Policy our lives depend on: Health research in election 2014

We all care about health – ours, our family’s, and even that of one or two politicians (perhaps). We also care that the 15 billion dollar annual health budget is spent on health care that works.  I contend that both these cares are only as good as the health research that underpins the treatments we receive.  Therefore, I have compiled what I could discover about health research policy from the policy documents available online of the political parties contending the current NZ general election. I have tried to focus on where health research in a particular area is promised or on health research infrastructure. In some places I’ve extracted from a more general science and/or innovation policy those policies I think likely to impact health research.  Obviously some parties are still releasing policy.  I invite them to send me any policies that they think relevant and I will update.  I think you will be surprised at what is missing in the list below.

The parties are in reverse alphabetical order.

United Future*

Health Policy: http://www.unitedfuture.org.nz/policy/health

  • Increase funding for health research to bring New Zealand’s funding up to at least the OECD average as a proportion of GDP;
  • Establish a national register for Type 1 Diabetes, a diabetes research fund, and increase funding for Type 2 Diabetes testing;
  • Make no change to the legal status of cannabis for medicinal use until a robust regulatory testing regime is developed that proves cannabis use causes minimal harm to an individual’s health
  • Introduce a sabbatical scheme that would allow health professionals to take a year out of work every five years to update their skills and knowledge;
  • Promote more research to address youth related health problems such as suicide, alcoholism, and bulimia.

Science Policy: http://www.unitedfuture.org.nz/policy/research-science-and-technology

Too long to put in detail, but policies such as “simplifying different funding mechanisms” and specifying biotech as one of half a dozen key research areas requiring focus are likely to impact on health research.

Health spokesperson (Associate Minister of Health): Peter Dunne MP peter.dunne@parliament.govt.nz

 

New Zealand First

Health Policy: http://nzfirst.org.nz/policy/health

  • Ensure an on-going commitment to the funding of health research, research institutes, and for training.

Science Policy: None

RS&T Portfolio holder: Tracey Martin MP tracey.martin@parliament.govt.nz

Health Portfolio holder: Barbara Steward MP   barbara.stewart@parliament.govt.nz

 

National

Health Policy: https://www.national.org.nz/news/features/health

No specific policy on any health research

Science Policy: None

Health spokesperson (Minister of Health): Tony Ryall tony.ryall@national.org.nz

Science spokesperson (Minister of Science and Innovation): Steven Joyce steven.joyce@national.org.nz

 

Maori Party

Policy: http://maoriparty.org/our-policies-kawanatanga/

  • We will support: … Roadshows to promote educational pathways in areas where Māori are under-represented – ie health science academies (Te Kura Pūtaiao Hauora) or science camps.

Science Policy: No specific policy but some comments in the policy above about research and development include establishing an investment fund for Māori Research and Development which may impact on health research.

Health or Science spokespeople: Unknown

Contact: Teururoa Flavell MP teururoa.flavell@parliament.govt.nz

 

Mana

Health Policy: http://mana.net.nz/policy/policy-health/

No policy specifically dealing with health research

Science Policy: None

Contact: Hone Harawira MP hone.harawira@parliament.govt.nz

 

Labour

Health Policy: http://campaign.labour.org.nz/full_health_policy

  • We need a health system that is based on evidence about what works – not fixated on manufactured targets or political slogans

Health spokesperson: Annette King annette.king@parliament.govt.nz

Science Policy: No specific science policy. Within the Tertiary Education policy it says:

  • support research in universities, including through:
    • a continued commitment to Centres of Research Excellence,
    • ensuring the sustainability of the Marsden Fund and other research funds
    • supporting the career pathways of graduates, to encourage our researchers to develop their careers and contribute to New Zealand.

Science Policy: None

Science Spokesperson: Moana Mackey MP moana.mackey@parliament.govt.nz

 

Internet

Health Policy: https://docs.google.com/document/d/1g4RY7Sh-vYZN1WAIx_A-AEZlYzNjMhzY81KnfKLMGp0/edit

Copyright and Open Research Policy: https://docs.google.com/document/d/1Le3rY0wlh9tJaBzpxK5xrpeWID-j5FmeE4dqONdQATE/edit

  • Mandate that all taxpayer-funded research be open access with the public able to freely access and re-use it.

