Letters

In their recent article on false-positive screening mammograms and their effect on rescreening rates within the BreastScreen WA program, Sim and colleagues posit that an absolute reduction in future rescreening of 3 percentage points can be seen among women who are recalled for assessment but do not have breast cancer. The analysis presented did not adjust for other factors known to influence rescreening ...

Nathan A M Dunn

To the Editor: The recent editorial by Kefford1 fails to mention that (i) the 5-year survival for malignant melanoma is excellent at 89% for males and 91% for females; (ii) treatment with the new melanoma drug ipilimumab for the 1279 people who died from melanoma in 2007 would cost the Australian Government $156 million based on the quoted drug cost of $120 000 for a course of four injections; and ...

Graeme W Morgan

To the Editor: Kefford’s contention that making cancer drugs affordable requires coherent policy and cannot be left to market forces1 is correct. Two new drugs, ipilimumab and vemurafenib, are now approved by the United States Food and Drug Administration and the Australian Therapeutic Goods Administration for use in metastatic melanoma. However, their efficacy in a minority of patients is low. The cost of this palliative treatment ...

Sonia Fullerton

In reply: The letters of Morgan and Fullerton correctly emphasise the importance of palliative care in the management of patients with metastatic melanoma. They also draw attention to the immense cost of new drugs for melanoma, and their limited efficacy in life extension — something I also emphasised.1 Much ignored in this debate is the rapid and dramatic improvement in quality of life experienced by ...

Richard F Kefford

To the Editor: Methylnaltrexone is a peripheral opioid antagonist registered for the treatment of opioid-induced constipation (OIC) on the basis of quality Phase III studies.1 Monitoring uptake of a new medication such as methylnaltrexone after it has been listed on the Pharmaceutical Benefits Scheme (PBS) is crucial to understanding how such medications can be best used in routine clinical practice. Compared with the whole population, higher ...

Debra S Rowett · Katherine Clark · Maxine K Robinson · David C Currow

To the Editor: In September 2012, the Australian Institute of Health and Welfare (AIHW) released its report on cancer survival and prevalence in Australia from 1982 to 2010, incorporating incidence and mortality estimates for all malignancies reported to Australian cancer registries.1 Cancer is a leading cause of morbidity and mortality in Australia, accounting for about 20% of the total disease burden and 30% of deaths.2 Liver cancer ...

Jennifer H MacLachlan · Benjamin C Cowie

To the Editor: On 5 June 2012, the forum “Eliminating childhood lead toxicity in Australia — a little is still too much” was held at Macquarie University to examine new evidence on the toxicity of lead and its implications for Australian children and communities. Presently, the National Health and Medical Research Council (NHMRC) recommends an increasingly obsolete intervention level that was established in 1993: blood lead levels ...

Mark P Taylor · Chris Winder · Bruce P Lanphear

We support the recommendation of Runciman and colleagues for national agreement on clinical standards of health care, and highlight the importance of including routine health promotion activities as a core part of quality care in clinical practice. The indicators used by Runciman et al fail to consider core aspects of preventive care, such as screening and evidence-based behavioural interventions for lifestyle risk ...

Annemarie Wright · Bruce Bolam

Tests for serum vitamin B12 and red cell folate levels are commonly requested in elderly inpatients to rule out reversible causes of cognitive impairment (eg, delirium). This imposes some cost on the community. The evidence for the association of cognitive impairment and vitamin B12 deficiency is inconclusive. It is also unclear whether other markers, such as elevated mean corpuscular volume (MCV) and ...

Celia S M Ting · John C Oldroyd · Michele R Levinson

The implication by Wilson and colleagues that selection processes might at any stage be designed “to identify students ... who are likely to develop physical or mental illness ... that will impair their ability to practise in an empathic and professional manner” raises significant ethical and legal issues. The solution suggested by Wilson et al with reference to “fitness to practise” processes in place in medical schools suggests a link ...

Patrick D Mahar

To the Editor: Most of us in the medical profession would have had encounters with colour blind doctors at some stage, perhaps unknowingly. Colour blindness, more formally known as congenital colour vision deficiency (CVD), affects 8% of males and 0.4% of females.1 For those of us who perceive the world in a different spectrum, tasks involving colour in the workplace may provoke anxiety.2 One could argue ...

Navin I Dadlani

To the Editor: The closet is a common lesbian response to prejudice, discrimination and stigma. Many rural lesbians choose to “pass” as heterosexual and keep their sexuality secret.1,2 Research shows that this secrecy is fuelled by the fear of violence, including harassment, ostracism and rejection,2 and it is unlikely that a lesbian will disclose her sexuality to a doctor unless she feels safe. Without full ...

Cathy Wheel

To the Editor: The latest guidelines for the management of absolute cardiovascular disease (CVD) risk released by the National Vascular Disease Prevention Alliance1 question the utility of conventional risk assessment methods to accurately estimate cardiovascular risk of individuals with depression. Subsequently, these guidelines advocate that individuals assessed for CVD risk be assessed for depression and other psychosocial factors. This appears to be a promising advance, ...

