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Time to heal? Consult your body clock.

What is your clock telling you? Time for lunch, time for that next appointment, or maybe it is something far more profound which could affect your entire wellbeing. Perhaps the answer depends on which clock you have tuned into. The clock on the wall may be telling you one thing, your body clock quite another.

The concept of the body clock isn’t a new one. Anyone who has travelled abroad knows all too well the effect which multiple time changes can have on their system. And even if you are more of a staycationer then you may still be all too aware of the impact of twice yearly UK clock changes on eating and sleeping patterns.

However, it seems as though the clash between imposed time and personal body clocks may only be the tip of the iceberg when it comes to our personal time zones. Indeed, the more that scientists study the body clock, more they are learning about the interaction between time and well-being. In this last month alone two important studies have illustrated the way in which well-being is influenced by our body clocks.

In the first study led by Professor David Montaigne of the University of Lille, researchers highlighted the way in which our body clocks influence our chances of recovering from heart attacks and heart surgery. Identifying some 300 genes which link the body clock to heart well-being, the study found that ongoing heart damage was more prevalent in those had undergone heart surgery in the morning than in the afternoon. So much so, that those who had surgery in the afternoon had a 50% lower chance of cardiac event than those scheduled for morning surgery.

The implications are profound and could lead to complete rethink of the way in which surgery times are scheduled not just for hearts but in respect of a range of conditions. The second study reinforced the importance of considering the body clock, and indeed the clock on the wall, when it comes to understanding recovery times.

The study reported by the Medical Research Council revealed that wounds received during the day healed 60% faster than those at night. This apparently is down to ‘actin’, an essential protein which governs the ability of skin cells to migrate into wounds and to start the healing process. Actin is itself governed by the circadian clock, being more active in the day than in the night and therefore more able to in initiate the healing process by day. Interestingly the study also revealed that in nocturnal mice the process is reversed.

Other studies in the past have cast light on the way in which our body clocks influence mood, concentration and our ability to carry out day-to-day tasks. Whether you are a morning or evening person could profoundly influence the way in which you approach your daily round; with tasks allocated in accordance with your circadian rhythms improving outcomes in areas such as productivity, accuracy and so on.

The more we understand our body clocks, the more we can optimise treatments and increase chances of recovery. Given their individual body clock, should a patient see a physiotherapist in the morning or afternoon, at what time of day would it be best for the individual to exercise in order to promote fitness or healing, and when is the best time to tackle that mountain of paperwork? We may not have all the answers yet, but as more and more studies report their findings it may not be too long before circadian rhythms are seen as an intrinsic part of managing well-being.

Mental health is everyone’s problem

It scarcely seems a year ago when we were celebrating World Mental Health Day and examining the 2016 theme of psychological first aid. Now we are returning to the subject, looking at this year’s theme of mental health in the workplace.

It’s a fitting topic for this twenty-fifth World Mental Health Day, highlighting the way in which mental health isn’t simply something which is hidden away at home, but travels with people out into the wider world; impacting on workplaces, employee and customer relationships, and the ability of people to perform everyday tasks. Think of mental health in the workplace and stress may come up as a topic but the truth is that just as the nature of work can contribute to a range of physical problems, so too can the nature of work contribute to a number of mental health issues.

Indeed, according to the organisation MHFA England, three out of five employees have experienced mental health issues in the last year because of work. It’s a shame therefore that the same organisation comments that just 24% of line managers have received any form mental health training.

So what’s the solution? NHS employers have put together some guidance which is aimed at helping NHS managers to support workplace mental well-being. The suggested approach is split into two sections, supporting staff who are experiencing mental problems and promoting a healthy approach to work.

The advice is all fairly straightforward and ties in with other best practices such as boosting work culture and improving employee engagement. It talks about promoting work-life balance, giving people control over their workloads and providing resources. As such, although the guidance is targeted towards those working in the health service, it would also be appropriate in other fields. In particular, it would also be appropriate for other health professionals who may be in danger of letting their work overwhelm their mental well-being.

Stress is a very overused word and whilst the connotation is generally negative, stress can in some instances help to push us towards achieving goals which we may not have thought possible. Nevertheless, some forms of stress can be debilitating, leading to problems with sleep, depression and even physical health problems. And stress doesn’t simply arise because of an excessive workload. Worries about finances, uncertainties around patients missing appointments, repetitive tasks which distract from core competencies; all these and more can affect mental well-being.

