News briefs

UK experts want ban on tackling in school rugby

More than 70 UK doctors and health experts have written an open letter addressed to government ministers, chief medical officers and children’s commissioners, calling for a ban on tackling in school rugby games, The Guardian reports. “The majority of all injuries occur during contact or collision, such as the tackle and the scrum,” the letter says. “These injuries, which include fractures, ligamentous tears, dislocated shoulders, spinal injuries and head injuries, can have short-term, life-long and life-ending consequences for children.” Rugby is a compulsory part of the UK physical education curriculum from the age of 11 in many boys’ schools, particularly in the independent sector, The Guardian says. The letter’s authors urged schools to move to touch and non-contact versions of the game. “Repeat concussions have been found to have a link to cognitive impairment, and an association with problems such as depression, memory loss and diminished verbal abilities. Children also took longer to recover to normal levels on measures of memory, reaction speed and post-concussive symptoms.” The Rugby Football Union said it took player safety “extremely seriously” and that recent changes meant young players underwent a “gradual and managed” introduction to the contact version of the game.

PLOS ONE paper provokes social media backlash

Retraction Watch reports that a paper on the biomechanics of the hand published in PLOS ONE has provoked a social media backlash for using apparently religious language in the abstract, introduction and conclusion. “In conclusion, our study can improve the understanding of the human hand and confirm that the mechanical architecture is the proper design by the Creator for dexterous performance of numerous functions following the evolutionary remodeling of the ancestral hand for millions of years.” Some commentators on Twitter described the publication of the paper as “an absolute joke” and “a big problem”. A spokesperson for PLOS was quoted by Retraction Watch as saying: “PLOS has just been made aware of this issue and we are looking into it in depth. Our internal editors are reviewing the manuscript and will decide what course of action to take. PLOS’ publishing team is also assessing its processes.” The corresponding author is listed as Cai-Hua Xiong, based at Huazhong University of Science and Technology in China.

Australian health system “underprepared” for heatwaves

A Climate Council report has found Australia’s health system is underprepared to deal with longer, hotter and more intense heatwaves, the ABC reports. “The Climate Council report … found nursing homes and medical centres across the country may not be equipped with necessary back-up energy and water supplies in extreme heat. The council noted several states had upgraded heat and health warning systems since the deadly heatwaves in 2009, but the lack of a streamlined response system was putting lives at risk. The report found heatwaves put pressure on health services, with emergency call-outs jumping almost 50 per cent and heart attacks almost tripling in the heatwaves of January and February 2009. By 2030, Australia’s annual average temperature is predicted to rise by 0.6 to 1.3 per cent, with the globe continuing to heat up to the end of the century, the report said. The report highlights the global problem of heatwaves, pointing to 55 700 deaths during the Russian heatwave in 2010, and 3700 killed in India and Pakistan in May 2015.”

Astronaut Scott Kelly and his twin a boon to science

Commander Scott Kelly has returned to Earth after 340 days on board the International Space Station (ISS) and a raft of scientists and doctors can’t wait to get their hands on him, Forbes reports. Any astronaut coming home is scrutinised, but Cmdr Kelly’s return was particularly anticipated because he has a twin brother. Retired astronaut Mark Kelly has spent the past year on Earth, providing scientists conducting NASA’s Twins Study with the chance to conduct the ultimate “controlled experiment”. Weightlessness can lengthen the spine and body by up to 3%, can cause loss of muscle — most notably in the heart — and bone mass; cause the head to swell; and cause dizziness and fainting on return to Earth. There are also issues of radiation exposure without the shield of the Earth’s atmosphere.

[Comment] NextGen HIV prevention: new possibilities and questions

In less than a decade, HIV prevention has evolved from a reliance on education, behavioural interventions, and use of condoms to focusing on the optimum use of antiretrovirals to suppress infectiousness and for primary prophylaxis. Landmark studies have shown the efficacy of the early initiation of treatment for people infected with HIV,1 and the use of oral pre-exposure prophylaxis (PrEP) for those at highest risk to decrease HIV transmission.2 Despite PrEP being shown to be efficacious in most trials in which it was assessed, the paramount importance of consistent use of preventive medication was shown when oral and topical tenofovir-based regimens did not show efficacy in three studies involving young African women, primarily because of suboptimum adherence.

