Melioidosis is endemic in Cairns, with the number of cases increasing since 2015 (here and here). This year, however, there has been an extraordinary season, with more than four times the number of cases in Cairns already than in any prior year. One hundred cases of melioidosis have been reported in…

Following the COVID-19 pandemic, humanity reverted to the small world behaviours that leave us vulnerable, perched as we are on our increasingly dynamic and unpredictable planet. Late last year, we watched the climate conference, COP28, continue the slow walk of humanity’s response to the changing…

Dr Will Cairns explores the challenge of forecasting in complex systems. He writes that even the best forecasting systems cannot make decisions for us; it is up to us as humans to decide the best way forward. As I described in Part 1, my previous InSight+ article (here), atom bomb creator Leo Szilard…

Dr Will Cairns reflects on a chance childhood meeting with the physicist Leo Szilard, inventor of the atom bomb, and wonders about our capacity to address the challenges facing humankind. In 1960–61 my family travelled around the world via Hong Kong and England to my father’s sabbatical on Long…

Death in older people can be a consequence of the natural processes of their decline in biological old age, and there is no need to impose a pathological explanation, writes Dr Will Cairns. Several weeks ago the Australian Institute of Health and Welfare (AIHW) released How long can Australians live?,…

AUSTRALIA’S most popular politician, NSW Premier Mike Baird has been grappling with the dilemma of how to pay for health care. He penned an opinion article in The Australian suggesting that raising the GST to 15% would pay for health care, saying “all funds raised would be directed…

AT a recent palliative care meeting discussing morbidity and mortality, we realised that for many of our patients there is simply not enough room in the “other significant conditions” section of the death certificate to list all their diseases.This observation fed into my thoughts about…

HUMAN life expectancy will increase to 150 years within this century. Really? When I was a GP I used to visit my frail elderly nursing home patients in my lunch break. Frequently I found them fast asleep in front of Days of Our Lives. This gave me pause for thought about how we live out our final years.…

PERHAPS it’s my age, but I seem to have been to more than the usual number of funerals lately, and there have been others for relatives and lifetime family friends that were too far away to attend.Many of the words I heard at the various commemorative ceremonies had the intent of validating the…

FEW doctors would think we can afford to provide all treatments that have been invented — let alone those still to be invented — for everyone who might benefit.By “all treatments” I don’t mean those of uncertain or dubious benefit, but only those that can be shown to deliver…

NOT long ago, I was asked to see a woman in her early 50s who had been diagnosed with advanced and incurable lung cancer.She had been offered chemotherapy that might have prolonged her life for a time, perhaps even a year. This treatment would probably have caused her some unpleasant side effects and…

MANY years ago when I was starting out in palliative medicine, I went with an oncologist to visit a youngish woman who was rapidly deteriorating as a consequence of her advanced cancer.I saw a clear but quickly masked flash of horror cross the face of her husband when the patient said she would be willing…

“Daddy used to say that if he get so old so that he couldn’t drink beer and catch catfish then I had to put him in a boat and set him on fire, so that no-one could come and plug him in the wall.” from the movie Beasts of the Southern Wild I HAVE talked about death with thousands of people over…

The Palm Cockatoo Midwifery Group Practice (MGP) at Weipa Hospital, Cape York Peninsula, has assisted local women to give birth locally rather than travelling 800 km to Cairns. The group wants to make a culturally safe space so that more Aboriginal and Torres Strait Islander women can give birth in…

Women from Weipa, Napranum, Aurukun and Mapoon came together on Alnigth land alongside nationally and internationally renowned health and human rights advocates to draw a line in the sand for health equity. InSight+ journalist Becca Whitehead attended the Western CapeHER in Napranum, Far North Queensland,…

Injectable medications originally developed for the treatment of diabetes are also effective for weight loss, and have surged in popularity for this purpose around the world. In Australia, Ozempic is approved for the treatment of type 2 diabetes, while Wegovy is approved for weight management. Both…

Late last year, an AI-generated video faked the image of a well known endocrinologist and spread dangerous medical advice on Facebook. InSight+ spoke to industry professionals about the effect these fakes have on health and trust. Last year, diabetes patients clicked on a Facebook ad that read: “Managing…

Antidepressants are being overprescribed, but there is limited guidance for general practitioners or their patients when it comes to stopping the medication. A perspective published in the Medical Journal of Australia has called for a re-evaluation of antidepressant prescribing in primary care. Antidepressant…

This week, the MJA published new evidence of the national prevalence of intimate partner violence (IPV). The survey of a representative sample of 8500 Australians adds new knowledge about the prevalence and nature of physical, psychological and sexual violence between intimate partners aged 16 years…

Despite changes to mandatory reporting obligations in 2018, many Australian doctors remain hesitant to seek treatment for mental health concerns, fearing they might be reported to the regulator. Dispelling this perception is vital to ensure doctors seek treatment when they need it. One of the most common…

