First, the ruckus over the "new" mental health policy turn in Australia. My concerns are with the apparent change in emphasis from getting a large number of undiagnosed and untreated people in the community onto some sort of treatment path vs. providing special assessment and treatment centres for young psychosis sufferers and people who are showing behaviours suspected to be on the verge of psychotic illness. To me this seems to be unbalanced because there are epidemiologically many more people with depression, anxiety and associated conditions [eg. obsessive compulsive disorder, hoarding problems, panic attacks] than young people with early psychosis or some signs of it.
- Then there is the associated fracas concerning the backing of new treatments for mental illness by the prominent psychiatrist, Professor Ian Hickie. There has been a lot of public and academic mud-slinging about an article published in the British Medical Journal claiming to review studies of agomelatine (a derivative of melatonin, a naturally occurring human brain chemical). More on the academic and clinical side, there has been debate about the safety of some recently introduced atypical antipsychotic medications Some atypical antipsychotics [mainly Clozapine, Risperidone, Olanzapine, Quetiapine, & Aripiprazole] are approved for treating schizophrenia and others are approved for acute mania, bipolar depression, psychotic agitation, bipolar maintenance, and other indications. How can we be sure that Agomelatine and atypical antipsychotics approved and used in Australia now have really undergone exhaustive clinical testing? What evidence has the TGA used to decide whether these agents should be publicly subsidised? It's very difficult for anyone to get any straight information out of the TGA, so I'm not hopeful of shedding much light on this one, although there may be some clues on other blogs from people on the 'inside'.
- The anti-vaxers are crowing over their court "victory" against the Health Care Complaints Commission, although this matter has been covered well in Losing in the Lucky Country blog. Anyone with an interest in public health would love the AVN to disappear, but there are some vocal supporters who don't seem to want to go away, although a Whooping Cough outbreak in WA makes their mission look counter-productive at the moment.
- Another matter that concerns me is the apparent rise [and recent leveling out] in asthma and allergy prevalence in Australia, especially in very young children. Surveys still show that proper asthma care plans are rarely made in conjucntion with a primary care doctor or clinical nurse consultant. In addition, there is controversy surrounding antibiotic use for conditions known to trigger asthma attacks, such as sinus iinfection. There needs to be a full and open debate on the burden the community bears due to asthma and associated condiitons because it is a true public health issue, affecting up to 20% of the population at any time- as much as depression.
- My MPH dissertation research opened up a heap of public heath issues that I'd like to talk about in the blog,, eg. the lack of success in reducing medication dosing errors in Australian hospitals and nursing homes. Also there is the fact that some medications may affect some people adversely due to possession of particular genes, while this is not being made clear by doctors. There are pathology tests available to test whether someone may react adversely or might need a much larger or smaller dose than average, which can be done before a patient swallows the first pill. Yet a colleague and I could not even get doctors to talk about surveying them about their use of these tests, let alone do an actual survey of GPs and specialists. We discovered plenty of reasons why these doctors didn't want to use the tests, but nothing on which specialties might be under-using them with direct consequences for patient safety. Maybe everyone is doing the right thing, but we can't find out as the evidence is not allowed to be collected.
- The last topic I'll list is the debate on whether we should have universal free basic health care in Australia or whether we should divide the system into privately vs publicly insured sub-populations. We have a mixture at the moment, but no sensible regulation based on what people actually receive in return for their private investment. I would rather have basic universal coverage and I would like a clear list of conditions, medications and procedures [like an NHS List] which would be covered and a clear list of conditions that could ONLY be covered in the private user-pays system. This is probably a vain hope in a country that cannot produce a proper list of medical and surgical performance indicators, let alone just one measure per Principal Diagnosis, on which the nations doctors and hospitals could be compared. There is no quality without quantitative measurement in my neck of the woods! Then there is no qualitative measurement of patient service-completeness & "satisfaction", without a standardisation of care based on numbers either.
- Obviously I could devote quite a few posts to these issues. So- if anyone reads this post- tell me what most interests you and I'll tackle that first.