New Zealand's most controversial health news from 2016

Smoking has become more expensive and less appealing this year.
Chris McKeen

Smoking has become more expensive and less appealing this year.

Sex, drugs, death and taxes - facts of life sure to spark debate among those game enough to raise them at a dinner table.

This year, the male Pill, the right to consume medical marijuana, and the right to "die with dignity" have been major talking points among New Zealanders. A levy on soft drinks has been mooted, alongside banning smoking in outdoor areas. Doctors have went on strike for safer hours and dentists have questioned the value of flossing.

Here's a rundown of heated health news from 2016. 

It's been an interesting year in healthcare.
StockSnap

It's been an interesting year in healthcare.

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BARRIERS TO SMOKING INCREASED

Cigarettes have become more expensive, less appealing, and more stigmatised this year, with increased taxes, plain packaging and cafes and restaurants making their outdoor areas smoke-free.

In May, the Budget delivered a tobacco tax increase of 10 per cent per year over four years, raising the cost of a packet of cigarettes from about $20 to about $30 by 2020.

At the time, Associate Health Minister Peseta Sam Lotu-Iiaga said previous increases reduced per capita tobacco consumption by about 25 per cent.

The tax has been criticised as "racist", as it has a disproportionate financial impact Maori, who are more likely to smoke and tend to be of lower socioeconomic status. 

ACT party leader David Seymour was among those who opposed the tax.

"For the past five years those taxes have gone up by 10 per cent every year.  Adding the increases together, tobacco taxes have almost doubled, but the number of smokers has barely budged," he wrote in a column for the Sunday Star-Times

"What do you say to the 35.5 per cent of Maori and the 15 per cent of New Zealanders who still smoke, barely different from when the tax increases started, who now pay twice as much tax?"

"Increased cigarette taxes have taken $28 a week from the average smoker. That is more than the Government's $25 increase in benefits, and almost as much as the increase in the minimum wage for the past five years."

Meanwhile, cafes and restaurants around the country renewed enthusiasm to ban smoking from their outdoor areas. 

At least 18 cafes and restaurants in Marlborough declared their outdoor spaces "smoke-free" to mark World Smokefree Day this year. Restaurants across New Zealand had already adopted the policy. 

A majority of Hutt City councillors voted to ban smoking from areas such as parks, sports grounds, beaches and train stations, and Wellington city councillors debated an action plan to turn entrances of all publicly accessible buildings, the city's bus stops, libraries, community centres, Botanic Gardens and inner city parks, into smoke-free areas, voting unanimously to widen the capital's smoking ban to include most public spaces. In Christchurch, a voluntary trial hoped to convince about 50 cafes and restaurants to make their outdoor dining areas smoke-free this summer. 

Switching from smoking tobacco to "vaping" e-cigarettes has been mooted as a life-saving alternative, which also has potential to guard against weight gain experienced by ex-smokers. 

Currently, liquid nicotine used in e-cigarettes is illegal to sell in New Zealand, though it can be imported for personal use.  

Lotu-Iiga has called for submissions on regulating e-cigarettes, to take recommendations to Cabinet by the end of 2016. 

In September, a long-awaited move for the Government to ban branding on cigarettes came into force. The Smoke-Free Environments (Tobacco Standardised Packaging) Amendment Bill passed its third and final reading in Parliament with 108 votes to 13.

It is now illegal for companies to print any branding on cigarette boxes, only allowing the name in small, plain type with graphic warnings about the risks of smoking. The warning would take up 75 per cent of the pack, with the text and colour similar to that used in Australia.

Lotu-liga said at the time he hoped to see the new packs in stores late next year.

FLOSSING BECAME OPTIONAL

Flossing is no longer recommended by the US Health Department. Photo: Stock

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Fewer people have been reaching for the dental floss since the United States Health Department omitted the practice from its recommendations this year. It was first included in 1979.

In 2015, journalists from the Associated Press submitted Freedom of Information inquiries regarding the scientific basis for the recommendation. The requirement was subsequently dropped from the latest Dietary Guidelines for Americans.

The AP reported the US government "acknowledged the effectiveness of flossing had never been researched, as required".

The news organisation had appraised 25 studies that generally compared the use of a toothbrush with the combination of toothbrushes and floss, finding the evidence for flossing was "weak, very unreliable," of "very low" quality, and carried "a moderate to large potential for bias".

Some dentists have argued flossing helps protect against periodontal (gum) disease. 

Wayne Aldredge, president of the American periodontists' group, acknowledged the weak scientific evidence and the brief duration of many studies. Still, he urged patients to floss to help avoid gum disease.

