Doctor and activist


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Category: Personal

BUGA UP Nostalgia

16 November 2022

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

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

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

www.youtube.com/user/BUGAUPTube

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Submission to Inquiry into Online Gambling

11 November 2022

Dr Arthur Chesterfield-Evans

The Internet Problem

The issue of online Gambling is similar to many problems in that online gambling involves an area of activity that is largely beyond the direct control of the Australian Parliaments, or indeed any single Parliament.  The internet was designed to be anarchic, and so it is.

Programs to deal with gambling regulation are thus ineffective, but the limited terms of reference of this inquiry suggests that governments are not thinking in terms of what they can do at a systemic and global level and are turning instead to a focus on the individual.

Need for an Industry focus rather than an Individual Focus

It must be noted that where creating public health problems benefits an Industry, the response must be against that Industry.  Concentrating on individuals while the Industry markets to the world is a very inefficient strategy.  To use a historical example, the Tobacco Industry marketed with ubiquitous ads, sponsorships, product placements and many other techniques, yet wanted medical professionals and school education to be the only techniques used against them, framing the issue as personal choice (and responsibility) and ‘smokers v. non-smokers’ requiring courtesy (and no criticism and restrictions).

This is the situation that the Gambling Industry is in now. They demand to be able to market to the world, but want all harm minimisation programs directed at individuals.  They know that this is a winning strategy for them.

What the Federal Government Can Do

While it is true that the Australian Federal government has no effective jurisdiction over the internet, and does not licence or control the Hotels, Clubs and Casinos with their poker machines, it has control over Australian media advertising laws and also allocates grants to States.  The Federal government could ban all Gambling advertising on electronic media in Australia, and lessen grants to States in proportion to their revenue from Gambling. This would stop the States getting any benefit from gambling revenue, which they rely on quite highly.  Western Australia, which is missing out on Gambling revenue would certainly support this.

The ban on tobacco advertising and sponsorship has set a precedent for action on public health issues, and there was censorship of certain opinions that were antithetical to a national COVID strategy, so the idea of a ban on Gambling advertising is not new or radical.  VicHealth also replaced tobacco advertising with ads for healthy lifestyles and anti-Gambling advertising could replace ads for Gambling. The protest group, BUGA UP (Billboard Utilising Graffitists Against Unhealthy Promotions) in the 1980s used satire of tobacco advertising to sharpen the focus on the Tobacco Industry’s absurd imagery and callous disregard for the lives of their customers.  They won hearts for their Robin Hood approach to the entrenched power of the Tobacco Industry and set the world standard for action against tobacco, because compared to their actions, everything else became ‘moderate’.  But less recognised than their billboard campaign  was the re-framing of the debate from ‘smokers v non-smokers’ and ‘personal choice’, to a ‘Tobacco Industry campaign to make a profit even though it kills people’.  This reframing in the public mind allowed governments to stand up to the Tobacco Industry and forced political parties to eschew their donations (at least publicly).. 

Gambling Industry Strategy

The Gambling Industry’s ads are very clever, appearing to take the loser’s side to identify with (usually) him and dangle the prospect of a win, though of course this is statistically impossible in the medium term. They are perverting the idea of ‘mateship’ to a group Gambling session with a cheery comparison of who they are backing as they watch sport.  This would be very vulnerable to a satiric response, based on a commiseration as to which mug lost the most and a final comment that ‘gamblers are losers’.

Laissez-faire v. Health

The Federal government is responsible for the health of Australians and with an increasing percentage of health problems being related to lifestyle choices, the government cannot simply ‘leave health to the market’.  ‘The market’ will sell anything that makes money irrespective of whether it has good health outcomes or not, so leaving the national wellbeing to ‘the market’ is a highly flawed strategy as the government in the end picks up the tab for all problems. The Federal government should unashamedly promote sales and practices that are good for health and discourage things that are not.

Encouraging good personal decisions

Any reasonable management textbook will say that the best way to manage things is to have good decisions made at the lowest possible level within the organisation. Yet gambling advertising uses distractions and dreams of riches that are statistically extremely unlikely to encourage people to gamble, and thus not use their money wisely. If the ads said ‘Do not contribute to superannuation’, ‘Do not save’, Do not worry if you do not have enough money to feed your kids’, there would be a huge outcry.  Yet this is the outcome with a large percentage of gambling money received being from people who cannot really afford it.  The social problems created take an immense amount of effort from government and NGO charitable organisations to try to rectify them. Often they cannot.  This problem is entirely created because of bad decisions on gambling made by people who the Gambling Industry has conned.  It is exactly like people taking up smoking. It was portrayed as a bit of harmless pleasure, but when people were hooked, it did them immense harm.  Gambling is the same.

Need for Gambling Research

One the other problems of Gambling is that the research is funded by the industry, so its scope and nature are controlled.  The amount of harm that it does is poorly quantified, so that there is little evidence for those opposing Gambling to use in political debate. The lack of evidence and the lack of debate suits the Gambling Industry fine- they are more than happy to continue and extend the status quo.  Given that the Federal government is a major player in cleaning up the social problems created by the Gambling, it should insist that there be well funded research on the social consequences of Gambling, and the nature of this research should not be determined by the Gambling Industry.  The Gambling Industry in Australia is extremely large by world standards, perhaps the largest in the world apart from little enclaves like Monaco or Macau where the money is retained by the State and the social problems are either ignored or assumed to be manifest elsewhere.  The social indices of distress are very high in Las Vegas.  It might be said that the Gambling Industry in Australia is like the gun lobby in the US; it is almost unchallengeable.  This must change, and the Federal government must initiate the change.

