Still raving about Better Access

From: //blog.artdoxa.com

This blog post is actually a very long comment on the blog by Jacinta Patterson titled "Argument by anecdote in mental health". The anecdote that Better Access money was being wasted on the over-concerned rich and not on the disadvantaged and genuinely mentally ill, seemed to be the main reason put forward in the press, explaining the cuts to Australia's mental health budget for 2011- 2013.

Aha- this post (referred to above) is still getting responses! I dropped in when it was first posted, but my comment doesn't seem to have got through! As a Better Access client and a former mental health researcher trained in public health, I can find many ways of examining the whole scheme!

It's difficult, firstly, to examine Better Access without the stats from the rest of the outpatient mental health sector. As someone said above, many people, mainly with schizophrenia or manic depressive disorder [these names make it clearer as far as I'm concerned; I know the controversy], are covered by Headspace and  community mental health clinics [which are hospital outreach disguised]. The NEW cases of psychoses, or those at high risk [pro-dromal; the people who were to receive medications if they seemed on the edge of real psychosis], hopefully benefited from Better Access, but I can't see how I can tease them out of the figures from the govt. I would assume that plenty of these people would not recognise they needed help, just as always happened in the past- the only way I imagine they got into Better Access would be if their GP was alert enough when seeing them for another complaint. How alert are GPs usually? Don't know- no figures. There's no epidemiological data from the past on this and I don't know anyone collecting it, so we can't judge.

Anguish at work- needs help

The figures suggest many new clients for mental health care under Better Access and the sudden proliferation of various therapist groups in the community suggests the same- there are community nurse mental health counsellors, psychology-trained, social-work-trained, [I don't know any] occupational therapy-trained plus more, putting up shingles. Most have few empty slots in their calendars, so someone is filling them. My guess is that new clients who couldn't afford private care before are cashing in on the Medicare scheme to get help they've needed for a long time. I know hardly anyone besides myself who has seen a psychiatrist for more than one session under Better Access and I think that is because psychiatrists won't take merely the Medicare rebate as full payment. Mine agreed to it beforehand, because I asked specifically and because I knew her before she qualified. However, her receptionist didn't know this and when I had received 2 sessions and handed her the rebate cheque for the first one she asked: "How would you like to pay the rest; cheque or credit card?". I told her I had no income, no insurance and no benefits, so she was going to have to accept Medicare or take me to court! My shrink cleared it up with her!

USA, ER visits for mental illness increased

I would suggest that psychiatrists have kept on seeing the same sort of clients they always saw- those referred through hospitals and other professionals, mainly privately insured [the uninsured wait to see their psychiatrist in hospital outpatient clinics every week and get the same doctors as they had privately], a slight leaning towards upper income, definitely more city/suburban people and hardly a trace of indigenous Aussies. However, at outpatient clinics there have continued to be stacks of lower-income clients, young people avoiding parental scrutiny and indigenous and other-cultural-group clients. Because there are virtually no psychiatric emergency "drop-in" centres, the poor old Emergency departments of public hospitals have copped the majority of psychotic, alcoholic and suicidal people, usually in terrible emotional states and which the emergency doctors, nurses, police and ambulance personnel are least trained to handle. Better Access could do with setting up a few Psych Emergency Facilities at least on the outskirts of  major towns. I don't think the community is going to suddenly get better at detecting mentally ill relatives and friends before they reach crisis point- they've never seen psychosis etc before, it's scary and they hope it will go away if they ignore it. Maybe the NEW Headspace places can change the culture of stigma and disdain of help-seeking by young men, but I'd like to see it happen before I'd have much hope.

In bed crying? Get help via Better Access

I'm a bit confused about why the change from 10 to 18 sessions in Better Access had to be made and announced because the clients from last year are going to have to see SOMEONE sooner or later. If clients who are still in need of care go back to their previous therapist, which most of us would prefer to do [and that would be therapeutically beneficial], are they suddenly going to say "Bugger off or pay me twice as much?" I can't see it happening except where psychiatrists have hard-hearted receptionists! I'd like to hear from some people about their experiences, since there's NEVER going to be a statistic on this!

As for GPs getting less money for the first consultation under Better Access- I can't work out how the huge amount extra was justified in the first place. The GP gives you a batch of questionnaires to fill in while he/she sees another person, then asks a few brief questions face-to-face, adds up the simplest depression/anxiety scores, gives feedback and may write a standard referral on the computer if you seem to need care elsewhere. Otherwise, if the GP is doing the counseling themselves, people just make regular appointments as they would for anything. I can't imagine that many GPs deduce much themselves from this 1st appointment, even those with special mental health training- mine didn't, that's for sure. Apart from questionnaires, the GP does have some documents to complete proposing a treatment plan, etc, but it's not clear how an ordinary GP could predict what is going to happen with a mental health case anyway- psychiatrists find it hard enough. In my book, the cut in Medicare rebate is justified- doctors just got used to it. Couldn't they feel good about contributing to Public Health with these sessions, rather than through some dubious primary care "health promotion" program? The cuts for ongoing counseling I'm not sure about- halving the rebate seems harsh.

