Monthly Archives: January 2020

What makes a good psychologist or psychiatrist and how do you find one you like?

We all struggle from time to time, but many people benefit from seeing a therapist.

What makes a good psychologist or psychiatrist and how do you find one you like?

January 20, 2020 12.41pm AEDT


  1. Jade Sheen Associate Professor, School of Psychology, Deakin University
  2. Amanda Dudley Psychologist and Lecturer, Deakin University

Disclosure statement

Jade Sheen is a recipient of an Australian Government Office and Learning and Teaching grant and several Department of Health and Ageing grants.

Amanda Dudley does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.


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Hi, I have mental health issues and I would like to know what makes a good or bad psychiatrist, psychologist or neuropsychologist.

Key points

  • Understanding the different roles of psychologists and psychiatrists, and how they align with your needs, will help you decide what type of therapist to see
  • find a therapist you feel safe and secure with, even if that means trying a few before finding one you like
  • find out how much they charge in advance. If cost or access are issues, or if it would make you more comfortable, consider going online for help.

Who does what in mental health care?

Each type of mental health worker will have a different area of speciality, as well as different qualifications, training and experience.

In your question, you talked about psychologists and different areas of specialisation like clinical psychologists, neuropsychologists and psychiatrists, all of whom play a role in the assessment and treatment of mental health conditions.

Understanding the role of each and how it aligns with your needs may help you in your decision.

Psychologists in general

Psychologists provide assessment and therapy to clients, either through individual or group format and aim to enhance a person’s well-being.

A psychologist typically completes a minimum of six years of training, including university and practical experience, and is required to be registered with the Psychology Board of Australia.

Clinical psychologists

Clinical psychologists provide a range of psychological services to people across their life. Services typically focus on the assessment, diagnosis and treatment of mental illness.

Clinical psychologists complete additional supervision in the practice of clinical psychology beyond their six years of university.

Clinical neuropsychologists

Clinical neuropsychologists assess and treat people with brain disorders that affect memory, learning, attention, reading, problem-solving and decision-making.

Like clinical psychologists, neuropsychologists complete those six years and receive additional supervision in the practice of clinical neuropsychology.

Psychologists and psychiatrists have different backgrounds but both assess and treat mental illness. Kaleidico


Psychiatrists are doctors who are experts in mental health. They diagnose and treat people with mental illness and prescribe medications, if appropriate.

Psychiatrists typically complete four to six years of an undergraduate medical degree before undergoing general medicine training within a hospital. Then they complete several years of specialist training in psychiatry and must be registered with the Australian Health Practitioner Regulation Agency.

You might need to try a few therapists to find the right one

Therapy requires a person to feel safe and secure and establish trust with another person. So the fit between the two of you matters.

In the same way you may try a few hairdressers or GPs before you feel in safe hands, you may need to try out a few therapists before you find the right one.

Try not to feel disheartened; your persistence in this area will pay off.

Read more: Thinking of seeing a psychologist? Here’s how to choose the therapy best for you

Ideally, you should select a therapist who is appropriately qualified but also, one you can connect and engage with. To test this, you should leave the first session with a sense of hope, even in the face of challenges.

This is not to say therapy will always be a comfortable process. It will be your therapist’s job to encourage and support you in making uncomfortable changes, so there may be times where you feel challenged or uncomfortable. It’s helpful to communicate this openly with your therapist and allow space to explore this with their support.

Ask your community for recommendations

Word of mouth can be an excellent tool when sourcing a good therapist. Consider asking your GP, family, friends or local community who they recommend.

Once you have some names, do your homework. Look up their qualifications, read about them if you can, and make sure that they practise in the area that you need.

Mental health is a broad term and as such, therapists may choose to focus on particular areas within it. If the therapist you’ve chosen doesn’t practise in your area, don’t worry – just ask them if they have a referral suggestion for you.

Find out how much they charge

In Australia, there are a lot of different ways to access mental health support. Some options include private practitioners working in clinics or schools, community services and public mental health services. Each of these settings will have a different fee or access structure associated.

For example under Medicare, a person may be eligible for up to ten sessions (individual and/or group) with a registered psychologist per calendar year with a referral from their GP.

These sessions may be bulk billed (with no out-of-pocket expense), or there may be a fee associated and rebates available. Fees can vary greatly, however the Australian Psychological Society recommends a fee of A$251 per 50-60 minute session. Medicare rebates range from A$86 (for psychologists) to A$126.50 (for clinical psychologists and neuropsychologists). This would leave you out of pocket A$124.50 or A$165.

Out-of-pocket costs for private psychiatrists also vary. They may be bulk billed, or charge a fee. An initial consultation may cost around A$400, with a Medicare rebate of A$201.35, leaving you out of pocket A$178.65.

Mental health services at headspace are either free or low cost. And some schools also offer free psychological services.

Ask your GP about the specific costs and rebates when you discuss referral options.

Consider going online

Online therapy will be a good fit for some young people. Will Rodrigues/Shutterstock

While there is much to be gained from the personal experience of therapy, access can be a problem in some regional and remote area of Australia.

