NEWS 7
COVID-19 hospitalisation & mortality continue to be a reality for older Australians 2
NEWS 7
Rectal feeding : Doctors accused of ‘ medicalised rape ’
PAGE 5 “ Although fluids ( water , saline ) can be absorbed through the rectal mucosa , IV administration of fluids replaced hydration via the rectal route by the mid- 20th century .
“ Once a physician determines that artificial administration of nutrition is medically necessary , the standard method to deliver nutrition is through a nasogastric or orogastric tube , percutaneous endoscopic gastrostomy , jejunostomy or intravenously through a deep vein .”
Beyond the potential rectal administration of fluids for fluid resuscitation in emergency situations in remote settings when it is the only treatment available , she said rectal feeding is no longer deemed legitimate medical practice .
“ Even those who advocate for forcibly feeding individuals participating in hunger strikes never suggest the use of rectal feeding .”
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COVID-19 hospitalisation & mortality continue to be a reality for older Australians 2
3 considerations when managing patients with COVID-19
1
Early testing and treatment of high-risk patients is crucial . 3 , 4 , 5
Waterboarding , at least in the form of the so-called ‘ enhanced interrogation technique ’ employed by CIA officers , was devised under a multimillion-dollar contract with the intelligence agency by two psychologists , James Mitchell and Bruce Jessen . Their identities were revealed in 2007 in a celebrated article by Katherine Eban published in Vanity Fair called ‘ Rorschach and Awe ’. They have since become pariahs .
“ This is important , as like most antivirals ... time to initiation is perhaps the biggest determinant of how effective they are .”
Associate Professor Paul Griffin ,
Infectious Diseases Specialist , Microbiologist and Researcher Source : Personal communication , 2 September 2023
2
Age continues to be a risk factor . 2
The highest rates of severe COVID-19 illness is in patients ≥60 years , according to Australian data . 2
Adapted from Communicable Diseases Intelligence COVID-19 Australia : Epidemiology Report 79
3
Age-specific weekly rates of COVID-19 cases admitted to ICU or died , by date of onset , Australia , 24 October 2022 to 10 September 2023 2
References : 1 . LAGEVRIO Product Information . October 2023 . 2 . COVID-19 Australia : Epidemiology Report 79 for the reporting period ending 24 September 2023 . 3 . Australian Government Department of Health and Aged Care Coronavirus ( COVID-19 ) website - testing . https :// www . health . gov . au / topics / covid-19 / testing . Accessed 28 Sept 2023 . 4 . Australian Government Department of Health and Aged Care Coronavirus ( COVID-19 ) website - testing positive . https :// www . health . gov . au / topics / covid-19 / testing-positive . Accessed 28 Sept 2023 . 5 . Australian Government Department of Health and Aged Care Coronavirus ( COVID-19 ) website - oral treatments . https :// www . health . gov . au / topics / covid-19 / oral-treatments . Accessed 28 Sept 2023 . 6 . Gentry CA , et al . J Infect 2023 ; 86 ( 3 ): 248 – 255
Age group
Real world evidence has shown the importance of treating older patients with COVID-19 . 6
Treatment with oral antivirals ( OAVs , LAGEVRIO or nirmatrlevir / ritonavir ) was effective in reducing hospitalisation and death vs no OAV treatment in patients ≥65 years . 6
Before prescribing either OAV , please review the full product information available at www . ebs . tgs . gov . au .
Both products are listed on the PBS , however different criteria apply . Please see www . pbs . gov . au for current PBS criteria .
12 10 8 6 4 2 0
n / N Odds ratio
( 95 % CI )
Percentage of patients (%)
Professor Sondra Crosby .
Retrospective observational study US Veterans ≥65 years diagnosed with active mild to moderate SARS CoV-2 infection n = 43,416 6
Outcomes by no OAV treatment vs OAV treatment
Primary endpoint : Composite hospitalisation or death within 30 days
10.2 p < 0.0001
4.75
139 / 1370 65 / 1370 0.44 ( 0.32 , 0.60 )
No OAV Received OAV ( molnupiravir or nirmatrelvir / ritonavir )
Secondary endpoint : Hospitalisation within 30 days
p = 0.0003 7.74
4.46
139 / 1370 65 / 1370 0.44 ( 0.32 , 0.60 )
Secondary endpoint : Death within 30 days
p < 0.0001 3.14
0.58
139 / 1370 65 / 1370 0.44 ( 0.32 , 0.60 )
The torture technique they came up with for eliciting intelligence is widely seen to be useless , especially within the intelligence community itself .
In terms of an explanation as to why they did it , it has been suggested that psychology , when regarded as a scientific rather than therapeutic discipline — one focused on identifying the specific inputs to generate specific outputs — renders some of its practitioners
Scan QR code for study designs : MOVe-OUT and US Veterans Study blind to the ethical dimension of what they do .
There have been questions about whether the doctors involved in monitoring prisoners undergoing ‘ enhanced interrogation ’ were complicit in torture .
One possible response is to say they were present to mitigate harm even if they failed to prevent it .
There is less ethical ambiguity surrounding doctors involved in rectal feeding .
But those who took part remain unknown , at least in the public domain .
“ Publicly available information does not specify the professional identities of the medical officers who authorised and performed the rectal feeding and hydration ,” Professor Crosby said .
“ However , according to the chief of medical services … the CIA Office of Medical Services included physicians ,
‘[ They ] cannot be entrusted to protect the welfare of patients .’
psychologists , physician assistants and nurses who were directly involved .”
She then went through what you assume no modern doctor post-1945 needs to be told but what still , tragically , has to be repeated .
“ Both ethical and legal standards require reasonable medical judgement and prohibit providing treatment that cannot benefit a patient .
“ Furthermore , international human rights laws , and basic human decency , prohibit participation in cruel , inhuman and degrading treatment that can constitute torture .”
At this point , she makes explicit the acts these doctors perpetrated .
“ Given the lack of medical benefit , those medical officers authorising , ordering or participating in the non-consensual penetration of the anus under the guise of feeding have committed acts that meet the definition of rape under federal law 10 USC § 920 ( a ) and ( g )( c ).
“ The non-consensual penetration of the anus embodies the violence , abuse , humiliation and degradation rape victims experience .”
No doctors are absolved of ethical and legal responsibility for their actions when they commit “ heinous acts ” on behalf of and with permission of the state , she adds . JAMA 2023 ; 21 Dec .