ER will always get self-harm clients

As for the $1.4 billion: Why won't this much be NEEDED for mental health in the future and blow out lesser budgets? You can't hope to "cure" many people, and for the ones fixed up enough to go it alone, another new one will walk in the door & use the Medicare dollars.

Have a look at what happened in California after their mental health budget was slashed. DO we want that in Australia? :
http://disabilityrightsgalaxy.com/2011/10/01/the-system-is-broken/

The USA has even more problems with mentally ill people reporting to ER than we do in Australia:
http://www.msnbc.msn.com/id/25520178/ns/health-mental_health/t/some-psych-patients-wait-days-hospital-ers/
http://vtdigger.org/2011/11/09/frustration-over-upheaval-in-states-mental-health-system-mounts/

Wrong place for mental health care- too tense & anxious

Why self-harm now?: http://thelinc.co.uk/2010/03/self-harm-the-cause-the-facts-the-support/

Moving ahead: http://www.bipolarlifestyles.com/tag/hospitalization/

MS is now a Public Health Concern

'via Blog this'

Last night on ABC TV [national, free to air, Australia], I saw an interview with a woman who claimed she had been cured of MS by a controversial surgical procedure to the blood vessels draining the spine and brain. I pricked up my ears as I had never heard anything on the topic of CCSVI [Chronic Cerebrospinal Venous Insufficiency]. A neurologist explained that an Italian, Doctor Paolo Zamboni, had discovered that the veins in the neck of MS sufferers were not big enough for the volume of blood coming from the brain, so that back pressure built up, injuring nerves. I assume this guy has done blood flow studies to support this idea of insufficiency in MS vs all clear in non-sufferers- I don't know. The transcript of the interview with various doctors and sufferers is available at: http://www.abc.net.au/7.30/content/2011/s3399100.htm

This sounds reasonable because MS is a progressive condition where muscles throughout the body become weaker due to deterioration in the nerves which carry messages from the brain and spine. There are many theories on why the nerves become damaged, but no one has proven any one cause for all MS people. Some alternatives have included stray measles virus (just as poliomyelitis virus left over from childhood infection can produce post-polio syndrome in adults); toxic chemicals in the environment breaking down nerve coverings; vitamin and nutritional imbalances or insufficiency or above-normal need; damage from leached metals from amalgam dental fillings and good old genetic inheritance.

Apparently a Newcastle [NSW, Australia] general medical practitioner [not a neurology specialist], has been assessing blood flow in MS patients' necks and referring them for stenting or balloon angioplasty procedures to widen the channels inside veins carrying blood back to the heart. Dr Paul Thibault claims that two thirds of people referred have had significant improvement in their muscle function, including the woman on the program [ who has been able to go on a vigorous overseas holiday.

Quote:

KERRI CASSIDY: I actually went on an overseas holiday and I walked halfway around Europe for three weeks. I couldn't believe it that I really didn't think I'd ever be able to do that.

She looked and sounded really good compared with footage of her before the procedure, so I did a little exploration on the Internet.

First, I was quite surprised to see that someone had won a medical award for clinical and research contributions to Multiple Sclerosis because I had thought MS was only a problem suffered by very few people and that the cause was unknown or highly disputed. More surprisingly, it wasn't Dr Thibault from Newcastle, but a Professor Bill Carroll from Perth!

The award announcement says:

"Professor William (Bill) Carroll wins the 2011 John Studdy Award
John Studdy, Multiple Sclerosis Australia (MSA) and Multiple Sclerosis Research Australia (MSRA) would like to congratulate Prof William Carroll on being awarded the prestigious John Studdy Award.
The John Studdy Award is given annually to an individual in recognition of their outstanding,
consistent and selfless provision of meritorious service to people with MS.
... In addition to being one of the country’s most eminent neurologists, Bill performs a
leadership role throughout the world...
...Prof Carroll made a significant contribution in promoting ... and helping to subsequently
establish Multiple Sclerosis Research Australia (MSRA)..."

At various times I heard that there were some promising trials of drugs for MS in Australia, but assumed these measures were supportive but not curative. The national prescribing service [PBS] had approved some new drugs which I understood were very expensive, under their provisions to fund a certain number of treatments for "rare" conditions where the economics of private use were impossibly restrictive. Two people I know personally are taking some of these new drugs and they've told me they are feeling better and can do things they couldn't previously, eg. stand up in the kitchen and prepare food, rather than half-heartedly chopping up the lettuce on a wheelchair tray. However, neither has taken a walking tour around Europe!

