The Critical Decade: Global action building on climate change:

This report from the Climate Commission updates us particularly on the progress of China and the United States,the world’s largest economies, in tackling climate change.

Key findings in the document include:

•  China will begin introducing seven emissions trading schemes this year that cover a quarter of a billion people. A national trading scheme is planned, based on these models.
• China has emerged as the world’s renewable energy powerhouse, taking ambitious strides to add renewable energy to its mix. 2012 was another year of extraordinary growth:
•  Between 2005 and 2012 China increased its wind power generation capacity by almost 50 times. The amount of electricity generated from wind in 2012 was about 36 per cent higher than in 2011.
•  New solar power capacity expanded by 75% in 2012. Solar power capacity is expected to triple to more than 21,000 megawatts by 2015.
•  In 2012 China invested US$65.1 billion in clean energy, 20% more than in 2011. This was unmatched by any nation and represented 30% of the entire G-20 nations’ investment in 2012.
• Emissions in the US have been declining. With continued efforts the US is on track to meet the national goal of reducing emissions by 17% on 2005 levels by 2020. Policy settings have made a contribution, as well as the impact of the economic downturn and a progressive shift away from coal to gas.
•  Important foundations have been set that are likely to have a lasting impact in the coming decades, including:
•   In January 2013 the world’s 9th largest economy, California, commenced an emissions trading scheme.
•  More than half of US states now have policies to encourage renewable energy.
•  In just four years, between 2008 and 2012, the US has nearly doubled its installed renewable energy capacity.
•  US investment in renewable energy was US$35.6 billion in 2012, second only to China.
•  The number of countries pricing carbon is increasing, with four new schemes starting so far this year. Emissions trading schemes are now operating in 35 countries and 13 states, provinces and cities. These 48 schemes, together with the 7 Chinese schemes, are expected to involve 880 million people and about 20% of global emissions.

Globalization, climate change and human health

In this NEJM article Anthony McMichael provides a structured analysis of the effects of globalization on population health and our current understanding of the effect climate change will have on human health.

He concludes by noting the role of the health sector in the considerable challenge that lies ahead “For populations to live sustainably and with good long-term health, the health sector must work with other sectors in reshaping how human societies plan, build, move, produce, consume, share, and generate energy”. Read the full article here.

Climarte

The arts world is raising it’s voice against climate change. Climarte: arts for a safer climate has just been launched. “CLIMARTE harnesses the creative power of the Arts to inform, engage and inspire action on climate change”. Find out more.

Accreditation programs are deployed widely to monitor and promote safety and quality in healthcare. Governments, health service organisations and accreditation agencies have invested considerable resources into programs, but to date, evidence of their effectiveness is limited and varied in some areas prompting the question: is it money and time well spent?

A recently published Evidence Brief examines this question (see here for full details). It synthesises findings from a recent literature review of 122 published empirical studies regarding health service accreditation programs. Overall, these studies investigate varied aspects of accreditation, including the impacts on:

• measures of quality (for example, indicators of organisational performance or patient outcomes);
• health service processes, policies and operating environments;
• organisational change mechanisms; and
• professionals’ attitudes.

Improving the quality of healthcare is undoubtedly a key aim of accreditation, and over 60 studies have evaluated program impacts on different quality measures. Unfortunately, the majority do not use non-accredited health services as control sites in comparative study designs, decreasing the strength of evidence produced. Also, findings from individual investigations are shaped by contextual issues limiting the generalisability and comparability of studies, with examples of both positive and negative impacts identified.

Advocates of accreditation argue that a key benefit is that it stimulates improvements in health service processes, policies and operating environments. Some research supports these claims, with one study demonstrating that staff in accredited organisations are more compliant with best-practice guidelines and open to implementing changes that improve quality and safety. However, few high-quality studies have examined whether programs actually deliver such tangible benefits.

Fortunately, there is stronger evidence on how preparing for and undergoing accreditation establishes mechanisms for change within health service organisations. The research suggests that accreditation causes organisations to change because:

• staff become more engaged in quality improvement activities, such as self-assessment;
• systems for delivering quality care are promoted within the organisation;
• data is collected, collated and used for internal and external benchmarking more often; and
• staff begin to implement best-practice guidelines.

One particularly perplexing aspect of the evidence concerns health professionals’ views of accreditation programs. Overall, the research shows that professionals see accreditation as an effective method of promoting quality and safety in healthcare, and they are more likely to remain satisfied and employed in accredited organisations.

However other studies have found that professionals have concerns about the human and financial resources needed for organisations to participate successfully in programs, and that participation might divert attention and resources away from more (unspecified) critical organisational and system-level problems. How quality would be systematically managed and assessed remains unclear without an accreditation program. As engaging health professionals in the accreditation process is critical to its success, it would be valuable to further explore the reasons for this issue.

When taken as a whole, the published research evidence provides credible support for health service accreditation programs, but there are limitations that make it difficult for policymakers to forge ahead with confidence. The evidence base is considered to be of only moderate quality, and findings from individual studies regarding the same topics are highly contextual in many cases.

