Doctor and activist
24/12/2021
23 December 2021
Just in case you missed the 1970s, Dee Madigan has some historic insights into the end of tobacco advertising and the start of social marketing. ABC Radio National 4/12/21http://www.abc.net.au/…/when-the-tobacco-ads…/8993580<
24/12/2021
22 December 2021
The huge, systemic and ongoing cop-out approach of the Federal and now the NSW State governments seems to be based on the hubristic belief that governments can set the agenda and influence the media to the extent of creating a perceived reality conducive to their interest. This is often successful, as the news becomes ‘What Mr Morrison did or said today.’
The narrative is changed slightly, so unless you are watching carefully, it always seems OK.
As in Animal Farm, ‘You may not sleep in a bed with sheets’. People did not remember the ‘with sheets’ bit of the slogan, but, hey, you do forget things.
But neoliberalism likes to stress individual responsibility. It allows small government, which advantages bigger players who can move into monopoly positions in an unregulated situation. It allows governments to have the perks and trappings without having to do too much as not much is expected these days.
The Federal public service is actually too small to do much except tell the States what they should do, and even this function is increasingly left to the politicians and their minders, those ambitious political science (or mainly art-law) graduates (with no scientific expertise). Hence the need for the Army when anything actually needs to be done.
But the key aspects of the current policy of getting rid of masks, social distancing restrictions, QR codes, and limits on people numbers in groups is a foolish populism and an assumption that business will do better if commerce returns to normal. This is right out of the IPA playbook. ‘Let ‘er rip and if a few oldies and sickies die off, that is the price of society continuing’.
It also has the advantage that nothing is the government’s fault any more. If the omicron variant gets out of control, that is obviously because it is so infectious and out of the Government’s control. If the population choose not to go out to protect themselves and the businesses go broke, that is not their fault, they opened everything up (and also saved a motza by not having any more pesky jobkeeper or jobseeker payments).
To say that this non-strategy will not work is to understate the situation. We managed to control the situation when there was no vaccine. Now that there is, the governments wants to throw away all public health norms for infectious disease and rely on vaccination alone. This has conspicuously not worked in Europe. Look at the Daily Case histograms (see link below) for Denmark, the UK, France, Spain and Italy. It seems that Germany, Belgium and the Netherlands have managed to begin to turn around the latest spike, but I have not researched their latest policy changes. Israel, largely triple-vaxxed is doing better. The US has a rising spike- it will be interesting what happens with their poorly vaccinated population.
But there is no need to look overseas. The Australian graph is already rocketing up with new highs reached every weekday. We are not triple-vaxxed and now there is another vaccine shortage. NSW yesterday was responsible for 3763 of the national total of 5724 (66%) and the percentage is rising. So Perrottet is as bad as Morrison. (Figures from covid19data.com.au).
Individuals cannot protect themselves when the virus is everywhere unless they become hermits, and even then they will have trouble getting fed. It needs mass action. It is a public health problem that needs government action. This is so obvious that it is extraordinary that it should even need to be stated. But our governments have reached such a low level of effectiveness that we are in grave danger. The Lucky Country is about to squander its advantages yet again. We can only hope that the National Cabinet meeting is the platform for a national about face.
Please protect yourselves and try to get the governments to see reason.
12/11/2021
11 November 2021
The Health system has a major divide that is not often spoken about- the divide between mental health and physical health.
Physical health tries to be a science and likes to think that its diagnoses and treatments are based on sound experimental evidence. If someone is sick and there are not enough facilities there is a fair effort from the medical profession and relatives to get more resources and they are mostly successful. There is a highly respected system and career structure.
Mental health has similar endeavours, but has less of a scientific base for its diagnoses and treatments. There has been a lot of work on neurotransmitters associated with depression and drugs that supposedly increase the good ones, but no single test is associated with a diagnosis, and diseases are defined. It gives it a lingering stigma of imprecision.
The workforces in mental and physical health have relatively little crossover, even isolated within the same hospital. When I last worked in the health system 9 years ago in a hospital that had both an active ED and a mental health facility, patients were triaged as physical or mental, different teams saw them, and neither team wanted much to do with the other stream’s patients. There was a shared waiting room, but different personnel, assessment areas, practices and wards. Getting one of the other team to assess someone was an afterthought, or only when the pathology was fairly gross.
When I was in tobacco control, there was a lot of reluctance to try to get mental health patients to stop smoking as ‘they needed it’, which was another way of saying that to add the nicotine withdrawal to their generally stressed situation was merely making trouble. But the public health statisticians said that people with mental health problems had a lot of physical problems and died about 14 years earlier (AIHW). So glossing over the physical health of mental health patients is not without consequence.
