This week’s Health Wrap has been written by my colleague Ellice Mol, another new Sax Institute staff member. Ellice is our Digital Communications Manager, is a dab hand at producing digital content and has also worked in radio, video and film production. We hope you enjoy the Wrap. Send us your ideas via Twitter to @medicalmedia.

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By Ellice Mol

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Over the counter medicines under review

Paracetamol and aspirin could be taken off Australia’s Pharmaceutical Benefits Scheme (PBS) in a proposed budget measure designed to save millions of dollars, while over-the-counter access to Nurofen Plus, Panadeine and other common painkillers sold to millions of Australians each year could soon be curtailed amid reports of harmful side effects, addiction and fatal overuse, WA Today reported.

Health Minister Sussan Ley confirmed the Federal Government is looking at removing subsidies from medicines like paracetamol, aspirin, and antacids that can be bought without a prescription and allowing pharmacies to discount the patient co-payment as part of negotiations over the Community Pharmacy Agreement, Croakey reported.

This comment piece on The Conversation gives support to moves to reclassify about 150 codeine-based drugs such as Nurofen Plus and Panadeine Forte as prescription-only. Author Jennifer Pilgrim, a postdoctoral researcher in forensic toxicology at Monash University, argues that codeine-combination painkillers pose multiple risks, from addiction to overdose, and should be used for the shortest time possible at the lowest dose. Moving them to prescription-only would not disadvantage people in acute pain because newer medicines combining paracetamol and ibuprofen provide better pain relief without fewer risks, she writes.

Meanwhile the Sydney Morning Herald has reported the tragic death of Imogen Cunningham who died from paracetamol poisoning after becoming addicted to over-the-counter pain medications, with little idea of just how dangerous the drugs could be.

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Medicare review

Health Minister Sussan Ley has announced a review of Medicare that will “reform and revamp both the MBS (Medicare Benefits Schedule) and the primary care system so that they deliver better for patients”. In a comment piece in the Sydney Morning Herald, Jeffery Braithwaite, professor of health systems research and foundation director of the Australian Institute for Health Innovation at Macquarie University, said the MBS review does two important things. First, he said, it gets her and the government out of the jam that the GP co-payment plan introduced in last year’s budget. And second, and more important, it gives the government, the medical profession and health management at all levels a chance to look at where in the health system real savings can be made. Opposition health spokeswoman Catherine King has welcomed both MBS and PBS reviews, but says any savings achieved in the MBS review must go back into health.

A group of health economists, writing in The Conversation, agreed the MBS review was an indication of a more considered and consultative approach to formulating health policy but said it would fail unless it dealt with the ‘elephant in the room’ incentives to over-treat that are created by our fee-for-service system. Under the just launched Choosing Widely campaign, reported by the Sydney Morning Herald, five of Australia’s peak specialty medical groups have identified 24 tests and treatments that physicians and patients should question. See the Croakey series on the initiative.

In another piece on The Conversation titled ‘Want to reform Medicare? Target specialist services, not primary care’, Peter Sivey, Senior Lecturer, Department of Economics and Finance at La Trobe University, says that while the review should consider the role of incentives and a culling of ineffective treatments, the big differences in equity and efficiency across the categories of Medicare spending should be of paramount importance.

This Croakey article by Dr Tim Woodruff from the Doctors Reform Society, however, suggests that co-payments are far from “dead, buried and cremated”, with analyses of recent policy announcements suggesting we are heading ever faster towards a two-tiered, US-style health system.

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Under stress

In the lead up to this week’s 2015-16 Budget, the Close the Gap Campaign Steering Committee has urged a moratorium on the Western Australian Government’s plans to close remote Indigenous communities, saying such a move is at odds wtih the commitment to Closing the Gap. It’s called for no action to be taken until:

  • The health and wellbeing impacts, as well as implications for other matters such as native title rights, of such closures are properly and independently assessed;
  • The Federalism Review process has been completed and therefore that;
  • The Federal Government works with the Western Australian government to ensure that current levels of support for remote area communities are maintained.

