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Parental consent and the treatment of transgender youth: the impact of Re Imogen

Fiona Kelly, Simona Giordano, Michelle M Telfer and Ken C Pang
Med J Aust 2022; 216 (5): . || doi: 10.5694/mja2.51431
Published online: 21 March 2022

Recent legal changes are negatively affecting provision of timely medical care to Australian transgender youth

The number of transgender and gender diverse (henceforth, trans) youth seeking medical treatment has risen sharply over the past two decades in Australia and overseas.1,2 Unique legal requirements for consent to this treatment in Australia have developed through Family Court case law since 2004. Until recently, it was necessary for a young person seeking pubertal suppression or gender‐affirming hormone treatment to secure Family Court approval before treatment could commence, even in circumstances where both parents and the young person’s treating doctors supported treatment and considered it to be in their best interest, and the young person was deemed Gillick competent, which is achieved when a young person has “a sufficient understanding and intelligence to enable him or her to understand fully what is proposed”.3 The requirement for court approval was removed for puberty suppression in 2013 by Re Jamie,4 but the restrictions on gender‐affirming hormone treatment remained until the Full Family Court decision of Re Kelvin in 2017.5


  • 1 La Trobe University, Melbourne, VIC
  • 2 University of Manchester, Manchester, UK
  • 3 Royal Children's Hospital, Melbourne, VIC
  • 4 Murdoch Children’s Research Institute, Melbourne, VIC


Correspondence: ken.pang@mcri.edu.au

Acknowledgements: 

Ken Pang is supported by the Royal Children's Hospital Foundation and the Hugh DT Williamson Foundation, neither of which had any role in the planning, writing or publication of this article.

Competing interests:

Michelle Telfer and Ken Pang are members of the Australian Professional Association for Trans Health.

