Modest Expectations – Deakin

I am indebted to the Washington Post for the above photo. To many of those who experienced it, the eclipse was a spiritual event. In the Indiana town of Bloomington, at 4 minutes past three on the afternoon of April 8 the eclipse lasted for four minutes. Buddhist monks marked it with a puja ceremony, a “ritual honouring and promoting inner and planetary healing,” according to the Tibetan Mongolian Buddhist Cultural Center (sic).

In my blog on New Year’s Eve 2023, I wrote about our experience of the total eclipse in 2002, which was best seen at Ceduna, whither four of us travelled across Australia to view it. In my blog, I mentioned the late Jack Pascachoff who had observed 75 eclipses.

We met some of these eclipse devotees in Ceduna – but do not remember Pascachoff among the crowd. These people travelled from one eclipse site to the next – which at that time was Chile, I heard one of them say. Well, as I said at the time, some people collect teddy bears, and others obsessively try to visit every state in the USA. These people collected their presence at one eclipse after another.

In reading his obituary, I loved the anecdote of an eclipse in Manitoba, when Pascachoff was shocked by the drivers who just turned on their headlights and kept moving. As one would say, takes all types…

He enthused his students and “an even better eclipse was forecast for 2024, with totality from Mexico to the Canadian Maritimes. He wanted everyone to observe it. As for him, he was already plotting hotel reservations in Sinaloa, the place with the best view.”  Sinaloa, located in northwestern Mexico has a 650 km Pacific coastline, with Culiacán as its capital.

Alas, he died well before that recent eclipse which indeed did what he hoped to see, at least for him not from Earth.

What is weird is the response of some of the Republicans. There is a difference between a personal spiritual response based on emotion and the people who seemed to have rejected the science underlying eclipses, including their location and time, all of which science has enabled us to know precisely when they will occur.

Instead, they seem to have retreated to the superstitions of the mediaeval age, where they related these events to intervention of their God. Yet these people subliminally accept the science, which has predicted when eclipses occur, as demonstrated by scientists such as the late Jack Pascachoff. Otherwise, why would those Buddhist monks pictured have been so prepared with all the modern appurtenances?

Pleading the Belly

 In 1588 Pope Sixtus V declared all abortion murder, with excommunication as the punishment. Then, a few years later, Gregory XIV released a papal bull that claimed it was not a sin unless the foetus was animated or moving. The Pope Sixtus V bull that called abortion a sin was overruled by this Gregorian bull. Additionally, Pope Gregory rescinded the legal classification of abortion as homicide. In further explanation, Gregory XIV was the virtual successor of Sixtus V, the intervening Pope, Urban VII, having lived for only 11 days after installation.

It took nearly 300 years before Pius IX again declared all abortion murder in 1869, and this remains the official position of the Church, reaffirmed by the current Pope.

Thus, the Arizona Law of 1864 on abortion was in place even before the Pius IX bull. The Arizona Supreme Court recently upheld this criminal law first enacted in 1864 that allows sending a doctor or other medical provider to state prison for two to five years for performing an abortion that is subsequently not deemed “necessary to save” a woman’s life. There are no time limits—the prohibition begins “the morning after”—and no other exceptions, such as for pregnancies that resulted from rape or incest.

It was re-affirmed when Arizona became a State in 1912.

Pleading the belly

But that’s not all left on the Arizona books dating back to 1864, as it still has a “pleading the belly” provision, although it is not identified in so many words. “Pleading the belly” is a common law provision, which is first mentioned in Britain in 1375. It means that no woman convicted of a capital crime can be executed if she is pregnant, normally having to be certified by multiple doctors. This meant there was a stay of execution until the child was born. Then, the woman could be executed. This provision was codified into British statute in 1931 when the Sentence of Death (Expectant Mothers) Act, made it illegal to sentence a pregnant woman to death. But not so seemingly in Arizona, where it remains on the books, if ambiguously, to this day.

Wait for the Arizona Supreme Court to have a case before it on the matter.

Remote Working

I was intrigued by a recent Economist article on the growth of remote working. COVID-19 and the development videotelephony software programs stimulated remote working. Yet as the Economist states, that there are some professions where remote working is impractical; although my point of view is now that of a consumer, I also have a view of a profession in which I was once a practising doctor.

One of the banes of my professional life occurred when I was a first-year resident medical officer in an outer suburb hospital where we “first years” had to share the emergency load. Most of the time when on duty the doctor could be up all night. There were times when you were summoned from bed to see someone presenting at the emergency department, but there was one particular colleague who never got out of bed – he issued instructions from the depth of his pillow and left the patients for his colleague to see in the morning.  Welcome to the doctor remotely working or more properly described as bludging. I always got out of bed when I was called. Telehealth as a substitute has provided a convenient and acceptable means to the medical profession now loathe to do home visits or work after hours.

Therefore, one of the downsides of remote working is that it may fit the genius working in a garret, but it also suits the bludger, who wants to give the semblance of work, since remoteness enables meeting an illusion that work is being accomplished remotely, This illusion has metastasised to such an extent that none of the workforce becomes available to the general public, since they are in the nirvana of meeting remotely.

Therefore, I start my assessment of remote working sceptically because remote work flexibility has many unexpected undesirable consequences. I once ran a program in a Government department for five years, and it was a time before that alphabet of why a particular bureaucrat can have days off without any planning or goes on some useless training course existed. Then there is the added pernicious action of not allowing the bureaucrat to settle down in one job to ensure that the general public is confronted by both ignorance and lack of corporate knowledge.  Thus, if one is intent on making it as difficult as possible for the general public to penetrate the bureaucratic jungle, then confront it with a potpourri of bureaucratic dysfunction working.  Remotely.

Remote working is just the icing on this dysfunction: “Hullo, I am ringing to talk to Mr X”, “He’s not here. He is working from home today.” Can you give me his number?”, “No, I’m afraid we can’t give that information.” “When will he be in?” “No idea” “Is there anybody else who can help?” “I’m sorry but I have to go to a meeting to discuss the meeting schedule. You’ll have to excuse me…” and that is the polite version.

Remote working should be banned for those whose main role is to provide a direct customer role. It is difficult enough without having these people not at work in the office. In other words, for government bureaucrats, there should be an assessment carried out by an independent source to see if there is any merit in this cohort of office bureaucrats being allowed to work remotely.

Having taken that position in relation to bureaucrats the industries in which the Economist reported the highest level of remote-work flexibility are coding and technology, architecture, engineering and business jobs. About half of people working in computer or mathematical jobs work remotely full-time. In these cases, ability to communicate is generally not a problem.

The Economist reports that McKinsey have shown that half of women report being unable to work remotely at all, compared with 39 per cent of men. But what does it mean in relation of remote working? It is not an ephemeral gender issue.

