-Scholarly Pursuits-

Pay Attention

2011-12-01T21:27:00.000+10:30

I've recently come across a report inrelations to ADHD. This is an interesting and controversial area of medicine and psychiatry. ADHD is characterised by a number of symptoms including; inattention, hyperactivity and disruptive behaviour predominately observed in the paediatric population. The main stay of treatment for ADHD and associate disorders is psycho-stimulants drugs such as dexamphetamine. The diagnosis of this condition is on the rise particularly in preschoolers, where pharmacotherapy is being prescribed in favour of alternative approaches. The use of stimulants at such an early age has been recently endorsed by the American Academy of Pediatrics. This trend is a concern for me as a health professional.

The increased diagnosis and prescription of such medications may adversely affect these patients, in light of minimal long term safety data. Questions remain unanswered regarding the use of these agents, including the length of time the proposed treatment should be continued safely and how effective is the treatment long term. Furthermore, the diagnosis may lead to inappropriate classification of children, given the broad nature of the criteria encompassing behaviours that are a spectrum of childhood activity. This in turn may result in unnecessary exposure of children to stimulants and the associated adverse effects such as agitation, insomnia and anorexia. Moreover, pharmacological treatment may be perceived as a quick fix and eliminates the pressure and burden experienced by parents in the process of establishing behvaioural boundaries and discipling children.

Having said this, pharmacotherapy still plays a role in the treatment of ADHD particularly in conjunction to cognitive behavioural therapy. The outcomes may be in fact more favourable in such circumstances and negate the need for dose escalation. Additionally, the lack of treatment may result in poor academic and social interaction which may also induce a negative psychological impact and perpetuate behavioural dysfunction.

In conclusion, the higher prescribing of stimulants to young children is of concern given the lack of long term safety data and controversies associated with the diagnostic criteria. The treatment may serve as shifting parental responsibility in favour of pharmacotherapy. However, in some circumstance psycho-stimulant use is a must and its use should be in a judicious manner.

Health and Media: A Week

2011-11-20T17:15:00.000+10:30

Barriers to a good night's sleep

This brief article published in the Health Weekend Professional Australian, highlights the important role sleep plays in an overal approach to a healthy lifestyle and the consequences associated with poor sleep, particularly for patients suffering from sleep apnea. Patients suffering from this conditions can exhibit poor sleep due to brief cessation of breathing and the condition adversely impacts upon cardiovascular, psychological and lifestyle factors. Sleep apnea is frequently managed with the use of continuous positive airway pressure, which ensure the airways remain open. However, recent research sheds doubt upon the true efficacy of treatment and alternative approaches require further exploration!

GPs told to resist antibiotic requests for cough and colds

A report recently publicised by the UK Guardian highlights a commonly known and extremely disturbing fact that is provided very limited attention by health professionals; over prescribing and excessive use of antibiotics for the treatment of viral ailments. Whilst this report quantifies the British experience and the ever growing contagion of multi-antibiotic resistant bacterial organism, no doubt the pattern is similar in Australia. The issue stems from the lack of public awareness and the acquiesce of GP following request by patients experiencing the common cold. The issue is worsened by reports of antibiotic 'hoarding', a phenomenon I have witnessed in my community practice. The lack of interest in the development of new antibiotics by the pharmaceutical industry means more judicious use of antibiotics to halt resistance is a public health imperative.

http://www.guardian.co.uk/society/2011/nov/18/gps-antibiotics-coughs-colds

Teenagers having sex are a minority

Here is one for the concerned parent. This report by the New York Times highlights potential changes towards sex in the American teenage population. Research has identified a decrease in the rate of teenage sex in comparison to previous periods, greater use of contraception and a decrease in teenage pregnancy, although the US rates are higher than comparator countries. It would fascinating to examine the potential factors that have contributed to this observation, whether specific demographic and localities perform better. Interesting report nonetheless and how would Australia fair?

http://www.nytimes.com/2011/11/15/health/teenagers-having-sex-are-now-a-minority.html?ref=research

An Insight into the Genetics & Molecular Biology Laboratory

2011-11-14T18:47:00.002+10:30

A limited glimpse into the laboratory that I've spent a good portion of my past year in. The memory is laced with wonderful triumphant moments and periods of trepidation, self-doubt.

Research Acknowledgements

2011-11-14T18:33:00.001+10:30

Adapted from abduzeedo.com

My research could not have been accomplished without the help, support and guidance of wonderful individuals throughout my research year. It is with great pleasure and gratitude that I acknowledge their support:

I am thankful of my supervisor, Dr Michael Wiese for his patience, ongoing support and expertise throughout the written and experimental component of the project. He has played a pivotal role in my scientific understanding and research capabilities, for which I am deeply grateful.

