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Preference: Statistics, epidemiology and research design

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Coordinated approach needed to improve Indigenous ear health

Ear health is the focus of the 2017 AMA Indigenous Health Report Card, with doctors calling on all Governments to works towards ending chronic otitis media.

Releasing the Report Card in Canberra on November 29, AMA President Dr Michael Gannon challenged the Federal Government and those of the States and Territories to work with health experts and Indigenous communities to put an end to the scourge of poor ear health affecting Aboriginal and Torres Strait Islanders.

The Report’s focus on ear health was part of the AMA’s step by step strategy to create awareness in the community and among political leaders of the unique health problems that have been eradicated in many parts of the world, but which still afflict Indigenous Australians.

“It is a tragedy that in 21st century Australia, poor ear health, especially chronic otitis media, is still condemning Indigenous people to a life sentence of hearing problems – even deafness,” Dr Gannon said.

“Chronic otitis media is a disease of poverty, linked to poorer social determinants of health including unhygienic, overcrowded conditions, and an absence of health services.

“It should not be occurring here in Australia, one of the world’s richest nations. It is preventable.

“Otitis media is caused when fluid builds up in the middle ear cavity and becomes infected.

“While the condition lasts, mild or moderate hearing loss is experienced. If left untreated, it can lead to permanent hearing loss.”

Dr Gannon said that for most non-Indigenous Australian children, otitis media is readily treated, but for many Aboriginal and Torres Strait Islander children, it is not.

Estimates show that an average Indigenous child will endure middle ear infections and associated hearing loss for at least 32 months, from age two to 20 years, compared with just three months for a non-Indigenous child.

The Report Card, A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities, was launched in Parliament House by Indigenous Health Minister Ken Wyatt

Mr Wyatt commended the AMA on its 2017 Report Card.

Over the past 15 years, he said, the AMA’s annual Report Card on Indigenous Health has highlighted health priorities in Australia’s Aboriginal peoples and communities.

“Reports can be daunting and they can be challenging,” the Minister said.

“But above all, they can be inspiring.”

Mr Wyatt said it was a tragedy that the most common of ear infections and afflictions were almost entirely preventable.

Yet left untreated in Indigenous children, they had lifelong effects on education, employment and well-being.

“It’s not somebody else’s responsibility. It’s the responsibility of all of us,” he said.

“Hearing is fundamental.”

Shadow Indigenous Health Minister Warren Snowdon also commended the AMA on its report.

He said the Government and the Opposition worked collaboratively on Indigenous health issues.

“We’re not interested in making this a point of political difference, we’re interested in making it a national priority,” he said.

Green’s Indigenous Health spokeswoman Senator Rachel Siewert welcomed the Report and stressed the importance of addressing Indigenous health issues.

Australia’s first Indigenous surgeon, ear, nose and throat specialist Dr Kelvin Kong, who is also the Chair of the Australian Society of Otolaryngology Head and Neck Surgery’s Aboriginal Health Subcommittee, received the report with enthusiasm.

He said cross-party support on this issue had been “phenomenal”.

Dr Gannon said the AMA wants a national, systematic approach to closing the gap in the rates of chronic otitis media between Indigenous and non-Indigenous infants and children in Australia.

The Report calls on Governments to act on three core recommendations: namely, that a coordinated national strategic response to chronic otitis media be developed by a National Indigenous Hearing Health Taskforce under Indigenous leadership for the Council of Australian Governments (COAG); that the wider impacts of otitis media-related developmental impacts and hearing loss, including on a range of areas of Indigenous disadvantage such as through the funding of research as required are addressed; and that attention of governments be re-directed to the recommendations of the AMA’s 2015 Indigenous Health Report Card, which called for an integrated approach to reducing Indigenous imprisonment rates by addressing underlying causal health issues.

“We urgently need a coordinated national response to the lasting, disabling effects and social impacts of chronic otitis media in the Indigenous adult population,” Dr Gannon said.

