Slater and Gordon health grants open

Invitations are being invited for this year’s Slater and Gordon Health Projects and Research Fund grants.

The law firm opened its 2017 grants applications process on July 3 and will close them on 17 August.

AMA members have been invited to apply for eligible projects.

Small grants of up to $3,000 are available to support the continuing education of medical and allied health professionals seeking to enhance their expertise in caring for and treating patients or clients in these areas.

The Fund also provides grants of up to $25, 000 to eligible not-for-profit organisations in Australia and the UK that focus on illness and prevention and the improvement of treatment and care for people with: an asbestos related disease; a occupational caused cancer; or significant disability caused by catastrophic spinal cord or brain injury.

The Fund has provided $300,000 in grants for medical research and health projects since it was established in 2014.

The Fund was built on the Slater and Gordon Asbestos Research Fund, which provided $1.4 million towards education, medical research, and other projects designed to improve the treatment of people who have an asbestos related disease.

Further details on the grant should be directed to the Manager of Secretariat, Ms Suzy Mallet on 03 8644 8466 or researchfund@slatergordon.com.au

Grants to help country practices

The Federal Government has given $13 million in grants towards general practices in regional Australia, to enable more doctors, nurses and other health professionals to complete their training there.

Assistant Health Minister David Gillespie recently announced that grants of up to $300,000 each have been offered to successful applicants across Australia to upgrade their facilities and allow for more training in country practice.

The grants must be matched by the selected practices.

“These grants will enable more doctors and other health professionals to get their hands-on training in regional communities,” Dr Gillespie said.

“That provides an immediate benefit to the communities, with more health professionals available to attend to their needs.”

The grants will be used to expand practice facilities with additional consultation rooms and space to allow for more teaching. Grants will also be used to create meeting rooms where patients can receive education about health conditions, such as diabetes, so they can take a more active role in managing their own health.

As well as construction or renovation, they may be spent on fit out, computing technology or medical equipment.

“In the longer term, it also makes it more likely that junior doctors will choose to stay in these or other rural communities, when they are fully qualified,” the Minister said.

“The Government supports a strong primary care workforce that can meet Australia’s future healthcare needs.

“Improving access to doctors and other health professionals in rural and regional Australia is a priority for our long term national health plan.”

The list of successful applicants is available on the Department of Health’s website www.health.gov.au. The successful applicants will receive their grants during 2016-17 and 2017-18.

CHRIS JOHNSON

More than 5,000 new FGM cases reported in England

The National Health Service (NHS) in the United Kingdom has recorded 5,391 new cases of female genital mutilation (FGM) in the past year.

NHS Digital has released the second annual FGM figures for England. It has shown almost half involved women and girls living in London, with a third being women and girls born in Somalia, while 112 cases were UK-born nationals.

Most of the cases were spotted by midwives and doctors working in maternity and obstetric units.

The practice is illegal in the UK, as it is in Australia. The UK has also legislated so it is compulsory for family doctors, hospitals and mental health trusts to report any new cases in their patients. Intentionally altering or injuring the female external genitalia for non-medical reasons carries a sentence of up to 14 years in jail.

The majority of cases originally had FGM done to them abroad and as a young child, however, 18 of the newly recorded cases that year took place in the UK.

Ms Meg Fassam-Wright, the acting director of the UK’s National FGM Centre, said it was important that the cases were being identified so the data could help provide a clearer picture of FGM in England.

“These are often cases of women who have had FGM a number of years ago and that their health needs and other needs are potentially being identified through the collection of this data, so we can plan for the future better because these women – some of them – will have long-term health problems as a result of FGM,” Ms Fassam-Wright said of the report.

Wendy Preston, the head of nursing at the Royal College of Nursing, warned that the fall in the number of school nurses in recent years was detrimental to efforts to tackle the issue, and called on the government to attract and retain school nurses.

“The Government must act to attract and retain school nurses, to help address the problem at grassroots level, and maintain momentum in the fight to eradicate FGM,” she said.

The AMA has developed a position statement condemning FGM and noting that any medical practitioner who engages in the practice of any form of female genital mutilation is guilty of professional and criminal misconduct.