Thankfully, there are a number of excellent online resources available:

  • Centre for Clinical Interventions provides online resources and self-directed therapy modules for bipolar, anxiety, depression, eating disorders and other mental health conditions
  • Beyond Blue provides support for anxiety, depression and suicide prevention
  • Black Dog Institute is dedicated to understanding, preventing and treating mental illness. It has a range of resources, particularly for depression and anxiety
  • Brave supports young people to overcome anxiety.

Remember, we all struggle from time to time. For many, therapy plays an important role in improving their mental health and setting them back on their path.

Read more: Online therapies can improve mental health, and there are no barriers to accessing them

Are the eyes the first clue to diagnosing illness?

Featured Articles in Internal Medicine In the News

Are the eyes the first clue to diagnosing illness?

John Murphy, MDLinx | October 15, 2019

The eyes are the window to the soul—and the body. Eye doctors can tell a lot about your overall health just by looking in your eyes. That’s because the eye is the only place in the body that provides an unobstructed view of blood vessels, nerves, and connecting tissue. As a result, eye examinations and tests can provide earlier diagnoses on diabetes, high blood pressure, cancer, multiple sclerosis, and other conditions.


Eye doctors can often identify certain diseases in the eye before they manifest anywhere else in the body.

“There is an intricate communication between the eye and the rest of the body through the blood, blood vessels, and nerve connections. The eyes can reflect illness that begins in another tissue far away from the eyes themselves,” according to ophthalmologist Rebecca Taylor, MD, on the American Academy of Ophthalmology website.

Here are just a few of the many conditions that may be detectable in your eyes before anywhere else in the body.


Because blurred vision is one of the first signs of diabetes, eye doctors are often the first to diagnose patients with this condition. Blurred vision may occur in people with prediabetes or diabetes due to increased plasma glucose levels that alter the shape of the eye’s crystalline lens.

But blurred vision can also be a result of diabetic retinopathy, in which damaged blood vessels in the retina can weaken, bulge, or seep into the retina. Left untreated, this leads to diabetic macular edema, in which damaged blood vessels leak fluid that causes swelling in the macula—the area of the retina responsible for central vision. Eye doctors commonly diagnose diabetes in these patients even when they haven’t exhibited any other diabetic symptoms.

On a related note, researchers in Australia have developed a way to test the tear film in the eye to screen for diabetic peripheral neuropathy in people with type 1 diabetes. Peripheral neuropathy affects nearly half of people with diabetes, causing numbness, weakness, pain, and other symptoms in the hands, legs, and feet. But it can be very difficult to diagnose in the early stage. These researchers predict that eye doctors—or any healthcare professional—will be able to simply take a sample of the patient’s tears to identify this diabetic complication as early as possible. So far, the test is only applicable to those with type 1 diabetes.

High blood pressure

Of the 103 million US adults with high blood pressure, about 20% don’t even know that they have it. Again, eye doctors are frequently the first clinicians to identify this condition.

High blood pressure in the body goes hand-in-hand with high blood pressure in the eye. This results in narrowing of the blood vessels in the retina as well as other characteristic ocular changes, resulting in hypertensive retinopathy. The severity of hypertensive retinopathy in the eye generally correlates with the severity of hypertensive damage in other organs, such as the brain, heart, and kidneys. Swelling of the optic disk (papilledema) indicates that blood pressure is extremely high and requires immediate treatment.


Cancer commonly metastasizes to the eye. The most typical intraocular metastases arise from breast or lung cancers, but they can be related to brain tumors, as well. Ocular symptoms don’t often occur, but malignancies may have characteristic appearances in the eye. A patient with leukemia, for instance, may present with retinal hemorrhages.

Because ocular metastases are sometimes the smallest clinically detectable lesions of disseminated malignancies, the eye doctor can help evaluate the efficacy of systemic cancer treatment by regularly monitoring these lesions.

Multiple sclerosis

Several years before multiple sclerosis becomes detectable, the first harbinger may appear in the eye. Optic neuritis—an acute, painful vision loss that occurs in one or both eyes over a few days to 2 weeks—can be its initial manifestation. After one episode of optic neuritis, 70% of eyes recover on their own within 3 to 6 months. But within the next 5 years of such an episode, more than 40% of young women (age 20 to 40 years) will manifest signs and symptoms of multiple sclerosis.

Myasthenia gravis

About 75% of patients with myasthenia gravis present with ocular manifestations. Of these, about 20% have only ocular manifestations. Although myasthenia gravis may affect any skeletal muscle, muscles that control eye and eyelid movement, facial expression, and swallowing are most frequently affected.

The hallmark of this chronic autoimmune neuromuscular disease is muscle weakness that worsens after activity and improves after rest. Because weakness is a common symptom of many disorders, the diagnosis of myasthenia gravis is often overlooked or delayed in people with mild or localized muscle weakness. In most cases, the first noticeable symptom of myasthenia gravis is drooping of one or both eyelids (ptosis) due to weakness of the eye muscles. And ptosis can lead to dry eye, another characteristic symptom.

Alzheimer disease

Within the past few months, news reports announced that a simple eye test could diagnose Alzheimer disease. The truth is that this eye test isn’t fully proven just yet—but researchers are working on it. Using a very high-tech ocular angiography scanner, the researchers found that people with Alzheimer disease had fewer blood vessels and less blood flow in certain parts of the retina than people with mild cognitive impairment as well as healthy controls. They concluded that changes in the microvasculature of the retina might be linked to small blood vessel changes in the brains of people with Alzheimer disease.

