Issues
Volume 200 Issue 3
In this issue
Policies — clinical and political — for better health
The federal government, less than 6 months old, faces many challenges in health care. Establishing priorities will be useful if they guide attention and resources towards where they are likely to offer the best yield in promoting health and providing care for sick and injured people, while honouring the principles of efficiency and equity in the way that we do things and to whom we attend. The Journal has asked six health leaders to suggest policy pointers — matters that, in their opinion, warrant the attention of the new government and about which policy might be developed for effective action. The first response is by eminent Melbourne health economist and academic Stephen Duckett (doi: 10.5694/mja13.00224). Duckett sets out his call for policy under three headings — keeping the Medicare promise, going beyond the provision of services and ensuring good governance. He splits his proposals into what a first-term and second-term government might aspire to do. His wide experience in health service management makes his recommendations especially pertinent. Brian Head, program leader in policy analysis at the University of Queensland, wrote “Policy decisions emerge from politics, judgement and debate, rather than being deduced from empirical analysis. Policy debate and analysis involves an interplay between facts, norms and desired actions, in which ‘evidence’ is diverse and contestable” (Aust J Public Admin 2008; 67: 1-11). Policy that works distils evidence from several sources. It includes the kind that supports evidence-based medicine, but there is also the evidence that comes from an assessment of political feasibility and evidence that comes from what we might call experience. Doctors are often frustrated when the evidence they present, from both basic and clinical science and from professional experience, is trumped by politics. But the nature of a democracy is such that this is to be expected. Policy on initial screening for acute life-threatening disease benefits greatly from medical input. Although, strictly, it is case finding, the study by Parsonage and colleagues (doi: 10.5694/mja13.10466) evaluates the use of a more sensitive troponin test for more quickly determining the presence of myocardial damage in line with an “accelerated biomarker” strategy for assessing and managing suspected ischaemia and infarction. Their findings validate the use of this strategy, formulated by the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. Here, medical evidence informs the policy that governs the interaction between patients and health care provision. Because enthusiasm frequently runs ahead of utility when it comes to screening, Maxwell and colleagues (doi: 10.5694/mja13.10974) advocate for a national framework for newborn bloodspot screening. Such frameworks have proved their worth in other countries, and one is needed here. Kane and colleagues (doi: 10.5694/mja13.10955) welcome progress in the use of cell-free fetal DNA tests of maternal serum for aneuploidy screening (and the extension of related tests to pregnancy outcome prediction) in the first trimester even though these tests have some distance to travel before sensitivity, specificity and predictive value will be clear. Ah, the delight of reading an article that describes success in closing a gap — any gap! Gaps so often cause lamentation with no design for a bridge. Tideman and colleagues (doi: 10.5694/mja13.10645; see linked editorial by Carroll and Thompson doi: 10.5694/mja14.00016]) describe a splendid cardiology network in South Australia that supports patients who have had acute myocardial infarction and who live in places remote from major hospitals in receiving appropriate timely and evidence-based care. The network involves providing advice from metropolitan hospital specialists to rural health practitioners, carefully stratifying patients into three risk categories to determine who needs reperfusion angiography most urgently, and then organising it. The mortality gap between city and rural dwellers was consequently abolished. Here, policy built the bridge to bring rural outcomes closer to city ones. In all of these examples, policy served as a vehicle for organising thought and care. It is critical to achieving the best clinical outcomes. The challenge to our nation is to ensure that our state and federal policies are as sound as we can help make them. We doctors do not make the policies, but we contribute positively and importantly to them.
Stephen Leeder
Highlights from our archives
Highlights from our archives
The full content of this article is available by downloading the PDF.
Editorials
Cardiology networks: improving the management of acute coronary syndromes
Long distances to advanced cardiac care are an Australian reality. Optimal access to timely care must be a national objective.
Gerard E Carroll AM, MB BS(Hons), FRACP FCSANZ · Peter L Thompson AM, FRACP, FACC, MBA
A decade of promises in personalised cancer medicine: is the honeymoon over?