Adrienne E O’Neil

To the Editor: Hyperhidrosis is uncontrollable, excessive sweating. Severe primary focal palmar hyperhidrosis is a significant disability. It interferes with many activities of daily living and induces social avoidance behaviours that can lead to symptoms of social anxiety disorder. Symptoms begin in childhood or around puberty and affect both sexes equally.1 There are a number of treatments for palmar hyperhidrosis, which have varying degrees of success. ...

Ingrid C Chung · Bruce C L McGeorge

To the Editor: Alkali drain cleaner has previously been reported to cause oral, oesophageal and cutaneous burns.-4 The risk of these cleaners causing full thickness cutaneous burns in children needs to be emphasised. Two toddlers recently presented to our hospital with severe burns after exposure to alkali drain cleaning products. An 18-month-old boy opened the box and bit open the silver foil packet of a foaming ...

Rachel A D’Cruz · Erik R La Hei · Andrew J A Holland

To the Editor: In deference to Grattan-Smith,1 defendant doctors are clearly advantaged and plaintiff patients disadvantaged by the High Court’s decision in Tabet v Gett,2 because a patient must now prove on the balance of probability (> 50%), not possibility (< 50%) as before, that negligence by the doctor caused harm. Nonetheless, like us, Grattan-Smith empathises with the harmed plaintiff who receives no compensation and bears all litigation ...

Neera Bhatia · James Tibballs

To the Editor: In June 2007 we highlighted the inconsistent application of community-accepted harm minimisation strategies, when offered to prisoners, among the various Australian jurisdictions.1 We sought information from the eight prisoner health services to assess how harm minimisation strategies were being implemented in each jurisdiction (Box). Progress has been slow, particularly in Queensland and the Northern Territory. The positive progress, however, has been the trial of condom ...

Michael H Levy · Carla Treloar

To the Editor: Kowal’s article resonates with our experience.1 However, the National Health and Medical Research Council has supported genetic testing in Indigenous Australians for longer than she cites. Through a 1995–1997 project grant, a 1998 PhD scholarship,2,3 a 2006 program grant and an Australia Research Fellowship (2008–), the NHMRC has supported work on kidney and related chronic diseases, in protocols endorsed by two remote communities and approved ...

Wendy E Hoy

To the Editor: We read with interest the article by Kowal about genetic research in Indigenous health.1 As stated, this topic is extremely sensitive, but it is one that we must now tackle. The article raises a related issue that has not received any attention: the provision of genetic health services to Aboriginal and Torres Strait Islander people. We should not presume that Aboriginal and Torres ...

Gail Garvey · Christina M Bernardes

In reply: I thank Hoy, and Garvey and Bernardes, for their responses. Hoy highlights the difficulties her group has experienced in conducting genetic research in an Aboriginal community over two decades. Indeed, this was the project I referred to as losing its ethics approval as a direct result of the Human Genome Diversity Project. She attributes the difficulties she has faced to conflicting views between ...

Emma E Kowal

To the Editor: In response to Duckett’s question, “is now the time to send a signal that poor-quality care should not be rewarded in activity-based funding?”,1 Queensland Health answers with a resounding “yes”. In addition to activity-based funding (ABF), Queensland Health applies a purchasing framework model with the aim of improving health care safety and quality, leading to better-quality outcomes for the same or lower cost. ...

Kirstine M Sketcher-Baker · John G Wakefield · Jane V Partridge

To the Editor: I welcome Nowak’s article on using stories to drive change in medical practice.1 It highlighted what I feel to be the main failure of evidence-based medicine. Although evidence-based medicine may be a great way to discern differences in the success of various treatment modalities, it may not be the best way of teaching them. In my experience, it sucks the vibrancy and immediacy ...

Peter J McLaren

To the Editor: The recent editorial by Kappagoda poses a much neglected question for the medical profession.1 There is a longstanding unmet need to consider undergraduate and postgraduate training and education in medicine generally as a continuum, with streaming as a natural corollary.2 Of the two papers that reported on the changes to the medical curriculum at the University of Sydney since the introduction of the ...

Thomas K F Taylor

To the Editor: We agree with Taylor and others that Australian medical training is too long.1,2 In 2008, Garling provocatively stated “I know of no other university-based performance qualification that requires such lengthy education and training. The only training period remotely approaching this length of time is that to become a Jesuit priest”.3 One year of medical training could be eliminated by reducing clinical and preclinical training ...

Kerry J Goulston · Kim Oates

To the Editor: A recent editorial in the Journal1 is another in a long line of articles arguing that national linkage of routine care-delivery data will enable us to improve the health care provided to Australian patients.2 However, over the past three decades, progress on national data linkage has been painfully slow. Anyone who has ventured down the path of obtaining national linked data can ...

Michael D Coory