Article Types
Perspectives
Medicine and science must oppose intolerance and censorship
Friends of Science in Medicine should avoid threatening their own valuesScience has always been — and should be — a battleground for contending views on what is true. Because of the close connection between knowledge and power, however, the risk is always present that those who command the dominant theories or ideologies will rely on their positions of influence to overcome those who oppose them. ...
Paul A Komesaroff MB BS, PhD, FRACP · Amber Moore BChineseMed(Hons), BA(Hons) · Ian H Kerridge MPhil, FRACP, FRCPA
International medical graduates in Australia: a historical perspective (1930–1950s)
The postwar arrival of refugee doctors heralded changes to the Australian health workforce that we are still adjusting to todayInternational medical graduates (IMGs) are an important part of Australia’s health workforce, accounting for about 23.5% (n = 16 186) of all doctors in Australia today.1 The recruitment and placement of IMGs in rural areas is particularly vital to the provision of health services in rural Australia, where there ...
Daniel R Terry BNurs, MInternatHlth · Jessica J Woodroffe BA(Hons), PhD · Quynh Le PhD, MAppComp, MEdStud · Kathryn J Ogden MB BS(Hons), MPH, FRACGP
Is it too late to prevent a decline in mental health care for older Australians?
Action is required now for future older Australians to receive adequate mental health careOver the next 20 years, the number of Australians aged 65 years and over is projected to nearly double from around 3.2 million to about 6.2 million people.1 Individuals with lifelong mental illness will be joined by those with new mental disorders, such as mood disorders, late-life psychoses and anxiety disorders that are often associated with ...
Roderick G McKay BSc, MB BS, FRANZCP · Brian M Draper MB BS, MD, FRANZCP
Can we educate out of racism?
Dennis McDermott argues that educating doctors about the health consequences of everyday racism towards Indigenous Australians challenges all involvedAgenuine engagement with Indigenous health issues challenges medical students and doctors alike. When participants in medical education analyse racism as a social determinant of health, the challenge deepens. The experience can range from disquieting to profoundly disturbing. For educators, the experience can be stressful, even daunting. Analysing racism ...
Dennis R McDermott BEc, BA(Hons)(Psych), MA
Ten principles relevant to health research among Indigenous Australian populations
Working with Indigenous communities towards research that is relevant, effective and culturally respectful. Writing in the Journal about Indigenous health in 2011, Sir Michael Marmot suggested that the challenge was to conduct research, and to ultimately apply findings from that research, to enable Indigenous Australians to lead more flourishing lives that they would have reason to value. As committed Indigenous health researchers in Australia, we reflect ...
Lisa M Jamieson PhD · Yin C Paradies PhD · Sandra Eades PhD · Alwin Chong MPH · Louise Maple-Brown PhD · Peter Morris PhD · Ross Bailie PhD · Alan Cass PhD · Kaye Roberts-Thomson MPH · Alex Brown PhD
Genetic research in Indigenous health: significant progress, substantial challenges
Genomics is a powerful research tool, but it must be handled with careOf all the measurements and biological samples used in health research, it is the extraction and analysis of genetic material that has caused the most controversy in indigenous health research across the globe. No other kind of research has a specific inter- national non-governmental organisation dedicated to opposing it — the Indigenous People’s ...
Emma E Kowal MB BS, BA(Hons), PhD
Aboriginal women, alcohol and the road to fetal alcohol spectrum disorder
“The girls don’t drink much; ’bout the same as the fellas.” I am an Aboriginal woman, with traditional connections to the Bidjara people from central western Queensland and extensive experience in working with Aboriginal women who consume alcohol during pregnancy. During several decades of working in the health field, I have asked myself and others why Aboriginal people drink alcohol at such dangerous levels. As I have reported ...
Lorian G Hayes MAppEpid, BAppHlthSc(Hons)
The tobacco industry and Aboriginal and Torres Strait Islander people
A systematic search at the source of the smoking problemWhile there has been a redoubling of efforts to reduce smoking rates among Indigenous Australians, Indigenous health researchers have paid almost no attention to the tobacco industry — the “vector” of smoking-related diseases. The exceptions are two reports of the use of Aboriginal images to advertise Winfield cigarettes in Europe.1,2 We decided to examine industry documents ...
