MEDICARE’S IDENTITY CRISIS

MEDICARE’S IDENTITY CRISIS

Bulk-billing in Australia is poised on a scalpel’s edge.
Why? It is a matter of the simple economics of running a small business.
Back in 1984 when Medicare was introduced, the rebate for a bulk-billed service by a GP covered 71% of the recommended fee at the time.
Many doctors signed up at that stage, agreeing to take a smaller fee in exchange for simpler administration by billing the government direct…and in bulk. Remember that these were the days before electronic transfer of funds, when processing of cheques took up to a week and every transaction needed to be physically recorded with paper and pen.
At the beginning, bulk billing was stupendously popular with everyone… patients, government and many doctors.
The rebate was only ever intended as a subsidy for patients, but over the years this has morphed into an expectation that health care is “free” and that the government pays bulk-billing doctors generously for their services on the patient’s behalf.
This has been little more than a national scale “pea-and-thimble” trick. It is a complete illusion that Australia has a “free” health care system or that the rebate is “generous”.
Anything that is “free” to a consumer has to be paid for by someone, somehow.
There is a Medicare levy on taxpayers, sure, but that doesn’t go close to paying for the cost of running the health system.
Other taxes also contribute to Medicare and the public hospital system and the Pharmaceutical Benefits Scheme. But even that doesn’t cover the cost of health care.
So Medicare is also facing something of an identity crisis. It is certainly not a “universal health funding scheme” as it does not universally fund the value of medical services.
Over the decades since the introduction of Medicare, the rebate for seeing a doctor has fallen further and further behind the rising costs of running a practice and is now way behind where it should be if the Medicare Benefits Schedule had kept up with inflation and labour costs over that time.
Patients who have been “bulk-billed” by their GP have been blissfully unaware that when a doctor bulk bills them, they are providing a substantial discount. Using the most frequent item number as an example, the Medicare rebate for a standard consultation of around 15 minutes is only $36.30. This is the amount the government reimburses the patient if you have been privately billed, and it is the amount paid on your behalf to the doctor if you are bulk billed. This is compared with the AMA recommended fee of $73 (which has been indexed to inflation). Now more than ever before it is the doctor who is subsidizing the patient’s health care costs and making up for Medicare’s shortfalls.

The last straw was the announcement by Labor in the 2013 Budget that Medicare rebates would be frozen (as opposed to just chilled) for the next year in an effort to save over $664.3million. That $664.3 million is now being shouldered by GPs as they yet again absorb increased salaries, practice maintenance costs, equipment and supplies costs, computer costs, insurances and more.

Into the future there are some options.
We have already seen a trend to fewer long consultations by GPs. General practitioners spending even less time on each consultation is counter-productive and would affect the quality of care, particularly for people with more complex health care needs.

The option of the $6 patient copayment is one that was apparently raised by the Commission of Audit. According to reports, concession card holders would be exempt from the copayment and families would have 12 visits a year before being asked for a copayment. That will mean, of course, that if the government does not feel like increasing the rebate to keep pace with future practice cost increases, it will simply increase the patient co-payment.
The reaction to the $6 copayment surely cannot be about the $6. That’s the equivalent of the cost of a cappuccino or a road toll.
This is more about the symbolic end of the illusion of “free” healthcare.

The copayment is not the only option.
Another option is for taxes from general revenue to be increased and for the Medicare Benefits Schedule to bring rebates into line with where they should have been, and then increase with inflation into the future. Considering the current Budget deficit, don’t hold you breath on that one.
Option three is glaringly obvious. Doctors give up on bulk billing, charge a fee and the government of the time will just have to figure out what it wants Medicare to be.
In the time since 1984, general practice has become a specialty with several more years of study and supervised practice beyond university and hospital training, and greater responsibilities for managing chronic and complex health care conditions. Medicare has steadfastly failed to recognize this, discouraging the longer consultations that are needed to manage more complex cases and squeezing bulk-billing general practices financially.
This debate on the future of Medicare and bulk billing has been brewing for many years. It is time to get it out in the open.
If Australians value high quality primary health care, then as a nation we need to invest in it. How we do that will determine the future of healthcare in this country.

