IN 1883, the superintendent of England’s Bethlem Royal Hospital for the mentally ill wrote about a groundbreaking project to get patients involved in creating art. “… we have been engaged in painting artistically one of the male infirmaries, and although it has been somewhat…

JUST how far should we go in editing the human genome? Researchers grappled with some thorny ethical issues last week at an international summit on human gene editing hosted by the US National Academy of Sciences. Emerging technologies are making gene editing easier, cheaper and more effective,…

BACK in 2012, the then Labor federal government announced a review of private health insurance cover for “natural therapies”, declaring those that could not demonstrate clinical effectiveness would no longer be eligible for rebates. The government wanted to ensure that the very substantial…

THE shadow of thalidomide is long. Marketing of the antinausea drug to pregnant women in the 1950s and ’60s resulted in an estimated 10 000 babies around the world being born with birth defects and — it’s often claimed — eventually led to the more stringent regulation of…

PUBLIC health advocates have long been frustrated at how hard it is to persuade vaccine-hesitant parents of the safety and benefits of immunisation. One study published last year found educational interventions with parents could actually make them less likely to vaccinate their children. The…

IF you want to gauge the influence of a particular scientific paper, one thing you might do is check Google Scholar to see how many citations it has. The number you see may offer a rough guide to the importance of the research, but there’s no easy way to know whether it represents widespread…

OCTOBER has been a flood of pink again this year, thanks to Breast Cancer Awareness Month, with the colour adorning everything from vitamins to car accessories. Next month, our Facebook feeds will sprout unfortunate facial hair as men show their support for Movember, the annual fundraising effort…

AUSTRALIA’S hardline policies on asylum seekers are in the spotlight again. It was revealed last week that a 23-year-old Somali asylum seeker who was allegedly raped on Nauru received no response to her initial pleas to authorities to be allowed to come to Australia to have the resulting…

THERE’S nothing like a hint of a medical conspiracy to get people’s heart rates up. Among the perennial conspiracy theories are those that claim doctors only promote immunisation because they’re in the pay of the pharmaceutical companies, or that they deny patients’ access…

IN the first century, Pliny the Elder advised against purchasing slaves from the asbestos mines because their life expectancies were short, although he also believed this wondrous material offered protection against all spells, especially those of the Magi. From the 1920s, a growing scientific…

EVIDENCE-based medicine is one of the mantras of our times, but does it always live up to its promise? Few doctors would challenge the need for evidence-based medicine (EBM) to support clinical interventions, particularly ones that carry risks. The commitment to evidence-based practice is, after…

A PROFESSOR of science at one of Australia’s sandstone universities told me a couple of years ago that his department head would routinely schedule departmental meetings for 8 am or 4.30 pm. My informant had got into the habit of hitting “reply all” to emails about meetings to…

A STUDY published recently in The Lancet showing people who work long hours are at increased risk of stroke has had a lot of attention in recent weeks. Working 55 hours a week or more was associated with a 33% increase in stroke risk, compared with working 35‒40 hours, according to the large…

A LEADING philosopher once warned that technological developments in communications would impair memory and other cognitive functions, giving us access to huge quantities of information but depriving us of the wisdom needed to understand them. You might think the subject of that diatribe was Google,…

GETTING the money together to run a clinical trial isn’t the easiest of tasks, particularly when it is for rare conditions where the potential returns are unlikely to be big enough to attract industry support. But for the incurably ill patient, who’s exhausted all conventional treatment…

AMERICAN astrophysicist and all-round media star Neil deGrasse Tyson has been talking up a storm on his current Australian tour. A passionate advocate for science and science education, Dr Tyson last week argued that we need a more scientifically literate population and — even more importantly…

HOW far should authorities go to encourage universal childhood vaccination? The recent “Disneyland” measles outbreak in the US saw almost 200 people fall ill after an infected person visited the theme park. It prompted some tough medicine from Californian legislators. Under new…

AN elderly family friend recently complained to me about a doctor mate of hers. Struck down by a bad cold, she’d asked him for an antibiotic prescription during a visit and was furious at his refusal. Her narrative about what had happened was clear.  She was suffering. He could…

DETROIT oncologist Farid Fata was sentenced to 45 years’ jail this month, in what has been described as America’s worst case of medical fraud. Fata gave massive doses of unnecessary chemotherapy to hundreds of patients, causing permanent injury to many, The BMJ reports. Some of…

TEN years ago, a new regime began in medical publishing that was designed to rein in manipulation of published trial results. From July 2005, the International Committee of Medical Journal Editors (ICMJE) announced member journals would only consider a paper for publication if the trial was registered…

WHAT’S a pharmaceutical company to do when it develops a drug that turns out not to work in its target condition and causes a range of nasty side effects? Bin it, perhaps? A better option might be to invent a new condition to suit the failed drug — and then paint any opposition…

IN 1374, a woman called Agnes of Stratton appeared before the London courts, seeking damages from a surgeon who had failed to deliver on a promise to repair her mangled hand for a reasonable fee. The case was dismissed on a technicality but, as arguably the first medical negligence case in English…

IN attempts to communicate complex science to a general audience, scientists and journalists often look for the colourful detail, the emotive anecdote that will help an audience connect with otherwise abstract ideas. That’s why the individual patient story is a staple part of so many media…

WHEN a woman has prenatal testing to check the genetic health of her fetus, she’s unlikely to expect the test to instead reveal concerns about her own health. But the more we succeed in pulling pull apart the human genome, the more it presents us with unexpected clinical and ethical challenges. Among…

YOU may have seen claims earlier this year that eating a daily dose of chocolate could help you lose weight.The claims were based on research from Germany’s Institute of Diet and Health, which found chocolate with a high cocoa content was a “weight loss turbo”, significantly increasing…

“YOU’D think people would have burnt the nursing homes to the ground”, writes New York surgeon Dr Atul Gawande in his book, Being Mortal.The reason we haven’t, he writes, is because we lack the imagination to find a better way of caring for old people, a way to “make life…

“TO be an editor is to live dangerously”, wrote Dr Martin Van Der Weyden, former editor of the MJA after completing his tenure at the journal in 2011.In an article setting out some of the attempts by interested parties to influence content in the journal on his watch (covering everything…

IN a world where private corporations can patent human genes, it’s encouraging to find examples of information being freely shared for the benefit of humanity.When Jonas Salk was asked in 1955 who owned the patent to the polio vaccine he had invented, he famously replied: “Well, the people,…

RESEARCHERS designing clinical trials often exclude people with multiple health problems for fear they might make it harder to assess the true effects of the treatment being studied.It sounds sensible, but it means drugs often end up being tested on people who don’t bear much resemblance to those…

CANCER patients looking for alternative treatments can find a dizzying array of products and services online, from weird diets and nutritional supplements to coffee enemas and bizarre electrical contraptions.These often seem to come with a side dose of conspiracy theories about mainstream medicine and…

HAS anybody ever died at Disneyland? Some claim the theme park shunts its most unfortunate visitors off the premises before allowing them to be declared dead, presumably in an attempt to preserve Disney’s reputation for unsullied cheeriness.That may be an urban myth but, even if you can’t…

WHAT information do parents need when facing agonising decisions about life-support for a desperately ill child, and how should it be presented to them?Parents’ first port of call will generally be the health professionals caring for their child and, in a shared decision-making environment, their…

A STUDY of fast-food advertising directed at children would seem like grist to the mill for a major international paediatrics journal, especially when the research appears to show companies disregarding their own industry guidelines.But when researchers seek to name and shame big companies, things can…

WHEN we do a Google search, most of us are probably focused on the data we are trying to access.We tend to be less aware that the very search terms we choose are in themselves data — information that can be used by corporations or governments to monitor everything from political movements to consumer…

WE all know the comfort of belonging to a tribe: the agreeable sense that we are among people like us, and the guilty pleasure we may take in despising those in the other tribe.It’s a feature of every primary school playground and, for most of us, continues to play a role in our adult lives —…

‘TIS the season to be jolly … or jolly loose with scientific claims anyway.Actually, it may always be the season for that judging by some thought-provoking research from Cardiff University in the UK.When exaggerated stories about medical “breakthroughs” appear in the general…

THE development of full artificial intelligence could spell the end of the human race, physicist Stephen Hawking warned last week.“It would take off on its own, and redesign itself at an ever increasing rate”, he said. “Humans, who are limited by slow biological evolution, couldn’t…

MELBOURNE woman Caroline Lovell collapsed and died in 2012 after giving birth to her second child at home.    The inquest into Ms Lovell’s death was held earlier this year and heard she had asked to be taken to hospital shortly after the birth, saying she was dying.Sadly, that did…

SYSTEMATIC reviews are often described as the gold standard when it comes to levels of evidence: policymakers rely on them in making decisions about issues as diverse as tobacco control and the management of prison populations.    But not everybody agrees they are a good foundation for…

IN 1837, the family of early Melbourne settler Joseph Tice Gellibrand made the first life insurance claim in Australia after their relative headed out to Victoria’s western district and was never heard of again.They got their £2000, but the supposed circumstances of his death caused something…

WHEN somebody offers to donate a kidney to a desperately ill friend or relative, it’s an act of unparalleled generosity.But what happens if they later change their mind?The ramifications for the two individuals involved, and their broader family or social network, can be huge.Psychiatrist Dr Sally…

IN 1881, the young son of a Chinese merchant in Sydney fell ill with the much-feared disease of smallpox.The succeeding outbreak caused widespread panic well out of proportion to its actual impact, as historian Garry Wotherspoon has documented. In 1881‒82, there were 163 cases of smallpox in Sydney…

IN 2010, global expenditure on life sciences research, most of it biomedical research, was US$240 billion (A$274 billion), according to a paper published in The Lancet earlier this year.That’s a lot of money in anyone’s books. But are we getting value for it?Stanford epidemiologist Professor…

YOU don’t see the word “gentle” in the title of a scientific paper all that often.But there it is atop a paper coauthored by two homeopaths and two prominent Australian medical ethicists, Associate Professor Ian Kerridge and Professor Paul Komesaroff: “A gentle ethical defence…

THE principle of medical neutrality demands that all those who are sick or injured in times of conflict receive non-discriminatory access to care and that health professionals be allowed to give that care unimpeded.It’s rarely that simple, though, when a country is in a state of warfare or civil…

IMAGINE you head a multinational pharmaceutical company and you have a potentially lucrative drug ready to go to market.Only problem is it’s extremely expensive and, although research demonstrates some benefits over existing treatments, these may not be substantial enough to convince health authorities…

WE talk a lot about patient-centred care these days. It’s embedded in the education of future health professionals, in guidelines and in the rhetoric of policymakers and government.As the Victorian Department of Health puts it: “Patient-centred care puts the individual at the heart of all…

A FORMER colleague recently told me about her struggle to get corporate sponsorship for a science communication project.“Oh, no”, a number of potential sponsors had responded. “We wouldn’t want to support anything controversial.”Just when did science, and the communication…

WHEN I worked on a consumer health magazine some years ago, we used to raise an eyebrow at the conflicting health claims that came across our desks.This week’s miracle exercise regimen for building core strength could be next week’s certain path to injury. Today’s super food might…

ANAESTHETIST Scott Reuben was once an influential figure in pain management: his research showing the benefits of COX-2 inhibitors for postoperative pain in patients undergoing orthopaedic surgery was widely cited and influenced clinical practice around the world.Problem was the former professor of…

MEDICAL researchers are rightly required to declare potential financial conflicts of interest when they publish their results, but what of other, more personal, factors that might lead to bias in their findings?    Should, for example, a scientist working on a particular disease disclose…

“LOOK at beautiful pictures, study perfect pieces of statuary, forbid as far as possible the contemplation of unsightly and imperfect models”, was the advice Mrs Emma Drake MD gave to pregnant women in her 1908 instructional manual, What a Young Wife Ought to Know.Medical experts of the…