Despite the promise of human genomics, very few successful treatments have emerged
Robyn L Ward MB BS(Hons), FRACP, PhD
In brief
From the CSIRO
A low-carbohydrate diet may help in managing type 2 diabetes
News
The full content of this article is available by downloading the PDF.
Perspectives
Time to recognise sexual orientation as a social determinant of health
A recent Senate Committee report makes for welcome reading for lesbian, gay and bisexual Australians
Jed Horner BA, BHSc(Hons) · Nick J Roberts BSc(Hons)Psych
Priorities for a new government: keeping the Medicare promise, thinking beyond services and getting governance right
Good health policy crosses multiple parliamentary terms, and acknowledges that there are no simple answers
Stephen J Duckett PhD, DSc, FASSA
Recent developments in early pregnancy screening: are we getting closer to the Holy Grail?
Non-invasive prenatal testing heralds a new era in antenatal care
Stefan C Kane MB BS, BMedSc, FRANZCOG · Fabricio Da Silva Costa PhD, FRANZCOG, COGU · Shaun P Brennecke MB BS, DPhil, FRANZCOG
Newborn bloodspot screening: setting the Australian national policy agenda
Australia lags behind other countries in developing a national policy framework for newborn screening
Susannah J Maxwell BSc, MPH · Peter O’Leary BSc, PhD
Letters
Alopecia areata and suicide of children
Boys with rapid-onset alopecia may be at risk of self-harm
Rodney D Sinclair
Surgery for adult obstructive sleep apnoea
The debate about bariatric surgery as a cost-effective and holistic surgical option for OSA continues
Kenneth CM Wong
Surgery for adult obstructive sleep apnoea
The debate about bariatric surgery as a cost-effective and holistic surgical option for OSA continues
Stuart G MacKay · Edward M Weaver
Primary prevention of cardiovascular disease: new guidelines, technologies and therapies
Does a formulaic approach based on traditional risk factors measure up?
Duncan J Campbell
Primary prevention of cardiovascular disease: new guidelines, technologies and therapies
Does a formulaic approach based on traditional risk factors measure up?
Constantine N Aroney
Primary prevention of cardiovascular disease: new guidelines, technologies and therapies
Does a formulaic approach based on traditional risk factors measure up?
Mark R Nelson · Jennifer A Doust
The significance of Good medical practice: a code of conduct for doctors in Australia
Many doctors do not appreciate the significance of the Code
Ian R Gough
Infants born in Australia to mothers from countries with a high prevalence of tuberculosis: to BCG or not to BCG?
Study highlights a need to examine BCG vaccination program delivery across Australia
Frank H Beard · Kristine K Macartney
Infants born in Australia to mothers from countries with a high prevalence of tuberculosis: to BCG or not to BCG?
Study highlights a need to examine BCG vaccination program delivery across Australia
Amanda Gwee · Ranmali Rodrigo · Dan Casalaz · Nicole Ritz · Nigel Curtis
Acute myopericarditis following intravenous zoledronic acid for the treatment of Paget’s disease
Bisphosphonates aren’t known to cause myocardial injury, but zoledronic acid may be an exception
Monique R Watts · Andris H Ellims · David S Eccleston
Fatal misuse of codeine–ibuprofen analgesics in Victoria, Australia
Those addicted to OTC codeine often do not fit stereotypes of illicit drug users and may present as well groomed professionals
Brian R McAvoy · Claire L Tobin
Fatal misuse of codeine–ibuprofen analgesics in Victoria, Australia
Those addicted to OTC codeine often do not fit stereotypes of illicit drug users and may present as well groomed professionals
Jennifer L Pilgrim · Olaf H Drummer
Realigning Medicare: further changes in general practitioner consultation delivery rates
We need a better understanding of the effects of policy levers on general practice before adjusting Medicare further
Michael J Taylor
All great leaders must first learn to follow
A doctor who is an effective follower will also be a much better clinical leader
Erwin Loh
For debate
Revalidation — what is the problem and what are the possible solutions?
Does Australia need a revalidation process as part of renewing medical registration?
Kerry J Breen MB BS, MD, FRACP
Research
Impact of a regionalised clinical cardiac support network on mortality among rural patients with myocardial infarction
Has access to expert risk stratification and early invasive management closed the gap for rural patients?
