Modest Expectations – Melbourne

There is no doubt about NSW; by far and away, the most cases of coronavirus in Australia are there. Granted that it is the biggest state, but the cavalier way that public servants and at least one of the politicians have behaved has exacerbated the problem.

Gladys Berejiklian has one very great ability and that is to talk without saying “um” or “ah” without taking a breath.

It makes it is very difficult to interrupt her, and when anybody succeeds in breaking into the flow, her mouth becomes a tiny moue and her dark eyes those of the avenging disapproval. Such a countenance belies the actual situation that she is a weak leader. And now six months to sort out the Ruby Princess fiasco. Really?

Wait a minute, the Premier has adopted the Chant approach of “zig-zag”. She has asked Brett Walker SC to have a look at it as well – a “special commission of inquiry” in the same litany as “loved ones”.

What next – The Premier’s astrologer?

One despairs of any justice in NSW. This confusion gives a number of people time to muddy the waters, and already Ms Sherry seems to have slid away. Predictable! And the same cruise ships with different titles with all their verminous cabins will be back next year scratching the same political backs and contributing nothing to our economy except grief.

Premier, you are always using the words “Loved Ones”. Tell me how many of those with the sobriquet of your favourite words have died because of the Ruby Princess fiasco. No urgency to know, Premier, no need to know. Six months will do. Hiding behind a special commission? No, I am sure you are not, as you already have a good idea of what has flowed between Carnival representatives in Sydney and your Government.

Can somebody get Ms Sherry to front an interview with her sommelier boss? After all, she has a wonderful residence in Annandale as a backdrop.

The Ruby Princess fiasco testifies to a Premier who not only tried to deflect the behaviour of her Health Department but also failed to sack those responsible for its behaviour. After all, the fiasco has led to how many deaths? Instead the Premier has filibustered. Asked specifically whether she would apologise to those whose COVID-19 is due to the Ruby Princess, or to the families of those who have died, the Premier – in time-honoured fashion – just answered a different question. However, at least the media are finally onto it – they took their time.

Now the barbarians are at it again. They are those whose natural constituency is in the dystopian world of Trump. The irrepressible Chant is at it again inadvertently aiding the dystopians, as she advocates a “zig-zag” approach. Are you seriously advocating going off on a tangent and then backtracking, and then going off on another tangent and the backtracking to a different position? Zig-zagging, as I interpret it, is all about confusing everybody. Really, Dr Chant, do you really mean that?

However, the person to watch now is Mr Barilaro – you know, the man who wanted to close the ABC, the bushfire station so important for distributing information in his electorate – and then was overseas initially when the bushfires were ravaging his electorate. You remember the man?

In the background he is a cheerleader for re-opening the Rugby League, presumably because of its precarious financial position which, like the berthing of the Ruby Princess, the financial situation of a badly run organisation being more important than the health of the Australian population.

Perhaps it is a prelude to Barilaro bobbing up on another front. As he said in his maiden speech to the NSW Parliament:

The New South Wales ski fields have been forced by successive governments to compete with one hand tied behind their back. My vision is to make the New South Wales ski fields number one again, by removing barriers, aligning government policy and industry opportunity, creating a level playing field and engaging all stakeholders to develop a strategic plan to deliver a world-class alpine experience to rival the best ski resorts in the world. 

In our last blog but one it was pointed out that ski fields are a potent source of community spread of the virus.

As Mr Barilaro said in this same maiden speech, quoting Jack Lang:

Always back the horse called self-interest, it is the one that is trying.

You highlighted this quote, Mr Barilaro. It must have made an impression. 

Primrose Pell

From the 13th century onward, it’s easy to see how secretly gay men found in the church, and the church alone, a source of status and power. Marginalised outside, within they could become advisers to monarchs, forgive others’ sins, earn a stable living, enjoy huge privileges, and be treated instantly with respect. Everything was suppressed, no questions were asked in seminaries, and psychological counseling was absent (and even now is rare). Scarred, scared men became priests, and certain distinct patterns emerged.

This quote was written by Andrew Sullivan, an openly gay commentator a Roman Catholic and a follower of the great English conservative philosopher, Michael Oakeshott. The full article appeared on 21 January 2019 under the title of the Gay Church in the New York magazine.

Is Cardinal Pell gay? What does it matter if he is? I have no problem with homosexuality that is not predatory. I had a fellow medical student, a good friend, who dropped out of medicine and was subsumed into anglo-catholicism, became an Anglican monk, and I heard that he died of AIDS some time ago.

I have written extensively about Alister Brass, who was an inspiration for me, and whom I miss greatly, even though he has been dead for 34 years. As a teenager I read Peter Wildeblood’s account of being criminally charged with homosexuality and then spending time in prison for what was ultimately bad law. I was appalled on reading his book Against the Law.

As a boy, I grew up when the “confirmed bachelor” culture was transitioning into open avowal of one’s sexual preference. To me it seemed an innocent pastime for blokes who preferred other blokes, whatever the euphemism.

I have always hated the word “closet”; it may just as well be applying to a confessional box or any dark and secretive environment where homosexual activity is possible. However, homosexuality should not be stigmatised. After all, Tasmania, the last state to do so, expunged it from the criminal code 20 years ago.

Celibacy once may have been a means of survival of the intellectual tradition, but now seems to be a honeypot for communal homosexuality. What is distressing is the level of denial and hypocrisy with which the Roman Catholic hierarchy surrounds this association.

Thus celibacy and homosexuality are uneasy companions, although at one end there is Saint Augustine who was openly gay, and at the other end St Thomas Aquinas to whom homosexuality was an abomination.

Now Australia has seen George Pell acquitted by the High Court for historic sexual offences. In the background, there is a heavily scrubbed report of the Commission into Institutional Responses to Child Sexual Abuse.

So as not to misstep in the quagmire of the High Court, below is essentially a compilation of quotes, including from those advocating Pell be freed.

Now the High Court judges say that is not enough. Other witnesses who gave evidence that they thought the Cardinal would not have had the opportunity to commit the lewd acts ought to have been taken into account, even though they could not give a first hand or personal evidence of what happened to those boys on that day.

Bizarre. One witness swears on oath: this is what happened to me at this place on this day. Other witnesses say: I do not know what happened on that day but that is not what usually happens – and that creates a doubt and voids the conviction. Compounding improbabilities become “reasonable doubt”.

It was argued that because Pell’s assistant, Portelli, didn’t have a specific memory of standing on the stairs on the chosen dates of December 15th or 22nd, 1996, that his testimony about Pell’s practice of being out front could not be relied upon.

 Justice Patrick Keane replied: “I can say I shaved last Friday and I don’t have a recollection of it, not because it didn’t happen but because I shave on work days”.

His point? Do you have specific memories of things done out of routine?

No, we remember things out of the ordinary. Therefore it is unreasonable for Portelli to have a specific memory about two dates in 1996.

The judges also made the point that the accuser’s recollection of the sacristy wasn’t actually proof of the abuse, only proof that he had been there.

Let me tell a story – perhaps a parable. Let us say it was the early years of the last century. Let us say it was Lonsdale Street in Melbourne. In this parable, there was once a junior barrister who used to be shaved by a barber, as was the custom of the day prior to going work.

At the same time of the day early in the morning there was a judge, a man of distinction, who would come in to the same barber shop and be shaved also. The younger and older men would exchange pleasantries and talk about legal cases while they were shaved and perfumed. Most days, they would leave together and walk to Chambers. However, there were some days the judge would leave before the young barrister. One day, the young barrister, the judge having left earlier, decided to take a short cut up a quiet lane, and turning the corner, he perceived a familiar person – it was the judge, who seemed to be adjusting his trousers. In front of him against the wall was a young boy not more than 13 or 14 clutching a newly-minted shilling.