Health or Science spokespeople: Unknown

Contact: hello@internet.org.nz

 

Green

Health Policy: No general health policy, but some on particular issues.

No policy specifically dealing with health research.

Green innovation Policy: https://www.greens.org.nz/policy/smarter-economy/smart-green-innovation

Some aspects of this policy may impact health research, in particular:

  • $1 billion of new government funding over three years for research and development to kick-start a transformational shift in how our economy creates wealth;
  • The Green Party will fund an additional 1,000 places at tertiary institutions for students of engineering, mathematics, computer science, and the physical sciences.

Health or Science spokespeople: Unknown

Contact greenparty@greens.org.nz

 

Conservatives

Health Policy: None

Science Policy: None

Health or Science spokespeople: Unknown

Contact: Office@conservativeparty.org.nz

 

ACT

Health Policy: http://www.act.org.nz/policies/health-0

No policy specifically dealing with health research

Science Policy: No science policy

Health or Science spokespeople: Unknown

Contact: info@act.org.nz

________________________________________________________________________________________________

*Disclaimer: I used to be a member of United Future and made submissions on the health and science policies in 2008. A few echoes of those submissions remain in the policies.

Cheesecake files: A stadium full

As we’ve been enjoying the World Cup and the Commonwealth Games my latest cheesecake appeared in print online. The topic once more is Kidney Attack biomarkers – those pesky little proteins in the urine that appear when your kidney is injured.  This time I have been getting stuck into some math (sorry) to try and understand what it is that affects when these biomarkers appear in the urine after injury.  I call this a biomarker time-course.  A “Pee Profile” may be a better term but it would never get past the editor.  What I care about is whether the type of biomarker and/or extent of injury, affects the pee profiles.

There are three basic types of biomarkers.  First are those that are filtered from the blood by the two million odd filters in the kidney.  Often they are then reabsorbed back into the blood in the little tubules where the pee is produced – that is, they don’t appear in the urine.  Think of it like a stadium with many entrances.  People (biomarkers) come in and sit down (are reabsorbed).  If, though, a section of the stadium has been fenced off because of broken seating from the previous game (the injury), then some of those entering the stadium may end up exiting it again (the pee biomarkers).  The numbers being reabsorbed and exiting will also depend on whether all the entrances are open – if some are closed then this will have a flow on affect on the rate of people leaving the stadium.

The second are preformed biomarkers.  If we change the analogy slightly, imagine these as people already in the stadium (if the analogy was accurate they would have been born there!).  If some terrible injury happens (like the 4th, 5th, 6th and 7th goals of a now famous football match) some of those people would get up and exit quickly.  The overall rate of exit would reflect on the extent of the injury.

The third, are induced biomarkers.  These are ones that don’t already exist, but are produced in response to an “injury.”  Instead of being biomarkers, let us think of the spectators as produces of these biomarkers and let noise be the biomarker.  There is some background noise of course, but when an “injury” (goal, gold medal performance etc) occurs there is a sudden increase in noise which slowly dies down.  Depending on the team and the number of supporters this will be softer or loader and will carry on for shorter or longer periods (Goooooooooooaaaaaaaaaaaa……lllllllllllll).

The upshot of it all were many coloured graphs and a step towards understanding how we may better make use of the various types of novel biomarkers of kidney injury that have been recently discovered.

PlosOneFigs

_____________

Pickering, J. W., & Endre, Z. H. (2014). Acute kidney injury urinary biomarker time-courses. PloS One. doi:10.1371/journal.pone.0101288

 

 

How to improve your citation record

Peter Griffin over on Griffin’s Gadgets published a fun post on New Zealand’s seven most influential scientists based on data collected by Thomson Reuters and available at http://highlycited.com. Apparently they are all in the top 1% of cited scientists.  The ODT was obviously impressed by all this number waving and boasted of one of Dunedin’s own being part of the elite.  I was devestated not to be on that list, so I got thinking how I could move up the rankings.  Using Google scholar instead of Thomson Reuters is better for the ego of course because they allow a broader range of journals to be counted as citing or citable.  Unfortunately, if everyone did this I’d not be ranked any better.  Alternatively, I could send tweets out to everyone whom I cited hoping they’d be good enough to cite me back.  If I was really smart, I’d choose to cite most frequently those who publish most often.  Then I came across an easy answer in this graph – I must publish in Multidisciplinary journals!  I better get on with it, only 1650 potential citing days till PBRF 2018 …

