Your health, yourself - Ogilvy Commonhealth Worldwide

Your health,
yourself
Your health,
yourself
For more information please contact: [email protected]
David Davenport-Firth
Giorgio Pasqual
Lois Hall
Caroline Howe
Morten Frederiksen
Rick Evans
Antonia Betts
Lourdes de Pablo
Lexi Fletcher
Carsten Edwards
Jean-Marc Mosselmans
Michael Dumigan
Andreas Kindler
Ditlev Ahlefeldt-Laurvig
Lisa Roby
Beril Koparal
Tracey Wood
Thomas du Plessis
1. Foreword
Gloria Gibbons
4
2. Introduction
David Davenport-Fırth, Giorgio Pasqual, Lois Hall
7
3. Thiery’s Techno Training
Caroline Howe, Morten Frederiksen, Rick Evans
15
4. Marta’s Nutrition Mission
Antonia Betts, Lourdes de Pablo, Lexi Fletcher
21
5. C
laude’s Case of Compliance
Carsten Edwards, Jean-Marc Mosselmans, Michael Dumigan
27
6. Dana’s Daily Dose
Andreas Kindler, Ditlev Ahlefeldt-Laurvig, Lisa Roby
33
7. Harry’s Inherited Health
Beril Koparal, Tracey Wood, Thomas du Plessis
39
8. References
45
9. Colophon
48
3
1.
Foreword
Gloria Gibbons
President, EAME, Ogilvy CommonHealth Worldwide
Your health, yourself
Foreword
Let’s get personal. And see what we think of the experience.
Over the next few pages you will be introduced to Thiery, Marta, Claude, Dana
and Harry – each of whom (like most of us) have specific health concerns to deal
with and/or wellness goals to reach. As both consumers and patients today, they
have access to a wide range of personalised technology that promises to smooth
their path to wellbeing. But whilst in theory these individualised offerings
are more effective than traditional approaches, in reality success is far from
guaranteed. It seems that even though health information is readily available
at the touch of the button or a swipe of the finger, it is rarely packaged in a way
that is truly relevant and meaningful to us as consumers.
Here at Ogilvy CommonHealth, we have made it our business to understand
how the trend towards personalised health can best be harnessed to improve
health outcomes. There is no doubt that this route has the power to achieve
positive health change, but why – and more importantly – how can this be
best achieved?
So before you or your brand dives headfirst into the world of personalised
health, be sure you know the answers to some essential questions. Are we sure
that opening up health information to consumer control will actually improve
health behaviour? How high is the risk of overwhelming or even alienating
the patients who most need our support? And if personalised health data is
engaging, how should it best be packaged and delivered for optimum effect?
You will find the opinion of our health behaviour change strategists and planners
in Part 1 of this Redport.
In Part 2, we get more practical. Our European network has been busy reviewing
real examples of personalised health programmes in action, across five key
health areas: Fitness, Nutrition, Adherence, Over-The-Counter (OTC) and
Personalised Medicine. By exploring each of these through the eyes of a typical
consumer (this is where Thiery, Marta, Claude, Dana and Harry come in), we
can start to better understand all factors that shape patient behaviour. Knowing
this, we can then explore the underlying motivations for current behaviour, as
5
Your health, yourself
Foreword
well as the potential triggers that could modify it. And it is at this point that our
behaviour change enthusiasts get motoring, identifying the most effective way to
communicate personalised health to consumers, making it their business to know
what methods are already showing promise and what strategies should
be employed to gain best commercial advantage in the future.
So, if you are battling with how to make your brand experience more personal,
or the service offering that supports your brand achieve a tangible and positive
health outcome for your customer, read on.
Gloria Gibbons
President, EAME, Ogilvy CommonHealth Worldwide
6
2. Introduction
David Davenport-Firth, United Kingdom
Giorgio Pasqual, Italy
Lois Hall, United Kingdom
Your health, yourself
Introduction
We live in the age of the individual. It may have started off modestly, with the
ability to choose your mobile ringtone or customise your desktop wallpaper,
but in recent years the trend has grown exponentially – to the point where
self-expression now reigns supreme. As consumers, the 21st century offers a
seemingly limitless array of opportunities to personalise not only how we interact
with the world, but the very way the world interacts with us. So why shouldn’t
the arena of health follow suit? After all, we already possess a naturally proactive
interest in our own existence. And if you combine this with the age-old desire to
categorise, monitor and analyse aspects of one’s own life – think banking, bills,
time management – it seems pretty obvious that we might want to pay closer
attention to our vital statistics.
Take the formidable rise of the ‘e-patient’ as case in point. At this moment,
millions of individuals around the globe are frantically clicking away on the
Internet or any one of its interconnected tools in an effort to seek out, share and
sometimes create their own information about health and wellness. And whilst
to date this phenomenon has mainly focused on the distribution of medical
knowledge to the masses, the latest developments are more intimate. How much
do you know about the ‘Quantified Self’ concept? If the answer is ‘not a lot’ then
listen up. To quantify oneself in regards to health means to gain a deeper (often
numerical) understanding of one’s body as a machine. More specifically, as a
unique machine driven by distinctive data. It can mean knowing how high your
body mass index (BMI) is or how low your cholesterol is. It can mean (accurately!)
tracking weekly kilometres jogged or five-a-day consumed. It can mean taking
the medication designed for your specific DNA, not that of your neighbours.
And in all of these pursuits, self-quantification makes use of the latest advances in
digital technology to provide users with the most personalised and precise service
possible.
What is for certain is that the future’s here, and it wants to get to know you. The
real question is: should we let it? After all, configuring your latest smartphone or
tablet to reflect each quirk of your individuality is pretty harmless, but the same
may not be said when we let people tinker with their own complex biology.
In this report we examine both sides of the debate, to better understand when
and how this approach should be employed (or avoided).
8
Your health, yourself
Introduction
The case for more personal health information
When it comes to our health, we are often our own worst enemy. Some of the
greatest threats to our general wellbeing, like obesity, heart disease and sexually
transmitted infections, are more often than not brought on by personal lifestyle
decisions. Some governments have enjoyed moderate success with smoking bans
and taxes on high fat foods, but the hard truth is that truly effective change has
to start with the individual.
You know those public health campaigns which gently hint that it would
be wise to limit our salt consumption or aggressively shock us with pictures
depicting the grotesque consequences of smoking cigarettes? Well, the evidence
suggests that too many of us just aren’t listening. And even if we do listen,
we very often don’t do, even when faced with a concrete diagnosis. Physicians
constantly struggle to combat low adherence to the necessary lifestyle changes
and medication prescribed to patients with serious chronic diseases, such as
diabetes and arthritis. And if you think this situation might improve any time
soon, think again. Medical resources across the globe, not to mention the
healthcare professionals who deliver them, are becoming increasingly stretched
as the general population ages by the second. Relying on national health systems
to provide individual attention to each and every patient who demands it is no
longer a realistic solution. Which all leads to one very stark conclusion: health
behaviour change is now a critical issue.
