Volume 224, published ahead of Issue 11

Commercial determinants of health (CDoH) describe the health-harming products and practices from corporate activities. The rise of global mega-corporations means these entities have unprecedented power and impact over the public's health and environments, mediated by multi-pronged influence over individual behaviours, the scientific evidence base, policymakers and regulatory bodies. Clinicians are not immune to corporate reach. Having an umbrella term and dedicated academic focus for CDoH helps us to understand shared industry tactics and develop safeguards to mitigate harms. We encourage clinicians to combine forces with academics and other professionals to counteract the health harms. There are things we can all do.

Lisa Parker, Nicholas Chartres, Kellia Chiu, Barbara Mintzes, Lisa Bero

Cancer accounts for three in 10 deaths in Australia, yet many cases are preventable or can be detected at an early stage. Maximising cancer prevention and early detection is one of the six strategic objectives of the 10-year Australian Cancer Plan. This perspective article reviews the current progress and challenges of reducing the cancer burden, along with future opportunities. It explores how to address modifiable risk factors, particularly tobacco smoking, alcohol use and sun exposure and the advances in screening programs for bowel, breast, cervical and lung cancers. It highlights the potential for risk-stratified and genomics-informed screening, emphasising the need to support participation through equitable and culturally safe approaches.

Erin L. Symonds, Billie Bonevski, Richard Edwards, Nathan J. Harrison, Sana Ishaque, Nicole M. Rankin, Sibel Saya, Renee J. Smith, Carolyn Ee

The Medical Journal of Australia (MJA)–Lancet Countdown on health and climate change in Oceania was established in 2017 and produced its first regional assessment in 2018 and annual updates from 2019 to 2025. It examines five broad domains: (1) health hazards, exposures and impacts; (2) adaptation, planning and resilience for health; (3) mitigation actions and health co-benefits; (4) economics and finance; and (5) public and political engagement. In this, the eighth report of the MJA–Lancet Countdown, we track an extensive suite of indicators across these five domains, accessing and presenting the latest data and further refining and developing our analyses. Our analyses show that exposure of infants and older adults to heatwaves in Australia and Aotearoa New Zealand has increased substantially over the past decade due to climate change, and half of the 16,230 young Australians aged 14–19 years surveyed reported that they are worried or sad about the impacts of climate change, including its threat to people, and about 1 in 7 reported that such feelings are negatively affecting their daily life. Increasing heat-related mortality alone is placing a large economic burden on Australians, with associated inflation-adjusted costs over the period 2021–2025 being more than double what they were at the start of the century, now averaging an estimated US$1.49 billion per year nationally. In other areas, some progress is being made. New Zealand's Health National Adaptation Plan 2024–2027, published in October 2024, lays the foundation for building climate resilience within its health system, while acknowledging the environmental and social determinants of health that apply more broadly. The provision of climate services to the health sector in both Australia and New Zealand is categorised as advanced. In Australia, healthcare-related greenhouse gas emissions generally declined from 2016 to 2023. In conclusion, the threat to physical and mental health from climate change continues to grow. Despite pockets of progress, Australia and New Zealand have a long way to go to adequately mitigate and adapt to climate change, and in so doing not only avoid health impacts but seize the opportunity for generational health gains. Important opportunities have been lost, such as the failed attempts to amend Australia's Climate Change Act 2022 to ‘require decision-makers to consider the health and well-being of children in Australia when making significant decisions’. In 2026, Australia is in the spotlight as President of Negotiations for the United Nations Climate Change Conference (COP31)—an unprecedented opportunity for the Australian Government to push through the sizable step change in global climate action that is now critically required.

Paul J. Beggs, Tanya Singh, Hilary Bambrick, Nicolas Borchers Arriagada, Kathryn Bowen, Anthony G. Capon, Philomena Colagiuri, Tara Crandon, Troy J. Cross, Lynette Dimer, Donna Green, Ivan C. Hanigan, Maddie Heenan, Thanh Ho, Ollie Jay, Harry R. Kennard, Fiona Langridge, Martina K. Linnenluecke, Zerina Lokmic-Tomkins, Raymond Lovett, Calla MacGregor, Arunima Malik, Rebekkah Markey-Towler, Veronica Matthews, Christopher D. McKay, Celia McMichael, Kerry Nice, Jacqueline Peel, Sachith Seneviratne, Katherine Sievert, James Smallcombe, Mark Stevenson, Stefan Trueck, Sotiris Vardoulakis, Aditya Vyas, Bronwyn Wilkes, Jake T. W. Williams, Alistair J. Woodward, Ying Zhang, Muhammad M. Hasan, Marina B. Romanello

Australia has recognised strengths in MedTech, yet pivotal trials and first approvals (including for Australian-origin devices) often occur offshore. The Therapeutic Goods Administration (TGA) is well-positioned to further support local innovation while maintaining confidence in the medical devices approved for use by shifting effort earlier in development. We outline the current landscape of risk-based regulation across the medical device lifecycle and frame the issues for clinicians during an upcoming period of active discussion and consultation. The existing priority review pathway could be refined for devices under development. Targeted early access approaches must recognise unmet needs and carefully weigh uncertainties around safety and performance. Internationally, regulators increasingly act as collaborators as well as adjudicators of innovation, helped by targeted programs. The TGA aims for an optimised regulatory system that responsibly facilitates access by Australians to MedTech innovation, while aligning timelines with clinical need and sustaining public trust.

