Rising to the health challenge for Aboriginal and Torres Strait Islander peoples: what will it take?

A united stand from medical professionals and organisations will send a powerful message.     

Transport and health: en route to a healthier Australia?

We have been slow to recognize the impact that decisions about transport, land use and infrastructure have on health. Apart from encouraging a sedentary lifestyle, reliance on motor vehicle transport has a range of adverse health effects (traffic accidents, air and noise pollution, and greenhouse gas emissions). Physical activity equivalent to 30 minutes (in total) of brisk walking on all, or most, days of the week provides preventive and protective benefits for a wide range of health conditions (including cardiovascular disease, diabetes, depression and osteoporosis). "Active transport"--walking, cycling and/or using public transport instead of car travel--could have dual health benefits by providing physical activity and reducing the adverse health effects of motor vehicle transport. Doctors, medical administrators and health advocates can encourage the use of "active transport", and influence community-based programs and policy development about land use planning and travel demand management.     

The Research Quality Framework and its implications for health and medical research: time to take stock?

As the Australian university sector awaits final decisions about the introduction and stipulations of a research quality framework (RQF), to assess the quality and impact of research, we have studied international commentary on the value of such exercises. This suggests there is little hard evidence to recommend the proposed RQF. The UK government led the field in 1986 with its research assessment exercise (RAE), which is widely believed to have compromised clinical academic medicine by failing to satisfactorily acknowledge the contribution of clinical academics, not only to research but also to teaching and clinical practice. After the 2008 RAE, the UK government will move to a simpler, metrics-based system for assessing research quality and allocating funding. The New Zealand Performance Based Review Fund (PBRF), introduced in 2003, is based on a combination of peer review and performance indicators. Several concerns have been raised; among them is the real cost-benefit ratio of participation, with reports that many universities have spent more on the exercise than they will gain in funding increases. The scoring system has received the most criticism and, after the partial round assessment scheduled for this year, the controversial unit of assessment will be reviewed. It might be more cost-effective for Australia to modify existing research assessment processes than to undertake a potentially costly and arduous exercise.     

Individual and family consent to organ and tissue donation: is the current position coherent?

The current position on the deceased's consent and the family's consent to organ and tissue donation from the dead is a double veto-each has the power to withhold and override the other's desire to donate. This paper raises, and to some extent answers, questions about the coherence of the double veto. It can be coherently defended in two ways: if it has the best effects and if the deceased has only negative rights of veto. Whether the double veto has better effects than other policies requires empirical investigation, which is not undertaken here. As for rights, the paper shows that it is entirely possible that individuals have a negative right of veto but no positive right to compel acceptance of their offers. Thus if intensivists and transplant teams turn down the deceased's offer, they do not thereby violate the deceased's right. This leaves it open whether non-rights based reasons-such as avoiding bad publicity or distress -require intensivists and transplant teams to turn down or accept the deceased's offer. This, however, is beyond the scope of this paper. The current position may or may not be wrong, but it is at least coherent.     

Pandemics, antiviral stockpiles and biosecurity in Australia: what about the generic option?

In view of the possibility of a human pandemic of avian influenza, a first-line strategy for many countries is stockpiling of antiviral neuraminidase inhibitors (oseltamivir [Tamiflu] and zanamivir [Relenza]), which can reduce mortality, morbidity and influenza transmission. However, global supply of the antivirals is controlled by the European-based patent owners, Roche and GlaxoSmithKline. This prevents competition in the manufacturing and distribution of antivirals and has reduced global supply capacity and affordability. The Australian Government has acknowledged that, in the event of a pandemic, its own stockpile of antivirals will be limited and reserved for those on a confidential rationing list. Pharmacies are running out of stocks, limiting opportunities for individuals to secure supplies privately. Compulsory licensing provisions, permitted under domestic patent law, would allow Australian generic manufacturers to start producing antivirals locally or import them from generic producers at affordable prices. Australia also has an opportunity and a responsibility to promote compulsory licensing and generic antiviral production in the Asian region, to ensure our neighbours can establish pandemic stockpiles in a timely and affordable manner.     

The radial approach in the cardiac catheterization laboratory: is it meant to become the gold standard?

The transradial approach in interventional cardiology was born twenty years ago. Since then, many studies and meta-analyses have compared it with the former approaches, the transfemoral in particular. The most recent data is reviewed in this article through a double perspective: an anatomical and technical viewpoint in terms of a practical and successful vascular access; and a clinical and economical viewpoint with actual data concerning access site bleeding, access site complications, with a particular emphasis on the radial approach. Its impact on major adverse events, cost-effectiveness and patient comfort are also discussed. New advances and techniques are emerging with the radial approach which is gaining more and more magnitude in the world of interventional cardiology. However, can we actually affirm that this approach is meant to become the gold standard?     

The performance and problems of the Turkish pharmaceutical industry: is there a need to develop a national drug policy?

Turkey has a big pharmaceutical industry—of the drugs consumed there, 90% are manufactured domestically. Eighty percent of this manufacturing is run by foreign companies. In this study, the performance of the Turkish pharmaceutical industry in terms of the technology and production is examined and compared with that of some other countries, and the importance of the essential drugs list and national drug policy is discussed. At the end of the study, strategies are suggested toward meeting the main current challenges in the Turkish pharmaceutical industry.