Modest Expectations – The Spine

In an advertisement for the MD Anderson Cancer Center in a 2009 issue of Harper’s, a healthy triathlete smiles. His name is Bill Crews and under his name is the word “lymphoma” with a red line through the word. It is five years since he had been diagnosed and now following “an individual treatment plan”, he was in remission attested to which was completion of 14 triathlons at that point.

To celebrate his achievement a Bill Crews Remission Run was organised annually to provide funding for this Houston- based Cancer Center. Then there is a brief note in 2014 to say the website advertising the run is “inactive”. There is no record of Bill Crews dying – just that one word “inactive”.

It got me thinking, since my closest male friend also succumbed to lymphoma some years ago, although his course between diagnosis and death was far shorter. Once you get cancer, except for some skin cancers, you know your life will be limited. We all will die, but there is no need to face it until the doctor across the desk signals your mortality. You can of course avoid this confrontation by suiciding, being murdered, killed in an accident or sacrificed deliberately by those who would wage war.

What if I responded to the doctor after the sentencing: “I want you to tell me the exact day I am going to die.” What would be the response?

“Unfair question. Impossible to know.”

“OK, then will it be next week, week after… and this year, next year, sometime, never?”

We can be very precise with the input when we are provided with an individual treatment plan. Therefore, if you can give me such a plan, then it is reasonable to know the outcome, or what to expect. After all, infallibility is a power that some health professionals like to assume – well doctor, how long will I live? But then nobody writes on a funeral notice – he lasted x time longer than the doctors predicted or that the doctor got it so horribly wrong, he died well before the predicted date – perhaps in the middle of some surgical procedure, where the euphemism for “surgical vanity” is “heroic”.

The problem is that what I have written above is so foreign to how society is ordered. Most of us try and live in a predictable world. We expect that if we go to the gym in the morning it will be open at a certain hour. We know that lunch follows breakfast and we have a mid-morning coffee break.

Bill Crews probably had such a regimen. Cancer came; cancer went; but it never does. It marks time. How much of that time was consumed by unpleasant morbidity; how much did life become unbearable; and in the end, how much did he wish to live – all unanswerable now.

In fact, we live in a world of uncertainty. The flow of information from so many portals means that life is like traversing an Arabian souk. We never know what will happen next, but we always have the option of wanting or not wanting to know what we have bought – without it being varnished with fakery.

What does that all mean? Government, despite the various inputs, has to make the most cost effective allocation of resources in the face of all the individual treatment plans. There is no incentive for those manufacturing, distributing and prescribing the various medications to be less than optimistic. The cost of development of a drug is always stated as being so expensive so that the end product mirrors this expenditure. However, in the World of Optimism, who is going to undertake the rationing on behalf of community affordability. The plea, the crowd funding, the picture of the cancer sufferer, the hoped for remission mistaken for cure are all part of the emotional appeal. However, what price does one pay for a small addition to life of variable quality – what is an average of six months worth?

Policy should not be predicated on the outliers. Bill Crews had non-Hodgkins lymphoma. Through all the obfuscation surrounding survival rates, maybe his ten-year survival rate was about average when the last mention of Bill Crews was made.

Therefore, assessing the cost of Bill Crews’ treatment may be a useful indication of the individual cost for the condition. That statistic is just as important as knowing the relative success of the individual management plan and generalising from that one example.

But my whole case is predicated on two assumptions: the first is that the lack of mention of the poster boy by MC Anderson Cancer Center (now also with a red slash through the word “Cancer”) public relations, and the inactivity of the Remission Run from 2013 onwards means that Bill Crews is now cycling on a higher plane. In line with MD Anderson Center publications, I have not mentioned the word “death”.

The second is what Bill Crews’ individual management plan cost when everything was tallied, its figure would be useful enough to be used as a guide to cost – assuming that those costs could be found and adjusted for current prices.

Hopefully the responses, outraged or not by such reductionism, would be a welter of data trying to disprove my assumption. However, that could lead to a good controversy if the policy makers were listening, and cost could be determined with all the accompanying arguments laid out. Then tell the taxpayers!

The Senile Trail

Listening to the Health Minister, he talks about “self stigma” and that we should reach out for help. Well, may I tell you, if you bother to listen, Minister, self-stigma is a meaningless term, when you are crying spontaneously for no reason, when your body is at a point where you cannot undertake the activities you were once able to do; and you are alone. You reach out for what? The phone lines are always busy in the daytime. Trying reaching out at 3am in the morning wherever you are for help. About all that is left is the late night / early morning radio programs that provide an outlet to the old, the sick, the lonely who can’t sleep and who communicate with fellow callers from across the state or the country, through the radio: “How is Beryl from Cooma, we haven’t heard her on the show for quite a while, does anyone know?”

There is a great deal of breast-beating going on, because despite all the expense spent on input, nobody has a solution to care of the aged. I have been associated with nursing homes that work well, because there is a continuity in management and the constant positive is that those in charge worry and care for their nursing home community.

Being dependent implies that I have a carer, which fortunately I have “in spades”. I can no longer live independently unable to have shower, cook, dress and generally manage any housework efficiently – without help. It is frustrating knowing that when you are dependent, you have to wait – you have to learn patience without surrendering yourself to outright submission.

However, being in a wheelchair and then suddenly left facing a blank wall in an airport adds another dimension. The person responsible who leaves you without saying anything just adds that element of being ignored. It is no longer just waiting, you are being ignored and that adds a new reality. It is a sign that you a bit of garbage to be swept when the mood takes the handler. In the end, you lose your self-respect unless dementia beats you to that realisation.

Such are elements of growing old – such are the elements of being in care, where the rules are such that you – the resident – are governed by regulations engineered by government bureaucrats far away from your bedside. They call it compliance or accreditation – a meaningless term to indicate everything is under control. Unless you have a family, whether natural or manufactured, to act as the antidote, then every day is one day nearer to death, and increasingly you wish that day will come. Those words like “accreditation” have a meaning to those who love making paperwork look like an illuminated manuscript.

Are there any solutions beyond having a caring carer not an impersonal person – a shift worker with an inadequate handover when they come on duty, their measly remuneration ultimately dependent on some distant hedge fund?

All solutions are just a variation on that fact of individual care without the negative embellishment.

For instance, I mentioned in a previous blog the series shown on the ABC where four year olds visited an aged care facility over a seven-week period. Then the series finished, with an elaborate farewell antic. I wrote in my blog* at the time:

However, if the attempt of mixing the groups is just voyeuristic – “been there; done that”; then I believe the makers of this series have probably done a disservice to all involved if nothing further eventuates.

Old age is an increasing societal challenge. It should not be just a case of waste management. Yet I fear that is happening – and David Attenborough-like explorations of human foibles and cuteness should not replace serious consideration of what can be done.

The clue is in the series – get the elderly to tell their stories, whether they have a four year old audience or not. After all, it gives you a sense of relevance, even when you may be the only one listening. However even one child listening and responding with questions is a bonus. After all, I believe we are all storytellers.

My argument was not against the idea; my concern was it being generalised – the implication being that infant schools be co-located with nursing homes, so there is ongoing integration of experience – not just a one-off “gooey-eyed” curiosity but as part of a conscious government policy.

After all, each group’s experiences are transitory – the children grow up hopefully socialised to understand what it is to be old; and one of the aged care participants died between filming and release of the documentary. Such is life, as Mr Kelly is reported to have said.

It was ironic when the aged care report was released recently there was no mention of the documentary as one remedy – even seemingly by the ABC.

* Modest Expectations – Duckworth 30/8/19

Mount Augustus

 Uluru has been closed at last. To me, there has never been any question. The traditional owners should have the right to invite strangers to climb this extraordinary monolith. I have walked around the base which is measured at 10.6 kilometres and to me it felt ‘right”. Being a “whitefella” does not exclude you from being in touch with this extraordinary country. One of the things I have learnt from my association with the Aboriginal people is to know when the Land is accepting your presence.

The idea that climbing the Rock is akin to climbing a cathedral may satisfy some people as an excuse. However, the analogy does not hold. Tourists are like ants on the roofs and spires of famous cathedrals and churches; and prohibition to climb churches is more related to safety or privacy rather than it being a spiritual taboo.

The bogan chant of why can’t I go anywhere because this is Australia and I am Australian is OK if you are a self-absorbed narcissist who does not believe that any restrictions apply to yourself. There is a high-falutin’ word for this – “libertarian” and a more macho term – “individual”, its anthem: “I am what I am”.

Well, Mount Augustus may be just what you are looking for, to express your feeling and being what you are. Mount Augustus is technically a monocline but then for you guys, it is a “humongous Rock”. It is not red and bald like Uluru – it is covered by bush and it is still called by the “whitefella” name rather than its Wadjari name of Burringurrah.

Burringurrah / Mount Augustus

However, it is the largest rock in the world and I went there 20 years ago; so it exists and has not shifted. It is a bit inconvenient being 500 kilometres inland from Carnarvon. Uluru is tiny compared to Burringurrah. There is an eponymous Aboriginal settlement close to the monocline.

Rather than walking around the base, we were carted around the 43 kilometres in a minivan at a hair-raising speed by a male nurse then living in the outstation. The trip ended back near the settlement, when the van hit a large pothole and lost its wheel. Fortunately the sand provided a cushion and we were all uninjured and trudged back to the settlement. It just emphasised how huge this Rock is.

Currently, the local Wadjari people allow visitors to climb Burringurrah but unlike Uluru, there is scrub and a trail, which takes around five hours to climb and return.

Watch this space! I remember when Uluru was Ayers Rock and was hard to get there.

Burringurrah speedway

Sydney Ferries Fiasco – A form of naval gazing

Guest Blogger: Neil Baird#

It could be said that the only thing keeping the New South Wales Liberal/National Coalition state government in power is the even greater incompetence of the State Opposition. If the latest controversy over the renewal of the Sydney Ferries fleet is any indication, the Gladys Berejiklian led coalition is certainly not an exponent of open government. The Opposition has only now awakened to an announcement that was made nine months ago in February.

Unusually, the announcement about Sydney’s ferry renewal was made from Liberal Party headquarters and not from the Minister for Transport’s office. Sure, the party was in election mode but what were they doing issuing a press release announcing a $1.3 billion project in such an underhand way? What was the government trying to conceal? Why will just 13 comparatively simple and small ferries cost $ 1.3 billion? That figure appears grossly excessive. Or does that include running and maintenance costs for nine years as mentioned in one report? Why would the government not be more transparent?

Given their other shenanigans with the Northern Beaches and Mona Vale hospital projects, for example, taxpayers have every right to be suspicious. For the record, the three larger ferries are to be built in Indonesia, presumably by Penguin Marine; the 10 smaller ones are being built by Jianglong in Zhuhai, China. The local firms mentioned below Ross Roberts/Harwood Marine were never invited to tender. Nor was anyone else apparently.

It has since been fully revealed, in an 23 October 2019 press release from Opposition Leader, Jodi McKay, that the fleet replacement was a “done deal” by 27 February 2019 when the Liberal Party announcement was made.

The story goes that in early February this year a couple of Australia’s leading ferry builders had been approached with a vague invitation to tender for the ferries. Apparently they didn’t respond to the approach. So did at least one leading firm of naval architects. None could be bothered to respond as they had such bad previous experience in dealing with Sydney Ferries, apart from being very busy anyway.

The subject went quiet for a few months and has only now been revived by Ms McKay who seems to have confused the facts.

Simply put, after endless problems, mainly with the maritime union, the operations, but not the ownership, of Sydney Ferries has not officially been privatised. It is a public-private arrangement, which avoids the need to go out to tender. The French-owned transport conglomerate, Transdev have contracted to operate the ferries, and seem to have eliminated most of the problems when it was run by the NSW Government.

Yet the curious way the ferries were ordered remains, with virtual concealment of the nature and cost of project from the taxpayers of NSW.

While Ms McKay has revealed some of facts, other parts of the story are off-beam. While the Trade Unions have been one of the major reasons for the problems at Sydney Ferries, the relative absence of shipbuilders in NSW has not helped.

However, she is partly correct. The ferries could have been built locally, as she advocates, but the only company in the NSW with experience in building ferries of the size ordered is Harwood Marine of Yamba in Northern NSW.

Strangely, Harwood was not even approached or invited to tender. Indeed, the managing director of Harwood was unaware of the government’s intentions until very recently. Harwood has been busy with a major expansion of its company’s facilities including, ironically, a 60 metre shed in which large aluminium ferries could be built. Equally ironically, those who could have benefitted – the local youth workforce in a town where unemployment stands at 23 per cent – didn’t get a look in.

Apart from Transdev, which is expected to correct Sydney Ferries’ inadequacies, one major local firm will benefit from the association with Transdev. That is the Port Macquarie-based company, Birdon, which moreover has been contracted to build ferries in China and Indonesia for Transdev.

Birdon is a highly reputable company, as is Transdev. This fiasco is no reflection on either. The government may well get a good deal in the end. However, the problem is the opaque process that the government followed. The State Opposition has been unaware of such a major project, until the belated statement from Ms McKay. It is also a major problem that Harwood, a significant employer and highly reputable local shipbuilder was not even asked to express interest in the project.

The taxpayers of New South Wales have not been well served by its politicians.

We have not heard the end of this.

# Neil Baird is non-executive Chairman of Baird Maritime, a global maritime trade publisher. Among his other positions, Neil is a long-serving director of the Australian Shipbuilders Association.

Mouse Whisper

Once I heard the confession of a poker-faced mouse whisperer despite it being difficult to squeeze into a murine confessional box.

In January 2004, I was in grade 12 of high school and about to graduate. I operated a profitable web design business as a part time job for some spending money. Seeing as my legal name is Mike Rowe, I created the domain MikeRoweSoft.com for my portfolio. The Canadian lawyers of Microsoft didn’t like this (I really don’t know how they found my site, I had 2 visitors a day. One was me (sic), one was my mom). They sent me a couple of emails and a large legal document telling me to give up my domain name. I asked for $10k. They said no. I went to the media. Hilarity ensued.

Since then I’ve been a full time professional poker player for the last 3 years. I’ve made enough to buy a condo and live very comfortably in that time. I have finished 5th in the PokerStars Sunday Million for $97,500 as well as 31st at the PokerStars Caribbean Adventure earlier this year for $40,000. So I guess you can ask about the poker stuff as well if anyone wants to.

And no, I didn’t sell out for an XBox.”

The site was still active in 2017, but not now.

Modest Expectations Skat

“The problem with the drought is that it is predominantly affecting National Party electorates and as the Prime Minister charges round these electorates all he succeeds in doing is emphasising the impotency of government, while making the National Party look like drongos. Then enter off right, the Belgian fixative who does a deal with Hansen who knows when to throw a tantrum. Obviously her colleague in Tasmania has viewed this Flemish reflex, which has been adapted from Pavlov’s observation on canine behaviour. Frankly, I am sick of Keating’s unrepresentative swill being given a disproportionate voice while I struggle to pay my mortgage and make ends meet, all because of the manipulation by a Flem.”

