This bondage isn’t right

BY DR JOHN ZORBAS, CHAIR, AMA COUNICL OF DOCTORS IN TRAINING

There’s a key difference between bondage and bonding. One is a contract between two or more parties, requiring informed consent, and designed for the mutual benefit of all involved. The other is a terribly flawed stick that the Australian Government seems intent on bashing medical graduates with, in a poorly informed attempt to provide a rural workforce.

In Australia, we have two medical bonding programs: the Bonded Medical Places (BMP) scheme and the Medical Rural Bonded Scholarship (MRBS). There are several different versions of these schemes, if you count the number of different contracts that now exist since their inception, but they can broadly be summarised as follows. The BMP scheme provides participants with a Commonwealth Supported Place (CSP) in medical school in exchange for a return of service of one to six years in rural and regional Australia. The MRBS scheme provided participants with a CSP in medical school and by the time it was axed a scholarship of $26,310 a year in exchange for six continuous years of work as a specialist in rural and regional Australia. Sounds simple enough, but the more you dig, the more you realise just how bad a deal this is for these future doctors and the patients they’re supposed to be serving.

You see, the first major flaw in this plan is that bonding just doesn’t work. Funnily enough, if you force someone to do something on your terms in an uncertain and inflexible manner, it turns out that people don’t appreciate the experience and they don’t come back. When bonding in medical school was first conjured up, the AMA provided evidence that similar schemes overseas, especially in North America, had failed to provide any form of sustainable medical workforce. More than 13 years have now passed and an exceedingly small number of scheme participants have completed their return of service. In fact, more participants have withdrawn or breached their agreement than those who have completed their return of service. Not exactly a ringing endorsement.

Compare this with the other measures and programs that are supported by the AMA. We know that having a rural background significantly increases your chance of going rural, and we have strongly supported increasing the quota of students from rural backgrounds. We floated the idea of Regional Training Networks in 2014, to help allow those who wanted to work and stay rural obtain fellowship in a more sustainable manner and reduce infrastructure duplication in what is already a resource poor area of medical training. We supported the Prevocational General Practice Placements Program and, following its abolition by the Abbott Government, subsequently developed an alternative proposal for a Community Residency Program (CRP), to enable doctors to have meaningful rural experiences in their pre-vocational years, while they work out exactly what career they want to pursue. And we have long supported an increased rural focus in the Specialist Training Program (STP), allowing registrars to be adequately funded to work in rural areas on progression to fellowship. It’s a suite of measures that encourages positive experiences and supports trainees along their often complicated and difficult path.

But the Government has chosen to focus on draconian bonding schemes. Let’s explore the MRBS for a second, mostly as initially on paper it looks very attractive. You take a 17-year-old undergraduate student and you promise them $26,310 tax free and a place in medical school for a return of service. Sounds reasonable. Except what 17-year-old understands Medicare? Hell, how many healthcare workers and bureaucrats even understand Medicare? Do we adequately explain to them that leaving the scheme will result in a 12-year ban from Medicare, effectively killing their medical career there and then, simply because of a change in their life situation and circumstances? Do we explain to them that as they train to become a rural general practitioner, they will be effectively forbidden from working in the city for short periods of time, preventing them from upskilling in crucial rural skill sets such as emergency medicine, obstetrics and anaesthetics? Do we explain to the orthopaedic trainee that they only have 16 years from the start of medical school to complete their requirements? Caveat emptor is one thing, but conscriptive blackmail is another.

And even if you are one of the few to complete your return of service, just how happy will you be at the end of it all? What doctor, having had to deny themselves the opportunities of personal and professional development at the behest of such an authoritarian scheme, will look kindly on rural Australia? When you take away mastery, autonomy and purpose, you’re left with a bitter, angry human. That’s not the kind of person that rural Australia deserves.

The AMA Council of Doctors in Training is continuing to lobby government to adjust the BMP and MRBS for the good of its participants and the Australian public that it purports to serve. Nobody is arguing that a return of service isn’t owed, but it certainly shouldn’t function like this. If you or someone you know is affected by these schemes, we’d like to hear about it. Please contact me at cdt.chair@ama.com.au and let’s see if we can’t loosen the bureaucratic nipple clamps, just a little bit.

