Medical education for rural, regional and remote communities 04 - Blackburn commemoration - The University of Sydney
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Sydney Medical Alumni Association and the University of Sydney School of Medicine magazine Autumn 2019
radius
Medical education for rural,
regional and remote communities 04
Blackburn commemoration Working with Lambie Dew Reunion
continues on campus philanthropists oration recaps
08 10 12 26
B
This edition
—
04
Medical education for rural,
regional and remote communities
The University of Sydney has
welcomed federal government
funding to give medical students their
full training in regional Australia.
08
Blackburn commemoration
The Edward Ford Building, one of the University’s medicine
continues on campus teaching and research spaces
The University’s No. 1 Oval
was recently renamed the
Blackburn Oval.
16 22
10 Needle-free device could Where are they now?
How the University improve vaccine delivery We report on Associate
works with philanthropists Pain-free injections are on Professor Payal Mukherjee,
To ensure donors have the best the horizon. ENT surgeon; and Dr John Affleck,
experience of giving, the University aerospace medicine specialist.
has a dedicated professional team.
18
Statin therapy found safe and 26
12 effective for people over 75 years Reunion recaps
The 2019 Lambie Dew Oration Statins reduce risk of major For the classes of 1961,
The Sydney University Medical cardiovascular events 1978 (OBL) and 1983.
Society invites readers to the next irrespective of age.
oration on 10 October 2019.
28
20 Upcoming reunions
14 Weight gain in early childhood For the classes of 1954, 1955,
Increased physical activity affects teenage heart health 1957, 1964, 1969 and 1999.
linked to better mood Early weight gain can set up
Resetting body clocks could help teenagers for poor health outcomes.
bipolar and depression disorders.
For Sydney Medical School alumni news Radius was produced and printed in Edited by Michael Frommer, Office of
and enquiries, contact Sally Forbes partnership with the University of Sydney the Executive Dean, and Kristen Barnes,
Email: sally.forbes@sydney.edu.au and Publish Partner, February 2019. Marketing and Communications,
Website: sydney.edu.au/medicine/alumni © 2019 The University of Sydney 19/7960 Faculty of Medicine and Health
Cover: A student and medical practitioner walk down a hallway in the School of Rural Health in Dubbo.
C
Head of School and Dean’s message
—
Welcome to the Autumn issue of Radius
The 2019 academic year represents campuses in Dubbo and Orange), Within the Murray-Darling Medical
the first full year of the new Faculty of the University Centre for Rural Schools Network, the University of
Medicine and Health. Many changes Health in Lismore and the Broken Sydney was awarded funds to set up
have taken place in the University Hill University Department of and operate a full four-year graduate-
of Sydney School of Medicine Rural Health. entry medical program in Dubbo.
and throughout the University of Once Australian Medical Council
Sydney, and we look forward to In parallel with these changes, accreditation is achieved, these
their consolidation. the Australian Government is students will undertake and graduate
implementing policies to strengthen with the University of Sydney Doctor
The former faculties of medicine, the rural medical workforce by of Medicine degree.
dentistry, pharmacy, and nursing and investing in rural medical education.
midwifery have been re-established In December 2018, the Australian Funds were also awarded to
as schools within the Faculty of Government announced the award Charles Sturt University, in
Medicine and Health, to be joined of funding to seven universities collaboration with Western Sydney
in 2020 by the Faculty of Health for the establishment of six University, to set up a five-year
Sciences. The University of Sydney standalone rural medical programs undergraduate medical program in
School of Public Health and the in New South Wales and Victoria, Orange and Bathurst.
School of Medical Sciences, both forming the Murray-Darling
previously part of the Faculty of Medical Schools Network. The University of Sydney will
Medicine, now stand separate from continue to offer Sydney-based
Sydney Medical School within the The rationale is to attract rural students extended rural placements
Faculty of Medicine and Health. residents and others to study in Dubbo, Orange, Lismore and
The University of Sydney School medicine in rural settings; evidence Broken Hill, and will collaborate with
of Medicine now comprises seven shows this leads to more graduates Charles Sturt and Western Sydney
metropolitan clinical schools, as well seeking to live and practice in Orange (see page 4 of this issue of
as the School of Rural Health (with medicine in the bush. Radius for further information).
2
This edition
—
Rural landscape in Dubbo
At the same time as we are planning our highly successful Critical Care Medical School to recognise major
to introduce the full medical program). I am particularly pleased to achievements in clinical research.
program in Dubbo, our work on announce the launch of our Genomics
significant changes to the four-year in Clinical Practice unit, which has Much of our work takes place at
curriculum is at an advanced stage. been accredited by the Specialist the interface of medicine and the
In 2019, the proposed changes will Advisory Committee in Clinical various domains of science. Late last
be submitted to the University’s Genetics of the Royal Australasian year I was delighted to observe the
Academic Board for approval, and College of Physicians for College creative energies of our students at
the Australian Medical Council will Fellowship trainees. the interface of medicine and the
then consider the new curriculum for arts and humanities, supported by
reaccreditation. A description of theAlumni who visit the Camperdown/ the Harris Student Fellowship. One
new curriculum will appear in the Darlington Campus will notice of the successful Harris Fellows,
Spring 2019 issue of Radius. the changing landscape as new Dr Isabel Hanson (now a graduate),
buildings become prominent on used her prize to engage a cartoonist,
Major developments are continuing the skyline. The demolition of the Safdar Ahmed, to capture her ideas
in our postgraduate medical Blackburn Building, to make way in images. The resulting work has
coursework program in 2019, for an ambitious new building just been published in the Guardian
including the launch of our new program in the new health precinct, Australia. As we know, the roots of
Master of Medicine/Master of was a source of some heartache medicine run deep, and some draw
Science in Medicine (General for many of us. The Blackburn nourishment from the arts.