And the trouble is that when our mental equilibrium is out of balance it is all too easy to be locked in the problem without being able to step back and see the solution. So we brood over fluctuating appointment patterns when we could be opening our business up to online booking or sending out appointment reminders in order to cut down on no-shows. And at the end of a long day, when we should be stepping away and unwinding, the challenge of sending out invoices or dealing with day-to-day paperwork seems overwhelming; so much so that we simply don’t have the mental capacity to look for other solutions such as taking secure card payments at the time of booking or electronically filing patient records.

Mental health issues come in many forms and many guises. Some we have little control over, but there are some which we have it in our power to prevent or mitigate. Technology can help to manage the routine, to remove time pressures and to provide a measure of control over workloads. This World Mental Health Day let’s take time to step back and look and see what we can do to make a difference.

Suffering from cyber-chondria?

Feeling a bit funny? Worried about those lumps and bumps? Got a strange collection of symptoms which don’t seem to add up? Yes you may need to consult your doctor, but you should also be prepared to be told that you are suffering from a newly identified disease which according to a recent study is costing the NHS at least £420m a year.

The study looked at the causes and effects of cyber-chondria which the researchers say could be the underlying reason for as many as 1 in 5 of hospital outpatient appointments. As Prof Peter Tyrer, one of the authors of the study, explained “Dr Google is very informative, but he doesn’t put things in the right proportion.”

Cyber-chondria does create a dilemma for the health profession. On the one hand, we are being asked to reduce the burden on the NHS by self-treating minor ailments or consulting local pharmacists in the first instance. On the other hand, a propensity to misdiagnose the causes of symptoms following an internet search could either lead to unnecessary appointments or to patients not presenting at their GP surgery when early treatment for a condition could prevent ongoing problems.

There appears to be no one straightforward answer. And it’s certainly true that when someone presents with a range of symptoms, some may be related to a genuine ongoing illness, whilst others can be laid at the door of health anxiety. Ignore all the symptoms and the chance for early intervention can be missed, treat all symptoms as potentially genuine and hospital referrals increase significantly. So awareness and proportionality, knowing your patient, can play a significant role in sifting illness from the cyber-chondria maze.

That’s not to say that cyber-chondria isn’t an illness in its own right. Indeed the report’s authors suggest that for those suffering from acute forms of health anxiety, some form of psychotherapy may be in order. And as with any other illness; the earlier the treatment, the better the prognosis.

This approach was borne out in another field recently when the results of a back pain pilot were released. The pilot run by a primary care service in Hertfordshire saw a physiotherapist with spinal expertise triaging and providing advice to patients who self-referred to a clinic. With further expertise available as a back up and the ability to directly book ongoing treatment the experiment saw 85% of patients discharged after a first appointment. Moreover, on the spot advice on exercise and rehabilitation meant that only 3.5% of patients needed to be referred to secondary care as opposed to a 12% GP referral rate.

The main message which arises from studies such as these is the importance of early intervention when treatment is required. In a health system which is seeing an ever increasing demand for its services this isn’t always easy. However, even little tweaks to processes and procedures can make a measurable difference to boosting patient treatment times. Even something as simple as SMS text messaging which reminds patients to attend appointments can not only boost early treatment, it can also ensure that treatment times are fully utilised.

Of course, there are times when the chance for early intervention has been missed and the mantra ‘better late than never’ comes into play. We are indebted to the Jewish Chronicle for highlighting just how effective physiotherapy can be. Four years ago, Ann Rowe was wheelchair bound and dependent on hoisting equipment. Now, thanks to intensive physiotherapy, at the age of 87 she has completed the Parallel London 5k event.

Early treatment, late treatment, ongoing treatment; what this story and others show is that when health professionals are freed from administration and able to do what they do best, providing good and targeted therapies, great things can happen.

Opening the door to physiotherapy

The government’s announcement that it intends to fund an extra 10,000 training places for nurses, midwives and other health professionals has been welcomed by the Chartered Society of Physiotherapists (CSP). Whilst the exact breakdown between the various disciplines is as yet unclear, any increase in physiotherapy training has to be welcomed.