  • 1. Pang KC, de Graaf NM, Chew D, et al. Association of media coverage of transgender and gender diverse issues with rates of referral of transgender children and adolescents to specialist gender clinics in the UK and Australia. JAMA Netw Open 2020; 3: e2011161.
  • 2. Wiepjes CM, Nota NM, de Blok CJM, et al. The Amsterdam Cohort of Gender Dysphoria Study (1972–2015): trends in prevalence, treatment, and regrets. J Sex Med 2018; 15: 582–590.
  • 3. Gillick v West Norfolk and Wisbech Area Health Authority [1986] AC 112.
  • 4. Re Jamie [2013] FamCAFC 110.
  • 5. Re Kelvin [2017] FamCAFC 258.
  • 6. Kelly F. “The court process is slow but biology is fast”: assessing the impact of the Family Court approval process on transgender children and their families. Aust J Family Law 2016; 30: 112.
  • 7. Telfer MM, Tollit MA, Pace CC, Pang KC. Australian standards of care and treatment guidelines for transgender and gender diverse children and adolescents. Med J Aust 2018; 209: 132–136. https://www.mja.com.au/journal/2018/209/3/australian‐standards‐care‐and‐treatment‐guidelines‐transgender‐and‐gender
  • 8. Re Imogen (No. 6) [2020] FamCA 761.
  • 9. O’Connell MA, Nguyen TP, Ahler A, et al. Approach to the patient: pharmacological management of trans and gender‐diverse adolescents. J Clin Endocrinol Metab 2021; 107: 241–257.
  • 10. Priest M. Transgender children and the right to transition: medical ethics when parents mean well but cause harm. Am J Bioeth 2019; 19: 45–59.
  • 11. Jowett S, Kelly F. Re Imogen: a step in the wrong direction. Aust J Family Law 2021; 34: 31–56.
  • 12. Secretary, Department of Health and Community Services v JWB and SMB (Marion’s case) (1992) 175 CLR 218.
  • 13. Young L. Mature minors and parenting disputes in Australia: engaging with the debate on best interests v autonomy. UNSW Law J 2019; 42: 1362–1364.
  • 14. A flawed agenda for trans youth [editorial]. Lancet Child Adolesc Health 2021; 5: 385.
  • 15. Bell and Mrs A v Tavistock and Portman NHS Trust [2020] EWHC 3274 (Admin).
  • 16. Davis LS. Transgender children and their parents struggle to cope with restrictive laws. CNN Health 2021; 22 June. https://edition.cnn.com/2021/06/14/health/trans‐kids‐care‐state‐bans‐wellness/index.html (viewed Feb 2022).
  • 17. Rew L, Young CC, Monge M, Bogucka R. Review: Puberty blockers for transgender and gender diverse youth‐a critical review of the literature. Child Adolesc Ment Health 2021; 26: 3–14.
  • 18. Mahfouda S, Moore JK, Siafarikas A, et al. Gender‐affirming hormones and surgery in transgender children and adolescents. Lancet Diabetes Endocrinol 2019; 7: 484–498.
  • 19. Simons L, Schrager SM, Clark LF, et al. Parental support and mental health among transgender adolescents. J Adolesc Health 2013; 53: 791–793.
  • 20. Australian Professional Association for Trans Health. AusPATH statement on medical gender affirmation and Re Imogen. 21 Sept 2020. https://auspath.org.au/2020/09/21/auspath‐statement‐on‐medical‐gender‐affirmation‐and‐re‐imogen/ (viewed Feb 2022).
  • 21. Tobin J, The UN Convention on the Rights of the Child: a commentary. Oxford University Press, 2019.
  • 22. UN Committee on the Rights of the Child. General Comment No 4 (2003): Adolescent health and development in the context of the Convention on the Rights of the Child (CRC/GC/2003/4). https://www.refworld.org/docid/4538834f0.html (viewed Feb 2022).
  • 23. Children’s Hospitals Australasia; Association for the Wellbeing of Children in Healthcare. Charter on the Rights of Children and Young People in Healthcare Services in Australia. 2017. https://children.wcha.asn.au/sites/default/files/australian_version_final_210911web.pdf (viewed Feb 2022).
  • 24. Clark BA, Virani A, Saewyc EM. “The edge of harm and help”: ethical considerations in the care of transgender youth with complex family situations. Ethics Behav 2020; 30: 161–180.
  • 25. Notini L, McDougall R, Pang KC. Should parental refusal of puberty‐blocking treatment be overridden? The role of the harm principle. Am J Bioeth 2019; 19: 69–72.

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Responding to the rising number of suicides using barbiturates

Bridin P Murnion and Darren M Roberts
Med J Aust 2022; 216 (4): . || doi: 10.5694/mja2.51409
Published online: 7 March 2022

Suicide prevention requires ensuring that social media are responsible and accountable, and that poisoning surveillance systems are adequately supported

Barbiturates have a narrow therapeutic index, and accidental or deliberate poisoning can cause coma and cardiorespiratory arrest. Barbiturate‐related death rates were high in the mid‐20th century, when barbiturates were still commonly prescribed, but safer alternatives mean that clinical indications for prescribing them are now extremely limited.1 Over the past twenty years, however, interest in barbiturates has increased, particularly in their use at the end of life.2


  • 1 Western Sydney Local Health District, Sydney, NSW
  • 2 The University of Sydney, Sydney, NSW
  • 3 Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, NSW
  • 4 Royal Prince Alfred Hospital, Sydney, NSW



Competing interests:

No relevant disclosures.

