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SOME time ago, I gave a short presentation to medical students about the role of medical journals in health advocacy.
It was a topic close to my heart. I spoke enthusiastically about the need for advocacy to rise from sound evidence, and the often slow and incremental role of medical journals in bringing objective data to light that might underpin calls for change — the power of the written word.
MJA InSight this week shows some of the ways this process can play out.
Our lead news story involves research published in the MJA that builds on earlier work, and may well be the tipping point for a change in Australian immunisation practice. The use of acellular pertussis vaccine, with its low incidence of adverse events, has seen immunisation coverage rates in children rise in the past decade but the new study adds to mounting evidence of a need to tweak the vaccination schedule to provide the best possible protection.
Sometimes a single patient story is dramatic enough to create a little wave of change of its own. Such is the case of an elderly man who developed a serious complication from warfarin therapy after stopping an interacting medication. An expert commenting for our second news story described the MJA report as a “wake-up call” to prescribers, prompting a need to change the way we think and communicate about drug interactions in general.
In compiling our third news story we encountered a mood for change in the aged care sector. A letter to the MJA, written by an eminent palliative care physician, highlighted the poor medical care we deliver to residents of aged care facilities. A geriatrician colleague broadly supported the author’s proposal of basing specialist GPs in these facilities, but the call for a complete overhaul of health care in the sector came with a warning: “It’s a failure of bureaucrats and politicians. This issue doesn’t get the attention it deserves and in the current political climate I doubt that it will”.
There is increasing frustration that another important health issue is not getting the attention and political will it deserves. According to public health experts writing in The Conversation last week “the world community has dithered for two decades over climate change”.
The recently released 5th Intergovernmental Panel on Climate Change report included a chapter summarising the evidence for the effect of climate change on human health. In InSight this week a comment article by two concerned doctors expresses the need to reframe climate change as a health issue, and encourage doctors to extend “a long tradition of advocacy on public health issues” by getting involved in mitigation efforts.
In my talk on the role of medical journals in advocacy I chose the topic of health and health care for asylum seekers. An example of an article that used objective clinical information to highlight the difficulty of caring for the psychological needs of children in immigration detention was a case report published in the MJA in 2003.
The following year, after a far-reaching inquiry that canvassed evidence from multiple sources, the then human rights commissioner Dr Sev Ozdowski said Australia’s immigration detention policy has failed to protect the mental health of children, provide adequate health care and education and protect unaccompanied children and those with disabilities. He called on the federal government to release detained children immediately.
A decade on, and with about 1000 children in detention, another inquiry into the same issue is underway.
As outlined in an InSight comment by two doctors who visited detention centres in Darwin late last year, immigration detention is still no place for children.
The authors list just a few of the many health bodies that have expressed concern about the physical and psychological risks of prolonged detention. Added to this are the voices of many individuals who have been moved to write persuasively and eloquently in journals, newspapers, blogs, on social media and wherever else they hope to have influence.
We have used our words to call for change. Now we need the will to make it happen.
Dr Ruth Armstrong is the medical editor of MJA InSight.
I’m glad that the MJA is both scientific and concerned about the health of the nation. In the same way that we medicos have been advocates for changes to public policy regarding smoking in the past we continue to have a responsibility to speak up whenever people’s health is endangered by something that we know about. Climate change will have severe effects on public health in the future and detention centres are known to be brutal to the mental health of the inmates especially, of course, the children.
How can we not be advocates? If not us, then who?
I hold misgivings about Ruth Armstrong’s article. First, I do not find the MJA of high quality as scientific journal. And I think that its staff should devote themselves first and foremost to making it so. Being a member of the AMA, its publisher, I feel entitled to make that comment. And secondly, I deplore the current fashion of the tenured doctor pursuing a personal advocacy agenda on the company’s time, and using the company’s impromateur; be it the MJA, a College, a University, or a Department of Health.
I AM SO GLAD YOU MENTIONED CLIMATE CHANGE.
The problem is not whether climate is changing or not. A simple thermometer used regularly sorts most of that out. The problem is what can we do about it?…which brings me to that elephant in the room. While the billions of humans on the planet all need food and shelter and the right to procreate our impact on the planet will continue unabated. Even if you buy a Toyota Prius IT WILL MAKE BUGGER ALL DIFFERENCE.