Modest Expectations – Barry Marshall & Obey

Pauline has parked her grandstand in the News Ltd car park, where she is advocating a High Court challenge to border closure. This is a normal Pauline stunt, unsurprising given that the Queensland elections are imminent -and there is nothing like a confected confrontation magnified by that shrill tone of hers.

One concession you have to give to this lady, she plays “victim” very well. One of the ploys when I used to be an official visitor to psychiatric hospitals in New South Wales was the way the inpatients could produce someone who had been “victimised” and ask me to help “save”, usually, a “her”.

My companion visitor was a wise woman, who unlike myself had long practical experience as a psychiatric nurse. She warned me not to be “sucked in’’, but listen to the complaint and investigate. However, she said – maintain rationality –don’t be get caught up emotionally as these people are very clever, since it was a practised scenario, and they try you out.

Whenever I watch Pauline, I am reminded of this advice, since whenever she is pushed into a corner the voice becomes quavery and the tears well up.

The one hand clap, Pauline.

But back to reality.

How much is this High Court challenge going to cost, Pauline? $300,00? More? For what, Pauline? A failed challenge? Of course, the victim.

However, who is going to pay? You, Pauline? No way. I’m afraid it is going to be us mug punters, of course; the real victims.

Telehealth – Look Mother! No hands

I was brought up as a medical student to believe that the essence of being a doctor was to take a full history from the patient and then to do a full examination.

That was a message. The face-to-face consultation was the basis of consultative medicine and the skill was to make the correct diagnosis – or if unsure, to provide a set of differential diagnoses based on what you had elicited as symptoms and signs of the patient’s condition.

However over the course of my medical career technology has intruded upon the “maestro” doctor able to diagnose the patient before he or she sat down. Observation to me remains a very important element as it was to Dr Arthur Conan Doyle, who invested his sleuth, Sherlock Holmes, with the same or enhanced degree of observation he had as a doctor.

The astonishing array of technology and increasing differentiation of care has been something I have witnessed through my long career. Sometimes I have watched and sometimes I have been closely involved, for example with the introduction of Magnetic Resonance Imaging (MRI) into the private sector and its recognition by Government – not always the most tranquil moment of my career.

There has always been agitation from the medical profession for reimbursement for non-face-to-face consultations. With the corporatisation of medicine, where the bottom line is everything, this agitation has not lessened. “Money for jam”, as the old saying goes, many jars of which will inevitably be transferred offshore.

Having watched telehealth progress through phone conversations to uncertain video links through to more reliable technologies such as Zoom has meant that technology has challenged traditional ways of medicine.

My only hope is that the government, which is increasingly strapped for cash, monitors it use.

I have used telehealth as a patient, and for a person with limited mobility it has been particularly beneficial. I have found that the doctors have been more punctual, but that anyway may be because of the lower volume. Telehealth acts as a screen. For the plastic surgeon, you can send a picture of the lesion, and get an opinion over the phone and in my case, yes it looked as though it needed to be removed; then a regular check up with the rheumatologist reviewing my pathology, a critical aspect in my ongoing chronic disease. More importantly in talking to my neurologist, he listened to my history, and said yes, it was important to see me, but I should have a cervical spine MRI first.

Two of the three telehealth consultations required subsequent face-to-face consultation. My general practitioners friend said that with the modern video technology, it is possible to diagnose simple conditions, such as a strained muscle, by observation and prescribe a treatment without seeing the patient in the rooms.

My appointments to see specialists could only be undertaken by face to face consultations – removal of a lesion from the face, assessment for cataract removal, neurological examination for the particular set of signs.

As someone who developed an auto-immune disease insidiously, after my diagnosis it was apparent that I needed not only a good general practitioner but also one who would provide continuity of care.

Being a doctor myself, I am in the worst category in regard to regularly seeing a doctor. I can do all that general practitioner stuff – but of course I cannot. It is impossible to have an objective view of yourself until, as I found out one night, I knew that I was dying. Hypochondria is one thing; a sense of impending death is another.

I survived the night, and because of the pain and stiffness and overall weakness, I went back to my orthopaedic surgeon whom I had consulted a dozen years earlier for my acute painful knee.

At this time, I had no regular general practitioner although most days I was surrounded by them at work. However, the orthopaedic surgeon knew what it was, but orthopaedic surgeons treat by operation and not by drugs and so he flicked me over to his trusted rheumatologist. Now rheumatologists are gentle ruminative folk, but have long lists of patients; so waiting for up to six weeks is not uncommon for an appointment.

Miraculously I saw the doctor that afternoon. He prescribed tests and drugs, but I was not to take the drugs until the test results came back.

The starting line could not have come sooner; within 24 hours after taking the first tablets, my condition improved dramatically.

Unfortunately dramatic improvement didn’t equate to immediate cure, but that’s another story.

What is interesting however, in a story about telehealth, is how do you diagnose this sort of disease. As one of my general practitioner colleagues said to me that this is a GP diagnosis – you ask: “Can you roll over in bed?”

This was very much after the fact. I had already been diagnosed and was being treated. However, I had not noticed it before; he was right, I could not roll over in bed.

Theoretically, if the doctor had been as astute as this Scot, who had seen cases before, a telehealth diagnosis might have been made.

But then again I still would have had to see him in a face-to-face consultation. Telehealth is not a panacea and I would caution government and suggest once the COVID-19 pandemic is controlled, to review its application closely, especially the biggest users and then ask why? As I know too well, governments are reluctant to wind back largesse for fear of vested interests squawking about compromising people’s health.

Telehealth is a bonanza for the corporate health business, where throughput is everything, and health care a by-product.

Nevertheless, far more insidious is the large health conglomerates where the owners are dependent on government payments to profit, inevitably providing donations to political parties to keep the tap turned on. Donations after all have a wonderful effect of assisting politicians to roll over – not necessarily in bed.

Hey, Pellegrini, whatcha doing with that test tube?

A new study shows coronavirus patients who took hydroxychloroquine to treat COVID-19 had a higher risk of death than those who weren’t given the drug.  

The study, published Friday in the medical journal The Lancet (22 May), also found that COVID-19 patients were more likely to develop serious heart arrhythmias if treated with hydroxychloroquine, or its closely related cousin chloroquine.  

Arrhythmias can lead to a sudden cardiac death, the report said, but researchers did not associate the study’s fatalities with adverse cardiac affects. 

Even though it’s only an observational study – not the gold standard double-blind, randomized, controlled trials – experts say the enormous sample size makes it compelling.

The study comprises of 96,000 coronavirus patients from six different countries who were hospitalized between Dec. 20, 2019 and April 14, 2020. Nearly 15,000 patients were treated with hydroxychloroquine or chloroquine alone or in combination with an antibiotic.

When I heard that the Walter & Eliza Hall Institute for Medical Research (WEHI) were about to embark on a trial to enlist 2200 health workers into a trial to test the efficacy of the drug being a preventative agent against the virus, I checked the date. No, it was not April 1st.

Professor Marc Pellegrini is employed at the WEHI with one of those expansive titles, which suggest he is important. On television, his justification for the trial is that the drug kills the virus in the test tube. So, I might add, does bleach.

I wondered how this experiment has come about.

This modern day Lancelot has given his project a grandiose title – COVID-19 Shield. Here I wonder whether you need a diploma in public relations rather than a science degree in this modern world purporting to be medical research.

I have not the seen the protocol except it seems to be a randomised controlled trial; but one important report I would like to see is that of WEHI Ethics Committee on the proposed study and the reasons for approval.

In the latest bulletin of WEHI, there is a coy mention of this trial without naming the drug and the brief comment that it is being funded by the Australian Government. There does not seem to have been the award of a peer-reviewed grant as one would expect for such a potentially dangerous activity.

The problem for the Australian government is that there is pressure coming from the non-medically qualified – especially from such a medical expert as Clive Palmer.

In response to the above Lancet article, the WHO is reported to have put on hold the hydoxychloroquine arm of review. However, the report has all the hallmarks of the WHO walking away (or should I say “crabbing” away), without losing face.

But WEHI seems defiant. At least Professor Pellegrini is. May I suggest it is time you retire the Shield, Sir Lancelot.

Finally, as The Washington Post noted – as I have – who says Trump has been taking the drug. Has anybody seen him take it? This person who lies, lies and lies. Why would his statement of putative self-administration be any different? In any event, he now says that he has stopped taking the drug. Come on, Donald, which is the lie?

The time I under-dosed with Chloroquine (Plaquenil)

It was about 30 years ago and we went on a tour of Africa. Among measures to be taken were the mandatory yellow fever vaccination and a prophylactic antimalarial, then hydroxychloroquine, which was marketed under the name plaquenil.

It was a wide-ranging trip, which excluded South Africa, then in the grip of the apartheid Afrikaans. However, in many ways it was defining as it led to us, especially my wife, returning almost yearly to the continent.

We had previously been to North Africa – Morocco and Tunisia – but this was a month long roam through Southern and Eastern Africa. The trip incorporated the island of Madagascar, the French Département of La Réunion and then finally the Seychelles. 

We spent some time in Madagascar, both in the jungle near Antananarivo, the capital, and the island of Nosy Bé looking for lemurs and indris. After leaving there, we flew to Saint-Denis, the capital of La Réunion, where the intention was to climb La Fournaise, the volcano at the end of the island. The year previously we had reached the summit of Yasur, on the island of Tanna in Vanuatu. This is one of the only active volcanoes in the world where you can stand and look down into its fiery cauldron. La Fournaise presented another opportunity to do so.

Le Piton de la Fournaise, Reunion Island

However, while having a drink at the bar of the hotel on arrival, I started to feel unwell. I went to bed, and then passed out. As described to me I began to get very hot, and my temperature was apparently swiftly rising, and as my wife said I became quickly delirious. She did not know quite what to do except keeping sponging me to try and reduce my temperature. She told me that her plan was to phone a public health physician acquaintance in Paris, in the event that I needed to be admitted to hospital because, as she said, her French wasn’t up to an emergency admission. However, about one in the morning, suddenly I was a bundle of sweat. I woke up; my temperature was dropping. My pyjamas were absolutely soaked with perspiration

How could this be; I was taking the plaquenil regularly, but then I reviewed my dosage – it was below the prophylactic dose. God knows even to this day how this happened, but it was obviously my mistake. Fortunately, my wife did not succumb. So even though I felt lousy and confused, I increased the dose to therapeutic. The worst residual symptom was a terrible headache behind the eyes. I have never had one like it before or since.

That was it, except I felt lousy for over a week, but I did not have another crisis – nor have I had a recurrence since that day.

However, I always take Malarone, the current anti-malarial drug of choice whenever there is the prospect of contact with a malaria-bearing mosquito overseas.

But back to La Réunion, we did see around the island, including the Cirques, tropical remnant of extinct volcanoes but we never did climb La Fournaise.

No, I did not have a test to confirm – not malaria – confirm my anserine status.

But at least after that experience I can swear by hydroxychloroquine – for malaria!

Just a lurk

COVID-19 causes massive inflammation boosting cytokines, which increase the liver’s production of clotting factors, explains Beverley Hunt, medical director of Thrombosis UK and a practising clinician. For example, fibrinogen levels in a severely ill COVID-19 patient are 10-14 g/L, compared with 2-4 g/L normally and 5-6 g/L in a pregnant woman. “A COVID patient’s blood is enormously sticky,” she told The BMJ.

“All patients in critical care are at increased risk from clots because they are immobile, and when you are sick you have sticky blood,” says Hunt. Studies of venous thromboembolism rates among non-COVID patients in critical care show that rates of thrombosis can be as high as 28% if patients are not given any prophylaxis. Among patients given prophylaxis the rates are halved. So, we seem to be seeing significantly higher rates of thrombosis in COVID patients. 

“Thrombosis is definitely contributing to the high mortality rate from COVID,” says Hunt. “Not only can it lead to a pulmonary embolism, which can be fatal, but there are also higher rates of strokes and heart attacks.”

In this report in the British Medical Journal, a United Kingdom medical specialist is musing on COVID-19. Now at the outset one would have thought that the only experts interested (or consulted) would be emergency physicians, anaesthetists and respiratory specialists. However, this is a doctor expert in blood clotting which has arisen as a major COVID-19 complication, especially as the amount of anti-coagulant to be given seems to be unsettled. Moreover, there there are reports of late onset deep vein thrombosis. My Swedish correspondent mentioned COVID-19 toes, which appear to be a severe form of chilblains, pointing to this being the virus being an instigator of widespread disturbance in blood clotting.

What is further intriguing and indicates the widespread effect of the virus is loss of the sense of smell as an early sign. In humans, the olfactory cell location measures 9 cm2 and lies on the roof of the nasal cavity.

With the common cold when there is swelling of the nasal epithelium non-specifically, sense of smell is impaired. However there are reports that this COVID-19 virus infiltrates the sustentacular (supporting) cells which, together with olfactory cells, constitute the pseudocolumnar epithelium underpinning the nasal cilia and microvilli. Among other functions these cells have an effect on how odours are perceived by the olfactory cranial nerve.

It was interesting looking at the histology of the nasal lining, and its complexity. The olfactory nerve and its connections are one of the most neglected areas in medicine, because the sense of smell is more related to lifestyle rather than considered a major marker of disease. However, if it is indeed an early marker of COVID-19, attention should be paid to the way the nasal swab is taken to assist early detection, especially if the olfactory area of the nose is where the virus may lurk first.  This infiltration indicates how profound this virus may be in invading the body.

