PCEHR breakthrough Doctors win right to bill for e-health record work, p5 Inside PCEHR: Should I sign up? AMA Guide, p6 Doctors must oversee treatment of asylum seekers, p8 Prime Minister leads tributes to AMA, pp11-14 Abortion drug approved, p20 Men to get the Pill?, p35 Chocolate is good for you, p35

australian medicine - september 3 2012 Issue 24.16 - september 3 2012 2 australian2 medicine - september 3 2012 AUSTRALIAN

Managing Editor: John Flannery Contributing Editor: Dominic Nagle Editor: Adrian Rollins in this issue Production Coordinator: Kirsty Waterford Graphic Design: Streamline Creative, Canberra Advertising enquiries NEWS Streamline Creative Tel: (02) 6260 5100 Fax: (02) 6260 5200 Australian Medicine is the na­tion­al news publication of the Australian Medical 5-10, 15-25, 37-38 Association Limited. (ACN 008426793) 42 Macquarie St, Barton ACT 2600 Telephone: (02) 6270 5400 Facsimile: (02) 6270 5499 special featureS Web: www.ama.com.au Email: [email protected] Australian Medicine welcomes diversity of opinion on national health issues. For this reason, published articles reflect the views of the 11 AMA Parliamentary dinner authors and do not represent the official policy of the AMA unless stated. Contributions may be edited for clarity and length. 30 AMA: A HISTORY Acceptance of advertising material is at the absolute discretion of the Editor and does not imply endorsement by the magazine or the AMA. All material in Australian Medicine remains the copyright of the AMA or the author and may not be reproduced without permission. The REGULAR FEATURES material in Australian Medicine is for general information and guidance only and is not intended as advice. No warranty is made as to the accuracy or currency of the information. The AMA, its servants and agents will not be liable for any claim, loss or damage arising out of 4 vice President’s message reliance on the information in Australian Medicine. 26 gENERAL Practice executive officers 27 therapeutics 28 AMSA 29 THE economy

President Vice President Dr Steve Hambleton Prof Geoffrey Dobb 32 HEALTH on the hill 35 research 39 PUBLIC health opnion

Chairman of Council Treasurer 40 WINE Dr Rod McRae Dr Peter Ford 41 Member services

EXECUTIVE officer EXECUTIVE officer Dr Liz Feeney Dr Iain Dunlop Cover: AMA President Dr Steve Hambleton (2nd from r) with Prime Minister Julia Gillard, Health Minister Tanya Plibersek and AMA Vice President Professor Geoffrey Dobb at the AMA Parliamentary Dinner, Great Hall, Parliament House australian medicine - september 3 2012 3 a3ustralian medicine - june 4 2012 australian medicine - september 3 2012 3 vice president’s message

Where’s the evidence?

by AMA vice president professor geoffrey dobb

Modern medicine is evidence based, so new therapies or items are being considered for de-listing. procedures need clear evidence of benefit to be accepted A seasonally suitable example might be the use of vaccines into medical practice. Any new drug seeking a listing on the for preventing influenza in the elderly. This intervention is Pharmaceutical Benefits Schedule (PBS) needs a robust body recommended worldwide for individuals aged 65 years or older of evidence for efficacy and safety supported by pharmaco- as a means of reducing the risk of complications in a vulnerable economic evidence of cost effectiveness. A similar framework population. However, in 2010 a Cochrane review of 75 studies underlies applications for new listings on the Medicare Benefits into influenza vaccination in the elderly found only one Schedule (MBS). randomised clinical trial, and this did not detect any significant Such an approach is consistent with prudent use of the taxpayers’ effect on influenza complications. The other studies were all of healthcare dollar, but where is the evidence to come from? In its poor quality, so the authors were unable to reach any conclusion absence, Australians stand to be deprived of life enhancing or about the efficacy of influenza vaccines in the elderly. This life prolonging drugs and procedures, but calls for evidence can doesn’t mean that influenza vaccines don’t work, just that there easily become a dead weight on progress and innovation. isn’t good evidence that they do. It’s not surprising, therefore, that the authors recommend that, to resolve the uncertainty, an The advent of the Independent Hospital Pricing Authority (IHPA) adequately powered randomised clinical trial is needed. But who has further potential to stifle innovation. If hospital admission is to fund it? for a disease process or procedure is founded on its historic cost there is less incentive to innovate, especially if innovation carries A lot of work would need to be done, in consultation with those higher initial costs even though there is increased patient benefit, running clinical trials and with health consumers, to develop and perhaps future savings to the cost of health care. the necessary ethical framework and research infrastructure. Public education would be another challenge. This is not an easy The history of innovation in health care is positive. Costs option. Nevertheless, public debate about the funding of health associated with research, development, passing regulatory innovation is a debate that perhaps we have to have. hurdles and initial marketing are amortised over time. Benefits associated with reduced hospital length of stay or reduced Australia has many groups with expertise in running pragmatic hospitalisation persist. But innovation needs investment today for clinical trials with patient-centred outcomes, so we should be the dividends to accrue in the future. With funding for research confident there is the capacity to do it well. Providing new and development in short supply, and likely to come under even treatments only within the context of a clinical trial is not a new more pressure, a new approach and new funding sources are concept, but doing it on this scale may be seen as controversial. needed. However, if the alternatives are to either prevent or restrict the access to new treatments in Australia, or fund them on the basis This may be a good time to re-think our approach to these of imperfect evidence, the clinical trial should be preferred. difficult issues and provide a robust evidence base for new treatments. When there is some sound evidence of benefit, but Worldwide, countries are struggling to meet the escalating perhaps not sufficiently robust to justify PBS or MBS listing or costs of health care. As a profession, we advocate for as much funding through the IHPA, the treatment could be provided funding as possible to be devoted to health care, but we also to half of those with agreed indications and the funds saved have a responsibility to ensure the dollars are well spent. The by not treating the other half used to support the clinical trial aging of the baby boomer generation is about to put greater infrastructure needed to assess the efficacy, safety and cost pressure on all health budgets and, in this context, striving for effectiveness of the treatment in an Australian setting. These trials effectiveness - and not just the ‘efficiency’ that is the focus of should have patient-centred outcomes, such as survival or quality bureaucratic attention - will do much to ensure our health system of life. The same approach could also be used if drugs or MBS is sustainable.

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4 australian4 medicine - september 3 2012 news

Doctors win recognition for PCEHR work

The Federal Government has bowed to something that has been concerning pressure from the AMA and will allow some of you.” doctors to bill for time spent preparing The Minister said “strong representations” and maintaining shared electronic health from the AMA had also convinced her to records as part of Medicare Benefits delay the PCEHR capability requirement Scheme consultations. for the e-PIP to May 2013. In an important change that should help “We believe that these decisions deliver some much-needed momentum acknowledge the central role that GPs to its Personally Controlled Electronic will be playing in an effective e-health Health Records (PCEHR) scheme, the records system,” Ms Plibersek said. Commonwealth has acceded to AMA demands that doctors be compensated for AMA President Dr Steve Hambleton said the extra work involved in supporting the the changes were a welcome and much- system. needed improvement in arrangements for the PCEHR, and would encourage In a further breakthrough, Health doctors to become actively involved in Minister Tanya Plibersek has delayed been at the forefront of criticisms of the the implementation of the scheme. the introduction of requirements that way the Government has devised the practices have PCEHR capability to “The Government has clarified that PCEHR scheme, and the haste with which remain eligible for the Practice Incentive additional time spent by a GP on a shared it has been introduced. Program (PIP) e-health payment. health summary or an event summary The system has been dogged by technical during a consultation will count towards The new rules were originally to come glitches and delays, and in its first six the total consultation time, and that the into effect in February next year but weeks little more than 5000 people relevant time-based GP item can be billed doctors will now have until May 2013 to registered an interest in having a shared accordingly,” Dr Hambleton said. meet the PCEHR requirement. electronic record. “The Minister has fully explained how This new cut-off date, while an In a nationally televised speech soon after doctors can safely and confidently improvement, remains a tight deadline its 1 July launch, Dr Hambleton warned provide new PCEHR clinical services, for doctors to ensure their practices are that the scheme would stall without the such as a shared health summary, under PCEHR-ready. support of GPs. current MBS items.” Ms Plibersek announced the changes, The AMA has had a number of meetings Dr Hambleton said the move, together which she said had been made as the with a three-month delay in the full with the Minister and senior Government result of “strong representations by the introduction of new e-PIP requirements, officials about concerns including a AMA and feedback from GPs”, during a was important in helping GPs prepare for lack of compensation for doctors for speech to the AMA Parliamentary Dinner the PCEHR system. the extra work involved in creating and on 22 August. maintaining electronic health records “They will allow doctors more time to “As a result of that consultation, I can and an absence of software for practices make the transition to the new e-health confirm that GPs will be able to bill to link in with the system, as well as environment in their practices, and are a the Medicare Benefits Scheme (MBS) unresolved concerns about record more positive outcome from the ongoing for preparing both shared health security and privacy and insufficient discussions the AMA has had with the summaries and even summaries as part public information about the scheme. Minister’s office and the Department [of of a consultation,” Ms Plibersek said. “In Health and Ageing],” the AMA President But Dr Hambleton said the concessions deciding which item to bill, GPs will only said. made by the Government would help have to consider the reasonable time it encourage doctors to take part. would take, not the complexity of the While supporting the principle of shared consultation, which I know has been electronic health records, the AMA has ...continued on page 6

australian medicine - september 3 2012 australian medicine - september 3 2012 5 news

AMA Guide to using the PCEHR

The AMA has prepared a guide for in terms of managing their health have yet to be put in place for doctors doctors on how to use the personally information, the PCEHR also limited and practices, but key concerns are being controlled electronic health record its own clinical usefulness for medical addressed (see Doctors win recognition (PCEHR) system. practitioners, because of concerns about for PCEHR work, p5). the content, accuracy, and accessibility of The AMA Guide to Using the PCEHR, information in the system. As important aspects of the PCEHR are which has been developed in close finalised, including the ability to integrate consultation with practitioners, is He added that medical practices with practice software, the PCEHR should available on the AMA website at http:// would also have to make significant become a valuable addition to quality ama.com.au/pcehr. investments of time and money to meet all of the PCEHR’s legal obligations. This health care. It provides information and guidance to would include changes to clinical and The AMA will continue to work to ensure help medical practitioners decide whether administrative workflows, and practices that the best possible PCEHR is available or not to participate in the PCEHR system, would have to draw up new operational and explains how they might use the policies and protocols to comply with the for patients and health professionals. PCEHR in their day-to-day practice. PCEHR legislation. The AMA Guide to Using the PCEHR, AMA President Dr Steve Hambleton While these limitations and start-up costs which has been prepared with the said the AMA supports patients taking are real, the PCEHR holds the promise of cooperation of the National Electronic responsibility for their own health, reducing adverse events and duplication Health Transition Authority, will help and giving them control of their health of treatments. With the right system and doctors get a better understanding information could help encourage them the right support, the PCEHR can help of what is involved when they are to do so. doctors to improve the patient health care considering using the PCEHR system, and experience. But Dr Hambleton warned that, by assist them in making a more informed putting patients in the driver’s seat Some elements of the PCEHR system decision about participating.

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Doctors win The value of GP AMA Membership

recognition for Being a member of the AMA helps ensure AMA plan would see red tape slashed GPs can get on with their work looking and reward for pro-active quality care; PCEHR work after patients knowing that their own • encouraging support and training for interests are being cared for, according to the next generation of GPs. The AMA AMA President Dr Steve Hambleton. ...continued from page 5 is pushing for infrastructure grants to “The activity that is required to create and In two videos highlighting the value of AMA improve training facilities and more maintain a shared health summary is a new membership for GPs, Dr Hambleton says funding to support supervisors; the organisation can look after his interests clinical service for doctors that will need to • working to restore funding for GP while he is busy tending to patients. be factored into current clinical practice. rebates for mental health; The work involved in creating an event “AMA is the leading voice for general • getting the Government to go back to summary will also have to be factored into practice,” Dr Hambleton says. clinical practice,” the AMA President said. the drawing board on Medicare Locals “These activities are clinically relevant “The AMA in the only independent voice, and ensure that GPs at the centre of services that will require extra work for the independently funded organisation that coordinated primary health care; doctors who choose to provide them.” looks out for the interests of GPs.” • assisting GPs to move away from “The announcements are significant As part of its advocacy on behalf of bulk-billing and to charge a fee that incentives for doctors to take part. The GPs, the AMA is currently working reflects their true practice costs and Government has delivered a catalyst to with governments on key policy issues professional worth. accelerate the implementation of the including: PCEHR.” The videos can be viewed at • improving care for patients with http://youtu.be/0pdC4myw6sE and AR To comment click here complex and chronic disease. The http://youtu.be/TxUkcIhPO7c

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6 australian medicine - september 3 2012 news

