Is oral health the unspoken determinant?

BY AMA PRESIDENT DR TONY BARTONE

According to the Australian Institute of Health and Welfare’s (AIHW) report Australia’s Health 2012, most people will experience oral health issues at some point in their life. In fact, oral diseases are recurrently among the most frequently reported health problems by Australians.

Considered a disease of affluence up until the late 20th century, poor oral health outcomes have now become an indicator of disadvantage, highlighting a lack of access to preventative services. Insufficient access to, high cost of, or long waiting periods for dental services; and low oral care education, have all been associated with patients not seeking dental care when it is needed. Of course, non-fluoridised water supplies also has a role in explaining the prevalence.

However, more recently, it is the modifiable risk factors like poor nutrition, smoking, substance use, stress, and poor oral hygiene that are considered to have the greatest impacts on periodontal diseases.

Dental conditions frequently rank in the top 10 potentially preventable acute condition hospital admissions for Aboriginal and Torres Strait Islander people and were the third leading cause of all preventable hospitalisations in 2013-14, with 63,000 admissions.

Like most other health conditions, Aboriginal and Torres Strait Islander people have poorer oral health outcomes. While Indigenous people currently have most of the same oral health risk factors as non-Indigenous people, they are less likely to have the same access to preventative measures, leading to marked disparities in oral health between Indigenous people and other Australians.

While the majority of oral health concerns are often considered inconsequential, such as avoiding certain foods, or cosmetic with people embarrassed about their physical appearance, there is a significant body of evidence which suggests that oral health may be the undiscussed determinant of health.

More than two decades ago, population-based studies identified possible links between oral health status and chronic diseases such as cardiovascular disease (CVD), diabetes, respiratory diseases, stroke, and kidney diseases, as well as pre-term low birthweight. And the relationship appears to lie with inflammation.

It is clear more research is needed to determine the exact links (if any), between periodontal disease and chronic disease condition, however, the growing body of evidence links poor oral health to major chronic illnesses.

The Government has made numerous financial commitments to improving access to dental services, however, oral health data will continue to demonstrate that without equitable access to dental services, Australians, and particularly Aboriginal and Torres Strait Islander people, will continue to suffer poorer oral health outcomes, and potentially poorer health outcomes, as a result.

The AMA supports improved Doctor/Dentist collaborations if such partnerships could lead to increased early identification of both chronic disease and oral health conditions, particularly for Aboriginal and Torres Strait Islander peoples, for whom oral health services are less frequently accessed.

Dental Health Week is 6-12 August 2018.

Government recognises failing men’s health

The Federal Government will establish a National Male Health Strategy.

To run from 2020 to 2030, the announced strategy is in response to the poorer health outcomes experienced by Australian males compared to females.

The Government hopes to identify what is needed to improve male health, and will develop the strategy in consultation with key experts and public feedback.

Health Minister Greg Hunt used the occasion of Men’s Health Week in June to announce the plan, saying developing a good strategy was important because more males die at every stage of life.

“Males have more accidents, are more likely to take their own lives, and are more prone to lifestyle-related chronic health conditions than women and girls at the same age,” Mr Hunt said.

In April, the Government also announced further funding for Men’s Sheds to support the mental health and overall wellbeing of Australian men. The funding is a part of the total $5.1 million that the Government is providing to the Australian Men’s Shed Association over the three years to June 2019.

AMA President Dr Tony Bartone said the AMA was pleased the Federal Government recognised that Australian males have poorer health outcomes, on average, than Australian females. He welcomed the announcement of the strategy.

The AMA called for a National Men’s Health Strategy in its Position Statement on Men’s Health 2018, released in April.

“An appropriately-funded and implemented National Male Health Strategy is needed to deliver a cohesive platform for the improvement of male health service access and men’s health outcomes,” Dr Bartone said.

He said it was important medically because Australian men are less likely to seek treatment from a general practitioner or other health professional, and are less likely to have the supports and social connections needed when they experience physical and mental health problems.

Dr Bartone said Australian men should regularly take the opportunity to do something positive for their physical or mental health.

“Book in for a preventive health check with a trusted GP, get some exercise, have an extra alcohol-free day, or reach out to check on the wellbeing of a mate,” Dr Bartone said.

The AMA Position Statement called for a major overhaul of men’s health policy, including a new national strategy to address the different expectations, experiences, and situations facing Australian men.

