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

Modest Expectations – Thaddeus Stevens

Shirley Shackleton is one of those inconvenient people whom governments just wish would go away – in her case she is a reminder of a government without compassion complicit to murder if not genocide. At the Balibo Fort Hotel, there were two books for sale – hers written a decade ago – and a volume of Xanana Gusmao’s speeches.

There were three copies of the Shackleton book – “The Circle of Silence”. One at the top had been multiply caressed. So we bought the one on the bottom, which seemed the least ravaged – the cost was immaterial. It was Balibo.

Shirley Shackleton will be 90 next year and unless there is somebody to take up her crusade, when inevitably she shuffles off the mortal coil, her inconvenient noise will cease. There is a son, a lawyer, a magistrate living in Perth. Maybe he will take up the crusade.

However as the personalities fade, it does not dim the enormity of what we have done as a nation to the Timorese – turned our collective head away. Yes, there have been other journalists, notably Peter Greste, imprisoned by authoritarian regimes, but he survives and to the best of my knowledge the Australian government was not complicit in his imprisonment.

The building in Balibo where the Balibo 5 were executed (Photo Sue Morey)

There is still the case of the bugging of the Timor-Leste government and this ongoing Orwellian campaign to eliminate whistle-blowers with the Press caught like the Balibo 5 in the cross-hairs of governmental suppression.

When I was President of the Students Representative Council at the University of Melbourne, ASIO came calling – that friendly invitation to come and join the party. I never crossed that threshold. It is another story. But I am sure I was not on my Pat then … and recruitment patterns now?

The only thing I can say is that presumably the same personality types are still being recruited as in my day, but now with many more toys; truly terrifying. As for me, I never looked good in a gabardine raincoat.

Balibo sunset (Photo Sue Morey)

Anti-Vaxer – Prosecute for Genocide

When I was born, it was dangerous to be a child. There were few defences against the ravages of infectious diseases. There was no penicillin. The only immunisation apart from small pox available as a young child was against diphtheria. Nobody in the wilds of anti-vaxer propaganda would ever had heard of or seen diphtheria – a paediatrician friend of mine has seen it once – it was a huge killer of children before the introduction of a vaccine. In the decade up to 1935, over 4,000 children died of the disease; mass immunisation had commenced in 1932. Between 1996 and 2005 there were no deaths, but three have been recorded since that time.

The vaccine was later combined into triple antigen, targeting whooping cough and tetanus as well.

I am an age as are my sons that we all had measles, chickenpox and mumps as children – and we were all very sick. However it was the late Gay Davidson, whose younger daughter developed a rare late complication of measles infection who brought into public view the importance of the vaccination against measles in particular. The brain goes to mush, and the beautiful vivacious child becomes a vegetable over time before dying – a horrible death. Gay Davidson was an important face in advocating immunisation against measles and in the late 1990s the immunisation rates rose in Australia, the Australian government then being a very strong proponent.

Finally, there was poliomyelitis. There was no vaccine when I was a child. I went through an epidemic when contact between schools was banned. Ice cream was banned. Children died and those who survived the disease were added to the wards of crippled children in every city of Australia; children in iron lungs; children with heavy calipers; children with all stages of disability. I was immunised first with Salk and then given Sabin. Poliomyelitis had nearly been eliminated before the antivax barbarians in their various guises have come calling.

The problem is that the community’s level of immunisation is a measure of civilisation. As the antivaxers – the health barbarians with their poisonous message – raise the level of uncertainty in the community, so will go civilisation as we know it. It is paradoxical that in a world where the diversity of safe vaccines is expanding, in so many places the level of immunisation is falling because of the uncertainty promoted by antivaxers.

I have detailed five diseases where the burden of disease has fallen dramatically because of immunisation. There were many other diseases that have yielded to vaccines. Some I faced growing up. As medical students we vaccinated one another against smallpox. This disease has been eliminated from the face of the earth. When I first went overseas, together with my passport I also had a yellow booklet showing that I had been vaccinated against smallpox and immunised against typhoid, cholera and later yellow fever.

This country has had a brilliant immunisation program since the 1990s and much of the early success of this program can be attributed to Michael Wooldridge, the then Minister for Health, as well as the indomitable Gay Davidson. Nobody has written her story. However, the program and the strategy is clearly and crisply stated up to 2024.

Yet I cannot remember it mentioned once in the recent election campaign as a signature of success.

However, in Australia the government is fixated on keeping our borders intact by keeping a few poor refugees out rather than drawing attention to the ongoing successful national immunisation plan.

The charlatan, former doctor Andrew Wakefield and his girlfriend, Elle MacPherson from their lodging in Austin Texas are demonstrating how destructive systematic antivax propaganda can be. If a government becomes timid in the face of community agitation as it has done on fluoridation, then this country should watch out, especially if these antivaxers start infiltrating the political grass roots.

