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Hypoplastic left heart: the next chapter in our unsolved problem

By Professor David Winlaw 

Paediatric cardiac surgeon and Victor Chang Institute Faculty member, Professor David Winlaw provides commentary on a recent study published in Heart, BMJ on long term outcomes in children born with hypoplastic left heart syndrome (HLHS).

The story of paediatric cardiac care over the last 35 years can be told through the many successes and failures in the surgical management of hypoplastic left heart (HLH). In their Heart paper, 1 Rogers and colleagues bring the second chapter to a close and foreshadow the next chapter for a specialty which, in the UK, is never far from newspaper headlines.

In chapter 1 (pre-2000), neonates with HLH faced daunting odds of survival despite consistent success in other forms of complex neonatal cardiac repair. Many services and some countries did not offer surgery for this condition and the balance between the benefits of procedural volume versus local access to care was constantly debated. The ethical foundation of treating newborns with HLH was constantly questioned, and success or failure of entire surgical programmes was predicated on acceptable early survival of this cohort.

The second chapter spans 2000–2015, when patients described in this report were born and began their surgical pathway. Consistent and excellent results were being achieved by units in the UK2 and USA. There was rapid dissemination of techniques and philosophies of care to the point where most large programmes routinely managed HLH and achieved good early outcomes.

Truly team-based care, a focus on the intensive care needs of the postsurgical neonate and tight integration of surgery with cardiology became understood as fundamental to achieve optimal outcomes. This hospital and human infrastructure lifted early outcomes for all other forms of paediatric cardiac surgery; part-time paediatric cardiac surgical practice became uncommon and expectations continued to grow.

This report of outcomes is particularly important and will be welcomed by the international community working in congenital heart disease (CHD). Unlike most other reports of outcome in HLH, this report is population based (England and Wales). Further, the raw data are derived from a mandatory national audit scheme, the outcomes of almost a thousand patients is reported and survival has been validated using a national death register. We can be confident that this report is a true picture of overall outcomes, free of selection bias and representing the outcomes from all units who undertake such work. The results have been achieved in the context of resources provided by the National Health Service, a public-sector provider. It is real, and the benchmarks are believable.

Rogers and colleagues1 describe the multiple pathways children follow to achieve a total cavopulmonary connection (the Fontan operation). This is the last of the planned operations for children with HLH and other morphologies where a single ventricle supports the entire circulation. The objective of the surgical pathway is to achieve Fontan completion—if that is not possible, children face a difficult and limited future. Fontan completion is usually followed by several decades of good quality life, although the incidence of new medical problems increases over time.3

In the current era, outcomes after individual components of the pathway, for example, survival after initial ‘Norwood’ surgery, are important for surgical audit purposes but do not describe quality of the whole programme. This study is how outcomes in CHD should be reported, that is, taking into account the whole journey travelled, in this case en route to Fontan completion. It would be very useful to have similar knowledge of outcomes for patients with other forms of congenital heart disease. The utility of such information is in the subsequent tailoring and optimisation of care, a better understanding of where resources are best deployed and to inform prenatal counselling. Analyses of financial burden to patients, parents and the community might also prompt consideration of how to lessen the impact on income and productivity, an inevitable consequence of caring for children with a chronic illness.

The report includes analysis of more recent surgical strategies to improve early outcomes. Application of the ‘hybrid approach’, where the major operation involving aortic arch reconstruction is deferred beyond the neonatal period, has been used mostly to manage patients with high-risk characteristics for routine first-stage surgery. This approach was utilised in just over 6% of patients, mostly high-risk candidates (extracardiac anomalies, prematurity, low birth weight) and as expected the hospital mortality for this group is high. Outcomes for the traditional pathway have improved in the recent era, although it is uncertain whether this is as a result of iterative improvements in surgery and perioperative care or that some of the high-risk patients have been transferred from the traditional to the hybrid pathway. This study does not address the potential utility of the hybrid approach in high-risk or normal-risk patients as entry criteria were not defined, and the role of this approach remains to be established.

Two studies from North America are the most direct comparators for this study. Despite differences in inclusion criteria, outcomes are remarkably similar for early and late outcomes. The first was a comparison between different surgical strategies to create a source of pulmonary blood flow during the first operation (the Single Ventricle Reconstruction (SVR) trial).4 It was conducted in largely academic centres in mostly normal-risk patients and provided a contemporary (2005–2014) understanding of survival after surgery for HLH. The SVR trial reported that 32% of patients were deceased at 3 years versus 36% in this study. There are differences in the way transplantation was considered as an endpoint in the two studies, but the number of transplants in the Rogers study was very small and this difference is not central in a comparison of outcomes. It is regrettable that adequacy of raw data in the UK study did not allow comparison of outcomes according to shunt type.