Jeffrey J. Brownscombe, Christine E. Gee, David T. Hau, Kyle A. Sheldrick, Mario E. Vittorino, Tracey L. Duffy

We report the case of a 34-year-old male with persistent fever, ascites, thrombocytosis and clinical deterioration despite broad-spectrum therapy who was ultimately diagnosed with peritoneal tuberculosis and concurrent chronic myeloid leukaemia. Initial investigations, including interferon-γ release assay and ascitic acid-fast bacilli, were negative, highlighting the limited sensitivity of traditional testing in extrapulmonary disease. Diagnosis required molecular testing and adenosine deaminase measurement, with delayed confirmation by culture. Bone marrow aspirate and trephine, pursued to broaden the differential diagnosis, revealed a Philadelphia chromosome. This case underscores the need for sustained diagnostic vigilance, multimodal investigation and avoidance of diagnostic parsimony.

Zayn Al-Timimi, Gem Chew, Martin Browne, Christiaan Mostert

A 46-year-old male presented with 2 months of progressive painful visual loss. Examination revealed bilateral panuveitis, widespread ulcerative cutaneous lesions and alopecia. He had a positive treponemal antibody test and a rapid plasma reagin of 1:2048. Findings were consistent with severe secondary syphilis in an otherwise immunocompetent patient.

Fiona Spencer, Michael Taggart

Adoptive cellular therapies (ACT), including tumour-infiltrating lymphocyte (TIL), T-cell receptor-engineered T (TCR-T) cell and chimeric antigen receptor T-cell (CAR-T) therapies, represent an evolving class of immunotherapies with established efficacy in selected haematological malignancies and emerging applications in solid tumours. Additional platforms under investigation include virus-specific T cells, tumour-associated antigen-specific T cells, natural killer (NK) cell therapies and dendritic cell-based therapies. The therapeutic scope of ACT is expanding beyond oncology into autoimmune and fibrotic diseases, infectious diseases and inherited metabolic and immune disorders, highlighting the broad potential of cellular immunotherapy platforms. In solid tumours, efficacy remains limited by tumour antigen heterogeneity, immunosuppressive tumour micro-environment and impaired immune cell trafficking and persistence. These barriers are driving development of next-generation cellular products and combination strategies. Characteristic immune-mediated toxicities, particularly cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), remain important considerations. Although potentially severe, these toxicities are generally manageable with early recognition, multidisciplinary care and prompt specialist intervention. As ACT indications expand in Australia, clinician familiarity with indications, mechanisms of action and toxicity profiles is essential to support informed patient discussions, appropriate patient selection, timely referral and prompt toxicity recognition and management. Non-oncology specialists have an important role in shared care, including patient identification, referral coordination, monitoring for delayed or late toxicities and provision of ongoing survivorship and supportive care. Achieving equitable national access to ACT will require streamlined health technology assessment processes, coordinated reimbursement and delivery funding models and structured referral networks with cross-institutional collaboration to support the specialised infrastructure required for their delivery.

Sarah Childs, David Ma, Anthony Rodrigues, Jennifer Massey, Rasha Cosman, Venessa Chin, Laila Girgis, James Lynam, Peter Lau, Barbara Withers, Anthony M. Joshua, Ben Tran, Jayesh Desai, Simon J. Harrison, John Moore, Jia Liu

Objectives To understand general practice staff and consumers' views of MyMedicare, which is Australia's voluntary patient registration scheme introduced in October 2023 to enhance continuity of care.Study TypeQualitative exploratory research using semi-structured interviews. Analysis was conducted using an inductive approach.Setting, ParticipantsAustralian primary care including general practices, community organisations and the wider Australian community. Data were collected from January 2025 to April 2026. Consumers eligible to register with the MyMedicare scheme and general practice staff (general practitioners, practice nurses, practice managers, reception staff) involved with registering patients under the scheme. Interviews conducted with 45 general practice staff and 50 consumers.Main Outcome MeasuresQualitative expression of general practice staff and consumers' awareness of, and knowledge about, MyMedicare, their perceptions of the value of the scheme and practice staff's experiences of implementing the MyMedicare scheme.ResultsStaff and consumers demonstrated broad support for the concept of voluntary patient registration to enhance continuity of care; however, staff described limited current benefits, substantial implementation burden for practices and administrative processes, which could sometimes distract from clinical work and undermine continuity of care. Consumers had limited understanding of the MyMedicare scheme and why they should register and, in most instances, did not find it was providing them with anything beyond their pre-existing care.ConclusionThe current paucity of benefits from MyMedicare registration for both consumers and practices may have implications for the success of the scheme. Anticipated funding for patient care linked to MyMedicare has encouraged large numbers of practices to register despite the administrative workload, whereas low consumer awareness of the scheme and limited benefits for patients are likely contributing to much lower levels of patient registration. Without further incentives for consumers and practices, the MyMedicare scheme may have limited impact on continuity of care and patient outcomes.

Sanjyot Vagholkar, Ashfaq Chauhan, Gaston Arnolda, Maha Iqbal, Janani Mahadeva, Rebecca Mitchell, Elizabeth Manias, Kate Churruca, Bronwyn Newman, Magdalena Raban, Kirsten Moore, Ramya Walsan, Johanna Westbrook, Jeffrey Braithwaite, Charbel Badr, Lily Edwards, Reema Harrison