¶ Intro / Opening
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I'm Peter Martin, host of The Economy Stupid, where we find our Sin relationships.
She only wants a man.
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How settled is your tummy?
Ah how settled. Now I'm a GP who's gonna touch wood as I answer this because I know we could be tempting fate here. Pretty good. But I am someone who if I'm worried, my brain talks to my tummy. This is how I explain it to my children.
Well it's true. There's a lot of crosstalk between your brain and your your abdomen and so on. Mine's I don't want to get into too much detail.
Please.
Yeah.
I was up and down, I have to say. It almost has been since I'm a kid, but I think probably that brain ball connection's important. But you know, whether that's actually what's going on in people with irritable bow syndrome is a matter of debate. But that's one of the things that we're going to be talking about today on the health report.
¶ General Health News Updates
I'm Pri Alexander or Marine Jury Land.
And I'm Norman Swann on Getico Land.
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Also on the show we look at a study that has looked at people presenting with bowls. symptoms in general practice and real variations in investigation.
Which has serious consequences. But you know, we've also got a story about electronic health records. Well really my health record. And we've got a story of somebody who actually was diagnosed with breast cancer through the app, discovered it.
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In the news, something that we don't talk about often diphtheria, a bacterial infection which can be very serious.
Yeah, and there's been an outbreak in the Kimberley.
There has been, but this is something I've only studied, Norman. We learn about it in medical school. I've never seen a case. And this is of course a bacterial infection which can cause skin lesions or you can actually get really sore throat fever and you can get what we call a pseudomembrane on the back of your throat where you can't breathe.
The essence of diphtheria is that it's a bug that produces a toxin. So it's a bit like tetanus. And the toxin is what can cause a lot of problems. And a lot of people went to medical school think this is just actually in your throat and in the throat it's a life threatening condition. You get this membrane at the back of the throat which can block
uh your breathing and particularly in children. But you can also get myocarditis and inflammation of the heart and you can die of that too. So it's a nasty, nasty disease, totally preventable with immunization. But it's also it can also infect the skin and cause wound lesions.
So Western Australian Department of Health have reported seven cases in Aboriginal people living in the Kimberley region since December. Northern Territory has reported four cases. South Australia has a case of diphtheria in the APY lands. Now just for context, in twenty twenty five there were less than forty cases across the country. So this is significant and
For everyone listening, diphtheria is on the national immunisation programme. For children they get multiple doses. They get another booster dose in year seven at school. But for anyone who is fifty and over, it is recommended that you consider a booster of diphtheria tetanus hoping cough.
And a lot of people go away, Norman, and I see them just before they're going away to Thailand or Indonesia countries where diphtheria is circulating. It is so worthwhile considering a booster dose. It's about thirty-five to fifty dollars depending on where you get it.
And just to explain. the outbreak. Some of the outbreak is skin lesions and others skin infection. But actually there have been a couple of respiratory cases. So I mean th this is really serious. Yes. And if we fall below you the um you know ninety, ninety five percent rate of immunization in the community this could spread. So you've just got to be careful about this.
Yes, against human papillomavirus in boys. So this is a study that's been published in Jarma Oncology done by researchers from Japan asking the question, does that nine valent HPV vaccine, that's what we use here in Australia on the schedule,
Meaning nine different versions of the human power.
Strains. Does it lower the risk of HPV-related cancers in adolescent boys and young men? And we're talking about head and neck cancers, penile, esophageal, and anal cancers. HPV is associated with all of them.
Interestingly, that's not the main reason why boys were started to be immunized for HPV. It goes back to the rubella story. Is what they discovered was'cause rubella being a pernicious infection, when women become pregnant and you get congenital rubella, which is an awful disease. I actually have seen a couple of cases and you just don't want to ever see another one uh in a little baby.
So they thought well w we we we will just immunize girls against rubella and they found that in fact that didn't really control the disease. You had to immunize boys as well to get that effect. And HPV it's even more important because boys infect girls with HPV. It says it's a sexually transmissible disease. So to really control human papillomavirus you've got to immunise boys as well. But there are benefits for boys.
And just to link it again, just to really make the connection, Norman, HPV is what causes most cervical cancers too. So initially it was girls. Some countries still only vaccinate girls. But really, as you say, the benefit is in vaccinating everybody. And it appears now that everybody yields benefit because what this study found is that in the group who were vaccinated there was a 46% lower risk of these HPV-related cancers.
