Eavesdrop on Experts

“You don’t know what health problems a population has unless you can measure them, and that’s what I try to do,” says Alan Lopez, Laureate Professor of Global Health at the Melbourne School of Population and Global Health, University of Melbourne.

“If you’re going to improve a population’s health, then you need to know which are the leading causes of death, and particularly which ones are increasing so that you can match interventions to those health problems,” he says.

Professor Lopez specialises in descriptive epidemiology, which looks at not the causes, but the measurement of disease and mortality patterns in populations.

He says getting the measurement right on lung cancer, heart disease, COVID-19, measles, TB or road traffic accidents, matters a lot to health policy.

“If you can demonstrate that death rates from a particular condition or disease are rising rapidly, or falling rapidly, then you’re either doing something wrong, or something right and policy can be calibrated according to that knowledge.

“The really big concern, is that three or four decades ago, Australians began to become obese in large numbers, and now we have one in three Australian adults clinically obese. About another one in three are overweight.

“Both of those categories carry significant excess risk of death, primarily from major vascular disease, like heart attacks and stroke, but also from some cancers. Those death rates for cardiovascular disease are no longer declining. In fact in Australia, they are, or are about to rise.

Professor Lopez says it isn’t an outrageous contention, that life expectancy for the generation born in the last 10, or 20, or 30 years, will be lower than their mothers and fathers.

“That, I think, is a major public health concern. We have achieved a lot of what we’re going to achieve in terms of mortality reduction through smoking control, but there’s still more to be done.”

Episode recorded: June 18, 2020.

Interviewer: Dr Andi Horvath.

Producer, audio engineer and editor: Chris Hatzis.

Co-production: Silvi Vann-Wall and Dr Andi Horvath.

Banner: Getty Images.

Major depressive disorder is common and costly – one in seven Australians will experience depression in their lifetime. So understanding what’s going on in the brain and using that knowledge to identify new, faster-acting therapeutic strategies for treatment makes sense.

“Our job is to record the electrical activity of nerve cells, the excitable cells in the brain, by way of eavesdropping on their function,” says Professor Scott Thompson, Professor and Chair of the Department of Physiology and Professor of Psychiatry at the University of Maryland School of Medicine.

“Our research is focused on the neurobiology of depression, what goes wrong in the brain when there is a case of depression and we would like to use that knowledge to offer up ideas for better, more effective, faster acting antidepressant drug treatments,” he says.

While current antidepressants – that include SSRIs (Selective Serotonin Reuptake Inhibitors) like Prozac – are effective in two thirds of patients, they typically require four to eight weeks to work and may then still need changes to the dose.

“SSRIs inhibit the uptake process of the hormone serotonin, so it builds up to a higher concentration. SSRIs like Prozac were discovered accidentally, they were being developed for treatment of problems with blood pressure and, lo and behold, some patients reported that their mood was better.”

“But where Prozac takes six to eight weeks to work, within a matter of a few hours, depressed patients given ketamine report an improvement in their mood and in their symptoms.

“Ketamine has a rapid antidepressant action, but it comes with its own set of problems. It’s an anaesthetic so it’ll knock you out if you take too much and can have a hallucinonogenic effect because it activates cells throughout your brain.

“We came up with a class of molecules that would target particular structures limited to the brain’s ‘reward circuitry’. So, in [animal models] this ketamine is a novel candidate for a rapid antidepressant, without the side effects.”

Episode recorded: February 12, 2020.

Interviewer: Dr Andi Horvath.

Producer, audio engineer and editor: Chris Hatzis.

Co-production: Silvi Vann-Wall and Dr Andi Horvath.

Banner image: Getty Images.

“The work on conspiracy theories surprises me every day because I’m troubled by the general lack of trust in so many institutions – political and health institutions – that have been trusted for a long time,” says Dr Robin Canniford, Senior Lecturer in Management and Marketing in the Faculty of Business and Economics at the University of Melbourne.

“As to why this is happening now, I would draw on the climate of fear that people are experiencing,” Dr Canniford says. “In addition to the fight or flight response that we know psychologically as a response to fear, I think one thing that humans tend to do is to make up stories to rationalise that which they afraid of and that which they can’t control.”

