Archive for the 'Health' Category

The Great Health Debate

Published
by
Mark
2 days, 11 hours ago
in Health and Politics
. 70 Comments

Today’s Question Time saw some interesting tactics from the government; suspending standing orders to allow Tony Abbott to talk about health and hospitals policy. I’d be interested to hear from anyone who saw the debate, but from what I heard on the tv, it looked like Abbott was mostly in bluster mode, and Rudd quite assured. Clearly Labor believes that Abbott wants to talk about anything but health, and that his lack of command of the detail, and lack of any substantive alternative policy will work to the ALP’s credit.

So, the debate Rudd challenged him to on Tuesday will be interesting. It’ll also keep the media focus squarely where the government wants it to be for the next little while.

Elsewhere: Bernard Keane.

Elsewhere: Tigtog at Hoyden.

Update: The commentariat seems to be impressed by Abbott’s performance. By way of example, Samantha Maiden:

But the egg ended up all over Labor’s face as the Opposition Leader rose to the challenge, hurling abuse at Kevin Rudd.

Righteo, then.

Update: Bernard Keane in Crikey today:

If Abbott could spend Tuesday’s debate repeating yesterday’s dose and bagging the Government and explaining that he didn’t cut health funding, it’d be fine, but there’s now an expectation he must do more than criticise Rudd, that he must offer something positive. It obviously wasn’t in the Coalition’s planning to be producing a full-blown health policy at this stage. Rudd himself will presumably use the debate to make yet another of the many announcements about health funding that he promised back when he kicked off the health debate. If so, Abbott’s failure to produce something of substance will look particularly poor.

All of which is why, despite the alleged risks of debating your opponent, Rudd is happy to be doing just that.

Sex-selective IVF

Published
by
Robert Merkel
5 days, 20 hours ago
in Ethics, Health, Life, Medicine, Parenting and Philosophy
. 80 Comments

The National Health and Medical Research Council is apparently reviewing whether the prohibition on those undergoing IVF treatment selecting the sex of the (hopefully) resulting children should be retained. This guideline is part of “Ethical guidelines on the use of assisted reproductive technology in clinical practice and research”, a document last revised in 2007.

The ABC report quotes Professor Gab Kovacs as advocating an end to the ban; ACCESS Australia has, in the past, made submissions to the NHMRC on the guidelines suggesting that some of their members have requested the ban be removed, their 2004 submission makes the following claim:

There is no evidence to suggest that there is a significant preference for either sex where this (RM: deliberate sex selection) has been done in Australia or internationally.

This may well be the case with regards to IVF, and it may well be the case in Australia, at this particular moment in time. But it’s certainly not the case globally. Throughout parts of Asia, sex ratios at birth are highly skewed, with the relative scarcity of girls attracting the term “gendercide”.

As a society, I don’t think we’ve made any serious attempt to work through the potential societal consequences of allowing parents to choose the sex of their children. Is it a discussion that we should be having?

So, how about that hospitals plan?

Published
by
Mark
1 week, 3 days ago
in Education, Government, Health, Industrial Relations, Media, Policy, Politics and Polls
. 7 Comments

Tony Abbott’s performance in question time today, and the timing of his parental leave thought bubble more generally, suggest that his major imperative was to switch the topic of debate from health. That’s despite the Coalition running a very active scare campaign about hospital closures in the bush, but it’s probably because of the polling on Rudd’s initiative. I suspect also that it wouldn’t be going out too far on a limb to venture a modest prediction that that Labor might be headed for an uptick in the polls.

Some Coalition MPs have suggested that this plan came about so suddenly because Abbott had become privy to private party polling.

I strongly suspect that the Labor Party might have had a bit of a turnaround – perhaps related to the National Curriculum and health, and Abbott might be responding to that. It could also explain why he felt he had to release some ‘positive policy’. It could well be that his negativism has had an impact; I note that Labor Ministers have been reiterating the ‘Senate obstructionism’ line again this morning.

In short, on where the parties actually stand, one shouldn’t believe what one reads in The Australian.

Meanwhile, whether or not Abbott makes health a focus of his parliamentary attack, the Premiers continue to ponder the National Health and Hospitals Network. Kevin Rudd has wrought his own ambush, confident that there’s no political skin to be lost picking a fight with the states on this battleground. But that doesn’t mean that some of the Premiers haven’t been posing some good questions – interestingly, probably more from Kristina Kenneally than John Brumby.

