Modest Expectations – At Last Michael Bowlby

Kizzmeika Corbett

Have you heard the name Kizzmeika Corbett? Well, this 35-year old immunologist is a very significant person. A leading researcher on coronavirus spike proteins and mRNA vaccine technology long before the COVID-19 pandemic emerged, Corbett’s work proved critical to developing a coronavirus vaccine in record time. For a year and a half, she worked around-the-clock alongside her team at the National Institutes of Health (NIH), where they developed the vaccine in collaboration with Moderna.

A native of North Carolina, she early showed her innovative scientific mind. It should be added that although it is very rural, part of the tobacco road mythology where the leaf was king, North Carolina is a powerhouse in medical and health-related research, particularly at the University of North Carolina in Chapel Hill and Duke University in Durham.

After a period working on dengue fever at Chapel Hill (with field work in Sri Lanka) and her PhD having distilled immunology research into that virus in 2014, she went to work at the NIH.

Here she attracted the attention of the Head of Faculty, Barney Graham, and was appointed to lead the coronavirus research team, meaning that years before the Virus became a pandemic, Corbett was laying the foundation that would one day allow immunologists, herself among them, to quickly formulate a vaccine against the ever-changing coronavirus.

She has become one of just a handful of scientists around the world with expertise in the viruses’ distinctive spike proteins and antibody responses — knowledge that made it possible to quickly develop and deploy vaccines.

It should be noted that the use of mRNA in making vaccines had been around for 40 years, but the breakthrough came when a protective coating for the mRNA was discovered, since injected mRNA without such protection was destroyed in the body.

In her matter of fact way, Dr Corbett describes her work.

My contribution was helping to design the vaccine, leading the preclinical studies that informed the Phase I clinical trial and designing assays used for testing of clinical trial samples.

The quest in early January 2020 was to gear up. We started ordering all the things that we needed around animal experiments. We mapped out a plan. I started assigning roles to team members.

If you want to go fast in a pandemic, then messenger RNA (mRNA) is a shoo-in. It can be manufactured very quickly in very vast quantities, and you can essentially just swap out the protein once you have the system down. We collaborated with Moderna so we could get the system down pat.

Recently she decamped to Harvard as an assistant professor at T.H. Chan School of Public Health. “Assistant” is not far up the academic ladder, but like many who wish not to be overburdened with administration nor become what we used to call in Australia “Qantas professors” because they flew from conference to conference wringing as much as they could from their research.

She is therefore still the epitome of the researcher working long hours with a partner who is the assistant dean in the same school. It is not an uncommon set up, with two people intensely committed to research developing deep personal relationships to compensate for the long hours in the laboratory which research imposes. Having a partner able to share the language in which your research is couched – to understand what drives you, in this case someone who is really changing “the shopfront of society”, and not just moving the manikins around to provide an appearance, rather than effecting true change.

A year ago or more, who of the general public had heard of mRNA technology. On December 8 last year, the first dose of a COVID-19 vaccine outside a clinical trial was given. We’ve moved a long way scientifically in combatting the Virus but it is clear that our social structures have not been so successful.

Dr Corbett had already tried to change that situation, and in so doing, she fell foul of former President Trump. However, it is clear that within Dr Corbett there is more than one messenger RNA.

Such a little disease…

Rubella

Once, rubella was a scourge of pregnant women. It was a very mild disease. In fact, rubella wreaked havoc in the first trimester of pregnancy. It was very transmissible . It was also known as “German measles”, because of its fascination for German physicians in the 19th century, and measles because it caused a rash. Measles comes unremarkably from the Old English, meaning “many spots”.

An Australian ophthalmologist, Norman Gregg, first described the association between rubella and birth defects.  As reported in the Australian Dictionary of Biography: His alert clinical observations and inquiring mind enabled him to make his outstanding discovery about rubella. On 15 October 1941 in Melbourne he delivered a paper on ‘Congenital Cataract following German Measles in the Mother’ to the Ophthalmological Society of Australia which was published in its Transactions. 

My clash with the Virus came twice, in 1964 and 1966. I cannot remember having had rubella, but as happens when you least want it to happen (sound familiar), I was exposed each time to a patient with rubella.

It was a time when a rubella epidemic was sweeping Europe and the United States. During that short period in the USA there were 12.5 million cases of rubella. In the USA, 20,000 children were born with congenital rubella syndrome (CRS)). Of these 11,000 were deaf, 3,500 blind, and 1,800 intellectually disabled. There were 2,100 neonatal deaths and more than 11,000 abortions – some spontaneous miscarriages, and others “performed surgically” after women were informed of “the serious risks of rubella exposure during their pregnancy”.

It so happened that in each of the years, 1964 and 1966, I was exposed to rubella in the course of my medical practice – as a first year intern and then as a pathology registrar. I also did a number of locums during those years.

Prophylaxis against rubella was injection of gamma-globulin. In the case of rubella, one was not spared – 10 mls into each buttock and five into the right arm. Being injected with a needle of a gauge that you could probably run a train through, left me with a painful legacy. However, two boys born normal was a no-brainer in terms of receiving the gamma-globulin injection during my wife’s first trimester.

The rubella virus had been isolated in 1962, and a vaccine followed in 1969, which was incorporated in the vaccination schedule a year later; and the virus has all but vanished now.

I do remember that one of the members of the Students’ Representative Council Executive probably had been a victim of CRS. Her sight was compromised, but we never talked about it, and although she fell into what some would say, the FLK basket, in retrospect her sheer ability, her doggedness in getting things done, yet her innate kindness belied her disability. In retrospect, with all my other colleagues on the Executive, I was a medical student. The other males were law, engineering and architectural students, in those days when men were kings and women were not, she earned respect. And for God’s sake, she was a social studies student!

I lost contact with her after university. She has long since died. Yet when I starting writing this piece, I suddenly realised how much we took for granted about this remarkable women. But then I muse alone. All the other members of that Executive, whose memory I treasure, are dead also.

However, my sons, I still remember the injections, well worth it, but hardly a treasured memory. 

Snottites

As I probably mentioned in a previous blog, I accumulated New Scientist magazines, even though I never had time to read them.  After I started writing the blog, as the magazines were conveniently stacked in the office, they served as a source of some of my material, even though some were 20 or more years old. Most of the issues came in an era before the modern technologies, and therefore there was a certain quaintness.  Having fulfilled this purpose of providing source material, I broke the link which bound me in this state of habituation and threw them out.

Now I am down to my last few. One of which highlights the snottite. If there were a word which immediately disgusts, “snottite” would be a major contender.

Let me put it in context: This place stinks. The rotten-egg smell of hydrogen sulphide hits before you even enter the mouth of the cave. Acid drips from the walls and ceiling. Slime coats the rock with coloured blotches like ghastly gelatinous wallpaper. And then there are the “snottites”, white, wobbling versions of stalactites with the consistency of phlegm.

The snottite is a mixture of gypsum and sulphur, with bacterial activity within them which ensures a stalactite appearance stretching as far as half a metre from the ceiling of these caves. This is the sulphurous environment of the underground where even Orpheus and Eurydice wore gas masks.

The bacteria cause a coating of slime to develop over these calcareous formations. The slime forms curtains and loops that some liken to mozzarella cheese. Some slime is red in colour; some white or black. At the tip of these snottites drops sulphuric acid with a pH of 0.5. This is a hazard for cavers, where a drip on the t-shirt can burn a hole, not to mention the damage if a drip directly hits one in the eye. The skin is bad enough. Just as a comparison, battery acid is 0.8 pH; thus, snottite sulphuric acid is twice as strong.

These snottites exist in a set of caves where life is perpetuated through the metabolism of sulphur. The original cave where they were discovered in the Mexican State of Tabasco was the Cueva de Villa Luz (The Lighthouse Cave). Its name came from holes in the roof of this cave which let the light in; it was a traditional place for religious ceremonies, at least at the mouth of cave.

Lechuguila Cave

Then a guy called Jim Pisarowicz, a caver from South Dakota, explored deep into the cave in 1987 and found the snottites. That cave system is two kilometres long. However, the simultaneous discovery of the Lechuguila Cave in New Mexico, stretching 140 kilometres in length and at a depth of 500 metres, in one word dwarfed the original discovery of life in a cauldron of sulphur. Recently these sulphurous caves have also been found in Wales and elsewhere.

Under the microscope a snottite contains a dense mesh of fine bacterial filaments embedded in a mess of sticky polysaccharides that form sulphur crystals. Many of the bacteria oxidise the sulphur, but others devour these organic compounds. There are also higher organisms which consume the bacteria. One researcher has distilled the observations into a “consortium based on sulphur metabolism”.

There are fish called mollies which survive in this extremely acidic environment, even though the mollies deep in the cave were somewhat different from those at the mouth of the cave.

What does it all mean?  One supposition is that if there is such subterranean activity on Earth, why not on Mars. Not sure where it gets you – except to make sure your t-shirt on Mars can withstand acid burns.

What I find amazing is that we humans co-exist with a world where sulphur is the essential ingredient. But then, what is Hell?

Personal Irresponsibility

Janine Sargeant MPH

“Just off phone to Aussie friend who visited Germany. Testing station on every corner: takes five minutes, walk in, no line, results in 3 hours at the most. And they can do 80 million daily.  A twitter observation

 On December 12th I wrote the following email. I didn’t send it and have just found it saved in my “drafts” folder:

  • Did you see today’s numbers by the way – bloody awful – 800 in NSW? Perrottet better get onto this PDQ or we’ll have thousands of cases a day and be locked out of the rest of Australia again.

I looked at this draft email on the 26th, just two weeks later. On the 26th, the case numbers were 6,310. What happened in those two weeks? It was two weeks of Perrottet’s Christmas gift to NSW; throwing public health caution in the bin along with the used Christmas wrappings. No abundance of caution, just an abundance of Omicron, although he can’t sheet home all the blame to that variant. Masks off, QR codes gone, social distancing ditched – packed nightclubs, parties and raves in!

Today is the 30th, there are 70,928 active cases in NSW and the new cases up to 8.00 pm on the 29th are 12,226. That’s exponential growth in anyone’s book.

However, the Premier has told us not to worry about case numbers anymore; worry about hospitalisations instead (and those numbers are also now increasing exponentially). Sure, but what about all those people linked to cases who are now in isolation. If you assume a ludicrously low average of one per case, that’s over 140,000 in isolation; assume half a dozen, that’s getting up towards half a million people in isolation; where do you stop? That’s a lot of people who can’t leave their houses, who can’t work – perhaps in one of those hospitals with burgeoning numbers of COVID cases – and a lot of people sitting at home and wondering just what happened in the past two weeks.

Further, the time now taken to be advised of proximity to a “case”, courtesy the recently ceased and more recently-partly reinstated QR code, has blown out to 4-5 days. By which time you may have been out and about with COVID, given that omicron has a median incubation period of 3 days.

The “testing debacle” means that people in isolation who have needed tests on day 1 or 2 and then day 6, were likely to end up having their day 6 test before they even got the results from their first test. What a waste of time and resources. The most modest of Christmas arrangements were thrown into disarray with hosts packing up the Christmas fare and taking to the road to deliver “care packages” around the city to isolating family members. One of our family members recently turned up to a testing centre at 7.30 am and was told there was already a six hour wait – and that was in Melbourne, not Sydney. Have we demonstrated that with 6,000 plus daily cases (and who knows how many people wanting a test so they can go to Queensland), we have effectively broken the NSW Government’s testing capacity? All we can say now is thank heavens Queensland and Tasmania have just announced the removal of the PCR requirement from 1 January otherwise testing in NSW would be completely crippled. Although replacing these tests with Rapid Antigen Tests (RATs) is presenting its own difficulties with supply.

Endless testing queues

At 6,000 cases a day and with State border crossing PCR requirements, the collection centres have been overrun and pathology labs are days behind despite working round the clock; inevitably, errors have crept in. Positive results require double checking which significantly slows down the test processing so as case numbers grow, the pathology response inexorably slows down. No matter how meticulous a laboratory’s quality control, systems and people under extreme pressure inevitably result in human error. So nearly 1,500 people have received wrong results in the past week; of these around 900 have now had their negative results rescinded, having been out in the community for days.

Happy Christmas NSW from Uncle Dominic

Did anyone foresee this? Where are our public health experts? Go forth and multiply the cases, says the Premier; go on holidays, go to your parties, and that’s exactly what has happened. The younger citizens have partied and raved into the night on the back of their vaxxed status and we’ve seen some spectacular superspreader events. Next, we have New Year’s Eve and then an Ashes Test; mercifully, if the Melbourne test is anything to go by, that game will be mercifully short, but just long enough to fill the new year’s COVID coffers to overflowing.

Twenty thousand cases a day and half a million in isolation in NSW by New Year’s Eve? Not beyond the realms of possibility. Happy New Year from the NSW Government. According to Premier Perrottet “it’s all going according to plan” as long as you don’t disappear into the shifting quicksand of Government COVID policy. Plans are meant to prevent chaos, not create it.

On the 30th we have now seen a change in the rules of isolation and the Prime Minister telling us we have no right to line up for a COVID test if we don’t have symptoms. Hopefully all those industries requiring employees who have been in isolation to have negative PCRs are changing their policies now as well.

And what about those RATs that you can’t find for love nor money? It’s the only time in my life I’ve gone into a pharmacy and asked if they have any RATs for sale. COVID – a whole new world.

Hazzard with two “Z” – The Alchemist from Wakehurst

Unlike the previous writer, I had been going to let the stupidity of the NSW government in relation to the Virus go through to the keeper. There are enough satirists, with an eye to the ridiculous – the antics of the Premier Pirouette. Coupled with those of Morrison, Australia potentially has a marvellous export – the Fountainhead Circus.

