. < https://www.fool.com/investing/2021/12/14/question-determine-future-of-30-trillion-metaverse/ > accessed 12 ^th March 2022.

[9] National Health Service (NHS). Addiction: What is it? < https://www.nhs.uk/live-well/healthy-body/addiction-what-is-it/ > accessed 24 ^th March 2022.

[10] ND Volkow, M Boyle. Neuroscience of Addiction: Relevance to Prevention and Treatment. Am J Psych. 2018; 175:8.

[11] Ibid

[12] Volkow ND, Wang GJ, Telang F, et al.: Cocaine cues and dopamine in dorsal striatum: mechanism of craving in cocaine addiction. J Neurosci 2006; 26:6583–6588.

[13] Volkow ND, Koob GF, McLellan AT: Neurobiologic advances from the brain disease model of addiction. N Engl J Med 2016; 374:363–371.

[14] Volkow ND, Baler RD: NOW vs. LATER brain circuits: implications for obesity and addiction. Trends Neurosci 2015; 38:345–352.

[15] Volkow ND, Morales M: The brain on drugs: from reward to addiction. Cell 2015; 162:712–725.

[16] Ibid 10

[17] Whitaker LR, Degoulet M, Morikawa H: Social deprivation enhances VTA synaptic plasticity and drug-induced contextual learning. Neuron 2013; 77:335–345.

[18] Ibid.

[19] Reed P. Will the Metaverse Impact Mental Health? Psychology Today. https://www.psychologytoday.com/gb/blog/digital-world-real-world/202110/will-the-metaverse-impact-mental-health accessed 25 ^th March 2022.

[20] Murgia M., Bradshaw T. Metaverse “cannot escape” UK online rules, say experts. Financial Times https://www.ft.com/content/fa34ddf1-03d9-4375-b38a-96f251fda98b accessed 31 ^st March 2022.

[21] Ibid.

[22] Ibid.

[23] Bansu T. The metaverse is the next venue for body dysmorphia online. https://www.technologyreview.com/2021/11/16/1040174/facebook-metaverse-body-dysmorphia/ accessed 31 ^st March 2022

[24] Collective Wellbeing CaRegulating the future: the Online Safety Bill and the metaverse. https://www.carnegieuktrust.org.uk/blog-posts/regulating-the-future-the-online-safety-bill-and-the-metaverse/ accessed 31 ^st March 2022

[25] Casert R., Chan K. Whistleblower warns of potential impact of Facebook’s metaverse project. https://www.belfasttelegraph.co.uk/news/world-news/whistleblower-warns-of-potential-impact-of-facebooks-metaverse-project-41033588.html accessed 31 ^st March 2022

[26] Family Addiction Specialist. A New Age of Digital Addiction- What the Metaverse Means for Mental Health and Digital Addiction. < https://www.familyaddictionspecialist.com/blog/a-new-age-of-digital-addiction-what-the-metaverse-means-for-mental-health-and-digital-addiction accessed 31 ^st March 2022

[27] Statista. Main reasons for joining the metaverse according to internet users worldwide in 2021. https://www.statista.com/statistics/1288870/reasons-joining-metaverse/ accessed 31 ^st March 2022

Childhood Obesity & COVID-19: When Two Pandemics Collide.

PAR003_OE@heg.com — Wed, 26 Jan 2022 08:46:59 GMT

Even with a new year, it is unfortunate that the COVID-19 pandemic has spilled over into 2022 as a result of the Omnicron variant, a mutation of the SAR-COV-2 virus. Though, whilst this pandemic has raged and continues to linger, there has been another pandemic in circulation. This pandemic has been growing steadily, yet rapidly, and has amplified the effects of the COVID-19 virus. This pandemic is obesity. In this feature, we will be addressing both obesity & childhood obesity in relation to the COVID-19 pandemic, the future consequences and the measures implemented to change course.

At the start of the 21st Century, obesity has steadily emerged as a modern pandemic with devastating consequences to global health worldwide. According to the World Health Organisation (WHO), obesity has tripled since 1975, has contributed to killing more people than underweight across the global, has been diagnosed in over 340 million children and adolescents aged 5-19 in 2016 and 39 million children under the age of 5 in 2020.¹ Turning our focus domestically, to the UK, childhood obesity rules have increased substantially over the past year in the UK, according to the UK Government’s National Child Measurement Programme. This rise in prevalence is the largest single-year increase since the program began in 2006 and truly does highlight the worldwide rising trend of obesity among children and adolescents.² In the midst of this alarming, yet “quiet” pandemic, the outbreak of the COVID-19 virus quickly reached pandemic levels and as a result, protocols and measures such as lockdowns and closing of schools were implemented as a means to reduce the R-rate and hence, the spread of the virus.

The COVID-19 virus and the measures implemented have devastatingly compounded the obesity pandemic. Through the effects of lockdown and disruption to schooling; children and adolescents are experiencing a more sedentary lifestyle than they did prior to the pandemic. Unsurprisingly, with an increase in recreational screen time of up to 4 hours a day (in children aged 12-13), the rate of BMI increase has almost doubled amongst children and adolescents aged 2-19 years during the pandemic compared to pre-pandemic according to a US study.³ The final area, in which the COVID-19 pandemic has compounded the obesity pandemic, is in further exacerbating food insecurity. This in turn has resulted in the purchasing of cheaper packaged and processed food, a trend observed in those from areas of higher deprivations and susceptible to a higher prevalence of obesity and Type-2 diabetes. The compounding of the obesity pandemic by the COVID-19 will undoubtedly cause problems and indeed have consequences upon NHS resources. These future consequences are being seen now in the present.

The leading future consequence that is posing a present day challenge is a rise in hospital admissions seen in obese and overweight members of the population throughout this pandemic. Based upon systematic reviews and meta-analyses, the data overwhelmingly shows a positive correlation between overweight and obesity and a higher risk of admission into intensive care and poorer outcomes for COVID-19. For instance, in Italy, a nation ravaged by the pandemic, it is reported that 99% of deaths have been inpatients with pre-existing conditions commonly seen with obesity such as; hypertension, heart disease, Type-2 diabetes and cancer.⁴ This trend has also been observed in other European nations too. According to a report in the UK, out of 10,465 critically ill patients confirmed with COVID-19, 73.7% were either overweight or living with obesity.⁵ The witnessing of future consequences manifesting themselves, as a result of the population’s current poor state of health, with relations to COVID-19, bodes ominously for the future of not just our national health services, or the health of our economy, but for the health of our population.

The ominous sentiment towards the childhood obesity pandemic, and the rising incidences in the UK, is evoked and validated by multiple research studies that indicate that overweight and obese children are more likely to become obese adults developing non-communicable diseases (NCD) such as Type-2 diabetes, cardiovascular disease and cancer at a younger age than children deemed to have a healthy weight.⁶ Add this to an aging UK population and a steady rise in UK life expectancy from 2011 up until 2019, it depicts the worrying possibility of children growing up as adults living with chronic disease requiring extended care over a much longer period.⁷ ⁸ Considering the cost of obesity to the NHS stands at approximately £6.1 billion per year and the cost to the wider economy, estimated at £27 billion a year, and even higher, such a future of chronic illness, greatly impacts the economy further given that the COVID-19 pandemic has financially cost the UK £251bn (though other studies suggest its in the region of £394bn).⁹ ¹⁰ ¹¹

The first major economic impact to be exacted would be the further tightening of the financial constraints the NHS was, and still is, tackling with regards to rising expenditures in treating complications of overweight and obesity. For instance, the NHS has apportioned £14bn a year to treat diabetes with almost 60% being spent on the secondary care (hospital) admissions due to complications with Type-2 diabetes (myocardial infarction, diabetic nephropathy, diabetic neuropathy and leg amputations).¹² Part of the remaining capital from within the £14bn is allocated towards treatment and management costs of Type-2 diabetes through primary care and polypharmacy (prescriptions) despite their costs continuing to rise. Yet, financial projections suggest that the cost of diabetes is expected to rise to an estimated £16.9bn by 2035.¹³ Given the current climate and commitment a British Government would have to the NHS in times such as these; a remedy to cover these expenditures could entail pumping more money into the NHS and public health sector from the UK Treasury. However, this option would raise fears and concerns with regards to inflation, a factor that would greatly affect those from lower socioeconomic backgrounds.

The second economic impact pertains to a nation’s economic output as a result of extensive treatment of chronic NCD among its citizens. A study found that diseases in general, particularly chronic diseases deprive individuals of their health and productive potential. Hence, from a country’s perspective, chronic disease reduces the ultimate economic productivity (revenue) of a nation by depleting the quality and quantity of a country’s labour force.¹⁴ When the COVID-19 pandemic passes, the UK cannot afford to have a sickly population that curtails her economic prowess and her capacity to compete in a competitive and rapidly changing global economy. The UK cannot become undone, economically, as a result of a preventable disease. In order to steer clear of such a fate, solutions must be and have begun to be implemented to safeguard the nation’s health and future.

Acknowledging the current obesity crisis in UK and the future implications to the nation, the government launched its childhood obesity initiative.¹⁵ The government’s proposed strategic initiative includes, but is not limited to; the implementation of a soft drinks levy (sugar tax), taking out 20% of sugar products, helping all children become physically active for at least an hour and encouraging clearer food labeling practices.¹⁶ The initiatives listed above were the impetus behind the creation of our beverage product Fergie’s Sparkling Water®. Fergie’s Sparkling Water ® is a refreshingly fruit-flavoured water, available in three flavours and free from calories, sugars and sweeteners. Fergie’s Sparkling Water® aspires to not only become a staple brand in the UK, but a healthier alternative to sugar-laden soft drinks & beverages. Fergie’s Sparkling Water®, is our vehicle and contribution towards helping to tackle childhood & adolescent obesity. In addition to the government’s 2016 Childhood Obesity: a plan for action, The NHS, via its NHS: Long Term Plan, seeks to rollout 15 new specialist clinics to support severely obese children and young people in England in the coming months.¹⁷

As we leave one pandemic, we enter into another that has not only been waiting but growing over the last 24 months. We must do everything we can to address this pandemic that could prematurely rob us of our economic productivity and people. Nnadi’s Healthcare & Pharmaceuticals through Fergie’s Sparkling Water® seeks to do what it can to help in arresting and reversing the full consequences of childhood obesity upon our nation.

References:

1 World Health Organisation (WHO). Obesity & Overweight. June 2021.

https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight . accessed 10th January 2022

2 Editorial. Childhood obesity: A growing pandemic. The Lancet Diabetes & Endocrinology. https://www.thelancet.com/action/showPdf?pii=S2213-8587%2821%2900314-4 accessed 10th January 2022

3 Ibid

4 Istitvto Svperiore Di Sanita. Characteristics of COVID-19 patients dying in Italy Report based on available data March 20th, 2020. https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_20_marzo_eng.pdf accessed 16th January 2022

5 Intensive Care National Audit & Research Centre (ICNARC). COVID-19. https://www.icnarc.org/About/Latest-News/2020/03/22/Report-On-196-Patients-Critically-Ill-With-Covid-19 accessed 16th January 2022

6 Ibid 2

7 V Raleigh. What is Happening to the Life Expectancy in England? Kings Fund. https://www.kingsfund.org.uk/publications/whats-happening-life-expectancy-england accessed 16th January 2022.

8 Age UK. Later Life in the United Kingdom 2019. https://www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/later_life_uk_factsheet.pdf accessed 6th January 2022

9 Public Health England. Health matters: obesity and the food environment. 17-3-2017. 1-2-2017.

10 The Centre for Economics and Business Research (CERB). One year since lockdown: The £251 billion cost to the UK economy. https://cebr.com/reports/one-year-since-lockdown-the-251-billion-cost-to-the-uk-economy/ accessed 16th January 2022

11 Institute for Government. The cost of coronavirus.

https://www.instituteforgovernment.org.uk/explainers/cost-coronavirus accessed 16th January 2022

12 Diabetes.co.uk.. The Cost of Diabetes. www.diabetes.org.uk/resources-s3/2017-11/diabetes%20uk%20cost%20of%20diabetes%20report.pdf accessed 16th January 2022

13 Diabetes : Cost of Diabetes. https://www.diabetes.co.uk/cost-of-diabetes.html accessed 16th January 2022

14 D Abegunde A Stanciole. An estimation of the economic impact of chronic non-communicable diseases in selected countries. WHO: Department of Chronic Disease and Health Promotion (CHP). 2006. https://www.who.int/chp/working_paper_growth%20model29may.pdf accessed 16th January 2022

15 UK Government. Guidance: Childhood Obesity: a plan for action. https://www.gov.uk/government/publications/childhood-obesity-a-plan-for-action/childhood-obesity-a-plan-for-action accessed 18th January 2022

16 Ibid

17 NHS. NHS to open first specialist clinics for severely obese children. 2021. https://www.england.nhs.uk/2021/11/specialist-clinics/ accessed 18th January 2022

Nnadi’s Healthcare & Pharmaceuticals Annual Report 2021: Letter from Managing Director

PAR003_OE@heg.com — Tue, 21 Dec 2021 09:35:50 GMT

Dear Reader,

This has been most certainly a year of highs and low and I am please to report that we are ending the year on much delayed, though welcomed, high.

This year began most promisingly with steady sales of Fergie’s Sparkling Water® throughout Q1, despite the delays incurred in the previous year. As we approached the end of Q1, we successfully completed a round of funding and hence achieved a key milestone of the year, that saw us heading into Q2 with the opportunity to further expand the volumes of Fergie’s Sparkling Water®. To our great misfortune we ran into difficulties as a result of an unreliable link within our supply chain. This unwelcomed saga robbed us of a fully operational Q2 and Q3 in both time and treasure. Upon reflection and analysis this episode has delivered a most valuable learning experience that should stand the company in good stead and has seen us fortify our supply chain moving forward. I am glad, at least, that this rectification has taken place in Q4 of this year, providing a springboard onto a clear path into 2022.

Despite the trials and tribulations endured midway through this year, we still remained productive insofar as further identifying the first cohort of our OTC medicines we will be progressing with and the articulation of our digital health device; R.O.S.I.A.®. Technology like this and of its kind will be of equal interest and importance to us in the coming years.

Looking back at 2021, there exists one area I’ve identified in which, I believe, we have fallen short and requires our attention and improvement in 2022. The area I am alluding to is the level and rate of engagement we currently have with the public. Even with all things considered, with regards to delays and unforeseen setbacks, I believe that the true potential and relevance of Nnadi’s Healthcare & Pharmaceuticals will not be met or recognized without consistency in public engagement. We seek to do better on this front heading into 2022.

Though all our milestones for 2021 may not have been met with the intended momentum desired, I take heart, nonetheless, in the fact that we have not been derailed or despondent by our performance mid-2021. I can say that the character and attitude of this company during this year truly embodies the company’s motto of “Onwards We March”. Whilst 2021 further tested this company’s resolve, 2022 will test the economic and commercial prowess and I am confident that this fledging company and quiet beast will find its balance and will hit its stride from 2022 onwards.

We await this New Year with a replenished resolved and an unwavering focus upon the milestones we seek to achieve. We wait for the New Year and the next chapter in this company with excitement and bated breath.

I would like to take this opportunity to ask you to keep safe and to extend to you and yours a Merry Christmas and a Happy New Year.

Most Sincerely,

Sonny Ume

Founder & Managing Director,

Nnadi’s Healthcare & Pharmaceuticals Ltd.

A Shot in the Arm: Bioethical Principles associated with the COVID-19 Vaccines

PAR003_OE@heg.com — Wed, 22 Sep 2021 12:10:07 GMT

As we head into the autumn and winter season of 2021, the UK government is striving to avoid a scenario of having to declare another unwelcomed and crippling lockdown as a means to reducing the R-rate, cases of COVID-19 and pressure on NHS hospitals. The government’s leading strategy resides in the current vaccination programme. As of the time of writing, in the United Kingdom, 92.5m doses have been administered, 44m are fully vaccinated, which means 66.1% of the UK population are fully vaccinated. ¹

To stave off complacency and hence, spikes in COVID-19 cases, the concept of a “vaccine passport” has been discussed and proposed as a means of achieving a firmer grip on controlling the spread of the virus. A vaccine passport, in the UK, would involve an NHS app with a QR code confirming the holder’s vaccination status; naturally acquired immunity and recent negative test results. ² A paper alternative would also be available. As of this autumn, such a passport will be arriving to these shores. After a majority vote in the Scottish parliament, the Scottish First Minister, Nicolas Sturgeon MSP, announced that Scotland would be introducing a compulsory vaccine passport for large gatherings in Scotland with immediate effect as of the 1st October 2021. Recently, the Welsh First Minister Mark Drakeford, announced that “COVID Passes” will be introduced to Wales in order for people to enter large indoor venues as of the 11th October 2021. The UK Government considered the adoption of a vaccine passport scheme in England, but the proposal had initially been scrapped before the current Health Secretary Sajid Javid MP, announced the Government’s Winter Plan to Parliament with “Mandatory COVID passports’ as part of the Government’s Plan B contingency to tackle the COVID-19 virus this winter.

As it currently stands, the collective objective and zeitgeist in the UK towards the COVID-19 virus and the COVID-19 vaccines is one of urgency towards prevention and protection. Though understandable, it does call to the forefront the bioethical principles and the examination of these principles when applied to the COVID-19 vaccines.

Bioethics is defined as the branch of applied ethics that studies the philosophical, social and legal issues arising in medicine and the life sciences. ³ To us as a company, bioethics is where the compassion of medicine and the wisdom of the Law converge. At the central point of convergence between the disciplines of medicine and law is the bioethical principle of autonomy. Autonomy is the right to self-government, personal freedom and will, so as to act freely and independently provided that one has the capacity to understand one’s situation in order to make a decision about the care they receive which is in their best interest. Autonomy is synonymous with the recognised legal principle of self-determination- meaning that one has sovereignty over one’s life and in doing so possesses the right to control what happens to them. This right and legal principle form the basis and necessity for requiring consent, to any form of medical treatment and in doing so maintain bodily inviolability. ⁴ Despite the rights of autonomy being enshrined within the field of medicine and at the core of the relationship between healthcare professionals (HCP) and patient, the leading rebuttal to the right of autonomy relating to how best to tackle COVID-19 pandemic is the argument for paternalism, buttressed by utilitarianism.

Starting with the latter, Libertarians would agree with the philosophy that one must be free to pursue a conception of life that is conducive to human flourishing. However, the utilitarian would propose that if one’s autonomy adversely affects other people, then the exercising of one’s own autonomy cannot be conducive to human flourishing. ⁵ It is at this junction of the argument that paternalism may be introduced to rectify “injurious” autonomy for the beneficial interest of the many. Paternalism is deemed as an authority that seeks to make a decision on behalf of another individual under the justification of appealing to the principles of beneficence (the duty to do good). Within the realm of medicine, paternalism would manifest itself in the form of the HCP making the decision that a medical procedure or the administration of a medicinal product would be appropriate and necessary for a patient’s well-being. Nevertheless, as noble as the concept of paternalism appears it can not supersede autonomy, in so far as a person of sound mind that possess the mental capacity to truly make autonomous decisions. Should autonomy need to be applied, in such a situation involving an incapable individuals (due to intellectual disability), then paternalism seeks to restore autonomy. In this instance, it would then raise the question as to whether this is genuine paternalism as it could be argued that the restoration of autonomy would mean it could not have been exercised in the first place. Paternalism implemented where an individual is self-autonomous would be seen as an infringement upon the rights of the individual and in terms of bioethics, those of the patient. As established in the ruling of Justice Cardozo in Schloendorff v New York Hospital (1914) 105 NE 92 :

“Every human being of adult years and sound mind has a right to determine what shall be done with his own body; [and a surgeon who performs an operation without his patient’s consent, commits an assault]…”

This sentiment is echoed and expanded upon by Justice Flaherty in the case of McFall v Shimp (1978) 10 Pa D & C (3d) 90, who articulates the importance of autonomy and its safeguarding in a free society:

“Our society, contrary to many others, has as its first principle, the respect for the individual, and that society and government exist to protect the individual from being invaded and hurt by another.”

He continues:

“For our law to compel the defendant to submit to an intrusion of his body would change every concept and principle upon which our society is founded.”