Off-line Gambling

It is interesting that the Clubs lobby is under challenge at a state level.  The origin of this is uncertain.  There has always been a lobby against Gambling, and this may have been helped by the rapid rise in the inflation rate which is straining the family budget, particularly of disadvantaged people, who are the ones most affected by Gambling losses.  It is also no doubt helped by the revelations that the Casinos have happily laundered money for organised crime, by-passing their regulatory systems, and being perceived by organised crime as an easier target than foreign jurisdictions.  The public also notice that the Casino boards were well stacked with ex-politicians, who were presumed to be there to smooth the political pathway of the Casinos in their dealing with regulation or (even) enforcement. It might be noted that despite the huge amounts of money being laundered and the findings that the Casinos were not fit to have licences, their share prices have only suffered modestly, showing that everyone knows that eventually their licence will be restored and it will be ‘business as usual’. The public is also well aware that the charade, ‘’I had no idea what was happening’ from the politically connected people at the top, merely leads to a resignation or two, but there is no penalty on the individuals.  An aboriginal youth can go to gaol for petty theft, but laundering billions for organised crime merely leads a Casino director to a sojourn in the yacht club.  While the major political parties have been very reluctant to upset the Hotel and Club industry, as evidenced by the 20 year delay in introducing smoke-free indoor air legislation, the rise of the Teal candidates threatening once safe seats, has pressured the major political parties to take a more ethical stance, and also  blunted the financial advantage that support  from the pubs and clubs lobby gives to their campaigns. 

Online v. Off-line Gambling

But the final possibility for the pressure on the Clubs and Hotels may have come from the Online Gambling lobby. If it is assumed that people who want to gamble will use what is available, there is a real possibility that the lack of poker machines availability in pubs and clubs may lead to an increase in online Gambling.  Supporters of the pubs and clubs are quick to point out that the clubs are non-profit and spend their monies enlarging their premises and providing facilities in Australia, as well as paying at least some tax to State governments. If there were a change towards online Gambling this money would go overseas.  This overlooks the social context of gambling. Playing a poker machine is quite different  from going online, so there is unlikely to be a direct transfer, even if the online experience is made more similar.

Need for Federal Government Action on all Gambling

The lesson for the Federal government, however, is that Gambling must be discouraged at both the pub and club level, and online at the same time. Both have similarly detrimental financial consequences for the players and punters, though the industries are distinct. From the public’s point of view, it is worrying that the terms of reference of this inquiry neglect that issue of Gambling in pubs, clubs and the TAB, as it suggests that these influences have restricted the terms of reference.  The regulation of the internet is also a wider problem, which usually comes into focus with the issues of inflammatory hate speech, medical disinformation, defamation or an aspect of pornography.  Gambling for money should be in a similar category to these and discussed in a similar context.

Recommendations:

  1. The Federal Government should recognise that the Gambling Industry and its power is the reason that Australia has a worse Gambling problem than almost any other developed country and the the Gambling Industry has a hold on Australian politics as strong as the Gun lobby in the USA, and with a detrimental effect that could be of similar magnitude.
  2. The Federal government should take an unequivocal stand that Gambling is harmful in that it encourages poor financial decision-making which puts a strain on the whole welfare system, Federal, State and NGO.
  3. The Federal government should recognise that all forms of Gambling need to be discouraged, pubs, clubs, TAB, on-course and online and this needs to be an unequivocal campaign, similar to Quit or for the necessity for vaccination.
  4. The campaign against Gambling needs to be in schools and have both a mathematical component as part of statistics, and a more practical part looking at online Gambling, and the social institutions which encourage Gambling.
  5. The campaign against Gambling must involve electronic media advertising bans on TV and all advertising and sponsorship.  It must involve active ads against Gambling as well as merely bans on pro-Gambling ads.  It should use satire and be prolonged.
  6. The control of online Gambling should be seen in the context of minimising the harm of the ubiquitous internet, and research on how to lessen Gambling should be pursued with endeavours to lessen other social harms such as child sexual exploitation, bullying, vaccine disinformation, tobacco and vaping advertising and disinformation, hate speech, video games that promote violence and defamation.
  7. The Federal government should fund Gambling research so that the social consequences can be quantified and rational decisions made about the cost-benefit to society.  Gambling research should not be neglected, limited, financed and controlled by the Gambling Industry as is currently the case.
  8. There must be support for people who have a gambling problem. Such services need to be publicised, and destigmatised, as happened for those with mental illness.  However, individual services must not be a substitute for a more systemic industry-focussed approach.
  9. There needs to be  a national register of addicted gamblers to allow better exclusion from gambling facilities. If this were comprehensive, it could be used to prevent addicts losing money online with a caveat emptor for those who took the bets from registered addicts.  The credit card companies could be recruited not to allow Gambling to such addicts and not to honour Gambling debts incurred by registered addicts.
  10. The Federal government should consider family support for addicted gamblers in the same way that child support is available for at risk families.

About the Author

Dr Arthur Chesterfield-Evans is medical doctor, who trained in surgery and became a tobacco-control advocate, then an Australian Democrat MLC in the NSW Upper House. He is currently working as a GP.

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The Queen and I

9 September 2022

I cannot say I ever met the Queen, or that she had a clue who I was, so if you are looking for that, read no further.

I was at the Coronation amazingly enough, as my father went to England to study surgery and I was taken to the parade and was apparently old enough to wave a flag, but not old enough to remember doing so.  (No sums please).

A friend from school, whose father was a parson and who was a very decent fellow went to London for life experience and got a lowly place at a respected PR firm.  It turned out that the PR firm did the PR for the Queen and he was attached to the small unit that did it.  His major boss was promoted to head the whole organisation and the next boss left suddenly and he, at a relatively young age became the Queen’s personal PR agent.

He was there for some years then came back to Australia, as he wanted his kids to grow up as Aussies.  He was much admired for his work there and was naturally quizzed at some length about how things worked.  He said that the Queen was very hard working and always very thoroughly briefed about everyone she was meeting, both their personal background the political or social issues that they were interested in.  He said she was astute, conscientious, kind and decent.  But she was not a Pollyanna. She was realistic about people. If they were silly, she would tacitly acknowledge this as she sought a strategy to deal with the situation.  He was very discrete about specifics and did not mention that he was rushed back to London to deal with the Royal fallout from Diana’s famous TV interview, but he did let one significant issue slip.  He was asked about the Queen’s attitude to Australia becoming a Republic. 

