Issues
Volume 219 Issue 5
Editor’s choice
Collective voices: the role of medical journals in advocating for global health
When medical journals take action collectively it can be very powerful. Two articles in this issue of the MJA highlight what these actions can look like, and their effects. An editorial on the role of health professionals in reducing the risks of nuclear war was authored by an international group of editors, including myself as Editor‐in‐Chief of the MJA (doi: 10.5694/mja2.52054). It will be published by over 100 journals worldwide. Its topic could not be more urgent — the effect that the use of nuclear weapons would have on our world and the role of medical professionals in speaking up about this. Although nuclear weapons might seem to be a topic that lives primarily in the realm of international politics, medical professionals have a long and distinguished history of effectively advocating against nuclear weapons. The 1985 Nobel Peace Prize was awarded to the International Physicians for the Prevention of Nuclear War (IPPNW) for their work in educating policy makers and the public about the medical consequences of nuclear war at a time of heightened global tensions during the Cold War. The IPPNW's subsequent campaign — the International Campaign to Abolish Nuclear Weapons — expanded advocacy to include many other groups, leading to the adoption of the Treaty on the Prohibition of Nuclear Weapons in 2017. The Treaty has 92 signatories, including 68 member states; Australia is not a signatory.1 As the editorial notes, we are now again in especially dangerous times with global instability in Ukraine: “Any use of nuclear weapons would be catastrophic for humanity. Even a ‘limited’ nuclear war involving only 250 of the 13000 nuclear weapons in the world could kill 120 million people outright and cause global climate disruption leading to a nuclear famine, putting 2 billion people at risk.” There could not be a more important public health message for medical journals to disseminate. More closely related to the day‐to‐day work of medical journals is their role in maintaining the quality and integrity of medical research literature. In 2004, the International Committee of Medical Journal Editors (including the MJA) decided to require the registration of all clinical trials if they were to be published in their journals.2 This step, initially by a small group of journals, was a key part of improving the evidence base in medicine by making it less likely that only positive trials would be published in medical journals. Trial registration is now accepted as the norm, including at the MJA. The perspective by Seidler and colleagues reviews the clinical trial landscape in Australia, which is based on data from the Australian New Zealand Clinical Trials Registry (ANZCTR) and which captures over 95% of registered trials occurring in Australia (doi: 10.5694/mja2.52059). Of particular interest, they note how more early phase trials are being captured through trial registration — which is especially important to minimise waste in early stage clinical research. They also comment on the role of trial registration in supporting open science: “Prospective trial registration is another important cornerstone of the open science movement which the ANZCTR is promoting and facilitating”. The global open science movement has gained momentum in recent years through the UNESCO Recommendation on Open Science,3 and it is now increasingly clear that journals need to be part of this. Ultimately, these articles highlight the importance of collective voices, including of journals such as the MJA, in advocating on the major global medical challenges of our time.
Virginia Barbour
Perspectives
The changing landscape of clinical trials in Australia
Australia has a vibrant and changing clinical trials landscape, but there are areas requiring improvement
Anna Lene Seidler · Melina L Willson · Mason Aberoumand · Jonathan G Williams · Kylie E Hunter · Angie Barba · R John Simes · Angela Webster
Australian National Clinical Evidence Taskforce COVID‐19 drug treatment guidelines: challenges of producing a living guideline
National living COVID-19 guidelines have been a valuable resource for clinicians across Australia; responsiveness and adaptability are essential to their ongoing relevance
For the COVID‐19 Drug Treatment Panel of the National Clinical Evidence Taskforce
Medical education
Management of opiate dependence related to dihydrocodeine–sorbitol misuse
Regular use of dihydrocodeine, which can be purchased over the counter without a prescription, can lead to opioid use disorder
Richard CJ Bradlow · Baden Hicks · Temika Mu · Daniel Pham · Michelle Sharkey · Noel Plumley · Dan I Lubman · Shalini Arunogiri
Ethics and law
Feasibility of organ donation following voluntary assisted dying in Australia: lessons from international practice
Organ donation after VAD in Australia appears to be both legally and clinically feasible
Jan Bollen · Courtney Hempton · Neera Bhatia · James Tibballs
Editorials
Reducing the risks of nuclear war — the role of health professionals
The health community must rise to the challenge and work with renewed energy to reduce the risks of nuclear war and eliminate nuclear weapons
Kamran Abbasi · Parveen Ali · Virginia Barbour · Kirsten Bibbins‐Domingo · Marcel GM Olde Rikkert · Andy Haines · Ira Helfand · Richard C Horton · Bob Mash · Arun Mitra · Carlos A Monteiro · Elena N Naumova · Eric J Rubin · Tilman A Ruff · Peush Sahni · James Tumwine · Paul Yonga · Chris Zielinski
Voluntary assisted dying in Australia: emerging questions
Both law and practice should be refined to better satisfy the wishes of people approaching the end of their lives
Roger W Hunt
Research
Access to voluntary assisted dying in Victoria: a qualitative study of family caregivers’ perceptions of barriers and facilitators
Adequate support for doctors, navigators, and other facilitators is vital for the effective functioning of voluntary assisted dying processes
Ben P White · Ruthie Jeanneret · Eliana Close · Lindy Willmott
Substance use, socio‐demographic characteristics, and self‐rated health of people seeking alcohol and other drug treatment in New South Wales: baseline findings from a cohort study
Health services should collect comprehensive patient information during assessment to facilitate more holistic, tailored, person-centred care
