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Why women turn to illegal cannabis despite rising medical demand

<div class="theconversation-article-body"> The number of women using medicinal cannabis is growing in New Zealand and overseas. They use cannabis treatment for general conditions such as <a href="https://www.liebertpub.com/doi/pdf/10.1089/jwh.2020.8437">pain, anxiety, inflammation and nausea</a>, as well as gynaecological conditions, including <a href="https://pubmed.ncbi.nlm.nih.gov/40445778/">endometriosis</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/39766334/">pelvic floor conditions</a>, and <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC10314536/">menopause</a>. However, their experiences with medicinal cannabis remain under-explored in research and overlooked in policy and regulation. As our work shows, they face several gender-specific barriers to accessing medicinal cannabis. Some of these hurdles lead women to seeking cannabis from illegal markets. New Zealand introduced the <a href="https://www.health.govt.nz/regulation-legislation/medicinal-cannabis/about-the-medicinal-cannabis-scheme">medicinal cannabis scheme</a> five years ago to enable access to legal, safe and quality-controlled cannabis products for any condition a doctor would deem suitable for a prescription. A <a href="https://pubmed.ncbi.nlm.nih.gov/39418607/">recent analysis</a> found the number of medicinal cannabis products dispensed has increased more than 14-fold since 2020, with more than 160,000 prescriptions administered during 2023/2024. In the first two years of the scheme, women were the primary recipients of medicinal cannabis prescriptions. Between 2022 and 2023, the number of prescriptions issued to female patients <a href="https://www.nzherald.co.nz/nz/the-regions-age-groups-and-ethnicities-using-the-most-medicinal-cannabis/LNG7NHEDI5GYJMG6SCER7B3HKQ/">doubled to 47,633</a>. Our findings from a <a href="https://nzdrugtrends.co.nz/">large-scale national survey</a> show that although women perceive physicians as supportive of prescribing medicinal cannabis, they were less likely to have prescriptions than men. This is similar to <a href="https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-024-00992-1">findings from Australia</a>. Potential reasons include the <a href="https://www.health.govt.nz/publication/annual-update-key-results-2022-23-new-zealand-health-survey">cost of visiting health professionals</a>, unpaid care-giving duties, lower workforce participation and a <a href="https://www.women.govt.nz/women-and-work/gender-pay-gap">pay disparity</a> – all creating barriers to accessing health services. Women were also more likely not to disclose their medicinal cannabis use to others, citing it would be less accepted by society because of their gender. <h2>Gendered risks in illegal cannabis markets</h2> Our <a href="https://www.tandfonline.com/doi/full/10.1080/09687637.2025.2481297?src=#d1e531">latest study</a> aligned with <a href="https://www.mdpi.com/1660-4601/19/3/1536">Australia</a> in finding that women often seek cannabis from illegal sources because of perceived lower prices. Many could not financially sustain accessing legal prescriptions because medicinal cannabis is not funded by New Zealand’s drug-buying agency Pharmac. Study participants discussed the health risks of accessing illegal cannabis such as consuming products without knowing how strong they are or whether they have been <a href="https://www.tga.gov.au/news/news/tga-warns-consumers-about-potential-harm-unlawfully-supplied-medicinal-cannabis">contaminated</a> with harmful substances. They also characterised illegal cannabis markets as unsafe and intimidating for women, with little legal protection and the presence of predatory male sellers. Some even described gender-specific experiences of physical assault, intimidation and sexual harassment, particularly when cannabis buying occurred in drug houses or locations controlled by the seller. Women accessing medicinal cannabis in illegal markets increasingly relied on female suppliers, viewing them as safer and more reliable. Some also helped connect others to these suppliers and used social media to warn other women of unsafe male suppliers. This created informal women-led support networks for access. <h2>Accessing legal prescriptions</h2> <figure class="align-right "><figcaption></figcaption></figure> One of our <a href="https://doi.org/10.1080/09687637.2025.2476989">recent studies</a> found many women begin their journeys with medicinal cannabis online via social media, often leading them to <a href="https://doi.org/10.1186/s12913-022-09021-y">cannabis clinics</a> with a strong digital presence. Women are now a growing demographic for specialised medicinal cannabis clinics in <a href="https://pubmed.ncbi.nlm.nih.gov/32019776/">New Zealand</a> and in <a href="https://www.sciencedirect.com/science/article/pii/S0965229921000819">other countries</a>. Cannabis clinics have a reputation among medicinal cannabis consumers for being more knowledgeable and positive about treatments than general practitioners and other health providers. Women have been encouraged by positive online testimonies from other women using cannabis treatments for gynaecological and other conditions. Female medicinal cannabis patients also described the financial burden of accessing a prescription, including consultation fees and the costs of products as barriers to access. Their relationships with their GPs strongly influenced their decision to seek a prescription. Those with prior experiences of having their pain underestimated or misdiagnosed in mainstream care were more likely to source legal medicinal cannabis from cannabis clinics. <h2>Policy and practice</h2> The current scientific evidence for using medicinal cannabis for gynaecological conditions is still emerging. Clinical trials are under way in Australia to evaluate cannabis treatment for <a href="https://www.westernsydney.edu.au/nicmhri/research/research_projects/medicinal_cannabis_and_endometriosis">endometriosis and period pain</a>. Women’s reliance on online sources and personal recommendations to learn about medicinal cannabis highlights a gap in public awareness and government education about the legal prescription scheme. <a href="https://www.publish.csiro.au/hc/HC22122">Hesitance to discuss and recommend cannabis</a> treatment among GPs also persists as a barrier to access. Online peer networks on social media platforms are promoting women’s agency and informing their decision making around medicinal cannabis, but also raise the risks of misinformation. Although marketing of medicinal cannabis to women may improve their engagement with the prescription scheme, it may also put them in a vulnerable position where they are encouraged to pursue expensive treatment options which may not be effective. The collective findings from our studies indicate complex financial, social and systemic factors affecting safe and equitable access to medicinal cannabis for women. To improve women’s engagement with New Zealand’s medicinal cannabis scheme, we suggest GPs should have informed and non-stigmatising discussions with female patients to explore when medicinal cannabis might be an appropriate treatment option. Better access to good official consumer information about medicinal cannabis and greater investment in clinical trials for gynaecological conditions would also improve and support women’s decision making about their health.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/258797/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> By <a href="https://theconversation.com/profiles/vinuli-withanarachchie-1278697">Vinuli Withanarachchie</a>, PhD candidate, College of Health, <a href="https://theconversation.com/institutions/te-kunenga-ki-purehuroa-massey-university-806">Te Kunenga ki Pūrehuroa – Massey University</a>; <a href="https://theconversation.com/profiles/chris-wilkins-1110463">Chris Wilkins</a>, Professor of Policy and Health, <a href="https://theconversation.com/institutions/te-kunenga-ki-purehuroa-massey-university-806">Te Kunenga ki Pūrehuroa – Massey University</a>, and <a href="https://theconversation.com/profiles/marta-rychert-1108013">Marta Rychert</a>, Associate Professor in Drug Policy and Health Law, <a href="https://theconversation.com/institutions/te-kunenga-ki-purehuroa-massey-university-806">Te Kunenga ki Pūrehuroa – Massey University</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/more-women-are-using-medical-cannabis-but-new-research-shows-barriers-push-some-into-illegal-markets-258797">original article</a>. Image: Pexels / Binoid CBD and Alesia Kozik </div>

