Topics

Cancer immunotherapy during the COVID‐19 pandemic presents management challenges from immune‐related toxicities, requiring careful patient selection

The coronavirus disease 2019 (COVID‐19) pandemic has led to fundamental re‐evaluation of the benefits versus risks of treatment in oncology. Immunotherapy has had an expanding presence in oncology, becoming a primary systemic treatment option in diseases such as melanoma, lung, urothelial, renal, and head and neck cancers. Immune checkpoint inhibitor (ICI) therapy, namely anti‐programmed cell death protein 1 (anti‐PD‐1), anti‐programmed cell death ligand 1 (anti‐PD‐L1) and anti‐cytotoxic T‐lymphocyte‐associated protein 4 (anti‐CTLA‐4) antibodies, halt the negative regulatory checks of T lymphocytes, thus activating the immune response against tumours. Patients with cancer receiving these treatments are faced with a unique set of treatment‐related toxicities driven by an autoimmune mechanism.

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1 Canberra Hospital, Canberra, ACT
2 Australian National University, Canberra, ACT

Correspondence: yada.kanjanapan@act.gov.au

Competing interests:

No relevant disclosures.

1. Bersanelli M. Controversies about COVID‐19 and anticancer treatment with immune checkpoint inhibitors. Immunotherapy 2020; 12: 269–273.
2. Dai M, Liu D, Liu M, et al. Patients with cancer appear more vulnerable to SARS‐COV-2: a multicenter study during the COVID‐19 outbreak. Cancer Discov 2020; 10: 783–791.
3. Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with COVID‐19 in Wuhan, China. Clin Infect Dis 2020; 71: 762–768.
4. Lim SY, Lee JH, Gide TN, et al. Circulating cytokines predict immune‐related toxicity in melanoma patients receiving anti‐PD‐1-based immunotherapy. Clin Cancer Res 2019; 25: 1557–1563.
5. Robilotti EV, Babady NE, Mead PA, et al. Determinants of COVID‐19 disease severity in patients with cancer. Nat Med 2020; 26: 1218–1223.
6. Garassino MC, Whisenant JG, Huang LC, et al. COVID‐19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry‐based, cohort study. Lancet Oncol 2020; 21: 914–922.
7. Wolchok JD, Rollin L, Larkin J. Nivolumab and ipilimumab in advanced melanoma. N Engl J Med 2017; 377: 2503–2504.
8. Motzer RJ, Tannir NM, McDermott DF, et al. Nivolumab plus ipilimumab versus sunitinib in advanced renal‐cell carcinoma. N Engl J Med 2018; 378: 1277–1290.
9. RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with COVID‐19 — preliminary report. N Engl J Med 2020; https://doi.org/10.1056/nejmoa2021436 [Epub ahead of print].
10. Del Castillo M, Romero FA, Argüello E, et al. The spectrum of serious infections among patients receiving immune checkpoint blockade for the treatment of melanoma. Clin Infect Dis 2016; 63: 1490–1493.
11. Schwarz M, Kocher F, Niedersuess‐Beke D, et al. Immunosuppression for immune checkpoint‐related toxicity can cause Pneumocystis jirovecii pneumonia (PJP) in Non‐small‐cell lung cancer (NSCLC): a report of 2 cases. Clin Lung Cancer 2019; 20: e247–e250.
12. Fujita K, Kim YH, Kanai O, et al. Emerging concerns of infectious diseases in lung cancer patients receiving immune checkpoint inhibitor therapy. Respir Med 2019; 146: 66–70.
13. Picchi H, Mateus C, Chouaid C, et al. Infectious complications associated with the use of immune checkpoint inhibitors in oncology: reactivation of tuberculosis after anti PD‐1 treatment. Clin Microbiol Infect 2018; 24: 216–218.
14. Läubli H, Balmelli C, Kaufmann L, et al. Influenza vaccination of cancer patients during PD‐1 blockade induces serological protection but may raise the risk for immune‐related adverse events. J Immunother Cancer 2018; 6: 40.
15. Failing JJ, Ho TP, Yadav S, et al. Safety of influenza vaccine in patients with cancer receiving pembrolizumab. JCO Oncol Pract 2020; 16: e573–e580.
16. Segelov E, Underhill C, Prenen H, et al. Practical considerations for treating patients with cancer in the COVID‐19 pandemic. JCO Oncol Pract 2020; 16: 467–482.
17. Weinkove R, McQuilten ZK, Adler J, et al. Managing haematology and oncology patients during the COVID‐19 pandemic: interim consensus guidance. Med J Aust 2020; 212: 481–489. https://www.mja.com.au/journal/2020/212/10/managing-haematology-and-oncology-patients-during-covid-19-pandemic-interim-0
18. Friedlaender A, Kim C, Addeo A. Rethinking the optimal duration of immune checkpoint inhibitors in non‐small cell lung cancer throughout the COVID‐19 pandemic. Front Oncol 2020; 10: 862.
19. Robert C, Ribas A, Hamid O, et al. Durable Complete Response After Discontinuation of Pembrolizumab in Patients With Metastatic Melanoma. J Clin Oncol 2018; 36: 1668–1674.