I would like to express my gratitude to the staff and clinicians from the Department of Clinical Immunology & Allergy in Royal Adelaide Hospital for providing access to the clinical data and blood samples from participants involved in this study. Moreover, a sincere thank you to Dr Andrew Rowland at the Flinders Medical Centre Clinical Pharmacology Department for providing access to diclofenac and naproxen human liver microsome used in this study.

A special thank you to the staff at the Institute of Medical and Veterinary Science, who were involved in processing and separation of patient sera for use in this project. Additionally, I acknowledge the support of the laboratory technicians working in the Genetics and Molecular Biology Laboratory at the University of South Australia for assistance and training in the use of laboratory equipment.

Lastly, I would also like to thank my friends, family and partner for their endless support, advice and encouragement to pursue my dreams and instilling a passion for science and discovery. Without their enduring love none of this could have happened. I am eternally grateful for the sacrifices and hardship faced by my parents in order for me to experience all the wonderful opportunities afforded to me in Australia.

Research Abstract & More!

2011-11-13T21:21:00.002+10:30

After a delayed absence it is with great pleasure for me to report that I am back. The thesis and seminar presentation have been completed, allowing me to commence with regular blog updates of all things health. To celebrate my emergence from the ether, I have redesigned the blog with a more contemporary design thanks to Google! Additionally, what better way to kick start the blog by providing the abstract of my year long research and a glimpse into the laboratory which has been my second home for past year or so...I look forward to posting enlightening and topical subject matter in the field of health, research and academia. Stay tuned for regular updates!

Investigating the Underlying Pathophysiology of Selective Nonsteroidal Antiinflammatory Drug Hypersensitivity and Diagnostic Approaches

Background: Nonsteroidal antiinflammatory drug (NSAID) hypersensitivity reactions can be immune and non-immune mediated (anaphylactoid). Patients suffering from immune-mediated reactions demonstrate selective reactions to an NSAID in contrast to the anaphylactoid mechanism. The pathophysiology of selective hypersensitivity is unclear, but hepatic metabolism may play a role. The aim of the study was to explore the concept of selective NSAID hypersensitivity and demonstrate specific immunoglobulin (Ig)E towards haptenated proteins of human liver microsome (HLM) or parent NSAID and/or metabolites.

Method: Sera from 22 participants with a history of immediate NSAID hypersensitivity were obtained from the Royal Adelaide Hospital Immunology Department. Circulating IgE in pooled sera towards diclofenac/naproxen, as well as metabolites conjugated to human serum albumin and polylysine were investigated via enzyme-linked immunosorbent assay (ELISA) and dot blots. The role of hepatic metabolism was explored via western blotting using HLM incubated with diclofenac/naproxen and co-factors instigating key metabolic pathways in the presence of pooled participant sera.

Results: Clinical data was obtained and 7 participants were classified as selective-reactors, 8 were cross-reactors and 7 were NSAID tolerant. No specific IgE towards parent diclofenac/naproxen and metabolite conjugates were detected, although the carrier polylysine caused non-specific IgE binding. Circulating IgE towards haptenated HLM proteins also appeared to be absent.

Conclusion: The lack of specific IgE towards NSAID/metabolite is incongruence with previously published literature. However, circulating antibodies targeting haptenated hepatic proteins have been detected in particular for diclofenac, contrary to the study findings. Thus, more research is required to explore the pathophysiology of selective NSAID hypersensitivity.

A Short Break

2011-09-19T23:28:00.000+09:30

Dear Loyal Readers

You may be wondering why the silence, the absents posts or the in frequent replies. I am aware and keen to recommence with the commentary, reviews and analysis. Alas! I am juggling work, full time research and intensively occupied with completing my thesis. I look forward to recommencing the blog and frequent postage over the next few weeks. Stay tuned to this frequency as I will be back bigger, stronger and a little bit wiser!

Kind regards

Hamed

Health & Media: A Week

2011-08-14T18:49:00.000+09:30

Hi-Tech Stimuli Help to dull the pain

This one is for the avid video game connoisseurs and virtual reality enthusiasts. An article in the Weekend Health reports the potential role virtual reality may provide in rehabilitation of stroke patients and the appeal this may have for younger patients who readily lose interest in the routine and tedious physical activity regiments. Moreover, researchers have successfully employed video game consoles such as the Nintendo Wii and Ipad applications to assist in fine motor tuning and cognitive exercises. Research has also investigated the role these novel approaches have upon pain perception and have demonstrated success in augmenting analgesic benefits of pharmacological agents and the potential role in the paediatric population. Although this is the starting point and more trials are required to compare efficacy of this approach to standard-care treatment, it is nonetheless fascinating!

http://www.theaustralian.com.au/news/health-science/hi-tech-stimuli-help-to-dull-the-pain/story-e6frg8y6-1226113730661

