21st Century Medicine

Heading off the superbug apocalypse, preventing heart disease from childhood, new gene targeted treatments for melanoma, and reassessing the science about back pain were among the subjects tackled in 21st Century Medicine – a series of public lectures hosted by the University of Sydney’s Sydney Medical School in 2013.

2013 Program

25 September - Why Diets (usually) Fail

Associate Professor Amanda Salis Senior Research Fellow, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School

Presented in conjunction with Sydney Ideas and the Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders

A major reason why diets fail is that the body responds to energy restriction with a 'famine reaction' that increases appetite, reduces metabolic rate and alters circulating concentrations of hormones in a way that stimulates fat accumulation. Drawing on insights from her work leading a research team at Sydney University’s Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Associate Professor Amanda Salis will discuss three scientifically based strategies that may reduce the intensity of the famine reaction, thereby increasing the efficiency of weight loss. Having personally struggled with binge eating and excess weight (and having now lost 28 kilos and kept it off for over 15 years), Amanda is passionate about her team’s research, which aims to help more people to lose excess weight and keep it off for life.

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2 October - Back Pain – time to get it right?

Professor Chris Maher, Director, Musculoskeletal Division, The George Institute for Global Health, Professor, Sydney Medical School

Presented in conjunction with Sydney Ideas and the George Institute for Global Health

The 2010 Global Burden of Disease Study has revealed that back pain is the leading cause of disability worldwide and has been for the last 20 years. By any measure we have failed the large number of people with back pain. To put that in perspective, on any day in Australia one quarter of the population will be suffering back pain.

This talk will describe the burden of back pain across the life span and outline what we know about best practice in prevention and management. The presenter will then offer some insights into what we are doing wrong and what we should be doing to solve this major health problem.

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9 October - Beating Melanoma – targeting genes

Professor Graham Mann, Associate Dean, Research, Sydney Medical School, Professor Melanoma Institute of Australia and Professor Westmead Millennium Institutel

Dr Georgina Long, Medical oncologist, Melanoma Institute Australia, Fellow Cancer Institute NSW and clinical researcher, Sydney Medical School

Presented with the Melanoma Institute of Australia and the Westmead Millennium Institute

Graham Mann and Georgina Long will outline how their genetic research is changing the whole landscape of melanoma research and why it is giving hope to those with melanoma or at high genetic risk of getting it.

Professor Mann will explain how researchers are coming to grips with melanoma behaviour: the genes that have changed in melanoma, the genes that drive melanoma and which make the difference between the ones that are aggressive and dangerous, and those which are easier to treat.

Dr Georgina Long will then outline the results of clinical trials which have delivered the first effective drugs against melanoma. She will outline how after many years of research, they've developed drugs to target the particular mutations that cancers have. The great news is that for the first time, people with advanced melanoma can be treated with drugs that increase survival rates.

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16 October - Preventing the Superbug Apocalypse

Professor Jon Iredell, Professor Centre for Infectious Diseases and Microbiology at Westmead Millennium Institute for Medical Research and the Westmead Clinical School

Associate Professor Tom Gottlieb, Clinical Associate Professor and Senior Specialist, Concord Hospital

Dr Vicky Sheppeard, Director Communicable Diseases, NSW Health (Chair)

Presented with the Westmead Millennium Institute and the Marie Bashir Institute

Antibiotics – the great medical discovery of the 20th century – have produced a monster. While the highly-publicised golden staph threat is being addressed in Australia, the emerging issue is with gram-negative bacteria – bacteria that doesn't survive well in external environments but spreads from person to person. The interconnectedness of everybody’s microflora means that gut microbes are shared very effectively. It’s not just humans who share them - even migratory water birds transmit them around the world. E. coli from a hospital dump in Europe might be ultimately deposited in South America, Asia or Australia. It is a global ecological problem with potentially catastrophic effects. Associate Professor Gottlieb will describe the worst case scenario and analyse the causes and responses. Professor Iredell will then outline the various solutions his research team are investigating in an attempt to avert disaster.

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30 October - Early Detection of Heart Disease in the Young and Preventing it in Adults

Professor David Celermajer, Scandrett Professor of Cardiology, Sydney Medical School, Royal Prince Alfred Hospital and Children’s Hospital at Westmead, and Clinical Director Heart Research Institute

Presented in conjunction with the Heart Research Institute

Heart disease remains the number one cause of early disability and death in the western world and now, surprisingly, has become the most frequent cause of early death in the developing world also.