But Dr Canniford adds that some of the questions raised by the public are fair and relevant.

“If we take the United Kingdom as an example, the SAGE Committee –the group of scientists who were put together to advise on the response to COVID-19 – remained a closed shop. Now the questions then immediately come about, well why can’t the public know who’s on a committee that’s making decisions about their livelihood?”

“And when voters are witnessing a set of global leaders, many of whom themselves are promoting what we can only call conspiracy theory – promoting cures to the virus that rely on bleach for example – it is no wonder that people are searching for nefarious groups who they believe to be controlling them.

“It is no wonder that there is a lack of trust at the moment and I think that is really fuelling and providing the fertile soil for this kind of conspiracy theory to grow.”

Episode recorded: May 28, 2020.

Interviewer: Dr Andi Horvath.

Producer, audio engineer and editor: Chris Hatzis.

Co-production: Silvi Vann-Wall and Dr Andi Horvath.

Banner: Getty Images.

“A lot of people think of an earthquake as a one-off example, but [the after shocks from the 2010-2012 Canterbury earthquake] went on for a year and a half,” says Mark Quigley, Associate Professor of Active Tectonics and Geomorphology in the School of Earth Sciences at the University of Melbourne.

“At any time we could be sitting in our University or at home and just have this strong shaking come and just completely disrupt our world. Through all that, you had to try to keep your teaching curriculum going as best you could,” Professor Quigley says.

“Those were the experiences I had in Christchurch, and they’re so analogous to what’s happening now on a whole bunch of levels.”

Professor Quigley describes how people can use challenging times as an opportunity to stimulate new alternatives.

“There will be opportunities here to better engage the underprivileged countries around the world with things like scientific conferences and meetings through virtual connections... that they never were able to afford through their own challenges that they might face.”

“As an earthquake scientist, I’ve been really fascinated by the fact that earthquakes are still happening, but there’s not the usual urban noise levels like cars, so we can study them now in urban environments with much more accuracy and precision than we ever would be able to.”

He asks “can we try – in the face of something that is affecting the entire globe, to find novelty and innovation in some of the approaches we’re taking?”

“Perhaps things like creating virtual materials that will benefit your academic communities and your students going forward?”

Episode recorded: April 6, 2020.

Interviewer: Dr Andi Horvath.

Producer and editor: Chris Hatzis.

Audio engineer: Arch Cuthbertson.

Co-production: Silvi Van-Wall and Dr Andi Horvath.

Banner image: Shutterstock.

“I think it’s very likely we’ll get to good drugs even quicker than we’ll get to a good vaccine,” says Peter Doherty, Nobel Prize winner, University of Melbourne Laureate Professor, patron and namesake of the Doherty Institute for Infection and Immunity.

“What’s worked for HIV is what we call designer drugs,” Professor Doherty says. “Structural biologists design a chemical which will fit in to the really important part of that [virus] structure for binding to the cell, for instance. That would be a blocker, and that’s an effective drug.”

In terms of what we need to do to prepare for a future pandemic caused by an unknown virus, Professor Doherty highlights the work of CEPI, the Coalition for Epidemic Preparedness Innovations.

“[CEPI] funded the research of Professor Paul Young and his group at the University of Queensland, who’ve developed the primary Australian COVID-19 vaccine candidate. They developed a platform technology called the protein clamp. When this new virus came along, they were just able to slot in those new virus genes and move down that road,” he says.

“So, I think we need an equivalent of the CEPI organisation that’s involved in developing drugs against all the major classes of virus that could be a potential threat to us.”

But Professor Doherty reminds us that COVID-19 isn’t the biggest threat facing humanity, “this is something we’ll be through in 12 to 18 months”, he says.

“The biggest threat facing humanity is clearly climate change and we all understand that if we’ve got any sense at all. I think, personally, that what should come out of this is we need to rethink some of the ways we do things.”

Episode recorded: April 22, 2020.

Interviewer: Dr Andi Horvath.

Producer, audio engineer, editor: Chris Hatzis.

