The surgeon general of Florida wants to scrap vaccine mandates in the state, including requirements for children to be vaccinated to attend school.
Also, a Eureka Prize win for infectious diseases research for a team that found a single vaccine could protect against both meningococcal B and gonorrhea.
And a call-out for information on GLP-1 prescribing — are they being prescribed to people with no clinical reason to take it?
Preeya Alexander: You've been around for a while, Norman, in a good way…
Norman Swan: Yeah, like 10 minutes, you know.
Preeya Alexander: What's one of the most surprising things you've come across?
Norman Swan: Very early on, I remember reading this research into people who were addicted to heroin, and when they studied these people, they discovered they actually weren't on heroin, they were on something else which wasn't addictive. It was either powder or basically another substance; they'd been sold something by the dealers that wasn't actually heroin.
Preeya Alexander: That they thought was heroin, though?
Norman Swan: That's right. And when they were told that it wasn't heroin, they went into full withdrawal.
Preeya Alexander: Wow!
Norman Swan: The power of the brain. And since then, I've been fascinated by the placebo effect, because they thought they were on heroin.
Preeya Alexander: And the placebo effect is real. Patients often say to me, 'What do you think about me taking this? I'm taking it for my leg pain or my cramping,' and I say there's not much evidence to support it, but I say, look, there's limited harm if you're happy to spend the pennies. And there is some power in placebo.
Norman Swan: It's a lot of power; 40% of the effect of any drug is probably placebo.
Preeya Alexander: So that's one of the things coming up on the Health Report today, we're looking at a study showing how the brain has a map when it comes to pain and where the placebo effect comes in.
Norman Swan: I'm Norman Swan on Gadigal land.
Preeya Alexander: And I'm Preeya Alexander on Wurundjeri land.
Norman Swan: So on the show today we've actually got a bit of a theme going, Preeya, haven't we, where there are conditions which are being under-diagnosed or misdiagnosed and really need to be redefined.
Preeya Alexander: So in the dementia space, lots of people get diagnosed with Alzheimer's, but there's another diagnosis, frontotemporal dementia, and there are calls for the diagnostic criteria to be changed.
Norman Swan: And also young people with complex and unusual mental health issues which are being labelled all sorts of things, but turn out to be autoimmune and treatable with immunotherapy.
So, what have we got in the news?
Preeya Alexander: We're back to the US, interestingly, where yet again there's more developments in the vaccination space, and they're not good ones. So in Florida, the State Surgeon General, Dr Joseph Ladapo, has announced the decision to eliminate all vaccine mandates in the state.
Norman Swan: Yeah, he's got form. God knows how he passed his medical exams. He was anti-mask in Covid, and you could actually call him an anti-vaxxer. As a public health physician, you just wonder what he stands for.
Preeya Alexander: Well, he's undermining public health initiatives, is what it seems like. At the moment there are requirements for schools, just like there are here for people to show vaccination status of their children, and he has described them as immoral intrusions on people's rights and that they hamper a parent's ability to make health decisions for their child.
Now, there's a lot that's been happening, and we've covered a lot with RFK, Covid vaccines, the schedule has been changed, and a lot has happened in the last week where nine former directors of the CDC, the Centres for Disease Control in the US, have published an op ed in the New York Times, and they have said some very significant things about the current health administration and possible dangers.
Norman Swan: And this comes in the light of the Director of the CDC, Susan Monarez, being sacked. Well, first of all RFK sacked her, she refused to go, and then it took the President to sack her because she'd been appointed by Congress, and that was because she refused to follow his directives, particularly in relation to vaccines because they've changed the Vaccine Advisory Committee. I mean, the place is in a mess. And, as you say, a significant number of people have left, a significant number of people have been sacked. They're talking about reorganising, moving prevention to another agency. And the worry is that if there is an outbreak of a new pandemic, America will not be able to cope. But we could suffer from that, because we need countries around the world to identify new organisations that are appearing, so if they appear on our doorstep we'll know what's going on. And America is going to be flying blind if the predictions of these former CDC leaders are right.
Preeya Alexander: The American Medical Association, in response to this decision in Florida, have said that this would undermine decades of public health progress. We need to remember there's robust evidence showing that particularly the childhood vaccination schedule really does protect the individual, it protects other children, it protects staff. And I think a lot of people, Norman, still think, oh well, it's just chicken pox, it's just a viral infection, it's only whooping cough, but a lot of these conditions can be fatal and have significant flow-on effects and negative consequences.