A refined way to complain

Caption: AMA Vice President Dr Stephen Parnis (l) with Medical Board of Australia Chair Dr Joanna Flynn and Dr Susan Nuehaus at the AHPRA/MBA meeting

By AMA Vice President Dr Stephen Parnis

Last month, a working group of senior AMA members and I met with the President of the Medical Board of Australia, the CEO of AHPRA and their senior officials to continue a process begun in 2015 to improve notification processes, particularly for doctors who are the subject of a complaint.

A common problem in recent years has been that investigations have taken far too long. To better assist timely and sensible vetting of notifications and complaints, we discussed the decision matrix AHPRA has developed for use by the Health Care Complaints entities and the Medical Board. This process steers complaints and notifications to the right pathway, significantly reducing the time taken for a preliminary assessment, and reducing unnecessary angst for doctors.

It was obvious from the discussion, and from the data presented to us by AHPRA, that the benchmark times for preliminary assessment of notifications are contributing to improved performance by AHPRA, in all states except Queensland, where a new regulatory regime has been established.

With that notable exception, I expect that this is leading to a more timely and transparent process for practitioners, and it would appear to be reflected in the number of representations practitioners have been making to the AMA in recent times.

However, these benchmark timeframes are more difficult to set for formal investigations. For example, some investigations have to be put on hold until other statutory processes, such as police investigations or coronial investigations are completed. That said, the Medical Board and AHPRA, following representations from the AMA, has recognised the necessity of better communicating the process to practitioners. I expect that here, too, improvements are being felt.

Ageing cases are now automatically escalated, so that more urgent and senior people are involved. Doctors are being advised about the reasons for delay. These matters are now reviewed at specific intervals by senior staff members, and in some cases by Medical Board members at an earlier stage, to ensure that all but unavoidable delays are eliminated, and to accelerate progress if at all possible.

Obtaining feedback from doctors about their experience is essential, and the Medical Board and AHPRA now accept that gaining a better understanding of a medical practitioner’s experience is essential to refine processes. I expect further work and progress in this area over the next year.

I and my AMA colleagues have raised serious concerns about the Medical Board’s practice of seeking out the expectations of complainants about the outcome of their complaint. We are particularly concerned that this may give rise inappropriate expectations, and deny due process.

According to the Board, understanding a notifier’s expectations assists AHPRA to determine the pathway for the compliant i.e. the local Health Complaints Commissioner, or the Medical Board/AHPRA. The practitioner will be provided with this information, but only as it relates to what the Board has decided to investigate. This will allow the practitioner to focus only on the issues under investigation when responding to the Board, and may expedite more timely resolution of a complaint. We will continue to monitor this issue closely.

We concluded our most recent meeting with an important discussion about how the experience of the scheme can better inform the profession to deal with poor performance earlier.

The Medical Board and AHPRA have established a unit to look at how MBS data can be used to identify risks sooner, such as by providing examples of specific types of practice or certain scenarios which regularly become cases of concern to the medical profession and the wider community.

Clearly, early detection and prevention would protect the public and further enhance the standing of the medical profession.

Prevention is always better than cure and, if used appropriately, could be used as an opportunity for effective education by our medical schools, the learned colleges, and the medical indemnifiers.

Our next task is to ensure that the data collected by this unit is sufficiently robust.

The Working Group will continue to work through this important process, and the AMA regularly engages with the Medical Board and AHPRA through frequent meetings of the AMA President and Vice President with the MBA President and AHPRA CEO.

I wish to thank the members of the working group for their tremendous expertise and commitment – Dr Susan Neuhaus, Dr Roderick McRae, Dr Antonio Di Dio and Dr Jonathan Burdon.

In closing, I also wish to acknowledge the positive and strong relationship between the AMA and the Medical Board of Australia and AHPRA. It fosters a robust and effective exchange, and will continue to improve the regulatory environment for medicine in Australia.

Our drivers deserve the best: Owler

AMA President Professor Brian Owler has called for tougher vehicle safety standards, improved road user education and the development of a national road trauma database as part of efforts to reduce death and injury on the country’s roads.

Professor Owler told a Senate inquiry into road safety that there was much that can and should be done to reduce traffic trauma, including the adoption of world-leading design rules and technologies, such as autonomous emergency braking.

“I do not see why an Australian life should be worth any less than the life of a European or US or Japanese citizen,” he said. “I think our vehicles should be rated to the highest standards. It makes good sense.”

