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Nation-first pill testing trial at Canberra music festival
Australia’s first pill testing trial will be held at a music festival in Canberra later this year, prompting applause from drug reform advocates but concern from the Federal Government.
Revellers at the Spilt Milk festival in November will be able to have their illicit substances tested for purity and authenticity, and will have the option of safely disposing of the pills if they turn out to be not what they thought they had purchased.
ACT Health Minister Meegan Fitzharris said the testing would be provided free by the Safety Testing and Advisory Service at Festivals and Events (STA-SAFE), which is led by Harm Reduction Australia, Australian Drug Observatory, Noffs Foundation, DanceWize and Students for Sensible Drug Policy.
A similar proposal for another festival in May was denied.
Ms Fitzharris said the decision had been made after careful assessment of the STA-SAFE proposal, and of pill testing schemes in New Zealand and Canada.
“We need to find the right balance between letting young people know it’s illegal to take drugs, they can be very harmful, but also being realistic because we’ve seen deaths at festivals, five in 2015 alone, so if that helps to keep people safe, it’s worth doing,” Ms Fitzharris said.
“Pill testing means young people who are considering taking drugs can be informed about what’s really in their pills, and how potent they are, and it creates an opportunity to remind them of the risks before they make the final decision to take a drug.”
While the AMA has always supported a range of drug harm minimisation measures, AMA President Dr Michael Gannon raised concerns that the trial might send the wrong message.
“We do need to do better but we also need real evidence that something works,” Dr Gannon told The Project.
“And the last thing we would want to do is give people a false sense of security about taking illegal drugs cooked up in someone’s bath tub.”
The AMA is concerned that pill testing does not entirely remove the risks associated with taking illicit drugs, as people react to drugs differently, and may also be influenced by the amount of drug consumed, gender, age, weight and other substances consumed such as alcohol.
The announcement coincided with the launch of a new national TV and online advertising campaign cracking down on ice and party drugs, aimed at school leavers who are preparing to celebrate the end of their school education.
Federal Health Minister Greg Hunt said while the pill testing trial was a matter for the ACT Government, the Federal Government did not support it “as a matter of principle”.
“Saying that any drug is okay is not okay,” Mr Hunt told Weekend Sunrise.
“People can have a reaction to any drug. There are no safe illicit drugs, and I think that’s a very important message.”
Festival goers will be able to attend a medical tent and provide a sample of a drug to be tested using laboratory grade equipment for free.
After receiving the results, the person will have the option of keeping the pill or discarding it in an amnesty bin containing bleach.
Regardless of the test outcome, trained drug counsellors will warn festival goers about the health risks of illegal drugs.
Dr David Caldicott, an emergency medicine specialist and advocate for Harm Reduction Australia, said the move would stop people taking drugs and prevent deaths.
Research from overseas programs showed up to 60 per cent of people who had their pills tested went on to throw them away, he said.
ACT Chief Police Officer Justine Saunders said ACT Policing supported the program and had been actively working with ACT Government and stakeholders.
“ACT Policing will be patrolling the festival to ensure patrons enjoy the event in a safe environment,” she said.
“Police will not enter the health facility that contains the pill testing station unless requested to do so by festival organisers, security staff or emergency services or in response to an emergency situation.”
MARIA HAWTHORNE
[Editorial] A multisectoral approach to childhood development
On Sept 20, at Financing the Future: Education 2030, a high-level UN conference in New York City, NY, USA, international leaders pledged to end the global education crisis. Without immediate action, by 2030 an estimated 825 million of the 1·6 billion young people in the world will be unable to reach their full potential—a catastrophic failure to meet Sustainable Development Goal 4: inclusive and quality education for all. But investment in education alone is not enough. The Lancet Series on Early Childhood Development highlighted health, nutrition, child protection, and safe peer environments, in addition to education, as factors that contribute to ensuring success for young people.
Indigenous health, an AMA priority
The Federal Government needs to broaden its thinking when it comes to addressing the healthcare needs of Aboriginal and Torres Strait Islanders, because the current situation is unacceptable, according to AMA President Dr Michael Gannon.
Addressing the Australian Indigenous Doctors’ Association (AIDA) conference in the Hunter Valley in September, Dr Gannon said Indigenous doctors were vital to the health of Indigenous Australians.
“The AMA has said time and again that it is simply unacceptable that Australia cannot manage the health care of the first peoples, who make up just three per cent of our population,” Dr Gannon said.
“When it comes to Indigenous health, the Federal Government needs to broaden its thinking.
“For too long now, people working in Indigenous health have called for action to address the social issues that affect the health of Aboriginal and Torres Strait Islander people.
