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Ross Walker
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Strokecheck: does it cause more harm than good?

Thursday, April 20, 2017

By Ross Walker

Concerns have been raised about a new service known as Strokecheck, which is offered in certain pharmacies in Australia. These pharmacies host general practitioner consultations, where the person is questioned about the risk factors for stroke and if they are significant. A free ultrasound of the carotid arteries is offered. Strokecheck appears to be significantly promoted on social media and has also combined with a gym, a university and a large company to promote the service.

But, this has raised significant concerns within the medical profession. The president of the Australia and New Zealand Society of Vascular Surgeons, Dr Bernard Bourke said, “I am concerned the group is disease-mongering and masquerading as a charity to make money out of Medicare. It’s a rip off”, he said. “They’re putting the fear of God into people”.

Dr Bourke went on to say that “there was absolutely no evidence that people without symptoms of stroke should be getting screened for the stroke risk and having ultrasounds. This decision should be made by consultation with their regular general practitioners”.

Dr Bourke quoted a recent review by the US Preventive Services Task Force, which concluded that general screening in the population using ultrasounds of the carotid arteries for stroke risk caused more harm than good.

So, what is the reality here? Firstly, it is my strong opinion that any ultrasounds should be performed by highly trained technicians and reported by specialists in the area who are reading these all of the time. The results of carotid ultrasounds can often be over-interpreted leading the patients to believe they have more issues than is really the case.

Also, an important point left out of the debate in an article published in the Sydney Morning Herald on March 25 is that carotid atherosclerosis is only one cause of stroke, and a normal carotid scan does not mean you are risk-free. Secondly, many people over the age of 60 will have a degree of carotid atherosclerosis which will never cause any issues.

Let me make the point that the two major risk factors for stroke are hypertension and atrial fibrillation. The presence of significant hypertension - which is typically long-standing, poorly controlled high blood pressure or atrial fibrillation - will immediately alert a doctor that the sufferer has a higher risk for stroke, requiring further investigation and management.

These two major factors aside, there are five categories of stroke that need to be considered as the underlying factors which need investigation and management.

1)  Carotid atherosclerosis - this is a major cause of stroke and the reason the carotid scanning is being offered. In my opinion, however, it is being offered in the wrong setting by the wrong people.

2) Lacunar infarction - this is typically a different type of stroke, with a very dramatic presentation. But, in many cases, there’s a complete recovery, or the person is left with minimal disability. The real cause here is a bout of poorly control blood pressure. The management is, of course, better control of the blood pressure.

3) Cerebral embolism - although there are many causes of cerebral embolism, the major factor is atrial fibrillation. Atrial fibrillation is where the top chambers of the hearts develop a chaotic rhythm, where these chambers quiver without effective contraction. Because there is then sluggish flow within these chambers, small clots can form which may then break away and travel up to the brain - potentially causing a stroke.

4) Paradoxical embolism - the commonest cause of this condition is a Patent Foramen Ovale. In utero, this communication between the right and left atrium in the heart is open because we derive our blood supply and oxygen from the umbilical vessels. When we take our first breath, the pressure on the left side of heart increases, typically closing the flap. But in around 30% of cases, a small communication is left. If a clot forms on the venous side of our circulation (with situations such as prolonged immobilisation), it may break away and travel up towards the lungs. If it is going through the right atrium at the wrong time, and for some reason the pressure increases on the right side of the heart such as is seen with straining, coughing or sneezing, the small clot can be forced across this flap and again can travel up to the brain where it may cause a stroke.

 5) The final relatively common cause of stroke is a disorder of blood clotting. Any condition that makes the blood thicker may precipitate the formation of a clot, and thus, a subsequent stroke, if this occurs in the cerebral circulation. There are eight relatively common genetic causes of excessive blood thickness, the commonest cause being a condition known as Factor Five Leiden. But there are also acquired causes that typically occur as one ages. This is especially so over the age 50, and is commonly associated with medical therapy such as hormone replacement therapy, chronic inflammatory conditions, and even cancer. 

There are a number of other rarer causes of stroke which are outside the scope of this article, but clearly having a screen in a pharmacy is not, by any means, an adequate assessment. And in some cases, it may cause excessive worrying about something that is purely a normal aspect of ageing (such as minor carotid atherosclerosis) and in other cases, may falsely reassure someone that they do not have a risk of stroke and therefore, they may not seek proper medical attention.  

As always, these matters should be managed by a competent physician.

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4 good reasons to eat your fruit and veggies

Thursday, April 13, 2017

By Ross Walker

One of the most accepted truths in medicine is the benefits of regular ingestion of fruit and vegetables. It’s been the standard suggestion for many decades to have, on a daily basis, two to three pieces of fruit, along with three servings of vegetables. A serving is half a carrot, as an example.