I have always lived close to where I have had an office. For a long period, I had offices in both Melbourne and Sydney and had a home within 20 minutes of where I worked, even in peak traffic. My wife worked in the same office, working in different areas, even though our jobs may have intersected at times. My career as a consultant meant considerable travel, but if “remote working” is taken literally, yes, I worked in remote locations. Thus, working with my wife was one of way of avoiding “remote working”, because there was always one of us in the office, if considering the two locations as being one office.

The Economist straying into another area made the following point: Couples compromise in all kinds of ways for their lives to work together. If she is offered a big promotion, conditional on moving to Chicago, she may have to turn it down if his job is tied to New York. The geographical liberation of either partner makes it possible for the other to ascend the corporate ladder.

In other words unless couples are faced with being required to work remote from one another, compromises must be made to keep the couple together. I faced that in my early career, when both of us graduated in medicine and then having children in our early twenties, still pursued separate careers, and both ended up undertaking PhDs in separate institutions.

We found a solution. We set up our own community-based childcare centre able to take a child in its first year to being able to go through the first five years. We had an appropriate mix of staff to cover both care and education. Both our sons are alumni of that childcare centre, which remains in operation 60 years after it was established.

The other was the fact that the maternal grandparents filled in as carers when the boys were not only in the early childhood centre but afterwards when they were in primary school. This, coupled with the proximity of work and both the early childhood centre and school, allowed the two careers to progress, without one parent having to sacrifice their career. Remember that was the sixties, when prejudice against women working was strong, and yet we were able to persuade the Department of Health to change its attitude and contributing funding to the childcare centre, mainly for capital costs to ensure that the building satisfied the extensive departmental regulations.

Thus, how ambiguous is the word “remote” when applied to “work”.

Spinal Surgery

I thought I would explain the reasons for deferring my operation. I am sure you respect that the choice I have made has not been undertaken without much deep consideration of balancing the risks and benefits. My response was largely generated from our last consultation and your subsequent letter to {orthopaedic surgeon} – Letter to Spinal Surgeon

The furore of the level of spinal surgery disclosed by the ABC program Four Corners seemed to centre on one neurosurgeon who was already deemed incompetent, having had limitations placed on his practice. However, “surgical cowboys” exist and when you need to decide to give consent or not, you need to know the ones with a lasso.  The average person, often anxious or fearful, must make a choice based on asymmetric information. Asymmetric information since the doctor has the information, and anyway he or she is obviously not going to say that the procedure he or she will use is “crap” and has been shown not to work.

I was faced with this question of spinal surgery eight years ago. I had a major car accident in 1981 and was left with the underlying damage where osteoarthritis would be a long term result. The orthopaedic surgeon initially did not undertake arthroscopy on the grounds that if he did it, knee replacement would be inevitable. This decision gave me ten years of relative mobility – able to undertake up to an hour walks.

That was until late 2013 when I developed polymyalgia rheumatica, that the whole downward spiral in my mobility commenced. Gradually with cortisone, the pain associated with the PMR eased. Nonetheless I was faced with using one and then two sticks, and eventually using a wheelchair for distances such as airline concourses, for instance.

I was then further faced with having my knees replaced by prostheses. However, since I had symptoms related to the arthritis of my spine in both cervical and lumbar region, I was referred to a spinal surgeon. The orthopaedic surgeon was loathe to operate on my knees without a spinal assessment to see if I needed surgery. I first found the spinal surgeon’s attitude unusual from the start in that he left the consultation to somebody I presumed was a doctor or nurse, barely competent in taking a clinical history, which resulted in my clinical notes stating I was a heavy smoker whereas I had not smoked for 36 years.

For a time, despite my misgivings, I accepted the need for operations, with the surgeon saying he would have to take bone from my left iliac crest for my cervical surgery and then, with little intervening time, undertake a laminectomy on my lumbar spine, as if his skill was the only consideration.

Abnormal spinal MRI

In retrospect I should have terminated this nonsense, especial as he intended to do an MRI on the morning of the operation to “check all this”. I have had many MRIs, which all showed spinal pathology, but what he seemed to ignore was that the spinal cord was not impinging on the spine. Sure, I had intermittent tingling in my fingers, but this was only minor. Sure, I had pain in my back, but it was not incapacitating.

I had been undertaking hydrotherapy for several years, The neurologist confirmed, looking at the same MRI as the surgeon, that it clearly showed space between spinal cord and spine.

I then made the decision to defer the operation and sent a letter to the spinal surgeon, rather than meeting face-to-face which may not have been guaranteed before he had launched into using his operative skills on me.

Frankly I was worried by his arrogance and yet saying I could die under the knife. He seemed to ignore my myriad co-morbidities nonetheless.

He never replied to my letter seeking justification.

My putative operation remains on hold, as they say, “sine die.”

It is eight years later, and my spinal symptomatology remains much the same, although I have other co-morbidities, which render anything he proposed at that time a sure-fire death sentence now.

I believe that there is a role for a medical qualified health broker, who can provide independent advice backed by best evidence available for those less informed than myself to help redress the information gap.

Some of the medical commentators would better be suited as health brokers instead of being interviewed on TV, where words are more ephemeral and generally after the fact. This episode of Four Corners seems not to have generated media comment, despite the descriptions of questionable practice, where these expert independent voices condemned the actions of this particular surgeon. If these voices had been co-ordinated and presented to the patient as the voice of a health broker, then the outcomes as depicted may well have been different.

Iris Sargeant

Iris was the goddess of rainbows. Rainbows were her connection between heaven and earth.

Iris was my mother-in-law. She died on Wednesday evening. She was 98. She was a great lady, who was born into the Lutheran diaspora, her ancestors having fled religious persecution in Prussia. Her family came from Katowice, which is now in Poland. Her family initially settled in South Australia, and some of the families then settled in rural Victoria and others in southern New South Wales, with Iris being born in Walla Walla north of Albury, in 1926.

Iris very much embodied the rural woman, growing up with four brothers and a sister. Her father was Theodore Gustav Hoffmann and her mother Alma, born Schroeter. Growing up in a time when having a German name had its difficulty, especially during WWII. Iris was tolerant, forgiving, a highly intelligent person at a time where women were confined to domesticity and not encouraged to go much further than early primary school. With her love of books she had always wanted to be a librarian and she enjoyed painting and colouring.

Iris had two other qualities that set certain people apart. She had grace and concern for others, even when she was clearly dying and hearing that I had had a relapse, she said “Is there anything I can do to help?”

Says it all. Now she is moving up her rainbow in a cascade of colours. Iris, the artist has left a legacy to be celebrated – herself painted large.

That soft gentle voice saying “Time for me to go now. I won’t say goodbye. Just look for me in the rainbows after the rain.”

A rainbow of coloured pencils

Mouse Whisper

Two mice walked into a tavern in Cincinnati. They ordered to two thimbles of Mouscadet.

