Vitamin D deficiency at birth linked to schizophrenia

Vitamin D deficiency at birth is associated with a significantly increased risk of schizophrenia, according to a new study, confirming a potential way to prevent the disease in the future.

Researcher Professor McGrath, from UQ’s Queensland Brain Institute, told doctorportal: “it’s very unusual that we find risk factors that are so readily treated by safe, cheap and publically accessible interventions.”

“Obviously it’s not a done deal yet. It’s a correlational study and randomised controlled trials need to be done. But we feel we need to keep chasing down this hypothesis.”

The case-controlled study, published in Scientific Reports, included 2602 participants. They were randomly selected from all infants born in Denmark between 1981 and 2000, who received a diagnosis of schizophrenia.

Controls, drawn from the same birth cohort, were individually matched on sex, date of birth and were alive and free of schizophrenia at the time of onset of the matched case. The concentration of 25 hydroxyvitamin D (25OHD) was assessed from neonatal dried blood samples, which have been collected and systematically stored since 1981.

The researchers found that those with 25OHD below 20.4 nmol/L (consistent with standard definitions of vitamin D deficiency) had a 44% increased risk of schizophrenia compared to those in the reference category.

Unlocking an enduring mystery around schizophrenia

Professor McGrath said that researchers have known for a long time – since around 1920 – that people born in winter have a slightly increased risk of developing schizophrenia than those born in other seasons.

“This has always been a bit of mystery. People thought it might have been due to infection and other factors, but we proposed it could be vitamin D, which is mostly known to be linked to bone health.”

Professor McGrath said that most of the work done at the Queensland Brain Institute has demonstrated that if vitamin D is removed from animal models, brain development will be altered.

“That was the hypothesis, so we needed to find a sample. Fortunately, our colleagues in Denmark have access to a biobank, and in 2010 we did a study with this and showed that vitamin D deficiency at birth was linked to an increased risk of schizophrenia.”

“In this new paper, we’ve looked at the research question in a much bigger sample of 2602 and we’ve found exactly the same thing – that babies who have vitamin D deficiency at birth have a 44% increased risk of schizophrenia.

Biological mechanism behind the association is complex and still being probed

“Vitamin D is related to steroid hormones, and we know that if you have steroid hormones you reduce the rate of cell division and you drive cell differentiation.”

New emerging theories relate to the common genetic variants in calcium pathways, which have been shown to increase schizophrenia risk.

“It turns out that vitamin D in many areas of the body, including the brain, alters these exact same channels and we’re exploring that question currently”, Professor McGrath said.

“The problem with vitamin D is that it is one of those hormones which does lots of things to lots of different tissues, so we’ve got a very big sandpit to play in and it will be a challenge to sort out what the mechanisms are.”

Research to tease out a link between vitamin D and other brain disorders

Professor McGrath studies an active area of research: “We have funding from a Danish research agency to measure vitamin D in a very large sample of 80,000 babies and we’ve started that now in Copenhagen, and it will be about two years before those results are ready.”

“We’re looking at whether low vitamin D impacts on other brain disorders. We’ve done some work in the Netherlands a couple of years ago where we measured vitamin D in maternal sera that was taken at 20 weeks of gestation.”

This large study showed that for mothers who had low vitamin D during mid-gestation, their offspring had an increased risk of autism and related symptoms at age 6.

“So we’re wondering whether vitamin D deficiency is just bad for brain development,” Professor McGrath said.

“Most kids that are exposed to vitamin D deficiency are fine – they might have weak bones but most don’t get mental illness. However, we have not been able to reject the hypothesis yet based on epidemiology.”

Artery hardening begins before high school: Australian study

Only a minority of Australian 12-year-olds have ideal cardiovascular health, research shows, with arterial stiffening evident before some children start high school.