  • 1. Darke S, Chrzanowska A, Campbell G, et al. Barbiturate‐related hospitalisations, drug treatment episodes, and deaths in Australia, 2000–2018. Med J Aust 2022; 216: 194–198.
  • 2. Sinmyee S, Pandit VJ, Pascual JM, et al. Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying. Anaesthesia 2019; 74: 630–637.
  • 3. Campbell G, Darke S, Zahra E, et al. Trends and characteristics in barbiturate deaths Australia 2000–2019: a national retrospective study. Clin Toxicol (Phila) 2021; 59: 224–230.
  • 4. Queensland University of Technology. Voluntary assisted dying. Updated 23 Nov 2021. https://end‐of‐life.qut.edu.au/assisteddying (viewed Nov 2021).
  • 5. van den Hondel KE, Punt P, Dorn T, et al. The rise of suicides using a deadly dose of barbiturates in Amsterdam and Rotterdam, the Netherlands, between 2006 and 2017. J Forensic Leg Med 2020; 70: 101916.
  • 6. Ryan CJ, Callaghan S. Legal and ethical aspects of refusing medical treatment after a suicide attempt: the Wooltorton case in the Australian context. Med J Aust 2010; 193: 239–242. https://www.mja.com.au/journal/2010/193/4/legal‐and‐ethical‐aspects‐refusing‐medical‐treatment‐after‐suicide‐attempt
  • 7. Royal Australasian College of Physicians. Voluntary assisted dying. 2020. https://www.racp.edu.au/advocacy/policy‐and‐advocacy‐priorities/voluntary‐assisted‐dying (viewed Nov 2021).
  • 8. Jeste DV, Saks E. Decisional capacity in mental illness and substance use disorders: empirical database and policy implications. Behav Sci Law 2006; 24: 607–628.
  • 9. Evenblij K, Pasman HRW, Pronk R, Onwuteaka‐Philipsen BO. Euthanasia and physician‐assisted suicide in patients suffering from psychiatric disorders: a cross‐sectional study exploring the experiences of Dutch psychiatrists. BMC Psychiatry 2019; 19: 74.
  • 10. World Health Organization; International Association for Suicide Prevention. Preventing suicide: a resource for media professionals. Geneva: WHO, 2008. https://www.who.int/mental_health/prevention/suicide/resource_media.pdf (viewed Nov 2021).
  • 11. Brown J, Berling I, Jiranantakan T, et al. Toxicovigilance for suicide prevention following Internet promotion of sodium nitrite [abstract]. Injury Prev 2021; 27 (Suppl 2): A18‐A.

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Time for equal access to breast reduction surgery in Australia

Elisabeth Elder
Med J Aust 2022; 216 (3): . || doi: 10.5694/mja2.51386
Published online: 21 February 2022

Women with symptomatic macromastia need relief from a condition that can seriously impair their quality of life

In this issue of the MJA, Crittenden and colleagues report their cost–utility analysis of breast reduction surgery for women with symptomatic breast hypertrophy in Australia.1 Their key finding is that breast reduction surgery is cost‐effective, the cost per quality‐adjusted life‐year (QALY) being considerably lower than the recommended willingness to pay thresholds in the Australian health care system. The authors prospectively assessed health‐related quality of life (SF‐6D utility scores) for 209 women with symptomatic breast hypertrophy before and 12 months after breast reduction surgery. The SF‐6D, a six‐dimensional single health utility score, is derived from the Short Form‐36 (SF‐36), one of the most widely used instruments for assessing health‐related quality of life (range: 0 for death to 1 for perfect health). Their scores were compared with those for 124 women with similar symptoms who had not yet had reduction surgery. The mean SF‐6D scores were similar at baseline, and improved significantly for the women who had undergone surgery (0.313; standard deviation [SD], 0.263 to 0.626; SD, 0.277) but declined slightly (0.296; SD, 0.267 to 0.270; SD, 0.257) for those who had not. The effectiveness of the procedure was measured as the mean differential QALY gain (1.519; 95% confidence interval, 1.362–1.675), obtained at an incremental cost‐effectiveness ratio (ICER) of $7808 per QALY gained.


  • Westmead Breast Cancer Institute, Sydney, NSW



Competing interests:

No relevant disclosures.