Are we best served by continuing to pursue high-tech solutions for health care, or should we be allocating funding to more cost effective measures? There is no doubt that new high-tech targeted medical treatments being introduced into 21st century health care deliver great benefits to people. As a community,…

As access to medicinal cannabis in Australia increases, so too does the risk of poisoning, especially in adolescents and small children. A research letter published in the Medical Journal of Australia has examined the rise of cannabis poisoning in Australia since the legalisation of medicinal cannabis.…

It is hoped that the incoming Queensland Government keep Queensland on the path to safe and fully accessible reproductive health care for all women and pregnant people within the public sector. Throughout the 20th century, abortion remained in the criminal legislation of all Australian states and territories,…

The addition of fluoride to drinking water has improved dental health worldwide for over 70 years but is still hindered by misinformation; let’s look at the evidence. In the recent past, it was not uncommon for people to lose the majority, or even all, of their adult teeth before reaching old age.…

Further restrictions on the sale of paracetamol will begin from 1 February. InSight+ spoke with a toxicology expert about the changes. From 1 February 2025, packs of paracetamol will contain fewer tablets, both in pharmacies and in other places that paracetamol is sold. The TGA is also encouraging retailers…

Although there is a potential role for PAs within the Australian health care system, this must be accompanied by rigorous regulatory oversight and governance to monitor their impact. Physician assistants (PAs) have been widely used in the US and now the UK, with approximately 4000 in the UK (referred…

When it comes to allocating finite health care resources, a focus on longevity and “glamorous” high-tech disease treatment has been distracting our attention away from the benefits of disease prevention. Opportunity cost is an economics term that I first heard at a workshop on palliative care and…

Around the country, private maternity hospitals are closing, with enormous implications for many Australians needing care and for the health system as a whole. The COVID-19 pandemic has had profound effects on Australia’s health system, not least of which has been the enduring pressure on our public…

As ANZAC Day approaches, we hear the remarkable story of Major Josephine Mackerras who was turned down for a Member of the British Empire award despite being recommended for the commendation for making significant scientific efforts during the Second World War.  In recent years, much has been written…

The final report of the Aged Care Taskforce is on the right track to improve the sector, but there needs to be more clarity to make sure it’s viable for the future, experts say. Released in mid-March, the final report of the Aged Care Taskforce provides a comprehensive strategy with recommendations…

Declining fertility may help our damaged environments, but will create hugely complex social and economic problems and threaten health care as we know it, writes Dr Will Cairns in Part Two of this two-part series. In Part One of this two-part series on population, I explored how our current low levels…

With the Total Fertility Rate dropping in almost all nations, the world’s human population is expected to fall spectacularly in the next few hundred years, writes Dr Will Cairns in Part One of this series. That we humans are quite good at short-termism is scarcely surprising, given our origins from…

Women with ovarian cancer have been “let down” by institutional and medical biases, the Assistant Health Minister said, as Parliamentarians, advocates and patients gathered for the Teal Ribbon Parliamentary Breakfast in Canberra recently. Christine Crupi was aware of her cancer risk. Her mother…

Our study recommends antenatal care providers reconsider widespread prescriptions for pregnancy supplements, with the need to promote whole food diets in pregnancy instead, write Dr Linda Gallo and Associate Professor Shelley Wilkinson. A well planned and balanced diet is the foundation of a healthy…

We must urgently allocate more resources to upskilling general practitioners to better diagnose and manage Parkinson disease, particularly in regional areas, writes Dr Shanna Fealy. Parkinson disease is the second most prevalent neurodegenerative disease globally, trailing only Alzheimer disease. In…

Health systems need to adopt a workplace culture centred on human wellbeing to build a healthy workplace culture that is fit for the modern era. Psychosocial hazard policies could be effective levers to drive this change. For too long, doctors and other health care professionals across Australia have…

New research has uncovered poor representation of Aboriginal and Torres Strait Islander peoples in trials of parenting programs in Australia. A review, published in the Medical Journal of Australia, found that the specific needs of Aboriginal and Torres Strait Islander families have not generally been…

With Queensland health care workers facing alarming levels of workplace violence and aggression, it is essential for health organisations to adopt a safety culture to stop this bad behaviour in its tracks, writes Dr Elise Witter. A recent night shift I completed in the emergency department (ED) ended…

Under the recently amended Sex Discrimination Act, the medical profession risks attracting the scrutiny of the Australian Human Rights Commission unless sex discrimination, sexual harassment, sex-based harassment, and victimisation of complainants or witnesses are eliminated in its workplaces and training…

The World Health Organization Framework Convention on Tobacco Control Tenth Conference of the Parties will discuss next generation tobacco control policies, as the incoming New Zealand Government receives strong international condemnation for repealing recent tobacco control measures. In November, the…

A new tool, called the Raising Awareness Tool for Endometriosis (RATE), has been developed to help prompt early conversations between health providers and women about endometriosis-related symptoms, in efforts to improve early detection. Endometriosis is a chronic medical condition which, according…

