Genicular Artery Embolisation (GAE) has emerged as a novel, minimally invasive treatment for symptomatic mild-to-moderate osteoarthritis of the knee and post-arthroplasty knee pain, and may provide immediate and long-lasting pain relief with improvement in patient function.

Osteoarthritis is a common disease and a major cause of morbidity. It has a rising incidence and prevalence, with data from the 2019 Global Burden of Disease Study1 showing the number of osteoarthritis cases in Australasia has increased by 116% in the last three decades, from an estimated 1.76 million cases in 1990 to 3.8 million cases in 2019, with the knee being the most commonly affected site. 

The most recent Australian National Health Survey (2017-18)2 estimates 3.6 million Australians are affected by arthritis, representing 15% of the total population, the majority of which are likely to be osteoarthritis, the most common form of arthritis. 

Treatment for knee osteoarthritis largely depends on disease severity. Treatment for mild and moderate osteoarthritis aims to reduce further joint injury through lifestyle and risk factor modification, involving physiotherapy and muscle strengthening exercise, weight loss, and pharmacologic therapy with paracetamol and topical or oral non-steroidal anti-inflammatory medications for analgesic effect. 

Inage by Tom Magliery

Gun Control

Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.”
National Rifle Association tweet of 8 November 2018 

This tweet by the NRA from almost four years ago riled many American doctors involved in trauma care. It was made in response to the  American College of Physicians policy statement, Reducing Firearm Injuries and Deaths in the United States which deemed gun violence a "public health crisis" that "requires the nation's immediate attention."

It gave rise to the hashtag #ThisIsOurLane which sought amongst other things to end the 1996 Dicky amendment prohibiting the Centers for Disease Control and Prevention (CDC) from funding research into gun control. Similar research on automotive deaths and cigarette consumption had previously led to changes in public opinion, the law and ultimately reduced premature deaths. 

The Australian gun law reform that resulted from the Port Arthur Massacre of 1996 is frequently cited as a successful demonstration of what can be achieved. It has contributed to the three fold decline in gun deaths from the early nineties.

“I’m not going to waste my shot
It’s time to take a shot”
Hamilton, an American musical

In April 2020 Dr Anthony Fauci, an internationally renowned immunologist and an adviser (somewhat reluctantly) to President Donald Trump as the lead of the White House Coronavirus Task Force, said in an interview before The Economic Club of Washington D.C. ‘What keeps me up at night is the emergence of a brand new infection, likely jumping species from an animal; that's respiratory born, highly transmissible, with a high degree of morbidity and mortality. And, lo and behold, that's where we are right now.’

To date the USA has had over 86 million cases of confirmed SARS-CoV-2 infections and a million Americans have died from the disease (in Australia around 50 people are still dying of the disease weekly). The country’s death rate was the second highest worldwide, only slightly behind the leader, Brazil. Such a result seems incredible for the country with the most advanced health systems in the world, although access to high quality care is restricted and depends on being able to afford expensive treatments. It is far from universally accessible. 

American author, Michael Lewis, looked at the first year of the American covid epidemic in his book, The Premonition - A Pandemic story. He describes how the American approach to pandemic planning evolved under the George W Bush administration arising out of the Biodefense Directorate of the Homeland Security Council in 2005. 

Grafton's first two patients to complete same day joint replacement

There have always been demands for efficiency in health care and this only seems to increase. Year after year, the Australian health budget grows by a greater percentage than GDP and this is not sustainable. The COVID-19 pandemic has further increased the need for efficient delivery of medical services. Local disasters like the steriliser breakdown in Grafton or the terrible floods in Lismore and surrounds further blow our surgical waiting lists out. 

I have been in Northern NSW for a bit over 10 years but it wouldn’t be a surprise if waiting lists for elective surgery in the public system are as bad now as they have ever been. That also has flow on effects for the provision of care in the private system, where especially in Victoria, significant private capacity has been used for the provision of public elective surgery.

There is clear impetus for change here. As clinicians though, improvements to our models of care ideally arise in a patient focused manner with the motivation being to do the best we can for the patient in front of us. In many cases that will also result in more efficient health care. Day-only total joint replacement is an exciting example where patient centered concerns align with a benefit at the health resource level.

This is not ground-breaking stuff. It is self-evident that, all other things being equal, it is both a better patient experience and more cost effective if a patient recovers from (say) pneumonia more rapidly rather than more slowly. So why, aside from a few isolated pockets of ERAS (enhanced recovery after surgery) programs, aren't we seeing more of a concerted effort to have people recover more rapidly after surgery?

Voting in Australia

Australia is well known around the world for its compulsory voting system and the system is the envy of some countries. But who misses out when it comes to a voice say in the upcoming Australian Federal Government election? And what is the fine for not voting?

If you receive an 'apparent failure to vote' notice, you can: provide a valid and sufficient reason for not voting. tell us that you did vote and provide details. pay a fine of 1 penalty unit at the time of the offence ($137.00) or half this amount ($68.50) if paid before the deadline. 

But if one doesn’t enrol for voting in the first place then there is no fine. And some purposely don’t enrol, no doubt for many reasons, including not trusting the system to represent them etc. Some may just find the process too hard because of lack of access to the internet or not knowing how.