Tobacco control in the spotlight at AMA national Conference

AMA President Dr Michael Gannon announced the AMA/ACOSH National Tobacco Control Scoreboard 2017 at the AMA National Conference.

Queensland topped the AMA/ACOSH National Tobacco Control Scoreboard 2017 as the Government making the most progress on combating smoking over the past 12 months.

Queensland narrowly pipped New South Wales for the Achievement Award, with serial offender the Northern Territory winning the Dirty Ashtray Award for putting in the least effort.

Judges from the Australian Council on Smoking and Health (ACOSH) allocate points to each State and Territory in various categories, including legislation, to track how effective government has been at combating smoking in the previous 12 months.

Dr Gannon described the results however as disappointing because no jurisdiction scored an A this year, suggesting that complacency has set in. He also said that it is disappointing that so little progress has been made in the Northern Territory over the past year.

“Research shows that smoking is likely to cause the death of two-thirds of current Australian smokers. This means that 1.8 million Australians now alive will die because they smoked,” Dr Gannon said.

“It is imperative that governments avoid complacency, keep up with tobacco industry tactics, and continue to implement strong, evidence-based tobacco control measures.”

The judges praised the Queensland Government for introducing smoke-free legislation in public areas, including public transport waiting areas, major sports and events facilities, and outdoor pedestrian malls, and for divesting from tobacco companies.

However, they called on all governments to run major media campaigns to tackle smoking, and to take further action to protect public health policy from tobacco industry interference.

The Northern Territory, a serial offender in failing to improve tobacco control, has been announced as the recipient of the AMA/ACOSH Dirty Ashtray Award for putting in the least effort to reduce smoking over the past 12 months.

It is the second year in a row that the Northern Territory Government has earned the dubious title, and its 11^th “win” since the Award was first given in 1994. More than 22 per cent of Northern Territorians smoke daily, according to the latest National Drug Strategy Household Survey, well above the national average of 13.3 per cent.

“It seems that the Northern Territory Government still does not see reducing the death toll from smoking as a priority. Smoking is still permitted in pubs, clubs, dining areas, and – unbelievably – in schools,” Dr Gannon said.

The Northern Territory Government has not allocated funding for effective public education, and is still investing superannuation funds in tobacco companies.

A full list of the State and Territory results can be found on the AMA website: media/amaacosh-national-tobacco-control-scoreboard-2017-topped-qld

Meredith Horne

PICTURE: Dr Robert Parker, President AMA, NT collects the Dirty Ashtray Award from Dr Michael Gannon.

[Correspondence] New ACMD regulations threaten UK’s pharmaceutical discovery

In December, 2016, the UK Government, on the advice of the Advisory Council on the Misuse of Drugs (ACMD), made two problematic changes to the UK drug control regulations of the Misuse of Drugs Act 1971. First, they put into effect new very wide-ranging bans against a whole range of synthetic cannabinoids. Second, they rejected an appeal by senior UK scientists to remove tetrahydrocannabivarin (THCV) from Schedule 1—the highest level of control—of the Act. THCV is a chemical found in the cannabis plant that UK scientists have identified as a potential therapeutic: keeping it in Schedule 1 severely impedes their research of THCV in the UK.

Air pollution linked with heart damage

A new report presented by the European Society of Cardiology says that there is strong evidence that particulate matter (PM) emitted mainly from diesel road vehicles is associated with increased risk of heart attack, heart failure, and death.

The lead author Dr Nay Aung, a cardiologist and Wellcome Trust research fellow at the William Harvey Research Institute, Queen Mary University of London, UK, said the cause for the heart damage “appears to be driven by an inflammatory response – inhalation of fine particulate matter (PM2.5) causes localised inflammation of the lungs followed by a more systemic inflammation affecting the whole body.”

Regarding how pollution might have these negative effects on the heart, Dr Aung said PM2.5 causes systemic inflammation, vasoconstriction and raised blood pressure. The combination of these factors can increase the pressure in the heart, which enlarges to cope with the overload. The heart chamber enlargement reduces the contractile efficiency leading to reduction in ejection fraction.