As they perched on the counter, they noticed the name of tavern to be Blind Tiger.

Why, they squeaked to the owner who, elbows on the counter, answered them by way of explanation.

“In prohibition days, when anybody was looking for a drink, they would look out for the Blind Tiger where you paid money to go into the speakeasy  to see the Blind Tiger and would get a drink, free or if money needed to handed over, the bartender was concealed by a blind so that there was nobody visible to provide the drink, while money was passed through a slot to a tray behind the blind.”

It did not take long for the customer to become blind and tigerish.

Another, thimble, my good mice.

 

 

 

 

 

Modest Expectations – Marcus Aurelius

How depressing to see the Prime Minster spending “quality time” with Lachlan Murdoch, at a time when Murdoch is trying to bully the newsletter publisher, Crikey into submission. The description of Crikey as a minnow is to underestimate its clout and the intention of Eric Beecher to confront what he perceives as the malign influence of the Murdochs.

Eric Beecher

It is important to place Beecher in context, and while his own bio is scant, this quote from the Public Interest Journalism Initiative provides a summary of his early achievements. Beecher started in newspapers as a journalist on The Age in Melbourne and later worked at The Sunday Times and The Observer in London and The Washington Post in the US. In 1984, at age 33, he became the youngest-ever editor of the Sydney Morning Herald and in 1987 was appointed Editor-in-Chief of the Herald and Weekly Times newspaper group.

He has spent a large part of his later life as the pamphleteer, railing against the privileged plutocracy, which has grown under cover of globalisation and the so-called information revolution. He has explored alliances with other writers with a like attitude.

Lachlan Murdoch is targeting him in the defamation jurisdiction on Earth most sympathetic to the complainant – namely NSW.  Nevertheless, Beecher has taken the decision after initially retracting the offending comment to challenge the Murdoch Empire of “alternative facts”. As Beecher has commented, any morality in journalism has been sacrificed in the pursuit of financial profit, and Murdoch, once the supporter of Whitlam and the Republic, has given over to a son without any connection to Australia, apart from a father who has long deserted his citizenship, again in the pursuit of profit.

Thus, it is tedious to see the Prime Minister giving the Murdochs the normal vassal symbolism of going cap in hand to them. When will they learn? Remember, Rudd was entrapped by a Murdoch operative in a New York strip club. Prime Minister, have you forgotten the disgusting behaviour of Murdoch in Great Britain, where yon Rupert almost apologised by closing down the “News of the World”? But then it was the other son James in the firing line, rather than Lachlan.

I’m not surprised that Marles joined in the pilgrimage to Compostela de St Rupert, given his common Geelong Grammar School heritage with Rupert. Marles, as with Murdoch, had an elderly father, and both his parents were high achievers.  So, both “slumming” in a working class electorate and rubbing shoulder with the establishment is a recurrent behavioural pattern among some of the Victorian Labor party private school elite.

But really, Penny Wong!  Or were you just practising dealing with some of the unsavoury types lurking around the world in some of the foreign affairs portfolios?

Presumably to demonstrate neutrality in the ongoing stoush, the Prime Minister should visit Crikey and break bread with Eric Beecher and his crew in a less plush setting but in keeping with his electorate’s wish.

Finally, yes, we have contributed to Crikey’s defence.

St Kilda

I have been reading about St Kilda.

Not the beach suburb of Melbourne, although I must admit that I was surprised of an association; I’ll come back to this later.

St Kilda was a few rocks stranded in the Northern Atlantic Ocean about 60 km from the Outer Hebrides and where, for centuries, a small group of hardy settlers subsisted. Until the nineteenth century, they lived a very isolated existence with the occasional ship calling carrying salt, iron and timber for which they traded cows, sheep, feathers and grain.

It was a hard life, living in such a state without money, where the whole population gathered as their local council, with strict observance of the Sabbath with Christianity interwoven with pagan practices, where the infant death rate was greater than 50 per cent because of neonatal tetanus, which is terrifyingly described.

The islanders raised sheep and cattle and grew some crops, barley and potatoes. They did not fish, but rather raided the bird nests which were clustered in the steep cliffs which ringed the islands.

Abandoned houses, Hirta

The largest and inhabited island was Hirta and thus the inhabitants were more commonly called Hirtans rather than Kildans. The link with Melbourne is that some of the islanders apparently found their way to Melbourne.  St Kilda beach in Melbourne may have sea birds on its sands, but that was the only similarity. The immigrants would have missed their roasted puffin, but surely cooking a puffin reminds one of the old recipes about cooking a galah with a stone.

Collecting eggs and birds from the cliff face was a Hirtan skill, which even to today’s rock climbers would have presented a challenge, as the ropes they used were very rudimentary, with much jollification while this hazardous operation was happening.

In the nineteenth century, St Kilda became a tourist spot, even though landing on the island presented problems, especially when the weather was bad. There was a post office where postcards could be stamped. Photographs of the islanders became popular. Paradoxically, the standard of living rose, as shown in contemporary photographs of the improvement in the housing, but the attrition of a population, now exposed to the mainland “delights” increasingly losing their previous self-sufficiency, accelerated.

The final paragraph of the description of the Hirtans in Shadowlands is evocative. By 1930, the population was reduced to 36.

…in the dying days of August 1930, the final postcard was sent. Its message, from a tourist called Freda, said, just “Last Greetings from St Kilda.” Then the post office was shut forever. The final service was held in the church and bowed by sorrow, the islanders rounded up their dogs, those indomitable hunters and guardians, tied weights around their necks, placed them in sacks, and dropped them from the pier, looking sorrowfully on as the yelping bundles sank beneath the waves. They returned to their houses and waited for HMS Harebell.

And up on the stacks of Boreray, from their nests in the cliffs, the birds rejoiced.” 

It is an example of the problem of civilisation intruding on a community which has achieved a fragile ecological balance and then, over time, from being endangered they are rendered extinct. Our forefathers characterised the Australian Aboriginal people as remnants of the Stone Age whereas they had developed a very complex hunter/gatherer society, but unlike the Hirtans they had a far bigger canvas upon which to work. Nevertheless, what have we learnt from the Hirtans, especially as with the Australian Aboriginals, there was no written language – not even an ogham?

Same Old Rubbish?

I have been a supporter of the Essendon Football Club for most of my life. It was because of the Doust family, who lived on the corner; and then after WWII they went back to Britain, leaving me with a black and red scarf. We lived nowhere near Essendon, and so it was quite a trip across the city to watch them play. The Victorian Football League (VFL) then was essentially composed of inner suburbs extending west and north. The only team in the eastern suburbs was Hawthorn, and when I was small, its team was a “basket case”.