Pulsation reveals which embryos have the chance of success in IVF

Research at cambridge have developed a novel tool to assess the viability of fertilised eggs for use in IVF. Currently, there are few good tools available for this purpose and to ensure successful implantation and pregnancy multiple fertilised eggs are insert into the female uterus. This is one of the reason why twins, triplets etc are common occurrence in IVF pregnancy. Moreover these can further increase the risk of harm to foetus competing for the same resources and may place the mother at risk of miscarriage and pregnancy complications. The team at Cambridge University is using the pulsation of embryos as a tool to assess viability of fertilised eggs to aide in selection of the embryo most optimal for implantation. The data derived from mouse models indicates a higher pulsation rate is correlated with greater success for live pregnancy. However, as yet no work has been performed in humans to examine applicability. Read on:

http://www.guardian.co.uk/science/2011/aug/09/pulsations-embryos-success-ivf

http://www.nature.com/ncomms/journal/v2/n8/full/ncomms1424.html

Blood test can tell fetal sex at 7 weeks, study says

On the theme of pregnancy and childbirth, a new blood test can determine the sex of the baby in as early as 7 weeks post conception. The test assesses the DNA of foetus circulating in the mother's blood and negates the need for more invasive procedure such as amniocentesis. The test has been available for a number of years but little is know about its sensitivity. Moreover, the procedures have not been standardised and may vary across different labs. The recent article in JAMA has shed light on the specificity and sensitivity of the test and could pave the way for greater use in the future. The dark-side of this tool is the advent of greater gender-selection and early abortion, where the 'undesired' sex is detected. The upside is the early screening of gender-related genetic disorders which can be detected much earlier than previously and the ability for expecting mothers to perform such tests at home. What are your thoughts on this?

http://www.nytimes.com/2011/08/10/health/10birth.html?ref=health

http://jama.ama-assn.org/content/306/6/627.abstract

Super Clinics: a benefit or lost cause

2011-08-13T20:27:00.000+09:30

Adapted from the Australian

I've been highly interested in whether super clinics may or may not be of benefit to our ageing population's healthcare needs and have been avidly following developments. A recent report in The Australian newspaper has provided me with a perspective that I have not considered in the past. Super clinics are purported to provide a well-rounded suite of clinical and healthcare services which encompasses service delivery from both GPs (centric) and other allied health professionals. It serves as a one stop-shop and provides greater access with an emphasis on after hours care to those in need.

Nevertheless, a number of obstacles have arisen and the implementation has been riddled with controversy. For example there have been cases of clinics established in areas with adequate community healthcare availability. Moreover, some have been situated in areas of political importance to minimise voter backlash and sandbagging. Additionally, there is little evidence as yet that these services reduce emergency department attendance (most likely attributed to inflexible after hours service). Thus demonstrating the deficiencies in this poorly executed endeavour. Moreover, recent reports have highlighted the negative impact and adverse workforce pressures these clinics are inducing. Small clinics have been forced to close or downsize. Furthermore, super clinics have been noted to poach general practitioners as well as exacerbating regional medical workforce shortages. Additionally, some clinics are dominated by male practitioners which may deter female patient attendance.

However, there positives to support the utilisation of super clinics. Firstly, bulk billing services may improve access to healthcare for the economical disadvantaged and may encourage more frequent medical check ups. These clinics can foster greater participation and support from allied health professionals to optimise patient care. Super clinics can also serve as a fantastic training site for healthcare professionals of the future and with greater awareness decrease pressure on hospital emergency departments. I'm interested in what you the readers think of super clinics.

Health and Media: A Week

2011-08-07T15:44:00.000+09:30

Help at hand for cancer survivors

So you've been diagnosed with cancer, underwent treatment and thankfully were rid of the cancerous cells threatening your life. Post treatment you are elated, thankful of modern medicine and advancement which has given you a new lease on life! Yet you feel exhausted, depressed, anxious of the recovery process and where to seek support. This article in the Weekend Health encapsulates the recovery challenges bravely faced by cancer survivors. It is an area which I have given little thought of as the focus in my pharmacy training has been the diagnosis, treatment of cancer and the expected adverse reactions associated with chemo/radiotherapy. A first in Australia is a charity organisation established by cancer survivor Rick Christie that aims to address this by providing survivors with the knowledge and expertise to facilitate recovery post treatment. The beauty of this group is that it is not restricted to only adults but also to improving the lives of paediatric patients, who often have more to gain from such support.

http://www.theaustralian.com.au/news/health-science/help-at-hand-for-cancer-survivors/story-e6frg8y6-1226108316575

