Volume 201 Issue 5

Through gynaecological cancer prevention and treatment, assisted reproduction and good pregnancy care

Tania Janusic

Assisted reproductive technology has come a long way in 40 years

Gabor T Kovacs MD, FRANZCOG, CREI

Vaccinated women need to be screened

Annabelle Farnsworth MB BS(Hons), FRCPA, FIAC

The road to elimination of HIV transmission by 2020

Levinia Crooks AM, BA(Hons), MBA · Michael R Kidd AM, MD, FRACGP

Australians are living on average 25 years longer than a century ago, but are doing it with more chronic diseases

Australian Institute of Health and Welfare

n/a

A call for active leadership on climate change This week the Journal publishes an open letter from 12 medical and health scientists to the Prime Minister urging that climate change be included on the agenda for the upcoming G20 meeting that he is hosting in Brisbane in November. The letter argues that climate change and health are interlocked with the global economy, and that vigorous and enlightened debate about the consequences of climate change on human health is justified at a meeting focused on international economics. An interview with Professor Jeffrey D Sachs, a prominent American economist and Director of The Earth Institute at Columbia University and past Chair of the World Health Organization's Commission on Macroeconomics and Health, calls on Australia to show leadership. Sachs has served as special adviser to two Secretaries-General of the United Nations, first guiding the development and then the implementation of the Millennium Development Goals, which seek to reduce global poverty, particularly through health gain for mothers and children and through reduced HIV and AIDS, by 50% by 2015. His primary concern today is with achieving sustainable development before a malignant tipping point occurs in global temperature. The interview and the open letter both call for action from the Australian Government. We look forward to a positive response.

Stephen R Leeder MD, PhD, FRACP

Dear Prime Minister, We urge you to include human-induced climate change and its serious health consequences on the agenda for this year's G20 meeting. The world community looks to high-income countries for a strong lead. Current climate trends, driven by global warming, threaten the basis of future economic prosperity, regional political stability and human health. As concern rises in many countries, including increasing awareness of the risks to human health and safety, many G20 members are strengthening their commitment to substantive mitigation action. The new United States regulations limiting coal-fired power plant emissions are explicitly linked to the protection of health. Meanwhile, if Australia passes up opportunities for new energy technologies and efficiencies, we will forfeit gains in long-term economic security and fail to contribute fairly to reducing worldwide risks to human health. There are serious risks from climate change to the health of populations everywhere — widely documented in national and international scientific assessments. The risks include, but extend well beyond, intensified heatwaves, floods, fires and the spread of disease-bearing mosquitoes. Regional food yields and hence child and adult nutrition are at risk. Water shortages threaten the quantity and quality of drinking water, hygiene and agriculture. Warming and acidification of oceans endanger marine food sources. Infections such as gastroenteritis increase with warming, as do levels of important hazardous air pollutants. Threats to rural and coastal assets and livelihoods will adversely affect mental health. Adverse health outcomes related to climate change are already evident in many regions of the world. By mid century, serious health risks are likely to be widespread, particularly in vulnerable communities, including in Australia. Workloads and economic and logistical demands on the nation's health system will also rise as these impacts increase. Near-term cost savings from health gains resulting directly from emission-reducing actions could be substantial. For example, the savings from health gains due to reduced heat extremes and accompanying air pollution would greatly exceed those accruing to agriculture from the same reduction in exposure. In the long run, the harm to human health from climate change is more than an avoidable burden of suffering, injury, illness and premature death. It signals that our mismanagement of the world's climate and environment is weakening the foundations of health and longevity. This issue warrants urgent consideration at the G20 meeting. The health of present and future generations is at risk from ongoing human-induced climate change.

