Issue 13 / 14 April 2014

FACE-saving spin aside, last week’s WA Senate election rerun was a disappointing exercise for Australia’s major political parties, with both suffering substantial swings against them.

There were at least two well publicised “disappointments” in the medical literature last week as well. Like the election results they were not unexpected but they are worth a mention in this issue of MJA InSight.

The updated Cochrane Review Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children has been a long time coming. Concerned about their discovery of discrepancies in the published data and publication bias, the authors had struggled with pharmaceutical giant, Roche, for more than 4 years, to obtain access to the company’s raw data on oseltamivir.

As regulators and public health bodies around the world consider the disappointing possibility that billions of dollars have been wasted on stockpiles of minimally effective drugs, we asked Australian experts what this might mean for pandemic preparedness in Australia in one of our news stories.

Also making news last week were the results of a NHMRC draft review of the evidence for the effectiveness of homeopathy released just in time for World Homeopathy Awareness Week.

The NHMRC message that “The available evidence is not compelling and fails to demonstrate that homeopathy is an effective treatment for any of the reported clinical conditions in humans” was reported by media outlets around the country and was even picked up internationally but belief systems are strong when it comes to complementary medicines. In her column this week, Jane McCredie wonders what will change in response to the review.

Disappointment and frustration with the federal government’s refusal to engage with doctors about possible changes to health in the upcoming Budget, underpinned the tone of an AMA media release late last week. One of the speculated changes to Medicare — a copayment for patients consulting a GP — is the subject of two articles published online in the MJA today. As state and federal health ministers were preparing to meet to debate the reform agenda in Brisbane last Friday, we sought comment from a range of experts about the copayment for another of our news stories.

The word disappointing does not do justice to the scenario described in an article in the latest issue of the New England Journal of Medicine. The authors open with the dilemma for an 80-year-old man living in an aged care facility who, when scheduled for bowel cancer surgery, learns that he has a 50% chance of death within a year, and is likely to experience significant functional decline if he survives. Following on from last week’s news story in MJA InSight, which prompted productive discussion about medical treatment for aged care residents, this week’s featured news story looks at how we can — and are — improving decision making about surgery for older people.

The news this week is not all disappointing.

The MJA InSight team launched the "best reader comment" competition in March and, after a little poll of our own, we have our first winner. Dr Michele Meltzer posted a comment on Jane McCredie’s column on the need to support carers, bringing a first-person perspective to Jane’s advocacy for this group.

Stories of lived experience have a way of bringing us back to the messy business of helping people navigate their health and the systems that surround it. It is one thing to explain to a patient that an antiviral is unlikely to do much for their influenza, or that they’re wasting their money on homeopathy, but what about someone with a life-changing disease who wants to take a chance on an unproven treatment? In a moving account, GP James Best describes his internal struggle in seeking to rescue one such patient from the “peddlers of false hope”.

We all balance hope and disappointment in our life every day, but in medicine that balancing act can provide some salutary lessons.


Dr Ruth Armstrong is the medical editor of MJA InSight.

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