[Correspondence] Brexit—a perspective from the other side of the Channel

We read with interest Dmitri Nepogodiev and colleagues’ Correspondence (July 30, p 459)1 supporting European research collaboration after Brexit. Research collaboratives in the UK have shown that multicentre studies can be run by trainees, enabling a change in the traditional paradigm of clinical research, which in turn provides benefit to both patients and investigators.

[Correspondence] Revising the ICD: explaining the WHO approach

From the late 19th century, the International Classification of Diseases and Related Health Problems (ICD) has been the backbone of cause of death statistics. Over time, country uses of the ICD have moved beyond tracking mortality, and now include morbidity statistics, health financing, research, and clinical care. Regular revisions of the ICD are necessary to accommodate advances in medical knowledge. The product of the ongoing revision will be suitable for a digital environment and include electronic tools for coding, browsing, translation, review, and mapping.

[Perspectives] The age of youth

Just how recent is our fascination with anti-ageing products and procedures? In 2009 the Academy of Medical Sciences published a report on how ageing research might be reinvigorated. Whilst generally putting forward an optimistic vision for the future impact of this research the Academy were also cautious to note that “it is important to emphasise the limitations of ageing research. Promises of substantial increases in lifespan, reversing ageing or even immortality are unlikely to be fulfilled in the foreseeable future, if at all”.

[Perspectives] David Cooper: Australia’s fighter against HIV and discrimination

“The story of HIV is a modern medical miracle”, says David Cooper, who diagnosed some of Australia’s first cases in 1983. “From despair and tragedy, we have moved into an era of chronic treatable illness, in just 30 years.” The inaugural Director of the Kirby Institute for Infection and Immunity in Society, at the University of New South Wales, Sydney, since its establishment in 1986, Cooper has dedicated his career to research into HIV epidemiology, treatment, and prevention. Indeed, he’s been involved in trials of all the HIV medications on the market today.

[World Report] Profile: The Kirby Institute celebrates 30 years

The Kirby Institute for Infection and Immunity in Society (the Kirby), based at the University of New South Wales, Sydney, Australia, is celebrating its 30th anniversary this year. Established as a key component of Australia’s response to the HIV crisis in 1986, the institute was known for 25 years as the National Centre in HIV Epidemiology and Clinical Research. In 2011, it was renamed the Kirby Institute to honour Australia’s long-serving (now retired) High Court judge Michael Kirby, a renowned champion of health and human rights.

[Comment] 6 year follow-up supports early autism intervention

There have been few large randomised controlled trials of early intervention for children with autism spectrum disorder, even fewer with follow-up data, and none with such a lengthy follow-up period as that reported by Andrew Pickles and colleagues1 in The Lancet. These researchers assessed long-term outcomes for children who had received a parent-mediated intervention versus treatment as usual nearly 6 years earlier. That earlier study from 20102 was notable for its rigorous methodology.3

Gene tests on ‘don’t do’ list

Medical experts have taken aim at ‘direct to consumer’ genetic testing services amid concerns that they are causing unnecessary expense and alarm.

Medical experts have warned that patients should not initiate genetic tests on their own, particularly for coeliac disease and for the genes MTHFR and APOE, which are, respectively, associated with levels of folate and susceptibility to Alzheimer’s disease.

The Gastroenterological Society of Australia has recommended against genetic tests for coeliac disease because the relevant gene is present in about a third of the population and “a positive result does not make coeliac disease a certainty”.

Similarly, Human Genetics Society of Australasia Clinical Professor Jack Goldblatt said variants of the MTHFR gene were “very common in the general population [and] having a variant in the gene does not generally cause health problems”.

Additionally, Professor Goldblatt said that although the APOE gene was considered a risk factor for Alzheimer’s, “having a test only shows a probability, so people undertaking [the test] can also risk being falsely reassured”.

“Unnecessary genetic testing can lead to further unnecessary investigations, worry, ethical, social and legal issues,” he said. “In particular, we caution people to not initiate testing on their own. Genetic tests are best performed in a clinical setting with the provision of personalised genetic counselling and professional interpretation of test results.”

The recommendations are among 20 made by the Gastroenterological Society of Australia (GESA), the Royal Australian and New Zealand College of Radiologists (RANZCR), the Human Genetics Society of Australasia and the Australasian Chapter of Sexual Health Medicine, as part of program being coordinating by the Choosing Wisely Australia campaign to improve the use of medical tests and treatments.

The advice includes cautioning women against self-medicating for thrush, improved use of radiation therapy to treat cancer, and careful use of colonoscopies.

Professor Anne Duggan from GESA said colonoscopies had a “small but not insignificant risk of complications”, and those undertaken for surveillance placed “a significant burden on endoscopy services”.

Professor Duggan said surveillance colonoscopies should be targeted “at those most likely to benefit, at the minimum frequency required to provide adequate protection against the development of cancer”.

The RANZCR said radiation treatment was “a powerful weapon” in the treatment of cancer, and half of those diagnosed with the disease would undergo radiation therapy.

But the College advised that such treatment should be provided within clinical decision-making guidelines, “where they exist”.

In particular, it has recommended sparing use of radiation to treat prostate cancer.

Dean of the College’s Faculty of Radiation Oncology, Dr Dion Forstner, radiation oncology might not be immediately required where prostate cancer is diagnosed.

“Patients with prostate cancer have options including radiation therapy and surgery, as well as monitoring without therapy in some cases,” Dr Forstner said.

