Doctor and activist


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Category: Health

Apartheid Education Buses

23 November 2023

I live near a turning circle in a good area of Sydney.  There is a Bus Stop there and the government bus there has an ad with a picture of a forlorn looking schoolgirl saying that she cannot have a decent education, so would I donate to The Smith Family so she can.

As the ad displays there, 8 shiny new buses take private school children from the turning circle to 8 different private schools.

It seems that our governments are happy to subsidise ‘choice’ so that they do not have to fund a fair go and we are happy to tolerate an apartheid education system.

 

www.theguardian.com/australia-news/2023/nov/23/australia-100-wealthiest-schools-earnings-income-data-education-department?utm_term=655e79e42ab1fedfc11542549409ff2e&utm_campaign=AustralianPolitics&utm_source=esp&utm_medium=Email&CMP=aupolitics_email

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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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Advocacy to Delay the Silica Benchtops Ban

18 October 2023

I wondered why the NSW Government was delaying the ban on silica-containing benchtops until July 2024.  Infectious diseases have no political friends, but industrial diseases do. Below is a full page ad in today’s Sydney Morning Herald advocating a delay on the ban and some regulations about how to cut the benchtops with no dust.  They also point out correctly that other benchtop materials have some hazards, and there are a lot of other products that produce silica dust when cut or dug. And they point out that a lot of people are involved in installing benchtops.

 

It is true about other products being harmful. But it is also true that there are readily available non-toxic alternatives that could be used. It is a bit rich for an industry that did precious little to stop the development of silicosis now to ask to be regulated.  The obvious solution is to minimise the harm from all sources of silica including cutting concrete and digging sandstone foundations.  That requires regulations that often actually exist, but Safework does few site inspections and relies on ‘self regulation’ and a ‘notify us’ system of light regulation, based on a fundamental contempt for OHS as soon as it inconveniences business.

 

The government must be forced by publix pressure to ban silica benchtops, which are basically all silica except for a bit of binder chemical, and to enforce other regulations with filtered air and barriers with PPE (personal protective equipment) as a last resort. Concrete or sandstone must be cut with water on the saw so that there is minimal dust.

 

It is depressing, but not surprising that those who have created so much of a problem by setting up an import system for this toxic product now have the gall to lobby against effective government action.

C:\Users\chest\OneDrive\Pictures\SMH Silicosis Ad 231018.jpg

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Classification of Impairment

4 April 2023

I was lucky enough in my surgical training years to have most of a year working as neurosurgical registrar for Dr John Grant.  He set up the 1st spinal Injuries Unit  in Australia saying that while everyone was looking for a miracle cure that would allow injured spinal tissue to repair, most paraplegics were dying of bedsores or infections coming up their urinary catheters and much better practices and training was needed.

He went to England in 1960 and with Sir Ludwig Guttman started the Stoke Mandeville games, the precursor of the Paralympics. He developed the Paralympic Games to help his patients, who were mostly young men whose lives had been shattered after a catastrophic injury, often after doing something daring or unwise.  Wheelchair athletics was a major part of this, as it gave the young paraplegic people something to strive for.  John Grant became head of the Australian Paralympic movement and Chair of the Organising Committee of the Sydney 2000 Paralympic Games.  My part was merely to help treat the spinal patients. 

Later I moved into occupational medicine so as to fund my work in the anti-tobacco movement.  There I found impairment from workplace injury and had to decide who could work and who could not. This got a nasty edge to it as insurers wanted people classified as fit, so that if they would not work their pay could be suspended.  The Courts argued about this until the legal process was deemed so expensive that the American Medical Association worked with the insurance industry to devise a complicated medical examination which measured ‘Whole Body Impairment’  as a percentage.  This was not supposed to simply translate simply into how much money an injured person was awarded, but of course that is exactly what happened. Since pain cannot be measured it had to be left out of the calculation, so you can have terrible pain, but if you have only lost a few measurable degrees of back movement, your percentage impairment may be minimal.  The system also makes no distinction between an impairment and a disability. If you are a labourer and have a lower body injury and cannot work at all or are someone who works at a desk and can maintain their previous income, the impairment is the same.  I have never learned the details of the system, as I think it a bad farce, but it is used to assess impairment in Australia, makes a lot of money for the doctors who do the medicals, and saves the insurers a fortune.  Of course there are few who try to fake injury, but in my experience this is fairly rare, far rarer than insurance companies would  have you believe.

But making an objective assessment of what a person can and cannot do is not easy, and so one is to pity the classifiers who want a level playing field by classifying people for the Paralympic Games. Given that each country wants to pick a team of winners and they classify their own athletes, it is little wonder that in some countries ‘intellectually disabled’ are as smart as anyone else, or that you cannot even notice a limp in some of the runners.

