How the same-sex marriage vote will impact on human rights and democracy

 Supporters of the ‘yes’ vote celebrate the 
result at a street party outside the Victorian Trades Hall in Melbourne. AAP

Prime Minister Malcolm Turnbull’s promise of same-sex marriage by Christmas will almost certainly be honoured. We will continue to argue for some time whether the long, expensive and emotionally charged process that’s delivered this change was worth it.

The postal survey basically reaffirmed what opinion polls had made clear for some years. It also introduced certain dilemmas for MPs, who were asked to cast a conscience vote while acknowledging the wishes of their constituents.

Before the poll several MPs said they would follow the vote of their electorate. Some opponents of change, like Matthias Corman, felt bound to vote for the legislation. Others, including Pauline Hanson, abstained.

The dilemma is most acute for Labor members in the lower house, as all but four of the electorates that recorded a “no” vote are held by Labor members. Three senior Labor figures – Jason Clare, Tony Burke and Chris Bowen – who represent the electorates with the highest “no” vote all support change.

The Labor members who are opposed are seemingly united by their connections with the Shop, Distributive and Allied Employees’ Association (SDA), the last bastion of the Catholic right in the Labor Party.

Labor is managing its divisions smartly: clearly the handful of anti-marriage MPs were told they could vote no provided they did nothing to delay or water down the legislation. The same is not true of the government parties, where the marriage debate is caught up in the increasing febrile battles for control.

There will be further attempts in the lower house to introduce “religious freedom” protections into the legislation, despite the fact that it already exempts religious institutions from having to perform same-sex marriages.

In fact, the amendments the right seeks are largely attempts to water down existing anti-discrimination provisions.

Focus on human rights

Much of the discussion has invoked “human rights”, not a concept that is often central in Australian political debate.

There’s a certain irony in members of a government that has long been engaged in rancorous debate with its own Human Rights Commission suddenly wanting to incorporate sections of international human rights law into domestic legislation.

“Human rights” are an abstract notion, which are created, protected and destroyed by political action. Most countries do not recognise human rights as encompassing sexual orientation and gender identity. This has been the subject of increasingly heated debates within United Nations forums.

Australia, like most of what we used to call “the Western world”, is committed internationally to the position Hillary Clinton articulated when she pronounced that “gay rights are human rights”.

Achievement of marriage equality is a further step towards recognition that discrimination based on sexual orientation and gender identity is unacceptable. Symbolically, this is a victory that goes far beyond marriage, even if it is not the support for political correctness that Turnbull’s predecessor, Tony Abbott, foresaw.

But the process has had significant costs, both for the principles of parliamentary government and for thousands of queer Australians, who felt abused and harassed by attacks from the “no” campaign.

As “yes” campaigner Magda Szubanski said:

The LGBTQI community were used as unwilling human guinea pigs in a political experiment. We may never know the exact human cost of this experiment. The truth is some of us did not survive this process.

Magda Szubanski addresses the crowd following the announcement of the same-sex marriage vote result. AAP

New political challenges

Szubanski may be exaggerating, but there is considerable evidence that many people found the protracted campaign very difficult.

Calls to help services for LGBTI people increased considerably. Material and emotional resources that could have gone into other issues were consumed by the marriage debate, although some newly energised young queers may now engage in broader political advocacy.

But most LGBTI Australians are very much like the rest of the country. The week after the poll result the Perth Pride committee banned refugee advocates from their parade.

Although the ruling was retracted under criticism, it was a reminder that the coalition around marriage was often born of immediate self-interest. Despite the language of rights and equality, many marriage advocates have little concern for broader issues.

In the fortnight between the announcement of the poll result and the Senate vote we saw both the forcible removal of men on Manus Island from one makeshift camp to another, and a long parliamentary process establish limited right to die laws in Victoria.

The latter was achieved without a poll or a plebiscite. This showed that parliaments can resolve difficult moral questions through their own processes. The former raised much more intractable questions of human rights than a change to the Marriage Act.

Marriage equality caught the public imagination, in part because despite the fears of the right there are no real losers if marriage is extended to more people.

As former British prime minister David Cameron said, he supported same-sex marriage because he is a conservative. Unfortunately, his Australian counterparts have a less generous vision of conservatism.

David Cameron speaks in support of same-sex marriage legalisation.

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No Don Burke, there is no link between autism and harassing behaviour

 Burke sought to use Asperger’s syndrome as as 
explanation for why he harassed and bullied staff on Burke’s Backyard.

Allegations that Don Burke indecently assaulted and bullied staff during his time hosting Burke’s Backyard were heinous enough. But in an interview with A Current Affair the other night, he created another victim: the autism community.

In the interview, Burke claimed that he has Asperger’s syndrome:

I haven’t been medically diagnosed but I’ve worked it out, what it is, and it’s a terrible failing.

I have difficulty looking anyone in the eye. I can look in the lense, but I have real difficulty looking anyone in the eye … it’s a typical thing. And I miss all their body language and often the subtle signs that people give to you like, ‘Back off, that’s enough’, I don’t see that.

I suffer from a terrible problem with that, of not seeing … and no-one can understand how you can’t see it. But you don’t.

In examining Burke’s comments, it’s helpful to separate “excuse” from “explanation”. It’s clear there is no excuse for humiliation, bullying and harassment. Nevertheless, reasonable explanations can still underlie inexcusable behaviour.