The regular ingestion of this dose of fruit and vegetables is associated with reductions in all forms of cardiovascular disease, cancer, and many other chronic conditions. It’s a sad fact that only 10% of modern society would consume this amount of fruit and vegetables on a regular basis.

There have been four recent studies which have reinforced this notion to an even greater level:

Study One

The regular ingestion of fruit and vegetables is associated with lower rates of lung disease. A study of 44,000 Swedish men, aged between 45 to 79 who were followed up for 13 years, showed over 60% had smoked at some stage in their life, 24% were current smokers and just under 40% had never smoked.

During this time, just over 1900 cases of chronic obstructive pulmonary disease (COPD) were diagnosed. The rates of COPD in those who had less than two servings per day of fruit and vegetables were 1,166 per hundred thousand cases in current smokers, and 506 per hundred thousand in former smokers. When compared with those people who had five servings of fruit and vegetables per day, there was a 35% reduction in the risk of COPD.

Interestingly, it appears that the best benefits come from leafy green vegetables, capsicum, apples and pears. Interestingly, there was no effect in regard to COPD from the regular ingestion of berries, citrus fruits, bananas, roots and cruciferous vegetables, tomatoes, garlic, onions and green peas.

Study Two

The second study looked at the relationship between fruit and vegetable intake and dementia. It’s estimated that around 47.5 million people suffer dementia globally and this is expected to triple by 2050. Having the recommended two pieces of fruit and three servings vegetables per day has been demonstrated in the study to show a significant reduction in dementia. The study looked at 17,700 older Chinese adults who were followed up for six years.

There was an even greater reduction in dementia seen with every extra three portions per day of fruit and vegetables. It is felt that the protection against dementia seen in the regular ingestion of fruit and vegetables is due to the high concentration of antioxidants, anti-inflammatories and B-group vitamins.

Study Three

The third study looked at the psychological well-being of young adults. This was a very short-term study, performed on 171 students in New Zealand aged 18 to 25. They divided the students into three groups. The first group was advised to continue eating their normal food without any change. The second group were given two additional servings of fruit and vegetables by the investigators. The third group were given prepaid produce vouchers with text messages sent to remind them to eat their fruit and vegetables.

A psychological assessment was performed at the start of the trial and two weeks later looking at the parameters of mood, vitality, motivation and the symptoms of depression and anxiety.

Only those physically given the two additional servings of fruit vegetables showed any improvements and these were purely in mood vitality and motivation. There were no changes in the indicators of depression and anxiety and in reality, it would take much longer for the brain chemicals to change than the short two-week period of this trial.

Study Four

The final, and probably most striking trial, was a meta-analysis of 95 studies on two million people. The trial showed clearly that the higher the intake of fruit and vegetables, the stronger the benefit. This study basically looked at double the recommended intake of fruit and vegetables i.e. 10 portions of fruit and vegetables on a daily basis, which is the equivalent of 800g or 10 servings. Those who ingested 10 portions per day had the lowest risk of death and premature disease. 

Of the two million people, there were 43,000 cases of ischaemic heart disease, 47,000 cases of stroke, 81,000 cases of cardiovascular disease and 94,000 deaths. Those who ingested 10 portions per day of fruit and vegetables had an overall 33% reduction in death and disease. It appears that apples, pears, leafy green vegetables and cruciferous vegetables such as broccoli and cabbage give the best benefits. The study also showed that even 2.5 portions of fruit and vegetables per day led to an 18% reduction in stroke, 16% reduction in heart disease, 13% reduction in cardiovascular disease and a 4% reduction in cancer. With each 200 gram increase in fruit and vegetables i.e. 2.5 portions per day, there was a 15% reduction in death.

When you compare those people who had minimal fruit and vegetables to those who had 10 portions per day, there was a 33% reduction in stroke, 28% reduction in cardiovascular disease, 24% reduction in heart disease, 13% reduction in cancer and an overall 31% reduction in death.

It was suggested that if everyone on the planet had 10 portions per day of fruit and vegetables, we would prevent 7.8 million deaths a year globally.

So, the big question is, which veggies are best? It appears that there were no benefits when separating raw and cooked vegetables. Apples, pears, citrus fruits and green leafy vegetables (e.g. spinach) and cruciferous vegetables (e.g. cabbage and broccoli) are the best for reduction in stroke, cardiovascular disease, heart disease and premature death. The best reductions for cancer were leafy green vegetables, yellow or red vegetables such as capsicum and carrots.

The message is very clear - listen to what your grandmother said and eat your fruits and vegetables.