The AMA Indigenous Health Report Card 2017 A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities can be found at article/2017-ama-report-card-indigenous-health-national-strategic-approach-ending-chronic-otitis

 CHRIS JOHNSON

Government launches online resource to fight antimicrobial resistance

The Federal Government has used Antibiotic Awareness Week in November to launch a new online resource for industry and the community, as part of Australia’s ongoing work to tackle the rise of antimicrobial resistance.

Antimicrobial resistance (AMR) occurs when microorganisms, like bacteria, that cause infections resist the effects of the medicines used to treat them, such as antibiotics.

As a result of antibiotic resistance, standard medical and veterinary treatments may become ineffective and infections may persist and spread to others.

The Government’s funding commitment to help tackle the rise of AMR is $27 million – including $5.9 million from the landmark Medical Research Future Fund.

The planned AMR website, is one of the first priority areas of the Implementation Plan. It will aim to provide information for the community, health professionals, animal health professionals, farmers, animal owners and the broader agriculture industry.

Australia is one of the developed world’s highest users of antibiotics – one of the main causes of AMR. In 2015, Australian doctors prescribed more than 30 million antibiotic scripts through the Pharmaceutical Benefits Scheme.

Many patients are not aware that antibiotics only work against infections caused by bacteria and should not be used to treat viruses like colds, flu, bronchitis and most sore throats.

AMA President Dr Michael Gannon said in a recent ABC interview that AMR is a concern and there needed to be: “Better stewardship in hospitals, better education for GPs, but perhaps most importantly better education for people in the community for them to understand when antibiotics are not only not required, but they’re potentially dangerous or risky.”

AMR has both a health and economic impact with infections requiring more complex and expensive treatments, longer hospital stays, and it can lead to more deaths.

The World Health Organisation (WHO) believes global urgent change is needed in the way antibiotics are prescribed and used because antibiotic resistance is one of the biggest threats to global health, food security, and development today. Antibiotic resistance can affect anyone, of any age, in any country, including Australia.

WHO also believes that even if new medicines are developed, without behaviour change, antibiotic resistance will remain a major threat. Behaviour changes must also include actions to reduce the spread of infections through vaccination, hand washing, practising safer sex, and good food hygiene.

“A lack of effective antibiotics is as serious a security threat as a sudden and deadly disease outbreak,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO.

“Strong, sustained action across all sectors is vital if we are to turn back the tide of antimicrobial resistance and keep the world safe.”

A recent study published in the Medical Journal of Australia shows that antibiotic resistance is on the rise and is present in our communities in Australia.

Lead researcher Dr Jason Agostino from the ANU Medical School said about 60 per cent of drug-resistant staph infections were picked up in the community, so infection control needed to shift from hospitals to the community.

“The problem of infections resistant to antibiotics in our community is not just a theoretical problem that will happen some time in the future – it’s happening right now,” Dr Agostino said.

Until the early 2000s in Australia, staph infections resistant to antibiotics mostly occurred in hospitals. The researchers found hospital infection rates are improving, with decreased infections in two of the region’s largest hospitals.

The study found that patients most at risk of the drug-resistant staph infection in the community are young people, Indigenous Australians and residents of aged-care facilities.

“We also need to improve the way we share data on antibiotic resistance to staph infections and link this to hospitalisation across health systems,” Dr Agostino said.

You can find out more about the progress of the Implementation Plan actions in the National Antimicrobial Resistance Strategy Progress Report at www.amr.gov.au.

MEREDITH HORNE

 

Alcohol damage could start at conception

New research that examines alcohol consumption’s long-term negative health effects and how they could start even from the time of conception has been published.

Published in the Journal of Developmental Origins of Health and Disease and the American Journal of Physiology is one of the first studies to look at alcohol in preconception rather than during pregnancy.

Professor Karen Moritz from The University of Queensland’s Child Health Research Centre UQ said the research using animal models found that exposure to alcohol around conception made male offspring more likely to seek a high fat diet more often as they aged.

