Ruth Armstrong: Who's responsible?

WHO is responsible for health? It’s a surprisingly controversial question and the purported answers have long been divided along political lines, with the left accused of promoting a “nanny state”, and the right of victim blaming.

Between these polar opposites there is broad agreement that government should provide the infrastructure to promote health, health leaders should guide the way, and individuals should heed the messages and make good choices. It’s really a matter of where to draw the lines of responsibility.

In our efforts to curb obesity, for instance, we have grappled with several food options. Should we outlaw unhealthy foods, heavily tax them or restrict their availability? Is informative labelling the key, or should we assume people have enough knowledge to decide without guidance?

Adding to the complexity, as recent experience with the aborted launch of the federal government’s food labeling website can attest, these issues can become further clouded when political agendas and commercial interests are involved.

This issue of MJA InSight touches on several aspects of balancing responsibilities in health. Our lead news story looks at what is happening in Australia with direct-to-consumer genetic testing following the recent severe curtailing of the activities of 23andMe, the mail-order genetic testing company, by the US Food and Drug Administration.

Change is afoot in the way our own Therapeutic Goods Administration will consider these tests which, depending on where you sit, smacks of either rank paternalism or responsible regulation.

Out on an even more contentious limb is the issue of whether people who need money and understand the risks should be able to make the choice to sell an organ for transplantation. The question has been the subject of a recent ethical debate and some interesting research, as detailed in Jane McCredie’s column this week.

Always aware of his responsibility to improve health care, a recent European holiday afforded our regular rural medicine commentator, Aniello Iannuzzi, an opportunity to consider, in his first column for 2014, the responsibilities and working environments of rural doctors in Australia.

It is tempting to think in “buyer beware” terms about the many Australians who waste their money on unproven supplements. In the second of two articles discussing the controversy surrounding the Swisse Wellness company and La Trobe University, John Dwyer asks whose responsibility it is to make sure the public’s healthy intentions are directed where they will be most effective.

Increasingly seen as a responsibility of the medical profession is the need to make clinical choices that are both of high quality and cost efficient. The US Choosing Wisely campaign seeks to encourage health care professionals to do just that, and has recently gained momentum with recommendations on which low-value tests, treatments and decisions can be dispensed with in the emergency department. Another of our news stories canvasses Australian emergency medicine physicians on whether a similar “list” applies here.

In the lead-up to the federal Budget, Health Minister Peter Dutton, last week, revealed some of the thinking around the government’s drive for Medicare reform. In a subsequent television interview, he reignited concerns about the possibility of introducing a copayment for GP consultations.

In the flurry of responses, contributing to what will no doubt continue to be a robust debate, one comment, attributed to University of NSW Emeritus Professor of Medicine John Dwyer — the same Professor Dwyer writing for InSight this week — stood out: ‘‘Before you would ask Australians to pay more for their health it’s the responsibility of governments and healthcare professionals to look at the system and say: are we wasting a lot of money?’’

As we shoulder our part of the responsibility for health, it is encouraging to see that this is beginning to happen. Good health doesn’t come cheap these days but Australians deserve the best value for money they can get.

 

Dr Ruth Armstrong is the medical editor of MJA InSight.