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Chapter 1: What is the main topic discussed in this episode?
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Norman, I'm happy to declare that on the weekend, on a Friday night, I quite enjoy a glass of champagne or a gin and tonic.
You're telling me you're a pisspot?
No. No, actually, I've significantly reduced my alcohol intake because of a lot of the stuff that we are now seeing in terms of risks. Bowel cancer, breast cancer, all the rest.
And it used to be thought that there was a safe lower limit or indeed it was a bit health protected. That was a misleading interpretation of the research. And in fact, there's a straight line of risk. Or is there a straight line of risk?
We're going to find out because that is coming up on The Health Report. I'm Priya Alexander on Wurundjeri land.
And I'm Norman Swan on the lands of the Gabrielino, Tongva and Quiche peoples. So guess where that is?
Maybe you should tell people so they're not Googling and they're listening to us.
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Chapter 2: What new findings about alcohol and disease risk are discussed?
They might dissipate over time, but memory loss was one that tended to hang around.
We're now used to the notion of long-term sequelae from viral infections, and there certainly are long-term sequelae from Ebola, but unfortunately in healthcare systems that are barely coping with the day-to-day stuff, much less this.
And I think, you know, we've talked about Ebola. We did a bonus episode on it a while ago, but it does have a very high mortality rate. So for the people who do survive, there appear to be really long-term implications. And yeah, as you say, there's unlikely to be support for those people in the current climate in Congo and Uganda.
Paracetamol is back in the news.
So I think people will remember last year we covered very heavily the announcements made by the Trump administration, which were false. We should be clear talking about leucovorin, which is a generic form of folinic acid for the treatment of autism. They also urged pregnant women not to take paracetamol in pregnancy because they said it increases the risk of autism in the infant.
These are, of course, not backed by research or any robust evidence, but there's a study that has been published or a research letter that's been published in JAMA Network, which has looked at the impact of these statements on people's Google searching. What do they tend to search for after big statements like this are made?
And the results of the study were huge increases, 378% in searches for various of these compounds and also huge searches in terms of intent to buy. In other words, how do you buy these substances? And as a control, they had multivitamins, for example. Was it just a general interest in health products?
topics that caused this increase or was it specific to this and they use multivitamins as a control and in fact the interest in multivitamins online went down during that period didn't go up so a lot of people distracted you would imply there was unreasonable demand problematic
There were more than 4 million additional searches for paracetamol with pregnancy or autism into Google in the two weeks. So they've looked at the two weeks after this press conference occurred. That is just astounding to me, Norman.
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Chapter 3: How can changing drinking habits impact health?
I spoke to AstraZeneca, and they were unable to tell me which other countries were involved. And they implied in my phone conversation with them that it was actually due to the pricing in the PBS. And now AstraZeneca has come out with a statement which essentially confirms that.
This is the only bit you really need to know, but it says the decision to discontinue the Zoladex monthly, the 3.6 milligram implant from Australia's pharmaceutical benefits scheme, the PBS, reflects the way the PBS currently works, which means that the price offered is too low, making it unsustainable to supply the medicine on the PBS.
And the other story we've been following is on assigned benefits. Do you want to remind people what assigned benefits are, Priya?
Yes. So this is when you come and see me, the GP. You assign your Medicare benefit to me. So you say, I'm happy to be bulk billed by the GP. And the federal government had proposed that from the 1st of July, every single time you saw a health professional like your GP, you would need to sign something to actually be bulk billed for the consult. And that needed to be stored for two years.
It could be paper, it could be electronic. And there was a huge amount of concern, particularly for aged care residents, also for Aboriginal health services. And we actually covered this in great detail. And there appears to be a lot of concern and noise and the government has somewhat backtracked. And I kept saying potential, Norman, and alas, maybe I was right.
Yes. So we are told that the federal government is going to do something about this in terms of aged care facilities and Aboriginal community controlled health services and allow things like permanent assignment of benefits so that you don't have to keep on repeating the process. So some success there.
Okay.
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Chapter 4: What role does music volume play in workout intensity?
And also verbal consent will still be available in all settings for 12 months, which, you know, was reintroduced during COVID. It has certainly changed the game and made access easier for bulk billing people via telehealth or in the consulting room. So yeah, let's watch this space.
On ABC Radio National, you're with a health report.
Norman, I declared that I don't mind a champagne or a gin and tonic and you were awfully silent at the start of the show. You didn't declare nothing.
No, I didn't declare nothing because I wasn't asked.
Chapter 5: How accurate are clinical diagnoses of Parkinson's disease?
You know, you're totally obsessed with your own drinking.
But the question is, with everything that you know, do you consume any alcohol?
I do consume alcohol, but actually not that much. I would probably only have maybe a glass or two of wine on a Friday or on a Saturday night. So I probably would only have about four standard drinks a week.
Yeah, there you go. That's probably similar to me unless I have an event. And I think we all are much more aware- Is the event before the alcohol or after the alcohol? It's during, they're usually together. Okay, fine, okay. But I think we're learning more and more about the potential health risks associated with alcohol.