Caring

The surprising ways that coffee can interfere with medication

<div class="theconversation-article-body"> For many of us, the day doesn’t start until we’ve had our first cup of coffee. It’s comforting, energising, and one of the most widely consumed beverages in the world. But while your morning brew might feel harmless, it can interact with certain medicines in ways that reduce their effectiveness – or increase the risk of side-effects. From common cold tablets to antidepressants, caffeine’s impact on the body goes far beyond a quick energy boost. Tea also contains caffeine but not in the same concentrations as coffee, and doesn’t seem to affect people in the same way. Here’s what you should know about how coffee can interfere with your medications – and how to stay safe. <h2>1. Cold and flu medicines</h2> Caffeine is a stimulant, which means it speeds up the central nervous system. Pseudoephedrine, a decongestant found in cold and flu remedies such as Sudafed, is <a href="https://medlineplus.gov/druginfo/meds/a682619.html">also a stimulant</a>. When taken together, the effects can be amplified – potentially leading to jitters or restlessness, headaches, fast heart rate and insomnia. Many cold medications already contain added caffeine, increasing these risks further. <a href="https://www.mdpi.com/1422-0067/22/10/5146">Some studies</a> also suggest that combining caffeine with pseudoephedrine can raise blood sugar and body temperature – particularly important for people with diabetes. Stimulant effects are also a concern when combining caffeine with ADHD medications such as amphetamines, or with <a href="https://allergyasthmanetwork.org/news/coffee-and-asthma/">asthma drugs</a> such as theophylline, which shares a similar chemical structure to caffeine. Using them together may increase the risk of side-effects such as a rapid heartbeat and sleep disruption. <figure><iframe src="https://www.youtube.com/embed/9eL16Exry48?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <h2>2. Thyroid medication</h2> Levothyroxine, the standard treatment for an underactive thyroid, is highly sensitive to timing – and your morning coffee can get in the way. <a href="https://onlinelibrary.wiley.com/doi/10.1155/2020/7909703">Studies show</a> that drinking coffee too soon after taking levothyroxine can reduce its absorption by up to 50%. Caffeine speeds up gut motility (the movement of food and waste through the digestive tract), giving the drug <a href="https://www.jandonline.org/article/S2212-2672(16)00200-8/abstract">less time to be absorbed</a> – and <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC8002057/#:%7E:text=Several%20studies%20on%20patients%20with,Benvenga%20et%20al.">may also bind</a> to it in the stomach, making it harder for the body to take in. These effects reduce the drug’s bioavailability, meaning less of it reaches your bloodstream where it’s needed. This interaction <a href="https://www.endocrine.org/news-and-advocacy/news-room/2022/drinking-coffee-does-not-hinder-the-absorption-of-liquid-thyroid-medication">is more common</a> with tablet forms of levothyroxine, and less likely with liquid formulations. If absorption is impaired, <a href="https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/">symptoms of hypothyroidism</a> – including fatigue, weight gain and constipation – can return, even if you’re taking your medicine correctly. The same timing rule applies to a class of osteoporosis medications called <a href="https://medlineplus.gov/druginfo/meds/a601011.html#precautions">bisphosphonates</a>, including alendronate and risedronate, which also require an empty stomach and around 30-60 minutes before food or drink is taken. <h2>3. Antidepressants and antipsychotics</h2> The interaction between caffeine and mental health medications can be more complex. <a href="https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/ssri-antidepressants/overview/">Selective serotonin reuptake inhibitors</a> (SSRIs), such as sertraline and citalopram, are a type of antidepressant medication <a href="https://purehost.bath.ac.uk/ws/portalfiles/portal/225886346/Lalji_McGrogan_and_Bailey_JADR_2021.pdf">widely used</a> to treat depression, anxiety and other psychiatric conditions. <a href="https://onlinelibrary.wiley.com/doi/10.1155/2020/7909703">Lab studies</a> suggest caffeine can bind to these drugs in the stomach, reducing absorption and potentially making them less effective. Tricyclic antidepressants (TCAs), such as amitriptyline and imipramine, are a class of older antidepressants that work by affecting the levels of neurotransmitters in the brain. They were among the first antidepressants developed and are <a href="https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/antidepressants/overview/#:%7E:text=Tricyclic%20antidepressants%20(TCAs),to%20treat%20chronic%20nerve%20pain.">less commonly used</a> today, compared with newer antidepressants such as SSRIs, due to their potential for more side-effects and higher risk of overdose. TCAs are broken down by the liver enzyme <a href="https://onlinelibrary.wiley.com/doi/10.1155/2020/7909703">CYP1A2</a>, which also metabolises caffeine. The competition between the two can slow drug breakdown, <a href="https://onlinelibrary.wiley.com/doi/10.1155/2020/7909703">increasing side-effects</a>, or delay caffeine clearance, making you feel jittery or wired longer than usual. Clozapine, an antipsychotic, is also processed by CYP1A2. <a href="https://onlinelibrary.wiley.com/doi/10.1155/2020/7909703">One study showed</a> that drinking two-to-three cups of coffee could increase blood levels of clozapine by up to 97%, <a href="https://medlineplus.gov/druginfo/meds/a691001.html#side-effects">potentially increasing risks</a> such as drowsiness, confusion, or more serious complications. <h2>4. Painkillers</h2> Some over-the-counter painkillers, such as those containing aspirin or paracetamol, include added caffeine. <a href="https://link.springer.com/article/10.2165/00003088-200039020-00004">Coffee can speed up</a> how quickly these drugs are absorbed by accelerating how fast the stomach empties and making the <a href="https://onlinelibrary.wiley.com/doi/10.1155/2020/7909703">stomach more acidic</a>, which improves absorption for some medications such as aspirin. While this may help painkillers work faster, it could also raise the risk of side-effects like stomach irritation or bleeding, especially when combined with other sources of caffeine. Though no serious cases have been reported, caution is still advised. <h2>5. Heart medications</h2> Caffeine can temporarily raise blood pressure and heart rate, typically lasting three-to-four hours after consumption. For people taking blood pressure medication or drugs that control irregular heart rhythms (arrhythmias), this <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC8101832/#:%7E:text=Table%20I.&text=The%20next%20stage%20of%20hypertension,response%20to%20calcium%20channel%20blockers.&text=The%20potential%20for%20caffeine%20to,Table%20II%20summarizes%20these%20recommendations.">may counteract</a> the intended effects of the medication. This doesn’t mean people with heart conditions must avoid coffee altogether – but they should monitor how it affects their symptoms, and consider limiting intake or switching to decaf if needed. <figure><iframe src="https://www.youtube.com/embed/r-YwCCNDOy0?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <h2>What can you do?</h2> Coffee may be part of your daily routine, but it’s also a potent chemical compound that can influence how your body processes medicine. Here’s how to make sure it doesn’t interfere. Take levothyroxine or bisphosphonates on an empty stomach with water, and wait 30-60 minutes before drinking coffee or eating breakfast. Be cautious with cold and flu remedies, asthma treatments and ADHD medications, as caffeine can amplify side-effects. If you’re on antidepressants, antipsychotics, or blood pressure drugs, discuss your caffeine habits with your doctor. Consider reducing intake or choosing a decaffeinated option if you experience side-effects like restlessness, insomnia or heart palpitations. Everyone metabolises caffeine differently – some people feel fine after three cups, while others get side-effects after just one. Pay attention to how your body responds and talk to your pharmacist or GP if anything feels off. If you’re ever unsure whether your medicine and your coffee are a good match, ask your pharmacist or doctor. A short conversation might save you weeks of side-effects or reduced treatment effectiveness – and help you enjoy your brew with peace of mind.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/256919/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> By <a href="https://theconversation.com/profiles/dipa-kamdar-1485027">Dipa Kamdar</a>, Senior Lecturer in Pharmacy Practice, <a href="https://theconversation.com/institutions/kingston-university-949">Kingston University</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/coffee-can-interfere-with-your-medication-heres-what-you-need-to-know-256919">original article</a>. Image: Pexels / Jonathan Borba </div>

Body

More people are trying medicinal cannabis for chronic pain. But does it work?

<div class="theconversation-article-body"> More Australians than ever are being prescribed <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/medicinal-cannabis">medicinal cannabis</a>. Medicinal cannabis refers to legally prescribed cannabis products. These are either the plant itself, or naturally occurring ingredients extracted from the plant. These ingredients, such as THC (tetrahydrocannabinol) and CBD (cannabidiol), are called cannabinoids. Some cannabinoids are also made in labs to act like the ones in the plant. Medicinal cannabis comes in different forms, such as oils, capsules, dried flower (used in a vaporiser), sprays and edible forms such as gummies. Since regulatory changes in 2016 made medicinal cannabis more accessible, Australia’s regulator has issued <a href="https://dashboard-data.health.gov.au/single/?appid=1066afbe-2b37-427d-8c47-2caa5082cccc&sheet=088f611b-10de-4d72-be68-ccf8d12c54e9&select=clearall">more than 700,000 approvals</a>. (But approvals for medicinal cannabis don’t reflect the actual number of patients treated. One patient may have multiple approvals, and not all approved products are necessarily prescribed or supplied.) Around half of the approvals have been for chronic pain that isn’t caused by cancer. In Australia, chronic pain affects around <a href="https://www.aihw.gov.au/reports/chronic-disease/chronic-pain-in-australia/summary">one in five</a> Australians aged 45 and over, with an enormous impact on people’s lives. So what does the current evidence tell us about the effectiveness of medicinal cannabis for chronic pain? <h2>What the evidence shows</h2> A <a href="https://www.bmj.com/content/374/bmj.n1034">2021 review of 32 randomised controlled trials</a> involving nearly 5,200 people with chronic pain, examined the effects of medicinal cannabis or cannabinoids. The study found a small improvements in pain and physical functioning compared with a placebo. A <a href="https://pubmed.ncbi.nlm.nih.gov/29847469/">previous review</a> found that to achieve a 30% reduction in pain for one person, 24 people would need to be treated with medicinal cannabis. The 2021 review also <a href="https://www.bmj.com/content/374/bmj.n1034">found</a> small improvements in sleep, and no consistent benefits for other quality of life measures, consistent with <a href="https://pubmed.ncbi.nlm.nih.gov/29847469/">previous reviews</a>. This doesn’t mean medicinal cannabis doesn’t help anyone. But it suggests that, on average, the benefits are limited to a smaller number of people. Many pain specialists have <a href="https://theconversation.com/medicinal-cannabis-to-manage-chronic-pain-we-dont-have-evidence-it-works-157324">questioned</a> if the evidence for medicinal cannabis is sufficient to support its use for pain. The <a href="https://www.choosingwisely.org.au/recommendations/fpm6">Faculty of Pain Medicine</a>, the professional body dedicated to the training and education of specialist pain physicians, recommends medical cannabis should be limited to clinical trials. <h2>What does the regulator say?</h2> Guidance from Australia’s regulator, the <a href="https://www.tga.gov.au/products/unapproved-therapeutic-goods/medicinal-cannabis-hub/medicinal-cannabis-guidance-documents/guidance-use-medicinal-cannabis-treatment-chronic-non-cancer-pain-australia">Therapeutic Goods Administration</a> (TGA), on medicinal cannabis for chronic non-cancer pain reflects these uncertainties. The TGA states there is limited evidence medicinal cannabis provides clinically significant pain relief for many pain conditions. Therefore, the potential benefits versus harms should be considered patient-by-patient. The TGA says medicinal cannabis should only be trialled when other standard therapies have been tried and did not provide enough pain relief. In terms of which type of medical cannabis product to use, due to concerns about the safety of inhaled cannabis, the TGA considers pharmaceutical-grade products (such as nabiximols or extracts containing THC and/or CBD) to be safer. <h2>What about people who say it helps?</h2> This evidence may feel at odds with the experiences of people who report relief from medicinal cannabis. In clinical practice, it’s common for individuals to respond differently based on their health conditions, beliefs and many other factors. What works well for one person may not work for another. Research helps us understand what outcomes are typical or expected for most people, but there is variation. Some people may find medicinal cannabis improves their pain, sleep or general well-being – especially if other treatments haven’t helped. <h2>What are the side effects and risks?</h2> Like any medicine, medicinal cannabis has <a href="https://www.tga.gov.au/products/unapproved-therapeutic-goods/medicinal-cannabis-hub/medicinal-cannabis-guidance-documents/guidance-use-medicinal-cannabis-treatment-chronic-non-cancer-pain-australia#s9">potential side effects</a>. These are usually mild to moderate, including drowsiness or sedation, dizziness, impaired concentration, a dry mouth, nausea and cognitive slowing. These side effects are often greater with higher-potency THC products. These are becoming more common on the Australian market. High-potency THC products represent <a href="https://dashboard-data.health.gov.au/single/?appid=1066afbe-2b37-427d-8c47-2caa5082cccc&sheet=088f611b-10de-4d72-be68-ccf8d12c54e9&select=clearall">more than half of approvals in 2025</a>. In research studies, generally <a href="https://pubmed.ncbi.nlm.nih.gov/29847469/">more people experience side effects</a> than report benefits from medical cannabis. Medical cannabis can also <a href="https://pubmed.ncbi.nlm.nih.gov/36317739/">interact with other medications</a>, especially those that cause drowsiness (such as opioids), medicines for mental illness, anti-epileptics, blood thinners and immunosuppressants. Even cannabidiol (CBD), which isn’t considered intoxicating like THC, has been linked to serious drug interactions. These risks are greater when cannabis is prescribed by a doctor who doesn’t regularly manage the patient’s chronic pain or isn’t in contact with their other health-care providers. Since medicinal cannabis is often prescribed through separate telehealth clinics, this fragmented care may increase the risk of harmful interactions. Another concern is developing cannabis use disorder (commonly understood as “addiction”). A 2024 study found <a href="https://www.sciencedirect.com/science/article/pii/S0376871624001844?via%3Dihub">one in four people</a> using medical cannabis develop a cannabis use disorder. Withdrawal symptoms – such as irritability, sleep problems, or cravings – can occur with frequent and heavy use. For some people, tolerance can also develop with long-term use, meaning you need to take higher doses to get the same effect. This can increase the risk of developing a cannabis use disorder. <h2>How does it compare to other treatments?</h2> Like many <a href="https://www.healthdirect.gov.au/chronic-pain">medicines for chronic pain</a>, the effectiveness of medicinal cannabis is modest, and is not recommended as a sole treatment. There’s good evidence that, for conditions like back pain, interventions such as exercise, cognitive behavioural therapy and pain self-management education can <a href="https://theconversation.com/do-any-non-drug-treatments-help-back-pain-heres-what-the-evidence-says-253122">help</a> and may have fewer risks than many medicines. But there are challenges with how accessible and affordable these treatments are for many Australians, <a href="https://www1.racgp.org.au/getattachment/e0603085-695c-4fbb-b7d9-ba77057e5a97/Management-of-chronic-pain-in-a-rural-Australian-s.aspx">especially outside major cities</a>. <h2>So where does this leave patients?</h2> The growing use of medicinal cannabis for chronic pain reflects both a high burden of pain in the community and gaps in access to effective care. While some patients report benefits, the current evidence suggests these are likely to be small for most people, and must be weighed against the risks. If you are considering medicinal cannabis, it’s important to talk to your usual health-care provider, ideally one familiar with your full medical history, to help you decide the best approaches to help manage your pain.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/256471/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> By <a href="https://theconversation.com/profiles/suzanne-nielsen-35849">Suzanne Nielsen</a>, Professor and Deputy Director, Monash Addiction Research Centre, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/myfanwy-graham-2392855">Myfanwy Graham</a>, NHMRC Postgraduate Scholar and Fulbright Alumna in Public Health Policy, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/more-people-are-trying-medicinal-cannabis-for-chronic-pain-but-does-it-work-256471">original article</a>. Image: </div>

