Letters

To the Editor: I agree with Baum on the objective evidence of the good health of Australians and that there still is room for improvement in our primary health care system, but I think it is simplistic of her to characterise “fee-for-service general practice” as providing “episodic care”.1 The Royal Australian College of General Practitioners description of “person centred, continuing, comprehensive and coordinated wholeperson health ...

Mark R Nelson

In reply: Australian general practice generally provides good primary medical care. However, while Nelson says a significant amount of activity is disease prevention, the Bettering the Evaluation and Care of Health study indicates that, in terms of problems at general practitioner–patient encounters, prevention constitutes less than 9.1% of activity and, in terms of reasons for encounters, it constitutes less than 15.9%.1 The general practice model works ...

Fran E Baum

To the Editor: Zimmet draws attention to the looming catastrophe of diabetes.1 However, there is a concomitant health catastrophe — climate change, “the biggest global health threat of the 21st century”.2 We believe that it is not useful to argue whether diabetes or climate change is a greater threat to health. Rather, diabetes and climate change are predictable manifestations of contemporary human ecosystems: The conjoined processes of ...

Rosalie Schultz · Peter Tait

To provide quality health services, we need to collect meaningful data and invest in embedded research and development

Julie A Halton

To the Editor: I would like to commend Penington for his insightful opinion piece regarding the challenges facing the Australian health system over the next decade.1 I, and I am sure many others, share his warranted concern regarding the future of quality and safety in health care in a politically charged, target-based funding system. As highlighted by Penington, the recently published McKeon report provides a suggested ...

Justin M Nazareth

To the Editor: The response of Sievert and colleagues for the Gastroenterological Society of Australia1 to an article on iron deficiency anaemia in a young woman2 missed the point. In the absence of menorrhagia, dietary deficiency of iron is extraordinarily rare unless the individual is a vegan. The young woman presented with a haemoglobin level of 61 g/L and was treated with iron supplements over a ...

Terry D Bolin

To the Editor: The Gastroenterological Society of Australia (GESA) response1 to the anonymous father’s heartfelt account of the suffering and ultimate death of his daughter, misdiagnosed on a number of occasions by general practitioners and medical specialists, was, in my view, inadequate. The young woman certainly warranted a colonoscopy, if not at presentation then certainly after 6 months of unsuccessful iron replacement therapy. Sievert and colleagues should ...

Randolph S Williams

In reply: We appreciate the interest of Bolin and Williams regarding our article.1 We agree that further investigation of iron deficiency anaemia was indicated in this patient, as her clinical presentation of severe, unexplained anaemia is clearly articulated in the Gastroenterological Society of Australia recommendations as requiring such diagnostic investigation, as stated in our article. Colonoscopy would have been the most appropriate investigation. Williams states ...

William Sievert · Barbara A Leggett · Finlay A Macrae

A screening checklist has proved successful in Queensland

Jennifer K Broom · Mark D Kelly · Alex F Broom

To the Editor: The article by Segard and Macdonald is interesting but has significant methodological weaknesses and reports data that do not support all of their conclusions.1 Methodologically, retrospective dataset reviews with little demographic or morbidity data to avoid confounding (it is unclear why these were not available) are problematic. Additionally, death certificates were used as a surrogate for improved outcomes from additional diagnosis. Segard and Macdonald ...

David Mountain

In reply: We thank Mountain for his comments. As he points out, it is only possible to infer cause and effect from observational data. The fact that referrals for D-dimer levels and computed tomography pulmonary angiography increased during the same period does not prove that one “drove” the other, although we believe this is a reasonable inference. Importantly, D-dimer testing was introduced as a “rule-out” ...

William B G Macdonald · Tatiana Segard

Hi-tech selfies may save lives

Monika Janda · H Peter Soyer

Children at clandestine drug laboratories are at risk of physical injury as well as exposure to methamphetamine and toxic chemicals

Sharon L Hawkrigg · Peter M Winterton

What is the ideal smoking reduction strategy and who should be targeted

Simon Chapman

In reply: We thank Chapman for his comments and note that our article1 offers support for his proposal for a smartcard smokers licence for retail tobacco sales.2 Recent data from the Australian Health Survey indicate that nearly 6% of 15–17-year-olds are current smokers, and over 4% smoke daily.3 This figure is likely an underestimate.3 Given these statistics, tobacco control policy must continue to embrace adolescents. ...

Roger S Magnusson · David C Currow

The safety and benefits of homebirth remain contentious

Susan Ieraci · Amy B Tuteur

To the Editor: The recent article by Catling-Paull and colleagues1 documents the apparently very low perinatal mortality associated with state-funded homebirth, mostly among women in Western Australia. However, the 2007 triennial report of the WA Government Perinatal and Infant Mortality Committee (PIMC) stated that, for homebirth: The term perinatal mortality rate was 6.7 per 1000 total births, compared with a term perinatal mortality rate of 2.1 per 1000 total births in the ...

Donald M Clark