Cars equipped with autonomous emergency braking can detect the threat of an imminent collision and apply the brakes, either avoiding an accident or significantly reducing its severity.

Professor Owler said it was not just about preventing fatalities. He said people involved in simple accidents like rear-end collisions can suffer injuries such as whiplash that can have serious lifelong consequences.

He told the committee he had seen “many young people” who had lost their job and their partner after suffering whiplash and subsequently developing a dependence on opioids while trying to manage the pain.

Often, calls to tighten design and safety standards are resisted on the grounds that will add to production costs.

But Professor Owler said the marginal increase to the cost of a vehicle was more than offset by the huge savings to be made from preventing deaths and injuries that, over a lifetime, might cost millions of dollars in care.

One of the biggest blank spots in efforts to cut down the road toll was the lack of a national road trauma database, he said.

Though road deaths were recorded and shared across state borders, this did not extend to traffic accident injuries, hampering efforts to come to grips with the scale of the issue and how it could best be tackled.

“The number of deaths is only a fraction of the number of injuries that occur,” Professor Owler said. “While some of those injuries might heal…there are many injuries that are very devastating or at least result in significant time off work, loss of income, disruption to families. Being able to record that information is a very basic step that we need to take in order to be able to assess how we are going to make roads and cars safer.”

“It would provide a platform for being able to assess any investment [in road safety] that is made. But it will also allow us to determine where the problems are occurring”.

Professor Owler said while this was important, the most significant action governments should take would be to improve driver behaviour through education – particularly aimed at young people learning how to drive.

He said there was “a lot of positive feedback” regarding programs that aimed to educate those about to get their driver’s licences about speed, driving conditions, distractions and the role of passengers.

“People will make mistakes, and that is why education is so important, particularly for young drivers,” the AMA President said.

Adrian Rollins

The sick will pay heavy price for Govt cuts

Patients are likely to face blow outs in emergency care and elective surgery waiting times from next year, and may even miss out on care altogether, unless the Federal Government acts immediately to unwind massive Commonwealth public hospital spending cuts.

AMA analysis shows a huge shortfall in Federal funding for hospitals will rapidly open up from mid-2017 as a lower indexation arrangement kicks in, creating a gap in resourcing that State and Territory governments are unlikely to be able to cover.

AMA President Professor Owler said the states and territories were facing an “economic disaster” unless the Federal Government urgently restored its funding, and warned patients would be forced to wait longer for vital health care and may, in some cases, miss out altogether.

“As hospital capacity shrinks, doctors won’t be able to get their patients into hospital or keep them there to receive the critical care they require,” Professor Owler said. “Doctors will always do the best they can by their patients, but these cuts mean the system as a whole simply won’t be able to meet the demand.”

His warnings came amid mounting speculation the Commonwealth will provide emergency funds to avert a pre-election crunch in public hospital finances – though it is expected to make little dent in the long-term shortfall, which is projected to reach $57 billion by the middle of next decade.

Expectations are increasing that Prime Minister Malcolm Turnbull will use a rare joint meeting with the nation’s premiers and treasurers scheduled for 1 April to clear the decks on a range of contentious issues in the lead-up to the Federal election, not least massive cuts to Commonwealth support for public hospitals unveiled in the Government’s disastrous 2014-15 Budget.

The Prime Minister has reportedly already offered New South Wales Premier Mike Baird an emergency $7 billion cash injection to tide the State’s public hospital and education systems through till after the election, which could come as early as July or as late as November, and other premiers are now lining up to demand similar assistance.

Professor Owler said such handouts would help relieve pressure on hard-pressed public hospitals in the short-term, but if a financial crisis for the nation’s public hospitals was to be averted there needed to be an overhaul of Commonwealth-State arrangements to ensure hospitals were supported by a reliable long-term source of funding that grew in step with the increase in demand for their services.

“It is clear there is a crisis in public hospital funding and an immediate commitment is required, but a quick fix will not solve the long-term capacity problems for public hospitals or ease the economic burden on State budgets,” he said.

There is mounting evidence that the performance of hospitals is already being hurt by a squeeze on their finances, even before massive cuts detailed in the controversial 2014-15 Budget come into effect.

The human cost

The AMA’s annual Public Hospital Report Card, released earlier this year, showed that hospital performance is already beginning to suffer as the flow of Commonwealth funds slows.