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Fresh medical report sheds new light on Shane Warne’s sudden death

New details have emerged regarding the sudden death of cricketing legend Shane Warne, who passed away in a Thai hotel room in March 2022 at the age of 52. A newly surfaced medical report, published by The Sun, reveals that multiple medications were found in Warne’s luxury villa on the Thai island of Koh Samui. These included two types of Viagra – Sildenafil (marketed as Viagra) and Kamagra (an unregulated version available in jelly sachets) – as well as Dapoxetine, a drug used to prevent premature ejaculation. While Viagra and Dapoxetine are legal with a prescription, Kamagra is illegal in Thailand but widely available over the counter. It remains uncertain whether Warne had taken any of these medications before his passing. Warne had a known history of heart issues, and these medications carry warnings for individuals with cardiovascular conditions. However, a post-mortem examination conducted in Thailand concluded that Warne died of natural causes due to congenital heart disease, ruling out foul play. Despite this, recent reports claim that Thai police removed Kamagra from Warne’s hotel room during their investigation. Meanwhile, News Corp reported that Warne had openly discussed using Viagra during his relationship with actress and model Elizabeth Hurley. Warne was staying at the Smujana Villas resort with three friends at the time of his death. CCTV footage captured two massage therapists leaving his villa shortly before he was found unresponsive at approximately 5pm His friends called for medical assistance at 5:40pm, with paramedics arriving at 6pm and initiating CPR at 6:10pm. Dr Dulyakit Wittayachanyapong, who oversaw Warne’s treatment at Thailand International Hospital, described his condition upon arrival, stating: “When he arrived at hospital, his face was green and pale, he had black blood in his nose and mouth, which was unusual. There was no sign of life.” Hospital staff attempted resuscitation for 43 minutes before Warne was declared dead at 6:53pm. According to the medical report, doctors intubated him and administered adrenaline and sodium bicarbonate in an attempt to revive him. Blood tests revealed that his oxygen levels had plummeted to a critical 40%. In the weeks leading up to his death, Warne had been on a liquid diet, and his lifestyle reportedly included habitual smoking and drinking. His sudden passing sent shockwaves through the cricketing world, with fans and former teammates mourning the loss of an icon whose impact on the sport remains unmatched. Images: Instagram

Caring

What’s the difference between heat exhaustion and heat stroke? One’s a medical emergency

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/matthew-barton-1184088">Matthew Barton</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> and <a href="https://theconversation.com/profiles/michael-todorovic-1210507">Michael Todorovic</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> When British TV doctor Michael Mosley died last year in Greece after walking in extreme heat, local police said “<a href="https://www.telegraph.co.uk/news/2024/06/10/michael-mosley-autopsy-symi-greece-death/">heat exhaustion</a>” was a contributing factor. Since than a coroner could not find a definitive cause of death <a href="https://www.theguardian.com/media/2024/dec/20/michael-mosleys-cause-of-death-unascertainable-coroner-says">but said</a> this was most likely due to an un-identified medical reason or heat stroke. Heat exhaustion and heat stroke are two illnesses that relate to heat. So what’s the difference? <h2>A spectrum of conditions</h2> Heat-related illnesses range from mild to severe. They’re caused by exposure to excessive heat, whether from hot conditions, physical exertion, or both. The most common ones include: <ul> <li> heat oedema: swelling of the hands, feet and ankles </li> <li> heat cramps: painful, involuntary muscle spasms usually after exercise </li> <li> heat syncope: fainting due to overheating </li> <li> heat exhaustion: when the body loses water due to excessive sweating, leading to a rise in core body temperature (but still under 40°C). Symptoms include lethargy, weakness and dizziness, but there’s no change to consciousness or mental clarity </li> <li> heat stroke: a medical emergency when the core body temperature is over 40°C. This can lead to serious problems related to the nervous system, such as confusion, seizures and unconsciousness including coma, leading to death. </li> </ul> As you can see from the diagram below, some symptoms of heat stroke and heat exhaustion overlap. This makes it hard to recognise the difference, even for medical professionals. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/636118/original/file-20241204-15-qhk6rk.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/636118/original/file-20241204-15-qhk6rk.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/636118/original/file-20241204-15-qhk6rk.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=455&fit=crop&dpr=1 600w, https://images.theconversation.com/files/636118/original/file-20241204-15-qhk6rk.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=455&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/636118/original/file-20241204-15-qhk6rk.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=455&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/636118/original/file-20241204-15-qhk6rk.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=572&fit=crop&dpr=1 754w, https://images.theconversation.com/files/636118/original/file-20241204-15-qhk6rk.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=572&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/636118/original/file-20241204-15-qhk6rk.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=572&fit=crop&dpr=3 2262w" alt="Heat exhaustion vs heat stroke venn diagram" /></a><figcaption><a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></figcaption></figure> <h2>How does this happen?</h2> The human body is an incredibly efficient and adaptable machine, equipped with several in-built mechanisms to keep our core temperature at an optimal 37°C. But in healthy people, regulation of body temperature begins to break down when it’s hotter than about 31°C with 100% humidity (think Darwin or Cairns) or about 38°C with 60% humidity (typical of other parts of Australia in summer). This is because humid air makes it harder for sweat to evaporate and take heat with it. Without that cooling effect, the body starts to overheat. Once the core temperature rises above 37°C, heat exhaustion can set in, which can cause intense thirst, weakness, nausea and dizziness. If the body heat continues to build and the core body temperature rises above 40°C, a much more severe heat stroke could begin. At this point, it’s a life-threatening emergency requiring immediate medical attention. At this temperature, our proteins start to denature (like an egg on a hotplate) and blood flow to the intestines stops. This makes the gut very leaky, allowing harmful substances such as endotoxins (toxic substances in some bacteria) and pathogens (disease causing microbes) to leak into the bloodstream. The liver can’t detoxify these fast enough, leading to the whole body becoming inflamed, organs failing, and in the worst-case scenario, death. <h2>Who’s most at risk?</h2> People doing strenuous exercise, especially if they’re not in great shape, are among those at risk of heat exhaustion or heat stroke. <a href="https://www.who.int/multi-media/details/main-heat-vulnerability-factors">Others at risk</a> include those exposed to high temperatures and humidity, particularly when wearing heavy clothing or protective gear. Outdoor workers such as farmers, firefighters and construction workers are at higher risk too. Certain health conditions, such as diabetes, heart disease, or lung conditions (such as COPD or chronic obstructive pulmonary disease), and people taking <a href="https://theconversation.com/is-my-medicine-making-me-feel-hotter-this-summer-5-reasons-why-199085">blood pressure medications</a>, can also be more vulnerable. Adults over 65, infants and young children are especially sensitive to heat as they are less able to physically cope with fluctuations in heat and humidity. <h2>How are these conditions managed?</h2> The risk of serious illness or death from heat-related conditions is very low if treatment starts early. <a href="https://www.redcross.org.au/emergencies/prepare/heatstroke-and-heat-exhaustion/">For heat exhaustion</a>, have the individual lie down in a cool, shady area, loosen or remove excess clothing, and cool them by fanning, moistening their skin, or immersing their hands and feet in cold water. As people with heat exhaustion almost always are dehydrated and have low electrolytes (certain minerals in the blood), they will usually need to drink fluids. However, emergency hospital care is essential for heat stroke. In hospital, health professionals will focus on stabilising the patient’s: <ul> <li>airway (ensure no obstructions, for instance, vomit)</li> <li>breathing (look for signs of respiratory distress or oxygen deprivation)</li> <li>circulation (check pulse, blood pressure and signs of shock).</li> </ul> Meanwhile, they will use rapid-cooling techniques including immersing the whole body in cold water, or applying wet ice packs covering the whole body. <h2>Take home points</h2> Heat-related illnesses, such as heat stroke and heat exhaustion, are serious health conditions that can lead to severe illness, or even death. With <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01208-3/fulltext">climate change, heat-related illness</a> will become more common and more severe. So recognising the early signs and responding promptly are crucial to prevent serious complications.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/240992/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/matthew-barton-1184088">Matthew Barton</a>, Senior lecturer, School of Nursing and Midwifery, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> and <a href="https://theconversation.com/profiles/michael-todorovic-1210507">Michael Todorovic</a>, Associate Professor of Medicine, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whats-the-difference-between-heat-exhaustion-and-heat-stroke-ones-a-medical-emergency-240992">original article</a>. </div>

Body

Readers response: What’s your best advice for managing medications while travelling?

