The "football" withdrawal
Remember when temazepam capsules were removed from the Pharmaceutical Benefits Scheme in 2002? Concern that intravenous drug users (IDUs) were injecting the gel in the popular little capsules led to this change of policy. Knowing that if there’s a way around such restrictions someone will find it, Breen et al conceived a cunning three-pronged study to determine whether this was the case (→ The effects of restricting publicly subsidised temazepam capsules on benzodiazepine use among injecting drug users in Australia).
A guideline that is followed
When the National Health and Medical Research Council released guidelines for the management of early breast cancer in 1995, most surgeons who treat the disease believed they were accurate and useful. To discover whether this confidence has translated into changes in practice, McEvoy et al examined management patterns for breast cancer in Western Australia throughout the '90s (→ Breast cancer in Western Australia: clinical practice and clinical guidelines).
An innocent bystander?
The role of homocysteine in B12 and folate metabolism is well established, but over the past 30 years or so its association with atherothrombosis and (more recently) even osteoporosis has emerged. So, should we be measuring and treating patients' homocysteine levels? Hankey et al reveal the answer (→ Clinical usefulness of plasma homocysteine in vascular disease).
More than met the eye
A man was found semiconscious in a park with what looked like nasty orbital cellulitis. Over the next few days, with the help of modern imaging techniques and a history from the patient (when he was able to speak), the cause of his condition emerged (Robaei et al, Orbitocranial penetration by a fragment of wood).
All fired up
That’s Chapman and Balmain’s state of mind as they call for all cigarettes sold in Australia to be "fire-safe" — meaning they self-extinguish when they're not being puffed (→ Time to legislate for fire-safe cigarettes in Australia). And why not, when many of the house and bush fires in this country are started by the smouldering butts of errant smokers?
Now that we know the importance of good glycaemic control in all people with diabetes, it is not surprising that the first-ever consensus statement on diabetes control in women preparing for pregnancy includes ambitious recommendations for ideal HBA1c levels. See “Consensus statement on diabetes control in preparation for pregnancy” for the statement, from the National Diabetes in Pregnancy Advisory Committee.
Also in the news recently was the tragic case of a Newcastle man who died after taking γ -hydroxybutyrate (GHB) while on a night out in Sydney. According to research by Caldicott et al, this death is not the first among recreational users of the drug, also known aptly as "GBH" (grievous bodily harm) (→ Fatalities associated with the use of γ-hydroxybutyrate and its analogues in Australasia). In a related letter, Brown explains why GHB is no longer used for its original purpose — anaesthesia (→ Epidemic of γ-hydroxybutyrate (GHB) ingestion).
CAM and the next frontier
Our voyage of discovery in the MJA Complementary and Alternative Medicine series winds up in the subject’s twilight zone, its evidence base. How do we progress beyond saying, "We need more research"? Series editors Bensoussan and Lewith show the way forward (→ Complementary medicine research in Australia: a strategy for the future). Will it never ever happen, we wonder...
The landmark clinical trial of St John’s wort in treating depression was the work of a relative newcomer, the US National Center for Complementary and Alternative Medicine. Its leaders, Chesney and Straus, describe what feats can be achieved with government foresight and the appropriate research infrastructure (→ Complementary and alternative medicine: the convergence of public interest and science in the United States).
"If you don’t put your finger in it, you've put your foot in it." Failure to remember this little axiom has led to much embarrassment when it is revealed that the diagnosis could have been made by a simple digital rectal examination (DRE). However, according to Lawrentschuk and Bolton’s survey of final-year students at the University of Melbourne, gaining competence in DRE can be difficult (→ Experience and attitudes of final-year medical students to digital rectal examination).
When the Family Court handed down its decision to allow a 13-year-old to take the first steps in preparation for a sex-change process, there was a public outcry. In “Ethics and the proposed treatment for a 13-year-old with atypical gender identity” Spriggs looks beyond the media hype and knee-jerk outrage that surrounded the case at the facts (and the ethics) of what was actually decided.
For the man who has everything . . .
Consider a whole-body CT scan for Christmas! Start saving now, though, because it will set you back over $800, plus the cost of further testing for the estimated one-third of recipients who will require it. Will it be money well spent? Anderiesz et al are not convinced (→ Whole-body computed tomography screening: looking for trouble?).
Register or perish
Recently, the body of evidence that has led to widespread confidence in some antidepressants came under fire when it was revealed that a number of studies with negative findings had not been published. Publication bias is not a new phenomenon to editors. After a discussion at their recent meeting, the members of the International Committee of Medical Journal Editors have come up with a strategy for ensuring that future trial results don’t fall through the cracks (→ Clinical trial registration).
Another time ... another place
I was trying to persuade a headmaster to randomize caning and detention for boys who were caught smoking. He answered . . . that the trial was unnecessary as he always knew which boy should be caned . . . I checked . . . and it looked as though his method was simple. He caned them all.
Archibald Leman Cochrane, 1972
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