Norman Swan: And we can't be complacent. I mean, in New South Wales a group of people are wanting to have another demonstration crossing the Harbour Bridge. This time it's supposedly under the rubric of against government corruption, but there are sovereign citizens and anti-vaxxers involved there. So the anti-vax movement is still not huge, it's overstated how big it is in Australia, but it's there, and we can't be complacent. When it comes to vaccines there's something to celebrate this week in terms of Australian research.
Preeya Alexander: There is. So the Eureka Awards have come out, and the prize for Infectious Diseases Research has gone to a group who've shown that vaccination against meningococcal B offers cross-protection against gonorrhoea.
Norman Swan: It's the same family of organisms, so it's called Neisseria. So the meningococcal bug is called Neisseria meningitidis, and the gonorrhoea bug is also a part of the Neisseria family, and they cross-react, which is amazing because gonorrhoea is a global infection with huge antibiotic resistance.
Preeya Alexander: And also when it comes to meningococcal B and gonorrhoea, these are two infections that disproportionately impact First Nations people. So this could have very significant public health consequences if there was widespread vaccination against meningococcal B rolled out, but at the moment most of my patients pay for it privately, and only some people can receive a funded vaccine from the government.
Norman Swan: And it leads the advisory committee ATAGI to approve it, and then the government to approve that. And we'll come back to that in a future episode of the Health Report.
Preeya Alexander: We've talked a lot about GLP-1 on the show.
Norman Swan: The Ozempic kind of drugs, Wegovy, Mounjaro, et cetera.
Preeya Alexander: Injectable medications which are used in type 2 diabetes which have also developed a lot of benefit in the weight management space. And we've done several interviews on the Health Report so people can go back and listen to them, but we spoke to Associate Professor Samantha Hocking, an endocrinologist, about the medications' potential side effects, like nausea. We also did a follow-up with Dr Sarah Trobe from the National Eating Disorders Collaboration about the need for people to be screened in any body size for eating disorders before these medications are dispensed.
Norman Swan: And before you go on, we will have links to those interviews in our show notes.
Preeya Alexander: Now, we talk a lot about the benefits of the medications, and I think we must acknowledge that for some people living with overweight or obesity, for people with insulin resistance in diagnoses like polycystic ovarian syndrome, these medications have changed the game for some. However, we are starting to see, and I say 'we' because I'm speaking to colleagues on the ground, and I started to notice some things, and I've spoken to pharmacists, endocrinologists, psychologists, dietitians, people that I work with, about the fact that we're starting to see people with no clear medical indication using these medications.
Norman Swan: Well, they're getting some of it on telehealth consultations…
Preeya Alexander: I think through online telehealth services and probably face to face. And I think this raises the question of how widely is this occurring. Some patients have told me honestly; 'I really appreciate the transparency, Preeya, I knew you weren't going to give it to me, but I'm just letting you know that people have told me that if I just lie about my weight, my height, I can attain it from this particular service.' And I just wonder how widespread it is, if there are other people in the community noticing this, if there are health professionals in any capacity noticing it, and what is the duty of care here? Because I take the role of writing a script and giving someone something quite seriously and doing no harm.
Norman Swan: So what we're talking about here is, well, it could create an eating disorder, you could get a nutritional deficiency, you could go seriously underweight, and you could have muscle wasting. So I mean, there's a whole series of things that could actually be a problem. And there are rare eye side effects, which we've talked about on the show before. No drug is harmless, and these are not harmless drugs.
Preeya Alexander: And if you prescribe these medications…so most clinicians, I think, like me, will offer allied health support, exercise physiology, because people should be doing more resistance training, because you lose muscle mass. A dietitian should be seen because you need to increase your protein intake. A lot of support is required for these patients, and if they're not getting it…and all the harms you've just discussed, but if this is now a tool in the beast of diet culture, which it potentially is, then I think we need to try and prevent harm.
Norman Swan: So we've approached AHPRA, which is the regulatory agency for health practitioners, particularly doctors, but also other practitioners as well, to see what they're doing about it, because it's a major issue in terms of regulation. If it's a concern for you, or you disagree with us, why don't you contact us at healthreport@abc.net.au.