So how do we stop being enemies and start making health our new best friend?
Quantifying our health, ourselves, could well be part of the answer. If delivered
smartly, personally relevant health information might not just motivate us more,
it might actually help us (finally) understand and appreciate the risks and
rewards of our daily behaviours. Would knowing the effect a mid-morning
packet of crisps has on our blood pressure provide us with the willpower to reach
for an apple instead? Would we pass the bus stop and walk home if we knew that
they were all the steps needed to reach our daily target? Would we stick to a daily
prescription if the doctor told us that the benefits were greater for our particular
genetic profile? Perhaps. After all, studies in diabetes, hypertension, medication
9
Your health, yourself
Introduction
compliance and weight loss have shown that patients who successfully selfmonitor their activities and set personal goals enjoy improved health outcomes
and higher levels of adherence to treatment1-6.
If this is the case, the good news is that today’s wired up society is well prepared
to take on the self-quantifying challenge. Armed with our smartphones (which
are estimated to be within our reach 75% of the time7), we have an abundance of
apps at our fingertips to comprehensively track aspects of our lifestyles, analyse
results and observe improvements over time. These self-monitoring tools can
then be easily integrated into social health networks so that as patients we can
share experiences and advice on the best treatments.
One such peer platform is known as The Quantified Self (QS) Movement. With
over 5000 members in 42 countries8, worldwide groups have regular meetings
where data is compared and different devices and quantifying approaches
reviewed. The Movement is growing rapidly, with the most popular tracking
tools focusing on diet, weight, fitness and sleep patterns. Members of the QS
Movement are well aware that focusing on your health, yourself, can bring a
number of benefits. Instead of relying on personal impressions and memories
to keep track of health behaviours, they make use of devices that hold vast
quantities of accurate data and automatically identify patterns and trends.
When this data is analysed effectively, personal risks can then be clearly
articulated and contextualised for individuals, and health gain meaningfully
mapped out over time.
The case against more personal health information
It all sounds very promising doesn’t it? But before we all yell ‘sign me up!’ and
jump aboard the self-quantifying bandwagon, a few words of caution…
What about the people who are unable to reach the goals their personalised
tracker sets them? If a target weight or blood glucose level remains unmet, the
overriding result is likely to be frustration or disillusionment. In fact, a recent
study into self-monitoring to improve diabetes treatment found that the main
10
Your health, yourself
Introduction
concerns that patients had with the system were disappointment with unmet
expectations and difficulty fitting the programme into the demands of daily life1.
What about the people who feel pressure sharing results with peers on a
social networking site? It is one thing not to reach your own goals in private, but
quite another to fail when others are watching. Some high-level users may even
put themselves at risk of harm in order to keep up the competition. One such
case is that of William Flint, a man who was killed while racing down a hill in
an attempt to regain the top ranking on a cycle-tracking app called Strava9.
What about the people who take self-monitoring too far and become obsessed with
keeping track of daily habits and behaviours? Even if they don’t push themselves to
injury, fixating on one aspect of their lifestyle that is perceived to be at fault can lead
to increased stress and the propensity towards unnecessary self-diagnosis7.
What about the people who are weary of further intrusion into their everincreasingly less private lives? Rather than put up with more interference from the
public or private sector in regard to their health, these people may simply prefer
to ignore the noise and bury their heads firmly in the sand.
And finally, what about the people who don’t have sufficient knowledge or
understanding to analyse the data that they have been provided with? If
comprehension is insufficient, then there is a risk that the user will tend towards
finding faults with themselves that may not exist. So if the user has a tendency
towards self-treatment (as may be suggested by their enthusiasm for selfmonitoring) then this could at its worst lead to self-prescription, thereby doing
more harm than good10.
So it’s safe to say that any serious approach to self-quantification has to keep
these potential risk areas firmly in mind. But the popularity of the QS Movement
also suggests that the method is working for a substantial sector of society – so
what lies between success and failure? The manner in which personalised data is
delivered is vital.
11
Your health, yourself
Introduction
The apps which make the process of data upload as effortless as possible for the
end user are the ones most likely to catch on in the long term. Currently, many
tools require manual updating of records, which is not only intrusive but takes
precious time out of a person’s day7. This makes it unlikely that data entry will
be routine, resulting in sporadic and fragmented records of events. The more
sophisticated devices automatically record data and the best even synchronise it
with online analysis programmes in real time – providing a seamless transition
with minimal disruption to the user.
Aside from the effort to upload data, a common barrier to self-tracking is simply
a lack of interest or understanding. This means that health information needs
to not only be engaging, but also simple enough to be universally accessible.
The average person is likely to find sorting the data that matters from what
doesn’t time consuming and intellectually daunting – in fact, many patients
who have to actively monitor a condition like Type II diabetes don’t always
fully engage for these very reasons11. Plus we can’t realistically expect doctors
to start using precious consulting time to clarify statistics that are proving too
mystifying for their patients.
One way to remain motivating and practical is is to explain both immediate
and long-term health risks and benefits in a straightforward yet inspiring
manner. Establishing aspirational but realistic goals and providing self-efficacy
reinforcing feedback against the attainment of these goals can help bring selfmonitoring systems to life, making them personally meaningful on an ongoing
basis. And if we can achieve this holy grail then maybe even those with their
heads in the sand might not want (or be able) to ignore us any longer. Of
course, that’s not to say that the fear of intrusion and the question of Internet
security should be ignored – many studies show that computer concerns are one
of the major attributing factors to the low uptake of digital monitoring tools4.
12
Introduction
Your health, yourself
Health highlights:
Health behaviour change is now a critical issue.
If done well, the provision of more personally relevant health information can
effectively change health behaviour:
Do:
Don’t:
•B
ase strategy on well-founded
• Overload and overwhelm people
behavioural change theory
with information, thereby boring
(particularly goal theory and
them, or even worse, alienating them
self-regulation theory) and evidence
from the task altogether
published in reputable journals
•P
romote achievable, tangible health
• Encourage patients to take
self-monitoring to extremes or
rewards and demonstrate concrete,
misunderstand its output, thereby
realistic risks, all the time allowing
negating any positive effects
consumers to set goals and receive
and causing additional health or
feedback
psychological issues
•M
ake sure data is well visualised, (for
example with clear and compelling
infographics) and contextualised
to the user’s life
•F
acilitate simple, straightforward
data collection that requires minimal
manual effort
•E
nforce tight security
to protect privacy
13
3. Th
iery’s Techno
Training
Caroline Howe, United Kingdom
Morten Frederiksen, Denmark
Rick Evans, United Kingdom
Your health, yourself
Thiery’s Techno Training
Meet Thiery. He’s a 32-year-old social worker who is proud of his university
education and what he considers his ‘digital-savviness.’ He enjoys sport but he’s
no fitness fanatic – since graduating, the daily gym workouts have dwindled
to an occasional run around the block. Like most of us he knows he should do
more, so when friend Dan suggests a fun run for charity it proves the perfect
opportunity to get fit quick.
