People are asking me if they should get vaccinated. It shows how trust in our institutions has been eroded. A few years ago no one would have questioned it.
The side effects are far less than the death rates from COVID, particularly in older age groups or those with other health conditions. COVID also seems to have a considerable amount of long-term after-effects in a significant percentage of people; note the difference between the infection rate and the recovered rate in the statistics. (Of course some may have just been lost to follow-up).
Children seem to have few symptoms, but if they are not infected and grow older without immunity, it would be ironic if they are then badly affected later. Mumps is like that- relatively trivial in youth, but can cause pancreatitis, encephalitis and sterility later. Years ago in the pre-vaccination days, if a child had chicken pox or measles, the mothers would all bring their children to be deliberately infected at a ‘Pox Party’, though these are now discouraged. This sort of immunity may well be spreading and giving herd immunity in countries that have COVID now endemic, but it would be unwise to do it here as it would spread it to more vulnerable demographics.
Chicken pox can cause herpes zoster (shingles) in older folk, which is very painful, and now has a vaccine (Zostavax) that is very expensive but free after age 70.
This article is about the Oxford-Astrazeneca vaccine, which is not the Pfizer one that is currently being rolled out in the UK. It seems that the Oxford one is the first to publish the results of a Phase 3 trial, and though a lot of people have been vaccinated, not many people have been infected, which means that the numbers on which the conclusions are drawn are still not large. There is an embedded link in the article that gives a good summary of the trial procedures. It seems that the Oxford vaccine will have the advantages that it is easier to store, and transport and is cheaper. Presumably as this article is now published, its roll out is imminent also.
From an Australian perspective, there is now a huge rollout of the Pfizer vaccine in the UK, so we will know exactly how well it works by the time it gets here.
It is sad that the Qld Uni vaccine has been abandoned as it gives a false positive for the HIV/Aids Antibody test. Presumably it would have worked, and perhaps an alternative HIV/Aids test might have distinguished the two apart.
Here is an article about the US Health system and its response to COVID. Basically it seems that the US government is subsidising COVID treatments so that they are more lucrative than treatment of other diseases, so the private operators are filling their hospitals with COVID patients whether they need to be admitted or not, and non-COVID patients are excluded.
The other thing that is interesting is that there has been a huge growth in administrators since the 1970s. It has to be understood why private health systems are so inefficient. They have to keep individual insurance databases to keep track of premiums and churn as people change funds. When someone is treated they have to account for every band aid, visit, procedure or investigation, bill the patient and pay the practitioner. They have to market their product, compete for staff, and then figure out ways to avoid paying if possible.
Universal systems have everyone eligible, so do not need to worry about who is getting treated. No need to market the system, maintain many different churning databases, compete for doctors, keep accounts for every details of every treatment and bill and pay for them individually.
In terms of better health care there is no problem of adapting to whatever disease needs the most attention as the staff are motivated to do the most effective treatments, and there is no distortion of priorities to maximise profits.
The US health system is the least effective in the developed world in terms of delivering health care. but it is the most effective at its primary object- turning sickness into money.
No one has looked too closely at why the Australian system has been able to respond. Basically our public health system is State-based hospitals, which are still largely public and have doctors who could be re-directed to testing and vaccination. They can also change to do COVID if needed, and treat disease on their merit.
The private hospitals did very well out of the government subsidies here because they were emptied ready for a COVID influx that never came and they just pocketed the cash without much publicity for this from either themselves or the Government.
Australia has continued on its previous course, which is to starve Medicare and help the private system move towards a US system by stealth, and the COVID pandemic has so far not brought this to light. What is left of the public system has done well, helped by the fact that we are an island nation, so had some warning and could act to quarantine ourselves. The government was happy to take advice from the medical professionals because it had made such a mess of not taking advice from the firefighting professionals. But Medicare is still being quietly destroyed and we are moving to a US system of private medicine.
The government saves money on Medicare doing this, even though the system is much less efficient and much less equitable. But the key reason is not the savings on Medicare, it is the money to the Party coffers from the Private Health Industry (PHI), which is now much stronger with the changes John Howard did to the Aged Care system in 1997, which made it effectively a for-profit system, and the NDIS also a for-profit system, subsidised by the taxpayer through the Medicare levee, which was ironically not being used for health. (The discussion of the Aged Care system was in one of my posts last week).
The key thing to understand in the destruction of Medicare is that the rebate to doctors which was set at 85% of the AMA fee, so as to replace private medicine, has risen at half the inflation rate for 35 years and is now 46% of the AMA rate. Doctors are paid half what they were, so specialists mostly will not use it, and GPs who still bulk bill just do shorter visits.
Here is the article on the US response to COVID. Their prevention is also hopeless, as with such a poor welfare system the people cannot afford to stop work, and the story that it was a hoax was also promoted by President Trump. The obsession with ‘individual rights’ sits uneasily with the idea of staying home for the common good, and makes disinformation campaigns easier. People wanted to believe it was a hoax, because they could not afford to stop work anyway.
I attended a DRS (Doctors Reform Society) zoom webinar on the future of health care with Professor Stephen Duckett and aged care with Professor Joseph Ibrahim of Monash Uni, a geriatrician whose experience is in evidence-based aged care.
It was not encouraging.
Preamble:
My own experience of nursing homes was initially as an after-hours doctor when I used to judge nursing homes by what I turned the Urine Smell Index; the worst ones smelled of urine when you opened the door at night. As a GP years ago I found it increasingly difficult to find someone trained to talk to about the patients’ treatments.