There remain major knowledge-gaps that need to be addressed to understand what aspects of accreditation programs work, in what contexts and why. These questions may be in part answered by ‘ACCREDIT’, a five-year Australian Research Council Project administered by Professors Braithwaite and Westbrook at the Australian Institute of Health Innovation, University of New South Wales. Without the robust evidence that such large-scale and long-term studies can produce, policymakers will need to continue drawing on expert opinion, small-scale program evaluations and cautious comparative assessments of the literature when reviewing, revising or implementing accreditation programs.

The decision, announced last Friday by the Pharmaceutical Benefits Advisory Committee (PBAC), to recommend that mifepristone (RU486) be listed on the PBS, is an important step towards national accessibility of the drug.

Accessibility, affordability, safety and choice for all Australian women are the goals we, along with many others, have been working towards since we made our first application to import mifepristone to  the Therapeutic Goods Administration (TGA) in late 2005, when the Harradine amendment was still in force.

However, while congratulations are certainly in order, above all to Marie Stopes International Australia (MSIA), who guided the application through the PBAC, there are still some obstacles to overcome.

The PBAC has recommended that mifepristone gain an authority-required listing for termination of pregnancy up to 49 days (7 weeks) gestation. The current TGA licence for MS Health (the MSIA-associated company that gained marketing approval for the drug in August 2012) also specifies an upper limit of 49 days in the first three months of pregnancy (although also permitting the use of the drug after three months in hospital practice).

Currently MS Health maintains a register of doctors who may prescribe mifepristone – this includes specialist gynaecologists, all doctors who previously had the Authorised Prescriber approval of the TGA, and doctors who have successfully completed an online educational program provided by MS Health. Presumably doctors in these categories would also be those who would be able to obtain the authority to prescribe mifepristone on the PBS.

The cost of mifepristone once on the PBS would be $12 for concession card holders (this includes both mifepristone and the drug misoprostol, used with mifepristone) and $72 for general patients (the current non-PBS price of a single tablet of mifepristone is $308).

However, mifepristone is widely recognised, overseas and in recent practice in Australia, as appropriate for early medical abortion up to 63 days (9 weeks) gestation, and in Australia the majority of early abortion requests are for gestations later than 49 days. Those of us who have prescribed mifepristone as Authorised Prescribers of the TGA for the last six years have safely used the drug in the first 63 days of pregnancy, but use is now restricted to the first 49 days – for no obvious compelling reason.

While some practitioners have suggested that it would be possible to use the drug “off-label” between 49 and 63 days– that is, outside the regulations but within the boundaries of normal practice – it is not clear what the practical and medico-legal implications would be of using an authority-required drug in this manner. (A doctor prescribing an authority-required drug must confirm the indications and obtain approval from the Commonwealth Department of Health and Ageing if the drug is to be supplied on the PBS.)

The current regulations of the TGA require that doctors not registered to prescribe mifepristone complete the MS Health online program, which in our experience takes several hours, possibly a time challenge for a busy GP. In addition, the drug is currently available only in pharmacies who register with MS Health. A GP or other doctor can therefore only prescribe mifepristone for a woman who can access a registered pharmacy.

Pharmacies must already have an account with Symbion, MS Health’s one chosen distributor, or must open an account. There is likely to be reluctance by some pharmacies (and possibly by Symbion) to open an account for just the occasional order. It is to be hoped that with the PBS listing will come a decision that the drug, like all other PBS listed drugs, must be available in all Australian pharmacies.

As the drug becomes available nationally, it is also important that there is public awareness of the major differences between Australia and those countries, especially the United Kingdom and other European countries, which have provided guidelines for safe practice of early medical abortion.

Since we first began providing early medical abortions at home in Cairns in 2006, this has become by far the most common way in which the procedure has been carried out in Australia. This is not the case in Europe, where after two or three decades most early medical abortion still takes place in clinics.

Moreover, in European countries there is usually an integrated system of abortion care and emergency care that women can access in the event of a problem with a home medical abortion; women can easily receive appropriate and non-judgmental care in these health systems. In Australia most early abortion takes place in the private sector (apart from services in South Australia) but women are often dependent on public sector care if a problem arises (which may happen in 2-5% of cases).

As early medical abortion becomes more widely available in Australia it is essential that all emergency services become familiar with the care of women presenting in conjunction with a home medical abortion, and that appropriate and sympathetic care is rapidly provided.

It is also essential that guidelines for the performance of early medical abortion are closely adhered to. This applies in all cases but particularly to situations where women are travelling away from the site of administration of the mifepristone, often a considerable distance, and planning to carry out the abortion process, which requires the self-administration of the second drug, misoprostol, at home.

It is important to ensure before mifepristone is given that a pregnancy is not an ectopic and that it is of the stated duration (ideally using ultrasound). Attention should be given to the prevention of post-procedure infection. There should be a support person who is well-informed about the procedure, and who undertakes to stay with the woman until the abortion process is complete. Follow-up is vital and the provision of future reliable contraception highly desirable.

