Does exercise lower your biological age?

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So you're a big exerciser. What are you up to today, Priya?

Why is today's not a good day'cause I've been here with you.

All right.

Well I look I've walked to the to the tram stop both ways.

that's pretty good

Yeah, there's some movement of my body, but look, yesterday I did a Pilates class, the day before that I did my cardio tennis, which you know I love.

Yeah, and I'm terrified you're gonna invite me along to the

Rydyn ni wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i wedi'i

I deliberately don't tell you when I'm in Melbourne.

It feels like that.

I hide, I hide. I feel you know, I I've cycled in, so I feel pretty good. But that's one of the stories we're looking at today. Does in fact cycling into work doing physical activity like Priya? Does that make you younger biologically? That's just one of the stories on today's health report.

I'm Priya Alexander and we're in Jury Lair.

And I'm Norman Swan on Garigo Land.

Also coming up on the show, gynecologists are raising alarms about growing barriers to abortion access in parts of the country. This is very concerning stuff.

It's claimed by the gynecologists that this is insidious and the shape of things to come, maybe like the American situation. And more on bulk billing barriers with a change to government policy, this time quite existential in terms of a particular health service.

First we're covering in the news Ebola again and we're just doing a little update here and there have been some changes. So as of the second of June, the latest data from the C D C in the United States says three hundred and sixty-three confirmed cases, sixty-two confirmed deaths, and Uganda now has fifteen confirmed cases as well, but we know that the numbers are likely much higher than that.

And as we go to where, the World Health Organization has said that there is some indication that it's levelling out, but it's too early to say that we're it's over or under control.

The WHO have also said that they are really advising against travel restrictions and travel bans, and I think they're particularly calling out the US on this, who have banned anyone from affected areas from entering the country. And they're saying that it's actually making it much more difficult to have a united and fast response on the ground and it's also disrupting supply chains as well. So they've really warned against countries doing that. And at the moment Australia doesn't have

And we do have an isolation unit at Westmead Hospital in Sydney if there is any question there. And some positive news on vaccines that uh if you go right back to the beginning of COVID, one of the reasons we got vaccines so quickly is that there'd been an effort to develop vaccine technologies which could turn around a vaccine very quickly after a new bug or virus has been identified. And they're using those technologies to try and turn around

And I guess the only other update in this space is that the federal government has committed two five million dollars in support to the global response and so hopefully that is going to help things on the ground. But still a very worrying time for Congo and its neighbouring countries.

And another study suggesting qu quite disturbing levels of kids using AI chatbots for their mental health systems.

So this has been published in Dharma Pediatrics and it's used US adolescents and adults, so it's quite a broad age range, twelve to twenty one.

Yeah, what what they did it's not a huge study. They they did a study of about a thousand adolescents and inquired about you know to w look at what their AI usage was. uh in associated with mental health issues. Then they grossed it up. If that was true for a thousand kids

So almost a fifth of the people surveyed reported using AI for a mental health reason for advice. And that was up about fifty percent from the year prior, so the the use is certainly escalating. Over forty percent of the Norman were doing it monthly or more often. And the people who were doing this highest, who were going onto a onto a chat bot and using it for mental health advice, the highest use was amongst those were eighteen to twenty one, women or female.

So it's not as if they weren't seeing somebody for assistance.

Yes. They w they were seeing somebody, but they also turned to the chat bot as well.

And what we know about chatbots is that they try and be nice to you. And although there are guardrails against self harm. There have been some notorious examples where somebody's learnt to get round the guardrails and the AI chatbot hasn't actually encouraged them to self harm.

Yeah, I think it's deeply concerning because we've covered and we can link these episodes in the show notes. We have done a little bit on the use of chatbots for mental health, for health advice, how safe they are. And it really can put people in troubling situations. And I think for me, when I read this, I thought, I have a lot of these patients in my room and without the oversight of a psychologist,

So just something to be alert for. And then a troubling story about the removal of a drug, not entirely, but partly, for women who have breast cancer. The brand name's Zolodex, the the actual drug is called Gosserolin. And it blocks estrogen and it's also used in endometriosis.