Which is interesting because it really only went to the age of twenty six'cause H P V immunisation hasn't gone on for that long. But it was hundreds of thousands of boys who'd been immunised versus you know, a two million control group. So it was really what you would call a case control study and uh and showed that even with the small numbers at that age, you still saw a significant effect.
But the authors did say that they need longer term data because a lot of this stuff has a very long tail in terms of H P V exposure and then it's sitting around there for years and causing, you know, the cells to change. So This is wonderful and I think this really makes the case for vaccinating boys and girls, but that some more longer term data would be even better.
¶ Pharmaceutical Pricing and Biosimilars
So guess what topic we're going to talk about next?
We don't have a sound.
We do have a sound. Through the glass at James, our producer, and he's iffy about it. I think is a good sound myself.
Are you going to do it every time or is it being played? You're gonna do it every time. Okay.
And for those of you who wonder what it is, it's a sound of constipation because there are side effects of these GOP bond drugs. Anyway, the the headlines this week were that Eli Lilly, the manufacturer of terzepatite, the uh Monjaro, the uh drug for obesity but also type two diabetes. They've seem to have left the negotiating table with the pharmaceutical benefits advisory committee, saying the price being demanded of them is too low.
A bit of context here. There are some GLP ones like Ozempic which are on the PBS, which if you have type two diabetes, yes, you can get it at a subsidised price. It might be twenty five dollars or the seven dollars seventy if you've got a concession card.
And drillaglutide's another one?
Yes. Monjaro is to Zeppet and that is only available privately in Australia at the moment. And what they tried to do was say This is a really good drug. It acts through dual pathways. It's it's been shown in some studies to be even better at glucose control and diabetes, be really good at weight management better than some of the other drugs. So they tried to say, let's put it on the PBS for people with type 2 diabetes so it's affordable, equity, let's make it accessible to people who need it.
The pharmaceutical benefits advisory committee, though, makes an economic judgment on this as well as other effective effectiveness judgments. and came to the conclusion that Eli for the benefits that they were claiming, the price was too high. What often happens behind the scenes with the PBA C and getting on the PBS is negotiation, is that they go into negotiation with the company
So who do? The PBS or the payback? Uh
Um that's a very good question. Um, who actually does the negotiation? I think it I think it's the pharmaceutical benefits advisory committee that does, but I could be wrong about that. Point is there's a negotiation.
And w a lot of drug companies like to do what Apple does, for example. So if you buy a Mac in Paris or a Mac in Sydney, it's gonna cost you the same. They want un they want uniform pricing. But in fact what really happens is Uh Australia negotiates its own price and we negotiate some of the best prices in the world for some of these drugs.
But Eli Lilly wasn't going to play that game and they decided that the price that the PBAC wanted was unrealistic and they were not going to actually do that. Now this in context is part of criticism of the Pharmaceutical Benefits Advisory Committee that's coming from the United States. Pressure on Australia saying this is unfair, anti competitive.
So you have to see this in context. But it's entirely up to the sponsor, Eli Lilly, the pharmaceutical company involved, to not put their drug on the pharmaceutical benefits advisory scheme. And that's what they've chosen to do at this point.
And for people this costs$645 a month, roughly, if you're on the higher dose. But it can be costly, Norman, and with this decision, around four hundred and fifty thousand people are going to miss out on the medication with type two diabetes. I mean, I'm thinking from a clinician point of view, oh, it would be a game changer. It's sad.
Except that there are other drugs available.
There are, but sometimes you you don't get the response that you need from that medication and you go, Wouldn't it be wonderful to go to the dual action medication for this person? And it's a big financial hit.
So the question here, is the story over? Um or will Eli Lilly come back to the table for a dis for a discussion on that? And interestingly there's also Um, SandOS and other drug companies been pushing an issue, which is an interesting issue, which we should probably cover in more detail in future health reports, about biosimilars and how to get biosimilars on onto the market. Now, to explain what these are.
Over the last twenty odd years there have been biological drugs coming onto the market which have quite dramatic effects on autoimmune disease, sometimes on cancer, lymphoma and so on. Incredibly expensive. So the original versions of these could cost you sixty, a hundred thousand dollars a year. Now, these biosimilars, there there's a whole issue around patent and patent protection here, but biosimilars are drugs which purport to have the same effect as the original drug.
But they're not generics. It so if you take a generic form of a statin, say, for cholesterol reduction, in theory it's exactly the same drug as the branded drug. Whereas biosimilars, because biologic drugs are complex, they're huge molecules, they're produced by biological processes, the biosimilars are not identical to the original drug.
Are they as effective?
