Category: Healthcare

More and more sports physicians are now providing homoeopathic remedies. One is Tom Kastner, on the staff of the Institute for Applied Training Science in Leipzig, Germany, and a physician for Germany’s cross-country skiers. He had homoeopathic agents in his medical bag during the recent Tour de Ski, an annual cross-country skiing event in Europe.

“To be clear: There’s no scientific proof of the efficacy of homoeopathic,” Kastner says. “It’s contrary to scientific laws, which creates a conflict for a doctor with scientific training.”

Based on the principle that “like cures like”, homoeopathy is a system of complementary or alternative medicine in which ailments are treated with highly diluted substances that in larger amounts would produce symptoms of the ailment. The aim is to stimulate the body’s self-healing response.

Kastner knows homoeopathy is important to many people and isn’t surprised that sales of homoeopathic medications have reached high levels.
“It’s no different in sport than in normal life,” Kastner says. “The question is, for what symptoms do I offer homoeopathic medications? I’d like to give the athlete something, although it’s not absolutely necessary to take recourse to substances that may have a high potential for side effects.

“Athletes who have had a positive experience with them gladly go back to them.”

One such athlete is Nicole Fessel, a cross-country skier from the Bavarian Alps. She’s long had a neurological problem and is constantly looking for relief.
“One of the things I came across is homoeopathy,” Fessel says. “I don’t swear by it, but I use it. Our doctors advise me on it quite well.”

In Kastner’s view, homoeopathy’s psychological aspect plays the biggest role. “These medications can help if you believe they will, similar to the placebo effect,” he notes. “There’s an interaction between mind and body.”

Homoeopathy’s placebo effect is discussed from time to time in medical journals and at medical conferences.
“Sometimes, as a doctor, you’ve got to set your own position aside and simply work with the positive attitude of the patient – in this case, the athlete,” Kastner says. “It’s a show of confidence.”

It’s important to bear in mind that homoeopathic medications aren’t natural remedies. Sport physicians know that the homoeopathics they obtain from certified companies aren’t on the list of banned doping substances.

“I’d advise everyone, also recreational athletes, not to obtain homoeopathic medications from the depths of the internet. You never really know what’s in them,” Kastner says.

Though not a proponent of homoeopathy himself, Kastner doesn’t wholly dismiss it either.
“Everyone has to experience it for themselves and decide how much faith to put in it. But especially as an attending physician, you should know the limits of the use of homoeopathics.” – Gerald Fritsche/dpa

A few years ago, I worked on an acquisition. The team was trying to decide whether to acquire a small company that had built a great application. The target looked like they were hot stuff. And the folks on my team were excited.
Cool functionality. Productivity. What more could you want?
The software had some amazing functionality. So much so that the physician who was the brains behind the operation had increased his personal productivity like you wouldn’t believe. He was THE most productive physician in his specialty across his entire region. He was a physician in a small Canadian market, building for a single province-wide market with a population of 8 million.

How about a bigger addressable market?
The problem was the real target market was not Canada; it was the US. In the US market, the product was part of a mature market segment. In other words, what they had built was essentially a tuck-in capability. An app for the app store, not the app store itself.

No market intelligence – that’s a problem
Most of the major US HIT vendors had already built out or acquired this functionality. It’s just that no one on his team had looked at the market outside their own small Canadian geography. All of their points of reference were in an internal market – which has multiple barriers to entry in healthcare. They completely ignored the US (and global) landscape.

Do I need to mention that the acquisition didn’t go through?

A different approach: suss out the market
I’m telling you this story because I want to contrast that situation with a client team that is doing the exact opposite. First of all, you should know that they aren’t traditional marketers. They are academic researchers who are commercializing imaging technology.

Look beyond the product to the market
Like many startup founders with an engineering, medical, or academic background, their focus has been the product – not the market. But that’s shifting. Recently, they put together a comparative competitive grid. The grid lists all the players in their market, not just the competitors. That’s a smart move.
Why? Because the purpose of doing competitive intelligence or market intelligence when you’re a startup is grasping the market. Not building the product. When you build the product, you validate with users and buyers. When you build a business, you need to know the market.

The flip from product to business
Their initial competitive grid focused on features and functionality. But a smart founder won’t build out her roadmap based on a feature gap. Instead, she looks for her firm’s strategic strengths relative to the market landscape, and she captures the shifting market dynamics. So this is how you do that.
7 things to track for market intelligence

1. Start by making a list.
Fire up Excel. In the first column, put down the name of your company. Then list all competitors, both direct and indirect. List potential partners. Technology partners. Distribution partners.

