We’re nearly a week into the Federal election campaign now and so far there’s been no focus on ATOD aside from the Ben Cousins issue overshadowing the wider political narrative. There’s still five weeks to go so there’s some hope for substantive announcements though my guess is the two major parties will ‘me-too’ on the current approach.
I thought it might be a good juncture for people to comment on their ideal policy announcement in an election campaign. Within financial constraints, what policy announcement would you make that would change people’s lives and also help get you elected? Is it possible to do both? Would love your thoughts……
I caught and interesting comment in the Journal of the American Medical Association (JAMA) about research identifying 5 alcoholism subtypes from a population survey:
“Alcoholism Subtypes – Bridget M. Kuehn
JAMA. 2007;298:853.
Scientists from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have identified 5 distinct subtypes of alcoholism, some of which defy the traditional stereotype of alcoholism.
In the past, efforts to identify subtypes of alcoholism have relied on data from individuals receiving treatment for the condition. But only about 25% of alcoholics ever receive treatment (Dawson DA et al. Addiction. 2005;100[3]:281-292), so subtypes derived from samples of individuals in treatment are likely to be skewed.
To get a representative picture of alcoholism subtypes, the NIAAA scientists analyzed the responses of nearly 1500 individuals with Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) alcohol dependence who responded to the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey of more than 40 000 US residents. They found that nearly 20% of individuals with alcohol dependence are highly
functional, are well educated, and have high incomes (Moss HB et al. Drug Alcohol Depend. doi:10.1016/j.drugalcdep.2007.05.016 [In press]).
Analysis of the data revealed that the individuals could be grouped into 5 subtypes: young adult, young antisocial, functional, intermediate familial, and chronic severe. More information about the subtypes is available at http://www.nih.gov/news/pr/jun2007/niaaa-28.htm”
“Alcoholism” is one of those terms that people love trying to define, but these sub-types may actually assist in determining the type of intervention undertaken. It’ll be interesting to see how robust the sub-types are when exposed to real life situations and lives.
The Wall Street Journal has run a story on teen binge drinking, discussing the merits of parents providing restricted and supervised access to alcohol for their teenage children. Studies demonstrating the impact on binge-drinking are quoted and the question asked: is restricted access an answer to the USA’s binge-drinking issues.
When I first worked in AOD it was widely accepted that such an approach was useful, and I’m yet to see a lot of evidence refuting it. For those of you working in health promotion / community development, have you seen a ‘chaperoned alcohol consumption’ approach work?
This week, Australian households receive an A4 booklet entitled “Talking with your kids about drugs”. When it arrived I had a distinct feeling of deja vu as I remembered similar booklets arriving in the mail when I was a teenager myself during the 80’s. It was around the time Bob Hawke got up on stage with Dire Straits at the Sydney Entertainment Centre to accept a cheque from the band toward the drugs campaign at the time (The National Campaign Against Drug Abuse).
The current offering doesn’t seem a lot different to the one of twenty years ago – lots of facts and figures on the effects and impacts of each substance combined with positive role model case studies. What I’m interested in – does it have any demonstrable difference? I was encouraged initially by the TV advertisements which pushed the family communication angle. The print offshoot doesn’t seem to be offering a lot new though. What are your thoughts?
It is with regret that the Board of ADCA announces the resignation of the CEO, Donna Bull. Donna has played a major role in ably steering ADCA through a period of transition and managing the multiple, and often competing demands. She leaves the organisation in a very strong position.
Donna will be leaving ADCA on 7 September to take a leading role in delivering AOD services in a major Australian industry. The Board expects to appoint an Acting CEO by that time.
While the Board will miss working with Donna as ADCA CEO, we are very pleased that she will be remaining in the sector and look forward to her future contribution to the sector in her new role.
Prof Robin Room
ADCA President”
I have no inside knowledge on the resignation but it seems it’s one of those cases where industry has come in with the more attractive offer. NGO’s can’t hope to match those sort of offers and so there’s more knowledge lost in the sector that becomes the property of the company the person moves to. Any company with good corporate governance processes in place will make new employees, particularly those higher up the food chain, sign an agreement that states any work they create during their employment becomes the property of the company. It’s not an unreasonable request given the degree of competitiveness in some industries, but it further decreases the likelihood of someone moving back into the NGO sector.