Drugs have been found ineffective for Veteran's stress

Post traumatic stress disorder (PSTD) is prevalent in soldiers serving in wars, specially those deployed over a prolonged period of time. This is especially applicable to Australian soldiers serving overseas in Iraq, Afghanistan and those returning home to loved ones. PSTD in in this population is managed by antidepressants and in refractory cases antipsychotics such as risperidone and quetiapine. A recent study published in the JAMA and reported by the New York Times identified that such treatment have been found to be ineffective and no more beneficial than placebo with greater risk of adverse drug reactions. This highlights difficulties in the treatment of PSTD, specially given the reluctance of many soldiers to seek help and overcome the stigma associated with mental-health.

http://www.nytimes.com/2011/08/03/health/research/03psych.html?ref=health

Who falls to addiction and who is unscathed

This New York Times article follows from the recent death of Amy Winehouse and her publicised struggle with alcohol and drug addiction. The article provides a fascinating perspective on the underlying of cause of addiction and those at risk of succumbing to its lure. It highlights that individuals who suffer from psychiatric or personality disorders may be at a greater risk. Furthermore, it may exemplify a vicious cycle whereby substance abuse exacerbates the psychiatric illness leading to further substance abuse as a source of remedy. Moreover, the article discusses the role of the environment and the nature of the individuals brain (specific focus on the dopaminergic pathways) as potential risk factors that may increase risk of addiction in those with diminished susceptibility. A fascinating read:

http://www.nytimes.com/2011/08/02/health/02abuse.html?ref=health

Journal Club: Dose-dependent association between UGT1A1*28 polymorphism and irinotecan-induced diarrhoea: A meta-analysis

2011-08-03T19:58:00.002+09:30

This weeks journal club article was courtesy of a PhD student who is partway in completing her postgraduate studies. This is an unconventional journal for a journal club discussion, as it its not a typical trial rather a meta-analysis looking at the anticancer drug irinotecan, commonly used in the treatment of metastatic colorectal cancer in conjunction with other cytotoxic agents such as 5-flurouracil and oxaliplatin. There is uncertainty about the effects of genetic polymorphism of the glucuronidation enzyme UGT1A1 and increased incidence of diarrhoea, a frequent and potentially deadly adverse drug reaction associated with this drug. The authors try to explore this by performing a meta-analysis of the published trials, which report data relating to this genetic polymorphism.

The article is published in the European Journal of Cancer, a peer-reviewed journal that publishes original research, editorial comments, review articles and news on basic and preclinical research, clinical oncology (medical, paediatric, radiation, surgical), translational oncology, and on cancer epidemiology and prevention. Additionally, the journal has an impact factor of 4.9 and to date the article has been cited 4 times (not surprising given the relatively recent publication).

The article in review is titled: Dose-dependent association between UGT1A1*28 polymorphism and irinotecan-induced diarrhoea: A meta-analysis. It is descriptive and sets out the objectives of the three authors. It provides the reader with a clue of the possible research methodology, statical analysis and reporting structure that one may expect from a meta-analysis. Moreover, the authors are either affiliated with an academic institution or hospital.

The abstract of this article is thorough but I found the style (may be enforced by the Journal) convoluted. typically the abstract is divided into the various components that we can come to expect in an article ie. background, methodology, results, discussion and conclusion. Whilst these were not explicitly differentiated the information was present and it provided a clear summary of the intention and study outcomes.

The introduction provided the reader with an in depth overview of the therapeutic role of irinotecan, mechanism of action and the expected adverse drug reactions (specific focus on diarrhoea and neutropenia). The introduction is completed by informing the reader about the polymorphism under investigation and the specific aim of the meta-analysis.

As is the case with systematic reviews, the procedures used by the author to identify articles for the meta-analysis, including how the articles were identified as well as inclusion and exclusion criteria were discussed. However, I found the exclusion criteria should have been more scrupulous and expanded to eliminate other confounding variables (I'll talk about later). Authors assessed the quality of studies, although this was not preformed by a none affiliated researcher. Furthermore, statical testing was clearly set out to examine heterogeneity between the published papers, statistical significant of the result etc..I have to admit I was not familiar with the Egger test, as well as the Duval and Tweedie nonparametric 'trim and fill' procedure.

The result of the study were interesting to say the list. Interesting because several confounding factors were not adequately addressed in this study (no mention in the discussion), such as the role of additional chemotherapy agents on the occurrence of diarrhoea, which may have been falsely attribute/worsened irinotecan-induced diarrhoea. Moreover, how were potential alterations in dose of irinotecan in such patients accounted for by the authors, given the fact that the results were stratified according to irinotecan dose. In addition, how were differences in actual protocol between study regions (Europe, Asia and USA) accounted for? Nevertheless, the authors attempted to address some of the shortcomings by performing a meta-regression that indicated study design, age or sex ratio was not significant source of heterogeneity in the data.