Cries from opponents of the PBS listing of mifepristone that this action will increase the rate of unplanned pregnancy in Australia have no basis in fact. The drug has been widely available in many parts of the world for up to thirty years and has been well-researched.

It has been clearly established that women make the decision for abortion quite separately from that about the method of abortion. Making mifepristone more easily available simply increases the choices for Australian women who have already made the (often-difficult) decision to have the abortion.

Importantly, national availability of the drug has the potential to make abortion easier to access for women in rural areas of Australia, as well as less expensive for a group of women who frequently are in dire financial circumstances.

There has also been progress in recent weeks in the reform of Australian abortion law, with the passage through the Tasmanian lower house of legislation decriminalising abortion in that state. This is welcome news. While it would be good to think that the two states most recalcitrant in regard to abortion law reform, NSW and Queensland, might follow suit, this seems unlikely.

However, the eventual national availability of early medical abortion using mifepristone may well make archaic NSW and Queensland abortion laws completely obsolete.

If a woman in early pregnancy can easily consult her general practitioner (or other doctor of her choice) requesting termination, and agreement is reached between them that state law is complied with, the procedure can go ahead in the privacy of the woman’s own home. The state plays no role in this.

Ultimately, abortion law in NSW and Queensland would go the way of laws on duelling and driving a horse-and-carriage on the public way, other pieces of 19th century law that the Queensland parliament has voted out of existence in recent years.

The last seven years have seen a succession of advances for Australian women’s right to choose. Increasingly there is awareness, among the public, the various health professions, and politicians, that abortion is not a criminal or religious matter, but a health issue, and with around 100,000 abortions annually, it is an important health issue for all Australian women.

The events of the past two weeks represent significant progress in our efforts to gain safe legal accessible medical abortion in Australia, but only when women, doctors and pharmacies have easier and less restrictive access to the drug will all our goals be truly met.

Caroline de Costa is professor of obstetrics and gynaecology at James Cook University School of Medicine, Cairns. Michael Carrette is a Cairns gynaecologist.

Further reading:

1. World Health Organisation Taskforce on Post-ovulatory Methods of Fertility Regulation. Comparison of two doses of mifepristone in combination with misoprostol for early medical abortion: a randomised trial. BJOG 2000; 107: 524-30
2. Therapeutic Goods Administration. Registration of Mifepristone Linepharma (RU486) and GyMiso (Misoprostol) 30August 2012; At www.tga.gov.au accessed 1/9/2012
3. Victorian Law Reform Commission. Law of Abortion; Final Report. Victorian Government Printer, 2008
4. Grimes DA, Creinin MD. Induced abortion: an overview for internists. Annals of Internal Medicine 2004; 140:620-26GoldstoneP, Michelson J, Williamson E. Early medical abortion using low-dose mifepristone followed by buccal misoprostol: a large Australian observational study. Med J Aust 2012; 197(5): 282-6.

This article has also been published at Crikey.

Many thanks to The Conversation for allowing us to re publish the below report by Trent Yarwood:

The Communicable Diseases Network of Australia (CDNA) and the Australian Society for Infectious Diseases (ASID) conference in Canberra last week was largely overshadowed by the machinations in nearby parliament house. And what little media attention it did receive failed to highlight a very significant public health advance.

A parliamentary report entitled Diseases Have No Borders was released with a number of recommendations, including border security, systems for migrant health, advice for Australians travelling overseas, pandemic planning, further research and addressing a shortage of skilled public health workers.

Many of these projects would be the role of the body mentioned in the last of the report’s recommendations. This item considers the case for the establishment of a centre for disease control in Australia (CDCA or more popularly, the ACDC – for music fans).

This is not a new idea. The Public Health Association of Australia’s (PHAA) conference in 2011 had a headline debate on the establishment of a CDC, and they and others have been calling for the creation of such a body for a while.

The American CDC has a very high profile, has existed since 1946 and employs 15,000 staff. The European CDC is smaller, having starting out from a single office in 2005 but has grown rapidly. The diversity of member states in Europe has been a challenge for ECDC, but Australia could learn from its experience.

Like many other aspects of health, public health in Australia is state-based. The Communicable Diseases Network of Australia (CDNA) is made of representatives from the state and federal health departments, the Australasian Society for Infectious Diseases and other stakeholders. The network prepares national guidelines that state public health units either use or base their own guidelines on.

The recent outbreak of listeriosis associated with Jindi cheese resulted in 26 people becoming ill and three deaths in three states. Local public health units interviewed the people affected to identify a possible source. This part of the process can be difficult, as the German E. coli outbreak of 2011 showed.

Once the source of the infection is determined, the information is distributed though the CDNA and channels such as OzFoodNet, so that people in all states and territories are aware of possible exposure.

