more_vertControversy over the safety and efficacy of statins has harmed the health of potentially thousands of people in the UK. After publication of disputed research and tendentious opinions about statin use among people at low risk of cardiovascular disease in 2013, patients already taking statins were more likely to stop their medication both for primary prevention (an 11% increased risk of stopping treatment) and secondary prevention (a 12% increased risk). Over 200 000 patients were estimated to have stopped taking a statin in the 6 months after adverse media coverage.
Preference: Statistics, epidemiology and research design
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[Correspondence] Treating sickle cell anaemia: the TWiTCH trial
We read with interest the results of the TWiTCH trial1 comparing hydroxyurea with transfusions for the treatment of sickle cell disease. As a patient-support charity, we acknowledge the potential of this study to inform and change clinical practice geared towards reducing the risk of childhood stroke associated with sickle cell disease. As strong advocates for patient’s choice, we believe informed choice should remain key to the use and interpretation of this research in clinical practice.
[Comment] Prisoners, prisons, and HIV: time for reform
Prisoners and detainees worldwide have higher burdens of HIV, viral hepatitis, and tuberculosis than the communities from which they come. This disease burden among prisoners has been recognised since the early years of these inter-related pandemics.1 Yet the health needs of prisoners receive little attention from researchers or advocates working to improve responses for these diseases, and scant funding for prevention or treatment interventions. This Lancet Series on HIV and related infections in prisoners1–6 shows that the reasons for this neglect include the very factors that make prisoners and detainees vulnerable to infection and unable to get treatment: unjust and inappropriate laws; underfunded and overcrowded prisons with large numbers of individuals in lengthy pre-trial detention; policing practices that lead to imprisonment with compulsory drug detention centres that provide no evidence-based treatment for substance use disorders and inadequate health care; and discriminatory criminal justice systems.
TGA presentation: University of New South Wales, Faculty of Medicine, 19 August 2016
This presentation provided an overview of working at the TGA for scientists and engineers, as an alternative to a career in academic research
[Editorial] China: health takes priority
In 2013, the Lancet issue on China called for three steps to tackle China’s health challenges: understand the underlying causes for the rapid health transitions; support innovative, robust, and transparent research; and establish and implement sound health policies. This month, at China’s highest-profile national health conference in 20 years, President Xi Jinping has placed health at the heart of all policy making and called for full protection of every citizen’s health by stating: “an all-around moderately prosperous society cannot be achieved without the people’s all-round health”.
Small investments can make a big difference
For the AMA, Aboriginal and Torres Strait Islander health has been, and will remain, a priority. It is our responsibility to advocate for and support efforts to improve health and life outcomes for Australia’s First Peoples.
The AMA works closely with Aboriginal and Torres Strait Islander people in a number of ways to contribute to our mutual goal of closing the health and life expectancy gap between Indigenous and non-Indigenous Australians.
We have close relationships with NACCHO, the Australian Indigenous Doctors’ Association and the Close the Gap Steering Committee, through which we collectively contribute to the national debate on Indigenous health issues. The Taskforce on Indigenous Health, which I Chair, is another way that the AMA works in partnership with Indigenous people.
Each year, through the Taskforce, the AMA produces an annual Report Card on Indigenous Health – a landmark publication that makes practical recommendations to governments on how key Aboriginal and Torres Strait Islander health issues should be addressed.
This year the Report Card will have as its focus the eradication of rheumatic heart disease (RHD). RHD is an entirely preventable, third world condition that is wreaking havoc on the lives of Indigenous people in remote communities, primarily those in central and northern Australia. The 2016 Report Card on Indigenous Health will be a vital contribution to addressing RHD – a disease that should not be seen in Australia in the 21st century.
The AMA also supports policies and initiatives that aim to reduce other chronic and preventable diseases – many of which have an unacceptably high prevalence in remote Indigenous communities. An example of this is the little-known blood-borne virus HTLV-1, which in Australia occurs exclusively in remote Aboriginal communities in central Australia.
The AMA recognises that Aboriginal people living in Central Australia face many unique and complex health issues, and that these require specific research, training and clinical practice to properly manage and treat.
The AMA, as part of our broader 2016 election statement, called on the next government to support the establishment of a Central Australian Academic Health Science Centre. This is a collaboration driven by a consortium of leading health professionals and institutions, including: AMSANT, Baker IDI Heart & Diabetes Institute, Central Australian Aboriginal Congress, Central Australia Health Service, Centre for Remote Health, Charles Darwin University, Flinders University, Menzies School of Health Research, Ngaanyatjarra Health Service and Nganampa Health Service.
The AMA sees the proposed Health Science Centre as a very significant endeavour to improve the health outcomes of Aboriginal people living in remote communities. There are already tangible benefits from this type of collaborative and multi-disciplinary approach to health services and research.
The aim of the AHSC is to prioritise their joint efforts, principally around workforce and capacity building and to increase the participation of Aboriginal people in health services and medical research.
Some examples of achievements include: the Central Australia Renal Study, which informs effective allocation of scarce health resources in the region; the Alice Springs Hospital Readmissions Prevention Project, which aims to reduce frequent readmissions to hospital; and the Health Determinants and Risk Factors program, which better informs health and social policy by understanding the relationship between health and other factors such as housing, trauma and food security.