Public Hospital Doctors role central to AMA

BY DR ROD McRAE, CHAIR, AMA COUNCIL OF PUBLIC HOSPITAL DOCTORS

I’d like to state my thanks for all the input and interest from PHD members at our recent National Conference. It was invigorating to experience your enthusiasm for the many issues directly affecting public hospital doctors. An important issue about which I do want to remind you is actually how you “describe” yourself for AMA membership purposes. In order to keep the CPHD vibrant and relevant to key issues, we must have a solid base. Today we can choose our membership category more accurately. I hope more doctors based in public hospitals, particularly those with a Specialist qualification, will choose to identify in the public hospital doctor membership category as opposed to their medical craft group if they have one, when it comes to identifying their AMA membership as you will be invited to do soon, and thus remain engaged with the CPHD.

Vale Dr Patrick Pritzwald-Stegmann

Multiple issues are before the CPHD. None is more relevant than safety in the workplace. On July 21, a Memorial Service was held for AMA member Dr Patrick Pritzwald-Stegmann, who died after substantial time ventilated in one of our ICUs after an alleged “coward’s punch” received in the foyer of a Melbourne metropolitan public hospital resulted in a profound brain injury. This is now a Coroner’s and police matter. I am regularly horrified at the experiences of violence in our community and our workplaces, but this is all the more poignant for me as Patrick was a recent close colleague of mine with whom I had worked extensively.

There are many intersecting issues in our community, most of which lead to the public hospital system. They include mental health issues, whether acute, chronic or acute-on-chronic, illicit drug use, perhaps loading up on mental health issues, increased passive tolerance of greater violence in and by the now metropolises (as opposed to tight-knit communities), and a general lack of respect for those providing any type of community service. Emergency service providers and our colleagues and other healthcare workers in emergency departments face the brunt, but it is throughout the public hospital system. I note that our population is growing remarkably, we have generated profound productivity improvements, but there remains a yawning gap of lack of public hospital capacity investment to match the essential hospital requirements of the complex, multi-system, elderly and/or obese, chronic illness sufferers. It is readily observable how “house full” messages contribute to patient frustration, then anger and venting in our workplace. It was equally offensive to see lauding of “this is what 182 blows to the head looks like” related to a recent violent “sport” designed to inflict brain injury. It is easy to see some might link these ingredients, resulting in an unsafe workplace for us.

In perhaps a curious coincidence, I am now chairing an Australian Standards committee revising the standard Security for Health Care Facilities. It will be a template for consideration of security risks for any and all health care facilities in Australia. Its origin related to large public hospitals, but changes in technology and hospital interventions means security issues are everywhere that medicine is practised, including hospital-in-the-home and all points travelling between, patient record security, medication and medical gas security, microorganism security, IT security, food security, let alone staff safety and security. I will be pleased to receive your thoughts on this topic. Obviously not everything will be totally relevant to all, but in these days of terrorism and bioterrorism, it will be a useful tool for risk analysis. It will be a sad day if every part time medical point of care in a high rise tower through to our major teaching hospitals needs to have the same security we now take for granted on getting to the airside of an airport, surveillance cameras or requires trained and authorised security personnel with Tasers and policing powers comparable to Protective Service Officers.

Of note, none of the above may have prevented Patrick’s injury, or some of them may have caused the alleged perpetrator to pause.

Public Hospital Funding

It is clear an expansion and greater funding of public hospital’s is required to meet the increasing demand, separate to security investments. This is about to accelerate in my view as more reduce private health insurance due to increasing premiums coupled with increasing mortgage, energy and education costs pressures. An important discussion will be how best to use the now billions of tax dollars shoring up publically listed health insurance companies’ profits and employee bonus payments, whilst squeezing the marketplace and offering frequently inadequate products to bamboozled patients seeking a tax break.

