By Kellie Bisset
What the evidence uncovered
Evidence has turned the tables on two issues this past fortnight: whether our multimillion national investment in antiviral drugs is justified; and whether significant spending on alternative treatments such as homeopathy is a good use of money.
First, to antiviral drugs, and the release of a Cochrane Review that found what many had long suspected – the antiviral drugs Tamiflu and Relenza are largely ineffective in reducing complications from influenza and, given their side effects, may not be worth the considerable expense governments around the world have gone to in stockpiling them.
Cochrane began looking at the effectiveness of Tamiflu in 2005 and has attracted significant publicity in its attempts to persuade drug manufacturers Roche and GSK to hand over their unpublished data on Tamiflu and Relenza. The Conversation’s Reema Rattan takes a comprehensive look at the situation in this article republished on Croakey. And one of the Cochrane reviewers, Bond University’s Professor Chris Del Mar, has compiled via Croakey, a series of questions to the Australian Government on how it might consider its current investment in antivirals in light of this new information (the Department of Health has now responded to his queries).
And to homeopathy, for which the NHMRC finally released its much anticipated review. It found no reliable evidence for homeopathy’s effectiveness and has distributed the report for public consultation. Pharmacology lecturer Ian Musgrave outlines the issues here for The Conversation as does Ken Harvey for The Drum. And Loretta Marron, CEO of Friends of Science in Medicine, asks in this Croakey post, is this really the end of the road for homeopathy?
The NHMRC will also publish a review on a range of other complementary medicines next year. The results of this review will inform whether the natural therapies in the review’s scope should continue to receive Government private health insurance rebates. But in the meantime it has released an information guide for doctors and other healthcare workers on how to address issues around complementary medicines and therapies with patients. The guide acknowledges many patients don’t discuss their complementary medicine use with mainstream health providers, and it says that without a full understanding of patients’ motivation for seeking certain therapies, it is difficult to provide patient-centred care.
This comment piece in The Guardian from Ranjana Srivastva touches on exactly this issue. Patients just want to be heard, she says, and if alternative therapies fill this need, despite the evidence against them, this should cause western medicine to rethink its approach to patient communication.
Reaching out to vaccine skeptics
These issues translate readily to other areas of pubic health, including immunisation education, which continues to occupy the minds of those dealing with anti-vaccination lobbyists and parents who are simply unsure.
This piece from NPR looks at various approaches US doctors are taking to convince parents that immunising their children is important. And the Ottowa Citizen explores the issue of vaccine-hesitant mothers in Canada.
Withholding tax benefits from parents who refuse to immunise is not the answer, according to this ABC report quoting the University of Sydney’s Associate Professor Julie Leask.
Many consider that addressing the misinformation spread by organisations such as the Australian Vaccination Skeptics Network is a good starting point – but who are they really? This article on news.com.au says that while the the group’s list of professional members has been taken off the internet, in 2011, 128 of 198 listed professional members were chiropractors.
High profile anti-vaxxer and US celebrity Jenny McCarthy has been in the news again, with a column written for the Chicago Sun-Times that has been attacked across the spectrum. This summary of the debate in The Atlantic is worth a read. It encourages health professionals and journalists to depersonalise the issue and “go after the the misinformation, not the misinformed”.
Public health: from climate change to gun violence and the Nanny State
Professor Fiona Stanley says her whole career has been about preventive health. As a result, she can’t sit idly by and let climate science be politicised when ignoring it will have profound public health implications. The ABC’s RN Breakfast and the SMH both covered her recent speech to doctors and medical students in Perth, where she said she “can’t be silent” on this important issue.
For more on environment and health, Croakey’s Michelle Hughes has posted a round-up of recent events in the space. And, writing for MJA Insight, Mark Braidwood and Catherine Pendrey from Doctors for the Environment Australia say it’s time for health professionals to act.
“Climate change could be the great disrupter of our age and threatens to reverse major health advancements,” they write.”It is projected to increase the risk of under-nutrition in poor regions due to decreased food production, with estimates of up to 25 million more underweight children by 2050 compared with a future without climate change.”
