Australian Doctor Australian Doctor 2 June 2017 | Page 7

COMMENT
paul smith
LAST week, Minister for
Health Greg Hunt chose —
wisely or not — to give his
first major speech after the
budget, which was a disap-
pointment to many GPs, to
a roomful of doctors at the
AMA’s annual conference.
Two opposing political
narratives currently surround
the health budget. Labor says
it’s all about continuing the
cuts. But Mr Hunt’s stance
is that the re-indexation of
Medicare — the pledge to
slowly thaw the freeze — is a
winner for the specialty.
When Australian Doc-
tor later put the question to
him that GPs didn’t see it
that way, his response was
unsurprising.
He referenced those pre-
budget “written agreements”
he had secured with the
RACGP and AMA.
Hunt says re-indexation is
a win for general practice
The Minister for Health, Greg Hunt, addressed the AMA
conference last week.
the comments of GPs.” (‘GPs’
“The indexation is what
seems to be his shorthand for
has been sought and I can
the RACGP).
only refer … to the written
So these pacts, the cause
partnerships. This is all evi-
of fraught discussion, are
dence that [re-indexation] is
being used as the minister’s
of fundamental importance.”
gold shield to the accusations
Mr Hunt claims the budget
that indexation fixes nothing,
offers $550 million in “GP
that it’s still slowly eroding
support” over the next two
patient rebates for GP care.
years.
In a fluent performance
“It’s a very significant
before the AMA faithful, Mr
increase that has been backed
Hunt made one other impor-
by the written agreement
tant point — his ambitions
with the GPs and backed by
for Health Care Homes.
He dropped heavy hints
the scheme would evolve
to embrace pay-for-perfor-
mance. The pilots will receive
capitation payments of up to
$1800 a year to look after
complex chronic disease
patients. But this may not be
forever.
“We should be moving to
much more genuine outcome
payments in the Health Care
Home model … I’m flexible.
This is a trial. It is not the end
of it. We can improve the
model,” Mr Hunt said.
Whether pay-for-perfor-
mance is the way to do it, will
be another hot debate for the
future. Even those doctors
who signed his ‘peace in our
time pacts’ will be seeking
something much less con-
troversial for Health Care
Homes: real investment.
The AMA’s National
Conference took place in
Melbourne on 26-28 May.
Medical cannabis cuts seizures in
severe epilepsy, study shows
rada rouse
NEJM Medical cannabis has
been shown for the first time
in a randomised clinical trial to
alleviate convulsive seizures in
children with epilepsy.
The findings add weight
to anecdotal accounts
that cannabidiol can stop
recurrent drug-resistant
seizures, say the researchers,
although they note the high
rate of adverse events and
drop-outs from the active
arm.
The trial in 120 children
with Dravet syndrome (a
genetic form of epileptic
encephalopathy) shows
three children (5%) became
completely seizure-free after
taking cannabidiol for just over
three months, compared with
none in the placebo group.
And in another 40% of
participants, the frequency
of convulsive seizures fell by
50%, compared with 27% for
those on placebo.
However, no significant
reduction was seen in non-
convulsive seizures.
Professor Ingrid Scheffer,
chair of paediatric neurology
at the University of Melbourne
and director of paediatrics at
Austin Health, is a member
of the international team of
investigators.
She says the study proves
cannabidiol is effective in
severe epilepsy.
“I am delighted that we
finally have high-level evidence
that cannabidiol is effective for
uncontrolled seizures in Dravet
syndrome. The next question is
whether cannabidiol is effective
in other forms of epilepsy,” she
says.
The trial, funded by GW
Pharmaceuticals, saw
participants given either 20mg
of oral cannabidiol solution per
kg of body weight plus usual
therapy, or placebo and usual
therapy.
Overall, 62% of those in
the cannabidiol group saw an
improvement in their condition
by at least one category
on a seven-category scale,
compared with 34% of those
on placebo..
However, adverse events
were more common in the
cannabidiol group and included
diarrhoea, somnolence and
abnormal liver function tests.
Eight patients receiving the
active drug withdrew from
the study compared with one
patient on placebo.
Further trials of cannabidiol
were already underway in
other groups of patients with
epilepsy, Professor Scheffer
said.
New England Journal of
Medicine 2017; online.
Counsel about psoriasis in pre-pregnancy
ANTONY SCHOLEFIELD
WOMEN with psoriasis should
consider pre-pregnancy
counselling because of the
complex issues they might
face, including the need for
medication review, experts
say.
New guidance for doctors
on managing pregnant women
with psoriasis has been
drawn up by the Australasian
Psoriasis Collaboration, a
group of dermatologists with
input from a clinical geneticist.
The advice, published
in the Australasian Journal
of Dermatology, includes

more detailed information
about psoriasis medications
in pregnancy than that
provided by the Australian
Drug Evaluation Committee’s
categorisation system, the
authors say.
They suggest women
should consider counselling
prior to conception.
The risk of the child
inheriting psoriasis is small,
just 16% if one parent has
the disease, but 50% if both
parents have it.
Other health risks are
disputed, with some studies
showing that women with
psoriasis are at increased risk
of preterm or low-birth-weight
babies, as well as miscarriage.
However, other studies show
no increased risks.
Psoriasis often improves
during pregnancy and flares in
the weeks following birth, but
about one-quarter of women
report that psoriasis worsens in
pregnancy, the guide says.
Women with psoriasis are,
however, more likely to have
other risk factors, such as high
BMI, depressive symptoms or
a smoking habit than women
without psoriasis.
The guide also warns
doctors to be cautious when
offering live vaccines for
neonates due to potential
exposure in utero to anti-TNF
biologic therapies.
It adds that doctors should
prefer well-established anti-
psoriatic drugs, as newer
ones might have only limited
fetal and maternal safety
data, in particular for possible
behavioural teratogens.
The guidelines, produced
with an unrestricted grant from
AbbVie, include a full list of
medications.
Australasian Journal of
Dermatology 2017; online.
www.australiandoctor.com.au
2 June 2017 | Australian Doctor |
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