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GLUTEN FREE, LACTOSE FREE BANANA BLUEBERRY MUFFINS

It’s Sunday and by popular request I set about producing a batch of gluten free, lactose free banana and blueberry muffins. Some of my Twitter followers asked for the recipe so before I forget what I put in there, here it is:
You will need a muffin tray
Ingredients:
2 1/2 cups gluten free self raising flour
3/4 cup brown sugar
1 teaspoon ground cinnamon
2 tablespoons rice bran oil
2 or 3 ripe bananas
Punnet of blueberries
1 egg
1 cup lactose free milk
Cinnamon sugar to garnish

What next:
Preheat the oven to 180-200 deg C
Put the dry ingredients in one bowl
In a separate bowl, whisk the egg. Add the bananas and mash them, add the milk and rice bran oil.
Pour the wet mixture into the dry mixture, blending as you go.

Grease the muffin tray with rice bran oil.
Place some blueberries in each muffin well.
Place mixture in to wells. Press some blueberries into the top of each muffin.
Sprinkle with cinnamon sugar
Bake for 20 minutes

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STATIN DEBATE

The Catalyst program on ABC television did exactly what the program’s name promises. The report on the association of cholesterol levels and heart disease outcomes, and the prescribing of statins was the catalyst for weeks of passionate debate and controversy in our profession and in the broader community.
It is high time we had this debate.
Working in general practice, we are constantly faced with having to make judgment calls about risk and benefit…not on the basis of single substance, single health outcome studies, but balancing the needs of the real patient sitting in front of us with often multiple health problems and medications, or the patient who is asymptomatic but wanting to stay well.
While the case seems clear for the benefits of statins in secondary prevention of heart disease for patients at high risk, “indication creep” has resulted in more and more people taking statins as some sort of insurance policy or a way of atoning for lifestyle sins.
The benefit of prescribing a statin to treat a lab result in an otherwise healthy adult is negligible, but the risk of significant adverse effects is not.
Side effects we all see include cognitive decline, which can be mistaken for senile dementia, muscle pain and weakness, reduced exercise tolerance and non-specific indigestion (which has often led to the patient being prescribed proton pump inhibitors which have their own long term problems like magnesium deficiency and osteoporosis)
Similarly, there is no evidence that higher dose statins give a significantly greater outcome benefit than lower doses, yet all too frequently I see elderly patients come back from their cardiologist or discharged from hospital on huge doses for questionable benefit and causing major reduction in quality of life.
If the only outcomes you are measuring are cardiovascular events, you are missing out on all of the other possible negative consequences of blocking a significant metabolic pathway, only one of which is the production of the essential coenzyme Q10. While some of the pharmaceutical companies are moving to add CoQ10 into their statins to address this, it is not the only potential problem.
And if the only precaution a patient is taking against hyperlipidemia or cardiovascular risk is taking a pill a day, they are not doing nearly enough to reduce their risk.
No single drug can take the place of comprehensive lifestyle measures and we need to see more research comparing statins with integrative approaches to cardiovascular risk management.
All therapeutic guidelines need to be revisited regularly.
And when they are revisited, the process must be seen to be entirely independent. As GPs we rely on expert panels to dissect and distil the mountain of evidence that emerges to guide these decisions we make for our individual patients. Without casting any aspersions on individual experts, anyone who has received industry funding for their own research on statins should be excluded. On the other hand, we need to include integrative medicine doctors, and multidisciplinary “non medical” experts such as exercise physiologists and dieticians.
In addition to reviewing the prescribing guidelines, we also need to look at doctors’ prescribing behaviour to see how well it aligns with guidelines. Too many people are taking statins who should not, on the evidence, be taking them.
We need to be prepared to be regularly questioned by our patients about prescribing decisions, and to de-prescribe wherever that is appropriate.
We do our patients a great disservice if we slavishly perpetuate medical dogma just because it has been previously “accepted wisdom”, or if we shy away from the debates we must have to continually evolve medical practice with the patient’s best interest at heart.
Published in Medical Observer 22 November 2013