This virus is not going away soon and while Australia has, up until now, done an excellent job in suppression, “lurk” is probably the most concise way to describe it.

The Hungerford Games

We camped on the Queensland side of the fence, and after tea had a yarn with an old man who was minding a mixed flock of goats and sheep; and we asked him whether he thought Queensland was better than New South Wales, or the other way about. 

He scratched the back of his head, and thought awhile, and hesitated like a stranger who is going to do you a favour at some personal inconvenience. 

At last, with the bored air of a man who has gone through the same performance too often before, he stepped deliberately up to the fence and spat over it into New South Wales. After which he got leisurely through and spat back on Queensland.

Henry Lawson wrote thus about his experiences in Hungerford in 1893, when he had walked there with his swag from Bourke. The expectorating man’s name was Clancy, that familiar ‘loveable larrikin” character alienated from officialdom. Sorry, that is my ironic interpolation, and on the contrary Henry Lawson was not impressed by him.

There was no Pauline Hanson around in those days, and anyway she would not have been able to vote or stand for any of the colonial Parliaments in Australia at that time.

The Royal Flying Doctor Service (RFDS) periodically does medical clinics in Hungerford – this population speck, which straddles the border of New South Wales. This settlement is about a three hour drive along the Dowling Track from Bourke. I have always hankered to go there since I worked with the RFDS, for no other reason that it is there and like so much of western Queensland it epitomises my image of the laconic yet irreverent stoicism of the Outback.

We have years ago thought to drive there, but there had been heavy rains and the road beyond Bourke was impassable. The road is still unmade, but even though it is not the first place one would think to cross the border, my hankering is still strong. So I thought I would find out more.

The problem is that the Royal Mail Hotel is on the Queensland side of the Queensland-New South Wales border, which is defined by the wild dog fence. There is a border gate at Hungerford.

To get more intelligence on the current situation, I rang the publican at the Hotel. The news was grim. The gate is locked; the coppers have the key and even if I could he said it would inadvisable to try and climb over the gate. Anyway we would be aliens from New South Wales – waratah cockroaches invading the land of Cooktown orchid cane toads. So we could not stay at the inn.

So Premier Palazczuk, I promise I won’t make a High Court challenge if you open the Hungerford gate and allow us to stay in the pub. I’m not sure about the High Court challenge – however I believe there is a class action being mounted by a consortium of wild dogs to remove the fence between the two States. And it is only an unsubstantiated rumour that Clive Palmer is funding their challenge.

Muri Succursus

Mus Virgilis “destillat ab inguine virus”

We mouselings, as you know, pay homage to our celestial creator, Rodentia Nora. So we have knowledge of Latin – one of the greatest bard being one Mus Virgilis.

Given how much used the word “virus” is, we had a peep at its derivation.

“Virus” is a rare second declension neuter word for “poison” or “slime” and that attracted me to see if there was a plural form, “vira”. But the word has never been found in a plural form in Latin literature. Thus “viruses” is acceptable – even though the “es” suffix is generally associated with third or fifth declension Latin words.

And certainly do not say “viri”, which is Latin for “men”.

Modest Expectations – Kennedy

When I wrote about Sweden in my blog on 27 March, Australia was paralleling Sweden in numbers of COVID-19 cases – well sort of.

2,016 people have been reported infected with COVID-19 in Sweden (20 cases per 100,000 inhabitants). Nationally, 25 of the cases have died.

Australia had 3,047 cases with 14 deaths at the time (12 cases per 100,000 inhabitants). Of that total then, 300 infected were attributed to the Ruby Princess circus.

Reviewing the figures as of 20 May, the current Swedish figures are 31,523 cases (315 per 100,000 population and projected to be the highest per capita death rate in the world) with 3,831 deaths and 4,971 recovering. Australia by contrast has 7,081 (29 per 100,000 inhabitants) with 100 deaths.

My friend who is a senior radiologist, who once ran the department at the Karolinska Institute in Stockholm, has written to me last week (sic):

… In Sweden a large proportion of elderly who died from COVID-19 were not only old but in special care facilities …

Our experts seem to view yours and New Zealand’s very successful containment effort with scepticism, thinking that in the end, spreading is inevitable. However, the alternative that we are experiencing with many dead elderly is really also very painful indeed. Hopefully you will be better prepared when (if) the virus spreads again. We have had to put much of ordinary health care on hold and reports are that many who should seek care are not, ie transient ischaemic attacks (TIA,) coronary disease patients, symptomatic cancers.  

The much increased ICU capacity, fourfold increase, takes a toll on all other activity. 

… Life is not as normal as reported in international media, all shows and theatres are cancelled, very few travel by Metro compared to normal. Largely the restaurants are complying with rules of sparsely seated customers, with no waiting lines… However many are enjoying the outdoors and our small wood next door sees many visitors, keeping prescribed distances…

We are hoping for restrictions to ease so that we can at least visit Öland.

Lutheran church, Öland

Öland is an island four hours drive from Stockholm connected by a bridge across the Kalmar Sound and we had hoped to spend some part of the Northern summer there. Not now unfortunately.

My friend continued:

I have worked for some time, and noted the high proportion of pulmonary emboli in our COVID patients, as well as other interesting things with this baffling infection. Rashes, COVID toes, white lungs (usually associated with widespread asbestosis – Ed), cerebral complications, abdominal symptoms.  The list is endless.”

My friend mentioned a smorgasbord of diseases arising from COVID-19. This infection is neither the flu nor just a bad cold. And my friend does not even mention Kawasaki disease; there is much more in the COVID-19 malignant store to sample.

His comments were backed up in a report in the NY Times (May 16).

In essence, the report agreed that the Swedish mortality was very high among the elderly but unlike Italy where there was a high concentration of multi-generational families, Sweden lives in a far less cramped space with many more single person households.

The average Swede has less diabetes, obesity and heart disease than in the other countries with a high infection rate.

Even so the Swedish economy has not emerged unscathed –and a contraction of the GDP by seven to ten per cent is predicted by the Central Bank.

Therefore, for those idiot Australian Borises who want to open Australia tomorrow, think Sweden – and not as an Ikea panacea.

Thank God for our senior health people who said don’t go to see the “Sharkies” and hug each of the players in turn, but shut down Australia.

Sweden provides a salutary lesson as Australia re-opens its leisure activities.

Non dimentica

When you author a blog, you open yourself up to being wrong publicly. So I trawled back through my blogs to see when I first mentioned the coronavirus. It was late February, and at that time I was somewhat Thomasine, because a large group of our nationals had been airlifted back to Australia from Wuhan. None of them had tested positive before or after the quarantine.

Yet there was something I was unaware of at the time I wrote the piece and that was how many Chinese were working in sweatshops in Northern Italy. The Chicago Tribune as far back as 2009 reported an estimated 30,000 Chinese are legal immigrants in this city (Prato) of 180,000. Another 30,000 illegal immigrants are also suspected to live here. Many among the Chinese work in small hidden factories for as long as 14 hours a day.

One of our informants recently confirmed that there have been regular flights from Wuhan to Milan, with up to 100,000 Chinese“guest workers”. making shoes there. Once out of the wild meat market, the virus thus had a saloon passage to the delights of Lombardy and Emilio-Romagna. There here were the crowded conditions both at work and domestically to spread the virus.

Despite there being no positive cases among the Wuhan evacuees, Australia had closed its borders to China and then selectively to other countries – but not to the United States, which we should have.

Yes, I was skeptical – and the question remains in my mind why were there no positive cases detected in the people being flown out of Wuhan. If there were none, what was the major reason? I know, the plane air conditioning had been bolstered – what else? Social distancing? Masks? Hand washing? Repeated cleaning of the airplane toilets and no moving from the one seat unless going to the toilet? In the end no-one was infected – in 400 people out of Wuhan.

As for what I wrote, I think I overused the word “hysterical”, which I now regret. 

Abiden with me, fast falls the eventide …

 the New Yorker’s Adam Gopnik decided that this was the night that changed everything. “Not only, as we did not know then, was President Obama in the midst of the operation that would lead shortly to Osama bin Laden’s killing,” he wrote last fall, “it was also the night when, despite that preoccupation, the President took apart Donald Trump, plastic piece by orange part, and then refused to put him back together again.” Report in the Washington Post concerning the White House correspondents’ dinner in 2011.

It is about time that the Democratic Party in America prepares for its Peregrine moment. A Peregrine moment? Bob Hawke. The Labor party, which has always been gentle on its leaders up to that time, vanquished Bill Hayden and replaced him with a more formidable challenger to the then Australian Government – Bob Hawke. Not that Bill Hayden was any slouch and certainly in his long-term influence he has been much better than Joseph Robinette Biden Jnr.

In November this year, this man who served 35 years as a senator for Delaware will reach his 78th birthday and he is asking America to elect him to serve a period of time, which will see him leave office at 82 years of age, or perhaps at 86 years.

The most disturbing vision of Biden is his rear view – essentially that of an old doddering man. Then turn him around and there is that ever-engaging smile – as if he has a giant axon inside his skull that is connected to all the facial muscles, which make him smile on cue when somebody rings the metaphorical bell.

Biden is a plagiarist, discovery of which aborted his 1988 Presidential campaign. Plagiarism is a mixture of deceit and intellectual laziness – or underlying dumbness. This flaw resurfaced in certain dealings last year.

As I abhor hugging and extravagant shows of affection (one of the only positive outcomes from this virus), it is unfair to criticise his “touchy-feely” approach, unless it degenerates into the “creepy-gropey”.

Nevertheless, one positive sign that he is a good man is how he has handled grief and he has much to grieve about in his life.

Wilmington Railway Station

He seems popular, and although I did not see him on the railway platform of Wilmington, that city is an Afro-American with old patrician heritage veneer – it is this cultural gap that Biden has been able to span his whole professional life. After all, he has spent his life in politics with an early daub of lawyer on his escutcheon.

America is in a mess; no matter when the change is made there is a White House reduced to the political nursery of the Baby Trump, and there will need to be someone very focused to clear out the rattles, the dolls, the bucket and spade, and other geegaws fondled and thrown around in the past four years.

I fear Biden just doesn’t have the ability – no fire, only embers. My earlier comments about him have not changed, and my support for Bloomberg would still hold had it not been for this entry of Obama into the frame.

it struck me this week listening to Obama– is perhaps Biden only the shill? A cleverly-concocted shill for Obama. Maybe there is a residual something behind the Delaware smile.

There has not been a contested convention requiring multiple ballots since Eisenhower won the Republican nomination for President in 1952.

Only one President has served two non-consecutive terms – Grover Cleveland, a New York Democrat who was both the 22nd and 24th president.

Yet Obama may be the next to do so. After all, he is only 59 years of age and even another two terms would make him only 67, much younger than either Trump or Biden.

Will there be a contested Democrat convention? I would doubt it if Obama continues to surge. Biden probably may even nominate him.

Obama’s recent entry into the political debate is that of the man of stealth with disarming ruthlessness, just the needed antidote for Trump. Here was a man at a dinner, the master of the lampoon without any sign that at that same moment he was supervising the killing of Osama Bin Laden.

America is in a crisis, in a way that it has not been since the outbreak of the Civil War. Trump just has no sense of national leadership. His genius has been in dividing and ruling a circle of sycophants and chancers in a building on Pennsylvania Avenue and then darting off to rally to and sustain “his apprentices” – a hate-filled armed militia in the event that he does not get elected democratically.

Trump has a pathological fear of Obama – there is something deep in his twisted psyche, which no amount of ranting can exorcise. There is no doubt that if Obama wins and the Democrats get control of both the House of Representatives and the Senate, there would be no more the mister-nice-guy of his first term of 2008. Obama may very well push through an agenda not that much different from the one promoted by Elizabeth Warren. At the same time, he would be the focused commander in chief commissioned to slay the coronavirus by putting America on a war footing. Bringing order to chaos.

Nevertheless, I would speculate that one significant force who would not like to see Obama contest the election is his wife, Michelle. Why? Because as he exposes and humiliates Trump on the election trail with an increasingly unhinged Trump, then with all the fomented madness in America, Obama would be a prime target for assassination. That is the American way.

But as I have said often, what would I know? But then I cried when Kennedy died.

Just a Footnote – talking of Presidents

Once when a young doctor wanted to become a consultant physician, one pathway led to a year in the pathology department doing post mortems. Just as if one was training to be a surgeon, time in the anatomy department was one tried and tested way to that career.

One Friday morning, the Department boss came to me with his mischievous smile and said that he would like me to undertake an interesting task. The person on the slab had been born with Peutz-Jegher syndrome, which is an inherited disease where part of the syndrome involves multiple polyposis in the bowel. These polyps, usually benign, nevertheless could be very distressing and require multiple operative interventions.

In this case, they had been multiple with resultant adhesions all through the abdomen. The question of my boss when the post-mortem had been requested was to see if this particular person had had an undetected cancer in the large bowel.

It is a somewhat ironic situation that whereas I could do up to three postmortems in a morning then, post mortems even in the large hospitals today are rare. However, they are rampant on current television. Admittedly, there is still a swathe of forensic post mortems, and having been someone who was actively involved undertaking post-mortems it is sometimes hilarious to glimpse the portrayal on television.

