Doctor and activist


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Category: Public Health

‘Health Policy’

Chesterfield-Evans, A. (2024)

Journal of Australian Political Economy  No. 92, pp. 98-105.

HEALTH POLICY

Arthur Chesterfield-Evans

Just before the 2022 federal election, Mark Butler, now the Minister for
Health in the Albanese government, spoke to the National Press Club,
praising the courage of the Hawke government in creating Medicare in
1984. His speech also set modest priorities for a prospective Labor
government, committing to (1) improve the digital health record and make
the MyHealth record actually useful; (2) develop multidisciplinary care;
(3) establish a new funding model for ‘MyMedicare’; and (4) grow the
medical workforce, with special mention of nurses and pharmacists (Butler
2022). Significantly, Butler did not commit afresh to Medicare as a
universal health scheme free at the point of delivery, the key element of
the original 1984 scheme that he praised. In an environment where,
politically, it seems that taxes cannot be increased, perhaps this ideal may
be an impossibility, but it is surely significant that it is no longer stated as
an aspiration.

Currently, Medicare is quietly dying as the low rebates cause doctors to
abandon it. Australia is moving to a US-type private system by
default. This has resulted in large amounts of hand-wringing rhetoric, but
so far little action. This short article comments on the changes initiated by
the current Labor government during its first year and a half, contrasting
these with the deep-seated problems needing to be addressed if better
health outcomes are to be achieved.

Labor’s reforms

The government has made some minor changes to Medicare which came
in with great fanfare on November 1, 2023. There were new item numbers

for new specialist technologies or treatments and an increased Medicare
rebate for GPs, up to $41.40 for a standard visit for a RACGP member,
which is 40.6% of the AMA fee. Doctors without the RACGP qualification
still get $21, which is 20.6% of the $102 AMA fee.

When Medicare was born, the Medicare rebate was 85% of the AMA fee.
The rebate has risen at half the inflation rate for 39 years, so doctors now
feel ripped off every time they see a Medicare patient. Labor blames the
disparity on the rebate freezes of the previous LNP Coalition governments,
but its own record is poor. Successive governments of all types have
deferred to the private health lobby and are starving Medicare, slowly
defaulting towards a principally private system, as in the USA. This is a
deeply-troubling prospect because the US health system has been
recurrently criticised (Commonwealth Fund 2021) – and rightly so –
because it makes access to health care dependent on ability to pay. Notably,
however, it is the world’s best system at turning sickness into money.

The other recent Labor ‘reform’ was to allow pharmacists to process
prescribed medications to cover patients’ requirements for 60 days, rather
than 30 days, thereby halving the costs of prescribing and dispensing.
While this may seem helpful, patients are often confused by complicated
generic names and generic brands; and compliance or discontinuation of
medicines is a largely unquantified problem. These are existing problems
with the current arrangements for dispensing medications: the recent
policy change, while well-intentioned, does not redress them. It transfers
resources from professional staff to the pharmaceutical industry.

The ‘Strengthening Medicare Taskforce’ had good medical and allied
health representatives and support. Its December 2022 report defined the
problems but, trying to avoid controversy, positive suggestions were thin
on the ground. A deeper analysis and more comprehensive approach to the
redress of health issues is needed.

Basic problems in the health system

Diverse funding sources causes cost-shifting

Fundamentally, no-one is in overall control of the health system. It has a
number of different funding sources: the Federal and State governments,
the Private Health Insurance industry (PHI), Medicare and individuals

themselves. Workers Compensation (WC) and Compulsory Third Party
(CTP) insurers also put in a bit. These arrangements lead to a situation
where each funding entity attempts to shift costs without any real care for
the overall cost of the system. Private entities such as pathology and
radiology also have an interest in providing more services, whether they
are needed or not.

The broad division of the health system is that public hospitals and
emergency departments (EDs) are State-funded, and non-hospital services
are Federally, PHI or self (patient) funded. There is some overlap,
however, because the State’s provision of some community-based services
allows them to save on hospital-bed days; and private funds paid to State
hospital in-patients are eagerly sought. The starvation of Medicare (which
reduces the Federal government’s spending) has resulted in more patients
going to EDs at higher (State) cost, as well as increasing PHI and patient
costs.

This cost-shifting has evident implications for the affordability of health
care: notably, a recent study showed that Australia, when compared to 10
other countries, scored poorly on its measure of affordability
(Commonwealth Fund 2021).


