Modest Expectations Skat

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Bubble Australia

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

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

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

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

Another Play with Words

Guest Blogger – Chris Brook*

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

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

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

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

Basically the theory is simple – along the lines of:

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

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

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

How could anyone object to such a set of targets?

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

Some of the issues emerging are:

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

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

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

This is but a teaser – an opening shot.

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

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

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

Tiempo, damas y cabelleros por favor

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

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

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

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

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

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

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

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

All shook up …

Guest Blogger:  Janine Sargeant*

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

Like him or loathe him, Elvis is everywhere

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

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

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

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

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

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

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

Mouse Whisper

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

Ebony mouse whispering

Modest Expectations – October

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

The Moral Basis of Christopher Pyne

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

Banfield’s work – required reading for Christopher Pyne

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

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

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

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

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

Mane Course

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

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

Guaranteed 100% beef free

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

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

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

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

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

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

Walla walla catsmeat

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

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

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

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

Withering Foxglove

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

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

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

“Squills” – Drimia maritima

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Education System Fails Australia.  Will micro certification help?

Neil Baird

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

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

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

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

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

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

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

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

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

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

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

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

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

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

*Science, technology, engineering and mathematics

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

Mouse whisper

As reported in the SMH this week by James Massola:

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

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

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

Go Sharkies. Go Joko.

Modest Expectations – Theodore R

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

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

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

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

They call it Molly

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Morrison – the Funambulist

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

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

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

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

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

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

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

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

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

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

Jacques Miller

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

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

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

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

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

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

Enough said.

Mouse Whisper

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

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

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

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

Modest expectation – Hourglass

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

Overlooking the promised land, from Mount Nebo

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

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

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

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

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

Rhiannan Iffland. Who?

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

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

Rhiannan Iffland

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

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

Rural Health

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Brethren

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

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

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

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

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

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

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

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

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

Mouse Whisper

An interesting comment overheard in the back streets of Whroo.

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

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

Talk about the long game …

The umbrella protest

Modest expectations Jiminy

In the Weekend NYT, there was a thought-provoking article saying we now have a great way in Instagram of recording aphorisms – the one-liners, deep philosophical verbal gestures. Jean Crispin writes:

“This should be the golden age of the aphorism. Constrained as we all are by time, attention and social media platform character limits, when we pull out our smartphones and stare into their illuminated fields, we can take in only so much. Shouldn’t those words be perfectly chosen to vibrate with hidden meanings?”

An aphorism has a way of bending you to its hidden truth, changing your way of thinking not with a 20-page document of well-reasoned arguments, but with just a sentence or two.”

I have two responses – one is that an Instagram is a vehicle for one line vanity press – “Look at me, aren’t I clever?” Mostly, the answer is no! In fact, given the weight of encouragement her opinion may give, I would introduce a Crispin Licence to Practise in her golden age.

The other is a question: “Have you ever read an anthology of aphorisms.” It is eye-glazingly boring unless you want to filch one and then pass it off as your own cleverness.

However Chris Brook, later in this blog, makes a very valid point, if obliquely. The name “blog” implies stodge as if we are working our way up a muddy hill. However, as Brook points out, the blog is a very good place to set up a conversation as long it remains coherent.

A blog is a modern cartouche. Not only does it name the author who is trying to explicate an eternal truth but also in itself it is self-contained. As I am writing, I glance up and see the front wall of our house; it is a variegated set of bricks that have been put together to cohere. Not exactly the wall of a Pharoah’s tomb, but the wall of brick cartouches is a sufficient metaphor for policy by cartouche aka blog. Thus, the blog can be used to build a policy wall, which Chris Brook is doing incrementally with his health policy contributions.

Napoleon Bonaparte, when he saw the ancient Egyptian way of hieroglyphic messaging, thought it looked like a gun cartridge, hence the name “cartouche”. I am sure he would have had a less viscous name for “blog”, perhaps “L’araignée boisée” abbreviated to “abois”.

A Memo to Me Mate the Minister for Minerals

Change is something that can take a long time. Therefore it is useful to live long enough to see change happen and then see the society change, especially when you yourself started on the wrong side of history.