Essendon did not conform to the original teams when in 1897 the VFL was formed. Essendon was not an inner working class suburb.  Yet Australian Rules was essentially a working person’s game, despite having a posh beginning as a game between an Anglican and a Presbyterian private school.

Many of the clubs were both Irish and Roman Catholic, none more so than Collingwood in the era when John Wren virtually owned the club. Essendon was not Roman Catholic – far from it.  But the nuances of this history were lost on one small boy, even the fact that Essendon once played their games in East Melbourne where the railway yards now stand and they were nicknamed “the Same Old”.

By the time I became a supporter, the team was located at Windy Hill, high on the hill in Essendon where the gales blew. In winter it was a place for the frozen spectator, even rugged up and with the obligatory Thermos in hand; and because the suburb Essendon had become the location of Melbourne’s airport, the football club adopted the nickname of the “Bombers” in 1940.

It was a different time with the VFL progenitor, Victorian Football Association (VFA), having many of its teams in the eastern, south-eastern and southern Clubs still active. Oakleigh, nicknamed the Devils even though they wore gold and purple colours, just down the road was my club, but I was never as addicted to Oakleigh in the same way as I was to Essendon.

This long introduction is to say that most of my life has been consumed in my support of Essendon, even at one time being a paid-up Essendonian. However, that changed when the game became an exercise in keepings-off and Essendon relinquished its Windy Hill home.

Windy Hill, 1980s

Sport at the top level is now a moneyed game driven by TV rights. There is also a stadium fetish, to ensure that the pampered few are spared the rigours of winter with access to glass boxes awash with alcohol. The players from teenage years are moved around as well-paid commodities without, in most cases, any deep-seated loyalties. After all, being doled out in a draft means that these players are separated from their hearth and home. And that gnaws away at the special nature of the Game loyalties.

Curiously, the game is reverting to the original game where there seemed to be limitless players, running on and off in a blur, to maintain the momentum of the game, keepings off, scragging; little men in yellow running around making arbitrary decisions so they can keep up with a game, which is driven by the manic desire of those who run the game to make it faster and faster. The only difference between the original game in 1958, which perhaps should be introduced, is running among the gum trees in Yarra Park and the length of the playing arena when rules as today were arbitrary or non-existent – and of course the little yellow officials.

However, there is a veneer of corporate civilisation. As somebody wrote about the Essendon worship of bright and shiny baubles “Walking up the concrete steps, Essendon’s headquarters feels like a corporation. The generic nature of the massive building continues inside where it becomes immediately clear the home of this historically great football club – which has not been anywhere near great since it moved to Tullamarine – has no heart.

That is my problem – once a fanatical supporter who imparted the same spirit to my sons and then they to most of the grandchildren. But then only one of these six was alive – just – when Essendon won its last premiership in 2000. My heart has gone – I no longer care.

Maybe a flicker of nostalgia when I read about Michael Hurley’s complete loyalty to the club. (pictured)

A picture of loyalty

The AFL has a heritage round, but what is meant by heritage? True heritage would be playing twenty a side – eighteen on the field with two emergencies, which came on as replacements and were not interchangeable. Yet that rule only operated from 1946 until 1978 when the interchange rule was introduced. The longest time the rules of the game have not been changed was nine years between 1877 and 1886. Now, there is more year-to-year fiddling with the rules than in a Bullamakanka bush band.

Then see how the spectators would enjoy it. The grounds are more uniform than in the past. When playing at Hawthorn, you were on a compressed ground wedged against the railway lines – and with the right conditions the full back kicking out, if accurate enough, could kick a goal at the other. I repeat “if the conditions were right”. Oh, for the suburban grounds that had character.

Now, what an exercise in sterility, but the AFL is now politically correct. Gillon McLachlan, scion of the South Australian Establishment, you have left your legacy – you have pasteurised the game behind pay walls. Well done.

What the Butler saw

The Strengthening Medicare Taskforce is bringing together Australia’s health policy leaders. The diverse membership has been drawn from across the health professions, and includes consumer, rural and regional and Aboriginal and Torres Strait Islander representatives.

The Taskforce will work to deliver concrete results through its recommendations, including:

  • Improved patient access to general practice, including after-hours.
  • Improved patient access to GP-led multidisciplinary team care, including nursing and allied health.
  • Greater patient affordability.
  • Better management of ongoing health conditions including chronic conditions.
  • Decreased pressure on hospitals.

Here we go again. The Same Old!

The Hon. Mark Butler MP

Mark Butler, a lawyer and union official prior to being elected to Parliament, under Rudd had an exposure to matters relating to Health, in various parliamentary secretary and ministerial positions between 2009 and 2013. He had been Shadow Minister for Health since January 2021

Unlike another South Australian, Neil Blewett, who maintained continuity in the portfolio whether in Opposition or Government to became one of the best Ministers of Health, when the Labor Party went into Opposition, Butler was handed the shadow environmental portfolio by the then Opposition Leader, Bill Shorten. The Health shadow portfolio was passed to Catherine King. After the 2019 election, the shadow Health Ministry was held by Chris Bowen, until it was passed back to Mark Butler. The Health portfolio seems to have been in the “pass the parcel” category among the Labor gentry.

The Hon. Neal Blewett

One of the prerequisites for the Health portfolio incumbent is that unless one learns the language of Health, it condemns you to being at the whim of translators. Blewett as a linguist was fluent in Health, and he also had a bunch of public servants who had served in health matters for a considerable period, and while they were not necessarily health professionals, they were more or less fluent in Health. Guys like Alan Bansemer and Bernie MacKay.

A 17 member committee is doomed to failure as anything but a megaphone, given that allows every member an average of 3.5 minutes an hour to speak. Also the bigger the Committee the more unwieldly, although technology allows for everybody not to be in same room for a meeting; however, that introduces the trickiness of the membership being in isolated cells, without any meaningful interaction. But maybe that is a deliberate ploy. I have faced public service running interference and have dealt with it mostly – without winning any popularity polls.

Scanning the list of Butler’s Committee, the only one with any decent corporate memory is Stephen Duckett; like all of us who have been in the health sector for as long or, in my case, longer than him we have our own set of biases. Duckett sure has his, and his bias against private practice is well-known. He is sure to raise salaried practice and capitation as alternatives; but Medicare has served Australia well, even under conservative governments where it is always allowed to decay. Added to this the central agencies hate uncapped programs as Medicare has been.

My problem with the medical representation is that each is there because they have been elected as distinguished members of one of the many tribes of medical graduates, not as experts in health economics and policy. To them, reforming the health system is not a full time pursuit, but a task force gives them all the opportunity to whinge, and in a couple of years these office holders are gone.

The only medical graduate on the committee, a former President of the AMA with some experience of the vicissitudes of Medicare, is Hambleton. He does not fill me with any confidence because once when I asked why the AMA had ceased being deeply involved in establishing doctor’s incomes, he seemed confused about the value of the bilateral Medicare Enquiries between the AMA and the Federal Government last held in 1984.