Practice and Primary Health Care) family graciously consented for the
courses. These programs are designed Blackburn name to be attached to the Professor Arthur Conigrave
for both new and experienced adjacent No. 1 Oval, and this took BSc(Med) ’79 MBBS ’82 MSc ’83
practitioners. We continue to add place in a ceremony on 25 October PhD ’92 MD ’08
coursework to existing programs (described on page 8). We are also Head of School and Dean of
(such as mechanical ventilation proposing to introduce the ‘Ruthven Sydney Medical School
and extracorporeal life support to Blackburn Medal’ to allow the Sydney
3
4
Rural health
—
Medical education
for rural, regional and
remote communities
The University of Sydney has
welcomed federal government funding
to give medical students their full
training in regional Australia.
Written by Michael Frommer
and Dan Gaffney
In December 2018, the Australian Government announced the
establishment of the Murray-Darling Medical Schools Network
with funding earmarked in the May 2018 federal budget. This
multi-university network is designed to address rural and
regional doctor shortages by increasing the numbers of
medical students who undertake their entire medical studies
full time in rural, regional and remote communities.
The new funding allows the University of Sydney to build on
the significant contribution it makes to health professional
education, research and health care in rural, regional and
remote New South Wales (NSW). The University will convert
the School of Rural Health campus in Dubbo to deliver the full
four-year Sydney Doctor of Medicine (MD) program, enrolling
24 students in each cohort, beginning in 2021.
“The University of Sydney is delighted with these federal
funding outcomes, which will allow us to build on the already
significant contribution we make to health professional
education, research and care delivery in rural, regional and
remote NSW,” says Professor Stephen Garton, Provost and
Deputy Vice-Chancellor.
5
Rural health
—
Top left: Leafy
surrounds at
the School of
Rural Health,
Dubbo Campus
Right: Students
and staff gather
outside the
clinical school
“We look forward to working with other health disciplines from the and also to the local economy,”
our partners in the Murray-Darling University of Sydney and other says Professor Garton.
Medical Schools Network: the universities to complete short and
University of New South Wales, longer-term clinical placements “We will be pursuing targeted
Charles Sturt University and Western in rural sites throughout Australia. recruitment strategies to maximise
Sydney University in NSW, and the University of Sydney students may the number of students accepting
University of Melbourne, Monash undertake placements in Orange, places for the Dubbo medical program
University and La Trobe University Dubbo, Broken Hill, Lismore and who are drawn from the region and
in Victoria.” surrounding communities. from other rural, regional and remote
communities. This will include an
The funding consists of $7.65 million “From an enhanced base at Dubbo, emphasis on prospective Indigenous
to extend medical training facilities our end-to-end rural medical and low SES student recruitment.”
on the existing School of Rural program will be delivered in close
Health campus in Dubbo. The site collaboration with the Western NSW Students who undertake the Dubbo
is adjacent to Dubbo Base Hospital, and Far West Local Health Districts, medical program will graduate with
where a major redevelopment the Western NSW Primary Care an MD degree from the University of
project is nearing completion. Network, Aboriginal health services, Sydney. They will have opportunities
Teaching will be supported through the Royal Flying Doctor Service and to undertake placements at rural sites
the Australian Government’s Rural local councils. Once operating at outside Dubbo and at remote sites
Health Multidisciplinary Training full capacity, 96 medical students in far-western NSW. They will also be
(RHMT) program. will be based full time in Dubbo able to undertake short placements in
and surrounding communities. This Sydney if they wish.
The longstanding RHMT program will provide a tremendous boost to
provides opportunities for health care in Dubbo and the region, The Dubbo plan provides for the
students in medicine and many recruitment of new teaching staff who
6
Rural health
—
Left and far left:
Images of Dubbo
Below: Medical students
practise delivering
procedures on a
training manikin
will be based in Dubbo and will join the be possible for Year 4 University of
staff and affiliates who currently teach Sydney students in Lismore.
Sydney-based students undertaking
extended rural placements in Dubbo Detailed planning for the Dubbo site
in Year 3 or Year 4 of the MD program. has begun. The intention is to build
The Doctor of Medicine program’s an extension to the existing clinical
online teaching materials and school building, forming an L-shaped
assessment systems will be used, and structure with direct access to
Dubbo students will have access to Dubbo Base Hospital. The extension
the full range of resources available will accommodate an anatomy
at the University of Sydney, including teaching facility, other ‘wet’ and ‘dry’
online library access. laboratories, a clinical simulation
laboratory, and other learning and
In order to accommodate the Dubbo teaching spaces, as well as staff offices
medical program and Charles Sturt and amenities.
and Western Sydney Universities’
new undergraduate medical school Future issues of Radius will report
in Orange and Bathurst, the number on progress at the Dubbo site and
of Sydney students undertaking on related developments in Orange,
extended rural placements in Orange Lismore and Broken Hill.
and Dubbo will be reduced.
It is hoped that a compensatory
increase in extended placements will
Medical student uses stethoscope
on newborn patient
7
Medical School news
—
Professor Ruthven Blackburn’s sons: Dr Simon Blackburn and Angus Blackburn, next to the plaque at the entrance to the oval
Blackburn commemoration
continues on campus
Written by Michael Frommer
Built for the Faculty of Medicine Reflecting its design concept, the In 2018, it was demolished to make
in 1933, the Blackburn Building building, funded by the Rockefeller way for new buildings in the health
was designed to bring a university, Foundation, was often referred precinct. Sydney Medical School
clinical environment and research to as ‘the New Medical School’. Historian, Associate Professor
laboratories into close proximity. This name stuck for many years Catherine Storey OAM, commented
The goal was to enable ‘science even after the Blackburn name on the building in a recent article1 in
learned in the laboratory’ to feed was attached to it in 1960. the Medical Journal of Australia:
into medical practice and education.