PSYCHIATRIST Dr Peter Young last week defined torture as “the deliberate harming of people in order to coerce them into a desired outcome”.That, he said, is what is happening in Australian-run detention centres — intentional creation of suffering with the aim of coercing asylum seekers…

EVIDENCE-based medicine is the mantra of modern-day medical practice.It underpins the treatment and advice given to patients and is the basis for mainstream medicine’s critique of non-evidence-based alternative therapies.But what happens when the evidence changes?A recent large Australian study…

IN 2007, a 1-year-old South Australian boy died after the dangling cord from a window blind above his cot became wrapped around his neck.The forensic pathologist in the case, Professor Roger Byard, told the coronial inquest death by hanging was a recognised risk when cots were put next to blinds.  …

IF you’re peddling a seriously unhealthy product, what strategy might you adopt to boost sales?One favourite corporate strategy has long been to seek to associate the harmful product with something healthy and wholesome.Perhaps one of the finest examples was the long-running More Doctors Smoke…

RECENTLY I wrote about the placebo effect, asking whether there were ethical ways for health professionals to harness its undoubted power in their therapeutic relationships with patients.There are no easy answers given that placebo appears to work best when the patient believes they are receiving an…

FACING a distressed teenage patient crying “You don’t understand!”, paediatrician Dr Kelly Curran was tempted to prove otherwise by sharing her own medical history.The 14-year-old girl had just been told her colonoscopy results were abnormal after enduring months of bloody diarrhoea.…

I WALKED past an open doorway in the southern Italian village of Paestum some years ago.It was early evening and, inside the room opening directly onto the street, a body lay on a table surrounded by flickering candles. Grieving relatives sat either side; neighbours came in and out, paying their respects.It…

WANT to stay young forever, cure autism, asthma or Parkinson’s, overcome spinal cord injury, or be rid of the pain caused by arthritis?Somewhere in the world, a clinic will be offering stem cell therapy that is designed just for you.None of these treatments are evidence based, but that’s…

THE first thing I heard as I returned to consciousness after a surgical procedure a few years ago was a conversation about Antarctica.In true nerd style, I felt the need to step in to correct an error made by one of the conversationalists in the recovery room. ‘There are no polar bears in Antarctica”,…

THERE is one treatment for conditions ranging from depression to back pain to irritable bowel syndrome that produces impressive results with minimal side effects. Yet clinicians are often reluctant to prescribe it.Why? Because this particular silver bullet is the placebo effect.Although the mechanisms…

MANY years ago, a friend told me her GP, a man of strong religious beliefs, had repeatedly failed to act on her husband’s requests to be referred for a vasectomy.The doctor never actually came out and said he wouldn’t do it. He just kept letting it slide.    Whatever you think…

FOR much of human history, parents must have needed to be cautious about bonding with their newborn babies, perhaps waiting months or even years until they could be confident of the child’s survival.Although reliable figures are obviously hard to come by, it has been estimated that 40%‒60% of…

I REGISTERED with an Indian surrogacy clinic last week — not because I wanted a baby, but in the interests of research.The clinic estimated it would cost me around $38 000 to acquire twins via surrogacy and a premium egg donor, who was an educated woman of higher socioeconomic status or one who…

WHERE would you expect to find the results of a landmark drug trial more accurately reported — in the general news media or in the scholarly literature?There’s no doubt media outlets often get it wrong when reporting medical stories, but an analysis published by JAMA Internal Medicine last…

WHEN Australian virologist Frank Fenner stood in front of the World Health Assembly to declare the world free of smallpox back in 1980, it marked the first time public health efforts had succeeded in eradicating a major infectious disease.In fact, it’s still the only example of such global eradication,…

DO you remember dysphoric social attention consumption deficit anxiety disorder?The condition first appeared in 2007 when it was said to affect millions of Australians, leaving them with the sense something was missing in their lives.They felt empty after a full day of shopping and didn’t feel…

IT’S not often you see a homeopathy manufacturer in trouble for including an actual therapeutic ingredient in their product, but that’s what happened in the US recently.A company called Terra Medica last month voluntarily recalled 56 products in its Pleo range after the Food and Drug Administration…

IN 1774, when Johann Wolfgang von Goethe was 24 years old, he wrote a semi-autobiographical novel, The sorrows of young Werther, about a passionate romantic who kills himself in a dramatic and ritualistic way because he is unable to be with the woman he loves.Authorities in several countries banned…

SHOULD we have the right to end our lives at a time and in a way of our own choosing, and what role might the medical profession play if we did?I wrote recently in this blog about a philosophical argument that sees no valid ethical distinction between allowing someone to die by withdrawing medical treatment…

IN the late 1960s, before the world’s population hit three billion, a movement emerged with the snappy title of ZPG, or Zero Population Growth.There was even a 1972 movie, Z.P.G. — a dystopian vision of a polluted and overpopulated Earth, in which governments banned giving birth for a generation.…

ON the day of a planned family picnic, an 84-year-old woman shoots herself three times because she cannot see any other way to escape the demands of caring for her 86-year-old husband.After the unsuccessful suicide attempt, she tells doctors she has been planning this desperate action for 2 years, saying…

IS the distinction between euthanasia and withdrawing treatment to “let a patient die” really just a legal fiction?The law and codes of medical ethics see the act of turning off a ventilator as fundamentally different from that of delivering a lethal injection. But should they?  …

A GROUNDSWELL of public opinion, people citing ruined lives and serious health problems — it can be hard for politicians and public officials to stand against that kind of outcry.Sometimes, of course, the upset is justified. Sometimes it is on shakier ground. And sometimes it may even be manipulated…

IF someone living in desperate poverty wants to sell a kidney, do we have the right to tell them they can’t?Expatriate Australian ethicist Professor Julian Savalescu has defended people’s right to sell their body parts:“If we should be allowed to sell our labour, why not sell the means…

FUNDRAISING is big business these days, and hospitals are often at the forefront, wooing major donors, establishing “grateful patient” programs, and actively seeking bequests.But what is the doctor’s role in all this?US medical institutions are increasingly relying on “physician…

“I AM a senior physician with over six decades of experience who has observed his share of critical illness — but only from the doctor’s perspective”, writes Dr Arnold Relman in last week’s New York Review of Books.That all changed when Dr Relman broke his neck in a fall…

WHO guards the guardians? It’s a question that applies to any organisation or group of people charged with monitoring the behaviour of others, whether it’s the police force or pharmaceutical regulatory authorities.A number of researchers have recently turned their attention to a bit of guardian…

GETTING a drug trial off the ground is never easy: regulatory approvals, funding, logistical issues all have to be resolved.But each of those challenges is multiplied exponentially if the potential therapeutic agent just happens to also be an illicit recreational drug.An editorial in the February edition…

“IT’S been six wonderful years of watching people being run over by trucks and electrocuted on their wedding night”,  one of the cast members of The Young Doctors said when the hospital drama became Australia’s then longest running TV soap back in 1982.The program, which…

WE humans are quite good at convincing ourselves that rules are for other people.The less nimble or less skilled might need to comply for their own safety but we can safely cross against the red light or send a quick text while driving to meet friends.I don’t know how scientifically based it is,…

WE’VE heard much in recent years on the potential for clinical researchers’ relationships with industry to skew published research findings, with flow-on effects on prescribing and other aspects of clinical practice.This Cochrane review, for example, last year found industry-sponsored trials…

“I THOUGHT I would just share with you what science says today about silicone breast implants”, US Senator Tom Coburn told a Senate Judiciary Committee meeting in 2005, according to a report in the Washington Post.“If you have them, you’re healthier than if you don’t. That…

THE devastating images from the Philippines in the wake of typhoon Haiyan have probably led many of us to reach for a credit card and make a donation.It’s an easy decision to try to help other human beings in strife.The relief teams that those donations — and taxes — help fund are…

WHAT’S a doctor to do when a patient wants something that is not clinically indicated?Getting out the liquid nitrogen to remove an unsightly skin blemish during a routine GP visit might seem harmless enough, but what about prescribing beta-blockers to help manage exam nerves or agreeing to a request…

COMBINING a Thai beach holiday with a nose job or a bit of bridge work is nothing new, but it seems this kind of medical tourism could soon be covered under Australian private health insurance.At least one Australian private health insurer is planning to offer customers offshore surgery packages covering…

“THE science of medicine alone [among the professions] is kept so carefully concealed from the world, and the art must necessarily be practiced in so private a manner, as renders it difficult for the public to form a just estimate of a physician’s knowledge from the success of his practice”,…

RECENTLY, I wrote about the ethical challenges posed by prospective parents shopping for an egg or sperm donor on the basis of the genetic traits they had to offer.But that concept seems tame in comparison with “in-vitro eugenics”, a term coined by Australian philosopher Dr Robert Sparrow…

IN 2009, health authorities around the world were stockpiling neuraminidase inhibitors such as oseltamivir (Tamiflu) in anticipation of a feared influenza pandemic.Billions of dollars were spent based on the belief the drugs would help prevent and treat the disease, providing a windfall for the pharmaceutical…

IN 1979 Roald Dahl published a novel that was definitely not aimed at his usual market of primary school children.My Uncle Oswald tells the story of Oswald Hendryks Cornelius, an unscrupulous maverick and “the world’s greatest fornicator” who, in the early years of the 20th century,…

DEBATE about the effects of pornography has raged for a very long time.For all I know, the inhabitants of ancient Pompeii may have agonised over the effects of their famous explicit murals on young minds.In more recent times, there have been plenty of studies associating exposure to pornography with…

IN 2005, then Health Minister Tony Abbott famously declared that the Coalition government of which he was part was “the best friend Medicare has ever had”.The comment related specifically to a recovery in bulk-billing rates (which had initially plunged under the Howard government) but it…

WHY do some highly educated, affluent parents decide against vaccinating their children?Health professionals often scratch their heads over the apparent contradiction of “somebody who should know better” making a decision that is not in the best interests of either their child or the broader…

TO get their products approved by regulators so they can access the goldmine that is Australia’s Pharmaceutical Benefits Scheme, pharmaceutical companies need data — and lots of it.Increasingly, that data comes from clinical trials conducted in developing countries, where costs are lower…

A MEDICAL student told me recently he was thinking of adopting a pseudonym on Facebook.Not that he posts anything particularly compromising on the social media network, but he was worried some of the pictures he was tagged in by fellow med students might damage his future employment prospects as a doctor.It’s…

IT’S amazing what plain old water can do if you put enough marketing spin around it.Yes, I’m talking about homeopathy again, thanks to a recent decision by the Therapeutic Products Advertising Complaints Resolution Panel.The panel was responding to a complaint led by the indefatigable Dr…

WE have known for decades that people with mental illness are at greater risk of physical disease and premature mortality than the rest of the community.But that knowledge has not always translated into effective action to combat the problem.Psychiatrist Professor Graham Thornicroft, writing in the…

LIKE many people with an essentially rational world view, I occasionally lapse into superstition.I have even noticed a vague sense of unease if I can’t find a piece of wood to touch when I need to prevent misfortune (and, no, tapping my own head doesn’t cut it).New research from the University…

WHEN Shakespeare’s Juliet lamented “What’s in a name?” she certainly didn’t have disease processes in mind.But how does her argument that names don’t matter — things are what they are regardless of what we choose to call them — stand up when it comes to…

MANY professions have their rites of passage and initiations that leave their survivors bloodied and bruised but confident of their admission to the tribe — perhaps none more so than medicine.The trials of hospital residency — the 120-hour weeks, the procedures performed at the end of a…