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Perspectives

Demographics and performance of candidates in the examinations of the Australian Medical Council, 1978–2019

Neville D Yeomans, Jillian R Sewell, Philip Pigou and Stuart Macintyre

Med J Aust 2021; 214 (2): . || doi: 10.5694/mja2.50800
Published online: 5 October 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Medical education

Health services administration

Australia has relied, for most of its history, on international medical graduates (IMGs) to supplement its workforce. Since 1978, IMGs applying for general registration to practise in Australia have usually needed to pass the examinations of the Australian Medical Examining Council, or since 1986, its successor, the Australian Medical Council (AMC). The AMC provides several pathways to registration by the Australian Health Practitioner Regulation Agency (AHPRA). The route now termed “the standard pathway” consists of a two‐part assessment including a multiple choice question (MCQ) examination followed by a clinical examination. While most IMGs are required to pass both examinations, since 2007, IMGs who qualified in the so‐called competent authority countries (the United Kingdom, Ireland, the United States and Canada) have usually not been required to sit these examinations.1

1 University of Melbourne, Melbourne, VIC
2 Centre for Community Child Health, Melbourne, VIC
3 Australian Medical Council, Canberra, ACT

Correspondence: nyeomans@unimelb.edu.au

Acknowledgements:

We acknowledge the assistance of Kevin Ng and Prathyusha Sama, Senior Computer Programmer and Software Developer at the AMC, for programming to extract the de‐identified data analysed in this article.

Competing interests:

No relevant disclosures.