The PBS started subsidising oral Gilenya (fingolimod) on 1st September, 2011, bringing the cost of using it down from X to $34 per script. Because this can be taken via the mouth, it is far more convenient than other drugs preceding it, such as injections of Interferon Beta. The latter often caused reactions at the needle site and flu-like symptoms. One friend of mine complained of feeling as though she was getting the flu and having to use her asthma inhaler more, but thought she had improved her muscle strength in her arms for using her wheelchair.

When Interferon was first tried in Australia I can remember it cost a lot- something like $1200 to $2 000 per month, which was not affordable for most people. When the PBS adopted Interferon under their subsidised program, it reduced to between $30 and $80 per month, depending on changing doses in line with improvement/deterioration. The new Gilenya should now be $34 per prescription filled, like any other medication, eg. Ventolin asthma spray [2-pack].

As the ABC program revealed, the surgical procedure to widen the blood vessels in the neck needs to be subjected to the same vigorous trials as the new drugs have been through, to make sure it works for the majority of people with MS. The procedure is moderately dangerous and there have been a few deaths, so it is more than a simple experience with guaranteed good results. Even when performed well, only 2/3 of patients report improvement, so the costs must be considered in proportion to the number of people likely to benefit [this is where Public Health gets into the act].

The MS Society lobbyists and individuals in the community do not fully understand what a dilemma their requests to surgeons create. Many with MS want the procedure right now, before their function deteriorates or before the disease progresses too far, but this is fraught with medical and economic dangers. Economically, since so many requested the procedure when it was subsidised under Medicare, people with other more common conditions (such as blocked veins in the legs or arms) were being pushed further down waiting lists by the perceived urgency of the CCSVI for the MS patients. Surgeons became concerned [and tired from long operating hours] that the Medicare system was becoming "unfair" because more people with rare conditions were receiving procedures than those with common conditions with PROVEN treatments.

Thus, the relevant government authorities have withdrawn support for CCSVI as an MS treatment until good trials have shown that it benefits a significant majority, just as the procedures for blocked veins in the legs do for their sufferers. With leg vein clearing or bypass people gain a lot of function [eg. they can walk again, maybe work], deaths associated with it are very rare, the danger is not high compared with operations on neck veins and the costs per patient are reasonable given the good results achieved.

At this stage I don't feel confident to summarise all the factors we should consider when assessing the "fairness" of public health spending on Multiple Sclerosis, but there are some good articles on which you can base your own assessment:

Benchmarks of fairness:

http://www.who.int/bulletin/archives/78(6)740.pdf

Justice & fairness in Public Health:

http://plato.stanford.edu/entries/publichealth-ethics/#JusFaiPubHea

In the UK a subsidised drug for MS seems to make people worse than no treatment at all. Where's the fairness?:

http://pharmexec.findpharma.com/pharmexec/Europe+Features/Fairness-Risk-Sharing-and-the-European-Price-Cuts/ArticleStandard/Article/detail/676558

A discussion of fairness and provision of subsidies for hyper-expensive treatments:

http://www.nuffieldbioethics.org/sites/default/files/files/Hyper_expensive_treatments_background_paper.pdf

"...Why... does our nation’s health stay bad, even in some areas get worse, and the poor still die younger than the rich?":

http://www.sochealth.co.uk/news/Withoutwalls.html

For summaries of information about MS, read:

Australia; The MS Society: http://www.msaustralia.org.au/aboutms-moreinformation.asp

USA; NINDS: http://www.ninds.nih.gov/disorders/multiple_sclerosis/multiple_sclerosis.htm

Australia: From science journalist Michael Slezak. http://www.smh.com.au/world/science/the-facebook-treatment-for-ms-20110330-1cgfi.html

Daron Acemoglu on Inequality | FiveBooks | The Browser

Daron Acemoglu on Inequality | FiveBooks | The Browser:

'via Blog this'

Public health views economic disadvantage and inequality as the main factors behind poor population health. If the lot of the most deprived in every country cannot be improved, the whole community cannot become healthier.

Ray Moynihan has written this one so I don't need to

We should stop pharmaceutical companies from dealing directly with practising physicians/doctors. An accountable government-approved/appointed group should be the party to recommend drugs for use by a country's doctors. I'll keep saying it and I guess, so will Roy Moynihan. His article:

It’s not you, it’s the patients: why doctors should tell drug firms it’s over

Doctors' wining and dining by drug companies distort prescribing patterns and may influence them to recommend less-than-ideal drugs. PhillipC/Flickr

This week Radio National’s Background Briefing looks at how pharmaceutical companies market their products to doctors.

The program is presented by Ray Moynihan, an award-winning journalist, columnist at the British Medical Journal and conjoint lecturer at the University of Newcastle.

---

You’ve written and researched extensively about the business of medicine – what is it that attracts you to this area?