The researchers said they found evidence of harmful effects even when levels of pollution associated with diesel vehicles were less than half the safety limit set by the European Union.

Dr Aung said: “We found that the average exposure to PM2.5 in the UK is about 10 µg/m3 in our study. This is way below the European target of less than 25 µg/m3 and yet we are still seeing these harmful effects. This suggests that the current target level is not safe and should be lowered.”

In the UK, where the study was conducted, the Government recently produced its third attempt at a plan to bring air pollution to within levels considered safe under European Union legislation after judges ruled the previous versions were not effective enough to comply with the law.

Dr Penny Woods, chief executive of the British Lung Foundation, said: “Air pollution (in the UK) is a public health crisis hitting our most vulnerable the hardest – our children, people with a lung condition and the elderly.”

Dr Woods added that, while progress was being made in high-income countries to reduce deaths from cardiovascular disease and cancer, those caused by lung disease had “remained tragically constant”.

The World Health Organisation (WHO) estimates that some 3 million deaths a year are linked to exposure to outdoor air pollution. WHO also believes that indoor air pollution can be just as deadly. In 2012, an estimated 6.5 million deaths (11.6 per cent of all global deaths) were associated with indoor and outdoor air pollution together.

Only one in ten people breathe safe air according to WHO guidelines and over 80 per cent of the world’s cities have air pollution levels over what these guidelines deem safe.

The Australian Medical Association has developed a Position Statement on Climate Change and Human Health that acknowledges air pollution is the world’s single largest environmental health risk.

Meredith Horne

Germany set to introduce fines of up to €2,500 for failing to vaccinate

A new German law will be introduced obliging kindergartens to inform the authorities if parents fail to provide evidence that they have received advice from their doctor on vaccinating their children.

Parents refusing the advice risk fines of up to 2,500 euros under the law expected to come into force in June this year.

Health Minister Hermann Gröhe said it was necessary to tighten the law because of a measles epidemic.

Germany has reported 410 measles cases so far this year, more than in the whole of 2016. A 37-year-old woman died of the disease this May, in the western city of Essen.

The German government wants kindergartens to report any parents who cannot prove they have had a medical consultation.

However, Germany is not yet making it an offence to refuse vaccinations. The children of parents who fail to seek vaccination advice could be expelled from their daycare centre.

Vaccination rules are being tightened across Europe, where a decline in immunisation, has caused a spike in diseases such as measles, chicken pox and mumps, according to the European Centre for Disease Prevention and Control (ECDC).

Italy made vaccination compulsory in May this year, after health officials warned that a fall-off in vaccination rates had triggered a measles epidemic, with more than 2,000 cases there this year, almost ten times the number in 2015.

In 10 European countries, cases of measles, which can cause blindness and encephalitis, had doubled in number in the first two months of 2017 compared to the previous year, the ECDC said last month.

Measles is a highly infectious vaccine-preventable disease, and globally still one of the leading causes of childhood mortality.

The World Health Organisation reports that the European Region includes highly effective and safe measles and rubella vaccines in their vaccination programs; however, due to persistent gaps in immunisation coverage outbreaks of measles and rubella continue to occur.

The Australian Medical Association endorses the overwhelming scientific evidence that vaccination saves lives. Important immunisation information is available in the Australian Academy of Science publication, The Science of Immunisation: Questions and Answers, which is available at www.science.org.au/immunisation.html .

Meredith Horne

Service acknowledged at the highest levels

Prime Minister Malcolm Turnbull put it in a nutshell when he told doctors they were dedicated to service.

Addressing the AMA’s National Conference in Melbourne on May 27, Mr Turnbull captured the theme of the three-day event when he put down his speaking notes to express appreciation for the medical profession.

“You’ve committed yourselves to a life of service – undiluted. A commitment. A compassion. We thank you for it,” he said.

“Our health system is the envy of the world. Our skilled doctors, our nurses, all your allied professionals, work tirelessly to give the best possible care and your Government thanks you for that.

“Thank you for your dedication, thank you for your professionalism, thank you for your compassion.

“We will match you with a commitment to ensure that you have the resources at every level to continue to deliver the practical love that keeps Australians well.”