“We found that exposure to alcohol resulted in male offspring having a sustained preference for high-fat food, which indicated the reward pathway in the brain was altered by alcohol exposure around conception,” Professor Moritz said.

“Surprisingly we found alcohol exposure at this time had no effect on alcohol preference in offspring of either sex later in life.”

In the study, which was conducted on rats, the equivalent of four standard drinks was consumed every day for four days either side of mating. Male offspring which were exposed to alcohol in this way developed elevated preferences for foods high in fat.

The Australian Guidelines to Reduce Health Risks from Drinking Alcohol has been developed by the National Health and Medical Research Council. No alcohol consumption is their current recommendation for pregnant women, and those who planning a pregnancy.

The dangers of consuming alcohol whilst pregnant are well documented and widely acknowledged. The message that there is no safe level of fetal alcohol exposure has been widely disseminated for the best part of the last decade.

More is emerging about the impact of alcohol consumption prior to conception. A separate but related study by UQ found that male offspring of mothers who had consumed alcohol around conception had five per cent more body fat than offspring of mothers who had not consumed alcohol around conception.

Professor Moritz said the study also found both male and female offspring were more likely to suffer from fatty liver when exposed to alcohol at conception.

“Our results highlight that alcohol consumption, even prior to a fertilised egg implanting in the uterus, can have lifelong consequences for the metabolic health of offspring,” she said.

The research highlights the vulnerability of the developing embryo. Previous studies have identified a link between paternal alcohol consumption around conception and epigenetic alterations.

Given that half of all Australian pregnancies are unplanned, the challenge remains reducing alcohol exposure in the early stages of unplanned pregnancies, when the mother may not even know she is pregnant.

The AMA recently raised its concern that the Government’s new National Drug Strategy did not focus on alcohol – even though alcohol-related harm alone is estimated to cost $36 billion a year.

AMA President Dr Michael Gannon has called for a national alcohol strategy.

The AMA position statement on Fetal Alcohol Spectrum Disorder is available here: position-statement/fetal-alcohol-spectrum-disorder-fasd-2016

The 2009 Australian Guidelines to Reduce Health Risks from Drinking Alcohol can be found here: https://www.nhmrc.gov.au/guidelines-publications/ds10.

GEORGIA BATH AND MEREDITH HORNE

The evil you cannot see

BY PROFESSOR STEPHEN LEEDER, EMERITUS PROFESSOR, PUBLIC HEALTH, UNIVERSITY OF SYDNEY

Concern about air quality in Australia popularly centres around two topics:  exhaust stacks from city road tunnels and climate change.  Neither are as critically important as the effects of small particle pollution. 

Beijing: we have a problem

In China, massive problems were noted in Beijing recently due to massive levels of pollution attributable to very small particles. Even though currently we don’t have anything like the challenges facing China it is wise to be well-informed about what is happening in other countries because of our interconnectedness.

The consequences of small particle pollution can be immediate as well as long-term. They can rank with acute causes of illness like infections and with cigarettes causing heart disease and cancer over decades. 

Estimates provided by the WHO, the American Heart Association and the Global Burden of Disease team hover around three million deaths a year due to these small particles that are less than 2.5 microns in diameter: for comparison a human hair is 50-70 microns in diameter.

These particles are so light that they dance, free of gravity, in our air. Slipping through the nose and throat, they penetrate our lungs where they can pass like oxygen into our blood stream. They are known as atmospheric particulate matter ‘PM2.5’.

They do not cause the pollution we can see, although they travel with it. The small diameter of these particles enables them to penetrate to the deepest recesses of the lung unimpeded by the lung’s standard defences.  There they can cause local damage or slip into the blood stream.  It is this easy access to the whole body via the blood that accounts for their effects on the heart and other organs.

The countries most at risk of problems due to small particle air pollution are clustered around the Middle East and Asia.  More generally affluent countries in Europe and in the Americas are not nearly so badly affected.

Oh oil – is this another of thy stings?