Burke sought to use Asperger’s syndrome as that explanation. Whether or not Burke would meet criteria for Asperger’s syndrome is not the issue. The problem is that the statements he made about Asperger’s syndrome are utterly false and have an impact far beyond his own circumstance.

Remind me, what is Asperger’s syndrome?

Asperger’s syndrome is part of the autism spectrum, and is characterised by difficulties with social interaction and communication.

Autism spectrum conditions are diagnosed by a team of clinical experts, often including a specially trained medical doctor, a psychologist and a speech pathologist. While autism is a heritable condition (it “runs” in families), we currently don’t know enough about the genetic factors underlying the condition and so we diagnose based on observable behaviours.

A defining characteristic of autism (and Asperger’s syndrome) is differences in social behaviours, such as difficulties initiating or maintaining social interaction with others. However, these social difficulties bear no relevance to a lack of empathy for others, which, of course, underlies bullying and harassing behaviour.

Empathy comes in two forms – cognitive empathy (ability to recognise others’ emotions), and emotional empathy (ability to feel others’ emotions once that emotion has been recognised). There is strong research evidence that some individuals with autism may have challenges with cognitive empathy, but no evidence for difficulties with emotional empathy.

In essence, once there is understanding of what a person is feeling, people on the autism spectrum are often intensely empathetic.

More likely to be bullied than a bully

While the behaviours that characterise autism can create challenges in day-to-day life, there is no link between autism and the perpetration of bullying and harassment. Indeed, dozens of scientific studies have investigated this, and all evidence indicates that people on the autism spectrum are far more likely to be the victims of these behaviours than the other way around.

Burke’s statements create real and lasting damage. There is considerable research evidence showing the stigma that still surrounds autism, and the detrimental effects that stigma can have on people with the condition and their families.

I think about the young man with Asperger’s syndrome, who has fostered enormous courage to attend and enjoy school, and now has another target placed on his back.

I think about parents of newly diagnosed children, who are met with yet another jarring myth to swirl around their tired and worried minds. I think about how this may affect their view of the years that lie ahead of them. These years will come with great challenges, but also the greatest of joys.

I think about employers, who are just starting to understand the vast talents and economic benefits people on the autism spectrum bring to their workplace, and how even the smallest seeds of doubt can be fertilised by the public airing of patently false statements.

I think about all of these people – the wonderful autism community – and how they would feel in being used as a punching bag yet again. The autism community frequently takes punches from media and public figures in an attempt to excuse or explain human behaviour.

Australia would do very well to not simply ignore Don Burke’s comments, but instead use the anger they generate to continue the path of cherishing and valuing the diversity that the autism community provides our society.


This article was written by:
Image of Andrew WhitehouseAndrew Whitehouse – [Winthrop Professor, Telethon Kids Institute, University of Western Australia]

 

 

 

 

 

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Science or Snake Oil: will horseradish and garlic really ease a cold?

 Horseradish hasn’t been studied, and studies on 
garlic found it probably does nothing. from www.shutterstock.com

Some of us may have heard that horseradish and garlic supplements help ease cold and flu. Blooms High Strength Horseradish and Garlic Complex claims it has

a soothing antimicrobial action that helps fight off the bugs that can cause colds and flu and provides symptomatic relief from upper respiratory tract infections.

Others, such as those promoted by Swisse and Blackmores, claim to be “traditionally used in Western Herbal Medicine to provide symptomatic relief of sinusitis, hay fever and upper respiratory tract infections”. And the Swisse and Blackmores products (and many others) add additional ingredients, commonly vitamin C, which is claimed to be beneficial for “immune health”.

There are two categories of “evidence” allowed by the Therapeutic Goods Administration (TGA) to validate indications or claims made for complementary medicines: scientific or traditional.

Scientific evidence is based on the scientific literature, such as trials in humans. Traditional evidence is based on theories outside modern conventional medicine, such as Western herbal medicine, traditional Chinese medicine and homeopathy.


Read more – Science or Snake Oil: can turmeric really shrink tumours, reduce pain and kill bacteria?


So, what does the research say?

A search of the medical journal database PubMed failed to find any clinical trials on the combination of horseradish (Armoracia rusticana) and garlic (Allium sativum), with or without vitamin C. Nor were any clinical trials found on horseradish alone.

The authors of a 2014 Cochrane review concluded there was insufficient clinical trial evidence supporting garlic in preventing or treating the common cold. A single 2001 trial(from the Garlic Centre in the UK) suggested garlic may prevent the common cold, but more studies were needed to validate this finding. Claims of effectiveness appear to rely largely on poor-quality evidence.

2013 Cochrane systematic review explored whether taking vitamin C (0.2g a day or more) reduced the incidence, duration or severity of the common cold. The 29 trial comparisons involving 11,306 participants found taking vitamin C regularly failed to reduce the incidence of colds in the general population.

Pictures of two supplements, Horseradish & Garlic
Supplements can claim they’re a traditional medicine, meaning they don’t have to prove they’re effective. Screenshot, Author provided

Regular supplementation had a modest effect in reducing the duration of common cold symptoms by a few hours. The practical relevance of this finding is uncertain. The authors felt this level of benefit did not justify long-term supplementation. Finally, taking vitamin C at the onset of cold symptoms was not effective.

Vitamin C deficiency can impair immune function, but this is uncommon in Australia and best prevented by eating fruit and vegetables.