Respecting a self-autonomous individual’s decision, no matter how incongruent it may seem, should not give rise to alarming rhetoric or to the notion of deprioritising unvaccinated patients. Such a notion contravenes the central pillar of bioethical principles of non-maleficence (do no harm) and justice (fairness). In light of the Government’s Winter Plan and attitudes towards mandatory COVID passports, it is imperative that views towards the COVID-19 vaccines do not erode or encroach upon the autonomy of free UK citizens. Such an erosion and encroachment would yield substantial consequences with long-term ramifications to three key areas we have identified, long after the COVID-19 pandemic itself.

Imbalance of Power in Favour of The State:

The first consequence of erosion and encroachment of a citizen’s autonomy will result in the creation of a public bill (a proposal for new law) that becomes law, which will create an imbalance of power in favour of the State. The creation and upholding of these laws, via legal rulings, would set course for uncharted territory by potentially fostering dangerous precedence. The wisdom and longevity of the Law (in England & Wales) seek not to remedy issues of today but to foresee those that may arise tomorrow. The cornerstone of common law and the reaffirmation of judicial rulings unwavering and consistency are entrenched in the adherence to precedence. Therefore, should a future government seek to override self autonomous decision-making, again on the grounds of paternalism, they need only refer to those laws drafted and adhered to during the COVID-19 pandemic so as to widen the scope of government power. The protection of individual sovereignty is vital, as individual rights provide a corrective to this imbalance by ensuring that the rights of the individual will be given due consideration and respect.

It is worth mentioning that under The Coronavirus Act 2020, Schedule 19 Section 3 subparagraph (1)(2).14 the Government does not compel any individual to mandatory vaccination. However, the potential requirement of a mandatory COVID passport is not within the spirit of the law and touches upon the second consequence to our society.

Disruption to Societal Cohesion:

The implementation of a mandatory COVID-passport runs the risk of growing a dichotomy that will indeed disrupt societal cohesion amongst the UK population. The dichotomy of the COVID-19 passport, arises in the generation of labels such as “Vaccinated” (Partially Vaccinated) and “Unvaccinated”. This form of labelling and categorisation of individuals shares unnervingly similar connotations with attitudes and language associated with leprosy-“clean” and “unclean” that would lead to discrimination and ostracisation of biblical proportion amongst our society both figuratively and literally. At the other end of this scale those who opt not to take a COVID-19 vaccine are met with the hostility as they are deemed “selfish”, “ignorant” or worst still an “anti-vaxxer” for expressing their right of autonomy. ⁶ Another area of disruption relates to employment, as one’s vaccination status could be the difference between one retaining their livelihood or losing it. ^{7 8} Yes, a strong argument can be made for HCPs and care workers to be vaccinated when working in a care setting and with those most vulnerable to the virus. However, such an emotive and understandable argument neglects to acknowledge the sensitivity and again, the precedence it would set, if an individual’s sovereignty and autonomy were to be infringed by societal pressure.

It falls upon the Government to again safeguard these rights in a free society. In order to do so, the Government must gauge the temperature of society and dampen propaganda and rhetoric that fans the flames of hostility and judgmental pressure upon the expression of an individual’s autonomy and self-determination. Failure to safeguard these rights breeds a climate for distrust and dissent in the long-run destructively distorts perception and efforts made with regards to all vaccination programmes in the UK.

Seeds of distrust particularly towards all vaccination programmes:

The final consequence of the erosion and encroachment on the right of autonomy would be the seeds of distrust sown amongst society towards all vaccination programmes, past and present. This feeling would be capitalised upon by opportunistic and true anti-vaxxers who would seek to hijack the narrative on vaccines resulting in reduced uptakes of vaccines (including childhood immunisation schedules). ⁹ The “ bungling of the vaccine over the line ” (given that the clinical trial process generally takes as long as 8-10 years in order to generate extensive clinical data) further fuels skepticism amongst those with a clinical or non-clinical backgrounds. This also says nothing of their concerns surrounding the intrusion of their autonomy too. The desire for a favoured short-term outcome could jeopardise the great work of the vaccination programmes since its inception and in the future.

The current climate and sentiment towards vaccines expressed across these aforementioned consequences can be tempered by acknowledging, promoting and adhering to the bioethical principle of autonomy and the right of self-determination along with the benefits of the COVID-19 vaccine.

As a healthcare & pharmaceutical company who certainly acknowledges the bioethical principles of medicine, we too acknowledge the efficacy of medicine. Medicine is most efficacious when a proactive and preventative stance is adopted rather than a reactive stance. Prognosis is greater with the former than the latter. Therefore, if you identify with the leading risk factors of COVID-19:

- Older Age (65 years and older)

- Respiratory Problems

- Heart Disease

- Diabetes (Type I & II)

- Obese

- Cancer

- Downs Syndrome

- Weakened Immune System

Then we would encourage you to speak with a trusted and qualified HCP (pharmacist, GP or nurse) so as to ensure you are able to make an informed decision about taking a COVID-19 vaccine. This should be your own decision free from external influence, pressure or judgment.

Should you decide not to get a COVID-19 vaccine then, we would urge you to take the necessary precautions to keep yourself and others safe.

We both value and respect your health and autonomy.

References:

1 Our World in Data. Coronavirus (COVID-19) Vaccinations. https://ourworldindata.org/covid-vaccinations?country=GBR accessed 14th September 2021.

2 Institute for Government. COVID Passport. https://www.instituteforgovernment.org.uk/explainers/vaccine-passports accessed 14th September 2021.

3 RF Chadwick. Bioethics. Britannica. https://www.britannica.com/topic/bioethics accessed 14th September 2021.

4 M Stauch K Wheat J Tingle. Sourcebook on Medical Law. Cavendish Publishing Limited. 1998.

5 Ibid.

6 BBC NEWS. Covid: Turning down Covid vaccine is selfish, says Michael Gove. 27 July 2021. https://www.bbc.co.uk/news/uk-politics-57987016 accessed 18th September 2021.

7 J McKay. ‘No jab, no job’ rule is causing an ‘exodus’ of care staff, warns union. Nursing Notes. https://nursingnotes.co.uk/news/social-care/no-jab-no-job-rule-is-causing-an-exodus-of-care-staff-warns-union/#.YUR4-mRKgy4 accessed 17th September 2021.

8 Carehome.co.uk. I am going to lose my much-loved in a care home as I refuse to have the Covid vaccine.

9 T Shepard. ‘Its psychologically easier’: how anti-vaxxers capitalized on coronavirus fears to spread misinformation. < https://www.theguardian.com/society/2020/jun/06/its-psychologically-easier-how-anti-vaxxers-capitalised-on-coronavirus-fears-to-spread-misinformation accessed 19th September 2021.

Prescriptions to the Moon? The Growing Cost of NHS Prescriptions in England.

PAR003_OE@heg.com — Thu, 17 Jun 2021 14:45:17 GMT

“Crypto to the moon!” This is the bullish, and at times immensely speculative, sentiment adopted and exalted by impassioned cryptocurrency holders whenever the price of digital currencies rises exorbitantly, more so during this pandemic. It would seem that the trend observed in rallying cryptocurrency market prices are somewhat reflective, but to differing extents, of the rising price in NHS prescriptions for patients in England.

As of April 1st 2021, prescription prices in England are set to rise with the cost of an NHS prescription (per item) rising from £9.15 to £9.35 (an increase of 2.2%) and the NHS pre-payment certificate rising from £105.90 to £108.10 (an increase of 2.1%). ¹ It is believed that these increases are in line with inflation. At this point, it should be mention that those exempt from NHS prescription payment; full-time students, over 60’s, those on income support and those with chronic long-term conditions such as diabetes etc., will be unaffected by these price increases. However, the timing of said increases, given the current economic landscape, shines a light on this re-emerging topic, its economic implications to both the public and the NHS, whilst calling for the scrutinising of NHS spending and the development of strategies towards the NHS devising, operating and maintaining an economically sustainable model for the delivery of care in the years to come.

The year 2020 was chaotic and punishing to the fortunes and aspirations of the UK economy, families and individuals. These new NHS prescription charges find themselves being introduced into a reeling economy that has seen unemployment rise (despite the government supporting an estimated 4.5 million employees via Job Retention Scheme, otherwise known as Furlough, the initiative has been deemed a stay of execution prolonging the inevitable), the deterioration of the labour market, an increase in redundancy claims and looming uncertainty surrounding the COVID-19 pandemic’s impact upon inflation. ^2 3 What’s more, climbing prescription prices affect a grey area of population estimated to be in the region 300,000 people labelled as the “The Forgotten Unemployed”. This cohort consists of people, predominantly young men and older women; 55-64 years of age, who are without jobs or on very low wages and not claiming benefits they are entitled to. ⁴ Sadly, it is most likely that such a group would either retain its numbers or increase in size due to the pandemic’s impact on the economy. In addition to this demographic, there exists patients who are required to pay for long-term chronic illnesses such as Parkinson’s Disease (PD) and Inflammatory Bowel Disease (IPD). The concerns around NHS prescription prices are certainly founded given that latest projections indicate the price of an NHS prescription will exceed the £10 mark, costing an NHS patient in England £10.15 (per item) by 2025. ⁵ In order to address and arrest the rise of NHS prescription on this forecasted trajectory in England, it is essential to understand the economics surrounding this topic.

Economics, in particularly microeconomics, is the study of human behaviour, specifically an individual’s decision-making in relation to demand and scarce resources with an alternative use. In such a system, price governs consumer behavior and herein lies the concern with NHS prescriptions potentially and on course to exceeding the £10 mark. It will influence, and hence, negatively affect a patient’s health-seeking behavior. The common adage “Health is wealth” would not be adhered to due to the commonly observed economic phenomenon of price elasticity. Elasticity can be defined as the sensitivity of a given products demand in relation to fluctuation in price, thereby deeming a product as elastic (meaning demand is sensitive to price increase) or inelastic (meaning demand is not sensitive to price increase). Applying this to principle and economic observation to that of prescription prices, a prescription, in the eyes of a patient may be viewed as elastic and not as inelastic as the common adage professes. Therefore, a price increase could potentially discourage a patient from seeing their GP or other NHS prescribing healthcare professional or fulfilling a prescription as a result of price.

As from the cartoon above, a can of cola valued at $1 is reasonably priced. However, should the price increase to $3 consumers would shun the can of cola. On the other hand, milk once priced at 80c, now costing $2.40 would not cause for consumers to shun milk. The difference in behaviour to price, is defined by the consumers perception of value or necessity to them. This is what determines demand with a marketplace.

In light of pricing influence, another contributory factor governing patient behaviour and decision-making are socioeconomic pressures. A patient in this situation is met with the dilemma of opportunity cost, which equates to making a decision between the choice of obtaining a completed prescription or being short on a personal loan repayment for that month, or having an attenuated shopping budget or skipping a meal. Opportunity cost is the loss of other alternatives when one alternative is chosen. ⁶ Such a dilemma bears both short-term and long-term consequences. In the short-term, poor health choices are made by patients that result in poor health outcomes. In the long-term, the consequences are not only visited upon the patient they are visited upon the NHS, thus there exists a long-term pharmacoeconomic implication in rising NHS prescription costs in England.

Prescriptions aid with the management or treatment of ailments and disease and can work as a form of preventative medicine, in a more specific fashion than their over-the-counter (OTC) medicines counterparts, in a primary care setting. If we take the example of a simple acute skin infection (cellulitis) of a leg, failure to address this short-term can potentially amount to a significant cost in the long-term. To perform a cost-benefit analysis of treatment within a primary care setting as opposed to treatment in a secondary care setting for such an infection, one would need to consider the following components in their analysis. The cost of 7-day course of treatment with a two-item prescription for a 28 box of flucloxacillin 250mg, four times a day (QDS) and 15g tube of 2% fusidic acid, QDS at a price of £1.67 and £1.92 respectively. ⁷ Assuming the patient does not present to their GP or opts not to fulfill their prescription and the infection becomes worse, the patient may then be admitted to hospital where upon admission a bed costs on average £222. ⁸ Once admitted the clinical team will begin a course of treatment involving intravenous (IV) flucloxacillin 2g, every 6 hours QDS at a cost of £6 per 2g vial equating to £24 for a single day of treatment in a hospital care setting. ^{9&nsp;&nsp;10} In total, treatment at this stage would cost the NHS a minimum of £246 in comparison to £3.59 at primary care. Should the patient continue in prolonging to seek treatment and delay therapeutic intervention through a prescription, the infection can lead to necrotizing fasciitis and in extreme cases surgical intervention would supersede therapeutic intervention in order to improve patient prognosis (in order to avoid death), a single limb amputation would be the treatment of choice.

Surgery of this nature depending on complexity, can range from £5,776- £19,751. ¹¹ These costs say nothing of the aftercare support via NHS occupational therapist, which would set the overall cost soaring. Nevertheless, it demonstrates the vast cost, from just under £4 to almost £20,000, a cost benefit analysis would take have to take this into consideration in its calculation in the treating of a simple infection if caught early in cellulitis. Acknowledging the long-term pharmacoeconomic complications to the NHS, it should serve to galvanise all involved stakeholders to work towards strategies, with the rationale of minimising costs from health complications through a modern and sustainable prescription charge system for England.

On the topic of prescription charges, there exist two schools of thought with opposing arguments. The leading argument for abolishing prescription charges, suggests that such charges create a false economy and is a tax on the sick based on an obsolete and unjust exemptions list that has not been amended since 1968. ¹² The leading argument against abolishing prescription charges, propose the reformation of the current exemption list and charging policy, as abolishing prescription charges would cost an estimated £600m. The proposed reformation draws on the findings from the Baker’s Health & Social Care Report Commission, commissioned in 2014. The report acknowledges that a charge of £9 an item was too high, suggested reducing prescription charges by 2/3, and that by reducing the exemptions, but leaving a cap in place for prescription charges, could raise more money than the current charge (this is in accordance to prescription charges in 2014), hence reducing the burden on the less well off who do pay, whilst seeing those who are not currently paying under this system, pay something. ¹³ Despite these proposals, there may indeed be resistance, namely politically, over the implementation of the suggested removal of a blanket exemption for older people, as this would not be a “vote winner”.

Scrapping prescription charges is the most popular and far easier than reforming the current system, but to do so at the tune of £600m calls for serious consideration. The Barker Report presents a spectrum of options for funding new settlements including charges for healthcare, cuts in other areas of public spending and higher taxation.

Although this approach makes sense theoretically, the practical application of increased taxation would succumb to the same economic fallacies of other economic policies drafted with the utmost altruistic intentions to address short-term issues whilst neglecting the long-term consequences. As American economist Arthur Laffer once said “When you cut the highest rates on the highest income earners government gets money from them”. This theory is best depicted in Laffer’s Curve.

As you can see from the diagram there is a point at which raising tax rate may increase revenue. However, and as it is quite often the case tax rate beyond a certain threshold results in a reduction in tax revenue, defeating the initial intended purpose of raising taxation.

We would support the prioritisation of savings over higher taxation as means to arrest escalating prescription prices in England. It was purported by an independent auditor, that the NHS wastes £7.6bn a year, an analysis that is somewhat corroborated by the Lord Carter report which identified and called for £5bn of savings to be made annually by 2020. ^14 15 A final finding that reinforces our stance on prioritising savings over taxation is the conclusion arrived at by the National Audit Office (NAO), who concluded that the NHS is not financially sustainable. ¹⁶ Furthermore, this conclusion echoes the same admonition made back by the NOA in 2019 when highlighting that then, Prime minister Theresa May’s cabinet’s pledge of £20.5bn towards fixing the crisis within the NHS would not suffice. Taking into account the projected level of waste amounting £7.6bn and the conclusions of the NAO, it would question the sagacity of implementing a strategy to address this crisis by requesting higher taxation. A justification for introducing more money into such a system in its current form is improbable and indefensible. Moreover an increase in national contribution, off the back end of an economically challenging time for a majority of citizens within England, would be most tone-deaf.

The prioritisation of savings, and to be clear, cuts, are necessary in order to liberate capital, which in conjunction with a revised exemption list, can contribute towards reducing prescription costs in England. Regretfully the politicisation of the NHS has led to the word “cuts” being used as a perniciously ominous and derogatory term, demonstrating a lack of commitment to the NHS by one political party to another. The NHS may indeed be free at the point of delivery (something that should remain forever more), but in actuality the NHS is not free at all. It is funded, rather substantially, by taxpayer’s money and so it calls for responsible custodianship in the management and sensible deployment of funds within the service. In order to successfully achieve the objective of reducing prescription charges, it will require the utmost cooperation and transparency for and from all those who are working on the current prescription policy of England. Tackling the issue of continually rising prescription prices in England cannot be done on a soapbox of populism and political pandering, as this serves to the detriment of the future of the NHS and the patients.

Nnadi’s Healthcare & Pharmaceuticals is in full support of a reformed exemption list and a subsidised prescription cost through savings that arrest the continued trajectory that would see £10 plus prescription by 2025. By achieving a balance of both cuts and reformation it prevents and protects patients from the bullish, though gradually spiralling, price rises in prescription costs, as seen in cryptocurrency markets, whilst ensuring the sustainability and financial long-term welfare of the NHS and patients in England.

Helpful Resources & Signposting :

If you need support with your prescription payment or health cost call;

NHS Help with Health Costs helpline: 0300 330 1343

If you are on low income and would like to see what support is available visit https://nhsbsa-live.powerappsportals.com/knowledgebase/category/?id=CAT-01286 for more information.

Prescription Charges Coalition is a group of 51 organisations calling for government to scrap prescription charges for people with long-term conditions Visit http://www.prescriptionchargescoalition.org.uk/about.html to learn more.

References:

1 Pharmaceutical Services Negotiation Services (PSNC). Prescription charges rise to £9.35 from 1st April.< https://psnc.org.uk/our-news/prescription-charge-to-rise-to-9-35/>. Accessed 6th June 2021

2 Office for National Statistics (ONS) Unemployment rate (aged 16 and over, seasonally adjusted). <https://www.ons.gov.uk/employmentandlabourmarket/peoplenotinwork/unemployment/timeseries/mgsx/lms>Accessed 6th June 2021

3 Resolution Foundation. Rising unemployment is taking a huge toll on young people, even as firms are learning to live with lockdown. <https://www.resolutionfoundation.org/press-releases/rising-unemployment-is-taking-a-huge-toll-on-young-people-even-as-firms-are-learning-to-live-with-lockdown/> Accessed 6th June 2021

4 Resolution Foundation. 300,000 “forgotten unemployed” people aren’t accessing the state support to which they are entitled. <https://www.resolutionfoundation.org/press-releases/300000-forgotten-unemployed-people-arent-accessing-the-state-support-to-which-they-are-entitled/> Accessed 6th June 2021

5 Prescription Charges Coalition. Coverage of Price Rise. <http://www.prescriptionchargescoalition.org.uk/latest-news> accessed 6th June 2021

6 J Fernando. Opportunity Cost. Investopedia 2020. https://www.investopedia.com/terms/o/opportunitycost.asp accessed 12th June 2021

7 British National Formulary 75. British Medical Journal Group and Pharmaceutical Press.

8 National Institute for Health and Care Excellence (NICE). Costing statement: Implementing the NICE guideline on Transition between inpatient hospital settings and community or care home settings for adult with social care needs (NG27) https://www.nice.org.uk/guidance/ng27/resources/costing-statement-2187244909 accessed 12th June 2021

9 Ibid 7

10 Buckinghamshire Healthcare NHS Trust. Management. 364FM.6 Management and treatment of cellulitis <http://www.bucksformulary.nhs.uk/docs/Guideline_364FM.pdf> accessed 12th June 2021.

11 L Steed. This is how much it costs the NHS to perform an operation to you. Surrey Live. <https://www.getsurrey.co.uk/news/surrey-news/how-much-costs-nhs-perform-14462706> accessed 12th June 2021

12 Royal Pharmaceutical Society (RPS). Prescription Charges: Policy Topic. < https://www.rpharms.com/recognition/all-our-campaigns/policy-a-z/prescription-charges> assessed 13th June 2021

13 The Barker Commission on the Future of Health and Social Care: A new settlement for health and social care. Final Report. <https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/Commission%20Final%20%20interactive.pdf> assessed 13th June 2021

14 The Carter Report: Review of the Operational Productivity in NHS Providers Interim Report 2015. < https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/434202/carter-interim-report.pdf> accessed 13th June 2021

15 J Gornall. How the NHS wastes a staggering £7.6bn a year. < https://www.dailymail.co.uk/health/article-4377250/How-NHS-wastes-7-6bn-year.html> accessed 13th June 2021

16 Care Management Matters. NHS system is not financially sustainable. < https://www.caremanagementmatters.co.uk/nhs-system-is-not-financially-sustainable/> accessed 13th June 2021.