A new health paradigm is needed

Yet more fundamentally, there is a huge problem with the conceptual
model of the health system. In common parlance, the ‘health system’ is the
‘paying to treat illness’ system. Paying doctors to see and treat patients is
seen as the major cost and is the most politically fraught element in the
system.

Historically, everyone was assumed to be healthy and had episodes of
either infectious diseases or surgical problems. They went into a hospital
for a brief period and either recovered or died. The legacy of this is that
heroic interventions are over-resourced and the more cost-effective early
interventions are under-resourced.

Infectious disease is now relatively uncommon, notwithstanding the recent
and ongoing coronavirus concerns. Most disease is chronic; and the
objective is to maintain health for as long as possible and to support those
who need support in the community rather than in institutions. ‘Health’
must be re-defined as a state of physical and mental wellbeing; and
maintaining it as ‘demand management’ for the treatment system.

Life-style diseases of diet, obesity, smoking, vaping, alcohol, drug-use and
lack of exercise need attention. It might be commented that these habits
are more determined by the political economy of the products than by any
health considerations; and the government should intervene to re-balance
this market failure.


Hierarchies, cartels and corporatisation

The medical system is hierarchical with specialists at the top and GPs at
the bottom. The specialist colleges have produced less practitioners than
would have been optimal. The starvation of General Practice has led to
increasing specialist referrals for simple procedures. Most patients are
happy to go along with this, though often much less happy about the rising
costs. Practitioners tend to work down to their station rather than up to
their capacity. GPs, if given the appropriate additional education and
empowered to act, could do what quite a lot of specialists do now, while
nurses could take the load from GPs; and, in terms of home support, a more
comprehensive and flexible workforce needs to be developed.

Private medical insurance systems are a further source of problems. They
have marketing, churn, profits, liability and fraud issues; and they make it
necessary to account for every item of every procedure. While the
corporations watch every cost, the regulator cannot. Corporations buy
medical practices and take up to 55% of the gross revenue. Smaller
radiology practices are being gobbled up as investments (Cranston 2020).
If overheads are defined as the amount of money put in compared to the
amount paid for treatments, Medicare costs about 5% and PHIs, as they
are regulated in Australia, about 12%. In the USA, the private health funds
take up to 35%, and Australia’s CTP system got close to 50%. A universal
health insurance system could avoid many of these costs and would be far
superior from a social equity point of view.

Similar problems are evident in the provision of care for people with
disabilities. Labor pioneered the NDIS when last in office a decade ago,
and rightly claims this as evidence of its commitment to redress the
previous neglect. However, the NDIS can be considered as a privatisation
of the welfare system. It overlaps medical system functions and is poorly
regulated. If its efficiency is judged by the percentage of money put in that
is paid to the actual workers delivering the service, care is not very

efficient. There have also been significant criminal rip-offs (Galloway
2023).

Retirement care arrangements have major flaws too. Aged-care
accommodation is largely driven by the real estate industry; and access to
continuing care is an add-on of often dubious quality.

What should the government do?

The problems described above are diverse, deep-seated and not easily
rectified. However, a government intent on staying in office for a series of
terms could heed the call for some big thinking, drawing on the experience
of health practitioners themselves. Here is a list of what might be done,
becoming more medical and more politically difficult as it progresses:

Keep people healthy with education, clean water, sanitation, housing,
good food, regular exercise, high vaccination rates, road safety,
universal swimming lessons, CPR and first aid training and the active
discouragement of smoking, vaping, alcohol and drug use, junk food
and gambling.

Provide housing with graded community support options for those
people with disadvantage or impairment. Create a registration and
insurance system for home and community support services, so that
individuals can buy standardised services from other individuals.

Maintain fixed staff-patient ratios related to the disability
classification of residents in institutional care.

Make maximum use of community and school interventions and
support services such as District and Community nurses and School
nurses, mental health support networks, Aged Care Assessment
Teams, Hospitals in the Home etc.

Address health problems as early and as low down the support and
treatment hierarchy as possible, by empowering those who provide
the services.

Create a meaningful regulatory, inspection and enforcement system
for support services, both community and residential, and for
workplaces and recreational facilities.

Use the medical information system to research drug and treatment
effectiveness.
Support General Practitioners and try to increase their ability to solve
problems without referral. Have GPs work in Health Centres with
community support workers as far as possible; and improve
communication with data collection a by-product of normal work, not
an additional imposition.