And there's been a big landmark review published in a journal called Addiction, which has looked at alcohol's role in driving a big range of issues.
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Chapter 6: What are the neurological effects experienced by Ebola survivors?
What is the burden of disease that we can attribute to alcohol? And the interesting thing here is that it's not all very black and white and there's as always good and bad. And I spoke to Professor Juergen Rehm, who is Senior Scientist and Researcher at the Centre for Addiction and Mental Health in Canada.
I think there are three really key findings. The first is that very clearly, with more information and more biological evidence available, the impact of alcohol has been underestimated in the past. We find more and more causal links where alcohol plays a role in creating disease burden.
Let me give you one example of a disease condition which had not been linked to alcohol before in prior WHO or burden of disease reviews, and that is early onset dementia. very clearly alcohol consumption and especially heavy drinking is linked to onset of dementia and it is linked to onset of dementia especially for early onset, meaning in the years of dementia before age 65.
Secondly, what we found is that a lot of the conditions are reversible, meaning we should not concentrate only that alcohol causes that many burden, but we should also concentrate on that we can still do something. We can, in some cases, completely reverse the damage, and in other cases, slow down the acceleration of alcohol attributable disease.
Can we talk about the levels of alcohol consumption? Because you've just mentioned there the burden of disease, this attachment or this association with early onset dementia. What level of drinking are we talking about here? Are we talking about one, two drinks per week? Are we talking about 10 standard drinks in a sitting? What level confers this kind of risk?
Okay, the risk is very disease specific. There is no overall risk level and most diseases have an increasing risk with the more you drink. So it is quite a clear relationship. The more alcohol is consumed, the heavier the damage. Now, that is not enough for people. They want to know. We want more. Exactly. The main thing is... there is no risk-free level of alcohol.
One drink a day, one standard drink a day is clearly increasing the risk of female breast cancer. So for dementia, not to escape your question, one drink a day is not making any big difference. It is really such a small increase in risk you can barely measure it. For dementia, a lot of the risk is in accumulating lots of relatively heavy drinking over time.
But your crux is really that we don't know what the safe level is because there's a real discrepancy in guidelines and recommendations across different countries. Australia says no more than 10 standard drinks a week for men and women. Canada says there's no safe level and it says if you have two standard drinks or less per week that you're likely to avoid alcohol-related consequences.
But there's really big discrepancies here and you're saying that there's really no safe level. Is that fair?
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Chapter 7: What are the implications of misdiagnosis in movement disorders?
What does it mean? It means that certain consequences of alcohol will be removed almost immediately. most clear and most logic and everybody knows it. If you don't drink before you take some activities like driving or changing a light bulb, it's good for you, it's good for your reaction time, it helps.
But also for things which are quite important for disease generation in modern times, if you reduce your risks, of hypertension via drinking less alcohol. And again, you see those risk reductions, your blood pressure goes down the next day, and if you repeat this exercise, hypertension may go down and fade away. That has been shown in randomized trials.
Very clearly, alcohol is one of the most effective ways to reduce your hypertension.
Your high blood pressure.
Your high blood pressure, exactly. If you drink alcohol, you may get alcohol attributable cancer. This cancer develops over quite a long time, 10 years and more. So if you stop drinking, you may not reverse the cancer in your body. However, you reverse any chance of new cancer if you have no cancer in your body. Most people don't know if they have cancer in their body.
Let's say they're in year five. Cancer is usually detected after seven, eight years. So basically, yes, you reduce your risk of cancer if you reduce your drinking, and that every drink helps. Every drink less reduces your risk of cancer.
After all of that, JĆ¼rgen, I have to ask you the question that I think everyone is pondering. I certainly am, and I don't mind a gin and tonic occasionally or a red wine, like on the weekend. With all your knowledge and everything that you know and with this big landmark review, you've looked at all the studies, you know everything now.
Do you drink any alcohol now or have you completely abstained?
I'm not a complete abstainer. I think with all my knowledge now, I have reduced my drinking to around three drinks, three standard drinks per week.
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Chapter 8: What strategies can help improve diagnosis accuracy in patients?
No problem. I'm happy to answer. And I think it's a fair question.
Professor Juergen Rehm, who is Senior Scientist and Researcher at the Centre for Addiction and Mental Health in Canada.
So the next time you've got an event, does that change anything for you?
I think I was already onto this, but I do like JĆ¼rgen's very balanced approach that it's not all good, it's not all bad, there's no safe level, but you're not safe leaving your house anyway. So, you know, it's all about being informed and making a decision for yourself.
Very sensible. You're listening to The Health Report here on ABC Radio National.
I can't imagine, Norman, what is in your headphones when you're working out. I just imagine maybe classical music.
Well, do you know something? I have stopped. You shouldn't have asked me this because you're going to see it after the hour.
Here we go.
Here we go. I actually don't listen to anything anymore. I've decided that I'm going to get into contemplative mode and focus on doing the exercises properly. So I actually get into a kind of meditative kind of space when I'm at the gym rather than listening to podcasts or whatever.
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