While more research must be done, the researchers hope that they will eventually have a test that signals changes in the eye before any changes in cognition become detectable.

Menopause and sexuality: prevalence of symptoms and impact on quality of life.

Maturitas. 2009 Jun 20;63(2):138-41. doi: 10.1016/j.maturitas.2009.03.021. Epub 2009 May 21.

Menopause and sexuality: prevalence of symptoms and impact on quality of life.

Nappi RE1, Lachowsky M.

Author information



This article aims to summarise the available knowledge on the prevalence of sexual symptoms at the menopause and their impact on quality of life in elderly women. Sexual changes are analysed in the context of the menopause transition and beyond.


The medical literature was searched (1990-2008) with regard to menopause and sexuality using several related terms.


The prevalence of sexual symptoms at the menopause differs across studies depending on several factors such as sample size, design, hormonal status and country. The most common sexual complaints are reduced sexual desire, vaginal dryness and dyspareunia, poor arousal and orgasm and impaired sexual satisfaction. Age and declining oestradiol levels have significant detrimental effects on sexual functioning, desire and responsiveness (arousal, sexual pleasure and orgasm) across the normal menopause transition, while reduced androgens levels played a role in hypoactive sexual desire disorder (HSDD), a symptom frequently diagnosed in surgically menopausal women.


Women attending menopause clinics are vulnerable to female sexual dysfunction (FSD) because of a complex interplay of individual factors variably affecting well-being. Surgically menopausal women may be more distressed by sexual symptoms. Giving women the opportunity to talk about sexual problems is a fundamental part of health care and may improve their quality of life.

Hold the prescription: Try these 7 natural antibiotics instead

Featured Articles in Internal Medicine In the News

Hold the prescription: Try these 7 natural antibiotics instead

Melissa Sammy, MDLinx | January 23, 2020

There’s no doubt that prescription antibiotics, such as penicillin, have made a profound difference in the treatment of otherwise fatal diseases since their discovery 80-odd years ago. However, experts have shown that as many as 20% of patients treated with antibiotics experience adverse side effects that range from mild allergic reactions to severe gastrointestinal disturbances. Because of this, more people are turning to folk medicines that include the use of natural antibiotic remedies.

Here are seven natural antibiotics—aromatic plants, herbs, spices, and their derivatives—that have been proven effective in clinical trials.




Commonly consumed as a tea or taken as a supplement, the herb goldenseal (Hydrastis canadensis) is often combined with echinacea for the prevention or treatment of the common cold. It is also used in traditional medicine for the treatment of various infections related to the eyes, skin, and urinary tract, as well as for diarrhea, vaginitis, and canker sores—despite the lack of direct evidence supporting its use for these conditions.

The reasoning for this may be due to berberine, a substance in goldenseal that has been shown to kill some strains of bacteria and fungi in in vitro studies. In one study examining goldenseal’s efficacy, researchers showed that goldenseal extracts were able to stop methicillin-resistant Staphylococcus aureus (MRSA) from damaging tissue.

The authors concluded that their “data lend support for the traditional use of H. canadensis to treat skin infections,” adding that “H. canadensis leaf extracts possess direct antimicrobial activity that is due in part to the alkaloid berberine, but not canadine or hydrastine.”

Pau d’arco

Pau d’arco

Derived from the inner bark of several Tabebuia tree species, pau d’arco—also known as taheebo or lapacho—is endemic to South America, where its earliest reported medicinal uses date as far back as 1873. Due to its reported antifungal and anti-inflammatory properties, pau d’arco is often consumed as an herbal tea for a wide range of inflammatory ailments and infections, including arthritis, fever, prostatitis, candidiasis, bacterial infections, parasitic diseases, dysentery, boils, and ulcers.

In one in vitro study, naphthoquinones, the active compounds found in some Brazilian medicinal plants including pau d’arco, demonstrated antifungal and antibacterial activity against gram-positive bacteria. These findings support those from other laboratory studies of the efficacy of pau d’arco on infections. However, further studies in humans are needed.



Myrrh has a rich history, dating back to ancient times. Described in both the Bible and Talmud as one of the primary ingredients in holy anointing oil, this russet- or golden-colored resin had a variety of historical uses that ranged from religious incense and insect repellent to facial treatment and kohl eyeliner. Old-world medical practitioners valued myrrh for its antiseptic and anti-inflammatory properties, and considered it to be an effective remedy for an array of ailments, including indigestion, toothaches, and even leprosy. They also used myrrh in combination with frankincense as a purifying agent to stop the spread of airborne disease and bacteria—a practice some experts believe actually has some merit to it.

In one study, for instance, the combined use of frankincense and myrrh oils was shown to be effective against select pathogens. In another more recent study, burning myrrh and frankincense incense decreased airborne bacteria by as much as 68%. The findings from these studies and those from other laboratory studies over the past two decades lend credence to myrrh’s reported antibiotic profile.

Today, myrrh is still used in Ayurvedic medicine, traditional Chinese medicine, and aromatherapy, and is included in many natural mouthwashes and toothpastes as an FDA-approved additive. According to some research, myrrh oil may aid in pain relief and the healing of mouth sores.



