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+ 17 — THE WEEKEND
Ebola: virulent killer virus, and there’s no weapon in the doctor’s bag
E
BOLA thrives just where you least
expect it to — in the hospitals dedi-
cated to stamping out outbreaks of
this extraordinarily virulent virus.
So rather than destroying the virus,
efforts to care for its victims have
actually fanned the flames of deadly
Ebola outbreaks. Healthcare becomes
killer rather than life saver.
This is because Ebola is spread from
person to person by direct contact with
the blood, secretions and other body
fluids and tissues of its victims. Contact
with soiled bed linen or clothing is also
extremely risky, which makes caring for
patients, both dead and alive, a highly
dangerous pursuit.
People with Ebola haemorrhagic fever,
the disease the virus causes, need to be
isolated and treated with strict barrier
Doubts over
milk’s role in
strong bones
Milk is rich in calcium, but suggestions it is necessary
for bone health are overblown, reports Peta Bee
H
OW COMFORTING it is
for parents of the child who
won’t eat to know that at
least she’s getting calcium
from that evening cup of milk.
Drinking milk and eating dairy
foods as a way to strengthen bones
has always been something of a
mantra for the layman and nutri-
tionist worried about the risks of
developing osteoporosis in later life.
But recent research has raised ques-
tions about the benefits of milk, yoghurt
and cheese on bone health.
A report in a recent issue of the US
journal Pediatrics (2005;115(3):736-43)
suggests there is ‘‘scant evidence’’ that
dairy intake has much effect on promot-
ing strong bones. The report’s authors —
researchers on the Physicians’ Commit-
tee for Responsible Medicine (PCRM) in
Washington — based their findings on a
review of 37 studies.
Of these, 27 showed no relationship
between dairy foods or dietary calcium
and bone health in children and young
adults, while the remainder found only a
small association. This led researchers to
conclude that ‘‘under scientific scrutiny,
the support for the milk myth crumbles’’.
According to Amy Joy Lanou, a nutri-
tionist in the PCRM team, calcium, of
which dairy food is a source, does play an
important role in the development of
bones. But Dr Lanou says their findings
showed that physical activity during the
peak years of bone growth (between
birth and the early twenties) is a far
stronger indicator of a strong skeleton in
adulthood than dairy consumption. ‘‘It is
really important for parents to under-
stand that milk is not a necessary food
for young people,’’ she says.
‘‘If children can’t drink milk for health
or other reasons, their bones are still
going to be just fine.’’
There is no denying that osteoporosis
is an increasing problem. According to
Osteoporosis Australia 1.9 million people
in Australia had the condition in 2002 —
a number expected to jump to 2.2 million
by 2006, and to 3 million by 2021.
Every eight minutes someone is ad-
mitted to an Australian hospital with an
Have doctors, will complain says British research
ACCESS to high-quality healthcare simply
encourages people to complain about
their illnesses, research suggests. A study
in the British Medical Journal found that
70 per cent of the UK population was
taking medicines to treat or prevent ill-
health, or enhance wellbeing. However,
studies of people living in Bihar — the
poorest state in India — found that rates of
self-reported illness were very low, while
rates in the United States were very high.
Author Iona Heath, a London GP,
suggested that the more people are
exposed to contemporary health care, the
sicker they feel.
BMJ 2005;330:954-6
■ ■ ■
CHANGING shift patterns are bad for the
health and lead not only to poor attention
spans but potentially harmful
physiological effects. Britain’s Health and
Safety Executive compared two shift
patterns used by offshore oil workers, and
found that the more popular shift pattern
put workers at higher risk of heart disease
and diabetes. One shift pattern for each
two-week stint on an oil rig involved
working straight day or night shifts for the
entire two weeks. The other involved a
split roster of seven night shifts followed
by seven day shifts. Although more
popular with workers because it meant
they were more used to normal sleeping
patterns by the time they returned home,
New Scientist reported that urine tests
found the sleep hormone melatonin was
not adjusted to the new sleep times. The
men also had abnormally high levels of
fatty acids in the blood.