"It's like building a house and not painting two sides of it," he said.

"Ultimately those two sides are going to rot away quicker."

Writing for the Guardian, British dentist Ollie Jupes said his colleagues had long abandoned the practice.

"The fact is, the British dental profession gave floss a quiet burial years ago after sneaking it out the back and finishing it off humanely with a lump-hammer. Yes, in the UK we realised ages ago that - and if you still religiously floss daily, look away now - flossing simply doesn't work as a health measure (or a fetish).

"Even with the best technique, the evidence doesn't support flossing as an adjunct to brushing. Most patients, even if they bother to get the minty-waxed out the box, are exceptionally heavy-handed and macerate their gums like they've been chewing on bare vacuum cleaner flex.

"I know of no dentist who flosses. Not one."

​PETE EVANS OFFERED DANGEROUSLY MISLEADING ADVICE. AGAIN.

Pete Evans is a controversial Paleo evangelist. Photo: Fairfax NZ

Paleo Pete was up to his old tricks again in 2016, offering advice beyond the ambit of his expertise as a chef, cookbook author and judge on the Australian incarnation of My Kitchen Rules.

Evans has repeatedly riled medical professionals with his unscientific recommendations, which famously included a "Paleo" cookbook for babies who release was withheld after the president of Australia's Public Health Association said there was a "very real possibility that a baby may die if this book goes ahead".

This year, Evans told his 1.5 million Facebook followers that sunscreen contained poisonous chemicals and eating dairy products caused osteoporosis. His wife Nicola Robinson Evans, the Kiwi model formerly known as Nicky Watson, jumped on her husband's pseudo-science bandwagon, advocating homemade toothpaste instead of a tooth-protecting, fluoride-based product. 

The reports provoked the usual reaction from the healthcare industry, decrying Evans' lack of mandate to offer medical advice. 

Surely if 2016 has taught us anything, it's that an orange man cannot be trusted. 

JUNIOR DOCTORS CAMPAIGNED FOR SAFER ROSTERS 

Junior doctors strike outside Christchurch Hospital. Photo: John Kirk-Anderson/Fairfax NZ
Thousands of New Zealand's junior doctors went on strike for 48 hours in October, in a bid to cajole the country's DHBs to offer safer rosters in the form of fewer days worked in a row. 

The average junior doctor works 53 hours per week. There had been reports of doctors falling asleep while driving due to their workload.

Fairfax reporter Rachel Thomas explained the DHBs and Resident Doctors Association have have agreed to fix the remainder of the rosters, but under the current employment agreement, a clause related to penal rates means DHBs would have to pay the medical staff for days off. 
A second strike was planned for November 23-24, but was cancelled due to civil defence emergencies in Wellington and North Canterbury following major earthquakes. A new date for a second strike has not been scheduled.

SUBMISSIONS HEARD ON EUTHANASIA BILL

Matt Vickers, the husband of Lecretia Seales, speaks at an inquiry on voluntary euthanasia at Parliament in 2016. Photo: Kevin Stent/Fairfax NZ

Parliament's Health Select Committee received a record number of submissions this year on the subject of voluntary euthanasia. 

The issue returned to the political agenda in 2015, following the death of terminally ill Wellington lawyer Lecretia Seales, whose High Court bid to allow her doctor to assist her death failed that June. 

Following the case, ACT leader David Seymour launched a bill that would legalise voluntary euthanasia. The bill would not be heard until it is pulled from the ballot.

Fairfax reporter Henry Cooke explained the proposed law only allows euthanasia with the active consent of the patient.

In the meantime, the Health Select Committee began an investigation into assisted death after receiving a petition started by former MP Maryan Street.

Chair of the Health Select Committee and National's Tamaki MP Simon O'Connor said at the time, the petition was asking for a full discussion of the issue.

"The Committee decided to open an investigation and seek submissions from Kiwis over the course of a few months."

Stuff launched a reporting series on the issue, to facilitate public understanding and debate. 

Public submissions closed in February. Of 21,435 letters received, more than 1800 submitters felt strongly enough, that they also wanted to appear in front of the Select Committee to speak to MPs directly. 

Prime Minister John Key supports the inquiry, but would not put the issue on the Government's work programme. Labour leader Andrew Little took it off Labour's programme because the party had more pressing issues to attend to. 

In October, police began what was dubbed an "illegal" sting, pulling over elderly drivers understood to have attended a meeting on voluntary euthanasia under the guise of breath-testing them. It was discovered after Nelson woman Patsy McGrath, a member of the Voluntary Euthanasia Society and the Nelson chapter of Exit International, had her store-bought helium balloon kit seized. 