New research has found notable inconsistencies in how different medical schools approach the teaching of women’s cardiac health, prompting calls for more comprehensive education on this topic.   Ischaemic heart disease ranks as the second leading cause of death among Australian women (here),…

Despite recent improvements to abortion access in Australia, inequities remain in access to pregnancy termination. New research has found that access to abortion care in Victoria has improved, but the complex interplay between contraceptive use, unintended pregnancy and induced abortion requires further…

A decision to hand over water fluoridation decisions to local councils in Queensland a decade ago has resulted in more than a million Queenslanders having less access to fluoridated water, putting them at a greater risk of dental disease. New research, published in the Medical Journal of Australia,…

Barriers abound in implementing artificial intelligence across Australia’s health care systems, with Queensland researchers calling for more government funding to take advantage of this emerging technology. Australia’s health care system has been described as “impervious” to the alure of artificial…

Wood heater smoke in the Australian Capital Territory is estimated to cause similar mortality to the extreme smoke of the Black Summer Bushfires of 2019–20, new research has found. The alarm has been sounded about the dangers of wood heater smoke, with new research showing just how deadly exposure…

Despite endometriosis being common among women in Australia, it remains unknown which patients will benefit from surgery, prompting the need for more local research, write Dr Samantha Mooney and Associate Professor Sarah Holdsworth-Carson. Endometriosis is a condition where tissue similar to the lining…

While many other drugs get national attention, a significant number of people still die from heroin overdose. Doctors and the general public could be forgiven for assuming that the “heroin problem” is no longer with us. In recent years, the focus of the media has been squarely on drugs such as methamphetamine,…

An action plan is needed to care for people with lipid disorders in Australia to reduce the burden of cardiovascular disease. Cardiovascular disease (CVD) remains our nation’s biggest killer, with a frequency of one in four deaths due to CVD. In 2020, approximately 56 700 people aged 25 years and…

As 2023 comes to a close, so too does our first year bringing you InSight+ every week. It’s been a challenging year, but also a rewarding one, as the InSight+ team worked hard to bring you the latest medical news and expert opinion with each issue. Before we head off on a well earned holiday, we wanted…

Veterans are exposed to challenging life circumstances after military service, and Australia’s lax gambling regulations make it too easy for veterans to gamble and fall on hard times, write Sean Cowlishaw, Olivia Metcalf and Nicole Sadler. Suicide is a major public health issue globally and in Australia,…

Women’s health is in the spotlight this Wednesday with InSight+ releasing a special issue delivered straight to your inbox. On 30 August, InSight+ will be releasing our first special edition newsletter to all subscribers. The special issue, focused on women’s health, features four exclusive articles…

The Medical Journal of Australia has published an editorial, supporting an Aboriginal and Torres Strait Islander Voice to Parliament. New approaches are needed which place Aboriginal and Torres Strait Islander communities at the heart of discussions and decision making about their futures, according…

A new partnership will allow medical students to train on live emergency aeromedical evacuation flights in the Northern Territory – a service essential to rural and remote health care. Sometimes it is just you keeping a critical patient alive. Emergency aeromedical retrieval staff are highly trained…

Reform, not resilience, is the key to changing the narrative and culture of the medical profession and will save doctors’ lives, write Dr Emma Hodge and Dr Elise Witter. The rampant prevalence of poor mental health of doctors in training is a silent epidemic within the health care sector. The studies…

We must avoid the risk that health care becomes the target for profiteering, writes Dr Will Cairns. The Australian Government needs to take further action to ensure Australian health care remains affordable, and to avoid us heading down the path to health care calamity that is being taken by the United…

It is hoped that a reduction in the maximum packet size of immediate release paracetamol will reduce the harm from intentional overdose, but have the changes gone far enough? The Therapeutic Goods Administration (TGA) has recently finalised their decision regarding paracetamol packet size limits. From…

Health services are increasingly being encouraged to reduce their carbon footprint. The Intergovernmental Panel on Climate Change (IPCC)’s most recent report outlines the significant threat posed to human health by the climate crisis. In turn, health care professionals and organisations are recognising…

New research has found poisonings from modified release paracetamol has not significantly declined, despite being up-scheduled to Schedule 3 (pharmacist-only medicine). A research letter published in The Medical Journal of Australia explores the impact of up-scheduling modified release (MR) paracetamol…

Indigenous health advocates hope that the launch of a new, dedicated First Nations health journal will help Close the Gap, while in a small town in the Northern Territory, six students have made local history by graduating with qualifications in Aboriginal Primary Health Care. Six students have graduated…

General practice and primary care are not an island; they are a significant feature in the complex integrated landscape of our health care system, writes Dr Will Cairns OAM … The Strengthening Medicare Taskforce report was released a few weeks ago. I must say, I was disappointed, not by what it did…