If you’re on twice the salary and can’t utilise any new intellectual property you’ve created, would you move back?
Over the past few months of writing for this blog, I’ve learnt a few things about the specific challenges of writing a health-related blog and thought they were worth passing on:
1. Define your niche
This isn’t an issue specific to health blogs but is pertinent all the same. The health fiels is so expansive that establishing a more defined area is nearly essential. A multiple sclerosis (MS) blog will gain more interest than a neurological disorders one. The former gives the opportunity for MS sufferers and their family and friends to identify with the issue. The latter may make most people feel sleepy after reading the title.
2. Put your ideology on the table up front
Health, politics, ethics and religion are all fundamentally intertwined. Before starting your blog you should take a hard internal look at your perspective. There’s nothing wrong with an ideological bent for your blog, but be damned transparent about it from the start. Some blogs do attempt to take a consensus approach and that can work well if the discipline of non-partisanship is maintained. If you’re running a pro-legalisation drug blog but want to hear both sides of the debate, then keep comments open and avoid the temptation of censoring comments that don’t meet your world view.
3. Know your field
No-one needs to be an expert in a health field to blog about it, but at the very least you need to have a solid grasp of the basics. The surest way to alienate readers is to get the basics wrong. It also gives the perception of a lack of interest on your part. If you don’t know the difference between schizophrenia and multiple personality disorder then don’t inflict your ignorance on the public by starting a mental health blog – unless the niche is really well defined so that clinical terms aren’t important. Even then, you’re playing with fire.
4. Knowledge maintenance or death
Health, like any other discipline, evolves constantly. Keep yourself up to date so you sound informed in your blog posts. I run a syndicated feed with the latest news related to the blog’s purpose – use it for your own enlightenment.
ProBlogger are runnng a 31-day project on improving your blog – well worth checking out whether you’re already established or not.
“The Australian Institute of Criminology (AIC) is undertaking a review of the National Community Crime Prevention Programme (NCCPP). The NCCPP is a $64 million grants programme that provides funding for grass roots projects designed to enhance community safety and crime prevention by preventing or reducing crime and antisocial behaviour, improving community safety and security, and reducing the fear of crime. More information about the programme and the projects that have been funded is available at www.crimeprevention.gov.au .
The purpose of this review is to examine the appropriateness and effectiveness of the NCCPP and to help inform government decisions regarding the direction of future investment in crime prevention at an Australian Government level. As part of this process, an online survey has been developed. The AIC invites anyone who has worked or is interested in crime prevention, had exposure to the work of the NCCPP or has views about how the programme might be improved to participate in the review and to complete the survey. Knowledge of the programme itself is not required.
The survey should take approximately 20 minutes to complete, and is entirely confidential. The deadline for submissions is 5pm (EST) Friday 17 August.
If you haven’t seen it already, check out the excrutiatingly US presidential Kevin 07 website launched today. Once your eyes adjust, what you’ll see is a fairly comprehensive marketing effort that accentuates the generation gap between the Prime Minister and the aspirant. There’s links to Myspace and Facebook as well as a very healthy dose of video and other Web 2.0 baubles.
There’s no doubt the website will have an impact in marketing and political terms but I’m primarily interested in the potential policy impacts. The health section of the site only has broad objectives at present, one of which is an increased focus on prevention services. What’ll be interesting is whether the input from the public contributed from the site has any bearing on the finer details of policy when its released. The history of Labor politics and factions suggests not.
It’s hard not to see the website as a ‘hey, look at me, I’m web savvy’ effort rather than a true consultative, policy-driven enterprise. Here’s hoping I’m wrong.
The publication last week of a substantial meta-analysis of the link between cannabis and psychosis has brought about some significant debate both in the maintsream media and the AOD profession.
The Lancet podcast interviews one of the article’s authors and he’s very up front about the fact that establishing causality from a meta-analysis is fraught with difficulty. That said, the paper’s authors believe around 50% of cannabis-related psychosis is probably related to other factors like use of other substances, pre-existing mental illness and so on. That still leaves 50% of cases where there may be a direct causal link. The authors go to great lengths to emphasise that the link cold be explained by another factor, but that given there’s not likely to be significant new findings in the near future, the current practice of advising that cannabis use canbring a risk of psychosis is an appropriate strategy.
