Putting a DJ in da house

Even in the age of the smart phone and all the information and distractions it puts at a person’s fingertips, doctor waiting rooms can be a source of tedium and dread for some.

Stacks of National Geographic, House & Garden and People magazines can help entertain and divert, and some practices even have a television tuned to the news in the corner.

But the Phonographic Performance Company of Australia (PPCA) says that businesses, including medical practices, often overlook the calming and soothing potential of music in helping pass the time and tempering anxious thoughts.

It has been well established that music can exert a powerful influence on emotions and moods.

A paper looking at the effects of background music (The effects of background music on health and well-being by University of London academic Susan Hallam in Music, Health, and Wellbeing, edited by Raymond MacDonald, Gunter Kreutz, and Laura Mitchell, 2012), cited evidence from a range of studies pointing to the many and varied ways people respond to music – often to the benefit of their health.

For instance, a 1995 review of the use of music in hospitals found it was associated with reduced perceptions of pain, anxiety and stress, enhanced the effects of anaesthetics and analgesics and reduced the length of hospitalisation.

In particular, Hallam wrote, calming background music has been shown to have a direct impact on biological indicators of stress such as cortisol and blood pressure, in addition to perceived anxiety.

“Perhaps the most striking example of the power of music to impact on health comes from research on babies born prematurely,” Hallam wrote. “In comparison with groups not provided with background music, exposed groups gain weight, increase food intake and reduce their length of stay in hospital.”

These findings support the results of research commissioned by the PPCA regarding the benefits of background music to businesses.

The non-profit organisation, which licenses the playing of recorded music in public places, commissioned an online survey of 500 small and medium sized businesses in April and May, 83 per cent of which thought music helped reduce the tedium of waiting for service, and 76 per cent thought it provided a distraction.

But before rushing to install sound system in the waiting room, practices should also be mindful of the potential pitfalls of background music.

Hallam warns that where people do not have control of the music they are subjected to, or where it is a poor ‘fit’ with their mood, self-perception or needs it can fuel, rather than allay, anxiety.

“If background music is imposed, whether in a public space, in an on-hold telephone situation, or at home it could, in some cases, cause extreme distress,” she wrote.

For example, a large survey of people’s views of background music played in public places in the United Kingdom found that a third found it annoying (another third reported not noticing it).

More significantly, the hard-of-hearing found background music to be particularly problematic. Eighty six percent reported that it frequently drowned out speech and announcements, which was especially an issue in restaurants.

Another consideration for business is the potential effect on staff. Hallam cited a the results of a survey conducted by the UK Noise Association in 2007 which found that 40 per cent of employees disliked it, almost a third tried to ignore it, and just 7 per cent said they actually liked it.

Adrian Rollins

Signs not good for flu season

The nation’s top medical officer has issued an urgent call for people, particularly vulnerable groups including pregnant women, the elderly and those with chronic illnesses, to get vaccinated against the flu amid signs the nation is headed for its worst season on record.

Official figures show that so far this year more than 14,124 have caught the flu – double the long-term average for the period – and a third higher than for the same time last year.

In a worrying sign that the flu season is gathering momentum, figures compiled through the National Notifiable Diseases Surveillance System show that in in just one month, from 5 June to 6 July, an extra 4911 laboratory-confirmed cases were reported, including almost 2000 in the first week of July.

Underlining the seriousness of the illness, the Health Department said it had so far been notified of 36 deaths associated with influenza since the beginning of the year, with the likelihood that number will rise sharply as the rate of infection accelerates.

Commonwealth Chief Medical Officer Professor Chris Baggoley specifically urged people considered to be at risk, including those aged 65 years and older, Indigenous Australians, pregnant women, and those with cardiac disease and chronic respiratory conditions and illnesses, to take advantage of the free vaccine provided by the Government.

“Flu is highly contagious and spreads easily from person to person, through the air, and on the hands,” Professor Baggoley said. “We need to get higher uptake [of the vaccine] among these groups.”

The Chief Medical Officer emphasised the importance of doctors and other health professionals in helping ensure people were vaccinated against the disease.

“Immunisation is still the best form of protection from influenza, and health care professionals play an essential role in ensuring high uptake,” he said.

The National Seasonal Influenza Immunisation Program began late this year because of a rare double strain change in the vaccine to cover two new strains of the virus – one of which caused havoc in the northern hemisphere.

