Volume 197 Issue 5

Can Australia rise to the challenge of reducing the rate of avoidable stillbirths? The large, well conducted study by Drysdale and colleagues published in this issue of the Journal shows a 2.4-fold increase in the odds of late-gestation stillbirth for women giving birth in Australia who were born in South Asia, compared with women born in Australia. The relative risk was most pronounced at 41 weeks’ gestation, ...

Vicki J Flenady MMedSc(ClinEpid), PhD · David A Ellwood MA, DPhil, FRANZCOG

Mifepristone, in conjunction with misoprostol, is extremely effective for medical abortion at any gestation and is now widely used throughout much of the world for this purpose. However, the history of the drug in Australia has been controversial. For 10 years from 1996, it was the object of federal legislation that allowed its use ...

Caroline M de Costa PhD, FRANZCOG, FRCOG · Michael Carrette MB BS, FRANZCOG

Assisting in the creation of life is not without its risksWhether it were possible for Nature, or Art to beget a Man out[side] of the body of a Woman, and naturall matrix? To this I answer, that it is in no way repugnant to the Art of Alchymie, and Nature, yea it is very possible . . . — Paracelsus1 There have been few advances that ...

Michael J Davies MPH, PhD · Eric A Haan MB BS, FRACP

The full content of this article is available by downloading the PDF.

The full content of this article is available by downloading the PDF.

Policies to prevent medical photography being performed unethically and unlawfully are critical in the digital ageIn the era of easily obtainable, easy-to-use digital cameras, any owner of a camera can be a “medical photographer”. Yet professionalism in obtaining medical photographs is much more than the sum of one’s equipment. Digital cameras, especially the ones in smartphones, give clinicians a high degree of autonomy in taking ...

Kara Burns BSci(AppSci)(Hons) · Suzanne Belton PhD

Professor Peter Brooks advocates increasing productivity and reducing demand to prepare for what lies aheadIf future increased health care demand in Australia is simply met by increasing medical workforce capacity by the year 2025, our country will go bankrupt. However, recently released modelling shows us how we can meet this demand in other ways. The most recent Health Workforce Australia report provides an interesting model of ...

Peter M Brooks MD, FRACP, FAFPHM

Professor Richard Murray explains why action on generalism, regional training and service reform is a national policy emergencyIt might surprise some to know that among wealthy Organisation for Economic Co-operation and Development (OECD) countries, Australia has an average number of doctors for its population.1 Australia has more doctors per capita than ever before, more than New Zealand, Canada, the United States and the United Kingdom. With ...

Richard B Murray MB BS, MPHTM, FACRRM

Could savings for governments from objective reductions in preventable hospitalisations create long-term incentives for evidence-based health care? It is to our collective shame that those with chronic conditions in Australia suffer “a miserable existence in trying to organise their health care and prevent further deterioration”. With more than 1 million adults with cardiovascular disease and at least 800 000 with diabetes, we are ill equipped for the looming “tsunami ...

Jeanette E Ward PhD, FAFPHM, FACHSM

The recent High Court decision that dismissed the tobacco industry’s case against tobacco plain packaging has rightly been hailed as a landmark victory for the federal government and public health against a lethal industry. The Attorney-General (and former Health Minister), Nicola Roxon, deserves the highest praise for her leadership and determination to reduce Australia’s tobacco-related death toll, as do the politicians of ...

Mike M Daube · Simon Chapman

To the Editor: In South Australia, the incidence of developmental dysplasia of the hip (DDH) diagnosed at or after 3 months of age was 0.22 per 1000 live births between 1988 and 2003, corresponding to a rate of 4–5 new cases per year. Since September 2009, 34 children have been treated at our institution for DDH diagnosed at 3–18 months of age, which equates to an incidence of 0.7 per 1000 live births in SA. ...

Nicole Williams · Bruce K Foster · Peter J Cundy

Bhatia and Tibballs claim that the High Court ruling in Tabet v Gett that removed “loss of chance” as a possible course of action by patients is “to the advantage of doctors”. They end with a note of regret and hope that this means of litigation might be revived. However, the authors fail to convey the complexities of the case. The patient, a ...