By this I mean I started smoking when I found a half empty packet of brown Capstan in the train on the way home one night when I was 17 years old and from then on I smoked until I was 40, when I gave up. I have never had a cigarette since. But back then tobacco usage was pervasive. I owned several pipes so that tobacco could give me gravitas. They didn’t.

One of my memories is being in the emergency department during my internship. We used to light one cigarette from the butt of the last one. Many of the senior doctors smoked and we were corralled into the room at the end of the ward so that he, the senior doctor, could have a smoke (never “she” then) while he taught. The Medical Journal of Australia had until recently then been accepting advertisements from cigarette companies. My father, who was a doctor smoked cigarettes and more often Cuban cigars. He died in 1970 – he had a heart attack. It was Tobacco that helped get him.

It was Richard Doll who, with his colleagues in Oxford, identified the link between lung cancer and cigarettes from the late 1940s. He authored an article on doctors’ smoking habits in 1954. This whole public health investigation was not on the political radar, and even when it was there was a reluctance to interfere given how much cigarette money was sponsoring so many activities, including political parties.

Like many of my contemporaries in the health industry, I had one particularly uncomfortable moment on the way to weaning myself from cigarettes. I happened to be in the office of one of Jimmy Carter’s advisers. I asked whether he would mind me smoking, pulling out a packet of Gaulois. He looked at the packet and suggested that they were worst cigarette to smoke from a lung cancer point of view. Needless to say the rest of the conversation could have been better.

However, it was three years before I abruptly stopped. By that time I was working for the AMA, but there was no overt pressure for me to stop. I just decided one day it was a dirty habit. I just smelt. Cigarette ash like coal dust was a pollutant. So I went cold turkey. I surprised myself and never smoked again. And one of these days, we as nation will have to go cold turkey on coal, before it is too late.

The only contribution I have made to policy in this area of tobacco happened one day in the early 1980s during my time at the AMA. I was rung up by a friend who was then on his way up the bureaucratic ladder, who asked what I thought about indexing the excise on tobacco products. I said great idea – and QED, it came to pass.

However, far more importantly, community behaviour has changed in Australia. The smoker is very much a pariah in public places – the array of butts on the windy corners of the city reinforce the image of the uncaring polluter.

One wonders how long it will be for those who hold up a lump of coal in Parliament proudly, to be like the young doctor in the emergency department lighting a cigarette amid an atmosphere of tobacco smoke, and change. Hopefully it will not take 17 years.

One cigarette executive once said of me that I was a hypocrite in my attitude to smoking. No, I said, as our coal-fired politicians and their minions hopefully may eventually recognise, they will eventually become as I did over the matter of cigarettes – a penitent.

Not to everyone’s Taste

When I went to the Baltic States a little time ago I visited many churches. I climbed the Hill of Crosses in Northern Lithuania. My visual cortex is an attic stacked with images of Christ the Child and Christ the Man. These are not my image of Christ nor indeed of my God the Father who dominates those below as if some Jovian presence as though Heaven is at the top of a religious escalator. As for the Holy Spirit as some wraith dodging in and out of my cerebral inglenooks … really?

Hill of Crosses

I therefore cannot conjure a visual image of the Trinity. I do not have the capacity to do so. They are not Three clustered on a Throne. I am thus left with my other known senses to provide me with some reference point by which I can relate to the Trinity.

I cannot touch Them, although in some worlds people seem to believe in the supernatural. Whether that is some kinaesthetic experience where God in various forms intrudes is again beyond my ability to fathom.

I cannot hear God. It is not that I am deaf, but I have not had the experience of having auditory communication, although I may have missed it – by not having paid enough attention, not being able to break the code or simply not knowing the language.

I thought that since frankincense and myrrh were so important in the Nativity that perhaps there would be a particular fragrance where I may be able to smell God. To me substances that emit a smell are important to my being. In particular I love herbs in all their differentiation. The Bible is full of references to herbs, and for a moment I toyed with the ability to distil these olfactory sensations as a means of conceiving God. But then the idea was too difficult and my brain inadequate to process – at least at this point in time.