In an imperfect world, hard decisions and sacrifices must be made in order to maintain equity when it comes to allocating the finite resources of our health care system, writes Will Cairns ... IT is not often that the challenges of resource allocation make it on to the front pages of the paper, into…

I AM not ashamed to say that huge swathes of 2022 have completely baffled me. Welcome to the last issue of InSight+ for the year, by the way. We’ve had a cracking year, with our readership growing by about 40% on 2021 by user numbers, and our articles being clicked on just shy of 895 000 times in…

ON a recent flight I sat next to a businessman who was bemoaning the difficulty for workers facing a two-week wait for an appointment with a GP in the small mining community where he does business. He said that the lack of access to GPs was stifling economic development in rural and remote areas because…

A robust system would protect those of us who do the right thing, and a transparent, fair system would take a lot of the stress out of an honest day’s work. That’s going to take time, and it cannot be an excuse for continued expectations that doctors carry the burden of implementing unannounced…

AT some point in their career most doctors will be asked by one of their patients: “Well doc, how long have I got?” This is a question that has many possible underlying meanings for the patient, and any numerical answer is almost certain to be wrong. Generally, we can best help the patient by exploring…

OVER the past few weeks, there has been a flurry of reports on the decline of bulk billing, the shortage of GPs, and the small proportion of medical students and junior doctors who see GP training as their career path of first choice. One might be forgiven for thinking that these problems emerged only…

THE US Supreme Court is very likely to overturn the landmark Roe v Wade pro-choice decision which has guided women’s reproductive rights since 22 January 1973. But what will that mean for Australians seeking an abortion? The answer is complex and contested, but Australians would be remiss to be too…

WHERE you live should not determine if you survive a serious accident, yet people who live in rural and remote Australia are up to five times more likely to die from their injuries than those in major cities. Time is the real killer. The farther you are from a tertiary hospital, your risk of death after…

PROFESSOR Edward O Wilson, who died on 26 December 2021, was a biologist who translated his exploration of the natural world into consideration of why and how we humans have come to be the way that we are, and of our place in the ecology of life on earth. Wilson was at heart a naturalist. Starting as…

IT always feels like a relief moving towards the end of the year, doesn’t it? Like somehow viruses and other global players will take a break just because the calendar is counting down. But if 2021 has taught us anything, it’s that pandemics don’t have much respect for summer holidays. This is…

FEW of us would be happy boarding a flight if we knew that the pilots did not have the knowledge and skills to deal with both the predictable and the unexpected challenges that might threaten a safe landing. Recently, I had a conversation with a pilot friend who (like many of his colleagues) is in the…

OVER the past few weeks, I have noticed that social commentators and journalists have been invoking the “social contract” in their musings. Noisy protests, induced by COVID-19, economic distress and the activities of anti-vaxxers, are forcing us to think about the balance between the rights and…

THERE is an acknowledged disparity in the health and wellbeing of residents of Australia’s rural areas and metropolitan centres. One often overlooked aspect of health inequity is infectious disease transmission and prevention. This is especially true with respect to mosquito-borne diseases that affect…

MANY people have puzzled over why animal species (including us) each have their particular natural maximum lifespans; why it is they deteriorate and die when they do. A new article by Colchero and colleagues in Nature Communications sheds some light on this issue and can help us understand why further…

RECENTLY, I watched a lecture that addressed the impact of global climate change on the future of Australia’s Wet Tropics World Heritage Area. Up here in the north of Queensland, we have the highest mountains in the state, including Mt Bartle Frere (1622 m) and Mt Bellenden Ker (1593 m). Bellenden…

THE global pandemic of SARS-CoV-2 has cut a swathe through healthcare workers across the globe. Significant numbers have died from COVID-19 acquired at work, and each of them has left behind a much larger number of grieving and distressed colleagues, not to mention their families. Many have had their…

FIFTEEN months ago, under the looming shadow of the SARS-CoV-2 pandemic, I wrote an article for InSight+ about the variety of uncertainties in what lay ahead. We did not know how the disease itself (ie, morbidity and mortality) and its disruptive effects on society and the economy at large would play…

IN staffrooms around the country, there are conversations going on about gender equity in the workplace. Medicine is no different. Some say that we have achieved gender equity in medicine, as there are now more commencing female medical students than male (51.3%). They are wrong. Let’s talk facts:…

EVEN before the onset of the COVID-19 pandemic, we have advocated, along with many others, for the public availability in Australia of ethically informed guidelines and protocols for triage decision making in the event that disaster overwhelms our health systems (here, here and here).   These are not…

NOT long ago, I was scanning through a recent edition of New Scientist when I noticed a report on an analysis of ancient human DNA sequencing that described the P1104A allele (variant) of a gene (TYK2) that increases human susceptibility to and mortality from tuberculosis. Kerner and colleagues found…

BORN in 1949, I was a generally healthy child, apart from experiencing several of the then common communicable diseases of childhood – as an infant I had whooping cough and in primary school hepatitis A, mumps, chicken pox and measles. Each of these diseases can kill or cause serious complications…

