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Preference: Government and politics

Expert Panel for Life Saving Drugs Program

The Government has appointed Australia’s former Deputy Chief Medical Officer Dr Tony Hobbs as chairman of the Life Saving Drugs Program Expert Panel.

In announcing the appointment, Health Minister Greg Hunt said the panel was being established to help improve access to lifesaving medicines for rare diseases.

The Life Saving Drugs Program (LSDP) provides free medicines to treat patients with rare and life-threatening diseases.

Medicines funded through on the LSDP include some high cost medicines that do not meet the criteria to be funded on the Pharmaceutical Benefits Scheme.

Currently, the Government funds 13 different medicines for nine very rare diseases through the LSDP, providing physical, emotional and financial relief for people and families in need.

The LSDP supported 393 patients in 2016-17 at a cost of $116 million and over the past six years the number of patients accessing these medicines through the program has grown over 65 per cent.

“The new expert panel will support the evaluation of medicines for funding and provide advice to the Chief Medical Officer,” Mr Hunt said.

“The diverse experience of the appointees will ensure that the program is supported by some of the very best minds in evidence evaluation and health technology assessment.”

Other members of the six-member panel will include clinical experts Professor Jonathan Craig and Professor Elizabeth Elliott, health economist Adjunct Professor Jim Butler, consumer nominee Nicole Millis and industry nominee Liliana Bulfone. 

Dr Hobbs’ appointment is for four years, with the new expert panel members’ terms varying from two to four years.

“Highly respected in their fields, this group will make a major contribution in considering the suitability of new medicines for inclusion on the LSDP through advice to the Commonwealth Chief Medical Officer,” Mr Hunt said.

Other recent changes to the LSDP include clearer eligibility criteria for inclusion on the LSDP, a more transparent and timely assessment process, new pricing policies similar to those that apply to PBS medicines, and the review all of the currently funded LSDP medicines.

The changes follow the Government response to a review of the LSDP chaired by Professor Andrew Wilson.

  

Russians who meddled in US election also messing with American vax debate

The same Russians trolls who interfered with the US election are also spreading misinformation about vaccines, according to research from Washington DC.

Scientists at George Washington University have recently released a study in which they found Russian trolls and bots flooding Twitter and other social media outlets as part of the immunisation debate.

The discovery was made while the scientists were researching ways to improve communication methods for American health workers.

They were amazed to find extensive deliberate misleading content being spewed online in attempts to skew the debate and dissuade consensus over vaccinations.

Further digging uncovered that several false online accounts belong to the same Russian trolls who meddled with the 2016 US election. Malware bots were also being used.

But, in further evidence of deliberate efforts to confuse the situation, the trolls tweeted both pro- and anti-vaccine content, according to the researchers.

“The vast majority of Americans believe vaccines are safe and effective, but looking at Twitter gives the impression that there is a lot of debate,” said Assistant Professor David Broniatowski of GWU.

“It turns out that many anti-vaccine tweets come from accounts whose provenance is unclear. These might be bots, human users or cyborgs – hacked accounts that are sometimes taken over by bots. Although it’s impossible to know exactly how many tweets were generated by bots and trolls, our findings suggest that a significant portion of the online discourse about vaccines may be generated by malicious actors with a range of hidden agendas.

“We started looking at the Russian trolls, because that data set became available in January. One of the first things that came out was they tweet about vaccines way more often than the average Twitter user.”

The research states that trolls tweeted on vaccines about 22 times more often than regular Twitter users.

A random sample of 1.7million tweets was collected between July 2014 and September 2017 was examined. Non-vaccination rates of children in the US is climbing.

Some of the misinformation – and deliberate lies – that are being tweeted talk of “vaccine damaged children” and a “secret government database”. Other tweets link the debate to God, race, and even animal welfare.

Click baits were also used, encouraging social media users to click on advertisements and other content, only to be diverted to malicious messaging about immunisation.

Earlier this year, Twitter deleted 3,800 accounts linked to the Russian government-backed Internet Research Agency, which is the same group researchers at GWU examined.

The researchers didn’t examine Facebook, but in the face of damming criticisms this year of the social media giant’s operations, it removed 135 accounts in April linked to the Internet Research Agency.

