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

Out damned paradigm!

I have decided that whatever double blind crossover placebo-controlled# trials can do for sorting out the good treatment from the bad, they're completely beyond the pale* in mental health!
My starting points are roughly these:
1. Taking major depression as an example:
a) every case has individual real-life occurrences as contributing factors: maybe being totally neglected emotionally as a child, or having a string of teenage relationships ending in "betrayal".
b) every case happens to a different brain

c) every case has a certain set of present/absent, good/bad liver enzymes
d) whatever the age, size or shape of the person, they have a different "felt response" to the same dose of a drug
e) everyone has different ways of reasoning
f) we all afford differential salience to "stimuli" such as words, happenings, situations and other people's moods.
g) if interpersonal therapy happens, each person will have a different first impression (therapist AND client), which will influence the course of the relationship;
h) therapists all have different interpretations and ways of implementing different therapies (their "style")
i)different client vs. therapist personality combinations either work or don't work in particular therapies, no matter what the therapist thinks about their own "objectivity" in the interaction.
j) clients have differing "stickability" in their regularity and timing of visits to a therapist.
k) additional contributors may/may not occur DURING treatment by any mode eg. parent dies, husband leaves etc.
l)many factors contribute to what "dose" of therapy or medication will alter core symptoms, regardless of liver enzymes etc.
m) many people on medication never get a good therapeutic effect because of recommended dosing levels, especially if they are not referred to a specialist after partial response. Specialists can observe the person while pushing the medication to the biological limit and achieve complete remission (or rule out that medication).
n) people have different "feeling criteria" of when they are "OK" again after an amount of treatment- it may be quite different to what a therapist concludes.

Anyway, having committed heresy, I'll slink away to gather some evidence!

Go small and save the world- and yourself!!

Blog Action Day 09!
I've been thinking about preventing cardiovascular disease and associated problems like diabetes (which follows obesity) and kidney failure (which follows diabetes)...etc. SO much of the medical and scientific literature is about what they conveniently term "secondary and tertiary prevention"- but that is all AFTER THE FACT! The community seems to be abysmally slack in stopping it all from starting in the first place- even with adults who are already headed down the heart disease track we say "It's your individual responsibility to exercise and eat properly" as though that absolves everyone from worrying about it any more. I've come to the conclusion that we have to stop all this Anglo-Saxon protestant crap about responsibility- TELLING us what we SHOULD DO...and BELIEVE humans are basically neglectful sods far more interested in "The Moment" and start SHOWING US WHAT TO DO!
Give us a bl**dy DEMONSTRATION every day and keep showing us. Encourage us to join in ALL THE TIME, come walking and playing in the park with us and tell us we're doing OK. Where are the personal trainers for every neighbourhood? PLEASE MR RUDD! Why don't we do it first in Australia and show the rest of the world we will not fall into the Western black hole of fat and sloth!
It frankly gives me the creeps when people my own age are having stents in their coronary arteries, being investigated for mini-strokes and have been put on drastic hospital-directed diets and prescriptive exercise programs they find deadly boring!
I know that lots of so-called "cost effectiveness" studies have shown that many heart disease and obesity prevention programs are not "worth it"- but I think they've left something vital out of their equations. What about all the wasted resources teenagers and adults have put into getting fat and clagging up their arteries?? Can't we count that as a potential saving for the future? As a small person, (though no longer sylph-like! LOL), I have always been pissed off with the wear and tear caused by larger people- not only do you consume more than your fair share of the planet's food, you also wear out the environment faster- paths, roads, lawns, carpets, furniture, cars- everything- you great galumphing sods!! Your clothes are bigger- taking more earthly resources (cotton and linen) and more petroleum (synthetic fibres), there are kilometres more sewing in your seams, tonnes more rubber in your shoes, less space and more load in your fridges! An article in the New York Times seems to agree with me a lot!
GET SMALLER AND PREVENT CLIMATE CHANGE!!!!!
Here's someone else who seems to have cottoned on as well!