In the US alone, around 100 children were reported to have died from the flu during the northern flu season, and there was also widespread illness among the elderly.

For the first time under the national immunisation program, Australians have access to single-dose vaccines covering the four most common flu viruses, including three quadrivalent formulations.

The World Health Organisation and the Australian Influenza Vaccine Committee have recommended that vaccines this year cover one existing and two new strains – the California H1N1-like virus that has been in circulation since 2010, the Switzerland H3N2-like virus and the Phuket 2013-like virus.

There have been claims that the delay to the vaccination program has contributed to the strong start to the flu season by leaving a large number of people unprotected, and Professor Robert Booy of the Influenza Specialist Group told the Herald Sun fewer people had been vaccinated that “we would have liked”.

But Health Minister Sussan Ley said the Government was ahead of where it was last year in acquiring vaccine doses.

Ms Ley said that so far in 2015 4.5 million doses had been bought under the National Immunisation Program, 200,000 more than were distributed in 2014.

She did not say how many of these doses had been administered.

Ms Ley said the flu season usually peaked in August and September which, given that it usually takes around three weeks following vaccination to develop immunity, meant people needed to get themselves vaccinated as soon as possible.

Promisingly, early figures suggest vaccinations are helping to reduce the number and severity of infections.

The pilot Flu Tracking surveillance system, a joint University of Newcastle, Hunter New England Area Health Service and Hunter Medical Research initiative that collects data from a weekly online survey, has so far identified only low levels of influenza infection.

But it found that 3.4 per cent of those not vaccinated against the flu suffered fevers and coughs, and 2.1 per cent had to take time off work, while among those vaccinated, 2.7 per cent had coughs and fevers and 1.6 per cent reported having to take sick leave.

The results underline calls from AMA Vice President Dr Stephen Parnis for people, particularly elderly and vulnerable patients and health professionals, to make sure they are vaccinated against the flu.

Dr Parnis said it was important for doctors, nurses and other health workers to get the flu vaccine, for the sake of their own health as well as that of their patients.

Adrian Rollins

AMA in the News – 21 July

Your AMA has been active on policy and in the media on a range of issues crucial to making our health system better. Below is a snapshot of recent media coverage.

Print/Online

Doctors, teachers face gags under immigration laws, Sydney Morning Herald, 4 June 2015
Doctors and teachers working in immigration detention facilities could face up to two years in prison if they speak out against conditions in the centres or provide information to journalists. AMA President Professor Brian Owler said this was the first time doctors had been threatened with jail for revealing inadequate conditions.

Medical research fund could be ‘slush’ fund: Labor, The Age, 5 June 2015
The Abbott Government could raid its Medical Research Future Fund to pay for election promises and “pet projects” under proposals before federal Parliament, Labor has claimed. AMA President Professor Brian Owler said decisions about which research projects would be funded needed to be made at arm’s length from the minister.

Help for violence victims, Northern Territory News, 5 June 2015
A new resource to assist doctors in providing better support for victims of family violence was launched by the AMA at the AMA National Conference. AMA President Professor Brian Owler said the medical profession had a key role to play in the early detection, intervention and treatment of patients who has experience family violence.

Experts fear flu season shaping as the worst on record, The Saturday Age, 6 June 2015
The first five months of 2015 have been the worst on record for influenza, with experts warning Australia could be in for a rotten flu season. AMA Chair of General Practice Dr Brian Morton said Australia tended to follow the northern hemisphere’s flu season, which had been severe due to the emergence of new flu strains.

Banned flu drug still being given to children, Sunday Mail Brisbane, 7 June 2015
A disturbing number of doctors have ignored multiple warnings against administering the flu vaccine Fluvax to children younger than five years, even though there are safe alternatives. AMA President Professor Brian Owler said this risked undermining an otherwise safe vaccine schedule.

Leaked trade deal terms prompt fears for Pharmaceutical Benefits Scheme, The Guardian, 11 June 2015
The leak of new information on the Trans-Pacific Partnership agreement (TPP) shows the mega-trade deal could provide more ways for multinational corporations to influence Australia’s control of its pharmaceutical regulations. AMA president Professor Brian Owler said while doctors were very concerned at the possible effects on Australia’s health care system, their fears were routinely dismissed by Trade Minister Andrew Robb.