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Eating ourselves to death

Thursday, April 06, 2017

By Ross Walker

It has often been said that you are what you eat. The evidence has been mounting over the past few decades that this is certainly the case when it comes to our health. There is no doubt that the greatest health epidemic of the 21st century is that of diabesity. Diabesity is, of course, the combination of diabetes and obesity. 

There is certainly a genetic component, with 30% of Caucasians, 50% of Asians and close to 100% of people with darker skin, carrying the gene for insulin resistance. This gene is a survival advantage if you are a hunter gatherer but a major disadvantage if you live in a modern society. Basically, being insulin resistant allows you to store fat around the belly after a large feed. As hunter gatherers, we would kill the beast and because there were no prehistoric Kelvinators, we would need to have a large feast and store the fat for a few days until the next kill. These days, we’re in continual feast mode with breakfast, lunch and dinner and we sit on our bums all day, with little exercise. It has now been estimated that around 70% of cardiovascular disease has insulin resistance as a significant contributing factor. 

Study suggests 50% of cardiovascular disease can be blamed on poor diets 

A recent report from the University of Washington suggested that 50% of cardiovascular disease can be blamed on poor diets. It is not just consuming poor quality food, but also avoiding wholesome foods that leads to this statistic. There have been a number of studies performed over the past few decades clearly showing that consuming two to three pieces of fruit per day and three to five servings of vegetables per day leads to a significant reduction in the rates of cardiovascular disease, diabetes, obesity, cancer and all modern chronic illnesses for that matter.

A number of studies have confirmed that consuming 10 to 15 natural nuts per day leads to a 50% reduction in cardiovascular disease. There have been multiple studies performed on the Mediterranean Diet, and these have confirmed significant reductions in all of the above conditions. The Mediterranean diet is very clear and straightforward. It is based around wholesome fresh foods, and in particular, fruit and vegetables along with fish, chicken, nuts, dairy and olive oil with occasional meat and no processed foods. Interestingly, it is not just the diet but also the entire lifestyle which includes a large breakfast of fruit and whole grains, toiling in the fields in the hot Mediterranean sun in the morning and then having the biggest meal at lunchtime. This meal is shared with the family and friends along with one to two glasses of wine. The carbs and the alcohol leads to postprandial sleepiness and everyone has a lie down for an hour and then goes back to work in the hot Mediterranean sun. The smallest meal is the evening meal. There are some important points to be made here. Firstly, the body is not like car. With the car, you put in the fuel and use it when needed. If you put the fuel in your body i.e. food, if you don’t burn off the fuel within a few hours it gets laid down as belly fat and possibly fat in your arteries. 

Secondly, the system is much more geared to sin then it is penance. What I mean by this is, if you go for a brisk half an hour walk, you burn 300 calories. If you have a small piece of chocolate cake, there’s your 300 calories. Also, our bodies were really only designed to work efficiently for 30-40 years wandering around a jungle with a spear. We weren’t designed to go double our use by date, consuming excess food and sitting on our backsides all day. Thus, when you’ve gone past the age of 40 and especially when the hormones go south at age 50, your metabolism really starts to tank and it becomes very easy to put on weight. If we seriously wish to tackle all of our modern diseases, we need a significant rethink about the ways we treat our bodies. Albert Einstein once said, “We cannot solve our current problems with the same thinking we used to create them”.

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How do you find Doctor Right?

Thursday, March 30, 2017

By Ross Walker

During a recent radio interview, I was asked the very good question, “How do you pick a good doctor?” Although it is a very good question, it is actually quite difficult to answer. With the increasing availability of information on the Internet and of course, the ubiquitous "Dr Google", the services provided by the medical profession are becoming increasingly under the microscope. I remember when I was growing up many years ago, most doctors had an almost Godlike presence, not to be questioned, only revered.

With the increasing availability of information from many sources including the Internet and all aspects of media, intelligent members of the community are starting to question many of the services available. There is no doubt that, in many situations, the computer offers quicker and more accurate information then does the so-called expert in the area. So, back to our initial question: How do you pick a good doctor?

Firstly, this is where I believe the Internet does not give you the answer. There are an increasing number of websites available which critique doctors. But, the problem with these websites and many other sources of information is who is inputting the data. Typically, because of pre-selection bias, any comments about doctors are not critiques, but rather criticisms. It is human nature that you’re more likely to complain about bad service and make this public rather than to promote and proclaim good service when you receive it. The negative emotions created by a bad interaction tend to have a more profound and long-lasting effects than any “feel good” moments when you receive good service. Thus, Internet comments about doctors are probably more skewed to negativity rather than positivity.

Secondly, the selection of a doctor is also based around the service required. Many common, easy-to-treat conditions are handled very well by your local general practitioner. I believe the best way to pick a good general practitioner is to ask your friends, family and people who live in your area who have also availed themselves of the services of the doctor in question. Then, it’s really up to your experience. Were you satisfied with the consultation? Were your questions adequately answered? Did the doctor listen to your symptoms and take adequate time to elicit a good history? Were you examined? Was your blood pressure checked? Have you had a satisfactory outcome, and have your symptoms and problems been resolved?

