A year in Canberra

Moving to Canberra for work is a rite of passage for many young professionals in Australia. And so it was that I moved to there in early 2015 to undertake 12 months of neurology advanced training. Putting aside my ingrained bias about the national capital – a product of growing up in Sydney – it’s actually a very nice place. There are many differences and quirks, though, and I thought I’d share my Sydneysider perspective…

The bush capital

Firstly, to understand Canberra in general, it’s helpful to think of it as a large country town that happens to be the national capital. This is a city where there actually are kangaroos on the streets. If you manage to get here (Canberra International Airport has no international flights), you’ll discover the population of only 380,000 is sprawled out across an area about 40km north-south and 15km east-west. The planned city is organised into districts, the urban ones being: North Canberra, South Canberra, Woden, Belconnen, Tuggeranong, Weston Creek, Gunghalin and Molonglo.

Canberra land axis, view from Mt Ainslie

Parliamentary Triangle land axis (Mt Ainslie, Capital Hill, Red Hill), view from Mt Ainslie

Being in the Australian Capital Territory (ACT) means that there are many acronyms featuring ACT, some better than others, including:

  • ACTION – ACT Integrated Omnibus Network – public bus service
  • IntACT – Information technology ACT – ACT Government IST service
  • TransACT – internet service provider
  • GastrotrACT – private gastroenterology practice

Winter is coming

The first thing many Canberrans tell you about on arrival is the winter. By Australian standards, this city gets cold – a product of location (150km inland) and altitude (600m). Negative temperatures on winter mornings are the norm. Even in late September, during Floriade Nightfest, the effective temperature (with wind chill) was 0°C! Despite this, the dryness means that it rarely snows (less than 1 day this year).

Typical car thermometer reading whilst driving to work

Canberra state of mind

No-one working in the public sector here tells you what they actually do, only the ambiguous statement that “I’m a public servant”. It’s an almost meaningless statement in a city where the Australian Public Service is the largest employer. I’m a public servant too, but clearly what I do as a medical doctor is very different from my public servant neighbour does in the Australian Defence Force.

Speaking of my neighbours, there are very few people living in my inner-south neighbourhood who are actually from Canberra. The large proportion of people from interstate temporarily makes for a unique melting pot, with a very different vibe from any NSW town/city despite the geographical location.

The over-representation of young educated professionals also has other consequences. More people attend major events than one might expect for a city this size, such as Enlighten, Floriade Nightfest, Nara Candle Festival, etc.; and bumping into friends and colleagues is a near-certainty.

Enlighten festival 2015

Enlighten festival 2015

There also seem to be a lot of Volkswagen Golf GTIs…

Lots of GTIs in Canberra

Another reflection of the city’s demographics are the progressive tendencies of the ACT Government (at least in comparison to other Australian jurisdictions). Amongst other things:

  • Single-use plastic bags are banned, causing quite some confusion the first time I went to the supermarket (and some very contrived “reusable” plastic bags)
  • Major investment in wind and solar power, such that the ACT appears to be on-track to meet its 90% renewable energy target by 2020
  • A program to purchase all private homes contaminated by “Mr Fluffy” loose-fill asbestos (at huge expense)

The slow lane

Capital works in the ACT proceed much more slowly than equivalent work in Sydney or Melbourne. Construction on major projects such as Majura Parkway, Constitution Avenue, and Bowen Place; appear to stand still for extended periods and are subject to (repeated) delays. The Acton Tunnel was damaged a few months ago by an over-height truck and was closed for almost 3 days for temporary repairs.

Speaking of roads, everyone knows that Canberra has a lot of large roundabouts. What is less well-known is that the majority of Canberra’s roads have a chip seal surface (aka spray seal or coarse chip), a form of surfacing usually only found on rural roads, resulting in a harsh and noisy ride compared with asphalt. The ACT Government justifies the use of chip seal this by citing the much lower cost, which is probably a financial necessity considering the extensive road network for the small population. It is mystifying, however, when the ride/noise is worse after a road undergoes resurfacing; for example the recent works on Hindmarsh Drive and Tuggeranong Parkway.

Chip seal road surface

Normal for Canberra…

Overall, though, this place has grown on me over the year and I’m actually quite sad to be returning to Sydney in 2016. I’ll definitely miss the inner-south lifestyle, the lack of traffic, the politician-spotting (I live within 500m of PM Malcolm Turnbull), the national institutions, the cultural quirks, the many friends I’ve made, and yes even the weather.

Australia to adopt INNs

The Therapeutic Goods Administration (TGA) has announced that it will proceed with international harmonisation of drug names used in Australia from April 2016. For the past decade or so, since the United Kingdom moved to the World Health Organization’s International Nonproprietary Names (INNs), we’ve been in the anomalous situation of using former British Approved Names despite these no longer being used in the UK (nor listed in the British Pharmacopoeia). The TGA website has a list of affected drugs.

Some changes are trivial:

  • Substitution of “ph” with “f” (e.g. cefalexin, guaifenesin)
  • Substitution of “y” with “i” (e.g. amoxicillin, ciclosporin)
  • Substitution of “th” with “t” (e.g. indometacin)

Others are more significant (and will require dual-labelling for 3 years), for example:

  • Dosulepin (dothiepin)
  • Formoterol (eformoterol)
  • Furosemide (frusemide)
  • Glycopyrronium bromide (glycopyrrolate)
  • Hydroxycarbamide (hydroxyurea)
  • Lidocaine (lignocaine)

On the contentious subject of adrenaline vs epinephrine, the TGA has followed the UK practice where dual-labelling “adrenaline (epinephrine)” will be used indefinitely.