The call followed the latest demonstration of anger and anxiety about the WA moves at the 1 May rallies, under the #SOS Blak Australia banner, with many thousands of people people rallying in remote communities, country towns, regional centres and capital cities, as Croakey reported. Croakey also published this open letter from Dr Melissa Stoneham of the Public Health Advocacy Institute of Western Australia and colleagues, who urged health organisations and professionals to sign this letter, join the marches, and stand up for the health and wellbeing of Aboriginal peoples and communities.

The United Nations permanent forum on Indigenous issues also recently supported a submission by the Kimberley Land Council condemning the proposed closure.

The public campaigning appeared to have had some effect: Croakey reported that the WA government is stepping away from its original warnings that up to 150 communities might have to close and softening its rhetoric. It has now, finally, released details about the process it is launching, including how it will conduct consultations with the communities, but it is still talking of “significant” closures.

Meanwhile, more details about the much-criticised tendering processes for the Federal Government’s Indigenous Advancement Strategy emerged in submissions to the Senate inquiry examining the process. The ABC reported that less than half of the successful applicants for the first round were Aboriginal and Torres Strait Islander organisations.

Concerns about hostile or stressful processes are not confined to the IAS. There had been much relief in March when the Federal Government announced that funding for 112 Aboriginal and Community Controlled Health Organisations (ACCHOs) had been secured for the next three years, however Croakey reported concerns at the levels of information and tight timelines involved to meet funding deadlines. “Most organisations will be offered three years funding, but services assessed as high risk may be offered a 12 month agreement,” the Health Department spokeswoman revealed.

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Muenchausen by internet

Australian “wellness blogger” Belle Gibson, who became an online and media sensation off the back of claims she cured terminal brain cancer through diet and lifestyle alone, has been exposed for fabricating her tragic cancer story. She admitted to the Australian Women’s Weekly that “none of it is true” and is now being investigated over her promised charity donations, Guardian Australia reported. Helen Razer wrote on Crikey’s Daily Review that a disease that ruins the lives of many served only to improve Gibson’s as she claimed to have several of its most incurable varieties and to have beaten them all with natural secrets available for just $3.79 at the App Store.

Jules Montague, a consultant neurologist at the Royal Free London NHS Foundation Trust, wrote in The Guardian that the diagnosis of Münchausen syndrome has dominated analysis of Gibson, saying it comes under the rubric of a wider term, factitious disorder: the intentional production (feigning) of disease in order to assume the role of a sick person.  Montague cites a 2011 publication, Innovations in clinical neuroscience, that suggested that 9 per cent of inpatients receiving complex medical and surgical treatment suffer from some form of the disorder. Münchausen is the most severe form of factitious disorder, accounting for about 10 per cent of cases. She says the behaviour of this group is dramatic: visiting different hospitals with various aliases, injecting faeces into the veins to induce sepsis, or eating rotting food to perforate the bowels.

Another focus around the Gibson case has been on the wellness industry that she was part of: writer Jessica Alice asserts in this Junkee article that “a movement that rejects science and embraces a value system based largely on aesthetics is bound to be engulfed by capitalism.” Alice also writes about the late Jess Ainscough, otherwise known as the ‘Wellness Warrior’, who was diagnosed in 2008 with epithelioid sarcoma. Faced with a terrible option of amputation,  she chose the ‘natural healing’ of Gerson therapy instead, a treatment with no scientific basis that her mother also used to try to fight her own fatal breast cancer years before. Gerson therapy involves a variety of supplements and daily coffee enemas. Jess also ate clay to “detox” her body.

The lack of substance in the wellness movement, Alice writes, could be forgiven if all it offered was its pleasant aesthetics, if it was just another style. “But its insistence on ‘healing’ and its bizarre, inconsistent obsession with the ‘natural’ leaves it ripe for exploitation by the Belle Gibsons of this world,” she writes.