Looking down the list it seems that the aim is to include every player in the provision of primary care and a wish list of aims without any means of achieving it. Thus presumably, the Department will prepare a series of working papers – a variation on the Jenny Macklin National Health Strategy Initiative where she was asked to review Australia’s existing system, which produced a series of discussion papers of varying quality. That task force was disbanded in 1993, without any discernible effect on the health system. My involvement goes back to listening to Gough Whitlam expounding on health reform in 1969 at the time of the Nimmo inquiry, when the genius of John Deeble and, to a lesser extent, Dick Scotton provided the intellectual capital for both Medibank and Medicare.

The crux of the primary care problem is that despite all the talk about professions working together, it just does not happen spontaneously. I am a patient in a very good general practice, with very competent medical and nursing staff.  They have their tasks and they don’t spend their time in formal training in how to get along. As a patient, I want to be able to converse with my general practitioner and yet realise I have a limited time to do so.  Yet despite its caring profile, this long term traditional suburban general practice has been absorbed into the corporate world, and if it were not profitable, you could bet your bottom dollar that this world would not be there.  This presents a bit of a paradox. Substantial investment on the one hand; crying poor on the other.

The other variable is general practices now closing off appointments for new patients, which effectively caps throughput. Given that Medicare is uncapped – and the rule of thumb is to maximum daily limits for doctor – namely seeing 80 patients a day for 20 days a year or 30 telehealth consultations for the same period a year, otherwise any more will attract a reference to the Professional Services Review Committee. That is the only comment on optimal throughput – two extreme positions.  The Committee should address optimal throughput.

Given that the public has been used to bulk billing in general practice, I can now ask a question: “What is general practice?” and then ask, “what is the most cost-effective way to deliver general practice?”

My premise is that general practice is heterogeneous. Yet it conforms to certain rules. For instance, at least three doctors are required if the practice provides a 24-hour service. Yet how many practices exist as standalone services providing such a service? In rural areas in the small towns such a service is problematic, but general practitioners there do have a local hospital to back them up. I have no idea what the “urgent centre” proposed by NSW and Victoria is; and where does the staff come from – Mongolia?

In any question of general practice, one must ask the question of what level of coverage by general practice yields the most effective return. The fact that the so-called 24 hours clinic or general practice attached to urban hospitals has not become standard suggests this is a work pattern unacceptable to the majority of the general practice workforce, notwithstanding that its income is underwritten by government.

From a question of what is general practice, and the most cost effective organisation of same, then it becomes a cost accounting exercise. The best cost accounting depends on ensuring that all the assumptions underpinning the process are clear. There are times when approximations will be made; and it is the test of any good cost accountant to know when to approximate. After all, if one waits for a complete census of any population when 90 per cent will provide a useful approximation and if the information can be obtained in a reasonable time, then delays are avoided that otherwise can render the data of limited use.

The problem is that the advice provided by cost accounting is ignored by government, because it is often inconvenient. We once showed that the most effective radiation oncology practice was one based on three linear accelerators at any one site. What happened was the States bent to political pressure and scattered one machine facilities across its jurisdiction; as well as being uneconomic, these facilities had difficulty maintaining staff.

In the end, once the true costs are known, then it can be discussed what should be the professional cost of the practice, the expected income of the general practitioner, which is subsidised through fee for Medicare benefit and what can be gained by additional charges that the patient has to find. This  figure is complicated by the corporatisation of general practice. After all, general practitioners can charge what they believe is fair and reasonable. What does their corporate boss want to charge?

The Federal government provides a patient benefit not a doctor’s fee. The patient benefit is constitutionally valid; but setting fees is not. The Australian voters in the 1973 referendum rejected Federal control on prices and income.

And there you are. Answers are gained, and the 17 member committee can deal in facts adorned by assumption rather than opinion warped by bias and, I hesitate to say, “enlightened self interest”.

Where fantasy meets reality 

In the Boston Globe, Stephanie Ebert runs a regular opinion piece chronicling what is happening due to the Supreme Court ruling, overturning Roe v Wade. This is her latest update I’ve edited hopefully without affecting the original content.

The consequences of withholding reproductive choice were expressed in stark and varied terms, by a Republican state legislator in South Carolina, by voters in New York, by political pundits balling up their midterm predictions, and by HBO viewers shocked by the premiere of the “Game of Thrones” prequel “House of the Dragon.”

But before we get to Westeros, let’s stop in the Palmetto State (South Carolina), where a Republican state lawmaker’s abortion regret clearly struck a chord.

Rep. Neal Collins 

Rep. Neal Collins told an emotional story about the real-life fallout of the “Foetal Heartbeat Bill” he had supported, which prevented a 19-year-old whose water broke at 15 weeks from terminating a pregnancy that was not viable. She was sent home from the hospital with a greater than 50 percent chance of losing her uterus, he said, and a 10 percent chance of developing sepsis and dying.

“That weighs on me. I voted for that bill,” Collins said in a video clip that circulated on social media. “These are affecting people.”

The clip was picked up by CNN Politics, where commentator and former Trump aide Alyssa Farah Griffin said that in some states, the GOP was going too far with abortion restrictions.

“This very extreme position will backfire on Republicans — not having exceptions for rape, incest and life of the mother — and I absolutely think we need to course-correct,” she said.

That’s the view of many political observers who are rewriting their predicted narratives for the midterm elections since voters began having their say at actual ballot boxes. A special election victory by Congressional candidate Pat Ryan — a New York Democrat who campaigned on abortion rights after the Supreme Court struck down Roe v. Wade — is a sign that Democrats are now more competitive in the midterms than anticipated.

Anger over the abortion ruling is translating into new voter registration and could fuel a pushback at the ballot box, several new analyses suggested.

Tom Bonier, CEO of the political data firm TargetSmart, dug deep into Ohio voter registration and reported that women out-registered men by an 11 percentage-point margin since the Supreme Court’s Dobbs decision on June 24 — a huge change from the 2018 midterms.

Bonier documented the surge of women who registered to vote in Kansas after the leak of the Supreme Court’s draft ruling in early May before Kansans voted overwhelmingly to preserve abortion rights in the state’s first-in-the-nation referendum on the issue.

Not to be outdone, the New York Times’ The Upshot examined new voter registration in 10 states and found the number of women registering to vote rose by about 35 percent after the decision was leaked, while men had an uptick of 9 percent.

Meanwhile, abortion bans have taken effect in 12 states. But in one of those, Idaho, the Justice Department prevailed in a legal challenge that partially blocked criminal prosecution of doctors who perform abortions. A federal judge agreed with the Justice Department that Idaho’s abortion ban conflicts with the federal Emergency Medical Treatment and Labor Act, which requires hospitals that receive federal funding to provide treatment in medical emergencies.