Having mentioned several of the discrepancies in the meta-analysis the authors concluded that polymorphism of the glucuronidation enzyme is indeed associated with a greater risk of severe diarrhoea and that there was no ethnic differences. This is indeed supported by the study data and the odds ratio, bearing in mind that most individual studies did not demonstrate a statical significant odds ratio. This article is a great starting points for academic and health professionals interested in understanding how a meta-analysis is developed and the typical data representations eg. forrest plots.

Let me know what you think. If you would like the article send me a comment and an email address. I'll provide you with the article as soon as I can.

http://www.sciencedirect.com/science/article/pii/S0959804910001875

Health & Media: A Week

2011-07-31T20:34:00.001+09:30

Medical Research Warning Over Human cells into Animals:

A panel of medical researchers and ethicists led by Professor of Medical Genetics at the University of Cambridge is exploring the ethical and moral dilemmas that are arising with the advent and greater use of genetic manipulation of animals to exhibit human qualities for the purpose of research into conditions such as Down's Syndrome. The article highlights that society must monitor such research, particularly as newer techniques are developed to genetically explore human diseases in animal models. This is to ensure research is conducted appropriately with minimal harm to animals and the greater population. The panel suggests upfront public discussion and debate regarding potential research as well as establishing independent ethics panel with a specific focus in assessing such experiments. This article incidentally ties to recent reports of a glow in the dark genetically modified dog by South Korean Researchers. For the full articles:

http://www.guardian.co.uk/science/2011/jul/22/medical-research-humans-animals-regulation

http://www.reuters.com/article/2011/07/27/us-korea-dog-idUSTRE76Q1MK20110727

Drug for hyperactivity may help reverse memory decline in ageing brains

This is an interesting piece of research published in Nature and reported by the Guardian Newspaper. Researchers at Yale have identified the secondary signalling chemical cAMP may play a role in working memory loss by investigating a drug that helps counter-act the effects of the messenger molecule. This drug brought about more noticeable restoration in the brains of elderly monkeys in comparison to the younger alternatives. This is exciting because it may pave the way for greater understanding of memory as well as improving brain function and management of conditions such Alzheimer's disease which is becoming more prevalent in our increasing ageing population.

http://www.nature.com/nature/journal/vaop/ncurrent/full/nature10243.html
http://www.guardian.co.uk/science/blog/2011/jul/29/drug-hyperactivity-memory-decline-ageing

Chronic demand squeezing the life out of our medical system

It has been a hot week for medical reporting in the news, with the Weekend Australia dedicating two broadsheets on the future of our healthcare system in the Inquirer. The article discusses the advancement in the management and treatment of patients in the Australia healthcare system and cites statical data to support the claims made. However, the fascinating aspect of the feature begins with the assessment of the challenges of an ageing population on the healthcare system and the impact this will have upon our provision of health-related services and subsidies. The complexity of the scenario is made evident with the rise of obesity and sedentary lifestyles in the younger generations which will place further pressure on a system reaching its maximum capacity. A number of solutions are explored by the author such as judicial use of diagnostics, greater scrutiny of new treatments by health economists and a move from the disjointed and complex "silo" medical models, where a chronically ill patient may visit several consultants with shifting responsibilities.

http://www.theaustralian.com.au/national-affairs/health-of-the-nation

(other interesting reports on the web page)

Pharma giant pays a price for loyalty scheme

As Pfizer struggles to come to grips with the soon to be off-patent block buster drug Lipitor it seeks to find new strategies to maintain its stranglehold. This article follows the heated withdrawal of Pfizer drugs from wholesalers and negative consequences this has had for patient access to the company's drugs. I have had first hand experience with this issue and have been formally involved with a petition to our local MP.

To further limit pharmacist adoption of generic alternatives, which could potentially save the PBS millions, Pfizer plans to pay pharmacist incentives to ensure patients remain on Lipitor by directly paying and providing subsidised access to the company's catalogue of generics. Should we as a professional body allow Pfizer to dictate the terms of our conduct and should we allow Pfizer to further jeopardise our ability to care for our patients?

PBS Expenditure: Is it fair to blame?

2011-07-27T20:46:00.001+09:30

I feel slightly disappointed with the recent coverage in the Australian and their exclusive reporting on pharmaceutical expenditure. My gripe with the recent events emerged from an article unfairly criticising community pharmacies, as means to attack the backbone of pharmaceutical supply in this nation, the Pharmaceutical Benefits Scheme (PBS). The article highlighted cost differences between over-the-counter paracetamol preparations ($2 add a discount pharmacy) vs the cost associated with a prescription supply (approximately $12 for 3 boxes). This is a petty issue but it is important for me highlight the key facts that were excluded in the newspaper article and draw the reader's attention to the endemic problem that exists.

