No more mercy

But it’s a good thing.

Sydney’s Mercy Ministries has gone bankrupt.

While being promoted as a counseling and psychiatric care operation for young women, allegations surfaced last year that the ‘treatment’ consisted of isolation, denial of drugs and exorcisms to expel their inner demons. Showing Scientology isn’t the only cult that preys on people in need.

Megachurch Hillsong, which was the driving force behind the ministry in Australia (it is still operating overseas), has ditched the mess and run away screaming.

60 Second Science: Kids competition

Through the ABC Teaching Science mailer.

Children in Australian schools can win cash prizes by creating a 60 second science video. The video can be filmed or animation, and must “demonstrate and explain a scientific experiment, principle or concept.” (Full rules here)

Registration closes at the end of September. The prize has been set up thanks to funding from the Victorian Department of Education – but there is a $1000 of prize money available in each state ($400 and $100 for first and second in primary and secondary divisions).

Entry forms available here.

The curious case of the unqualified qualication

According to 6minutes.com.au the Chiropractor’s Association of Australia has asked people to stop practicing chiropract. Well, particular people. Doctors in particular. Because they are not qualified enough.

Oh, wait we are only at the entrance to this rabbit hold.

According to the CAA it takes a minimum of 5-years to become a chiropractor, while a doctor can just upskill with a correspondence course from the RACPG.

The article also suggests that tha CAA candidly admits that there are risks associated with spinal manipulation. I wonder if the wider chiropractic community will accept these risks are potential (and any risk will not be wholly mitigated by the presence of trained ‘professional’).

Now while the CAA almost seems laughable here, they are actually attempting to enforce exactly what the evidence-based medicine community has asked of them: clean up their own house. They are accepting responsiblity for the safe practice of chiropract by all practicioiners, by attempting to get some training standards in place.

Rather then laughing this off perhaps the EBM community should be asking – why are all these actual GPs and MDs engaging in an unproven non-reality based mode of practice with established associated risks, and why is the RACPG encouraging it?

I can think of a couple of weak reasons, can you?

Today is special

Today was the first day of classes for my Graduate Diploma.

It only consisted of a lecture and tutorial for our field studies unit – but for some reason QUT has two hour lectures. Not that I am complaining or anything. At least one good thing you can expect from the education faculty is that the lecturers know how to teach.

Today was included some discussion on teaching/learning, as well as what exactly this “Middle Years” thing that I signed up for was actually about. There was also fruitful discussion on creating and developing our personal teaching philosophy – which in addition to our performance on pracs will form a major part of our assessment for this unit. In reflection, perhaps I should work towards obtaining the required texts for classes, they may actually be useful (then again everything does seem to be downloadable from the Blackboard site).

Some statistical information that came out of today included (note: some of these were dated 1998 and 2000*):

• 1 in 5 school students in Australia are affected by poverty
• 1 in 4 school students come from a culturally diverse background
• 83% of school students with a disability attend a regular school
• 18% of school students have a parent with a disability
• less than 40% of ATSI (Aboriginal or Torres Strait Islander) children finish high school at a year 12 level
• roughly 30% of pre-service teachers are “career switchers”
• $21 million is spent on stress leave for Australia’s teachers each year

The last one was perhaps not the most encouraging thing to hear on our first day (but I guess at least it’s not $22 million, and remember these are only Aussie dollars, they quite literally give them away).

Image credit: Exploding dog

*They were also scrawled hurriedly in my notepad so may be less than acccurate

Jump, on Three…

Darn you Auntie!

You taunt me too much. I’m fairly sure I’d just started my previous job and you taunted me similarly with some sort of awesome youth television hosting opportunity (think it was travel around Australia and videotape it for JTV).

This time ABC has announced a casting call for all eager beavers interested in hosting any sort of television show on their upcoming children’s programming channel, ABC3. All you need is a high school certificate. Why again am I trying to get yet another degree?