I have lived in this other universe when there are few antivaxers –yes it was a universe where there was an antivax element who believed if you were vaccinated with cow pox you would grow horns, but why were there so few antivaxers? Vaccines apart from smallpox were new. Since there were no evidence-based preventative measures, the populace just accepted that it was God’s will that children should die a myriad of deaths from these diseases.

Today, in that universe antivaxers would be in their element, no vaccines – just watching children die. But of course according to the antivaxers, saving the children from autism. Today it would be what I would say is not God’s will but Genocide.

To Cook a Roo – Part 111

Charlie diversifies

Pintubi are practical. They cooked all creatures in their skin. The fat content of Australian native animals is too low for cooking on a spit. That would create a hard dry gristle and there were neither cooking containers to stew meat, nor any salt available. Furthermore getting about near naked makes retaining animal hides unnecessary.

As no salt or other flavouring was used in traditional Pintubi cooking, this was literally life lived in the raw in what they laughingly if not longingly called “before trouser time”.

Cooking in the skin must happen right away and before the blood congeals so no road kill gone stiff! Not once in six years eating the cooked-in-skin earth oven food did I crunch on any stones!  

The niftiest cooking trick I saw was that used for the delicious rumiya (sand goanna) a white meat that tastes much like chicken. Averaging about 40cm long they are abundant and easiest to catch in spring when they start new burrows in the sandy earth. They live mainly on ants and insects having neither the ghastly infectious bite of the large carrion eating goannas nor a gamey smell. By pushing the hind legs hard into the abdomen the contents of the sand goanna’s gut are forcefully excreted so they don’t need to be cut open. To cook, the skin is scorched to remove the outer layer, which would otherwise ruin the flavour, before it is placed under the ashes for about 10 minutes. The meat is mostly in the tail and there’s some fat attached to the skin and at the loins. The 10ml steel bore pump rod I always had was sought after by the goanna hunters who used it to probe sand goanna tunnels so that you follow the hole by probing from the surface instead of laboriously digging deep along a tunnel that can be seven metres long. 

Plant “tucker” was far less plentiful but some was so excellent that it could not be improved by any flavourings. In the spring, the pungana bean, which was shown to me, was my favourite. Growing like giant acacia pods on a three meter high shrub and similar in appearance to snake beans, the long pods are cooked in a minute on a burning clump of grass, the green soya sized beans with a flick of bright yellow tastes like corn.

Rumiya and plains bustard (about a turkey sized bird) were tasty cooked in the earth fire pit and much better than food from my tucker box a few weeks after the last trip to town. I only ate feral cat once, cooked by Minyina and the horrific look of that fore half of scorched cat passed to me dripping juices with the charred skin peeled back over canine teeth was unappetising. However, I was hungry enough and it all stayed down which is more than I can say for the last time I had ample helpings of kangaroo in 1984, three years on from the cooking lesson at Tjiterong. (To be continued)

Mouse Whisper

To cap off this blog of culinary delights, I was talking to this Pangolin at the international arrivals at the Wood’s Point airport who told me that one is permitted to bring a kilogram of civet coffee back into Australia without having to declare it. Apparently it makes the best “Catpoo-cino” and yes, that’s what they call it!

 

Modest Expectations Septimus

Jeff Kennett recognised during a trip to New York that the colour yellow stood out in the visual spectrum. He had seen the New York taxis were all yellow and they stood out somewhat better than the various muted colours of the taxis in Melbourne at that time. So he decreed the yellow taxi for Melbourne.

Clive Palmer has recognised his party’s colour stands out like wattle in springtime.

Mr Palmer is a clever man. The hoarding owners know that and make him produce the cash before they agree to display his message.

On the hoardings Mr Palmer’s image appears to be photo-shopped so he looks much lighter and younger than he actually is – he is a very heavy gentleman and sometimes when he was captured asleep in Parliament, I wondered whether he had Pickwickian Syndrome named after the fat boy in that Dickens novel who was always falling asleep.

But while the heavyweight Mr Palmer is barely on view in person in this campaign, his messages are there: “Fast Trains”, “More Wages”, “Cheaper Energy”, “Free Cake” and they have apparently resonated with some in the electorate. Clive has perceived the end stage of the information revolution; photo-shopped images and two word policies. “Clive Palmer” itself is a policy.

Mr Palmer has been underestimated. His Chinese partners have found that out. His nickel workers have found that out – shimmering generosity followed by real famine. It is now up to the Australian electorate not to overestimate Mr Palmer.

And remember! Yellow is also the colour used for biohazard warnings.