The second study5 is not directly comparable in its approach but also provides a useful benchmark for survival—that around 60% of patients will be alive at 6 years after birth. Again, an outcome which is broadly comparable with outcomes demonstrated in this study. Taken together, we have an evidence base to counsel parents considering a future for their fetus or neonate with HLH. The take-home message is that at 3 years after birth, survival is likely to be around 65%–70% and 60% at 6 years.

The inadequacy of survival as the only endpoint in assessing outcomes is well recognised. Neurodevelopmental disability affects around 30% of survivors, with a range of outcomes from delay in reaching developmental milestones, through learning and behavioural disorders such as autism, and in rare cases cerebral palsy. This is not just about HLH, however, with similar rates seen in others undergoing neonatal cardiac surgery, including those where a ‘normal’ circulation is restored in a single operation. Numerous variants in shared pathways determining brain and heart development are likely to play a major role.6 Psychological concerns for child and family are highly prevalent and also highly modifiable through interventions starting at time of antenatal diagnosis. Provision of such multidisciplinary care speaks to the nature of the institutions required to provide optimal care and the costs involved.

With such concordance in outcomes between major studies in HLH, it is reasonable to ask whether a ceiling has been reached and if this is as good as it gets? Can further improvements be expected with current approaches, other than through incremental and iterative group learning? We have improved outcomes of the standard pathway by having more stringent selection criteria, minimising the impacts of high-risk characteristics including low birth weight and prematurity through adaptions of the hybrid approach and delayed Norwood surgery. Should we expect more?

Some of the answers may lie in the developmental origins of HLH itself. Present understandings point towards HLH not being a simple consequence of ventricular growth arrest as a result of mitral or aortic valve atresia. Instead, HLH is the end result of a pan-cardiac developmental disorder including the cardiomyocyte.7 Our operations address inflows and outflows but the development of ventricular dysfunction is an important and common pathway towards deterioration in clinical performance and sometimes death. Developmental defects evident within myocytes may well reduce the ability of the right ventricle to perform in the long term and explain some of the morbidity and mortality in patients with ‘perfect’ technical outcomes. Cell therapy approaches are being trialled to address this problem and medium-term outcomes are awaited.

In this, the year that saw the passing of Francis Fontan, we are more aware than ever that achievement of the Fontan is just the beginning of another journey for child and family. HLH may2 or may not8 represent a worse substrate for long-term outcomes, but further improvements can be expected as mechanisms of Fontan failure are better understood. For most, we can expect that today’s patients with HLH surviving to Fontan will have an adult life and that education, employment and family are achievable in most.

In the next chapter, subspecialisation of care for those with a single ventricle and seamless transition of multidisciplinary management into adult life will improve the quality of life for child and family. But there is more to learn in pre-Fontan care and through patient cohorts such as this, we need to identify and address modifiable factors that might produce a better substrate for the Fontan. Optimisation of pulmonary arteries prior to Fontan completion through stenting or additional surgery might also be important. Timing of Fontan completion—varying starkly in this study—highlights the lack of an evidence base to support firm clinical guidelines for something as simple as timing of the last procedure.

The imperfections of the Fontan are well recognised but for now it is what we have. Let us hope the next chapter brings a new treatment paradigm for HLH.

Professor David Winlaw is a paediatric cardiac surgeon and researcher. He is based at The Children’s Hospital at Westmead and is Professor in Paediatric Cardiac Surgery at the University of Sydney. He is the Head of Paediatric Cardiothoracic Surgery in the Sydney Children’s Hospitals Network. Professor Winlaw is also the newest faculty member to join the Victor Chang Cardiac Research Institute, working very closely with Professor Sally Dunwoodie.  

