Ruth Armstrong: Global struggles

AUSTRALIA’S relationship with the rest of the world has been under scrutiny recently.

The omission of climate change from the agenda of the G20 summit in Brisbane, rumours and leaks about the Trans-Pacific Partnership Agreement negotiations, and our response to the Ebola crisis in West Africa have been criticised both at home and abroad.

As a small but wealthy country, who should we follow, and how can we lead? How do we balance domestic concerns with global responsibilities, and which of our successes might we export?

These are questions in health care as much as in any other arena, and we touch on a few this week in MJA InSight.

Our lead news story concerns a drug that has been approved for stroke prophylaxis in patients with atrial fibrillation in more than 100 countries worldwide since 2010.

There has been some disquiet in Australia and overseas about the quality of the evidence and the way dabigatran has been promoted and marketed since its initial approval in 2010.

Our story concentrates on two recent “real world”, post-approval US studies with slightly conflicting results that raise important cautions about patient- and dose-specific risks. According to an expert commenting for MJA InSight, the US findings, while informative, might not be directly applicable to Australia, and points to a “crucial need” for local postmarketing data.

In a slightly surprising twist on globalisation, Australians have embraced medical tourism in a big way. When private health insurer NIB announced its foray into the industry earlier this year, the AMA warned that the overseas “surgical holiday” was a recipe for health care commodification, multiresistant infections, and treatment fragmentation.

For our second news story we sought comment on an article published online in the MJA, which asks what the Australian regulators need to do to catch up with medical tourism’s runaway success.

Another MJA online article, which posits a leadership role for Australia in the global policy response to diabetes, is the subject of our final news story.

Published to coincide with World Diabetes Day on 14 November, the MJA article reveals that the world is finally waking up to the immense threat of diabetes and other non-communicable diseases and is ready to plan coordinated global action. Speaking to MJA InSight, experts warned that it will be a long haul, and that the solutions lie outside the health system — in our food policies, lifestyles and public spaces.

In an MJA InSight comment, AMA president Brian Owler argues stridently that, while the health care workers bear much of the brunt of alcohol misuse in Australia, the solutions to this problem also lie outside the health system. Following the AMA’s National Alcohol Summit he called for an end to the current fragmented approach to alcohol misuse, and challenged the federal government “to develop an ambitious, comprehensive, and world-leading national alcohol strategy”.

Owler has vowed that until the government takes up the mantle of leadership in this area, “the AMA will highlight every road fatality, every bashing, every child with fetal alcohol spectrum disorder, [and] every tragedy that arises from our unhealthy drinking culture …”.

Successive Australian governments have shown courageous leadership in tobacco control, most recently by making us the first country to introduce plain packaging of cigarettes.

If our current government accepts the challenge to combat alcohol misuse, Australia has the potential to again lead the world in addressing another important global public health issue.
 

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