more_vertOn Jan 14, 1992, Le Monde published an interview with the French social scientist, Pierre Bourdieu (1930–2002). Bourdieu drew a distinction between what he called the two hands of the state. The left hand represented those ministries that “are the trace…of the social struggles of the past”—notably, health and education. The right hand was symbolised by “the technocrats of the Ministry of Finance”. Bourdieu had lived through a decade of Margaret Thatcher and Ronald Reagan, and the influence their policies had had on politicians in France.
Preference: Education
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[Correspondence] How gaps in policy implementation cause public health malpractice
The Lancet Commission1 on pollution and health (Feb 3, p 462) highlights the global health and economic costs of pollution. The acute and chronic lead intoxication seen in Flint, MI, USA, where inadequate monitoring and abatement of lead in the water supply resulted in lead toxicity in more than 27 000 children, was a prime example of such costly pollution-related disease.2 The contamination of Flint’s water placed these children at risk for neurological injury, severe behaviour problems, reading disabilities, and decreased educational attainment.
[Series] Prevention and treatment of low back pain: evidence, challenges, and promising directions
Many clinical practice guidelines recommend similar approaches for the assessment and management of low back pain. Recommendations include use of a biopsychosocial framework to guide management with initial non-pharmacological treatment, including education that supports self-management and resumption of normal activities and exercise, and psychological programmes for those with persistent symptoms. Guidelines recommend prudent use of medication, imaging, and surgery. The recommendations are based on trials almost exclusively from high-income countries, focused mainly on treatments rather than on prevention, with limited data for cost-effectiveness.
[Correspondence] Transparency in continuing medical education – Author’s reply
We agree with Graham McMahon that some of the statements in our Comment1 were broad. We have issued a correction to our Comment regarding the reporting requirements of joint provider activities under the Sunshine Act. We wrote our commentary in the spirit of academic freedom, and some statements were theoretical and not empirical. However, the comments that were stated as factual were cited. We aimed to inform physicians of potential risks in the way that continuing medical education (CME) activities are funded and of potential risks that remain in the current funding structure.
[Department of Error] Department of Error
Golestaneh L, Cowan E. Hidden conflicts of interest in continuing medical education. Lancet 2017; 390: 2128–30—In this Comment, the following statement should have read “But payments by MECCs to accredited CME providers are not subject to transparency laws designed to combat industry influence on physician behaviour, including the 2013 Physician Payment Sunshine Act that mandated public reporting of all financial payments by industry to physicians and teaching hospitals until recently. Industry can still award an unreported, unrestricted grant to an accredited organisation as long as it does not know the identity of the CME faculty”.
[Correspondence] Transparency in continuing medical education
In their Comment,1 Ladan Golestaneh and Ethan Cowan (Nov 11, p 2128) question the integrity of continuing medical education (CME) courses that are accredited by CME providers. We believe their Comment conveys inaccuracies about joint providership, which we discuss below.
[Editorial] Safeguarding medical education in conflict
On May 23, during the World Health Assembly, the International Federation of Medical Students’ Associations (IFMSA) presented Attacks on Medical Education, case reports collected by IFMSA member organisations in seven countries where violent conflict has affected medical education.
Excellent choice for Excellence in Healthcare Award
The recipient of the AMA Excellence in Healthcare Award 2018 wants to know how she can use it to build greater awareness for a very worthy cause.
Professor Elizabeth Elliott AM FAHMS was presented with her award by outgoing AMA President, Dr Michael Gannon, at the AMA National Conference in Canberra in May.
Professor Elliott is a pioneer in research, clinical care, and advocacy for Fetal Alcohol Spectrum Disorder (FASD) and was named the winner of the AMA Excellence in Healthcare Award 2018 during the opening session of the Conference.
FASD is caused by prenatal alcohol exposure and is recognised as the leading preventable cause of prenatal brain injury, birth defects, and developmental and learning disability worldwide. There are lifelong consequences for children born from alcohol-exposed pregnancies.
The AMA Excellence in Healthcare Award is for an individual, not necessarily a doctor or AMA member, who has made a significant contribution to improving health or health care in Australia. The person may be involved in health awareness, health policy, or health delivery.
Professor Elliott was nominated for the award by the National Organisation for Fetal Alcohol Spectrum Disorder (NOFASD), the first and largest organisation dedicated to FASD in Australia.
Over the past 20 years, FASD has evolved from being a little-known, poorly recognised, and misunderstood condition to becoming a major strategic focus for Commonwealth and State Health Departments.
“I am really delighted to be acknowledged, but I really accept the award on behalf of all the children and families I work with, and of course a lot of dedicated clinicians,” she told Australian Medicine.
“I guess for me it’s particularly nice that the group that nominated me was the national organisation.
“I read something that said this was an opportunity to highlight this cause so I’m very keen to find out how to use the AMA network to raise awareness.
