After over ten years of the DocQ column, Dr Fiona Bisshop looks back over a decade of healthcare advances in her DocQ retrospective.
I realised when I began to write this, on the cusp of a new decade, that the column is now over ten years old.
A lot happened in that time, especially in the fields of HIV, PrEP, sexual health and trans health. We also watched various diet fads come and go, 3D printing of body parts (sadly not yet available from vending machines), and the rise of the opioid crisis.
DocQ retrospective: Diet and weight-loss
The high protein low carb diet became very popular, also the no-carb, the keto, the 5-2, and the fast 800. However, as we approach the end of the decade, weight loss specialists returned to age-old advice. It’s all about the total number of calories ingested. One more time, it’s not what you eat but how much you eat of it. It looks like low calorie and intermittent fasting is the current recommendation. As the obesity epidemic worsens, I promise you that you will hear more about this!
Did you know that you can now get a test to check your genetic susceptibility to certain medications and individualize your care? This is pharmacogenomics. It’s a DNA test which looks at the enzymes in your liver to see how quickly you metabolize various compounds. This helps guide your doctor to choose an appropriate treatment. Unfortunately, Medicare does not yet fund the test but is not too expensive.
DocQ retrospective: STIs
At the beginning of the decade, Hepatitis C was still largely untreatable due to the terrible side effects and low effectiveness of available therapies. However, now we can cure almost everyone in just 8 weeks with a single pill a day, thus preventing long-term outcomes of liver cirrhosis and cancer!
Drug-resistant gonorrhoea has been in the headlines for a while, and we have spent the past few years preparing for it to become a big problem here (it hasn’t yet). New antibiotics are few and far between, but trials are underway for alternatives to the good old shot in the bum!
Syphilis has not gone away. In fact, it has become a bigger problem than ever in some communities, especially in indigenous and remote communities. It’s still quite common in men who have sex with men, so regular testing is still important.
Speaking of testing, this decade has seen the appearance of rapid tests available for a bunch of STIs, including Chlamydia, Gonorrhoea, Syphilis and HIV. These are available free at certain clinics such as RAPID in Brisbane.
Nanotechnology creates tiny robots that allow amazing ways of getting medications into the body, such as through patches or implants. Just how big is a nanometre? It’s one billionth of a metre. A human hair is 75,000 nanometres. Got it?
DocQ retrospective: Smoking and Vaping
Smoking is finally starting to go out of fashion, and in some countries, being replaced by vaping of electronic cigarettes. There is concern about vaping lung disease and popcorn lung. However, this is mostly related to the widespread use of DIY vaping solutions with added THC (the psychoactive ingredient in marijuana).
DocQ retrospective: HIV
The management of HIV has come forward in leaps and bounds in the past 10 years. By 2010 we knew about combination drug therapy as a highly effective way to control HIV and prevent progression, but early in the decade, we had only one single pill option (which had significant side effects). Now, here we are with a handful of safer, well-tolerated and effective single pills. Long-acting injectable treatments are just around the corner. We also have more options for treating people with the drug-resistant virus. There have been 2 cases of HIV cure after stem cell transplantation, but sadly a reliable cure is still a long way off.
Another huge advance in sexual health is the appearance of PrEP, the HIV prevention pill. It first appeared in demonstration studies (QPrEPd in Queensland). After multiple worldwide studies proved its effectiveness, it finally made it onto our PBS. This continues to be a game-changer in HIV prevention.
The biggest thing to happen this decade in the field of HIV was the acknowledgement of “U=U” – undetectable equals untransmittable. The cornerstone of this concept is that a person living with HIV who has an undetectable viral load (< 200 copies of virus per ml of blood) cannot transmit the virus to their sexual partner. This understanding is changing the lives of people with HIV. They can now enjoy sex without fear or guilt of passing on their virus. We should all make sure we spread this message whenever the opportunity arises to help reduce stigma.
DocQ retrospective: Trans healthcare
Over the past 10 years, there have been big changes in access to hormones for trans and gender diverse people. That comes thanks to a small but growing group of medical and allied health professionals working hard to improve trans health in Australia. It is my hope that within a decade, we will be able to say the same about trans surgeries.
So, that’s the decade. Yes, I have left out a few things. However, don’t worry. In the new year, I will continue to assail you with advice about everything from bad breath to fisting. In the meantime, please take care of yourselves and your friends. Enjoy the festivities and don’t forget to stand under the mistletoe on New Year’s Eve!
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