Australians were pioneering innovation in healthcare long before chatGPT – here, in no particular order – are some of their most revolutionary moves.
From antibiotics to zygotes, Australian innovators have been changing healthcare for over a century, mostly for the better. Here are our top 10:
While Dr Alexander Fleming is often credited with discovering penicillin in 1928, neither he nor the several chemists he recruited were able to extract sufficient amounts from the culture surrounding it, with one expert declaring that large-scale production was “almost impossible”.
More than a decade later, Adelaide pharmacologist and pathologist Howard Florey and German-born British biochemist Ernst B Chain came across Fleming’s work and enlisted scientists for the ‘Penicillin Project’, including Florey’s wife, Australian doctor and medical scientist Mary Ethel Florey.
After three years of experimentation, Florey, Chain and colleagues extracted enough pure penicillin to begin animal trials in 1940, with the first human trial carried out a year later through Mrs Florey’s introductions. It was also Mrs Florey who recorded and led the first large-scale clinical trial of penicillin in 187 patients with sepsis.
Once Howard Florey took penicillin to America in June 1941, large-scale production skyrocketed with the US’s pledge to join the Second World War coming that same year. Penicillin has since revolutionised the treatment of infectious diseases and is estimated to have saved over 82 million lives.
For his efforts Professor Florey was jointly awarded the Nobel Prize in Physiology or Medicine in 1945 with Sir Ernst Chain and Sir Alexander Fleming for producing the world’s first antibiotic.
The Florey Institute, the largest brain research centre in the southern hemisphere is named in his honour.
Multi-channel cochlear implants
After witnessing his father struggle with hearing loss for much of his life, ENT surgeon and neuroscientist Professor Graeme Clark embarked on a quest to “fix ears” and designed the first multi-channel cochlear implant allowing severely-to-profoundly deaf people to understand speech.
Since Professor Clark’s first operation with the device in 1978, the multi-channel implant has been a world leader in cochlear implants for the past 40 years and accounts for almost all of the implants received by more than one million patients across 120 countries.
In 1984 Professor Clark founded the Bionic Ear Institute and acted as its director until 2005.
Australian physician Barry James Marshall and pathologist Dr Robin Warren met during internal medicine training at Royal Perth Hospital in 1981, and a year later the pair had performed the first culture of Helicobactor pylori, hypothesising that the bacteria was responsible for peptic ulcers and gastric cancer.
After a year of testing stomach cultures and discovering that the bacteria took longer than two days to grow, Marshall and Warren submitted their findings to the Gastroenterological Society of Australia but reviewers turned them down, rating their paper in the bottom 10% of those they’d received that year.
A year later in 1984, Marshall infected himself by drinking a broth containing cultured H. pylori. Eight days later, a repeat endoscopy showed evidence of gastritis and a biopsy revealed that the bacteria had colonised his stomach. The experiment, which demonstrated a causal link between H. pylori and gastritis, was published in the Medical Journal of Australia in 1985 and remains one of the most cited articles from the journal.
Marshall and Warren’s discovery overthrew decades of medical doctrine and paved the way for establishing a causative link between H. pylori and stomach cancer.
It took a decade of political tension to establish Australia’s national health insurance scheme. First introduced by the Whitlam government in 1975 as “Medibank” only to be abolished by the Fraser government in 1981, the scheme was eventually reinstated in 1984 as Medicare.
Originally limited to professional medical services, pathology, radiology, acupuncture, optometry and dental procedures for palate deformities, the scheme has been repeatedly expanded to include services such as PET and MRI scans, allied health, nursing and midwifery, chronic disease management and telehealth consultations.
Since their introduction, Medicare and the Medical Benefits Schedule have undergone a number of major reviews and changes, including an independent review into Medicare’s integrity and the addition of voluntary patient registration model MyMedicare this year.