Unfair; of course. But that is one example of how Australia is perceived as being governed. Maximising the influence of a few to the detriment of the majority. Just the frustration of being a young urban graduate, and collectively primed to burst forth, when the articulate leader of reform – perhaps a numerate “Whitlam” would help – emerges in the next three years, a person who puts the interests of the country first. Or do we reach a Chilean tipping point where the rules become radically different.

Some weeks ago, I recounted briefly that I had just come back from Chile where I made a point of visiting the Museum of Memories and Human Rights. At the time I said that the museum was “the brainchild of President Michelle Bachelet, to ensure that one memory sticks in the mind of the Chilean people. On a wall on the first floor are myriad photographs of Chileans murdered by the Pinochet regime – 130,000, probably more.”

Recently, she has visited Australia in her role as the UN Commissioner on Human Rights to deliver the Whitlam Lecture, which was booked out by the time I got round to it. But from snippets, I got the gist.

I had also seen an enticing advertisement for a house nestled in a valley between Santiago and Valparaiso – separate terraced complex houses a sauna, Jacuzzi and hot tub, and two bathrooms. The property also includes a one-bedroom guesthouse, a covered parking area for four cars and organic orchards with 750 avocado trees and other fruit trees with “income-producing potential”; on 17 acres handy to both Santiago and Valparaiso. The price? About AUD2m. All this under the headline: “Following a tax hike and a steep drop in sales, prices are rebounding thanks to a stable economy and new infrastructure projects.”

Yes, when we had been in Santiago in late August, it had seemed very quiet; well run city, taxi driver even praised the cops as the only honest police force in South America. However, that contrasted with a comment in The Economist about the current President, Sebastián Piñera, which concerned the social conflicts with students that had bedevilled his first term. In order to reinforce the point, The Economist alleged police had tried to cover up their murder of a member of the Mapuche, an indigenous people.

The Economist added, “That followed a string of scandals – ranging from planting evidence to corruption – in the Carabineros, the once-revered police force. The army is no better. Some officers have been found to have stolen public money; others have sold arms to drug-traffickers.

Somewhat different perspective from that of our driver as we drove through quiet suburban streets to the Museum …

Sure, when we later went on the road to Valparaiso, the slums stretched along it for miles inducing a feeling of unease.

On the way, stopping for a wine tasting in the Casablanca Valley, it was just what you would expect from a wine tasting vineyard in Australia – impeccable surroundings both inside and out, a fire to warm this predominantly young stylish crowd from the winter cold. I was reassured there that Chile was an exemplar of middle class respectability.

Then off to Valparaiso, where the poor in barrios cling onto the sides of the steep hills, yet all with a stunning view of the ocean. Here the streets plunge down these steep slopes – a variation on the big dipper. Barrios did not exude stark poverty but the people in the doorways or struggling up the streets with their provisions did not look happy.

It’s not that long since Valparaiso was almost destroyed in a massive earthquake, and the city has a shabbiness that belies the fact that it is a tourist centre and the politicians meet here in the National Congress building. The city had a sullen feeling, despite it being one of those places where there is so much intrinsic beauty, at least to my eye, despite its vulnerability to earthquakes.

Now two months on, the cities are aflame, the streets are crowded with a rioting populace, the army has been called out. The 130,000 dead on Bachelet’s Memorial wall have had a few added.

The cause? A seemingly minor increase in subway fares has proved the tipping point. The people have had enough. The country’s prosperity revealed has been heavily weighted to a small fraction of the community who can afford to buy the property described earlier.

The currency is devaluing, the inequity in everything from wages to health care lies revealed. The hatred of politicians has boiled over; despite conciliatory gestures. People lie in the streets, dead or injured. Tear gas lingers; property estimated to be worth $2 billion Australian dollars has been destroyed in the rioting, and the number arrested harks back to Pinochet’s times. The military are on the streets, their punitive powers on show. Piñera has cancelled two international conferences presumably not to show the World his intention to return to a military dictatorship.

After all, he has an approval rating of 14 per cent, presumably by all those hiding within gated communities. Piñera is reputed to be the wealthiest man in Chile, having introduced credit cards into that country and, as a badge of his mercantilist mind, he has manipulated stock such that he faced court more than once. He is the sort of person, who fits in with the definition of “politician”. He is a man well versed in fraud who has tried to shuffle his Ministers, but the protests have increased. Shuffling or sleight of hand generally also means taking money from someone else’s pocket.

Those in the streets are not fooled. They can see what awaits them on the horizon. All they have to do is go in the Museum and see the filmed images the morning Chilean democracy last died on 11 September 1973.

Bubble Australia

The Congress in Valparaiso has been invaded, and while the major excuse given for the increasing development of Parliament House into an impregnable Bubble Australia, thought must have been given to a popular invasion to construct it in such a manner. Presumably Bubble Australia has food and cocktails in store to last for six months in the event of a siege.

When people hate politicians enough, the tipping point will be reached. We are not immune from a Chilean-like situation – the only difference is that Australia has yet to have experienced a Pinochet. Yet we have a number of very good would-be impersonators.

I think Chile needs you back, Michelle. As for Australia, the space is unfilled – as yet. But then one of the characteristics of these new movements, apart from their youth is the difficulty in finding the leader to be carted off to gaol, effectively decapitating the rebellion. The Extinction crowd is on the streets, but they do not have the same mentality as the police force in its armour plate; and one has to hope wearily not to have a rerun of Queensland brutality à la Springbok tour or ageing commentators of both genders mimicking Askin’s admonition to drive over curly-headed young Sri Lankans – metaphorically of course.

However, if a society is unequal in its rewards system, and in their Morrisonian Bubble the beneficiaries try to insulate themselves, eventually someone will prick the Bubble or let the air be exhausted from the Bubble. It may take time, but there will come a time if there is no remedial action, we could end up like Chile or, for that matter, Hong Kong or Beirut.

Another Play with Words

Guest Blogger – Chris Brook*

The NSW government has announced that it is moving away from activity based funding in health care, to an outcomes-based funding approach. More recently the Australian Treasurer has declared that he wants Australia to do likewise to a quality care approach and eliminate low value and unnecessary care.

Both reflect the adoption of a new approach to measurement of value.

This announcement presages the latest fashion in health care economics and organisational design in the United States, which is value-based health care.

It is growing into a huge industry reaping enormous fees for consultants. As with any scheme, it gains keen audiences for its promoters because of its purported benefits and simplicity.

Basically the theory is simple – along the lines of:

(a) value, never quite defined but clearly related to outcomes and

(b) value, again never quite defined but including elimination of low value or unnecessary care resulting in:

  • integrated care
  • improved efficiency at all levels
  • team based care
  • patient-focussed care
  • higher quality care
  • better outcomes
  • improved prevention of ill heath and
  • lower cost

How could anyone object to such a set of targets?

And this all happens, apparently, through tweaking of economic signals along with better IT, better data capture and use, incentives for provider re-organisation and a value focus by patients. No wonder funders love the idea, or at least the components they choose to understand. However, like all things that sound too good to be true, it is too good to be true.

Some of the issues emerging are:

  • it is a North American solution to a North American problem
  • it assumes complete market flexibility, both patient and provider
  • it does not define outcome (clinical, functional, meeting expectations – actual against expected) and
  • it does not define value (whose or which value particularly)

Nonetheless some very interesting tools are being developed, such as much better prediction software which may dramatically alter future risk rating down as far as the individual level (with all the accompanying risks that entails).

To give the topic due attention needs at least a podcast discussion, with more than one opinion to assess.

This is but a teaser – an opening shot.

It does remind me that the world thought it had the solution to health care back in the 1930s, with the establishment of health maintenance organisations with uncannily similar promises – and promise!

As a very smart man once said to me looking into the mirror: “Chris, health maintenance organisations are a great idea and always will be.”

*Chris Brook PSM FRACP is a medical practitioner with 30 years senior management experience in the Australian health system

Tiempo, damas y cabelleros por favor

I came across the 29 May 2009 issue of Time which listed the 100 most influential people in the World. These lists are just one form of vanity press, a filler where high profile people are paid to write about other perceived high profile people who, unlike the writers, have attained the “magic” hundred.

The first one listed was Teddy Kennedy, who promptly died before the end of the year – and his legacy was his work in advocating for still unfinished health care reform. The second one listed was Gordon Brown, his paean written sympathetically by J.K. Rowling. He is long gone from the influential hundred; although he is probably behind the scenes within the Scottish resistance to Brexit.

However, in the 100 influential figures listed, both Boris Johnson and Elizabeth Warren get prominent space. A young Boris Johnson with boyish face and laughing eyes is eulogised by Conrad Black. One might say that it takes one to know one, but Black, ten years on pardoned by Trump for his malfeasance, was right in saying that Boris was a man to watch.

For her part, Elizabeth Warren is there for her expert knowledge of bankruptcy through all its shades, and her take on the financial services industry; she is “characteristically unfazed by the criticism.”

Surprisingly Putin and unsurprisingly Trump are not listed, and Xi Jinping is reduced to a narrow column on page 28. After being described in his role then as the Chinese vice-premier as “best known to many Chinese for his singing wife”, the writer goes on to pen that Xi lost his patience at a meeting in Mexico. He is quoted as saying, “Some foreigners can’t seem to mind their own business and sit around complaining about China.” But as the writer went on “He carefully flavoured the complaint as a joke, which took some of the pressure out. The politician’s instinct, it seems, is always at the ready.”

And as the writer said earlier in his piece: “the running joke in Beijing is that anytime there is a potentially nasty task, Xi gets it.”

First, Xi may joke, but he is no joke, and secondly I am not sure how he would describe Trump, but he obviously has a great deal of experience in such matters.

As for the rest, well there are those in elected office, those blazing a trail as “influential” and in the end there is mostly a Warholian outcome – maybe a tick over 15 minutes.

All shook up …

Guest Blogger:  Janine Sargeant*

Hard to believe, but there apparently are “Elvis Loathers” – designated by areas of calm cobalt blue on a demographic map of the USA. The “Elvis Lovers” are bright red and shake up much of the eastern half of the US.

Like him or loathe him, Elvis is everywhere

This map appeared in the August 1993 issue of American Demographics. Prepared by a Texas market research firm, using demographic data and addresses of members of Elvis fan clubs, it purports to show the depth and breadth of Elvis fandom. The most “Elvis-friendly” places apparently are small towns dominated by mills, farms and main street retailers, but also the newer blue-collar baby boomer suburbs on the edges of cities like Atlanta, Miami, Austin, Kansas City and San Diego.

Bob Lunn, then president of Direct Image Concepts Inc., said he launched the Elvis survey for a client wanting to sell Elvis memorabilia. While the client went bankrupt, Lunn’s company enjoyed plenty of publicity by making the survey available to the media. The 7,000 responses to his questionnaires came from Elvis fan club members. He used the responses to develop a composite of the then typical Elvis fan: a conservative, blue-collar, white woman in her 40s or 50s who votes Republican, has a high school education or less, is married with children, watches sitcoms and the Home Shopping Network and reads Bride’s Magazine and the National Enquirer. The typical fan also drives American sedans or pickup trucks, swims in above-ground pools, smokes menthol cigarettes, drinks malt liquor, and eats white bread, canned meats and Velveeta – all of which probably had a place on Elvis’s pantry shelves.

The Elvis map showed the clear divides that commonly exist in the US between east and west and north and south, although in this instance the north eastern states (with the exception of New York and Boston) certainly carried the flag for Elvis.

However, the map demonstrates how data can mislead. Based on Lunn’s methodology Alaska, with the exception of Anchorage, apparently is full of Elvis Loathers. Problem is, not much population in Alaska to move that state into the red zone (or perhaps it is just that the moose prefered Little Richard). Look more closely at the blue zones (except perhaps Blue Hawaii) and to a large degree the problem is a lack of individuals to sign up with an Elvis fan club.

What would the map show if it were redone now? Probably a lot more of “Elvis Who?” in beige, although it would likely now be called “Elvis? Meh.”

Exercises like these are an amusing diversion, but perhaps not to be relied on, as Lunn’s client discovered.

Janine Sargeant runs a medical association in the not-for-profit sector.

Mouse Whisper

Funny coincidence but my mouse trainer’s thirty-second wedding anniversary has fallen in the week of the thirty-second Modest Expectation blog. A coincidence, but in the world of gifts even for such an anniversary, ebony is the go.

Ebony mouse whispering

Modest Expectations – October

i with my dear friend le canard trump join together in congratulating Justin Trudeau in seeing off the forces of the far right. I think that is the same as seeking the betterment of both countries, is that not correct, Mr President?

The Moral Basis of Christopher Pyne

You know when you hear the words after yet another expose of a particular corporate malfeasance: “we take these matters very seriously…” by which time you have turned off because you have heard it all before.

Banfield’s work – required reading for Christopher Pyne

However, The Moral Basis of a Backward Society written by the American political scientist, Edward Banfield, should be required reading as Australian moral trajectory is directed towards the end situation described by Banfield.

In his examination of Sicilian society in the 1950s he points out that the whole basis of the society is to rob society for personal gain. “Rob” implies criminality and while Sicily is the home of the Mafia, my use of the term is broader to embrace the morally bereft rent-seekers who tip-toe on the edge of legality. You know for instance the persons who profit from “insider knowledge” to make a living, and essentially do nothing else to advance society, while they line their own pockets.

Banfield describes the person at the centre of his dysfunctional society as a male who “lives moment to moment, which governs his behaviour either because he cannot discipline himself to sacrifice a present for future satisfaction or because he has no sense of the future. He is therefore radically improvident.” However, I would not want to be sexist, and in our current era only attribute such a quality only to males.

One of the problems of Australia is that corruption is often confused with mateship, a characteristic which can be traced back to the Rum Rebellion, as the brown paper parcels are laughingly distributed. Added to this heritage, Australia is gaining the reputation as a Chinese Laundry while every aspiring politician sees his or her eventual future as a rent seeker.

You know if Banfield was alive today, he may well have undertaken writing a sequel to his book called The Moral Basis of Christopher Pyne and then, as Banfield did with Sicily, generalise his conclusions so we could benefit from his insights. But alas, where is the Edward Banfield among our political scientists today, Professor Van Onselen?

Mane Course

Some years ago, a prominent culinary scribe (he hates being called a food writer) wrote an article in the Good Food section stating inter alia the following:

“At the same time, the outrage overlooked the paradox that Australia has exported horse meat for human consumption since the 1970s. Today, we’re one of the world’s biggest exporters, with two accredited abattoirs – one in South Australia’s Peterborough and the other in Caboolture, Queensland.

Guaranteed 100% beef free

According to the Department of Agriculture, Fisheries and Forestry, we exported 6,137 tonnes in 1998-99 and 2,320 in 2006-07 to 14 countries including Russia, Switzerland, Belgium and France.

 The Department estimates between 30,000 and 40,000 horses are slaughtered each year, but this includes about 33 licensed knackeries butchering horses for the domestic pet-food market, including thoroughbreds, standard breeds and wild brumbies.”

The writer has a strong Slovenian heritage, and horsemeat is freely available in that country, but the biggest importers of horse meat are Italy and France and the biggest exporters of horse meat, which in the OECD definition includes not only “equine” but also “ass, donkey and zebra”, are Argentina followed by Mongolia and Canada. Australia is a small player in the international market.