The TGA accepts a traditional indication if that use has been recorded in internationally recognised traditional sources for a period of use that exceeds three generations (75 years). Traditional indications or claims don’t mean a product actually works – that requires scientific evidence.

What’s the verdict?

Products such as Blooms High Strength Horseradish & Garlic Complex claim they fight off bugs, but those claims that lack scientific validation. This breaches many provisions of the Therapeutic Goods Advertising Code 2015.

Products such as Swisse Ultiboost High Strength Horseradish + Garlic + Vitamin C, claiming horseradish and garlic have been “traditionally used in Western Herbal Medicine”, have correctly invoked the TGA’s “traditional paradigm”. But it’s important to remember this doesn’t mean these products work.

What’s the implication?

Recently, more and more purveyors of complementary medicine have been making “traditional” claims for their products.

If consumers are to make an informed choice about medicines claiming traditional use, a mandatory statement is required on the label and on all promotion explaining what this means. It should be explained to consumers the “tradition” is not in accordance with modern medical knowledge, and there is no scientific evidence the product works.

Without such a disclaimer, consumers will be misled and the TGA will be seen to be endorsing pseudoscience. But to date, industry, the TGA and government have refused to take on-board such proposals.


Read more: Which supplements work? New labels may help separate the wheat from the chaff


This article was written by:

Image of Ken HarveyKen Harvey – [Associate Professor, School of Public Health and Preventive Medicine, Monash University]

 

 

 

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Is apple cider vinegar really a wonder food?

 It makes a tasty dressing, but the health 
claims are overblown. 

Folk medicine has favoured apple cider vinegar for centuries and many claims are made for its supposed benefits.

Apple cider vinegar is made by chopping apples, covering them with water and leaving them at room temperature until the natural sugars ferment and form ethanol. Bacteria then convert this alcohol into acetic acid.

Strands of a “mother” will form in the cider. These are strained out of many products but left in others, and are often the target of health claims. The “mother” can also be used to start the production of the next batch of cider.

But will apple cider vinegar really help you lose weight, fight heart disease, control blood sugar and prevent cancer? And what about claims it is rich in enzymes and nutrients such as potassium?

Weight loss

The evidence that apple cider vinegar helps fight fat is weak.

A short-term study in Japan added two daily drinks of 15 millilitres of apple cider vinegar mixed with 250 ml of water to the usual diet of overweight men and women. Their weight fell by about one kilogram over 12 weeks, but returned to usual levels within four weeks.

According to a UK study, it may be that vinegar can suppress appetite. When offered a pleasant-tasting vinegar drink, one that was less palatable, or a non-vinegar drink with their breakfast, volunteers who downed both vinegar drinks felt slightly nauseated. Not surprisingly, this depressed their appetite, with the least palatable vinegar drink having the greatest effect.

Picture of apple cider vinegar
The ‘mother’ is strained from some cider vinegars and left in others. Mike Mozart

Others claim taking apple cider vinegar with meals will help digest proteins faster and therefore generate higher levels of growth hormone. This is claimed to break down more fat cells. Unfortunately, there’s no evidence to support such ideas.

Claims that pectin – a type of viscous dietary fibre – in cider vinegar will help weight loss by making you feel full for longer ignores the fact that the pectin in apples is not found in apple cider vinegar.

Heart disease

Pectin is again credited for cider vinegar’s supposed benefits for heart disease, with claims it “attracts bad LDL cholesterol”.

However, the Japanese study referred to for weight loss found no difference in LDL cholesterol with either a low or higher amount of cider vinegar over a 12-week period.

Others claim that cider vinegar works like a broom to clean toxic wastes out of the arteries. Sadly, there’s no evidence for that one either.

Blood sugar and diabetes

Several studies have reported on the effects cider vinegar can have on blood glucose levels. One small study of healthy volunteers found that adding vinegar to a meal reduced glucose and insulin levels – at least for 45 minutes – and increased satiety for up to two hours.

Another small study of people with type 2 diabetes reported adding vinegar to a high carbohydrate meal reduced the subsequent rise in the blood glucose level.

However, this effect was only apparent for a high glycaemic index carbohydrate, such as mashed potatoes. When the carbs came from a lower GI food such as wholegrain bread, the vinegar had no effect.

A word of warning for those with type 1 diabetes who also have damage to the vagus nerve (a common co-problem): when taking apple cider vinegar in water before a carb-rich meal, the delay in the stomach contents passing to the small intestine may alter the quantity of insulin so the usual daily injection may be inappropriate.

Other diseases

As for allergies, acne, arthritis, hiccups and leg cramps, there is no evidence that apple cider vinegar prevents or cures any of these conditions.

Nor is there evidence from any studies that cider vinegar has benefits for preventing or curing cancer. Unproven cancer cures can waste valuable time in seeking reliable treatments.

So is it worth taking?

Some sites promoting unrefined cider vinegar claim it is a good source of potassium. We certainly need potassium to help regulate the balance of water and acidity in the blood.

But with apple cider manufacturers declaring their products have just 11 milligrams per 15 ml serve (and a recommendation for two serves a day) it is a negligible source. The recommended dietary intake of potassium is 2,800 mg/day for women and 3,800 mg/day for men. Bananas have around 400 mg.

Picture of bananas
An average banana has 400 mg of potassium. Scott Webb/Unsplash

In Australia, products cannot claim to be a source of any nutrient unless a reasonable daily intake provides at least 10% of the recommended daily intake (RDI). A “good source” must have 25% of the RDI.