  • 1. Crittenden TA, Ratcliffe J, Watson DI, et al. Cost‐utility analysis of breast reduction surgery for women with symptomatic breast hypertrophy. Med J Aust 2022; 216: 147–152.
  • 2. Singh K, Losken A. Additional benefits of reduction mammaplasty: a systematic review of the literature. Plast Reconstr Surg 2012; 129: 562–570. PMID: 22090252
  • 3. Crittenden T, Watson DI, Ratcliffe J, et al; AFESA Research Group. Does breast reduction surgery improve health‐related quality of life? A prospective cohort study in Australian women. BMJ Open 2020; 10: e031804.
  • 4. Crittenden TA, Watson DI, Ratcliffe J, et al. Outcomes of breast reduction surgery using the BREAST‐Q: a prospective study and comparison with normative data. Plast Reconstr Surg 2019; 144: 1034–1044.
  • 5. Lewin R, Liden M, Lundgren J, et al. Prospective evaluation of health after breast reduction surgery using the Breast‐Q, Short‐Form 36, Breast‐Related Symptoms Questionnaire, and Modified Breast Evaluation Questionnaire. Ann Plast Surg 2019; 83: 143–151.
  • 6. Crittenden TA. Quality of life and other outcomes of breast reduction surgery [thesis]. Flinders University, Adelaide; Nov 2020. https://theses.flinders.edu.au/view/5f596e3a‐e41f‐4ca8‐bae8‐6f42d9b936f1/1 (viewed Dec 2021).
  • 7. Widmark‐Jensen E, Bernhardsson S, Eriksson M, et al. A systematic review and meta‐analysis of risks and benefits with breast reduction in the public healthcare system: priorities for further research. BMC Surg 2021; 21: 343.
  • 8. Winter R, Haug I, Lebo P, et al. Standardizing the complication rate after breast reduction using the Clavien–Dindo classification. Surgery 2017; 161: 1430–1435.
  • 9. Krucoff KB, Carlson AB, Shammas RL, et al. Breast‐related quality of life in young reduction mammaplasty patients: a long‐term follow‐up using the BREAST‐Q. Plast Reconstr Surg 2019; 144: 743–750.
  • 10. Australian Department of Health. Medicare Benefits Schedule: item 45523. MBS Online. http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=45523&qt=ItemID (viewed Nov 2021).
  • 11. Australian Department of Health. Medicare Benefits Schedule: item 45644. MBS Online. http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=45644&qt=ItemID (viewed Nov 2021).

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Taking a broader view of the health care needs of people with chronic kidney disease

Kevan R Polkinghorne and Peter G Kerr
Med J Aust 2022; 216 (3): . || doi: 10.5694/mja2.51387
Published online: 21 February 2022

Older patients may never need kidney replacement therapy, but their other medical conditions require attention

Chronic kidney disease (CKD) is a public health problem worldwide.1 An estimated 1.7 million Australian adults, about 10% of the population, have biomedical signs of CKD,2 but more than half are unaware of their condition. People at particular risk include those over 60 years of age, Aboriginal and Torres Strait Islander people, and people with hypertension, diabetes mellitus, obesity, established cardiovascular disease, a personal history of acute kidney injury or smoking, or a family history of kidney disease. CKD is associated with higher all‐cause mortality, higher rates of cardiovascular disease, and reduced overall quality of life.3,4


  • Monash Medical Centre, Melbourne, VIC


Correspondence: peter.kerr@monash.edu

Competing interests:

No relevant disclosures.

  • 1. GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2020; 395: 709–733.
  • 2. Australian Institute of Health and Welfare. Chronic kidney disease (Cat. no. CDK 16). Updated 15 July 2020. https://www.aihw.gov.au/getmedia/0372ad7a‐7297‐4e7b‐a3e4‐5681c342ed2f/Chronic‐kidney‐disease.pdf.aspx?inline=true (viewed Sept 2021).
  • 3. Levey AS, Coresh J. Chronic kidney disease. Lancet 2012; 379: 165–180.
  • 4. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351: 1296–1305.
  • 5. Keith DS, Nichols GA, Gullion CM, et al. Longitudinal follow‐up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med 2004; 164: 659–663.
  • 6. Ravani P, Quinn R, Fiocco M, et al. Association of age with risk of kidney failure in adults with stage IV chronic kidney disease in Canada. JAMA Netw Open 2020; 3: e2017150.
  • 7. Jose MD, Raj R, Jose K, et al. Competing risks of death and kidney failure in a cohort of Australian adults with severe chronic kidney disease. Med J Aust 2022; 216: 140–146
  • 8. Cherney DZ, Repetto E, Wheeler DC, et al. Impact of cardio‐renal‐metabolic comorbidities on cardiovascular outcomes and mortality in type 2 diabetes mellitus. Am J Nephrol 2020; 51: 74–82.
  • 9. Australia and New Zealand Dialysis and Transplant Registry. 42nd report, chapter 3: Mortality in end stage kidney disease. Adelaide: ANZDATA, 2019. https://www.anzdata.org.au/wp‐content/uploads/2019/09/c03_mortality_2018_ar_2019_v1.0_20191202.pdf (viewed Dec 2021).
  • 10. Foote C, Kotwal S, Gallagher M, et al. Survival outcomes of supportive care versus dialysis therapies for elderly patients with end‐stage kidney disease: a systematic review and meta‐analysis. Nephrology 2016; 21: 241–253.
  • 11. Kidney Health Australia. Chronic kidney disease (CKD) management in primary care. 4th edition. Melbourne: Kidney Health Australia, 2020. https://kidney.org.au/health‐professionals/ckd‐management‐handbook (viewed Sept 2021).