I just hope they get some decent talent, and not the airheaded morons who host those sponsored video music shows on the weekends at midday, and not contrived scripted personalities like The Shak. Being  non-commercial channel, Auntie has had a good track record of cultivating actual talent.

Applications for MeOn3 close next Friday.

Alas as it was for the BestJobInTheWorld, I don’t have a video camera, so can’t put an entry together. Besides, we are meant to stick to the plan this year.

My new housemate (who I went to high school with) has also suggested this to me. Grrrr…

Name your job

One of the final pieces I need to line up is part time work while I study, if only to minimise my need to deal with Centrelink.

This means dusting off and brushing up the old resumé… and making myself as appealing as possible to employers.

Something interesting in my “to post” box was some research out of Canada that showed employers are discriminating against persons with non-English names that might be perceived as difficult to pronounce. If you’d like to see the names they used, the actual working paper here: Why Do Skilled Immigrants Struggle in the Labor Market? A Field Experiment with Six Thousand Resumes.

A few weeks after I read this item, the story circulated in the Australian press, this time citing an Australian study from ANU that used only 4,000 resumes. Headlines abounded stating that Australian bosses were racist.

Now this may be fair conclusion, but it neglects to mention that this scenario is the same any where – someone with a local sounding name is always more likely to be hired (the Australian study found that Italian surnames were no hinderance in Melbourne, a city with Australia’s largest Italian community). This does not mean it’s an okay practice, but it is something to consider.

For just one dollar a day

No, I am not about  to con you into some religious sponsorship program.* Absolutely no African children for sale here.

It’s about SunSmart awareness and skin cancer prevention. The idea is that for $1 per day per person the Australian government could encourage people to regularly use sunscreen and prevent over 100,000 cancers and 20 deaths each year. This is based on some trials done in Queensland.

Now some of you might be trying to do the math. It is a little over 8 billion dollars annually for Australia’s 22 million inhabitants. But the authors make a compelling case by comparing it to the cost of public cosmetics expenditure, as well as government spending on vaccines (which cost $100s per dose).

Sunscreen is important for all Australians.

An exemplary example of framing science?

*Food for thought on religious-based missions here, here, and here

Scabies treatment uptake in regional indigenous communities

In doing some background research for this blog entry, I discovered scabies causes 1 death in Australia per year. Yikes!

That aside, the point of this blog was to help illustrate that health is not just about big killer diseases. And that non-lethal diseases are not issues that do not need to be taken seriously. A non-lethal disease like scabies still represents a burden on the community. It drains on health resources, it also drains on family resources, and can also be a source of conflict and agitation.

This paper is an Australian study published through PLoS Neglected Tropical Diseases, it examines scabies and treatment uptake in two rural Aboriginal communities in northern Australia. A number of factors lead to these communities experiencing a high burden of scabies infestation – including distance from resources, household overcrowding and high mobility between households. Those most at risk are young children.

In general, the best known way to control endemic scabies is through community-based mass treatment initiatives. However these initiatives require community awareness and cooperation in order to be successful. This study looked to not only measure levels of cooperation and success, but also what barriers exist in the community that might hinder such initiatives.

Scabies is primarily an inflammatory condition caused by the bodies reaction to burrowing behaviour and eggs laid by the scabies mite (pictured to the left). In Australia, the approved treatment for scabies is a topical cream, permethin that is applied to the entire body. In the study, a “Healthy Skin Day” was held in the community, and all community members were advised to utilise the cream over an 8-day period. The study then followed those households in which at one or more cases of childhood scabies were subsequently identified.

If a child was diagnosed with scabies, the parent was given cream to use not only on the child, but every other member of the household. Not only is this because there is likely to be others not diagnosed but affected in the same household, but the mites are likely to just leave the treated person and go over to new host.

As expected scabies susceptibility was lower in households that experienced universal treatment. However, while 80% of children directly diagnosed with scabies used the supplied creams, compliance rates amongst other people advised to follow the treatment because of someone else in the household being diagnosed was less satisfactory (44% of these persons used the cream). Just over three quarters of households had at least one household member not take the treatment, and in almost a fifth no one followed the treatment. The study also noted that treatment cooperative households were more likley to remain in the study, meaning that if anything these statistics are possibly over-estimating compliance rates.