Doctors ‘critical’ to successful PCEHR: Govt report

A confidential Federal Government report has suggested making the use of electronic health records mandatory for “some activities” in order to overcome resistance among some doctors to the adoption of its troubled Personally Controlled Electronic Health Records (PCEHR) scheme. A confidential Department of Health and Ageing report, completed late last year and released under Freedom of Information laws on 14 August, warned the Government it faced “significant barriers” in convincing doctors to participate in its shared electronic health record scheme because of concerns over compensation, information integrity and system reliability. Months before the Government relented and decided to allow doctors to bill for time spent preparing and maintaining PCEHR records (see Doctors win billing rights in PCEHR breakthrough, px), the report warned that reimbursement for GPs was one of several actions that would need to be taken to enlist the support of practitioners for the scheme. In an echo of warnings from the AMA, the report, The readiness of Australian General Practitioners for the eHealth record, said It found scepticism was greatest among practice owners and the participation of GPs was “critical” to the policy’s success. managers, and suggested that to overcome resistance it might be It said GPs will provide much of the essential information for the necessary to make the use of e-health records compulsory for system, particularly as many patients were likely to nominate some activities. their family doctor as the creator and curator of their shared “Specific training or tools for managers on computerising their health summary. systems, or even mandating the use of e-Health records for some “GPs are also likely to be an important influence on the adoption activities, may therefore be required,” the report said. of eHealth records by patients, and a source of information,” the In addition to concerns around compensation, doctors expressed report said. “GPs play an important role in building consumer doubts about the confidence they could have regarding the support for adoption, with 76 per cent of consumers surveyed accuracy and comprehensiveness of information in shared stating they would be more likely to sign up for an eHealth health summaries, and were worried system breakdowns could record if asked to by their GP. undermine their productivity. “The successful engagement of GPs is therefore likely to advance Almost 60 per cent of doctors surveyed for the report said system the use of eHealth records to improve care delivery and achieve compatibility and the risk of malfunctions were major potential improvements in health outcomes.” barriers to the successful adoption of e-health solutions. But the report acknowledged the extra burden the scheme would Underlining concerns about how time-consuming PCEHR-related impose on the already stretched time and resources of practices work might be, 73 per cent of GPs estimated it would take more and doctors: “All these roles place additional time, resource and than 15 minutes to explain the system to patients, and more than financial burdens on GPs, [who] are already known to be time half thought it would take more than a quarter of an hour to poor, and the negative consequences of any additional time, create a shared health summary. resource or financial burden associated with this new national system on GPs cannot be understated [sic]”. Reflecting this, inadequate financial incentives was seen as one of the most significant barriers to participation in the scheme, According to the report, the major concern for GPs about the though the potential for improved patient care was listed as the PCEHR – particularly those most familiar with the scheme – was most important inducement to sign up. the lack of reimbursement for time spent implementing and using the system. AR To comment click here

australian medicine - september 3 2012 australian medicine - september 3 2012 7 news

Ensure quality care for asylum seekers, for humanity’s sake: AMA President

health impact” on those involved, Health Advisory Group currently particularly children. overseeing detainee health services was The Federal Government is facing a large inadequate to the task and had to be and growing catalogue of compensation replaced. action from asylum seekers claiming to “It is limited. Its members are constrained. have been traumatised by their time in It does not have the teeth [required],” he Australian detention centres, and many said. former detainees held under the previous Government’s so-called Pacific Solution Dr Hambleton said that as part of its have suffered serious mental health work, the proposed expert medical problems, with numerous incidences of Panel would monitor the health services self-harm and depression. available to the local communities on “Indeterminate detention has a serious Nauru and Manus Island who will host mental health impact,” Dr Hambleton the detention centres. said. “There is plenty of research He offered the AMA’s assistance in evidence of the harm that detention drafting the necessary legislation and causes to a child’s development. We must providing suitably qualified doctors to do the right thing.” serve on the Panel. AMA President Steve Hambleton He said the most recent figures from the Department of Immigration and “It will add humanity to an otherwise Citizenship showed that, as at 30 June, inhumane policy,” Dr Hambleton told the AMA President Dr Steve Hambleton 591 children were in closed detention parliamentarians. has made an impassioned call for the - more than half of all asylum seekers The AMA’s call came amid a brewing appointment of an independent medical in detention – while a further 489 were panel to oversee the quality of health care stoush between the Commonwealth and in community detention living under the states over access to public hospital provided to asylum seekers. strict conditions, while a further 81 had services for foreign students and 457 visa bridging visas, that allowed them only In a hard-hitting speech to the AMA holders. Parliamentary Dinner, attended by very limited access to health care and Prime Minister Julia Gillard, Health other support. Foreigners are barred from getting Minister Tanya Plibersek, Mental Health “The long term detention of desperate Medicare-funded primary healthcare Minister Mark Butler and dozens of people seeking a better life is not good services without insurance, but a report parliamentarians and senior public for the health and wellbeing of detainees in The Australian shows a proportion servants and health professionals, Dr of any age,” he said. “It is a defeat are using public hospital services while Hambleton lamented the re-establishment for social justice and fairness. But the serving out insurance waiting periods, of offshore processing of asylum seekers contemporary political debate around while others have let their insurance and urged speedy action to ensure asylum seekers is far removed from social lapse altogether. independent supervision of their health justice and fairness.” One Queensland hospital has moved care. Dr Hambleton called for the appointment to prevent visa holders receiving “The Australian Parliament has voted for of “a truly independent expert medical anything but emergency obstetric and offshore processing of asylum seekers Panel” to oversee the quality of health gynaecological services, and NSW services for all detainees, both onshore in Nauru and on Manus Island,” the hospitals are being directed to provide and offshore. AMA President said. “It is now up to the only “minimum and necessary” care for Parliament to ensure that these desperate He said the Panel should be empowered visa holders who do not have proof of people seeking a better and safer life to visit detention centres and inspect insurance or the ability to pay. have access to quality health services.” their health services – and the access of The Commonwealth has warned such The reinstatement of offshore processing detainees to them – and provide quarterly treatment could damage Australia’s ability brings with it the prospect of indefinite reports to Parliament, the Prime Minister to attract foreign workers and students. detention, which Dr Hambleton warned and relevant Ministers.

was likely to have “a serious mental The AMA President said the Immigration AR To comment click here

8 australian8 medicine - september 3 2012 news

Senate committee backs AMA call to scrap flawed rating system

A parliamentary committee has called rural communities faced in obtaining guide the eligibility for, and distribution for the much-maligned classification medical services. of, incentives”. scheme for country doctor incentives to Dr Hambleton said the Committee’s “When these workforce factors are be scrapped as part of an overhaul of findings on the shortcomings of the examined in relation to population arrangements to boost rural health care. existing classification system were size and geographical remoteness of In an outcome hailed by the AMA, the particularly welcome. communities, population size is a more Senate Community Affairs References sensitive measure in directing where “We are pleased that the Committee has recruitment and retention incentives Committee recommended that the identified the significant weaknesses should be provided. Australian Standard Geographical apparent in the application of the ASGC- Classification – Remoteness Area (ASGC- RA classification system that underpins “This new six-level geographical RA) system be discarded and replaced Commonwealth programs to support classification provides a better basis with a scheme that takes account of a the rural medical workforce, and for equitable resource allocation of broad range of factors including location, recommends that it be replaced,” he said. recruitment and retention incentives to population, workforce and professional doctors based on the attractiveness of Dr Hambleton said failings in the system, and social factors in determining the non-metropolitan communities, both which is currently under review, resulted allocation of incentives. professionally and nonprofessionally, as in many small rural areas being stuck with places to work and live.” The change was part of a range of the same incentive structures as much measures suggested by the committee larger towns, exacerbating inequities in In its report the Committee said it following its 11-month inquiry into factors the distribution of health services. approved the methodology and data affecting the supply of health services and utilised by Professor Humphreys and his In its report the Committee warned, medical professionals in rural areas. colleagues, and “would like to see this “there will never be a perfect model that incorporated into a new scheme”. The committee found that there were does not result in some anomalies”. significant disparities in access to vital The Committee also recommended “However, evidence provided to the health services between metropolitan reforms to teaching and training Committee during its inquiry did not and rural areas despite efforts over many arrangements, including better incentives support the use of the ASGC-RA scheme years to address the imbalance. for rural GPs providing training for in its current form as the sole determinant pre-vocational and vocational students “Medical specialist numbers plummet of classifying areas for workforce and the extension of the HECS outside the major cities, to levels as low incentive purposes,” the report said. Reimbursement Scheme for doctors as one-sixth of those in the large capitals,” “Even the evidence in general support of to nurses and other allied health the report said. “Accessibility, particularly the scheme was heavily conditional on it professionals. in remote areas, is an issue.” being augmented with further datasets to It said that while doctors encountered provide a more accurate representation of Dr Hambleton said the strong focus of personal and professional barriers workforce conditions across the country.” the report on supporting teaching and training in rural areas was important, as to working in rural areas, including The Committee wrote approvingly of was increased efforts to encourage more income, professional development, a classification model developed by rural students to study medicine. housing and opportunities for spouses researchers at the Centre of Research and children, allied health professionals Excellence in Rural and Remote Primary “The AMA fully supports these faced additional hurdles from restrictive Health Care that based the distribution approaches, which need to incorporate Medicare funding arrangements and of incentives more on population appropriately funded incentives rather lower remuneration, which affected and professional considerations than than the current draconian system of the ability to find affordable and secure geographical location per se. unfunded bonding of students to rural accommodation. areas,” he said. “Another welcome In their submission to the inquiry the recommendation is the need to ensure AMA President Dr Steve Hambleton said researchers, led by Professor John that Government reforms to after hours the report echoed many of the issues Humphreys, recommended the use of a GP services do not result in funds being highlighted in the AMA’s Regional/Rural classification system in which “sentinel withdrawn from general practices that are Workforce Initiatives Position Statement professional and other factors known currently providing after hours services.” released earlier this year, and underlined to be significantly associated with the significant problems that people in recruitment and retention are used to AR To comment click here

australian medicine - september 3 2012 australian medicine - september 3 2012 9 news

AMA vows to fight changes to midwife collaboration rules

The AMA has declared war on a move by on 10 August to “vary the determination medical practitioners; the nation’s health ministers to change on collaborative arrangements to enable • fail to recognise the significant collaboration arrangements between agreements between midwives and consultation involved in the doctors and midwives, warning the hospital and health services”. development of the existing measure will put the safety of mothers Dr Hambleton immediately condemned determination; and babies at risk. the decision, which he said was as • will fragment patient care; The AMA’s peak body, the Federal dangerous as it was unexpected. • will transfer the responsibility for Council, has condemned the proposed The AMA Federal Council considered the patient care from medical practitioners changes, which would allow midwives issue as a matter of urgency at its 22 August to non-medical bureaucrats; and to enter directly into collaboration meeting and passed the following motions: agreements with hospitals and health • will undermine the safety and quality 1. That Federal Council, in recognising services without including medical of Australian maternity services. practitioners, and has resolved to that collaborative models of care between campaign to have the decision reversed. midwives and medical practitioners are Dr Hambleton urged Ms Plibersek and the an essential element of a high quality and Federal Government to re-visit the decision. In a strongly worded speech to the AMA safe maternity services system in Australia, “Minister, please don’t let the States and Parliamentary Dinner on 22 August, AMA calls on the Commonwealth Government to Territories railroad good policy,” the AMA President Dr Steve Hambleton warned immediately abandon its proposed changes President said. “We did not expect this Prime Minister Julia Gillard and Health to the National Health (Collaborative change. Let’s please talk about it before a Minister Tanya Plibersek that the policy arrangements for midwives) Determination final decision is made. about-face was viewed very dimly by his 2010 which would permit midwives to enter organisation and would be resisted. directly into collaborative arrangements “We want to ensure the best possible “It is a change that brings big risks to with a hospital or health service. care – collaborative care – for mothers and babies.” patients and quality health care,” Dr 2. That Federal Council condemns Hambleton declared. “The AMA takes this the Government’s proposed changes The West Australian Health Minister, Dr change very seriously [and] resolves to to the National Health (Collaborative Kim Hames, has been directed to present campaign against the proposed changes.” arrangements for midwives) a paper on long term collaborative Determination 2010 as they: arrangements to the peak body of the As reported in the 20 August edition nation’s health ministers, the Standing of Australian Medicine (to view click • are contrary to original policy Council on Health, in November. here), the Commonwealth agreed at a intent of the Government to promote meeting of the nation’s health ministers collaboration between midwives and AR To comment click here

Glasson eyes off challenge to former PM

Former AMA President Dr Bill Glasson is arrange an introduction”. by Labor members. among a field of five candidates contesting Dr Glasson and Mr Rudd live close by But the Coalition is sceptical it will be Liberal National Party preselection for the each other in the electorate and know able to unseat Mr Rudd, who is a strong Queensland seat of Griffith, held by former each other well. campaigner and popular local member. Prime Minister Kevin Rudd. The Coalition expects to poll strongly At the 2010 election he comfortably held Dr Glasson, who was AMA President in Queensland in next year’s federal onto his seat despite a 3.8 per cent swing between 2003 and 2005, revealed his election, given the unpopularity of the against him, receiving more than 58 per candidature at the AMA Parliamentary Gillard Labor Government and the recent cent of the vote on a two-party preferred Dinner, which was also attended by Mr Rudd. landslide result in the state election basis, compared with his LNP rival Rebecca Acknowledging the presence of the earlier this year, which saw the Liberal Docherty, who won 41.5 per cent of the vote. potential political rivals at the dinner, National Party (LNP) swept into power The result of the LNP preselection for the current AMA President, Dr Steve with a massive 71 seat majority in the 89 seat should be resolved by the middle of Hambleton, cheekily suggested to Dr seat State parliament. the month. Glasson that “you might like to have a The LNP currently holds 21 federal seats chat with Kevin after the speeches. I can in Queensland, compared with eight held AR To comment click here

10 australian10 medicine - september 3 2012 Parliamentary Dinner

Prime Minister Julia Gillard headlined a list of senior politicians including Health Minister Tanya Plibersek, Shadow Health Minister Peter Dutton and Australian Greens health spokesman Richard Di Natale who paid tribute to the AMA at its annual Parliamentary Dinner on 22 August. The following are excerpts of their speeches. Prime Minister Julia Gillard

