The man, the legacy
Dr Rob McEvoy, co-founder of this magazine, died on Monday, April 17 with the same courage and determination in which he lived.
He opted for voluntary assisted dying after spending his last four years staring down Progressive Supranuclear Palsy.
As readers of Medical Forum will instinctively know, PSP never takes kindly to defiance, but as readers will also know, Rob could do defiance pretty well.
In life, as in the moment of his passing, his business partner and partner in life, Jenny McEvoy (yes, the knot was tied at a wonderful, intimate ceremony several years ago), was right by his side.
Medical colleagues will all have their own Rob McEvoy story. He was blunt, at times forceful, in his opinions on all subjects that affected his beloved profession and magazine.
He was fiercely committed to the values of medicine – the healing part, where the patient in front of him took precedence over pretty much everything else.
He was a fearless champion for the undervalued and underappreciated general practitioner, of which he was one for the first 30 years of his career, and he had a distrust of the business of medicine – partly because he felt awkward about the transactional aspects of it, and partly because he could see how it could erode the very values he held dear.
Rob and Jenny started Medical Forum, in its current form, 23 years ago as an independent, ethical free-to-readers news magazine for West Australian doctors – every WA doctor they could find. When I began working at the magazine as managing editor in 2012, I had to memorise and incant daily – independent, ethical, local and, not irregularly, no conflict of interest.
Those underlying publishing values have seen the magazine become staple reading for WA doctors and a valued voice for the medical profession.
Vale Dr Rob McEvoy, your legacy lives on.
By Jan Hallam
A staged approach to treatment
Researchers at Curtin University have identified the genetic signature of pre-malignant liver cells, offering hope to the almost 3000 Australians diagnosed with the deadly cancer each year.
The study, published in the journal Cell Genomics, found that quantifying pre-malignant liver cells in patients with liver disease could help determine their future risk of developing cancer.
First author Dr Rodrigo Carlessi, from Curtin Medical School and Curtin Health Innovation Research Institute, said the discovery had the potential to save lives by changing how chronic liver disease patients are staged and monitored, based on their cancer risk.
“The research used cutting-edge technology to identify the molecular fingerprint of thousands of genes, one cell at a time,” Dr Carlessi said.
“During this process, we discovered the genetic signature and its diagnostic value, which was subsequently confirmed in several hundred individual patient liver samples.
“This finding is significant because it gives us a vital piece of the puzzle that could pave the way for a new diagnostic test for liver cancer, which causes 10% of all cancer-related deaths in Australia.”
Colleague Professor Nina Tirnitz-Parker, also from Curtin, said liver cancer was often diagnosed late in Australians.
“Due to a lack of readily available and accurate laboratory tests or biomarkers, many patients of advanced liver cancer live less than 12 months as treatment options are limited when patients are diagnosed at later stages,” she said.
Eating disorder help at hand
A series of programs for people with eating disorders is getting underway in WA.
The Body Esteem Program, developed and run by Women’s Health and Family Services, is the only community-based peer program in WA supporting people with eating disorders.
More than one million Australians are living with an eating disorder and less than a quarter receive treatment or support.
The WA program offers peer support groups including a youth program starting in May for 16-20 year olds (all genders, all eating disorders); a youth carer program also starting in May, an adults program for all genders aged 18 and over, starting in July; and an online program for rural and remote people (all genders, aged 18 and over, all eating disorders).
BEP is a free service for people with eating disorders such as anorexia nervosa, bulimia nervosa, binge eating disorder or other specified feeding and eating disorders.
It has been specifically designed to enable participants to take personal control of their recovery using the support and learned experience of peer-facilitators.
For more information or referrals go to whfs.org.au/services/eating-disorders/
Pioneering transplants give hope
The immune-boosting power of a healthy gut microbiome is being harnessed in an Australian-first “poo transplant” trial aimed at saving the lives of severely ill blood cancer patients and meeting an urgent need for new treatments.
The clinical trial is being led by QIMR Berghofer clinician-scientist Dr Andrea Henden at the Royal Brisbane and Women’s Hospital, using a biological product made by Australian Red Cross Lifeblood from the Rotary WA Health Innovation Centre in Perth.
Faecal microbiota transplant is emerging as a potential treatment for a range of conditions. Trillions of gut microbes from the stool of a healthy donor are transferred into a patient to replenish their depleted gut microbiome and improve their immune response to fight disease.
This is the first time FMT will be trialled in Australia in blood cancer survivors who have developed severe Graft-versus-Host-Disease, which is caused by their lifesaving bone marrow transplant when donor immune cells attack the recipient’s organs and tissues.