A team from Melbourne’s Murdoch Children’s Research Institute assessed the cardiovascular health of 1028 Australian children aged 11-12 using the seven risk factors of the American Heart Association’s Cardiovascular Health (ICVH) score: physical activity, weight, diet, blood glucose, cholesterol, blood pressure and smoking status.

Only 7% of the children (76) had a perfect ICVH score, and only 39% (406) achieved ideal levels in six out of the seven metrics. The median score was 5/7.

For the first time, the researchers demonstrated that ICVH scores in children were associated with vascular function.

Each additional point in a child’s ICVH score was associated with slower carotid-femoral pulse wave velocity (0.07m/s reduction in pulse wave velocity) and greater carotid elasticity (0.009% per mm Hg).

This relationship was largely mediated by BMI and blood pressure, according to the study published this month in the International Journal of Cardiology.

Study co-author, Professor David Burgner of the University of Melbourne told doctorportal: “If parents were aware that even before their child starts high school, risk factors such as increased BMI and raised BP were already associated with stiffer arteries – which increases the chance of heart attack and stroke as adults – then you’d hope that would galvanise families to try to reduce their risk factors.”

“Cardiovascular disease risk occurs from childhood onwards and we already see associations between risk factors and preclinical changes in the arteries by mid-childhood,” he said.

A family problem

The researchers also assessed 1,235 parents of the children – in most cases the mothers.

The median ICVH score in the parents was lower than in children (4/7), and the association with vascular function was stronger, the study found.

ICVH scores in adults were also linked with changes in vascular structure. Each additional point in an adult’s ICVH score was associated with a smaller carotid intima-media thickness (-7.3μm per metric unit), a measure of subclinical atherosclerosis.

The study found children whose parent had non-ideal health in any of the seven metrics had substantially higher odds for non-ideal health in that metric, for all metrics except physical activity and serum glucose. Children typically did more exercise than their parents.

Ideal diet was the metric least likely to be attained by both adults and children.

Family-based interventions

Professor Burgner said the study highlighted the need for family-based interventions to reduce cardiovascular risk from early on in life.

“Clearly many of the risk factors are shared within families, so considering the family rather than the individual as the unit for interventions that address modifiable environmental risk factors such as increased physical activity or diet may have more impact than just focusing on the adult or child in isolation,” he said.

Professor Burgner said it was unknown whether the poorer vascular function seen in children with lower ICVH scores in the study was reversible.

“The adverse changes in children are smaller than in adults and only relate to the elasticity of the arteries. This likely reflects a longer cumulative exposure to risk factors the older you get,” he said. “Certainly the consensus is that children are physiologically more ‘plastic’, so changes are likely to be reversible, but it is not well understood.”

The study cohort was drawn from the Longitudinal Study of Australian Children and Child Health Checkpoint. The authors cautioned that it was likely to have under-represented socio-economically disadvantaged families.

Dr Richard Liu, another co-author of the study, said that BP measurement should be routine in children. However in practice it was rare.

“Arguably all children with a raised BMI should be screened but it is important that it be done appropriately – that abnormal readings are repeated at least twice, the cuff is appropriately sized and equipment calibrated, and values are measured against established centiles for age, sex and height,” he said.

[Correspondence] Tackling the challenges of child health care

Richard Horton (July 14, p 106)1 noted the UK’s mediocre performance with respect to child health. As representatives of the European Public Health Association and the European Paediatric Association/Union of National European Paediatric Societies and Associations, we strongly endorse Horton’s call for greater integration between public health and paediatrics and are already working towards this goal. We have jointly called for greater emphasis on prevention to tackle the changing burden of childhood disease, increasingly dominated by long-term conditions, many of which are caused by modifiable behavioural and environmental factors.

[Editorial] Transition health care for adolescents

The American Academy of Paediatrics, the American Academy of Family Physicians, and the American College of Physicians have updated their collective 2011 clinical guidance in a new report, Supporting the Health Care Transition from Adolescence to Adulthood in the Medical Home. According to new data, a health-care transition plan is in place for only 17% of American adolescents who have special health-care needs and for only 14% of adolescents who do not have special needs.

