Archive | November, 2013

The best investment

30 Nov

Best reason to quit smoking #1
Because it’s the single best thing you can do for your health. The life expectancy of a smoker in the year 2000 is the same as the life expectancy of a non-smoker in the year 1900. That is – smoking eliminates all the benefits of antibiotics, anaesthetics, surgery, ambulances, Intensive Care Units etc. There is NOTHING you can do for your health – exercise, lose weight, take cholesterol tablets – that is as effective as stopping smoking.

Best reason to quit smoking #2
Cigarette prices are going up by 12.5% on December 1st due to increased tax and that will continue each year till 2016 (at least).
Assuming a pack costs about $20, a pack-a-day smoker is spending $7300 a year on cigarettes. (How many weeks work does that equate to in your job?)
A 40 year old will spend $182,500 on cigarettes by the time s/he retires. (Of course with the increased tax rises in coming years, that will rise significantly). An 18 year old smoker will spend over $343,000.

Actually both figures are wrong. If a 40 year old were to take their cigarette money and invest in their retirement savings (assuming 9% compound per year), they will retire better off by over $600,000.

And an 18 year old who invests their 30/day cigarette money will retire with an extra …. $4.3million!! (That’s the benefit of compound interest!)

If you want help to stop, we would be delighted to spend time with you talking about the addiction, the habit and the many ways we can help you quit.

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Privacy and the Private Sector

27 Nov

A disturbing article in todays The Age http://www.theage.com.au/digital-life/digital-life-news/medical-examinations-used-to-access-your-private-information-20131126-2y7t9.html suggests that some private companies that provide workplace and pre-employment medicals then forward the information to a private business which stores the information for the longer term.
Apart from this activity being illegal under the National Privacy Principles, it’s a gross violation of the basic principle of medical confidentiality.
In general patients have a right to expect their personal medical information will remain private unless they specifically allow that information to be shared. That’s why we are not able to pass on a husband’s test results to their wife or discuss a teenage child’s health issues with their parents – unless we have previously obtained specific consent.
There are a few exceptions to the privacy rules. There are legal circumstances when we are obliged to reveal information – such as a court subpoena or a demand by the coroner’s court.
It is also generally accepted that doctors can share clinical information with others involved in your care – for example referrals to medical specialists, or discussing treatment options with allied health practitioners. Even then, the information being shared needs to be relevant to the issues being discussed.
But the idea that a company not involved in ongoing care can store your health information long term, when it was provided only as a step in applying for a job is beyond any limit of what is acceptable.
Unfortunately many patients don’t read the fine print of the consent forms they are signing. That applies not just to medicals but also applications for health, life, income and travel insurance; employment applications and many other forms. Be aware that if we are completing a form that you have signed we are obliged to provide all the information that is asked for provided that you have consented.
We encourage you to read and think carefully about what you are consenting to release and to discuss with us any issues that you are uncomfortable about us releasing. There may be ways of phrasing information in a manner that is honest but less compromising.

Safety in (correct) numbers

25 Nov

We would like to draw your attention to a recall of Children’s Panadol Baby Drops which has been declared by the TGA (Therepeutic Goods Administration – the government body which regulates drugs in Australia).

Children’s Panadol Baby Drops are given by a syringe which comes with the medicine bottle. Some batches of the Panadol have been supplied with a faulty syringe. Note that the Panadol itself is perfectly safe. However the syringe markings are in the wrong spot and therefore you may accidentally give a bigger dose of medication than intended.

The CORRECT syringes have the markings of millilitres starting right at the tip of the syringe.

The FAULTY syringes have the measuring label markings start further up the syringe.

It is very unlikely that a child will come to harm even if you have used a faulty syringe, but it is best to be sure. If you aren’t clear on whether your syringe is correct or not, please take it in to your pharmacy or drop in to the clinic and ask one of the nurses or doctors to take a quick look.

For more info see the TGA announcement: http://www.tga.gov.au/safety/alerts-medicines-childrens-panadol-baby-drops-syringe-131122.htm which includes pictures of the faulty and correct syringes.

Statins, Statistics and Stations

5 Nov

TV shows love a good controversy and where there isn’t one available it’s always handy to be able to generate one.

