UNSW appoints new Dean of Medicine

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Professor Vlado Perkovic, formerly Executive Director of The George Institute for Global Health, has been appointed Dean of Medicine at UNSW. He succeeds Professor Rodney Phillips, who will move to the new role of Pro Vice-Chancellor, Health within the Division of Enterprise at UNSW, after four and a half years leading the Faculty. After training as a general physician in internal medicine and specialising in nephrology at Royal Melbourne Hospital – “I loved hospital pace, but it was long hours and constant on call” – Professor Perkovic was pulled toward a career in medical research. He has since published more than 200 peer-reviewed papers, which have produced major findings identifying better ways to prevent and treat kidney disease, including multiple clinical trials and meta-analyses. “Medical schools have a mandate to help society move forward and tackle our collective challenges. To be progressive, address inherent disadvantages in the health system, harness underused technology, improve health care in remote areas and be a part of a global community that helps people wherever they live,” he says. “The development of UNSW’s partner hospitals in the south-east and south-west of Sydney is critical in allowing universities and researchers to connect with community. With these developments, we will be uniquely placed with the largest co-located health, innovation and education zone in NSW. This integration with adjacent Randwick hospitals will put the faculty at the forefront to deliver improved health care of the future.”

Codeine misuse in Australia reduced by prescription-only changes

The move to prescription-only codeine in Australia has seen a 50% reduction in the monthly rate of codeine-related poisoning calls and halved codeine sales, according to research led by the University of Sydney, published in Addiction. The study is the first peer-reviewed research to examine the short term implications of the removal of over-the-counter sales of low strength codeine in February 2018. In the 12 months following the changes, the researchers found a 50% reduction in the monthly rate of codeine-related poisoning calls; a 79% decrease in low strength poisoning calls with no significant change in high-strength poisoning calls (only low strength codeine products containing ≤ 15mg codeine per dose unit were affected by the legislative change); no significant increase in poisoning calls with other pharmaceutical opioids; and no significant change in the codeine dose taken in intentional poisonings. In the 14 months following the changes, the researchers also found: overall codeine sales halved; low strength codeine sales decreased by 87%; and no change in sales of higher strength preparations. Prior to the legislative changes, codeine was the most commonly used opioid analgesic in Australia, with consumption exceeding that of the United States despite Australia having a population 7% the size of the US.

A faster way to treat cancer?

Researchers from the Children’s Medical Research Institute were surprised to discover a new way that an enzyme in cancer cells, telomerase, acts to keep cancer cells multiplying. This could mean a faster way to stop cancer cells in their tracks. The research, published in Science Advances, was conducted by Tracy Bryan, who was initially skeptical of the findings. “We were very surprised at the direction this research took. I was very sceptical that telomerase could protect DNA in a way that we didn’t know about. However, our PhD student, Omesha Perera, convinced me that what we were seeing was an entirely new role for the hTERT component of telomerase in keeping cancer cells alive. The evidence was too strong to ignore.” Cells of the body naturally stop dividing after a certain number of divisions. Each time a cell divides, the protective tips at the end of DNA strands shorten and eventually the DNA itself frays and the cell dies. Cancer cells can continue to multiply past natural limits by using telomerase to lengthen the protective tips of their DNA. Because telomerase is quite specific to cancer cells, researchers have focused on suppressing its ability to lengthen the protective DNA tips. But so far, suppressing telomerase’s ability to lengthen cancer cell DNA has proved to be too slow for stopping cancer cells. “One of the disadvantages of suppressing only the known – catalytic – activity of telomerase is the lag-time that it takes for cancer cells to die. Even once you stop the telomerase’s catalytic activity, cells must still undergo many divisions before the DNA’s protective tips have sufficiently frayed enough for them to die. Inhibiting the catalytic activity of telomerase just isn’t fast enough. But this research has shown that the catalytic activity isn’t the only way that telomerase keeps cancer cells alive. We’ve shown that the hTERT component of telomerase works to actively recruit other proteins known to protect the cancer cell DNA. If you can simultaneously suppress the hTERT component from recruiting proteins at the same time you suppress telomerase’s ability to lengthen the DNA, it’s likely to make cancer cells die much more quickly.”

Experts advise against routine bowel cancer testing for all over 50s

Routine testing for bowel cancer should not be recommended for everyone aged 50–79 years because, for those at very low risk, the benefit is small and uncertain and there are potential harms, says a panel of international experts, writing in The BMJ. Most guidelines recommend screening for everyone from age 50 years, irrespective of their individual risk. At this age, the risk of developing bowel cancer over the next 15 years is typically 1–2%, meaning that in a group of 100 people with the same risk factors, one or two will develop bowel cancer within the next 15 years. The four most common screening options are home faecal testing (FIT) every year or every 2 years, sigmoidoscopy (examination of the lower colon) or colonoscopy (examination of the entire colon) at a clinic or hospital. Recently published research on the long-term effects of bowel cancer screening has shed new light on the benefits and harms, and has the potential to change current recommendations. An international panel of researchers, clinicians and patients reviewed the evidence base, including this new evidence, to evaluate the benefit-to-harm balance of screening using a “risk-based approach”. They took account of an individual’s cumulative risk of bowel cancer over the next 15 years together with risk of harm from the procedure (eg, bowel perforations, unnecessary treatment) and quality of life (eg, anxiety, burden of procedure), as well as a person’s values, preferences and life expectancy. Their recommendations apply to healthy individuals aged 50–79 years with a life expectancy of at least 15 years. For men and women with an estimated 15-year bowel cancer risk below 3%, they suggest no screening and say most informed individuals in this group are likely to decline screening. However, for men and women with an estimated 15-year bowel cancer risk above 3%, they suggest screening with one of the four options, and say most informed individuals in this group are likely to choose screening after discussing the potential benefits and harms with their doctor. The panel does not recommend any one test over another, but they found convincing evidence that people’s values and preferences vary considerably regarding whether to test and what test to have.

What’s new online at the MJA

Narrative review: Phage therapy for severe bacterial infections: a narrative review
Petrovic Fabijan et al; doi: 10.5694/mja2.50355
Activity against antibiotic-resistant pathogens and a lack of serious side effects make phage therapy an attractive treatment option to combat refractory bacterial infections … FREE ACCESS for 1 week

Podcast: Dr Aleksandra Petrovic Fabijan, and Associate Professor Ruby Lin, from the Centre for Infectious Diseases and Microbiology at Westmead Hospital, Sydney … OPEN ACCESS permanently

Podcast: Professor Ian Hickie, co-Director Health and Policy, at the Brain and Mind Centre, University of Sydney … OPEN ACCESS permanently



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