In New South Wales Parliament as an MP I was asked to pass legislation that lessened the number of trained nurses required on staff. ‘Flexibility’ was the key and many homes and facilities ‘had people who were not really sick’ we were told. I was not convinced but the legislation went through anyway.
When my widowed mother was no longer able to cope at home and the family went looking for supported accommodation it soon became clear that the driving force in Aged Care is real estate profits. The family home is sold and the object is to get the family to buy an overpriced retirement Villa with varying levels of support in the villa and then hopefully automatic entry into an attached nursing home, usually with quite a poor urine smell index. When the old person dies the villa profit largely reverts to the corporation.
A dear old widower professor who lived up the road needed support in his 90s. The home support contract offered needed at least 4 hours per week at $65 per hour. The person delivering the care was paid $20 an hour. I am unsure how District Nurses are allocated.
In 2000 Prime Minister Rudd asked for ideas for his ‘2020 Vision’. I wrote and suggested that he register the skills and training of Home Care workers so that they could be hired and evaluated like Uber of any other online service and the ‘quality control and insurance’ would not be why the contracting agency became so ‘vital and expensive’ (that it would end up costing more than the person who actually did the work). I never even had an acknowledgement of my suggestion.
Prof Duckett was of the opinion that things had got a lot worse since the 1997 Aged Care Act, John Howard’s work, which created ‘a business opportunity’ Prior to this there was a system called CAMSAM which was two modules; Care Aggregated Module and Standard Aggregated Module. These were funded separately. If they did not spend their Care money it was forfeited, so they could only profit on Services.
After 1997 there was no distinction so profits could be made from either component, so the quality of care declined, usually with lower staffing levels.
Some private-for-profit nursing homes have good care, but this is not common. Some not-for-profits also had very poor care, but the general rule is that the standard of care relates to the number and training of staff. The low wages (approximately equals $20 per hour) mean that the staff need to work multiple jobs in multiple locations which is what spread the COVID epidemic in Melbourne. Government run homes tended to have better staffing ratios, so were better able to act against the infection.
Professor Joseph Ibrahim commented that the terms of reference of the current Royal Commission on Aged Care were very narrow, only covering 5 years, and could not lead to prosecution. He felt that this was deliberate. The issues of overprescribing and assault have come up often.
He felt that this meant that it’s conclusions might be weaker and then not implemented, with a tendency to kick difficult problems down the road.
The commissioners themselves were of interest:
Richard Tracey had died before the enquiry started
Another, a Western Australian prosecutor had opted out (an unusual action as being on a Royal Commission is normally a good career move).
The two final commissioners are:
Tony Pagoni, Chairman- a retired judge who had had a specialisation in tax law and
Lynette Briggs- a career health bureaucrat
Commissioner, Briggs has put out a report asking that aged care be returned to the control of the health department. Prof Ibrahim comments that is very unusual for one Commissioner to make a public statement before the final report and this indicates that the commissioners are not in agreement.
Currently there are about 250,000 care workers and about 200,000 Professionals. The care workers need six weeks training at a TAFE level to get a ‘Certificate 3’ About 1/3 are new migrants. They are paid about $20 per hour and casualised to decrease staff costs. The unions are worried that the new RECP (Regional Comprehensive Economic Partnership) trade treaty actually allows trade in people and that more visas for cheap labour in these areas will not help residents or local jobs.
The $20 billion dollar industry is founded approximately $14.5 billion from government, $4 billion from RADS and $2-4 billion for additional services.
There are not-for-profits, but the large for-profit providers have increased since the 1977 act and are largely highly profitable big corporations, some multinational like BUPA.
Professor Ibrahim is concerned that there is a lack of supervision.
There are no forensic accountants looking at what it costs to run an aged care facility and this has allowed supernormal profits by big players. Money has been spent poorly or ‘hived off’. Obviously if the government runs some homes themselves there will be public service experience.
Prof Ibrahim believes that the future directions of aged care will be set by the multinational for-profit providers because these are the people who have direct access to the government. There is no significant advocacy for aged care residents. He contrasts this with breast cancer advocates who pressed for less radical operations, and for Gay men who pressed for more enlightened AIDS/HIV policies.
There have been discussions of ‘quality-of-life’ that have tended to be spoken of as needing less healthcare, but quality of life cannot be good without good health care.
The aged care industry likes home care as it lessens their costs and also pushes the liability back onto GPs. A sense of proportion is necessary:
There are 2.5 million well older people and 200,000 in aged care.
More radical treatments are now done in older age groups such as dialysis or cardiac surgery in the over 90s, very is some debate over this period some would say that it is a just to deny routine treatments but there is some distortion of priorities by having these lucrative procedures as fee-for-service, and there is also some inequity.
Since the development of antibiotics, medicines are seen as curative, but in fact they should be seen as being in three classes:
1. Curative
2. Palliative
3. Preventative
There is quite a lot of cost-ineffective medication use, such as for osteoporosis.
Solutions. (These are not just from the presenters)
A national registration system for all levels of care workers period this should include people who do home help with shopping cleaning and gardening as well as Medical & personal care workers.
Existing TAFE courses should be recognised but more courses will be needed.
There needs to be a feedback database for complaints/praises and ratings as there is for AirBNB, restaurants etc. The feedback database needs to be actively monitored by the regulator to follow up complaints or untoward events.
There needs to be a regulation system with accreditation and regular random inspections of facilities and surveys of residence.
Academic researchers such as AIHW (Aust. Institute of Health and Welfare) should be at arm’s length and should have long-term commissions to do longitudinal studies of aged welfare and satisfaction so that individuals cannot be targeted if they state that they are not happy with the care in their institutions.
This should be combined with health research.