8Medical School news
—
“The building has struggled to to be transferred to the adjacent No. 1 address in reply to Dr Spence. He
cope with the ever-increasing Oval. This took place on 25 October acknowledged the University’s
demands placed upon it by a very 2018 in a ceremony hosted by the continued recognition of his father’s
different medical community to Vice-Chancellor, Dr Michael Spence and grandfather’s contributions.
its original occupants. Its architect AC, at the oval’s grandstand. In his
had designed … spaces for the address, Dr Spence commemorated At the conclusion of the ceremony,
isolated researcher, his test-tubes the father and son for whom the members of the Blackburn family
and fume cabinets, notebooks and oval is now named – Professor Sir were presented with small pieces
journals. The model did not readily Charles Bickerton Blackburn and of masonry collected during the
promote collegiality. The numbers of Professor Charles Ruthven Bickerton Blackburn Building’s demolition.
researchers have grown exponentially, Blackburn – and highlighted A plaque outlining the careers of
and they now work in teams, the immense importance of the Sir Charles Blackburn and Professor
connected with a complex technology commitment to academic medicine Ruthven Blackburn stands at the
infrastructure for which our original that they exemplified. entrance to the oval.
building was not designed.” 1
Storey CE. Vale New Medical School
Members of the Blackburn family (the Blackburn Building), University of
Sydney. Medical Journal of Australia,
The Blackburn family accepted the were present at the ceremony. Dr 2018; 209 (5): 199-201e1.
need for the eponymous building Simon Blackburn, one of Professor
to be replaced, and graciously Ruthven Blackburn’s sons and a
consented for the Blackburn name distinguished engineer, gave an
Top: Vice-Chancellor Dr Michael Spence Dr Simon Blackburn, Professor Matthew Vadas AO
Left: Professor Arthur Conigrave addresses the crowd and Michael Spence at the naming ceremony
9Philanthropy
—
How the University
works with philanthropists
Medical research inspires more people to donate to the University than any
other activity. Philanthropy has brought new buildings, equipment, research
and scholarships. To ensure donors have the best possible experience of
giving, the University has put together a dedicated professional team.
It was a first for Australian universities motivates donors. “It often comes In philanthropy, there are three main
when Vice-Chancellor, Dr Michael from a personal experience, or the types of giving: donations spent as
Spence AC, announced in January experience of a family member,” he the donor directs; endowments held
that the University’s INSPIRED says. “The experience of illness is a in perpetuity that generate interest;
campaign had reached its target of strong motivator, but it can also come and bequests, where the gift is made
$1 billion. from their educational background, through a provision in a will.
or a general interest in a field of
Almost half that figure was directed by medicine and health.” The gift, or pledge of a gift, is not
donors to go to initiatives in medicine necessarily the end of the relationship.
and health. Gifts ranged from a The offices of the Division of Alumni
few dollars to a single gift of $35 and Development are busy, and no “Where a gift has supported research,
million in support of the University’s less busy now the INSPIRED campaign we regularly update the donor on
new health precinct, currently has ended. The Development progress and research outcomes,”
under construction. Officers divide their time between Mr Smith says. “We try to get the
donor-related activities and building donor or the donor’s family to
Every dollar given is gratefully relationships with researchers meet the academic staff whose
received, and for donors who want to and academics. work benefits from their gifts, or to
make a meaningful gift, the University meet scholarship holders whose
has a team of people who make the Charly Brown is the Associate Director scholarships they have funded.”
process of giving as easy as possible. for Mental Health and Neuroscience
These Development Officers are in the Development Office, “My job is Rachel Love is an Associate Director
part of the Division of Alumni and to understand what is important to of Development. She spends a lot
Development and they come from people, what they’re passionate about. of her time with researchers at the
diverse fields including psychology, I work with them to find a University University’s Save Sight Institute and
science, economics and commerce. program, often research-based, that talking with donors interested in
they find meaningful.” that area.
As well as helping with the technical
aspects of making a gift, they also To do this effectively, it is also “The gift is just the beginning of
help donors connect with work that important for Development Officers what we hope will be a continuing
reflects their passions. to know what research and other work relationship. We want supporters to
is being done on campus, and where know they’ve made a difference and
Joel Smith, Senior Director of gifts can have the greatest impact. that they’re an important part of the
Development for Medicine and Health, research process itself. This gives
has a particular understanding of what something back to them,” she says.
10Philanthropy
—
Ms Love gives the example of a and succinct information. They are To find out more about the Division
donor who at the age of 12 years also available for broader discussions of Alumni and Development, or if you
was diagnosed with keratoconus, an with supporters. have questions about philanthropy
eye disorder affecting one in 2000 at the University of Sydney,
people that distorts vision by changing They connect potential donors with please contact Joel Smith.
the shape of the cornea. The donor University people who can use that
wanted to help other people with gift in a way that will have the most Phone: +61 2 9351 3574
the condition. beneficial impact. Email: joel.smith@sydney.edu.au
“His initial gift led to a world first – it
helped establish the Save Sight
Keratoconus Registry, an online
database to collect information from
patients and clinicians about the
outcomes of keratoconus treatment.
It’s a very valuable clinical resource.
“Later the supporter went on to
make another gift, funding a new
research position at the Save Sight
Institute to analyse the registry’s
data and expand its reach nationally
and internationally.”
“Making a meaningful donation can be
powerful and even therapeutic for
people who have confronted a health
crisis, but many of them don’t know
how to go about it,” says Mr Smith.
“The first person they talk to is often
their clinician.
“It’s not about clinicians asking anyone
to give. The best way clinicians can
support people who want to give is
by putting them in contact with the
Development Office.”
Development Officers are always on
standby for advice and assistance.
They are a resource to help donors
along the path of giving and for
academics to pass along relevant
Right: Many organisations fundraise
for medical research, but most
of the actual research is done
through universities
11School events
—
The 2019 Lambie Dew Oration
Readers of Radius are cordially invited to the 2019 Lambie Dew Oration,
to be delivered by Professor Jeffrey Rosenfeld AC OBE KStJ, senior
neurosurgeon at the Alfred Hospital in Melbourne and Director of the
Monash Institute of Medical Engineering. Professor Rosenfeld will speak on
‘Medicine at the extremes, from the battle for Mosul to the bionic eye’.