WHEN I searched Volumes 1 to 3b of the recently released final report of the Royal Commission into Aged Care Quality and Safety for their perspective on the role of palliative care in aged care, I found only limited use of the keywords of my trade: death/dying, palliative care, advance care planning,…

MANY years ago, I looked after a man who was dying at home from a lower body malignancy. He had had significant pain but, choosing not to travel over 1000 km to Brisbane for palliative radiotherapy, accepted an epidural and was being cared for at home by the local domiciliary nursing service and with…

SUMMER holidays are for pondering the past and preparing for the future. At the end of every year, many of us reflect on the events of the previous year and sometimes hark back to simpler times. The past 14 months have given us a jolting reminder of our entanglement in the complexities of the ever-changing…

REMEMBER 2016? That was the year the world lost some greats – George Michael, Carrie Fisher, Debbie Reynolds, Leonard Cohen, Mrs Brady, R2D2, Gene Wilder, Elie Wiesel, Muhammad Ali, Prince, David Bowie, Alan Rickman, Jon English – it was teen hero carnage. We couldn’t wait to see the calendar…

MY fellow [insert collective noun for residents of geopolitical region]. Tonight, as your [insert role description (eg, President, Prime Minister, Premier, Chief Minister etc)] and the leader of our wonderful [insert classification (eg, nation, state, territory)] of [insert name of nation, state or…

The article has been modified slightly from the original written at the invitation of Australia’s national peak body for spiritual care and ageing, Meaningful Ageing Australia, and was first published in their newsletter in June 2020. Reprinted with permission. ALMOST 10 years ago, I wrote a short…

LIKE many people who had been enjoying a bit of light relief on the evening of 22 June 2020, I found myself struggling to try to reconcile the latest episode of “reality TV” MasterChef Australia with the reality of the story of COVID-19 in the Newmarch House residential aged care facility when we…

GREATER understanding of the distinctions between palliative care and voluntary assisted dying (VAD) – among clinicians and the public -- is urgently needed, say experts who have highlighted the complexities in navigating VAD in palliative care in the MJA. VAD was legalised in Victoria in June, 2019,…

BUILDING an understanding of our pandemic is a big challenge when we are up to our necks in a torrent of news, opinion and speculation. While most of us view COVID-19 from within our own interests as a socially disruptive disease that kills a lot of people, it can be informative to take a step back…

OVER the past few weeks, we have seen a rapid increase in the incidence of coronavirus disease 2019 (COVID-19) in residential aged care facilities (RACFs) in Victoria. Understandably, this is causing growing anxiety in the community, and particularly for the families of residents of RACFs. Here in Queensland,…

THE founder of modern triage systems is often said to be Dominique Jean Larrey, a surgeon in Napoleon’s army also credited with the introduction of ambulances to the battlefields of the late 18th century. A swashbuckling figure and master of emergency amputation, Larrey established a categorical rule…

ALMOST no one in Australia will have escaped seeing reports from Italy, the UK and the USA of unimaginable numbers of deaths, overwhelmed hospitals, emotionally drained and fearful health workers forced to make impossible decisions, and patients dying alone, quarantined from the love and support of…

IT IS now several months since the COVID-19 pandemic began to gather over the horizon, much like a cyclone, but with the early warning clouds obscured by the smoke of bushfires. Over that period, the public focus of attention and planning has naturally been on containment and preparation. From the moment…

AS was probably inevitable from the outset (in retrospect), the novel coronavirus (COVID-19) first identified in China in late 2019 is now spreading across the world. COVID-19 is virulent and highly contagious and ideally suited for rapid dissemination through our interconnected global community. Until…

WHILE I was writing my previous article on disasters at a global scale, I wondered what kind of responses would be generated from the medical community by the suggestion that global climate change could disrupt our health systems with catastrophic consequences. Interestingly, only seven comments have…

AN article in a recent edition of The Guardian told of the experiences of Sarah, a woman who died from cancer. The journalist was her husband, Mike Addelman. He told the story of Sarah’s suffering from the moment of the diagnosis and throughout her treatment by the oncology team until she was transferred…

LATE in 2019, I was in my car listening to the radio when I heard a statement from an advocate for more research into the prevention of dementia. It went something like this: “If we could prevent or delay the onset of dementia, then people could die from something else first and we could reduce the…

BY now, after three other articles on disaster management, you probably imagine me to be a miserably pessimistic catastrophiser. Actually, I am generally cheerful and optimistic by nature. However, striving to be like a good chess player (which I am not), I am intrigued about long term complex interactions.…

WELCOME to the last issue of InSight+ for 2019! Forty-eight issues in and we’ve covered a lot of ground – from adolescent concussion to XDR typhoid. This year we formed partnerships with the Black Dog Institute and the Murdoch Children’s Research Institute to bring you regular content. We are…