Then there is taste, and in the early hours of one Thursday morning, I realised that when I have taken the Bread and the Wine at Communion it is somehow different. I cannot express that thought any further, but taste is a very complex physiological phenomenon. Taste is itself a trinity of cranial nerves – the facial, the glossopharyngeal and the vagus.   Surely that is a coincidence!

Perhaps, just maybe, that is how God is in my head. But I am still uneasy and unsure to presume even that. But it is the only way I can sense my God.

Chris Brook on Health

Whenever the future of the Australian health system in Australia is discussed, the discussants tend to focus on their own area of special interest and to adopt the “gap filler” approach. It is the basis of incrementalism.

It seems pragmatic and sensible to target perceived areas of deficiency. Examples of this currently are:

  • universal dental care (a costly initiative if ever adopted)
  • mental health care including youth suicide ( very deserving of consideration)
  • better public information to facilitate informed decision making
  • integrated care initiatives.
  • In fact the list is endless. It is a question of priority.

Filling gaps seems to assume that all is otherwise rosy in the health care system, when of course it is not. I listed above some of the schemes. Underlying the edifices we wish to build are the fault lines.

  • Think how far dental health schemes are from universality
  • Think lack of coordination between GP type primary care and specialists
  • Think of the gulf between hospital care and any form of community based care whether specialist, general practitioner or other
  • Think cost shifting between levels of government between care settings and funders including private insurance funds, a set of pernicious behaviours raised to an art form in some jurisdictions
  • Think out of pocket costs and deliberate privatisation of services
  • Think of the difficulty for the increasing number of people with chronic and often multiple morbidities in navigating the fragmented health system.

Above all, think “systems”! Then ask why don’t we actually have one! For historic reasons we have a set of arrangements based largely on fee for service, whether Medicare, Hospital casemix funding, or Pharmaceutical Benefits scheme.

Multiple costly government attempts to engage general practitioners, with the latest being primary health care networks (PCHN), but also with practice incentives, IT incentives and without anything similar for specialists. They just have not been sensibly considered.

There are many questions about the Australian health system. For example, why is Australia’s rate of hospital admissions some two and a half times greater than virtually all other OECD countries? The answer lies solely in what Australia counts as an admission where it includes day treatments and day procedures as admissions when no actual overnight stay is involved. Once this is taken into account the Australian apparent admission rate plummets to the normal international level. Australia does this for accounting and payment purposes and it may be said that it works reasonably; but could it be better if done differently?

Many countries are far more advanced in consideration and implementation of capitation-based funding for large parts of health care, adjusted for risk using some really very good predictive tools, such as DxCG predictive for risk.

The appeal of capitation since the 1930s has grown with the birth of Health Maintenance Organisations like Kaiser Permanente. Offering an annual payment for all care should allow flexibility in the “what and where” of care including, most importantly, preventive services. It should allow tailored care for individuals and greatly facilitate navigation.

The theory may not always translate because the bogey of managed care is that it is rationing in disguise – and rationing has caused many problems notably in the USA, in particular knowing where to draw the line.

Nevertheless, capitation has its advantages, especially for the funder.

Fee for service at the extreme is a free-for-all encouraging providers to offer as many services as possible to as many people as possible, whereas capitation encourages providers to offer as few services as possible to the least number of people.

So measurement of adequacy of patient benefit must be part of any approach, being preferably outcome based, incorporating the triad of: clinical assessment, whether periodic or after a specific care; patient reported health outcome measurement, including some measure of satisfaction; and periodic functional assessment. Here elective surgery is the easiest one to reference – post-joint surgery or post spinal surgery; one functionality, the other more relief of pain.

Barriers are pervasive. The structure of the Australian Constitution originally only accorded one Federal health power – that of quarantine – and has made the Australian health system a patchwork, which is increasingly fraying around the stitches.

One blog is too short a space to go much further, so take this as just a start. Serious policy is always work-in-progress. However serial blogging over time will help, as now is a very appropriate time to take this whole policy area much further.

The rise of the zinger

I remember when the late Senator John Button, in a mischievous moment in the Senate, once asked the Minister of Science a question without notice: how many centimetres there was in an inch? The Minister did not know. Button achieved his point; he made the Minister look like an idiot. Although amusing at the time, it has not improved the quality of the politicians who have been given the science portfolio – that is when the portfolio hasn’t been abolished.