References

 1. Rogers LPagel CSullivan IDet alInterventional treatments and risk factors in patients born with hypoplastic left heart syndrome in England and Wales from 2000 to 2015. Heart 2018doi: 10.1136/heartjnl-2017-312448. [Epub ahead of print 25 Jan 2018].doi:10.1136/heartjnl-2017-312448

2. McGuirk SPGriselli MStumper OFet alStaged surgical management of hypoplastic left heart syndrome: a single institution 12 year experience. Heart 2006;92:36470.doi:10.1136/hrt.2005.068684

3. d’Udekem YIyengar AJGalati JCet alRedefining expectations of long-term survival after the Fontan procedure: twenty-five years of follow-up from the entire population of Australia and New Zealand. Circulation 2014;130:S32S38.doi:10.1161/CIRCULATIONAHA.113.007764 

4. Ohye RGSleeper LAMahony Let alComparison of shunt types in the Norwood procedure for single-ventricle lesions. N Engl J Med 2010;362:198092.doi:10.1056/NEJMoa0912461

5. Wilder TJMcCrindle BWPhillips ABet alSurvival and right ventricular performance for matched children after stage-1 Norwood: modified Blalock-Taussig shunt versus right-ventricle-to-pulmonary-artery conduit. J Thorac Cardiovasc Surg2015;150:144052Discussion 50-2.doi:10.1016/j.jtcvs.2015.06.069

6. Jin SCHomsy JZaidi Set alContribution of rare inherited and de novo variants in 2,871 congenital heart disease probands. Nat Genet 2017;49:1593601.doi:10.1038/ng.3970

7. Liu XYagi HSaeed Set al. Nat Genet >span class="cit-pub-date">2017;49:11529.doi:10.1038/ng.3870

8. Downing TEAllen KYGlatz ACet al. Long-term survival after the fontan operation: twenty years of experience at a single center. J Thorac Cardiovasc Surg 2017;154:24353.doi:10.1016/j.jtcvs.2017.01.056

Originally published in Heart, BMJ.

'I use zebrafish to fight heart disease. I want girls to know STEM isn't just for boys.'

By Dr Inken Martin 


Growing up with a scientist for a father my family dinner discussions often revolved around advances in medicine, astronomy and neuroscience. So, it never occurred to me as a young girl that my interest in maths or science wasn't "normal".

As a female cardiovascular disease researcher and passionate supporter of women in science, I was thrilled to see Quantum Physicist Michelle Simmons named 2018 Australian of the Year a couple of weeks ago. As I believe having strong role models and mentors is key for girls and women to pursue science in school, university and at the workplace.

Unfortunately, it’s still the case that only 16 per cent of Australians qualified in science, technology, engineering, and mathematics are women. So, there is far more work to be done to encourage young women to consider a career a STEM field as an option for them and as something they might enjoy.

Young girls are just as good in maths and sciences as boys and I want my three daughters and other young girls to be confident in these areas and not shy away from pursuing a career in this field if they are interested.

In my experience science can be an incredibly rewarding career choice if you are curious, enjoy being intellectually challenged and want to contribute meaningfully towards solving some of the most pressing problems of our time.







However, young women will often move away from studying science in school after Year 10 and pursue what are perceived to be more typically “female” subjects, such as English or humanities. It’s thought that the misconception that women are not successful in STEM professions may contribute to this.

What also worries me is the amount of STEM qualified women who are opting out mid-career. A key contributing factor is the lack of female representation at institute department head and director levels which has a direct impact on the lack of female role models and mentors in science.

However, change is in the air, with more and more universities and research institutes making great efforts to promote gender equity.

The underrepresentation of women in science fields is a huge shame, not only for these women but for the growth of Australia’s STEM industries and the future of research in this country. Women can bring different experiences and ways of thinking to their work, which is extremely valuable when you are trying to solve a problem or innovate.

Many people wouldn’t believe that the work can also be incredibly flexible. In my career at the Victor Chang Cardiac Research Institute in Sydney I have benefitted from flexible working arrangements and opportunities that consider my carer responsibilities.

In fact, just last year I was able to attend the 10th Zebrafish Disease Models Conference in San Diego, USA, while having any extra childcare expenses covered, thanks to the Heart Foundation NSW Cardiovascular Research Network.

With our changing economy, now more than ever is a crucial time for young women to develop skills in fields that are at the forefront of technological development.

So, I encourage you to speak with the young women in your life about how they can future-proof their careers for the jobs of tomorrow.

Dr Martin is a German-trained medical doctor who now lives in Sydney with her husband and three young girls. She is a senior postdoctoral research fellow at the Victor Chang Cardiac Research Institute and a Heart Foundation NSW Cardiovascular Research Network funded researcher.

She uses zebrafish models to investigate causes and potential treatments for inherited forms of human adult heart diseases such as cardiomyopathy and atrial fibrillation. For her work she was recently awarded the prestigious Ralph Reader Basic Science Prize at the 2017 Cardiac Society of Australia and New Zealand (CSANZ) annual scientific meeting.