Heritability of frontotemporal dementia

One of my side projects over the past 2 years has been research in the cognitive neurosciences under the supervision of Dr James Burrell at Neuroscience Research Australia (NeuRA). Specifically, we were looking at the heritability of frontotemporal dementia.

Preliminary results from our study were published as a poster at the Australian and New Zealand Association of Neurologists (ANZAN) Annual Scientific Meeting 2014 in Adelaide. I doubt that anyone else at a neurology conference would typeset a poster in Helvetica Neue Light!

Our poster at ANZAN ASM 2014

This culminated in a paper which was accepted in the Journal of Neurology and published in November 2014 (vol 261 no 11). The abstract is reproduced below, along with the correct author affiliations (an error was introduced by the journal subeditors – Professors Kwok, Halliday and Hodges are not affiliated with Concord Repatriation General Hospital).

Po et al. J Neurol 2014

Author Affiliations

Concord Repatriation General Hospital, Sydney, Australia – KP, JB
Sydney Medical School, The University of Sydney, Australia – KP
Neurosciences Research Australia, Sydney, Australia – FL, NG, LB, JK, GH, JH, JB
The University of New South Wales, Sydney, Australia – JK, GH, JH, JB


Frontotemporal dementia (FTD) is reportedly highly heritable, even though a recognized genetic cause is often absent. To explain this contradiction, we explored the “strength” of family history in FTD, Alzheimer’s disease (AD), and controls. Clinical syndromes associated with heritability of FTD and AD were also examined. FTD and AD patients were recruited from an FTD-specific research clinic, and patients were further sub-classified into FTD or AD phenotypes. The strength of family history was graded using the Goldman score (GS), and GS of 1-3 was regarded as a “strong” family history. A subset of FTD patients underwent screening for the main genetic causes of FTD. In total, 307 participants were included (122 FTD, 98 AD, and 87 controls). Although reported positive family history did not differ between groups, a strong family history was more common in FTD (FTD 17.2 %, AD 5.1 %, controls 2.3 %, P < 0.001). The bvFTD and FTD-ALS groups drove heritability, but 12.2 % of atypical AD patients also had a strong family history. A pathogenic mutation was identified in 16 FTD patients (10 C9ORF72 repeat expansion, 5 GRN, 1 MAPT), but more than half of FTD patients with a strong family history had no mutation detected. FTD is a highly heritable disease, even more than AD, and patients with bvFTD and FTD-ALS drive this heritability. Atypical AD also appears to be more heritable than typical AD. These results suggest that further genetic influences await discovery in FTD.


Po K, Leslie FVC, Gracia N, Bartley L, Kwok JBJ, Halliday GM, Hodges JR, Burrell JR. Heritability in frontotemporal dementia: more missing pieces? J Neurol. 2014;261(11):2170–7.

doi: 10.1007/s00415-014-7474-9
PMID: 25156163 (PubMed)

HbA1c now funded for diagnosis

From 1 November 2014, glycated haemoglobin (HbA1c) testing is now funded on the Medicare Benefits Schedule for the diagnosis of diabetes mellitus – MBS item 66841 (up to once every 12 months).

MBS item 66841

The Australian Diabetes Society and other international organisations have recommended since 2011 that an HbA1c ≥48 mmol/mol (≥6.5%) can be used to establish a diagnosis of diabetes.1 Until now this has been impracticable in Australia as it was only Medicare-funded for patients with established diabetes, however this new listing on the MBS provides clinicians with a more practical and efficient way to make the diagnosis.

1. d’Emden M, et al. The role of HbA1c in the diagnosis of diabetes mellitus in Australia. Med J Aust 2012;197:220–1. (full text)

RACP exams

“Congratulations. You have been successful in the 2014 Clinical Examination.”

Getting through the Royal Australasian College of Physicians (RACP) examinations this year has been a long, difficult, but ultimately rewarding journey. More than a year of near-constant study, the evening lectures at work and online, the Deltamed course in Melbourne, the written exam at Wentworth Park (with the plastic picnic chairs!), a brief period of respite after passing the written, the many evenings and Saturday mornings spent at the hospital practising cases, and finally the clinical exam held interstate (in my case Greenslopes Private Hospital, Brisbane)…

Greenslopes Private Hospital

My colleagues and I are immensely grateful to everyone who taught and supported us over the past 18 months – we couldn’t have done it without you. Thank you!

Photo credits: Dr Kieren Po (photos 1 & 3), Dr Priyanka Sagar (photo 2)

Normandie 70 ans plus tard

As we commemorate the 70th anniversary of the D-Day landings in Normandy (6 June 1944), I’ve been reflecting on my visit to the region in 2012 and the continuing legacy of that fateful day. It was indeed an eerie experience walking on ground where thousands of soldiers had given their lives.

Gold Beach, near Arromanches-les-Bains, was one of the British landing zones. These days it seems to be a popular recreational beach, however reminders of its wartime role are ever-present. Remnants of the Mulberry Harbour built by the British to offload matériel lie scattered around Gold Beach.

Gold BeachMulberry Harbour, Gold BeachOmaha Beach, to the west, was one of the American landing zones. The terrain is steeper and more rugged, and it’s not hard to imagine how difficult it must’ve been for US forces landing here under enemy fire.

Omaha Beach

Omaha Beach fortificationCimetière américain de Colleville-sur-Mer (Normandy American Cemetery and Memorial) looks over the beach and is a sombre reminder of the costs of war.

Normandy American Cemetery and MemorialReflecting Pool, Normandy American Cemetery and Memorial The photos above are also on my Flickr photostream.