Dr Bartone said that the AMA looked forward to engaging with the Federal Government to develop initiatives to address the reasons why men are reluctant to engage with GPs, and the consequence of that reluctance.

The AMA wants investment in innovative models of care to overcome such barriers.

In 2008, the Rudd Labor Government developed a National Male Health Policy, the first for Australia. Part of this program’s funding enabled an Australian Longitudinal Study on Male Health to build a strong evidence base in male health. The study can be found here: https://tentomen.org.au/

The AMA Position Statement on Men’s Health 2018 is at position-statement/mens-health-2018

MARIA HAWTHORNE and MEREDITH HORNE

Aged care building as an election battleground

Opposition Leader Bill Shorten recently used an appearance on ABC’s Q&A program to declare aged care is in a fundamental state of crisis and that he aims to make it a central national issue.

Mr Shorten said if the aged care system was not adequately funded at the national level, it was simply being set up to fail.

“It is a problem. It is a crisis,” he said.

“We need to sit down as a nation. Forget the politics, take off your Liberal hat or your Labor hat when you walk in the door, and start talking about how we properly fund aged care.”

The Government maintains that the latest Budget has seen a considerable boost in the overall spend for aged care, increasing from $18 billion a year to $23 billion over four years.

However, the Opposition believes that the Government has cut $2 billion from aged care by moving money from residential care and reallocating it to home care.

Speaking in Adelaide following the Q&A program, Mr Shorten said that there were many things to do to help improve aged care, and he has not ruled out a Royal Commission.

“We’ve got to make sure that aged care staff are valued, paid properly and properly trained. Two, we’ve got to make sure that the promises being made to vulnerable people in their care are being delivered on. Three, we’ve actually got to do a lot more to challenge the scourge of dementia,” he said.

In April, the AMA launched its Position Statement on Resourcing Aged Care 2018 to outline the workforce and funding measures that the AMA believes are required to achieve a high quality, efficient aged care system that enables equitable access to health care for older people.

AMA President Dr Tony Bartone said Australia’s ageing population will require an increasing amount of medical support due to significant growth in the prevalence of chronic and complex medical disorders and associated increase in life expectancy.

The AMA has called for more Government funding and support to allow ongoing access to medical and health care at home, so people can remain in their home for as long as is appropriate.

The AMA also believes there needs to be improved access for older people in residential aged care facilities (RACFs) to doctors through enhanced Medical Benefits Schedule (MBS) funding, and research into improved models to facilitate medical care in RACFs. Currently, inadequate MBS funding is a barrier for GPs to attend residents of aged care facilities, as they do not compensate for the significant non-face-to-face time (travel, finding residents and staff, etc) that comes with caring for RACF residents.

The AMA also believes that more nurses are needed in full time employment in aged care, and a minimum nurse to resident ratio should be included in the Aged Care Quality Standards.

Dr Bartone said AMA members have reported cases where nurses are being replaced by junior personal care attendants, and some residential aged care facilities do not have any nurses on staff after hours.

“It is unacceptable that some residents, who have high care needs, cannot access nursing care after hours without being transferred to a hospital Emergency Department,” he said.

The House of Representatives is currently conducting an Inquiry into the Quality of Care in Residential Aged Care Facilities in Australia. At the time of publication, more than 100 submissions had been received.

The AMA gave evidence at the inquiry in May and the submission can be read here: www.aph.gov.au/DocumentStore.ashx?id=00ae9808-57c3-476f-8533-385e701fa619&subId=563295

The AMA Position Statement on Aged Care Resourcing can be found here: www.ama.com.au/position-statement/aged-care-resourcing-2018

MEREDITH HORNE

Europe’s digital highway changing the future of health care

The European Commission continues to strategically progress digital changes to modernise its healthcare system, with significant funding announced in their June EU Budget.

The budget announcement proposes to create the first ever Digital Europe program and invest €9.2 billion to align the next long-term EU budget 2021-2027 with tackling increasing digital challenges.

Andrus Ansip, the European Commissioner’s Vice-President for the Digital Single Market, said the announcement would ensure the EU budget was fit for the future.

“Digital transformation is taken into account across all proposals, from transport, energy and agriculture to health care and culture. We are proposing more investment in artificial intelligence, supercomputing, cybersecurity, skills and eGovernment – all identified by EU leaders as the key areas for the future competitiveness of the EU,” Mr Ansip said.