FOR decades stem cell research has offered the tantalising prospect of potentially transformative treatments for conditions as varied as macular degeneration, Parkinson disease and type 1 diabetes.At the same time, there are few areas of medical research that have generated as much controversy —…

WE live in an age of self-improvement.Women can have their breasts enhanced. Men can get a silicon six-pack implanted under the skin of their abdomen. (Be warned: this does not look good on a slightly tubby gentleman. I’ve seen pictures.)Anybody with enough space on their credit card can acquire…

IN her book, Tell me the truth: conversations with my patients about life and death, Melbourne oncologist Dr Ranjana Srivastava writes about a patient with advanced gastric cancer.“I want you to tell me how I will die”, the survivor of the Bosnian war said to her. “I have asked a few…

LIKE many people, I have had a somewhat lackadaisical approach to getting an annual influenza shot.If it’s been offered free at my workplace, I’ve tended to do it. Otherwise, I mostly haven’t bothered.As anybody who reads this blog regularly will know, I’m a strong supporter…

ONE of the most chilling scenes I have seen at the cinema was in the 2006 film Little Children.Convicted paedophile Ronnie turns up at the local swimming pool with mask and snorkel to join the crowds of shrieking children in the water. It’s a classic image of the predator, circling below the water…

THE discovery of the “incidentaloma” has long been dreaded by clinicians.What to do about the unexpected nodule found on a scan conducted for another purpose? The patient has no symptoms and it’s probably nothing, but once you know something is there it’s hard to ignore it.These…

IT was good to see the public outcry last week that forced television ads marketing fish oil supplements as a means to improve children’s NAPLAN* scores to be removed.Sometimes, the purveyors of quackery just go too far.And, at other times, they totally get away with it.Homeopathy certainly got…

IN the 19th century, the options for treating measles were limited — bed rest in a darkened room, light food (“diluted milk, vegetable soups, and meal gruels”), perhaps a wet pack.The main challenge for doctors was to prevent respiratory complications such as bronchopneumonia and there,…

WHEN a new pharmaceutical product hits the market, we expect regulators and professional bodies to be rigorous in assessing its safety and efficacy before any recommendation is made to patients. But screening tests? Not so much. Perhaps it’s natural that people are instinctively more worried about…

METAPHORS for the spread of information in our digital age often draw on the language of infectious disease: when an idea really takes off in cyberspace, we say it has gone viral. But what happens when the subject of online interactions is communicable disease itself, or health more broadly? Researchers…

A RECENT article on Asperger’s syndrome in the Good Weekend got me thinking about the way certain diagnoses become part of the zeitgeist. Back in the 19th century, diagnosis of neurasthenia was so popular it was known as “the fashionable disease”. The condition was associated with fatigue, muscle…

BETWEEN 1932 and 1972, the US Public Health Service recruited 399 poor black Alabama share-croppers with syphilis to a study examining the natural history of the disease. Described as the longest non-therapeutic experiment on humans ever conducted, the Tuskegee study has become synonymous with unethical…

WITH genetic researchers building an ever more detailed picture of the role genes play in shaping our lives come ever more complex questions about the right to keep such information private. Most people who have a genetic predisposition to a particular condition will probably choose to share that knowledge…

LAST week I spent some time in the parallel universe of alternative cancer treatments — products that often make huge promises with little evidence to support either their safety or efficacy. I was looking into the so-called black salves, topical treatments that supporters claim have been “successfully…

WHEN Dr Jerri Nielsen discovered a lump in her breast back in 1999, she didn’t have much option but to treat herself. Dr Nielsen was spending winter as the team doctor at the US South Pole research station at the time. With no colleagues to rely on, and no possibility of evacuation before the spring…

THE basis of Australian patent law is the 1623 Statute of Monopolies, an English law designed to rein in the royal power to grant monopolies that were often used as a means of raising funds or rewarding loyal subjects. Patents granted by Elizabeth I and James I had caused considerable unrest, particularly…

IT doesn’t matter how many times a well-meaning expert tells us we’re more likely to be struck by lightning than to be eaten by a shark. Most of us will still be more afraid of the big fish than we are of a summer thunderstorm. And so it is with medical litigation. Despite studies suggesting doctors…

A SYDNEY GP has been ordered to pay $364 000 to a morbidly obese patient because he had failed to refer the man to a weight loss clinic or for laparoscopic surgery. The patient argued the GP was legally responsible for the progression of his pre-existing liver disease to cirrhosis, liver failure and…

RATIONING of health care is always going to be a vexed issue, and never more so than when it comes to neonatal intensive care. A paper published online last week by the Journal of Medical Ethics puts the question bluntly, asking: “Which newborn infants are too expensive to treat?” “We are already…

IN 1946, master of expression George Orwell wrote an essay on “language as an instrument for expressing and not for concealing or preventing thought”. “Political language — and with variations this is true of all political parties, from Conservatives to Anarchists — is designed to make lies…

THE sequencing of the human genome promises unparalleled opportunities to fight disease, identifying the genetic variants that predispose us to various illnesses or protect us from them. In support of that noble endeavour, thousands of people around the world have donated their de-identified genetic…

WHILE doing a research project some years ago, I came across a 19th-century advertisement for a potion called Vitadatio, described as “the great healer of all blood diseases” and “the only genuine Tasmanian herbal remedy”. The tonic cured (bear with me here): “Consumption, Hydatids, Bright’s…

“IT is useless to attempt to reason a man out of a thing he was never reasoned into” is a quote attributed to Irish satirist Jonathan Swift, famous for, among other things, inventing an island of tiny people somewhere off the coast of Australia. I’ve seen variants of the quote ascribed to Mark…

BACK in the 1860s, Mrs Isabella Beeton wrote in her Book of Household Management about the necessary qualities of the wet nurse: “The age, if possible, should not be less than twenty nor exceed thirty years, with the health sound in every respect, and the body free from all eruptive disease or local…

WHY is cracking down on the deadly international trade in fake and substandard pharmaceuticals proving so difficult? The WHO’s Framework Convention on Tobacco Control this month set in place a new treaty designed to combat the illicit international trade in tobacco products. An excellent initiative,…

IN a competitive labour market, it’s increasingly important to have an edge, but how far should we be prepared to go to achieve that? Could CVs soon include information on not just the degrees we have or our work experience, but also the cognitive enhancements we have undergone to improve our memory…

THE rich nations of the world have in recent years become increasingly dependent on doctors and other health workers recruited from developing countries. The practice hasn’t been without its critics, with the WHO’s code of practice saying states should discourage active recruitment from developing…

A FEW months ago, for a conference presentation, I compiled a list of words researchers could use in published papers to increase their chance of getting media attention for their findings. Breakthrough, cure, risk, new, threat, warning, battle, fight and aggressive were some examples. Attach any of…

WHEN a Cochrane Review last week found regular health checks in asymptomatic people offered no benefits in mortality or morbidity, it prompted news stories around the world. “Annual health checks do not reduce mortality” was the headline in the BMJ or, as Fox News put it: “Yearly physicals deemed…

SCREENING embryos for Down syndrome or cystic fibrosis is a common and relatively uncontroversial practice these days, but how far should we be prepared to go in our quest for the perfect child? If tests exist, should we allow parents to screen out low intelligence, emotional coldness, or a predisposition…

ONE of the most enthralling science stories of this year has been the landing of NASA’s Curiosity rover on Mars, with its eerie pictures of arid landscapes and of an ancient dried-up streambed. But where was the balance in these reports? Why didn’t we hear from the Flat Earth Society on why the…

EVIDENCE-based medicine is the mantra of modern medical practice. But what happens when the evidence presented to doctors and the public is flawed, or even actively misleading? British doctor and writer, Ben Goldacre, well known for his skewering of various forms of quackery in his book Bad Science,…

IN the ongoing global war on obesity, New York City’s Board of Health this month voted to ban the sale of super-sized sugary drinks in restaurants and cinemas. It’s a move in the right direction and one Australian regulators might do well to consider, along with more stringent food labelling requirements…

INDIA has long been known as the “pharmacy of the poor” thanks to a thriving generic drugs industry that provides low-cost pharmaceuticals to countries throughout the developing world. Indian generics account for more than 80% of drugs used to treat HIV/AIDS and the country is also the most important…

Electric shock treatment, hypnosis, nausea-inducing medication and psychoanalysis were among the “treatments” medicine offered for homosexuality as recently as 30 years ago. Attempts to cure homosexuality are no longer part of mainstream medical practice, which is perhaps why the case of a Sydney…

THE wheels of public policy grind slowly in this country. Calls for a no-fault compensation scheme for medical injuries date back nearly 40 years — to at least the 1974 Woodhouse Commission, when New Zealand got its no-fault accident compensation scheme, if not earlier. We’re still waiting. The…

WHETHER it’s the “cancer breakthrough” story or the alarmist exposé of a treatment putting “thousands at risk”, it isn’t hard to come up with examples of over-hyped medical stories in the general media. Since 2004, the Media Doctor website run by the Newcastle Institute of Public Health…

IN most Western countries it is generally accepted both legally and by the community that parents do not have the right to refuse potentially life-saving treatment for their children because of their own religious or other beliefs. The best known example relates to Jehovah’s Witness where parents…

The teeth gnashing over Australia’s “poor” performance at the London Olympics has been unedifying, to say the least. Quite apart from the unfair pressure placed on individual athletes, it makes me wonder how we have come to focus so narrowly on Olympic gold medals as the measure of our sporting…

Looking into the side effects of ophthalmic drug Lucentis (ranibizumab) last week, I was struck by how much simpler and easier it was to remember the brand name than the generic— a common experience with prescription drugs. Lucentis uses the Latin word for light as its root; a good marketing message…

It’s an often-lamented fact that Australia has one of the lowest rates of organ donation in the developed world. According to the Australia and New Zealand Organ Donation Registry, about 1500 people are currently on transplant waiting lists in this country, most of whom are in need of a kidney. An…

HOW selective we can sometimes be about science, particularly when our most cherished beliefs are at stake. When it comes to climate change, environmental groups generally treat scientists as heroes, relying on the consensus of experts to bolster their campaigns. Raise the topic of genetic engineering,…

SCIENCE fiction writers often try to imagine the brave new future worlds that will be created by medical advances — the ultimate conquering of disease perhaps, or a nightmare society in which genetic engineering turns us into something less than human. But speculative time travel is a risky business…

AFTER my grandmother fell in the street and broke her nose, I was with her in hospital when a plastic surgeon came into the room. He inspected the damage, turned to an attending colleague and, without acknowledging the patient at all, said: “It wouldn’t be worth operating.” My grandmother hauled…

IN this era of patient empowerment, there’s increasing demand for personal access to medical data, but how many of the following scenarios would most doctors feel comfortable with? • Pathology labs adopting a policy of always communicating routine test results directly to patients as well as their…

POSTMARKETING research into a new drug might seem like an unambiguously good thing. After all, what could possibly be wrong with an attempt to evaluate safety and efficacy in a real-world setting, as opposed to the more rarified environment of the clinical trial? Well, nothing — if that was actually…

IN cases of severe apoplexy, patients could not survive “the greatness of the illness combined with the misery of advanced life”, wrote Aretaeus of Cappadocia in the second century. Happily, these days the prognosis is rather better for people with apoplexy or, as we now call it, stroke. But has…

HOW does an annoying aspect of everyday life get turned into a medical “syndrome”? It’s a question people in the renewable energy industry might well ask as they contemplate the increasingly vocal opponents of wind farms and the raft of assertions made about alleged devastating health effects.…

“THE doctor who fails to have a placebo effect on his patients should become a pathologist”, wrote English neurologist Dr J N Blau back in 1985. The mechanisms of the effect may remain largely mysterious, but placebos have been a central component of the healing arts since prehistoric times. Sugar…