WHILE working as a junior doctor, I was diagnosed with Hodgkin lymphoma and treated with radiation therapy. During my experience as a patient sitting on the other side of the desk, I discovered the contrast between two seemingly interchangeable terms I had previously used in my regular practice: sympathy…

Son I’ve made a life out of readin’ people’s faces And knowin’ what their cards were by the way they held their eyes The Gambler, words and music by Don Schlitz and sung (most famously) by Kenny Rogers on The Muppet Show THESE words well describe the art of communication in medical practice.…

AS Australia takes its first steps in regulating voluntary assisted dying (VAD), experts say there are many lessons to be learnt from the Netherlands’ 25-plus years’ experience in VAD. In August 2019, 61-year-old Kerry Robertson, who had been living with breast cancer since 2010, was the first person…

FOR many decades now, we have been hearing about the precipitous and ongoing decline of Earth’s systems. Our climate is warming, species extinction rates are tens to hundreds of times higher than background rates, and soon plastic rubbish will outweigh fish in our oceans (here, here and here). It…

THANK you all for your responses to my last two articles on voluntary assisted dying (VAD) (here and here). I will reply with a series of direct responses and supplementary comments that I hope will resolve any lack of clarity about my views – VAD is a complex issue that defies the limits of 2000-word…

SEVERAL weeks ago, I went to a case presentation of a patient with influenza A who had been ventilated and spent 8 days in the intensive care unit (ICU). The patient was part of this year’s unexpected and unseasonal surge in cases across Australia and, given the uncertainty about this atypical event,…

TRIAGE was barely necessary following London’s Moorgate train crash in 1975. The walking-wounded arrived first, covered in soot. Those with more serious injuries trickled in slowly over the course of the day as they were cut from the wreckage when they could be reached. And when, as a medical student…

SUBSEQUENT to the publication of my previous article on palliative care and voluntary assisted dying (VAD), I discovered that a significant misprint had crept in between proofs and publication. Rather than 5%, it should have read: “In Oregon over 90.5% of patients who utilised VAD in 2018 were under…

This article is part of a monthly series from members of the GPs Down Under (GPDU) Facebook group, a not-for-profit GP community-led group with over 6000 members, that is based on GP-led learning, peer support and GP advocacy. IN THE days prior to 4 February 2019, Townsville received over 1100 mm of…

ABOUT 20 years ago, during one of the exacerbations of the at times heated debate about the legalisation of voluntary assisted dying (VAD), someone asked me if, as the then President of the Australian and New Zealand Society of Palliative Medicine (ANZSPM), I would be willing to participate in a discussion…

Cancer risk: one bottle of wine equals 10 cigarettes a week British researchers, published in BMC Public Health, are using the well established link between cancer and tobacco to help communicate links between moderate levels of alcohol and cancer, raising public awareness of alcohol-related cancer…

BUREAUCRATIC restrictions on medical abortions are hurting Australian women and it is long past time they were lifted, says a leading women’s health expert and advocate. Mifepristone, known commonly as RU486, is the drug used to initiate the medical abortion process. It is currently listed by the…

FOR me, the recent comments in InSight+ about the experiences of junior doctors with the current structures for training (here and here) highlight our failure to develop a cohesive long term plan to proactively adapt the medical workforce to meet contemporary expectations for work/life balance and the…

WELCOME to the last issue of MJA InSight for 2018! It’s been another big year for us – 706 783 pageviews for the year, a rise of 24% on 2017 – and that’s down to you, our readers, so thank you from all of us. In 2019, you can expect a couple of changes. MJA InSight will be known as InSight+…

LIKE many of our colleagues, I have been involved to varying degrees in the response to a number of community “disasters”. As a medical student at the London Hospital in 1975, I became scribe for the triage registrar on the day of the Moorgate London Underground crash that killed 52 people. When…

AS a palliative medicine specialist, I eagerly turned to the table of contents of the newly minted Guidelines for the prevention, detection, and management of heart failure in Australia 2018. My hope was that I would find directions to the section addressing the psychosocial and end-of-life care needs…

THIS week, 16–22 April 2018, is National Advance Care Planning Week, which provides the opportunity for us to consider why advance care planning (ACP) is elbowing its way into the heart of health care as a core responsibility for doctors, whatever our field of practice. A recent article in The New…

CARDIOPULMONARY resuscitation (CPR) is a violent activity. Many of those subjected to CPR suffer multiple broken bones or severe internal injuries. For otherwise healthy people who experience a heart attack or an accident, the benefits can outweigh the risks. However, for patients who are dying from…

FOR the past few years, I have been presenting graphs of the data from life tables (from 10 sources that I gathered for my book) that describe the dramatic changes in mortality of the past couple of hundred years. Thinking my ideas relatively novel, I have banged on here, there, and everywhere about…

WELCOME to the last issue – no. 48! – of MJA InSight for 2017. It’s been a big year for the MJA and InSight. The Journal has a new website which has attracted more than 3.2 million pageviews, and, after the correction of a mistake in the way it was calculated, it has a new journal impact factor…