The European Commission’s legislative framework is based on new technologies enabling cross-border access of data to create more personalised, accurate and patient-oriented health care in a safe environment.

The framework is designed to overcome three challenges; ageing population and chronic diseases putting pressure on health budgets; unequal healthcare quality; and shortage of health professionals.

Currently EU citizens have the right to access health care in any EU country and to be reimbursed for care abroad by their home country.

The Commission’s digital health goal is to reduce administrative costs, avoid human errors, optimise the use of medical data and increase quality of services by systematically aligning healthcare IT systems and implement systems that support open standards-based data exchange.

The Commission recently established a set of measures to increase the availability of data in the EU, building on previous initiatives to boost the free flow of non-personal data in the Digital Single Market.

Thirteen European countries signed a declaration in April for delivering cross-border access to their genomic information. This is a game changer for European health research and clinical practice: sharing more genomic data will improve understanding and prevention of disease, allowing for more personalised treatments (and targeted drug prescription), in particular for rare diseases, cancer and brain related diseases. The target of the EU is to make one million genomes accessible in the EU by 2022.

The European Commissioner for the Digital Economy and Society, Ms Mariya Gabriel, said the agreement was founded in the understanding modern health relies on digital innovation and cross-border interoperability.

“Secure access to genomic and other health data among Member States is essential for better health and care delivery to European citizens and to ensure that the EU will remain at the forefront of health research.”

MEREDITH HORNE

Big tobacco’s latest scam revealed

A new study from the University of Bath’s Tobacco Control Research Group has exposed evidence that big tobacco is still facilitating tobacco smuggling, while also trying to control a global system aimed at preventing it.

The research draws on leaked documents. It also investigates industry front groups and details elaborate lengths the industry has gone to control to undermine a major international agreement, the Illicit Trade Protocol.

The Protocol aims to protect public health by stopping the tobacco industry from smuggling tobacco, but the University of Bath research shows how tobacco companies are trying to get around it by employing elaborate scam techniques.

Released in June, the research paper was published in the journal Tobacco Control and it calls on governments and international bodies to crack down on the tactics of big tobacco companies.

It requires governments being much more vigilant in ensuring that the systems designed to control tobacco smuggling are free of industry influence.

The study argues that despite the tobacco industry claiming to have changed and to be themselves the victims of counterfeit tobacco (and have lobbied to work with governments to help tackle counterfeit tobacco), it is still facilitating tobacco smuggling.

Approximately two thirds of smuggled cigarettes may still derive from industry, the study states. It highlights how companies have developed their own track and trace system, known as Codentify, and lobbied around the world for it to adopted, while at the same time creating front groups and paying for misleading data and reports.

The University of Bath’s research has revealed:

Big Tobacco funding (through a front group) the World Customs Organisation’s conference on illicit or smuggled tobacco;
Philip Morris International (PMI) setting up a $100 million fund for research on illicit tobacco, which funds organisations whose previous reports on tobacco smuggling have already been widely criticised; and
PMI funding INTERPOL to promote Codentify.

Leaked documents show the four major transnational tobacco companies hatched a joint plan to use front groups and third parties to promote Codentify to governments and have them believe it was independent of industry. It also reveals how these plans were put into action. For example, the study reveals how a supposedly independent company fronted for British American Tobacco (BAT) in a tender for a track and trace system in Kenya.

Professor Anna Gilmore, Director of the Tobacco Control Research Group, explains: “This has to be one of the tobacco industry’s greatest scams. Not only are tobacco companies still involved in tobacco smuggling, but they are positioning themselves to control the very system governments around the world have designed to stop them from smuggling. Their elaborate and underhand effort, implemented over years, involves front groups, third parties, fake news and payments to the regulatory authorities meant to hold them to account.

“Governments, tax and customs authorities around the world appear to have been hoodwinked. It is vital that they wake up and realise how much is at stake. Our simple message is this: no government should implement a track and trace system linked in any shape or form to the tobacco manufacturers. Doing so could allow the tobacco industry’s involvement in smuggling to continue with impunity.”

The report’s co-author Andy Rowell said: “By analysing new leaked documents from the tobacco industry and other contemporary evidence, it’s clear that the masters of deception are up to their old tricks. The evidence suggests the industry is still facilitating tobacco smuggling, whilst trying to control the international system to stop smuggling. But authorities should not let the sly old tobacco fox look after the hen house.”