And while the headline politics might have been the primary focus of media attention, some good work continues to be done on analysing the policy itself. I’ve posted some salient links over the fold. Continue reading ‘So, how about that hospitals plan?’

Health and hospitals and the polls

Published
by
Mark
1 week, 5 days ago
in Health and Polls
. 8 Comments

We’ve had close to a week of public debate on Kevin Rudd’s health and hospitals plan, and today’s Nielsen poll shows resounding majorities among every demographic and voters of all parties for the proposition that the Commonwealth should take more responsibility for funding hospitals. Over the fold, I’ve borrowed a table from Possum to illustrate the results.

What should be of most concern to the Opposition is the very large number of their own voters who support such a policy. It might, of course, be objected that support is soft, but that ignores the fact that this plan was launched on the basis of reinforcing well entrenched public attitudes about the failures of the states in hospital management; attitudes Tony Abbott would have been well aware of when he frequently proposed a Commonwealth takeover as Health Minister.

No doubt it will also be claimed that support will ebb, as with the ETS (though it still has majority approval). But the introduction and selling of this plan has been very different – a high profile announcement, followed by a media blitz – much more akin to a budget. And interest groups which will resonate positively with public opinion – doctors, nurses, have reacted supportively.

Continue reading ‘Health and hospitals and the polls’

Rudd’s health policy

Published
by
Mark
2 weeks, 3 days ago
in Federal Elections, Government, Health and Politics
. 63 Comments

Kevin Rudd has released his health policy at the National Press Club.

Essentially, it encompasses a phased takeover of responsibility for activity based hospital funding by the Commonwealth, with 30% of GST revenue to be diverted directly to hospitals. Funding would flow to individual hospitals, with local authorities being funded to treat individual patients, and the establishment of national standards of care.

Primary health care will become the sole responsibility of the Commonwealth.

Politically, it buys the Commonwealth a possible fight with the largely unpopular state governments, and appears to short circuit the state health departments, leaving them with residual functions for the less glamorous administrative functions of hospital systems. It also incorporates the local focus Tony Abbott has championed, with flexibility for clincal and funding decisions to be made at hospital or regional level. The Commonwealth would become, in effect, a regulatory and activity based funding body, rather than ‘taking over’ hospitals, but the threat of a referendum remains.

Subsequent announcements between now and the election will focus on extra beds, doctor and nurse training, support for GPs, and the introduction of electronic patient record monitoring.

The AMA is supportive; the Coalition opposed.

Detail of the National Health and Hospitals Network Plan can be found here.

Update: Bernard Keane observes at The Stump that the plan comes with a snappy slogan – “funded nationally, run locally”.

Update: Melissa Sweet analyses the announcement at Croakey.

Update: The transcript of Kevin Rudd’s Q&A at the Press Club is now available here.

Abbott takes a stand in defence of private health

Published
by
Mark
3 weeks, 5 days ago
in Federal Elections, Health and Politics
. 24 Comments

This week in Parliament Labor will gain another double dissolution trigger, as the Coalition has vowed to stop changes to the threshold for the private health insurance rebate. Labor will be keen to draw a parallel between this move and Abbott’s tenure as Health Minister, arguing that less money will be available for public hospitals. The ALP will also no doubt utilise Barnaby Joyce’s previous equivocal comments on the measure to ram home the point about fiscal indiscipline from the opposition.

Kevin Rudd’s health policy is likely to be the centrepiece of the government’s plan for re-election.

Meanwhile, writing at The Age, Kenneth Davidson provides a very good argument for not subsidising the private health insurers at all.

Teenagers, brain scans, and biology as destiny

Published
by
Robert Merkel
4 weeks, 1 day ago
in Health, Medicine, Parenting, Policy, Politics, Science and Sociology
. 47 Comments

It was the perfect storm of teenage recklessness, and five died as a result. A few weeks ago, Stephen Johnstone got behind the wheel of his Falcon XR6 to leave a party, after what appears to be a confrontation of some sort. He must have been exceptionally and obviously drunk to everyone around him, given his blood alcohol level was, according to toxicology reports, 0.19. There were five friends in the car – indicating that at least one didn’t have a seat belt on. He then screamed down Plenty Road -a major road in Melbourne’s outer north-east, gunbarrel straight with an 80km/h limit – at 140 km/h. Almost inevitably, he lost control and wrapped the car around one of the trees that line the road, killing all but one of the car’s occupants.

