Issues
Volume 219 Issue 2
Editor’s choice
Taking a wide view of what affects health and health care
This issue of the MJA covers a range of topics, outside usual clinical care, which demonstrate the importance of taking a wide view of what affects health and health care in modern times, and recent Australian history. In their research article, Schofield and colleagues take a modelling approach to assessing the health care and societal costs of inherited retinal diseases (IRDs) in Australia (doi: 10.5694/mja2.51997). These diseases are the leading cause of blindness in working age adults and thus have a substantial effect on patients and their families. There are now treatments available, notably voretigene neparvovec, publicly subsidised for in vivo gene therapy in Australia in 2020. In their article, which forms part of the EPIC‐Vision study, Schofield and colleagues assess survey responses from 94 people with an IRD and find that societal costs are much higher than health care costs: “Total estimated lifetime cost was $5.2million per person with an IRD, of which 87% were societal and 13% health care costs.” The authors conclude that “As the societal costs associated with IRDs are much larger than the health care costs, both contributors should be considered when assessing the cost‐effectiveness of interventions for people with IRDs”. In a linked editorial, Kamien and colleagues note the importance of understanding societal costs: “As medical professionals, we often place emphasis on calculating health care costs but fail to consider wider societal costs, which are much higher for IRDs than their health care‐related costs” (doi: 10.5694/mja2.52012) They conclude that “health economic analyses are vital when applying for [Therapeutic Goods Administration] listing of therapies that could improve the lives of Australians with IRDs”. A summary of recommendations by Langford and colleagues of a recently published clinical practice guideline for deprescribing opioid analgesics provides important new information for clinicians managing patients on long term opioids (doi: 10.5694/mja2.52002). The eleven recommendations are patient centric, and aim to “provide advice about when, how and for whom opioid deprescribing should be considered, while noting the need to consider each person's goals, values and preferences”. The recommendations range from “developing and implementing a deprescribing plan for persons being prescribed opioids at the point of opioid initiation” to “the use of interdisciplinary or multidisciplinary care, or a multimodal approach that emphasises non‐pharmacological and self‐management strategies to deprescribe opioids”. The authors note that these are the “first evidence‐based guidelines for opioid deprescribing” and are intended to “facilitate safe and effective deprescribing to improve the quality of care for persons taking opioids for pain”. Lastly, an article by Barraclough and colleagues shines a light on a racist chapter in the history of Australian medical care: the “offshoring” hospital treatment of Asian patients from Christmas Island between 1963 and 1985 (doi: 10.5694/mja2.52009). The authors reflect that although “The scheme was ostensibly benevolent in intention, having at its core the welfare of the majority of the island's inhabitants by providing them with hospital care … [it] was unashamedly based upon the racial classification and segregation of patients … Asians were to be treated in Asia”. As the authors reflect, this policy has an echo in the current Australian policy of offshore detention treatment of asylum seekers.
Virginia Barbour
Perspectives
Proposals to waive intellectual property rights for pandemic response products in the World Health Organization pandemic accord need Australia's support
The Australian Government should review its position and support intellectual property waivers in the pandemic accord
Deborah Gleeson · James Scheibner · Dianne Nicol
Sleepwalking towards more harm from asthma
The burden of asthma for patients and doctors can be reduced through simple evidence-based approaches to care and self-management
Christine R Jenkins · Philip G Bardin · John Blakey · Kerry L Hancock · Peter Gibson · Vanessa M McDonald
Medical education
Unusual hepatitis B virus findings in blood donors
Blood donor screening laboratories use different testing algorithms to diagnostic laboratories and may yield results which do not conform to the usual patterns with which clinicians are familiar
Christopher D Swan · Clive R Seed · Claire E Styles · Iain B Gosbell
Calcinosis cutis of the thumb
A 57-year-old woman receiving intermittent haemodialysis presented with a six-week history of a traumatic, painful, firm swelling of her right thumb
Mitchell Hunter‐Dickson · Jessica Conway
Medical history
Treaties for “offshoring” hospital treatment of Asian patients from Christmas Island, 1963–1985: a racist chapter in the history of Australian medical care
The Australian Government ’s offshoring policy for hospital care of Christmas Island residents classified as “Asian” contradicted the spirit of the United Nations multilateral convention against racial discrimination
Simon Barraclough · Alison Hughes · John Oldroyd
Editorials
Advancing our knowledge of people who die by suicide in order to improve suicide prevention
Too many people with severe depression do not receive appropriate and timely support and care