When other cases occur, an outbreak is identified, but right now, the response still occurs state-by-state. A centre for disease control would make streamline this process and make it faster and more efficient. It would not only be the source of surveillance data, but also the responding body. This would improve response times to outbreaks – and this is often critical for containing them.

Bringing experts together would also facilitate workforce training and public health research. These were two of the other recommendations of the report. The touted centre would be a mecca for students in Australia’s epidemiology training course.

A centrally-funded health agency would also federalise funding for disease control and public health. States tend to target preventive health functions for health savings, so federal funding would help maintain services in the face of local cost-saving efforts.

Although a CDC would have a primarily clinical role, the benefits of centralised data collection for research would be enormous and more than offset any concern about a public health “brain drain” to a national body.

Australia has a unique position in the world by virtue of being a a developed country in a region with a high prevalence of communicable disease. We have significant research expertise in public health and an excellent public health workforce.

We already have one famous AC/DC. Now is the time for the Flick of The Switch to create another.

It is only very early days; the results of the inquiry was to recommend establishing a mapping exercise and review. Although it might seem like yet another bureaucratic hurdle, as with many aspects of public health, it’s the long game that’s most important. Once a review is established, I encourage as many people as possible to make a submission.

Trent Yarwood is an infectious diseases and public health clinician and a member of both ASID and PHAA. He does not consult to, own shares in or receive funding from any company or organisation that would benefit from this article. The opinions in the article are his own and do not necessarily reflect those of his employer.

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

This week the SA government announced the implementation of many of the reviews findings. Below Kaye Mehta, senior lecturer, Nutrition & Dietetics, Flinders University reminds us why the funding cuts and service changes announced will cost us all in the future.

Ms Mehta writes:

The South Australian government’s announcement on Friday 21 March to cut $14.7 million of community-based health services (euphemistically called non-hospital health services) is a travesty of wise budgetary management.

This funding cut has followed progressive dismantling of the state’s community health services which were the site of creative and innovative health promotion and illness prevention programs that used to earn us international recognition.

As obesity and chronic diseases have consumed more and more of the state budget the government has reduced its funding of health promotion and prevention and ploughed its precious funds into treatment programs.

The shame is that at least two-thirds of chronic diseases are preventable; and throwing money at treatment can never hope to reduce the problem of chronic disease – it is only health promotion and illness prevention approaches that can hope to do this.

The government’s decision to cut funding of health promotion programs displays lack of courage and vision to take a long-term view and to invest in creating a healthy population rather than respond to short-term demands for more clinical services to treat our unhealthy population.

Unhealthy eating habits and subsequent obesity are major contributors to chronic diseases and our government has unwisely decided to axe some important community nutrition promotion programs that are delivering positive healthy eating outcomes.

Programs such as Start Right Eat Right which promotes healthy eating practices in child care settings focus on building a healthy population from the early childhood years. A visionary government would commit to establishing healthy eating habits early in life.

Even the apparent reprieve given to the Community Foodies program following strong pubic outcry of their imminent demise, is potentially a poisoned chalice. Passing the Foodies program to the non-government sector shows a startling lack of understanding about what expertise allowed this program to achieve its fantastic nutritional and health outcomes.

The success of the Community Foodies program is entirely due to its design and implementation by dietitians, social workers and community development workers who have specific expertise in nutrition science, community education, and community capacity building. These personnel are health workers and the Community Foodies program is a health program underpinned by health objectives. Taking it out of the health sector and into the non-government sector does not guarantee the program the same access to health expertise.

This is nothing short of condemning it to failure and smug justification that it did not deserve to have continued funding in the first place. Even more damning is that the Foodies program is coordinated by a state-based team but implemented by dietitians and other health workers employed by health services across South Australia. Continuing to fund the state coordinating team albeit in the non-government sector but removing capacity of state-employed health workers to implement the program is nothing short of ripping out its heart while continuing to hook it up to a life support system. The program has little chance of maintaining its successful track record and will almost surely be de-funded after a short time.

So the government’s announcements appear logical on the surface but on closer analysis spell the end of health promotion programs and a shameful legacy to this state on its mandate of building a healthy community.

The utter waste of this decision is that the state will lose the health promotion expertise we have been recognised for and it will take enormous additional investment to re-build this workforce. The policy wheel will almost certainly turn to re-instating a health promotion and illness prevention workforce because it is highly unlikely that we will achieve a healthy state by investing in illness.

Recently  Donna Ah Chee, CEO , Central Australian Aboriginal Congress, gave a speech at the launch of the Kidney Action Network, examining progress in managing this major health threat to indigenous communities and the work still ahead.  Many thanks to Donna for allowing us to provide the full transcript of her speech below:

The stark reality of the numbers of Aboriginal people on dialysis here in Alice Springs is a constant and real daily reminder of the work that still needs to be done to address Aboriginal health disadvantage and Close the Gap in our life expectancy.

However, at the outset I think it is vital to acknowledge the very real health improvements that are now being seen in the prevention and treatment of chronic illnesses, the very diseases that have created this kidney disease crisis.