Dr Malcolm Dobbs from the Victorian Department of Health and Human Services summarised the issue perfectly:
“We don’t have perfect evidence about whether there is a causal relationship between cannabis use and increased risk of psychosis, but this meta-analysis has confined its choice of studies to longitudinal cohorts, and made allowances for possible factors that could explain (confound) differences in risks between cannabis users and non-users.
The authors of the comment estimate that if there is a true causal relation, the increased risk would mean that 800 yearly cases of schizophrenia in the UK could be prevented through cessation of cannabis consumption.”
Of course, whether a direct causal link is established or not, the pivotal issue is effective education programs and not falling into the trap of demonising a substance that has some demonstrably beneficial medical effects in the right circumstance. Any illicit substance is great fodder for misrepresentative sensationalism. The meta-analysis is purely another small step toward understanding the link between cannabis and mental health – there’s still plenty of work to be done yet.
A general update to MSIC supporters has been distributed by Medical Director Ingrid Van Beek. It makes an interesting read overall however the marked criticisms of the “pseudo-science” of the NGO Drug Free Australia (DFA) are noteworthy.
The full missive:
“Dear Supporters
On behalf of the staff of the MSIC, I am pleased to inform you that legislation to extend the trial of the Medically Supervised Injecting Centre (MSIC) for a further 4 years (to the end of October 2011) has now passed successfully through both houses in NSW Parliament. We are of course glad that the NSW Government continues to support this important public health initiative. The support for this bill from the Greens, Independents including Clover Moore, Dawn Fardell and Robert Oakeshott and five Liberal MPs (who were allowed a conscience vote) was also very encouraging.
While the parliamentary speeches in favour of the bill were heartening for the staff at the MSIC, comments like the following made by the member for Castle Hill in his speech against the bill were less so: I am willing to bet that some of those working at the centre will be trawling the streets for addicts to get their numbers up because, after all, it is their livelihood. Indeed, when I pointed out the escape clause [the new provision that a review will be triggered should MSIC utilisation drop below 75% of current levels] to my wife she immediately suggested that staff would pull people in off the street and get them to inject inside the injecting room so that they could maintain their jobs.
Likewise, repeated assertions that the MSIC merely encourages experimentation with dangerous drug cocktails were abhorrent to us. I sometimes wonder if anyone ever suggests of my cardiologist colleagues that they must be very concerned about the impact of the decreasing rate of tobacco use in the community on their “livelihoodsâ€â€¦surely not, given their obvious life-long career commitment to improving the community’s health status. Similarly those of us who have chosen to work with drug users in what is arguably one of the most challenging fields within the public health sector don’t deserve to have such aspersions cast.
It was also deeply disturbing to see the extent to which the misinformation produced by Gary Christian of Drug Free Australia (DFA) permeated many of the speeches of those opposed. That this compilation of pseudo-science gained credence comparable to the various reports tabled by the team of internationally recognised researchers from Australia’s National Centre in HIV Epidemiology and Clinical Research who undertook the MSIC’s evaluation, is a travesty. I suspect that many of the MPs who used DFA’s various statistical extrapolations in their speeches didn’t even realise that apart from being fundamentally flawed, they referred to the first 18-month period of what has now been a 6-year trial. But I am reassured that it did little to change the way the politicians actually voted in the end.
I have pasted hereunder the MSIC’s response to the 6 key arguments circulated by Mr Christian to all MPs prior to the parliamentary debate for your information (attached herewith).
Finally, to coin the words of DFA’s CEO: that the Australian Medical Association, the Royal Australasian Colleges of Physicians, Emergency Medicine, Psychiatry, the Alcohol and other Drugs Council of Australia, the Australian Drug Foundation, the Australasian Society of HIV Medicine, the Hepatitis C Council of NSW, the NSW Users and AIDS Association, the AIDS Council of NSW, Family Drug Support, the Ted Noffs Foundation, Reverend Bill Crews of the Exodus Foundation, Sydney City Council, all of the parishes in Kings Cross, the large majority of local residents and businesses in Kings Cross and many others support the MSIC – speaks for itself.
Your ongoing support is greatly appreciated. Thank you.
Dr Ingrid van Beek
Medical Director”
