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

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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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

This article was written by:




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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

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.





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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

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.





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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.


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]
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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Four reasons Victorian MPs say ‘no’ to assisted dying, and why they’re misleading

 Victoria’s Parliamentary Secretary for Treasury  
and Finance Mr Daniel Mulino voted against the state’s assisted dying bill. 

Victoria’s upper house has resumed its debate on the Voluntary Assisted Dying bill. The bill is now at the committee stage and a vote is expected as soon as Thursday (it needs 21 votes to pass).


At the conclusion of its last sitting, the Legislative Council voted 22:18 in favour of the legislation. Of the 18 members who voted “no”, 15 gave speeches articulating reasons for their view. We examined those speeches and identified four major themes. These were: the bill doesn’t have adequate safeguards to protect the vulnerable; legalising assisted dying presents a slippery slope; palliative care services must be improved first; and a doctor’s duty is to treat, not to kill.

Some of these arguments are misleading and they all require close scrutiny.

1. Insufficient safeguards

The most frequently cited reason for opposing the bill was the inability of safeguards to adequately protect the vulnerable. Liberal Bernie Finn expressed concern that:

There is no regard to treatable depression or other mental illness that may be driving a request to seek suicide, so long as the patient has decision-making capacity. […]

Rachel Carling-Jenkins of Cory Bernardi’s Australian Conservatives noted the bill:

[…] has no detail on how an assessing doctor will satisfy themselves that the person has informed consent in the regime.

And the Liberal David McLean Davis said he was voting against the bill as it didn’t adequately address issues of “pressure and duress”. He said:

[…] I am very concerned that there will be those who seek to inherit, those who seek to take advantage of a vulnerable person.

Concerns that vulnerable people are at risk under such laws have been rejected in top peer-reviewed journals such as The Lancet and the New England Journal of Medicine as well as by the Canadian courts, who have cross-examined evidence testing the findings of this research. Justice Smith of the Supreme Court of British Columbia concluded that:

the empirical evidence gathered in the two jurisdictions [Netherlands and Oregon] does not support the hypothesis that physician-assisted death has imposed a particular risk to socially vulnerable populations.

Further, the Victorian bill does address “treatable depression” in the sense that a person can only access assisted dying if they are assessed to have mental capacity to make the decision. If the doctor is unsure about this – for example because of the patient’s depression – the doctor must refer the person to a health professional with appropriate skills to assess capacity.

Read more: Victoria may soon have assisted dying laws for terminally ill patients

The concern about doctors not being confident of informed consent is also surprising. As part of everyday practice, doctors are aware of their legal obligation to inform patients about treatment, and the need to obtain consent for it. The bill also contains a detailed list of information that must be provided to someone seeking assistance including the person’s diagnosis and prognosis, possible treatment options, palliative care options, the potential risks of taking the substance and the expected outcome of doing so.

2. The slippery slope

The slippery slope argument contends that even though the Victorian model is currently a conservative one, that doesn’t mean it won’t evolve over time. Labor’s Nazih Elasmar argued that

[…] it has been the norm for euthanasia laws to become increasingly permissive […] The Netherlands and Belgium are perfect examples. Euthanasia laws in the Netherlands now apply to children as young as 12, while in Belgium there is no age limit.“

But this argument is also misleading. The Victorian bill is modelled on the Oregon Death with Dignity Act which has not been amended since it was enacted 20 years ago. It is disingenuous to suggest a broadening of the law is the “norm”. In this regard, the Netherlands and Belgium are not “perfect examples”.

Read more: In places where it’s legal, how many people are ending their lives using euthanasia?

3. Palliative care should improve instead

In terms of palliative care, there were two inter-related arguments. First, that we should be focusing on increased funding to palliative care to widen its reach, instead of introducing assisted dying.

Liberal Joshua Morris stated that for “palliative care not to be appropriately funded in our state […] is nothing short of shameful” and that provision of palliative care “must be in place before a bill of this type is considered”.

The second argument is that offering people assisted dying but not palliative care, as Labor’s Daniel Mulino said, “is not a real choice”.

But access to assistance in dying is a separate and distinct issue. Chair of Victoria’s advisory panel for the assisted dying legislation, Professor Brian Owler, has said palliative care is the “main game” when treating patients approaching the end of their lives. This will always remain so.