In emergency departments, the proportion of urgent Category 3 patients seen within the clinically recommended 30 minutes fell back to 68 per cent in 2014-15 – a two percentage point decline from the previous year, ending four years of unbroken improvement.

Meanwhile, improvements in elective surgery waiting times have stalled – the median delay in 2014-15 was 35 days, six days longer than a decade earlier.

Professor Owler said there was a real human cost to be paid for such a deterioration in performance.

“For a patient requiring urgent attention for abdominal pain, this could mean they are seen one to two hours after they present to the ED,” he said. “Their symptoms could be consistent with indigestion, or could be a perforated bowel. The quicker a doctor can see them and make a diagnosis, then the quicker they can receive relief from their pain, and their condition can be prevented from deteriorating, potentially to a very serious situation.”

In the Budget, the Coalition announced it would renege on hospital funding guarantees to the states, saving $1.8 billion over four years, while a further $57 billion would be would be saved by 2024-25 by downgrading the indexation of Commonwealth hospital funding to inflation plus population growth.

Increasing the squeeze, the Independent Hospital Pricing Authority has set the National Efficient Price – which determines how much the Commonwealth pays for hospital services – at 1.8 per cent lower than the amount that was set last year, locking in hospital underfunding.

States under pressure

The massive Commonwealth cuts have outraged the states, which have warned of a significant reduction in hospital services unless another stream of funding is found.

The savings appeared to be part of a broader Commonwealth strategy to dump most of the funding responsibility for health services onto the states and directly on to patients, and occurred in the context of a renewed debate about taxation and the structure of the Federation.

Two premiers, Mr Baird and South Australia’s Jay Weatherill, had championed changes to the GST and income tax arrangements to give states access to a more robust stream of revenue to fund hospitals and schools, but they were undercut when Mr Turnbull dismissed any talk of changing the consumption tax.

The resistance of Canberra to calls for more funds has been stiffened by the fact that all the states are currently in surplus, while the Commonwealth expects a deficit of $37.4 billion this financial year, and no return to surplus over the next four years.

But, while Treasurer Scott Morrison has continued to talk tough, telling the states to sort out their hospital funding problems themselves, behind the scenes Mr Turnbull has reportedly been approaching some premiers to discuss a possible deal.

Professor Owler discussed the looming crisis in a meeting with Mr Weatherill earlier this month, and the SA Premier echoed his concerns.

Any short-term deal offered by Mr Turnbull would only “kick the can down the road”, he told ABC radio.

But he indicated the states were likely to accept any injection of funds offered.

“Mike Baird and I have been pushing for a much bigger solution – a 15-year solution – but we have to be realistic, we’re on the shadows of an election, and it’s an urgent problem,” Mr Weatherill said.

Adrian Rollins

[Correspondence] Zika virus outbreak: reproductive health and rights in Latin America

In mid-January, 2016, health ministers from different Latin American countries made public recommendations to women and couples to postpone pregnancy for 6 months to 2 years in the face of the Zika virus outbreak.1 These recommendations seemed out of place in view of the fact that 56% of pregnancies in the region are unintended.2 Poor quality of sex education, poor access to contraception, high prevalence of rape, and cultural barriers that make it difficult for women to negotiate the use of contraception with their partners, result in large groups of women who do not have control over their sexual and reproductive lives.

[Perspectives] Xueqing Yu: a driving force in Chinese nephrology

Born to farming parents in China’s Jiangxi Province, Xueqing Yu was among the first generation of his family to benefit from a university education. “I lived in the countryside and saw how difficult it was for people to have a good medical service”, he recalls. The idea of joining the struggle to improve health care was sown and, in due course, he became a physician: an academic whose career has taken him to the pinnacle of nephrology, his chosen specialty. Now Professor of Medicine and Director of Sun Yat-sen University’s Institute of Nephrology in Guangzhou he’s also the current President of the Chinese Society of Nephrology.

[Perspectives] Attention deficit hyperactivity disorder

Think of all the names we have for children who cause trouble in classrooms: difficult, disruptive, naughty, attention-seeking, badly brought up, just plain bad. After the end of World War 2, American psychiatrists, pharmaceutical companies, and educationalists added a new term to this list, and a potent new frame for bad behaviour. Children who could not keep themselves in a chair or concentrate on a blackboard were not difficult or bad but hyperactive. They were suffering, so the new argument ran, from “a genetic, neurological glitch”, in the words of the historian Matthew Smith, and their condition could be managed with regular doses of stimulants.

