In This Issue

Work with us

Over the past few months the federal government has implemented a range of strategies, including deploying military personnel and doctors, aimed at eliminating the abuse of children in Indigenous communities. While this focus, and the promise of an ongoing commitment to the welfare of Indigenous children, is welcome, some Indigenous leaders and groups such as the National Sorry Day Committee have expressed dismay at the lack of consultation reflected in the government’s approach. In “Interventions to halt child abuse in Aboriginal communities”, Ring and Wenitong add their voices to the calls for the government to work with, rather than for, Aboriginal people to address the many factors that lead to Indigenous child disadvantage.

Skin turf wars

With reportedly burgeoning numbers of skin lesion excisions and overuse of flap repairs to close wounds, the management of skin cancer by general practitioners, particularly those working in skin clinics, has come under scrutiny of late. Askew et al add some data to this interesting debate with a national study that shows GPs are treating over half of all non-melanoma skin cancers and over a third of all melanomas, with flap repairs increasing between 2001 and 2005 as a proportion of all excisions (→ Skin cancer surgery in Australia 2001-2005: the changing role of the general practitioner). Meanwhile, Queensland researchers Youl et al found the diagnostic accuracy of regular GPs to be similar to those working in skin cancer clinics (→ Diagnosing skin cancer in primary care: how do mainstream general practitioners compare with primary care skin cancer clinic doctors?). Summing up some of the current controversy, Commens advocates for strengthening medical education in skin cancer management so that all patients have access to competent treatment (→ Skin cancer: changing paradigms of practice and medical education).

Unregulated and untested — naturally

Bioidentical hormone replacement therapy (HRT) regimens, tailor-made by compounding chemists, administered as lozenges or troches and generally more expensive than traditional prescription HRT, are marketed to women as being a natural and gentle HRT alternative. However, in “Three cases of endometrial cancer associated with “bioidentical” hormone replacement therapy” Eden et al warn (with three illustrative cases) that some bioidentical preparations may not contain enough available progesterone to protect the endometrium from the carcinogenic effects of unopposed oestrogen.

Mile-high ketoacidosis

Thought you’d heard all the possible travel nightmare stories? Diabetic patients requiring insulin need to travel with good documentation of their medication requirements and all supplies carried in a clear plastic bag ready to declare to security staff. So says Skowronski, whose insulin-dependent patient ended up in intensive care after being prohibited from carrying his insulin and syringes onboard a flight home from Norway (→ Airline security and diabetes).

Monitor PBS changes

You’ve probably heard about some changes to the Pharmaceutical Benefits Scheme that will save the PBS money by promoting the use, and reducing the price, of generic medications. However, the wisdom of the National Health Amendment (Pharmaceutical Benefits Scheme) Bill 2007 has been questioned by some experts, and the Bill was recently the subject of a Senate Committee inquiry. Articles outlining some of the concerns were published on the eMJA while the inquiry was running, and now appear in print. Faunce warns that the creation of two formularies, in which single brand F1 drugs are effectively protected from reference pricing against drugs in the multiple brand F2 category, will lead to a rise in the prices paid for patented drugs and may reflect an ongoing United States agenda to undermine reference pricing in Australia (→ Reference pricing for pharmaceuticals: is the Australia-United States Free Trade Agreement affecting Australia’s Pharmaceutical Benefits Scheme?). Searles et al believe that categorising drugs in this way may lead to a less evidence-based PBS, and that the cost of generic drugs will continue to be overpriced by international standards (→ Reference pricing, generic drugs and proposed changes to the Pharmaceutical Benefits Scheme). Harvey et al sum up the concerns in a linked editorial, pointing to a way forward that might increase the affordability of medications for both patients and the community (→ The National Health Amendment (Pharmaceutical Benefits Scheme) Bill 2007: reform or fracture?). The inquiry recommended that the Bill be passed but that the Minister report to the Senate on the impact of the reforms in 1 year’s time.

Another time . . . another place

Since I have seen three diabetics in the course of a year die, with remarkably similar symptoms in which there was a peculiar comatose condition preceded and accompanied by dyspnoea, I believe that it . . . has to do with a form of death which . . . bears the closest relationship to the disturbances in the metabolism in diabetes . . . [Kussmaul breathing]