Recently the Government rejected a proposal to abolish the private health insurance rebate and effectively take funds it saves from that, along with hospital funding, to provide a standard benefit for services, regardless if they happen in a public or in a private hospital. This would effectively take Commonwealth funds from public hospitals and force patients to pay more for coverage. This would reduce the amount the Commonwealth contributes to the cost of public hospitals to a paltry 35 per cent. The 42 or 43 per cent funding we’re getting from the Commonwealth now is not sustainable for future public hospital operation.

A 35 per cent share would be a disaster in the super-stretched public system and in the private system for that matter. In recent years we’ve seen the Commonwealth’s share of funding to public hospitals drop below 45 per cent with a formula that only relies on growth in CPI and population. The AMA’s Public Hospital Report Card shows that performance in the system, such as wait times in the emergency department or for elective surgery, are not improving, or indeed are going backwards. So we can be thankful that this reduction has been ruled out.

But with consideration of the way hospitals are funded, we need to focus on priorities and things that might work in the hospital system. This especially includes quality and safety initiatives as well as increasing the utility of secondary hospitals or in the community. We must put more resources into primary care prevention as a long-term strategy for reducing the rate of increase of pressure on public hospitals.

Let’s hope governments see sense and realise that proper health care is a sound investment and saves money in the long term, and that engaging with doctors is the only way to develop sound health policy. I look forward to discussing these and other issues with you in upcoming CPHD meetings and other events.

AMA’s successful stand for sensible and safe pathology testing

BY PROFESSOR ROBYN LANGHAM, CHAIR, MEDICAL PRACTICE COMMITTEE

One could be forgiven for thinking that he AMA thinks little of pharmacists, given the nature of the media reports around the recent successful AMA campaign to stop Amcal pharmacies ordering unnecessary pathology screening tests.

The truth is quite the opposite. The AMA greatly respects the valuable contribution pharmacists make in improving the quality use of medicines. Pharmacists working with doctors and patients can help ensure better medication adherence, improved medication management, and also help in providing education about medication safety.

The AMA agrees that pharmacists’ expertise and training are under-utilised in a commercial pharmacy environment where they are necessarily distracted by retail imperatives.

That is why the AMA is fully engaged in the current review of pharmacy remuneration and regulation being undertaken by an independent panel appointed by the Federal Government.

In a comprehensive submission to the panel lodged last year, the AMA was supportive of alternate models of funding being explored that would encourage and reward a focus on professional, evidence-based interactions with patients. Our submission also supported ongoing funding of effective and cost-effective pharmacist medication management programs, particularly those targeting Aboriginal and Torres Strait Islanders, and a relaxation of the restrictive pharmacy location rules.

The panel has now released an interim report revealing its likely recommendations to Government on the future of pharmacy funding and regulation.

The proposed recommendations pick up on many of the AMA’s suggestions and concerns, and, if implemented, would radically improve the transparency of pharmacy funding and refocus government investment on evidence-based and cost effective services.

Unsurprisingly, the Pharmacy Guild of Australia is highly critical of the report, slamming it as “without merit”, “ill-considered”, “threatening” and “undermining” as well as stating it has “serious concerns about the true intention of the review”.

Some of the key recommendations supported by the AMA include:

banning the sale of homeopathic products from pharmacies altogether;

physically separating other complementary medicines from “pharmacy only” (schedule 2) and ‘pharmacist only’ (schedule 3) in pharmacies to better help consumers understand that these medicines have not been assessed for effectiveness in the same way as S2, S3 and prescription medicines;

moving the funding of pharmacist services programs from the Guild-controlled Community Pharmacy Agreement to other government funding streams to improve transparency and facilitate coordination with other primary health care programs;

removing current bureaucratic barriers to medicines programs and pharmacy services that hinder access to indigenous Australians; and

changing the pharmacy location rules with potential to improve options for pharmacy co-location with general practices.

The AMA is very supportive of the interim report and lodged a favourable submission in response in July.

Unfortunately, the Guild has already brokered a deal with the Coalition Government to shelve any changes to location rules in the foreseeable future. It will be interesting to see what appetite the Government has for taking up the panel’s final recommendations, particularly given the next Federal election date is not so far away.