The AMA Indigenous Health Report packaging laws. Cards have been influential in guiding Big tobacco threw everything at stopping health policies for Aboriginal peoples this – and they failed. and Torres Strait Islander peoples for more than a decade now. The message here and around the world is now clear: you can beat big tobacco. They have had a significant influence in our efforts to Close the Gap. It’s obvious, when we talk about these The AMA has been a champion for issues, that we’re all on the same page and I improving Aboriginal and Torres Strait thank you for your support along the way. Islander health. It’s also obvious that we don’t always Your recent AMA Aboriginal and Torres agree. That’s a given in a democracy. Strait Islander Health Audit Report is But your expertise and advocacy is only your latest important contribution to invaluable, and there are so many areas policy and practice. where our goals and methods are shared. Fifty years since the several Australian branches of the British Medical You’ve played a key role in the national You are a staunch defender of our public Association merged and created our own debate and just as important, you’ve hospitals. national medical association, it’s a night played a vital role on the ground, in the Your support for the National Disability to celebrate. communities, with our Indigenous people. Insurance Scheme is greatly appreciated. For fifty years you’ve been advocates – And our public investment is designed to My Government has put a lot of effort not just on behalf of your members but in work with you. and funding into medical training. We the broader cause of health in Australia. Our Stronger Futures in the Northern have provided a record number of It’s quite an achievement that your Territory health initiative is a comprehensive training places, and you’ve supported us association, representing your profession, health package to deliver better primary as we’ve done it. who does from time to time relieve pain health care, dental and allied health services for others but give pain to governments, to more than 65,000 Aboriginal people in Your pressure on the States to provide more is held in such a respected light. the Northern Territory. intern places and ease bottlenecks in the system in the years to come is important. You’ve given us the occasional headache, It’s a lot of work in a lot of areas, but one and it’s not just this government but where we know progress is being made. You are making a great contribution in the public health area. governments before. But that’s a It’s critical that we speak out strongly testament to the power of your advocacy. on this progress to the Australian Your voice is heard across the board I have been working with the AMA for community, because the greatest threat – obesity, alcohol and drug abuse, a long time, for around ten years since I to the progress of Indigenous Australians immunisation, the health of asylum seekers, became Labor’s Shadow Health Minister. is the false notion that we can’t make a climate change and health, anti-bullying difference, that nothing ever works. messages, food labelling, the social It’s good to be able to be with you and determinants of health, mental health. think about some of that past, but also to It’s a journey of countless short steps – look to the future together. not a journey where there are single days That’s a broad body of work. And it touches of brilliant victory. and helps many of the more disadvantaged And in looking to the future I want to and vulnerable in the community. speak to you about two important areas But in the fight for better health in our where we are doing and continue to do country, there are some of those shining A lot has changed in the AMA in the last so much good work: Indigenous health days, and last Wednesday [15 August] fifty years, and a lot’s changed in our and smoking. was one of them. nation too. Together, we are making progress The High Court rejected the legal But what hasn’t changed is the importance towards Closing the Gap. challenge by big tobacco to our plain of your service and your voice. To comment click here australian medicine - september 3 2012 australian medicine - september 3 2012 11 news news

Parliamentary Dinner

Health Minister Tanya Plibersek

produces the best policy outcome, and We believe that these decisions as Minister I have always been grateful acknowledge the central role that GPs to the AMA for their frank and fearless will be playing in an effective e-health advice. I do not always take it, but I have records system. always been grateful for the advice. I look forward to working closely with Through all the debate the AMA has the AMA and other groups as we roll out remained for me a valuable link to this magnificent transformation of health doctors and clinicians right around in Australia. Australia. Last week was a terrific week for public For years we have been working closely health policy. Many are still on a high with the AMA and other groups on the roll out of the Government’s e-health from that historic High Court victory over records system. Big Tobacco. And, as a result of that consultation, I It is another fine example of how the want to make a couple of announcements Government has worked with the AMA tonight. and other organisations to deliver for all Australians. First, I can confirm that GPs will be able to bill the MBS for preparing both shared It was a victory for everyone and every health summaries and even summaries as family that has lost someone to smoking. part of a consultation. I remember last year, when Big Tobacco In deciding which item to bill, GPs will announced it would challenge the We do have a vast number of Members of only have to consider the reasonable Government’s plans for plain packaging, Parliament here tonight. time it would take, not the complexity the Prime Minister said ‘We are not of the consultation, which I know has I would like to congratulate the AMA on going to be intimidated by Big Tobacco’s been something that has been concerning tactics, whether they are political tactics, being 50 years young. some of you. whether they are legal tactics, we are not It is a wonderful opportunity to be here We have worked with the AMA on going to take a backward step. There is with all of you. detailed guidance notes to helps GPs no compromise. We are going to deliver.’ with this, and these will be available on I know how important the AMA is and Well, Prime Minister, you were right. what a vital role you play in our health the department’s website. sector. Secondly, I want to confirm that in We were not intimidated, we did deliver response to strong representations by and I am very pleased to be here tonight The AMA is an important voice for the AMA and feedback from GPs, the with the Prime Minister and the Attorney doctors and a source of advice to the Government has also decided to delay General and so many others of you who Government. the PCEHR capability requirement for the have been involved in this fight for many It is a strong contest of ideas that e-PIP until May 2013. decades.

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12 australian12 medicine - september 3 2012 news

Parliamentary Dinner

Shadow Health and Ageing Minister Peter Dutton

I wanted to say in relation to my dealings the change of government in 2007 it was with Steve Hambleton, with Francis over $50 billion a year. Sullivan - who of course has had a There has, of course, much been made long history around this place in public in this Parliament in recent weeks about health policy - and also to the previous the Government’s changes to plain Presidents, thank you very much for the packaging of tobacco. The other side of professional way you have dealt with us. the story is the introduction of graphic I have always thought that a career in health warnings, which I think was one the AMA would be some sort of training of Tony Abbott’s greatest achievements as course for a career in federal politics, Health Minister. considering how rough you play your politics. I suspect that perhaps that it may Of course, the election cannot be far off, be the other way around. and people will rightly be asking what will the Coalition have in store at the next If Tony Abbott were here tonight, he election. would talk about his passion for the health sector, for the time he spent as From the Coalition’s perspective, we health minister. always say that past performance is the best indicator of future capacity, and I He considers that to be almost the think the contrast of the last four years most formative years of his time in this compared with the actions and what was federal parliament, and there is a lot of delivered in the preceding 11 years will If institutions could talk they would tell discussion, of course, around certain provide people with a very significant funny tales about different periods of political issues at the moment, but if decision to make at the time of the next you consider the burden of debt when time. From a party political perspective election. John Howard came in 1996 - which it is amusing sometimes to look Campbell Newman has faced coming into The Coalition at the next election is beyond our four walls to other political Queensland - it makes it very difficult to committed to taking money away from organisations, to the way they interact, invest in the sorts of places, particularly the ever-growing health bureaucracy. to people who have separate state- in health, that you would want to. There will be no Super Clinics, there will affiliated arrangements, and to see the be no new health bureaucracies, under a But the first responsibility of Government goings on in organisations such as the Coalition government. AMA, and I am sure that if the institution is that, having paid down debt, you can could talk, it would talk about 50 years invest in a number of areas that you We want to make sure we can get money of rich history, some of which I am sure would want, and one of [Tony Abbott’s] to the frontline services, to the doctors, have been repeated from many, many crowning announcements was the $1.9 nurses and clinicians that can change decades, some sets of discussions and billion put into mental health in 2006. lives. deliberations no doubt underway today It is amazing, when you consider that in That is what you are all dedicated to, and and tomorrow will have been held in 1995-96 the spend in the health portfolio at the time of the next election that is decades past, but I hope not into decades was just under $20 billion. And by the what we will be dedicating ourselves to in the future. time Tony Abbott left the portfolio with as well.

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australian medicine - september 3 2012 australian medicine - september 3 2012 13 newsnews news

Parliamentary Dinner

Australian Greens Health spokesman Senator Richard Di Natale

The AMA is strongest when it takes on a enormous. bold public health agenda; when it is, to There will be questions raised about the use the AMA’s own words, more than just speed and manner of the implementation, a union. but I think we all agree the end game The AMA has been an important voice in of networked, real-time and universally the tobacco control debate, [and] I was accessible access to information will really pleased to work with the AMA and improve health care on the ground. a coalition of health groups around the issue of alcohol-related harm. There will be some things on which the Greens and the AMA will disagree. The AMA has also been an important voice on indigenous issues. The role of pharmaceutical companies in our profession is probably one area. I’d also commend the AMA and Steve It’s always been my view that it is Hambleton for speaking out on the dangerous to underestimate the influence harmful health impacts of indefinite commercial interests can have. mandatory detention for refugees. On the vexed issue of private health I have followed with interest the insurance, we feel that the best way implementation of the National Health to involve the private sector is to Reform Agenda. In many ways, they are purchase services directly, rather than My first direct involvement with the AMA the biggest changes to health policy since by subsidising private health insurance. was as a fresh faced medical graduate the introduction of Medicare. The current subsidy is as inefficient as it from Monash University. Many of the reforms we’ve seen are is unfair. Soon afterwards, I became an active hospital financing reforms, rather than But we don’t agree with higher penalties member and joined the AMA Doctors genuine health reform. They haven’t for high income earners who don’t take in Training group, who were aiming to yet led to major changes in the way it up. That might surprise you, but it runs reduce the unsafe working hours for new Australians access health care. counter to the principle of universality. graduates. We didn’t get very far and I’m I’m even more interested to see how afraid we’ve still got a lot more work to Medicare Locals develop. Everyone should have the right to use do in that area. the public system, just as they have the They have enormous potential to ensure obligation to pay into it with their taxes. I went on to spend the next few decades that funding is matched to need at a working in community general practice, population level. We don’t want to see Australia develop Aboriginal health and global public a two-tier health system like the United health, and it soon became clear to me I understand that the prospect makes States. that if we are to achieve real progress in some of you nervous about the role of Our system of universal health care is health we need to tackle those factors the GPs, but general practitioners will remain efficient and fair. It is the envy of much of lie outside the health system. front-and-centre of primary care. the world, and we should be justly proud. Our efforts as health professionals are A core aim of Medicare Locals is to The Greens have focused in particular wasted unless we also improve people’s provide the vehicle to reorient the health on the area of dental health. It is clearly access to housing, education, clean air system away from hospitals to primary the greatest area of inequity in the health and water, secure employment and care. They will work closely with Local Hospital Networks to make sure that system today. participation in community life. primary health care services and hospitals We are committed to continue working At its core, health is a social justice issue. work well together. with the Government to reform the I believe this is where the AMA does its We also welcome developments in existing scheme and put something even best work. e-health. The efficiencies to be gained are better in its place.

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14 a14ustralian medicine - september 3 2012 news

AMA in action

The AMA played host to Prime Minister Julia Gillard and senior Government and Opposition MPs including Health Minister Tanya Plibersek, Attorney General Nicola Roxon and Shadow Health Minister Peter Dutton, who were among more than 180 guests attending the annual AMA Parliamentary Dinner in Great Hall of Parliament House on 22 August. The dinner, which was hosted by AMA President Dr Steve Hambleton, brought together politicians and AMA leaders from across the country. It was attended by more than 30 federal Members of Parliament from all the main political parties, as well as presidents and senior officials from each of the AMA State and Territory branches, together with senior health bureaucrats and leading health experts. The keynote speech was delivered by Ms Gillard, and the guests also heard from Dr Hambleton, Ms Plibersek, Mr Dutton and Australian Greens health spokesman Senator Richard Di Natale. The Parliamentary Dinner coincided with the quarterly meeting of the AMA Federal Council, which was held in Canberra. The day before the Dinner, Dr Hambleton addressed the Australian Medical Students’ Association’s Leadership Development Seminar in Parliament House, which was also attended by AMA Doctors in Training Committee chair Dr Will Milford and AMSA President James Churchill.

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Pre-dinner drinks in Parliament House Marble Foyer

AMA President Dr Steve Hambleotn with Prime Minister Julia Gillard AMA President Dr Steve Hambleton chats with Attorney General Nicola Roxon

australian medicine - september 3 2012 australian medicine - september 3 2012 15 news

AMA in action

Dr Richard Kidd (2nd from l) with Associate Professor John Gullotta and Liberal MP Teresa Gambaro

AMA President Dr Steve Hambleton with Health AMA President Steve Hambleton with Chief Medical AMA Queensland President Dr Alex Markwell Minister Tanya Plibersek Officer Chris Baggoley talks with Health Minister Tanya Plibersek

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AMA in action

AMA President Dr Steve Hambleton with participants at the AMSA Leadership Development Seminar dinner

Former AMA President Dr Bill Glasson (r) with AMA Former Prime Minister Kevin Rudd with former AMA President Dr Steve Hambleton addresses WA CEO Paul Boyatzis and former RACGP President AMA President Dr Mukesh Haikerwal the AMSA Leadership Development Seminar at Claire Jackson Parliament House

australian medicine - september 3 2012 australian medicine - september 3 2012 17 news ama in the news

Your AMA has been active on policy and in the media on a range of issues crucial to making our health system better. Below is a snapshot of recent media coverage.

