For about $400 you can buy your own genetic profile from companies like Pathway Genomics and 23andMe. Giving humans this kind of knowledge about their health risks presents a tremendous communications opportunity, and challenge.

Our hope is that humans, armed with certain knowledge, might actually improve their fates. This concept, which is very nicely described by Thomas Geotz in The Decision Tree, has been around for quite some time in the field of public health. Yet, in many ways it is revolutionary.

For just one example of how serious this movement is, Johns Hopkins, the perennial hospital ranked number one in the country, has revamped its entire medical school curriculum to focus on personalized medicine – the idea of tailoring treatment and prevention based on a person’s individual genetic profile.

But uncovering the genome and its mysteries cannot stand alone if it’s to benefit society. This movement requires a guide. Individuals are fated in some ways to progress toward diseases encoded on their DNA, and the knowledge of what those diseases are in and of itself won’t change that fact. However, individuals do in fact have the power to bend this fate and shape it in a manner that might dramatically improve their health and well-being.

This is where communications will be critical. With the proper information, education, and incentives, patient understanding of their genetic risks could bring health care to an unprecedented point in medical history. Communicating the potential and providing a framework with which to deliver it is as important as the science itself.

As seen on the PRWeekus.com “Insider” blog on April 2, 2010. This blog post is the final post in a series of three blogs focusing on communications and personalized medicine. Each week PRWeekus.com features a guest blogger on its “Insider” blog.

It is estimated that 60 to 80 percent of Americans have used the Internet to find health information, rivaling physicians as the most common source of information. The term Web 2.0 has been created to signify the idea of an interactive web, one that invites users to share experiences, to lead discussions and change, and to adapt the Internet to make it a public forum rather than a static informational grid. The potential for technology to continue to influence health decisions is impressive; more specifically, its potential in transforming well-being could be enormous.

One area in which technology is nascent is in wellness programs. Employers are just starting to realize the connection for instance of providing employees with a dedicated support structure for quitting smoking or losing weight. In what might seem to be an obvious connection, the happiness of employees directly relates to their perception of work and health, among other factors. By providing them with the network to improve those facets of their lives via integrated seamless programs, employers can close this gap and create sustainability to these endeavors.

The connection between communication, technology and patient care is increasingly becoming more established.  These facts present an amazing opportunity for companies adept enough to take advantage of them. Through the use of new technology (smart phones) health information can be made available to employees at an unprecedented level, taking the emphasis on wellness to an entirely new level and reinvigorating an already thriving area.

As seen on the PRWeekus.com “Insider” blog on April 1, 2010. This blog post is part of a series of three blogs focusing on communications and personalized medicine. Each week PRWeekus.com features a guest blogger on its “Insider” blog.

PatientsLikeMe doesn’t try to be the support community that you might find in the discussion forums at American Cancer Society’s cancer.org, which are important.  Heywood’s community primarily focuses on gaining insights into living with diseases based on the collection almost everything that happens to those affected people, documented by patients themselves or their loved ones.  Heywood is not without his detractors in the medical world, especially those that would challenge the scientific rigor of conclusions the site’s data could lead one to. Privacy experts also take issue with this extent of personal data being exposed widely.

Meanwhile PatientsLikeMe continues to collect data that you can’t help but want to apply to living with a disease, which sometimes gets lost in the search for treating and curing a disease.  Heywood isn’t the first human to have the idea of initiatives to collect transactional data of life that would benefit the Homo sapien collective.  In April 2002, popular tech columnist and pundit Robert X. Cringely’s post on his PBS blog I, Cringely Chase Cringely: Finding Meaning in a Lost Life was an emotional read that detailed the loss of his infant son to Sudden Infant Death Syndrome while he held the boy in his arms.  Cringely’s search for meaning brought him to the notion that SIDS could be beat if we knew more about this mysterious syndrome.  He suggested the idea of monitoring all infants, knowing that a certain percentage would die (according to SIDS statistics) but we would know a great deal about what was going on preceding the deaths.