WHEN you hear talk of international drug cartels, your first thought is probably of Colombian drug barons or the poppy fields of Afghanistan. However, there are far more deadly forces at work than those, as a review in The Lancet Infectious Diseases makes clear. South-East Asia and other parts of the…

SHOULD commercial operators be allowed to patent genes? It’s a question that has been sparking debate since at least the 1980s when the first such patents appeared. On one level, the answer seems obvious. As substances found in nature, genes can be considered “discoveries” rather than “inventions”…

REPORTING on suicides has always been a vexed issue for the media. Conventional wisdom and previous media reporting guidelines said the subject was best avoided for fear accounts might encourage other vulnerable people to follow suit. As a result, the phrase “no suspicious circumstances” in media…

THE physician, wrote Hippocrates, “must be clean in person, well dressed, and anointed with sweet-smelling unguents”. But what, assuming you have your unguents sorted out, does “well dressed” mean in the context of modern medicine? A much-cited 2005 study suggested patients had a strong preference…

BACK in 2010, I raised a question about why Australian hospitals and health care providers have been so much slower than their overseas counterparts to engage with patients through social and other online media. A survey of 935 Australian hospitals had found a grand total of three hospital blogs, two…

THIS country’s most prominent anti-vaccination group, the confusingly named Australian Vaccination Network, had a legal win last week when NSW authorities restored the organisation’s charitable fundraising authority. The AVN’s licence to seek public donations had been revoked in 2010 after the…

IF you were considering the various fields a psychiatrist in training might need to study, evolutionary biology probably wouldn’t be at the top of your list. But a group of European and North American psychiatrists recently argued evolutionary theory could help to explain a range of clinical disorders…

WHAT does broccoli have to do with the principle of universal access to health care? Well, if you’ve been following the legal arguments over US President Barack Obama’s proposed health care reforms, apparently quite a lot. In a country where an estimated 50 million citizens have no health insurance,…

I clamped my teeth together, biting down hard. I now held the baby’s legs in my hands, with its head still inside Mathilde. Its blue feet hung down limply over my wrists, lolling to each side. “Come on,” I said to Mathilde. “Another push.” READING GP Dr Susan Fox’s evocative story about…

WHEN a developing country stands up to the might of the pharmaceutical industry and refuses to accept drugs being priced out of the reach of its citizens, it’s tempting to cheer. In a judgment handed down by India’s patent authority this month, pharmaceutical giant Bayer was forced to grant a license…

SOME people with a taste for science fiction claim today’s babies could be the first immortal generation thanks to new technologies that might allow us to switch off the ageing process. But others are warning this could actually be the first generation in centuries to have a lower life expectancy…

“ ‘MIRACLE’ drugs put thousands at risk,” trumpeted a recent front-page headline in a Sydney newspaper. “Thousands of Australians could be taken off cholesterol-lowering medications because of mounting evidence they increase the risk of diabetes and dementia,” the Sydney Morning Herald article…

AT a recent dinner party, a man who did not believe in anthropogenic climate change asked me how I could know it was “true”. When I told him I was relying on the consensus of climate scientists who knew far more about the issue than I did, he replied with an exasperated “Scientists!”, followed…

THE idea of patients making public comments on hospital websites would probably send a shiver up the spine of some Australian hospital administrators, but it’s now standard practice in the UK. In 2008, that country’s National Health Service set up NHS Choices, a website designed to help patients…

LAST December, GlaxoSmithKline was found guilty of irregularities in obtaining informed consent and fined by an Argentinean court in relation to trials of its pneumococcal vaccine, Synflorix, in rural provinces of that country. According to a report in The Lancet, local regulators found parents of some…

THE face-to-face consultation has always been at the heart of quality medical treatment. Despite all the wonders of new technology and the much-touted benefits of telemedicine it’s hard to see that changing radically. Email, stripped of many of the usual cues we use to interpret what other people…

THERE hasn’t been a lot of middle ground in the fiery debate about Australian universities offering courses in the various branches of alternative medicine. On one side stand the Friends of Science in Medicine — 400 or so doctors and scientists lobbying universities to abandon degrees in “quackery”.…

WHEN Socrates wrote that the unexamined life was not worth living, he could not have imagined just how over-examined our lives would become. When we’re not keeping track of our Facebook friends or measuring our online influence score via Klout, we can be collating and sharing the most mundane details…

TRANSPARENCY is the buzz word of the moment when it comes to the pharmaceutical industry’s financial relationships with doctors and other health care professionals. In the US, the New York Times reports the Obama administration is poised to mandate public disclosure of all industry payments and gifts…

AFTER the overindulgence of the festive season come the regrets, the resolutions and — for some in search of absolution — an arcane ritual called the detox. Eating healthily and getting a bit of exercise might be a more productive response, but why settle for an extra serve of leafy green vegetables…

THE master of the short story, Anton Chekhov, famously said, “Medicine is my lawful wife and literature my mistress”. Chekhov’s career as a country doctor in 19th-century Russia provided a wealth of material for his stories and plays, bringing him into contact with people from all classes of Russian…

IT’S a generally accepted principle in preventive health that carrots work better than sticks — giving people an incentive to adopt a desirable behaviour is likely to be more effective than punishing them for an undesirable one. So why has the federal government decided to switch from rewards to…

MOST humans on this planet — past and present — would count themselves lucky to face the health problems we confront today. “What?” the world’s subsistence farmers might ask. “You’re worried about being too fat?” Well, yes, we are, though perhaps we’re not worried enough. The World…

A CURIOUS book landed on my desk recently with the catchy title, Anyone who tells you vaccines are safe and effective is lying. Here’s the proof. Just another anti-immunisation crank, you might think, except that the author is one Dr Vernon Coleman, an English GP who, according to the cover endorsements,…

VITROLIC reviews on sites like TripAdvisor, where consumers rant about the rudest waiters in town or the giant cockroaches that ruined their dining experience, often raise a chuckle. All harmless fun you might think. But what happens when anonymous online reviewers turn their attention to doctors rather…

ANYBODY who wants to make a quick buck should go into the hair removal business — it is probably one of the best options around. With contemporary fashion mandating a war on body hair, and customers prepared to pay through the (depilated) nose to comply, it’s an unparalleled business opportunity.…

THE guttural cougher behind me and the explosive sneezer to my right did not really help when I saw Contagion last week. Perhaps the world’s first epidemiological thriller, the new Steven Soderbergh film imagines what might happen if an entity like the bat-borne Nipah virus ever became reassorted…

THERE was much celebration when physicist Brian Schmidt won a Nobel Prize this month for his research into the expansion of the universe, and quite right too. But does our focus on the Nobel lead us to neglect some of our other worthy research and science heroes? A group of Melbourne neuroscientists…

IT’S no secret that Australians today are having children later in life than previous generations. Australian Institute of Health and Welfare figures show the average age of Australian women giving birth in 2008 was 29.9 years, up by about a year on the 1999 figure. We know that women bearing children…

A COUPLE of years ago, British psychiatrist Professor David Nutt landed in hot water after he wrote in the Journal of Psychopharmacology about an addictive behaviour that caused injury once in every 350 uses. He cited traffic accidents, neurological damage and deaths. He found that the risks of the…

PHARMACISTS have long felt like the poor relations in the broader family of health professionals when it comes to status and respect, if not monetary reward. In recent years, their representative bodies have lobbied for expanded prescribing rights, for recognition of their role as front-line “clinicians”…

WHEN research published in a medical journal this month reported that 10% of mental illness in women was caused by abortion, it was no surprise to see the news picked up by anti-abortion websites around the world. And it wasn’t a surprise to see the sensational findings receive uncritical coverage…

THERE has been a lot of doom-saying lately about the state of the family and the damaging effects this can have on children. A report this month by University of Sydney law professor Patrick Parkinson made front-page news around the country when it drew a link between the decline of traditional family…

AS waistlines expand and our lives become more sedentary, the devastating impact of chronic disease rises inexorably across both the developing and developed world. Next week, the United Nations will be shining a spotlight on what it calls the global epidemic of non-communicable disease at a landmark…

YOU almost have to be a hermit these days to avoid substantial amounts of your professional and personal information being available to all and sundry online. It could make privacy concerns over personal electronic health records seem so 1990s. At least that would appear to be the conclusion reached…

FANCY some liposuction with your beach holiday? Or perhaps some cosmetic dentistry? Then Thailand has the package for you. Those looking to purchase a kidney or engage in some experimental stem cell therapy are more likely to pack their bags for India, assuming they are not overly burdened by ethical…

BACK in 1997, the movie Gattaca painted a picture of a technological dystopia where citizens conceived the old-fashioned way without the benefits of genetic manipulation formed a despised underclass. The best science fiction is really always about us and the kind of society we are capable of creating.…

IT’S good to see the federal government finally paying some serious attention to the desperate needs of disabled people and those who care for them. The government’s announcement last week that it would move to set up a national insurance scheme, as recommended in a Productivity Commission report…

STOP the presses! It has been proven that most women worldwide do not experience orgasm. Or so the good folk at the Advanced Medical Institute would have us believe. I received another little black envelope from AMI in my letterbox last week. After getting one of these last year, I wrote about the way…

GPs can get pretty creative requests for medical certificates at times, whether it’s workers taking a sickie or students looking for an extension on an assignment. But some campaigners against mandatory bicycle helmet laws seem to be particularly optimistic about the outcome of their visit to the…

JOURNALISTS have long known that the T in TGA doesn’t stand for transparency. Getting an answer from Australia’s drug regulator in response to even the most routine query can be a task of Sisyphean proportions. Questions to the Therapeutic Goods Administration must generally be submitted in writing,…

IN the past few weeks there has been a lot of news about socioeconomic disadvantage being linked to poorer health outcomes. We tend to shrug and say, nothing new there. But is that really an adequate response? Yes, we’ve known for a long time that people of lower socioeconomic status have higher rates…

THE New York Review of Books isn’t necessarily where you expect to see a former editor-in-chief of the New England Journal of Medicine deliver a blistering critique of contemporary psychiatric practice. But that is what Dr Marcia Angell, who now teaches at the Harvard Medical School, has done in a…

THOSE do-good wowsers will stop at nothing in their never-ending quest to control our lives. They’ve made us wear seatbelts and bike helmets, taken all the fun out of a good old bake in the sun and now they want to stop fast-food institutions from advertising to little children. Fortunately, somebody…

HIGH-profile cases of doctors behaving badly always raise the question of why colleagues did not step forward earlier to sound the alarm. How did Dr Jayant Patel manage to keep operating for as long as he did at Bundaberg Hospital? And why did it take so long for the murderous Dr Harold Shipman to be…

THE law of defamation is there to protect us all from malicious or untruthful scuttlebutt — and a good thing too. But surely things have gone too far when it becomes easier for commercial interests to make unsubstantiated claims about health products than it is for a doctor or scientist to criticise…

THE spectre of thalidomide looms large, despite its rehabilitation in recent years as a cancer treatment. As you’d expect, patients taking the teratogenic drug are given detailed advice about contraceptive precautions — or at least they should be. But what happens when this clinical imperative collides…

AS the federal government prepares for another attempt to means test the private health insurance rebate, isn’t it time we had a proper discussion about this controversial element of our health system? A lot of claims are made on both sides, but finding clear evidence about the rebate’s impact on…

WANT to raise a little Sam Stosur or perhaps a (not so little) Ian Thorpe? If hot-house parenting is your thing, you might want to make sure your investment in coaches and nutritional supplements is well targeted before you start the campaign. After all, you wouldn’t want to get up at 5 am every day…

RISK-TAKING behaviour in young people is hardly news. Some evolutionary psychologists suggest that such behaviour, especially in young men, can be a high-stakes mating strategy. The man who slays dragons and rescues princesses may risk dying an untimely death, but he also stands a chance of reaping…