Number of cites per document v H index for New Zealand documents published 2011-12. Source: SCImago. (2007). SJR — SCImago Journal & Country Rank. Retrieved June 25, 2014, from http://www.scimagojr.com

Number of cites per document v H index for New Zealand documents published 2011-12.
Source: SCImago. (2007). SJR — SCImago Journal & Country Rank.
Retrieved June 25, 2014, from http://www.scimagojr.com

 

Happy birthday “New Zealand Science Today”

It’s one year, 2184 articles, 460 subscribers, and 11,721 “flips” since the online Flipboard magazine which collates articles about what NZ scientists are doing and saying was first published.  Thanks to all the contributors, and especially to all those out in NZ Science-ville who are making a difference and letting the world know about it.  New Zealand Science Today can be found on Flipboard or on the internet here.NZ Science Today

 

 

100 days to do something about diabetes

So the NZ election is about 100 days away.  I want action from the political parties on an issue that in the next decade could affect a million of us, shortening lives, and cost us tens of billions of dollars.  The issue is simply diabetes.  Already 7% of adults have diabetes and another 18.6% is on the way to getting it (“pre-diabetic”). For our medical system  – and all tax payers – this means billions.  For individuals it means shortened lives, amputations, dialysis, blindness etc etc etc.  For employers it means workers taking sick days. For communities and families it means missing grandparents. Surely this is the biggest health issue and one of the biggest economic issues facing the country.  Where is the media about it?  Where are the questions to the politicians? I’ve blogged before about the lack of specific and evidence based policy amongst the political parties.  Where are their new policies?

Here’s a promise – I will publish on this blog any policy of any registered NZ political party specifically aimed to slow the diabetes epidemic. Along side that policy I’ll publish any evidence that is supplied as to why the party thinks that policy will work.

Free advertising – surely all the parties will take this up?

Cheesecake files: Of bathtubs and kidneys

Sitting in the bathtub you notice that there is a slow leak around the plug.  You adjust the taps to maintain a flow of water that exactly counteracts the loss due to the leak; the water level stays constant.  This is called a steady state and the same thing happens with out kidneys and the molecule used to assess their function.  Our bodies generate creatinine at a constant rate which finds its way into the blood.  Under normal circumstances our kidneys excrete that creatinine into the urine at the same constant

rate.  The creatinine concentration in the blood, therefore, stays constant.  When our kidneys get injured (as they very often do in hospitalised patients) this is like plugging the leak.  Just as the water level in the bathtub would rise slowly – undetectable at first – so too does the creatinine concentration rise slowly.  It normally takes a couple of days to be noticed.  Most of my work has been about trying to detect this injury to the kidney early.  However, if the kidneys start to recover then excess creatinine is only slowly cleared from the blood by the kidney – a process that similarly can take a day or two before it is detected.  Just as not knowing if the kidneys have been harmed makes treatment and drug dosing difficult for the nephrologists and intensivists, so too is not knowing if they have recovered.  My latest publication (aka a cheesecake file) that has appeared in press presents a simple tool for the physicians to try and determine if kidney function has recovered after having been compromised.

This particular piece of work began when a St Louis Nephrologists (a kidney doc), Dr John Mellas, contacted me to say that although a manuscript of his had been rejected by reviewers, he thought there was merit and could I help him (he found me through a search of the literature).  I confessed to being one of the reviewers who had rejected the manuscript!  Fortunately, John was forgiving.  His problem was that he was called in to the intensive care unit to look at a patient with high blood creatinine concentration.  Should he put the patient on dialysis or should he wait?  If he knew if the kidney was already recovering, then he would be less likely to put on dialysis. We talked about the issue for a while and eventually settled on a possible tool which we could test by looking at the behaviour of creatinine over time in abut 500 patients in the ICU.  The tool is quite simple.  It is the ratio of the creatinine that is excreted to the creatinine that is generated.  If more creatinine is being generated than excreted then probably the kidney function is still below normal, however, if more is excreted than generated then probably the kidney is recovering.  The difficulty is that there is no way to measure in an individual what the creatinine generation is.  We ended up using equations based on age, sex, and weight to estimate creatinine generation.  This is a bit like using an equation which takes into account pipe diameter, mains water pressure, and how many turns of the screw the tap has had to determine the rate of water flow.  Creatinine excretion, though, can be easily measured by recording total urine production over several hours (we suggest 4h) and multiplying this by the concentration of creatinine in the urine.

