Volume 216 Issue 8

Information from trusted influential messengers that is clear and consistent might be successful in addressing patients’ beliefs in health-related conspiracy theories

Mathew D Marques · Karen M Douglas · Daniel Jolley

Colchicine is an inexpensive new treatment for coronary heart disease that is both safe and effective in select patients

Stefan M Nidorf · Jamie Layland · Philip C Robinson · Sanjay Patel · Peter J Psaltis · Peter L Thompson

Australia needs better data on health inequities to support building back fairer from the pandemic

Joanne Flavel · Martin McKee · Toby Freeman · Connie Musolino · Helen Eyk · Fisaha H Tesfay · Fran Baum

Health authorities need to develop a nationally consistent, sensible, ethical and jurisdictionally feasible process for disposal of educational human bone sets

Jonathan Coman · Simon S Craig · Anne‐Maree Kelly

A 25-year-old woman presented via ambulance following a jellyfish sting

Anthony C Rengel · Sue Davel · Sarah O’Connor · Nicholas Medcraft

A 55-year-old man was referred for management of resistant hypertension

Kay W Choy · Renata Libianto · Ian Simpson · Jun Yang

A 79-year-old man presented with painful lesions over his left arm on a background of non-Hodgkin lymphoma, which was well controlled on rituximab

Luke S McLean · Danny Rischin

The evolution of treatment for a distinctly Australian affliction

Alon Taylor · Hannah North · Narinder P Singh · Paul A Fagan

A condition considered rare is not sought; a condition not sought is not diagnosed; a condition not diagnosed is considered rare…

Mark R Nelson

Registries are invaluable assets that not only benefit medical research, but also health care for all

Peter FM Choong

GPs actively screening for primary aldosteronism could facilitate early treatment of this readily managed form of secondary hypertension

Renata Libianto · Grant M Russell · Michael Stowasser · Stella M Gwini · Peta Nuttall · Jimmy Shen · Morag J Young · Peter J Fuller · Jun Yang

About 80% of participants could be adequately supported by primary care and community organisations

Seok Ming Lim · Nicole L Allard · Janelle Devereux · Benjamin C Cowie · Michelle Tydeman · Alistair Miller · Khanh Ho · Brigitte Cleveland · Liz Singleton · Karen Aarons · Paul Eleftheriou · Thomas Chan · George Braitberg · Andrea Maier

Adjusted 30-day and 12-month rates declined for patients who underwent surgery

Lara Harvey · Ian A Harris · Rebecca J Mitchell · Adrian Webster · Ian D Cameron · Louisa Jorm · Hannah Seymour · Pooria Sarrami · Jacqueline Close

Where applicable, recommendations are harmonised with current national guidance for type 2 diabetes in children and adolescents

Jencia Wong · Glynis P Ross · Sophia Zoungas · Maria E Craig · Elizabeth A Davis · Kim C Donaghue · Louise J Maple‐Brown · Margaret J McGill · Jonathan E Shaw · Jane Speight · Natalie Wischer · Stephen Stranks

To the Editor: Larcombe and colleagues1 report a range of potentially harmful chemicals in locally purchased e‐liquids, highlighting the need for rigorous Australian standards and regulation of vaping liquids. However, the biological and clinical significance of these findings is unclear. Simply detecting the presence of a chemical with a potential risk has little meaning. The risk to human health depends on the level of exposure, under a fundamental principle of toxicology that “the dose makes the poison”.2 Apart from flavouring chemicals, most of the chemicals in the e‐liquids were at low or very low levels. Low doses of chemicals are ubiquitous in the environment, including arsenic in tap water and acrylamide in coffee.3 These cause little harm. To properly assess risk, the dose should be referenced to some standard, such as an established occupational or environmental exposure standard. No such comparison was made; therefore, no conclusions should be drawn. Nicotine was found at trace levels in six out of 65 samples. The authors imply that this has “implications for health and addiction”. However, nicotine was detected at a dose of 0.29 mg/L, which is around 1000 times lower than the lowest concentration of nicotine (3 mg/mL) in commercial e‐liquids and is not of any biological or clinical significance. Furthermore, as the authors note, predicting the risk to health should be based on the analysis of vapour rather than e‐liquid. This is a far more useful guide to the exposure of chemicals to the user. Most importantly, any risk should be compared with the risk from smoking. As frequent vaping is largely confined to smokers, minor harm from vaping is justified if it allows switching from the far more harmful behaviour of smoking.4 A Public Health England review found that most toxins responsible for health damage from smoking are absent in vapour and those that are present are at much lower levels (below 5% and mostly below 1%) than in tobacco smoke.5 It is disappointing that the authors declare no relevant disclosures when three of the four funding organisations have established antivaping positions (the Minderoo Foundation, Lung Foundation Australia, Cancer Council Western Australia). This should have been declared in the competing interests statement.

Colin P Mendelsohn · Alex D Wodak

In reply

Alexander Larcombe · Sebastien Allard · Benjamin Mullins

To the Editor: We recently reviewed the first studies of the real‐world effectiveness of coronavirus disease 2019 (COVID‐19) vaccines.1 We found evidence of protection against serious illness and death but noted the difficulties in performing such studies in Australia. This was because of the (then) low national case numbers and lack of ready access to the necessary linked health data. Since then, the literature on vaccine effectiveness has expanded dramatically. By February 2022 the Johns Hopkins Bloomberg School of Public Health and partners had generated a database of 181 studies conducted in 26 countries.2 The most studied vaccines were Pfizer (117 studies), Moderna (47), AstraZeneca (43), Janssen (17) and Sinovac (8). Twenty‐three studies investigated booster doses, and seven studies mentioned analysis of the Omicron variant. Study outcomes included infections (117 studies), hospitalisations (69), deaths (30), and viral transmission (5). Study designs varied, with 32 mentioning cohort analysis and 16 mentioning test negative analysis in their titles. Most studies were performed in the United States (56 studies), followed by Israel (32), the United Kingdom (29), Qatar (9), Canada (8), Brazil (6) and Denmark (4). Not one of the listed studies was conducted in Australia. We should be asking why. Australia no longer lacks the case numbers to make estimates of vaccine effectiveness. We collect good data on vaccination status, infections (including viral variants), hospitalisations and deaths, plus the information needed to adjust for confounding of the associations between vaccine exposure and outcomes. However, authorities have not linked these datasets at individual level and made them available for detailed analysis. This situation should not continue. There are well established principles for protecting the privacy of individuals who are included in routinely collected data.3 The Commonwealth and state governments and relevant agencies seem unable or unwilling to link and properly analyse these data. Consequently, they should ensure that regularly updated comprehensively linked de‐identified datasets can be accessed by qualified researchers. Stephen Duckett has recently called for an Australian review of lessons from the COVID‐19 pandemic using a systems rather than a punitive lens.4 We agree. Better linkage, access and analysis of our health system data should be high on the list.

David A Henry · Mark A Jones · Paulina Stehlik · Paul P Glasziou