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IN HARM’S WAY

IN HARM’S WAY
Every so often you come across a loophole in the law that you just cannot believe exists.
Child protection has been a massive political hot potato, and rightly so… particularly since the tragic case of little Kiesha Weippeart who was killed by her birth mother after many, many risk of harm reports.
This is an area that makes me feel very passionate and super-protective on behalf of the children involved. Children who are at risk of harm, or who have already been harmed to the extent that they have had to be removed from their parents and placed in foster care are incredibly vulnerable. They deserve all the protection our community can provide them.
Every child in our community deserves protection from harm, mistreatment or neglect.
Part of our system of protection is a register of people in the community who are unsuitable to care for children.
The system is set up so that people who are not safe around children are not allowed around children. Anybody’s children.
So what about the parents who have had children removed because they have demonstrated they are unable to care for their child or children, or they have injured, abused or neglected their own children?
Imagine my shock this week to learn that people who have had their own children removed for neglect or abuse are free to go and get a job looking after or working with other people’s children.
What about the “working with children check” you ask? That only covers criminal offences against children.
The agencies which employ child care workers and babysitters do their background checks to see if prospective employees are on the register of offenders. But because the proceedings of the Children’s Court, the fostering system and child protection generally is shrouded in secrecy in the interest of the privacy of the children involved, abusive parents are able to hide behind that screen and evade being listed on any official alert. This is how they are able to get through a character and police check.
Unsuspecting schools, child care centres or parents looking for a babysitter or nanny for their child have no idea whether the childcare worker they are sent through the agency has been found incapable of looking after their own children. They just assume the checks have been done.
It is crazy to think that someone like Kristi Abrahams, who prior to her confession and now conviction for killing her own daughter, could have escaped any register of people likely to be unsafe with other people’s children despite all of those risk of harm reports and the previous removal of Kiesha for her protection. It defies logic. It defies belief that this situation could exist.
I always try to see all sides of an argument, but given the vast number of options for employment which do not involve contact with children, surely it is glaringly obvious that these incompetent or abusive parents should be excluded from these occupations?
Starving your child, beating your child, emotionally destroying your child, sexually abusing your own child (as opposed to someone else’s child) is apparently not enough to warrant inclusion on a register of individuals who are not suitable to work with children because these parents rarely face criminal charges.
I have asked people who work in child protection in New South Wales why this loophole exists. I am not getting satisfactory answers. Political staffers tell me that their hands are tied because that is what the law currently says. Well I say change the law.
This has to change.
Minister Pru Goward, Premier Barry O’Farrell…please take a look at this situation and act for the protection of all children.

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MOTHERING: THE MOTHER OF ALL ROLES

First of all: Happy Mothers Day!!
Jackie and I have the honour of being Ambassadors for Barnardos Mother of the Year Awards. Our heartfelt congratulations to all of the superb finalists for this years awards. Each one challenges us to think about motherhood and mothering, and to consider our own roles within our families and in our communities.
Special congratulations go to the winner for this year, Hasiba Cesko who survived and kept her children safe during the Balkan war, then made her way to Australia where she worked her way from factory worker to business owner. She said “My children are my inspiration every day”.
Here is the keynote address I delivered at the award ceremony for the Australian Mother of the Year:

