Transcript - Dr Gannon 2GB - Obesity, Codeine, and Prescription Drugs
Transcript: AMA President, Dr Michael Gannon, with Mark Levy, 2GB, 19 December 2017
Subject: Obesity, Codeine, and prescription drugs
MARK LEVY: Well, it's a big day in the world of medicine. As I mentioned earlier, I can't believe that New South Wales doctors are being told they can't tell a patient that they're fat. I mean, I'm fat. I'm the first person to admit it.
The world has gone mad, but then on a more serious note, new research by the Australian Institute of Health and Welfare has found that almost one million Aussies are abusing prescription drugs. It's a scary thought, and the Government's prescription monitoring scheme, which is at least a year away, couldn't come soon enough. And we're also hearing today about the shocking conditions that some of the most vulnerable are subjected to in New South Wales mental health units.
So I thought we'd check in with the President of the Australian Medical Association. Dr Michael Gannon's on the line right now. Doctor, good morning.
MICHAEL GANNON: Good morning, Mark.
MARK LEVY: Mate, let's start off with the issue that's certainly got people fired up: the fact that doctors can't tell you you're fat and they can't use words like obese. It's my understanding that obese is a medical term. Where does the Australian Medical Association stand on this push, this move by New South Wales Health?
MICHAEL GANNON: Well look, you're exactly right when you state that obese is a medical term. It's based on- the current definitions are based on Body Mass Index, and that's not a perfect measurement either. It doesn't take into account the fact that people with significant muscle mass might be called obese and they're actually probably in a fairly healthy situation. But overall, it's a useful metric. None of it's perfect, and the reality is it is a medical definition. Now, it's not the first time that New South Wales Health has come up with a crazy idea like this. Doctors need to be sensitive when they're dealing with patients and, yeah, I think the use of the word fat's a bit outdated. We don't want people to get upset in their interactions with doctors, but practising medicine's not a popularity contest. You have to give uncomfortable news to patients, you have to come up with treatment or management plans they're not necessarily happy about, and this directive flies in the face of common sense.
MARK LEVY: Well, there's no point sugar-coating the issue, is there? Being obese can affect your health, long-term and short-term, so if a doctor says: listen, you've got to lose some weight, you've got to listen. There's no point wrapping them up in cotton wool and taking the softly, softly approach, as I've touched on. You want to know what's wrong with you by a doctor who's trained in that field.
MICHAEL GANNON: Well, that's right, and sometimes it will lead to changes in treatment plans, and sometimes they are arbitrary, when you look at a certain weight limit. And you're right, you can't sugar coat these issues. So, if you'll forgive me using an example from my speciality, if you are above a certain weight, you will be told that you have to deliver your baby in a larger hospital. That's an occupational health and safety issue for the people who might be looking after you, especially in the context of an emergency. If you're above a certain BMI, that's a recognition that you have a different set of risks. You might be more likely, if you're having surgery, to get a blood clot. You might be more likely to get an infection, you might be more likely to admit to an intensive care unit. So we can't play around with terminology to suit people. It's a disappointing development in our society that people can say: I'm offended, and therefore that's the end of the discussion.
MARK LEVY: Alright, Doctor. Let's have a look at some of the other things that are around the place today in the medical world. The new report by the Australian Institute of Health and Welfare that says almost a million Australians are abusing prescription drugs. Why is this, and what's behind it?
MICHAEL GANNON: Well, this is a concerning report. Unfortunately, we don't get advance copies of the AIHW report before the media does these days, so it's hard to comment in detail. But as to your specific question, we do have a problem with prescription drug abuse. We do support the moves both by the Commonwealth Government and the Victorian Government to enhance real-time prescription monitoring systems. When you read the stories of the number of individual prescriptions people can obtain in a day for narcotics, for sedatives like benzodiazepine, it's quite amazing. If people had the same wits, application and skill in the skill required to go to 30 or 40 or 50 different doctors or pharmacists to get drugs that they either use themselves or sell onwards, you'd- they'd be very successful people. We do have a problem. We support the Government's moves to make low-dose codeine prescription only, but part of the message in that change needs to go to my colleagues. Doctors need to recognise - as the majority do - that drugs like codeine, to a lesser extent morphine, are not appropriate drugs for chronic pain that's not cancer-related. We're learning more and more about better medications that are less likely to result in dependence, less …
MARK LEVY: [Interrupts] Just on codeine, though, just on codeine, and I know you've been very supportive of the Government's move to make codeine medication prescription only. But doesn't this research show that making something prescription only won't actually fix the problem? And when you look at codeine addiction, it exists in just 0.011 per cent of the population. Surely you can't punish the other 99 per cent of the population. There must be better ways.
MICHAEL GANNON: Well, I know the point you're making, but what we need to look at is we need a fundamental re-education across the medical profession, but the community as well, that drugs that are designed for acute pain have no role in chronic pain. So, whether you're talking codeine, phosphate, four milligram tablets or 30 milligram tablets, that is not a useful drug for chronic pain syndromes. We need to get these people in to see experts in pain medicine, experts in addiction medicine. They're two areas where we need to see more resources going, and we need to see that change. We've got a problem with opioid abuse, and that is across the board, whether you're talking about people who start off with over-the-counter codeine, the higher doses prescribed by my colleagues, or whether you're talking about illicit use of fentanyl, oxycodone, or heroin. There's a problem across the board.
MARK LEVY: Alright. I mentioned this earlier: I can't believe we still don't have a national network for pharmacists, but the Federal Government I know recently did commit $16 million for a real-time monitoring scheme, but is it a simple fact that it's a little too late?
MICHAEL GANNON: Well, the Pharmacy Guild sometimes try and fix their own system. That doesn't have the reach or the coverage we need; $16 million is not going to be enough to get the result that we need. This is a problem. The coroners in states like Victoria have pointed to this. Too many people are dying with massive doses of opioid in their body, and that's a responsibility for everyone. Doctors have a responsibility. We have overprescribed oxycodone, codeine, other powerful opioids in recent years, but part of what's involved is getting our patients to a greater understanding of the fact that these are not the answer, beyond short-term use of pain relief, for example, after surgery.
MARK LEVY: Alright. Dr Gannon, one last one. I want to ask you about the case involving Miriam Merten, but what's stemmed from that, the inquiry into New South Wales Mental Health Units and Emergency Department Safe Rooms. It really is unbelievable stuff. I can't believe what's going on behind those walls. I mean, we're talking about seclusion, restraint. What's your reaction to this report that's been handed down by New South Wales Health?
MICHAEL GANNON: Look, I'm not familiar with the individual case or the individual report, but one thing I can say is that, across Australia, there's been chronic underinvestment in mental health services. There is an effective discrimination against mental health patients when you compare it to physical health problems. We've seen some State governments experiment with separate Ministers for Mental Health from Ministers for Health, but this is a key responsibility of Health Ministers across Australia. We simply need to do better. We need to do better in terms of acute mental health beds within our hospitals. What we did a generation ago is we decided the old asylums were not the model to help people get better, but then we didn't invest in the right number of beds in major hospitals, and just as importantly, in step-down facilities as people get better. It is no exaggeration to call our mental health system a crisis, and we need to shine a light on the need for greater investment.
MARK LEVY: Alright, fantastic. Thanks so much for your time this morning.
MICHAEL GANNON: It's been a pleasure.
MARK LEVY: Dr Michael Gannon, the President of the Australian Medical Association. There's a fair few things for us to delve into in the medical world today.
19 December 2017
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