We’re in British GQ: Summer Edition!

PAR003_OE@heg.com — Thu, 17 Jun 2021 09:22:06 GMT

Fergie’s Sparkling Water® has been fortunately chosen to appear in British GQ magazine summer editions running from June to August 2021.

GQ magazine is a luxury men’s magazine that focuses on topics such as fashion, style, fitness, books and food & drink.

We are delighted to have been selected to feature within British GQ’s “The Beach Bar” segment. If you’d like to get your hands on a case of Fergie’s Sparkling Water® this summer, then get in contact with us via, contact@nnadis.co.uk to reserve your case and we’ll happily add you to our pre-orders list.

Visit www.fergiesparklingwater.com .

Speak UP: Pandemic or Not, Your Health Matters!

PAR003_OE@heg.com — Wed, 28 Apr 2021 11:41:40 GMT

As the UK population and economy gradually stirs from the national lockdown and restrictions, in line with the road map to recovery and with much eagerness and excite for the summer be it home or abroad, there remains certain norms and attitudes associated with the COVID-19 pandemic we must stir from and leave behind too.

The initial impact of the COVID-19 pandemic had (and to some extent still has) upon our health services and economy has not been seen on our shores since peacetimes began. In response to the crisis the UK government devised and promulgated the slogan “Stay at home. Protect the NHS. Save lives.” as a means to flatten the curve (rise in the number of COVID-19 cases against our healthcare system’s capacity) and reduce the R-rate (rate of infection). The vast majority of the UK population complied and given the severity of the situation, from reported statistics on rate of infection, the number of cases and deaths as a result of COVID-19, along with the accounts of NHS frontline workers, all other health conditions became somewhat “secondary”. Consequently, daily reports of the COVID-19 pandemic and strict adherence to the government slogan, as a mark of solidarity with the NHS, created the norm, attitude and belief over the past 12 months that any illness or symptom, unrelated to COVID-19, were “non-urgent” and “unimportant” during these times. This trend has been reflected in GP records, which has seen a 50% reduction in diagnoses since the coronavirus outbreak¹. More worryingly, a UK analysis has revealed that 8,000 more people have died in their homes since the start of the coronavirus pandemic than in normal times. Of this total, 6,400 people died of conditions unrelated COVID-19². These findings among the population could be attributed to three factors:

i) Individuals wishing not to be a bother or a hypochondriac.

ii) Wishing not to add further pressure on the NHS.

iii) Fear of contracting COVID-19.

However, this needn’t be the case. At the time of writing, the landscape has changed epidemiologically. COVID-19 cases are dropping as the virus is no longer the leading cause of death in England according to the Office for National Statistics (ONS)³. COVID-19 is now the third leading cause of death in England. Furthermore, the case rates have fallen in nearly all regions except for the South West of England⁴. This much welcomed news is bolstered by, and quite possibly attributed to, the success of the UK’s COVID vaccination program. According to NHS England, it is estimated that 89.7% of people aged 45 and over in England have received their first dose of the COVID-19 vaccine and that the current total for the first dose of the COVID-19 vaccine administered in the UK stands at 33 million. For completeness the current total for the second dose of the COVID-19 vaccine administered stands at 5 million and counting. Things are indeed changing and changing for better it would seem.

Therefore, we would urge you or anyone you know who has delayed or chosen not to visit a healthcare professional or an appointment until the pandemic is completely over, not to. Now is the time, as is any time, to speak up about any ailments and to attend any appointments regarding your health and well-being. If something has been bothering you; be it pain, swelling, redness, irritation, chesty cough, bleeding, persistent reflux, any of which has caused you to self medicate by using over the counter medicines, then please go and visit your GP or pharmacist so that they can provide you with the care you need and deserve. Nnadi’s Healthcare & Pharmaceuticals has and will always champion prevention and preventative medicine over treatment. This is crucial in the following clinical areas which have been most affected by the pandemic:

Cancer

Cancer screenings have declined during the COVID-19 pandemic, with delays to some invitations and follow up appointment or both being outright suspended. Changes in health seeking behavior have indeed been observed with urgent 2-week wait for cancer referrals decreasing by up to 80%⁵. Furthermore, a substantial increase in the number of avoidable cancer deaths in England are to expected as a result of diagnostic delays due to COVID-19 outbreak in the UK⁶. According to the latest figures, 38% of cancer cases are preventable⁷.

Dental Care (Oral Health)

Dental care has felt the full impact and disruption of COVID-19. According to a report by Healthwatch, over 38,082 people during the July-Sept 2020 experienced difficulty accessing dental care via limited NHS appointments, postponed treatments, a lack of information and issues surrounding affordability⁸. Aside, from the general notion of visiting the dentist for treating acute dental pain, regular dental visits are vital for identifying early signs of mouth cancer and treating gum disease & infections before complications arise⁹.

Eye Care

Optician visits have declined too since the start of the pandemic considering that 250 people start losing their sight in the UK, in addition to 1 in 5 people will live with sight loss in their lifetime. With age-related macular degeneration (AMD) is a leading cause of blindness in the UK, hence it is even more worrying that this decline in optician visits affect patients with wet AMD, a treatable condition if caught early. The reported reduction in AMD presentation is as low as 25%. Overall, new referrals have dropped from 65% to 87% within the first month of the coronavirus outbreak compared to the same period in 2019¹⁰.

Cardiovascular Disease (CVD)

Sadly, during this pandemic, there has been a 50% drop in heart attack A&E attendees, meaning individuals are putting there lives at risk as they avoid or delay seeking medical attention¹¹. This equates to 5,000 every month or 1,100 people every week are not receiving emergency care for heart attacks¹². The main reason for this is due, once again to the pandemic, as 71% of cardiologist believe that patients fear contracting the virus if they expose themselves to a hospital setting¹³. This fear of exposure to a clinical setting is a cause for concern for those who would benefit from a cholesterol test in order to identify the “silent killer” that is hypercholesterolaemia associated with heart disease. Although high cholesterol does not mean you are more likely to catch COVID-19, the infection seems to follow a more severe clinical course in patients with CVD¹⁴.

This is by no means an exhaustive list, but these are health issues that have proven most problematic during this pandemic and bear the most consequences to both individuals and the health service in the future. Whichever service you need to access, PPE along with the full safety measures in accordance with the government’s COVID-19 guidelines have been implemented to keep you safe during your visit. To reiterate the leading treatment to the aforementioned health issues, and with all others, is preventative medicine. Prevention leads to a more favourable prognosis (outcome) and is vitally important in the long run with regards to the allocation of NHS resources and spending. It is the surest way to help keep the NHS and yourself in the best shape as possible in the years ahead.

So please, whether you are planning to have a staycation or making travel arrangements for a summer abroad, check-in with your GP, pharmacist, dentist or any other healthcare professional in order to receive the necessary treatment, support, or simply the all clear before starting your summer.

References:

¹ N Davis. Fear of contacting GPs during Covid outbreak ‘fuelling missed diagnoses’. The Guardian. 2020.

https://www.theguardian.com/society/2020/sep/23/fear-of-contacting-gps-during-covid-outbreak-fuelling-missed-diagnoses

² P Duncan D Campbell. More people dying at home during Covid-19 pandemic –UK analysis. The Guardian. 2020.

https://www.theguardian.com/society/2020/may/08/more-people-dying-at-home-during-covid-19-pandemic-uk-analysis

³ Office for National Statistics (ONS). Covid-19 Round up: The coronavirus (COVID-19) was the third leading cause of death in March 2021 after being the leading cause of death for four consecutive months.

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19roundup/2020-03-26

⁴ J Gammie. Covid cases drop as virus no longer leading cause of death in England. Evening Standard. 2020

https://www.standard.co.uk/news/uk/england-south-west-public-health-england-nhs-england-ons-b931222.html

⁵ C Maringe J Spicer M Morris et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modeling study. Lancet Oncol. 2020; 21(8)1023-1034.

⁶ W Hamilton. Cancer diagnostic delay in the COVID-19 era: What happens next? Lancet Oncol. 2020; 21(8)1000-1002.

⁷ Cancer Research UK. Statistics on preventable cancers.

https://www.cancerresearchuk.org/health-professional/cancer-statistics/risk/preventable-cancers

⁸ Healthwatch. Dentistry and the impact of COVID-19.

https://www.healthwatch.co.uk/news/2020-12-09/dentistry-and-impact-covid-19

⁹ You Smile Dental. 4 Reasons Why a Dental Checkup is important.

https://www.yousmiledental.com/blog/4-reasons-why-a-dental-checkup-is-important/

¹⁰ D Hutton. COVID-19: As patients avoid appointments, vision may be in jeopardy. Opthalmology Times.2020.

¹¹ J Bakker. Lives at risk due to 50% drop in heart attack A&E attendances. British Heart Foundation.

https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2020/april/drop-in-heart-attack-patients-amidst-coronavirus-break

¹² ibid

¹³ ibid.

¹⁴ D Radenkovic.S Chawla M Pirro et al. Choleserol in Reation to COVID-19: Should We Care About it? J Clin Med 2020; 9(6): 1909.

Grin and Bear it? Sugar’s Impact on Oral Health

admin@ciutz.co.uk (Blog Admin) — Thu, 11 Feb 2021 15:44:28 GMT

A sweet tooth is something a majority of us can be guilty of possessing. This normal characteristic craving, over time, can not only leave a sour taste in the mouth of the possessor, but figuratively in the mouth of the NHS too. Sugar’s impact on the body and, disruption of normal physiology that contributes to obesity and type II diabetes is well defined (see our Can I Live? : Free Sugars Impact & The Livers Role article ) and very much at the forefront of the current societal health narrative that influences the public’s purchasing decision. However, sugar’s impact on oral health has not accrued as much coverage and attention as other sugar-related diseases or illnesses that pose a threat to good health. This article seeks to present the facts and concerns surrounding sugar’s role in the development of tooth decay (also known as dental caries) and explain why such concerns are equally as justified as sugars roles in the onset of obesity, type II diabetes and some cancers.

Tooth decay occurs when acid from within the mouth causes demineralization. This is the removal of calcium, enamel and dentine from the tooth, which weakens the tooth’s surface leading to the formation of a hole or cavity that may result in pain or infection. Sugar’s role in this disease comes in the form of being the available substrate or food source for bacteria (biofilm) within the plaque. The bacteria metabolises the available sugar and produces acid as a waste product. With a high availability of sugar, from a diet high in free sugars, like fructose and high fructose corn syrup (HFCS), the greater amount of acid produced. A diet consistent of high free sugars results in repeated and prolonged acid attacks that go on to form the signs and symptoms of tooth decay in a person. Acknowledging this, the World Health Organization (WHO) formulated guidelines for dental health and obesity prevention.

The WHO recommends a reduced intake of free sugars throughout the life with a reduction of free sugars intake to less than 10% of the total energy intake (a strong recommendation) and preferably below 5% of total energy intake (conditional recommendation) in both adults and children ¹ . Within this guideline free sugars are defined in accordance with the Scientific Advisory Committee on Nutrition (SACN) definition, as all sugars added to foods and drinks by the manufacturers, cook or consumers, as well as sugars naturally present in honey, all kinds of syrups and unsweetened fruit juices. The WHO have arrived at these recommendations based upon data clearly showing that people already consuming significantly more sugar than they should, increases the risk of dental caries. The recommendations proffered by the WHO are most welcomed as tooth decay is an international public health challenge with no less than 80% of the world’s population affected and is the most common chronic infectious disease of childhood. If we focus on the statistics around tooth decay in England alone, one gains a truly alarming insight into the scale of the problem.

The statistics surrounding the incidences in the United Kingdom over the last three years have been harrowing. In 2016 there were 35,205 cases of Under 10s receiving hospital treatment for tooth decay in England. To apply some context to this figure, it was twice as many admitted to hospital over the same period for a broken arm, which was 17,043 cases. The number of hospital admission for tooth decay were even greater than cases of asthma which had 19,585 cases, greater than cases of epilepsy which had 10,397 cases and greater than cases of appendicitis which had 3,805 cases.

In the following year of 2017, tooth extractions for the treatment of tooth decay rose to a record 42,911 cases. This rate equated to 170 cases a day ⁴ ! In fact as of 2013 the number of hospital operations to remove multiple teeth under 18s had gone up by nearly almost 20% in four consecutive years since ⁵ . The latest statistical figures for 2017-18 reveal that the number of multiple tooth extractions in under 18s rose to 43,515. From collated data going back to 2012-13, the most affected age group with the highest admissions to hospital due to tooth decay were aged between 5 to 9 years old. Admissions in this age group rose for the three consecutive years ^{6 7} .

These figures are frustrating and simply unacceptable when one considers that tooth decay is 90% preventable and that NHS dental treatment is free for all under 18s. Therefore, 26% of children in the North West of England should not have missed school, 67% of parents should not have had to witness and report that their child had been in pain from tooth decay, of which 38% of children had sleepless nights because of dental pain. In addition to this, parents should not have to run the risk of potentially losing many working days to care for their child ⁸ . As a result of the clear impact sugar and tooth decay has on the everyday life of the children and potentially the consequences on their household income, the UK government and clinicians have placed great emphasis on preventative policies to address, halt and reserves the unmitigated crisis of tooth decay and extractions in England.

The proposed preventative policies for the UK tooth decay crisis from healthcare professionals (HCPs), clinical institutions, charities and the government are formulated with the rationale of not just providing a solution with short term benefits, but one that delivers an efficient and sustainable long term solution.

On the matter of sustainability the most obvious benefit is economically, as prevention reduces the burden of tooth decay on the NHS. The treatment of dental disease places a significant cost on the NHS, as most notably seen in 2014, which saw dental treatment for all ages cost £3.4 billion. A further breakdown reveals that the average cost of a tooth extraction in hospital for a child aged 5 and under is £836. The total spend on tooth extractions among the under 5s was £7.8m. Additionally, in the financial year 2015 to 2016 the cost of tooth extractions was approximately £50.5 million among children aged 0 to 19 years old. From the financial years of 2012-13 to 2016-17, the cost of removing severely decayed teeth in under under-18s has risen over those four years from £27.3m to £36.2m.

Adopting the preventative approach, not only makes sense from an economic viewpoint, it tackles ‘Dental Neglect’. Dental neglect is defined, as the persistent failure to meet a child’s basic oral health needs, likely to result in the serious impairment of a child’s oral or general health or development. It is vital that the prevention of dental caries begins from childhood onwards. Even low levels of caries in childhood are of significance to levels of caries throughout the life of the child. Children who have high levels of disease in primary teeth have an increased risk of disease in their permanent teeth. If treated, these teeth will again require long-term maintenance throughout the life of the child. The importance of better oral care does not only apply to the under 5, or 5-9 years age group but to all children and adolescents who are the most at risk when combining all age groups. Tooth decay leaves more of an impact on the latter aforementioned age group that transcends anatomical and physiological consequences. Studies have shown that dental disorders, including, tooth decay and tooth loss severely influence self-esteem levels in adolescents. Based upon the findings from a study using the Rosenberg Self Esteem Scale (RSES) to assess self-esteem, they found that females, more so than males placed greater emphasis on appearance and hence were more affected psychologically from dental disorders than their male counterparts ⁹ . Yet, the psychological impact of dental disorder is not confined to just adolescents. Children with poor dental health suffer beyond anatomical and physiological consequences too in the sense that their ability to eat, play, socialise and speak is limited causing them to be withdrawn and self-conscious from an early age. Taking preventative action on oral and dental health prevents a child or an adolescent from carrying such an insecurity, throughout the most formative years of their lives. The preventative approach not only goes some way to ensuring the social and psychological development and to an extent that the mental health of the most at risk age group, it unifies preventative measures with those of non-pharmacological intervention.

Society, overall, is now more health conscious and discerning towards the food it purchases and consumes than ever before. This shift in consumer habit and thinking lends credence to the notion that our health is inextricably linked to our diet. It is for this reason the preventative approach advocates for programmes, policies and initiatives that reduce free sugars. This collective objective gave rise to the creation of Fergie’s Sparkling Water®.

Fergie’s Sparkling Water® is a contribution from a pharmaceutical company to serve as a worthy alternative to sugary carbonated and non-carbonated beverages. Fergie’s Sparkling Water® boasts a truly fruity, flavoursome and refreshing taste free from sugars, sweeteners and preservatives. Fergie’s Sparkling Water® is available in three enticing flavours: Lemon, Lime & Kiwi, Apple, Blackcurrant & Elderflower and Watermelon & Cranberry.

The rationale behind the development of Fergie’s Sparkling Water® is not only to present an option that when taken would seamlessly fit into the schedule or lifestyle of an individual with the return of maintaining good health, but to serve as a vehicle to help disseminate the benefits of preventative measures that reduce and prevent the impact of sugar and tooth decay on a child’s education, self-esteem and their household income for instance. Through Fergie’s Sparkling Water®, Nnadi’s Healthcare & Pharmaceuticals seeks to work collaboratively with parents, schools, HCPs, institutions, charities and the government to tackle this crisis and prevent its proliferation in the years and generations to come.

If Nnadi’s Healthcare & Pharmaceuticals can bring its perspective and clinical understanding via Fergie’s Sparkling Water®, it should make a marked difference not only to the health of children and adolescent but to the financial health of the NHS. Our efforts, as a British pharmaceutical company, should contribute towards a more sustainable health service that is capable of reallocating spending from treating this preventable crisis and redirecting it towards successfully purchasing and securing new life saving drugs for life-threatening illnesses. In the end, we aid in building a healthier United Kingdom, consisting of a healthier population, supported by a healthier NHS, all from making effortless changes towards detrimental dietary choices and habits, to a more conducive one that benefits the population’s dental and oral health. This is something truly worth smiling about.

Reference :

1 World Health Organisation (WHO) guideline on sugars intake for adults and children. http://www.who.int/nutrition/publications/guidelines/sugars_intake/en /.

2 Scientific Advisory Committee on Nutrition (2015) SACN Carbohydrates and Health Report. London: Public Health England.

3 J Breda J Jewell A Keller. The Importance of the World Health Organization Sugar Guidelines for Dental Health and Obesity Prevention. Caries Res 2019;53:149-152

4 H Siddique. Rotten state of Children’s teeth in England exposed in hospital data. The Guardian https://www.theguardian.com/society/2017/oct/31/rotten-state-childrens-teeth-england-under-10-hospital-treatment-tooth-decay

5 D. Campbell. Dentists warn of child tooth decay crisis as extractions hit new high. The Guardian. < https://www.theguardian.com/society/2018/jan/13/dentists-warn-of-child-tooth-decay-crisis-as-extractions-hit-new-high >

6 Royal College of Surgeons. Number of Children aged 5 to 9 admitted to hospital due to tooth decay rises again. < https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/hospital-admission-tooth-decay/ >

7 M Watson. Government green paper aims to clean up oral heal. < https://www.dentistry.co.uk/2019/10/03/government-green-paper-aims-clean-oral-health />

8 Health Matters: Child Dental Health. < https://www.gov.uk/government/publications/health-matters-child-dental-health/health-matters-child-dental-health >

9 P Kaur S Singh A Mathur et al. Impact of Dental Disorders and its Influence on Self Esteem Levels among Adolescents. J Clin Diagnostic Res 2017, Vol-11(4): ZC05-ZC08.

Can I Live? : The Impact of Free Sugars & The Liver’s Role

admin@ciutz.co.uk (Blog Admin) — Thu, 11 Feb 2021 15:30:36 GMT

Back in the 1970’s, 1980’s and 1990’s the dietary villains on the scene were fats. This resulted in a spike in the production, purchase and consumption of low fat foods, meals and diets, heralding the “low-fat craze” seen during these decades. However, as the 21st Century approached, medical and scientific research presented their findings that in actuality fats were not the villains after all. With a new millennium came a new dietary bad guy. Sugar.