David P Thomas MB BS, PhD, FAFPHM · Laura Bond BHSc, MPH
Kissing goodbye to key opinion leaders
Drug industry report reveals strained relations with medical “thought leaders”One of the hottest topics in the business of medicine is how the new sunshine of disclosure is affecting relations between drug companies and so-called key opinion leaders, or KOLs. In the United States, growing public scrutiny of company payments is now causing many doctors to shy away from corporate invitations to consult, speak or advise. ...
Ray N Moynihan BA
Your time starts now — translation time lines for major ophthalmic discoveries
Key performance indicators for medical research do not always indicate the long-term success of a treatmentTranslation into reduced morbidity and mortality is the ultimate measure of success for medical research. However, this may take decades and often researchers are dead before the full impact of their research is realised. Gregor Mendel’s research is an excellent example, with the most important publication in genetics remaining uncited ...
David A Mackey MD, FRANZCO
The Independent Hospital Pricing Authority and mental health services: it is not a case of “one size fits all”
Applying a generic form of activity-based funding to mental health risks perpetuating an inappropriate hospital-centric model of psychiatric care. The upcoming implementation of activity-based funding (ABF) should drive unprecedented levels of transparency and has the potential to deliver vital funding increases to mental health services. However, current plans to apply a generic form of ABF based on diagnosis-related groups (DRGs) to mental health risk a continuation ...
Alan Rosen FRANZCP, MRCPsych, DPM · Patrick D McGorry AO, MD, PhD, FRANZCP · Hamish R M Hill BA(Psych)Hons, GradDipCouns, AssocMAPS · Sebastian P Rosenberg BA, MPA
Designing incentives for good-quality hospital care
Is now the time to send a signal that poor-quality care should not be rewarded in activity-based funding?Public hospitals in Australia are in for a shake-up over the next few years, with boards being reintroduced in many states and activity-based funding (ABF) being rolled out nationally.1 ABF will replace global or historic budgets for hospitals in most states. National casemix classifications will be agreed, and ...
Stephen J Duckett PhD, DSc, FASSA
Not window dressing, but key to making medical research matter
Rachel Nowak explains why improving communication standards will be essential in the drive to speed research translationPssst ... Want your research findings or health guidelines to change how doctors treat patients? Then take a tip from an ex-journo: Use plain English. Keep it short. Tell stories. Journalists have, for centuries, used these tools first to hook ...
Rachel E Nowak BSc, MA, PhD
Disease mongering and low testosterone in men: the tale of two regulatory failures
Disease-awareness campaigns on low testosterone and ageing highlight the need for changes to regulations. Currently, direct-to-consumer advertising of prescription-only medicines is legal in only two industrialised countries, the United States and New Zealand. However, in countries where direct-to-consumer advertising is not allowed, including Australia, Canada and countries in the European Union, pharmaceutical companies have found ways ...
Agnes I Vitry PharmD, PhD · Barbara Mintzes PhD
Tempering hope with realism: induced pluripotent stem cells in regenerative medicine
The moral panic surrounding human embryo research has fuelled unrealistic public expectations for the imminent success of induced pluripotent stem cell therapyTraditionally, treatment for chronic degenerative conditions revolved around reducing symptoms and improving physiological functioning in the hope of gaining some (often limited) increase in life expectancy. However, in the past decade, the advent of ...
Ronald K F Fung BSc(Adv) · Ian H Kerridge MPhil, FRACP, FRCPA · Loane L C Skene LLB(Hons), LLM, LLD · Megan J Munsie BAppSc, MRepSc, PhD
When less can mean more
Ray Moynihan hears a new professional–consumer alliance ringing the alarm on overused interventionsSometimes truth is stranger than fiction. In the United States a few weeks ago, nine leading doctors’ groups published lists of the top five overused tests and treatments within their specialty areas.1 What’s more, they did it with enormous fanfare and in partnership ...