There were multiple factors that contributed to treatment not being followed through: treatment not being a priority, treatment was not considered necessary, and treatment caused discomfort. The first two of these responses point to issues in education and trust. The community needs to be aware of the burden of disease on the community, and the benefits of treatment. Trust is a more trickier issue, as the relationship between indigenous communities and the government is one giant elephant that I’m not quite ready to take on that I’m not quite wanting to take on at the moment. The last points to a question of whether the proscribed treatment is appropriate for these communities.

The authors point out that in a hot, crowded environment, a sticky cream-like substance is possibly not the most enjoyable of treatments to experience. The cream also needs to be washed off in the morning, and with drought and water access also being an issue in regional communities, provides further complications with treatment compliance. Sadly while creams like permethin are the only treatments available in Australia at present, oral treatments for scabies do exist and would seem on the front a more acceptable treatment for the tropical environment. Pills might also be considered more like “real working medicine” and therefore encourage higher rates of compliance.

This study, while obviously not carried out with unlimited resources, does a very good job at highlighting the multiple factors that complicate rural health.

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La Vincente, S., Kearns, T., Connors, C., Cameron, S., Carapetis, J., & Andrews, R. (2009). Community Management of Endemic Scabies in Remote Aboriginal Communities of Northern Australia: Low Treatment Uptake and High Ongoing Acquisition PLoS Neglected Tropical Diseases, 3 (5) DOI: 10.1371/journal.pntd.0000444

Image credit: Scabies by MacAllenBrothers

Trends in internet influenza

At the start of the month, Google announced it was expanding its search-engine-based epidemiology surveillance tool, Flu Trends, to process information originating from Australia and New Zealand (previously it was processing U.S. statistics and a beta Mexico version).

The tool is based on there being a correlation between the number of people typing in influenza-related keywords into Google and the actual number of cases of influenza in the country. Google claims it is supported by historical data. The concept does make sense: when you are your family are sick with flu-like symptoms, that would be the time you are more likely to search for information on possible causes - Thus people searching for “flu” could reflect the cases across the country.

But I was skeptical at how well it would work in a pandemic. Google’s data might hold up for its recorded history, but that does not extend back to 1968-9 – the last influenza pandemic. A pandemic not only involves the potential for an increased number of influenza cases and increased severity of those cases, it also means an increased amount of media coverage and public awareness. When I last looked at Google Trends and health searches, I saw a possible link between media coverage of Kylie Minogue and Australian searches for breast cancer. There is a good reason to suspect that the statistical relationship between search terms and disease cases will not hold up during pandemic conditions. This concern is not addressed appropriately in the Flu Trends FAQ.

 

Google Flu Trends Data, as of 20 June, 2009. Click for larger image. A - US 2008/09 search data c.f. historical B - Australia 2008/2009 data c.f. historical (2008/09 dark blue, historical light blue). C - Australia historical search data (blue) compared with official historical epidemiological seasonal ILI (infleunza-like-illness) data (orange)

Looking at the U.S data, for this past season, it looks like it could be an accurate reflection. And if anything, rather than seeing a spike of search term activity this year, there was not much difference than previous years. In fact, the historic data contains several search spikes that do not exist in this years trends. All this information could either accurately reflect that the influenza pandemic thus far has been little more than out-of-season seasonal flu, or, just maybe, that the increased media activity and awareness have actually actively decreased usage of Google for health information.

Were people being directly channeled towards non-search websites, like flupandemic.gov.au? Were they getting enough influenza information from other websites they frequent, like news websites? Was there enough offline influenza resources that people did not feel the need to Google to find out more? Or were people just overloaded and desensitized by the mass media hysteria?

I still prefer the Rhiza Labs case-mapping tool. It is much more informative and accurate.