Day One and he turns to his trusted smartphone for inspiration. Within a
couple of clicks he has downloaded a free pedometer app, which keeps him
going for a week or so – until he spots Dan’s wearable fitness tracking device.
One trip to the store and €100 later, a similar gadget is his. Thiery is pretty
chuffed with the purchase – it tracks his steps, the stairs he climbs and, when
he’s back, his sleep patterns. Synced up with his laptop and mobile, the device
displays all his data in a handy dashboard, allowing him to input his daily food
intake and rewarding him with a collection of goal orientated ‘achievement’
badges. Dan, of course, is still one step ahead – his device feeds into a social
networking site for runners where he tracks progress against others and thrives
off ‘friendly’ peer competition. But Thiery’s not bothered. The daily miles are
increasing and he’s right on track to complete the 13 miles in a respectable time.
Well, OK, he’ll admit, it would be pretty great if that time was a few seconds
faster than you know who’s…
Thiery’s in good company. Thanks to a rapidly growing mobile health industry
that currently boasts more than 40,000 health and fitness apps12, his experience is
becoming increasingly commonplace. In 2012, 38% of health app users
tracked exercise, fitness or heart rate13 and by 2016, the market for sport and
fitness apps alone is expected to reach $400m, with apps for wearable fitness
devices being a driving factor14, 15. Big manufacturers like Nike are sharing shelf
space with smaller independent brands like Fitbit, and new names are arriving on
the market every day.
But do these personal tracking devices work? Well Thiery certainly thinks so,
and the data seems to agree. Fitbit say that by seeing how much they move in
16
Your health, yourself
Thiery’s Techno Training
real time, users walk 40% more each day to hit the recommended 10,000 steps a
day16. And doctors also approve. In 2012, 90% of physicians surveyed in the US
thought tracking fitness was a good thing, with 40% thinking it could reduce
the number of visits needed to their office, freeing them up for other patients17.
But let’s not forget that Thiery has done his research, seeking out reputable apps
and devices and paying for the ‘best’. He has shown commitment to his goals and
put in the required legwork – creating his profile, carrying his device, syncing up his
app and uploading ongoing data. What about the rest of us? For those less willing
or able than Thiery to put in the required effort or resource, reaping the rewards
is more of a challenge. Firstly, there’s the cost. Whilst Thiery had the cash to buy
his top of the range device, for others the price of such tools (up to $200) may be
prohibitive. Then there is the question of effort and motivation. Thiery has a fun
run to prepare for and a competitive best friend to beat, but without these specific
goals and ambitions, many people lack the self-discipline to make the most out of a
tracking device. Because of this, no matter how sophisticated the technology, most
personalised trackers fail to impact the overall fitness of an individual or society. In
fact, when Brigham Young University in Utah analysed 127 such popular products
they found that the majority fell short of achieving this goal18.
Will more of us be successful in the future? Well the fitness tracking market
seems to be aware of the potential barriers created by lack of user motivation or
engagement, and are already attempting to innovate the problems away with a
variety of ‘nudge’ techniques.
One new product, ‘Withings Smart Activity Tracker’, will send you push ‘buzz’
alerts if you have been too inactive. And the KickStarter app ‘Zombies, Run!’
turns exercise into a game – you run not because you want to get fit, but because
you want to reach safety and avoid total zombie apocalypse.
Where might this innovation lead to? Well if digital fitness solutions are really
going to make a difference to our collective health, they need to break out of
the zeitgeist. They need to make themselves accessible and attractive to the
population at large, most of whom are not so ‘digitally-savvy’ (or affluent) as
17
Your health, yourself
Thiery’s Techno Training
our boy Thiery. What about a gadget designed for Thiery’s elderly aunt that
encourages her to walk when she usually takes the bus? She’s never touched a
computer but the device could send information directly to the manufacturer,
who aggregates the data and posts it on to her as a handy print-out. The best
solution is not necessarily the most technological one.
Fitness tracking manufacturers will also need to start collaborating not just with
gaming app developers but also with social scientists who understand how to
bring about behaviour change. An ideal future scenario for Thiery would be one
where tiresome manual input has been eradicated entirely. Fully micro-chipped,
his data will be automatically digitally aligned – no effort required above and
beyond the hard work he puts into exercise. Instead of merely explaining how
fit he is in ‘numbers’ and ‘shapes’, a more meaningful dashboard could provide
an (easy to interpret) holistic output that combines medical and injury history,
genetics and biometric data. And what if fitness product providers started
working more closely with specialist healthcare providers and
device makers? Such cross-fertilisation could result in truly useful tools that
track fitness alongside other health metrics, such as blood sugar levels or asthma
medication adherence.
That’s not all that tomorrow may bring. What if national healthcare systems
were able to benefit from the information provided by these digital tools and
devices? What if every time Thiery goes out for a run, the chip in his wristband
feeds real-time data directly to his GP, allowing his healthcare provider to
track and monitor health and fitness from afar? Potential problems could be
identified before they arise, potentially eliminating the need for some face-to-face
consultations. Statistics for whole cities and regions would be readily available
– effectively providing scientists with large-scale, cost-effective, ‘real time’
epidemiology studies.
And whilst Thiery doesn’t consider himself ‘army fit’ just yet, he might find that
future employers use tools similar to those already introduced by some national
defense organisations. ‘AF Tracker’ monitors servicemen’s exercise drills and
18
Thiery’s Techno Training
Your health, yourself
progress, helping everyone keep an eye on physical fitness levels. Why wouldn’t the
government start checking similar stats for those working in health, teaching or social
care? If they do, Thiery will be ready. He’s still diligently entering data and the big
race day is drawing closer… but will he beat rival Dan? Keep those fingers crossed!
Health highlights:
Personal fitness tracking is a thriving sector that is growing by the day.
For engaged and motivated users, self-monitoring of physical activity can prove
effective, leading to improved health behaviours.
Do:
Don’t:
•O
vercome lack of consumer self-
• Ignore less ‘digitally-savvy’, lower
discipline with creative ‘nudge’
socio-economic groups who cannot
techniques
afford or understand expensive
•C
ollaborate with a range of third-
tracking tools
parties including behavioural
change experts to create the most
effective approach
19
4. MMission
arta’s Nutrition
Antonia Betts, United Kingdom
Lourdes de Pablo, Spain
Lexi Fletcher, United Kingdom
Your health, yourself
Marta’s Nutrition Mission
Meet Marta. At 24 years old, she’s just left university armed with a master’s
degree and an extra 10 cms around the waist. Now Marta is getting married and
she wants to go on a diet to get in shape for her big day. So what does she do?