To access the peer-reviewed paper see: http://tobaccocontrol.bmj.com/lookup/doi/10.1136/tobaccocontrol-2017-054191

CHRIS JOHNSON

New NHMRC code of conduct has researchers worried

A revised research code of conduct released by the NHMRC and Universities Australia this month has been criticised by several leading academics, who say it may be open to abuse.

Under the new code, any serious breach of research ethics, such as plagiarism, falsification or fabrication, must be investigated by the institution itself, rather than by an independent body. Academics have flagged several concerns with this arrangement. Cell biologist Professor David Vaux, who is deputy director of science integrity and ethics at Melbourne’s Walter and Eliza Institute of Medical Research, notes that including any external members on investigatory panels is optional in the new code of conduct.

“Self-regulation just doesn’t work. This represents a step backwards, and will inevitably lead to conflicts of interest,” he told the website Retraction Watch.

Academics are worried that without an independent investigating body, researchers are less likely to get a fair, impartial hearing, and that public confidence in Australian research might also take a hit.

It also means that institutions, even small ones, will have the extra burden of establishing their own research integrity offices. A much more economic solution, and the route most other developed countries have taken, is to pool resources into an independent body, says Professor Vaux.

Countries such as the United States, Canada and the United Kingdom have set up independent bodies to deal with serious research misconduct. Even China, hardly an exemplar of transparency, has recently said it will no longer rely on research institutions to investigate their own researchers and will set up a process within the Ministry of Science and Technology.

“We are going in the opposite direction to China,” notes Professor Vaux.

Another problem academics have flagged with the code is its preference for the term “breach”, categorised from minor to serious, rather than the more conventional “misconduct”.

While research “misconduct” is reasonably robustly defined as instances of plagiarism, falsification and fabrication, “breech” casts a wider net and potentially opens the door to investigating any so-called breach, US bioethicist Nicholas Steneck has warned in an interview with Nature Index.

The code defines research misconduct as serious breaches carried out with “intent, recklessness or negligence”, a definition that some say puts too much emphasis on the subjective state of mind of the researcher and not enough on the objective trustworthiness of the research itself.

The Australian research community has faced a number of high-profile cases of research misconduct over the past few years. These include the case of Dr Caroline Barwood and Dr Bruce Murdoch of the University of Queensland, who in 2015 were among the very few medical researchers ever to face criminal charges in a case of research misconduct. Both were found guilty of fraud for falsifying research into Parkinson’s disease, and both received suspended sentences.

The new code of conduct came into force on 14 June, and failure to comply with it could result in suspension of NHMRC funding.

[Perspectives] Chen Wang: new President of CAMS and PUMC

Professor Chen Wang, Director of the Centre for Respiratory Medicine at Beijing’s China–Japan Friendship Hospital, is the new President of the Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC). Of the several reasons for welcoming the appointment, the most obvious is Wang’s expertise in the respiratory diseases that are a leading cause of morbidity and mortality in his country and impose a great socioeconomic burden. Moreover, he makes no secret of his enthusiasm for curbing tobacco use, which, while now recognised by the Chinese Government as a key public health issue, remains high.

[Comment] Screening men for AAA under magnification loupe in Sweden

Nationwide screening for abdominal aortic aneurysm (AAA) in men has only been implemented in Sweden and the UK. In 2016, the Swedish National Board of Health and Welfare, a government agency under the Swedish Ministry of Health and Social Affairs, re-established its support for the recommendation to screen men aged 65 years with one ultrasound examination of the abdomen,1 stating that on the basis of available evidence, ”the benefits will outweigh the harms”. In The Lancet, Minna Johansson and colleagues2 report estimates of the effect of AAA screening on disease-specific mortality, incidence, and surgery in a real-world setting.

[Comment] Response to the Ebola virus disease outbreak in the Democratic Republic of the Congo

The unfolding outbreak of Ebola virus disease in the Democratic Republic of the Congo (DRC) dominated discussions at last month’s World Health Assembly (WHA) in Geneva, Switzerland. Several funding pledges were made and WHO estimated that US$26 million will be required to control the outbreak.1 On May 8, 2018, the DRC Government declared an outbreak of Ebola virus disease, initially in a remote area of the Equateur Province (figure).2 As of June 10, 2018, the Government of DRC reported 66 cases of Ebola virus disease and 28 deaths (case fatality rate 42·4%).

The doctors who received Queen’s Birthday honours

Former AMA President Professor Brian Owler is one of over 40 Australian doctors recognised for their service in the Queen’s Birthday honours list announced on Monday.