So this is the key. So the t the t and this is what the barrier is to their use. No, they're much cheaper. So twenty-one biosimilars have actually been approved by the therapeutic goods administration as of last month.
Would we know any of them? What do we talk do we know a name?
Uh well it's for example for rheumatoid arthritis that has several biosimilars. Rituximab, which is used in lymphoma amongst other things, that has a few biosimilars, tends to be drugs that are coming out of patent and they produce these biosimilars. For a generic to come on the market they've just got to prove that the drug is a s a simil you know, is the identical chemical drug.
For biosimilars, they do actually have to prove equivalence in a clinical trial. They don't have to show curates that in a phase three, but they actually have to show equivalence. But there's still a fair amount of resistance amongst specialists, uh non GP specialists in cancer and rheumatology and so on, to use biosimilars and get used to them because they're not the same drug.
And so what Sandoz is doing i self interestedly is trying to get a discussion going about this. But potentially it could save the country quite a lot of money if these biosimilars are just as uh just as effective. But you'll find a fair bit of skepticism amongst some specialists about this.
And it could make the drug company a lot of money. There's a reason for the push. I'm just you know. Right.
And some of these mainstream companies are producing their own biosimilar, so Pfizer, Sandoz and others. So there's a lot of money here. They may not be s saving quite as much as they could, but it's an interesting issue.
On ABC Radio National, you're with the Health Report.
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¶ Irritable Bowel Syndrome Biomarkers
Irritable bow syndrome is very common, Norman. You've kind of declared that perhaps you have it on air.
Tommy Rumbling.
I feel like we know your knee and now we're we're moving to the guts. But it is a very complex condition, irritable bowel syndrome, and it can really impact people's quality of life. But at the moment diagnosis is based on fulfilling symptom criteria. Undergoing investigations, you know, blood tests, still samples to make sure that nothing else is going on like C.
You're not really diagnosing the IBS, you're inju you're seeing whether you've missed something.
Yeah, you kind of have to fit this symptom profile and then we i it's a diagnosis of exclusion. We have to make sure there's nothing else going on. There's a study suggesting that perhaps there are clear biomarkers, that perhaps there is something going on in the body that we can detect that can help build the case for diagnosis of IBS.
And this could be a really big change for people in this area. And I spoke to lead author of the study, Doctor Grace Burns, who's a postdoctoral researcher in the Centre for Research Excellence in Digestive Health at the University of Newcastle.
What we did was we took all of the published literature and all of the other previous studies and tried to analyze them as one body of work to try and really pick out what are consistent signals because there's a lot of You know, this marker is up in these studies, but this marker is down. So we were trying to really pick out clear, consistent markers that are. I guess associated with IBS over uh people that are healthy, but also people with other gastrointestinal conditions such as
uh inflammatory bowel disease. And what we found was that there is a consistent signature in the peripheral blood in that there are some inflammatory markers that are higher in patients with IBS compared to healthy people. And then there are also differences between IBS patients and patients with those more what we refer to as organic gastrointestinal conditions, but inflammatory bowel disease or celiac disease, for example.
Which one comes first, Grace? Because does this change the notion that IBS is a functional disorder, does this I guess what I'm asking is, are these biomarkers raised because of the underlying mechanisms or pathology in IBS, or are these markers that you found, these pro inflammatory cytokines, are they causing the IBS? Which way is it, do you think?
Oh
Um, so that's a really great question. It's hard to say because, again, there's so much heterogeneity that It potentially could go both ways, but it is likely that the IBS is potentially, for whatever reason, whatever's causing the IBS, whatever's that initial trigger of the IBS. is causing the body to respond in an inflammatory manner, which is then um, you know, those signatures are then remain within the blood and the circulation and are um
p predictable there. But it's also again further complicated because we know that while you know about half of people with IBS have what we call a gut to brain driven disorder, where um the IBS seems to initiate in the gut itself. The other half seem to have more of a brain to gut pathway. where there's some kind of like the psychological or brain factors may actually drive the gut dysfunction. So there's another layer of complexity in actually unraveling that. And it's really hard to s to know.
And I guess the third aspect to consider here is that we also know that somewhere between 10 to 20 percent of IBS cases actually start after like a gastroinfection, if you like. And so we refer to them as post-infectious. And in that scenario, it's potentially that um inflammatory scenario exists before the IBS develops.
The fecal cow protectin test, so that looks for inflammation in the gut, that's a stool test that can often pick up people with things like inflammatory bowel disease, so it'll often be raised. You appeared to find that people with irritable bowel syndrome have higher levels of fecal calc protectin, but not as high as people who have inflammatory bowel disease.