When it comes to specialist services, this is a somewhat different matter. I am a cardiologist and come from the category of doctor known as specialist or consultant physicians. Consultant physicians are diagnosticians and have a deep understanding of therapeutics i.e. the nonsurgical treatments available to treat conditions. One of the greatest skills of a good physician is the ability to take a thorough and accurate history from the patient, which involves listening to the person’s story and looking for clues as to the diagnosis and then to formulate an appropriate management program. Again, asking the questions in previous paragraph are appropriate to know whether you have received a good service from the doctor. Again, to find a good specialist in this area does involve asking your general practitioner, and also any other friends, family, or acquaintances who have seen that specialist previously.

Finally, how do you pick a good surgeon? This is certainly not a sweeping generalisation, but many surgeons do not have the same people skills seen with good general practitioners or consultant physicians, but the technical skills may be second to none and when you are in an operation, this is really of paramount importance. If you are having major surgery and there is time, it certainly doesn’t hurt to obtain a second opinion. A good surgeon is not just technically brilliant, but also knows when and when not to operate. It is still my opinion the surgeon should have excellent communication skills and explain carefully to the patient exactly what he or she intends to do, what are the potential benefits of the procedure and also, of course, potential complications. Again, picking the right surgeon involves asking your general practitioner, any friends you may have in the medical profession and, of course, any people you know who have availed themselves of this person’s service in the past.

In the 21st-century, it's important that each individual realises that they are the driver and doctors, in reality, should be advisers and servants. If you do not feel this is the case for you, then find another doctor. A number of years ago I made podcast series titled “It’s your body, ask the right questions”. It’s my opinion that nothing is more true than this statement.

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Myth: BPA free is a safer alternative

Thursday, March 23, 2017

By Ross Walker

BPA is a chemical used in the lining of some food and beverage packaging, in particular plastics and aluminium cans to protect food from contamination and extend shelf life. Manufacturers give you a clue as to the BPA content by the RIC, or Resin Identification Code. It is marked (typically on the bottom of a plastic container) in an arrowed triangle. The triangle is usually so small it’s very hard to read the number without a microscope. RICs 1, 2, 4, 5 and 6 are very unlikely to contain significant amounts of BPA, whereas 3 and 7 are the typical suspects. 

The BPA story is quite frightening. In 2007, a consensus statement was released by an expert panel suggesting the average BPA levels in humans were above those proven to cause harm in laboratory animals. 

Apart from concerns about the foetus, there are links between BPA and obesity, diabetes and heart disease. Poor brain development has also been linked to BPA, with claims of links to autism and ADHD, along with heightened sensitivity to drugs of abuse. 

There are also claims regarding BPA’s links to a variety of cancers. 

The xenoestrogens, Phthalates, BPA and other synthetic oestrogen mimickers bombard the female endocrine systems, breasts and ovaries from a very early age. High levels during pregnancy, along with using hard plastic bottles, which are constantly rewarmed, to feed young children, leech these toxins into the milk. 

This is a highly plausible argument as to why young girls are starting menstruation earlier and earlier. 

So, since concerns over BPA in plastics, aluminium cans and other commonly used household appliances have been raised by various experts and media commentators, with the increasing awareness in the general public, people are rushing for alternatives. You must then ask the question, are the suggested alternatives any safer?  

The correct answer here appears to be probably not! Two of the commonly used BPA alternatives are BPS and BHPF. The reality is that both of these chemical alternatives are still bisphenols, and there is now increasing scientific evidence that these so-called safer alternatives are still endocrine disrupting chemicals (EDCs), which have close to identical hormonal effects.  

A recent study published in Nature Communications by a group of Chinese and Japanese researchers looked at the effects of BHPF in pregnant mice. This study showed very similar health issues seen with BPA. The group then tested water bottles by filling them with hot water and then testing the water for BHPF levels. They found significant levels of BHPF in just under half of the samples tested, including three baby bottles. They then collected blood samples from 100 random college students who reported drinking water from bottles and found significant levels of BHPF in seven out of 100 people tested.

Although there is no clear evidence of any health detriments from BHPF exposure, this, and previous research I have reported on BPS, raise concerns about the ubiquitous use of plastics to store food and fluid in modern society, regardless of the claims on the bottle, such as BPA free. If anyone opens their fridge, it is difficult to find something that is not stored in plastic.