Funding for palliative care should be increased so that palliative care services are available to all who need it. The government can, at the same time, increase funding for palliative care and pass legislation allowing assistance to die. We are advocates for palliative care and would welcome that outcome.

As for the issue of choice, it makes no sense to suggest an otherwise eligible person should not have assistance to die because he or she does not have access to palliative care. The proponents of this argument are effectively saying it is better to have no options rather than one option at the end of life, which cannot be right.

4. Doctors should do no harm

This argument holds that an assisted dying bill will undermine the nature of the doctor-patient relationship, which is based on trust. Arguments in this theme also contend assisting patients to die is the very antithesis of what doctors do. Nazih Elasmar referred to the Hippocratic oath, noting that it says “first, do no harm”.

It’s important to note that for a person to be eligible for assisted dying under the Victorian bill, the time of healing has passed. The person is terminally ill and will inevitably die.

Secondly, many in our community including health professionals do not regard assisted dying as a “harm”. A recent Tribunal decision has accepted this view.

What counts as harm depends on context. For example, we do not normally think surgeons are violating the Hippocratic oath when they cut into our skin during life-saving surgery, yet cutting into our skin is a form of harm. We accept this harm because it is outweighed by the fact the surgery is life-saving. We can similarly argue helping people die more comfortably is not a form of harm, but is actually a benefit.

Thirdly, it is important to acknowledge that every day doctors, patients and families make decisions to withhold or withdraw treatment that will result in a patient’s death. Pain relief is also provided knowing this can accelerate death. These actions are not thought to undermine the doctor-patient relationship.

As the debate over the bill continues in Victoria’s Legislative Council, we repeat our earlier call that all MPs interrogate their positions, including the biases that underpin them, to be intellectually rigorous. Debates must be being based on reliable evidence.

This article was co-authored by:
Image of Lindy WillmottLindy Willmott –  [ Professor of Law and Director, Australian Centre for Health Law Research, Queensland University of Technology];
Image of Andrew McGeeAndrew McGee – [Senior Lecturer, Faculty of Law, Queensland University of Technology]
Image of Ben WhiteBen White – [Professor of Law and Director, Australian Centre for Health Law Research, Queensland University of Technology]





This article is part of a syndicated news program via



What causes breast cancer in women? What we know, don’t know and suspect

 Different people have very different chances of being 
diagnosed with breast cancer. Pablo Heimplatz/Unsplash

This is a long read. Enjoy!

Breast cancer is the most common cancer in women worldwide and the second-most-common cause of death from cancer. Although the chances of curing breast cancer have risen recently, efforts to prevent occurrence in the first place have been less successful. Around one in eight women in Australia are expected to be diagnosed before the age of 85.

Despite the disease being common, different people have very different chances of being diagnosed with breast cancer. Working out this chance for each person guides who will benefit most from ways to reduce risk. These can involve changes in diet and exercise, preventive medications, or even surgery in high-risk cases.

We’re aware of many things about a person’s lifestyle or genes that increase the chances of getting breast cancer, but we don’t always understand how these might cause the disease. This is partly because much of our research is based on “association studies”.

Here, a researcher notices something more common in people with the illness and compares people with and without the illness to confirm this link. While this provides us with an association between the common element and breast cancer, it does not prove that thing directly caused the illness.

Also, for breast cancer, usually no single risk is particularly large. There may be a few risks in any one person. So it’s often difficult to say absolutely what caused breast cancer in that person.

It’s likely a combination of the effects of a person’s risks combined with an element of bad luck. This is different, for example, to lung cancer where smoking is the clear cause in many cases.



Oestrogen, the predominant female hormone mainly produced by the ovaries, plays a well-known role in breast cancer development and protection.

Picture of contraceptive pills
The contraceptive pill contains oestrogen and so increases the risk of breast cancer for the period it is taken. from

A range of factors that are known to affect a woman’s breast cancer risk (like how many children she has) also affect how much oestrogen she is exposed to throughout life. Oestrogen causes breast development in puberty and during pregnancy helps the breasts develop for breastfeeding. Unfortunately, increased oestrogen over a long time can also cause damage to normal breast cell DNA and cause these damaged cells to multiply, which can start a cancer.