Relationships with industry

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

A major priority for the AMA’s Ethics and Medico-Legal Committee (EMLC) will be the review of the Position Statement on Medical Practitioners’ Relationships with Industry 2012. The statement provides guidance for doctors on maintaining ethical relationships with “industry”, including the pharmaceutical industry, medical device and technology industry, other health care product suppliers, health care facilities, medical services such as pathology and radiology, and other health services such as pharmacy and physiotherapy.

The current Statement encompasses the following sections:

medical education;
managing real and potential conflicts of interest;
industry sponsored research involving human participants including post-marketing surveillance studies;
meetings and activities organised independent of industry;
meetings and activities organised by industry;
hospitality and entertainment;
use of professional status to promote industry interests;
remuneration for services;
product samples;
dispensing and related issues; and
relationships involving industry representatives.

Doctors’ primary duty is to look after the best interests of their patients. To do so, doctors must maintain their professional autonomy, clinical independence and integrity, and have the freedom to exercise professional judgement in the care and treatment of patients without undue influence by third parties (such as the pharmaceutical industry or governments).

But what happens when the impetus to change the relationship with industry comes from within the profession itself? For example, the AMA’s current policy on doctors and dispensing states that:

11.1 Practising doctors who also have a financial interest in dispensing and selling pharmaceuticals or who offer their patients’ health-care related or other products are in a prima facie position of conflict of interest.

11.2 Doctors should not dispense pharmaceuticals or other therapeutic products unless there is no reasonable alternative. Where dispensing does occur, it should be undertaken with care and consideration of the patient’s circumstances.

In recent years, we have heard from members who believe this position is too strict and doctors should be able to dispense pharmaceutical products, arguing that it’s more convenient for patients and leads to better compliance. For example, patients may be more likely to fill their prescriptions onsite at the doctor’s office than if they have to go offsite to a pharmacy. In addition, the doctor is there to answer any questions relevant to the prescription which will reduce pharmacy call backs and waiting times.

Historically, the AMA has strongly advocated that doctors do not make money from prescriptions. Allowing doctors to dispense pharmaceuticals or other therapeutic products (other than in exceptional circumstances) would be a fundamental shift in this position – but is that a sufficient reason not to change it?

After all, dispensing pharmaceuticals or other therapeutic products is not in itself unethical so long as it is undertaken in accordance with good medical practice. Unfortunately, however, there can still be a strong perception of a conflict of interest, particularly if doctors are making a profit rather than just recovering costs. So for many doctors – but more importantly our patients and the wider community who are our ultimate judges – this is a line which should not be crossed.

These are the types of issues the EMLC will consider in reviewing this policy and we will endeavour to seek members’ views during the process.

The EMLC will also be developing an overarching policy on managing interests, highlighting the potential for professional and personal interests to intersect, and at times compete, during the course of a doctor’s career. While a real, or perceived, conflict of interest is by no means a moral failing, it is important that doctors are able resolve any potential for conflict in the best interests of patients.

The Position Statement on Medical Practitioners’ Relationships with Industry 2012 is accessible on the AMA’s website at position-statement/medical-practitioners-relationship…. If you would like to suggest any amendments to the current Statement, please forward them to ethics@ama.com.au.

Why it costs so much to see a specialist – and what the government should do about it

Australians pay too much when they go to medical specialists. The government can and should do more to drive prices down. A current Senate Inquiry on out-of-pocket costs will hopefully lead to some policy action.

The problem is clear to anyone who has had to see a specialist recently. About 85% of GP visits are bulk billed, but the rate of bulk billing for visits to a specialist is much lower, at around 30%. The out-of-pocket costs can be very high, hurting patients.

To work out how to reduce the out-of-pocket costs for specialist care, we first need to identify why they are so high. There are four potential reasons.

1. Government rebates?

It may be that rebates for some procedures or for attendances are set too low. Rebates are set by government and may bear no relation to the actual cost of providing a service. Unlike in Canada, there is no obligation in Australia for government to consult with medical practitioners before setting fees.