Saudi Arabia and Qatar have the highest annual average concentrations of small  particle as so much of their energy requirements are met through the use of fossil fuels – desalination plants, air conditioners and other devices designed to manage the ferociously hostile heat all run on oil. 

How can such small particles rob us of health?  Small particles are a very mixed group – they can be made of a gas. Diesel particles are like tiny meteorites – they have a solid carbon core surrounded by two layers of chemicals.  Both the mechanical irritation caused by the particles and the chemical impact of them can cause damage.  Small particles can destabilise coronary artery plaques leading to thrombosis.

By comparing the death rates of communities exposed to different levels of small particles, and taking into account differences in other risk factors such as cigarette smoking, the GBD group have attributed millions of deaths each year attributable to small particle pollution. 

Their research is the most sophisticated, but depends on death statistics that are often incomplete or of poor quality, meaning that all estimates are provisional.  But research 1996 done by Doug Dockery and his Harvard research group in six major US cities where health and pollution data are less problematic demonstrated the level of justifiable concern about small particles. 

They found no level of small particle pollution that was entirely without risk.  So the WHO ‘safe’ standards are pragmatic, rather as our ‘safe drinking’ levels of alcohol consumption do not mean that even small amounts of alcohol are free of health effects.  The American Heart Association, the AHA, has taken a deep interest in small particle pollution, partly because the majority of deaths attributed to it are deaths from heart disease.  After looking at all the studies the AHA concludes that larger particles are not associated with an increased risk of death, just the evil tiny ones that you cannot see.

Don’t jog – walk more

What can be done?  The measures that have successfully rid our skies from large particle pollution – clouds of black smoke and high levels of sulphurous pollution – will help reduce the levels of small particle pollution.  Moving from diesel to natural gas for large motor vehicles in the long term would be a welcome move.  Renewable energy may reduce the production of small particles – you would need to ask someone else.

In the meantime, by following air pollution indexes, patients with existing lung or heart disease should be warned not to exercise vigorously or unnecessarily on days when the small particle levels are high.

The atmosphere is not indifferent to our fuel-burning activities  Small particle pollution is yet another example of how important it is to assess our activities to see what cost we are imposing on our environment.

 

Thunderstorm asthma

BY DR RICHARD KIDD, CHAIR, AMA COUNCIL OF GENERAL PRACTICE

With then end of the year fast approaching, there are many joys that this time of year brings, but also many hazards. One such hazard is increased risk of thunderstorm asthma. It is now just over a year since the disastrous thunderstorm in Victoria that triggered a mass asthma emergency, with 8,500 people requiring hospital care and ten sadly losing their lives.

While Victorian hospitals featured prominently in the Victorian response, we also know that many patients accessed GP care and advice, including through after hours GP services.

Research is being conducted to better understand why epidemic thunderstorm asthma events occur. It is believed that grass pollens swept up into the clouds as a storm forms, absorb moisture and then burst open filling the air with small allergen particles. Unlike the larger grass pollen grains that cause hay fever, these particles are small enough to be drawn deep into the lungs. The irritation caused resulting in swelling, narrowing and additional production of mucus in the small airways of the lung, making it very difficult to breath.

Symptoms are quick to come on and typically involve wheezing, chest tightness and coughing, much like asthma.

As GPs, it important to be aware that it is not just people with asthma or a history of asthma that are susceptible to a thunderstorm asthma event. Anyone who suffers seasonal hay fever is also at risk. It is important that our at-risk patients understand this and know how to minimise their risks and manage any symptoms if they experience epidemic thunderstorm asthma.

Thunderstorm asthma is now recognised as a serious health threat and over the last year a range of resources have been made available to GPs to assist them in preparing their patients for the grass pollen season and any epidemic thunderstorm asthma event.

 GPs should make sure they are up to date with the recommendations in the Australian Asthma Handbook and can undertake the free NPS Medicinewise Clinical E-Audit Asthma Management – supporting patients to achieve good control.This tool will help you improve the individual management of your patients by identifying risk factors, reviewing asthma control, adjusting management and reinforcing the benefits of maintaining an up-to-date written asthma action plan.