There is also no evidence to support the idea that apple cider vinegar makes it easier to absorb calcium.

On the good side, like all vinegars, it has virtually no kilojoules and, mixed with extra virgin olive oil, makes an excellent salad dressing.

Finally, a word of warning: don’t drink apple cider vinegar “neat”. It can damage the throat and oesophagus. Even diluted, its acidity can damage tooth enamel.


This article was written by:
Image of Rosemary StantonRosemary Stanton – [Nutritionist & Visiting Fellow, UNSW]

 

 

 

 

 

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More and more older Australians will be homeless unless we act now

 A homeless man sleeping rough in the city. 
More and more older people will be homeless on current trends.

One of the most pressing challenges older Australians face is finding secure accommodation with suitable amenities. And as the numbers of older Australians grow, the pressure to provide housing that meets their needs is increasing. We may be facing a crisis of ageing homelessness in coming years.

A new report from Mission Australia has called on all levels of government to act immediately on the critical shortage of appropriate housing and support services for older Australians at risk of homelessness.

A look at the trajectory of Australia’s ageing population gives a clear sense of the urgency of this issue. Today, 16% of our population is over 65 years of age. By 2101, 25% of Australians are likely to be over 65. People over 55 already make up around 17% of the homeless population – and this figure is likely to grow.

Affordable housing and related aged care services are already in short supply. Evidence of this is the increasing numbers of older homeless people seeking help from specialised homeless services.

Why are older people more at risk?

Older Australians face the same risks of falling into homelessness as everyone else. But they also face extra challenges related to ageing. These include physical and cognitive changes, reduced earning capacity and family changes, on top of the lack of suitable housing alternatives. All these factors can put older people at greater risk of becoming homeless.

Self-funded accommodation is simply not an option for many older Australians. Many depend on social security or social housing to cover accommodation and living expenses. Age Pension payments are modest – a maximum of A$407 per week for single people and A$613.60 for couples – which might be enough if people have adequate superannuation and own their home by the time they retire. Many do not.

The combination of low incomes and rising living costs is a significant factor in older people’s homelessness. The supply of private rental housing or social housing for people on very low incomes is limited.

Even if social housing is available, many of the complexes are poorly maintained or have mixed tenancy. This can cause older people to feel intimidated and isolated.

As rents continue to climb, private renting is beyond the means of many older people. Age discrimination further narrows the restricted market of affordable housing. Landlords may prefer tenants who are receiving a regular income from employment.

People with health problems, including mobility and cognitive impairment, and who require greater support may become unable to maintain their present living arrangements. However, they may also be unable to find or afford accommodation that caters for their needs.

Older people who have suffered elder abuse, in particular financial abuse or failed family accommodation arrangements, are especially vulnerable. Elder abuse is commonly inflicted by close family members. This can both impoverish an individual and isolate them from family support networks.

Which groups are most vulnerable?

Older women are especially at risk. Many women who have raised children and not been in secure paid employment have little or no superannuation in later years. This leaves them with reduced capacity to support themselves, particularly if they have fled family violence.

Traditionally, support services are aimed at younger women with children. Mission Australia has called for investment in housing tailored to the needs of older women experiencing family violence.

Mission Australia has also identified disproportionate numbers of Aboriginal and Torres Strait Islanders among the homeless population. Overcrowded housing is a key factor here. In 2011, 74% of Indigenous people were living in severely overcrowded dwellings.

What needs to be done to reduce homeless?

Significant funding is certainly needed to overcome the ever-growing problem of homelessness in our ageing population. Older Australians are not a homogeneous group. Housing options need to be provided that meet the needs of people with different financial, social, physical and cognitive capabilities.

Funding is also need to put support in place not only to allow people to move from homelessness to permanent accommodation, but also to counter the factors that lead to homelessness. These include the shortage of affordable rental accommodation, lack of accessible support networks, and financial insecurity for older people on low incomes.

Alternative housing options could include congregate housing. In this model, tenants live in units but support staff are on site. Another possible model is campus housing where villages contain housing with different levels of care. If tenants’ level of care changes, they can move to other housing in the village.

Alternative housing for those who are more independent include share housing models, which aim to provide low-cost accommodation to homeless women. Government financial incentives for alternative housing such as granny flats and co-ownership would also help ease the demand on government-run housing facilities.

The need for appropriate housing for our ageing population is urgent. The rise in homelessness among older people is sad but clear. Governments must prioritise research and implementation of a range of accommodation options to better prepare Australians for the challenges of finding suitable housing as they get older.


This article was written by:
Image of Teresa SomesTeresa Somes – [Associate Lecturer, Macquarie University]

 

 

 

 

 

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Research Check: will a coffee a day really keep heart attacks at bay?

 There is a link, but there may be other  
reasons why people with heart failure drink less coffee. Kyle Meck/Unsplash

A recent headline in the Australian newspaper claimed “A short black a day can keep heart attack at bay”:

American scientists have unearthed fresh evidence that coffee exerts protective effects against heart failure and stroke.

According to the researchers, for every extra cup of coffee drunk per week, there was a 7% reduction in risk of heart failure and an 8% risk reduction for stroke.

So, is this more good news for coffee lovers, or a case of be careful what you read?

As the researchers explain in the media article:

We don’t know if it’s the coffee, compounds in the coffee or behaviour associated with drinking coffee.