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Acting on better data for general medical care will help solve our acute hospital access crisis

Harvey H Newnham
Med J Aust 2022; 216 (3): . || doi: 10.5694/mja2.51385
Published online: 21 February 2022

Smarter measures for general medicine are needed to improve hospital access

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  • 1 Alfred Health, Melbourne, VIC
  • 2 Monash University, Melbourne, VIC


Correspondence: H.Newnham@alfred.org.au

Acknowledgements: 

I thank my many colleagues clinical and non‐clinical from local, national and international units and boards who have contributed to the ideas discussed in this article: in particular, Richard Coates, Daniel Fineberg, Felice Borghmans, Lara Kimmel and Andrew Way of Alfred Health for creating space for, and leading, conversations that matter.

Competing interests:

No relevant disclosures.

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Retracted: Preparing Australasian medical students to practise environmentally sustainable health care

Med J Aust 2022; 216 (2): . || doi: 10.5694/mja2.50585
Published online: 7 February 2022

Retraction: Madden DL, Horton GL and McLean M. Preparing Australasian medical students to practise environmentally sustainable health care. Med J Aust 2020; https://doi.org/10.5694/mja2.50585.

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Correspondence: 

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Reducing the number of unplanned returns to hospital after treatment for peripheral artery disease

Bethany Stavert and Sarah Aitken
Med J Aust 2022; 216 (2): . || doi: 10.5694/mja2.51369
Published online: 7 February 2022

Improved, integrated care for older patients with complex medical needs could avert some modifiable causes of readmission

The incidence of peripheral artery disease (PAD) is rising around the world as populations age and the prevalence of diabetes, obesity, and cardiovascular disease increase.1 The clinical manifestations of lower limb PAD range from asymptomatic atherosclerosis and exertional pain caused by intermittent claudication, to chronic limb‐threatening ischaemia with rest pain, ulceration, and necrosis. Long term survival is poorer for patients with PAD than for people with many common cancers,1 and quality of life and patient‐reported outcomes are impaired.2 A recently published analysis of Global Burden of Disease Study data found that lower limb amputation rates were higher in Australia than in eighteen other high income countries, highlighting the need to improve outcomes for people with PAD.3


  • 1 Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
  • 2 Concord Clinical School, University of Sydney, Sydney, NSW, Australia


Correspondence: sarah.aitken@sydney.edu.au

Competing interests:

No relevant disclosures.