Each year, our student society Sydney For each year’s Lambie Dew Oration, Professor Jeffrey Rosenfeld AC OBE
University Medical Society (SUMS) SUMS invites a distinguished KStJ has agreed to give the 61st
convenes the Lambie Dew Oration, speaker to address a medical or Lambie Dew Oration, taking place
held in honour of Charles Lambie, social topic of their choice. on Thursday 10 October 2019.
the inaugural Bosch Professor of
Medicine at the University of Sydney, The 60th Lambie Dew Oration was Professor Rosenfeld is a Professor
and Harold Dew, the inaugural Bosch delivered on 12 October 2018 by of Surgery at Monash University,
Professor of Surgery. Associate Professor Kelvin Kong, a Senior Neurosurgeon in the
Worimi man from the Port Stephens Department of Neurosurgery at
When Lambie and Dew took up area. In addition to his roles as the Alfred Hospital in Melbourne,
their appointments in 1930 and an otolaryngologist and surgeon, Director of the Monash Institute
1931 respectively, they were the first and his work with the University of Medical Engineering, and Major
full-time professors of medicine and of Newcastle and the John Hunter General in the Australian Defence
surgery in Australia. The medical Hospital, he frequently conducts Force – Reserves. He has been
curriculum they developed in the clinics in remote parts of Australia, extensively involved in military
1930s became the foundation for and has been a prominent advocate medicine, and his research focuses on
undergraduate medical education in for Indigenous health and Indigenous traumatic brain injury and restoring
the University of Sydney. doctors. Associate Professor Kong sight to individuals with severe
has chaired the RACS Indigenous vision impairment using bionic
The undergraduate program they Health Committee, and been a vision technology.
introduced was delivered (with many board member of the National
updates and modifications) until the Centre of Indigenous Excellence Lambie Dew Oration:
introduction of the graduate-entry and the Australian Indigenous Thursday 10 October 2019, 6 pm,
medical program in 1997. Doctors’ Association. Great Hall, University of Sydney
12Philanthropy
—
Lambie Dew Oration previous speakers
Speaker Date
Associate Professor Kelvin Kong, otolaryngologist 2018
and head and neck surgeon from the University of
Newcastle, Australia’s first Indigenous surgeon, and
the first Indigenous Fellow of the Royal Australasian
College of Surgeons
Professor Fiona Wood AM, Director of the Western 2017
Australian Burns Service, Consultant Plastic Surgeon
at Fiona Stanley Hospital and Princess Margaret
Hospital for Children in Perth, and Winthrop Professor
of Surgery at the University of Western Australia
Professor Gordian Fulde AO, Director of the 2016
Emergency Departments at St Vincent’s and
Sydney Hospitals, and Senior Australian of the Year
Professor Frances Baum AO, Matthew Flinders 2015
Distinguished Professor of Public Health at
Flinders University of South Australia and
Commissioner on the United Nations Commission
on the Social Determinants of Health
Professor John Yu AC, former Chief Executive 2014
Officer of the Children’s Hospital at Westmead,
former Chancellor of the Australian National
University, and Australian of the Year
Ms Helen Clark ONZ, former Prime Minister of 2013
New Zealand and former Administrator of the
United Nations Development Programme
Enquiries about the event:
alumni.medicine@sydney.edu.au or +61 2 8627 1905
Right: Guests of the 2018 Lambie Dew oration
given by Associate Professor Kelvin Kong
13Research
—
Increased
physical
activity
linked to
better mood
Written by Dan Gaffney
A new study published in JAMA Psychiatry1 reveals that
increasing physical activity may be an effective way to boost
mood, especially in people with bipolar disorder.
The finding suggests that physical activity may play an
influential role in regulating mood and could therefore be a
viable target for clinical intervention – a positive finding as
physical activity is more easily changed than mood states.
Researchers from the University of Sydney and leading
institutions in the United States, France, Hong Kong and
the Netherlands reported that increases in physical activity
tended to be followed by improvements in mood and perceived
energy levels. This beneficial effect was even more pronounced
in a subset of the study – subjects with bipolar disorder.
The findings challenge prevailing theories of depression,
proposing that sleep problems, low energy, and low activity
levels are the result of depressed mood.
14Research
—
The study, which examined “Systems regulating sleep, disturbed body clocks are the basic
interactions among these factors, motor activity and mood cause of these disorders, and that
suggests the opposite may be true – treatments such as physical exercise,
have typically been studied
that instability in activity and sleep light exposure and melatonin-based
systems could lead to mood changes. independently. This work medicines need to be much more
demonstrates the importance specifically focused on stabilising the
“Treatments that disrupt the body of examining these daily body clock.
clock may be more likely to cause
systems jointly rather than
harm in patients,” says study co- “Treatments that disrupt the body
author, Professor Ian Hickie AM, in isolation.” clock, like some of the commonly
of the University of Sydney’s Brain Dr Vadim Zipunnikov prescribed serotonin-based
and Mind Centre. Johns Hopkins University antidepressants may be more likely
to cause harm in these patients.
Other key findings “This study exemplifies the potential
−− The researchers found for combining the use of physical “This study highlights the way our
bidirectional relationships activity trackers and electronic international consortium with
between physical activity and diaries to better understand the nodes in the United States, Europe,
subjective energy, and between complex, dynamic interrelationships Australia, Canada, China and Hong
physical activity and sleep duration. among multiple systems in a real- Kong is using highly informative
time and real-life context,” says case data to transform the diagnosis
−− On average, a higher activity level
senior author Dr Vadim Zipunnikov and treatment of the major
at one timepoint was associated
of Johns Hopkins University. mood disorders.”
with improved mood and
“Systems regulating sleep, motor
increased perceived energy at the
activity and mood have typically Study details
next timepoint during the day.