Well what any young, Wi-Fi connected dieter with a specific weight loss goal
would do of course. Marta downloads a calorie tracking app, plugs in her info,
sticks to her personalised plan and watches the pounds melt away…
It’s not an implausible scenario by any means. Just like we saw in the fitness
sector, a plethora of digital solutions exist to aid dieters like Marta – ready to
collect personal data, create personalised plans, record personal eating habits
and track personal weight loss through a simple website or smartphone app.
And just as was the case for Thiery, these apps and devices prove effective for
our motivated bride-to-be. After all, experts agree that collecting and recording
information about your diet encourages you to consume fewer calories, and
personalised interventions have been shown to promote long-term weight loss19, 20.
So it seems like Marta can’t (or rather can) lose. But exactly who are the
sugar-free fairy godmothers helping her on her journey? Established diet giants
like Weight Watchers®, Slimming World and Jenny Craig® have introduced
services that let consumers monitor their calorie intake and physical activity,
but apart from them the main players are smaller set-ups from outside the
traditional dieting sector. MyFitnessPal, for example, is a free and easy-to-use
app that provides consumers with flexibility and freedom to fit healthy eating
into their individual lives. To date, the programme has 30 million registered
users and 2 million food listings21.
So Marta has logged-on and shifted-off those extra pounds. The big day arrives
and everyone agrees that she looks absolutely FAB in the photos. But what
happens if we fast forward a few months into the future…? Just 12 months on,
as Marta celebrates her first wedding anniversary with husband Karl, we find
that our bride has joined the 96% of app users who stop using a programme
within 1 year after downloading it22. As a result Marta’s weight has started
to creep up, and she’s looking longingly at those framed photos on the
22
Your health, yourself
Marta’s Nutrition Mission
mantelpiece. It seems that without the personal motivational target of getting
slimmer for her ‘big day’, the apps on their own just don’t offer enough
incitement to put down those potato chips.
And what about if we take a dive even further into the future? Fifteen years
later, Marta’s family has expanded to include teenage twins and a young
daughter. But that’s not the only thing that’s grown. Karl was feeling pretty smug
back during Marta’s dieting days, when he could eat what he wanted without
ever changing shape. Now it’s a different picture. Karl is every cardiologist’s
worst nightmare – overweight, high blood pressure, cholesterol that is through
the roof and Type II diabetes. Could the stresses of family life be to blame? The
twins, 13, have suddenly shot up 12 cms and are constantly asking to be ferried to
their intensive schedule of after-school activities, often missing family meals as
a result. The youngest, Sophie, hasn’t grown out of her baby fat and is proving
to be a spoilt and fussy eater. Between them, Marta’s clan has a variety of very
specific nutritional and health requirements. It has been no use trying to get
Karl to follow a smartphone based weight loss app like she so successfully used
pre-wedding. And as for the kids?! She’s worried they might not be getting the
necessary nutrition they need, but she’s not entirely sure what to do about it.
Whilst personalised nutrition has to date stuck close to the topic of weight
loss (and for good commercial reasons), the next step will be to apply existing
knowledge and technology to address a variety of nutritional needs. It will
also involve the creation of approaches that are increasingly intuitive, accessible
and less demanding for the end user. Instead of manually calculating calories,
perhaps Karl would have more luck with an automated system such as the
‘Bite Counter’ device23, essentially a pedometer for your dinner. And what
about addressing his blood pressure by tracking salt intake, or cholesterol with
saturated fat? Is there a service that could help ensure that the teens are getting
a nutritionally balanced diet suited to their active lifestyle, age and gender, even
when they are away from Marta’s watchful gaze and faced with the lure of the
school vending machine? And now that Marta has finally steadied the scales
after years of yo-yo dieting, is there a tool that could help her maintain her
23
Your health, yourself
Marta’s Nutrition Mission
weight, rather than head for a specific weight-loss target?
Perhaps what Marta and her family need is to get even more personal. What
kind of individualised nutritional information could they get by looking at
their DNA? The link between our genes and what we eat is an area that is
starting to receive increasing attention, meaning we may soon have a whole
new individualised spin to ‘eat this, not that!’ Current research has reached
a stage where it can show that certain foods enhance the action of protective
(or harmful) genes, whilst others tend to suppress them. As just one example,
scientific studies in America have proven that Pima Indians from the Southwest
get Type II diabetes at eight times the rate of the White American. The hope
is that with more detailed genetic profiling, we can replace blanket ‘fad’
recommendations (like one glass of red wine a day) with scientifically validated
customised nutrition plans. This could allow food manufacturers and retailers to
provide unique meal solutions to help consumers battle specific diseases.
Mapping out how specific genes interplay with our food intake is not going to
be a short or easy task. But there are already some interesting results that hold
potential for the future. Women with the gene enzyme COMT for example, are
thought to take more cancer-fighting benefits from green tea than others. And
most relevant for Marta’s family, is the discovery that certain people with the E4
gene for protein (27% of the UK population24) are at an increased risk of diabetes
and high cholesterol. The good news is that if you know you have this gene
and take adequate steps to combat it – stop smoking, give up alcohol, exercise
regularly, and so on – you can remove the genetic predisposition entirely.
What could this mean for Karl? So far he hasn’t paid much attention to his
cardiologists repeated pleas to avoid the extra servings of chips. And perhaps
this behaviour isn’t entirely irrational – after all, GPs routinely put people on
low salt diets to control high blood pressure even though evidence suggests that
it doesn’t work for as much as half the population. But what if he found out
that his specific genes put him at increased risk of high cholesterol? Would this
knowledge make him more likely to finally change his health behaviour for
the better?
24
Marta’s Nutrition Mission
Your health, yourself
The potential for the food industry to capitalise on this research in the future is
tremendous. And in the meantime, the wealth of health data on food choice and
related nutrient intake that manufacturers and retailers have amassed over the
years could be shared with the scientists attempting to map out our nutritional
genetics. One such project is the European Food4me25 initiative – it’s certainly
something for Marta and the gang to look out for in the future…
Health highlights:
The multi-million Euro weight-loss industry has created a natural demand for
personalised nutrition.
Future success rests on expanding this model to a variety of nutritional needs,
as well as ensuring approaches are less labour intensive and longer-lasting.