The above article was written when certain restaurants were introducing horsemeat in various guises on the menu, and being picketed for doing so. Thus horsemeat on the menu became a short-lived exercise. But if there is a surplus of horse flesh, eating it remains an option. If a horse is slaughtered cleanly and humanely, what right has anybody to deny their fellow citizen access to a horse menu?

Nevertheless the writer very clearly set out the numbers being slaughtered and I cannot remember then any of the current breast-beating which is being drummed around the country in response to the recent ABC documentary. However, once the visual images are added to the fact, then the crescendo of breast-beating and teary humbug becomes almost too much for anyone to bear.

The fact is – and it is an inconvenient fact – that when a basically greedy industry over-producing a product to be syndicated among a gullible public means that many of the animals do not pay their keep, what do you do? Release them into the wild so they become an ecological pest or just kill and cremate them. Or use them for food.

Walla walla catsmeat

During and just after the war, horsemeat was sold in the butcher shops as pet food because sheep and beef was rationed – and there was no outcry. In fact, the distinctive cry of the street vendor of horsemeat was very distinctive: “walla walla catsmeat.”

Not all horses can be buried standing up like Mummify or have a comfortable Living Legends retirement. If Australia wants to tackle this particular problem then it should look at the supply chain, and especially at the advertisements offering yearlings that will conquer the racetracks. Shares in these horses that are available for purchase should include the rider (pardon the pun) that you – the owners with “a hundred of your best friends” – are also responsible for the horse for its whole life, including its death certificate.

Further, I would advocate that every protester be given a horse as a token of their love and devotion, together with a certificate of ownership. The certificate can be traded in, stained with tears, if the person wishes to return the animal to its equine funeral home. It used to be called an abattoir before the community outrage ensured that the name be changed and photographs were banned.

Seriously, if the community cares about the welfare of horses, it would not condone the obscene amount of money invested in a few horse races to benefit people who are already very wealthy to the detriment of unwanted horses that die an excruciating death.

Withering Foxglove

In 1785, William Withering, a Birmingham physician, wrote a treatise setting down the history of his patients where the extract of digitalis purpurea – the foxglove – was used. Many of his patients had severe oedema, which is a sign that the body is cracking up and not able to maintain the distribution of body fluids in an appropriate manner. After all, each of us is a compartmentalised bag of salt water, with a few calciferous supports called bones to distinguish us from amoeba.

Oedema has a number of authors. Where there was an underlying cardiac reason for the oedema and associated problem, Withering showed the foxglove extract worked. It just happened to be the extract that yielded a substance which aided cardiac function.

Quoting from the notes of his patient 136, Withering wrote: he was ordered to take two grains of pulv. Digitalis every morning and three every night; likewise a saline draft with syrup of squills, every day at noon. His complaints soon yielded to this treatment, but in the month of November following he relapsed, and again asked my advice. The Digitalis alone was now prescribed which proved as efficacious as in the first trial. He then took bitters twice a day and vitriolic acid night and morning, and now enjoys good health.

“Squills” – Drimia maritima

Before the Digitalis as prescribed, he had taken jallop purges, soluble tartar, salt of steel, vitriol of copper, etc.

Withering used digitalis as a blunderbuss, but this was one patient in which he seemed to get it right. However, as with everything else much of the treatment then was based on purge or emetic – and the basis of such treatment was hardly evidence based, and some of his patients with oedema for whom he prescribed digitalis did not get better and death ensued.

However, Withering was wandering in the darkness of medical ignorance; and that cannot be said of today when under the cover of Pharmacy as a learned profession, the spruikers are out selling much the same array of quackery, just different names. One pill on sale 13 ingredients – a modern day equivalent of the Withering squills:

Vitis Vinifera (grape seed), Silybum marianum (milk thistle)

Selenomethionine, Betacarotene  Thiamine nitrate (vitamin B1) Calcium pantothenate (vitamin B5), Pyridoxine hydrochloride (vitamin B6);Vitamin B6, Cyanocobalamin (vitamin B12) Ascorbic acid (vitamin C); Vitamin D-alpha-Tocopherol; Vitamin E; Zinc amino acid chelate and with a garnish of Folic acid.

A normal balanced diet obviates the need for vitamins and selenium can be toxic, especially if children swallow a few of the tablets that have been left lying around.

In one case Withering had success infusing a young grossly oedematous man with digitalis. He obviously was feeling very chuffed, as he finishes the case history (sic): I forgot to mention that this gentleman, before I saw him, had been for two months under the care of a very celebrated physician, by whose direction he had taken mercurials, bitters, squills, alkaline salts and other things, but without much advantage.

The pity that the paradox of having knowledge unlike Withering in his pioneer use of digitalis, over 200 years later, the same quackery exists but with different titles is being flogged; and in the same unregulated environment no much different from that in which Withering medicated.

I read an interview with Jack Gance, the founder of Chemist Warehouse. There was not one mention of the word “therapeutic’ in the interview. It was all about money and profit margins, and when you see its advertisements where you see these laughing, presumably satisfied, customers with shopping trolleys brimming with all types of his alchemy, then you know how deep, drug taking is rooted in our society. And as a society we have the audacity to humiliate strip-searching young teenagers. Back to the advertisements with the hysterical customers pushing their drug cornucopia to the check out desk – just money stripping here.

The Medical Board of Australia is investigating this whole area of complementary medicine currently. On a major homeopathic website there are a number of anecdotes attesting to its value. They are uniformly positive, reminiscent of the testimonials that adorned the patent medicines and remedies sold through magazines. I find it unsurprising that such a biased sample appears on the website. However, there is no end to gullibility.

Let me just add to these anecdotes a contrary view. In 2013 I went undiagnosed for a period of time, and among the remedies suggested was krill oil. It is interesting when one is very sick, the promise of a therapeutic nirvana supersedes logic.

As it turned out, it was an orthopaedic surgeon who diagnosed my condition where other doctors and apothecaries including myself did not. I had a nasty affliction with a gradually worsening triad of pain, stiffness and weakness, so much so that one night as I stood in my bathroom I knew I was dying if there was no intervention.

Fortunately I was pulled back from the brink – not by krill oil, but by prednisolone. My therapeutic response was almost instantaneous, such that I am not writing his blog from a celestial platform.

Cortisone, a naturally occurring substance in the body, was crucial, administered in a therapeutic dose to counter the autoimmune disease process; plus paracetamol for the pain- killer, a chemical, an aniline compound first manufactured in the 1880s. No oil of krill or any substance from the alchemist crucible.

Education System Fails Australia.  Will micro certification help?

Neil Baird

The retiring Secretary of the Department of Prime Minister and Cabinet, Martin Parkinson, recently joined a long list of well-qualified commentators in warning of the dangers of falling living standards arising from Australia’s declining productivity growth.

As an employer for more than 40 years, I regretfully have to agree. Parkinson partially blames political instability and policy uncertainty. He is undoubtedly correct in that assessment but I firmly believe that the major factor in our productivity decline is the general failure of our wider education system.

As I see it the problem is that the primary, secondary and tertiary education sectors have all become anti-business over the last 50 years. One of the benefits of advancing age is being able to look back on an education experience that was generally pro-business. I was fortunate to attend a school where successful business leaders were hailed almost as heroes. Even at university, at least in my undergraduate years, they were tolerated or, at worst, ignored.

Since the late sixties all that has changed. While the ageing Communist Party of Australia and its various “fellow travelling” organisations were gradually declining, they were being replaced by similarly agitprop inspired groups who began to infiltrate and eventually dominate our education system.

That movement started in the universities and quickly spread through both levels of our schools and by the early 1980s the movement had effectively been institutionalised. Unfortunately business did little or nothing to counteract this; education became widely anti-business. Our children were, and are being, taught that business is bad and sales people are crooks. Not only is this attitude destructive, it produces too few people who are productively employable which, in turn, severely handicaps our national productivity.

As a global publisher of maritime trade magazines and organiser of their accompanying trade exhibitions, I know the publishing, events and maritime industries quite well. Their problems are essentially similar and largely they are the result of the output of our schools and universities. Like many western democracies (except perhaps the USA) it is becoming impossible to find enough good and competent staff.

I see this problem as largely attitudinal and those attitudes are mostly shaped by an education system that focuses on what I call “fluffy”, easy subjects in the social sciences to the detriment of the more difficult STEM* subjects. Apart from their underlying political inspiration, universities generally favour the “fluffy” subjects because they attract more fee-paying students.

The old “Techs” – the technical colleges – have been allowed to wither on the vine. Under the Whitlam and Dawkins “education revolutions” they became TAFEs, many of which eventually were turned into universities. The Whitlam Government introduced free university education for the masses, ignoring the Commonwealth Scholarships scheme, which quickly devalued university degrees, at enormous cost, and allowed the “fluffy subjects” to gradually dominate our universities.

A couple of years ago I, and many others connected with the maritime industry, were shattered to learn of the University of New South Wales’s intention to close its globally esteemed school of naval architecture. That institution was the world leader in producing the designers of fast ferries, patrol boats and the like. However, the demand for such graduates is not high, about 15 per annum. Despite the important facts that all UNSW naval architecture graduates were quickly employed and their fees covered more than double the direct costs of their course, UNSW is terminating the course this year.

Of course, 15 graduates does not in any way compare with the fees being contributed to the university, and its counterparts throughout the country, by its hundreds of marine biology, environmental science, media studies and journalism students, for example. The fact that most of those students, upon graduation, will be lucky to find employment as baristas or, largely unnecessary, public servants is of little or no relevance to the UNSW or its other university counterparts. Meanwhile, like my company, Australia’s naval architecture firms and ship builders, which are all significant exporters, will have to employ graduates from overseas. Worse still, they now have to establish their construction activities offshore.

Much the same applies to the trades. Everyone I know in shipbuilding is having trouble filling trade positions such as welders, electricians and ship- wrights. Even the catering trade, I understand, is having similar problems. It seems strange that, with all the people in this country of Italian heritage, my local Italian restaurants have to recruit chefs from India. I understand, from a nephew in the business, that modern apprentice chefs are failing to survive long in the business because their teachers have left them unprepared for the realities of the work and discipline involved with their roles.

Anecdotally, this seems to be a problem that affects companies across the whole spectrum of business. Recruiting competent enthusiastic staff is very difficult. Meanwhile, our governments boast of keeping our unemployment levels “down” to 5.2 per cent even though, in my view, that has been achieved by overloading our Federal and state bureaucracies with “fluffy” graduates. Our more intelligent politicians are well aware this does nothing for national productivity. Unfortunately, few, if any, of them are doing anything about it.

Now, what we are effectively doing is shifting our productivity offshore. Our bright, hard working people and our vigorous businesses are being forced to develop overseas while our domestic economy slowly stifles itself into unproductive mediocrity.

The Federal Government initiated the Hayne Inquiry into the banks and finance sector. That has led to some promising reforms. It should do the same with education and examine the vital relationship between education and productivity. Then, something might be done to reverse our inexorable long-term decline in productivity.

*Science, technology, engineering and mathematics

Neil Baird PhD is non-executive Chairman of Baird Maritime, a leading global maritime trade publisher. Neil is a former chairman of the World Ocean Council and of the Australian Marine Environment Protection Association, and a long-serving director of the Australian Shipbuilders Association.

Mouse whisper

As reported in the SMH this week by James Massola:

Joko and Morrison met for about 15 minutes at the presidential palace yesterday and afterwards, Morrison said he had discussed the Indonesian-Australian free trade deal, counter terrorism co-operation, the proposed new Indonesian capital on the island of Borneo and the recent deadly riots in Papua and West Papua

Wow – Speed diplomacy. Pity they did not have another 15 minutes or Morrison would have had time to talk about the Sharkies’ prospects for 2020. The fact that he spent only 15 minutes discussing the above matters says something about Australian-Indonesian relations.

However, Morrison had nearly an hour with Vice-President of China Wang and given that the main object was to get into the good books of President Xi so that presumably he will be eventually granted an audience, an hour pleading his case may be a better use of time than worrying Indonesia about the potential re-run of Timor-Leste in West Papua – and yes, the Bali bombing was a long time ago.

Go Sharkies. Go Joko.

Modest expectations – Westphalia

I understand le canard Trump was instrumental in securing the treaty of Westphalia in 1648. That statement is about as idiotic as his justification for welshing on the Kurds because they did not help in Operation Overlord.

It reminds me of the bon mots uttered by Marshall Green, the shadowy US Ambassador to Australia, who was implicated in the Whitlam dismissal.

“When he heard there may be Turkish troops posted to the Vietnam War, Green is reputed to have said: “I have always wanted to see Kurds in Hue.”

There is no mention of Miss Muffet or the tuffet upon which she was sitting.

Upon which Miss Muffet sat …

Diversion to Lithuania

I have been reading a book written by David Smiedt about being a Lithuanian Jew. I have always admired the Lithuanian Bund – a collective of Jewish socialists with their Polish and Russian brothers and sisters who provided a bulwark of social idealism and democratic spirit in an area that was rife with anti-semitism and authoritarian politics. They were a reservoir of Yiddish speaking Jews and were opposed to the Zionist element of Judaism, at the time when an independent Jewish state in Palestine was very much debated.

Many of the Bund came to Australia, and I remember a former Yiddish school in Carlton being rented by a group of young parents including myself as a day nursery. It was surplus to their needs, but we inherited an elderly Lithuanian, Joseph Giligich, who was very much the “hands-on landlord”, and even though his constituency had moved from Carlton south of the Yarra, he was always buzzing around.

He was not the only Lithuanian to attract my attention, for very many of the refugees from the Baltic countries after World War 11, whom I met, were Latvian. However there was one in my year of medicine, who introduced himself as “Casey”, which sounded Irish, and then uttered his surname that, like Icelandic surnames, tend to be long and trail away into the distance. The scribe politely asked how it was spelt and he started “Z…d…” The rest was lost in the mirth of the class. He was Lithuanian born.

It was some years before I had the opportunity with a friend to visit Lithuania – and yet it was not a Jewish Lithuania that I saw. It was very much a Roman Catholic Lithuania.

It is a long drive from Riga to the capital, Vilnius. So we have an intermission. We stop off at the Hill of Crosses near the town of Siauliai (pronounced “Sharlie”). As I mentioned earlier in my Jiminy blog, this Hill is an extraordinary sight to behold as we near it. “Behold” is the right word, as it is a religious experience – thousands of crosses and crucifixes of all dimensions piled together on this hill and around its base As they are mostly composed of untreated wood, they are grey and slowly rotting. Some are pasted with chips of golden amber but the sun has gone and they too merge into a cheerless greyness. It is a vision of Golgotha seen though the eyes of Mervyn Peake.

For Lithuanians this is a sacred spot, and despite it being pulled down during the Russian rule, the Lithuanians have ensured that it has sprung up again. The various notes in various languages strewn on and among the crosses indicate the Hill is not restricted to the locals. I gaze out on the adjacent lush meadow bordered by a clear stream. The forget-me-nots nestling among the crosses under the cypress trees provide a dash of nature to this oppression of crosses and crucifixes. I would have thought that this scene would provide a degree of tranquillity. But it does not. The Hill has a stench of death.