The young barrister uttered a cry, the man who was the judge turned, his expression one of power. What was the young barrister to do? After all, he and the judge regularly shaved together; how could he in retrospect possibly ever remember the day years on what had happened on that particular day – unless he had openly accused such a respected member of the community then; a man of power, a man who wore a wig, a man who could pronounce life or death on a personal career?

Perhaps, just like all your hypothetical speculation, Mr Justice Keane, there is always a confounding storyline – fable or parable – however you define it.

Especially in a real life situation getting away from our exchanges of parables, if it emerges that there was a history in a person’s background of systemic cover ups, the law is presented with a dilemma. Men of distinction do not lie under oath. Axiomatic?

Of course, that is only non-admissible speculation to the collective mind of the High Court, but still enough for a jury to convict in a Victorian court. However in the Court of Courts, there is this reasonable doubt, because no other has come forward to dispute the man of power’s testimony. The child is in essence disbelieved.

It will be interesting if Pell, despite all the travel restrictions, suddenly turns up in Rome on his way to a new closeted life in the denizens of the Vatican, away from a succession of the civil cases, which threaten to follow.

However, there was one touch I loved about wee Georgie Pell, the prisoners cheered in Barwon prison when they heard of his release. I remember that the prisoners cheered when Johnny Cash played for them in Folsom prison – but then Johnny Cash had a guitar.

I have one last quote from the porter in Macbeth as he opened the gates – this for the departing Pell, who has had a life of power so eloquently portrayed in the initial quote from Andrew Sullivan.

I had thought to have let in some of all professions that go the primrose way to the everlasting bonfire. 

Boris

He is the type of Pom who reminds me that England is a nice place to visit but not be infected by the culture – by a product of the Eton boot camp – that nurtures the professional buffoon with the razor sharp mind.

Maybe he has now learnt a lesson that will resonate in his future actions. The buffoon, who boasted he was shaking hands with all and sundry in a hospital, while COVID-19 lurked. Hopefully that buffoon will be replaced by a less arrogant and more compassionate person who does not run the country in the same slapdash manner as we have seen him washing his hands – otherwise, God help the United Kingdom.

There is nothing more humbling than looking into the eyes of the person who has saved you. I know from personal experience.

However, the community is sick of spin doctors who aid and abet the culture of lying; Johnson revealed how really sick he thought he was. It was far sicker than the public was led to believe. Those in charge determined that Boris should not die. The fact that he had two staff constantly caring for him showed how intensive his care was. Otherwise he would not have survived. There must have been fear that a secondary cytokine storm may have intervened and finished him off. It must have been close.

Therefore, can we but cast this spinning vermin out from the Temple No 10? Almost Johnsonian?

And for God’s sake Johnson, grow up. There are many unseeing eyes watching you. 

The World that Boris Missed

A lot of radio stations in Europe will collaborate this Friday (March 20th 2020) at GMT 07:45 to sound the track of Gerry & The Pacemakers – You’ll never walk alone. Please join this collaboration to show gratitude to the people that are doing their best to help us survive this pandemic. And to have our thoughts by the people who lost their loved one.

When I first saw this announcement, it triggered a number of conflicting memories. The song originally came from the Rogers and Hammerstein musical “Carousal”, which in turn had been adapted from a French story about a fairground rouseabout who had difficulty declaring his love for his girlfriend; nevertheless she gets pregnant; he is killed in an accident before his child is born; but is permitted to return to earth for a day to see the child.

“You’ll never walk alone” is a highly sentimental song, which nevertheless moves me. It is just one of a number of good songs in this musical. However, the musical’s recognition was dwarfed at its release by some of Roger and Hammerstein’s other musicals: “Oklahoma”, “South Pacific”, the “King and I”. I saw the film as a teenager.

Some years on I was persuaded to go to hear a group of Liverpudlian bands that were touring Australia in the 60s in the wake of the Beatles phenomenon. One was Gerry and the Pacemakers. Gerry Marsden, the lead singer, was one of those Tommy Steele lookalikes – all teeth and quiff.

I went because a friend had free tickets and while I remembered “Ferry cross the Mersey”, the West Melbourne Stadium was not the best place for romantic ballads. My memory of it faded from view, until the late Paul Lyneham, the ABC personality with that somewhat crooked personality, revived memories with a band he called sardonically “Pacemaker and the Gerries”, which as it turned out in a macabre way foreshadowed his death.

Another fragment many years on – I was in the Melbourne Cricket Ground, the night Liverpool played there in 2013. It was one of the last nights, before I was stricken with my illness – a night I remember clearly walking to the ground and then dodging the traffic to catch a tram back to the apartment – almost my last night of freedom.

In any event, the fans as one had erupted into their Liverpool Football club anthem “I’ll never walk alone.” In the bellowing it loses the romantic lilt of Hammerstein’s words and the melody itself is drowned. However, the intensity remains.

All the pieces have come together with that simple announcement above and the accompanying video of ordinary people singing or miming or whatever – there is something about British working class optimism that makes up for all the Boris buffoonery. 

Opening Australia Too Soon

We now appreciate the Tasmanian Premier closing his borders so none of his Tasmanians can cross to the mainland. However, his action in quarantining the Mainland from the outbreak in Tasmania shows great foresight. We always thought it was the reverse. What cunning!

The “Burnie Incident” is unsurprising, given the demonstrated level of incompetence in the health service, proof of what happens when all the rules that the Commonwealth government put in place are ignored or flouted. Strange things happen when discipline is lax – generally such laxity teams up with incompetence.

One of the problems with many, but by no means all, small hospitals is that administrative capacity of the hospitals is deficient. In particular medical administration is often problematical as incompetents are shuffled between these health services, often with glowing references. This a general comment and not one specifically assigned to either the Burnie or Mersey hospitals, which have a conjoint administration.

Tasmania is lucky it has so many hospital beds. Some years ago, the question was always raised as to why the Mersey Hospital needed to be built, but then there must have been a seer in their midst who saw virus in the mist.

In Burnie, the virus has been let out of the bottle – infection control has been such that COVID-19 has been let loose in the community. One of the Ruby Princess passengers has been blamed for being the first case in the North-West. However ascribing actual blame is for others.

What is important now is that there is a real life situation to follow the out-of-control virus, not some abstract model. Australia can now witness from its falling rate overall what happens in a region where it is easily out of control and to see if the Australian remedy can be reinstated and indeed works.

Burnie in its population makeup is not unlike a western Sydney suburb. There are a string of small towns along the coast from Wynyard, abutting Burnie to Devonport like an attentuated suburban Melbourne and Sydney. I mention Wynyard and Devonport specifically because they are the two travel hubs for north-western Tasmania. Rex flies to Wynyard and Qantas though Qantaslink to Devonport. Devonport is where the Spirit of Tasmania berths, and given the current history of boats and the virus, there is a certain vulnerability I would have thought.

With such restrictions the north-west provides an opportunity to see how quickly the virus can spread and how quickly this underprepared community reacts. If the virus escapes the enforced isolation of the 5,000, then every community in this part of Tasmania is at risk. Possibly viral spread could engulf Tasmania.

Wynyard

The next two weeks will tell all, but it is to be hoped that the introduction of the Army, AusMat, and emergency supplies of equipment and trained staff will halt the spread. There is the complication of the FIFO miners, who are flying in through Devonport but are moved immediately to the mines down the West Coast and thus avoid Burnie. Further, there is always the follow up question of how many miners come from Burnie or other north-west coastal towns?

Hopefully, the police will continue to conduct comprehensive surveillance not only along the coast but also the three main ways south. The first is across Cradle Mountain (from the guys who went from the topiary town of Railton to Strahan – they must have got a shock to be apprehended). The second is the main route down the Murchison Highway, although there is a possible diversion through Hellyer Gorge. Finally, for those who really want to take the COVID-19 virus on a scenic trip South, there is a third route along the Road to Nowhere down through the Tarkine and across the Pieman River at Corinna; hopefully the ferry is still running.