Print/Online Radio deal/4192118 AMA President Dr Steve Hambleton Doctors diagnose climate health cost, Dr Hambleton, 2MCE Orange, 24 said the move by the Federal and State MX, 16 August August 2012 governments to allow midwives to strike deals directly with hospitals and health The Australian Medical Association The Australian Medical Association says services meant they will be able to operate showing that $6 billion of health spending Parliament needs to take responsibility for the without help from doctors. could be saved by addressing climate health of asylum seekers while in detention. change and its causes. AMA President Dr Politicians have been told at an AMA Steve Hambleton said climate change was parliamentary dinner an independent panel is AMSA a significant worldwide threat to human vital to observe the health of asylum seekers, health that “requires immediate action”. and report to Parliament. Dr Hambleton said Medical internship places still lacking the panel needs to be above bureaucracy to as second round offers released AMA President campaigns on ensure asylum seekers have access to quality health services. Today, hundreds of medical students will midwives and asylum seekers, 6 receive internships for next year in the Minutes, 23 August, 2012 Dr Hambleton, 5AA, 23 August 2012 second round of offers, but many still face uncertainty with latest figures indicating that http://www.6minutes.com.au/news/ New research shows men should not delay approximately 244 graduates will miss out. latest-news/breaking-news-ama-president- having children because they risk passing on campaigns-on-midwives genetic mutations. Scientists have found each Health leaders of the future converge AMA President Dr Steve Hambleton year after the age of 20 doubles the chances on Canberra used the opportunity of the [AMA] of mutations in his offspring. Dr Hambleton One hundred of Australia’s brightest Parliamentary Dinner to start campaigns said the findings should serve as a warning. medical student leaders will today come against midwives’ collaborative agreements together in Canberra to discuss pertinent and the detention of children of asylum TV health issues at the Australian Medical seekers. Students’ Association (AMSA) National Dr Hambleton, Channel 9 News, 16 Leadership Development Seminar. Family GPs hooked on scripts for August 2012 painkiller OxyContin, The Herald Sun http://www.youtube.com/watch?v=_Fbw_ AMSA: All talk and no action on 26 August 2012 NI9Xao&list=UUx5NFeUd5hs3wnViy_ internships http://www.heraldsun.com.au/news/ LjWrw&index=1&feature=plcp Today, the Australian Medical Students’ national/family-gps-hooked-on- AMA President Dr Steve Hambleton Association (AMSA) is calling for urgent scripts-for-painkiller-oxycontin/story- comments on the decision by the and decisive action to increase the number fndo317g-1226458054965 Therapeutic Goods Administration to of medical internships. Australian Medical Association head Steve restrict use of over the counter cough Asylum seeker debate lacks humanity Hambleton said OxyContin is important for and cold medicines to children under the – AMSA pain management. age of six. Amid hot political debate on processing Doctors to be paid for e-health work Dr Hambleton, Channel 10, asylum seekers, the Australian Medical The Sydney Morning Herald, 22 Melbourne, 27 August 2012 Students’ Association (AMSA) is August 2012 calling upon politicians to recall their AMA President Dr Steve Hambleton humanitarian values. http://news.smh.com.au/breaking-news- discusses this season’s influenza strain. He national/doctors-to-be-paid-for-ehealth- says influenza can affect anyone at any Senate report highlights need for work-20120822-24myg.html age, and every now and then it will affect improved rural workforce planning someone who is perfectly well. Doctors had wanted a separate fee for The Australian Medical Students’ setting up patient summaries but the Association (AMSA) welcomes the recent Doctors concerned by midwife hospital Australian Medical Association welcomed Senate Community Affairs Reference deal, ABC News, 11 August 2012 Ms Plibersek’s announcement they would Committee report on the factors affecting receive up to $100 for working on e-health http://www.abc.net.au/news/2012-08-11/ the supply of health services and medical records under existing Medicare items. doctors-concerned-by-midwife-hospital- professionals in rural areas.

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18 australian18 medicine - september 3 2012 news

INFORMATION FOR MEMBERS Pathology and diagnostic imaging request form changes

New laws affecting information that must be provided to patients must include the following mandatory statement: Your doctor on pathology and diagnostic imaging request forms have come has recommended that you use [insert name of pathology into effect. provider]. You are free to choose your own pathology provider. However if your doctor has specified a particular pathologist From 1 August, all branded request forms must include a patient on clinical grounds, a Medicare rebate will only be payable if advisory statement, which informs patients that they are free to that pathologist performs the service. You should discuss this take their referral to a provider of their choice. with your doctor. The information required is different depending on whether the • An alternative statement may be used that is the same as request form is for a pathology service or a diagnostic imaging above but where the word ‘doctor’ is replaced with ‘treating service. practitioner’. Diagnostic imaging request forms In all cases, it will be an offence for pathology and diagnostic imaging providers to produce or distribute branded request • All branded diagnostic imaging request forms produced and forms that do not contain a patient advisory statement. distributed from 1 August must include a statement advising patients that they are free to take their referral to a diagnostic However, patients who present branded request forms without imaging provider of their choice. the patient advisory statement will still be eligible for a Medicare rebate. This recognises that old forms may remain in the system • The wording, formatting and positioning of the statement will for sometime and providers can only control the distribution of be at the discretion of the provider but must be obviously new forms. positioned to ensure the patient has a reasonable likelihood of It is important that pathology and diagnostic imaging service noticing and being able to read the advice. providers ensure they have up-to-date business and after hours Pathology request forms contact details for medical practitioners in their region, not just those in their usual catchment area, in case critical results need to • All branded pathology request forms produced from 1 August be communicated urgently. To comment click here

Be an Australian Medicine travel writer Sick of glitzy infomercials posing as travel stories? Want to tell your colleagues what places, near and far, are really like? Here’s the chance to reveal your favourite holiday spot, or to share travelers’ tales from the exhilarating and glorious to the tedious and disastrous. Australian Medicine invites readers to write and submit travel stories of up to 650 words, with two bottles of fine wine sent to the author of each article published. Pictures welcome. Please send stories, with your contact details, to: [email protected]

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australian medicine - september 3 2012 australian medicine - september 3 2012 19 news

Access to abortion drug opened up

The medicines watchdog has lifted tight sponsor,” the TGA said. “The sponsor and reproductive healthcare”. restrictions on access to the controversial is planning a comprehensive education The TGA said RU486 was “generally well- abortion pill RU486 in a move hailed as program.” tolerated”, and since 2006 there had been an “important milestone” for Australian Practitioners who have a fellowship or 792 documented cases of adverse effects, women. diploma from the Royal Australia and mostly incomplete abortions that required The Therapeutic Goods Administration New Zealand College of Obstetricians follow-up surgery. has added Mifepristone (RU486) and and Gynaecologists are exempt from the It said common side effects include GyMiso (misoprostol) to the Australian training requirement. nausea, vomiting, diarrhoea, dizziness, Register of Therapeutic Goods, greatly Distribution is expected to be nationwide. abdominal pain, headache, vaginal enhancing access for doctors and women bleeding, uterine spasm, fatigue and to the drugs, which have until now been “Based on the sponsor’s proposed chills. subject to tight controls. distribution plan, where a pharmacy is nominated by a medical practitioner It said there had been rare instances of The TGA said it had made the decision recognised by the sponsor as having significant haemorrhage and cervical following rigorous assessment taking into completed appropriate training to tearing, and one recorded death in account the safety, efficacy and quality of prescribe the medicines, and the Australia due to sepsis. the medication. pharmacy agrees to supply the product, it According to the TGA, failure rates are RU486 has been available in Australia will be available,” the TGA said. slightly higher for medical abortion since 2006, when ministerial veto over the Health Minister Tanya Plibersek (between 2 and 7 per cent of cases) drug was lifted, but only a small number welcomed the regulator’s decision, which than surgical termination, but both were of practitioners – 187 as at August this she said gave Australian women access to considered to be “safe and effective”. year – have been authorised to prescribe medicines that have long been available it. to millions elsewhere. “Experience has shown that bleeding and pain are more significant with a medical But, following last week’s decision, “For more than two decades, tens of termination, but medical termination registered medical practitioners who have millions of women throughout the world does not involve an anaesthetic and successfully completed a training course have used RU486,” Ms Plibersek said. its attendant risk,” the regulator said. will be able to prescribe the two drugs. “This listing means Australian women will “Women may prefer medical termination The medicine has been sponsored by a have the same options as women in over to surgical termination of their pregnancy, not-for-profit subsidiary of Marie Stopes 46 countries including the UK, USA, New as it occurs in the privacy of home and is International, which is planning to roll Zealand and in Europe. less invasive.” out an education program for medical Marie Stopes is considering whether to It said doctors should confirm pregnancy practitioners, both online and through apply to have the drugs, which are out before administering the medication, and personally tailored training sessions. of patent, listed on the Pharmaceutical ectopic pregnancy had to be excluded. Benefits Schedule. “It is the sponsor’s intention that access “As for surgical termination, follow up is and distribution will be controlled via A spokeswoman for the organisation said essential,” the TGA said in its advice. successful completion of the training and its intention was to ensure all women had medical practitioner registration with the access to “affordable choices in sexual AR To comment click here Prostate cancer a grey area for GPs

The majority of GPs are uncertain about prostate cancer, while more than 80 per Dr Jane Crowe, who led the study, said how to treat prostate cancer, with 80 per cent were not confident in managing the results showed that there was great cent complaining the clinical guidelines the sexual rehabilitation and continence uncertainty among GPs about how to are confusing and lack clarity, research problems of prostate cancer patients treat prostate cancer. has found. following treatment. “Clearly more research is required so we According to a study by the Australian The findings have been released to can develop better and more accurate Prostate Cancer Research Centre coincide with the launch of the Blue testing,” Dr Crowe said. Epworth, around a third of GPs do not September campaign, which aims to raise refer to any guidelines when testing for funds for prostate cancer research. AR To comment click here

20 a20ustralian medicine - september 3 2012 news

Govt movesnot toi cefill to gap ME MBin ERSdental health

More than three million children will care,” Ms Plibersek said. “We have a Under the scheme, children aged receive Government-subsidised dental responsibility to ensure Australians between two and 17 years whose families care as part of a $4 billion overhaul who are least able to afford to go to the are eligible for Family Tax Benefit Part A of oral health funding by the Federal dentist, and particularly children, should will be entitled to subsidised basic dental Government. be given access to government-subsidised treatment, capped at $1000 per child over oral health care.” In a move hailed by AMA President a two-year period. The estimated cost of Dr Steve Hambleton as a “huge Dr Hambleton said the package was this element of the package is $2.7 billion improvement”, Health Minister Tanya a strong acknowledgement of the over six years. Plibersek has announced the Government importance of dental care in overall The Commonwealth will provide a health, and was a significant advance on will subsidise dental treatment for 3.4 further $1.3 billion to State and Territory current arrangements. million children and almost 1.5 million governments to expand public dental pensioners and other adults on low “This is a huge improvement on the services for low income adults, on the incomes in the next six years. existing dental scheme,” the AMA condition that they maintain their current The initiative is seen as an important President said. “There is less bureaucracy level of dental care services. advance in an neglected and under- and red tape, and the program is better A further $225 million has been allocated funded area of health care, and will help targeted at those with the greatest need. to build “dental infrastructure” in outer shield the Government from attacks from “While it is not a universal system, it metropolitan, rural and regional areas. both the Greens and the Coalition over will go a long way towards improving the issue of dental health in the lead up to the dental health of the Australian The program will replace the Medicare the next federal election. community.” Teen Dental Plan and the Chronic Disease Dental Scheme, which the Ms Plibersek said the Dental Health Dr Hambleton said that GPs saw a lot of Government said was poorly targeted and Reform package was in addition to the patients who had oral health problems wasteful. $515 million allocated in the May Budget but who avoided dental treatment to reduce public dental waiting lists because of the cost. Ms Plibersek said the package had and fund extra training for dentists and been devised as a result of “detailed nurses. “This package will give many families the confidence that cost should not be an discussions” with the Australian Greens, The Minister said the policy would help impediment to good dental care,” he said. and legislation to enshrine the new fill a gap in the nation’s health services. entitlement for children would be Assistance in the package is carefully introduced during the current Spring “While Medicare and free hospital care directed to those in low income session of Parliament, with passage have been a basic right for Australians households, which are more than twice expected by the end of the year. for decades, millions of people in this as likely as the well-off to have family country still go without adequate dental members with untreated tooth decay. AR To comment click here Book Reviewers If you devour books and want to share your knowledge, passion, likes and dislikes with your colleagues, Australian Medicine invites you to become a book reviewer. You can review books on any medical or health topic you like, and can be as complimentary or scathing as you think is warranted (as long as it is not libellous). Just keep it under 650 words. Australian Medicine will supply the book, which you get to keep after the review. Interested? Just email the editor at [email protected], including the book subjects you would be interested in reviewing and a current postalTo address. comment click here

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australian medicine - september 3 2012 australian medicine - september 3 2012 21 NEWS

Flu losing its grip as season turns

The influenza scourge that has gripped hardest-hit by the virus, accounting influenza season began earlier in 2012 much of the country this winter appears for 31 per cent of all cases nationwide, than it has in recent years, and the to be petering out. compared with 21 per cent for NSW, 16 number of cases accelerated much more per cent for SA, 13 per cent for WA, 12.2 sharply. Official figures show the number of new per cent for Victoria and 3.4 per cent for influenza infections reported by health “The intensity of the rise in cases for Tasmania. The territories combined had 3 authorities has declined since peaking in 2012 has also meant a higher peak in per cent of cases. mid-July, with less than 6100 laboratory- notifications,” the Surveillance Report confirmed cases between 21 July and 3 The report said the predominant flu said. “However, the total number of August, down from almost 6500 identified virus this year has been influenza A notifications for the entire season (up to in the preceding fortnight. (H3N2), with “very few” notifications of 23,553 as at 3 August) may not result in the pandemic H1N1 2009 virus, which a substantial variance compared to [sic] “Although some jurisdictions have the Department speculated might be previous seasons.” continued to report widespread activity due to changes in immunity among the above baseline levels, influenza activity The report said that the predominance of population. decreased across most of Australia,” the influenza A virus compared with the the Department of Health and Ageing’s “In recent years the proportion of H1N1 virus has meant that the age profile latest Australian Influenza Surveillance influenza A viruses circulating in of those infected has returned to the more Report said. “Influenza-like illness activity the community has been low,” the familiar patterns of years preceding the has continued to decrease, with current report said. “This may have led to 2009 pandemic, with the number of cases activity levels similar to the peak levels some reductions in immunity across peaking among children less than four experienced during the 2010 and 2011 the population, and thus might be years of age and among adults older than seasons.” a contributing factor to both the 70 years. predominance of this virus among the The exception was Queensland, where So far 23 deaths have been officially population, and the apparent intensity of the number of cases has continued to attributed to influenza, with the median the season.” increase. In the two weeks to 3 August, age 74 years. the northern state accounted for almost While health experts have raised the According to the FluTracking online 45 per cent of new cases, with 2664 alarm about what appears to have been data collection system, those vaccinated people confirmed with the infection, an unusually severe and pervasive flu against the flu were marginally less likely compared with 903 in Western Australia, season, this perception may have been to suffer fevers and coughs or lose time 779 in South Australia, 727 in Victoria, 548 driven more by a rapid spike in infections from work because of illness than those in New South Wales and 347 in Tasmania. rather than the total number of cases. not immunised. The figures show Queensland has been According to the Department, the AR To comment click here