  • 1. Fowkes FGR, Rudan D, Rudan I, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet 2013; 382: 1329–1340.
  • 2. Abaraogu UO, Ezenwankwo EF, Dall PM, Seenan CA. Living a burdensome and demanding life: a qualitative systematic review of the patients experiences of peripheral arterial disease. PLoS One 2018; 13: e0207456.
  • 3. Hughes W, Goodall R, Salciccioli JD, et al. Trends in lower extremity amputation incidence in European Union 15+ countries 1990–2017. Eur J Vasc Endovasc Surg 2020; 60: 602–612.
  • 4. Woelk V, Speck P, Kaambwa B, et al. Incidence and causes of early unplanned readmission after hospitalisation with peripheral arterial disease in Australia and New Zealand. Med J Aust 2022; 216: 80–86.
  • 5. Smith SL, Matthews EO, Moxon JV, Golledge J. A systematic review and meta‐analysis of risk factors for and incidence of 30‐day readmission after revascularization for peripheral artery disease. J Vasc Surg 2019; 70: 996–1006.e7.
  • 6. Thillainadesan J, Aitken SJ, Monaro SR, et al. Geriatric comanagement of older vascular surgery inpatients reduces hospital‐acquired geriatric syndromes. J Am Med Dir Assoc 2021; https://doi.org/10.1016/j.jamda.2021.09.037 [online ahead of print].
  • 7. Thillainadesan J, Yumol MF, Hilmer S, et al. Interventions to improve clinical outcomes in older adults admitted to a surgical service: a systematic review and meta‐analysis. J Am Med Dir Assoc 2020; 21: 1833–1843.
  • 8. Vogel TR, Kruse RL. Risk factors for readmission after lower extremity procedures for peripheral artery disease. J Vasc Surg 2013; 58: 90–97.e1‐4.
  • 9. Anand SS, Caron F, Eikelboom JW, et al. Major adverse limb events and mortality in patients with peripheral artery disease: the COMPASS trial. J Am Coll Cardiol 2018; 71: 2306–2315.
  • 10. Paige E, Doyle K, Jorm L, et al. A versatile big data health system for Australia: driving improvements in cardiovascular health. Heart Lung Circ 2021; 30: 1467–1476.
  • 11. Medicare Benefits Schedule Review Taskforce. Vascular Clinical Committee report. Updated 28 May 2021. https://www.health.gov.au/resources/publications/taskforce‐findings‐vascular‐clinical‐committee‐report (viewed Dec 2021).

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High value health care is low carbon health care

Alexandra L Barratt, Katy JL Bell, Kate Charlesworth and Forbes McGain
Med J Aust 2022; 216 (2): . || doi: 10.5694/mja2.51331
Published online: 7 February 2022

Culling low value care will cut health care carbon emissions

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  • 1 University of Sydney, Sydney, NSW
  • 2 Northern Sydney Local Health District, Sydney, NSW
  • 3 Western Health, Melbourne, VIC
  • 4 University of Melbourne, Melbourne, VIC



Acknowledgements: 

Alexandra Barratt received funding from the National Health and Medical Research Council (grant no. 1104136).

Competing interests:

No relevant disclosures.

  • 1. Beggs PJ, Zhang Y, McGushin A, et al. The report of the MJA–Lancet Countdown on health and climate change: Australia increasingly out on a limb. Med J Aust 2021; https://doi.org/10.5694/mja2.51302.
  • 2. Cunsolo A, Ellis NR. Ecological grief as a mental health response to climate change‐related loss. Nat Clim Chang 2018; 8: 275–281.
  • 3. Malik A, Lenzen M, McAlister S, et al. The carbon footprint of Australian health care. Lancet Planet Health 2018; 2: e27–e35.
  • 4. Tennison I, Roschnik S, Ashby B, et al. Health care’s response to climate change: a carbon footprint assessment of the NHS in England. Lancet Planet Health 2021; 5: e84–e92.
  • 5. Brownlee SM, Chalkidou KMD, Doust JP, et al. Evidence for overuse of medical services around the world. Lancet 2017; 390: 156–168.
  • 6. Braithwaite J, Glasziou P, Westbrook J. The three numbers you need to know about healthcare: the 60–30‐10 Challenge. BMC Med 2020; 18: 102–02.
  • 7. Gordon L, Waterhouse M, Reid IR, et al. The vitamin D testing rate is again rising, despite new MBS testing criteria. Med J Aust 2020; 213: 155–155.e1. https://www.mja.com.au/journal/2020/213/4/vitamin‐d‐testing‐rate‐again‐rising‐despite‐new‐mbs‐testing‐criteria
  • 8. Services Australia. Medicare group reports. http://medicarestatistics.humanservices.gov.au/statistics/mbs_group.jsp (viewed Oct 2021).
  • 9. Zhi M, Ding EL, Theisen‐Toupal J, et al. The landscape of inappropriate laboratory testing: a 15‐year meta‐analysis. PLoS One 2013; 8: e78962.
  • 10. McAlister S, Barratt AL, Bell KJL, McGain F. The carbon footprint of pathology testing. Med J Aust 2020; 212: 377–382.e1. https://www.mja.com.au/journal/2020/212/8/carbon‐footprint‐pathology‐testing
  • 11. McGain F, Muret J, Lawson C, et al. Environmental sustainability in anaesthesia and critical care. Br J Anaesth 2020; 125: 680–692.

