Published: 22 April, 2022
Today is World Earth Day
April 22nd, 2022, marks the 52nd anniversary of World Earth Day. While this day has meaning for us all in terms of our individual and collective efforts in doing our part to "invest in our planet", we would like to focus on the role of healthcare professionals, medicine and health. In the lead up to this day, the University of Toronto has released a two-part series on "embedding Earth Day thinking and doing into everyday family medicine". The series, which includes ten recommendations for action, focuses on how general practitioners (family physicians) can use their clinical practices, professional voices and choices to address factors driving climate change and to advocate for the health of patients and the planet.
Ten recommendations for action
- Consider areas for personal action, e.g. reducing use of cars, reducing consumption of meat
- Counsel patients on the co-benefits of climate mitigation activities, e.g. when giving advice about a healthy diet for a person with obesity or cardiovascular disease, share the evidence about plant-based diets being better for the planet
- Provide advice to those at risk of climate-related illness, e.g. talk to people with asthma and COPD about air quality health indexes and avoiding going outside in hot, humid and high pollution days
- Switch to dry powdered inhalers where appropriate – these have a smaller carbon footprint than metered dose inhalers
- Continue to use virtual care when warranted – providing telehealth services reduces greenhouse emissions of people using transport to get to the clinic
- Choose wisely – every health activity has a carbon footprint, every test ordered consumes energy and materials
- Develop and embed multidisciplinary sustainability teams, e.g. share ideas and resources, consider best models of care for implementing environmentally sustainable practices, consider waste and use of disposable materials
- Treat climate change as a health emergency – the World Health Organization and the Lancet have called climate change the greatest health threat of the century, infectious diseases are predicted to increase and it is likely we will face further global pandemics
- Think beyond our patients to broader public health benefits, e.g. advocate for public health change in your local community
- Start talking about climate justice on Earth Day and every day – change begins at home, at work and then at a system level
Begin with Part 1 of the series here (link to Part 2)
Safety concerns with Miracle Mineral Solution
Medsafe has issued a safety communication as a reminder of the safety concerns around Miracle Mineral Solution, a product promoted as a "water purification solution" with unsubstantiated claims of effectiveness against pathogens including COVID-19. These products contain high concentrations of sodium chlorite (a bleach and disinfectant) and when mixed as directed, the solution forms chlorine dioxide, a highly toxic compound.
This reminder comes after a report was notified to CARM of a person who required ICU treatment after consuming Miracle Mineral Solution with the intention of treating COVID-19.
Advise patients who enquire about this product that it should not be consumed in any circumstance as this can cause life-threatening adverse effects.
New patient resource: Managing your money after being diagnosed with a serious or terminal illness
Sorted and the Cancer Society have collaborated to release an online resource for people who have been diagnosed with a serious or terminal illness, to assist them and their family/whānau with organising their finances. Sorted (www.sorted.org.nz) is a free, independent service provided by Te Ara Ahunga Ora Retirement Commission.
Advice covers several topics including:
- Finding financial assistance
- Discussing the situation with your employer/landlord/bank
- Borrowing money to cover treatment
- Managing housing, work and insurance needs
- Accessing legal advice
The full resource is available here
A printable brochure covering key points is available here
Supply issues with smoking cessation treatments
All patients who smoke should be encouraged to stop and provided with cessation support, including both behavioural and pharmacological treatment. Currently, the options for pharmacological support are limited due to supply constraints. Varenicline has been unavailable for almost 12 months due to a manufacturing safety issue, and bupropion* supply is now being managed in New Zealand due to increased global demand and manufacturing constraints. This leaves nicotine replacement therapy (patches, gum or lozenges) as the remaining funded pharmacological option; note that this is usually the first-line recommended treatment for smoking cessation. Nortriptyline (funded) may also be an option for some patients. Read more about smoking cessation treatments here.
N.B. Vaping is not an approved smoking cessation method, but health care professionals can provide information to help smokers make an informed choice: read more here.
*Bupropion is also occasionally used off-label as a treatment for depression. There are no other medicines in this class that are funded; refer to the antidepressant switching table in NZF for guidance on changing antidepressant treatment.
Coming soon: resources for managing concussion
Next week we will be releasing a suite of new resources on managing concussion/mild traumatic brain injury in primary care, supported by the ACC Injury Prevention and Health Partnership teams. Contrary to popular belief, concussion doesn’t just happen to rugby players, in fact the most common cause of concussion in New Zealand is falls. While clinical management has traditionally centred around "watchful waiting" and extended rest, there is mounting evidence that passive management can compromise recovery. Therefore, a more deliberate gradual return to activity is best. We were fortunate to be joined by Dr Stephen Kara who shared his expertise with us in our two-episode slidecast. The series also includes written resources and a CME case study.
Watch your inbox next week for more details!
Paper of the Week: Genomic discrimination
In a recent editorial in the New Zealand Medical Journal, members of AGendDA discuss the far-reaching implications of genetic testing, beyond just the actual results. A group of New Zealand clinicians, academics, scientists, lawyers and representatives from Māori, Pasifika, medical charities and patient groups have formed an alliance to call for a ban on the use of genomic information by insurance companies; Against Genomic Discrimination Aoteoroa (AGenDA).
Genetic testing has become an essential tool in the fight against cancer and many other serious long-term conditions. As our knowledge of genetic associations with disease becomes more complex, there has been a move from testing single genes to analysing entire genetic profiles – known as genomic testing. This can lead to beneficial health improvements and outcomes, but the flip side is that this genetic profiling is also being used by health and life insurance companies to assess individual risk and future health needs, and therefore as a means for denying insurance or raising premiums. This means that when a person requires a genetic test for a health need, they also need to consider what the implications of this test would be for their insurance. It doesn’t seem like a very fair decision to have to make.
Read more here.
Shelling A, Bicknell L, Bohlander S et al. Genomic discrimination in New Zealand health and life insurance. AGenDA: Against Genomic Discrimination in Aotearoa. N Z Med J 2022;135(1551).
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