The data comes from observational studies showing an association between coffee consumption, and heart failure and stroke. It does not prove causation. It shows that people who drank more coffee had lower rates of heart failure and stroke, not that drinking more coffee was responsible for reducing this risk.

There may be other reasons why people with heart failure and those who have had a stroke drink less coffee, for example, being on fluid restrictions for medical reasons, or not being able to move independently enough to make a cup of coffee.

That doesn’t mean you should avoid having another cup of coffee. A review of 20 observational studies from 2014 found those who drank the most coffee had longer life expectancies than those who drank the least or no coffee.

Again, these studies showed correlation not causation, but the evidence to suggest coffee is good for you is mounting.

How was the research conducted?

This story came from an abstract of a presentation to the American Heart Association’s 2017 Scientific Sessions on November 14. The researchers used data from more than 12,000 adults in the Framingham Heart Study to look for eating and drinking habits associated with heart disease.

The study used a powerful new statistical approach called random forest machine-learning methods. This uses all the individuals’ data to construct multiple decision trees and work out what the common patterns are when predicting their health outcomes. The researchers said this technique was a bit like the algorithms used in the marketing programs that predict our shopping behaviours.

The researchers confirmed that high blood pressure, high blood cholesterol and older age increased the risk of heart disease. They also identified that higher intakes of coffee predicted a lower risk of heart failure and stroke.

Barista making a coffee
Important questions about the research are unclear: how coffee intake was assessed, whether decaffeinated coffee was included, and exactly how much was consumed each day or over the week. Tim Wright/Unsplash

Lastly, the researchers created a statistical model that included the well-documented heart disease risk factors – age, sex, total and HDL (good) blood cholesterol levels, blood pressure, smoking and diabetes – that are used to calculate a person’s Framingham Risk Score. This is a person’s ten-year probability of developing cardiovascular disease, including stroke, heart failure and atherosclerosis (fatty deposits that clog arteries).

This analysis found that including coffee consumption in the equation improved the accuracy of the Framingham Risk Score in predicting heart failure and stroke by 4%.

The researchers reported finding similar trends – the 7% reduction in risk of heart failure and 8% risk reduction for stroke – in two separate studies.

What does this mean?

The study in the media headline was not about heart attack, it looked at heart failure and stroke, which are very different conditions:

  • Heart attack is triggered by short-term lack of blood and oxygen to the heart muscle causing some muscle cells to die
  • Heart failure means the heart can’t pump blood around the body adequately
  • Stroke is when the blood supply to the brain is interrupted by either a blockage or a burst blood vessel.

This difference is important because while something might be good for the heart muscle itself, it’s not necessarily good for the blood vessels in the heart and brain.


Read more: Tom Petty died from a cardiac arrest – what makes this different to a heart attack and heart failure?


The data was from a conference abstract only. So it includes very limited details of the methods and results, and misses important information such as:

  • which variables were adjusted for in the statistical analyses (external factors that might skew the results)
  • how coffee intake was assessed
  • whether decaffeinated coffee was included, and
  • exactly how much was consumed each day or over the week.

While it’s great to hear about early research findings, the data has not gone through the full peer review publication process and so we will have to wait to eventually read the full paper.

Most importantly, this data comes from observational studies and shows an association between coffee consumption and heart health. It does not prove causation.

So is coffee good for your health?

If you are a smoker, it’s wise to avoid regular coffee. A review of the best evidence found a higher risk of lung cancer for smokers who drank regular coffee, although drinking decaffeinated coffee was suggestive of a lower risk.

Among those with high blood pressure, caffeine in coffee does lead to an immediate increase in blood pressure that can last a few hours. However, there is no evidence of an overall higher risk of heart disease.

For a host of other reasons including a lower risk of type 2 diabetes, prostate cancer, liver cancer, and a longer life expectancy, drinking coffee is now on the list of things to consider to improve your overall health. – Clare Collins


Blind peer review

This is a fair and accurate assessment, and accords with the data from two studies published this year on death from any cause (and heart disease and stroke). –Ian Musgrave


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There’s some evidence lithium protects from dementia, but not enough to put it in drinking water

 

When people think of lithium, it’s usually to do with batteries, but lithium also has a long history in medicine. Lithium carbonate, or lithium salt, is mainly used to treat and prevent bipolar disorder. This is a condition in which a person experiences significant mood swings from highs that can tip into mania to lows that can plunge into depression.

More recently, though, lithium has been explored as a potential preventive therapy for dementia. A recent paper even led some to question whether we should start putting lithium in drinking water to lower population dementia rates.

Some have suggested putting lithium in tap water could ward off dementia. from shutterstock.com

But despite early studies linking lithium to better cognitive function, there is currently not enough evidence to start using it as a preventive dementia strategy.

Lithium’s medical history

Lithium is a soft, light-silver metal present in many water systems, which means humans have always been exposed to it. Its concentrations in water range from undetectable to very high, especially in geothermal waters and oil-gas field brines. The high concentration of lithium in some natural springs led to it being related to healing.

In the 19th century, lithium water was used to treat gout and rheumatism. Of course this was with little objective evidence of any benefit. Early attempts to treat diseases such as kidney stones with higher doses of lithium often led to lithium toxicity – potentially irreversible damage to the kidneys and brain.

The landmark event in the medical history of lithium was a 1949 paper by Australian psychiatrist John Cade in the Medical Journal of Australia. This demonstrated its benefit in bipolar disorder, then known as manic-depressive illness. The psychiatric community took some time to absorb this finding – the US regulator the Food and Drug Administration only approved lithium for use in 1970.

