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Budget takes aim at health Universal health care in Government sights, p8

10 Public hospitals under pressure 11 Indigenous health’s temporary lifeline 12 Close 457 loophole: AMA 19 Post-antibiotic world looms 20 Pap smear’s days numbered 34 Plain packaging laws provoke trade storm WHO declares global polio emergency INSIDE 29

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President Vice President Chairman of Council Treasurer Executive Officer Executive Officer 3 Dr Steve Hambleton Prof Geoffrey Dobb Dr Iain Dunlop Dr Elizabeth Feeney Dr Brian Owler Dr Stephen Parnis

VICE PRESIDENT’S Government project has still to deliver MESSAGE It is governments, not its potential efficiencies. The other great opportunity is in telehealth. doctors, who need to While there has been some take up, particularly for consultative services, telehealth remains greatly under- utilised, especially for a country change archaic practices with such a dispersed population as Australia. In particular, the potential for improved access to general The Better Bang for your Buck issue Nevertheless, the most interesting for 46 per cent of Medicare costs, practitioners for those in rural and of Health Voices, the magazine article comes from Federal Health and potential roles for private health remote communities has still to be BY AMA VICE PRESIDENT of the Consumer Health Forum, Minister Peter Dutton, because it insurance in primary care. realised. PROFESSOR GEOFFREY DOBB includes articles from a range of provides some insight into the current Missing from the article is any commentators on health policy thinking of Government on health More fundamental are the acknowledgment of the world leading as well as contributions from the policy, and there has been little inefficiencies that arise from our health outcomes enjoyed by the Coalition, Labor and Greens. external indication of that since the Federal funding system. Australia is average Australian, or the role that election. “failing to reap The underlying theme is that it is successive Commonwealth and Much was made of the ‘blame game’ possible to reduce waste and improve Given recent media coverage though, State Governments have played in under our previous Government but, the potential efficiency in our health system - and it is not surprising that it is written contributing to current inefficiencies. make no mistake, duplication of it’s hard to argue with that. from the “Growth in spending on Australia is failing to reap the services or worse - service gaps - rewards health is unsustainable” perspective, Some of the articles just say what potential rewards of modern continue. even though Australia is in the middle you expect them to say. information and communication of modern of OECD countries in the percentage Whether it is under-provision of aged technology. The Personally Controlled For example, Terry Barnes pushing of gross domestic product we spend care services (a Commonwealth information and Electronic Health Record languishes his $6 co-payment plan again, David on health, with predictions it will responsibility), leaving elderly people as we wait on the outcome of the Baker highlighting the potential increase by only about 1 per cent in in our public hospitals while they communication Government initiated review. savings from greater use of generic the next decade. wait for a place to be available, or technology medicines, and Jeremy Sammut After spending more than $1 billion, the interface between Local Hospital Key points made by the Minister resurrecting personal Health Savings there is little evidence at the point of Networks and Medicare Locals, include suggestions of change to ” Accounts. Others, including the health care delivery of its existence. many areas of clear responsibility for Medicare now that it is 30 years old. Shadow Health Minister Catherine funding and health service delivery He uses a comparison between the Health care is information rich, King and Greens health spokesman still need to be resolved. Richard Di Natale, point to the Kingswood and the cars of today and the benefits from the secure potential savings from investments as a way to mount his argument for sharing of information are clear, from Peter Dutton’s article is titled, in general practice and preventative change, as well as a focus on the increased patient safety to reduced “Change imperative to end archaic health. 10 per cent of patients who account duplication of investigations. This practices”.

MORE P6 5 VICE It is governments, not doctors, who PRESIDENT’S MESSAGE need to change archaic practices

... FROM P5

Here he must be referring to the ‘inefficiency’ relates to the role our public hospital sector because public hospitals play in the teaching general practice has changed and training of future generations of drastically over the last three health professions, not just medical, decades - as small to medium size but also nurses and allied health. businesses, there has been no other Public hospital culture comes from option. the top, and there is still too much Any archaic practices - such as old fashioned bureaucracy here. making a telephone call to confirm Endless forms and documentation in a prescription under the Authority a largely information technology poor system - are those forced upon environment are a familiar overhead general practice by the bureaucracy. for those working in our public But even the public hospital system hospitals. Forms needing up to six has made great improvements in signatures for an approval are still a efficiency over the three decades of reality. Medicare. Well done to the Consumer Health This is reflected by much shorter Forum for bringing a broad range of hospital lengths of stay, increased views on health reform together. It’s used of day case admissions, a shame the AMA was not included. implementation of hospital-in-the The AMA has a lot to contribute to home and rehabilitation-in-the- the debate. home systems and, more recently, Certainly, we would always wish reductions in the time patients spend to contribute to Government policy in our emergency departments. positively and proactively rather Almost every clinical process than having to respond to ill- has been subject to clinical conceived policies after their public service redesign, from waiting list announcement. management to the admission But we reserve the right to defend pathway for our unplanned both doctors and patients against admissions. poor public policy when quiet It is often forgotten that some of the advocacy is not enough. 6 COMMENT SECRETARY GENERAL’S REPORT Federal Budget a dramatic prelude to AMA National Conference

May is the time of year in the life cycle of the the Treasurer hands down a challenging Federal contribution made by members added to AMA when many different activities come to a Budget. Health Minister Peter Dutton has said the AMA Roll of Fellows. The AMA’s flagship peak. on many occasions that he wants to start “a research publication, the Medical Journal of Australia will provide an award recognising May brings the National Conference and new conversation about health”. The shape of that conversation will become clearer tonight, excellence in medical research. The recipient BY AMA SECRETARY the Annual General Meeting. With National of the AMA Indigenous People’s Medical GENERAL ANNE TRIMMER Conference comes the election of the President Budget night. Scholarship will also be announced. and Vice President, both of which are contested Both Mr Dutton and the Shadow Health this year with the end of Dr Steve Hambleton’s Minister Catherine King will address the The Annual General Meeting will take place on For those three years in office. National Conference, and this will provide an Friday 23 May, at which voting members of the AMA (not just delegates to National Conference) delegates“ coming Much will be said elsewhere of the enormous opportunity for delegates to hear more about will have an opportunity to vote on the new contribution made by Dr Hambleton but, the Government’s objectives. to Canberra Constitution for the AMA. This will bring to as someone reasonably new to the role for National The National Conference includes several policy conclusion a long campaign to modernise the of Secretary General, I express my great sessions that will inform debate within the governance of the AMA and lay the groundwork Conference, I admiration for the load that he carried during a medical profession on topics as diverse as the for a more efficient structure for the future, look forward to period when the AMA was without a Secretary global challenge of non-communicable disease; something I have written about previously in General, albeit with the support and input of welcoming you variation in medical practice; the challenge of Australian Medicine. Those members who the secretariat. For all that he has done, both in caring for those who serve in overseas conflicts; have not yet sent through a proxy form are to what will be a contributing to the running of the organisation and disaster relief. There will also be a session encouraged to do so. It can be found in the great event. May and in his wide-ranging engagement on health which deconstructs the Federal Budget as it member only section of the AMA website. in Canberra is policy issues, I add my acknowledgement, relates to health. thanks and best wishes. For those delegates coming to Canberra both colourful In addition to the policy sessions, National for National Conference, I look forward to The 2014 National Conference, to be held in and cold, so come Conference recognises and awards outstanding welcoming you to what will be a great event. Canberra, begins next Friday, 23 May. prepared contributions in several ways. There is a May in Canberra is both colourful and cold, so This week, Canberra is again centre stage as ceremony to acknowledge the outstanding come prepared!

” COMMENT

7 NEWS Health care on the frontline of painful budget cuts

The AMA has warned that plans to radically GP co-payment overhaul health funding arrangements such as imposing a GP co-payment and allowing The Government has all but confirmed it insurers to charge the less healthy with will introduce a patient co-payment. Both higher premiums would push health care out Mr Hockey and Health Minister Peter Dutton of the reach of families and undermine the have talked approvingly of the need to get principle of universal access. those with the capacity to make a greater contribution to the cost of their health care. AMA President Dr Steve Hambleton said changes recommended by the National The Commission has recommended patients Commission of Audit, including a $15 upfront be charged a $15 co-payment for their first 15 visits to a GP each year ($5 for charge for GP visits and an extra $5 for concession card holders), and $7.50 ($2.50 each prescription, would push more of the for concession card holders) for every visit responsibility and cost of health care on to after that. individuals and families, raising the risk that report by the Family Medicine Research The AMA President said there was particular many would defer or decline to seek the In addition, the co-payment for PBS Centre found an average of 5.3 visits per concern about how it would affect the treatment they needed, undermining health medicines should be raised by $5 to $41.90, and leading to a higher national medical bill and the general patient safety net should capita, while a crude calculation dividing the vulnerable, including Indigenous people, later on. be lifted by almost $200 to $1613.77, the annual number of GP consultations (129 the elderly, those on very low incomes and Commission said. Concession card holders million) by the population (23.4 million) people with mental illness. “It is clear that the Commission’s would be liable to a $2 co-payment once the yielded an average of 5.5. recommendations have been put forward by “Whatever the Government comes through safety net threshold of $360 was reached. business leaders and bureaucrats with no Dr Hambleton said the proposed changes with, we need to make sure that we do not input from people with health and medical Speaking in justification of the co-payment, would shift “more and more health costs on increase the barrier to primary health care for expertise,” Dr Hambleton said. “It is a health Commission of Audit Chair Tony Shepherd to patients, including the most vulnerable these four groups,” he said. “We have great system designed by bean counters for bean implied that many people were going to the – working families, the elderly, and the concerns that if the bar is raised, it could counters. It puts saving money ahead of doctor unnecessarily: “All Australians, on chronically ill.” actually cost us more, not less, in the long term.” saving lives.” average, go to the doctor now 11 times per “The new high co-payment proposal for GP year. I just don’t think we’re that crook”. While the Abbott Government has said visits would see sick people abandon or delay Dr Hambleton also voiced concern that it will not adopt all of the Commission’s But the AMA and other health experts have visits to the doctor, which would ultimately the co-payment would create even more recommendations, tonight’s Federal Budget taken issue with the claim, which they argue cost the health system more, as these red tape for GPs, constraining them from is expected to include a raft of its proposed is a gross exaggeration. The Royal Australian patients would eventually require much more spending more time with their patients and measures. College of General Practitioners said a recent expensive hospital treatment,” he said. undermining preventive care.

MORE P9 8 NEWS It has called for greater competition in pharmacy by scrapping the industry’s ownership and location rules, Health care on the frontline and has urged that the scope of practice for occupations such as nurses and pharmacists be extended – both of painful budget cuts recommendations which are highly controversial and likely to trigger a strong backlash. ... FROM P8 Dr Hambleton said the extension of nurse and pharmacist practice was a serious concern for the AMA, as were a Since the idea of GP co-payments was most recently revived “The community rating of health insurance products number of other proposed measures including: late last year, there has been mounting speculation that means unhealthy lifestyle choices made by some private health funds might offer policies to cover the extra force up premiums for all,” the Commission said. • a merger of Health Workforce Australia and GPET with cost, but the Commission explicitly called for such a move to “Consideration should be given to relaxing rules relating to the Department of Health and Ageing, which would be prohibited. ‘improper discrimination’ that prevent health funds from undermine the capacity to undertake essential medical charging different prices based on a person’s individual workforce planning to ensure the community has access The AMA and other health policy experts have also warned characteristics.” to the right number of doctors in the right places; of the risk that a GP co-payment might force more patients to seek treatment in public hospital emergency departments. But Dr Hambleton said community rating was an important • winding back changes to the medical indemnity insurance principle, and weakening it to allow insurers to charge bigger industry that were implemented by Prime Minister Tony To address this, the Commission suggested that the States premiums for people with lifestyle-related issues such as Abbott when he was Health Minister; and be “encouraged” to introduce a system of emergency obesity was a “slippery slope”. department co-payments for “less urgent conditions”. • scaling down and delaying the National Disability He said obesity could be due to a whole range of factors out Insurance Scheme. In addition, the Commission has recommended that GPs of a person’s control, including the nutrition of the mother who want to bulk bill patients be prevented from waiving the during pregnancy, low birth weight and other epigenetic Other recommendations include giving the Health Minister co-payment. factors, health and nutrition literacy, education and family the authority to add and remove medicines from the PBS In measures that would specifically hit higher income stability. schedule and allowing drugs approved by “certain overseas households, the Commission proposed that the better off be “It’s too simplistic to say that if we charge people more, all agencies” to be added to the PBS without obtaining separate blocked from Medicare subsidy for “basic” health services, of a sudden the problem will go away,” Dr Hambleton said. TGA approval. be precluded from access to the private health insurance “We support community rating. It’s the fairest way to deal Dr Hambleton urged the Government to reject the rebate, and that the General Extended Medicare Safety Net with these issues and there are other things we should do to Commission’s recommendations and instead talk with the threshold be raised to $4000. decrease the impact of obesity on health care costs.” medical profession about reforms that would make the best use of available health funds. Community rating Increased competition between “The only good thing about the Commission’s health In a radical break with the principle of not allowing health professions recommendations is that they will be easy for the insurers to cherry pick members, the Commission said Just as controversial, the Commission has recommended a Government to reject them – and the AMA will be urging the community rating should be relaxed to allow health funds to series of measures that would intensify competition within Government to do so,” the AMA President said. charge higher premiums for members who are smokers or and between health professions, as well as merging or axing have some other lifestyle-related health risk factors. a string of health agencies. Adrian Rollins