Co-producers: Silvi Vann-Wall and Dr Andi Horvath.

Banner image: Shutterstock.

“Isolation is bad for a lot of people,” says Cathy Humphreys, Professor of Social Work at the University of Melbourne.

“It’s bad for people’s mental and physical health, it’s bad for domestic violence and child abuse,” she says. “But, of course, when you’ve got this extraordinarily virulent virus you don’t have too many choices [but to stay home to prevent its spread].”

“In Western Australia for example, the most worrying aspect of the data we are seeing is a 30 per cent decline in the calls women have been making to the helpline, even though they are potentially experiencing a lot more violence,” she says. “But they haven’t got the opportunity to be able to seek help.”

But she says there has been an international increase in the use of searching on websites and chat rooms to try and gain information.

“There’s a lesson there about expanding the ways of being able to access women and their children at a time when you’ve got increased danger,” Professor Humphreys says.

“Men have been reaching out to the men’s help line and workers in men’s behaviour-change programs have continued to contact the men individually in case management and support.

“I think we might see a bit of an avalanche of people coming out of isolation and calling for help.”

1800RESPECT - 1800 737 732 - 1800respect.org.au

Men’s Referral Service - 1300 766 491 - ntv.org.au

Lifeline - 13 11 14 - lifeline.org.au

Episode recorded: April 17, 2020.

Interviewer: Silvi Vann-Wall.

Producer, audio engineer and editor: Chris Hatzis.

Co-production: Silvi Vann-Wall and Dr Andi Horvath.

Banner: Getty Images.

“I think a unique thing about this COVID pandemic is it’s been a real triple whammy for a lot of people,” says Dr Grant Blashki who is a GP, Associate Professor at the Nossal Institute for Global Health, University of Melbourne and lead clinical advisor at Beyond Blue.

“People are obviously worried about their health, not getting the infection. Secondly, many have lost jobs or are under a lot of financial pressure at the moment.

“Thirdly, their home life has been drastically transformed. For some people, it might be that they’re home on their own. For others, they might find suddenly they’re in a very busy household with partners and kids,” he says.

Working with Beyond Blue, Dr Blashki has been encouraging people to be proactive about maintaining their mental wellbeing.

“Sometimes we do just have to shut off, particularly if the media is getting too much,” he says. “Your mind isn’t designed to be on all the time, it actually gets exhausting.”

“And routine is really useful. I recommend that people create a schedule for the day and the week.” Dr Blashki also recommends one pleasurable activity and one activity that gives you a sense of achievement each day.

“Something that you like doing, going for a walk, if you can, depending on your isolation situation, “ he says. “Or reading a book, watching your favourite show, and one achievement activity. That might be enrolling in an online course you’ve been wanting to do or fixing up your CV or cleaning that cupboard that you’ve been ignoring.”

“We also tend to underestimate ourselves, and most of us have got a bit more resilience than we think,” he says.

Beyond Blue Coronavirus Mental Wellbeing Support Service - 1800 512 348 or coronavirus.beyondblue.org.au

1800 RESPECT - 1800 737 732 or 1800respect.org.au

Lifeline - 13 11 14 or lifeline.org.au

Episode recorded: April 14, 2020.

Interviewer: Dr Andi Horvath.

Producer, audio engineer and editor: Chris Hatzis.

Co-production: Silvi Vann-Wall and Dr Andi Horvath.

Banner: Getty Images.

“Our profession began with infectious diseases,” says Professor Tony Blakely.

“So, if I break it down and say epidemic and -ology, which equals study, we are the study of epidemics – epidemiology,” he says.

“My day job is to model the effect of interventions on the population’s health.

“Sometimes I look in the rear vision mirror of the car and sometimes I look out the front window and I actually forecast the future, under business as usual. Then I layer an intervention over that, like a tax on sugary drinks or a colorectal cancer screening program.

“Then we estimate the health gains (from those interventions) and report back to our academic and policy end users on which interventions appear to have a big impact, versus a small impact, and which are cost effective.”

Professor Blakely explains that this particular skillset also applies to modelling COVID-19 infection control and exit strategy models.