The 4 corners of Monday 2 April looked at the whole Paralympic Classification system and produced damning figures that 10 of 12 of the gold medal winning Spanish basketball were not disabled at all, and that in some areas 69% of the winners had minimal disability.

As this sad farce continues there is a huge kerfuffle lest the tiny number of trans athletes with the genetic advantage of having had male hormones might get an advantage over females.

John Grant must be turning in his grave.

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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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The Silicosis Epidemic- A Symptom of Wider Regulatory Failure

Dr Arthur Chesterfield-Evans 28 February 2023

The epidemic of silicosis amongst tradespeople working with manufactured stone was predictable, preventable, and an illustration of a broken OHS system across NSW and the rest of Australia.

Until 2011, NSW had a workplace health and safety regulator whose statutory role was to “promote the prevention of injuries and diseases at the workplace and the development of healthy and safe workplaces”. The WorkCover Authority of NSW included specialist sentinel groups that researched, monitored, inspected and educated workplaces for dust diseases, farm and rural health (including pesticides) and noise, amongst other matters. Crucially, WorkCover also employed industrial hygienists and an occupational medicine group. These groups enabled the agency to anticipate many problems before they manifested in the state. The current furore over manufactured stone using powdered crystalline silica would probably have been averted if the dust diseases group were still in place.

For example, manufactured stone was previously produced in NSW, but made with powdered talc or limestone in a fibreglass matrix. The Dust Disease group discovered an employer using the cheaper silica flour and immediately put a stop to that. Similar proactive actions by this group halted the importation of mineral-bearing products adulterated by asbestos, such as brake shoes and gaskets, before they became a problem. Issues raised by the increasing use of carbon fibre and nano particulates would also have been within the purview of the Dust Disease group.

However, following the election of the coalition in 2011, the NSW government’s focus shifted to the financial losses of the workers compensation scheme. The insurance and workers compensation schemes were split from WorkCover with the creation of iCare and the State Insurance Regulatory Authority (SIRA).  Workcover also lost its independent source of premium income.

Limited funding for the remaining inspectorate and other functions such as promoting workplace injury prevention now came from Consolidated Revenue, set by NSW Treasury. Over the next few years WorkCover’s management under John Watson (the generic manager, not the Labor politician) shed many of its professionally qualified staff. New inspectors were less qualified than previously, a rule book replaced comprehensive understanding of occupational health and safety, workplace inspections decreased and in-depth investigations virtually vanished.

WorkCover’s system of Authorised Medical Practitioners, which trained GPs in occupational medicine across the state, was completely abolished. The excellent training manual for AMP’s, better than most textbooks, was written and maintained by Dr Kelvin Wooller at WorkCover. When he left, the regulator would not allow Dr Wooller to continue using the manual to train NSW medical practitioners but did nothing with it. Expertise in occupational medicine has consequently decreased in the wider medical community, making it difficult for many employers to find “a registered medical practitioner with experience in health monitoring”, as specified by the Work Health and Safety Regulation, and for workers to get a definitive diagnosis and compensation for workplace illnesses and diseases.

WorkCover was abolished in 2015, replaced by SafeWork NSW, which is now part of the Department of Customer Service, the department that is all things to all people.  The government seems not to understand what its function should be.

The regulation of workplace health and safety in NSW should be handled by vigilant sentinel occupational disease groups to provide workers with proactive protection and help keep workplaces safe. A core group of government-employed professionals is necessary as a repository for learnings and information that would otherwise be lost. This is the OH&S philosophy that drives other countries.

NSW has few workplace inspections, almost no penalties for appalling workplace practices and a cost-minimisation approach to the treatment of injured workers as the government reduces the premiums of workers compensation to make NSW ‘business-friendly’ at the cost of workers’ lives. There are currently a lot of inspections of benchtop manufacturers and suggested and overdue bans of manufactured stone with silica, but reactive activity in response to a significant epidemic has not fixed the systemic problem.

This needs to be an election issue in NSW. It should also be noted that John Howard’s similar 2007 changes to the Federal government regulator –the National Occupational Health and Safety Commission, (WorkSafe Australia), now Safe Work Australia –meant that that policy/advisory body also has far fewer personnel, less expertise and a less pro-active approach.  The perception of OHS as merely slowing industry’s “progress” has damaged the process nationally in a similar way to that of NSW.  The Federal government also needs to act in this area.

This article was published in John Menadue’s Pearls and Irritations 28 February 2023

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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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Trust – a letter to Ross Gittins, who wrote the below article on Trust

18 December 2022

Dear Ross,

I congratulate you on your article on ‘Trust’.  It is the glue that holds society together, and when it is broken there are huge consequences.

Since the first plane hijacking in 1970 checking people onto planes is a growth industry. Years ago you could walk into any office building, take the lift to the top floor and ask the General Manager’s secretary if you could speak to (almost always) him.  Now everyone carries tags even to get in the front door or the lift.  This may all be related to inequality or only mostly.