Padraic J Grattan-Smith

To the Editor: In describing 8 years of experience in managing adolescent gender identity disorder (GID) at a paediatric hospital clinic, Hewitt and colleagues highlight a small group of patients who require momentous life-long clinical decisions made in a timely manner.1 However, the rarity of this condition means that experience in any centre is limited. The authors state that authorisation from the Family Court of Australia is ...

Ann J Conway · Julie C Hamblin · David J Handelsman

To the Editor: I welcome the article by Hewitt and colleagues,1 but their protocol is problematic. Suppression of puberty improves mental health and general functioning, but not body image and dysphoria.2 For this, cross-sex hormones and/or surgery are the only effective treatments.2 Withholding cross-sex hormones until children are 16 years of age may worsen their mental health,3 cause resentment, and encourage self-medication. Increasingly, young transsexual people are ...

Zoë Hyde

In reply: We thank Hyde and Conway and colleagues for their correspondence following our report on treatment for young people with gender identity disorder (GID).1 We follow current international consensus recommendations for management,2,3 but accept that as more research is performed, there may be future adjustments to endorsed protocols. At present, patients can apply to the Family Court of Australia for authorisation of treatment that ...

Jacqueline K Hewitt · Campbell Paul · Louise K Newman

In Cape York Indigenous communities, alcohol restrictions started in 2002–2003, with local prohibition in some communities since 2008. These restrictions may have halved alcohol-related injuries, a historically important change. However, residents of Cape York Indigenous communities suggest that there has been an accompanying rise in cannabis use over this period. During consultations in 2011 for Minister Macklin’s controversial Stronger Futures in ...

Cape York Cannabis Project Team

To the Editor: The Victorian Doctors Health Program (VDHP) was established in 2001. It is the only full-time doctors’ health program in Australia. Based on similar programs in North America and Europe, the VDHP provides a comprehensive, supportive service to medical students and doctors suffering from mental health and/or substance use issues. The lifetime prevalence of substance use disorders in Australian doctors has been estimated at ...

Cheryl Wile · Kym Jenkins

Cunningham’s perspective provides a timely review of the literature relating to the maternal psychological outcomes of holding stillborn babies, which remains controversial. It is unfortunate that some popular media sources reported it incorrectly as saying that seeing and holding stillborn babies may cause harm. The correct conclusion is that the literature is inconclusive. The Australian and New Zealand Stillbirth Alliance strongly supports Cunningham’s ...

Vicki J Flenady · Christine Carroll · Ros M Richardson

To the Editor: A 60-year-old male farmer presented to the Gold Coast Hospital Emergency Department with a 2-day history of fever (38.5°C), retro-orbital pain, photophobia and confusion. In the preceding 2 weeks he had been working on a farm that had cattle and horses and which was infested with rats. The property had been flooded in the 2011 Queensland flood disaster, about a month before he worked ...

Ryan Markham · Andrew Slack · John Gerrard

Australia has among the world’s lowest maternal and perinatal mortality rates, with the latter more than halving over the past 40 years. However, as in other high-income countries, a decline in neonatal rather than fetal deaths has mainly contributed to falling rates, leading to calls for more attention to preventing stillbirth. Identified maternal risk ...

Henry Drysdale MB BS · Sanjeeva Ranasinha MEpid, MSc(ApplStat) · Amanda Kendall BMid · Michelle Knight RM, LLB · Euan M Wallace MD, FRCOG, FRANZCOG

The antiprogesterone mifepristone combined with a prostaglandin analogue (misoprostol or gemeprost) is effective for terminating early pregnancy and has a favourable safety profile.

Philip Goldstone MB BS(Hons) · Jill Michelson RN, RM, MBA(HealthAdmin) · Eve Williamson BPharm, PDM

Chlamydia, caused by the bacteria Chlamydia trachomatis, is a sexually transmitted infection (STI) and the most commonly notified disease in Australia and in Western Australia ...