I only mention these routes as apparently there has been an allegation of a COVID-19 carrier, known to have infected a number of health workers, who has vanished from the north-west. Cannot be found. But then there a myriad of unmade roads and forest tracks impossible to police.

It is the problem of Tasmania. One of the most beautiful places on the planet, yet its inhabitants demand much while disregarding their responsibility to conserve and preserve; they could give back more. In this case together with the rest of Australia they may watch how this snafu is corrected.

Mouse Whisper

Hairdressers and barbers take a bow. Excoriated because you were allowed to remain open while others were not, you have plied your trade without being a school for scandalous conduct.

But like all mice I fear a Trim.

Trim

Modest expectations – The Invincibles

Ah, the delightful Matthew James Canavan saying that Malcolm Bligh Turnbull should come to Collinsville and face the people there, with or without a caravan. It is one of those “what are you?” moments that are part of the Australian psyche when you know you have the mob behind you, especially if the mob is composed of guys you would expect to be unionists with eureka flags on their working clothes.

What a statement. I may as well respond and issue a similar invitation, “Mr Canavan, please come to the electorate of Kooyong, where I have a property and talk to my fellow constituents about the need for more coal-fired power stations. I am sure Minister Frydenberg would be overjoyed to see you and then direct you to the electorate of Higgins and then perhaps on to Chisholm and Goldstein. Don’t forget to bring a lump of coal to remind us what it looks like.”

Ever been to Victoria, Mr Canavan – you know Northern and Eastern Victoria to shore up the seats of Mallee, Nicholls and Gippsland. I am sure your fellow Nationals there would be anxious to pass around your lump of coal with the media in attendance, and your Queensland persona rampant?

Lozzo di Cadore

Now, Mr Canavan, I note your ancestors come from a place called Lozzo di Cadore – a beautiful area in the Italian Alps near to the Austrian border. Ever been asked to be on the show who do you think you are?” But perhaps you already know that Lozzo di Cadore translates as the Stench of Cadore. There are 28 commune, as you probably know, in the province of Belluno, and for whatever reason your ancestors came from that one named Lozzo di Cadore. Perhaps a coal-fired power station there would enhance its meaning.

In fact, there are a few of us who are thinking of targeting some of these Victorian seats with an anti-coal message and you wouldn’t mind us using pictures of you and Mr Joyce – you know big overpowering photos of you beside a cart load of coal personally handled by you or Mr Joyce – alongside the photo of the local member. We shall make sure your photos will show you both grinning just to show the sunny if somewhat smoky side of your nature. After all, it would give full meaning to the term “Coalition”.

Tom Reeve

Collinsville is in the Bowen Basin. Even though I have been to many coal mining towns in Outback Queensland, I don’t remember ever going to Collinsville. But the name has stuck in my memory. Why? Because one of Australia’s greatest thyroid and parathyroid surgeons, Tom Reeve, did a stint at Collinsville 18 months after graduation. It would have been around 1949. After that he moved to surgery and never looked back, as they say in the classics.

However, his reminiscence of his stint on Collinsville below in an article he wrote in 2004 for the Medical Journal of Australia showed the value of career development in rural Australia. Tom was a University of Sydney graduate and I remember him saying to me that it was somewhat of an experience getting off the train in Collinsville unknown to the locals and yet knowing you were there for at least a year. In fact, he stayed for 18 months. I have always used his experience to illustrate that time as a rural doctor can lead anywhere.

As the only doctor in town, I enjoyed 18 months of rich clinical experience. Post-term obstetric deliveries, head injuries, critically ill children, motor vehicle accidents and accidents involving horses all hastened my clinical maturity. I remember a young jackeroo with a perinephric abscess after a nasty horse-related accident. As we were stranded by floods at the time, a surgeon in Mackay took me through the operative steps by phone. All ended well.

The community was full of reliable, loyal Aussies with enormous hearts. They were openly friendly and had a great bank of skills, and gave their local doctor the comfort often absent today.

An outbreak of croup in some young children was the most formidable of my experiences. They desperately needed steam inhalation, but I was a little nonplussed as to how to supply it. One father spoke with his boss at the mine workshop, who rapidly produced a large galvanised watering can with four arms, each capped with a watering-can rose. Placed on a primus stove, this device effectively dispensed steam to four mosquito-netted cots simultaneously. Problem solved!

Tom Reeve AC CBE became a giant in surgery. I once asked him to review surgery at Broken Hill Hospital when the late Ross Webster, himself the Foundation Professor of Community Medicine at the University of Melbourne, was Medical Superintendent of the Hospital. There are days indelibly remembered, and one of these days was when we three lunched at the old Menindee hotel, south of Broken Hill. This was the actual building that Burke and Wills stayed in on their way North. The hotel has since burnt down, but the one unusual and unexpected thing I remember was the solitary red hibiscus flowering in the corner of courtyard.

 

No symbolism – just a dash of colour on a courtyard to be remembered.

Parasite is not only a Korean film

Should the people working in a minister’s office hidden from public scrutiny given their integral public purpose? Public records note the cost and number of ministerial office staff, but the government guidelines don’t require publication of appointments, as has to occur with the public service. With the Prime Minister’s 58 staff averaging $233,000 in 2017 and the Opposition Leader’s 39 staff averaging $193,000, is there a need for more scrutiny?

Silly question. When I was Principal Private Secretary to the Leader of Opposition, his advisers numbered six. Add three assistant secretaries, who could write shorthand at 120 words a minute and type at least 80 word perfect a minute and put up with us males; and that was the office, plus of course the electorate secretary. Ten all up.

We worked very hard, but then it was by choice. The long hours and the need to become an essential part of the policy process rather than just political games were complemented by the fact we all lived cheek by jowl.

Why has the Leader of the Opposition’s office grown to 39? In the old Parliament House there would not have been enough room for that many in the cramped quarters. I have always thought the new Parliament House was an example of Mussolini brutalism. Compared to old Parliament House, there is so much space. Whereas in the old Parliament House, King’s Hall was accessible to the public and politicians and the people mixed together. However, with this mania for security and the extravagant amount of space so that you could run a Formula one around the corridors means that the public gets excluded from consideration except at election time; and the party branch structure for politicians is a “tiresome” token of connectivity with the electorate.

Added to this is the claque of advisers without any experience except in the brutality of factional politics and a taste for authority – if not authoritarianism. Some advisers are very good, and there was no doubt that Arthur Sinodinos as adviser to Howard was one who was essential dampening down the negative side of the Prime Minister’s personality.

However, having had to deal with advisers and having seen how others deal with them, the environment which they inhabit gives them a sense that in the name of their boss they can imitate the same bad behavior – the obscenities, the verbal assaults, documents thrown, the demeaning treatment of experienced experts, the endless bad temper, the sexual harassment, the cynical misuse of entitlements, all in various degrees of toxicity depending on the office. Worst of all is the time waiting, because there is a cohort of politicians who are perennially late. This is a topic for a separate blog.

The extent as with the number of advisers has grown – let us not say “exponentially” because though I may hypothesise that the contents of the Trough are increasing in this manner, there needs to be someone to present the evidence. In all, Parliaments are rubbish cultures, not the least because they are divorced from the world in which their electors live.

Parliamentary Courtiers

The problem is when there is an explosion of entitlements, then Opposition is nowhere in the Parliament – nobody is going to blow the whistle and not take the money. All the politicians on this issue are on the one side of the House.

The problem of course is that the amount and nature of expenses come out, and then there may be an outcry if someone has been too greedy, but the lid snaps shut on the Trough. Feeding time is over, and we mug punters do not have any further knowledge – it is asymmetric information par excellence further obscured by the piety of politicians invoking confidentiality measures and security reasons not to be frank with the people who elected them.

The current unfolding behaviour of some elements of the National Party and the Prime Minister’s office in relation to the grants may have vented some aroma from a hole in the Trough, but the government has Gaetjens and Associates, expert Lid Repairers by Appointment on the job, brought in to seal the leak.