Have independent evaluation of the numbers needed in the specialties
and pressure the colleges to provide these numbers. Use waiting times
as an initial index.

Initiate either university-based or college-based continuing medical or
professional education, with mandatory refresher exams every
decade.

Have universal professional indemnity insurance, with doctors and
other health professionals unable to be sued if they report all incidents
of sub-optimal outcomes within 48 hours of becoming aware of them,
and participate in regular quality control meetings.

Publicise and promote organ donation, end of life plans, wills and
enduring powers of attorney as sensible steps in life-management.

Evaluate Intensive Care interventions in QALY (Quality-Adjusted
Life Years) terms, researching their outcomes and comparing them to
earlier intervention initiatives.

Change the composition of the Pharmaceutical Benefits Advisory
Committee so that it has no pharmaceutical industry representative on
it; and remove ministerial discretion from its decisions. The previous
system evaluated new drug listing approvals with a cost-benefit
analysis (Doran et al. 2008), but the Howard reforms of 2007,
following the Australia-US Free Trade Agreement and lobbying by
Pfizer, put a drug industry representative on this committee, making
its negotiations more transparent and thus more difficult for the PBS
to negotiate prices (Access to Medicine Working Group 2007).

Work towards replacing Workers Compensation and CTP insurance
schemes with income guarantee schemes (this will only be possible
when Medicare allows timely treatment).

Create a credible and indexed scheme for paying medical
professionals which does not have KPIs that distort performance.
Make Medicare a universal taxpayer funded health system that is free
at the point of delivery and stop subsidising PHI. It might be noted
that the Government currently quotes Medicare and PHI costs
together as a sum rather than itemising the two, which serves to
disguise the subsidy to PHI (Parliament of Australia 2022).

Conclusion
The current federal Labor government has made statements about health
policy reform and done minor tinkering during the first year and a half in
office. Based on this start, it is doubtful that it will have the courage to
make the necessary major changes, addressing the systemic problems.
Fine rhetoric is unlikely to achieve much. That makes it doubly important
to develop proposals for more fundamental reform. Written with this
intention, the suggestions made in this article could be the basis for
tackling the fundamental institutional and political economic issues
problems associated with personal and societal ill-health.

Dr Arthur Chesterfield-Evans trained as a surgeon in Sydney and the UK
and is a Fellow of the Royal College of Surgeons. He currently works as a
GP with interests in workers’ compensation and third-party injury. He has
been a tobacco activist and an elected member of the upper house of the
NSW Parliament. He has Master’s degrees in Occupational Health and in
Political Economy.

chesterfieldevans@gmail.com

References

Butler, M. (2022) ‘Address to National Press Club, 2 May,’ available:

www.health.gov.au/ministers/the-hon-mark-butler-mp/media/minister-for-health-and-aged-
care-speech-national-press-club-2-may-2023.

Commonwealth Fund (2021) US Report, available:
www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-
reflecting-poorly.

Cranston, M. (2020) ‘Radiology enjoys a post-virus buying boom’, Australian Financial
Review, available: www.afr.com/policy/economy/radiology-enjoys-a-post-virus-buying-
boom-20201106-p56c7k.
Doran, E., Henry, D., Faunce, T.A. and Searles, A. (2008) ‘Australian pharmaceuticals policy
and the idea of innovation’, Journal of Australian Political Economy, 62, pp. 39-60.
Galloway, A. (2023) ‘Federal crime syndicates using cash vouchers and gifts to steal NDIS
funds’, The Sydney Morning Herald, available: www.smh.com.au/politics/federal/criminal-
syndicates-using-cash-vouchers-and-gifts-to-steal-ndis-funds-20230414-p5d0ma.html.
Parliamentary Library (2022) Health overview, available:
www.aph.gov.au/About_Parliament/Parliamentary_departments/Parliamentary_Library/p
ubs/rp/BudgetReview202223/HealthOverview.
PBS (2007) ‘Access to medicines working group’, available: www.pbs.gov.au/info Access to
Medicines /general/working-groups/amwg/amwg-jul-2007.
Sax, S. (1984) A Strife of Interests: Politics and Policies in Australian Health Services,
Sydney: George Allen and Unwin.
Searles, A., Jefferys, S., Doran, E. and Henry D.A. (2007) ‘Reference pricing, generic drugs
and proposed changes to the Pharmaceutical Benefits Scheme’, Medical Journal of Australia,
187(4), pp. 236-39.
Strengthening Medicare Taskforce (2022) Taskforce Report, Commonwealth Department of
Health, available: www.health.gov.au/sites/default/files/2023-02/strengthening-medicare-taskforce-report_0.pdf.
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How Much Exercise Should You Do?