Cardiovascular disease and cancer make up around 80% of the causes of death and disability in our society, and although we do not commonly associate our increasing exposure to many different forms of plastic and these diseases, this is something that health authorities need to seriously consider. Although it appears the greatest danger comes from reusing and reheating plastic containers, which is commonly done with baby bottles, it still comes back to the question I ask quite commonly: What is the safe dose of poison?

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Medical myth: Having a life purpose is a delusion

Thursday, March 16, 2017

By Ross Walker 

I recently read a brilliant article in New Scientist by Teal Burrell titled A meaning to life: How a sense of purpose can keep you healthy.

When you think about it, there are really only two possibilities in life. The first: you’re born, you live to experience good luck and bad luck and then you die and basically rot in the ground. The second alternative, however, involves some purpose to life with some immeasurable, inexplicable driving force which some people refer to as God or our soul, which leaves the body at the moment of death, travelling in some fashion to a place that is not earthly.

Many people live their lives because of the prize at the end, with an absolute certainty about where they’re going. Some people see this exit from Earth as a welcome release from their current suffering. So, we have to ask ourselves the question: are people who see a purpose to living just deluding themselves?

Some people see this purpose in religion, their career, money, their family or quoting the article, “pure escapism”. I must say, I believe it is very important to have something to get you out of bed every day rather than just viewing your life as pure existence.

The point of this superb article by Teal Burrell was to analyse people with a sense of purpose and compare them to people without it. The article quotes the well-known Austrian psychiatrist, Viktor Frankl, who survived Nazi concentration camps and went on to develop Logotherapy which basically is summarised by his book Man’s Search for Meaning. The basic summary of Frankl’s work is that life is not about the suffering, but the way you handle the suffering, which makes it important and gives it meaning.

The health advantages of having a sense of purpose are quite striking. The well-known public health researcher Victor Strecher at the University of Michigan in Ann Arbor (whom I’ve had the pleasure of meeting) is the author of the book, Life on Purpose. When Dr Strecher analysed alcoholics who developed a sense of purpose, he found they were less likely to resume heavy drinking. People who have a higher purpose in life are less likely to develop sleep disturbances as they age. Interestingly, women with more purpose rated their sex lives as being more enjoyable.

A large study from the US followed over 7000 middle-aged people and found that having a sense of purpose was associated with the significant reduction in the risk of dying over a 14-year period. The same is true for 9000 people in the UK over the age of 50. In this group, those with the highest sense of purpose had a 30% lower risk of death over a 10-year period. The article also went on to quote lower rates of heart disease, stroke and Alzheimer’s disease in people with a higher sense of purpose.

Prof Strecher was quoted as saying that the reason that having a sense of purpose isn’t seen as a significant public health priority is that it is too vague a concept to be measured or assessed. Unfortunately, many reductionist scientists along with cynical members of the public still want to believe that having a sense of purpose is purely a form of self-delusion and fear of death.

One of the concepts discussed in the article was whether having a sense of purpose is really just a replacement for religious faith. Interestingly, being religious didn’t predict a low risk of heart attack or stroke, and again, it was pointed out that many non-religious people also have a high level of purpose through other facets of their life. Some people argue that if you have a stronger sense of purpose, you’re more likely to practice healthy lifestyle principles. But, there is now increasing research to suggest that a sense of purpose by itself improves biologic markers of good health. Prof Steven Cole from Los Angeles has actually performed research on the influence of well-being and sense of purpose. He focused on two different types:

1. Hedonics – those who derive their purpose from self-gratification with pleasure and reward

2. Eudaemonics – those who have a sense of purpose beyond self-gratification.

This is where it becomes fascinating. Those people who were basically hedonistic had a high expression of inflammatory genes and a lower expression of genes that produced disease fighting antibodies. This pattern is also seen in people who are lonely or stressed. For people scoring high on the Eudaemonic scale, the blood markers were exactly the opposite. Often people in the group with a higher sense of purpose and service have much lower heart and breathing rates, and lower adrenaline levels. Basically, this form of sense of purpose switches off the fear-flight-fight system. Interestingly, focusing on a higher purpose and things of value stimulates the part of the brain known as the ventral striatum and suppresses the more emotional part of the brain such as the amygdala.

It appears that this form of sense of purpose can also lengthen telomeres which is associated with reduction in biologic ageing. A practice such as meditation can also protect the telomeres. Both Cole and Strecher give advice on how to strengthen your sense of purpose. It is always important to start small by focusing on making your work more meaningful and putting more effort into your important relationships. Setting goals in each domain of your life, family, work, community and personally can also improve your sense of purpose.

The evidence actually appears quite overwhelming that having a sense of purpose is more than just self-delusion. Whether there is something beyond the grave is a discussion for another time and another place but from all the scientific evidence that has been presented, it appears quite clear that having a sense of purpose and a sense of service to other people is an important end in itself.