After that, lithium as a drug transformed psychiatric practice, especially in the treatment and prevention of bipolar disorder. This led to extensive research into the mechanisms of lithium in the brain.

How lithium affects the brain

Lithium has long been used to treat and prevent bipolar disorder. from Wikimedia Commons

We don’t know exactly how lithium works, but we know it helps the way brain cell connections remodel themselves, usually referred to as synaptic plasticity. It also protects brain neurons by controlling cellular pathways, such as those involved in oxidative stress (where the brain struggles to control toxins) and inflammation.

Animal studies have shown that long-term treatment with lithium leads to improvement in memory and learning. These observations led to studies of lithium’s protective effects on brain neurons in bipolar patients who had been taking it for a long time.

One of these was a review of more than 20 studies, seven of which examined dementia rates in patients with mood disorders (such as bipolar) being treated with standard therapeutic doses of lithium. Five of these studies showed lithium treatment was related to low dementia rates.

The review looked at four randomised controlled trials (comparing one group of patients on lithium with a group taking a placebo). These examined lithium’s effects on cognitive impairment (such as memory loss) or dementia over six to 15 months.

One study did not show a statistically significant benefit on cognition but showed a biologically positive effect on the levels of a protein that promotes nerve cell growth. The other three showed statistically significant, albeit modest, beneficial effects of lithium on cognitive decline.

Lithium in water

A number of epidemiological studies – which track patterns and causes of diseases in populations – have linked lithium concentrations in drinking water with rates of psychiatric disease. In the above-mentioned review, nine out of 11 studies found an association between trace-dose lithium (low doses in drinking water but not detectable in blood of the people consuming it) and low rates of suicide and, less commonly, homicide, mortality and crime.

More recently, researchers in Denmark conducted a nation-wide study linking dementia rates based on hospital records for people aged 50-90 with their likely exposure to lithium. This was based on the lithium levels in the waterworks predominantly supplying the region where they lived.

Those with higher dementia rates came from regions with lower mean levels of lithium in the water than those without. This was 11.5 micrograms (µg) per litre compared to 12.2µg per litre.

A Danish study showed more people with dementia came from areas with lower levels of lithium in the tap water. Photo by Luis Tosta on Unsplash, 

The Danish population is geographically stable and the health record linkage is excellent for such studies. The reliability and validity of dementia diagnosis in Danish health registers is also high. But the study had a number of limitations.

The lithium intake was based on sampling of waterworks that provide water to only 42% of the population. The sampling was done for only four years (2009-2013) and extrapolated to a lifetime.

Many potential, additional variables were not considered. For instance, a major source of lithium is diet, and some bottled water contains lithium. The study did not take this into account.

An intriguing aspect of the results, for which no explanation was given, was that the relationship wasn’t linear. That is, lower doses (5.1-10µg per litre) increased the risk of dementia by about 20%, whereas exposure to levels over 15µg/L reduced the risk by about the same amount.

We’re not there yet

Observational studies (which make educated assumptions by observing a sample of the population) have considerable merit in the epidemiology of dementia, but have sometimes led to blind alleys. Aluminium is a useful example, with its preventive role in dementia still unclear after several decades of observations. A concern is lithium may take the same path.

Lithium was once widely used as an elixir and even as a salt substitute, but was discredited because of lack of effectiveness, marked toxicity and early death. We must wait for more observational studies with the rigour such studies warrant before we start clinical tests of its effects in drinking water.

We must also study the potential harmful effects of lithium on the thyroid and the kidney, as these organs bear the brunt of long-term harms of lithium. For now, there is insufficient evidence to add lithium to the drinking water.


 

 

 

 

This article is part of a syndicated news program via

Four reasons the Australian government should consider litigation against tobacco companies

 Smoking costs taxpayers more than 
$30 billion annually, should tobacco companies foot the bill? 

While Australia’s impressive record of tobacco control legislation has seen the national daily smoking rate fall from 24% in the early 90s to 12.2% in 2016, there’s still more that could be done.

In a commentary in the Medical Journal of Australia today, we’re arguing governments should consider litigation against the tobacco industry to recover the massive health care costs associated with use of their products. These costs have been borne by Australia’s health care system, and there are a number of reasons that this an opportune time to consider legal action.

1. Costs are increasing

Tobacco is still a critical public health issue and remains the leading cause of preventable death, killing 15,000 Australians every year. Associated social and economic costs were estimated to be A$31 billion annually in 2008, and are now likely to be considerably greater.

2. Anti-tobacco support is strong

Support for tobacco control in Australia remains strong, as demonstrated by plain packaging legislation and widespread political backing for tobacco tax increases.

3. Legal action is supported by the WHO

Legal action is an increasingly important tobacco control instrument, and its value is recognised by the World Health Organisation’s Framework Convention on Tobacco Control, which Australia has ratified.

4. It’s already happening elsewhere

The tobacco industry has recently experienced a series of international legal setbacks including challenges to Australia’s plain packaging legislation.

Current litigation in Canada provides potentially useful lessons for similar action here. British Columbia became the first Canadian province to commence legal action in 1998. Once its constitutional right to do so was upheld by the Supreme Court of Canada, following challenges by the tobacco industry, the remaining nine provinces followed British Columbia’s example and have filed lawsuits to recover health care costs.

