Article Types
Editorials
The need and direction for drug law reform in Australia
Illicit drug use should be viewed primarily as a health and social problem, and be funded accordingly. Half a century of a drug policy relying primarily on drug law enforcement has failed to curb the demand and supply of illicit drugs in Australia. However, adverse consequences of this approach have increased overall, including deaths, disease, crime and corruption. Every year, 400 Australians die from a heroin overdose. ...
Alex D Wodak FRACP, FAChaM, FAFPHM
A life-cycle approach to monitoring benefits and harms of medicines
Collection of high-quality data and management of risk are ongoing needs. Regulatory agencies worldwide are giving greater recognition to postmarketing surveillance, as part of a life-cycle approach to maintaining safety of medicines. This approach involves monitoring the potential benefits and harms of each medicine, and managing risks, throughout development, preregistration testing, registration and postmarket use in the community. The current grounds for initial and continued registration of ...
Emily Banks MB BS(Hons), PhD, FAFPHM · Sallie-Anne Pearson BSc (Hons), PhD
Bringing stillbirth out of the shadows for all women having a baby in Australia
Can Australia rise to the challenge of reducing the rate of avoidable stillbirths? The large, well conducted study by Drysdale and colleagues published in this issue of the Journal shows a 2.4-fold increase in the odds of late-gestation stillbirth for women giving birth in Australia who were born in South Asia, compared with women born in Australia. The relative risk was most pronounced at 41 weeks’ gestation, ...
Vicki J Flenady MMedSc(ClinEpid), PhD · David A Ellwood MA, DPhil, FRANZCOG
Early medical abortion — available and safe
Mifepristone, in conjunction with misoprostol, is extremely effective for medical abortion at any gestation and is now widely used throughout much of the world for this purpose. However, the history of the drug in Australia has been controversial. For 10 years from 1996, it was the object of federal legislation that allowed its use ...
Caroline M de Costa PhD, FRANZCOG, FRCOG · Michael Carrette MB BS, FRANZCOG
Reproductive technologies: the alchemy of life
Assisting in the creation of life is not without its risksWhether it were possible for Nature, or Art to beget a Man out[side] of the body of a Woman, and naturall matrix? To this I answer, that it is in no way repugnant to the Art of Alchymie, and Nature, yea it is very possible . . . — Paracelsus1 There have been few advances that ...
Michael J Davies MPH, PhD · Eric A Haan MB BS, FRACP
Individualising type 2 diabetes management: new treatment options and models of care
Better outcomes require tailored strategiesThe past 15 years has seen the advent of many new classes of antidiabetic agents. We now have biguanides, sulfonylureas, thiazolidinediones, dipeptidyl-peptidase IV inhibitors, glucagon-like peptide 1 receptor agonists, a variety of insulins and a-glucosidase inhibitors. This has resulted in a surfeit of choice, but has also increased the complexity of decision making as there is no simple algorithm for escalation of treatment ...
N Wah Cheung MB BS, FRACP, PhD
A limb lost every 3 hours: can Australia reduce amputations in people with diabetes?
Increased foot problems due to diabetes means a national focus on coordinated foot care is essential. Data from the Australian Institute of Health and Welfare (AIHW) suggest that one Australian loses a lower limb every 3 hours as a direct result of diabetes-related foot disease (DRFD). Further data suggest there has been a 30% increase in diabetes-related amputations in Australia over the past decade, with 8% of ...
Shan M Bergin BAppSci(Pod), PhD · Jan B Alford RN, MEd(AdEd), CDE · Bernard P Allard MB BS, FRACS(Vasc) · Joel M Gurr BSc(Pod), MBA · Emma L Holland RN, CDE, MA(Ed) · Mark W Horsley MB BS, FRACS(Ortho) · Maarten C Kamp FRACP, MHA, GAICD · Peter A Lazzarini BAppSci(Pod) · Vanessa L Nube DipAppSci(Pod), MSc(Med) · Ashim K Sinha MB BS, MD, FRACP · Jason T Warnock DipAppSc(Chir), GradCertDiabEd · Paul R Wraight MB BS, FRACP, PhD
Drug treatment for melanoma: progress, but who pays?