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Is there any basis for Hanson's vaccination comments?

Thursday, March 09, 2017

By Ross Walker

Recently, Pauline Hanson was hijacked by Barry Cassidy on the ABC Insiders program when she was put on the spot about her opinion regarding vaccinations. Up until now, she has been riding high in the polls, in my opinion, more from the poor performance of her opponents. Her recent ill-informed and ignorant comments unfortunately do represent the views of a minority of the population.

A recent survey suggested that around 95% of the population have their children vaccinated, but a third are still suspicious around the dangers of this practice. The anti-vaxxers are still trotting out the nonsense that there is a link between vaccination and autism. This issue was first raised by a now totally discredited researcher by the name of Andrew Wakefield, where it has been demonstrated that his research is fraudulent. There has never been one, non-fraudulent study demonstrating any link between vaccination and autism.

The anti-vaxxers carry on about the mercury in vaccinations in the form of thiomersal, as a potential cause of autism. These ignorant people do not realise that thiomersal has not been used in vaccinations in children for decades. The reason why this entire argument around vaccination and autism continues is that the MMR vaccine is given at around 18 months, which is when a child’s speech starts to develop beyond monosyllables. Regardless of vaccination, if the child is autistic, the signs of poor speech and the other manifestations of autism become clearer around this time. But, parents who have to endure this difficult diagnosis are always looking for something to blame and vaccinations are an easy target, despite the lack of any evidence whatsoever.  

Another interesting comment by Ms Hanson was the test to see if the child was allergic to vaccinations. I’m not sure what this test is, but it is certainly not in the medical arena. A recent study published in AIMS Public Health has clearly shown that between the years of 1963 to 2015, vaccination has prevented around 200 million cases of polio, measles, mumps, rubella, varicella, adenovirus, rabies and hepatitis A, with the estimated prevention of 450,000 deaths.

In 1962, Prof Leonard Hayflick from the University of California in San Francisco developed a normal human cell strain which is able to safely grow viruses and subsequently produce vaccines against more than 10 diseases. In a recent interview, Prof Hayflick was quoted as saying, ”Vaccination is a particularly important issue to think about now, given the rise of the anti-vaccine movement that has the potential to reverse the health gains achieved through one of the most powerful interventions in medical history. The anti-vaccination movement endangers the health of an entire generation children”.

The problem I see is that the new generation of parents have no idea about the incredible dangers that were seen in the last century from the diseases now almost totally prevented by vaccination. Smallpox has been completely eliminated from the face of the earth through vaccination. People are no longer suffering the severe debilitating neurologic problems from polio. Preventing measles helps stop the dreadful intellectual impairment seen with the condition known as subacute sclerosing panencephalitis.

Unfortunately, we are now seeing re-emergence of whooping cough which certainly can kill young children. This is clearly because people are refusing to the vaccinate their children. If a person such as Ms Hanson chooses to be in public life, and clearly is gaining traction as a political force in Australia, it would be wise for her to choose her words carefully and be more educated around subjects that are clearly outside her area of expertise.

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Myth: Contraception is only for women

Thursday, March 02, 2017

By Ross Walker

With the burgeoning world population, the need to prevent pregnancies has become an increasingly discussed topic. The recent Dan Brown novel and subsequent movie, Inferno, was interestingly all around this topic, albeit the villain’s solution was somewhat too drastic. It is my opinion that for long-term sustainability of our resources and environment, the world can only cope with around four billion people. At present, we are approaching eight billion. Any visit to an intensely populated city is evidence that our current population growth is unsustainable.

So, regardless of your own personal view, I believe it’s time we all adopted a less self-centred worldview to responsibly contribute to better control the world’s population through prevention of pregnancy. The real solution here which, unfortunately, will be unpalatable for many people, is for only financially viable couples in long-term relationships – who only desire to have a small family – to be the ones becoming pregnant.

So, to quote the excellent New South Wales Family Planning Association website, I would like to give a brief overview of available methods of contraception, and their assessment of what information we should consider when accessing it.

1) The proven effectiveness of the method

2) Health issues which the person considering contraception may suffer that may limit particular choices

3) The ease-of-use

4) Potential side-effects of the method of contraception

5) All the alternatives available to the person

6) Reversibility

7) Protection against sexually transmitted infections

Contraception is divided into reversible and irreversible techniques. The most effective is the “fit and forget” long acting, reversible contraceptives which include IUDs and contraceptive implants. They are suitable for any age and have no contraindications to people with other health issues. They are easily removed and promptly reversible but you require a health professional to supervise and perform the implantation. There is also no protection against sexually transmitted infections. These are over 99% effective.

The Implanon subcutaneous contraceptive device is close to 100% effective and lasts for three years. The intrauterine devices last for around five years.

