Issue 32 / 1 September 2014

IN the past few weeks it seems everyone with access to water, a refrigerator and a social media network has taken the "Ice Bucket Challenge”.

People around the world from all age groups, persuasions and walks of life have posted homemade videos of themselves being doused with cold water, and have challenged their friends to do likewise to raise money in support of amyotrophic lateral sclerosis (motor neurone disease).

Not everyone is supportive of the use of extended selfies and viral marketing to highlight a single disease for charitable attention. Both armchair critics and academics have argued that the Ice Bucket Challenge is a vanity exercise encouraging ill considered, poorly directed giving, and diverting money and attention from more worthy causes.

On one level, these objections miss the point — this very modern movement has managed to engage large numbers of people, many who would not normally donate to charity. Whether by design or serendipity, it is an idea that has risen to the challenge of its time.

This week in MJA InSight, we look at some of the ways fresh ideas and innovative thinking are needed to meet contemporary challenges in medicine. Our first news story examines the game-changing effect of human papillomavirus (HPV) vaccination on cervical screening.

The recent recommendations of the Medical Services Advisory Committee, to raise the age of first screening and replace 2-yearly Pap smears with 5-yearly HPV testing, have been well received but an MJA study and some overseas experiences have prompted one cytology expert to voice concern that changing some aspects of the program might undermine its success in unexpected ways.

While advances in cancer prevention and management have improved outcomes overall, the results of an Australian audit published in the MJA seem to indicate that ovarian cancer has been left behind. MJA InSight asked Australian leaders in gynaecological oncology what ideas and innovations are on the horizon to turn this situation around.

Occasionally in medicine, an idea finds its time to supplant previous understandings of a disease. According to infectious diseases physician Paul Goldwater, this could happen if more research confirms his theory about the cause of sudden infant death syndrome (SIDS). In a comment this week, he explains how earlier work, including that used to posit respiratory or brainstem causes, fits with his own research to suggest that bacterial sepsis is the final event in SIDS pathogenesis.

In another comment, Garry Egger and John Dixon, two doctors with expertise in obesity and lifestyle medicine, say it is time to reimagine doctor–patient consultations in order to manage the modern epidemic of “… complex, lifetime metabolic, cardiovascular, respiratory or carcinogenic disorders”.

They have been researching, and advocating for the funding of, “shared medical appointments” in which multiple patients attend for consecutive group visits where “all can listen, interact, and learn”.

New knowledge about a link between the promotility agent domperidone and sudden cardiac death has caused concern about the drug’s off-label use to increase milk supply in women trying to initiate breastfeeding. An MJA article, which says safety concerns may not be relevant to the lactating population, is the subject of another InSight news story.

As community standards change it can be worth revisiting our response to ethical issues. In her column this week, Jane McCredie asks if it is time to take the disciplinary response away from individual institutions and into the criminal realm as more and more instances (and consequences) of research fraud come to light.

When the Ice Bucket Challenge reached my household last week it provided an opportunity to discuss basic neurological concepts, the random unfairness of dread diseases, the power of social media, the importance of authenticity and what a charitable donation feels like when docked from your pocket money. I also learned to use a phone as a video recorder (on the second try).

These seem like positive short-term outcomes but whether this idea, like any other, will have a lasting impact is a question that can only time can answer.


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

One thought on “Ruth Armstrong: Time will tell

  1. Randal Williams says:

    Without wishing to be seen as a kind of charity grinch ( bah humbug)  , I think the ice bucket challenge is an example of the power of social media to promote a silly idea. Firstly it is a waste of water, and the energy required to freeze it, and then to wash and dry the clothes.  Secondly someone, sooner or later, is going to have a severe vasovagal reaction or even a cardiac arrest. Why not donate to MND to NOT have a bucket of iced water thrown over you? I just dont get it.

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