• Then create the following following columns:
• Business model
• Target market segments
• Revenue
• IP
• Regulatory
• Product capabilities, features, functionality.
  Fill them in using the step-by-step instructions below.

2. Business model: capture how they make money.
What are their business model components? In other words, what do their customers buy from them? Hardware, software, services, licensing, implementation? Just by understanding how they’ve packaged their intellectual property, you’ll get a handle on their business model…

• Is manufacturing involved?
• do they have a clinical affairs function to handle regulatory approval?
• do they have a major service or implementation component to their software?

3. Target market segments. Who are they selling to?
Are your competitors addressing exactly the same customer segments as your firm? If so, how exactly are you competing? What is your competitive advantage, and how can you defend it?

4. Revenue
If you’re in an early-stage market, are your competitors all other startups? If so, do they have revenue? Look for deals in press releases to find out. If they’re bigger companies, look for the financial reports.
Revenue will tell you if the market is heating up. And for your marketing strategy, you’ll get a handle on how much education your market segments are going to need from you.

5. IP
Do your direct competitors have IP protection? If your exit strategy is to become acquired, you need your own IP strategy in place.

6. Regulatory
If you’re developing a regulated healthcare technology, look at the approval status of competitors. Do they have clearance? Which programs – CE Mark, FDA 510k? Other jurisdictions? And what are their target geographies? (Don’t say they’re all global – no early-stage regulated medical device or software platform is going to sell in every market.)

7. Product features and functionality
The first 6 items on this list tell you if this is a viable market. Product functionality helps you understand how to differentiate and win. Now add several columns with the most significant features and capabilities. Not just where you win, but where they win too.

Do the work upfront
Want to be one of the 10% of startups that survive? Then start doing your market intelligence homework. Collect the data. Enter the right market and make the smart calls. Get on the path that takes you beyond me-too moves.

It’s something almost everyone has experienced: No sooner do you lie down in bed and drift off to sleep, than you have to cough. And if you’re getting over a cold, you might end up coughing half the night. Annoying though this may be, it serves a purpose, doctors say.

Meant to expel the irritant, the cough reflex is coordinated by the medulla oblongata, part of the brain stem that contains the center controlling involuntary vital functions, including regulating blood pressure and breathing. Conscious thought – which originates in the cerebrum, the largest part of the brain – isn’t necessary.
So go ahead and cough, says Dr Sabine Gehrke-Beck, from the Charite hospital in Berlin, Germany. “Even if it’s annoying, you can’t effectively suppress it anyway.”

In the case of coughing caused by colds, she adds, there’s not even proof that the supposedly strongest cough suppressant – the opioid painkiller codeine – is actually more effective than a placebo. “In any event, you’ll sleep better with codeine, though.”

If you’re determined to stop your cough, she says, a doctor can prescribe codeine for you. But she warns that the drug can quickly become habit-forming, and instead recommends patience and warm beverages such as tea, which help to thin out mucous and can soothe your throat. – DPA

Colorectal cancer screening tests can help to find pre-cancerous growths or lesions and remove them, reducing patients’ risk of developing the disease and its related morbidity and mortality issues. It is highly treatable if detected early.

However, because the standard screening age in Malaysia is 50 and patients are often unaware of the prevalence of colorectal cancer, the disease is often overlooked, resulting in diagnosis at later stages.

“General awareness of colorectal cancer is quite low and I don’t think people realise that it is one of the most common malignancies not just all over the world, but especially in Malaysia,” says Datin Dr Wendy Lim, consultant gastroenterologist and hepatologist at Sunway Medical Centre. “The important thing to know is that it is preventable.”
Dr Lim shares that colorectal cancer is the second most common cancer among men in Malaysia and the third most common cancer among women, according to a 2003-2005 study by the Health Ministry on cancer incidence in peninsular Malaysia.

“People are happy to screen for breast, cervical or prostate cancer, but when we ask them to screen for colorectal cancer, there’s always that moment of hesitation. When it involves procedures such as testing stool samples or undergoing a colonoscopy, they tend to shy away,” she adds.
“We want to get people thinking about their own risk. So much depends on people coming forward and asking after screening methods to protect themselves from the risk of developing colorectal cancer.

“There are a lot of studies looking at exactly when it happens and when exactly the risk increases. The age at which colorectal cancer occurs in Malaysians is much lower compared to Western patients, so what we are advocating for is that screening begins at 40 in this country.”

Nipping It In The bud

Implementing a nationwide screening programme can help medical professionals detect cancer early in the population. Colorectal cancer screening tests can also find pre-cancerous growths or lesions and remove them, reducing patients’ risk of developing the disease and its related morbidity and mortality issues.