For those people who would prefer more short-term solutions, there is a depot injection of a form of progesterone, which can be given every 12 weeks. This is also highly effective.

Apart from condoms, the most commonly used form of contraception is the oral contraceptives pill, the minipill and the NuvaRing. The NuvaRing is inserted vaginally by the woman and replaced every three weeks.

At this stage, the only commercially available reversible contraceptive device for males is a condom, which has somewhere between 80 to 98% effectiveness depending on how carefully it is used. There is also a female condom which has a similar effectiveness rate and, of course, the diaphragm, which is somewhere between 88 to 94% effective. Condoms also offer protection against sexually transmitted infections.

Interestingly, a very effective form of contraception is breastfeeding, which is around 98% effective if the woman has given birth in the previous six months, is still not having periods and is fully breastfeeding.

The other less effective methods are fertility awareness based methods, which include the rhythm and temperature methods, which are over 75% effective, and the commonly used withdrawal method, which ranges in effectiveness of between 78 to 97%.

Emergency contraception, the so-called morning after pill, can be taken up to five days after unprotected sex but it is most effective within the first 24 hours.

Reversible contraception includes tubal ligation for a female and vasectomy for males. There is the potential for reversal but this requires re-operation and is not highly successful. Both of these forms of contraception are around 99.5% effective.

Apart from condoms and vasectomy, there have been numerous attempts over the years to discover an effective male contraception. Until now, hormonal manipulation, such as used with the oral contraceptive pill for females, has been disappointing and rather difficult to achieve. Other methods have looked at reducing sperm production in the testicles, preventing the sperm fertilising the egg and targeting the sperm’s ability to swim. These techniques have shown reasonable promise. Another interesting approach is what is known as the “clean sheet method” which allows orgasm but not ejaculation. This affects some of the muscles that are involved in ejaculation.

Probably the most interesting and recently researched area is using a polymer gel known as VasalGel. This gel is injected directly into the vas deferens under local anaesthetic. The vas deferens is the tube that connects the testicles to the prostate gland. The gel blocks the flow of sperm through the vas deferens and has been coined a “reversible vasectomy”. This creates a 2cm barrier in the vas deferens and therefore the sperm cannot get through. It has been trialled in rabbits and has been shown to be reversible after two years. A recent study in 16 monkeys showed it was 100% effective in preventing pregnancy. Interestingly, in a similar environment, fertile monkeys mating with mature female monkeys showed an 80% percent pregnancy rate. The complication rate of VasalGel was minimal. Standard vasectomy has around a 30% rate of what is known as sperm granulomas, which was only 3% with VasalGel.

The development of effective male contraception, in my view, is a welcome innovation and should be encouraged. Always the concern with males is firstly whether they are prepared to go through this minor procedure, and secondly, whether they would be honest with new partners about whether they had pursued male contraception. Regardless, we all really need to start becoming more aware of the human footprint on this planet and effective, viable means of reducing the world’s population. If we don’t, we will be seeing a very different world over the next 50-100 years.

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Medicare: our God-given right?

Thursday, February 23, 2017

By Ross Walker

I’m sure many people who read the Sunday Telegraph on January 22 of this year read that just over 2200 people in NSW died on the waiting list for elective surgery in the 2015-16 period. The report suggested that over half of these patients had been waiting more than 55 days, which is 18 days greater than the Australian average. Up to 10% of patients had to wait close to 12 months, again, greater than the Australian average.

We heard the usual outcry from the Labor opposition blaming the current health minister in New South Wales for this unacceptable situation. The New South Wales AMA President, Professor Brad Frankum, suggested it was the increasing pressure on accident and emergency departments that had a knock on effect to elective surgical waiting times.

In my view, no one is addressing the real issues which comes down to two key areas:

1) Over-population. With the world’s population increasing at a rapid rate, no government across the globe can continue to provide the necessary infrastructure for not just the health system, but all aspects of living in the modern world.

2) In Australia – the outdated and unaffordable Medicare system. It is said that 48% of Australians are on some form of welfare but the reality is that 100% of people are on welfare, i.e. Medicare.

Over $50 billion is spent every year on Medicare and this is paid for with borrowed money because of the incredible debt levels in Australia. Medicare was first introduced as Medibank in 1972 under the Whitlam government. In 1972, medicine was not particularly expensive with much less available pharmaceutical agents, medical procedures and investigations.

Over the past 40 years, we have seen an explosion in costs because of major advancements in all of these areas. The reality is that our current system is unaffordable when we expect the government to foot the bill for a significant proportion of medical costs. Don’t get me wrong, Medicare is very good for the medical profession as we have a steady income from the government, but, in my view, is not good for patients.