National Health and Medical Research Council
A decade after the Federal Health Council was set up to oversee cooperation between Commonwealth and state health authorities, a review of its operations saw it taken apart and replaced with the National Health and Medical Research Council.
In addition to the federal council’s previous role of reviewing Commonwealth and state cooperation and advising on public health matters, the NHMRC was expanded to provide advice on health and medical research, including Commonwealth spending on medical research. The National Health and Medical Research Council Act 1992 provided the first legislative basis for the NHMRC, with amendments passed in 2006 establishing the Council as an independent statutory agency under the Health and Ageing portfolio.
One of the NHMRC’s first grants went to Australian neurophysiologist and philosopher John Eccles, who shared the 1963 Nobel Prize for Medicine with Sir Alan Hodgkin and Sir Andrew Huxley for pioneering research on the neurochemistry underlying signal transmission by nerve cells.
Cervical cancer vaccine
Professor Ian Frazer, a clinical immunologist at the University of Queensland, began developing a vaccine for cervical cancer caused by human papillomavirus alongside virologist Dr Jian Zhou in 1990.
Using molecular biology to synthesise particles in vitro that mimicked the virus’ shape, by 1991 Frazer, Zhou and colleagues developed the first of four vaccines offering protection from HPV strains 16 and 18, responsible for 70% of cervical cancers.
It took 15 years for the TGA to approve the first vaccine, Gardasil, in 2006, and a year later Australia rolled out the world’s first national HPV vaccination program. Since its commercial release, 200 million doses of the vaccine have been distributed across 130 countries.
Modern heart transplantation would not be possible without the work of Australian cardiac surgeon Victor Chang. After graduating from the University of Sydney and completing a brief stint as chief resident at the Mayo clinic, Chang returned to work at St Vincent’s Hospital alongside surgeon Harry Windsor, who performed the first heart transplant in Australia in 1968.
Between 1984 and 1990, Chang’s unit performed around 200 heart transplants and 14 heart-lung transplants with 90% of recipients surviving beyond the first year. Chang also helped to establish the National Cardiac Transplant Unit, Australia’s leading centre for heart and lung transplants, and pioneered the development of inexpensive, artificial heart valves used widely throughout Asia.
Tragically, Chang was murdered in 1991 in a failed extortion attempt after two men, Chew Seng (Ah Sung) Liew and Choon Tee (Phillip) Lim, picked Chang at random from a magazine featuring Asians who had “made it good” in Australia. Liew and Lim ran their vehicle into Chang’s car, forcing him to pull over. When Chang refused to hand over any money, Liew shot Chang twice in the head, once into his right cheek and once at point-blank into Chang’s right temple.
Heart in a Box transplant
In 2014, a collaborative surgical team at Victor Chang Cardiac Research Institute and St Vincent’s Hospital successfully transplanted the first heart that had stopped beating.
With the heart reanimated using a unique preservation solution and portable machine, the technique was expected to increase number of heart transplants globally by as much as 30%.
The National Disability Insurance Scheme
Legislated in 2013 by the Gillard Government, the NDIS was established as the first cooperative approach between the federal government and Australians with disability to provide financial support for the disabled community.
Fully rolled out across Australia by 2020, the scheme now supports more than half a million adults and children with disability, many of whom are receiving support for the first time.
While far from perfect and currently under deep scrutiny the NDIS is unquestionably a step forward for the disability community.
To interoperability and beyond
An interoperable national e-health program based on personally controlled unique identifiers is now in operation in Australia. At least in theory.
As of February 2019, all Australians have a My Health Record created for them unless they have opted out of the system, although individuals can choose to delete their record at any time. The record supports prescription information, medical notes, referrals, and diagnostic imaging reports.
Patients can view their own medical information and control who can see it, as well as add information about allergies, adverse reactions, and their health care wishes in the event that they become unable to communicate.
While some consider it “too big to fail” and in dire need of technological infrastructure support, the EMR has the commitment of the Federal government and the attention of the digital health community.
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