The Prime Minister was the star attraction at the conference, which was bursting with high-profile and influential speakers who gathered to further the debate on the nation’s healthcare policies.

Opposition Leader Bill Shorten addressed the conference and also thanked the medical profession for its commitment.

But he added his observation the Government was trying to silence doctors with its staggered thawing of the Medicare rebate freeze.

“If you like, it’s the minimum they can get away with paying to keep people silent,” Mr Shorten said.

“It’s like cash for no comment.

“I believe the Government has got a calculus here. What is the minimum they can pay to make healthcare issues go away as an election point?”

The AMA has praised the Budget decision to lift the freeze, while also noting the announcement wasn’t everything doctors had hoped for.

AMA President Dr Michael Gannon added that the Government – or any political party – should not be fooled into believing the AMA will be quiet about advocating for issues it believes in.

Health Minister Greg Hunt repeated his praise for doctors while again outlining his plan for the national health system.

Shadow Health Minister Catherine King expressed Labor’s commitment to public hospital funding and to an immediate blanket lifting of the Medicare rebate freeze.

Greens Leader Richard Di Natale, a doctor himself, poured praise on the profession – noting the strong and positive stance the AMA has taken on marriage equality, while also delivering a caution over messaging around climate change policy.

Minister for Indigenous Health and Aged Care Ken Wyatt joined in on two policy sessions; Olympic and Commonwealth Games athlete Jane Flemming illuminated a panel on tackling obesity; news and media personalities Paul Bongiorno and Julie McCrossin moderated separate policy sessions; and actors presented an excerpt of a new play Women Doctors in War.

Beyond the valuable contributions the high-profile personalities made to the National Conference, the event was also well-served by a string of other guest speakers and panellists, as well as by the AMA leadership.

The conference addressed in detail many of the serious issues confronting the medical profession, including doctors’ health and wellbeing; disease and threats beyond borders; organ donation; obesity; health care in violent situations; and tobacco control.

Chris Johnson

AMA a key player in federal politics

AMA President Dr Michael Gannon opened the 2017 National Conference letting delegates know that while the past 12 months had been eventful, much had been achieved in the realm of health policy.

He continued with that theme throughout the three-day event in Melbourne, which brought together not only the elite of the medical profession but also the highest level of Australian political leaders.

“The AMA is a key player in federal politics in Canberra. The range of issues we deal with every day is extensive,” Dr Gannon said.

“Our engagement with the Government, the bureaucracy, and with other health groups is constant and at the highest levels.

“Our policy work is across the health spectrum, and is highly regarded.

“The AMA’s political influence is significant.”

Describing the political environment over the past year as volatile – which included a federal election and two Health Ministers to deal with – Dr Gannon said the AMA had spent the year negotiating openly and positively with all sides of politics.

“Our standing is evidenced by the attendance at this conference of Prime Minister Malcolm Turnbull, Opposition Leader Bill Shorten, Greens Leader Senator Richard Di Natale, Health Minister Greg Hunt, Minister for Aged Care and Minister for Indigenous Health Ken Wyatt AM, and Shadow Health Minister Catherine King,” he said.

“Health policy has been a priority for all of them, as it has been for the AMA.”

While the Medicare rebate freeze was the issue to have dominated medical politics, there are still more policy areas to deal with in the coming year.

The freeze was bad policy that hurt doctors and patients.

“I was pleased just weeks ago on Budget night to welcome the Government’s decision to end the freeze,” Dr Gannon told the conference.

“The freeze will be wound back over three years. We would have preferred an immediate across the board lifting of the freeze, but at least now practices can plan ahead with confidence.

“Lifting the freeze has effectively allowed the Government to rid itself of the legacy of the disastrous 2014 Health Budget.

“We can now move on with our other priorities… We will maintain our role of speaking out on any matter that needs to be addressed in health.”

Dr Gannon said while the Medicare freeze hit general practice hard, it was not the only factor making things tough for hardworking GPs.

General practice is under constant pressure, he said, yet it continues to deliver great outcomes for patients.