There should be formal structured feedback systems with residents’ groups having paid advocacy groups and formal places and rights on regulatory bodies.
There must be minimum wages and conditions for all workers and minimum staffing standards.
The Regulatory body must have a policing function, supervising staffing and wage levels and food and care standards
Final Comment
Note there are a large number of public submissions on the Royal Commission website, many of which make discouraging reading. The privatisation seems to have led to profit-seeking rather than an improvement in care, and the political forces seem likely to continue this.
Doctors tend to assume that everyone knows certain things, particularly because everyone they meet usually does. They also tend to think that everyone knows the order of importance of what they know.
Many years ago as I started to campaign against tobacco, Henry Mayer, the first Professor of Political Economy in Sydney, who had a regular column in the SMH told me that the health people were invisible in the media on the tobacco issue. I said that this was ridiculous, it was the most studied subject in the history of medicine, with over 60,000 papers and growing daily. He pointed to a person called Tollison, who wrote in the non-medical media that was read by the business sector. There were no medical responses there. The mainstream also media had relatively little on tobacco, as tobacco advertising was one of the major sources of revenue.
So the harm of tobacco was known, but ignored, like the fact that you are going to die one day.
It came home to me, when I amputated the leg of a smoker for vascular disease. He had bad lungs and a bad heart. I said, ‘Look mate, if you keep smoking, you will lose the other leg.’
To my amazement he replied, ‘Look, all you doctors go on about smoking, but if it was as bad as you say it is, the government would do something about it’.
He had internalised the government’s non-action as being mute testimony to it not being a problem. Doctors are, after all a subculture that claims to have expertise in a certain area, as do engineers, educators, weather forecasters and many other groups. In tobacco, the Tobacco Industry, the Australian Hotels Association, Clubs and Pubs and the advertisers and sponsorship recipients fought like tigers to stop reasonable public health policy. They are probably still retarding it- there has not been a Quit campaign in Australia for over a decade.
Trump’s denial of the significance of COVID19 must have struck a chord with those who knew that in the absence of decent welfare system a lockdown would send them broke. They needed to believe that they could carry on, and he and his denial were their salvation. A lot of business interests supported them- they would go broke too.
So it was interesting that the health facts became politicised, and wearing a mask was as much a political statement as a medical one. Politics was not, and will not be in future a good basis for personal preventive heath decisions. So controlling the COVID epidemic in the US will be harder than here, where mainly apathy and complacency are in the way.
The figures that only 4% of people in the US changed their view on the dangers of COVID goes some way to explaining why Biden did not have a landslide. For many people, COVID was not an issue, Trump’s rhetoric was plausible if you did not fact-check, and the economy had been going OK prior to the epidemic.
SMH today:
Virus neglect didn’t infect Trump vote
Shaun Ratcliff
?
Since the first person was diagnosed with COVID-19 in the US, more than 10 million cases have been confirmed and nearly a quarter of a million people with the virus have died.
Watching from afar, in a country where the coronavirus has been significantly less lethal, it is surprising the incumbent president did as well as he did.
While the pandemic probably did cost him votes, surveys we have run over the course of the year showed there are strong partisan effects on attitudes towards COVID-19, with supporters of Donald Trump mostly unconcerned about the risks from the virus, and getting less worried as the year went on.
These surveys were run in May and September. Both surveys consisted of responses from more than 1000 Americans.
In May, approximately 40 per cent of all Americans were very or extremely worried about the possibility they or a family member might catch the virus. Almost the exact same number were only a little or not at all worried. According to our data, this level of concern actually declined slightly between May and September.
This was largely a partisan affair. Respondents who said they were going to vote for Joe Biden retained a similar level of concern during this period, with 48 per cent very or extremely worried in May, and 50 per cent in September.
However, respondents who said they would vote for Trump were not very concerned about COVID-19 in May – about 19 per cent reported they were worried about it in the first survey and just 11 per cent of Trump voters reported this level of concern in the second survey.
The partisan differences, and the declining trend in Republican concern about COVID-19, are largely the product of the extremely polarised media and political environment in the US.
Trump voters are less trusting of information on COVID-19 from medical experts than Biden supporters, and between May and September a quarter of Republican voters became less likely to trust information from these experts.
This difference may, in part, stem from the media through which they obtain information. Those with the lowest levels of trust tended to rely upon more conservative cable and online news like Breitbart and Fox News, for instance, which have played down the risk posed by the pandemic.
Republicans who rely more on these conservative media outlets were more likely to have lower levels of trust in medical experts, even after controlling for demographic differences between Democrats and Republicans. They were also as likely to trust Donald Trump as medical experts for information on the coronavirus.
In this polarised environment, very few voters abandoned Trump between May and September (only about 4 per cent in our data), and hardly any shifted to support Biden.
Trump supporters tended to align their position on the coronavirus with their political allegiance. Relying more on media that downplayed the significance of the coronavirus, and taking cues from Republican leaders, they decided the pandemic was not a significant threat.
Our data indicates Biden was able to win over a small number of voters who supported neither candidate at the start of the year. It was enough to win in the end, but not enough to deliver the predicted landslide.
Shaun Ratcliff is a lecturer in political science at the United States Study Centre, University of Sydney.
About 37 years ago BUGA UP (Billboard Utilising Graffitists Against Unhealthy Promotions) identified the problem of advertisers marketing to children and produced a guide, ‘AdExpo- A Self-Defence Course for Children’. It was in black and white as BUGA UP had no money and the ads are a bit dated now, but the text us still relevant. www.bugaup.org/publications/Ad_Expo.pdf
Advertisers market to children, and are successful with it. Now there is the internet, which has made things a lot worse. Kids can be targeted with the parents only dimly aware of what is going on, and before the kids have actually been formally ‘taught’ anything. The ads are part of the exciting environment that their little heroes show them. At last attention is being drawn to this. This article is from the NY Times, with a cut-down version in the SMH of 7-8/11/20.