Despite an increase of 15% in the number of physiotherapists graduating this year, the CSP estimates that the profession requires an additional 500 graduates per year in order to cope with rising demand. Commenting on the announcement Karen Middleton, the CSP’s chief executive, said “This opens the door for more physiotherapists to contribute to patient care in much-needed ways, and to address current workforce shortages.”

The demands which an ever ageing population place on the physiotherapy profession cannot be underestimated. Those who are young and relatively fit may see physiotherapy as purely delivering a one-off series of treatments following a sporting injury or other accident, but in fact the physiotherapy remit is far wider.

The NHS choices website comments that “Physiotherapists consider the body as a whole, rather than just focusing on the individual aspects of an injury or illness.” Approaches highlighted by the website include education and manual therapy, together with advice on movement, tailored exercise and physical activity. This means that at any one time physiotherapists are dealing with a complete mix of complex and routine conditions. For example, the first appointment of the day may require the delivery of some form of manual therapy, manipulating the body in order to ease stiffness following a car accident. The next patient through the door may need advice on simple exercises to ease the pain in arthritic fingers, and so on.

Opportunities available for physiotherapists are wide-ranging. Whilst some will work directly within the National Health Service, others may join private practices or work directly for other bodies such as sports clubs or companies. Whichever pathway they follow, they will generally work alongside other health professionals, looking to deliver a complete service which is designed either to keep people fit and healthy or to return them to full mobility as swiftly as possible following an event.

As with everything in the health profession, time is of the essence. Individuals want to be mobile, and health professionals want to help as many individuals as possible to achieve that aim. That’s why the CSP are looking for increased numbers to join the profession, but it’s also why health professionals themselves are increasingly adopting digital solutions to take care of routine tasks.

Quite frankly, every minute of administration time saved is a minute which can be used in helping to improve people’s lives. As a result systems such as the electronic filing of patient notes, the use of secure email to transfer records, and the maintenance of an electronic diary system are now firmly established in many health practices. Add to that services such as appointment reminders by SMS text or email which are helping to reduce the number of no-shows, and physiotherapy time is increasingly being targeted towards treatment rather than administration.

In 2017 there are 2,136 places for physiotherapy students at universities across the country. With the government initiative opening the door for further increases in years to come it can only be good for the future of physiotherapy and of those who rely on it.

Paying by card?

£58 billion!

That’s the total spend on all credit and debit cards in the UK in April 2017, the most recent figures available at the time of writing. Credit cards accounted for just short of £17 billion, whilst the debit card spend was boosted by the growing acceptance of contactless payments.

Overall our growing love affair with the card as a form of payment has resulted in a 6.8% year-on-year rise in card spending. Partially thanks to the contactless element, this translates into a 12% increase in transaction numbers.

What does this mean for business? Well for a start it makes it far easier for businesses to move away from cheques and cash and towards card payments. The old arguments about cards and businesses which accept cards being the preserve of the few now simply don’t hold sway. So much so, that this writer was surprised recently to be asked for a cheque in payment. Luckily the request came in advance, saving a round-trip to retrieve the cheque book from its secure drawer.

Quite simply, card payments are convenient for both customers and businesses. More importantly, they speed up the receipt of funds for the business. Particularly so in businesses which have traditionally relied on the service/ invoice/ cheque payment route. Simply sending out the invoice and waiting for the cheque to arrive in return could easily take up a couple of weeks; and by the time bank clearing has taken place and funds are available for use the original service is a distant memory. Secure card processing generally delivers cleared funds approximately one week after the appointment.

The growing acceptance of cards as a means of payment has also brought further benefits, particularly for those businesses such as health providers which rely on an appointment system. Taking card details at the time of booking, whether on the phone or online, tends to concentrate the mind and that means that clients are far more likely to turn up for their appointments. Particularly so if the health practice operates a ‘no-show fee’ system, charging clients who fail to turn up a percentage of the overall fee.

Adding a further service such as sending out SMS text messaging or email to remind clients of the appointment also helps to ensure that clients either turn up to their appointment or cancel well in advance. It can be all too easy in a busy life to forget the date or time of an appointment so scheduling reminders acts as a handy aid memoire.

When it comes to health services, anything which can boost attendance numbers is welcome. Both in the public and private sectors time is of the essence and resources are stretched. Those who fail to turn up to appointments not only jeopardise their own treatment plan, they also block or delay the chances of treatment for others. So the hidden cost is far higher than simply having a team of health professionals sitting and waiting for a client who has either forgotten or has no intention of turning up.