Is this something that might be used in the future in that if you're querying someone has IBS, a clinician might actually order a faecal cow protectin and and it might not be that it's outside the normal range, but it's higher than Then what normal people have?
Yeah. Yeah. So Fecal cow protectin is really important in terms of monitoring and diagnosing um inflammatory bowel disease, as you said. And people being investigated for IBS, if they haven't already had things like inflammatory bowel disease ruled out, will actually have
Cal protected measured. And so there's real opportunity here to kind of change that clinical practice where if it is slightly elevated and we would have to kind of redefine the cutoffs where we would consider, you know, a normal F Cal versus an IBS. Cow protectin versus an organic disease. But yeah, there is absolutely opportunity here to kind of improve the diagnostic process by considering fecal cow protectin, which Yeah, it's just a stool sample, it's not invasive, it's routinely done.
But it can be costly. It can cost seventy dollars because it's not always funded.
It's absolutely costly. Um, and you know, that is something that would obviously be, you know, something we'd urge to be considered and it would require a lot more clinical testing. Um, but I mean the evidence does suggest that it does have benefit and it could save, you know, potentially other costly tests if you can take out, I mean, if you're undergoing diagnosis for IBS.
You've potentially had a whole bunch of procedures done, including colonoscopy, including blood tests, including stool tests for parasites and so on, that are also costly. Yes, I guess there could be an argument made there for. looking into this further to kind of reduce some of that economic burden.
stuff that we've discussed, Grace, how does it translate into the real world? Because people are listening, oh, I think I have IBS or I've been diagnosed with it or I think my child has it.
You know, we're talking about these pro inflammatory markers, interleukin six, T NF alpha, these are, you know, quite specific inflammatory markers that we're talking about. Are people gonna go and have this ordered? Is this just gonna be done off the bat or is there still a way to go for this to actually have an impact on the ground in the diagnosis of IBS in people.
Yeah, so there's absolutely still a way to go for there to be impact in terms of IBS diagnosis. I mean, one limitation is that these markers such as IL six are quite Not generic, but they're inflammatory markers that are associated with a number of conditions and physiological states. So they're not. Uh specific to IBS per se. I guess the real right now impact of this work is that it really provides uh validation that.
IBS has often been considered what we call a functional disorder where there's no biological basis. And for patients, that can be quite disheartening. I mean, you think about having these really this really huge symptom burden that disrupts your everyday. Like there's
significant quality of uh life impacts of having IBS. Um, and to then be told that there's nothing biologically wrong with you is quite invalidating and quite stressful. And so I think the The real point, you know, the today impact of this work is that it does show that there are immune system changes.
that we can detect, that we can measure, that show that IBS patients are different to healthy controls. And yeah, absolutely, there's plenty of further work that could be done in terms of implementing the signature for diagnosis. We're really just adding to that body of work. A significant proportion of our population we know have IBS. We know people live with crippling abdominal pain and changes in their bowel habits. And I really implore you to go and talk to your GP.
about it. Um because there are things that you can do to kind of um Firstly, make sure it's not something more sinister, but also to try and make suggestions to help you improve your quality of life.
Doctor Grace Burns from the Centre for Research Excellence in Digestive Health at the University of Newcastle.
You're with the health report on ABC Radio National.
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¶ Bowel Cancer Investigation Disparities
Norman, we've talked quite a bit about bowel cancer on the health report, particularly about increasing bowel cancer rates in younger people. Not many people actually engaging in the bowel cancer screening program despite it being very effective. There's a study that's been published involving researchers from the University of Melbourne, University of Sydney, and it's looking at people presenting in general practice with symptoms that could be bowel cancer.
And there's not very consistent investigation. There's big variations and it's a little bit concerning because are people being missed and do we need clearer guidelines? We are joined now on the health report by Dr. Shao Qi Li, who is a research fellow in the Cancer in Primary Care team at the University of Melbourne and also an author on the study. Thank you for joining us.
Thank you so much, Priet.
Can you just talk us through what some of the symptoms are that people might be going to see their GP with that could be bowel cancer that aren't being investigated?
Well the symptoms uh abdominal pain, diarrhoea, constipation, something like uh erectal bleeding and those are has a really high positive predict value.
So you've got these people coming. So you looked at a very large data set of people coming through general practice to see what happened to them. And you looked at whether th or not they were investigated and this is retrospective. So you looked at the people who were diagnosed with bowel cancer eventually and then what their journey was through general practice, is that right?
