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.

The Conversation recently ran a nine-part series examining the rise of antibiotic-resistant superbugs and what we can do to avoid a return to the pre-antibiotic age.

Frank Bowden, Professor of Medicine at Australian National University and Senior Staff Specialist Infectious Diseases at ACT Health, opened the series with a reflection on the history of hand hygiene and how poor compliance among Australian doctors is putting patients at risk:

Infections, like taxes, are inevitable (to paraphrase Benjamin Franklin). Most are acquired in the community and the dangerous ones are, in the main, very difficult to prevent. But many infections are preventable and, regrettably, most of these occur as a consequence of hospitalisation.

It has been estimated that around 180,000 hospital-acquired infections occur in Australia each year and these infections result in almost two million additional days in hospital.

About ten years ago, health systems belatedly acknowledged that the means of reducing the transmission of infection in hospitals was right before our eyes: on our hands, to be precise.

Read the full story here

**

John Iredell, NHMRC Practitioner Fellow and Head of the NHMRC Centre for Research Excellence in Critical Infection at University of Sydney, looked at the battle between naturally occurring and antibiotic-resistant bacteria in human ecology:

At the beginning of the 20^th century, around one in three children in countries such as Australia and the United States died of infection before the age of five. But since Howard Florey first described the power of penicillin in 1947 and antibiotics became widely available, we have come to expect that life-threatening bacterial infection can be easily managed.

Early antibiotic therapy still means the difference between life and death for a previously healthy young person with a severe blood infection. However, we have long known that bacteria can quickly adapt to overcome the antibiotics that used to kill them. These antibiotic-resistant bacteria are often referred to as “superbugs”.

Read the full story here

**

Trent Yarwood, Infectious Diseases Physician at Queensland Health and Associate Lecturer at University of Queensland, discussed the drivers of antibiotic resistance:

Antibiotic resistant bacteria are becoming a major problem. Calls to action on increasing rates of resistance have been made by the World Health Organization, the US Centers for Disease Control (CDC), and by the Australian Societies for Infectious Diseases (ASID) and the Australian Society for Antimicrobials (ASA).

And the media regularly features articles about superbugs and mega-superbugs. So why, if everyone is aware of the problem, are we still not winning the fight?

Antibiotic resistance is caused by excessive antibiotic use. If bacteria aren’t exposed to antibiotics, there’s no impetus for them to become resistant. But much modern medicine would be impossible without antibiotics (most surgery, for instance) so they are a necessary “evil”.

Read the full story here

**

Darren Trott, Senior Lecturer of Veterinary Microbiology at University of Adelaide, outlined the hunt for superbugs in Australian livestock and companion animals:

Australia has some of the world’s most conservative restrictions on using antimicrobial drugs in livestock. Possibly as a consequence, we have some of the lowest rates in the world of antibiotic resistance in the bacteria (such as Salmonella and Campylobacter) that cause food poisoning.

Australian producers do not use broad-spectrum antibiotics such as fluroquinolones or gentamicin in livestock production. The antibiotic ceftiofur is governed by strict label requirements.

However, Australia is increasingly importing fresh food, including vegetables, from countries where these antimicrobial drugs are used indiscriminately in both animals and humans. Australia’s primary producers are under great pressure. They have to compete with cheap imported products that are often of inferior quality and may come from countries where the use of antibiotics in livestock is not so tightly regulated.

Read the full story here

**

Bernd Becker, Senior Research Officer at University of Queensland and Matthew Cooper, Professor, Institute for Molecular Bioscience at University of Queensland, examined the strongest of the superbugs and the forgotten antibiotic that can fight them:

New Dehli metallo-beta-lactamase 1, or NDM-1 bacteria as they’re commonly known, are among the most dangerous superbugs to have emerged in recent years. They’re resistant to almost all the antibiotics we’ve discovered to date.

NDM-1 was first described in 2009 in a Swedish patient who’d been in New Dehli, India. It’s a gene that can be transferred between bacteria, which allows them to produce a very powerful enzyme that destroys what was previously our last line of defence – the carbapenem antibiotics (distant cousins of penicillin that were the last standard antibiotics still able to kill some of the earlier superbugs).

Now there’s only one antibiotic left that really works against this new generation of superbugs – a forgotten antibiotic called colistin.

Read the full story here

**

Matthew Cooper, Professor, Institute for Molecular Bioscience at University of Queensland and David Shlaes, Anti-Infectives Consulting, looked at the issues blocking the antibiotic development pipeline:

Most experts considering the subject agree that the antibiotic development pipeline is not sufficient by a long shot. The days when there was always a new antibiotic just around the corner to treat the latest superbug are long gone.

Still, fixing the antibiotic pipeline is not rocket science. The main difficulty lies in finding molecules that enter the bacterial cell, stay there and inhibit growth of the bug without being toxic to us. What prevents us from overcoming this difficulty is that the number of people working on the problem has shrunk to historically low levels.

Read the full story here

**

Marc Pellegrini, Researcher at the Walter and Eliza Hall Institute, pondered what we could learn from the past to avoid a future with no useful antibiotics:

History not only shows us our errors but also predicts our future. So, we don’t need to speculate about what a world full of superbugs and useless antibiotics would look like, we just need to recall the pre-antibiotic era (before the 1930s).

Our trajectory into the past is compounded by an ageing population that’s more susceptible to infections, overcrowded hospitals where infected and uninfected patients share facilities, a complacency toward basic hygiene principles and globalisation and its attendant increase in medical tourism that provides a free flight for any superbug seeking a new home.

Read the full story here

**

Dyani Lewis, Sexual health researcher at University of Melbourne, examined the possibilities of poo transplants to restore balance in gut ecosystems:

Antibiotics joined our growing arsenal of weapons in the fight against disease over seventy years ago. Their target – the bacterial infections that putrefied our wounds, filled our lungs with pneumonia, and made our genitals less than appealing to our lovers. Bacteria were worthy opponents, and with antibiotics, the war against infection seemed ours to win.

But gradually, two facts have become abundantly evident. The first is that not all bacteria are foe. There are billions of bacteria – many of them essential to our health – that call us home. We’re each colonised by trillions of microbes forming communities that occupy every imaginable niche in our body.

Read the full story here

**

Mark Butler, Senior Research Fellow at the Institute for Molecular Bioscience at University of Queensland and Matthew Cooper, Professor, Institute for Molecular Bioscience at University of Queensland, concluded the series with a look at what new and improved antibiotics are in the pipeline in the fight against superbugs:

Bacteria are one of the most successful colonisers of the planet. They can be found in almost all environments we know – from the deepest oceans to acid lakes, and inside and on our bodies. And the history of medicine is the struggle to defeat them.

One of the reasons for the success of bacteria is their rapid growth (some divide every 20 minutes) and ability to quickly mutate and exchange their genetic code (their DNA). These factors facilitate rapid evolution, which today has led to the emergence of drug resistance in bacteria. These bacteria eventually evolve into multi-drug resistant (MDR) bacteria, or “superbugs”, that are almost impossible to control. Some bacterial infections are so difficult to eradicate that amputation is the only option available to physicians.

