Letters

In reply: The response of Chapman to my article is not surprising, given his involvement in the Alpert article.1 The recommendations of Alpert and colleagues have already been criticised internationally, and debate on the effectiveness of pharmacological smoking cessation therapies is not new. Meta-analyses have shown 50% to 70% greater quit rates for nicotine replacement therapy (NRT) compared with placebo or in controls.2,3 Advocates of ...

Johnson George

To the Editor: National disclosure of health care-associated infections has recently been facilitated by the launch of the MyHospitals website by the Australian Institute of Health and Welfare (http://www.myhospitals. gov.au). As high rates of Staphylococcus aureus bacteraemia (SAB) have been reported at our tertiary health care facility,1 we wish to outline the pitfalls and potential misrepresentation of generic health care infection surveillance data when used ...

Leon J Worth · Karin A Thursky · Monica A Slavin

To the Editor: Rates of health care-associated Staphylococcus aureus bacteraemia (HCA-SAB) and hand hygiene (HH) compliance are now subject to public disclosure on the MyHospitals website (http://www.myhospitals.gov.au). HH compliance and HH alcohol hand rub and liquid soap procurement have been associated with reduced methicillin-resistant (but not methicillin-sensitive) S. aureus bacteraemias, generally in the presence of other co-interventions.1,2 However, the National Hand Hygiene Initiative advocates that ...

E Geoffrey Playford · David McDougall · Mary-Louise McLaws

To the Editor: Speer and colleagues’ recent article concerning pancreatic cancer outcomes makes sobering reading.1 Notwithstanding the results of surgery being in line with other case series, they found a somewhat high rate (nearly 40%) of positive resection margins in patients undergoing surgery with curative intent. The authors also cite evidence from other studies indicating benefit from a small number of surgeons each performing a ...

Andrew A Thomson

To the Editor: A 24-year-old Sudanese woman presented to her general practitioner in 2011 with one month of fatigue, dizziness, abdominal distension and facial oedema. Hypocortisolaemia was present: morning cortisol, 13 nmol/L (reference interval [RI], 240–620 nmol/L), afternoon cortisol, 9 nmol/L (RI, 100–280 nmol/L). In contrast to this profile, she appeared cushingoid (moon facies, central obesity, skin fragility and striae) with skin depigmentation on her face, back and hands (Box, A). ...

Rebecca F Goldstein · Helena J Teede · Carolyn A Allan

To the Editor: Coiera and colleagues’ call for national e-health clinical safety governance1 is timely, given that the proposed rules and regulations for the personally controlled electronic health record (PCEHR) from the Department of Health and Ageing2 neglect this crucial component. The Royal Australasian College of Surgeons (RACS) has called on the Australian Government to provide better clinical governance arrangements for the PCEHR. In a letter ...

Julian A Smith

To the Editor: Although both sides of the debate about screening mammography1,2 acknowledge the mortality benefit due to screening and the risk of overdiagnosis, the magnitude and relative value of these need further clarification and reflection. In calculating the number of breast cancer deaths averted using a relative risk reduction of 35%, Roder and Olver overstate the benefit. Other estimates of effect are lower (eg, ...

Alexandra L Barratt · Paul P Glasziou

To the Editor: Recent studies have highlighted the safety of administering influenza vaccine derived from embryonated chicken eggs to egg-allergic individuals,1-3 as long as the vaccine contains no more than 1 g of egg ovalbumin per dose. This is reflected in recommendations by expert advisory groups including the Australasian Society of Clinical Immunology and Allergy.4 These recommendations have been strengthened by further evidence of the safety ...

Raymond J Mullins · Michael S Gold

To the Editor: Complementary medicines may lack evidence of safety and efficacy, but conventional medicine lacks evidence of efficacy in 30%–40% of cases,1 and the breast implant and hip replacement debates demonstrate safety concerns. The debates about conventional versus complementary medicine expose how out of touch the medical profession is with the views of government and the people about complementary medicine. The medical profession was ...

Simon J Spedding

To the Editor: The article by Wilson and colleagues concludes with the words: “... to ensure that only those applicants most likely to succeed are selected for medical training”.1 What does the word “succeed” really mean? Success is not only measured by the award of the MB BS (or MD). Academic brilliance and commitment to lifelong learning are not sufficient either. Compassion, kindness, respect for ...

Jeffrey V Rosenfeld

To the Editor: Wilson and colleagues thoughtfully summarise medical school selection procedures, highlighting the need for greater social accountability.1 We would strengthen the aim of choosing applicants with “the characteristics required to be competent medical practitioners”1 by arguing they should also be responsive to community needs. What are the “outcomes” of interest in selecting medical students? Methodological problems abound, and studies mostly consider outcomes that are ...