Encouraging news for prognosis of extremely premature babies

Parents of extremely preterm infants may gain reassurance from a new study showing dramatic day-by-day improvements in long-term prognosis for those receiving intensive care.

The study in The Lancet Child and Adolescent Health followed up 715 children born at less than 28 weeks gestation who were offered intensive care in Victorian hospitals during three distinct periods (1991-92, 1997 and 2005).

Almost three-quarters of the children (73%) offered intensive care survived to age 8 years, and 83% of the survivors were free of major disabilities (moderate-to-severe cerebral palsy, blindness, deafness, or profound cognitive disability).

Encouraging news

A major finding of the study was that an extremely premature baby’s risk of death and major disability rapidly declined in the first few days after birth, such that by the time of their discharge home their risk of death was similar to healthy full-term babies’.

Lead study author, Associate Professor Jeanie Cheong from the Royal Women’s Hospital in Melbourne commented: “This is very encouraging news for parents who are often very frightened when taking their newborn baby home from hospital.”

The study also confirmed four sentinel events in the postnatal period that strongly increased the likelihood of major disability: grade 3 or 4 intraventricular haemorrhage or cystic periventricular leukomalacia (both indicating brain damage), postnatal corticosteroid use to treat or prevent lung injury and surgery in the newborn period.

Almost one-half (48%) of the extremely preterm babies avoided all of these complications, and of those that did avoid these events, 93% survived without major disability.

Parents deserve regular updates

The study authors said the rapid changes in prognosis in the first few days after birth should be acknowledged by clinicians and conveyed to families.

“As survival prospects change rapidly immediately after birth, ongoing counselling should be provided… If one of the four major events arises, advice should be updated,” they wrote.

Professor Cheong said the study’s findings demonstrated how each baby’s individual risk changed significantly over the course of their intensive care treatment.

“Parents may be taking home their baby fearing that they are at a much higher risk of death or long-term disability than is the reality,” she said. “Now we can tailor the risk information to bring much-needed reassurance to parents.”

Preventing preterm births

The mean gestational age at birth in the study was 25.6 weeks and mean birth weight was 835g. Three survivors died between discharge and 2 years of age, but no additional deaths occurred between 2 years and 8 years of age.

Mortality by age 8 years was lower in infants who were given antenatal corticosteroids than in those who were not (OR 0.61, SD 1.2 and CI 0.39-0.97, p=0.37) and decreased with increasing gestational age at birth (0.58 for every 1 week increase). For babies born at 23 weeks, the chance of survival was around 45% for those offered intensive care.

Only seven (8%) of live births at 22 weeks gestation were offered intensive care, and only two of these children survived.

There was little difference in survival with major disability between birth eras.

Professor Cheong told doctorportal: “The ultimate goal would of course be to prevent preterm birth, and there are a lot of efforts happening in that space.”

“The reality is, however, that extremely preterm babies will continue to be born and we have the responsibility to parents and the children themselves, to inform them of the risks associated with death and major disability.”

Youngest kids in class more likely to be diagnosed with ADHD

New research has shown that the youngest child in a classroom is more likely to be diagnosed with ADHD, throwing into question the value of the ADHD label.

Dr Martin Whitely, research fellow at the John Curtin Institute of Public Policy based at Curtin University, told doctorportal that “I personally think the label of ADHD is not at all useful.”

“It masks a whole host of factors. Late birthdate isn’t the only thing that characterises ADHD – it’s kids that are sleep deprived, kids who have suffered trauma, kids whose parents are going through a messy divorce, kids who are being bullied, kids who have been sexually abused.”

“There’s research showing that all of these other factors are associated with ADHD diagnosis.”

“What we can do is stop labelling kids and start looking at their individual circumstances. And even if you don’t accept that, we have to give kids the time they need to mature.”

