In This Issue

Facing up to climate change

The morning after the recent federal budget announcement, a Sydney Morning Herald letters contributor wrote wanly, “Eagerly I looked to today’s headlines, hoping for ‘Govt decides Earth worth saving’, or ‘Entire surplus to fund renewable energy’. Alas, the state of denial over climate change persists.” And, seemingly, it does. In this issue, Woodruff et al issue a challenge to our government to do much more, much sooner about the impending health crisis that climate change will bring (→ Action on climate change: no time to delay), while Kefford (→ Medical heat for climate change) draws on examples of past, successful campaigns to urge doctors to use their collective influence to hasten the action to reduce greenhouse gas emissions.

Editors: independent or unemployed?

Back in February, the stable and serene world of medical editing was rocked by the sackings of the Editor-in-Chief and Deputy Editor of the Canadian Medical Association Journal (CMAJ). As the name suggests, CMAJ is owned by the Canadian Medical Association. The sackings have been widely attributed to an ongoing dispute between the editors and the association, regarding control of journal content. So is editorial independence an illusion? Like a good marriage, says Van Der Weyden, it takes communication and respect to make the owner/editor relationship work (→ Sackings at the Canadian Medical Association Journal and editorial independence).

Spoiled for choice

After years of consultation, Australia is about to have a national bowel cancer screening program based on faecal occult blood testing. One of the main issues for those designing a screening program is whether the test will be acceptable to the target population. The Multicentre Australian Colorectal-neoplasia Screening (MACS) Group has examined this question in a randomised controlled trial designed to examine whether having a choice of screening modality influenced the decision to participate (→ A comparison of colorectal neoplasia screening tests: a multicentre community-based study of the impact of consumer choice). But participation rates aren’t everything, say Salkeld et al, who dream of a public health utopia where patients are firmly in charge of their own destinies (→ Consumer choice and the National Bowel Cancer Screening Program).

Herbal reaction

Ginkgo biloba is a herbal remedy, often used to treat memory impairment and other neurological symptoms. In “Acute generalised exanthematous pustulosis induced by the herbal remedy Ginkgo biloba”, Pennisi reports an adverse reaction which is usually associated with antibiotics, in a man who took ginkgo for tinnitus.

Costing adverse events

One of the unfortunate aspects of adverse events in hospitals is that they increase costs by increasing patients’ length of stay and, often, the complexity of their treatment. Studies examining adverse events often involve extensive record review or prospective data collection but, in “The incidence and cost of adverse events in Victorian hospitals 2003-04”, Ehsani et al show that using routinely collected hospital morbidity data can be an economical way of costing and counting adverse events — with a view, of course, to prevention.

In the wake of last year’s Bundaberg Hospital scandal there have also been calls to make hospital administrative data public, so that patients can come to their own conclusions about the safety of hospitals. In “Public reporting of hospital outcomes based on administrative data: risks and opportunities”, Scott and Ward examine the usefulness of this suggestion.

In any given year, one in 200 Australians will experience an episode of bipolar disorder. We now know a lot about managing this illness and, of course, the main person coordinating management is generally a general practitioner. Thus, the Clinical Update from Mitchell et al in this issue (→ The management of bipolar disorder in general practice) is a welcome and timely contribution. But are some best-practice recommendations “pie in the sky” in the current under-resourced and poorly coordinated mental health environment? Hickie and Blashki argue for a more pragmatic approach (→ Evidence into practice: the mental health hurdle is high).

Missed opportunities

Up to 60% of intravenous drug users (IDUs) in Australia are hepatitis C positive, at least a quarter have had hepatitis B, and 1%-3% are HIV positive. As drug and alcohol agencies may represent the only contact that IDUs have with the medical community, they are an important venue for opportunistic screening for, and (in the case of hepatitis B) vaccination to prevent, these viruses. However, as Winstock et al discovered, many agencies are currently unable to provide this service (→ National survey of HIV and hepatitis testing and vaccination services provided by drug and alcohol agencies in Australia).

Community resistance

Several recent articles in the MJA have flagged the growing problem of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections. As clinicians wrestle with the implications of CA-MRSA for empirical therapy, Vlack et al add some important information to the mix, with their study of CA-MRSA carriage rates among school children in a Queensland Indigenous community (→ Carriage of methicillin-resistant Staphylococcus aureus in a Queensland Indigenous community).

Another time . . . another place

It appears to me that melancholy is the commencement and even part of mania . . . The melancholics turn to sorrow and despondency only . . . If at any time a relaxation occurs . . . hilarity supervenes, but these persons go mad.