Do:
Don’t:
•P
rovide personal health information
• Assume all users have a fixed and
beyond calories
motivating long-term goal
•C
ollaborate with food scientists to
explore the potential of personalised
nutrition based on individual DNA
25
5. CCompliance
laude’s Case of
Carsten Edwards, United Kingdom
Jean-Marc Mosselmans, France
Michael Dumigan, United Kingdom
Your health, yourself
Claude’s Case of Compliance
Meet Claude. He’s a 43-year-old family man who has recently been diagnosed
with hypertension. His physician has prescribed him a broad range of
medications (in fact it seems to Claude that there is a new one everyday),
accompanied by strict instructions on the importance of taking them daily. Both
his doctor and his wife (the latter via a lot of Googling) have forewarned him of
the unpleasant consequences his disease could bring. At the bottom sits a myriad
of minor complications and time-consuming visits to the clinician, in the middle
follows a range of irreversible impairments from cardiac events and right at the
top: DEATH. By all accounts Claude’s got a lot of good reasons to adhere – and
he does, but only sometimes.
So why don’t death, decline and inconvenience weigh more heavily on Claude’s
mind? It may seem nonsensical to an observer, but the reality is that Claude’s
attitude is a common one – only 50% of patients in developed countries adhere
to their medications as prescribed26. It is estimated that each year in the EU
alone, mis-dosing and non-adherence results in 194,500 otherwise preventable
deaths and €125 billion of costs due to unnecessary hospitalisations, medical
procedures and physician treatments27. And all of this is without even considering
the impact of poor health on productivity and quality of life. Furthermore,
Claude’s hypertension is only one of a myriad of diseases that suffer from poor
adherence. In diabetes, good glycaemic control is associated with reduced
resource utilisation; however, 43% of patients don’t achieve adequate control
and insufficient medication is a key reason for this28, 29. Likewise for those with
schizophrenia, risk of relapse is 3.7 times greater if they are non-adherent – yet this
is the case for over 50% of patients their first year out of hospital30.
Sobering statistics. So again we have to ask, why is this the case? Surely our
health is our most valuable asset. Well the fact is that many patients, even when
faced with the wagging finger of a clinician, fail to connect the consequences
of their inaction to the serious, and often inevitable, health risks of nonadherence. The reasons for this are complex. Adherence is strongly influenced
by the environment in which people live, as well as how healthcare systems
and practitioners deliver care. It is also intrinsically linked to an individual’s
28
Your health, yourself
Claude’s Case of Compliance
perception of illness, their level of self-management, confidence and motivation
and preconceptions about the outcome of treatment26. So maybe it is that Claude
lacks trust in that wagging clinician finger, especially if that finger continues to
push an ever increasing range of medications in his direction. Or it might be that
unlike much of today’s world, there is no independent positive feedback loop to
help him stay on track. Side effects, whilst minor, are real and present; long-term
consequences are mere probabilities. For Claude, adherence brings no instant
reward nor immediate punishment.
So how can we help Claude face reality? To date, two main approaches have
been taken to deal with non-compliant patients like Claude. The first, education,
strives to improve knowledge and awareness of risks but can be costly, timeconsuming and often ineffective. The second – the simplification of treatment
regimens – aims to alter the dosage frequency or mode of administration of
certain drugs, most notably statins. Some success has been enjoyed in both
areas but two things are still clear: simplifying a dosing regimen is unlikely to
affect a person who does not believe that the therapy will improve their health;
and knowledge alone is not enough to ensure good adherence habits. On top
of this, healthcare systems tend to see adherence from the perspective of the
overall population, which means that the impact on individuals is lost among the
statistics. Yet no number is scarier than One, when the ‘One’ being referenced
is you. So providing more personal health information to patients like Claude
may be the best way to tackle the problem of non-adherence.
There are already a number of successful examples utilising this approach in
the marketplace, suggesting that such a strategy has potential. In the spheres
of smoking, weight loss and diabetes for example, daily psychological support
can be provided for extensive periods online, with patients receiving individual
progress reports and goal-orientated messaging via interactive websites and
SMS. Furthermore, such programmes can address ‘non-compliance’ with
specifically targeted customised messages, and offer follow-up support for
months or even years after the health goals have been reached – two methods
that behaviour change studies have found to be particularly effective31.
29
Your health, yourself
Claude’s Case of Compliance
The digital technology behind these approaches allows patients to be reached at
any time of the day, wherever they may be – putting medication in the forefront
of minds and naturally building adherence into lives like never before.
But guess what? Once again, just as we saw in nutrition and fitness, these new
methods prove to be most effective amongst patients who are already reasonably
well motivated and ‘digitally-savvy’. What about those people who simply
can’t remember to take their medicine, or don’t want to? For these patients,
a different approach is being explored that allows doctors and carers to take a
more active role in adherence monitoring. One example of these new ‘smart
technologies’ has been designed by SentiCare® to let a designated care advisor
know when a patient has forgotten to take their medicine or otherwise veers
from their prescription guidance. The technology revolves around an intelligent
‘PillStation’, which scans pill containers whenever the lid is closed.
Some are taking this smart technology even further. The latest methods being
tested actually put microchips into medicines, allowing HCPs to track the
treatment as it passes through the body, thereby monitoring how and when it
is delivered to the individual. In August 2012, the US FDA approved the first
such pill for testing and many think that this type of personalisation holds a
lot of potential for the future. In markets where patients are reimbursed for
prescriptions, microchip tracking could be linked to economic incentives to
ensure full treatment compliance.
What lies ahead for patients like Claude? There is an obvious opportunity
for pharmaceutical companies and healthcare providers to strengthen their
products’ value propositions by providing programmes which support optimal
adherence. Patient education, ongoing patient support, training for personal
and comprehensive communication strategies can all help patients like Claude
stay on track when they most need it. And the patient is not the only beneficiary.
Adherence programmes can be a great way to create long-term relationships
between brands and consumers, enhancing corporate reputations and
encouraging loyalty.
30
Claude’s Case of Compliance
Your health, yourself
In order to create an environment that supports optimal adherence, it will be
essential for the industry to work with communication specialists in order to
truly understand the distinct needs of different audiences. Input from multiple
stakeholders will be needed to develop messages and tactics that are effective
in influencing behaviour. The urgency in realising this opportunity will become
increasingly apparent as non-traditional healthcare players, routed in big data,
strip funding from medications and emphasise the non-pharma aspects of
treatment regimens. So Claude, it’s time to take your medicine!
Health highlights:
Non-adherence is a serious problem for the healthcare industry, costing lives
and money.
Personalised approaches to compliance have the potential to improve
individual adherence behaviour.
Do:
Don’t:
•W
ork closely with expert
• Treat adherence from a total
communicators and multiple
population perspective – solutions
stakeholders to create truly engaging
should be tailored to the individual
patient support programmes
•E
mbrace new technologies to
support those unable or unwilling
to take responsibility for their own
treatment compliance
31
6. Dana’s Daily Dose
Andreas Kindler, Germany
Ditlev Ahlefeldt-Laurvig, United Kingdom
Lisa Roby, United Kingdom
Your health, yourself
Dana’s Daily Dose
Meet Dana. Better yet, come back and meet Dana tomorrow. Right now she’s
got one of her infuriating weekly headaches and let’s be honest, she’s not much
company. Yes, we know, she should pay her GP a visit and sort it out but you
know what Dana’s like, she doesn’t want to bother anyone. Easier to just pop by
the supermarket pharmacy whilst doing her weekly shop and pick up a packet of
‘PainAway’ pills – a reassuringly familiar brand that she has used since these darn
headaches started on her 30th birthday, nearly 4 years ago.