As seen with those aforementioned decades, scientific findings shifted the consumer’s spending habits, once again, by the late 2000’s and early 2010s towards items on the supermarket that were low in sugar, sugar free or with no added sugar. This trend led to one reputable publication declaring, “Sugar is the new tobacco!” By associating sugar with that of the addictive and harmful carcinogenic (as widely perceived) agent of tobacco, it now placed sugar, sugary products, the brand proprietors of these products, as well as, the food industry as a whole, under the glaring spotlight of societal scrutiny. The very same scrutiny the tobacco industry found themselves under after the research paper published in the 1950’s by British epidemiologist Dr. Richard Doll and Dr. Austin Bradford Hill, establishing the relationship between smoking and lung cancer ¹ . This scrutiny swiftly developed into a demand for accountability due to the growing and irrefutable epidemiological evidence highlighting the impact high sugary products have on the health of the public. This concern for public health is an issue that has led the World Health Organisation (WHO) to publish a guideline regarding “free sugars”.

According to their latest guidelines on this topic, WHO recommends a reduced intake of free sugars throughout the life course. Free sugars are defined as all sugars in any form; all naturally present in fruit and vegetable juices, purées and pastes and similar products in which the structure has been broken down or that have been added by manufactures, consumers during cooking or at the table ² . Free sugars include monosaccharides and dissacharides of which fructose, sucrose and high fructose corn syrup (HFCS) are the most ubiquitous. The recommendation as set by the WHO entails a reduction of free sugars intake to less than 10% of the total energy (strongly recommended) and preferably below 5% of the total energy intake (conditional recommendation) in both adults and children ³ . These recommendations are made having seen worldwide obesity nearly triple since 1975, the categorisation of 39% of adults aged 18 years and over in 2016 as overweight, of which 13% were obese. Alarmingly, 41 million children under the age of 5 were overweight or obese in 2016 ⁴ . Aside from an obesity and overweight epidemic, there is now a growing epidemic of type II diabetes. WHO revealed that the number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014 almost quadrupling over three decades ⁵ . Bringing this closer to home, more people than ever in the UK have diabetes. According to Diabetes UK, if nothing changes more than five million people in the UK will have diabetes by 2025 of which 90% of people will have type II diabetes ⁶ . The epidemiological findings have galvanised governments and public health institutions to formulate and implement policies and initiatives in order to address the ominous trajectory towards a life changing chronic disease. However, what impact does sugar have on our bodies that would deem a reduction in the intake of dietary free sugars, more than just the latest dietary craze we have seen in decades past? The answer is that high and frequent consumption of free sugars can do substantial and, in some cases irreversible damage, to our physiology and vital organs over time.

The common association between sugar and a major organ is the pancreas. The pancreas, also considered a gland, is responsible for secreting the hormone; insulin via the beta cells (β-cells) of the islet of Langerhans. Insulin is responsible for clearing glucose in the bloodstream by increasing glucose uptake in muscle cells and fat cells (adipose tissue), via glucose transporters, which allows for glucose to be stored as glycogen in muscle cells and the liver to be used at a time when glucose levels are low. Insulin also prevents gluconeogenesis (the creation of glucose in the body). These processes are how insulin regulates glucose levels within our bodies. A diet consisting of high free sugars significantly diminishes the pancreas’s ability to meet the now high insulin demands attributed to such a diet. A consequence of this pathophysiology, is that this now overworked and overwhelmed organ can no longer produce or create a sufficient amount of insulin. Whatever insulin is produced and released, the body is no longer responsive to it. This is referred to as insulin insensitivity. This is the hallmark of type II diabetes. The damage by free sugars unfortunately does not end here.

Not only is the pancreas affected, the liver too is compromised. The liver is truly a remarkable organ that marries complexity and simplicity in terms of the biochemistry it performs that is essential for it to carry out its function. Free sugars, predominantly those of fructose and HFCS used in the food industry, are capable of inflicting their damage via further disruption of chemical processes within the hepatocyte (liver cells). A high influx of fructose to the liver (considered to be 85g-100g of fructose per day from Westernised diets, five times the amount in the comparison to human diets 1,000 years ago) leads to the disruption of normal glucose metabolism by a chemical pathway that leads to the rapid stimulation of lipogenesis (fat creation) and triglyceride (TG) accumulation. This in turn contributes to reduced insulin sensitivity and hepatic insulin resistance/glucose intolerance. The over production and accumulation of TG is a cause for concern as they are the starting material for the formation of very low density lipoprotein (VLDL), otherwise known as bad cholesterol. Its is deemed “bad cholesterol” as VLDL transports cholesterol from the liver to tissues and through this process it inadvertently contributes to the build up of cholesterol on the walls of the arteries. This build up can trigger inflammation and eventually create plaques that lead to atherosclerosis, a major cardiovascular disease (CVD) responsible for strokes. The pathological pathway leading to CVD from lipogenesis is one divergence the other is lipogenesis and impaired fat oxidation from a diet high in free sugars, resulting in fat accumulation in the liver. This can lead to two chronic liver diseases; nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH).

The aggregation of the above conditions; insulin resistance, obesity, heart disease (stroke), type II diabetes, hypertension, NAFLD and NASH have led to the medical community referring to these conditions collectively as metabolic syndrome. What’s more, the pancreas, liver and heart are not the only vital organs to be affected. Free sugars affect the kidneys, the eyes and have recently shown to be a risk factor in the development of some cancers. It is for this reason and host of conditions we believe Fergie’s Sparkling Water® can make something of a contribution towards steering the British public away from a fate consigned to either or a combination of these conditions.

Nnadi’s Healthcare & Pharmaceuticals intends to combat this silent and impending epidemic through Fergie’s Sparkling Water®. Fergie’s Sparkling Water® is a refreshing, tasty, full fruit flavoured sparkling water beverage free from sugars, sweeteners, preservatives and calories. It is a beverage that can be enjoyed on its own, with meals, or shared with friends and family. We are certainly not claiming that Fergie’s Sparkling Water® treats or reverses the onset of type II diabetes, obesity or stroke. Rather, Fergie’s Sparkling Water® was devised with the rationale of providing the consumer with an alternative option worthy of space on a retailer’s shelf and in the consumer’s basket. By choosing Fergie’s Sparkling Water® the decision to live a much healthier lifestyle through their diet, for instance, is done with such congruence to a person’s daily life and routine. The purchasing of Fergie’s Sparkling Water® on these health grounds is substantiated by a report from the British Soft Drink Association (BSDA) that stated the most effective way to achieve change with regards to sugar and its negative health impact, was to reduce sugar in the formulation and development of products that would form part of an individual’s diet. The creation of a beverage like Fergie’s Sparkling Water® is integral to the WHO’s desire to see chronic illnesses, like type II diabetes, being addressed through non-pharmacological intervention. This is something Nnadi’s Healthcare & Pharmaceuticals will be pursuing in this decade and beyond. Through our medium and channels we should continue our non-pharmacological approach, whilst seeking to encourage moderation as opposed to strict abstinence or pontification. The latter routes are ineffective and counterintuitive to achieving our goal.

Our decision to create a soft drink product was not solely commercially influenced in so far as aligning ourselves with the latest market trend. Rather, the decision to create Fergie’s Sparkling Water® was driven by a sense of obligation and duty to address the long term threat and damage high free sugar consumption has on individuals and our National Health Service (NHS). Therefore, it stands to reason that Nnadi’s Healthcare & Pharmaceuticals has a legitimate stake in this health issue, irrespective if this said product conventionally falls outside of the products associated with or found within the pharmaceutical industry. Furthermore, we are in a unique, yet privileged position to continue this preventative narrative with the authenticity derived from our clinical knowledge, our desire to educate and empower, all whilst collaborating with other stakeholders such as schools, parent, healthcare professionals (HCP), charities and public health institutions.

In the end, Fergie’s Sparkling Water® embodies the very philosophy so dear to Nnadi’s Healthcare & Pharmaceuticals. Fergie’s Sparkling Water® provides a new perspective on healthcare, predominantly in primary care, that coincides with our maxim “From bench into lifestyle™” as opposed to the industry adage of “bench to bedside”. By this time it may be too late. This is something we cannot afford, nor is it something we wish to see when tackling the effects of high dietary free sugars that elicit preventable, chronic and potentially life-threatening illnesses.

References:

¹ Doll R, Hill AB. Smoking and carcinoma of the lung. British Medical Journal 1950 Sep 30 2(4682): 739-748.

² Scientific Advisory Committee on Nutrition (2015) SACN Carbohydrates and Health Report. London: Public Health England.

³ World Health Organisation (WHO) guideline on sugars intake for adults and children.

< http://www.who.int/nutrition/publications/guidelines/sugars_intake/en/ .> accessed 17th August 2020

⁴ World Health Organisation (WHO) Factsheet: Obesity and Overweight < https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight > accessed 17th August 2020

⁵ World Health Organisation (WHO) Factsheet: Diabetes < https://www.who.int/news-room/fact-sheets/detail/diabetes > accessed 17th August 2020

⁶ Diabetes UK: Us, diabetes and a lot of facts and stats. < https://www.diabetes.org.uk/resources-s3/2019-

02/1362B_Facts%20and%20stats%20Update%20Jan%202019_LOW%20RES_EXTERNAL.pdf > accessed 17th August 2020

New Product: Fergie’s Sparkling Water®

PAR003_OE@heg.com — Wed, 10 Feb 2021 12:11:23 GMT

Nnadi’s Healthcare & Pharmaceuticals is pleased to announce the launch and availability of our maiden product; Fergie’s Sparkling Water ^® .

Fergie’s Sparkling Water ^® is available in three delicious flavours: Lemon, Lime and Kiwi, Apple, Blackcurrant & Elderflower and Watermelon & Cranberry.

With Fergie’s Sparkling Water ^® , we aim to address the growing rise of obesity and tooth decay that lead to chronic life-changing diseases in the UK. Fergie’s Sparkling Water ^® , is a demonstration of Nnadi’s Healthcare & Pharmaceuticals staking its claim and intent to contribute towards the battle for a healthier nation by providing a healthier alternative amongst current beverage options.

This product has been much anticipated by the company and we are delighted to have it on the market and available for you to enjoy!

We look forward to and welcome your orders.

Nnadi's Healthcare & Pharmaceuticals Annual Report 2020: Letter from Managing Director

PAR003_OE@heg.com — Thu, 17 Dec 2020 15:46:06 GMT

Seeing Eye to Eye on the Matter

PAR003_OE@heg.com — Mon, 21 Sep 2020 11:14:57 GMT

The sense of sight is often referred to as a gift. Sight allows for the ease of navigation, provides us with a sense of the inclusion in our world and also allows us to witness great events in our time. Sight confers appreciation of the beauty and splendor that resides on our planet. Sight brings light in all meaning of the word, into our lives. The loss of the gift of sight is no different to the robbery of our treasured possession. A loss of sight brings a sense of frustration and isolation leaving an individual to feel excluded. It plunges the said individual in to the darkness both the literal and figurative sense, and from within this darkness it leaves an individual feeling most vulnerable. The loss of sight is not far from the feeling of being dealt a cruel hand. This needn’t be the case. This brief article will explore eye care within the UK, what it means to individuals, the UK economy the ramifications to the NHS and what is being done to save, maintain and improve the nation’s sight.

Within the UK, it is believed that 250 people lose their sight everyday, with 1 in 5 set to lose their eyesight in their lifestyle ¹ . Yet with 50% of sight loss being avoidable and 16 million free NHS test are conducted each year, it calls for a deeper assessment of eye care within the UK ² . The leading loss of sight in the UK is refractive error (shortsighted and long-sightedness), followed by age-related macular degeneration (AMD), cataracts and other eye conditions, glaucoma and diabetic retinopathy. Looking ahead it is projected that sight loss will increase by a third from 2 million currently, to 2.7 million by 2030 and could potentially double to over 4 million by 2050 ^{2 3} .

The leading causes of eye loss from those listed above are certainly preventable if detected early before ocular signs and symptoms develop. Therefore, looking at the nation’s attitude towards eye care is vital in order to establish areas for intervention and investment.

Data from conducted research suggests that the sense of sight is the most valued of all the five senses, with 78% of people saying it is the sense they would like to lose the least ¹ . The same poll sought to identify the key barriers that prevented individuals from visiting their opticians and found that the leading reasons were; i) they did not think anything was wrong with their eyes (33%), ii) others did not have the time or the opportunity to get round to it (24%) and iii) others were concerned about the cost of new glasses (17%).

These reasons, for not having a regular eye test, contain fallacies both flawed and flimsy in equal measure. The first is complacency. This is the single most dangerous factor that contributes to sight-loss. The presence of no palpable signs or symptoms is the main iniquity of vision loss. Vision loss is a gradual process of deterioration. The presentation of symptoms reduces the chances of a favourable prognosis (recovery). It is for this reason that regular visits to the opticians are paramount in detecting early signs of vision loss, even if you believe your vision to be fine an eye exam can also provide information about your general health (see pie charts below). The second fallacy is not having enough time. This is a convenient, yet insufficient reason when applied in context over a two-year period. Over this period, over half (59%) will get their boiler checked, over 42% will make four trips to the dentist, 36% will have reviewed their mobile phone contract at least once and 23% will have had a health check twice. An appointment takes less time than a film or TV show from a streaming site is between 20 to 30 minutes. To put this into perspective the average British road user spent 115 hours in traffic last year ⁴ . A possible reason that could be proffered for this perceived lack of will towards taking an eye exam, could be due to the principle of moral hazard. Moral hazard is defined as the phenomenon of not taking precaution to avoid risk of injury or consequence due to some form of coverage and protection. The coverage and protection in this form is the NHS. These findings indicate that education and increased awareness is required to change attitudes towards eye care amongst the population.

The next area, aside from addressing attitudes, entails identifying those most at risk of vision loss. As it stands, there are 350,500 people across the Isles who are registered blind or partially sighted. We must do our utmost to ensure we do not contribute to this number by failing to reach those who are most at risk and those whose conditions are preventable. Those most at risk are; children and young people, low-income individuals, people of certain ethnicity, people leaving with diabetes, people learning disabilities, people who smoke and stroke survivors. The three groups we shall touch upon quality are the ones in need of the most funding considering these economic times:

i) The Elderly : We have rapidly aging population with 11.8 million of our 67 million are aged 65 and above with around 79% of people living with sight loss are over the age of 64. In addition to this 35% of people aged 85 or over are living with sight loss.

ii) People on Low-income : Perplexingly, children and older people living in poverty are less likely to have an eye examination despite being eligible for free NHS-funded eye tests. Concerns and barriers to visiting an optometrist have included transportation costs to opticians, and the cost of glasses.

iii) People of Certain Ethnicity : African and Caribbean people are four to eight times at risk of developing certain forms of glaucoma, compared to Caucasian people. The risk of diabetic eye disease is around three times greater in South Asian people compared to Caucasian people. Black Afro-Caribbean people are also at a higher risk of diabetic eye disease.

It is vital that finance and funding be available either through direct government investment or by the reallocation existing resources to support these groups. This was certainly a challenge going forward, however, the COVID-19 pandemic has compounded and heightened the challenges further. The shape of the economy certainly has a stake in eye care within the UK.

As a measure to obtain a handle on the COVID-19 virus by reducing the ‘R’ rate (rate of viral replication) the government initiated a national lockdown. The decision to do so was not without disruption and consequences, both being visited upon the economy. Given the imminent impact on existing jobs the government launched a furlough scheme equating to £60bn (£14bn a month) ⁵ . In addition to this the government, provided £15bn for grants for small firms, £10bn to support for the self-employed, a £5bn emergency response package for the NHS with a further £6bn (£1.2bn a year paid over 5 years) to pay for staff and upgrades across the NHS. It is believed that the total sum of these crisis packages is more than £100bn ⁶ . As a result of these urgent financial rescue packages issued by the government, the UK fell into recession for the first time in 11 years as gross domestic product (GDP) fell 2.2% in the first quarter of 2020 and gain in the second quarter of 2020. It was said that the economy contracted by 20.4% during the lockdown ⁷ . The recovery from this economic downturn was anticipated to be a “V-shaped” recovery and according to the latest data from the ONS, the economy grew by 6.6% in July. However, it is still very much below the pre-pandemic levels. With this weakened economy there still remains there still remains a requirement to meet the goals for eye care for the nation via NHS funding to ensure that those three aforementioned groups are not left behind as it was. That their access to quality eye care does not deteriorate beyond the current situation, which already sees the government spending £28.1bn on eye care consisting of direct and indirect costs amounting to £3bn and £25.1bn respectively. ²

The answer to this tremendous economic burden is to adhere to unified goal of creating a more robust and sustainable NHS. At the centre of this goal, lies the benefit and the necessity of preventative medicine related to public health. Eye care is no different and hence, is not exempt from this course of action.

The first step towards achieving this goal is to increase education and awareness regarding available and proposed services applicable to these core groups. Universally across these groups, awareness of available NHS is vital. In addition to the increase of awareness, adjustments must be made in the manner of delivery pertaining to these groups. For the over 65 years of age, domiciliary eye tests should be made available along with regular reviews and examinations for corrective lenses should they need to be dispensed or prescribed. This risk group is most dependent on NHS services should vision loss occur and subsequently impact levels of independency previously enjoyed. Failure to meet this group’s need places a greater burden on the economy and the NHS’s finances.

For low-socioeconomic groups, an improvement in patient experience is key to surmounting key barriers to access eye care. An example of such enhanced experience would involve streamlining services to allow for tests, reviews and treatments to be performed in one visit, which significantly reduces the cost to these groups whilst quashing the reasoning that a visit to the opticians is challenging and time consuming. Offering non-retail optometry services in alternative locations in deprived areas would be an effective way to catch early stage eye disease.

For Black, Asian, Minority Ethnicity (BAME), both awareness and alternative venues would be most certainly welcomed, however anticipating demand utilising previous years and current data of prevalence within geographical areas within UK, as opposed to responding to capacity crisis, would serve this group the best. It is important that this methodology of screening and service providing is adopted quickly, as figures show that demand in the access for eye care services is and will increase in the years to come. Education amongst this risk group regarding commonly associated diseases such as hypertension, heart disease and diabetes is essential for favourable prognosis in ocular disorders in these individuals. The overall message is that education, awareness and flexibility in the delivery of service is urgently required. Data shows that an individual’s perception and attitudes are appreciative of the values and benefits of a trip to the opticians despite barriers. Therefore, conversion to uptake of these services and preventative measures is how this goal, of reducing financial burden and vision loss is to be achieved.

Closing points:

Secondly, reinforcing education to and awareness to compound public perception and attitude must extend to holistic approaches that promote favourable lifestyle choices and habits that are synonymous with good eye health. As a result individuals should seek to improve their diet ensuring they incorporate the recommended daily allowance of Vitamin A, B6, B9, B12, C, D, E, K, orange fruits & dark green vegetables. It is encouraged that individuals increase their levels of physical activity, their levels of sleep and begin or continue with smoking cessation if they are still smoking. According to statistics, 10 million people in the UK are smokers. Smoking increases the risk of AMD. If an individual stop smoking after a period of years the risk of developing AMD is reduced ² . In addition to this individuals should do their utmost to maintain regular check-ups and the donning of protective eyewear when necessary. Investment in education and health promotion is another cornerstone to the goal of a sustainable NHS.

Thirdly, opticians and related professional bodies must continue producing and update current guidelines on how they are dealing with the COVID-19 pandemic. The virus is indeed a major barrier for particular groups in accessing an optician, as there are concerns over safety regarding contracting the virus. Those most at risk of contracting COVID-19 people over the age of 60 and BAME are those for whom primary eye care services are important to. Again if possible domiciliary services and alternative non-retail venues must be explored, if they have not been so far.

Finally, the implementation of these measures in order to meet the goals of a sustainable NHS going forward, whilst reducing vision loss with the UK will take a concerted effort across all healthcare professionals (HCP) in primary care setting, GPs, optometrist, pharmacists, community nurses and health care and social care workers. Be it a consultation requiring a referral from the GP or optometrist, or when a pharmacist reviews a patient’s medication particularly a diabetic patient or when a nurse visits a patient’s home to change dressing as part of wound management care, each HCP must be vigilant to the opportunity to intervene and encourage and promote eye health. All interactions wherever they should arise, should stress the importance of preventative intervention to reverse preventable vision loss from occurring. However this must not be left solely to primary care professionals. The private health sector, along with secondary care within the UK, has a role to play in amplifying this initiative surrounding the utility of a preventative approach to tackle vision loss. In some way this is a concerted and national effort to ensure that the financial burden in a future economy, from a present economy impacted by this pandemic doesn't widen the gap between successfully reducing the rate of vision loss and in obtaining a sustainable NHS.