The system I propose is that we introduce free, non-discounted healthcare for the lower 20% of earners (including people on some form of welfare) and everyone else pays private insurance linked to their income. The 21st percent earner may only pay $2 per week, whereas extremely wealthy people clearly would be paying a substantial cost for private health insurance. I would also propose that anyone suffering a genuine emergency and admitted through an accident and emergency department would receive care for free under this system. This would not include people who use accident and emergency departments such as general practices.

This would ensure that socially disadvantaged people would not have to wait too long on elective waiting lists for surgery. Many people wait for over a year in pain to have spinal surgery or hip replacements because someone who could afford private insurance decided they would go through Medicare, thus displacing a person who can’t afford healthcare down the waiting list.

Unfortunately, the vast majority of people now living in Australia have grown up with the attitude that Medicare is their “God-given right”. However, unless we do something about our current population growth and debt levels, our children and grandchildren will be living in a completely different world where wars will be fought over food and water and expert medical care will be a thing of the past. Do we have the right to leave this type of legacy for future generations?

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The dangers of overcooking your food

Thursday, February 16, 2017

By Ross Walker

It’s often been said that ‘you are what you eat’, but could it also be – as many people have suggested for a long time – that many common diseases are also what we eat and how we cook what we eat? I, as well as many other health professionals, have been saying for many years that many common diseases are linked to our modern lifestyle.

There’s no doubt that following the five keys to good health markedly reduces the risk for all diseases by around 70%, and a recent study has shown a reduction in cardiovascular disease by 83%.

1. Quit all addictions

2. Seven to eight hours of quality sleep each night is as good for your body as not smoking

3. Nutrition: eat less, and eat more naturally

4. Exercise three to five hours per week, in some form

5. Happiness is, no doubt, the best drug on the planet

Three recent disturbing reports have linked common aspects of Western diets with diverticular disease and also cancer risk. The first report was part of the Male Physicians Trial in Boston, which followed 46,500 doctors for an average of 26 years. One component of the trial was for the doctors to fill in a food questionnaire every four years. Specifically, to look at intake of red meat, poultry and fish and, in this case, the link to diverticular disease. When they looked at red meat intake, the higher the intake, the higher risk of diverticular disease whereas more poultry and fish reduced the risk. Specifically, they compared the doctors who never ate red meat with those who would consume red meat at least six times per week.

Red meat intake was also associated with an increased intake of non-steroidal anti-inflammatory drugs, other painkillers, cigarette smoking, being sedentary and reduced dietary fibre. Those doctors with an increased intake of fish and poultry were also more likely to use aspirin, be non-smokers and be regular exercisers. After controlling for all of these factors, men with the highest red meat intake versus those with the lowest intake had a 58% increased risk for diverticular disease. Strangely, the strongest risks occurred with the highest intake of unprocessed meats. Swapping red meat for fish and poultry reduced this risk by about 20%.

Those with the higher intakes of red meat also had higher levels of C-reactive protein and ferritin, both markers for inflammation. High levels in the blood stream of these two proteins were also linked to a higher rate of cardiovascular disease, cancer and diabetes, again through the common factor of high inflammatory risk. It is believed that high intake of red meat has a direct effect on the gut microbiome. Unprocessed meats typically require higher temperatures for cooking, which release a number of chemicals that may lead to damage in the bowel wall.

A number of studies in the past have also linked high consumption of grilled, barbecued or smoked meats to an increased risk for breast cancer. This particular study followed just over 1500 women who were diagnosed with breast cancer in the mid 1990s. All answered a food questionnaire every five years and were followed for over 17 years. During this time, 597 women died, of which 40% died of breast cancer. Those with the highest intake of grilled, barbecue or smoked meats prior to diagnosis had a 23% increased risk for all-cause death, compared with those who had the lowest intake, at the start of the trial.

Finally, a report from the Food Standards Agency - UK (FSA) has recently launched a campaign about the potential damage from acrylamide, the chemical which is formed when starchy foods are subjected to high temperatures. This new campaign is called “Go for Gold”, and suggests that people should cook all of these particular types of foods to a much lighter, golden-yellow colour rather than burning foods to much darker colours. This includes foods such as potatoes, breads, chips and other cereal based products. The dangers of acrylamide have been discussed for a number of years, but this recent report continues to highlight the potential issues of overcooking food.

When combining the results of all three reports there is a common message. It may not be the foods themselves that are the problem, but the way we are cooking the foods. The Aussie barbecue is a tradition, but should not be seen as a licence to chargrill foods to a state where the meat is not only well done, but almost black. The dangerous chemicals released by overcooking are almost certainly causing more health issues than the food itself.

Let’s not forget the wise words of the Father of Medicine, Hippocrates, when he said: “Let food be thy medicine and medicine be thy food”.

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