Death talk

Euthanasia campaigner Philip Nitschke was in the news again recently when Sydney Airport officials confiscated a “death machine” he was taking to a US conference. He also took part in a debate at last year’s AMA National Conference on whether euthanasia and physician-assisted suicide should be legalised. Opposing speaker Margaret Somerville (page 171), Professor of Law at McGill University’s Centre for Medicine, Ethics and Law, presents her side of the debate.

He said, she said

The accusations fly and passions run high in our correspondence columns (page 187) on subjects as diverse as pertussis, ethics committees, emergency departments, the boundaries of medicine and pharmacoeconomic modelling. And if you thought systematic reviews were boring, the fallout from a recent controversial Cochrane review on mammography continues, via concerns about lying and the quirks of the English language.

The mystery of the clinical trial

Our Trials on trial series continues as Gebski and Keech (page 182) examine some of the statistical methods used in clinical trials. Meanwhile, Mackerras (page 180) analyses a real trial comparing lifestyle modification with metformin in reducing the rate of conversion from impaired glucose tolerance to type 2 diabetes.

Taking “no” for an answer

Australian parents have the right to decline vaccination of their children. Occasionally, as in the case reported by Goldwater et al (page 175), this results in disease for the child, and considerable ethical tension for the treating doctors. On page 150, McIntyre et al consider what this case has to teach us about the issue of vaccination refusal and the best approach to the tiny minority of parents who are true conscientious objectors.

Focus on the foreskin

Speaking of medical decisions parents make for children, the rate of neonatal male circumcision has declined markedly in Australia, in line with advice from various learned bodies. On page 155, however, Spilsbury et al report a Western Australian study which suggests that phimosis is being overdiagnosed, leading to unnecessary circumcision of young boys. In response, Dewan (page 148) gives some no-nonsense advice on what phimosis actually is. Meanwhile, Darby (page 178) dispels some of the myths about why various cultures practised circumcision in the first place.

Medical education in the 21st century

This issue of the Journal examines how we should define a “good” medical graduate today. Dean and colleagues (page 163) compare how prepared graduates were from different medical school programs for that ultimate test, internship. Aretz’s editorial (page 147) affirms the value of such follow-up studies, while advocating new ways to assess other qualities required of the 21st-century doctor.

We’re at the cutting edge of educational innovation, say Nair and Hardie in their Conference Report of the 2002 Meeting of the Australian and New Zealand Association for Medical Education (page 152), but educators need to continually rethink.

Students have their say

Many of us will remember witnessing unethical or insensitive behaviour by those senior clinicians we trailed in our student days. How many of us actually did something about such incidents? Bloch (page 167) documents similar experiences of students today and their sense of powerlessness to act in these situations. Can anything be done? Turn to this challenging Clinical Ethics article to find out.

Kastowsky’s Personal Perspective (page 170) describes the emotional odyssey of a week spent at the morgue as a medical student.

Goitre reconnoitre

Recent studies suggest we can no longer assume that iodine deficiency is rare in Australia. McDonnell and colleagues (page 159) confirm this in their report on the iodine status and prevalence of goitre in over 600 Melbourne schoolchildren.

Another time ... another place...

Some psychiatrists and sociologists say it [circumcision] is the mother exacting retribution for male domination in society. I prefer to think mother wants it done because everyone else has it done. What slaves we are to conformity.

Brian Heber (MJA 1966; 2: 729 [letter])