David M Lawrence · Barbara Sheil
Health economic aspects of inherited retinal diseases: looking for cost‐effective treatments
Both health care costs and broader societal costs should be considered when evaluating the cost-effectiveness of new therapies
Benjamin Kamien · Rachael Heath Jeffery · Fred K Chen
Research
Psychotropic and other medicine use at time of death by suicide: a population‐level analysis of linked dispensing and forensic toxicology data
Monitoring adherence to pharmacotherapy and safe medicine storage and disposal could reduce the risk of suicide
Kate M Chitty · Nicholas A Buckley · Jessy Lim · Zein Ali · Jennifer L Schumann · Rose Cairns · Benjamin Daniels · Sallie A Pearson · David B Preen · Andrea L Schaffer
The health care and societal costs of inherited retinal diseases in Australia: a microsimulation modelling study
To assess the cost-effectiveness of IRD treatments, the substantial societal costs of IRDs must be considered
Deborah Schofield · Joshua Kraindler · Owen Tan · Rupendra N Shrestha · Sarah West · Natalie Hart · Liny Tan · Alan Ma · John R Grigg · Robyn V Jamieson
Research letter
Consistent mask use and SARS‐CoV‐2 epidemiology: a simulation modelling study
Higher mask wearing rates across all ages would reduce the cumulative infection and mortality burden in Victoria
Joshua Szanyi · Samantha Howe · Tim Wilson · Tony Blakely
Guideline summary
Clinical practice guideline for deprescribing opioid analgesics: summary of recommendations
Opioid deprescribing is a complex and challenging practice, with continued prescribing the default behaviour
Aili V Langford · Christine CW Lin · Lisa Bero · Fiona M Blyth · Jason Doctor · Simon Holliday · Yun‐Hee Jeon · Joanna Moullin · Bridin Murnion · Suzanne Nielsen · Rawa Osman · Jonathan Penm · Emily Reeve · Sharon Reid · Janet Wale · Carl R Schneider* · Danijela Gnjidic*
Letters
Young‐onset dementia diagnosis, management and care
Melanie Bahlo
Young‐onset dementia diagnosis, management and care
Samantha M Loi · Monica Cations · Dennis Velakoulis
News
Health care system lets down today’s youth
The warning bell has been sounded on the state of the health care system and its ability to adequately treat and triage youth mental health conditions. Former Australian of the Year and prominent psychiatrist Professor Patrick McGorry has called for a reimagining of health care to address the “rising tide” of mental ill health in young Australians. In a perspective published in The Medical Journal of Australia, Professor McGorry, Professor David Coghill and Professor Michael Berk argue that the mental health of many young Australians is rapidly declining, and that young people with more complex conditions need access to intensive secondary care. “A comprehensive youth mental health system involves much more than entry level primary care,” they write. “Young people with more severe, complex or persistent conditions need more expert, sustained and intensive care. Yet this next level of secondary care is largely absent, resulting in a large cohort of young people described as the ‘missing middle’.” The recent National Study of Mental Health and Wellbeing revealed that the prevalence of mental disorders in 16–24-year-olds has risen by 50% — from 26% in 2007 to 39% in 2021. The rise in young women is significantly greater than in young men, with rates reaching 48%. The authors write that early intervention for potentially disabling illnesses safeguards mental wealth, notably with psychosis. In the Perspective, the authors argue for four solutions. The first solution proposed is prevention and an increasing understanding of the trends occurring in global society. “The answers are likely to involve a blend of socio-economic and generational changes, rising adversity and inequality, and unforeseen consequences of technological advances,” they write. The second solution proposed is early intervention, involving integrated primary youth mental health care being the focal point. “Primary care generally needs reimagining and a new financial model. The surge in need, workforce shortages and the collapse of bulk-billing has created a perfect storm both for GPs and headspace centres,” they write. The third solution states that young people with more severe illnesses need expert, multidisciplinary teams to recover. “This requires a more specialised tier of care, a back-up system for primary care providers for young people, so far only available in a small number of ‘oasis’ zones,” they write. The fourth solution involves changing how funding is distributed through the National Disability Insurance Scheme. “Young people in the early stages of potentially disabling mental illnesses, including treatable neurodevelopmental disorders such as [attention deficit/hyperactivity disorder (ADHD)], should be prioritised and no longer excluded,” they said.
Annika Howells
We need to chat about artificial intelligence
Enrico W Coiera · Karin Verspoor · David P Hansen
Investing in health and wellbeing at a societal level
Virginia Barbour
Commercial determinants of human rights: for‐profit health care and housing
Jennifer Lacy‐Nichols · Rebecca Bentley · Adam G Elshaug
Upholding our rights in research: calling for urgent investment in Aboriginal and Torres Strait Islander health research ethics
Michelle Kennedy · Janine Mohamed
Field cancerisation and radiotherapy: a case of treatment complications
Sarah K Morton · Selim Ozluer · James Muir