Anthony J McMichael AO, MB BS, PhD, FTSE · Stephen R Leeder AO, MD, FRACP, PhD · Bruce K Armstrong AM, MB BS, DPhil, FRACP, FAFPHM · Antony Basten AO, MB BS, DPhil, FRCP, FRACP, FRCPA · Peter C Doherty AC, BVSc, MVSc, PhD · Robert M Douglas AO, MB BS, MA, MD, FRACP, FAFPHM, FRACGP · Adele C Green AC, MB BS, PhD, MSc, FAFPHM · Gustav J V Nossal AC, MB BS, BSc(Med), PhD · David J C Shearman FRACP · Fiona J Stanley AC, MSc, MD · Graham V Vimpani AM, MB BS, PhD, FRACP, FAFPHM · Alex D Wodak AM, MB BS, FRACP, MRCP, FAFPHM, MRACP

We must reinvigorate our sense of humanity, justice and foresight Jeffrey Sachs is an American economist and Director of The Earth Institute, Quetelet Professor of Sustainable Development and Professor of Health Policy and Management at Columbia University. He is Special Adviser to United Nations Secretary-General Ban Ki-Moon on the Millennium Development Goals, having held the same position under former UN Secretary-General Kofi Annan. He is known as a commentator and advocate for the relief of poverty, the achievement of improved health in developing countries and for environmental sustainability. From 2000 to 2001, he chaired the World Health Organization Commission on Macroeconomics and Health, which made clear the linkage between health gain, relief of poverty and economic growth. Sachs is author of The end of poverty: economic possibilities for our time (2005). His most recent book is To move the world: JFK's quest for peace (2013). He was interviewed by the Editor-in-Chief of the Medical Journal of Australia, Stephen Leeder, who worked with Sachs in New York in 2003–2004, about the upcoming G20 meeting in Brisbane, Australia, in November. What is your primary message as an economist interested in the relief of poverty about sustainability and its relation to both economics and human health? It is not possible to consider ending poverty in the midst of human-induced climate change. Even if poor countries, such as those in Africa, make some short-term progress in the fight against poverty, this progress will be overtaken by climate disruption. Africa already is suffering from food price shocks, famine, heatwaves, droughts and other extreme climate shocks. We've got to get real: fighting poverty and environmental degradation go hand in hand. How could the upcoming G20 meetings in Brisbane be an important forum for consideration of the economics of sustainability? The G20 countries are the world's most important economies. They account for the lion's share of global greenhouse gas emissions. If the G20 gets its house in order, the world can be saved. If not, the G20 will wreck the world, pure and simple. So what will it be? Will the richest and most powerful countries also be the most short-sighted, or will they understand that they hold not only their fate but the fate of humanity in their grasp? Brisbane is therefore crucial. The prospects are not bright. The Australian Government claims it is driven by science, but it seems to us on the outside that it is driven by mining interests, or by the likes of Rupert Murdoch, the world's number one anti-science propagandist. The G20 should acknowledge that 2015 is the most important year of diplomacy on sustainable development in at least 15 years. We have three mega-summits next year. The first is on Financing for Development, in Addis Ababa, Ethiopia, in July 2015. The next is on Sustainable Development Goals, at the UN headquarters in New York, in September 2015. The third is on climate change — the so-called COP21 [21st Conference of Parties] of the UN Framework Convention on Climate Change — in Paris in December 2015. The Brisbane G20 should help to prepare the world's leading countries to be true forward-looking problem solvers during these three crucial summits next year. Can the world still prevent runaway climate disaster? Yes, but we've almost run out of time. In 2009, and again, 2010, the world's governments agreed to fight to keep global warming below 2°C. Yet we are on a trajectory of 4–6°C by the end of this century. In fact, we could trigger runaway climate change, in which warming unleashes various feedback processes (such as the release of carbon dioxide from vegetation, soils and permafrost) that could lead to runaway climate disaster. That's why the 2°C limit is also called a “guardrail” for the world: one that keeps us from spinning completely out of control. So, to be more specific, can we still keep warming below 2°C? Yes, just barely, if all major economies of the world begin to take very strong and consistent actions to decarbonise their national energy systems in three main ways: shifting to low-carbon electricity, moving from fossil fuels to electricity in vehicles and buildings, and massive gains of energy efficiency. A fourth main global pillar is to shift from deforestation to reforestation and to reduce emissions from agriculture. These transformations are deep, but they are feasible. And they will not only protect the climate but also boost prosperity if we apply our efforts and ingenuity to the effort. We are running out of our planet's carbon budget — that is, the amount of carbon the world can burn and still remain below 2°C. But do you see these transformations being achieved by economic reasoning alone? No. A reinvigoration of a global moral code must also be a lifeline in the 21st century. Pope Francis is utterly correct and compelling when he speaks of the “globalisation of indifference”. We have lost our moral compass as a global society. The mass media, the cynicism of Murdoch and others, have crowded out decency, humanity, justice and foresight. Yet each of us wants our children and grandchildren to survive and to flourish. We each have an instinct, a moral fibre, to keep the world safe for the future and for each other. Yet we have to reinvigorate this morality, to overcome the immorality of greed and power that drive our societies today. At a time when our societies have unprecedented technological capacity in hand to end extreme poverty, a billion people worldwide are chronically hungry and destitute; in a period when health care technology enjoys astounding advances, 6 million children under the age of 5 worldwide still die each year of utterly preventable causes; and in an era when sustainable technologies for energy, industry, buildings and transport could rein in climate change, the world rushes headlong towards climate catastrophe — our attitudes and moral judgements will be the most important determinants of our fate, not our resources or our capacities. At this stage of history, humanity is at a crossroads, with the future course of our own choosing. We have the technical means to solve our national and global problems — to banish poverty, fight disease, protect the environment, and train the illiterate and unskilled. But we can and will do so only if we care enough to mount the effort. President John F Kennedy made the point compellingly a half-century ago. In his inaugural address in January 1961, he noted: “For man holds in his mortal hands the power to abolish all forms of human poverty and all forms of human life”. Two years later, on the quest for peace with the Soviet Union, J F K made the most essential point, the key reason for hope in peaceful problem solving, on poverty, climate change and the end of war itself: So, let us not be blind to our differences — but let us also direct attention to our common interests and to the means by which those differences can be resolved. And if we cannot end now our differences, at least we can help make the world safe for diversity. For, in the final analysis, our most basic common link is that we all inhabit this small planet. We all breathe the same air. We all cherish our children's future. And we are all mortal.

