Issue 38 / 13 October 2014

THE announcement that Australia had become active in the conflict in Iraq was, in some ways, no surprise. Looking back at the century since the start of World War I, involvement in one conflict or another is the rule, rather than the exception.

This activity has not excluded doctors. In this issue of MJA InSight, Navy reservist Dr Andy Robertson has written a comment to highlight the Australasian Military Medicine Association’s 100th anniversary and its conference next weekend.

Robertson, a public health physician whose military ties go back 35 years, writes that involvement with the armed forces can give health care workers the opportunity to use their skills “in a range of different scenarios and places, from conflict to humanitarian assistance to disaster response”.

While serving in the military can be fulfilling for doctors in Australia, those living elsewhere have not had such benign experiences. In her column this week Jane McCredie explores the long and ongoing history of persecution of medical personnel who care for the victims of conflict, or draw a line in the sand about what they will and won’t do on behalf of the incumbent regime.  

In assembling this issue of MJA InSight, we seemed to encounter conflict at every turn. Our lead news story was commissioned to highlight a recent initiative by Australasian College for Emergency Medicine to conduct an independent review of the evidence for thrombolysis in acute stroke.

A representative of the college told MJA InSight the review was necessary because possible industry bias had produced conflicting evidence in the area, but two neurologists approached for the story were adamant that there was no need for a review.

The debate has been simmering for some time, and it is hoped that patients will be the winners with consistent, definitive advice once the available research is critically analysed once again.

The MyHospitals website, established in late 2010 to enable public reporting and comparison of key hospital quality indicators, was initially a source of conflict between clinicians, hospital administrators and health bureaucrats.

A recent survey from the US, in which hospital leaders were asked about America’s more comprehensive public reporting site, Hospital Compare, revealed concerns about unintended consequences such as distraction, diversion of resources and gaming.

For another of our news stories we asked Australian lead clinicians about their experiences, now that MyHospitals is up and running here.

Some conflicts in medicine are personal. An expert commenting for another InSight news story believes that the biggest threats to the success of Australia’s bowel cancer screening program are patients’ conflicted feelings about handling faeces and of potentially receiving a cancer diagnosis.

A sophisticated modelling study has just been published in the MJA, showing how many lives could be saved if the rollout of the national screening program were expedited, but if we don’t help Australians fight their internal conflicts, the program will never reach its potential.

At the RACGP conference over the weekend a group of doctors stirred up a hornets’ nest when they launched the No Advertising Please (NAP) campaign, asking doctors to “ban pharmaceutical representatives from their surgeries”.
Journalist Ray Moynihan outlines the thinking behind the campaign in a comment this week, but it looks like the NAP protagonists have quite a fight on their hands. In the hours following the launch media reports quoted the AMA and Medicines Australia as saying the ban was not needed, and the RACGP did not take the opportunity to offer support.

If the experience of the ethics committee charged with updating the Royal Australasian College of Physicians’ Guidelines for ethical relationships between health professionals and industry is anything to go by, unqualified support might not be forthcoming.

A year after the draft document was abruptly removed from public consultation it has still not resurfaced, suggesting ongoing conflict about best practice in this area.

Most of us try to avoid conflict, but sometimes it is justified. Uncertainty about the undue influence of industry on research and practice has the potential to harm the profession and damage patient care. It’s a fight we need to have.


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

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