First swine flu death in Australia

My boss and some co-workers are flying to Melbourne on Monday to meet with clients. We were joking about how they should be extra careful while visiting the “swine flu capital of Australia“. Maybe she should put herself in a week-long quarantine when she gets back.

One of our Medical Writers pointed out how its all overblown. And I pointed out that no one had died in Australia yet.

Well, I guess I should stop opening my mouth to talk about swine flu from now on. A 26-year old Indignous man from central Australia died in Royal Adelaide Hospital ICU died from a number of complications, including pneumonia. He was infected with the Mexican Influenza A/H1N1 virus.

It is not known where or when the man contracted the virus, nor how much it may have contributed to his fate.

I’ve pointed elsewhere on the internets that WHO has expressed concern over the possibility that Indigenous Canadian groups may be more susceptible to the A/H1N1 virus. Let’s hope that situation is not true here (or there, even).

Do we take this as a sign to panic? That we aren’t doing enough? Or are the governmental precautions still too heavy handed? They won’t do anything to help, they did not help this man? Does this change anything? Is it just a continuation of SNAFU ‘flu?

Image Credit: ‘Chasing pig at Gatton College‘, Unknown circa 1940s – State Library of Queensland on flickr

Insight into Australian medical marketing

Insight on SBS ran a televised forum on medical marketing practices in Australia about a month ago, but I’ve only just caught up and watched it – it’s still available online. The forum involved proponents from within the industry, key watchdog figures, specialists, general practitioners, medical students and a few patients/consumers.

The key thing everyone seems to want is transparency - including the pharmaceutical industry, if only to appease public concerns.

Unregulated pharmaceutical advertising looks like this

It was good to see a discussion that focused well on the situation here in Australia (i.e. no direct-to-consumer advertising, subsidised universal healthcare, and a strict marketing code of conduct by an industry body enforced by an independent review panel). The best points I feel were made by the professor who pointed out that there is no problem with transparency, but why are we singling out the medical profession and pharmaceutical industry? Why are we not as concerned about the links the industry has to politicians, or pharmacists*, or the influence created by sponsorship of mining, agricultural, tourism and other industries on their respective providers?

No industry is as regulated and scrutinised as our medicines industry. Yet, it continues to be criticised as not doing enough. Sure, the system is by no means perfect, breaches occur – but they are pulled up on breaches, punished, and those breaches are publicised (and as the Pfizer representative said, that hurts their public  image much more than any fine). I would not like to silence the critics, as that is the only way we can improve this system. They made good points that I’ve already blogged about recently drug samples don’t help, and brand name reminders (no matter their value) influence doctors.

Some concerns though seem a bit silly. What is wrong with bringing doctors from overseas to talk about medical advances? And just as odd, what is wrong with a mere 3% of doctors being sponsored to go overseas to learn about medical advances? Do they think Australia should develop it’s medical knowledge in isolation from our neighbours and field leaders in the US and Europe?

And some were just based on pure inability to comprehend how industry works, or anti-industry sentiment. I’m sure one person brought up the low cost of medicine manufacturing per pill compared to per pill costs to the consumer (because that is the only cost the industry faces ever?).

Some things I would have liked to have seen discussed more (or at all):

• Spokespersons from either medical education or advertising companies – the people who actually produce the marketing materials?
• Education in university medical courses – are medical students in Australia trained to deal with industry?
• Training given to industry representatives regarding the code of practice – why do breaches still occur if everyone knows the rules?
• Those industry marketers not participating in the MA, who watches them?
• More scrutiny on those outside of the industry – pharmacists, consumer products, CAM and others who make spurious health claims  and marketing incentives outside of regulatory bodies?
• The ghost writing issue (this was probably avoided due to the legalities surrounding the Merck/Elsevier case, or SBS just didn’t know about it)

*The “chemists” the crusie ship guy were on about, were more than likely street-pharmacists, or even pharmacy assistants, regarding sales of alternative medicines, vitamins and/or consumer medicines – absolutely nothing to do with prescription medicines. I wonder if they’ll do a similar special with the Pharmacy Guild?

