TOP STORIES

Gaps list furore

Australian Association of Surgeons (AAS) President and well-known critic of managed care, Dr Graeme Brazenor, is taking legal advice after his name was listed as a 'preferred provider' on the Medibank Private website.

Dr Brazenor, a neurosurgeon in Victoria, said he was 'personally affronted' by the health fund's act.

Toxicologists quit

The national service providing expert clinical advice on poisoning cases to doctors and hospitals has been rocked by the resignations of four toxicologists.

The exodus has left just seven toxicologists to handle poison emergencies across Australia.

Financing survey gives GPs no way out

An Australian Divisions of General Practice survey on the memorandum of understanding (MoU) has left GPs confused and without options, AMA Chairman of General Practice Dr David Rivett has warned.

He has cautioned GPs not to rush any decisions on the GP MoU, despite the deadline for responses to the survey ending 30 August.

Cancer report sparks political contest

A new report showing severe shortfalls in radiation oncology services in Australia provoked a pre-election health debate in Parliament last month, with politicians clambering to defend their cancer policies.

The 'National Strategic Plan for Radiation Oncology', released by the Royal Australian and New Zealand College of Radiologists, found a shortfall in services which left 10,000 patients without treatment in 2000.

Health policy confirmed as Australians' top priority

Polling has rated health spending as Australians' top priority, re-affirming AMA plans to intensify policy pressure on the Government and the Opposition before the Federal election.

Conducted by the ACNielsen organisation, the poll showed that when people were asked to rank priorities, 43% put health spending first.

INSIDE

At the end of their tether

ALP Federal Member for Werriwa, Mark Latham, claims the AMA is not doing enough to help GPs in his outer western Sydney electorate. In early August he organised a meeting in Campbelltown, NSW, between himself, AMA President Dr Kerryn Phelps and 12 GPs to discuss GPs' concerns.

Surgeons better placed under AMA banner

AMA President Dr Kerryn Phelps says the current debate about the expected application by the Society of Australian Surgeons (SAS) to register as a union may be seen by some surgeons as an indication that the AMA is not capable or willing to effectively represent them or their interests.

She says this could not be further from the truth.

Nation faces crisis on poison information

The national service to help doctors deal with medical crises involving poisonings has been stretched to breaking point by the resignations of four of the 11 toxicologists on call.

A passport to trade practices support

A new AMA online training package for doctors on the Trade Practices Act is the first step in a process of members being supported 'online'.

The biomedical revolution - what may we become?

Winner of the 1996 Nobel Prize in Medicine and former Australian of the Year, Professor Peter Doherty, gave the 2001 Kenneth Myer Lecture at the National Library of Australia last month.

He said the big excitement in science was that the 'who are we' question is in the process of being opened out in the most extraordinary way.

From the Vice President - The stem cell dilemma

Dr Trevor Mudge

The past few weeks have seen a great deal in the media about stem cells. Given the complexity of the subject, one wonders how many newspaper column inches have been read and digested and how many have been merely glanced at for their mad scientist shock value.

Readers of Australian Medicine will at least be able to recall some details of the basic science involved from their undergraduate years. As a simple gynaecologist, albeit with a long-term involvement with reproductive technologies, my understanding is less than expert.

Why then the interest? We are used to headlines reporting research breakthroughs and promises and might be's. Is stem cell research all it is cracked up to be? From the people I talk to it seems that for once the hype may well be lived up to.

Briefly, the science holds out promise of growing new cell types from embryonic stem cells to cause them to differentiate or change into a particular type of adult human tissue. This could then be used to replace defective or aged tissues in disease states. The potential range of possibilities is huge. A brief sample would include diabetes, Alzheimer's and other dementias, spinal cord damage and even the possibility of growing organs for transplantation.

Of course given the uncertainties of future research results, all of this may come to nought. The possibilities, however, are both exciting and real. The problem of rejection of an allograft remains but may be overcome for the first time by the use of cloning technologies to replace the nucleus of the harvested stem cell with the nucleus of the adult recipient.

Apart from the undeniable problems with the success of the research, we are left with the ethical dilemma of the source of the stem cells. Even a secular view of ethics must be predicated on respect for human life. For many religious groups that life begins at conception and respect for it is absolute and brooks no balancing considerations. Such a view would not approve of the production of embryos specifically for the harvesting of stem cells, with the death of the embryo an inevitable consequence.

What then are the potential sources of stem cells? Currently they include:

* Embryos specifically produced for the purpose of research;

* Aborted foetuses;

* Cord blood;

* Surplus IVF embryos;

* De-differentiated adult cells - not yet possible but remains a theoretical possibility; and

* Harvested stem cells from adult tissues - recent success in brain tissue has stimulated hope in this area.

None of these sources has yet been shown to be more productive or successful than any other. It could well be argued that the situation is analogous to a horse race. Given the richness of the ultimate prize for society and the uncertainties surrounding the prospects of each horse, it is critical in my view that they are all given a run.

The new US Bush administration has had a difficult series of choices in this area and George W's decision is an interesting compromise. Free enterprise America bans almost nothing, however the taxpayer funds a large amount of very expert medical research. The dilemma was whether to fund stem cell research through the public purse. The decision announced last week was to fund research on existing stem cell lines (perhaps less than 100) but to deny it to both exiting 'spare' IVF embryos and certainly to the production of embryos specifically for research purposes.

The AMA has made a submission to the House of Representatives' Andrews Committee on human cloning technologies, supportive of the medical and disease lobby to allow such technologies to proceed. We have not yet addressed the thorny issue of what is an acceptable source of stem cells.

Views anyone?

Dr Trevor Mudge is Vice President of the Federal AMA