In an interview with Good Morning America, the poet Maya Angelou told Diane Sawyer: “I think of mother often. I think of myself as mother. I think of men as mother — some men. My son has mothered his son, fathered his son. I don’t think you have to be a woman to mother.”
Now before anyone flies into a feminist frenzy…
This conversation prompted me to look up a definition of “mothering” and I came up with this:
Mothering: verb. “Bringing up (a child) with care and affection”
I thought it was interesting that this definition said nothing about biology, or even gender. It was about the act of bringing up a child with care and affection.
Angelou speaks as a poet, and in those simple few sentences she lays bare just some of the complex reality of mothering in this new era of changing family structures.
Life has forced me to look at motherhood from many different angles too.
I have been a biological mother since I was 23. Jackie is a step-mother to my two oldest children, Jaime and Carl, who refer to us as “their Mums”.
Jackie and I have done crisis foster parenting.
We are now adoptive mothers to our youngest daughter Gabi, thanks to the bipartisan support of same sex adoption in NSW. This happened just a couple of years ago under the compassionate leadership of Barry O’Farrell and Kristina Kenneally.
In my day-to-day role as a general practitioner, I talk to many mothers about their ups and downs and do what I can to help to guide them through the tough times.
And yes, like Maya Angelou, I have met a few men who are doing what we would call “mothering”, if it were not for their gender.
The traditional notion of the family has been expanded beyond the restricted definition of a nuclear biological family to include step-families, blended families, single parents, gay parents, international adoption and surrogacy.
In our culture, “mothering” is substantially, but not uniquely, a woman’s role.
All of the literature …and good old common sense tells us that what children need in order to flourish is a safe, loving home environment.
And central to that is the mother of all roles: mothering.
Children need the fundamentals: healthy food, a warm bed, clothes, cuddles, security, routines and … time with their parents and other trusted adults.
Someone to listen to their concerns and talk them through their troubles.
A good education
A sense of security
Strong constructive role models.
And time to play…to just be children.
Jackie and I are honoured to be Barnardos Mother of the Year Ambassadors.
Both Jackie and I grew up with family narratives that embraced the notion of communities caring for children in need. Jackie’s father was a foster child who escaped from Europe just before World War 2.
When his foster placement here in Australia disintegrated, he grew up in a children’s home.
My grandmother grew up in an orphanage. She didn’t like to talk very much about her experiences, but what I was able to piece together left me in no doubt how tough it had been for her. I also figured that she was better off in the orphanage than the treatment she got during her time in foster care. I know how very important it was to her to provide a safe and loving home environment for her children.
The simple fact that Jackie and I were asked to be ambassadors for Barnardos speaks volumes.
From one perspective we are a very conservative, traditional family:
Two parents, one working from home.
Two grown children who visit us regularly.
One child in high school. We make sure one of us goes to every sporting and school event. Jackie is the go-to parent for fashion and hair advice, sorting out the social life, organizing meals, liaising with teachers, debating, ferrying back and forth to all the extra-curricular activities and supervising homework.
I take Gabi to school sport, organize adventures in Kayaks and on paddle-boards, we engage in discussions of world events, politics and philosophy and take trips to the art gallery.
We all love musicals.
We haven’t got time to wonder about rigid gender roles or family structures.
This is our family.
For those amongst us who have had wonderful and positive experiences of our mothers, mothers-in-law, step-mothers, foster mothers, mothers by adoption or mother figures, Mothers’ Day is a wonderful opportunity to tell her how much you appreciate her.
But there is a flip side to this coin.
It can also be the saddest time of the year for those amongst us who are estranged from our mothers, for those amongst us whose mothers have been taken from us by death or misadventure, and for children who have been removed from their mothers for their own safety.
Through our personal experience of foster parenting and “the system” we have developed such respect for the difficult and emotionally–charged work being done by child protection workers in the field and for all of the services provided by Barnardos.
We have experienced the frustration and the elation of caring for children who are frightened, traumatised and vulnerable and seeing them flourish in a safe and secure environment.
But we have also become painfully aware that not all stories have happy endings.
When we first heard the statistics, I reached straight for Google to double check them. They HAD to be wrong. But sadly they aren’t.
The Australian Institute of Health and Welfare report for 2011-12 showed there were more than 250,000 notifications of alleged abuse involving 173,502 children. Of the notifications, less than half of cases were investigated and they found 48,420 substantiated cases. 


NSW had the highest number of notifications, with almost 100,000 allegations of abuse.
Here is a statistic that astonishes me every time I see it: In Australia, one child dies EVERY TWO WEEKS from abuse or neglect.
One child every two weeks!
It is shocking to me that in Australia, a land we call the ”lucky country” there are so many children at risk.
The statistics are not just numbers.
The tragic fate of little Keisha Weippeart haunts us all and stands as a gruesome reminder that there are so many children who are not only poorly mothered but whose lives are at risk. They may not make the headlines, but every two weeks there is another child just like Keisha who dies because they were not kept safe from abuse or neglect.
And this is why the work of organisations such as Barnardos and child protection workers and fostering parents is so very important.
For me, it also raises the question of what more every one of us might do to improve the lives of children in need of care and safety, not just through government or official agencies, but as members of the community.
And this is also why the celebration of all of the good and positive things about mothering is so important.
The Mother of the Year Award is an opportunity for us to reflect on the meaning of motherhood and to celebrate mothers in all our guises and in all our different family structures.
Our finalists are exceptional women who have impressed the judges with their stories of selflessness, compassion, and dedication.
Through life circumstances or through a personal determination to make a difference to the lives of children in their care, these women have stepped up. They have gone above and beyond any usual expectations of motherhood. They have all earned a place here today.
And the next time we think we are having a tough day… we can all think of these women and draw on their inspiration to step up, to do more, to do better… for the sake of the children.