When I was presented with this body, it was so scrunched up and distorted, it was hard to determine the age, but I do remember that there were remnant spots on his lips and face, which are part of the syndrome. The eyes were open and even after all the post mortems that I had undertaken, I had an immediate sense of pity – even in death the eyes showed the pain.

One of the ways I coped with post mortems was to put on a metaphorical mask for any emotions as I donned my apron and gown over what are now defined as scrubs (but then called boiler suit) and never take a memory of the post mortem away from the department.

Not in this case; I can still see this person in my mind’s eye. Of all the post mortems I have ever done, he did leave an impact, because he was the epitome of misfortune. Why had he been afflicted so – to live for what?

But you cannot have the luxury of thinking much about the meaning of life when you are doing post-mortems.

However, the task at hand was the congealed mass of intestine – seemingly an amorphous matted lump – and I had to open the bowel from duodenum to rectum without losing continuity in my dissection.

How the hell did he survive for so long? It was laborious work to dissect. The body had been stitched up and removed. All my colleagues had finished their post mortems and left. There I was; left on my own to dissect the bowel.

The complication was that I was supposed to be groomsman at a wedding at 6, and as the day progressed, I began looking at the clock. Eventually I finished, sometime around 5 o’clock. I had found no cancerous growth. However, I had finished and I knew I had done a good job.

I was fortunate that the mortuary attendants were still there and after having a shower, they helped me don my evening dress – white tie and tails which, when you are in a hurry, can be excruciatingly fiddly. An incongruous sight. In a hospital morgue.

Mortuary attendants are a genus of their own – in this case one was a large lump of a man with a funereal voice, who obviously enjoyed the work; the other a smaller man, whom I remember always swore by Cooper’s sheep dip as a great hair restorer. He used it daily. He had a thin wispy comb-over. The two of them were a somewhat quixotic pair.

Dressed, I dashed across the hospital car park and into my car. It was a short drive to the chapel where my friend was being married. I did not have time to see my wife, who on the previous Saturday had given birth to our second son, Marcus. In those days, life post-partum was a more leisurely affair, as Sister Fabian insisted that the mothers needed rest, but of course I could have my evening meal with my wife – just pop across the road after work, doctor.

But tonight was different and when I emerged from the hospital replete in white tie and tails, I remembered it was the day LBJ was coming to town and all the streets around where I was going would be blocked off.

Bugger! However, I was able to take a circuitous route and fortunately found a place to park – at least walking distance from my destination.

I took my umbrella because it was about to rain. There were numerous people along my route down Toorak Road. I really did not notice them as I was walking as fast as I could. I thought of running, but when you are like a stuffed white cockatoo, I thought it unwise.

So concentrated was I that it was not until it hovered directly over me that I looked up and saw the helicopter. Suddenly I felt I was the target. I stopped and waved gingerly. The helicopter crew having seen that it was only a strange young guy in fancy dress with a furled umbrella, rose and left me after a few whirring minutes.

At that moment, the big dark limousine whipped past. There they were – President Johnson with Prime Minister Holt – a brief glimpse of them through a bulletproof window.

Then they too had gone. I reached the chapel before the bride.

Quite a day.

Can I call you Belford?

Two mildly proptosed eyes peer through a crack in the closet door – then the perfumed polished head emerges looking around and then it is out – darting around the space – a twirling gossamer-haired Titania.

Then satisfied that the stable remains groomed, it retreats into the closet, more a cupboard where this remarkable beast has a number of instruments – the microphone, the megaphone, the semaphore flags, a euphonium, even a full set of drums. Here it changes into a different mode – no longer queen but king. And if we had penetrated the closet there would have been a number of jolly mates, who spent more time in the light, but in this cupboard they prove what religion is without devotees.

Belford, I am truly sorry about your departure. Such an ornament of darkness is irreplaceable because such perfection – a rugby coaching Titania, even if Balmain never benefited from your trail of tauric stardust.

However, away with sarcasm and irony; a lamentable trait which is stimulated by the very thought of you, Belford.

What a disheartening performance, Mr Albanese, your obsequies to Belford. Moreover, you are now the inheritor of the Labour tradition-the traditions of Curtain and Chifley.

What would they have said about this creature, who has said the vilest things about Jacinda Ardern and Julia Gillard? They are women. Belford seems to have a deep hatred of the successful woman – none are allowed into his closet wardrobe, no way.

So why on earth would you, Albanese, join Abbott and Howard (and predictably Morrison) in their obsequies? Do you intend joining them in losing your seat at the next election? I just happen to have a vote in your electorate as does my wife – and our friends. After all, you are not too young to remember that even Belford lost the safe Liberal seat of Eastwood at a by-election, never to be pre-selected again.

I believe that Belford has had a breakfast audience of 17 per cent. Perhaps we can ensure you get the same vote in the next Federal election – perhaps a few more per cent.

The electorate just has to find its Zali Steggall – willing to challenge your antediluvian views – the electorate has a bit of time to find someone, Mr Albanese, someone who can continually provide a reminder for your praise of Belford, the misogynist.

And remember, Mr Albanese, Belford was in all probability shafted by the Melbourne establishment. Your potential nemesis, Mr Albanese, is Victorian. I am unsure but perhaps then you would get more than 17 per cent of the caucus vote once your praise of Belford sinks into your colleagues.

The Sutherland Reds and Campsie Green factional mates of yore may have excused this behavior but they are almost extinct – and your hero, Belford is about to fall off the wall – enclosed in his own green bottle.

And as you may realise, although he was a good unionist and a Sydney boy, Ted Grayndler is buried in Melbourne – admittedly not “by”.

Mouse Whisper

A colleague of my mausmeister, Professor Leeder, has suggested that a uniformed public health service should be created here as in the United States. There is some value in this idea as it would make public health much more easily identifiable as part of the emergency response team. While it has blended in so well at present, being a uniformed service would provide both a discipline and continuity. However like all uniformed services there is always the danger of attracting the characters, who prefer vestments and braid to activity.

Nevertheless, my mausmeister thought that the comment below (as reported by The Economist) of a current Prior of a Camaldoli order was very relevant. This order is a Tuscan offshoot of the Benedictines, who have an excellent tradition of teaching yet within the monastery are encouraged to keep their own company, in prayer and reflection – without loquacity.

Still, liberalism has its limits. The liturgy, the scripture, the ritual, the tradition, is the container that holds this life together. You start losing that, it’s a free-for-all.”

Think about it. Wise words. It has a relevance in all sorts of way at the current time, not just to public health, or to a putative uniformed service, and also not only to Christianity.

Benedictine monastery, Tuscany

Modest Expectations – Pike’s Peak or Bust

The Cook / Covid-19 comparison highlights a problem with a cohort of young doctors who go into public health medicine. Generally they are very intelligent, but some, unlike Sue Morey or Nick Coatsworth for example, have lived a professional life in cotton wool. Among them, you get a few smartarses, where the ready availability of Twitter and one more glass of red than should be imbibed leads to a misstep. The higher up the career ladder, the more the misstep becomes obvious. If the misstepper ends up on the ground, the question arises whether the person is mortally injured or will just bear a stigma on his or her professional life.

There are no real excuses for such a puerile tweet, where superficially it may be seen as a clever expression of a belief. However, despite the predictable blustering from the Liberal political cognoscenti pazzi, they should rest assured that the good doctor would have been given a verbal flogging by the Premier.

Yet he would recognise that she is a hard worker in a stressful position, and one who would definitely be against premature opening up Victoria and having to combat the “joy boys”, jocks and the Murdoch publications braying for sport to be reintroduced for solely financial benefits with a slight simpering regard for the community health.

Andrews learnt a lesson at the last minute, pulling back from the Grand Prix. With the potential of a cohort of infected Europeans mingling with the crowd, Australia may well have been plunged into a crisis. It has been bad enough with the antics of the NSW government in regard to the Ruby Princess. I do not underestimate the involvement of this good doctor given the reckless behaviour in the neighbouring State with Victoria not locking its borders against NSW.

Just a word of advice to you Dr Van Diemen, if you want to say what you like publicly, wait until you get to my age, and then it does not matter. You will recover from this glitch and hopefully have a successful career. But ditch Twitter and leave your wisecracks to spaces where the walls are not listening. Everybody in stressful positions needs to sound off occasionally, but go find a few like-minded galahs to share your frustrations. I mean the fluffy grey and pink ones.

A little known encounter of Jimmy Cook

Since everybody is getting into Cook, I thought reviving a relevant part of my novel “Sheep of Erromanga” would enliven the discussion about of the impact of this Yorkshireman on one small island in the South Seas. The story centres around a young Australian called Philip Morey who spent two years on the then New Hebrides island of Erromanga in the1930s, and this describes the end of a trek across the island.

At last, Philip had emerged from the dark jungle through the line of giant tamanu trees. Through the foliage he was met with a vista of huts along the water’s edge. To his left, the dancing silvery shards of the river Ounpontdi made him stop. 

So this was Potnarvin, lying under the lee of a mountain called Traitor’s Head. He shaded his eyes as he looked upwards. The mountain appeared to rise to what he estimated to be about 3000 feet. Its height was hard to gauge as clouds obscured the peak. As Philip was to find out over the three days of his stay, Traitor’s Head was almost perpetually covered in cloud. The clouds concealed the fact that Traitor’s Head was a volcano. It had not erupted for nearly two hundred years, but had done so twenty-five years after Captain Cook had been there on an exploratory voyage. 

The mountain had received its name from Cook who, on landing on the beach, wondered why such apparently friendly people were armed to the teeth. One of Cook’s muskets had misfired and the friendliness had vanished in an instant. A battle had followed and, before Cook was able to get back to the ship, one of his sailors had been mortally wounded and at least two of the Erromangans lay dead. Philip thought the “Traitor” was an odd choice by Cook, given that he had a meticulous way of naming his discoveries. The Captain was probably just annoyed. “Traitor” did not seem to be the right word, although the incident was certainly prescient of Cook’s future.

The villagers, unlike their ancestors, had welcomed Philip. They seemed to appreciate the quiet tall young white man, who came out onto the beach stopping to look around and unbuckle his rucksack.

Cook’s response was predictable – confrontation with bloodshed. At the time of Cook’s visit, the Erromangans were cannibals, with a strict etiquette concerning where the white man could move around on the beaches where they landed. These rules were transgressed as they were later with the arrival of Presbyterian missionaries. When they crossed this line they were killed. In addition the natives developed quite a taste for Scottish missionaries – haggis?

Purchase a copy of The Sheep of Erromanga! Email enquiry to: SheepofErromanga@gmail.com

The recidivist Carnival

On February 27 this year, a cheery ABC reporter noted:

… the effects of swine flu in the grip of the 2009 pandemic was confronting. This disease affected people who don’t often get the flu, afflicting young adults whose previously healthy lungs became white and cloudy with pneumonia. While most recovered, many did not. By the end of 2009, more than 37,000 Australians had been diagnosed with swine flu. 

More than 190 people were dead. 

Worldwide, the US Centres for Disease Control estimate swine flu killed as many as 575,000 people. Eighty per cent of them were under 65. 

Let’s contrast the swine flu epidemic with the spread of the novel coronavirus — or COVID-19 as it is now known.

The new virus is sweeping through parts of China and infecting small numbers all over the world…

I will not detail some of the learned academic predictions that were criticising our draconian measures e.g. close our borders to China. Their expert advice was just wrong.

Now just what was being reported in the media in the autumn of 2009?

As suspected swine flu cases in the Hunter New England health area jumped to 72 yesterday, a Hunter family quarantined at home after a cruise on virus ship Pacific Dawn slammed the handling of the outbreak. 

The Exxxxxxo family of Thornton was ordered into quarantine on Tuesday, a day after they arrived home from a 10-day cruise on the Pacific Dawn, and only after Mrs Chris Exxxxxxo contacted health authorities.

“There were 2000 or so passengers wandering around who had no idea that they should be avoiding contact with other people.” Mrs Exxxxxxo contacted NSW Health who confirmed the family should be quarantined and was later contacted by P&O Cruises.

As the flu emergency escalates, the Federal Government has ordered enough doses of swine flu vaccine for 10 million Australians. The Exxxxxxo family has spent the past week in lockdown in their home and will not be allowed out until they receive the all-clear on Sunday… 

…When the Pacific Dawn cruise ship docks in Brisbane today, after cutting short its cruise because of the flu threat, the Queensland Government will invoke tough quarantine powers to stop interstate passengers disembarking. Three crew members have tested positive to the virus, but have recovered with treatment. Five passengers await test results. Health officials will screen the ship’s 2000 passengers and 700 crew. Only Queensland residents will be allowed to disembark and will be asked to quarantine themselves for seven days.    

“We are being extremely cautious in our testing arrangements for anybody who presents themselves with flu-like symptoms” Carnival Australia chief executive Ann Sherry said.

Of course, that is what you would say, Ms Sherry, with your winning smile. It is however understood that people with swine flu contracted on Carnival ships may not have agreed.

And then about the same time there was another media release…

Minister for Health, John Della Bosca, today announced NSW would upgrade its Swine Flu protocols for cruise liners who arrived in NSW waters. 

The NSW approach to arriving cruise ships has been developed in consultation with the Commonwealth. 

