The real thing?
When the Federal Minister for Health announced that celecoxib would be funded by the PBS from August 2000, his high hopes for COX-2 inhibitors mirrored those of the general and medical communities. In the months that followed, however, the fallout from the drug's listing included concerns about adverse events and a budget blowout. Kerr et al, using data from the General Practice Research Network, confirm and partially explain one of the most enthusiastic prescribing epidemics Australia has seen (→ Lessons from early large-scale adoption of celecoxib and rofecoxib by Australian general practitioners). According to Dowden, this was largely due to a highly successful marketing campaign (→ Coax, COX and cola). In the US, where a similar scenario was played out, the promotion of rofecoxib in 2000 cost more than the advertising budgets for Pepsi and Budweiser beer!
Devils in the details
In clinical trials there needs to be a speedy, seamless process for informing sponsors and co-investigators of significant adverse events. Australia has clear guidelines for how this is to be done, but Liauw and Day believe some of the bureaucratic requirements might prove counterproductive (→ Adverse event reporting in clinical trials: room for improvement).
Our failing hearts
Consider yet another by-product of the ageing population: an epidemic of heart failure. Perhaps good news for the manufacturers of the many effective therapies for this condition. However, Campbell believes we have an alternative (→ Heart failure: how can we prevent the epidemic?).
Every baby born in Australia since the early 1960s should theoretically have had a heel prick for newborn blood screening. Inevitably, however, some babies slip through the net, missing the opportunity to be screened for an ever-expanding list of treatable disorders. In South Australia, Metz et al have linked two routine databases to determine what factors increase a baby's chances of missing screening (→ Newborn screening in South Australia: is it universal?), leading to Wilcken's conclusion that targeting these "at-risk" groups will bring us closer to the utopia of universality (→ Does every baby get a newborn screening test?).
Meningitis not on menu
The solution to an intriguing case featuring a young man with aseptic meningitis and peripheral eosinophilia is unveiled by Senanayake et al in this issue's Lessons from Practice. Turn to for tips on what to ask the patient and your laboratory (→ First report of human angiostrongyliasis acquired in Sydney).
In this issue's Snapshot, yet another young man turns up with a headache and surprising findings, as described by Allan and colleagues (→ Giant occipital intracranial and extracranial meningioma).
Drugs and crime
We know that people who are drug dependent are more likely than others to commit crime, but the study of Heffernan et al indicates just how widespread and intertwined the problems of drug use, psychological distress and crime are (→ Substance-use disorders and psychological distress among police arrestees). While most would also agree that arrestees should have access to drug and alcohol services, Makkai cautions against the assumption that this would reduce crime (→ Substance use, psychological distress and crime).
Burden and the bottom line
The past 10 years have seen major changes in the way we measure disease and injury in populations, as well as a growing realisation that, to allocate scarce resources, we need accurate statistics. Lopez explains some of these concepts that underpin the work of the Centre for Burden of Disease and Global Health Research, at the University of Queensland (→ Evidence and information for health policy: a decade of change).
It will come as no surprise that the skill base required of rural GPs is often quite broad. Do these skills vary according to the remoteness of the GPs' location? Humphreys and colleagues (→ The influence of geographical location on the complexity of rural general practice activities) conducted a novel study asking rural GPs across Australia whether they performed certain "sentinel" activities that indicate practice complexity.
The real deal
When Little addressed the recent Australian Health Care Summit "powerpoint" hijinks and laser pointers were conspicuously absent. As the text of his speech will attest, the power was in the points he made, as he threw down a moral gauntlet to the assembled experts (→ Money, morals and the conquest of mortality).
As the MJA Practice Essentials - Endocrinology series continues, Couper and Prins tackle the new treatments for diabetes (→ 2: Recent advances in therapy of diabetes).
In the ever-popular EBM: Trials on Trial series, Morris and Leach dissect an RCT of surgery versus watchful waiting for young children with persistent otitis media. The study used an "intention-to-treat" analysis which, as Heritier et al explain, is the gold standard (→ Inclusion of patients in clinical trial analysis: the intention-to-treat principle).
Another time ... another place...
William Osler, 1901
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