Thinking through what Minister Hazzard had said, what would have happened if a State Health Minister had said during the polio pandemic – “It’s inevitable that everybody’s going to get it?” You could barely hear this Metaphor through the swishing of iron lungs and the clanking of braces attached to children’s limbs.

What do you think vaccination is for, you chump?

The idea that it is a good idea to let epidemics “rip” so we can get the illusory herd immunity, is arrant nonsense. The one thing you and I share, Minister Hazzard, is that our ancestors survived among other things the Black Death. However, there were many other perils our forebears weathered so that you and I could walk on this dry and dusty land.

Even in the time of our forebears, they went to the country from the city to evade the plague bacteria that lived in the flea that lived on the rat that the sailor jacks bought from the city seaports. As you sat on that estate balcony, oh God that dreadful Pirouette is coming up the drive, fresh from sailing back from the Levant. He calls out – “no worries, I have perfumed the air in which I travelled to rid us all of the miasma.”

“Must not stand in the way of unlimited travel”, he adds.

Our parents dodged the Spanish flu, and even the worst estimate at a time when there was no vaccine defence against the Virus but people wore masks was only 5 per cent of the population. The influenza virus comes and goes as a pandemic, and I know I have had it. But according to the Hazzard dictum, why bother vaccinating – we’ll all get it. Nevertheless, there is a new vaccine annually tailored to the particular influenza strain which provides partial immunity. I will take it anytime to avoid the Hazzard spread.

So, Minister Hazzard, let us also dismiss that little reported diphtheria epidemic that your parents dodged in the twenties, to be saved by the arrival of a vaccine in the early 1930s. Of course, your parents were lucky to dodge Spanish flu. Both Spanish flu and diphtheria wreaked havoc, especially among children, as your parents were probably then.

But they are different (diphtheria caused by bacteria and flu a virus), even though both have vaccines to control their spread and hence confound the Hazzard Rule of “everybody will get it”. Diphtheria is caused by a bacterium, and the arrival of antibiotics in the 1940s has curbed a bacterial pandemic taking hold.

The population gave up on flu pandemic measures because they were “tired of them”, and paid a heavy price

Influenza continues to present a hazard, as I suspect coronavirus will be, also requiring a new vaccine variant annually, although frequency for such vaccine administration remains unclear.

And there is also the matter of “long COVID”. If I had lost my sense of smell and taste, if I were young, I would be looking at my future with trepidation, because the nerve fibres of the olfactory cranial nerve enters the olfactory part of the brain near the optic chiasma. Therefore, the virus is very close to the brain when it infects the olfactory nerve, and the course of post-viral brain syndromes is well recorded. I have personally had a family member with such a syndrome with devastating, life shortening effects.

I shudder when Hazzard’s comments echo down his corridor of ignorance.

Thus, the voice of Minister Hazzard may also reflect a politician overwhelmed by bad news and in effect surrendering. Time for you to do the right thing and take a rest, murmuring herd immunity as you drift off into stress-related sleep.

I’m sorry, but you are just not capable for whichever of the above reasons, but then some politicians never get it! I suspect you are one of them.

On the other hand, this seems sensible…

Reprinted from the Boston Globe with thanks.

With cases of Omicron surging nationwide, you may be wondering if that runny nose or aching throat is a dreaded case of COVID-19 that’s finally tracked you down, or if it’s merely a symptom of the common cold.

On top of that, the flu virus, which had all but vanished last year as the pandemic gripped the nation, appears to be making a comeback, according to the latest data from the Centers for Disease Control and Prevention. 

Distinguishing between it all can be hard, and finding a COVID-19 test can be harder. Here we try to break down what we know about Omicron symptoms so far (remember, much is unknown this early in the outbreak) and how they may differ from the common cold and flu, or even from the previous variant, Delta.

Omicron is now the dominant variant in the USA and is spreading at a rapid rate, with cases rising about 23 percent in the past two weeks or so alone, according to data from the CDC. The variant has an unusually high number of mutations, some of which may be enabling it to evade immune protection. And early data has demonstrated that it is about two to three times more transmissible than the Delta variant. As a result, many, including those who are vaccinated, are likely to test positive for the virus.

Because the variant is a relatively new discovery, scientists are still studying the severity of illness and what symptoms it will bring — and if they vary from other strains. Some hopeful news arrived this week, with three teams of scientists, who studied the course Omicron took in South Africa, Scotland, and England, releasing preliminary results that showed infections more often resulted in mild illness compared to those from the Delta variant before it. The findings suggested those infected were less likely to be hospitalised, but there were caveats.

Preliminary reports indicate that those infected with the variant generally display similar symptoms to those who have been infected with either Delta or the original coronavirus. 

Data scientists with the health company Zoe used the most recent data from London, where the prevalence of Omicron is higher than in other regions throughout the United Kingdom, to analyse symptom data and compare it with data recorded in early October when Delta was dominant. The analysis found no clear difference between the two — and only about half of people experienced “the classic three symptoms of fever, cough, or loss of sense of smell or taste.” The top five recorded symptoms in both periods were a runny nose, headache, fatigue, sneezing, and sore throat. They tended to be “mostly mild” and “cold-like.”

In the United States, possible symptoms of the coronavirus listed by the CDC include fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, the new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhoea.

When Delta became the dominant variant and led to an uptick in cases, cold-like symptoms became more common, as the lead scientist in the ZOE COVID Study noted last week. It appears to be the same case with Omicron, and some of the key symptoms first seen earlier in the pandemic — namely a loss of taste and smell — are not as typical.

An analysis published by researchers in Norway following a small Omicron outbreak among “fully vaccinated” people found that only 23 percent of patients reported a loss of taste, and only 12 percent reported a loss of smell. Meanwhile, a runny or stuffy nose, fatigue, cough, and a sore throat were the most common symptoms.

Early evidence also suggests that Omicron is less likely to spread deep into the lung tissue, despite it replicating in the upper airway quickly, which could help to explain why infections may appear milder. A study undertaken by Hong Kong University researchers found that replication of the variant in deeper lung tissue was more than ten times lower than the original of the virus.

It should also be noted that, according to data collected by ZOE, the symptoms one experiences can vary depending on vaccination status. 

Both the flu and the common cold are contagious respiratory illnesses that share similar symptoms despite being caused by different viruses, according to the CDC. In general, flu symptoms are more intense and begin more abruptly, while colds are usually milder and do not typically result in serious health problems.

The symptoms of the flu, according to the health protection agency, can include muscle or body aches and “fever or feeling feverish/chills.” It can have associated complications. Meanwhile, people who have a cold tend to have a runny or stuffy nose.

Compared to the flu, COVID-19 can cause more serious illnesses in some people, according to the CDC. It can also take longer for people to experience symptoms and they can be contagious for a greater period of time.

The CDC also stressed that because some of the symptoms of both the flu, the coronavirus, and other respiratory illnesses are so similar, testing is required to “tell what the illness is and to confirm a diagnosis,” especially because people can be infected with both the flu and COVID-19 at the same time.

In short, for those looking to determine what they are sick with for travel or planning purposes, public health experts recommend getting tested for the coronavirus beforehand.

Mouse Whisper

As I was slouching towards Mousehole these words came out of the ether and flattened my nose. 

I think we are well advised to keep on nodding terms with the people we used to be, whether we find them attractive company or not. Otherwise they turn up unannounced and surprise us, come hammering on the mind’s door at 4 a.m. of a bad night and demand to know who deserted them, who betrayed them, who is going to make amends.”

Rest in peace, Joan Didion. For there will be no more 4.00 am calls, but I know what you meant. Life is indeed complicated.

Joan Didion

 

Modest expectations – The Physical Basis of Personality

Friday, April 13, 2029, will be a showtime for asteroid Apophis, for the general public and astronomers alike. Apophis will come so close that it’ll be visible to the unaided eye alone; something that almost never happens with asteroids. It will appear first in the Southern skies and seem to streak across the Pacific Ocean and America before orbiting off to outer space. During this time the Earth’s motion will cause the asteroid to shake if not stir.

Apophis

Apophis is 320 metres across and if it struck the Earth it would have a circumferential destructive effect of several hundred kilometres from where it hit.  Instead, it is predicted to miss by the predicted 13,000 kilometres.

The asteroid first attracted community attention in 2004 when its orbit, in relation that of Earth, became a matter of controversy. It should be noted that Easter day in 2029 falls on April 1.

Endangered Elements

The idea that there are endangered elements that could face a severe shortage in 100 years does not warrant the interest of other “endangered species”. There are nine listed as “endangered”, which sounds quaint when the world is failing because of the atmospheric pollution due to other elements – notably the products of the ubiquitous carbon and nitrogen.

In any event, the “endangered” nine are arsenic, gallium, germanium, gold, hafnium, helium, indium, tellurium and zinc.

Indium was an elusive element and it was not separated from other metals until 1863. It was named indium because examination of it spectroscopically showed a very prominent indigo spectral line.

In May 2007, the New Scientist reported that a material chemist at the University of Augsberg in Germany reported that the world would run out of indium within ten years. The price was over $1000 per kg at the time.

Fourteen years on, and the world has not run out of indium. Most of the indium is stored in China. Its price does not appear on most stock markets as only about 800 tonnes is produced each year. A particular platform underwritten by the Chinese government tried to corner the market, by stockpiling tons of the stuff – and then despite an artificially created shortage found that the price which had soared to its highest level in 2005, fell which is not what it was supposed to do.

Indium is alloyed with tin and oxygen to form the transparent, conductive oxide that coats the screens of TVs, mobiles and laptops. The element is also used in infrared lasers that transmit data down optical fibres that enable the Internet. In combination with gallium, it is used to make the LEDs that backlight screens and are increasingly used for domestic lighting.

Indium (atomic no 49) has the unusual property when molten of clinging to (wetting) clean glass and other surfaces; this makes it valuable for producing hermetic seals between glass, metals, quartz, ceramics and marble. Its use has given it an aura of indispensability, but as with the 1972 MIT thesis adopted by the Club of Rome that the world would soon run out of crucial resources, this did not eventuate. The world is now more concerned not with quantity but with the quality of the output. Indium as the elemental metal is toxic if ingested; left in the ground it remains locked up, even if it is becoming an “endangered species”.

Predictions of it becoming an extinct species have been revised upwards and the new prediction is now 2025. However, indium is being recycled and even other elements such as silver which are more plentiful have been substituted in manufacturing. Thus, all the world can breathe a collective sigh (at least among the cognoscenti). Indium may remain endangered but is not a metallic dodo.

I should hasten to add that does not imply that the endangered elements will disappear from the Earth completely. It means that there will come a point when the supply of these elements will be limited or when it is no longer economically viable to extract or use these elements. At such a juncture, we will have to seek alternatives, as has occurred with indium.

Arsenic always gets a bad press. A beloved poison of the mystery writers, yet once used as a medication for syphilis, it is also a contaminant of waterways because it is used in the production of gold. I find it somewhat surprising that arsenic which has been used as a pesticide, especially in treating wood in particular – rather than rats – is endangered. Arsenic is very toxic, yet I find it difficult to believe it is considered an endangered element, given how many rivers and wells are contaminated around the world – just ask those living in rural Bangladesh and Taiwan.

Arsenic is often used as a doping agent for solid-state devices such as transistors. Doping is the intentional introduction of impurities into an intrinsic semiconductor for the purpose of modifying its electrical, optical and structural properties. It seems to me the new alchemy, but it seems also that there is a degree of elemental interchangeability. It is not the inflexibility of turning lead into gold.

Some time ago, I wrote a blog on another endangered element, hafnium. Australia has some of the biggest deposits of this rare element, which is found as the junior partner in zirconium ore. Purification is very costly and, by its nature, potentially detrimental to the environment. As I have written, hafnium is used in the manufacture of nuclear reactor rods, and a pilot project employing hafnium was set up over a decade ago at the Australian Nuclear Science and Technology Organisation (ANSTO).

Where is this all going? It’s elementary, dear Watson. But only if the world lasts another century in its current form with so just many cowboys and indiums.

Remembering Latvia

I have previously written about touring the Baltic countries, and at this time when there is disturbance in the region again, Latvia has a special significance. It has more Russian-speaking inhabitants than the other two Baltic countries. Hence, it is regarded with some caution by the other two – the object of the sidelong glance.

The whole area again has attracted attention because of the current confrontation on a Byelorussian border and Poland in particular, but also Lithuania.

Latvia sits on the sidelines. Prior to COVID-19 we travelled to the Baltic countries. Below is a snapshot of Latvia, pre-COVID-19.

We arrived in Latvia and headed for the capital, Riga. One of the most noticeable aspects of this whole drive is the fact that the border changes everything. Estonia does not blend with Latvia nor does Lithuania blend with Latvia; nor Estonia with Lithuania. It is as though there is a cultural crevasse between the three countries. The Estonians relate to the Finns; the Lithuanians to the Poles. And the Latvians? They sit between the two with, as I have noted above, a significant proportion of the population Russian-speaking.

The hotel where we stay in Riga lies at the confluence of roads and away from the city.

In the park across from the hotel are tearooms. My companion looks over the variety of teas. Exotic teas? No, she will have coffee. I order a cute bowl of “rabbit food” – everything including the beans are in miniature in an appropriately small bowl. What a healthy lunch for a dwarf. As we walked away, I am reminded of the true meaning of “famished”.

There are several areas of Riga where these old wooden houses also survive. The wooden house is a characteristic feature of Latvia and I wonder how they survived the wars. They would be so easy to torch, but there are streets of wooden houses, with various degrees of decoration –mostly in brown, but blue is a favourite alternative colour – sky blue to steely blue to presumably match the changing climate.