What I wish I knew as a junior doctor

Dr Nikki Stamp is a cardiothoracic surgeon based in Sydney. Follow her on twitter. If you work in healthcare and have a blog topic you would like to write for doctorportal, please get in touch.

It’s that time of year when our fresh faced and newly minted interns start working as real doctors! Congratulations on making it this far. Medical school is an achievement and you should be very proud of your work thus far.

Being a doctor is such a wonderful privilege and a career that can provide you endless satisfaction. As you embark on your career, it can all seem so overwhelming. Likewise if you’re making another important leap, such as to being a Registrar. It’s exciting and scary all at once.

Here’s some of the things I wish I had known as a junior doctor, or things that have made my life easier over my working life so far.

Keep an open mind

Being open minded is very important as a junior doctor. For your patients, be open to the fact that they may have a reason for skipping clinic, not understanding you or having different world views to you. One of the great things about our profession is that you get to meet people from all walks of life and from every background.

For yourself, be open about what you might experience. The term may not be as bad you think it will. Perhaps you wanted to be surgeon but would really rather be an emergency physician. Go into every job with eyes wide open because not only will you learn things that will always be useful, you just may stumble upon your passion in medicine.

Plan your life not just your career

Work life balance is not just about family and children. Being a doctor with friends, hobbies and just good old sleep ins will make you a well rounded clinician. You need to be as fit and healthy as you can be to be able to do your best work. Being chronically sleep deprived does not help this.

Having friends is so important. You’ll need a support system and a way to debrief. You need people to have fun with to make you a happy human. Medicine lumps you with some difficult times and it’s important to maintain a human connection.

But plan your career too

Once you work out what you want to do, find out what you need to do to get a training position. Talk to your Registrars and Consultants about what things would be beneficial for a career in surgery for example. You may want to get involved in some research or do courses offered by hospitals and colleges. Don’t forget the importance of clinical work though. All the research in the world won’t replace learning good clinical skills. Be in theatre or cath lab or wherever it is you want to end up.

Besides finding a specialty that you actually enjoy, it’s important to be pragmatic too. Make sure that you factor in things like the lifestyle of a particular specialty. It’s also becoming increasingly important to think abut what your employment prospects are at the end of the road. We may be coming into a time when securing full time employment as a specialist is tricky, so be sure that you’re not getting into an area where there may not be a place for you.

Ask for help and ask early

It’s really easy to think that everyone expects you to know or be able to do everything. That is simply not the case. If you’re in over your head, or you don’t know what’s going on, ask for help. You have so many resources at your fingertips, including nursing staff and other allied health professionals. Don’t be afraid to kick your problems up to someone more senior as they can not only help you, but you’ll learn something too. The doctors who worry me the most are the ones who don’t realise their own limitations and struggle on stubbornly. Don’t be that doctor.

Always be honest

Similar to the above, don’t tell porky pies. You often get found out and it can lead to patient complications. if you’re asked a patient’s creatinine and you don’t know it, say so. Then say you will find out. That is much more professional and safe than making it up.

Likewise with patients, we’re often afraid to admit that we don’t know the answer to their questions. That’s absolutely okay, tell them and again, say that you’ll find out.

Be organised

On some terms more than others, a ward round will finish and you realise ou have dozens of jobs to do. At least half a dozen people will be harassing you to get them done too! Don’t be overwhelmed, just keep a list of things that need doing that works for you. Triage your jobs and work through the most clinically urgent ones first, then head down the list.

Talk to patients

Patients want to talk to the staff who are looking after them. They want to know what’s going on with their condition and if you ask the right questions, they will give you a huge amount of information. That can be used to make the diagnosis, treat the disease and discharge them safely and with great satisfaction.

We don’t always have time to sit down and chat for as long as we like and that’s okay. I’ve said that I don’t have the time to chat right then, but make time to go back and speak to them later. And sometimes they just want to chat about themselves. And that’s okay too.

For patients who don’t speak English as a first language, don’t forget an interpreter. This includes deaf patients who may use Auslan as a first language. Giving information in their own language can make a huge difference to their day.

Introduce yourself

Dr Kate Granger is a geriatric medicine consultant in the UK who has a terminal cancer. As a patient, she was shocked at how few staff introduced themselves to her during her treatment. She started a campaign called “Hello My Name Is” and aims to encourage health care workers to introduce themselves to patients. Don’t rely on your name badge to do it for you!