We discovered that by using the ratio between estimated creatinine generation and creatinine excretion we were able to tell in most patients if the kidney was recovering or not.  My hope is that physicians will test this out for themselves.  The good thing is that it requires only minimal additional measurements (and costs) beyond what are already made in ICUs, yet may save many from expensive and invasive dialysis.

Pickering, J. W., & Mellas, J. (2014). A Simple Method to Detect Recovery of Glomerular Filtration Rate following Acute Kidney Injury. BioMed Research International, 2014. doi:10.1155/2014/542069

 

HRC success in Christchurch

The Health Research Council announced Programme and Project grant recipients.  Here’s the list from the Christchurch campus of the University of Otago in which I get a brief mention :).  If others have abstracts of successful grants they’d like posted on this blog, then please let me know.

*****Update: It’s come to my attention that this announcement sent to Uni Otago staff left off the investigator lists investigators who were not current University staff.  I’ve added a few I know about below, but here may be others left out of the list, sorry.  ****

Monday, 9 June 2014.

University of Otago, Christchurch researchers have been awarded more than $8 million of Health Research Council 2014 funding. The results were announced by Minister Steven Joyce at 11.30am today.

The funded projects are:

  • HRC Programme Grant to Professor Mark Richards: Heart Failure: markers and management ($4,980,858).
  • HRC Project Grant to Professor David Murdoch: Legionnaires’ disease in New Zealand: improving diagnostics and treatment ($999,467).
  • HRC Project Grant to Dr Ben Hudson: A randomised controlled trial of nortriptyline in knee osteoarthritis ($1,190,921).
  • HRC Project Grant to Professor Tim Anderson Genetics, brain imaging, and cognitive decline in Parkinson’s disease ($1,178,804).
  • Emerging Researcher First Grant to Dr Tracy Melzer: Imaging markers of imminent cognitive decline in Parkinson’s disease ($149,943).

A summary of each project follows:

HRC Programme Grant to Professor Mark Richards ($4,980,858)

Heart Failure: markers and management

Heart failure (HF) will affect 20% of people now aged 40 years and confers high rates of early readmission and death.  Professor Richards and his team will implement an integrated programme addressing unmet needs in HF including: (1) The IMPERATIVE-HF controlled trial of intensified immediate post-discharge management using special blood tests to individually grade risk and guide intervention with rapid adjustments to treatment to improve outcomes. (2) Testing of candidate kidney damage markers for early warning of this frequent and dangerous complication of HF. (3) Establishing correct sampling times for novel markers for best prediction of early and long term outcomes in HF. (4) Testing our newly discovered markers for early warning of pneumonia complicating HF. (5) Clarification of diagnoses and testing management plans for patients in the Emergency Department with breathlessness or chest pain who do not have clear-cut HF or heart attacks but who nevertheless have elevated blood biomarkers and a poor outlook.

Other investigators are: Prof Vicky Cameron, Prof Richard Troughton, A/Prof Chris Pemberton, A/Prof Miriam Rademaker, A/Prof Chris Frampton, Prof Chris Charles, Dr Leigh Ellmers, Medicine, A/Prof John Pickering, Dr Anna Pilbrow (all University of Otago). Professor Zoltan Endre (University of New South Wales), Dr Martin Than (ED, Christchurch District Health Board), Prof Robert Doughty (University of Auckland), Dr James Pemberton (Cardiology, Auckland District Health Board)

HRC Project Grant to Professor David Murdoch ($999,467)