It was interesting to note recently that a COVID-19 infection in a mental health inpatient went undiagnosed for 4 days, and drew attention to the fact that mental health patients had a poor vaccination rate also.
www.smh.com.au/national/nsw/hospital-patient-s-covid-19-infection-undetected-for-four-days-20211105-p596aw.html
30/09/2021
30 September 2021
Here is a realistic assessment of how to stop an epidemic if you have the choice. Liberal Premier Peter Gutwein has some modelling coming. Bear in mind that 20% of the Tasmanian population are under 16 year of age, so if no kids are vaccinated the actual rate is still only 70%, not 90%. Even you assume that kids will not get sick, which is actually not a reasonable assumption, there are 30% who can spread COVID and 10%, the adults, who are quite vulnerable.
In reality, it is hard to get vaccination rates over 90%, though Blacktown LGA has 95% with first jabs, and presumably Tasmania would also being trying to vaccinate 12-15 year olds and younger if possible.
Meanwhile Morrison is stopping welfare payments to States when they get over 70%, which is actually starving people into unlocking. Even Conservative NSW Treasurer Perrottet is adding some welfare payments from the State budget.
www.abc.net.au/news/2021-09-29/tasmania-wont-reopen-covid-border-before-90pc-vaccination/100500844?sf249931972=1&fbclid=IwAR2NqGfeDQA9rGcnm7XQ6iLiDGK7XH1PNkRsjYs3uL15J31hP7qLbDsby88
22/09/2021
22 September 2021
At last! A government that does the sensible thing. The Victorian government will only open up if people are vaccinated. Thanks to NSW the Delta variant genie is out of the bottle and spreading nationwide. Business wants to unlock, some with no care for anyone but themselves.
Victoria wants to unlock but minimise spread among those now having more interpersonal contacts. The R (Reproduction) number is the number of cases each case infects. If everyone is vaccinated, less people will get it and those who have it will get it to less people.
Reasonable medical opinion is that the risks of vaccine are massively less than the risks of getting COVID, so the case against vaccination is incredibly weak on medical grounds. The ‘right not to have your body violated’ etc sounds very dramatic, and makes vaccination equivalent to rape in a semantic sense. But in a practical sense the two concepts are as far apart as could be. One is sensible medicine and the other is a crime.
Anyone who thinks that this does not matter should look at the graph of NSW cases that has peaked and is just starting to fall. Anything that can flatten the curve or make it fall is good. Anything that makes it rise is creating deaths and misery.
I am a member of the Council for Civil Liberties and have spent years working against excess government power. But sometimes it is necessary to act for the common good. I have no time for smokers’ rights or the right to spread disease. The Morrison government is as usual missing in action when real leadership is needed. ‘Let every workplace decide’, is a nightmare for retail business owners, offices and just about every other employer. Gladys is similarly missing. Dan Andrews has stepped up, despite a motley crew in the streets spreading disease and demanding the right to continue to do so.
What of the Health System? We are going the way of the Americans by stealth, and the fact that the public system is what has helped us survive is being glossed over, hidden by subsidies to private hospitals. The Federal government has been quietly trying to kill public medicine for years. The Medicare rebate has fallen from 85% of the AMA rate to 45%, so for the same bulk-billing work doctors incomes have almost halved over 35 years, while subsidies to the inefficient Private Health Insurers continue. Being a GP is now a little-sought speciality. (I have a FB page- Fix Medicare that I spend too little time on).
The States have maintained the public hospitals at a minimal level, as all the lucrative work has been siphoned off by the private system basically doing the easy stuff. There is No slack in the system, not that counting the number of ICU beds should factor. All our efforts should be to keep people out of Hospital and ICU by prevention of infection.
Have a look at this article on the anti-discrimination aspects of mandatory vaccination, and also look at the NSW cases, just turning down, but likely to rise if anything, like opening up from lockdown, tips the balance.
www.smh.com.au/national/victoria/here-s-why-no-jab-no-entry-is-not-discrimination-20210920-p58t2v.html?fbclid=IwAR2jrbfGJsq6fD-J-unnAn12j9UyWvdk-do5BpE23bI0z0gQ8kknq5nc39c
04/09/2021
4 September 2021
The Governments, Federal and NSW State, seem hell bent on ending the COVID lockdown.
Morrison stuffed up the vaccine and Gladys stuffed up the lock-down.
Now Morrison is talking about ‘Freedom’ and ‘One Australia’ showing that patriotism is the last refuge of a scoundrel. Gladys is talking about the need for more deaths as if it is an inevitable consequence of the Delta strain and that nothing can be done to mitigate the situation . She is talking about bed numbers and trying to conjure ICU nurses out of thin air. The fact that the State public hospital system is always at full capacity with beds in corridors in ED is well known to any health professional who has any dealings with the system and is about to bite us big time.