It’s a good story. I’m essentially a journalist and the corruption within the medical world is an incredible story to follow and investigate.

The extent of the financial entanglement between doctors and drug companies seems to know no bounds and I think it’s vitally important that there’s more scrutiny of these relationships.

The reason people are interested in doctor-drug company relations is not because of the desire to expose doctors wining and dining habits, the reason to expose this is because it distorts prescribing patterns and it means doctors are more likely to prescribe the latest and most expensive medicines. Sometimes a good thing but other times, wasteful and dangerous.

The example we use in the program is the antidepressant Cymbalta. Here’s a drug that is getting the thumbs down from a number of independent educational groups but is being ferociously promoted by drug company reps who stand to get a sizeable bonus if they can get a certain number of patients taking this drug.

And it’s being promoted by specialists, who are being paid generous fees secretly to present company slides about it at “educational events” to their peers.

Rennett Stowe

This is an extremely unhealthy aspect of the Australian health-care system, and I think one of the most frightening aspects of what Petra Helesic [a former drug company insider] says is how she became aware in recent years of how aggressively anti-psychotic drugs were being marketed for depression.

That, in itself, is worthy of a great deal of public scrutiny.

What can be done to ensure the independence of the medical profession?

There are many ways in which doctors, professional groups, universities, hospitals and other players in the health-care system can roll back their interaction with some of the unhealthy marketing practices.

A classic example comes from Christchurch, New Zealand, where many doctors have stopped seeing pharmaceutical company sales representatives and have replaced that kind of interaction with independent education.

In the same town, the college of general practitioners has stopped taking drug company sponsorship for their annual conference.

This is one of many examples around the world where there are small-scale attempts to engender a more independent relationship between health professionals and the pharmaceutical industry.

One of the simple things that every single university could do tomorrow is to mandate all of their staff to declare their financial relationships with drug and device makers and make that available on a publicly-searchable website.

That’s the sort of thing University of Sydney’s Professor Martin Tattersall and others have been suggesting. It’s going to become standard practice around the world and I would love to hear an argument about why it’s not possible for Australian universities to do that.

There’s also a great opportunity here for the tertiary education sector to offer genuinely independent education to our health professionals.

The industry appears to fund the lion’s share of ongoing professional education either directly at these dinners or indirectly through their sponsorship of conferences, seminars and meetings.

But there’s an abundant amount of evidence that industry-funded approaches are not in the best interest of patients or the public.

There’s a real, genuine, timely opportunity for the tertiary education sector to play a bigger role in this kind of education.

The AMA strongly opposes having a public register that names doctors who receive benefits or attend events sponsored by pharmaceutical companies, instead favouring disclosure of the cost of meals and names of restaurants.

AMA president Steve Hambleton says, “bringing it down to an individual level is going too far”. Why do you think the AMA is resisting transparency?

One of the things that Steve Hambleton says very clearly in the program is that one of his concerns is that being on a public register could besmirch a doctor’s reputation.

ArtBrom/Flickr

But if there’s something wrong with being associated with these marketing events, then why are doctors going to them?

If doctors believe that attending drug company lunches and dinners or accepting those generous speaking fees ($750 to $1500) are in the interests of their patients and in the public interest, then they should have no problem at all with that information being transparent and publicly available.

But there’s huge resistance from the AMA in Australia and its very much behind thinking around the world on this.

In fact, one of the senior executives of one of the companies in Australia has already publicly flagged the potential desirability of much greater transparency, in terms of disclosing the names of doctors who attend dinners and the amount of money that drug companies pay to individual specialists.

And Medicines Australia, the industry body for pharmaceutical companies, has said greater transparency is one of the things they will be looking at in their review of their voluntary code.

But more importantly, the United States has a law called the Sunshine Act, which is sitting there as a policy option for the Australian government.

It would be great to hear the argument for why such transparency isn’t appropriate in Australia but is in the United States.

What ways could doctors be learning about medicines that are independent or not emanating from drug companies?

There are three that were mentioned in the program – the National Prescribing Service, which is Australian; the Drugs and Therapeutic Bulletin out of the United Kingdom and; Prescrire which is a very reputable French journal.

There are many other sources, such as the Cochrane Collaboration, and there are many ways in which doctors can educate themselves.

But the truth is that going along to a dinner in a fancy restaurant in your local area is easy, and it’s fun. And you’re treated like a bit of a VIP.

A small but growing number of other doctors are absolutely horrified by the fact that their colleagues are still going in their thousands to these promotional events – which are described as “educational” in an extremely disingenuous way.

This article was originally published at The Conversation. Read the original article.

If you would like to hear from the other side, there is an account here: http://circ.ahajournals.org/content/121/20/2221.long

China adopts Western obesity.