“When the Pacific Dawn arrived this week, its passengers had not been to any jurisdiction where Swine Flu was present and it was considered unlikely the virus was on the ship,” Mr Della Bosca said. 

“The two children from the Pacific Dawn who have since tested positive for Swine Flu had not travelled overseas before boarding the ship, had no contact with affected countries, and were not considered to be at risk. 

“An additional 16 people from the ship have since been confirmed to have Swine Flu. Six of these people are currently in Queensland. 

“These people have been assessed by public health staff and placed into isolation. 

“Further public health assessment of contacts of these passengers is now underway.”

Similar pattern. Let them all off the boat – she’ll be “jake”. The NSW Chief Health Officer then – the incomparable Kerry Chant.

Unlike COVID-19, a vaccine was rapidly developed for swine flu, (the existing influenza vaccine was partially effective) which then helped contain the viral spread. Nevertheless, on a population basis Australia had the third highest number of cases worldwide. The virus affected the elderly, young children and pregnant women particularly, and spread so rapidly that contact tracing was well nigh impossible. Fortunately, it was not as deadly as initially believed, unlike COVID-19.

In the case of Victoria, it was bought there by a well-to-do Australian family returning from the USA by air. Their children spread it in the two well-known private schools they attended and the spread was accelerated by a “social” dance. Later, its spread was tracked along certain tramlines passing through Bolli-wood a.k.a. Toorak.

It is interesting that although it was first berthed in Victoria, the cruise ship made sure it spread the virus to NSW where the normal laissez-faire attitude (see Chant) predominated. However, in Queensland the Pacific Dawn was refused permission to berth, and the following may be apocryphal but nevertheless it is a good story. A highly-placed Queensland official threatened to order gunboats, a.k.a. whatever Dutton inherited, into the Brisbane River to make sure it did not happen – bit of a wimp the current Premier – only closing the borders.

The Office – viruses thrive on randomness

Some time ago, as I reported previously, well before the COVID-19 outbreak, I was sitting in the foyer of the Alfred Hospital in Melbourne where there was a hand sanitiser predominantly displayed. Virtually everybody entering and leaving the hospital ignored the instructions to clean their hands.

Last week I was waiting in the foyer of Cabrini Hospital in Malvern and next to where I was sitting, near the hospital exit, there was a hand sanitiser. Despite the hospital foyer having all the trappings of virus prevention, this sanitiser was mostly ignored. Yet on the other side of the foyer not five metres away all the preventative measures were in place – maintaining a safe distance in defined queues, temperature and verbal screening, hand sanitiser use being required.

The difference – one side of the foyer was supervised; on the other, no supervision.

The problem with any loosening of the COVID-19 chains is that the new concepts of hygiene are yet to be embedded in the nation. As I have said, the standard of public toilets gives a clue as to how seriously hygiene has been embraced by this country. Driving between the two capital cities this past week for medical appointments, I observed that the toilets along the Hume Highway are just as bad or as average as they have always been. There has been no change except toilet paper has disappeared for various reasons from some of the dispensers.

Having issued this caveat, there is no doubt the underlying strength of the Australian health system has been shown even given some of the dills, often influential, who have tried to disrupt the public health protocols, because that is what they are – dills with a deep-seated sense of entitlement and self-importance – the essence of “Do you know who I am?”

As I wrote last week, there is a good case for the re-opening of schools, and paradoxically Premier Andrews being so hardline means that the other politicians have to be more measured.

Viruses love disorder

The more that you contain the natural community Brownian movement into more laminar flow then the more order you bring to contain the enemy. However, at the same time it must be recognised that open plan and activity-based work spaces designed 20 years ago to maximise the number of occupants were also designed to maximise “random” contact between staff members who were moving around in the workspace. The post-COVID-19 office has to contend with minimising disorder while dealing with now-outdated office planning that maximised apparent randomness.

While the concept of working from home has seemed to solve the problem of halting the viral spread, the evidence of long term efficacy of working from home is mixed. Some may praise its “flexibility” and claim that efficiency has improved, while others use the word “chaos”.

In my mind’s eye I have a hospital operating theatre. Here people are gathered together for hours on end to perform operations and in so doing assuring the patient does not acquire an infection attributable to the operation. The air conditioning must be maintained at such a standard that the air circulating is pure enough for the most complex operation – such as a joint replacement – to be undertaken with the least risk.

In the end, the assumption must be that the post-virus office must be big enough to provide sufficient space for people to congregate while maintaining a certain distance from one another without shouting. Street clothing does not seem to be a major factor in viral spread, but the operating theatre staff do not go into an operating theatre in their street clothes as the nineteenth century surgeons did. They change into their green or blue scrubs, their head covered and mask at hand. And at the operation a further gowning with all the appropriate obedience to the rules takes place, and this ritual is repeated for each patient.

Professor Lindsay Grayson

Professor Lindsay Grayson, the Australian doyen of hand hygiene succinctly summarised the national hand hygiene study after eight years observation in 2017 – The National Hand Hygiene Initiative (NHH) has been associated with significant sustained improvement in hand hygiene compliance and a decline in the incidence of staphylococcus aureus bacteremia (HA-SAB). Key features include sustained central coordination of a standardised approach and incorporation into hospital accreditation standards. The NHHI could be emulated in other national culture-change programmes.”

The challenge to community cleanliness is to accept the challenge for its offices as set down by Professor Grayson.

The new office order

The elements of the new order now are being tested everywhere, have they penetrated into every individual’s brain … at least not yet.

The elements include:

  • Social distancing and limiting the time spent in face-to-fact contact or in a closed space with others
  • Lift etiquette and disinfecting
  • Masks (understanding how and when they should be worn and by whom)
  • Air conditioning
  • Hand hygiene and not touching the face
  • Temperature checks
  • Responsibility for the regular cleaning of one’s designated work area, including equipment such as computer keyboards and phones
  • Regular cleaning of the office, reception, kitchen areas and the toilets
  • Quarantining anybody who shows the slightest sign of a respiratory infection
  • Viral testing
  • Being able to plug into a internal form of contact tracing to identify if employees are not generally within their designated areas (that is, for the purposes of maximum numbers to ensure social distancing)
  • Food outlets
  • Making provision for workers who are at a higher risk

This is part of the equation – the other major element is how to get employees to and from work safely when public transport is designed around maximising the number of passengers and when work hours are not staggered, but that is a future blog.

One of the theoretical advantages has been the advance in communication over the past decade. This has meant that isolated people can see one another – good reliable images of the people. How far that improvement in this distant communication can supplant actual face-to-face contact will give researchers a great deal of time to seek answers. Online meeting platforms will be an essential part of the response to this pandemic.

It is up to those who head the large firms to enforce social distancing – not sitting huge distances away, although appropriate spacing of work areas will be important, but being careful of exchanges – the hand shake, the hug, the kiss on the cheek, borrowing somebody’s pen. It is these social gestures, essentially random, upon which the virus thrives.

There must be an etiquette in the use of lifts, as is occurring in hospitals already, with the maximum number of people prominently displayed. Again this demands discipline.

The meeting room should contain a round table of appropriate size, and the air conditioning should be such that a joint replacement could be performed on the table with little chance of airborne infection. Time spent in closed meeting rooms should be minimised.

This leads to the discussion about planning an office to be open plan or not. As the NYT reported this week: “Some companies have begun mentioning a return to one of history’s more derided office-design concepts: the cubicle. There is talk also of the cubicle’s see-through cousin, known as the sneeze guard.

“Cough and Sneeze Protection Screens,” is how they are being marketed…

Earlier in the article “Soon, there may be a new must-have perk: the sneeze guard. This plexiglass barrier that can be mounted on a desk is one of many ideas being mulled by employers as they contemplate a return to the workplace after coronavirus lockdowns. Their post-pandemic makeovers may include hand sanitizers built into desks that are positioned at 90-degree angles or that are enclosed by translucent plastic partitions; air filters that push air down and not up; outdoor gathering space to allow collaboration without viral transmission; and windows that actually open, for freer air flow. 

All very good, and some of these changes are evident in our hospitals and retail outlets, but it is imperative that offices have a structure to ensure that all the changes are effected. In other words there is a team of enforcers, from the time the person enters the office area initially to use the hand sanitiser to the odd time he or she may use the toilet. You see that sign in the aeroplane toilets to respect the next user by cleaning up after yourself. One can believe that some who use the toilet are blind. After a few hours in the air the said toilet can become unclean because of lax enforcement. The new office will ensure that cleanliness is maintained

Then there is consideration of the material that you use to outfit the office anew. In a NEJM article and combined with another source, it was shown that the virus persisted up to four hours on copper, eight hours on aluminum, 24 hours on cardboard and two to three days on plastic and stainless steel. Elsewhere it has been shown that on glass or wood surfaces, the virus will remain present for up to 4 days.

Reassuringly it has been shown that Covid-19 can be eradicated within one minute by disinfecting surfaces with alcohol, 0.5% hydrogen peroxide, or bleach containing 0.1% sodium hypochlorite.

Watching the thermographic camera in operation while I waited at Cabrini Hospital was an impressive demonstration of its capability, and the question is the number needed and their positioning. Having temperature taken manually is probably more consuming of staff time. Nevertheless the receptionist or however he or she is described must be someone who understands the basic requirements of public health, and it should not be too difficult to arrange an instruction in this. After all, the responsibility extends to ensuring clean toilets, that there is form of “contact tracing” of anybody in the building, with the current chunky badges of identification need to be reviewed.

One of the other matters which follows is how food and drink is dispensed. Bringing your own coffee cup and lunch is an obvious solution. Trialing take-away has been happening in the community, and therefore how the workers obtain their coffee and lunch needs to be mapped. When food and drink is raised, then the spectre of alcohol is also raised. I have some doubt that those affected by drink respect social distance. Then what does the office do with those who smoke, coffee in hand outside the building. As I walked around the outskirts of the Royal Melbourne Hospital last week, even there were numerous staff members in their scrubs outside smoking in corners away from the elements.

Thus in the end someone in the office must be the arbiter deciding who needs to be tested or sent home. There is a certain unrealistic optimism about a vaccine, and clearly the anti-viral drugs do not work on coronavirus. If they did, the cure for the common cold would have been had long ago. As for hydroxychloroquine … be careful Palmer, what is your pitch when the first person dies using that drug rather than killing the virus – go green rather yellow?

Those in business must take a pessimistic view and not believe the vaccine is just around the corner. However, in equal measure they must take an optimist view that careful planning and implementation of a rearranged COVID-19 office space will support both the reopening of business in 2020, but also recognise this will be the “new norm” for the foreseeable future.

As for masks, they may be obligatory in the operating theatres where the operating team are kitted up with sterile gowns and gloves, however in the community I have this image of the Italian smoking, his mask limp around his chin. Masks are ideal to irritate, to touch – as are gloves when the gloved hands are moving from one potentially infected surface to another. Masks thus can be a definition of false security as are latex gloves – only as clean as the last touch.

In the end, the broader community has to come to an understanding of what is needed to provide a safe working environment because the changes that are needed cannot be achieved without everyone giving up some personal “freedoms”. At the same time reliance on pre-COVID-19 legislation to direct the ways things were done won’t cut it any more. Governments have to review all their relevant legislation to make sure they don’t allow sloppy hygiene to continue.

This is whither I have arrived – a personal exercise calling on what seems to be a reasonable allotment of information in turn to provide a reasonable allotment of advice.

Mouse Whisper

I was self-isolating outside my mousehole when I looked up at my mausmeister’s television and saw a man called Nev who turned up on the screen. He seems to reflect this economic imperative, which is taking over from the lingering pandemic, as his mates are getting restless. Doctors should stick to the hospitals was the secondary unvoiced agenda.

Pardon my meek mousiness by addressing you as Nev. I thought I heard it correctly that you said there will not be another pandemic – you will make sure it does not happen again? (see above). Hope the viruses are listening.

You know Nev, you, the bloke who maybe can’t see the trees for the Forrest.

Danse Macabre

Modest expectations – Tom Waits

From the Carnival playbook as reported by The Washington Post:

More than 20 passengers were still too ill to leave the ship (Coral Princess), along with 38 crew.

Of the 1,020 passengers on board, about 993 were expected to be declared fit to fly, he said. They will be taken by bus straight to Miami International Airport, where most will avoid terminals and take charter flights. A minority of the passengers, he said, would take commercial flights; those passengers would be brought to a terminal that is not being used until they board.

As with the above Washington Post report, it is now 4 April and the number of COVID-19 cases has just reached 5,548 in Australia. If it had not been for the cruise ships, it would be considerably less than 5,000, and fortunately not the 10,000 Dr Greg Kelly and his fellow petitioners prophesised for 4 April.

Fortunately, at the centre of this activity federally we have a cohort of knowledgeable, calm public health specialists that you need in a crisis and obviously they are not going to release the models if the assumptions are wrong. The world is not a TV reality show. It is a planet at war. Therefore getting the strategy right is everything.

The Carnival is over?

As the Ruby Princess saga grows, my recommendation to sack Dr Chant appears mild now that all of the NSW Government seems to be in a state of self-preservation or that of hazard reduction. It was so obvious from the start that people being hurried off the boat meant something was afoot. Only too true – 10 per cent of the positive cases in Australia and 11 deaths as of 6 April.

However, the media were dozing – but not now. The Australian Financial Review at last discovered the media demure Ann Sherry. The Australian is calling for governmental scalps.