Yes. So this is a drug that I think people would know it because it is used in prostate cancer, breast cancer, and for some patients with endometriosis. It does suppress the sex hormones. So if there is a tumour like a breast cancer that relies on estrogen to actually grow, if you block the estrogen, it can help reduce the recurrence of breast cancer.

Yep. So I'm about telomilograms and it's approved for men with prostate cancer.

This low dose one, Norman, I had a cause what AstraZeneca have said is we are removing it off the PBS, we're removing it from the private market in Australia, so it will not be available, the low dose one, 3.6 milligrams. to anybody because of commercial reasons. The lower dose pen is the one that women will often use for breast cancer. It's currently on the PBS for people with endometriosis. There's eligibility criteria, but

So what the company has said that they'll have a free access service for a few months after for a while after they removed the drug in November of this year, and they're going to apply for PBS approval for the larger dose version for women with breast cancer and endometriosis. So I spoke to the AstraZeneca um about this.

Please explain that because it's I think it's always very interesting. Punishment why? Because

Because we achieve amongst the lowest prices for drugs internationally. And uh the pharmaceutical industry hates that because other countries follow Australia. So our our pricing, although the pricing is often kept confidential, people have a sense uh that Australia is doing quite well. So I I challenged Astra on this. So what Astra has said is that

It is.

It is punishment.

And don't forget that we actually covered this same issue in the context recently of a GLP one. It was Monjaro that they were trying to get on the PBS and there was a little bit of discourse about the price that we were willing to pay for it and the drug company said no, we're not proceeding.

Yep. So it will stay on the private market. So why w the other thing is why they're removing from the private market as well s um is is also an interesting decision. So it's not transparent what in fact is going on here with AstraZeneca. They've promised to get back to the health report if in fact they have more information that they can offer.

And I think that there will be a lot of people who are quite anxious about this and I have patients that I'm going I don't know what they're going to go on, I'm gonna have to contact their medical oncologist or gynecologist to see what our options are. But this will hurt a lot of people, so unfortunate decision.

On ABC Radio National, you're with the health report.

Abortion care in Australia is currently under a lot of pressure and people might see in their newsfeed that there are proposed changes for multiple states, South Australia, New South Wales and Queensland. And there are a lot of medical professionals who are really quite concerned that a service that is already difficult to access that should be a basic human and healthcare right for everybody. is going to become much more difficult to access.

I think a really important uh barrier that women face is access. So although abortion is legal everywhere in our country, access is a problem because we don't have providers, especially rural regional areas. We don't have providers for the medical abortions as well as surgical abortions.

And cost can also be a barrier. I think a lot of people don't realise that many women who access abortion services are still paying quite a lot out of pocket often.

Yes, absolutely. So although that access has improved, especially again for surgical abortion, often women are paying out of pocket for the procedure.

And that can be hundreds of dollars.

That can definitely be hundreds of dollars.

Let's start with Queensland then, where the proposed change is that endorsed midwives and nurse practitioners who concurrently prescribe this thing called MS two-step, which is the Mifi Pristone and Missaprosto, what people might know as a medical abortion. The proposed change is to stop endorsed midwives and nurse practitioners from prescribing and dispensing and delivering this kind of medical abortion to women. What would that change cause?

That would change things, especially again for rural regional women. because often rural and regional services rely on nurse practitioners and endorsed midwives. Often they don't have the doctors there to be able to prescribe it. And we have to remember that nurse practitioners and midwives are trained.

And right time is quite key because there's a cutoff for nine weeks for medical abortion in Australia, which some would argue is quite conservative. In the northern hemisphere they they certainly go a little bit later. But this is potentially going to mean some women in those regional and remote areas just don't get access in time.

Correct. So if you don't get access in time to medical abortion, then your next option is surgical abortion. if you live in a place where medical abortion is difficult to get, you are definitely not going to get a surgical abortion easily in that place. So that means you're probably going to have to travel. perhaps thousands of kilometers, spend the money on travel, spend the money on staying where you're going to.