In the wake of the deaths, there’s been considerable discussion of what can be done to protect teenage drivers from themselves. The shock-jock standby – crushing hoons’ cars – has made a return to debate, though with limited enthusiasm from the police. The Age has given some attention to the range of vehicles that P-plate drivers are allowed to drive, perhaps not realizing that the Falcon XR6 that Johnstone was driving is actually no faster – and has consiiderably better steering, suspension, and brakes – than a base-model Falcon. And a researcher from Monash University, John Reid, has been publicizing the idea that teenage drivers should undergo screening for “immature brains” using either screen-based tests or brain scans, with those identified as having such undeveloped brains prevented or restricted from driving until their brains mature somewhere in their twenties.

Continue reading ‘Teenagers, brain scans, and biology as destiny’

So, what exactly does ‘direct action’ mean?

Published
by
Mark
1 month ago
in Federal Elections, Health, Howardia, NSW Government, Polls and Queensland
. 22 Comments

Tony Abbott’s second policy release since becoming leader also carries the ‘direct action’ badge – the underwhelming ‘plan’ to institute local boards for public hospitals in Queensland and New South Wales mirrors the Coalition’s climate change policy in highlighting this theme.

The politics of this message are potentially quite effective. Small, bite sized initiatives portrayed as community based and focused around individuals and localities are meant to provide a big contrast with Kevin Rudd’s approach to governance. It’s designed to play into the attack line – “Rudd promises the world, but his grand visions just result in a bureaucratic mishmash”, and this theme is also meant to resonate with the notion that Rudd once was able to empathise with voters’ day to day concerns, but is now off in some stratospheric space alien to the proverbial kitchen table.

In short then, the contrast arises from dressing policy up as both ‘direct action’ (it could happen overnight, not after fifty reviews and a round of COAG committee meetings) and achievable and realisable (it’s not about fixing the planet, but about making a difference).

The irony, of course, is that Action Man Abbott’s threadbare policy cupboard is in reality full of big government boondoggles chosen for their purely symbolic value rather than their chance of achieving anything much. The cynicism of targeting policy to particular states where Labor governments are deeply on the nose and impacting on Rudd’s polling can’t really be disguised by the Howardian rhetoric of an ‘intervention’.

Whatever happened to the vision thing?

Published
by
Mark
1 month, 1 week ago
in Federal Elections, Health, Media and Politics
. 84 Comments

George H. W. Bush was famously incapable of projecting what he termed “the vision thing” in his unsuccessful campaign for re-election in 1992, but at least he knew what he needed to, but couldn’t, do.

I noted the other day that Dennis Shanahan was something of a barometer for the current state of the ‘political narrative’. I should have remembered that an even better one, whose often indecipherable columns frequently seem to be pure stream of consciousness, is Malcolm Colless.

Writing today in The Australian, he seems to think he is delivering some sort of killer punch:

Returning from Copenhagen, where he failed to make any ground, Rudd calmly began unveiling a whole series of new visionary canvases depicting future challenges around issues such as health services, population growth and the need for greater productivity to support an ageing community.

One thing that impressed me about Rudd on Q&A last night was that he quite rightly conveyed the message that the government, any government, can’t fix everything. That’s surely just truth, but Tony Jones response in the interchange on the alcopops tax and the drinking age showed the media reflex where the government is expected to have solved every problem yesterday in spades – “But then they’re just drinking something else”. As Rudd pointed out, the stats actually show a fall in alcohol consumption in younger demographics, but apparently that’s immaterial if a policy measure which has some impact doesn’t act as if it’s a magic wand?

What, exactly, is wrong with debating what sort of infrastructure, skills and services are needed for a growing population now? If you stop to think about it outside the drum beat of the political narrative, it’s a hard question to answer.

Kevin Rudd won the 2007 election, in part, because he could articulate a longer term vision. John Howard didn’t have one for even a single term, let alone one for the nation. What sort of Australia would Tony Abbott like to shape? We simply don’t know, if we were to go on his current public statements. His timescale is the eternal now, the cost of milk, today’s political opportunity, a soundbite from question time. Lost in the endless stream of applause for his being “pugilistic”, “authentic”, “interesting”, etc. is any debate about what he might actually do as Prime Minister, let alone any public debate on what are urgent questions which we must address as a nation.