Taking care of patient data

There’s no escaping the fact that we live in a data driven, online world. And why shouldn’t we? Properly managed, electronic storage of data can free up substantial amounts of time, leaving us free to concentrate on the more interpersonal and interesting aspects of our jobs and lives.

Just take the electronic filing of records for example. With x-rays, scans, clinical notes and histories all being available in a single patient record at the touch of a button; it’s far easier for health professionals to diagnose and understand the nature of a particular problem and move swiftly towards developing a treatment regime. It’s also far easier for data to be shared between health professionals, enabling complex cases to be managed in a more holistic way.

Add in the benefits of time saved in not having to print out records, manually file them and then post or courier information between health centres and it’s easy to see how health practices and their patients benefit from electronic data storage.

However there is one area of concern with electronic data storage and that is the question of security. Now it has to be said that many of the problems arising from electronic data storage are simply replications of problems that can arise in a paper driven world. Yes it is possible to email a record to the wrong person but it is equally possible to put a patient record in the wrong envelope or for paper copies to be lost in the post.

And even with errors there are some aspects of data management in which electronic storage comes up trumps. Miss-file a paper record and you can spend hours searching for it, miss-file an electronic record and a reasonable data search facility can help you to retrieve the file relatively quickly.

Naturally our trust in the security of data isn’t helped when we see headlines which would indicate that the health sector is responsible for considerable numbers of security breaches. The Information Commissioner’s Office (ICO) summary of data protection reports and concerns for 2016/17 indicates that the health sector is responsible for 41% of self-reported incidents. To put this in context, next on the list is local government with 11%.

On first indication this would be a concern; however, the report highlights the fact that the health sector’s mandatory reporting policy naturally leads them to report more incidents than other sectors. Looking at the types of data breaches, whilst it is true that 11% relate to data being sent by email to an incorrect recipient, this has to be taken in context with the 15% of reports relating to data being posted or faxed to an incorrect recipient and the 14% of occasions when paperwork was lost or stolen.

It’s often said that security is a state of mind and what the ICO report highlights is the importance of treating patient data (whether in paper or electronic form) with the same level of care as you would give to the patient. When data is being transferred between health practitioners it only takes a few seconds to check and double check that the forwarding email address is correct and that the request comes from a genuine source. Similarly with security being forefront of people’s minds, passwords are less likely to be left lying around on desks or set to the standard default of password or 1234.

Electronic data isn’t simply some laboursaving device. Patient information is real and personal. Being human we’re all going to make mistakes from time to time but being security aware will help to minimise those mistakes and ensure that patient data is treated with the care that your patients deserve.

A healthy mind in a healthy body

The idea of the connection between a healthy mind and a healthy body was further strengthened recently with the release of a research paper via the British Journal of Sports Medicine. The research, which reviewed thirty-nine existing studies, focused on the way in which staying fit and healthy could help to stave off brain degeneration, particularly in the over 50s.

Interestingly, optimal levels of exercise identified consisted of a mix of aerobic and muscle training activities. Apparently muscle training helps to improve both memory and the brain’s ability to plan and organise whilst aerobic exercise helps areas such as thinking and reasoning.

Before you sign up to those gym classes, it’s worth noting that carrying out the required amount of exercise to help brain power needn’t be all that taxing. For example, simply carrying a heavy shopping bag could count towards muscle training, whilst walking or cycling to work could be enough to tick the aerobic box. Of course that does depend on individual circumstances so if you work from home and have groceries delivered you may have to think again about your exercise regime.

Commenting on the survey Dr Justin Varney from Public Health England highlighted the way in which even ten minutes of exercise can prove beneficial. However, he also pointed out that we’d be better off undertaking 150 minutes of exercise each week as this has been shown to cut the risk of dementia and depression by a third.

Whilst exercise is good at any age, the report’s authors highlight the particular link between exercise and brain health in the over 50s. One of the authors from the University of Canberra commented that the results were ‘convincing enough to enable both types of exercise to be prescribed to improve brain health in the over-50s.’

Apparently exercise can be good for brain health even in those who have already started to show evidence of cognitive decline, perhaps making it a complimentary treatment for those who are suffering in the early stages of dementia. Adding to the mix is the fact that physical activity has also been shown to help to reduce the risk of certain conditions including some cancers and type II diabetes.