The AMA also recognises the need for increased training and education for doctors in identifying and treating women and girls who have undergone FGM, and recommends the inclusion of FGM training in tertiary medical curricula. The position statement can be found at: position-statement/female-genital-mutilation-2017

MEREDITH HORNE

[Viewpoint] Israel: a start-up life science nation

Advances in biomedicine are the product of a combination of research, technological progress, and innovation. The environment needed to promote such progress includes strong academic education and research, vibrant health and hospital systems, an entrepreneurial culture, and the appropriate industrial infrastructure. Senor and Singer1 provide a detailed analysis of the reasons for the surge of technology-based companies in Israel—what they call a start-up nation. In this Viewpoint, we examine the development of Israeli life science research and associated industry and analyse the reasons Israel has become a life science start-up nation.

[Series] Maternal and child health in Israel: building lives

Israel is home to a child-oriented society that values strong family ties, universal child benefits, and free education for all children from 3 years of age to school grade 12. Alongside the universal health-care services that are guaranteed by the National Health Insurance Law and strong, community-based primary and preventive care services, these values have resulted in good maternal and child health. In 2015, infant and maternal mortality (3·1 deaths per 1000 livebirths and 2·0 deaths per 100 000 livebirths, respectively) were lower than the mean infant and maternal mortality of countries within the Organisation for Economic Co-operation and Development.

[Perspectives] Rafael Beyar: a meeting of medicine, science, and technology

Rafael Beyar is a medic who embodies the entrepreneurial spirit of Israel. As an author in the Lancet Israel Series, Beyar writes about Israel’s start-up culture. His outlook is shaped by his vision of “the whole circle of building the concept of medicine, engineering, science, and humanity, intertwined around the patient”, he says. “For the past 11 years I have been director of Rambam Health Care Campus. My goal from the beginning was to take the great clinical infrastructure that we have at the hospital, and the great science, and the great engineering abilities at the Technion, and to combine them in a unique institution that brings together medicine, engineering, and science, through education,” Beyar explains.

Medicinal cannabis – still a lot of misinformation

BY AMA VICE PRESIDENT TONY BARTONE

It seems hardly a week goes by without a news story on medicinal cannabis or a media interview request on the subject.

However,despite all of the information, the amount of misinformation in the general community is significant and at times is very concerning. Many in the media believe that it is currently possible to go to your local GP and have medicinal cannabis prescribed for chronic pain. If not; why not? Presumably the patient would then go down to the local pharmacist and have it dispensed. Journalists are amazed when told that there are both State and Federal government laws and restrictions that still present significant barriers and that these restrictions need to be adhered to.

Medicinal cannabis certainly has had a very political and community driven introduction in this country. Things have been moving quickly, beginning with the passage of legislation in November 2016 involving the Therapeutic Goods Administration. Since that time, medicinal cannabis no longer falls under Australia’s most stringent of schedules – reserved for dangerous drugs – thereby allowing for provisions to be put in place to use cannabis on medical grounds.

Just this month we have had a Senate vote to increase the ease of availability of all forms of medicinal cannabis for terminally ill patients. Some have described this as a political stunt and posturing. In essence, moves in this space are happening so quickly that it is quite likely opportunities and processes are evolving that render the recent Senate amendments potentially unnecessary.

More importantly and perhaps of more concern is that the usual guidelines and requirements for the introduction of new medications seem to have been forgotten in respect of medicinal cannabis. It seems that safety and concern for rigorous, clinically proven guidelines are dispensed with – all in the name of compassion for a patient population who are just as deserving of the same standard of care as the rest of the community when it comes to safety and harm minimisation. It seems that all the tenets of our world-class system have been forgotten and are suddenly archaic and of little value in the face of a voracious community perceived need. This is spurred on by numerous media stories featuring long-suffering patients and their families who are forced to access the illegal black market.

Under the TGA Special Access Scheme, some forms of medicinal cannabis are already available. This scheme provides for the import and supply of an unapproved therapeutic good to individual patients on a case-by-case basis.

