Thread by @DrJohnOrchard

Why do poorer Australians have shorter life expectancy than wealthy ones? Exercise and opiates as comparative risk factors: a flaming 🔥🔥🔥 hot long thread including the #RedRoosterLine 1/many

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo We’ve known for a while than life expectancy is slightly worse (4-6 yrs) in poorer Australians with smoking status, diet, exercise and maybe less access to “good” medical care being potential explanations healthstats.nsw.gov.au/Indicator/bod_…

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo Exercise is now receiving its due as a very important lifestyle factor bmj.com/content/366/bm…. @BMJ has just urged us to include Exercise as a routine part of medical consultations, saying it is perhaps the only “medical” treatment with only benefit vs no substantial harm

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ Exercise treatment in medicine can be provided by any health professional, but it is “core” for Exercise Physiologists (EPs), Physiotherapists and Sport & Exercise Medicine (SEM) physicians. Sadly it is badly underfunded in the Australian medical system johnorchard.com/resources/arti…

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ For example Rheumatology patients (drug-based medical specialists) gets A$228 rebate for initial 45 minute chronic care consults, $114 for 20 min review consult; SEM physician patients (also medical specialists) gets $74 and $37 rebates, 2/3rd less smh.com.au/business/medic…

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ How badly does lack of funding affect access to exercise-based health services? For physio services, it is hard to assess, as its likely that not all physio consults are equal. I suspect in wealthy areas, physios charge more $s but provide better “quality” exercise-based consults

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ Let’s switch momentarily from exercise to diet. There have been fascinating articles written about the distribution of food outlets within big cities (like Sydney) and how perhaps this may affect different diets in different suburbs
honisoit.com/2017/09/food-f…

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ It has generated plenty of interest on Twitter that the Red Rooster fast food franchise has plenty of Sydney outlets, but only in the lower socioeconomic suburbs. By contrast there is an upmarket chicken franchise that only has its 11 outlets in the wealthy suburbs

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ Chargrill Charlies has opened a single franchise outside Sydney, in the upper-middle class suburb of Camberwell in Melbourne. Whereas Red Roosters are plentiful in Queensland, Victoria and WA particularly, but also in country NSW on the north coast, and western parts of NSW

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ Chargrill Charlies maybe has more salad and veges than Red Rooster, and it costs more than twice as much. Is it that much healthier? Possibly, but who knows, they’re both chicken. It may be healthier but it may be primarily snob value that wealthy Sydney patrons will pay more

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ Is medical treatment biased by location in the same way? We’d like to hope it isn’t in Australia. For a well-funded and important medical specialty like Rheumatology, there is a bias towards more practitioners in wealthier suburbs, but there is reasonable distribution

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ Rural areas are a similar story for Rheumatology – far Western NSW is undersupplied, but overall you could fairly conclude that there is reasonable access to Rheumatologists in bigger country towns (in NSW).

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ Now what happens to the supply of medical specialists when you cut the Medicare rebate by 66% compared to Rheumatology and hence the vast majority of the doctor fee has to be paid out of pocket by the patient? Note the distribution of SEM physicians in Sydney

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ Country NSW is even worse. There are only SEM physicians in Newcastle (1), Gosford (1) Wollongong (2) and a registrar spends a few days a month in Orange. It’s fairly accurate to say that in NSW if you have a Red Rooster outlet nearby, you don’t have a SEM physician available

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ Are all medical services less available in low socioeconomic and rural areas in Australia? Well, funny you ask, because there is one medical service that is far more common in these areas: opiate prescriptions. Pale areas have low rates and blue areas have higher rates

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ People in low socioeconomic and rural areas are price sensitive, so they can’t afford SEM physicians, but they CAN afford opiates. In rural areas particularly, opiates prescribed by doctors are subsidized and cheap

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ Are the contrasting availability of SEM consults and opiate prescriptions by location connected? Most probably: if you have chronic back pain, knee or shoulder pain etc, you can get SEM in high socioeconomic areas but for these same conditions elsewhere you get opiates

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ The difference between exercise (which makes you live longer) and opiates (which make you die early) is stark, much more of a life-expectancy differential than whether you local take-away chicken is Chargrill Charlies or Red Rooster

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ How do we get lower socioeconomic and rural patients off opiates and instead using exercise-based treatment? It starts with funding: Physio, EP and SEM physicians all need better funding under Medicare in order to make services more affordable

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ There is a proposal on the table to make rebates for all medical specialists the same, so that SEM physicians patients would get the same rebates as Rheumatology patients. Then SEM physicians could cross the Red Rooster line and work in less-affluent areas www1.health.gov.au/internet/main/…

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ Sadly the AMA @ama_media is opposing the recommendation that all medical specialists should generate the same patient rebates under Medicare. It is outdated that @ama_media are not supporters of #ExerciseIsMedicine 🦕🦖🦕🦖🦕🦖ama.com.au/submission/ama…

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ @ama_media Opiate deaths are rising in Australia (pic) and it has been suggested that overuse of opiates will put an end to rises in life expectancy in Australia, which has already happened in the USA mja.com.au/journal/2019/2…

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ @ama_media We have a medically-prescribed opiate epidemic in Australia (blue), and a lack of access to Sport & Exercise Medicine in poor areas in Australia, but SEM physicians (red) are politically friendless, as @ama_media has chosen to oppose SEM not support it

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ @ama_media The opiate crisis in Australia and why lower socioeconomic patients get prescribed opiates rather than exercise-based programs needs far more analysis by the mainstream media. We need Exercise medicine >>> opiate medicine. Thread ends

@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ @ama_media @threadreaderapp Unroll please

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@JudkinsSimon @stephenjduckett @CroakeyNews @DrChrisBarton @ACSEP_ @apaphysio @ESSA_NEWS @Kaubo @BMJ By the way, opiate prescription data referenced from: safetyandquality.gov.au/sites/default/… which is disconcertingly close to Red Rooster store map redrooster.com.au/locations/ (exception: Tasmania)