Sure, Rudd can be criticised for raising expectations about a quick fix to the health system. But why are so many so critical when he actually does have to negotiate his way through a complex policy domain with multiple stakeholders? What would Tony Abbott’s “decisive” or “direct action” on health actually imply? Do any of the commentators even stop to think about what the answer might be?

And still they defend him

Published
by
tigtog
1 month, 2 weeks ago
in Ethics, Health, Medicine and Parenting
. 19 Comments

The Times: MMR doctor Andrew Wakefield ‘abused his position of trust’

The doctor who first claimed that the MMR vaccine could cause autism has been found guilty of a series of misconduct charges, that include putting children through painful and unnecessary tests, a disciplinary hearing has ruled today.

Dr Andrew Wakefield showed “a callous disregard” for the suffering of children and “abused his position of trust” as a doctor in carrying out a study which sparked the biggest vaccine scare in a generation and has been blamed for the resurgence of measles in Britain, the General Medical Council (GMC) found.

He was also found to have brought the medical profession “into disrepute” after he took blood samples from youngsters at his son’s birthday party in return for payments of £5 and failed to disclose vital conflicts of interest around his work – which has since been discredited.

Along with two former colleagues who were also involved in the study on 12 children, originally published in the Lancet medical journal in 1998, Dr Wakefield now faces being suspended or struck off the medical register if this verdict is confirmed by GMC later this year.

The findings from the 1998 Wakefield et al study on 12 children have failed to be replicated in subsequent studies involving millions of children. He failed to disclose conflicts of interest to the editors of The Lancet before his original paper was published in 1998 (he had received £55,000 before the study even began from lawyers representing parents wanting proof that the MMR had caused autism in their children, and had patented an alternative ’single shot’ measles vaccine for his own personal gain). In the decade since the publication he received 8x his medical salary from fees as an “expert” provided through the UK legal aid system meant to assist people in poverty. The flagrant procedural flaws in the study (the children were not a random sample of cases from one hospital, the families had been specially recruited from already-existing anti-MMR activist groups, and their medical histories were manipulated and misrepresented) right from the off make its approval for publication by The Lancet’s peer review system look none too clever either, although of course peer review is never proof against blatant fraud (that’s what subsequent replication-attempt studies tend to reveal).

The original Wakefield study is as debunked and discredited as it is possible for a piece of unethical cherry-picking “research” to be. Yet the article goes on to describe how supporters of Dr Wakefield attended the GMC hearings to heckle the chairman read out the panel’s verdicts and cheer as Wakefield addressed reporters afterwards. Continue reading ‘And still they defend him’

Even the devil sometimes speaks true? Rudd, Labor and the 2010 election

Published
by
Mark
2 months, 3 weeks ago
in Climate change, Federal Elections, Government, Health, Howardia, Industrial Relations, Policy and Politics
. 50 Comments

We have it on good authority, that of St Thomas Aquinas, that demons and evil spirits can sometimes speak the truth. Now, I’m not saying that Janet Albrechtsen falls into either of those categories, but for once I was interested to read something she wrote:

It is disappointing if this is now the politics of Rudd’s prime ministership. Despite Rudd’s tendency to conflate issues as moral challenges, he appears to view every political decision through one prism: inflict no pain and it’s all gain for him. … Here, in a nutshell, is Rudd’s political nirvana. He can continue a prime ministership based on rhetorical flourishes and symbolism without inflicting any pain on voters.

Much of Albrechtsen’s analysis is inflected with the spleen one would expect (and the illusion that to introduce WorkChoices is to do good), but I suspect she has something of a point. I’ve been critical myself of Rudd’s ‘big tent’ strategy – the accumulation of political capital for its own sake. As I’ve also commented, the Labor Party, in the face of Abbott’s leadership, is likely to downplay climate change as an issue. In an election year, the theme will move to an accentuation of the argument that Abbott and his frontbench waxworks represent a return to Howardism; but a nastier, more brutish version. And don’t be misled, they’ve hardly even begun to fight on this front. In many respects, the smart political move is to let Abbott prepare his own noose, as his negatives are already very much defined in the public mind.

