1. The Healthy Option Is that the Route to Funding? Sport and Recreation Alliance Annual Conference 4 th May 2011 Dr William Bird MBE GP Intelligent Health Physical Activity Alliance

2. Meet Julie; she has PA deficiency

3. Julie’s dad has PA deficiency

4. Julie’s grandmother has PA deficiency

5. Symptoms of PA deficiency Increase risk of poor mood/low self esteem Weight gain Sallow Skin Poor Sleep Muscle wasting Constipation Increased falls (Elderly) Accelerated cognitive decline

6. Fitirex® Fitirex® is a natural supplement for PA deficiency In a practice of 10,000 about 6,600 have PA Deficiency. However 7100 believe they do not have deficiency Give Fitirex® to 60 men over 60 yrs with PA deficiency and every year one less will die compared to the control group

9. Fitirex Treatment 30% reduced risk of death 35% reduced risk in CVD CHD and Stroke 35% reduced risk in Type 2 Diabetes 35% reduced risk in Hip Fracture 80% reduced risk in Osteoarthritis Disability 30% reduced risk of Colon Cancer 20% reduced risk in Breast Cancer Reduced risk of Alzheimers Disease

10. Dose of Fitirex® Low Dose – elderly and those recovering from any illness – No previous encounter – Can be used to treat metabolic conditions Moderate Dose – Most treatments fall in this range High Dose – Only under trained supervision unless already taking regular dose

11. Side Effects of Fitirex® At low dose there are no known side effects Most side effects at moderate dose are minor musculoskeletal. High dose can cause musculoskeletal damage, immune deficiency, metabolic disturbance and possibly collapse. It is encourage to build up the dose slowly and review during this increase in dose.

12. Cost of PA deficiency Those with PA Deficiency have – 38% more days in hospital – 5.5% more family physician visits – 13% more specialist services – 12% more nurse visits A Total of 27 million people suffer from deficiency Total cost to NHS over £1 billion

13. Cost per Quality Adjusted Life Year Cost of Statin suppliment up to £17,000 Cost of Smoking Cessation up to £9515 Cost of Fitirex® suppliment up to £440 NICE recommend that a drug or intervention that costs up to £30,000 per QALY is justified 68 patients can be treated with Fitirex® for one intervention costing £30,000

14. GPs Choice Antidepressant Bisphosphonate Statin ACE Inhibitor Aspirin Beta Blocker NSAID Metformin Orlistat

15. HOW DO YOU SELL FITIREX TO A GP CONSORTIA? START WITH A DIAGNOSIS

16. Diabetes and Fitirex® – You just need to treat 6 people with Fitirex® to prevent those with impaired GTT from developing Diabetes.* – The equivalent is 10 for diet 6 for diet and Fitirex® 11 for anti diabetic drugs and 6 for Orlistat – Fitirex® can delay onset of diabetes for an average of 3.6 yrs even up to 14 yrs after intervention.** *Gillies et al BMJ 334 19 Jan 2007 **Li, G Lancet 2008; 371:1783-89

17. Hip Fracture and Fitirex In older women The Numbers Needed to Treat to prevent one hip fracture is estimated at 90 for bisphosphonates McClung MR, Geusens P, Miller PD, Zippel H, But a recent study of 160 women of which half were prescribed FITREX there were no hip fractures compared to five in the control group. Bensen WG, Roux C, New England Journal of Medicine 2002; 344: 333-340.

18. Pain in Osteoarthritis Although most GPs understand the importance of prescribing Fitirex® to control pain in Osteoarthritis. 29% from a recent study thought that rest was the best treatment. Although Fitirex® is recommended in NICE guidelines GPs are not told whether they should – refer patients – advise patients – or prescribe to patients

19. Depression and Dementia Fitirex® has similar effect than any other antidepressant and cognitive behavioural therapy and is considerably cheaper. A long term supplement of Fitirex® can delay the onset of dementia and can certainly increase independence in the elderly

20. Three ways to prevent heart disease. All have the same effect on a population

21. For £30,000 some prevent more heart attacks than others Prevents 38 Prevents 2 Prevents 1

22. Fitirex is the most cost effective Fitirex treats 38 Smoking Cessation treats 2 Statins treat 1

23. Investment favours B&C even though it is not as cost effective as A Physical Activity Smoking Cessation Statins

24. Record Outdoor Health Questionnaire

25. HOW DO YOU SELL FITIREX TO PUBLIC HEALTH? PEOPLE, PURPOSE, PLACE

26. People

27. Purpose

28. Place