Late birthdate effect just as strong in low and high prescribing countries

Dr Whitely co-authored the systematic review, published in the Journal of Child Psychology and Psychiatry, which looked at a total of 19 studies in 13 countries, covering over 15.4 million children.

A total of 17 of the 19 studies found that the youngest children in a school year were considerably more likely to be diagnosed and/or medicated for ADHD than their older classmates. Two Danish studies found either a weak or no late birth date effect.

Dr Whitely said that what was especially interesting was that “this effect was just as strong in a high prescribing country like the US, Canada or Iceland, or a relatively low prescribing country like Denmark, Sweden or Taiwan, or to a lesser extent Australia which is on the lower to middle end.”

A lack of a strong effect in Denmark may be accounted for by the common practice of academic ‘redshirting’, where children judged by parents as immature have a delayed school start. Redshirting may prevent and/or disguise late birthdate effects and further research is warranted

Dr Whitely said that the findings of the study are significant because previously, it had been argued that the birthdate effect was evidence of high prescribing countries like the US.

“This actually brings into question: is there a safe level of prescribing that eliminates misdiagnosis? Based on this evidence, there isn’t.”

“We can’t have confidence that even when prescribing rates are low, there isn’t misdiagnosis”, he said.

Teachers can mistake immaturity for ADHD in the classroom

Dr Whitely explained that a potential reason for the late birthdate effect stems from the fact that parent perception of these children differs considerably from how teachers see them.

“Parents don’t rank them against other kids in the class, whereas teachers do, so the teachers are ranking the youngest kids in the class as having behavioural problems, when this is actually just a perfectly normal function of their age-related immaturity.”

He said there is evidence to indicate that while teachers do not diagnose ADHD, they are often the first person to suggest a diagnosis.

“Teachers start off the diagnostic process by talking to parents and even when they don’t do that, they provide information via a behavioural checklist and report on the kid’s behaviour.”

“If they’re ranking a child in the class who is aged 5 against other kids in the class who are 6 years old, and they’ve seen him acting very immaturely, then they’re ranking him based on 20% less life experience and that’s leading to kids being labelled as psychiatrically disordered”, Dr Whitely said.

New autism guidelines aim to improve diagnostics and access to services

New Australian autism guidelines, released this week, aim to provide a nationally consistent and rigorous standard for how children and adults are assessed and diagnosed with autism, bringing to an end the different processes that currently exist across the country.

There is no established biological marker for all people on the autism spectrum, so diagnosis is not a straightforward task. A diagnosis is based on a clinical judgement of whether a person has autism symptoms, such as social and communication difficulties, and repetitive behaviours and restricted interests. This is an inherently subjective task that depends on the skill and experience of the clinician.

This judgement is made even more difficult by the wide variability in symptoms, and the considerable overlap with a range of other developmental conditions such as attention deficit/hyperactivity disorder (ADHD), intellectual disability, and developmental language disorder.

Further complicating autism diagnosis in Australia is the lack of consistent diagnostic practices both within and between states and territories. This leads to patchy and inconsistent rules around who can access public support services, and the types of services that are available.

It is not uncommon in Australia for a child to receive a diagnosis in the preschool years via the health system, for instance, but then require a further diagnostic assessment when they enter the education system. This is a bewildering situation that has a significant impact on the finite financial and emotional resources of families and the state.

The new guidelines aim to address these inconsistencies and help people with autism and their families better navigate state-based support services. It also brings them into line with the principles of the National Disability Insurance Scheme (NDIS), which seeks to determine support based on need rather than just a diagnosis.

National guidelines

In June 2016, the National Disability Insurance Agency (NDIA) and the Cooperative Research Centre for Living with Autism (Autism CRC), where I’m chief research officer, responded to these challenges by commissioning the development of Australia’s first national guidelines for autism assessment and diagnosis.

We undertook a two-year project that included wide-ranging consultation and extensive research to assess the evidence.