Most of us are familiar with the culinary uses of oregano in olive oil-based and tomato-centric dishes, but did you know that this Mediterranean herb also has important medicinal utility as an antibacterial and antifungal agent? In a review of studies focusing on the antibiotic and antimicrobial activities of several spices and their derivatives, researchers found that oregano was among the most effective natural antibiotics against several strains of bacteria and fungi—including Salmonella, Escherichia coli, and Bacillus subtilis—and was especially effective as an essential oil.

Thyme essential oil


Like oregano, thyme is another culinary gem that has been shown to have strong bactericidal activity as an essential oil. In a study that examined the antibacterial activity of thyme and lavender essential oils on strains of Staphylococcus, Enterococcus, Escherichia, and Pseudomonas genera, researchers found that “thyme essential oil demonstrated a good efficacy against antibiotic resistant strains of the tested bacteria.” In another study that focused exclusively on the effect of thyme essential oil on standard bacterial strains and 120 clinical strains derived from patients with infections, “thyme essential oil strongly inhibited the growth of the clinical strains of bacteria tested,” according to the authors.

Neem oil


Neem oil is derived from the fruits and seeds of the neem tree (Azadirachta indica), which is endemic to the Indian subcontinent. Although neem oil has a gamut of uses in traditional Chinese and Ayurvedic medicine, it is largely prized as an antibacterial and antifungal agent, and is used for the treatment of ringworm, head lice, bacterial infections of the skin, and other skin conditions like hives, eczema, psoriasis, and scabies.

Recently, researchers have begun to study neem oil’s impact on health and disease, with a particular focus on its antiseptic properties. In one review of neem oil’s medicinal uses from prehistoric to contemporary times, researchers found evidence supporting neem oil’s strong antibacterial and antiviral profile, citing its efficacy against parasitic diseases and some sexually transmitted diseases like gonorrhea. With respect to skin diseases, they concluded that “[n]eem has a remarkable effect on chronic skin conditions. Acne, psoriasis, eczema, ringworm and even stubborn warts are among the conditions that can clear up easily when high-quality, organic neem oil is used.”

Furthermore, in a 2016 study in which researchers studied the antibacterial effects of neem oil on 107 strains of MRSA, they found that all strains were killed upon exposure to neem oil within 12 hours, with 56 strains killed after only 1 hour of exposure.

“[Our] results are suggestive of antibacterial effect of Neem oil on multidrug resistant MRSA. Since neem oil exhibited bactericidal effect on MRSA, it may find clinical application as a topical antibiotic for MRSA infections,” concluded the authors.



Anise, or aniseed (Pimpinella anisum), is a spice with a distinct licorice-like taste that is often used as a flavoring additive in desserts and beverages. Among its many health benefits, anise has been shown to inhibit bacterial and fungal growth, making it a powerful antimicrobial agent. In a 2017 study, for instance, researchers assessed the antibacterial and resistance modulatory activity of aniseeds waste residue extract (ASWRE) and star anise waste residue extract (SAWRE) against 100 isolates of Streptococcus pneumoniae, S. aureus, Klebsiella pneumoniae, E. coli, Acinetobacter baumannii, and Pseudomonas aeruginosa. They found that both ASWRE and SAWRE demonstrated significant bactericidal activity against all of the bacterial strains tested, and were notably synergistic when used with conventional antibiotics.

“The combination between anise waste extracts and the test antibiotics could be useful in fighting emerging drug-resistant bacteria. These results suggest that both aniseeds and star anise waste residue methanolic extract (post-distillation) could be good economic sources of multidrug resistance inhibitors…Their use in combination with conventional antibiotics should be further studied for in vivo activities. This may lead to the development of much needed drug enhancing preparations,” concluded the authors.

The adverse side effects of prescription antibiotics coupled with the rising threat of drug-resistant bacteria has led many patients—and scientists—to look to the plant kingdom for answers. But while natural antibiotics may offer healthier alternatives to prescription antibiotics, they are not entirely without risk. After all, just because something is natural doesn’t necessarily mean it’s safe. Natural antibiotics should be used in moderation to reduce the risk of toxicity, and should only be used following clinical consultation to avoid any potential adverse herb-drug interactions.

Busting the 5 myths of aging

Featured Articles in Internal Medicine In the News

Busting the 5 myths of aging

John Murphy, MDLinx | December 09, 2019

No one likes getting older—including physicians. Perhaps that’s why myths about getting older persist, even among healthcare workers, despite research showing that old age is not itself a death sentence. Indeed, older age doesn’t automatically mean living with dementia, depression, loneliness, or other illnesses, as the following myth-busters reveal.  


Old folks in a line

There are numerous myths and misconceptions about old age. Here are five of them, and why they’re false.

Myth: Most old people have dementia

Dementia is not a normal or inevitable part of aging. Only about 3.6% of US adults aged 65 to 74 years have dementia (including Alzheimer disease, the most common type of dementia), according to recent data. However, the prevalence of dementia does increase with age, affecting 13.6% of those aged 75 to 84 years, and 34.6% of those aged 85 years and older.