1. Medical Board of Australia. Competent authority pathway [website]. AHPRA, 2019. https://www.medicalboard.gov.au/Registration/International-Medical-Graduates/Competent-Authority-Pathway.aspx (viewed July 2020).
2. Australian Government Publishing Service. Human Rights and Equal Opportunity Commission — annual report 1990–91. Canberra: Commonwealth of Australia; 1991. https://humanrights.gov.au/sites/default/files/Annual_Report_90-91.pdf (viewed July 2020).
3. Australian Competition and Consumer Commission and Australian Health Workforce Officials’ Committee. Review of Australian specialist medical colleges: report to Australian Health Ministers. Canberra: Commonwealth of Australia, 2005.
4. House of Representatives Standing Committee on Health and Ageing. Lost in the labyrinth: report on the inquiry into registration processes and support for overseas trained doctors. Canberra: Commonwealth of Australia, 2012. https://www.aph.gov.au/Parliamentary_Business/Committees/House_of_Representatives_Committees?url=haa/overseasdoctors/report.htm (viewed July 2020).
5. Geffen L. Assuring medical standards: the Australian Medical Council 1985–2010. Canberra, ACT: Australian Medical Council, 2010.
6. Australian Medical Council Limited. IMG guides. https://www.amc.org.au/publications/img-guides/ (viewed July 2020).
7. United Nations Statistics Division. Geographical regions 1999. https://unstats.un.org/unsd/methodology/m49 (viewed July 2020).
8. Australian Bureau of Statistics. Migration, Australia, 1993–2018 [Cat. No. 3412.0]. Canberra, ACT: ABS, 2018. https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3412.02017-18?OpenDocument (viewed July 2020).
9. Breen K, Frank I, Walters T. Australian Medical Council: a view from the inside. Intern Med J 2001; 31: 243–248.
10. McCoubrie P. Improving the fairness of multiple‐choice questions: a literature review. Med Teach 2004; 26: 709–712.
11. Yeomans ND. They came to heal: Australia's medical immigrants, 1960 to the present [dissertation]. Melbourne: University of Melbourne, 2018: 120.
12. Dewhurst NG, McManus C, Mollon J, et al. Performance in the MRCP (UK) examination 2003–4: analysis of pass rates of UK graduates in relation to self‐declared ethnicity and gender. BMC Med 2007; 5: 8.
13. Shellito JL, Osland JS, Helmer SD, Chang FC. American Board of Surgery examinations: can we identify surgery residency applicants and residents who will pass the examinations on the first attempt? Am J Surg 2010; 199: 216–222.
14. Rubright JD, Jodoin M, Barone MA. Examining demographics, prior academic performance, and United States Medical Licensing Examination scores. Acad Med 2019; 94: 364–370.
15. Unwin E, Potts HWW, Dacre J, et al. Passing MRCP (UK) PACES: a cross‐sectional study examining the performance of doctors by sex and country. BMC Med Educ 2018; 18: 1–9.
16. Sandhu H, Adams A, Singleton L, et al. The impact of gender dyads on doctor–patient communication: A systematic review. Patient Educ Couns 2009; 76: 348–355.
17. Menzies L, Minson S, Brightwell A, et al. An evaluation of demographic factors affecting performance in a paediatric membership multiple‐choice examination. Postgrad Med J 2015; 91: 72–76.
18. Lipner R, Song H, Biester T, et al. Factors that influence general internists’ and surgeons’ performance on maintenance of certification exams. Acad Med 2011; 86: 53–58.
19. McGrail MR, Russell DJ. Australia's rural medical workforce: supply from its medical schools against career stage, gender and rural‐origin. Aust J Rural Health 2016; 25: 298–305.

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Research letter

Implementing cardiovascular disease preventive care guidelines in general practice: an opportunity missed

Charlotte M Hespe, Anna Campain, Ruth Webster, Anushka Patel, Lucie Rychetnik, Mark F Harris and David P Peiris

Med J Aust 2020; 213 (7): . || doi: 10.5694/mja2.50756
Published online: 5 October 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Cardiovascular diseases

Health services administration

General medicine

Cardiovascular disease (CVD) is the leading cause of death in Australia.1 New treatment guidelines based on absolute CVD risk estimates were adopted in 2012.2 General practitioners are central to implementing these guidelines, as about 90% of people in Australia consult GPs each year,3 but large evidence–practice gaps in the management of people with CVD in general practice have been reported.4

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1 The University of Notre Dame Australia, Sydney, NSW
2 The George Institute for Global Health, Sydney, NSW
3 University of New South Wales, Sydney, NSW
4 The Australian Health Prevention Partnership, Sax Institute, Sydney, NSW
5 Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW
6 Office of the Chief Scientist, The George Institute for Global Health, Sydney, NSW

Correspondence: charlotte.hespe@nd.edu.au

Acknowledgements:

The University of Notre Dame received a Bupa Health Foundation grant for research into cardiovascular disease and diabetes that funded the Q Pulse study and a quality improvement project in 46 practices in the Central and Eastern Sydney Primary Health Network. Ruth Webster is supported by a National Health and Medical Research Council (NHMRC) Early Career Fellowship (APP1125044), Anushka Patel by an NHMRC Principal Research Fellowship (APP1136898), and David Peiris by a Heart Foundation Future Leader Fellowship (101890) and NHMRC Career Development Fellowship (APP1143904).