So then we go to New South Wales, different proposed change there. They're trying to ban sex selective abortion. So people find out the gender of their baby perhaps after ten weeks if they've done the non-invasive prenatal test. and they're attempting to say that sex selective abortion should be banned. Is there any evidence, Nisha, that there is an issue with sex selective abortion being higher in New South Wales? Why the proposed change?

There is no evidence to suggest that there is a problem in New South Wales or anywhere else in Australia. The people who are pushing for this change are relying on data that is very old. there is no evidence that this is something that would be happening and there are already guardrails again to make sure that that does not happen. It's important to remember in these situations that there are certain medical conditions, inherited conditions, that go with the gender of the fetus.

And if this change went through, it would have serious implications for patients, as you mentioned, but also for the clinicians who are potentially delivering the care. They're suggesting a forty four thousand dollar fine or five year prison term.

I think criminalization of any healthcare procedure is not the way forward at all. We have seen what happens with criminalization. It has taken us many years. It's only as recent as twenty twenty three when we decriminalized abortion. It is only in the last few months that the UK has decriminalized abortion. It is very important that we don't put healthcare into any sort of criminal code, because then that just may practitioners who provide the service feel like they don't want to do it anymore.

So Nature, all of this is in the context of South Australia as well. There's a push there to ban abortions after twenty five weeks, which usually only occur if there's a really serious medical issue. Is all of this Queensland, New South Wales, South Australia? Is all of this really about restricting abortion care further for women and putting more barriers?

Yes, one hundred percent. If you just listen to the people who are pushing for these things, you can hear them say that their ultimate aim is to criminalize abortion and to make abortion not available for women in Australia. That is their aim. And this is just tinkering around the edges to get to that aim. And we have to stop this right now.

I just wonder if you if the the college has a position on some hospitals, which is now getting a little bit more media attention who don't provide abortion care bc on religious grounds. Does the college have a clear position on that where, you know, abortion should be a basic health care or human right? Should it you know, should there be the ability to d deny this kind of care for women?

The college's position is very clear, Priya. Individual practitioners can be objectors, conscientious objectors, that is their right. they have a duty to refer women who approach them for abortion to another provider who should be able to provide them with abortion care. And publicly funded taxpayer money should be used to provide the full gamut of legal health care in Australia. And that should include abortion care, contraception, sterilization.

Nasha Cott, obstetrician and president of the Royal Australia and New Zealand College of Obstetricians and Gynecologists.

So Pierre, this next story it just suits you down to the ground, you know,'cause you know, you're a fanatic exerciser.

Oh, fanatic.

Does it make you younger? Is a question.

Well that is the question. I wouldn't say fanatic exerciser though. I just I really enjoy moving the body and I know I feel better when I do it. And now I have even more evidence that it's good for me.

Well you do from this paper which is about Biological age and physical activity. So there's a bit of explaining to do before we come to our guest who's Andrea Meyer from the National University of Singapore, about biological age. Now anybody who's reading the the stuff about longevity at the moment

Absolutely. Thank you for having me. Um, physical activity is very important and now we can measure it and express it as the biological age.

So you did this review. What did you find? Because it was a bit of a mixed picture. You didn't find it made you older, but it was a bit of a mixed picture to the extent to which it showed you that you were biologically younger.

Yes, so we have many epigenetic clocks so we can um measure based on the epigenetic makeup uh lots of markers. Um very often Uh we are using uh clocks which either are trained to predict mortality or diseases. And what we were able to find if somebody has more steps. It's very likely that that person, these these individuals, also have a biologically younger age using the Hovart clock and the grim age.

Rydyn ni'n mynd i'n mynd i'n mynd i'n mynd i'n mynd i'n mynd i'n mynd benefit in terms of biological age getting younger.

Yes, and that's a little bit difficult because we uh had to standardize all these uh cohorts and um because everybody looked at physical activity a little bit uh differently. Um so what we were only able to showcase is that there is an association. It's a strong association, it's c it's uh statistically significant, but we what we were not able to showcase of how many steps.