What also has been forgotten in all of this is that there is a significant amount of State legislation to be complied with. The States and Territories will decide whether medical cannabis will be made available – and more importantly, which type of patients will be able to use it. Some States and Territories have indicated they will list the conditions (e.g. QLD: Legal for specialists to prescribe for some patients; NSW: Available for adults with end-of-life illnesses; VIC: Available for children with epilepsy) The TGA is currently undertaking significant amount of education and information sharing with the medical community. This is especially necessary when a large portion of the media reporting is on access to prescribers and the relatively small numbers of prescribers or applications to prescribe. This is not surprising when clinical guidelines are in a state of evolution and there is uncertainty among many doctors about who should be eligible. Right from the beginning we have also maintained that there needs to be great clarity around how the medical cannabis system will operate. There is a paucity of information from the Government, which is adding to the confusion.

The AMA has many other concerns.So much still remains to be clarified. Information about either the dosage or form of medicinal cannabis needs to be available to patients. In countries that have medical cannabis (Canada, Holland, Israel) there are only a few types of cannabis available and they are packaged and dispensed like any other pharmaceutical product, with information on strength, use, dosage etc. The different types of cannabis are prescribed for designated medical conditions. It is not yet clear how medical cannabis will be dispensed. Is it to be dispensed through pharmacies, secure home delivery or from nominated GPs?

It is also not yet clear who will be able to approve medical cannabis prescribing and whether doctors will need to undertake additional training to become an “approved” cannabis prescriber/dispenser. The AMA has been told that modules are being created for doctors, but we don’t know exactly how or where this will be implemented.

There are some pharmaceutical cannabis products already approved by TGA (like Sativex) and controlled and standardised herbal cannabis, such as the products produced in the Netherlands. The system may be so convoluted and complicated for patients and prescribers that it won’t be able to fulfil the reason it was established and patients may continue to use the black market.

The recent Senate vote effectively means the Senate has supported an amendment to therapeutic goods laws to change category A of the Special Access Scheme for cannabis. The effect of this will speed access to medicinal cannabis for people with a terminal illness. What this means is that from now on, a patient can go and see a doctor who can order medicinal cannabis for that patient if they have a terminal illness. If medicinal cannabis is not available in Australia, they can obtain it from overseas. This is most concerning in terms of guaranteeing safety and efficacy of the product imported. Doctors will only need to notify the TGA within a 28 day period.

What is needed is for the current consultative processes between TGA, Federal and State Governments with the appropriate stakeholders to continue. A lot has been achieved in a very short space of time. However, safety and reliability of product as well as clear clinical guidelines for use need to be firmly developed and supported by clear information sharing and training of doctors concerned. Politics should not be allowed to influence and certainly media and community information needs to be facilitated so that expectations do not exceed practicality.

Tobacco control in the spotlight at AMA national Conference

AMA President Dr Michael Gannon announced the AMA/ACOSH National Tobacco Control Scoreboard 2017 at the AMA National Conference.

Queensland topped the AMA/ACOSH National Tobacco Control Scoreboard 2017 as the Government making the most progress on combating smoking over the past 12 months.

Queensland narrowly pipped New South Wales for the Achievement Award, with serial offender the Northern Territory winning the Dirty Ashtray Award for putting in the least effort.

Judges from the Australian Council on Smoking and Health (ACOSH) allocate points to each State and Territory in various categories, including legislation, to track how effective government has been at combating smoking in the previous 12 months.

Dr Gannon described the results however as disappointing because no jurisdiction scored an A this year, suggesting that complacency has set in. He also said that it is disappointing that so little progress has been made in the Northern Territory over the past year.

“Research shows that smoking is likely to cause the death of two-thirds of current Australian smokers. This means that 1.8 million Australians now alive will die because they smoked,” Dr Gannon said.

“It is imperative that governments avoid complacency, keep up with tobacco industry tactics, and continue to implement strong, evidence-based tobacco control measures.”

The judges praised the Queensland Government for introducing smoke-free legislation in public areas, including public transport waiting areas, major sports and events facilities, and outdoor pedestrian malls, and for divesting from tobacco companies.

However, they called on all governments to run major media campaigns to tackle smoking, and to take further action to protect public health policy from tobacco industry interference.

The Northern Territory, a serial offender in failing to improve tobacco control, has been announced as the recipient of the AMA/ACOSH Dirty Ashtray Award for putting in the least effort to reduce smoking over the past 12 months.

