The Contemporary Significance of the Holocaust for Australian Psychiatry.

In this paper we survey briefly the components of the Holocaust directly relevant to the psychiatric profession and identify the main themes of relevance to contemporary psychiatry. The euthanasia program, the persecution of lesbian, gay, bisexual, transgender and intersex (LGBTI) citizens and the complex relationship between the psychiatric profession and Nazi state are the main themes to emerge from this survey. We then compare this period with key themes in the history of Australian psychiatry and link these themes to some of the contemporary ethical challenges the profession faces

Psychiatry, genocide and the National Socialist State: lessons learnt, ignored and forgotten.

The genocide of European Jews perpetrated by the National Socialist (Nazi) regime in Germany and its satellites was a distinctly modern event. The bureaucratised and industrialised nature of the Nazi plan (the Endlösung or Final Solution) is generally considered the defining characteristic of the Nazi regime’s genocide. It placed that particular genocidal endeavour in a modernist context, unparalleled in human history. Prior to the establishment of extermination camps in Poland, the Nazi regime had perpetrated or fomented both sporadic massacres and a militarised program of executions in Eastern Europe, in what has been termed “Holocaust by bullets” (Desbois, 2008). Yet despite the murder of 1.5 million Jews by SS and police mobile killing squads (Einsatzgruppen), the defining symbol of the Holocaust was the industrialised killing centre at Auschwitz-Birkenau. Importantly, the gas chambers of the Reinhard camps (Belzec, Sobibor, and Treblinka II) and Auschwitz-Birkenau did not appear de novo for the purposes of killing Europe’s Jews (Friedlander, 1995). The medical profession, in collusion with Adolf Hitler’s Chancellery (KdF), had developed and refined a large scale, state-financed and well-concealed program of victim selection and mass transportation to dedicated killing centres with effective techniques of gassing and disposal of victims’ remains. The template for the Endlösung evolved as a medical procedure, developed primarily by psychiatrists (Burleigh M, 2002)

The Medical Innovation Bill: Still more harm than good

The Medical Innovation Bill continues its journey through Parliament. On 23 January 2015, it was debated for the final time in the House of Lords and with one final amendment, the House moved to support the Bill, which then moved to the House of Commons on 26 January. It will be debated again on 27 February 2015. The Bill’s purpose is to encourage responsible innovation in medical treatment. Although this goal is laudable, it is argued that the Bill is unnecessary and has the potential to undermine the very cause it aims to advance. More useful for encouraging responsible innovation is the continued education of health-care professionals on how the law already supports practitioners who look to improve care through responsible innovation

An empirical study of tissue banking in Australia: Navigating regulatory and ethical challenges

Collections of tumour samples can be an invaluable resource for medical research. There are, however, numerous ethical and legal challenges associated with tumour banking. While there has been extensive discussion of these issues in the legal and ethical literature, there are few available empirical data in relation to the activities of tumour banks in Australia, their practices around ethically charged issues, and their success in implementing complex regulatory guidelines. The aim of this study was to gain more information about the activities of tumour banks in New South Wales, Australia, with a particular focus on their management of, and attitudes towards, ethical and regulatory issues. A survey of 27 tumour collection and research facilities was conducted using a 55-item questionnaire. There is significant heterogeneity of research methodologies as well as of methods for gaining consent and ensuring donor privacy, and there is general concern among the research community about ethical and regulatory issues related to tumour banking. Heterogeneity of practice and uncertainty about ethical and regulatory requirements is problematic in its potential to hinder research and its potential to generate the space for unethical practice, whether intentional or unintentional. There is a pressing need to address these issues so that tumour banks can be used in the most ethical and efficient way possible

The Role of Personalized Choice in Decision Support: A Randomized Controlled Trial of an Online Decision Aid for Prostate Cancer Screening

Importance Decision support tools can assist people to apply population-based evidence on benefits and harms to individual health decisions. A key question is whether “personalising” choice within decisions aids leads to better decision quality. Objective To assess the effect of personalising the content of a decision aid for prostate cancer screening using the Prostate Specific Antigen (PSA) test. Design Randomized controlled trial. Setting Australia. Participants 1,970 men aged 40–69 years were approached to participate in the trial. Intervention 1,447 men were randomly allocated to either a standard decision aid with a fixed set of five attributes or a personalised decision aid with choice over the inclusion of up to 10 attributes. Outcome Measures To determine whether there was a difference between the two groups in terms of: 1) the emergent opinion (generated by the decision aid) to have a PSA test or not; 2) self-rated decision quality after completing the online decision aid; 3) their intention to undergo screening in the next 12 months. We also wanted to determine whether men in the personalised choice group made use of the extra decision attributes. Results 5% of men in the fixed attribute group scored ‘Have a PSA test’ as the opinion generated by the aid, as compared to 62% of men in the personalised choice group (χ2 = 569.38, 2df, p< 0001). Those men who used the personalised decision aid had slightly higher decision quality (t = 2.157, df = 1444, p = 0.031). The men in the personalised choice group made extensive use of the additional decision attributes. There was no difference between the two groups in terms of their stated intention to undergo screening in the next 12 months. Conclusions Together, these findings suggest that personalised decision support systems could be an important development in shared decision-making and patient-centered care.funded by the National Health and Medical Research Council of Australia under Program Grant number 6633003

Racially-conditional donation: The example of umbilical cord blood

While direction of donated tissue to family members has long been accepted, direction to members of specific racial groups has been opposed, on the basis that it is discriminatory and contrary to the ethos the institution of organ donation seeks to promote. It has, however, recently been proposed that racially conditional donation may provide a useful--and ethically acceptable--way to address the social inequalities and injustices experienced by certain cultural groups. This article examines the ethical, legal and cultural arguments for and against racially conditional donation, concluding that the practice is more likely to undermine the values of equity and justice than to promote them and that it may also lead to other unfavourable personal and social outcomes