More recently, Facebook removed another 650 fake accounts linked to Russia and Iran that appear to have be set up purely to spread misinformation.

The study is published in the American Journal of Public Health.

 

 

 

WMA backs Turkish medical leaders

The World Medical Association (WMA) has called for the reinstatement of the leaders of the Turkish Medical Association (TMA) following their dismissal by the Turkish Government.

The dismissal comes on top of the removal of the TMA Secretary General, Dr Bülent Nazim Yilmaz, from his duty as a public servant, and the termination of family medicine contracts of TMA Council members.

WMA Secretary General, Dr Otmar Kloiber, urged the President of Turkey to intervene to stop these unwarranted attacks on leading members of the medical profession.

Earlier this year, the TMA issued a press statement declaring that ‘War is a Public Health Problem’, a self-evident fact that war causes major health problems.

Dr Kloiber said the TMA statement is in line with WMA policy and the widely-held belief that war should be avoided wherever possible because of its impact on health.

“We are appalled at the way leading members of the TMA have been treated over the past few months,” Dr Klober said.

The TMA has a proud record of upholding human rights and denouncing all violence.

 

England to stop selling energy drinks to kids, no bull

The UK Government is banning the sale of high-sugar, high-caffeine energy drinks to children in England.

Concerns have flared across Britain in recent years over the damage energy drinks are doing to children and teenagers; and a consultation process was implemented to determine the best way to prevent sales to minors.

Prime Minister Theresa May said the consultation formed part of the government’s strategy to tackle childhood obesity.

Energy drinks such as Red Bull and Monster Energy are often sold at cheaper prices than soft drinks in the UK, placing consumption of them by children in that country about 50 per cent higher than that of those in other European nations.

Some large retailers in Britain have already banned sales of energy drinks to young people.

But according to government figures, two-thirds of children aged 10 to 17 and a quarter of those aged six to nine currently drink them.

Government figures also state that sugared energy drinks have 60 per cent more calories and 65 per cent more sugar than regular soft drinks.

However, it is the high level of caffeine in energy drinks that is being used as the major justification for the ban.

Hyperactivity, sleeping problems, headaches and stomach aches in children are often linked to the consumption of energy drinks.

According to reported statistics, a 250ml can of Red Bull contains about 80mg of caffeine, which is about three times that found in a 500ml can of Coca-Cola.

The ban will apply to drinks containing more than 150mg of caffeine per litre.

The Conservatives in the UK have taken numerous productive steps in relation to childhood obesity, having already introduced a tax on sugary drinks.

In Australia, no such action has been taken or appears to even be considered.

Instead, the Coalition Government in Canberra has backed a much criticised pledge from the soft drink industry to reduce sugar content in its drinks by 20 per cent by 2025.

The AMA wants the Government to introduce a tax on sugary drinks in Australia.

The AMA has a policy of price differentiation making a difference to people’s behavior.

 

 

 

[Correspondence] Brazil’s health catastrophe in the making

Brazil’s political and economic crises are diverting attention from the resumption of a neoliberal model of health care by its government. Here we briefly summarise the health reforms and their likely long-term implications. The new policies can be seen from three perspectives: austerity, privatisation, and deregulation.

Green light from Committee for Gold, Silver, Bronze, and Basic

The Federal Government’s proposed private health insurance policy reforms look set to become law this year after a Senate Committee recommended passing the Bills.

The Committee investigating the new Gold, Silver, Bronze, and Basic policy proposals made just one recommendation when it reported in the first sitting week of the Spring session of Parliament – “that the Senate pass the Bills”. 

Committee Chair, Liberal Senator Slade Brockman, said that the Committee recognised that some people still had concerns about the policy categories, and the rules that will implement the product reforms.

“Some submitters disagreed with the inclusion of a Basic policy,” Senator Brockman said.

“CHOICE, the Australian Medical Association, the Australian Private Hospitals Association, and Day Hospitals Australia objected to the category on the basis that these policies provide low value cover to consumers, and exist to take advantage of the financial incentives provided by Government.

“Submitters also expressed concerns that, if the draft rules were adopted, particular products or services may only be available in high product tiers. For example … the AMA considered that, as 50 per cent of pregnancies are unplanned, pregnancy should be covered in Bronze rather than Gold.”