Jeffrey D Sachs BA, MA, PhD · Stephen R Leeder MD, PhD, FRACP

This much maligned galactagogue may carry no direct risk to breastfeeding women

Luke E Grzeskowiak PhD, BPharm(Hons), GradCertClinEpid · Lisa H Amir MB BS, MMed, PhD

The “ending HIV” movement calls for new and innovative approaches to testing

Marianne Gale MB BS, MPHTM · Joanne Holden MHlthPolicy · Christine Selvey MB BS, MSc · Kerry Chant MPH, FAFPHM · Bill Whittaker

Study failed to acknowledge its own limitations and the hand hygiene advances already made

Andrew J Stewardson · Philip Russo · M Lindsay Grayson

In reply: Any concerns that our finding may undermine the HHA program should be redirected to addressing doctors’ underperformance

Mary-Louise McLaws · Syed Azim

Does doctors’ non-compliance result from a flaw in the protocol?

Sara L Barnes

In reply: The protocol is not flawed or unreasonable, but it is difficult to put into practice

Gwendolyn L Gilbert

Seeking reassurance for consumers and health professionals

Debra S Kennedy

Do we always need to invoke one of the Acts, with all its inherent clumsiness?

Paul Dignam

In reply: The emergency principle may be applied legally without any prior approval or documentation