Read the full story here

**

A reminder to Croakey readers that TC articles are freely available for republishing under a Creative Commons license.

Thanks to The Conversation’s Health + Medicine intern Georgina Scambler for collating this wrap. 

A young woman from Papua New Guinea has sought treatment at Cairns Base Hospital for extensively drug-resistant tuberculosis (XDR-TB), a  difficult and expensive disease to treat. After five months in isolation, she is likely to stay in hospital care for the next two years, and her chances of  being cured are frighteningly low. Patients with drug-resistant TB must endure a long course of treatment (24 months or longer) with harsh side effects, such as permanent hearing loss and temporary psychosis.

Treatment for one case of XDR-TB can cost $500,000 to $1 million, with no guarantee of cure. Our methods of treatment and control for TB are not sustainable in the face of highly drug-resistant TB that is as transmissible as drug-susceptible strains; investments must be made into better solutions.

New vaccines, drugs and diagnostics are urgently required to ultimately eliminate one of the world’s oldest and deadliest infectious diseases. Unlike other major diseases such as HIV and malaria, TB is transmitted via airborne particles, complicating infection control measures. TB spreads through air just like the common cold and most people are completely unaware when TB exposure occurs. Although treatable, the TB germ is becoming more deadly as it evolves to dodge our current medicines.

In 2011, there were an estimated 78,000 cases of multidrug-resistant TB (MDR-TB) in the Western Pacific Region. From 2001-2010, 59 cases of MDR-TB have been diagnosed by the Cairns Regional TB Control Unit, which encompasses Far North Queensland and Torres Strait. XDR-TB has been reported in 84 countries. The World Health Organization estimates that each year there are 440,000 new cases of MDR-TB globally. Last year, only 13% of these patients were diagnosed and enrolled in treatment. This means hundreds of thousands of people worldwide are going untreated and continuing to spread drug-resistant forms of the disease. India has now reported TB cases so difficult to treat that some have labeled them totally drug-resistant TB (TDR-TB).

MDR-TB continues to be a threat to Australia’s citizens who work or travel throughout the region. Eleven countries in the Asia Pacific region – Afghanistan, Bangladesh, Cambodia, China, India, Indonesia, Myanmar, Pakistan, the Philippines, Thailand and Vietnam – are among the 22 countries that carry 80% of the global TB disease burden. Each report high rates of drug-resistant TB. Last year, MDR-TB reached crisis levels in Papua New Guinea, inciting former Health Minister Jamie Maxtone-Graham to pronounce it a greater health emergency than HIV/AIDS. Australia’s aging population and high numbers of people with chronic health conditions increase our vulnerability as a nation.

Vaccines are one of the most cost-effective tools in the fight against infectious diseases. There is broad consensus that the development of an
effective TB vaccine is a key global health priority. Twelve TB vaccine candidates are currently in clinical trials and research groups within
Australia are leading the development of additional promising candidates.

We applaud the Australian government for the time and effort spent developing AusAID’s  Medical Research Strategy for the Asia Pacific region. A contribution of $10 million for malaria research highlights the Australian government’s commitment to lead through innovation. We hope that there is a similar vision for funding research and development of new tools to fight TB. We are especially glad that TB vaccines have been included in the Medical Research Strategy. Vaccine research and development is a lengthy process involving large-scale clinical trials with thousands of
participants over multiple years. Australian participation alongside other donors in funding the TB vaccine development effort would help accelerate progress, and build on AusAID’s leadership role in tackling the Asia Pacific region’s major health challenges.
Jamie Triccas is Associate Professor and Head of the Microbial Pathogenesis and Immunity Group, Department of Infectious Diseases and Immunology at the University of Sydney. Ben Marais is Deputy Director and Patrick de Burgh Associate Professor at the Sydney Institute for Emerging Infections and Biosecurity, University of Sydney.

It estimates that globally there were 201,200 respiratory deaths (range 105,700—395,600) with an additional 83,300 cardiovascular deaths (46,000—179,900) associated with the pandemic. Eighty per cent of the respiratory and cardiovascular deaths were in people younger than 65 years and 51 per cent occurred in southeast Asia and Africa.

The study has been widely reported, with a variety of headlines.

But as Dr Julie Leask, Senior Lecturer in the School of Public Health at the University of Sydney, reflects below, media audiences may have received quite different impressions about the import of the findings depending upon how they were framed.

***

Making sense of the news about the swine flu toll

 Julie Leask writes:

This morning, mainstream media reported on a story about the number of deaths worldwide from the 2009 influenza pandemic.  The story nicely illustrates how the shape of the influenza beast can vary, depending on the perspective.

A person could make the death toll sound very alarming or trivial. And each statement could be true – just framed differently.

When thinking about how to summarise this story into a tweet, I was struck by my options.

Option 1 – ignore the whole thing. Most people will opt for this but they are also making a choice.

Option 2 – use the Sydney Morning Herald’s own headline “Swine flu death toll revised to nearly 300,000 people”

Option 3 – re-tweet the headline from the ABC World Today’s report: “Experts say swine flu death toll 15 times higher” 

As a headline, this one is designed for effect. It gives audiences an impressive measure of pandemic-caused deaths relative to lab confirmed influenza-based estimates, but nothing absolute (to be fair, the contents of the report gave these).

There were at least two more options: the first appeals to those, like me, who see influenza as a disease that is under-estimated and wish to emphasise its seriousness:

Option 4 – “The flu pandemic killed up to half a million globally”, which would be loosely based on The Lancet Infectious Diseases article’s upper estimate of total deaths taken from here:

We estimated that 151 700–575 400 respiratory and cardiovascular deaths associated with 2009 pandemic influenza A H1N1 occurred during the first year of virus circulation in every country in the world.

Option 5 might appeal to those who think the pandemic was a beat-up: “Death toll from the pandemic similar that from yearly influenza.”

By its co-location with seasonal influenza, it would make the pandemic look more ordinary and banal. It would ignore the disproportionate impact on younger people and hence the more than tripling of years of life lost (9 707 000 years) compared with seasonal influenza (2 841 700 years).

All these options, while true in some way, portray the problem differently and are likely to generate different responses in audiences.

They illustrate a more general phenomenon: that all humans make choices in how they select and respond to risk information.

The idea that some simply report facts is called “naïve realism”. The choices that sub-editors make in writing their headlines reflect differing intentions.

And our choices as tweeters  – what we re-tweet and what we write – will reflect our knowledge, experiences, feelings, and goals.

It is therefore intriguing when journalists and others convey the notion of simply reporting “what is out there”, as if they did not screen out, keep in, choose who to quote and how, and what words and images to assign to things.  It’s something we noticed in our study of how journalists select and shape news stories.

We were surprised by this view, given the widely acknowledged phenomenon of framing. In the lingo of journalists themselves, a story can have many angles.