COMMENT 9 NEWS But growth in demand for private hospital services is outstripping that for the public system, particularly for Public hospitals stretched elective and non-acute care. Between 2008-09 and 2012-13, private hospital admissions for palliative care, rehabilitation, health by rising demand maintenance and other subacute and non-acute services grew by almost 14 per cent a year, compared with 8.2 per cent in the public system. demand from an ageing population. Over the same period, private admissions for non-surgical Analysis of the data by the AMA shows that the number and non-emergency care grew by 6.4 per cent, compared of public hospital beds available for every 1000 people in with 4.2 per cent in public hospitals, and same-day the crucial 65 years and older age group – where demand admissions in private facilities increased by 5 per cent a is greatest – has tumbled by almost 43 per cent past two year, compared with 3 per cent in the public system. decades, from more than 30 in 1992-93 to 17.8 in 2012- Furthermore, almost 1.4 million of the 2 million elective 13. surgery admissions in 2012-13 were in private hospitals. Total bed numbers fell by 234 last financial year and, Dr Hambleton said that, in contrast to public hospitals, the across the population as a whole, the number of beds per private system had increased its bed capacity since 2009- 1000 people slid down to 2.59. The ratio has not improved 10 to keep pace with the growth in demand. since 2009-10. The difference was highlighted by AIHW figures showing AMA President Dr Steve Hambleton said the results that total recurrent spending on public hospitals (in showed public hospitals were being starved of the constant price terms) grew by an average of 4.7 per cent resources needed to meet the growth in demand. a year between 2008-09 and 2012-13, compared with an “We have maintained roughly the same bed to population annual average of 12.2 per cent among private hospitals. numbers over recent years, while there has been The surge in private hospital care has caused some to increasing demand for hospital services,” Dr Hambleton warn that a two-tiered health system is developing in said. “This is why public hospital waiting times are long. which those that can afford it are able to circumvent Our public hospitals need greater support and funding, not lengthy queues for surgery in public hospitals by getting cuts.” Public hospitals are not keeping pace with the growth in treatment in the private system. The Institute’s figures show that the public system still demand for their services, underlining AMA concerns that Consumers Health Forum spokesman Mark Metherell told provides the bulk of hospital care – almost 60 per cent of they be spared from any cuts in tonight’s Federal Budget. the Sydney Morning Herald that the majority of people who the 9.4 million hospital admissions in 2012-13 were in the Australian Institute of Health and Welfare figures show did not have private health insurance were unable to avoid public sector, and more than two-thirds of the 28 million there has been a steady decline in public hospital capacity waiting for elective surgery. patient days reported by the nation’s hospitals were in the in recent years, particularly in the face of increasing public system. Adrian Rollins

COMMENT

10 NEWS In addition to the 12-month funding lifeline for Aboriginal Community Controlled Health Services, Mr Dutton also Indigenous health gets approved $98 million to fund five specific Indigenous health programs – Primary Health Care, Healthy for Life, Australian Nurse Family Partnership, New Directions: temporary lifeline Mothers and Babies, and Stronger Indigenous Health Services – being delivered by 90 organisations across the country. The Federal Government has been urged to extend its babies born in the 12 months to mid-2013 had had their 12-month funding lifeline for Indigenous-run health birth weight recorded by a primary health care provider. A spokesman for the Health Minister told The Australian services to give them financial certainty for at least an that “extending the funding to June 2015 provides the “Government investment in Aboriginal Community extra five years. continuity for these organisations to deliver important Controlled Health Services is money well spent,” Dr services to Indigenous people over the next 12 months”. AMA President Dr Steve Hambleton said confirmation Hambleton said. “There is clear evidence that it saves from Health Minister Peter Dutton that the nation’s 150 lives and improves quality of life for Aboriginal peoples. National Aboriginal Community Controlled Health Aboriginal Community Controlled Health Services will It closes the gap.” Organisation Chair Justin Mohamed said the extra receive $333 million in the Federal Budget to enable funding was recognition of the significant contribution them to keep operating until mid-2015 was welcome, but Indigenous-led health services were making in closing added longer-term financial security was required, urging the health gap. the Abbott Government to guarantee funding for at least Aboriginal Community But Mr Mohamed warned that, welcome though the funds the next five years. “ were, more was needed. “Aboriginal Community Controlled Health Services deliver Controlled Health Services “The Aboriginal population is growing, and demand for the highest quality, culturally appropriate health care to deliver the highest quality, our services is increasing at a rate of more than 6 per the Aboriginal population,” Dr Hambleton said. “These cent a year,” he said. “We need to have surety that we services make a huge difference to people suffering culturally appropriate health will have the resources to continue to improve the health serious health conditions.” of our people over the long term to meet this growth.” His comments were supported by the results of a report care to the Aboriginal Mr Mohamed said funding should grow in line with that found marked improvements in the performance inflation and should be guaranteed beyond the next of health services treating Aboriginal and Torres Strait population financial year. Islander people. ” “We are only now starting to see the results of programs Using data from more than 200 primary health care put in place five years ago,” he said. “As such, we organisations that mainly treat Aboriginal and Torres Strait Delivering the annual Commonwealth Closing the Gap need to move to a more secure funding model, moving Islander people, the Australian Institute of Health and report in February, Prime Minister Tony Abbott said the from the current three-year agreements to five-year Welfare found that there had been a jump of between 5 gap in rates of child mortality between the Indigenous agreements.” and 9 percentage points in key health services, including and non-Indigenous community had halved in the past detailed health assessments of adults, developing team decade, but admitted there had been almost no progress It was a call backed by Dr Hambleton, who urged the care arrangements for patients with type 2 diabetes and in narrowing the gap in life expectancy – currently around Government to move to a five-year funding agreement recording baby birth weights. 10 years – between Indigenous Australians and the rest “as soon as possible”. of the community. Nationally, the Institute found, 58 per cent of Indigenous Adrian Rollins COMMENT 11 INFORMATION FOR MEMBERS

NEWS Close 457 loophole for junior National doctor positions: AMA Medicines

Hospitals and health departments should temporary residents that studied medicine “It is untenable that substantial numbers of Symposium be forced to prove they attempted to fill in Australia and may seek permanent doctors continue to be recruited directly from junior doctor vacancies locally before being residency, it appears that many have been overseas into intern and RMO positions when 2014 allowed to hire practitioners from overseas, recruited directly from overseas,” the AMA a ready supply of local graduates appears to according to the AMA. said. “This is potentially limiting employment be available,” the Association said. The 2014 National Medicines Urging a shake-up of current 457 visa and training opportunities for domestic It said some State and Territory health Symposium will be held in medical graduates.” arrangements, the AMA said the recruitment departments and hospitals did not appear to Brisbane from 21-23 May of large numbers of doctors from overseas The pressure on medical training places be using the 457 visa as intended. and draws together an to fill junior doctor positions in hospitals was is intensifying. Last year, just 3125 intern “The 457 visa is intended to fill workforce no longer tenable given the pressure on international and national places were available to meet the needs gaps, not displace locally training and highly training places for local medical graduates. audience of clinicians, health of 3300 domestic and international full fee skilled junior doctors…particularly at a professionals, academics Even as swelling numbers of domestic paying medical graduates, and the number time when domestic medical graduates are and researchers, health medical graduates struggle to secure of such graduates is projected to reach struggling to get access to essential training internships and prevocational training 3824 by 2017. places,” the AMA submission said. consumers, policy makers places, official figures show many health and industry. This year the Health Workforce Australia predicts there will The Association said it valued the authorities and hospitals continue to recruit symposium will explore be a shortage of 450 first-year advanced contribution that international medical heavily from overseas, potentially displacing current and future medicines vocational training positions a year from graduates have made, and continue to locally trained junior doctors and preventing make, but added that it was incumbent challenges relating to them from undertaking the additional 2016, placing even more pressure on RMO on State and Territory health departments sustainability, translating training they need to complete their positions, forcing junior doctors to wait even and hospitals to help build a sustainable evidence into action and qualifications. longer to enter vocational training. domestic medical workforce. ethical decision making in In its submission to the Independent Under current immigration arrangements, “The number of domestic medical graduates health. Review of the 457 visa program, the AMA employers can sponsor medical practitioners is projected to grow even further and, in cited official figures showing around 2000 from overseas on 457 visas - including For more information about these circumstances, the current exemption doctors entered Australia on 457 visas last international graduates of Australian medical the symposium visit http:// [from labour market testing] cannot be financial year, and said it was aware that schools – without having to demonstrate justified,” the AMA said. www.nps.org.au/about-us/ 916 resident medical officer (RMO) positions that they have tried to recruit locally first. what-we-do/campaigns- were filled by 457 visa holders in the same The AMA said this exemption from labour The Review is due to report by the end of events/national-medicines- period. June this year. market testing was not justified, and should symposium

“While some of these RMOs will be be scrapped. Adrian Rollins COMMENT 12 GLOBALPRACTICE 2014 AMA National Conference Australian Perspective 23 - 25 May, National Convention Centre, Canberra

NEWS Budget, global health key items on National Conference agenda

The impact of the Federal Budget on health and the “It is a unique opportunity, in the week after the Budget, Mungherera; former Defence Minister and AMA global challenge of non-communicable diseases will be for AMA leaders from all around the country to provide President Dr Brendan Nelson; National Preventative major themes of the looming AMA National Conference. their input for our response to the Budget,” Dr Hambleton Health Taskforce Chair Professor Rob Moodie, and said. gastroenterologist Professor Anne Duggan. The National Conference, which is expected to draw hundreds of AMA members from across Australia to Conference debates on the Budget and health policy In addition to policy sessions, the National Conference will Canberra in the last weekend of May, is shaping as an will be informed by first-hand information from the be asked to make decisions crucial to the future direction important opportunity to gauge the medical profession’s Government, with Health Minister Peter Dutton (and his of the AMA. reaction to what promises to be one of the most Labour rival Catherine King) due to address the meeting On Friday 23 May, the AMA’s Annual General Meeting significant Budgets for health in many years. on Friday, 23 May. will be held, at which delegates will be asked to vote on Already the Federal Government has flagged it is likely There are also several policy sessions related to the a proposed overhaul of the Association’s constitution. to introduce a patient co-payment for GP services, and Conference’s overarching global health theme, including The key proposed change would see operational and its Commission of Audit has suggested a range of other the global challenge of non-communicable diseases; corporate compliance responsibilities devolved to a radical changes that would fundamentally alter the the challenges of practising medicine internationally; governance board, freeing the Federal Council to focus on structure of the health system, including relaxing the integrating global health training into postgraduate its prime policy formulation role. principle of community rating in private health insurance, medical education; the challenge of caring for defence On Sunday 25 May there will be a vote for the new AMA increasing the scope of practice of pharmacists, nurses force and emergency personnel who serve overseas; and President and Vice President, with current President Dr and allied health professionals, and lifting restrictions in variation in medical practice between Australia and other Steve Hambleton stepping down from the role. the pharmacy industry. countries. More information about the National Conference is AMA President Dr Steve Hambleton said the timing of the Delegates will hear speeches and presentations from a available at: https://ama.com.au/nationalconference Conference, coming just 10 days after the Budget was wide range of international and local experts including handed down, was extremely fortuitous. World Medical Association President Dr Margaret Adrian Rollins