When taking a trip, many people often have to factor in how their changing schedule will affect their regular medication routines. We asked our readers for their best advice on managing medications while travelling, and the response was overwhelming. Here's what they said. Kristeen Bon - I put each days tablet into small ziplock bags and staple them at one corner. All that goes into one larger ziplock bag and into my toilet bag. I store all the outer packs flat into another ziplock bag and that stays in the zip pack with my first aid kit in the main suitcase. I travel long haul up to six times a year and this is the most manageable way I have found. Diane Green - Firstly, take sufficient supply of all meds to last the time I'm away. I separate morning medications and evening medications. Then it depends on how long I'm away. I have one that needs to be refrigerated. Depending on where I travel, this can entail arranging overnight in the establishment fridge while taking a freezer pack for daytime travel. Irene Varis - Always get a letter from my doctor, with all my prescriptions for when I get overseas. Saves you a lot of trouble! Helen Lunn - Just get the chemist to pack into Medipacks. I usually take an extra week. I alway put some of the packs in my partners baggage incase my bag goes missing and a pack and a doctor’s letter in my hand luggage. Jancye Winter - Always pack in your carry on with prescriptions. Jenny Gordon - Carry a letter from doc with all medications, leave in original packaging. Double check that it isn’t illegal to carry your medication as some countries have strict regulations for things like Codeine. Always carry in carry on as you don’t want them to get lost. Nina Thomas Rogers - Be organised with all your medicines before you leave. Image credits: Shutterstock

Travel Tips

More Australians are using their superannuation for medical procedures. But that might put their financial health at risk

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/neera-bhatia-15189">Neera Bhatia</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> A record number of Australians are accessing their superannuation early on compassionate grounds, mainly to fund their own medical procedures – or those of a family member. Some 150,000 Australians have used the scheme in the last five years. Nearly 40,000 people <a href="https://www.ato.gov.au/about-ato/research-and-statistics/in-detail/super-statistics/early-release/compassionate-release-of-super">had applications approved</a> in 2022-23, compared to just under 30,000 in 2018-19 – an increase of 47%. Some people think this flexible use of funds is a good way to ensure people can fund their own medical needs. But more transparency and better oversight is needed. <h2>What are compassionate grounds?</h2> Since July 2018, the Australian Tax Office has administered the early release of superannuation – meaning before <a href="https://www.ato.gov.au/individuals-and-families/super-for-individuals-and-families/super/withdrawing-and-using-your-super/super-withdrawal-options#Preservationage">retirement</a> – under certain circumstances, including compassionate grounds. <a href="https://www.ato.gov.au/individuals-and-families/super-for-individuals-and-families/super/withdrawing-and-using-your-super/early-access-to-super/access-on-compassionate-grounds/expenses-eligible-for-release-on-compassionate-grounds">Compassionate grounds</a> for you or your dependant (such as child or spouse) are: <ul> <li>medical treatment or transport</li> <li>modifying your home or vehicle to accommodate special needs for a severe disability</li> <li>palliative care for a terminal illness</li> <li>death, funeral or burial expenses</li> <li>preventing foreclosure or forced sale of your home.</li> </ul> The medical treatment must be for a life-threatening illness or injury, or to alleviate acute or chronic pain, or acute or chronic mental illness. The treatment cannot be “readily available” through the public system. Cosmetic procedures are excluded. You also have to prove you cannot afford to pay part or all of the expenses without accessing your super, for example, by spending your savings, selling assets or getting a loan. People who can access other funding for the expense, such as via the <a href="https://theconversation.com/lists-of-eligible-supports-could-be-a-backwards-step-for-the-ndis-and-people-with-disability-236578">National Disability Insurance Scheme</a>, are ineligible. <h2>Why are people using this scheme more?</h2> The ATO has not explained what is driving the surge. General cost-of-living pressures may play a role. People may have fewer savings to draw on for medical procedures. But the treatments most commonly being accessed using superannuation – fertility treatments, weight loss surgeries and dental care – point to other systemic issues. There have long been issues with IVF and <a href="https://theconversation.com/why-isnt-dental-included-in-medicare-its-time-to-change-this-heres-how-239086#:%7E:text=The%20real%20reason%20dental%20hasn,has%20a%20structural%20budget%20problem.">dental care</a> not being readily available or funded in the public health system. Weight loss surgeries (including <a href="https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394258">bariatric surgery</a>) can help combat potentially life-threatening conditions such as heart disease. Recent <a href="https://www.monash.edu/news/articles/fewer-australians-having-bariatric-surgery-monash-university-led-report">research</a> suggests there has been an overall drop in the number of Australians having bariatric surgeries since 2016. But of those, 95% are performed through the private system. While early access to super can provide individuals access to critical treatment, there are issues with how compassionate grounds are defined and regulated. <h2>Lack of clarity</h2> As my co-author and I <a href="https://www.unswlawjournal.unsw.edu.au/wp-content/uploads/2021/06/Issue-442-PDF-3-Bhatia-and-Porceddu.pdf">have shown</a>, the vague wording of the <a href="https://www.legislation.gov.au/F1996B00580/2022-09-28/text">Superannuation Industry regulations</a> leaves them worryingly open to interpretation. For example, the meaning of “mental disturbance” is not defined. You may not meet the criteria of having an acute or life-threatening illness, or acute or chronic pain. But if you can show a certain condition causes you acute mental disturbance, you may qualify to release your superannuation early. People accessing their superannuation for IVF use this criterion, for example, by arguing they need to access funds to continue treatment and alleviate the acute mental distress caused by ongoing infertility issues. Two registered medical practitioners are each required to submit a report demonstrating the treatment is needed, and one must be a specialist in the field in which the treatment is required. However, the regulations do not specify clearly that the specialist should have relevant qualifications. In the IVF example, this means the specialist opinion can be provided by a fertility doctor rather than a mental health expert – and that person may stand to profit if they later also provide treatment. <h2>A closed-loop system</h2> Conflict of interest is another major issue. There is nothing in the regulations to stop a medical practitioner – such as a dentist – being involved in all steps and then financially benefiting. They could encourage a patient to access superannuation for a treatment, write the specialist report and then also receive payment for the treatment. Some clinics <a href="https://www.theguardian.com/australia-news/2024/apr/06/online-ads-promote-simple-access-to-super-to-pay-for-healthcare-despite-strict-rules">promote</a> accessing superannuation as an option to pay for expensive treatments. This raises important questions about the independence of the process, as well as professional ethics. Medical practitioners making recommendations for early release of superannuation should be doing so on genuinely compassionate grounds. But the potential for exploitation remains an ethical concern, when a practitioner can financially benefit from recommending early access to nest egg funds. Transparency around potential <a href="https://theconversation.com/people-are-using-their-super-to-pay-for-ivf-with-their-fertility-clinics-blessing-thats-a-conflict-of-interest-161278">conflicts of interest</a> are impossible to ensure without proper oversight. <h2>What is needed?</h2> 1. Mandatory financial counselling The ATO <a href="https://www.theage.com.au/healthcare/worrying-trend-record-number-of-australians-raid-super-to-fund-medical-treatments-20240920-p5kc44.html">has warned</a> accessing super early is not “free money”, with a spokesperson urging people to get financial advice. But the law should go a step further and make this compulsory. That way people making decisions during an emotionally charged moment can understand any future implications. 2. Tightening of the criteria Greater clarity in the legislation – such as defining “mental disturbance” – would help prevent loopholes being exploited. 3. Better oversight Less health-care industry involvement would promote greater transparency and independence. An independent body of medical practitioners could assess applications rather than practitioners who could financially benefit if applications are approved. This would help alleviate perceived and actual conflicts of interest. Accessing superannuation early may be the only option for some people to start a family or access other life-changing medical care. But they should be able to make this decision in a fully informed way, safeguarded from exploitation and aware of the implications for their future.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/239588/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/neera-bhatia-15189">Neera Bhatia</a>, Associate Professor in Law, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/more-australians-are-using-their-superannuation-for-medical-procedures-but-that-might-put-their-financial-health-at-risk-239588">original article</a>. </div>

Money & Banking

"Never been seen before": Fergie reveals new details from 9/11 near miss

Sarah Ferguson, affectionately known as Fergie, has taken to Instagram overnight to share new details of her 9/11 near miss. 24 years on, the Duchess of York, who has previously revealed that she was meant to be in the World Trade Centre's North Tower when the plane struck the building, has shared more details of the day. Fergie recalled how her friend, billionaire businessman Howard Lutnick, gave her an office on the 101st floor of the World Trade Centre at the time, for her charity Chances for Children. The charity's logo had a mascot called Little Red, which was eventually made into a doll for a child named PJ who survived the 1995 Oklahoma City Bombings. On the day of the 9/11 attacks Fergie was due to attend a meeting in the office, but was running late because of an earlier engagement, so she was still on route to the building when the terrorists struck. "I was driving in the car and I was late for work... and Little Red was found in the rubble," she said in the video. Fergie opened a box to reveal her own Little Red doll that survived the attacks. While she has previously talked about the doll, this is the first time she revealed what it looked like. "A fireman picked her up, carried her out, like the fireman that picked up PJ all those years ago in the Oklahoma City Bombing," she continued. "And CNN filmed it and said, 'Look, a child's doll.' And Larry King said, 'That's no child's doll. That's Fergie's Little Red' and she stands for children's rights all over the world and she's a sign of hope for children. "What no one has ever seen before and I would like to share this with you is the actual doll that survived in 9/11. "So here, I have it at home. Normally I talk about Little Red and here is the actual doll that survived. "You can see the dust from the building — that's never been seen before. <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/reel/C_xjdvMKSCn/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/C_xjdvMKSCn/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Sarah Ferguson (Fergie) (@sarahferguson15)</a> </div> </blockquote> "And I hope Little Red will be talked about all over the world because she's just a very strong, stoic little person." She also shared that on the day, Little Red "sat on her desk overlooking Manhattan on that fateful day when the towers came down." "She came down through the rubble and landed fully intact," she wrote. "Little Red was carried out of the rubble in the fireman's hat exactly as PJ, a child burn victim, was carried years earlier in the Oklahoma City bombing, where the doll was first inspired to bring hope during difficult times and raise money for aid. "Little Red now sits in the 9/11 memorial museum and serves as a reminder of hope within the darkness. We will #neverforget," she continued before encouraging her followers to donate to the Cantor Relief Fund, to support families affected by disaster. Images: Instagram