Have a heart ... and save it

I've been thinking about preventing cardiovascular disease and associated problems like diabetes (which follows obesity) and kidney failure (which follows diabetes)...etc. SO much of the medical and scientific literature is about what they conveniently term "secondary and tertiary prevention"- but that is all AFTER THE FACT! The community seems to be abysmally slack in stopping it all from starting in the first place- even with adults who are already headed down the heart disease track we say "It's your individual responsibility to exercise and eat properly" as though that absolves everyone from worrying about it any more. I've come to the conclusion that we have to stop all this Anglo-Saxon protestant crap about responsibility- TELLING us what we SHOULD DO...and BELIEVE humans are basically neglectful sods far more interested in "The Moment" and start SHOWING US WHAT TO DO!
Give us a bloody DEMONSTRATION every day and keep showing us. Encourage us to join in ALL THE TIME, come walking and playing in the park with us and tell us we're doing OK. Where are the personal trainers for every neighbourhood? PLEASE MR RUDD! Why don't we do it first in Australia and show the rest of the world we will not fall into the Western black hole of fat and sloth!
It frankly gives me the creeps when people my own age are having stents in their coronary arteries, being investigated for mini-strokes and have been put on drastic hospital-directed diets and prescriptive exercise programs they find deadly boring!
I know that lots of so-called "cost effectiveness" studies have shown that many heart disease and obesity prevention programs are not "worth it"- but I think they've left something vital out of their equations. What about all the wasted resources teenagers and adults have put into getting fat and clagging up their arteries?? Can't we count that as a potential saving for the future? As a small person, (though no longer sylph-like! LOL), I have always been pissed off with the wear and tear caused by larger people- not only do you consume more than your fair share of the planet's food, you also wear out the environment faster- paths, roads, lawns, carpets, furniture, cars- everything- you great galumphing sods!! Your clothes are bigger- taking more earthly resources (cotton and linen) and more petroleum (synthetic fibres), there are kilometres more sewing in your seams, tonnes more rubber in your shoes, less space and more load in your fridges! An article in the New York Times seems to agree with me a lot!
GET SMALLER AND PREVENT CLIMATE CHANGE!!!!!
Here's someone else who seems to have cottoned on as well!

It's so danged complicated!

My Health Economics lectures are still pretty interesting, although my friend, Polly, is not exactly enthralled. What I've noticed is how terribly complicated the picture is becoming surrounding the allocation of resources fairly within the health system!
We've been looking at how Australian public hospitals "never say NO" to performing surgical procedures or somehow treating a person's problem regardless of age or disability. I already figured there must be a bit of "NO" going on, or the hospitals would be bulging with 95 year-olds having heart transplants! Yes indeed, there are some "NO"s emerging, much to the disgust of several students in the class. For instance- an Intensive Care Unit that does not admit anyone aged 90 plus. I had been mildly surprised when my friend E told me her 92 year old MIL was in a high-dependency ward but not ICU after she had a stroke which made her quite delusional and unable to talk coherently- obviously her age was excluding her from the top treatment category. I had already been privy to the fact that certain physicians at unnamed hospitals "pull the plug" on young male accident victims whose brain injuries appear irremediable after some days in ICU, but hadn't heard about anything else. The over-90 rule seems perfectly sensible to me, given the expense of ICU, the pressure on the beds from younger people with more prospect of recovery and the average lifespan being 79 (men) and 80 (women) in Australia. In my world-view, the 92 year old has indeed had a "fair innings" as the noted health economist, Alan Williams, might have said.
However, the question facing everyone in the health care profession (and facing us as students during a tutorial!) is: How mindful of public dollars should the bedside doctor or nurse really be?
Obviously there are views ranging from "Of course they should be- who pays them anyway!?" to "It is not ethical for doctors to consider costs when saving lives".
I am inclined to think that having regard for the probability of a good outcome given the investment of public dollars should be a routine consideration- something "trained for" in a medical education, not something that comes as a big surprise when doctors are questioned later about particular decisions. It would be good to see that consideration of the general cost to society built into the contracts or agreements that medical personnel work with. Just because lives are involved doesn't mean people should abandon the principle of general utility- as a public servant I couldn't order an antique oak desk for my office even if I was allergic to the laminate in the generally supplied ones!
Now the outlook has shifted along to the issue of how we rate someone's prospects of a good life following a medical treatment, vs. how much it is going to cost the public purse, and ultimately, the taxpayer. For this some fancy measurements have been invented such as the Quality Adjusted Life Year or QALY. Be ready for a rollercoaster ride when I get stuck into this little monster!