Senator Brockman said that the Committee understands that private health insurance can be a complex product that is confusing to many people.

AMA President, Dr Tony Bartone, appeared before the Committee in August, and told it that even doctors were confused by the array of choices and policies on offer.

“It is for that reason that we support the concept of developing Gold, Silver, and Bronze insurance categories,” Dr Bartone told the inquiry.

“Doctors are intelligent people. But I can tell you that we are all bewildered by the many different definitions, the carve-outs and exclusions from some 70,000 policy variations.

“That’s not my figure – it’s the Government’s. It’s unbelievable. No wonder we’re always being caught out.”

The Committee called for a public information campaign to help consumers understand the product design reforms, saying that would allow more consumers to be better informed about the different tiers and their inclusions.

Greens Senators Richard di Natale and Rachel Siewert lodged a dissenting report, arguing that the reforms would have little effect in improving the sustainability of the market.

“What we are instead seeing is an ideological commitment to throw good money after bad,” they said.

“The private health system operates only through the generosity of vast public subsidies of more than $6.5 billion each year. There is no argument that, without these subsidies, the market would collapse.”

Labor Senators Lisa Singh and Murray Watt also raised concerns that the reforms could have unintended consequences, including making it easier for insurers to cancel policies and harder for Australians to afford care when they need it.

“Labor Senators therefore support calls by the Australian Medical Association, Australian Healthcare and Hospitals Association, and others for the measures in this Bill to be reviewed after implementation,” they said.

They endorsed the main report’s recommendation to pass the Bills, ensuring their passage through the Senate.

The Government is expected to move to finalise the legislation in the Spring session.

The Committee report is available at https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/PrivateHealthInsur2018.

Allergy funding not to be sneezed at

The Federal Government has announced it will invest more than half a million dollars in projects to improve the lives of Australians who live with allergies.

It will fund projects identified as part a National Allergy Strategy, which was developed by the Australasian Society of Clinical Immunology and Allergy and Allergy and Anaphylaxis Australia.

Projects include development of standardised food allergy content to be included in all accredited food hygiene courses, and the development of online resources for teens and young adults with allergies to share their experiences.

Another project will determine how to improve access to care for people with allergic conditions, particularly those in rural and remote areas.

Allergies can have significant adverse effects on the quality of life and overall health of people, and affect about 20 per cent of the Australian population living with allergies.

About 4.5 million Australians are affected by hay fever and allergic rhinitis, while one in 20 Australian children and one in 50 adults has a food allergy.

 

Under pressure – new ‘Triple Pill’ for hypertension

A new low dose three-in-one pill to treat hypertension could transform the way high blood pressure is treated around the world.

A trial led by The George Institute for Global Health revealed that most patients – 70 per cent – reached blood pressure targets with the ‘Triple Pill’, compared to just over half receiving normal care.

With high blood pressure the leading cause of disease burden worldwide, it’s expected the findings, published in JAMA, will change guidelines globally.

The George Institute’s Dr Ruth Webster said this was a major advance by showing that the Triple Pill was not only more effective than standard care, it was also safe.

“It’s estimated that more than a billion people globally suffer from high blood pressure, with the vast majority having poorly-controlled blood pressure.

“Our results could help millions of people globally reduce their blood pressure and reduce their risk of heart attack or stroke,” Dr Webster said.

The researchers tested an entirely new way of treating hypertension by giving patients three drugs, each at half dose, in a single pill for early treatment of high blood pressure.

Traditionally, patients begin treatment with one drug at a very low dose, which is increased over time with additional drugs added and increased in dosage to try to reach target.

Dr Webster said that patients are brought back at frequent intervals to see if they are meeting their targets, with multiple visits required to tailor their treatments and dosage.

“This is not only time inefficient, it’s costly,” she said.

“We also know that many doctors and patients find it too complicated, and often don’t stick to the process. This new approach is much simpler, and it works.”

The trial, which was conducted in Sri Lanka, enrolled 700 patients with an average age of 56 and blood pressure of 154/90 mm Hg.

Patients were randomly assigned to receive either the combination pill or usual care – their doctor’s choice of blood pressure lowering medication. The Triple Pill consisted of the blood pressure medications telmisartan (20 mg), amlodipine (2.5 mg), and chlorthalidone (12.5 mg).

