more_vertThe World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions.
Preference: Journalology and Publishing
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[Correspondence] Health equity in Israel
Although The Lancet is to be commended for publishing an important letter on the Gaza assault,1 the Health in Israel Series omits key aspects and viewpoints.
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
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
Paul McCartney and his welcome return to Australia … finally
BY CHRIS JOHNSON
By the time this edition of Australian Medicine arrives hot off the presses, Sir Paul McCartney’s One on One world tour would have not only found its way to Australia, it will be almost over.
Because of early end-of-year publishing deadlines, combined with the usual lead times between design, print and delivery, this hard copy edition of AusMed won’t be able to include a review of one of Macca’s Aussie concerts. Do keep an eye out online though, because there will be a review. Sir Paul back Down Under will be too good to miss.
It was 1993 when Sir Paul last performed in Australia, as part of his well-received New World Tour. That tour was his last anywhere for nine years. He had his wife Linda with him then – an integral part of the band and the obvious love of his life – who died five years later from breast cancer.
McCartney was coming back to Australia in 2002. The tour had been announced. But it was cancelled after the Bali bombings, with the feeble excuse that the last thing Australians needed then was a pop concert when they were grieving for the loss of their citizens in that terrorist attack.
His excuse for cancelling didn’t add up at all, given the fact Sir Paul not only performed a special benefit concert in New York the month following the Twin Towers attacks there on September 11, 2001 – he organised it, rounded up his celebrity mates to lend a hand, and he even wrote a special song for the occasion.
All is forgiven, Sir Paul. The wait has been far too long, but Australia is pleased you have returned.
And why wouldn’t we be?
There is no other way of putting it than this – Paul McCartney is an absolute legend, and rock n roll music would not be what it is today if he had not come along.
It is no myth that even as a young lad, Paul McCartney could produce sweet music from any instrument he was handed. That natural talent simply improved as he aged.
Yes, many musicians (better musicians even) have come along since the Beatles, since Wings, since Sir Paul – but all have been shaped in some form by the music he has penned and performed.
The brilliance of Lennon and McCartney cannot be overstated and neither can McCartney’s driving and creative force in that dynamic duo and in the Fab Four generally.
Going by the set lists of his tour so far, audiences will be treated to a superb mix of Beatles’ songs. Let it Be, Love Me Do, Lady Madonna, Yesterday, Hey Jude, Blackbird and much more of the Beatles’ catalogue have featured so far – as well as nods to his former bandmates with Something (written by George Harrison), Give Peace a Chance (a John Lennon classic), and I Wanna Be Your Man (a Lennon and McCartney tune that was sung by Ringo Starr).
Then there are the Wings and McCartney solo numbers that have been pulled out of the bag this tour – Jet, Live and Let Die, Maybe I’m Amazed, and Band on the Run to name just a few.
There are literally hundreds and hundreds (close to a thousand) songs McCartney has written, either by himself or in collaboration.
At least half of those are instantly recognisable by music lovers across the generations.
Getting to hear and see a few dozen of these momentous songs being performed live by the man who actually wrote and recorded them is a treat that defies description.
MBS Reviews – A long way to go, and a lot of improvement needed
BY DR ANDREW MULCAHY CHAIR, MEDICAL PRACTICE COMMITTEE
Members will recall that the AMA cautiously welcomed the MBS reviews in 2015, noting it was a far-reaching exercise with an ambitious two-year timeline.
The AMA’s support for the MBS reviews has always been contingent on the review being clinician-led and having direct and early involvement of the specialist colleges, associations and societies (CAS). The AMA has called for the review to be fully transparent from decision making through to implementation, and be underpinned by a scientific approach. There must also be scope to add new items to achieve the overall aim of ‘modernising’ the MBS.
In March, the AMA entered into a compact agreement with the Government for a shared vision for Australia’s health system. We committed to support in principle the ongoing operation of the MBS Review Taskforce, including a transparent, consultative clinician-led approach to high-value care and future-proofing the system. During that time the Government extended the review another three years to 2020.
Under the compact, the AMA is committed to work with the Department of Health to deliver on agreed recommendations arising from the MBS Review in conjunction with the relevant sectors. The AMA will continue to identify areas to improve the review process and recommendations.
The AMA’s approach to the MBS review has always been to defer recommendations relating to specialty items to the relevant CAS groups, and comment on the broader policy.
Now two years into the review, the AMA is continuing to press the Government to ensure that reviews remain more than just a cost-cutting exercise, or a mechanism to meddle with the scope of clinical decision making.
In this context, the AMA reviews concerning recommendations against a set of key principles to determine if a response to the Taskforce is necessary. This work is undertaken through stakeholder consultation with an AMA Working Group drawing from the broader membership, and the Medical Practice Committee. AMA also facilitates an annual CAS meeting for stakeholders to air concerns and receive information as the reviews progress.
Based on these feedback mechanisms, 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.
In our latest submission to the MBS Review Chair, the AMA highlighted a number clear deficiencies and significant variations in the process adopted by the MBS Review Taskforce and the Clinical Committees.