Up until now Dana has just got on with it, managing her symptoms pretty
successfully in her opinion. But recently a few doubts have started to niggle. Is she
too tense? Does she need glasses? Or could it even be something more serious?
Before causing a fuss and scheduling what would probably be an unnecessary
appointment, she conducts a little Internet research and quickly comes across a
useful online clinic hosted by one of the private pharmacy chains. The automatic
symptom checker suggests that she suffers from chronic migraines and advises her
(no surprises here) to consult her GP. For once, she agrees.
So is Dana’s behaviour normal? Indeed it is. Like Dana, more and more of us are
self-medicating or turning to the advice of pharmacists before heading straight
to our GP or specialist. In fact, nearly two thirds of seasonal allergy sufferers have
been shown to only visit their doctor if self-medication doesn’t work sufficiently32.
This trend is no doubt encouraged by recent developments in the European
pharmacy industry. By expanding into multiple retail channels, accessibility to over
the counter (OTC) medication has increased dramatically at the same time as
fresh and innovative products have hit pharmacy shelves. Relaxed regulations have
led to the arrival of new players including many mass-market supermarket chains
and as a result not only is the entire sector experiencing unprecedented growth –
but the stakes are rising.
So how does the theme of personalised health fit into this picture? Well for forwardthinking pharmacies the benefit of a more individualised approach could be
twofold: improving public health whilst providing a much needed competitive
edge. Knowing that Dana (like many of us) approaches her purchase of OTC
medication like any other consumer good means that the brands looking to shine
34
Your health, yourself
Dana’s Daily Dose
will have to think harder about each patient’s particular shopping experience.
Many OTC retailers are already capitalising on this by offering personal apps at the
point of sale, allowing consumers to access information and offers relevant to them
through codes and links on their smartphones. But why not get even more up close
and personal?
The world of retail offers a cosy environment for OTC manufacturers to forge
stronger and more meaningful relationships with consumers, but only if they
place sufficient value and focus on building brands. Whilst Dana might not be
open to advice from a huge unfriendly sounding pharmaceutical, she might listen
to lifestyle recommendations from a name she trusts – like ‘PainAway’ or the ownbrand of her preferred supermarket. Plus, where better to introduce an incentive
or loyalty programme than in the supermarket aisle, where consumers are already
familiar with systems of point counting and coupon clipping? What if a ‘health
value’ was attached to the different consumer health products offered by the
pharmacy – from functional food products to OTC medication – and this data was
collected and exchanged into personalised customer incentives and membership
privileges?
Apart from encouraging loyalty, personalised health information can be used in
other ways by innovative pharmacies to deliver truly effective patient care. Selfmonitoring products have long been used to help millions of people worldwide
treat lifestyle diseases such as diabetes, hypertension and high cholesterol. As
technology advances, allowing for more precise consumer data and more hightech devices, the opportunity for OTC to create mutually beneficial applications
is clear. In 2012, Alliance Boots launched the Eye Check mobile app, a consumer
service that performs checks and tests across a range of eye health markers including
visual acuity, duochrome and colour astigmatism. Users can track results, receive
individualised eye health advice and even use the integrated Boots Optician finder
to locate their nearest store and make an appointment.
And if you think that sounds futuristic, wait until you hear what else the industry
innovators have in the pipeline. In the coming years, the hot phrase in OTC circles
is sure to be ‘laboratory miniaturisation.’ What this concept aims to do is allow
35
Your health, yourself
Dana’s Daily Dose
users to conduct specialised tests in the comfort of their own home, using small
personal devices, or ‘labs-on-a-chip’. For doctor-adverse patients such as Dana, this
technology could be especially appreciated, allowing her to detect the early onset
of disease and instantly get test results without the inconvenience of a clinic visit.
And if she does need a second opinion, hi-res cameras and imaging algorithms will
enable her self-medication to be supported by the remote observational screening of
a medical practitioner.
Capturing and sharing personal data in this manner brings obvious advantages
to both the patient and the pharmacy who supplies their medications. In so far as
regulation allows, cross-analysis of an individual’s lifestyle and health behaviour
can reveal opportunities to promote healthy lifestyle options and products that
will improve patient health and pharmacy sales. Just as consumer brands have
been doing for years, OTC manufacturers can now start to understand the real
world behavioural patterns of their consumers and tailor promotional messaging
in real time. Customer websites can be automatically customised to perfection, and
individualised communication – emails, voicemails, responsive digital billboards in
the public space – can all deliver promotional messages that fit the current needs of
the patient.
But what about Dana? Well the good news is that she has felt much calmer since
her official migraine diagnosis. However, she’s now faced with a new health
concern. Encouraged by her recent experiences of online health she took the advice
of best friend Joyce (and 230,000 other users) and joined ‘HealthOn’, a pharmacy
support and loyalty programme. During the sign-up health check and profiling the
system noticed that the cholesterol results of a recent blood test were far from ideal.
At first Dana was alarmed but HealthOn has really helped her take control of the
situation. As a member she has free access to an online ‘virtual clinic’ with real
physicians, one of whom recently recommended a brand new cholesterol-lowering
OTC product in place of an expensive prescription. Plus the membership gives her
a 15% discount on most medications, free delivery and the culmination of ‘healthvalue’ points, which she can exchange for rewards such as health services or product
discounts.
36
Dana’s Daily Dose
Your health, yourself
All in all, Dana is feeling happy and healthy. The highly personal attention she
enjoys from the online pharmacy reassures her that everything is ticking along
nicely and for once the health information they send is right on target. The
articles are interesting to read and pleasant to receive with a friendly tone that
makes a nice change from the usual pushy emails and door drops. And then there
is the MediFriendTM – a state-of-the-art healthcare device that regularly and
easily evaluates her main health stats. After saving up enough health-value points
she redeemed them online for the product, and all she has to do is put a small
drop of blood on its little screen every day – everything else is automatic. Data is
transmitted to a central database and immediate feedback is sent on the results. Not
only can she track her cholesterol levels – her main concern at the moment – she
can also receive feedback on her OTC pain medications to ensure she has the
optimal dosage. If anything looks untoward, Dana is immediately notified and an
appointment (either in person or online) is booked with an appropriate healthcare
professional. Which is one less headache to worry about!
Health highlights:
Patients who regularly self-medicate with OTC products are good candidates
for self-quantifying their health.
Future solutions can help consumers (safely) take increased responsibility for
the treatment of common, chronic conditions.