However, for most who come this is a sacred spot for pilgrimage. For them, placing a cross or crucifix among the many others may seem a fulfilment – an apologia for the journey. Lithuanians are Roman Catholics and as a country they have a natural affinity with Poles, who, like them, are Catholic. Small Polish flags are seen poking through the adornment of crosses testifying that it is a place of pilgrimage. For me, despite the gloomy appearance, the Hill is the second most arresting sight in Lithuania that I have seen until Vilnius.

The weather that has been threatening suddenly bursts open on my way back to the car park, which is about half a kilometre away. While our driver has been able to drop us near the Hill to let us out, he has to retreat to the car park. I get drenched.

It is still raining when we get to Vilnius. Our experience was somewhat different from the author of the Lithuanian odyssey, who explored the underbelly of the city.

The square outside our hotel has a number of intersecting lanes and streets lanes adding to its central importance. The square is lined by shops, amid which is the church of St Casimir. Nearby to the hotel is the National Philharmonic Hall, where we venture to hear the works of a Lithuanian composer, Osvaldas Balakauskas. The building reflects the Russian stucco socialist realism of the time. It was built in the 1940s. The music of a modern Lithuanian composer is challenging and we don’t have the energy to interpret all his nuances – we leave at the interval.

The weather has started to warm up on our second day, so we have the option of sitting out on the pavement or inside. We sit outside, quietly sipping a pre-lunch ale, when suddenly they descended. A line of cars and motor cyclists – men in red berets and army uniforms –men in dark suits with those radio earpieces dangling from their ears, seamlessly alighting in feathery concert from the cars – a fluid movement as though it had been a learnt art at bodyguard school.

Even the car doors are closed quietly. However, this is an exercise in hanging about until the centre of attention, who seems to have the rank of Lieutenant General arrives, has a brief kerbside conference with his staff and disappears inside. Amid all this activity we are not disturbed, not asked to leave, not frogmarched away.

The minders are all very relaxed but alert. They tell us who is coming, the name sounding like Gaubys. There is no self-importance in these men, apart from the number required to protect this dignitary. They chat to us. The Lithuanian army is supposed to be a reasonable fighting force. We are not very far from the Belarus border, and if we were allowed we could have had gone to Minsk and back for lunch -that is if you prefer Belorussian cuisine. However, the iron curtain still clanks at the border of these two countries.

Instead, being in the centre of town there are convenient cafés. One named California across the street takes its clue from its title and serves food with an American brio. I have the clam chowder and not the hamburgers. The café across the other lane is the Café Montmartre where the food has a very French flavour – the familiar eponymous onion soup, snails, even frogs’ legs are available. This shielded us from what is very endemic in all Baltic cookery. No matter how tricked up it is, it all comes down to meat and vegetables – with some fish. The grilled sea bream at the Café Montmartre is probably the best fish I had on this journey.

Lithuania is known for its glassblowing – stikliai – and there are many shops, which put this Lithuanian art on display. From one of these shops, I buy a simple small glass robin as a memento.

It is also known probably more widely for its amber, as is Latvia.

The Vilnius Cathedral has a neoclassical colonnaded façade and the building is topped by three statues, the central one – St Stanislaus, the patron saint of this country, carries a cross.

The cathedral has a high vaulted Gothic nave adorned by paintings and frescoes. They are again nothing remarkable. I light a candle for my close friend since it is nearing the tenth anniversary of his death. I stop for a moment before the basilicaform chancel and sanctuary. It is a strange place to remember him. I cross myself.

Close by there is the 13th century tiered tower, once part of the city defences but since the 19th century, the cathedral belltower. The bells ring out at 5pm but we are here in the morning.

Outside is a Dominican friar, who is speaking Russian animatedly to his companion. It is an example of the unexpected. I could see this as the opening scene in a John le Carré scripted film (or am I thinking of Dan Brown?) – a Russian-speaking “supposed” Dominican monk up to something. (This poor innocent man here in the portico becomes the subject of a vivid imagination).

Then an unforgettable moment occurs. My eye catches a small child being slowly rotated by his mother on a small patch of pavement. We wander over to see what the child is doing. They leave. This is the square within the Square where the last or first person stood when, as mentioned earlier, two million Lithuanians, Latvians and Estonians held hands to celebrate the three countries released from Russian rule. It is just a single marker of a symbol of a solidarity, which is missing in all the other relationships between the three countries.

Stebuklas Miracle Tile, Cathedral Square, Vilnius

Standing on this marker because of its simplicity and yet its significance as a currency of communication is my trip highlight. Having duly rotated on the spot as a symbol of good fortune, I walk with my companion away across the square to the gardens where the trees shield us from the increasing warmth of the day.

I cannot forget the mother with her child standing on the marker – he looking down, she gently turning him around. I hope the child enters a world where “sekmes, veiksmi , edumay guide him on through this turbulent World – and each a word in a different language but meaning much the same – good luck.

But first don’t let Trump know of this country that has seen so much pain since its Grand Duchy days between the 13th and the end of the 18th centuries, and of the three Baltic countries has the smallest Russian population. Yet it borders the Russian Baltic exclave of Kaliningrad and its neighbour Belarus may as well be Russian.

The last part of our walk through the University of Vilnius is somewhat of an anticlimax – up a hill, curving narrow street, no shade, weather now hot, little green space to rest. I buy a Lithuanian flag at the university bookshop. Now I have the three flags of the Baltic countries and, as with everything else, they could not be more different. But remember these people did once hold hands across all their borders in 1989, 30 years ago, on August 23 – and they have not forgotten.

As David Smiedt, who works as a comedian, concluded following his far more extensive exploration of Lithuania than mine, admitting that he views the world through a Jewish lens:

“I envy their self-assuredness, which I originally mistook for aloofness or suspicion. Lithuania, like its inhabitants will hold your gaze.”

Amen. 

The Case of Gladys Liu

Lodged in the Prime Minister’s unintentionally leaked “talking points” between Northern Syria and Infrastructure are three dot points about the member for Chisholm (sic):

  •  Ms Liu has spent a considerable amount of time over the last three weeks reviewing her association with all community organisations. With nearly 1,000 Chinese organisations in Victoria alone it has been a lengthy task.
  •  Ms Liu has very clearly stated that she does not wish to be a member of any organisation that has not received her explicit consent. She has asked that she be removed from all organisations that have not received her consent.
  •  Ms Liu is confident that she is not linked to any organisations that may have inappropriate associations.

“Now go away and stop bothering me” is the subtext.

However, the first talking point implies our member for Chisholm is so disconnected with what she has been doing that she had to go through 1000 Chinese organisational names. I don’t know about you Prime Minister, but I know which organisations that I am linked to – and I do not have to go through the telephone book.

Next point, the weasel is out of the burrow – explicit consent. What does that mean? Now she has asked that she be removed from all organisations that do not have her “explicit consent”. Now, Prime Minister, given she has combed through 1000 organisations, how many would that be?

Final point – she is confident – but are you? And then the weasel attacks again “inappropriate associations”.

The fact the Intelligence Community warned Malcolm Turnbull about Gladys Liu should not be ignored; what has changed that has now prompted your Assistant Minister to use the word ‘smear’ in relation to the questioning of Ms Liu? If logic is used, then does the Intelligence Community with their advice to your predecessor form part of the smear.

For my part, what if she believes in the Chinese system of government, I do not see that as a crime. However, if anybody is a member of a proscribed organisation or has committed offences under the broad brush of ‘espionage’ then it becomes a different matter. The Prime Minister has obviously made the assumption that this is not the case.

However, she is now a Member of Parliament and what she says will be carefully watched not only by the Opposition but also by her erstwhile colleagues. However, just as we will have American apologists there is no reason for there not to be Chinese apologists in Parliament.

Ultimately, the ballot box will tell whether the case of Mrs Liu results in her being re-elected or not.

She made a very eloquent maiden speech, which implies that she has a literary grasp of the English language. However, if she becomes a Chinese apologist manquée, then she will not only have the ballot box to deal with. I suspect Beijing will be watching also.

However, if the Prime Minister does wish to show his trust in Ms Liu, he should ensure for instance that she is made a member of the Parliamentary Joint Committee on Intelligence and Security.

Ms Liu is not the first Chinese-born member of parliament to to be questioned over a Chinese-based organisation connection. Only last year, Mr Pierre Yang, an upper house Western Australian Labor member of parliament apologised for not disclosing membership of two associations allegedly linked to the Chinese communist party from which he has since resigned. Given the problems the NSW branch of  Labor Party are having with their association with Chinese benefactors, this is yet another challenge which our European exclave called Australia is facing, lying as we do geographically at the end of the Dragon’s tail.

Mouse Whisper

Topolino is indebted to David Smeidt for this sample of Yiddish humour:

One day Shlomo and Moshe are talking about holidays. Shlomo says, “I think I am just about ready to book my winter holidays again, but I’m going to do it differently this time. In the past, I have always taken your advice about where to go. Three years ago you said to go to Eilat. I went to Eilat and my wife Ruth got pregnant. Then two years ago, you told me to go to Bermuda and Ruth got pregnant again. Last year you suggested the Canary Isles and, as you know, Ruth got pregnant yet again.”

Moshe asks, “So what are you are going to do different this year, Shlomo?”

“This year,” replies Shlomo, “I’m taking Ruth with me.”

Eilat

Modest expectations – Joel

Given that our prime Minister loves to immerse himself in a biblical toga, this quote from the first book of Joel, which is incidentally the 29th book in the Old Testament and thus reflects the fact that this is my 29th blog that had its genesis 29 weeks ago, seems appropriate.

The vine is dried up, and the fig tree languisheth; the pomegranate tree, the palm tree also, and the apple tree, even all the trees of the field, are withered: because joy is withered away from the sons of men. 

The problem is that the drought conditions have not affected Australia equally. In fact if you look at the agricultural forecast, the crops in Victoria, South Australia and West Australia seem to be doing nicely thank you very much. There is a small caveat on there being spring rains.

Darling River

Where Australia is in drought is in NSW and Queensland where the Murray-Darling basin has been wrecked and where the National Party holds most of the electorates lining the river.

The cotton industry has been particularly greedy when it comes to use of water, but the cowboys who have played around with the water rights have not helped, and there has been one disaster piled upon another as the rivers have dried up.

I, as an Australian, have been appalled by revelations about the Basin, but then what would I know? I am just a city dweller sitting on the coastline of Australia looking out on the Parramatta River. Nevertheless, like the rest of us I am inflicted with the fatuous comments of our politicians in relation to climate change.

One lesson, which does not seem to have penetrated the skulls of these politicians, is the lessons learnt from the past.

I have travelled extensively around Australia during a time when I was responsible for the rural stock take on health 20 years ago. Even then I was amazed by the extent of the open dams, which had been created to harvest water from the Darling and its tributaries. There were a few seasons when the rains came, the water flowed and everybody lost focus on the fact that this is a dry, dry land.

However, travel to South Australia and there is a line named after a very meticulous gentleman called Goyder who determined that below the line he had drawn, cropping could be undertaken with a degree of surety and above it not. Below the line the farmer can be assured of a mean of 240mm rain a year.

In fact testimony to the accuracy of his observations one can see the abandoned farm houses of those who did farm above the line. With climate change Goyder’s Line has been moving south and farming in South Australia has adjusted to the shift. South Australia produces 20 per cent of the country’s grain; most of it is grown without irrigation. In fact the Yorke Peninsula, where the best malting barley is grown, has no rivers at all. However, like its companion Eyre Peninsula, one can see the line metaphorically as it crosses these two areas. The farmers respect its scientific basis.

South Australia does not have any National party members elected to its bicameral legislature. South Australia is a desert state. I remember sitting on a verandah in Clare having a glass of that distinctive Clare riesling, when my host asked whether I knew I was 90 minutes from Adelaide and yet 90 minutes from Oororoo, which is above the Goyder line on the fringe of the desert. Increasingly Australia has to adjust to the degradation of the Murray-Darling Basin. Queensland and NSW will become desert states; however they await their George Goyder to show them how to cope.

David Littleproud

As the plane makes its descent, the local member scans the surrounding country, pointing enthusiastically to patches of water adjacent the many streams cutting across the verdant plain.

“It’s where the creeks have spread out,” he remarks. “It’s the best I’ve seen it in a long time.”

How things change! These words were uttered by Mr Littleproud in 2016 as he flew into his constituent town of Tambo.

Switch to last Sunday and there he was on television defending the allocation of one million dollars to the Moyne Shire for drought relief.

Now I know something about the Moyne Shire having once been a ratepayer in the Borough of Port Fairy before it was absorbed into the Moyne Shire. I also know quite a bit about the Moira Shire in Northern Victoria, having worked in Cobram, Yarrawonga , Numurkah and Nathalia for a decade.

That is where the departmental stuff up has occurred. The names have been confused. Moira Shire has been the centre of dairying in Northern Victoria along the Murray River. In this Shire Murray Goulburn dairying co-operative had a large factory complex, the travails of which I had a front row seat over a number of years.

Hence Moira Shire is a substantial dairying area together with a declining number of orchards, both industries requiring much water. Its rainfall this year is well below that of the mean rainfall.

So the simple solution for Littleproud was to admit the stuff up. But not this not very little proud “duck” – to coin a phrase. He stood on his dig and said that the northern part of the Moyne council was in drought. Consulting the map the most northerly part of the Shire is around Hexham and Woorndoo. The rainfall here is about the mean at this time of the year – 40 cm – hardly drought conditions. In any event the major dairying area is in the south of the Shire near the coast. I wonder whether the Minister has ever visited (or will visit) either Shire to assess the validity of his comment about the drought in the Moyne Shire, rather than making silly statements as he did this week.

For my part I have enjoyed a very pleasant sausage sizzle in the Minister’s town of his birth, Chinchilla, as I watched the coal train rumble by through the centre of town. We were on our way to Eromanga, so we had a view of the progressively dry microclimates along the way.

Littleproud has been a lucky man. His father was a National party Bjelke Peterson era minister and, as was the custom with the National Party, Littleproud has been the beneficiary of inheriting the increasingly arid electorate of Maranoa.

The rainfall in this part of Australia is half the average up to this point and a quarter of the rain was received on one day in March. However, how much relevance that has to a man of the country who now lives in Warwick, two hours closer to the coast than Chinchilla, I would not know.

I have read about the water scams, the gouging, the incompetence, bodgie water right transactions, the alleged criminality of stealing water from the McIntyre by Mr Cotton-Farmer-of -the-Year, John Norman, the sly allusion of his distant relationship to Littleproud’s wife, the subversion of the Culgoa River by the Sino-Japanese owned Cubbie station, not to mention the draining of the entire Darling River and its reduction to pools of algae infested toxin.

All that – but the water has gone. There is no more and of course the Coal Vandals are loose and want to pollute all the aquifers by mining sensitive areas throughout Queensland and NSW.

As I said, Littleproud has been a lucky man. He is also lucky because he followed Barnaby Joyce, who probably vies for the sash of the Champion incompetent bull politician ever.