Now three weeks later, it is the NSW Government trying to weasel out of its responsibility. Carnival is the culprit shipping line that has the dubious honour of having two firms in Miami that specialise in launching legal actions against it – that includes all the shipping lines owned by the Miami-based Arison family. Mr Sture Myrnell is their local head and has sparingly fronted the media. Mr Myrnell, born in Bergen, was once the sommelier on the QE2 and although he has been promoted to dizzying heights, he has probably not lost his taste for a good sherry.

Which reminds me.

Now Ann Sherry was replaced by Mr Myrnell as CEO in 2018, but is still the Executive Chair and it was pointed out that she was responsible for external relations – aka lobbying.

Once Ms Sherry was not afraid to front the media. In an interview, she made the point that thinking big was crucial. She was quoted as saying in this 2018 interview:

I think it’s important not to lose touch with what’s happening in your organisation. One of the great challenges of leadership is that you’re busy and there’s a million things people demand from your time. So, it’s easy not to know what’s happening on the frontline of your business, and just let people tell you. My view, though, is that it’s better to find things out yourself rather than rely on layers of organisational filtering to tell you what’s going on. I think this is especially important in a customer-centric business. It’s crucial to be visible and to communicate to people on the frontline that you understand how important their jobs are.”

After all the above interview started with the following “Coming off a high-profile, extremely successful tenure as CEO of Westpac New Zealand…”

The report in the NZ Herald 5 December 2008 begged to differ somewhat:

Sherry was chief executive for four-and-a-half years and resigned from Westpac after she was moved sideways to head up the group’s Pacific banking division on the back of poor performance from the New Zealand division.

She earned more than $3 million per year in the position.

Maybe the word was not “profile” but “profitable” – and an interesting definition of “extremely successful”.

The situation is serious – very serious – not just because of the number of additional COVID-19 cases and deaths directly attributable to the Ruby Princess, but because the NSW Government somehow lost control of its public health measures during a worldwide pandemic when cruise ships had been identified as one of the most effective vectors for the virus. That is unforgivable.  

Therefore every link in the communication chain needs to be examined. I believe that Ms Sherry’s role as Executive Chair, irrespective of her belated attempt to escape the title, in influencing the decision-making process now and over the time of her stewardship should be critically examined as part of this review.

Now that there is a full police enquiry underway, in the end there may be the prospect of criminal charges. This review must be comprehensive and nobody should be shielded; equally, innuendo should be confirmed as fact or any particular person exonerated.

And finally Prime Minister this cruise ship behaviour has not been an isolated example to flick away. It has been happening for years.

Hibernation

I have been chipped for not looking forward to predict what we might look like after the virus has passed.

My predictions on the future are based on the proposition that there will no vaccine against this virus in the near future. The second is that immunity to COVID-19 is not life long. In other words, one infection will not guarantee that the individual will not be susceptible to other attacks. The same applies to a vaccine; some common colds are due to coronavirus and come back in a different form year after year. There is no vaccine that works.

The problem with the hibernation analogy is that the animal sleeps through its time of food deprivation. Its life is about foraging for food to be converted, and here the brown fat accumulation is an important factor up over many generations – not an immediate fix, but one essential to sustain the slumbering animal.

However, when the bear emerges from hibernation, the external factors have been at work providing the bear with sustenance from the very time it comes out of its den. The hibernation cycle does not factor in a continuing winter because spring always comes.

When the government uses hibernation as a metaphor it should realise hibernation it is not a one-off aberration of nature. It is not for everyone. However for some creatures, it occurs year in year out – the word itself is derived from the Latin word for wintry – hiemalis. Thus Prime Minister, you are not the head bear, although many of your sloth of bears may be somewhat grizzly.

Australia must emerge into a new world, which prizes personal and public hygiene. It is a world where everyone including the police force carries hand sanitisers. It is a world where coughing without shielding your mouth becomes as unacceptable as spitting. Every restaurant has pepper, salt and sanitiser on the table, and before food is served the patrons are politely asked whether they have used sanitiser.

At home as I was in the days before antibiotics lulled the community into a false sense of security, children always washed their hands before a meal – but then we said grace. As we grew up, with the advent of the fast food industry with the disposable society, washing hands before meals then lapsed.

Meanwhile, hygiene in hospital has improved immensely, and that is largely because it has been recognised that washing one’s hands between examining each patient is essential. It was a simple manoeuvre as was the abandoning of wearing ties and the improvement of the attire of staff – particularly those archaic nursing outfits. It is now as different a world as the time when surgeons operated in their frock coats in the nineteenth century and more recently when I was a junior doctor, when the anaesthetist’s monocle fell into the sterile neurosurgical site. Why, because this particular gentleman was peering over the neurosurgeon’s shoulder. Bad form old boy.

It is time to transfer these hospital lessons to the community. One measure of this is the standard of public toilets. As I have written before about how these are diminished in number in the major city centres. However, the technology is evident to establish a clean safe environment in those facilities.

Thus, when the virus passes for the moment Australia needs investment in hygiene – in public health – so that it is the aim to generally reach hospital grade level. In so doing this should evoke a cultural change in this country where nobody is exempt – and that means settlements like Utopia or Soapy Bore, Toorak or Byron Bay – yes you! Not singling you out, just reminding everybody that we are a nation with mutual obligation – it applies equally to you as it does to the smallest outstation.

One Labor Minister in Whitlam’s government once made the astounding observation “Australia is an island surrounded by water.”

The Terra Australis face that was turned towards the original adventurers and buccaneers was very unappealing and they left and those who were shipwrecked died in the harsh climate or were absorbed into the local aboriginal people.

Then our border control need be mindful of the unseen, not spend time hounding the vulnerable and looking in the mirror of this nation and seeing Pauline Hanson.

However the underlying premise is that the Federal government should take the original power allotted in the original Australian constitution – that of quarantine and thus assume national control of public health.

Australia has emphasised biosecurity in relation to fauna and flora, which has been moderately successful, but in terms of spread of human disease less well.

After this last episode it is not the poor unfortunates awash in the Timor Sea, but cruise ships with their crowded cabins and archaic air conditioning. Huge floating cesspools no longer should be allowed to berth in Australian ports. It is an industry that needs urgent review. As one correspondent has written:

Long ignored by cruise lines seeking to sell older tonnage are air conditioning and plumbing issues.

Ships built after 2000 are suspected of having air conditioning and plumbing and sewerage problems, some of which problems are major. 

The older ships will not survive nor are resaleable as they’ll be seen as potential health problems. Why? Breathing the same recycled air in every cabin or room will no longer be acceptable to paying passengers.  

The cruise industry must be re-evaluated, and Carnival and all its affiliates banned indefinitely – or should it be said that any ship owned by the Arison family. In other words, nobody begrudges a well-run shipping line, one that does not evade taxes, does not fly flags of convenience, does not use underpaid staff – and if the arcane Maritime Law needs to be repurposed for Australian conditions let the government assure that is so.

The other major area of potential infection and violation of the borders are the airlines. However, biosecurity in relation to plane passengers has always been lax – handing out pieces of paper is no substitute for targeted testing.

The question must arise as to the level of hygiene on planes where people are packed together and the air conditioning is dodgy at best. Should the passengers be handed sanitiser along with bottles of water; should passengers be handed out masks at the same time as headsets.

Once the country had quarantine stations; once Australians going overseas carried yellow books to assure that we had been inoculated (or vaccinated in the case of small pox) against typhoid and cholera and, if we were going to endemic areas, yellow fever. Until this pandemic, only the latter has survived as mandatory. However, given there is no vaccine for COVID-19 then having a yellow booklet does not apply except for yellow fever.

However, there are past measures that worked, but reminding the passengers of basic hygiene becomes as important in the training of cabin staff as being able to serve meals. Toilets on planes are a potential source of infection given how poorly the hygiene is policed and on long flights used to change into sleep wear.

However, it is also air conditioning that needs to be assured at “hospital grade”, not continually recycling stale air but providing clean air at all times. As one source with more knowledge in the air ambulance sector where there is liable to be more exposure to infection has written … It has not yet been disproven that exhaled droplets are not aerosolised by the cabin conditioned air flow, and some planes may not recycle enough air to effectively dilute aerosol pathogens, or they don’t pass recycled air through HEPA (high efficiency particulate air) filters.

Therefore, the future Australia as it emerges must have a different approach to hygiene. Once this is assured then it must have a continuing impact on the economy, and not be forgotten by government with a strangled budget.

The Long White Shroud

In this time of COVID-19 crisis, a farce is being played out within the Royal Australasian College of Physicians. Once a prestigious body responsible for overseeing the qualifications and hence the quality of consultant physicians and paediatricians it is rapidly becoming the Ruby Princess of the medical profession.

The Royal Australasian College of Physicians (RACP) was founded in 1936 as the Australian College aping its British counterpart, because our medical traditions have always been linked to the Old Country, fob watch and chain. Two years later, the New Zealanders accepted the invitation to join. Between that time and 2010 there had been only three Presidents from New Zealand.

Then Dr John Kolbe emerged. A respiratory specialist at Auckland Hospital, his wife a prominent surgeon who had been President of the counterpart surgical Australasian College and one who has publicly listed herself as a consultant for Siggins and Miller, a consultant firm based in Brisbane which is entangled in the current college mess. This is a slightly complicated situation since one of the principals of which, Ian Siggins died two years ago, but Mel Miller is still lurking around. Her role and ongoing involvement, if any, is for others to investigate further.

And indirectly, another Queensland connection lingers around as the Commissioner of the Australian Charities and Not-for-Profit Commission (ACNC) which is the middle of this imbroglio has as its Commissioner, Garry Johns, a former Labor member for the Brisbane seat of Petrie but now a darling of the right. He has been, as reported, experiencing his own internal problems within the Commission. His original appointment in 2017 was described as bizarre by certain of those familiar with the charities field, especially in regard to statements ascribed to him about indigenous people.

Following Kolbe there has been another New Zealander, currently the incumbent, Mark Lane. Two of three aspirants in the current election for President-elect are New Zealanders. There is thus this select pack of All Blacks. There were three New Zealand Presidents over 72 years; now the prospect of three within 15 years. It suggests that there is now enough confidence among the New Zealand physicians to form their own College; never tell a New Zealander that they should be a State of Australia. Let us guarantee a fond farewell.

The next problem is that with time, the active elements of the consultant physician workforce have formed their own specific societies based on subspecialist skills and technology.

Some of them drifted completely away and formed their own collegiate enclaves, such as the psychiatrists and dermatologists. At the same time, the paediatricians, whose governing body had been separate although existing under the same certification, rejoined the College.  Faculties were created in public health, occupational and rehabilitation medicine, and the consultant physician element in the college was further diluted by the creation of College Chapters.

While this dilution effect was progressing, the College undertook a review of the “collegiate relationship” with the then “specialty societies of the RACP”; the upshot has been that the relationship was effectively severed. The societies were relegated to distant cousin status, while at the same time the College took all their existing curricula as part of upgrading its own responses to AMC requirements. The specialty societies were left delivering training within an increasingly bureaucratic and unresponsive college structure that, in the view of the societies, was unwilling to provide resources to those societies for their contribution.

If it were not for the fact that the letters FRACP certify their members a meal ticket, many sub-specialties would have broken away, but government unwittingly, through regulation and connivance, have allowed this monopoly to continue. Therefore the College, irrespective of its current intrinsic hollowness, has been allowed to continue in its current unchallenged form.

Over the past 20 years since the time that the ill-starred late Craig Paterson was appointed the CEO the internal troubles have grown. However concurrently the level of farce has grown, fuelled by the presence of another New Zealander and would be physician rangatira, Dr John O’Donnell.

I was once on the Council of the College in a saner time when its impact on the community, apart from being a certification mill, was evident. However, what has stirred me to write this was a ridiculous set of propositions put to an extraordinary general meeting (EGM) held fittingly in New Zealand in 2019. The intent of the propositions was to create a select group to be known as “respected Fellows” whose role was to create a quasi-theocratic model superseding the current College democratic elections.  One young female college Fellow asked whether passage of these motions meant that all other Fellows would not be respected. Enough said. This takeover attempt by a small cabal was soundly defeated.

But now they are at it again. Presumably the same crowd with the same would-be rangatira is leading this pack of All Blacks. They want to convene an EGM at a time when this country and New Zealand are locked down in crisis. There is no valid reason given for this action, but apparently they have the numbers to pursue this self-serving, totally unnecessary course of action.

Perhaps it is linked to a document produced by a Brisbane-based firm Effective Governance. Their review purported to describe what is wrong with the College, but the endless list of recommendations revive some of the very problems identified in 2019 – e.g. a nominations committee to select Board candidates to ensure they have the “right set of skills” for the Board and essentially to remove the concept of popular election by Fellows of candidates who don’t necessarily have such skills. At the same time the proposed number of Board members is 6-8; that, combined with the “required skill sets” will make it increasingly difficult for a College Fellow to be elected to this Board. Is this what the College Fellows really want? On reading the document I raise the question of whether the report should have been consigned to the garbage can long ago, and incidentally what did this Review cost?

If I were a conspiracy theorist, I would be asking how much of this advice on governance over the years has emanated from a limited number of sources in Queensland. What of the direct Kolbe connection to Siggins Miller?