17 November 2023

It has been shown that exercise lessens mortality and lengthens life by lessening the chance of cancer and cardiovascular diseases like heart attacks and strokes.

So the question has become ’How much exercise do you have to do; how long and how hard?’

New research has been done in 2 major studies, and an editorial that evaluates them.

In a study by Stamatakis in the European Heart Journal, the amount of Vigorous Physical Activity (VPA) was measured for a week in 71,893 UK Biobank middle-aged adults using a wrist-worn accelerometer.  Their mortality was compared after 5 years and was:

No exercise                                                                           4.2%,

1-10 mins of exercise/week                                                 2.1%

10-30 mins                                                                              1.8%

30-60 mins                                                                              1.5%

over 60 mins                                                                             1.1%

What is remarkable about this is how little vigorous physical activity is needed to halve mortality!

There was also a linear relationship between the frequency of exercise and mortality.

In other words, the more often you exercise the better, with 27 times a week having the lowest mortality, but only short bursts are needed.

 

A similar study by Demsey on 88,412 middle aged UK Biobank adults showed that a higher amount of Physical Activity Energy Expended (PAEE) was associated with a lower mortality after 6.8 years.

If this energy expenditure was made up of more Moderate to Vigorous Physical Activity (MVPA) there was an additional benefit.  Cardiovascular disease rates were 14% lower when MVRA was 10-20% of PAEE.

The bottom line is that exercise is good and incorporating a little in your day will benefit you.

Vigorous exercise can probably be equated with being short of breath, so walking up a hill or steps briskly rather than strolling is better.  Obviously any sort of sport that involves some period of exertion is good if you are able to do it. If you have done no exercise for a while or have very poor fitness, just increase it slowly – walk a bit faster initially and build up from there.

It is good to know that every bit helps!

 

Here are the studies:

https://academic.oup.com/eurheartj/article/43/46/4801/6771381

https://academic.oup.com/eurheartj/article/43/46/4789/6770665

https://academic.oup.com/eurheartj/article/43/46/4815/6774597

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Loneliness is a Major Public Health Issue

17 November 2023

The World Health Organisation (WHO) has declared that loneliness is a major public health issue.  The COVID isolation worsened the situation, but at least drew attention to it.  Declining family size, the stress on the individual, and the ability to live alone have worsened the long-term trend to loneliness.

The Japanese have recognised this for some time, but have not mastered the problem.  In Australia it seems only to get attention when some old person is discovered dead for months when the smell emanates from their flat or their electricity is cut off.  In the younger age groups, suicide may be the first  and last sign.

From a medical point of view, I have quite a lot of patients that have long-term painful problems that cannot be resolved and render  them unable to work.  They are often financially embarrassed also, a fact that they often try to hide.  They are recognised as depressed but people are reluctant to acknowledge that medications do not help much.  This week I had a patient who asked if the insurer would pay for a companion dog, as he could not really afford to feed it.  We discussed dog sources and sizes.  My guess is that workers compensation insurers will be willing to pay for tablets that don’t work as they are a ‘medical expense’, but not a little dog that may be a more practical solution.

An article in the Guardian surprised me that loneliness is a bigger problem in Africa than in Western countries.  I had assumed that the strong family ties and interdependency would make it a worse problem in Western rather than African societies.

What is needed is governments to recognise that there is a value in the relationships between people.  It used to be called ‘social capital’, but the term seems to have fallen out of favour. We could encourage ‘Meet Your  Neighbour Day’, street Christmas parties and other activities that encourage interpersonal contact beyond the social media apps.  Both civic and domestic architecture could give more thought to encouraging human to human contact.

www.theguardian.com/global-development/2023/nov/16/who-declares-loneliness-a-global-public-health-concern

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Fracking for Gas Destroys Farmland

15 March 2023

Some years ago, I was a farmer in New Zealand.  I met a cashed-up American who was in NZ trying to buy farmland.  I asked him why he was NZ rather than Australia.  He said, ‘Australia is fuc*ed , mate.  The governments have let them frack it all, and soon they won’t be able to farm’. 

