Ruth Armstrong: Left field

THERE’S not a strong a tradition of playing baseball in Australia, but thanks to our exposure to American language and culture we all know the meaning of the term “out of left field”.

“Left field” is how I came to the MJA almost 17 years ago. Established as a GP, I saw an advertisement for a medical editor training position in a national newspaper. It put a question mark in my head about whether this could be the missing link between my knowledge of medicine, love of written communication and compulsion to advocacy.

It has been just that, although the work of a medical editor provides few left field moments. Change is generally predictable or incremental, and new ideas and findings tend to build on earlier work.

Now and then, however, there’s an unexpected finding to be explored, an idea that approaches a problem from a novel perspective, or an unpredictable turn of events. It’s that kind of a week in MJA InSight.

An observational study from France, published in the BMJ, is the subject of our first news story. The study addressed the increasingly important question of whether people over the age of 70 years derive any benefit from taking lipid-lowering therapy for primary prevention of cardiovascular disease.

Surprisingly, such therapy was associated with a 30% reduction in stroke risk after a mean of 9 years follow-up, but no meaningful difference in coronary heart disease, leading experts to question whether unknown biases and confounders were at play due to the non-randomised nature of the study.

Another left field finding reported in our News in brief section is that, globally, cold weather is a much bigger contributor to mortality than hot weather. The authors of the study, published in The Lancet, correlated weather patterns with more than 74 million deaths over 27 years in 13 countries to make the novel observation, which has been obscured because most research has focused on heat as a cause of death.

A Bill currently before the Tasmanian Parliament, detailed in an MJA editorial, also seems to have come out of left field. Called the Tobacco-Free-Generation, the legislation would make it illegal to sell tobacco to anyone born this century, progressively raising the age of legal tobacco purchase, and thus potentially thwarting smoking initiation as the years roll on.

The private member’s bill was debated in parliament earlier this year, and has some hurdles to overcome before it is enacted but experts commenting for MJA InSight said they supported its ambitious goal.

The idea that a “blanket policy” could be discriminatory seems a bit left field but it was something one hospital administration had to accept when challenged on their written advice to patients that they could not guarantee consultations with same-gender doctors. The rationale for this is outlined in a comment for MJA InSight from public health physician and health lawyer Marie Bismark, with the underlying advice that “unintentional discrimination can still be unlawful”.

As the changes to health funding in the recent federal Budget are slowly fleshed out, some left field revelations are causing disquiet in medical circles. A comment for MJA InSight from federal AMA president Brian Owler highlights the AMA’s response to both the expected and the unexpected components of the government’s latest health policies.

The worst left field moment for a medical journal editor is when you realise your own and your owner’s definitions of editorial independence are so greatly at odds that your role is untenable. As Jane McCredie outlines in her column this week, the history of medical publishing is “littered with editors” who came to that realisation when their owners showed them the door.

No doubt there’s some baseball advice here to help editors stay in the game but, as Jane says, there are no easy answers when the economic models that have long supported medical journals appear to be broken and the ideologies of editors and owners seem to be so much at odds.

Right now as an editor, the baseball analogy I can most relate to is that of Barry Lyga’s protagonist Josh, in the young adult novel Boy Toy.

“I do what I've trained my whole life to do. I watch the ball. I keep my eye on the ball. I never stop watching. I watch it as it sails past me and lands in the catcher's mitt, a perfect and glorious strike three.”

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