22 australian medicine - september 3 2012 news

TGA admits error but sticks by paracetamol warning

The medicines watchdog has admitted to errors in a warning it issued about accidental paracetamol poisoning following a complaint by toxicology experts reported in Australian Medicine. In a notice posted late last month, the Therapeutic Goods Administration said it had “become aware of an error” in an article outlining concerns that paracetamol could cause harm even when used at therapeutic doses. But, despite the admission, the regulator has stuck by its warning that paracetamol can cause liver damage even when used as directed. “The text should read ‘In a study 662 back down from its warning about the The warning, published in the TGA’s patients with acute liver failure, 275 were potential harm from paracetamol use. cases of severe paracetamol-induced Medicines Safety Update Volume 3, “This error does not change the hepatotoxicity. 131 (48 per cent) of these Number 4, was heavily criticised by a underlying reason for the orginal cases were the result of an unintentional group of toxicologists at the Victorian article, which was to raise awareness overdose and 19 (7 per cent) of the Poisons Information Centre, who claimed among health professionals that in 275 patients had not exceeded the the watchdog had misinterpreted and certain situations, paracetamol-induced recommended maximum daily dose of 4 misrepresented the studies it cited in hepatotoxicity can occur at normal grams,” the authority said, adding that the support of its announcement. therapeutic doses and, in fact, was citation should have been to a paper by the documented cause of death for a In the original bulletin (to view, click AM Larson et.al. 2005. “The author and 45-year-old Australian woman,” the TGA here), the medicines regulator warned the editor of MSU regret this error.” paracetamol could cause liver damage, said, adding that risk factors included even when taken at normal doses. The admission followed a complaint from fasting, regular excessive alcohol use and Dr Zeff Koutsogiannis, Dr Shaun Greene “concomitant use of drugs that induce “The hepatotoxic effects of paracetamol and Dr Bronwyn Bebee, toxicologists at cytochrome P450 (CYP) 2E1”. when taken as an intentional overdose the Victorian Poisons Information Centre The doctors agreed with advice from are well known,” the TGA bulletin said. and the Austin Toxicology Service, that the regulator that, when administering “However, paracetamol hepatotoxicity the study cited by the TGA showed that paracetamol, it was advisable to check can also occur in other situations, “supratherapeutic accidental ingestions whether the medication was also being including accidental overdose and use at make up a significant proportion taken from other sources. normal doses.” of the severe paracetamol-induced The regulator cited as evidence a study hepatotoxicity, and not at therapeutic But they said that, if taken as directed, published in the Medical Journal of doses.” paracetamol was a proven safe and effective analgesic. Australia in 2007 by J.S. Lubel et al of 662 The doctors argued that to claim, as the patients with severe paracetamol-induced TGA had done, that the study showed the “Discouraging its use by physicians and hepatotoxicity, which it said showed use of paracetamol at therapeutic doses patients could potentially lead to more that “48 per cent [of patients] had not can cause hepatotoxicity was “a gross harm through [use] of other analgesic exceeded the recommended maximum overstatement and misleading.” alternatives, including non-steroidal daily dose of 4 g[rams]”. anti-inflammatory agents, salicylates and But despite admitting error in the way it opiates,” the doctors said. But the TGA has since admitted this characterised the study’s findings, and

statement was wrong, as was the citation. in the citation, the watchdog refused to AR To comment click here

australian medicine - september 3 2012 australian medicine - september 3 2012 23 NEWS

Tough TB bug crosses border after defences cut

Pressure is mounting on the Queensland and Federal Public Health, Dr Justin Denholm and colleagues from Victorian governments to reinstate funding for tuberculosis clinics in the Infectious Diseases Service argued that people with latent TB Torres Strait and Papua New Guinea amid concerns people infection posed no immediate risk to the community, and may with drug resistant strains are entering the country in growing never develop active tuberculosis. numbers. “Therefore, any attempt to exclude or defer potential immigrants Doctors warn the decision to close health clinics in the Torres on the basis of latent infection would be disproportionate and Strait islands in June has forced people coming from PNG with unjustified,” Dr Denholm and his colleagues said. drug-resistant strains of tuberculosis to seek treatment further While there was little risk involved in testing for latent TB, Dr south, in Cairns, Townsville and Brisbane. Denholm said treatment was potentially deleterious, depending Cairns-based respiratory specialist Dr Graham Simpson told the on the overall health and age of the patient. Courier Mail said the country was facing a “slow epidemic” of “While testing and medical review could be mandated, a decision drug-resistant TB as people infected with the disease in PNG to be treated for latent infection should be voluntary, just as it is came south in search of treatment. for citizens,” he said. “Most drug-resistant TB in this state is imported,” Dr Simpson Dr Denholm said it could also be deemed discriminatory if said. “It is a slow epidemic, not like the flu season. It takes screening was applied only to immigrants from countries where decades and has enormous momentum. Once it gets a hold, it is TB was highly prevalent. hard to stop.” “Such limitations could be discriminatory, but could also be His warning came as an infectious disease expert cautioned that argued as justifiable,” he said adding that issues surrounding moves to compulsorily screen immigrants for latent TB may not the accuracy of any screening program would also need to be be straightforward, and involved thorny ethical issues. considered. In a paper in the Australian and New Zealand Journal of AR To comment click here The stethoscope maketh the doctor

Forget the hundreds of hours spent the online consultation experience of and reflex hammers according to the studying anatomy and training in medical patients. extent to which they inspired feelings of techniques, or the years involved in trustworthiness. Professor Jiwa said in traditional face-to- honing skills and developing expertise. face consultations patients were able to “The stethoscope was king,” Professor If doctors really want to earn the trust engage all five of their senses, while in Jiwa said, with 95 per cent of respondents of their patients, all of this effort counts online consults they had to rely on just reporting it inspired the greatest feelings for little unless they wear a stethoscope, two – sight and sound. of trust. according to a study by the Curtin Health “If we are to see doctors online, the five He recommended that doctors Innovation Research Institute. senses are not engaged,” Professor Jiwa conducting consultations online consider Just as truckies have their blue singlets and told online newsletter eHealthspace. “So, using props, particularly stethoscopes, construction workers their hard hats, so in order to get the best experience online, though he admitted they could be abused too doctors must have their stethoscopes, the doctor must make the most of the by unscrupulous operators. an investigation into patient responses to traditional medical symbols available.” “It could be very easy to deceive people online consultations has found. The researchers asked 168 patients online,” Professor Jiwa said. “You don’t need a licence to buy a stethoscope.” The researchers, led by Professor Moyez to rank traditional medical symbols Jiwa, set out to discover ways to enhance including stethoscopes, surgical scrubs AR To comment click here

24 australian24 medicine - september 3 2012 news

TGA comes down hard on male pills

Authorities are taking a big stick to a black market in illegal male glibenclamide is commonly used to control blood sugar levels in pills they warn pose a “serious risk” to users. people with type 2 diabetes. The Therapeutic Goods Administration has warned any The TGA said none of the products had been assessed by it for shipments of the illegal medications Rock Hard for Men, Ultra quality, safety or efficacy, and were being manufactured in a for Men and Extra Power detected at the border will be seized place “not approved” by the regulator. and destroyed, and has urged anyone with the products to immediately stop taking them and discard unused doses. It said the commercial supply of the products was illegal, and a number of people who had them had bought them online. “Rock Hard for Men [and Ultra for Men and Extra Power] poses a serious risk to your health and should not be taken,” the TGA The watchdog said it was working with the Australian Customs said in a safety advisory issued on 29 August. and Border Protection Service to help stop future shipments The watchdog said testing showed that the products contained entering Australia, and urged people to exercise “extreme undeclared prescription substances tadalafil and glibenclamide, caution” when buying medicines from offshore Internet sites, despite claiming to be composed entirely of herbal extracts. warning they may contain undisclosed or potentially harmful ingredients. Tadalafil is a PDE5 inhibitor, currently marketed in pill form for treating erectile dysfunction under the name Cialis, while AR To comment click here

Former Health Minister faces end to corporate life, Patel gets re-trial

Former Federal Health Minister Michael his position on the board of a number of The prosecution had originally alleged Wooldridge is facing an indefinite ban other organisations, including the Vision that Dr Patel had generally incompetent from corporate appointments over Eye Institute, Australian Pharmaceutical and grossly negligent in his treatment of allegations of a breach of director’s duty Industries and the Royal Melbourne patients. while at the helm of failed retirement Tennis Club. village group Prime Retirement and Aged But after evidence showed that he By contrast to Dr Wooldridge’s travails, Care Property Trust. had performed surgery “competently notorious doctor Jayant Patel has won a enough”, the prosecution changed its The corporate watchdog, the Australian High Court challenge to his conviction focus to the decision by Dr Patel to Securities and Investments Commission, on three manslaughter charges and one undertake surgery. has launched legal action against Dr count of unlawful grievous bodily harm Wooldridge and other directors of arising from his conduct as a surgeon at The High Court ruled that the earlier Australian Property Custodian Holdings, Bundaberg Base Hospital. evidence about the surgery was alleging they breached their duties to prejudicial and not relevant to the An official commission of inquiry led to investors by authorising the payment of findings that Dr Patel had negligently prosecution’s revised case. a $33 million fee to managing director caused 13 deaths and, after he was found Bill Lewski when the trust listed on the Meanwhile, tributes have flooded in for guilty by a Supreme Court jury, he was Australian Securities Exchange in 2007. GP and Australian National University sentenced to seven years jail. academic Marjan Kljakovic, who died According to the Sydney Morning Herald, But, in a stunning result, the High Court following a heart attack last month. investors pumped $550 million into the found that there had been a miscarriage float, only to see Prime Trust collapse Professor Kljakovic, 57, was Professor of justice at his original trial because the into administration in late 2010. of General Practice at the ANU Medical prosecution changed the focus of its case School. If the legal action succeeds, Dr during the proceedings, and had ordered Wooldridge faces having to relinquish a re-trial. AR To comment click here

australian medicine - september 3 2012 australian medicine - september 3 2012 25 general practice

Ask the AMA first

by Dr Brian Morton

“The AMA was successful in obtaining an undertaking from the DHS that they would continue to process claims on the current paper vouchers to allow practitioners time to exhaust their existing supply”

At the recent AMA Parliamentary Dinner every is not an option that works for everyone. Currently, political speaker noted in their speeches the around 7 per cent of bulk bill claims are still made contribution that the AMA makes in its advocacy by paper. The DHS is still keen to move as many to health policy development and implementation. providers as possible to electronic claiming, but Not consulting us and taking actions where has acknowledged that provisions are needed to unintended consequences have not been guarded support those for whom it is not a viable option. against usually results in backflips and political The AMA was successful in obtaining an embarrassment. undertaking from the DHS that they would The Department of Human Services (DHS) recently continue to process claims on the current paper learned the consequences of not asking the vouchers to allow practitioners time to exhaust AMA first when they announced that they would their existing supply. The DHS will also be making cease to provide printed bulk billing forms and some changes to facilitate use of the new online by the end of the year would cease processing voucher template, and will provide printed them. Despite having the opportunity at the June copies to those practitioners without access to a Stakeholders Consultative Group meeting to computer or printer. In addition, the requirement consult with the AMA on the effect of doing this, on practitioners to keep a paper copy of the they failed to even raise it as something they were assignment of benefit for up to two years will be considering. lifted. As a result, the announcement was met with some This situation has further highlighted to the resistance from medical practitioners who typically Department of Health and Ageing that the Health use paper forms. The feedback DHS received Insurance Act 1973 which governs the assignment from the AMA and from those directly affected, of benefits will need to be updated to take account such as non-computerised practices, locums, after of the electronic environment in which the majority hours doctors, and doctors providing home and of practitioners now work. Hand signed signatures residential aged care facility visits, was sufficient in this brave new world are inconvenient and fast for DHS to meet with the AMA to broker better becoming impractical. arrangements. By not consulting with the AMA on the vouchers Electronic claiming is a convenient option for the DHS created a lot of grief for itself and for patients and practitioners alike; facilitating faster affected practitioners as well. Still, some of the best payments claimed at the point of care. It also lessons in life are learnt the hard way. Let’s hope allows DHS to streamline processing. However it they’ve learnt this one.

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26 australian26 medicine - september 3 2012 therapeutics

Revision of the Medicines Australia Code of Conduct

by professor geoffrey dobb

“It must not There has been considerable debate about individual patients. This approach appears similar the transparency of relationships between the to the current model in Australia. The AMA Code be forgotten pharmaceutical industry and health professionals, of Ethics requires medical practitioners to disclose including medical practitioners. relevant financial interests to their patients. that there is a The AMA supports transparency of relationships I don’t want to pre-empt the findings of the public benefit between pharmaceutical companies and health Working Group, but if individuals were to be professionals. named in a public record, there would need to be in medical The Medicines Australia Code of Conduct already strong governance arrangements so that it contains practitioners requires its members to publicly report total only correct, complete and current information payments related to educational events. The revised which is presented in a way that allows the public continuing Code submitted to the ACCC for approval will to make accurate and informed judgments about extend the reporting requirement to total payments individual practitioners. ethical to health professionals to attend and/or speak It must not be forgotten that there is a public at educational events, to participate on advisory benefit in medical practitioners continuing ethical relationships boards, or to provide consulting services. relationships with the pharmaceutical industry. Medicines Australia recently announced a Working with the Medical practitioners’ involvement in, and provision Group to examine a range of models that would of advice about, the development of medicines pharmaceutical increase transparency further. The AMA has contributes to a product that is not only efficacious been invited to participate and we welcome the in a laboratory but also in real-life practice settings. industry” opportunity to work with Medicines Australia and the other stakeholders to get an outcome that Medical practitioners involved in the development is respected by consumers and the health care of medicines are often then best placed to pass on community. knowledge to their colleagues to ensure they are Some commentators have called for transparency used appropriately. measures similar to the Sunshine Act adopted in the Pharmaceutical companies also seek medical US, which requires public reporting of payments or practitioners to be on clinical advisory committees benefits to individually named health professionals. to ensure they have access to independent advice The US is currently the only country that has taken and medical expertise. this step, and it has not been smooth sailing to It is in the best interests of patients that medical implement this legislation in practice. Reporting practitioners are fully informed about new or has still not begun more than two years after it was improved medicines. passed. Any new transparency model must be appropriately Other countries are considering models that require implemented so that it does not risk discouraging each health professional to make information legitimate and ethical relationships. available to their patients that describes any relationship with pharmaceutical companies. This I welcome your views. Please forward them to way, relevant information is provided directly to [email protected].