Tarun K Sen Gupta · Richard B Murray · Robin A Ray

In reply: We agree with Rosenfeld that success in medical training means more than graduating with knowledge, technical brilliance and commitment to lifelong learning. Admission interviews are designed to assess non-academic features, such as empathy, communication, working in teams and professionalism. We acknowledge that current selection processes are unable to identify students with major personality disorders or those who are likely to develop physical or mental ...

Ian G Wilson · Christopher Roberts · Eleanor M Flynn · Barbara N Griffin

To the Editor: At first, Thacker and Moseley appear to do an about-turn on much of their published work by de-emphasising the role of the brain and nervous system in the human pain experience.1 However, on closer scrutiny, their reflection encapsulates key messages for health professionals about pain not being located in the tissues, while exposing the inadequacy of non-person-centred approaches to their practice and ...

Lester E Jones · Laura Y Whitburn

To the Editor: A 62-year-old woman was admitted on 10 January 2012 for cardiac monitoring after her implantable cardioverter–defibrillator (ICD) discharged four times over a few hours. She had a history of ventricular tachycardia due to ischaemic cardiomyopathy, and had had an ICD (D284DRG Maximo II DR, Medtronic, Minneapolis, Minn, USA) inserted 6 years earlier. Her ICD had ...

Bo Xu · Howard Connor · Robert Ziffer

To the Editor: The report by Scott and colleagues on the “demographic characteristics, diagnostic category, stage of illness, as well as psychosocial and vocational impairment” of 1260 patients presenting to two Sydney headspace centres1 is problematic for several reasons. No convincing data were presented to support the authors’ conclusion that the research demonstrated that “well designed youth ...

Jon N Jureidini

To the Editor: The study of headspace attendees by Scott and colleagues1 illustrates problems common in articles being used for lobbying purposes in the Australian mental health policy arena. These include misrepresentation of evidence, inappropriate medicalisation, and undeclared competing interests. The authors refer to un(der)employment, lack of engagement in study, and receipt of income support as ...

Melissa Raven

In reply: The detailed demographic, diagnostic and disability data we presented1 responds directly to the critics of headspace clinics. Following the initial establishment phase,1 our two centres now provide services to 390 and 411 young people per month, respectively (data from July to September 2011). Each of the 30 established headspace services now assesses an average of 265 clients ...

Ian B Hickie · Daniel F Hermens · Elizabeth M Scott

To the Editor: An important and controversial article authored by Haines and Lowenthal1 was recently published in the Internal Medicine Journal. The authors challenged evidence used by Ian Gawler on his website (iangawler.com) and in his book2 to support meditation and dietary interventions as cancer therapy. Publication of the article was subsequent to initial submission ...

Emma S McBryde

In reply: The article referred to by McBryde was submitted to the MJA in 2011. Patient consent was requested, following standard MJA practice for all manuscripts containing potentially identifying patient data or images, but this was not provided by the authors. We agree that all the information was already publicly available, and it was for ...

Annette G Katelaris

To the Editor: In their editorial, MacLennan and Morrison1 listed Curtin University’s Evidence Based Complementary Medicine as a pseudoscientific unit. This citation was completely unjustified. The unit, which is part of both the Bachelor of Pharmacy and Master of Pharmacy (graduate entry) degrees, was developed for the sole purpose of providing pharmacy graduates with the knowledge, ...

Jeffery D Hughes · Liesl A Blott

To the Editor: Clinical pathways and guidelines are the inevitable consequence of evidence-based medicine and, in general, have been a force for good in terms of patient care. However, the experiences of Nanan et al1 and Dietz and Stokes,2 and my own experience of working with countless exasperated colleagues in clinical practice, suggest that the ...

Paul M McGurgan

To the Editor: Your focus on obesity in the 20 February 2012 issue of the Journal expresses the frustration of many of us working in this area. After 25 years, it is clear that we have achieved little in reducing the problem at the population level and that the existing model for dealing with obesity, based on personal ...

Garry J Egger

To the Editor: We congratulate Green and Maiorana1 on their recent article highlighting the value of exercise in obesity management. The urgent need for action to prevent further weight gain in adults and to reduce the proportion of the population that is obese was recognised 25 years ago. However, despite massive public health efforts to reduce obesity ...

Rosemary A McGinnes · Judy A Lowthian

To the Editor: We read Scott and Harris’s1 article with great interest and agree that new funding models for diabetes care must be carefully designed to ensure that interventions are effective. For this reason, the Diabetes Care Project2 (formerly the Coordinated Care for Diabetes Pilot) developed pilot interventions following reviews of international trials and extensive ...

Tim Fountaine · Jonathan E Shaw · Paul Z Zimmet