Ray N Moynihan BA
Is it appropriate to treat people at high-risk of psychosis before first onset - Yes
Youth mental health expert Alison Yung says safe treatments should be offeredSchizophrenia carries a great personal and economic burden. It begins with a non-psychotic prodromal phase before the onset of characteristic positive symptoms such as delusions and hallucinations. This prodromal phase is therefore a potential target for early intervention. Criteria have been developed to identify the ...
Alison R Yung MD, MPM, FRANZCP
Is it appropriate to treat people at high-risk of psychosis before first onset? - No
Schizophrenia expert David Castle suggests caution, especially regarding medication useIt has been suggested that one can “predict” schizophrenia at an individual level. Features posited as being part of these so-called ultra-high risk (UHR) criteria1 include risk factors (eg, a family history of schizophrenia), symptoms (eg, attenuated positive psychotic symptoms) and longitudinal trajectory (decline in functioning). ...
David J Castle MD, FRANZCP, FRCPsych
Holding a stillborn baby: does the existing evidence help us provide guidance?
It is now less clear how parents should be advisedIn Australia, stillbirth is defined as the loss of a fetus of at least 20 weeks’ gestation, or 400 g birth weight if gestational age is unknown. Every year in Australia there are 1750 stillbirths.1 Several studies have reported that stillbirth, regardless of how it is managed, can have ...
Kelly A Cunningham BSc, PhD
The need to tackle concussion in Australian football codes
A call for systematic and comprehensive investigation into the long-term effects of football-related head trauma. Postmortem evidence of chronic traumatic encephalopathy (CTE) in the brains of American National Football League players who suffered concussions while playing have intensified concerns about the risks of concussion in sport. Concussions are frequently sustained by amateur and professional players of ...
Frederic Gilbert PhD · Bradley J Partridge BPsych(Hons), PhD
Engineering the surgical imagination
John Cartmill and David Butt discuss how surgery might change with robot-like enhancements to surgeons’ capabilitiesThe advent of the surgical “robot”, exemplified by the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, Calif, USA), brings fresh approaches, possibilities and questions to the field of surgery. Because of their capacity to augment dexterity, strength, coordination and vision, ...
John A Cartmill · David Butt
The ageing surgeon
Wise guidance for winding down from a full workload is at handWhereas surgeons may be perceived by some of their colleagues as arrogant, self-centred and totally lacking in humility and insight, much has been achieved by the Royal Australasian College of Surgeons (RACS) in recent years to influence surgeons’ behaviour through a number of strategies ...
Bruce P Waxman FRACS, FRCS, FACS
Clinical software on personal mobile devices needs regulation
Juanita Fernando says clinicians need some legal certainty around phone and tablet use. The regulation of clinical software for personal mobile devices (PMDs) has increased in relevance for physician practice. The plausible benefits of using software ...
Juanita I E Fernando GradCertBusSys, MA, PhD
Towards sharing health-services data
Data sharing would speed progress in improving the Australian health systemThe benefits of data sharing have been demonstrated in genomics, where it has accelerated progress and provided an understanding of complex issues sooner.1 Hoping to ...
Michael D Coory MB BS, FAFPHM, PhD · Craig L Fry BSc(Hons), DrPH
Beyond evidence: reappraising use of CA-125 as post-therapy surveillance for ovarian cancer
Reconsidering the place of disease monitoring after treatmentWomen who have completed primary chemotherapy for ovarian cancer commonly have serial assessment of the serum tumour marker cancer antigen 125 (CA-125).1 This practice has been based on the ...
Paul Harnett MB BS(Hons), FRACP, PhD · Ian H Kerridge BMed(Hons), FRCPA, FRACP · Christopher F C Jordens BA(Hons), MPH, PhD · Kim Hobbs BSocStud(Hons) · Catherine Mason MB BS, MPH, FRANZCP · Bronwen M Morrell BA(Hons)