The College also advised that while whole-breast radiation therapy decreased the local recurrence of breast cancer and improved survival rates, recent research had shown that shorter four-week courses of therapy could be equally effective “in specific patient populations”. It said patients and doctors should review such options.

The Chapter of Sexual Health Medicine made several recommendations, including advising against tests including herpes serology and ureaplasma in asymptomatic patients, and the use of serological tests to screen for chlamydia, because of frequent inaccuracy and the possibility of false-positive results.

In addition, it flagged concerns about the treatment of thrush.

Chapter President Dr Graham Neilsen said it was concerning that many women with recurrent and persistent yeast infections self-administered treatment, or were prescribed topical and oral anti-fungal treatments.

Dr Neilsen said it was important that patients had “good conversations” with clinicians about appropriate care.

“It is important to rule out other causes…such as genital herpes or bacterial vaginosis, so that other infection are not left untreated,” he said. “As well as the importance of ruling out other causes before commencing anti-fungal agents, inappropriate use of antifungal drugs can lead to increased fungal resistance.”

The 20 recommendations are the latest instalment in an ongoing program, coordinated by Choosing Wisely, in which 23 medical colleges and societies are working to improve the use of tests and treatments based on the latest evidence.

The process is separate from the Federal Government’s MBS Review, which is examining all 5000 items on the Medicare Benefits Schedule.

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News briefs

Trio of female researchers win research awards

Three health and medical researchers have won 2016 Women in Research Citation Awards from Thomson Reuters IP and Science, and the Australian National University. Dr Alize Ferrari is a research associate for the Psychiatric Epidemiology and Burden of Disease Research (PEABOD) Group based at the Queensland Centre for Mental Health Research. She holds affiliate positions with the School of Public Health at the University of Queensland and the Institute for Health Metrics and Evaluation at the University of Washington. Her research investigates the global epidemiology of mental and substance use disorders, the ecological risk factors and outcomes of mental and substance use disorders, and providing technical expertise to national and international mental health epidemiological surveys and burden of disease studies. Dr Annie Lau is a Senior Research Fellow at Macquarie University, leading the Consumer Informatics team which focuses on patients and healthcare consumers. Her research program investigates the impact, design, and science of Information and Communications Technology on consumers, patients and their carers. Her interests lie in e-health, consumer informatics, health service engagement, social computing and human behaviour modelling. Dr Julie Schneider is a lecturer in Work Integrated Learning (WIL) at the Faculty of Health Sciences and an Honorary Associate at the Menzies Centre for Health Policy at The University of Sydney. Her work explores the experiences of hearing impairment and DSI among adult Australians, with particular focus on prevalence, impacts and implications for improved models of service delivery. She is Deputy Chair for the Deafblind International Research Network, an initiative established to promote collaboration between researchers with shared interest in the topic of combined vision and hearing loss.

Online learning helps chemo patients’ attention and memory

Research out of the University of Sydney has shown that chemotherapy patients assigned to an online learning program had less cognitive symptoms immediately following the intervention and at 6 months’ follow-up than those who received standard care. The online program – “Insight from Posit Science” – uses “adaptive exercises targeting processing systems aimed at improving cognition through speed and accuracy of information processing”. It is now available as an internet-based program and accessible at: http://www.brainhq.com/welcome. Up to 70% of cancer patients report cognitive symptoms following chemotherapy. These symptoms have been linked to poorer quality of life and increased depression, anxiety, and fatigue among cancer survivors. The study examined 242 adult cancer patients who had completed three or more cycles of chemotherapy in the previous 5 years, and who self-reported cognitive symptoms, indicated by changes in concentration and/or memory. Of those who participated in the study 89% were women with breast cancer. Participants were assessed on self-reported cognitive function, as measured by the Functional Assessment of Cancer Therapy Cognitive Function version 3 (FACT-COG) questionnaire; and objective neuropsychological function – as assessed by Cogstate, an 18-minute computerised battery, comprising seven tests evaluating processing speed, decision making, working memory, executive function, continuous performance, matching, and new learning. In other results, the online program group showed significantly lower levels of anxiety, depression and fatigue than the standard care group immediately after treatment, but not at 6 months; there was no difference in quality of life between the groups immediately following the intervention, but the online program group had better quality of life at 6 months; there was no difference on objective neuropsychological function between the comparison groups immediately following the intervention, or at 6 months.

[Correspondence] Health metrics priorities: a perspective from young researchers

The Sustainable Development Goals (SDGs) update the global development agenda for the post-Millennium Development Goal (MDG) era, emphasising the world’s most pressing problems and the need for collaborative local, national, and global action to achieve those goals.1 The Institute for Health Metrics and Evaluation (IHME) and peer institutions inform global health decision making by producing health estimates that measure progress towards targets related to the SDGs.2 With the SDGs’ emphasis on the complex relationship between health and development, we, as young researchers at IHME, see an opportunity for the health metrics field to examine its priorities through collaboration and outreach within and outside of the health metrics field.

[Perspectives] Marie Vahter: the arsenic detective

Marie Vahter first came across the harm arsenic can do to the environment and health in her native Sweden during the early 1980s, when a large copper smelter was spewing the toxin into the air and sea. She did her PhD in toxicology, focusing her dissertation on the kinetics of inorganic forms of arsenic in relation to animal species. Today, she is a Professor in Environmental Medicine at the Karolinska Institutet, Stockholm, where she directs research into the immediate and long-term effects of early-life exposure to toxic metals such as arsenic, manganese, cadmium, and lead.