With the pandemic influenza story, we are looking at a complex beast where there are many different ‘truths’. Influenza experts themselves talk about a ‘double truth’: yes, the pandemic looked like a regular influenza season in many ways; no, it affected young adults much more.

Representing disease burden is a tricky business, as illustrated by the ‘pertussis elephant’.

Here, an elephant is surrounded by blindfolded men. Each man is feeling a different part of the elephant – the tail, the trunk, the foot, the flank. Each part represents different ways of counting how many are affected by pertussis (whooping cough): culture, clinical symptoms, serology and PCR. Each method is imperfect but helps to build a picture of the overall shape of the thing.

Like pertussis, influenza is a disease which can be serious and sometimes devastating. It can also be unproblematic and transient.

Different people will have different angles on it. Some angles will be completely erronenous, or truth will be watered down to homeopathic proportions. But most will represent a part of it as best they can, albeit imperfectly.

The Sydney Morning Herald online article, written by a journalist from Agence France-Presse, did a little of this – it gave enough information to show us the multiple perspectives – yes influenza killed many people, yes, assessing mortality is difficult and yes, mortality figures were similar to seasonal influenza.

Medical journalists tend to report such stories better than generalist journalists because they have cultivated a more trusting relationship with experts, have established some technical knowledge, and greater understanding of the nuances. They may also be able to advocate for a more reasonable headline.

Hence, with all the changes to mainstream media, including big staff reductions, it would be deeply concerning to see specialist reporters threatened with extinction, with their greater capacity for quality reporting and making sure the complexities are not ignored when reporting on stories like the influenza pandemic.

 ***

PS From Croakey

As an addendum to Julie Leask’s final point – perhaps this article is a reminder to all of us involved in communicating – whether as researchers, journal editors, clinicians, policy makers, advocates, marketers, journalists, sub editors, bloggers, tweeters and others – to be reflective about the framing we choose. It matters.

***

• For further reading on influenza, see these stories at The Conversation.

Can Australia manage similar?

The NPS is hoping so – as you may have heard, it has launched a campaign using social media and mainstream media to engage the wider community in tackling inappropriate use of these drugs.

(And on Thursday, the Chair of the NPS Board, Dr Janette Randall, is scheduled to address the National Press Club in Canberra  on: “Back to the future: life without effective antibiotics”. More details at bottom of post.)

 ***

Dr Lynn Weekes, CEO of the NPS, writes:

It’s hard to believe that before the discovery and use of antibiotics, an infection from something as simple as a scratch had the potential to kill.

It’s even harder to believe that we might be returning to an era where bacterial infections could again kill unabated – but this is fast becoming a reality. There is a real chance that 2030 will be like 1830 when it comes to management of simple infections.

The message is clear — the world is running out of effective antibiotics.

And if we don’t act now to combat the development and spread of antibiotic-resistant bacteria, we could find ourselves in very dangerous territory, with a plethora of hard-to-treat illnesses causing serious complications, or even death.  The World Health Organization has labelled antibiotic resistance as one of the greatest threats to human health today.

Click here to view the embedded video.

Research recently conducted by NPS found many Australians are still in the dark when it comes to antibiotic resistance and its causes. In a survey of over 1000 respondents, 40% didn’t know taking antibiotics when you don’t them increases antibiotic resistance, and only 40% knew you should not take antibiotics for viruses.

It’s this lack of knowledge which contributes to consumers taking antibiotics with a sense of complacency. But taking them ‘just in case’ even if they’re not really required is more likely to be damaging than not taking them at all.

The research by NPS also indicates that we often go to our GP expecting antibiotics, with 1 in 5 respondents saying they expected their GP to prescribe them for themselves or their child for a cough or cold.  When asked if they expect to be prescribed antibiotics for an ear, nose, throat or chest infection, this number jumped to almost 4 in 5 (79%).

It turns out we’re also not shy when it comes to asking for antibiotics, with more than half of respondents (51%) saying they would ask their GP to prescribe antibiotics when they have an ear, nose, throat or chest infection. Requests for antibiotics to treat their child’s cold or cough were double that of parents asking for one themselves (14% vs 6%), with fathers more likely to ask than mothers (22% vs 9%).

The global misuse and overuse of antibiotics has driven us to the edge of the cliff in our ability to treat bacterial infections. This is why NPS is launching the consumer phase of its new 5-year campaign to tackle antibiotic resistance in Australia.

The overall goal is to reduce the incidence of antibiotic prescribing by 25%, which would bring Australia in line with the OECD average of defined daily dose of antibiotics per capita/per day.

The good news is that if we can curb our use of antibiotics, we can reduce bacterial resistance to antibiotics. The actions of every individual makes a difference to the future of our children.

The NPS campaign will encourage all Australians to sign up via Facebook and become antibiotic ‘resistance fighters’, pledging to take some simple actions to fight the increase and spread of antibiotic-resistant bacteria in the community.

Resistance fighters are everyday Australians who don’t expect antibiotics for viral illnesses, such as colds or the flu, who take antibiotics exactly as directed by their doctor when they are prescribed them, and who practice good hygiene to help stop the spread of germs.

If 35,000 Australians sign up to join the fight against antibiotic resistance, this would help put us on the right track to reducing Australia’s antibiotic use in line with the OECD average.

The mass media component of the campaign will feature advertising and community service announcements on television, in print and online, to raise awareness of the issues regarding antibiotic resistance.

This will be supported by a number of consumer interventions to help change attitudes and behaviours towards antibiotic use, including a new antibiotics iPhone app (launching next month) which helps people who have been prescribed antibiotics to take them exactly as directed (dose, frequency and duration) and allows users to track their daily health.

Running alongside this is the campaign for health professionals, providing a number of resources and interventions for GPs, pharmacists, nurses and others to promote use of best-practice guidelines for URTIs, encourage symptomatic management of colds and the flu, and to facilitate better patient communication when discussing antibiotic resistance and correct use of antibiotics.

A similar effort was first launched in Sweden in 1994, followed by a number of comprehensive campaigns to address the misuse of antibiotics. The result was a 22% reduction in antibiotic prescribing between1993 and 1997. In 2010, a study showed that 78% of the Swedish population is willing to abstain from antibiotics.

If we could achieve a similar result in Australia, it would have a great impact on reducing antibiotic resistance.

***

• To reserve tickets to hear Dr Janette Randall, chair of the NPS Board, at the National Press Club in Canberra on Thursday 26 April, visit here or phone the National Press Club on (02) 6121 2199.

It is about the push for treating “preconditions”, the subject of a talk given recently by Dr Ivan Oransky, the executive editor of Reuters Health, at a recent TEDMED conference in Washington DC on technology and medicine.

Meanwhile, in other parts of the world, many people miss out on potentially life-saving treatments. One such example is Chagas disease, which affects millions of people in the Latin American region. The CDC has declared it one of a group of neglected parasitic infections.