Popular YouTube channels often bombard young children with thinly veiled ads for junk food, a new study finds.
One of the most popular YouTube videos from Ryan’s World shows its star, Ryan Kaji, pretending to be a cashier at McDonald’s. “It’s a stealthy and powerful way of getting these unhealthy products in front of kids’ eyeballs,” a public health expert says.Credit…via YouTube
That is the conclusion of a new study published on Monday in the journal Pediatrics. The authors of the study analyzed over 400 YouTube videos featuring so-called kid influencers — children with large social media followings who star in videos that show them excitedly reviewing toys, unwrapping presents and playing games. The study found that videos in this genre, which attract millions of young followers and rack up billions of views, were awash in endorsements and product placements for brands like McDonald’s, Carl’s Jr., Hershey’s, Chuck E. Cheese and Taco Bell.
About 90 percent of the foods featured in the YouTube videos were unhealthy items like milkshakes, French fries, soft drinks and cheeseburgers emblazoned with fast food logos. The researchers said their findings were concerning because YouTube is a popular destination for toddlers and adolescents. Roughly 80 percent of parents with children 11 years old or younger say they let their children watch YouTube, and 35 percent say their children watch it regularly.
A spokeswoman for YouTube, citing the age requirement on its terms of service, said the company has “invested significantly in the creation of the YouTube Kids app, a destination made specifically for kids to explore their imagination and curiosity on a range of topics, such as healthy habits.” She added, “We don’t allow paid promotional content on YouTube Kids and have clear guidelines which restrict categories like food and beverage from advertising on the app.”
Young children are particularly susceptible to marketing. Studies show that children are unable to distinguish between commercials and cartoons until they are 8 or 9 years old, and they are more likely to prefer unhealthy foods and beverages after seeing advertisements for them.
Experts say it is not just an advertising issue but a public health concern. Childhood obesity rates have skyrocketed in recent years: Nearly 20 percent of American children between the ages of 2 and 19 are obese, up from 5.5 percent in the mid 1970s. Studies have found strong links between junk food marketing and childhood obesity, and experts say that children are now at even greater risk during a pandemic that has led to school closures, lockdowns and increased screen time and sedentary behavior. The new findings suggest that parents should be especially wary of how children are being targeted by food companies on social media.
“The way these branded products are integrated in everyday life in these videos is pretty creative and unbelievable,” said Marie Bragg, an author of the study and an assistant professor of public health and nutrition at the New York University School of Global Public Health. “It’s a stealthy and powerful way of getting these unhealthy products in front of kids’ eyeballs.”
Dr. Bragg was prompted to study the phenomenon after one of her co-authors, Amaal Alruwaily, noticed her young nieces and nephews obsessively watching YouTube videos of “kidfluencers” like Ryan Kaji, the 9-year-old star of Ryan’s World, a YouTube channel with 27 million subscribers, formerly named Ryan ToysReview.
The channel, run by Ryan’s parents, features thousands of videos of him excitedly reviewing new toys and games, doing science experiments and going on fun trips to stores and arcades.
Children’s channels like Ryan’s World — which are frequently paid to promote a wide range of products, including toys, video games and food — are among the highest grossing channels on YouTube, raking in millions of dollars from ads, sponsored content, endorsements and more. According to Forbes, Ryan earned $26 million last year, making him the top YouTube earner of 2019. Among the brands he has been paid to promote are Chuck E. Cheese, Walmart, Hasbro, Lunchables and Hardee’s and Carl’s Jr., the fast food chains. One of his most popular videos shows him pretending to be a cashier at McDonald’s. In it, he wears a hat with the McDonald’s logo, serves plastic Chicken McNuggets, cheeseburgers and French fries to one of his toys, and then eats a McDonald’s Happy Meal. The video has been viewed about 95 million times.
“It looks like a normal child playing with their normal games, but as a researcher who studies childhood obesity, the branded products really stood out to me,” Dr. Bragg said. “When you watch these videos and the kids are pretending to bake things in the kitchen or unwrapping presents, it looks relatable. But really it’s just an incredibly diverse landscape of promotion for these unhealthy products
In a statement, Sunlight Entertainment, the production company for Ryan’s World, said the channel “cares deeply about the well-being of our viewers and their health and safety is a top priority for us. As such, we strictly follow all platforms terms of service, as well as any guidelines set forth by the FTC and laws and regulations at the federal, state, and local levels.”
The statement said that Ryan’s World welcomed the findings of the new study, adding: “As we continue to evolve our content we look forward to ways we might work together in the future to benefit the health and safety of our audience.”
Other popular children’s channels on YouTube show child influencers doing taste tests with Oreo cookies, Pop Tarts and Ben & Jerry’s ice cream or sitting in toy cars and ordering fast food at drive-throughs for Taco Bell, McDonald’s, Burger King, KFC and other chains. “This is basically a dream for advertisers,” said Dr. Bragg. “These kids are celebrities, and we know from other rigorous studies that younger kids prefer products that are endorsed by celebrities.”
To document the extent of the phenomenon, Dr. Bragg and her colleagues identified five of the top kid influencers on YouTube, including Ryan, and analyzed 418 of their most popular videos. They found that food or beverages were featured in those videos 271 times, and 90 percent of them were “unhealthy branded items.” Some of the brands featured most frequently were McDonald’s, Hershey’s, Skittles, Oreo, Coca-Cola, Kinder and Dairy Queen. The videos featuring junk food have collectively been viewed more than a billion times.