He was from the US and had seen it happen there. The problem is that politicians are mostly  lawyers and accountants and do not know what they do not know.  Perhaps they are easily conned by lobbyists in suits.  The fact is that the surface of the earth is like a layered cake with rock strata that stop water simply going to the lowest level.  If an underlying impermeable level is broken, the water which may have been kept in the overlying soil drains to a deeper level.  So big mines or fracking, which means fracturing and cracking the stratum, allows gas to be released upwards, but also allows the water to flow downwards. This leaves the topsoil without water, which eventually will turn it to sand as the organic matter dies. 

The nett effect is that the gas is released once, but the water escapes forever. The gas company makes its money and moves on- the yield of the land is forever damaged. The farmer is the first economic casualty, national production notices it more slowly.  The chemicals used in fracking also pollute the groundwater, so bores used for stock produce undrinkable water. There is no method for removing these chemicals from the groundwater.

The advocacy group, ‘Lock the Gate’, are doing their best but are still losing the political battle and the gas companies are still expanding activities.  Some of the best agricultural land is the Darling Downs in Queensland and the Liverpool Plains in NSW, which are both under threat.  What is also likely to happen is that they will frack near the Great Artesian Basin, which is a huge water body under a third of Australia. It is currently unpolluted by fracking chemicals, but if it becomes polluted, which seems inevitable, there will no usable water in huge areas of arid Australia. It will be a national ecological disaster.

The words of the American entrepreneur are ringing in my ears.

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Please Write Submission re Vaping by 16 January

28 December 2022

Vaping is now own by tobacco companies who are following exactly the same path as they did with tobacco. They managed to get out of having to prove it was safe because a few naive doctors, still fight the tobacco wars said it was ‘better than tobacco’, an incredibly low bar to clear- not really a bar at all.

Then they said it could be used to quit, and a handful of doctors who made a living from Quit clinics when 99% of people quitting just do so, supported this. Now it is being marketed in new ways to that the adds are not visible to those who are likely to oppose vaping and the habit is growing hugely, with the Industry also using peer-to-peer marketing to evade and futures regulations or prohibitions.

Vaping is now more of a gateway to smoking than a path from it, and that suits the Industry just fine.

It is likely that the solvents will be harmful in the long term, so the precauti0onaly principle would mean that it should be banned until it is proven safe, which is frankly unlikely.

In London there is now a coffee shop that advertises Vaping and Coffee’ which assumes that indoor vaping is not smoking and will be tolerated by non-vapers. Presumably they will resists vaping controls indoors until passive vaping is shown to be harmful and tat might take 30 or 40 years- a total tobacco epidemic re-run. So please write a submission to the inquiry.

 

smh.com.au

Now here’s a deadline: We have until January 16 to help stop toxic vaping

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British American Tobacco launches new Campaign to legitimise Vaping.

23 November 2022

Almost all the vaping products are owned by tobacco companies, and the marketing is almost a re-run of their tobacco campaigns. i.e:

1. Assume that it is here to stay, and hence legitimate and unstoppable.
2. Suggest that ‘courtesy and consideration’ is all that is needed.
3. Fight regulation as much as possible.

Naturally they are keen to say that any attempt to restrict nicotine is doomed to failure as it is already totally available on the Black Market.

It might be noted that when there were different regulations in Canada from the US for tobacco labelling, cigarettes were smuggled through the Indian reservations, and all labelling that used to allow the source of the cigarettes to be identified was removed from the packaging, which showed what contempt the tobacco industry had for regulations that lessened their sales.

We might expect that similar things are happening in sales of vaping products and liquids. Naturally as they talk about how hopeless it is to regulate vaping products they want to hark back to the failure of alcohol prohibition in the 1930s, which led to Al Capone and his gangsters.

Older folk will remember that as the tobacco control movement grew stronger in the late 1970s we were attacked as ‘wowsers’ and ‘killjoys’, with the implication that we were stopping people having a good time, which was what smoking was all about. It is the same tactic again. We want to stop all the happy vapers.

The tobacco industry used the fact that some doctors think that vaping can help people QUIT to allow them to sell their product without having to prove it was safe. They only had to prove it was less dangerous than tobacco- a very very low bar.