“Education, housing, employment, sanitation, clean water, and transport – these all affect health too.
“This is clearly recognised in the Government’s own National Aboriginal and Torres Strait Health Plan 2013-2023, yet we continue to see insufficient action on addressing social determinants.
“One message is clear – the evidence of what needs to be done is with us. There is a huge volume of research, frameworks, strategies, action plans and the like sitting with governments – and yet we are not seeing these being properly resourced and funded. We do not need more paper documents. We need action.
“The AMA recognises that Indigenous doctors are critical to improving health outcomes for their Aboriginal and Torres Strait Islander patients.
“Aboriginal and Torres Strait Islander doctors have a unique ability to align their clinical and cultural expertise to improve access to services, and provide culturally appropriate care for Indigenous patients.
“But there are too few Aboriginal and Torres Strait Islander doctors and medical students in Australia.”
AIDA used its conference to celebrate the organisation’s 20th anniversary and had a conference theme of Family – Unity – Success.
Dr Gannon congratulated AIDA on the anniversary, noting that it had “come a long way”.
He said Aboriginal and Torres Strait Islander people face adversity in many aspects of their lives.
“There is arguably no greater indicator of disadvantage than the appalling state of Indigenous health,” he said.
“Aboriginal and Torres Strait Islander people are needlessly sicker, and are dying much younger than their non-Indigenous peers.
“What is even more disturbing is that many of these health problems and deaths stem from preventable causes.
“The battle to gain meaningful and lasting improvements has been long and hard, and it continues.
“I am proud to be President of an organisation that has for decades highlighted the deficiencies in Indigenous health services and advocated for improvements.
“While there has been some success in reducing childhood mortality and smoking rates, the high levels of chronic disease among Indigenous people continue to be of considerable concern.
“For the AMA, Aboriginal and Torres Strait Islander health is a key priority. It is core business.
“It is a responsibility of the entire medical profession to ensure that Aboriginal and Torres Strait Islander people have the best possible health.
“It is the responsibility of doctors to ensure that patients – all patients – are able to live their lives to the fullest.”
This year, the AMA’s Report Card on Indigenous Health – to be released in November – will focus on ear health and hearing loss.
Aboriginal and Torres Strait Islander people in Australia suffer from some of the highest levels of ear disease in the world, and experience hearing problems at up to 10 times the rate of non-Indigenous people across nearly all age groups.
Hearing loss has health and social implications, particularly in relation to educational difficulties, low self-esteem, and contact with the criminal justice system.
The report card will be a catalyst for Government action to improve ear health among Aboriginal and Torres Strait Islander people.
Dr Gannon told the conference that at every opportunity, the AMA highlights the issues of housing, clean water, transport, food security, access to allied medical services, and other social determinants that contribute to chronic disease and act as barriers to treatment and prevention.
And he said the AMA will continue advocating for an increase in the number of Indigenous doctors in Australia.
“The AMA has been a persistent, sustained, and powerful voice on Indigenous health for decades,” he said.
CHRIS JOHNSON
PIC: Dr Jeff McMullen, Dr Michael Gannon, Charles Davison, and Karl Briscoe
Emergency department use in developed countries
A global study undertaken by George Washington University has evaluated the use of emergency departments in seven developed countries and has identified areas where efficiencies are needed.
The study, conducted with Royal Philips researchers, found that Australia has a low use of emergency departments when compared to Canada, the US, the UK, the Netherlands, Switzerland and Germany.
This finding points to Australia’s strong access to primary care resulting in less frequent use of emergency resources.
The paper, Acute unscheduled care in seven developed nations: a cross-country comparison, compares the similarities and differences across nations with a focus on care delivery and the impact of socio-economic factors.
The research from Philips and the GWU School of Medicine and Health Sciences reveals unsustainable ED use in some developed nations.
Better access to primary care can result in lower ED use.
The findings of the report show Germany (22 per cent) and Australia (22 per cent) as having the lowest ED use, likely resulting from better and faster access to primary care — nearly two-thirds of Australians (58 per cent) and three-quarters of Germans (72 per cent) were able to make same or next day appointments with their primary care physicians (PCPs) compared to less than half of Americans (48 per cent) and Canadians (41 per cent).
“In looking at the way emergency departments are used around the world, we were able to obtain valuable new insights to help improve care delivery,” said Jesse Pines, from GWU.
“Because of research findings presented in this report, all emergency departments, no matter their location, have the opportunity to efficiently improve the way care is delivered in emergency department settings.”
Kevin Barrow, managing director of Philips Australia and New Zealand said the research shows Australia ranked relatively well when it comes to hospital emergency department admissions.