While the complexities of these cases and challenges by the tobacco industry make them drawn out and costly, the potential return is enormous. The province of Ontario is seeking CAD$50 billion (A$52 billion) in damages, while Quebec is seeking CAD$60 billion (A$62 billion).

Court proceedings would be long and protracted, but the potential payoff would be substantial. from www.shutterstock.com

What would need to happen first?

Experience of Canadian provinces should be taken into consideration if legal action is to be pursued in Australia. Any action would first require at least one jurisdiction to establish a legal mechanism that would enable litigation.

This could be enacting legislation similar to British Columbia’s. It would also need to take into account the Australian health care system involves areas of federal, state and territory responsibility, which may mean states, territories and the Commonwealth could all be claimants.

Given the size of claims made by Ontario and Quebec, it would be imperative that parent companies of Australian subsidiaries remain as defendants. This would require marshalling evidence that points to parent company direction and oversight of local operations.

It should be assumed the tobacco industry will challenge and delay the litigation process at every opportunity, pushing up costs and testing the resolve of claimants.

As the Canadian experience suggests, suing the tobacco industry would be a complex and protracted process that would require commitment of significant resources by government and relevant experts.

But the potential benefits of litigation are significant. As well as potential recovery of billions of dollars spent on treatment of diseases attributable to smoking over past decades, litigation would serve as a stark reminder of the health and social impacts of smoking, and the misconduct of the tobacco industry.

It would also contribute to the denormalisation of smoking, and generate public support for future public health measures. If governments do pursue litigation, they will need to be prepared for a long and complex battle. But there could be substantial financial and health rewards from holding the tobacco industry in Australia responsible for their wrongs.


This article was written by:
Image of Ross MacKenzieRoss MacKenzie – [ Lecturer in Health Studies, Macquarie University]

 


Ross would like to thank his MJA coauthors Eric LeGresgley and Mike Daube.

 

 

 

 

This article is part of a syndicated news program via

Bee aware, but not alarmed: here’s what you need to know about honey bee stings

 Bees don’t attack unless they 
feel threatened.

A Victorian man died last week after being stung by several bees. While bee sting deaths are rare (bees claim around two Australian lives each year), bees cause more hospitalisations than any venomous creature.

Bee stings cause nearly the same number of deaths each year as snake bites. The University of Melbourne’s Pursuit/Internal Medicine Journal

Around 60% of Australians have been stung by a honey bee; and with a population of more than 20 million, that’s a lot of us who have just experienced pain and some swelling.

So what happens when we’re stung by a bee, and what determines whether we’ll have a severe reaction?

How do bees sting?

Honey bees work as collective group that live as a hive. The group protects the queen, who produces new bees, with worker bees flying out to collect nectar or pollen to bring back to the hive.

Bees have a venom sac and a barbed stinger at the end of their abdomen. This apparatus is a defensive mechanism that is used if they feel under attack; to defend the hive from destruction. The barb from a bee sting pierces the skin to inject the venom, with the bee releasing pheromones that can incite other nearby bees to join the defensive attack.

Honey bees work as a collective. Shutterstock

The venom is a complex mixture of proteins and organic molecules, that when injected into our body can cause pain, local swelling, itching and irritation that may last for hours. The specific activity of some bee venom components have also been used to treat cancer.

A single bee sting is almost always limited to these local effects. Some people, however, develop an allergy to some of these venom proteins. Anaphylaxis, a severe allergic reaction that is potentially life-threatening, is the most serious reaction our body’s immune system can launch to defend against the venom.

It is our body’s allergy to the bee venom, rather than the venom itself, that usually causes life-threatening issues and hospitalisation.

How do I know if I am allergic?

If you have not been stung by a bee before you are unlikely to be allergic to the venom. However, if you have been stung by a bee, there is the potential to develop an allergy. We do not know why some people become allergic and others don’t, but how often you are stung seems to play a role.

If you have experienced very large local reactions from a bee sting, or symptoms separate from the sting site (such as swelling, rashes and itchy skin elsewhere, dizziness or difficulty breathing) you may have an allergic sensitivity. Your doctor can assess you by taking a full history of reactions. Skin testing or blood allergy testing can help confirm or exclude potential allergy triggers.

An allergy specialist is key to assess people’s risk of severe allergic reactions (anaphylaxis).

There is an effective treatment for severe honey bee allergies, called immunotherapy. This involves the regular administration of venom extracts with doses gradually increased over a period of three to five years. This aims to desensitise the body’s immune system, essentially to “switch off” the allergic reaction to the venom.

Venom immunotherapy is very effective at preventing severe reactions and is available on the Pharmaceutical Benefit Scheme, whereas other immunotherapy treatments in Australia cost an average of A$1,200 per year.

First aid for a bee sting

Bees usually leave their barbed sting in the skin and then die. Remove the sting as soon as possible (within 30 seconds) to limit the amount of venom injected. Use a hard surface such as the edge of a credit card, car key or fingernail to flick/scratch out the barb.

For a minor reaction such as pain and local swelling, a cold pack may help relieve these symptoms.

If a bee stings you around your neck, or you find it difficult to breathe, or experience any wheezing, dizziness or light-headedness, seek medical advice urgently.

Prevention

Despite being a species introduced by European settlers, the honey bee (Apis mellifera) plays an essential role within Australian agriculture. We need to appreciate their essential functions, and try to prevent stings.

