Quiet 'missing middle' kids left struggling at school
It was during COVID-19 lockdowns that she began noticing her kindergarten son struggling with reading and literacy.
When he returned to normal lessons at school he was getting top marks for effort, but his learning difficulties were discouraging him by year 3.
"We had a lot of pushback about attending school and not wanting to be there, but when he was there he was wonderful and his teachers loved him," said Lizzy, a mum from rural NSW who asked not to use her surname.
"Then he'd come home and he'd just completely implode.
"They couldn't see the frustration and pressure because he was masking it during the day."
Lizzy's son falls into what rural psychologist Tanya Forster describes as "the missing middle".
These are the often compliant and quiet children whose learning difficulties may go unnoticed in under-resourced public schools, particularly in rural and regional areas.
Their delays also often don't fall into the narrow diagnostic eligibility for further learning support in the education system.
"The pressure on (teachers) in the classroom is really considerable and the way that the school system is designed, it's still quite a traditional model," says Ms Forster, who leads the Macquarie Health Collective in Dubbo.
"Unfortunately, at the moment, it's not necessarily meeting the inclusive needs of modern-day students."
The situation is likely borne out in the recent NAPLAN results, which show one-in-10 Australian students need more help to meet basic education standards.
NAPLAN also confirmed an enduring regional divide with just 20 per cent of students in very remote areas exceeding expectations, compared to 70 per cent of their city peers.
"The results tell us a lot about what we probably already know: that there are lots of kids at school that are struggling," Ms Forster told AAP.
"Unfortunately, many of those kids can't access the support that they really need."
Federal Education Minister Jason Clare says while there are some encouraging signs of improvement in numeracy and literacy, the results show there is more work to do.
All states and territories have signed agreements with the government to fix public school funding, Mr Clare says.
"This funding is tied to real and practical reforms," he said in a statement issued on Wednesday.
"Phonics checks and numeracy checks to identify students who need additional support, and evidence-based teaching and catch-up tutoring to help them keep up and catch up."
But regional families come up against other deeply entrenched problems, such as poor access to specialist services.
There were 53 specialists per 100,000 people in remote areas in 2022, compared to 160 in the cities, with years-long public waitlists for developmental assessments with pediatricians in the regions.
Disasters such as floods, fires and COVID-19 may have pushed regional kids out of school, with the non-attendance rate at 14.6 per cent compared to the pre-pandemic level of 10.6 per cent, according to a Jobs and Skills Australia report.
The report recommended a suite of changes to re-engage and motivate young people, including linking them with local mentors and employers outside schools.
While health and education reforms slowly work away in the background, former high school teacher Shannon Chapman says families can look at NAPLAN results as an opportunity to explore children's strengths.
"NAPLAN results do not capture valuable skills and knowledge, such as a student's resilience, confidence, their creativity, their leadership," said Ms Chapman, a teaching and learning facilitator at the Dubbo clinic.
"You probably do have this incredibly well-rounded child that may have below the standard NAPLAN results, but that does not capture a lot of skills and knowledge."
Like many rural parents, Lizzy went to the private health system to receive a formal diagnosis for her son.
That has opened up valuable learning and support programs, sparking a change in her son that's like "night and day".
"I am grateful for the team we were able to eventually access, but I'm more worried about the people that don't have that or it's not accessible," she said.
"You have to fight really hard to get it and to be seen and heard."
Lizzy is a proud mother of two rambunctious boys who love playing with their friends, kicking the footy and swimming.
It was during COVID-19 lockdowns that she began noticing her kindergarten son struggling with reading and literacy.
When he returned to normal lessons at school he was getting top marks for effort, but his learning difficulties were discouraging him by year 3.
"We had a lot of pushback about attending school and not wanting to be there, but when he was there he was wonderful and his teachers loved him," said Lizzy, a mum from rural NSW who asked not to use her surname.
"Then he'd come home and he'd just completely implode.
"They couldn't see the frustration and pressure because he was masking it during the day."
Lizzy's son falls into what rural psychologist Tanya Forster describes as "the missing middle".
These are the often compliant and quiet children whose learning difficulties may go unnoticed in under-resourced public schools, particularly in rural and regional areas.
Their delays also often don't fall into the narrow diagnostic eligibility for further learning support in the education system.