In conclusion, our sense of sight is important and somewhat of a gift according to the public, even though some attitudes with regards to eye care are indeed contradictory. Nevertheless, it remains that the principles of preventative medicine are adopted towards eye care. These specific groups; the older people of society, people from low-socioeconomic backgrounds and people of BAME ethnicity should not be left behind. This commitment has been made more challenging by the economic damage inflicted by COVID-19. With the government spending up to £100bn on a financial crisis, it poses a threat and places additional strain on the future economy and the desire for a robust and sustainable NHS if preventative eye care is not adopted and continued today to stave off vision loss and the subsequent costs that follow. Therefore the government, primary care, secondary care and the private sector must be in alignment to tackle vision loss within the UK. Failure in working towards this objective could further exacerbate the impact of eye care for the UK economy, NHS and the public. On this one occasion it would be ideal if the true price of the gift of sight were not subjective and that all associated players involved could see eye to eye on the matter.

Signposting & Useful Documents:

The College of Optometrists Primary Eye Care COVID-19 Pandemic Guidance: https://www.college-optometrists.org/guidance/covid-19-coronavirus-guidance-information/covid-19-college-guidance/primary-eye-care-covid-19-pandemic-guidance.html >

Free NHS eye tests and optical vouchers: https://www.nhs.uk/using-the-nhs/help-with-health-costs/free-nhs-eye-tests-and-optical-vouchers/

Reference:

1. RNIB. The State of the Nation Eye Health 2017: A Year Review.

2. RNIB. The State of the Nation Report 2016

3. RNIB. Eye Health and Sight Loss Stats and Facts. 2018

4. S Barnes. Motorists wasted 115 hours in traffic jams last year, research finds. The Telegraph.

< https://www.telegraph.co.uk/news/2020/03/09/motorists-wasted-115-hours-waiting-traffic-jams-last-year/ > accessed 17th September 2020

5. D Strauss. UK’s furlough scheme to cost less than expected, says watchdog. Financial Times.

6. B Chu. How much does the furlough scheme cost, compared to 2008 banks bailout, Trident and HS2? Independent.

https://www.independent.co.uk/news/uk/politics/coronavirus-furlough-cost-how-much-banks-bailout-trident-hs2-a9514231.html accessed 11th September 2020

7. D. Jordan UK economy continues recovery in July. BBC News < https://www.bbc.co.uk/news/business-54113948 > accessed 11th September 2020

Sign of Four: Leading Causes of Vision Loss in the UK

PAR003_OE@heg.com — Mon, 21 Sep 2020 10:40:04 GMT

Sight loss for any individual can be debilitating, frustrating and simply quite frightening when it does occur. Sight confers a sense of independency and without it imparts the feeling of vulnerability. Therefore, it is paramount that we safeguard our sight by proactively being involved in the maintenance and improvement of our eye care. In this article we shall list and explore the four leading eye conditions that contribute to sight loss in descending order.

4) Diabetic Retinopathy

Prevalence in the UK : 95,000.

Diabetic retinopathy is the leading cause of blindness in people under the age of 60 in industrialised countries. After 20 years from the onset of diabetes over 90% of people with Type I, and over 60% of people with Type II will have diabetic retinopathy ¹ .

Pathology: How does it affect sight?

Diabetic retinopathy is a micro-vascular disease that affects the retina, as a result of complications from long standing diabetes. This is how impairment of loss of vision occurs. The main problem with diagnosing retinopathy is that it is symptomless until the disease is far advanced.

Is it preventable? Yes.

This is dependent on regular eye exams leading to early detection and intervention.

Is it curable? No.

This is because diabetes is life-long condition. Therefore, there remains a possibility that future retinal damage and vision loss may still occur.

Medication or treatment options :

Treatment options for diabetic retinopathy usually occur when the condition reaches an advanced stage and there exists a serious risk to an individual’s vision. Current treatment for advanced diabetic retinopathy includes laser treatment to treat the growth of new blood vessels; eye injections are give directly into the region of macula (an area of the eye at the back of the retina with a large concentration of cones responsible for sight) to treat maculopathy that can threaten sight. Finally, an individual can undergo eye surgery to remove blood or scar tissue, if retinopathy is too advance ² .

What else can be done?

Firstly, achieving tight glycaemic (blood sugar level) control is paramount to preventing and delaying the progression of mild to moderate retinopathy in patients with Type I diabetes. Equally Type II diabetics must also achieve tight glycaemic control and tight blood pressure control. This recommendation is applicable to pregnant women. This requires appropriate coordination and balance between, diet, anti-diabetic and anti-hypertensive medication. Above all else, regular dilate eye exams are key to preventing vision loss, in conditions that becomes noticeable at moderate or advance stage. Worryingly in England, between the third quarter of 2015/16 to 2016/17, the uptake for diabetic retinopathy screening when offered fell by 1.5% from 83.6% to 82.1% respectively of those years ³ . This condition, like many others conditions in medicine, are highly responsive to preventative measures. If you yourself or anyone you know is at risk of developing diabetic retinopathy, we would encourage to speak with your optician regarding an eye exam and your local pharmacist, GP or other healthcare professional (HCP) should you require support with medication or current lifestyle.

3) Glaucoma

Prevalence in the UK : 145,000

According to statistics, glaucoma is second only to age-related macular degeneration (AMD) as a cause of blindness in the UK. From current estimates extrapolated from population surveys, it is indicated that there are 700,000 cases of glaucoma in the UK. High risk factors consistent with any individual over 35 years of age, of Afro-Caribbean descent, diabetic and those with a family history of glaucoma.

Pathology: How does it affect sight?

Glaucoma is condition of the optic nerve in which a loss of retinal nerve fibres leads to vision loss. A significant and manageable risk factor is intraocular pressure in the eye. An all-inclusive definition is quite difficult to provide, as glaucoma does not represent a single pathological condition. It consists of an extension and widely differing clinical features. There exists:

i) Primary (open-angle) glaucoma : No ocular disease is present just either an acute or chronic case

ii) Acute (angle-closure) glaucoma : An abrupt rise in pressure due to sudden closure of the angle of the anterior chamber between the cornea and iris where the aqueous humour

iii) Chronic simple (Open-angle) glaucoma : This occurs gradually without symptoms.

Is it preventable? Yes & No.

There are no known ways of preventing vision loss from glaucoma, unless it is recognised in the early stages. Glaucoma, in particularly primary open angle glaucoma, is hereditary therefore it cannot be definitively preventable. A central strategy to supporting and preventing vision loss from glaucoma, involves increasing access to care for individuals of Afro-Caribbean ethnicity who are categorised within a high-risk group as they are eight times more likely to develop open angle glaucoma ⁴ .

Is it curable? No.

Medication or treatment options :

The treatment goal for glaucoma is to reduce the amount of aqueous humour produced. Therefore the rationale for treatment is to reduce the intraocular pressure (IOP). The drugs of choice are beta-blockers timolol, levobunolol and betaxlol. The preferred route of administration is directly into the eye in the form of eye drops. Other classes of drugs prescribed include carbonic anhydrase inhibitors, consisting of brinzolamide and dorzolamide. Alpha-receptor stimulants such as apraclonidine and brimonidine can also used as a therapeutic option in the management of glaucoma. Finally, prostaglandin analogues such as lantanoprost and bimatoprost make up the mainstay therapies used in treating glaucoma. In more advances stages surgical treatment is also available.

What else can be done?

The best thing you can do to combat glaucoma is to regularly undertake eye exams. Early detection and careful, lifelong treatment can maintain vision in most people. Unfortunately, glaucoma’s prevalent form is primary (open-angle) glaucoma is a silent, slow and progressive form of vision loss.

Holistic approaches involving one’s lifestyle will also contribute towards staving off vision loss due to glaucoma. These include maintaining a healthy weight achieved through an appropriate diet and physical activity and regular exercise. Where possible attempting and committing to quitting smoking and reducing caffeine intake to moderate levels helps, as evidence suggests that high amounts of caffeine may increase eye pressure. Finally, appropriate eyewear and hat to prevent over exposure to sunlight when outdoors is very much recommended.

2) Cataracts

Prevalence in the UK : 380,000

Cataract contributes to 1 in 5 individuals losing their eyesight. Over half of people aged over 65 will be affected by this condition and it can occur even earlier with cataracts developing in children. Research shows that some individuals face a barrier in accessing the surgery required, as securing surgical intervention can appear to be something of a postcode lottery. Statistics predict that a demand for surgery is due to rise in the coming years ³ .

Pathology: How does it affect sight?

Cataract is defined as an opacity (cloudiness) in the lens of the eye that results in blurred vision. Cataract generally builds up slowly over several years ⁵ .

Is it preventable? No.

This is a condition that occurs with advancing age but there exists holistic approached to slow it down.

Is it curable? No.

However, it is treatable nonetheless.

Medication or treatment options :

The only treatable approach for cataracts is surgery. Cataract surgery entails the removal of a cloudy lens in your eye and replacing it with an artificial material such as plastic or silicone. Cataracts surgery is usually a day procedure, meaning you will be able to go home on the same day as the surgery. The surgery is usually performed under local anaesthesia you will be awake but you will not feel any pain. Surgery under general anaesthesia is possible but it is less common. Aftercare is important regarding the dressing, pain management and the appearance of the eye post surgery.

What else can be done?

Again as with previous eye conditions regular you must continue having rgular eye exams, as an individual advances with age, will allow for early detection intervention. Other measures that could be taken include reducing extensive exposure to sunlight, using appropriate eyewear such as quality sun-glasses, cut down on smoking and fortify your diet with the necessary vitamins A, C, D, E, orange fruit and cruciferous vegetables necessary to support healthy eye function.

1) Age-related Macular Degenerative (AMD)

Prevalence in the UK : 475,000

AMD is the leading cause of blindness in the UK. As the ageing population within the UK grows, it is suggested that AMD in the UK will rise by 59% between 2015 and 2035 from 1.85% among over 50s in 2015 to 2.36% in 2035. Despite local services adapting to fulfill needs, a crisis in capacity continues to threaten optimal care and access to potentially sight-saving treatment. Risk factors for this condition are obesity and hypertension. Incidences of AMD are higher in females than males.

Pathology: How does it affect sight?

AMD is the slow deterioration of maculae cells, cells that are located on the yellow spot on the retina at the back of the eye, which surrounds the greatest concentration of cones. As a result, the condition impacts the clear sharp, central vision that affects everyday activities such as driving, reading and cooking.

Is it preventable? Yes.

Is it curable? No.

Medication or treatment options :

Treatment for AMD is dependent upon whether an individual is diagnosed Dry AMD or Wet AMD. With the former no treatment is available but vision aids can be provided to better improve the patients quality of life and with the latter, however treatment is available via regular eye injections and at times through photodynamic therapy (PDT).

The eye injections consist of anti-vascular endothelial growth factor (anti-VEGF) therapy. Anti-VEGF medicine prevents abnormal blood vessels leaking, growing and then bleeding under the retina. This prevents further damage to the retinal light receptors and loss of central vision. This treatment is highly effective in preventing further vision in 90% of those treated ⁶ . Alternatively PDT involves light being shined at the back of the eyes in order to destroy abnormal blood vessels that are responsible for causing Wet AMD. PDT may be used in combination with anti-VEGF injections.

What else can be done?

Again regular checks with advancing age is key to identifying AMD as soon as possible there are common risk factors associated with AMD such as obesity and hypertension; can be regulated through appropriate lifestyle choices in terms of diet and exercise. Both lead to the maintenance and achievement of a healthy weight. Again this diet must consist of essential vitamins and fruit essential to eye health. Given the sensitivity of the area in question, the retina, smoking has the capacity to increase one’s chance of developing AMD by two to five folds. Smoking induces AMD as the retina has a high rate of oxygen consumption, hence anything that affects oxygen consumption, hence anything that affects oxygen delivery to the retina may affect vision ⁷ . Additionally, smoking causes oxidative damage, which may contribute to the development and progression of this disease. Smoking cessation is strongly recommended and encouraged. Adopting a healthy lifestyle and beneficial habits at an earlier age greatly improves the outcomes and management of AMD going forward.

Closing points:

We would encourage you to phone before hand or visit your nearest optician to establish their guidelines for COVID-19 with regards to their store and an appointment with your optometrist. The key to managing and even preventing some of these conditions rests upon having regular eye exams. Eye exams conducted by optometrist provide three benefits. Firstly, as mentioned before eye exams allow for early detection and intervention that improve an individual’s prognosis and improvement to one’s quality of life. Secondly, an eye examination is not just an assessment of the eyes alone and can in fact be a good indicator of general health. Finally, early detection, early intervention and improved prognosis for an individual diagnosed with an ocular condition proves to be cost effective and contributes enormously to having a sustainable NHS in the future.

Signposting & Useful Documents:

Free NHS eye tests and optical vouchers: https://www.nhs.uk/using-the-nhs/help-with-health-costs/free-nhs-eye-tests-and-optical-vouchers/

Reference:

1. R Walker C Whittlesea. Clinical Pharmacy and Therapeutics. Fourth Edition. 2007. Churchill Livingstone Elsevier.

2.NHS Diabetic Retinopathy. < https://www.nhs.uk/conditions/diabetic-retinopathy/treatment/> accessed 15th September 2020 >

3. RNIB. The State of the Nation Eye Health 2017: A Year Review.

4. S Leamon H Lee. A glaucoma case finding pilot with African Caribbean community. RNIB. < https://www.rnib.org.uk/knowledge-and-research-hub-research-reports/prevention-sight-loss/glaucoma-african-caribbean-community > accessed 15th September 2020

5. Cataract. BUPA. < https://www.bupa.co.uk/health-information/eyes-sight/cataracts > accessed 9th September 2020

6. Moorfields Eye Hospital NHS Foundation Trust. Patient Information: Anti-VEGF Intravitreal Injection Treatment. < https://www.moorfields.nhs.uk/sites/default/files/uploads/documents/Patient%20information%20-%20intravitreal%20injections%20for%20AMD.pdf > accessed 16th September 2020

7. BrightFocus Foundation. Macular Degeneration. < https://www.brightfocus.org/macular/prevention-and-risk-factors > accessed 16th September 2020

National Eye Health Week: Brief Overview of General Eye Care

PAR003_OE@heg.com — Mon, 21 Sep 2020 10:06:31 GMT

Monday this week marks the beginning of National Eye Health Week. Unfortunately it has fallen at a time when we are currently experiencing a global viral pandemic. COVID-19 has been disruptive to our daily lives, personal income and health. For the latter this shouldn't be the case. Whilst advanced therapies, which are performed in secondary care (hospital) settings, for patients have been postponed for a future date, clinical services, appointments and treatments in primary care remain fully operational. This includes the opticians. Therefore, COVID-19 should not deter you from ensuring your eyesight is in good health.

During COVID-19 our initiative of “Assumed Responsibility” now termed as “New Normal/ New You” (to be launched soon), not only covers developing new routines and new habits, to maintain or continue eating well and keeping active during COVID-19, but also applies to looking after your general health and well-being after this period going forward. Appropriate eye care is included in this initiative and is something I hope you will see through our articles this week.

The segment below is a brief introduction to general eye care and gives an indication into services that support you in maintaining your eyes and how we hope to contribute during National Eye Health Week.

How Do the Eyes Work?

The eyes are complex light sensitive organs that allow us to distinguish the subtle variations in shape, colour, brightness and distance. This feat is achieved by presenting light as a visible frequency of electromagnetic spectrum that passes through the cornea, which is detected by photoreceptors in the retina. These photoreceptors are known as rods and cones. A common dysfunction regarding the presentation of light is myopia (short-sightedness). The condition raises when the distance between the lens and the retina is longer than normal. Myopia is corrected using by concave lens.

The other common ocular dysfunction is hypermetropia (long-sightedness) this occurs when the distance between lens and retina is shorter than normal. This is corrected by convex lens.

Hypermetropia tends to affect individuals more with advancing age. Around 785,000 experience sight loss due to uncorrected refractive error. This is something that could be easily remedied with the appropriate corrective eyewear.

Best Way to Take Care of My Eyes?

Regular appointments

One of the best ways to take care of your eyes and hence, protect your vision, is to schedule regular eye examinations with your optometrist. Unfortunately, almost of people quarter (23%) are unable to see as was well in the distance or up close as they used to and have not yet sought advice ¹ . If you are experiencing any deterioration in your vision you must act quickly. Do not wait until you experience significant pain or when the deterioration begins to actually affect your visibility. At this point it may be too late and the chance of recovery becomes significantly lower. Again a theme you will find with all the posted literature for National Eye Health Week, is the emphasis and importance of preventative measures. Eye care is one of the most responsive areas where preventative measures can make an enormous difference to eye health and general well-being. Ocular diseases are gradual, slow and silent in pathology with serious consequences that can lead to permanent vision loss. A contribute factor to vision loss is complacency and the tragedy of vision loss is compounded when statistic show that 50% of vision loss is preventable ² . In addition to this an eye examine from an optometrist is.

We would recommend you to continue with regular examinations even in the midst of COVID-19 pandemic. Make contact with your local or regular opticians and find out what measures they have in place to ensure your safety during your examination.

Parents & Guardians of Children

The role of parents and guardian are can not be understated in safeguarding children’s vision. Just as with an adult’s vision, regular eye examination in children is vital to identifying any problems that could not only impact them at present but also as they grow. Disruption in a child’s vision may indeed affect their academic attainment and social development ³ . Furthermore, children are at higher risk of vision impairment if they very premature, low birth weight babies, children from most economically deprived backgrounds, children from South Asian ethnic groups and children with learning difficulties. These particular risk groups should not have regular free NHS eye exams to ensure that they are not left behind in terms of eye care. Early detection and early intervention staves off vision loss in the long run.

Adjustments to Work & Lifestyle:

Making certain adjustments in our day-to-day life, along with regular eye exams, all contribute towards good eye health. Beginning with work, the most effective practice to adopt is to reduce unnecessary eyestrain. Adjusting the lighting, such as being in an environment with soft lighting and using digital devices such as a TV, tablets and smartphones, with reduced glaring ⁴ . Taking regular breaks to rest one’s eyes. This also ties in with the recommendation of limiting screen time wherever possible to ease tension on the eyes ⁴ . These core suggestions are applicable to working with computers with the addition of adjusting the screen monitor, blinking often to refresh and moisten the eyes by redistributing tear fluid in the eye. This recommendation can be supported by the use of artificial tears that can be bought over the counter (OTC) at your local pharmacy ⁴ .

In terms of lifestyle, the most obvious is exercise and physical activity as it contributes to increasing blood flow to the optic nerve as well as improve cardiovascular function. The next lifestyle adjustment involves a diet that consists of essential vitamins like Vitamin A, orange fruits & vegetables and cruciferous vegetables. These vegetables can be incorporated into most diets via homemade smoothie shakes or healthy snacks.

In Closing

Please have a look at the other articles posted “ Seeing Eye to Eye on the Matter ” and “ Sign of Four ”, follow us on our social media pages for more information and updates. We hope you find the content throughout this week truly beneficial.

Signposting & Useful Documents:

The College of Optometrists Primary Eye Care COVID-19 Pandemic

Guidance: https://www.college-optometrists.org/guidance/covid-19-coronavirus-guidance-information/covid-19-college-guidance/primary-eye-care-covid-19-pandemic-guidance.html

Free NHS eye tests and optical vouchers: https://www.nhs.uk/using-the-nhs/help-with-health-costs/free-nhs-eye-tests-and-optical-vouchers/

Vision Matter: http://www.visionmatters.org.uk/

References:

1. RNIB. The State of the Nation Eye Health 2017: A Year Review.

2. RNIB. Eye health and sight loss stats and facts. 2018

3. CE Basch. Vision and the Achievement Gap Among Urban Minority Youth. J Sch Health. 2011. 81,10:1746-1561.

4. Mayo Clinic. Eyestrain https://www.mayoclinic.org/diseases-conditions/eyestrain/diagnosis-treatment/drc-20372403 accessed 20th September 2020

COVID-19 Series PART III

PAR003_OE@heg.com — Mon, 14 Sep 2020 11:17:50 GMT

COVID-19 Series, PART III: The COVID-19 Vaccine & Other Therapeutic Options

The final part of this section seeks to look into the therapeutic options used to fight COVID-19. In Part I we saw that the current strategy used by doctors on the front line involved the preservation of vital organs from the cytokine storm that raged outside of the lungs. This defensive approach is more passive than the proactive and preventative holistic approaches we recommend for the public. Given that the tentative and crucial aspect of the battle occurs in a secondary care, it serves those in this setting well to know that there exists another strategy they can contribute to other than the wait-and-see approach when managing a patient’s condition on an intensive care ward. Therefore, the creation of a vaccine serves as a viable and proactive solution that can complement the holistic approaches. We shall now look into the vaccine associated with COVID-19. We will not go into detail regarding each proposed vaccine as this is beyond the scope of this series.

