Additional research funding for rare cancers

The Federal Government has announced a $69 million boost to help medical researchers in their fight against rare cancers and rare diseases.

The funding is aimed at assisting patients who often have few options and poor life expectancy.

Health Minister Greg Hunt said the Government was committed to investing in research to find the answers to these challenges.

“This is a significant boost on the $13 million that was originally flagged when we called for applications and reflects the incredibly high calibre of medical research that is happening right here in Australia,” Mr Hunt said.

The new funding includes more than $26 million for 19 research projects as part of the landmark Medical Research Future Fund’s Rare Cancers, Rare Diseases and Unmet Needs Clinical Trials Program.

These projects will undertake clinical trials for devastating conditions like acute lymphoblastic leukaemia in infants, aplastic anaemia, multiple sclerosis and Huntington’s disease.

Researchers at the University of New South Wales will test a vaccine to target glioblastoma, a lethal brain cancer and the most frequent cause of cancer deaths in children and young people.

Another clinical trial at the University of Queensland will evaluate the benefits of medicinal cannabis for people with advanced cancer, and define the role of the drug for patients with cancer in palliative care.

Monash University is researching a new preventive treatment for graft versus host disease following a bone marrow transplant which could halve instances of the life-threatening complication, while a trial by the University of Western Australia to simultaneously compare a range of cystic fibrosis treatments may lead to improved care for this complex disease.

Other trials will explore the effectiveness and safety of aspirin compared to heparin to treat blood clots and test a new triple therapy regimen to target rare viral-driven brain lymphomas.

Prior to this announcement, rare and less common cancers received 12 per cent of the cancer research dollar, despite accounting for over 50 per cent of cancer deaths.

Details of the rare cancer projects that have received funding can be found here: www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2018-hunt008.htm

MEREDITH HORNE

AMA shines in Australia Day Honours

Former Australian Medical Association President Dr Mukesh Haikerwal has been awarded the highest honour in this year’s Australia Day awards by being named a Companion of the Order of Australia (AC).

He is accompanied by the current Editor-in-Chief of the Medical Journal of Australia, Laureate Professor Nick Talley, as well as longstanding member Professor Jeffrey Rosenfeld – who both also received the AC.

The trio top a long and impressive list of AMA members to receive Australia Day Honours this year.

AMA Federal Councillor, Associate Professor Julian Rait, received the Medal of the Order (OAM).

A host of other members honoured in the awards are listed below.

AMA President Dr Michael Gannon said the accolades were all well-deserved and made he made special mention of those receiving the highest Australia Day Honours.

“They have dedicated their lives and careers to helping others through their various roles as clinicians, researchers, teachers, authors, administrators, or government advisers – and importantly as leaders in their local communities,” Dr Gannon said.

“On behalf of the AMA, I pay tribute to all the doctors and other health professionals who were honoured today for their passion for their profession and their dedication to their patients and their communities.

“The great thing about the Honours is that they acknowledge achievement at the international, national, and local level, and they recognise excellence across all avenues of human endeavour.

“Doctors from many diverse backgrounds have been recognised and honoured again this year.

“There are pioneering surgeons and researchers, legends across many specialties, public health advocates, researchers, administrators, teachers, and GPs and family doctors who have devoted their lives to serving their local communities.

“The AMA congratulates all the doctors and other health advocates whose work has been acknowledged.

“We are, of course, especially proud of AMA members who are among the 75 people honoured in the medicine category.”

Dr Haikerwal, who was awarded the Officer in the Order of Australia (AO) in 2011, said this further honour was “truly mind-blowing” and another life-changing moment.

“To be honoured on Australia Day at the highest level in the Order of Australia is beyond imagination, beyond my wildest dreams and extremely humbling,” Dr Haikerwal said.

“For me to be in a position in my life and career to receive such an honour has only been made possible due to the unflinching support and unremitting encouragement of my closest circle, the people who have been with me through every step of endeavour, adversity, achievement, and success.”