"The pressure on (teachers) in the classroom is really considerable and the way that the school system is designed, it's still quite a traditional model," says Ms Forster, who leads the Macquarie Health Collective in Dubbo.
"Unfortunately, at the moment, it's not necessarily meeting the inclusive needs of modern-day students."
The situation is likely borne out in the recent NAPLAN results, which show one-in-10 Australian students need more help to meet basic education standards.
NAPLAN also confirmed an enduring regional divide with just 20 per cent of students in very remote areas exceeding expectations, compared to 70 per cent of their city peers.
"The results tell us a lot about what we probably already know: that there are lots of kids at school that are struggling," Ms Forster told AAP.
"Unfortunately, many of those kids can't access the support that they really need."
Federal Education Minister Jason Clare says while there are some encouraging signs of improvement in numeracy and literacy, the results show there is more work to do.
All states and territories have signed agreements with the government to fix public school funding, Mr Clare says.
"This funding is tied to real and practical reforms," he said in a statement issued on Wednesday.
"Phonics checks and numeracy checks to identify students who need additional support, and evidence-based teaching and catch-up tutoring to help them keep up and catch up."
But regional families come up against other deeply entrenched problems, such as poor access to specialist services.
There were 53 specialists per 100,000 people in remote areas in 2022, compared to 160 in the cities, with years-long public waitlists for developmental assessments with pediatricians in the regions.
Disasters such as floods, fires and COVID-19 may have pushed regional kids out of school, with the non-attendance rate at 14.6 per cent compared to the pre-pandemic level of 10.6 per cent, according to a Jobs and Skills Australia report.
The report recommended a suite of changes to re-engage and motivate young people, including linking them with local mentors and employers outside schools.
While health and education reforms slowly work away in the background, former high school teacher Shannon Chapman says families can look at NAPLAN results as an opportunity to explore children's strengths.
"NAPLAN results do not capture valuable skills and knowledge, such as a student's resilience, confidence, their creativity, their leadership," said Ms Chapman, a teaching and learning facilitator at the Dubbo clinic.
"You probably do have this incredibly well-rounded child that may have below the standard NAPLAN results, but that does not capture a lot of skills and knowledge."
Like many rural parents, Lizzy went to the private health system to receive a formal diagnosis for her son.
That has opened up valuable learning and support programs, sparking a change in her son that's like "night and day".
"I am grateful for the team we were able to eventually access, but I'm more worried about the people that don't have that or it's not accessible," she said.
"You have to fight really hard to get it and to be seen and heard."
Lizzy is a proud mother of two rambunctious boys who love playing with their friends, kicking the footy and swimming.
It was during COVID-19 lockdowns that she began noticing her kindergarten son struggling with reading and literacy.
When he returned to normal lessons at school he was getting top marks for effort, but his learning difficulties were discouraging him by year 3.
"We had a lot of pushback about attending school and not wanting to be there, but when he was there he was wonderful and his teachers loved him," said Lizzy, a mum from rural NSW who asked not to use her surname.
"Then he'd come home and he'd just completely implode.
"They couldn't see the frustration and pressure because he was masking it during the day."
Lizzy's son falls into what rural psychologist Tanya Forster describes as "the missing middle".
These are the often compliant and quiet children whose learning difficulties may go unnoticed in under-resourced public schools, particularly in rural and regional areas.
Their delays also often don't fall into the narrow diagnostic eligibility for further learning support in the education system.
"The pressure on (teachers) in the classroom is really considerable and the way that the school system is designed, it's still quite a traditional model," says Ms Forster, who leads the Macquarie Health Collective in Dubbo.
"Unfortunately, at the moment, it's not necessarily meeting the inclusive needs of modern-day students."
The situation is likely borne out in the recent NAPLAN results, which show one-in-10 Australian students need more help to meet basic education standards.
NAPLAN also confirmed an enduring regional divide with just 20 per cent of students in very remote areas exceeding expectations, compared to 70 per cent of their city peers.
"The results tell us a lot about what we probably already know: that there are lots of kids at school that are struggling," Ms Forster told AAP.
"Unfortunately, many of those kids can't access the support that they really need."
Federal Education Minister Jason Clare says while there are some encouraging signs of improvement in numeracy and literacy, the results show there is more work to do.
All states and territories have signed agreements with the government to fix public school funding, Mr Clare says.
"This funding is tied to real and practical reforms," he said in a statement issued on Wednesday.
