Letters

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

To the Editor: Could Handelsman comment on whether he considered opioid-associated hypoandrogenism when describing the increasing prescribing of testosterone?1 Opioid-induced androgen deficiency has become more recognised, and is one of the most common causes of testosterone deficiency among men in many communities.2,3 It may be that the increase in opioid prescribing4 has complemented the promotion of testosterone therapy. Stephen P Fitzgerald General Physician and Endocrinologist

Stephen P Fitzgerald

To the Editor: The recent article by Handelsman describes the pattern of testosterone prescribing in Australia from January 1992 to December 2010.1 The author concludes that the progressive increase in Pharmaceutical Benefits Scheme (PBS)-subsidised testosterone prescribing is likely to be due to promotion-driven prescribing for speculative, non-approved indications.1 The article does not make any reference to the prescribing of testosterone for opioid-induced androgen deficiency. The use of ...

Peter M Herriot

To the Editor: The focus of HIV clinical care has shifted since the advent of potent antiretroviral therapy (ART). This change is characterised by a reduction in HIV-specific morbidities, an increase in HIV non-specific comorbidities,1,2 and an accompanying lack of clinician confidence in managing these comorbidities.3 The measurement of key performance indicators (KPIs) is useful for monitoring and improving clinical performance, but it is yet ...

Mark D Kelly · Jennifer K Broom · Sharon Young

To the Editor: The Australian Defence Force (ADF) ensures outstanding medical care for wounded soldiers by providing skilled field medics, sophisticated evacuation services and excellent in-theatre hospital care. In Afghanistan, in 2011–2012, among 136 troops deployed for 5 months, our ADF medical team dealt with six soldiers who had had significant exposure to blood: two sharps injuries incurred while searching insurgents two sharps injuries to medics providing combat casualty care two ...

Anthony D Holley · Daniel J Weber · Michael C Reade

To the Editor: In their article, Weller and colleagues describe how simulation can be used to reduce the underlying causes of adverse events.1 They point out that the Lucian Leape Institute is urging medical schools to take advantage of simulation to equip students with skills to protect patient safety.2 We are encouraged by this, and wish to share our experience of using simulation to improve ...

Susan A Welch · Julie L Gawthorne · Melinda J Berry

To the Editor: Australian gonorrhoea infection rates are rising.1 Infection spreads through various sexual practices, and extragenital infections are commonly asymptomatic.2 Nucleic acid amplification tests (NAATs) provide rapid, sensitive testing, regardless of the site involved or presence or absence of symptoms.3,4 There have therefore been calls for a change to NAAT-based screening for high-risk groups, including men who have sex with men (MSM).5 Limitations include ...

Miranda Sherley · Karina J Kennedy · Sarah J Martin

To the Editor: We report a case in which the concurrent administration of colchicine and simvastatin led to significant morbidity with myopathy and intestinal dysfunction. An 84-year-old man presented with an acute flare of gout, and was treated with 1 mg of colchicine daily for 3 days, and then 0.5 mg daily. His pain improved over the next 72 hours. He then noticed progressive generalised muscle ache and weakness in ...

Danielle H J Oh · Shuang Quan Chan · Andrew M Wilson

To the Editor: Murray and colleagues make an important call for the transition to more socially accountable medical education, and identify students as partners in this process.1 The Australian Medical Students’ Association (AMSA), the peak representative body for Australia’s 17 000 medical students, recently passed policy at its July council meeting that strongly aligns with this vision for educational and institutional responsiveness to community needs.2 For the past ...

Daniel Yore · Erica L Parker · Catherine G A Pendrey

To the Editor: O’Connor and colleagues have presented conclusions from their research1 that are congruent with my empirical observations. I congratulate them for highlighting the overriding themes, and add a perspective from England. The burgeoning of chronic treatable ocular diseases such as age-related macular degeneration means that hospital capacity is overwhelmed. The peaks in demand seen today surpass the best predictions from a decade ago; pharmacological ...

Jagdeep Singh Gandhi

To the Editor: Adrenaline is often added to local anaesthetic for injection because the vasoconstrictive effect of the catecholamine counteracts the dilative effect of the local anaesthetic, decreasing systemic absorption and prolonging its action.1 Traditionally, the use of this drug combination has been discouraged in structures supplied by end arteries — most notably the digits, but also the nose, ears and penis — on the ...

Christopher J D Barlow

The recent High Court decision that dismissed the tobacco industry’s case against tobacco plain packaging has rightly been hailed as a landmark victory for the federal government and public health against a lethal industry. The Attorney-General (and former Health Minister), Nicola Roxon, deserves the highest praise for her leadership and determination to reduce Australia’s tobacco-related death toll, as do the politicians of ...

Mike M Daube · Simon Chapman

To the Editor: In South Australia, the incidence of developmental dysplasia of the hip (DDH) diagnosed at or after 3 months of age was 0.22 per 1000 live births between 1988 and 2003, corresponding to a rate of 4–5 new cases per year. Since September 2009, 34 children have been treated at our institution for DDH diagnosed at 3–18 months of age, which equates to an incidence of 0.7 per 1000 live births in SA. ...

Nicole Williams · Bruce K Foster · Peter J Cundy