So the question that I've got, I've got a couple lots of questions is Uh so we y what you can't tell me is about does, whether Priya doing a highly active um Plate his class, thank you. Um uh on you know, six days of the week, which she doesn't do, but you know, six days of the week is going to have a younger age than somebody else because you've just taken a snapshot in time. But because you've taken a snapshot in time, it could be People like Priya do Pilates on a regular basis.

Yes, absolutely. Because there are lots of confounding factors, we call them. Because people who have more steps, it might be that they are more health conscious, that they have a better diet, that they have better sleep, that they're caring about their health. they do preventative measures and therewith have a lower uh biological age. Absolutely. So out out of cross-sectional studies we call them, we cannot actually refer to any causality.

Okay. So in other words what you've got is an i an interesting indication that you might be biologically younger if you do exercise, but that needs more work to nail it.

Andrew, I'm just wondering, just zooming out for people, you talk in the paper about GERO protective, that if you are physically active, that it protects against the aging process. Can you just give us How? How does physical activity actually help the body at that kind of anti-aging process level? Give us some more motivation to move.

Oh yes, so you already have the motivation I heard, which is absolutely great and we should all move. Um So physical activity is is very nice because if you are physically active, your uh circulation is much, much better. Your heart is pumping much, much more. And what we know not only on systemic level, so for example, you are physically active, you you really feel your heart, you you see that your s your skin is going to glow because of the physical activity.

Hormones produced by the muscle tissue.

Yeah, it's it's it's not so much myocines can also be inflammatory molecules. So it's a group of uh of molecules which are positively um regulating cellular activity, for example, your brain activity. What we also know is that if somebody is physically active and going from a non-active to an active state, that the mitochondria in a cell, which is actually essential to to build energy of your cell and there was the body.

So Andrea, based on this research, good preliminary news, watch this space. Thank you very much indeed.

Thank you.

Professor Andrew Maher, who is at the National University of Singapore.

On IBC Radio National, you're with the Health Report.

Last week, Norman, we talked about potential changes to bulk billing and the need for healthcare professionals from the first of July to actually Attain consent. From patients and verbal consent will not cut it anymore.

They're not potential, they're real changes, aren't they?

Hope. I do. I've lived enough now I feel to know that sometimes things don't go ahead and I'm hoping all the Noise that we're making is doing something to people who make decisions, but you can't verbally consent to being boat billed from first of July. Whoever is claiming the Medicare service from you needs an electronic stored signature from you from every single service. And it either needs to be from the patient or from a caregiver.

And you last week foreshadowed that this was going to create great problems and I questioned you on that. But a faithful listener to the health report who's uh Professor Paul Torzillo, who's a professor of respiratory medicine at the University of Sydney, but he's also a longstanding practitioner in Aboriginal medical services in the Posi area as well, and is medical director of the Nanampa Health Council in Alice Springs.

Thanks.

So just to outline what the problem is for an umpower health council

Um Nunabah Health Council services. People who live across a hundred and twenty thousand square kilometres in the northwest of South Australia, right in the middle of the country. We've got six main clinics. w without reception staff, without admin officers, they service a population where on best estimates, less than four percent of people speak English in their home, let alone in their community. And the idea that we would somehow be able to produce a form, either digital or written.

Now you were told to go to the health department who'd give you some help on this, did they?

Look, we've had some interactions with the department and those interactions have

So Paul, the suggestion is that either you continue to deliver services and you're not compliant and if you're audited there's obviously an issue. Or if you can't actually attain this signature and keep it for two years, you have to keep the record for two years, you're saying there are no reception and admin staff? then you're essentially delivering the service but forfeiting the fee. And I imagine that that would equate to a huge loss for the funding of this service.

W we estimate pretty conservatively it's going to reduce our budget by about two million dollars. It's got some other spin offs. Priya you probably know that general practitioners who work in remote areas do get a remote area benefit and that's actually linked to their use of Medicare. So that

Au revoir.

being unable to Medicare.