Making cancer drugs affordable requires coherent policy and cannot be left to market forcesMelanoma is 10 times more common in Australia than in most countries,1 and kills more than 1300 Australians every year.2 The good news is that we now have effective drug treatments for metastatic melanoma. Two drugs, ipilimumab3,4 and vemurafenib,5 are now approved by the United States Food and Drug Administration and the Australian Therapeutic ...
Richard F Kefford AM, PhD, FRACP
The role of statin therapy in patients with lower vascular risk
New evidence from an international prospective meta-analysis should be incorporated into clinical and Pharmaceutical Benefits Scheme guidelinesThere is no doubting the fundamental role of statin therapy in patients with established cardiovascular disease. However, its role in primary prevention, particularly among patients with lower absolute cardiovascular risk, has been uncertain.1 In 2010, in a meta-analysis of data from 170 000 individual patients with or without cardiovascular disease, the ...
Anthony C Keech MB BS, MSc, FRACP · Jordan R Fulcher BSc(Med), MB BS · John Simes MD, SM, FRACP
Funding of new cardiac technologies in Australia
A scarcity of funding resources is limiting patient access to major advances in medicine. Health care spending represents a substantial and increasing proportion of national expenditure in most countries. Total annual health care spending in Australia now exceeds $120 billion, or 9.4% of gross domestic product. The highest proportion of health care funding is spent on cardiovascular disease, which accounted for 11% of total expenditure in the ...
David W M Muller MB BS, MD, FRACP
The future of acute rheumatic fever and rheumatic heart disease in Australia
Can we be optimistic?An 8-year-old Aboriginal girl presents with shortness of breath and severe mitral regurgitation, and requires urgent surgery; a young Torres Strait Islander mother has a disabling stroke related to mitral stenosis; and a middle-aged Aboriginal community leader dies from infective endocarditis associated with a mechanical valve. These are the realities of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in Australia. Globally, ...
Graeme P Maguire MB BS, FRACP, PhD · Jonathan R Carapetis MB BS, FRACP, PhD · Warren F Walsh MB BS, FRACP, FACC · Alex D H Brown BMed, MPH, PhD
A dog walking on its hind legs? Implications of the CareTrack study
Despite its limitations, this important study highlights a genuine need for systematised performance monitoring[It] is like a dog’s walking on his hinder legs. It is not done well; but you are surprised to find it done at all. Samuel Johnson1 The results of the CareTrack study, reported by Runciman and colleagues in this issue of the Journal,2 and the accompanying commentary by the study authors3 represent an ...
Ian A Scott MB BS, MHA, FRACP · Christopher B Del Mar MD, MB BChir, FRACGP
Facilitating better end-of-life care
All health professions aim to provide the best care they can for their patient. However, achieving this is easier said than done. In this issue of the Journal, Horey and colleagues document the implementation of a care pathway aimed at facilitating care at the end of life (EOL) in 14 residential aged care facilities (RACFs) ...
Geoffrey K Mitchell FRACGP, PhD
The legitimacy of academic complementary medicine
Standing up for common senseScience sets out to rigorously eliminate bias, not to assert it. The arguments mounted for the closure of complementary medicine courses in Australian universities by the Friends of Science in Medicine in a recent editorial in the Journal1 are highly emotive and, while having a gloss of superficial reasonableness, they do not stand up to critical review. In a letter sent ...
Stephen P Myers BMed, ND, PhD · Charlie C Xue BMed, PhD · Marc M Cohen BMedSc(Hons), MB BS(Hons), PhD · Kerryn L Phelps MB BS, FRACGP · George T Lewith MD, FRCP, MRCGP
The spirit of the tent embassy: 40 years on
Indigenous self-determination is essential to health and wellbeingFor me, the Aboriginal tent embassy is something that has always been there in my consciousness as something I gain strength from, and a reminder of how far we’ve come (and how far we have to go) in building a better future for Aboriginal and Torres Strait Islander peoples. Now at its 40th anniversary, the tent embassy continues to ...
Peter O’Mara FRACGP, FARGP, GradDipRuralGenPrac
Indigenous health: New Zealand experience
What can the Treaty of Waitangi teach Australia about reducing disparities in health? The health status of indigenous populations in Australia and New Zealand gives justified cause for concern. After European colonisation, their survival was threatened by a range of infectious diseases to which they had little or no immunity. Though no longer the threat posed in the 19th century, the incidence of infectious diseases remains ...