On other public health matters, the US marked national public health week from April 7 to 13, with hundreds of communities across the country participating in events. Here’s a snapshot of the themes that graced the week, a highlight of which was the Centers for Disease Control and Prevention’s Public Health Nerd campaign, which encourages people to get nerdy and discuss all things public health.
The American Public Health Association quoted its executive director Georges Benjamin as saying: “I support CDC’s Public Health Nerd campaign because, as a nerd, I think National Public Health Week is about bringing communities together to make us all healthier.”
The week also coincided with the WHO’s World Health Day, which this year put the spotlight on vector-borne diseases such as malaria and dengue fever.
Meanwhile, Bill Gates, whose Bill & Melinda Gates Foundation has a particular focus on fighting malaria, has joined eight prominent Indonesian businessmen in pledging $80million to tackle public health issues in Indonesia.
In the US, doctors have taken a stand on gun violence, with the American College of Physicians releasing a position statement on the impact of firearms, including recommendations reported by The Washington Post suggesting doctors should counsel patients on the risks of having guns at home. This Post blog also tackles the issue, suggesting that even kids know gun violence is a public health issue, and adults need to check their hypocrisy.
In the UK, public health has also been up for discussion, but in the context of whether system changes devolving public health responsibility to local government are actually working. This Guardian article examines the issues and Deutsche Welle takes a look at how Britain is faring in the Nanny State debate as it grapples with issues such as rising rates of obesity.
As the NHS welcomed a new chief executive in former Blair health adviser Simon Stevens, Guardian blogger and radiologist Jacky Davis said it was timely to point out that assertions the NHS was unsustainable and required up-front patient charges were “erroneous”.
“Research is clear that charges of this sort deter the poor and the elderly – the very people who need the NHS most – and as a result they present later with more advanced illness,” she wrote.
Sounds like Australia and Britain are having parallel debates over healthcare funding…
Health waiting game continues
On that note, the Grattan Institute’s Stephen Duckett talks about “sustainability panic”, which is what Australia appears to be witnessing in the lead-up to the May Budget. This, he writes for Croakey and The Conversation, is often used to justify shifting the burden of health spending from the wider society to a vulnerable few, the co-payments debate being a case in point.
Professor John Dwyer’s latest commentary for the SMH on the co-payments debate is worth reading and can be found here. And Croakey columnist Dr Tim Senior has likened policy suggestions that patients should be charged for inappropriate attendances at emergency departments as akin to a zombie apocolypse.
“This is the ultimate health care zombie – a ‘daft policy that refuses to die’,” he writes. “And it’s an apocalypse because it makes the health system cost more but it’s no more effective.”
Rationing vs increased taxes is a false dichotomy, Duckett argues, pointing out there are other solutions, such as identifying overspending and waste.
The Grattan Institute has released another report – on workforce reform and the need to re-evaluate how we ask highly trained health professionals to spend their time. Peter Breadon looks at the issues on Croakey and The Conversation.
Health Minister Peter Dutton, in a piece for the journal Health Voices, has renewed discussion around efficiencies and what role the private sector might play in achieving them. This piece in the Fairfax press gives an overview.
Meanwhile,the May Budget funding and policy guessing game is getting to some. The AMA released a statement calling for some real dialogue with the government and an end to the “crazy policy speculation” in the media.
Stories like this one in The Australian are no doubt contributing to the uncertainty. It says federal state and territory health ministers meeting in Brisbane recently expressed concern that independent agencies such as the Independent Hospital Pricing Authority, the Australian National Preventive Health Agency and the National Health Performance Authority are “straying beyond their charter”.
Then there’s the suspension of some early superclinic projects, with other, more advanced projects hoping for a reprieve. They can at least take heart in knowing they’re not the only ones playing the waiting game.
Tense wait over Aboriginal health funding
Like many other bodies, Australia’s 150 Aboriginal Commity Controlled Health Services are tensely awaiting news of their ongoing funding. In this piece in the Canberra Times, Winnunga Nimmityjah Aboriginal Health Service CEO Julie Tongs says ”There are 150 Aboriginal community controlled health services nationally and none of us are guaranteed after June 30″.
Research recently carried out at the health service and presented at the prestigious Richard Doll seminars at Oxford University found that the impact of family and friends quitting smoking had much more of an impact on Indigenous smoking rates than strategies such as celebrity quit messages.