Competing interests:

George Health Enterprises, the social enterprise arm of the George Institute for Global Health, has received funding for the development of fixed dose combination therapy, and has commercial relationships involving digital innovations similar to the interventions in the INTEGRATE study.

1. Australian Institute of Health and Welfare. Deaths in Australia. Updated 6 Aug 2020. https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/leading-causes-of-death (viewed Aug 2020).
2. National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk. Apr 2012. http://www.cvdcheck.org.au/pdf/Absolute_CVD_Risk_Full_Guidelines.pdf (viewed May 2020).
3. Royal Australian College of General Practitioners. General practice: health of the nation 2018. Sept 2018. https://www.racgp.org.au/download/Documents/Publications/Health-of-the-Nation-2018-Report.pdf (viewed Aug 2020).
4. Webster RJ, Heeley EL, Peiris DP, et al. Gaps in cardiovascular disease risk management in Australian general practice. Med J Aust 2009; 191: 324–329. https://www.mja.com.au/journal/2009/191/6/gaps-cardiovascular-disease-risk-management-australian-general-practice.
5. Joshi R, Patel A, Peiris D, et al. INTegrated Electronic General practice support tool, phaRmacy led intervention And combination Therapy Evaluation trial (INTEGRATE) [abstract]. Heart Lung Circ 2015; 24 (Suppl 3): S385.
6. Hespe CH. Q Pulse. Reducing cardiovascular disease (CVD): translating an evidence based quality improvement tool into “real‐world” general practice [ANZCTR registration: ACTRN 12615000108516]. Updated Jan 2018. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367376&isReview=true (viewed May 2020).
7. Heeley EL, Peiris DP, Patel AA, et al. Cardiovascular risk perception and evidence–practice gaps in Australian general practice (the AusHEART study). Med J Aust 2010; 192: 254–259. https://www.mja.com.au/journal/2010/192/5/cardiovascular-risk-perception-and-evidence-practice-gaps-australian-general.
8. Nieuwlaat RSJ, Khatib R, Yusuf S. Why are we failing to implement effective therapies in cardiovascular disease? Eur Heart J 2013; 34: 1262.
9. Sheppard JP, Fletcher K, McManus RJ, Mant J. Missed opportunities in prevention of cardiovascular disease in primary care: a cross‐sectional study. Br J Gen Prac 2014; 64: e38–e46.
10. Berwick DM. Lessons from developing nations on improving health care. BMJ 2004; 328: 1124–1129.

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Editorials

Frailty in older adults: moving from measurement to management

Emily H Gordon and Ruth E Hubbard

Med J Aust 2020; 213 (7): . || doi: 10.5694/mja2.50778
Published online: 5 October 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Gerontology

Health services administration

Incorporating routine assessment of frailty into health care would benefit both older people and the health system

The past two decades have seen a tremendous research effort dedicated to defining, measuring and validating the frailty construct. Large cohort studies of older adults living in the community have consistently found that frail people are at risk of a range of adverse outcomes, including death, disability, and institutionalisation.1 More recently, there has been a move from population‐based cohort studies of frailty to analyses of data collected during routine clinical encounters. In this issue of the MJA, Khadka and colleagues2 contribute to this body of translational research with a large retrospective cohort study of community‐dwelling Australians undergoing Aged Care Assessment Program (ACAP) eligibility assessment.

1 Centre for Health Services Research, University of Queensland, Brisbane, QLD
2 The University of Queensland, Brisbane, QLD

Correspondence: r.hubbard1@uq.edu.au

Competing interests:

No relevant disclosures.