The Psychopathology of Politics

I once toyed with going to Yale to undertake a doctorate in the psychopathology of politics. It was the early 1970s and I had come under the influence of Alan Davies, the then Professor of Politics at the University of Melbourne. “Foo”, as he was affectionately called, continued to influence much of my thinking in this area, and enabled me to write about it, getting some currency in the 1970s when I was considered to be “someone of promise”.

I didn’t go to Yale, but my interest in politics remained. I have two aphorisms that have stood the test of time: “all politicians proceed from a basis of low self-esteem” and “politics is the systematic organisation of hatreds”. The first is attributed to Harold Lasswell, a major American political theorist, and the second to one of that political Adams family which yielded two American Presidents.

However in the potpourri of personal politics where the pathology lurks, it is the ability to see yourself through the eyes of the viewer, which is a saving grace. Jacinda Ardern has that skill. She is an art gallery of images; so many images she is able to project and yet remain that singular woman I described in an earlier blog.

On the other hand, one thing about Bill Shorten is that he doesn’t have the intuitive sense of image that Ardern has. If I were his adviser, every time I saw him jogging I would tell him to jog away from the media lens. Or if he insists in exercising to find a medium in which he does not look like a duck, paddling along, paradoxically without a bill. Watching him jogging, it’s hard not to expect him to quack. But then again when you’ve got a critic like Murdoch, who presumably was not called “Boof” for nothing at Geelong Grammar, then your jogging gait is only a small irritant.

Morrison understands this image aspect of politics much better than Shorten. Whether his “aw shucks” approach has worked, we will find out in about a week’s time if the independents don’t cruel the pitch. Morrison abandons images that don’t work, like his “happy clapper” church routine. He is the ultimate pragmatist. Research obviously is telling him that the baseball cap is working. Remember Turnbull venturing into Queensland with his brand new Akubra? He was referred to as “that tent peg” – wide hat thin body.

You don’t want your audience laughing at you; only with you. This is another aphorism and one of perspicacity in being able to tell the difference.

Of Australian politicians, Penny Wong is wonderfully deft in a way that is not Ardern, yet from the same school; those who can stand outside themselves and see their image as others do. Her minimalist approach to herself is extremely effective. 

Dental Benefits

Stephen Duckett, well remembered in a past life as the Raider of the Lost Cookie Jar, has instigated a discussion on one of the most neglected areas of Australian politics – establishing a national dental health scheme. There was a somewhat insipid yet positive response from Shorten but as far as I can see nothing from the Liberal Coalition.

The paper is timely and whether you agree with the detail or not, it is important. However, it is 67 pages long and I don’t intend to critique it – rather it is useful to emphasise a few points and place the accent on different areas.

First of all, let us say that the advocacy for a dental benefits scheme, along with a medical and pharmaceutical scheme, has never had a champion in the Australian parliament. In fact I cannot establish whether there has ever been a dentist in the Australian Parliament.

After the Constitutional amendment in the 1946 referendum, the ubiquitous Earle Page, (a rural medical practitioner in his own right) championed the adoption of a national medical scheme, which was established in 1953, and massively updated following the Nimmo Report in 1969 with first Medibank and then Medicare.

Yet government policy has been silent on a universal dental policy. First of all, organised dentistry was opposed to it as they saw it as unnecessary government intervention in affairs of the mouth.

However, there are a number of matters that need to be addressed before the detailed question of coverage and affordability can be considered.

The first is the matter of fluoridation. Australia has a vocal fringe group opposed to fluoridation of water. To these people, it is yet another of the many tentacles of the Giant Conspiracy. There are many rural local government areas, particularly in Queensland, that do not have fluoridated water.

It is not only the Conspiracy Theorists, but also some Big Business that wishes to thwart fluoridation. I experienced this side of the debate where a community, in a public meeting, supported fluoridation without dissent, but the largest industry in the town – Murray Goulburn, which was not present at the meeting – went direct to government to say it would not put fluoridated water in the milk products. The reason given was that the Asian market rejected fluoride in milk products.

The community decision was ignored. Business triumphed over public health. Until a separate water pipe bringing unfluoridated water was provided at taxpayers’ cost to Murray Goulburn, the children of the Victorian township of Cobram unnecessarily forwent fluoridated water for nearly a decade after the community decision.

The point is that any universal dental scheme must take into consideration the requirement for universal fluoridation in the water (with the only exemption being those communities that have the recommended level already naturally present in the water supply), and not to be prisoner to the vagaries of some local governments. This whole question of national fluoridation needs to be addressed before benefits are paid for dental treatment.