GPs are delivering high quality care and are the most cost effective part of the health system.

“One of the most divisive issues that the AMA has had to resolve in the past 12 months is the Government’s ill-considered election deal with Pathology Australia to try and cap rents paid for co-located pathology collection centres,” Dr Gannon said.

“We all know that our pathologist members play a critical role in helping us to make the right decisions about our patients’ care. They are essential to what we do every day.

“It was disappointing to see the Government’s deal pit pathologists against GPs.

“The recent Budget saw the rents deal dumped in favour of a more robust compliance framework, based on existing laws. This is a more balanced approach.”

Other issues the President highlighted as areas the AMA is having significant influence included: Health Care Home Trial; the Practice Incentive Program; My Health Record; Indigenous Health; After-Hours GP Services; the MBS Review; public hospitals; private insurance; and the medical workforce.

Chris Johnson

AMA lends support to build the Indigenous health workforce

As a 13-year-old, James Chapman watched his father, a proud Indigenous man from Yuwlaaraay country, die after a short, seven-week battle with acute myeloid leukaemia. As a school leaver, he became his mother’s carer for 12 months as she recovered from brain surgery.

Today, the 25-year-old, second-year medical student has won the 2017 AMA Indigenous Medical Scholarship – $10,000 a year for each year of study – to help him pursue his dream of becoming a medical professional.

AMA President Dr Michael Gannon, who presented the Scholarship at the AMA National Conference in Melbourne said that Mr Chapman’s story was inspiring.

Dr Gannon believes the award is important because Indigenous people have improved health outcomes when they are treated by Indigenous doctors and health professionals. This is highlighted by the need to build the building the Indigenous health workforce where in 2017, there are just 281 medical practitioners employed in Australia as Aboriginal or Torres Strait Islander – representing 0.3 per cent of the workforce.

Mr Chapman said that while he did not realise it at the time, his father was a victim of the gap that exists between Indigenous and non-Indigenous Australians when he saw firsthand communities with access only to a visiting doctor and nurse.

He dreamed of one day becoming a doctor, but was discouraged by his teachers. As a young student at the University of Wollongong his study was derailed when his mother was diagnosed with a brain tumour, and he became her carer for a year while she recovered.

“Constantly in clinical environments, my dream of becoming a medical professional became more intense, and after my mother recovered, I began a Science degree with the intention of completing post graduate medicine,” Mr Chapman said.

Now in his second year, Mr Chapman intends to study from Wagga Wagga from his third year onwards to experience rural health, and rural and remote Indigenous health care. He hopes to become a GP, working with Indigenous women and children in rural and remote Australia.

Dr Gannon said that, in 2017, a total of 286 Aboriginal and Torres Strait Islander medical students are enrolled across all year levels across Australia. However, four of the 15 colleges are yet to have an Indigenous trainee.

“The AMA Scholarship has assisted many Indigenous men and women, who may not have otherwise had the financial resources to study medicine, to graduate to work in Indigenous and mainstream health services,” Dr Gannon said.

The AMA Indigenous Medical Scholarship was established in 1994 with a contribution from the Commonwealth Government. The AMA is looking for further sponsorships to continue this important contribution to Indigenous health.

Donations are tax-deductible. For more information, go to advocacy/indigenous-peoples-medical-scholarship

Meredith Horne

2017 AMA media and advocacy awards

At the 2017 AMA National Conference, six media and advocacy awards were presented.

A new award category was opened for this year’s entries – the Best Public Health Initiative. State and Territory AMAs were invited to nominate an outstanding public health initiative or campaign – other than smoking and tobacco control – launched by their State or Territory Government in calendar year 2016.

Nominated by AMA NSW, The NSW Government, won this award for its campaign to combat childhood obesity. The NSW Health campaign is a comprehensive whole-of-government plan with the specific target of reducing overweight and obesity rates of children by 5 per cent over 10 years.

The judging panel, headed by Public Health Association of Australia CEO Michael Moore, noted that the campaign stood out for its clear strategic directions, and its strong focus on children and young people.

The Best Lobby Campaign 2017 was awarded to AMA Western Australia for their ‘Three-year Employment Contracts for Interns’ campaign.

