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

Swine flu brain pop

Rather good UK children’s animated production explains the current swine flu novel Mexican A/H1N1 influenza outbreak.

Some innacuracies, but its hard to tell exactly how dated this might be. Still, definitely good enough at explaining key concepts effectively for schoolchildren

Hattip: Malaysia SMS

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

Your internet has a drugs

Whiz Kids: Alec & Shanna and The Computer That Said NO To Drugs!

Computers and drugs, do they mix?

So the last post didn’t quite Pharm me all out as it was supposed to, so here’s a few remaining links in my medical marketing and related sturf I’d like to purge from my chest before they become totally irrelevant:

1. Dose of Digital has a Top 10 marketing ideas for Pharma. I wonder if the critics agree with any of these (such as doing away with branded websites)
2. Tips for using Twitter as a pain log (also advice on when to ignore your doctor)
3. The UK National Health Service (NHS) has engaged the community online with a remarkably well done website. Not only does it provide health advice, contact details and news – it also responsibly examines health claims made by the UK media and lets you know the real story between red meat and sperm.
4. The U.S. FDA has made steps towards global domination: In January it set up its first permanent base in Costa Rica
5. A bit more technical, an article on establishing standards in biomarkers research. Biomarkers are molecular tests used to type diseases like cancers to determine which treatments are the best for you.

Rx-ky business

Well, AFM called me up on the Insight post for painting my town¹ a little too apologetic for our phriends in Pharma (possibly due to some comments I made on this post of his, and these over at The Scientist, and also just today on Flickr…) .

So I guess I should make some self-apologetics, that my point has *not* been that Pharma is cute and cuddly and can always be trusted – c’mon they are industry – the wonderful Merck saga unfolds beyond just deceptive journals – this sort of awful ‘hit list’ language to “neutralise” and worse, “discredit”, critical doctors makes me cringe (and if you’re sick of hearing about Vioxx, you can get upset at Lilly’s innapropriate off-label Zyprexa marketing instead). There is nothing I can concoct to attempt to downplay the totally unethical nature of that sort of behaviour, to me it is indefensible. There are bad elements out there. Even if we rule the Vioxx shenanigans as an exceptional exception (which is the closest I can get to a defence) just take a look at the US statistics on Pharma fines and settlements made by over the last 9 years (and that just to the government, does not include private parties, class actions etc.)

Pharmaceutical companies are corporations. And yes, they are motivated by making money. And AFM is right, some guy in marketing will try to put that goal ahead of making quality medicines. But let’s remember that’s also what these companies are about making medicines. Medicines that help people. People do not get into this industry because they want to hurt people.

And that is where I start to get annoyed by anti-Pharma movements.

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.

Pandemic is not a synonym for crisis

…necessarily. In this case it’s more SNAFU.

I read this weekend’s Sunday Herald during lunch today. There was a double page spread on the growing “Swine Flu Crisis!” (251 Infected!*).

While I’m not sure if this graph is actually based on real figures, it does put the pandemic in perspective:

see more Funny Graphs

The threat of Mexican flu is quite relative. This strain may only turn out as bad as regular flu. But regular flu isn’t something to sniff at. Each year influenza occurs on a pandemic scale, this kills about 250,000 – 500,000 worldwide. So when the health authorities are saying “this is just like seasonal influenza”, they may be quite right to downplay the threat, but there is still a threat – SNAFU.

Was that enough mixed messages?

 

Hattip for GraphJam: Cheshire

*It’s now over 300, but didn’t reach 800. Either Mexican flu (or the testing labs) took the weekend off, or it’s possibly slowing down.

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.

Pandemic panic epidemic

I have a few posts lined up about swine flu. With Australian cases of A/H1N1 Mexican influenza have been steadily creeping up, I should try and get them out before we all die or something.

But i’ll take my chances and post them tomorrow, it’s getting quite late.

However I just loved that one of my friends back home pasted this on facebook. The local paper is panicking that some cruise ship that dropped of some infected passengers in Sydney (more about them later) has detoured so that instead of being distantly offshore of the Queensland coast in the Great Barrier Reef, it is now slightly less distantly offshore of the Queensland coast in the Great Barrier Reef. [Insert dramatic tone].

