Letters

To the Editor: We agree with Selvey and Carey1 that minimising the environmental impact of the food supply chain is vital. However, we disagree with recommendations that target some food categories. Variation in environmental footprint within a food category can be more important than the variation between categories.2 Research on environmental modelling systems needs to address complex trade-offs between factors such as carbon emissions, water, land ...

Manny Noakes · Bradley G Ridoutt · Gilly Hendrie · Brian A Keating

To the Editor: We agree that nutritious food choices should also be sustainable, but Selvey and Carey’s portrayal of seafood production1 is incorrect. The 2012 assessment of Australia’s fisheries found that only two of the 111 fish stocks classified (1.8%) were overfished, rather than the 40% claimed by Selvey and Carey, and one of these (bluefin tuna) is rebuilding rapidly.2 Assuming 15 million Australians eat two 100 g portions of seafood every week, our annual seafood requirements are 156 000 tonnes from the 241 100 tonnes of current sustainable fishing and aquaculture production. Globally, current fishing pressure is sustainable in 70% of world fish stocks.3 Demonising seafood based on discredited science claiming the world will run out of fish by 20484 does not help in making nutritious food choices. All food production has an environmental impact. We and others have applied the life-cycle analysis methods advocated by Selvey and Carey to several seafood industries. The amount of carbon dioxide produced by fisheries is lower than that from chicken, pork or beef production.5 Wild fisheries use little water and no fertilisers, pesticides or antibiotics,5,6 which makes seafood a healthy and sustainable choice for people and the environment.

Bridget S Green · Anna K Farmery · Colin D Buxton

To the Editor: We agree that nutritious food choices should also be sustainable, but Selvey and Carey’s portrayal of seafood production1 is incorrect. The 2012 assessment of Australia’s fisheries found that only two of the 111 fish stocks classified (1.8%) were overfished, rather than the 40% claimed by Selvey and Carey, and one of these (bluefin tuna) is rebuilding rapidly.2 Assuming 15 million Australians eat two 100 g portions ...

Caleb Gardner

To the Editor: Selvey and Carey infer that the consumption of imported seafood by Australian consumers is evidence that Australian seafood production is unsustainable.1 However, trade in canned and frozen seafood is extensive because these products are stable and because of the comparative advantage of production between countries. The same process results in Australia’s reliance on imported electronics, clothes and cars — it does not ...

Alexandra McManus

To the Editor: The two contributions by Gray and colleagues1 and Loblay and colleagues2 on the topic of salicylate intolerance illustrate that absence of evidence does not equate to evidence of absence.3 Neither paper quotes the admittedly sparse European peer-reviewed literature on the topic, including an understanding of the basic biochemistry,4,5 a diagnostic test, and clinical prevalence studies of intolerance to dietary salicylate.5-7 A wealth ...

Richard F Heller · C Ann Heller · Jane Heller

To the Editor: I am concerned that the recent articles on salicylate diets in the Journal1,2 may be seen as a current position statement on the usefulness of a low-chemical elimination diet. An elderly psychiatrist colleague said in 1976, “In 20 years time many parents will not be giving their children red cordial but scientists will still be discussing the issue!” The discussion continues, not because ...

Joan C Breakey

In reply: We are pleased that our publication has generated discussion regarding the benefits of low salicylate diets. However, the correspondence and references from Heller and colleagues and Breakey do not provide any further evidence for the use of such diets and simply reaffirm the lack of good-quality data in this area. Until such data are available, the use of salicylate elimination diets remains an ...

Paul E A Gray*

To the Editor: Despite concerns about suspected reductions in general practitioner visits for Australian children,1,2 there has been a lack of research to investigate trends in GP visits over the past decade. We explored trends in GP visits using linked data between the Medicare Benefits Schedule (MBS) database and the consecutive biannual survey (2004–2010) of two cohorts — the infant cohort (aged 0–1 years in 2004) and ...