But this explanation cannot account for the very high variation in fees. If high levels of billing above the nominated fee were due to inadequacies in the fee paid by government, then this would apply to all specialists equally. But in fact, some specialists charge more than others.

2. Supply and demand?

It may be that a specialist’s ability to charge a substantial out-of-pocket premium is simply the result of high demand for a particular service in a particular location.

Certainly, if the market for specialist care was functioning perfectly, supply would adjust to meet demand. But the reality is that specialist care is not a perfect market. Even with the increase in the number of medical graduates in Australia over recent years, there are still shortages of specialists in rural and remote parts of the country.

Here, the government needs to do more. It should consider whether specialists’ productivity can be improved, or whether other health professionals could perform roles in areas of short supply. The Grattan Institute’s 2014 report, Unlocking skills in hospitals: better jobs, more care outlined some options such as nurses performing endoscopies or providing sedation, work mostly now done by medical specialists such as gastro-enterologists.

Left to their own devices, specialists tend to establish their practices in more salubrious, city locations. There’s no guarantee newly accredited specialists will set up shop where their services are needed most. So the government should offer some carrots and wield some sticks to encourage new specialists to practice in rural and remote areas.

– How much?! Seeing private specialists often costs more than you bargained for

– For real health reform, turn the spotlight on specialists’ fees

Carrots could include subsidies and other support for the first few years in rural or remote practice. Sticks might include restrictions on access to Medicare billing in areas of existing over-supply in particular specialties. This would not preclude specialists establishing practices in over-supplied areas, but rather would limit public subsidies in those areas and thus provide an incentive for newly-minted specialists to go where the need is greatest.

Medicare already provides differential rebates for general practice in different parts of the country (rural and regional compared to inner city). Why not do the same for specialist practice?

3. Market power?

High specialist charges and consequent high out-of-pocket costs may simply be the result of specialists using their market power to maximise their income. Even in areas of reasonable supply, specialists may be able to charge high fees because they benefit from established referral patterns. That is, local GPs, clinics and hospitals may refer patients to particular specialists almost by habit, without paying heed to the fees they change. Patients may not be aware of these fees until they’re committed to being treated by that specialist.

The government could limit rebates in built-up areas already serviced by other specialists.
from www.shutterstock.com

A good way to respond to market power is to strengthen the market, to use competition between specialists to drive prices down. And the first step to improving competition is to increase transparency about prices charged.

The government – and perhaps private health insurers too – should publish information on specialists’ fees: the proportion of visits that are bulk billed, how each specialist’s fees compare to the average of specialists in, say, a 10-kilometre radius, and so on.

The government should further discourage higher fees by eliminating a rebate when fees are significantly above the standard rebate. For example, rebates might be paid only if the specialist fee is less than twice the standard rebate.

4. Skill-based premiums?

The fourth reason there may be high out-of-pocket charges is that some specialists are able to charge a premium for skill – or at least they might claim that is the basis for their high fees. Unfortunately, patients have no way of knowing whether this skill-based premium is warranted.

Again, transparency can help here. Governments and private health insurers should publish information which would help patients and their GPs assess whether a specialist’s outcome-based premium is warranted.

There are, of course, challenges associated with publicly reporting indicators of specialists’ quality of care. Agreement would need to be reached on what the key quality indicators for a range of procedures are in each specialty. Imperfect measures can be gamed, or discourage specialists from treating high-risk patients. And not all differences in performance metrics reflect actual differences in performance.

But opportunities for gaming or over-interpreting performance metrics could largely be removed by reporting performance within broad bands – for example: the bottom 25%, the central half, and the top 25% of performers. In the first instance, reporting should simply state whether, based on the specialist’s record, future performance is likely to be of a high standard.

Excessive costs for specialist care hit patients in the hip pocket and can discourage some from seeking appropriate treatment. Driving these costs down would make Australia a fairer and healthier nation.

Stephen Duckett, Director, Health Program, Grattan Institute

This article was originally published on The Conversation. Read the original article.