The House of Blackheads, Riga

Latvia is the home of amber, and from the selection in a shop inside the wonderfully named House of Blackheads, I purchased a couple of pieces of yellow amber. Amber has always attracted me from the time I was a small boy on first seeing an insect caught in the fossilised pine resin.  I remember my mother had a necklace of red amber; amber is always so warm and my mother showed me that after rubbing amber with fur, the amber could attract tiny scraps of paper. It was magic to a small boy. Later I would learn that stroking amber with cloth provided for human curiosity the earliest demonstration of an electrical charge.

One interesting impression of the Baltic countries is even as their existence is threatened by Russian invasion, the whole feeling is one of a fantastical past – a surrogate home for the Pre-Raphaelite movement, where Arthurian Knights would be invited for a guest appearance at some Baltic Armageddon in a joust with a company of Blackheads.

Everywhere there seems to be evidence of mediaeval valour, varlets and knaves, clattering armour, and unmerciful treatment of the vanquished. The House of Blackheads, with its huge façade, draws on all sorts of architecture. It has its curlicues and statues on a bright terracotta coloured façade; and to honour the Blackhead name – an effigy of Saint Maurice, the black saint revered by this coterie of Knights, stands on one side of the front doorway.

The building has been razed several times, the last after the Russians destroyed what the Nazis had missed. The rebuilding program is a tribute to Latvian doggedness. Yet Latvia remains vulnerable to invasion, even though its border with Russia is not as long as the Estonian-Russian border, the latter has a better defence being mostly swamp and marshes. Even so the Estonians are threatening to build a 110 kilometres long fence.

Riga Cathedral

However, Russian influence remains in Latvia. Yet the Riga Cathedral epitomised the strong Lutheran influence and the informality of a kindergarten being located in its precincts.

One morning we journeyed to Jurmala, a seaside resort near Riga, recommended not to be missed.

Our guide pays the toll to reach this littoral enclave. Here is the Russian embassy, a quietly luxurious residence set back from the road. My companion jumps out of the car to photograph it. Our guide looks concerned. But she is back without any fusillade of bullets. It is only the camera that winks at us.

During the Russian occupation, Jurmala was a popular resort with senior officials from the Kremlin. Even now our guide says much of the property in Jurmala is owned by Russian oligarchs.

Our guide, who has an uncanny resemblance to Radar in M.A.S.H., steers us into a wooded area known as the Ragakapa nature park. Here in this reclaimed dune area, we peer through the wire fence at a fishing village which has been created complete with long boats.  The exhibit is closed –and that was that. Jurmala was yet to wake up from its winter hibernation. It is a summer resort on the Baltic with a beach, 33 kilometres long –and there are sanatoria, spas, buckets and spades.

Radar is a multi-faceted personality. He talks with the high-pitched voice of his TV twin. He tells he does this job part-time. He is Jewish and he spends his time researching the genealogy of Latvian families, Jews in particular. It keeps him busy particular at the times of the year when there are no tourists. He also claims other ancestors – a very defined group with a long history but now in serious decline.

They are the pure Livonians who are a small group now, but he like many Latvians is proud to claim Livonian heritage, given their long history as Teutonic knights. Its language is akin to Estonian and is classified as “dormant” since the last fluent speaker died two years ago. The Livonians suffered badly under the Russian occupation. Their land is where the Germans made their last stand in Latvia at the end of World War II. Retribution followed.

The Baltic States have been the stage for almost continuous conflict. Yet what cannot be denied is the beauty of the Jurmala setting with its beach, its dunes, its forested environment. And there is something both romantic and nostalgic about places where there are wooden houses.

Yet there, in all this quaintness back in the capital, there is Restorans 3. This restaurant is in Old Riga, itself a convolution of narrow cobbled streets where negotiating them is only for the expert – but eventually the taxi driver finds his way around the tangle of one-way streets and drops us off at this restaurant with its wide picture windows and a kitchen open for customers to see the virtuoso preparation.

We sit by the window. There is only one other customer, a nattily dressed Chinese man, who seems only to be drinking coffee, and soon leaves. For a time we are the only diners as we face the formidable gustatory menu. She avoids the tongue and the ox heart items. She hates tongue; and ox heart is a meat too far. While ostensibly there were five or seven on the tasting menu, by the time we have worked our way through the meal, there were three other courses –including a sorbet intermission.

As with all Baltic countries, Latvians love beer. However, there is a Riga drink – balzam. It is a black liqueur. Having been required on a few occasions when as a post-graduate research scholar to take iodine after inadvertently labelling myself with radioactive iodine, I taste the balzam. I am transported back to my heady iodine days.  It tastes just as bitter and unpalatable as iodine.

End of story: my first and last drink of balzam. Extreme bitterness is not that quaint.  Radar is back next morning; time to move on to Lithuania.

A Road past Gundagai

I first drove to Sydney at Christmas 1957. My mother had died the previous year and my father had a one-off job as a ship’s doctor on the SS Lakemba going to America. I had recently got my driver’s licence, and thus with nothing to keep me in Melbourne, I decided to go and see my cousins in Sydney. I took the old man’s Peugeot and my dog, the wonderfully frisky blue roan pedigreed springer spaniel called Smokey and a few other essentials. We made good time stopping off only for petrol and Smokey to have a No 2. He was a well-disciplined dog, nonetheless, and once was enough, he assured me.

We left early and made very good time out of Melbourne. The problem was once you got to Goulburn it was still a four-hour drive over the Razorback to Sydney no matter how many chances you took. The Hume Highway then was two lanes, and as a result of it being the busiest country road in Australia, it was where there were numerous horrendous accidents inciting lurid newspaper coverage.

Since then, I have travelled back and forth innumerable times.

I was reminded of an incident much later, when I was driving along the highway, which was still largely two-way, with still a number of difficult sections to negotiate on the way to Sydney. It was 1968 or 1969, my wife alongside me in the front and our two young children were in the back of the car.  There were no seat belts then.

On a rise some 20 kms from Gundagai, there had been an accident.  A car had left the road and struck a tree. There were several people clustered around something. When we got out of the car, we saw that there was a young woman lying on the verge. She was deeply unconscious, with terminal Cheyne Stoke breathing, and moreover there was brain visible through the fractured skull. She was near death, but there was also a child, restless and crying out, obviously cerebrally irritated. An ambulance had come and taken away somebody who one of the onlookers said to us appeared dead. The other two had been left, God knows why!

There was nothing much one could do for the woman, but the child was another matter.  There was a guy who volunteered his station wagon, and so we lifted the child into the back, and my wife who was also a doctor climbed in to look after the child. We left the dying woman. There was nothing we could do for her, but we hoped that at some stage another ambulance would turn up. Out on the highway, we had no means of communication then.

The old wooden railway bridge from the 19th century in Gundagai

So, there we were. I was in the car with the boys; my wife in the back of a Good Samaritan’s station wagon with the unconscious child. It was raining but I took a robust approach in speeding towards Gundagai. Then we came to the long wooden bridge across the Murrumbidgee River and flood plain. For some reason there was a long line of cars queuing to cross the bridge. I took a chance and with horn blaring dashed down the wrong side. For some reason there were no cars daring to cross, but right near the end of the bridge my car skidded on the slippery wooden surface. It is a situation where the sub-cerebral instincts kick in, and for some miraculous reason I did not fly off the bridge. It is a long way down to the Murrumbidgee River flood plain.

Anyway, we arrived at the hospital. Gundagai, at that time, had a strong procedural base, and our appearance caused the general practitioners at the hospital preparing for their operating theatre list to pause.

The child was bought in, and we handed his care over to the Gundagai practice. To them it seemed all in the day’s work – no fuss – just a slight annoyance of having their routine upset – we were waved away.  As for me, irresponsible, driving as I did with two unrestrained children. It was a sign of the times; I do not sweat when I remember the incident.

In any event, that was the last we heard of it, apart from me telephoning the hospital next day and being told that the child was still there, and there were no concerns. For a while I scanned the papers for a coroner’s report. There was nothing, or I missed it.

Twenty-five years later, when I was reviewing the NSW Ambulance Service, the transition from ambulance driver to allied health care professional had begun. Change is a slow process, especially in inward-looking uniformed services.

I was reminded of that escapade this week when I saw images of this 800 metre long wooden Prince Alfred bridge being dismantled, its boarded heritage clattering to the ground with a promise to retain the section which actually crossed the river. The extensive flood plain now has not only a sweeping four lane highway bypassing the town, but also, for some reason, a large dead gum tree poking above the road parapet, painted in a garish blue. Why?

By the way, I picked up my first speeding fine on my way back from Sydney in early 1958. Five pounds for fanging through Albury. The police motor cyclist caught me after I had entered Victoria. Those were the days. I did not protest, Smokey said I deserved it.

The Use of the Car as a Weapon

Iowa is one of three states, along with Oklahoma and Florida, to enact laws this year giving drivers some degree of legal immunity if they use their vehicles to hurt protesters, part of a wave of “hit and kill” bills introduced in 13 other states by Republican legislators since 2017 (as shown in the figure below). Most of those proposals came after one of the most sustained periods of demonstrations in US history following George Floyd’s murder, and the effort to crack down on protesters has sent a chilling message to activists, who believe it will encourage violence against them. – Boston Globe.

Yet another example of the reversion of America to the glorification of violence – the staple diet of American fantasy.

Marching along streets and roads has been a characteristic of protests in particular of African-Americans but not exclusively.

In the year after the George Floyd incident, The Boston Globe found across America 139 cases of cars being deliberately rammed into people. Only 65 of these have been taken to court, with only four convicted of a felony. One hundred people have been injured and four killed.   Not a huge number, some would say; but wait a minute, deliberately using the car as a weapon!

Yet the legislators in essentially very Republican states run the line of driver being surrounded by violent rioters and in trying to get away, some of the pedestrians may be hit by the car, where the driver at risk feels his or her life in danger. The thesis plays the white audience which spawned a person like James Field who, well before the George Floyd murder, in 2017 ploughed his Dodge Challenger into a crowd of demonstrators in Charlottesville, South Carolina, only stopping when he struck a white Camry, which was pushed in turn into a maroon minivan.

As was described, this young man had driven nine hours from his home south of Toledo in Ohio to be there to kill – this person was described by one of the victims, as she lay half under the car with a smashed leg, as having lifeless eyes. Fields was later convicted and given two life sentences. Would legislation to protect the driver have made any difference to the outcome for the victims? I doubt it.

Yet despite this crime, these States are endeavouring to twist the narrative to the protesters not the driver being the villains. As such, it would be somewhat ironic if such a law protected protesters at a far right rally with its pronounced anti-vaccination bias, such as those who surrounded vehicles on the Bolte Bridge in Melbourne and deliberately caused damage to them.

The problem with this legislation is perspective and from any perspective this legislation is wrong-headed.

Mouse whisper

As recounted in Harper’s Magazine February 2005

A story headlined “Syria seeks our help to woo U.S.” in Saturday’s Weekend Australian misquoted National Party senator Sandy Macdonald. The quote stated, “Syria is a country that has been a bastard state for nearly forty years,” but should have read, “Syria is a country that has been a Baathist state for nearly forty years.”

The Australian regrets any embarrassment caused by the error.

I doubt there would be any apology forthcoming now – defence in truth.

Palmyra, Syria … then

 

Modest Expectations – Vile Bodies

If you are writing a sermon, it is good to have a text, in this case from The Gospel of The Boston Globe.

At a time when climate change and those who fight it demand that coal be treated like tobacco, as a danger everywhere it is burned, Australia is increasingly seen as the guy at the end of the bar selling cheap cigarettes and promising to bring more tomorrow.

Along with koalas, kangaroos, and beaches, the country — the world’s third-largest exporter of fossil fuels — is becoming known for refusing to clean up its act.

With just days to go before a major UN climate conference in Scotland, Australia is one of the last holdouts among developed nations in committing to net-zero emissions by 2050, and it has refused to strengthen its 2030 target or make plans for transitioning away from its deep commitment.

Coal-o-phile Dundee

The country’s prime minister, Scott Morrison, only recently agreed to attend the climate summit after criticism from Queen Elizabeth II and a crowdfunded billboard in Times Square that mocked his reluctance to address climate change, calling him “Coal-o-phile Dundee.”

Australia’s inertia points to a pressing challenge for the world: how to get places that profit from a dangerous product to transition before it becomes too late. With the threat of even more damaging storms and fires looming if temperatures keep rising, a combine-and-conquer approach is required — fossil fuel users and producers both need to kick the habit.

The kings of carbon are not in a rush. A UN report recently released found that coal, oil, and gas production will keep growing at least until 2040, reaching levels more than double what is needed to prevent a catastrophic rise in global temperatures.

Australia is a major contributor to the problem. In energy terms, the continent is essentially a bigger version of West Virginia: Coal is still king, natural gas is celebrated, and the conservative government has a lot in common with Senator Joe Manchin, a West Virginia Democrat, who has blocked President Biden’s sweeping plan to shift the country toward renewable energy.

In May, the International Energy Agency released a detailed overview of what it would take to cut carbon dioxide emissions to net-zero by 2050 and keep the average global temperature from increasing by 1.5 degrees Celsius over preindustrial levels — the threshold beyond which the Earth faces irreversible damage.

Near the top of the list: end investment in new sources of fossil fuels.

Australia’s response? Yeah, nah.

The federal government still revels in Australia’s role as the world’s largest coal exporter. A report from the Department of Industry, Science, Energy and Resources last month used a medal icon in denoting the country’s status as the world’s coal leader, expected to ship out 439 million tons this year, up from 400 million tons last year.

In the last month alone, three new coal mining projects have been approved. In New South Wales, a production hub for the thermal coal burned in power plants — some of the biggest contributors to global emissions — proposals for 20 new coal mines are under review. And that does not include a giant project in the state of Queensland, where the Indian industrial giant Adani is trying to build the largest coal mine in the world.

Nor does it include Australia’s expansion of natural gas. The government plans to open at least five new gas fields, including the giant Beetaloo Basin project in the Northern Territory, which has been granted subsidies of around $170 million. The tax breaks given to the fossil fuel industry last year alone were worth more than what Australia spends on its army — and the federal resources minister, Keith Pitt, said this month that the government should spend even more to protect coal and gas.