COMMENT 13 INFORMATION FOR MEMBERS

NEWS Leeder honoured for life Free tool to track of achievement registration requirements The AMA has developed • Store all certificates of a free online tool to help completion; Among the speakers were former and policy during a long career doctors to keep track of the Federal Health Minster Dr Neal studded with achievements. • Keep a log of practice- information they need to Blewett, NSW Health Minister based reflective activities, Professor Leeder, who is professor meet the Medical Board of Jillian Skinner, World Heart including clinical audits, of public health and community Australia’s annual continuing Foundation President Professor K. peer reviews and medicine at the University of professional development Srinath Reddy, Emeritus Professor perfomance appraisals; Sydney, was instrumental in the (CPD) requirements. and John Hamilton, NSW Ministry of development of the Menzies Each September, practitioners, Health Director General Dr Mary Centre for Health Policy, set • Log hours spent on online when renewing their Medical Foley, Sydney Medical School up to inform health policy and learning, reading journals, Board registration, may be Dean Professor Bruce Robinson, knowledge by providing high- teaching and other Deeble Institute Director Dr quality analyses of health issues. required to provide evidence activities. The enormous contribution made Anne-marie Boxall and Dr Henry they have complied with the In addition, Professor Leeder is The system keeps a tally of by eminent public health expert Greenberg of the Mailman School Board’s CPD requirements. Editor-in-Chief of the Medical hours, enabling practitioners and Australian Medicine columnist of Public Health. Journal of Australia, is Chair The AMA CPD Tracker has to keep track of what needs to Professor Stephen Leeder was be completed before the end Reflected the breadth and depth of the Western Sydney Local been developed to enable recognised at a special event doctors to progressively of the registration year. hosted by the University of Sydney of Professor Leeder’s work, Health District Board, academic gather and organise the early this month. topics covered in the one-day coordinator of the University of The Tracker has been information needed to forum included health policy, Sydney’s Master of Health Policy developed taking full account Current and former health substantiate declarations the international epidemiology degree and is Director, Research of the requirements set ministers, senior health officials made to the Board about of chronic disease, medical Network, Western Sydney Local out in the Medical Board’s and leading health academics CPD, so that evidence can be education and public health Health District. Continuing Professional and experts were among a quickly and easily produced Development Registration education and training. Professor Leeder’s latest distinguished list of speakers on demand. Standard. who addressed a day-long forum Organisers said the event had Australian Medicine column, on The AMA CPD Tracker can be The service is free to AMA organised to honour Professor been held to celebrate the the health implications of the used to: members. Non-members can Leeder’s valuable contribution to enormous contribution made by Federal Budget, ‘Now, if pigs would fly?’ is on page 27. subscribe for an annual fee of public health policy over many Professor Leeder in public health • List courses completed, $250. decades. research, educational development Adrian Rollins including the organisation that accredited the CPD To register for the product, COMMENT activity; please sign up here. 14 INFORMATION FOR MEMBERS

NEWS Roderick McRae. Senior medicos contest Dr Kidd has been nominated by former AMA President and political aspirant Dr Informed Bill Glasson and AMA South Australia President Dr Patricia Montanaro, Financial Consent AMA Presidency while Dr Parnis was nominated by Dr Haikerwal and Dr Morton, and Dr It’s important to keep For the first time in five years there will Canberra. McRae was nominated by Dr Gary talking about fees be a ballot for the AMA Presidency after Speck and Dr Robert Conyers. The new President will serve for two Vice President Professor Geoffrey Dobb years if a proposed new Constitution for It is possible either Professor Dobb or and AMA New South Wales President It is important for doctors to inform the AMA is adopted by the AMA Annual Associate Professor Owler may also Associate Professor Brian Owler both General Meeting to be held on the first join the runoff, as National Conference their patients about the cost of the nominated for the position. day of the National Conference, Friday Standing Orders give unsuccessful care they will be providing, and for The vacancy has been created by the 23 May. President candidates the option to patients to ask doctors about the imminent departure of current President stand for election as Vice President. Under the overhauled structure, the Dr Steve Hambleton, who is stepping fees and costs associated with that operational and corporate compliance While the positions of President and down from the post he has occupied care. responsibilities will be devolved to a Vice President will be contested, two since 2011. governance board, freeing the Federal other Executive Officer posts, Chairman The AMA ‘Let’s Talk About Fees’ Both Professor Dobb, who is Head of Council to focus on its prime policy of Council and Treasurer, have been material provides straight forward Intensive Care at Royal Perth Hospital, formulation role. filled without contest. and Associate Professor Owler, who information about ‘8 questions AMA Secretary General Anne Trimmer is a Consultant Neurosurgeon at The Ms Trimmer, who is also the AMA said the change would allow the AMA patients should ask their doctor Children’s Hospital at Westmead, are Returning Officer, reported that to become a more effective and agile about costs before hospital members of the AMA Executive Council. Canberra-based ophthalmologist Dr organisation, raising the possibility the Iain Dunlop was the sole nominee treatment’. Professor Dobb has been nominated new-look Federal Council could appoint for Chairman of Council, a position by former AMA President Dr Mukesh small working groups and task forces he currently fills, while current AMA The ‘Let’s Talk About Fees’ Haikerwal and AMA Queensland to develop contributions to health policy Treasurer and anaesthetist Dr Elizabeth brochures, A5 tear off pads and President-elect Dr Shaun Rudd, while debates, drawing on the expertise of Feeney was confirmed in her role posters are available to members Associate Professor Owler has been AMA members as needed. uncontested. nominated by AMA Council of General free of charge. To place an order There will also be a ballot for the Practice Chair Dr Brian Morton and While both have been declared position of Vice President, which is call Kate Frost on (02) 6270 5428 former AMA Queensland President Dr elected, their renewed tenure could the subject of a three-way contest or send an email to feeslist@ama. Alex Markwell. be exceedingly short – both positions between Brisbane GP Dr Richard Kidd, would be made redundant under the com.au The election for the AMA Presidency will AMA Victoria President and Emergency proposed new Constitution. be held on Sunday, 25 May – the third Department specialist Dr Stephen The information is also available day of the AMA National Conference in Parnis and Victorian anaesthetist Dr Adrian Rollins on the AMA website at https://ama.

COMMENT com.au/ifc. 15 NEWS Print industry heavyweight to head AMPCo Board

Former print industry high flyer Richard Allely has position that may be abolished at the AMA Annual been appointed to Chair the Board of the AMA’s General Meeting on 23 May if proposed changes to medical publishing arm, Australasian Medical the Constitution are adopted. Publishing Company (AMPCo). They will be joined on the Board by columnist Rowan Mr Allely, a former senior Fairfax executive, was Dean, who has a background in advertising and credited with reviving the fortunes of print industry commercial film-making. heavyweight PMP Limited during a period of major The new appointments, approved by the AMA Federal disarray in the printing and distribution group. Council, were triggered by the retirement of three The transformation plan he oversaw as Chief existing Board members, Dr John Kessell, Dr Peter Executive Officer from early 2009 was seen as Ford and Dr Roderick McRae. instrumental in achieving big improvements in the company’s performance in subsequent years.. AMA Secretary General Anne Trimmer paid tribute to the many years of service provided by Dr Kessell, Dr He announced his resignation from PMP in Ford and Dr McRae: “Their support for, and interest in, September 2012, but his contract with the company AMPCo over this time is recognised and appreciated”. does not expire until 30 June this year. He will take up his position as AMPCo Chair on 1 July. Ms Trimmer said the Federal Council has decided to hold a fifth AMPCo Board position vacant until early Current Chair, AMA President Dr Steve Hambleton, next year, to allow the new Board to operate for a few is stepping down from the role, but will continue to months “in order to identify which, if any, additional serve on the AMPCo Board as an AMA representative, skills might be needed to complete the Board”. as will the other AMA representative Dr Elizabeth Feeney, who also serves as Treasurer of the AMA – a Adrian Rollins

COMMENT

16 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 rather than crowding doctors’ waiting rooms, Commission of Audit Chair Tony Shepherd said. AMA President Dr Steve Hambleton said it was important that people be encouraged Doctors fear cut will hit 100 jobs, health planning, Adelaide Advertiser, 26 April 2014 to see their doctor when ill.

Health Workforce Australia, the independent body that ensures there are enough doctors, Scare over anaesthetics, Sunday Mail, 4 May 2014 nurses, and other health care workers to meet the nation’s needs, could be axed in the upcoming Federal Budget. AMA Vice President Professor Geoffrey Dobb said the state of Doctors said a national recall of two batches of the most widely used anaesthesia drug the board and executive staff was concerning because it indicated the Government was probably would not affect scheduled surgery. AMA Vice President Professor Geoffrey Dobb intending to cut it. said the recall would not delay surgery because hospitals held sufficient supplies in reserve.

$6 bulk-billing fee hits poor, spares rich, Sun Herald, 27 April 2014 Overweight people could pay more for health cover, Sydney Morning Herald, 5 May 2014 A $6 fee for visits to bulk billing doctors would fall most heavily on Sydney’s poorest Overweight people could pay more for health insurance if the Abbott Government adopts residents, an analysis shows. AMA President Dr Steve Hambleton said that $6 was enough a National Commission of Audit proposal to allow health funds to charge some customers to convince people to defer treatment. higher premiums because of their lifestyle choices. AMA President Dr Steve Hambleton said there were better ways to help people improve health than charging them higher health Death of free care, Herald Sun, 2 May 2014 premiums. Medicare as we know it would end, with bulk billing scrapped and those earning more than $80,000 denied benefits under a health revolution proposed by the National Commission of Radio Audit. AMA President Dr Steve Hambleton slammed the recommendations and said it would put health, medical, and pharmaceutical care out of reach for Australian families. Dr Steve Hambleton, 4BC Brisbane, 21 April 2014 AMA President Dr Steve Hambleton discussed a program called SmartVax, which sends An end to universal health coverage, Australian Financial Review, 2 May 2014 clients a text following a vaccination, asking whether they have experienced any side The middle class would be required to cover their own health costs and Medicare would effects. Dr Hambleton said it will help with adverse event reporting. be left as a basic safety net under a National Commission of Audit plan. AMA President Dr Steve Hambleton said such payments would be a powerful disincentive, and could stop Dr Brian Morton, 3AW Melbourne, 21 April 2014 people going to the GP when needed. AMA Chair of General Practice Dr Brian Morton discussed a selective leak in the lead-up to the Federal Budget suggesting that doctors may be required to make final assessments for Visit a pharmacist, not your doctor: audit boss, Courier Mail, 3 May 2014 people to keep the disability support pension. Dr Morton said that arm’s length assessments People who need medical certificates should be heading to their local pharmacy or nurse would be better.

17 MORE P18 Dr Steve Hambleton, 6PR Perth, 5 May 2014 NEWS AMA President Dr Steve Hambleton talked about the AMA IN THE NEWS Commission of Audit proposal that insurers be allowed to vary prices based on lifestyle choices. Dr Hambleton said encouraging a healthy population would deliver the health ... FROM P17 savings the Government was looking for. Dr Steve Hambleton, SBS Ethnic Radio, 22 April 2014 Dr Steve Hambleton, Triple J Sydney, 29 April 2014 AMA President Dr Steve Hambleton discussed a major AMA President Dr Steve Hambleton talked about medicinal TV review of homoeopathy in Australia which could lead to cannabis. Dr Hambleton said scientifically speaking, stricter industry regulation and changes to private health cancer patient Dan Haslam’s testimonial as to its benefits Dr Steve Hambleton, SBS Sydney, 21 April 2014 insurance coverage of homoeopathic treatments. did not help determine the real efficacy of medical AMA President Dr Steve Hambleton discussed Australians marijuana. Professor Geoffrey Dobb, 2SM Sydney, 22 April 2014 going overseas for cosmetic surgery. The AMA is concerned a package offered by insurer NIB gave the AMA Vice President Professor Geoff Dobb talked about Dr Steve Hambleton, 666 ABC Canberra, 30 April 2014 illusion that offshore surgery was safer than it actually co-payments for GP visits. Professor Dobb said the AMA AMA President Dr Steve Hambleton discussed the latest was. is concerned people will be deterred from seeing their GP snapshot of Australia’s hospital system from the Australian and attend hospital emergency departments instead. Institute of Health and Welfare, which indicagted that Dr Steve Hambleton, Sky News Sydney, 2 May 2014 Dr Steve Hambleton, ABC NewsRadio, 23 April 2014 hospitals were an increasing cost to the economy. AMA President Dr Steve Hambleton commented on the Dr Hambleton said to have fewer patients, medical Commission of Audit report. Dr Hambleton said it is a AMA President Dr Steve Hambleton discussed the treatment techniques needed to be improved. major attempt to shift costs onto patients at every income of elderly patients. Dr Hambleton said the way the elderly level. were cared for in facilities needed to be reviewed in Dr Steve Hambleton, 4BC Brisbane, 1 May 2014 discussions involving doctors, patients, and families. AMA President Dr Steve Hambleton talked about the Professor Geoffrey Dobb, ABC1 Adelaide, 3 May 2014 Dr Steve Hambleton, 2SER FM, 23 April 2014 decision to stand down a Rockhampton surgeon found AMA Vice President Professor Geoffrey Dobb talked about to have removed the wrong kidney from a patient. Dr AMA President Dr Steve Hambleton discussed end-of-life two batches of the anaesthetic propofol that had been issues. Dr Hambleton said a lot could be done in intensive Hambleton said it was a serious offence and there was a quarantined. Professor Dobb said this was the first time a care to extend life, but the questions needed to be asked five-step procedure to follow in considering disciplinary problem had occurred with the drug. about the quality of life afterwards. actions required. Dr Steve Hambleton, Channel 9 Perth, 5 May 2014 Dr Steve Hambleton, 2GB Sydney, 1 May 2014 Dr Steve Hambleton, 2UE Sydney, 24 April 2014 AMA President Dr Steve Hambleton talked about high AMA President Dr Steve Hambleton talked about the AMA President Dr Steve Hambleton talked about possible health premiums for smokers and people who are problem of addiction to codeine. Dr Hambleton said GP co-payments and other impacts on the health system if overweight. Dr Hambleton said if insurers were allowed to codeine was an analgesic related to morphine and Commission of Audit recommendations would adopted in cherry pick healthy people, it will make insurance for less pethidine narcotics. the Federal Budget. healthy people unaffordable.