Caring

John Boland’s battle against prostate cancer and the urgent need for reform

John Boland, a 74-year-old retired Navy Reserve Lieutenant Commander, found himself at a crossroads – a place where hope and despair often meet in the lives of those battling life-threatening illnesses like prostate cancer. Diagnosed five years ago, John’s journey has been a relentless fight against a disease that, despite medical advancements, still claims the lives of 10 men in Australia every day. After undergoing surgery and 37 rounds of radiation therapy, John’s battle was far from over. His PSA (Prostate-Specific Antigen) levels, an indicator of prostate cancer activity, were not dropping sufficiently, signalling that the fight was only getting tougher. It was then that John was introduced to a groundbreaking treatment: Lutetium-177 PSMA therapy (LuPSMA), a targeted radionuclide therapy with pinpoint accuracy to attack cancer cells. This innovative treatment offered a glimmer of hope, a chance to strike at the heart of the disease that had disrupted his life. But there was a catch – the cost. Each round of LuPSMA treatment costs $10,000, and while some patients may require up to eight rounds, John’s doctors recommended two based on his response. Even so, the financial burden was immense, forcing John to dip into his superannuation, ultimately spending $60,000 on the treatment that was not covered by insurance. Despite the financial strain, the results were nothing short of miraculous. After just the first round, John’s PSA levels dropped by a staggering 95%. After the second, they fell to nearly zero. The treatment had not only attacked the cancer but had also restored his quality of life, allowing him to once again enjoy the simple pleasures – time with family, daily activities and even golf. It was a victory that brought renewed hope and confidence for the future, a victory that made the $60,000 investment worth every cent. “My case was remarkably successful after the second treatment, which are eight weeks apart, after the scan had no cancer, and my PSA was effective to zero. So it was a reliable result for me and a huge boost, but unfortunately, they're $10,000 a time, and you can require up to eight treatments,” says John. “Fortunately we were able to fund it from our superannuation pension account, the $20,000, but I imagine that a lot of people, they can’t find that $20,000.” But John’s story, while inspiring, also highlights a grim reality: many Australians are not as fortunate. The LuPSMA treatment that worked so well for John remains out of reach for many others due to its prohibitive cost. And this isn’t just an isolated issue; it’s a systemic problem affecting thousands of men across the country. A new report, the <a href="https://www.pcfa.org.au/media/nbennwom/aus-np-1123-80001-amgen-access-gap-report_april-2024-data-final-approved.pdf" target="_blank" rel="noopener">Australian Patient Access Gap Report</a>, has shed light on the alarming delay in the public availability of new medicines in Australia. The report reveals that Australians with life-threatening illnesses are waiting an average of 591 days – more than 18 months – for access to new, potentially life-saving medicines. For some, the wait can be as long as three years. These delays are not just statistics; they represent real people, real lives hanging in the balance. The Prostate Cancer Foundation of Australia (PCFA), the country’s leading organisation in the fight against prostate cancer, is calling for urgent reform. They argue that the current system, which often requires multiple rounds of review before new treatments are approved for public use, is failing Australians. PCFA CEO Anne Savage points out that while 10 men die from prostate cancer every day, the approval process for new treatments drags on, leaving patients like John Boland to fend for themselves – often at great financial and emotional cost. “In almost every instance, Australians are being denied access to new medicines that can extend and save their lives, simply because our approval systems have not kept up with the pace of change,” she says. “In relation to prostate cancer, applications typically undergo two or three rounds of review before achieving a positive recommendation, while 10 men die a day from the disease. It’s simply not good enough.” John’s story serves as a strong call to action. His successful treatment with LuPSMA is a testament to the power of modern medicine, but it also underscores the urgent need for change. No one should have to choose between their life savings and their life; it’s time for Australia to modernise its pharmaceutical benefits scheme, ensuring that all Australians, regardless of their financial situation, have access to the treatments they need. As we move forward, the PCFA is urging Australians to take part in initiatives like <a href="https://www.thelongrun.org.au/" target="_blank" rel="noopener">The Long Run</a> during Prostate Cancer Awareness Month in September, raising awareness and funds to support the fight against this devastating disease. For John Boland, and for the thousands of others who share his struggle, we must work towards a future where no one is left behind in the fight against cancer. Image: Courtesy of John Boland.

Caring

What happens in my brain when I get a migraine? And what medications can I use to treat it?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/mark-slee-1343982">Mark Slee</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> and <a href="https://theconversation.com/profiles/anthony-khoo-1525617">Anthony Khoo</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> Migraine is many things, but one thing it’s not is “just a headache”. “Migraine” <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1029040/">comes from</a> the Greek word “hemicrania”, referring to the common experience of migraine being predominantly one-sided. Some people experience an “aura” preceding the headache phase – usually a visual or sensory experience that evolves over five to 60 minutes. Auras can also involve other domains such as language, smell and limb function. Migraine is a disease with a <a href="https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(18)30322-3/fulltext">huge personal and societal impact</a>. Most people cannot function at their usual level during a migraine, and anticipation of the next attack can affect productivity, relationships and a person’s mental health. <h2>What’s happening in my brain?</h2> The biological basis of migraine is complex, and varies according to the phase of the migraine. Put simply: The earliest phase is called the prodrome. This is associated with activation of a part of the brain called the hypothalamus which is thought to contribute to many symptoms such as nausea, changes in appetite and blurred vision. <figure class="align-center "><img src="https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=485&fit=crop&dpr=1 600w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=485&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=485&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=610&fit=crop&dpr=1 754w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=610&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=610&fit=crop&dpr=3 2262w" alt="" /><figcaption>The hypothalamus is shown here in red. <a class="source" href="https://www.shutterstock.com/image-vector/brain-cross-section-showing-basal-ganglia-329843930">Blamb/Shutterstock</a></figcaption></figure> Next is the aura phase, when a wave of neurochemical changes occur across the surface of the brain (the cortex) at a rate of 3–4 millimetres per minute. This explains how usually a person’s aura progresses over time. People often experience sensory disturbances such as flashes of light or tingling in their face or hands. In the headache phase, the trigeminal nerve system is activated. This gives sensation to one side of the face, head and upper neck, leading to release of proteins such as CGRP (calcitonin gene-related peptide). This causes inflammation and dilation of blood vessels, which is the basis for the severe throbbing pain associated with the headache. Finally, the postdromal phase occurs after the headache resolves and commonly involves changes in mood and energy. <h2>What can you do about the acute attack?</h2> A useful way to conceive of <a href="https://www.migraine.org.au/factsheets">migraine treatment</a> is to compare putting out campfires with bushfires. Medications are much more successful when applied at the earliest opportunity (the campfire). When the attack is fully evolved (into a bushfire), medications have a much more modest effect. <iframe id="Pj1sC" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/Pj1sC/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> Aspirin For people with mild migraine, non-specific anti-inflammatory medications such as high-dose aspirin, or standard dose non-steroidal medications (NSAIDS) can be very helpful. Their effectiveness is often enhanced with the use of an anti-nausea medication. Triptans For moderate to severe attacks, the mainstay of treatment is a class of medications called “<a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1678146819/Factsheet_15_2023.pdf?1678146819">triptans</a>”. These act by reducing blood vessel dilation and reducing the release of inflammatory chemicals. Triptans vary by their route of administration (tablets, wafers, injections, nasal sprays) and by their time to onset and duration of action. The choice of a triptan depends on many factors including whether nausea and vomiting is prominent (consider a dissolving wafer or an injection) or patient tolerability (consider choosing one with a slower onset and offset of action). As triptans constrict blood vessels, they should be used with caution (or not used) in patients with known heart disease or previous stroke. Gepants Some medications that block or modulate the release of CGRP, which are used for migraine prevention (which we’ll discuss in more detail below), also have evidence of benefit in treating the acute attack. This class of medication is known as the “gepants”. Gepants come in the form of injectable proteins (monoclonal antibodies, used for migraine prevention) or as oral medication (for example, rimegepant) for the acute attack when a person has not responded adequately to previous trials of several triptans or is intolerant of them. They do not cause blood vessel constriction and can be used in patients with heart disease or previous stroke. Ditans Another class of medication, the “ditans” (for example, lasmiditan) have been approved overseas for the acute treatment of migraine. Ditans work through changing a form of serotonin receptor involved in the brain chemical changes associated with the acute attack. However, neither the gepants nor the ditans are available through the Pharmaceutical Benefits Scheme (PBS) for the acute attack, so users must pay out-of-pocket, at a <a href="https://www.migraine.org.au/cgrp#:%7E:text=While%20the%20price%20of%20Nurtec,%2D%24300%20per%208%20wafers.">cost</a> of approximately A$300 for eight wafers. <h2>What about preventing migraines?</h2> The first step is to see if <a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1677043428/Factsheet_5_2023.pdf?1677043428">lifestyle changes</a> can reduce migraine frequency. This can include improving sleep habits, routine meal schedules, regular exercise, limiting caffeine intake and avoiding triggers such as stress or alcohol. Despite these efforts, many people continue to have frequent migraines that can’t be managed by acute therapies alone. The choice of when to start preventive treatment varies for each person and how inclined they are to taking regular medication. Those who suffer disabling symptoms or experience more than a few migraines a month <a href="https://www.nejm.org/doi/full/10.1056/NEJMra1915327">benefit the most</a> from starting preventives. Almost all migraine <a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1708566656/Factsheet_16_2024.pdf?1708566656">preventives</a> have existing roles in treating other medical conditions, and the physician would commonly recommend drugs that can also help manage any pre-existing conditions. First-line preventives include: <ul> <li>tablets that lower blood pressure (candesartan, metoprolol, propranolol)</li> <li>antidepressants (amitriptyline, venlafaxine)</li> <li>anticonvulsants (sodium valproate, topiramate).</li> </ul> Some people have none of these other conditions and can safely start medications for migraine prophylaxis alone. For all migraine preventives, a key principle is starting at a low dose and increasing gradually. This approach makes them more tolerable and it’s often several weeks or months until an effective dose (usually 2- to 3-times the starting dose) is reached. It is rare for noticeable benefits to be seen immediately, but with time these drugs <a href="https://pubmed.ncbi.nlm.nih.gov/26252585/">typically reduce</a> migraine frequency by 50% or more. <hr /> <iframe id="jxajY" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/jxajY/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> <h2>‘Nothing works for me!’</h2> In people who didn’t see any effect of (or couldn’t tolerate) first-line preventives, new medications have been available on the PBS since 2020. These medications <a href="https://pubmed.ncbi.nlm.nih.gov/8388188/">block</a> the action of CGRP. The most common PBS-listed <a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1708566656/Factsheet_16_2024.pdf?1708566656">anti-CGRP medications</a> are injectable proteins called monoclonal antibodies (for example, galcanezumab and fremanezumab), and are self-administered by monthly injections. These drugs have quickly become a game-changer for those with intractable migraines. The convenience of these injectables contrast with botulinum toxin injections (also <a href="https://www.migraine.org.au/botox">effective</a> and PBS-listed for chronic migraine) which must be administered by a trained specialist. Up to half of adolescents and one-third of young adults are <a href="https://deepblue.lib.umich.edu/bitstream/handle/2027.42/147205/jan13818.pdf">needle-phobic</a>. If this includes you, tablet-form CGRP antagonists for migraine prevention are hopefully not far away. Data over the past five years <a href="https://pubmed.ncbi.nlm.nih.gov/36718044/">suggest</a> anti-CGRP medications are safe, effective and at least as well tolerated as traditional preventives. Nonetheless, these are used only after a number of cheaper and more readily available <a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1677043425/Factsheet_2_2023.pdf?1677043425">first-line treatments</a> (all which have decades of safety data) have failed, and this also a criterion for their use under the PBS.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/227559/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/mark-slee-1343982">Mark Slee</a>, Associate Professor, Clinical Academic Neurologist, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> and <a href="https://theconversation.com/profiles/anthony-khoo-1525617">Anthony Khoo</a>, Lecturer, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-in-my-brain-when-i-get-a-migraine-and-what-medications-can-i-use-to-treat-it-227559">original article</a>. </div>