Save the planet for better health, The Canberra Times, 24 June 2015
The biggest boost to public health this century could come from action to tackle climate change, such as shutting down coal-fired power plants and designing better cities, according to a Lancet Commission report. AMA President Professor Brian Owler said the Australian health system was not prepared for climate change.

‘Whistleblowers’ challenge Australia’s law on reporting refugee conditions, CNN, 2 July 2015
More than 40 doctors, nurses, teachers, and other humanitarian workers have signed an open letter to the Australian government, challenging a new bill that could put whistleblowers in jail for disclosing the conditions of Australian detention centres. AMA President Professor Brian Owler said the act puts doctors in a dilemma when treating detainees and asylum seekers if they have concerns about the provision of their health care.

Medibank dust-up sparks care debate, The Saturday Age, 11 July 2015
AMA President Professor Brian Owler said the contract clauses being pushed by Medibank Private that put financial risk for unplanned patient readmissions and preventable falls back on private hospitals are evidence the newly listed market leader has shifted its priority to shareholders.

Radio

Professor Brian Owler, 666 ABC Canberra, 28 May 2015
AMA President Professor Brian Owler talked about the issues surrounding the bulk billing of GPs. Professor Owler said a doctor can bulk bill and this means they can accept the amounts from Medicare.

Dr Brian Morton, 5AA, 3 June 2015
AMA Chair of General Practice Dr Brian Morton discussed medicines on the drug subsidy scheme will rise in price on July 1. Dr Morton said that any medicine that currently costs consumers less than $36 will be hit by the rise.

Professor Brian Owler, 702 ABC Sydney, 4 June 2014
AMA President Professor Brian Owler talked about Medicare. Professor Owler said there have been a number of reviews but, these have never really been dealt with the schedule as a whole.

Professor Brian Owler, ABC Classic FM, 11 June 2014
AMA President Professor Brian Owler discussed health issues including the “Don’t Rush” road safety campaign, neurosurgery, and vaccinations.

Dr Brian Morton, 3AW, 29 June 2015
AMA Chair of General Practice Dr Brian Morton talked about issues with Dr Google. Dr Morton said it could be beneficial when trying to understand a treatment a patient is undergoing.

Professor Brian Owler, 612, 13 July 2015
AMA President Professor Brian Owler discussed diabetes in Australia. Professor Owler said the majority of type 2 diabetes cases were preventable and encouraged people to eat healthier food and get regular exercise.

Television

Prof Brian Owler, ABC Brisbane, 29 May 2015
The AMA has warned that doctors’ fees could go up if the freeze on Medicare rebates for GP visits continues, and that even patients with private health insurance could end up paying more

Prof Brian Owler, Channel 9, 31 May 2015
A new online tool to help doctors identify and respond to family violence has been rolled out. The resource launched by the AMA allows doctors to provide information on support services.

Dr Stephen Parnis, Channel 7, 13 June 2015
AMA Vice President Dr Stephen Parnis discussed warnings Victoria was on the verge of a whooping cough epidemic. Dr Parnis said deaths from whooping cough were not common but were entirely avoidable.

Dr Brian Morton, Channel 10, 20 June 2015
AMA Chair of General Practice Dr Brian Morton warned of a spike in emergency department admissions, with the price of some of the most common Pharmaceutical Benefits Scheme prescription medications set to rise.

Recruitment into clinical trials — patient, recruit thyself

Improving rates of recruitment into clinical trials, especially later-stage trials that require more participants, is a big challenge facing the Australian clinical trials sector. Successful clinical trials require not just sufficient funding, talent and clinical know-how, but also an adequate number of participants.

Already, Australia lags behind the United Kingdom in this regard. In June 2014, the UK’s National Institute for Health Research Clinical Research Network announced its three millionth participant in trials conducted over the previous 6 years (http://www.crn.nihr.ac.uk/blog/news/patient-recruitment-to-research-studies-hits-three-million). In contrast, a benchmarking survey of Australian clinical research activity by the Pharmaceuticals Industry Council indicated that 53% of Phase III trials carried out in Australia in 2010 achieved less than 80% of their recruitment target.

So, how can we boost recruitment? One method is by capturing more participants at clinics by improving the recruitment process at that stage. Perhaps a more useful approach would be to give potential participants the ability to register for trials themselves. While such functionality already exists for specific conditions, a resource that provides information on all Australian clinical trials for all conditions would greatly benefit clinical research.