Now vaping is used more as a gateway to smoking than a path from it, and often if there is nicotine in the vape it can be used alternately as a substitute. So presumably will be a move to push vaping in smoke-free areas. Then vaping will be the ideal product for the tobacco industry, being used everywhere, helping consumption, and keeping some people smoking at other times. Just like the good old days.

Health interests have to keep the government onside, but also demand some serious anti-vaping campaigns.

Vaping uses solvents, which dissolve fats. If this is the case, it is like upmarket petrol sniffing, as it will dissolves cell membranes, especially in the brain, which has the highest blood supply of any fatty tissue in the body. This is likely to lead to gradually progressive dementia. Naturally this may take years to manifest, and even longer to be identified and scientifically proven, given that a highly sceptical Industry that will criticise the research; in short a re-run of the tobacco wars.

If we look at the history of tobacco, it was used in relatively small quantities until the invention of the cigarette rolling machine by Duke in 1898. It was massively marketed during and after WW1 from 1914. It was shown to cause lung cancer in 1950. Advertising bans started in the mid 1970s, but full sponsorship bans and smoke-free indoor air did not come until 2000. The tobacco epidemic lasted a full century; so watch out for a vaping re-run with a dementia epidemic in older folk. Unlikely? No;. quite possible. So will the tobacco industry prove it is is safe. They can’t, don’t want to; now don’t have to, and have put out this BS new organisation.

www.theaustralian.com.au/the-oz/news/big-tobacco-company-behind-vaping-overhaul/news-story/1078baf2358e5ba3d96c6235aac49610

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BUGA UP –  the issues keep resurfacing

19 November 2022

BUGA UP originated in 1979, when its 3 founders were prevented from a regular evening out to re-face tobacco billboards by pouring rain.  As it they sat and waited, they thought about how to publicise their work so that it did not appear as random anti-tobacco graffiti. They wanted a word that would be irreverent and would embody the concept of hitting back against the unhealthy promotions. After some discussion, the word BUGA UP was developed, an acronym for Billboard Utilising Graffitists Against Unhealthy Promotions. From that night they signed all the re-faced billboards with BUGA UP.

The major problem at that time was tobacco promotion, which accounted for over half outdoor advertising, with alcohol second. The concept was self-regulatory in that anyone taking up a spray can had to make their own decision about what they wanted to say, i.e. what they were willing to be arrested for. 

A relatively large number of graffitists, especially from the medical fraternity, were inspired by what appeared to be a large campaign and were willing to be arrested for spraying on tobacco billboards. Other activists were concerned about alcohol promotion and some were concerned about sexism in advertising.  A relatively small percentage were willing to be arrested for junk food or drink ads. (There were no ads for gambling at that time).

BUGA UP, however, looked at the whole issue of the regulation of advertising, asking that it not be one-way communication with no input from consumers or regulators as to the content or consequences of the promotions.  The advertisers’ position was that it was their money, they could  say what they liked, as this was ‘freedom of commercial speech’. Note the extra word in the cliche ‘freedom of speech’.

The advertisers set up a farcical ‘Advertising Standards Council’ which had very loose ‘codes of practice’ and an industry dominated judicial system, which took so long to work that the ad campaign was invariably over even if they banned an ad, which very rarely happened as they had the numbers in the kangaroo courts.  One hapless paediatrician was recruited onto one of these committees, had his name used to champion the quality of its membership, and of course was outvoted in every deliberation.  He eventually acknowledged sadly that he had been ‘used’ and he resigned.

But BUGA UP was active, producing a publication, ‘Billboard’, which was sent to all the major players in the advertising industry to emphasise to them that their regulatory systems were recognised as farcical.  BUGA UP invented the ‘Advertising Double Standards Council’ to satirise the ‘Advertising Standards Council’.  Its slogan was ‘If advertising standards are good, double standards are twice as good’.

One of BUGA UP’s members, Peter Vogel, wrote over 400 complaints about many ads. He was labelled a ‘serial complainer’ and they wanted not to respond to his complaints. He insisted that by their own charter they had to. They rejected all 400+!