A neurosurgeon, Professor Owler was appointed a Member in the General Division of the Order of Australia (AM), for his “significant service to medicine through the leadership and administration of professional medical organisations, and to education”.

Professor Owler first came to mainstream prominence in a media campaign to highlight the horrors of high-speed car accidents.

“It sometimes just takes one split-second decision to end in a world of tragedy and I have seen everyday people, good people, who made those split-second decisions that ended up costing either them or tragically their family and their children’s lives and of course the lives of others as well,” he says.

Among other doctors to be honoured is Professor Mark Brown, appointed Member of the Order of Australia, who is recognised for his work in nephrology and in medical research, particularly in hypertension in pregnancy. The professor of renal medicine at UNSW was instrumental in setting up the renal supportive care program at St George Hospital in 2009, and has also been involved in an award-winning outreach program for homeless men with Mission Australia.

Dr Andrew Skeels, formerly the medical director of Clare Holland House in Canberra, has been recognised with an AM for his work in palliative care. In an interview with Fairfax Media, Dr Skeels said the greatest lesson he has learned from palliative care is to be able to understand the situation from the patient’s perspective.

“Learn to walk in their shoes and see the world in their eyes and that’s very different to a lot of other areas of medicine and it took a long, long time for me to learn that,” he said.

Professor David Cooper, who sadly died in March aged 69, was posthumously appointed a Companion of the Order of Australia for his “eminent service to medicine, particularly in the area of HIV/AIDS research, as a clinician, scientist and administrator, to the development of treatment therapies”. Professor Cooper diagnosed some of the first HIV cases in Australia in the early 1980s. He was the inaugural director of the Kirby Institute in 1986 and dedicated his professional life to research that ultimately transformed an HIV diagnosis from a death sentence to a manageable chronic disease.

Below is a list of AMA members and former members who have been recognised in this year’s Queen’s Birthday Honours list:

OFFICER (AO) IN THE GENERAL DIVISION

Professor Rinaldo BELLOMO

Ivanhoe Vic 3079

For distinguished service to intensive care medicine as a biomedical scientist and researcher, through infrastructure and systems development to manage the critically ill, and as an author.

Professor Christopher Kincaid FAIRLEY

Hawthorn Vic 3122

For distinguished service to community health, particularly in the area of infectious and sexually transmitted diseases, as a clinician, researcher and administrator, and to medical education.

Emeritus Professor Vernon Charles MARSHALL

Ivanhoe Vic 3079

For distinguished service to medicine, particularly to renal transplant surgery and organ preservation, to accreditation and professional standards, as an academic, author and clinician.

Dr David Charles PESCOD

Beveridge Vic 3753

For distinguished service to medicine, and to Australia-Mongolia relations, particularly through the provision of surgical and anaesthetic care, and to health education and standards.

Professor Michael Francis QUINLAN

Nedlands WA 6009

For distinguished service to medicine, particularly through strategic leadership in the development of tertiary medical and social education in Western Australia as an academic and clinician.

MEMBER (AM) IN THE GENERAL DIVISION

Professor Rodney John BABER

Surry Hills NSW 2010

For significant service to medicine in the field of obstetrics and gynaecology as a clinician and researcher.

Professor Anthony Frank BROWN

New Farm Qld 4005

For significant service to emergency medicine as a clinician, author and educator, and to professional organisations.

Associate Professor Geoffrey David CHAMPION

Mosman NSW 2088

For significant service to medicine in the field of paediatric rheumatology, and to medical research and treatment of musculoskeletal pain.

Dr Michael Gerard COOPER

Castlecrag NSW 2068

For significant service to medicine in the field of anaesthesia as a clinician, teacher, mentor and historian.

Dr Paul Vincent DESMOND

Albert Park Vic 3206

For significant service to medicine in the field of gastroenterology as a senior clinician and researcher, and to professional associations.

Dr Charles Roger GOUCKE

For significant service to medicine in the field of pain management as a clinician, academic and mentor, and to professional societies.

Dr Timothy Roger HENDERSON

Alice Springs NT 0870

For significant service to medicine in the field of ophthalmology, and to Indigenous eye health in the Northern Territory.

Dr David Russell HILLMAN

Nedlands WA 6009

For significant service to medicine as an anaesthesiologist and physician, to medical research into sleep disorders, and to professional organisations.