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I am relieved to see that alprazolam (Xanax) looks set to be rescheduled so that access is restricted. It is highly addictive and causes enormous social and medical problems, particularly with addiction. It is now widely accepted that it causes more harm than good.
My colleagues and I have become increasingly concerned about the overuse of this whole group of pharmaceuticals. Benzodiazepines, or as they are popularly known “benzos” with brand names including Valium, Serepax and the more potent Rivotril, Ativan and Xanax are so commonly prescribed that their potential for causing serious problems is too often overlooked or understated.

It all began in 1960 when the compound chlordiazepoxide (Librium) was launched in the UK, followed by diazepam (Valium) in 1963. By the late 1970s benzodiazepines had become the most aggressively marketed and commonly prescribed of all drugs in the world. By the early 1980s there were 17 benzodiazepines on the market worth billions of dollars worldwide. There are now almost 30 different versions, with their generic name usually ending with the suffix “–azepam”.

These days I cringe when I am asked for a repeat prescription for Xanax. I have seen so many people get into trouble with side effects or addiction and then terrible difficulty unwinding that addiction and learning to live without the medication.
It starts innocently enough. A prescription for the lowest dose just to get you over a few exam nerves. Then the exam period comes and goes and you find that you need a dose to help you cope with the anxiety you get as you withdraw from the medication. Then you need the medication just to feel “normal”, or at least not anxious. You can’t sleep with “taking something”. In some cases, that dose won’t work any more and you figure out that you now need two pills, then a higher dose is needed to get the same effect. It can take as little as a few weeks for dependence or addiction to develop. But these are not the only problems.

The use of benzos leads to a slowing down of your mental and physical processes.
A 2012 French study published in the British Medical Journal found that new use of benzodiazepines in the elderly was associated with a significant, approximately 50% increase in the risk of dementia. The authors wrote: “Benzodiazepines remain useful for the treatment of acute anxiety states and transient insomnia. However, increasing evidence shows that their use may induce adverse outcomes, mainly in elderly people, such as serious falls and fall related fractures.”
Benzos figure prominently in worsening depression and suicide attempts. They have a list of side effects that really needs to be taken seriously (muscle weakness, blurred vision, panic attacks, poor quality of sleep, confusion, clumsiness, mood swings and memory problems)
Mixing benzos with other sedative drugs or alcohol increases the risk of accidental death.
Benzos cross the placenta so babies born to mothers who are taking benzos may need to spend time in a special care nursery because they are likely to have trouble feeding, have a low body temperature, appear floppy and lethargic and have breathing problems. They may be very irritable and suffer their own drug withdrawal syndrome.

Guidelines for the use of benzos are routinely ignored. They are intended for occasional short-term use only, and in my view restricted prescribing of alprazolam in particular is well overdue.
Even the guidelines for the management of anxiety and insomnia warn against long term benzos.
Treatment of longer-term anxiety or insomnia involves a comprehensive integrative approach to the underlying causes of the problem. Sometimes a switch to a different class of medication is appropriate. Sometimes totally non-pharmaceutical methods are the way to go, such as exercise, mindfulness and lifestyle decisions.
If you have been taking a benzo regularly and longer than a few weeks, it is important to withdraw carefully and gradually, and under medical supervision. Going cold turkey can be dangerous with withdrawal effects including convulsions.
If your doctor baulks at writing you a prescription for a benzo, or wants to talk to you about ways of avoiding them, understand that it could be a key to greater wellness.
As you reduce your dependence on benzos, you also need to address the underlying reasons you started taking the medication or continued to take it.
It will take more time and effort than swallowing a pill, but it is worth it in the long run.