Critics argue that it is all the product of a warped political and media culture that has spent decades doing the industry’s bidding while deceiving the public, exaggerating coal employment, and understating the need to reverse course. Federal elections are often won or lost in the coal areas of Queensland, and with another contest due next year, the coalition government’s junior partner, the National Party, which represents regional areas, is playing a familiar hand.

“For at least 10 years, they’ve been telling people that climate change is rubbish, that it doesn’t exist, that we can continue digging up and burning coal forever and a day,” said Zali Steggall, an independent member of Parliament who unseated a former prime minister, Tony Abbott, in 2019 with a campaign focused on climate. “They have a difficult job now in turning around to those communities and saying we were wrong or misleading you and we need to do this.”

Until the devastating bush fires of two years ago, Australians might not have blinked at their government’s continued support for fossil fuels. The country is responsible for less than 2% of the world’s carbon dioxide emissions.

But the Australian public has become increasingly concerned. Polls show that a strong majority of Australians want climate action even if the costs are significant and want the government to stop approving new coal mines.

There is some momentum at the local level. Several states, including New South Wales, have committed to net-zero by 2050 and more immediate emission reductions that go beyond the 26%-28% cut that Australia promised with the Paris climate agreement.

Thanks also to changes in farming practices and solar panels on people’s homes, Australia’s emissions are now projected to fall by around 34% by the end of this decade compared to 2005 levels. But that decline is still weak by international standards, with the United States promising cuts of 50%-52% by 2030, Britain agreeing to a 78% decline by 2035, and Japan pledging a reduction of 46% by 2030.

I remember the first weeks of Whitlam’s reign. I also remember the treachery and traducery of McMahon’s last year where the Government refused to confront the obvious reforms needed. And with the decay, the government leaked continually rather than made a splash, with McMahon himself the master of the watering can.

When Whitlam won the 1972 election, there was no leisurely transfer of power. He brushed the inept McMahon aside and, with Lance Barnard, with the blessing of the then Governor General Paul Hasluck, set up a temporary duumvirate.

This enabled Whitlam to immediately abolish conscription, end Australian military participation in South Vietnam and release Vietnam draft resisters from prison. He recognised Communist China and warned the United States against renewed bombing in North Vietnam.

Whitlam had a degree of courage, which I have found in only one other major politician in my experience.

I only hope that when the next Government comes to power, the person who becomes the Prime Minister acknowledges the matters relating to climate, as so clearly set out above, and sets about a clear remedy.

It should be possible through those who have paid the Porter legal bills to identify the biggest polluters in this country, not only in terms of climate change but also of the social fabric of the nation …

… and stop this disgraceful persecution of people, who are universally of colour as the modern version of non-white is now called, by releasing them from the various concentration camps, if you want to be brutally frank, imprisoning these persecuted refugees who have come by sea.

And finally, let us judge those who would loot the Treasury, and release their names. Strip away the black tape of redaction and coverup.

The overriding lesson for Australia at this very difficult time for the future of not only ourselves but also the planet – those determining the nation’s policy are just not up to the challenge. Brown nosing is no substitute for policy.

An Eloquent Statement on leaving Kinross Wolaroi School, Orange

… I believe that each and every one of us in the graduating class of 2020 has something special to offer to our friends, our family and to our community so long as we persevere. After 13 years of schooling, we will finally enter into the wider world and go our separate ways. They say that smooth seas do not make skilful sailors. This year has been anything but smooth sailing and I know that wherever we end up, we will all be well equipped to face and overcome the challenges that life throws at us. I hope that you find happiness wherever you may go in life and I wish you all the best for the future. – Edward Taylor Year 12.

In explanation, I was looking for something else and came across the magazine of this hybrid Presbyterian/Methodist co-educational boarding school located in Orange New South Wales. I don’t know whether I had ever heard of the school, but casually reading it, I came upon the valedictory address given by this young man. I wished I had been able to articulate my future at his age as well he did at the end of a difficult year. He will need all that resilience while the present clowns of climate change control his generation’s destiny and will be headstones by the time this young man will fulfill his own expectations.

George Repin

George died a week ago at 3.30pm. He was 93, and thus he had a life well lived. He was a Russian émigré from Shanghai, whose family started Repin’s coffee inns in Sydney in 1930. These were very successful, and the name Repin became a household name for a place to have a cup of tea as well as coffee. During the Depression, hard-up businessmen used the coffee shops to run their ailing businesses. American servicemen during WWII, unused to tea, found access to coffee through Repin’s – a boon. Repin’s in the fifties were the places the Push literati frequented in the afternoon to discuss how many angels were on certain pinheads.

George Repin’s father died suddenly in 1949 and George, recently graduated doctor, was midway through his residency at the Royal Prince Alfred Hospital. He abandoned his medical career for the moment and took control of the family business.

Despite being a household name in Sydney, the name Repin meant nothing to me because I was born in Melbourne, and there was a large social gulf between the two cities. I cannot remember any Sydneysider who holidayed in Melbourne. We had family in Sydney, but although we were frequent visitors, my father loving Manly and my mother having a close friend who lived in Point Piper, I can never remember Repin being mentioned. It would have been easier if I had known this when I moved to Sydney in 1979.

After the family coffee business closed in 1966, George joined the AMA and after a period became Secretary General, just in time for the negotiations to commence on the shape of the health care system following the report of the Nimmo Inquiry in 1969. The Ludecke Inquiry was where George became blooded in dealing with the Federal Government. Then the Whitlam government came to power in 1972, with its stated intent of introducing a universal health scheme.

George was an avowed opponent of governmental control of medical practice. He was also very skilled in preserving the interests of doctors, including medical incomes, while ensuring that he never confused the Federal government’s constitutional power to provide a range of health patient benefits – but not doctor’s fees. The word  “fee for medical benefit” was the mantra one used when discussing medical benefits and beware the glittering eye if you strayed into saying that the Commonwealth government had the power to set doctors’ fees.

It was not riveting stuff, but the meticulous way that George controlled such syntax meant the AMA countered the Commonwealth Health Department from implying it determined doctors’ fees. Yet I believe it was a deliberate ploy to imply, falsely, that if doctors did not charge a fee equivalent to the patient benefit, they were flouting the law.

Doctors could charge what they considered to be fair and reasonable. Incomes and prices were the responsibility of the States and I was closely associated with the referendum that Whitlam initiated late in 1973 where the intent of a “yes” vote was to transfer these State powers over incomes and prices to the Commonwealth. The referendum was soundly defeated, but it meant I was well acquainted with this division in Commonwealth powers.

The disciplined Repin approach meant that, for a long period until the destructive Shepherd influence, the power of the AMA over medical incomes was due to this one man, paradoxically through the way he handled the periodic government-initiated reviews of the patient fees for medical benefits.

As such he had a major stabilising influence on the profession at a time when there was a diffusion of medical specialties into subspecialist groups. Much of this could be attributed to the adherence to the relativities which had been built into the medical benefits system but owed somewhat to the way the various existing specialties in 1970 valued themselves. This resulted in distortions of the actual value, but it was the genius of Repin that maintained acceptance of relativities – in one word some of the profession were more knowledgeable and skilled than others in the initial phase. This self-valuation created distortions.  Yet George always maintained that a doctor could do anything, given circumstances, and somehow he was able to assure the relativities in the fees for medical benefit – no mean feat.

His resilience was tested by a severe bout of Guillain-Barre syndrome, but in true Repin style he overcame this disease, which almost paralysed him for a time, and went back to full-time work..

For most of the time during the Repin stewardship, government accepted the AMA as the sole legitimate representative of the profession. George had to juggle  differences, such as between the NSW Branch, which was essentially an employer’s organisation, and the Victorian branch with very much an industrial approach negotiating terms and conditions with the Victorian State in a number of landmark cases.

For five years from 1979 I was his Deputy at the Australian Medical Association. We were two very different individuals; he did not support my appointment, but just after I commenced, George went overseas and on return he seemed satisfied with the way I handled the preparation of the AMA submission to government, where I had the opportunity to work with one of the most highly respected and able Sydney lawyers of the time, Bob Stephens.

This gave me an early insight into how organised and meticulous George Repin was. Despite his distaste for government control, his strength in negotiation and ability to coalesce the profession around the importance of medical benefits (whether Medibank or Medicare) paradoxically ensured that his legacy was woven into both schemes. In turn, this has assured the ongoing system Australia has today, despite it having become somewhat tattered over the past decades.

Not long after I started, in early 1980, he agreed that I should take the lead secretariat role in the preparation of the AMA submission to the Jamison Inquiry (the Commission of Inquiry into the Efficiency and Administration of Hospitals). This enabled me to travel around the AMA branches and receive an early valuable lesson on how organised medicine worked around Australia. The AMA agreed to the appointment of Robert Wilson, an excellent economist and cost accountant, to assist me.

The submission was highly regarded by the bulk of the AMA grandees and more importantly for myself was that I achieved an independence within the organisation, which forged the basis of our ongoing relationship.

My relationship with George was totally professional. I do not remember having any social interaction with him. I was never invited to his home; I never even had a social drink in his office or elsewhere. He only told me one thing about his boyhood. It has stuck with me. On one occasion when at Scot’s College, after being bullied, he hid behind a fence and threw rocks at his tormentors. I bet he was accurate, but I didn’t quiz him.

Always combative though our relationship was, he imposed a way of handling circumstances which proved very valuable. I wish I had had him as a tutor as a young man as he would have imposed an intellectual discipline, foreign to my instincts but I suspect very Russian. Our politics were so far apart, but only rarely did they disturb our relationship, and as someone commented if we happened to be on the one side, which occasionally happened, nobody could stop us.

At the outset I said I would work there for at least five years, as the superannuation arrangements were second best only to Qantas then. In five years and one month after beginning the job, I left to set up a consultancy business. I remember George firmly shaking my hand as his last gesture. George was to work for another three years before relinquishing the post. Having negotiated the move, understandably he himself did not want to move to Canberra.

The one thing I did wonder about was why, after 1984, the periodic reviews between the Government and the AMA were abandoned with his say-so; that was George’s source of power and authority. It may be that, after supporting their abandonment, he missed them. Maybe he just got tired of Bruce Shepherd.

As for me, I had experienced one of the most productive five year periods of my life; George taught me a lot; yet I never asked his advice.  After I left the AMA I never talked more than a dozen words to him.

It was a pity because reading his regular column in the “Pittwater News” only after his death, I realised what an underlying affinity I had for George. As with everything he did, he did not waste a word.

When I heard he was terminally ill, I sent a short message thanking him. I hope he read it. I meant what I wrote.

Monterey

The challenge came. What about canneries? You’ve spent enough time in northern Victoria to know all about them. Mentioning canneries reminded me of what has been one of my favourite places to visit in the world. Previously, in one of my earlier blogs, I had mentioned the junction of the Darling and Murray Rivers as my favourite place in Australia.

After my blog, last week, on tanneries and stannaries, she had said “What about canneries and for that matter granaries!” Monterey, an easy choice!

Lying south of San Francisco, Monterey was written about by John Steinbeck. The canneries that line the waterfront are now stylish reminders of an era long gone when the run of sardines was such down the Pacific coast that catching and canning sardines became the sustenance living of many, especially during the Depression. But like so many profitable fishing industries, it died when the fish were no more – overfished in an era where the notion of conservation did not exist.

Cannery Row

We amble down Cannery Row, made famous by Steinbeck. It retains some of the old atmosphere, if not the smells of what it was. Monterey has its own “rialto”, structures bridging the road now announcing that this is Monterey Canning Row, but yet prosaically this “rialto” was only a place for offices rather than being vibrant walkways above the street.

This was one of Steinbeck’s haunts and he was very friendly with Ed Ricketts, the pioneering marine biologist whose work, particularly on tidal flows, established his reputation. Ricketts was not unlike Steinbeck in appearance, politics and living a full life, whatever that means. He was killed on the edge of Cannery Row in 1948 when hit by a train. He was only 50.

The cannery façade thus still exists, punctuated by hotels and stores selling memorabilia, but what is the most memorable at the end of the Row is the three-storied Hewlett Packard Aquarium, with the three-storied kelp forest as the first sight of this structure.

The one area where the child in me emerged was the interactive pond where one could handle the various sea creatures, the starfish and the gooey sea anemones. I don’t remember any sea urchins, but given their spikes and the care taken to ensure kids like me still had a hand after removing my arm from the water, there probably weren’t any; yet it was a tactile experience so important in tuning the senses.

Sea otters

Staying at the Monterey Plaza Hotel enabled us to see the sea otters, frolicking in the sea in the lee of the hotel, with its deck acting as a viewing platform. The sea otter’s fur, unlike that of the seals is not waterproof. Therefore, the otters have to eat a large amount of fish and shellfish daily. One’s sleep can be disturbed by the sound of those animals cracking open the shellfish as they float on their backs in the sea. One of the reasons for them becoming an endangered series was that their voracious appetites provided competition for the fishermen – and the otter pelts could also command a good price.

Like many of the places I have visited, I suspect Monterey has become one of those tourist destinations, and therefore I probably will never go back, if only to retain memories of a less tourist-infested age.

The Age of Confusion

The advent of vaccination has shown a course of action where there have been both positive and negative aspects, but moreover it has provided a window on what works and what does not.

One of the prime movers in vaccination, when the national levels of vaccination had started lagging in the mid 1990s, was Michael Wooldridge when he became the Federal Minister of Health in 1996. One of the most vocal advocates of the campaign was the late Gay Davidson, whose daughter, Kiri, had died of a complication of measles. Gay was both an influential Canberra journalist and a mother who had first hand experience of the horrific decline of her daughter from a beautiful vibrant child to a helpless vegetative state because of this rare late complication of measles.