In Texas, the decision was the exact opposite. A federal judge agreed with Attorney General Ken Paxton that the state can’t be compelled by the federal government to save a pregnant woman’s life with an abortion.

In other news

Once vulnerable, N.H. Senator Maggie Hassan is suddenly benefiting from abortion ruling, other Democratic breaks – The Boston Globe.

Google, criticized for steering those search for abortion to anti-abortion crisis pregnancy centres, takes steps toward clarity – Bloomberg

The aforementioned HBO series “House of the Dragon,” which requires both trigger and spoiler alerts for a brutal childbirth scene that was upsetting to many women.

Still, one of the showrunners told the L.A. Times that the women consulted during production offered positive feedback.  “Some felt it wasn’t violent enough,” he said.

Was it gratuitous – as was often said about its patriarchal forebear “Game of Thrones?” Was it transparent in its intentions, like a latter-season “Handmaid’s Tale”? I was surprised to discover it was written and filmed well before the Supreme Court ruling.

Mouse whisper

Appalling taste. According to The Economist, there are those Brits who are promoting Larry the Cat as the next British Prime Minister. Extraordinary how the Brits have embraced this serial murine killer. But then Larry has had to deal with Boris Knotgudonov, who has tried to portray himself as a cool cat, but turned out to be an appalling mouser.

Meanwhile, back in Hammersmith …

 

 

 

Modest expectations – Three hundred and four thousand four hundred and eighty

COVID-19 comes to all. I thought I had some idea where I picked it up. I have limited contact with people, because my disability makes it difficult moving around, especially when there are steps. Until you are disabled, you do not realise how difficult it is to avoid them; the world is not a level field.

The virus is harassing my upper respiratory system, and it has been a challenge to dislodge the tenacious phlegm. The whole picture is that of congested misery.

On Wednesday last, we drove from Swan Hill to Albury, a distance of about 400 kilometres. Lunch was a Cornish pasty and coffee in the shade of pepper trees in Wycheproof.

By the time we arrived in Albury, I had developed a cough, and initially my RAT was negative; but next day it was positive.  The inevitable march of the Virus through the house had commenced.  By the weekend, we were all RAT positive. For us, it was inconvenient to say the least to be away from home, but at least we were isolating ourselves.

I was prescribed Lagevrio (molnupiravir). Paxlovid (nirmatrelvir/ ritonavir), the other antiviral drug, was contraindicated.

Of course, there are no controls to confirm whether Lagevrio had any effect, but now with the cocktail of vaccines and anti-viral capsules, I seem to be holding my own. I have just taken my last four capsules. The congestion has much improved, but is still lingering.

In Albury there has been a supply shortage of antivirals. For a time early in the week Albury may have been in danger of running out of the antiviral drugs if promised deliveries didn’t eventuate. Familiar? Here we go again. Governments blithely change the conditions for availability without determining whether there is a sufficient supply. It is a nightmare, when we – like so many others – are confined to home and depend on the drugs being delivered.

I remember my last tussle with the flu about five years ago. That lasted six weeks with a residual cough for months afterwards., I could see the long dark corridor where there are no open doors and no light at the end.

The pandemic has persisted. Public health measures are now a matter of choice in regard to responsibility. No longer any of those public measures – such as contact tracing, hand washing, masks, social distancing observed. They work, but just as our forefathers did not throw away their weapons because WW11 persisted for more than two years, there is no reason why we could not have adapted if we had had anywhere decent leadership, beyond shutting borders.

Quarantine facilities have been built at great cost, but it seems nobody has thought how to use them. This is very ironic given the decades long experience of confining boat people. Having experienced a period of being in lockdown without any ability to go out, these facilities present the opportunity to enable that group of people to have a shelter until the infective status changes.

It is amazing to see how technology, through the manufacture of new vaccines, anti-virals and diagnostic tests, even down to improved masks, has occurred.

But such improvement in the efficiencies of social practices has lagged, and we all should share the blame, not just Dr Murphy. Nevertheless, it was a time when, except for brief flashes of government accepting responsibility and not blaming everybody else, our social structures have been found lacking. The pandemic still rages; thank God for the scientists and technologists who have provided some weapons, but the virus is far from unconditional surrender.

By the way, a week after testing positive, I am still positive, albeit weakly.

Can you believe these remnants of the Dark Ages!

When I was a first-year medical graduate working at a suburban hospital, one of my earliest memories was coming out of one of the emergency bays on my way to the next when I looked up. At the end of the corridor of flapping curtains against the emergency department wall was a trolley. On the trolley was a young woman who had apparently just been wheeled in and was waiting for a bay in which she could be seen. She was very pale, very grey; she looked very sick, even from where I was standing.

Immediately, I remembered I had seen her in the emergency department the previous day.  She was complaining of a vague lower abdominal pain.

She said she was not pregnant, but she did have some tenderness in the left fornix. She was unmarried; and it was a time when if you were unmarried and under the age of 21, there was a mixture of denial, stigma in her history, and yesterday she had not looked unwell, certainly not as she was now.

I could suspend belief or rationalise why I had missed the diagnosis, so obvious as I looked at her with that grey pallor of impending disaster.

In those days, when you graduated you were considered fully fledged. That was it. Your training wheels had been removed. You could practice unsupervised after you had been through six years of undergraduate education.  I had stuffed up. Looking at her lying on a trolley I knew that I had missed an ectopic pregnancy. I had stuffed up.

I moved with the speed of a penitent, and I immediately ordered that she be taken to the operating theatre. The senior obstetrics resident was alerted and in turn the general practitioner obstetrician. The operation to remove the ectopic pregnancy was successful. Nobody stood around, arguing her clinical diagnosis. They just saved her life; no problem.

I learnt a lesson that day; and my peers were forgiving. It just confirmed  that if you stuff up, admit it and learn; then recriminations are somewhat superfluous. There was none of the huge panoply of undertaking root cause analysis or any of the fancy names designed by bureaucrats to define the scapegoat , the sacrificial offering to protect the system from the predations of legal jackaldom.

Where am I leading? Ectopic pregnancy requires termination for the health of the mother. The embryo is developing outside the uterus, and undiagnosed or untreated will eventually cause a catastrophic haemorrhage and maternal death.

When I was a young doctor, chemical treatment of ectopic pregnancy did not exist. The drug methotrexate was introduced to destroy the ectopic pregnancy. Methotrexate can kill a wide and diverse number of targets, including the ectopic embryo. Usually given in a single injection, methotrexate has a cytotoxic effect on the trophoblastic tissue – the cells that enable the embryo to stick in normal circumstances to the uterine wall.

Methotrexate treatment of ectopic pregnancies is considered safe, effective and cheap, with no major side effects. Intramuscular methotrexate has the advantage of tubal conservation and saves patients from requiring surgery. It is easier to administer than intraoperative route, which these days is laparoscopic and hence needs expertise.