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Chiropractors warned about anti-vax fringe

A comment was made on Twitter earlier today that I was photographed at the recent conference of the Chiropractors Association of NSW with an individual alleged to have made anti-vaccination comments. Note: being photographed with someone is not an endorsement of their views.
I opened the conference with an address entitled “Redefining the Mainstream”, which I warned would be confronting to some of the attendees. The following is an excerpt of that address outlining some of the areas I felt chiropractors needed to address as a profession, including their lack of response to anti-vaccination comments made by members of their profession:
“ANTI-VACCINATION
Another serious concern is that a vocal minority of chiropractors is opposed to vaccination of babies and children. Vaccinations are talked of as “toxic poisons” and blamed for numerous diseases and conditions such as ADHD, autism, diabetes and cancers.”
The CAA (NSW) doesn’t have a position statement on immunisation, but some of your board members are known to be professional members of the controversial Australian (Anti)-Vaccination Network, a group discredited by the Health Care Complaints Commission.
NOT having a position supporting vaccination but having chiropractors, who are members of your association, the CAA (NSW), making public statements against vaccination makes your entire profession an easy target for criticism. This criticism is not only of the vaccination position, but becomes a more generalized criticism of chiropractic.
FUELLING CONTROVERSY
A public lecture by a Sydney chiropractor last year added fuel to the controversy. He made statements which were not only controversial, they were manifestly WRONG, along the lines of:
• “a child given all the vaccines on the schedule would receive 2370 times the accepted toxic dose (of mercury).
Mercury has not been used in vaccines for many years.
• “Vaccine makers grow chicken pox virus on aborted fetuses and these viruses are used in vaccines”
We do not develop vaccines using human fetuses.
Making unsupportable claims in the name of your profession is like painting a target on your chest and saying “AIM HERE”.
It is sure to provide ammunition for the ultra-conservative critics, while the otherwise open-minded and accepting members of the mainstream medical profession will be understandably forced to distance themselves.
It is said that some elements of chiropractic want to be a breakaway primary health provider. There are great dangers for a health discipline operating in isolation from current mainstream medicine. Like any other health care practitioner, you are not immune from the medico-legal consequences of working outside of the boundaries of your discipline and training, and missed diagnosis or delayed effective treatment can be a tragedy for a patient and a disaster for the practitioner.

IN RESPONSE TO THE ANT-VACCINATION COMMENTS: WAS THERE AN IMMEDIATE AND CLARIFYING RESPONSE BY ORGANISED PROFESSIONAL BODIES? No
WAS A FORMAL POLICY POSITION STATEMENT DEVELOPED AND PUBLICISED? NO
ENTER THE “FRIENDS”
Nature abhors a vacuum. So…At the end of 2011 we saw a concerted and organised push by ultra-conservative forces targeting certain health disciplines, including chiropractic. A group calling itself “Friends of Science in Medicine” came out of nowhere with an alarming and far-reaching agenda.
In fact, chiropractic was reserved a special place in their target zone.
Chiropractic became an easy target, NOT because of the vast majority of practitioners and academics working responsibly, but because of the utterances of one or two unrepresentative chiropractors making claims about chiropractic doing something for which there is no evidence or plausibility: chiropractic as an alternative to vaccination of children.
The demands included the shutting down of the RMIT paediatric chiropractic clinic. A letter by Loretta Marron addressed to the then Health Minister Nicola Roxon said: “It is high time that universities returned to their core principles and dropped pseudoscientific courses which lead to attacks on vaccination and the promotion of expensive, useless and potentially harmful treatments.
Ironically, no evidence is presented that “chiropractors frequently discourage vaccination of children.” The letter then linked the notorious Australian Vaccination Network (AVN) to chiropractic, claiming that “a number” of chiropractors are members of the AVN.”
Hope that clears up any confusion about where I stand

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Stilnox sinks swimmers

How disturbing is this story about our Australian Olympic swimmers downing the drug zolpidem (Stilnox or Ambien) as part of a “bonding exercise” then making a pest of themselves around the London Olympic village?
It is disturbing on so many levels.
I love watching the Olympics. It is the two weeks every four years that I have the television on constantly and I make every excuse not to go out in case I miss that great Olympic moment live. Like most people, I was expecting great things from our swimmers in 2012. I was a competitive swimmer in my school years. Never at the level of these athletes, not even close, but enough to know how hard they must have worked to get to London, let alone to earn a medal.
But something went terribly wrong in London. Actually a lot went terribly wrong. The first indication was the apparent lack of team cohesion. The stands were notable for the absence of the usual “Aussie Aussie Aussie” cheer squad of other swimmers.
The next sign of trouble was the lamentable lack of preparation of our swimmers for their post-performance media interviews. Whoever let Emily Seebohm loose, unprepared, on the pool deck in view of the world’s media, crying tears of disappointment and apologising for an Olympic silver medal?
World champion James Magnussen obviously performed under expecations…his own and everyone else’s. He and Eamon Sullivan insisted taking Stilnox had no effect “at all” on their swim performances in London. Sure.
The obvious question at the time was: “Where was the team psychologist?”
Second question: “What do you mean there wasn’t one?”

