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 Winter Editorial 2021

Once I had a love and it was a gas
Soon turned out to be a pain in the ass
Seemed like the real thing only to find
Mucho mistrust, love's gone behind
Ooh, oh, ooh, oh

Miley Cyrus (October 2020) covers Blondie’s 1979 original, Heart of Glass

 

This issue’s cover features one of glass sculptor Harriet Schwarzrock’s many luminescent pieces. The talented artist’s heart-warming creations pulse with electricity, after being infused with neon, xenon, argon or krypton. The hearts are not anatomically or physiologically correct but may exhibit occasional conduction defects. See Robin Osborne’s full review here.

‘X’, and the 2021 Federal Budget marked the spot where Australia’s COVID-19 conversation changed. Eradication and elimination had been the total focus for over a year and Australia has been among world leaders in control of the virus. However, the Treasurer and prominent health spokespersons changed the conversation in mid-May, foreshadowing the opening of the borders, and the import and spread of the virus throughout the continent. 

The rising left-lower to right-upper stem of the X can represents the rising immunisation rate and the downward limb of the COVID-19 infection rate. The success of the USA vaccination program is seen in Australia by the drop in numbers of infectious patients coming from that country. The vast majority of infectious cases are now emanating from the unvaccinated areas, particularly the Indian subcontinent. Vaccinated people don’t get COVID-19..

The X downward limb can also represent the decreasing risk with age of the rare vaccine-associated immune thrombotic thrombocytopenia and the rising limb, the increased death rate with age. 

Patients place greatest weight on their immediate risk and have delayed immunisation in the absence of active infections in the community. However, the business sector and now the government have made it clear that Australia will need to open up its borders. The date has yet to be determined but will be at least several months after the Federal election which is thought most likely to be called between October 2021 and March 2022. On page 5 we explore some of the numbers. 

Nordocs has completed its COVID-19 webinar series that ran from August 2020 to June 2021. The webinars have fostered a dialogue between the primary and secondary health care sectors and identified a number of issues that could usefully be addressed with a more coordinated approach. Areas such as improving and facilitating GP participation in Lismore Base Hospital’s multidisciplinary team meetings were raised in several webinars and the value of a local oesophageal pH and manometry service was highlighted by the local upper GI surgeons in April.

On pages 20 and 21 the State members for Clarence, Chris Gulaptis, and Ballina, Tamara Smith, debate the ethics of permitting and even financially supporting the greyhound racing industry. While diametrically opposed they both make strong arguments. 

As with many aspects of modern life that come to the medical profession’s attention a little may be OK, a lot causes harm. Smith notes the secondary adverse effects of gambling on a small section of the racing community and that the NSW government is not totally impartial. It also has a dog in the race. 

On page 19 we report the shelving of the NSW Ice inquiry. It is 15 months since Commissioner Dan Howard tabled his report. It contained recommendations unpalatable to the NSW government. Three of the recommendations - more supervised injecting centres, retiring drug detection dogs, and enabling pill testing at music events - have been rejected. 

Recognition that drug use is common in the community, especially amongst young people, is a step too far for the NSW Liberal and National parties. The fear is tacit that approval may encourage more drug taking. However the cost in turning a blind eye is added up in young people’s lives. 

There are overseas models for a more liberal drug policy such as those from Portugal, Peru and some American states. NSW has dabbled in harm restriction with its drinking lockout laws but wound them back to a large degree after pressure from the alcohol and entertainment industries. It would appear that innovations in public health policy in this area will require a change of government. 

Dr Andrew Binns reviews Professor Henry Reynolds’ latest book, Truth-Telling on page 22. “History is written by the victors'' is a saying that has been attributed to Winston Churchill and to many others, and it is a truism that goes back to antiquity. The black armband wars in Australian history departments from the late 90s have largely died down and the white settlement of Australia from both a black and white perspective is to be taught in NSW schools. 

American social psychologist Jonathan Haidt in debate with former English politician, Nick Clegg, has argued that as a society becomes richer it becomes less tribal and less committed to the prevailing narrative. It can entertain other interpretations of its history. It is an interesting hypothesis that is now being tested in a variety of western nations. 

On 17 May 2021 Henry Reynolds expounded on the themes in his book in a one-hour ABC radio conversation with Richard Fidler

After 36 years of exemplary service to the North Coast Community, Dr Hugh Fairfull-Smith has retired. On page 30 he reflects on his arrival in this part of the Antipodes and on starting a geriatric service from scratch. Making do and making it up as you go along were skills that he soon acquired and mastered. 

Medicine has changed a lot in that time and new services and staff are now available. However, on behalf of all general practitioners in the area, I can say that Hugh’s calm approach to families (and their GPs!) in crisis will be greatly missed. We wish him well in retirement and hope he can relax, knowing the next phone call is just trying to tee up a bike ride. 

Also departing is North Coast General Practice Training. Starting in 2002 it trained over 700 GPs, OTDs and junior doctors in its 19-year history. Over the last five years it pivoted several times in response to changing government directives and policies. However, the lack of a stable, long-term government direction for general practice training has finally taken its toll. On page 8 we report on its troubled history and on page 9 its ‘wake’ in Coffs Harbour in mid-May. 

On 18 May 2021 Dr Steven Kennedy, Secretary to the Treasurer, addressed the Australian Business Economists forum. He reviewed the success of Australia in dealing with the COVID-19 epidemic in both medical and financial terms and outlined the fiscal policies over the next ten years that would manage the hit to the economy that has been sustained. 

The Budget flagged a significant increase in mental health, employment services and disability and aged care, the last two perhaps largely in response to recent Royal Commissions. On page 16 Robin Osborne delves into the final report of Aged Care Royal Commission and on page 12 the interim report of the Disability Royal Commission. 

Given this marked increase in spending Dr Kennedy sees opportunities for raising efficiency in both of the sectors and in health more generally. The dividend to the government would be greater, possibly much greater, than $33 billion over 20 years. In aged care he sees four principles to increase the sector's efficiency and effectiveness - more choice, improved competition, more efficient pricing, and improved accountability and governance. 

Sydney based economics journalist, Ross Gittins is not convinced. He says, “We’ve been watching these attempts at micro-economic reform for decades. They all work the same way: take a public service that’s always been provided by the government, turn it into something that looks like an ordinary market by adding choice, contestability, monetary incentives and a smidgen of regulation, and you won’t believe the difference it makes.

“Well, I would believe it’s very different – just not that it’s better. We’ve seen this game played many times and seen many stuff-ups. Using “contestability” to turn a public good into an artificially created market is the econocrats’ version of magical thinking.” 

He concludes “To see ‘human services’ as “the next wave of productivity reform” is, to borrow a favourite expression of legendary Treasury boss John Stone, ‘the triumph of hope over experience’.” 

Healthy North Coast is reviewing its Board advisory structure. On page 7 we look at some recent suggestions about how this might evolve. The current proposal envisages a smaller but more powerful Clinical Council with a direct voice to the HNC Board and the hospital sector and also a dedicated mechanism for the Aboriginal voice to be heard. “Nothing about us, without us” should be the focus. 

“The triumph of hope over experience” was originally used by Samuel Johnson to describe remarriage after an unhappy separation. Yet we all need hope to repair a shattered heart.