So what should be done? The lockdown can only buy time to improve the vaccine rollout, but this is still very much worth doing. Figures from NSW that I posted last week suggested that vaccination reduced the chance of being in ICU by about 97%. Vaccinated people can still get and transmit COVID as it seems that the antibodies are not in secretions, so it is not until the virus invades that the body starts to fight it. But as the disease is milder, vaccinated people will cough less, spread the virus for less time and be less sick themselves.
NSW has given about 7.2 million doses to a population of 8.2 million people. For everyone in NSW to have 2 doses it would take about 16 million doses. If we assume that about 4% of people are anti-vaxxers and want to take their chances, and 16% are children under 12 for whom the vaccines are not approved, then 80% of the total population should be vaccinated, which will take about 13 million doses. At the current rate of a million doses a week, that should take about 6 weeks from now.
The government already has a huge debt and will avoid a lot of future costs by prevention rather than ‘cure’. A support package for those who cannot work is naturally needed also. There was a full page ad in the SMH last week with a number of businesses urging the Government to stick to the opening up timetable of the Doherty Report. Given that the Doherty Report recommendations were based on a far lower number of cases and it was assumed that what cases there were could be traced and were not Delta variants, the report needs to be reconsidered. Perhaps because it is from a reputable research organisation and that it is a long read it has not been seriously challenged, The Government has used it to try to justify the early opening.
One of the disappointing things in my life has been the revelation that some people really do not care a fig about anyone as long as they are personally OK. I was initially shocked to find that the Tobacco industry really did not care how many people died as long as they could make money. I found that the asbestos industry was the same, and then that most businesses skimp on safety on the principle that ‘we take the money, you take the risk’ There has also been the worrying trend, which I still link to Harvard management theory in the 1980s that managers can manage anything, and just need to buy any expertise that they do not have. Often that do not even know what they do not know, so they neglect to ask, do not know who or what to ask, or find the advice inconvenient. And sometimes they put ads in the paper.
We also cannot assume that those in Government know or care or that their primary concern will be for the welfare of their constituents. Presumably their unlikely re-election is what they are focused on.
So please sign the petition to stop the early opening- it currently all we can do.
29/08/2021
29 August 2021
Ok. I am making a prediction. The totally irresponsible Liberal COVID policies will destroy both the Morrison government and the NSW Liberals.
Why? The strategy of unlocking with only 70% of over 16 adults vaccinated is totally irresponsible. It is true that less children will get a bad infection and die, but some will- perhaps 1 in 100,000. But if a few million children go back to school, that is still a significant number. The unvaccinated children will also get infected and go home to their families and infect them. Every parent who has had kids start at day-care knows how many more colds they got that year.
As far as the adults are concerned, if there are still 30% of them unvaccinated, that is a huge number to make an epidemic. The hospitals always manage with very slim margins of capacity. How many beds are in corridors and how many trolleys in ED normally? Quite a few. Now they are stopping non-urgent surgery, but these cases are not trivial, and cancer patients may well die of their delays.
But they key point is that the hospital system will be overwhelmed by cases and that those cases would not be necessary if the government held its nerve and continued the lockdown until all those who wanted the vaccine had it- upwards of 95% perhaps. If NSW is vaccinating a million people a week and has 8 million people needing 2 doses each, that is 16 weeks, less the fact that almost half the adult doses has been given. 12 weeks might be a realistic estimate, better if the vaccine can be hurried further. As far as the children are concerned, I recall in the 1950s when polio vaccine came- we were simply lined up in the school corridor at lunch time and everyone was done.
The cost of vaccination compared to the cost of hospitalisations does not bear thinking about. It is also probably that the cost of the hospitalisations and time lost will exceed the cost of a decent home support system- but Morrison will not even consider this, still talking about tax cuts before the election, as the national debt balloons to record levels. Do the rich really need this?
Morrison also wants to force states that have almost no COVID to open up. Qld and WA, having isolated themselves, controlled COVID and given themselves quite a remarkably normal quality of life do not want to be forced to open to NSW and Victoria, where COVID is frankly out of control. Morrison needs Qld seats to get re-elected. If he forces Qld to open and the pandemic spreads there as it will, his chances of re-election is nil.
Gladys Berejeklian is now talking about vaccinations, trying to distract attention from the number of cases and is systematically getting us used to the idea that since we now can never get to zero cases, we have to open up, and might as well do it now as later. This is not true, if now we are not vaccinated, and later we will be. She is blamed for the Delta virus escape as she did not mandate vaccination for limo drivers who ferried people from the airport to the quarantine hotels and then was slow to lock down Bondi when the infection escaped in June. So now to say it is all inevitable and unlock with what amounts to a very low vaccination rate is likely to lead to very big epidemic, the health system being overwhelmed, a lot of unnecessary deaths and yes, Gladys losing the election.
And Gladys does not like Morrison either, so she had better throw him under a bus before he does it to her.