In the past I have identified the three elements of this political toxicity, but no-one takes any notice because it is inconvenient: sleep deprivation, isolation and boredom. However, it is probably time to revise what I wrote an age ago from personal observation.

Boredom is still an important factor. Let me quote from a definition of the Mafia consigliere – 95 per cent hanging out and five per cent ultimate brutality.

Here in Parliamentary Australia the brutality may be just factional brutality – consigliere credentials honed sharp by the advisers from their student politics days. Never had a real job, just hanging around the particular Party of their persuasion slicing their way to the top.

Boredom? I always remember the implication at the heart of beauty was evil. Baudelaire may have said something like that because he was a master at pitting unlikely scenarios together: “As a small child, I felt in my heart two contradictory feelings, the horror of life and the ecstasy of life.”

Hence, although Parliament House may give the impression of a hive of activity, at the heart of this inactivity is boredom – doing the same thing over and over again, leaking, evening up all scores and new ones also, pettiness cloaked as activity.

As I asked rhetorically earlier: why does the leader of the Opposition need 39 advisers. Perhaps someone could volunteer to tell us publicly what they all do. How do they evade boredom for instance?

The problem is when courtier expansion has no brake, and when each incumbent has his or her own idiosyncrasy translated as a need for a new specific post such that when the incumbent changes the post is not necessarily abolished. Why? There is nobody to ask what that position was doing there in the first place.

It is the same with any dynastic institution – it’s called tradition. Not that it is all expansion. For instance, until the coronation of Queen Victoria at each Coronation there was apparently a Royal Gruel carrier, presumably because one of her predecessors became peckish during the ceremony and needed a bowl of porridge.

I once floated the idea that there should be cohort of ministerial advisers who would go out and live with the community and learn what were the pressing problems on the job. I had learnt from experience that living close to a problem helped to solve that problem. For instance when we wanted child care for our infant children we started a co-operative (still running today) where the parents ran the show employing the staff and making sure it was properly resourced. Problem alleviated. I came to being a ministerial adviser with a large amount of outside work experience.

Put another way, how many of the Ministerial Advisers were seen helping out during the bushfires in the early part of the year – on deck or there in the aftermath? It would have been useful for an adviser to suggest to their boss, the Prime Minister to take hampers of “loaves and fishes” to Cobargo, for instance. I heard though that they were allegedly too busy undermining the Premier of NSW, while the State burned. Sorry, that does not count. 

The Patron Saint of Blackbirds

I always remember the headmaster announcing to the school that several lads in dark blue suits had been seen trashing a theatrette in the city.

Now Melbourne Grammar School boys in those days wore blue suits, but there was also another school, where the students also wore dark suits. The words “St Kevin’s” rippled through the audience. The headmaster droned on telling us that he told the owners of the theatrette and perhaps the police that it could not possibly be Melbourne Grammar School boys. They always wore their caps. Such was our headmaster’s presence that they went away and did not bother us again.

The point of the story was that essential identifying component of our uniform was the school cap, which we kept on everywhere we went in public. OK, pull the other leg, but that was uttered as school dogma in those halycon days.

At the time, St Kevin’s was firmly ensconced on the second rung of Melbourne private schools, but because it existed in the nether end of Toorak, we Grammar boys used to run into them from time to time emerging from their Gardiner Creek base.

Private schools in my time reflected the sectarian divide of Melbourne, and Roman Catholic schools in heart of Protestant Melbourne breached this divide. Thus running into them did not mean co-habitation, especially because of their status we never played sport against them. However, how unfair it may have been, St Kevin’s already had a stigma as so tellingly portrayed on Monday night.

What I noted in the Four Corners program was the almost subliminal reference to Scotch College and Xavier College, two of original Melbourne private schools, which are still single sex. Each of these schools has had its problems, but not to the same extent as St Kevin’s. Hmmm?

Thus, if the Victorian premier is ordering the review of one, why stop there with St Kevin’s and not have a review of all these supposed premier schools. It would be interesting to see how the culture compares between the single-sex and co-educational schools.

As is becoming clear, it is not a question of boy versus girl and the interaction between the two, which was how the debate was set in my years of school for co-education denial. The debate is now about whether single sex schools act as a magnet for paedophiles.

There was a degree of prescience in the chant we Melburnians had to endure when I was at school: “if you can’t get a girl, get a Grammar boy”. That is Melbourne Grammar – I’d hate to implicate Geelong Grammar as a butt for such mockery.

Mouse whisper

My mausmeister told me of a couple of his supposed bon mots. He said them first in an interview he did when he had his brief period of Warhol glow.

One he said was that once 50 years ago what was accepted as God’s will is now described as medical negligence.

The second: when two or more doctors are gathered together you have a new medical specialty.

Damien Hirst’s M. Mouse

Modest Expectations – Adelaide

I used to listen to his Letters from America – clever oral essays – the British gentleman reflecting on the mores of the day from his study in America. The author was Alistair Cooke, a remarkable figure in his adopted country, who wrote his observations in his weekly epistle until just before his death in 2004.

He had been in America since the early 1930s as a correspondent, but at the heart he was a film critic, and moreover mixing with the “stars”. One of the films he wrote about accepted the doomsday hypothesis of the last survivors of planetary nuclear war. The film was Stanley Kramer’s “On the Beach” adapted from an eponymous novel by a British expatriate who went under the non-de-plume, Neville Shute.

Melbourne was the chosen site for the film, and I remember being in the school quadrangle when Gregory Peck turned up with his son, presumably to enrol in the school while he made the film. I was struck by how much presence Gregory Peck had, without creating any fuss – just dad taking his son to school which, in 1958 was somewhat unusual, but I suppose my dad took me to school on my first day. In fact on reflection he did, found me being bullied by a future archdeacon and had me learn to box as a consequence.

Ava Gardner’s comment on Melbourne was cutting – she thought it a perfect place to make a film about the end of the world. After all, Melbourne pubs closed at six o’clock begetting the six o’clock swill where large glasses called “pots” were lined up to be consumed in the half-hour of grace before the doors were locked. Restaurants were sparse, and any place where you could drink required that alcohol to be bought in a brown paper bag and taken off the table if not drunk by nine o’clock. Men drank beer; women were segregated in the hotel lounge and God, it was not done to have a woman in the front bar. Women of refinement drank sherry; and Scotch whisky was the drink of the “top end of town”. Then, wine was consumed by the bohemian fringe of this apocalyptic maledom, as Ava Gardner viewed it.

In his review of the film, published in the Guardian 17 December 1959, about which Cooke is positive – “a story…as clean and unsentimental as a skull.” However, on the imagery reflecting on the future, Cooke is pessimistic. He quotes the collective wisdom of three think tanks to write:

They agree in approximate terms that nuclear war in the next decade is more likely than not. They warn us that the military decline of the United States in the short span of fifteen years has left it open to a devastating attack; that the disarmament at the United Nations and Geneva may blind the United States to the possibility that the Soviet union with a clear superiority in the arms’ race will use it to blackmail or attack its major opponent without warning. 

Neville Shute, the author, subscribed to the mutual annihilation theory rather than the above, (which seemed in accord with that of Cooke) since it mirrored the mindset of the late 1950s and 60s before the Vietnam War monopolised the headlines.

However, when Khrushchev engineered the Cuban missile crisis and failed, that was it – one episode of blackmail and the Russians withdrew to its reality. Competition with the United States in hindsight was illusory once the Americans got serious. However, it was not until Reagan called the Russians’ bluff and thus three decades later the Russian empire was in ruin.

Now we have Putin, the arch illusionist, at it again. Russia has divested itself of land, but they have been mindful that maintaining a number of satraps is important. Garrisoning countries is a costly exercise for a country with a GDP not much bigger than Australia’s. This time he wields his power by bullying his neighbours, which provides occupational therapy for his armed forces whether they be in the Ukraine or the Caucasus. Up to this time he has not manufactured a reason to march across Lithuania so that that exclave of Kaliningrad can be re-united with Mother Russia; but if he thought he could get away with it, who knows.