Through work conducted by the National Health and Medical Research Council and the Australian Government Department of Industry and Science, there is now such a resource. The recently launched Australian Clinical Trials website (http://www.australianclinicaltrials.gov.au) allows potential participants to take matters into their own hands. With a few clicks of the mouse, individuals can find a trial in which they are interested and send a pro forma email to the contact person for the trial.

This is a big step in the right direction. Encouraging patients and clinicians to use this resource to its best advantage will be the next challenge. Meanwhile, the government will continue to work on other aspects of clinical trial recruitment to keep Australia competitive in the clinical trials space.

[Perspectives] How not to clone a mammoth

The first line of the US mule-training manual is said to read: “First gain the animal’s attention by striking it smartly between the ears with a stout stick”. For authors, their book’s title does the same job. I got some odd glances on the tube a while ago when I was reading a work provocatively labelled (in sixty-point capitals) The Wisdom of Whores which, despite the empty seats that opened up on both sides of me, is in fact an enthralling account of the epidemiology of HIV/AIDS. The most recent Diagram Prize for Oddest Book Title of the Year at the Frankfurt Book Fair was won by Strangers Have the Best Candy, which should also guarantee a seat on a crowded train.

[Viewpoint] Can mass media interventions reduce child mortality?

Many people recognise that mass media is important in promoting public health but there have been few attempts to measure how important. An ongoing trial in Burkina Faso (ClinicalTrials.gov, NCT01517230) is an attempt to bring together the very different worlds of mass media and epidemiology: to measure rigorously, using a cluster-randomised design, how many lives mass media can save in a low-income country, and at what cost. Application of the Lives Saved Tool predicts that saturation-based media campaigns could reduce child mortality by 10–20%, at a cost per disability-adjusted life-year that is as low as any existing health intervention.

[Perspectives] Making sex add up

Sex research is notoriously problematic, not least because sex is shrouded in taboo and stigma. So it’s interesting to read a book that seeks to tell “the real story about sex in modern society”. In Sex by Numbers, David Spiegelhalter draws on the findings of the pioneering British National Survey of Sexual Attitudes and Lifestyles (NATSAL), alongside other sources, to give a valuable overview of sex statistics—on everything from how often people have sex, to the changing profile of same-sex experiences, to the average energy expenditure during sex, to the median ejaculation time after vaginal penetration, to the rate of teenage pregnancy, and much more.

[Comment] Diabetes, obesity, and the metabolic syndrome: a call for papers for EASD and the World Diabetes Congress

Diabetes, obesity, and the metabolic syndrome are starting to overtake communicable diseases as major threats to health worldwide. The prevalence rates of diabetes and obesity are rising sharply, and while some of the causes are clear—for example, adverse changes in physical activity and diet, led in some populations by demographic change—better strategies for prevention and treatment are still needed. Research into treatment, public health and education interventions, and epidemiology is urgently required to address this epidemic.

‘Cracking good’ team supports life of service

A rural GP with a “cracking good” health team and a life-long fascination with the life of birds is among AMA members recognised in the 2015 Queen’s Birthday honours.

Dr David Hollands who, with his wife Margaret, has lived and worked in the east Victorian town of Orbost more than 50 years, was awarded a Medal of the Order of Australia for his many decades of service to his community, as well as his enormous contribution to ornithology.

In an interview with his local newspaper, the East Gippsland News, Dr Hollands recalled how, when he and his wife first arrived in Orbost not long after migrating from Britain, local doctors were expected to do “almost everything”, from delivering babies and stitching up cuts to dealing with major trauma cases.

“There was nothing like the air ambulance or helicopter evacuations,” he told the East Gippsland News. “People expected that the local doctor would cope with almost everything.”

Dr Hollands was among 20 GPs, specialists, researchers and educators recognised for their significant contributions to the health of the community and their services to medicine in the Queen’s Birthday Honours List.

AMA President Professor Brian Owler said the diversity and breadth of the accomplishments cited in the awards were testament to the significant contribution to the community made by medical practitioners every day.

Among the recipients is South Australian GP Dr Anh-Tuan Ngo, who had been a doctor in the South Vietnamese army and came to Australia as a refugee with his family in 1984. Since arriving in Australia, Dr Ngo has worked tirelessly, not only to look after his patients, but to serve the local Vietnamese community and support other veterans of the Vietnam War.