The author criticised the inefficiency of the PBS and cited this example along with a subsequent example in today's paper with regards to other generic brands. The author generalised all paracetamol preparations (included sustained-release formulations), she failed to highlight that costs over-the-counter are dependent upon suppliers, the buying power of the pharmacy and demand (which may differ between pharmacies). The author's prices were based upon discount pharmacies which are not representing of the profession and which patients may not have ready access to. Consequently, her suggestion for paracetamol to be eliminated from subsidisation on the PBS is prematurely unfounded based on the aforementioned points. Additionally, the elimination of paracetamol may pave the way for the use of less desirable first line analgesics, which may paradoxically increase expenditure through increase in adverse drug reactions, abuse and long term safety concerns.

Whilst I agree with the need for optimisation of the PBS to ensure timely registration and subsidisation of new treatments, I believe it is unfair for pharmacies to be the escape goat of this issue. This is a groase simplification of a complex issue in the advent of an ageing population and rising pharmaceutical costs. Healthcare inefficiencies should be managed across the broader system from pharmaceuticals to provision of care by doctors, nurses and allied-health professional. Cost-saving should not just apply to the pharmacy profession (already struggling with downward pressures) and the PBS but to the entire system to ensure equitable access to healthcare for future generations. Savings in multitudes of area may pave the way for adoption of near treatments that have demonstrated cost-effectiveness and utility. So lets stop this finger pointing exercise and lets work together to ensure that we are prepared for the healthcare challenges of the future!

Health & Media: A Week

2011-07-24T20:20:00.000+09:30

Early trauma takes a long-term toll:

It is some what intuitively obvious that our experiences in childhood may play an important role in our development into adulthood and influence our perception and personality. An article in the Weekend Australian Health describes how these experiences, if traumatic can instigate life long mental illnesses and sadly go unrecognised by psychologist and psychiatrist. The article alludes to the aforementioned professions focus on the biological and symptomatic management of these traumatic manifestation with little regard towards the holistic nature of the disorders. However, these origins of mental health problems are becoming more and more recognised, attempts are being made to ensure early childhood interventions, before significant disease progression occurs. Having said this, it is unclear if current treatment strategies may suffice in managing such patients and whether long-term cure can be achieved.

http://www.theaustralian.com.au/news/health-science/early-trauma-takes-a-long-term-toll/story-e6frg8y6-1226099244794

Anti-HIV monoclonal antibodies produced in GM plants:

I was blown away by this news when I read the article, although no official publication of the trial is as yet available. This is another example of the ingenuity of the human race that may bring about wide scale benefits for individuals. The research group has been able to successfully develop monoclonal antibodies in plants and upon subsequent purification processes produce pharmaceutical grade agents. The procedure is claimed to be up to 100x cheaper than conventional approaches. This has huge implications for the developing countries where access to life-saving treatments is often hampered by cost, ease of access and cold chain requirements. Imagine if such treatments could be locally produced via GM plants. Perhaps an unstated aspect of this is the reduced carbon foot print. Julia Gilard sleep easy!

http://www.guardian.co.uk/science/2011/jul/19/anti-hiv-drug-gm-plants

Male Contraceptive:

Women have always been at the forefront of pharmacological methods of contraception. However, as it turns our men may play a greater role in the near future. Male methods of pharmacological contraception have been under investigation for a number of years with data relating to the extend of efficacy and potential risks emerging. There are a number of approaches employed such as inhibiting sperm generations (testosterone, progestin), altering sperm motility (targeting calcium channels on sperms) to inhibition of sperm maturation (retinoic acid). However, much more research is required to establish safety, long term efficacy as well as the most optimal methods of delivery (gels, depot injections and oral formulations). With the backing of the pharmaceutical industry and government agencies, no doubt male contraception may become a future reality.

http://www.nytimes.com/2011/07/24/health/research/24contraception.html?pagewanted=1&_r=1&ref=health

Emergency Hospital Visits- A New York Times Blog

2011-07-18T14:21:00.000+09:30

Whoever has been admitted to a hospital's emergency department will undoubtedly agree with Dr Chen's commentary on the current status with a particular focus on the American hospital system, which is extensively reliant on health insurance to operate. Dr Chen's essay is a follow up of a letter submitted to the New England Journal of Medicine by Dr Maa (June 16, 2011) titled: The Waits That Matter, which paints a personal picture of the impact of extensive waiting times in ED and the traumatic experience that may be afflicted to patients and their family. I'm sure all health professionals can appreciate the broad and far reaching scope of this problem. From my experience working in a busy hospital I can attest for the chaos, lengthy waiting times and hectic nature of the ED.