COMMENT 18 NEWS pneumonia infections. need to engage internationally to act on Post-antibiotic world Resistance to one of the most common multidrug resistance. treatments for urinary tract infections, “We simply do not have a new antibiotic fluoroquinolones, was also found to be up our sleeve to treat some of these almost upon us “very widespread”. conditions.” Furthermore, Australia’s relative The WHO said its report would be used geographic isolation did not confer to kick-start a global effort, led by it, of dying from infections and injuries that immunity from these disturbing trends, to address drug resistance, including would have been considered minor for according to the WHO. their parents or grandparents. the development of shared tools and The agency found that the Western standards, and better international “Without urgent, coordinated action by Pacific Region, of which Australia is a collaboration to track drug resistance, many stakeholders, the world is headed part, had high levels of E. coli resistance measure its impact, and design effective for a post-antibiotic era in which common to fluoroquinolones, and there was also solutions. infections and minor injuries which have widespread resistance by K. pneumonia to been treatable for decades can once third generation cephalosporins. In the Western Pacific Region, the WHO again kill,” WHO Assistant Director-General “In some parts of the Region, as many said it would reinvigorate region-wide for Health Security Dr Keiji Fukuda said. as 80 per cent of Staphylococcus aureus networks to track antibiotic resistance that The WHO survey of 114 countries infections are reported to be methicillin- had been established in the 1980s but discovered antibiotic resistance has resistant (MRSA), meaning that treatment had since withered. spread alarmingly and was now a feature with standard antibiotics does not work,” In addition, it has urged patients to use in most regions of the world. the WHO reported. antibiotics only when and as prescribed, The agency revealed that resistance to In addition, it named Australia as among a and has called on health professionals to The World Health Organisation has warned cabapenem antibiotics – considered the handful of countries including Japan, the be diligent in applying infection control that humanity is headed for a post- treatment of last resort for infections UK, France and Canada, where the last measures, and only to prescribe and antibiotic era in which even minor injuries caused by the common intestinal resort treatment for gonorrhoea - third dispense antibiotics when they are truly generation cephalosporins – had failed. and infections could be deadly unless bacteria Klebsiella pneumonia – is now needed. nations, groups and individuals begin found in every region of the world. This Earlier this year, AMA President Dr Steve Dr Fukuda warned that “unless we take immediately to work together to track is particularly concerning because K. Hambleton warned of the threat posed significant actions to improve efforts to medicine use and resistance. pneumonia is a major cause of hospital- by drug-resistant bacteria, including acquired infections including pneumonia those carried by travellers infected while prevent infections and also change how In its first global assessment of antibiotic and sepsis. overseas. we produce, prescribe and use antibiotics, resistance, the WHO has found that in the world will lose more and more of large parts of the world commonly used In some countries, the WHO found, “No longer do our borders protect us from these global public health goods, and the antibiotics have been rendered virtually resistance has meant that carpabenem multi-resistant organisms,” Dr Hambleton implications will be devastating”. useless, meaning that for the first time antibiotics were not effective in more said. “These are a major threat to our in generations many people face the risk than half the patients being treated for K. health system, so it does mean that we Adrian Rollins COMMENT 19 five years is even more effective NEWS than, and just as safe as, screening No longer just boy or girl Cervical test to go viral with a Pap test every two years,” the Department said. “MSAC also The Australian Capital Territory has become the first jurisdiction The dreaded biennial Pap smear was uneven, with those who were determined that a HPV test every five in the country to allow people to be registered on their birth could be dumped and replaced with a wealthier or living in cities significantly years can save more lives and women certificates as neither male nor female. more effective five-year cancer screen more likely to have a regular Pap will need fewer tests than in the test if the Federal Government adopts smear than those less well off or living current two yearly Pap test program.” In an amendment that come into force late last month, a new the recommendations of an expert in remote areas. category of Intersex/Indeterminate/Unspecified will be included While millions of women and girls advisory panel. But, even though only six out of 10 in all ACT birth certificates, and can be nominated by people have been and are being vaccinated who are intersex or who identify as having an indeterminate or In a move that could increase the women in the target group participate, against HPV, the Health Department the figures suggest the screening unspecified gender. extent of cervical cancer screening advised they would still require and save more lives, the Medical program has saved many lives. cervical screening because the Executive Director of the ACT Government’s Office or Regulatory Services Advisory Committee (MSAC) The Institute found that, in the 10 vaccine did not protect against all Services, Brett Phillips, said the amendment also dropped the has proposed that the current two- requirement that those who wanted to change the sex on their years following the introduction of forms of the HPV that cause cervical year Pap smear test be replaced with birth certificate had to have undergone sexual reassignment the screening program in 1991, the cancer. a similar procedure that only has to incidence and fatality rate of cervical surgery. be carried out every five years. cancer halved, and have since held Not only will the HPV be less frequent, Instead, he said, “a person born in the ACT who wishes to steady at around nine new cases per women can also commence it later But relief for women could still be change their sex must provide evidence that they are either an 100,000 women diagnosed each some time off, with the Federal in life. intersex person, or that they have received appropriate clinical year, and two deaths per 100,000. Government warning the change was Current advice is that women undergo treatment for alteration of the person’s sex”. unlikely to be implemented before “In 2012, for every 1000 women regular Pap smears between 20 2016. In addition, the amendment has extended to time allowed for screened, eight had a high grade and 69 years of age, but MSAC abnormality detected, providing an parents to register a birth, from 60 days to six months, to “reduce The proposal has come amid recommends that the HPV test opportunity for treatment before pressure on parents of babies who are not clearly male or female, evidence that less than 60 per cent not commence until a woman turn by allowing additional time to make complex decisions about the of women targeted under the National possible progression to cancer,” the Institute said. 25 years, with a final test to be registered sex of their child”, Mr Phillips said. Cervical Cancer Screening Program conducted between 70 and 74 years. have Pap smear tests. According to evidence presented to The changes coincided with a landmark High Court ruling that The Federal Government said the quashed an attempt by the NSW Registry of Births Deaths and The Cervical screening in Australia MSAC, the new five-year test will be MSAC reommendation “will now Marriages to register an androgynous person called Norrie as 2011-12 report from the Australian even more effective. be considered after extensive either a male or female. Institute of Health and Welfare found While the procedure is the same as consultation with State and Territory that around 58 per cent of women that used to collect a Pap smear, the In an earlier hearing, NSW Court of Appeal ruled in support of aged 20 to 69 years participated sample of cells collected will be tested health authorities, medical and Norrie’s application, declaring that “as a matter of construction ... in the screening program between for the human papillomavirus (HPV), pathology experts and community the word sex does not bear a binary meaning of ‘male’ or ‘female’.” 2009 and 2012, equivalent to more “which we now know to be the first stakeholders,” adding that “it is The High Court ordered that Norrie’s applications be sent back than 3.7 million people in a two-year step in developing cervical cancer,” anticipated that changes will not be to the Registrar for determination in accordance with its reasons, period. the Federal Health Department said. implemented prior to 2016”. and dismissed the Registrar’s appeal. The Institute found participation “MSAC found that a HPV test every Adrian Rollins Adrian Rollins 20 COMMENT COMMENT on what works best to save the most lives, and that is NEWS DNA test no substitute for faecal FOBT,” Professor St John said. Australian biotechnology company Clinical Genomics co-developed the test with CSIRO, and the new test has bowel cancer screening been clinically validated in collaboration with the Flinders Centre for Innovation in Cancer at Flinders University.

The Cancer Council has urged people to continue using But he warned that the test should not be seen as a faecal occult blood test to screen for bowel cancer, replacement for the faecal test. warning that a recently-developed blood test is only a “If this test becomes available in the future I think the third as effective in detecting the disease. message would need to be that the faecal test is the We would welcome Cancer Council Australia Chief Executive Officer best place to start for people who are due for screening. “the addition of a blood- Professor Ian Olver said the faecal occult blood test Then the plasma test would be for those people who (FOBT) remained the “gold standard” for bowel cancer can’t or won’t screen with a faecal test,” he said. based test if it assists with screening despite the development of a DNA test by a Professor Olver said there had been mixed messages team of Flinders University researchers. about the blood test, which he said was only a third as surveillance, but the focus The new test involves the detection of two genes that sensitive for advanced adenomas and stage one cancer has to be on what works as the FOBT test. ‘leak’ into the blood when bowel cancer is present. best to save the most lives, Using blood samples from more than 2000 hospital “New biomarkers for major disease usually attract media patients in Australia and the Netherlands who were coverage, but it is important to remain focused on the and that is FOBT evidence,” he said. “As the developers of the DNA test scheduled for colonoscopy or for bowel surgery, the have noted, it could have a role as an adjunct to FOBT.” researchers found the test could detect bowel cancer in ” 65 per cent of cases, and the detection rate rose to 73 Professor Olver said the “outstanding” results achieved Clinical Genomics Chief Executive Officer Dr Larry per cent for cancers that were at stage two or higher. by the FOBT screening program confirmed it as the best population screening test: “We cannot risk having this LaPointe said the evaluation results “give reason to be Presenting the findings at the Digestive Diseases Week message confused”. optimistic about the prospect of improving screening conference in Chicago earlier this month, Professor rates by providing another option for people who can’t or Graeme Young, of the Flinders Centre for Innovation in The Cancer Council has urged GPs to continue to won’t screen for bowel cancer using home-based tests”. Cancer at Flinders University, said the test could be used encourage asymptomatic patients 50 years and older to Dr LaPointe said the test could become available in in future as an adjunct to the current FOBT screening screen for bowel cancer with a FOBT test. Australia on a “user pays” basis as soon as early spring. program. Gastroenterologist Professor James St John said the “These results show the test has the potential to “A blood test is likely to overcome some of the barriers national FOBT program, when fully implemented, had the underpin a cost-effective blood test that identifies those to screening with faecal tests,” Professor Young said. potential to prevent 70,000 bowel cancer deaths in the with a curable bowel cancer. This has the potential to “It might prove to be acceptable to those failing to next 40 years, and the main focus needed to remain on rolling out the full biennial FOBT screening program. save many lives by complementing existing screening participate in screening using established methods, programs,” added Dr LaPointe. which at the moment are primarily based around faecal “We would welcome the addition of a blood-based test tests.” if it assists with surveillance, but the focus has to be Adrian Rollins COMMENT