In PubMed, I came across this interesting article about body weight trends in China:

Emerging disparities in overweight by educational attainment in Chinese adults (1989-2006). from the International Journal of Obesity [London]

It appeared to be a great naturalistic study of the effect of increasing capitalism on body weight. Since China dropped strict communism and allowed individual financial enterprise, there has been a gradual division of their society into the more and less educated and the more and less well-off. Some scholars from California analysed the China Health & Nutrition Survey data and discovered that well-educated Chinese women have become slimmer and well-educated Chinese men have become much larger than their less educated fellows.

I haven't delved into the methodology to see were the sample came from and how severe the differences in education or income, but it is an interesting result for the Chinese to follow the Western pattern, rather than that of a society where bodily bulk means power and money, eg. in some African groups & formerly in the Pacific Islands.
From Robert Lindsay's blog, this photo of a Western, Caucasoid, Chinese man:

We seem to accept in Australia that people from lower SES groups become more obese than their high-SES neighbours due to eating too many high-fat, high carbohydrate foods and not enough fruit, vegetables and lean meat (protein). Would the same mechanism have emerged in China or does their different dietary tradition insulate them from this effect? Perhaps the Chinese have adopted Western-style meals and fatty take-aways as the norm these days (it didn't seem to be the norm when I visited a few years ago, but youngsters obviously relished their KFC and McDonalds when they had enough money for them)?

These possibilities need to be explored before accepting that the Chinese change in the distribution of obesity is due to Westernisation of the diet. There is also the racial mixture of the people in the study sample to consider. In the East of China, especially the giant cities of Beijing & Shanghai, most people are the larger-boned Han Chinese, but in the West most are more Caucasoid with finer bones and fairer hair. The diets tend to be different as well, with higher fat, more protein in the East and less variety, less fat and less food overall in the West.

From Fotopedia, a Han Chinese child:

However, we still haven't explained why rich women are thin and rich men are fat (on average, compared with other SES groups). Is there more to it than diet and psychology?

6 Principles for Averting Collapse | Living Climate Change

6 Principles for Averting Collapse | Living Climate Change I really go for the first one. In fact I've been trying to live this one since I was about 15!

Keep your germs to yourself. If others can't, then get vaccinated!

Science uses germs to make medicines!

A different kind of CleanTech—Clean Genome E. coli

This article explains how some forms of the common uman bowel "germ", the bacteria E. coli, can actually be used to produce some of the most amazing drugs in medicine's arsenal.

The explanation is quite understandable for anyone with a science degree, but may seem rather strange for others. I think I could explain it a little more simply.

Cancer from plastics vapors?

Hmm... nothing here now- must have been disappeared by the old Blogger. Anyway, I had an article referenced on firefighters being denied claims on cancer.

Firefighter cancer risk study would be interesting as they are exposed to possibly damaging vapors from plastics and petroleum derivatives. Here's another item from Melbourne's The Age, with a call by unions to allow firefighters to claim cancer on insurance for work.
Union wants firefighter cancer law
Ben Schneiders
June 16, 2011

It seems logical that with modern homes and buildings containing plastics, that firefighters could inhale a lot of toxic fumes and particles if they are not wearing sealed suits on arrival at fire scenes.

Australia's firefighters union discovered that there was actually a campaign against their claims!

NOT public health: Fantastic visualisation of the brain's nerve pathways

Researchers map, measure brain's neural connections

This technology might help me explain what I think goes wrong with the development of an autistic brain. It's very hard to figure out the parts formed at various embryological stages when you can't see inside the brain. Now I can see how the mirror neurons fit the picture.

The article mentions autism- I must explore the associated articles in the journals.

Shetland Inspiration

Shetland Inspiration

Loved this website showing images from the Shetland Islands. decided to explore them via Google Earth & some other information sites. I'd love to visit, but that's unlikely. My interest started when I discovered Shetland knitting and was sparked again when I found that our neighbour's surname was pretty much only found in the Orkneys [Heddle- which is a spinning/weaving term as well]. I wonder how much of the year the sea is calm enough to go there via sea- I've eard it's pretty wild up that way!

Cut the bullshit and get your kids immunised!

This post has been appearing and disappearing constantly! I can't get it to appear in editing, then it disappears in the real post, so I have to start again!! I think Blogger is still having digestive troubles.

First of all, I spotted an article in GOOD about how 8 kids from one little church community died from measles in 1991.

"In 1991, nobody from First Century Gospel Church was prosecuted for failing to give measles vaccinations to the congregation’s children, a decision that resulted in eight of the kids dying from an outbreak of the illness."

They died because their parents falsely believed that vaccination was unnecessary because faith in God could fix their kids instead. Imagine if eight children who attended one church in your neighbourhood all died over a short period of time! How would any Australian community let those poor victims of religious delusion die from a disease which is totally preventable? I'm sure most people these days have NEVER seen anyone with measles. You probably don't have any relatives who are deaf or have lifelong brain damage from measles, either. This is all good. BUT some people who have never seen the symptoms think it isn't a risk any more and so DON'T vaccinate their kids. Do they realise that one of their kids' could easily catch it from a visitor or another unvaccinated child?