Factors that increase lifetime oestrogen exposure and, with that, breast cancer risk, include having no or few children and starting your family at an older age. Oestrogen production is interrupted while women are not menstruating during pregnancy and breastfeeding, which decreases the overall lifetime exposure to oestrogen. Going through puberty earlier or menopause later, which both increase a woman’s total number of menstrual cycles, is also linked to higher risk.

Combined hormone replacement therapy (HRT) or the oral contraceptive pill, both of which contain oestrogen, increase risk for the period they are taken. However, for the contraceptive pill the risk is small, as breast cancer is rare at the age it is used. Reduced prescriptions for HRT has recently been shown to have led to a reduction in breast cancer cases.

Women who have more children earlier and breastfeed are at lower risk of breast cancer. Both cause an increase of oestrogen around the pregnancy but then lower levels than normal for many years after.

Dairy, meat and vegetables

There is a widespread concern that elements of the modern diet add to breast cancer risk. But the belief that preservatives and pesticides are major contributors has never been confirmed.

Pictures of fresh vegetables
Research shows vegetables can protect from cancer. Alexandr Podvalny/Unsplash

Similarly, no risk increase has been found for people consuming dairy products. Eating meat appears to cause little or no risk. But the fifth of the population eating the highest levels of red or processed meats (bacon, sausage, ham) have a 25% higher risk of breast cancer than the fifth who eat the least – and appear to have increased rates of other cancers. This is probably because processing causes small amounts of cancer-causing toxins to form in the meat.

There is some limited evidence that eating more fish reduces breast cancer risk. This may be due to the protective effect of omega-3 fats. And there is relatively strong proof that vegetable consumption lessens risk, although how this works is not known.

Despite much being said about the protective powers of “super veggies”, such as kale, broccoli, tomatoes and strawberries, there is so far no evidence they are really better than others. Similarly, organically grown vegetables do not give greater protection than those grown in the usual way.

Studies exploring the benefits of vitamin supplements show no conclusive evidence these affect breast cancer risk, although vitamin D may provide modest protection if at healthy levels compared to low levels.

Lifestyle, obesity and stress

Alcohol increases lifetime breast cancer risk by around a tenth per drink per day for the period during which drinking occurs. Active smoking, but not passive smoking, also increases risk by about a fifth – especially in younger women.

Woman exercising
Exercise lessens the chance of breast cancer. Jacob Postuma/Unsplash

Caffeine may be mildly protective and chocolate appears safe in moderation. This is provided consumption does not lead to substantial weight gain, as obesity has repeatedly been shown to increase breast cancer occurrence by about a fifth, especially in post-menopausal women.

This may be because fatty tissues produce oestrogen. Also, obese women have higher insulin levels, another hormone that can lead to breast cancer. Those developing full diabetes in later life, when insulin levels are usually very high, are at an even higher risk – a two-fifths increase.

Contrary to popular belief, sugar itself does not appear to directly affect risk in moderation. However, too much sugar may increase risk indirectly through obesity, which can then cause diabetes.

Exercise substantially reduces the chance of a breast cancer diagnosis, although how this works is not yet understood. The duration rather than intensity appears important, with three hours of moderate aerobic exercise weekly reducing breast cancer risk by about a fifth. Exercise also improves survival after breast cancer.

High stress levels are widely believed by the general public to cause cancer, likely because both are common. However, large studies comparing people exposed to very high stress situations such as bereavement, bankruptcy or divorce have not found any difference.

Many researchers have also looked at whether sleep patterns might affect breast cancer, especially from nightshift work, but have not confirmed a risk.

Genetic factors

It is well known women who inherit faults in particular genes which repair damaged DNA, particularly the BRCA 1 and 2 genes, have a high risk of both breast and ovarian cancer – up to an 80% lifelong risk for breast cancer and 40% for ovarian cancer.

Having a mutation in the BRCA 1 and 2 genes may lead some women, like Angelina Jolie, to have preventive surgery. Cancillería del Ecuador/Flickr

This high predictable risk leads some women to opt for preventive medication or even surgery, which includes removing both breasts and ovaries. Such solutions, although radical, give affected women the same life expectancy as women in the general population.

Even in the absence of such gene faults, a family history of breast cancer does increase personal risk. Those with a single first-degree relative (mother, sister or daughter) have approximately double the risk ( of those with no family history or about 24% lifelong risk in Australia.