The National Asthma Council Australia has also made available a range of resources for GPs and other healthcare professionals in the event of another thunderstorm asthma event, which can be accessed here. These include information papers on epidemic thunderstorm asthma and managing allergic rhinitis in people with asthma and advice on preventative treatment.

In addition, the Asthma Australia website also contains general information about asthma which may be of use to GPs, including how to prepare for and respond to an asthma emergency. They also have specific resources for health professionals.

The key is ensuring at-risk patients understand the risks, know how to reduce them, and have an action plan for responding to symptoms. 

This will be my last column for 2017, with the year seeming to go very quickly due to the never-ending advocacy of the AMA on GP issues. On behalf of the Council of General Practice I will take this opportunity to wish you all a safe and happy time with family and friends over the holidays. 

It’s about time

BY DR JOHN ZORBAS, CHAIR, AMA COUNCIL OF DOCTORS IN TRAINING

Wage theft. Let’s call it what it is. When you have a contract to do a job, and you do that job, and you don’t get paid… that’s wage theft. Every fortnight, tens of thousands of doctors-in-training have the work that they’ve done processed into government payment systems. And every fortnight, tens of thousands of dollars and hours go missing.

The way we pay the majority of our doctors-in-training, and for that matter almost every government employee in the country, is embarrassing. It shouldn’t be a hard task. Any organisation that employees people needs to know what these people are doing and how long they are doing it for. Seemingly, this simple calculation was left out of the design plans for almost every HR system I’ve come across in the public sector. Every fortnight, we face a gauntlet of timesheets and rosters that almost invariably result in everyone getting paid less than they’re worth. The system takes its Angel’s Share, and I guarantee you it’s more than 2%. After this tax is levied, you then receive a payslip. Well, you might receive a payslip. They often don’t find you, as was the case when for a quarter of my intern year, my payslips were sent to a regional hospital 600 kilometres away from where I worked in an entirely different health service. And when you do find them, they’re indecipherable. There’s a series of figures and digits that put the techniques that casinos use to confuse us to shame. If big tobacco ever wants to make a comeback in Australia, they need to talk to big hospital.

Of course, no doctor is going hungry in Australia tonight. These dollars aren’t going to decide between life and death. But the dollars aren’t the problem. They’re a surrogate marker for time, and in our vocation we know that time is more valuable than almost anything in this world. When our patients start talking about the “if only-ies” of their lives, we can’t help but reflect on ours. Every hour of your life should be an hour worked and paid, or an hour not worked and not paid; it’s not rocket surgery. When we allow unpaid hours to propagate, those are hours that you don’t get to spend with your family. They are hours you don’t have to prepare for your fellowship exams. They are hours that you don’t spend with your friends enjoying your life and theirs, in shared experiences that you’ll never forget. They are hours that are taken from you. Stolen from you. Lost to you. Make no mistake about it, there is no greater time vampire than your payslip.

This is a system that hides risk. If you can’t accurately capture what your staff are doing, then you can’t safely run a health care service. You will be staffed incorrectly. You will be insured incorrectly. Your leave liability goes through the roof, and your overworked underpaid doctors resign as their access to leave slowly erodes. The pennies you save on wages today multiply into the errors and catastrophes of the future. Morale falls while culture crumbles. Come to think of it, the single worst action you could take to harm patients is to shortchange your doctors, your nurses, and every other person that keeps healthcare ticking.

But the worst part of this tragedy is us. We’re the enablers. We’ve been bailing the system out for years, and for what? When the razor gangs make their rounds, it’s the ultrasound fellowships and the research posts that go missing. But never the run of the mill registrar and resident positions. And you want to know why? It’s because we’re cheap. We’re extremely efficient, we’re too busy to complain and we’re terrible at understanding our rights as employees. Meanwhile, everybody wants to talk about resilience and the inherent difficulties we face in medicine that make it ineffably hard to be a doctor. The irony! I can resuscitate a trauma patient with half a liver and no kidneys. I can hold a family meeting for my critically unwell and soon to be departed ICU patient. I can’t explain my payslip to you. Let that sink in for a moment, and remember it next time someone lectures you about the inherent difficulties in medicine.

