Medical outlook for 2005
Vaccinations Immunization continues to improve, as six-in-one vaccines
for children reduce the number of needles. Some new vaccines are now
being made available free for older Australians.
Problems with vaccines, such as the one for flu, still exist because,
maybe, we are somewhat complacent. Deaths at a Liverpool nursing home
in 2004 showed that only one in four patients and one in four staff
received their flu vaccine.
A good reminder is that the NHMRC recommends all carers, nurses,
doctors and people looking after patients at high risk of contracting
the flu should be vaccinated. Only about 35 per cent of staff in major
Australian hospitals gets vaccinated - not a good track record.
Because of the changes in vaccine recommendation, and better vaccines,
ask your doctor for the latest updates. A three-in-one tetanus injection,
which includes whooping cough, should stop the spread of that disease
to young babies.
Heart disease
Heart disease is, in many ways, managed differently now. First, we
try to stop the onset of problems by reducing, among other things,
blood pressure, cholesterol and sugar. Smoking is still a major cause.
We can also address heart attacks better. Our preference now is to
put a stent into the heart within an hour of the onset of heart-attack
symptoms, and thereby open the arteries. The stent can literally stop
the whole attack. If, after an attack, the heart fails, new treatments
keep people alive longer; and even heart transplants become more common
and manageable.
Now is a good time to live in Australia, from a health point of view,
but prevention is still the preferred option - even if we do a good
job of repairing the broken heart.
Cholesterol
Cholesterol has been associated with heart disease. A new drug has
been introduced into Australia this year to help lower cholesterol.
It is agreed around the world that the lower the cholesterol the better.
Once, a total cholesterol level less than six was good. Now, it should
be four, or even three. If a year has gone since you last had a fasting
cholesterol level done or, if you have cholesterol above five, it
might be time to recheck the level.
This is a problem you can do something about. Exercise and good
diet make a big difference, and make you feel good. Do it now.
Bowel cancer
Faecal occult blood testing - Australia has the third highest incidence
of bowel cancer in the world. Most researchers blame our diets but
are not sure if the problem is the high amounts of barbecue food or
low fibre.
Improving one’s diet seems the simplest way to fix the problem but,
because we will still have it for a while, Australia will soon run
a national bowel cancer screening programme.
For the last five years, we have argued about the best way to do
national screening for bowel cancer. We do it in a similar way to
that in which we now do breast cancer screening.
The test looks at blood in bowel motions (faecal occult blood [FOB]
test), and most people do not like the idea of testing their faeces.
Fortunately, the new tests are less offensive.
When agreement is reached about the age at which testing should start,
and how often is should be done, FOB tests will become a regular feature
for all of us. If a test is positive (blood found in the faeces),
further testing is needed to confirm bowel cancer. About one in 10
tests will reveal cancer.
SARS
SARS does not need isolation if it re-emerges. Recently published
data suggests that contact with someone with SARS will not necessarily
mean you need to be isolated.
The data concluded that strict isolation of people with SARS symptoms
should be enough to control the disease. SARS caused more than 774
deaths and 8,098 infections worldwide. At this stage, it has not re-emerged.
Blood supplies
Short supplies of blood products, and blood contamination, have long
been issues of concern. Passing on HIV has also been concerning but,
with our screening programmes, this should not happen in Australia.
Hepatitis C is routinely looked for, but people who have been in
the UK at the time of the mad-cow disease are still excluded.
It is no wonder there was excitement when the crocodile O2 carrying
haemoglobin seemed to be very like human blood. This raised the possibility
that the croc’s blood could be a source of artificial blood for human
transfusion. While the finding is exciting, the most realistic way
to improve blood supplies in Australia is for normal, healthy people
to donate as much blood as they can.
Australia has one of the safest and best blood donation services
in the world because of donors’ generosity. Keep it up.
Arthritis medication
Arthritis drug Vioxx was withdrawn this year because of the possibility
that it caused heart attacks.
The withdrawal cost the international drug company over $2.5 billion
in sales and, of course, some internal grief.
The research that revealed the drug’s shortcomings was examining
the reduction of bowel cancer that seems to come from some arthritis
drugs - including aspirin.
Research on laboratory rats (European Journal of Nutrition,
2004) suggests that an arthritis tablet, and the Mediterranean diet,
might help protect one against bowel cancer. Once again, this is good
research but a long way from proving the benefit.