Now the US Centre for Disease Control is releasing some alarming statistics about the current rash of measles cases.

It's happened with Whooping Cough (pertussis) where many middle-aged adults whose childhood vaccinations have worn off, get nasty attacks of Whooping Cough that lay them low for weeks. Some cough for months, making work impossible or difficult- imagine being a miner? Note though, that adult Wooping Cough is easily stopped in its tracks by the antibiotic erythromycin, which you can get from your GP or local 24-hour clinic. It works quickly- I've had Whooping Cough as an adult and had to convince the old GP to do a swab to prove I had it.

From unvaccinated people and the expired immunity in adults, babies are starting to get Whooping Cough again. People may not realise that babies can catch it because the immunisation for this doesn't begin until 2 months of age (I think- please correct me if incorrect). This means that newborns who have doting grandparents as babysitters are completely open to infection and at high risk of serious illness or death! My efforts to encourage new grandparents to become re-vaccinated have been surprisingly unsuccessful. Some say- "I'd know if I was infectious, so I wouldn't babysit that day", or, as many nurses say about influenza, "I'm too healthy. I'd never get whooping cough". It's noticeable these days that people continually question public health advice as though the experts don't know anything. Now this sort of advice is based on so many years of work- generations in fact with some diseases (like smallpox), it needs to be accepted at face value. People should regard it as solidly as they would regard injunctions against punching out strangers in a crowd! But no. I keep plugging away, having a word in an ear here or on Facebook another day, hoping the message is persistent enough it will trick.

There is a great chart at this site you can print off that tells you what needles babies should get at what ages. It also has a handy guide to the main physical abilities of babies at those ages:

http://www.gpnnt.org.au/client_images/305400.pdf

Visit these other more erudite blogs for more info, esp. if I haven't convinced you:

http://www.australianimages.com.au/opinion/vaccination.php [Has a video of a child with Whooping Cough just to show how awful it is].

Roald Dahl (yes, the story book guy) had a baby who died from measles- too young for the vaccine. Here's an interview with him talking to Cory Doctorow (yes, another book guy...):

http://boingboing.net/2009/06/03/roald-dahl-on-vaccin.html

Dancing with disruption - Panel on Public Sector Innovation

Dancing with disruption - Panel on Public Sector Innovation

We really need to have some conversations about involving the community in designing and lobbying for changes in the way health care reaches them. A few citizens' juries on limited topics are great, but there's a lot more scope for people to influence policy and delivery of health!

David Chalmers

David Chalmers

This guy sounds as though he'd be very interesting to read in relation to my interest in autism and the salience of visual perceptions. Wow- he's worked with Doug Hofstader as well! I'd better read his online material and see if I need to delve into his book: The Conscious Mind: In Search of a Fundamental Theory . I found this gem of a bloke in the list of speakers for TEDx Sydney for May 28th 2011.

Little old loudmouth!

This content also appears at: http://www.reportingonhealth.org/blogs/little-old-loudmouth

This morning I decided I needed to let off some steam because I had far too many possible comments circling my brain to get them out in one session! Luckily, I was reading Virginia Hughes talking about a review of treatments for autism. After trying hard to get a very lonnng comment accepted and being told my email address was a crock, I decided I needed to join a forum where I could comment at leisure as a registered contributor. So, here I am.

As I've delved into the health field while doing an MPH, I've found I am quite passionate about a whole range of issues. I'm sure half of it is mere ego- but who cares in blogs? Aren't they a great spot to let the ego run free? My irrepressible impulse to write several pages of response to Virginia Hughes' blog entry is built on 35 years worth of thought about the origins of autism and quite a bit of empirical research, but many years ago. Meanwhile, I have kept up my reading on the topic of my abandoned PhD and I still feel that no one has exactly pipped me at the post and I want to let it all out!

I think I can explain why most autism treatments don't seem to work very well, as well as why traditional drug trials will never show the worth of various anti depressants for major depression. I'd really like to put forward my ideas on possible neurodevelopmental problems behind visual perceptual difficulties that autistic people suffer, especially in relation to social cues. For instance, the review of the work on mental rotation by researchers such as Soulieres et al, 2011, was quite logical and reasonable- but I think there is a totally different way to explain it which links to a lot more research on characteristics of ASD people. Hopefully, over the next few days, I'll be able to log in on the relevant websites and make some comments with my alternative explanations for the findings reviewed.