Since the beginning of the Primary Health Care Access Program (PHCAP) in the NT back in 2001, there has been a continuing improvement in life expectancy amongst Aboriginal people in the Northern Territory, primarily because of a decline in premature deaths in midlife caused by chronic illnesses.

The NT is currently the only jurisdiction on track to Close the Gap by 2031, if the current trend continues.

There is now much better access to evidence-based treatments, including medicines, than was previously the case. We have many more health professionals on the ground now. This has helped to detect renal disease early and slow its progression.

However it is vital that we do much more in terms of the primary prevention of renal disease in the first place, and this requires action to prevent the epidemic of obesity and diabetes.

I have just been to a national forum in Canberra on this issue, organised by Diabetes Australia. Congress made four key policy proposals to address the prevention of the obesity and diabetes epidemic:

1. To re-establish the Primary Health Care Access Program, or PHCAP, so that the expanded primary health care core services model can be fully funded and so make further improvements in access to primary health care.
2. To fund the key early childhood programs (ante-natal and for the first three years of childhood)  that will help to ensure that all young people have good self-regulation and impulse control and will be more resistant to the development of addictions including fat and sugar
3. To introduce an alcohol floor price, as cheap alcohol consumption is a major contributor to obesity and the inability to self-manage chronic disease
4. The introduction of a 20% tax on glucose—especially on the glucose in sugary soft drinks—and fat, with hypothecation of the tax to ensure that the tax is used as a subsidy for fresh fruit and vegetables

We must get much more serious on the prevention of renal disease than we have been up to now.

However, there are now some early signs that for the first time the rate of increase in End Stage Renal Disease may have at least plateaued, as the number of new patients coming on to dialysis in the NT has declined slightly for the first time.

There are many reasons for this, but it is at least partly due to the real improvements that have been made in the NT health system, where a large injection of new resources have been allocated over the last decade in a planned way, according to need.

Unfortunately, in recent years many new resources have been allocated through competitive tendering. This form of funding allocation has been fragmenting the health system, and has the potential to slow down the gains that we have made up to now.

Also, the way that renal dialysis services are being delivered has not been part of this change process. We are largely stuck in the same “centre-based” approach that we have had for decades, with patients being given little option other than to move to Alice Springs and other major centres to  go on to dialysis.

It should be acknowledged that there have been efforts to get some dialysis patients home on ‘self-care’ home haemodialysis, but only a very small proportion of our people are currently capable of achieving this.

Congress has advocated for many years for the option of nurse-assisted home-based haemodialysis for all of the reasons outlined in the Central Australian Renal Study, which was completed in 2010.

Congress recognises the work being done by the Western Desert people to help themselves deal with the high levels of kidney problems in their communities.  They have led the way in taking initiatives to ensure that there are better options, including nurse-assisted home haemodialysis.  Where government have failed to deliver, Aboriginal people have had to try to fill the void with their own funds.

The Western Desert Nganampa Walytja Palyantjaku Tjukaku remote area dialysis services organisation has shown that nurse-assisted home haemodialysis is not only possible, but also very highly valued by the community. This vision needs to be built on by using existing government resources differently; dialysis needs to be decentralised, and provided out bush where people live. It is very likely that this option is not only better but also cheaper. It is not acceptable that in the absence of this option some of our people are choosing to die at home without life-saving dialysis treatment.

There have also been some encouraging signs recently in terms of improved access to renal transplantation for Aboriginal people, with more than 20 transplants in the NT last year. There is still a lot more improvement needed in this area because renal transplantation is the definitive treatment for End Stage Renal Failure, and allows people to live a full, active and healthy life once more. We know that a lot of dedicated people are working hard on this issue.

There has been a lot of work done to bring kidney disease in remote communities to the attention of governments. This work was distilled in the 2010 Central Australian Renal Planning Study.

Congress is very concerned by the refusal of the state and Territory governments to engage with the key recommendations of the Renal Planning Study. This is why we need stronger advocacy and political action. This is why we need the new Kidney Action Network.

There has been a failure to recognise and act on the fact that Alice Springs has to be the hub centre for delivery of services to people in most of the tri-state (NT-SA-WA) cross border desert areas, which rely on Alice as their natural, geographic, social and cultural regional centre.

The failure to provide serious support to the ‘Alice Springs hub centre’ concept means that many patients are still forced to move to Adelaide and Perth, which are too far from their families, communities, social life and cultural necessities.

Congress fully recognises the impact these planning and infrastructure failures have on individuals, their families and their communities. Congress also recognises that tri-state planning is not something that has ever been done well. This is a big challenge for our complex, federated system.

For the sake of the End Stage Renal Patients across the whole of central Australia, we have to get this tri-state planning right and ensure people are provided the right type of renal replacement treatment in their home communities. This must include nurse-assisted home haemodialysis. We also have to address the obesity and diabetes epidemic through effective prevention. We need to all join together through this new Network and make sure all the necessary changes are achieved.

