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.In…

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 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…