You may recall that a majority of Australians wanted Australia to be a Republic but they were split over whether the President should be a figurehead like a Governor-General or Queen, or whether he/she should have executive powers as in the USA.  John Howard therefore arranged that Electors were asked on 6 November 1999 whether they approved of:

A proposed law: To alter the Constitution to establish the Commonwealth of Australia as a republic with the Queen and Governor-General being replaced by a President appointed by a two-thirds majority of the members of the Commonwealth Parliament.

This naturally split those who wanted a Republic into those who wanted a President appointed by Parliament and those who wanted an elected President.  This carefully crafted split allowed the No vote to win.

The Queen apparently felt that it was inevitable that Australia should become a Republic and that it should stop silly-shallying with it and get on with it as Canada had done.  Naturally she did not say so, and my friend, who has since died would roll over in his grave if he knew that I was taking the role of a gossip columnist in writing this.

But I believe this story to be true, significant and a tribute to the Queen’s realism. 

My view is that we should have a President who is non-executive, and we need major constitutional change as to how Parliament works at the same time.  The latter half may be a hard ask.

But there is no doubt that the Republican debate is coming soon.

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Some Thoughts for the Jobs Summit- Arthur Chesterfield-Evans

27 August 2022

Definition of unemployment
Years ago, the ABS definition of unemployment was less than 25 hours a weeks of full time work,
which was considered to be a living wage.
The world’s definition was any regular work, even 1hr per week. The Australian definition was
changed ‘so comparisons could be made’ and unsurprisingly our unemployment rate improved
dramatically. But the figure is actually meaningless as an index of how the population’s work status
is. All gig workers on non-living wages are treated the same as full time permanent workers as the
latter category dwindles mightily.
What no one is saying is that the unemployment rate is very low because all the foreign students
and visa workers, who were getting very exploited in the gig economy, are no longer there. Even
backpackers, willing to work for poor wages as a ‘life experience’ are no longer here.
Employers have had a dream run for about 40 years. What has happened is:

  1. Australia has de-industrialised so that the organised groups of full time workers that were
    unionised and could demand a reasonable share of wages has dwindled hugely as a
    percentage of the workforce, weakening the unions.
  2. The governments, inspired by neo-liberal ideas of free markets, have attacked unions so that
    wages can be lowered. Wages are seen as a cost to the exclusion of their other attributes.
  3. Globalisation has made workers compete across the world, so as long as the goods produced
    are transportable or the service offered can be done remotely, many jobs can be ‘offshored’.
  4. It is easier for employers either to import goods rather than manufacture them here or to
    move services offshore.
  5. Increased labour mobility has helped:
    a. The development of Education as an export commodity has brought many students
    here, who are only allowed to work 20 hrs per week. Since they cannot live on that
    amount of money they are forced to work ‘illegal’ hours, so employers pay cash or
    low wages or both.
    b. The ‘work visas’ from developing countries has allowed tasks such as fruit picking to
    be done at exploitative labour rates as the workers do not know what they are
    entitled to. No effort seems to have been made to inform them, and they have no
    power if they were informed.
  6. The internet has enabled jobs to more casual, as recruitment is quicker and simpler, allowing
    more part-time and short-term work.
  7. ‘Labour Hire’ has meant that the rights of workers can be undermined. Because workers are
    not ‘full time’ but only get what shifts are ‘available’, they can still be ‘with the agency’ in a
    legal sense, but be given no work. If there is a workplace injury, creating a legal obligation
    to the employer in terms of wages and rehabilitation, this can be avoided or minimised. The
    person who they actually did the work for (and who was responsible for their injury) is not
    their employer- the agency may be, but even they can say that they are merely a conduit to
    a workplace who take a commission only for the hours worked.
    In economic terms, workers are now in a perfect market, so the price falls. Higher executives claim
    to be in a ‘world market’, so can take stratospheric salaries and the gap between rich and poor will
    grow. This is very bad for social cohesion, and in the subcultures of management there is a real and
    dangerous loss of contact with the world in which the employees live.

What is needed is:

  1. Government has to recognise and state that in an unregulated market, the power of
    employers will allow the continuation of the increasing inequity of the last 40 years. People
    are unwilling even to state this obvious fact.
  2. The Government needs to recognise, acknowledge and implement the idea that everyone
    should be able to participate in society. Not all jobs will make a profit, and a volunteer
    framework needs to be created for older folk and long term unemployed which gives them
    dignity and the ability to participate in society. But volunteers must not be cynically used to
    replace paid jobs; they should concentrate on doing jobs that are needed but otherwise
    might not be done. A structure of tasks and volunteer coordinators is needed, organised by
    local government and based on models such as the bush regenerators of Hunters Hill.
  3. Award wages for job categories are needed to set norms as a starting point for negotiations.
  4. Collective bargaining with general awards, and employers that want to deviate from them
    have to justify their position with appeals to a Tribunal.
  5. Support for Unions. Many workers cannot negotiate with big businesses any more than ants
    can negotiate with elephants. Bureaucratic Fair Work Commissions are needed to enforce
    rules, but there have to be people at the workplace to observe and advocate. The
    Commission cannot replace workplace membership systems.
  6. Aged Care and Disability industries need rules set with more input from residents,
    complaints mechanisms and enforcement. Self-regulation is frankly no regulation.
  7. A regulator and external enforcement is also needed in the aged and disability residential
    sector. Currently this is driven by real estate- the idea is to get people to sell their houses,
    move into overpriced units and then be ripped off, even in the supposedly not for profit
    sector. Once in there the level of care needed tends to increase, but not to be provided.
  8. A systematic assessment project for overseas qualifications is needed. In my own
    experience there are large numbers of very well qualified Koreans who have nothing
    recognised and work in very menial jobs. This is discrimination and a waste of talent.
  9. The Commonwealth Employment Service should be re-established as a Federal public
    service department. The idea that public servants do not work hard is frankly wrong and
    offensive. The private sector incentives have resulted in cream-skimming. The onerous
    ‘mutual obligations’ are punitive and just waste employers time. Centrelink does not meet
    its mutual obligation to help people. It takes up to 2 hours for them even to answer the
    phone. They are currently set up like a business that strives to minimise its costs by
    deflecting customers’ requests. A whole new philosophy is needed in job placement.
  10. Training is needed, especially in trades. Apprenticeships have been badly neglected as
    education has been seen as a commodity, and university education almost a universal right
    to gain entry to the upper middle class. TAFE, which was a very valuable training venue to
    get skills, a place where aging tradesmen could transfer their skills and a major social ladder
    for people pf all ages to better themselves, and hence a considerable driver of social equity
    has been long neglected. The Government needs to research the skills mix needed,
    subsidise places to fill those needs, and subsidise apprentices, obviously with supervision so
    that here cannot be systematic churn, which has happened with some job subsidy programs.
    This research can be done within the public service, hopefully with some links to academic
    departments that study employment needs.
  11. In terms of future industries, the government has to have policies that favour the change to
    renewable energy. An example of this is that Electric cars should be able to plug into the
    grid and buy and sell electricity on the spot market. This will make them part of the solution
    to the problem of energy storage, rather than exacerbating peak demand. It will also allow
    owners to offset their purchase costs. If there is a change of policy the jobs in this case will
    follow.
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Finland