LONG-TERM goals are all very well, but not if they allow us to defer doing the things that need to be done right now. Is it time the federal government shifted its focus away from the commitment to closing the 17-year gap in life expectancy between Indigenous and other Australians within 20 years to…

EVER wondered what happened to Andrew Wakefield, the discredited doctor whose claims of a link between the MMR vaccine and autism led to a slump in immunisation rates around the world? Well, he’s alive and well and still winning over audiences in Texas, according to this story in the New York Times…

WHEN the COX–2 inhibitor rofecoxib (Vioxx) was withdrawn from the market in 2004, the focus of doctors and the media was — understandably — on the cardiovascular risk for patients who took the drug. As a journalist covering the story at the time, I never considered that allegations that the manufacturer…

LIKE many patients, when faced with a difficult health decision I have occasionally asked a treating doctor, “What would you do in my position?”. When a doctor has prefaced a recommendation with the words “If it were me …”, I have tended to give more weight to the advice than I might have…

AS scientist and author Isaac Asimov put it: “The most exciting phrase to hear in science, the one that heralds new discoveries, is not ‘Eureka!’ but ‘That’s funny …’.” Alexander Fleming probably said something like it back in the 1920s when he noticed a strange mould eating up the bacteria…

IT’S hard to believe anybody would still use a solarium. Tanning salons seem so, well, 1980s, along with big hair and big shoulder pads. And we know how dangerous they are: several studies have established a link between solarium use and increased risk of melanoma and squamous cell carcinoma. Australian…

THE ability of unwashed medical hands and equipment to transmit disease from one patient to the next was a 19th century discovery. So it is puzzling that, 150 years after Hungarian physician Ignaz Semmelweis discovered that the puerperal fever killing his obstetric patients was actually transmitted…

WHEN I lived in Italy, public drunkenness was so rare it would bring people out on the street, in the way we might gather to gawk at a passing circus elephant. “Ubriaco (drunk)!” people would cry, laughing as they pointed out the curious sight to their children. You’d be kept pretty busy if you…

IN 1860, the editor of the Australian Medical Journal had this to say about women who wanted to become doctors: “… a woman who voluntarily devotes herself to a state in which the abandonment of the domestic qualification seems a necessity, is a being whom men do not love and with whom women can…

IT’S hard to argue with the theory behind advanced care directives: allowing people to specify the level of medical care they wish to receive ahead of time should help to prevent unnecessary interventions and improve their chance of a peaceful death. But few things in life, or its ending, are that…

MORE than 3000 students around the country have just started taking their first steps on the long road to a medical career, with all the excitement and trepidation that entails. There’s no doubt we need them, but will our struggling health system be able to give these young people the education they…

I RECALL seeing a TV comedian talking about obesity figures that showed Australia riding high in the international rankings. “Is there anything we’re not good at?” he quipped. Well, if there was a gold medal for obesity, new figures suggest Australia would be a serious contender. A landmark global…

WANT to earn a million dollars for a little bit of research? All you have to do is prove homoeopathy works. Magician, escape artist and outspoken North American sceptic James Randi may be offering the incentive in the confidence he’s never going to have to pay up, but the supporters of homoeopathy…

WHY is it so hard to get our act together on palliative care? We’re talking about an intervention that improves patient and carer wellbeing, reduces costs to the health system, and may even extend life expectancy — yet we struggle to offer it to many who would stand to benefit. Melbourne oncologist…

A YOUNG woman recently described to me medical examinations she experienced in childhood — lying legs apart on a metal table as medical students watched a senior colleague insert a finger into her prepubescent vagina. Bonnie was subjected to these attentions because she has complete androgen insensitivity…

A TEARFUL patient fronts the TV cameras: a mother of two young children, she’s battling a life-threatening illness and has mortgaged her house to pay for a new wonder drug that penny-pinching bureaucrats are refusing to fund. Who do you think will win this particular public relations war? The policymakers…

MEDIEVAL churches used to engage in vigorous argument over which of them owned the “authentic” foreskin of the circumcised Jesus Christ, the only part of him believed not to have ascended bodily to heaven after the resurrection. At one point, as many as 18 churches are supposed to have asserted…

HANDS up all those who think 2011 will see an end to the federal/state “blame game” over provision of health services. Nobody? I thought so. There’s no doubt the current system, with the federal government largely (though not entirely) responsible for primary care while the states run the hospitals,…

A PSYCHIATRIST who missed out on a job because of explicit drunken photos on Myspace, a doctor rejected by employers because a Google search revealed an interest in witchcraft, a doctor facing potential defamation charges for posting a blast about a colleague’s alleged incompetence on a social networking…

WHEN Frank Fenner graduated from medicine in 1938, Australia was in the grip of a polio outbreak. As a fifth-year medical student, Fenner had responded to a plea for help from the Metropolitan Infectious Diseases Hospital in Adelaide, where (as he documented in his 2006 autobiography) he found himself…

IMAGINE a proven, demonstrably cost-effective treatment for a common debilitating condition but we don’t make it available to the majority of sufferers. Sounds improbable? Not if the condition is obesity. Although governments around the country have expressed support for increasing the availability…

AS if nose jobs, boob jobs and Botox injections weren’t enough, an increasing number of women are apparently now looking to get their genitals “recontoured” in the never-ending search for bodily perfection. The Sydney Morning Herald reported last week on a surge in demand for vaginal cosmetic…

ONE of the big challenges facing the health sector in the brave new digital world is how to best use social media and other technologies to engage with patients. In recent months, I’ve written about US surgeons tweeting live from the operating theatre and about an Australian doctor who got into trouble…

AN intemperate reader contribution in the Sydney Morning Herald got me thinking about all the hours I’ve spent flicking through ancient magazines (or, more likely, trying to get some work done) in various doctors’ waiting rooms. It used to be accepted that waiting till well past your appointment…

HARM minimisation vs zero tolerance: it’s a debate that just won’t go away in areas ranging from sexual behaviour to illegal drug use. Those who argue for harm minimisation have to deal with complex, often murky, ethical choices. Should a doctor who knows their patient is engaging in dangerous,…

THE “science of empathy” might sound like a contradiction in terms, but could this new field of knowledge help doctors improve clinical outcomes for patients and reduce their own risk of burnout? Psychiatrist Helen Reiss thinks so. Neuroimaging is helping us understand how our brains process the…

AUTHORS of scientific breakthroughs are often referred to as “the father of” whatever new field they usher in, but the term is particularly appropriate for Robert Edwards. Edwards was awarded the Nobel Prize in Medicine last week for his pioneering work on in vitro fertilisation (IVF), which is…

“DOCTORS caught revealing secret patient information in Facebook posts,” trumpeted the headline in Sydney’s Sunday Telegraph recently. And it got worse. “Doctors have been disclosing sensitive medical information — and even mocking patients — on Facebook,” the article said. Dozens of people…

THE SMALL black envelope in my letterbox was marked ADULTS ONLY. In smaller letters, it promised medical information was inside. Most of us send our junk mail straight to the recycling, but this was clever packaging and I bet I wasn’t the only one to break the seal. I should have guessed the package…

NEW DRUGS have to jump through all sorts of hoops to get approval for marketing in Australia, but once they’re out there, it’s a different story. Experts have been calling for a more coordinated system for monitoring drug safety in Australia for years – and particularly since the September 2004…

It used to be said that pneumonia was the “old man’s friend”, allowing a gentle decline into oblivion at the end of life. But such a simple death is becoming an increasingly rare phenomenon, as technology offers an ever-expanding array of means to prolong life. The seemingly endless menu of possible…

Ever wondered why the tobacco industry cares so much about Australian moves to bring in plain packaging of cigarettes? Surely they don’t think people smoke because they like the stylish gold box or the picture of a large mammal with a hump? Or that brand loyalty will disappear just because the packs…

How does one of the world’s leading medical journals come to publish an article that finds a medical intervention is no better than sham treatment but goes on to recommend it as possible first-line therapy? That was one of the questions being asked in the medical blogosphere after the New England…

The independent candidates and one Greens member fielding calls from their new best friends in the major parties are a mixed bag in terms of background and ideology. Pity the Labor and Coalition strategists scrambling to find a blend of policies – and, let’s face it, bribes – that will appeal…

It could have been a suburban school hall circa 1985 rather than Canberra’s National Press Club in the middle of an election campaign. Health Minister Nicola Roxon was every inch the school prefect, earnest and sincere when presenting her own arguments, deeply concerned when listening to opponent…

“You don’t see geriatricians driving around in Porsches,” a member of that profession once said to me. He had a point. Findings from the largest ever survey of Australian doctors’ earnings, covered by InSight two weeks ago, put geriatricians near the bottom of the list. The outright winners…

Vaccination is perhaps the classic case of balancing the general good against individual freedom. Just as we limit the right to free speech by saying it is not OK to shout “Fire!” in a crowded cinema, we limit the right to refuse medical treatment by saying that all children should be immunised…

Am I the only one missing the days when Julia Gillard and Tony Abbott actually had forthright exchanges about matters of substance? Even the worm couldn't get excited about last night's debate. When the two faced off in the health portfolio, their encounters were often fiery, funny, even disconcertingly…

Sports teams around the nation must be quaking in their boots at rumours Geoffrey Edelsten is looking to sell an interest in medical clinics with a value estimated in media reports at as much as $200 million. When the flamboyant former GP was spending big in the 1980s he famously bought the Sydney Swans…

When surgeon Craig Rogers, Director of Robotic Renal Surgery at the Vattikuti Urology Institute at Henry Ford Hospital in Detroit, Michigan, set out to remove a patient’s renal tumour, his plan was to do everything he could to save the organ. But he was temporarily taken aback when he saw the size…

IT'S a fair bet that Kevin Rudd won’t be doing a spell on the psychiatrist’s couch to help him through the trauma of his dramatic ousting from the leadership. Psychiatrists probably rank just above miners in Rudd’s personal lexicon of favourite professions these days, in the murky depths below…

It’s been a privilege to write for Insight+ these past 12 years, exploring that rich vein. To all who have read and engaged with what I’ve written, thank you. WHAT do Gwyneth Paltrow’s jade vaginal eggs, the wisdom of Socrates, and the multiple foreskins of Jesus have in common? They’ve all…

YOU’VE probably seen some of the headline findings of the 2021 census over the last couple of weeks: we’re an increasingly multicultural society, we’re decidedly irreligious, and the millennial generation is overtaking the baby boomers as the dominant age group. The usefulness of the census is…

Medicare: You have been in close contact with someone who has Omicron. Please follow the link below to order your PCR kit… WHEN I received this text last week, there was a microsecond of anxiety. “Oh no, here we go again” was my first thought, swiftly followed by the realisation that Medicare…

A DECADE ago, a new genre of speculative fiction began to be featured at writers’ festivals: “cli-fi”, dystopic stories set against a backdrop of catastrophic climate change. More recently, a novelist told me the term was no longer useful: “All fiction is climate fiction now,” they said. The…

MUCH has been written about the potential long-term effects of the COVID-19 pandemic, including potential cardiovascular risks, the impact on mental health and of course long COVID. But an increase in facial dysmorphia, along with the resulting demand for cosmetic procedures, might not be the first…

HISTORIANS of the future may find Australia’s 2022 election campaign somewhat puzzling. They’ll see lots of talk about the cost of living – and fair enough – as well as plenty of chest thumping about national security. Climate change is there too, although I’d be prepared to bet our future…

WHEN functional magnetic resonance imaging (fMRI) technology was developed in the early 1990s, hopes were high: the ability to look inside our working brains, to see how they fired in response to stimuli or when undertaking cognitive tasks would surely be a powerful clinical tool. Potential benefits…