This system isn’t the brainchild of some villainous mastermind. It isn’t even a direct effort of government to minimise costs. It’s just simply evolved in an environment in which we’ve stood back and allowed it to happen. And it’s hard to talk about. There’s always someone who wants to make you feel shameful. They want to make it about money, and not about time. Every email you send becomes a less and less wanted intrusion. You’re made to feel the villain, and that’s just for asking for what is rightfully yours! Every unpaid hour we’ve been guilted into letting slide just helps to make life harder for all of us, our patients included. We focus so much on the money that we see it as a dirty act, when really it’s about time. Let’s collectively stop talking about money and start talking about time. This is about fair and due process, and enabling a health system than can actually function.

So next time somebody steals from you, stand up and make yourself heard. If your problem isn’t resolved, call the AMA (of which you are no doubt a member, you fine medical citizen you!). If you employ doctors-in-training, take a look at the processes you have around overtime and staffing. If you are a board member for a health service, audit the real hours that your doctors-in-training are working, so that you can appreciate the quantum of the silent risks that your company or service is being exposed to.

When they steal your money every fortnight, they make your life marginally harder. But when they steal your time, they make your life impossible. And you shouldn’t stand for that. Your time is priceless. 

The road ahead for 2018

BY DR ROD McRAE, CHAIR, AMA COUNCIL OF PUBLIC HOSPITAL DOCTORS

Another calendar year has flown.  CPHD meets regularly to make sure AMA’s positions are informed by those with a Specialist qualification and choosing to self-identify as public hospital doctors.  This embraces the Specialist employed experience and the continuing quest for continuous public hospital medical quality and general systems improvement.  We have an influencing position that is enhanced by more members taking opportunity to solidify CPHD’s base and keep us rich with progressive ideas.  Industrial negotiations for employed medical practitioners are currently underway in several jurisdictions, many of which have been impacted by the federal government’s alteration of previously understood arrangements related to salary packaging.  It will be of acute interest to observe how these negotiations are managed, as most have mandated elections from the time of my writing to October 2018.

COAG – Public Hospital funding Agreement

In July 2017, the States and Commonwealth executed a health care funding Agreement out to 2020.  It laudably touts incentives aimed to reduce avoidable sentinel events, hospital acquired complications and avoidable readmissions.  However, if a State does not achieve an arbitrary benchmark, the otherwise locked in 45 per cent of their public hospital funding could be at risk (including a slice of an additional $2.9 billion of capped services growth funding). 

There becomes a risk that any public hospital not adequately meeting its risk improvement targets, irrespective of cause, will then bear funding cuts, yet still be required to meet the defined Agreement imperatives (thus a potentially downward spiral of ‘doing more with less’).  Such a hospital would be incentivised to rapidly make change in the hope of reducing its funding loss.  Public hospitals may insist members work unsociable hours (for alleged quality & efficiency reasons), roll-out an unmanaged expansion of private practice arrangements (to cover funding shortfalls) and redirect Doctor’s clinical support time to the design of new systems (all to avoid the penalties).  CPHD will work on these and a host other concerns that require our reasoned and measured response.  In 2018, CPHD will monitor against such potentially perverse outcomes that may arise from the underpinning by an ultimately penalty-based regime, let alone the potential for cherry-picking. 

Private Practice

For this health care funding agreement round, the Commonwealth seems to have flagged its willingness to consider change to the arrangements applying to private patients admitted to public hospitals.  As discussed in October, there are good reasons why CPHD is concerned about any attempt to substantially reform existing arrangements, including availability of specialist clinical skills & equipment, supplementation of public hospital income and breadth of case mix available for optimum teaching, training and research.