According to Médecins Sans Frontières (MSF), it is transmitted by blood sucking insects that live in cracks in the walls and roofs of mud and straw housing, common in rural areas and poor urban slums in Latin America.

People can be infected but show no chronic symptoms for years. Debilitating and sometimes life threatening chronic symptoms develop in approximately 30 per cent of people infected. Chagas can cause irreversible damage to the heart, oesophagus and colon, shortening life expectancy by an average of ten years.

In an article commemorating International Chagas Day (which was Saturday, April 14,) Dr Unni Karunakara, international president of MSF, outlines some of the achievements – and remaining challenges – in tackling this “silent disease”.

***

Much more needs to be done to put this silent, neglected disease on the agenda

Dr Unni Karunakara writes:

The fight against Chagas – a tropical parasitic disease that affects between eight and ten million people in Latin America – has seen major advances in recent years.

This is good news for sufferers of the neglected disease, and also for Médecins Sans Frontières, as we have been working on improving access to existing medicines for Chagas, and have been advocating for more research and development into its treatment.

The latest advance was announced last month, when Argentina became the second producer of benznidazole, the main drug used to treat Chagas, thanks to a joint effort between the Argentinian Ministry of Health and the NGO Fundación Mundo Sano. This was the latest in a series of breakthroughs in the battle against the disease.

Demand for treatment has increased significantly in recent years, as more adults are now being treated, in addition to children. New medical evidence has also shown the benefits of benznidazole for patients at the chronic stage of the disease. Meanwhile, the Pan American Health Organization (PAHO) has issued two resolutions on Chagas disease, with a focus on screening and treatment.

Last year we received encouraging news when a new paediatric dosage of benznidazole was registered in Brazil, a development supported by the Drugs for Neglected Diseases Initiative. Before this, there was no specific formulation adapted for children, even though the recovery rate from Chagas treatment is higher in minors.

Other developments are underway: Médecins Sans Frontières and the World Health Organization are involved in a joint study to simplify diagnosis with rapid tests. If the results are positive, it will be possible to scale up screening among pregnant women and in remote communities affected by Chagas.

These are all significant steps. However, as we mark International Chagas Day on 14 April, we need to remember that there is still a long road ahead in the struggle to put this silent and neglected disease on the agenda.

More policies, more funding and more investigation are all needed if we are to prioritise the health of Chagas sufferers.

Chagas programmes across Latin America currently depend on a single laboratory to produce benznidazole – the Brazilian public laboratory LAFEPE (Laboratorio Farmaceutico do Estado de Pernambuco) – as Argentina has not yet started producing the drug for export.

Having only one producer causes supply risks, as we saw last October, when a shortage of the drug and the threat of stock ruptures forced Médecins Sans Frontières to suspend the opening of new Chagas projects in Bolivia and to reduce its diagnosis of new patients in Paraguay over a period of time. To this day, supply is still not guaranteed in several countries.

Although we welcome the announcement that benznidazole will also be produced in Argentina, as a step toward overcoming the vulnerability caused by having a single manufacturer, this news should not overshadow the fact that there is a huge need for research to find new drugs.

Benznidazole and nifurtimox, the other drug used to treat Chagas, were developed more than 40 years ago and, while manageable under medical supervision, they can also have side effects.

There is also a major need for a ‘test of cure’, to confirm the parasite has left the patient’s body after treatment. Without such a test, it can be difficult to convince people to be treated, while for patients it can be hard to live without knowing if the treatment was successful. A test of cure would also allow the effectiveness of new medications to be evaluated.

At present, there are few ongoing initiatives designed to find a test that could confirm a cure sooner, while the long-term investment and commitment needed to achieve this are absent.

The lack of effort to fight Chagas threatens the lives of millions of people around the world who are living with this disease without even knowing it. The symptoms can take years to develop, but once the disease has become chronic, it can cause serious heart and digestive problems that may be fatal. Chagas causes about 12,500 deaths every year.

Pamela, a patient at a Médecins Sans Frontières clinic in Cochabamba, Bolivia, was unaware that she had the disease, and transmitted the parasite to her two children. “When the health centre confirmed that the three of us were positive [for Chagas], I broke down and cried because my children – the only family I have – were sick, and it was my fault,” she says. Pamela’s story is repeated in rural areas all over the continent.

Luckily, she and her family were able to get free treatment at a Médecins Sans Frontières clinic. But thousands have no opportunity to be diagnosed and treated for the disease.

In 2009, on the centenary of Chagas’ discovery, Médecins Sans Frontières launched its ‘Breaking the silence’ campaign to raise awareness about the disease and to call on governments to prioritise access to diagnosis and treatment for those affected.

While advances have been made since then, today we are faced with the need to repeat this appeal. Until Chagas has stopped being the ‘silent disease’, we must continue to make a noise.

• Dr Unni Karunakara is international president of the medical humanitarian organisation Médecins Sans Frontières.

In the article below, Daniel Reeders, a senior project worker in multicultural HIV, sexual health and viral hepatitis prevention in Melbourne – and blogger – reflects upon the legacy of the campaign over the past 25 years.

***

What did the Grim Reaper teach us?

Daniel Reeders writes:

In April 1987 I had just turned six. I was far too grown up for Play School, and my television memories from this time are Mary Delahunty reading the ABC news, and the Grim Reaper. Quite a contrast — Mary was much better coiffed and dressed.

But I loved the Grim Reaper ad, too. It was by far the weirdest thing I’d ever seen;  I found it thrilling — a mini horror movie before bed.

Click here to view the embedded video.

The iconic campaign was developed by Eighties ad man, Siimon Reynolds, for NACAIDS.  It turns 25 this week.

At six, of course, I had no idea what the ad was about.  In the years to come I received comprehensive, whole-of-school sex education, including contraception — all at Catholic schools.  I’m guessing the apocalyptic tone of the ad scared the parents and teachers in our school community enough to cut through traditional barriers.

In 1996, the year I came out to myself as a gay man, a team led by Dr David Ho announced the discovery of effective combination therapy.  This effectively ended the AIDS crisis in the developed world.  It marked a shift in thinking from dying of AIDS and living with HIV.  For his troubles, Time made Dr Ho its Man of the Year, and for everyone not in a risk group, HIV faded from public view.

In my late teens I thought everyone should just use condoms until the last person with HIV died out.  Using condoms came easily to me, so I couldn’t see how could it be so hard for everyone else.  Then I dated a lovely man, safe sex all the way, and after we broke up, in the middle of a fight, he told me he was positive. Seeing his pain up close really shook me up.  It changed how I think about safe sex — from a strategy of self-protection to a way of living with others in mixed status community.

In 2004 I began work as a health educator at the Victorian AIDS Council.  The agency was under intense pressure and it was not a happy place to work.  Since 2000, there had been small increases in the number of new diagnoses each year.  In mainstream and gay media outlets, commentators claimed prevention was failing and laid the blame on the AIDS council.

