LETTER FROM AUSTRALIA           313

A Federal election is due before the end of 2007, but the Prime Minister seems to be holding off announcing any date until the last possible minute. The Opposition has a commanding lead in the opinion polls and a landslide defeat of the government is predicted. Both major parties have been trading blows in the false election campaign for so long now that the population’s interest in the outcome is fast waning. Health has emerged as a major election issue. In relation to gross domestic product (GDP), health expenditure is running at close to 10% and rising at a faster rate. Around $A 4000 is spent on healthcare per person per year. Hospitals consume 35% of the total expenditure but are never able to perform to the high expectations of the community. Australians have universal health insurance under the Medicare system which entitles them to free treatment if they choose to be admitted to a public hospital and also to a rebate covering a proportion of doctor’s fees for community-based consultations. All taxpayers contribute 1.5% of their taxable income as a Medicare levy. Many Australians take out additional private health insurance to provide cover in the event of treatment being provided in a non-government hospital setting. The funding for government-run public hospitals is complex with about half coming from the State Government and half from the Federal Government. This generates tension between the two levels of government because, although both contribute to the running costs in roughly equal proportion, the administration of these hospitals is entirely controlled by the State Government. In this Federal election campaign, both major parties have hinted that they would consider exercising much greater control over public hospitals that were not performing well. Apart from this, there have been promises of an additional $A 2 billion for the ailing mental health system and promises from both sides for additional funds to support services for autistic children.
   Some news that is considerably more interesting for clinicians is that two rotavirus vaccines are now registered in Australia. Rotavirus was first recognized by Australian researchers, Ruth Bishop and Ian Holmes, who carried out electron microscopy studies on faecal material at the Royal Children’s Hospital, Melbourne in 1973 and subsequently identified the virus particles in duodenal biopsy specimens. Rotavirus is responsible for 520 000 deaths in infants and children under 5 years of age each year, mostly in developing countries, and for 45% of all hospitalizations in this age group. The first live rotavirus vaccine produced by Wyeth was tested in 1998, but was withdrawn 9 months later when a cluster of cases of intussusception occurred in vaccinated children. Subsequent epidemiological studies suggested that the risk of intussusception was in fact very low—1:32 000 live births—but by then the vaccine was no longer available. Professor Julie Bines and colleagues have studied regional differences in the incidence of intussusception and have been able to confirm that the risk of this condition in Viet Nam is 3.5 times higher than it is in Australia. The increased incidence is not related to rotavirus; instead, the strongest association seems to be with adenovirus infection.
   Two other discoveries stand out as landmarks of Australian research success. The first is the discovery made by Marshall and Warren in 1985 that peptic ulceration is an infectious disease, not one caused by stress as was previously thought. The identification of Helicobacter pylori in gastric biopsies and Marshall’s demonstration of Koch’s principles by experiments carried out on himself make classic reading. The second is the demonstration by Professor Fiona Stanley from Perth of a clear association between the risk of neural tube defects and the dietary intake of folate in the first trimester of pregnancy. Stanley’s elegant large scale epidemiological studies and the first papers of Marshall and Warren were all published in the Medical Journal of Australia and are among the 10 most often read publications from that journal.

GARRY WARNE