DEPENDING on where you live in Australia, you may have been feeling a bit jittery and uncertain in recent weeks. No, I’m not talking about the upcoming federal election, but the end of daylight saving in those states that observe the practice. That bi-annual shift in our clocks has always been controversial,…

TENSIONS between government and the research community are hardly new. Researchers will always want more money. Governments will always want to hand out the cash for electorate-pleasing roads and sport facilities. The first-century Roman poet Juvenal knew what he was talking about when he wrote of political…

EVERYBODY loves a hero, whether it’s Cathy Freeman winning the 400 metres at the 2000 Olympics or the people rescuing flood victims from Lismore rooftops in their tinnies. Perhaps the archetypal image of the modern hero is that of the firefighters rushing into the World Trade Center towers immediately…

BACK in 2008, psychologist Jeffrey Arnett wrote a much-cited article criticising American psychology research for focusing almost entirely on just 5% of the human population (Americans) while claiming to reveal generalised truths about the whole of humanity. His examination of research published in…

LOOK through book best-seller lists, and you’ll see one genre that towers over all the others. No, it’s not romance or crime fiction, but what might loosely be called self-improvement, an unruly grab-bag of works purporting to hold the secret to getting rich, thin, decluttered and, above all, happy.…

MOST of us probably assume we can trust the research we read in peer-reviewed journals, assuming it has been honestly reported, or at least that the study has actually been conducted. But are we wrong? Former BMJ editor Dr Richard Smith suggested in a 2021 blog post research fraud was now so widespread…

THE English word chaos derives from the ancient Greek “khaos”, meaning a vast chasm or void, at times designating the emptiness of the universe before creation, at others the abyss of the underworld. It was the Roman poet Ovid who brought the term closer to its contemporary meaning, seeing chaos…

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…

IT’S often said that, when you compare somebody with an opposing point of view to the Nazis, you’ve lost the argument. If that’s true, a letter I received last week didn’t take long to self-combust. “The mainstream medical media in Australia are no better than the Nazi Party propaganda machine…

“Then God said, ‘Let us make humankind in our image, according to our likeness; and let them have dominion over the fish of the sea, and over the birds of the air, and over the cattle, and over all the wild animals of the earth, and over every creeping thing that creeps upon the earth.’” –…

NOT that long ago, Tasmania’s opium poppy industry was widely lauded for the economic boost it offered the island state. The poppies not only offered farmers a far more lucrative crop than potatoes, they were also being used in the production of medicines that could provide much needed relief to suffering…

A COURT transcript appearing to show an Australian vaccine expert admitting COVID-19 vaccines don’t work has gone viral on social media in recent weeks. Sensational stuff, or at least it would be if it had actually happened. Conspiracy theorists come in many shapes and sizes, but if there’s one…

AT a New York Italian restaurant last month, three men allegedly assaulted a member of staff because she asked to see proof of COVID-19 vaccination before seating them indoors. The woman was repeatedly punched and had her necklace broken, according to news reports. Carmine’s restaurant said in a statement…

IN a search for distraction from record-breaking lockdowns, thuggish “freedom” protesters, and – can this really be happening – earthquakes, I found myself thinking last week about anatomical naming. As you do. Our glorious human bodies have so many moving parts it takes a dictionary to list…

IF you’ve ever looked into the history of vaccination, you’ve likely heard that this vital preventive health measure was discovered, or invented, by English country doctor Edward Jenner at the end of the 18th century. The World Health Organisation is just one of many organisations to say so. Jenner…

– We’ve been in that cave forever – Three days is not forever – It is with this family The Croods, DreamWorks animated feature, 2013 UNLIKE the bumbling Stone Age family of The Croods, most of us have spent a lot more than three days in our caves over the past 18 months. The roller-coaster of…

“It is useless to attempt to reason a man out of a thing he was never reasoned into.” THIS quote was attributed to Jonathan Swift in an article in Scientific American back in 1851, and I’ve often quoted it to justify my withdrawal from discussion with social media acquaintances posting reams of…

IN the early 1990s, US psychiatrist Dr Jonathan Shay began using the term “moral injury” to describe a particular kind of trauma he observed in the Vietnam veterans he was treating. Moral injury occurred, he believed, when there was a betrayal of “what’s right” by either those in authority…

AT the end of 2020, I quoted from Daniel Defoe’s A journal of the plague year in one of my columns for InSight+. That book is probably the most striking literary text produced by Europe’s repeated outbreaks of bubonic plague, albeit written well after the events it describes. I have spoken to many…

IT IS now apparently compulsory to insert the word “bungled” before any mention of Australia’s COVID-19 vaccine roll-out. I’ve done it myself, but last week, with renewed outbreaks of disease around the country, I began to wonder if the word was adequate. The origins of the word “bungle”…

RACIST histories have long bedevilled health systems around the world, creating understandable distrust of medicine in some people from minority groups. I’ve written before about exploitative, in some cases abusive, past research conducted on Indigenous people in Australia. In the US, the roll-call…

IF Australians were becoming complacent about the risks of COVID-19, recent events in Victoria should have made us think again. With the state now in its second week of lockdown, the consequences of an inadequate quarantine system and bungled vaccine roll-out have become clearer than ever. The latest…

A FEW years ago, researching a book about the science of sex and gender, I went down the rabbit hole of reading popular psychology books on the subject. Friends had to suffer regular outraged text messages as I struggled through a morass of unscientific claims of the “why men can’t find things in…

IN December 2020, US family doctor Steven LaTulippe had his licence to practise medicine suspended over his opposition to mask wearing and other preventive measures against COVID-19. According to the Oregon Medical Board, LaTulippe regularly advised patients it was “very dangerous” to wear a mask,…

IN 1943, during the darkest days of World War II, senior army doctor Bill Keogh lobbied Australia’s war cabinet to establish domestic manufacture of a promising new drug, penicillin. Military field trials of the new antibiotic, developed in Oxford by Australian pharmacologist Howard Florey and colleagues,…

THIS past year of isolation and disruption has warped the passage of time for many of us. I’ve described 2020 to friends as both the fastest and slowest year of my life. Certainly, the days when people could travel the world at will, could plan without fear of an unexpected lockdown, seem immeasurably…

AUSTRALIA echoed last week with calls for an end to violence against women and dismantling of the power structures that enable it. The stories coming out of Canberra in recent weeks have revealed a toxic culture, where bullying is rife and young women are seen as disposable commodities, quickly discarded…

ADVERTISING targeted at women has long been accused of fuelling unhealthy anxieties about body image, with airbrushed, and sometimes outright anorexic, models creating a beauty standard that bears little relation to reality. Whether it’s body size or ageing, the message in the ads relies on shame…

WE need to talk about social media. Good things have come from platforms like Twitter and Facebook: the ability to share and access important content widely and swiftly, a more powerful voice for people who might be denied access to traditional media, unparalleled global connection. But, boy, is there…

TASMANIAN police issued two large fines to interstate travellers who refused to wear masks at Hobart Airport last week, defying COVID-19 regulations. My first reaction when I read the ABC report was the two men got what they deserved. And they probably did. In separate incidents, they had been asked…

YOU’VE probably heard some of the wackier assertions about the various COVID-19 vaccines currently being rolled out around the world, from the claim they include aborted human fetuses to the one that says they will change your DNA. The competition is stiff, but my favourite remains the persistent…

“THE face of London was now indeed strangely altered,” wrote Daniel Defoe in A journal of the plague year, his famous chronicle of that city’s bubonic plague outbreak of 1665–1666. Although the book purports to be an eyewitness account, Defoe was actually only 5 years old when the plague occurred.…

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…

IT IS always good to see a great scientific thinker being recognised for their contribution. So, it is heart-warming to see that well known expert on all things related to health, Pete Evans, receive one of Australia’s highest honours. The celebrity chef recently received the Australian Skeptics’…

IF somebody described themselves as “an extremely busy integrative oncologist with back to back patients”, what conclusions would you draw about their qualifications and practice? Naturopathy might not be the first profession that comes to mind. Or perhaps it would be in this age of smoke and mirrors.…

“AUSTRALIA is a global success story when it comes to education,” wrote consultancy firm Ernst and Young in a 2018 report. Earning $26 billion a year, education was our third largest export industry, the report said. Numbers of full-fee-paying international students increased tenfold between 1994…

IN the wake of World War II, nations came together as never before to try to prevent future catastrophes on that scale. The United Nations (UN) was established, along with its array of international agencies, while the European Union helped bring unprecedented peace to that troubled continent. This…

IN the summer of 1984, Australian gastroenterologist Barry Marshall quaffed a cup of lukewarm beef extract laced with Helicobacter pylori to confirm the then outlandish hypothesis that the bacteria caused gastric ulcers. With conventional wisdom blaming ulcers on stress, sufferers at the time were generally…

A LETTER appeared in mailboxes around my inner-city area last week containing vital new information with the potential to radically alter our approach to public health. Headed “The Corona Virus is a Scam”, the letter stated germs did not cause disease and viruses did not exist. The unnamed author…

MANY people have speculated in recent months about what the post-COVID-19 world may end up looking like, with predictions ranging from authoritarian dictatorships to utopian visions of more equal, environmentally sustainable societies. The reality will likely fall somewhere in between, but it seems…

IF you were asked to nominate risk factors associated with the COVID-19 pandemic, you’d probably mention physical proximity to others or inadequate hand hygiene. You might be less likely to nominate the disease’s high public profile as a factor adversely affecting health outcomes, but that is the…

“I WILL not be muzzled like a mad dog,” yelled one man at a public hearing on a proposal to mandate wearing of face masks in Florida. “I have the ability to do what I want, when I want, how I want,” said another. Across the United States, there have been reports of people being abused for wearing…

THE rise in new COVID-19 cases in Melbourne last week shone a light on some of the cracks in our health system and our society more broadly. Centred around a number of suburbs in the city’s multicultural north, the disease hotspots are in areas with “very strong pockets of disadvantage”, according…

GEORGE Floyd is more famous in death than he ever was in life. The African American man died after a Minneapolis police officer knelt on his neck for almost 9 minutes while arresting him, sparking protests around the world. Floyd is not the first black man to die during an interaction with the forces…

I ASKED an intensive care doctor recently how he thought the antivaccination crowd would likely respond to the development of a vaccine against COVID-19. “They’ll be first in line to get it,” he said. It’s one thing to be anti-vaccine when you live with the illusion humans have conquered infectious…

“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair …” THE…

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…

“Human activity in this place seems to have completely died out; the streets are empty and deserted … The [shops] are closed. Dogs alone roam in the streets …” NO, not a description of contemporary New York, but an eyewitness account of the Manchurian pneumonic plague of 1910–11, cited in…

IT IS a truth universally acknowledged that a virus in possession of a good transmission rate must be in want of a fake cure … The COVID-19 virus is not the only thing that has been spreading wildly around the world in recent weeks. Predictably enough, the global pandemic has opened the door to an…

IT’S hardly surprising the inhabitants of 14th century Europe saw an outbreak of bubonic plague as a supernatural event rather than a microbiological one. The Black Death, as it was known, was thought to be a punishment sent by an angry deity in response to the wickedness of humanity, and the responses…

AFTER colour film came into general use in the mid-20th century, manufacturer Kodak sent out reference cards to help developers achieve the best colour matching in photographs. The so-called Shirley cards, distributed for several decades from the 1950s, showed smiling Caucasian women with porcelain…

CRISIS situations can bring out the best in people. We’ve seen that in abundance this catastrophic bushfire season, as firefighters risk their lives and health day after day and local communities pull together to support each other. Sadly, though, a crisis can also bring out the worst in some. The…

IN 2007, the US enacted a law requiring the results of clinical trials to be published within one year of completion. It was a no-brainer. Clinicians and members of the public need access to trial results to stay up to date on likely benefits and harms of treatments. Researchers need to know what others…

