Christine Gee: Open for debate

THERE is probably no better example of how differing opinions can hold up legislation than the proposed $7 copayment for GP and diagnostic services.

Announced in the federal Budget 6 weeks ago, we seem no closer to resolution of the, at times, heated debate over the rights and wrongs of a copayment. The new AMA president Associate Professor Brian Owler made the AMA’s position quite clear last week, writing in the Sydney Morning Herald that the AMA “is supportive of some co-payments, but not the one proposed by the government”.

MJA InSight columnist Dr Aniello Iannuzzi thinks our legislators should consider the equity of the current copayment proposal. Why, he asks in his comment article this week, is there no copayment for specialist services, particularly when “the GP Medicare rebate is paltry in comparison with the rebates for specialist consultations”?

In the next fortnight a new Senate will sit in Canberra and will hold the outcome of this debate in its hands.

Another debate that legislators may have to grapple with is whether e-cigarettes should be made legally available in Australia. The evidence for e-cigarettes is shrouded in as much fog as the smoking area outside a city office building.

In our first news story this week, InSight reports on how leading public health advocates in Australia and around the world are split on whether legislators should regulate the sale and use of this new product.

Debate also swirls around the use of some drugs by mothers while pregnant and when breastfeeding. For women with epilepsy or depression, concerns about the impact of anticonvulsants and antidepressants on their children can put their own treatment at risk.

Our second story this week provides some reassurance about continued use of these treatments during pregnancy and breastfeeding, although, again, the experts are not all reading off the same sheet. Weighing up risks and benefits for both mother and baby is likely to remain a conversation that must be had with each patient.

Risks and benefits are also front of mind when an obese patient seeks advice about bariatric surgery, particularly laparoscopic adjustable gastric banding. Our third news story highlights the need to add revisional surgery to the list of risks for those undergoing a lap band procedure.

And let’s hope that those carrying out the procedure are using a safety checklist to reduce any chance of complications. Yet, not all doctors embrace what is often described as “tick-box” medicine.

In a comment article this week Dr Simon Hendel argues why they should, even in hospitals with low rates of postoperative complications, as there is always room for improvement.

Medicine and its practice are ever evolving as new research brings new wisdom. But in the heat of any debate about medicine, it may be worth remembering the wise words of Michael Palin in his book Diaries 1969-1979: The Python Years: “I am very cautious of people who are absolutely right, especially when they are vehemently so.”

 

Dr Christine Gee is a deputy medical editor of the MJA and acting medical editor of MJA InSight. Dr Ruth Armstrong is on leave.