So ABC-TV show Catalyst did an excellent job last week running a two part episode on how statins – a family of tablets used to treat high cholesterol – are overprescribed, not very useful and that doctors don’t adequately think about (or warn patients about) their side effects.

There is enough truth in those claims that they can’t be rejected out of hand. But there is enough about the claims which bends, distorts or maims the truth that they have to be refuted in clear terms. Our depth of feeling can be gauged by the fact that it has drawn us back into blogging!

So what’s true and what’s not. Well …..it’s complicated.

Nobody ever died of high cholesterol.  People die of heart attacks and strokes. The controversy is whether cholesterol is a cause of those fatal conditions, and whether lowering cholesterol with tablets is worthwhile.

We know FOR CERTAIN that high cholesterol is associated with heart attacks.

We know ALMOST CERTAINLY that cholesterol is a risk factor.

We know FOR CERTAIN that statins lower cholesterol in most people.

We know FOR CERTAIN that people who have already had a heart attack, on average live longer if they are put on statins.

We are REASONABLY CERTAIN that people who have not had a heart attack but have high cholesterol are, on average, less likely to have one if they take statins.

We are REASONABLY CERTAIN how likely it is that statins will reduce the risk.

We are REASONABLY CERTAIN that in most individual people, taking a statin will not help – because most people will not have a heart attack, and statins don’t always work in people who do.

We have NO IDEA in a large group of people, which ones will be helped by the statins and who won’t.

We know FOR CERTAIN that a small number of people will get major side effects from statins and a moderate number of people will get mild side effects.

We have NO IDEA in a large group of people who will get the side effects till they’ve had them.

 

So ….should you take (or keep taking) statins?

Perhaps the most important concept to help understand whether statins are useful for you is an idea called Number Needed to Treat (NNT for short).   This tells us how likely it is that a statin will help.  And then YOU need to decide what degree of risk you are willing to accept.

In the following examples it’s not important to understand the individual risk factor numbers – it’s the overall risks that matter:

Imagine a 50 year old male, non-smoker, non-diabetic, with a blood pressure of 140/85 and a cholesterol ratio (Total cholesterol/HDL) of 6.  

His chance of a heart attack in the next 5 years is 5-10%. A statin might reduce that risk by about a quarter. Whether the patient thinks the statin is helpful depends on how his doctor presents the figures:

Doctor 1:   If you take a statin, we can reduce your risk of a heart attack by 25%  (ie from say 7.5% to 5.7%)

Patient 1: Wow Doc, that’s great …gimme a script

OR

Doctor 2: If you take a statin we can reduce your risk of heart attack by 1 or maybe 2%  (ie from say 7.5% to 5.7%)

Patient 2: And run the risk of side effects? Your kidding – why would I bother?

OR

Doctor 3: If we cloned 100 of you and we gave none of you statins, about 93 of you would not have a heart attack in the next 5 years, 7 of you would.  If we gave you all statins – 95 would not have heart attacks, 5 would.  So we can prevent one heart attack for every fifty people who take the tablet.  For the other 49 – about 46 WON”T have a heart attack whether or not they take a tablet. Three WILL have a heart attack whether or not they take a tablet and about 1 of you will prevent a heart attack by taking a statin tablet for five years.

Patient 3:  Well….I don’t want to take a tablet that’s useless, but the idea of a heart attack is pretty scary and I’d want to do whatever is reasonable to reduce the risk. Let me think about it……

 

Another example – a 60 year old diabetic woman who smokes and has a blood pressure of 160/100 and Cholesterol Ratio of 6. Now the NNT to prevent a heart attack is about 13 …ie 12 women out of 13 will get no benefit from the tablet but the 13th will avoid a heart attack.

For some patients, that screams “take the tablet”.  For others, that’s still not enough of a sure thing for them to want to take medication.

The problem with shows like the Catalyst program is that they suffer from the same deficiency as medical research – they deal with statistics, not the individual concerns of each patient and their own views on what they want for their health.

For that you need to see your GP.

We strongly urge patients already on statins NOT to stop taking them till they have had a proper discussion with their family doctor. We know FOR CERTAIN that is a worthwhile exercise!

 

PS … we cheerfully note that losing weight, controlling blood pressure and especially stopping smoking are usually more important than controlling cholesterol. Those issues are subjects for another day!