■ ■ ■
GIVING emergency doctors specific
training in making referrals improves
+ +
CORRECTION
OK PROOF
50 25 15 8 7
A BUG’S LIFE
By Dr Adam Taor
nursing, which involves wearing protec-
tive clothing: masks, gloves, gowns and
goggles. This is hardly practical in remote
areas of the African countries where
outbreaks have struck, such as the Dem-
ocratic Republic of Congo, Sudan and
Gabon. That’s why when Ebola out-
THE MILKY WAY
Suggested daily calcium intake
■ Australian men and pre-menopausal
women 800mg
■ Post-menopausal women 1000mg
■ Pregnant women 1100mg
■ Breastfeeding mothers 1200mg
■ Children aged eight to 11, two to three
servings a day of milk, yoghurt and cheese
■ Adolescents aged 12 to 18, three to five
servings a day
The National Health and
Medical Research Council
osteoporotic fracture. This is expected to
rise to every three to four minutes by 2021.
As many as four out of five people with
osteoporosis don’t know they have it,
according to Osteoporosis Australia,
which could explain the much lower
incidence rates recorded in official statis-
tics. The Australian Institute of Health
and Welfare estimated that 52,000 Aus-
tralian men, and 248,000 Australian
women, had osteoporosis in 2001 — about
1.6 per cent of the population. Because
the condition becomes more common
with age much higher incidence rates are
recorded among the elderly. According to
the 2001 Australian National Health
Survey, 10.5 per cent of women aged 65-74
had osteoporosis, increasing to 12.3 per
cent among women over 75. The percen-
tages among men were 1.2 per cent and
1.5 per cent respectively.
However other experts suggest that
the emphasis on dairy foods is over-
played, and point out instead the impor-
tance of other factors including weight-
bearing exercise, genetics, smoking, pro-
tein consumption and an adequate in-
take of vitamin D.
Walter Willett, head of nutrition at
Harvard University School of Public
Health and the principal investigator in
the Nurses’ Health Study (which has
followed the diet and lifestyle habits of
72,000 women for 25 years), says that
there is ‘‘no solid evidence that merely
increasing the amount of milk in your
diet will protect you from breaking a hip
The pulse
Compiled by Adam Cresswell
patient outcomes, researchers have
found. A questionnaire sent to 72 doctors
at a hospital in Stevenage, north of
London, found 56 per cent initially
reported having difficulties with referrals —
although further questioning revealed all
had had some problems. Many of the
emergency doctors were young and
relatively inexperienced, and the survey
found perceptions of personality clashes
with doctors accepting referred patients.
The paper in the Emergency Medicine
Journal recommended there be formal
training in referral techniques, perhaps
incorporated into medical school
teaching, clear guidelines on the role of
emergency medicine doctors, and
education of specialists on accepting
referrals.
Emergency Med J 2005;22:355-358
■ ■ ■
TAKING antibiotics weekly for a year does
not cut heart attack risk for patients with
stable coronary artery disease, according
to a University of Washington study. The
bacterium Chlamydia pneumoniae has
been found in the arterial plaque of
patients with coronary artery disease,
leading some experts to speculate that
87654321012345678
CMYK
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Health
breaks appear, they are often amplified
in hospitals and among those having to
dispose of the bodies.
Ebola first appeared, seemingly from
out of nowhere, in the mid-1970s in Sudan
and Zaire (now the Democratic Republic
of Congo) and is named after the Ebola
River in the latter country. After the first
outbreaks the virus laid low for a decade
or so only to emerge again, and since then
there have been regular outbreaks in
which 50-90 per cent of infected patients
have died.
Ebola’s sporadic nature makes it un-
predictable, and it doesn’t help that
despite extensive study we still don’t
know exactly where the virus comes
from. It’s believed it lives naturally in the
African rainforests using an animal as a
host, but we don’t know which type of
Milk: Good reasons to drink it, but to grow healthy bones isn’t one of them
or crushing a backbone in later years’’.
Professor Willett found instead that
women who drank a glass of milk twice a
day for many years were as likely to a
suffer broken bone as those who drank
only a glass a week.
In a separate study of 43,000 men the
Harvard research team also failed to link
long-term low-dairy consumption with
brittle bones.
It has also been suggested that dairy
foods and meat can even promote a
leaching of calcium from the bones.