THE new year is generally a time of hope and expectation. Not for Australia this year. As our country burns, the dominant emotions for many of us are grief and anger. Grief for the people who have lost homes and loved ones. For the at least half a billion animals that have died and for the loss of habitat…

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…

IN November 2019, South Dakota unveiled a bold new campaign to tackle the growing problem of methamphetamine addiction in the state. They called in Minnesota agency, Broadhead, paying a reported fee of just under USD $450 000 for a series of ads designed to raise public awareness of the issue. The campaign…

PROFESSOR Brian Wansink was a shining star of research into the behavioural aspects of healthy and unhealthy food consumption. Head of Cornell University’s Food and Brand Lab, he published hundreds of academic papers, was a US Presidential adviser on dietary guidelines, and made frequent media appearances…

IN the days leading up to Victoria’s catastrophic Black Saturday bushfires, south-eastern Australia suffered a gruelling run of extreme-heat days. At the height of the 2009 heatwave, Victoria’s morgue was receiving 50 bodies a day, three times the usual number, the state coroner told the Age. Hospitals…

IT’S not exactly unusual for alternative health practitioners to make claims of benefits that go well beyond their expertise or, in some cases, the physical laws of the universe. But “qualified naturopath and nutritionist” Barbara O’Neill arguably took things to a new level with claims including…

IN 2009, South African athlete Caster Semenya raced away with the women’s 800m event at the athletics world championships, leaving the other competitors more than 20 metres behind her. She wasn’t allowed to enjoy her triumph for long. Allegations soon emerged that Semenya was “really a man”…

AROUND the turn of the 5th century, St Augustine of Hippo sought to delineate the parameters of righteous giving. Christians, the early father of the church wrote, should target their charity first to the just and, when giving to sinners, should take care not to support the sin. Augustine famously prayed:…

In the first place, nobody denies that certain harms and damages, which actually and visibly afflict men, animals, the fruits of the Earth, and which often come about by the influence of stars, may yet often be brought about by demons … Malleus Maleficarum, 1486 HUMANS have long believed in the power…

ALTERNATIVE medicines often seem to inspire a quasi-religious fervour in their adherents, but I recently came across an organisation that takes things to a whole new level. The Genesis II Church seeks to “bring health to the world” through sacraments that treat Alzheimer’s, obesity, depression,…

Forever young Forever young May you stay Forever young Bob Dylan WHEN Dutchman Emile Ratelband in 2018 sought to change his legal age from 69 years to 49 years in a bid to reduce discrimination against him and improve his dating prospects, it attracted headlines around the world. It’s not clear how…

WHEN public figures indulge in anti-immigrant rhetoric, it’s not too hard to imagine this might cause psychological harm in the groups being denigrated. But could the health effects go further, even affecting future generations? A recent article in JAMA investigated the association between preterm…

FROM Medusa with her head of writhing snakes, to the priapic satyrs and the imprisoned and vengeful Minotaur, classical mythology abounds with strange part-human creatures. These hybrid beings are rarely friendly, coming from the murky shadows of nightmare to disturb our sunlight world. The source of…

IN the 1920s and 1930s, teams of scientists from Adelaide made frequent excursions into central desert communities to conduct elaborate experiments on the physiology of Aboriginal people. Doctor and medical historian Warwick Anderson wrote in his book, The cultivation of whiteness, of forced taking…

FOR American family physician Lou Ortenzio, it began with a drug sample left by a pharmaceutical representative. Struggling with a tension headache while seeing patients well into the night, the then 35-year-old doctor was amazed by the feeling of wellbeing that spread through him after taking an extra-strength…

IN the 2017 Netflix series, 13 Reasons Why, 17-year-old Hannah Baker creates a series of audio tapes to be listened to after her death, each explaining how individual people in her life contributed to her decision to commit suicide. The 13 tapes detail bullying, sexual assault and shaming by Hannah’s…

AFTER the heated rhetoric of the election campaign, the whole country could probably do with a restorative health program. Time for a national detox, perhaps. Happily, there are a multitude of white knights keen to come to the rescue, with their juice fasts, rectal coffee shots, and miracle toxin-removing…

IN the opening years of the 20th century, a woman who found herself in a certain condition and did not want to let nature take its course had to choose between a number of unpalatable options. If traditional remedies such as a bottle of gin and a hot bath or throwing herself down the stairs didn’t…

A TELEVISION advertisement for Coco Pops showed an elaborate cartoon production line for the sugar-heavy breakfast cereal: a wooden rooster pushed the cereal on its way, an animated toaster set off a variety of musical instruments made of spoons and other kitchen items, culminating in the bowl of cereal…

THE private health insurance system in Australia came a bit closer to being evidence-based last week when a host of unproven “natural” treatments were removed from the list of services for which consumers could claim a taxpayer-subsidised rebate. The 16 removed services include naturopathy, homeopathy,…

IMAGINE a health system in which one particular body part was carved out of medical training and normal care arrangements, with treatment provided only to those who could afford to pay for it. The eye perhaps. The skin. Or the heart. We’d think such a system ridiculous, and it would be; yet, that…

“I’M boooored,” I would say to my mother during the interminable school holidays of childhood. “Well, find something to do. Use your imagination,” she’d reply with not a skerrick of sympathy. Are such exchanges still commonplace? Today’s offspring are more likely to be micromanaged, protected…

IN the film, 99 Homes, Mike Carver is a Florida real estate broker intent on doing the next big deal and evicting loan defaulters against the backdrop of America’s 2008 housing crisis. An empty shell of a man, without moral compass or much in the way of human connection, Carver constantly sucks on…

IN the winter of 1952, London was hit by a health crisis of epic proportions. The toxic smog that engulfed the city in December that year is estimated to have killed 12 000 people. So numerous were the deaths and hospital admissions on the smog’s peak weekend, health authorities initially assumed…

“THERE are fads in illness, as in most things,” writes Dr Richard Shepherd in a recent memoir of his long career as a forensic pathologist in the UK. “Their popularity waxes and wanes according to our perceptions.” Dr Shepherd is particularly referring to the shifting diagnoses around sudden…

IF you’re still feeling a bit queasy after the festive splurge, the fault may lie with, not your own greed, but a hitherto unknown toxic substance that has unleashed chemical warfare in your body. In the weeks leading up to Christmas, I’m sure I wasn’t the only one to be bombarded by advertisements…

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+…

A FULL-page advertisement in the West Australian recently caught my attention. “The truth about colloidal silver and ionic silver,” read the headline, followed by a great deal of sciencey-sounding stuff about electrical systems and nanoparticles. The ad included pictures of the ionic silver products…

WITH Christmas only just over a month away, my thoughts have wandered to the Monty Python classic, Life of Brian, particularly, the scene when the three wise men accidentally go to the wrong stable, where they find baby Brian. Brian’s mother Mandy (memorably played by Terry Jones) is unimpressed by…

AUSTRALIAN Olympic Committee CEO Matt Carroll recently warned Australia’s medal tally at future Olympic Games was at risk unless the government pumped an extra $60 million a year into elite sports. Carroll welcomed the federal government’s recent announcement of an extra $50 million for high performance…

A FRIEND told me recently about the experience of accompanying her elderly mother to a medical appointment. My friend was taken aback that the doctor repeatedly directed his questions to her rather than her mother, who has several medical issues, none of them cognitive. “How is she sleeping?” the…

A storm of controversy erupted back in 2016 when the University of Wollongong granted a Doctorate in Philosophy to antivaccination campaigner Judith Wilyman for a thesis entitled A critical examination of the Australian Government’s rationale for its vaccination policy. The humanities thesis alleged,…

SEARCH online for “children’s screen time” and you’ll quickly get the sense that computer games and other screen-based entertainment are going to be the ruination of today’s young people. Too much screen time wrecks brains, eyesight, language development, social skills, educational and job…

THREE years ago, the Washington Post reported on IBM’s ambitions for its much-hyped artificial intelligence system: Watson. “The idea is to use Watson’s increasingly sophisticated artificial intelligence to find personalized treatments for every cancer patient by comparing disease and treatment…

“Which brings us at last,’" continued Mr Foster, "out of the realm of mere slavish imitation of nature into the much more interesting world of human invention.” He rubbed his hands. For, of course, they didn’t content themselves with merely hatching out embryos: any cow could do that. “We…

EARLY in 1951, a young woman called Henrietta Lacks presented to Baltimore’s Johns Hopkins Hospital, one of the few hospitals in the region that would treat African American patients. Sex was painful, she told doctors, and she’d been bleeding unpredictably. It didn’t take long for the medical…

IN 2013, a 21-year-old Spanish physics student, Mario Rodríguez, died of leukaemia after refusing a second round of chemotherapy in favour of “natural” remedies recommended by his homeopath. In the wake of his son’s death, Mario’s grieving father, Julián Rodríguez, launched a legal action…

DECLARATIONS on feel-good issues that everybody can agree on are often referred to as “motherhood statements”, based on an assumption that anything to do with mothers and babies will make us all feel warm and fuzzy. You might have expected the resolution on breastfeeding that went to the United…

“MILLIONS more of us should be taking antidepressants,” trumpeted a headline in the UK’s Daily Mail earlier this year. “Largest-ever study claims the pills DO work and GPs should be dishing them out.” The review of more than 500 published and unpublished trials in nearly 120 000 patients with…

THIS week has been a wild ride. At the start of it, I was simply a GP on the northern beaches of Sydney, with lovely patients, work that I enjoy, which includes palliative care, and party preparations for my 6-year-old. I had just read an article by Ben Doherty of The Guardian newspaper, which described…

WHEN the Collins Dictionary anointed “fake news” its 2017 word of the year, it was presumably because the publishers deemed the term so important it didn’t really matter that it wasn’t actually a single word. Misinformation is hardly new, but the platforms it spreads on these days certainly…

A FRIEND told me a while back that she’d read an article linking broccoli consumption to cancer. “I give up,” she said, throwing her arms in the air. I haven’t been able to track down the research into the deadly effects of cruciferous vegetables, but my friend’s reaction does tell us something…

I RECENTLY came across a remarkable headline in the New York Post: “Doctors warn women against putting wasp nests in their vaginas”. Those of us with the relevant anatomy are no doubt relieved to have been warned about this before we succumbed to the ever-present temptation to, well, put a wasp…

WHEN 28-year-old Jerika Whitefield’s mitral valve was damaged by endocarditis, she needed life-saving surgery to repair it. Before performing the surgery, doctors in her native Tennessee gave her a blunt warning: if she repeated the behaviour that had caused the infection in her heart, they would…

NOBODY wants to talk about death. It is one of the few experiences we all share, yet it is perhaps the biggest of all taboos in our contemporary Western societies. We work out at the gym, eat our organic veggies, spend way too much on miracle wrinkle creams, all in a vain attempt to deny the inevitable.…

BRITT Maria Hermes is not about to win a popularity contest in naturopathic circles. The former naturopathic doctor has become something of a scourge to her ex-colleagues through her campaign against what she now calls quackery and fake medicine. “Pseudoscience is widely incorporated into the naturopathic…

“UNLESS care is exercised in selecting food, a diet may result which is one-sided or badly balanced – that is, one in which either protein or fuel ingredients (carbohydrate and fat) are provided in excess,” wrote the father of American nutrition science, Wilbur Olin Atwater, back in 1902. “The…

WHEN television presenters decide to mount a health campaign, it’s not hard for things to go wrong. The team at Channel 7’s morning program, Sunrise, probably thought they were doing their good deed for the year when they encouraged viewers to undergo a range of cancer screening tests. Morning television…

IN HER article published on 20 November 2017, Jane McCredie pointed to a Viewpoint by Barsky published in JAMA that reminded us about the harm that doctors can do when they are not aware of the possible implications of what they say to patients. The other side of this coin that is not discussed by Barsky…