1. Kojima G, Iliffe S, Walters K. Frailty index as a predictor of mortality: a systematic review and meta‐analysis. Age Ageing 2018; 47: 193–200.
2. Khadka J, Visvanathan R, Theou O, et al. Development and validation of a frailty index based on Australian Aged Care Assessment Program data. Med J Aust 2020; 213: 321–326.
3. Mitnitski A, Mogilner A, Rockwood K. Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal 2001; 1: 323–336.
4. Rockwood K, Mitnitski A. Limits to deficit accumulation in elderly people. Mech Ageing Dev 2006; 127: 494–496.
5. Clegg A, Bates C, Young J, et al. Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing 2016; 45: 353–360.
6. Ludwig C, Busnel C. Derivation of a frailty index from the resident assessment instrument – home care adapted for Switzerland: a study based on retrospective data analysis. BMC Geriatr 2017; 17: 205.
7. Burn R, Hubbard R, Scrase R, et al. A frailty index derived from a standardized comprehensive geriatric assessment predicts mortality and aged residential care admission. BMC Geriatr 2018; 18: 319.
8. National Institute for Health and Care Excellence. Multimorbidity: clinical assessment and management (NICE guideline NG56). Sept 2016. https://www.nice.org.uk/guidance/ng56/resources/multimorbidity-clinical-assessment-and-management-pdf-1837516654789 (viewed Aug 2020).
9. NHS England. Supporting routine frailty identification and frailty through the GP Contract 2017/2018. Apr 2017; updated June 2019. https://www.england.nhs.uk/publication/supporting-routine-frailty-identification-and-frailty-through-the-gp-contract-20172018 (viewed Aug 2020).
10. Ellis G, Whitehead M, Robinson D, et al. Comprehensive geriatric assessment for older adults admitted to hospital: meta‐analysis of randomised controlled trials. BMJ 2011; 343: d6553.
11. Lin HS, Watts JN, Peel NM, Hubbard RE. Frailty and post‐operative outcomes in older surgical patients: a systematic review. BMC Geriatr 2016; 16: 157.
12. Poudel A, Peel N, Nissen L, et al. Adverse outcomes in relation to polypharmacy in robust and frail older hospital patients. J Am Med Dir Assoc 2016; 17: 767.e9–767.e13.

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Editorials

Red‐flagging the prescribing of oral corticosteroids for people with asthma

Christine F McDonald and Christopher J Worsnop

Med J Aust 2020; 213 (7): . || doi: 10.5694/mja2.50777
Published online: 5 October 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Endocrine system diseases

Respiratory tract diseases

Pharmaceutical preparations

High cumulative doses are often unnecessary and can have major adverse effects

The isolation of compound E, later known as cortisone, from the adrenal gland in 1949 led to its use for treating many medical conditions; the first randomised controlled trial of its benefit for people with asthma was published in 1956.1 However, adverse effects are associated with cumulative corticosteroid doses, both with long term continuous use of low dose preparations and with repeated short courses of high dose preparations. The introduction in 1970 of inhaled corticosteroids (ICS) revolutionised asthma management, providing anti‐inflammatory benefits with a markedly reduced side effect profile. Yet many people with asthma are less adherent to ICS use as preventive treatment than their health care professionals would wish. As many as 80% of patients do not adhere to preventive therapy as prescribed,2 and both practical and perceptual barriers to adherence have been described.3

Austin Hospital, Melbournne, VIC

Correspondence: Christine.McDonald@austin.org.au

Competing interests:

Christine McDonald has received speaker’s fees (paid to her organisation) from Menarini and Astra Zeneca. Christopher Worsnop has received speaker’s fees from HealthEd, GlaxoSmithKline, AstraZeneca, Cipla, Boehringer Ingelheim, Mundipharma, and Menarini.