However, this illusion of the powerful strutting дуче also depends on his manipulation of Trump. Maybe I am only dazzled by the illusion of an image of a marionette with golden hair, on a wire, being paraded before a worldwide audience.

However, Prince Andrew was not the only person to be seen in the company of Mr Epstein – a figure who, in death, increasingly resembles The Tar Baby.

I wonder what Mr Cooke would have thought of this scenario which, in another context from the film “On the Beach”, could end up in mutual annihilation.

Another Alister – Another Time

There was another Alister, whom I admired greatly. His name was Alister Brass. “Alister” has a protean number of ways of being spelled.

Alister was the editor of the Medical Journal of Australia for a period in the mid 1980s – not only a doctor, a journalist, a war correspondent, but also a man of great innovation and integrity. He was lost prematurely to AIDS.

He did not have to adorn his ego with citations and references to his own achievements. He did not have the basic insecurity that often accompanies this display, and not to put a fine point on it, he viewed being editor as a full-time occupation, not a part-time bauble.

The Nobel laureate, Dr Barry Marshall wrote a telling piece about how Alister Brass helped him, reporting on self-administration of Helicobacter pylori to himself as part of fulfilling Koch’s postulates to prove that the bacillus caused peptic ulcer. Alister Brass had seen the original paper that Barry Marshall and Robin Warren had published in 1984 in The Lancet. Brass had encouraged Marshall to write an article for the MJA, which was duly submitted to “scrupulous referees” (Marshall’s words), who demanded a re-write and the final published article in 1985 became very influential in the recognition of Marshall and Warren’s work by a sceptical worldwide audience.

Marshall could not have been more clear about the value of Alister Brass’ role, as all great editors have, in ensuring the work, which eventually brought Marshall and Warren the Nobel Prize, was scrupulously refereed and then published. As Marshall himself concluded years later Re-reading that paper every few years, I am impressed by how far the MJA Editor was ‘sticking his neck out’ in allowing me to publish a hypothesis as to the cause of peptic ulcer. It was a further 5 years before journals allowed the word ‘cure’ to appear in articles about duodenal ulcer, and almost a decade before mainstream United States journals could accept it as proven.

Be that as it may, the point should be clearly made that two people who were outside the conventional medical establishment at that time (they were in Perth during the period of the research), Marshall and Warren, were nowhere near the major beneficiaries of medical research funding – Victoria or NSW.

The rush to citations as a sign of pumping out research papers has recently been criticised by the Chief Scientist, Alan Finkel. He mentions the “salami-slicing techniques” whereby, why have one paper when you could have three out of one piece of research? Then there is the multiple authorship where those who seem to be at the top-end of frequent flyer points appear on an article to which their input is negligible. I believe the citations record tallies over 5,000 authors. The emergence of a plethora of non peer-reviewed journals offering to publish articles in return for money, has just added to the proposition that “citations” are being discredited as a valid measurement of scientific worth.

Marshall and Warren were a temporary antidote to the accusation that so much of this form of research is trivial. The question remains: should the community reward funding submissions that emphasise process (of which parading a wealth of citations is one criterion and that insidious “proven track record” is another) rather than an outcome bestowing a tangible benefit on the community?

It is a pity that Alister Brass’s life was cut short, because we would not have to be reminded of the Journal’s worth by some obscure measurement. It would have been self-evident. He would clearly have made the above question irrelevant through the way he extracted the very best from authors and researchers in the same way Ingelfinger and Relman as Editors defined The New England Journal of Medicine.

A load of old cobblers

I sit and cobble at slippers and shoon, From the rise of sun to the set of moon; Cobble and cobble as best I may, Cobble all night and cobble all day.

In 1982 I invited David Owen, then at the height of his political powers, to give the address at the 50th anniversary of the Australian Institute of Political Science*.  Named in his honour, Sir Norman Cowper attended this inaugural Oration. Sir Norman had been among the founders of the Institute, although that is another story.  Dr Owen charged the Institute nothing. I was able to wrangle a first-class airfare London to Sydney return out of Qantas (in the days before business class and Irish parsimony).

These days politicians, after their retirements, have a habit of charging large amounts of money to perform while they garner a luscious pension for which we all pay. The current Treasurer, Minister Frydenberg, now aged 48, will in all probability be no exception. No need to retrain good ol’ Josh after the age of 60, except to identify the location of the amenities cabinet in whichever ambassadorship he has been awarded and later on retrained on how he stores his cash when there will be no banks left we can trust.

Politicians advocating this course for the elderly should not do so unless they are also serious about being role models, insisting on retiring on modest pensions and seeking retraining. Otherwise they could be subject to ridicule with a restive population calling for the re-introduction of the pillory.

Perhaps Abbot could resume his religious calling and be retrained as a Pentecostal minister; my favourite rent-seeker, Christopher Pyne because of his fixer obsession being retrained on reaching 60 as a paper hanger. However I jest – but if you think about it further, why not? Also, perhaps the word for this breed is “train” rather than “retrain”.

At my 70th birthday I was chirpy enough for people to exclaim that 70 was the new 50. It is seductive to believe that aphorism. However, when Frydenberg exhorts the elderly to retrain the answer is for what – and what time will be required for this mythical retraining and then, assuming anyone, anywhere would consider hiring this retrained person, one may only be able literally to work for a few years. Even though the average living age may have crept up to over 80, this increase in quantity cannot be necessarily equated to quality and ergo capacity to work.

Susan Ryan, Age Discrimination Commissioner from 2011-2016, used to bemoan the fact that there was age discrimination in Australia. Well, thank you for borrowing my pocket watch and telling me what I already know – if you’re over 40 and wanting a job, good luck. What did she do in her five years there? But then she was followed by another “retrained politician”, Dr Kay Paterson – and there is silence broken only by the chirping of crickets when the question is asked, what have you actually done to solve the problem of age discrimination for older Australians looking for work?

So what is the Frydenburg retraining all about? I worked until I was 75 years, and the only retraining I needed was to cope with my disease over my last 15 months, when I was deprived of independent living. However, with a carer for whom no government assistance was sought, I was enabled to ease into retirement. I had a few part-time “hangovers” from my previous jobs, which provided employment for another 18 months. Thus I was well into my 77th year when I finally finished.

Therefore it may be more about convincing employers of the worth of retaining the employees on, say, a contract for three to five years. On the other hand, I do not believe that the economy should be burdened with unproductive ageing staff. I can say that because – in the terms of the Italian calibration of age – I am about to pass from vecchio to anziano. 

Jokes aside, “working” and “ageing” provide a complex situation. I have had to deal with people who should have long since retired, and increasingly they had presented a hazard. It becomes a very difficult situation especially if they have accolades from their careers, which suddenly become more important to them when their livelihood and relevance are threatened.

I have one advantage. I have my marbles and I can look back over the past 20 years during which Treasury has put out a number of papers on this matter of ageing and the workforce – for what effect?

Just giving more benefits for a relatively small but vocal segment of the ageing population without the bother of setting up retraining scenarios, with only a marginal chance of success.

The “Golden Age” index is touted as a benchmark, but the index age range is 55-64. Fifty-five is a ludicrous age to retire, but was the basis of many public service plans with penalties imposed for working beyond that age. As a result, there has been the growth of so-called consultant work – doing what you were doing before, but at a higher rate of remuneration to top up that indexed pension, and stimulating the rise of the rent-seeker class.

Minister Frydenberg, can I hand you the last?

The Victorian TAFE sector says it takes a year to train to become a cobbler aka shoemaker. Another way of being the life and sole of the party when and if you get to 70!

*Now the Australian Institute of Policy and Science

Jesus the Leader

Now a rather sad case of a man when a post-graduate student who, when he was a student at the US Army War College, wrote a dissertation on Jesus Christ the Leader.

