Australian molecular microbiology students’ breakthrough in TB

Australian researchers and students at the University of Queensland are using their innovation to tackle tuberculosis (TB) – one of the world’s leading infectious-disease killers.

University of Queensland students have identified promising inhibitory compounds during a molecular microbiology practical course this semester.

TB is the leading cause of death due to an infectious agent, globally killing approximately two million people each year.

Mycobacterium tuberculosis, the bacterium responsible, currently infects over one third of the world’s population and, although most cases respond to standard antibiotic therapy, drug resistant strains are on the rise and new antibiotics for TB are urgently needed.

Students at the University of Queensland’s School of Chemistry and Molecular Biosciences have discovered five or six compounds that inhibited growth in a harmless bacterium related to TB.

TB research head Dr Nick West said it appears that students have identified some very interesting compounds and resulted in further research now being a reality.

“There has not been a new general use anti-TB drug for 50 years,” Dr West said

The students were undertaking a UQ microbiology course in which they screened a compound library for inhibitors of TB, working through 7000 random compounds.

Dr West said the exciting breakthrough came when they realised a small number completely inhibited the bacteria.

TB resistance will be raised at the upcoming G20 summit this month in Hamburg, Germany and there is hope that political will can be fostered to tackle antimicrobial resistance (AMR) and turn the tide on tuberculosis.

This comes on top of a resolution by the United Nations General Assembly late last year that moved to ensure UNGA hold the first-ever high-level meeting on the fight against tuberculosis in 2018.

Meredith Horne

Single biggest health burden is cancer attributed to tobacco use

Cancer accounts for about one-fifth of Australia’s health burden, with tobacco use the biggest contributor, newly released figures reveal.

The Australian Institute of Health and Welfare (AIHW) has released research based on data sourced from the 2011 Australian Burden of Disease that shows cancer was the greatest cause of health burden in Australia, accounting for around one-fifth of the total disease burden.

AIHW’s burden of disease analysis is more than merely counting deaths or disease incidence and prevalence, burden of disease analysis takes into account age at death and severity of disease for all diseases, conditions and injuries, in a consistent and comparable way.

“This (burden) is calculated in terms of years of life lost due to early death from cancer, as well as the years of healthy life lost due to living with the disease,” AIHW spokeswoman Michelle Gourley said.

Almost half (48 per cent) of the total cancer burden in 2011 is from five cancers—lung, bowel, breast, prostate and pancreatic cancers. However the single biggest burden —and almost one-quarter (22 per cent) of the total cancer burden can be attributed to tobacco use.

The report states that most (94 per cent) of this burden was due to dying prematurely, with only a small proportion of the burden due to living with a cancer diagnosis. Even though fewer people die from cancer than cardiovascular disease, the burden of cancer deaths is higher.

The AIHW report also found that Indigenous Australians experienced 1.7 times the cancer burden of non-Indigenous Australians. In particular, Indigenous males experience 2.3 times the lung cancer burden of non-Indigenous males, and Indigenous females 2.6 times the lung cancer burden of non-Indigenous females.

Australians living in rural Australia were also shown in the report to face a higher burden, especially the burden of lung, bowel, prostate and pancreatic cancers.

“Indigenous Australians experienced a cancer burden 1.7 times that of non-Indigenous Australians, and the gap was particularly notable when it came to lung cancer,” Ms Gourley said.

Further, poorer Australians found themselves with an increased rate of cancer burden, with people in the lowest socioeconomic group experiencing 1.4 times the cancer burden of people in the highest group. In particular, the rate of lung cancer burden in the lowest group is almost twice the rate in the highest group.

This report presents detailed findings on the burden due to cancer in Australia using results from the Australian Burden of Disease Study 2011.

Meredith Horne

Research reveals alarming medical workforce gender inequality in Ireland

The Irish Medical Organisation (IMO) has released research that shows Irish female doctors face many unfair challenges due to their gender, including bullying and family pressures slowing their career progression when compared to their male equivalents.

IMO President Dr Ann Hogan said: “It is obvious from the research that gender still continues to impact on careers in the medical profession with family considerations often affecting female practitioners to a greater extent than their male colleagues.”

The research showed nearly half (46 per cent) of female medical practitioners have delayed having children for reasons related to their careers in medicine, compared to just 19 per cent of male medical practitioners.

Eighty-five per cent of female doctors do not believe that existing workplace supports adequately provide for an opportunity to balance medical workloads with family commitments. Seventy-one per cent of male doctors agree with this.

The report also found 28 per cent of female NCHDs report having experience gender-based bullying in the workplace during the last two years, while 6 per cent of male NCHDs report the same.