The second consideration is the Australian Constitution and the question of “what are ‘dental benefits’?” If the dentists had encouraged the provision of a dental benefit scheme from the outset, then the definition of “dental” would have been clear. However, there are a number of health professions that have “dental” in their title. Not are the least of which are “dental hygienists”. These professions with dental in their title could argue that their services should be eligible for benefits under the Australian Constitution. Unlike “medical” which has been defined, any profession with “dental” in its title could be recognised as an independent profession. For instance, the Australian Health Practitioner Regulation Agency (AHPRA) lists dental hygienist, dental therapist and dental prosthetist.

I am a great supporter of a universal dental scheme, but I am also opposed to shovelling out money without consideration of the consequences. This will be a recurrent theme as my blogs keep piling up.

A Child Care Parable

There once was a young post-graduate student, who was pregnant. She had graduated in medicine and then there were restrictions on pregnant women being interns in hospital. Some reasons had a trace of validity, but most were the consequence of male prejudice in a male dominated profession. Her husband was newly graduated in medicine but the annual wage for an 80-100 hour week was about 1,000 pounds including his board, but not hers. She remembered escaping being machine-gunned by a low flying American plane in the war. Although a small child in the street in Ljubljana, and the plane was so low she saw the face of the pilot, who aborted his strafing run when he saw that it was a child. He was black.

She was thus of migrant parents who had been refugees from central Europe. So her upward progress had been though determination and sheer hard work. She wanted a career, but she also wanted her child to be looked after in a safe environment in which she had a role in assisting. So she started a group with friends, who initially raised funds by serving coffee and biscuits at the university theatre. Eventually she secured a premise in an old Jewish school in the inner city near the university.

Then the battle for recognition and viability started – making ends meet and battling a government department headed by conservative male bureaucrats and complicit older women, whose model was the wartime nursery. These were set up so that women were freed to work in the factories and elsewhere. After the war, it was assumed women would know their place and retire behind the white picket fence. Those who wanted careers could resort to parents or nannies.

A fire had occurred six years before in a childcare centre, in which a number of children had died. Regulations were tightened, some justified, others less so. For instance, there needed to be a dining room with spatial dimensions of ten square feet for the first ten children and then eight square feet per child after that, presumably on the basis that the more children there were the smaller they became. Really?

Attitudes hardened and the idea of providing for parents to run a co-operative was resisted. However the co-operative was formed with parents as directors and the government reluctantly provided funds to renovate and equip a centre in accord with their strict regulations.

Parents paying fixed term fees from one to five days a week solved the question of financial certainty and hence assured financial viability.

The Centre had a trained registered nurse with child and midwifery qualifications as the executive officer and a kindergarten teacher, and others trained to various skill levels, both full time and part time, meeting the requirement for one staff member per five children for infants and one for fifteen when they were at kindergarten level. I use the word “skill” because education here requires in-service training, more males, and adequate salaries. Of these aspirations, she never enticed a male onto staff. Otherwise she was very successful.

She was adamant that all the staff be trained and cared for by the executive. The turnover rate as a result was low.

She had two sons, one who went into care at six weeks. They are now in their fifties, successful in different fields, each with a working spouse and each with three children.

Her advice even now could help a government intent on bringing in a childcare scheme, free of rorts. Subsidising the for-profit sector without demonstrable parent involvement is not the right business model.

The Centre she set up is still going strong.

Mouse Whisper

Experienced at the lunch table at the Magill winery in the suburbs of Adelaide when asked whether she preferred to be called “woman” or “lady” the young waitperson responded: “established female”.

Modest Expectations Fathom

This question may be seen as a bit odd for those who don’t have a father who was a young man in the 1930s, and I say father not mother – not to be disrespectful to women – but as a sign of the times in the 1930s.

“Which side were you on during the Spanish Civil War?” Did you back the republican government or Franco? It is a double-barrelled question, because that war can be interpreted as a battle between fascism and communism for two reasons. Hitler was testing out his military might, not only on the Republican army but also the Spanish citizens and Stalin was making sure, in the guise of supporting the Republican cause that he sacrificed socialists and anarchists to his form of authoritarianism, laughingly described as communism. However, the Republic was the legitimate government.

The Spanish Roman Catholic Church supported the Franco insurgency as also did the Church in Ireland. An Irish brigade was formed to fight for Franco. It was so ill-disciplined that Franco sent them home. However, the Irish connection is a recurring theme.

Most of those men from other democratic countries, including Australia, who went to fight were on the Republic side. The only recorded Australian who actually went to fight for Franco had a change of mind and he was killed while flying for the RAF in 1940.

However, it is a textured question. The cloth for the Spanish Civil War was woven years before. The Italian Futurist movement, which glorified war and dismissed history as bunk, was hidden beneath its paintings and poetry that provided the warp for the rise of Mussolini. Disaffection and perceived decay of the Weimar republic among other factors led to the rise of Hitler in Germany.