It is the second year in a row that the Northern Territory Government has earned the dubious title, and its 11^th “win” since the Award was first given in 1994. More than 22 per cent of Northern Territorians smoke daily, according to the latest National Drug Strategy Household Survey, well above the national average of 13.3 per cent.

“It seems that the Northern Territory Government still does not see reducing the death toll from smoking as a priority. Smoking is still permitted in pubs, clubs, dining areas, and – unbelievably – in schools,” Dr Gannon said.

The Northern Territory Government has not allocated funding for effective public education, and is still investing superannuation funds in tobacco companies.

A full list of the State and Territory results can be found on the AMA website: media/amaacosh-national-tobacco-control-scoreboard-2017-topped-qld

Meredith Horne

PICTURE: Dr Robert Parker, President AMA, NT collects the Dirty Ashtray Award from Dr Michael Gannon.

Future Leader Receives AMA Award

A junior doctor and researcher, whose experiences as the child of refugee parents inspired her to establish a health promotion charity for migrants, refugees, and asylum seekers, has won the AMA Doctor in Training 2017 Award.

Dr Linny Phuong, a Paediatric Infectious Disease Fellow at the Royal Children’s Hospital Melbourne, was presented with the award by AMA President Dr Michael Gannon at the AMA National Conference 2017 in Melbourne.

Dr Phuong is the second winner of the Award, which was introduced in 2016 to recognise outstanding leadership, advocacy, and accomplishments of a doctor in training. The recipient is awarded a place at the AMA’s Future Leaders Program.

Dr Gannon praised Dr Phuong, the founder and director of the Water Well Project, for her contributions to teaching, medical education, research, and doctors’ wellbeing, as well as her professionalism and compassion towards children and their families.

“Dr Phuong exemplifies the characteristics of a caring doctor, an inspiring leader, and a tireless philanthropist and humanitarian,” Dr Gannon said.

Dr Phuong is highly regarded by her peers at the Royal Children’s Hospital where, as Deputy Chief Resident, she is in charge of the doctors’ wellbeing portfolio. She is also a successful medical researcher, having published several papers.

Dr Gannon also paid tribute to Dr Phuong’s awareness of the many challenges faced by refugee families in accessing health services, noting that five years ago, she founded the Water Well Project, a not-for-profit health promotion charity which improves the health and wellbeing of migrants, refugees, and asylum seekers by providing health literacy support and education.

Meredith Horne

Study questions whether older doctors are wiser

An observational study published in the BMJ has investigated whether the outcomes of patients admitted to hospital differ between those treated by younger and older doctors.

The Harvard study was undertaken because the relation between a doctor’s age and performance remains largely unknown, particularly with respect to patient outcomes. Clinical skills and knowledge accumulated by more experienced doctors can lead to improved quality of care. Doctors’ skills, however, can also become outdated as scientific knowledge, technology, and clinical guidelines change.

The conclusion to the research suggests you’re likely to live longer when treated by someone under 40.

The researchers are keen to stress that their findings should be regarded as exploratory. Nonetheless, they highlight the importance of patient outcomes as one component of an assessment of how a doctor’s practices change over a career. The purpose of continuing medical education is to ensure that doctors provide high quality care over the course of their careers.

The study, performed at acute care hospitals in the U.S between 2011 and 2014, looked at patient readmissions, the costs of care, and deaths within 30 days of being admitted to the hospital.

The difference in patients’ 30-day mortality rates were 10.8 per cent when they were treated by a doctors under the age of 40, compared to 12.1 per cent for doctors aged 60 and up.

There was an exception: for older doctors who were treating high volumes of patients, age did not translate to higher mortality in patients.

Dr Yusuke Tsugawa, the study’s author said, older doctors bring experience because they’ve been practicing a longer time, but younger doctors have more current clinical knowledge.

“A lot of patients have a perception that older doctors give better quality of care. But previous studies, multiple studies, have shown that younger doctors have more aptitude. We found those treated by younger doctors had significantly lower mortality compared with those treated by older doctors,” Dr Tsugawa said.

“Medical technologies are evolving all the time and it might be harder for older doctors to keep up with the evidence. And new guidelines are updated every five to 10 years. Newer doctors train based on the newest evidence and skills and technologies. Therefore, they may be more up-to-date when they start providing care.”

Meredith Horne