So Littleproud could be lucky if he would be more proactive and seek remedies quickly and not be wedged by the climate change deniers.

However, Littleproud’s performance thus far does not augur well, and one may predict that Chinchilla, his hometown could soon be a mining town in a desert, as its water supply diminishes.

Thus, where is the National water policy; as usual caught up in the pass-the-parcel policy, which is translated into massive inaction.

Prayer and rain dancing is the substitute and if rain comes, then who wants the discipline of a water policy beyond “miracle wishes”?

Perhaps in the interim Mr Littleproud may like to move from Warwick to Roxby Downs to get a taste of what awaits his current policy unless rain dancing bears mean raindrops falling on his head.

As he knows, Roxby Downs in South Australia is a major mining area producing both copper and uranium. Like Chinchilla, profitable mining. Currently this year Roxby Downs has had 4 cm of rain against a yearly average up to October of 12 cm. It requires the water to be desalinated and the population depends on the aquifers.

Spaghetti Maranoa, anybody?

A tale of two athletes

Guest Blogger:  Janine Sargeant*

Wednesday the 9th was Peter Norman Day.

Dawn Fraser was suspended for 10 years (shortened to four years) for her alleged flag-stealing effort at the 1964 Olympic Games; Australia considered her a hero. Among her honours, she was Australian of the year in 1964 (the “flag” year), inducted into the International Swimming Hall of Fame in 1965, awarded an MBE in 1967, appointed an AO in 1998 and an AC in 2018; bearer of the Olympic Torch in the Sydney Olympics opening ceremony 2000. She has a swimming pool named after her – just down the road from where I am writing this.

But Dawn Fraser has lacked one thing – grace and nobility of spirit. She was rewarded for being a genuine woman larrikin, who could swim fast.

You know the true blue Aussie who is quoted as saying: “I used to do some terrible things in the marshaling area to upset my rivals.”

Compare this to Peter Norman. He ran the fastest 200 metres ever by an Australian to win a silver medal at the Olympic Games in Mexico City in 1968 – his time of 20.06 seconds still stands as the Australian record – 51 years later. But because he supported two black athletes in their support of black rights (that Carlos and Smith defined as human rights) and, as a Christian stood up for human rights, he wore a badge of the Olympic Project for Human Rights, he was shunned by the athletic establishment in Australia – that is a remarkably strong word “shunned” – it has so many overtones and undertones.

Remember the American Avery Brundage was then the Olympic head honcho – a man who had been lavish in his praise of Hitler before the 1936 Olympics in Berlin. He threw the black Carlos and Smith out of the Games.

The pervasive authoritarian right wing culture permeated Australia. Wilfrid Kent Hughes, dripping knighthoods, was still alive in 1968. He not only had identified very clearly with fascism before the War but also had run the 1956 Olympic Games in Melbourne. One can imagine in the denizens of the Melbourne Club, this “disgraceful” Norman being discussed.

Unsurprisingly, Norman was not selected for the 1972 Olympic team, despite running qualifying times. The Australian Olympic Committee to this day disputes all claims that he was ostracised – a claim made during the annual pig fly-past.

Unlike Dawn Fraser, Peter Norman had both grace and nobility of spirit. He was not a larrikin, but he ran fast.

The two black athletes he supported – John Carlos and Tommie Smith – have not forgotten him. They were pallbearers at Peter Norman’s funeral on 9 October 2006

Belatedly, long after he had receive the accolade from his black brothers, in 2012, the Australian House of Representatives passed an official apology motion recognising Peter Norman’s achievements and his bravery in wearing the Olympic Project for Human Rights badge in solidarity with Tommie Smith and John Carlos. The House apologised for the treatment Peter Norman received on his return to Australia and, belatedly, recognised the powerful role that he had played in furthering racial equality.

Peter Norman was recognised with his induction into the Sport Australia Hall of Fame in 1999 and the Athletics Australia Hall of Fame in 2010, awarded an Australian Sports Medal in 2000 and an Order of Merit from the Australian Olympic Committee in 2018 – all of this, assuaging our collective guilt.

A bronze statue honouring Peter Norman at the Albert Park athletics track in Melbourne was unveiled this week on the 13th anniversary of his funeral.

As he said to Carlos and Smith “I will stand with you.”

Now Peter Norman stands with us all.

Janine Sargeant both swam and ran … but the Olympics never beckoned. She runs a medical association in the not-for-profit sector.

An affair of the heart

Senator Bernard Sanders has had a heart attack. He has been treated but it is unclear whether he suffered any permanent damage to his heart, or whether they thrombolysed him and stented him so the muscle was not deprived of oxygenated blood so the coronary arteries could be unblocked. Almost as good as new.

Bernie Sanders

Now Sanders is one sturdy post-vintage model in the automobile parlance, where running boards and crank handles are still provided. Yet would I be dependent on one such car? Perhaps on a quiet road without much traffic, and with a mechanic in the back seat.

When Bernie and I were young graduates on different continents, the treatment for a heart attack was to put you up on chocks in bed to rest, and if there were any squeaks to give you pain relief with morphine and if the engine was failing give you digoxin and if the engine was not running regularly try and correct the rhythm by drug or by electric shock.

Then came the specialised garages called coronary care units and things have become so sophisticated that the modern-day, post-vintage Bernie can leave hospital after a few days, re-bored for his next foray in winning over the American electorate.

There is a debate about “ageism” and whether it is wise to have a large number of the post-vintage vying for the most important post in the Western World. People can hark back to the fact that Eisenhower had a heart attack while President but that was near the end of his eight years and there was little resistance to Nixon taking over. The same may be said for Churchill, who was already 65 at the outbreak of World war 11 and was still puddling around as Prime Minister far beyond his use-by date in the 1950s.

So in the USA, the current situation is that all the leading contenders for the nomination are 70 years of age and above. When I reached 70 it was cited as the new 50. However, that does not mean that age has stalled – and I doubt 80 is the new 55 or 60. In any event, Trump is showing disturbing neurological signs and symptoms; Biden has been revealed as a serial plagiarist which never augurs well; Sanders has had his go last time; which leaves as a “newbie” of the 70 and over brigade, Elizabeth Warren.

I have never seen her in person, but on TV she is hard-working, articulate, intelligent, engaging, humorous – all the qualities which a misogynistic electorate will ignore at best and hate at worst.

Trump, even through the fog of impending dementia, knows he has Biden’s measure, because he will continue to bully and berate until Biden will have had enough of the abuse – this guy who frankly has little to him and certainly not the destructive firepower of Trump.

As for Bernie Sanders, he has to survive. Trump does not know how to deal with him. Crazy Bernie. Really? Pretty pathetic, Donald, you old canard.

If Sanders does survive then maybe, just maybe, we will be singing Moonlight in Vermont, but somehow given the 14 month grind ahead, the Democrats will probably end up with a younger candidate.

As for Warren, the Clinton burden is considerable.

This coming year will be long year for the President and his challengers as we may expect the stress and physical demands play out on the older contenders to the Presidential crown. Maybe, beggar the thought, it could all prove too much and we could have four funerals without a wedding.

Mouse whisper

In 1977 when one of the referendum questions put to the Australian electorate was whether it would agree to a retirement age placed on all Federal judges including High Court judges of 70 years, the “yes” vote was the highest recorded in any referendum with all states voting for and over 80 per cent of the electorate over all.

As one learned source stated: It appears that in Australia, age provokes a reaction of vacation rather than reverence, and the electorate saw no reason to make an exception of High Court judges.

I like that unusual use of “vacation” – the judges were encouraged to get on their bikes when they turned 70 and to have a “vacation vacation”.

On their bikes …

Modest expectations – Parrot

I want children growing up in Australia to feel positive about their future, and I think it is important we give them that confidence that they will not only have a wonderful country and pristine environment to live in, that they will also have an economy to live in as well. I don’t want our children to have anxieties about these issues.”  

The antidote for such anxieties?

 Religion is the opium of the People.

 You get good Marx for that solution. 

The safety valve

I never thought when I was challenged to write a blog, which I’m sure among the cacophonies of ideas and opinions may be read by one or two, looking for a murine apparatus and getting the spelling wrong. However, the blog is a safety valve. It allows one to shower cyberspace with words – and since cyberspace is self cleaning then you do not pollute but leave, in one’s own mind, priceless gems hanging like lanterns lighting humanity as they get swallowed by the uroboros.

However as the twilight glimmers, one of the only facilities left to me now is writing. Assuming that this is my skill, I am writing as if there is no tomorrow so that there is a legacy for what it is worth. I always listened to Alistair Cooke’s Letter from America every week when he was alive; there was always a reason for saying what he did. The book of his travel around America when he was a young man inspired me to see as much as I could, since that axiom that one is a long time dead rings so true – despite one’s affirmation of life everlasting in the Apostolic Creed. The problem is that these Creeds were hatched when 40 years was the life expectancy; thus before one realised the horror of old age and being cast into the Life Everlasting nursing home.

Rockchoppers revisited – A Weapon of Mass Destruction

I read Rockchoppers just after it was released in 1982. It was written by a Roman Catholic priest, Edmund Campion and in the wake of what I thought was the awakening of the Roman Catholic Church following Vatican II and with it the growth of the worker-priest movement. It was a brilliant book.

Chartres Cathedral Rose Window

His description of Chartres cathedral – there is none better. To stand, kneel whatever your stance in Chartres Cathedral the cathedral is, the nearest I myself have ever felt of being in a divine presence. Edmund Campion put my inchoate thoughts in print elegantly, compellingly. He quotes those stirring words of Fulbert, one of the Bishops of Chartres.

We are as dwarfs on the shoulders of giants. We can see more and farther than they, not because we have keener eyesight or because we are taller than they, but because we are raised up and held aloft by their grandeur. 

Yet as I clear my library of books accumulated over more than half a century, I wonder how Campion feels today about his Church beset by a tidal wave of child molestation, unacknowledged children of priests and the indefensible maintenance of the seal of confession in cases of child rape, the non recognition of woman as priests, the hurt and harm to so many of the flock over which these men in frocks and silly hats have presided. Shepherds they ain’t, although they do carry a crosier – representing the shape of a crook.

Corpus Christi College in Victoria, a seminary, has been revealed as a cesspool breeding pederasts. On re-reading his book, Campion is very chatty about his early life, except for the time he spent in the Manly seminary studying for the priesthood. He dismisses it in a few lines – “for years I would have nightmares that I was back inside those walls”. That is all, and his book then pursues the doctrinal-political pathway of a man whose beliefs are in line with those of the worker priest at a time when Santamaria was in ascendency. Yet he must have known about the increasing social dysfunctionality of the Church – he is too astute and sensitive not to have known.

However, this week watching these Roman Catholic apologists wheeled out for the courteous Lisa Millar and Geraldine Doogue to interview, there are the masks of geniality that are difficult to challenge, especially if you have been conditioned since childhood with a sense of guilt. You can never be rude to the Church. The Church would never send in the current Archbishop of Melbourne for interview as the public relations front – just get a good ol’ empathetic face of a Father Brown understudy with a purple vest to pour on the paternal charm.

This is the Roman Catholic Church in delay, delay and delay mode; the creed of Catholicism, as it is with many religions, is secrecy and rearguard. The description of church architecture to over the centuries as described by Campion designed to increasingly separate the congregation for the priest to enhance the impenetrable secrecy should be standard reading as should be his antidote in Chartres.

Personally I am pessimistic and the Campion book holds the clue of why that is. Within all religion there is a reactionary group fearful of change which intelligent unscrupulous populists like Santamaria can exploit, as he did through the DLP before it was effectively destroyed in the 1974 Federal election.

However, it is not only the conservative Roman Catholics, but also in Newt Gingrich’s cleverly exploitation in harnessing the political clout of the evangelical Christian movement in 1990s. There are two forces – fear and the authoritarian personality, which oppose the forces that Campion wanted unleashed to liberalise the Catholic church. Therefore, to protect the base the traditionalists are prepared – if not to condone the despicable behaviour outlined above – then to look the other way or throw a blanket of sophistry over it.

Richmond – A Reflected Glow

I am not a Richmond supporter. However, I easily could have been if the kids on the corner of the street where I lived when I was five had not been Essendon supporters. Deeply impressionable, I became a passionate Essendon supporter, a support that was transferred to my sons and their children.

Michael Egan, Major of Richmond

However, my great grandfather, Michael Egan was Mayor of Richmond in the early 1870s and there is even a street named after him in Richmond. He distinguished himself by biffing another councillor who dared to disagree with him, but many of his other achievements as a councillor have been lost when at some time later the Council records were incinerated – some say suspiciously.

Michael Egan made a fortune with a wood yard, initially at the end of Rowena Parade and then transferred to Punt Road, where the Yarra River was convenient for transporting the wood. Anyway most of the wood ended up in the goldfield diggings, and when the great Crash of the 1890s came, I was always told that he survived because his money was in the Bank of NSW.

During the 1970s I frequented the Vaucluse Hotel in Richmond where we had monthly meetings, and this was time when the licensee, Graeme Richmond, was one of the geniuses behind that golden period when Richmond was last a powerhouse football team; and mine wasn’t. However, despite the horror of the period I did not change my colour from red sash to yellow.

Then Kevin Sheedy came along, a Richmond champion footballer as coach of Essendon in 1981. I thought Sheedy a dirty player and remembered him breaking Des Tuddenham’s leg, another ferocious footballer of that era, who had gone to Essendon as playing coach from Collingwood.

Now this Sheedy had come to Essendon as coach, and there was a perverse satisfaction in him losing five out of the first six games as coach such that he contemplated putting on the boots and coming back as a playing coach.

Then the Sheedy era blossomed. Essendon won 15 games in succession until it lost the very last game of the season to Geelong to Geelong and subsequently the 1981 elimination final. In three years though, Sheedy achieved his first premiership with my team – the first since 1965 – and during this time it turned out that Sheedy had been an Essendon supporter as a kid.

The tide was turning. Sheedy in my eyes now had been a fearless, uncompromising player, who brought the best out of his players instilling that intense fearlessness, of which the current Richmond coach, Damien Hardwick, as one of his protégés was a beneficiary.

One day Sheedy had also stopped to play cricket with my sons who were practising on one of those malthoid wickets in Yarra Park close to the Richmond Cricket Ground. How good was that for two teenage boys forever devoted to the Essendon red and black! Richmond and Essendon were thus forever closely intertwined.

However, even before Sheedy was appointed, I did make amends in relation to the yellow and black when in 1979 I moved to Balmain – Richmond on the Parramatta River as I called it – and became a very strong rugby league supporter of the then Balmain Tigers.

Balmain colours were orange and black. But what is there in a different shade of colour?

But then that is another story. 

Trudeau or Scheer. Scheer who?

It’s colder; they play ice hockey more; their bacon is really ham; and their obsession with maple syrup products borders on unhealthy. So penned a BBC reporter in an introduction to an article about the Canadian versus American political system.

The Canadians go to the polls on 21 October with 338 ridings up for grabs. Next week, the leaders of the various parties face the media in a Quebec venue – one in English –the other in French before audiences presumably who can understand “pollyspeak” in two languages.