According to Colin Campbell, of the
department of nutritional biochemistry
at Cornell University, these foods con-
tain good amounts of animal protein,
which makes blood more acidic; the body
Tumour fighter: Broccoli, and read chilli, can slow growth of hard-to-treat cancers
removal of the bug could reduce the risk
of subsequent cardiac events. The study,
published in the April 22 edition of the
New England Journal of Medicine , found
no benefit from antibiotic therapy.
Researchers randomly assigned 4,012
men and women to receive either once-
weekly doses of azithromycin or a placebo
for one year. There was no significant
reduction of cardiac events — defined as
death, heart attack, unstable angina,
angioplasty or cardiac surgery — after
nearly four years among participants
receiving antibiotic compared to those
given placebo.
NEJM 2005;352:1637-45
animal. Humans have contracted Ebola
via infected chimpanzees, gorillas and
monkeys, but it’s thought that these non-
human primates have been infected
directly from the virus’s natural host.
Ebola is a type of virus called a filovirus,
and it has a long filament-like shape.
Once infected people tend to develop
symptoms of Ebola haemorrhagic fever
two-21 days later. At first they may have
a fever and a headache along with severe
weakness. Then they may develop vomit-
ing, diarrhoea and abdominal pain with
impaired kidney and liver function. Some
patients also have bleeding under the
skin, or from the gut or orifices such as
the eyes. There is no specific therapy or
vaccine for Ebola haemorrhagic fever;
treatment is aimed at supporting the
patient.
tries to neutralise this by drawing cal-
cium from the bones.
Professor Campbell argues that the
more dairy people eat, the more calcium
they will need to consume to balance
these losses. His research has shown that
in Asian countries, where dairy intakes
are low, their populations suffer one fifth
fewer broken bones than in Britain or
America. ‘‘Those countries that use the
most cow’s milk and its related products
have the highest fracture rates and the
worst bone health,’’ he says.
Bridget McKevith, a nutrition scientist
for the British Nutrition Foundation, says
that adults and children need no more
than 0.8g of protein per kilogram of
bodyweight every day, about two servings.
■ ■ ■
BROCCOLI and red chilli may help slow
tumour growth in hard-to-treat cancers,
two new studies suggest. The findings,
presented at the annual meeting of the
American Association for Cancer Research
this week, looked at the effect on cancers
that have poor prognoses. One study
found that capsaicin, the ‘‘hot’’ ingredient
in red chilli that is often associated with
antioxidative and anti-inflammatory
activities, disrupted the cell function of
cancerous pancreas cells and caused their
death without affecting normal cells.
Pancreatic cancer is one of the most
aggressive cancers with poor survival
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3 4 Drop
Death toll 64: Health workers in Kitwit hospital, Zaire, in 1995
‘‘Too high an intake of animal protein is
known to affect bone health adversely,’’
she says. ‘‘The same is true of highly
processed foods and products that cause
high levels of acidity, such as fizzy drinks.’’
But McKevith and the majority of
nutritionists remain cautious about the
suggestion emerging from this research
that it may be time to ‘‘ditch the dairy’’,
because full-fat milk is a ‘‘convenient
source’’ of fat and calories for children
under 12.
‘‘Some calcium is essential in the diet,’’
she adds, ‘‘and dairy remains a useful way
to get it, although it is not the only step we
should take to protect our bones.’’
The Times
rates. The second study examined the
benefits of phenethyl isothiocyanate
(PEITC), a constituent of vegetables such
as broccoli, on ovarian cancer. Ovarian
cancer cells exposed to PEITC for 24 hours
showed significant disruption to their
growth processes. PEITC treatment also
made the cancer cells more likely to die.
■ ■ ■
OVERWEIGHT people are much more
likely to suffer knee damage, researchers
have demonstrated. University of Utah
School of Medicine researchers found the
likelihood of tearing the meniscus, the
cartilage that bears much of the load on
the knee joint, increases dramatically with
body mass index (BMI). Overweight
people are at least three times more likely
to tear their meniscus, while the most
obese men and women are 15 and 25
times, respectively, more likely to tear the
cartilage, the researchers report in the May
edition of the American Journal of
Preventive Medicine . The authors studied
515 patients who underwent meniscal
surgery between 1996-2000, and
compared them to 9,944 others. Men with
a BMI of 27.5 and higher and women with
a BMI of 25 or higher were three times
more likely to tear their meniscus. Men
whose BMI exceeded 40 were found to be
15 times more likely to tear their
meniscus; women in that BMI category
were 25 times more likely.