Having said that, the level of exercise undertaken has to be appropriate for the individual. Suddenly moving from a sedentary lifestyle into marathon running whilst dressed as a weightlifter may not be the best of ideas! Starting out with a health check up or taking advice from a health professional such as a sports physiotherapist may help to identify what options would best suit an individual.

Another option may be to contact local sports clubs, many of which now offer social sporting activities for older people. Sports such as walking football, kick golf and rambling rugby are all growing in popularity and can be a great way of getting fit whilst maintaining an active social life; another identified brain booster. The importance of staying fit in order to help to boost brain health shouldn’t really be a surprise; but when studies such as these come along to highlight the benefits to be gained from even a moderate amount of exercise, perhaps a time that we all looked to stepping up the desire to stay fit.

A happy and healthy Easter break

The Easter bank holiday weekend is upon us and with it comes the usual crop of warnings about staying healthy over the long weekend. Apart from common sense advice such as ensuring that repeat prescriptions are filled and collected in advance of the weekend and that medicine cabinets are well-stocked, health boards have also been reminding people about the importance of choosing the right pathway should healthcare be required over the weekend.

The prime message which health boards are trying to convey is that accident and emergency departments are there for serious and life-threatening emergencies, and should not therefore be used as a first port of call for minor injuries and ailments which could be treated elsewhere. In many instances sprains and strains, cuts and grazes could be treated at home whilst local pharmacies may be the best port call for other minor ailments.

A quick internet trawl of the advice arising from health boards also highlights the importance of telephoning 111 for advice or downloading the HANDi App which provides advice and support to parents and carers in respect of children’s illnesses. However, it has to be said that prevention is better than cure and it is therefore important that people take care of themselves in order to reduce the burden on health services.

For example, if the weather should turn fine this bank holiday weekend then keeping to the shade, staying covered up and making sure you are well hydrated could help to prevent heatstroke or sunburn. On the other side of the coin, a small amount of sun is good for us as it helps our bodies to produce vitamin D, a vital ingredient in the development of healthy bones and teeth. With 700 cases of rickets diagnosed in 2013/14, shunning the sun altogether may not be the best solution for long-term health.

Then there’s the other bank holiday tradition of indulging in a sudden spurt of gardening or DIY. For those of us who spend most of our lives sitting in front of a computer screen, suddenly indulging in heavy exercise may not be the best idea for the health of our muscles and ligaments this Easter. So whilst you may not be taking part in organised sport, taking time to warm up before attacking that vegetable patch could help to prevent muscle damage. Then it’s a case of taking regular rest breaks to give tired bodies a chance to recover before they are stretched too far.

And while we’re on the subject don’t neglect the importance of following correct procedures when lifting heavy objects. It’s all too tempting to lean forward to pick up that bag of potting compost but if you do you may well be putting your back in danger. So standard advice says to bend your hips and knees as you squat down to the object you want to move, keep it close to your body and straighten your legs to lift. And when you are lifting or holding heavy object avoid turning or twisting your body.

Following best practice advice may help people to avoid that other bank holiday tradition, the after holiday trip to the physiotherapist, chiropractor or osteopath. Yes being sensible may mean that you take two days to do something that you thought you could achieve in one; but don’t forget we have got two more bank holidays coming up in May so there’s plenty of time to spread the workload this Easter and stay healthy.

Time for a clear out

If you missed ‘national clear your clutter day’ don’t worry – there is still plenty of time to make a difference. With a nod to the allegedly diminishing practice of spring cleaning, clear your clutter day on 11^th March 2017 was billed as a chance to clear unwanted items either for profit or a sense of positive change.

The day’s organisers recommended using a simple four box sorting system as a way of identifying which items could be sold, upcycled, swapped or recycled. And the message wasn’t just aimed at decluttering households, businesses too were urged to join in and have a good sort out and tidy.

There were also some handy hints for those of us who may find the notion of a mass tidy-out a little intimidating. These included breaking down the area to be tidied into manageable chunks, either by room or even by cupboard or drawer. If even that seems insurmountable, the organisers suggest getting into the habit of clearing one item per day. It may not seem much but over the course of the year that makes 365 unwanted items cleared out of the home or business and into a charity shop or recycling facility.