The researchers could not always tell which products the influencers were paid to promote, in part because sponsorships are not always clearly disclosed. The Federal Trade Commission has said that influencers should “clearly and conspicuously” disclose their financial relationships with brands whose products they endorse on social media. But critics say the policy is rarely enforced, and that influencers often ignore it.
McDonald’s USA said in a statement that it “does not partner with kid influencers under the age of 12 for paid content across any social media channels, including YouTube, and we did not pay or partner with any of the influencers identified in this study. We are committed to responsibly marketing to children.”
Last year, several senators called on the F.T.C. to investigate Ryan’s World and accused the channel of running commercials for Carl’s Jr. without disclosing that they were ads. The Council of Better Business Bureaus, an industry regulatory group, also found that Ryan’s World featured sponsored content from advertisers without proper disclosures. And a year ago the watchdog group Truth in Advertising filed a complaint with the F.T.C. accusing the channel of deceiving children through “sponsored videos that often have the look and feel of organic content.”
In March, Senators Edward J. Markey of Massachusetts and Richard Blumenthal of Connecticut introduced legislation to protect children from potentially harmful content online. Among other things, the bill would limit what they called “manipulative” advertising, such as influencer marketing aimed at children, and prohibit websites from recommending content that involves nicotine, tobacco or alcohol to children and teenagers.
The F.T.C. has long forbidden certain advertising tactics on children’s television, such as “host selling,” in which characters or hosts sell products in commercials that air during their programs. Critics say the agency could apply the same rules to children’s programs on the internet but so far has chosen not to.
“It’s beyond absurd that you couldn’t do this on Nickelodeon or ABC but you can do this on YouTube just because the laws were written before we had an internet,” said Josh Golin, the executive director of the Campaign for a Commercial-Free Childhood, an advocacy group.
“These videos are incredibly powerful,” he said. “Very busy parents may take a look at them and think that it’s just a cute kid talking enthusiastically about some product and not realize that it’s often part of a deliberate strategy to get their children excited about toys, or in the case of this study, unhealthy food.”
Anahad O’Connor is a staff reporter covering health, science, nutrition and other topics. He is also a bestselling author of consumer health books such as “Never Shower in a Thunderstorm” and “The 10 Things You Need to Eat.”
Europe is trying to get out of lockdown, but did not have the COVID19 epidemic under control, so the numbers are rising quite steeply, and look likely to be more than the first wave. I tried to put some graphs together, but it has proved beyond my computer management competence, so I can only refer readers to the Worldometers COVID home page and ask you to click on the individual countries and scroll down to the ‘New Infections’ graph if you want to check what I am saying.
The UK, Ireland, France, Belgium, the Netherlands, Portugal, Poland, Czechia, Austria, Denmark are all rising. Spain was following the same pattern, but has just started a new lockdown. Germany is ticking up, somewhat more modified, as is Norway. Sweden continues to have cases, but there is some doubt now about how they collect their figures.
The lesson for Australia is clear. We have to be conservative and go for elimination. Suppression will not work. There is danger that NSW has people no longer getting tested, presumably because admitting that an infection is possible means you have to self-quarantine for 2 weeks and have a nasty thing stuck up your nose, when you might just have a cold.
Daniel Andrews has taken the flak, but implemented a policy that has probably saved Australia. No thanks to Morrison, whose advice has been frankly mischievous.
Stephen Duckett, one of the architects of Medicare, tells it like it is.
This is what I have been saying for years. If you think the banks are bad, you have not dealt with insurers. They will do anything rather than pay people’s legitimate medical and living expenses.
My poor patients literally starve. They change their addresses each visit as they couch-surf their friends. The foreign patients with no Medicare cannot even get GP treatment, and because they are often paid sub-award wages in cash cannot even prove their incomes. Most specialists simply will not operate for the Medicare rebate, and even if they will the waiting time is a year. I tell the patients where the soup kitchens are. They are in huge pain and the most I hear from governments are warnings that they have been on narcotics too long, as they wait for the surgery that the insurers have refused to pay for.
The patient Scott with his supportive wife, at the beginning of the 27/7/20 4 Corners tells the story of his shattered life, which is just like what my patients tell me.
The Victorian the Ombudsman, Deborah Glass did an investigation into WorkSafe Victoria, the callous government insurer there. She found appalling behaviour and says so very clearly.
In NSW it is the same- the appalling, hopeless iCare, who should be called ‘I Don ‘t Care’ put together a bunch of insurance executives who had no experience in working with people. They all got awarded huge salaries and set about having computer algorithms to replace claims clerks. So when a claim goes wrong (which takes a while to figure out as 3 week delays are pretty much the norm), you call and ask to speak to the case manager. You can’t. But if you persist eventually you find one, but he or she only got the claim yesterday. i.e. There had been no person managing it until you hassled like hell, and it is often refused anyway.
Meanwhile the patient had no treatment and the fat cats at the top had not noticed that their system had a few glitches. And most of the concern in both the management echelons and the media is about some financial deficit which, if we are to believe the totally out-of- touch iCare CEO, Ken Nagle, depends how you do the accounting.
No one seems to remember that this is just a health insurance scheme to help Workers’ Compensation and Motor Vehicle accident Victims. If Medicare worked it would be completely unnecessary, and it cannot even manage to function like a private health insurer. It assumes that all doctors are crooks who cannot be trusted to order just the tests and operations necessary- they all have to be evaluated and denied by insurers who get every dollar that they refuse to pay, and who seek out dodgy doctors to carry out ‘Independent Medical Examinations’ (IMEs) to deny normal treatments. If the IME doctors do not do what the insurers want they get no more work from them.