Alan Jones uses the same ploy but slightly differently. Ask a relevant question when confronting someone ideologically at odds, but unlike Jones who does his homework, the other person has not done so.

So when Jones asks one of these adversaries what is the current level of CO2 in the atmosphere, and that person doesn’t know, Jones goes on his victory tirade. It doesn’t matter if that person knows the answer, reality is not based on some human dot not knowing the answer.

Oh please … the zinger. Smart, but it doesn’t help when we are seriously discussing the future of Planet Earth.

The reality is that the level of CO2 in the atmosphere is straight lining upwards like the trajectory of a bullet into the sky. We have passed the 400 ppm mark.

If fossil-fuel burning continues at a business-as-usual rate, such that humanity exhausts the reserves over the next few centuries, CO2 will continue to rise to levels of order of 1500 ppm. Then forget about the human race. Think Venus with billowing clouds of CO2 disguising the uninhabitable planet surface below.

But Alan, you will not be around, nor shall I – but unlike you, I have descendants for whom I feel responsible.

Mouse Whisper

Three years too soon? Or don’t talk about the Polls? It was not only Newspoll. Some weeks before the election …

“Labor is comfortably ahead of the Coalition in the latest Guardian Essential Poll, and just over half of the voters in this fortnight’s sample, particularly voters under 34, worry Australia is not doing enough to address climate change.”

Modest Expectations – Whistling Dixie

I have just been looking at the election results again, and remembering very clearly the backslapping which occurred with the landslide that Bjelke-Petersen effected in the 1974 election in Queensland when the ALP was reduced to 11 seats. At the same time the Queensland Labor Party, the Santamaria-Vince Gair offshoot, was wiped out completely.

The only safe Labor seat left then was Port Curtis or, as it is now named, Gladstone. True to form, in the 2019 swing to the Coalition in the electorate of Flynn, which is a pendulum electorate at the best of times, Gladstone remained Labor as did much of Rockhampton.

Queensland has this history over the past 50 years of being electorally volatile.

However, what intrigued me recently was Blackwater, which is touted as the coal mining capital of Queensland; the coal is exported via rail to Gladstone. The two booths there voted strongly Labor, as did the electors of Bluff down the road where the coal trains interchange in 2019.

The story of Blackwater is instructive – named because of the colour of the water passing across the coal seam. It had a population of 77 in 1966. Then the open cut coalmines came and the population swelled to 10,000 in the 1970s to decline to a current figure of about 4,000. There were about 1,000 voters at the two booths. The majority voted Labor (57 per cent at one booth and 64 per cent at the other). It is also true that other coal towns across the Bowen Basin of Collinsville, Moranbah, Dysart and Tieri all voted for Labor.

Small figures but instructive as a pointer. Given how unreliable the polls are, you might as well attribute the swing in Flynn to the State Government with the duumvirate (or more correctly duamfeminate) of Palaszczuk and Trad, as to the substitution of Morrison for Turnbull. However, quite rightly there was the Longman by-election and subsequently the swing back on May 18, which would point more to the second as the major cause for that phenomenon Nevertheless, change is not always due to one factor.

Flynn has a great many people on the land doing it tough because of the drought, and as you cannot directly blame God, well the State Government may as well cop the blame through its surrogate, Shorten, despite him being the son-in-law of the Queensland Dame, surely a person of renown in her own State.

Blackwater is just one of 40 odd mining centres in the Bowen Basin, which is South of the Galilee Basin.

Admittedly one of difficulties in defining voting patterns in the Bowen Basin is the number of “fly-in-fly-out” (FIFO) mining employees, estimated at 18 per cent of the population. It would be interesting to know the home postcodes of these FIFO miners but the assumption that they are locals, who earn the money that sustains the local economy, needs to be tested if we wish to clearly define the miners’ voting patterns. 

Strathmore Furore 

I came to Australia as a 14-pound “Pom” on the S.S. Strathmore, a P&O liner. The 14 pounds is an estimate. I might have weighed a pound more or less at four months old, in 1946, when I arrived with my Mum. The ship berthed first at Fremantle.