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australian medicine - september 3 2012 australian medicine - september 3 2012 27 AMSA

Leadership and professionalism in medical education

by James Churchill

“In the interests of the highest quality health care, it is important that Australia’s future doctors are equipped with these skills to lead change through health system and workforce reform”

It has been recognised that strong clinical medical leaders came together to develop their leadership produces better performing health leadership capacity at AMSA’s recent National systems, greater clinician engagement and higher Leadership Development Seminar in Canberra. quality care. So why have medical schools not been Delegates heard from prominent leaders in health focussed on teaching their students to be leaders? and politics, and were challenged to realise their Australia is in the midst of the biggest health reform responsibility, as young professionals, to be agents since Medicare, with significant initiatives including of change for better health. the implementation of national e-health systems, To date, few Australian medical schools have a restructuring of primary care through Medicare prioritised the education of medical students Locals, and a transition to activity-based public in leadership skills and 21st century medical hospital funding. professionalism. Government agencies including the Independent Hospital Pricing Authority and the National Hospital Australian medical education is on the cusp of Performance Authority have been established to a revolution, of sorts. The Australian Medical maximise the efficiency and performance of health Council’s recent review of medical schools’ systems. accreditation standards proposed numerous changes which, if endorsed, would significantly In addition, there currently exist significant increase the profile of social accountability, challenges to the maintenance of a sustainable professionalism and leadership training in medical health workforce, including training capacity curricula. bottlenecks and a current heavy reliance on international migration. The review proposed, among other things, that there be new graduate outcomes regarding health Continuing with the status-quo has been labelled and society, professionalism and leadership. Skills “untenable”, and health workforce reform will in health advocacy and systems-thinking form the no doubt play a central role in shaping the future building blocks for the education of effective 21st medical workforce. century medical professionals, who are responsive In this context, clinician leadership is crucial to lead to population health needs. reforms for a sustainable system which maintains In the interests of the highest quality health care, the quality of health care and medical training in it is important that Australia’s future doctors are Australia. In order to produce sustainable solutions, equipped with these skills to lead change through the medical profession simply must be engaged in health system and workforce reform. A greater these processes of health system and workforce focus on leadership and professionalism in reform. Australia’s medical curricula is a very positive step Recognising this challenge, 100 of Australia’s future in the right direction.

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28 australian28 medicine - september 3 2012 the economy

Reserve Bank in no rush to cut interest rates

by Australian Medicine editor Adrian Rollins

“In a sign that The Reserve Bank of Australia appears unlikely Westpac’s Matthew Hassan, expect that subdued to cut official interest rates tomorrow despite a conditions in much of the domestic economy, the central slowdown in China, continuing ructions over combined with volatility associated with a sovereign debt in Europe and the lowest inflation possible break-up of the eurozone and negligible bank sees in years. growth in Europe and the United States, will eventually give the RBA little choice but to ease Speculation that further interest rate cuts are local interest rates further. no immediate imminent were pushed along last month when the decision by BHP Billiton to shelve its massive So far this year the central bank has cut its cash need to loosen Olympic Dam project led to declarations that the rate from 4.25 to 3.5 per cent, and it now down mining boom was over. 1.25 percentage points from where it was this monetary time last year. But, even though the terms of trade have peaked policy, Reserve (and have actually been gradually dropping for At this level, said Mr Stevens, interest rates were 12 months) and the rate of investment growth “a little below” their medium-term average. is slowing, mining production is continuing to Bank Governor “With growth close to trend and inflation expand and global commodity demand remains consistent with the target, but the global outlook solid. Glenn weaker than it was and confidence a bit on the The boom in commodity prices might have subdued side, we have judged this to remain the Stevens told a ended, but resource investment as a share of appropriate stance,” the Governor said. gross domestic product is not expected to peak But Mr Hassan said persistent gloom among parliamentary until 2013 or even 2014, and growth in mining consumers would undermine domestic growth exports has a long way to run yet. committee last and eventually convince the RBA it has to reduce The boom in prices might be over, but the interest rates further, predicting the cash rate will month that resources sectors will remain a strong support for eventually have to be cut to 2.75 per cent. growth for a considerable time yet. The low inflation rate – the RBA preferred the economy In a sign that the central bank sees no immediate measure of underlying inflation is just below 2 need to loosen monetary policy, Reserve Bank per cent (at the bottom end of its 2 to 3 per cent was in a “very Governor Glenn Stevens told a parliamentary target band) and headline inflation is growing at committee last month that the economy was in a just 1.2 per cent – suggests the central bank has respectable “very respectable position”. room to cut interest rates and stimulate growth if it feels it is necessary. position”” “We have an unemployment rate of a bit over five per cent; core inflation is two per cent; our But it is wary that inflation pressures could government is AAA rated—that is a smaller and build if it presses down harder on the growth smaller set of governments in the world today— accelerator. our banks are strong; and we have been given, Mr Stevens noted that the effect of the strong by the global economy, a huge gift by the terms dollar in dampening price pressures is waning. of trade rise,” Mr Stevens said. “In the history of the Australian economy, in the time I have been “The more moderate growth of domestic costs working as an economist, that is a pretty good and prices will need to continue, in order for set of outcomes, I must say. That is not to say inflation to remain consistent with the monetary we should not try to do even better, but, on a policy objective,” he said. historical reading, you would have to say that is a Those do not sound like the words of a central very respectable position.” banker on the verge of brining in an interest rate Some private sector economists, including cut. To comment click here australian medicine - september 3 2012 australian medicine - september 3 2012 29 More Than Just A Union – a history of the AMA

This is the third in a series of excerpts from a history of the AMA, More Than Just A Union: A history of the AMA, launched by AMA President Dr Steve Hambleton during a nationally televised speech to the National Press Club on 18 July. In this edition, former presidents David Weedon and Keith Woollard recount their experiences and achievements at the helm of the organisation during Paul Keating’s prime ministership and subsequent defeat, and the arrival of Michael Wooldridge as Health Minister in the first Howard Government. The publication, which can be viewed at http://ama.com.au/a-history-of-the-ama, is considered by the AMA to be very much a work in progress, and invites contributions from members past and present. AR To comment click here Reluctant conductor

By Dr David Weedon, AMA President, 1995-96

to receive a call in 1988 from Dr Bruce he would continue on as a very effective Shepherd, who urged me to nominate AMA President. I thought I was reasonably for a position on the Federal Council. safe, particularly when some sections I accepted, probably because of my of the media turned on the prospective susceptibility to flattery, rather then based Liberal Party candidate, for reasons that are on any real desire to start a ‘career’ in probably best not canvassed here. the Federal arena. Such was not to be. A few years later, I joined the Federal To my surprise and horror, I received a Executive. As Vice-President from 1993– call from Bruce Shepherd at noon on the 95, I watched in awe as Brendan Nelson Saturday. He said he had “good news”: as Vice-President, and then President, Brendan had won preselection and I captivated his audiences on numerous would be AMA President. occasions, even cynical members of the The reluctant President was soon filling In the latter years of my term as President medical profession. His handling of the very big shoes. I hated every second of of the Queensland Branch (1983–84), I press was truly amazing, and I marvelled the ensuing year, but tried not to show had the opportunity to attend the Federal at his ability to think on his feet, and it. Only two incidents of that ‘hell year’ Assembly of the AMA. The highlights handle all situations. This job was not for remain in my mind – the first, a visit of the meetings (for a newcomer) were me, I remember thinking on numerous to Kirribilli House to meet the Prime the enforcement of strict rules of debate, occasions. Minister of the time, Paul Keating. He and the humour associated with the All was to change. Brendan decided to was so different to his public image. I will daily motion to “suspend so much of throw his hat into the political ring by always remember his informal manner, the standing orders that would allow nominating as a candidate for the Liberal his politeness to a potential thorn in smoking to occur” for the remainder of Party for the federal seat of Bradfield in his side, and his frank assessment of all the afternoon. 1995. Health Ministers that he had encountered; In my early years as a delegate I was and second, becoming lost in Parliament Nominations for the presidency of the surprised that this motion passed, let House and the then Health Minister, Dr AMA closed on the Friday, a day before alone that it was even being considered. Carmen Lawrence, asking me if she could the selection of the candidate in Bradfield. Eventually, after several years, I was “show me the door” (in good humour). I agreed to nominate, along with Brendan pleased to be present when the motion Nelson, for the position of President of I have a personal rule that I try to keep. was lost and smoking was outlawed. the AMA. If Brendan was unsuccessful Never return to an organisation that one After an absence of about 12 months the following day (for which I prayed), from the Federal scene, I was surprised I would withdraw my nomination and ...continued on page 31

30 a30ustralian medicine - september 3 2012 ...continued FROM page 30 has previously served. Accordingly, I will not be at the launch Hopefully after serving for 23 years in AMA politics, I have learnt of this book, for which I apologise in advance. I broke that rule one thing – how to Chair a meeting. It is like conducting an once in the AMA, and regret very much my brief return to Chair orchestra – if the wind instruments are too loud, it is essential to an Extraordinary Meeting of the AMA. Each ‘side’, including silence them; if the violins are too soft one needs to bring them in me as Chair, had legal advisers in attendance and the meeting (to the discussion). There is no place for the beating of drums in an achieved little, and soon was adjourned. orchestra or meeting. My baton has now been laid to rest.

To comment click here Medical Politics

By Dr Keith Woollard, AMA President 1996-1998

usually be the first person to turn up for disappeared subsequent to that betrayal! the morning meeting! To my surprise, the other great issue that There was only one serious hiccup, when arose was the attempt by the health funds I called the renowned Rohan Greenland to introduce US-style managed care into to ask why he was not there to pick me the private hospital system. Fortunately, up at the Canberra airport, only to be told the surgeons had been well trained by that the meeting was at Sydney airport. Bruce Shepherd to protect their interests Fortunately, the shuttle got me to that (and those of their patients). What started meeting on time as well. off as an offer of substantially higher payments in return for a degree of control I remember my sense of surprise when over surgical practice by the health funds, Brendan Nelson, our best-known ended up being no more than higher My pathway to the Presidency President, approached me at a social payments from the health funds - not a commenced on a fateful Thursday function and encouraged me to look bad outcome for the medical profession. evening when I went home to have towards a position as Federal President. dinner with my family rather than attend With his sudden elevation to serious But my best moment came at a a clinical staff meeting at Fremantle political life, I was then elected to follow dinner with Michael Wooldridge and Hospital. In my absence, I was appointed David Weedon. representatives of the private hospital the AMA Hospital Representative. industry. We took to him the concept Not unexpectedly, the main issues of lifetime health cover, whereby health My eyes were opened to the world of during my terms involved conflict with insurance premiums would be steadily medical politics. It quickly became clear Government, to the extent that the Health increased for late entrants to the system. that Government was not our friend, Minister, Michael Wooldridge, eventually To his credit, Michael introduced the but a serious competitor in directing the closed down communications. proposal (despite advice that focus future of medicine. Junior doctors had the provider number groups hated it). That single component The requisite training program to issue to deal with. They rightly perceived of the changes to health insurance deal with the awesome structures of this as a setback for their career produced a 50 per cent increase in Government included a long period of prospects, and there was a broader membership in private health funds training by Peter Jennings, a remarkable concern within the profession that the and helped underwrite the future of our State AMA employee who spent his restrictions on medical practice held by private hospitals and private surgical professional career representing our Government would be used to conscript colleagues. interests to Government and other doctors to unattractive positions. Junior My period as President ended when bodies. doctors were magnificent in responding I was defeated by my Vice President. The move into the Federal AMA was not to calls for industrial action, and came My disappointment at missing out on straightforward, given the lack of any close to defeating the legislation, but another year of travelling to Canberra direct flights between Perth and Canberra. were undermined at the last minute by once or twice a week was modest. I I settled into a regular pattern of catching the Australian Democrats. However, as remain a proud supporter of the AMA the midnight horror to Melbourne with a result of the strength of their protests, and am especially pleased that we have the aid of Temazepam, one hour in the a series of governments since have trod had such a magnificent variety of Federal lounge to breakfast and shower, then warily in attempting to coerce Australian Presidents to add flavour and diversity to a short hop to Canberra where I would graduates. The Australian Democrats the organisation.