And why are certain people so seemingly keen to cover up about those who have requisitioned the EGM? And as for this EGM, especially at such a perilous time with COVID-19 and both countries effectively isolated, why are the usual suspects pushing such a destructive line?

However, I am not such a theorist, but I do like Kolbe to Bolitho to Talley to Yelland to Lane – what a sparkling daisy chain of “respected fellows. Once they were Presidents, and now…?

Last year I wrote to the RACP President, the New Zealander Dr Lane, asking for the release of the list of signatories to the 2019 EGM request. His dismissive reply relies more on legal smartness rather than common sense. Why was the list of signatories withheld? What did Dr Lane, as the President of the College, want to hide – a preponderance of NZ signatories?

The problem presented by this year’s EGM is that it ultimately will become an exercise in unexpected consequences, which may lead to a totally new organisation to guide the training and ongoing guidance of consultant physicians and paediatricians.

Maybe it is about time for consultant physicians to dispense with the current structure altogether with its over-regulation and expensive payments to a band of rent-seekers.

Maybe it is the right time to let the New Zealanders go and we revert to a purely Australian college. Our health systems are so different, our training is different; we may speak the same language but our cultures separate. Yes it is a good time to flag – once we are on the other side of the current health crisis – that we need a debate about this College of ours being purely Australian; after all, such a proposition is based on a purely utilitarian approach. It is totally ridiculous that this College could be run by a NZ rump.

And further, what about a breakaway College prepared to look after the interests of Australian consultant physicians and paediatricians, and not be burdened by the vestments of yesterday?

And as a footnote, almost as an afterthought, does having New Zealand Fellows compromise the charity status of the College in Australia. I cannot see the College’s New Zealand element being ascribed charity status in its own country. Just asking for clarification. Nothing more.

But first, in the interests of decency, those behind the resolution should withdraw their request for an EGM immediately. Otherwise every politician in Australia will know about this unnecessary distraction in this time of coronavirus. 

Mouse Whisper 

From a riverine relative, I am indebted for the following

Hydroxychloroquine costs around USD90 per 50x200mg tablets in the US for those who have insurance, or USD650 for those who don’t.

By contrast 100x200mg tablets cost AUD16.50 on a private script in Australia – a 40-fold difference before taking account of currency differences.

Make America Rich Again!!!

Modest expectations – Carthaginian Vanilla

How appalling is Mr Albanese suggesting that the Parliament adjourn for a whole day as a part of respect and condolences admixed with confected piety.

All that does is delay what he then said is vital – that is, the passage of urgent legislation.

Otherwise such a gesture is symbolic of Parliament – hypocrisy and inaction.

By all means apologise that you did nothing about preventing the bushfires but spare us the crocodile tears – and get on with the business of government. In fact you should be meeting earlier.

And incidentally get away from this Albo and Scomo nonsense. It sounds as if they are clowns.

No caption required

Fell or Fall

I have written about clearing the trees around the house surrounded by bush. That’s fine if your land does not abut land where the owners can’t be found. The chap who cleared parts of the block and the boundaries asked Council about the absent owner. The Council were not particularly interested; so we went ahead and took down the trees on the boundary and in so doing, cleared the scrub from a large section of the block. This was last year. There were several trees that required a specialist arborist to fell them safely so that they did not fall on the house – a possibility if you do not have the specialist knowledge. In addition the insurance companies take a dim view of those who are literally “cutting corners”.

Even with gutter guard to prevent the accumulation of leaves in the gutters, these trees were a fire risk. We have a celery pine growing close to the back door. That was spared but pruned, as was the leatherwood, so essential for the bees to make honey with its distinctive flavour.

The detritus of forest clearing

However the mass of fallen trees if left present a problem. It was bought to mind by the allegation that the NSW Forestry Corporation leaves what is called “slash” after they have cut down trees. This outcome should be remembered anytime the foresters say we need “to thin the trees”. As you drive through areas which have recently been harvested, there is always a lot of residual wood left in the cleared coup. Around settlements, some trees when they are cleared by Councils are wood chipped, but these wood chipping enterprises seem to be carried out alongside roads where bringing in the appropriate machinery requires clear access.

But back to our block – left with a large pile of wood, there were several ways to go. We could have a controlled burn – a “pile fire” – with the local volunteer fire brigade using it as a training exercise. That proved not to be feasible. The pile of wood was on the absent landowner’s property. Then there was the problem that there was never suitable weather for such a burn to be organised safely, or so the local fire chief said.

In the end, we had the pile of wood removed, some of it would be used as firewood as many of the houses still have open fireplaces, but the rest moved to garden waste – still flammable but away from the property.

There is still a way to go, but bushfire prevention needs a concerted approach if the community is not to end in charred regrets.

Next to our property is a deserted miners cottage, which was illegally moved on site many years ago. It had been lived in, but now the empty land is covered in blackberries. Blackberries have also threaded their way along the foreshore and there has been no attempt to remove the bushes; the trees have been allowed to increase in number, because some eucalypts and melaleucas proliferate at a great rate. There is now a thick line of bush between the foreshore and the heritage footpath – so much so that visitors walk on the road at night because the footpath is too dark. The only clear line of sight to the harbour along this foreshore is in front of the former mayor’s property.

In the end in this over-governed country, we the ratepayers depend on the competency of local government and its finances are dependent on the ratepayers and the amount of money that trickles down from the State and Federal governments. So, can I ask what is being done about those people who buy a bush block and then do nothing to clear vegetation?

In our case on each side that is the situation. We have taken unilateral action, as we prefer prevention to “re-embering” a once pristine countryside.

Tasmania is here to burn. This is a serial problem, a new ABC soapie called “Burnt Hills”?

Postscript

I bought my wife a chainsaw for her birthday. No, we shall not destroy the habitat of the New Holland Honeyeaters or the wrens, who of course love a pile of rotting timber as a habitat. Then perched in the trees are the yellow-tailed black cockatoos. Green rosellas come calling once in a while – they are particularly fond of stripping fern fronds. There is still plenty of bush, but as the local fire captain said, keep it at least 30 metres back from your house. Enter the chain saw.

However, there are still those melaleucas, which are constantly sprouting. We cut them down. What next? The wood has few commercial usages, beyond a brush fence which was constructed years ago when the Council accidentally cleared a piece of our property and we needed a temporary fence while the undergrowth grew back.

Here on the west coast of Tasmania I thought we would be free of the bushfire smoke. However silly me – the population and wildlife of the West Coast are enshrouded in smoke. I worry that my grandchildren will show photographs of what their grandchildren will never have seen as they splutter with their chronic respiratory disease – blue skies.

A small question

One of the intriguing facts of the recent bush fires, which came to light in the fire started in Ebor, a self-styled village in the northern tablelands of NSW, is the impact of illicit crops. Here some guy tried to “back burn” to save his marijuana crop and in doing so set the bush alight with horrendous effect. I have been through Ebor some years ago, and chose not to stop. It is duelling banjoes country.

Even more dangerous are “meth labs”? A large one of those turned up as well. The bush has a way of hiding all manner of things, but the production facilities are flammable.

I have tried to find out whether growing marijuana in the bush leads to small isolated communities resistant to bushfire evacuation for obvious reasons. If marijuana growing in isolated communities can be substantiated, then such horticultural endeavour presents a hazard to human life, if nothing else. The answers don’t lie in intensifying police action, which in turn leads to hiding cultivation in more and more remote inaccessible bush.

However, it is a vexed situation as was tobacco cultivation in the Ovens Valley – the last place in Australia where it was commercially grown. I was working in Myrtleford in the years of the last tobacco crops grown there; we watched the whole farce of growers, “standover merchants” and various government agencies chasing one another around the district at harvest time which was enough for the government to enact their own variety of “chop-chop”.

Tobacco at Myrtleford

The crop is no longer grown in the Ovens Valley, and it is not a crop that is easily able to be illicitly grown there. The kilns for drying the tobacco leaf are a giveaway although many have now been re-purposed as stylish Airbnb accommodation. Anyway Australian tobacco leaf was never rated as much good, and until the early 1980s it was one of, if not the most heavily subsidised crop grown in Australia because of its inferior quality. I remember being a party before the Industry Assistance Commission Inquiry, on behalf of the medical profession, to argue the case for the subsidy to be withdrawn.

Therefore, given the changing attitudes to marijuana cultivation, would it not be better grown in controlled conditions away from the bush? After all, it would be one way to enhance tourism if they could visit a legal greenhouse and see the crop under cultivation and sample … just a thought.

I have a bone to pick with you

An interesting emergency occurred last week when we were having a meal of fish and chips. A fish bone lodged in my wife’s throat. This once happened to me when I was having a meal in Derby in the Kimberley. It was probably barramundi, and fortunately I was having the meal with the legendary outback doctor, Randy Spargo. The spectre of being evacuated to Perth, a distance of 1800 kilometres, confronted me if the bone could not be dislodged. Water and bread was Randy’s solution, and after the initial trial, we went to the local hospital to pursue his cure. Randy was extraordinary – it was as though he talked the bread down – a “bone whisperer”. Randy had worked for a long time among Aboriginal people and at one point had an Aboriginal partner. Randy had a very calming way of handling a situation that could have turned awkward. In the end, the bone cleared my throat, whether “talked down” or not.

We went back to the café and finished our meal. Next to the restaurant was a meeting of Pentecostalists, complete with glossolalia and very audible groaning, which created a fraught atmosphere when we left for the hospital. When we returned after the bone had “gone South”, all was silent.

So last week we embarked on the bread and water exercise. It was unsuccessful, as was the banana; so we called an ambulance and with the expectation of there being at least an hour’s delay then dialled a general practitioner friend for any other suggestions to try in the meantime. He suggested that the bone might be caught up in a tonsillar crypt, and reassured us that if it was not causing breathing problems we could leave it until the morning and via a referral from the general practitioner to an ear, nose and throat specialist the bone could probably be removed under local anaesthesia. This would be a two-stage procedure, potentially drawn out, dependent on the availability of the doctors.

We were about to accept our friend’s advice, and cancel the call to the ambulance when two paramedics turned up after an hour. The situation explained, Rocco, one of the paramedics asked if we had any Coca-Cola or lemonade – something both carbonated and acidic. As we had Coca-Cola he suggested my wife gargle with it. She went out to the kitchen, gargled and Eureka, it worked almost immediately. A few gulps and all’s well. So we learnt something, because as Rocco said the first response if they had taken her to the Accident & Emergency Department would be to purchase some Coca Cola from a vending machine and see if that shifted the bone.

As there were a few minutes while the fish bone was moving its way down the gullet, I asked how they had found their education. It was nearly 30 years since I undertook a review of the NSW Ambulance Service, and one of my recommendations had been to establish a formal tertiary education course for ambulance officer training, not only to introduce a reproducible training program, but also to assure reciprocity for Ambulance officer recognition between State services. At the time, training was internal and there was no reciprocity between the States. Learning was robotic and one of the teachers was reputed to carry a baseball bat to establish what passed as a learning environment.

It was a time when the NSW Ambulance had more ranks than the British Army such was the promotional system based on seniority rather than qualification. Behind this system was “the Brotherhood”, in which the power of the ambulance service rested at the time. Not a particularly enticing prospect for someone entrusted with review. However the NSW Ambulance Board at the time was progressive. Changes came. It seemed that the education recommendation has survived with these two paramedics being graduates of this system that had its genesis in the early 90s.

As Rebecca, the other paramedic there at the “Fishbone incident” said, looking at me just as they were leaving; “Thanks for the HECS debt!” I think she was joking.

Barramundi

When I have had the best seafood meal, I record it – not the exact date or time as they are immaterial except in a general sort of way. I am too impatient to be an angler and the complexity of the fly fisherman is well beyond my ken. However, I remember inter alia my very best barramundi meal.

It was Good Friday about 20 years ago and the temperature in the shade was in excess of 40oc by mid morning. We had pulled up at a nondescript store outside Wyndham. There was a sign advertising fish and chips, but given the time and place there was no expectation of there being any tucker available. No fish apparent. One of the young Aboriginal guys there looked at the other and said could we wait a half an hour or so. We agreed to wait.

Sure enough – a freshly caught barramundi appeared. One of the guys had gone down to the Gut and speared one. We didn’t mind waiting and then sitting in the shade, the sublime enjoyment of consuming this most notable meal of barramundi. When you are not expecting excellence, you appreciate it so much more. Legally caught? Of course, with a wink.

And one more thing…

I was a bit taken back by the army chief, Angus Campbell, jumping out of a helicopter onto the deck of the “Adelaide” to be surrounded by many cheering troops and saying what a good job they had done. I thought it would be better if this claque were out working in the community rather than giving the General a rousing cheer on a boat moored off Eden.

I wonder what would have happened if the head of the firefighters had called them in for a rousing reception while there were still bushfires all around. Condemnation I suspect.

Irrespective of the motive, with all due respects it was a bad look, redolent of George Bush declaiming on the Abraham Lincoln under a banner “Mission Accomplished.”

The fact is that the defence force was caught unprepared, and while they are obviously learning lessons with them increasingly visible in helping with bushfires, your self-congratulatory action, Angus Campbell, was a poor, unnecessary image which hopefully will not be repeated.

It is the problem with public relations staff trying to justify their existence.

Mouse whisper

The local vicar on the Tasmanian West Coast also owns the earth moving business. One feels very safe in the hands of someone who can move both heaven and earth.