It is for these reasons that immediate action is necessary and steps are taking place to address this growing problem. In the UK limits have been imposed to waiting times in ED. Dr Chen highlights moves in the American healthcare system to rectify this problem through changes in priorities, further allocation of resources and personal. As a pharmacist, I believe we can play integral role by ensuring medications are available in a timely manner and assistance to physicians in obtaining an accurate medication history. Furthermore, extension of working hours within the department can allow the physicians greater access to ward pharmacist, which serve as an important link to other components of the hospital pharmacy department. I'm keen to hear your thoughts on this ballooning healthcare challenge!

http://well.blogs.nytimes.com/2011/07/14/when-hospital-overcrowding-becomes-personal/?ref=health&gwh=32548F4FFCBEBD12EBA05E0124631F6A

Health & Media: A Week

2011-07-17T14:31:00.001+09:30

Adapted from CurtisJoeWalker

Stool solution for deadly colitis
This article summarised the C. difficile outbreaks and the limited therapeutic strategies for the management of the infection (advent of resistant strains) and the current colonic impacts of the bacterial over growth. The weekend health article discusses an conventional treatment for the management of the severe cases via transplantation of stool from a healthy donor to the infected patients. The author admits that currently there is very limited experience with this radical treatment, a side from observational and anecdotal evidence. Having said this, currently there are no cost effective strategies for the management of outbreaks and the consequences can be devastating for the patients (colostomy).

http://www.theaustralian.com.au/news/health-science/stool-solution-for-deadly-colitis/story-e6frg8y6-1226095211667

Uproar on the road to healing

A second article in this week's Australian Weekend Health follows on similar complimentary medicine theme discussed last week. However, this time the row is between two medicos, one (previous AMA president) supporting the integration of complimentary medicine in the prescribing arsenal of physicians and the other (medical professor) claiming such a move belittles the importance of evidence-based practice and constitutes support by the profession for certain dubious alternatives therapies. As a pharmacist, I whole-heartily advocate evidence-based practice (frankly as a profession we should implement more of this) and guidance for patients regarding the risks and benefits. However, I allow the judgment about the use of alternative therapy to the patients (where safety can be ascertained).

Vaccines, the CIA, and how the War on Terror helped spread polio in Nigeria

The next article is from the Guardian UK discussing the vaccination debacle which has unfolded in Pakistan and the previous experience in the continent of Africa (specifically Nigeria). The article discusses the challenges of mass vaccination and the trust required for the task to successfully become implemented. This trust is fragile, specially where lack of education and incorrect understanding (means of populations control, sterility, introduction of HIV etc...) of the quintessential outcome is rife. The problem is exacerbated by recent rumours of CIA vaccinating children residing in Abbotabad to gain genetic information that may have identified the family of Osama Bin Laden (sounds science fictionesque)

http://www.guardian.co.uk/science/the-lay-scientist/2011/jul/15/1

Critic: Is Higher Education Overrated?

2011-07-13T17:51:00.002+09:30

Adapted from the Australian Literary Review (Tom Jellett)

What a fascinating read this was. It provided me with a perspective that is rarely reported in academia! Education is the foundation of development, advancement and social harmony, as such the western world in particular the US, UK and Australia have a particular interest in expanding higher education participation and have in fact established national participation goals. However does higher education participation automatically yield progress in our contemporary society? Professor Glyn Davis, the Vice-Chancellor of Melbourne University tries to answer this through his analysis of recent published evidence.

He sites several authors and publications that aim to clarify the impact of higher eduction attainment in an era of ever-growing university participation. The picture isn't pretty, as research highlights despite greater undergraduate qualifications many graduates lack the necessary skills such as critical thinking, communication and writing skills that are demanded in the workforce. Davis tries to explore why this is the case and identifies several concurrent factors at work. Commonly the finger is pointed at academics and the priorities of the institutions that may rely on out-dated practices and extensive focus on research and publication output. How can we expect these institutions to provide a modern and relevant curriculum, which is student focussed. Davis does not just blame the organisations but also the places responsibility on the students themselves. He cites research indicating that students are simply not prioritising academic endeavours for a number of reasons (e.g. socialising, employment, lack of motivation etc..).

He concludes his essay by advocating the importance of liberal arts and a shift towards postgraduate education in similar fashion to the US. I must admit that I agree with the general points and concerns he has expressed regarding the pitt-falls of greater university participations and a shift in priorities of the institutions. However, my gripe with his article relates to his biased view of Australian Universities and the impression that other international universities have not adopted modern approaches in teaching. Moreover, a side from the introduction of CLA tests he does not provide many solutions to improve the quality of teaching and learning in our Universities.

What are your experiences with higher educations and do you think it provided you with the foundation to meet the challenges of the work-force?

http://www.theaustralian.com.au/news/arts/hitting-the-books-or-booking-the-kegs/story-e6frg8nf-1226084956529

Critic: Those Happy Pills A New York Times Opinion Piece

2011-07-12T18:38:00.001+09:30

I know, I know I promised to discuss the UniSA Personalised Medicine Journal Club article. However, I've had a change of heart and have decided to adopt a less formal article, an opinion piece in fact by psychiatry Professor Peter D. Kramer residing at Brown University, Rhodes Island USA. Psychiatry, mental illness and the treatment of conditions associated with the psyche are an area of enormous interest to me. These conditions are predominantly silent and assail the sufferer in a private struggle that alters perception, reality and may ultimately result in suicide. So I've taken it to liberty to discuss Kramer's opinion regarding the effiicacy of antidepressants and the recent negative media portrayal.