It is common in Malaysia for colorectal cancer in individual cases to get picked up a lot later compared to people in similar age groups in countries with nationwide screening programmes. In those countries, people are given notice once they turn 50 to undergo screening for colorectal cancer.

These notices include test kits that recipients have to return to screening facilities with stool smear samples. Those with negative screening results are given the all-clear and will start receiving test kits annually. Those who are tested positive, however, are referred to hospitals for a colonoscopy.

According to Dr Lim, this national initiative for a screening programme is what we sorely lack in Malaysia.

“As opposed to screening tests such as ones for breast cancer, where if you discover a lump,cancer has already developed, colorectal cancer screening is more about preventing cancer from developing. If polyps are found while screening, they can be removed almost immediately. Polyps are often non-cancerous growths, but are pre-cancerous, which means some can develop into cancer.”

She adds that since the risk of colorectal cancer increases from age 40 onwards, screening people at an earlier age could help detect the disease in its earlier stages and lead to better prognoses for patients.

“In a way, screening will not only decrease mortality rates but also result in substantial cost savings to the nation’s healthcare by avoiding putting patients through expensive chemotherapy, radiotherapy and palliative care as well as reducing loss of productivity from patients’ inability to work,” shares Dr Lim.

Looking Out For indicators

“Unfortunately, there are little to no visible symptoms for colorectal cancer. That is why we currently push for people to undergo screening from age 50. There are some who present with bleeding in their stool or black stool.
Abdominal pain, unexplained weight loss and loss of appetite are also some indicators people should take notice of. If someone comes in with these symptoms, we forgo the stool test and go straight to the colonoscopy,” says Dr Lim.

Patients should also ask questions and be informed about the different screening procedures available. For instance, colonoscopies should be done by a trained gastroenterologist who has extensive experience in endoscopy and is skilled in detecting and removing polyps.

She adds that, for now, Malaysians aged 40 and up should commit to regular screening for colorectal cancer.

“It is not a hugely demanding task. Someone with an average risk with no family history of colorectal cancer would be subject to a general colonoscopy only once every 10 years. Stool tests and sigmoidoscopies (lower large intestine and rectum examinations) are annual, and virtual colonoscopies can be done once every five years,” asserts Dr Lim.

“Of course, technology plays a part as well. There are advanced gadgets such as wide-angled, high-resolution colonoscopes that can help us differentiate between benign and non-benign lesions.”

She continues, “I hope we can inform the public that colorectal cancer is more common than we think, and that men and women are equally affected. As mentioned before, there is a certain aversion to the topic of colorectal cancer, but we need to be more open about the rising risk of this disease.”

Debunking myths on colonoscopy

Dr Wendy Lim is of the opinion that having every hospital treat each colorectal cancer case the way it does in notifying the Health Ministry of infectious disease cases would be helpful in contributing to a comprehensive cancer registry.

“Information on screening procedures should be transparent, and since there are several methods available, people can choose one or a combination they are most comfortable with.

“For instance, if you are of average risk, you don’t necessarily have to go for a colonoscopy if you are squeamish about the process. Research the various screening methods, explore preferred and alternative methods, and choose the ones most suited to you,” says Dr Lim.

Many people are concerned about colonoscopies, and understandably so. For your gastroenterologist to perform an ideal scan of your colon, the colon first has to be cleansed and emptied. Colon preparation, or “prep” as it is known, is an essential step to emptying the colon.

Below are some myths about colonoscopies debunked, so you may undergo screening for colorectal cancer with peace of mind.

Myth
I have to drink a large amount of laxative solution to empty my bowel during prep.

Fact

ost prescribed laxative solutions now are taken in split doses, allowing you to drink half the solution the night before and the other half the morning of your procedure.

Myth
I cannot eat or drink anything but water during prep.

Fact
Clear liquids and food low in fat and fibre are completely fine to consume during prep. Anything from clear broth to popsicles are allowed, as long as nothing is artificially dyed red, blue or purple. However, it is advisable to stop eating or drinking four hours before your procedure.

Myth
Colonoscopies can be painful.

Fact
Most patients are either fully or lightly sedated during the procedure, and the flexible scope minimises the chance of you feeling any pain. Some slight discomfort is to be expected.

Myth
My colon may be perforated during the procedure, so it is too risky.

Fact
Colonoscopies are extremely safe when performed by highly trained and experienced professionals. Your risk of experiencing a perforated colon during a colonoscopy is less than 0.2%.

Myth
I will be passing gas for days after the procedure.

Fact
Air is introduced into the colon during a colonoscopy for the gastroenterologist to better view the intestinal walls. You can expect to be passing gas for a while after the procedure, but it should not last for days.

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