"Phonics checks and numeracy checks to identify students who need additional support, and evidence-based teaching and catch-up tutoring to help them keep up and catch up."
But regional families come up against other deeply entrenched problems, such as poor access to specialist services.
There were 53 specialists per 100,000 people in remote areas in 2022, compared to 160 in the cities, with years-long public waitlists for developmental assessments with pediatricians in the regions.
Disasters such as floods, fires and COVID-19 may have pushed regional kids out of school, with the non-attendance rate at 14.6 per cent compared to the pre-pandemic level of 10.6 per cent, according to a Jobs and Skills Australia report.
The report recommended a suite of changes to re-engage and motivate young people, including linking them with local mentors and employers outside schools.
While health and education reforms slowly work away in the background, former high school teacher Shannon Chapman says families can look at NAPLAN results as an opportunity to explore children's strengths.
"NAPLAN results do not capture valuable skills and knowledge, such as a student's resilience, confidence, their creativity, their leadership," said Ms Chapman, a teaching and learning facilitator at the Dubbo clinic.
"You probably do have this incredibly well-rounded child that may have below the standard NAPLAN results, but that does not capture a lot of skills and knowledge."
Like many rural parents, Lizzy went to the private health system to receive a formal diagnosis for her son.
That has opened up valuable learning and support programs, sparking a change in her son that's like "night and day".
"I am grateful for the team we were able to eventually access, but I'm more worried about the people that don't have that or it's not accessible," she said.
"You have to fight really hard to get it and to be seen and heard."
Lizzy is a proud mother of two rambunctious boys who love playing with their friends, kicking the footy and swimming.
It was during COVID-19 lockdowns that she began noticing her kindergarten son struggling with reading and literacy.
When he returned to normal lessons at school he was getting top marks for effort, but his learning difficulties were discouraging him by year 3.
"We had a lot of pushback about attending school and not wanting to be there, but when he was there he was wonderful and his teachers loved him," said Lizzy, a mum from rural NSW who asked not to use her surname.
"Then he'd come home and he'd just completely implode.
"They couldn't see the frustration and pressure because he was masking it during the day."
Lizzy's son falls into what rural psychologist Tanya Forster describes as "the missing middle".
These are the often compliant and quiet children whose learning difficulties may go unnoticed in under-resourced public schools, particularly in rural and regional areas.
Their delays also often don't fall into the narrow diagnostic eligibility for further learning support in the education system.
"The pressure on (teachers) in the classroom is really considerable and the way that the school system is designed, it's still quite a traditional model," says Ms Forster, who leads the Macquarie Health Collective in Dubbo.
"Unfortunately, at the moment, it's not necessarily meeting the inclusive needs of modern-day students."
The situation is likely borne out in the recent NAPLAN results, which show one-in-10 Australian students need more help to meet basic education standards.
NAPLAN also confirmed an enduring regional divide with just 20 per cent of students in very remote areas exceeding expectations, compared to 70 per cent of their city peers.
"The results tell us a lot about what we probably already know: that there are lots of kids at school that are struggling," Ms Forster told AAP.
"Unfortunately, many of those kids can't access the support that they really need."
Federal Education Minister Jason Clare says while there are some encouraging signs of improvement in numeracy and literacy, the results show there is more work to do.
All states and territories have signed agreements with the government to fix public school funding, Mr Clare says.
"This funding is tied to real and practical reforms," he said in a statement issued on Wednesday.
"Phonics checks and numeracy checks to identify students who need additional support, and evidence-based teaching and catch-up tutoring to help them keep up and catch up."
But regional families come up against other deeply entrenched problems, such as poor access to specialist services.
There were 53 specialists per 100,000 people in remote areas in 2022, compared to 160 in the cities, with years-long public waitlists for developmental assessments with pediatricians in the regions.
Disasters such as floods, fires and COVID-19 may have pushed regional kids out of school, with the non-attendance rate at 14.6 per cent compared to the pre-pandemic level of 10.6 per cent, according to a Jobs and Skills Australia report.
The report recommended a suite of changes to re-engage and motivate young people, including linking them with local mentors and employers outside schools.
While health and education reforms slowly work away in the background, former high school teacher Shannon Chapman says families can look at NAPLAN results as an opportunity to explore children's strengths.
