Tasman Medical Journal

ISSN:  2652-1881

Category: TMJ Blog

Evolving appreciation of risk associated with environmental per- and polyfluoroalkyls (PFAS), the so-called forever chemicals

As a child the writer was told a joke about a liquid which dissolved everything.  The question was what container could you keep it in?  We now have a modern counterpart, a compound (or indeed, thousands of related compounds to date) that do not degrade, and the question arising is how can they be prevented from accumulating in the environment?  The molecules in question are carbon chain compounds in which all mid-chain carbon atoms are bonded to two fluorine atoms.  The result is compounds that are extraordinarily chemically stable and resist physical or biological degradation.  The energy content of carbon single bonds1 with fluorine and other common atoms present in organic molecules (Table 1) demonstrates why polyfluorinated alkyl substances (PFAS) are resistant to degradation and hence potentially hazardous or toxic.  In addition, fluorine atoms are large compared to oxygen and hydrogen and impose steric hindrance on potential substitution. Note especially

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Why Tasman Medical Journal does not support the Voice

This journal has as its main aim the publication of papers which support the health of all Australians, and to the extent that its publications apply elsewhere, worldwide.  So stating a purely political point of view is controversial.  But this one has a strong health aspect, as did the subjects of our previous intrusions (on the war in Ukraine1­ and COVID policies in Australia2).  The matter here is a proposed addition to the Australian Constitution, subject to a YES vote in a national referendum in late 2023.  Since the health status of aboriginal Australians is undeniably poor compared with the community as a whole, the question of interest to this publication is whether the proposal is likely to improve the health of this underprivileged group. The proposed amendment contains two changes.  It both purports to recognise an aboriginal presence (for 40,000 to 60,000 years prior to the British arrival in

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Are neonates from vegan mothers at risk of taurine deficiency?

TMJ Blog 12; uploaded 14 May 2023. Taurine, an organic amino sulphonic acid* (2-aminoethanesulphonic acid; Fig 1), is present in animals but not plants and is thought to have a role in neonatal and infant development, especially of the neurological system.1  Observational data suggest that relative taurine deficiency during the neonatal period is associated with adverse long-term neurodevelopmental outcomes in preterm infants.2  Because the placenta and newborn livers lack γ-cystathionase required for taurine synthesis2,3 and immature renal tubular reabsorption causes loss of taurine in the urine,4 unborn babies and breast-fed neonates receive taurine from the mother.  We address here the question of whether supply of taurine from vegan mothers represents a hazard for the neonate and infant. Taurine depletion has been observed in very low birth weight babies receiving total parenteral nutrition.5  During pregnancy, vegan mothers can be deficient in vitamins B12 and D, iron, iodine, zinc, and omega-3 fatty

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Efficacy of psilocybin in severe depression: what is the evidence?

IntroductionIn a world first, the Therapeutic Goods Administration (TGA) in Australia has scheduled psilocybin in the treatment of severe depression treated by registered psychiatrists, acting with approval of a human research ethics committee (from July 1 2023).1  The decision has been controversial because risk of leakage to the streets is substantial and because it was made in the setting of extreme lobbying by outside organisations and individuals.  Leaving these interesting aspects on one side, I summarise here the published evidence for the efficacy of psilocybin. How do we “know” a therapeutic drug works? The listing of a drug as a medicine relies of scientific evidence of efficacy. The underlying epistemological question is how can that reliable evidence be obtained?  The gold standard accepted globally is by a controlled clinical trial, which takes account of random or systematic sources of bias that might cause approval of agents that are either ineffective

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Current trends in COVID-19 infection and treatment

