Monday 9 December 2019

The Lazarus Solution

I've taken full advantage of working in academia pretty much all my adult life. Academic Institutions, even not-exactly-Harvard places like The Institute, have active interest in many different fields and tendency to bring visiting speakers in from Outside. If one of my colleagues takes the trouble to invite someone to talk to their students, then that speaker is unlikely to be a total sleeper. Accordingly I do my best to rock up to hear what they have to say - I've heard from the horse's mouth about being a prison governor, a forensic scientist, running a homeless charity, a boxing coach, an arachnologist, the world's expert on sequence alignment. Last Friday, I taught my last class for the term just in tme for the launch of a sparkling new initiative:
Sports Students as Mentors for Boys and Young Men
As the least sporty person I know - my sporting ventures seem to involve a lot of sofa - that's a pretty unlikely channel for my enthusiasm. For the launch of an official Erasmus / EU initiative, it was pretty chaotic: it started in a different place, at a different time from that announced in an e-mail the night before. Which meant that I got to chatting with a young feller who is doing a Master's in Strength & Conditioning at The Institute; must be a protestant, I thought, to arrive a little early for an appointment. He's doing a MSc because he wants to teach at his Alma Mater and reckons the post-graduate degree will give him the edge. Good luck with that, I thought, because the lecturing staff on the Sporty side of our department are none of them close to retirement and quite cosy in their jobs. But I brightened with the thought: "Y'know, we're having the departmental Christmas party in a tapas bar next Thursday evening, the only thing for it is to forment a terrorist outrage to create some vacancies in the faculty". But I could see that he really didn't have the bottle to thus decisively take control of his own destiny, and I asked what was the fall-back position.

"I want to do exercise therapy with the chronic sick", he said. This gave me a frisson because I could immediately see great possibilities with such an endeavour. The father of one of the admin staff at work had recently died and the obit mentioned that the old chap had spend the previous 8 months occupying an acute bed in one of the major Dublin teaching hospitals. I'm sure he got the best of care, and I'm not suggesting that he overstayed his welcome, and the HSE and the Min of Health think that is the right way to spend out tax-dollars,but that bed cost a nominal €800/day or the bones for €200K for the stay. You could get a lot of exercise therapy around the country for that sort of money. My new pal was chapter and verse on the health and wellness benefits of pushing out exercise regimes among the chronically ill: multiple sclerosis, cancer, COPD, heart disease and diabetes. Getting people out of bed is a one way to prevent bed-sores!  Exercise develops agency, reduces pain, distracts from negative thoughts, stimulates the immune system, develops appetite, increases lung function, engenders happiness. That's a lot of QALYs engendered through one salaried health-care professional.

It's not an easy option! It's damned hard for the patient to do the necessary work - they feel like shit, for starters, chemo drains them, multiple incisions make them delicate. Exercise Man told me that 50% of his clients throw in their cards before the end of the 12 week regime. Whoa! I replied, half your people complete the course! They feel better, they need few pain-killers, their immune system is fighting back, they're less snappy with The Help, the grand-childer see a profile in courage. That's effin' bri'nt, you should be proud.

From the way it actually functions the HSE could be better called the Disease Service Executive because the whole lumbering tottering edifice is based in treating disease with ever more expensive drugs and devices. Only a tiny token fraction of the budget is devoted to prevention or prophylaxis rather than cure. Because exercise and physiotherapy is coal-face stuff and sort of boring it becomes invisible at budget time: so many CAT-scans to buy, so many titanium hips in the store cupboard . . . quadruple heart by-pass? that sounds sexy, let's have more of them. It's a bit like the position with the road-traffic downsides of sleep deprivation: 2 hours lost REM sleep puts you as dangerous behind the wheel as someone technically drunk. But spending of drink aware campaigns is 100x that spent on sleep education.

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