True, some cognitive changes are normal with age—such as slower reaction times and reduced problem-solving abilities—but many older adults can outperform middle-aged and younger adults on intelligence tests that draw on accumulated knowledge and experience. Also, many factors related to older age aside from dementia can affect memory and cognition, including prescription drugs, tiredness, stress, depression, and other medical conditions.

Myth: Older age is accompanied by depression

In older age, psychological problems like depression frequently occur with physical illnesses such as stroke, heart disease, diabetes, and hip fracture. Older patients and their caregivers may simply resign themselves to the belief that these feelings are typical, so they don’t seek diagnosis and treatment.

But, age alone is not a risk factor for depression, noted clinical psychologist Simon Tan, PsyD, in Psychology Today. “Most older adults, most of the time, are not depressed. Depression is not a normal part of growing old but rather an illness that needs to be treated,” Dr. Tan wrote.

Myth: It all depends on your telomeres

There’s been a lot of interest lately in the relationship between aging and telomeres. What are telomeres? They’re DNA sequences that cap the ends of human chromosomes. As cells grow and divide, telomeres protect the chromosomes’ integrity during DNA replication. But telomeres shorten as we age and eventually lose their ability to function. Because telomere length is related to cellular aging and because cells in older people have shorter telomeres, researchers think that telomeres are related to the aging process and age-related diseases.

As compelling as the theory of shortened telomeres may be, however, “[a]ging is not caused by one event,” wrote William Mair, PhD, in The Washington Post. Dr. Mair studies the biology of the aging process at Harvard University’s T.H. Chan School of Public Health, Boston, MA.

Some of our cells age without shortened telomeres, Dr. Mair pointed out. “Many animals have telomeres much longer than ours, yet they age faster than we do,” he noted. “Shortening telomeres may even be useful, protecting against unchecked cell division, which is a hallmark of cancer.”

Myth: We’re getting older—and sicker

As a trend, human lifespan has been continually increasing. As of 2017, a baby born in the United States is expected to live an average of 78.6 years. Compare that with the average lifespan of 47.3 years in 1900. But while people are living longer, it seems like they’re not living any healthier. In a widely reported study in the American Journal of Public Health, researchers showed that Americans have increased their years living with illness and disability more than they have increased their years living without illness and disability.

But these problems aren’t inevitable. We can change them.

As the researchers themselves pointed out, “The outlook for the future depends on the trends in disability across the age range. It appears that we may have begun to prevent or delay the onset of some diseases as well as their progression to disability, which would be a positive influence. In addition, the obesity epidemic appears to be abating. These very recent trends may be promoting an increase in the length of nondisabled life as well as total life expectancy.”

Myth: Old people don’t have sex

We prefer to think that Grandma and Grandpa are not getting busy in their old age—we prefer to not think about it at all, really. But the “facts of life” are a fact of life, even in the golden years.

“Although frequency of sexual activity may decline in older adulthood, many older adults continue to enjoy a physically and emotionally fulfilling sex life,” according to the American Psychological Association’s Office on Aging. “Like younger adults, older adults who are in good health—and have a willing partner—are more likely to engage in sexual activity.”

Plus, sexual activity offers physical, mental, and emotional benefits that are helpful to seniors, too, such as better sleep, less stress, more positive mood, and improved marital satisfaction.

One more myth—for physicians

Another myth is that, with the aging of Baby Boomers, the field of geriatrics is growing. Unfortunately, it’s not.

“Who will take care of the increasing number of aging, more medically complex and frail people? If you think more geriatricians are being trained to meet the growing number of older patients with multiple chronic illnesses, think again,” wrote Michael D. Cantor, MD, JD, chief medical officer, CareCentrix, Hartford, CT, in an editorial on the New England Journal of Medicine website.

“We need to make it easier and more desirable for doctors to choose careers in geriatrics,” Dr. Cantor wrote. “Older Americans need and deserve geriatricians—today and in the future.”

New complementary medicine health claims lack evidence, so why are they even on the table?

New complementary medicine health claims lack evidence, so why are they even on the table?

July 21, 2017 6.10am AEST
The Australian drugs regulator is overhauling the health claims made by suppliers of complementary medicines, including homeopathic therapies. And some curious options are up for discussion. from

Australia’s drugs regulator seems to be endorsing pseudoscientific claims about homeopathy and traditional Chinese medicine as part of its review of how complementary medicines are regulated.

In the latest proposed changes, the Therapeutic Goods Administration (TGA) is looking at what suppliers (also known as sponsors) can claim their products do, known as “permitted indications”. An example of a “low level” permitted indication might be “may relieve the pain of mild osteoarthritis”.

If approved, the suppliers can use this permitted indication to market its listed product, one of about 11,000 listed complementary medicines on the Australian Register of Therapeutic Goods (indicated by “Aust L” on packaging).

However, the spreadsheet of 1,345 draft permitted indications includes many that seem to lack evidence to back them.

Complementary medicines are the subject of the latest TGA review of permitted health claims. Author provided

For instance, despite the Therapeutic Goods Advertising Complaints Resolution Panel upholding complaints of a lack of evidence that magnesium (and homeopathy) “relieves muscle cramps (and restless legs)”, this permitted indication is on its draft list.