PATIENTS with symptoms suggestive of bowel cancer are languishing on colonoscopy waiting lists in parts of Australia, even though an equally effective triaging test – virtual colonoscopy – could be performed immediately and prevent delays in diagnosis, radiologists say. In a Perspective in the MJA,…

AS I lay on the bed, my consultant engaged with us in a dialogue. The sole purpose of our discussion was that, together with my wife, we would make a wise decision. The consultant explained our options; she described the positives and negatives of all of the possibilities; she encouraged us to take…

“I can only remember one patient who had terminal COPD who killed himself and it came as a complete shock to our team and myself. I know I did not appreciate his existential distress as his physical symptoms seem to have been well controlled.” IN the summer of 1971, after I finished university in…

This article was first presented at a session of the 14th National Rural Health Conference held in Cairns from 26-29 April, 2017. IN April 2016, the fact that Australia rated seventh in the world in terms of life expectancy was headline news. But as everyone who lives and works in rural and remote Australia…

FOR many years I had thought that the title of my sister’s PhD in statistics was Rumour spreading in bees and spread the idea widely before she corrected my misapprehension. I became a figure of family mirth and derision when she told me that actually it was titled Rumour spreading and disease. The…

CONTINUING debate about euthanasia and physician-assisted suicide (PAS) in Australia and around the world needs to take heed of the evidence around the use of these interventions, and the role that psychological distress plays in patients looking to these options, a leading US bioethicist says. In a…

POTENTIALLY severe cases of dengue in returned Australian travellers are slipping through the cracks, as a significant proportion of cases with warning signs of life-threatening infection are going unrecognised, say researchers. A retrospective analysis of confirmed dengue cases at four Australian health…

In Stress and burnout in intensive care medicine: an Australian perspective and Have the courage to act on burnout, Simpson, Knott and Corke have addressed a very important problem, not just for intensivists, but also for many of the other specialists who treat patients with life-limiting illnesses…

WELCOME to the penultimate edition of MJA InSight for 2016, a year that has been both unforgettable and very much in need of forgetting. The deaths of a string of pop culture icons that included David Bowie, Alan Rickman, Glenn Frey, Harper Lee, Jon English, Ronnie Corbett, Prince, Muhammad Ali, Kenny…

WATER-absorbing beads look like lollies, are being marketed as “sensory learning aids” for autistic children, can expand to the size of a golf ball if ingested, and are not detectable by x-rays – what could possibly go wrong? The answer to that is that since 2004, 129 incidents involving water…

ASKED what tools they have to improve the care they offer patients, few doctors or other health professionals would think of data. Better drugs, devices and tests tend to get the credit, perhaps with a nod to better work practices and clinical evidence. But data are no longer the preserve of the statistician…

WHILE driving to work this morning I was contemplating writing a comment on a recent article in Nature that identified that the maximum lifespan for humans is about 115 years and not increasing. Lo and behold, the AM current affairs program on ABC radio put up a short piece about a man who has created…

IT has been suggested that we humans are unique because we do not leave people behind. However, I don’t think that it is quite that simple.First of all, we are not unique in manifesting compassionate and altruistic behaviours. There are many examples of other animals that put their lives at risk to…

RESEARCHERS are calling for new initiatives to reduce the incidence of accidental daily dosing of methotrexate after they identified continuing harm, including deaths, from dosing errors.Writing in the MJA today, researchers reported that eight deaths had been linked to methotrexate dosing errors between…

“We’ll be able to play tennis with our great-grandkids. People won’t spend the last years of their lives in nursing homes; they’ll be able to be productive members of society right up to the end.”    – Dr David Sinclair quoted in McMahon B. The new ageless. Weekend Australian…

OVER the past few years I have been a part of the development of Queensland’s Statewide strategy for end-of-life care. The strategy emerged from a bipartisan parliamentary committee that found, as have other states, a significant need to improve the care of people at the end of their life in our communities.…

LATE last year, The BMJ published a systematic (Cochrane) review of the efficacy of methylphenidate for children and adolescents with a diagnosis of attention deficit hyperactivity disorder (ADHD). The results were reported as suggesting that “methylphenidate may improve teacher-reported symptoms…

OVER the past few months there have been a number of TV public affairs programs and much online commentary about how we might best deal with the inevitability of death. The discussions have explored palliative care, euthanasia, physician-assisted suicide, advance care planning, place of care, futility,…

EXPERTS are calling for action to address the rising prescription rates of ADHD medications, after new research published in the MJA revealed a dramatic increase in misuse and overdoses. Lead author of the study, Dr Rose Cairns from the NSW Poisons Information Centre (NSWPIC) at the Children’s Hospital…

IN Australia, 23 cases of Zika virus (ZKV) infection have been reported in returned travellers from South-East Asia, Pacific Islands and South America since 2012, but widespread transmission here is unlikely for a number of reasons.ZKV infection is a mosquito-borne pathogen that has widened its geographic…