21 an algorithm to rate the cost effectiveness But, while the manufacturers of Yervoy NEWS of expensive medicines, and will urge have agreed to participate in a Managed Prove you are worth it, physicians to use the system to discuss Entry Scheme for their drug, the makers of the costs with their patients. Kalydeco, Vertex, have strongly objected to the PBAC recommendation. Global spending on cancer drugs alone drug companies told jumped by almost 30 percent to $US91 In a statement issued late last billion between 2008 and 2013, according month, Vertex said it was “extremely as little as $6 a prescription to use the to a report by the IMS Institute for disappointed” with the conditions the extremely costly drugs. Healthcare Informatics, and a review of PBAC had imposed. drug prices by news service Bloomberg “These conditions fail to reflect the In return, the sponsors of the medicine found that in the US the cost of dozens substantial clinical benefits recognised would commit to reimbursing part or all of medicines for ailments ranging from by the PBAC, and would result in limiting of the cost of their drugs if they did not cancer to multiple sclerosis, diabetes and the number of eligible Australians who achieve the promised improvements in high cholesterol had doubled or more in would be able to receive Kalydeco,” the patient health. price since late 2007. company said. “We believe that physicians PBAC Chair Dr Suzanne Hill told News But manufacturers argue such price are in the best position to make treatment Corporation newspapers the Managed increases are justified by the high cost decisions, based on what is most relevant Entry Scheme had been in place since of developing new treatments. Forbes to individual cystic fibrosis patients.” 2010 and was already being used to trial magazine reported that the average cost Vertex said it was particularly unhappy the melanoma treatment Yervoy, which of developing a single drug was $US350 with PBAC conditions that it said would costs more than $120,000 for a typical million, and could be far higher for big exclude the sickest patients from receiving four dose treatment. companies that are simultaneously Kalydeco, and with discontinuation “There has been an agreement in place developing several products, only a criteria which it believes would result in with Medicines Australia since 2010 fraction of which will ever reach the The nation’s chief medicines advisor has patients being taken off treatment despite where the [Health] Minister will agree market. approved the publicly-subsidised supply benefiting from the drug. of two extremely expensive drugs, on to list medicines under Managed Entry Explaining the decision to recommend the “Unlike any other country, Australia is condition that they prove to be as effective Schemes where the pharmaceutical listing of Soloiris, PBAC said that “despite seeking to impose strict eligibility and as claimed. companies collect data that shows they the extremely high price requested, discontinuation criteria to limit the number perform in the real world the same way the medicine could be cost-effective The Pharmaceutical Benefits Advisory they perform in the clinical trials,” Dr Hill of patients who could benefit, or are if the sponsor agreed to participate in Committee (PBAC) has recommended said. “If the patients don’t improve, you showing benefit, from this medicine,” that the $300,000 a year cystic fibrosis a Managed Entry Scheme that would don’t get the subsidy.” Vertex said, signalling it was unwilling to require the pharmaceutical company medicine Kalydeco, and the $500,000 enter into the proposed Managed Entry There is mounting international concern to rebate part or all of the price of the a year treatment for atypical haemolytic Scheme arrangement. uremic syndrome (aHUS), Soliris, be listed about very high prices being charged for drug, depending on how well the patient on the PBS through the Managed Entry some medicines. responds to treatment”. “We hope the Government will reject the Scheme, which provides provisional listing unreasonable conditions recommended by In the United States there is a mounting In its submission to the PBAC, the subject to proven performance. the PBAC and list Kalydeco so all eligible backlash against spiralling prices for new company estimated that supplying the Australians can benefit,” it said. If agreed to by the drug companies, the and existing medicines, and the American drug in the first five years would cost the arrangement would see patients pay Society of Clinical Oncology is working on PBS up to $200 million. Adrian Rollins COMMENT 22 compared with 7 per cent coming in as NEWS air cargo and less than 5 per cent being Flood of drugs fuelling carried in by plane passengers or air crew. The AMA has for several years raised concerns that people, particularly young pursuit of body beautiful men, are putting their health at risk by taking steroids and other PIEDs in trying to achieve an idealised body shape. Steroids, peptides and other performance people conducted last year. and image-enhancing drugs are being AMA President Dr Steve Hambleton said The Survey found 74 per cent of those detected at the border in record amounts, the evidence showed a disturbing trend who started injecting illicit substances in underlining fears that many young people among young people to pursue some the previous three years had sought out are putting their health at risk in the idealised image of physical perfection. steroids and other performance and image pursuit of idealised body types. enhancing compounds, up from just 27 AMA Vice President and Chair of the Indicating massive growth in the trade, per cent a decade earlier. Public Health and Child & Youth Health more than 10,350 shipments of anabolic Committee, Professor Geoffrey Dobb, said By comparison, the proportion of androgenic steroids, beta-2-agonists, using PIEDs could have serious health new users reporting a preference for peptides and other hormones were consequences, and there were particular or failure, liver damage, cardio vascular methamphetamines plunged from around intercepted by customs and border agents concerns about the composition and problems, and the commonly reported 50 per cent in 2006 to just 11 per cent last financial year – a 19 per cent jump safety of hormones and supplements testicular atrophy, reduced fertility, last year. from a year earlier and a huge increase bought online or obtained illicitly. gynaecomastia and an increased risk from around 1000 interceptions a decade The increased popularity of performance of prostate cancer. For adolescent male “Hormones may be requested from earlier, according to an Australian Crime and image enhancing drugs is being users, additional effects may include medical practitioners but should, of Commission report. fuelled, in part, by its ready availability. stunted growth and accelerated puberty. course, only be prescribed when clinically As investigations continue into the use of The Crime Commission said the indicated,” Professor Dobb said. “Much In its Position Statement Body Image supplements at Australian Rules and rugby uncontrolled production and trafficking more often, hormones and supplements and Health, updated in 2009, the AMA league football clubs, information in the of such substances in some parts of the are obtained at gyms or over the internet. called for action to address the issue of Illicit Drug Data Report 2012-13 suggests world meant there was a virtually unlimited Anything from these sources is dubious unhealthy body image, including a code the market for performance and image supply available online. in terms of both content and safety. For for the media industry around the portrayal enhancing drugs (PIEDs) is growing fast example, Dinitrophenol, which is promoted of body images and role models and the “Due to the varying legal status of PIEDs and goes far beyond professional athletes. as a fat loss supplement, has caused establishment of a national network of internationally, producers can manufacture severe illness and death.” researchers, educators, policymakers and There was a 36 per cent jump in the and stockpile PIEDs in countries where industry representatives to coordinate number of steroids seizures in 2012-13 they are unregulated, and utilise online Problems associated with the use of practices addressing the incidence of to 331, and arrests of both suppliers and websites to reach the global market,” it steroids, peptides and other PIEDs unhealthy body image. users surged 30 per cent to 661 people. said. include extreme mood swings can occur, possibly resulting in paranoid jealousy, Professor Dobb said his Committee was The growing popularity of steroids, This is borne out by data showing that the extreme irritability, delusions and impaired likely to review the Position Statement to peptides, clenbuterol and other vast majority (88 per cent) of performance judgement, Professor Dobb said. expand reference to issues of male body performance and image enhancing drugs and image enhancing drugs detected image. was highlighted by an Australian Needle coming into the country were being The physical consequences of steroid and Syringe Program Survey of 2400 imported through the postal system, abuse for men include kidney impairment Adrian Rollins COMMENT 23 INFORMATION FOR MEMBERS

NEWS Type 1 diabetes rate high, Essential GP tools at the but not getting worse click of a button The AMA Council of General • checklists and Practice has developed a questionnaires in PDF Australia has so far proved immune to the their 20s. resource that brings together format, available for international trend toward rising rates of type 1 By comparison, less than 9 per cent were diagnosed in one place all the forms, printing; diabetes. in their 30s, and little more than 4 per cent were 40 guidelines, practice tools, • commonly used forms in While the prevalence of type 1 diabetes in Australia years or older. information and resources printable PDF format; is well above the developed country average, the used by general practitioners The peak age group for diagnosis was the 10 to 14 • clinical and administrative national incidence of the lifelong condition has in their daily work. years age group, where the rate of incidence reached guidelines; and remained broadly stable since the turn of the century, 32 per 100,000 – a rate five times greater than The GP Desktop Practice • information and other unlike the experience in many other countries. that experienced among those in their early 40s, Ms Support Toolkit, which is free resources. Type 1 diabetes data collated and analysed by the Senes said. to members, has links to around 300 commonly used In addition, there is a Australian Institute of Health and Welfare show that While the rates of diagnosis have remained relatively administrative and diagnostic State/Territory tab, with 2367 people were diagnosed with the disorder in stable, they are still high by international standards. 2011 – half of them aged 18 years or younger. tools, saving GPs time spent information and forms According to the AIHW, the average annual incidence fishing around trying to locate specific to each jurisdiction, The rate of incidence in 2011 was 11.1 cases per of type 1 diabetes diagnosis among children aged them. such as WorkCover and S8 100,000, just a little above the annual average of 14 years or younger between 2000 and 2011 was prescribing. The Toolkit can be 10.9 recorded between 2000 and 2011. 23 new cases per 100,000 children, compared with downloaded from the AMA The information and links in the OECD average of 17 per 100,000 – though the Institute spokeswoman Susana Senes said type website (http://ama.com.au/ the Toolkit will be regularly Australian rate was comparable to that in the United 1 diabetes developed when the immune system node/7733) to a GP’s desktop updated, and its scope will be States and Canada. destroyed insulin-producing cells in the pancreas. computer as a separate file, expanded as new information Researchers believe this is the result of an interaction The Institute’s analysis showed type 1 diabetes, and is not linked to vendor- and resources become between genetic and environmental factors, though it like its type 2 cousin, is more common in men that specific practice management available. is still not known exactly what causes this to happen. women (incidence of 13 per 100,000 in males software. Members are invited compared with 8 per 100,000 in females). to suggest additional The AIHW figures highlight the extent to which the The Toolkit is divided into five information, tools and affliction, which requires regular doses of insulin to But it is less common among Indigenous Australian categories, presented as easy resources to be added to manage, appears in the early years of life. than the general population, and the incidence is to use tabs, including: the Toolkit. Please send greater in cities and large towns than in remote Between 2000 and 2011, 22 per cent of all type 1 • online practice tools that suggestions, including any areas. diabetes diagnoses were in people aged 19 years or can be accessed and/or links, to generalpractice@

younger, and a further 12 per cent were in people in Adrian Rollins COMMENT completed online; ama.com.au 24 INFORMATION FOR MEMBERS

NEWS Australian Medical Association Limited ACN 008 426 793 ABN 37 008 426 793 Common anaesthetic in Notice of Annual General Meeting contamination scare Notice is hereby given that exhibited to Members the Fifty-Third Annual General at https://ama.com.au/ Meeting of members of Australian constitution Medical Association Limited will Propofol Sandoz, because of suspicions that 6. To transact any other business be held at 4.10pm on Friday batches of the drug have become contaminated which may properly be 23 May 2014 at the National with the Gram-negative bacteria Ralstonia Convention Centre, Canberra, transacted by an Annual pickettii. Australian Capital Territory. General Meeting. A member eligible to vote at the Concerns were aroused last month when three Business: Annual General Meeting may patients at two South Australian hospitals 1. To receive the Minutes of the appoint a proxy in accordance with developed sepsis after receiving propofol. Fifty-Second Annual General Clause 22 of the AMA Articles of Meeting held in Sydney on Association. A proxy need not be The extent of the possible contamination has Friday 24 May 2013. a member of Australian Medical been narrowed to two batches of the Provive 2. To receive and consider the Association Limited (section MCT-LCT 1 per cent emulsion for injection in 20 Annual Report of Australian 249L Corporations Act). To be millilitre vials: A030906 and A030907. Medical Association Limited effective the proxy form must be deposited at the below place not Drug company AFT Pharmaceuticals has for the year ended 31 December 2013. less than 48 hours before the time quarantined both batches, and tests are being for holding the Annual General conducted by the TGA to confirm whether or not 3. To receive the audited Meeting. Financial Reports for contamination has occurred. Australian Medical Association Proxies are to be deposited with The TGA said propofol was only used in hospitals Limited and its controlled Australian Medical Association Limited by mail or hand delivery and “certain health facilities”, and advised that entities for the year ended 31 December 2013. to: it should only be used if no alternatives were available and “the benefits outweigh the risks to 4. To appoint auditors for Secretary General (Company Australian Medical Association Secretary) the patient”. Health authorities have warned doctors Limited and its controlled Australian Medical Association and hospitals to suspend use of a common The health scare has raised concerns that entities. Limited anaesthetic following concerns it may have AMA House planned operations may need to be postponed. 5. To consider, and if thought fit 42 Macquarie Street become contaminated, causing blood poisoning adopt as a special resolution, Barton ACT 2600 in at least three patients in South Australia. But AMA Vice President Professor Geoffrey Dobb the following motion: said the incident was unlikely to delay treatment A proxy form can be accessed at The Therapeutic Goods Administration That the Memorandum and because there were sufficient alternatives and https://ama.com.au/proxy. has advised health professionals to avoid Articles of Association of back-up supplies on hand. administering the widely-used intravenous the Company be repealed Ms Anne Trimmer anaesthetic propofol, marketed as Provive and Adrian Rollins and replaced by the new Secretary General Constitution in the form 21 March 2014 COMMENT 25 NEWS MAY HEALTH EVENTS The dates and events listed are major awareness days, conferences, weeks and months related to health. If you know of an upcoming national health event please email the details to [email protected]

Sun Mon Tue Wed Thur Fri Sat 26 27 28 29 1 2 3 World Asthma Day; National Heart Week; NSW PKU Awareness Day; National Jelly Baby Month; National Crohns & Colitis Awareness Month; National Tracky Dack Day

4 5 6 7 8 9 10 National Motor Neurone International Midwives World Ovarian Cancer World Lupus Day Disease Week Day Day

11 12 13 14 15 16 17 International Nurses Day; National Schizophrenia World NF Awareness International ME/CFS Awareness Week Day; Day; World Hypotension Day National Food Allergy Week 18 19 20 21 22 23 24 National Walk Safely to World Autoimmune National Myeloma Day; National Macular School Day Arthritis Day National Medicines Degeneration Awareness Symposium 2014 Week; National Palliative Care Week; Australia’s biggest morning tea

25 26 27 28 29 30 31 National Kidney Health National Multiple National Kidney Health World MS Day NSW Gold Week World No-Tobacco Day Week Sclerosis Awareness Week Week

