By Ben Plumley, Vice President, Global Access and Partnerships, Tibotec

33 million people worldwide are living with HIV, and 70% of those are in sub-Saharan Africa.

Sub-Saharan Africa countries – already some of the poorest in the world – do not have adequate financial and human resources to provide the services their citizens living with HIV need.

The healthcare capacity gap is one of the key themes of 2009′s World AIDS Day and World AIDS Campaign. A number of extraordinary innovative approaches to providing AIDS treatment and care have been developed in recent years. Whether it is through “Centers of Excellence” with state of the art treatment, training and research facilities, or community-led and managed providers of home based care, African solutions to particular African problems are now driving the response to HIV/AIDS.  

Uganda is a prime example of both hi-tech and low-tech approaches. The Infectious Diseases Institute (IDI) in Uganda’s capital, Kampala, is a leading East African center providing optimal care and prevention for HIV and AIDS and works to develop innovative approaches to health training. Operated by Makerere University, IDI is a non-governmental organization that offers a full spectrum of advanced HIV care, support, training and groundbreaking, globally respected research. The facility lab meets and indeed exceeds western standards, and its activities are conducted with highly trained and experienced treaters and researchers.

Not thirty minutes away, in the townships that surround Kampala, TASO (The AIDS Support Organization) is a world-renowned community-based organization that has a network of local clinics where people with HIV can collect their ARV regimens. They even have a cadre of young motor-bicycle based healthcare workers delivering ARVs and home-based care to clients unable to get to the local clinics.

For all healthcare workers across Africa, providing HIV treatment and care comes with unique challenges.  The priority over the last few years has been for first-line therapy. In coming years, a growing focus will be for potent and safe second-line treatment regimens, as some patients begin to build resistance to or fail their first-line treatments.  Companies like Tibotec can help by providing medical education either directly or through collaborations with public and private sector organizations, providing treaters and decision makers with accurate information about our medicines:

From Angela Chiu, Interactive Marketing Manager, Vistakon, Hong Kong

30 July 2009, building classrooms at Cherish

Most days at Cherish, we laid bricks for an hour or so before we were invited to join their daily morning prayer session. The children were between 1 year old to 10 years old, and all were carrying lovely faces, some smiled, some giggled, some laughed, some jumped, some danced…they were so energetic and lively.  No one could tell they were actually HIV-infected. 

I had a chance to speak one-on-one with Rachael Parson, a full time childcare manager. She told me that the children being taken care of in Cherish seldom fall very sick. The virus inside their bodies has been well contained.  This is an amazing result, and it comes not only because of being given the right antiretroviral treatment but also a well-rounded diet fueled by the self-sustained organic farming at Cherish. Most important of all, it’s the living hope and love being provided to these children. At Cherish, these children are embraced with a promise of future hope. The strength of that love and hope goes so far, it is able to cure and enliven them. I think every one of us can imagine that hope is a crucial factor to save one’s life; no treatment or doctor can cure if a patient loses hope.

The energy of these children also enlivened us!  We were also given hope and meaning to carry on the building.  After the prayer session, our energy level and morale were boosted.  A team member shouted to the group, “Look at these kids, let’s get the classroom done!” Yes, let’s get the classroom done so that their future can be embraced.

This amazing experience reminds me Hope Lodge Project, where I find incredible spirit of the patients in spite of dealing with the challenges of cancer treatment. 

Every now and then I hear about work that is being done by people in their own time that causes me to stop and think to myself, am I doing enough to help others?  Earlier this year, a coworker of mine contacted me to tell me about a trip she was taking to Africa – not to take in the sites, but to give something back to the communities.  She asked if she could share her experiences with the folks who read JNJBTW, and I was more than pleased to say yes.  The following post is the first of three that I have the pleasure to put up on the blog. Now, keep in mind, Angela’s trip to Africa and the work that she did there was not an official Johnson & Johnson project, but I felt it was important to share her accomplishments as an example of what people can do outside of their work lives when they set their minds to helping others.