Yeah, yeah, that's right. I think the motivation of this study is, uh, because we know that coronavirus is the second leading cause of the cancer death in Australia. We know that the chances of a survival are much higher when cancer is diagnosed early. The problem is that the symptoms like abdominal pain, diarrhea, and constipation, those are extremely common in general practice.
And the vast majority of those people with the symptoms do not have cancer. So our GP is facing a really difficult judgment call every single day.
Uh well they might be facing if we'd judgment call, Shokay, but the um what you showed was that if you c came from a rich area or m a wealthy suburb You are much more likely to get investigated than if you were from a disadvantaged suburb.
the most uh social recommended diswanted patients have forty five percent low odds of being referred for coronoscopy or specialist care. That is really concerning, I think, from our data.
You also found that if people presented multiple times to the G P so they kept going back with their symptoms, that they were actually more likely to be investigated. So Is a takeaway perhaps for people listening if you're worried if things aren't settling to keep knocking on the door because you may then get the investigation you require?
Yeah, that's a good point. I think there's a message for consumers. If you have the persistent bow cancer symptoms, whether that's rare to bleeding or changing your usual bow habit, un explaining weight loss or abdominal pain that keeps coming back, say your GP and don't include it. So our data says that um the repeated visit definitely So the GP is the right place to start and returning if things don't improve and that is very important.
Isn't part of this also that if you're living in a disad if you're a GP in a disadvantaged area your patients are less likely to be insured and therefore you're throwing them at the mercy of the public system with long waiting lists. So in the back of your mind it might be, well, I might refer them for a colonoscopy, but it's going to be six months before they actually get one, even longer.
But you'd still refer them.
Yes.
You'd still make the referral pattern, so it would show up in this study because it would be it would be seen as an investigation or or something that's been done.
So they're giving up before they start.
Well, I wonder if it's more complex'cause there are time constraints in general practice and I know the the way you've done this study appears to be looking through records and the reason for encounter and I have to say that Shaoqui, when I write in the notes, often the nuance is captured in the clinical record. and what I've discussed, and it might have been the third thing that someone's raised in a consult, so it might potentially not have been picked up, I don't know, in your study.
Yeah, I think that's a real problem. It's one of the I think a limitation. So the GP software has a a reason for encounter feel. So but there's no single standardized format. So one duping might write blood in stool, another probably just write rectal bleeding. It is likely that we are not able to capture all relevant symptoms from the free ticks.
Shoki, thank you very much for joining us.
Thank you so much for
Dr Shoki Lee, who's a research fellow, cancer and primary care team at the University of Melbourne. and the Victorian Comprehensive Cancer Centre. So I mean, uh I think the message here, you know, you're the real doctor, not me, uh Priya, but you know, the message here is a new symptom, any new symptom that you've never had before. Don't give up on it because particularly if you're over forty, but even under forty, this could be something serious. Get it checked out and don't let it go.
And I think we should point out that there are increasing bowel cancer rates in younger people, so in that under fifty age group, and the rates actually in people over fifty, we're detecting it well, they're part of the the screening program. But symptoms like rectal bleeding A change in Bow habit.
Take it seriously, go and talk to someone and if you feel, you know, not validated or reassured enough, persist again.'Cause this study shows that if you keep going back, you're more likely to be investigated.
And go back sooner rather than later.
Yes, on ABC Radio National, you're with the Health Report.
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¶ My Health Record: Benefits and Challenges
So Priya, this uh this is um a controversial topic for you'cause you you're not necessarily a believer in the My Health record, are you?
You're throwing me under the bus. It's not that I'm not a believer, it's that I sit in the consulting room and often try to access a record which is incomplete. And it can be quite a clunky system.
I'm a believer and I think people should be on it, but you know, we'll have this conversation as we go forward. But as an example of what it can do, uh we've got Christine Quong on the line. Christine is a nurse. And you'll hear a little bit about our health journey in a moment. She's also in involved in the digital health industry herself, so you could argue that she, like me, is a believer. Hi, Christine.
Hi Norman, hi Brienne.
You had diverticulitis, you were in hospital and you had a C T scan for your diverticulitis. And it showed that it was good news for your diverticulitis, but there was one thing missing when it got back to your GP.
I got a phone call from the specialist to say you know, the diaticulus is fine, just continue on the old antibiotics and the usual like, you know, if the pain gets worse or I don't feel any better, go back to the hospital. In about the week later, for some reason, and I'm a bit like Priya initially when my health record came out, I
didn't want to share my information. So I don't know if I forgot to opt out or what happened, but I'm kind of grateful that I now have got the My Health record in there. And for what, as uh Norman mentioned, I do work in digital health space. So we have been looking at how quickly, you know, your records can come through.