To comment click here australian medicine - september 3 2012 australian medicine - september 3 2012 31 health on the hill

health on the hill

Coalition plays down the vaccination from within their own In answer to a question from Liberal MP health plans amid budget budgets. Dr Andrew Southcott, Health Minister concerns But in his speech to the AMA Dinner, Tanya Plibersek admitted that, as at 11 Mr Dutton was unapologetic about the October last year, 10 Super Clinics were The Liberal Party has taken aim at GP need for cuts, and indicated that budget found to have submitted operational Super Clinics and the health bureaucracy austerity would limit scope for spending plans that were unacceptable and as it seeks to dampen hopes for a major on health initiatives until government required amendment, while the plans of lift in health spending from an incoming debt was reduced. a further 14 had been accepted. Coalition government. “If you consider the burden of debt when So far there are 27 GP Super Clinics in As the Opposition seeks to refine its John Howard came in, in 1996 - which operation, with a further five approaching political message ahead of next year’s Campbell Newman has faced coming into full operational capacity. federal election, Shadow Health and Queensland - it makes it very difficult to Ageing Minister Peter Dutton has flagged But this is short of the Federal invest in the sorts of places, particularly plans to wind back some Government Government’s original target for 36 clinics in health, that you would want to,” the health programs and re-direct funds from to be up and running by the end of June Shadow Minister said. the federal public service. this year, and has underlined concerns “The Coalition at the next election is But, in a more hopeful message, Mr about the program since its conception. committed to taking money away from Dutton said that, once the debt was “paid down”, there was scope for Government AMA President Dr Steve Hambleton the ever-growing health bureaucracy,” said that although the organisation was Mr Dutton told the annual AMA to invest “in a number of areas that you would want”. not opposed to the establishment of GP Parliamentary Dinner last month. “There Super Clinics in areas of demonstrated will be no Super Clinics, there will be His comments came as a leading need, it was concerned the selection of no new health bureaucracies, under a economist, Chris Richardson of Deloitte clinic locations was largely a political Coalition government.” Access Economics, warned the scale of process. His comments echoed remarks from spending commitments being made by The Australian National Audit Office Opposition leader Tony Abbott that the both of the major political parties – most Coalition would aim to run a government recently the Federal Government’s $4 is investigating the operation of the “slimmer” than that operated by Labor. billion Dental Health Reform package program, and the Federal Government – made a return to Budget surplus this withdrew $44 million from the $650 Mr Abbott told The Australian that more financial year increasingly unlikely. million scheme in the May Budget. than 20,000 public servants had been added to the federal bureaucracy since In a sign that Budget concerns are AR To comment click here 2007. weighing increasingly heavily on the Coalition’s health plans, Mr Dutton has “I think we can run a slimmer and more refused to set a time frame for the repeal Future Fund free to invest in effective government in Canberra,” he of laws subjecting the private health tobacco said. insurance rebate to means-testing, citing The Federal Government is resisting a The comments come at a sensitive Budget constraints. The Coalition has push by the Australian Greens to direct time, with the Queensland Government been a dogged opponent of the change. the Future Fund to withdraw investments coming under increasing attack over AR massive cuts to its public service and To comment click here in tobacco companies. spending, including the controversial Greens Senator Dr Richard Di Natale has decision to axe a statewide influenza Almost half GP Super proposed a Bill calling for the Future immunisation program for health Clinics sent back to drawing Fund, whose portfolio has reached a professionals that has come in the midst board value of $77 billion, to immediately divest of one of the state’s worst flu seasons on itself of about $200 million worth of record. Almost half of the GP Super Clinics shares in tobacco companies including Under the change, local health boards in operation had had their official British American Tobacco, Philip Morris will continue to be offered a subsidy operational plans rejected, figures and Imperial Tobacco. of $8 for doses of the vaccine, but will released by the Federal Government have to cover the cost of administering show. ...continued on page 33

32 australian medicine - september 3 2012 health on the hill

health on the hill

...continued from page 32

But Finance Minister Senator Penny as well as through the World Trade in life,” Senator Carr said. “Getting a Wong said that although the Government Organisation. health check will help children’s chances was a world leader in taking action of being successful at school. Problems Dr Tienhaara said action through the against tobacco products and smoking, can be identified early, and solutions Hong Kong treaty could be particularly it did not support proposals that would sought.” dangerous. infringe on independence of the Future But AMA President Dr Steve Hambleton Fund and the conduct of its investments. “The investor-state dispute under has expressed reservations about the Hong Kong treaty is particularly “We do not believe that it is appropriate a proposal from Deakin University concerning for supporters of the [plain for governments to be hands-on directing academics for a program to weigh and packaging] legislation,” she said. “Unlike investments for the Future Fund,” Senator measure children in schools as a way of the WTO, there’s no exception under the Wong told Palrliament last month. “The combating obesity. treaty for public health measures. And, Future Fund should exercise its discretion unlike in the Australian Constitution, Researchers from the university said there regarding investment independently ‘exproporiation’ is defined very broadly.” was a need for routinely collected data of the Government and independently to monitor the problem, and suggested of the wishes of particular ministers, AR an opt-out schools program as a way senators or MPs.” To comment click here of ensuring extensive coverage and participation. Otherwise, she said, “you could get to Families lose out for a rather odd position where you might skipping doctor visits But Dr Hambleton was among a number have a politician - for example, Senator of health experts who expressed [Ron] Boswell – saying that they should The families of more than children have concerns that weighing and measuring not invest in renewable energy because had their welfare payments docked for children, unless handled sensitively, he does not believe in climate change”. failing to take their offspring to see a could exacerbate problems around body doctor before starting school. image. The debate followed a second legal defeat for the major tobacco companies In a tough new approach to child AR To comment click here when the High Court rejected their health, the Federal Government has application for special leave to appeal a carried through on its threat to withhold Freedom of Information decision. a payment of $726.35 per child from Watchdog gets extra teeth families on income support payments The nation’s health ministers have moved British American Tobacco had been and Family Tax Benefit Part A who did seeking access to legal advice provided not take their four-year-olds to see a to strengthen the health practitioner to Government regarding plain doctor last financial year. watchdog by increasing the size of its packaging laws. management committee. Figures released by the Government Both the Administrative Appeals Tribunal show almost 67,000 four-year-olds Effective today, three extra officials will and the full bench of the Federal Court received a check-up, while a further join the Australian Health Practitioner had agreed with the Government that the 27,402 missed out. Regulation Agency’s management committee, expanding its membership advice was covered by legal privilege, The Department of Human Services from five to eight people. and the High Court refused to hear the wrote to 77,000 families late last month case, awarding costs against the tobacco reminding them of their obligation to The ministers decided to reappoint all company. ensure any child turning four years in five existing members of the committee, Despite the legal setback, the fight 2012-13 has their health checked. including one-year extensions for Chair against Australia’s landmark plain Human Services Minister Senator Kim Peter Allen and Professor Genevieve packaging laws is far from over, an Carr said the health checks, which can be Gray, an extra two years for Professor Australian National University trade and undertaken from three years of age, were Merrilyn Walton, and an additional three legal expert has warned. important in helping identify and address years for Michael Gorton and Professor Con Michael. Dr Kyla Tienhaara said the laws faced problems at an early stage. challenge under the terms of the Hong “Everyone knows how important Kong-Australia bilateral trade agreement, education is to increasing opportunities ...continued on page 34

australian medicine - september 3 2012 australian medicine - september 3 2012 33 health on the hill/news

INFORMATION FOR health on the hill MEMBERS Free tool ...continued from page 33 to track They will be joined from today by The Australian Health Workforce Ian Smith, of the Western Australia Ministerial Council, which is Country Health Service, former comprised of the nation’s Federal, registration Department of Health Victoria State and Territory health ministers, Secretary Fran Thorn, and New reported there were 274 applicants requirements South Wales Health Deputy Director- for 105 vacancies on the boards General Karen Crawshaw. covering practitioners groups and occupations including the Medical The AMA has developed a free online tool to In a statement the ministers Board, the Nursing and Midwifery help doctors to keep track of the information said staggering the timing of Board, optometry, pharmacy, they need to meet the Medical Board of appointments would help ensure psychology, dentistry, chiropractic Australia’s annual continuing professional continuity and overlap in the and physiotherapy. development CPD requirements. committee’s membership, while Each September, practitioners, when renewing the committee’s expansion would About 90 per cent of current board members sought reappointment, their Medical Board registration, may be play a role in “strengthening and required to provide evidence they have and 72 health practitioners were guiding the work of AHPRA in complied with the Board’s CPD requirements. further embedding the safe delivery selected from 134 applicants, while The AMA CPD Tracker has been developed of the National Registration and 33 community representatives to enable doctors to progressively gather and Accreditation Scheme”. were appointed from the 140 who applied. organise the information needed to substantiate The appointments followed the declarations made to the Board about CPD, selection of 105 practitioners Among those reappointed was so that evidence can be quickly and easily and community representatives Dr Joanna Flynn, who is Chair of produced on demand. the Medical Board, while Anne to fill vacancies on boards for The AMA CPD Tracker can be used to: Copeland was reappointed as Chair 10 industry and specialty groups of the Nursing and Midwifery Board. • List courses completed, including the under the National Registration and organisation that accredited the CPD activity; Accreditation Scheme. AR To comment click here • Store all certificates of completion; • Keep a log of practice-based reflective INFORMATION FOR MEMBERS activities, including clinical audits, peer reviews and perfomance appraisals; and • Log hours spent on online learning, reading Expert witness training journals, teaching and other activities. The system keeps a tally of hours, enabling Doctors and other health professionals are invited to attend a two-day training practitioners to keep track of what needs to be session on providing expert testimony in court. completed before the end of the registration The course, to be run by the Australasian College of Legal Medicine, provides year. instruction on how to be an expert witness, and what will be expected when The Tracker has been developed taking full attending court. account of the requirements set out in the Medical Board’s Continuing Professional As part of the training, attendees will be required to submit a report (from which Development Registration Standard. identifying details have been deleted) a month prior to the course. During the training they will be led and cross-examined on the contents of the report. The service is free to AMA members. Non- members can subscribe for an annual fee of When: 24-25 November, 2012 $250. Where: Royal College of Surgeons, 250-290 Spring Street, East Melbourne To register for the product, please sign up here. Registration: Forms available at www.legalmedicine.com.au To comment click here More information: Australasian College of Medicine, 02 4573 0775

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34 australian34 medicine - september 3 2012 research

RESEARCH

Male pill hopes rise “What was initially a side project in our walking test and had a significantly laboratory has become a major focus of higher score in the questionnaire than The long hunt for an effective and research. those in the control group. hormone-free birth control pill for men may soon end with the discovery of “We’re still aggressively advancing a Lead researcher Regina Leung, a a compound that cuts sperm counts derivative of it as a cancer drug.” physiotherapist at the Concord without affecting the sex drive. The research was reported in the medical Repatriation Hospital, said the study showed that regular Tai Chi improved United States researchers have identified journal Cell. muscle strength and balance, contributing a small compound, known as JQ1, which KW produces a rapid and reversible decrease To comment click here to an overall increase in exercise capacity in sperm count and movement. and quality of life – results not identified Tai Chi lends balance to the in previous studies of Tai Chi and COPD. When tested on mice, the compound breathless did not affect sex drive or the ability to “Improvement in balance and muscle reproduce later – when doses of the strength of the lower limbs in very compound were withdrawn, sperm important in reducing the risk of falls for counts rebounded and the mice involved people with COPD, who are generally were able to produce healthy offspring. more at risk as their balance tends to be worse than others in the same age Lead researcher Dr James Bradner, of group,” Ms Leung said. the Dana-Farber Cancer Institute in Boston, said he was working on creating The study was published in the European an inhibitor molecule that could make Respiratory Journal. cancer cells forget they were cancer, KW leading to potential new treatments To comment click here for lung and blood cancers, when he stumbled across the JQ1 compound. The Chinese martial art Tai Chi can Daily dose of chocolate Dr Bradner found that JQ1 inhibited boost the strength and overall wellbeing good for the heart a protein in the testes, BRDT, that is of patients with chronic obstructive integral to sperm production. pulmonary disease, a University of Sydney study has found. “In mating studies, JQ1 accomplishes a complete and reversible contraceptive The researchers found that Sun-style Tai effect in males without adversely Chi is more effective than standard medical affecting testosterone levels or mating care in fostering rehabilitation among behaviours, and without prompting those suffering the debilitating condition. obvious birth defects in offspring,” Dr For the study, 42 people with chronic Bradner said. obstructive pulmonary disease (COPD) “The cells effectively forget how to were divided into two groups: half attended Tai Chi classes twice a week and make mature sperm, resulting in a The self-serving claim of chocaholics practiced at home, while the remainder profound decrease in sperm count and that eating chocolate is as good for them impaired motility, leading to a complete followed usual medical management as going to the gym may have some contraceptive effect. It’s really stunning.” protocols, which did not include exercise. substance after all. Dr Bradner said that although the drug The researchers tested the exercise A study by University of Adelaide had so far been only tested on mice, it capacity of all participants with a walking researchers has found that eating dark would probably work in humans due to test and measured muscle strength and chocolate may be as effective in lowering their reproductive similarities. balance, and all participants completed a blood pressure as increasing exercise or questionnaire. “As early as next year, we may have a eating a healthier diet. sense of how well this works in humans,” Patients who attend the Tai Chi classes Dr Bradner said. performed 75 per cent better in the ...continued on page 34

australian medicine - september 3 2012 australian medicine - september 3 2012 35 research

RESEARCH

...continued FROM page 33 However, not everyone is convinced The study examined the effect of hair of the benefits. The National Heart colour on anaesthetic requirements The researchers reviewed 20 studies Foundation warned that chocolate, and recovery time after surgery. More examining the benefits of consuming despite its antioxidant properties, had than 450 patients undergoing general cocoa daily and discovered it could high levels of sugar and saturated fat. anaesthesia for elective surgery were reduce blood pressure by 2 to 3mm of examined. mercury. The review was published by The Lead author, Melbourne anaesthetist Cochrane Library and involved 856 Lead author Dr Karen Ried, of the Professor Paul Myles, said the study was people who consumed 3g to 100g of dark National Institute of Integrative prompted by previous research that chocolate or cocoa powder each day for Medicine, said “the reduction in blood suggested redheads were less sensitive pressure achieved with cocoa is between two to eight weeks. to general anaesthetics due to variants of

somewhat comparable to other lifestyle KW To comment click here the melanocortin-1 receptor gene. modifications such as diet and exercise, “We expected to find a small difference, and may serve as a complementary Research busts redhead with redheads waking up faster after treatment option”. pain myth surgery,” Professor Myles said. “Although Dr Ried said the benefits of eating dark there was an apparent effect, it was not chocolate may stem from the flavanols it due to hair colour, but to gender. contains. “We already know that women are “Flavanols are responsible for the less sensitive to general anaesthetics formation of nitric oxide in the body, and and, once we accounted for gender nitric oxide causes blood vessel walls to imbalance, the effect of hair colour was relax and open wider, thereby reducing negligible. blood pressure,” she said. “The basic science is quite compelling “High blood pressure is an important and is still likely to be true.This is risk factor for cardiovascular disease, because the genes that determine both contributing to about half the the hair colour and pale skin of redheads cardiovascular events, such as strokes probably influence how anaesthetic and heart attacks, worldwide and around Research from the Australian and New drugs act on the brain.” a third of cardiovascular-related deaths. Zealand College of Anaesthetists has The research was published in Evidence from epidemiological studies found no evidence that redheads feel Anaesthesia and Intensive Care. has suggested that cocoa might reduce more pain than patients with other hair this.” colours. KW To comment click here

