Issue 6 / 24 February 2014

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.


5 thoughts on “Ruth Armstrong: Who’s responsible?



    Suppose you wanted a Vegemite sandwich and they gave you a FIVE STAR SHERATON GOURMET MEAL AND MADE YOU PAY FOR IT!!!

    Sounds ridiculous?

    You would not pay would you?

    Well that is what happens every day in our health system….but because it is largely paid by taxes we think we are not paying for it BUT THE MONEY MUST COME FROM SOMEWHERE.

    The only way you can ensure you get a vegemite sandwich, when that is all you asked for, is to KEEP THE GOVERNMENT OUT OF THE CONTRACT.

  2. Dr John Mahony says:

    Discussions about welfarism v individual responsibility will undoubtedly never find full resolution, but surely all here can agree that the ultimate *authority* ought to be this medical profession.

    As recognised by WHO

    But if this is the case, why do I get the impression that the various “health care professional” Boards of AHPRA are all of equal standing and therefore each a law unto themselves as to the scope of practice of each profession?

    How do each of these other Boards get to decide ad liberum to expand their roles into what are new fields of practice for them, which are, invariably and necessarily, otherwise *our* fields, without *our* Board having any veto right.

    Do we run health care, as our qualifications and training equip us to do?

    Or are we, as a profession, running some sort of therapeutics bazaar, from which “health care professionals” represented by other Boards can come along and browse the modalities on offer and cherry-pick this and that treatment to adopt as their own as the whim takes them (say, frinstance, anything that looks easy and lucrative)?

    How did we get in this mess, and how do we get out of it?

    How do we get back to running the show?

  3. Dr Yaacov (John B.) Myers says:

    Health is an individual and social responsibility. This is a general statement as well as one that can be used in favour of co-payments and for those who cannot afford it, who do not have the money on them at the time, to “owe” or be given free treatment. To make health responsibility more personal, would focusing on Biological age not chronological age assist?  A lot of joy and feeling of accomplishment is expressed by those on shows who lose weight and are joyed by the years they’ve gained, which leads to education and functional discussion. Informed positive encouragement does more than a big stick. Whose responsibility is it? Adults have shown we are not capable of many things other than subjective self-interest, power and politics and finances before more important things. So why not support children to take responsibility into their own hands. One way would be to encourage children to become hHealth ambassadors, by donating ten cents a week to a charity of their choice to make a difference to ensure a more compassionate world to live in when they leave school, and emphasise God given values, to live by, which is another issue at the heart of the health problem. We (adults) condone and preach duplicitous beliefs, prejudice and lies. This has to stop. Without focus there is dysfunction. Without a system of justice (not a Justice system) society fails. Transparent accountability without exception is central to a national health agenda, as is granting compensation when it is due to balance penalty, learning to say sorry and thank you; nurturing compassion and encouragement to do what is both good and right to promote health + care for all.

  4. Thomas Walker says:

    ALL should read “TRICK OR TREATMENT’ By Simon Singh PhD and Edvard Earnst MD.(latter is in Dept of Complimentary and Alternative Medidcine at University of Essex UK).

    Using Cochrane criteria for efficacy, Herbal medicines do NOT make it and have the possibility to harm. A recent study from Adelaide Aust quoted in Canberra Times  24/2/14, showed most did NOT comform to their criteria registered with TGA. Not good enough!

    The same book found that Chiropractic, Accupuncture and Homeopathy also failed.

    So stop spending taxpayer’s and our own money on things proven NOT to be  effifcacious.

  5. Roger Paterson says:

    The government and health regulating do-gooders have a lot to answer for with regard to the obesity epidemic. Not to mention the fast food outlets. The problem is that we have all been told for a long time now that fat is bad for you. But how is it bad for you? Does it make you fat? The counter-intuitive answer is that it does not. Fat is bad for your arteries, and even then, not all fats. The result of the wholesale diminution of fat (and flavour) in the diet of the population has been an expolsion of carbohydrate consumption. And even complex carbs and low GI is still converted to fat storage if consumption exceeds calories burned. So we eat obesity generating food so that we don’t clog our arteries??! Which is worse? An epidemic of diabetes, sleep apneoa, hypertension and all the other obesity related morbidities, or atherosclerosis which is being more than adequately managed with statins? 

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