Danger: new MJA series
Don’t read our new series on complementary and alternative medicine (CAM) if you'd like a polite chronicle of the different therapies (that’s been done already). Don’t read it if you expect a CAM-bashing critique or even a feel-good acceptance of all things complementary. (Life’s a bit more complex than that.) But, if controversy and debate are up your alley, you're in the right place! In “Complementary and alternative medicine — with a difference”, series editors Lewith and Bensoussan give the rationale for the series, while Coulter and Willis speculate on why people are willing to spend more on CAM than on "ordinary" medicine (→ The rise and rise of complementary and alternative medicine: a sociological perspective).
In good time for the next school holidays, we present the tale of Australia’s largest outbreak of Legionnaire’s disease, which occurred at the Melbourne Aquarium. Greig and colleagues describe how the source was rapidly traced, and what the ensuing detective work revealed (→ An outbreak of Legionnaires' disease at the Melbourne Aquarium, April 2000: investigation and case–control studies).
Playground arm harm
Speaking of fun pastimes that can be dangerous, Australian safety standards for children’s playgrounds are aimed at preventing serious head injuries, but upper-limb fractures are still common. Sherker and Ozanne-Smith visited playgrounds where children had broken an arm to determine whether our standards need to change if we wish to protect little limbs from harm (→ Are current playground safety standards adequate for preventing arm fractures?).
The uses of research
If you still believe that the purpose of medical research is to improve healthcare, two short articles in this issue should set you straight in time for Medical Research Week (June 5–12). Ernst has had a few disturbed nights dreaming up the "ten commandments of pseudoscience", which are aimed at advancing the cause of the researcher (→ My pseudoscientific nightmare). Meanwhile, a Postcard from the UK finds our Aussie spies puzzling over the Research Assessment Exercise, a real-life nightmare (involving, among other things, a "star" rating for research) being lived out in UK universities (→ Research assessment: there must be an easier way).
Rays raise reservations
A recent article published in The Lancet used available data to calculate that, in Australia, about 431 cancers per year may be attributable to diagnostic x-rays. Although this estimate is far from exact, Dickie and Fitchew explain why we should take it seriously (→ Medical radiation and the risk of cancer).
We've all grown accustomed to worried-looking politicians regaling us with the horrors of “Our Ageing Population”. In the face of some impressive rhetoric on the subject, Coory went looking for evidence that elderly populations cause health budget blowouts (→ Ageing and healthcare costs in Australia: a case of policy-based evidence?).
Another current favourite is that emergency department overcrowding can be attributed to the decline in general practice bulk billing rates. Hanson et al and Knox (Letters) are in agreement with the recent statement from the College of Emergency Medicine in overturning this old chestnut (→ Bulk-billing GP clinics did not significantly reduce emergency department caseload in Mackay, Queensland).
The people’s choice
Judging from the newspapers that cross our desks here at the MJA’s headquarters in Sydney, public interest in medical error is at an all-time high. Some commentators have suggested that an anonymous system for reporting errors will encourage disclosure, but, according to the study by Evans et al, the general public may beg to differ (→ Anonymity or transparency in reporting of medical error: a community-based survey in South Australia).
Burton and Sanders also went straight to the source to find out how Western Australian couples would feel about donating stored embryos for medical research (→ Patient attitudes to donation of embryos for research in Western Australia).
Rats rejoice . . .
Warfarin for the treatment of atrial fibrillation may soon be redundant, say Eikelboom and Hankey (→ The beginning of the end of warfarin?). A new drug, ximelagatran, seems to be “non-inferior” in preventing stroke and to have a better side effect profile, but there are still some unanswered questions.
In the public interest
For those of you who think enforcing playground safety standards is a threat to autonomy, try locking sick people up! It’s rarely done, but legal under certain circumstances, say Senanayake and Ferson (→ Detention for tuberculosis: public health and the law). Their discussion of two recent public health orders issued to patients with tuberculosis explains when and why.
Sustaining our species
World Environment Day falls on 5 June. Last year, a cross-section of concerned Australians, including doctors, participated in a 9-month internet-based conference on sustainability. In “In search of sustainability”, Towle provides a report.
Another time ... another place...
I’ve always been a quack. I’ve always been an excellent quack. The only difference between me and the quacks I don’t like is that I don’t try to get rich off my quackery, and I try to be honest about it.
Eugene A Stead, Jr. 1997
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