Do:
Don’t:
•S
upport autonomous individuals
• Rely on technology to do all the
with tools that give personal control
work. Digital devices need to be
without replacing professional
accompanied by scientifically sound
health oversight
behavioural support
•C
reate simple solutions that provide
automatic feedback and require little
manual effort
37
7. HHealth
arry’s Inherited
Beril Koparal, Turkey
Tracey Wood, United Kingdom
Thomas du Plessis, United Kingdom
Your health, yourself
Harry’s Inherited Health
Meet Harry. In fact, chances are you already have. Harry’s a bit of a health freak
you see. So if you’ve been to your GP recently, visited a health food store or even
logged-on to an Internet health forum or two, probability is you have crossed
his path. Being as health focused as he is, Harry is very keen to understand as
much as he possibly can about his health and the potential medical conditions
he may face in the future. When he found out about the affordable new online
DNA testing kits, he couldn’t believe his luck. He had always wanted to discover
more about his genes and now for a mere hundred dollars, rather than a few
thousand, he finally could. He ordered two (just to be sure) and waited patiently
for them to spit out his genetic secrets.
When Harry first logged on to see his results, he was distraught. Clicking
through to ‘My Disease Profile’, the first thing he discovered was that he had
an ‘Elevated Risk’ of a heart attack. He was also told that he was at ‘slightly
higher odds’ of schizophrenia and had a reduced ability to break down a toxic
by-product of alcohol and cigarette smoke called acetaldehyde. But as he
continued reading he relaxed – the information seemed too general to illicit
any real concern. Plus, there were a couple of points he quite liked the sound
of – he was more likely to taste certain bitter flavours (he didn’t realise some
people couldn’t), shared a genotype with ‘many world-class sprinters’ and
enjoyed a reduced sensitivity to the smell of BO. All in all, Harry thought that
wasn’t too bad.
Was Harry’s test a waste of time? Personalised medicine, defined as the
diagnosis and treatment of patients based on their individual characteristics,
presents arguably the most important development for medical science and
healthcare in recent decades. After all, as Hippocrates once said: “It’s far more
important to know what person the disease has than what disease the person
has.” But the journey towards a fully functioning personalised medicine
approach has not, and will not, be easy. To date, some of the most promising
‘personalised’ medications have failed to get regulatory approval, whilst others
have not been profitable in the marketplace. It requires large quantities of
accurate and segmented patient and population data, without which results are
40
Your health, yourself
Harry’s Inherited Health
no more insightful than Harry’s mail order mess. As his example has shown, the
industry still has some way to go before all the results of genetic testing can be
usefully applied. But that doesn’t mean the test was a waste of time.
Even though physicians currently use all the available and observable evidence
they can to make a diagnosis or prescribe a treatment tailored to each individual,
current response rates for drugs are still low – averaging 50% across all categories
and just 22% in oncology33. Personalised medicine could be the solution for
improving these response rates as well as minimising the side effects associated
with many therapies.
The encouraging news is that a number of notable success stories already exist.
Numerous drugs have been developed for a variety of cancers, including breast
and rectal, that can only be prescribed to a subset of patients with tumours that
have specific protein markers or gene mutations. This targeted approach has
demonstrated impressive results in oncology. And in HIV, physicians regularly
prescribe a cocktail of drugs tailored to the genetic subtype of each patient –
often extending the life expectancy of the newly diagnosed by 20 to 25 years33.
And it is not just the actual diseases that shrivel in the face of targeted,
genetic approaches. Personal data also plays a crucial role in the avoidance
of treatment side effects. Warfarin, used to prevent blood clots, is now only
recommended for specific genetic profiles that are known to respond to the drug
– thus avoiding potentially serious consequences. So whilst Harry’s do-it-yourself
testing kit was not particularly illuminating, the data underlying it are already
being put to use in other medically significant ways.
So can Harry expect something more useful tomorrow? What these handful
of examples demonstrate is that personalised medicine has a definite future –
the only question is how and when. One possibility is that the pharmaceutical
industry, who face growing pressure to develop affordable accessible medicines
for markets across the world, will use personalised medicine to successfully
deliver cost-effective treatments to clearly defined subsections of the population.
Another is that scientists will concentrate their research on the slew of common,
41
Your health, yourself
Harry’s Inherited Health
chronic diseases like Type II diabetes, rheumatoid arthritis, obesity and
coronary heart disease that have a significant genetic component. But it is
not just new drug development that offers opportunities. R&D departments
should also take a second look at drugs which have failed clinical trials due to
low efficacy across the general population or dangerous side effects. Are these
treatments actually genetically sensitive, with potential to deliver great results to
a specific, but significant subgroup of patients?
Of course, as personalised medicine changes the way individuals understand
and manage their health, a new set of moral dilemmas will also come into
focus. Let’s imagine that there really is someone for everyone and even with
his obsessive health habits our hapless Harry falls in love and gets married.
How does he feel when his wife brings up the question of genetic testing on
their unborn child? Harry had been more than happy to send off for his own
DNA testing kit and analysis but do the same rules apply for his kid? As the
technology becomes increasingly sophisticated and more widely practiced, this is
an area of personalised medicine that will affect us all.
What does this all mean for Pharma? Making personalised medicine work
will require dramatic changes in pharmaceutical business strategy, including
the creation of business models with unfamiliar new capabilities. But the truly
forward thinking companies will realise that it is not just what happens deep
underground with the hard working scientists in R&D that spells the recipe for
success. Since personalised medicine presents such a completely new approach
for patients and professionals, it will be how these products and methods are
marketed and communicated that really separates the winners from the losers.
Brands and companies that wish to profit from personalised medicine will
require the development and implementation of clever, connected strategies
across the full range of medical communication disciplines. Success will
ultimately depend on the ability to demonstrate value to a wide range of
demanding stakeholders. This means that payer communications, medical
education, expert engagement, PR, brand development and digital strategy will
all be critical elements of any intelligent marketing plan.
42
Harry’s Inherited Health
Your health, yourself
Finally, traditional mass-marketing approaches will no longer be appropriate
for the range of new, individual drugs. Embedded within the fabric of future
communications, campaigns will need strategies that enable patients to
understand their personal data and treatment pathways. And let’s not forget
dear Harry. His experience with the online testing kit has left him a little wary of
all things DNA, which means it might be time to reach out with that proverbial
(organic) carrot and build back a little trust…
Health highlights:
Personalised medicine has the potential to provide patients with highly
effective, targeted treatments whilst reducing risks of dangerous or undesirable
side effects.
The industry has its work cut out in developing a fully functioning approach
that brings real added value to patients, professionals and healthcare providers.