But it is also the rise of the manager.  The best expose of this I have read is ‘The Political Economy of Health’ by Julian Tudor-Hart.  He follows the British NHS from its founding till 1998. At first it was a noble experiment with all those in it paid adequately and trying to give health for all as well as they could. The whole thing was self-governing, and everyone was trusted to procure things as cheaply as possible and look after each other and the patients.  Then managers came and asked ‘What is the cost of a day in hospital?’ or’ What is the cost of an  X-Ray?’  Some said that it was unwise to ask this, as keeping records that detailed would simply add to costs, which everyone was reasonably sure were as low as possible already.  Hart details successive management demands and consequent cost increases until the cost of management became about 35% of the total, without any apparent improvement in the service.

Managers do not trust people to do their jobs, so they insist on KPIs, which then become more important than the job itself, distort the tasks done and kill any initiative that might have been used by the staff.  Since the task are all defined to be as simple as possible the staff are de-skilled or not allowed to use any initiative and the managers award themselves a pay rise, so the gap between the lowest and highest paid reaches its current obsene level.

We now have a situation where most people work down to their station rather than up to their ability.  We have a huge workforce in security and no one is allowed to use their own initiative beyond their management defined protocols as they pour time into producing KPIs so that they can be checked up on. Management has created immense overheads, even on top of their own inflated salaries.  And no one can figure out why productivity growth is stalled!  More trust is one solution.  I can think of others.

2022: The year our trust was abused to breaking point

Ross Gittins Economics Editor   SMH

December 14, 2022

As the summer break draws near, many will be glad to see the back of 2022. But there’s something important to be remembered about this year before we bid it good riddance. Much more than most years, it’s reminded us of something we know, but keep forgetting: the central importance of trust – and the consternation when we discover it’s been abused.

Every aspect of our lives depends on trust. Spouses must be able to trust each other. Children need parents they can trust and, when the children become teenagers, parents need to be able to trust them. Friendships rely on mutual trust.

Trust is just as important to the smooth functioning of the economy. Bosses need to be able to trust their workers; workers need bosses they can trust. The banking system runs on trust because the banks lend out the money we deposit with them; should all the depositors demand their money back at the same time, the bank risks collapse.

Just buying stuff in a shop involves trust that you won’t be taken down. Buying stuff on the internet requires much more trust. Tradies call on our trust when they demand payment before they start the job.

Our democracy runs on trust. We trust the leaders we elect to act in our best interests, not their own. Our country’s co-operation with other countries rests on trust. Of late, our relations with China, our major trading partner, have become mutually distrustful.

The trouble with trust, however, is that it can make us susceptible. And, as Melbourne University’s Tony Ward reminds us, it can be just too tempting to the less scrupulous to take advantage of our trusting nature.

They can get away with a lot before we wake up. But when we do, there are serious repercussions. Much worse, the loss of trust – some of it warranted; much of it not – makes our lives run a lot less smoothly.

The truth is that, as a nation, we’ve slowly become less trusting of those around us. But this year is notable for events where trust – or the lack of it – was central.

It’s widely agreed that the main reason the federal Coalition government was tossed out in May was the unpopularity of Scott Morrison. The Australian National University’s Australian Election Study has found that the two most important factors influencing political leaders’ popularity are perceived honesty and trustworthiness.

Its polling showed Morrison 29 percentage points behind Anthony Albanese on honesty, and 28 points behind on trustworthiness.

By contrast, many were expecting Daniel Andrews to be punished at the recent Victorian election for the harsh measures he insisted on during the pandemic. It didn’t happen. We don’t have fancy studies to prove it, but my guess is he retained the trust of the majority of voters.

The ANU study always asks questions about trust in government. This year it found 70 per cent of respondents agreeing that “people in government look after themselves” and only 30 per cent agreeing that “people in government can be trusted to do the right thing”.

This helps explain why the federal election was no triumph for Labor. The combined primary vote for the major parties fell to 68 per cent, the lowest since the 1930s. Labor’s own election report explains this as “part of a long-term trend driven by declining trust in government, politics and politicians”.

Related Article

Jessica Irvine

Senior economics writer SMH

Ward reminds us of the benefits of a high level of trust. It reduces “transaction costs” – the cost of doing business. “Profits and investments are higher if you don’t have to spend lots of time and money checking whether other parties are honest or not,” he says.

“People invest more in their own education if they believe a fair system will reward their efforts. If you think the system is rigged, why bother?”

Comparing countries, economists have found strong links between more social trust and higher levels of income. Trust is one of the top determinants of long-term economic growth.

And high-trust societies, with less distrust of science, had better outcomes in tackling COVID. That’s one respect in which we didn’t do too badly this year.

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