Originally published in Mamamia.

We can't let our kids die younger 

Urgent action is required to prolong the lives of a generation faced with  'diabesity'.

By Professor Bob Graham, Victor Chang Institute 
      Professor Shaun Jackson, Heart Research Institute 


In 2004, renowned American cardiologist Valentin Fuster and his colleagues made the startling prediction that “one in three children born in the year 2000 will develop diabetes, resulting in a 30 per cent reduction in life expectancy”. If true, this would cut short the lives of millions of Australian children by up to 25 years, making it the first time in human history that children would, on average, be leading shorter lives than their parents.

Is this possible and why isn’t this front-page news? No one knows exactly how bad the obesity and diabetes epidemic will become, but the voices of concern are growing louder as the statistics worsen, and in some communities it is far worse than many of us imagined a decade ago. Today, three times as many people in the world die from over-nutrition than from starvation or malnutrition.

The health implications of this “diabesity” epidemic are enormous. Obesity and diabetes are major risk factors for a broad range of cardiovascular diseases, including coronary artery disease, kidney disease, stroke and dementia. Diabetes also causes blindness and leads to limb amputations. Based on trends, this scenario will get worse, leading to a tsunami of cardiovascular diseases that could overwhelm a healthcare system already struggling to deal with an ageing population.

Much of the problem begins in childhood and the obesity epidemic worsens through our teens and early adulthood. Once considered a disease of middle and older-aged adults, we are now seeing type 2 diabetes far more commonly in children and young adults, leading to health complications at a far earlier age.

This is most dramatically demonstrated in our indigenous communities, where high rates of obesity and diabetes affect the health of those in their 30s and 40s. Sadly, it is our most vulnerable who are at greatest risk. But none of us is immune.

What can we do? Perhaps a good starting point is to learn the lessons of history.

This is not the first time we have faced a cardiovascular “epidemic”. In the first half of the 20th century, Australians experienced soaring rates of heart disease and stroke. Back then, the causes of the epidemic weren’t widely recognised, nor did we have insight into the necessary preventive measures.

Painstaking medical research during the 1950s and 60s helped identify the major risk factors, particularly smoking, high blood pressure and high cholesterol. Co-ordinated government actions including greater tobacco industry regulation and public health campaigns, plus advances in medical treatments and technologies, led to a dramatric drop in rates of heart disease and stroke.

This is one of the great success stories of the 20th century and has helped improve the life expectancy and overall wellbeing of millions.

However, the job is far from done. Heart disease remains our leading cause of death, and the gains made in recent decades are being reversed by obesity and diabetes. And this time the impending cardiovascular epidemic is different, with the effects of sugary drinks, unhealthy high-calorie foods and our sedentary lifestyle, rather than smoking and cholesterol, taking centre-stage.

Government-led initiatives are critical, as only they can directly regulate the food manufacturing and other industries that are contributing to the “diabesity” epidemic. Medical research is also vital, to understand how diet and physical activities influence the metabolic changes central to the development of cardiovascular disease. This new knowledge will be essential to help identify individuals who are at greatest risk and allow early intervention.

Expanding our public health campaigns is also essential in changing the “obesogenic” environment. Rigorous research can provide the necessary evidence to support specific interventions. Research will also help inform local councils, employers, schools, the media, medical practice, insurance companies and the agricultural industry on how best to work 

co-operatively to improve urban design, promote physical activity, improve the supply and affordability of nutritious food and encourage better eating.

Immense effort and resources are required to address these problems, but can we afford not to make this investment? In our view it would be immoral to not invest, because our children would die younger and inherit social, health and economic problems of a magnitude not seen before.

So, where will the resources come from? A significant burden must be borne by the food companies contributing to the problem in such a big way, earning vast profits from high-calorie, low nutritious-value foods. Perhaps, in addition to a “sugar tax” on sweetened foods and beverages, we should consider a much broader “health tax” on companies contributing to and profiting from our “obesogenic” environment, possibly including computer and internet-related firms.

Regardless of how funds are raised, substantial resources must be channelled into not-for-profit research organisations and government programs aimed at tackling the “diabesity” epidemic and preventing the looming second coming of cardiovascular disease. Medical research can help us understand why certain individuals are particularly susceptible to obesity. It is vital that effective interventions that can be used early in life are developed, while clinical trials will be essential in assisting patients at high risk of obesity or diabetes-related complications.

None of this will happen without overwhelming public support and recognition that we need to fundamentally change the unhealthy environment we have created for our children.

