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In This Issue

Med J Aust 2004; 181 (5): .
Published online: 6 September 2004

Smoke gets in your eyes

But does passive smoking cause breast cancer? A recent draft review of the evidence from the California Environmental Protection Agency now proposes that it does. However, experts from Australia’s National Cancer Control Initiative urge caution in interpreting the evidence (→ Passive smoking and breast cancer: is the evidence for cause now convincing?).

On firmer ground, we do know about the cardiovascular effects of smoking. Hurley and colleagues calculate that we could save billions in the Pharmaceutical Benefits Scheme over the next 40 years if smoking rates could be reduced by as little as 5% (→ The potential for tobacco control to reduce PBS costs for smoking-related cardiovascular disease).

And remember there’s a group in society that’s usually highly motivated to quit, say Ford and Dobson — pregnant women (Letters, (→ Smoking and pregnancy)). They analysed the risks that smoking poses to mother and infant, and the possible savings (in more than monetary terms) with strategic smoking interventions in pregnancy.

Also, in this issue’s Letters, follow the dust-up from a recent controversial MJA editorial proposing that smokers be given lower priority on surgical waiting lists (→ Smoking cessation and elective surgery: the cleanest cut).

SAFE as saline

A 1998 Cochrane meta-analysis cast grave doubt over intensive care practice worldwide by suggesting that albumin use in fluid resuscitation was dangerous. However, a recent landmark study conducted in Australian and New Zealand ICUs has shown that this is not so. According to key players Finfer et al, this randomised controlled trial, entitled SAFE (Saline versus Albumin Fluid Evaluation), was a milestone that did more than definitively answer an important clinical question (→ The SAFE Study: a landmark trial of the safety of albumin in intensive care).

Doctors going public

Public reporting of surgical performance has been available in the US for years and is being introduced in the UK. Neil et al ask if we should do so too (→ Public reporting of individual surgeon performance information: United Kingdom developments and Australian issues), as a former President of the UK General Medical Council weighs into the debate on accountability (→ Time for hard decisions on patient-centred professionalism).

Paget’s out of the closet

Recent advances in understanding and treating Paget’s disease of bone are the subject of Walsh’s Clinical Update (→ Paget’s disease of bone). We may not know why newly diagnosed Paget’s disease now seems less common and less severe, but we can map its genetic mutations and treat it safely.

 

CAM and the next generation

As we approach the end of our series on Complementary and Alternative Medicine, it’s become clear that doctors ignore the subject at our (and our patients') peril. Owen and Lewith describe how overseas medical schools familiarise students with CAM, and how the ideal medical curriculum might do so (→ Teaching integrated care: CAM familiarisation courses). Brooks outlines the Australian Medical Council’s stance on this, which may explain why our medical schools are in a state of flux (→ Undergraduate teaching of complementary medicine).

George et al show how conventional healthcare providers' attitudes to CAM can influence those with chronic obstructive pulmonary disease (→ Use of complementary and alternative medicines by patients with chronic obstructive pulmonary disease).

Stroke risk

What puts someone at risk of having another stroke after a first one? By identifying risk factors in over 7000 patients, Lee and colleagues shed more light on secondary stroke prevention (→ Risk factors for ischaemic stroke recurrence after hospitalisation).

Epidemiologists treat child abuse

The recent overturning of one mother’s conviction for child abuse in the UK and its repercussions for over 200 other cases have prompted timely considerations for National Child Protection Week (5–11 September): Hilton’s letter cites cases where those convicted (and innocent) were less fortunate (→ Unexpected infant death: lessons from the Sally Clark case), while expats Heller et al apply some very lateral thinking to legal decision-making when child abuse is suspected (→ Suspected child abuse: false positives or false negatives?).

Turning Japanese encephalitis

The disturbing consequences in two cases of Japanese encephalitis reported by Geraghty and McCarthy ((→ Japanese encephalitis vaccine: is it being sufficiently used in travellers?)) and Hanson et al (Letters, Japanese encephalitis acquired near Port Moresby: implications for residents and travellers to Papua New Guinea) illustrate the desirability of vaccinating travellers to endemic areas. In fact, evidence from the latter case has prompted the Australian Technical Advisory Group on Immunisation, responsible for the NHMRC’s Australian immunisation handbook, to consider changing recommendations for travellers to Papua New Guinea.

FTA + PBS = ?

The debate that has raged over how the Free Trade Agreement between Australia and the US may affect our prized Pharmaceutical Benefits Scheme prompted our rapid online publication of two articles now in print: American Outterson gives a provocative and refreshingly unparochial view (→ Free trade in pharmaceuticals), while Harvey et al spell out exactly what the concerns are (→ Will the Australia-United States Free Trade Agreement undermine the Pharmaceutical Benefits Scheme?).

Out of harm’s way

Ritter et al report on the 15th International Conference on the Reduction of Drug Related Harm, where it was clear that harm reduction has achieved mainstream acceptance, with good reason (→ Reducing drug-related harm: Australia leads the way).

Another time ... another place

Medical practice requires men and women who are devoted to people as well as to their own egos.

John Langone Harvard Med 1995



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