This was manifest not only in Australia, but as the New York Times noted this week in an editorial: In the 1930s and the 1940s, The Times was largely silent as anti-Semitism rose up and bathed the world in blood. That failure still haunts this newspaper.

A young Sydneysider, Phillip Morey, experienced its rise in the early 1930s, when he recognised the Fascists with that expressive word “rodomontade”. Below is taken from a memoir written about Philip’s experience:

He loathed the fascist New Guard that had been cavorting around New South Wales at the time. He considered the rhetoric of Eric Campbell, its leader, to be a “bombastic rodomontade”.

Philip remembered Campbell from two years before when the antics of Captain De Groot on Saturday 19 March in 1932 had initiated a confrontation with the Lang Government. Not that Philip had much sympathy with Jack Lang …

Francis De Groot was an Irish fascist who lived on his own bravado. Campbell was the populist Fascist — organiser of clandestine training for his New Guard for whom Mussolini in Italy and this new fellow Hitler in Germany seemed to have some answers to the world disorder.

Philip was determined that he was not going back to this world where the colour of the shirt seem to dominate — whether they were “black shirts” or “ white shirts” — Philip had thought Campbell’s posturing all very puerile — playing soldiers with his band of followers in various parts of Sydney. He had heard just before he’d left that they had been drilling in Killara, further up on the North Shore. Campbell had even issued a directive on street fighting — how to march with fixed bayonets and how to clear buildings with grenade, tear gas and rifle.

The text rings true when you see the antics of the extreme right today. The current mob has the ethnic hatred of Eric Campbell and later Eric Butler with his League of Rights. Then the target were Jews, and there is still residual anti-Semitism, but Muslims are now the prime target, and unlike the pathetic followers of Eric Campbell, their spiritual descendants have access to murderous weaponry.

How more insidious are the inheritors of Bartholemew Augustine Santamaria, in the 1930s, a rising intellectual within the Labour movement and protégé of Archbishop Mannix, once an avowed member of Sinn Fein? Santamaria was an avowed admirer of Franco, the only difference between Franco and Mussolini was that Franco stayed neutral during World War II and died in bed.

The Santamaria playbook mimicked his perceived communist foe in the union movement. He created industrial “Groups” within trade unions, backed by a secretive “Movement” designed to plant Catholic operatives in key positions throughout the Australian Labor Party – only now they are embedded in the Liberal Party.

But back to the question of 1936, how many of those who now support the heir to the Movement in the Sydney Institute would have voted Franco if they had been in the time of my father? However, I do not want to limit that question only to that select few – anybody can answer.

And the relevance? Franco was a tyrant who clothed himself in the Roman Catholic Church – currently in the western world, we would have one would-be tyrant, who clothes himself in fundamentalist creationism and another in the Orthodox Church. They are most prominent but not potentially the only ones. Franco is their shroud.

The “textured” metaphor is apt.

And my father? I believe he would have voted for the Republic, but then I never asked and he was unpredictable.

Fanfare for the Common Man – A Reflection on Anzac Day

Across the water from the small township of Lubec, Maine is Campobello Island in Canada. I have crossed the bridge to the island. Campobello Island is synonymous with Franklin Delano Roosevelt. Roosevelt smiled. Roosevelt exuded optimism. He was also a cripple, struck down by poliomyelitis one morning on this most beautiful of islands. Yet he strove for independence.

Until the ghastly event in Christchurch, I thought I came from a country where to “bare arms” is to get down to work with my fellow citizens. Yet I live a country where our major commemoration is a World War One disaster at Gallipoli and our national day is called by some “Invasion Day,” when Great Britain dumped a bunch of their unwanted – convicts and marines – in a desolate place called Botany Bay in 1788. Despite its apparent vigour, Australia is a country rooted in pessimism.

By contrast, the USA national day celebrates something more than putting a British foot on a distant shore.

Australia has a dirge for a national anthem. That of the USA was forged as the smoke from the British bombardment of Fort McHenry cleared and the American flag was still flying. Francis Scott Key was inspired to write the words of “The Star-Spangled Banner.” Today Fort McHenry is one of two places in the United States where the fifteen-star flag still flies. The other is at the end of the Oregon Trail.

I have seen much of Australia.

But then I have been privileged to roam the United States too. I have sponsored two musk oxen called Amethyst and Pixie Stix in Alaska. I have sat in the South San Franciscan courtyard of Genentech just after it had started listening to the late Bob Swanson’s aspirations and then writing about it. I have eaten king salmon in Salem, Oregon, and crab in Sabine Pass, Texas – both sublime experiences. I have stood at the door of that miracle of Minnesota, Mayo. I have gazed at Mount Rushmore and know now why those four presidents were carved. I have wept at Shiloh. I have stood in the wheel ruts of the Oregon Trail in Douglas, Wyoming. I have joined in a march to the San Francisco Tenderloin on January 15 to honour Martin Luther King. And oh, so much more!