Other examples include “supports transport of oxygen in the body”, “regulates healthy male testosterone levels”.

The list contains around 140 traditional Chinese medicine indications, such as “Harmonise middle burner (Spleen and Stomach)”, “Unblock/open/relax meridians”, “Balance Yin and Yang”.

There are also around 900 additional indications for unspecified “traditions”. These include, “Renal tonic”, “Helps healthy liver regeneration”, “Emmenagogue”, “Vermifuge” and “Vulnerary”.

Endorsing traditional medicines without evidence they work

Australia is a multicultural society, and it’s appropriate we respect and have some knowledge of complementary medical traditions.

Some observations made in these traditions have led to valuable, efficacious medicines, such as Artemisinin derivatives isolated from a herb used in traditional Chinese medicine.

However, scientific investigation has not substantiated many other aspects of such traditions, such as the homeopathic principles of “like cures like” and traditional Chinese medicine concepts of meridians through which the life-energy known as “qi” flows.

We also cannot assume traditional medicines are safe, as emerging data highlights how common adverse reactions and drug interactions really are.

Just because complementary medicines are based on long-held traditions doesn’t mean they work or are safe, as international data show. Author provided

For example, Hyland’s homeopathic baby teething products were recalled by the US Food and Drug Administration and then the TGA. This was because lack of quality control over potentially toxic ingredients – belladonna alkaloids – associated with adverse events in hundreds of babies.

In China, out of the 1.33 million case reports of adverse drug event reports received by the National Adverse Drug Reaction Monitoring Center in 2014, traditional Chinese medicine represented around 17.3% (equivalent to around 230,000 cases).

What we propose

Listed medicines, like those mentioned, are meant to contain pre-approved, relatively low-risk ingredients. They should be produced with good manufacturing practice and only make “low-level” health claims for which evidence is held. However, the TGA does not check these requirements before the product is marketed.

So, to safeguard shoppers, consumer representatives (of which I was one), suggested the proposed list of permitted indications should be short and only contain modest claims such as, “may assist” or “may help”.

We also argued that, for consumers to make an informed purchase, claims based on “traditional use” should always have a disclaimer along the lines of what the US Federal Trade Commission uses for homeopathic products.

For example, “This product’s traditional claims are based on alternative health practices that are not accepted by most modern medical experts. There is no good scientific evidence that this product works”.

However, industry representatives argued they needed a long list of permitted indications to allow consumers to tell the difference between one product and another. They also argued that disclaimers for traditional medicines were unnecessary. Their wishes made it to the draft list, rather than ours.

While we welcome moves to better regulate complementary medicines in Australia, this current list of permitted indications, without disclaimers, represents a government endorsement of pseudoscience.

Worse, it will encourage consumers to purchase often ineffective and sometimes dangerous products

Association of mindfulness and stress with menopausal symptoms in midlife women.

Climacteric. 2019 Jan 17:1-6. doi: 10.1080/13697137.2018.1551344. [Epub ahead of print]

Association of mindfulness and stress with menopausal symptoms in midlife women.

Sood R1, Kuhle CL1, Kapoor E1,2, Thielen JM1, Frohmader KS3, Mara KC4, Faubion SS1.

Author information



Midlife women frequently experience stress and menopausal symptoms. Mindfulness is thought to mitigate stress by avoiding emotional reactivity and ruminative thinking. We sought to assess the association of mindfulness and stress on menopausal symptoms among midlife women.


In this cross-sectional study, women aged 40-65 years completed questionnaires, including the Menopause Rating Scale (MRS), the Perceived Stress Scale-4 (PSS-4), and the Mindfulness Attention Awareness Scale (MAAS). Linear regression was used to assess the impact of mindfulness and stress on menopausal symptoms with use of univariate and multivariable analyses, adjusting for patient characteristics.


In this cohort of 1744 midlife women, higher mindfulness (MAAS) and lower stress (PSS-4) scores correlated independently with lower menopausal symptom (MRS) scores. On multivariable analysis, a significant interaction effect was observed between the MAAS and PSS-4 on the MRS, such that with higher PSS-4 scores, the magnitude of association between the MAAS and lower MRS scores was larger.


Among midlife women, higher mindfulness and lower stress correlated with lower menopausal symptom scores independently. Among women experiencing more stress, the magnitude of association between mindfulness and lower menopausal symptom scores was greater, largely driven by psychological subdomain scores. Mindfulness may mitigate menopausal symptoms among midlife women.

Doctors are now prescribing this ‘treatment’ to fight cancer

Featured Articles in Oncology In the News

Doctors are now prescribing this ‘treatment’ to fight cancer

Naveed Saleh, MD, MS, for MDLinx | December 09, 2019

Once upon a time, patients with cancer were advised to rest and relax, especially after cancer treatment such as chemotherapy, so as not to strain themselves. This isn’t so much the case today, when exercise is encouraged for this patient population—and even dosed into treatment regimens.


Doctor offering prescription to patient

The ACSM recommends that all physicians ask their patients with cancer about physical activity, and if inadequate, recommend more.

In the 1990s and 2000s, evidence cropped up that contraindicated previous beliefs that exercise was bad for patients with cancer. In turn, these studies laid the foundation for the burgeoning field of exercise oncology. Today, there are more than 1,000 randomized, controlled trials on the topic.