So instead of Instagram you you troll through my health record, is that what happened?
I do. Well, I kind of look through and, you know, I have some other s things and, you know, the regular health checks are being passed, you know, the age of forty five. So, you know, being a nurse, you've got to practice what you preach as well. So it's doing all the screening and everything.
Your C T scan was in there. What did you find when you went in and had a look at it?
So it
It did report that my diverticulus fine, uh, and because of the abdomen it did look at you know my liver and everything else, but it did have on the report that there was a six millimeter lesion on my right breast. and if concerned should get further ultrasound. So it wasn't usually in like the bright bold or anything like that. And I just happened to read it, which I thought was a little odd because the specialist hadn't told me.
Um, and then I was next having, you know, a couple of weeks later follow up with my GP, so raised it with them. They never got the report. So that report actually only went to my specialist and the emergency doctor. So from then on my GP was like, Yep, let's send you for an ultrasound and another mammogram. And then that sort of was how I found um my stage two breast cancer. So finished my radiation treatment and um started back at work last week. So
I'm sorry to hear about the breast cancer, Christine. I I just wonder though, you are a nurse, so you've got a medical background, so you could interpret the report, which is wonderful and I guess very lucky in this in this sense. But is this not potentially a failure of communication where the hospital didn't actually communicate with the GP so that things could be followed up? I just wonder if this is success of the app or if this is failure of communication within the healthcare system.
I think there's still elements of the healthcare system and I think that's why it's still really important that some processes are maintained, like, you know, checking your GP and all that sort of stuff. I did follow up with the specialists to better understand how come the report didn't go back to my GP. So in their practice software, my GP was listed as an interested party. Uh so for whatever reason it didn't go there. And my care was through public and private.
So there's, you know, a whole thing about, you know, the your information's not being shared from either of those two very fluidly. So I think it, you know, it's helpful to have all your information on the my health record. And as you said, as an I'm a nurse.
But even when you're going through all this, you forget things. I forgot, you know, I was making notes for what to ask and it was kind of helpful to have all that information there so I could process and also talk to uh my specialist a bit more about it. So I think that's kind of the imp important thing as well.
Well obviously it made a huge difference to you. But uh just finally, Christine, is all your breast cancer information there in your my health record, everything that's happening to you in hospital, is that all there as well?
No, not currently. So it's mainly all the resul results. Uh some of the discharge summaries from my um have been in there, but not so much from the public system at the moment. So yeah.
a huge gap which we are going to follow up in a moment with uh Dr. Amandy Panscher, who's the Chief Clinical Advisor of the Australian Digital Health Agency. But Christine, thanks very much for joining us.
Oh, thank you for having me.
And by you know the wonders of modern technology priya, we have Dr. Amandeep Hansra here with us, who's the Chief Clinical Advisor of the Australian Digital Health Agency and a general practitioner herself. Thanks for joining us, Amandeep.
Thank you so much for having me.
So you mean we're here to sort of rejoice in the fact that you've had a million downloads to the 1-800 Medicare app, which has used to be the My Health app. And we've just spoken to Christine. So before we rejoice in this, every time I talk about my health record, and I'm a believer uh to GPs, they s there there's a moan that goes through the audience. It's clunky. It's still PDFs, believe it or not, not searchable documents and be able to move around easily through that.
There's no hospital information. You just wonder how common a story like Christine's actually is, given how clunky this My Health app is, despite we've spent maybe half a billion dollars on it.
That's a great question, Norman. And I'm I'm happy to kind of unpack that a little bit. So the 1-800 Medicare app is actually the patient's version, the way that they access their My Health record. So
If we think about the app separate to what the doctors see. So the app is, you know, what we're really excited about in terms of patients, you know, have now accessed um well, there's eighteen thousand of them accessing it every week. There's obviously a million downloads and if you actually have used it and I have it myself and my kids have it, it is one of the most user-friendly apps that you know I have ever seen a government um come out with, to be honest, in terms of you know being able
You've actually done something right for a chain, have you?
It's it's it's amazing and I am not someone that's easily impressed with apps and I have to say this one, I literally opened it this morning, was just showing it to my um my physio and was just um and and wowing her with um things like the timelines and the scripts and all the Medicare information in there and the results. So I think from a patient side, they have really won at the moment in terms of having a great user-friendly app
on their end. I think for the the doctor side, and you're a hundred percent right, like it
It has historically been a bit of a difficult user interface. It's been a bit clunky to access things that we wanted to access. But there is work now underway to improve that. So we're going through a modernization of actually making the doctor side of the My Health record much more user-friendly and, you know, moving away from PDFs and moving away from multiple clicks to go in and out and really having that, as you said, searchable functionality.