Dr Merkes writes:

A team of medical researchers has recently issued another challenge to the still widely held view that animal research benefits humans. Dr Junhee Seok, together with 38 other medical scientists from across the US and Canada, published a study with the title “Genomic responses in mouse models poorly mimic human inflammatory diseases”  in the Proceedings of the National Academy of Sciences of the United States of America (open access).

The authors report on a systematic comparison of the genomic response between human inflammatory diseases and murine (rat and mouse) models. They looked at burns, trauma and sepsis (infection in the blood).

The mouse model

Mice are one of the most commonly used species in the laboratory. Because they share genes with humans, it is widely assumed that they provide useful models to research human diseases such as cancer, cardiovascular diseases and diabetes.

Compared to other animals, mice are small, relatively inexpensive, and easy to breed and keep. The use of genetically engineered mice who can mimic diseases has become quite common.

While the mouse is considered a good model by many biomedical researchers, others have questioned how well mouse models reflect the complex physiology of human disease.

What did the researchers find?

The researchers of the recently published study found that the genomic responses to different acute inflammatory stresses are highly similar in humans, but these responses are not mirrored in the current mouse models. The mouse immune system and the human immune system do not respond in the same way to stress. The researchers could not find more than a random association between the murine models and the human conditions.

Consequently, drugs that are beneficial to mice and rats may or may not work for the same conditions in humans. They may even be harmful.

The authors of the study conclude that their “study supports higher priority for transitional medical research to focus on the more complex human conditions rather than relying on mouse models to study human inflammatory diseases” .

Animal models are not useful to study human diseases

I have argued elsewhere that animal models are not predictive of human health. This is also the opinion of many experts in the field (see examples 1,2,3,4,and 5 )

Dr Andrew Knight, a European Veterinary Specialist in Welfare Science, Ethics and Law and Fellow, Oxford Centre for Animal Ethics, has recently published a book titled “The costs and benefits of animal experiments”  in which he reviewed over 500 scientific publications about the contributions of animal experimentation to human healthcare and the extent to which laboratory animals suffer. He concluded that actual human benefit is rarely – if ever – sufficient to justify the costs.

This new study about mouse models and inflammatory diseases provides further evidence for the problematic use of animals in biomedical research. But will it stop funding bodies to continue financial support for research that is so fundamentally flawed? Will it encourage researchers to change their long-held beliefs in the usefulness of animal models? Will it propel the general public to question the myth of animal experimentation leading to cures for common diseases?

There are alternatives to animal research. Initiatives such as the Innovative Methods and Alternatives to Animal Research Unit  at the John Curtin School of Medical Research, Australian National University, provide support to the research community in finding alternatives to using animals in biomedical research.

Dr Seok and his colleagues had tried to publish their findings in several journals. While the reviewers did not find fault with the paper, one of the authors reported that “the most common response was, ‘It has to be wrong. I don’t know why it is wrong, but it has to be wrong.’ . Long-held assumptions are difficult to let go.

A paradigm shift towards non-animal alternatives

We are seeing a paradigm shift  in biomedical research from using animals to using non-animal alternatives. Anomalies are appearing in the animal research paradigm with increasing frequency. Seok and his team have added to the body of evidence that highlights the anomalies. There is denial and disbelief from those working within the paradigm, as the above quoted response from the reviewers shows. It will be some time before the paradigm collapses and animal research will be a practice of the past. Until then, we must keep exposing its inadequacies.

Michael Moore writes:

The Premier of Queensland and his Minister for Health were quite upbeat about the launch of the “Blueprint for Better Healthcare”.  Although the argument was about patient centred healthcare, the framework of the launch was largely about economics.  The position is not hard to understand.  The LNP government is focussed on getting into surplus and health consumes more than a quarter of the budget.  The thinking is that if the services for patients can be delivered more efficiently, with less expenditure on overheads, there will be more money for frontline services.

After the opening speech by senior executive of Macquarie Capital – a major sponsor of the event – the two ministers emphasised the importance of reform in Queensland Health if the myriad of issues are to be managed effectively.

It is not surprising with an economic framework and the intention to move from “repair to recovery” that the issues were focused on hospitals, outsourcing to the private sector and key conservative values such as smaller government, lower taxation, better management and individual enterprise.  “We are not undermining public healthcare,” he stated, “we are finding innovative ways to deliver”.

The “Blueprint for Better Healthcare” is really a blueprint for better sickness care.  But politicians delight in talking in positive terms.  The Queensland Premier Campbell Newman and his Health Minister Lawrence Springborg were certainly upbeat on what they see as positives in health reform in their state.  In dismissing the protestors outside the $200 dollar lunch/launch Springborg provided a choice about either being “on his train” or “being under it”.  An interesting turn of phrase for a minister who has a choice himself about improving the care of people who have fallen underneath a locomotive or taking preventative action to stop people falling underneath it in the first place.