1. Subcommittee on clinical trials in asthma. Controlled trial of effects of cortisone acetate in status asthmaticus: report to the Medical Research Council. Lancet 1956; 271: 803–806.
2. Bårnes CB, Ulrik CS. Asthma and adherence to inhaled corticosteroids: current status and future perspectives. Respir Care 2015; 60: 455–468.
3. Lindsay JT, Heaney LG. Nonadherence in difficult asthma: facts, myths, and a time to act. Patient Prefer Adherence 2013; 7: 329–336.
4. Hew M, McDonald VM, Bardin PG, et al. Cumulative dispensing of high oral corticosteroid doses for treating asthma in Australia. Med J Aust 2020; 213: 316–320.
5. Aaron SD, Vandemheen KL, FitzGerald JM, et al. Re‐evaluation of diagnosis in adults with physician‐diagnosed asthma. JAMA 2017; 317: 269–279.
6. Bateman ED, Boushey HA, Bousquet J, et al. Can guideline‐defined asthma control be achieved? Am J Respir Crit Care Med 2004; 170: 836–844.
7. Eger KAB, Amelink M, Hekking PP, Bel E. Overuse of oral corticosteroids in asthma‐modifiable factors and potential role of biologics. Eur Respir J 2019; 54 (Suppl 63): OA5334.

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Ethics and law

Female genital mutilation or cutting: an updated medico‐legal analysis

Ben Mathews and Elizabeth Dallaston

Med J Aust 2020; 213 (7): . || doi: 10.5694/mja2.50768
Published online: 5 October 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Ethics and law

Health occupations

Social determinants of health

A recent landmark High Court decision both directs and reassures medical and other practitioners in clinical and community settings that no parent or individual can compel this unlawful procedure

Many people from countries where female genital mutilation or cutting (FGM/C) is customary have migrated to Australia and other nations. Legislation in many of these nations prohibits any person, including medical practitioners, from conducting FGM/C.1 Important questions exist about the nature of the prohibition, and lawful and ethical practice in dealing with requested FGM/C. Medical practitioners, community practitioners and religious leaders deserve sound guidance about legal responsibilities and optimal clinical practice.

1 Queensland University of Technology, Brisbane, QLD
2 Johns Hopkins University, Baltimore, MD, USA

Correspondence: b.mathews@qut.edu.au

Competing interests:

No relevant disclosures.