“We need to raise awareness of (1) the fact that are still lots of women who drink during their pregnancy not knowing they might harm their unborn child, and (2) there are lots of doctors who are very reluctant to ask pregnant mothers about their drinking.
“They don’t want to upset the doctor-patient relationship, and yet women tell us they want to be asked. They want clear advice. In fact many of them tell us they want to be told not to drink during pregnancy. They want a clear message from doctors.”
Professor Elliott is a Distinguished Professor in Paediatrics and Health at The University of Sydney School of Medicine and a NHMRC Practitioner Fellow. She has been a passionate advocate for raising awareness of FASD for more than 20 years.
In presenting her the award, Dr Gannon said Professor Elliott played a significant leadership role in developing the Australian Guide to the Diagnosis of FASD and online training modules, new clinical services, a national FASD website, and a national FASD register.
“She chaired the Australian Government’s National FASD Technical Network and is Co-Chair of the NHMRC Centre of Research Excellence in FASD, and Head of the NSW FASD Assessment service,” Dr Gannon said.
“She was lead clinician in the Lililwan study on FASD prevalence in the Fitzroy Valley and has published extensively on FASD.
“She contributed to WHO, NHMRC, and RACP alcohol guidelines and has been a keynote, invited, or scientific presenter at more than 300 conferences nationally and internationally.
“Professor Elliott is a true pioneer in the FASD field and has contributed to the development of Australia’s response to FASD, through addressing aspects of health policy, health care delivery, education, and health awareness in the work she has undertaken.
“However, FASD is only one component of Professor Elliott’s work, which includes disadvantaged children in Immigration detention, with rare disorders, and living in remote Australia.
“In 2008, she was made a Member of the Order of Australia (AM) for services to paediatrics and child health and, in 2017, she received the Howard Williams Medal from the Royal Australasian College of Physicians (RACP) – its highest award – for her contribution to paediatrics in Australia and New Zealand.
“Much of her work has been undertaken voluntarily, and has strengthened Australia’s health systems and their capacity to respond to FASD.
“Her efforts have improved health care services in FASD and changed health outcomes for children and families living with, and affected by, FASD.
“She is a worthy recipient of the AMA Excellence in Healthcare Award.”
CHRIS JOHNSON
War zone gynaecologist named AMA Woman in Medicine
AMA Woman in Medicine 2018, Professor Judith Goh AO, has described receiving her award as a great honour and privilege.
Adding that it was acknowledgement for the work of a dedicated team of health professionals, Professor Goh told Australian Medicine the award would also help build awareness for the plight of women’s health.
“We often live quite comfortably in Australia but for most women around the world, surviving their pregnancy is not taken for granted,” she said.
“So this is great recognition. But we don’t do these things to be recognised. We do it because we want to do it.”
Professor Goh is a dedicated gynaecologist who volunteers her time treating women in war zones and Third World countries.
She was named the AMA Woman in Medicine 2018 at the AMA National Conference in May.
She is a urogynaecologist who has devoted her career to women’s health. Her next stops are Bangladesh, Myanmar, and some African countries.
A world-renowned surgeon who has spent approximately three months every year for the past 23 years training doctors in Third World countries in repairing vesico-vaginal fistula – a devastating injury that can occur following prolonged, obstructive labour – Professor Goh was noticeably touched by the honour.
In presenting her the award, outgoing AMA President Dr Michael Gannon noted that Professor Goh’s nominators – colleagues from the Australian Federation of Medical Women and the Queensland Medical Women’s Society – have described her career as both humbling and inspirational.
“Since 1995, Professor Goh has donated her time and expertise, working abroad several times a year as a volunteer fistula surgeon in many parts of Africa and Asia, including Bangladesh, Sierra Leone, Ethiopia, Tanzania, Uganda, the Democratic Republic of Congo, and Liberia,” Dr Gannon said.
“Professor Goh runs the twin projects, Medical Training in Africa and Medical Training in Asia, via the charity, Health and Development Aid Abroad (HADA), using funds raised to help pay for women’s surgeries such as the correction of genital tract fistulae and prolapse, while training the local staff in these areas.
“To carry out her work within a dedicated team of professionals, Professor Goh often has to brave political unrest, and perform surgery in challenging environments, as well as deal with the emotional and social injuries to her patients due to war, rape, domestic violence, poverty, shame, and grief.
“Her work has changed lives for the better for hundreds of affected women, correcting their often long-standing and preventable obstetric trauma, including vesico-vaginal and recto-vaginal fistulae, with the minimum of overhead costs to maximise the reach of her services.
“Professor Goh uses her time abroad to upskill local practitioners in this area of medicine, and to raise awareness of the underlying causes of chronic complications of birth trauma, including poverty, lack of education, lack of awareness, and the subordination of women in some cultures.
