Volume 197 Issue 6

Illicit drug use should be viewed primarily as a health and social problem, and be funded accordingly. Half a century of a drug policy relying primarily on drug law enforcement has failed to curb the demand and supply of illicit drugs in Australia. However, adverse consequences of this approach have increased overall, including deaths, disease, crime and corruption. Every year, 400 Australians die from a heroin overdose. ...

Alex D Wodak FRACP, FAChaM, FAFPHM

Collection of high-quality data and management of risk are ongoing needs. Regulatory agencies worldwide are giving greater recognition to postmarketing surveillance, as part of a life-cycle approach to maintaining safety of medicines. This approach involves monitoring the potential benefits and harms of each medicine, and managing risks, throughout development, preregistration testing, registration and postmarket use in the community. The current grounds for initial and continued registration of ...

Emily Banks MB BS(Hons), PhD, FAFPHM · Sallie-Anne Pearson BSc (Hons), PhD

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

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

Ray Moynihan rings some notes of caution coming from experiences elsewhereChange is perennial in health care, but some changes are more significant than others, like the personally controlled electronic health record (PCEHR) currently being rolled out across Australia. An ambitious reform, its much-touted benefits are safer and more effective care, less duplication of unnecessary tests — and, of course, enhanced datasets for researchers. As with ...

Ray N Moynihan BA

Lower specificity and lower positive predictive value necessitate a cautious approach. The advent of cardiac troponin (cTn) assays has redefined acute myocardial infarction (AMI) and revolutionised the care of patients with suspected AMI presenting to emergency departments (EDs). So central has cTn measurement become to the diagnosis of AMI that, since 2000, the formal criteria start with detection of rise and/or fall in serum troponin levels ...

Ian A Scott FRACP, MHA, MEd · Louise Cullen MB BS, FACEM · Jillian R Tate MSc, FFSc(RCPA) · William Parsonage BM BS, BMedSci, FRACP

Better journalistic standards for reporting on medical tests will mean better informed health care consumersScreening of healthy groups in the population and diagnostic testing on suspicion of disease are fundamental components of health care delivery and disease prevention. As the general media are important sources of health information for consumers, accurate and balanced reporting is essential. Media reporting of diagnostic tests is skewed towards screening ...

Amanda J Wilson PhD · Jane Robertson PhD · Benjamin D Ewald BMed, MMS, PhD · David Henry FRCP

Reporters need to balance real-world writing pressures against idealised reporting standards. When doctors and academics critique mainstream media health coverage, they typically suggest that this is to educate reporters about their failings, and/or to sound the alert generally about the media’s tendency to mislead a naive public into believing dangerous falsehoods about risks of disease, side effects of medicines, miracle cures and so on. The article by ...

Julie C Robotham MA

To the Editor: In response to Duckett’s question, “is now the time to send a signal that poor-quality care should not be rewarded in activity-based funding?”,1 Queensland Health answers with a resounding “yes”. In addition to activity-based funding (ABF), Queensland Health applies a purchasing framework model with the aim of improving health care safety and quality, leading to better-quality outcomes for the same or lower cost. ...

Kirstine M Sketcher-Baker · John G Wakefield · Jane V Partridge

To the Editor: I welcome Nowak’s article on using stories to drive change in medical practice.1 It highlighted what I feel to be the main failure of evidence-based medicine. Although evidence-based medicine may be a great way to discern differences in the success of various treatment modalities, it may not be the best way of teaching them. In my experience, it sucks the vibrancy and immediacy ...

Peter J McLaren

To the Editor: The recent editorial by Kappagoda poses a much neglected question for the medical profession.1 There is a longstanding unmet need to consider undergraduate and postgraduate training and education in medicine generally as a continuum, with streaming as a natural corollary.2 Of the two papers that reported on the changes to the medical curriculum at the University of Sydney since the introduction of the ...

Thomas K F Taylor

To the Editor: We agree with Taylor and others that Australian medical training is too long.1,2 In 2008, Garling provocatively stated “I know of no other university-based performance qualification that requires such lengthy education and training. The only training period remotely approaching this length of time is that to become a Jesuit priest”.3 One year of medical training could be eliminated by reducing clinical and preclinical training ...

Kerry J Goulston · Kim Oates

To the Editor: A recent editorial in the Journal1 is another in a long line of articles arguing that national linkage of routine care-delivery data will enable us to improve the health care provided to Australian patients.2 However, over the past three decades, progress on national data linkage has been painfully slow. Anyone who has ventured down the path of obtaining national linked data can ...