Now what is happening in the Redneck States of the America?

In addition to surgical abortions, anti-abortion laws in some states such as Texas have also banned several drugs that can be used for inducing abortions. Among the medicines banned under these laws include drugs such as methotrexate, mifespristone, and misoprostol. Besides inducing abortion, these medications are also used for the treatment of other conditions.

Moreover, these laws allow the state to prosecute health care prescribers and pharmacists for dispensing such abortion-inducing medications.

Recent reports suggest that the reversal of abortion rights has also indirectly impacted women who use these medications for conditions other than for a medication abortion.

Although States such as Texas have banned these medications for terminating pregnancies, the laws permit the use of these drugs for miscarriages and ectopic pregnancies.

However, the fear of penalties, including being criminally charged, has resulted in some pharmacists refusing to dispense these drugs for the above.

In addition to ectopic pregnancies, methotrexate can suppress the activity of the immune system and is used in the treatment of autoimmune conditions, including rheumatoid arthritis, scleroderma, and lupus. Methotrexate is also used for the treatment of inflammatory bowel disease and a variety of cancers, including breast cancer, lymphoma, leukemia and lung cancer. Depending on the nature and severity of the disease, the dosage required varies; for a period I was prescribed the drug but in a far lower dose than required for neoplasia – or ectopic pregnancy for that matter.

Nevertheless, in these anti-abortion States , believe it or not, there are reports of disrupted access to methotrexate for patients with autoimmune disorders. Some rheumatologists have stopped renewing prescriptions for methotrexate, and moreover pharmacists are refusing to dispense.

Paradoxically, methotrexate can cause birth defects.

This has had a knock-on effect. The risk of birth defects and the lack of access to abortions have made rheumatologists wary of prescribing methotrexate to women of childbearing age with these concurrent diseases. As one source has said: “Frankly, methotrexate is one of my go-to medications for any number of diseases, including rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, myositis, and systemic sclerosis. I expect that some rheumatologists will understandably worry about prescribing methotrexate to patients because if the patient inadvertently became pregnant, the foetus has now been exposed to this medication. This is really worrisome as methotrexate is a very effective medication that we rely on to treat a number of debilitating and serious autoimmune diseases.

Indeed.

Justice John Roberts

Now America has John Roberts as the de facto Surgeon-General. He presides over a Supreme Court which could be reasonably considered is now the legal equivalent of the untreated ectopic pregnancy – eventually if left alone it will all end up in tears – however you pronounce it.

America remains untreated. We await the death of this motherland in the eventual haemorrhage of a Constitution constructed when the population had a median life expectancy of 35 years.

Eventually, the blood of all is shed. See, your gloves, Chief Justice Roberts, are smothered in the blood of your country, shed for no-one but the hubris of your colleagues.

The Unsinkable Molly White

Anissa Gardizy a 35 year old reporter on the Boston Globe. Her short biography states that Anissa Gardizy is a general assignment business reporter. She graduated from Emerson College with a B.S. in journalism and took economics classes at Framingham State University. Prior to joining the Globe full-time, Anissa was a co-op on the business desk, and she held internships at the Telegram & Gazette in Worcester and The Information in San Francisco. 

Below is her recent profile of Molly White, who had to take time out because of her robust criticism of cryptocurrency. She has been verbally attacked; which probably means she has obviously come too close to the festering centre of cryptocurrency activity.

Ms Gadizy writes:

Depending on whom you ask, cryptocurrency is either digital snake oil or revolutionary technology. Crypto markets have plunged in recent weeks and everyone is looking for answers.

So it makes sense that a website dedicated to documenting mishaps, failures, and scams in the industry is suddenly taking off. And who’s behind it? Molly White, a 29-year-old Wikipedia enthusiast and former HubSpot employee who has emerged as one of the industry’s most pointed critics.

How the 2016 Northeastern University graduate, who lives in the Boston area, came to be one of the most listened-to people on crypto and blockchain tech is complicated. But it started in the past year, when the field became impossible to ignore.

The price of bitcoin surged to an all-time-high of nearly $70,000 in November. Ads for crypto companies were featured during the Super Bowl. Celebrities changed their Twitter profile pictures to non-fungible tokens, or NFTs. Some of White’s friends began quitting their traditional tech jobs to work for crypto firms.

White, a longtime Wikipedia editor on the side, started to research the technology. But the more she learned, the more she realized crypto was being marketed as something everyone should be getting into, despite a history rife with fraud, scams, and predatory marketing.

“[I was] seeing people get screwed over again and again and again,” White said. “There wasn’t a permanent record of what was actually happening and how poorly a lot of these projects were ending.”

Her first instinct was to start writing Wikipedia articles about crypto and the related field of web3.” But she quickly realized Wikipedia wouldn’t be the best place for her work — among other things, it would have required her to take a neutral approach.

“I have a pretty strong opinion,” she said.

Software engineer Molly White at work on her laptop

So late last year, while working full-time at HubSpot, White created a website called “Web3 is Going Just Great”. (The name is as sarcastic as it sounds, with the longer version ending with “…and is definitely not an enormous grift that’s pouring lighter fluid on our already smouldering planet.”) On the site, she chronicles  sometimes several times a day — bad things happening in crypto.

“There’s a narrative that’s become so loud and pervasive, that everyone should be getting involved in this,” she said. “It feels like I have this obligation to speak out about it.”

And others are listening.

She is regularly quoted by national news outlets, was a guest lecturer at Stanford University, and has advised US senators, including Senator Elizabeth Warren, on blockchain and cryptocurrency.

As White has learned over the past year, criticizing crypto isn’t easy. In a space known for unwavering optimism and “bro culture,” she’s the outspoken opponent pointing out its problems.

White has been the victim of online harassment, doxxing (when private information is revealed about someone), and threats of violence. As a result, she doesn’t share much identifying information about her family or where she lives.

White, who grew up in Maine, started editing on Wikipedia around the time she was 13. “My family knew I was doing it, and to some extent my friends knew,” she said. “It was kind of just like, ‘Oh, that’s one of Molly’s weird hobbies.’”

Though she got started writing about her favourite bands, White now focuses on controversial viewpoints and male-dominated spaces, including right-wing extremism and “involuntary celibates,” or incels. She has also served on the site’s arbitration committee, which settles its toughest disputes.

Andrew Lih, a Wikipedia veteran who has known White since she was a teen, said most editors concentrate on topics they take a personal interest in. White, he said, tackles things “she absolutely doesn’t like.”

“She wants to make sure the record has the best information,” he said.

Lih credits White’s rise to her ability to present information in a way that is digestible. On her crypto website, she writes in a terse, matter-of-fact style and uses hashtags such as #yikes, #badidea, and #hmm. She isn’t condescending or alarmist, either.