In his recent address to the National Press Club, NACCHO CEO Justin Mohammed talked about the ripple affect on communities of having a healthy Aboriginal community controlled health sector. And according to the National Indigenous Times, Tom Calma has attacked the government silence on future funding for the sector.
Blue Mountains doctors have also called for an integral Aboriginal health program in their local area to be quarantined from cuts in the May budget.
New survey findings on bullying and racism further highlight the importance of culturally appropriate health services. The research project on the impact of racism on the health and wellbeing of young Australians found 70% of the participants in the project reported experiencing one of the 11 outlined racist scenarios. School was the main setting for racist behaviours.
Committing dollars to mental health care
When it comes to funding in the mental health sector, adequate investments should not be considered unachieveable, writes Professor Patrick McGorry. His piece for Croakey looks at two recently released reports on mental health care funding, and suggests they have not only underestimated the amount of money required to support a proper mental health care system, they overlook the right of those with mental illness to have equal access to care as patients with cancer or heart disease.
Mental Health Council of Australia CEO Frank Quinlan has also raised some questions about equity for people with mental illness in the context of the National Disability Insurance Scheme. He says one of the main questions to resolve is why, of the 489,000 Australians living with a mental illness and the 200,000 or more of these living with ongoing significant psychosocial disability, only 57,000 will be eligible for the highest level of support available through the NDIS.
Meanwhile, the youth mental health service headspace, which was founded by Professor McGorry, has attracted media attention over disagreement between its management and former board member Professor Ian Hickie. The SMH covers the story here.
Rural and regional raw deal
The National Rural Health Alliance has pointed out that, as in so many other areas of health, regional Australians get a raw deal compared to the rest of the population when it comes to skin cancer. Their submission to the House of Representatives Standing Committee on Health Inquiry into skin cancer says the incidence of and mortality from melanoma is higher in regional areas than it is in major cities. It says difficulty accessing services is likely to be a major factor.
While ongoing access issues plague healthcare in the bush and can in no way be underestimated, they have had driven an unlikely positive. Out of necessity, rural doctors have been early adopters of technology, placing Australian telehealth is at the forefront of the industry, Australian College of Rural and Remote President Dr Richard Murray told the Australian Telehealth Conference.
Other Croakey reading you may have missed this fortnight:
- Fat free and 100% natural: seven food labelling tricks exposed
- Some questions about new investments in diabetes care
- PHC Research Conference: an opportunity to expand your contribution to improve primary health care
- Train in vain: How the Queensland contract dispute leaves junior doctors floundering
You can find previous editions of the Health Wrap here.
Do you have an issue you think the health wrap should cover? Contact me on Twitter @medicalmedia
* Kellie Bisset is The Sax Institute’s Communications Director. She has worked in mainstream and medical journalism and communications for more than 20 years. During that time she edited both of Australia’s weekly medical publications for doctors, Australian Doctor and Medical Observer and developed a strong interest in health policy and evidence. The Sax Institute is a not-for-profit organisation that drives the use of research evidence in health policy and planning.
” … attempts to persuade drug manufacturers Roche and GSK to hand over their unpublished data…”
“..no reliable evidence for homeopathy’s effectiveness… ”
So the pharmaceutical manufacturers decide which data should not be relied upon in one case, and the allopathic medical institutions decide what is not reliable data in the other case.
““The creatures outside looked from pig to man, and from man to pig, and from pig to man again; but already it was impossible to say which was which.” ” George Orwell.
The findings of the Cochrane Review are not unexpected, given that the primary purpose of Tamiflu is to reduce the spread of the virus, NOT to lessen the effects of influenza once one has it. The purpose of stockpiling it is to try to avoid outbreaks from becoming epidemics.
Dear Matthew Sullivan
1. Actually I think the primary intent of marketing the drug was as symptom control. The notion of reduced spread, and also reduced complications (especially hospital admissions) after contracting influenza came with the threat of pandemics.
2. It doesn’t matter what the ‘primary purpose’ was. Analysing trial data can tell you additional information anyway if there were enough events.
And indeed, the review found neither of these (reduced spread, or admissions to hospital after contracting influenza) from using Tamiflu.