App Store trend of 2018: Self-care

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Apple’s distribution platform for mobile apps, the App Store, recently selected self-care as its trend of the year. Wellness apps designed to encourage healthy habits, improve sleep, reduce anxiety and increase mindfulness have been the major trend on the iOS platform over the past year, according to Apple.

Fittingly, one of these popular apps is called #SelfCare, launched by TRU LUV Media in summer 2018. Designed like a game, the app promotes emotional wellbeing via breathing exercises and other small acts of self-care. Another is called Shine – Self-Care & Meditation, which delivers free daily motivational messages, 5-minute affirmations and meditations, plus tips on how to reduce stress, improve sleep and increase focus.

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The popularity of such apps is good news for OTC marketers, especially those operating in lifestyle and VMS categories that focus on mental wellbeing, i.e. sedatives & sleep aids and herbal memory & brain health. Apple noted that apps for physical health, such as those that track calories and steps, have long been popular with iOS users, but emphasised that this trend towards apps for mental health is a new phenomenon.

That said, what may be somewhat concerning to OTC marketers is that this evolving definition of self-care doesn’t appear to include self-medication. While OTC New Products Tracker lists medical device launches in 2018 that incorporate an accompanying app – such as Nokia Sleep and Natural Cycles, the latter designed to aid conception – supplements or drugs backed by a mobile app are much thinner on the ground.

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Self-care in Canada: Meandering Path to New Regulations

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Mathematically, the shortest distance between two points is a straight line. However, in public policy it is rare to chart such a clear direction. Reading through the “What was Heard” report from Health Canada’s public consultation on self-care regulation, which was conducted online in late 2016, there does not appear to be any real consensus over new proposals for an overhaul of all the regulations for non-prescription medicines, Natural Health Products (NHPs) and cosmetics.

Although the report was completed months ago, it was only released in late March this year, as a backgrounder to a series of town hall style discussions on a more detailed set of changes starting 4th April. While the government has developed a more detailed set of proposals that address some of the concerns set out in the report from last year’s consultation, it would appear that those attending the provincial feedback forums will not have the opportunity to digest these details prior to giving their advice. In fact, one of the key findings of the report was that all stakeholders felt that the original outline lacks enough specificity to make cogent comment.

Reading the report, it is interesting how what was heard may not actually be fully representative of what was said. For example, the report concludes that “many participants in the consultation see considerable value in the clarity that would be provided by a single regulatory approach to all three affected areas” (i.e. cosmetics, NHPs and OTCs). What the data show is that in virtually all stakeholder categories, the support across several key measures was only around 30%. Taken another way, roughly 70% or more of the stakeholders would not be more confident in these proposals.

The report notes that most of the concerns came from the NHP segment. This should not be a surprise since all previous consultations were only about moving OTCs out of the prescription drug regulations. For non-prescription medicines, this was round two of the discussions but for the NHP and cosmetics sectors this was novel territory. The visceral reaction was clear given that the NHP community spent years developing a set of regulations independent from drug classification and achieved it through a parliamentary process. They perceived that rolling all OTCs and NHPs into one single regulation was a step back in time, especially given the tone of the documents about claims-based barriers to market access.

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There weren’t many points where all stakeholders agreed. However, it seems there was a strong consensus that self-care products (OTCs, NHPs and cosmetics) “should not be regulated in the same manner as prescription drugs”. Far from an epiphany, this was the basis for the idea that OTCs should be granted their own regulations outside the prescription regulations, just as NHPs were granted such regulatory status. Cosmetics have never been in the prescription drug framework.

There was no consensus on the specific elements of the new framework. The risk-based approach was supported to the degree that most agreed that “products which pose a greater risk of harm should receive greater scrutiny and be subject to significant requirements”. Where the consensus fell into disarray was around the confusion between evaluating products for their individual risk and categorising products broadly into risk levels. The proposal seemed to set out a lower-risk category where claims would be limited and as such the government would not review and license them for sale. This type of product would be supported by pre-cleared information such as monographs.

The logic suffered in some stakeholders’ view since the model would seem to require lower-risk products to move into higher risk categorisation when clinical data would be provided to create greater confidence in the claims. The report notes that “there is no consensus that the proposed risk-based approach would create more confidence when purchasing self-care products”. In fact, 82% of consumers and healthcare professionals and 93% of cosmetics manufacturers said it would not give them more confidence.

The thought of requiring only “scientific” proof to justify health claims met with resistance from most stakeholders (except the five OTC drug companies). Only 30% of all respondents agreed with this notion and that was not highly differentiated across several segments. The support for stricter reliance on “science” (not defined but often assumed to be clinical trial data) was low with consumers (30%), healthcare professionals (33%), NHP companies (21%) and cosmetics manufacturers (30%). On the other side of the argument, academics and researchers were more supportive (60%).