If you see a bee let it be (sorry); don’t swat it or step on them. Our bees don’t attack unless they feel they need to defend their hive.

Do not attempt to locate a hive, call an expert.

For more information on allergies go to the ASCIA website. Local bee keeping groups are a good source of knowledge about local bee populations.


This article was co-authored by:
Image of Ronelle WeltonRonelle Welton – [University of Melbourne]
and
Image of Kymble SpriggsKymble Spriggs – [Clinical Associate Professor, University of Melbourne]

Other articles that might be of interest are:

Ten years after the crisis, what is happening to the world’s bees? – 
Common pesticides can harm bees, but the jury is still out on a global ban
Bees in the city: Designing green roofs for pollinators

 

 

 

 

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This is how to create social hubs that make 20-minute neighbourhoods work

 Highton Shopping Village in Geelong. 
Leila FarahaniAuthor provided

Successful neighbourhood centres are important as places to meet and for social activity. People’s access to neighbourhood centres and the diversity of buildings and commercial uses found there can significantly influence how, and to what extent, we interact.

Developing successful neighbourhood centres is at the core of Plan Melbourne’s strategy to create 20-minute neighbourhoods. These are neighbourhoods where people can access most of their needs within a 20-minute walk, cycle or public transport trip.

We recently studied the impacts of having diverse shops, businesses and eating places in suburban neighbourhood centres. Recently published in Urban Design International, our study looked at three such centres in Geelong, Australia.

Good planning can reduce suburban isolation

Often in today’s suburban communities, their only direct connection to cities is through roads and freeways. Immobile residents and people without access to private vehicles, such as teenagers and the elderly, can feel trapped in their homes. Even mobile residents can feel isolated when social interactions depend on using their cars.

Evidence suggests the design and planning of neighbourhoods have impacts on the sense of community and social life in them. Ensuring people have opportunities to interact with others, improving liveability and encouraging a sense of community are now key objectives of government agencies like VicHealth.

Neighbourhood planning and design can encourage face-to-face social interaction in various ways. Promoting diverse commercial uses in local centres is considered to be effective.

Diverse uses promote social activity

Our study mapped users’ activities through observation of how they socialised. The study explored how the arrangement and diversity of commercial uses in neighbourhood centres might better promote or affect the social life of neighbourhoods and reduce isolation. The goal of such strategies is to generate a sociable atmosphere, attract a diversity of users and create more vibrant places at night.

Pavement dining was found to play an important role in generating social activities in neighbourhood centres. Several socialising activities – such as people chatting, having a coffee or meal together – happen around cafés and restaurants. These are also the longest-lasting social interactions.

The areas of greatest social activity on pavements are the ones claimed by café chairs and shades. To encourage social activities on streets, local councils should promote the use of pavements by eateries and other traders.

Food stores and other convenience stores attract many visitors to local centres and enhance the chances of interaction among residents. Besides diversity of uses, the number of stores allocated to each group of uses is important. The right mix of stores and services provides the balance neighbourhood centres need to successfully meet local requirements.

Diversity of uses – rather than housing multiple traders in single-tenant “super” markets – can also enhance the character of a street. Diversity can give a street or a local centre an attractive, sociable atmosphere. Pakington Street, crowded with bars and restaurants, is an example of a vibrant social hub in Geelong.

Pakington Street in Geelong
Pakington Street in Geelong. Leila Farahani, Author provided

Diversity of uses also leads to a diversity of users. Co-locating different commercial uses, such as boutiques and clothing, specialty food shops or gaming parlours, can make streets more appealing to various groups of people. Planning neighbourhood centres that appeal to a diverse range of people in terms of age, gender, physical ability and cultural background can guarantee the vitality and success of local centres.

As well as planning, it’s vital that these social hubs are close to the homes of the people who use them. Suburbs can still be isolating environments if people have to get into their cars to visit their nearest social hub.

Diversity is also important in determining a street’s nightlife and evening economy. This is because certain uses are more prominent in the evening, and enhancing social activity on streets creates a safer night-time environment.

More social, happier and healthier

Why should planners work to promote social interactions? The suburban lifestyle is associated with weaker social ties and increased social isolation. The lower the density the greater these associations.

Social isolation is a major risk factor for morbidity and mortality. Socially isolated people are at risk of low self-esteem and higher rates of coronary heart disease, depression and anxiety. So people living in low-density suburbs are at particularly high risk.

Feelings of isolation in low-density suburbia are harder on some residents than others. People who spend much of their time at home, such as the elderly or those with debilitating disability, are more vulnerable. The story of Natalie Wood, found in her home eight years after her death, is a sad example.

While communication technology sometimes can reduce isolation, this does not replace the value of face-to-face interactions. By analysing and understanding the diversity of uses needed for a local centre and carefully planning a balanced mix of functions, planners can help encourage these interactions and social cohesion in suburbs.


This article was co-authored by:
Image of Leila Mahmoudi FarahaniLeila Mahmoudi Farahani – [Research Officer in Urban Studies, RMIT University];
 
Image of Cristina Garduño FreemanCristina Garduño Freeman – [Postdoctoral Research Fellow, Australian Centre for Architectural History, Urban and Cultural Heritage (ACAHUCH), University of Melbourne];
 
Image of David BeynonDavid Beynon – [Senior Lecturer and Architect, Deakin University]
and
Image of Richard TuckerRichard Tucker – [Associate Professor and Associate Head of School (Research), Deakin University]

 

 

 

 

 

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