The United States in all its diversity has been my energiser from the first time I ever went. Even in adversity, this country has always exuded optimism, irrespective of Trump.

“Make America great again!”

What rubbish! America remains great so long as it never lose its Smile, it never loses its Optimism; but above all it never loses July the Fourth and its Constitution.

If we want to replace January 26 as Australia Day…

“The first celebration of Wattle Day was held on 1 September 1910 in Sydney, Melbourne and Adelaide. Plans in 1913 to proclaim the wattle as a national emblem and to celebrate Wattle Day nationally were interrupted by World War I, but wattle remained a strong symbol of patriotism during the war years.”

This Google entry sums up Wattle Day succinctly.

One can only be struck by the colours of the Australian countryside in early spring. The yellow displayed is not only because of the wattle but also because of the canola in the broad acres and broom along the roads – there are so many yellow wildflowers but elsewhere it is the yellow of the prickly gorse scourge. So every symbol has its downside.

Intermingled with these patches of yellow is the eucalyptus green countryside – the wattles themselves, the gum trees and then there are the green pastures and cereal crops yet to ripen.

And when the land is so green and yellow should this be the time to remember our country with a national day? After all, the Argentinians, whose national day is May 25 say you can look up into the sky and see their flag. In September we would have the option of both looking up to see the Southern Cross but also to see our national colours across the land.

Even D.H. Lawrence in his rather dismissive novel about Australia, Kangaroo, wrote: In spring, the most delicate feathery yellow of plumes and plumes and plumes and trees and bushes of wattle, as if angels had flown right down out of the softest gold regions of heaven to settle here, in the Australian bush.

And what a time of the year! September is the gateway to the football finals; the cricketers are emerging from their chrysalides; and the festival finishes on the first Tuesday in November. A September 1 Australia Day would be a time of rebirth and not one stained by the metaphors surrounding colonisation and invasion.

Leave January 26 to New South Wales to work through those first years of the Rum Rebellion – and with climate change the temperature will probably be the same in September as it is now in January.

The Doctors’ Dilemma

In 1946 the Australian Constitution was amended to include the provision of health benefits for medical treatment, dental treatment, hospital and pharmaceutical benefits. Very specifically defined. In 1946 when this question was asked of the people of Australia, there was not the diversity of health professionals operating outside an institutional framework.

Therefore whenever any other professional group (apart from the dentists) wants access to Medicare, they have been blocked by the Constitution. Except that there have been a number of instances where the Constitution has been sidestepped, notably in the 1970s when optometrist benefits were introduced. It so happened that at that time there were a number of optometrists who were politicians on both sides of the House – and bingo, benefits were introduced because optometrists in the provision of these services were deemed “medical”.

In fact, many areas of medicine could not operate without the inclusion of the cost of the nurses, technicians and scientists, as occurs in pathology, radiotherapy and diagnostic imaging. The fee for Medicare benefit can incorporate a professional component (the doctor moiety) the technical moiety (including the non-medical staff) and a capital component (for the machinery). This is best exemplified in the structure of radiotherapy benefits.

However with the expansion of the Medicare Benefits Schedule after 2000, payments were made to a whole variety of health professionals through the Medicare Benefits Schedule but all were contained within or linked to medical care.

This interplay with doctors is shown by the midwife eligibility criteria:

A collaborative arrangement is an arrangement between an eligible midwife and a specified medical practitioner that must provide for:

(a)  consultation with an obstetric specified medical practitioner;

(b)  referral of a patient to a specified medical practitioner; and

(c)  transfer of the patient’s care to an obstetric specified medical practitioner, as clinically relevant to ensure safe, high quality maternity care.

There is no independent set of benefits. “Collaborative” is the closest the government legal advice has allowed given that “deeming” would be a red rag to the bull for the present generation.

However, this cute sidestepping trying to avoid the Constitutional restrictions only survives unless there is a High Court challenge.

Currently this manoeuvring does not threaten the doctor’s livelihood, but once the threat of another health professional group threatening general practice incomes then it is not only the politicians who will hit the fan.

Obviously if your basic income is government guaranteed who would not want that? The AMA is reported as being opposed to nurse practitioners obtaining Medicare benefits for their patients as with the independent stream of allied health professionals. If the government were to do so, would nursing be deemed “medical” or would the Government have to put nursing benefits as a Constitutional amendment to a referendum? With the backing of powerful nursing unions in an atmosphere ignited by the MeToo movement, any referendum would be a forgone conclusion.

Getting an amendment into the Constitution would be one achievement; it would then be a case of setting the scale of benefits. All the arguments about relativity would explode both between professions and within the nursing profession and each of the other professions included in the Constitutional amendment.