CHRIS JOHNSON

AMA MEMBERS IN RECEIPT OF HONOURS

COMPANION (AC) IN THE GENERAL DIVISION

Dr Mukesh Chandra HAIKERWAL AO
Altona North Vic 3025
For eminent service to medical governance, administration, and technology, and to medicine, through leadership roles with a range of organisations, to education and the not-for-profit sector, and to the community of western Melbourne.

Professor Jeffrey Victor ROSENFELD AM
Caulfield North, Vic
For eminent service to medicine, particularly to the discipline of neurosurgery, as an academic and clinician, to medical research and professional organisations, and to the health and welfare of current and former defence force members.

Professor Nicholas Joseph TALLEY
Black Hill, NSW
For eminent service to medical research, and to education in the field of gastroenterology and epidemiology, as an academic, author and administrator at the national and international level, and to health and scientific associations.

OFFICER (AO) IN THE GENERAL DIVISION

Emeritus Professor David John AMES
East Kew, Vic
For distinguished service to psychiatry, particularly in the area of dementia and the mental health of older persons, as an academic, author and practitioner, and as an adviser to professional bodies.

Dr Peggy BROWN
Sanctuary Cove, Qld
For distinguished service to medical administration in the area of mental health through leadership roles at the state and national level, to the discipline of psychiatry, to education, and to health care standards.

Professor Creswell John EASTMAN AM
St Leonards, NSW
For distinguished service to medicine, particularly to the discipline of pathology, through leadership roles, to medical education, and as a contributor to international public health projects.

Professor Suzanne Marie GARLAND
Docklands, Vic
For distinguished service to medicine in the field of clinical microbiology, particularly to infectious diseases in reproductive and neonatal health as a physician, administrator, researcher and author, and to professional medical organisations.

Dr Paul John HEMMING
Queenscliff, Vic
For distinguished service to higher education administration, to medicine through contributions to a range of professional medical associations, and to the community of central Victoria, particularly as a general practitioner.

Professor Anthony David HOLMES
Melbourne, Vic
For distinguished service to medicine, particularly to reconstructive and craniofacial surgery, as a leader, clinician and educator, and to professional medical associations.

Dr Diana Elaine O’HALLORAN
Glenorie, NSW
For distinguished service to medicine in the field of general practice through policy development, health system reform and the establishment of new models of service and care.

MEMBER (AM) IN THE GENERAL DIVISION

Dr Michael Charles BELLEMORE
Croydon, NSW
For significant service to medicine in the field of paediatric orthopaedics as a surgeon, to medical education, and to professional medical societies.

Dr Colin Ross CHILVERS
Launceston, Tas
For significant service to medicine in the field of anaesthesia as a clinician, to medical education in Tasmania, and to professional societies.

Associate Professor Peter HAERTSCH OAM
Breakfast Point, NSW
For significant service to medicine in the field of plastic and reconstructive surgery as a clinician and administrator, and to medical education.

Professor Ian Godfrey HAMMOND
Subiaco, WA
For significant service to medicine in the field of gynaecological oncology as a clinician, to cancer support and palliative care, and to professional groups.

Dr Philip Haywood HOUSE
WA
For significant service to medicine as an ophthalmologist, to eye surgery foundations, and to the international community of Timor Leste.

Adjunct Professor John William KELLY
Vic
For significant service to medicine through the management and treatment of melanoma, as a clinician and administrator, and to education.

Dr Marcus Welby SKINNER
West Hobart, Tas
For significant service to medicine in the field of anaesthesiology and perioperative medicine as a clinician, and to professional societies.

Professor Mark Peter UMSTAD
South Yarra, Vic
For significant service to medicine in the field of obstetrics, particularly complex pregnancies, as a clinician, consultant and academic.

Professor Barbara S WORKMAN
East Hawthorn, Vic
For significant service to geriatric and rehabilitation medicine, as a clinician and academic, and to the provision of aged care services.

MEDAL (OAM) IN THE GENERAL DIVISION

Professor William Robert ADAM PSM
Vic
For service to medical education, particularly to rural health.

