Topics
Pharmacology
The pricing of statins and implications for Pharmaceutical Benefits Scheme expenditure
To the Editor: Following two articles in the Journal,1,2 I wish to provide an update on the pricing of statins in Australia and the implications for Pharmaceutical Benefits Scheme (PBS) expenditure. I was prompted to do so by a recent review by the Pharmaceutical Benefits Advisory Committee (PBAC), which was instigated by the Senate when it passed legislation enabling the current pharmaceutical pricing arrangements.3 The ...
Philip M Clarke
Prescribing trends before and after implementation of an antimicrobial stewardship program
An antibiotic stewardship program in a tertiary referral hospital immediately reduced use of broad-spectrum antibiotics but will it stand the test of time?
Kelly A Cairns BPharm, GradDipClinPharm · Adam W J Jenney MB BS, FRACP, FRCPA · Iain J Abbott MB BS · Matthew J Skinner MB BS, FRACP · Joseph S Doyle MB BS, MSc, FRACP · Michael Dooley BPharm · Allen C Cheng MPH, PhD, FRACP
Rethinking psychotropics in nursing homes
While research supports use of psychotropic medications by nursing home residents in some clinical situations, we use them too often, for too long, at doses too high, in dangerous combinations and without adequate consent.
Sarah N Hilmer MB BS(Hons), FRACP, PhD · Danijela Gnjidic BSc(Hons), PhD, MPH
Real-time monitoring of Schedule 8 medicines in Australia: evaluation is essential
A real-time reporting system for controlled drugs may improve the safety of Schedule 8 medicinesOver the past decade, increased prescribing of pharmaceutical opioids in a number of countries has raised professional and public concern about iatrogenic opioid dependence and fatal opioid overdoses. Most fatal drug overdoses in the United States are now from opioids.1 Although not as high as in the US in absolute terms, the ...
Fiona L Shand BSc(Hons)(Psych), MClinPsych, PhD · Gabrielle Campbell BA(Psych), MCrim · Wayne Hall BSc(Hons) (Applied Psych), PhD · Nicholas Lintzeris BMedSci, MB BS, PhD · Milton Cohen MD, FRACP, FFPMANZCA · Louisa Degenhardt BScHon, MClinPsych, PhD
Importance of ambulatory blood pressure in hypertension management
To the Editor: In their article, Head and colleagues stated that “white coat hypertension carries minimal actual CVD [cardiovascular disease] risk”.1 However, a failure to identify white coat hypertension, and to misdiagnose it as true hypertension, can lead to inappropriate prescription of antihypertensive medications, with associated financial costs and adverse effects such as falls and acute kidney injury, which are unrelated to CVD risk. Although the ...
Patrick Coleman
Importance of ambulatory blood pressure in hypertension management
In reply: The cardiovascular risk associated with white coat hypertension itself is quite separate from the risk of treating white coat hypertension inappropriately. We agree that there are considerable issues associated with treating elderly patients for hypertension and possibly inappropriately treating white coat hypertensive patients. However, although white coat hypertension is more common among elderly patients, the condition needs to be considered in a broader context ...
Geoffrey A Head · Barry P McGrath · Mark R Nelson · Michael Stowasser
The hazards of brussels sprouts consumption at Christmas
A festive season dietary indiscretion precipitated hospital admission for one patient who was on anticoagulation therapy.
Stephen J Pettit MB BS, PhD, MRCP · Alan G Japp MB ChB, PhD, MRCP · Roy S Gardner MB ChB, MD, MRCP
Can we feel it in our waters? Antimicrobials in aquaculture
Eating fish once or twice a week is promoted as good for your health — but is there a downside as well? With the global decline in wild fish stocks, there is an ever-increasing demand for aquaculture-produced fish and other aquatic foods. The aquaculture industry is relatively new but is growing rapidly in ...
Mary D Barton BVSc, PhD, FACVS · Olasumbo L Ndi BSc, MSc, PhD
A life-cycle approach to monitoring benefits and harms of medicines
Collection of high-quality data and management of risk are ongoing needs. Regulatory agencies worldwide are giving greater recognition to postmarketing surveillance, as part of a life-cycle approach to maintaining safety of medicines. This approach involves monitoring the potential benefits and harms of each medicine, and managing risks, throughout development, preregistration testing, registration and postmarket use in the community. The current grounds for initial and continued registration of ...
Emily Banks MB BS(Hons), PhD, FAFPHM · Sallie-Anne Pearson BSc (Hons), PhD
Pharmacoepidemiology of testosterone prescribing in Australia, 1992–2010
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
Pharmacoepidemiology of testosterone prescribing in Australia, 1992–2010
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
Simulation in clinical teaching and learning
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
The Jarisch–Herxheimer reaction in a patient with leptospirosis: a foreseeable problem in managing spirochaete infections
To the Editor: A 60-year-old male farmer presented to the Gold Coast Hospital Emergency Department with a 2-day history of fever (38.5°C), retro-orbital pain, photophobia and confusion. In the preceding 2 weeks he had been working on a farm that had cattle and horses and which was infested with rats. The property had been flooded in the 2011 Queensland flood disaster, about a month before he worked ...