Talk about Pandora’s Box. In amongst this mayhem the central agency boffins would be tearing their hair out over the fiscal consequences of all this.

And compounding all this political noise is the proposal put forward by Shorten to set up a universal dental scheme – I shall deal with that in my next blog. Ah, the joys of policy formulation.

Mouse Whisper

The owner of the Dry Dock pub on the Finke River was heard to say to the customer in white:

“Son, when are six feet eighteen hands? Not too difficult to fathom the answer.”

Modest Expectations Fore

Golf puzzles me. However, I do enjoy fluttering around the Masters Golf Course in Augusta on the YouTube bird. A floral pilgrim arboretum with quaint names like Amen Corner and Flowering Crab apple; kaolin coloured bunkers; water courses and ponds interwoven with trees and bushes which seemed to be groomed rather than planted. The spring flowering dogwood, azaleas and magnolias provide a regimented colouration – red, pink yellow and white. The annual Master’s tournament is testimony to that Brownian movement which is America. The winner this year – an epithet for Trumpian America – tiger woods.

In contrast, every time I pass the Rosebery golf course on the West coast of Tasmania, against the mountainside away from the local zinc mine there are abundant green fairways dotted with a mixture of exotic and native trees – just varieties of green. Perfectly groomed but lacking bunkers. Never have I seen anybody playing golf there – not even a Tasmanian devil stirring – it seems a golfing Marie Celeste -an epithet for Canberra at election time.

Lessons from the Memorial Sloan-Kettering Malfeasance

The whole political spectrum is awash with promises of funding for cancer but it is nigh impossible to predict the expected outcome from the actual outcome. The ALP seems to want to provide money for patients whereas the commitment on the Coalition side seems to favour research.

Except for certain localised cancers, mainly of the skin, the cancer patient become a statistic in the survival rate – in other words the cancer patient always hopes to be at the far end of the survival curve. Increased research funding is equated to increased survival.

The current Australian election campaign is awash with promises to tackle cancer. The time-honoured political response is to promise more money for research – however it is dressed up. Politicians have always seen cancer funding as a vote winner – they can provide funding without strings and bask in the immediate kudos.

Therefore, the recent Memorial Sloan Kettering Institute disclosure is something to make everyone pause. This institute is prestigious, shorthand for “above reproach”. I have actually visited this sprawling but unremarkable bastion of cancer treatment and research on the East Side of Manhattan.

The New York Times has been progressively reporting what one may describe as “malfeasance” – corruption seeping through the upper echelons of the Institute.

The heart of the matter as reported by the NYT is that fact that “scrutiny of researchers’ stakes in start-ups has intensified at a time when venture capitalists are betting millions of dollars on the next potential cure for cancer and when expensive treatments like immunotherapy have fueled public concern over rising drug prices.”

As reported in the NYT, a review, conducted by the law firm Debevoise & Plimpton presented a week or so ago concluded: “that officials frequently violated or skirted their own policies; that hospital leaders’ ties to companies were likely considered on an ad hoc basis rather than through rigorous vetting; and that researchers were often unaware that some senior executives had financial stakes in the outcomes of their studies”.

There has been a great amount of public soul searching, but it seems that despite the list of questionable activities at the Institute most if not all those with fingers in pie have survived and the cosmetic changes and promises to do better have not been matched by deeds. The excuse is that culture change takes time, but when the direction of research becomes a branch of a hedge fund, then in the long term the effect is that of a “warm lettuce leaf” sanction.

However, when the scandal emerges in a leading institution in USA, it is reasonable to assume it is not an isolated example. The problem is that anything to do with health is now a business and health is just one commodity on the sprawling profit and loss sheet. Aiming to save lives in the most effective manner – an incidental – is met with guffaws by this coterie. So let the policy makers shed the faux Pollyanna approach to research funding, knowing how difficult it is to remove emotion from any decisions – hence this is an area where any policy makers worth their salt should follow the money trail – and hopefully not end up finding a Memorial Sloane Kettering Institute at the end of the trail.

Howard Florey, our greatest Australian, the man who gave penicillin to the world would have shaken his head in disbelief. He never benefited from the discovery; never made a buck out of a drug which saved millions of lives but ironically changed the fortunes of the pharmaceutical companies who picked up the patent.

After all, infectious diseases were the cancer equivalent of the day. Lest we forget. 

The Out-of-Pocket Expenses

Cancer is multifactorial; it is an expression of everyone’s mortality.

We, the patients have to bear the brunt; and given the mortality surrounding cancer that brunt is so often deadly.

Pancreatic cancer in particular has a five-year survival rate of 7-8 per cent; and that is survival not quality of life.