But any election theme that Abbott represents the past requires painting Rudd as representing a brighter future. I’m not so certain Labor can just run on its record – a la the first term Hawke government, which got a nasty surprise in the 1984 election. Continue reading ‘Even the devil sometimes speaks true? Rudd, Labor and the 2010 election’

Production-line medicine

Published
by
Robert Merkel
3 months, 3 weeks ago
in Developing world, Economics and Health
. 15 Comments

Courtesy Kevin Drum, a Wall Street Journal piece on Devi Shetty, an Indian surgeon-entrepreneur who has adopted a more-is-better approach to heart surgery, and in doing so driven prices down while improving outcomes:

Dr. Shetty, who entered the limelight in the early 1990s as Mother Teresa’s cardiac surgeon, offers cutting-edge medical care in India at a fraction of what it costs elsewhere in the world. His flagship heart hospital charges $2,000, on average, for open-heart surgery, compared with hospitals in the U.S. that are paid between $20,000 and $100,000, depending on the complexity of the surgery.

The approach has transformed health care in India through a simple premise that works in other industries: economies of scale. By driving huge volumes, even of procedures as sophisticated, delicate and dangerous as heart surgery, Dr. Shetty has managed to drive down the cost of health care in his nation of one billion.

A large fraction of that difference is the lower salaries paid in India, and the uniquely inefficient mess that is the US health system. But, even compared with other Indian clinics, the costs appear to be in the order of 50% lower.

Continue reading ‘Production-line medicine’

Another reason to decriminalise abortion

Published
by
Paul Norton
4 months, 2 weeks ago
in Adelaide, Education, Health, Immigration, Medicine, Policy and Politics
. 56 Comments

It has been reported that one in three terminations of pregnancy at the Women’s and Children’s Hospital in Adelaide is performed on students from abroad.

The emphasis of experts and authorities quoted in these reports is on the need for improved sexual and reproductive health education and information for international students, and nobody will quibble with such calls. However, it should also be obvious to anyone whose critical faculties have not been overborne by misogynist ressentiment, and whose capacity for compassion has not been vitiated by religoius fanaticism, that the last thing the young women in these difficult circumstances need is for the Criminal Law to intrude in their cases.

Meanwhile, Tegan Leach and Sergie Brennan are still waiting for Anna Bligh to grow some vertebrae.

Doctor enrolments

Published
by
Robert Merkel
4 months, 3 weeks ago
in Disability, Health and Parenting
. 12 Comments

It seems that a proposal to reward doctors for “enrolling” patients with higher care needs, such as young children and those with chronic diseases, has caused a bit of debate amongst the community of general practitioner community.

The idea first came to attention in the National Health and Hospitals Reform Commission’s final report, which proposed that such individuals “have the option of enrolling with a single primary health care service to strengthen the continuity, coordination and range of multidisciplinary care available to meet their health needs and deliver optimal outcomes.”

Continue reading ‘Doctor enrolments’

Obama, healthcare and social democracy

Published
by
Mark
7 months ago
in Health, Medicine, Politics, Sociology and USA
. 126 Comments

Reports that Barack Obama is prepared to concede the public option in the health care bill (with some perhaps vague hope that it might be reinserted in a conference between the House and Senate on reconciling inconsistent provisions) expose the difficulty any President faces in securing even an approximation to what are basic and threshold social democratic reforms in the United States.

Leaving aside the obvious attempt to articulate the health care plan with ‘right to life’ scaremongering through all the nonsense about ‘death panels’, we still have a textbook example of how culture and ideology can cause blindness to collective interests (and indeed self interest). No amount of rhetoric about the possibilities of self actualisation and choice over life goals has any meaning if there is sustained structural inequality in health outcomes (and therefore life chances), and if there is no real attempt to ameliorate this inequality through collective action by the state.

At The Global Sociology Blog, SocProf hones in on the reasons for the absence of any discussion of, or even awareness of, class inequality in American culture and politics.

Obama now faces the familiar dilemma of attempting to save political face through the passage of some watered down bill which will do nothing, and may even be harmful, given the capture of representatives and Senators by the private interests of health insurers. Progressives also face a painful dilemma – an oft repeated one: whether to be complicit in the passage of a measure whose momentum is now driven almost solely by political calculation or whether to take a stand on principle. John Odum poses this well. But it seems unlikely that conditions – under the current political arrangements – for the passage of genuine health care reform will ever be more favourable.