More than 500 people attended the lunch with private industry having an overwhelming presence.  And they were not disappointed.  Examples of services to be outsourced included pathology and radiation oncology.  But that is not enough.  More money for the private sector was in stark contrast to his attitude to grants to organisations which were often “little more than a gratuity”.  A portal will be established for the private sector to have better access to the bureaucracy “so they can negotiate the maze of bureaucracy” even though “we now have much less bureaucracy”.

In response to my question about the lack of prevention in the plan and how it contrasted with the sensible statements on obesity he had made that very morning in the Courier Mail, the Minister pointed out that he had a very wide portfolio and could not cover every issue in detail. However, the government was keen on encouraging individual responsibility recognising the level of obesity in Queensland.  Prevention should largely be the work of Medicare Locals however he was keen to work with them to deliver better primary health care.  Why?  He explained the Commonwealth failures at the primary health care level wound up his responsibility in the hospital system.

A close colleague of mine who sat with me at the Population Health Network table has recognised the importance of working with the elected government of the day – no matter where they are on the political spectrum.  Although she suggests the need to collaborate more and drip feed public health principles, I cannot help feeling that a rapid transfusion would be more efficient – providing better value for money.

My colleague had the following reflections on the launch:

In getting ready for my first official LNP function, I got dressed as corporately as I could. I pulled out the private sector high heels.  This is a new world order in Queensland.  “There’s a new train leaving the station” as Lawrence Springborg put it in his speech “and you can either be on it or under it”.  I was keen not to be under it!

Walking from the hotel carpark, I passed PSU and QNU protestors who included several of my former colleagues.  I probably knew more of them than the luncheon guests I was about to join.  But no point lamenting the past!  It is now time to get on board and work out how to work with this government for the health of Queenslanders.

I was adopting an optimistic approach and was keen to look for leverage points and understand how to speak the language of this government. After all the front page of our newspaper that morning headlined the minister’s possible plans to regulate the sale of junk food, perhaps acknowledging that solutions to the obesity epidemic lay beyond personal responsibility.

Wishful thinking!  There was none of that at this policy launch.  The premier first spoke of fiscal responsibility, returning the state to surplus, the failure of unions to responsibly represent their workers….  On health, he talked about outsourcing, co-sourcing, hospital in the home and the need for Queensland Health to return to its core business - ”looking after the sick”.

Lawrence Springborg spoke next.

The LNP’s “Blueprint for better healthcare” has six key values and a framework for delivery with four elements.  Prevention does not appear in the document.  The minister went on to speak about the alignment of the policy with core LNP values which included personal responsibility, small government and small bureaucracy.  He spoke with pride over the number of jobs cut from Queensland Health corporate office with a glint in his eye that even more cuts could be made.  He spoke about changing regulations to make outsourcing easier for health and hospital networks.

How interesting!  On the matter of obesity, he has chosen to invest in a hotline for one on one counselling – perhaps the easiest of the obesity strategy options to outsource - rather than tackle broader environmental determinants which often require less investment.  Reiterating issues from his speech to the Health Media Club he said there was no evidence of any previous investment in obesity prevention in Queensland actually working.  On this occasion he added that we were instead taking the WA Health approach , although there was no mention of any evidence of its effectiveness.

He spoke very little about Indigenous Health – around half a minute in the last few minutes of the talk – but he is interested in capacity building in this area.  Ironic given this is one of the workforces hardest hit by recent job cuts.

There were positives.  During question time he affirmed the government’s commitment to research and teaching irrespective of whether or not services are outsourced.  He announced an “innovation portal” through which he was keen to hear about ways in which the department could perform better.

Afterwards, those few of us with a population health background talked about the need to collaborate more and drip feed public health principles to the new administration.  We all had examples of how this had successfully been done in the past. 

The challenge in public health is to remain optimistic, defend areas that remain and look for opportunities to inform action in a collegiate, collaborative way.  Perhaps public health can even provide leadership.

Facebook is helping the Aboriginal Health and Medical Research Council of NSW spread anti-smoking messages to communities across the state.

The Aboriginal Health and Medical Research Council of NSW’s Tobacco Resistance and Control (A-TRAC) team created a Facebook page to help promote the Kick the Habit anti-smoking campaign. So far, the use of the social media site has delivered many benefits to the AH&MRC, it’s member ACCHSs and the communities they serve by helping to spread information about tobacco resistance and control, and encouraging Aboriginal people from communities across NSW to engage with the project.

Kick the Habit is a social marketing campaign funded by the NSW Ministry of Health that involves working with Aboriginal communities to develop resources that encourage members of the community to quit smoking. It is managed by the AH&MRC’s A-TRAC Program, which has the broad goal of reducing tobacco use among Aboriginal people by integrating tobacco control and smoking cessation activities into the Aboriginal Community Controlled Health Service (ACCHS) model of comprehensive primary health care.

Launched in 2011, the Kick the Habit Facebook page marked the AH&MRC’s first foray into social media. According to A-TRAC Senior Project Officer Summer Finlay, the Kick the Habit Facebook page has been an effective way of connecting with community members and workers in ACCHSs to help spread the anti-tobacco message.