Want to know more?
Items are referenced where possible. A
reference such as ‘‘2005;35:18-25’’
means the source article was published
on pages 18-25 in volume number 35 of
the publication, in 2005. A doi number or
website address is used for research
published on a journal’s website.
2/12/95
AUS 23-APR-2005
AUSTRALIAN APRIL 23-24, 2005— 17 +
In hospital
and worked
to death
From previous page
rosters (being on-call every second day
for 24 hours),’’ she says.
And according to Dr Page a shortage
of doctors in rural areas means longer
working hours for country GPs as well
as hospital doctors.
With an average ratio of 3,000 people
to one doctor in many parts of Austra-
lia, she says rural GPs work long hours
and are often expected to be a ‘‘one-stop
shop’’ dealing with primary care needs
as well as hospital-like emergencies.
But while Page says there is no doubt
that there are unsafe shift practices in
rural hospitals, she says that it can
often look worse on paper than it is on
the ground.
‘‘The smaller the town the less likely
it is that there will be people in the
hospital at any given moment. So while
you are on-call frequently, you are not
necessarily called in,’’ she says.
That argument doesn’t persuade
Drew Dawson, from the Centre for
Sleep Research at the University of
South Australia. He says it’s wrong to
assume you won’t become fatigued if
you’re not physically doing work; in-
stead, it’s lack of sleep and recovery
time that are significant.
‘‘What the research shows is that if
somebody is on call they sleep with one
ear open, and so the recovery value of
that sleep is not as good as it would
appear,’’ he says.
According to Dr Dawson, the biggest
gap in doctors’ fatigue research is the
correlation between adverse medical
events and doctors’ hours.
He says one of the biggest stumbling
blocks in his attempts to research this
topic has been hospital ethics commit-
tees.
‘‘The difficulty for many ethics com-
mittees is if we actually find that a
doctor makes a fatigue-related error,
what are the liability implications for
the hospital?’’ Dawson says.
Lack of funding has also been an
issue, with the National Health and
Medical Research Council telling Daw-
son for the three years he has applied
that while the topic was an important
one, no funding was available.
And paradoxically, according to Daw-
son, attempts to limit or cut doctors’
hours are themselves problematic.
‘‘The problem is that if you cut
working hours then you potentially
reduce the labour supply and therefore
there will be less medical care avail-
able,’’ he says. ‘‘And it may be the case
that a tired doctor is better than no
doctor at all.’’
This is an important point in a
climate of widespread medical work-
force shortages.
He also argues that past attempts to
cut junior doctor hours has just shifted
the problem to senior doctors, who now
find themselves on call at night as well
as needing to meet their daytime res-
ponsibilities, including surgery.
‘‘What you have done is problem-
shift, not problem-solve,’’ he says.
And solving the problem is what the
Australian Council for Safety and
Quality in Health Care, which was
established by state and territory
health departments in 2000, hopes to do.
Their recently launched fatigue pro-
ject — Developing National Principles
and Tools for the Recognition, Preven-
tion and Mitigation of Fatigue in
Health Workers — may be quite a
mouthful, but council and project mem-
ber Cliff Hughes says the issue ‘‘is too
important for an acronym’’.
Nor will it be limited to just doctors.
After a series of interviews and focus
groups with a range of health care
professionals, the project will develop
guidelines, which will be evaluated in a
number of pilot studies across the
country later this year.
But Professor Hughes says there are
no plans at this stage for a legislative
approach. ‘‘Something as complex as
fatigue and workforce issues will need
to remain voluntary because they will
depend entirely on local circumstances
and those circumstances can vary from
day to day, and even from shift to shift,’’
he says.
Contacts
Health Editor Adam Cresswell
(02) 9288 2494
Fax (02) 9288 3077
cresswella@theaustralian.com.au
Medical reporter Clara Pirani
(02) 9288 2255
Fax (02) 9288 3077
piranic@theaustralian.com.au
Science reporter Leigh Dayton
(02) 9288 2333
Fax (02) 9288 3077
daytonl@theaustralian.com.au
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