Importation of generic hepatitis C therapies: Bridging the price - access gap in high-income countries

The global burden of hepatitis C infection and the emergence of effective therapies An estimated 80-150 million people are infected with hepatitis C infection (HCV) worldwide, with the highest prevalence rates in low- and medium-income countries of Africa and Asia. HCV-related liver disease mortality is estimated to be half a million per annum.1,2 Chronic HCV treatment was interferon-based for two decades, with the addition of ribavirin (RBV),3 pegylated-interferon (PEG-IFN)4 and initial protease inhibitor direct acting antiviral (DAA) therapies (telaprevir, boceprevir)5,6 subsequently providing stepwise improvements in the rate of sustained virological response (SVR). Despite these improvements, interferon-containing HCV therapy uptake remained low in most countries, ranging from <1% to a maximum of 5% of people with chronic HCV initiating therapy each year.7 Fortunately, recent years have seen a revolution in HCV therapeutic development, with the advent of interferon-free DAA therapies, which disrupt replication through inhibition of HCV protease, polymerase and NS5A function.8 Simple (single daily dosing oral regimens), highly tolerable, short-duration (8-24 weeks) regimens with extremely high efficacy (cure rates above 95%) have been developed and registered internationally. Used in various combinations depending on HCV genotypes and previous treatment exposure, these include: sofosbuvir/ledipasvir ,9-11 paritaprevir/ritonavir/ombitasvir/dasabavir/+/-ribavirin ,12-14 sofosbuvir/daclatasvir,15,16 elbasvir/grazoprevir,17,18 and sofosbuvir/velpatasvir. There is clear evidence that HCV cure impacts HCV-related liver disease and hepatocellular carcinoma (HCC) risk.19 Early treatment may have greater benefit. Furthermore, as a result of the high efficacy and tolerance, and ease of delivery of these medications, HCV treatment as prevention is being explored in some countries, particularly treating high prevalence populations, such as people who inject drugs and incarcerated populations.20 The broad implementation of these therapeutic regimens has the potential to dramatically impact HCV-related disease burden globally. Indeed, new HCV treatments have been deemed so important that some (sofosbuvir, daclatasvir) were added to the 2015 WHO Essential Medicines List along with a number of their combinations.NHMRC project grant, App 108067

Racially-conditional donation: The example of umbilical cord blood

While direction of donated tissue to family members has long been accepted, direction to members of specific racial groups has been opposed, on the basis that it is discriminatory and contrary to the ethos the institution of organ donation seeks to promote. It has, however, recently been proposed that racially conditional donation may provide a useful--and ethically acceptable--way to address the social inequalities and injustices experienced by certain cultural groups. This article examines the ethical, legal and cultural arguments for and against racially conditional donation, concluding that the practice is more likely to undermine the values of equity and justice than to promote them and that it may also lead to other unfavourable personal and social outcomes

Case Series of Triathletes with Takotsubo Cardiomyopathy Presenting with Swimming-Induced Pulmonary Edema

OBJECTIVES: To report three cases of triathletes who presented with swimming-induced pulmonary edema (SIPE) following water immersion. They were subsequently diagnosed with Takotsubo cardiomyopathy (TCM). DESIGN: Retrospective case series. METHOD: All cases were recreational athletes competing in mass participation triathlons between June 2018 and 2019. They were initially managed by the event medical team and subsequently at the local tertiary level hospital. Written consent was gained from all the subjects. RESULTS: The three triathletes were aged between 50 and 60 years, two were females, and all presented with acute dyspnoea on exiting the water. Two also presented with chest pain and haemoptysis. A diagnosis of SIPE was suspected by the medical event team on initial presentation of low oxygen saturations and clinical signs of pulmonary oedema. All were transferred to the local emergency department and had signs of pulmonary oedema on chest radiographs. Further investigations led to a diagnosis of TCM with findings of T wave inversion in anterolateral electrocardiogram leads and apical hypokinesia on transthoracic echocardiogram and unobstructed coronary arteries. CONCLUSIONS: This case series presents triathletes diagnosed with SIPE and TCM following the open water swim phase. It is unclear whether the myocardial dysfunction contributed to causation of SIPE or was the result of SIPE. Mass participation race organizers must be prepared that both SIPE and TCM can present in this population. Those presenting with an episode of SIPE require prompt evaluation of their cardiac and pulmonary physiology. Further research is required to ascertain the exact nature of the relationship between TCM and SIPE

Magnetic metamaterial superlens for increased range wireless power transfer.

The ability to wirelessly power electrical devices is becoming of greater urgency as a component of energy conservation and sustainability efforts. Due to health and safety concerns, most wireless power transfer (WPT) schemes utilize very low frequency, quasi-static, magnetic fields; power transfer occurs via magneto-inductive (MI) coupling between conducting loops serving as transmitter and receiver. At the "long range" regime - referring to distances larger than the diameter of the largest loop - WPT efficiency in free space falls off as (1/d)(6); power loss quickly approaches 100% and limits practical implementations of WPT to relatively tight distances between power source and device. A "superlens", however, can concentrate the magnetic near fields of a source. Here, we demonstrate the impact of a magnetic metamaterial (MM) superlens on long-range near-field WPT, quantitatively confirming in simulation and measurement at 13-16 MHz the conditions under which the superlens can enhance power transfer efficiency compared to the lens-less free-space system