Professor Kramer introduces his opinion piece by highlighting the controversy surrounding the use of antidepressant and the potential placebo effects that have been heavily publisised of late. He quotes the editor of New England Journal of Medicine and research by Dr DeRubeis (advocate of non-pharmacological management) which alluded to the limited efficacy of antidepressants. However, he remains firm in his belief that antidepressants are efficacious and quotes anecdotal experience of a friend suffering from stroke.

Moreover, he questions the assessment of the FDA and the design deficiencies (e.g. inappropriate patient recruitment, alternative end points) of trials as reasons why placebo has such a dominant effects. He supports this point by suggesting two specific study designs, which may demonstrate differences in efficacy, narrow (assessment of efficacy in niche conditions) and broad (large scales trials). In my opinion he raises valid points regarding study design but discussion about unpublished literature demonstrating poor treatment outcome and publication bias undermines his argument. Moreover, his reference to 'neural block' that antidepressants supposedly eliminate, as a potential mechanism of action is interesting but is unfounded. Nevertheless, his case is supported by the distinction between alterations in therapeutic efficacy between severe (more responsive) and mild depression. Also, it appears as though he values the placebo effect as legitimate approach.

My biggest beef with his article is the fleeting mention of side effects, which can be problematic specially with older agents. Additionally, he does not address the over prescribing of antidepressants and the importance of non-pharmacotherapuetic approaches (e.g. cognitive behavioural therapy) in management of depression. Why does he not compare this to antidepressants, as a point of discussion?

I'm keen to hear what you guys think! Feel free to leave a comment.

http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepressants.html

A Week in Health

2011-07-10T17:45:00.002+09:30

There have been a number of health outcomes and research publicised in the media this week, of which some relate to the pharmacy profession.

The most outstanding sensational national news is an ongoing legal dispute between a complimentary medicine manufacturer and the regulatory agency Therapeutic Goods Administration, Australian Competition and Consumer Commission and an academic at the La Trobe University. It is a fascinating scenario that encapsulates the problematic issues that arise from the medicinal registration system utilised in Australia, more specifically the R and L categorisation. Moreover, it brings to light the negative image that is portrayed by the pharmacy profession (not all of course) that support the dubious weight loss product of this particular company. It demonstrates the conflict between business interests and our desire to practice in a evidence-based manner.

http://www.theaustralian.com.au/news/health-science/weight-loss-nasal-spray-saga-shows-up-watchdog/story-e6frg8y6-1226090175156

The next hot item is not so much a clinical orientated health news but rather equitable access to medications by patients in Australia. For those who are aware one of Pfizer's blockbuster drugs is soon coming off patent in Australia, paving the way for generic production of atorvastatin, which could potentially save patients and the government millions by driving down the acquisition cost of atorvastatin. However, to retain market share and dominance Pfizer has defied the current medication distribution models utilised in Australia and opted for a direct delivery of Pfizer related medications. This has created concern about timely access to the companies catalogue of medications and complaints have been raised by pharmacist around the country about late delivery of medications, particularly in a rural setting.

http://www.theaustralian.com.au/news/health-science/drug-giants-opt-out-fuels-consumer-fears/story-e6frg8y6-1226090170728

Stayed tuned over the next day or two as I will be critically evaluating a pharmacoeconomic research article for Hep C treatment, to be discussed in the weekly Journal Club.

A brief statement of purpose

2011-07-06T20:51:00.000+09:30

This is the first post of hopefully many insightful, interesting and scholarly discussions, with a special focus on health and research. To place this blog in to some sort of perspective, I would like to briefly mention a little about myself and what you should expect from my future blog posts.

I am a young health professional, graduating with a degree of pharmacy after which I was privileged to undertake intern training at a busy metropolitan hospital. My work in the hospital instilled in me a passion for research, education and clinical implementation of research into daily practice. Upon completion of my training I returned back to university to pursue research with the school of pharmacy and medical sciences. I'm greatly enjoying research despite the obstacles and challenges associated with such a fulfilling endeavour.

I hope to cover insightful research articles in all facets of health and medical conditions reported in the literature. Having said this, the blog is not restricted to just health but I hope to post articles relating to Australian current affair, world and environmental issues and any other riveting observations. No doubt I will mention a little about my own experience as a young health professional undertaking research and practicing as a pharmacist....so stayed tuned and feel free to comment.