CPHD recognises and supports the long-standing rights of public hospital patients who elect to receive services as a private patient, but appreciates there does need to be balance.  It is a no-brainer that clinical need, not private/public status, must be the determinant for patient prioritisation and that the patient must be free to make informed choice without unfair inducements or undue pressure to convert to private insurance.  Equally, Doctors must be assured of their right to provide care without undue pressure to encourage conversion from public status.  CPHD will be at the vanguard of any mooted change agenda. 

Personal Safety

In my August Australian Medicine piece I expressed how I am regularly horrified at the experiences of violence in our community and our workplaces.  Therefore, CPHD motives are obvious in its lead advocacy for better investment in security, awareness, technology and facilities to make all employees safe when at work.  It seems to me our response should be health professional holistic rather than just doctor specific (i.e. protecting the team).  We still want accessible and personable care for the public so excessive responses are to be avoided (think armed security in Victorian emergency departments previously batted off by AMA because the idea presented more dangers than it solved).  CPHD will produce an AMA position to reduce workplace dangers in light of escalating population growth, mental health / substance abuse presentations and the anger born amongst some from frustrations at the lack of public hospital responsiveness and capacity. 

Overall, your Council of Public Hospital Doctors is in the business of emerging trend identification and response.  No doubt in 2018 some ‘curly’ policy pronouncement will emerge from government ranks but we are consultative, responsive and equipped to ensure our public patients and our public employed clinical ranks are protected from the excess of public service thought bubbles or political ideology.

I offer season’s greetings to all of our AMA membership family.  It is important for all to ensure they have a sensible break and attend to personal well-being, family and friends, and to start 2018 refreshed and invigorated.  See you in the New Year! 

 

[Perspectives] Lalit Dandona: surveying the burden of disease in India

India is not only a large country but a diverse one. As the Director General of the Indian Council of Medical Research, Soumya Swaminathan, points out, “A lot of planning and policy making are done locally, so it’s important for each state to have an idea of their particular disease burden and what their risk factors are and how they’ve changed over time.” For offering precisely this, the India State-level Disease Burden Initiative Collaborators’ Lancet article on variations in epidemiological transition across Indian states in the Global Burden of Disease Study will be welcomed.

New research project into type 1 diabetes funded

The Government has announced and funded a new researc hresearch project into type 1 diabetes.

The project will be run by St Vincent’s Institute of Medical Research in Melbourne and will bring together four of Australia’s top research teams. It will be headed by Professor Thomas Kay.

Type 1 diabetes, for which there is currently no known cure, represents around 10 per cent of all cases of diabetes and is one of the most common chronic childhood conditions. It affects approximately 150,000 Australians.

Although its onset occurs most frequently in people under 30 years, type 1 diabetes is emerging more in older people.

New research suggests almost half of all people who develop the condition are diagnosed over the age of 30.

The project will focus on three intersecting themes: 

  • early life and understanding why the disease develops;
  • prevention and seeking to identify new drugs to stop the disease from occurring; and
  • treatment aiming to improve therapies to replace the cells that are destroyed during the disease process.

This research will be critical to developing integrated approaches to assist those with the disease and to find ways to stop it occurring in the first instance.

Professor Kay said the emotional, physical and financial impacts of type 1 diabetes are far-reaching for those who are diagnosed with the disease, as well as for their families and friends. 

“It is our intention to make discoveries that positively impact on those living with the disease, and hopefully, prevent others from developing it in the future,” Professor King said.

“On behalf of myself (from St Vincent’s) and my co-chief investigators Professor Andrew Lew and Professor Len Harrison (both from the Walter and Eliza Hall Institute of Research); and Professor Philip O’Connell from the Westmead Institute of Research and Westmead Clinical School (NSW)) – we are honoured to accept this substantial grant to undertake research into type 1 diabetes, and are grateful to the Australian Government for making this important, and potentially for some, life-changing announcement.

“Collectively, we have spent many years of our professional lives investigating type 1 diabetes, so we are keen and committed to do our best to make discoveries that will prevent or minimise, its impacts.

This funding is from the National Health and Medical Research Council’s grants program.

CHRIS JOHNSON