1. Vinois AMA, Mwenda ER, Calimoutou E, et al. Compendium of international and national legal frameworks on female genital mutilation. Washington, DCWorld Bank Group, 2018. http://documents.worldbank.org/curated/en/828661517490252879/ (viewed Mar 2020).
2. McKenna K. Mother jailed in Brisbane for arranging daughters’ genital mutilation in Africa. ABC News 2019; 21 Mar. https://www.abc.net.au/news/2019-03-21/genital-mutilation-brisbane-woman-jailed/10924058 (viewed Mar 2020).
3. The Queen v A2; The Queen v Magennis; The Queen v Vaziri [2019] HCA 35. 16 October 2019. http://eresources.hcourt.gov.au/downloadPdf/2019/HCA/35 (viewed Mar 2020).
4. UNICEF. Female genital mutilation: a new generation calls for ending an old practice. New YorkUNICEF, 2020. https://data.unicef.org/resources/female-genital-mutilation-a-new-generation-calls-for-ending-an-old-practice/ (viewed Mar 2020).
5. World Health Organization. Eliminating female genital mutilation: an interagency statement. Geneva: WHO, 2008. http://www.who.int/reproductivehealth/publications/fgm/9789241596442/en/ (viewed Mar 2020).
6. World Health Organization. Female genital mutilation. Geneva: WHO, 2020. https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation (viewed Mar 2020).
7. Australian Institute of Health and Welfare. Towards estimating the prevalence of female genital mutilation/cutting in Australia. Canberra: AIHW, 2019. https://www.aihw.gov.au/reports/men-women/female-genital-mutilation-cutting-australia/contents/summary (viewed Mar 2020).
8. Zurynski Y, Phu A, Sureshkumar P, et al. Female genital mutilation in children presenting to Australian paediatricians. Arch Dis Child 2017; 102: 509–515.
9. WHO Study Group on Female Genital Mutilation and Obstetric Outcome, Banks E, Meirik O, et al. Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries. Lancet 2006; 367: 1835‐1841.
10. Mathews B. Cultural and technological challenges. In: New international frontiers in child sexual abuse: theory, problems and progress. Springer, 2019: pp. 243‐295.
11. Mathews B. Female genital mutilation: Australian law, policy and practical challenges for doctors. Med J Aust 2011; 194: 139–141. https://www.mja.com.au/journal/2011/194/3/female-genital-mutilation-australian-law-policy-and-practical-challenges-doctors.
12. United Nations General Assembly. 67/146, Intensifying global efforts for the elimination of female genital mutilations. Resolution adopted by the General Assembly on 20 December 2012. https://undocs.org/pdf?symbol=en/A/RES/67/146 (viewed Mar 2020).
13. Mathews B. Legal, cultural and practical developments in responding to female genital mutilation: can an absolute human right emerge? In: Sampford C, Maguire R, Lewis B editors. Human rights and shifting global powers. LondonRoutledge, 2013: 207–227.
14. Mgbako C, Saxena M, Cave A, et al. Penetrating the silence in Sierra Leone: a blueprint for the eradication of female genital mutilation. Harv Hum Right J 2010; 23: 111–140.
15. Muteshi J, Sass J. Female genital mutilation in Africa: an analysis of current abandonment approaches. Nairobi: PATH, 2005. http://www.path.org/publications/files/CP_fgm_combnd_rpt.pdf (viewed Mar 2020).
16. Moeed SM, Grover SR. Female genital mutilation/cutting (FGM/C): survey of RANZCOG Fellows, diplomates and trainees and FGM/C prevention and education program workers in Australia and New Zealand. Aust N Z J Obst Gynaecol 2012; 52: 523–527.
17. Australian Medical Association. Female genital mutilation. CanberraAMA, 2017. https://ama.com.au/position-statement/female-genital-mutilation-2017 (viewed Mar 2020).
18. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Female genital mutilation. Melbourne: RANZCOG, 2017. https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical%20-%20Gynaecology/Female-Genital-Mutilation-(C-Gyn-1)-Nov17.pdf?ext=.pdf (viewed Mar 2020).
19. Royal College of Obstetricians and Gynaecologists. Female genital mutilation and its management (Green‐top Guideline No. 53). London: RCOG, 2015. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg53/ (viewed Mar 2020).
20. American Academy of Pediatrics. Ritual genital cutting of female minors. Itasca, IL: AAP, 2010. https://pediatrics.aappublications.org/content/126/1/191.full (viewed Mar 2020).
21. World Health Organisation. Global strategy to stop health‐care providers from performing female genital mutilation. Geneva: WHO, 2010. https://www.who.int/reproductivehealth/publications/fgm/rhr_10_9/en/ (viewed Mar 2020).
22. The Brussels Collaboration on Bodily Integrity. Medically unnecessary genital cutting and the rights of the child: Moving toward consensus. Am J Bioethics 2019; 19: 17–28.
23. Arora KS, Jacobs A. Female genital alteration: a compromise solution. J Med Ethics 2016; 42: 148–154.
24. Dawson A, Rashid A, Shuib R, et al. Addressing female genital mutilation in the Asia Pacific: the neglected sustainable development target. Aust N Z J Public Health 2019; 44: 8–10.
25. Dawson A, Homer CS, Turkmani S, et al. A systematic review of doctors’ experiences and needs to support the care of women with female genital mutilation. Int J Gynecol Obst 2015; 131: 35–40.
26. World Health Organization. Guidelines on the management of health complications from female genital mutilation. Geneva: WHO, 2016. https://www.who.int/reproductivehealth/topics/fgm/management-health-complications-fgm/en/ (viewed Mar 2020).