“And (for) the cost of health care for both government and individuals, in comparison to other countries surveyed, reflecting the relative ease of access to primary care in our country,” he said
“However, the findings also identified a need to improve departmental efficiencies and increase activities to minimise the burden on acute care facilities, by continuing to focus on preventive care, chronic disease management and the education of patients on the appropriate care for their health needs.”
Data has been formulated into a list of key areas researchers say impact the way care is delivered in emergency settings, and the broad differences in available treatments across countries.
They include:
• Social determinants (smoking, eating, violence, substance abuse and poverty) have a strong impact on the use of EDs;
• Reduced access to health insurance results in poorer population health; placing a greater strain on emergency departments;
• Sick patients do not make the most efficient decisions about when and where to seek medical care;
• Extensive provider training is mandatory for effective delivery of acute unscheduled care; and
• Quality measures for EDs are immature and not standardised.
“There’s a belief that easy access to primary care can result in lower emergency department use,” said Mark Feinberg of Philips North America.
“However, as a result of this report, it is clear that even if people have easy access to primary care and full healthcare coverage, there is no guarantee the patients will make economically prudent decisions to seek the most appropriate medical care setting.”
The complete report can be accessed at: www.healthsystems.philips.com/acute-unscheduled-care
CHRIS JOHNSON
[Comment] Offline: The post-American age
Consider Singapore for a moment. In progress towards the health-related Sustainable Development Goals, Singapore ranks first out of 188 nations (the UK is tenth; the USA, 24th). In measures of the quality of medical care (the Healthcare Access and Quality Index), Singapore ranks 21st (the UK is 30th; the USA, 35th). In this month’s world university rankings, produced by the Times Higher Education, the National University of Singapore (NUS) was 22nd. NUS is now the leading university in Asia. Singapore, all 241 square miles of it, became a sovereign nation in 1965.
[Comment] Beating NCDs can help deliver universal health coverage
In WHO’s drive to ensure good health and care for all, there is a pressing need to step up global and national action on non-communicable diseases (NCDs), and the factors that put so many people at risk of illness and death from these conditions worldwide. By action, we mean coordinated action that is led by the highest levels of government and that inserts health concerns into all policy making—from trade and finance to education, environment, and urban planning. Action needs to go beyond government and must bring in civil society, academia, business, and other stakeholders to promote health.
[Global Health Metrics] Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning.
Tough toes a requirement in the bush
BY DR SANDRA HIROWATARI, CHAIR, AMA COUNCIL OF RURAL DOCTORS
Rural Doctors need to have fairly tough toes. They get stepped on so often. We know when our toes have been stepped on because it hurts. Stepping on rural doctors’ toes can take on subtle forms.
Role Substitution
Throughout Australia this is happening: nurse practitioners prescribing medications; pharmacists giving out medical certificates and flu shots; physician assistants doing colonoscopies. In the rural regions this role substitution was based on a dire need for manpower – understandable but if the doctor is there, please mobilise these role substitutes elsewhere. Further, it would be nice to let local rural doctors know and have a say in how the allied professionals will be liaising with us.
When another cook comes into the kitchen, it’s okay if we invited them. However it is toe crunching when they come into the kitchen, chuck out the soufflé, move the pots and pans around and tell the diners they cook better than we do. I ask you, is this going to motivate me to stay in the kitchen?
The other day a patient said she would wait for the visiting pap smear nurse to visit to get her routine pap smear done. Ouch. I am a pap smear queen. I travel with my pap equipment, what’s wrong with me, the good ol’ family doctor doing it?
The Non-Existent Discharge Summaries
Patients often come to us saying: “Back two or three months ago they cut out my appendix. You know, they must have told you.” Or: “They told me to get my blood pressure and sugars checked as soon as I got back home.” Or even: “Sorry, doc I just remembered I was supposed to show you my scar.” I cover for my hospital colleagues by saying their bookkeeping must be behind, I am glad they are okay, I regret that I did not know until this minute that they just about died two months ago.
Retrieval Service Extraordinaire
They swooped into my ED, looking through me as If I was not there, stern blue with flashy fluorescent stripes on their trouser side seams. Efficient, military precision, hardly saying a word. They pulled out the IV I had carefully started and replaced it. They took off the splint I fashioned and replaced it, hoisted my patient on their snap-snap stretcher and they were off. At one point I tried to introduce myself: “Hi, I’m Dr S….”. I think one of them nodded, never introduced themselves, never gave me a thump on my shoulders to tell me “well done”, and they did not tell me what was wrong with my IV and splint. Later I commented to the nurse they could have just kidnapped my patient. I have every confidence my patient is okay, but my toes hurt.
