Saturday, March 5, 2011

Further to The Hon Nicola Roxon's Response - here is what her Deparment of Health and Ageing's Chief Medical Officer and Principal Medical Officer have to say about SCD in young people


Senator SIEWERT-I wanted to ask you about sudden cardiac arrest in young people. I have had correspondence about it and I have also seen some issues about it. There has been a bit of attention given to the issue. I am wondering: is it an issue that the department is aware of? Have you been looking at any statistics on it?

Ms Halton-We have our own expert. He can start.

Prof. Bishop-I am not an expert. The important thing about screening relates to whether in fact this can be screened for. It can be difficult. There is a methodology in relation to screening that has got to show that by introducing something you can show an overall reduction in mortality. It has to be of a sufficient amount to essentially justify a larger program. That is a basis on which screening things are set up. They are set up specifically on the basis of being able to show mortality reduction at a population level. While I think we all understand the individual case, I think screening is quite a different methodology. Dr Singer may like to take this a little bit further.

Dr Singer-Thank you. I do not know whether the Chief Medical Officer knows more than I do, but I am not aware of a particular screening test for this condition. There certainly are a number of tests I would regard as potential candidates. They would not be economically viable for this kind of thing over a population level.They are fairly extensive tests that would need to be done.

Senator SIEWERT-In terms of the potential screen techniques, do you say that they are expensive or do you not think there is actually a screening technique?

Dr Singer-I am not aware of a screening technique that is available for this condition, but as I said there are a couple of potential candidate screening tests. They are not really screening tests; they are diagnostic tests and they are not cost-effective in this setting.

Senator SIEWERT-I have seen wildly varying differences on how many people could potentially be affected and how many people have died as a result of this. Has the department looked at how many people have been affected by this?

Dr Singer-Not to my knowledge.

Senator SIEWERT-How do you know it would not be cost-effective if you do not know how many people have died as a result of this? I am not trying to be smart; I am just—

Dr Singer-I understand. My understanding is that this is a relatively rare condition.

Senator SIEWERT-Okay. What counts as ‘relatively rare’?

Dr Singer-I am not in a position to give you an exact figure, I am afraid.

Senator SIEWERT-Okay.

Dr Singer-But certainly this is one where the other problem with it is that it is not a single pathological condition. It is more a syndrome in that it is something that happens, but there are a number of potential causes for it. So, as a result, usually the only way that you can identify the problem is to actually show an abnormality in the cardiac rhythm and that, I would expect, would require something like an electrophysiological study, which is a fairly invasive study and certainly is not a candidate for population screening. Simpler tests that might be a candidate, such as, for example, an electrocardiogram, do not identify cases with any reliable sensitivity. That is the main issue.

Senator SIEWERT-It seems to be the cases that you hear reported are associated a lot with young athletes.

Dr Singer-That is true, yes.

Senator SIEWERT-Is there a potential role for awareness raising or highlighting this for young athletes.Because I do not know much about it—you said there are a number of causes—I do not know if that is going to work anyway or if there is anything you could do about it.

Dr Singer-There certainly has been a reasonable amount of attention paid to this in the international literature, particularly in the US where it has been a fairly popular—that is not the right word—issue where some attention has been paid, and certainly some of the American based medical journals that I read, such as the New England Journal of Medicine and Annals of Emergency Medicine, certainly have highlighted cases where this has been an issue. Yes, I guess there is potentially the opportunity for raising awareness amongst health practitioners in this, but certainly anyone who reads the literature would be aware, anyway.

Senator SIEWERT-Thank you.

Perhaps someone could send the Doctors' this simple Blog - it may assist in providing them with a bit more information than they currently have, such as the following from the CRY - UK Website.

The ECG test when used in isolation is not as comprehensive as when used with the Echo, but it will detect the majority of abnormalities. This includes 97% of those young people who might be at risk of Hypertrophic Cardiomyopathy, which is the most common cause of Sudden Death Syndrome in the UK. Recent research has shown that 1 in 500 people have Hypertrophic Cardiomyopathy. The ECG test is also the definitive test for Wolfe-Parkinson-White (WPW)and Long QT Syndrome. The ECG test will not pick up Coronary Artery Anomalies or Coronary Artery Disease.

Perhaps they can also refer to their own Department's website regarding the prevalence of Hypertrophic Cardiomyopathy which is described as not rare and this condition alone affects 1:500 - refer to Sports Section.

There should also be some information available to them, since according to Nicola Roxon the Government has spent $24 million dollars since 2000 into better understanding and addressing SCD.


  1. Thank you for keeping us posted,your doing a great job!!!The floodgates are slowly but surely opening!!! For a country so advanced in so many ways its an absolute joke that we have "so called medical experts" with very little knowledge of HCM and the devestating effects it has on our young...Awareness can and will save lives!!!!!

  2. Prof. Bishop is on the the Council of NHMRC. Three weeks before this sitting in Parliament the NHMRC awarded the top ten research projects for 2010.One award was to a Sydney cardiologist for:

    'his work into the most common genetic heart disorder - hypertrophic cardiomyopathy - that has lead to new strategies to improve diagnosis and prevent sudden death in young patients with this often fatal condition.'

    He seemed very eager to pass this hot potato over to Dr Singer who is the Principal Medical Advisor for the Dept of Health & Ageing.

    It is deeply concerning to see the games these people play in Parliament when young lives are on the line. I found it very offensive.