Noting the commitment made by the profession to sit on the Clinical Committees and Working Groups, the AMA has continued to stress that there must remain absolute transparency of the review process.
In particular: where a decision is being made in contradiction to the advice of the profession, there should be clear evidence and data to support such a decision.
We also called for early engagement of CAS on each of the Clinical Committees to ensure recommendations are practical and consistent. We have called for complete transparency, starting with how Clinical Committee members are selected and details of the Committees’ scope of work. Finally, the AMA has strongly recommended the Clinical Committees engage early with other Department areas including the Medicare Compliance and Professional Services Review to ensure that any changes to the schedule are practical for clinicians and do not result in sub-optimal care for patients. We all know a poorly worded MBS item can set up a practitioner to fail.
What we don’t want to see is a confusing MBS schedule, with medical practitioners as scapegoats.
With more than half the Clinical Committees yet to be established, there is still a long way to go. The next round of public consultations is expected to occur in February, 2018, commencing with the anaesthesia and oncology reports. The AMA continues to monitor with interest, and encourages the profession and the CAS to engage in the consultation and review process early. 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
In the meantime, the AMA has and will continue to hold up our end of the compact with a commitment to a stronger MBS review. Government must ensure the Review does the same through a significant improvement in the way they conduct it.
Secretary General to change next year
AMA Secretary General Anne Trimmer will next year leave the organisation she has led since 2013.
Ms Trimmer recently announced she has decided to pursue a different career direction when her five-year contract with the AMA expires in August 2018.
She informed the AMA Board of her decision before announcing it to staff in November.
AMA President Dr Michael Gannon Ms Trimmer had provided strong, stable leadership of the AMA Secretariat.
Under her direction, he said, the Secretariat had delivered a well-informed and strategic platform for the work of the AMA’s President, Vice President, Board, and Federal Council.
“Anne has maintained the AMA’s reputation as the peak medical advocacy group in the country and one of the most significant and successful lobby groups in Federal politics,” Dr Gannon said.
“The AMA has direct and personal access to the Government, the Parliament, and the bureaucracy from the Prime Minister down.
“Our leading and collaborative role in political and health circles is influential and agenda-setting.
“Anne has been at the helm through the controversial co-payment crisis, the subsequent Medicare freeze debate, the successful Scrap the Cap campaign against reforms to self-education expenses, the AMA’s survey of members to update our position on euthanasia, the AMA’s first ever Health of Asylum Seekers Summit, and the launch of our position on marriage equality.
“At the same time, she drove significant governance reforms for the Association, including establishing the AMA Board, implementing resource-sharing arrangements between the AMA and its subsidiary, the Australasian Medical Publishing Company (AMPCo), and building stronger relationships with the State and Territory AMAs, especially on membership issues.
“She is also the AMA’s representative on the Government’s Private Health Ministerial Advisory Committee (PHMAC).
“Anne has built strong personal and professional relationships with key decision makers in Canberra, which helped drive the AMA’s advocacy and influence in national politics.
“On behalf of the Board and the Federal Council, I thank Anne for her outstanding contribution to the AMA and the health sector, and wish her every success in her future endeavours.”
The AMA Board has commenced a process for a seamless transition to a new Secretary General in 2018.
CHRIS JOHNSON
Department updates guidelines for young children’s physical activity
New national guidelines on physical activity, sedentary time and sleep for young children have been launched by Health Minster Greg Hunt.
Australian 24-Hour Movement Guidelines for the Early Years (Birth to Five Years): An Integration of Physical Activity, Sedentary Time and Sleep differs from the previous guidelines in covering the entire day, including recommendations on how to help children get good quality sleep.
The Guidelines also provide ideas and examples of how to incorporate adequate movement in an infant, toddler or preschooler’s day – and how parents can fit these into their own busy days.
Mr Hunt said following the Guidelines was associated with better growth, stronger muscles and bones, better learning and thinking, better mental, emotional and social well-being, better motor skills, healthier weight, as well as reduced injuries.
The 24-Hour Movement Guidelines have been developed by experts across Australia with input from national and international stakeholders, and in partnership with Canada, which developed the world’s first 24-hour movement guidelines.
University of Wollongong (UOW) early childhood expert Professor Tony Okely, who led the project to update the guidelines for the Health Department said the decision to include sleep recognised its importance in optimising health, development and learning.
“Sleep plays an essential role in a child’s growth and development and shares an interrelated relationship with physical activity,” he said.
“If a child receives good quality sleep, they will have the energy to be active, and an active child is a well-rested child.
“These Guidelines also acknowledge that the whole day matters and individual movement behaviours, such as physical activity, sedentary behaviour and sleep need to be considered in relation to each other when examining their associations with health and developmental outcomes in children.”
Limited access to sedentary screen time is also an important part of the 24-Hour Movement Guidelines. The recommendation of no sedentary screen time for children under two, and no more than one hour for those older than two.
“Screen time while sitting can counteract the health benefits of physical activity, leading to language delays, reduced attention, lower levels of school readiness and poorer decision-making,” Professor Okely said.
