WA News News & Reports Research in the hot north
Research in the hot north
Written by Dr Timothy Barnett
Thursday, 03 August 2017

 

Acute rheumatic fever (ARF) is an autoimmune disease triggered by group A Streptococcus (GAS) infection, with adolescents and young people most at risk. Recurrent episodes of ARF lead to cumulative heart valve damage and the development of rheumatic heart disease (RHD).

Despite often being referred to as a Third World disease, Australia’s Indigenous communities have some of the highest rates of ARF and RHD in the world. Children from these areas also experience a high burden of GAS skin infections, with an average of 45% of young people having impetigo, commonly known as school sores, at any given time.

GAS infection of the throat (strep throat) initiates the development of ARF, but it is not clear whether GAS skin infections can also cause it. Also, the exact mechanism that causes the autoimmunity of ARF is very poorly understood. This has meant that we still don’t have a diagnostic test for ARF, and no targeted treatments that improve long-term outcomes.

There is a need to better control rampant skin infections in remote communities, but the spectre of antibiotic resistance hangs over these programs. Environmental and social factors contributing to the disease also need to be addressed.

As part of the Improving Health Outcomes in the Tropical North: a multidisciplinary collaboration (HOT NORTH) being undertaken at the Telethon Kids Institute under the leadership of Prof Jonathan Carapetis, work is being done to improve methods for monitoring GAS antibiotic susceptibility.

Of particular focus is cotrimoxazole, increasingly used to treat GAS and Staphylococcus aureus skin infections in Northern Australia, and the subject of a clinical trial (led by Dr Asha Bowen, Telethon Kids Institute). This work includes the identification of cotrimoxazole-resistance genes, developing improved laboratory testing methods, and systems that will allow genetic testing for impetigo pathogens and antibiotic-resistance genes directly from clinical samples.

Unravelling immune system derangements that lead a GAS infection to become ARF is another collaborative project being undertaken. We are working to identify immune signatures of ARF that will then be used to develop a diagnostic test and/or possibly new immune-based therapies. By understanding the types of immune cells and GAS antigens that contribute to ARF, we may also be able to shed light on the significance of GAS skin disease as a trigger for ARF.

Hopefully the work will ultimately reduce the incidence of primary GAS infection, and subsequent development of ARF and RHD in children at risk. Improved molecular understanding of the link between GAS infection and ARF should also lead to better treatments and diagnostic tools, thereby reducing the health burden of ARF and RHD.

By Dr Timothy Barnett, Senior Research Fellow, Telethon Kids Institute

 

While communication is one thing, investigation of notifications is another. We believe good doctors want the bad ones weeded out but they don’t want to be part of a witch hunt or get buried in lawyers, politics or paperwork.

The national Medical Board can respond to a complaint or act on the advice of the WA Medical Board to establish an assessment panel to either examine the health or performance and professional standards of a doctor. Health consumers are represented on panels along with medical practitioners.

The Medical Board and AHPRA have undisclosed lists of doctors who are approved by them as panellists and probably as expert witnesses. Many of these people, we believe, were ‘grandfathered’ across when National Law first came in (2010). Their impartiality is as unknown as they are. Then we have expected biases of the legal assessors, chosen by AHPRA, possibly thrown into the mix.

Is there a problem, Houston?

It is important this is sorted to everyone’s satisfaction as 42% of doctors in our survey thought panellists could lack impartiality to a serious extent.

In fact, only one quarter of doctors we surveyed (n=195) were happy with the impartiality shown by AHPRA or the Medical Board in processing a complaint (with 36% unhappy and 39% undecided). Nearly all of those who were unhappy said they were concerned that unfairness will be seriously damaging to someone. Investigation is a very confronting experience.

If someone is being investigated by a panel, either the panel or the person being investigated can opt for a more out-in-the-open State Administrative Tribunal (SAT) judicial hearing – the panel usually refers because it feels the evidence before it constitutes more serious professional misconduct.

What Fair Doctors Want

Talking to doctors, they appear to want an apolitical system of investigation that is fair and timely. They want to be treated reasonably. Unlike the legal profession, their work is mostly built around trust and honesty. They do not want a return to the ‘good old days’ where those with a political bent in the medical profession could influence what the Medical Board did.

While this is a very difficult area for us to investigate, with arguments and counter-arguments at every step, we cannot understand why the Medical Board would turn to arguably the most political organisation, the AMA, for its counsel (the national Board Chair met earlier this year with “senior leaders from AHPRA and representatives of the AMA” to workshop doctor complaints).

Why? Our e-Poll responses raise a question mark over the AMA’s involvement (and we don’t think AMA members have been polled on this issue.)

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