Against the evidence they suggested it was reckless young gay barebackers who were getting infected.  Activists who had protested the Grim Reaper campaign could now be heard calling for a new fear campaign to scare these young men into taking HIV seriously.  That was the Reaper’s first legacy, in my view: a new sense of crisis occasioned a new call for fear appeals.

Herein lies the dirty truth about fear campaigns: people want them, but only to scare ​other people.  Asked if they find the ads frightening or persuasive ​themselves​, they demur.

A synthetic meta-analysis by Witte & Allan (2000) showed that actually inducing fear is a tricky business.  If audience members are genuinely frightened and doubt their ability to avoid the threat, they react with denial and avoidance, not behaviour change.  The approach backfires among the people who need it most.

The Reaper’s second legacy lay in the odd locution, “always use a condom–always.”  In fact, even as the ads went to air, researchers on the Social Aspects of Prevention of AIDS (SAPA) study were collecting data that would show gay men using HIV testing in relationships to make sure both partners had the same status before they stopped using condoms.

Risk reduction strategies like this one aren’t perfect, but their partial protective effect is well established in research, and they help bridge the gap between the ideal of 100% condom use and reality.  Commentators demanding a return to condom reinforcement by fear campaigns overlook the simple fact that, at the height of deaths from AIDS, gay men still had unprotected sex — for intimacy, love and community.

I think the ultimate legacy of the Reaper is not in prevention, but politics.  As the historian Paul Sendziuk argues in his book ​Learning to Trust​ (2003), the Grim Reaper campaign generated widespread public support for policies and strategies Sir Humphrey Appleby might otherwise have described as ‘courageous’.  They funded affected communities to develop targeted, relevant, funny, ​sexy​ campaigns and resources that acknowledge both risk and pleasure.  Like this one from ACON sending up the Grim Reaper ad itself:

Click here to view the embedded video.

Yet political courage has been known to wane.  As a post-mortem by Bernard, Kippax & Baxter (2008) showed, HIV rates rose in Victoria and Queensland after they cut HIV funding in the late 1990s, and remained stable in New South Wales, which maintained it.

There are signs that a rejig of Commonwealth funding will leave HIV competing with hepatitis B & C — both serious epidemics in their own right — for the same pool of money.

So maybe it’s time for a sequel — how does ​Bride of the Grim Reaper​ sound?  (Siimon, let’s talk.)

• Daniel Reeders is a senior project worker in multicultural HIV, sexual health and viral hepatitis prevention in Melbourne.  He has previously been Health Educator at the Victorian AIDS Council/Gay Men’s Health Centre and Campaign Coordinator at People Living With HIV/AID Victoria, as well as a member of the Victorian Government Department of Health Ministerial Advisory Committee on GLBT Health and Wellbeing (2008-2010).  He writes a blog on HIV stigma and prevention strategy at http://badblood.wordpress.com.

This post is a personal opinion and does not reflect the position of his employers.

References

Witte, Kim, and Mike Allen. “A Meta-Analysis of Fear Appeals: Implications for Effective Public Health Campaigns.” Health Education & Behavior 27, no. 5 (October 1, 2000): 591–615. Online abstract: http://heb.sagepub.com/content/27/5/591.abstract

Bernard, Diana, Susan Kippax, and Don Baxter. “Effective Partnership and Adequate Investment Underpin a Successful Response: Key Factors in Dealing with HIV Increases.” Sexual Health 5, no. 2 (June 2008): 193–201.  Online abstract: http://www.ncbi.nlm.nih.gov/pubmed/18686337.

Sendziuk, Paul. ​Learning to Trust.​  2003.  Sydney: UNSW Press.

Kippax, Sue, Connell, R.W., Dowsett G.W., and Crawford, J. Ch 4 “The SAPA Project”, in ​Sustaining Safe Sex​. 1993.  London: Routledge.

In the article below, Dr Marianne Gale, a TB and HIV Advisor for Médecins Sans Frontières, describes the terrible toll that this disease is taking upon people around the world.

(Update, 26 March: And more on related themes from other MSF doctors in this PLoS blog, Zero MDR-TB deaths in children in my lifetime?)

 ***

An urgent plea for help on World TB Day

Dr Marianne Gale writes:

As we mark another World TB Day and the 130^th anniversary of the discovery of the tubercle bacillus by German physician Robert Koch, there is little reason to celebrate.

The global crisis of tuberculosis sadly continues, its scale only expanding as most governments and donors sit idly by.  This emergency is only exacerbated by the increase in the deadlier form of the disease, the strain of TB that does not respond to the regular drug regimen, multidrug resistant TB (MDR-TB).

In light of new data collected by Médecins Sans Frontières, it is alarming to note that there is little being done to avert a health emergency.

We are finding MDR TB in shocking numbers, notably in new patients, suggesting the crisis is much larger than had been thought. In South Africa for example, our teams have seen a 211 percent increase of TB diagnosis per month in our clinic in KwaZulu Natal following the introduction of a new rapid diagnostic test. Of those patients confirmed, 13.2 percent were resistant to the drug rifampicin, one of the most effective drugs for treating TB.

As my colleagues from Médecins Sans Frontières and I see on a daily basis, MDR-TB takes a horrific toll on a patient. A persistent cough, fever, weight loss, chest pain and breathlessness will ultimately lead to death if the right treatment is not administered.

There are currently an estimated 650,000 people living with MDR-TB worldwide. Shockingly however, around 90 percent of these patients have absolutely no access to treatment.

Access to this treatment is now hanging even more on tenterhooks. The recent cancellation of Round 11 of the Global Fund to Fight AIDS, Tuberculosis and Malaria has left millions of patients suffering from these diseases in dire circumstances. Its role is paramount: the Global Fund is the leading international funding mechanism for TB, supporting over 80 percent of international commitments for TB treatment.

Practically, this means that no new grants for eligible countries are available, and therefore treatment cannot be increased. The final consequence of this is that many governments will not have the resources to tackle epidemics at a rate that can keep up with the spread of this deadly epidemic.

In Australia’s own backyard, in Myanmar, we are seeing MDR TB on an enormous scale. It is estimated that there are 9300 cases every year, and so far, just over 300 patients in total have received treatment. Myanmar’s five year plan to reach a further 10,000 people living with the disease has been seriously undermined with the Global Fund cuts.

Little medical advance to celebrate

For those who can access it, a mere ten percent of patients around the world, existing treatment remains extremely outdated and hugely expensive. The drugs that were developed decades ago are highly toxic and have to be taken for up to two years. Patients must endure intolerable side effects including extreme nausea, vomiting, loss of appetite, mental health deterioration and fever.

On top of this, we fear that current statistics may only be scratching the surface of the problem. Diagnostic tools are also extremely outdated, and we know for example that 95 percent of TB patients worldwide lack access to proper diagnosis. Thousands of patients are therefore not receiving the treatment they urgently need.

To control drug resistance, the issue of incorrect treatment and the availability of over-the-counter prescription drugs must be tackled. Although drug resistance is a man-made problem, it can be turned around with the implementation of approaches recommended by the World Health Organisation and stricter control of drug availability on the private market.