The directors and top executives of iCare should be sacked and the whole thing given to ICAC to examine. ICAC needs more resources also.
SIRA (State Insurance Regulatory Authority) has been more hopeless than ASIC and APRA were with the banks, and should be abolished also. This story came from a whistle-blower, not from SIRA, the responsible agency, though some of us have been trying to get SIRA to act for years.
SIRA became a bit more interested after the Hayne Royal Commission into Misconduct in the Banking, Superannuation and Financial Services Industry reported in February 2019, presumably as they realised that if the Commission has been given enough time to look at insurance, they would have had their own hopeless regulatory efforts scrutinised. They had an internal investigation, the Dore Inquiry (no, you almost certainly have not heard of it), but it did actually find that iCare was behaving appallingly. The report release was delayed 5 months (July-December 2019) and released just before Christmas with iCare’s reaction, which was to admit that they had made ‘mistakes’ and that they accepted all the recommendations. Great PR! Released on a busy day to avoid scrutiny and if you as a journo were a tiny bit interested, there was no story because iCare accepted the changes suggested. The SIRA strategy worked- no scrutiny of either iCare or SIRA.
At last there is a 4 Corners on this! Watch it if you missed it!
Let us hope that when it goes to ICAC some major changes are achieved. It seems that 4 Corners is the only regulatory force in the country. I guess that is why the government wants to de-fund the ABC.
He was the author of the famous ‘Morling Judgement’’’ which sent a shock around the world in 1991 as it stated that ‘passive smoking was potentially lethal’.
This has to be put in context if its significance is to be duly recognised. The seminal article about smoking causing lung cancer had been written by Doll and Hill in the British Medical Journal in 1950, and many articles followed in the 1950s linking smoking to a great many diseases.
In 1961, the Royal College of physicians, concerned that the UK government had not done anything to curb smoking, commissioned their landmark report ‘Smoking and Health’ in 1962. The US Surgeon-General did the same, resulting in a similar report in 1964.
The tobacco industry had to decide whether it would scale down its production, or tough it out and take the money. It did secret research which confirmed that burning tobacco produced carcinogens and other harmful products which could not actually be removed. There was a change of personnel and ethos. Prior to 1950, tobacco was a legitimate product like anything else. After the research was confirmed, the decision to keep selling and to deny the effects and hinder government action was the strategy that everyone working at the top of the tobacco industry had to accept.
Tobacco use was mainstream. 45% of all US adults smoked in 1954 (Statistica- Gallup) and consumption peaked in Australia in 1963. People smoked everywhere. There were no smoke-free areas in bars, restaurants or anywhere else. It was normal for house guests to light up and then ask ‘where is the ash tray? The Tobacco industry was keen to maintain this situation and talked of the need for ‘courtesy and tolerance’ between smokers and non-smokers, which was code for ‘doing nothing political’. Smokers all ‘chose to smoke’, which of course meant that they had voluntarily (and knowingly) assumed the risk and consequences of their behaviour. The tobacco industry also gave money to political parties, just asking for a secret promise that there would be no legislation against them before the next election. The medical industry were unaccustomed to this, and kept giving advice that was ignored, with a few significant voices such as Dr Nigel Gray of the Victorian Anti-Cancer Council and Dr Cotter Harvey of the Thoracic Society doing what advocacy they could.
Non-Smokers Rights groups were the main driving force for change in the US in the 1960s and 1970s arguing that people had a right not to breathe smoke. The health charities, Cancer Councils, Heart Foundations were very keen to be non-political as their core business was raising research funds. Real activists soon discovered that their opponents were not the smokers, but the industry, who claimed that there was no proof that passive smoking was harmful, and that courtesy and consideration was all that was needed. Their public stance was referred to as the ‘tightrope policy’. They had to admit that many people believed that tobacco was harmful, as they had to contend that the smokers knew the risk that they were taking and hence could not sue them for deceiving them. But they also had to claim that they did not know that smoking was harmful, so that they were no liable for selling unsafe goods. It was absurd, but it continued.
The tobacco industry as well as being very politically active were the major advertiser, tobacco being second only to food. This meant that the media were more reluctant to run stories that would affect their advertising revenue. Outdoor advertising was also ubiquitous with over 50% of billboards being for tobacco, reminding people to smoke, and especially plastered all over convenience stores where cigarettes were sold.
In 1981 Prof Takeshi Hirayami published a seminal paper showing that non-smoking wives of smoking husbands got more cancer than wives of non-smokers (Br Med J (Clin Res Ed) 1981;282:183). At last there was substantial medical evidence of the harm of passive smoking.
In Australia the medical groups had done quite good advocacy and in NSW a Transport Minister, Pat Hills, simply banned smoking on buses and trains in 1977, but pubs and clubs knew that smokers drank and gambled more than non-smokers, so they took the money from the tobacco industry and lobbied hard against smoke-free indoor air. The restaurant industry followed them, somewhat lamely.