The guidelines do not define what behaviours an individual must show to be diagnosed with autism. These are already presented in international manuals, such as the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5) and the World Health Organisation’s International Classification of Diseases (ICD-11).

What the new guidelines provide is a detailed description of the information that needs to be collected during a clinical assessment and how this information can be used to inform the ongoing support of that person, including through a diagnosis of autism.

The guidelines include 70 recommendations describing the optimal process for the assessment and diagnosis of autism in Australia.

Understanding strengths and challenges

A diagnostic assessment is not simply about determining whether a person does or doesn’t meet criteria for autism. Of equal importance is gaining an understanding about the key strengths, challenges and needs of the person. This will inform their future clinical care and how services are delivered.

In essence, optimal clinical care is not just about asking “what” diagnosis an individual may have, but also understanding “who” they are and what’s important to their quality of life.

We know diagnosis of autism alone is not a sound basis on which to make decisions about eligibility for support services such as the NDIS and state-based health, education and social support systems.

Some people who meet the diagnostic criteria for autism will have minimal support needs, while other individuals will have significant and urgent needs for support and treatment services but will not meet diagnostic criteria for autism at the time of assessment.

Some people may have an intellectual disability, for example, but not show the full range of behaviours that we use to diagnose autism. Others may present with the latter, but not the former.

In the context of neurodevelopmental conditions such as autism, it is crucial that a persons’s needs – not the presence or absence of a diagnostic label – are used to determine eligibility and prioritisation of access to support services.

What may influence an autism assessment?

The guidelines also detail individual characteristics that may influence the presentation of autism symptoms.

Gender is one key characteristic. Males are more commonly diagnosed with autism than females. But there is increasing evidence that autism behaviours may be different in males and females. Females may be better able to “camouflage” their symptoms by using compensatory strategies to “manage” communication and social difficulties.

It is similarly important to consider the age of the person being assessed, because the presentation of autism symptoms changes during life.

The guidelines provide information on how gender and age affect the behavioural symptoms of autism. This will ensure clinicians understand the full breadth of autistic behaviours and can perform an accurate assessment.

The next step is for all clinicians and autism service providers across Australia to adopt and implement the guidelines. This will ensure every child and adult with autism can receive the optimal care and support.

Andrew Whitehouse, Winthrop Professor, Telethon Kids Institute, University of Western Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

“Extremely reassuring” studies back up vaccine safety assurances

Patients can be reassured about vaccine safety on the basis of two large studies that have directly tested claims about the potential harms of the human papillomavirus (HPV) and pertussis vaccines.

The first study, published in the journal Pediatrics this month, found no association between HPV vaccination and primary ovarian insufficiency (POI) among almost 200,000 female patients enrolled in the Kaiser Permanente health system in Oregon and Washington.

Claims of a link between HPV vaccination and POI have circulated widely on the internet on the basis of published case series. These include a case published in BMJ Case Reports in 2012 of a 16-year-old Australian girl whose menstrual cycle became scant and irregular following vaccination.

The report prompted a statement from the Therapeutic Goods Administration at the time saying there was no “plausibly biological basis” for the link.

Latest HPV vaccine study “extremely reassuring”

Now Associate Professor Julia Brotherton, medical director of registries and research at the Victorian Cytology Service Registries said the latest study was “certainly significant and extremely reassuring”.

Out of 199,078 female patients aged 11 to 34 – 58,871 of whom received the HPV vaccine in adolescence – the study found 33 probable and 13 possible cases of primary ovarian insufficiency after follow-up averaging five years. Only one of the cases was vaccinated against HPV before symptom onset; a 16-year-old who received her third dose of HPV vaccine almost two years before estimated symptom onset.

This time lag was “not consistent with the authors of case reports who observed onset within 12 months of vaccination”, the authors noted.

They added: “although we did not formally test, we did not observe any temporal clustering of vaccine exposures among patients”.

More than half of the confirmed POI cases were patients who were diagnosed at age 27 or older, and only one patient was diagnosed under the age of 15.

