Ruth Armstrong: Gough effect

ON an ordinary November day in 1975, the deputy principal of my suburban primary school burst into the classroom to loudly announce: “The Governor-General has sacked the Prime Minister”.

His excitement caught on: about half the class erupted in a rowdy cheer, while the rest sat silently exchanging meaningful glances. I expected to witness furious table thumping rather than cheering at home that night, and I was not wrong.

Politics can divide us but with the death of Gough Whitlam last week it’s been amazing to see how memories of his vision, intellect, optimism and sheer determination have managed to transcend politics to inspire almost everyone.

One often repeated Whitlam quote is his instruction to his supporters on the day of his dismissal to, “Maintain your rage and enthusiasm …”.

While this was said in the context of his ill fated ambition to return to power, it is an anthem by which some people live their lives. One of the great pleasures of being a medical editor is being able to provide a platform for the rage and enthusiasm of those who use these two emotions productively to change behaviour and improve health.

Recently in MJA InSight, we have seen plenty of “rage and enthusiasm” from both contributors and readers, with our articles on Medicare, thrombolysis, pharmaceutical representatives and homeopathy.  

InSight contributors also hold passionate views about medical professionalism. In a comment this week, emergency physician Sue Ieraci says doctors’ tendency to “blame and shame” each other for missing diagnoses needs to stop, as it is causing waste and harming patients.

One news story looks at another difficult professional issue: the rare but daunting dilemma of coming into conflict with a patient’s family members in making decisions about end-of-life care. An article published online in the MJA outlining how the courts view disputes about futility was the springboard for this story.

US-based epidemiologist, John Ioannidis, has spent the past decade raging (very politely) against the “sloppy science” that forms the evidence base for medical practice. In her blog, Jane McCredie refers to a recent article by Ioannidis, which begins with a startling calculation that about 85% of research resources are wasted. Two of the problems Ioannidis cites are apparent in our news stories this week.

Another news story relates to data sharing, with the need to define the benefits, risks and costs of percutaneous transcatheter aortic valve replacement (TAVI).  

An Australian study has just been published showing good results with TAVI in patients in whom conventional valve replacement surgery would be moderately or prohibitively risky. However, as the Medical Services Advisory Committee considers whether Medicare should fund the procedure, InSight learned that some centres have been reluctant to share their data, claiming it is “commercial in confidence”.

Our other news story underscores the problem of fragmented, short-term research into new drugs, which leads to delayed recognition of rare or unusual adverse effects. A US study has tried to quantify the occurrence of impulse control disorders in patients taking dopamine agonists but, as in Australia, obtaining this information relies on discretionary reports, meaning that the estimates are likely to be imprecise.

Lack of confidence in the evidence base for practice is an increasingly strident theme in the medical literature. In his article Ioannidis goes beyond the rage to suggest strategies for improvement.

If we applied these strategies to our research efforts they could well be as transformative as some of the Whitlam reforms that the nation has been reflecting on for the past week.

In the meantime, I salute those of you whose rage and enthusiasm is manifested in a passion to improve health. Keep up the good work and remember you’ll always be welcome in MJA InSight.

 

Dr Ruth Armstrong is the medical editor of MJA InSight. Find her on Twitter: @DrRuthInSight