“It is obvious that female doctors’ experiences of gender-based bullying, harassment, and sexual harassment differ greatly from male doctors’ experiences. This is an indictment for our profession and must be addressed,” Dr Hogan said.

Unfortunately the findings of the IMO are mirrored in many countries. A recent report published in the Journal of the American Medical Association (JAMA) found a third of women physicians reported being sexually harassed while for men, the number was 4 per cent.

The AMA believes that sexual harassment in the medical workplace is unacceptable. Sexual harassment affects physical and mental health, and undermines performance and professionalism in the workplace. Further, sexual harassment can influence career choice and career progression.

A copy on the AMA position paper on sexual harassment in the medical workplace can be found at: position-statement/sexual-harassment-medical-workplace .

Meredith Horne

Paradigm shift in monitoring and improving brain health

The world’s most prestigious gathering of medical practitioners in functional medicine and integrative care hosted a symposium in Los Angeles recently, featuring today’s greatest revolutionaries in changing how we view and treat brain health.

The Annual International Conference of the Institute for Functional Medicine chose scientifically-disruptive and broadly-acclaimed neuroscientist Dr Michael Merzenich to address its plenary session.

Dr Merzenich unveiled a revolutionary approach to monitoring, maintaining and improving brain health. The system uses apps and digital therapies.

Dr Merzenich is the Chief Scientific Officer of Posit Science, maker of BrainHQ brain exercises and assessments.

He joined Alzheimer’s experts Dr Dale Bredesen (of UCLA and the Buck institute) and Dr Rudolph Tanzi (of Harvard and Massachusetts General Hospital) for a discussion of the application of neuroplasticity to dementia.

The theme of the conference was The Dynamic Brain: Revealing the Potential of Neuroplasticity to reverse Neurodegeneration.

Dr Merzenich discussed research supporting the idea that we can systematically harness brain plasticity and drive positive changes in brain systems through plasticity-based training.

“Breakthroughs in technology and science will permit people to monitor their brain health on a daily basis and take appropriate action to maintain their brain health using a device they already carry in their pockets,” he said.

“A phone with apps to assess current condition, to suggest holistic interventions, and to deliver the right brain exercises. This technology already exists, and all the pieces are coming together.”

Dr Merzenich believes we are in the midst of a paradigm shift regarding how we view and treat most aspects of brain health.

“We don’t have a magic pill to prevent or cure heart disease, and instead look to behavioural changes to reduce risk and early interventions to address symptoms,” he said.

“There is a rapidly growing consensus among thought leaders that we need a similar approach to cognitive disorders and improvement. This approach will include nutrition, physical exercise and environmental factors – but the single most important elements will be lifelong monitoring of brain health and appropriate plasticity-based brain exercises.”

Dr Merzenich is professor emeritus at University of California San Francisco, where he maintained a research lab for three decades. He ran the seminal experiments that led to the discovery of lifelong plasticity – the ability of the brain to change chemically, structurally and functionally based on sensory and other inputs. He pioneered harnessing the power of plasticity in the co-invention of the cochlear implant, which has restored hearing to 100,000s of people living with deafness.

Dr Merzenich also pioneered the application of plasticity in the development of plasticity-based computerised brain exercises, which have helped millions of people.

Chris Johnson

Blitzed: Drugs in Nazi Germany

Book Review
Blitzed: Drugs in Nazi Germany

Reviewed by Simon Tatz

The rise of Adolf Hitler and Nazi Germany has been analysed, documented and researched for almost a century now, and until recently one assumed there was little if any new evidence to be uncovered.

Blitzed: Drugs in Nazi Germany, by Norman Ohler, became an international sensation when it was published last year. Ohler’s ground-breaking and cleverly written research centres on two aspects of the Third Reich: the use of methamphetamine by the German military, and the role of Adolf Hitler’s personal physician, Dr Theodor Morell.

German pharmaceutical companies such as Merck, IG Farben and Bayer were world leaders prior to WWII, and Germans were huge consumers of what are now illicit drugs, including cocaine and heroin. Three German pharma companies (Merck, Boehringer and Knoll) controlled 80 per cent of the world cocaine market in the 1920. But it was the Temmler factory that Blitzed focus on. Tremmler began producing Pervitin, a methamphetamine pill, in 1937. It soon became a staple of German civilians, then the military. They even manufactured a ‘meth’ brand of chocolates to make ‘housework more fun.’ Each chocolate was equivalent to a modern day ‘hit’ of crystal meth.