Kerri Eagle · Christopher J Ryan

Objectives: To investigate the characteristics of parents and intended parents and their current and planned behaviour in relation to surrogacy arrangements. Design, setting and participants: Members of two Australian parenting support forums who were considering surrogacy or were currently or previously in a surrogacy arrangement were invited to complete an online survey during July 2013. Main outcome measures: Sociodemographic characteristics; proportions engaging in domestic uncompensated and overseas compensated arrangements; countries used; costs incurred; and impact on behaviour of state laws criminalising compensated surrogacy. Results: Of 1135 potential participants, 312 (27%) commenced the survey. Of these, 24 did not fulfil inclusion criteria and 29 did not complete the survey. Eighty-nine respondents were considering surrogacy and 170 had commenced or completed surrogacy. Many respondents (53%) considered both overseas and domestic surrogacy. Among those who only considered one option, overseas surrogacy was considered significantly more often than domestic surrogacy (92% v 8%; P < 0.05). Only 22 respondents (8%) commenced with a surrogate in Australia. The most common countries used for compensated surrogacy were India and the United States, and average total estimated costs were $69 212 for India and $172 347 for the US. Barriers discouraging domestic surrogacy included concern that the surrogate might keep the child (75%), belief that it was too long and complicated a process (68%) and having no one of the right age or life stage to ask (61%). Few intended parents (9%) were deterred by state laws criminalising compensated surrogacy. Conclusions: Most Australian intended parents via surrogacy consider or use overseas compensated arrangements. Laws banning compensated surrogacy do not appear to deter those seeking surrogacy arrangements.

Sam G Everingham BSc, MA, MPH · Martyn A Stafford-Bell MB BS, FRCOG, FRANZCOG · Karin Hammarberg RN, BSc, PhD

Smoking cessation or reduction should be made a clear priority for improving pregnancy outcomes

Nicolette A Hodyl PhD, GradCert(Biostats) · Luke E Grzeskowiak PhD, BPharm(Hons), GCertClinEpid · Michael J Stark PhD, MB ChB · Wendy Scheil MB BS · Vicki L Clifton PhD

Concerns that women may not continue to participate in screening appear to be warranted

Alison C Budd PhD · Julia M L Brotherton BMed(Hons), MPH(Hons), FAFPHM · Dorota M Gertig MB BS(Hons), ScD, FAFPHM · Theresa Chau BPsychSc · Kelly T Drennan BHlthSc, PGCertCommDev · Marion Saville MB ChB, FIAC, GradDipMed(ClinEpi)

Reasons behind geographic and socioeconomic differences in survival warrant further investigation

Satyamurthy Anuradha MB BS, FRCS, PhD · Penelope M Webb MA, DPhil · Penny Blomfield MB BS, FRANZCOG, CGO · Alison H Brand MD, FRANZCOG, CGO · Michael Friedlander FRACP · Yee Leung MB BS, FRANZCOG, CGO · Andreas Obermair MD, FRANZCOG, CGO · Martin K Oehler MD, FRANZCOG, CGO · Michael Quinn MB ChB, FRANZCOG, CGO · Christopher Steer MB BS, FRACP · Susan J Jordan MB BS, FRACGP, PhD

Websites promoting emerging breast imaging devices overpromise on safety and effectiveness

Thomas D Vreugdenburg BHSc(Hons) · Caroline O Laurence BA(Hons), MHSM, PhD · Cameron D Willis BPhysio(Hons), PhD · Linda Mundy BSc, MPH · Janet E Hiller BA, MPH, PhD

It is time to improve communications about risks and bene?ts

Jane H Williams BA, MDevStud · Stacy M Carter BAppSci, MPH(Hons), PhD · Lucie Rychetnik BSc(Hons), MPH, PhD

A high standard of pregnancy care should be provided for all women

Caroline M de Costa PhD, MPH, FRANZCOG

What is urgent research, and how should we support it without excessive bureaucracy?

John B Best AO, MD BS, PhD, DSc(Hon)

Review of Overcoming baby blues: a comprehensive guide to perinatal depression by Gordon Parker, Kerrie Eyers, Philip Boyce.

Sarah Mares

n/a

Laura Lamprell MB BS(Hons), BSc · David Wright MB BS, FRACS

Dr Alan Hughes spends his semiretirement in some of the world’s most underresourced health hotspots, delivering babies, repairing fistulas and saving the lives of women giving birth in the most difficult of conditions.

Cate Swannell

This calendar will be updated each month. If you have an event you would like to add, please include relevant details in an email to cswannell@mja.com.au

Cate Swannell