Poverty or security
Australia’s foreign aid has been in the spotlight lately, particularly in relation to our neighbours in Papua New Guinea, the Pacific, Indonesia and Asia. As we consider the budget, Zwi and Grove issue a challenge to our aid-brokers, to consider not just national but global and even human security, and to focus our efforts on poverty alleviation (→ Australia’s role in promoting achievement of the Millennium Development Goals).
In one voice
If there is a crisis in Australian heath care it surely revolves around a depleted and demoralised workforce. Although it is in doctors’ best interests to address this, some of the potential solutions under discussion, such as task substitution, have led to dismay and division in the profession. In “Health Workforce Innovation Conference”, Brooks and Ellis report on a recent conference addressing workforce innovation, and in “Debating health workforce innovation”, Van Der Weyden calls for unity as we seek and consider the route to high-quality, safe health care for our patients.
Fit for work?
Just over 3 years ago, seven people died and many others were injured in a train crash at Waterfall, south of Sydney. Could anyone have predicted that the train driver would suffer an episode of ventricular fibrillation, or that the guard’s mental state would prevent him from acting promptly to avert the accident? In “The Inquiry into the Waterfall train crash: implications for medical examinations of safety-critical workers”, Hocking explains the implications of the recommendations of an inquiry into the crash for the conduct of occupational medical examinations for safety-critical workers.
Work it out
For an opportunity to test your spot diagnostic skills, flip to this issue’s Diagnostic Dilemma (Chakraborty et al, “Unilateral limb hypertrophy and shoulder weakness in a 37-year-old woman”). Would you suspect the cause of this patient’s lifelong unilateral arm hypertrophy?
Therapeutic opportunities
Over the past decade, with the introduction and widespread use of disease modifying antirheumatic agents, the outlook for patients with rheumatoid arthritis has improved markedly. Of course, the proviso is that people who will benefit are identified and treated early in the course of the disease. In “Early combination disease modifying antirheumatic drug treatment for rheumatoid arthritis”, Roberts et al provide a useful update on the early signs and treatment options now available.
Osteoporotic vertebral fractures have traditionally been treated conservatively. A relatively new treatment for these fractures, percutaneous vertebroplasty, is becoming increasingly popular but is yet to be rigorously evaluated. In “Clinical outcomes after acute osteoporotic vertebral fractures: a 2-year non-randomised trial comparing percutaneous vertebroplasty with conservative therapy”, Diamond et al compare the outcomes of a group of patients who elected to have the procedure with those of another group who declined treatment.
More medical abortion
An article in the MJA ’ s 3 October 2005 issue called for the licensing of mifepristone in Australia for medical abortion, but not every doctor agrees that this is the best way forward. In a letter to the Editor, van Gend presents another view (→ Mifepristone (RU-486) and limits to abortion).
Pointer to pain management
The treatment of acute pain is another area in which medical thinking has changed with an expanding evidence base. A recently revised document (Acute pain management: scientific evidence) from the Australian and New Zealand College of Anaesthetists, Faculty of Pain Management, is now widely endorsed both in Australia and overseas (Macintyre et al, “Acute pain management: the evidence grows”).
Vaccination evaluation
Pneumococcal vaccination for Indigenous people was introduced gradually in Queensland from 1996 and is now available throughout Australia. Recently, Hanna et al took the opportunity to assess the effect of the program on rates of invasive pneumococcal disease in Indigenous adults and children in north Queensland. They present their findings in “Invasive pneumococcal disease in Indigenous people in north Queensland, 1999-2004”.
Performance enhancement
Imagine being the doctor at the centre of an athlete doping scandal. As outlined by Orchard et al (MJA Practice Essentials — Sports Medicine, “4. The use and misuse of performance-enhancing substances in sport”), an awareness of the legalities of various drugs in sport is essential if you are treating anyone who might be subject to drug testing.
Another time . . . another place
[Poverty] is basically a political problem, whose radical solution will require a return to distributive justice. Why write about it in a medical journal? Because doctors are also citizens; they have opportunities to observe and perhaps to mitigate the effects of poverty; and they should be, in Virchow’s words, “the natural advocates of the poor”.
Sir Douglas Black, 1999