In October 2019, the American College of Sports Medicine (ACSM) convened an expert panel to report recently updated guidelines regarding the role of exercise in cancer survivorship. Let’s take their results from the top, and focus on the role of exercise as a cancer treatment.

Benefits of exercise in cancer

“The ACSM panel found evidence that providing specific exercise prescriptions for a number of cancer-related health outcomes benefitted people living with or beyond cancer,” said former ACSM president and panel co-chair Kathryn Schmitz, PhD, MPH, professor, Departments of Public Health Sciences and Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA. “As an example, we saw strong evidence that an exercise program consisting of a half hour of aerobic exercise three times weekly was sufficient to improve anxiety, depression, fatigue, quality of life, and physical function in cancer survivors.”

Concerns about lymphedema secondary to twice-weekly resistance training have been raised, but the panel found this type of exercise did not increase the risk of disease and even offered some health benefits. However, compared with resistance training alone, symptoms of depression and anxiety have only been shown to improve with resistance training combined with aerobic training.

It remains to be elucidated whether exercise also improves other cancer-related outcomes—including cardiotoxicity, peripheral neuropathy, pain, cognitive function, or chemotherapy completion rate—as well as whether exercise boosts treatment tolerance.

In terms of survivorship, exercise prescribed to patients with colon, breast, or prostate cancers has been linked to lengthened survival. However, not enough evidence exists regarding potential survival benefit in those with other types of cancer. On a related note, the ACSM recommends that all cancer survivors heed to general public health recommendations for physical activity, which is either 2.5 to 5.0 hours per week of moderate-intensity activity or 1.25 to 2.5 hours per week of vigorous activity.

Exercise prescription

Years ago, it was unclear to most that exercise is good for the heart, and now everybody knows this thanks to a paradigm shift. Similarly, the ACSM hopes for a paradigm shift in how providers, caregivers, and patients with cancer view exercise as beneficial and necessary in treatment.

“ACSM has just started a new initiative called Moving Through Cancer,” said Dr. Schmitz, “which focuses on increasing awareness of the value of exercise for cancer survivors, along with educating the cancer clinician workforce to refer, coordinate, and prescribe exercise; expanding opportunities to exercise; and shifting policy so that, by 2029, exercise is standard practice for all patients living with and beyond cancer.”

Importantly, any exercise regimen needs to be personalized to patient preference and functional status. Factors including age, cancer type/stage, adverse effects of treatment, and comorbidities should be taken into consideration.

Counseling patients

Lots of people with cancer don’t exercise. These patients should be advised to try some type of physical activity as a means to improve their health. Simply going from no exercise to some exercise is a great improvement. The ACSM recommends that all physicians ask their patients with cancer about physical activity, and if inadequate, recommend more.

“Even if that is all providers have time to do, it demonstrates to patients that physical activity is an important part of managing their health and lays out the expectation that being physically active is healthier than being sedentary,” said Dr. Schmitz. “This is true even for patients with advanced disease and those experiencing limitations, although those cancer patients will need a medically supervised program.”

Bottom line

Physicians are busy professionals. Unpacking the benefit of exercise for your patients will take precious minutes. However, many patients with cancer enjoy exercise programs greatly, and appreciate the guidance in retrospect. Focusing on exercise can be a productive and empowering portion of the clinical encounter.

In interested in learning more, the Moving Through Cancer initiative’s website provides ample information on high-quality exercise programs and answers to frequently asked questions. Keep in mind that physicians need to refer patients to exercise programs, with most exercise programs requiring physician approval.

10 Amazing Benefits of Progesterone

Dr. Steven Hotze

10 Amazing Benefits of Progesterone

Jun 16, 201710 Amazing Benefits of Progesterone

The hormone progesterone is often associated with pregnancy, but did you know that it has many other amazing benefits for your body? A woman’s progesterone levels gradually decline with age, which allows estrogen to dominate, causing many unwanted negative health symptoms. By restoring your progesterone levels back to normal, you can alleviate your symptoms.

10 Amazing Benefits of Progesterone

1. PMS – Progesterone regulates the menstrual cycle and relieves the symptoms of premenstrual syndrome.

2. Anxiety, Depression and Low Moods – Progesterone acts as a natural antidepressant, relieves anxiety and improves moods. It also relieves postpartum depression which is caused by the drastic drop in progesterone after childbirth.

3. Migraines and Headaches – Progesterone is helpful in relieving migraines and headaches.

4. Fertility and Pregnancy – Progesterone promotes the survival of the embryo and fetus throughout a pregnancy.

5. Fluid Retention and Weight Gain – Progesterone relieves fluid retention and weight gain caused by estrogen dominance.

6. Sleep – Progesterone has a calming effect that helps promote sound sleep.

7. Bone Health – Progesterone promotes bone building and helps reverse osteoporosis.

8. Thyroid Function – Progesterone helps the thyroid hormones be used by the cells of your body which allows for optimal thyroid function and energy.