The message was clear. Vaccinate! Now another campaign.  What has been encouraging, after a very hesitant start, is how vaccination against COVID-19 has progressed. The problem is that the early ambivalence, aided by the social media, allowed all the misinformation to gather momentum.  Fortunately, the momentum for universal vaccination that may have been slower at the outset has at last been far greater recently. The rare complications from the vaccine administration, which fuelled the initial hesitancy seem now to have been mostly cast aside as witness the successful introduction of vaccination in school children above the age of 11.

The other complication of the early hesitancy was the failure of the Commonwealth government to effectively lead the response, because it had not ordered enough of the mRNA vaccines , banking on both the Queensland version and the licensed AZ vaccine to do the job. The Queensland vaccine was a flop, and those academics who promoted it so vigorously should have been more roundly condemned than they were for their flagrant self-publicity. As for the AZ vaccine, once the production line was sorted it has been effective, if less popular than Pfizer and now Moderna.

What has been done in NSW and Victoria emphasises the desire of people to get out of prison – to be paroled – except each Premier has a huge number on parole, including a substantial number who should continue to be locked up because of their flagrant disregard of the rules. Separating this unvaccinated group for re-incarceration would be a challenge, and currently the appetite for any such action is not strong.

It is time to change reporting the number vaccinated to a more correct number by incorporating the 12 years plus age group. Presumably this is not being done because of the lesser level of vaccination of this age group. This number has been increasing rapidly and will soon not be different from the adult population.

This will be further complicated by the extension of vaccination to children aged five to 11. The White House announced (and since confirmed by the FDA) that they will soon be able to get a COVID-19 shot from paediatricians, the local pharmacy and potentially even from their schools. The detailed plans for the expected authorisation of the Pfizer shot for these younger children are expected shortly, after lengthy studies to test vaccine safety. The recommended dose will be about one-third of the adult dose. It will be interesting to see whether the TGA delays approval in Australia until just before the school year starts next year.

United States regulators have also signed off on extending COVID-19 boosters to Americans who received the Moderna or Johnson & Johnson vaccines and anyone eligible for an extra dose can now receive a brand different from the one they received initially.

From our point of view, there is a need to assure the same level of vaccination in every State (and that includes Western Australia); and the challenge of assuring the first double dose vaccination, monitoring the teenage vaccination, introduction into children and assuring an ordered booster regime needs to be answered – as does the need to factor in additional variants, such as the emerging new Delta AY.4.2 variant identified in the UK and USA. It would be useful to obtain details of the vaccination program – the assumption being we have enough vaccines and identification of recipients nationally is assured, and I mean assured, not waved away into some contract deal among mates.

May I suggest somebody think of Jeroen Weimar for the task, even if he doesn’t bob up in a general’s uniform (but look out for the coffee cups).

Congratulations, Minister Hunt, you seem to be adopting aphorisms from The Prince, in particular when the news is good: release it unto the multitude in small amounts deliberately and progressively. Apparently this ploy helps maintain the applause.

Mouse Whisper

I was talking the other day to my one of bandicoot cousins, Bullum, and the topic turned to this Virus, the one we are hopping to avoid.  I thought it was a good test of the efficacy for each of the Commonwealth funded Aboriginal Medical Services (AMS) to see how well they vaccinated their particular mob. Bandicoot Bullum said he was a bit nonplussed by those who seemed to speak for the various AMS complaining about the Government not vaccinating their mob.

He thought that it would be one of the key jobs for each AMS to get to as close to 100 per cent vaccination as possible, and only complain if they were not supplied with enough vaccine. He thought there was no shortage of supply; yet doses have been reported as going to waste. But maybe the bush telegraph would tell him something else.

He seemed to have a good point. This is now a time when the strength of the AMS can be tested, rather just being at the mercy of our brother rhetorical advocates.

Modest Expectations – Twenty of dark chocolate

Neale Daniher

Neale Daniher is a very brave man. I admire him greatly as the epitome of all that is great about being an Australian. He fully deserves the Order of Australia recently bestowed on him; he also deserves to be invested with it as soon as practical while he can still walk.

For seven years his health has progressively deteriorated. He has motor neurone disease (MND), yet he has maintained a defiance against this progressively incurable disease.  Today, he has almost lost his ability to speak. It is a terrible disease, and I know that when I developed my own disease one of the differential diagnoses, soon discounted thankfully, was MND.

The symbol for what Daniher describes as “The Beast”, with inadvertently or not its Biblical imagery, has been the ice bucket, the ice bath, the ice pool – a plunge in order to raise funds for research.

The problem is that research into the cure for motor neurone disease is at the same level as it was when I was born. Getting nowhere substantially is not restricted to MND.  I have known researchers who have spent their lives trying to develop a malaria vaccine or find a cure for Duchenne’s muscular dystrophy – to no effect. Honourable failures – the dilemma for those seeking more money for such research. That is problem personally I have in contributing money for research into this disease – poor return on investment.

Lou Gehrig

Around the time I was born, a famous baseball player died of amyotrophic lateral sclerosis (ALS), the most common form of motor neurone disease. The disease was given his name, Lou Gehrig. He too was a brave man; a film starring Gary Cooper was made of his life. Lou Gehrig died about three years after the onset when he was only 37 years old in 1941.

Now 80 years on Neale Daniher, in his time a very gifted footballer whose playing days were foreshortened by knee injuries, is dying of the same disease. The onset of his disease was when he was 53. Over seven years survival is testimony to something innate.

Increasingly, auto-immunity is being ascribed as the culprit. Auto-immunity, the tendency of the body to destroy itself when the immune system goes rogue, is the battlefield. It is an area where the disease has been victorious up to now, particularly in the case of this disease, which causes the destruction of the nerve cells that control voluntary muscular movement.

There are a few inconclusive drugs and conservative measures which may prolong life; and as long as Neale Daniher remains optimistic, then his will to live deserves every support. After all, more than 2,000 people have the disease in Australia, and the total cost of therapeutic support per person averages out as $1m. Two are diagnosed every day; two die every day of the disease.

When there is no longer Neale Daniher around fighting against destiny, let us make sure those with this terrible disease do not die alone, paralysed, slowly suffocating. In other words, strengthen palliation, help strengthen family support but do not – I repeat – do not raise false hopes of a cure.

A muddy Saturday

This is a very simple story about a group of University students who, in 1958, won the Juniors Premiership in the Victorian Amateur Football League. It was a time when there was only one university in Victoria and therefore most of the teams that we played reflected the division between “town” and “gown”, even though the diversity of the team list reflected the normal cross-section of society. The only bond between us was a desire to play football and being under 19 we were consigned to the Juniors.

The two adult teams were the University Blacks and Blues, which were in the top grade and produced a number of players for the pinnacle, the then Victorian Football League (VFL) where you got paid. The other University team for those who just wanted a game was the University Reds.

There was a hierarchy; even as 18 year olds there were a few university students who just played VFL. which, in those days, had an Under 19 nursery as well. They were just too good to play amateur football. Many were in fact champions, not just making up the then “twenty”.

There also was the Victorian Football Association which headed a cascade of suburban and country teams where footballers who had had enough of the paltry returns from playing under the then Coulter Law in the VFL, left to play and/or coach a country team. These players would receive a generous wage and were often set up as the licensee of the local pub.

Then there were the “lily-whites” – the amateurs. In the University hierarchy, this was the place where the cohort of youngsters who were not drafted into the Blues and Blacks played. Some went straight into the top teams; some oscillated between the top teams and the Juniors.

Nevertheless, the Juniors won the Grand Final, and three members of our winning team climbed onto the roof of the University Union Building. They were said to be in a jolly state when they climbed up and affixed the Premiership flag. As one said later, they did not know how they managed to climb onto the roof given the ethanol haze that surrounded them. The flag was returned early the next week neatly folded and nothing more was said.

After that year, the team went their various ways, but one person stuck in my mind and obviously the minds of many of the others, who had known him better. He was a few years older than us and had played for the University team. He was always immaculately dressed, with his signature furled umbrella, given the grounds we played on barely afforded any shelter from the Melbourne winter. He was in direct contrast to the coach, Peter Kelliher, who was a knockabout fellow who acted, as all coaches do, with a mixture of encouragement and invective.

Ian Hamilton Munro was different. He was almost the pastoral adviser to the team – a very kind and compassionate man who was always around when you were injured, when you were having a lousy game. He was a counterpoint to the coach – one person I could always picture on the side lines – often a solitary spectator on a windswept oval.

Somebody suggested that, as we approached the 50th anniversary of the Premiership, the survivors of that year should meet annually for lunch. The first, in 2005, was deemed such a success that it was decided we would have one every year, so that has occurred every year, including 2020. This cohort, then in their youthful sixties when the lunches started are now in their eighties. Our coach, having had a stroke a decade before, was an infrequent participant from early into the lunch cycle.  The immaculate Ian Munro was a regular attender, until he fell victim to old age several years ago – and then he too was gone.

Such a small group, men now who are bonded by a football premiership gained so long ago and all accepting their mortality, has now decided to establish the immortality of their achievement and to honour their paterfamilias by donating a cup in his name for annual presentation by the Melbourne University Football Club for an annual match between the now two Melbourne University Juniors teams.

The cup is made from spun brass, silver-plated. It sits on a dark tallowwood plinth around which is collar of silver-plated nickel with enough space to engrave the annual winners for the next 80 years. It was made by the silversmiths and goldsmiths that make the solid gold Melbourne Cup each year for “that race which stops a nation” – the first Tuesday in November; these same trophy makers also create the trophies for the Australian Tennis Open; they are the last such company in existence in Australia.

Munners Cup

Ian Munro might have been embarrassed, like all good generous persons who give much, but never expect recognition. However, he would have liked the enamelled crossed furled umbrellas – one black, one blue – under his name on the trophy – the Munners Cup.

Even to us well aged, he was still always Munners – not Ian Hamilton Munro. However, that name is the cup’s pseudonym inscribed on the reverse side of the plinth. A simple story with hopefully a long nostalgic tail.

Morrison – A Description in One Word

What struck me was the stony-faced Prime Minister who had been persuaded by his Mate, Mat Cormann, to attend a West Coast Eagles match. The boos around the ground when he was introduced were universal. As part of a meet and greet in the morning, he had been persuaded by one of his consigliere, the irrepressible Mr Forrest, to partake in morning PT. It was a more typical photo-opportunity to show off his eminently “daggy” self.

He does not like to be booed. I notice that he has not turned up at any of the football matches in Victoria.

The other fact about the Prime Minister is that he is not that intelligent; yes, smart in the ways of the Molonglo swamp but not particularly well read or thoughtful. Like all people not blessed with any real sense of personal identity, he is totally versed in public relations, and therefore takes the temperature of his quarry – be it Liberal Party pre-selection or Australia before doing anything; hence he leads from the rear.

His problem, and his is not unique in this regard, is to have as the rule of thumb that you never have any Ministers and advisers more intelligent than he is.  The Prime Minister has succeeded in that endeavour, with one exception. That is the recently departed German-Belgian-West Australian, a chameleon of great skill, Mathias Cormann. There is a genus of politician who, when the master rings a bell, will argue without any shame but on cue that black is white – and too many do it persuasively, all the time knowing where the career escalator is located. Cormann has shown himself to be such an engaging man.

Morrison does not brook dissent; he just cannot take it. Part of this is explained by his reliance on a Christian belief system that does not take criticism easily. Much of the Pentecostal beliefs are couched in uncompromising, simple terms, which require no thought but a belief in a literal interpretation of the Bible. This is a Book where the ambiguities of the authors have been reduced to cartoons. His father was one such believer, and here is a person who has been coached in what some would say is a heretical belief system.

Morrison’s trip overseas has been not unexpectedly revealing. The Prime Minister of Singapore, Lee Hsien Loong, gently chided him about his aggression in relation to China; and even in the matter of mask wearing he seemed to guide our uncertain Prime Minister.

The Prime Minister has been hoping to amble the world stage but having been relegated to a landing slot at an airport distant from the G7 meeting it should have warned him at the start. There are no better people than the Poms in insulting one and then being able to smooth it over once everybody recognises that the insult was deliberate, if nuanced.  The perfect word for British diplomacy – nuance!

The daggy “Scomo” image which he believes is the basis of his rural popularity – in Queensland and New South Wales – seems not to have translated as well into International Prime Minister. Here is a guy who not only threw himself at the feet of Trump but has an old friend with connections with the dark side of the web – one of those peddling those conspiratorial beliefs, which are so much of the Trump madness.

If he were to have someone close who is visionary, with ideas that he could sample, then he may not be in his current predicament – and if he did not have an adviser called Stewart.

Biden has proved not to be the doddering front man that some of us wrongly feared, but at the centre of some hard-nosed advisers, who probably worry that Morrison is a security risk – hence the intrusion of Johnson into the Biden-Morrison meeting. It would be a problem for our relations if his words “ritual sex abuse” get wide currency in the corridors of the White House. Can Biden trust that anything he says to Morrison will not appear somewhere as an unacceptable comment?

When Howard extracted special treatment in the Kyoto Protocols for our fossil emissions, the United States owed us for our support in the Bush War Coalition of the Willing; Biden owes Morrison nothing.

In relation to the domestic scene, obviously if your Government’s handout to Big Business is essentially little more than to further enrich, then the recipients of such largesse have every reason to support the current regime. It is not an unusual situation when both sides of politics are compromised, but there is a limit which the community, however rendered compliant by the Virus, will tolerate. Australia sliding into plutocracy is not a pleasant sight.

It is also helpful for Morrison that the Murdoch newspapers’ unceasingly support him, bolstering him in a constituency of flag wavers for fossil fuels and where the environment is being progressively degraded by climate denialists.  For the moment these Murdocistas are spooking the rest of the community.