What is a vaccine & how does it work?

A vaccine is a special preparation of antigenic material that can be used to stimulate the development of antibodies and thus, conferring active immunity against specific pathogen ¹ . There are three types of vaccines; live, killed and toxoid.

i) Live: A live vaccine consists of an attenuated (weakened organism) to invoke an immune response with only very mild symptoms. This initial response to this attenuated pathogen would be deemed the primary response. Live vaccines would be administered for Measles, Mumps, Rubella, Smallpox, Polio (oral Sabin), BCG and Yellow Fever. These vaccines are never administered to immunocompromised individuals.

ii) Killed: These vaccines are completely safe, but the immunity conferred by them even when given with an adjuvant (an immune system booster), trigger an immune response that cannot induce disease. These vaccines are inferior to live vaccines. As a result they require booster doses. Killed vaccines would be administered to individuals for; Pertussis, Polio (parenteral Salk), Cholera, Influenza, Rabies, Typhoid.

iii) Toxoid: Toxoid vaccines are harmless, but trigger the same type of immune response as the normal toxins produced in particular bacterial diseases. Toxoid vaccines are administered to individuals for Diphteria and Tetanus.

Vaccines have been the vehicles of choice in the process of developing effective immunisation policies and programs. The general principle behind a vaccine and immunisation is to provoke an immune response to a particular pathogen’s harmful effects in the future. This is achieved through the creation of antibodies that seek out the specific infections pathogen, binding to them and then marking it for destruction by T-cells of the immune system. The pathogen has initiated a specific immune response and these specific antibodies remain in the system. It is said generally that the individual’s immune system now has a “memory”. Not only are antibodies produced to the primary response, the first encounter with the pathogen, the next time the body encounters the same offending pathogen again, antibodies are produced but at a much higher concentration. The graph below depicts this appropriately. This is same principle is pathway is to be used in the proposed vaccine ChAdOx1 nCoV-19 otherwise known as the “Oxford Vaccine” ² .

Vaccines create a controlled and “safe environment” for the body to become familiar with the disease so it knows how to fight the disease more effectively with reduced risk to the patient. Simply put, the immune system is the student and a vaccine is the mock exam that heightens the preparedness for the real and definitive end of year examination.

Do we need a vaccine for COVID-19?

This is a matter of contention. The contention and scepticism surrounding the vaccine stems from the accompanying statistics associated with reported COVID-19 cases. These figures along with the opinions of legal, economic and political commentators expressed through all media factors have contributed to attitudes towards the response to the virus and pandemic measures. According to global figures from Google’s COVID-19 data centre, out of the 25,334,339 COVID-19 worldwide cases; 16,669,674 individuals recovered. Therefore, the global recovery rate having contracted the virus is 66% (65.7%) ³ . The death rate from the cases is calculated at 3% (3.34%) with 848,084. When looking at the statistics derived from Worldometer, from active cases of 6,884,865 infected patients, 6,824,240 suffered from a mild condition, meaning 99% of patients had this experience of COVID-19. Out of the active cases, 60,625 patients were deemed serious or critical meaning that serious or critical cases of active cases of COVID-19 constitute 1% of the active cases ⁴ . From the closed cases totalling 19,143,562 patients, 95% of those cases were a result of the patients recovering and being discharged. Out of the total closed cases 863,516 deaths were recorded making up 5% of cases. If we look closer at the statistics for the United Kingdom, the case fatality rate (CFR) stands at 12% from 337,000 cases from a country with a population of 67.8 million people with 41,504 deaths reported. These findings can erroneously form the basis of the belief that COVID-19, “is just a bit of flu”. However, this misconception on the threat and severity of COVID-19 is highlighted when we consider the latest literature and statistics surrounding seasonal flu.

According to a document published by Public Health England relating to influenza in the UK, when using algorithmic model called, Flu monitoring of excessive mortality or FluMOMO, to estimate the excess number of deaths associated with influenza activity adjusted for temperatures, one can see that the deaths due to flu between the 2015/16 period to 2019/20 are considerably lower than reported number of deaths due to COVID-19 already this year ⁵ . Looking even closer at the data, the deaths associated with influenza, so far from the 2019/20 season up to week 9 alone, exceeds two other seasons (2015/16 and 2018/19) and is greater than the deaths attributed to one season alone (2016/17). An argument can be made that the reason for the low deaths could be due to the level of vaccination uptake amongst the 65+ years recorded at 73% (72.6%) across all countries in the UK.6 Nevertheless, the one constant remains that the 65+ years are most at risk than any other age demographic in each respective season from 2015/16 to 2019/20.7

Furthermore, there exists opposition to the use of the CFR as a tool to assess the severity of COVID-19. It is believed that the CFR is obsolete once it became apparent that people present as asymptomatic and hence should not be counted in confirmed cases ⁸ . A more comprehensive metric proposed, is the infection-fatality rate (IFR). The IFR is a statistical tool that uses data on known infections including best estimates for undiagnosed and asymptomatic cases; to generate numbers on how likely it is for an infected person to die from the disease ⁹ . This type of calculation is performed every year to generate the figures for seasonal influenza, similar to the FluMOMO model mentioned above. The IFR can be calculated in two ways; they could estimate the number of infections based on serology results that test individuals for antibodies against the coronavirus. These tests can reveal whether a person has been infected even if they don't show symptoms. Or researchers can use statistical methods to infer the total number of infections based on what is known about the number of confirmed cases and the estimates for asymptomatic infections. When the IFR taken as opposed to the CFR, COVID-19 is 50 to 100 times more lethal than the flu on average. Additional opposition and scepticism expressed towards the COVID-19’s severity resides in the lag with regards to paperwork involving reporting and recording causes of death, on death certificates. This in its self has attracted scrutiny as allegations have been made that deaths during this pandemic have been misappropriated to COVID-19 and is hence responsible for the swell in numbers of reported case deaths from COVID-19 ^{10 11 12} .

Equally, rebuttals could be raised to the points above. It can be said that irrespective of whichever metric taken the fatality rate of COVID-19 is still rather low. The argument regarding the death lag as a result of strained administrative logistics involving paperwork still wouldn't generate a seismic number that would skew the weekly reporting of deaths associated with a confirmed cases of COVID-19 greatly.

Nnadi’s Healthcare & Pharmaceuticals’s position on the subject of the necessity of a COVID-19 vaccine is predicated on the scientific findings and observations of frontline clinical staff that are treating COVID-19 patients. Our position is that any individual who falls within the high risk demographic; being over 65+ years of age, male, of Afro-Caribbean or South Asian descent predominantly, diabetic, clinically obese with a BMI above 30, with cardiovascular issues (i.e. hypertension) and asthmatic, must indeed seriously consider being vaccinated against the COVID-19 virus. Aside form the statistics that depicting global and national recovery and death rates, the ferocity of a COVID-19-induced cytokine storm that is not confined to the lungs and can in fact inflict grievous physiological insult on multiple vital organs, is a gamble not worth taking. In the meantime, do all that you can to boost your immune system. We would strongly recommend that you adopt our holistic approaches detailed in ( Part II of this series ), in order to achieve this. We would also encourage you to speak with your pharmacist, GP or a trusted healthcare professional, who knows you well, regarding your health about the proposed COVID-19 vaccine. Not taking the vaccine is not a demonstration of strength nor is it an omission of weakness. Neither is taking the vaccine an admission of weakness and omission of strength. The true essence and success story of medicine and healthcare is not in treatment, but in prevention.

Will the government force us to take a vaccine for COVID-19?

No. We would even go as far as saying that it is highly unlike and it would be unwise for Her Majesty’s Government to impose mandatory vaccination across the UK now or in the future. This substantiated and explicitly states so in the Public Health (Control of Disease) Act 1984, Section 45 (E): Medical Treatment, which states that (1) Regulations under section 45B or 45C may not include provision requiring a person to undergo medical treatment. (2) Medical treatment includes vaccination and other prophylactic treatment.13 This is prohibition is extended to Scotland an Northern Ireland through The Coronavirus Act 2020 under Schedule 19 Section 3 subparagraph (1)(2).14 These laws set important limitations to the scope government powers.

These limitations are in keeping with the bioethical principles that under pin, medical treatment between healthcare professional (HCP) and patient. The leading bioethical principle is autonomy. Autonomy is a right that subsists with you and gives you the independence and freedom to make your own choices in order to make decisions about your care. Autonomy is closely associated with informed consent. Informed consent is when the patient grants permission and hence initiates any form of medical or therapeutic intervention having been made aware of the full risks and benefits associated with the treatment. No treatment can begin without your explicit consent. You should not make any decision under coercion or without being fully armed with the benefits, but more so, the risks entailed with any treatment. The proposed COVID-19 vaccine is no different and will not infringe upon the law or your rights.

Given the urgency to develop a vaccine for COVID-19, is it safe?

Any medicinal product intended for human use must be safe before launching on the market. Irrespective of these unusual and unprecedented circumstances surrounding the urgency in the development of a vaccine for the COVID-19 virus, there resides well-founded concerns over the accelerated publishing of pre-printed, non-peer reviewed (checked by two other scientist in the said field who check for any inaccuracies or mistakes) articles surrounding the virus, the regulatory process and hence the safety profile, with regards to long-term side effects, a direct by-product of the two former processes ^{15 16} . Our industry has a predisposition towards erring on the side of caution. This attitude is not a passive stance but rather one that vociferously demands more information and answers when shining a scrutinous torch on opaque data generated from research findings. At Nnadi’s Healthcare & Pharmaceuticals, we share this stance too and in doing so subscribe to the common adage used within the garment industry of; “measuring twice and cutting once”. We, along with all other pharmaceutical companies, seek to develop new vaccines with elevated and improved therapeutic and safety profiles. At this stage, it would be premature to denigrate or exaggerate safety concerns when a completed and approve vaccine arrives on the market along with the clinical scientific literature accompanying its availability.

What is Nnadi’s Healthcare & Pharmaceuticals’ position on vaccines?

Our position is simple. We are pro-vaccines, pro-science and pro-safety. It is important we do not conflate the circumstances surrounding the COVID-19 vaccine with that of other vaccines that make up an individual’s immunisation schedule. It is ironic that due to the greatest medical advancement and global health achievement, parts of globe consisting of a pocket of individuals and groups that forget the atrocities and misery childhood disease wreaked on a global scale. Prior to vaccinations, diseases such as measles (responsible for mental retardation or damage to the central nervous system), rubella (a disease that contributed to children being born with brain damage, autism and other abnormal congenital diseases), diphtheria, whooping cough and polio, were rampant globally and within the UK ^{17 18} . Putting this into perspective, if small pox had not been eradicated it would cause 5 million deaths worldwide a year. As of August 2020, Africa is declared free of wild polio, a crippling viral disease that has negatively impacted the quality of life of many children on the African continent.

Unfortunately, a barrier to vaccine uptake are unfounded fears of vaccine leading to autism, a claim that has been greatly discredited, retracted and unethical in terms of its research, or viral videos online created by anti-vaccine groups laden with incorrect, misleading and unsubstantiated claims. These claims are irresponsible and reckless when disseminated to the general public with substantial consequences. As of last year and entering into 2020, there have been reports of a spike in MMR cases in the UK ¹⁹ . Vaccines are indeed effective therapeutic agents that have demonstrably reduced new cases of life threatening diseases when administered to the population.

Vaccines, particularly childhood vaccines, are efficacious in 85% to 95% of children who receive them. Therefore, it is imperative to keep up to date with the full vaccination schedules.

What other therapeutic options exist to combat and treat COVID-19?

Aside from the proposed vaccine, there have been touted and existing medications that have proved effective in the treatment of COVID-19. Nevertheless, the main treatment of choice is dexamethasone. Dexamethasone is corticosteroids and their mechanism of action (how they work in the body) is to produce anti-inflammatory and immunosuppressant effects by inhibitory release of cytokines. Based on a national clinical trial RECOVERY, preliminary tests found that treatment with dexamethasone given at a dose of 6mg once a day lowered mortality by 8-26% in comparison to 4321 participants (out of 2104) who received standard treatment ²⁰ . This discovery via the RECOVERY trial, offers hope but it would be considerably myopic to wholeheartedly take solace in this medication. The use of dexamethasone indicates that an individual is at a critical stage due to the advancements of the virus to the severe phase. The prognosis of the patient at this stage is clinically precarious and even more so if the individual falls into the demographic most at risk from COVID-19.

Signpost & Useful Documents :

British Society for Immunology: Celebrate Vaccines: https://www.immunology.org/celebrate-vaccines/public-engagement/guide-childhood-vaccinations/how-vaccines-work

Public Health (Control of Disease) Act 1984 https://www.legislation.gov.uk/ukpga/1984/22

The Coronavirus Act 2020 https://www.legislation.gov.uk/ukpga/2020/7/schedule/19

Reference

1. Oxford Concise Medical Dictionary. Oxford University Press. 2020. 10th Edition.

2. J Gallagher. Coronavirus: Oxford vaccine triggers immune response. BBC News. < https://www.bbc.co.uk/news/uk-53469839 > accessed 2nd September 2020

3. Google News. Coronavirus (COVID-19) Dataset < https://news.google.com/covid19/map?hl=en-GB&mid=%2Fm%2F02jx1&gl=GB&ceid=GB%3Aen > accessed 2nd September 2020

4. Worldometer: COVID-19 Coronavirus Pandemic. < https://www.worldometers.info/coronavirus/ > accessed 2nd September 2020

5. Public Health England. Surveillance of influenza and other respiratory viruses in the UK. Winter 2019 to 2020.

< https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/895233/Surveillance_Influenza_and_other_respiratory_viruses_in_the_UK_2019_to_2020_FINAL.pdf > accessed 2nd September 2020

6. Ibid

7. Ibid

8. C Arnold. How scientists know COVID-19 is way deadlier than the flu. National Geographic. < https://www.nationalgeographic.co.uk/science-and-technology/2020/07/how-scientists-know-covid-19-is-way-deadlier-than-the-flu > accessed 2nd September 2020

9.Ibid

10. P Duncan N Davis N McIntyre. Are officials figures overstating England’s COVID-19? The Guardian. < https://www.theguardian.com/world/2020/jul/21/analysis-why-englands-covid-19-death-toll-is-wrong-but-not-by-much > accessed 3rd September 2020

11. Full Fact. Covid-19 is the underlying cause of death for most people who die with it. < https://fullfact.org/online/deaths-only-from-coronavirus/ > accessed 3rd September 2020

12. Derry Journal. COVID-19 put on death certificates of symptomless patients: MLA < https://www.derryjournal.com/health/covid-19-put-death-certificatesof-symptomless-patients-mla-2862354 > accessed 3rd September 2020

13. Public Health (Control of Disease) Act 1984. < https://www.legislation.gov.uk/ukpga/1984/22 > accessed 3rd September 2020

14. The Coronavirus Act 2020. < https://www.legislation.gov.uk/ukpga/2020/7/schedule/19 > accessed 3rd September 2020

15. H Thomasy. In the Race to Crack Covid-19, Scientist Bypass Peer Review. Undark. < https://undark.org/2020/04/01/scientific-publishing-covid-19/ > accessed 22nd August 2020

16. F Guarascio J Mason. It’s not for me: speed of COVID-19 vaccine race raises safety concerns. Reuters < https://uk.reuters.com/article/us-health-coronavirus-vaccine-safety/its-not-for-me-speed-of-covid-19-vaccine-race-raises-safety-concerns-idUKKCN252284 > accessed 5th September 2020

17. R Conniff. The world before vaccines is a world we can’t afford to forget. National Geographic. < https://www.nationalgeographic.com/culture/2019/08/cannot-forget-world-before-vaccines/ > accessed 3rd September 2020

18. British Society for Immunology. Celebrate Vaccines: How Vaccines Work < https://www.immunology.org/celebrate-vaccines/public-engagement/guide-childhood-vaccinations/how-vaccines-work > accessed 3rd September 2020

19. PA Media. Mumps cases in England rise to highest level in decade. The Guardian. < https://www.theguardian.com/society/2020/feb/14/mumps-cases-england-rise-highest-level-decade-mmr > accessed 4th September 2020.

20. RM Johnson JM Vinetz. Dexamethasone in the management of covid-19. BMJ 2020; 370:m2648

COVID-19 Series PART II

PAR003_OE@heg.com — Mon, 14 Sep 2020 10:45:16 GMT

COVID-19 Series, PART II: Holistic approaches against COVID-19. What you can do.

As explained in Part I of our series , it is apparent that the main objective for clinical staff in the fight against COVID-19 is avoid the patient’s condition progressing from the viral phase to the pulmonary phase and then to the dreaded severe phase. It is this final stage that unleashes a devastating autoimmune reaction that exponentially raises the chances of the patient fatally succumbing to COVID-19. Amongst the clinical healthcare professionals (HCP) there resides a very much founded fear and sense of urgency to protect patients with pre-existing endothelial dysfunction and other physiological risk factors (being a male, diabetics and obese etc.) from the inflammatory response due to endotheliitis (inflammation of the endothelial lining). The key take home messages from Part I, based on the accounts of front line doctors, is that COVID-19 “is not just a little flu” and that preventative measures are still the most effective approaches in dealing with this pandemic. This part of the series look at the holistic approaches you can adopt and hopefully answers the question of what you can do to protect yourself and others.

The Basics: Hygienic & Social Practices.

Hand-washing, as simple as the activity is, proved to be revolutionary in the fight against microorganisms and viral pathogens. Just as this practice was much welcomed in the 1800’s, it is even more so and highly effective in 2020. Hand-washing with soap is more efficacious than the use of alcohol or disrespectful. Scientifically, soap is effective because the COVID-19 virus is self-assembled nanoparticle in which the weakest link is the lipid (fatty) bilayer. In simple terms the soap outcompetes on two fronts. Firstly, the soap, due to its fat-like substances known as amphiphiles (possessing both water loving and water hating properties), of which some are structurally similar to the lipids in the virus membrane, is able to compete with the said lipids in the viral membrane. Soap competes with non-covalent bonds that help bind the protein, viral RNA and lipids together. Thus, soap effectively “dissolves” the “glue” holding the virus together. All that is required after this point is water completely destroy the virus. Secondly, soap molecules are able to compete with the interactions between the virus and the skin surface. Soon the virus becomes detached and falls apart due to the combined action of the soap and water ¹ . Numerous studies present irrefutable evidence from their findings on the efficaciousness of hand-washing. The most poignant and relevant to our argument are these two points. Firstly, a million deaths a year could be prevented if everyone routinely washed their hands ² . Secondly, that hand-washing reduces the risk of respiratory infections by 16% ³ .

In addition to basic hygienic practices the wearing of a mask and facial covering help enormously in reducing the transmission of COVID-19 to other individuals. According to the scientific briefing from the World Health Organization (WHO), COVID-19 is primarily transmitted between people through respiratory droplets. Hence, COVID-19 spreads by direct contact with an infected person or people and via indirect contact with surfaces in the immediate environment or with objects used on the infected person ⁴ .

The picture above speaks for itself regarding the effects of a mask. To reiterate, the primary rationale is to minimise the spread of pathogens to others. The use of a mask and face covering is an effective tool in reducing the ‘R” rate (the viral reproduction number) from exceeding 1.0. As a result of face masks being effective and very much alignment with government’s initiative to reduce the R rate triggering a second wave, the government have now made face masks mandatory for any individual on public transport and in certain indoor settings across England and Scotland ⁵ . Face covering and wearing a mask is mandatory in the EU and across the globe with a total of 120 countries following suit in making masks and face covering mandatory ⁶ .

