Over that last year Global Family Doctor has reported several studies showing that higher fat content in diets is healthy. The latest one this week by Esposito et al showed that newly diagnosed diabetics who were instructed to follow a Mediterranean diet with 40% fat content had better blood sugar control, better cholesterol reduction, less use of oral hypoglycemic medicines, and more weight loss that those instructed to follow a standard diabetic diet.

In June 2009 we reported the study by Jenkins et al showing that a diet high in plant-based fat lowered cholesterol. A systematic review by Mente et al that we reported in April showed benefit of Mediterranean diet and intake of fish oils for prevention of heart disease. In January we reported a study by Salas-Salvado et al in which Mediterranean diet plus 30 g daily of mixed nuts decreased the risk among people with metabolic syndrome to advance to diabetes type 2 compared with Mediterranean diet alone.

It seems like time to abandon low fat diets and recommend good fat diets instead.

The two Fs of politics: fascination and frustration. The convoluted ins and outs of political decision making are, like most complex systems, a challenge to understand and difficult to predict. The closer you are to the seat of decision making, the better is your predictive ability. So right now I am developing a political predictive tool and I have started a pilot study to predict whether a nation of 4 million humans and 40 million sheep will have a prostate screening program. It could be potentially a big program although a colleague from NZ's largest off shore island (the big one north of Tasmania) did note that you would have to exclude all the ewes and wethers from the program. PS NZ = New Zealand, not a state of Australia or somewhere near New Mexico

Seriously, NZ could become famous as the first nation in the world to have a national prostate cancer screening program. The decision could be made by a group of politicians who will consult with evidence experts, urological and cancer specialists and men who have prostate cancer.  
This heady combination should be balanced by a patient perspective, especially men who do not have prostate cancer and have never been screened. Trouble is the complexity of the issue means that it is very difficult to find such men who are sufficiently well enough informed to be able to provide sufficient insight into the real patient perspective on prostate screening.

The very nature of the political enquiry is that squeaky wheels are the loudest, but consulting with the likes of a prostate cancer men's group is rather akin to asking the Ford Falcon Owners Club what is the best car to buy.  Similarly the specialists medical groups for whom a large percentage of their work load is prostate cancer will have a viewpoint resultant from a highly selected patient population. Hopefully a highly selected disease based viewpoint will be balanced by a generalist perspective (i,e, family physician) uncontaminated by specialist opinion. After all in most countries where generalists are the gatekeeper of health. It is us who actually do the screening. The specialists     only investigate those who have already been identified as having a potential abnormality.

So look at the politicians who will potentially make the decision. Trying to guess bias associated with political identification (left wing, right wing, Tory, Liberal, conservative, socialist what ever) seems impossible to predict. More importantly, health literacy and personal reflective ability of the politicians should be the influencing factor in this. Can they recognise bias, can they understand science and evidence, are they reflective, can they step outside of political party lines? I hope so :-) and perhaps some of them can, but if we as a profession fail to acknowledge our biases and poor understanding of evidence, we should not expect any different from a political committee.

Reality is that any decision made by the committee will not be right. It could fly in the face of evidence, ignore patient autonomy, fail to oil the squeaky wheels or be one big fiscal drag. Damned if they do, damned if they don't. I hope they will ultimately consider the patient perspective, that of men considering being screened and not that of the Ford Falcon Owners Club.

Right now our little town is in the grip of the swine flue pandemic. Its officially an epidemic.  The reported rate of influenza presentations in the last two weeks in the 6 practices has sky-rocketed, being about 5 times the normal seasonal rate of influenza presentation. (Its winter here)

There are many lessons that we have already learnt, with clearly significant success from the “stay at home” message for at least in our practice we are only seeing the reasonably sick patients and alas those who can't read or hear the public health messages. We haven't been overrun with patients yet....Clearly good practice and public health organisation has allowed the development of systems to cope with the high number of sick fortunately only about 1% of whom require intervention. A great practice for a more virulent epidemic.

Talking with other medical centres, it seems that good practice management is key to handling the problem, particularly focusing on barrier hygiene and isolation techniques. You have to combine this with skilled reception staff and excellent phone nurse triage but it works. 

Funny thing is that a little over a couple of months ago the idea of barrier techniques was being  laughed at by most docs including the author. That was until my practice manager and I visited a couple of practices in Toronto where the SARS epidemic had such an impact on primary care. To see practices where curtains were not used for patient privacy was a little surprising until our good host from McMaster Uni pointed out the reservoir of viruses and bacteria that such niceties provided.

This evening, at a public health meeting for all primary care, the hygiene strategy was emphasised. However the idea that we should removed curtains was laughed down as being “over the top” although I note that we were discouraged from having seats with “furry” seat covers. Now I admit that there is a significant difference between seat cover material and curtains, but I have a faint suspicion that we will come to change our views on this. History does not repeat itself, just that doctors make the same old mistakes.

Another interesting observation from the epidemic to date has been the fact that the “hard to reach” have become the most likely to suffer. The non European population, especially itinerant workers here to prune the 1000s of hectares of grapes in the valleys suffer more because of both language and also cultural problems. The former issue is blindingly obvious, but some of the social behaviour, especially “sickness behaviour” such as whole families visiting when someone becomes sick, clearly facilitates infection spread. Interestingly one important cultural group has already altered the practice of kissing greeting at meetings in response to the epidemic.

There must be other models of this type of social change out there.