I'm indeep, I just to just to jump in, I like I think it's wonderful, A, kind of having this integration because it does feel very siloed. And I also think it's wonderful for patients to have access to information. And we just spoke to Christine. Christine is, you know, has high health literacy, is a nurse, has picked up this finding on the CT scan and followed it up with her GP.
If people don't have clinical knowledge and they've got access to all their results on this app which is really user friendly, but the clinician is sitting in the room and I can't see the results And the patient doesn't detect it, is it is there still a really big failure in communication between healthcare systems and does my health record or the app really fix that? Does it really address it if people aren't health literate or they don't have the app?
Yeah, look, I think um Priya, we have to address this information you know access issue from multiple points, right? So I think Absolutely, we have not solved the fact that, you know, you as a GP, me as a GP doesn't get the information at the right time that you know, that we want. And we're trying to
try try and do what we can to make sure that, you know, this as as I said with Norman, the systems talk to each other so we can get that information faster. But I think in the first instance, what we're trying to do is is at least empower and enable our patients to have access to that information.
And we're not asking patients to, you know, we're not expecting them to be equipped to interpret all of our information themselves. It shouldn't be about them having to do that on their own or us replacing clinicians with patients, you know, trying to manage their own health care.
It's about kind of supporting those better conversations. And if we don't have access to that information, at least the patient has it, like someone has it out of the two. I don't know if you've ever had an appointment where a patient's turned up to discuss a result.
you know, you know they've had the test, you don't have the result either. And you're both sitting there going, I'm not sure what we're both doing here. Um, and, you know, we have to rebook them. And I think what we want is at least while we're working on the provider side. can we at least have the patients owning their own results and their own information?
And just for information sake, so all pathology providers, all radiology providers have signed up to this, so all results go into your uh your my health record.
Well by the first of July it will be mandatory. So it's um a legislative requirement um for anyone that's accessing Medicare. So essentially we've had to use that lever because it used to be voluntary and obviously when things are voluntary some people opt in, some don't, and it's not great for the patient who happens to go to a particular pathology provider that doesn't happen to upload. So we want all patients to have
the same access to their information. So it it will be mandatory. There will be some tests that, you know, based on any clinical harm or safety issues over things like histopathology, we don't want patients to find out that they've got cancer sitting at home on their own. So some of those will still be subjected to delays in in terms of patients accessing that information. But your general everyday stuff from you know 1st of July when it becomes mandatory will be available for all patients.
And indeed, a lot of people might be listening going, Okay, I might get this up, I'm gonna download it. I've had a lot of patients Who are perhaps older who really find it quite difficult to link their MyGov, they find it really difficult to actually set the app up. What would you say to people who are listening thinking about doing it?
So my advice is to you i is is to um if you can't do it yourself, you know, if you've got
at your 14-year-old grandchild
Yeah. But it is quite tricky the MyGov component.
It it is. And I think if you are struggling, then it's worth ringing um we've got a helpline. If you just go to our website, there's a helpline number there that you can ring and we can help you navigate it. We are working very closely with the parts of the government that run my gov service to see how we can streamline and make that easier.
'Cause to me that is the toughest bit of the whole process. And then once you're past that and now, you know, I can just open mine in like three seconds, it becomes so much easier. You don't have to keep going back in and going through that whole process. But it is a once-off thing.
But if you have trouble, ring our helpline because we'd love to help you. I would say your GP may not be able to help you. Um I've had some patients ask me and we've gone, well, we actually need to, you know, spend a bit of time doing this. So um but you know
Maybe he's too busy on the fact.
That's right.
Yeah, some
Or navigating the record on the other end, the clunky record. Definitely ring a hell.
Blind.
Amandeep, thank you very much for joining us.
Thank you so much for having me.
Dr. Amadeep Hansra, who is Chief Clinical Advisor of the Australian Digital Health Agency, and the app is called the one eight hundred Medicare app.
On ABC Radio National, you're with the Health Report.
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¶ Listener Mailbag and Farewell
So what's in the mailbag this week?
So Andrew has written in in response to a comment that you said about having your appendix removed.
So let me explain the story before we get into Andrew's thing'cause you know this is my favorite little organ we is there's been a rise in appendicile cancer in young people. And one of the theories behind this is that we were increasingly treating appendicitis with antibiotics. And are we missing some appendicile cancers by leaving the appendix in there? No, we'll hear from anyone.