“In 2012, she was made an Officer of the Order of Australia (AO) ‘for distinguished service to gynaecological medicine, particularly in the area of fistula surgery, and to the promotion of the rights of women and children in developing countries’.
“Her humble dedication within this field of women’s medicine, and her brave and generous service to women all over the world, is inspirational, and very worthy of recognition as a recipient of the AMA Woman in Medicine Award.”
Professor Goh said many women felt ashamed after delivering stillborn babies.
“In some places it is seen as a failure. There is even violence against them in some communities. We are building a community where lot of women can come together and feel supported,” she said.
“In our country we no longer really say ‘mother and child are well’ after a baby is born. It’s taken for granted, so the first question is how much did the baby weigh.
“But there are so many places in the world where this cannot be taken for granted.”
The AMA Woman in Medicine Award is presented to a woman who has made a major contribution to the medical profession by showing ongoing commitment to quality care, or through her contribution to medical research, public health projects, or improving the availability and accessibility of medical education and medical training for women.
CHRIS JOHNSON
APY Lands medical student awarded scholarship
A medical student who makes patient education films in Pitjantjara language, and who plans to provide health care to the people of Central Australia, is the recipient of the 2018 AMA Indigenous Medical Scholarship.
Pirpantji Rive-Nelson, from Alice Springs, is a final-year medical student at the University of Queensland. He is attending the Rural Medical School in Toowoomba and he plans to return to Central Australia to work as a clinician.
Outgoing AMA President Dr Michael Gannon presented Mr Rive-Nelson with the scholarship at the AMA National Conference in Canberra in May.
The AMA Indigenous Medical Scholarship was established in 1994 with a contribution from the Commonwealth Government. The AMA is seeking further donations and sponsorships from individuals and corporations to continue this important contribution to Indigenous health.
Mr Rive-Nelson told Australian Medicine he felt honoured to receive the scholarship.
“It’s great. It serves two purposes for me,” he said.
“It is a bit of a pat on the back for my efforts, in terms of medicine being quite a gruelling degree and you’re getting constant feedback and always told to improve in many areas.
“So it’s kind of nice to get a pat on the back and know that I’m on the right track. So that’s been great.
“And also to be given the opportunity to come down here to meet some of the bigger players in the medical community. That’s a bit of a treat.
“I think people where I am from will definitely notice it, but I don’t think people will understand the gravity of it and the fact that the AMA is the peak governing body for medicine in Australia. But people will recognise it as an achievement and will be very pleased to see it.
“At the end of the day it definitely bolsters my confidence in medicine in terms of keeping me on track.”
Upon receiving the award, Mr Rive-Nelson said his aspirations included a fulfilling and challenging career practising medicine in Alice Springs Hospital, inspiring youth of Central Australia to pursue health careers, and to take on leadership and advocacy roles within Central Australia and national health care organisations.
“Many Indigenous Australians of Central Australia do not speak English as a primary language, and seeking health care from the Alice Springs Hospital is a daunting experience,” Mr Rive-Nelson said.
“Therefore, I hope to actively assist Pitjantjatjara-speaking patients, and my colleagues, by being a clinician who is able to navigate both languages and cultures competently.”
Mr Rive-Nelson is also making short patient health education material in Pitjantjara language, including a YouTube video on kidney disease, which won an award from the University of Queensland.
Fewer than 300 doctors working in Australia identify as Aboriginal and/or Torres Strait Islander – representing 0.3 per cent of the workforce – and only 286 Indigenous medical students were enrolled across the nation in 2017.
Dr Gannon said Mr Rive-Nelson was a deserving recipient of the $10,000 a year Scholarship.
“Pirpantji Rive-Nelson is a respected member of the University of Queensland medical school, and of the tri-State region comprising the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands, the Ngaanyatjarra Lands, and the Central Lands Council lands,” Dr Gannon said.
“He grew up in communities including Irrunytju, Pipalyatjara, and Kalka, and has been exposed to a traditional life that most young Indigenous people can only dream of.
“He is a Wati – a fully-initiated man – and many of his family are Ngangkari – traditional bush doctors. Pirpantji will be the first initiated Pitjantjatjara Wati to become a doctor in the Western medical model, and he will be able to collaborate with Ngangkari to share knowledge and better outcomes for the health of the Central Australian community.
“The significant gap in life expectancy between Indigenous and non-Indigenous Australians is a national disgrace that must be tackled by all levels of Government, the private and corporate sectors, and all segments of our community.
“Indigenous people are more likely to make and keep medical appointments when they are confident that they will be treated by someone who understands their culture, their language, and their unique circumstances. Mr Rive-Nelson is that person.”
CHRIS JOHNSON
More information is available at donate-indigenous-medical-scholarship
Mr Rive-Nelson’s kidney health video can be viewed at https://www.youtube.com/watch?v=cgIjvo0oQTo