Body

Mysterious leg pain that’s quietly killing older Australians

Peripheral Artery Disease (PAD) has long been overshadowed by its more widely recognised counterparts, such as heart attacks and strokes. Often referred to as the “poor cousin” or “Cinderella” of cardiovascular diseases, PAD affects one in five older Australians, yet it remains largely under-diagnosed and misunderstood. However, a wave of optimism is sweeping through the medical community with the launch of <a href="https://www.hri.org.au/our-research/centreforpad" target="_blank" rel="noopener">The Centre for Peripheral Artery Disease</a>, an Australian-first facility dedicated to pioneering research and improving patient outcomes. Spearheaded by the Heart Research Institute, the Centre for Peripheral Artery Disease, marks a significant step forward in addressing the challenges posed by PAD. The centre aims to fill critical gaps in our understanding of the disease, which is responsible for a limb amputation in Australia every two hours. This initiative promises to enhance diagnosis, transform patient care, and raise awareness about PAD. Associate Professor Mary Kavurma, the Centre Lead, is at the forefront of this ground-breaking effort. “We’re supercharging research into PAD because there are still many unknowns about the disease’s biology that could unlock new methods for early detection and better management,” she explains. This research is particularly urgent given the prevalence of PAD among women and First Nations Australians, groups that remain disproportionately affected by this condition. The centre’s mission is to develop a simple blood test for early diagnosis and explore novel therapies that could reduce the need for limb amputations and significantly improve patients’ quality of life. Unlike current treatments that primarily focus on symptom management, this new approach seeks to prevent the disease from progressing. One of the most inspiring aspects of the centre is its commitment to involving patients and their families in the research process. At the inaugural consumer meeting, nearly 20 patients and their carers shared their personal experiences with PAD. Take the story of Simon Josephson, a renowned advertising guru – who famously designed the Solo logo. PAD almost cost him his life after taking more than five years to diagnose. He woke up one morning with a sore leg, thinking he’d overdone it exercising but the 73-year-old – who was otherwise healthy and active – unknowingly had Peripheral Artery Disease, caused by a build-up of plaque in his arteries causing them to narrow and stiffen. It wasn’t until a trip to the hospital emergency department years later that doctors would discover his aorta had expanded to more than twice the usual size and was at risk of rupturing. He immediately underwent open heart surgery and has faced a lengthy recovery. The launch of <a href="https://www.hri.org.au/our-research/centreforpad" target="_blank" rel="noopener">The Centre for Peripheral Artery Disease</a> heralds a new era of hope and progress in the fight against PAD. Through world-leading research, community engagement, and a commitment to patient-centred care, the CPAD is poised to make a profound impact on the lives of many Australians. As Assoc Prof Kavurma aptly put it, “By understanding more about this debilitating condition, we are paving the way for better health outcomes and a brighter future for all those affected by PAD.” Images: CPAD

Caring

Taking too many medications can pose health risks. Here’s how to avoid them

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/caroline-sirois-1524891">Caroline Sirois</a>, <a href="https://theconversation.com/institutions/universite-laval-1407">Université Laval</a> When we see an older family member handling a bulky box of medications sorted by day of the week, we might stop and wonder, is it too much? How do all those pills interact? The fact is, as we get older we are more likely to develop different chronic illnesses that require us to take several different medications. This is known as polypharmacy. The concept applies to people taking five or more medications, but there are all sorts of <a href="https://doi.org/10.3390/pharmacy7030126">definitions with different thresholds</a> (for example, four, 10 or 15 medicines). I’m a pharmacist and pharmacoepidemiologist interested in polypharmacy and its impact on the population. The research I carry out with my team at the Faculty of Pharmacy at Université Laval focuses on the appropriate use of medication by older family members. We have published this <a href="https://doi.org/10.1093/ageing/afac244">study</a> on the perceptions of older adults, family carers and clinicians on the use of medication among persons over 65. <h2>Polypharmacy among older adults</h2> Polypharmacy is very common among older adults. In 2021, a quarter of persons over 65 in Canada were prescribed <a href="https://www.cihi.ca/en/drug-use-among-seniors-in-canada">more than ten different classes of medication</a>. In Québec, persons over 65 used an average of <a href="https://www.inspq.qc.ca/sites/default/files/publications/2679_portrait_polypharmacie_aines_quebecois.pdf">8.7 different drugs in 2016</a>, the latest year available for statistics. Is it a good idea to take so many drugs? According to <a href="https://journals.sagepub.com/doi/10.1177/07334648211069553">our study</a>, the vast majority of seniors and family caregivers would be willing to stop taking one or more medications if the doctor said it was possible, even though most are satisfied with their treatments, <a href="https://doi.org/10.1093/ageing/afac244">have confidence in their doctors</a> and feel that their doctors are taking care of them to the best of their ability. In the majority of cases, medicine prescribers are helping the person they are treating. Medications have a positive impact on health and are essential in many cases. But while the treatment of individual illnesses is often adequate, the whole package can sometimes become problematic. <h2>The risks of polypharmacy: 5 points to consider</h2> When we evaluate cases of polypharmacy, we find that the quality of treatment is often compromised when many medications are being taken. <ol> <li> Drug interactions: polypharmacy increases the risk of drugs interacting, which can lead to undesirable effects or reduce the effectiveness of treatments. </li> <li> A drug that has a positive effect on one illness may have a negative effect on another: what should you do if someone has both illnesses? </li> <li> The greater the number of drugs taken, the greater the risk of undesirable effects: for adults over 65, for example, there is an increased risk of confusion or falls, which have significant consequences. </li> <li> The more medications a person takes, the more likely they are to take a <a href="https://www.doi.org/10.1093/fampra/cmz060">potentially inappropriate medication</a>. For seniors, these drugs generally carry more risks than benefits. For example, benzodiazepines, medicine for anxiety or sleep, are the <a href="https://www.inspq.qc.ca/sites/default/files/publications/2575_utilisation_medicaments_potentiellement_inappropries_aines.pdf">most frequently used class</a> of medications. We want to reduce their use as much as possible <a href="https://www.canada.ca/en/health-canada/services/substance-use/controlled-illegal-drugs/benzodiazepines.html">to avoid negative impacts</a> such as confusion and increased risk of falls and car accidents, not to mention the risk of dependence and death. </li> <li> Finally, polypharmacy is associated with various adverse health effects, such as an <a href="https://www.doi.org/10.1007/s41999-021-00479-3">increase in frailty, hospital admissions and emergency room visits</a>. However, studies conducted to date have not always succeeded in isolating the effects specific to polypharmacy. As polypharmacy is more common among people with multiple illnesses, these illnesses may also contribute to the observed risks. </li> </ol> Polypharmacy is also a combination of medicines. There are almost as many as there are people. The risks of these different combinations can vary. For example, the risks associated with a combination of five potentially inappropriate drugs would certainly be different from those associated with blood pressure medication and vitamin supplements. Polypharmacy is therefore complex. <a href="https://doi.org/10.1186/s12911-021-01583-x">Our studies attempt to use artificial intelligence</a> to manage this complexity and identify combinations associated with negative impacts. There is still a lot to learn about polypharmacy and its impact on health. <h2>3 tips to avoid the risks associated with polypharmacy</h2> What can we do as a patient, or as a caregiver? <ol> <li> Ask questions: when you or someone close to you is prescribed a new treatment, be curious. What are the benefits of the medication? What are the possible side effects? Does this fit in with my treatment goals and values? How long should this treatment last? Are there any circumstances in which discontinuing it should be considered ? </li> <li> Keep your medicines up to date: make sure they are all still useful. Are there still any benefits to taking them? Are there any side effects? Are there any drug interactions? Would another treatment be better? Should the dose be reduced? </li> <li> Think about de-prescribing: this is an increasingly common clinical practice that involves stopping or reducing the dose of an inappropriate drug after consulting a health-care professional. It is a shared decision-making process that involves the patient, their family and health-care professionals. The <a href="https://www.deprescribingnetwork.ca">Canadian Medication Appropriateness and Deprescribing Network</a> is a world leader in this practice. It has compiled a number of tools for patients and clinicians. You can find them on their website and subscribe to the newsletter. </li> </ol> <h2>Benefits should outweigh the risks</h2> Medications are very useful for staying healthy. It’s not uncommon for us to have to take more medications as we age, but this shouldn’t be seen as a foregone conclusion. Every medication we take must have direct or future benefits that outweigh the risks associated with them. As with many other issues, when it comes to polypharmacy, the saying, “everything in moderation,” frequently applies.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/230612/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/caroline-sirois-1524891">Caroline Sirois</a>, Professor in Pharmacy, <a href="https://theconversation.com/institutions/universite-laval-1407">Université Laval</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/taking-too-many-medications-can-pose-health-risks-heres-how-to-avoid-them-230612">original article</a>. </div>

Body

Shopping centre locked down after violent altercation

Two teenage boys have been arrested after a violent altercation broke out in South Australia's largest shopping centre. On Sunday afternoon, three boys allegedly confronted another group of teens at the Westfield Marion centre’s food court armed with “expandable batons”, with reports one of the boys was also armed with a knife. The violent altercation triggered Westfield’s emergency lockdown and evacuation procedures, with alarms blaring throughout the centre and major storefronts locking their doors to keep shoppers safe. Heavily armed specialist police officers stormed the centre in search of the teens, but they were unable to be found. Following hours of investigating, two boys, aged 15 and 16, were found, arrested and charged with assault, affray and aggravated robbery. The two teens will appear in the Adelaide Youth Court on Monday afternoon, and police continue to search for any outstanding suspects. Assistant Commissioner Duval said police knew the identity of a third offender, and encouraged him to turn himself in. “His identity is known, and at some point we will catch up with him,” he told Today. Duval said police believe the boys knew each other and it was "not a random attack". He also confirmed that police had seized two expandable batons from the teens, explaining, "It's a baton that effectively expands, not dissimilar to what police would use." "Certainly the possession of them is very concerning, that formed part of the allegation of what these boys were charged with." Following the incident, a spokesperson for Westfield issued a statement saying the safety of customers, business partners and people is their "highest priority". Image credits: Nine News