Another approach to minimising the spread of the pathogen is for the population to adopt and adhere to social distancing guidelines. As mentioned earlier, transmission occurs when a person is in close contact with someone who has respiratory symptoms and is therefore at risk of having his/her mucosae (mouth and nose) or conjunctiva (eyes) exposed to potentially infective respiratory droplets ⁷ . The argument for social distancing is validated by mathematical modelling devised by Dr. Robin Thompson, a junior research fellow mathematical epidemiologist, that demonstrated that without social distancing being observed one sufferer could in six weeks have started chains of transmission with 1093 cases. In comparison, a model with social distancing observed would see the same sufferer, in six weeks start chains of transmissions with 127 cases ⁸ . Therefore, a reduction in person-to-person contact reveals a scenario in which case numbers could be reduced by almost 90% through social distancing. Given that 80% of individuals who contract COVID-19 present as asymptomatic (showing no signs or symptoms associated with the disease), it exacerbates the concerns and compounds the complacency around the rate and transmission of infection. Despite scientific advances proposing hotly anticipated therapeutics, observing social distancing, facial covering and regular hand-washing with soap (preferably, but hand-gel/sanitisers can be used if soap is unavailable) are the main barriers to the virus so far. These measures are not taxing physically, they are cheap and they prove to be highly effective.

If we could conclude on a bold note, knowing what we know now about this virus so far, and the immunological devastation it can cause, a lack of consideration for each other is equally as dangerous as the COVID-19 virus itself.

Exercise & Physical Activities.

Reviewing holistic approaches that can be adopted and assessing them against the disease state of the offending pathogen, exercise and physical activity are certainty stellar and proactive holistic practices with benefits that meet and exceed immunological protection from COVID-19.

Despite exercise-immunology being considered a relatively papers on this field show that the immune system is very responsive to exercise in accordance to the extent and duration that reflects the degree of physiological stress imposed by the workload. Acute exercise, defined a moderate and vigorous intensity aerobic exercise of bouts less than 60 minutes durations enhance anti-pathogen activity of tissue macrophages (helpful large scavenger cells) as well as simultaneously increasing the recirculation of immunoglobulins, anti-inflammatory cytokines, neutrophils, NK (natural killer) cells, cytotoxic T cells and immature B cells of which play critical roles in immune defence activity and metabolic health. Simply put, acute exercise stimulates the interchange of innate immune system cells (fast effective responders and the first line of defence against germs) between lymphoid tissues and the blood compartment, with an aggregating effect over time of improved immunosurveillance against pathogens and cancer cells and decreased systemic inflammation. In general acute exercise is now viewed as an important immune system adjuvant (booster) to stimulate the ongoing exchange of leukocytes between the circulation and tissues ⁹ .

The real take home point with regards to encouraging the incorporation of exercise, is that sessions under 60 minutes will suffice to confer the desired and protective benefits above. Equally research has shown that overtraining and adopting intense physical exercise above 60 minutes can have deleterious effects on the individual’s immune system as a result of the physiological stress experienced by the exerciser.

More pertinently to COVID-19, numerous randomized controlled trials (RCT) conducted to establish the relationship between exercise and upper respiratory infections (URTI), showed a reduction of URTI symptoms in those individuals who undertook moderate exercise and physical activity that ranged between average 40-50% in comparison to those who were largely sedentary. Noticeably, those who engaged in strenuous excessive and prolonged exercise experienced a 2-6 fold increase in presenting with URTI symptoms. Furthermore, epidemiological studies suggest that regular physical activity is associated with decreased mortality and incidence rates for influenza and pneumonia. Given the collective findings from the RCTs, it serves to substantiate and hopefully bolster public health guidelines urging individuals to be physically active on a regular basis.

Another risk factor aside from URTI symptoms is clinical obesity, defined as a body mass index (BMI) of above 30. Obesity is linked with persistent increases inflammation biomarkers defined as chronic or systemic inflammation. Obesity induces a constant state of low grade inflammation characterized by activation and infiltration of proinflammatory immune cells such as macrophages and granulocytes and a dysregulation of acute phase proteins reactive oxygen species (ROS) metalloproteinases, and other cell signaling molecules ¹⁰ . Regular exercise training has an overall anti-inflammatory influence mediated through multiple pathways. Numerous epidemiologic studies have shown decreased levels of inflammatory biomarkers in adults with higher levels of physical activity and fitness of which the effects are still favourable and noticeable when BMI is adjusted. Exercise/physical activity is essential along with dietary adjustments, in better managing and reducing an individual’s weight. As the most reason recent comprehensive study found that obesity increases risk of COVID-19 death by 48% and what’s more the study goes on to suggest that the vaccine may not as work as well for overweight people ¹¹ .

The final risk factor and point regarding the benefit of exercise and physical activity is its effect on age, otherwise termed as immunosenescence. Immunosenescence defined as the gradual deterioration of the immune system brought about by the natural advancement of age. This increases the susceptibility to infections, autoimmune diseases, neoplasia’s, metabolic diseases, osteoporosis and neurologic disorders. However, this natural phenomenon can be remodelled and delayed by undertaking habitual exercise. In cross-sectional studies comparing immune function in highly conditioned and sedentary women found that the highly conditioned elderly women had significantly higher levels of NK cells and T-lymphocytes function and reduced illness rates compared with the 30 sedentary elderly women. The delaying of the onset of immunosenescence via physical exercise confer conducive physiological attributes to stave off and improve the prognosis of a COVID-19 infection by enhancing the individuals vaccination response, lowering inflammatory response to bacterial challenge and improve the NK cell activity.

Supplements, Dietary & Lifestyle Habits.

Along with basic hygienic practices social distancing and exercise, supplements, dietary and lifestyle changes have a role aiding boost or preserve an effective and responsive immune system.

Beginning with Vitamin D, fat-soluble vitamin capable of enhancing absorption of calcium in the small intestine and in doing so promotes calcium homeostasis (normal functioning) to promote bone health, a deficiency in this vitamin has been associated with an increased autoimmunity as well as an increased susceptibility to infection ¹² . According to multiple cross-sectional studies carried out between 1988 to 1994 involving 19,000 subjects, which investigated the association of lower levels of vitamin D with increased infection, individuals with a lower vitamin D (<30ng/ml) were more likely to self-report a recent URTI than those with sufficient levels ¹³ . These findings where consistent when adjusting for variables including season, age, gender, body mass, race. In another cross sectional study involving 800 military recruits in Finland. Those recruits with lower vitamin D levels lost significantly more days from active duty secondary to URTI. It is worth mentioning that studies reporting potential benefits of administering vitamin D to decrease infections have not been consistent. Nevertheless, a well-designed prospective double blind placebo used nasopharyngeal (nose and throat) swab cultures and a therapeutic dose of vitamin D showed that the administration resulted in a statistically significant (42%) decrease in the incidence of influenza infection ¹⁴ . The beneficial effects of vitamin D on protective immunity are due in part to its effects on the innate immune system. Vitamin D plays an important in the innate antimicrobial response. The necessary vitamin D to meet these levels of protection can be obtained through supplement, sunlight above all dietary intake.

Dietary intake along with the aforementioned acute exercise not only manages weight management and obesity, but also provides a noticeable boost to the immune via the diversity of the gut microbiota. The gut microbiota influences human health and immune function, though fermentation of indigestible food components in the large intestine. The microbiome and derived metabolites include short chain fatty acids and biotransformed bile acids have been shown to influence immune function both within the gut and systematically. However, it is worth mentioning that research in this area is emerging and more needs to be done to determine potential linkage between immune function in physically fit individuals. Nevertheless, consuming a well-balanced diet with sufficient energy to maintain a healthy weight, with a focus on grains, fruits and vegetables to provide sufficient carbohydrate and polyphenols that reduce exercise-induced inflammation and improve viral protection, is thoroughly recommended.

Finally, lifestyle is the last holistic approach and the most impactful on the maintenance of and fortification of an effective immune system in an individual. These lifestyle recommendations adhere to consistently overtime, become positive daily habits. These lifestyle recommendation include facilitate regular high quality sleep avoid excessive intake of alcohol, consume a well-balanced diet and the development of stress management and copying techniques to decrease load of life hassles, stress, negative life events and emotions. Numerous studies have revealed that sleep deprivation reduces the levels of cytokines, infection fighting antibodies and cells. The consequences of this is that it makes the body less responsive to vaccines an consequently this has a profound on antiviral immune response ¹⁵ .

With regards to alcohol, its combined effects on both innate and adaptive immunity significantly weaken host defences predisposing chronic drinkers to a wide range of health problems including infections and systemic inflammation ¹⁶ . More pertinently to COVID-19, alcohol disrupts ciliary function in the upper airways impairs the function of immune cells (i.e. alveolar marcophages and neutrophils), and weakens the barrier function of the epithelia in the lower airways. Often, the alcohol-provoked lung damage goes undetected until a second insult, such as respiratory infection leads to more severe lung disease than those seen in non-drinkers ¹⁷ . Also alcohol alters the number of relative abundances of microbes in the gut microbiome, these organisms affect the maturation and function of the immune system.

The effects of stress, emotional trauma on the immune system are well documented. Studies have shown that stress is responsible for immunological dysregulation in children, adolescence and adults alike, which presents with an increase blood levels of pro-inflammatory cytokines and even more so with chronic stress. In addition to this chronic stress is activation of latent viruses. Latent virus activation can reflect the loss of immunological control over the virus and frequent activation can cause wear-and-tear on the immune system.18

In conclusion, the hoslitic approaches adopt the most effective strategy and something all healthcare professional prescribe to the public, prevention. Only through prevention can COVID-19 be well managed and contribute to the fatalities attributed to this virus. To reiterate these holistic measures are easy to incorporate into our daily lives, they are relatively inexpensive and so present a low barrier to adopt and they are indeed highly effective in preventing the spread of the virus. Adhering to these measures makes a serious effort and contribution towards reducing the pressure on NHS resources both financially and emotionally. What’s more, complying with hygienic & social practices in the form of wearing a mask and regularly hand washing are fitting and meaningful acts we can undertake to show our appreciation for and solidarity with NHS workers, key workers and each other. In the final part of this series, we shall look at the proposed vaccine and therapeutic options used to combat the virus.

Reference

1. P Thordarson. The coronavirus is no match for plain, old soap – here’s the science behind it. MarketWatch. < https://www.marketwatch.com/story/deadly-viruses-are-no-match-for-plain-old-soap-heres-the-science-behind-it-2020-03-08 > Accessed 30th August 2020.

2. V Curtis S Camicross. Effect of washing hands soap on diarrhoea risk in the community: A systematic review. Lancet Infect Dis. 2003;3(5):275-81.

3. T Rabie V Curtis. Handwashing and risk of respiratory infections: a quantitative systematic review. Trop Med Int Health. 2006; 11(3):258-67.

4. WHO. Mode of transmission of virus causing COVID-19: Implications for IPC precaution recommendations < https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations > Accessed 27th August 2020.

5.BBC News. Coronavirus: Face covering use expanded in England and Scotland. < https://www.bbc.co.uk/news/uk-53702291 > Accessed 27th August 2020.

6. J Henley. Global Report: France tightens mask rules as Covid cases rise in Europe. The Guardian. < https://www.theguardian.com/world/2020/aug/18/global-report-france-tightens-mask-rules-as-covid-cases-rise-europe > Accessed 30th August 2020

7.Ibid 4

8. S Whitebloom. Social distancing works: Here’s the Maths. Oxford Science Blog. University of Oxford. < https://www.ox.ac.uk/news/science-blog/social-distancing-works-here-s-maths > Accessed 27th August 2020.

9. DC Nieman LM Wentz. The compelling link between physical activity and the body’s defense system. J Sport Health Sci. 2019; 201-217.

10. Ibid

11.S Boseley. Obesity increase risk of Covid-19 death by 48%, study finds. The Guardian.< https://www.theguardian.com/world/2020/aug/26/obesity-increases-risk-of-covid-19-death-by-48-study-finds > Accessed 29th August 2020.

12. C Aranow. Vitamin D and the Immune System. J Investig Med. 2011;59(6):881-886

13. AA Ginde JM Mansbach CA Camargo Jr. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2009; 169(4):384-90.

14. M Urashima et al. Randomised trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr. 2010; 91(5):1225-60.

15.MR Irwin. Why Sleep is important for Health: A Psychoneuroimmunology Perspective. Ann Rev Psychology. 2015; 66:143-172

16. D Sarkar MK Jung H Joe Wang. Alcohol and the Immune System. Alcohol Res. 2015; 37(2):153-155.

17. Ibid.

18. JN Morey IA Boggero AB Scott SC Segerstrom. Current Directions in Stress and Human Immune Function. Curr Opin Psychol. 2015; 5:13-17

COVID-19 Series PART I

PAR003_OE@heg.com — Mon, 14 Sep 2020 10:13:36 GMT

What is the origin of COVID-19?

COVID-19 is believed to have originated from the capital of Hubei province in Wuhan, The People’s Republic of China.

COVID-19, like that of Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), Acquired Immune Deficiency Syndrome (AIDS) and Ebola, is a zoonotic disease meaning it is an infectious disease that can be transmitted from animal species to humans. Scientific research suggests that bats are the likeliest reservoir as COVID-19s closest relative is a bat virus that shares 96% of its genome. There is a possibility that the virus was transmitted from bats to pangolins, an endangered species, sometimes consumed as a culinary delicacy, and then onto humans ¹ .

What is COVID-19?

COVID-19 is a SAR-COV-2 virion, which is a pathogen of the coronavirus family that includes member viruses responsible for SARS and MERS infections. Each virion is a spherical protein shell, encapsulating a ball of ribonucleic acid (RNA), the virus’s genetic code (genome). The exterior of the COVID-19 virus, labeled the envelope, is made up of phospholipid layer (fatty), of which this layer is covered with spiky protrusions called glycoproteins. Glycoproteins play an important role in the activation of the virus ² .

What are the signs & symptoms of COVID 19?

Individuals with COVID-19 initially present with the following signs and symptoms:

Fever
Fatigue
Persistent coughing
Shortness of Breath
Anosmia (loss of smell)
Ageusia (loss of taste)

These signs and symptoms are not too dissimilar to that of the common flu. In addition to this, approximately 80% of will be asymptomatic (presenting with no symptoms), which in of itself is a major concern and significant contributor to the potential exponential rise in cases. According to front line doctors, the latter symptoms are rather telling and indicate that COVID-19 attacks other regions of the body outside of the lungs and in this case it seems to attach the central nervous system (CNS).

What is the disease state of COVID-19?

COVID-19 is able to elicit its effect via the glycoprotein upon its surface binding to the angiotensin converting enzyme 2 (ACE2) receptors in a human host. The ACE2 is integral to regulating our blood pressure. ACE2 receptors can be found on vital organs and other organs, these include the lung heart, kidneys and intestine. Notably, ACE2 receptors are expressed by endothelial cells. These cells are thin single flat cells that line the interior surface of blood vessels and lymphatic vessels. According to a recent paper, there is evidence of direct viral infection of the endothelial cells, attributed to the interaction between COVID-19 and ACE2 receptors, and the development of endothelial inflammation called endotheliitis ³ . Based on the teams findings from histological (tissue) samples from deceased patients who succumbed to COVID-19 and recovering patients from the condition, COVID-19 is responsible for endothelial dysfunction, shifting vascular equilibrium towards more vasoconstriction with subsequent ischaemia (blockage of the blood vessels), inflammation with associated tissue odema (swelling) and a procoagulant state (clotting). Hence, COVID-19 induces endotheliitis in several organs as a direct consequence of viral involvement and the host’s inflammatory response (immune response shall covered later) ⁴ .

This finding goes some way to explaining and providing a strategy for protecting vulnerable patients with pre-existing endothelial dysfunction, which is associated with; the male gender, smoking, hypertension, diabetes, obesity and established cardiovascular disease, all of which are associated with adverse outcomes in COVID-19. These findings also explain the rationale of using therapies to arrest and combat the attack on the endothelium while tackling viral replication via the use of anti-inflammatory anti-cytokine drugs ACE inhibitors and statins ⁵ .

COVID-19 operates in the same manner as other viruses by hijacking the host cells protein-making machinery (ribosomes) in order to translate its RNA to replicate more viruses. In just an hour a single cell can be forced to produce tens of thousands of new virions, which then infect other healthy cells. COVID-19 acts in a nefarious fashion, in a series of ways. Firstly, it codes for protein that remain within the host cell. Secondly, it can prevent the host cell from sending out signals to the immune system that indicates it’s under attack. Thirdly, it encourages the host cell to release newly created virions. Finally, its assists the virus in resisting the host cells innate immunity.

Our immune system’s role in COVID-19

Our immune system is the last line of defence and when threatened by an invading pathogen a physiological game of “cops and robbers” ensues. Generally with viral infections the body raises the temperature in an effort to kill off the virus. White blood cells begin to seek out the offending pathogen with the intention of ingesting and destroying the infected cell or by creating antibodies to identify, arrest and neutralise the virus from further infecting the host cell, whilst also making chemicals that are toxic to infected cells. However, COVID-19 is a multifactorial disease that exceeds the misconception that “it’s just a little flu” and this is attributed specifically to our immune system’s response to COVID-19. Dr Roger Paredes, explains that there are three different stages of people developing COVID symptoms;

i) The Viral Phase

This phase is the most common phase and the phase that misattributes the potential severity of COVID-19. At this stage the virus replicates quickly within the respiratory system. Symptoms are indeed similar to the common flu and disappear, spontaneously after 6 to 10 days. This is the case for about 80% of the patients. It is worth noting that throughout this period the virus is located only in the upper respiratory tract (URT).

ii) The Pulmonary Phase

In this phase the virus is located further down the respiratory tract. As a result, it can lead to complications like bronchitis or pneumonia. The development of pneumonia from those infected with COVID-19 occurs in 20% of patients. This type of pneumonia is a very specific type of pneumonia that attacks both lungs and is responsible for respiratory distress. This is the dreaded secondary infection that capitalises on a weakened immune system and is a leading cause of death.

iii) The Severe Phase

Around 10% of patients will enter into this phase as a result of a cytokine storm. This arises from the body’s immune system deploying all strategies to overcome the infection, however in doing so the body’s response can prove to be the most damaging. Aside from the body invoking a fever with the intention of cooking the virus to death, with an extensive fever can result in the degradation of the body’s own proteins, another strategy is for the immune system to launch an inflammatory response involving cytokines. Cytokines are cell-signaling protein molecules released by cells when activated by an antigen as enhanced mediators in an immune response. By the immune system deploying cytokines, they are tasked with hindering the virus’s ability to replicate and to kill some cells in order to repair damaged tissue. However, in an overzealous response by the body’s immune system results in the overproduction of cytokines that bombard the body creating an uncontrolled inflammatory response. Furthermore, what makes this a deadly hyperinflammatory response, is the fact it is not confined to lungs, but it is rather wide spread with damage seen in the kidneys, intestine, cardiovascular system (heart and coronary arteries) and the brain. So severe is the latter, as a result of the cytokine storm that attacks the CNS that it requires an individual to be admitted into intensive care ⁶ .

How do we protect those patients we identify as most at risk?

The best way to tackle COVID-19 is through prevention associated with contracting the virus (this shall be covered in the next part of this series). The next approach is to identify those most at risk and the demographic susceptible to COVID-19. Research, observation and reports have shown that a majority of patients who suffer from the pulmonary and severe phase are over 60 years old (though in some and rare cases young people can present with the signs and symptoms of this phase). We know that men have a higher rate of contracting the virus more so than women. We also now know, that individuals of an Afro-Caribbean and South Asian demographic are four times more likely to contract the virus, and that those with pre-existing conditions, due to endothelial dysfunction, are most at risk.

The next part seeks to look at the holistic approaches we can adopt and incorporate into your daily lives to reduce your chances of contracting COVID-19 and improve your chances of prognosis (recovery) should you succumb to the virus.

Reference

1. NV Patel. How does Coronavirus work? MIT Technology Review. Biotechnology < https://www.technologyreview.com/2020/04/15/999476/explainer-how-does-the-coronavirus-work/ > Accessed 21 August 2020

2.Ibid

3. Varga Z, Flammer AJ, Steiger P, Haberecker, Andermatt R, Zinkernagel AS. Endothelial cell infection and endotheliitis in COVID-19. The Lancet.2020; 395:10234:1417-1418.