Mason H Durie CNZM, MB ChB, DPsych, DLitt
Gentamicin and ototoxicity: why this drug is still in use
The fine line between therapeutic benefit and toxicity. In this issue of the Journal, Ahmed and colleagues1 focus our attention on the very real problem of gentamicin-induced ototoxicity, and especially on the frequently unrecognised problem of severe vestibulotoxicity. Their retrospective analysis of gentamicin-treated patients presenting to a balance disorders clinic found delayed clinical detection of vestibulotoxicity and an apparent lack of a relationship between toxicity and ...
John D Turnidge FRACP, FRCPA, FASM · John A Waterston MB BS, MD, FRACP
Are trans fats a problem in Australia?
What is in our food should be on the labelTrans fatty acids (TFAs) are produced by the food industry during partial hydrogenation of edible vegetable oils, such as soybean oil, canola oil and cottonseed oil. This industrial process leads to oils that are more solid at room temperature and have better physical properties for food processing, including increased shelf life. Low levels of TFAs are ...
Gunveen Kaur PhD · David Cameron-Smith PhD · Andrew J Sinclair PhD
Disciplinary notations on the Australian Register of Medical Practitioners
Clear guidance is needed on what information should be publicly available, and for how long. One of the fundamental realignments that has occurred to the doctor–patient relationship is the capacity of patients to acquire information from the internet and, on the basis of it, interact with their practitioners in new and different ways. Some of the ...
Ian R Freckelton BA(Hons), LLB, PhD
Is the end of chronic hepatitis C virus infection in sight?
Direct antiviral agents may hold the key to eradication, but only if they reach those who will benefitIn this issue of the Journal, Dore outlines the astonishing recent progress in the treatment of hepatitis C virus (HCV) infection,1 largely triggered by the approval in 2011 by regulatory bodies, both overseas and in Australia, of the first ...
Geoffrey W McCaughan MB BS, PhD, FRACP
Internet pornography and adolescent health
Early findings on effects of online pornography on adolescents show associations with risky behaviour. There has been an explosion in the use of the internet in the past decade, particularly among young people. In 2009, 96% of 12–14-year-olds in Australia went online, with 60% doing so via a mobile device. The massive volume of sexually explicit ...
Rebecca J Guy BSc, MAppEpid, PhD · George C Patton MB BS, MD, FRANZCP · John M Kaldor BA, MA, PhD
Does football cause brain damage?
Available evidence suggests anecdotal media reports need to be assessed carefullyThe critical issues in the clinical management of sports concussion include confirming the diagnosis, excluding structural abnormality and determining when players can be safely returned to competition. Despite the apparent simplicity of this process, the management of this one injury seems to provoke more debate ...
Andrew H Kaye MB BS, MD, FRACS · Paul McCrory PhD, FRACP, FACSP
Evolving psychiatric diagnosis and the DSM: hasten slowly
As the publication date draws closer, concerns grow over the proposed format of the DSM-5The American Psychiatric Association is currently undertaking a major revision of the Diagnostic and statistical manual of mental disorders, and the 5th edition (DSM-5) is due to be published in May 2013. The process of the revision of this publication has ...
Paul B Fitzgerald MB BS, PhD, FRANZCP
The urgency of saving lives through bowel cancer screening
While the government’s implementation of the National Bowel Cancer Screening Program remains stalled, Australians are dying unnecessarilyOne in 12 Australians will develop colorectal cancer (CRC), and it is the second most common cause of cancer death. It is one of only three cancers for which organised population screening is recommended, and it is the first to ...
Ian N Olver MD, PhD, FRACP · Graeme P Young MD, FRACP, AGAF
Survival from pancreatic cancer: it’s not just about the surgical mortality
Has the time come to form specialised centres for complex surgical procedures?The article by Speer and colleagues in this issue of the Journal reporting outcomes in patients undergoing pancreatectomy for pancreatic cancer in Victoria in 2002–2003 indicates the poor outcome for this condition on a population basis.1 Consistent with international series are the observations that only ...
Robert T A Padbury MB BS, FRACS, PhD