Oils ain’t oils: the essentials

You may have noticed my general feeling about so-called “alternative medicine” is that there is no “alternative” to medicine. One of my friends puts it another way:

Q. What do you call an alternative medicine that works?

A. Medicine.

There is no grand pharmaceutical conspiracy against natural remedies. Once a treatment demonstrates value to medical science, it will become accepted as medicine. That’s why, while you last month science bloggers descended upon a laughably flawed acupuncture study flouted as proof of effect and tore it to pieces, I doubt there’ll be a similar response at this a new international study currently in print that shows essential oils may have a role to play in combating infections caused by multi-resistant microbes.

It’s actually quite a well done study, with interesting results that provide an opportunity for the complementary medicine industry to clean up it’s act and get on board with whole evidence-based medicine paradigm, rather than remaining in the realm of snake oil and shamanism.

Roughhousing Aussie Youth

004, originally uploaded + © maisierevenge.

… must … resist … urge … to … post … cuteness …

Australia’s Biggest Morning Tea

Last time I posted a peer review blog, I saw a significant spike in readership (partly in thanks to a digg stumbleupon).

I’m going to selfishly* capitalise on a similar expected spike by asking readers to consider visiting: THIS LINK and donating to my office’s fundraising for The Australian Cancer Council with the Biggest Morning Tea.

The Cancer Council is engaged on all levels of Cancer Support – whether sponsoring clinical trials, providing patients with information, or support services for friends and families. These days it’s pretty rare to find anyone who hasn’t been affected in some way by cancer – even $5.00 can help one patient receive information and other resources.

THAT LINK AGAIN.

If you live in Australia, you might even consider hosting your own morning tea event in the coming weeks. There’s always time for cake…

*It’s for charity

Image credit: Swamibu (Creative Commons)

+++++ +++++ ++++++

UPDATE

Thanks to everyone who donated. Our event raised $228.00$248.00. You can register your office, school, organisation or even your lonseome self as a host for 2010 on the biggest morning tea website.

Swine flu arrives in Australia

I think we are getting to the stage where it’s pretty hard to deny that the current A/H1N1 Mexican Flu is a pandemic strain of flu. This made a lot of what I was planning to blog a bit obsolete (that’s why you should blog direct).

This week in Australia confirmed cases have been pretty much doubling each day. When I was putting together my flu resources for blogging on Tuesday, it was in the 20s. On Wednesday it jumped to just over 50. Yesterday it was near 100. Ten Late News just told me it’s 209. Will it be 1000 by the end of the weekend, or maybe it’ll hit a peak by 500?

The good(?) thing about the current form of the virus is that while it appears highly infectious, it doesn’t seem particularly lethal or morbid. But it doesn’t change the fact that influenza is a potentially lethal disease – so the less people who get infected in the first place the better (that’s directed at you anti-vax wingnuts and idiots planning swine flu parties). It also isn’t reassuring that the Spanish Influenza pandemic in the early 20th century was initially mild(-ish) and became increasiningly virulent.

Some stories from the past week of pandemic emergence:

• Diagnosed Canberra man claims, “I’ve had worse paper cuts“
• Investigative reporter Sarah Collerton goes a bit far for her job. After her flatmate is diagnosed with H1N1, she is thrown into quarrantine with her other flatmates, at least she has a laptop and can still write stories. Raises the question of whether quarantining potentially flu-free individuals with potential flu-infected ones is an appropriate action.
• Club Wah politely points out that people whinging about the lack of information available about swine Mexican flu, should possibly try looking for it.
• On the other hand some are woried that Health Minister Roxon is mentioning the possibility of cancelling football matches. Nice to see Australia has priorities.
• First case in Tasmania was identified tonight.
• Seven clinics have been set up to deal with Mexican flu in Victoria – I’ve read about clinics opening in Gold Coast, Brisbane and Adelaide as well.

To follow the Australian governments official pandemic phase alert, visit here.

For global information – I recommend the Google-Rhiza Labs interactive map project by Dr Niman.