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3D printing: potential clinical applications for personalised solid dose medications

Liam Krueger, Jared A Miles, Kathryn J Steadman, Tushar Kumeria, Christopher R Freeman and Amirali Popat
Med J Aust 2022; 216 (2): . || doi: 10.5694/mja2.51381
Published online: 7 February 2022

Three‐dimensional printing or additive manufacturing has the potential to transform personalised medicine

Personalised medicine aims to move gold‐standard care away from empiric prescribing for a typical patient towards tailored treatment for the patient as an individual.1 It is well known that the effect of a medicine on an individual can vary based on factors including sex, genetics and even hormones. Currently, the personalisation of medicines to adjust for factors such as these is limited by the doses and combinations that are commercially available. This inflexibility makes it difficult for clinicians to tailor the medication for individual needs. One technology that could revolutionise personalised medicine is a process called additive manufacturing. In this process, a three‐dimensional (3D) object is produced by fusing thin layers of materials on top of each other until the complete object is formed. This 3D printing method could be applied to medicines to include several drugs in a single tablet at entirely customisable doses set by the clinician, such as the proof of concept five‐in‐one polypill developed in 2015.2


  • 1 University of Queensland, Brisbane, QLD
  • 2 Australian Centre for Nanomedicine, University of New South Wales, Sydney, NSW
  • 3 Metro North Hospital and Health Service, Brisbane, QLD


Correspondence: a.popat@uq.edu.au

Acknowledgements: 

Amirali Popat is the recipient of a National Health and Medical Research Council (NHMRC) Career Development Fellowship (GNT1146627) and receives funding from the School of Pharmacy, University of Queensland. Tushar Kumeria pays respect to the Bedegal people who are the traditional owners of the land on which the University of New South Wales Kensington campus is situated. Tushar Kumeria also acknowledges the support from the NHMRC Early Career Fellowship (GNT1143296) and the University of New South Wales for support and Scientia Grant.

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E‐liquids and vaping devices: public policy regarding their effects on young people and health

Ira N Advani, Mario Perez and Laura E Crotty Alexander
Med J Aust 2022; 216 (1): . || doi: 10.5694/mja2.51362
Published online: 17 January 2022

Knowledge about the composition and physiological effects of e‐liquids is essential for assessing their effects on health

The popularity of electronic cigarettes (e‐cigarettes) has surged in the past few years, and it is estimated that 1.2% of Australians now use them.1 While the main premise in support of e‐cigarettes is that they are safer for smokers than conventional tobacco products, a considerable proportion of users are, unfortunately, never‐smokers or young people.2,3 In 2020, about 3.6 million young people in the United States reported current e‐cigarette use,2 and in 2017, 14% of secondary school students in Australia were reported to have ever used e‐cigarettes.3


  • 1 University of California San Diego, San Diego, CA, United States of America
  • 2 VA San Diego Healthcare System, San Diego, CA, United States of America
  • 3 University of Connecticut, Farmington, CT, United States of America


Correspondence: lcrotty@ucsd.edu

Acknowledgements: 

Laura Crotty Alexander was supported by VA Merit, National Heart, Lung, and Blood Institute R01, and Tobacco‐Related Disease Research Program pilot awards.

Competing interests:

No relevant disclosures.

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