Modest expectations – Montana

This is a story about the unexpected – an unremarkable story on the face of it, but like many stories of its ilk, instructive.

In August, as I have recounted several times in my blog, I was in Chile and in particular Valparaiso. As I was hobbling down a flight of stairs and across a doorway in the restaurant, my hand caught on something sharp. Whether metal or wood, it created a spectacular gash over my fifth metatarsal right hand. It as not particularly long, but it bled. My canes clattered to the floor. As I had nothing immediately at hand except paper serviettes to staunch the bleeding, and rudimentary Spanish to say “Ayuda”, it continued to bleed profusely. It took some time for my companion, who was sitting by the window in this upstairs-downstairs configuration, to come and put order into stopping the bleeding, by pressure.

Eventually Chilean band-aids were produced and these reduced the bleeding to an ooze. The wound was not stitched, but there was a bit of debridement and the edges of the wound were roughly opposed – without seeking outside medical help. I thought that was one reason it took a long time to apparently heal, but the skin remained pink as the scar tissue started to form.

One day about a month after I had returned home a lump appeared at the site of the scar. It grew relatively quickly, but the skin did not ulcerate. I went to my long time plastic surgeon in Melbourne. I thought there must have been some retained fragment – a foreign body that had been missed. The surgeon who has operated on me on a number of occasions said nothing except after a little hesitation, that he would take it off immediately.

Jean-Nicolas Marjolin

I was surprised by the length of the incision and its depth; I should not have been so surprised when the pathology came back – squamous cell carcinoma. Sometimes in wound tissue an aggressive skin cancer can erupt. That had occurred in my case – Marjolin’s is the eponymous name for it – normally these cancers appear as an ulcer, and this would probably have occurred in a few days if it had not been removed.

That was a month or so ago, but now the area has healed and the scar from the incision is barely visible.

A very good astute surgeon, now onto my next experience…

The Surgeon Never Replied

Below is a letter I wrote to a surgeon just prior to a proposed operation three years ago. I have still not had the operations, and although I have a few mild symptoms I have not had to endure the morbidity or my family the funeral costs which could easily have resulted from operative intervention. I am writing this blog to provide an informed consumer perspective on my doubts about spinal surgery.

The other problem with surgery, especially with severe osteoarthritis in the shoulder joints, is that when you are being moved about during cervical surgery the anaesthesia will mask any incidental damage being done in the shoulder. One does not feel the pain of tearing a ligament or muscles or the rotator cuff of the shoulder joint until one comes out of the anaesthesia, and suddenly there is another centre of pain. In the aftermath of proposed surgery, pain relief for me is always going to be tricky because of my sensitivity to opioids. That does not matter to the orthopaedic surgeon – the surgery itself is the centrepiece, not the subsequent morbidity nor the rehabilitation. After all, I was facing three major orthopaedic operations in short order – nearing the end of my eighth decade.

The following is my letter to the surgeon appropriately de-identified sent in the days before the operation.

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 Dr A. 

I note you made a comment that if I stressed my spine that there was a possibility of worsening the condition but I recently spent nine days in Malawi on a number of extremely rough terrains in a four-wheel drive without any apparent change.

Currently I have very mild numbness in my little and ring fingers intermittently in the morning on waking – not every day!

If one reads my latest MRI report it demonstrates that I have significant pathology in my cervical spine, yet I am virtually symptom free. You list the risks associated with the procedure without setting out the probability of any them occurring. Hence I take the paragraph in your letter to Dr A to mean that they are considerable risks. I thought it preferable to have the MRI at JHospital well before the operation rather than the day before – and there is no doubt that JHospital runs a very professional operation. However, so does the Diagnostic Imaging Department at IH, with which there appears to have been an unfortunate failure in communication (with yourself. I am sure you did not meant to criticise the IH nor the fact that at that time it was more convenient for me to have my imaging undertaken there.  

In addition you intend to take iliac crest bone which, as you rightly point out, is better than cadaveric bone for the putative operation on my cervical spine

However I have chronic polymyalgia rheumatica, the aetiology of which condition remains obscure, but there is one observation I would make which is that any shift in the dose of cortisone (currently 4 mgs a day) has a far more marked clinical effect than would be expected – manifested as stiffness and muscle weakness. There is no mention of the possible impact of operative trauma on such a condition, but you would have more information than I do. Therefore, that is one matter that needs to be resolved. The other of course is the effect that the cortisone has had on my bone given that I have been on the drug for three years, despite taking Vitamin D regularly.

I am nearly 77 years old, which is a factor, and the fact is that my cervical spine has significant pathology. The question that is raised is whether there is any guarantee that intervention would not have a cascading effect requiring more operative intervention for diminishing returns.

In relation to my lumbar spine, I do have symptomatology of mild spinal claudication as you have noted as 5/10, but as one senior physician said to me the other day, the major problem is my right knee – and knowing the success of such an operation would it not be preferable to do any operative intervention starting with the knee?

The question then arises of whether the operative schedule should be in reverse, and would a laminectomy guarantee relief of my symptomatology – particularly my ataxia and loss of proprioception? Your letter would seem to suggest otherwise. Is the fact that even if I had a lumbar spine operation I would not be helped? What are the odds of improvement given my age and lumbar pathology. 

I walk with two sticks for social reasons not because I need them invariably. For instance, I challenged myself the other day to walk without sticks but accompanied for three blocks to the coffee shop. There was some pain in my knee, minimal pain in my back and no symptomatology referable to my neck. The pain did not stop me at any stage, there and back.

I continue to do hydrotherapy twice a week and find it very helpful and, so as to clarify your comments in the letter concerning “Panadol Osteo” dosage, I am taking 4 tablets of Panadol (625mg) a day in divided doses and not six as previously. Do you think that a significant observation?

There are a number of other matters in your letter to Dr A, which could be better put. The comment concerning my heavy smoking history is totally ambiguous given that I have not smoked for 36 years, and it was taken not from any direct interrogation but lifted from my “confidential note”. The fact that I produced those notes to inform you so that it saved time and helped you to take a comprehensive history. I am sorry to have to make that point, but in providing such information it should be attributed and not just “noted”.

A copy of the letter was sent to Dr P who retired at the end of June and my doctor is now Dr Q locally. Given that the letter was sent to Dr A, who made the initial referral I am at a loss to understand how that occurred. The copy to Dr P has been archived at NHospital with certain agreed caveats. I believe that any copies of correspondence should not only be sent to Dr Q but also to Dr R, who has been the rheumatologist responsible for my treatment for PMR since 2013, when Dr A referred me to him, Dr A having made the initial diagnosis.

You have not referenced my severe shoulder osteoarthritis, which would be a consideration in any cervical spine surgery? (Here a confidential matter relating to another person has been excised from my letter.)

There are there other matters that puzzle me and that, given all the potential complications set out, I understand you will be away the week after the proposed date of surgery – and if that is true who would undertake my post-operative care, should any of the dire consequences set out in your letter occur. 

The second source of my puzzlement is an initial comment you made that you would be prepared to operate on my back four days after my cervical spine operation. Does that still hold true? 

The third matter is your comment that “ agreed with your need to alter the plan on the day before”. I must have misheard but I do not remember agreeing to a change in plan –especially as it would appear that a substantial part of my cervical spine is affected and yet I am virtually asymptomatic. My cervical symptomatology is better than it has ever been given the problems I had with it 20 years ago, and which were relieved by some excellent physiotherapy.  

Those cervical symptoms were resolved a long time before I first presented to Dr A. It is certainly not a decision I would take the day before the operation, given the seriousness of the complications you have listed. Hence this was my reason for undertaking the imaging a substantial time before the proposed operation.  

The underlying question is would it not be better to reverse the operative schedule on the basis of relief of symptomatology and enabling me to walk pain free, with a reasonable gait and with an improved ability to negotiate stairs, reverting to what I could do in early 2013 before the onset of the PMR, which seems to have acted as the tipping point for all this? 

As you foreshadowed in your letter you have awaited my further advice –and my basic response is the question above couched against the previous consultation, but not with the benefit of you reviewing the MRI and spinal X-rays

I asked for a number of second opinions. The average elderly person who is suffering from degenerative disease does not have that option because information in the health sector is so asymmetric.

To me the non-response to the letter reflects on the person. Here there is an arrogance characteristic of some of the medical profession. They do not see it, especially when they have only patient contact and are acting like a high paid tradesman, who comes in does his job, gets paid and moves on. From my experience very few tradesmen ever come back to view their work. Unfortunately, I was brought up to be a doctor and now as a consumer my perspective has only shifted to the other side of the desk. There should be debate, including this doctor who has remained silent for over three years. 

Boeing Sub-Max

In a investigative piece on Boeing at the time that it was amalgamating with McDonnell Douglas to monopolise the American plane construction in 1997, Boeing’s warts were well and truly revealed. McDonnell Douglas had some very good planes, but inter alia fell over because of its failure to build economic wide-bodied airliners, despite in 1995 receiving US$334m in rebates from kindly Uncle Sam.

Meanwhile the Pentagon was awarding Boeing US$1bn for “restructuring costs” and so eager was Export-Import Bank to ease any problems that Boeing might have, was renamed by some in Congress as the “Bank of Boeing”.

If you want to blame the Republicans for allowing this monopoly to occur, well that’s just not true. Increasingly when the truth of this has emerged, since there in the centre of these appalling decision, smoking a cigar in his Oval office was Mr Teflon – Bill Clinton.

He agreed with the advice that the Boeing position was legal because of the pressure it faced from Airbus. As the1997 correspondent said: “Using this logic all the US automakers could merge because the ‘Big One’ would still face foreign competition. Too bad the Detroit lobbyists can’t figure out a way to hide price hikes in the airline tickets and Pentagon procurements.”

Now Boeing is being confronted with a major problem – its latest airliners appear to be duds – and dangerous duds at that.

I have flown on most types of Boeing: 707 through to 747 internationally, 727 and 767 domestically, and even the 717 and 757 although not as commonly as the workhorse, the 737. They have all been good aircraft, although the Qantas 747s are becoming creaky and by preference I try to avoid them.

A former retired Boeing engineer and policy analyst has been reported recently as saying: “(There has been) a shift in the culture at Boeing from one which strove for engineering excellence to one focused on cost cutting. This deliberate strategy from the very top of the company led to massive, ill-thought-out outsourcing and the discarding of engineering talent as work was moved out of the Puget Sound region…(and in turn) has led to major failures on Boeing’s latest two major airplane development programs — first the heavily outsourced 787 Dreamliner and then the minimally upgraded 737 MAX. Both planes had to be grounded over safety issues.”

This failure has left companies in the supply chain in tatters. Fiddling and tweaking has not worked. Other airlines are running out of patience and are ordering planes from Airbus. As the airline fleets age then attention turns to maintenance; and if cost cutting takes over there as at Boeing, then air travel becomes not just an atmospheric pollutant but also a health hazard.

As has also been reported locally in the Seattle media “Boeing hopes for its first good-news event: the long-delayed first flight of the new 777X, with its massive composite wings. In late January, Boeing’s new leadership will reveal the latest tally of the cost of the MAX grounding, updating the $9.2 billion estimate through October. The rest of the year is likely to be a long slog, getting the MAX program restarted and slowly ramping back up again. No one can yet foresee the long-term impact.”

Boeing 737 Max engine

It sounds forlorn, since many of the mistakes Boeing has made in the 20 years interval have been glossed over by Government not holding them to account and the accompanying high profitability of the 737 until the MAX version came on line.

There have been failures such as not exploiting the 717, which, as one our own Alan’s choices, was particularly shrewd. There is now an increasing requirement for jet airliners with 100-150 seat capacity to run on regional services. The 717 fulfilled that need, but it was given the cold shoulder at Boeing because it was essentially a McDonnell Douglas enterprise and Boeing stopped making them. Only Delta, Hawaiian and Qantas have the plane in any numbers, and they are not selling them. Now through its Bombadier subsidiary, Airbus is filling the need. In the end the 717 will suffer as we all do – it will need spare parts that are no longer there.

However, all is not lost on the bottom line. There are the cost-plus projects where the Defence force chiefs inflate their budgets with expensive projects. Because they are seen as symbols of military might, it is interesting to reflect on the giant transport plane, built by Boeing, the C-17. With a budget of between USD200-300m a year for each one, one official labeled it the Golden Turkey because of its cost and its vulnerability to being blown apart by $22 mortar shell. Perhaps it has been made less vulnerable, especially after one crashed into an Alaskan forest in 2010.

Nevertheless more recently than that, someone who had experienced the joys of travelling in a C-17 said despite all the hype of being long range and being able to be refuelled in midair, it was more like a “stopping all stations conveyance” between the United States and Afghanistan, even including a stop for repairs.

Despite all the rending of garments, the Defence establishment continues to pour money into Boeing. In 2018, Boeing won contracts to build a new pilot training jet for the Air Force, an in-flight refueling drone for the Navy, and a fleet of the Airforce security helicopters.

As reported, Boeing’s “Defence revenues” had fallen by more than one-third over the timeline of a decade: from USD32.1 billion in 2007 to USD21.1 billion in 2017. But, President Donald Trump’s higher defence spending and three new military contracts put Boeing back in the game in 2018.

Still, to put all of the boondoggle in perspective, the Boeing commercial division in 2018 before the Supermax crisis billed USD60bn by airlines around the World.