Then there's the topic of public vs. private payment/hospitals/clinics in health care. Australia has had a fairly good universal health coverage system for many years in Medicare, although lately the gap between the scheduled fee and what an individual doctor names as his/her fee has grown so much that ordinary people find it difficult to get appointments and/or pay at all. The government covers everyone for the scheduled fee, which varies with the length and complexity of the consultation. When the fee gets higher, I certainly visit the doctor less and I know many others are similar. The trouble is, if I give in and visit after some illness has become quite nasty (eg. I get a chest infection and my asthma flares up suddenly), firstly the doctor chastises me, then I have to have a swathe of tests, then I get medication and the illness lasts up to 4 times longer than it would if it hadn't worsened within the first few days. So this episode ends up costing so much that I go into debt with my partner and/or friends in order to pay for the treatment. So the system doesn't really work for certain classes/groups of Australians.

In the UK and USA, recent financial and political changes have meant the health funding in those countries is being cut across some areas. There is obviously huge debate about whether cuts should go ahead in health (could cuts be made in other budget areas?), and then which areas to cut first, should everything be cut equally, will private practitioners cut costs by shedding poor patients? etc The health systems in most Western countries do not set priorities across the board for treatment of certain conditions, ages or use of procedures (such as stenting the heart). Therefore, even with cuts, some specialties are going to go over budget by doing what they did last year, or overspend on questionably necessary procedures and underspend on vital ones. Of course, there is good old health economics weighing in with making assessments of years of quality life gained from treatments and arguments about what a quality life consists of and how can you value a life in dollars! I can have heaps to say on articles about these topics, but I keep using time that should be spent on other things!

Having been a researcher in eating disorders for many years (where most of my publications came from) I also find I have plenty to say about articles and media reports on young children hating their bodies from very young ages and on how "the media" and "advertising" are making kids sick!

I'd better button it up at this point as my partner is crying for stewed quinces and yoghurt, but I could rave on, naming endless topics I want to blether on about!

Lucky Spotrick got hungry, eh?!

Epidermal Nevus Syndrome Follow-up

Epidermal Nevus Syndrome Follow-up

RiAus Adelaide Reef « RiAus On Demand

RiAus Adelaide Reef « RiAus On Demand

Europe Starting to Dive Under Africa?

Europe Starting to Dive Under Africa?

Too late I see we are too large

As everyone knows by now, health authorities across the planet have been getting in a terrible lather about increasing obesity. More people are becoming larger and their largeness is even larger than it was before!
I attended a charity event where people contributed delightful, multicoloured cupcakes for sale in a bid to raise funds for Australian Flood Relief.

[We've had shocking floods over a large proportion of the inhabited mass of Australia and that is a very big expanse of country to be under water. Some of it is still flooded after 3 months, other parts have had monster cyclones and been inundated again and again. People have lost the land their houses sat on, never mind the actual houses!]

Back to the topic at hand:

As I stood back after depositing my [dairy free] cupcakes on the sales table I observed the line-up of mainly women, many accompanied by youngsters in push-chairs. I was really quite shocked because just about every female over the age of 15 appeared to be overweight.

In contrast, I felt like a tiny, skinny little pimple on the face of the

earth. My GP has said I'm overweight for more than 12 months now, but I haven't made a major effort to do much about it. I'm just sitting on BMI= 25 and whenever I try to eat less and exercise more I lose track of myself while concentrating on something else- like study or having fun with friends; and then I end up eating as I always did, so the weight stays the same. At least it doesn't increase all the time these days! What's more, I'm revelling in having got rid of that horrible Black Dog of depression over the past 10 months and I'm not too keen on making anything I enjoy now into a negative experience. If I enjoy my food and don't balloon out, I'll just leave it be for a while.

However, what I saw with my own eyes was quite disturbing. I happen to know that people weren't nearly this big during the late 1980s and early 1990s because I really did measure them then! My work mates and I were doing research on women's attitudes towards their own bodies [you might call it body image]. We wanted to see how much of a role your actual size played in opinions about your body, eg. If you said "I feel fat when I look in the mirror", were you honestly overweight, or were you judging yourself too harshly? Of course it partly depended on weight, but in plenty of people real-world weight seemed to have very little to do with their miserable self-opinion. [I'm "Walker" among the authors]

When we measured height and weight, we found that about 20% of women were classed as overweight or heavier. That's one fifth of the population and when you looked at a crowd of people, it was believable. Eighty percent of women were normal weight or below, ie. BMI 25 and under, with mildly underweight around 18.5 to 20 and really underweight, continuing down to anorexic emaciation from 18.5 downwards. I met people whose BMI was only 13- just skin and bone, poor creatures.

