Three governments are currently consulting their constituents. Two are offering them a significant choice about future foreign policy: one is not. The US asks delegates to decide between a President Donald Trump who would expel Hispanics, bar entry to Muslims, and flatten parts of the Middle East, and a President Hillary Clinton who would take a tougher line against states which challenge the US. The UK has asked citizens to decide if Britain should separate from the European Union and, presumably, tie itself more tightly to the US. Australian leaders are asking voters almost nothing about what foreign policy initiatives would differentiate Prime Minister Turnbull from a Prime Minister Shorten. Continue reading →
The increasing vitriol between the Boomers and (mostly) Gen Y has singed more than a few nose hairs in recent years. You’d be well advised to approach any discussion between active combatants with full hazmat gear. And now the #Brexit has brought matters to a head.Continue reading →
It’s traditional that election time in Canberra brings out the road lobbies who ask for ‘all that extra cash’ which governments raise from fuel excise to be ‘put back into our roads’.
The problem is that the facts no longer bear this out. Australia is spending more on roads than it collects from fuel excise and vehicle registrations. It is going into more and more debt to build roads.
What is worse, it appears that official figures are being fudged to obscure this inconvenient truth from scrutiny – lest it get in the way of more promises for more and more multi-billion dollar road projects. Continue reading →
In late April the Federal Government released a discussion paper entitled ‘Redesigning VET FEE-HELP’. It had become apparent that continuing legislative changes put through the Federal Parliament were not enough to prevent the behaviour of some private training providers. The most recent of those changes was in January this year when the Higher Education Support (VET) Guidelines 2015 were introduced to “further strengthen the scheme and constrain growth” These Guidelines were aimed at capping VET FEE-HELP loans at 2015 loan amounts, protecting students from providers or their agents including new entry requirements, stronger cooling off periods and three fee periods rather than one up-front hit, and new eligibility requirements for providers. It is many of these changes that form the basis of the questions raised in the discussion paper, asking if these are enough or are there other ways of preventing the current ‘rorts’ that have become the centre of this national VET scandal. Continue reading →
Alcohol, drugs and driving simply do not go together. Driving requires a person’s attentiveness and the ability to make quick decisions on the road, to react to changes in the environment and execute specific, often difficult maneuvers behind the wheel. When drinking alcohol, using drugs, or being distracted for any reason, driving becomes dangerous – and potentially lethal!Continue reading →
There has been some speculation about how Brexit will affect Russia. Probably not a lot politically but we can only speculate about the economic effects.
No doubt the European Community will spend the next few years contemplating its navel and so be less focused on relations with Russia. The Europeans will be even less interested in Ukraine and this could be to Russia’s advantage but it could have a negative impact if this confusion leads to a stalling of efforts to reach a peaceful solution to the Ukrainian civil war. Russia would like a solution to be found so long as Russian interests were protected.
However, there is no suggestion that the UK plans to resign from NATO and it is NATO that Russia sees as the main threat to its security. NATO is seen to be dominated by the USA and the USA by neocons which may not be that far from the truth. If Europeans are preoccupied with their internal problems this could even lead to greater US domination of NATO. The stationing of US missiles on the Russian border is unlikely to be changed by anything the UK does.
It is too early to know how the Russian economy will be affected. There is much international panic about what will happen to the world economy but what will happen when things settled down remains to be seen. Obviously Russian oil and gas exports will be the major concern of the Russian Government.
Cavan Hogue is a former Australian Ambassador to USSR and Russia.
In 2011, after many years working in public hospitals and community mental health services I came to work for the Commonwealth Government’s privately contracted immigration detention health provider.
This was a time when there had been much public and professional criticism of immigration detention. The harms to mental health of prolonged arbitrary detention were already being documented through the Palmer Inquiry; in reviews by the Australian Human Rights Commission; the Commonwealth Ombudsman and; in Coronial Inquiries relating to a number of deaths in detention. Continue reading →
An important new study in the United States has found doctors who receive just one cheap meal from a drug company tend to prescribe a lot more of that company’s products. The damming findings demonstrate the value of new transparency laws in the US, and remind Australians we’re still very much in the dark about what our doctors get up to behind closed doors.