The most important diseases of the heart and blood vessels, such as heart attack, stroke and the effects of rheumatic heart disease, tend to manifest in middle to late age. Nevertheless, many of these disease processes take decades to develop and the first changes start to occur in teenage life. Sometimes, the earliest changes can even occur in childhood or rarely, even in foetal life. This new appreciation of the very early onset of disease has opened the window to the possibility of early detection and thus improved prevention.

‘Atherosclerosis’ is the process of build up of cholesterol plaques in the main blood vessels of the body that leads to heart attack and stroke. Our Lab was one of the first in the world to describe the earliest changes in the linings of the blood vessels, the so-called endothelial cell layers that show the harbingers of atherosclerosis later in life and can now be detected in humans using non-invasive techniques. These are mainly based on ultrasound and more recently, CT scanning and MRI scanning have given insights into early detection of vascular disease in children and young adults.

Rheumatic heart disease remains a devastating post-infectious illness that can lead to symptoms of breathlessness and even early death and is very prevalent in many regions of the world. We have recently also described techniques for early detection of valvular heart disease after rheumatic fever, again using ultrasound, and we “road tested” these in developing world countries, seeking a cost-effective and practical solution to early detection and thus late disease prevention.

Early detection of heart disease in childhood and young adult life thus opens up the important possibilities of preventing late disease, with enormous potential benefits across the world, to reduce the devastating impact of heart disease in later life.

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13 November - Mapping Teenage Minds

Professor Gin Malhi, Head of Psychiatry, Royal North Shore Hospital and Professor of Psychiatry Sydney Medical School

The teenage brain is dynamic and ever-changing and this is reflected in the exciting ideas and thinking of young people. The minds of teenagers are constantly engaged in learning across cognitive, emotional and social domains and therefore developmentally this is a critical time. Brain processes are vulnerable to environmental and biological stress and if teenagers are exposed to these during this time of rapid change the consequences can be dramatic.

Malhi’s neuroscience research group has investigated the minds of teenage girls using the latest and most sophisticated functional neuroimaging techniques and have managed to identify startling changes in the key brain regions that occur before the onset of any clinical problems. These subtle changes in how the brain works provide clues as to how and why emotional disorders emerge. This talk will be presenting cutting edge research findings and address how in the future we may be able to prevent the development of illnesses such as depression.

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20 November - Talking with Doctors – a view from the other side

Professor Stewart Dunn, Professor of Psychological Medicine at Royal North Shore Hospital and Sydney Medical School.

Doctors are trained over many years to listen to their patients in particular ways. Ways that ensure critical information is not missed. If you understand what is happening in the doctor's mind, it helps you to know what questions to ask, how to ask them and how to get the information you need.

We will explore how doctors learn to take a history, arrive at the correct diagnosis and initiate the right treatment plan. Most importantly we will examine research into how doctors deal with the emotional side of medicine, especially how they cope with people at extremely vulnerable times in their lives.

Professor Stewart Dunn has spent more than thirty years studying the relationships between doctors and their patients, how they communicate and share information and how they manage the emotional trauma involved in serious illness.

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27 November - Nine Months that Shape your World

Professor Jonathan Morris AM, Professor of Obstetrics & Gynaecology, Sydney Medical School - Northern, Director Kolling Institute of Medical Research

Events occurring in pregnancy have profound significance for both the mother and her baby. For the mother, pregnancy is like a stress test and provides insights into the likelihood of long term health complications such as diabetes, cardiovascular disease and cancer. For the baby the environment in the uterus and the timing of birth affects short term and long term health and development. This talk will outline the fascinating health implications of pregnancy and some of the research that informs us about the best time to be born.

Professor Jonathan Morris is a graduate of the University of Edinburgh and completed his Obstetric and Maternal Fetal Medicine sub specialty training in Sydney. He completed his PhD in Oxford and returned to Sydney in 1998 at the Royal North Shore Hospital. Since then he has built a perinatal research group that extends from basic science to population health. He is currently Director of the Kolling Institute for Medical Research and Head of the Northern Clinical School. His major research interests are the prediction, prevention and management of pregnancy complications.

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