Legal

Miss World Australia attacked outside shopping centre

Miss World Australia has taken aim at the lack of police response after she called Triple Zero for urgent assistance when she was attacked. Jasmine Stringer was running a workshop with a group of aspiring young pageant contestants at a Gold Coast shopping centre on Friday night, when a woman lunged towards the group in a random attack. "This person was hurling abuse at the young girls and then charged at me from across the road and punched me straight in the face," Jasmine told <a href="https://9now.nine.com.au/today/miss-world-australia-and-children-attacked-during-gold-coast-shopping-centre-event/cf15799c-99e7-45ee-b143-519bcff1114f" target="_blank" rel="noopener">Today</a>. "I fended her off and then she turned her sights to a 14-year-old girl." While doing her best to protect herself and the young girls, Jasmine called Triple Zero for assistance. As the young girls fled from the scene, Jasmine waited for police - or members of the public - to help, and was met with no response. "I guess the most concerning part of this whole story for me is that I called Triple Zero, we are in the Southport CBD of the Gold Coast, less than three kilometres from the police station and in a 15-minute time frame when women and children are being assaulted, there was no one turning up to help," the 27-year-old said. "I stayed there for 20 minutes on the call with the dispatcher and I was starting to get stressed, this woman was still physically attacking these children as they're trying to get into cars and taxis and it was escalating and I asked 'is someone coming?' and they were quite dismissive to me." As part of her Miss World Australia advocacy work, Jasmine has devoted a lot of time and effort into preventing violence against women, and says this attack is the second time within a month that she's called for help from police after witnessing a violent incident and there's been nobody there to help. 'I'm going to go to the police station today just make sure that the report is made and hopefully have the person who attacked us charged," she said. "But at this point in time, I've received no follow up from the police and it's been a really distressing situation." Image credits: Today

Legal

Shannon Noll postpones show due to medical emergency

Shannon Noll has been forced to postpone two of his upcoming shows in Victoria due to a medical emergency. The former Australian Idol winner, 48, took to Instagram to announce that he had to undergo an "emergency procedure" although the exact details of the procedure was kept under wraps. "Hi guys, due to unforeseen circumstances I'm afraid I have to postpone this weekend's shows at Thornbury Theatre and West Gippsland Arts Centre," he began on the post shared on Friday. "I'm so sorry to do this but I had to undergo an emergency procedure yesterday that now prevents me from travelling for the next few days. "Huge apologies again everyone but I look forward to seeing you all at the rescheduled shows soon!" he concluded. Fans took to the comments to wish the star a speedy recovery. "Health comes first, wishing you a speedy recovery," one wrote. "Hope you are back to good health quickly Shannon. All the very best," another added. "Health is the absolute priority - we hope that you’re back fit and fighting very soon!" a third commented. "Get well soon Shannon! Take the time you need to recover," added a fourth. It has been 20 years since the singer rose to fame after becoming a runner-up on the first season of Australian Idol. "To still be a professional musician travelling the country and playing music 20 years later after a singing competition, I'm so thankful and blessed," he told 9Honey. "And it's all because of the support the Australian public has given me over the years, during the ups and downs as well." "It's all because of the public. I'm thankful to them and will be forever," he added. Image: Getty

Caring

Asking ChatGPT a health-related question? Better keep it simple

It’s tempting to <a href="https://cosmosmagazine.com/news/chatgpt-and-dr-google/">turn to search engines</a> to seek out health information, but with the rise of large language models, like ChatGPT, people are becoming more and more likely to depend on AI for answers too. <div class="copy"> Concerningly, an Australian study has now found that the more evidence given to <a href="https://cosmosmagazine.com/technology/chatgpt-an-intimate-companion/">ChatGPT</a> when asked a health-related question, the less reliable it becomes. Large language models (LLM) and artificial intelligence use in health care is still developing, creating a a critical gap when providing incorrect answers can have serious consequences for people’s health. To address this, scientists from Australia’s national science agency, CSIRO, and the University of Queensland (UQ) explored a hypothetical scenario: an average person asking ChatGPT if ‘X’ treatment has a positive effect on condition ‘Y’. They presented ChatGPT with 100 questions sourced from the <a href="https://trec-health-misinfo.github.io/" target="_blank" rel="noopener">TREC Health Misinformation track</a> – ranging from ‘Can zinc help treat the common cold?’ to ‘Will drinking vinegar dissolve a stuck fish bone?’ Because queries to search engines are typically shorter, while prompts to a LLM can be far longer, they posed the questions in 2 different formats: the first as a simple question and the second as a question biased with supporting or contrary evidence. By comparing ChatGPT’s response to the known correct response based on existing medical knowledge, they found that ChatGPT was 80% accurate at giving accurate answers in a question-only format. However, when given an evidence-biased prompt, this accuracy reduced to 63%, which was reduced again to 28% when an “unsure” answer was allowed. “We’re not sure why this happens,” says CSIRO Principal Research Scientist and Associate Professor at UQ, Dr Bevan Koopman, who is co-author of the paper. “But given this occurs whether the evidence given is correct or not, perhaps the evidence adds too much noise, thus lowering accuracy.” Study co-author Guido Zuccon, Director of AI for the Queensland Digital Health Centre at UQ says that major search engines are now integrating LLMs and search technologies in a process called Retrieval Augmented Generation. “We demonstrate that the interaction between the LLM and the search component is still poorly understood, resulting in the generation of inaccurate health information,” says Zuccon. Given the widespread popularity of using LLMs online for answers on people’s health, Koopman adds, we need continued research to inform the public about risks and to help them optimise the accuracy of their answers. “While LLMs have the potential to greatly improve the way people access information, we need more research to understand where they are effective and where they are not.” Image credits: Getty Images <div> <noscript data-spai="1"><img decoding="async" class="aligncenter size-full wp-image-198773" src="https://cdn.shortpixel.ai/spai/q_lossy+ret_img+to_auto/cosmosmagazine.com/wp-content/uploads/2023/12/MICROSCOPIC-TO-TELESCOPIC__Embed-graphic-720x360-1.jpg" data-spai-egr="1" width="600" alt="Buy cosmos print magazine" title="asking chatgpt a health-related question? better keep it simple 2"></noscript> </div>  <img id="cosmos-post-tracker" style="opacity: 0; height: 1px!important; width: 1px!important; border: 0!important; position: absolute!important; z-index: -1!important;" src="https://syndication.cosmosmagazine.com/?id=301406&title=Asking+ChatGPT+a+health-related+question%3F+Better+keep+it+simple" width="1" height="1" loading="lazy" aria-label="Syndication Tracker" data-spai-target="src" data-spai-orig="" data-spai-exclude="nocdn" /><a href="https://cosmosmagazine.com/technology/ai/asking-chatgpt-a-health-related-question-better-keep-it-simple/">This article</a> was originally published on <a href="https://cosmosmagazine.com">Cosmos Magazine</a> and was written by <a href="https://cosmosmagazine.com/contributor/imma-perfetto/">Imma Perfetto</a>. </div>

Caring

Embracing healing: The rise of medical cannabis in Australia

In recent years, Australia has made significant strides in healthcare, particularly in the realm of alternative medicine. One such breakthrough gaining widespread recognition is the availability and utilisation of medical cannabis. <a href="https://www.oversixty.com.au/health/body/how-nurses-are-changing-the-conversation-around-medicinal-cannabis" target="_blank" rel="noopener">As attitudes shift and research unfolds</a>, the once-stigmatised plant is emerging as a source of genuine hope and relief for patients across the country. Medical cannabis, derived from the cannabis plant, contains compounds known as cannabinoids, notably THC (tetrahydrocannabinol) and CBD (cannabidiol), which possess therapeutic properties. While recreational use remains a contentious issue, the medicinal potential of cannabis cannot be overlooked. In Australia, its legal status has evolved; in October 2016 the Australian Government changed the law to allow organisations to grow cannabis for research and to make pharmaceutical products, allowing patients to access cannabis-based products under specific conditions. One of the most significant benefits of medical cannabis is its ability to alleviate symptoms and improve the quality of life for patients suffering from various medical conditions. From chronic pain and epilepsy to nausea induced by chemotherapy, medical cannabis offers relief where traditional treatments can fall short or have significant long-term side effects. For people with debilitating illnesses, this alternative therapy can open doors to a life with reduced discomfort and enhanced well-being. Moreover, the availability of medical cannabis fosters a more patient-centric approach to healthcare. By recognising the diverse needs of individuals and offering alternative treatment options, healthcare professionals empower patients to take control of their health journey. This shift towards personalised medicine acknowledges that what works for one person may not work for another, and cannabis-based treatments provide another tool in the arsenal of healthcare interventions. Australia's embrace of medical cannabis also extends to research and innovation. With an increasing number of clinical trials and studies exploring its efficacy and safety, the medical community is uncovering new insights into the potential applications of cannabis-based therapies. This commitment to scientific inquiry ensures that medical cannabis is integrated into healthcare practices responsibly and ethically. Furthermore, the legalisation of medical cannabis opens doors for economic growth and innovation. Australia's burgeoning cannabis industry has the potential to create jobs, stimulate investment and drive technological advancements in cultivation, processing and distribution. By capitalising on this emerging market, Australia can position itself as a global leader in medical cannabis research and production. Take the example of <a href="https://www.montu.com.au/" target="_blank" rel="noopener">Montu</a>, a Melbourne-based medical cannabis company that in November was <a href="https://www.montu.com.au/_files/ugd/0ee6ca_f78badef1cf64ccba22263ed6b5ea5d0.pdf" target="_blank" rel="noopener">named the fastest-growing tech company</a> in the entire country for the second consecutive year. The groundswell of public and investor support for such a company – whose stated mission is to deploy technology to create a better medical cannabis ecosystem for suppliers, practitioners, pharmacies and the patients they serve – is testament to the rapidly growing popularity of medical cannabis as a viable everyday resource for health and wellbeing. Companies like Montu that are streamlining and regulating access to medical cannabis via a growing network of medical practitioners are playing a vital role in getting help for those who need it most. Even though Montu was only formed in 2019, with its first products entering the market in 2020, the evolution of its company ecosystem has been dramatic to say the least. Now with a diverse range of companies under its umbrella, Montu is using innovative solutions to enhance the patient experience – from their "Leafio" dispensing system bridging the gap between suppliers and pharmacies, to their growing variety of products and brands, to their "Alternaleaf" telehealth service that connects patients with expert clinicians, and their high-end "Saged" professional online learning portal for healthcare professionals, this integrated approach is shaping a future where medical cannabis is accessible, efficient and tailored to meet the diverse needs of patients and healthcare providers alike. Perhaps most importantly of all, the availability of medical cannabis promotes harm reduction by offering a safer alternative to potentially addictive pharmaceutical drugs. For patients struggling with opioid dependence or other addictive substances, cannabis-based treatments provide a non-addictive option for managing symptoms, reducing the risk of substance abuse and overdose. The legalisation of medical cannabis in Australia marked a pivotal moment in the nation's healthcare landscape. With growing recognition of the therapeutic potential of cannabis-derived treatments, Australia has taken decisive steps to ensure that patients in need have access to this alternative therapy. Through rigorous regulation and oversight, the legal framework surrounding medical cannabis balances patient safety with the need for compassionate care, allowing individuals suffering from debilitating conditions to explore new avenues of treatment. This landmark decision not only reflected a shift in societal attitudes towards cannabis but also underscored Australia's commitment to evidence-based medicine and the well-being of its citizens. As attitudes towards cannabis evolve and its medicinal benefits become more widely recognised, Australia stands at the forefront of a healthcare revolution – one of hope, healing and a future where patients can experience relief and improved quality of life. Image: Getty