We urgently need increased access to diagnostics and treatment. New drugs and shorter and less toxic regiments are desperately needed. For this, funding is vital. The cost per patient is between US4,400 and US9,000 for treatment, clearly a price that is out of the reach of many in developing countries.

Every day, the tragic consequences of this disease are faced by thousands of patients globally.

World TB Day provides a timely reminder that governments, international donors and drug companies must immediately step up their commitment to fighting the spread of this disease.

As thousands of patients run out of breath, this crisis needs to be addressed before we run out of time.

• Dr Marianne Gale is a TB and HIV Advisor for Médecins Sans Frontières, based in Sydney

In the article below, Professor Lyn Gilbert, an infectious diseases physician and clinical microbiologist with a strong interest in preventing healthcare-associated infections, provides some of the wider historical context.

***

Making sense of hand hygiene data

Lyn Gilbert writes:

The MyHospitals website posted hand hygiene compliance data, by hospital, for the first time, on March 6^th. It’s interesting reading but easily misinterpreted without some background. Hand hygiene is a simple concept but compliance data are complex.

Everyone knows (more or less) that hand hygiene by healthcare workers can prevent transmission of germs and reduce infections – and the more the better.

A quick survey of MyHospitals data from 22 large public hospitals (with more than 500 beds), in all states, shows reported compliance rates between 61% and 83%.

The national benchmark is 70%, but many believe it should be higher. What do these rates actually measure and why is the benchmark not 100%?

Although most people accept the concept that hand hygiene can reduce infection risk, there are widely differing views about when and how often it is necessary.

The concept goes back at least to the mid-19^th century and predates the germ theory of disease. At the Vienna General Hospital, the professorial assistant in Obstetrics, Ignác Semmelweis, was troubled by the fact that women whose babies were delivered in the clinic staffed by doctors and medical students were three times more likely to die from childbed fever than women admitted to the midwives’ clinic.

The only significant difference between clinics was that medical students, but not midwives, performed autopsies on women who had died from childbed fever. Semmelweis suspected that they carried “cadaverous particles” on their hands to the women in labor, thus spreading infection. He ordered the students to wash their hands in chlorinated lime (calcium hypochlorite) when they left the mortuary to go into the labour ward and the childbed fever rate fell within a month to one similar that in the midwives’ clinic.

The evidence was not well received and Semmelweis was angrily ridiculed by many of his colleagues, who could not conceive that they could be responsible for causing the deaths of patients they cared for. He was not the first to suggest that childbed fever was contagious, but no one before had produced evidence that it could be prevented by hand washing.

During the 20^th century, with the development of vaccines and antibiotics, infectious diseases were thought to be a thing of the past.

Asepsis in the operating theatre, including the surgical hand scrub, continued, but the general idea of hospital hygiene – spotless wards staffed by nurses in spotless uniforms overseen by a matron in a starched veil – lost currency and hospitals became more informal, accessible and “friendly”.

Hand washing by healthcare workers was still expected, of course, especially after examining a patient with an infection or if hands were obviously soiled.

More than that was difficult, even for the most conscientious healthcare workers; hand basins were sparsely distributed, so hand washing after contact with every patient disrupted workflow and took time that no-one had to spare in a busy ward.

In 2001, the Institute of Medicine’s report “To Err is Human” pointed out that more people died in the USA, from preventable medical mishaps in hospitals, than from motor vehicle accidents, cancer or AIDS.

The report made little mention of hospital-acquired infections (HAI), but quoted Centers for Disease Control estimates, that 2 million patients developed HAI in acute care facilities in the USA, annually, at a cost to the health system of US$3.5 billion¹. Moreover, it was estimated that at least a third (or up to 70%, depending on the type of infection²) were preventable by simple, inexpensive infection control measures, such as hand hygiene.

At the same time there was mounting alarm about increasing rates of antibiotic resistant bacteria, causing HAI and deaths in the most vulnerable patients – who are immunosuppressed, severely injured or recovering from major surgery.

Treating these infections was increasingly difficult and expensive; some were resistant to all available antibiotics. One effective way to reduce the risk was to protect patients from being exposed to these bacteria, by stopping their spread on the hand of healthcare workers.

In Australia, a number of reports by working parties and expert groups on antimicrobial resistance and surveillance of HAI were commissioned by the Australian Government, between the 1980s and early 2000s, but there was little action until the Australian Commission on Safety and Quality in Healthcare (ACQSHC) was formed in 2005 and determined that HAI would be one of its priority areas for 2007-10.

An ACQSHC publication on surveillance of HAI³, highlighted hand hygiene as a major strategy to reduce the estimated 200,000 HAIs occurring in Australian hospitals each year.

The renewal of interest in hand hygiene was timely. In 2000, researchers in Geneva led by Professor Didier Pittet demonstrated that the easy availability of alcohol-based hand rub (ABHR) significantly increased compliance with hand hygiene. This was associated with a fall in the rates of nosocomial infection and transmission of antibiotic resistant bacteria⁴. AHBR is as effective as soap and water, more convenient to use – because it can be placed at each bedside – and causes less skin irritation.

These findings were the basis of the WHO’s “Clean Care is Safer Care” program, a major component of which is the “SAVE LIVES: Clean your hands” campaign, which aims to have 15,000 healthcare facilities signed up to improve hand hygiene, by May 2012 (so far 14,825 have enrolled).

Hand Hygiene Australia was engaged by the ACQSHC, in 2009, to implement the National Hand Hygiene Initiative (NHHI), to improve hand hygiene and reduce HAIs in Australian public acute healthcare facilities. To do this and to show it was being done, required standardisation of hand hygiene practice, a consistent, accurate way to measure compliance and an objective marker of HAI incidence.

The WHO’s “5 Moments of Hand Hygiene” (see Figure) was chosen as the standard hand hygiene system for Australia, which was one of the first countries to sign up to the WHO program.

The rate of healthcare-associated Staphylococcus aureus bloodstream infection (SABSI)⁵ was chosen as an objective, easily measured marker of compliance with infection control practice, including hand hygiene.

Implementing the NHHI required all States and Territories to sign up to the program. Some were initially reluctant to do so because they already had well-established hand hygiene programs and while they have all now agreed, implementation of the program has been delayed in some States.

The next step was to train “gold standard auditors”, to ensure that compliance would be measured consistently and data comparable between facilities. This has been a mammoth task involving face-to-face workshops in all major cities and significant time commitment by many “frontline” staff. These auditors are responsible for training ward auditors, who perform audits and report a designated total number of “moments” regularly to Hand Hygiene Australia.

The data reported on the MyHospitals website recently were the results of audits reported in the third audit period for 2011, from 589 hospitals, covering more than 300,000 “moments”. There is still variation between States and Territories and individual facilities, in the numbers of “moments” audited by different hospitals and rates of compliance.