Unlike some critics, White doesn’t think all crypto is a scam. Rather, she believes there has been an explosion of “really scam-y projects” that downplay the risks. She worries crypto is being cast as a “ticket to financial freedom” to people who don’t have money to lose.

According to data published by the Federal Trade Commission, more than 46,000 people have reported losing over $1 billion in crypto to scams since the start of 2021.

Long term, White believes crypto will likely exist as a niche, speculative vehicle for high-risk takers.

Most people would agree that regulators need to address crypto scams for the industry to be viable. More controversial is White’s sceptical view of blockchain, crypto’s underlying technology, which has been hyped in recent years as a potential cure-all for problems related to Internet security, privacy, and financial systems. Blockchains are public, electronic databases that are distributed across a network of computers. The technology is intended to be immutable (meaning records can’t be modified) and decentralized (meaning data are stored across the network and not held by any central party.)

Proponents believe blockchain tech could eventually transform everything from financial systems to social media, creating a digital world where individuals have increased control over their own data. Many people refer to this blockchain-based vision as “web3.”

There’s been a proliferation of venture capitalists, startups, and politicians touting its potential, including a growing cluster in Boston. Late last month, hundreds of people attended an all-day summit on web3 on the top floor of the MIT Media Lab, put on by venture capitalist John Werner. It drew industry heavyweights, including cryptographer Stuart Haber, who co-invented the blockchain.

But White doesn’t think blockchain is revolutionary technology. Last month, she and a group of about two dozen computer scientists, researchers, and academics, signed a letter to US lawmakers to express their concerns about the field. Signatories included well-known technology figures like Harvard lecturer and cryptographer Bruce Schneier, Boston-based entrepreneur Miguel de Icaza, and software engineer Grady Booch.

“By its very design, blockchain technology is poorly suited for just about every purpose currently touted as a present or potential source of public benefit,” they wrote, calling it a “solution in search of a problem.”

White’s critics say the technology is in its early stages and will improve. But she disagrees, noting that the two most popular cryptocurrencies have been around for more than a decade. She also thinks blockchain, by design, contains inherent flaws — such as the inability to edit or delete data — that will make it difficult to use and potentially even harmful.

Greg Raiz, managing director of Techstars Boston — which just launched a crypto accelerator program with Boston-based blockchain firm Algorand — disagrees with White’s assertion that crypto is past its early days. In fact, he said it feels like “we’re still in the first inning of this game.”

While he doesn’t think blockchain will be the “solution to everything,” he isn’t writing off its potential to address social, monetary, and business problems. He added that criticism of web3 is “super healthy.”

“Any type of unbalanced exuberance toward a technology isn’t great,” Raiz said.

Sounds that he is pronouncing an “Amen” to the unsinkable Molly.

Parliamentary staffing

The first reaction to the protesters of the newly-elected backbenchers – not aligned to any particular party – to a reduction in the four advisers to one  in line with other back benchers, was that of the howls of the deprived. Really, you poor diddums – only one adviser and four electorate officers. When perceived as privileged already, complaining about the level of the porks, is one way to lose the electorate, especially before you have even placed your toe in the political water. I was surprised when Dave Pocock started the Whimper.

In 1973, the Leader of the Opposition had a Press Secretary, a Principal Private Secretary (PPS), a Deputy Private Secretary and an Assistant Private Secretary. There was one other adviser who was from the government and picked up much of those tedious jobs and fashioning questions on notice and an add on to the Parliamentary Library. Needless to say, we were all male, and the secretarial staff who did all the work were women. I was the PPS. However, the Leader of the Opposition was thus limited to four advisers, including the Press Secretary – not one backbencher.

I believe it was more important not to interfere with the electorate staffing. For senior members of any party the electorate secretary is very important to remind even the Prime Minister that he represents an electorate, even if it may be traditionally very safe. Nowadays that cannot be guaranteed. Thus, the electorate office is an important bastion. In the case of the backbencher, especially those who have gained their seat by the adroit use of social media to win the popular vote, their activity will be augmented by an electorate office, government funded. Cathy McGowan in the northern Victorian electorate of Indi is an important bellwether since she developed an electorate office system, which was shown to be transferable to her successor, Helen Haines.

Cathy McGowan

As the sociologist Max Weber observed, charismatic leadership is very dependent on the individual’s appeal, but in her case McGowan (an unlikely charismatic) was able to “bureaucratise” the electorate staff so her successor did not need to change the systemic aspects of the McGowan legacy. In other words, the model was robust enough to survive the transition from one to another strong-willed woman.

McGowan concentrated on her electorate and where she thought relevant generalised the needs to that of Australia. Maybe the fact that she came from a large cohesive family provided her with a model for an electorate office, but whatever it was, her electorate brew worked.

Developing her model from an electorate base provides a challenge for the new raft of independents, whatever their colour. She had a strong personal appeal, which translated into strong personal loyalty by her staff. She did it with a strong electorate profile, which contrasted with the dysfunctional style of her predecessor.

A backbencher needing Canberra advisers is presented with the aspirant jetsam seeking to float as a successful “factional candidate” onto a red or green parliamentary cushioned sinecure. At this pupa stage the adviser may be more akin to N’drangheta Consigliere admixed with a tincture of Undergraduate Puerilism. Policy development is not one of the skills of this Canberra hybrid. More, it is a question of hanging out, gossiping, and covering the underlying boredom of those without any constructive thought coupled with outbursts of anti-social behaviour – sexism,  drunkenness and sexual harassment.

Policy becomes a joke; so-called policy becomes exercises in plagiarism – or just the “smart-arse” taking the role of the cynic – tearing down all constructive thought on the grounds that they are protecting Absolute Truth – otherwise excused as the role of the Devil’s advocate. Undertaking policy development is a skill, imperfect at best. It is a special quality requiring knowledge, so you know that you are not re-inventing policies that have been shown not to work, and enough knowledge to provide objectivity in an ocean of bias coupled with an ability to write clearly and succinctly. These skills lie outside the normal skill set of the normal adviser appointee.

Staffers aplenty

Well, minimising the number of advisers minimises the number of people designed to irritate and thus it seems leaving it at one each for all backbenchers is probably about right. Only need one person to get your dry cleaning, run errands, and ensure that the backbencher has his or her ego combed daily.

Mouse Whisper

Don’t know whence it came. Just a scrap of paper with the title “Death of a Babyweight.”

…needless to say, the comment was met with gales of laughter, but then that was another time when the sun shone and they were feckless and shallow students; and yes, the Associate Professor was as Federico would say a total bunghole who played the World for cheap laughs a person who always knew the mouse to kick – and now lies increasingly forgotten – someone essentially trivial. 

Perhaps you will understand the allusion, illusion and in the end the confusion.