The study could not adjust for contraceptive use, which the authors noted may mask the symptoms and onset of POI.

Nevertheless, they concluded: “We found no evidence of increased risk of POI after HPV vaccination, or other routine adolescent vaccination exposures, in this population-based retrospective cohort study with nearly 200,000 young women…We believe this study should lessen concern surrounding potential impact on fertility from HPV or other adolescent vaccination.”

Pertussis vacccine not linked to autism

A second study in Pediatrics investigated the potential association between prenatal tetanus, diphtheria, acellular pertussis (Tdap) vaccination and autism spectrum disorder (ASD) risk in offspring, using data from Kaiser Permanente Southern California.

The study followed up 81,993 pairs of pregnant women and their children for up to 6.5 years after birth. Almost half had received the prenatal Tdap vaccine.

ASD was diagnosed in 1,341 children, and incidence was greater in the unvaccinated than the vaccinated group; 3.78 per 1000 person years in the Tdap exposed versus 4.05 per 1000 person years in the unexposed (HR: 0.98, 95% CI: 0.88-1.09).

The authors concluded: “Prenatal Tdap vaccination was not associated with an increased ASD risk. We support recommendations to vaccinate pregnant women to protect infants, who are at highest risk of death after pertussis infection.”

Excellent choice for Excellence in Healthcare Award

The recipient of the AMA Excellence in Healthcare Award 2018 wants to know how she can use it to build greater awareness for a very worthy cause.

Professor Elizabeth Elliott AM FAHMS was presented with her award by outgoing AMA President, Dr Michael Gannon, at the AMA National Conference in Canberra in May.

Professor Elliott is a pioneer in research, clinical care, and advocacy for Fetal Alcohol Spectrum Disorder (FASD) and was named the winner of the AMA Excellence in Healthcare Award 2018 during the opening session of the Conference.

FASD is caused by prenatal alcohol exposure and is recognised as the leading preventable cause of prenatal brain injury, birth defects, and developmental and learning disability worldwide. There are lifelong consequences for children born from alcohol-exposed pregnancies.

The AMA Excellence in Healthcare Award is for an individual, not necessarily a doctor or AMA member, who has made a significant contribution to improving health or health care in Australia. The person may be involved in health awareness, health policy, or health delivery.

Professor Elliott was nominated for the award by the National Organisation for Fetal Alcohol Spectrum Disorder (NOFASD), the first and largest organisation dedicated to FASD in Australia.

Over the past 20 years, FASD has evolved from being a little-known, poorly recognised, and misunderstood condition to becoming a major strategic focus for Commonwealth and State Health Departments.

“I am really delighted to be acknowledged, but I really accept the award on behalf of all the children and families I work with, and of course a lot of dedicated clinicians,” she told Australian Medicine.

“I guess for me it’s particularly nice that the group that nominated me was the national organisation.

“I read something that said this was an opportunity to highlight this cause so I’m very keen to find out how to use the AMA network to raise awareness.

“We need to raise awareness of (1) the fact that are still lots of women who drink during their pregnancy not knowing they might harm their unborn child, and (2) there are lots of doctors who are very reluctant to ask pregnant mothers about their drinking.

“They don’t want to upset the doctor-patient relationship, and yet women tell us they want to be asked. They want clear advice. In fact many of them tell us they want to be told not to drink during pregnancy. They want a clear message from doctors.”

Professor Elliott is a Distinguished Professor in Paediatrics and Health at The University of Sydney School of Medicine and a NHMRC Practitioner Fellow. She has been a passionate advocate for raising awareness of FASD for more than 20 years.

In presenting her the award, Dr Gannon said Professor Elliott played a significant leadership role in developing the Australian Guide to the Diagnosis of FASD and online training modules, new clinical services, a national FASD website, and a national FASD register.

“She chaired the Australian Government’s National FASD Technical Network and is Co-Chair of the NHMRC Centre of Research Excellence in FASD, and Head of the NSW FASD Assessment service,” Dr Gannon said.