AMA’s marriage equality stance slammed

A petition demanding that the Australian Medical Association retract its support for marriage equality has garnered signatures from over 370 doctors, including many AMA members and six former AMA state presidents.

A group of doctors led by gastroenterologist and former AMA Tasmania president Dr Chris Middleton delivered the petition to AMA national president Dr Michael Gannon late last week. The group says the AMA’s position statement on marriage equality, released in May, is “fatally flawed”, particularly on the question of harm to children of same-sex parents. It also says that the AMA neglected to consult its own members before publishing its statement.

The AMA statement comes out strongly in favour of marriage equality on health grounds, stating that it is the right of “any adult and their consenting partner to have their relationship recognised under the Marriage Act 1961, regardless of gender”.

It says the lack of legal recognition can have “tragic consequences” in medical emergencies, when, for example, one spouse has to make decisions on behalf of an ill or injured spouse.

It also states that while same-sex parenting should be treated as a separate issue to same-sex marriage, “there is no putative, peer-reviewed evidence to suggest that children raised in same-sex parented families suffer poorer health or psychological outcomes as a direct result of the sexual orientation of their parents or carers”.

But the petition signatories, who include former WA AMA president Professor Paul Skerritt and former government minister and Queensland AMA president Dr John Herron, take issue with this claim.

In their critique, the signatories point to three recent studies which claim to find poorer emotional, educational or other adverse outcomes among children with same same-sex parents.

They say the AMA statement has “misled politicians and the public” on a number of other issues; it is “unworthy of the Australian Medical Association and we call for its immediate and public retraction”.

But the AMA is not backing down. In an interview over the weekend, Dr Gannon said he had expected that a portion of the AMA membership would be disappointed with the statement on marriage equality, but that he was happy to defend the process that had led to its creation.

“It was worked out through a working group made up of federal councillors and other experts,” he noted.

He said whether the AMA membership should have been polled about it was “something we will reflect on”.

But he added that the response had been “overwhelmingly supportive in terms of our position on marriage equality.”

He also reiterated the point that the issue of marriage equality was quite different from that of same-sex parenting.

“No one here is arguing about access to in vitro fertilisation or assisted reproduction for gay and lesbian people. That’s not the debate. The debate here is about marriage equality. So I think it’s important that we talk about what we’re talking about.”

He said that it was undeniably the case that a loving home is the right environment for a child to grow up in, regardless of the sexual orientation of the parents.

The AMA is not the only Australian medical body to come out in favour of marriage equality on health grounds. The Royal Australasian College of Physicians has stated that it “supports initiatives to amend legislation, policies and practices that are unfairly restricting the rights of the LGBTI population. This includes adjustments to marriage laws so that same-sex and transgender individuals can marry, regardless of their gender identity.”

The Royal Australian and New Zealand College of Psychiatrists has also put out a position statement in favour of marriage equality.

The Royal Australian College of General Practitioners, on the other hand, has remained silent on the issue.

Philippines HIV cases rapidly rising

The United Nations reports that the Philippines is home to the fastest growing rate of HIV/AIDS in all of the Asia-Pacific.

The country’s own Secretary of Health, Paulyn Ubial, has cited UN data (from UNAIDS) during a recent media conference in a bid to encourage more Filipinos to use condoms during sex and to volunteer for HIV testing.

In the past six years the Philippines has recorded a 140 per cent increase in new HIV/AIDS infections.

A total of 10,500 Filipinos were infected with HIV at the end of last year, with most new infections detected among young men.

This rate is a jump from the 4,300 cases recorded in 2010.

In May this year there were 1,098 new instances of HIV infections detected in the Philippines, which is the highest number of cases since 1984 when infections were first reported.

UNAIDS regional support team director for Asia-Pacific, Eamonn Murphy, said the Philippines could avert the growing the health threat and all but wipe it out by 2030 if the Filipino Government focussed its attention and resources on the people and locations in the country most at risk.

Eighty-three per cent of new HIV cases occurred among males who have sex with males and transgender women who have sex with males.