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Perspectives

Impact of antivaccination campaigns on health worldwide: lessons for Australia and the global community

Helen Petousis‐Harris and Lisbeth Alley

Med J Aust 2020; 213 (7): . || doi: 10.5694/mja2.50779
Published online: 5 October 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

The arrival of social media coincides with the point at which the antivaccination movement became globally coordinated

The antivaccination movement has roots in the first vaccine, smallpox, although opposition to the practice of artificially inducing immunity reaches back to the practice of variolation. Despite over two centuries of vaccination practice and all the advances in medical science and societal changes that have occurred over this time, the objections still follow the same themes. These have been eloquently described as: vaccines cause idiopathic illness, unholy alliance for profit, vaccines as poisonous chemical cocktails, cover‐up, towards totalitarianism, vaccine immunity is temporary, vaccines are ineffective, and health lifestyle alternative.1 For over two centuries, antivaccination activities, distribution of literature, membership and scientific establishment responses remained unchanged.2

1 University of Auckland, Auckland, New Zealand
2 Immunisation Advisory Centre, University of Auckland, Auckland, New Zealand

Correspondence: h.petousis-harris@auckland.ac.nz

Competing interests:

No relevant disclosures.

1. Leask JA, Chapman S. An attempt to swindle nature: press anti‐immunisation reportage 1993–1997. Aust N Z J Public Health 1998; 22: 17–26.
2. Wolfe RM, Sharp LK. Anti‐vaccinationists past and present. BMJ 2002; 325: 430–432.
3. Ryan J. A history of the internet and the digital future. Reaktion Books 2013.
4. Brügger N. A brief history of Facebook as a media text: the development of an empty structure. First Monday 2015; 20: https://doi.org/10.5210/fm.v20i5.5423.
5. Markowitz LE, Tsu V, Deeks SL, et al. Human papillomavirus vaccine introduction — the first five years. Vaccine 2012; 30 (Suppl): F139–F148.
6. Smith N, Graham T. Mapping the anti‐vaccination movement on Facebook. Inf Commun Soc 2019; 22: 1310–1327.
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Ethics and law

Ethical issues in reproductive genetic carrier screening

Lisa Dive and Ainsley J Newson

Med J Aust 2021; 214 (4): . || doi: 10.5694/mja2.50789
Published online: 28 September 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Ethics and law

Medical genetics

Environment and public health

Women's health

Publicly funded reproductive carrier screening programs must weigh up a number of ethical considerations

Reproductive genetic carrier screening (RCS) is undertaken by individuals or couples to determine their likelihood of having a child with particular autosomal recessive or X‐linked genetic conditions. It can be undertaken by anyone of reproductive age who wishes to have it, regardless of their family history or ancestry, and either before or during pregnancy.1 Some forms of RCS are currently available in Australia on a user‐pays basis, costing around $400–$500 per person. It is usually accessed via general practitioners but can also be accessed directly from testing companies.2 People who receive an increased chance result are offered genetic counselling to explore their reproductive options, which might include steps to avoid having a child with a genetic condition. Taking the test before pregnancy gives those with an increased chance result a wider range of reproductive options compared with prenatal testing.3

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University of Sydney, Sydney, NSW

Correspondence: ainsley.newson@sydney.edu.au

Acknowledgements:

The Australian Reproductive Genetic Carrier Screening Project (Mackenzie's Mission) is funded by the Australian Government Medical Research Future Fund as part of the Australian Genomics Health Futures Mission (GHFM73390 [MRFF‐G‐MM]). The funding source had no direct role in the planning, writing or publication of this article. The authors thank Alison Archibald, Edwin Kirk, Nigel Laing and Martin Delatycki, as well as members of the Mackenzie's Mission Research and Gene Selection Committees, for helpful discussions that informed the drafting of this article.

Competing interests:

Lisa Dive's position at the University of Sydney is funded by Mackenzie's Mission. Ainsley Newson is a Chief investigator with Mackenzie's Mission.

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2. Delatycki MB, Alkuraya F, Archibald A, et al. International perspectives on the implementation of reproductive carrier screening. Prenat Diagn 2020; 40: 301–310.
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Pagination