The overall national compliance for this period was 73%, a significant improvement on the first reporting period in 2009, when it was 64%. More detailed analysis shows considerable variation in compliance between “moments” – for example it is generally higher after than before contact. There are also differences between professional groups – from 58%, overall, for doctors, to 77% for nurses.

Healthcare-associated SABSI rates were first reported on the MyHospitals website in September last year, for the period June 2010-June 2011. They include SABSIs acquired 48 hours or more after admission to hospital (hospital onset) and healthcare-associated outpatient SABSI (defined by a series of criteria including a recent admission or procedure or the presence of some type of indwelling device, such as a venous catheter).

The reliability of these early data is patchy. There are agreed case definitions, but anecdotal evidence suggests that they are interpreted differently. It requires a detailed chart review, by an experienced clinician, to decide whether a SABSI in an outpatient is truly healthcare-associated and, if so, which facility it “belongs” to.

Until hospitals become more experienced with reporting, some of these may be misclassified as community-associated and not counted in calculation of rates based on the numbers of occupied bed days.

The greatest value of these “report cards” is for the facilities themselves, to see how they compare with similar hospitals. There are many factors that determine SABSI rates, apart from hand hygiene (although it is clearly important).

The challenge, for every clinician and every administrator in every facility, is to understand what factors contribute to the occurrence of SABSIs on their watch and act to ensure that none occurs that could have been prevented.

For Health Departments, politicians and the public the important information is not the rate for one time period, but trends. As the data are better understood and local responses implemented, they should improve. Already the National Hand Hygiene Initiative has improved overall hand hygiene compliance in Australian hospitals⁶.

Demonstrating a reduction in infection rates will be more difficult – a reported reduction in methicillin resistant Staphylococcus aureus (MRSA) infection is promising, but occurred in some facilities even before the NHHI was implemented and has been offset by increases in methicillin susceptible SABSI, which are easier to treat, but still serious.

Nevertheless, public disclosure of these data is a powerful incentive for improvement and a step towards an important goal – to make hospital infection prevention and control “everybody’s business”, not just the responsibility of a few infection control specialists.

• Lyn Gilbert is Clinical Lead, Infection Prevention & Control, Western Sydney Local Health Network, and Director, Centre for Infectious Diseases & Microbiology-Public Health

References:

1. Kohn LT, Corrigan JM, Donaldson MS (Eds). To Err is Human, Building a Safer Health System. Institute of Medicine, Washington DC, USA. 2001
2. Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidmiol, 2011; 32:101-114.
3. Cruickshank M, Ferguson J (Eds). Reducing harm to patient from health care associated infections: the role of surveillance. Australian Commission on Safety and Quality in Healthcare. Sydney, Australia. 2008. http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/con-pubs-hai-report
4. Pittet D, Hugonnet S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet, 2000;356;1307-12
5. Collignon, P. J., I. J. Wilkinson, et al. Health care-associated Staphylococcus aureus bloodstream infections: a clinical quality indicator for all hospitals. Med J Aust. 2006; 184: 404-406.
6. Grayson, M. L., P. L. Russo, et al. Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative. Med J Aust 2011; 195: 615-619.

Here is the latest compilation, covering from 6 October – December 23, 2011. The latest readership figures are now also available, showing that more than 137,000 people visited Croakey in 2011, with 305,987 unique pageviews.

The links below have been grouped into these categories:

General public health
Climate change and health
Food, tobacco, alcohol
Indigenous health
Mental health
Rural health
Health reform
TGA-related matters
Evidence-based issues
Personal health and healthcare
Pharma industry and conflict of interest issues
The Medicines Australia deal with The Australian
Other media-related issues
Wraps of health and medical reading at The Conversation

***

General public health

The GFC and global health: why Australia needs to step up to the plate
Mary Moran

The financial crisis and what it means for peoples’ health
Stephen Leeder

Why we need to transform Australia: leading public health expert
Bob Douglas

Uranium sales to India: a public health disaster?
Margaret Beavis

So we now have another international declaration on the social determinants of health. What difference will it make (or not)?
Sharon Friel

Has the WHO lost the plot, when it comes to tackling the social determinants of health?
Fran Baum

Public health experts take a stand against compulsory income management

Why we need healthy housing policy (and introducing Croakey’s first intern)
Caroline Chen

Is Victoria the pace-setter in health promotion?
Boyd Swinburn

Place-based approaches to supporting children and families: what are they, and why do they matter?
The Centre for Community Child Health

The Tax Forum: so much for “health in all policies”
Mike Daube, Ian Olver, Jan Barendregt, David Atkinson, Rob Roseby, Guy Maddern, AHHA, ACOSS

What is the single best thing you could do for your health? (Promoting physical activity on the eve of New Year’s resolutions…)

Some good news on childhood obesity (but who will act on it?)
Elizabeth Waters

New immunisation incentives are good policy, and merit sensible debate
Julie Leask

Why Meryl Dorey should stay on the Woodford Festival program
Jon Wardle

More people would cycle if helmets were not compulsory: new study
Chris Rissel

Cycle helmet debate continues
Tim Churches

The backlash against “pinkwashing” and breast cancer marketing
Becky Freeman

The backlash against universities offering complementary medicine courses
Loretta Marron

Some suggestions for the national and NSW reviews of health and medical research

Why do researchers donate their time and money to help private conference organisers make big bucks?
Simon Chapman

***

Climate change and health

A wrap of news on climate change and health: from Durban to Tuvalu and Martha’s Vineyard
Fiona Armstrong

Richard Smith: tweeting the news on climate change, health and security

Climate change is an “immediate, growing and grave threat” to health and security

***

Food, tobacco, alcohol

Who is supporting the push for pregnancy warnings on alcohol?

The supermarket grog wars are a health hazard
Michael Livingston

It’s time for a campaign to tackle media framing of alcohol and other drug issues
Laurence Alvis

Quit smoking, save money, feel better, and write a special book
Maxie Ashton

It’s a Knockout! ACMA report delivers blow to self-regulation
Jane Martin

The new draft dietary guidelines: look beyond the headlines
Warwick Anderson and Rachel Nowak

The latest news from the world of food policy and regulation
Michael Moore

The “fat tax”: some wide-ranging analysis
Rosemary Stanton, Jane Martin, Gary Sacks

***

Indigenous health

Why this Indigenous health project is an award-winner
Neil Thomson

How can health reform help Aboriginal and Islander health: a practical vision
Selwyn Button

Profiling some of the barriers to progress in Indigenous health
Judith Dwyer

***

Mental health

(Most of these articles were posted as part of an ongoing series associated with my articles on mental health reform that were jointly published by Crikey and Inside Story.)