From Anglea Chiu, Interactive Marketing Manager, Vistakon, Hong Kong

1 August 2009, classroom dedication at Watoto

When a coworker heard that I was going to Uganda to build a school, he said to me, “From an ROI perspective, it doesn’t make sense for you guys to go all the way from Hong Kong to Africa to build a school!  It’s much cheaper to employ local workers to do the building. Why don’t you all just donate the costs of the trip?  That makes better sense.” I kept silent at that moment because I had no idea how to answer. 

Before I enrolled in the trip to build a school in Kampala, Uganda, two friends had heard about it but were disappointed because they were not physically fit enough to join. Both of them were dealing with chronic health issues, not fatal, but serious enough to become obstacles to taking the essential vaccinations and medication that are pre-requisites for going to Africa. 

Similarly, about a week before I left for Uganda, I saw disappointed faces when a few colleagues were not able to give blood due to certain physical constraints; some were on medication, some were having other issues.

Their disappointments were a huge insight for me. A lot of people have the desire to help, because we would be rewarded by touching or improving others’ lives through our own abilities and resources. It makes us feel that we are a good person, at least not selfish, and we care. When this desire cannot be fulfilled, we find our good intentions, skills, talents and gifts are left dormant, these resources simply being wasted.    

From Bill Lin, Director, Corporate Contributions

With the majority of swine flu cases occurring in children and young adults, schools have become a battleground for the disease. School nurses and administrators play a crucial role in preventing the spread of the swine flu and responding appropriately to outbreaks of flu cases in their schools and districts so healthy kids can continue going to school.

The New Jersey Principals and Supervisors Association and Johnson & Johnson recently held a Swine Flu (H1N1) Preparedness Training Seminar to provide school health professionals and administrators with accurate information about the current pandemic and prevention methods, such as educating students about hand hygiene and what to do when a sick child comes to school. Videos from the training seminar are available on the health channel.

This video features Dr. Tom Kirsch, an Associate Professor and the Director of Operations for the Department of Emergency Medicine at the Johns Hopkins Bloomberg School of Public Health, talking about effective prevention strategies to stop the spread of swine flu in schools:

From Devon Prutzman, Director, WW Communications, Ortho-Clinical Diagnostics

Business ethics isn’t a new topic, but it does seem to take on particular relevance in light of today’s complex business environment. The tough challenges facing leaders in all sectors of society certainly aren’t going to be solved overnight and one Johnson & Johnson leader recently recognized the importance of helping current and future business leaders better understand the role of ethics in shaping the way they — and their organizations — do business.

I had the chance to watch Ortho-Clinical Diagnostics Company Group Chairman Nick Valeriani speak to members of the Rutgers University Institute for Ethical Leadership a few weeks ago on the topic of Creating an Ethical Organization and Dealing with Ethical Issues. Nick delivered the keynote address to more than 50 business students and business leaders for the first installment in the Ethical Leadership Speaker Series at Rutgers’ Business School campus in Newark, New Jersey. While he’s known for being an engaging speaker on any topic, it was clear that talking about ethics brought out Nick’s sense of passion about setting high standards for business leaders and for always doing the right thing. 

He began by discussing Our Credo and offering examples of how its values drive Johnson & Johnson’s business by encouraging “candid, transparent discussions to reach what we believe are the right decisions for our patients, our employees, our communities, and our shareholders.”  He talked about why building an ethical culture in an organization is important and shared some of the ethical challenges he has faced in his career, conceding that “it never gets easier to make these kinds of decisions as a leader. There are multiple sides to almost every decision and it takes a strong moral compass to stand by your values and make the tough calls.” 

He shared an example of making a tough call by reflecting on his decision to halt the U.S. launch and discontinue the international sale of a product gained through an acquisition. Nick acknowledged the disappointment of failing to deliver on a business objective, but said, “Once we understood what the data showed — that the product would not provide an additional benefit to patients, and in fact, could present additional risk – we knew we had a difficult choice to make. We held an honest and frank discussion about the options, but ultimately, the decision was clear: patients come first.” 