Rolled Up Eyes
Oh, that doctor from St Elsewhere put the patient on the wrong “xyz” drug, they missed the “abc” sign of the obvious disease called blankety blank. Yes we make mistakes, but we need the support from you, not the criticisms. When we catch our own failings, we step on our own toes in shame and self-recriminations. Can you be kind and advise us to not to crunch our own toes so hard? It will help keep us here in the outback healthy.
Continuing Medical Education
How do you think it feels to hear that nurses and medics who take the exact same rural procedural courses pay almost half what we do to attend? Do we pay more because we get a $2000/day stipend for taking rural procedural courses? Why should a rural GP spend precious Government funds on attending a course that has only the intrinsic value of less than the quoted price? Shouldn’t the course reflect the unique difficulty of the work of a rural medical officer and not the allied health provider? The Department of Health’s toes must hurt this time.
The Visiting Specialist
Please remember you are visiting. I live in this God-forsaken part of the world. Scabies, chronic suppurative otitis media, syphilis, rheumatic heart disease, post streptococcal glomerulonephritis, chronic disease management plans, is my meat and potatoes work. So how do you suppose my toes feel when a visiting team tells the community they have come to “clean up” the scabies, the CSOM, and get “caught up” with all the management plans? Hey guys, I am trying to do the same thing, with limited resources, could we join forces?
In the end it comes to patient care. It is their toes we are all looking after.
My gender and my degree
BY DR DANIKA THIEMT
The first documented English-speaking female doctor was Dr James Miranda Barry, a medical officer of the British Army between 1813 and 1865. Dr Barry devoted her life to the British Army, earning the highest medical rank available: Inspector General of military hospitals. In an era when academic professions were the sole privilege of male members of society, it was necessary for Dr Barry to conceal her gender, living and practising medicine as a man. Her sad reality was exposed only posthumously where examination revealed her secret. Even in death, she was denied her right to her true identity; her gender kept secret for a further 100 years.
In Australia, medical training was opened to women in the late 1800s, and our first female graduate was registered to practice in 1891. Female medical trainees are now thriving, with female medical graduates in Australia outnumbering men since the mid-1990s. Women currently make up more than two-fifths of vocational trainees, focused largely in obstetrics and gynaecology (74.5 per cent), paediatrics (72.8 per cent) and general practice (63.1 per cent). Contrast this to the figures from oral and maxillofacial surgery, intensive care and surgery and female trainees make up less than a third of trainees. How, when we see women making up half or more of medical graduates and provisional trainees, are we still seeing unequally representation in the ongoing workforce? What is happening along the way? How and why does a speciality that starts out gender-neutral result in a specialist workforce that is predominantly male?
Fixing gender inequity in medicine requires supporting women in leadership. Diversity in the boardroom enhances corporate performance and, to advance as a profession, we need to attract and retain female leaders. Female specialists, on average, earn 16.6 per cent less than their male counterparts. Although differences in average hours worked account for some discrepancies, other contributory factors include a lack of women in senior positions and a lack of part-time or flexible senior roles. There are already inspiring and engaged female leaders within our profession, leading the world in clinical practice, medical research and education. We should be harnessing their talent to inspire the next generation.
The changing demographic of our workforce could, in part, be to blame. Trainees are graduating from medical school later and spending more time in vocational training. This leads to greater family and social pressures on trainees and possibly an increase in the need for breaks or flexible training options. Evidence shows that access to flexible training helps to retain female trainees and is desired by both female and male trainees regardless of parental status. We need to dispel the belief that trainees must choose between career and family and instead focus on how we enable trainees to have both.
Gender inequity extends beyond medical workforce.Many of my female colleagues report being mistaken for nursing or allied health staff, a rare occurrence among my male colleagues. Similarly, senior female doctors are often overlooked by patients who prefer to talk to the male junior by her side. How do women thrive in medicine and become leaders when public perception seems to favour male doctors? I watch senior medical staff respond to “Miss” in conversation rather than the respectful “Dr”. Although this seems petty in the scheme of everyday practice, it is easy for female doctors to believe that our degrees come second to our gender. Although the actions of some do not make a rule, it is time that we stand together as a profession to advance women in medicine. It is time to advocate for female leadership not only in the eyes of the profession but also in the eyes of the public.
Equity isn’t about creating a false forced equality. We aren’t all equal and that should be celebrated. It certainly shouldn’t hold us back. Opportunities to become leaders won’t be taken by all of our trainees, but they should be provided to all, regardless of gender.
(A version of this article first appeared in Emergency Medicine Australasia in 2016.)