There seem to be six parties in the electoral campaign, although two of the parties have two and one member each – the Greens, two on the Vancouver islands and a one-man party led by a LePen-like character who holds a Quebec seat. This leaves the left-of-centre New Democratic Party under its leader, Jagmeet Singh, struggling to repeat its 2015 successes. The Bloc Québécois Leader, Yves-François Blanchet, seems more secure and concentrates on the francophone areas, and it is the loyalty of his constituency that will probably determine whether Trudeau can wrest seats and be re-elected.

Trudeau thus will have to win seats in Quebec, an aim helped by the fact that the Conservative leader, Andrew Scheer, who represents a riding in Saskatchewan, does not speak French well.

Saskatchewan

However, the end result of the election should be interesting. We Australians pay scant attention to Canadian politics, only mentioning briefly Justin Trudeau’s travails, when he had been embarrassed by his appearance in blackface on several occasions when young, well before politics beckoned. These antics have been portrayed by the right-wing media as though they were a mortal sin. However, given the rise of social media and the tendency apparently to trade intimate and potentially embarrassing images, maybe this minor transgression by Trudeau will be magnified in future elections for aspiring politicians as the “sins of the past” are paraded as “weapons of mass destruction”.

What is important about our future relations with Canada is that both countries for their size and GDP have substantial pension/superannuation funds, with the potential for investment. An example of this is the joint arrangement announced in August between Australian Super, Australia’s largest industry superannuation fund, and Ontario Teachers’ Pension Plan, Canada’s largest single-profession pension plan, to invest $1 billion each in the National Investment and Infrastructure Fund (NIIF) of India’s Master Fund.

Then this week, Webster Ltd, Australia’s monopoly grower of walnuts, signed a deal for an AUD854 million takeover, yet to be ratified, by PSP Investments, Canada’s huge public service pension fund. The same fund has funded the Hewitt Cattle Company to expand its holdings in the Northern Territory. PSP Investments also owns 25 per cent of the NorthConnex tunnel, 25 per cent of the Westlink M7 toll road, 33 per cent of the rail freight company, Pacific National and a large slice of BAI Communications – in political terms all highly strategic.

The problem with the two countries is that in addition to being far away from one another, they traditionally excel in different sports (unlike other countries in the British Commonwealth). So the two countries exist in parallel. Any communication between Morrison and Trudeau one can guess has been minimal; perhaps if Scheer becomes Prime Minister there will be more evidence of shared vision in a common adulation of Trump, given the way their political careers have slid forward.

Politicians are great followers and perhaps the investment profiles of the large superannuation/pension funds of each country may guide them to pool their common interests so there is a potential third force in this increasingly polarised world.

And one great advantage Canada has over Australia is the lack of the Murdoch shadow. It should be noted that James Murdoch has purchased a property in a remote part of British Columbia, but then does he count? After all, he has been caught providing funding for democratic aspirants for the U.S. Presidency.

Mouse whisper

Mentioning “Boof”. It may have been 2010 … with apologies to A.A. Milne.

Scott Scott Morrison Morrison whether a matter for glee,

Took great care of his bear, though he was forty-three.

Scott Scott said to the Rupert: “Rupert, ” he said, said he.

“Don’t ever go up to the top of the town if you don’t go up with me …

and look what happened – Scott2 Morrison2 has another bear called Lachlan.

Modest Expectations – Julia

Looking at this young woman Greta Thunberg, her face contorted with rage, one has to ask what is the next step?

Rosa Luxemburg’s comment may be relevant and somewhat re-assuring:

The most revolutionary thing one can do is always to proclaim loudly what is happening.

Yet what happened to Rosa Luxemburg, who is one of my admired people, as is Dietrich Bonhoffer? She was killed by the Freicorps in 1919, as was Bonhoeffer – hanged by the sons of the Friekorps at Flossenburg in 1945. They both spoke their mind. They challenged the equivalent to today’s violent alt-right. Both had a form of courage, I wonder whether I could ever emulate; probably not.

But back to Thunberg. What is her next step? She has confronted her Armageddon in a unique way. Yet her following may yet be ephemeral. How many of those who demonstrated last week believe that when the Sun rises tomorrow it will incinerate our Planet in a cloud of carbon dioxide.

Greta Thunberg, in her speech, was full of venom. She is confronting a world that is full of hatred stirred up by the newly-minted demagogues. She is no longer a schoolgirl; to these demagogues she is a revolutionary – a dangerous person. Sweden has a history of assassination. Remember Olof Palme. His killer has never been caught. I do hope Greta has good security.

The Man of Coal gets a Shiny Coating

The Prime Minister has come out of his visit to the United States with a new moniker – a Man of Titanium.

Titanium Man

Whether that sticks depends on whether the various spin doctors see any value in ridicule or defence emphasising the properties of titanium. Who knows? However, what else? Maybe some trivial contribution to Trump’s Mars Venture, a couple of speeches, opening a Pratt factory in Ohio in front of what looked liked a bikie convention. Wandering around the United States Morrison, despite all the flattery and pomp, presented a marginalised world figure.

Meanwhile, as well as the speech at the UN climate summit, Jacinda Ardern has given a headline speech at the UN Secretary General’s climate action summit private sector forum. She has been pushing her initiative, the Christchurch call to block extremism on the social media outlet; she has met with Sheryl Sandberg, COO of Facebook, Susan Wojcicki, CEO of YouTube and Brad Smith, president of Microsoft.

Her aim was to cement the Christchurch Call, during a roundtable with the tech companies including Microsoft, Google/Youtube, Amazon, Twitter and Facebook. Maybe the call will become an echo, but in our terms with the new crisis response protocol and the preparedness of Google to test it later this year, she’s giving it a red hot go – and what’s more, she is very relevant to what is occurring in the world.

She may not have been able to feast on Dover sole and apple charlotte with such luminaries as the Honorable Rudy Giuliani or the Honorable Katherine Henderson the other night, but Trump wanted to speak to her and it should be noted that Trump suddenly made time to drop by the Climate Summit – no show without Punch.

By contrast, our Prime Minister didn’t entrance everybody with his talk to the United Nations this week.

However, Morrison is not the tosser that some like to portray. I was thinking about what his next move with Ms Liu will be now that he has the Chinese well offside, and there seems to be some pushback by the Victorian Liberals.

Looking though the guest list for his dinner with Trump there was no Arthur Sinodinos – maybe a bit odd. But when the Niblick from North Shore who was at the dinner, comes home, he will be replaced by an envoy not tarnished by a Trump association; hopefully Sinodinos will be somebody who will be amenable to the Democrats. Just an errant thought chipped out of a cranial bunker.

Stop mucking about

One of the problems the health system faces is how to manage the aged person when their chronic condition develops into an impairment that requires varying levels of ongoing care, particularly institutional care. The health care system is faced with paying for custodial care – and preferably not in high-cost, state-managed acute hospital beds.

To the central Commonwealth agencies the imperative is to keep the aged brain and limbs working, for the forecast is that unless this is done there will not be enough people working to sustain the economy without extensive immigration.

This imperative to keep us working is an ironic outcome, given that the Commonwealth allowed the development of a superannuation scheme that required its own employees to retire on the eve of their 55th birthday. Under the terms of the scheme it was not worth working beyond that age. Moreover, there were financial penalties if you did.

That scheme has been retired, along with a lot of 55 year old public servants, but it illustrates a shift in thinking. It is not that long ago that the futurist chatter was about an increase in leisure time and the expectation of retiring to a recreational middle age. Given the imminent workforce problems, that is not an option for government planners. Therefore the workforce has to be healthy if it is to prolong its usefulness. After all, healthy life expectation starts from intra-uterine life.

The fact is that we have the technology to prolong existence. Whether that existence translates into the kind of life a person would care to be encased is a matter of personal value judgment. To many, though, the primacy of the individual is a societal norm.

So what about this question of an aged care health benefit under Medicare? The Commonwealth already has the power to legislate for a sickness benefit. Also, the Constitution picks out, in addition to the doctors and dentists, benefits for hospital care and pharmaceuticals.

In all the discussions of the Commonwealth’s powers, it was only the passage of the 1946 amendment that enabled the Commonwealth to intervene directly in health financing.

It then created successively the Pharmaceutical Benefits Scheme (1950), the Pensioner Medical Service (1951), the Hospital Benefits Scheme (1952) and finally the Medical Benefits Scheme (1953).

It might be argued that the Pensioner Medical Service was an embryonic attempt at an Aged Health Benefits Scheme. But it was a very limited attempt, restricted to some services provided by general practitioners to eligible pensioners and their dependants.

The matter of Commonwealth powers is relation to health was one of the terms of reference in the first major review of the Constitution established in 1927.

In its report two years later the Royal Commission, which undertook the review, revealed a strong difference of opinion on where responsibility should lie. The majority view supported a “softly, softly” approach, which would have health as a Commonwealth power but well fettered by the states and even local government.

What emerged strongly in the report was a recognition of the strong sense of co-operation between the Commonwealth and the States. But here the discussion was about quarantine and the promotion of public health. The fact that co-operation had failed under the “stress of epidemics” of smallpox in 1913, influenza in 1919, and plague in 1921, was seen by the Royal Commission as the reason for even more co-operation between the various governments, not less!

In fact, the Commonwealth Department of Health was created as a result of the influenza epidemic and problems arising from the return of large numbers of troops from the First World War. From the national approach to episodes, such as Severe Acute Respiratory Syndrome (SARS) and the Swine Flu epidemic are evidence that co-operation in this area has continued to the present.

But health financing is another matter. It is interesting to note that when the Constitution was next comprehensively reviewed in 1959, health was not mentioned in the deliberations. The Constitutional amendments of 1946 had resulted in the changes welcomed when the world was experiencing the advent of the “wonder drug” era. The cost of the health system was not a political issue.

So what has happened since?

John Deeble

As the late John Deeble, one of the architects of first the Medibank scheme of universal care (1974) and then Medicare (1983), identified over 30 years ago, from 1972 onwards the average wage level of public hospital employees started to rise far faster than both average weekly earnings and medical practitioner incomes. The impetus for this was, in his words, “a compulsory arbitration system which takes almost no account of the ability to pay and was completely unaffected by financing arrangements”.

A number of strategies have been employed to try to contain the cost of the health system since this trend became very apparent in the early 1980s. But in the end, when the smoke clears from any round of Commonwealth-State conversations on health, the problems foreshadowed in tailoring a health care system to projected demographic changes will persist. Yet near the end of the Howard era, there was an explosion of Medicare benefits, expansion of the Medicare Safety Net and the reintroduction of the private health insurance rebate.

One wonders, then, whether it would be best if there were some consolidation of the power of the Commonwealth, such that it assumed complete control of aged health care and, by implication, total control of health. Alternatively, should the Commonwealth simply retire from health care? This debate has achieved currency periodically, although with the number of reviews, which have been entered into from Rudd to Morrison, the debate has become rather muted waiting for the deliberations of these committees. The time that the Robinson Review has been allowed to meander needs to be curtailed as I mentioned before; and who knows where the Royal Commission into Aged Care Quality and Safety, constituted at the beginning of the year and due to release an interim report at the end of October, will end up.

There remains a need to stimulate discussion on how best to address the issue of providing for an aged health care benefit.

At first blush, advocacy of such a benefit would appear to be for “health care” after age 65. Any person, whether in the guise of “patient”, “client” or just plain “consumer”, would have the discretion to use that government-funded benefit how he or she thinks fit.

Such a libertarian solution is immediately hedged with all the provisos that abound in that “dark and pessimistic world we inhabit” – a state of affairs we might expect if we listen to those who try to ensure that any freedom of action is hung on a line of conditional discretion for our own protection.

This is the dilemma: the tug-of-war between freedom to do what you want and the imposition of the fiat of “what is good for you”.

And so the level of knowledge about the various courses of action that are available becomes crucial when determining the outcome of this tug-of-war in relation to the individual complaint.

It is the power of asymmetric knowledge. The provider has knowledge, which the consumer generally does not.

Constitutionally, the Commonwealth may have the power to establish an aged care benefit which could, for instance, be just a redefinition of the power to set “sickness benefits” (which is mentioned in the 1946 amendment).

The fact that so few referenda are passed is testament to the conservatism of the electorate. But it also indicates that the same electorate takes change seriously.

There have been four referenda since the one in 1946. The consequences? Aboriginal people have been given the right to vote; price and income control has not been conceded to the Commonwealth Government; and the Republic has been denied. A number of constitutional anomalies were clarified in the 1977 referendum.

The financing of aged health care is another major issue.

The prospect of a referendum will draw out the vested interests, to be tested in the glow of debate. And that is the point! It is the vested interest who may feel that such a debate would not be fruitful because it is too hard to change the system. But in the end it would be academic. Referenda are expensive, and in the current economic climate seen as a luxury; nor would the cession of powers attract much interest.

But if one level of government does not at least have the unequivocal power for health care of the aged then the proposition of a consolidated benefit for aged care will never be tested. The optometric scheme was introduced in 1974, and the sleight of hand used to assure Constitutionality was to deem the optometrist service as “medical”. In any event, the Commonwealth was providing a fixed benefit for a limited range of services. The optometrist had to accept the benefit amount.

This is very different from the medical benefit, where the benefit is the Government’s contribution to the overall medical fee, which remains at the discretion of the doctor. The Commonwealth has progressively tried to cap the Medicare expenditures and at the same time maintain the gap payments at an accepted level; hence the expanded Medicare safety net and bulk billing provisions, which are increasingly working less well and there is a rising concern between benefit and actual fee proceduralists, in particular, charge. Given his craving for publicity maybe it could be called the Teo effect after the cavalier neurosurgeon of the same name.

The language of the majority opinion in the 1929 Royal Commission report still resonates as a challenge to this nation to consolidate the health power in that sense of co-operation, which has been apparent in public health matters since Federation.

So let us play with the theme – directing the whole of our approach to health care, from conception onwards, towards conferring an aged care health benefit – but under a single power conferred by the Constitution. However, if the definition of “sickness benefit” is expanded then it may enable the benefit scheme to be extended to those health professionals that the current language of the Constitution excludes. There is for instance no provision for “a nursing fee for Medicare benefit”, unless you pursue the optometrist option – and I doubt whether either doctor or nurses would be happy that nursing services being deemed “medical” to attract a patient benefit

If that can be done without a referendum, there will be much saving of time and expense. But there is no doubt that referenda and the prospects thereof do focus the collective community mind.

Mouse Whisper

I love the story about an Australian bushranger called Charles Rutherford who was illiterate and lurked around the Lower Darling in the early nineteenth century. When he robbed a coach, he asked the passengers to read out the value of each cheque that he intended taking. Talk about honour among thieves. But there was more. He used to take his captives to a near-by hotel for drinks and lunch at which Rutherford, presided gun in hand.

Modest Expectations – Theodore R

I repeat what I said last week, eye gouging – or whatever euphemism is used in the charge – should result in the player being banned for life and the police called in.

Two weeks in a row – the one player. “Of no moment”, one cries, with a carefree flick of the polo stick. Is the AFL going to wait until a player is blinded?