Read!

Especially as a younger doctor, you will see so many new things. If you see something you haven’t heard of before, have a quick read about it. Our access to technology today means that we can often have a quick flick through something on our smart phones.

If you’re going to an operation, have a read about it the night before. It helps to understand what is going on much more and means you can ask some great questions and learn from the situation.

And finally…

Enjoy yourself! You have a great opportunity to have a stimulating and fulfilling career. you will get the chance to meet some amazing people and see incredible things. Look after your patients, look after yourselves and most of the rest will fall into place.

This post was first published at onthewards (a not-for-profit organisation that operates due to the generosity of junior doctors who volunteer their time and contribute content) on 13 February 2016 and is available at What I wish I knew as a junior doctor. If you work in healthcare and have a blog topic you would like to write for doctorportal, please get in touch.

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MJA chief embraces latest career twist

When the position as Editor in Chief for the Medical Journal of Australia became vacant last year, Nick Talley’s wife told him, “You should take that role”.

At the time, Professor Talley was well ensconced in his position as the University of Newcastle’s Pro Vice Chancellor (Health) and, with much already on the go, let the idea slide.

But, as has happened at other times in his life, a call out of the blue set Professor Talley’s career on a new path.

The Board of AMPCo, which publishes the MJA, approached him about becoming its Editor in Chief – an offer he happily accepted.

“My wife was right, that I would enjoy the role,” he told Australian Medicine.

Becoming the MJA Editor in Chief is not, on the face of it, an obvious move for Professor Talley, a gastroenterologist who has enjoyed a stellar career as a medical researcher and administrator, with more than 1000 publications to his name.

It is not the first time he has been head-hunted for a position that has taken his career – and life – in an unexpected direction.

In the early 1990s, while working at the Mayo Clinic in the United States, he was approached to become Foundation Professor of Medicine at Nepean Hospital in Western Sydney.

As he himself describes it, it was a significant challenge.

“I was 37 years old, had virtually no administrative experience, and was charged with the daunting task of developing teaching and research plus new clinical departments in a hospital that didn’t even yet have a physician’s training program,” he recalls.

After nine years in the position he was lured back to research and the Mayo Clinic Rochester in 2001.

Five years later, he was “tapped on the shoulder” to transform the Department of Medicine at Mayo’s Florida centre into “a cohesive academic entity”.

It was, Professor Tally says, an exhilarating experience: “I learnt more about the science of leading and management than at any other time in my career”.

This knowledge was to stand him in good stead when he was poached in 2010 to become Newcastle University’s Pro Vice Chancellor (Health), a post he has held ever since.

But, while overseeing the University’s research and education programs, Professor Talley is excited about the opportunities and demands of guiding the MJA in coming years.

It is a testing time to be assuming the helm of such a publication.

The rise of the internet has changed the way people access information, and vastly increased the amount that is available.

It has led many to question whether the days of MJA-style publications, particularly in their hard-copy format, are numbered – doubts sharpened by plunging ad revenues.

Questions are also being asked whether then process of peer review, used by the MJA to help verify the quality of the research that it publishes, is any longer suitable.

But Professor Talley looks on the task ahead of him with enthusiasm.

“We are in the middle of a digital revolution,” he says. “The way people obtain and use information is rapidly changing and evolving. It’s a very challenging and interesting time to be in the field of publishing.”

Armed with years of experience as a researcher and educator, Professor Talley has clear ideas about what the MJA needs to do.

“To provide important information and updates to clinicians at the coalface; to be a publication for first-class research of relevance to Australia; and to make clinicians aware of developments that will impact on what they do,” he says. “That is an enormously important role.”

Some believe the proliferation of open-access online journals in recent years may marginalise, if not kill off, publications like the MJA, but Professor Talley doubts this.

Though welcoming the idea that study data and results be open to all, he questions whether many such publications will survive, particularly because concerns about quality will have many doubting their usefulness.

While he is not sure that, in 10 years’ time, the journal will still be a print publication, he has no doubt that the MJA in some form has a strong future.

“There is a very important place for peer reviewed journals of high quality that act as gatekeepers for advances in science and scientific knowledge,” Professor Talley says. “There will still be a critical role for journals like the MJA, which has a pretty rigorous process of peer review, modelled on the best in the world.”

Adrian Rollins