Overkill

Overkill
Dr Paul Offit
Scribe 288pp

With ample end notes (50 pages worth) to support challenges he may expect to be forthcoming, this hit-list of medical myths and misguided therapies comes from a highly reputable source - the director of Vaccine Education at the Children’s Hospital in Philadelphia and a professor of vaccinology and paediatrics. He is also the author of ten previous works.
From both a clinician’s and a consumer’s perspective, Dr Offit’s narrative is disturbing one, indicating a massive waste of money on ineffective treatments and the delivery of false hope to patients who continue to believe in the “miracles” of modern medicine, or perhaps just canny advertising.
The chapter headings give a taste of what’s to come: “Finishing the Antibiotic Course Is Often Unnecessary”, “Vitamin D Supplements Aren’t a Cure-all”, “Baby [i.e. low-dose] Aspirin Doesn’t Prevent First Strokes or First Heart Attacks”, and “Prostate Cancer Screening Programs Do More Harm than Good”.

In April, University of Wollongong (UOW) final year medical students joined their peers from the University of Sydney and Western Sydney University in a clinical skills training day at the University Centre for Rural Health’s Lismore campus. This was part of a week of training to prepare them for the Assistant in Medicine (AIM) program. Another ten UOW final year medical students, placed at UCRH’s Murwillumbah Hub, undertook similar training.

The AIM Program is a Department of Health initiative designed as a bridging program to fast track final year medical students into the medical workforce in preparation for the potential COVID-19 surge. The number of AIM positions available is yet to be determined and will be dependent on clinical need.

The Lismore day included a tutorial program covering practical processes such as handover and referral notes, completing discharge summaries, death certificates; interpretation of ABGs and ECGs as well as a session on breaking bad news. Students also rotated through practical skills stations including hand hygiene, appropriate use of personal protective equipment (PPE), IV cannulation, urinary catheterisation, basic life support, and suturing. These skills were delivered by a number of clinicians from the Northern NSW LHD, including Surgeons, Emergency Physicians and GPs.

Flying foxes

When I studied virology as a vet student decades ago, it was accepted as a general rule that each species of virus was uniquely adapted to a single host species. Dogs didn’t get cat viruses and vice versa. You can’t get the cat-flu from your cat or give your flu to your dog etc.
Ferrets are a somewhat random exception: they have similar respiratory physiology, and the same sialic acid receptors that human Influenza viruses latch on to. So, you can get Influenza virus from your ferret, as well as passing it on to your ferret, and they provide a critically important animal model for studying influenza and other human viruses.
However, I digress…
The exception to this general rule, a species-jump or spill-over resulting in a novel viral zoonosis, has certainly made life more complicated of late. Whilst some of the recent zoonotic viral epidemics and pandemics have originated in monkeys (HIV from Simian IV), birds (H5N1 and others) and pigs, in the last two decades three large-scale disease outbreaks, including the current SARS-CoV-2, are coronaviruses that originated in bats. others are SARS in 2003, MERS in 2012, and SADS (Swine Acute Diarrhea Syndrome). Two of those three outbreaks began in China.

Lismore Base Hospital is rolling out an eReferral system for its outpatient clinics. 

The system uses Healthlinks’ SmartForms technology which will be familiar to general practitioners who complete the NSW Road and Maritime Services driver's licence renewals online. 

To create the referral the GP’s usual software will download a Base Hospital eReferral form from HealthLinks servers. The form comprises a number of fields many of which will be automatically populated from the GP’s software. Related documents such as pathology and radiology reports can be uploaded as part of the submission. Once all mandatory fields have been completed the form is submitted. Electronic confirmation of successful submission occurs in milliseconds. 

Former Governor-General, the Honourable Dame Quentin Bryce has added her weight to the mounting campaign for clearer warning labels on alcohol in order to lessen the chances of pregnant women drinking and causing Fetal Alcohol Spectrum Disorder (FASD).

Dame Bryce is among signatories from more than 100 organisations and over 1,000 individuals of an open letter calling on food safety Ministers to prioritise the health and wellbeing of children. 

The issue of alcohol labelling will be revisited at the July 17 meeting of the Australia and New Zealand Ministerial Forum on Food Regulation, which at its last meeting declined to endorse the recommendation by Food Standards ANZ (FSANZ) to mandate stronger warnings about the known link between alcohol and harm to unborn babies (see GP Speak Winter 2020 issue).

The letter followed the release of a report on polling by the independent, not-for-profit Foundation for Alcohol Research and Education (FARE) showing that 70 per cent of Australians want clearer health warnings on alcohol products. 

Concerningly, people in the age group most likely to be thinking about having a baby are the least aware that drinking alcohol when pregnant is harmful to an unborn.