Just published in the leading Journal of the American Medical Association (JAMA) Internal Medicine, this study is well worth a look for anyone interested in the hidden influences on how doctors prescribe.
Together with a host of other recent work, it adds to the growing mountain of evidence suggesting doctors who expose themselves to marketing strategies – from seeing attractive drug reps to attending sponsored “education” – are doing patients and the wider public a grave disservice.
Need for transparency
The new study took advantage of a new government-run and publicly available databasewhich discloses all drug company payments to doctors. Researchers looked at how often doctors prescribed four popular brand-name drugs, and linked prescribing rates to how often those doctors received meals from the drugs’ manufacturer.
They found that receiving just one company-funded meal was associated with a 20% increase in prescribing of Astra Zeneca’s cholesterol-lowering statin, Crestor, compared to other drugs in the same class.
For two other heart drugs, the increase was in the order of 50%. For Pfizer’s anti-depressant Pristiq, taking one free meal was linked to a 100% increase, or a doubling of the rate of prescriptions.
The average cost of the meals drug companies gave these doctors was between US$12 (A$16) and US$18 ($A24).
And when doctors ate sponsored meals on more than four occasions, their prescribing of the brand-name drugs rose dramatically. Perhaps unsurprisingly, doctors who got more expensive meals tended to have bigger prescribing increases.
Association not cause and effect
Perhaps the most important caveat, as the study’s authors stressed, is that “the findings represent an association – not a cause and effect relationship”. Nevertheless, the results reinforce similar findings from recent studies also using the new transparency data in the US.
In March investigative journalists at ProPublica found doctors who received drug company payments or gifts – mostly free meals – wrote scripts for brand-name drugs at much higher rates compared to doctors who didn’t take industry money.
In May, in the journal PLOS One, researchers found almost half of the 700,000 doctors in the US had received payments from drug companies. Specialties receiving the highest industry payments had the highest prescribing costs per patient.
And also in May, the JAMA Internal Medicine published a small study from the state of Massachusetts, similarly uncovering an association between payments from industry and modest increases in rates of prescribing brand-name statins (cholesterol-lowering medication).
So why does this matter?
The main concern in all the recent US studies is the unnecessary cost to patients and the health system when brand-name drugs are prescribed instead of cheaper generic alternatives.
But perhaps the more serious concern is the danger of doctors prescribing under the influence of drug company marketing – which always favours the latest new drug, rather than what’s in the patient’s best interest.
As The Conversation has covered recently, newer and aggressively promoted drugs can have very limited advantages over older ones, if any, and sometimes carry very serious side effects – particularly for the elderly.
There is already evidence many older Australians are at risk of harm from taking too many inappropriate medicines – and there is a growing push to promote “de-prescribing”, which means taking people off drugs they don’t need.
Australia still in dark
Compared to the new transparency regime in the US, Australia has fallen way behind. Under new rules some payments to some individual doctors will have to be disclosed from this August, but there are too many loopholes.
As a result of horse trading about the new rules – between the doctors, the drug companies and public authorities – any funding of meals costing less that A$120 will not have to be disclosed. And if doctors who have received payments don’t want their names disclosed in August, they won’t be.
Also, all of the roughly 25,000 events, including breakfasts, lunches and dinners which doctors and other health professionals regularly attend annually, will from now on remain totally secret – until there is regulatory reform.
Consumer groups are angry that citizens remain in the dark, and many doctors are horrified by the wining and dining of their colleagues, with some cutting their ties: refusing to see the attractive sales reps and seeking “education” elsewhere.
Disclosure on its own is no panacea
As others have pointed out, disclosure on its own is not a panacea, and it’s legitimate to ask why doctors should receive any free gifts or meals at all.
Already there’s been one legislative attempt to enforce more independence between doctors and drug companies in Australia, and it is likely more will emerge in the future.
Until then, it might be wise to inquire whether your doctor still takes the free meals – and perhaps seek your care elsewhere if the answer is yes.
Ray Moynihan is Senior Research Fellow, Bond University. This article was first published in The Conversation on 23 June 2016.
Buddhists say that everything has a cause and everything has an effect. Violence, oppressed minorities, rampant corruption and failed states are both causes and effects of global drug prohibition. Serious threats to national security are an important but rarely discussed cost of drug prohibition. Continue reading →