"NAPLAN results do not capture valuable skills and knowledge, such as a student's resilience, confidence, their creativity, their leadership," said Ms Chapman, a teaching and learning facilitator at the Dubbo clinic.
"You probably do have this incredibly well-rounded child that may have below the standard NAPLAN results, but that does not capture a lot of skills and knowledge."
Like many rural parents, Lizzy went to the private health system to receive a formal diagnosis for her son.
That has opened up valuable learning and support programs, sparking a change in her son that's like "night and day".
"I am grateful for the team we were able to eventually access, but I'm more worried about the people that don't have that or it's not accessible," she said.
"You have to fight really hard to get it and to be seen and heard."
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Sydney Morning Herald
5 hours ago
- Sydney Morning Herald
Deanna tried IVF with the lot. None of the costly, unproven add-ons worked, so she went back to basics
Australia's health ministers last month ordered a rapid review of the nation's assisted reproductive sector following a series of bungles and scandals, to determine if greater regulation can increase the safety and transparency of fertility clinics. Victoria is leading the national review, and a Victorian government spokesperson confirmed IVF add-on services would be included in consideration of existing or potential new legislative framework. 'A dedicated team has been established to undertake the review and will report back within three months,' the spokesperson said. Australia has the fifth-highest rate of IVF, fuelled by the strength of the commercial fertility sector and Medicare rebates with broad eligibility criteria that mean patients can continue coming back for cycles regardless of their chances of success. Four out five women accessing IVF also use add-on services during their treatment, which can greatly add to their costs as well as the profits and marketability of the clinics, but which may not increase the chances of success. An analysis of the non-core services being offered to Australian fertility patients by University of Melbourne researchers, prepared for this masthead, highlights the high costs and lack of evidence supporting services commonly upsold to potentially emotionally vulnerable patients. It reveals 44 treatment types ranging from free to $5000, and taking in everything from vitamins to plasma being injected into ovaries, genetic testing of embryos, injecting a single sperm directly into an egg and endometrial scratching, have little to no influence on the chances of having a live birth, pregnancy or miscarriage. Loading The analysis follows the launch of the Evidence-based IVF website in April, which is led by the University of Melbourne's Dr Sarah Lensen as an effort to better inform people undergoing IVF of the unproven add-ons. 'There are research articles out there on these different add-ons but the quality, broadly speaking, is really poor. Different providers are willing to draw the line in different places in terms of how much evidence they think they need before they're willing to offer or recommend something,' Lensen said. 'Sometimes there's a cost for special IVF conception vitamins or whatever, but they're probably pretty low risk, and they're not as big of a deal. 'Down the other end of the spectrum, there's the super-expensive $1000 treatment options that also come with risks because they're playing with patients' immune systems or injecting things into their ovaries that we don't really know what's going to happen. 'A lot of the add-ons that get offered slip through the cracks in terms of the existing regulatory system.' In Deanna Carr's case, she underwent two normal but unsuccessful cycles of IVF before adding steroids, blood thinners, aspirin and clexane during two further cycles. Determined more had to be done, Carr followed advice from online fertility forums and moved to one of Australia's largest clinics to seek out a specialist known for pushing the envelope. 'There's lots of conversation about which specialists to see, because these specialists are willing to be a lot more experimental – and, when we say experimental, it is literally meaning experimental. 'They're willing to try more add-ons, regardless of how inclined the research is to say that it doesn't work.' Tests at that clinic found Carr had a partial DQ Alpha gene match which may make her body more likely to attack or reject an embryo, though research suggests treatment for it does not significantly improve IVF success rates. To address the issue, a team of specialists gave Carr lymphocyte membrane immunotherapy, in which up to eight vials of blood were taken from her husband so his white blood cells could be extracted and then injected into her arm to correct her immune system with material that is genetically matched to their embryo. 