Caring

New details on man killed by snake at childcare centre

A childcare centre in Queensland, where father-of-three suffered a <a href="https://www.oversixty.com.au/health/caring/dad-dies-after-being-bitten-by-deadly-snake-in-child-care-centre" target="_blank" rel="noopener">fatal snake bite</a>, is under investigation by workplace safety officials. Jerromy Brookes, 47, was bitten multiple times on his arm while attempting to remove a snake from the premises on Tuesday afternoon. He was not a qualified snake catcher, and tragically passed away in Townsville Hospital after going into cardiac arrest at his home in Deeragun. “Workplace Health and Safety Queensland (WHSQ) is investigating an incident that occurred at a business in Townsville,” a spokesperson told 7News. “As this is a current investigation, WHSQ is not able to provide further information at this time.” WHSQ has the power to prosecute allegations of workplace safety breaches. Brooke is survived by his wife and three children. His wife was the person who called emergency services and provided first aid when Brookes began showing symptoms at home. A family friend has paid tribute to the fallen father saying: “Jerromy was helping remove a snake from another childcare centre in Townsville when the incident occurred." “He was doing his very best to keep the children safe.” It was believed that Brookes was trying to remove an eastern brown snake, one of the deadliest in the world, however the species has not been officially confirmed. Police are reportedly not investigating the incident as a criminal matter, but are working to provide a report for the coroner. Images: Facebook

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Attempts to access Kate Middleton’s medical records are no surprise. Such breaches are all too common

<a href="https://theconversation.com/profiles/bruce-baer-arnold-1408">Bruce Baer Arnold</a>, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> The <a href="https://www.abc.net.au/news/2024-03-20/claim-hospital-staff-tried-to-access-kate-middleton-health-info/103608066">alleged</a> data breach involving Catherine, Princess of Wales tells us something about health privacy. If hospital staff can apparently access a future queen’s medical records without authorisation, it can happen to you. Indeed it may have already happened to you, given many breaches of health data go under the radar. Here’s why breaches of health data keep on happening. <h2>What did we learn this week?</h2> Details of the alleged data breaches, by <a href="https://www.mirror.co.uk/news/royals/breaking-kate-middleton-three-london-32401247">up to three staff</a> at The London Clinic, emerged in the UK media this week. These breaches are alleged to have occurred after the princess had abdominal surgery at the private hospital earlier this year. The UK Information Commissioner’s Office <a href="https://ico.org.uk/about-the-ico/media-centre/news-and-blogs/2024/03/ico-statement-in-response-to-reports-of-data-breach-at-the-london-clinic/">is investigating</a>. Its report should provide some clarity about what medical data was improperly accessed, in what form and by whom. But it is unlikely to identify whether this data was given to a third party, such as a media organisation. <h2>Health data isn’t always as secure as we’d hope</h2> Medical records are inherently sensitive, providing insights about individuals and often about biological relatives. In an ideal world, only the “right people” would have access to these records. These are people who “need to know” that information and are aware of the responsibility of accessing it. Best practice digital health systems typically try to restrict overall access to databases through hack-resistant firewalls. They also try to limit access to specific types of data through grades of access. This means a hospital accountant, nurse or cleaner does not get to see everything. Such systems also incorporate blocks or alarms where there is potential abuse, such as unauthorised copying. But in practice each health records ecosystem – in GP and specialist suites, pathology labs, research labs, hospitals – is less robust, often with fewer safeguards and weaker supervision. <h2>This has happened before</h2> Large health-care providers and insurers, including major hospitals or chains of hospitals, have a <a href="https://www.theguardian.com/australia-news/2023/dec/22/st-vincents-health-australia-hack-cyberattack-data-stolen-hospital-aged-care-what-to-do">worrying</a> <a href="https://www.afr.com/technology/medical-information-leaked-in-nsw-health-hack-20210608-p57z7k">history</a> of <a href="https://www.innovationaus.com/oaic-takes-pathology-company-to-court-over-data-breach/">digital breaches</a>. Those breaches include hackers accessing the records of millions of people. The <a href="https://www.theguardian.com/world/2022/nov/11/medical-data-hacked-from-10m-australians-begins-to-appear-on-dark-web">Medibank</a> data breach involved more than ten million people. The <a href="https://www.hipaajournal.com/healthcare-data-breach-statistics/">Anthem</a> data breach in the United States involved more than 78 million people. Hospitals and clinics have also had breaches specific to a particular individual. Many of those breaches involved unauthorised sighting (and often copying) of hardcopy or digital files, for example by nurses, clinicians and administrative staff. For instance, this has happened to public figures such as <a href="https://www.latimes.com/archives/la-xpm-2008-mar-15-me-britney15-story.html">singer</a> <a href="https://journals.lww.com/healthcaremanagerjournal/abstract/2009/01000/health_information_privacy__why_trust_matters.11.aspx">Britney Spears</a>, actor <a href="https://www.nytimes.com/2007/10/10/nyregion/10clooney.html">George Clooney</a> and former United Kingdom prime minister <a href="https://www.theguardian.com/uk-news/2024/mar/20/when-fame-and-medical-privacy-clash-kate-and-other-crises-of-confidentiality">Gordon Brown</a>. Indeed, the Princess of Wales has had her medical privacy breached before, in 2012, while in hospital pregnant with her first child. This was no high-tech hacking of health data. Hoax callers from an Australian radio station <a href="https://theconversation.com/did-2day-fm-break-the-law-and-does-it-matter-11250">tricked</a> hospital staff into divulging details over the phone of the then Duchess of Cambridge’s health care. <h2>Tip of the iceberg</h2> Some unauthorised access to medical information goes undetected or is indeed undetectable unless there is an employment dispute or media involvement. Some is identified by colleagues. Records about your health might have been improperly sighted by someone in the health system. But you are rarely in a position to evaluate the data management of a clinic, hospital, health department or pathology lab. So we have to trust people do the right thing. <h2>How could we improve things?</h2> Health professions have long emphasised the need to protect these records. For instance, medical ethics bodies <a href="https://www.bmj.com/content/350/bmj.h2255">condemn</a> medical students who <a href="https://www.abc.net.au/news/2014-04-14/picture-sharing-app-for-doctors-raises-privacy-concerns/5389226">share</a> intimate or otherwise inappropriate images of patients. Different countries have various approaches to protecting who has access to medical records and under what circumstances. In Australia, for instance, we have a mix of complex and inconsistent laws that vary across jurisdictions, some covering privacy in general, others specific to health data. There isn’t one comprehensive law and set of standards <a href="https://theconversation.com/governments-privacy-review-has-some-strong-recommendations-now-we-really-need-action-200079">vigorously administered</a> by one well-resourced watchdog. In Australia, it’s mandatory to report <a href="https://www.oaic.gov.au/privacy/notifiable-data-breaches">data breaches</a>, including breaches of health data. This reporting system is currently <a href="https://theconversation.com/governments-privacy-review-has-some-strong-recommendations-now-we-really-need-action-200079">being updated</a>. But this won’t necessarily prevent data breaches. Instead, we need to incentivise Australian organisations to improve how they handle sensitive health data. The best policy <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1475-4932.12693">nudges</a> involve increasing penalties for breaches. This is so organisations act as responsible custodians rather than negligent owners of health data. We also need to step-up enforcement of data breaches and make it easier for victims to sue for breaches of privacy – princesses and tradies alike.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226303/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/bruce-baer-arnold-1408">Bruce Baer Arnold</a>, Associate Professor, School of Law, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/attempts-to-access-kate-middletons-medical-records-are-no-surprise-such-breaches-are-all-too-common-226303">original article</a>. Images: Getty

Legal

Dad dies after being bitten by deadly snake in child care centre

A beloved father has passed away after reportedly trying to remove an eastern brown snake from a child care centre in North Queensland. Jeremy Brookes attended the child care centre on Tuesday afternoon after one of his relatives reportedly called him over to remove the snake, according to The Courier Mail. Brookes was not a qualified snake handler and was bitten multiple times on his hand and arm. According to Queensland Ambulance Service acting district director Paula Marten, Brookes then managed to drive to his Deeragun home but he soon went into cardiac arrest. HIs wife performed CPR until paramedics arrived and he was rushed to hospital, but unfortunately could not be saved. “(He) was found to be in cardiac arrest by our crews,” Marten said. “The call was made by the patient’s wife, who then commenced CPR as the patient went into cardiac arrest. “The information provided to us was that the gentleman had been bitten in a different location and attended back to his residence, where his wife has immobilised his arm and wrapped it, when the onset of the symptoms occurred.” She added that snake bites were common in North Queensland and they were rarely fatal, but advised that if "you’re not aware of snakes, treat them as if they are venomous." “It’s really important that you stay calm and keep the person calm. “Apply basic first aid, which would be immobilisation and using compression bandages, and contact triple-0. “If you are unsure about what first aid measures to take, call triple-0, and they will walk you through what you need to do for the patient.” Eastern Brown Snakes are one of the most deadly snakes in the world, with the second most toxic venom. They can be found across the east of Australia including the Northern Territory, Queensland, South Australia, Victoria, NSW and the ACT. Brookes is believed to be the first person to have died from a snake bite in Australia this year. Last year, two people died from suspected eastern brown snake bites in Australia. Images: Facebook/ news.com.au

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Dad dies after being bitten by deadly snake in child care centre

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