Suggesting some long-term goals for mental health reform
Alan Rosen

Important for mental health: a fair society and a good start to life
Helen Keleher

Early childhood trauma and long-term health
Josey Anderson

Don’t rush the roadmap for national mental health reform: Alan Rosen

What matters for people living with psychotic illness
Sandy Jeffs

More effort needed to strengthen shared care arrangements for people with serious mental illness
Olga Anikeeva

Some lessons from rural innovation in mental healthcare
Charles Alpren

How we are dodging some important mental health issues
Matt Fisher

Falling through the gaps – the unmet mental health needs of people with intellectual disability
Sophie Howlett

A note of clarification about Croakey and coverage of mental health policy

***

Rural health

Physician assistants win support of rural/remote doctors – and a report from the coalface
Deborah O’Kane

Physician assistants: an update on the policy, politics and state-of-play
Sharon Barnwell and Allan Forde

Climate change and rural health: a GP’s call for action, plus an update on recent studies
Andrew Bracey

***

Could spending less on healthcare be better for our health?
Patrick Bolton

How can we ensure a sustainable health system? Plus recent articles on surgery waiting lists, e-health and gambling reform
Ann-marie Boxall

Health reform: the musical
With contributions from Philip Davies, Carol Bennett, Prue Power, Gawaine Powell Davies, Paul Grogan, Alan Rosen, Andrew Gunn, Andrew Pesce, Peter Sainsbury, Ruth Armstrong, Simon Burrow.

The Ministerial reshuffle and health: plus analysis of Roxon’s tenure and advice to Plibersek
Tony Hobbs, Andrew Pesce, Stephen Leeder, Robert Wells, Mike Daube, Peter Sainsbury, Gavin Mooney, Alan Rosen, Paul Grogan, Ian McAuley, Gawaine Powell Davies, Mary Chiarella, Justine Caines, David Penington, Michael Vagg, Ron Batagol, Anonymous

Some more advice for the new Health Minister, Tanya Plibersek
Prue Power, Carol Bennett, Jon Wardle, Hal Kendig

An update on the state of health reform: the pros, the cons and the questions
Jane Hall and Jonathan Karnon

Is this the future for Medicare Locals? (With musical references)
Philip Davies

Next round of Medicare Locals announced

Health reform: in whose interests? And what happened to the vision for primary healthcare reform?
Lyn Morgain

The quality of health service managers is an important health issue
Daryl Sadgrove

Are Australians willing to pay more for better oral health?
Rachel Katterl

Pressure for abortion law reform in Queensland
Caroline de Costa

The argument for a federal takeover of health in Tasmania
Martyn Goddard

The devil in the detail: how Tasmanians lost out in Royal Hobart Hospital deal
Martyn Goddard

Your thoughts on the good and bad of eHealth in primary health care?
Olga Anikeeva

Some things you mightn’t have known about Mick Reid (on the occasion of the Sidney Sax medal)

A nurse was murdered. Questions are being asked about health service management
Jenny Haines

Why Mary, Kylie and I may prefer to be known as Doctor….
“Enrico Brik”

A response to critics of organ and tissue donation reforms
Anne Cahill Lambert
***

TGA and related matters

Statement from Australian Skeptics on the Ken Harvey and SensaSlim cases

Some VERY interesting reading: on the TGA, Ken Harvey, and pertinent questions for public health advocates
Rebecca Johnson

Consumers need much better information about complementary medicines
Ken Harvey, Carol Bennett

***

Evidence-based issues

New international project to support evidence in practice and policy
Andy Oxman

A new health book that is worth reading (and free online)
Hazel Thornton

Why the US Preventive Services Task Force is recommending against PSA screening for prostate cancer

***

Personal health and healthcare

We need more action on hospital infections: expert
Lyn Gilbert

For those with chronic illness, what helps encourage self-care?
Petra Bywood

GPs are getting older and working more intensively. And what about their patients?
Helena Britt

How to improve understanding of palliative care?
Erin Koop

Concerns continue about unsafe home birth practices: Dr Andrew Pesce

Home births: it’s time to broaden the focus of the debate
Hannah Dahlen

Crying babies: what parents need to know Vs what they are often told
Pamela Douglas

Some wide-ranging conversations on death and dying

A push to improve pain management
Lesley Brydon

A personal story of living with pain
Geri Badham

***

Pharma and COI-related issues

US wants to give pharma more power over our medicines policy
Deborah Gleeson

Our medicines supply is not as secure as you might assume
Simon Quilty

Should pharma industry fines be used in good works that create positive industry PR?
Andrew Roberts

Clock is ticking on the NHMRC and conflicts of interest policy

Conflicts of interest: the issue goes on, and on….

Conflicts of interest in health and medicine: calls for a culture change

Update on the links between public health and corporate interests
Some reaction to the news on the Pharmacy Guild and Blackmores
Andrew Podger, Ken Harvey, NPS, Richard Di Natale

Pharmacy Guild deal with Blackmores ends in tears

***

The Medicines Australia deal with The Australian

Concerns raised about pharma-sponsored health journalism at The Australian
Medicines Australia, Gary Schwitzer, Charles Ornstein, Amanda Wilson, Wendy Lipworth, Carol Bennett, Christopher Jordens, Peter Mansfield, Philip Davies

Adam Cresswell responds to concerns about Medicines Australia’s deal with The Australian

The pharma industry is also distributing The Australian’s health series…

 The potential pitfalls of special deals between media and pharma
Tim Woodruff

Doing the dance: journalism and pharma

Medicines Australia: concerns about conflict of interest are overblown (and besides, we’ve got a great story to tell)
Brendan Shaw

No need to be so precious about conflicts of interest…the discussion continues
Ron Batagol

***

Other media-related coverage

Health story of the year (if not in the mainstream media): social media and health

New guidelines encourage nurses to embrace the potential of social media
Debra Cerasa

Social media and healthcare: recent news and developments
Carolyn Der Vartanian

Media Doctor Australia puts out a call for help
Amanda Wilson

An overview of changes at the health media watchdog, HealthNewsReview
Gary Schwitzer

What the news about health often leaves out
Amanda Wilson

What is the future of scientific publishing?
Ben Harris-Roxas

Does media coverage of health reflect the grant cycle of medical researchers?
Amanda Wilson

Medical writers: what do they talk about?
Justin Coleman

***

Wraps of health and medical reading from The Conversation

Reema Rattan, Froncesca Jackson Webb

December summary

November summary

October summary

***

Previous summaries of Croakey coverage

October, 2011

July, 2011

***

Thanks to Croakey’s supporters

And, finally, I would also like to take this opportunity to acknowledge and thank the organisations that have supported Croakey over the past year; particularly the Public Health Association of Australia, which organises the Croakey funding consortium, which also includes the Epidemiology Unit of the Victorian Infectious Diseases Reference Laboratory; the UNSW Research Centre for Primary Health Care and Equity; the Australian Health Care Reform Alliance; VicHealth; the Australian Health Promotion Association; and RaggAhmed. (More details here).

I would also like to thank Crikey, which provides logistical and other support and encouragement, and members of the Crikey Health and Medical Panel, who generously volunteer their time (often late at night) to contribute articles.

Thanks also to other contributors and, of course, to readers. I am looking forward to more healthy debate and discussions in 2012.