Do:
Don’t:
• Support
autonomous individuals
• Rely on technology to do all the
with tools that give personal control
work. Digital devices need to be
without replacing professional
accompanied by scientifically
health oversight
sound behavioural support
• Keep
communications friendly,
relevant and meaningful
43
8. References
Your health, yourself
References
1.Barlow J, et al. Self management approaches for people with chronic conditions: a review. Patient Educ Couns
2002;48:177–87.
2.Benhamou PY. Improving diabetes management with electronic health records and patients’ health
records. Diabetes Metab 2011;37(Suppl 4):S53–6.
3.Dennis EA, et al. Weight gain prevention for college freshmen: comparing two social cognitive theorybased interventions with and without explicit self-regulation training. J Obes 2012;2012:803769.
4.Parker R, et al. An electronic medication reminder, supported by a monitoring service, to improve
medication compliance for elderly people living independently. J Telemed Telecare 2012;18:156–8.
5.Ralston JD, et al. Patients’ experience with a diabetes support programme based on an interactive
electronic medical record: qualitative study. BMJ 2004;328:1159.
6.Wagner PJ, et al. Personal health records and hypertension control: a randomized trial. J Am Med Inform Assoc
2012;19:626–34.
7.Lathia N. Using idle moments to record your health via mobile applications. Available at: http://www.
cl.cam.ac.uk/~nkl25/publications/papers/lathia_mscss12.pdf (Last accessed May 2013).
8.Swan M. Crowdsourced health research studies: an important emerging complement to clinical trials in
the public health research ecosystem. J Med Internet Res 2012;14:e46.
9.Forbes. A quantified self fatality? Family says cyclist’s death is fault of ride-tracking company strava.
Available at: http://www.forbes.com/sites/kashmirhill/2012/06/20/a-quantified-self-fatality-family-sayscyclists-death-is-fault-of-ride-tracking-company-strava/ (Last accessed May 2013).
10.Santana S, et al. Informed citizen and empowered citizen in health: results from an European survey. BMC
Fam Pract 2011;12:20.
11.Choose Control Survey. Choosing to take control in type 2 diabetes. Available at: http://www.diabetes.
org.uk/Documents/Reports/Choose_Control_report.pdf (Last accessed May 2013).
12.Mashable. Top health and fitness apps to improve your workout and diet. Available at: http://mashable.
com/2012/04/29/best-fitness-apps/ (Last accessed May 2013).
13.Mobi Health News. Pew: 19 percent of smartphone users have health apps. Available at: http://
mobihealthnews.com/18965/pew-19-percent-of-smartphone-users-have-health-apps/ (Last accessed May
2013).
14.Mobi Health News. By 2016: $400M market for health, fitness apps. Available at: http://mobihealthnews.
com/14884/by-2016-400m-market-for-health-fitness-apps/ (Last accessed May 2013).
15.ABI research. Wireless health and fitness. Research report RR-MEDS-11. Available at: http://www.
abiresearch.com/research/product/1005339-wireless-health-and-fitness/ (Last accessed May 2013).
16.Fitbit Blog. Available at: http://blog.fitbit.com/ (Last accessed May 2013).
17.Float Mobile Learning. Available at: http://floatlearning.com/mhealth/ (Last accessed May 2013).
18.ABC News. Exercise apps don’t always work out, study says. Available at: http://abcnews.go.com/Health/
obesity-epidemic-smartphone-fitness-apps-work-brigham-young/story?id=17322887#.UJu7UKTPyME
(Last accessed May 2013).
19.Cheskin LJ. A personalised intervention reduced weight regain in overweight and obese adults who had
recently lost weight. Evid Based Med 2008;13:109.
20.Hollis JF, et al. Weight loss during the intensive intervention phase of the weight-loss maintenance trial.
Am J Prev Med 2008;35:118–26.
21.Business Wire. MyFitnessPal community reaches 30 million users, extends reach through new API.
46
Your health, yourself
References
Available at: http://www.businesswire.com/news/home/20121016005540/en/MyFitnessPal-CommunityReaches-30-Million-Users-Extends (Last accessed May 2013).
22.Daily Mail. Women have tried 61 diets by the age of 45 in the constant battle to stay slim. Available at:
http://www.dailymail.co.uk/health/article-2117445/Women-tried-61-diets-age-45-constant-battle-stay-slim.
html (Last accessed May 2013).
23.Bite Technologies. Calorie counting made easy. Available at: http://www.icountbites.com/ (Last accessed
May 2013).
24.University of Reading. The ApoE gene fact sheet. Available at: http://www.reading.ac.uk/web/FILES/
reas/EthicsGenotypeFactsheets.pdf (Last accessed May 2013).
25.Food4Me. Available at: http://food4me.org/ (Last accessed May 2013).
26.World Health Organization. Adherence to long-term therapies: evidence for action. Available at: http://
www.who.int/chp/knowledge/publications/adherence_report/en/ (Last accessed May 2013).
27.World Health Organization. Fifty-fifth World Health Assembly. Third report of Comittee A. Available at:
http://apps.who.int/gb/archive/pdf_files/WHA55/ea5552.pdf (Last accessed May 2013).
28.Briesacher BA, et al. Comparison of drug adherence rates among patients with seven different medical
conditions. Pharmacotherapy 2008;28:437–43.
29.Cutler DM, Everett W. Thinking outside the pillbox. N Engl J Med 2010;362:1553–5.
30.Fenton WS, et al. Determinants of medication compliance in schizophrenia: empirical and clinical findings.
Schizophr Bull 1997;23:637–51.
31.Krueger KP, et al. Improving adherence and persistence: a review and assessment of interventions of steps
towards a national adherence initiative. J Am Pharm Assoc 2003;43:668–79.
32.Be MedWise. Self-medication and allergies survey – executive summary. Available at: http://www.
bemedwise.org/survey/ExecutiveSummary.pdf (Last accessed May 2013).
33.Kulkarni A, McGreevy NP. A strategist’s guide to personalised medicine. Available at: http://www.
strategy-business.com/article/00131?gko=75ee7 (Last accessed May 2013).
47
9. Colophon
Your health, yourself
Colophon
Writers:
David Davenport-Firth
Giorgio Pasqual
Lois Hall
Caroline Howe
Morten Frederiksen
Rick Evans
Antonia Betts
Lourdes de Pablo
Lexi Fletcher
Carsten Edwards
Jean-Marc Mosselmans
Michael Dumigan
Andreas Kindler
Ditlev Ahlefeldt-Laurvig
Lisa Roby
Beril Koparal
Tracey Wood
Thomas du Plessis
Editor: Rebecca Salama
Researcher: Sophie Purvis
Designer:
John Green
Illustrations: Scriberia
Typeface:
Ogilvy J Baskerville
Printer:
Screaming Colour Ltd. www.screamingcolour.com
No article may be reproduced or transmitted
in any form without the written permission of the publisher.
Copyright © 2013 Ogilvy CommonHealth Worldwide
For more information please contact: [email protected]
49