Honey research prompts response from FSANZRESEARCH published in Food Additives & Contaminants: Part A, which found that “all but five Australian honeys tested had more contaminants than the European Food Safety Authority would consider safe or tolerable”, prompted a media frenzy – here, here,…

AUSTRALIA’S health systems and routine practices are Eurocentric and can be discriminatory for Indigenous Australians. Many might protest about this statement and argue that much reform has occurred in recent years, but statistics paint a different picture of the health and wellbeing status…

EXPERTS debating proposed legislative changes to provide a legal defence for doctors who administer medication that hastens or causes the death of a terminally ill patient, have cast doubt over consensus on euthanasia ever being reached.Associate Professor Will Cairns, director of the Townsville Palliative…

REDOUBLING efforts to prevent Indigenous Australians developing end-stage kidney disease is crucial given the social and practical difficulties of delivering complex care such as dialysis and transplantation in remote Australia, Dr Paul Lawton has warned.Dr Lawton, a nephrologist at the Menzies School…

AN innovative GP obstetric training and support program in rural Victoria has been credited with shoring up GP obstetric services in the region, with experts saying it could help to bolster GP obstetric services in rural areas across Australia.The implementation of the Gippsland GP obstetric training…

AUSTRALIA should be supporting young doctors who have skills in biomedical innovation and entrepreneurship, both to improve our health systems and to drive Australia’s transition from a resource-based economy.These sentiments were expounded in the recent Boyer Lecture delivered by Professor Suzanne…

Time to end HIV-positive proceduralists banA LETTER to the MJA has highlighted that Australia is lagging behind the rest of the world when it comes to lifting the ban on HIV-positive proceduralists. This follows the UK’s decision to end the ban for HIV-positive surgeons and dentists who are clinically…

MOST members of the medical profession know of the significant health disadvantage faced by the Aboriginal and Torres Strait Islander population in Australia.Statistics are regularly released in addition to responses such as the Closing the Gap Prime Minister’s report presented to the Australian…

LEGISLATIVE endorsement of patient-delivered partner therapy for chlamydia will be the final stamp of approval for a treatment already in wide use, say Australian experts.Professor Basil Donovan, head of the sexual health program at the Kirby Institute at the University of NSW, told MJA InSight that…

THE recently released “Screening for HIV: US Preventive Services Task Force Recommendation Statement” represents yet another bold step towards an AIDS-free generation in the US.Together with initiatives such as making HIV testing more readily available through innovative methods and encouraging…

INDIGENOUS health experts say research showing substantial increases in reports of child maltreatment in the NT must be interpreted with caution, with one expert adding that the figures are still alarming. A historical cohort study, published in the MJA, found that between 1999 and 2010 in the NT there…

WHEN we pulled up in the driveway of our first rented house in Camperdown, south-west Victoria, a woman’s face appeared over the fence. “Hello”, she said. “Who are you? What are you doing here?” I explained that we were doctors and would be working in the town. “Oh, you got any family here?”…

On 30 August 2012, the Therapeutic Goods Administration (TGA) announced registration in Australia of the drugs mifepristone (Mifepristone Linepharma) and misoprostol (GyMiso) for the purpose of early medical abortion (EMA) up to 49 days of pregnancy. Mifepristone is also registered for “pretreatment”…

EARLY medical abortion using low-dose mifepristone and buccal misoprostol is effective, safe and well accepted by women, according to a large observational study published just as the drugs were registered in Australia. (1) The study, published online by the MJA last Friday, was conducted by Marie Stopes…

MAKING the decision to leave my comfortable city practice for Broken Hill was not easy. I was working 4 days a week, enjoying the theatre, dining out and whatever else the city had to offer. My life was great, if not a little overindulgent. However, as a kid from the country, the lure of a rural practice…

Eliminating dengue is close AUSTRALIAN researchers are optimistic they have developed a way of cutting dengue fever infections, ABC AM reports. Specially bred mosquitoes, incapable of growing the virus that causes the fever, have been released in Cairns and have passed that crucial characteristic on…

Doctor numbers on the rise THE number of doctors in Australia rose by nearly a fifth between 2004 and 2008, according to a report in The Australian. Figures published by the Australian Institute of Health and Welfare showed there were 68 689 employed doctors in 2008, with all but 4600 in clinical roles,…

Sibutramine sales stopped SIBUTRAMINE has been banned from sale after a study showed it could cause a heart attack or stroke, according to a report in the Sun Herald. Pharmaceutical company Abbott announced it would stop distributing sibutramine, sold as Reductil in Australia since 2001, following a…

Gillard points to health policy in pitch to independents and Greens Prime Minister Julia Gillard said Labor's policy platform, including broadband, rural health and climate change, best matched the policy demands of the independents and stood the best chance of passing a Greens-controlled Senate, in…