26 sector, to determine a way forward in achieving efficiency targets that we will agree upon. We will PUBLIC HEALTH OPINION be consulting with the specialist medical colleges Now, if pigs would fly to discuss ways in which useless treatment can be removed from the register of services paid for by Medicare. We will be discussing monopolies When you glance at this column this morning you that our health service is to be paid for by all, with specialty services. We will be examining may be looking for something to take your mind and be available to all, whenever and wherever pharmaceutical pricing. off the budget to be brought down this evening they need it. “Madam Speaker there are two health service - a distracting word-picture about the crocuses “So I say to you, Madam Speaker, and to the whose delayed but recent arrival in New England community, there will be nothing in this Budget arrangements that I believe we need to consider this year signals the end of an especially deep that will decrease access to necessary care for critically, and they are the Australian National and long winter. those not able to afford private care by choice. Preventive Health Agency and Medicare Locals. Well, sorry, for as Nanki-poo said in The Mikado, There will be no additional co-payments for “The disease challenges we face as a nation BY PROFESSOR STEPHEN LEEDER “The flowers that bloom in the spring, / Tra la, items on the Medical Benefits Scheme, including make a strong claim for the enhancement of AND SHAUNA DOWNS visits to general practitioners. There will be no / Have nothing to do with the case.” The best I both these organisational entities. We need disruption to bulk billing. can do is to offer you my budget. Here it is. strong leadership to take us out of the epidemics “Madam Speaker, in presenting the Budget this “We accept that the steady rise in health care of obesity, diabetes and heart disease, and Madam year, I wish to begin by affirming the commitment costs needs to be addressed, and we will be prevention must provide that leadership. We need “Speaker, of this Government to the support and growth of proposing major reviews of the efficiency of to see evidence of a strong strategic intention in there are two two of our central national services, health and our services. We will not be moving to establish the next year from the Agency. education. Medicare only as a safety net. We will do nothing health service further to make superior quality care available “Medicare Locals are aggregates of general arrangements “Contrary to the accusations of our armchair only to those who can afford it privately. And, practitioners and other community health that I believe critics, this Government is determined to because we will retain the concept of universal workers that, in theory, could provide a critical conserve the values that have made this country contribution to health care, we will also maintain element in the long-term care of people with we need to great, and to manifest that commitment in the universal access to it - of all Australians - and chronic illnesses who, by default at present, too consider way we fund health and education. not deny wealthier Australians access to it, often end up in hospital. The name itself does critically, and “Recent rumours have unsettled the community, especially if they need it for catastrophic illness not help these entities to function, and they will or major surgery. they are the and tonight I want to reassure you and them that be rebranded and their mission clarified over the next 12 months. Australian we understand how important both health and “However, Madam Speaker, we accept that our education are for the expression of our deepest overall Budget situation needs action in relation “Madam Speaker, these are my preliminary National national values - values including humane to the rate of increase in health spending. I have comments about health and I shall speak later concern for the less well off, of giving people at mentioned already our search for efficiency, and Preventive about details. And now I turn to education...” Health Agency the margins of our community a hand up, and so we will be asking the states and territories ensuring everyone - everyone - in our community to join with us, and our partners in the private Feeling better? Good! Stand tall and face the day. and Medicare Locals COMMENT

27 ” past, highlighting that any changes should focus GENERAL on funding high quality longitudinal general PRACTICE What’s ahead for practice care, cutting red tape and supporting streamlined access to GP referred services. The AMA has also highlighted that private Chronic Disease health insurers (PHI) need to work more closely with general practice to improve care for PHI members with complex and chronic diseases, Management? including through the provision of funding for GPs.

Given the ageing population and the increasing enrolment and represents an up-front investment incidence of chronic disease, Health Minister in primary care, leading to better patient BY DR BRIAN MORTON Peter Dutton has sent some strong signals that outcomes and lower downstream hospital costs. there may be a funding announcement in the There is no doubt that existing chronic disease We do not know what Federal Budget on this topic. management items could be improved. Data “is in the Budget, but if the The AMA has been calling for additional support on CDM item claims show us that the current for patients with chronic disease, targeting those structure sees almost every GP Management Government is looking to with higher levels of clinical need. Plan result in a Team Care Arrangement, and that improve health outcomes for The AMA has been in regular discussions with very few reviews are undertaken. patients with chronic disease, the Government and the Department of Health There could be a number of reasons for the low over several years, with the Department floating number of reviews. Perhaps the patient has reforms will need to focus on a range of options including restructuring the passed on or moved away. Perhaps, rather than Chronic Disease Management (CDM) MBS contending with the red tape requirements of better supporting GPs in caring items, the concept of the medical home, patient billing the review item, GPs are doing the reviews for patients enrolment, capitated payments and so on. In and just claiming a consultation. Perhaps the addition, the Diabetes Care Project has been current structure places undue emphasis on the ” running now for a couple of years, and is due to front end of the chronic disease management conclude on 30 June this year. process rather than across the care continuum. We do not know what is in the Budget, but if On Budget night, I would hope to see a move to With quality chronic disease management more the Government is looking to improve health a model of care such as the DVA’s Coordinated about longitudinal and ongoing monitoring, outcomes for patients with chronic disease, Veterans’ Care Program, which provides for review, management and care, this data reforms will need to focus on better supporting GP-led comprehensive and coordinated care indicates that something needs to be done to GPs in caring for patients. for patients with complex and chronic disease ensure that patient progress against the plan is who are at significant risk of hospitalisation. It I will certainly be looking to see whether the reviewed. retains fee-for-service, but provides extra funding Government has been listening to the AMA, and for proactive management of these patients. The AMA has been prepared to discuss the judging any reform proposals in the context of It avoids the risks of capitation and patient restructure of items with the Government in the the type of ideas outlined above.

28 COMMENT and no longer require Authority approval over the THERAPEUTICS It’s a fact: DHS just keeps us phone. The Department believes that keeping up-to-date with PBS medicines that require phone authority hanging on the telephone will cut down the number of unnecessary calls and help free up operators. If getting through on the PBS Authority The good news is that DHS has introduced a new prescription service seems to be taking even telephone scheduling tool to help it anticipate longer than ever, the AMA can confirm this is not peak call periods. As a result, it reports that a figment of your imagination. in March and April, 73 per cent of calls were AMA President Dr Steve answered within 30 seconds. After months of badgering, the Department of “Hambleton wrote to all AMA BY PROFESSOR AMA President Dr Steve Hambleton wrote to all Human Services (DHS), which is responsible for members on 10 April to report GEOFFREY DOBB operating the phone line, finally provided us with AMA members on 10 April to report on ongoing updated statistics regarding call waiting times, so action by the AMA to eliminate the red tape on ongoing action by the that we could compare performance over time. caused by the PBS Authority system, and the AMA to eliminate the red tape Association had a productive meeting with DHS We can confirm what many doctors have officials last month. caused by the PBS Authority suspected, that call waiting times did get a lot worse between October 2013 and February The Department is now reviewing the questions system, and the Association 2014. phone line clerks are required to ask, to ensure had a productive meeting with each one is actually necessary. During this period, just 50 per cent of calls were DHS officials last month answered within 30 seconds, compared with 67 It will review five authority medicines ‘questions sets’ each month in consultation with its per cent during the same time a year ago. ” medical and pharmaceutical advisors, with Not only that. The DHA figures show that 16 per the aim of cutting down the time required for If you see ‘Authority Required (Streamlined)’ cent of callers were forced to wait more than two each phone call. For example, in April DHS marked against a medicine in the PBS, click on it minutes to talk with someone, up from 12 per reviewed and updated questions sets for multiple to find the four digit code for the relevant clinical cent a year earlier. sclerosis medications, as well as for terbinafine, indication and include it on your prescription. Even worse, this drop in performance occurred atomoxetine, ivabradine, adrenaline and imiquimod. Already, 95 per cent of doctors are doing this. despite a 12 per cent decline in the number of calls because an increasing number of DHS also reported that around 5 per cent of calls The top ten streamlined authority medicines for medicines were moved to streamlined approval to the Authority service were for medicines that which the Department receives unnecessary arrangements. are now covered by streamlined arrangements calls are:

MORE P30 29 INFORMATION FOR MEMBERS THERAPEUTICS It’s a fact: DHS just keeps us First-ever nationwide hanging on the telephone palliative care survey

... FROM P3 FROM P29 GPs have been asked to participate in the first-ever attempt to identify and map the availability of palliative and advance care planning services nationwide. • smoking cessation related drugs: line service. Nicotine, Nicabate P, Nicot Step 1 A survey being conducted by a consortium of leading national health, academic As always, the AMA welcomes member and Nicotine Patch; and aged care organisations aims to tap into the local knowledge of GPs to feedback. provide an accurate picture of the palliative and advance care planning services • anti-dementia drugs: galantamine But also make sure you report any available in each area. and donepezil; delays or other complaints about the The information collected will be used to help fill service gaps around the country, • anti-thrombotic agents: rivaroxaban phone line and its service quality and to develop a dedicated 24 hour hotline to provide specialist palliative care and and clopidogrel; directly to the DHS by sending an advance care planning advice. • pregabalin; and email to: customer.feedback@ GPs who decide to take part are asked to complete online survey of existing humanservices.gov.au palliative care and advance care planning arrangements in their practice. • quetiapine. This email address also appears in Completing the survey is expected to take around 15 minutes. Those who use prescribing software the right hand column of the AMA Project leader, Associate Professor Bill Silvester, said the survey seeks to capture provided by Best Practice and Medical homepage (www.ama.com.au) for your the knowledge of GPs, so that an accurate picture of services can be obtained. Directors should also note that the reference and ease of use. Department has received some reports “GPs and managers of aged care services have a good understanding of the from prescribers that this software may You can make sure Health Minister palliative care and advance care planning services currently available in their local area, so it is really important that as many as possible participate in the survey, not be providing prescribers with the Peter Dutton and Human Services because the results will determine how program resources can be targeted to streamlined authority code alert for Minister Marise Payne have a clear those in most need,” Associate Professor Silvester said. some streamlined medicines. picture of the impact on doctors by Findings from the survey will be incorporated into the first-ever national scan of If you notice your practice software copying them into your email: Minister. [email protected] and minister@ the sector, with the information used to develop a suite of programs under the does not reflect the latest PBS Specialist Palliative Care and Advance Care Planning Advisory Services Project. information, contact your software humanservices.gov.au vendor and advise the Department on These will include the 24 hour hotline, as well as education, training and web- The AMA knows just how frustrated based resources for health and aged care professionals to enhance their skills in customer.feedback@humanservices. doctors are with the PBS Authority palliative care and advance care planning. com.au. system, and is pushing hard for action. To participate in the survey, go to https://www.surveymonkey.com/s/ The system should either be scrapped Moving more medicines into GeneralPractitioner1 streamlined approval arrangements is or, at the least, drastically overhauled to an encouraging development, but we minimise the inconvenience and time The survey closes on Friday, 23 May. need to keep the pressure on DHS to wasting it causes for doctors and their For more information about the survey or the Advisory Services Project, contact allocate proper resources to the phone patients. Palliative Care Australia on 02 6232 4433. 30 COMMENT INFORMATION FOR MEMBERS Win a $50 iTunes/Google Play gift card AMA survey of GP registrar and hospital-based specialist trainees