The successful introduction of the three-year employment contracts for interns is a standout achievement. The reform eliminates the previous system of annual contracts, thereby eliminating both the cost and the stress of interns having to reapply for their jobs on an annual basis.

The judges commented that AMA WA’s policy success should contribute to improved health outcomes across the WA system, with the hope that this initiative may spread nationally over time. In addition, the successful recombination of the Minister of Health and Mental Health is also a noteworthy success for the WA branch.

Best Public Health Campaign from a State or Territory 2017 was awarded to AMA Western Australia for highlighting ‘Australia’s Mental Health Crisis’.

AMA WA has developed a state-of-the-art best practice mental health program that is being recognised Australia-wide as the best of its kind using a dual approach to reach youth at school and adults in the workplace – two groups under severe mental health pressure.

Judges commended the branch on the clarity and quality of the campaign. They said the effectiveness in engaging and delivering its important message pointed to a significant public health intervention that deserved to be recognised.

AMA Victoria received Best State Publication 2017 for ‘Vicdoc’, whichcovers the ethical, political, clinical, and work based issues facing the medical profession in great detail.

Judges commented that the publication was valuable and informative and a must-read for any Victorian doctor. The front covers were simple and with compelling use of images. The standard of writing in this publication was extremely high and very informative.

AMA Victoria was also awarded with the National Advocacy Award 2017 for their cooperation between federal AMA during the introduction of the Victorian Government’s ‘Assisted Dying’ legislation.

AMA Victoria’s actions and commentary on assisted dying have always referenced and reflected AMA Federal’s policy position.

AMA Victoria called for improved funding for palliative care services, and legislative changes to the Doctrine of Double Effect through the enactment of legislation to provide legal certainty to medical practitioners in connection with the accepted clinical practices of double effect and non-provision of futile care.

Judges commended AMA Victoria on its clear and concise submission to the inquiry into a very sensitive and often divisive issue.

Most Innovative Use of Website or New Media 2017 was awarded to AMA Western Australia for their creation of WAhealthfirst.com.au.

This website utilised a new media approach that generates conversation from content advocating AMA WA’s position on key political issues, most relevant to the recent State election earlier this year. An expected outcome of new media is to use technology available to provide clear and easy communication to the user. Judges commended AMA WA in the success of WAhealthfirst.com.au and said it was clear it simplified the voter education process of health policy while also providing the facts.

Meredith Horne

AMA President’s Award presented to a long-serving and dedicated GP

Professor Bernard Pearn-Rowe, who has been a constant advocate for general practice for almost three decades, has been recognised with one of the AMA’s highest awards, the President’s Award.

Professor Bernard Pearn-Rowe has juggled maintaining his solo GP practice in Perth with his active roles in AMA WA medical politics, including a term as AMA WA President, and his appointment as Foundation Professor of Clinical Studies at the University of Notre Dame.

Dr Gannon presented Professor Pearn-Rowe with his Award at the AMA National Conference 2017 Gala Dinner in Melbourne.

“During his time as Convenor of the federal AMA Council of General Practice (CGP), he has contributed to key policy areas including the role of general practice in primary care, e-health, medical education and training, GP workforce, red tape reduction, Health Care Homes, and the role of GPs in disaster situations,” Dr Gannon said.

“Professor Pearn-Rowe has been part of an AMA CGP that has emphasised the importance of quality general practice and the need for Governments to support this as part of a high quality, sustainable health care system.”

Amid his many commitments, Professor Pearn-Rowe has also found the time to pen a weekly medical column in The West Australian newspaper, making him an outstanding face of the AMA in WA.

Professor Pearn-Rowe was chair of the Royal Australian College of General Practice (RACGP) in Western Australia from 1989 to 1993, Chair of the AMA WA Council of General Practice (CGP) from 1998 to 2001, and Convenor of the Federal AMA CGP since 2004. He was appointed a Fellow of the federal AMA in 2004.

Professor Pearn-Rowe graduated in Medicine from the University of London in 1972 and joined the AMA in 1976. He has been active in AMA WA medical politics since that time, including a period as President of the AMA in Western Australia from 2002-2004. He was appointed a Fellow of the AMA in 2004.