Kellie S H Kwan BA(Hons), GradCertAppEpi · Edwina A Jachimowicz BNsng, MNsgSt(Midwifery), GradDipNseEd · Lisa Bastian BAppSc(Nursing), MPH · Lewis Marshall MPH, FAFPHM, FACSHM · Donna B Mak MPH, FAFPHM, FACRRM

Objective: To present updated national birthweight percentiles by gestational age for male and female singleton infants born in Australia.Design and setting: Cross-sectional population-based study of 2.53 million singleton live births in Australia between 1998 and 2007.Main outcome measures: Birthweight percentiles by gestational age and sex.Results: Between 1998 and 2007, women in Australia gave birth to 2 539 237 live singleton infants. Of these, ...

Timothy A Dobbins BMath, PhD · Elizabeth A Sullivan MD, MPH, FAFPHM · Christine L Roberts MB BS, DrPH, FAFPHM · Judy M Simpson BSc(Hons), PhD

The 2011 report of the Productivity Commission (PC) recommended the establishment of a no-fault national injury insurance scheme limited to “catastrophic” injury, including medical injury. The report is welcome, but represents a missed opportunity to establish simultaneously a much-needed no-fault scheme for all medical injuries. The existing indemnity scheme based on negligence remains a slow, costly, inefficient, ill targeted and stress-creating system. A fault-based ...

David Weisbrot BA(Hons), JD · Kerry J Breen MB BS, MD, FRACP

A new medical injury scheme will require realistic costing, careful planning and gradual implementationIn his recently published book, The righteous mind, American psychologist Jonathan Haidt makes the observation that “morality is an emotional issue, not a rational one; and in a contest between what we think is reasonable and what we feel in our hearts, emotion always wins”.1 Therefore, recent proposals for national disability and injury ...

Julian L Rait FRACS, FRANZCO, FAICD

Sir Peter Morris received an Honorary Doctor of Laws and delivered the 40th Halford Oration, “Organ transplantation: a medical miracle of the 20th century”, on 5 July 2012, as part of the celebrations for the 150th anniversary of the foundation of the University of Melbourne Medical School ...

Sir Peter J Morris AC, FRS, FRCS

DISTURBANCES OF SLEEP and daytime function are important diagnostic symptoms. Although most of us are well versed in the features and important impacts of sleep apnoea, a search for insomnia should be an indispensable part of most history-taking.Almost a third of our symptomatic patients present with symptoms of stress or mood disorder, where investigations of physical symptoms such as fatigue, dizziness, daily headache, chest pain ...

John M Worthington

Bob Kenihan was born in Adelaide, South Australia, on 1 February 1923, the son of Raphael Kenihan, a family medical practitioner. He attended Rostrevor College for his secondary schooling, before entering the University of Adelaide Medical School, from which he graduated in 1946. During this time, he excelled at sport, gaining a university Blue in lacrosse, as well as being proficient in cricket, swimming and golf. After ...

John M Svigos

Struan Robertson was born in Sydney on 27 January 1925, to parents who were both medical practitioners. He was educated at Sydney Church of England Grammar School, North Sydney, where he rowed in the First VIII and was a Lieutenant in the Cadet Corps. In 1943, he joined the Royal Australian Air Force (RAAF) as a pilot and served in the New Guinea campaign in Bougainville ...

James B Roche

CorrectionIncorrect reference: In “Emergency department overcrowding and mortality after the introduction of the 4-hour rule in Western Australia” in the 6 August 2012 issue of the Journal (Med J Aust 2012; 197: 148), the following statement was incorrectly attributed: “The authors stated that there were an estimated ‘120 deaths per annum associated with overcrowding in metropolitan Perth hospitals’, but that ‘[their] study did not examine the mechanisms by ...

Shyan L Goh

Women dominate the training ranks in obstetrics and gynaecology

Nicole Mackee

Dr Christopher Smith is a Laparoscopic Fellow with the Sydney West Advanced Pelvic Surgery Unit, which covers several public and private hospitals in Western Sydney

Cate Swannell

Professor Alastair MacLennan has spent the past 45 years working in obstetrics and gynaecology including 35 years at the University of Adelaide, where he was head of the discipline from 2006 until early 2012. He has published more than 350 peer-reviewed papers and five books, with particular research interests in cerebral palsy and menopause management. In 2011, he was made an Officer in the Order of Australia (AO). Now semi-retired, he continues as head of the internationally renowned Australian Collaborative Cerebral Palsy Research Group.

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