There are nearly 16,800 vocational medical college training programs, and identified survey results, the AMA will trainees undertaking a recognised training to identify emerging issues and trends in communicate survey findings to the program in Australia. vocational training. medical colleges to assist them with their quality assurance processes. During May, the AMA will be surveying AMA Council of Doctors in Training Chair hospital-based specialty trainees and GP Dr James Churchill said the surveys AMA Council of Doctors in Training registrars on their experiences in order were an important way of monitoring has developed and refined two parallel to guide the AMA’s advocacy efforts and the experiences of trainees undertaking questionnaires for general practice provide medical colleges with independent vocational training programs, and the and hospital-based specialist trainees feedback about their training programs. findings would provide the colleges with in consultation with college trainee The AMA Specialist Trainee and GP important feedback. representative groups and the colleges Registrar Surveys are confidential online “The AMA strongly supports the Australian themselves. The questions take into surveys that ask trainees about various model of medical vocational training, which account the Australian Medical Council’s aspects of their training, including the does a great job in preparing doctors for standards for accrediting specialist course curriculum; college assessment independent practice,” Dr Churchill said. medical education and training. and examination processes; the flexibility “But it’s important that colleges are aware The anonymous, ten-minute surveys of the training program; and training costs. of where they are doing well, and where are open to AMA members and non- The first AMA Specialist Trainee Survey, the overall training experience for trainees members until 30 May 2014. All trainees conducted in 2010, showed a high level of could be improved. are encouraged to participate. Complete satisfaction with work and training. It also “Most colleges already make the survey by the due date to go into the highlighted several areas that attracted commendable efforts to get the views of draw to win one of 10 iTunes or Google less positive results, including appeals their trainees. Our surveys will cover some play gift cards valued at AUD$50 each. * processes, recognition of prior learning, aspects of training that the colleges do not Go to www.ama.com.au/trainee-survey responses to bullying and harassment, necessarily seek feedback on from their and costs. The full results of the 2010 to complete the Specialist Trainee or trainees. survey can be viewed at: https://ama.com. GP Registrar Survey. au/2010-ama-specialist-trainee-survey- “The ultimate goal of the surveys is to * In the Australian Capital Territory, only assist the colleges to maintain the high report-findings-october-2011. AMA members are eligible for entry into quality of specialist medical education in The AMA plans to use the results from this the draw. View the Competition terms and Australia.” year’s surveys to highlight the strengths conditions at https://ama.com.au/terms- and areas for improvement in individual In addition to publicly reporting on de- and-conditions 31 DOCTORS IN procedural trainee continues to TRAINING AMA Trainee Forum 2014: DiTs focus work approximately 60 hours per week, generally consistent with trainees’ expectations and on regional training, telehealth, recommendations from training bodies, it is clear that protecting the quality of vocational training must accreditation and doctors’ wellbeing continue to be a significant focus for CDT. The AMA Trainee Forum, held each in major centres, provide innovative Given the primary reason for the The Forum also gives the CDT March, is critical in shaping the educational experiences for forum’s existence is to allow for an opportunity to seek trainee advocacy agenda of the AMA’s trainees and improve the standard discussion on important issues feedback on significant upcoming BY DR JAMES CHURCHILL Council of Doctors-in-Training of medical care able to be delivered for everyday DiTs, the ‘trainee issues on which AMA advocacy is (CDT). by trainees in rural and remote soapbox’ is always a valuable and planned. sites. entertaining session. It is the premier forum for In light of the Australian Medical CDT’s direct engagement with The Forum also heard from a This year, DiTs passionately Council’s impending review of ...valuable prevocational and vocational panel with significant experience in affirmed their support for their the accreditation standards for trainees from a wide range of junior and senior colleagues in establishing and managing regional specialist medical education, “ specialties on national issues Queensland, calling for resolution insights were training networks -- networks of the forum discussed the current important to DiTs. of the Senior Medical Officer health services delivering high- standards and areas on which gained from contracts dispute amid threatened This year’s Trainee Forum set out quality generalist and specialist advocacy should focus. mass resignations of trainees’ to push the boundaries of AMA training, allowing trainees to be presenters and supervisors. Thankfully, in recent Similarly, valuable insights were policy, with discussion of innovative based in regions where training weeks there have been significant gained from presenters and attendees during models for enhancing the capacity, in single-site settings may not be concessions from the Queensland distribution and delivery of medical viable. attendees during the final session Government, and the negotiation the final session training. regarding doctor mental health, While it’s clear that a one-size- of a revised agreement has largely wellbeing and suicide prevention. regarding doctor Fittingly, the session dedicated fits-all approach may not be defused tensions. to use of telehealth for teaching appropriate, further development With the AMA-beyondblue Mental The soapbox session also saw mental health, and training was conducted via of regional networks and hubs Health Roundtable coming up on 6 discussion of the results of the videoconference, with panellists shows significant promise for June in Melbourne, the discussions AMA’s recent survey into trainee wellbeing dialling in to Melbourne from improvement in regional training made it clear that trainees are working hours. as far as Cairns, Mount Isa and and the distribution of the medical ready to build upon work already and suicide rural Tasmania -- and not without workforce. The survey was commissioned to completed, and to determine a solid plan for addressing the health of prevention its routine share of technical The Trainee Forum discussed and investigate concerns that quality of challenges. training for procedural specialties is the profession. agreed upon valuable outcomes being threatened by the imposition ” Forum attendees discussed regarding both of these innovative Many thanks to all Trainee Forum of rosters with strictly-limited the value of opportunities via models of delivery of medical presenters and attendees for their working hours. telehealth to expand the access of training, which have already participation, and to AMA Victoria trainees in remote areas to clinical influenced the formation of new While the survey results for hosting the event at AMA encounters with specialists based AMA policy in the short time since. demonstrate that the average House, Parkville. 32 COMMENT Health on the hill Political news from the nation’s capital

Medicare crackdown falls short $98 million, or 66 per cent less than the expected savings.” In addition, the ANAO found significant deficiencies in the consistency and quality of compliance data collected by A Federal Government crackdown on Medicare rorts has When the crackdown was initiated in 2008, the Expenditure Human Services. raised a fraction of the expected revenue and has ended up Review Committee of Cabinet asked the responsible costing the Commonwealth rather than saving health funds, Ministers to report back on progress in 20011-12, but the In a review of 359 Medicare audits completed by the according to a damning audit report. Audit Office found “Human Services did not develop or Department between March and June last year, the Audit implement its proposal to monitor and report on savings – Intensified checks of compliance with Medicare rules were Office found that 33 (almost 10 per cent) “contained an opportunity missed, given ministerial expectations of a expected to deliver $70 million in savings between 2008-09 data inaccuracies that resulted in compliant claims being significant return on the Government’s investment”. and 2012-13, but an investigation by the Australian National incorrectly recorded and reported as non compliant”. Audit Office has found that the Department of Human Instead, the ANAO found that the Department tried to Responding to the findings, the Department accepted the Services bungled the process, conducting far fewer reviews fudge reports on the extent to which it increase audit and and audits than expected, and recovering far less money. compliance activity. ANAO’s recommendations to strengthen and refine its risk management frameworks and to develop a methodology The-then Rudd Government provided the Department with According to the Audit Office report, just once – in 2011-12 to monitor and report on the effectiveness of Medicare – did the Department reach its key performance target of almost $77 million to conduct an additional 8000 Medicare compliance audits. compliance audits and reviews over a four-year period. The completing 2500 audits and reviews each year. But it defended its decision to include feedback letters, extra effort was expected to result in the recovery of more It found that in 2012-13 Human Services, on its own than $147 million, providing a net saving of $70 million. initiative and without ministerial input, changed the mix of education programs and other activities in its compliance But the ANAO found that in four years debts worth just activities that counted toward compliance activity to include work. $49.2 million were identified and, of this, just $18.9 million less rigorous actions, such as ‘targeted feedback letters’. “While risk management, the completion of audit work had been recovered – meaning the crackdown resulted in Including such actions bumped reported compliance activity and achievement of savings is key to the Department’s for the year up to 2819 cases, whereas the ANAO found the an additional cost to the Government of $58 million, rather compliance activities, the Department is also pleased than a saving. actual number of agreed compliance actions was 2073. that the ANAO has noted the additional objectives of the “The available Human Services’ data shows that there “While acknowledging the Department’s advice that Compliance Program, including education and reinforcing was a $128.3 million shortfall in the savings achieved by targeted feedback letters were a valid compliance treatment health professionals’ awareness of compliance obligations. the Department, in the form of monies actually recovered, intended to encourage voluntary compliance, their inclusion Prevention and positive behaviour change are a very against the target set by the Budget initiative – some 87 resulted in inaccurate performance reporting for the important part of the department’s Compliance Program,” per cent less than the $147.2 million expected savings,” budget measure, as well as inaccurate and inflated internal Human Services said. the ANAO report said. “Even if all the debts raised ($49.2 reporting of its compliance coverage rate,” the Audit Office million) were recovered, the result would be a shortfall of said. Adrian Rollins COMMENT 33 Health on the hill Political news from the nation’s capital

Incentives to keep patients health in PHA Chief Executive Michael Armitage told the West on offer in Victoria alone, and they did not confer any health fund sights Australian that often, the first health funds knew that a advantage in terms of treatment priority or getting access to member had a serious condition was when they were a single room. Policy holders may get a choice of doctor, but Health funds are pushing to be allowed to pay doctors presented with a large hospital bill. only of those who have practicing rights at that particular incentives to keep patients healthy and out of hospital as public hospital. part of an expansion of private insurance to cover primary Mr Armitage suggested the incentive arrangement could health care. improve the quality of care while reducing health fund costs. A spokesman for insurer NIB admitted to the Sunday Herald Sun that its public hospital-only product was aimed at But an analysis by health insurance actuary Brent Walker As experts warn that a Commission of Audit proposal to higher income earners who were trying to avoid the tax force higher income earners off Medicare and into private suggests private health cover might be pushed out of the penalty on those without private health cover. cover would drive a massive increase in premiums, peak reach of many if recommendations from the Commission of industry group Private Healthcare Australia is planning a Audit are adopted. Adrian Rollins COMMENT major expansion into primary health. In recommendation 17, the Commission suggests that According to the West Australian, PHA is preparing to higher income earners be excluded from Medicare and Plain packaging laws at centre of world submit a reform blueprint to Health Minister Peter Dutton required to take out private health insurance, which trade storm that will include allowing health funds to pay GPs to provide would then have to cover GP visits, pathology and Australia’s breakthrough tobacco plain packaging laws preventive care services to their patients. pharmaceuticals. have become the centre of the biggest trade dispute in the Under current arrangements, private health funds are Mr Walker told the Adelaide Advertiser that to extend private history of the World Trade Organisation as worried countries banned from providing cover for GP services, but Mr Dutton health insurance to cover all the expenses that currently fell tussle over the protection of intellectual property rights and has expressed interest in an expanded role for insurers, under Medicare would force premiums up by around 150 the ability of countries to take public health measures. including in primary care. per cent, putting the cost of a typical health plan at $13,500 As at late last month, 35 countries had asked to join the a year. The PHA’s plan would see doctors paid an incentive by dispute as third parties, including the United States, the health funds to help improve the health of their members, The warning came as it was revealed that some health European Union, China, India, Brazil and Japan. including by providing advice on diet and exercise, the West funds are charging up to $2772 a year for insurance that In a major advance in the progress of the trade stoush, the Australian reported. only covers patients for public hospital care – an entitlement WTO last week appointed a three-member panel to begin they already have under Medicare. They might also receive payments for treating patients in hearings on the dispute and finalise a report within six accordance with clinical guidelines. The Sunday Herald Sun said there were 15 such policies months.

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The panel, to be chaired by former South African Trade Tobacco companies and producer countries are particularly argued that the laws breached their intellectual property Minister Alec Erwin and including international intellectual worried that if Australia’s plain packaging legislation stands, rights. property expert Professor Francois Dessemonted and many other countries will follow suit, undermining the global A spokesman for Trade Minister Andrew Robb told The distinguished Barbados politician Dame Billie Miller, will market for their products. Australian Financial Review that the Government would investigate complaints from five countries – Ukraine, So far, governments in Ireland and New Zealand have vigorously defend the plain packaging laws at the WTO. Indonesia, Cuba, the Dominican Republic and Honduras – flagged their intention to introduce similar plain packaging that Australia’s plain packaging laws breach international legislation, while the British Government has indicated it will “WTO members have a right to take measures to protect trade obligations regarding the protection of intellectual introduce plain packaging laws following a review. public health,” the spokesman said, adding that a number property rights (in particular, trademarks) and are Evidence about the effect of the measure so far is mixed. A of countries including Brazil, Canada, New Zealand, Norway detrimental to their tobacco industries. University of Sydney study found there had been a jump of and Uruguay had expressed their support for Australia’s almost 80 per cent in calls to the national Quitline since the case. Among the arguments, Cuba has complained that the laws were introduced, but tobacco companies claim there If the dispute settlement panel rules that Australia’s plain laws mean that its premium tobacco products, particularly has been no impact on the overall consumption of their cigars, cannot be differentiated from other products in the products. packaging laws do breach WTO trade rules, the country will Australian market, while the Dominican Republican argued have 60 days to challenge the decision before it becomes The Australian laws have the strong backing of the World formally adopted. they were detrimental to fair competition in the marketplace, Health Organisation. and were therefore inconsistent with Australia’s international If there is an appeal, it has to be heard within 90 days The WTO dispute is not the first legal challenge the trade obligations. by the WTO’s permanent seven-member Appellate Body, Australian Government has faced to the plain packaging and the Dispute Settlement Body has to accept or reject The dispute has attracted huge international attention laws. the appeal decision within 30 days – and rejection is on because of its implications for the marketing of tobacco In 2012 it successfully defended the plain packaging possible by consensus. products and, more broadly, the capacity of countries to legislation when the High Court of Australia dismissed a

enact public health measures. challenge from the major tobacco companies, who had Adrian Rollins COMMENT

35 INFORMATION FOR MEMBERS

LETTERS Keep an open mind on Lyme disease Medical claims for diagnostic imaging and

