BSLM Newsletter: July 2018

Dear Friends,

Welcome to the July Newsletter.

This newsletter comes hot on the heels of what has been described as a very inspiring conference (thank you everyone for making it so). As well as the word ‘inspiring’, I overheard the use of the word ‘family’ being used quite a lot. So I guess the written feedback backs up what was overheard with an eighty-five percent satisfaction rating. Now, having achieved family status, a wonderful place to reach, BSLM and its family members need to start looking outwards to friends and colleagues so that the Lifestyle as Medicine approach is increasingly seen as the most relevant instrument for change. This ‘change’ word, more than any other, seemed to crop up in presentation after delightful presentation.

It is entirely apposite then that the BSLM #1change campaign should be gently launched with song and laughter in Edinburgh. The campaign page on the website will gradually fill with individual examples of lifestyle change which chart the course to the calmer waters of settled good health. It is a far surer way of sustaining ourselves and our NHS.

Please offer momentum by engaging with the campaign and let’s make the difference!

Rob Lawson
BSLM Chairman

Happy Birthday NHS

by Dr Phil Hammond

The National Health Service, as any purveyor of lifestyle medicine knows, is largely a National Illness Service. We spend a fortune diving deeper and deeper into the river of illness, heroically dragging patients back to the bank and trying to put them back together again, with neither the time nor energy to wander upstream and stop them falling in. As technology advances, we can be tricked into treating the untreatable, prolonging life when a gentle death would be a much wiser and kinder option.

Perhaps we need a British Society for Dying in Style. Personally, if I don’t go suddenly, I’d like to see myself out, or be despatched like George V, whose physician Lord Dawson eased his passage in 1936 with a lethal injection of morphine and cocaine directly into the imperial jugular vein. Dawson, who was made a Viscount for his regicide, admitted his actions in a House of Lords debate, arguing there was no need to legalise euthanasia in the UK because ‘good doctors already helped their patients to die.’ Today, we all too often use our power and paternalism for the opposite effect. As the joke goes; ‘Why do they put rivets on coffin lids? To stop oncologists trying one last dose of chemotherapy.’

Lord Dawson scuppered the legalisation of euthanasia and his successor nearly scuppered the launch of the NHS. 70 years on, with thousands of doctors marching in the streets to ‘Save our NHS’, it’s easy to forget that 85% of them opposed its introduction, at least those who voted in a BMA plebiscite less than 6 months before launch day. The unspoken reason was that both consultants and GPs feared their private income might take a substantial hit if they were forced to be full-time state employees. More reasonably they worried what might become of them, and the NHS, if it was starved of cash and had a health secretary who was a power hungry control freak with a scant grasp of statistics. Perish that Huntish thought.

In the event, everyone’s favourite health secretary Nye Bevan, spurred on by overwhelming public support (and the Socialist Medical Association), decided to play medical establishment top trumps and pay a Harley Street visit to Lord Moran, president of the Royal College of Physicians. Bevan, an uncompromising socialist in opposition, was far more pragmatic in office and forged an unlikely alliance with Moran, aka ‘Corkscrew Charlie’ because of his cunning. Together they hatched a plan to allow consultants to practice privately on NHS premises using pay beds, and for GPs to be self-employed rather than salaried civil servants at the whim of the state.

Moran, who was Churchill’s personal physician, faced fierce competition at the RCP from Lord Horder, a brilliant diagnostician, George VI’s personal physician and outspoken opponent of the NHS. The future of the NHS may well have hinged on their 1948 battle for President, which was decided by members each placing a silver coin in a silver bucket as it was passed around the room. Moran won by just a few votes and his, and Bevan’s, plan was hatched. Bevan later regretted supporting the growth of private practice within the NHS, declaring that he had ‘stuffed consultants mouths with gold.’ At the time, it seemed a small price to pay for nationalising an entire health service overnight, to allow everyone access to care regardless of wealth.

As if Moran didn’t have enough gold, he later published a memoir as Churchill’s doctor and revealed he suffered from depression and was periodically ‘bitten by the black dog.’ This was considered poor form by many of his colleagues but was technically not seen as a breach of confidentiality at the time as Churchill was by then deceased. In any case, the GMC would never take action against anyone so obviously well-connected and white. Bevan and Churchill – great rivals at the time - are considered by many to be the most influential politicians of the last century, yet neither went to university, both had lisps and Bevan had a stammer to boot. And yet their huge influence came from their authenticity and ability as speakers to make their audiences believe in better, even when life seemed hopeless. Theresa May anyone?