Dr Marjorie Winifred CROSS
Bungendore, NSW
For service to medicine, particularly to doctors in rural areas.

Associate Professor Mark Andrew DAVIES
Maroubra, NSW
For service to medicine, particularly to neurosurgery.

Dr David William GREEN
Coombabah, Qld
For service to emergency medicine, and to professional organisations.

Dr Barry Peter HICKEY
Ascot, Qld
For service to thoracic medicine.

Dr Fred Nickolas NASSER
Strathfield, NSW
For service to medicine in the field of cardiology, and to the community.

Dr Ralph Leslie PETERS
New Norfolk, Tas
For service to medicine, and to the community of the Derwent Valley.

Associate Professor Julian Lockhart RAIT
Camberwell, Vic
For service to ophthalmology, and to the development of overseas aid.

Mr James Mohan SAVUNDRA
South Perth, WA
For service to medicine in the fields of plastic and reconstructive surgery.

Dr Chin Huat TAN
Glendalough, WA
For service to the Chinese community of Western Australia.

Dr Karen Susan WAYNE
Toorak, Vic
For service to the community of Victoria through a range of organisations.

Dr Anthony Paul WELDON
Melbourne, Vic
For service to the community, and to paediatric medicine.

PUBLIC SERVICE MEDAL (PSM)

Dr Sharon KELLY
Yeronga, Qld
For outstanding public service to the health sector in Queensland.

Professor Maria CROTTY
Kent Town, SA
For outstanding public service in the rehabilitation sector in South Australia.

Medicare Benefits Schedule Review update

The MBS Review Taskforce continues its work into 2018, with the next round of public consultations expected for release in February.

In the meantime, a number of clinical committees have yet to begin. The Department of Health’s MBS Review team is currently accepting nominations from medical practitioners with the relevant background to participate on the following reviews:

Aboriginal and Torres Strait Islander Health, Neurology, Pain Management, Urology, Allied Health, Colorectal Surgery, Consultation Services, General Surgery, Mental Health Services, Nurse Practitioner & Participating Midwife, Ophthalmology, Optometry, Oral & Maxillofacial Surgery, Paediatric Surgery, Plastic & Reconstructive Surgery, Thoracic Surgery, Vascular Surgery

The MBS Review Taskforce also has an interest in participants (both specialists and consultant physicians) for the review of specialist consultation items.

The success of the MBS reviews is contingent on the reviews being clinician-led and the AMA encourages medical practitioners with the relevant skillset to consider nominating to the clinical committees. Follow the online links to learn more about the individual items under review by each committee.

For more information or to submit a nomination, contact the MBS Review team.

The AMA’s approach has always been to defer recommendations relating to specialty items to the relevant Colleges, Associations and Societies (CAS) and comment on the broader policy. As such, the AMA does not have direct representation on individual clinical committees but supports the commitment made by members who do contribute their expertise to the review.

Through feedback mechanisms involving the CAS, a member-based AMA Working Group and the Medical Practice Committee, the AMA has responded to every single MBS review consultation – raising issues from across our membership, while stressing where systematic improvements need to be made. The AMA Secretariat and the President have done this through direct representations with the Health Minister, the Department of Health and in writing to the Chair of MBS Review Taskforce.

Recent submissions highlighted a number clear deficiencies and significant variations in the MBS review process, signalling a need for absolute transparency from the Taskforce and leadership on the clinical committees through early engagement of the relevant CAS.

This year, the AMA will continue to press Government to ensure the reviews result in sensible reinvestment into the MBS while protecting clinical decision making. It is therefore crucial that each committee has the input of practicing clinicians and consistent, practical advice from the CAS.