Michael D Coory

To the Editor: Could Handelsman comment on whether he considered opioid-associated hypoandrogenism when describing the increasing prescribing of testosterone?1 Opioid-induced androgen deficiency has become more recognised, and is one of the most common causes of testosterone deficiency among men in many communities.2,3 It may be that the increase in opioid prescribing4 has complemented the promotion of testosterone therapy. Stephen P Fitzgerald General Physician and Endocrinologist

Stephen P Fitzgerald

To the Editor: The recent article by Handelsman describes the pattern of testosterone prescribing in Australia from January 1992 to December 2010.1 The author concludes that the progressive increase in Pharmaceutical Benefits Scheme (PBS)-subsidised testosterone prescribing is likely to be due to promotion-driven prescribing for speculative, non-approved indications.1 The article does not make any reference to the prescribing of testosterone for opioid-induced androgen deficiency. The use of ...

Peter M Herriot

To the Editor: The focus of HIV clinical care has shifted since the advent of potent antiretroviral therapy (ART). This change is characterised by a reduction in HIV-specific morbidities, an increase in HIV non-specific comorbidities,1,2 and an accompanying lack of clinician confidence in managing these comorbidities.3 The measurement of key performance indicators (KPIs) is useful for monitoring and improving clinical performance, but it is yet ...

Mark D Kelly · Jennifer K Broom · Sharon Young

To the Editor: The Australian Defence Force (ADF) ensures outstanding medical care for wounded soldiers by providing skilled field medics, sophisticated evacuation services and excellent in-theatre hospital care. In Afghanistan, in 2011–2012, among 136 troops deployed for 5 months, our ADF medical team dealt with six soldiers who had had significant exposure to blood: two sharps injuries incurred while searching insurgents two sharps injuries to medics providing combat casualty care two ...

Anthony D Holley · Daniel J Weber · Michael C Reade

To the Editor: In their article, Weller and colleagues describe how simulation can be used to reduce the underlying causes of adverse events.1 They point out that the Lucian Leape Institute is urging medical schools to take advantage of simulation to equip students with skills to protect patient safety.2 We are encouraged by this, and wish to share our experience of using simulation to improve ...

Susan A Welch · Julie L Gawthorne · Melinda J Berry

To the Editor: Australian gonorrhoea infection rates are rising.1 Infection spreads through various sexual practices, and extragenital infections are commonly asymptomatic.2 Nucleic acid amplification tests (NAATs) provide rapid, sensitive testing, regardless of the site involved or presence or absence of symptoms.3,4 There have therefore been calls for a change to NAAT-based screening for high-risk groups, including men who have sex with men (MSM).5 Limitations include ...

Miranda Sherley · Karina J Kennedy · Sarah J Martin

To the Editor: We report a case in which the concurrent administration of colchicine and simvastatin led to significant morbidity with myopathy and intestinal dysfunction. An 84-year-old man presented with an acute flare of gout, and was treated with 1 mg of colchicine daily for 3 days, and then 0.5 mg daily. His pain improved over the next 72 hours. He then noticed progressive generalised muscle ache and weakness in ...

Danielle H J Oh · Shuang Quan Chan · Andrew M Wilson

To the Editor: Murray and colleagues make an important call for the transition to more socially accountable medical education, and identify students as partners in this process.1 The Australian Medical Students’ Association (AMSA), the peak representative body for Australia’s 17 000 medical students, recently passed policy at its July council meeting that strongly aligns with this vision for educational and institutional responsiveness to community needs.2 For the past ...

Daniel Yore · Erica L Parker · Catherine G A Pendrey

To the Editor: O’Connor and colleagues have presented conclusions from their research1 that are congruent with my empirical observations. I congratulate them for highlighting the overriding themes, and add a perspective from England. The burgeoning of chronic treatable ocular diseases such as age-related macular degeneration means that hospital capacity is overwhelmed. The peaks in demand seen today surpass the best predictions from a decade ago; pharmacological ...

Jagdeep Singh Gandhi

To the Editor: Adrenaline is often added to local anaesthetic for injection because the vasoconstrictive effect of the catecholamine counteracts the dilative effect of the local anaesthetic, decreasing systemic absorption and prolonging its action.1 Traditionally, the use of this drug combination has been discouraged in structures supplied by end arteries — most notably the digits, but also the nose, ears and penis — on the ...