Then there is this sleeping pill debacle. The AOC tweeted earlier today that they banned the use of zolpidem three weeks before the Olympic competitions because they were so worried about its effects.

“AOC ‏@AUSOlympicTeam
The effects of Stilnox on Grant Hackett were alarming and we imposed a ban to protect the health of our athletes 3 weeks before London”

That didn’t stop the swim team lads handing them around for fun.
Zolpidem is one of those medications that in my opinion just shouldn’t still be on the market. It is so easy for someone to become dependent on it, and the side effects are unpredictable and serious. Multiply that if it is mixed with alcohol.
And a fundamental principle of prescribed medicines is that they should never be shared.
The prescribing information has BOLD TYPE warnings about reports of unusual and bizarre behaviours.
There is now evidence of residual effects including impairment of motor and cognitive function the next day, with a warning about not operating machinery, and reports of an increased risk of car accidents the next day after taking it. The weird thing is that these Olympic athletes spend a lifetime training for a competition where a millimeter or a millisecond can mean the difference between first and second place. Knowing what we know, a drug like zolpidem has no place in that environment.

Insomnia is a problem and clinically it can be a huge challenge. But there are effective ways of managing it…without pharmaceutical medication.
One of the biggest chapters in my book “Ultimate Wellness” is devoted to solving sleep problems.
Zolpidem (Stilnox) is not one of those solutions.

In this case it seems the Stilnox was taken as a bit of a “fun” that backfired badly. The point is that an athlete got hold of a prescription for a banned medication, he carried it to London with the intention of taking it during the competition and shared it around his team mates.
The management of the swim team has some serious questions to answer.
I doubt that any athletes will be taking Stilnox again.

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Pioneers of Poo (or faecal transplant, “The Ultimate Probiotic”)

THIS ARTICLE APPEARED IN THE AUSTRALIAN,18 February 2013
It’s not so long ago that the topic of faecal transplant was a bit “on the nose”.
At this point I should explain what “faecal transplant” or FMT (Faecal Microbiota Transplantation) is. It is a procedure where a special preparation of gut bacteria is infused into the gut of a person with gut problems.
A person with a healthy functioning gut donates a sample of their stool (faeces) . It is screened for parasites and other organisms that can cause infection, then diluted, strained, and given to the recipient in one of three ways: via a tube that goes up through the nose and down through the stomach to the first part of the intestine, or via colonoscopy or by enema.
Until recently FMTwas considered experimental.

That was until the New England Journal of Medicine came out with a published study of the efficacy of faecal transplant in treating a particularly nasty and potentially lethal gut bug, clostridium difficile (caused by taking antibiotics which wipe out beneficial bacteria), this fringe dweller became an overnight sensation. The study found that FMT cured 15 out of 16 cases of clostridium difficile infection, compared with the cure rate with (ironically) antibiotics was only 3 out of 13 and 4 out of 13 cases in comparison groups.
Not only did faecal transplant work so much better than the standard strong antibiotics alone, but its effectiveness without the adverse effects of the current standard treatment was so superior, that the trial was stopped so the patients in the comparison groups could get the treatment.

As with many novel approaches to health problems, along the way to general acceptance there have been the pioneers, the cheer squads, the skeptics and the obstructionists.
Now our medical journals have started referring to FMT as not only “mainstream” but a “first line” treatment.
The Gastroenterological Society of Australia shifted from warning about FMT as “potentially unsafe”, to describing it as the “ultimate probiotic”.
I spend a lot of my clinical time talking to patients about gut function and what end product they produce in the form of a stool. Often, people don’t even think to raise the issue of their gut problems, having been told they have “Irritable Bowel Syndrome” and they just need to reduce their stress.
Sometimes these gut symptoms turn out to have a treatable cause, such as a parasite or a food intolerances.