The AMA continues to monitor the reviews with interest and update members along the way. The profession and the wider CAS are encouraged to do the same by engaging early with the clinical committees and public consultations. The full schedule of MBS reviews can be found on the Department of Health website: http://www.health.gov.au/internet/main/publishing.nsf/content/MBSR-about

For more information on AMA’s advocacy with the MBS reviews, contact Eliisa Fok
Senior Policy Adviser, Medical Practice efok@ama.com.au

Eliisa Fok
AMA Senior Policy Adviser

Enthused about Indigenous Medical Scholarship

It is pretty hard to imagine someone being more inspirational than Associate Professor Kelvin Kong.

Australia’s first Indigenous surgeon – having qualified as the first Aboriginal Fellow of the Royal Australasian College of Surgeons and specialising in otolaryngology, head and neck surgery – he is passionate about bridging the health gap between Indigenous and non-Indigenous Australians.

Hailing from the Worimi people of Port Stephens, he now practices paediatric and adult ear, nose and throat surgery at Newcastle, NSW. He also lectures there.

His career to date is impressive and he is hugely committed to helping others pursue their own goals. Describing Dr Kong as enthusiastic would be an understatement.

Included in his long list of accolades is the AMA Indigenous Medical Scholarship.

A young Kelvin was the scholarship’s recipient in 1997.

Australian Medicine asked Dr Kong how important it was then to receive the award and how it seems now in retrospect.

“At the time it was extremely important,” he said.

“It wasn’t a huge amount of money, but for me it was. It certainly wasn’t a little amount of money, but I wouldn’t have cared if it was five bucks.

“The biggest impact it had on me was being recognised by my colleagues and the medical fraternity as someone who is legitimate.

“I was being told that I can make a contribution. I stand very proud as a recipient of this scholarship. I hope it has paid off and I hope those who sponsored it believe their contribution was worthwhile.

“I was mid-career with my studies, year 3-4, and at a time when we are pouring beers, waiting tables and all that kind of stuff just trying to get through.

“This meant I could pay my bills and put food on the table and spend more time trying to feel normal.

“It is important in retrospect to acknowledge the pure fact that the AMA thought that this was a big enough issue to get its Board to recognise and seek to fund.

“That was huge. It says a lot about the AMA as an organisation that it had that vision.

“Medicine is hugely competitive, so to get some acknowledgement is very important. It gave me a lot of inroads into mentorship and leadership and allowed me to contact people with similar values to me.

“Australia is a diverse community and so is its medical community. This was normalising that it’s ok to achieve.

“In the Aboriginal community and in the wider community there can be this misconception that people are ‘getting in’ on the back of them being Aboriginal. The actual fact is, there are a lot of hugely talented people in the Aboriginal community who will make an enormous contribution to medicine.

“That was a great vision and I am eternally grateful for being given that morale boost.”

Dr Kong has used his scholarship, and all of the honours that followed, to help him play his part in addressing the disparity – not only in health outcomes, but in career opportunities – between Indigenous and non-Indigenous Australians.

“It is important to acknowledge the disparity of opportunities for people who live in the same country,” he said.

“We have a very robust medical industry. I know there is talk of maybe awarding two of these scholarships each year. I think it would be fabulous if there were ten.

“I was asking myself ‘how can the AMA enhance this more?’ and I thought that maybe one way is by increasing the number of scholarships – increasing the number of donors.

“There is a greater awareness among Australia and the medical community that this is genuinely important and we give value to it. It gives me that boost. It must give donors that boost too.

“We have this disparity in health outcomes, but there is a genuine desire in governments, in associations like the AMA, and in the community to address this.

“I am extremely lucky, first and foremost. I love my profession. I love my work. I love coming to work.

“As a Worimi man, I am heartened that we are as an Australian community seeking to address this disparity.

“I live a fantastic lifestyle. But my mother never had this opportunity, my Nan never had this opportunity.

“They would have done a better job.”

He says with a smile.

CHRIS JOHNSON

Information about donations towards the Indigenous Medical Scholarship can be found at: donate-indigenous-medical-scholarship

GPs highly efficient – Productivity Commission

Medical patients across Australia are highly satisfied with their GPs, according to the latest Productivity Commission report, which also found general practice to be the most efficient component of the health system.