Dr Otto Ranke, who became a meth addict himself, oversaw the widespread supply of Pervitin to the Wehrmacht and Luftwaffe. According to Ohler, it was the use of methamphetamine that allowed German tanks to sweep through France as troops stayed awake for two to three days and required little, if any food. The Blitzkrieg was supported by the enormous consumption of these Pervitin meth pills. In the Battle of Britain, Germany’s airpower inferiority was countered by providing their pilots with tablets that kept them awake for days on end. German pilots flew endless mission until they ‘burnt out’ and suffered the effects well known about excessive methamphetamine use.

Pervitin doses to the military ran to over one million per month in 1941, with civilian use put at 1.5 million units per year. Dr Ranke, Director of the Research Institute of Defence Physiology, ordered 35 million Pervitin tablets for the Western Front campaign, while the German Labour Front placed orders for 260 million, then 390 million, Pervitin tablets.

Nazi doctors knew the dangers of meth use and addiction, however they ignored the warnings because it enabled the Nazi war machine, at least initially, to sweep through Europe.

The more fascinating part of Blitzed is the role of Hitler’s personal physician, the mysterious Dr Morell. Despite being interrogated by the Americans after the war, his scrawled personal notes on Hitler haven’t been fully examined. Morell concocted a substance called ‘Vitamulin’, which was derived from rosehip powder, dried lemon, yeast extract, refined sugar and skimmed milk. He marketed this to Hitler and the SS. Hitler, a vegetarian whose diet was mainly salads and vegetables, apparently gained little benefit from the vitamin tablets (and later intravenous injections) but he certainly relied on the Eukodal (Oxycodon) as well as methamphetamine and cocaine his physician prescribed. Hitler was obsessed with his own health and ensuring he had the stamina to lead the war, and Blitzed describes the descent into increasing drug addiction.

In August 1941 Hitler first became seriously ill, and Dr Morell’s vitamin concoctions failed to improve his health. Here is the point where steroids are first used, followed by dolantin, an opioid similar to morphine. Dr Morrell is described as a proponent of polypragmasia – the use of multiple therapeutic modalities to manage a single condition.

Blitzed provides a wealth of fascinating medical research material, much of which lay hidden in archives and not assessed until recently, on the way hard drugs affected decision making by Hitler and the SS. One example is Dunkirk, where Goring’s morphine addiction is attributed to his delay in pursuing the British, thus allowing the famous Dunkirk evacuation.

The evils of Nazi Doctors have been well documented before, however this research has been on their victims and the inhumane experiments carried out in concentration camps and elsewhere. Blitzed – which reads more like a thriller – reveals the role of the personal physician and military doctors in disseminating methamphetamine, steroids, cocaine and morphine to both the architects of the Final Solution and the Third Reich, and the troops who carried out their orders.

[Perspectives] Orly Manor: public health leader in Israel’s health system

“Tikkun olam” translated from Hebrew means “to mend the world”, a maxim that has been at the heart of Orly Manor’s career. She is Professor of the Braun School of Public Health and Community Medicine at the Hebrew University of Jerusalem, and has been a leading figure behind the Lancet Series about health in Israel. Her current research activities are divided between two main projects: one evaluating the quality of treatment of Israeli health care, the other being a long-term project investigating the developmental origin of adult diseases.

[Correspondence] CONACYT’s freeze on postgraduate fellowships in Mexico

Although Mexico’s investment in research and development is low—around 0·5% of the gross domestic product is spent on this area compared with 2–4% in countries such as the USA, South Korea, the UK, Finland, and Japan (appendix)—CONACYT, the only state agency that funds research, has officially frozen the number of postgraduate fellowships available.1

[Comment] Paediatric head imaging decisions are not child’s play

Clinicians who care for paediatric patients with blunt head injury must reliably identify all patients harbouring serious injuries and avoid catastrophic misses that could lead to permanent disability and death.1–4 CT head imaging plays a key part in injury assessment, but is not suitable for most children because of cost, inconvenience, and risk of radiation-induced malignant transformation.1,2,5,6 Clinical decision tools, including the Pediatric Emergency Care Applied Research Network (PECARN),2 Canadian Assessment of Tomography for Childhood Head Injury (CATCH),4 and Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE)3 rules, have been developed to guide and inform paediatric CT head imaging decisions; however, concerns about the validity of these instruments prompted Franz Babl and colleagues to do a multicentre validation study1 that assessed their external performance.

[Comment] Sickle cell disease: tipping the balance of genomic research to catalyse discoveries in Africa

The completion of the Human Genome Project and the use of CRISPR/Cas9 for gene editing have begun to transform the diagnosis and management of disease. Sickle cell disease has been considered a perfect model for genomic research because it is a monogenic disease that is common and causes substantial morbidity and mortality but has no cure. The recent use of gene editing to modify disease severity1 and a case report of a patient with sickle cell disease who received successful treatment with gene therapy2 highlight the potential for translating genome-based knowledge into health benefits.

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.