'It's like weird blood brother stuff, and quite expensive,' Carr said. She was given a toxic cocktail of drugs including naltrexone and tacrolimus, which are more commonly used to treat cancer, as well as an intralipid infusion to 'knock out' her immune system. Added together, this cycle cost more than $8000. 'It didn't work. It ended up the same way all our other cycles ended,' she said. Carr's specialists then offered to step up the add-on treatments even further. They proposed a $5000 EMMA and ALICE test which would have seen Carr undergo another full IVF cycle but, rather than try for a pregnancy, the doctors would take a biopsy of her uterus to see if bacteria were present that might be impacting her pregnancies. If it found abnormalities, Carr was then to be prescribed cefalexin – a common antibiotic used for infections and cheaply available on the Pharmaceutical Benefits Scheme. 'It's what the doctor would give you for a sore throat. Why would they make me pay five grand for it? Why not just give me the medication?' Rather than spending $12,000 for another add-on-laden IVF cycle, Carr consulted the Evidence-based IVF site and realised there was little science to support the proposed treatment, then switched clinics to undergo a traditional – and successful – cycle. 'You get persuaded to add on because you obviously want it to work, and you're already spending so much, so this can financially tip you over the edge,' she said. 'A lot of these IVF companies know that. It does feel really unethical [because] a lot of the time people aren't being provided with proper information around the add-ons that are being suggested and the efficacy around them. And people are really desperate, so they'll just keep saying yes to things.' A Macquarie University professor of bioethics in the discipline of philosophy, Wendy Lipworth, last year published a study based on interviews with 31 doctors working in assisted-reproductive technology to see what their 'moral justification' for using add-ons was. The specialists' responses revealed evidence and innovation was not the driving consideration in many instances, and that regulatory reforms to only allow the use of unproven treatments in the context of formal scientific evaluation might be required. Lipworth said add-ons were often marketed as a point of difference between clinics, which may undermine individual doctors' ability not to offer them for patients. As a result, she believes any new regulation would need to focus on the clinics and what they are offering, rather than individual doctors wanting the best for their patients. 'Generally, there should be some expectation that they might at least be beneficial, even if there's no good evidence for it. That's a real balancing act,' Lipworth said. 'In fertility, the balance is going a little too far in the direction of too many things being offered without enough evidence. 'There might be room for some more regulation of how the products are advertised, how patients come to know about them, what they charge for them and so on. But the very act of using them is not in and of itself in any way unethical. 'What really matters is that people know that they're getting treatment for which there is not good evidence, and that they are able to make informed decisions about whether or not to use them. Loading 'That doesn't mean that anything goes and that patients should necessarily be able to walk into a doctor's surgery and say, 'my friend saw this on Facebook', or 'my friend used this and she got pregnant, therefore I want you to offer it to me'. 'There is still a duty of care to offer things that you, at the very, very least, are absolutely certain won't do harm.' Add-ons are not the only factor separating clinics, or the fees they charge. Lensen said premium clinics typically provide continuity of care so patients always get to see the same specialist and nurse, as well as improved customer service, which may not be provided at low-cost or public clinics. And, in many cases, the proliferation of add-on services is often more patient-driven than due to marketing by doctors or their clinics – which is why Lensen believes reforms are even more important, so regulators can step in when doctors fail to uphold their responsibility to dissuade patients from treatments that may not be in their best interests. 'The evidence is not that strong, but the patients are asking for it, or the clinic down the road is offering it, and so they end up using it too. But then when the research community does come out with robust evidence later, I think they do act,' she said. 'So it would be nice if we said from 'now on, no more offering a high dose of corticosteroids to patients. If you want to do that, they can take part in a placebo controlled trial'. 'A lot of the time, though, regulations are not aligned with the commercial interests of whoever they're trying to regulate – that's the whole reason we need them.'