He went on to explore the concept of “ethical leadership” by pointing out that it’s important to value both sides of the equation.  A code of ethics that is created without leaders who commit to “ingraining honesty and integrity into the corporate culture is an empty ideal,” he said. “And leadership that doesn’t ground itself in a commitment to doing the right thing is destined to fail.” 

The audience responded to Nick’s candor and honesty with a barrage of questions, engaging in a thoughtful dialogue about how to instill ethical values in their own organizations and how to face difficult issues in companies that don’t have clear standards for ethical behavior. It was evident that his advice resonated with the audience and that they valued the opportunity to learn from someone who has spent more than three decades learning to lead in a values-driven culture.

He closed the talk by offering a simple piece of advice to the present and future leaders in the audience on creating an enduring ethical culture: “be authentic.” He stressed that the single most important thing a leader can do is lead by example, holding him or herself to a high standard and being transparent about personal values. “Have the courage not to compromise,” he said. “Your behavior speaks louder than your words.”

As I’ve mentioned before on this blog, though healthcare companies (like Johnson & Johnson) would like to take a more active role in the ongoing conversations online, most are still sitting on the sidelines. Why? Well, there are a number of reasons, but one of the biggest is that there is quite a bit of uncertainty about just what is appropriate under the current regulatory framework.

It’s all rather complicated, but in the US a lot of the uncertainty around how to engage online concerns how companies that sell highly regulated prescription medications and medical devices can do so and still meet their regulatory requirements to 1) report any side effects that people may experience while taking their products and 2) to ensure they don’t promote their products beyond what is covered in their approved product label. It may sound relatively straightforward, but the reality is that these requirements cause pause since there is no clear guidance from the regulator about what behaviors or approaches are frowned upon and which are acceptable.

This uncertainty has not gone unnoticed, and for the past two days the FDA has held a hearing on the subject. I’ve been sitting in a crowded (and increasingly hot) conference room WITHOUT WiFi watching a steady stream of presentations. It’s been an interesting series of presentations so far – and it will take a while to digest all that has been discussed.

For those unable to be at the hearing or watch the webcast, some of the presentations and testimonies made can be found over at Health Central. You can also follow the flow of information from the two-day meeting on Twitter at #FDASM. I’ve also been noticing some interesting posts on the events over the past two days from Mark Senak over at Eye on FDA.

Between suggestions for different regulatory approaches, thoughts around how technology can be used to spread information and discussions about who is responsible for what, one theme kept recurring –that through responsible engagement, companies can help address and even correct misinformation about their products online. This ultimately could help patients and physicians make informed health decisions.

Hearing this theme come up again and again made me smile. You see, when the hearing was announced, it set off a flurry of meetings and discussions with people from throughout Johnson & Johnson – from legal, regulatory, public affairs and marketing — to determine whether we would participate in the meetings and, if so, what we would say.

Though there was a lot of back and forth, one thing was clear to us – that the Internet and social media play an enormously important role in public health and health literacy and that through responsible behaviors and actions companies can – and should – help address confusing or inaccurate information online. We wanted to advocate for flexibility in the regulatory approach to online content so that companies can participate more fully, and in so doing add their voices to the online conversation with the benefit of helping to advance health literacy by providing accurate and credible product information in real time. By speaking at the hearing, we felt we could share some of our ideas about how companies like Johnson & Johnson could engage responsibly in this space.

And so yesterday, Liz Forminard from Johnson & Johnson’s legal department and Philomena McArthur from regulatory affairs for our pharmaceuticals group, stood before the FDA’s panel and provided some thoughts on behalf of the company.

What did they say?

Well, the transcript will be captured in the docket, but I thought I’d highlight a few things they touched on:

• Companies should not be held responsible for policing the whole of the Internet.
• There should be some flexibility in regulatory approaches online, and for more opportunities to take advantage of technological resources to get people accurate, credible and current information where and when they need it.
• Having clarity in regulatory approach to social media is critical to enable participation from healthcare companies that provide a valuable source of product information

There was, of course, much more said – but I think the key to all of this will be an ongoing dialog between companies, patients and the regulator to develop workable – and flexible — approaches that will enable companies to be part of this conversation.