At least despite pressure he has got a one week suspension. Hardly enough.

It is disappointing to say the least that the ophthalmologists of all people have not weighed in – at least it does not appear to be so on the web site.

They call it Molly

Back in the mists of time when the Neanderthals walked Australian soil I, as a male post-graduate researcher, had a regular task. I had to climb a ladder and, on the top of a long Sephadex column encased in lead bricks, had responsibility for the purification of two radioactive iodine isotopes – I125 and I131.

The first of these isotopes had a half-life of about a month but the second isotope that of about ten days. Therefore for the research work, I131 had to be made frequently because as it decayed it lost both strength and purity for the work the laboratory was undertaking. Over the period, since we needed to be checked after each procedure, I labelled myself as well twice, which meant I had to take a dose of iodine to wash my thyroid out. Let me say that there are few worse punishments for laboratory carelessness than a dose of iodine. It sure defines bitterness.

So when I look at the latest problem that ANSTO is having with the supply of radioactive molybdenum (Mo99) then I have great sympathy for when things go wrong.

For the community, nuclear reactors mean enriched uranium and the possibility of bombs and big power stations. But OPAL (Open-Pool Australian Lightwater Reactor) at Lucas Heights does none of those things. However, its role is equally important, as the low grade uranium fission in the reactor has been producing a significant supply of the world Mo99 which in turn generates technetium (Tc99m). If you to identify the most important function of the reactor, this is it.

The ANSTO reactor has been having production problems with Mo99 since June last year. First there was a problem with generation of the technetium, which meant Mo99 had to be sent to Boston for Tc99m generation, and given the half-life of the isotope and the turnaround time for the Tc99m there needed to be spot-on timing to minimise the loss through decay of Mo99 in transit.

Now it is a more serious problem. A faulty valve in the dissolution cell means that while Mo99 can be made, it cannot be extracted to produce the Tc99m. There is already a huge shortage around the world as a number of reactors that did make the isotopes have closed down in recent years.

Before you all shrug your shoulders and say reducing radiation is good thing, everyone has to realise that this isotope Tc99m is the mainstay of detection for cancer, bone disease and some cardiac conditions. Without it, this area is like a blank black TV screen. With the TV, you expect to be able to switch on, the screen to light up and you then settle in for a good night of relaxation. The same is true for the specialty of nuclear medicine and diagnostic imaging in general, you expect not have any interruption in the program.

Currently, the ANSTO boffins are scratching their heads about how best to proceed, given there is an great amount of highly radioactive material unable to be removed before the repairs can be started – the equivalent of how to stop Rome burning.

Elsewhere everybody in the industry and relevant parts of medical profession have got off their backsides to scour the world for any spare Mo99 (there apparently isn’t much) and thus realistically searching for substitute tracer material which is generally more expensive. This substitute material has to be priced so as to ensure the industry does not go down because Medicare cannot adjust to pay the real cost of using the substitute radiopharmaceuticals.

The Government is very conscious about price and that is reflected in the precise definition of MBS item descriptors. It is an exercise in keeping the smallest number of moving parts operational – and when the crisis is passed then there can be what the dreamy educators would say – a time for reflection.

However, this whole period with ANSTO and its cascading troubles may need a great amount of investment to correct – and to many, nuclear reactor is equated to Chernobyl. Therefore, politicians get nervous, and if we could call it “fluffy duck” they may then be prepared to immediately stump up the money to fix the source of last year’s problem.

Having said that, this year’s problem has occurred in ANSTO’s newest world-class production facility. It might be a one in 10 or 15 years’ problem, but it is a major one and it has occurred very early in that 10 to 15 years.

The sector has responded as well as it can with emergency provisions being put in place very early on and a cooperative approach being taken. It will be a challenge to keep a smile on the face of the specialty if the shortage drags on.

The Lucas Heights reactor is a vital cog in assuring the community’s health if for nothing more than the detection of the conditions named above. What happens if an unfriendly country corners the world market for Mo99 even by default because Australia can’t get Mo99 out of ANSTO?

Morrison – the Funambulist

Morrison is about to go and participate in one of those tawdry Trump events – called a State dinner with all the trappings of Mar-a-Casablanca chic. An Australian Prime Minister can hardly turn down what no other World leader except Macron has been afforded – Trump with full garnish. Morrison knows that as a middle order leader, he has to be able to genuflect to both the USA and China almost simultaneously without either getting the legs crossed or suffering from a case of morderte en el trasero.

To avoid the latter condition and given he has an electoral mandate until 2022, Morrison will be banking on either a Trump re-election or the aspiring Democrats not noticing or caring who is and what he has said. After all, “A gunboat short? No worries – just ring Australia.”

However, keeping sweet with the Chinese is a different matter. To counter any perception that he is a total American sycophant, Morrison has been very strong in the defense of the member for Chisholm, whose links to the Chinese government seem like a tapeworm – you can see the head but extracting the total worm is a tortuous, long drawn out task. An official Chinese publication has risen to the bait, by praising him, but there is a great deal of unraveling before the Prime Minister is invited to a banquet in Beijing.

At the same time the media are having a field day not just on the member for Chisholm, but also all the Chinese donations appearing in modern variations of the brown paper bags. What it tells me is that the Chinese never miss an opportunity. If they see a line of politicians and bureaucrats with their noses in the trough, why not feed them?

However the Chinese government cares not a jot about the media – they care about who is in government, and it is better to get your way without having to use brute force. As the Japanese found out, Australia was not the easy target to conquer that Malaya and the Dutch East Indies were. However, in the minds of some Australians there are still remnants of “White Australia” and the “Yellow Peril”; even now when over one million Australians have Chinese heritage. So for the Australian government, the Chinese government presents a problem, especially when you can hardly see the problem through a blizzard of bank notes.

However, one of the most interesting Morrison appointments which has not gone unnoticed is Graham Fletcher as the Ambassador to Beijing. As one of his predecessors noted, Fletcher is the most fluent Mandarin speaker sent in this role and has in fact lived for periods in China. Contrast him with the moustachioed Iowan Terry Bransted, the American Ambassador, lauded by Trump as a great friend of China because Bransted apparently casually met Xi Jinping many years ago when the latter was a minor official on an agricultural delegation to the Mid-west. Great credentials when placed against those of our new Ambassador. I think not.

However, whether the member for Chisholm is a Chinese Government operative or not, Morrison is showing a degree of solidarity with her that has not been lost on Beijing. It is hard to believe that the advice Turnbull received which made him shy away from the then candidate for Chisholm would differ from the advice received by Morrison about the member for Chisholm. And yet there is the Prime Minister unabashedly defending her.

The ALP missed their opportunity to send the Chisholm electorate result to the Court of Disputed returns, challenging the Liberal party’s advertising as scandalous and deceptive. Had they done so it is probable that this episode would have been played out in a more frosty, less emotionally charged atmosphere. However, the billy has been kept boiling by the maverick Oliver Yates, who has the member for Kooyong in his sights also in his appeal to the High Court.

Anyway, in amongst all the activity, the Prime Minister in his actions in relation to the member for Chisholm is addressing Beijing without appearing to genuflect. He has already a semaphore from the Chinese. It now depends on what he says in Washington – probably no “on the stump with Donald Trump” would be a good starter

As I said above I hope the Prime Minister will avoid treatment for a bad case of morderte en el trasero.

Jacques Miller

Very briefly: Congratulations to Jacques Miller on co-sharing the Lasker award this year with Max Cooper, although in its announcement, the NYT put the Yank’s name first. They really can’t help themselves, given that the research giant was Miller, then a 30 year old when he made his initial discovery about the role of the thymus, that gland in the neck which few of us have ever contemplated. His work was seminal to modern immunology. Miller is now 88.

For God’s sake, you Swedes, he has deserved the Nobel Prize for years. Gus Nossal’ s elegant panegyric written eight years ago says it all. How many of us have been touched by his work – his genius.

Let Professor Nossal’s succinctness remind you of the impact of the discovery:

Miller is the last person to discover the function of a human organ — the thymus — and not a single chapter of immunology has been untouched by the discovery.

T cells became even more prominent when it became clear that they were the chief target of the AIDS virus. Miller continued to make discoveries about the thymus and T cells for many decades, including gaining important insights into:

  • how the immune system discriminates between self and non-self;
  • how it goes wrong in autoimmune diseases; and
  • how the whole orchestra of the immune system is regulated.

Enough said.

Mouse Whisper

We all know about Shanghai Sam – he is the guy the Prime Minister did not name as such – 17 times.

Perhaps though, without reference to the black kettle, we can now call the Prime Minister “Chinese Morrison No 2.”

“Chinese Morrison No 1” was also famous in his time – an Australian born in Sydney. George Morrison was a journalist who, as a correspondent for the London Times in the then Peking, had an important role in the defense of the various legations during the 55-day siege of the Boxer Uprising in 1900, the year of the Rat. Then, as adviser to the fledgling Chinese Government, he was a pivotal figure in the fall of the last Emperor and the birth of the Chinese Republic.

“Chinese Morrison No 2” should remember that 2019 is the Year of Pig – to the Chinese a symbol of wealth not necessarily with its head in the trough.

Modest Expectations – Klinefelters

Robert Mugabe, that unpleasant man from Zimbabwe, died recently at 95. I remember one of those Rhodesian types, I could see him elegant in a safari suit sipping a Pimms in a Bulawayo club in the days when Cecil was a remembered name. This guy voiced what I had wondered about for some time. He said that it was an open secret that Mugabe suffered from tertiary syphilis – or in more specific terms that variation known as general paralysis of the insane.

For some years after he assumed power in the new Zimbabwe carved out of the old Southern Rhodesia, Mugabe was viewed as a being a reasonable ruler of an emerging country but slowly over the years he was transformed into a tyrannical paranoid despot prone to grandiose ideas – and it was also noticeable that he was increasingly having difficulty with his balance.

The problem is that dementia has many manifestations, as does syphilis, which in its clinical manifestations is the great chameleon. While primary syphilis is relatively easy to diagnose, as the causative spirochete agent then wanders away from its genital base through the body and across the blood-brain barrier, syphilis can manifest itself clinically in many ways.

In a post-graduate examination may years ago, I was presented with a specimen of a large aortic aneurysm, which fortunately in my discussion I said could be a tertiary manifestation of syphilis – not the paretic but the luetic form. My examiners then launched into a thorough menu to find out how much I knew about syphilis. The specimen was just the amuse-bouche.

Syphilis is very well treated by penicillin if diagnosed, as the spirochaete does not or cannot conjure up any defence against the drug. However, the disease can disguise itself well, once the primary focus is healed. One of my recollections is that of a guy bought into the emergency department comatose and with these strange lumps over his body. One was biopsied and showed masses of plasma cells and then when stained appropriately, there was coil upon coil of spirochete. Syphilis unmasked and I believe once penicillin was administered he lost his lumps and became alert. Syphilis cured. However, it showed how deceptive syphilis can be.

However, penicillin availability has not cured the disease. Syphilis still prowls the community often strand in strand with the HIV virus.

Once upon time in the 1950s and 1960s, if Australians wanted a US visa, they needed to have a Wasserman test to show they were free of the spirochete; and before World War 11 some of states of the US, at the urging of the then Surgeon General, instituted mandatory testing for syphilis before a marriage license could be issued. How that was enforced is an area of speculation, but data did show that those about to marry was not necessarily the area where the Surgeon General should have been looking.

Now the Amazon behemoth is moving into heath care data collection with Alexa chirruping from the Bezos hip pocket. So what happens now if the data find the deceptive spirochete coiled up the policy maker brain? What of this person? Increasingly irrational you say – maybe we should wait till the person in question starts to fall over – literally. Then Mr Bezos may have the answer for us.

Not on my Kisser

I have always preferred shaking hands when greeting anybody, but I was taught as a boy to shake hands with a person of the opposite sex only when she proffered her hand. Relatives were different. As a small boy they would come at one at different angles to kiss me. Apparently, that was an acceptable trespass.

I agree very strongly with Leigh Sales about the unwanted kiss, especially when it lands on the lips whether dry or oozing with saliva. However, it applies for both sexes. As presumably Leigh Sales does, I like to control my personal space – those that come into it are only licensed to do so. Personal space varies; you know roughly how much you have. For me, it varies with the mount of grog I have drunk; and thus when one drinks too much that space is more easily invaded and vice versa.

I not only dislike being kissed by someone where the feeling is not reciprocated, but I also avoid the hug as much as possible. The hug makes me feel very uncomfortable, and here again personal space is violated unless it is consensual. In one TV chat program I watched, someone proudly said she was a hugger as though that gave her a complete license to do so.

Personal space I found out long ago is variable. Having tested it, if someone comes up to me, and wants to shake my hand, I have no problem with distance of the outstretched hand. I have been known to grasp the arm to regulate the greeting distance. If someone comes up to me aggressively, I generally do not back away.

People coming up behind me whether putting their hand on my shoulder or not do not worry me, but this is one area of personal space where many people feel most vulnerable and hate the person coming up behind them and touching them.

And of course it depends on the venue – a back lane at 3.00 am or an office at 10.00 am are somewhat different. Therefore, context is always important.

Being male gives one an advantage in maintaining personal space integrity. You develop strategies, but I would imagine a high profile person as Leigh Sales is, has many, but the ambush is difficult to manage especially if the assailant is someone you believe should have known better.

Eye Gouging

The National Rugby League recently inflicted an eight-week penalty for eye gouging on a Canberra Raider, but the Australian Football League slapped the wrist of a GWS player with a fine. Irrespective of the history of this player on the field, I found the defence by his captain ironic. He is alleged to have said, in reference to his colleague: “sometimes that means people look at stuff that he’s involved in in a light that’s probably not neutral”.

I agree if the eye gouging had resulted in blindness his victim would be in a light that was probably not neutral. He would be blind.

I am not an ophthalmologist but perhaps such a specialist could more eloquently tell the community of eye gouging leading to retinal tears, dislocation of the lens, vitreous haemorrhage, globe rupture, traumatic optic neuropathy or fracture of the orbital floor – and of course blindness is always an option.

I have a simple remedy. Ban eye gougers for life from the sport and call in the police.

After all, look at the penalty meted out for sandpapering a cricket ball. A cricket ball versus an eye!

Caribbean storm

This time it is the Bahamas; last time Puerto Rico. These are high profile remnants of hurricane fury. Battered by hurricanes of increasing intensity, the Caribbean is increasing liable to become a tropical rubbish dump.

The funny thing is that these events seem to be increasing in intensity while the climate changer Canutes are clustered on the shores of their indoor swimming pools sipping their strawberry daiquiris and watching the clouds roll by.

This troubling development is not going away, as these micro-nations, which are exploited either as reservoirs for the black economy whether money laundering or drug trafficking or for the tourist playground. There is a huge discrepancy between the living standards of the tourists and the ordinary citizens with many living as little more than subsistence farmers.

Climate change is real, and in countries which are as vulnerable as most of those in the Caribbean, these events of Nature, whether they be hurricanes or volcanic eruption like the one which destroyed most of Montserrat, have not the financial capacity to do much.