Lixin Ou · Jack Chen · Kenneth Hillman

Serotype 15A’s abrupt appearance in the Victorian population, along with its high-level antimicrobial resistance and increased mortality rate show the importance of continued enhanced surveillance of invasive pneumococcal disease.

Janet E Strachan · Stacey L Rowe · Eileen M Dunne · Geoffrey G Hogg

To the Editor: The National Human Papillomavirus Vaccination (HPV) Program Register was established in June 2008 as Australia’s first national adult vaccination register.1 School-based HPV vaccination is now in its 7th year, and from February 2013 includes boys. States and territories report information about HPV vaccination at schools to the Register. This information is used to prepare coverage reports for program management, to provide completion statements to ...

Julia M L Brotherton · Michael Batchelor · Karen Winch

New South Wales prisons data add to previous findings which show that Indigenous and non-Indigenous Australians achieve similar hepatitis C treatment outcomes.

Jeffrey J Post · Andrew R Lloyd · Denise Monkley

To the Editor: Leptospirosis in Victoria can be acquired locally or overseas. The clinical manifestations range from asymptomatic disease to multiorgan failure. We performed a retrospective case review of 147 notifications of leptospirosis to the Victorian Department of Health during the period 2002–2012. We aimed to investigate the epidemiology, clinical features and outcomes of leptospirosis in this population and identify any differences between patients who acquired ...

Jason A Trubiano · Brett A Sutton · Lucinda J Franklin

Tension between the need for an integrated national health system and the self-interest of states has led to negative consequences, including discrimination against junior doctors.

Dev A S Kevat · Fiona J Lander

To the Editor: Clinical practice is constantly evolving, and while doctors are accomplished in recognising the need for continual personal development and improvement, they traditionally have been difficult to engage in health care system redesign.1,2 Quality improvement (QI) initiatives are often met with disengagement, owing to a perception that they provide little clinical benefit and that resources could be better spent elsewhere.1 While QI initiatives certainly ...

Nicholas M Cheng · Ned W R Douglas

It is very unlikely that there is any substance to the suggestion that calcium supplementation increases the risk of cardiovascular disease.

B E Christopher Nordin

Vitamin D3 in oral supplements is derived from animal sources, so it is important to address this when recommending vitamin D supplementation to a person who adheres to a vegetarian diet.

Bettina Douglas

In reply: People requiring a purely vegetarian source of vitamin D should use vitamin D2 (ergocalciferol), which is produced by ultraviolet irradiation of the plant sterol ergosterol, and not vitamin D3 (cholecalciferol), which is derived from animal sources. As cholecalciferol is derived from sheep’s wool, which does not involve the sheep being killed, several cholecalciferol supplements are certified as halal. Some capsules contain gelatine (an animal ...

Caryl A Nowson · Rebecca S Mason

By comparing administrative data for the 2010–11 and 2011–12 financial years, a 318% increase in “ice”-related ambulance attendances was found to underpin a substantial rise in amphetamine-related attendances.

Cherie Heilbronn · Caroline X Gao · Belinda Lloyd · Karen Smith · David Best · Dan I Lubman

To the Editor: Potentially avoidable hospital admissions are a key concern for every health care system. Admissions for ambulatory care-sensitive conditions (ACSCs) have been used as a proxy measure of potentially avoidable admissions in research and in policy and program development since the early 1990s. Older patients with chronic conditions are the greatest contributors to ACSC admissions, and hospital admissions for ACSCs are particularly burdensome ...

Jo M Longman · Megan E Passey · Dan P Ewald

To the Editor: As reported by patients and staff at the Sydney Adventist Hospital (SAH),1 we too at Epworth HealthCare in Melbourne have found overwhelming acceptance of medical student participation in the care of our patients. As Victoria’s largest not-for-profit health care group, we have been training medical undergraduate students from both Monash University and the University of Melbourne for the last 7 years at our ...

Geoffrey L Metz · John C Catford · Alan Kinkade