Two out of three new HIV infections are among 15 to 24 year-old Filipino men, who reportedly have little awareness of HIV, including its symptoms and treatment.

CHRIS JOHNSON

Publically funded contraception set for challenge by the Trump administration

With the politics in the United States still playing out on the Affordable Care Act, the White House has reportedly moved forward with a plan to cut a provision that was introduced to protect women’s reproductive rights.

The Affordable Care Act expanded contraception coverage to about 55 million women with private insurance coverage.

The Trump administration is expected to amend the Federal regulation that requires employers to provide health-insurance plans that offer preventive care and counselling – which the US Department of Health and Human Services has interpreted to include contraception – at no cost.

The expected Presidential executive order will allow any business or organisation to request an exemption on religious or moral grounds.

The Obama administration issued regulations allowing religious employers to opt out of offering contraceptive coverage. However affected employees were then covered directly by their insurers.

Gretchen Borchelt, Vice President for Reproductive Rights and Health at the National Women’s Law Center, has said that hundreds of thousands of women could lose access to their birth control “if this broad-based, appalling, and discriminatory rule is made final”.

Many family planning advocates are concerned that this policy shift will see a result to an increase in abortion rates across the US. Recent research by the Guttmacher Institute suggests that improved contraceptive use, resulting in fewer unintended pregnancies, likely played a larger role than new state abortion restrictions in the decline between 2011 and 2014.

The American Congress of Obstetricians and Gynaecologists has issued a statement that denounces any plan to roll back contraception coverage, saying that any move to decrease access to these services would have a damaging effect on public health.

“Contraception is an integral part of preventive care and a medical necessity for women during approximately 30 years of their lives.

“Since the Affordable Care Act increased access to contraceptives, our Nation has achieved a 30 year low in its unintended pregnancy rate, including among teens.

“Unintended pregnancies can have serious health consequences for women and lead to poor neonatal outcomes,” the statement reads.

MEREDITH HORNE

Report warns blindness set to rise

A new study published in Lancet Global Health warns the number of blind people across the world is set to triple within the next four decades.

The research predicts cases will rise from 36 million to 115 million by 2050, if treatment is not improved by better funding.

A growing ageing population is behind the rising numbers.

Some of the highest rates of blindness and vision impairment are in South Asia and sub-Saharan Africa.

Although the percentage of the world’s population with visual impairments is actually falling, according to the study, the global population is growing and so the number of people with sight problems will soar in the coming decades.

Analysis of data from 188 countries suggests there are more than 200 million people with moderate to severe vision impairment.

That figure is expected to rise to more than 550 million by 2050.

“Even mild visual impairment can significantly impact a person’s life,” said lead author Professor Rupert Bourne, from Anglia Ruskin University in Cambridge.

“For example, reducing their independence…as it often means people are barred from driving.”

He said it also limited people’s educational and economic opportunities.

The worst affected areas for visual impairment are in South and East Asia. Parts of sub-Saharan Africa also have particularly high rates.

The study calls for better investment in treatments, such as cataract surgery, and ensuring people have access to appropriate vision-correcting glasses.

Professor Rupert Bourne said that interventions provide some of the largest returns on investment in eye health.

“They are some of the most easily implemented interventions in developing regions because they are cheap, require little infrastructure and countries recover their costs as people enter back into the workforce,” he said.

In Australia, the CEO of the Fred Hollows Foundation, Brian Doolan, spoke to the research, saying that more needs to be done for social development, targeted public health agreements and accessible eye health facilities.

“The strategies being used around the world have been shown to work, all we need is to get them to the right scale to address the growing global need,” Mr Doolan said.

According to Mr Doolan, the leading cause of blindness worldwide is poverty, followed by gender.

The report also indicates Aboriginal and Torres Strait Islander people are still three times more likely to be blind than other Australians. Most blindness in Australia is due to readily preventable or treatable causes of vision loss, including cataract, diabetes, refractive error and trachoma.

The AMA continues to call on the Federal Government to correct the under-funding of Aboriginal and Torres Strait Islander health services, including programs to limit preventable blindness.