Christopher J D Barlow

Workplace aggression is a worldwide concern that has been linked to impaired physical and mental health. There is limited international research describing the extent and impact of workplace aggression in medicine, however, and the few Australian studies have primarily focused on general practitioner experiences of patient aggression ...

Danny J Hills BN, GradCertMgt, MN(Hons) · Catherine M Joyce BA(Hons), MPsych, PhD · John S Humphreys BA(Hons), DipEd, PhD

Objective: To examine trends in hospitalisation for alcohol-attributable conditions in the Northern Territory Aboriginal and non-Aboriginal populations between the financial years 1998–99 and 2008–09.Design and setting: Retrospective descriptive analysis of inpatient discharge data from NT public hospitals.Main outcome measures: Alcohol-attributable hospitalisation by age, sex, Aboriginality, region of residence and medical conditions, with annual time trends.Results: Annual rates of ...

Shu Qin Li MPH, MB, BNursing · Sabine L M Pircher MPH, BNutrDiet · Steven L Guthridge MB BS, MPH, FAFPHM

One of the key goals of health reform is to drive hospital quality improvement by creating greater transparency in health services performance. With the launch of the MyHospitals website in December 2010, quality indicators for individual hospitals across Australia were publicly ...

Jessica Greene PhD · Jane Hall PhD

This case highlights the problem of burning charcoal briquettes in a poorly ventilated space, which can generate toxic carbon monoxide (CO) concentrations.1 CO is a colourless, odourless and non-irritating gas with no warning properties. Sources of CO are related to incomplete combustion of carbon-containing materials under conditions of restricted oxygen supply, and include faulty furnaces, unflued heaters, compressors, wood-burning stoves, vehicle exhaust, welders, other petrol- or ...

Chris Winder BA(Hons), MSc, PhD

A 71-year-old farmer from the Solomon Islands presented in Melbourne with fungating skin lesions on his left lower leg. The process began 20 years earlier, leaving areas of scarring between the active sites (Figure, A and B). He was otherwise well. A skin biopsy showed granulomatous inflammation with sclerotic bodies characteristic of chromoblastomycosis (Figure, C), and Fonsecaea pedrosoi was subsequently cultured and confirmed by ribosomal DNA internal ...

James Knox · Caroline Marshall

Global health is, by definition, an area of great breadth and depth. There is enormous diversity in health systems and health outcomes, with life expectancy at birth varying from 82–84 years in Australia and Japan to less than 55 years in more than 20 African countries. Despite this diversity and difference, communicable diseases such as HIV and severe acute respiratory syndrome, and our more recent understanding of the ...

A Rob Moodie MB BS, MPH

There are no sirens. Nor is the silence disrupted by the rush of feet or frantic blue lights. Instead, our enduring patients arrive at the hospital gates on foot, most having travelled for many hours, if not days, through the unrelenting 40° C heat; the privileged cling to motorcycles already laden with firewood and kitchen utensils in anticipation of a prolonged admission. Through these same gates arrived ...

James D Smith

John Greenwell was born on 10 October 1922 in Leura, New South Wales, to Harold and Sarah Greenwell. He was the youngest of four and his father owned a pharmacy in Katoomba. Educated at Katoomba Public School and Sydney Grammar School, he graduated in medicine from the University of Sydney in 1946. After a residency at St Vincent’s Hospital, Darlinghurst, and a brief experience in general practice in ...

Stephen J Steigrad

For Centuries people have been using encrypted messages to convey confidential information. During the process of encryption, a cipher (ie, algorithm) IS used to convert data into gibBerish that can only be decoded with knowledge of the key required to decrypt the information. In today’s world of medical science, most scientists are still communicating with one another, mostly unintentionally, using coded messages when discussing and ...

Henricus A M Mutsaers

Breast physicians are the linchpins of breast cancer management

Marge Overs

Dr Naomi MacIntyre is training to become a breast physician at Sydney Breast Clinic

Cate Swannell

Dr Sue Fraser is president of the Australasian Society of Breast Physicians. After working as Clinical Director of BreastScreen in Cairns for 15 years, Dr Fraser now works in various roles in breast medicine in Queensland and New South Wales. She also lectures at James Cook University in Cairns.

Interview by Marge

Surgeon Dr Kingsley Faulkner makes his mark away from the operating table, advocating for public health

Sophie McNamara

Income protection insurance can help fill the coffers when fate steps in — but it pays to choose the right policy

Amanda Bryan