“She was lead clinician in the Lililwan study on FASD prevalence in the Fitzroy Valley and has published extensively on FASD.

“She contributed to WHO, NHMRC, and RACP alcohol guidelines and has been a keynote, invited, or scientific presenter at more than 300 conferences nationally and internationally.

“Professor Elliott is a true pioneer in the FASD field and has contributed to the development of Australia’s response to FASD, through addressing aspects of health policy, health care delivery, education, and health awareness in the work she has undertaken.

“However, FASD is only one component of Professor Elliott’s work, which includes disadvantaged children in Immigration detention, with rare disorders, and living in remote Australia.

“In 2008, she was made a Member of the Order of Australia (AM) for services to paediatrics and child health and, in 2017, she received the Howard Williams Medal from the Royal Australasian College of Physicians (RACP) – its highest award – for her contribution to paediatrics in Australia and New Zealand.

“Much of her work has been undertaken voluntarily, and has strengthened Australia’s health systems and their capacity to respond to FASD.

“Her efforts have improved health care services in FASD and changed health outcomes for children and families living with, and affected by, FASD.

“She is a worthy recipient of the AMA Excellence in Healthcare Award.”

CHRIS JOHNSON

Candidate profile – Dr Janice Fletcher MBBS (Hons 1), MD, BSc, FRACP, FRCPA

Nominating for the position of AMA Vice President

My decision to nominate for Vice President came about after careful consideration about what I could offer the role, and, importantly, if I had the time to commit to the requirements of the position.

After a recent (second) knee replacement I also had to make sure I was fit to run. I, only half jokingly, credit my orthopaedic surgeon for this decision.

Having served as President of the AMA SA I have been exposed to the rigours of such a role.

I believe strongly in the role of the AMA, recognising the issues both at Federal and State level, having worked in South Australia, New South Wales, and Victoria. Coming from a small state, I bring geographic diversity to the executive table.

My professional background is diverse; paediatrics, genetics, pathology and medical administration. I was proud to be the fourth female President of the AMA SA.

As a strongly influential organisation, the AMA must be at the forefront of setting the health agenda for Australia. As experts in evidence-based medicine, we need an evidence-based approach to our profession.

We need to advocate for, and evaluate, research which will give us a true picture of the health needs of the Australian community and the workforce requirements in the next five, ten, twenty years and beyond. And we need to know who is currently being trained, and in what areas.

This will give our next generation of doctors a much better insight into where the jobs will be in the coming years.

In taking this proactive role the AMA will be re-established as the key decision maker, ensuring that the right policies are in place to steer the right course.

I have extensive experience in the public domain, with the media and have worked with all sides of politics.

I have been given a ‘sensible’ tag, which I wear proudly. This role is not about me, but more about the decisions the AMA makes. I bring to the table a considered approach, objectively looking at all sides of an issue. I know when to ‘keep my powder dry’ and when to go in, guns blazing.

Also of benefit to the AMA leadership team is my expertise in the field of genetics. As evidenced by the 2018 Federal Budget, this area of medicine is a key driver of our future and the impact it will have across all fields of medicine is significant. I am an Emeritus Member of the Human Genetics Society of Australasia, with professional respect across the country and internationally.

I am passionate about improving nutrition in our community, particularly in childhood. We must improve nutritional literacy for all Australians. We must also improve genomic literacy for the community, patients and all healthcare professionals.

A focus on the future is what is driving me to nominate for Vice President. As a teacher and researcher, I continue to work with many young doctors and students. If we don’t advocate strongly for them, they will not have a profession, but a mere job.

I am not running on a ‘ticket’ as I know I can represent the interests of all States and Territories and work alongside all President nominees.

If you would like further information or to contact me, please visit my website:

https://janicefletcher0.wixsite.com/aboutjanicefletcher I would love to hear from you.

* See other candidate profiles on this site.