This may be due to a host of other genes that have more minor impacts on breast cancer risk. New candidates are regularly added as research continues. Unsurprisingly, many of these genes are involved in processes in the body such as oestrogen and insulin action or DNA repair, although the way some work remains unknown.

Collections of these genetic markers can be tested together in a person’s blood to better predict their breast cancer risk.

Breast density, which is the “whiteness” seen on a mammogram, is also very useful in predicting the chances of breast cancer. More dense (white) tissue predicts higher risk. Given the strength of mammographic density as a risk factor and its prevalence in the population, it is likely to influence breast cancer in a large number of women.

Mammographic density is strongly related to oestrogen exposure and is also modified by menopause and HRT.

Calculating your risk

Importantly, it is the sum of all the above factors that defines personal risk. Research suggests women often do not have an accurate idea of their own risk of breast cancer, but there are several ways they can find out.

Online calculators are available to estimate your risk of breast cancer. Ben Jeffrey/Flick

Online breast cancer risk calculators are available, although some are designed for researchers rather than patients. A good one for patients is the Gail model, which uses family and reproductive history, as well as the occurrence of benign breast conditions, and can be filled in online. Cancer Australia also provides a risk calculator. Neither include mammographic density or the host of breast cancer genes that have been discovered, each with a small risk association. However, it can give an overall idea quite quickly.

The BOADICEA calculator is mainly used by researchers and works off a detailed family history. The Tyler-Cuzick calculator, mainly designed for use by doctors, adds mammographic density to other risk factors with the aim of making even better breast cancer risk predictions.

Clearly, predicting an individual’s risk of breast cancer without being able to reduce it would be of limited value. The above information does allow women to make a number of lifestyle choices, such adjustments being most valuable in women with higher risk.

Beyond this, drugs that limit oestrogen in the body can substantially lessen the chances of breast cancer. These include tamoxifen, which can reduce risk by about a third in all women, and aromatase inhibitors, which lessen risk by about two-thirds in post-menopausal women.

In practice, few women opt for such measures. This is likely due to concerns over relatively common “menopause-like” side effects and more serious, although rare, side effects of tamoxifen, including endometrial cancer and venous blood clots.

Good consumption of vegetables, limiting alcohol, avoiding being substantially overweight, especially after menopause, and getting regular moderate exercise will lower risk. Looking at mammographic density and considering genetic tests, especially in women with a family history, may be valuable and should be discussed with the family doctor.

Preventive medication or surgery can be used for those at high risk, usually in consultation with a breast cancer specialist.

This article was co-authored by:
Image of Andrew RedfernAndrew Redfern – [Senior Lecturer, University of Western Australia]
Image of Rik ThompsonRik Thompson – [Professor of Breast Cancer Research, Institute of Health and Biomedical Innovation and School of Biomedical Sciences,, Queensland University of Technology]





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Thunderstorm asthma: who’s at risk and how to manage it

 Hay fever sufferers should have access to an  
asthma puffer every spring, even if they’ve never had asthma symptoms

Late in the afternoon of a hot spring day, November 21, 2016, a thunderstorm from the northwest swept over Geelong and Melbourne, triggering the world’s most devastating thunderstorm asthma epidemic.

The scale and impact of this unparalleled public health emergency took Victorians by surprise. Thousands of people began, almost simultaneously, to experience breathing difficulties, because stormy winds and moisture can break up pollen into particles small enough to enter the airways.

Through valiant efforts by the ambulance service, hospital networks, general practitioners and pharmacists, the vast majority of thunderstorm-affected patients were successfully treated. Tragically, ten people died, and their deaths are now under coronial investigation.

Of the ten thunderstorm asthma epidemics reported in Australia, seven were in Melbourne. This highlights the city’s vulnerability to unique interactions between particular types of thunderstorms and springtime grass pollen exposure. But other temperate regions around Australia where grasses are cultivated for animal feed have also experienced thunderstorm asthma, such as Wagga Wagga in New South Wales. Thunderstorm asthma events may be influenced and potentially worsened by emerging changes in climate.

During the past year, government, universities, peak professional bodies and non-government organisations have worked collectively to review the event, understand the factors behind thunderstorm asthma, and implement plans to prevent a repeat of this tragedy.

Who’s at risk and what should they be doing?

Advice to patients and health care professionals on understanding and managing the risk of thunderstorm asthma is now available. The documents focus on the biggest risk factors: those who have hay fever and asthma.