Somehow the Sydney Daily Telegraph had got wind of stench from our ship. Was the Fremantle Doctor that stiff a breeze to reach Sydney?

The story the paper ran the day after the Strathmore arrived was headlined: alien passengers filthy, ship’s passengers allege. Unbeknown to me for sixty-odd years, around 200 refugees had boarded the ship in Port Said—distressing many of those who, like us, had embarked in Southampton.

A Mr Pugh (“ex-R.A.A.F”) said to the Telegraph: “They are mostly women over 50. “Some,” he added for good measure, “are aged 70”.

That sexism and ageism was just lustre dust to the real thrust of the tabloid’s story: These filthy Germans, Austrians, Czechs, Palestine Jews, Cypriots, Greeks and Maltese were covered in sores and so dirty that the real passengers dare not dip their toes into the same pool.

A Mr Spencer of Regent Motors in Melbourne described the refugees as verminous, pointing out that they refused to be deloused. He demanded, “Why don’t we select our migrants from the magnificent types offering in England, and in Norway, where there are 10,000 ready to come here?”

The Sydney Morning Herald also made news of passengers’ complaints. “They’d turned the ship into a floating ‘Tower of Babel’ (and) wore peasant-type shawls draped about their heads (or) jackets gaily bedecked with patterns worked in silver wire.”

The Herald too handed Messrs Spencer and Pugh a megaphone. Each said in turn:

“The immigrants spat on the decks, threw their fruit peelings everywhere, and hung their washing across the deck promenades. It staggers me that Australia should have to rely for its population on the type of people that this ship brought.”

Sydney’s broadsheet listed just some of the languages spoken in the seagoing Migdal Babel: Hebrew was the first mentioned … then Egyptian, German, Greek, Italian, Polish, Austrian, Hungarian, Yugoslavian (sic) and Czechoslovakian (sic).

The furore ran for several days in newspapers around Australia.

Then the following Friday, The Sydney Morning Herald published a letter from a man called David Hand. He was a passenger on the ship, an Australian, who was also an Anglican priest. His five-paragraph letter was written “purely in the interests of truth and justice”.

The fourth paragraph reads: “As a priest on board, I had occasion to learn a good deal about the moral or immoral behaviour of the passengers; and I know that the highest officers of the ship would support my contention that the morals of the British people were no better – perhaps worse – than those of the ‘aliens’.”

He added in the final paragraph, “Those who were privileged to get to know any of them usually found them friendly, keen to learn Australian ways and language, and full of admiration and gratitude of the British people.”

I must have had my foot tickled by one or two of them because I have always sensed what he means by “privilege”.

ME & my mouse are indebted to John Bevins for this recollection. John was responsible for some of the most potent and innovative social marketing and advertising campaigns from the 1980s to end of the century. 

Flynn Addendum – A Message for Albo

This is a tiny parable about the town, which perceived unfairness and bullying.

There was this Tamil couple with their two Australian-born daughters, who were taken from a Queensland town called Biloela in the electorate of Flynn (the majority of which voted 58 per cent for the Coalition). They have been in detention in Melbourne since 2018 under the Dutton aegis, to be deported back to a country where 48,000 Tamils have been killed.

Biloela liked this couple. In fact a petition was raised for them to stay – many people are signing it. The flag over Biloela is not blue. Fifty four per cent of the Biloela citizens voted Labor on May 18. Biloela North admittedly voted 51 per cent Coalition. However, Thangool, 12 kilometres down the road voted 71 per cent Coalition. “Small numbers. Means nothing.” Or perhaps just an example of small town fair play disliking the Big Government the Coalition says it despises and keeps banging on about.

The parable of this story is taken from the Book of Morrison paraphrased: “There is no fair go for those who are forced to go.” 

Coal and the Pro-Adani Canavan

Matthew lives in Yeppoon. He has a wife and four children. Yeppoon is a coastal community that is renowned for its beaches, tropical climate, and the islands out on the bay. So says Wikipedia. It is where people who can afford not to live in Rockhampton go. Rockhampton is on the Fitzroy River far from the coast. It is not the place in which to spend summer. Yeppoon is better.