Compared with patients receiving usual care, a significantly higher proportion of patients receiving the Triple Pill achieved their target blood pressure of 140/90 or less (with lower targets of 130/80 for patients with diabetes or chronic kidney disease).

At six months, 83 per cent of participants in the Triple Pill group were still receiving the combination pill compared to the majority of patients in the usual-care group still receiving only one, and only one third receiving two or more blood-pressure–lowering drugs.

Professor Anushka Patel, Principal Investigator of the trial and Chief Scientist at The George Institute, said this was big improvement.

“The World Heart Federation has set an ambitious goal that, by 2025, there will be a 25 per cent reduction in blood pressure levels globally, Prof Patel said.

“The Triple Pill could be a low-cost way of helping countries around the world to meet this target.

“This study has global relevance. While the most pressing need, from the perspective of the global burden of disease, is low-and middle-income countries, it’s equally relevant in a country like Australia where we’re still achieving only 40-50 per cent control rates for high blood pressure.” 

The George Institute is now looking at strategies to maximise uptake of the study results. This includes examining the acceptability of the Triple Pill approach to patients and their doctors, as well as cost-effectiveness, which will be important for governments and other payers to consider.

The study was funded by the National Health and Medical Research Council of Australia as part of the Global Alliance for Chronic Disease.

 

Coalition’s own goal on health policy

Scott Morrison is the new Prime Minister, Peter Dutton’s ambitions have been put on hold (for now), Malcolm Turnbull will leave politics, and it is highly unlikely that Greg Hunt will be back as Health Minister (having run as Deputy to Peter Dutton).

Over the coming hours, days, and weeks, there will be resignations, recriminations, a new front bench, and a new direction for the Coalition Government under Scott Morrison.

But through the murkiness of the Government’s leadership crisis this week one thing is starkly clear – the Coalition has scored a massive own goal on health policy with a Federal election just months away.

To continue the football analogy, the Government has gone into a penalty shootout to decide the World Cup final without a goalkeeper.

Come election day, Labor could well have free shots at goal on public hospital funding, private health insurance, the MBS review, primary care reform, and prevention – just for starters. And that is before Mediscare Mark 2 kicks in.

Yes, Labor is well prepared to repeat the tactics of 2016 to undermine the Coalition’s credibility on health. And the polls provide further ammunition.

With Greg Hunt’s resignation ahead of the leadership spill, the Government lost its third Health Minister since its election win in 2013.

After the co-payment disaster under Peter Dutton and the loss of Sussan Ley after her promising start in the key but complex health portfolio, things were looking pretty good for the Government and the sector with Greg Hunt at the helm.

Minister Hunt had won the trust and confidence of the profession, and had quickly developed a solid knowledge across the breadth and depth of health policy and the major players in the sector.

He was also a master at the PR side of health – lots of new drug announcements, photo ops with kids in hospitals, and a Ministerial office with an open door for advocates, lobbyists, and campaigners, including successive AMA Presidents.

He oversaw the gradual lifting of the Medicare freeze.

He was managing the MBS Review and the PHI Review with end dates in sight for reporting and implementing outcomes.

There was even talk of the Coalition matching Labor’s promise on public hospital funding.

He was fixing the My Health Record legislation to give greater confidence on security and confidentiality – and pledging a big education campaign to convince the Australian people to stay opted-in.

And he was working with the AMA and others to develop a bold new vision for general practice and primary care.

Greg Hunt was across his brief and had strong and friendly working relationships with most of the major health sector players.

The failed Health Care Homes trial and the botched launch of the My Health Record opt-out phase are negatives, however.

Now he is gone, and with him a lot of the hope that genuine meaningful health reform was within reach.

With the Federal election due in the first half of 2019 – but now possibly much earlier – the Coalition must go back to square one to rebuild its health policy credentials.

Sure, the bureaucratic machinery will continue behind the scenes with the various reviews, but there is no longer a credible messenger or an experienced tactician to craft the strategic political health messages that are needed to win votes in the limited time available.

With no obvious strong candidate on the horizon to take over Health, there is an outside chance that new PM Scott Morrison might try to make peace with the warring factions and keep Hunt in the portfolio. We will see.

You need a good spinner to be a winner. It is indeed an own goal.