A concept floated by government was that they would not evaluate and license certain types of products based on the types of claims being made. This was suggested to be accompanied by a disclaimer that Health Canada did not assess the claim. While cosmetics already enjoy a similar notification system, most stakeholders didn’t appear to support adopting a cosmetic-like system for OTCs and NHPs. The report notes that “participants are somewhat divided on the use of a disclaimer on products whose efficacy would not be reviewed”.

Despite the lack of consensus on a disclaimer, there would appear to be acceptance that changes could be made that would “facilitate informed consumer choice”. Some stakeholders have proposed adding labelling statements that would make it clearer when traditional evidence was used to support the claim. This, they feel, would add information that enhances consumer choice.

This consultation elicited a very strong response relative to most government consultations. Perhaps this was influenced by the fact that during the consultation period, Health Canada put out a very strong social media campaign and used traditional media stories to “clarify” some aspects of their proposals. With the communications efforts to ensure that the consultation garnered significant and reasoned responses, it should give some confidence in the results.

Perhaps one of the most telling observations related to the confidence stakeholders would have in the newly designed system. Consumers (78%), healthcare professionals (75%), NHP companies (80%) and cosmetics firms (63%) did not feel more confident with the new proposals. In a similar vein, 82% of consumers didn’t feel that the proposals adequately addressed their needs. The numbers were similar for healthcare professionals (78%), NHP companies (81%) and cosmetics businesses (74%). Only two OTC companies felt that their concerns were addressed.

The report concludes that “there is clearly a need for further detail on the proposed approach so that stakeholders may provide more specific feedback to Health Canada as the framework continues to be developed”. No doubt this is true and, as the government heads into the next phase of face-to face discussions, it would have been helpful to have that kind of detail available before asking stakeholders to respond.

Google Launches “Health Cards” in Australia

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Self-diagnosis can often lead to much panic and anxiety. UK newspaper The Telegraph reported in a 2015 survey that one in four of us choose to self-diagnose on the internet instead of visiting doctors. With OTC products so readily available in numerous regions, self-diagnosis could lead to self-medicating incorrectly.

Last week, Google launched verified medical information in Australian search results, detailing common health complaints such as coughs, infections, rashes and snakebites. However, Australian doctors have warned that while the information might be a conversation starter, it could lead to misdiagnoses and should never replace seeing a specialist.

Google revealed plans to launch Health Cards as part of Google search results in Australia after working on the project with doctors and medical agencies, one of which was the Mayo Clinic. The cards cover the details and symptoms of over 900 health conditions and diseases recommending next steps for concerned sufferers.

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llnesses and concerns featured in Google’s Health Cards will include tonsillitis, coeliac disease and eye infections, with some cards also featuring animated GIFs to demonstrate illnesses. Google Health Cards programme manager Isobel Solaqua said the project was created to address the growing number of medical questions fired at its search engine, stating that: “In fact, one in 20 Google searches are for health-related information … We developed this feature to help people find the health information they need more quickly and easily.”

Australian Medical Association federal vice-president Dr Tony Bartone said users should be “careful not to substitute health information for a qualified medical opinion”. Dr Bartone added that Google’s Health Cards could help patients refine questions for their doctor but medical professionals did not “want to end up with 50 reams of Google pages” brought into consultations.

Online health advice offers us a potential quick fix solution for ongoing health issues, enabling us to ease discomfort and anxiety. Considering this, Google Health Cards will no doubt be a feature that is used and appreciated by many. Though consultants have expressed concerns about confusion and misdiagnosis, is there the potential that this could boost OTC sales and allow people to avoid visiting consultants for minor issues?

AOMRC release list of 40 treatments that bring little or no benefit to patients

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The Academy of Medical Royal Colleges has released a list of over 40 treatments that bring little or no benefit to patients. The list is part of a campaign to reduce the number of unnecessary medical treatments.

Medical experts from 11 different specialties were asked to identify five treatments or procedures commonly used in their field that were not always necessary or valuable.

These have been used as part of the Choose Wisely campaign to highlight the need for patients and doctors to talk frankly about how health issues should be treated.

The advice suggests:

  • Tap water is just as good for cleaning cuts and grazes as saline solution
  • Small wrist fractures in children do not normally need a plaster cast, and will heal just as quickly with a removable splint
  • Children with bronchiolitis, or breathing problems, usually get better without treatment
  • Electronic monitoring of a baby’s heart is only needed during labour if the mother has a higher-than-normal risk of complications
  • Chemotherapy may be used to relieve symptoms of terminal cancer but it cannot cure the disease and may well bring further distress in the final months of life
  • Routine screening for prostate conditions using a test known as a Prostate Specific Antigen, or PSA test, does not lead to longer life and can bring unnecessary anxiety

ss_18694507_broken_arm_castThe Academy says there is evidence that patients often pressure doctors into prescribing or carrying out unnecessary treatments and the NHS is also coming under increasing pressure to reduce over-medicalisation – in other words the medicines and treatments it prescribes.

Alongside this list, for some time now, GPs have also been advised to cut back on prescribing antibiotics to patients. This will surely be a driver in the OTC market as patients may turn to self-medication if they are unable to get what they require under prescription.