However, this strange remnant from the Trump days has found the world stage somewhat guarded. As one would have expected, he was greeted in France with all the warmth that the appalling submarine contract with the French can muster. Whatever he may think privately, Macron has been polite; it will be interesting to see if he speaks to Morrison through an interpreter – or in English.  If the first, and from afar hard to know, Macron is maintaining distance so that any communications between the two can be properly interpreted, n’est-ce pas.

Another problem for Morrison is that not all the electorates in Australia are obsessed with maintaining coal mining. There are certain electorates in Queensland and NSW where urgent steps must be taken to transfer the workforce to other industries, not to bolster coal which has to be phased out if the world is to survive beyond the end of this century.

Unfortunately, Australia has a Prime Minister who is only concerned with his re-election, and his only response to climate change and the need to reduce carbon emissions is an underlined word “technology” – as if Technology is a God like Baal to be worshipped not defined. Here a throng of happy clapping followers with arms outstretched towards this Solution and repeating over and over again, “Technology. For thine is the Answer.”

Maybe I’ll wake up and blame all this on something I ate.

Aduhelm 

“I had no sense of where to turn for help, support, or even how to express the diagnosis with family, friends or co-workers. I was lost and crept further inward. There is no single handbook one can read to prepare; each journey is different, each course of the disease takes different, meandering turns—no two are alike, the experts will tell you, an observation that is clearly numbing in so many ways.”

The drug is called Aduhelm. It has just been given the all-clear by America’s Food & Drug Administration (FDA) to be prescribed for people with early Alzheimer’s dementia. As one correspondent said, for many people Alzheimer’s disease has passed through the early stage of memory loss and is not recognised until the cognitive abilities have declined significantly.

The quote above is from Mary, the wife of a journalist, Greg O’Brien who has written On Pluto: Inside the Mind of Alzheimer’s, which follows his own decline from the early onset of the disease. Her cry is clear; and there is no wonder that those families where there is Alzheimer’s disease in their midst want a cure. No wonder that news of a drug with any prospect for improvement will generate clamour for its availability – now.

Much of the excitement generated by this drug is that it is the first since 2003 to show any promise and it has cleared a path through the FDA, not without controversy, which resulted in some members of the committee overseeing its approval resigning in protest. The method of approval has also instilled a feeling of uneasiness in this blogger.

The drug is supposed to attack amyloid-beta, the protein which appears in the nerve tangle of the Alzheimer brain. However, nobody really can say whether it is the amyloid deposits which cause the disease or whether they are waste, the result of a process which leaves this protein functionally inert in the brain. Amyloid disease is one of those differential diagnoses for unexplained disease which my generation of doctors grew to know about and recognised with its distinct histological appearance on staining.

The problem is this drug, which is defined as an amyloid-beta-directed antibody reducing the number of plaques of amyloid, is that the benefits are minimal against its downside.

This is where the drug company, Biogen, which is set to make a “motza”, begins what I call the drug company gavotte. Immaculately arrayed in elaborate steps the gavotte dancers move around in intricate steps, a spectacle of elegant circles, arms waving, legs crossing, all to produce a mannered tableau.

Even the drug company’s paid expert, in a beautifully executed twirl, said the drug “potentially prolongs patients’ independence by several months, even a few years, as demonstrated in long-term study”. She said it is a “stepping stone for our next advances” gracefully executing a series of fluttering steps.

The consumer is transported into a trance, ignoring any side-effects, asking the government to make it universally available. Biogen proposes a charge of USD4,312 per infusion “for a patient of average weight”, or USD56,000 per year.

The Institute for Clinical and Economic Review, in a somewhat bizarre statement, has said Aduhelm should cost no more than USD8,300 per year, given the “insufficient” evidence supporting its benefits in clinical trials.

Dancing the gavotte …

Biogen has defended its pricing strategy, noting that the U.S. dishes out about USD600 billion in direct and indirect costs for the disease that affects roughly six million Americans. Now that is a beautiful sideways gavotte movement by the drug company.

Biogen plans to target between one to two million patients with early onset symptoms, executives said last week. The company, generous to a fault, says it won’t raise the price over the next four years.

It should be noted that this drug can only be given as an infusion in a healthcare facility; and then there are the side effects of brain swelling and bleeding, all factors to be integrated into the patient’s health status, a patient status which is directed only one way – down.

When the gavotte is transferred to Australia, it will be greeted by a solid history of successful lobbying for drugs of questionable benefits. First, there is the special pleading, which is always highly personal as one would expect. Ron Walker, the flamboyant businessman, was an influential example of this in his quest to have an experimental drug, Keytruda included for the treatment of melanoma, of which he was a sufferer. His influence on the then Minister saw the placement of this drug on the Pharmaceutical Benefits Scheme (PBS) for his particular indication at a per patient cost of $4,500 every three weeks for two years.

He achieved his goal; he died in 2018 with the benefit of an average life expectancy increase of 12 months over the cheaper chemotherapy. Not sure about the quality of that life extension. Nevertheless, the drug can now be prescribed to other cancer patients following the largesse of the current Minister, who provides a taxpayer subsidy of $120,000 annually per patient so entitled. Has Ron Walker’s intervention been cost-effective – or just costly?

The drug companies and their shareholders have a different requirement – profit at all costs. Lobbyists hang round drug companies like flies round questionable food, as one of my less than kind associates has said, ever ready to help with selling the product whatever its effectiveness; whatever its cost to the community.

Objectivity is the casualty. Hopefully, the Aduhelm saga will not get to his level, but sometimes I wonder whether governments have lost their sense of smell.

However, the cry from the wife still echoes. Yet will her husband, the author of On Pluto: Inside the Mind of Alzheimer’s, take Aduhelm?

My mind drifts back to Neale Daniher, and the need to ensure that while we wait for a cure the palliative services are not ignored, nor the family, and most importantly, that even the person with lowest profile dies with someone holding his or her hand.

Mouse Whisper

In recognition of my friend from Dalarna, Kyrkomus, I am reminded of Carl Linnaeus, the great Swedish botanist, who sometimes got it wrong. He said that potatoes were poisonous, because he noted that the vegetable was related to deadly nightshade. However, the first woman inducted in 1748 into the Swedish Academy in Sciences, Countess Eva Ekeblad, was so recognised by showing that potatoes were essential in the manufacture of wig powder, and more importantly that cool liquor, aquavit.

Skol!

Countess Eva Ekeblad

Modest Expectations – A Range of Lemon

In 2011, shortly before he became governor of the European Central Bank, Mario Draghi warned fellow Italians that Venice in the 17th century and Amsterdam in the 18th century planted the seeds of their collapse by putting elite privilege ahead of innovation. Corporate Italy can hang on to what is left of its sheen.

To which I would also ask, do you smell the gum leaves of Canberra in that quote?

Draghi then goes on with a quote from “The Leopard”, where Prince Trancedi Falconeri says to his uncle Dom Fabrizio, “If you want things to stay as they are, things will have to change.”

This is the last paragraph from an article published in the October 24th 2020 issue of The Economist about corporate decline in Italy. The article starts with an acknowledgement of that novel by saying, “Few works of literature capture the challenges of managing [societal] decay.

If you read very slowly you might be able to detect that we too have a leopard who has learnt to change his spots at the next leap of leopards passing through the spin of his mind. 

Waiting for Bliss

Last week I came across the word “bliss” – a word little used in these pandemic times, but once linked very firmly with “ignorance”. It is an old English word, and I would ask the readers, when could you genuinely say you had experienced a state of bliss?

What is a state of bliss? The definition varies from person to person. It is not wandering round in a trance; and it is not squatting on the floor and being told to meditate. It is not a set of rosary beads nor a set of bells – some may relate bliss to one or more of the senses – sitting in front of a log fire toasting marshmallows having come in from the icy cold and relaxing in a deep armchair drinking a suitably warmed glass of wine while listening to a the Tallis Singers’ recording of the Allegri’s Miserere. To me that is a suitable caricature of the meaning of bliss. This scenario can be explained in a conscious appeal to all the senses – extreme sensuality on a forgiving cliff face.

For me, bliss has always been unexpected. I was racking my brains trying to overcome the mist of ignorance to work through how many times in my life I have experienced bliss. Twice. Both were unexpected, and one instance came after a night in the Royal Women’s hospital student quarters in Melbourne back in the summer of 1962, and the other in 2002 all’aperto in Vancouver.

In one case I had experienced; and in the other I was waiting – in expectation. In both cases there was a woman involved – one in the past tense, the other in the future.

The summer of 1962 was the year when I just become engaged and where I used to sleep illicitly in the Hospital where my fiancé was doing her obstetrics term as a student. I used to leave the hospital a tick before six am and went over the road to a friend’s flat where he had a spare bed that I could “crash” on before going off for my job. For some reason, my friend was away. He had just finished an architecture degree and maybe it was a job out of town; I don’t remember but I would occasionally run into his cheerful flatmate over Vegemite toast and cup of tea.

This particular morning the sun was streaming into the room in his rented terrace,  a comfortable bed and the record player with George Shearing playing “Folks who live on the Hill”. The album with a young woman with her black dress spread around her, demure smile, looking upwards. Drifting into sleep with this environment, this was bliss, a sense that it could never get better – the recent times provided that core requirement of optimism – the security of such optimism in the past, present and future tense which leads into that bliss, which you want to last forever.

Vancouver

The second time, I was in Vancouver sitting outside, the weather was mild and I could gaze up at the mountains hidden partially by a scarf of sea mist. I was waiting for her to arrive, and the expectation of her arrival gave me that same sense of bliss. I did not sleep or even doze off, but had a very good Coho salmon. The wine was Washington State. That I remember, and unlike my normal approach, I ate very slowly and sipped rather than gulped. The mild temperature, open air, the food, the solitude among a late afternoon drinking mob provided the setting, but overall the expectation of seeing her that sealed the bliss. She was arriving later in evening from the other side of Canada.

Both were in good times, but this very juxtaposition of these two occurrences only has meaning when I paste them with those other vignettes which constitute life, so many of which do not have the same muted delicate colours which bliss has. Bliss is thus rare – at least for myself. I hope that in my last view of human experience I will be able to be full of bliss listening to Shearing playing Kern and Hammerstein, and with that expectation of seeing Her. 

Another time; another Trek

A pool of lotuses

A few weeks ago, my blog charted our eventful course to China in the summer of 1973. The weather was foul in Beijing. There were floods and we were unable to go to the Great Wall as a result, but it was interesting times to be there, given the turbulent period China was going through at the time.  I intend reviewing notes of the visit which are in one of my numerous archive boxes. As with our difficult journey to get there, leaving Beijing was no pool of lotuses either.

Our leaving Beijing when we did, produced one of the great regrets of my life. Unlike Gough, we did not meet Mao Tse Tung, but even though the Gang of Four were then in the ascendency and he was not, Chou en-lai was still a significant figure. The then Maltese Ambassador to China and also the High Commissioner in Australia – he was a shadowy figure but he kept popping up elsewhere – said that if we stayed another day he could arrange for us to see the great man. On reflection, there may have been a discussion with Stephen Fitzgerald, the Australian Ambassador, but my lasting impression was that it was a done deal but for one thing – we were on a tight schedule and on that schedule was a meeting with the Japanese Prime Minister Tanaka. In the scheme of things at the time, the meeting with Chou En-lai could not be fitted in. As I say, I still harbour that regret, to have missed meeting with one of the greatest men of the 20th century.

There was no direct flight from Beijing to Tokyo in 1973. The route would take us in a Chinese Ilyushin, as it turned out to be, to Guangzhou and then by train to Hong Kong, where we would fly to Tokyo. That was the plan, but this trip was one of the unexpected. The fellow travellers included the Chinese women’s volleyball team. That was unexpected; to see all these 1.8 metres tall Chinese women strolling down the aisle of the plane. As I reflected, I had lived in a world of stereotypes, and these young Chinese women were not that.

Then the fun and games started. We were forced to land at the then Henchow, and we were emptied out of the planes. Initially here was no information, and efforts to find out, even trying to contact the Australian Embassy in Beijing were unfruitful. So, all we had to do was wait. The flight crew parked themselves under the wing of the plane to get out of the sun.

The airport was on the outskirts of a village, which makes me think that although they gave us a name, it was not a major hub where we landed. The facilities were rudimentary and after a fruitless endeavour to get through to Beijing, I went for a stroll down to the village. After all, there seemed to be no security, and I had reached its outskirts, when I looked back and there was a soldier carrying a rifle running down the hill. It was clear from his gesturing that I was out of bounds. Although, he was smiling and his demeanour was surprisingly sympathetic to my venture, there were rules; and he escorted me back.

Otherwise, Geoff produced a football from somewhere, so the three of us entertained the few airport staff, the volleyball team who were standing at a distance from us on the tarmac and the aircrew under the wing. There seemed to be a cone of isolation around us.  Nobody ventured near us. Not surprising when we could not speak Mandarin, and there was no Chinese minder travelling with us.

When the ball rolled over to them, it was treated as if it were a bomb. Nevertheless, these three Australians cavorting around in the sun with a strange looking ball had an audience. Geoff had been a champion schoolboy footballer, and Bill Snedden had played competitive football, as I had. Mine had been curtailed not only because of lack of skill but by my need for glasses, and the fact that contact lens technology was very primitive during my playing years. In a tussle to get the ball, Geoff showed the benefit of wide hips when he easily brushed me aside in competing for the ball. Playing on a hot airstrip losing one’s balance on such a surface reminded of the times I used to play sock football in the school’s brick quadrangle. The hands suffered as they hit the bricks.

Eventually three hot, mildly sunburnt blokes were motioned to join the plane. In retrospect, the Leader of Her Majesty’s Opposition, lost in Central China playing kick to kick on a distant tarmac, was a mildly amusing incident but today, a major political figure uncontactable in the wilds of China…well…

As we found later when we arrived in Guangzhou, the delay was due to a storm described as “monsoonal” passing through the city at that time. The air navigation instrumentation then was not equipped to enable any plane to land safely during such a storm.