22 June 2022
I am currently in Finland, holidaying after the EuPRA (European Peace Research Association)
Conference in Tampere.
I had hoped that there would be more insights on the Ukraine situation, but peace research has its
topics and budgets set years ahead, so Ukraine was barely mentioned and no new insights given.
Finland generally is very pro-Ukraine, with Ukrainian flags flying alongside Finnish ones at railway
stations and even Ukrainian flag stickers on traffic poles.
The conference was mainly about ‘positive peace’ which means trying to get harmonious social
policy, with papers on minority, immigrants and disadvantaged groups, rather than ‘negative peace’
which is taken to be the absence of war. So there was surprisingly little on politics or foreign policy.
The situation of the indigenous ‘Sami’ (formerly called Lapps) was also a big topic. Researchers claim
it is very hard ever to get funding for peace research, and it has to be framed as ‘conflict resolution’.
The conference had a distinctly feminist flavour both in attendance and in tone. It was very
competently organised, principally by Masters and PhD students from the Tampere Institute of
Peace Students. Despite their acronym, TIPSY, the students were very serious and organised.
Participants were shepherded around by Norse goddesses, who seemed charmingly unaware of
their aesthetic attributes.
Finland is an affluent, modern country of 5.5 million with an ambience very like Sweden. They have
the best education system in the world, and almost all speak excellent English. Signs used to be
written in Finnish, Swedish and Russian, but there is a trend towards Finnish and English, as all
Swedes speak English, and Russian is becoming less important to the Finnish economy. Finnish is
quite a distinct and unusual language, quite different from Swedish, which was used by the elite
when Sweden occupied Finland, and is widely spoken. Finland has high taxes, a good welfare system
and a very high standard of public facilities. Incomes seem high as prices are about 50% higher than
in Australia. Petrol is about $A3.75/litre. There is a Universal Basic Income and no visible poverty.
I had not known much about Finnish history, but it had been something of a rural backwater with a
very low agricultural population, principally populated from Sweden. It was under Sweden until the
Swedish-Russian war of 1721, when it came under Russia. The Swedes took it back in 1788, and
Russia took it back in 1809, but left it relatively autonomous. Finnish nationalism was relatively late
to develop, starting in the 1850s. A Scot, Finlayson, set up textile factories in Tampere in the 1850s,
based on the model of Manchester, England. Tampere became the industrial heart of Finland. Lenin
came to Finland and stayed for some time in Tampere as it had a high population of workers. He
promised to give the Finns autonomy if the revolution succeeded. He actually met Stalin in Tampere
so the Lenin Museum there claims that there was the birthplace of the Soviet Republic.
Stalin had his own methods of funding the revolution, which included robbing banks such as the
Helsinki branch of the Russian bank. Relations between the Russians and the semi-autonomous
Finns had generally been good, though the Tsar in his last days from 1899 tried a policy of
Russification, which was not popular.
Lenin had to flee Finland from the Tsarist police, but after the revolution succeeded in 1917 the
Finnish Senate declared independence. Lenin kept his promise and supported the new republic but