Image via Wikipedia

I doubt the Borg, the fictional villains from the Star Trek franchise would be having such philosophical debates and not just putting the collected data to use in real time.  So do Borg value well-being more than us real humans?  As communications professionals I think we’re just beginning to see past the trivial use of social media as a distribution channel and now look to them as part of a more organic ecosystem that both accelerates information spread but also provides real time insight and feedback.  If we can get past privacy issues associated with this type of social information sharing we might be able to deal with well-being issues that could never be solved in the linear models of communication widely accepted now.  The continuing pervasiveness of mobile technologies getting closer and closer to extensions of our human form could be part of the solution.    Until then, Borg may be more human than we are in this capacity.

PM&R (also called physiatry) is a field often overlooked in medicine. For those who are not familiar with it, it covers a broad spectrum of conditions including: chronic pain, spinal cord injury, traumatic brain injury, stroke, joint replacement, multiple sclerosis, Parkinson’s, amputees, burn and cancer, women’s health, cardiac and pulmonary, and electrodiagnostic medicine. It also incorporates holistic approaches perhaps more than any other field, with many physiatrists receiving training in acupuncture and other alternative medical techniques. Because patients seek physiatrists’ care only after their acute illnesses are managed, the field does not garner the attention that typically goes to emergency care, cardiology, orthopedics, or any number of other more high-profile specialties. However, for those who have ever required rehabilitation, they will tell you first-hand how critical it is. PM&R is the medicine of functional ability, and just as importantly, how patients transition into the community. With offerings that range from physical and occupational therapy, to speech, vocational, and swallow therapy, PM&R is there to assist the disabled in the true sense of the word. It is a model within medicine because it thrives on a multi-disciplinary approach which always considers multiple aspects of a patient’s well-being. While other specialties do their work in “teams”, their approach does not entail the sort of all-encompassing view physiatrists adopt.

But that is where the discussion gets skewed. Here is a chief editor of a PM&R journal pointing out that monitoring patients’ health and wellness may be a niche market for clinicians. His sentiment, while accurate, is surprising on many levels. Aren’t all physicians supposed to be looking out for patients’ well-being already? Can wellness be a niche when the system as a whole should have a dedicated framework for approaching this issue? Unfortunately, medical care in the US focuses almost exclusively on disease management and more recently on prevention. There is in fact very little focus on wellness or well-being.

Surprising? It shouldn’t be. Despite the tremendous opportunity our health care system offers, critics continuously point out the poor outcomes data we churn out annually. Additionally, for those who have followed the discussion surrounding well-being in our other postings, this information should resonate clearly. It is not only employers who are faced with a dearth of understanding of what constitutes well-being, but providers as well. There is very little in medical school training about notions of well-being and how it might impact medical care. Patient satisfaction for example, which has consistently been shown to correlate highly with multiple aspects of patient outcomes, is not mentioned at all during training. And while hospitals have instituted wellness programs for their employees to stay aligned with employers in other industries, nearly all have ignored doing the same for their chief customer: patients.

A recent article in The Washington Post (Lovenheim, 11/10/09) discusses how many medical schools are changing their focus. Instead of anatomy, students now take classes on the physician/patient relationship, communicating with patients, and social and cultural issues in health care. George Washington University students were brought to Capitol Hill to learn more about health policy, and Johns Hopkins is revamping its curriculum based on the imminent growth of personalized medicine. Medical schools are trying to keep pace, as are some hospitals. A national licensing exam was instituted a few years ago that requires medical students to examine patient actors to assess communication skills and the Accreditation Council for Graduate Medical Education has included communication and patient care as two of the six core competencies of residency training.  But is this shift enough?

The notion of well-being permeates many different levels of our society and arguably has a profound impact on health outcomes. By defining what well-being means and understanding its role in health care especially, we may just be able to drive dramatic effects on patient care. While the editor of the PM&R journal has pointed out a tremendous niche for clinicians, we can only hope that it is quickly over-saturated.

The task force members, as well as others in the health field who decided to carry their torch, were woefully ill-prepared for the media. In the interviews I listened to, I heard them speak about how only X percent truly benefited from mammographies prior to turning fifty and the cost benefit didn’t merit earlier use. Tell that to the women in their 40’s for whom early detection of a lump via a mammography may have saved their lives.