Being completely “stuffed’, I have very little recollection of the city, except we were parked in a fine old hotel and the climate was subtropical. I remember the chintz curtains, looking out over lush tropical growth – the normal collection of monstera deliciosa and other undergrowth to which I could not put a name.

The next morning we were on the train to Hong Kong, and there were rice fields all along the rail line and the ubiquitous lychee trees in the middle of the fields.

Then we were across the border into Hong Kong, where we met up with Snedden’s wife, Joy, and had a relaxing time there.

I was left with the task of booking the flight to Tokyo. There were three alternatives BOAC, Alitalia and Air India. Given that forelock touching was the order of the day and there were people watching for aberrant republican behaviour, I chose BOAC. When guess what? Alitalia departed on time; BOAC was indefinitely delayed and Air India was about to leave. It was already taxiing out to take off when it was told to come back and pick up four Australians – travelling first class. Well, the revenue boost would have doubled that of the paying customers; there were only about ten others in economy, and it was the time before business class.  Also, it was a time when a country to have its own national airline was all important. Prestige before profit in those days.

We were not late for the meeting with Prime Minister Tanaka.

Backroad out of Ceduna … Where next?

Given my love of Strahan, for many years we have owned a blackwood pole house there; if it were not for the trees we would have a view of Macquarie Harbour. We once had such a view but that has now vanished in an entanglement of blackberry and tea trees. Strangely this tangle disappears down the Esplanade where there is an uninterrupted water view from the ex-mayor’s house.

I have only watched the Backroads show once, when it visited the small Victorian town of Beaufort, so much part of my family life. I thought the program strange, focussing on quirky periphery. This must make good television because the ratings are said to be high and the program receives substantial support from the ABC. It plays to a belief system of the viewers, it doesn’t shock and it gave a view of Beaufort uncluttered by any relevance. Nevertheless, those pictured obviously loved their half-hour of exposure.

At the same time a substantial film, television and book stream about the Australian bush country provides a different picture – a dark foreboding scene, deeply crime-ridden country towns, where there is always some secret which the townsfolk know but won’t tell and where a serial killer stalks the unsuspecting city-slicker. This is a country, the background to horror stories, of empty houses, banging doors, and where you only see the feet and the flashing knife.

I have had the benefit of seeing much of Australia and, looking through the schedule of past episodes of Backroads, I’ve been to most of the towns featured, not just as a tourist but to work, and that has included spending time in Aboriginal communities. Hence, for instance when I watched that extraordinary portrayal of the Aboriginal relationship in the film Samson and Delilah, it was reality, slightly “doctored” but essentially reality – it rang true, not from what I had read or had been told, but what I have seen.

 

Strahan

One of the challenges of being from “aways” is that it is important to blend in while realising that you are a “blow-in” and like all “blow-ins” you know it, they know it and, unlike the Backroads crew, when they pack away the camera, you from “aways” still have to live with the long time residents, and not be there just when the Macquarie Harbour is sparkling and the ocean is calm. The plaques around the foreshore remind of those alive how dangerous the seas are, but that was the risk of earning a living out in the Ocean.

The cinematography of Macquarie Harbour, the Southern Ocean and the accompanying rugged temperate rain forest with encircling mountains is brilliant. North barely seen are the two mountains, Heemskerk and Zeehan, the first 721 metes high, the second 684 metres. Both were seen by Abel Tasman when he sailed these two ships past the mountains in 1642. The mountains bear the names of those two ships; named by Bass and Flinders 1802 while circumnavigating Tasmania.

The Backroads episode provides this glorious perspective of the Wilderness, the Harbour, the Rivers and the Ocean. I agree, fantastic.  I have flown with a mate in his twin-engined Cessna on such a day – from Strahan over the Gordon and Franklin Rivers to the Southeast Cape and then back over the Walls of Jerusalem. Let me say there are not many days which provide the perfect uninterrupted vista without being buffeted around the sky by the powerful winds, because these are the “Roaring Forties” where the storms roll in with the greatest intensity.

“Backroads” has essentially a tourist view of Macquarie Harbour, two of the major rivers the Gordon and the Franklin, and the Southern Ocean. The King River, flowing as it does from Queenstown, being cleansed from metal pollution gets very little mention – maybe 12 years ago when the powerboat was taking people on adrenalin leaching trips up the river, it may have got a mention. But then the seaplane has gone too and the train which runs on the Abt railway gets not a mention, presumably because the engines were being overhauled. Yet that railway among others is essential to the Strahan narrative, otherwise if it were running why ignore the original lifeline after the convict settlement had gone.

Heather Ewart, the presenter, is pictured on the steel ketch “Stormbreaker”, drifting down the Gordon river; Heather Ewart on Sarah Island, a ruined convict settlement full of gore where the tourists are dropped off for a quick exposure to the horror that was; Heather Ewart as a walk-on participant in “The Ship that Was”, a long running sketch about adventurous escaped convicts, staged in a theatre setup on the wharf.

She is there interviewing a couple of young Aboriginal women from “aways” picking up shells on the beach. Mate, there are middens on the West Coast but not there where the full fury of the Ocean storms would have washed them away eons ago. Eventually, the show ends up in the woodworks, but not before we see Bob Brown, the Saviour of the West Coast wilderness and the film clips from that campaign so many years ago; the whales more recently stranded on the Ocean beach, and then for a piece of trivia, a waterskiing event to break some concocted world record for the most water skiers at any one time.  May I say I have never seen waterskiing on the Harbour as a regular activity. It is just too rough.

Picture postcard maybe; emphasis on the Wilderness, the magnificent scenery but except for a short reference to huon piners, not much about Strahan. Strahan does not exist because it is perched on a large, picturesque harbour. It was a port for the mines of Queenstown, on the other side of the West Coast Range – an isolated settlement set in the most beautiful part of Australia. People did not go there to admire the beauty; they went there to work. And the question is why – and why have they stayed?

While the background may be beautiful, the living conditions are harsh – but not the day that Heather Ewart blew in with her entourage. The opportunity missed of how a town has reconciled itself to the need to conserve when the genesis of the township was to exploit Australia. Isn’t that more the dilemma of modern Australia rather than the extent of the line of water skiers on the Harbour?

A hardy, resourceful community which has adapted – that has been my privilege of being a person from “aways” to know Strahan – to experience more than one sunset.

Somebody told me the week before Backroads was about the towns of the Dunmunkle Shire in the Wimmera. Now that is a place I know very well, particularly Minyip. Maybe I will look at what they have done with those townships.

St John’s Lutheran Church, Minyip

Special Pleading?

Let me give this person privacy. However, I have heard of a woman who was in remission from her disease of polymyalgia rheumatica and, having submitted to the AstraZeneca vaccine, promptly got an exacerbation of the disease, which has persisted.

The problem with polymyalgia rheumatica, nobody knows what causes it, whether it is a vasculitis or myopathy. What is known is that it occurs in older age groups and is associated with osteoarthritis and, in a number of cases, with another autoimmune condition, called temporal arteritis – a condition of the artery supplying the temple region. If not treated temporal arteritis can lead to blindness. This is patently a disease of a blood vessel.

Polymyalgia generally resolves by two years after diagnosis, which is complicated by the stealthy onset of the disease. Therefore, the onset is difficult to pinpoint. However, with me it burst out into a florid state of muscle pain, extreme weakness and stiffness of joints. In its untreated state one has the premonition of death, holding onto the basin in the bathroom and seeing the world disappearing from view – but trying not to let go. That is what occurred to me. After seven years the disease is chronic – I shall die with or because of the disease. The more the disease is stimulated by outside influences, the more it will shorten my life.

Treatment is cortisone, and it is in this titration of the amount of cortisone that provides symptomatic relief.  Methotrexate did nothing. Without cortisone, it is simple. I would be dead by now.

In the initial fulminant state, there is in addition to the indicators of infection, an indication that platelet function has been disturbed. In this particular case there was a marked thrombocytosis. Platelet problems are at the heart of the AstraZeneca side effects.

Being on cortisone therapy for over seven years means that adrenal function becomes compromised, well demonstrated when the replacement cortisone  was at point where it could be expected for the home grown cortisone to kick in if there was stress.  My adrenals did not kick in, and I experienced symptoms of hypoadrenalism.

Therefore, living on the edge should not be challenged by a vaccine which has its own problems, even if they are downplayed. Yes, I have had my influenza inoculation for 2021; yes I had my shingles inoculation several years ago. None provide 100 per cent protection; and indeed I have a mild reaction to the influenza inoculation; no pain at the site but a slight feeling of unwellness with upper respiratory symptomatology for several days. Symptomatically, my polymyalgia has got worse.

But then I am a doctor once a medical researcher and public health physician. The soothing words saying “do not worry” are not here crashing on a shore devoid of information. The case can be argued that it would be better to avoid the risk. However, in a country where choice is limited to who you know, well why not ask that I be given the Pfizer vaccine by my public health physician peers.

However, if my request is refused, maybe I will have to consign myself to the line of AstraZeneca injectees, with all the hollow assurances, but knowing that I am especially vulnerable to admittedly rare significant side effects.

If this insistence on AstraZeneca occurs, then I will post a daily message on social media telling everybody 24 hour by 24 hour how well I am going – and for Government “come in spinner.”

The coins are about to be tossed. The chances are of (a) no complications; (b) side-effects with the ultimate government prize of my death; or (c) putting the kip down and allowing me to have the Pfizer vaccine and of course my daily diary of how that vaccine is treating me.

Then of course I could not have the vaccine and die of that wonderful phrase “natural causes”; better than “misadventure”.

Mouse Whisper

I am entering into the world of invention. This invention threatens to take over the world, so they say. It is an American invention. It is a new type of pasta that is sweeping the trattorie of New York. There are 300 different types of pasta and yet for this new one, people have to wait for 12 weeks to get a packet of the new pasta, and then it costs USD18.00 plus postage. It is called “cascatelli” in reference to the Italian word for waterfall.

To me, the ravenous mouse, the pasta resembles a caterpillar, but this pasta is said to be able to capture ragu or vongole jetsam which may be drifting by in the sauce, flooding the pasta dish. This is the secret, opening up the tube and having pincer pasta pseudopodia able to clutch and not to let go of the tidbit onto your shirt (or in my case my mousling bib) but finding the safety of your mouth.

In Australia you can buy similar pasta, where the tube is closed, called creste di gallo – “coxscomb”. This pasta sells for about AUD$5.00.

As The Washington Post reports:

But it is the technology of opening the tube and having the right template that has the culinary world agog.

There’s no wrong sauce for this pasta. Every kind clings like Velcro.

It’s like a Venus fly trap. Anything that goes in there can’t get out.”

The pasta’s marketing materials refer to that grippy-ness as “sauceability.” Alongside “forkability” and “toothsinkability,” these goofy, made-up terms form the inventor, Dan Pashman’s trifecta of ideal pasta characteristics.

Ugh, that is sufficient mangling of the English language – bit like pasta.

 

Modest Expectations – The Size of the Universe

Is Australia an ochlocracy?

The Ancient Greek historian, Polybius drew on the traditional theory of the three constitutions: monarchy, aristocracy and democracy, which may decay into their perverted versions becoming respectively, despotism, oligarchy and “rule of violence”.

Okhlos

Okhlos is Greek for “mob”. Its potential was seen briefly in the storming of the US Capitol on January 6. It goes to show how rattled the Prime Minister continues to be when he invoked the spectre of mob rule such as that; and substitutes an irritating mantra of “the rule of law” (or does he mean lore and he has not bothered to read the evidence – but then he admits he never reads anything any time).

Morrison’s retreat behind a line of feeble excuses, backed invariably by people of privilege in the end is unsustainable. One transformation occurring in Australian culture which has probably been an important undercurrent in this societal change has been the appearance of the articulate young women who have had enough of the brutal misogyny, which hides behind the veil of Australian “mateship”.

This rise in the women voicing their experience of the underbelly of Australian social life is far from mob rule; it shows the best aspects of democracy, thriving on freedom of speech and the actions of a new leadership led by at least three young women – and presumably more of them to come.

Yet another Liberal Woman?

I watched Kate Jenkins’ underwhelming performance last Sunday morning on television. She is the Federal Sex Discrimination Commissioner, having jumped ship in 2016 from her role as the Victorian counterpart which she held for less than three years. Her successor in Victoria, Kristen Hilton, is about to finish a five years’ stint and is a female lawyer who came to the position from Legal Aid and community advocacy. Jenkins was from a different legal background and was a controversial appointment by the then Victorian Attorney-General, who happened then to be Liberal. She was appointed despite the selection committee unanimously recommending someone else, and indeed a number of the selection panel resigned in protest. After all, Jenkins had form, having worked for 20 years for Freehills, which was a law firm aligned to the employers in work disputes.

There was a change of Government in Victoria late in 2014, and despite her saying that the manner of appointment had been smoothed over, nevertheless when the opportunity arose to move back to a similar position under a Liberal government it is not surprising that she did.

It is somewhat of a dejà vu situation when, as Kate Jenkins was reported saying in 2018 after some Liberal Party MPs raised concerns about bullying inside the party, she suggested the community response would prompt conservative politicians to push for change. Her comments came at the same time one West Australian Liberal Senator, Linda Reynolds said it was time for Liberal MPs to stop talking about themselves and allow the party to deal with the bullying issue internally – the rule of lore methinks.

Now Kate Jenkins has been entrusted to look at the dysfunctionality of the Parliament House workplace, encouraging people to tell all but with no authority to name names. Initially, the Prime Minister had assigned one of his female colleagues, but after all what do you have a sex discrimination commissioner for? It seemed somewhat of an afterthought, but in the blokey culture in which the Prime Minister finds himself comfortable, it is unsurprising. After all, in this culture Kate Jenkins has to examine, the Office of Women has barely been heard. She has to report by November.