Professor Lawrence William HIRST

Chelmer Qld 4068

For significant service to medicine in the field of ophthalmology through the development of clinical care techniques and eye disease management.

Dr Ian John KRONBORG

Footscray Vic 3011

For significant service to medicine, particularly gastroenterology, and through innovative substance abuse treatment programs.

Professor Christine Faye McDONALD

East Malvern Vic 3145

For significant service to respiratory and sleep medicine as a clinician-researcher, administrator, and mentor, and to professional medical organisations.

Dr Terence William O’CONNOR

Greenwich NSW 2065

For significant service to medicine, particularly as a colorectal surgeon, and as an educator, clinician and administrator of medical organisations.

Professor Brian Kenneth OWLER

Wahroonga NSW 2076

For significant service to medicine through the leadership and administration of professional medical organisations, and to education.

Adjunct Associate Professor Leslie Lewis RETI

Toorak Vic 3142

For significant service to medicine in the field of gynaecology and women’s health as a clinician and educator, and to the community.

Adjunct Associate Professor Andrew Harris SINGER

Downer ACT 2602

For significant service to emergency medicine as a clinician, educator and administrator, and to professional medical organisations.

Dr Andrew Scott SKEELS

Bruce ACT 2617

For significant service to medicine, particularly in the field of palliative care, as a clinician and educator.

Professor Bernard Mark SMITHERS

Toowong Qld 4066

For significant service to medicine in the fields of gastrointestinal and melanoma surgery, to medical education, and to professional organisations.

Emeritus Professor David Harry SONNABEND

Rose Bay NSW 2029

For significant service to medicine in the field of orthopaedics, as a clinician and administrator, and to medical education.

Dr Domenico (Dominic) SPAGNOLO

Mount Lawley WA 6050

For significant service to medicine, particularly in the field of pathology, as a clinician, and to medical education as a researcher and author.

Dr John Douglas TAYLOR

City Beach WA 6015

For significant service to medicine as a urologist and urogynaecologist, to medical education, and to the community.

Dr Philip Geoffrey THOMPSON

Kenthurst NSW 2156

For significant service to medicine as a plastic and reconstructive surgeon, to health initiatives in South East Asia, and to professional organisations.

Professor David Allan WATTERS

Newtown Vic 3220

For significant service to medicine and medical education in endocrine and colorectal surgery, and through leadership roles with professional organisations.

Professor John William WILSON

Prahran Vic 3181

For significant service to medicine, and to medical research, in the field of respiratory disease, and to professional organisations.

MEDAL (OAM) IN THE GENERAL DIVISION

Dr Terence Francis AHERN

Brunswick Vic 3056

For service to medicine, particularly in the field of general practice.

Dr Peter Chester ARNOLD

Edgecliff NSW 2027

For service to medicine through a range of roles with professional organisations, and as a general practitioner.

The late Dr Keith Francis BECK

Late of Wauchope NSW 2446

For service to medicine through a range of roles.

Associate Professor Terry Dorcen BOLIN

Bellevue Hill NSW 2023

For service to medicine in the field of gastroenterology.

Dr Alan Edward BRAY

Woodville NSW 2321

For service to medicine, particularly to vascular surgery.

Mr Ian Alexander CAMPBELL

Horsham Vic 3400

For service to medicine as a surgeon.

Dr Kevin John CHAMBERS

Mildura Vic 3500

For service to medicine, and to the community of Mildura.

Clinical Associate Professor Michael James COOPER

Sydney NSW 2000

For service to medicine in the field of gynaecology.

Dr Jane Helen GREACEN

Bairnsdale Vic 3875

For service to medicine, and to community health.

Dr Jacqueline Kim MEIN

Cairns Qld 4870

For service to medicine, and to community health.

Mr Hugh Simpson MILLAR

Hawthorn Vic 3122

For service to medicine, particularly to otolaryngology.

Dr Michael MIROS

Loganholme Qld 4129

For service to medicine, particularly to gastroenterology.

Mr Donald Ivan MOSS

Ballarat Vic 3350

For service to medicine, particularly to urology.

Dr Roderic John PHILLIPS

Vic

For service to rogaining, and to paediatric dermatology.

Adjunct Clinical Professor John Graham ROSENTHAL

South Perth WA 6951

For service to medicine, and to the community of Western Australia.

Dr Richard Frank WILSON

Summertown SA 5141

For service to the community through a range of roles, and to medicine.