“We have three exit strategies out of this COVID epidemic. One, we eliminate, we lock our borders and we hunker down until a vaccine arrives. The second strategy is the one people call suppression or controlled adaptation because you really are adapting,” he says.

“The third option is we’ll protect our elderly, we’ll protect those with co-morbidities, we’ll get the best treatments possible, but we’re going to let this infection wash through society until such time we get to a number of people being infected that they’re therefore immune - we have what we call herd immunity.

“There are different pros and cons of each of those three strategies.”

Episode recorded: April 20, 2020.

Interviewer: Dr Andi Horvath.

Producer, audio engineer and editor: Chris Hatzis.

Co-production: Silvi Vann-Wall and Dr Andi Horvath.

Image: Getty Images.

One of the things about literature is that it always responds immediately to what’s happening in the environment, says Associate Professor Justin Clemens from the School of Culture and Communication at the University of Melbourne.

“People started writing responses to the plague immediately, but the most famous book is probably Boccaccio’s The Decameron, which was written after the plague in Florence of 1348,” says Professor Clemens.

The Decameron is a group of stories united by the overarching tale of a group of young aristocrats who have retreated to the hills to avoid the plague.

“They didn’t have Zoom, they didn’t have the internet and so they tell each other stories over the course of two weeks,” Professor Clemens says.

Dr Suzie Fraser adds that the Black Death, or the Bubonic Plague, was also depicted by visual artists using representations of death, pestilence and disaster.

“One of the most prevalent visual allegories that emerged in the Middle Ages was the Danse Macabre, or the Dance of Death,” Dr Fraser says.

“This theme depicts a universality to death where the living and dead exist side-by-side. Living people who are rich and poor, young and old, all genders and classes are being targeted, are being tugged, pulled and harangued into the afterlife.”

Fast forward to today, and COVID-19 is also bringing out some very positive examples of public creativity and citizen artists, says Dr Fraser.

“Dr Kate Just from the Faculty of Fine Arts and Music, along with Dr Tal Fitzpatrick, started an Instagram project titled COVID-19 Global Quilt.

“This project invites people to contribute a patch to the quilt which reflects their experience of the current pandemic.”

Episode recorded: April 8, 2020.

Interviewer: Dr Andi Horvath.

Producer, audio engineer and editor: Chris Hatzis.

Co-production: Silvi Van-Wall and Dr Andi Horvath.

Banner image: 17th Century Woodcut Depicting Londoners Fleeing from the Plague An illustration showing Londoners fleeing the country because of the plague. Printed 1630. (Photo by © Historical Picture Archive/CORBIS/Corbis via Getty Images)

WARNING: EXPLICIT LANGUAGE.

The inspiration for the exhibition Flesh after Fifty came about as a result of Professor Martha Hickey’s work in the menopause service.

“Women facing menopause at an early age would often say ‘I’m going to be an old woman’,” explains the professor of Obstetrics and Gynaecology at the University of Melbourne and Royal Women’s Hospital.

“Those two words together were the worst thing in the world. Reflecting on myself and the women that I knew and the contribution of older women, I really wanted to change that message.”

Lead curator of the exhibition Jane Scott describes the dilemma and also the delight of this exhibition was attempting to photograph 500 women over the age of 50 in the nude.

“Most of the women would comment and talk about the fact that they were unhappy in their own skin,” she says. “But once they got that off their chest, they started to talk about how proud they were of their bodies for carrying them around, for delivering them the ability to have the life that they now enjoy.”

“In an ageing society, it’s unsustainable to not give full recognition and support to old people,” adds Professor Hickey.

“Women are the larger proportion of older people. Maintaining their physical and mental health is absolutely paramount for us.”

Episode recorded: March 10, 2020.

Interviewer: Dr Andi Horvath.

Producer, audio engineer and editor: Chris Hatzis.

Co-production: Silvi Vann-Wall and Dr Andi Horvath.

The Flesh After Fifty exhibition is on at the Abbotsford Convent, Victoria, Australia, and runs until April 11, 2021. For more information visit the website, fleshafterfifty.com.

Banner: Getty Images.