He was appointed Foundation Professor of Clinical Studies at the University of Notre Dame in 2004 and was Foundation Professor and Head of Discipline of General Practice in the School of Medicine at the University of Notre Dame from 2006-2010. Since that time he has continued as an Adjunct Professor.

Meredith Horne

Doctors caring for doctors

BY AMA PRESIDENT DR MICHAEL GANNON

The health of doctors, especially our mental health, has been very topical in recent weeks.

It was a major focus at the AMA National Conference in late May, and it went viral on social media through the Crazy Socks for Docs awareness campaign, which was pioneered by Melbourne cardiologist, Dr Geoffrey Toogood.

Following National Conference, Minister Hunt announced a $47 million suicide prevention initiative, with $1 million set aside specifically to support mental health and reduce suicide in the health workforce. This was most welcome.

I have since written to the Minister about programs for mental health suicide prevention in the medical workforce.

I stressed to the Minister the importance of having the mandatory reporting requirements under the National Law amended, so as to not dissuade medical practitioners from seeking necessary medical treatment or assistance.

It is well known that doctors are at greater risk of suicidal ideation and death by suicide.

So far this year, we have lost several colleagues to suicide–and these are not isolated incidents.

While there is a wide range of factors involved in suicide, we know that early intervention could be critical to avoiding many of these tragic losses.

Unfortunately, the reality is that there are significant barriers, real and perceived, that prevent some doctors from seeking access to formal health care.

The AMA is working to change this situation, and is currently working with the Medical Board of Australia to establish accessible and robust doctors’ health services across the country.

One of the key barriers that the AMA has identified to accessing care is mandatory reporting.

Mandatory reporting for doctors was introduced in NSW in 2008, and then into the National Law for all practitioners in 2010.

The intention of the legislation was to ensure the protection of the public by requiring doctors and other health practitioners to report colleagues under defined circumstances.

The legislation intentionally created a very significant bar for reporting by stating that only matters of grave significance should be reported to the regulator.

One of the requirements for mandatory reporting is to report on health and impairment. This obligation applies to both colleagues and treating doctors.

The AMA, medical colleges, and the medical defence organisations have been concerned for some time that this provision creates a barrier to health professionals in accessing health care, particularly in relation to mental illness.

The lived experience of doctors’ health advisory services across the country confirms these fears.

An extensive study of over 12,000 doctors undertaken by beyondblue in 2013 revealed that one of the most common barriers to seeking treatment for a mental health condition were concerns about the impact of this on medical registration.

The Western Australian Government recognised this concern and after dogged, persistent, and forceful representation from AMA WA over many months, created a provision in their legislation to exempt treating practitioners from the requirements of the Act in WA.

While it has been difficult to collect clear evidence of the impact of the mandatory reporting provisions on doctors seeking treatment, the AMA, doctors’ health services, medical colleges, and the medical defence organisations receive feedback from doctors regarding their fears about seeking medical treatment.

We know anecdotally of cases of doctors travelling to WA for treatment.

Of great concern, it is very clear that some doctors are actively avoiding medical care, where possible, out of fear of the mandatory reporting obligations.

The Western Australian exemption has not made a material difference to the rate of mandatory notifications in that jurisdiction.

The Independent Review of the National Registration and Accreditation Scheme for health professions commissioned by the COAG Health Council in 2014 listened to the concerns of the medical profession and other groups, recommending that the National Law to be amended to reflect the same mandatory notification exemptions for treating practitioners established in the Western Australian law.

As health practitioners, we know the dangers of delaying access to medical treatment or of only providing limited information.

This risk is particularly pronounced with mental illness, where delaying treatment can result in a person ending up with a far greater level of impairment.

As such, we believe the current legislative arrangements are not protecting health practitioners and, equally importantly, they are failing to protect the public.

In my letter to him, I told Minister Hunt it is time for Health Ministers in the seven jurisdictions (excepting WA) to act on the recommendation of the 2014 review report. I am hoping for his support on this most important matter.