WHEN Venetian traveller Marco Polo visited China in the 13th century, he was gobsmacked by the country’s wealth and industry, observing canals carrying thousands of trading vessels, iron production dwarfing that of Europe, and “stones” that were burned instead of wood. Those stones were coal,…

IN the chaotic last days of federal parliament in December 2017 (remember the same-sex marriage debate?), the Therapeutic Goods Administration (TGA) and the Department of Health attempted to bypass Senate scrutiny of the Therapeutic Goods Administration (2017 Measures No. 1) Bill 2017 by persuading…

“AS a new parent, you might be wondering how the blue moon affects your baby,” one parenting website opined ahead of last month’s super blue blood wolf moon. According to the site’s experts, the impact was expected to be profound and wide-reaching. The celestial event could make the baby more…

A FEW years ago, I attended a medical conference that was different from any other I’ve been to; alongside the doctors and researchers were large numbers of patients and their families, not just in the audience but on stage as well. It may have happened, but I haven’t seen people with heart failure…

’TIS the season to detox … or so an assortment of commercial providers would have us believe. If you were slothful over the holidays, if you consumed too much Christmas pudding or sparkly alcohol, you may need to absolve yourself from your sins through the healing powers of any of a myriad “herbs,…

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…

A FEW years ago, I participated in a speed meet event at the Sydney Science Festival where members of the public were invited to quiz scientists and science writers about any topic of their choosing. At one point, I found myself facing an earnest young boy. “Jane,” he said, “what should we do…

“Sticks and stones may break my bones, but words will never hurt me.” I THINK we all sensed, when our parents told us to chant this in response to bullies, that we were being sold a crock. Words have power, and every child knows it. That may be as true in the clinical setting as it is in the playground.…

AS WE delve ever further into the human genome, ethical and legal frameworks are struggling to keep up. Given the potential of genetic information to affect people’s employment prospects, or ability to get insurance, there’s been an understandable focus on protecting genetic privacy. But what of…

IN THE middle years of the 20th century, Walter Freeman travelled around the United States in the vehicle he called his “lobotomobile” performing thousands of his trademark ice-pick lobotomies for a fee of just $25 a time. The surgical procedures could, he claimed, reduce suffering in conditions…

“AS anyone who has known a patient understands, Alzheimer’s is a merciless disease,” writes British neuroscientist Joseph Jebelli. “It strips the mind of decades of stored memories that have been sculpted and embedded deep within our brains. Slowly and steadily, it erodes an individual’s autobiography,…

AN early advertisement for the first female contraceptive pill depicted a figure from Greek mythology, a naked Andromeda bursting free from her chains. “From the beginning, woman has been a vassal to the temporal demands – and frequently the aberrations – of the cyclic mechanism of her reproductive…

IN early 20th century Berlin, crowds were entranced by a horse that could count, do arithmetic, read the time and identify playing cards, tapping out the answers to questions with his hooves. So famous was Hans the horse that the German board of education set up a special 18-month inquiry to determine…

WHEN I was pregnant with my second child some years ago, a lactation consultant offered me a brochure on how to express milk for an older child while in labour with the next one. Because what anybody going through one of the most arduous experiences known to humanity needs is to try to simultaneously…

A YEAR or so ago, I participated in a government consultation process designed to improve patient outcomes by bringing the arts into the health system. Will you also be looking at aged care? I asked during one session. It seemed like a sensible question at the time, but a participant who worked in theatre…

“ARTIFICIAL intelligence [AI] could put doctors and lawyers OUT of a job in FIVE YEARS’ time,” trumpeted a headline in Britain’s Express earlier this year. Could it be true? There’s no doubt technology is radically changing the nature of work across most areas of human endeavour. One of the…

“The state has no authority to subject people to death and injury in certain kinds of … accidents just because it hopes others will be saved in other kinds of accidents … The state has no authority to take chances with a person’s body, the ultimate private property” THAT quote is from a website…

VISITING Queensland’s Palm Island in 2016, I chatted to a middle-aged local outside the supermarket. He opened the conversation with: “Do you ever stop handing money over to your kids?”, then went on to entertain me with tales about his extended family. The stories were often hilarious, but I…

“IT’S not that I’m afraid of death; I just don’t want to be there when it happens,” film-maker Woody Allen wrote in his 1975 book Without feathers. Most of us would probably agree. Perhaps it’s why we so often find it hard to have clear-headed conversations about death and dying. Nowhere…

ABOUT 5 years ago, the director of a university pathology museum showed me around his collection. “We have every colour of the rainbow here,” he said with pride. “Blue?” I asked. He grinned and silently led me to a display case containing a blue-black slab that glistened like polished stone.…

FANCY a career change? You might want to consider becoming a counsellor. The good news is you don’t need to bother with the rigours of a psychology degree or its equivalent. You can become professionally qualified, and get a whole lot of fancy letters after your name, with just a few hours of online…

IN her novel, The Spare Room, Helen Garner gives a fictionalised account of her friend Nicola’s struggle against terminal cancer and resulting vulnerability to those claiming to perform miracles. Nicola travels from Sydney to stay with Helen and attend the Melbourne clinic of “Professor Theodore”,…

IT makes for good television drama: the terminally ill patient whose last chance is to be enrolled in a groundbreaking clinical trial. Emotional pleas are made, strings are pulled, every contact exploited to achieve the happy ending: enrolment in the trial. Except, not really. Even if the patient manages…

“Man loses both legs and arms at risk after white-tail spider bite,” trumpeted a headline in the Daily Telegraph last week. “White-tail spiders are commonly found in homes across the country, usually hiding in bedding and clothes draws [sic],” the newspaper went on, warning the spider’s bites…

WHEN I worked on a medical magazine some years ago, it was an ongoing struggle deciding which of the hundreds of studies published each week deserved a place in the publication. But there was one kind of research that always seemed to be greeted with enthusiasm by journalists and doctors alike: studies…

WHEN a new treatment for Duchenne muscular dystrophy (DMD) was put up for approval in the US in 2016, patient advocacy groups and hundreds of individual patients and their families packed the Food and Drug Administration’s (FDA) Advisory Committee meeting to give emotional testimony in favour of the…

EARLIER this year, Sydney’s Daily Telegraph took readers to the “graveyard war zone”, to the heart of the city’s “ice epidemic” where police and ambulance officers confront “crazed users with superhuman strength and subhuman reason”. Who knew the zombie apocalypse had arrived in sunny…

ASKED by a news magazine to comment on the mental health of a certain US presidential candidate, psychiatrists detailed his “grandiose manner” and “godlike self-image”, describing him as “paranoid” and a “counterfeit figure of a masculine man”. If you think I’m talking about 2016,…

WHEN parents of young children turn to the internet to answer their questions about immunisation, what they find can range from quality information to crazy conspiracy theories and downright lies. And, the more susceptible we are to those conspiracy theories, the more likely we are to see them: search…

IT IS customary to start a new year with resolutions: to actually use that expensive gym membership, to cut down on alcohol or sugar, to take steps towards the much vaunted, but elusive, state of “wellness”. I’m not immune to the general desire for self-improvement, but I’ve been trying to work…

RECENTLY, I wrote about what seems to be a growing lack of respect for evidence among politicians and others with vested interests in pushing a particular agenda. For the sake of balance, though, I thought I’d end the year by celebrating some of the rare triumphs for evidence-based thinking brought…

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…

ANNOUNCED in November 2016, a 3-year trial of publicly funded homebirth is to be offered to low-risk expectant mothers living in Canberra. This initiative sees the ACT join the Northern Territory and almost all states in the provision of publicly funded homebirth services. Only Queensland is yet to…

OXFORD Dictionaries recently announced its 2016 word of the year and the winner was “post-truth”, as in “we are now living in a post-truth world”. It’s not hard to see where they’re coming from. The American voting public recently chose a president-elect who has suggested that climate change…

A DECADE or so ago, there was a big push to get all clinical trials listed on a public register before they started enrolling patients. The move was designed to increase transparency, prevent researchers and trial sponsors from secretly changing endpoints, and make it harder for those with vested interests…

A FEW years ago, I attended a scientific conference on autism. In the foyer, among the drug company stands and the stalls selling learning aids, was a promotional display for hyperbaric oxygen treatment. Commercial providers of this service claim it offers huge benefits for everything from infectious…

WHICH routinely ingested substance is alleged to increase risk of cancer, thyroid disease, sickle-cell anaemia, depression, infertility, birth defects, sudden infant death syndrome, low IQ, Alzheimer’s, headache, chronic fatigue, violent behaviour, musculoskeletal damage, gastrointestinal problems,…

VIRTUE is not a word you hear used all that often in the cut-throat world of business, but it’s one that a group of Australian medical ethicists would like to see applied to the burgeoning in vitro fertilisation (IVF) industry. Some players in that industry have been under fire in recent times, accused…

THE randomised, placebo-controlled trial may be considered the gold standard in medical research, but that doesn’t mean it’s always the best approach. A 2003 systematic review, Parachute use to prevent death and major trauma related to gravitational challenge, lamented the lack of placebo-controlled…

ONLINE portals using secure pathways may be the best available solution to the dilemma of doctor-patient email communications, which sees practices lagging behind the “willingness of their patients” to connect via email. A systematic review published in Family Practice showed that far more physicians…

“DOES it have carbs in it?” one of the personal trainers from my gym asks in a local cafe, his face screwed up with disgust as though somebody has suggested he eats maggots. Actually, he’d probably be happy to eat maggots if you told him they packed a protein punch. Diet fads come and go, but…

MANY years ago I undertook a study of the general population in the US, trying to determine if trauma in childhood affected adult health. The results shocked and horrified me, and I didn’t want to believe them. So when I was back in Sydney, I followed up on this research. We discovered that about…

TO prepare for the Olympics, ancient Greek athletes apparently dined on delicacies such as deer livers, lion hearts and raw lambs’ testicles. We might laugh, but actually there was possibly a better rationale for some of those practices than for the superstitious rituals athletes engage in these days.…

NEWS broke recently that the “homeopathic vaccines” being sold by a Brisbane homeopath were made of nothing but refined sugar. Cyena Caruana, whose website is no longer publicly viewable, was apparently selling vaccines purported to protect against pertussis, measles, polio, meningococcus and malaria.…

UNITED STATES regulators recently approved a device, nicknamed the “stomach tap”, that allows obese people to drain part of the contents of their stomach directly into the toilet after every meal. This is how the Food and Drug Administration (FDA) described the AspireAssist device’s operation…

A SWEDISH study has found that high maternal body mass index (BMI) is an independent risk factor for perinatal mortality, and experts warn that these results are directly applicable in Australia. Professor Euan Wallace, director of obstetrics at Monash Health, told MJA InSight that he expected the link…

THOUSANDS of Australians have been walking the streets, parks and beaches of their cities with eyes glued to their smartphones following the recent release of a game called Pokémon GO.Pokémon GO is a new, free, smartphone game that augments reality and requires users to walk around in the physical…

THE suffering invalids of the 19th century were fortunate in the marvelous cures available to them.The extraordinary Sands’s Sarsparilla tonic, for example, offered a “radical and permanent cure” for swelling of the glands, diseases of the bones, joints and ligaments, rheumatism, obstinate cutaneous…

REVELATIONS that a Victorian provider of educational programs for “gifted” children had also been offering anti-vaccination advice made headlines around the world last week.Pat Slattery, founder of the WiseOnes business, had made claims about a link between vaccines and autism as well as inviting…

OF all the accusations levelled at plain packaging of tobacco products, perhaps the most bizarre is that it will help promote the revival of the Irish Republican Army.The once-prominent terrorist organisation stands to make an extra £22 million per year from smuggled cigarettes as a result of the Irish…