He described the Jesus model of leadership as love. His first criterion was that leaders traditionally sat at the top of the pile and issued orders, while Jesus “inverted the pyramid” and “he got down in the trenches and served the troops”. The rest of the “Jesus the Leader” dissertation proceeded from this statement.

Fast-forward 15 years and now Major General Gregg Martin faces his Jesus moment when as,

“The president of the National Defense University stepped down from his post last week following reports of an ongoing investigation into a poor command climate at the Defense Department-operated institution.

Maj. Gen. Gregg Martin officially relinquished the job last Monday…the move was approved by Chairman of the Joint Chiefs of Staff Gen. Martin Dempsey… Gen. Martin said he believed this was the right time for a new leader to guide the institution as NDU continued to prepare leaders for the challenges facing the U.S. Military.  

Martin was reported as having unilaterally ordered a series of sweeping structural changes at NDU without consulting its tenured faculty and other academic leaders, and that he threatened to fire anyone who challenged his plans. Martin responded that he was indeed seeking “transformational” change within the university, but that his comments were misinterpreted.”

Hardly a sign of mutual affection, but as Martin had written in his dissertation, “Jesus religiously took time away by himself, plug into his eternal power source – God’s Word – and recharge his battery. When things get extremely hectic, it may be time to consider taking an afternoon to play golf.”

Jesus thanks you for that advice. Some people may define the golf links as a wilderness but I think,

General, you are advising the wrong chap.

Jesus is the Palestinian chap on the right hand side.

In turn, Martin has languished in his own Pentagon wilderness for the past five years.

Mouse Whisper

Chevron ran an advertisement bemoaning the fact the United States reserves of natural gas were small compared to Russia, Iran and Qatar. In fact the United States and Turkmenistan vie for fourth place. This ranking has not interfered with the fact that the United States is the largest producer of natural gas ahead of Russia.

On contemplating this Chevron advertisement where ostensibly the message is that the USA has a smaller supply of one commodity than “shock horror” Russia and Iran, it struck my murine mind that how it was playing upon the fragile ego of the American people. Trump has also exploited the same fragility in his “Make America Great” mantra. Augmenting it with red dew drops of “Russia with Love” has led Trump supporters to wear T-shirts which say “I’d rather be Russian than Democrat”. You mean better be Stalin than Roosevelt?   I am really now mus confusus. People so insecure in themselves that they would compromise their country’s security. Maybe they should have a portrait of Benedict Arnold on their T-shirt as well.

Benedict Arnold

 

 

 

 

 

What Trump supporters are wearing this Fall.

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 – Parrot

I want children growing up in Australia to feel positive about their future, and I think it is important we give them that confidence that they will not only have a wonderful country and pristine environment to live in, that they will also have an economy to live in as well. I don’t want our children to have anxieties about these issues.”  

The antidote for such anxieties?

 Religion is the opium of the People.

 You get good Marx for that solution. 

The safety valve

I never thought when I was challenged to write a blog, which I’m sure among the cacophonies of ideas and opinions may be read by one or two, looking for a murine apparatus and getting the spelling wrong. However, the blog is a safety valve. It allows one to shower cyberspace with words – and since cyberspace is self cleaning then you do not pollute but leave, in one’s own mind, priceless gems hanging like lanterns lighting humanity as they get swallowed by the uroboros.

However as the twilight glimmers, one of the only facilities left to me now is writing. Assuming that this is my skill, I am writing as if there is no tomorrow so that there is a legacy for what it is worth. I always listened to Alistair Cooke’s Letter from America every week when he was alive; there was always a reason for saying what he did. The book of his travel around America when he was a young man inspired me to see as much as I could, since that axiom that one is a long time dead rings so true – despite one’s affirmation of life everlasting in the Apostolic Creed. The problem is that these Creeds were hatched when 40 years was the life expectancy; thus before one realised the horror of old age and being cast into the Life Everlasting nursing home.

Rockchoppers revisited – A Weapon of Mass Destruction

I read Rockchoppers just after it was released in 1982. It was written by a Roman Catholic priest, Edmund Campion and in the wake of what I thought was the awakening of the Roman Catholic Church following Vatican II and with it the growth of the worker-priest movement. It was a brilliant book.

Chartres Cathedral Rose Window

His description of Chartres cathedral – there is none better. To stand, kneel whatever your stance in Chartres Cathedral the cathedral is, the nearest I myself have ever felt of being in a divine presence. Edmund Campion put my inchoate thoughts in print elegantly, compellingly. He quotes those stirring words of Fulbert, one of the Bishops of Chartres.

We are as dwarfs on the shoulders of giants. We can see more and farther than they, not because we have keener eyesight or because we are taller than they, but because we are raised up and held aloft by their grandeur. 

Yet as I clear my library of books accumulated over more than half a century, I wonder how Campion feels today about his Church beset by a tidal wave of child molestation, unacknowledged children of priests and the indefensible maintenance of the seal of confession in cases of child rape, the non recognition of woman as priests, the hurt and harm to so many of the flock over which these men in frocks and silly hats have presided. Shepherds they ain’t, although they do carry a crosier – representing the shape of a crook.

Corpus Christi College in Victoria, a seminary, has been revealed as a cesspool breeding pederasts. On re-reading his book, Campion is very chatty about his early life, except for the time he spent in the Manly seminary studying for the priesthood. He dismisses it in a few lines – “for years I would have nightmares that I was back inside those walls”. That is all, and his book then pursues the doctrinal-political pathway of a man whose beliefs are in line with those of the worker priest at a time when Santamaria was in ascendency. Yet he must have known about the increasing social dysfunctionality of the Church – he is too astute and sensitive not to have known.

However, this week watching these Roman Catholic apologists wheeled out for the courteous Lisa Millar and Geraldine Doogue to interview, there are the masks of geniality that are difficult to challenge, especially if you have been conditioned since childhood with a sense of guilt. You can never be rude to the Church. The Church would never send in the current Archbishop of Melbourne for interview as the public relations front – just get a good ol’ empathetic face of a Father Brown understudy with a purple vest to pour on the paternal charm.

This is the Roman Catholic Church in delay, delay and delay mode; the creed of Catholicism, as it is with many religions, is secrecy and rearguard. The description of church architecture to over the centuries as described by Campion designed to increasingly separate the congregation for the priest to enhance the impenetrable secrecy should be standard reading as should be his antidote in Chartres.

Personally I am pessimistic and the Campion book holds the clue of why that is. Within all religion there is a reactionary group fearful of change which intelligent unscrupulous populists like Santamaria can exploit, as he did through the DLP before it was effectively destroyed in the 1974 Federal election.

However, it is not only the conservative Roman Catholics, but also in Newt Gingrich’s cleverly exploitation in harnessing the political clout of the evangelical Christian movement in 1990s. There are two forces – fear and the authoritarian personality, which oppose the forces that Campion wanted unleashed to liberalise the Catholic church. Therefore, to protect the base the traditionalists are prepared – if not to condone the despicable behaviour outlined above – then to look the other way or throw a blanket of sophistry over it.

Richmond – A Reflected Glow

I am not a Richmond supporter. However, I easily could have been if the kids on the corner of the street where I lived when I was five had not been Essendon supporters. Deeply impressionable, I became a passionate Essendon supporter, a support that was transferred to my sons and their children.

Michael Egan, Major of Richmond

However, my great grandfather, Michael Egan was Mayor of Richmond in the early 1870s and there is even a street named after him in Richmond. He distinguished himself by biffing another councillor who dared to disagree with him, but many of his other achievements as a councillor have been lost when at some time later the Council records were incinerated – some say suspiciously.

Michael Egan made a fortune with a wood yard, initially at the end of Rowena Parade and then transferred to Punt Road, where the Yarra River was convenient for transporting the wood. Anyway most of the wood ended up in the goldfield diggings, and when the great Crash of the 1890s came, I was always told that he survived because his money was in the Bank of NSW.