Ryan Markham · Andrew Slack · John Gerrard
Drug treatment for melanoma: progress, but who pays?
Making cancer drugs affordable requires coherent policy and cannot be left to market forcesMelanoma is 10 times more common in Australia than in most countries,1 and kills more than 1300 Australians every year.2 The good news is that we now have effective drug treatments for metastatic melanoma. Two drugs, ipilimumab3,4 and vemurafenib,5 are now approved by the United States Food and Drug Administration and the Australian Therapeutic ...
Richard F Kefford AM, PhD, FRACP
Drug policy at the margins: the case of growth hormone replacement for adults with severe growth hormone deficiency
Are current standards of evidence always appropriate when making the decision to subsidise treatment?
Wendy L Lipworth MB BS, MSc, PhD · Ken Ho MD, FRACP, FRCP · Ian H Kerridge BMed(Hons), MPhil, FRACP · Richard O Day AM, MD, FRACP
A screening program to detect aminoglycoside- induced ototoxicity
To the Editor: We note Ahmed and colleagues’ extensive case series of patients with severe vestibulopathy due to aminoglycosides. We attempted to develop a hospital-based screening program to detect vestibulopathy in inpatients that may be informative for others considering similar programs. We established a pilot project involving student pharmacists. Patients who received more than a single dose of any aminoglycoside antibiotic were identified by therapeutic drug ...
Maryam Teimoori · Gina Mistry · Carmela Corallo · Allen C Cheng
Is the non-medical use of prescription stimulants a problem in Australia?
To the Editor: There have been claims that the non-medical use of prescription stimulants is widespread and increasing in the United States and other developed countries, particularly among university students.1 In the context of rising education and general living costs, economic uncertainty and high rates of anxiety and depression among young people,2 it is plausible that some students may cope with study demands by using ...
Jayne C Lucke · Wayne D Hall
Gentamicin and ototoxicity: why this drug is still in use
The fine line between therapeutic benefit and toxicity. In this issue of the Journal, Ahmed and colleagues1 focus our attention on the very real problem of gentamicin-induced ototoxicity, and especially on the frequently unrecognised problem of severe vestibulotoxicity. Their retrospective analysis of gentamicin-treated patients presenting to a balance disorders clinic found delayed clinical detection of vestibulotoxicity and an apparent lack of a relationship between toxicity and ...
John D Turnidge FRACP, FRCPA, FASM · John A Waterston MB BS, MD, FRACP
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
The changing therapeutic landscape for hepatitis C
The next decade will be a crucial period in the public health response to hepatitis C virus (HCV) infection. The rapid development of direct-acting antiviral therapy for HCV infection has brought considerable optimism to the HCV sector, with the realistic hope that therapeutic intervention will soon be more effective and offer shorter treatment duration. ...
Gregory J Dore MPH, PhD, FRACP
Modelling antiviral treatment to prevent hepatitis C infection among people who inject drugs in Victoria, Australia
Objectives: To develop a mathematical model to project the potential impact of hepatitis C virus (HCV) treatment on HCV infection prevalence among people who inject drugs (PWID). Design and setting: An existing model of HCV transmission among PWID was parameterised using data from Victoria, Australia, including specific parameter estimates of the number ...
Margaret E Hellard PhD, FRACP, FAFPHM · Rebecca Jenkinson BEng(Geol), MEpid, PhD · Peter Higgs BSW, MA, PhD · Mark A Stoové BaAppSci(Hons), GradDip(Ed), PhD · Rachel Sacks-Davis BA BSc(Hons[Arts]) · Judy Gold BBiomedSci(Hons), PhD · Matthew Hickman MSc, PhD, FFPH · Peter Vickerman DPhil, BSc · Natasha K Martin PhD
Tertiary education institutions should not offer pseudoscientific medical courses
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
Avoiding adverse events with dabigatran by careful selection of eligible patients
A new drug with great promise, but be very aware of the risksDabigatran is the first new oral anticoagulant for the prevention of embolism in patients with non-valvular atrial fibrillation (AF) that has been recently ...
Ross I Baker BMedSc, FRACP, FRCPA · Paul Harper MD, FRCP, FRACP · Claire McLintock MB ChB, FRACP, FRCPA
New medicines — urgent need to assess outcomes in special groups
A few achievable strategies could improve translation of clinical research to practice. Randomised controlled trials (RCTs) provide the most internally valid method of evaluating new pharmaceuticals and, appropriately, provide the core evidence for marketing approval. However, ...
Jennifer H Martin MB ChB, FRACP, PhD · Michael D Coory MB BS, PhD, FAFPHM
Eligibility for medical thromboprophylaxis based on risk-factor weights, and clinical thrombotic event rates
Objectives: To measure eligibility for medical thromboprophylaxis using two Australasian guidelines — the Australia and New Zealand Working Party Guidelines [WPG] and the National Health and Medical Research Council Guidelines [NHMRCG]) — and ...
J Alasdair Millar PhD, FRACP, FRCP · Joanne E Lett MB ChB · Leonard J Bagley BPharm · Ian K Densie BSR