been studied independently. This Researchers used activity trackers
−− Likewise, increased energy at work demonstrates the importance and electronic diaries over a two-
one timepoint was associated of examining these systems jointly week period to collect data on
with increased activity at the rather than in isolation.” physical activity, sleep duration,
next timepoint. Importantly, subjective mood and energy levels
these associations controlled the “Modern psychiatry is rapidly from study participants with
current levels of mood, energy abandoning its traditional categories, bipolar I disorder, bipolar II disorder,
and activity respectively. such as major depression and bipolar major depressive disorder, or none of
−− Activity was inversely associated disorder, in favour of personalised these three disorders.
with sleep duration – more and more objective modes of
activity tended to be followed assessment,” says Professor Hickie. The participants comprised
by less sleep that night, and 242 adults (150 women and 92 men),
more sleep tended to be followed “These new modes of assessment then aged 15 to 84, including 54 people
by less activity the next day. form the basis for more accurate with bipolar disorder and 91 with
−− Tracking sleep, activity, mood predictions of illness course and, major depressive disorder.
and energy concurrently was most importantly, choosing the
particularly important in people most relevant treatments. They are Choi KW, Chen C, Stein MB, et al.
1
Assessment of Bidirectional Relationships
with bipolar disorder because the also providing unique insights into Between Physical Activity and Depression
changes in internal psychological probable underlying mechanisms. Among Adults: A 2-Sample Mendelian
Randomization Study. JAMA Psychiatry.
states were strongly influenced by Published online January 23, 2019.
both sleep and physical activity. “For bipolar disorder and atypical doi:10.1001/jamapsychiatry.2018.4175
depression, they strongly support
our working proposition that
15Research
—
Needle-free device
could improve vaccine delivery
Written by Dan Gaffney
University of Sydney scholars are testing a device that could eliminate
needles and end the need for cold chain storage of vaccines.
The device, a microprojection array patch, or ‘MAP’, The device could also boost immunisation rates – at
is a one square centimetre of biomedical polymer – least 10 percent of people have been reported to
smaller than a postage stamp – embedded with 5000 avoid influenza vaccination due to fear of needles.
vaccine‑coated microprojections that pass through Furthermore, the World Health Organization (WHO)
the skin’s outer layer to deliver a vaccine directly to estimates there are 1.3 million deaths each year due to
thousands of immune-rich cells in the skin. needlestick injuries and cross contamination.
The result is more efficient immunisation that does not Usability testing
require refrigeration like ‘current vaccines that use a The MAP device is applied to the skin using a
needle and syringe. disposable applicator that contains the product
and ensures reliable delivery.
The device is being commercialised by Australian biotech
company Vaxxas, with manufacturing research being In 2015, Vaxxas conducted a WHO-funded study testing
done by the University of Sydney and the Innovative the usability and acceptability of the applicator for polio
Manufacturing Cooperative Research Centre (IMCRC). vaccinations in Benin, Nepal and Vietnam. Cristyn Davies
believes the study provided valuable information and
“Delivering vaccines with this technology will be cheaper suggested great potential for the Vaxxas product.
and easier than liquid vaccines delivered by needles
because they don’t need to be refrigerated,” says Cristyn “With Vaxxas planning to develop and commercialise the
Davies from the University of Sydney. “This would offer device in Australia, our research will focus on how the
a significant advantage in remote locations, including in applicator is perceived by patients and administrators,”
developing countries where refrigeration to keep vaccines she says.
viable is a major challenge.”
Professor Rachel Skinner comments that Australia has
Cristyn Davies is evaluating the device with her University mature, well-developed vaccination services. “What
of Sydney colleagues Professor Rachel Skinner and immunisation providers expect in using the device,
Professor Robert Booy from the School of Medicine and and its acceptance by immunisation providers and
Professor Behnam Fahimnia from the Business School. recipients, may differ dramatically from those in
developing countries,” says Professor Skinner.
Together, they will test the utility and acceptability of the
device among patients and clinicians and assess its cost- “We will be testing the application in several settings and
effectiveness compared to conventional immunisations. across different age groups in the workplace and with GPs,”
says Professor Booy.
16Research
—
The findings will be compared with results from the
earlier WHO utility study to determine requirements in
different markets.
“We are at an important stage of the product development
process,” says Charles Ross, Head of Clinical Operations at
Vaxxas. “Before investing in manufacturing the applicator
at pilot scale, we want to be confident the device satisfies
design, end-user and logistical requirements for its
intended markets.”
“Vaxxas is a great example of manufacturing
innovation in Australia,” says David Chuter,
CEO and Managing Director at IMCRC.
“This research will give Vaxxas end-user and
distribution information that decreases risks
and accelerates the path to market and
identifies product and design parameters
required for subsequent pilot scale
manufacture in Australia.”
The MAP vaccine delivery system was
invented at the University of Queensland.
Development is continuing at the Translational
Research Institute.
Fast facts
−− Data from preclinical studies −− The MAP-delivered vaccines −− The device eliminates the risk
suggests the device will not only tested to date do not need to of needlestick injuries.
enhance the immune response be refrigerated, reducing costs −− In addition, it will reduce the
generated by a vaccine compared and alleviating transportation burden on patients suffering
to traditional delivery methods, issues, particularly to parts of from needle phobia.
but potentially do this at a the world where cold chain
fraction of a full vaccine dose. infrastructure is unreliable.
17Research
—
Statin therapy
Published in The Lancet1, the study
compared the effects of statin therapy
found safe and
(cholesterol-lowering medication)
in nearly 187,000 people who had
taken part in 28 large clinical trials.
effective for people
Participants were divided into six
different age groups, ranging from
aged over 75 years
under 55 to over 75 years, to assess
the effects of statins on major vascular
events (myocardial infarcts and
strokes), coronary revascularisation
procedure rates, cancer incidence
Written by Kobi Print and deaths.
Statins lower the level of low-density
lipoprotein (LDL) cholesterol in the
Statin therapy is safe and effective in blood and are prescribed to millions
of people around the world. Having a
people aged over 75 years and reduces high level of LDL cholesterol can lead
to hardening and narrowing of the
major cardiovascular events such as arteries and cardiovascular disease.
heart attacks and strokes, according to “Statin therapy has been shown to
prevent cardiovascular disease in a
new research at the University of Sydney wide range of people, but there has
been uncertainty about its efficacy
and the University of Oxford.