In this comment piece in MJA Insight, Dr Ken Harvey of the School of Public Health and Preventive Medicine at Monash University and a regular campaigner against non-scientific products, puts forward his views on how complementary medicines should be regulated. In his submission to the ‘Review of medicines and medical devices regulation: complementary medicines’, he proposes the Therapeutic Goods Administration (TGA) be given powers to apply timely and meaningful sanctions to manufacturers of any complementary products found to be in breach of the TGA’s advertising code, in order to deter repeated regulatory violations.

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Ripe for change on climate action

Australia’s peak medical and science organisations have joined forces to call for action from all Australian governments to plan for and address the impacts of climate change on human health, Croakey reported. The ‘Climate change challenges to health: Risks and opportunities’ report, released by the Australian Academy of Science, warns that vulnerable people, particularly the sick, elderly and poor, will “suffer disproportionately from the worst impacts of climate change”. It summarised the five main  pressures on health being: 1. the health impacts of extreme weather events, 2.changing patterns of disease, 3.disruptions to food and water supplies, 4.loss of livelihoods, and 5.increased threats to security.

Endorsing the report, AMA President Brian Owler said it provides compelling evidence of the significant threat that climate change poses to worldwide health, and makes the case for urgent action and planning.

The health impacts of climate change and other policies are also likely to be ‘front and centre’ for the new Greens Leader Richard Di Natale, who was elected to succeed Christine Milne after she announced her surprise departure last week. As Croakey observed, Senator Di Natale, former GP and public health specialist, was widely described as “little known” in the mainstream media after the election, but he is well known in health circles and was warmly welcomed in many quarters, including the AMA and Consumers Health Forum.

Still the science of climate change remains contested by the Prime Minister’s chief business advisor Maurice Newman who wrote a column in The Australian saying it is a hoax created by the United Nations as a ploy to implement global authoritarian rule. On The Conversation, John Cook, Climate Communication Research Fellow at the University of Queensland, discussed the impact of the denial of science, saying it has real societal consequences, as we have seen with HIV and AIDS in South Africa, with smoking over decades, and now where preventable diseases are making a comeback due to vaccination denial. He discusses the “worldview backfire effect”, where presenting evidence that threatens a person’s worldview can actually strengthen their beliefs, and says scientific research has offered us a solution: build resistance to science denial by exposing people to a weak form of science denial.

It’s an issue also explored by Simon Kuper in the Financial Times. When faced with complex problems, he says people often resort to a heuristic or pragmatic, simplified mental shortcut. One common shortcut is to use labels such as “natural”, “organic”, “local” or “homeopathic” as proxies for healthy. Conversely, “artificial” gets equated with unhealthy. Kuper says says scientists and governments need to change tack: instead of bombarding people with science, they should design policies that use our cognitive biases. “In today’s low-trust world,” he says, “science is in the doghouse with most other authorities.”

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Outsourcing the MJA

A report on ABC News last week revealed the sudden dismissal of the editor of the Medical Journal of Australia (MJA), public health expert Professor Stephen Leeder after he raised concerns about plans to outsource production of the MJA to global publishing company Elsevier. The company has been involved in several scandals including publishing a “fake” journal in Australia which was funded by pharmaceutical company Merck.

Croakey reported the en masse resignation of all but two members of the MJA’s editorial advisory commitee, and two senior editorial staff, in protest at the decisions to sack Leeder and outsource production to Elsevier. Leeder told the Sydney Morning Herald he felt “bereaved” by his departure from the MJA, but said that working with Elsevier was “beyond the reach of my ethical tolerance”. He expanded on the issues in this piece on The Conversation. The decisions by the Australian Medical Publishing Company (AMPCo), the fully owned subsidiary of the AMA, could see many researchers refusing to have anything further to do with the 101-year-old journal, public health academic Dr Ken Harvey told Guardian Australia. The AMA has fully backed AMPCo on its decisions.

Other Croakey reading you may have missed this fortnight:

 

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