But a breakthrough came in 1979 when 3 activists, Bill Snow, Ric Bolzan and Geoff Coleman formed BUGA UP (Billboard Utilising Graffitists Against Unhealthy Promotions). Coleman had studied political economy, and saw the issue as the tobacco industry killing people for money. BUGA UP saw irresponsible and misleading advertising as the major vehicle for the promotion of products that had no intrinsic worth, tobacco being the leading example. They wrote on billboards, changing the wordings in satiric and humorous ways, and signed their work, BUGA UP, which was an invitation for all to copy. They also did street theatre, often concerned with disrupting tobacco promotion activities in supermarkets or malls. This had an immense direct effect as the billboard posters were only being changed every 3 months and the leaflets and street theatre were amusing. There was a lot of popular support as most people saw that smoking was harmful, and governments were too craven to act. There was also a lot of publicity when Coleman and Neville Biffin were arrested in 1981 and charged with defacing a billboard. They were convicted in 1982 and fined, but praised by the judge (Daily Telegraph 26/2/82) and given a light penalty, which sent a strong message. It also sent a shot around the world by making all other tobacco activism seem moderate by comparison. Australia’s activism was seen as more direct with a ‘Robin Hood’ flavour, but was also more conspicuous because it was against the ubiquitous tobacco billboards, and targeted the industry directly, rather than the more subtle and legalistic approach of the non-smokers’ right groups who had previously been the front line against the industry. It might be noted that at the 5th World Conference on Smoking and Health in 1983 there were no scheduled sessions on political action or advocacy, and the first meeting was convened by renowned Californian activist Prof Stan Glantz. The presentation on BUGA UP had to be repeated as the room was not large enough for the people who had wanted to attend. The medical system was becoming energised.
The tobacco industry was very demoralised by this. They had set up a lobby group, pretentiously called the ‘Tobacco Institute.’ But this was re-energised by John Dollisson who was there from 1983-87.
In 1983 the Western Australian lower house supported a private member’s bill by Dr Tom Dadour to ban tobacco sponsorship of sport, but an energetic campaign led by Dollisson and using sporting bodies who received money from tobacco, defeated this in the upper house (Musk, BMJ Vol 290 25/5/85).
After his successful Industry fight against the WA Dadour bill, Dollisson’s feisty style set the tone for the tobacco struggles of the 1980s. He was physically strong and in debate would cram a number of aggressive arguments into each sentence, such as, ‘You are treating the smoking causes disease hypothesis as fact, then want to even say that passive smoking is harmful, and smoking is addictive and the advertising get the kids and then you want to tell people how to live their lives and trample on their rights and then you want the government to enforce a nanny state for you.’ (This is not a direct quote, but an example of how his speech was structured). Assuming that he was interrupted at this point, as he would not stop if he were not, the tobacco control advocate would then be able to only answer one of the points already raised. But Dollisson’s aggressive style eventually got him into trouble, with the Trade Practices Commission, prohibition of ‘misleading and deceptive conduct’ being used against one of his advocacy ads. Then the Australian Federation of Consumer Organisations bravely took him on. The story is told by Stacey Carter (Tobacco Control- BMJ Issue 12 Suppl 3):
In July 1986 he [Dollisson as CEO of the Tobacco Institute (TIA)] placed an advertisement in the national press entitled “A message from those who do…to those who don’t”29 in which he claimed “there is little evidence and nothing which proves scientifically that cigarette smoke causes disease in non-smokers”.30 Early in 1987, Dollisson placed a “followup” ad for the TIA, as demanded by the Trade Practices Commission, which among other things stated that the TIA did not accept that their original advertisement was misleading.31 This action triggered a six year legal war between TIA and the Australian Federation of Consumer Organisations (AFCO), at substantial cost to the TIA.
On 7 February 1991 Justice Morling decided that the TIA “had engaged in conduct that was misleading or deceptive” and banned the TIA from speaking publicly on ETS.40,41 On appeal the injunction was lifted, but the court granted a declaration that the advertisement was misleading and deceptive contrary to the Act and the TIA were ordered to pay a large proportion of AFCO’s costs.
The ‘Morling Judgement’ as it was termed was the first time in the world that passive smoking had been held by a court to be harmful, and this rang around the world.
Dollisson left the Tobacco Institute and went to Philip Morris where he helped the campaign against the Victorian Government’s Tobacco Act of 1987, which raised the State tobacco tax and replaced tobacco sponsorship money as well as promoting health (which replaced tobacco advertising from the advertisers point of view) and also funded medical research. The Victorian legislation, effectively paid off the tobacco industry’s bought acolytes, and the aggressive approach to advocacy by Dollisson in Australia was seen as backfiring.
The decision also set the precedent for the test case Scholem v NSW Dept of Health, where a psychological counsellor successfully sued for workplace tobacco smoke exposure in May 1992.
Australia has been drifting in its tobacco control endeavours of late, but Trevor Morling will be remembered for his contribution, as well for the many other achievements cited below.
The NSW Supreme Court has held that the children of a worker killed at home by her mentally ill partner in a domestic violence incident can have compensation.
It is good that the issue of domestic violence gets publicity and that the children get compensation. But it raises the issue of whether employers are seriously able to assess the domestic situation of all employees and then whether they can ever hope to intervene in them. Employers ran a long campaign not to have to pay for journey accidents, people injured on the way to work, on the basis that it was not a risk that they could control, yet which potentially might cause a big change in their insurance premiums and thus costs. If we want our employers to be concentrating on making their businesses efficient and looking for hazards in the workplaces that they do control, it is slightly dubious public policy to have them sniffing around about employees’ home life. This case is slightly unusual in that the employer was effectively a partnership bet ween the couple rather than having a distant employer, and the company had been deregistered which suggests some dysfunction But the money accessed was Workers Compensation insurance and this will affect premiums and potentially other work situations.
It is true that a lot needs to be done about the discovery and action on domestic violence. It is also true that mentally ill people need to live somewhere and that their carers are at risk. Judges faced with people in dire need of help such as the children in this situation search for answers, and the Workers Compensation insurance scheme is a source of such funds. But the precedent set is not a good one.