What is our current understanding of COVID-19?  A gigantic and possibly never-ending question.  It may appear that there is current COVID stability, but this is illusory, as new pathogenetic strains precipitating further pandemics are inevitable. What about the demand for booster innoculations?  Anti-COVID neutralising antibodies and clinical immunity produced by vaccines against SARS-CoV-2 virus are known to wane over a period of months.1  Antibody levels one booster dose after the primary series of vaccinations are fully restored but this effect also progressively declines.  Fortunately, the 3-dose regimen including RNA-based vaccines is also highly effective against severe disease and death from the Omicron strain.  The question arises as to whether a fourth dose will be required because of waning immunity, whether it will also be as effective as the initial “booster”, and if so will its effect also be transient?  The underlying implication is that a regular programme of boosters may

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No case for avoiding vaccination against COVID-19 based on alleged lack of vaccine efficacy

Widespread uptake of vaccination against SARS-CoV-2 infection is limited by a minority in the population who decline to be vaccinated.  The proportion varies between centres, and several reasons for non-vaccination exist or are stated.  These include social reasons, especially (in Australia) in remote indigenous communities; medical reasons in patients with impaired immunity and like diseases; distaste at administration of foreign compounds and other forms of disagreement with the principles of vaccination; and disbelief that in the case of COVID-19 the vaccines are effective, often conjoined with the belief that the vaccines are deliberately toxic or introduce toxic substances into the body.  The Journal supports the right of individuals to decline vaccination and with few exceptions (for example, in aged care facilities) has strong reservations over linkage of non-vaccination with discontinuation of employment.  I have discussed human rights issues in a previous article.   But we have no doubt that anti-COVID vaccination

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Babi Yar, War in Ukraine, and the Tasman Medical Journal

War causes death, disease, destruction, despair and destitution.  It is a valid topic for inclusion in a medical journal. Spare a momentary thought for Mr Vladimir Putin.  He does not seem to realise that by invading Ukraine he may have signed his own death warrant.  A week ago he might have expected to live a full life, notwithstanding earlier adventures, and he appears not to realise that violent adventurism based on lies only ends in tragedy.  Mother Russia, whom he is indulging, exists only in the creative minds of Russian romantics.  How do we respond as doctors to such an unfortunate but disturbed person?  Is he entitled to sympathy due to his lack of insight?  Perhaps, but the negative side of the Putin ledger is now inescapable.  Like most of the world, we denounce his actions in Ukraine. Several days ago the invading Russian army attacked a broadcasting station in

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Will discriminatory public health policies based on COVID-19 vaccine status cause social harm that exceeds the benefit?

This Journal, in an early publication from the pen of the Editor (1) and at a point prior to the availability of vaccines against SARS-CoV-2 infection during which lockdown of citizens was taken to be the only possible mechanism for reducing community spread of the virus, noted that the wider economic and social impacts of such measures had been overlooked.  I stated “…The natural and expected political imperative is to prevent unnecessary infections and deaths.  However, this must be balanced against the adverse chronic consequences of economic shutdown, which will produce its own health hazards, especially in the area of geriatric medicine and mental health.  Thus one reaches the conclusion that reversal of restrictions in the interests of resuming normal life must be undertaken before the pandemic has been fully controlled.” I also noted that the Premier and Chief Medical Officer of Western Australia made statements recognising that continuing social

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WA Government mis-steps in regulating community response to omicron strain of SARS-CoV-2

The Tasman Medical Journal is politically neutral but government decisions in health based on misapplication of science and/or causing widespread community confusion justify comment as they must have health consequences.  In a previous (1) and supplementary blog we summarised information demonstrating from four studies that the Omicron strain of SARS-CoV-2 is resistant to currently available vaccines until the “booster” or 3rd dose has been administered.  A further two studies confirm that conclusion (2,3).  Thus the description of double-vaccinated persons as “fully vaccinated” is wrong for the omicron strain, which is the strain currently feared most by the WA authorities. In response to the perceived risk of the omicron strain and in order to reduce its impact on the state hospital system, the WA government has recently reversed its ‘binding’ policy of opening the state borders on 5 February 2022 and introduced further restrictive regulations that even the state Premier has

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