Cap in hand to the Government you would think can go only so far, but Boeing has shown it has a capacious chapeau.

Mouse whisper

Just a message for the Nimbin anti-vaxxers …

Your child about two years old gets chicken pox; has a high fever – starts fitting – you prescribe one of those herbal remedies that incidentally has aspirin hidden away in it. Child severely incapacitated mentally – or dies.

Remember the name Reye, who first described the mixed brain and liver symptoms and signs as a syndrome in small kids.

Chicken pox plus aspirin; vaccinate against chicken pox. Reyes Syndrome no longer. QED.

Ralph Reye incidentally was an Australian pathologist – normally they are the doctors who deal with the dead.

Like polio, Reye’s syndrome was nearly eliminated until your mob came along.

Reye’s Syndrome

Modest expectations – “JH” Taylor 326

Did you pause on the 11th hour of the 11th day of November to remember?

If you did not, perhaps a line or two from Wilfrid Owen:

What passing-bells for these who die as cattle?

— Only the monstrous anger of the guns.

Only the stuttering rifles’ rapid rattle

Can patter out their hasty orisons.

No mockeries now for them; no prayers nor bells;

Nor any voice of mourning save the choirs, —

The shrill, demented choirs of wailing shells;

And bugles calling for them from sad shires.

 

What candles may be held to speed them all?

Not in the hands of boys, but in their eyes

Shall shine the holy glimmers of goodbyes.

The pallor of girls’ brows shall be their pall;

Their flowers the tenderness of patient minds,

And each slow dusk a drawing-down of blinds. 

We have not learnt have we; just forgotten?

Another Homage

The following is an unabridged reprint in part of a NYT article. I don’t normally do this but the story is so telling:

T.J. Abraham is a block of a man with a tree-trunk neck and a lantern jaw. He played football at a top Catholic high school outside Pittsburgh and then travelled downtown to Duquesne University, where he played another three years.

He was an offensive lineman back then, and he gloried in the fraternity of hit and get hit, joyfully clanking helmets. Sometimes he saw stars, sometimes he puked and so what? Get back up and get back in. “I probably got my bell rung 70 times,” he said Sunday with a crooked smile.

He always knew he would get on with life. He was a top student, and in time he became an obstetrics & gynaecology doctor, delivering so many babies, maybe 3,000, a gregarious guy who remembered birthdays and who could make a nervous expectant mother grin. He had a beautiful home and a wife and a young daughter and a teenage son. He was a son of western Pennsylvania and life was grand.

He shakes his head: Until it wasn’t.

It was about seven years ago that the now 42-year-old Abraham said he began to notice his temper flaring without reason. His memory and judgement became flickering lamps. In a panic, he began a medical trek that ended with an inconceivable diagnosis: neurodegenerative dementia.

 When I was about the same age, I had a serious car accident, which involved a wet night, my car aquaplaning on a country road, sliding up a muddy path and hitting a pole and bouncing into a dairy, as I was afterwards told. The car subsequently burst into flames, but somehow I was able to release the seat belt and scramble out of the car. I do remember standing, laughing uproariously while the sound of the oncoming ambulance was ringing in my ears. Then everything went blank until I woke up in the operating theatre.

In relation to my head, I had a severe enough head injury without internal bleeding. However, the space between the skull bone and covering galeal aponeurosis was spongy with fluid, presumably blood although to my knowledge it was never tapped. In other words, decelerating from 100 kms per hour to zero in less than a second caused a significant head injury. In my youth I had sustained head knocks playing sport, you could not avoid it if you boxed, as I did throughout school.

However, as Dr Abraham had said, having repeated head on collisions at about 50 kilometre per hour cannot be good for the brain irrespective of whether you have a helmet or not (galea as the Romans would call it). Being medical practitioners, he and I are acutely aware of changes in our mental ability; that is until we have lost the ability to be aware.

After the accident when my various injuries had healed, I made the decision without any consultation with anybody to return to work. Needless to say it was premature; I was tolerated but many later said that I was weirder then usual and obviously I had not recovered. However, unlike Dr Abraham I was on an upward spiral and at least among my peers returned to an acceptable “normal”.

I respect him greatly for admitting to his downward spiral. I hope it is arrested. I keep looking for evidence of the mental consequences of my accident; I have the evidence of the physical legacy from the accident, but my blog is my sentinel of mental decay.

However, with these equally old men vying for public office in the United States, do they get their mental abilities tested regularly? To what extent do these old men have the honesty portrayed by Dr Abraham? If Trump’s twitters are his substitute for a blog, then the content would worry me if I was an American voter – especially if one has been unfortunate enough to be able to trace the course of fronto-temporal dementia in others as I have.

If in fact we are to countenance age in itself as not being a bar to election, it does not help on the other hand when others blinded by the allure of power are not prepared to face the fact that mental deterioration may be occurring in one of its own grandees.

Thank you, Dr Abraham for being my inspiration. I wish you all the best, and that you somehow will be able to slow the process.

Justin Trudeau lives

Justin Trudeau in a season of seeming conservative supremacy retained power in Canada in the October election, albeit with a minority government. This time, he was delayed in announcing his cabinet until 20 November. He has taken a collective deep breath. After all, he lost every riding in Alberta and Saskatchewan.

Meanwhile back at the hand-wringing barn, as reported:

It’s true that the caucus was unified behind the idea that the party’s membership, not its elected members, should hold the leader to account. But that was where consensus ended. The meeting didn’t last seven hours because MPs were lauding the leader and his team.

Always the sign that the Conservative party leader, in this case Andrew Scheer, the member for Regina Qu’Appelle in Saskatchewan, is under extreme threat. The report goes on: 

There are very real concerns among MPs from Ontario in particular, that the party will be reduced to a rump in Canada’s largest province, if major changes are not introduced…

The loss of Milton, an Ontario riding formerly held by Lisa Raitt (Deputy Opposition Leader), is seen as a harbinger by (Conservative) MPs with commuter belt constituencies who have seen their vote share dip in successive elections since 2011.

It seems that the situation is the reverse of Australia. Here the Australian Labor Party (ALP) has released a review which, despite the verbiage, seems to be an exercise of exorcising itself of Bill Shorten. The Conservatives have not yet done that in Canada.

Queensland is to Labor as Alberta and Saskatchewan are to Trudeau. At least the ALP has seats in Queensland; Trudeau does not have a riding in either of those two provinces – no seats out of 48.

Trudeau also lost out to the Bloc Québécois in Quebec. Added to his woes, Jody Wilson-Raybould, the Minister who resigned from Trudeau’s cabinet in protest against what she believed to be a cover-up engineered by Trudeau, retained her seat in Vancouver. She is a formidable native Canadian woman lawyer, with a very strong public profile.

Trudeau thus did not get it all his own way, and he literally also got a few black marks during his campaign. However despite all, his party ended up with the most seats, and he knows that the New Democratic Party (24 seats) and the Greens (possibly 4) will support him on most issues – enough for a comfortable working majority. Both these Parties have strong climate change agendas.

On the other hand the far-right party, the agenda of which would certainly have been attractive to some in the current Australian Liberal party, fared appallingly, even though the leader had held a seat in the previous Parliament, which he lost in 2019.

What is interesting is the comment about the loss of the suburban commuter vote, which is the product of a more educated electorate and which presumably will not lessen. Given there is evidence of that same shift in voting patterns occurring in the Trumpian America, this is an interesting development that the ALP should examine. For instance, the only two seats that showed a swing towards the ALP in Queensland, which virtually guaranteed Morrison’s victory, were in Brisbane and Ryan, affluent Liberal Party urban strongholds, presumably the equivalent of the “commuter vote.”

The Canadian electoral system is far different from Australia; it is non-compulsory and first past the post, traditionally thought to favour the conservative vote – but I wonder whether that would still hold true. The Canadian Senate is a far different construct from the one here in Australia. In addition, the provinces do not have the powers of the Australian States. And of course, Canada is bilingual with a strong French influence, not only in Quebec but also in parts of Ontario and the Maritime provinces.

If I were Albanese I would at least being saying “hello” to Trudeau. How Trudeau is selecting his Cabinet, due to be released on 20 November, as I noted above, would be a good topic to break the ice – which will soon be forming on the Rideau Canal in Ottawa. Come skating with me, dear Albo. 

The Expert Prophesises

I found a scrap of paper, which had drifted across my desk. Dated 26 October 2016 it was written for The Australian by Robert Gottliebsen.

It starts with a definite conclusion: “Barring some totally unforeseen event, Hilary Clinton will be the 45th President of the United States.”

Then it analyses some of her policies, which if successful “may lead her to be re-elected for a second time”. How far has the world drifted from this Gottliebsen opinion piece, some may then say.

Therefore why bother reading on. As for the journalist he has to write another piece. He may hope that 13-day lag period between the 26 October piece being published and Trump’s election will be enough time for his readership to forget. He has no time to contemplate whether there was a sliver of usefulness when his first sentence is such an almighty gaffe. He probably hopes his readership would forget it.

Yet three years on it is worth reading. Gottliebsen suggests that Clinton would have concentrated on making small business work, because that is where she saw job creation – not in big business, which should be taxed more. Her policies were directed to more prompt payment by government to assure cash flow and to make to easier to operate, unlike Australia’s “bizarre anti-small business public servants (who) go out of their way to prevent small enterprises starting by blocking them getting an ABN”.

In enhancing her agenda, Gottliebsen suggested that small business would have gained a share of what he describes as “an infrastructure bonanza”. This involvement of small business provided Gottliebsen with the opportunity to state that the “Australian Competition and Consumer Commission to recognise modern-day ‘cartels’ excluding efficient small enterprises are run by unions in collaboration with their big company mates who, in turn, pay unions big sums for favourable treatment.”

The stimulus to small business by Clinton was designed to lift the minimum wage and pay other ancillary benefits, particularly health benefits – and also increase the workforce by immigration given the pool of refugees in which to dip.

What rings so true are these comments made at a time when Turnbull was resisting the Banking Royal Commission and before bodgie building construction, with widespread flammable cladding, was revealed.

It is not that those – let us not say top of town – just say those who congregate in the spring racing carnival marquees are solely to blame, but Gottliebsen was harsh about Australian business conditions, describing the alliance of big business and the unions as “blatant job-destroying corruption”.

If this is so, then what are politicians doing mingling with this mob, and moreover taking plush jobs on retirement from the same mob when the hurdy-gurdy stops playing? You rarely see these ex-politicians wandering along the streets of their erstwhile electorates asking what they can do for these people who may run small businesses, now these ‘exes’ have time on their hands and a large pension in their bank accounts. After all, small business was always good for a photo-opportunity in the electoral cycle when the politician wanted their vote.

Now what do you call a collection of lobbyists? Perhaps a trough.

Just because the prophecy was wrong does not mean the points being made by Robert Gottliebsen an age ago are not worth a little contemplation.

In fact, Thomas Phillipon, in a recently published book confirms a great deal of what Gottliebsen foresaw – at least in America. Domination by Amazon, Apple and Microsoft; fewer airlines; consolidation of hospital and pharmacy chains – all big business conglomerates at the expense of small business. And without appropriate legislation, the conglomerates swiftly become cartels -and Australia has many examples of this.

The Citation

Nicholas Talley is a man of many parts. He was the first person I came across designated “laureate professor”. I had known about the “poet laureate” and the “Nobel laureate” designations, all derived from the ancient tradition of placing a laurel/bay leaf garland on the deserving skull. But a laureate professor, what a vision!

Universities are good at diving into the Latin dictionary and coming up with flash words like “emeritus” for those who have retired and are off the payrolls. However, the emergence of retiring women academics has meant an increasing number of “emerita”, and those of us sub salis are known as “alumnus” or “alumna” – a mixed collection of whom traditionally would take the male plural “alumni”. A neuter variety would be known as an “alumnum” but the neuter plural “alumna” could be confused with the female singular.

Now universities are bestowing “laureate’’ on their deserving staff.

In any event should, in terms of consistency, these people of high office be called “laureatus” and “laureata”?

Added to the complexity is that “trees” in Latin are generally of the second declension, where most of the words are masculine, but trees although with male suffixes have the feminine gender.

And of course we come to the word bacca – which is attached to laureate also. Everybody knows presumably that they are graduating as a “laurel berry”.

The problem is that “laureate” is getting a bit common – how about Trabea professors – no worry about gender here.

Thus, hail Laureate Professor Nicholas Talley for introducing me to this topic – especially given his expertise in citations, he would know what a Trabea is. 

Mouse Whisper 

Wikipedia summarised it as well as anybody – up to a point:

The 1894 Open Championship was the 34th Open Championship, held 11–12 June at Royal St George’s Golf Club in Sandwich, England. J.H. Taylor won the Championship by five strokes from runner-up Douglas Rolland. This was the first Open Championship held outside Scotland.

 This was the first of five championships spread over three decades that Turner won, and in line with this blog number this first was the 34th Open. His 72-round total of 326 was the highest ever recorded to win the Open – and by five strokes!

By contrast on the same course in 1993, Greg Norman won with the lowest-ever score at that time of 267, since bettered by Hendrik Stenson with a 264 at Royal Troon in 2016.

There weren’t many horseless carriages around in 1894 either, but plenty of mashies, brassies and cleeks.

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 – 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 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