However, one suggestion that the office appointment be made by some independent body is ludicrous. Most ministerial offices have departmental liaison officers in any event. In many workplaces, one needs a police check. The problem lies in the fact that there are just too many parliamentary staff, the employing Minister needs to be confident of their loyalty and their moral compass. Cut back on staff numbers and get rid of the condottiere culture – 95 per cent of the time hanging out and five per cent ultimate brutality in the case of the Mafia. Applying that to the parliamentary office is boredom, gossiping and bullying – in varying degrees. Occasionally, they may contribute a snippet of relevance to portfolio deliberations.

As for the percentage of sexual harassment and assault admixed, that is surely the major task for Kate Jenkins. In her favour is that she seems to have been involved in sport, in particular the Carlton Football club. That probably has given her an insight into the blokey culture which, fuelled by alcohol and drugs, can become a very unpleasant scene.

However, the most obvious recommendations are that all cases of sexual harassment and assault they be immediately referred to the police and that Parliament House have a 24-hour counselling service on hand for the victim. The first harasser charged should be refused bail and have the case held over for a few months. This would be somewhat of a deterrent, as well as the name being on the public record instead of appearing nowhere but everywhere on social media – a case of “porterisation”.

Insurrection

When I was a medical student, there was only one medical school in Victoria. It was a traditional medical course, which had its roots in the Great Britain “honorary” system and Nightingale wards.

There was a vision of medical students in the mould of the 1950s series of “Doctor in the House” books, which were popular and vaguely true of a vanishing world.

We “fresher” students had a term of botany to start us in the world of human biochemistry, physiology and anatomy and then moving on to years in clinical medicine where we were introduced to our human pathology. However, that pathology included an introduction to the world of the medical hierarchy, enmeshed in a different pathology. It was a world of innate privilege. For instance, from my boys only private school about ten per cent of the students in my first year were old boys from my school; and most of those had been with me at school the previous year.  Therefore, there was an easy familiarity when we all gathered for our first term. None of the guys then from my school were more than acquaintances, as the friends that I had at school tended to be on the “arty fringe”, not on the treadmill of a year 12 two maths, physics and chemistry.

Despite having a headmaster enlightened for his time, having a factory to ensure a stream of first class honours and the academic superiority of the school, in the end, the school encouraged privilege and misogyny. After all, it was still a school where the boarders were banned from playing hockey, because it was a sport played by girls. Then there was the cruelty, both physical and mental. Until just before I entered the senior school, the prefects were allowed to cane, which some have reported did it with relish.

The masters – note male – were allowed to cane. I remember one time when I was framed as the instigator of a class riot and was caned in front of the class with a large wooden compass. This old boy had played tennis at championship level and his backhand was still a powerful weapon. Oh, such a wondrous time. And there we all were on the threshold of a career of caring and compassion.

There were few women then doing medicine, about 25 per cent at that time. One of them was a feisty blonde who as child had migrated with her parents and elder sister to Australia from Central Europe after the war. She attracted attention because she was always impeccably dressed, even down to her use of Mitsouko as a trademark, very good looking with a strong sense of morality, and willingness to engage men as equals.  This frank engagement was often misinterpreted. Because she was a fraction over 160cm, there was tendency by some to see her as a doll, unable to resist the fragrance of the male pheromones. Nothing was further from the truth. One professor, who had the reputation as a Lothario tried it on, got nowhere very quickly and punished her with a supplementary examination in his subject, which she ultimately passed. The professor wisely absented himself from this further examination.

There was the instance in one of those crowded raucous medical student parties, when a drunken male lifted her up and tried to sling her over his shoulder. Others intervened and he dropped her. In a flash she had flattened him with a fist which travelled from below knee level and he, helped by an inebriated lurch forward, copped the full intensity of the blow. She never gave any quarter; a remarkable woman (in the 1960s she was a pioneer in and passionate advocate also of early childhood education) who followed up with a successful career until she suddenly decided that she had had enough of a male-dominated world and retired. It was a pity.

The white shoe brigade

In our fifth year we had to undertake 10 weeks in the Women’s Hospital where during that period were to do twenty deliveries on our own, including two instrumental deliveries. That was one roster; the other was the episiotomy roster, where we had to go and sew up the incision made in the perineum when extracting the baby to avoid a tear. In those days it was a regular occurrence and we medical students had to do the suturing repair. It was an introduction to being on-call at night.

We were not to leave the premises without permission over the ten weeks and to compound this imprisonment, we had to wear all white – all white short coats, white shirt, white tie, white pullover, white trousers or skirt, white socks, white shoes. The one luxury we afforded ourselves when we were far enough down each list not to be immediately bothered being called was to go over the road to the Martini Bar at about eleven o’clock, have a veal parmigiana and watch a TV Western called The Rebel-Johnny Yuma.

The Professor of Obstetrics and Gynaecology was an owlish misogynist who had crawled up the pole of success by judicious naval service, membership of the Masons, a fortuitous lack of interest in the professorial post when he applied, allowing him to slide into academia without much, if any academic qualification. Then there he was, a graduate who had needed supplementary examinations to pass and was forced to undertake his first post graduate year at Tennant Creek, on the brink of a stellar career. He had a ruthless streak which, coupled with a few shrewd appointments, provided him with an aura of success. However, his most memorable utterances related to a distressed pregnant woman who came to him threatening suicide. His response – as recounted by him to us fifth year medical students – was that he showed her the window of his office and invited her to jump. The fact that she did not just proved triumphantly his insight into women. To our shame we just absorbed what he said and did nothing.

However the atmosphere, because of the activities of his lieutenants called “First assistants”, became so repressive with them singling out a Malayan Chinese student for special punishment. That was the trigger point. We students declared that enough was enough and petitioned the Professor in a written document signed by all but one of the cohort. We thought it an impressive display of solidarity, and the First Assistants were clearly rattled. Nothing happened immediately and then we felt the full force of the Professor; he isolated those he thought were the leaders and suddenly the rebellion melted away. After all, this guy could have a serious effect on careers. He enforced the punishment, “gating” the whole student cohort. This was eased as it gave the First assistants a “humane role” in releasing us from our imprisonment.

In the end a few of us, but particularly myself as I was by then Chair of The Medical Students Society, had a rough time, even though it was almost 18 months later before we faced the examiners. That is another story, but I evaded the trap – and passed, admittedly near the bottom of the year.

As to the fate of the petition, it was never seen again, except there was a second copy – signed similarly by the same set of students. I have it in my possession as an example of what he probably thought was an attempt at mob rule, but a useful document that can be added to his “in memoriam”.

After all, he was not the only disgraceful example of this disrespect for women. It was rife among obstetricians back then, but now change has occurred, especially with more female role models in the field with exemplary professional behaviour.

Then, as students, we accepted the mores, such as lining up to do an internal examination on a woman who had supposedly consented to the invasion. Some of those in my cohort, who signed the petition, became well-respected obstetricians and gynaecologists.

As for the Professor, he was knighted and acquired a trail of honorary academic degrees from all over the world, had a building named after him at one of the teaching hospitals in Melbourne and died as a revered misogynist in 1983.

IVF – Great Expectations?

The role of IVF as a ‘cure’ for infertility was crucial to the discursive construct of law as a barrier. ‘If medical advancements can help these people, it is not the role of Parliament to prevent it. Science was posited as a progressive force, aligned with nature, or perhaps with natural progress, which parliament should not impede. Paradoxically, then, law becomes both the problem and the solution as it ushers in a new era of reform.

In April 1988, my team reported to the then Commonwealth Department of Community Services and Health on the status of in vitro fertilisation (IVF). The Department prepared a summary report because some of the data we collected was confidential. The Departmental summary made the comment that the good data collected by my team “cannot be matched with good output data collected by the National Perinatal Statistics Unit (NPSU). (I use the term IVF, although ART, assisted reproductive technology, of which IVF is one, may now be more commonly used.)

To put our consultancy into perspective, the first in Australia and when 2503 pregnancies had occurred with 1851 live born infants. That was the raw statistic, and we looked at data from 1986 onwards from 15 units across Australia.

It was a time when the tabloids would pounce on any multiple pregnancy as though non-viable octuplets were in some way a blessing from God, a scenario which some members of the Roman Catholic Church applauded. It was just an instance of appalling practices, loading the woman up with fertilised eggs, on the grounds it was more likely one would be implanted.

I entered this review in a very positive frame of mind, because I knew Professor Carl Wood, who was part of the vanguard in the introduction of IVF.

The one invariable feature when we arrived at any of the units was the pictures of beaming bonny babies, so even from the early days the public relation teams were in the picture, so to speak.

Then our team confronted reality. The processes involved in IVF mean that the woman goes through a harrowing experience to conceive. Then there was the waiting period to know that the process was successful. There was some difficulty initially in finding the actual success rate. The success rate was a live baby in the basket – and multiple pregnancies counted as one. Full stop.

It was a problem in the early days and in one State where there was an “IVF cowboy” at the helm, because of his propensity to place multiple eggs into the uterus for implantation.  Of the 55 live births following IVF, 27 per cent were multiple births compared to 0.01 per cent of the total. There were 15 multiple births due to IVF of a total of 264 multiple pregnancies. Five sets were triplets born from IVF pregnancies during the time when there were only a total of 15 sets of triplets born across Australia.

The problem in assessing the “live baby in basket” against the number of IVF cycles was not made easy, because those who ran the IVF clinics were not the same team as those who delivered the women. There was thus no uniform data collection. This presented a difficulty since there were a number who might have been assessed as pregnant but who actually had a chemical pregnancy that did not progress.  This was another practice uncovered at the time – to count a rise in the hormone bHCG as a “successful IVF treatment” – a fancy bit of data manipulation since many never got beyond this stage.  In the absence of any reliable data collection, it was left to us to make the best estimate.

We noted that even at that time of our review four women had already undergone 13 treatment cycles without becoming pregnant. Considering the stress that one IVF cycle entailed, failure was a nightmarish experience – and 13 times! Added to this was a cohort of infertile men whose failure to acknowledge their own infertility created other problems. With the intracytoplasmic injection of one spermocyte into one oocyte, it always seemed to me the height of arrogance that a scientist could pick the right sperm for the right oocyte – a form of cellular eugenics. Yet in one way what could one expect. IVF was the product of veterinary medicine.

I came out of the experience of our consultancy rather differently from the person who was commissioned to undertake this review. Our reports received a mixed reception. For the most part of the succeeding 33 years, I have written nothing. Nevertheless, I have been disturbed by commercialisation of the expectations of women increasingly delaying their families – for many reasons. There is an increasing number of women in their forties seeking IVF treatment when they have certainly reached the fertility savannah if not the desert.

I was prompted to write by the following comment:

Going through IVF is the worst thing that has ever happened to me physically and emotionally. The financial costs made the whole thing far more stressful and limited how many attempts we could have. I know of people who have sold their houses and given up everything to pay for cycle after cycle to have the child they always dreamed of. What’s so infuriating, though, is that it absolutely does not have to be this expensive. This is what happens when medical care is run for private profit instead of public good.

At the time we undertook the review it was well before IVF became a hedge fund commodity like so much of health care now. One of the major reasons for the 1988 review was to understand the costs, and the report was inter alia a masterpiece in cost accounting (because of the involvement of Dr Robert Wilson).

IVF is now big business. It would be a brave politician or Department to establish an independent review as ours was. It is very difficult to work out the real success rate; it is in the interest of the industry to conflate the success rate. But the more important issue is that this is an industry that is in a position to prey on those who are so willing to give up so much for “a baby in the basket”.

The problem I have is “what is truth?” I could not believe this nonsense written by one of IVF specialists. His thesis that increasing IVF could replace falling migration levels is backed by this following burble:

Arguments based on a sense that IVF is futile for women in their 40s also hold little water these days. Twenty years ago, when I first began training in IVF, pregnancies in older women were a rarity. Yet 2017 data from Australia show that, for women aged between 40 and 44 using their own eggs, the cumulative live birth rate is well over 10% for the first cycle of IVF treatment and runs to as high as 40% by their eighth cycle of treatment.

The eighth cycle of treatment, I ask you! The cumulative live birth rate is simply, “if I keep going, what are my chances of pregnancy if I have another cycle, or another two cycles, or another three …”. Dangling a 40% success rate in front of a desperate person who is prepared to sell the house …. those who are running IVF clinics are in a position of  power -the sort of power men use to manipulate women.

Has the misogyny which once burned bright among obstetricians and gynaecology not been extinguished? Anybody making statements as airily as that suggests that it has not. Statements as that above should be tested urgently by another independent review.

I remember one piece of data that stuck in my mind. It was an early study that compared women who had undergone at least one IVF cycle and then gone back to conventional ways of procreation as those who had persisted and delivered an IVF baby. It was about the same – nine per cent.

This is another statistic that would be worth reviewing now.

Any advances on that?

Mouse Whisper

Witnesses under cross examination, however mighty their stature outside the courtroom, very soon became meek and mild and well-behaved in his hands. If they did not—if they paltered with him, or evaded his questions, or did not do justice to their testimonial responsibilities— the smell and sight of cordite smoke soon drifted into the courtroom.

I have never read a more flower-encrusted definition of bullying – in this case a description of the late Tom Hughes’ court antics.

These words are by Dyson Heydon, in a book review of Tom Hughes’ biography, in turn authored by one of those guys my mousemeister knew at school.

Attorney General Porter or his successor should not palter over the Dyson Heydon sexual harassment report in the wake of the Chief Justice’s condemnation last year of him.  Porter received a separate Departmental report on 25 February; and to all intents and purposes it is unsurprising he has done nothing since.