I’m struggling to work out how exactly it could travel along the east side of Australia without at some point being “off the coast of Rockhampton” (I’m going to just ignore the Bully momentarily forgetting that Rockhampton is not on the coast).

More than medicine

Hot on the heels of discussions about Pharma and digital media – GSK has recently launched a corporate blog More Than Medicine. They aren’t the first Big Pharma to do so, Johnson & Johnson is also present in the blogosphere with JNJ BTW.

The idea behind the blogs is to create a more comfortable dialogue between these large overarching organisations and the end-product consumers (i.e. you and me).

J&J: “Everyone else is talking about our company, so why can’t we?“

GSK: “Our goal is to encourage an open, productive discussion about a range of topics .. that doesn’t sound like it’s written in ‘legalese’.“

Already GSK has been called out for having pseudonymous bloggers – but while it might somewhat detract from their claim to broad openness, it’s hardly a rare thing amongst bloggers (ummm… does yours truly qualify?*) Relationships don’t have to be built up on a first name basis.

Already the two blogs have very different styles, and showcase positive ways in which Pharma can successfully harness this new media.

Naylor’s Law – You’re just like Big Tobacco

I’m naming this after the lead in Thank You For Smoking. I couldn’t find reference to this particular phenomenom anywhere.

I saw it twice in one day.

Here. An ad for the hippie doco Food Inc. in reference to the processed foods/factory farming industry.

And Here. A passing reference to anti-alcohol campaigns on a Radio National show.

I also here it plenty of times from the anti-vax crowd.

The law is:

As a discussion on the health effects of a product for human consumption progresses, the probability that one side will bring up a comparison to the tobacco industry approaches 100%.

Should this be grounds for forfeture of the debate?

I can definitely see myself comparing the alcohol lobby to the cigarette lobby. A “cool”, addictive, mind-altering substance associated with a myriad of ill-health effects – hell, they even have the same occasional claims of health benefit (red wine for heart disease). I suppose the main difference is there isn’t such a thing as passive drinking (is there?)

Just a reminder, or is it?

The decision on what medicines you are prescribed can be a matter of life or death. These decisions need to be based purely on what is best for you, the patient, not on who has the flashiest marketing campaign.

Medicines Australia, the national self-regulatory body for the pharmaceutical industry, is in the process of revising its Code of Conduct for 2010. The code is based mostly on ensuring that any marketing its members engage in is based primarily on accurately educating health-care professionals, and that their activities will withstand professional scrutiny and not bring the industry into disrepute.

The new code is expected to heavily crack down on the use of once ubiquitous Brand Name Reminder – all those free give-aways brand logos emblazoned on them. All brand name reminders will be expected to cost less than $20 and be directly relevant to the clinical setting – an umbrella or coffe mug is definite no, but this might also cover generic office equipment – like USB sticks, mousepads, sticky notes and pens.

Is this ban based on evidence? Sadly, yes. And even items under $20 may still cause some influence. And Research published in the Archives of Internal Medicine suggest the mere presence of logos can influence how a doctor thinks about what he prescribes. But that influence may be a good thing. It depends on how he was educated.

A spoonful of sugar helps the sugar go down

We learned the other week that lying to children can convince them that vegetables are cool¹. Well, the Australian sugar industry was obviously paying intention because they have released “healthyhealthier sugar“.

Yes! The power of science – “Sugar: with low sugar”. Lols.

Careful framing branding word selection is well afoot in this release. The news report claims the low GI sugar “can be used to reduce diabetes, obesity and blood pressure”. Okay, yes in theory it could potentially reduce incidence of developing these diseases, and may offer more options for those needing to monitor their GI intake. But let’s be clear, it’s use won’t act as some sort of cure, or alleviate your symptoms. It’s just possibly a better alternative (than standard sugar).

Okay, it’s hard to fault the industry too hard for actually working towards solutions to growing nutrion-based health issues – but perhaps the marketing and awareness campaign is laying it on a little thick.

—–

¹and mutagens are good for you

Lots of measles where there are none

Measles Measles everywhere. Even the Grammar Girl podcast has measles.

Thanks to anti-vaccination campaigners I get to read the following two stories on the same day:

• Australia now officially measles free
• Biggest measles outbreak in years (in Victoria, Australia)

Please explain?