Hay fever

In Australia, the biggest risk factor for thunderstorm asthma has been termed the “ryegrass pollen trifecta”. That is, sensitisation to ryegrass pollen, springtime hay fever, and exposure to high levels of ryegrass pollen on the arrival of the thunderstorm. Ryegrass is one of the most common grasses in southern regions of Australia. In Victoria, ryegrass pollen levels are highest between mid-October and late December.

While it’s tempting for people to trivialise hay fever, the condition can be serious, debilitating and chronic. Most people with hay fever manage their condition by taking antihistamines. They should also speak to their pharmacist or GP about using daily steroid preventer nasal sprays, which modify the disease process.

Patients with severe hay fever symptoms can be referred to an allergy specialist. In those whose condition can’t be managed by other medications, allergy specialists may recommend allergen-specific immunotherapy. This controls and treats the underlying allergic inflammation.

For thunderstorm asthma protection, the National Asthma Council of Australia recommends that people with hay fever in locations at risk of thunderstorm asthma carry an asthma puffer, available at any pharmacy without prescription, or know where they can easily get one.

Picture of a thunderstorm
Many of those affected were outside before or during the thunderstorm. from


At even higher risk of thunderstorm asthma are people with hay fever and known asthma. It’s important for them to seek medical review, update their asthma action plans and, if prescribed regular preventative medication, to take it regularly.

Of greatest concern are those with hay fever but who also experience symptoms of breathlessness, cough, chest tightness or wheezing during spring with their hay fever. They may have undiagnosed asthma and are particularly vulnerable to thunderstorm asthma, as they have not been prescribed asthma preventers or trained to manage their asthma. Media campaigns are now underway to alert such individuals of their need for medical consultation.

Are there tests to tell if you’re at risk?

Picture of an asthma reliver device
People with asthma should protect themselves with regular preventer use. from

GPs can arrange blood tests to confirm whether a person is sensitised to an allergen. This blood test measures levels of a specific antibody to an allergen source, such as ryegrass pollen. Subtropical grass pollens (such as Bahia and Bermuda) are also abundant and relevant in parts of Australia.

Patients referred to an allergy specialist may undergo skin prick testing to identify the allergens to which they are sensitised. Droplets of allergen extracts are placed on the skin and a small skin prick allows the allergen to penetrate the outer layer of skin. In patients sensitised to the allergen, a small red, swollen mark forms around the site within a few minutes.

A person who is not sensitised to ryegrass pollen (by either blood or skin prick testing) is very unlikely to experience thunderstorm asthma in Australia.

Should those at risk be watching the weather?

Most patients affected by thunderstorm asthma last year were outside, or inside with open windows, at the onset of the storm. Therefore, people who may be vulnerable to pollen allergies and thunderstorm asthma should be aware that exposure to weather and environmental conditions can lead to exacerbation of symptoms. During high-risk periods, they should stay indoors with all windows shut.

Based on a newly established network to monitor grass pollen exposure across Victoria regional forecasts of thunderstorm asthma risk now provide alerts to individuals and emergency services.

Pollen forecasts are available from the AusPollen Partnership sites, in Melbourne, Brisbane, Sydney and Canberra. AirRater provides pollen information in Tasmania.

This article was jointly authored by:
Image of Janet DaviesJanet Davies – [Associate professor, Queensland University of Technology];
Image of Francis ThienFrancis Thien – [Adjunct professor, Monash University]
Image of Mark HewMark Hew – [Head of Allergy, Asthma & Clinical Immunology, Alfred Health, Monash University]





This article is part of a syndicated news program via

Here’s why the 2017 flu season was so bad

 Vaccines for the flu offer mediocre coverage 
compared with those for other diseases. 

Australia has recorded 221,853 flu infections so far in 2017, more than any other year. As the flu season comes to an end, we’re beginning to understand why it was so bad. And it wasn’t because of increased, or more sensitive, testing.

A better vaccine could have reduced the rates, but not the high-dose Fluzone vaccine doctors were touting at the start of the week.

This year’s flu viruses

Multiple flu viruses circulate each year and are broadly grouped into two types: A and B.

Influenza B viruses have two main strains, while the influenza A viruses are more variable. The influenza As you get each year are usually A/H3N2 – the main player so far this season – or A/H1N1, which lingers on from its 2009 “swine flu” pandemic.