Bevan considered Churchill to be a white supremacist due to his military escapades abroad and his hard line towards striking Welsh miners. Churchill described Bevan as ‘a squalid nuisance.’ The NHS would not have happened if Bevan had not forced it through despite the BMA and Conservative opposition, but neither would it have happened if Churchill’s coalition government hadn’t agreed on the need for it after the war, and William Beveridge – appointed by Churchill - hadn’t seen it as a cornerstone of his welfare state reforms.

Labour Prime Minister Clement Attlee recognized this and as the launch date for the NHS approached, gave a placatory speech thanking all parties and the BMA for allowing such a momentous change to happen. This incensed Bevan who was keen to forever nail the NHS in public consciousness as a Labour creation. He reacted by giving a highly inflammatory speech on the eve of launch day, describing the appalling politically-induced poverty he had seen as a child and all Conservatives as ‘lower than vermin.’ Not one to speak off the cuff because of his stammer, he clearly meant every word.

When the NHS was launched, on July 5 1948, many newspapers focussed instead on the vermin speech, with Churchill suggesting that Bevan was mentally unwell and should check himself into one of his new NHS asylums. Some Conservatives merrily founded ‘Vermin Clubs’, including one Margaret Hilda Thatcher who – thirty years later – would wreak revenge on Bevan by trying (and failing) to convert it to a private insurance system before marketizing, fragmentizing, bureaucratizing and industrializing it. Somehow, it has remained upright if only just.

I’ve only every worked in the marketized English NHS, having entered medical school shortly after Thatcher came to office and shelved the Black Report which nailed the links between poverty, poor health and premature death. But I cling to Bevan’s vision that the UK is wealthy enough for no one to go without – housing, heating, food and healthcare – if we agreed a democratic and progressive way of sharing that wealth around.

The economic argument for investing in health, education, housing, food and transport is as strong now as when Attlee’s government delivered extraordinary regeneration and investment at a time of such austerity. We now know that the die for human health are cast in the womb, or even before, and that if a child has four or more Adverse Childhood Experiences (placental poisoning, poverty, abuse, neglect etc), their future health and attainment are irreparably blighted.

The challenge now for health and social care is how to prioritise whatever spending our politicians see fit to hand us, and I’d make a strong case for sorting out the bookends of life. We all deserve a wise and gentle death when the time comes, so let’s at least get the conversation going. After all, we are all going to die no matter how much we put into the NHS. I’d also argue that if the welfare of children is paramount, as enshrined in the Children’s Act, then so should the funding be. Any lifestyle and life-circumstance changes we can make to nudge-up the life trajectory of endangered children will have lifelong benefits for them and us.

As for the NHS, it’s likely to remain a National Illness Service for some while yet. The real National Health Service belongs to homes, communities, schools, higher education, workplaces, food manufacturers, libraries, recreation facilities, water companies, sustainable transport etc etc - and to all of us. Healthcare and selfcare are a delicate balance of both collective and individual responsibility for ourselves and our planet. And lifestyle medicine has the challenge of gluing it all together for the next 70 years, and stopping us falling into that river of illness well before our time. Good Luck.

Dr Phil Hammond is an NHS doctor working in chronic fatigue, BBC broadcaster, Private Eye journalist and comedian. His book, ‘Staying Alive – How to Get the Best from the NHS’ is published by Quercus. His tour dates for Happy Birthday NHS? are at drphilhammond.com, @drphilhammond

BSLM Conference 2018 Introduction Speech

Ceud Mile Failte — A Hundred Thousand Welcomes
by Dr Rob Lawson

On behalf of BSLM trustees and Directors, welcome to Edinburgh, Scotland’s capital city. I’m not saying that to annoy our Glasgow visitors, by the way. It is a certain fact in an uncertain world. A bit like the fact that Lifestyle Medicine, practiced with humility, is a certainty in that uncertain world called Medicine.
Something else that is very certain is the honour of having you all here today.
We are travellers from all over the world, all sharing the same vision and eager to learn from each other. A warm welcome to you all. Present from UK, Europe including Croatia, Middle East, Africa, Australia, USA.

I noticed that the back of the conference programme has a picture of an 18th century Scot, Adam Smith, philosopher, economist and part of the ‘enlightenment’ era. He referred to the ‘invisible hand’ contributing to the equilibrium of supply and demand in a capitalist economy. Given the dys-equilibrium between a finite supply available to the NHS and the demands on it from our increasingly disease-burdened population, I wonder if Lifestyle Medicine can be that ‘invisible hand’ which restores equilibrium and provides enlightenment. We should make it so.