Okay. Andrew writes, I was enjoying the latest episode when the issue came up of whether or not to have your appendix removed if you experience appendicitis. I was surprised that Norman said he'd hold a gun to the surgeon's head until he or she removed it, presumably without using general anesthetic.
Quite say that, Andrew.
I actually agree with you though, Andrew. I was surprised and my husband who's a surgeon went, Oh, I'm surprised Norman said it like that. So here we go. What about the role that it's now known to play in supporting the immune system? As well as housing good bacteria to help recolonize the gut after severe intestinal infections. I had my appendix out many years ago and still worry every time I need antibiotics it'll be harder to restore my gut microbiome. What are your thoughts? Cheers, Andrew.
So Andrew, you need to listen to this week's What's That Rash, Our Sister podcast, where we deal with exactly this issue and the appendix you're absolutely right is th is thought of as a safe house where the uh there are bugs
They in Basel's live. That's where they live.
Well no well this no the safe house is different. The safe house is for the microbiome. So it stores bacteria and other organisms. So if something happens to the microbiome of the gut, the but the appendix can deliver the microbiome back into the gut. But yes, you're right. It's also an immune organ that uh that actually trains the immune system and helps to control the immune system. sy'n sy'n sy'n sy'n sy'n sy'n sy'n sy'n sy'n sy'n sy'n sy'n sy'n sy'n sy'n sy'n Which uh
So you don't just want to chuck it out willy nilly.
No.
No. So you may need to rethink your approach here, Norman Swan, is what everyone's saying. Kathy's written in
Address to your husband, because
He was like, wow. Kathy's written in saying, as someone that listens to your informative program regularly, I was unaware of the link of the bracket gene mutations with prostate cancer. My husband has two close relatives that had breast cancer and breast cancer, ovarian cancer, and it's not until I've researched prostate cancer due to my husband's recent diagnosis that I've learned this link.
The surgeon agrees it will be a good idea to test my husband for the mutation after the surgery for our adult children to then know. Last week you mentioned the gene, but once again only in the context of breast and ovarian cancer, but it seems very important for men to know this connection too. Yep.
Mm. So men carry the BRACOGene and men uh and that puts them at higher risk of male breast cancer. Yes. Or prosthetic cancer and pancreatic cancer as well. So it's important for men to know that and they can be monitored as well. So it's for genetic counselling and so on. So it is important.
Renee has written in from Calgary and says I've been meaning to email for quite some time.
So this is not cut someplace in Western Australia or not.
I was gonna get there. Oh, you are Kenny would'cause it's in the email, I assume. But Renee says, I've been meaning to email for quite some time. I love the show. I love your interaction with each other and your stories about your lives. This is so nice, Renee. Thanks Norman for sharing growing up in Aberdeen and wiping out on your bike and doing in your knee and prayer for your stories about how you approach medicine and blending family and work. While you toil in your studio.
Producing the podcast. Remember the reach is possibly a lot further than you know and the impact on individual lives is significant and meaningful. I often listen to each episode more than once. I feel like bawling my eyes out. So nice. Thank you, Renee.
One of our huge Canadian audiences uh one of our
Are they huge?
Member. It's absolutely massive. You know, it's I think it's about five in the morning on a Saturday morning. I think it goes out on the Canadian broadcast.
Well we appreciate it.
Well, Renee heard it first on Canadian Br uh on C B C Radio and now she subscribes to Watch That Rash and the Health Report so she gets it on podcast. And she's become a quite an avid Australia file.
Yeah.
And uh just before we go, uh a few weeks ago we had Nick Brown on from the Wesley Hospital in Brisbane talking about prostate artery embolization. So this is a different way of treating enlarged prostate glands, uh where you block off the prostate artery. And um it was quite controversial, not least with um your husband as well, thinking that I was promoting this um overtly. But anyway.
Um we had some really thoughtful f feedback from a few people about that segment. People who'd had trouble with the procedure or concerns over its use. And we put some of those points to Nick and he's responded and we'll put that response on our website and as a link to the original segment.
Please keep writing into us. You see that we do enjoy them and we read them all. It's healthreport at abc.net.au
And don't forget our sister podcast, watch that rash. It's on vestigial organs, including whether the appendix is vestigial. But you know the answer to that
I'll see you next week with your appendix, hopefully.
Actually, is going to be your co host. And I'm looking forward to hearing how the two of you misbehave.
It's gonna be wonderful. Everyone should tune in.
See you then.
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