Legionnaires’ disease in New Zealand: improving diagnostics and treatment

Legionnaires’ disease is a severe type of pneumonia that is under-diagnosed in New Zealand. Special tests are required to make a diagnosis of legionnaires’ disease, but there are no clear guidelines about which patients to test. An enhanced testing system for legionnaires’ disease was developed in Canterbury and has been used there since 2010. The system involves targeted use of the current best test for legionnaires’ disease: PCR(polymerase chain reaction), which detects bacterial DNA. This approach has uncovered many cases of legionnaires’ disease that would have otherwise gone undetected. This study will roll out this same testing strategy across New Zealand for one year in order to measure the national burden of legionnaires’ disease, toimprove patient treatment, to identify cost-effective ways to test for legionnaires’ disease in the future, and to create better guidelines for the treatment of pneumonia.

Other investigators: A/Prof Patricia Priest, Prof Stephen Chambers, Dr Ian Sheerin.

HRC Project Grant to Dr Ben Hudson ($1,190,921)

A randomised controlled trial of nortriptyline in knee osteoarthritis

Osteoarthritis (OA) is a very common and painful condition.  Medicines currently available for treating OA pain are not ideal: they are either inadequately effective or cause unpleasant or dangerous side effects. Recent research has shown how the brain processes pain in OA and this has opened up the possibility of using different types of medicines for OA pain.  Nortriptyline (an antidepressant) has been used to treat persistent pain in other conditions, and other antidepressants may reduce pain in knee OA.  It is not known whether nortriptyline is useful in this condition.  We plan to test this effect by randomly allocating participants to treatment with nortriptyline or placebo and to measure changes in their pain before and after a period on the medication.  We hope that this will tell us whether nortriptyline will be helpful.  If it is, then we believe that many people may benefit from taking this medicine.

Other investigators: Prof Les Toop, Prof Lisa Stamp, Dr Jonathan Williman, Prof Gary Hooper, A/Prof Dee Mangin, Ms Bronwyn Thompson

HRC Project Grant to Professor Tim Anderson ($1,178,804)

Genetics, brain imaging, and cognitive decline in Parkinson’s disease

Many people with Parkinson’s are at risk of dementia but scientists and clinicians have been unable to predict when that will occur. Professor Tim Anderson and his team will do advanced brain scans (MRI and PET) gene testing and clinical evaluations in 85 Parkinson’s patients who have mild cognitive impairments, who are known to be at higher risk, and then determine whether they progress to dementia over the subsequent three years. By identifying characteristics present in the scans and genetic tests of those who develop dementia, compared to those who do not, Professor Anderson and his team can advance understanding of this important issue and establish a useful and reliable tool for researchers and clinicians. It is critical to do this so that preventative treatments to protect against dementia can be targeted at the most appropriate patients when that treatment becomes available and also to select the right ‘at risk’ Parkinson’s patients for trials of new treatments.

Other investigators are: Prof Martin Kennedy, Dr Tracy Melzer, Dr John Pearson.  Prof. John Dalrymple-Alford (University of Canterbury), Dr Ross Keenan (CDHB, Christchurch Radiology Group), Prof. David Miller (University College London)

HRC Emerging Researcher First Grant to Dr Tracy Melzer ($149,943)

Imaging markers of imminent cognitive decline in Parkinson’s disease.

Most Parkinson’s disease (PD) patients eventually develop dementia, which is the most burdensome aspect of this progressively worsening condition.  Mild cognitive impairments often indicate imminent dementia, but the two to 20 year time course poses a major problem for medical interventions, as brain changes associated with dementia in PD are still poorly understood.  Recent evidence suggests that neurodegenerative diseases such as PD progress along discrete brain networks.  One important network, known as the ‘default mode network’ appears particularly susceptible to neurodegeneration. Dr Melzer and his team will examine this network to determine if its disruption can specify which PD patients are vulnerable to progression to dementia within the next two years. A sophisticated but readily available brain imaging technique, called resting state functional imaging, will be used. These measures will assist in the selection of the most suitable patients for new treatments that may delay or prevent subsequent dementia in this vulnerable population.

The other investigator is: Prof Tim Anderson. Prof. John Dalrymple-Alford (University of Canterbury), Dr Ross Keenan (CDHB, Christchurch Radiology Group), Dr Daniel Myell (NZ Brain Research Institute)