MEDICAL MARIJUANA' DEBATE REIGNITED

Helen Kelly was fighting for the public good even in her final months. Photo: Kevin Stent/Fairfax NZ

Former trade unions boss Helen Kelly, who died of lung cancer in October, spent her final months advocating for the legalisation of medicinal marijuana. 

Kelly used cannabis oil sourced from the black market to relieve her pain and help her sleep.

Kelly was diagnosed with cancer in February 2015 and went public with her cannabis oil use later that year.

At the time, she said: "I've tried [cannabis oil]. I'm not promoting it as a curative, but as a pain relief it's incredibly effective for me and it doesn't make me feel sick, which morphine does."

Kelly has  been trying to get permission from the Ministry of Health to legally access medicinal cannabis for her pain relief, the hoops she needed to jump through took their toll emotionally.

She called for a referendum on the issue. 

Close to four weeks without cannabis, and Helen Kelly is taking morphine every four hours to manage the pain.

The former Council of Trade Unions president took her fight against terminal lung cancer to Cuba and the United States in August, in search of a miracle treatment.

But the search, and state laws, has meant she's been without cannabis since August 21.

In August, Californian-born Nelson resident because the first person to legally bring raw cannabis flower into New Zealand.

"We've made history," she said. I'm the first person to possess marijuana in its natural form since the Misuse of Drugs Act was passed. It's huge."

Legally people are allowed to bring medicinal marijuana into New Zealand.

The "loophole" law means anyone entering the country can lawfully carry with them a one-month supply of medicinal cannabis or cannabis-related product, as long as it was legally prescribed by a medical practitioner overseas.

In November, the Ministry of Health allowed Kiwis to take part in a  clinical trial investigating the effects of the newly-developed cannabidiol gel for stopping or reducing epileptic seizures, NZME reported.

FIZZY DRINK TAX SUGGESTED

Photo: Dinuka Liyanawatte/Reuters

New Zealand was looking to our British cousins this year for clues as to how to battle our increasing rates of obesity and Type 2 diabetes.

 UK Chancellor George Osborne announced his government's introduction of a tax on soft drinks in March, stating: "I am not prepared to look back at my time here in this Parliament, doing this job and say to my children's generation... I'm sorry. We knew there was a problem with sugary drinks. We knew it caused disease. But we ducked the difficult decisions and we did nothing."

The sugar tax will be limited to soft-drinks and not other sugary foods like lollies. 

Drinks will more than 8 grams of sugar per 100 millilitres will be taxed at a higher rate than drinks with less than 5 grams of sugar per 100 millilitres. 

"Pure fruit juices" and milkshakes will not be subject to the sugar-levy.

Naturally, public conversation in New Zealand turned to the prospect of our country adopting similar laws. 

Weeks after the UK announcement, 74 New Zealand health academics signed an open letter calling on the government to introduce a 20 per cent excise tax in the next budget. 

Mexico's soft drink levy - introduced in 2014 - increased the price of soda by about 10 per cent. The first peer-reviewed study of the tax by a group of Mexican and US researchers was published in January, finding sugar-sweetened drinks consumption in Mexico had decreased by an average of six per cent from what would have been expected had the tax not been imposed. 

Health Minister Jonathan Coleman has been adamant the Government will not introduce a sugar tax until there is more evidence of it being linked to a drop in obesity. Soft drink consumption is declining in New Zealand, while obesity continues to rise, according to research commissioned and released by the New Zealand Beverage Council and carried out by independent research company Nielsen.

MALE CONTRACEPTIVE STUDY SCUPPERED

An exhibition of oral contraceptive pills from history at Te Papa in 2015. Photo: Maarten Holl/Fairfax NZ

The world will have to wait a little longer for a male contraceptive drug to be made available, after study looking at the effectiveness of a male contraceptive injection was abandoned.

Nearly half the 320 participants in the study reported increased incidences of acne, more than a fifth reported mood disorders including thoughts of suicide, and more than a third reported raised libido - a total of 1,491 adverse events.

The female response to these reports was less than sympathetic - side effects of the female contraceptive pill include anxiety, weight gain, nausea, headaches, reduced libido and blood clots.

Adam Watkins, research fellow of Cell & Tissue Biomedicine at Aston University, argued the side effects of the male pill could be beneficial to romantic heterosexual relationships:

"With both partners actively taking contraceptives - and sharing an understanding of the side effects - a joint sense of responsibility for the couple's fertility would be established. Also, if one partner needed to take a break from their contraceptive, the other could start taking theirs, sharing the impact of those side effects."

 - Stuff

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