In This Issue

Methadone mystery

A dramatic desquamating rash of unknown cause has been observed since October last year in patients taking methadone in NSW. The rash has not previously been reported with methadone use and is under investigation by state public health units and the Therapeutic Goods Administration. Described in two case reports (Currie et al, and Kordjian et al), the syndrome’s public health significance warranted rapid online publication by the MJA within a month of receiving these reports. An infectious cause appears unlikely and the patients have generally made a good recovery (→ A syndromic rash in patients attending methadone clinics in New South Wales) (→ A case of desquamating rash associated with methadone use).

Registrars' report card

Were you ever left holding the fort (read ward) as an intern while your registrar vanished into theatre all day? Interns at a teaching hospital vented their opinions of their registrars to investigators Lack and Cartmill, who found a surprising dearth of research on a working relationship that impacts on healthcare (→ Working with registrars: a qualitative study of interns' perceptions and experiences). While the report card was positive overall, you may identify with experiences such as being told to check out the canteen menu!

Trial blazers?

Although we all perceive the importance of clinical trials, it is often not so straight-forward enrolling your own patients. When faced with someone who meets the inclusion criteria but who you are also treating as an individual, where do your loyalties lie? Caldwell et al put this and other questions to a group of Australian physicians and paediatricians (→ Barriers to Australian physicians' and paediatricians' involvement in randomised controlled trials).

Childhood leukaemia

Research into childhood leukaemia has taken many forms — from bench-top studies to large clinical trials of therapy. An exciting Clinical Update from Ziegler et al describes some of the ways in which these efforts have paid off in terms of reduced mortality and a better outlook for survivors (→ Advances in childhood leukaemia: successful clinical-trials research leads to individualised therapy).

One size fits some

Patients, doctors and pharmaceutical companies owe a great debt to the long-suffering residents of Framingham, Massachusetts. Thousands of prescribing decisions are made every week on the basis of the Framingham coronary heart disease risk function. It’s being increasingly recognised, however, that it may not be valid to extrapolate Framingham data to other populations. In "Is the Framingham coronary heart disease absolute risk function applicable to Aboriginal people?", Wang and Hoy test its mettle on a rural Aboriginal population.

What does it all mean?

In 2003, four respected international authorities released guidelines for treating hypertension. Although each drew on the same evidence, there were some important differences in recommendations; for instance, only one guideline recommended thiazide diuretics as first-line treatment for most patients. Whether you consider all this conflicting advice to be daunting or liberating, it does throw the evidence base into question. Peverill wonders whether some of the confusion might be related to some of the false assumptions we make when conducting and analysing hypertension research (→ Hypertension guidelines, meta-analyses and clinical trials: do we assume too much?).

Which bank?

Almost three years ago, in the UK, the Wellcome Trust, the Medical Research Council and the Department of Health launched an innovative project called Biobank — a massive study that plans to enrol 500 000 people (1% of the UK population), store their DNA and examine gene–environment interactions. Jamrozik et al consider such an undertaking to be worthy of a Postcard from the UK. They give the project their special brand of treatment (→ Biobank: who'd bank on it?).

Team players

It is estimated that substance use killed 23 000 Australians in 1998 — and cost the community $34.7 billion. Smoking and the abuse of alcohol and other drugs present a major public health conundrum for the Australian Government. In response to this, the Australian Department of Health and Ageing commissioned a review of the evidence for harm-prevention strategies. As Loxley et al discovered by reviewing the 159 contenders, many of the most effective strategies involve government policy and specific programs. Others, however, can be implemented by individual health professionals (→ A new integrated vision of how to prevent harmful drug use).

Paralysis by analysis

Colorectal cancer screening is finally on the move in Australia, with a federally funded pilot study of faecal occult blood testing having commenced last year. What should we be doing for our patients while we await the results? Well, we're spoiled for choice when it comes to screening modalities, but Macrae is prepared to lead the way (→ Screening for colorectal cancer: virtually there).