“There are about 50 ACCHSs in NSW and we can’t go to every community as much as we’d like, so Facebook helps us maintain relationships, connect with communities and sustain a presence, despite not being able to be there physically,” she says.

Right from Kick the Habit’s inception, social media was a key component in the social marketing campaign’s overall strategy. In 2010, the AH&MRC began Phase One of the campaign, which was a pilot program involving six communities in NSW. During Phase One, these communities worked to develop resources to increase awareness of smoking cessation options and reduce the prevalence of smoking in Aboriginal communities. After the pilot project was complete, Kick the Habit Phase Two was initiated and the program was rolled out to three communities in NSW with active participation by the local ACCHSs. A film starring local role models was made specifically for each community, and a state-wide compilation film was generated from each of the three community’s films. The communities also created a number of additional resources, including brochures, banners and posters, as well as a range of print and radio advertising materials. All of these were tied together using Facebook as a promotional tool.

“Back in 2010, when we were planning Phase One, I don’t think there were many NGOs using social media to promote campaigns, or at least not that we were aware of,” says Finlay. “There was a bit of trial and error but we took what we learnt in that pilot phase and applied that to Phase Two.”

Those lessons formed the basis for a series of social media usage guidelines created by the A-TRAC team. “We had a look at what was working and what wasn’t, and we used that to create the guidelines,” Finlay says. “It was a bit of a learning curve, but it was important that we addressed concerns about things like privacy and security, as well as established what we considered to be boundaries for acceptable use of social media.”

Chief among the issues that had to be addressed was how to moderate the site, especially with regard to dealing with inappropriate comments and other material. According to Finlay, Facebook makes it managing the site simple by allowing administrators to specify keywords that moderate posts automatically, which meant that if a user tried to post offensive material it would be blocked instantly.

“I think Facebook has gotten quite smart with security in recent years, so if people use the inbuilt security controls properly, they shouldn’t encounter significant issues.” Finlay says.

“Another good thing about Facebook is that you can approve people as they add you to their network, which allows us to reject inappropriate friend requests,” she says. “This hasn’t been a major issue for us, but you do have to be aware all the time. For example, we did have an issue with someone trying to use our page to promote a quit smoking program for financial gain, so of course we blocked them.”

Finlay says that of the many challenges associated with using social media to assist with health promotion campaigns, sourcing the right content and finding the time and resources to manage social media effectively are at the top her list.

“Social media is time consuming,” she says. “You really have to put work into the overall look and feel of your page.”

Content is another issue, both the type of material posted and the frequency with which the Facebook page is updated. “Sourcing material to put up can be quite difficult, particularly finding content that is Aboriginal-specific,” Finlay says.

“Having good content is only half the battle,” she adds . “You’ve also got to get the timing right. We found that if you posted multiple things on one day, there was too much material appearing in people’s news streams and they were ‘un-liking’ us, which was counterproductive. With Twitter it is different because people use keyword searches and don’t care if you post multiple times a day, but Facebook users seem to be much more cautious about content.”

Finlay says the A-TRAC team found it was better to provide a steady stream of content rather than post a large amount of material at one time, an issue she addressed in the AH&MRC social media guidelines. She also says there was a some of initial reluctance on the part of ACCHSs to send in content, due largely to concerns about consent. “That’s changed now, thanks to some encouragement and hard work on our part,” Finlay says.

“The guidelines also really help, because they outline with how to use the page and explain what to do and what not to do,” she says.

Consistency is also of paramount importance. “You also have to make sure that if there are multiple people acting as administrators on the account that you all use it in the same way,” Finlay says.

“That was one of the bigger challenges we faced. We had several people who were administrators and it had to have a consistent feel – it’s the Kick the Habit page, not a page for team members to express their individual personalities.”

In October 2011, Facebook created Insights, which provides measurements on a page’s performance and includes anonymous demographic data about the audience, enabling those administering the site to see how people are discovering and responding to posts. The data provided includes statistics on the reach of content (how ‘viral’ it goes), as well as breakdowns of who is using the page according to gender and region.

“As long as you have more than 30 people engaging on your page during a week, Insights can give you quite a comprehensive breakdown,” Finlay says.

“In addition to information about who is using the page, and which town or city they’re from, we’ve found the gender statistics to be particularly useful. For instance, we learnt that there are a lot more females engaging with the program than the males, some 67% as opposed to 33% for men. This kind of feedback is invaluable both for planning future campaigns and tailoring our messages to ensure we reach our target audience”

Finlay’s advice to others in the health sector who might be looking to social media to help advance their health campaigns is very straightforward: plan ahead and be prepared to put in a lot of time to make your page successful.

“Everyone involved has to be really clear on what you’re trying to achieve with social media, because there has to be a high level of consistency in the look and feel, and most importantly in your communications with people,” she says.

“Once you have established your goals, you need to understand that running the site is going to take time. Everyone must be prepared to put in the effort that’s required to make it happen.”