Some unfortunate people get multiple cancers – just not metastatic spread. Many cancers are terminal. Treatment is surgical, radiation, or chemotherapy – cut, irradiate, poison. There is nothing pleasant about cancer; and if you emerge from this experience and are presented with a huge bill then it adds to the unpleasantness.

One approach to alleviating the burden of cancer is to improve the funding of the actual care, and that seems to be at the heart of Shorten’s stance. Minimise or eliminate the out-of-pocket expenses. However, apart from waving a few figures around, the implementation is just that – short on detail.

There are number of matters which need to be balanced – the Medicare benefit the government is prepared to pay and the fee the doctors charge. The figure of $150 has been mentioned as some extra payment. What does that mean?

Inevitably as one grows older, one is faced with the prospect of surgery. As a privately insured patient, I always ask what will the whole business arrangement known as “operation” cost.

What is the price? How much will that vary from (a) the MBS benefit (b) the amount guaranteed by my level of health insurance? The surgeon is responsible for the whole episode including post-operative management no matter to whom he or she may delegate it.

There is the anaesthetist – the person who suddenly appears before the operation at the behest of the surgeon. Since the surgeon hires the anaesthetist, it is reasonable for his or her price to be disclosed.

Then there is the surgical assistant – often a supernumerary – but who has to be costed in and someone the patient probably never sees. “Is that person necessary?” is the obvious question.

The same occurs with pathology – the pathologist is rarely seen – and diagnostic imaging, where the patient may see somebody vaguely resembling a radiologist.

Then there is always the matter of complications to be factored in and therefore the total cost before anything else needs to be agreed. The patient should not have to bear all the risks.

Similarly there needs to be a price put on the radiotherapy or chemotherapy, with may occur in association with surgery or independently.

Then there is the unknown – the cost of palliative care. Unless, you the patient are demonstratively terminal, it is not something the average cancer patient wants to think about. But nevertheless it entails a price; dying from cancer is not cheap.

When you buy a house, you don’t buy it room by room. Therefore, for that purchase knowing what you do, what your entitlements are and then negotiating from a solid basis breeds a degree of certainty. If you as the buyer feel this task is all too daunting you get someone you trust with the appropriate knowledge to do it for you.

Buying a property and assuring health are no different in needing a broker than any other commodity.

Now try and translate that into what the political parties are suggesting as health policy. This area is complicated by the current review of the Medicare Benefits Schedule, which has been going along for four years but with an end point in creating a new MBS schedule without putting any value on any of the items. Alice may well be asking where is the tea party.

Yet the ALP has a proposal putting finite values on patient reimbursements and injecting them into health care financing. Pluck a figure from the policy teapot to give to the patient as an added benefit, and the market may absorb that benefit and the price for the service commensurately rises.

The current state of affairs is not the best situation in which this policy initiative is being put forward – private insurers put up their premiums, doctors charge what they believe their services are worth or what they think the market will bear, the central agencies of government hover to squeeze the value of the benefits.

Let us set out a premise. Once diagnosed, cancer treatment in our affluent society should be cost free to all. Having made this statement it is tempting to think that premise too fanciful. However that is the challenge and just throwing a consultation benefit or subsidising one piece of equipment to the exclusion of others does nothing to solve the problem.

It would be useful if the patient could choose a one-year or five year survival package with named participating doctors, health facilities and health insurers who would accept the package based on the mean expected survival. The actual projected expectations should balance out the assumptions underpinning the package. The assumptions should be made clear. Work on the basis that whatever figure, however fair and reasonable will be inevitably wrong; so err on the side of generosity.

This is not fanciful – there are arrangements where surgeons label them selves as “no gap” when linked to particular hospitals with arrangements with health insurance, but it is patchwork – sometimes quite attractive patchwork.

However, it does not absolve government, and when politicians enter funding for cancer, there should be a plan to give the cancer sufferer a non-transferable amount of funding either in a one or five year package according to the expected price of such service – realising that currently MBS benefits provide a de facto floor price – the public hospital provides a guaranteed government funded place. Private hospital insurance premiums and the AMA list of recommended fees provide the other end of the price spectrum. Work between those two limits and determine the fund holder. In the end if information were symmetrical it should be the patient and his or her family, however defined.

The resultant cost accounting exercise should not be beyond the wit of a smart bureaucracy. Absolve oneself from the clutches of the external consultants to do the work. Have a team dedicated to the task – not as happens all the time continually shift the bureaucrats around to destroy any continuity and thus disrupt the timetable.

Do not let the work of this well-intentioned attack on cancer meander for years. Have a very concise timetable – three to six months. There is enough information. It is a matter of distilling the options. Go to it.

Mouse Whisper

Overheard on Big Rat Island:

“Whose idea was it to change the Island’s name? Totally inappropriate! Kerr was not big.”

“But you forget the top hat, mate.”