Trying to win an argument by noting “only a small percentage” are helped is a losing formula. And cost benefit analyses when it comes to health are best limited to the offices of actuaries or in court rooms and should not be used when speaking with the public through the media.

There is no one answer obviously. Scholars, researchers, philosophers, and policy-makers have all approached this from different angles, providing a myriad of definitions and insights into well-being. However, the precise definition seems to be as elusive as harnessing the sustained feeling of happiness itself. The notion of well-being is undeniably a multidimensional construct. Yet, its importance to many facets of life is indisputable. In the world of business, well-being has garnered special attention, as employers and other key stakeholders strive to improve productivity, cut costs, and drive employee participation and results. Despite recent economic turmoil in fact, one element of business that has not suffered is wellness programs (Faircloth, Inc 2009). Consider the following facts:

• 89 percent of employees expect their workplace culture to promote healthy lifestyle concepts (Faircloth, Inc 2009)
• 91 percent of employers believe they can reduce their health care costs by promoting healthier living among employees (Mello, NEJM 2008)
• Health plans and employers now provide access and incentives for employees to maintain a healthy lifestyle and promote well-being.  This amazingly has now extended to penalties for not adhering to these same requirements (Mello, NEJM 2008)
• From 2004 to 2006, there was almost a three-fold increase in employers with more than 500 or more employees offering workers incentives to complete a health-risk appraisal, demonstrate good health behavior, or participate in a risk-reduction program (Mello, NEJM 2008)
• The use of premium differentials as incentives increased among large employers (Mello, NEJM 2008)
• Total annual health care costs reached $2.4 trillion in 2008 and are projected to reach $3.1 trillion in 2012 (Rosen)
• In 2008, 77 percent of employers offered health and wellness programs, and more than half of those currently without programs plan to add them, many within the next six to 12 months (Rosen)
• Research shows that 50 percent of a person’s health status is a result of behavior, and 75 percent of health care costs can be prevented, delayed, or curtailed through lifestyle modifications (Rosen)
• Nearly two out of three individuals are interested in participating in wellness programs, and 20 percent even are willing to pay extra for a wellness program (Rosen)
• 46 percent of those who have participated in a wellness program felt that it positively impacted their behavior choices (Rosen)

Aligning existing and new programs that contribute to the well-being of a company’s employees or beneficiaries can create a greater impact on its business objectives– well-being therefore is imperative. Well-being efforts and how they relate to improving a company’s image, reputation, and return on investment are becoming paramount in this discussion.

Obstacles to implementing effective wellness programs and addressing well-being of employees or beneficiaries are multifold. Most importantly, there is no standard definition of well-being and the system surrounding this issue remains clouded and fragmented. In the United States, notions of well-being center on the absence of disease, prevention, and access to treatment. On the other hand, in Europe, well-being includes happiness, work-life balance, and value in life. How to balance these characteristics, and more, is the trick. Additionally, companies are implementing programs as short-term remedies rather than focusing on long-term goals and objectives. By fomenting an interchange of information and cohesion of program infrastructure and corporate culture with health, work, and life improvement, companies may improve their approach and their desired results.

Different organizations have been attempting to relate well-being to everyday society, such as Gallup Research and the Princeton Center for Health and Well-Being. However, both of these, and others, seem to focus on health as the primary constituent/outcome of well-being, perhaps missing the overarching implications and importance of other factors.  It is our goal at Widmeyer Communications to shed light on both sides, to delve into the conundrum of why happiness is so difficult to quantify, and to help formulate solutions to solve the disconnect between employers and employees, providers and beneficiaries and between the European and U.S. approaches.

We hope you will join us in this journey and respond with questions, comments and insights.  In future posts, we will focus on the role of technology, current wellness program reach, future plans and endeavors employers could adopt, social media presence and other communications tools, and finally best strategies for managing this burgeoning area.

Contact:

212-260-3401

henry.engleka@widmeyer.com