29/08/2021
29 August 2021
An anti-vaxxer who keeps posting on my Facebook page also keeps demanding proof that the vaccine does more harm than good. I told her to do her own research as it is really too obvious.
I looked at the figures for NSW today and they made the point very clearly. There are 126 people in ICU of whom 13 have had one dose of vaccine and 1 has had 2 doses. The percentage of NSW people over 16yo unvaccinated are 37.3%, one vaccination jab 29% and two vaccinations 33.8%.
If vaccine did not work, the percentage of people in ICU would be the same in all 3 groups. This would mean unvaccinated would be 47 (37.2% of 126), one vaccine jab 37 (29% of 126) and two vaccine jabs 43 (33.8% of 126). But the numbers are: unvaccinated 113, one jab 12, two jabs 1.
So those with 2 jabs have only I person in ICU instead of 43, and those with one jab have 12 instead of 37. So the chance of being in ICU has been reduced by 42/43 (97.7%) with 2 jabs, and 25/37 (67.6%) with one jab. This is just a one day sample (yesterday in NSW), but the results are very significant. The data is from NSW Health via Juliette O’Brien’s website.
And the chance of dying due to vaccine is about 1 in a million.
www.covid19data.com.au/hospitalisations-icu
20/08/2021
20 August 2021
I spent over 20 years of my life with my principal task to fight the tobacco industry. I saw how harmful smoking was in my patients, and tried to tell them. But smoking was common, allowed everywhere and, after food, the most advertised product in the country. Shops were so covered with ads that when you drove into a town, you looked for the cigarette ads to find the food shop. It was normalised. One of my patients, whose leg I had just amputated said, ‘All the doctors say that smoking is harmful, but if it was the government would do something about it’.
There were almost no smoke-free restaurants anywhere, because the non-smokers had been trained to put up with it, and restaurateurs were worried that smokers might leave them. They knew that the non-smokers had no choice. The tobacco industry told the pub owners that smokers drank more and gambled more, so they had better not offend them, so the Australian Hotels Association were the major lobby, with the Registered Clubs and Restaurant Association tagging along. The tobacco industry disputed the science long after it was proved to any reasonable analysis, and smokers clung onto this. The tobacco industry PR followed what was called the ‘tightrope policy’. They did not know if smoking was harmful because they were not doctors, so they were not responsible for selling a lethal product, but because everyone had heard it was harmful, smokers were taking their own risks.
Smokers therefore said, encouraged by the Industry that it was their ‘right to smoke’, and then they denied that it harmed everyone else. So instead of the tobacco industry having to prove that passive smoking was harmless, the medical profession then had to prove it was harmful and then get legislation implemented, a process that took about another 45 years at about 43 deaths a day in Australia. Since non-smokers also got heart attacks etc, the Industry argued that they could not blame them on the second hand smoke.
Now we have the ‘right not to be vaccinated’ and the ‘right not to be excluded because we are unvaccinated’. Instead of spreading second hand smoke, unvaccinated people are spreading COVID virus. And they are saying that vaccinated people also spread the virus and can also catch it. Perhaps. But vaccinated people spread less virus, and the right not to be exposed to a virus trumps the right to spread it.
China unashamedly goes for the greatest good for the greatest number and puts little store on individual rights. Our tradition of Greek thought is all about the individual reaching his or her full potential, even if this means we tend to overlook the exploitation of others. This is becoming increasingly relevant as unregulated markets, like a Monopoly game, move money upwards and increase inequality.
I saw a meme yesterday that the CDC (Centre for Disease Control) does not mandate masks. This was in the context of the conclusion that ‘neither should we’. No doubt CDC does not need to mandate masks (assuming that the meme was correct)- the people who work there will have the vaccine ASAP.
The answer in civil rights terms if that anti-vaxxers have the right to be unvaccinated as consenting adults in private, but they do not have the right to go into public spaces where they may spread the virus. That is the individual rights answer and also the greatest good for the greatest number. We had a tobacco epidemic for 100 years, when it should have lasted 50 years if there had been science-based policy. This must not happen with this epidemic. We must have a lockdown until probably 90% of the whole population is vaccinated. We should vaccinate people who want it as fast as we can. Then we should have vaccine passports so we can open up again. Florida in the US is showing us what happens when silly policies are followed.
10/07/2021
10 July 2021
I felt that something was wrong when a Soldier started advising me about vaccinations.
Here is a good summary from Crikey of what seems to be happening.
www.crikey.com.au/2021/07/07/administration-with-authority-how-putting-the-vaccine-rollout-in-military-hands-is-corrosive-for-the-country/?utm_campaign=Weekender&utm_medium=email&utm_source=newsletter&wkndr=RFdETTg0am9ucG5qc2dpcVpTeTU2QT09&success=krsmvj