he hoped for world revolution, so sent help to the Reds in Finland who initiated a civil war in 1917.
The Reds were strong in the industrial cities such as Tampere. The White nationalists were more
middle class and rural. The war was short and brutal with victory to the new White republic but
many were killed and there were considerable recriminations. Russia at that time was fully occupied
with its own internal strife, but Finland respected their power, remained neutral and benefitted
from trade with Russia, as it increasingly industrialised.
In 1939, Hitler and Stalin signed the Molotov-Ribbentrop Agreement, which pledged non-aggression
between Germany and Russia and gave the western half of Poland and Lithuania to Germany. The
eastern half of Poland and all the countries east of it were ‘given’ to Russia.
The Baltic States, Latvia and Estonia were in this agreement, and so was Finland. Safe from attack by
Russia, Hitler then started WW2 by attacking Poland, and the Russians moved to take their half (so
that Poland ceased to exist). The Baltic States quickly fell to Russia, but Finland resisted, successfully
at first, but the Russians overcame them and took some territory in an unfavourable settlement, but
left them some degree of independence. When Germany invaded Russia, they demanded passage
through Finland to attack Norway, and the Finns agreed, not having much option. The Finns then
supported the Germans to get some of their territory back from the Russians, so in the settlement
after the war in 1944, the Russians took even more territory from the Finns, including part of
Lappland in the north, so that Finland no longer reaches the Arctic Ocean and Russia meets Norway
above them.
After WW2 the Finns built a Nordic welfare state and developed their industries, Nokia being the
best known example. Farm forestry is still a major industry, particularly pine and silver birch. There
are almost no grazing animals. They concentrated on education and industrialisation and their
economy grew as fast as many of the Asian ones, but with higher wages. They took a very neutral
foreign policy stance not to offend Russia, but did join the Euro currency launch in 2002.
Geographically, Finland is quite a large country as it extends so far north. It has no mountains and
only low hills and a large number of lakes which tend to have their long axes to the south-west due
to fact that the country was covered by a huge sheet of ice in the Ice Age, which moved to the south
west. It is quite warm in summer (now) and the Finns go to their summer cottages on the lakes. In
winter it is very cold, so all the houses are triple glazed and well insulated. There are no solar panels
and they are trying to become carbon-dioxide neutral, telling you on the tickets how much carbon
dioxide is produced by your bus or train journey. 28% of the electricity used is of nuclear origin.
Travelling is reasonably easy, though the Finnish language is difficult but almost everyone speaks
reasonable English. Getting used to cars on the right side of the road is a bit of a challenge, and
walking on the footpaths also, and the latter is rendered more complicated by the fact that the
footpaths also have a section for bikes and electric scooters which takes half the footpath, but there
is no consistency on which half. Finns smoke more than Australians and seem to have a lot of junk
food restaurants, so I suspect that the prevalence of obesity will be rising, especially as electric
scooters now considerably outnumber bikes, and are available everywhere to be picked up and used
after buying a plan and putting in a code.
It is a question of getting used to things, but in the meantime I am enjoying the capital of Lappland,
Rovaniemi. It is not possible to see the Northern Lights as these are at the Winter solstice in

December- here at present the sun sets for about half an hour a day and it never gets dark. The 8am
temperature is 14 degrees. I have heard that it is cold in Australia.

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Bullshit Jobs

8 April 2022


The idea of bullshit jobs is not new. It comes from a book in 2018.

However, with employment supposedly doing well, largely because we have excluded guest workers due to Covid, it is worth looking at how many jobs are actually needed.

Everyone needs something to do and a reasonable income to live on. The status of having a job relates generally to its perceived income, though there is some ‘doing good’ status associated with jobs like nursing despite their being chronically underpaid.

But technology replacing people has not brought the expected benefits because there seems no plan to spread the benefits evenly, or look at whether what is being done has any social utility. Many jobs that need doing are not done. Many people who want to work cannot, yet much energy and money is spent doing useless things.

I waste about 80% of my time as I treat Workers Comp and CTP injuries. About 20% of my time is deciding what treatment is needed, and about 80% filling in paperwork or writing reports to try to get the treatments paid for. On the other side there are a phalanx of clerks trying not to pay and to transfer the costs elsewhere. (i.e. to Private Health Insurance, Medicare or the patient themselves). Many doctors and lawyers also strive mightily in this unproductive area. The bottom line is that while the overheads of Medicare are about 4.5%, the overheads of CTP are close to 50%,; i.e half the money goes in processing or disputing claims or in profits for the companies indulging in this nonsense. And since many patients often cannot get the treatment or suffer long delays because of their efforts, it is a really bad use of human energy.

Someone needs to look hard at what we do and where the benefits go. Assuming that ‘the market’ will fix it is about as sensible as saying that ‘God’ will fix it, and is usually espoused with the same uncritical zeal.

Here is Wikipedia summary of the book:

In Bullshit Jobs, American anthropologist David Graeber posits that the productivity benefits of automation have not led to a 15-hour workweek, as predicted by economist John Maynard Keynes in 1930, but instead to “bullshit jobs”: “a form of paid employment that is so completely pointless, unnecessary, or pernicious that even the employee cannot justify its existence even though, as part of the conditions of employment, the employee feels obliged to pretend that this is not the case.”[1] While these jobs can offer good compensation and ample free time, Graeber holds that the pointlessness of the work grates at their humanity and creates a “profound psychological violence”.[1]

The author contends that more than half of societal work is pointless, both large parts of some jobs and, as he describes, five types of entirely pointless jobs:

flunkies, who serve to make their superiors feel important, e.g., receptionists, administrative assistants, door attendants, store greeters, makers of websites whose sites neglect ease of use and speed for looks;
goons, who act to harm or deceive others on behalf of their employer, e.g., lobbyists, corporate lawyers, telemarketers, public relations specialists, community managers;
duct tapers, who temporarily fix problems that could be fixed permanently, e.g., programmers repairing bloated code, airline desk staff who calm passengers whose bags do not arrive;
box tickers, who create the appearance that something useful is being done when it is not, e.g., survey administrators, in-house magazine journalists, corporate compliance officers, quality service managers;
taskmasters, who create extra work for those who do not need it, e.g., middle management, leadership professionals.[2][1]

Graeber argues that these jobs are largely in the private sector despite the idea that market competition would root out such inefficiencies. In companies, he concludes that the rise of service sector jobs owes less to economic need than to “managerial feudalism”, in which employers need underlings in order to feel important and maintain competitive status and power.[1][2] In society, he credits the Puritan-capitalist work ethic for making the labor of capitalism into religious duty: that workers did not reap advances in productivity as a reduced workday because, as a societal norm, they believe that work determines their self-worth, even as they find that work pointless. Graeber describes this cycle as “profound psychological violence”[2] and “a scar across our collective soul”.[3] Graeber suggests that one of the challenges to confronting our feelings about bullshit jobs is a lack of a behavioral script in much the same way that people are unsure of how to feel if they are the object of unrequited love. In turn, rather than correcting this system, Graeber writes, individuals attack those whose jobs are innately fulfilling.[3]