“The revised Guidelines incorporate the effects of screen time on a child’s growth and development and provide recommendations to parents or carers in how to mitigate these effects through an emphasis on increasing movement, and limiting sedentary behaviour and use of screens.
“A child can do sufficient physical activity to meet the guidelines, yet still be considered sedentary if they spend a large amount of their day sitting, lying down or restrained, especially in front of a screen.
“When a child is sedentary, try to incorporate quality behaviours such as reading, storytelling, playing with playdough and puzzles into their routine to enhance their cognitive development.”
The Guidelines also recommend that all screen use at these ages be educational.
Professor Okely says that meant co-viewing with a child, discussing content, and using it in ways that help a child make understandings of the world around them, such as to investigate, problem solve, create knowledge.
Other notable changes from the previous Guidelines include a recommendation for 60 minutes of moderate to vigorous physical activity included as part of the 180 minutes of total physical activity per day recommended for preschoolers.
30 minutes of tummy time for infants (spread over the day) is also a part of the new recommendations.
More information on the Guidelines can be found on the Department of Health’s website: http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines.
MEREDITH HORNE
Medical Indemnity
BY ASSOCIATE PROFESSOR JULIAN RAIT
As previously covered in this publication, the profession’s concerns about medical indemnity insurance have re-ignited since the Government announced reviews of all Commonwealth funded medical indemnity schemes and the underpinning legislation.
At the height of the indemnity crisis in the 2000s, many practitioners faced uncertainty about the future of their practice, with some thinking about leaving the profession all together.
Everyone was vulnerable.
The AMA played a pivotal role in stabilising the industry by bringing the profession together, and working with Government, to design schemes that were more equitable and affordable for practitioners.
However, these protections put in place by then Health Minister Tony Abbott looked to be under attack of late – indeed a saving has already been garnered through the MYEFO in December, along with the announcement of the review.
Since December, we’ve had a new Minister and thankfully, as it appears, a new approach. Following extensive lobbying by the AMA, the Terms of Reference (ToR) for the reviews into the Medical Indemnity Schemes appear to be far more informed.
The review has just commenced and the ToR appear to be more focussed on stability, understanding the importance of affordable indemnity insurance and affordable health care, and considering the international experience.
From an AMA perspective the schemes have been a resounding public policy success. They should remain and be strenuously defended.
We’re also aware that Medical Defence Organisations (MDOs) have been discussing what they wish to achieve through the review – including insuring that the outcome continues to promote stability in the industry, and maintains affordable premiums.
It is also expected that the role of insurers in providing universal cover – that is the requirement to be an ‘insurer of last resort’ in a particular jurisdiction, will come under review.
From an AMA perspective, there is a strong belief in the importance of universal cover, and that all indemnity insurers should be required to provide it, and that the arrangements should be fair and equitable. The last thing we want to see is a situation where an insurer, rather than a regulator, decides who can effectively practise in the medical profession.
From an insurance perspective, there is a desire to be able to charge a premium that reflects the level of risk in providing coverage, and to have a mechanism to encourage a practitioner to engage with the MDO and improve their practice.
One of the issues related to the indemnity review is any legislation changes that may be considered as part of ongoing AHPRA and MBA work. This potentially includes requiring indemnity insurers to disclose civil claims to AHPRA.
As all members know, the AMA does not support poorly performing practitioners. However, in absence of any level of detail about how these proposals will work we remain highly wary. Furthermore, a civil claims settlement, and poor medical practice, are not necessarily one and the same thing.
However, it is clear that there is an appetite in some jurisdictions for looking at mechanisms to reveal potentially poorly performing doctors – this builds on previous attempts via the revalidation agenda.
It is therefore critical that the AMA continue to advocate on behalf of our members on the importance of indemnity insurance; the critical requirement for the insurer and the regulator to be separate; and to address any ill thought out or underdeveloped approaches that unfairly target practitioners.
To that end, the AMA will closely watch the forthcoming proposed legislative changes, and the revalidation work underway by AHPRA.
In the meantime, Federal Council has reaffirmed our support for universal cover arrangements, and work has begun on our submission to the indemnity reviews.
But in the immediate term, this review needs to hear from the whole profession. The AMA has written to the Colleges, Associations and Societies, and in this publication, encouraging contributions to the Government’s indemnity review.
Providing affordable insurance flows directly through to affordable care, which is an issue the profession is focussed on right now. We need to ensure our voices are heard. For those who wish to make a submission, please see:
AMA Members are also welcome to directly contact me via my email address as follows:
[Correspondence] PubMed should raise the bar for journal inclusion
A survey by Manca and colleagues1,2 found that predatory journals active in neuroscience and neurology outnumber those regularly indexed in the main biomedical databases. Furthermore, this analysis of predatory publishing (as of October, 2016) showed that over 10% of predatory journals in three important subdisciplines are indexed in PubMed (12% for rehabilitation, 11·4% for neurosciences, and 20·2% for neurology).1,2