4.Ibid

5.Ibid

6.R Cereceda. New coronavirus not the real killer: it’s the patient’s immune system damaging vital organs. Euronews. < https://www.euronews.com/2020/04/09/understanding-covid-19-the-unknown-disease-with-multiple-faces > Accessed 22 August 2020

The Perfect Storm: COVID-19 & Diabetes

PAR003_OE@heg.com — Fri, 12 Jun 2020 08:46:31 GMT

The COVID-19 pandemic has unleashed devastation and disruption to lives and livelihoods the likes that, we have not seen on our shores since World War II. * The suffering has been abundant and varied. From our senior citizens who are the most vulnerable and beloved members of our communities and families, of which some have either been hospitalised or have sadly passed having succumbed to COVID-19, to those who have been furloughed and are awaiting a verdict on their future with a sense of trepidation, or to those who have lost their job, business and sense of identity that came with the role, position or industry they held or represented prior to the pandemic. This is to say nothing of those suffering from mental health issues; that have been exacerbated due to an enhanced feeling of displacement, isolation and abandonment as a result of this induced lockdown.

This virus has torpedoed the optimism and anticipation that heralded a new year and decade, and in the process has demonstrated itself as nothing short of a pernicious and opportunistic disease.

COVID-19 is a type of severe respiratory syndrome (SAR) caused by a specific strain known as SAR-coronavirus-2 (SAR-COV-2), which is highly infectious. COVID-19 patients present with symptoms almost identical to those of the flu such as; a fever, fatigue and a cough but can also present with a shortness of breath, or anosmia (a loss of smell).

What makes COVID-19 that more menacing and difficult to control, is the fact that 78% of people present as asymptomatic (showing no symptoms) thereby making it impossible to know whether a person is contagious or not. ¹ According to the latest figures, as of the time of writing (26th May 2020), the number of UK fatalities from reported cases of patients that have contracted COVID-19 stands at 14%. ² Those patients with pre-existing conditions are more likely to succumb to COVID-19. Out of the main pre-existing conditions two conditions stand out, diabetes and ischaemic heart disease (IHD), as depicted by the chart created by the Office for National Statistics (ONS) in Figure 1.

Figure 1: Proportion of deaths involving COVID-19 by age, sex and main pre-existing condition in England and Wales, March 2020.

Before the arrival of the COVID-19 pandemic, there was and still is an ongoing diabetes epidemic within the UK that is on course to becoming a crisis in the future. From a report compiled by Diabetes UK, 4.7 million people in the UK have diabetes, equating to one in 15 of the population, with a further one million people within the population living with undiagnosed type II diabetes. ³ According, to this report by Diabetes UK, it is projected that five million people within the UK will have diabetes by 2025. Alarmingly, 90% of those diagnosed with diabetes globally, have the type II variety.

Type II diabetes develops when the insulin response levels are not sufficient in effectively regulating (specifically by clearance) an individual’s blood glucose (sugar) level. This is due to the elevation of insulin levels over an extensive period of time, which subsequently results in cells becoming resistant to the effects of insulin (meaning glucose is not absorbed into the muscle and fat cells within the body). Eventually, insulin production decreases over a sustained period of time, causing the level of sugar in the blood to remain and become too high. This is clinically referred to as hyperglycaemia an (excessive amount of glucose in the bloodstream). The significance of diabetes, in particularly type II diabetes, is that it is a multifactorial disease with a cluster of common pathologies such as; obesity, insulin resistance, dyslipidemia (an abnormal level of fats in the blood) and hypertension, which are collectively referred to as metabolic syndrome.

⁴ Returning to the ONS study, at least one diabetes-associated pathologies; appeared in the top three most common main pre-existing conditions in deaths involving COVID-19 across multiple age groups for both genders. In the male category, a constituent of metabolic syndrome appears as one of the top three causes of COVID-19 related deaths in 10 age groups out of 11 (aged 0 to 90+). Whilst in the female category, one of the common diabetes-associated pathologies was found within the top three of common main pre-existing conditions responsible for COVID-19 related deaths in four out of 11 age groups.

Amongst male category, the leading most common main pre-existing conditions was IHD which accounted for almost 20% (18%) of COVID related deaths in England & Wales in March of this year. Interestingly, the highest incidences of deaths attributed to metabolic syndrome as the common main pre-existing condition in COVID-19 in the female category was seen in middle-aged women aged 50-54, 55-59 and 60-64. ⁵ Across both genders and all ages groups, diabetes and constituents of metabolic syndrome, accounted for, on average, approximately 16% (15.75%) of deaths in female patients and 20% of deaths in male patients in the month of March in 2020 for England and Wales.

The COVID-19 pandemic coupled with UK’s diabetes epidemic has culminated in a perfect storm. What’s more, both diseases share a common risk factor and affect the same demographics, consequently wreaking synergetic havoc upon specific areas and communities within the country. Both COVID-19 and diabetes share the risk factors of affecting those of advancing age and those from an African-Caribbean and South Asian ethnicity or Black, Asian and Minority Ethnics (BAME); hence making both demographics highly susceptible to both diseases. ^{6 7}

Furthermore, a recent study makes for ominous reading and further compounds the synergistic consequences upon the aforementioned demographics, as it proposes COVID-19 may in fact be a vascular disease given its disproportionate affect on individuals with cardiovascular comorbidities. ⁸ Diabetes is also a macrovascular disease, responsible for complications such as coronary heart disease (CHD) and strokes; both of which, again, affects an older demographic and BAME groups more.

⁹ In light of these findings and trends, there is a palpable sense of concern regarding a second wave of COVID-19 come the winter season.≠ Nevertheless, as we gradually move towards easing and exiting the lockdown, and enter into the summer, we are afforded a window of opportunity upon which to reflect and assume a renewed sense of responsibility over our lives. There are three key reasons why this opportunity must be proactively utilised.

Firstly, this opportunity must be used for the adoption and maintenance of daily physical exercise or activities. This lockdown has placed a great emphasis on mobility and staying active. It has spurred people to improvise and adapt their lockdown lifestyle in order to incorporate exercise as well as some physical activity that provides some resemblance to the activities they engaged in prior to the lockdown. These efforts should be applauded, encouraged and maintained during and post-lockdown.

Any form of physical activity you undertake makes a considerable difference towards staving off a sedentary lifestyle that plays a major role in the development and worsening of type II diabetes. These forms of exercise needn’t be grand or done by you alone. They can be done socially either with members of your household or with close friends (observing government guidelines). They can range from simple to challenging; whichever is a comfortable pace for you to begin with. So far as you start, it is never too late.

Secondly, we should use this opportunity to review our diet. Our cooking and consumption habits may have, to a degree, undergone a form of change during the lockdown. Our temptation to opt for a convenience meal or takeaway, particularly at the start of the lockdown, may have been curtailed. By doing so, we have reduced the amount of meals, condiments and accompanying beverages that are high in free sugars and salt. Be it out of love, necessity or experimentation, continuing the practice of making home cooked meals allows for you to consciously participate in your meals and account for its nutritional value and conducive effects on your body and well-being.

This is especially important in BAME individuals with or susceptible to type II diabetes or who fall into the at risk category for COVID-19 (those of advancing age, 65+ years). By opting to grill as opposed to fry, or replacing seasoning low in sodium as opposed to using salt or seasoning high in sodium, or by selecting a beverage free from sugars as opposed to established full sugar beverages, you are ensuring that you eat a healthy and well-balanced diet that is very much in alignment with a low to medium glycaemic diet.

This does not only allow you to achieve better control of your blood sugar levels, but it has the strong probability of sending type II diabetes into remission in the long-run. ¹⁰ For now, you’d be making a difference, in the short-run, in mitigating the dual effects of COVID-19 and diabetes.

Thirdly, by making a concerted and conscious effort to undertake and maintain physical activity, along with a healthy and balanced diet, you would be taking measures that would pay dividends for our NHS both in the short-run and in the long-run. In the short run, it would improve your chances of recovery, thereby reducing the demand on immediate resources such: as beds, clinical apparatus (ventilation equipment, if necessary) and healthcare staff, in both primary and secondary setting.

Whilst in the long-run it would liberate a sizeable amount of capital§, used to treat complications from a preventable and even curable chronic condition in type II diabetes. This newfound and available capital could then be reallocated towards allowing another patient elsewhere within the NHS access to a novel life-saving medicine. Your actions, unquestionably, would achieve a net benefit of a more robust, fair and economically sustainable NHS.

In closing, COVID-19 and diabetes make for a sinister combination. The effects of both diseases are clinically significant given the susceptibility of an aging and BAME demographic, of which the latter is also susceptible to macrovascular disorders such as cardiovascular disease (CVD), a leading complication of diabetes. However, through assuming responsibility of starting and maintaining physical activity and appropriate dieting, the full effects of both COVID-19 and diabetes can be mitigated somewhat.

The incorporations of these changes to your lifestyle needn’t be sudden or introduced in a manner that causes inconvenience. By starting small, incremental changes develop into habits, those habits become daily routine and hence, those daily routines shape and form our lifestyle. Overall, the desired outcome from this is to preserve and improve one’s chances of surviving COVID-19, whilst also supporting and saving the NHS in the short run and long run respectively.

As lockdown measures are eased and we begin to return to some semblance of normalcy it is vital that during this period we do not become reckless or complacent towards starting and maintaining our sense of assumed responsibility. It is crucial, that we do not allow the synergetic impact of both COVID-19 and diabetes to sweep across this country leaving behind a path of sorrow and devastation in its wake. Finally, it is imperative that we, Nnadi’s Healthcare & Pharmaceuticals, not only help to combat diabetes during this pandemic but continue to offer our efforts after it too. We along with you will assume our responsibility of remaining consistent in our contribution to supporting the NHS now and via its Diabetes Prevention Program as part of its Long Term Strategy Plan, in everyway we can.

Signposting :

For more information and on how you can support, please visit the following:

Diabetes UK: https://www.diabetes.org.uk/about_us/news/coronavirus

Diabetes.co.uk: https://www.diabetes.co.uk/?s=coronavirus

British Heart Foundation (BHF): https://www.bhf.org.uk/informationsupport/bhf-coronavirus-hub

BHF Donations: https://www.bhf.org.uk/

Footnotes :

* To apply context to that statement, we do not mean, nor are we comparing the 75 million recorded fatalities from that campaign against those of COVID-19 in any way. This comparison is made in terms of daily routines and the impact upon the economy.

≠ Despite there being legitimate concerns over the outbreak of a second wave of COVID-19 among the medical community; in depth research analysing epidemic waves argues that it would be unwise to make such claims based on substantial uncertainties and novelty of evidence. Our understanding of COVID-19 is still in its infancy and surveillance is recommended to guide preparedness planning. For more information on this see: CEBM: COVID-19 Epidemic ‘Waves’: https://www.cebm.net/covid-19/covid-19-epidemic-waves/

§ According to Diabetes.co.uk, it approximately costs the NHS £14 billion a year to treat diabetes and its complications. Breaking this cost down further; it costs the NHS over £1.5m an hour, which equates to 10% of the NHS budget for England and Wales. The NHS currently spends £25,000 a minute on diabetes.

References :

^1. University College London (UCL) Analysis: BMJ study suggests 78% of people with Covid-19 don’t show symptoms < https://www.ucl.ac.uk/news/2020/apr/analysis-bmj-study-suggests-78-people-covid-19-dont-show-symptoms > [accessed 29thMay 2020]

^2. Centre for Evidence-Based Medicine (CEBM): Global COVID-19 Case Fatality Rates < https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/ > [accessed 29th May 2020]

^3. Diabetes UK: Us Diabetes and a lot of facts and stats. < https://www.diabetes.org.uk/resources-s3/2019-02/1362B_Facts%20and%20stats%20Update%20Jan%202019_LOW%20RES_EXTERNAL.pdf > [accessed 31st May 2020]

^4. Basciano H, Federico L, Adeli. K. Fructose, insulin resistance and metabolic dyslipidemia. Nutrition & Metabolism.2005; 2:5:1-14.

^5. Office of National Statistics (ONS): Analysis of deaths involving COVID-19: deaths occurring in March 2020 England and Wales; Reference table for trackers.

^6. British Heart Foundation: Why are so many black and ethnic minority people dying from coronavirus-and what does it have to do with heart disease? < https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/behind-the-headlines/coronavirus/coronavirus-and-bame-patients > [accessed 31st May 2020]

^7. British Medical Association (BMA): ‘Deeply worrying’ ONS data highlights need to protect BAME communities from COVID-19, warns BMA.< https://www.bma.org.uk/news-and-opinion/deeply-worrying-ons-data-highlights-need-to-protect-bame-communities-from-covid-19-warns-bma >[accessed 31st May 2020]

^8. Varga Z, Flammer AJ, Steiger P, Haberecker, Andermatt R, Zinkernagel AS. Endothelial cell infection and endotheliitis in COVID-19. The Lancet.2020; 395:10234:1417-1418.

^9. British Heart Foundation (BHF): Information & support, risk factors, and ethnicity < https://www.bhf.org.uk/informationsupport/risk-factors/ethnicity > [accessed 02nd June 2020]

^10. Hallerg SJ, Gershuni VM, Hazbun TL, Athinarayanan SJ. Reserving Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients.2019; 11:766:1-17

A Letter from the Managing Director

PAR003_OE@heg.com — Thu, 04 Jun 2020 21:00:00 GMT

Dear Reader,

I would like to welcome and thank you for visiting our website. I trust that you now know a fair bit more about the organisation due to, in no small part one would hope, in my having articulated with brevity and clarity Nnadi’s Healthcare & Pharmaceuticals’ commitment to serving and improving your health, the health of the nation and what I envisage for the company going forward.

As it stands, the pharmaceutical industry and our National Health Service (NHS) face challenges both present and pending. The former in the shape of COVID-19, of which its impact poses both significant clinical and economical consequences, and the latter in the form of the incomplete and complex Brexit negotiations that loom on the horizon. Prior to these challenges, the course charted by this company in order to arrive at this stage now, has not been one of smooth sailing. The course has been fraught with obstacles, false starts and rejection, with a fair share of the unexpected occurring far too readily. Nevertheless, the company overcame and prevailed. Through tenacity, patience and optimism the company was able to navigate competently through those unpredictable and turbulent waters.

Upon pragmatic assessment of the current field of things, it is nothing short of precarious to commence with the launch of a venture of this undertaking in times of great national economic uncertainty. Nonetheless, in these times the nation looks towards the proprietors of small and medium enterprises (SMEs), those men and women, along with their diligent staff and co-workers to demonstrate the inherent and historical traits imbued within these islands of boldness, robustness and resilience for the sake of the country at her time of need.

I believe that Nnadi’s Healthcare & Pharmaceuticals is a company with the potential and capacity to achieve extraordinary things in the coming years. This claim can be substantiated and brought to fruition upon three conditions being met. Firstly, that we adhere to our objectives via our mission statement and company values of creating an organisation ready and attentive to the ever-changing landscape of challenges and opportunities awaiting the healthcare sector in the 21st Century. Secondly, whilst Nnadi’s Healthcare & Pharmaceuticals possesses unapologetically high ambitions, these ambitions are tempered with sober economic stewardship that affords sustainable long-term growth. And thirdly, that we acknowledge this country’s proud heritage and its consistent contribution to the advancement of the pharmaceutical and healthcare sector, over nearly two centuries, that has rightly depicted the United Kingdom as one of the leading crucibles for science, technology and medical therapeutics in the world. The success of this company is inextricably linked to preserving and respecting this legacy. If we can adopt and integrate these conditions, along with being effective custodians and contributors in this field of ours, whilst improving the nation’s health in the process, then it only serves to reinforce my confidence in my claim.

In closing, we are a company that seeks to make a valid and modest (at least) contribution to both the commercial prowess of the United Kingdom and the maintenance and improvement of your health as a member of the public. These aims and ambitions we have set and hold so dearly, are refined to meeting small key milestones over the next 6 months, the next 12 months and the next 24 months. Our attempts to achieve these accomplishments and meet our full ambitions will not be without challenges. However, if we apply those attributes synonymous with Britain, those attributes of industriousness and ingenuity, I see no reason, therefore, why we shan’t overcome any present or pending obstacles before us.

A lot of hard-work and gruelling hours lie ahead; nevertheless I relish the opportunity to continue on this journey of gradually building this organisation.

Again thank you for visiting and taking the time to read this letter. Nnadi’s Healthcare & Pharmaceutical hopes to serve you effectively and make you and the country proud.

nnadis-healthcareandpharma

Our Patron: Archangel Michael

Faith & Medicine: How Understanding the Relationship between Faith and Western Medicine to Better Improve Primary Care Health.

References:

Investment is a Waiting Game: Mini Update from Managing Director

Nnadi’s Healthcare & Pharmaceuticals Annual Report of 2022: Letter from Managing Director

Sponsorship Announcement: Unversity of Strathclyde Netball Club x Fergie’s Sparkling Water®

The Gauntlet: The Challenges that Lie Ahead for Big Pharma and the Industry as a Whole

Crying over spilt milk: Are the marketing practices to promote infant baby formula jeopardising breastfeeding?

Inflation: The Biggest Threat to Diabetes?

Tipping Point: Body Positivity vs. Weight Management

What is Prediabetes?

What is prediabetes?

Who is most at risk of prediabetes?

How do you treat Prediabetes, what can be done?

Diabetes (Type-2) Prevention Week

NEWS: Supporting the IFA Conference

Metaverse, Friend or Foe? How the metaverse could potentially lead to addiction & impact mental health

Leading Benefits of the metaverse worldwide in 2021

Dangers of the metaverse according to Internet users worldwide in 2021

Main Reasons for Joining the Metaverse, according to Internet users in 2021

Further Reading & Signposting:

Reference:

Childhood Obesity & COVID-19: When Two Pandemics Collide.

Nnadi’s Healthcare & Pharmaceuticals Annual Report 2021: Letter from Managing Director

A Shot in the Arm: Bioethical Principles associated with the COVID-19 Vaccines

Prescriptions to the Moon? The Growing Cost of NHS Prescriptions in England.

We’re in British GQ: Summer Edition!

Speak UP: Pandemic or Not, Your Health Matters!

Cancer

Dental Care (Oral Health)

Eye Care

Cardiovascular Disease (CVD)

References:

Grin and Bear it? Sugar’s Impact on Oral Health

Can I Live? : The Impact of Free Sugars & The Liver’s Role

New Product: Fergie’s Sparkling Water®

Nnadi's Healthcare & Pharmaceuticals Annual Report 2020: Letter from Managing Director

Seeing Eye to Eye on the Matter

Closing points:

Signposting & Useful Documents:

Reference:

Sign of Four: Leading Causes of Vision Loss in the UK

4) Diabetic Retinopathy

3) Glaucoma

2) Cataracts

1) Age-related Macular Degenerative (AMD)

Closing points:

Signposting & Useful Documents:

Reference:

National Eye Health Week: Brief Overview of General Eye Care

How Do the Eyes Work?

Best Way to Take Care of My Eyes? ﻿

Regular appointments

Parents & Guardians of Children

Adjustments to Work & Lifestyle:

In Closing

Signposting & Useful Documents:

References:

COVID-19 Series PART III

COVID-19 Series, PART III: The COVID-19 Vaccine & Other Therapeutic Options

What is a vaccine & how does it work?

Do we need a vaccine for COVID-19?

Will the government force us to take a vaccine for COVID-19?

Given the urgency to develop a vaccine for COVID-19, is it safe?

What is Nnadi’s Healthcare & Pharmaceuticals’ position on vaccines?

What other therapeutic options exist to combat and treat COVID-19?

COVID-19 Series PART II

COVID-19 Series, PART II: Holistic approaches against COVID-19. What you can do.

The Basics: Hygienic & Social Practices.

Exercise & Physical Activities.

Supplements, Dietary & Lifestyle Habits.

COVID-19 Series PART I

What is the origin of COVID-19?

What is COVID-19?

What are the signs & symptoms of COVID 19?

What is the disease state of COVID-19?

Our immune system’s role in COVID-19

How do we protect those patients we identify as most at risk?

The Perfect Storm: COVID-19 & Diabetes

Best Way to Take Care of My Eyes?