Graeber holds that work as a source of virtue is a recent idea, that work was disdained by the aristocracy in classical times, but inverted as virtuous through then-radical philosophers like John Locke. The Puritan idea of virtue through suffering justified the toil of the working classes as noble.[2] And so, Graeber continues, bullshit jobs justify contemporary patterns of living: that the pains of dull work are suitable justification for the ability to fulfill consumer desires, and that fulfilling those desires is indeed the reward for suffering through pointless work. Accordingly, over time, the prosperity extracted from technological advances has been reinvested into industry and consumer growth for its own sake rather than the purchase of additional leisure time from work.[1] Bullshit jobs also serve political ends, in which political parties are more concerned about having jobs than whether the jobs are fulfilling. In addition, he contends, populations occupied with busy work have less time to revolt.[3]

As a potential solution, Graeber suggests universal basic income, a livable benefit paid to all, without qualification, which would let people work at their leisure.[2] The author credits a natural human work cycle of cramming and slacking as the most productive way to work, as farmers, fishers, warriors, and novelists vary in the rigor of work based on the need for productivity, not the standard working hours, which can appear arbitrary when compared to cycles of productivity. Graeber contends that time not spent pursuing pointless work could instead be spent pursuing creative activities.[1]

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Loneliness and its solutions

25 February 2022


I sometimes watch Foreign Correspondent on ABC TV and by chance on 15/2/21 I came across this excellent programme on loneliness in Japan.


The ABC correspondent there looks at loneliness in the Japanese population from older folk dying alone, to younger people simply withdrawing from society.


Some of the older ones had no family or jobs. Some of the younger ones were so pressured to succeed and felt that they had failed, so simply withdrew from society. It seems that the pressure on kids all to be CEOs is an absurd and unachievable objective.


I am not sure that the situation in Australia is as bad, but I thought about some of my patients and could think of half a dozen immediately. With some of them , I am one of the only two or three people in the world they have any contact with, their relationships are tenuous.


None of them started with mental health problems. Here are some examples:


A 60 year old man worked for a security company looking after an insurance company. He was doing surveillance for them, but it took over his life as he was contacted 24 hours a day for various crises. Case management employees having conscience over what they were doing had to be rescued from self-harm in the toilets. Enraged claimants with refused claims threatened to blow up the company offices with cans of petrol. He saw staff high-fiveing as some claimant got a derisory settlement when they deserved and needed a lot more. It went on like this for years. When he said that he could not do this anymore he was treated as badly as any of the people he had dealt with. He told me this story, and I had hoped that with his considerable management skills and experience, he could be put into a less stressful position. But he deteriorated. Everything reminds him of the corruption of the world. He is estranged from his wife and they communicate with post-it notes on the frig. He goes for a walk at 11 at night so he will not have to speak to people in the street. One son has stuck by him and visits daily, and will build him a self-contained unit in his new home.


Another patient is a 62 year old ethnic taxi driver who was so badly bashed 11 years ago by a gang stealing his takings that he lost an eye, has never worked again and never recovered mentally or physically. He was divorced; lives alone and sometimes will not even answer the phone.


One is a 42 year old foreign student who came to study theology, wanting to become a pastor. Her English is not great. She is a trifle unworldly, and thought that the world is basically kind and people look after each other. She had a casual job in a motel and her boss asked her to move a bed down the stairs between floors. She said it was too heavy and she could not, but he threatened to sack her. She did it and got an injury to two discs in her back. She was frightened to have surgery, so was in agony for a couple of years and eventually agreed. She had minimal surgery, which was not successful. The insurer decided that she was not complying with what they wanted so refused to pay her. She was effectively broke and homeless, so an old lady from her church offered her a bed and food. But she lives a long way away and up a drive that is hard for my patient to walk up. She was effectively trapped. As a foreign person she did not even have Medicare for the minimal psychological help it offers (6 visits a year). Her mental health deteriorated and she shunned all outside contact, and would not even answer the phone. She has gone home to her family- I can only hope she improves there.


One is a 39 year old from a religious and teetotal family with a high sense of ethics. He was a top salesman of a computer company and became aware that they were ripping off some customers. He drew this to management’s attention, but they declined to do anything and he was labelled a whistleblower. Management supported him by putting out an email asking that he be supported for his mental health issues. He felt that this ostracisation was the end of his career, because he had asked them to behave ethically. He was certain that no one in his tight top group will now employ him, so he withdrew and started to drink to lessen the pain. His family then rejected him because of the drinking and his sales friends are estranged also. The psychologist gives him Cognitive Behavioural Therapy exercises and I try to get him to drink less and somewhat ironically counsel him that you cannot withdraw from the world merely because the baddies generally win. He lives alone, answers the phone and is just able to do his own shopping, but is not improving much.


These are just some examples that I know. Coasting home as GP at least keeps you in contact with life. The point is that many people have broken lives, but just keep living. None of these examples have done anything wrong themselves. Is a sense of ethics a mental illness?


As everyone has to ‘look after themselves’ in a consumer-oriented society, more people will fall through the cracks, especially as the gap between rich and poor is enlarged by pork barrelling which puts resources into areas that need them less, tax breaks for the rich, subsidies for private schools and private health insurance, derisory welfare payments, and insurers allowed simply to refuse to pay without penalty.


People need basic support with universal housing and universal health case. They need jobs or at least occupations and an adequate income to survive. And we need outreach and support services that can be called upon.
When people say, ‘There are not enough jobs’, they are taking nonsense. Anyone can think of many worthwhile things that need doing. And there are plenty of people who would be happy to do them. The problem is that in a world where nothing can be done that does not make a profit, a lot of things that need doing are not done. That is where the policy change are needed. We cannot simply look at the money and see to what level existing activities can be maintained. We need to look at what needs to be done, and then work out how to achieve it. We need to decide that everyone has a right to live and those who have a good life will live in a better society if everyone can share at least a basic quality of life. There has to be recognition that the ability to be profitable need not be the overwhelming criterion for what is done. Tax may go up, but if there is real re-think of priorities, it is not likely to be all that much.