During the 1970s I frequented the Vaucluse Hotel in Richmond where we had monthly meetings, and this was time when the licensee, Graeme Richmond, was one of the geniuses behind that golden period when Richmond was last a powerhouse football team; and mine wasn’t. However, despite the horror of the period I did not change my colour from red sash to yellow.

Then Kevin Sheedy came along, a Richmond champion footballer as coach of Essendon in 1981. I thought Sheedy a dirty player and remembered him breaking Des Tuddenham’s leg, another ferocious footballer of that era, who had gone to Essendon as playing coach from Collingwood.

Now this Sheedy had come to Essendon as coach, and there was a perverse satisfaction in him losing five out of the first six games as coach such that he contemplated putting on the boots and coming back as a playing coach.

Then the Sheedy era blossomed. Essendon won 15 games in succession until it lost the very last game of the season to Geelong to Geelong and subsequently the 1981 elimination final. In three years though, Sheedy achieved his first premiership with my team – the first since 1965 – and during this time it turned out that Sheedy had been an Essendon supporter as a kid.

The tide was turning. Sheedy in my eyes now had been a fearless, uncompromising player, who brought the best out of his players instilling that intense fearlessness, of which the current Richmond coach, Damien Hardwick, as one of his protégés was a beneficiary.

One day Sheedy had also stopped to play cricket with my sons who were practising on one of those malthoid wickets in Yarra Park close to the Richmond Cricket Ground. How good was that for two teenage boys forever devoted to the Essendon red and black! Richmond and Essendon were thus forever closely intertwined.

However, even before Sheedy was appointed, I did make amends in relation to the yellow and black when in 1979 I moved to Balmain – Richmond on the Parramatta River as I called it – and became a very strong rugby league supporter of the then Balmain Tigers.

Balmain colours were orange and black. But what is there in a different shade of colour?

But then that is another story. 

Trudeau or Scheer. Scheer who?

It’s colder; they play ice hockey more; their bacon is really ham; and their obsession with maple syrup products borders on unhealthy. So penned a BBC reporter in an introduction to an article about the Canadian versus American political system.

The Canadians go to the polls on 21 October with 338 ridings up for grabs. Next week, the leaders of the various parties face the media in a Quebec venue – one in English –the other in French before audiences presumably who can understand “pollyspeak” in two languages.

There seem to be six parties in the electoral campaign, although two of the parties have two and one member each – the Greens, two on the Vancouver islands and a one-man party led by a LePen-like character who holds a Quebec seat. This leaves the left-of-centre New Democratic Party under its leader, Jagmeet Singh, struggling to repeat its 2015 successes. The Bloc Québécois Leader, Yves-François Blanchet, seems more secure and concentrates on the francophone areas, and it is the loyalty of his constituency that will probably determine whether Trudeau can wrest seats and be re-elected.

Trudeau thus will have to win seats in Quebec, an aim helped by the fact that the Conservative leader, Andrew Scheer, who represents a riding in Saskatchewan, does not speak French well.

Saskatchewan

However, the end result of the election should be interesting. We Australians pay scant attention to Canadian politics, only mentioning briefly Justin Trudeau’s travails, when he had been embarrassed by his appearance in blackface on several occasions when young, well before politics beckoned. These antics have been portrayed by the right-wing media as though they were a mortal sin. However, given the rise of social media and the tendency apparently to trade intimate and potentially embarrassing images, maybe this minor transgression by Trudeau will be magnified in future elections for aspiring politicians as the “sins of the past” are paraded as “weapons of mass destruction”.

What is important about our future relations with Canada is that both countries for their size and GDP have substantial pension/superannuation funds, with the potential for investment. An example of this is the joint arrangement announced in August between Australian Super, Australia’s largest industry superannuation fund, and Ontario Teachers’ Pension Plan, Canada’s largest single-profession pension plan, to invest $1 billion each in the National Investment and Infrastructure Fund (NIIF) of India’s Master Fund.

Then this week, Webster Ltd, Australia’s monopoly grower of walnuts, signed a deal for an AUD854 million takeover, yet to be ratified, by PSP Investments, Canada’s huge public service pension fund. The same fund has funded the Hewitt Cattle Company to expand its holdings in the Northern Territory. PSP Investments also owns 25 per cent of the NorthConnex tunnel, 25 per cent of the Westlink M7 toll road, 33 per cent of the rail freight company, Pacific National and a large slice of BAI Communications – in political terms all highly strategic.

The problem with the two countries is that in addition to being far away from one another, they traditionally excel in different sports (unlike other countries in the British Commonwealth). So the two countries exist in parallel. Any communication between Morrison and Trudeau one can guess has been minimal; perhaps if Scheer becomes Prime Minister there will be more evidence of shared vision in a common adulation of Trump, given the way their political careers have slid forward.

Politicians are great followers and perhaps the investment profiles of the large superannuation/pension funds of each country may guide them to pool their common interests so there is a potential third force in this increasingly polarised world.

And one great advantage Canada has over Australia is the lack of the Murdoch shadow. It should be noted that James Murdoch has purchased a property in a remote part of British Columbia, but then does he count? After all, he has been caught providing funding for democratic aspirants for the U.S. Presidency.

Mouse whisper

Mentioning “Boof”. It may have been 2010 … with apologies to A.A. Milne.

Scott Scott Morrison Morrison whether a matter for glee,

Took great care of his bear, though he was forty-three.

Scott Scott said to the Rupert: “Rupert, ” he said, said he.

“Don’t ever go up to the top of the town if you don’t go up with me …

and look what happened – Scott2 Morrison2 has another bear called Lachlan.

Modest Expectations – Union

One can hardly believe that in a country with so many challenges there is so much concern over some footballer who made a list of people he wished to be assigned to Hell.

Echoing what I wrote in an earlier blog, Peter Singer, the bioethicist, is reported as having written:

“Folau is a born-again Christian, and his post was an expression of his religious beliefs. To prevent misunderstanding, I should say that I do not share those beliefs. As an unrepentant atheist, I am among those for whom, Folau believes, hell awaits. But that does not trouble me, because there is, in my view, no god, no afterlife, and no hell. Nor do I differentiate, ethically, between homosexual and heterosexual relationships.”

Singer picks up the “hell awaits”. It is not as though Folau is advocating violence or even earthly sanctions. Nevertheless, the sheer arrogance of such a list should not have goaded the Rugby Union establishment into a response, which in turn has started a chain reaction. It has enabled the fundamentalist Christian groups to start braying about religious freedom, using Folau as a martyr strung up on a goal post.

In the course of this saga the community is being suckered into a situation where a silly statement is now being adopted by those who want to use the cloak of the Christian Church to run extreme agendas; where dominance of women is one of, if not the main objective.

Symptomatic is the resurfacing of the anti-abortion crew, who have never gone away – the matter has become a surrogate for maintaining the subservient role of women. Christian churches out of the mainstream are very good at keeping women as handmaidens, where the violence is not necessarily physical. And it is not limited to Christianity.

I have a visceral dislike for abortion, but it is not my business – not my choice. It should be a woman’s choice.

There was one occasion when I was faced with a friend who wanted an abortion, and the potential father had disappeared. It was at a time before the Menhennitt ruling changed the secrecy and enabled abortions to occur openly, and the words “criminal abortions” rendered obsolete. (In Victoria, a landmark Supreme Court ruling in 1969 (‘Menhennitt ruling’) established that an abortion will be lawful if the accused held an honest belief on reasonable grounds that the abortion was both ‘necessary’ and ‘proportionate’.)

The whole episode made me so disgusted that we, in an ostensibly Christian society, were allowing women to be exposed to emotional and – on those occasions when the “backyard” procedure went wrong – physical trauma on women. Here a degrading scene was being played out, because men – predominantly men, and celibate men at that – thought it sinful.

Fortunately, my friend survived the ordeal. She recounted what had happened, I was appalled but we never talked about it again.