“A bone marrow transplant can be a double-edged sword. It saves the lives of people with aggressive blood cancers but can then take their lives by causing GVHD,” Dr Henden said.
“GVHD is particularly hard to treat in the gut, with patients often hospitalised for long periods of time where they are dependent on hospital care and intensive immune suppressing medications. Conventional immune-suppressing steroid medication fails to work in half of all GVHD patients.
“FMT is a really exciting new approach that could save lives. If we can restore a healthy gut microbiome in these patients, we can potentially influence immune function in the gut and treat the GVHD in a safer way that preserves the patient’s immunity.”
Lifeblood is at the forefront of FMT development in Australia, becoming the first licensed FMT manufacturer 18 months ago, and now offering the product to hospitals Australia-wide.
Just like blood donors, microbiota donors are screened. Stool is collected from volunteers and then processed and tested at Lifeblood’s TGA-licensed facility before being supplied to researchers and clinicians.
The research also hopes to discover if a specific microbe or its derivative is responsible for improving GVHD during faecal transplant, with a goal of eventually being able to offer patients a simpler targeted supplement or tablet that treats their disease.
New information uncovered by the trial could lead to more effective treatments for conditions such as Crohn’s disease and ulcerative colitis.
Robotic knees-up
St John of God Murdoch Hospital has become first hospital in Perth to introduce a type of robotic surgery technology to replace worn knees.
The VELYS Robotic-Assisted Solution helps surgeons perform knee replacement surgery that can be tailored to each patient, and is designed
to provide digital precision and accuracy to get them mobile quickly.
Orthopaedic surgeon Associate Professor Chris Jones, who played an advisory role in the robot’s development, performed the first knee replacement surgery in WA using the VELYS system at SJOG Murdoch.
The technology is designed to help surgeons achieve a well-balanced and precisely positioned total knee replacement, without the need for pre-operative CT scans.
On average, SJOG Murdoch does about 1300 total knee replacements a year, with this number predicted to increase rapidly over the coming years due to the ageing population and obesity crisis.
The robotic system is also being installed at several other SJGHC hospitals including Bunbury, and Geelong and Ballarat in Victoria.
Vale Simone McMahon
Organ donor activist Simone McMahon – WA’s Young Australian of the Year for 2008 – passed away last month at the age of 40.
Born with poor kidney function and suffering chronic renal failure by the age of nine, Simone had a kidney transplant when she was 11. After becoming unwell about 15 years ago, she was forced back onto dialysis. After failing to find a new kidney on the living donor transplant list, she then went on a deceased donor list.
Simone spent her life promoting organ and tissue donation and was a wish granter with the Starlight Foundation, spending much of her time supporting seriously ill children.
She was also a law graduate and Churchill Fellow recipient, whose scholarship allowed her to identify successful international models of organ and tissue donation and look at ways to support transplant recipients, donor families and living donors.
Simone volunteered for Transplant Australia, later becoming the founder and CEO of Organ Donation and Transplant Foundation of WA. She was made a Member of the Order of Australia in 2013.
A pain in the back
A study into the safety and effectiveness of painkillers to treat low-back pain has raised questions about their value.
The evaluation of analgesic medicines for acute, non-specific low-back pain found that uncertainty remained around their overall impact on pain relief and safety.
The study, published in BMJ, looked at 69 different medicines or combinations of analgesics. These included non-steroidal anti-inflammatory drugs, paracetamol, opioids, anticonvulsants, antidepressants, skeletal muscle relaxants and corticosteroids, to compare their effectiveness for adults with acute low-back pain.
The review concluded that clinicians should take a cautious approach in the use of analgesics and make treatment decisions in consultation with patients to address their specific causes of pain, severity of symptoms and individual preferences.
Dr Matthew Bagg, a research fellow at Curtin University, the Perron Institute and NeuRA, had a leading role in setting up the study and supervised it.
“Using meta-analysis, this has been the most comprehensive evaluation of its kind to inform clinical decision-making,” Dr Bagg said.
“It’s encouraging that these study results indicate the kind of trials that are necessary. At the completion of each new trial, we’ll systematically update the overall evidence base.”
Researchers found that while analgesics could provide effective pain relief for some patients, the impact on individual patients varied.
They said it was important for clinicians to take into account patients’ medical histories and tolerance for side effects to determine the most effective and safe treatment.
Back pain continues to be the number one cause of disability worldwide. According to the Royal Australian College of General Practitioners, musculoskeletal concerns are the second-most common reason for GP visits, after psychological concerns.
Most people who visit their doctor for acute non-specific low back pain, defined as low-back pain lasting fewer than six weeks, are prescribed an analgesic to manage their symptoms.