Yeppoon does not have a coalmine. Matthew has a younger brother called John. John likes coalmines. In fact he has been reported as keen to acquire the Rolleston mines, which were surplus to need for Glencore. John and Matthew seem to regularly communicate about their love for coal.

In a cuddly meal at the “Brekky Creek” Hotel in 2017 with the AFR, Matthew’s position was described thus: “The senator has become an avid reader of mining history and uses it to justify his position to use taxpayer funding to back Adani’s controversial mine, saying a leg-up from taxpayers helped get all new mining regions off the ground, evoking the “if you build it they will come” attitude of the Bjelke-Petersen era.”

Now I live around the corner from where there was once a coal mine, next to the primary school. The two mineshafts, Birthday and Jubilee, were sunk in 1897, and named for the 60th year of the Victorian reign. In fact my late neighbour as a boy used to dart round the corner to get lumps of coal from the dump for the family fire. He would brandish them triumphantly as he scooted home. Lots of soot in the air but it was only where the working class lived.

Matthew would be proud of how the then NSW Government offered to assist the viability of the coal mine when eventually after 30 years it was shown to be uneconomic, but in his terms needing “a leg-up.”

Oh, it was so picturesque, Matthew. Undercapitalised, the mine was never mechanised; so there were pit ponies lowered every morning to work in the mine’s narrow shafts. There were 159 men on the day shift, and the atmosphere was dusty with the temperature reaching 38 degrees C. Miners had a short life.

It is impossible to reconcile why any Australian government would tolerate such a situation, but during this time it was mostly a Labor seat with the then H.V. Evatt being one of the members for the Balmain seat when the miners were working under such appalling conditions. So much for his occupational health credentials!

But I digress. Even as late as the mid-eighties there were discussions about using the mine for gas supplies, and I remember that the opening to the mineshaft was still visible at that time.

Incidentally the remediation process for the mine took decades, including the death of three workers in an explosion of methane gas. To make the mine safe after that tragedy needed four million gallons of water – not sea water, fresh water – to get rid of the coal gas. Note water usage, Matthew.

As a student of mining history, I am sure Matthew would like to know the original stakeholders for the Balmain mine lived nowhere near Balmain. A bit like Adani, but more Old World. London to be exact.

And Matthew, somebody always has to pay the Piper … maybe your children and our grandchildren.

Hawke in the Willow

When I was seriously involved in politics, I met Bob Hawke once when he was Prime Minister and was very impressed and flattered that he knew who I was. He was one of those politicians who knew both faces and reputations. He was on a different rail line to me.

However, one night years later my wife and I with a few friends were celebrating our ninth wedding anniversary. Now the ninth wedding anniversary is willow for all of those who are not obsessed in knowing what to give on a particular anniversary. Needless to say, I had just presented my wife with a cricket bat at the celebratory festivity in the Flower Drum restaurant in Melbourne, when in walks Bob and Blanche with a few friends, including the late Martin Crowe, then recently retired after captaining the New Zealand cricket team.

Given that the last time Hawke had greeted me like a mate, and with a reasonably high sherbet level I took the cricket bat over to them after they had settled in but before any of that elegant Flower Drum Chinese tucker had started to flow. I asked Bob as a mate to sign the bat for my wife giving him a potted history of why I had a cricket bat in a posh Chinese restaurant. He obliged. Blanche signed too. Hawke however looked at me quizzically given that it was a unique experience to be asked to autograph a cricket bat in such an environment. However, that was the personal touch of the man.

Then as I thanked them and was walking back to our table, the owner of the restaurant insisted on signing it too.

As we were walking down Little Bourke Street after dinner, my wife had the cricket bat over her shoulder, and somebody in the street yelled out, “Melbourne is not that dangerous, luv.”

Mouse Whisper

Heard in the Manolo Blahnik industrial boot store in Paraburdoo.

“So if blue is Liberal and red is Labor, when they come together in the political centre do they mix to form purple? The Political centre must be called the Purple Patch then.”

By the way, just back from Mousehole where the last Cornish speaker, Dolly Penteath died in 1777. Her last words were defiant. “Me ne vidn cewswel Sowsnek” – “I don’t want to speak to English”.