The Productivity Commission Report on Government Services 2018 has found Australia’s general practice sector to be both cost effective and highly efficient.

But the report also shows that Australian Government total expenditure on GP services per person only grew by 80 cents between 2015-16 and 2016-17 – from $370.60 to $371.40

AMA President Dr Michael Gannon said the report highlights the funding pressure that general practice continues to operate under, and the pressing need for the Government to deliver new real investment in general practice in this year’s Budget.

“A well-resourced general practice sector can help keep patients out of hospital and save the health system money,” Dr Gannon said.

“GPs are providing more services for patients as the population gets older and, despite this pressure, satisfaction with these services remains high.

“The next Budget is a genuine opportunity to recognise and reward quality general practice.”

Dr Gannon said the Productivity Commission confirmed that the quality and productivity of Australia’s GPs is up with the best in the world.

Its report, he said, offered compelling evidence that the Government must provide greater support for general practice.

The number of GP services in 2016-17 was 6.5 per annum per head of population, which is up from 5.9 services per head of population in 2011-12.

“This reflects growing demand for GP services in the community due to the impact of complex and chronic disease, as well as an increase in GP numbers,” Dr Gannon said.

“There were 105.9 full service equivalent GPs per 100,000 population in 2016-17, compared to 82.9 per 100,000 population in 2011-12.

“Around 75 per cent of patients could get a GP appointment within 24 hours in 2016-17, which is consistent with previous years.

“Significantly, cost does not appear to be a significant barrier for patients who need to see a GP, with only 4.1 per cent of patients saying that they deferred accessing GP services due to cost.”

The Productivity Commission found that patients were highly satisfied with their GPs on a number of measures, including:

91.6 per cent said the GP always or often listened carefully to them;
94.1 per cent said the GP always or often showed respect; and
90.6 per cent said the GP always or often spent enough time with them.

CHRIS JOHNSON

Debate heats up as PHI premiums rise

Private health insurance continues to dominate political debate, with the Government approving a 3.95 per cent increase in premiums while the Labor Opposition promises to crack down on the industry.

Private health insurance (PHI) premiums will rise by almost $150 a year for most families from April 1, following Health Minister Greg Hunt’s nod to the providers to hike their fees twice as much as the rate of inflation – which last year was about 2 per cent.

The Minister points out, however, that the increase is the lowest since 2001 and would have been much higher if he hadn’t reined the insurers in.

Last year’s PHI premium increase was 4.84 per cent.

“Already, the significant private health insurance reforms that we announced in October last year have made an impact and they will continue to drive down costs,” Mr Hunt said.

The Minister said the Government’s reforms included $6.4 billion every year to the PHI rebate, and $1.1 billion savings to the prostheses list.

But Opposition Leader Bill Shorten has put the health insurance industry on notice, using an address to the National Press Club to declare that premium increases were out of control and that business as usual could not be sustained.

He said the PHI industry was becoming “a con”.

A few days later, the Opposition Leader announced plans to cap PHI increases to 2 per cent for two years in order to save families an average of $340.

He said Australians were tired of being “ripped off” by premium hikes.

Mr Shorten said his plan was a cost-of-living measure.

“The idea that taxpayers pay $6 billion a year to the big insurers, the idea these big insurers are making record profits and yet the premiums keep going up and up… can’t be sustained,” he said.

“Business as usual won’t cut it any longer for private health insurance.”

The Opposition Leader also promised that if elected, a Labor government would ask the Productivity Commission to review the whole private healthcare industry, with a focus on its value and quality.

Labor’s move brought immediate condemnation from the insurance lobby, but high praise from consumer groups.

Prime Minister Malcolm Turnbull accused Labor of trying to destroy the PHI industry and said Mr Shorten was making up policy on the run.

Mr Shorten and Shadow Health Minister Catherine King rejected the accusation and said private health insurance played an important role in Australia’s health system.

“But under Malcolm Turnbull, Australians are questioning the cost and value of private health more than ever,” they said in a statement.