Dear Sir or Madam Medical practitioners may not have the pathology provided to patients in public time, or inclination, to follow the debate I was alarmed by your recent in detail as the evidence related to Lyme hospital emergency departments publication of a piece named ‘Lyme disease in Australia builds, but they owe disease not a local-grown problem: Diagnostic imaging and pathologist in public hospitals under a medical it to their patients to keep open minds. pathologists’. specialist members should be aware practitioner’s name and billing And you owe it to your members to they are legally responsible for all provider number, the practitioner I wonder whether Dr Graves swore an give information that supports an must be made fully aware of, and be oath to ‘first do no harm’ when he was open-minded and productive dialogue, services claimed under Medicare that given the title before his name. And particularly taking into consideration are billed under their provider number prepared to accept responsibility for, I wonder if he has the faintest idea that the CMO’s investigations into or in their name, even if the billing was that billing; just how much harm his premature Lyme disease in Australia are far from done by hospital administration. • where services claimed are being and inappropriate comments are concluded. It is also worth noting that rendered in a public hospital, doing. His comments about testing Pathology and diagnostic imaging NSW Health has recently updated its medical practitioners should seek a perpetuate myths which help no-one. information on Lyme disease to advise services for patients in public hospital written guarantee from the hospital And especially concerning to me is his that ‘Clinicians should keep an open emergency departments are covered advice about treatment at the end of the mind about the possibility of locally- by Australian Government funding that the arrangement is not in breach article - surely treatment decisions are acquired Lyme disease’. The highest arrangements and are not eligible for of the relevant Australian Health Care made about individual patients by their price a medical professional may pay Medicare benefits. Agreement; and medical practitioners. for ignorance about this disease is a Emergency patients are to be treated as • public hospitals must provide doctors Likewise, Professor Beaman’s blow to their ego. But patients are public patients until a clinical decision with full records of all medical statement that the symptoms of Lyme paying with their lives. to admit has been made and the patient accounts raised in their name. disease are ‘consistent with being The AMA does not serve its members has elected to be admitted as a private alive’ is breathtakingly ignorant. This and their best practice by publishing If you believe your provider number description could not be further from this article. It does nothing to advance patient. may have been used in ways that the truth. And it is a comment that is the understanding of a very serious More information about this is available contravene the relevant provisions in profoundly insulting, in particular to the Health Insurance Act, the AMA disease. I hope that your intention is from the Medicare website: https:// those sickest patients who exist daily recommends you contact your State to publish another article which gives a www.medicareaustralia.gov.au/ feeling they are the living dead. more complete and updated overview. AMA Office. As this issue affects provider/business/audits/public- History is littered with examples of employment contracts, State AMAs will First do no harm. Please keep those hospital-emergency-depts.jsp diseases which were once dangerously words at the forefront of your minds. be able to coordinate representation for misunderstood. Examples such as H. The AMA provides the following advice affected members. pylori should not be too far from the Yours sincerely, to members about the use of provider The AMA will keep abreast of Medicare memory of current practitioners. Kirsten Smith numbers in public hospitals: compliance matters through its COMMENT • where medical services claimed participation on the DHS Compliance against Medicare are being rendered Working Group. 36 and cholesterol for the last 15 years coherent and consistent guide to valuing in collaboration with Professor Carlos life. Enrich from the University of Barcelona, Research and the latest paper was the result of Behavioural Science Professor Graham five years’ work involving researchers Loomes and his team have embarked on from the University of Sydney, the Garvan a four-year study into how governments Institute, and from universities and and others arrive at a value for life. research centres in Brisbane, Hamburg this has huge effects on the ability of “Putting a monetary value on life and Cholesterol gives cancer a and Barcelona. free ride cancer cells to move and spread through health and safety is difficult, and the the body,” he said. Adrian Rollins COMMENT answers can be pushed around by the Cholesterol’s already badly tarnished way the question is framed,” Professor “Our research found that having high image has just got a whole lot worse. Loomes said. amounts of bad cholesterol seemed to Your money or your life A team of researchers have found that the help the integrins in cancer cells to move “At the end of four years it is unlikely we substance, long linked to heart problems What price a life? In the romanticised and spread. will have a simple model to be used in and clogged arteries, also plays a major view, every life is priceless. every situation. But what we hope to have role in helping cancer spread through the “In contrast, we found that high levels of But, as unpalatable as it may seem, is a model that can be adapted and used body. good (high density lipoprotein) cholesterol keeps integrins inside cells, and may every day governments, insurers, urban in different areas.” In a finding set to intensify the focus therefore protect against cancer cell planners, hospital managers and many He said the figure that people arrive at on links between elevated cholesterol spread.” other routinely make decisions that put a levels and the incidence of cancer the finite value on life. may be influenced by considerations The discovery, published in the journal such as how the money is raised, and researchers, led by Sydney University In Britain, the Department of Transport is Associate Professor Thomas Grewal, Cell Reports, may shed new light on the number can also change according to cancer therapy. willing to spend up to $3.25 million on found that low density lipoprotein (LDL) safety measures that would prevent a considerations of fairness, which “can be – often referred to as bad cholesterol – Associate Professor Grewal told the death, while the National Health Service a trick thing to measure”. regulates the machinery that controls the vthat people with common cancers such judges that treatments that can deliver an “Should the same value be placed on old migration of cells through the body. as those of the breast, prostate, lung extra Quality Adjusted Life Year for up to people as opposed to children?” Professor and liver, often had low levels of LDL Associate Professor Grewal said cells in $54,000 could be considered good value Loomes asked. “Or pedestrians over cholesterol because it had been absorbed for money. the body typically stick to each other with motorists, as they are more vulnerable. by the cancer cells to help them grow and the help of Velcro-like molecules on their In Australia, the Pharmaceutical Benefits spread. How much allowance should be made for surface known as integrins. Cancer cells Advisory Committee uses the benchmark personal responsibility?” typically have more of these integrins, “Our findings advance the theory that of up to $50,000 for each extra Quality which help cancer cells that have knowing how to manipulate and lower Adjusted Life Year when assessing the He said the hope was that, by broken away from a tumour to take root bad cholesterol could significantly help efficacy of a medicine. understanding how people currently arrive elsewhere in the body. to reduce the ability of cancer cells to at a figure, “we may be able to reduce Now a team of academics from the spread. bias and error and get at figures that “Our study identified that bad cholesterol University of Warwick have set out to better reflect people’s underlying values”. controls the trafficking of tiny vessels Associate Professor Grewal has been determine what price can be put on a life, which also contain there integrins, and working on the link between cancer in an effort to give policymakers a more Adrian Rollins

COMMENT 37 NEWS declared dead of a heart attack 10 minutes after that – one hour and 44 minutes after the prisoner was first Inmate suffers slow death in strapped into the gurney. Mr Lockett was convicted in 2000 and sentenced to latest botched US execution death for the kidnap and murder of a 19-year-old woman during a home invasion. The woman survived the initial assault, and Mr Lockett ordered two accomplices to bury her alive, and raped one of her friends. His accomplices The United Nations has renewed its call for a moratorium how the death penalty is being applied,” Mr Obama said, are serving life sentences. on the death penalty in the United States amid outcry “and this situation in Oklahoma I think just highlights over the botched execution of a convicted murderer and some of the significant problems there.” The families of his victims expressed satisfaction at his execution, but the manner of his death had appalled the rapist. A timeline of the execution released by Oklahoma UN High Commissioner for Human Rights. The United Nations’ High Commissioner for Human authorities shows that it took a phlebotomist almost 50 Rights has warned the execution of Oklahoma death row minutes to find a vein after checking the prisoner’s arms, Spokesman Richard Colville said “the suffering of Clayton inmate Clayton Lockett may have breached may have legs, feet and neck. Lockett during his execution in Oklahoma on Tuesday 29 April, may amount to cruel, inhuman and degrading breached international law. Finally, the IV was inserted into a vein in Mr Lockett’s treatment according to international human rights law”. The comments came as details emerged of Lockett’s groin and a dose of Midazolam was administered. Mr Colville said that the execution also appeared to run final hours, including evidence that he took almost 45 The attending doctor declared Mr Lockett unconscious counter to the US constitution, which bars “cruel and minutes to die after being injected with an untested 10 minutes later, though witnesses reported that the unusual punishment”. cocktail of drugs, many of which appear to have leaked prisoner continued to move his head, fight against directly into his body after an intravenous line failed. his restraints and attempt to speak for a further three “The prolonged death of Clayton Lockett is the Witnesses said Lockett convulsed violently during the minutes. second case of apparent extreme suffering caused by malfunctioning lethal injections reported in 2014 in the execution and tried to lift his head, even after a doctor Once Mr Lockett was declared unconscious, the doctor United States,” he added, referring to the case of Dennis declared him unconscious. He died of an apparent heart administered vecuronium and potassium chloride through McGuire, executed in Ohio in January with an allegedly attack, 43 minutes after the execution had begun. the IV. untested combination of drugs. “What happened in Oklahoma is deeply troubling,” But, 10 minutes later, the doctor checked the IV and “The apparent cruelty involved in these recent executions US President Barack Obama said when asked about found that the vein had collapsed and the drugs had simply reinforces the argument that authorities international condemnation of US application of the death leaked out and been absorbed in the surrounding tissue. penalty following Lockett’s case. across the United States should impose an immediate The doctor then contacted the warden and informed him moratorium on the use of the death penalty and work for Mr Obama said Attorney General Eric Holder would be that not enough drugs had been administered to cause abolition of this cruel and inhuman practice,” he said. asked to “get me an analysis of what steps have been death, that there were not enough drug left to complete Authorities in many of the 32 states that still have taken, not just in this particular instance, but more the execution and that there was no vein to inject them the death penalty have been scrambling to find a broadly in this area”. into even if there was. supply of drugs to carry out executions after European The President said the death penalty’s application in the The doctor reported that, at that time, Mr Lockett was pharmaceutical companies, their usual source, placed US was problematic, with evidence of racial bias and the unconscious but still had a faint heart beat. an embargo on the use of their products for capital eventual exoneration of some death-row inmates. punishment, in line with European Union laws. The execution was officially called off 33 minutes after “All these, I think, do raise significant questions about the Midazolam was administered, and Mr Lockett was Adrian Rollins COMMENT 38 NEWS situation stands in stark contrast to the near-cessation of international spread of wild poliovirus from January Polio a ‘global health emergency’ 2012 through the 2013 low transmission season for this disease.” After reaching a record low of 223 cases in 2012, the transmission for the disease, raising concerns infections could become much more rapid and wide ranging when number of polio cases jumped to 417 last year and so conditions conducive to high transmission kick in during far this year 74 cases have been notified, including 59 in the northern hemisphere summer. Pakistan. “During the 2014 low transmission season there has Dr Hambleton said conditions in the Pakistan had already been international spread of wild poliovirus led to local outbreaks of the disease, and conflict in from three of the 10 states that are currently infected,” surrounding countries had helped its transmission, a the WHO said. “If unchecked, this situation could result view shared by the WHO. in failure to eradicate globally on of the world’s most “The consequences of further international spread serious vaccine preventable diseases.” are particularly acute today given the large number of It is only the second time the UN agency has declared polio-free but conflict-torn and fragile states which have an international public health emergency: the first was in severely compromised routine immunisation services 2009 during the global influenza pandemic. and are at high risk of re-infection,” the UN agency said. AMA President Dr Steve Hambleton said the disease’s The polio vaccination program in Pakistan, where the re-emergence was “extremely disappointing” given the disease has its strongest toehold, has been severely decades of effort put into eradicating the disease. disrupted by violence and misinformation. Almost 30 “The only disease we have eliminated is small pox, and polio vaccination workers and their police offer guards we wanted polio to be number two,” Dr Hambleton said. were assassinated in the country last year. Suspicions Polio remains endemic in three countries, Pakistan, about the vaccination program have also been Syria and Cameroon, and conditions of conflict and heightened in the wake of revelations the US Central regional instability have helped the disease spread to Intelligence Agency used a fake vaccination program as adjoining nations including, in central Asia, Afghanistan; cover to help hunt down Osama bin Laden. in the Middle East, Iraq and Israel; and in Central Africa, The polio virus, spread through faeces and contaminated Equatorial Guinea, Ethiopia, Somalia and Nigeria. water, attacks the central nervous system and can cause The World Health Organisation has declared a global The WHO said that, as at the end of 2013, 60 per cent paralysis within hours. It is fatal in up to 10 per cent of health emergency over the spread of polio, heralding of all polio cases were as a result of the international cases, and there is no cure. the unwelcome return of a devastating disease recently spread of the virus, with mounting evidence it was often pushed to the brink of extinction. being carried by adults traversing borders. The WHO said a coordinated international response was essential to prevent the spread of the disease. It said The WHO has taken the rare step of issuing a worldwide “The international spread of polio to date in 2014 unilateral action would likely be ineffective. alert following evidence that wild poliovirus is spreading constitutes an extraordinary event and a public health internationally during what is traditionally a period of low risk to other states,” the WHO said. “The current Adrian Rollins

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