This was a busy flu year with H1N1 strains and different strains of flu B all circulating, sometimes in the same person at the same time.

How vaccines are formulated

The formulation for a vaccine to immunise against all four flu viruses was decided back in September 2016 and the final product released seven months later.

Commonly, each virus is amplified by injecting well-growing “seed” virus into vast numbers of fertilised (embryonated) hens’ eggs. Fluid containing lots of new virus is removed, the virus is inactivated and the new vaccine is manufactured.

Today’s flu vaccines remain mediocre compared to those for measles or human papilloma virus, which offer 97% and 90% protection respectively. It’s normal for less than 60% of those vaccinated against the flu to develop a protective immune response.

In one study of the 2017 flu season a paltry 27% of Australians were vaccinated (73% weren’t), including just 6% of children. Among those vaccinated, 33% were effectively protected, though rates differed between the strains. The vaccine was 5-19% effective at protecting against H3N2 and 37% effective at protecting against H1N1 or flu B infections.

Flu vaccination doesn’t produce the same degree of immunity to flu viruses that wild infection does. But vaccine protection is much safer than getting the flu, and vaccination cannot give you the flu.

What went wrong in 2017

It’s difficult to predict what strains will dominate months later. Viruses within each flu type also change over time so H3N2 from years ago differs from H3N2 in 2017. These mutations reduce the effectiveness of flu vaccines.

Over the past year, H3N2 mutated after it was chosen as a vaccine strain. Additionally, the egg-grown H3N2 vaccine virus strain changed during vaccine production. For both these reasons, the vaccine no longer matched what we faced.

Would Fluzone have helped?

This week, media stories implied that if Australia had purchased a different vaccine, Sanofi Pasteur’s egg-grown inactivated Fluzone®, the massive flu epidemic would not have happened. Rubbish.

The Fluzone product being discussed is a high-dose flu vaccine licensed in the United States (2009) and Canada (2016) for those aged 65 years or older, but not for other age groups. It’s not available in Australia because Sanofi hasn’t applied to register it here.

This vaccine contains four times more antibody-inducing active ingredient, hemagglutinin (60µg rather than the usual 15µg) than a standard-dose vaccine. But it remains susceptible to problems discussed earlier – though this hasn’t been well studied.

High-dose Fluzone is a trivalent formulation (meaning it protects against three strains of flu), not quadrivalent (four-strain protection) as recommended in Australia this year.

No current vaccine could have prevented 2017’s flu epidemic.

How to better protect the elderly

H3N2 viruses cause more harm among the elderly than the young, whereas flu B strains tend to impact children more.

Flu virus infection directly damages cells and paves the way for bacterial infections. The elderly are particularly affected by the flu because an older immune system struggles to defend against infections; specialised immune cells are less effective, less able to respond to new viruses and prefer reminiscing about past viral battles which confuse new skirmishes.

Picture of an older person getting a shot
The elderly are disproportionately affected by the flu. thodonal88/Shutterstock

An ageing immune system also loses vaccine-induced antibody protection faster than a younger one.

To better protect the elderly, some rapid response options include moving immunisation closer to the start of flu season, adding an additional substance to boost the immune response to the vaccine, or increasing the amount of the virus active ingredient to produce a stronger defence against infection.

Is a high-dose vaccine safe and more effective than the standard-dose vaccines in the elderly?

Sanofi’s own research found its more expensive vaccine better protected older people from lab-confirmed flu, producing higher antibody levels than a standard-dose vaccine. High-dose Fluzone showed benefit over standard-dose vaccines across two seasons.

Other researchers found the elderly had fewer doctor visits and hospitalisations and that deaths were prevented.

But temporary, mild injection-site reactions were more common after high-dose vaccines because more active ingredient was injected.

However, absolute effectiveness is not clear as studies to date usually compare Fluzone to another vaccine.

Stopping a repeat in 2018

The Fluzone high-dose vaccines can reduce disease and death in the elderly but won’t halt spread of an efficiently transmitting flu virus.

Stopping flu viruses requires vaccines that are effective in those who most efficiently carry and spread the virus – pre-school and school-aged children, in whom rates are highest. It also needs higher uptake by the community.

The promise of a “universal flu vaccine” has been dangled since at least 1980. We need focused research to commercialise and license vaccines that effectively protect us from seasonal influenza.

This article was co-authored by: