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Morrison government promises $1.25 billion for health care

With health perennially a challenging election issue for the
Coalition, Scott Morrison has announced $1.25 billion extra funding he
says will provide more doctors, nurses and services.

Under a new Community Health and Hospitals Program, the federal
government will partner with communities, states and territories,
health and hospital services and research institutions to supply
funding in four areas. They are:

  • specialist hospital services such as cancer treatment, rural health
    and hospital infrastructure

  • drug and alcohol treatment

  • preventive, primary and chronic disease management

  • mental health

The funding is over the forward estimates period. The government has
not announced offsetting savings, but Monday’s budget update will show
strong revenue flows, enabling substantial money for a range of initiatives between now and the election as well as a healthy surplus next financial year.

The health program was unveiled as the federal, state and territories
meet in Adelaide on Wednesday for the Council of Australian
Governments with health one of the items on the agenda. Morrison dined
with first ministers on Tuesday night.

Morrison linked the extra funding to a strong economy, which “gives us
the ability to continue our record investment in Medicare, hospitals,
new medicines and new treatments.”

The new program would complement the government’s record investment in
public hospitals, he said.

“Our funding for public hospitals will more than double from $13.3
billion in 2012-13 to $28.7 billion in 2024-25”, he said.

“Our new five year National Health Reform Agreement will deliver more
than $30 billion in additional public hospital funding from 2020-21 to
2024-25, taking overall funding during this period to $130.2 billion”.

Three Liberal states and three Labor jurisdictions have signed on to
the new agreement.

But the Labor states of Victoria and Queensland are in dispute with
the federal government over money for hospitals. At issue is more than $600 million that has been withheld by the Commonwealth for services said not to have been delivered.

These two states have also not signed the national school reform agreement.

COAG will also discuss drought and security issues. The Commonwealth
will urge that state governments pay their bills to small business
within 20 days – they are expected to agree.

One key issue at COAG will be population. Ahead of setting next year’s
immigration cap – which Morrison earlier flagged will be lower than the previous 190,000 cap, that hasn’t been reached – the federal government is asking the states and territories for input.

Morrison has asked states and territories to provide by January 31 details about:

  • population carrying capacity with regional breakdowns, based on
    infrastructure and services provision

  • projected population growth

  • the contribution of the Commonwealth’s migration programme to
    population growth, broken down into temporary and permanent migration,
    and by visa class – skilled, family and humanitarian

  • skills that businesses will need over the next 15 years, broken
    down by region

  • plans for employment, housing, services, infrastructure and social
    cohesion, over the next five, 10 and 15 years

Business groups have warned against cutting immigration.

NSW premier Gladys Berejiklian, who faces an election in March, has advocated a big cut in the number of immigrants to NSW, saying recently “It’s time to tap the brakes and take a breather on immigration levels to this state. We should return to Howard-era immigration levels in NSW”.

Article source:

Vision and eye health in children | Learning article

Development of the visual system begins prenatally and continues after birth. However, owing to how personal and subjective a person’s sight is, children may not realise they have a vision problem. Sight problems in infants can cause developmental delays, therefore, early detection and management are essential in ensuring children have the opportunity to develop the visual abilities they need to learn. Pharmacists and healthcare professionals should be aware of the stages of vision development, as well as common eye conditions that present in childhood, in order to best support, advise and refer patients when necessary.

Stages of vision development

Infancy (birth to 3 years)

A baby’s vision improves rapidly over the first few months of their life[1], with the ability to judge distance (depth perception) developing at around five months of age. By two years of age, a child’s hand-eye coordination and depth perception should be well developed[1].

Preschool (age 3–5 years)

Development of accommodative facility (ability of the eye/s to focus on stimuli at various distances and in different sequences in a given period of time), vergence ability (movement of both eyes in opposite directions to obtain or maintain single binocular vision) and eye movements continues until the child is around five years of age. Toys, games and playtime activities help this by stimulating the process of vision development. Children should have a thorough, in-person optometric eye examination at 3–5 years of age to ensure that their vision is developing properly and there is no evidence of eye disease before they begin school.

School age (age 6–18 years)

Vision changes can occur without a child or parent noticing them. To reduce the risk of this happening, children aged 6–18 years should receive an eye examination every two years, or more frequently if specific problems or risk factors exist or if recommended by an ophthalmologist[2]. The most common vision problem is nearsightedness (myopia); however, some children have other forms of refractive error, such as farsightedness and astigmatism. Problems with eye focusing (the ability to quickly and accurately maintain clear vision as the distance from objects changes), tracking (the ability to keep the eyes on target when looking from one object to another) and coordination may affect school and sports performance (see Box 1)[3].

Common eye conditions

Refractive errors

Myopia (nearsightedness) occurs when the eyeball is too long, relative to the focusing power of the cornea and lens of the eye. This causes light to focus at a point in front of the retina, rather than directly on its surface. Myopia generally develops in children during their early school years and increases in severity as they get older. The age at onset is typically 7–16 years. Children may complain of headaches or need to sit closer to the whiteboard at school if they are struggling to read it.

Hyperopia or hypermetropia (farsightedness) is when people can see distant objects very well, but have difficulty focusing on objects that are up close. Children may experience headaches and squint in order to see more clearly, and may experience difficulty reading.

Astigmatism results in blurred vision for both near and far objects because light fails to come to a single focus on the retina. Instead, multiple focus points occur in front of the retina or behind the retina, or both. Astigmatism up to 2.00 dioptres (a unit of measurement of the optical power of a lens or curved mirror; D) is common in children aged under three years. Studies show that 30–50% of infants aged under 12 months have astigmatism (≥1.00D), which declines over the first few years of life, and becomes stable by around 2.5–3 years of age. An individual with astigmatism will usually also be nearsighted or farsighted[4]. Children may experience headaches, tired eyes and blurred vision[4].

Anisometropia is where the two eyes have significantly different refractive powers. Anisometropia of ≥1.00D is considered clinically significant. There is a low prevalence (4%) of anisometropia in children aged under six years; however, it has been shown to increase to nearly 6% at 12–15 years of age[5],[6].

Refractive errors can easily be corrected with glasses or contact lenses. Parents with children who are complaining of these symptoms should be referred to an optometrist for assessment and treatment.


Squint, or strabismus, is a common condition affecting around 2.1% of the population[7]. Although strabismus can develop at any age, it usually develops during childhood. Infantile esotropia (an inward turning of one or both eyes; see Figure 1) has an onset prior to six months of age. Accommodative esotropia typically has an onset of 2–3 years of age, but can develop before 6 months of age. Young children with constant unilateral strabismus (where the misalignment always affects the same eye) often develop amblyopia and impaired stereopsis (impaired depth perception). Early identification and treatment may prevent amblyopia (lazy eye) and preserve stereopsis. Treatment options include patching (wearing an eye patch over the stronger eye), glasses and surgery to correct the muscle around the eye.

Child with a squint

Figure 1: Strabismus

Source: Dr P. Marazzi / Science Photo Library

Infantile estropia, an inward turning of one or both eyes, has an onset prior to six months of age.


Also known as lazy eye, amblyopia is a vision development disorder where an eye fails to achieve normal visual acuity, even with prescription glasses or contact lenses[8]. The prevalence of amblyopia is estimated at 1 in 50 children[9]. Although it is a treatable condition in both children and adults, the potential for successful treatment is better when it is diagnosed and treated early, generally during the infantile and preschool years when the visual system demonstrates greatest plasticity[8]. Treatment includes patching, which may be required for several hours each day or even all day, and may continue for weeks or months. Patches often need to be worn with glasses[9].

Infective conjunctivitis

Redness and inflammation of the conjunctiva (the thin layer of tissue that covers the front of the eye) is indicative of the common condition conjunctivitis[10]. It can be caused by viruses (e.g. common cold) or, less often, by bacteria (most commonly staphylococcal or streptococcal bacteria). Viral conjunctivitis tends to cause a watery, red eye and can last for 2–3 weeks, whereas bacterial conjunctivitis is more likely to cause a red eye with a sticky yellow discharge (see Figure 2). Conjunctivitis can affect one eye or both eyes[9], is often self-limiting and can be managed through self-care (see Box 2); however, some parents may notice that their child has a cold, sore throat or feels unwell at the same time.

Child with conjunctivitis cr Dr P. Marazzi  SPL 18

Figure 2: Bacterial conjunctivitis

Source: Dr P. Marazzi / Science Photo Library

Conjunctivitis is a common condition that causes redness and inflammation of the conjunctiva, and can be either viral or bacterial in nature.

Box 2: Self-care for infective conjunctivitis

Pharmacists and healthcare professionals should advise parents of the following to help them manage their child’s infective conjunctivitis:

  • Gently clean away any sticky discharge from the eyelids and lashes using cotton wool soaked in cooled, boiled water;
  • Remove contact lenses — if the patient wears contact lenses, advise them to take them out and refrain from wearing any contact lenses until all symptoms of the infection have gone. Patients must not re-use old lenses, even after the infection has gone, as they could be a potential source of reinfection; instead, used lenses should be discarded and new lenses, solutions and cases used after an infection;
  • Use lubricant eye drops — these are available over-the-counter and may help ease any soreness and stickiness in the eyes. Patients should always follow the manufacturer’s instructions;
  • Wash hands regularly — viral and bacterial conjunctivitis are contagious and can spread very easily.

If symptoms have not cleared up after two weeks, patients should be referred to their GP.

Source: NHS Inform. Conjunctivitis. 2018. Available at: (accessed December 2018)

Patients may require antibiotics for bacterial conjunctivitis that is particularly severe (or has lasted for longer than two weeks). Chloramphenicol eye drops are usually the first-line treatment and are available without a prescription, but need to be used as per the patient information leaflet to get the best results. If chloramphenicol is not suitable, fusidic acid eye drops may be prescribed. This is often better for children as they do not need to be taken as frequently.

Babies up to one month of age with red eyes, swollen eyelids and a watery or sticky discharge from the eyes may have ophthalmia neonatorum. This is a severe infection that occurs in babies who are exposed to a sexually transmitted infection when passing through the birth canal. As this can lead to permanent eye damage, babies who display these symptoms must be referred to an eye specialist immediately for treatment[11].

Allergic eye disease

Children with allergic eye disease tend to have symptoms of sneezing, congestion and a runny nose, as well as itchy, red or watery eyes and swollen eyelids (see Figure 3). The pattern of symptoms will depend on the cause, for example patients allergic to grass will experience symptoms during the spring and summer, whereas those allergic to animal fur will have symptoms throughout the year. Children with mild symptoms can be managed with self-care advice (see Box 3).

Child with an alllergy causing a swollen eye

Figure 3: Allergic eye disease

Source: Dr P. Marazzi / Science Photo Library

Symptoms of allergic eye disease often include sneezing, congestion and a runny nose, swollen eyelids and itchy, red or watery eyes.

If the allergy symptoms are relatively severe, or if over-the-counter eye drops are ineffective at providing relief, patients should be referred to their GP.


A rare type of eye cancer, retinoblastoma, can affect young children (usually under five years of age)[12]. If diagnosed early, retinoblastoma can often be successfully treated; children treated for retinoblastoma who are diagnosed at an early stage have a survival rate of more than 95%[13].

This disease can either affect one or both eyes. If it affects both eyes, it is usually diagnosed before the child is aged one year. If it affects one eye, it tends to be diagnosed later, usually at 2–3 years of age.

Signs and symptoms of retinoblastoma include[13]:

  • A squint;
  • A change in the colour of the iris — in one eye or sometimes only in one area of the eye;
  • A red or inflamed eye, even if the child does not complain of any pain;
  • Poor vision — a child may not focus on faces or objects, or they may not be able to control their eye movements (this is more common when both eyes are affected); they may say that they cannot see as well as they used to;
  • An unusual white reflection in the pupil — this may be apparent in photos where only the healthy eye appears red from the flash, or it may be noticed in a dark or artificially lit room (see Figure 4).

Child with retinoblastoma

Figure 4: Retinoblastoma


Retinoblastoma may be noticed as a ‘white eye glow’, either in photographs or in an artificially lit room.

In accordance with the National Institute for Health and Care Excellence guideline ‘Suspected cancer: recognition and referral’, children with an absent red reflex should receive an urgent referral to an ophthalmologist (for an appointment within two weeks) for retinoblastoma[14].

Role of the pharmacist

Most babies begin life with healthy eyes and will develop their visual abilities without difficulty. However, eye health and vision problems can occasionally develop and may be difficult to notice. Pharmacists and healthcare professionals can advise patients and dispel common misconceptions around children’s vision, such as that children can only have their sight tested once they can read or that the child’s school or nursery will arrange their sight examination. They can also help advise parents on ‘red flags’ for eye and vision problems in their children. These include:

  • Excessive tearing — this may indicate blocked tear ducts;
  • Red or encrusted eye lids — this could be a sign of an eye infection;
  • Constant eye turning — this may signal a problem with eye muscle control;
  • Extreme sensitivity to light — this may indicate an elevated pressure in the eye;
  • Appearance of a white pupil — this may indicate the presence of a retinoblastoma.

If babies or children have any of these symptoms, they should be referred immediately to their GP, paediatrician or optometrist.

Article source:

Associations between sex work laws and sex workers’ health: A systematic review and meta-analysis of quantitative and qualitative studies


49,97,99,104,106,111,112,118,119,122,125,127,128]. This took the form of arbitrary arrest and detention, verbal harassment, intimidation, humiliating and derogatory treatment, extortion, forcible displacement, physical violence, gang rape, and other forms of sexual violence during raids and in police custody [49,97,99,103,104,106,111,112,118,122,127,128]. In Kenya, Mexico, Nepal, Pakistan, Serbia, Sri Lanka, and the US, sex workers experienced extortion (unofficial ‘fines’, payments, or bribes) or provided sexual services enforced through physical or sexual violence or under threat of detention, arrest, transfer to rehabilitation centres, or forced registration (Quotes 10 and 11) [49,101,103,110,119,122,128–130], with limited or no opportunity to negotiate condom use [128]. Similar extortion and/or arbitrary fines were reported in China, India, Thailand, and Turkey (Quote 12) [99,107,110,125]. In Nepal, cis female sex workers, including those hired as peer educators, reported being arrested, beaten, and robbed by police upon being found in possession of condoms [106].

Reporting violence could result in sex workers’ being further criminalised [49,97,120–122,127,128]. Sex workers were reluctant to report violence and theft to the police [98,125] for fear of the following: arrest for prostitution-related activities, unrelated petty offences, or non-payment of previous fines [97,98,116,120,124,131]; being accused of crimes they had not committed [49,103]; harsh treatment or moral judgement [97,120]; further extortion or violence [35,101,112]; disclosure in court [97]; prohibitive costs [112]; or because no action would be taken to address the crime [97,111,112,114,116]. Long-standing discrimination, and the sense that police viewed them as criminals, made sex workers doubt the police would take complaints seriously [114,115,128]. When reports were submitted to police, sex workers’ accounts were dismissed as implausible, with police simultaneously blaming sex workers for the violence they had experienced [49,120,125], discrediting them as victims (Quote 13) [97,103,121,127,128], and sometimes further attacking or extorting them [49]. Cis and trans women in Canada and the US reported police questioning whether it is possible for a sex worker to be raped [97,128]. (Quote 14). Similarly, in Kenya, one cis woman reported being asked by an officer ‘how a prostitute like me could be raped as I was used to all sizes’, discouraging her from going to the police in future: ‘Never will I again go to report a case’ [127]. This produces an environment of impunity, where further violence, extortion, and theft from police and others operate unchecked [98,103,120,121,125,127], perceived to be a major contributor in normalising violence against sex workers [26,125].

34,114]. While some cis and trans women in Canada felt that police were now more concerned for their safety [26,114], others felt that officers continued to view them as ‘trash’, blame them for the violence they experienced, and deprioritise their safety [97], despite laws and police guidelines constructing them as victims [26]. In contexts of regulation, registered sex workers in Guatemala viewed their health cards (recording compliance with mandatory testing) as protective against police and immigration harassment [126,132], and registered sex workers in Mexico had better access to police protection but rarely reported violence [35]. In Senegal, registered workers still experienced being disbelieved when reporting physical or economic violence to police and so were reluctant to report it as a result (Quote 16) [105]. Concerns about being exposed to family and friends were paramount [35,105] and deterred some from registering [126]. Relationships with police were precarious, conditional on maintaining registered status, which can vary each month depending on compliance with mandatory screening requirements—with those whose registration has (temporarily) lapsed facing arrest, detention, and/or fines (Quote 17) [35,126]. Those who were not registered were afraid they would be sent to jail or fined for working illegally, or for active drug use [35], and were more heavily targeted by police for fines, arrest, detention, extortion, and sometimes sexual violence [35,101,124]. In India, marked reductions in police raids and violence were achieved through a peer-based intervention that facilitated access to justice and challenged power relations between sex workers and police, although some officers cited lengthy procedures to dissuade reporting [99]. In Canada, Mexico, Thailand, and the US, some sex workers described certain officers’ concern for their safety and support, but such concern was the exception [35,97,103,125].

36,95,96] and more deserving of respect (Quote 18) [36]. The removal of threat of arrest—which reduced police power and afforded sex workers rights—gave sex workers, and particularly young people [95], greater confidence to report violent incidents, exploitation by managers, and disputes with clients [36,96]. However, some officers treated disputes with clients as breaches of contract rather than crimes [96]. While there were still some reports of abuses of police power, there were also examples of offending officers being prosecuted as a result, helping to challenge environments of impunity [36,94,96].

Article source:

Is laziness in YOUR DNA?

Is laziness in YOUR DNA? How much time you spend sitting, sleeping and moving is partly determined by your genes, find scientists

  • Researchers found 14 genes which appear directly linked to activity levels
  • They say DNA could have some influence over how much exercise people do
  • Understanding inactivity could reveal links to heart disease and brain problems 

Sam Blanchard Health Reporter For Mailonline

It can be difficult to think of good excuses to avoid the gym – but now you can blame it on your DNA.

Scientists who analysed data of more than 90,000 people now say genetics could be partly to blame for your laziness. 

Seven genes have been newly linked to physical inactivity by researchers at Oxford University, who compared the DNA and activity levels of people in Britain.

They say the links don’t let people off the hook for skipping the gym, but could go towards a better understanding of fitness, sleep and health problems.

Oxford University researchers used data from activity monitors on the wrists of more than 91,000 participants to create an accurate picture of how active they are in day-to-day life and compared this with their DNA to see if there was a link between genetics and activity (pictured: an example of one participant's activity)

Oxford University researchers used data from activity monitors on the wrists of more than 91,000 participants to create an accurate picture of how active they are in day-to-day life and compared this with their DNA to see if there was a link between genetics and activity (pictured: an example of one participant’s activity)

The researchers measured the time sent sitting, sleeping and moving around using activity monitors worn on the wrists of people who also gave their DNA.

Comparing the two allowed them to develop an accurate picture of how active the 91,105 people were in their day-to-day lives. 

They found 14 genes – sections of DNA which instruct the body to act in a certain way – which appeared directly linked to how physically active someone was.

Half the genes had never been seen to act this way before by scientists.

And studying the DNA could offer new insight into, for example, whether genes make people obese and therefore inactive, or inactive which then leads to obesity.

‘How and why we move isn’t all about genes,’ said Dr Aiden Doherty, who led the study.

‘But understanding the role genes play will help improve our understanding of the causes and consequences of physical inactivity.’


Four in ten British women are putting their health at risk by failing to do enough exercise, a major report revealed in September.

The UK is 123rd out of 168 countries in a league table of physical activity, with 36 per cent of British adults failing to hit exercise targets. That compares to the global average of 27 per cent.

Forty per cent of women and 32 per cent of men in the UK fail to do enough physical activity to stay healthy, according to the World Health Organisation.  

Experts fear a growing crisis in inactive lifestyles is putting millions of Britons at risk of cancer, diabetes and heart disease. 

Steven Ward, of the UK Active organisation, said: ‘These figures are a damning indictment of our nation’s health, with the UK lagging behind much of the rest of the world for activity levels. 

‘Physical inactivity is the cause of 37,000 premature deaths in the UK each year and costs our economy an estimated £20billion. This should be seen as a national disgrace.’ 

Physical inactivity is a growing public health problem because people’s sedentary lifestyles increase the risk of obesity, type 2 diabetes, heart disease and cancer.

Recent Sport England data has shown only around one in six English children do the hour-a-day of exercise recommended by the NHS.

And 40 per cent of British women don’t do enough exercise to keep themselves healthy, according to the World Health Organization. Similar figures exist for men.

While in the US, some studies have estimated that only a fifth of adults are doing the recommended amount of exercise each day. 

Health officials advise that adults take part in 150 minutes of moderate aerobic activity each week, such as cycling, or 75 minutes of vigorous activity, such as running. 

This should be bolstered with strength exercises on at least two days a week, in attempt to keep all the major muscles healthy.  

As well as its direct health effects, being inactive can also stop people sleeping properly, increasing their risk of psychiatric disorders and heart problems.

The study also revealed an overlap between physical activity genes and those which have links to neurodegenerative diseases, such as Alzheimer’s disease.

Professor Michael Holmes added: ‘This provides scientists with a wonderful opportunity to learn much more about how genes and environment interact in our daily lives, causing us to move as we do, and possibly putting us at increased risk of disease.

‘For instance, it might help us determine whether inactivity is a cause or a consequence of obesity.’

The research used data from the UK Biobank, a collection of data from half a million people across the country to be used by health researchers.

To test how accurately they were recording activity, 200 of the participants wore body cameras for two days, to be studied alongside the wrist-worn monitors. 

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What is an appropriate level of evidence for a digital health intervention?

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70 years of human rights in global health: drawing on a contentious past to secure a hopeful future

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North Metro Health inquiry avoids probing redundancy payouts

A further probe into the North Metropolitan Health Service contracts bribery scandal is holding off on investigating why three crooked executives were given six-figure redundancies in the lead-up to a damning Corruption and Crime Commission report.

In a recent letter to the Australian Medical Association, Premier Mark McGowan said the circumstances behind the approval of the redundancies were not being investigated as part of the inquiry’s terms of reference at this stage “for legal reasons”.

Senior executives John Fullerton and David Mulligan walked away from their positions with a total of $440,396 in 2016, while Shaun Ensor took a $163,506 redundancy payout in June.

Two months later the CCC report, which found the men had accepted bribes of travel, hospitality and cash, was released.

The payouts have raised eyebrows and were in the inquiry’s terms of reference because Health Department chiefs knew about the CCC investigation before signing off on the redundancies.

But a State Government spokeswoman said the payouts were being pursued by the State Solicitor’s Office in the hope of recovering the money and there was no need to duplicate the SSO’s work at the moment.

AMA president Omar Khorshid said he was surprised by the decision not to look into the payouts and was disappointed that the Government’s follow-up inquiry to the CCC expose was “too narrow”.

“If we really want a system that delivers better value for money, good patient outcomes and has staff that do the right thing, then you have to look at organisational culture and accountability,” Dr Khorshid said. “We need to get rid of the bad eggs. Some have been recognised, but it’s difficult to get rid of them and hold them to account.”

The CCC found evidence of systemic rorting by the executives who were wined and dined in return for lucrative NMHS contracts.

Mr Fullerton even had extensive renovations to his house paid for by the taxpayer using a bogus invoicing system involving the NMHS.

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Opinion: Healthiest diets include meat and dairy, say health professionals

We have read the opinion article titled “Health Canada’s new Food Guide is on the right track” (Calgary Herald, Nov. 27) with interest. We represent a growing number of Canadian physicians and health professionals, called the Canadian Clinicians for Therapeutic Nutrition, who use whole-food nutritional strategies, which often include meat, eggs and dairy, to prevent and often put into remission the burden of chronic non-communicable disease in our patients. This usually involves lower levels of carbohydrates and higher levels of natural fats than is currently recommended, a therapeutic nutritional strategy well supported in the literature.

We wholeheartedly agree with ensuring the food industry is not involved in creating new guidelines, but we do not believe the evidence supports a global, population-level switch to a plant-based diet. In fact, a comprehensive review of the scientific evidence for a plant-based diet published this year concluded that the current evidence is insufficient to conclude that a plant-based diet is generally healthy, and expressed concerns related to specific subgroups of the population. We believe that Canadians should be encouraged to maintain nutritious, whole food animal-based products such as meat and cardio-protective full-fat dairy in their diet if they choose, not because of any impact on the meat industry’s profits, but because animal products have always been a cornerstone of a healthy diet for humans. To our knowledge, there is no record of a population eating a “plant-based diet” in the history of human evolution; humans evolved eating meat and eggs and eventually, dairy.

A Food Guide directive encouraging a plant-based way of eating may have unintended, but not unforeseen, consequences. Nutrient requirements must continue to be met, and plant-based diets must be carefully constructed to include supplementation of the nutrients that are difficult and/or impossible to obtain when excluding meat products, such as B12, absorbable iron, zinc and long-chain omega 3 polyunsaturated fats. The potential negative effect of phytoestrogens on children is also a serious concern. The authors mentioned a reduced incidence of cancer. In fact, while some studies found that although the overall incidence of cancer was reduced, the incidence of some cancers is actually increased in an exclusively plant-based diet, as are some other diseases. More scientific study is needed before it would be safe to suggest a plant-based diet for the entire Canadian population.

Advocating for a reduction of sugar and processed food and a focus on whole foods are positions we strongly agree with, and we applaud Health Canada for making those suggestions. However, the proposed focus on a plant-based approach lacks sound scientific support. Several dietary patterns have been shown to improve people’s health, when compared to a western diet, including Mediterranean, Paleo, low fat/DASH, low carbohydrate/healthy fat, and whole foods plant-based/vegan. There are no scientific studies that show plant-based diets to be superior to these other dietary patterns, a fact not discussed by the authors of this opinion piece.

If Health Canada concentrated their message to Canadians to highlight the commonalities of these diets, which is the elimination of processed foods, Canadians would experience health benefits related to improved food quality with less sugar, refined flours and nutritionally deplete industrial foods, regardless of whether they choose to include animal products or not. Canadians deserve to be informed of all scientifically equal choices so they can tailor an individual dietary strategy based on dietary preferences, philosophical or religious beliefs, and metabolic health. Health Canada should help them choose and implement one of these equivalent dietary options, and should not overstate the evidence for one diet because it agrees with the personal views of a small number of Canadians, even if those Canadians predominate the guideline planning and discussion groups. Imposing the views of a small minority of Canadians on the whole population without sound scientific reason would be irresponsible, and potentially harmful.

Barbra Allen Bradshaw, MD FRCPC, anatomical pathologist, Abbotsford Regional Hospital and Cancer Care Centre, Abbotsford, B.C.; associate professor at UBC department of pathology and co-founder of Canadian Clinicians for Therapeutic Nutrition.

Carol Loffelmann, MD FRCPC­, Toronto anesthesiologist and co-founder of Canadian Clinicians for Therapeutic Nutrition.

Andrew Samis, BSc(Hon) MSc MD PhD FCCP FRCSC FACS, trauma team, RACE team and cardiac surgery intensivist KHSC, intensivist, general surgeon, physician stroke champion QHC; investigating coroner, Kingston area; assistant professor, department of surgery, Queen’s University, Kingston, Ont.

Eliana Witchell, MSc (Applied Human Nutrition), RD, founder/CEO of Eat ;Different RD, private practice RD, Toronto.

Jasmin Levallois-Gignac, MD FRCPC, nephrologist, Moncton, N.B.

Jay Wortman, BSc MD CCFP, family physician, assistant clinical professor, UBC, West Vancouver.

Èvelyne Bourdua-Roy, MD CCFP, family physician, Contrecoeur, QC, director, Clinique Reversa.

Miriam Berchuk, MD FRCPC, anesthesiologist, Rockyview General Hospital, Calgary.




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Top 10 workplace safety articles in 2018 — Safety+Health magazine, published by the National Safety Council

The National Safety Council eliminates preventable deaths at work, in homes and communities, and on the road through leadership, research, education and advocacy.

Learn more about the NSC mission.

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Healthcare technology markets: 5 predictions for 2019

Our work with healthcare enterprises indicates that health systems are investing in specific programs such as telehealth and remote monitoring. While these initiatives gather momentum, other digital health programs are struggling to emerge from pilot deployment and also face competing priorities for discretionary budgets.

Electronic health record (EHR) systems continue to consume a large chunk of enterprise IT budgets in health systems. Despite the growth of digital health solutions, EHR platforms, despite their well-known lack of user-friendliness, continue to be the default choice for health systems looking to improve patient engagement and caregiver enablement in the short term.

CIOs of health systems will face a trade-off between traditional EHR systems and emerging digital health technologies; ease of integration and deployment on the one hand, superior experience design and advanced analytical capabilities on the other.

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At this time, digital is a game of “small numbers,” and most digital health programs will deliver low returns on investment until they gain enterprise-wide adoption. Despite the growth of virtual care models, the reimbursement framework for telehealth is yet to catch up with adoption rates.

AI will make steady progress but will struggle with adoption gaps

The widely reported challenges faced by IBM Watson Health, reported extensively by Stat, reveal how advanced technology solutions often fail to get a grip on the complexities of clinical care.

AI has other problems too. There is a backlash against the vendor community’s “black box” algorithms compounded by the over-hyping and inflated promises resulting from vendors painting everything with an “AI” brush (much as they are doing with the “digital” brush).