“The Turnbull Government is failing to address this crisis and help Australians with the affordability of private health insurance, and as a result, people are walking away from private health altogether.

“Labor is choosing to put Australian families first, instead of the interests of the multibillion-dollar private health industry.”

The AMA has been at the forefront of the PHI debate and has repeatedly called for junk polices to be banned.

AMA President Dr Michael Gannon acknowledged Mr Hunt’s role in keeping this year’s premium hike to a lower rate than has previously been the case, but he said much more needed to be done to ensure consumers were getting value for money.

“Everyone should be asking what they’re paying for,” Dr Gannon said.

“Too often, patients or their loved ones find out only when they get sick that the cover they’ve purchased is not fit for purpose.

“There are too many policies where there are exclusions, carve-outs, caveats. The most egregious of these policies are those that tell you that you’re entitled to treatment as a private patient in a public hospital.

“Well, if you’re an Australian citizen, you’re entitled to free treatment in public hospitals, and there’s no discernible advantage. I’ve said many times that I need to be convinced why that’s not junk. It’s a level of coverage which does not support universal health care, and we think it’s a problem.”

AMA Vice Dr President Tony Bartone said PHI policies were far too confusing for consumers and there needed to be a simplification.

“Any increase on a product that’s not offering value to its consumers has got to be a concern,” Dr Bartone said.

“We’ve been asking for better value products, not products that actually increase in cost.”

CHRIS JOHNSON

Proposed incentive missing the mark on quality

BY DR RICHARD KIDD, CHAIR, AMA COUNCIL OF GENERAL PRACTICE

With the proposed start date of 1 March 2018 for the new Quality Improvement Incentive (QII) under the Practice Incentives Program (PIP) fast approaching, the AMA is becoming increasingly concerned that the proposed incentive arrangements are still not settled to the satisfaction of the profession.

Ideally, the QII should be taking us a step closer to rewarding quality care. However, the incentive has been short-changed of its key ingredient for supporting continuous quality improvement in general practices – funding.

The Government is not investing in this incentive, which means it is not investing in better data, quality improvement, or general practice. What it has done instead is pull $21.2 million out of PIP and sought to move existing PIP payments around. Abolishing the Quality Prescribing, Cervical Screening, Asthma, Diabetes, and Aged Care Access incentives to pay for the QII is a zero sum game and means that many practices will be financially worse off under the new incentive. In fact, for all intents and purposes, it would seem that the Government has lost its grasp of English in that an incentive is supposed to motivate or encourage someone to do something.

Practices are unlikely to implement the internal changes required to take up this incentive if the value of the incentive does not support the effort involved.

What is the Government thinking?

Through this incentive it wants data to better inform its policies and, while that is sensible, many practices are initially going to have to undertake a significant amount of work to improve the quality of their data. In addition, they will have to get up to speed on data governance to ensure that patients’ privacy is safeguarded. Patients will need to understand what data will be collected, how the data will be de-identified, what the data will be used for, and who it will be shared with.

If this work is not adequately funded, if the incentive does not provide a return on investment, practices will not take it on.

With this incentive supposedly only a few weeks away, we have no clarity on what the requirements are that practices will be asked to sign up for. We do not know what data will be extracted, whether quality improvement activities are to have a set focus, or how the quality improvement over time will be measured. We don’t even know what the dollar value of the incentive will be!

While the AMA is strong advocate for rewarding quality care, the proposed new QII is not fit for purpose. It is underfunded and critical detail is still missing. Practices should not be asked to sign up to a vague program that is likely to leave them worse off.

As the Government’s budgetary process rolls on the AMA will be continuing to make it clear to the Minister that the QII is under-funded and under-done. The solution is more time, thought and investment – something current policy settings sadly lack.

AMA fully supports Physician’s Pledge update

BY DR CHRIS MOY, CHAIR, AMA ETHICS AND MEDICO LEGAL COMMITTEE

As a member of the World Medical Association (WMA), the AMA takes great pride in highlighting the achievements of the WMA as a world leader in the development and promotion of global ethical standards for the medical profession.