Emma Black · Raimondo Bruno · Kristie Mammen · Llewellyn Mills · Krista J Siefried · Rachel M Deacon · Anthony Shakeshaft · Adrian J Dunlop · Nadine Ezard · Mark Montebello · Steven Childs · David Reid · Jennifer Holmes · Nicholas Lintzeris
Research letter
Hepatitis C treatment hesitancy among people with heroin dependence in Australia. A prospective cohort study
Testing for HCV infection should be better integrated into opioid treatment programs
Chris Tremonti · Maree Teesson · Christina Marel · Katherine Mills · Paul S Haber
Narrative review
Prevalence, pathogenesis and spectrum of neurological symptoms in COVID‐19 and post‐COVID‐19 syndrome: a narrative review
The long term impact of COVID-19 on neurological diseases remains uncertain and requires ongoing vigilance through longitudinal studies
Robb Wesselingh
Letters
This too shall pass: the performance of ChatGPT‐3.5, ChatGPT‐4 and New Bing in an Australian medical licensing examination
Oliver Kleinig · Christina Gao · Stephen Bacchi
News
More research needed into impact of COVID-19 on neurological conditions
Australia needs to commit to more research examining the neurological symptoms that can result from coronavirus disease 2019 (COVID-19), according to a Narrative Review published in the Medical Journal of Australia (MJA) today. Doctors and researchers still have much more to learn about the neurological symptoms that can result from COVID-19, according to Dr Robb Wesselingh, a research fellow at the Department of Neuroscience at Monash University. “An acute COVID-19 infection can lead to neurological symptoms such as a headache, peripheral neuropathies, seizures, encephalitis, Guillain–Barré syndrome, and cerebrovascular disease,” Dr Wesselingh said. “The majority of COVID-19-related illnesses resolve without treatment, which is reassuring to both doctors and patients, but we need more research and more vigilance about the impact of COVID-19 on the nervous system.” Monitoring links between COVID-19 and neurological symptoms is difficult because there is no active clinical registry in Australia collecting this information, he said. “We started an Australian Neuro-COVID-19 Registry at Monash University in mid-2020 but, due to the low incidence of COVID-19 infections during the initial lockdown periods, the registry never developed the momentum or funding that the international registries did and was closed in 2021,” Dr Wesselingh said. The review in the MJA also stresses the need for more longitudinal studies into the long term impact of COVID-19 on neurological diseases. “We absolutely need to be doing longitudinal studies in COVID-19 focused on the potential neurological sequelae, and in particular regarding the risk of neurodegenerative illnesses,” Dr Wesselingh said. “Most neurodegenerative illnesses have a long lead-in time after the likely initiating event or events, so you won’t capture any potential resultant illness unless you follow patients along for at least five to ten years. “Therefore, we need more research into this area to ensure that people who suffer these devastating symptoms are not left behind.” Read the Narrative Review in the Medical Journal of Australia
Sam Hunt
Urgent efforts needed to reduce vaping in adolescents
Urgent efforts are needed to reduce the uptake and use of e-cigarettes in Australian adolescents, with a study finding a fifth of young people had vaped in the past 12 months. One of the largest surveys of e-cigarette use, published in the Medical Journal of Australia, examined vaping trends among young people in three states. The majority of the students who took part in the survey attended independent schools and were living in major cities. The researchers from the Matilda Centre for Research in Mental Health and Substance Use, at the University of Sydney, invited 4445 students aged 14–17 years from 70 schools in New South Wales, Queensland and Western Australia to take part in the survey. Among the 4204 respondents, the study found that e-cigarette use had become fairly common among adolescents. “We found that 26% of respondents had used an e-cigarette, with the mean age of first use being 14 years,” Dr Lauren Gardner said, the study’s lead researcher and a research fellow at the Matilda Centre for Research in Mental Health and Substance Use. “E-cigarette use in the past twelve months was reported by 20.4% of respondents, and current regular use by 5.7% of respondents.” It found that the prevalence of use in the past twelve months was higher for boys and non-binary participants than for girls. The prevalence of current regular use was higher for non-binary participants and those who preferred to not report gender than for girls. Socio-economic status and remoteness did not influence the prevalence of current use or use in the past twelve months. The authors call for a multilevel approach to tackle the problem. “We need more support for young people through the primary care system,” Dr Gardner said. “The delivery of evidence-based prevention programs and resistance skills training in schools will also be critical. “Additionally, support needs to happen at a government level, such as through e-cigarette control policies, investment in prevention and cessation support, and communication campaigns.” Read the Research Letter in the Medical Journal of Australia
Sam Hunt
Supporting an Aboriginal and Torres Strait Voice to Parliament
Virginia Barbour
Getting to grips with invasive group A streptococcal infection surveillance in Australia: are we experiencing an epidemic?
Thel K Hla · Jeffrey W Cannon · Asha C Bowen · Rosemary Wyber
Mental health of young Australians: dealing with a public health crisis
Patrick D McGorry · David Coghill · Michael Berk
Saltwater injury: a case of chronic cutaneous Mycobacterium marinum infection
Ruby C Lee · Kennedy Wong · Yolanka Lobo · Heba Jibreal
Current debates and research in cardiovascular medicine
Francis Geronimo
Coronary stenting for stable coronary ischaemia: ain't misbehaving, just misunderstood
Derek P Chew · Sarah Zaman
Controversies and dilemmas in the diagnosis of heart failure with preserved ejection fraction
Sandhir B Prasad · David J Holland · John J Atherton
Defibrillator access across Australia: the first step in avoiding a chain of fatality
Elizabeth Paratz · Gregory J Page · Garry LR Jennings