9. Cancer Prevention – Progesterone protects you against endometrial and breast cancer.

10. Brain Healing – Progesterone reduces swelling and improves mental clarity after a traumatic brain injury.

Bioidentical Progesterone: The Real Thing
By replenishing your progesterone with bioidentical progesterone, you can relieve your symptoms. Bioidentical progesterone is identical to the progesterone made by your body. Progesterone is the natural female hormone that promotes pregnancy by preparing the body for conception, regulating the menstrual cycle and maintaining the pregnancy. It also balances the estrogen in your body and plays an important role in your overall well-being.

Progestins are NOT Progesterone
It’s important to make the distinction between progestin and progesterone, because they are not the same. Progestins (such as Provera) are synthetic chemicals with a different molecular structure than progesterone, which makes them patentable by the pharmaceutical companies, but they do not have the same beneficial effects as your body’s naturally occurring progesterone. In fact, progestins are used in hormonal contraceptives and in the “morning after pills” to prevent pregnancy. The Women’s Health Initiative showed that progestins cause bleeding problems, blood clots, and even cancer.

Mainstream medicine still erroneously uses these two terms interchangeably today. If you’re still in doubt, just ask your doctor if you can take progestin while you’re pregnant. You’ll hear a resounding “no”!

Mind-bending drugs and devices: can they make us smarter?

I return to work on Thurs 16th Jan, after a months break. I tried to avoid the internet, emails and my mobile, so I could have a complete break from work. I am now refreshed and ready to get back into the swing of things. I look forward to being of help to you this year.

Mind-bending drugs and devices: can they make us smarter?

This is part of our series on Changing the Brain, about what’s happening in our brain in various mental states and how we can change it for the better and worse.

Demand for drugs and devices that can enhance brain functions such as memory, creativity, attention and intelligence, is on the rise. But could the long-term side-effects outweigh the benefits of being “smarter”?

Known as “smart drugs” or “neuroenhancers”, the field of nootropics (literally translated as mind-bending) is one of the most debated topics in neuroscience. Healthy people of all ages are seeking cognitive enhancement for personal improvement, athletic performance, academic success, professional advantage and to maintain function into old age.

Demand is driven by a changing work environment that increasingly requires use of the mind and not the muscles, heavier workloads, pressure to succeed and an ageing population seeking to reduce the risk of dementia.

Strategies for cognitive enhancement are diverse, ranging from brain training programs to physical activity, drugs and brain stimulation devices. It’s well known neuroenhancers such as lifelong learning, brain training and physical activity have positive effects on memory and attention. These strategies are also safe and inexpensive. The downside? They require substantial time and effort.

Most of us already use brain stimulation

Neuroenhancers that can be swallowed (pills, liquids) or devices that can be worn, are appealing because they require much less effort. In fact, most of us already use a daily smart drug to improve alertness and attention: coffee.

The effects of caffeine on mental function have been known for centuries, and high levels of caffeine consumption (equivalent to five to six cups of coffee per day) were once banned in Olympic competition. Studies have shown alertness and attentiveness are increased and reaction times shortened, when caffeine is consumed.

These effects are greater in people who are sleep-deprived. With approximately 1.6 billion cups of coffee consumed worldwide every day, it’s clear cognitive enhancement is something most of us welcome.


Most of us drink a cup of brain stimulation every day. Danielle Macinnes/Unsplash

The risks

The case in favour of smart drugs becomes murkier as the level of risk becomes greater. Methylphenidate (MPH, also called Ritalin) is commonly prescribed for adolescents with attention deficit-hyperactivity disorder (ADHD). However, MPH can also improve working memory, attention, alertness and reaction times in healthy individuals.

The drug is sold on the black market to high school and university students as a study and examination aid. Students report taking the drug for its performance enhancing effects and not for recreational or medicinal use.

The use of MPH, a prescription-only drug, in healthy individuals is not without risk. At high doses, MPH can interfere with cognition and produce side effects that impair athletic performance.

Read more: We can change our brain and its ability to cope with disease with simple lifestyle choices

Other possible side-effects include anxiety, irritability, nausea, abdominal pain, heart palpitations and blurred vision. Concerns have also been raised about the potential for MPH to disrupt the development of the adolescent brain, with lasting behavioural consequences.

The risks associated with smart drugs raise an important ethical question. What level of risk should people who are otherwise healthy be willing to accept in pursuit of cognitive enhancement?

All drugs have side-effects. But when a drug is medically indicated, there is generally agreement the benefits outweigh the risks. Making this judgement in healthy individuals is much more complex. Where do we draw the line between the desire for improved cognition (and potentially greater productivity and success) and health? As the field of nootropics grows, this is a question we’ll need to ponder.

Non-invasive brain stimulation, where magnetic fields or electrical currents are applied to the brain using a device worn on the head, is another potential method of cognitive enhancement. These currents are thought to alter the activity of brain cells but, high quality evidence is lacking and long-term safety studies are yet to be completed.

Despite this, the simplicity of the technology (you can build a device with a 9V battery and a handful of cords) makes it difficult to regulate. There is a growing market for DIY brain stimulation and devices are available for purchase via the internet.

You can even find online instructions on how to build a brain stimulation device of your own. A key concern is healthy individuals using these devices could produce detrimental, long-lasting brain effects that are difficult to reverse.

There is no denying neuroenhancers exist and are widely used: the question is to what extent we will be able to make ourselves smarter in future, and at what cost?