18Research
—
and safety among people aged over trials are now studying the effects of Dr Fulcher added: “Fewer healthy
75 years,” says lead investigator, statins in more depth in apparently older people were represented
Professor Anthony Keech, Deputy healthy older people. in these clinical trials, so more
Director of the NHMRC Clinical information in this group of people
Trials Centre at the University “Our analysis found that would help confirm the same benefits
of Sydney. that we see in our overall trials
statin therapy appears to
population. A new randomised
“Our study summarised all the be just as effective in people trial in Australia, called STAREE,
available evidence from major trials aged over 75 years as it is is specifically exploring whether
to help clarify this issue, and found in younger people. We now statin treatment can prolong
there were significant reductions in survival free of disability in a healthy
have definitive evidence that
major vascular events in each of the elderly population.”
six age groups considered, including statins benefit older people
in patients aged over 75 years at the who have suffered a heart The study was conducted by the
start of treatment.” attack or stroke.” Cholesterol Treatment Trialists’
Collaboration, a joint initiative
Most previous statin trials defined Co-investigator, coordinated between the National
Dr Jordan Fulcher, Sydney Medical School,
‘elderly’ people as those over 65 years the University of Sydney Health and Medical Research Council
of age. Due to advances in medicine, Clinical Trials Centre, University of
including the development of Sydney, Australia; and the Clinical
“This study will provide guidance and
pivotal treatments such as statins, Trial Service Unit & Epidemiological
reassurance for doctors and patients
life expectancies are now much Studies Unit, Nuffield Department
that people are not automatically
greater. As a consequence, questions of Population Health, University
‘too old’ for treatments like statins
of the effectiveness of treatments of Oxford, on behalf of academic
to be effective.”
in the elderly have focused on researchers representing major statin
older age groups. trials worldwide.
Co-investigator Professor Colin
Baigent, Director of the Medical
Study results The work was funded by the UK
Research Council Population Health
Medical Research Council; the
The researchers found that statin Research Unit at the University
Australian National Health and
treatment reduced the risk of a major of Oxford, added: “The risk of
Medical Research Council; and the
vascular event by about 25 percent for heart attacks and strokes increases
British Heart Foundation.
each millimole per litre reduction in markedly with age, and yet statins
LDL cholesterol, with similar benefits are not prescribed as widely for older
across all ages – even those over 75. people as they should be.
They also found that statin therapy
did not increase the risk of deaths “Since the risk of heart attack and
from non-cardiovascular disease, or stroke increases with age, the
the risk of cancer, at any age. potential benefits are likely to be
even greater for older people.
Cardiovascular risk reductions
were observed irrespective of age, “Therefore, there is a need to ensure
in people with or without known that patients at risk of cardiovascular
vascular disease at the start of the disease due to their age are offered
trials. The evidence was less definitive statin therapy when there is good
among people aged over 75 without reason to believe that it will be
pre-existing vascular disease (those beneficial. Anyone with concerns 1
Cholesterol Treatment Trialists’
Collaboration. Efficacy and safety of
who were prescribed statin therapy about whether statin therapy is statin therapy in older people: a meta-
analysis of individual participant data
for the ‘primary prevention’ of heart suitable for them should discuss from 28 randomised controlled trials.
attacks and strokes). New randomised this with their GP.” The Lancet, 2019; 393(10170): 407-415
19Research
—
Weight gain in early childhood
affects teenage heart health
Written by Kobi Print
Obesity and cardiovascular risk factors in childhood and
adolescence are associated with increased risk of cardiovascular
disease in adulthood, the leading cause of death in Australia.
New research from the University development and subsequent effects How the research was conducted
of Sydney has found that excessive have not been well researched. This
The study assessed a group of
weight gain in children aged under is the first study to investigate the
410 Australian children from birth
two years can lead to elevated consequences of weight gain at two
throughout childhood to the age
cardiovascular and metabolic different stages of early childhood
of 14. Their weight, height, and
risk factor levels in teenage years and the subsequent occurrence of
waist circumference were recorded.
including increased cholesterol, cardiovascular disease in adults.
For 190 of those children, detailed
being overweight and having
measurements were also taken of
increased abdominal (central) fat. “Our study found there are two main
their cholesterol, blood pressure and
pathways to obesity as a teenager:
central fat at the age of 14 years.
Obesity and elevated cardiovascular rapid weight gain in the first two years
risk factor levels in childhood and of life (early weight gain), or rapid
Three groups were identified in the
adolescence are associated – in weight gain between ages two and five
study: normal BMI, “early rising”
adulthood – with increased risk of years of age (later weight gain),” says
excess BMI from the age of two years,
cardiovascular disease, the leading the study’s senior author Professor
and “late rising” excess BMI from the
cause of death in Australia. David Celermajer AO, Scandrett
age of five years.
Professor of Cardiology at Sydney
Published in The Journal of Medical School, the Charles Perkins
Lead author Dr Jennifer Barraclough,
Pediatrics1, the study tracked the Centre and the Heart Research
a cardiologist and PhD student at the
Body Mass Index (BMI) of children Institute, and a senior cardiologist at
University of Sydney and the Heart
from birth to 14 years of age and Royal Prince Alfred Hospital.
Research Institute says, “The early
found that earlier development of
weight gain group have more centrally
high BMI (in children aged under two “The data show that the timing
placed or unhealthy fat than the
years) resulted in higher cholesterol of the development of excess
later weight gain group. Fat around
levels, higher blood pressure, and BMI in early childhood is an
the middle is a key risk factor for
more central fat in adolescence, important determinant. Earlier
cardiovascular disease in adulthood.
compared with onset of high BMI in increases in BMI that persisted
children aged three to five years. through childhood results in greater
“The early weight gain group also had
central fat and higher cholesterol
significantly higher cholesterol levels
Teenage obesity is a major health in teenagers, independent of their
compared to a group of teenagers
problem in Australia, but its BMI at 14 years.”
with weights in the healthy range.