Eventually there had been so much publicity about advertising regulation that the advertising industry wanted the Trade Practices Commission to re-legitimise its self-regulatory system, presumably as they thought government regulation was possible in the future.  The Fairfax newspapers fronted this action, and it was opposed by ACA, The Australian Consumers’ Association. The advertisers said that their codes and practices were working well.  At this stage Peter Vogel of BUGA UP came out of the woodwork, with his huge file of denied complaints. He had systematically made complaints using every item of the advertisers codes of practice and had a farcical response to every item, which the Commission could judge for itself.

Two academics, Shenagh Barnes and Michael Blakeney  wrote a book called ‘Advertising Regulation’ (Law Book Co 1982) which concluded that the self regulatory system manifestly lacked credibility’. But despite the moral victory, the consequences of the trial were not good. The Trade Practices Tribunal concluded that it was not able to set up a regulatory structure, but could only either approve or reject what was put in front of it, so in the absence of any alternative it approved the self-regulatory system as it might have a bit of benefit over nothing at all. ACA, the Consumers’ organisation, was almost sent bankrupt by the legal fees involved, and overall the Industry had got what it wanted.  A few years later when the issue had faded from the public eye, the Advertising Standards Council faded too.

The original BUGA UP guide, ‘Ad Expo- a self-defence course for children’ from 1983 is still available  online, but of course its ads are now dated. (ww.bugaup.org/publications/Ad_Expo.pdf

But now, as gambling wreaks havoc with families, and childhood obesity skyrockets, the issue of irresponsible advertising is back in the spotlight. Let us hope that there is more success this time, but a lot of work will be needed even to get up the momentum that BUGA UP had in 1983.

Here is an article on sugar and obesity: 

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BUGA UP Nostalgia

16 November 2022

BUGA UP (Billboard Utilising Graffitists Against Unhealthy Promotions) was most active fro m 1979-1985, and had a big effect on tobacco and smoking. It was also a high point in the demand for advertising to be responsible for the consequences of its use of its products.

In the end, the advertisers accepted a ban on tobacco to keep the threat of stronger regulation at bay. They cut back on sexism a bit and the movement to regulate them died down. So alcohol, gambling annd junk food ads have survived.

Here is a link to some of the TV programs from that time and a little after.

www.youtube.com/user/BUGAUPTube

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Vaping- A WHO Guide

10 November 2022
The World Health Organisation is trying to lessen vaping, which is now reaching epidemic proportions in young people. The attached article clarifies the tobacco Industry’s gobbledygook, though it is fairly soft on their rapacious marketing.

Social media has allowed the tobacco industry to target children and young people without adults noticing, which is different from the tobacco marketing days, when everyone saw the same ads.

The Industry claims that since vaping is less harmful than smoking, it should be legal, and most importantly that they should not have to prove it is safe. They have achieved this latter, and now because this has allowed them to achieve high sales they have made it hard to ban. They also use a lot of kids marketing to kids, as happens with illicit drugs, to make it harder again.
Of course not very many people use vaping to quit, and it now seems that vaping is a gateway to smoking, and a way of not quitting. But do not expect the Industry to do anything except maximise their profits.
The health interests are ponderously getting their resources together, for a battle that will take a generation or two, if tobacco, asbestos, lead etc are any guide.
www.facebook.com/groups/GlobalTobacco/?multi_permalinks=5906974112658360&notif_id=1668001224984823&notif_t=group_activity&ref

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Priorities for a Pro-Life US State Senator

3 July 2022
One of my US friends quipped that ‘Republicans are pro-life until it is actually born’. During the birth
process Republicans are against free health care and after the birth they are against welfare, child
support, living wages, equal opportunity in education etc.
The Pro-life senator in Oklahoma, Wendi Sherman, who was the proponent of the abortion ban
there, said, “The purpose [of government] is to protect life, not to provide for citizens.”
The practical corollary of this definition of the role of government is that women are forced to have
children that they did not want and then forced to care for them, when they knew before the birth
that this was too difficult to attempt. One might ask whether this is the same religious view that was
extant when I was young that having a baby was punishment for the sin of having sex. There is no
quote or evidence of a question on this subject, but these sort of fundamentalist views do seem
extant in the US.
I wonder if political hardheads in the Republican party just use abortion to shore up the significant
religious vote. Abortion is painted as a ‘life and death’ issue and so has great weight. Other policies
like foreign wars, tax cuts for the wealthy and cuts to Medicare and welfare programs can sail
through because of this preoccupation/obsession.
www.abc.net.au/news/2022-07-03/abortion-rights-oklahoma-roe-v-wade/101167280

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