The same principle applies when a baby gets into trouble at birth and has long-term adverse effects. If the obstetrician is found to have erred, there is a lot of money to give the unfortunate infant. If he or she is not found to have erred, there is no money for the infant. So now the premiums for obstetricians are very high and some retire in consequence. 4 Corners ran a show on this issue some time ago and it turned out that one doctor was responsible for about 60% of the problem births in Western Australia and had declined to speak to the show. Wow- go after him! Who was he? The Professor at the biggest teaching hospital of course. Most of the difficult cases in the State were admitted under his name, and the staff of the hospital did their best with these cases.
What is needed is a compensation system that is no fault. Sometimes bad things happen. Sometimes people make mistakes. Sometimes big mistakes have small consequences and sometimes little mistakes have big consequences. With systems, it is not usually one person who makes a mistake, there are miscommunications, lack of clarity who was responsible, lack of availability of something or someone. Accident causation theory is now an academic discipline, but the legal profession has not really caught up, let alone the political system.
A lot needs to be done about domestic violence, but I am not sure that making it a workers compensation issue will do anything more than push it into the public eye and help these children. Employers and insurers will run a successful political campaign to change the law to exclude it. I am not often on the side of Workers Compensation insurers, but a better solution has to be found.
Prime Minister Scott Morrison was smugly distancing Australia from the riots in the USA over the George Floyd public murder, but voices were quick to point out that there had been 432 deaths in custody in Australia since 1991, despite Royal Commissions and their findings, which were not implemented.
The demonstration was planned as everyone here knows the COVID19 lockdown is gradually being eased as there are now few community-acquired cases in Australia.
But the Police applied to the Supreme Court and got them to declare the rally and march illegal under the COVID19 restrictions. I had been going to miss the march on health grounds, but the Police rather than the public health authorities wanting it declared illegal made me want to attend.
As I have written before, Police intolerance of any sort of dissent was clearly brought home to me when I wore a sign that said, ‘Respect the Dead by working for Peace’ at the ANZAC service in Hyde Park in 2019, where the police sergeant said that he would arrest me if I did not move 50 metres away.
John Howard initiated the needless Australian invasion of the Middle East against the wishes of 74% of the population who marched in 2004. The creation of a terror threat due to that folly, the handling of that threat by increasing surveillance, decreasing civil liberties and increasing Police power without supervision is a trend of our time. The other trend, the increase in social inequality has put pressure on Police, as the enforcers of the norms of a social system that excludes an increasing percentage of the population.
But the Police inability to handle mental illness or drunkenness and conflict has not been sufficient. There are too many deaths in custody, which principally affect Aboriginal people and too many Police shootings, which principally affect the mentally ill.
So I was not willing to sit at home because the Police did not want a demonstration that asked that they be called to account and change their ways.
Interestingly some of my son’s friends who are overseas students did not dare to go lest their visas be cancelled.
The Supreme Court’s ban on the rally and march was overturned on appeal in the morning, but my opinion was that most people going to the 3pm event were unaware of this and, like myself had decided to go anyway.
The city had prepared for the event by stopping the trams from Circular Quay, (could they have run from Central to Randwick?), and by the trains not stopping at Town Hall. So we walked from Circular Quay and the demonstration went back almost the full length of the Queen Victoria building in George St. It later went back further than this. Protesters were socially distancing and about two thirds were wearing masks. People were walking among the protesters issuing masks and hand sanitiser, and soon more than 90% were wearing masks. There was a wide spread of ages and racial origins.
The protest speakers were on the Town Hall steps, but could not be heard at all for a fair percentage of the crowd as the PA system which is on the traffic lights was not in use by the speakers. After about half an hour, at about 3.30pm the speeches stopped, and everyone assumed that the March would start. It did not. It was not clear what was happening, whether the rally was allowed and the march not. There was quite a lot of chanting of ‘Black Lives Matter’ and also activist shouting, ‘Too Many Coppers’ with the reply ‘Not enough Justice’.
There were Police amongst the protesters. They did not look comfortable, and I noted Glock pistols in their holsters. Glock pistols have no safety catches, so the only thing stopping them or someone else grabbing them was the flap and press stud on the top of the holsters.
We kept thinking that we were about to march, as we went forward in little bursts. But looking a long way ahead we could see that the placards were not moving. All that was happening was that the social distancing was being taken up. This and the chanting would have increased the infection danger somewhat, so one could only wonder at the reason for the delay. The rally and march had been scheduled from 3pm to 5pm with a break at 4.32pm when we were all to kneel for 1 minute to remember the 432 people who had died.
The March started a bit before 4pm and wound to Belmore Park near Central station with the stop and kneeling at 4.32pm an impressive moment. Belmore Park was totally packed, with social distancing quite undermined, so we took a photo and left. Apparently there were some minor scuffles between Police and people who stayed after 5pm.
It was interesting that the public, who have been very compliant and responsible throughout the COVID19 epidemic, were willing to defy the Supreme Court ban on the rally and march. The large Police presence suggested that they were willing to suppress the event, but there were a very large number of protesters, 17,000 seems a reasonable estimate. I do not think that the crowd would have tolerated not having the rally and not marching, so it might have escalated with lines of Police, riot shields, water cannon and tear gas. Fortunately sense prevailed.
It was a victory for the people in the sense that they stated in large numbers their attitude to Black Deaths in custody, and the limits to which they are willing to tolerate the Police, the government and the Supreme Court telling them what they may and may not do. The relatively poor uptake of the COVID19 tracking app is a similar indicator of the trust of government. No, we do not want COVID19, but we do not trust the government either.
As I get older, I trust people more and government and institutions less, and work for the power to go to those who legitimately own it, the people. This was a good day. Hopefully no COVID19 cases will result.