20Research
—
“Our study showed that the earlier the eating and activity are supported weight gain in the young child.
onset of excess fat before five years from a very young age. General practitioners and early
of age, the more likely the individual childhood nurses can also help to
is to have fat around the middle “These findings may provide an monitor weight gain in this critical
by adolescence. opportunity to identify ‘high risk’ period of life.”
young children and trial interventions
“The study also found that both early at an early age, prior to the 1
Barraclough JY, Garden FL, Toelle BG,
and late weight gain groups were development of high cholesterol and Marks GB, Baur LA, Ayer JG, Celermajer DS.
Weight Gain Trajectories from Birth to
more likely to have overweight or centrally placed fat which becomes Adolescence and Cardiometabolic Status in
obese mothers.” evident in adolescence and increases Adolescence. The Journal of Pediatrics, 2019;
https://doi.org/10.1016/j.peds.2018.12.034
the risk of heart disease as an adult.”
Starting healthy habits early
Professor Baur highlighted the
Co-author Professor Louise Baur AM,
importance of healthy infant feeding.
Head of Child and Adolescent Health
“Breastfeeding should be supported
at Sydney Medical School and Head of
where possible until at least 12 months,
the Clinical School in the Children’s
with solids introduced from around six
Hospital at Westmead, says: “This
months,” she says.
study has shown that it is important
for families and the community to
“Healthy eating and physical activity
understand the risks of excess weight
for all family members are also
gain in early life and to ensure healthy
important factors promoting healthy
21Community
—
Where are they now?
In every edition, we profile Sydney Medical School graduates
to see where their studies have taken them. This time we report on
Associate Professor Payal Mukherjee and Dr John Affleck.
Associate Professor Payal Mukherjee
Master of Surgery
After falling in love with the study medical applications of augmented “I’m very proud to work with a
of anatomy as a medical student, reality (AR), virtual reality (VR), diverse group of professionals,
Payal Mukherjee knew she wanted 3D printing and bioprinting. both in cultural background and
to pursue a career in ear, nose and in specialisation. The nature of my
throat surgery. Her PhD research, supported by a work is extremely multidisciplinary,
series of grants and collaborative spanning engineering, medicine,
She loved how dynamic and partnerships from the University science, psychology and information
technical the speciality was. What of Sydney and the University of technology,” she says.
she did not realise at the time was Wollongong, is now in test phase
how technology-dependent the field and could provide a groundbreaking Associate Professor Mukherjee
would be, and how much she would solution for people diagnosed is committed to her role as an
love finding solutions for severe with microtia. influential educator. “Everything
ear disorders and deformities using I do should be complementing my
new techniques. Using a 3D printer, the team is teaching work.”
constructing new ears for patients
While completing her training at whose own auricles are deformed. From her bases at the University’s
the Royal Price Alfred Hospital in By infusing the printed ear with Central Clinical School, Sydney
Camperdown, she gained exposure stem cells, they are creating Adventist Hospital Clinical School,
to a number of surgical academic living cartilage that should allow and her private practice, she
and research staff who inspired her for normal ear function without strongly supports Sydney Doctor
to pursue an academic pathway. As difficult surgery. of Medicine students undertaking
a result, she completed a Master MD research.
of Surgery degree at the University These types of advancements
of Sydney in 2010, and shortly after, are changing worldwide She is also using virtual reality to
took up a fellowship at Oxford. perceptions of medical devices and help students learn more about
their uses. While new technology anatomy through visualisation,
On return to Australia, a healthy will always raise questions of and she hopes technologies
mix of curiosity, passion and commercialisation, ethics and like this will become the norm
encouragement led her to regulation, the answer lies at both undergraduate and
commence a PhD in disruptive in collaboration. postgraduate levels.
technologies, specialising in the
22Community
—
“AR, VR and 3D printing are crucial
in understanding anatomy and for
designing reconstructive options for
the face, and there’s been significant
growth in this area recently,” she says.
“My goal for 2019 is to create a suite of
VR materials that are available online
for students to access.”
Associate Professor Mukherjee
doesn’t just educate clinical school
students. She also teaches primary
and high school age kids about
disruptive technologies and careers
in STEMM (science, technology,
engineering, mathematics
and medicine).
“I do a lot of work with students who
visit the hospital or come to our
virtual reality labs on campus at the
University of Sydney,” she explains.
“My colleagues and I familiarise
them with the technology and talk
to them about their future and
career opportunities.
“Surgery is a male-dominated Associate Professor Payal Mukherjee (right) and colleague Professor Gordon Wallace
show the 3D bio‑printed ears they have been working on
industry and I want to lead change in
this area. I want to be a role model
and show that a career in this field patients and students – I want to Changing the world in more ways
is female-friendly. Girls need to stay improve gender equity more widely.” than one, Associate Professor
engaged in STEMM education and Mukherjee was recently nominated
stop holding back. Through advocacy work with younger as a finalist in the NSW Premier’s
generations, Associate Professor Women of the Year Awards. She is
“We all have a role as humans to Mukherjee hopes to create new jobs widely respected for her exemplary
improve our community, and for and new areas of specialisation to work in adult and paediatric ENT
me, I believe it’s really important advance the future even more. surgery as well as in education
to benefit even more people than and gender equity advocacy.
23Community
—
Where are they now?
Dr John Affleck
Master of Medicine (Critical Care Medicine)
Dr John Affleck is one of Australia’s He became a designated aviation As well as examining pilots, Dr Affleck
most respected aerospace medicine medical examiner for the Civil became Medical Consultant for
specialists. At the age of 70, he Aviation Safety Authority, certifying Wingaway, overseeing patient air
has just added another impressive pilots to fly. He undertook training transfers in NSW – a role he has held
achievement to his distinguished in aviation medicine at the Royal Air for 14 years.
career: completing a Master of Force Institute of Aviation Medicine
Medicine (Critical Care Medicine) and is a Fellow of the Australasian In 2016, Dr Affleck took on another
degree at the University of Sydney College of Aerospace Medicine. appointment as Medical Director of
School of Medicine. Medevac Flights, which undertakes
international retrieval of sick and
“Because my job puts me in isolation, injured people.