INFORMATION FOR MEMBERS Puggy Hunter Memorial Scholarships for 2013 now open

Scholarships worth up to $15,000 a year are being offered of the following health professions: for Aboriginal and Torres Strait Islander people studying for • Aboriginal and Torres Strait Islander health worker; professional health qualifications. • Allied health (excluding pharmacy); Applications are being invited for Puggy Hunter Memorial • Dentistry/oral health (excluding dental assistants); Scholarships for 2013, offering up to $7500 a year for those engaged • Medicine; in part-time study and $15,000 a year for full-time students. • Midwifery; or • Nursing. The scholarships will be available from the start of the 2013 academic year, and are offered to Aboriginal and Torres Scholarship applications close on 16 September, and more details Strait Islander people who are, or will be, studying at a TAFE can be found at the Royal College of Nursing Australia website: (certificate IV and above) or entry-level university course in one http://www.rcna.org.au/ To comment click here

36 australian36 medicine - september 3 2012 news

Trade laws may stump plain packaging push in New Zealand

A United States Government push for But the Australian laws are still substance, and to balance the virtues of stronger intellectual property protection being challenged at the World Trade global trade against what is needed for in international trade treaties threatens to Organisation, and the NZ Government health protection at home.” derail a push for plain tobacco packaging appears wary of being the subject of Meanwhile, the Australian Government in New Zealand. similar action. has rejected a push by health insurers to NZ Prime Minister John Key has warned Greens parties in Australia, NZ and charge a higher premium for smokers. that the introduction of plain packaging Canada have issued a joint warning that Reaffirming the principle of community laws in his country was not “a slam proposed provisions in the TPPA could rating, Health Minister Tanya Plibersek told dunk by any chance”, despite strong restrict the ability of governments to the Sun Herald people should be charged support within the Government and the introduce laws to protect and enhance the same premium regardless of the state broader community for measures to curb public health. of their health, and cannot be charged smoking, according to a report in The They claim that a draft investment chapter more based on genetic conditions or other Conversation by Professor of Population of the Agreement, which is currently factors affecting their wellbeing. Health at the University of Auckland, being negotiated by governments from Alistair Woodward. AR Australia, the US, Canada, New Zealand, To comment click here Professor Woodward said that the NZ as well as several other nations, contained Government was torn between a desire proposals that would severely limit the to follow the Australian Government in ability of governments to act to protect INFORMATION taking strong action against smoking, public health and ensure access to safe FOR MEMBERS and concern that plain packaging laws and affordable medicines. could breach existing trade rules and “Leaked details of the TPPA reveal that complicate its negotiations for inclusion Suicide Prevention foreign investors and firms could sue in the proposed Trans Pacific Partnership Canada or New Zealand in a private Agreement (TPPA). Conference international tribunal if their parliaments The US is pushing for stronger intellectual or local councils pass laws that reduce A key adviser to the United States military property and investor protections in the their profits or adversely affect their on suicide will be among the keynote Agreement, which the NZ Government is businesses,” Australian Greens Senator speakers to address the annual Suicide keen to be a party to. Peter Whish-Wilson said. “This could Prevention Conference in October. include laws such as a requirement In a high-profile campaign in NZ against for large graphic warnings or plain Dr Thomas Joiner, who is Director the proposed plain packaging laws, the packaging of cigarettes and other tobacco of the US Military Suicide Research tobacco industry has warned that the products.” Consortium and Professor in Psychology policy would infringe its intellectual at Florida State University, headlines a property rights, which is the argument it In his article, Professor Woodward cites group of speakers that includes Dr Jerry INFORMATION FOR MEMBERS unsuccessfully put to the Australian High concerns that the threat of action alone Read, Director of the National Suicide Court last month. may be enough to discourage other Prevention Centre in the United States, governments following Australia’s lead, In their legal challenge to the Australia’s given the cost of defending such actions Edinburgh University Professor of world-leading plain packaging laws, the and the uncertainty of outcomes. Health Policy Stephen Platt and Jonathan tobacco companies had claimed the new Nicholas, chief executive of the Inspire measures amounted to an acquisition Professor Woodward said the issue Foundation. of their brands and logos by the is shaping as a key test of the NZ Government, and should be thrown out. Government’s resolve in meeting its target The conference, organised by Suicide to make the country smoke-free by 2025. Prevention Australia, is being held at the But the High Court found in favour of the Crowne Plaza Hotel, Coogee Beach, New counter argument from the Government “This is the importance of plain South Wales, on 10-11 October. that although the laws required the packaging,” he said. “It is a test of removal of trademarks from all cigarette government commitment to tighten the For registration and further details, visit: packets, they did not weaken the screws on supply, to continue the shift www.suicidepreventionaust.org/ companies’ exclusive ownership of their from viewing tobacco as a consumer conferences trademarks. commodity to treating it as a hazardous To comment click here

australian medicine - september 3 2012 australian medicine - september 3 2012 37 news

Spike in UK measles cases triggers vaccination warning

Britain is experiencing its worst measles Head of immunisation at the United of this year, with the annualised rate of outbreak in years, adding urgency to calls Kingdom’s Health Protection Agency, Dr incidence just 1.8 per 1 million people for parents to ensure their children are Mary Ramsay, said rates of vaccination – well down from last year when there vaccinated against the potentially deadly against the illnesses had improved in were 192 cases and the incidence rate disease and other harmful infections. recent years, though sufficient gaps in reached 8.5 people per 1 million. coverage remained to allow the disease to Across Europe, the average rate of Official figures show the number of flourish in pockets of the population. measles cases in England and Wales incidence of measles in the first six virtually doubled in the first half of this “Some children do not get vaccinated months of the year was close to 30 per on time and some older children, who 1 million, and ranged from almost 275 year compared with the same period missed out when uptake was lower, have per 1 million in the Ukraine, to 79 per 1 in 2011, with more than 960 children not had a chance to catch up,” Dr Ramsay million in Ireland, between 20 and 26 per infected. told the BBC. “Therefore, there are still 1 million in France, Belgium, Italy and the According to a report from the BBC, most enough people who are not protected United Kingdom, and 4.1 per 1 million in cases have been linked to travel to other to allow some large outbreaks to occur Germany. among unvaccinated individuals.” European countries. In Australia, WHO figures show that last According to British health authorities, In Australia, where rates of immunisation year measles were most common among 93 per cent of children younger than 13 are similar to those in Britain, the infants and toddlers less than two years months have been vaccinated against incidence of the disease has been much old, and in children aged between 12 and measles, mumps and rubella, while 87 lower. 15 years. In almost all instances those infected had not been immunised. per cent of older children have been There were just nine cases of measles administered a follow-up dose. in the country in the first four months AR To comment click here

Kiwi chemists take on the chronically ill

Australian pharmacists are being briefed on a controversial for pharmacists to “better use their clinical skills and expertise scheme under which their New Zealand colleagues are to within the primary health care team”. manage patients on chronic therapies in exchange for forgoing “The deal is aimed at moving pharmacy from being paid solely dispensing fees. by a medicine dispensing fee, to a patient-focused payment According to the New Zealand Government, all 947 of the model,” the Society said in a statement. country’s pharmacists have signed up for a three-year transitional agreement under which they are guaranteed an incremental rise “The new agreement rewards pharmacists for providing support in revenue in exchange for taking on a greater role in managing and advice so patients can better manage their medicines and patients. medical conditions. Details of the scheme will be presented to the Pharmaceutical “This will benefit patients, especially [the] approximately 200,000 Society of Australia Congress next month. New Zealanders with long-term conditions.” Announcing the event, the Society said the scheme offered a way AR

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38 australian38 medicine - september 3 2012 public health opinion

Are conscientious objectors wrecking our immunisation program?

by ProfESSOR Stephen Leeder

There is an ineradicable mystique about immunisation. into play – possibly to 2 or 3 per cent. This will be because more parents (who were otherwise not bothering to register as The mystique occurs because, by immunisation, biologically conscientious objectors for just $200) will now make the effort to active material is introduced into the body of the recipient that is register because they stand to lose up to $2178.” destined to alter his or her body’s functions. In symbolic and real ways, immunisation is unnatural. How far should we go in pressing the case for universal Occasionally things go wrong and, because the population being immunisation? Three observations are pertinent in forming a immunised is healthy and these side effects are caused not by a policy response. treatment but by a preventive agent among otherwise fit people, First, you don’t need everyone to be immune to prevent an concern runs high. epidemic occurring. If 90 per cent or more are immune, they Immunisation coverage is currently around 94 per cent for two create sufficient fire breaks to prevent the easy transfer of most year olds nationally. But resistance to immunisation is intense infectious diseases. So, good levels of public health could be enough among perhaps 1 to 2 per cent of parents to drive a maintained even if the CO rate climbed substantially – which it is decline in overall immunisation. These parents may worry that not likely to do in real terms. they are not doing the right thing for their child by agreeing Second, the ethical context is complex. Strong incentives may to have him or her immunised. The worry may grow as more raise the immunisation rates but damage voluntarism, just as vaccines are added to the list of those required. paying for blood for transfusion in other countries erodes the A new approach to encouraging immunisation shifts ethic of giving gifts. While incentives have helped maintain responsibility and reward from the doctor to the patient or high immunisation coverage, reservations exist about highly parent. As of May 2013, all GP immunisation-related payments disadvantaged groups missing out because it’s just too hard to get will cease, with the exception of the Australian Childhood vaccinated on time. Immunisation Register (ACIR) notification payment. From that Third, with regard to compulsory immunisation, a distinction date, the incentives will be directed at parents. Unless they exists between compelling parents to immunise their child for either immunise their children on time or declare themselves to their child’s sake and compelling them to be immunised for the be conscientious objectors (COs), the majority will forfeit up to sake of the community – to assure herd immunity. $2178 in the Family Tax Benefit Part A. The essence here is about ensuring all groups can get easy access Incentives for immunising one’s child are not new in Australia. to immunisation. But in the past they were smaller, and it took time for parents who did not want their children immunised to become aware of The erosion of provider incentives may be unfair by not what was on offer. Consequently, there has been a small increase removing the ‘push’, and depending only on the ‘pull’ to – from 0.23 per cent in 1999 to 1.44 per cent this year – in the encourage immunisation. proportion of parents registering as COs. The last words belong to Dr Leask: “I would warn people to be The new system – of linking the Family Tax Benefit Part A with very careful about over-interpreting increases in CO rates and full immunisation – still has a get out clause. COs do not have to coverage drops in the next year or two. “Next year, varicella, have their children immunised, and yet they will still receive the meningococcal C and pneumococcal vaccines will be included payment. Should we be worried? in the ‘fully vaccinated’ algorithm for children aged less than five. This may create an appearance of a decline in immunisation rates Dr Julie Leask, a research fellow and public health academic at as the criteria for full vaccination become stricter.” the National Centre for Immunisation Research and Surveillance in Sydney, writes: “Prospectively, the registered conscientious I agree. In practical terms we are not facing an immunisation objector rates will increase as the new larger incentives come crisis.

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australian medicine - september 3 2012 australian medicine - september 3 2012 39 wine

The Return To Terroir - Organic Champagne

by dr michael Ryan

One of the reasons I find wine so alluring is the sense of existence it creates. The reflection of its terroir and the wine makers guiding Wines Tasted hand amalgamate to form an often indescribable libation that truly is a living thing. Organic Champagne fits these criteria and stamps its own indelible mark on the consumer’s senses. Organic Champagne producers are tiny in the scheme of things. Some may make only 3000 bottles from single vineyards, whereas larger houses like Moet may make several million bottles that are sourced from up to 80 vineyards. These grandiose houses believe in the continuity of style and expression, whereas terroir-focused vintners let a wine’s idiosyncrasies shine. The use of natural yeasts is encouraged to aid in forming a wine with soul. There is a sense of honesty from these growers. On their labels you can find relevant information such as the percentage of Fleury 2004 Cepage Blanc de Blancs the blends, the date of disgorgement, whether a dose of liqueur is This is 100 per cent Chardonnay, and displays bread and yeast-like added after disgorging, and if they are organic or biodynamic. notes, with hints of candied lemon. The palate is full and generous. An importer with a bent towards organic Champagne is Nesh This is a rich wine that would suit duck liver pate. Simic, based in Noosa. He has a strong interest in health and well being, having Bachelor’s degree in Health Science from his native Fleury NV Champagne country in the former Yugoslavia, and this has transferred to all things organic. He works in the organic food industry and exudes Strawberries and citrus notes with floral influences combine to give a palpable sense of passion for things organic – one fuelled by his a lifted crisp palate. This is a very clean yet complex Champagne inclination to sail against convention. that I would pair with Sashimi. Nesh has visited many organic Champagne producers, and he tells me of their “Return to Terroir” campaign. This group includes Francois Bedel NV Entre Ciel ET Terre Champagne producers such as Fleury, Bedel, Frank Pascal, Courtin and David Leclapart and they, together with many other growers There is an alluring, delicate light yellow colour that from different appellations, want the wine to be as natural as it can is ironic, as this is made from the black grapes of be. Pinot Mineur (80 per cent) and Pinot Noir (20 per A criticism levelled at these producers is the variability of their cent). The nose is a delicate blend of apples, figs and vintages. But this tests the skill of the grower and the maker, who almonds. As the wine opens up, smokey bread-like are often one and the same. Some years may be dull in comparison characteristics emerge. The palate is uplifting, with to others, but some are simply stellar. Personally, in this world of a citrus-like burst of acid, followed by a sustained homogenous processed taste, I welcome this philosophy. structure. Try with a plate of charcuterie meats. Nesh proudly credits organic Champagne for meeting the woman who has since become his wife. She was looking for a bottle of Jose Ardinat 2004 Blanc de Blancs wine in a shop he worked at. He simply gave her a bottle of 95 Floral nuances abound on a platform of apple and Fleury Organic Champagne to her free of charge, and this led to a whirlwind romance. Who knew a bottle of Champagne could pears. Subtle yeast notes help give this Champagne a have such consequences? Nesh’s wares can be found at www. complex but crisp palate. Creamy Sydney rock organicchampagne.com.au oysters are perfect.

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40 a40ustralian medicine - september 3 2012 member benefits

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australian medicine - september 3 2012 australian medicine - september 3 2012 41 member benefits

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42 australian medicine - september 3 2012