Fighting for health dollars!

I was having some ideas while listening to the first two lectures in Health Economics. I guess what I think now will change over the course, so I should write down what I believe at different stages. At the moment I think the whole government health budget should be divided in a different way (of course, they couldn't SUDDENLY change the proportions of various segments, but could work towards it, in my ideal universe!).

Firstly I think we should look at the people in the population and see how many are in various age segments, and what these segments will average out being over the next 5 to ten years.

Then we should look at what services were used by the age groups, divided initially into medical/pharmaceutical vs. surgical vs community health and public health/health promotion. Obviously we'd find that not many dollars are spent in community, public health or health promotion. There seem to be stacks of dollars spent on pharmaceuticals and I noticed that dental costs take 6.6% of the nation's health $$- strange since we don't tend to think of our mouths as using a lot of our general health resources or time.
Dept of Foreign Affairs and Trade describes the health system for lay persons and outsiders: http://www.dfat.gov.au/facts/healthcare.pdf

How they work out costings at the moment: http://is.gd/2tfPT
And here is the expenditure in public and private sectors:
http://is.gd/2tfTR

I don't like DRGs (Diagnostic Related Groups) as they stand- although I may not understand them fully and therefore agree with them more than I think! However, I think that looking at the most prevalent illnesses for each age group and looking at the medical vs. surgical dollars spent on various procedures, rather than all admission costs, might result in a better idea of how to allocate funds in the future.
As well, I think that costs should be normalised/standardised for each age group and for the procedures and treatment packages most used so we can easily compare subgroups on a proportional rather than absolute cost basis.

Perhaps we look at the 50- 65 year old age group and find that there are a lot of cardiac-related surgical procedures and cardiac-related medications and GP consultations. We should look at what could possibly be "saved" by doing alternative things with the dollars at earlier ages and at how we might gradually reallocate the surgical dollars to prevention dollars. eg. we might see a lot of coronary artery bypass grafts (CABGs) and note that these cost a lot, whereas doing one or two stents on a younger person might achieve the same ends and give a longer average life after the procedure.
Giving a potential 25 years extra life to someone with a procedure at age 55 should be better than giving an extra 15 years at age 60 and each procedure and hospital stay ought to be cheaper on average, plus people are happier and have better mental health, saving some mental health dollars as well!

Therefore we need to use the Burden of Disease Statistics, look at getting the average number of years of life gained from various procedures/medical treatments, projecting the likely number of cases for the forward budget period and applying normed corrections for the proportions of the health budget to go to various health problem clusters. I noted that musculo-skeletal and respiratory diseases are priorities for the near future and that reducing cardiac disease and spending is also a continuing priority. There also looks to be a need to prevent acceleration in the obesity rate in order to avoid flow on costs to diabetes incidence/prevalence, cardiac disease strokes and falls. The community doesn't seem to have got the message about weight gain, especially in children and there don't seem to be huge innovative programs being introduced to remedy the situation- so this needs a lot of factoring in.

Anyway- rave rave. I'm just jotting here- will get down to specifics later.

Decisions decisions...

Who decides what proportion of a country's GDP should be spent on health and how much on all the other stuff? How do they decide? Who wins? How? What do they decide should get health dollars? How do they work that out from all the competing claims? Since, in Australia, Public Health has only received 1.8% of the health budget in the past, how can we change this? These are some of the things I have been wondering about as a student of Public Health, a few weeks before I begin a semester in Health Economics (or Health Resource Allocation, as the department can't seem to decide what it wants to name the course!).
I have been triggered to start this blog by a session at the Adelaide 2009 Festival of Ideas, titled "Who cares? The limits of health."
My first note from the session was appreciation for the information provided by Professor Fran Baum on her work with the WHO on the Social Determinants of Health. She seems committed to the ideal of "Health for All" within each country environment according to their needs and available resources. And I wholeheartedly agree, even though many people think this view is rather "pie in the sky"- I think if there isn't an ideal to aim for, why start?
Here's a link to a big blog about the http://www.politicsdaily.com/2009/07/29/health-care-rationing-and-my-81-year-old-dad (health care of someone's 91-year-old dad) these are the issues most families must deal with. The medical profession then has to collaborate in decision making about these individuals, keeping quotas, budget constraints and the health of others in mind.