Don’t worry nurse, its a *healing* sword

30 05 2010

I’m all up for learning in gaming, and even for gaming in learning (more on that story later), so the story of Healing Blade intrigues me. It even has a trailer.

A company called Nerdcore Learning has released what looks like a Magic: The Gathering Style Trading Card Game (TGC) that is supposed to help medical students remember what antibiotics they should be using for particular infections. It also mixes things up with cards for antibiotic resistance, as well as broad-spectrum antibiotics. I’m am quaking at the sight of Bacillus athrancis and his hordes of sparkly butterflies.

Yes. Your future doctor will have learned how to cure your ails by playing a medical-themed version of Yugi-Oh. Oh, dear, what?*

I wonder if they will release an OVA, or at least a web-comic.

If your interested in medical card games for younger demographics, there’s always Zygote Games’ Parasites Unleashed.

*Actually I’m far more worried about the med student likening his practice of medicine to Mass Effect





Abortion in Queensland – is it what you think?

12 08 2009

If you criminalise abortion, what do you expect will happen?

(The Australian) TEGAN Simone Leach was 19, pregnant and “scared” when her boyfriend’s sister arrived in Cairns last Christmas Day with a consignment of contraband tablets and doctor’s instructions written in Ukrainian.

What transpired after Ms Leach allegedly terminated her pregnancy with the abortion pill RU486 and the Queensland police got involved, has unleashed a legal and political storm of the like not seen before in this country.

Ms Leach will face court next month charged with the crime of procuring her own miscarriage, in what is believed to be the first case of its kind to be brought under Queensland’s century-old abortion laws.

If convicted, she faces up to seven years’ jail.

The young man in her life, Sergie Brennan, 21, faces up to 14 years’ imprisonment for attempting to procure an abortion and three years’ jail on a further charge of supplying the means to procure an abortion. [more]

As expected there is quite a lot of anger coming from liberal left sector – with the launch of the Pro-choice Action Collective in Queensland. They have a facebook group and a website. But is this the right case to be defending? Read the rest of this entry »





The curious case of the unqualified qualication

4 08 2009

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?





Scabies treatment uptake in regional indigenous communities

21 06 2009

ResearchBlogging.orgIn 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.


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





Rx-ky business

16 06 2009

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.

Read the rest of this entry »





Insight into Australian medical marketing

9 06 2009

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.

funny pictures

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?





Worst suicide attempt ever

2 06 2009

You gotta admit, it’s shows quite some guts (and that’s just for using a pun in the title, oh, Dr Spiers…) .

Can anyone find a print of the complete article?

It sounds interesting.

Hattip: the ever awesome AIR