Then Haiti is the classic failed State. Ruthlessly exploited by the Duvalier regime, classically described by Graham Greene in The Comedians, Haiti was subject to a massive earthquake in 2010 which killed 300,000; followed by a cholera epidemic; followed by two hurricanes. What chance has that country got to be anything but a pile of impoverished rubble. In my recent visit to Chile, I noted a number of black people roaming the streets obviously in low paid work. They were Haitian refugees. There are over 150,000 of them in Chile alone, about 10 per cent of the immigrant population.

However, only in one Caribbean country can you detect any systematic response to what will become a regular summer hazard – and unsurprisingly that is Cuba. In an article after hurricane Irma in 2017 devastated a 300 kilometres swathe across the island, affecting 90 per cent of the population, Jon Anderson noted in an article in the NYT:

Taking part in preparations for the defense of the island from the vicissitudes of hurricane season may have a practical imperative, but this, too, is framed as a revolutionary duty. For decades, beginning under Raúl’s late brother Fidel, Cubans have conducted annual drills to prepare for hurricanes, resulting in a national disaster-response system that has saved many lives during past storms. 

As another source noted about Cuba: These attributes are: (1) actively learning and incorporating lessons from past disaster events, (2) integrating healthcare and public health professionals on the frontlines of disaster response, (3) proactively engaging the public in disaster preparedness, (4) incorporating technology into disaster risk reduction, and (5) infusing science into risk planning.

None of the other countries have invested the way Cuba has in guarding against Nature’s invasion. There is no doubt that in disaster planning centralised control has its advantages as long as the people are part of that control. Cuba has had to live within constricted means because of the United States’ embargo. Although, like a growing number of people, I have visited Cuba, but for my part as a “working tourist” on an American delegation flying out of Miami in an unmarked Delta jet. I have sampled Cuban tourism, but it is not the mainstay as it is in the legitimate economy of other Caribbean nations.

Granted that Cuba is the biggest island but only 25 per cent more in land mass than Hispaniola which is shared by Haiti and the Dominican Republic. So size does not necessarily equate to economic stability.

Tourism is a fickle contributor to the economic health of the community. You can see the consequences of damaged resorts left to rot after experiencing a weather catastrophe. Nearer to home, just wander up the Queensland Coast. In the case of the Caribbean countries, which country of the G20, say, is prepared to go guarantor to rebuild after Nature has had her way? Certainly not the United States, the nearest and wealthiest neighbour. One just has to see the continuing plight of Puerto Rico, which has been left as a wreck by Trump – despite the fact that it is part of the United States, with even one non-voting resident commissioner in the US Congress.

In other words, the Caribbean is very much going to be the bellweather of climate as small nation after small nation is knocked over until even those of us reaching for a third daiquiri may be concerned that the increasing pile of rubble is blocking the view – and then there is that stench from a decayed economy!

But then it will be too late to do anything, and we, the generation who have caused it, have gone on our way out of earshot from the curses of the future generations for the legacy that we have left.

Mouse Whisper

The Modest Reflector loves conundra, and the title is Klinefelters – you know, the syndrome where people who can look a bit like women because they have XX sex chromosome, in fact have the attributes of men through their “Y” chromosome. And one Y trumps XX when it comes to sex.

Klinefelter’s syndrome has caused all sorts of problems in working out in which gender a sporting person with the XXY chromosome should compete. There is some suggestion before chromosomal testing was available, that a number may have competed as females in various Olympic Games, despite having the male sex chromosome.

Well, why is modest reflections Klinefelters? 25 is XXV in Roman numerals. Now take the stalk off the Y … not even original and he promises not to do it again.

“Babe” Didrikson Zaharias – “The Texas Tomboy”

Modest expectation – Hourglass

The member for Dickson, that doyen of child care ownership, is showing all the compassion that we have come to expect, and for which the good burghers of Dickson rewarded him with an increased majority at the last election. However, it was not all high fives out at Mount Nebo, where 75 per cent of the votes cast there were for the Labor candidate.

Overlooking the promised land, from Mount Nebo

It is not that the member for Dickson is not without compassion. He has a daughter born out of wedlock, whom he seems proud to have as part of his family with his second wife. Therefore I find it difficult to know why he is rejecting these two Australian children who are part of the growing multicultural nation family, because they happen to have Tamil parents.

Perhaps some of that affection he has extended to his daughter should rub off in a decision to enable these two little Australian citizens to remain.

But he won’t. He was trained as a Queensland copper to be tough, unrelenting, a man very much into leather. After all, any criticism in his home state is strangled by the Murdoch Press. He cannot stand loss of face. He has had so much of that over the past year. Yet his electorate apparently love him – the May election would have been a good ego stroke for his basic insecurities.

Why can’t these politicians stand loss of face? They are pitiable, but as I said, 53,000 of Dicksers love him.

However, I pity the children far more – and if they want to come back to Australia, they should be given passports like anybody else born in this country, including the Member for Dickson – notwithstanding any change in the Australian Citizenship Act 33 years ago. 

Rhiannan Iffland. Who?

I always think I know generally what goes on the sports pages. So it was somewhat surprising when television surfing in a non-English speaking country far from Australia, to come upon Red Bull-sponsored cliff diving. There are seven events this year where the contestants dive off cliffs mostly with temporary platforms jutting out over the sea. I have always associated this daredevil idiocy with the young Mexican divers at Acapulco.

However, now it is an organised sport which allegedly attracts 60,000 to 80,000 spectators, and the Australian, Rhiannan Iffland, who has combined her diving and trampolining into an extraordinary skill, is far and away the best female cliff diver in the world. At her last appearance – diving from the famous restored bridge at Mostar in Bosnia Herzegovina – she achieved straight tens.

Rhiannan Iffland

The last competition for 2019 is at Bilbao on 14th September where the competitors dive from the La Salve Bridge, 24 metres down into the River Nervion, in full sight of the Guggenheim museum. Majestic daredevilry. The sight of this young woman twisting and somersaulting, slicing into the water feet first is indeed breath-taking. The danger of this diving is underscored by the number of frogmen swimming around in the water waiting for the mishap.

I do not know if anybody can be bothered showing it to an Australian audience, but we are strangely unknowing about this woman’s extraordinary talent, given the fact that women’s sport overall is attracting more and more interest. Perhaps it is because she is so good, that even we Australians get bored with those who win all the time. We just expect it. Do we remember Heather Mackay who won the British open squash title for 16 years in a row before winning the inaugural world championship and then retiring? We certainly remember Winx, quite a female performer.

Rural Health

One of the repeated catchcries is the lack of rural health services in Australia. My response has always been that one has to actively transfer intellectual capital to the “regional, rural and remote areas” to encourage a positive outcome. In this blog, “rural” will be used to encompass all.

One of the most important developments in the medical system, amid all the jeremiads over the past two decades, has been the new medical schools with a rural emphasis, the rural clinical schools and the university departments of rural health.

These teaching institutions have facilitated transfer of intellectual capital to rural areas. Medical teaching has been shown to occur more than adequately outside the metropolitan teaching hospitals; and significant intellectual capital exists already in both the larger and the smaller rural hospitals.

Without this innovation, the health education system would have had great difficulty in handling the increase in medical students that occurred in the decade following the introduction of these new rural facilities.

However, this rural dispersal needs good medical management, and especially with the Government’s obsession with Regional Training Hubs, as though the basic structure does not already exist.

One inspiration underpinning the recommendations of my Rural Stocktake in 1999, which led to Government funding for the establishment of rural clinical schools and university departments of rural health, was the story of the Mayo Clinic and visits made to both to the Rochester Minnesota and Scottsdale Arizona campuses some years before I did the Stocktake.

The Mayo Clinic was formed by the Mayos – father and sons – in Rochester in the 19th century and to me has always exemplified that excellence is not confined to the largest conurbations. The Mayos proved to be very good managers and developed intellectual capital involving a wide range of skills, in the “wilds of Minnesota”.

Then one also remembers the story of a gifted doctor named Samuel Fitzpatrick, who was based in Hamilton in Western Victoria. He was a world authority on the surgery of hydatid disease, then a major affliction – particularly in Western Victoria where sheep farming was a major component of the local economy. The disease was of such importance that the then Royal Australian College of Surgeons established a national hydatid registry in 1926 that, until its cessation in 1950, identified over 2,000 cases. Such attention helped in the campaigns to reduce the incidence of hydatid infection in humans – the intersection of Fitzpatrick the surgeon and Fitzpatrick the public health doctor.

At the height of his practice Dr Fitzpatrick dreamt that this niche disease could propel Hamilton into having its own Australian version of the Mayo Clinic. However hydatid disease lessened as a major disease and, unlike that of his Mayo exemplar, Fitzpatrick’s dream faded. While Hamilton doctors have maintained a high reputation for medical care and procedural competence, this remained a country practice in Victoria.

The surgical virtuosos of the bush, like Fitzpatrick – the doctor who was that generalist with an equal ability to treat any disease or condition – increasingly disappeared. The intellectual capital that they possessed was not translated into major teaching and research facilities in rural Australia, let alone centres for public health as had occurred with the Mayos and their stake in rural America.

The rise of specialist medicine and then sub-specialist medicine, together with their resultant perceived skills and knowledge, concentrated teaching and learning in metropolitan teaching hospitals, and in so doing emphasised the importance of the individual at the expense of the total population denominator.

Public health was dismissed in some quarters as surveillance of “tips and drains” Yet public health training for many years was concentrated in the School of Public Health in the University of Sydney. Public health education as a medical specialty was invigorated by a consultant physician, Sue Morey, and a number of like-minded people following the Kerr White report. Dr Morey headed the resultant Faculty of Public Health Medicine, which ended up within the Royal Australasian College of Physicians.

One of the important outcomes of the growth of rural medical education has been the opportunity to be both director of medical service and director of clinical training. I was able test this association personally and found it fruitful, being involved in the establishment of a medical intern program that requires the interns to undertake 20 weeks in rural general practice, plus the mandatory hospital terms. Health education (rather than medical education per se) has been attached to a group of academics primarily in traditional teaching hospitals. I was lucky with having forward thinking CEOs in a number of rural health care services.

They realised that what I called small teaching services, where the general practitioners have provided a variety of services, are rich teaching environments. I term these health services as “teaching services”. My argument is that by having a series of interns each year, you give the local doctors the opportunity to teach without the layered bureaucracy of the medical colleges telling you what to do.

Hence the 20 weeks in general practice as an intern and the concept of rotating interns ‘in’ to the regional or teaching hospital, not “out “ from those same hospitals. In other words, the small teaching service are allocated the interns; not having to depend on the big hospitals.

That was the core of the M2M program which has been rolled out in across Victoria and, to conform to the commonwealth funding provisions rather than the intent of the program, then called “Rural Medical Generalist Program”. The Rural medical Generalist program is an Queensland concoction of the ACRRM.

It aims to provide a training program for that College and really a reason for that College to exist. Simply put it aims to skill general practitioners to work in the country. A very good thing, but for it to work well it has to have a defined connection with the rural clinical schools – and that was the aim of the intern training program.

Nevertheless, there is this major barrier to this program – the attitude of some senior members of the university hierarchy and their teaching hospitals – not all I would emphasis – who could not care a jot about rural Australia – the major universities are there to perpetuate elitism. You measure that by research dollars not by the benefit you may provide to rural Australia.

Medical education is one of those areas that, in the undergraduate field, have been attached to universities and the post-graduate qualifications left to the various Colleges. As I found out this leaves a gap in the first two post-graduate hospital years as intern and resident medical officer when there is often a high level of angst. There is a need for expertise and experience to assist the doctor in those first two years.

I realised this need for pastoral help with the interns – surely an accompaniment of an empathetic educational environment . Taken seriously medical education without forgetting the importance of public health should be a major concern of any university, which considers itself to have a pastoral role rather than a treasury for the fees of international students. If the university adopt that pastoral challenge just as the Mayos and Samuel Fitzpatrick did, then this whole exercise of having rural clinical schools, defined educational programs in the first two years of post-graduate life as a doctor is still relevant despite being in a different era

As one famous person once said: “Before you capture the citadels, secure the fields first!” Therefore, for the young doctor think of gaining experience in a rural post before tackling, rather than being absorbed into, the “citadel culture” of the urban teaching hospitals.

The Brethren

Back in the 1970s while fresh from his exploits in hastening the departure of Richard Nixon, Woodward wrote a book with Scott Armstrong about the United States Supreme Court from the 1969 term to 1975 term. This was the time when the Court was moving from the liberal court of Earl Warren to the more conservative court of Warren Burger. Earl Warren had resigned in the belief that he would be succeeded by somebody cut from his legislative cloth.

This did not occur, and instead the court became the plaything for Nixon appointees. Not only did Nixon appoint the new Chief Justice in Burger but also three other justices, only one of which – William Rehnquist – fitted what Nixon hoped the court would become – a bastion of conservatism. As with the current Chief Justice French, Burger was elevated directly to Chief Justice with all the administrative load that entailed, without any experience as a Justice of the Supreme Court.

What is fascinating about the book when read against the churning turmoil of the Trump presidency is how complicated are the politics of the Supreme Court. Not for nothing is the book named The Brethren for all the religious overtones that the name implies.

It deals with all the machinations of Roe vs Wade, which is where Trump supporters and the Roman Catholic Church want repealed. It should be realised that seven out of the nine judges concurred with the proposition that including three of the Nixon appointees including Chief Justice Burger voted for the proposition that the United States Constitution protects the rights of a pregnant woman to have an abortion.

Only the newly appointed William Rehnquist, later to become Chief Justice and Byron White, the only Kennedy nominee dissented. So despite the howls of the anti-abortioners, this decision represented a very diverse cross-section of men of different political persuasion.

However, the most chilling aspect of the book was its conclusion when it summarises four cases which hinged on the court’s interpretation of the Fourth Amendment to the United States Constitution. The Fourth Amendment states: The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.

In each case the decided that day in July 1975, the court ruled in favour of government rather then for the individual citizen. The final line says: “the center had won”, which can be roughly translated into “the right were gaining ascendency”.

It had been a short time between 1973 when the Roe vs Wade decision and July 1975 – the so-called Black Tuesday. When The Brethren was published in 1979, the composition of the court remained the same as it was in 1975.

However, changes were afoot with the very intelligent but ideologically driven Rhenquist in the wings awaiting his ascension into the Chief Justice role. In 1981, with the retirement of Burger the die was cast; the die which contains the court ruling in favour of Bush over Gore; the deviousness of McConnell in denying an Obama nominee, and the sad sight of Ruth Bader Ginsberg hoping her pancreatic cancer does not kill her before the next Presidential election -in other words outlasting Trump. Such is the state of American democracy. 

Mouse Whisper

An interesting comment overheard in the back streets of Whroo.

Every year, there is a change in the education curriculum in Hong Kong, so eventually the education program between the children of China and Hong Kong will be indistinguishable. The level of information manipulation will be the same.

By the time, the total absorption of Hong Kong into China occurs in 2047, who among those of the “one country, two systems” will have heard of the riots of 2019.

Talk about the long game …

The umbrella protest