That is the worry if this whole Folau imbroglio, with the forthcoming legal action, is allowed to energise this group of anti-abortionist misogynists over what is, in the end, a belief lodged somewhere inside Folau’s head that should have nothing to do with anything but his contract with RU.

Nearly 20 years ago, Susan Ryan, the former senator, reminded us it had not been that long ago that the House of Representatives’ vote against abortion – four years after the Menhennitt ruling – was 98 to 23.

“The debate was conducted in an all male chamber, the women were outside rallying, organising, shouting through loud hailers, preparing for disappointment. I decided that next time we should be in there making the laws.”

It is not often that I agree with Susan Ryan, but I do on this matter – wholeheartedly. The whole of the Coalition voted against the decriminalisation of abortion although one young Liberal party member who stood up with a flourish as though he was going to break ranks and cross the floor to vote for decriminalisation, looked around and seeing he would be on his own, sat down.

As for Folau, it may have been easier to tell him to get lost. Of course he would not have, but I do hope that when some other sportsman near the end of his career and with enough notoriety to be noticed, says something as stupid as Folau has, that the situation is better handled, including not to renew the contract at some astronomical figure.

For instance, select him in an Australian team and he can then work out who is the adversary, given that he likes to compile lists.

Somewhat more important than Israel Folau

Opera is watched by an estimated a total audience of 300,000. It is a form of artistic licence that belongs to a different age. In that age women were treated dreadfully, composers had various forms of pathology. Who knows how many operas were written under the creative phase of syphilis so rife then. But now, to try and change the opera so as to satisfy a fad is as crass as the efforts of the Bowdler family in the 19th century to change Shakespeare to remove the “dirty bits”.

It is ironic that a report in the SMH of the opera “deisembowdlerising” itself, is perched alongside a report about the number of hate and violent items appearing on Twitter, Facebook/Instagram and YouTube. Here those indulging in such unspeakable behaviour are totalled in the millions.

So while token behaviour to cauterise opera plots may make those involved feel appropriately righteous, the problem is not solved by tokenism towards women’s rights.

However there is, as reported, a public health emergency in the way social media has become diseased.

Humans coming in contact with one another harbour the means of infecting one another with both the good and the bad. Globalisation is the jazzy word that we have for the removal of barriers to the spread of a vector, be it conventional trade, disease or whatever.

As the globalisation of Christianity occurred so did the spread of European disease against which the Pacific islanders and Australian aboriginals among others had no defence.

Similarly the globalisation of those who went to the New World of the Americas took a cornucopia of transmissible diseases as the contribution of Europe in this “free trade of infection”. In return Columbus is reputed to have brought back larges doses of syphilis. So it was a form of bilateral trade.

In those days when there was no idea what caused disease: perhaps the miasma, which was great for the perfume trade; or some dark unknown medium, which provided the excuse to torch women – and the ersatz cure – the miracle sustained by intercession via prayer or veneration of some osseous part of a saint.

Perhaps it is encryption that is the best analogy, especially as the means it has to deceive is akin to microbial mutation.

However, it is always the word “plague” which focuses the mind. And while we do not have the spectre of bodies loaded on carts being wheeled to mass graves, the world is entering into a time of cyberdisease, and “cyberplague” is convenient shorthand, although it has been used in generic terms before.

We now know the bacteria Yersinia pestis causes plague. Fleas and lice carry the bacteria. They can also lodge directly on humans if sanitation is bad – otherwise rats, dogs and cats inter alia are convenient intermediate hosts.

These abbreviated instructions from the Centers for Disease Control (CDC) in Atlanta on how to prevent plague provide clues:

* Reduce rodent numbers. Make your home and outbuildings rodent-proof.

* Wear gloves if you are handling or skinning potentially infected animals to prevent contact between your skin and the plague bacteria.

* Use repellent if you think you could be exposed to fleas or lice.

* Keep fleas off your pets by applying flea control products. Do not allow dogs or cats that roam free in endemic areas to sleep on your bed.

So it should not be too difficult to assign the appropriate language to deal with Cyberplague. One thing is for sure: it is the role of Government to supervise. The private sector does not do this well.

This darkening cloud over social media is the scourge. It is a public health emergency. And Donald Trump seems able to call a National Emergency, at a drop of a red cap… if he understands.

Where did all the Money Go?

I received an email this week from John Kitzhaber, once the Governor of Oregon and the man who received international attention when he devised the Oregon Health Plan. In part he wrote:

The cost of health care in this country is utterly out of control.  Mind-boggling. Approaching $3.8 trillion a year. This amount of money has attracted a whole host of private equity funds (that are) simply milking the system to feed shareholder profits. We had big national for-profit insurance companies that are likewise using public funds to increase shareholder value instead of reinvesting in the community.

John Kitzhaber – painting by Henk Pander

That problem is now also occurring here. When the Medibank model was established here in Australia, the expectation was that the patient would receive a medical benefit when they consulted a medical practitioner to assisting in paying for that medical service.

Doctors were considered to be in solo or group practice, and in fact when the first benefits were struck for procedural items, it was assumed that the benefit reflected what the government was prepared to pay to the patient for the perceived skill of the doctor.

Therefore when the array of medical benefits was struck for a surgical procedure, it was assumed the patient benefit recognised the skill of the doctor. The cost of the attendant scrub nurses, the surgical materials, the operating theatre were all absorbed into hospital costs, covered either by the public or private hospitals. In other words, the Medibank the scheme was constructed on a guild model – a hangover from the time when doctors sent accounts in guineas to patients who could afford to pay.

However, the medical professional entrepreneurs recognised that with the advance in technology, particularly in pathology but followed by diagnostic imaging with the arrival of the CT scans, there was a “pot of gold” awaiting. Radiotherapy and general practice have followed, and now other specialties such as cardiology are the target.

Technology improvements emphasised two of the problems with an open-ended floor price scheme as Medibank and subsequently Medicare demonstrated. The first one was the entrepreneurial manipulation of throughput against capacity for a particular procedure. This was lucrative when the Medicare benefit was set at a low throughput and not scrupulously adjusted over time as throughput increased with technological improvements. The second was the tiresome ‘pass-the-parcel’ game between the state and federal governments, otherwise known as ‘cost-shifting’. Private sector entrepreneurs have been able to utilise this for their financial gain but state governments have equally become adept at the cost shift and at the same time burying the real costs of health care.

As can be seen, health financing was drifting away from the original intention of enabling the patient to get a fair and reasonable subsidy for their medical care

The problem with the business model, which may have been devised first by economic rationally doctors in the Edelstein mould, is that it has been transformed into a business model not unlike the one described by Kitzhaber.

Here the doctors may be listed as the providers but in reality it is a company which employs them in some form which is harvesting the profits and shovelling Medicare money who knows where into tax havens around the world. Medicare money has acted as seeding finance for the eventual acquisition of overseas health companies.

It is difficult to watch the Federal government being so compliant. The problem is compounded by these companies giving a fraction of their Medicare-seeded profits to political parties for them to enable to run election campaigns saying they are looking after “all Australians” and thus these private firms to have a firm foothold into the political process.

The central governmental agencies know this but at present their political masters are impervious to this flow of taxpayer’s money off shore – after all we have a taxpayer Medicare levy so some firm profiting from such taxpayer funding can buy a health service in the USA or a pathology company in Germany – in effect using Australian taxpayers’ money to fund their business and not only that, but funding where there is a guaranteed floor price for each of services. So risk is negligible once the investment model is settled.

Kitzhaber’s comments are more than timely.

And for us in Australia, it gives us gives another meaning among others for a sonic boom.

Mouse Whisper

Heard between Nobby and Cambooya driving through that magnificent black soil country of the Darling Downs.

“Mate, the soil is so good out here you can plant nails and they come up crowbars.”

Yes, appropriately it is Steele Rudd country out here. But as my young mouse cousin asked “Who is Steele Rudd?”

 

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.”