So, are we prepared to let our children die younger than us? This is perhaps one of the great moral challenges of the 21st century and a debate that our society must embrace.

Shaun P. Jackson is director of cardiovascular research, Heart Research Institute & Charles Perkins Centre, the University of Sydney; Robert M. Graham is executive director, Victor Chang Cardiac Research Institute, and professor of medicine at the University of NSW.

Originally published in The Australian

NSW students excel in science despite nationwide decline


More than 200 Year 11 students from NSW have been awarded a Victor Chang School Science Award for their passion and outstanding achievements in the field of science.

Nominated by their teachers, these bright students are being acknowledged for their tenacity and commitment in the classroom, despite a nationwide decline of participation in school science.

Unfortunately, recent statistics demonstrate enrolments in science, technology, engineering and mathematics (STEM) subjects are currently at the lowest level in over two decades[1].

Named after the late cardiac surgeon and pioneer of modern heart transplantation, the Victor Chang School Science Awards were established to celebrate young, gifted students and to foster growth in scientific studies.

Now in its 13th year, the awards also encourage the next generation of scientists to pursue a career in medical research. 

According to Professor Jamie Vandenberg from the Victor Chang Cardiac Research Institute, nurturing the future of Australian research is vital.

“Australia has such a proud science history, and through acknowledging these young students we’re giving the next generation of scientists the opportunity to see how research can directly touch people’s everyday lives,”

“As a scientist, not only are you contributing to building knowledge, but you are constantly solving problems and seizing opportunities while improving the wellbeing of society,” Professor Vandenberg explained.

The student winners from across NSW enjoyed a tour of the Victor Chang Institute, and had the opportunity to learn firsthand from our world-renowned scientists.

[1]  Australia’s national science statement 2017 http://www.science.gov.au/scie...

To find out more about the Victor Chang School Science Awards, click here.


Australia: a scientific Banana Republic – Is there hope?

By Professor Bob Graham


Australia has a proud record of achievements in science that have witnessed blockbuster discoveries and outputs, such as the Bionic Ear, a vaccine for cervical cancer and recently, the world’s first successful resuscitation and transplant of a ‘dead’ heart, with recognition at the highest level on the international stage in terms of Nobel and other prizes.  

 Nevertheless, funding of the research sector, arguably one of the nation’s most productive, has not kept pace with our population growth and the increased research needs to address urgent issues, such as ageing and obesity; major illness, such as heart disease and cancer, and global threats, such as equine encephalitis and Ebola.

 In addition, well-intentioned but ill-informed people have too heavily influenced planning by, and leadership of, the National Health and Medical Research Council (NHMRC). As a consequence, funding by the NHMRC, the nation’s major provider of biomedical research grants, is in rapid decline. Of the 3,700 applications submitted to the NHMRC in 2014, just 14.9% were funded. That’s the lowest success rate in the 75-year history of the NHMRC, and this is expected to fall further in 2015, to just 12%.

 This abysmal grant success rate is crippling the nation’s scientific progress, increasing the brain drain, jeopardising overseas recruitment, and threatening to wipe out an entire generation of young researchers—in essence, a crisis that demands drastic action or else Australia will rapidly become a Scientific Banana Republic; a situation that may be immutable or will take decades to reverse.

 Successfully addressing a crisis takes courage and leadership. In this regard the Federal Government’s proposed development of a Medical Research Future Fund, with its promise of a sustained increase in research funding, is an essential and welcome initiative. But it is by no means certain to receive sufficient bi-partisan support to be enacted, and if established, will take several years before it yields a substantial increase in funding.




 More hopeful in the short term is the very recently announced change in the leadership of the NHMRC. The new CEO, Prof Anne Kelso, is a highly respected scientist with a track record of innovation and pragmatism. We welcome her appointment and look to her wisdom, courage and leadership for a glimmer of hope at the end of a very long tunnel.

 Several simple moves by the NHMRC that Prof Kelso might want to consider, which, if enacted, would immediately improve grant-funding levels and restore confidence in the scientific enterprise, include:

 i ) A temporary moratorium on 5-year grants (whilst such grants, rather than the usual 3-year grants, are laudable as they provide greater stability and reduce wasteful time spent on the repeated writing and re-writing of grants, they seriously reduce the number of grants that can be funded each year—a situation that is untenable at times of funding austerity);

 ii) A reduction in the number of grants any individual investigator can hold from six to three (whilst few people hold more than three grants and hence the impact will be limited, this initiative will help to reduce the number of grant applications submitted each year)

 iii) A temporary cap on the total amount of funds allocated to any 3-year grant (many will object to this suggestion, but receiving at least some funds allows continuity of employment for research staff).

 iv) The quarantining of a proportion of grant funds specifically for the project-support of young scientists, for example, those within 5 years of receiving their PhD or MD degree.