Having a designated Health Science Centre would be a massive boost for research, clinical services, and lead to greater medical research and investment. The Centre would likely see more expertise and opportunities to develop Aboriginal researchers and health care workers.
Establishing and operating this Centre would cost $4 million a year – a modest ask considering the potential benefits it could deliver.
The AMA recognises that Aboriginal and Torres Strait Islander people have a lead role in identifying and developing solutions to respond to their health needs – the proposed Central Australian Academic Health Science Centre is a clear example of this. The AMA will continue to support the efforts of Indigenous people to improve health outcomes and urges governments to do the same.
Assisted dying advocates won’t lie down
The major parties are being challenged to declare their position on assisted dying after the Australian Greens announced plans to introduce national assisted dying legislation during the current term of Parliament.
As a review of the AMA’s policy on euthanasia and physician-assisted suicide reaches its final stages, Greens leader Senator Richard Di Natale has flagged his intention to put proposed Dying with Dignity laws up for debate.
“It’s never easy to talk about death, but our political leaders need to have the courage to take on challenging issues, especially when it concerns the rights of every Australian,” Senator Di Natale said. “The Greens believe that patients with intolerable suffering should have the right to have a say in the timing of their death. As a doctor, I know many patients would be comforted just by knowledge that the right existed, even if they never exercised it.”
While history suggests the Greens will fall well short of the support they need to make their Bill law, there is a growing push to make assisted dying legal.
In Victoria, a cross-party parliamentary committee has recommended that assisted dying be legalised for patients with serious and incurable illnesses, and high-profile television producer Andrew Denton has founded Go Gentle Australia to campaign for the right for patient to choose what happens at the end of their life.
In a nationally televised speech, Mr Denton accused conservative politicians from both the major parties of conspiring to thwart efforts to legalise euthanasia, and called on those with religious or moral objections to assisted dying to accept the right of others to have such a choice.
The presenter has urged the adoption of laws that, subject to strict criteria, would provide legal protection for doctors who assisted patients with terminal illness to die.
He said it would not be “a licence to bump off granny”, and would in practice make legal what was “already happening in Australia without regulation, without support, without transparency or accountability and, from the evidence received, sometimes without consent”.
The Greens Bill follows similar legislation in Canada and California.
In Canada, the Trudeau Government has proposed laws to allow adults with serious and irreversible medical conditions to seek a doctor-assisted death. To do so they must apply in writing, with two witnesses, and the request must be evaluated by two doctors or nurses. Once a request is granted there is a mandatory 15-day waiting period.
California has passed laws that allow people with less than six months to live to seek physician-assisted death, subject to assessment that they are of sound mind.
But in the United Kingdom, the House of Commons last year overwhelmingly rejected a similar proposal.
The issue of assisted dying was debated at length at the recent AMA National Conference, where a panel of medical practitioners and a medico-legal expert argued the merits of the idea.
Though there were sharply divergent views on whether or not doctors should be involved in helping patients to die, there was broad agreement that the medical profession could do better in supporting patients, families and friends at the end of life.
The results of an AMA member survey on the issue were discussed at an AMA Federal Council meeting last month, along with issues raised at the National Conference forum and a separate consultation on current AMA policy conducted through the pages of Australian Medicine.
Doctors, nurses and other health professionals working in acute care settings can learn more about caring for patients approaching death and their families through Flinders University’s End-of-Life Essentials package. The free online resource includes three learning modules looking at managing end-of-life issues in hospitals, recognising dying, and communication and decision-making.
The modules can be accessed at: www.caresearch.com.au/EndofLifeEssentials
Adrian Rollins
When to pull the plug
Is there really such a thing as a fate worse than death?
Seriously ill patients at a Philadelphia hospital certainly think so.
In a novel study, researchers asked 180 patients with advanced cancer, severe heart failure or restrictive lung disease, to rate various states of functional debility relative to death, including incontinence, mechanically-assisted breathing, being bedridden, relying on a feed tube, chronic moderate pain, and being confined to home or a wheelchair.
Two-thirds thought suffering bowel and bladder incontinence or relying on a breathing machine to live would be equal to or worse than death, as was being bedridden.
Just over half thought being perennially confused would be equal to or worse than death, as was being in constant need of care.
By contrast, few thought being confined to a wheelchair, being in constant moderate pain or being stuck at home all day was such a grim fate. And though a third thought relying on a feeding tube to live was worse than death, more thought it was preferable to dying.
The study was published in JAMA Internal Medicine.
Adrian Rollins
[Correspondence] Transparency and availability of data for cancer research
Open research data allows for verification, replication, scrutiny, and subsequent analyses of published studies, while reducing likelihood of research duplication. By contrast, failing to publish data, which is a key impediment in the fight against cancer and non-communicable disease epidemics, hinders timely and effective response to these challenges.1 Hence, data should be liberated and made widely available to researchers.1
[Correspondence] Scientific Panel for Health: better research for better health
Health is a human right, with research underpinning every advance in health care. Even if political Europe is under siege, health research must remain high on the agenda of all stakeholders. The Scientific Panel for Health,1 created under the Horizon 2020 Framework Programme for Research and Innovation of the EU, was born out of concerns of the European biomedical research community.2,3 Too often, high-quality research is not translated into innovation. European strengths and values are not embedded in or supported by research policies.