Read the Full Speech

View More Photos from the 2018 Conference on the BSLM Website
Password for the event page is edinburgh2018

BSLM Conference 2018 Session Review

The Sound of Music
by Vickie Morrish

OK. Confession time: I am a glutton for music. I greedily devour it during most activities in my day. Off to work? The radio livens up the road. Cooking a meal? I bake to background noise. Even when putting on my makeup you can be sure I’m styling to Spotify. Music has become instrumental (sorry) to the way I live my life. But the fact is, I’m not alone in my excessive consumption of the stuff. It’s everywhere. In fact, chances are you’re listening to it right now, with the average person listening to four and a half hours of music a day (1). Thanks to the digital revolution music is pumped directly into our brains whenever we put our headphones on.

Here’s a question for you: when was the last time you actually sat down (or stood up) and created something melodic? For many of us that activity is lost somewhere in childhood, with instruments dusty from neglect after reaching grade 2 or 3. But it’s time we picked up that forgotten flute or opened our mouths to sing, to start being creators once again and put the ‘hum back into human’ (2). This was Dr Rod Paton’s refrain at the BSLM conference in June. According to Rod, music is a celebration of what it means to be alive, and importantly, it is integral to our wellbeing and experience of life. Shower singers rejoice: it could well be that a song a day is exactly what the doctor ordered.

Music therapy is by no means new. Greek philosopher and mathematician – Pythagoras – believed music to be an essential component of health and self-care. But passively listening to music does very little. In fact, it can be downright detrimental. For instance, how many carols does it take until you say ‘bah humbug’ to the whole notion of seasonal goodwill? For shop assistants, the three-month onslaught of jingle bells and white Christmasses is enough to make a Grinch out of even the most patient of persons. According to Professor Elizabeth Margulis, director of the Music Cognition Lab, there is only so many times we can listen positively to a song before we become fed up (3). And this auricular overdose could have a very real, very negative effects on our mental health (4).

But music, when used right, has the power both to enrich and deepen the significance of life. For instance, Rod recalls the moment he watched a woman give birth on a refugee ship; the baby arrived to a chorus of sound made by the woman’s friends and family. Music was used to provide comfort, but it also celebrated and welcomed the new life in a way that’s unachievable without its presence. For Rod, the act of singing together and actively engaging in music in the here and now is key. When we listen to a song through our headphones we are far removed from the creation of that sound; when we create music in the present, we are connected immediately to the place and time of that sound’s creation, intensifying our experience.

More so than mindfulness, creating music together can improve physical as well as emotional health. It’s these qualities which led to the creation of The Warblers, a singing group from East Lothian and Midlothian, and which aims to improve the health of COPD patients via regular singsongs (5). The breathlessness experienced by patients with obstructive lung disease can be debilitating, but research suggests that singing can help patients manage their condition better, while providing a sociable and enjoyable activity (6). Take Dorothy, one of the many Warblers who visited the BSLM conference to sing for us. “I was diagnosed in 2007,” she told the room. “I couldn’t take two steps without getting out of breath and it took me six years until I finally went to pulmonary rehab”. But after joining The Warblers and learning singing techniques to control her breath, posture and stamina, Dorothy found her breathing significantly improved – so much so, Dorothy decided to join an acting class and exercise class based in the same building. “Who would think a diagnosis of COPD could lead to a life so full?” she asked us. But it is precisely this fullness that music provides. And it’s easily accessible, too. We just have to open our mouths.

Twitter: @vickiejamorr
Instagram: mylifestylemediclife

(1) http://www.nielsen.com/us/en/insights/news/2017/time-with-tunes-how-technology-is-driving-music-consumption.html

(2) https://www.youtube.com/watch?v=T2WmTaeeQ8c

(3) https://www.bbc.co.uk/music/articles/2458d692-b9ee-4afe-b119-9caed3570396

(4) https://www.facebook.com/skynews/videos/1972902619390992/

(5) https://www.warblers.org.uk/

(6) https://www.blf.org.uk/sites/default/files/Singing%20for%20Lung%20Health%20-%20a%20systematic%20review%20of%20the%20literature%20and%20consensus%20statement.pdf

Closing Address of BSLM Conference 2018

by Mr Laurence Stewart

So now it’s my job to summarise today’s meeting.

Where do you start? This has truly been a hugely diverse multi-disciplinary event, which is exactly what the British Society of Lifestyle Medicine is all about.

We have had Primal and Active play in which we have been willing and unwilling participants. We have had music as Lifestyle Medicine and musical performances including mass participation.

We have had presentations from osteopaths, nutritionists and nurses; woodworkers, acupuncturists, economists and epidemiologists; GPs, Public Health clinicians, secondary care specialists and academics.

And we have pushed the boundaries of technology to hear from the Godfather of Lifestyle Medicine, Prof Garry Egger, from the other side of our planet.

We have also been privileged to be the venue for a launch of the Scottish Public Health Reforms and the launch of our BSLM #1Change campaign. That’s truly an enormous range of activity in one day!

Read the Full Speech