Today, just before writing this blog entry I thought I'd better consult the current statistics so I could see what the government had been getting their knickers in a knot about:

Self-reported data from the AIHW (Australian Institute for Health & Welfare):

"Data from the 2004-05 National Health Survey showed that 47 % (7.5 million) of Australians aged over 15 years were overweight. Of these, one third (2.5 million) were obese.
Males were more likely than females to be overweight. Some 56% of males aged 15 years or over had a BMI of 25 or more compare to 39% of females [overweight and obese].
For both males and females, the highest rates of those who were overweight were aged 55-64 years, 68.5% and 52.2% respectively." [I am certainly not alone, with more than half of people my age overweight or obese by earlier standards]

Notice those stats are from 6- 7 years ago. There are more recent stats, but on much smaller numbers of people- so let's be kind and stick with the old numbers, because I haven't found a nice table with the new ones!

While searching for the above stats I came across the program of a conference in Australia during last week: The Australian Obesity Summit. In amongst the speakers I found the TV personality, Dr John Tickell, who is a doctor in real life and who runs expensive weight and exercise programs for a living. He always sounds (and looks) good but he hasn't shown me any longterm outcomes that stick with the ordinary adult in the community. It also struck me that nowhere in the conference program was there anything about people's attitudes and feelings, which are surely the factors behind the success or otherwise of a weight control program. He seems to recognise the magical value of food for women in the link, but I haven't heard what goes on in his sessions to confirm any psychological input.

In my webby travels I also came across the grim news that Australians are ranked third in the developed world's fattest population. What a [dis]honour.

Obesity: Australia ranked in global top three

And the delightful announcement that, yes -

Obesity Australia's biggest [sic] health challenge say experts

OK, so 39% of Australian women and even more men have their size rated above the norm- either overweight, obese or morbidly obese. Isn't it odd that men have a much higher rate of obesity than women, but women are the ones who worry about it AND get dumped on by men for being overweight. Hmm...pot calling kettle black here!

Sorry if you were at that function today, but I saw a room full of very worrying female bodies. Many of these overweight women were quite young- late teens to late thirties and I could see they had potential to become even larger because they were so much taller than the older women (like me). This photo was the only one I saw. I didn't take it, so faces are disguised to protect the innocent. I have no feelings either away as far as liking or not liking these people- it's just an illustration of what alarmed me.

Just for comparison, I'm only 150cm tall (about 5 feet) and my BMI is 25, giving me a weight of 56.2kgs or 8 stone-8lbs. Yes, I am verging on being too heavy for my height, and certainly a lot heavier than when I left school, a tiny, sickly streak of misery at about 32kgs [!! and never had anorexia nervosa in my life, just a bit weight-challenged as well as being height-challenged]. To see what I would have to weigh to be classified as obese (BMI 30 plus), I'll calculate a projected weight at BMI=31. That's 69.75 kgs [where would I put that??] or nearly 11 stone.

I can remember our chubby little admin officer at work in the Weight Disorder Unit was 12 stone and she didn't look good while she puffed going up stairs. To be morbidly obese I would have to weigh over BMI=34, so let's calculate for BMI 35. That would make me 76.5kgs and 12 stone on the dot. That's another 20kgs on top of what I weigh now, which is roughly 40kgs heavier than when I left school or more than TWICE my teenage weight. OMG!!

Thinking about the young women I saw today, some would have to be 100kgs or more as they looked very large, plus they were up to 1.80metres tall [nearly 6 feet]. That's a huge worry, plus I already worry about young friends who are already a bit overweight (from observation) and who tell me on Facebook what they had for dinner or lunch. Thinking to myself I cringe how close their size and eating habits are bringing them towards diabetes.

Ordinary people [and even some in health profession] seem to speak of diabetes far too casually. It fairly terrifies me and I think it would terrify them if they just contemplated it for a bit. I had the misfortune for my closest cousin to die at 19 from uncontrolled diabetes [I was also 19]. Sure, she overate when her parents weren't looking and hated having insulin and cortisone injections- but her mum had deliberately fed her to be huge (plus the younger two cousins). It was some strange neurosis borne of a poor family and the 1930s Great Depression. I also had two friends in their early 20s who suddenly got severe diabetes after participating in marathons and triathlons for a few years. Both were skinny guys who couldn't be told anything about looking after themselves, but they both became very ill and ended up on regular insulin injections. Such a shame- both had their PhDs by the age of 23 and had brilliant careers ahead of them but had to slow down when their diabetes hit and made them feel tired and ill.

This has been such a serious post- but it really struck me that the world has just been bumbling blindly into this obesity epidemic yet most individuals are completely unaware of the horrors that real obesity and diabetes can bring on a personal level. I'm not using scare tactics- it's really nasty to suffer the health consequences of obesity.

My idea of neighbourhood exercise and fitness programs part run by experts and volunteers may not be so pie-in-the-sky after all. However, in the real world we would have to do 1000% better than these hard-working guys: The Impact of a Community-Based

Heart Disease Prevention Program in a Low-Income, Inner-City Neighborhood by Jennifer L. O'Loughlin, PhD, and Gilles Paradis, MD, MSc, Katherine Gray-Donald, PhD, and Lise Renaud, PhD.