The Age
5 hours ago
- The Age
Deanna tried IVF with the lot. None of the costly, unproven add-ons worked, so she went back to basics
Australia's health ministers last month ordered a rapid review of the nation's assisted reproductive sector following a series of bungles and scandals, to determine if greater regulation can increase the safety and transparency of fertility clinics. Victoria is leading the national review, and a Victorian government spokesperson confirmed IVF add-on services would be included in consideration of existing or potential new legislative framework. 'A dedicated team has been established to undertake the review and will report back within three months,' the spokesperson said. Australia has the fifth-highest rate of IVF, fuelled by the strength of the commercial fertility sector and Medicare rebates with broad eligibility criteria that mean patients can continue coming back for cycles regardless of their chances of success. Four out five women accessing IVF also use add-on services during their treatment, which can greatly add to their costs as well as the profits and marketability of the clinics, but which may not increase the chances of success. An analysis of the non-core services being offered to Australian fertility patients by University of Melbourne researchers, prepared for this masthead, highlights the high costs and lack of evidence supporting services commonly upsold to potentially emotionally vulnerable patients. It reveals 44 treatment types ranging from free to $5000, and taking in everything from vitamins to plasma being injected into ovaries, genetic testing of embryos, injecting a single sperm directly into an egg and endometrial scratching, have little to no influence on the chances of having a live birth, pregnancy or miscarriage. Loading The analysis follows the launch of the Evidence-based IVF website in April, which is led by the University of Melbourne's Dr Sarah Lensen as an effort to better inform people undergoing IVF of the unproven add-ons. 'There are research articles out there on these different add-ons but the quality, broadly speaking, is really poor. Different providers are willing to draw the line in different places in terms of how much evidence they think they need before they're willing to offer or recommend something,' Lensen said. 'Sometimes there's a cost for special IVF conception vitamins or whatever, but they're probably pretty low risk, and they're not as big of a deal. 'Down the other end of the spectrum, there's the super-expensive $1000 treatment options that also come with risks because they're playing with patients' immune systems or injecting things into their ovaries that we don't really know what's going to happen. 'A lot of the add-ons that get offered slip through the cracks in terms of the existing regulatory system.' In Deanna Carr's case, she underwent two normal but unsuccessful cycles of IVF before adding steroids, blood thinners, aspirin and clexane during two further cycles. Determined more had to be done, Carr followed advice from online fertility forums and moved to one of Australia's largest clinics to seek out a specialist known for pushing the envelope. 'There's lots of conversation about which specialists to see, because these specialists are willing to be a lot more experimental – and, when we say experimental, it is literally meaning experimental. 'They're willing to try more add-ons, regardless of how inclined the research is to say that it doesn't work.' Tests at that clinic found Carr had a partial DQ Alpha gene match which may make her body more likely to attack or reject an embryo, though research suggests treatment for it does not significantly improve IVF success rates. To address the issue, a team of specialists gave Carr lymphocyte membrane immunotherapy, in which up to eight vials of blood were taken from her husband so his white blood cells could be extracted and then injected into her arm to correct her immune system with material that is genetically matched to their embryo. 'It's like weird blood brother stuff, and quite expensive,' Carr said. She was given a toxic cocktail of drugs including naltrexone and tacrolimus, which are more commonly used to treat cancer, as well as an intralipid infusion to 'knock out' her immune system. Added together, this cycle cost more than $8000. 'It didn't work. It ended up the same way all our other cycles ended,' she said. Carr's specialists then offered to step up the add-on treatments even further. They proposed a $5000 EMMA and ALICE test which would have seen Carr undergo another full IVF cycle but, rather than try for a pregnancy, the doctors would take a biopsy of her uterus to see if bacteria were present that might be impacting her pregnancies. If it found abnormalities, Carr was then to be prescribed cefalexin – a common antibiotic used for infections and cheaply available on the Pharmaceutical Benefits Scheme. 'It's what the doctor would give you for a sore throat. Why would they make me pay five grand for it? Why not just give me the medication?' Rather than spending $12,000 for another add-on-laden IVF cycle, Carr consulted the Evidence-based IVF site and realised there was little science to support the proposed treatment, then switched clinics to undergo a traditional – and successful – cycle. 'You get persuaded to add on because you obviously want it to work, and you're already spending so much, so this can financially tip you over the edge,' she said. 'A lot of these IVF companies know that. It does feel really unethical [because] a lot of the time people aren't being provided with proper information around the add-ons that are being suggested and the efficacy around them. And people are really desperate, so they'll just keep saying yes to things.' A Macquarie University professor of bioethics in the discipline of philosophy, Wendy Lipworth, last year published a study based on interviews with 31 doctors working in assisted-reproductive technology to see what their 'moral justification' for using add-ons was. The specialists' responses revealed evidence and innovation was not the driving consideration in many instances, and that regulatory reforms to only allow the use of unproven treatments in the context of formal scientific evaluation might be required. Lipworth said add-ons were often marketed as a point of difference between clinics, which may undermine individual doctors' ability not to offer them for patients. As a result, she believes any new regulation would need to focus on the clinics and what they are offering, rather than individual doctors wanting the best for their patients. 