MEREDITH HORNE

Substance abuse needs mature policy approach

The AMA has called on the Federal Government to treat substance abuse and other behavioural addiction problems within the community as a high-level priority to address.

Substance dependence and behavioural addictions are chronic brain diseases and people affected by them should be treated like any other patient with a serious illness.

AMA President Dr Michael Gannon said while the Government responded quickly to concerns about crystal methamphetamine use, with the National Ice Action Strategy, broader drug policy appears to be a lower priority.

“I don’t think we need to underestimate the cancer in our society that methamphetamine causes. It’s destroying lives, it’s destroying communities, it’s destroying families,” Dr Gannon said.

“But we can acknowledge that and at the same time reflect on the carnage that legal drugs still cause.

“Twelve per cent of Australians are still smoking. It’s the only habit that kills over half of its regular users and certainly impairs the health of the remainder.

“And alcohol; it’s a difficult conversation. So many of us enjoy a drink. Not many of us would think that we are problem drinkers. But if you look at how deeply inculcated in our society drinking alcohol is, you start to get an idea about the potential harm it causes.”

Given the consequences of substance dependence and behavioural addictions, the AMA believes it is time for a mature and open discussion about policies and responses that reduce consumption, and that also prevent and reduce the harms associated with drug use and control.

“Services for people with substance dependence and behavioural addiction are severely under-resourced. Being able to access treatment at the right time is vital, yet the demand for services outweighs availability in most instances,” Dr Gannon said.

“Waiting for extended periods of time to access treatment can reduce an individual’s motivation to engage in treatment.”

Substance abuse is widespread in Australia. Almost one in seven Australians over the age of 14 have used an illicit substance in the past 12 months, and about the same number report drinking 11 or more standard alcoholic drinks in a single session.

Substance use does not inevitably lead to dependence or addiction. A patient’s progression can be influenced by many things, such as genetic and biological factors, the age at which the use first started, psychological history, family and peer dynamics, stress, and access to support.

The AMA recently released its Harmful Substance Use, Dependence, and Behavioural Addiction (Addiction) 2017 Position Statement, pointing outthat dependence and addiction often led to death or disability in patients, yet support and treatment services were severely under-resourced.

The costs of untreated dependence and addictions are staggering. Alcohol-related harm alone is estimated to cost $36 billion a year.

Those affected by dependence and addictions are more likely to have physical and mental health concerns, and their finances, careers, education, and personal relationships can be severely disrupted.

Left unaddressed, the broader community impacts include reduced employment and productivity, increased health care costs, reliance on social welfare, increased criminal activity, and higher rates of incarceration.

About one in 10 people in Australian jails is there because of a drug-related crime.

Dr Gannon said the Government’s updated National Drug Strategy was disappointing because no additional funding had been allocated to it, meaning that measures requiring funding support were unlikely to occur in the short to medium term.

“The recently-released National Drug Strategy 2017-2026 again lists methamphetamine as the highest priority substance for Australia, despite the Strategy noting that only 1.4 per cent of Australians over the age of 14 had ever tried the drug,” he said.

“The Strategy also notes that alcohol is associated with 5,000 deaths and more than 150,000 hospitalisations each year, yet the Strategy puts it as a lower priority than ice.”

Dr Gannon called on the Government to focus on the dependencies and addictions that cause the greatest harm, including alcohol, regardless of whether some substances are more socially acceptable than others.

“General practitioners are a highly trusted source of advice, and they play an important role in the prevention, detection, and management of substance dependence and behavioural addictions,” he said.

“Unfortunately, limited access to suitable treatment can undermine GPs’ efforts in these areas.”

Behavioural addictions also include pathological gambling, compulsive buying, and being addicted to exercise or the internet.

Like substance dependence, they are recognised as chronic diseases of the brain’s reward, motivation, memory, and related circuitry.

Go to: position-statement/harmful-substance-use-dependence-and-behavioural-addiction-addiction-2017 to read the full Position Statement.

CHRIS JOHNSON