Philip A Tideman MB BS, FRACP · Rosy Tirimacco BSc · David P Senior MB BS, MSc, FACRRM · John J Setchell PhD, BM BS · Luan T Huynh MB BS, PhD, FRACP · Rosanna Tavella BSc, PhD · Philip E G Aylward MA, BM BCh, PhD · Derek P B Chew MB BS, MPH, FRACP
Validation of an accelerated high-sensitivity troponin T assay protocol in an Australian cohort with chest pain
Good diagnostic accuracy could have a major impact on health service delivery
William A Parsonage DM, MRCP, FRACP · Jaimi H Greenslade BPsych(Hons), PhD · Christopher J Hammett MB ChB, FRACP · Arvin Lamanna MB BS, FRACP · Jillian R Tate BSc(Hons), MSc · Jacobus P Ungerer MB ChB, MMed, FRCPA · Kevin Chu MB BS, MSc · Martin Than MB BS · Anthony F T Brown MB ChB · Louise Cullen MB BS
Trends in chlamydia positivity among heterosexual patients from the Victorian Primary Care Network for Sentinel Surveillance, 2007–2011
Victorian data show a concerning increase in chlamydia positivity over time, particularly in young women
Megan S C Lim PhD, BBiomedSci(Hons) · Carol El-Hayek BSc, MEpi · Jane L Goller RN, MPH, MHlthSci · Christopher K Fairley PhD · Phuong L T Nguyen BBiomedSci(Hons) · Rochelle A Hamilton MHlthSci · Dorothy J Henning GD-ADOLHW, MNurs · Kathleen M McNamee MB BS, FRACGP, MEpi · Margaret E Hellard FRACP, FAFPHM, PhD · Mark A Stoove BAAppSci(Hons), PhD
Chlamydia prevalence in young attenders of rural and regional primary care services in Australia: a cross-sectional survey
If GPs offered chlamydia testing to all young adults, rates of diagnosis and treatment would be much higher
Anna H Yeung BSc(Hons), MPH · Meredith Temple-Smith BSc, MPH, DHSc · Christopher K Fairley MB BS, PhD · Alaina M Vaisey BSc, MPH · Rebecca Guy PhD · Matthew G Law MA, MSc, PhD · Nicola Low MD, FFPH, MSc · Amie L Bingham BA(Hons), BSc, MPH · Jane Gunn MB BS, PhD · John Kaldor PhD · Basil Donovan MD, FAFPHM, FAChSHM · Jane S Hocking MPH, MHSc(PHP), PhD
Case reports
Transmission of tuberculosis infection in a commercial office
Delay in diagnosing an active case of TB led to a cluster of cases in an open-plan commercial office in Victoria
Mohammad Bagherirad MD · Peter Trevan BAppSci, AdvNurs · Maria Globan PhD · Elaine Tay MB BS · Nicola Stephens PhD · Eugene Athan MB BS, FRACP, MPH
Hereditary cause of severe recurrent bowel swelling that requires targeted therapy
A mystery solved after 15 years of pain and swelling
Suran L Fernando · Jamma Li
Reflections
Surgical simulation training: mobile and anywhere
A mobile unit allows surgical trainees to use state-of-the-art simulation equipment in urban and rural locations
Guilherme N Pena MD · Meryl Altree BNg · Wendy Babidge PhD · Guy J Maddern MB BS, PhD, FRACS
Poem
Careers
Honour and glory
Leaders of the medical community have again featured strongly in the Australia Day Honours list, reflecting another year of engagement with and innovation for the public benefit.
Cate Swannell
The power of systems thinking in medicine
Astika Kappagoda
Age, CKD and other kidney messages
David C Harris MD, BS, FRACP · John Feehally DM, FRCP
Learning by MOOC or by crook
Richard F Heller MD, FRACP, FAFPHM
Get back to work
Astika Kappagoda
Off-label prescribing
J Paul Seale MB BS, PhD, FRACP
Reducing off-label prescribing in psychiatry
Ian B Hickie MD