'Generally, there should be some expectation that they might at least be beneficial, even if there's no good evidence for it. That's a real balancing act,' Lipworth said. 'In fertility, the balance is going a little too far in the direction of too many things being offered without enough evidence. 'There might be room for some more regulation of how the products are advertised, how patients come to know about them, what they charge for them and so on. But the very act of using them is not in and of itself in any way unethical. 'What really matters is that people know that they're getting treatment for which there is not good evidence, and that they are able to make informed decisions about whether or not to use them. Loading 'That doesn't mean that anything goes and that patients should necessarily be able to walk into a doctor's surgery and say, 'my friend saw this on Facebook', or 'my friend used this and she got pregnant, therefore I want you to offer it to me'. 'There is still a duty of care to offer things that you, at the very, very least, are absolutely certain won't do harm.' Add-ons are not the only factor separating clinics, or the fees they charge. Lensen said premium clinics typically provide continuity of care so patients always get to see the same specialist and nurse, as well as improved customer service, which may not be provided at low-cost or public clinics. And, in many cases, the proliferation of add-on services is often more patient-driven than due to marketing by doctors or their clinics – which is why Lensen believes reforms are even more important, so regulators can step in when doctors fail to uphold their responsibility to dissuade patients from treatments that may not be in their best interests. 'The evidence is not that strong, but the patients are asking for it, or the clinic down the road is offering it, and so they end up using it too. But then when the research community does come out with robust evidence later, I think they do act,' she said. 'So it would be nice if we said from 'now on, no more offering a high dose of corticosteroids to patients. If you want to do that, they can take part in a placebo controlled trial'. 'A lot of the time, though, regulations are not aligned with the commercial interests of whoever they're trying to regulate – that's the whole reason we need them.'
The Age
5 hours ago
- The Age
Australia helps develop world-first vaccine against devastating virus
In a sign of how seriously governments treat the risk of foot-and-mouth, scores of cattle carcasses were buried on a research farm this year in Victoria as part of preparations for a potential outbreak. The cows died of toxic weed poisoning, not disease, but the trial is testing how best to compost and decontaminate dead cows should foot-and-mouth strike. An mRNA vaccine could roll out within weeks of an outbreak, potentially saving herds from large-scale culling. The vaccines also provide something called DIVA capacity (differentiating infected from vaccinated animals), which allows responders to test which animals were vaccinated and which were naturally infected, helping to more precisely define the scale of an outbreak. 'That may be something that speeds up a return to international trade after an incursion,' Laurence said. Foot-and-mouth disease has been eradicated from Australia for more than a century. America is also free from the disease, although some have raised concerns infected meat could be imported into the US from risky countries, processed and then sent to Australia. Loading 'I'm not convinced that the potential for importing beef from the US exposes us more to risk, but the fact is that we've now got foot-and-mouth, and lumpy skin disease, on our doorstep in Indonesia. So the risk of an incursion has actually gone up,' Laurence said. The vaccines use stands of 'messenger RNA' or mRNA that code for small viral proteins. When the mRNA is introduced to the body, muscle cells make the protein, which triggers the production of antibodies ready to attack the actual virus upon infection. The mRNA breaks down naturally in the body. 'It's simply an instruction set that we send to the body to ask the immune system to prepare a defence for a particular disease,' Peter McGrath from Tiba Biotech, the US-based company that developed the vaccine, said. 'So it's actually the simplest and safest way to make a vaccine of any technology currently available.' The vaccines last for a year in the fridge, or a month at room temperature, unlike early COVID-19 mRNA vaccines which had to be stored at sub-zero temperatures. In a trial of nine vaccinated cows exposed to the virus in Germany, none contracted the disease or shed the virus. 'That's never been achieved anywhere in the world before,' said Dr Peter Kirkland, from the Elizabeth Macarthur Agricultural Institute, which helped test and develop the vaccine. The vaccine could be made and distributed very quickly with the right setup, Kirkland, a NSW Department of Primary Industries and Regional Development scientist, said. 'You could actually roll out this vaccine potentially within a week of an outbreak starting.' The UNSW RNA Institute is working on the capability to manufacture the vaccine, he said. The Sydney institute is part of a newly announced $17.6 million RNA Research and Training Network, which aims to boost the RNA workforce in NSW. Loading Moderna's new taxpayer-funded mRNA factory in Melbourne rejected the NSW government's request to make the new vaccine, which still requires registration from the Australian Pesticides and Veterinary Medicines Authority. 'Developing local capacity to produce vaccines against emergency animal diseases is a critical priority for the NSW Government, Australia's livestock industries and our economy,' Agriculture Minister Tara Moriarty said.
