History and humanities

A fan of our “Stamps of greatness” series takes the connection between philately and medicine a step further, with an account of a chance moment in history.

Robert M Parker

The recent apology from the German Medical Association is commendable, but it fails to mention many of the victims of Nazi medicine.

George M Weisz MD, FRACS, MA

Recognition for individuals, and highlighting important causes in healthMost of us who work in health and medicine don’t expect a prize for what we do, but neither are we averse to a bit of competition. From the MJA’s perspective, the output of competitions — often comprising the most innovative and creative of submissions — makes for enriching content. Thus, in concert with a number of ...

Ruth M Armstrong BMed

Botanical taxonomy is a repository of medical biographical information. Such botanical memorials include the names of some indigenous orchids of Australia. By searching reference texts and journals relating to Australian botany and Australian orchidology, as well as Australian and international medical and botanical biographical texts, I identified 30 orchids indigenous to Australia whose names commemorate doctors and other medical professionals. Of these, 24 have names ...

John H Pearn MD, PhD, DSc

To the Editor: In London in the late 1960s, one of my chiefs regularly used a diathermy clamp (Med J Aust 2012; 197: 193) for the management of third and fourth degree piles. The patient was anaesthetised, placed in the lithotomy position, and draped. Meanwhile, the clamp was brought to red heat on a Bunsen burner in a side room and fetched into theatre by ...

William E M Renton-Power

In a week when the presidential election was imminent, but Americans were more concerned with Hurricane Sandy and Halloween, an Australian visiting professor in New Orleans shares his observations of life and health in the United States and the ongoing recovery from Hurricane Katrina.

Charles S Guest Visiting Professor

A reflection on surgical life in a public hospitalThe fluorescent tubes in the corridor shine with a watery blue light, casting dappled shadows from the newly hung Christmas decorations. The surgeon opens the door to the operating theatre, but it catches on the tinsel, unsticking it from the ceiling. 8 am. Already the day is in chaos: no breakfast, delayed clinic, unhappy administrators, and now this ...

Rosalind L Jeffree MB BS, MSc

To the Editor: This year, evidence-based medicine celebrated its 20th birthday.1 However, it remains difficult to translate research findings to the bedside,2 and many medical diagnoses and treatments are unable to meet the five levels of clinical evidence currently recognised in the United Kingdom (http://evidence basedmedicine.com.au/?page_id=30). This year, we also learned that what was previously believed to be junk DNA actually does something.3 A plausible translation ...

Peter D Jones

To the Editor: Puzzles, like alcohol consumption, are a time-honoured mode of entertainment used by humankind for having a jolly time. Yet, while most people are well versed in the dangers associated with alcohol misuse, the dark side of brainteasers is underappreciated. Indeed, the hazardous nature of this common and seemingly inconspicuous pastime is gravely misjudged. Allow me to elaborate. Not long ago, when I published ...

Rick Mutsaers

Policies to prevent medical photography being performed unethically and unlawfully are critical in the digital ageIn the era of easily obtainable, easy-to-use digital cameras, any owner of a camera can be a “medical photographer”. Yet professionalism in obtaining medical photographs is much more than the sum of one’s equipment. Digital cameras, especially the ones in smartphones, give clinicians a high degree of autonomy in taking ...

Kara Burns BSci(AppSci)(Hons) · Suzanne Belton PhD

As doctors, we spend a lot of time learning facts but little time is formally dedicated to learning how to think. Ideally, this skill is learnt (“picked up”) during the years of clinical teaching at the bedside, in the clinic and in the operating theatre. Errors in clinical interpretation and reasoning can occur at any point during patient care. These are often due not to ...

Annette Katelaris MB BS, MPH, FRACGP

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

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

You wake to a doctor, sitting where your leg would be. How brave, they say, as if a body is to be endured. Through a closed window — a wind-tossed tree. You wanted to be normal, not to be reassured. What is lost? An empty room soon fills with echoes. How brave, they say. As if a body is to be endured, you keep score, sitting in the stands. Who ...

Andy Jackson

In this issue, Handelsman (doi: 10.5694/mja11.11277) describes changes in the patterns of testosterone prescribing in Australia from 1992 to 2010. He reports that there has been at least a twofold increase in total expenditure on prescriptions, taking into account inflation and population growth, and the increase in expenditure is greater than the increase in prescribing. Yet, ...

Annette Katelaris MB BS, MPH, FRACGP

A very public slanging match has arisen between The Lancet and one of Australia’s most high-profile medical opinion leaders in psychiatry. The Lancet’s editor, Dr Richard Horton, has queried whether or not Professor Ian Hickie, of ...

Annette Katelaris MB BS, MPH, FRACGP

David Wigg MB BS, MD, PhD, FRCR, FRANZCR,made a considerable contribution and left a lasting legacy to radiation oncology and radiobiology in Australia. David was born in Adelaide on 14 September 1933 into a family with strong medical ...

Margaret M Wallington · Linda M Swaney

Pain, and, in particular, chronic pain, is older than medicine itself, and a major reason why people see doctors. It is central to human experience, and pervasive in clinical practice. However, pain — and patients in pain — are not well understood or managed. Our lack of understanding of pain mechanisms ...

Annette Katelaris MB BS, MPH, FRACGP

Objectives: To document and describe outpatient persistent pain management services in Australia.Design, participants and setting: Systematic survey conducted between 1 December 2008 and 31 January 2010 of 57 services providing outpatient care to adult clients with persistent pain, plus five specialised paediatric services throughout Australia.Main outcome measures: Service structure, including funding processes; activity, including client numbers, access to specialised services (inpatient care, pain relief interventions); waiting times; and use of allied-health-professional-based pain management programs.Results: Of 68 services identified, 57 participated in the study. The median waiting time from referral receipt to initial clinical assessment for a publicly funded outpatient adult pain management service was 150 days, compared with 38.5 days for a privately funded service (P < 0.05). There was substantial variability among providers in range of services offered, including provision and duration of allied-health pain management programs. The level of service provision for children and rural patients is notably lower than that reported for urban adult constituents.Conclusions: Persistent pain management services are currently unable to meet service requirements adequately, and waiting times are more prolonged for publicly funded than privately funded services. Greater service provision is required in rural areas and for children.

Malcolm N Hogg MB BS, GrDip(PM), FFPANZCA · Stephen Gibson BBSc, PhD · Amal Helou BHlthSc(Nursing), MM(PM) · Jacklyn DeGabriele BHlthSc(Nursing), GrDip(Midwifery) · Michael J Farrell BAppSc(Phty), MSc(Gerontology), PhD

Effective clinical practice is predicated on valid and relevant clinical science — a commodity in increasingly short supply. The pre-eminent place of clinical research has become tainted by methodological shortcomings, commercial influences and neglect of the needs of patients and clinicians. Researchers need to be more proactive in evaluating clinical interventions in terms of patient-important benefit, wide applicability and comparative effectiveness, and in adopting study designs and reporting standards that ensure accurate and transparent research outputs. Funders of research need to be more supportive of applied clinical research that rigorously evaluates effectiveness of new treatments and synthesises existing knowledge into clinically useful systematic reviews. Several strategies for improving the state of the science are possible but their implementation requires collective action of all those undertaking and reporting clinical research.

Ian A Scott FRACP, MHA, MEd · Paul P Glasziou FRACGP, PhD