 But if we are to address the crisis in Australian science, we will also need courage and support from the scientific community, who must look to Australia’s long-term scientific future, and we will also need help from universities, who, cash strapped themselves understandably look to the rewards of government funding by churning out PhDs in as short a time as possible. This results in a glut of PhDs, many of whom are poorly equipped for a lifelong career in the highly competitive world of research.

 Finally, we will need vision and resolve from the government. The secretariat responsible for the day-to-day activities of the NHMRC, for example, is grossly underfunded, when compared to similar agencies in the US, UK and Canada. This limits the efficient evaluation and continued review of grant-applications. Even a modest increase in the funding of the secretariat would help.

 But importantly, as noted by esteemed US scientist and businessman, Norman R. Augustine1, even in times of fiscal restraint, as we have today in Australia, indeed especially in times of fiscal restraint, “the key, if one wishes to survive long term, is the difference between spending for investment and spending for consumption….Research in the biomedical sciences appears to be among the soundest investments the nation can make on behalf of its citizenry”.

 Robert M. Graham, AO, FAA, FAHMS, MD

1Augustine NR. Is biomedical research a good investment? J Clin Invest. 124:5087-89, 2014

Originally published in the AFR

Young researchers are missing out in science's survival of the fittest  

By Dr Louis Wang

A person generally embarks on a career in research for altruistic reasons. There may be an instrinsic love for science and discovery, but generally this is coupled with an equal desire to make a positive difference to society, through discoveries aimed at reducing the personal and social cost of disease, or through innovations that improve quality of life or reduce the human impact on the environment.

 But offsetting all that altruism is the harsh reality of life. It is a jungle out there, and the road for early career researchers is not easy. Young researchers across Australia in the past week are celebrating the Australian Government’s promise of $417 million dollars over the next four years. And for good reason too. In the world of medical research, the recent drought in research funding has led to grant funding decisions reflecting the harsh realities of austerity.

 Young researchers are particularly vulnerable in times of resource scarcity and can easily get lost in the wild or picked off by predators in a survival of the fittest scientists.

 Scarcity of resources caused by successive droughts in research funding in recent years has had unfortunate effects on the medical research community. At its most severe, it devastates communities of postdoctoral scientists, who mentor and watch over research students, the loss of whom can cause mass extinctions across entire research programs. Additionally, it encourages promising young Australian researchers to move overseas in the hope of greener pastures. 

It also affects the type of research performed. In times of limited funding, researchers become very conservative with their research questions and reputations, preferring to focus on experiments that are more likely to generate positive results. 

This conservative approach is cost-effective and a necessary adaptation to the harsh climate, but some of mankind’s best discoveries and achievements were made because someone put their money, time and reputation on the line, and took a leap of faith.

Australia has been a fertile breeding ground for world-class researchers. To date, seven Australians have been awarded the Nobel Prize in the field of science. Some of the world’s greatest scientific heroes are Australian, having brought about the discovery of penicillin, the cause for stomach ulcers, the bionic ear, cervical cancer vaccine, revolutionising treatment for burns, as well as recently pioneering the successful transplantation of hearts from deceased donors. 

Investing in medical research is also vitally important to Australian healthcare. As an example, death rates from cardiovascular disease have dropped by 76% since the 1960s. Research leading to disease prevention, better diagnosis and treatment will ultimately have important flow-on effects and help offset the future expected increases in health budget expenditure resulting from our ageing population.

 Medical research is an investment in our future. We cannot save lives, improve health, quality of life, reduce impact of disease, and improve energy efficiency without groundbreaking discoveries. But we can’t make groundbreaking discoveries without investment in medical research.

This budget provides hope – not just for an early career researcher, but for Australia’s future. This funding boost may very well encourage a young undergraduate science student or a high school student who is interested in science to stay true to the path, someone who may have otherwise been lured into another career and lost to Science forever. And who knows? That high school student hearing the Abbott Government’s pledge in the past week may end up being the one who finds the cure for cancer, or a new source of energy that mankind desperately needs…he or she might even become Australia’s next Nobel Laureate.

Originally published in The Sydney Morning Herald

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