The link to the ABC program that initiated this tirade is below.
https://iview.abc.net.au/show/foreign-correspondent/series/2022/video/NC2210H002S00

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Djokovic Fiasco reflects no credit on Australia

6 January 2022

Most people know that Novak Djokovic is pushing to be the Greatest tennis player Of All Time (GOAT) and needs just one Grand Slam victory to achieve this. Most also know he has been very successful in the Australian Open, which starts next week.  There is little doubt that a lot of people, myself included would be very interested in whether he can win after his failure against Medvedev in the US Open.

Many people are aware that he has been anti-vax and he unwisely attended a tournament last May and he and a number of others got COVID19, presumably by the Delta variant, but this is not recorded.

He has never been a popular as the smooth Roger Federer, or the rougher battler Raphael Nadal who are his great rivals for the GOAT title.  He was seen as not quite as warm a character.  He was praised by the President in his native Serbia for his early victories, but this cooled a bit when he made politically progressive statements.  His anti-vaxx statements have been frankly embarrassing.

Australia has a rule that if you are not vaccinated you cannot have a visa. 

Whether this should be the only criterion for entry should be a moot point.  With most infectious disease, having antibodies at a certain level assumes that you are immune to reinfection with the same disease.  This works for polio, but with ‘flu, where the virus changes, people get infected by a different strain every year.

The CDC (US Centre for Disease Control) guidelines are somewhat equivocal about antibodies. They will not say that having antibodies means either than you cannot be infected or that any infection will be minor.  It seems that COVID is considered more like ‘flu than polio.

It was not clear on what ground Tennis Australia allowed him to come, but now Border Force have excluded him, and the Prime Minister smugly talks about rules being rules.

It is important that we are protected, and many Australians have endured a lot of suffering in lockdown to achieve this, so they have little time for people to be treated differently.  But if Djokovic had COVID 6 months ago, it is hard to believe that he constitutes a high risk when the whole country has decided to abandon masks, distancing, QR codes and venue number restrictions. One might wonder what his antibody status is, or whether this was known.

It is important that various agencies in a country remain independent. We do not want Border Force deciding medical issues, nor Tennis Australia deciding immigration policy.  But Australia looks pretty silly, when one group allows him and another does not.  As a tennis watcher, I would like to see him play, and it does seem that the politics are overcoming the science. 

Now we bring in the lawyers, another idiot factor?

www.smh.com.au/sport/tennis/novak-djokovic-launches-court-bid-to-fight-deportation-20220106-p59mdp.html

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Fake Science now an Industry

6 January 2022

Many years ago (?1977), I applied for the job as editor of the Medical Journal of Australia.  I had done two years as a surgical trainee and took a year off from the somewhat disillusioning hierarchical system.  I had done 3 and a half years of university English, but in terms of my experience editing, it was perhaps a long shot.

The salary was roughly the same as a second year resident, though more than half that salary had been overtime.  The job seemed a bit of dangerous niche, but it was worth thinking about.  I didn’t get the job (Dr Alan Blum from the US did), but was invited to apply for Deputy Editor.  The salary here was $20,000 less, which was more than a third. But the key reason I declined is that I hate having someone else waste my time. 

There is such an incentive to publish in order to climb academic ladders that most writing is done for the writer, not the reader.  As many papers are written as possible, so the idea of spending a lifetime sorting through thousands of papers to find ones of merit seemed a hazardous occupation with a great danger of drudgery.

When I thought about the issue I devised the Chesterfield-Evans theory of knowledge acquisition. It is an exponential graph with time on the horizontal axis and knowledge in the vertical.  With a little time you can get quite a lot of knowledge, but to get a little more or to get the forefront takes an immense amount of time, for the last bit of knowledge. This extra bit of knowledge may be well rewarded financially in medicine if you get it ‘approved’ as a specialty, but in many scientific endeavours there is no reward at all.  Getting to the forefront is made harder by the lack of incentive to write concise papers for the benefit of the reader.

In practices as a medical professional the explosion of information of indifferent quality has made reliance on key journals the easiest way to go, but even here the increased specialisation makes even being a reasonable generalist more difficult. The monetisation of knowledge makes the specialties not want to share all their information, the college and universities act like businesses and the drug companies want to sponsor a certain view.

When I wrote both my Masters theses, getting a good supervisor was a problem. No one really wanted to go through the writings of yet another postgrad.  My supervisor, Dr Chris Winder said that he would simply prefer students write concise papers and send the lot to a publisher, giving degrees to the ones considered worthy of publishing. 

But there has been a profusion of journals, initially driven by the profitability of these.  Now the pressure from students has been joined by a rogue element, the dodgy rip-off factories.  Plagiarism and now straight out fraud are now industries.

Those who seek knowledge now have to be more discerning. There is delight amongst the non-scientific who can, like Pontius Pilate ask, ‘What is truth’ and then also like Pilate not want to know the answer.

Sadly, politicians and managers who have agenda other than optimal knowledge are flourishing  in this environment.

I am glad that I did not become a medical editor; it is hard enough getting a broad-based knowledge of reasonably indisputable facts.

I am quite unsure how the confluence of factors favouring ignorance can be countered.  Making everyone learn some science and maths at school might be a start.

How fake science is infiltrating scientific journals

Harriet Alexander

January 5, 2022

In 2015, molecular oncologist Jennifer Byrne was surprised to discover during a scan of the academic literature that five papers had been written about a gene she had originally identified, but did not find particularly interesting.

“Looking at these papers, I thought they were really similar, they had some mistakes in them and they had some stuff that didn’t make sense at all,” she said. As she dug deeper, it dawned on her that the papers might have been produced by a third-party working for profit.

“Part of me still feels awful thinking about it because it’s such an unpleasant thing when you’ve spent years in a laboratory and taking two to 10 years to publish stuff, and making stuff up is so easy,” Professor Byrne said. “That’s what scares the life out of me.”

The more she investigated, the more clear it became that a cottage industry in academic fraud was infecting the literature. In 2017, she uncovered 48 similarly suspicious papers and brought them to the attention of the journals, resulting in several retractions, but the response from the publishing industry was varied, she said.