Another to be made a Member of the Order of Australia was Victorian GP Dr Barry Christopher who, in addition to his work as a doctor, campaigned for decades to advance Indigenous rights.

In the late 1950s Dr Christopher became President of the Victorian Council for Aboriginal Rights, and was a founding member of the Federal Council for the Advancement of Aborigines and Torres Strait Islanders.

Dr Hollands’ experience is indicative of how important is the role performed by many doctors in their community.

Working in an area that included 35 saw mills as well as major interstate roads, Dr Hollands and his wife – also a doctor – saw plenty of horrific accidents.

“Industrial health and safety was non-existent and alcoholism was absolutely rife – people would arrive at work on Monday still half pickled. So we had an enormous amount of trauma,” he said, adding that the number and severity of road accidents they attended were “just incredible”.

He recounted how 35 people were injured when a tourist bus overturned late at night, and he and another doctor worked for 48 hours straight at the Orbost Hospital, “non-stop setting fractures and sticking tubes in chests and sewing people up”.

Asked about his award, he said that although receiving it was “very nice”, much was due to a “cracking good team”, including his wife, two other doctors and devoted and capable nursing and surgery staff.

In addition to his medical work, Dr Hollands has also been recognised for his enormous contribution to the study of birds.

He told the East Gippsland News of his life-long fascination with ornithology, and his is the author of numerous books including Owls, Frogmouths and Nightjars of Australia, Owls – Journeys Around the World, and Kingfishers and Kookaburras.

“I’ve been a fanatical birder since about eight, so I’m getting an award for something I really love doing,” Dr Hollands said.

Professor Owler said Dr Hollands, Dr Ngo and Dr Christopher were examples of the major contribution made by many AMA members to aspects of life well beyond medicine, and were deserved recipients of Queen’s Birthday Honours.

Adrian Rollins

Flawed broadcast prompts thousands dump vital drug

Almost 3000 people are at heightened risk of a fatal heart attack or stroke as the result of the broadcast of a controversial television program questioning the safety of prescribed cholesterol-lowering medications.

A University of Sydney study published in the Medical Journal of Australia has estimated that around 60,000 people stopped taking prescribed statins immediately after the ABC’s Catalyst science program in October 2013 called into question the link between cholesterol and heart disease and included claims that statins were toxic.

The Sydney University researchers found that in the weeks after the two-part program was broadcast, the number of statins being dispensed dropped by 2.6 per cent – and by more than 6 per cent among patients not taking other medications – and that the effect was sustained.

The researchers warned that the “significant and sustained” decline in statins dispensing following the Catalyst broadcast meant it was likely that 60,897 people had stopped taking their medication, potentially causing preventable – and possibly fatal – major vascular events in up to 2900 people.

“The prevalence of statin use in Australia, and the established efficacy of these drugs, means that a large number of people are affected, and may suffer unnecessary consequences,” they warned.

Claims made in the Catalyst program about the usefulness and safety of statins are at odds with established medical advice and were met with a storm of criticism from health experts.

The ABC subsequently withdrew the program after an internal review judged that it had breached standards on impartiality.

But there are signs that the show has had a long-lasting effect on perceptions regarding the safety of statins. The Sydney University researchers said that, as at mid-2014, there was no sign of a rebound in the dispensing of statins after the sudden drop following the Catalyst broadcast.

The phenomenon has underlined the need for the media to be very careful about the way they report health issues.

The number of statins dispensed dipped sharply in 2012 following publication of a story about the risk of diabetes and dementia associated with statins use, and a 2007 news broadcast associating osteonecrosis of the jaw with bisphosphonate use provoked a 30,000 plunge in prescriptions.

NPS MedicineWise, which advises on the safe and effective use of drugs, has urged patients who have stopped taking their statins after watching the Catalyst program to immediately see their doctor.

Chief Executive Dr Lynn Weekes said that although all medicines carried risks as well as benefits, “we also know it’s very clear that people at high risk of a heart attack or stroke benefit substantially from statins”.

“It is worrying…that such a large number of people have stopped taking their prescribed statins,” Dr Weekes said. “Someone prescribed a statin is likely to be at higher risk of stroke or heart attack. For these medicines to reduce that risk, they need to be taken every day, and for the long term.”

Adrian Rollins