While the WMA adopts a wide range of global policy statements on ethical issues related to medical professionalism, human rights, patient care, medical research and public health, it also actively counteracts violations of its ethical standards.

As examples, the WMA consistently condemns governments and others who threaten to compromise professional autonomy and clinical independence, as well as those who undermine the role of medical neutrality and fail to protect healthcare workers in areas of armed conflict.

One of the oldest, and most defining, of the WMA’s ethical statements is the Declaration of Geneva, often considered a modern version of the Hippocratic Oath. Established in 1947, the WMA (of which the Federal Council of the British Medical Association in Australia was a founding member) was particularly concerned with the global state of medical ethics and decided to take on the responsibility of developing ethical guidelines for the world’s doctors.

The WMA believed that developing an international oath, or pledge, to be recited upon graduating medical school, would impress upon newly qualified doctors the fundamental ethics of medicine and raise the standard of professional conduct.

Attempting to seek international consensus on a pledge that was relevant to, and representative of, doctors from a wide range of cultural, religious, racial, political and linguistically diverse backgrounds, was challenging, but in 1948 the 2nd WMA General Assembly officially adopted the Declaration of Geneva to serve that role.

Over the years, the Declaration has undergone only minor amendments, the exception being its most recent iteration. In October 2017, the 68th WMA General Assembly in Chicago adopted the 7th revision of the Declaration, a culmination of a two-year consultation with more than 100 member National Medical Associations, as well as the public.

According to the Chair of the WMA Declaration of Geneva Workgroup, Dr Ramin Walter Parsa-Parsi of the German Medical Association, when reviewing the document, the workgroup considered modern developments in medicine and medical ethics, as well as contemporary WMA policies and international literature.

The Declaration has changed in subtle, but significant, ways. It is now more patient-centred. For the first time, it refers to patient autonomy and dignity and recognises the importance of ‘well-being’ to patient care. Further, the whole document has been reformatted to emphasise obligations to patients first followed by obligations to colleagues and society.

The updated Declaration better reflects the modern notion of collegiality, while doctors should respect their teachers, it now recognises they should respect their colleagues and students as well. Particularly relevant to the Australian context, the Declaration acknowledges the essential role that physician ‘well-being’ (and not just health) has on a doctor’s ability to provide a high standard of patient care.

In addition, it now refers to sharing medical knowledge for the benefit of the individual patient and wider health care, recognising the duty not just to the individual but the broader health system and society.

The WMA advocates that the Declaration of Geneva, now formally referred to as the Physician’s Pledge, be taken up on a global scale. The AMA has formally adopted the updated Declaration of Geneva. It is our hope as well that the Declaration will unite doctors throughout the world by affirming the highest standards of ethical conduct in the profession’s service to humanity.

The WMA Declaration of Geneva can be accessed at https://www.wma.net/policies-post/wma-declaration-of-geneva/.

[Comment] Pollution, health, and the planet: time for decisive action

For decades, pollution and its harmful effects on people’s health, the environment, and the planet have been neglected both by governments and the international development community. Pollution is the largest environmental cause of disease and death in the world today, responsible for an estimated 9 million premature deaths in 2015.1 92% of all pollution-related mortality is seen in low-income and middle-income countries.1 A new Lancet Commission on pollution and health aims to confront and overturn this urgent predicament.

[Correspondence] Great expectations – Authors’ reply

Non-ST-segment elevation myocardial infarction (NSTEMI) is associated with relevant mid-term mortality and might be associated with poorer long-term prognosis compared with ST-segment elevation myocardial infarction.1 All-cause mortality is the most objective and clinically meaningful endpoint regarding data quality of randomised controlled trials and patient prognosis. However, as pointed out by Gilles Lemesle and colleagues, all-cause mortality is unlikely to be an appropriate endpoint to power a randomised controlled trial funded by a government agency and investigating the optimal timing of invasive coronary angiography or other treatment strategies in non-ST-segment elevation acute coronary syndromes (NSTE-ACS).