“A lot of journals don’t really want to know,” she said. “They don’t really want to go and rifle through hundreds of papers in their archives that are generated by paper mills.”

More recently, she and a French collaborator developed a software tool that identified 712 papers from a total of more than 11,700 which contain wrongly identified sequences that suggest they were produced in a paper mill. Her research is due to be published in Life Science Alliance.

Even if the research was published in low-impact journals, it still had the potential to derail legitimate cancer research, and anybody who tried to build on it would be wasting time and grant money, she said. She has also suggested that journals could flag errors while articles were under investigation, so people did not continue to rely on their findings during that time.

Publishers and researchers have reported an extraordinary proliferation in junk science over the last decade, which has infiltrated even the most esteemed journals. Many bear the hallmarks of having been produced in a paper mill: submitted by authors at Chinese hospitals with similar templates or structures. Paper mills operate several models, including selling data (which may be fake), supplying entire manuscripts or selling authorship slots on manuscripts that have been accepted for publication.

The Sydney Morning Herald has learned of suicides among graduate students in China when they heard that their research might be questioned by authorities. Many universities have made publication a condition of students earning their masters or doctorates, and it is an open secret that the students fudge the data. The universities reap money from the research grants they earn. The teachers get their names on the papers as contributing authors, which helps them to seek promotions.

International biotechnology consultant Glenn Begley, who has been campaigning for more meaningful links between academia and industry, said research fraud was a story of perverse incentives. He wants researchers to be banned from producing more than two or three papers per year, to ensure the focus remained on quality rather than quantity.

“The real incentive is for researchers to get their papers published and it doesn’t have to be right so long as it’s published,” Dr Begley said. He recently told the vice-chancellor of a leading Australian university of his frustration with the narrative that Australia was “punching above its weight” in terms of research outcomes. “It’s outrageous,” Mr Begley told the vice-chancellor. “It’s not true.”

“Yes,” the vice-chancellor replied. “I use that phrase with politicians all the time. They love it.”

According to one publishing industry insider, editors are operating with an element of wishful thinking. This major publishing house employee, whose contract prevented him from speaking publicly, said when his journal started receiving a torrent of applications from Chinese researchers around 2014, the staff assumed that their efforts to tap into the Chinese market had borne fruit. They later realised that many of the papers were fraudulent and acted, but he was aware of other editors who turned a blind eye.

“Obviously there’s so much money in China and the journals have their shareholders to answer to, and they are very careful not to tread on Chinese toes because of the political sensitivity,” he said. “There’s a lot more they could do to sort the good from the bad because there is good science going on in China, but it’s all getting a bad name because of what some Chinese people have worked out — that there’s a market here for a business.”

Last month, SAGE journals retracted 212 articles that had clear evidence of peer review or submission manipulation, and subjected a further 318 papers to expressions of concern notices. The Royal Society of Chemistry announced last year that 68 papers had been retracted from its journal RSC Advances because of “systematic production of falsified research”.

To indicate the upswing in cases, German clinical researchers reported last week that in their analysis of osteosarcoma papers, just five were retracted before the millennium and 95 thereafter, with 83 of them from a single, unnamed country in Asia. University of Munster Professor Stefan Bielack, who published the study in Cancer Horizons, said some open access journals charged academics US$1500 to $2000 to publish their work, so they were more interested in publishing lots of papers than their scientific validity.

“There is a systematic problem and in some countries people might have the wrong incentives,” Professor Bielack said. “I think the journals have a major role. They all need to be more rigorous.”

The problem is not confined to China, but it has accompanied a dramatic growth in research output from that country, with the number of papers more than tripling over the last decade.

In 2017, responding to a fake peer review scandal that resulted in the retraction of 107 papers from a Springer Nature journal, the Chinese government cracked down and created penalties for research fraud. Universities stopped making research output a condition of graduation or the number of articles a condition of promotion.

But those familiar with the industry say the publication culture has prevailed because universities still compete for research funding and rankings. The number of research papers produced in China has more than tripled over the last decade, with dramatic growth over the past two years. The Chinese government’s investigation of the 107 papers found only 11 per cent were produced by paper mills, with the remainder produced in universities.

Until last year, University of NSW offered its academics a $500 bonus if they were the lead author in a prestige publication and $10,000 if they were the corresponding author of a paper published in Nature or Science. The system, which was designed to reward quality over quantity, was discontinued due to financial constraints.

But others have questioned whether the quality of a paper can be measured by the journal in which it is published, and an open access movement has sprung up in opposition to the scientific publishing industry, arguing that research paid for by taxpayers should be freely available to all.

Alecia Carter, an Australian biological anthropologist at University College London, said the emphasis on getting published in a high-impact journal rewarded sensational results over integrity, positive results over negative results and novel findings over building the evidence base. Researchers might inflate effect sizes or omit conflicting evidence because it muddied the overall story they were trying to tell.

“We as scientists know all these things that are wrong with the way the system is set up, but we still play the game,” Dr Carter said. “We’re all chasing the same thing.”

Dr Carter boycotts luxury journals, publishes as much as possible in open access journals and reports negative results, though this has come at a cost to her career. She was once asked at a job interview why she would bother reporting results that were not interesting.

“I said, ‘If it’s interesting enough to do the research then we should publish the results’.”

She did not get the job.

Here is an SMH article which stimulated my post:

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COVID Up Close

2 January 2022

I have tried to stay COVID safe, but we had a house guest, a friend of my son, Mike who had been stranded overseas for a year and came back to Brisbane and then to Sydney last Tuesday.  On Thursday he had a cough, so I asked him to Rapid Antigen Test (RAT), and he was positive.  Mike and I were negative, but the separation was minimal.

I was feeling a bit of a sore throat, headache and cough like an early flu and I managed to get another RA Test kit today (Sunday) and got a positive result.  Luckily, I had my 3rd vaccination 10 days ago, which is just long enough for it to start to work, so I am hopeful it will be a mild one.

It is ironic that I have had lots of requests to go back into the hospital workforce and resisted.

I will keep you posted. 

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