I wanted something to bring me
right up-to-date and keep my mind On top of that, he has continued
focused on problem-solving and doing locum ED work. From 2013 to
clinical evidence, to achieve the best 2017, he worked weekends as the sole
outcome for the lives I still hope to doctor in the ED at Cowra Hospital
save,” he says. in central west NSW, dealing with
everything from heart attacks and
Dr Affleck started work as a GP, asthma to burns, head injuries and
before spending six years as Chief other significant trauma.
Medical Officer of the Royal Flying
Doctor Service in Broken Hill – “I have 40 years of experience
starting a long career in the aviation working in the field and I think I am
medicine field. reasonably competent at what I do,
but there is always something to
“I had always had an interest in learn,” he says.
aviation. I had learned to fly and
owned my own plane at the time,”
he says.
Dr Affleck stands with Sandy Swanton,
Wingaway’s Chief Flight Nurse
24Community
—
Dr Affleck says he was concerned unsure about, such as clinical
that, despite past experience, he reasoning and communication,
might now only perform some were enjoyable and very rewarding.
procedures a couple of times a year.
To maintain his skills, he offered to “The subjects I studied in critical
work part time in the emergency care medicine were well-produced
department of a major Sydney and the modules for learning online
hospital, but he wasn’t able to do were well-constructed,” he says.
so, even on a voluntary basis, as the
hospitals’ priority was the training Dr Affleck says the degree not only
of registrars, not the maintenance reinforced his decision to continue
of skills of other doctors. practising, but demonstrates to his Dr John Affleck stands in front of
a medical retrieval aircraft.
insurer and the Australian Health
“My scope of practice is to assess Practitioner Regulation Agency
and manage emergency situations (AHPRA) that he is actively engaged He thinks engaging in academic
working alone. I found that for an in continuing medical education. activity is a good idea for older
ageing doctor, it is challenging to doctors – whether that is within
maintain exposure to and practise “It is really good to have put medicine, or another field such as
the skills required in the rural yourself through that intellectual learning a new language.
setting where a specialist cannot rigour of different clinical situations,
attend immediately.” then, when you face the situation in “The degree was useful for me as
real life, you have already rehearsed I don’t intend to retire in the next
In 2017, he enrolled in a Master of it in your mind, and you are ready,” few years,” he says. “If there are
Medicine (Critical Care Medicine) he says. doctors of advancing age who might
and completed the largely online be feeling the way I did, the Master
course in two years, while continuing “I acquired a lot of knowledge, and of Medicine is available in a lot of
to work full time. had a lot more knowledge updated different flavours – I did critical
and reinforced. I’m pleased I did care but other doctors might be
He admits he found some subjects the degree.” interested in other streams.”
hard work, such as cardiology, but
other subjects that he was initially
Pursue your interests and upskill
with a unit of study or a full
postgraduate degree in a broad
spectrum of specialty areas
including general practice and
internal medicine.
sydney.edu.au/
medicine-health-professionals
Dr Affleck cares for an infant patient
25Reunions
—
Reunion recaps
Class of 1961 Class of 1978 (OBL*)
57-year reunion 40-year reunion
Dr Bill Molloy RFD ED KLJ Dr Philip Hung MBBS, FRANZCR
A get-together of the 1961 year, some 57 years after On 22 of September 2018, 131 alumni and partners gathered
graduation, was arranged by Dr Ruth McMahon and at the Refectory in the Holme Building at the University
Dr Bob McGuinness and held at the Women’s College of Sydney to celebrate 40 years since our graduation. We
on 23 September 2018. were privileged to have 84 alumni and 47 partners join us.
The reunion was a very successful event. As it was a After drinks and canapés on the lawn, we made our way
bright sunny Sunday, we were able to use the courtyard into the Refectory where I gave the welcoming speech.
next to the Menzies Common Room for pre-lunch drinks I spoke of the many changes which had occurred in society
and meeting up again to reminisce about “old times” and in medicine since the time of our graduation.
and reconnect with the University. Following the main course, our surprise guest MC Molly
73 guests attended, with 50 of them from the Class Meldrum, aka Ian Butcher, introduced our entertainers:
of 1961. We had the privilege of having Professor soloists Mary-Anne Hockings, David Mawter, Jan Orman;
the Hon. Dame Marie Bashir AD CVO, herself a medical air guitarists Andrew and Dave McDonald; and the Village
graduate, to address us most warmly on this occasion. People Chris Ingall, Philip Graham, Lyn March, Mat Swann,
Steve Williams and Andrew McDonald, who had us
After the luncheon and very good speeches, some alternately mesmerised by their voices, and in stitches
guests attended a tour of the new Sibyl Centre at the at their on-stage antics.
Women’s College.
Unfortunately, the night’s festivities seemed to come to
In all, a very successful function and congratulations an end far too early. However, the evening proved to be a
to our organising committee. We look forward to our wonderful opportunity to remind ourselves of the fun and
60‑year reunion in 2021. camaraderie which we enjoyed during those formative
years and I believe that many bonds were reforged during
a lovely night of celebration.
Finally, I announced that after 30 years and five reunions,
I was retiring as convenor of the Reunion Committee.
Most fortunately, Andrew and David McDonald have already
announced their preparedness to take on planning for the
next reunion, our 45th, in 2023. So, please watch out for
a Save the Date notice in 2022.
*
O BL stands for “Old By Laws”. When the University transitioned
from a six-year to a five-year curriculum in 1973, it became
necessary to distinguish between the graduates who commenced in
1972 and those who started in 1973 – as both cohorts finished in
1978. The 1972 cohort was designated as the Class of 1978 (OBL)
and the 1973 cohort as the Class of 1978 (NBL) (“New By Laws”).
26You can also read
