Letters

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

To the Editor: In describing 8 years of experience in managing adolescent gender identity disorder (GID) at a paediatric hospital clinic, Hewitt and colleagues highlight a small group of patients who require momentous life-long clinical decisions made in a timely manner.1 However, the rarity of this condition means that experience in any centre is limited. The authors state that authorisation from the Family Court of Australia is ...

Ann J Conway · Julie C Hamblin · David J Handelsman

To the Editor: I welcome the article by Hewitt and colleagues,1 but their protocol is problematic. Suppression of puberty improves mental health and general functioning, but not body image and dysphoria.2 For this, cross-sex hormones and/or surgery are the only effective treatments.2 Withholding cross-sex hormones until children are 16 years of age may worsen their mental health,3 cause resentment, and encourage self-medication. Increasingly, young transsexual people are ...

Zoë Hyde

In reply: We thank Hyde and Conway and colleagues for their correspondence following our report on treatment for young people with gender identity disorder (GID).1 We follow current international consensus recommendations for management,2,3 but accept that as more research is performed, there may be future adjustments to endorsed protocols. At present, patients can apply to the Family Court of Australia for authorisation of treatment that ...

Jacqueline K Hewitt · Campbell Paul · Louise K Newman

In Cape York Indigenous communities, alcohol restrictions started in 2002–2003, with local prohibition in some communities since 2008. These restrictions may have halved alcohol-related injuries, a historically important change. However, residents of Cape York Indigenous communities suggest that there has been an accompanying rise in cannabis use over this period. During consultations in 2011 for Minister Macklin’s controversial Stronger Futures in ...

Cape York Cannabis Project Team

To the Editor: The Victorian Doctors Health Program (VDHP) was established in 2001. It is the only full-time doctors’ health program in Australia. Based on similar programs in North America and Europe, the VDHP provides a comprehensive, supportive service to medical students and doctors suffering from mental health and/or substance use issues. The lifetime prevalence of substance use disorders in Australian doctors has been estimated at ...

Cheryl Wile · Kym Jenkins

Cunningham’s perspective provides a timely review of the literature relating to the maternal psychological outcomes of holding stillborn babies, which remains controversial. It is unfortunate that some popular media sources reported it incorrectly as saying that seeing and holding stillborn babies may cause harm. The correct conclusion is that the literature is inconclusive. The Australian and New Zealand Stillbirth Alliance strongly supports Cunningham’s ...

Vicki J Flenady · Christine Carroll · Ros M Richardson

To the Editor: We read with interest McNamara’s pieces on the length of Australian medical training. The current training system is more a crude result of historical evolution than the outcome of a strong evidence base. The extra time taken by Australian doctors to become competent at a procedure is likely mirrored in other areas of medical knowledge and skill because of both internal (doctor) ...

Dev A S Kevat · James M Hillis

To the Editor: We read with interest the letter by Playford and colleagues, but important questions remain about the authors’ methods and conclusions.1 First, not only do the data periods for assessing hand hygiene (HH) compliance and for rates of health care-associated Staphylococcus aureus bacteraemia (HCA-SAB) not overlap, but the data period for HCA-SAB rates precedes the HH compliance data period. Second, the study design ...

M Lindsay Grayson · Philip L Russo

In reply: We thank Grayson and Russo for their interest and comments. Clearly our intent was to stimulate much-needed debate about the presentation and interpretation of publicly disclosed infection control data. Given that no study has shown a reduction in the rate of methicillin-susceptible Staphylococcus aureus bacteraemia (SAB) through increased compliance with hand hygiene (HH), we again question why the MyHospitals interpretive comments for these data ...

Elliott G Playford · David McDougall · Mary-Louise McLaws

To the Editor: The frequency and intensity of floods and other weather-related disasters is likely to increase with climate change. These disasters may affect both the physical and mental health of people who are directly affected. The extensive rainfall and subsequent flooding experienced throughout Queensland in December 2010 and January 2011 had significant impacts on large sections of the population. To assess the health impacts of the ...

Lyle R Turner · Katarzyna Alderman · Shilu Tong

To the Editor: The incidence of type 1 diabetes (T1D) in children is rising globally, including in Australia.1 Diabetic ketoacidosis (DKA) is the leading cause of diabetes-related deaths in children.2 Clinical manifestations of DKA include dehydration; rapid, deep, sighing (Kussmaul respiration); nausea; vomiting; abdominal pain and a reduced level of consciousness.2 There is an inverse relationship between the frequency of presentation with DKA and background incidence ...

Femke M A P Claessen · Kim Donaghue · Maria Craig