Whether you like it or not, you can’t live without the bugs in your gut, and the population of micro-organisms needs to be diverse to function well.
There are some the produce chemicals that modulate your immune responses. There are some bugs which manufacture essential vitamins such as vitamin K, B vitamins and folate. There are some that can even have an effect on your brain function and moods

If you interfere with the healthy balance of these bugs, either by diet or use of antibiotics or other medications, there are consequences for your health and wellness. Not only your gut function, but for your many other aspects of your wellbeing.
There has been a great deal of global concern in recent years about the often cavalier use of antibiotics which has led to the emergence of multi-resistant superbugs, including increasingly toxic strains of clostridium difficile infections, development of drug allergies and other effect of antibiotics on healthy gut function.
The study of probiotics is a fascinating and rapidly developing area of research, and FMT is one emerging form of probiotic therapy with untapped potential. In the years to come, research will focus on identifying highly targeted probiotic treatments for specific purposes.

Put simply, the microflora of the colon…in the vernacular ”bugs in poo”…represent the greatest potential for new approaches to health problems we have seen in a long time.

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On the rarity of inspiring leadership

“..we must be a source of hope to the poor, the sick, the marginalized, the victims of prejudice – not out of mere charity, but because peace in our time requires the constant advance of those principles that our common creed describes: tolerance and opportunity; human dignity and justice.” President Barack Obama
For those of us who believe in the principles of social justice, fundamental human rights, environmental sustainability and universal access to basic health care, the words in the second inaugural speech delivered by President Obama in late January fell like gentle rain after a long drought.
As an exercise in oration, it was a masterpiece. But its significance in framing the policy debate for the coming years is extraordinary. If you could write a prescription for the “future wellness” of a nation, this is how it would read. The medical profession has a huge stake in the collective wellness of our country. It affects every aspect of our daily clinical work as doctors, and has implications for the entire health system.
In his breathtaking oratory style, Obama spoke of a nation resolving to “protect its people from life’s worst hazards and misfortune.” He nominated some of the qualities that would take his country forward, including diversity and openness and said that every citizen deserves a basic measure of security and dignity. Obama also spoke of making hard choices to reduce the cost of health care and of strengthening disability assistance, Medicare, Medicaid, and Social Security. He pledged action on climate change, sustainable energy sources, marriage equality, child protection and equal pay for women.
His incoming government may not be able to fulfill all of the promises of this speech in the next four years, but the intention is certainly there, with an intrepid vision outlined for the years ahead. A lot will depend on the degree to which the political process interferes with its implementation.
Australia faces a Federal election this year, and as voters, we will all be called upon to think about what is important, not only to our individual interests, but to the future wellness of our nation. So many of the issues affecting the USA are also high on the political agenda here.
In Australia there are 110 substantiated cases of child abuse or neglect every day. Will an incoming government pledge to build support for child protection services rather than tighten the screws on funding in the name of budget savings?
How will an incoming Australian government deliver the promised National Disability Insurance Scheme in a way that is timely and meaningful for the people who have been waiting so desperately for assistance for so long?
How will we plan for a growing ageing population by strengthening social safety nets where traditional family support systems are changing?
Would a coalition government invest in sustainable energy sources or actually fulfill its threat to unwind the price on carbon?
Obama said, “..if we are truly created equal, then surely the love we commit to one another must be equal as well.” Will either major party respect the views of the majority of Australians and introduce marriage equality?
While the issue of equal pay for women may not seem on the surface to be a health issue, we know that social inequality relates directly to health inequality. With Australian women being paid 17.5% less than men for doing the same work, will a future Australian government act on this persistent injustice?
Truly great political speeches not only inspire emotion. They spark positive action.
How long have we waited in Australia to hear a speech from a political leader like the one delivered by Obama at his second inauguration? How long will we have to wait to hear the words that will include and embrace all of the citizens of our nation and frame a policy of inclusiveness and “social wellness” for our future?
Full text of President Obama’s 2nd inauguration speech: Full text: http://www.usnews.com/news/articles/2013/01/21/full-text-of-president-barack-obamas-second-inaugural-address

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