Interestingly the clear your clutter campaigners don’t stop at suggesting we declutter only physical items. Finances and even the contents of our in boxes also come under scrutiny. For example, we may not have much control over the inward flow of e-mails but do we really need to keep all of those sent ones which merely say ‘thanks’ or ‘have a happy birthday’? And then there is the delete box. If we have already identified an e-mail as no longer required why leave it lingering and taking up space in the delete folder? There may be a good business reason why some e-mails need to be kept but identifying which ones we really need helps us to rethink our business priorities as we clear.

Other suggestions include sitting down with all that paperwork which is cluttering up the office or home and having a good sort out. Whilst there is some paperwork which needs to be kept in physical form (property deeds or passport come to mind here) there is much which could be scanned and filed electronically. Not only does that declutter the office, by making use of a good indexing system it becomes much easier to find documents quickly when needed.

This is a practice which health professionals are increasingly adopting for patient records. Electronic filing is safe and secure and not only allows for instant retrieval it also helps to speed up treatment in cases where records may need to be shared across different specialists.

When it comes to decluttering finances, there are a few simple things which you can do which can make a measurable difference. Here again having paperwork and outstanding invoices lying around can add to stress levels so moving to electronic system could make a difference to the way in which finances are approached. Keeping a simple spreadsheet will help individuals to identify when key bills are due whilst for businesses moving to a form of electronic payment can smooth cash flow.

For example, healthcare providers such as physiotherapists or chiropractors may wish to consider taking card details at the time of appointment booking. Not only does this help to smooth cash flow; having provided card details patients are less likely to miss an appointment, particularly if a no-show fee is clearly highlighted on the appointment terms and conditions.

Busy lives make it all too easy to let clutter build up. We may intend to clear this when we’ve done that but then something else comes up and the clearing never gets done. Taking time to step back and re-evaluate can force us to stop and not only clear but also plan a less cluttered future.

A pain in the back….

There’s no escaping back pain. A sore back can not only affect neck and limbs as attempts to get comfy result in collateral pain elsewhere, it can also lead to headaches and depression as painful movement hampers and frustrates efforts to get on with daily life.

In the past treatments for back pain were largely along the lines of taking to bed with a few painkillers in the hope that the pain would ease. Nowadays the thinking is very much more along the lines of staying active; with the NHS choices website recommending a series of stretching exercises alongside gentle activities such as walking, cycling or water-based activities.

As with any other pain the temptation for those suffering from a bad back has still been to head for the pill box in a bid to feel more comfortable. However, a peer review has thrown up questions about the efficacy of taking non-steroidal anti-inflammatory drugs (NSAIDs) for back pain. The review concluded that taking NSAIDs was little better than taking a placebo with only one in six patients receiving any benefit from NSAID treatment. In addition, those patients who took the anti-inflammatory drugs were at a higher risk of gastrointestinal upset; perhaps the last thing which someone would want when already suffering from back pain!

The researchers concluded that there was an urgent need to develop analgesics which were more effective in treating back pain. However it would appear that more research is required as the peer review did not examine the efficacy or otherwise of exercise or direct interventions such as physiotherapy or chiropractic treatments. Certainly these are options to consider when looking to treat back pain as musculoskeletal professionals may be able to identify the root cause and suggest changes to posture or lifestyle which may help to speed up treatment and prevent re-occurrence.

Within the workplace too occupational therapists may also be able to suggest the best way for using equipment, or even sitting at a desk, which will optimise back health. For employers this is one area which should not be ignored as statistics from the health and safety executive indicate that in 2015/16 an estimated 8.8 million working days were lost due to work-related musculoskeletal disorders.

Work-related or not there is no doubt that back pain is something we can all do without, putting a strain not only on individuals and their families but also the health service as a whole. It’s one reason why health professionals are increasingly looking to find remedies which will help to relieve the strain on their own practices and maximise treatment times. For some, gentle remedies such as instituting online booking forms allied to automated appointment reminders have proved effective. Others have resorted to more intensive measures such as appointing virtual assistants or electronically filing patient records in a bid to reduce the strain on resources.

Whatever the remedy chosen, the more that health professionals are able to focus on working with patients to identify and treat the causes of back pain, the better it is not only for individuals but the country as a whole. With the study largely ruling NSAIDs out of the picture, the more we can focus on developing effective treatments, the quicker people will be able to get back to a pain-free lifestyle.

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