So you've written to the minister about this. Have you had any response?

Uh we wrote to the minister in November last year and had a response that indicated the department would be communicating with us and would find some ways to make this work for us.

Well that didn't work.

That didn't work. I've subsequently written again to the minister on the twenty eighth of last month and I've spoken to the minister's office. And there's been no response. And I think around the remote sector, the communication from the Commonwealth's been pretty quiet lately. I think at the moment their intention is to go ahead with this.

Now is the sector behind you here, Paul, uh the National Aboriginal Community Controlled Health Organization and so on?

Look, they've um there have been negotiations between Nacho and the Department and the Minister's Office. I'm not aware About where those arrangements are at the m at the moment. I mean, our information is at the moment that What's been proposed is going ahead. So I don't think the negotiations have made a difference to that.

Well thanks for coming on the Health Report. Paul, we will ask the Minister's Office for a response and monitor it accordingly.

Thanks very much for your time, I appreciate it.

And uh Paul Trzillo is professor of respiratory medicine at Rob Prince Alfred Hospital in Sydney and the University of Sydney, but he's also medical director of Nampa Health Council in Alice Springs.

So what's in the mailbag?

So we did a big deep dive into diphtheria last week.

Strongly recommend you going back and listening if you didn't hear it. It was a really good interview.

I agree with that.

By a great interview that Priya and I did on housing as a public health issue. If you want to really understand that, excellent.

If we don't want to pat ourselves on the

It's not pretty.

He was the talent.

But anyway, let's um

Esther has written in with respect to the diphtheria story. My mother was one of two women in her medical year, which wow, in itself is amazing. She did her pediatrics term nineteen forty two to nineteen forty-three at the then Royal Children's Hospital in Brisbane.

And from Colin.

On vitamin D, which was a story close to your heart, so we of course covered a review of the evidence which s suggested that people who are aging in the community, who are otherwise well, low risk of fractures, didn't need routine supplementation with calcium and vitamin D. And Colin says who is on vitamin D and declares that vitamin D supplementation, is there a case for old I'm 90 people where the skin has reduced capacity to produce vitamin D from sun exposure?

Well you're the clinician, Priya. I'm not I'm just a pretend doctor.

Well, I am the first one.

And we can't give individual advice. No, we cannot. We'll just speak generally.

I was about to say that just then. I was like we can't give you personalized medical advice. However, we did say Norman, or I did say the caveat. To this review, which basically looked at people without osteoporosis who were not at high risk of a fracture, who were not in nursing homes, and so.

I'm not ninety years old by the right.

So there are always caveats and if you have osteoporosis or other issues or you have a low vitamin D level, you're not going to fall into that review that we discussed and you might need calcium or vitamin D, but you speak to your own qualified health professional.

Thanks Colin. And now from Deb.

Deb says on the programme last week you were explaining that proposed changes in bulk billing in some situations, for instance nursing homes, could potentially be so burdensome that doctors may choose to privately bill rather than chasing a signature for bulk billing permission.

So so my understanding pre uh of this situation, you're the one who does the billing, but is uh a doctor can bill whatever they want. And they're free to bill to the patient a sum of money that would be equivalent to what they get back from Medicare, but then it's up to the patient to pay the money over the counter and the patient to actually claim from Medicare the money.

And something in my brain is saying that we're not actually allowed to do that, but I would rely on practice managers and uh GPs who own businesses who know how all of this works and the intricacies. I'm really good at the diabetes and the high blood pressure. This element I really rely on the admin staff. But also you're expecting people, Norman, in this case, if you could do that, which I'm not sure you legally can, to have forty two dollars. And that is not necessarily always the case.

And don't forget our sister podcast watched that rash. This week, if you're still coughing after a cold, does that mean you're still infectious?

Hmm, postviral cough made GP. Dream. Well it's a lot of general practice.

I'm sure it is.

I'll see you next week then, hopefully without a cough.

Keep it to yourself.

Yeah.