Robert (Bob) McInerney was a distinguished obstetrician, gynaecologist and sports doctor. He was born on 22 August 1918 in Haberfield, New South Wales, and educated at De La Salle College Ashfield, where he was dux in 1936. He won a scholarship to the University of Sydney to study medicine, and graduated in 1942, coming third in his year and receiving the Robert Craig Prize in Surgery.

During World War II, he served in New Guinea and Borneo as a medical officer with the 2/43 Infantry Battalion. On his return to Sydney, he worked at St Margaret’s Hospital as a medical superintendent and at St Vincent’s Hospital as assistant gynaecologist. He also spent time in England, where he worked at St Thomas’ Hospital in London and attained Fellowship of the Royal College of Surgeons.

In 1952, Bob commenced his Macquarie Street practice and married Betty Stormon. He also began his long association with the Western Suburbs Magpies Rugby League Football Club, where he was the club doctor until 1983.

He was a Fellow of the Royal College of Obstetricians and Gynaecologists, a member of the Executive Council of the International Federation of Gynaecology and Obstetrics, Chairman of the NSW State Committee of the Royal Australian College of Obstetricians and Gynaecologists, a member of the NSW Medical Board and a Master of the Medical Guild of St Luke.

In 1964, at St Vincent’s, he was the first Australian obstetrician to successfully perform an intrauterine blood transfusion.

His medical achievements were recognised in 1989, when he was made a Member of the Order of Australia.

In retirement, Bob lived an active life that included helping people addicted to alcohol and drugs in the Darlinghurst area, and he was a generous benefactor to a number of charities.

He developed ischaemic heart disease and congestive cardiac failure and died on 23 May 2014.

How much should past performance contribute to picking winners in grant competitions?

The weight that “track record” (TR) should contribute to the assessment of worth is a simple concept that is difficult to estimate. A synthesised value of TR is used to assess research grant applications. But what percentage of the overall variance does TR account for in determining success? In most human endeavours, assessors synthesise many variables to produce a single metric for TR that then becomes part of an overall scoring matrix. In assessing grant applications, the objective of this ranking is to minimise the risk that the grant given will not be productive.

In order to determine the true impact of TR, I used betting on horse races to determine the win–loss ratio when the shortest-odds favourite is backed (Pilowsky’s “P” for TR). Horse races were chosen to simulate grant panels, as horses, like grants, are “marked” to some extent on the basis of their TR. A nominal “bet” of $1000 was placed on each horse at an off-track totaliser betting facility between 16 December and 20 December 2013. A total of 125 bets were placed. Losses were 83 and wins 42 (34% of total). The simulation suggests that the pooled synthesis of available information by those with an interest in estimating the best outcome (a win) gives a value of between 23% and 46% on each day (n = 5 days; mean ± SD, 38% ± 9%). I note with interest that these values are similar to those used as TR metrics by grant agencies in the past. The National Health and Medical Research Council allocated 25% to TR for project grant assessments in 2013, suggesting that a higher percentage may be appropriate.

I propose that the same strategy can be applied in many situations where TR is likely to be an important factor. With this approach, TR obtained from as many sources (peers, other workers and colleagues) as possible ought to account for about 40% in the determination. If every horse in the race had an equal chance of winning (ie, TR is not important), then a value of 0% (no contribution to outcome) would be appropriate. As an aside, the longest-odds horse is very unlikely to win — no such examples occurred here. In summary, therefore, a “good, novel and exciting idea” may be important, albeit hard to quantify, but TR accounts for 40% of the likelihood that the personnel with the best performance in the past will achieve their goal. Certainly, there appears little justification for a value lower than 30%.

Out of interest, my fiscal outcomes per day varied as follows: Day 1, + $5800; Day 2, + $17 500; Day 3, + $2100; Day 4, − $16 700; Day 5, + $16 300; total, + $25 000. A total of $125 000 was gambled to achieve this result (20% per week or 1040% annualised). Note that the placing of $1000 bets may cause significant changes to the totaliser, which is affected by the total pool of bets placed when the race starts, and thus the final payout. On-track betting, where the odds obtained are fixed at the time the bet is laid, may yield different results. I suspect that a granting agency is closer in form to a totaliser, as the available pool of funds is fixed after the bets (grants) are placed (submitted).

The findings reported here are not intended to provide a path to wealth. For this, please consult your personal turf consultant. Quantifying TR is a different issue.

Professor Anthony McMichael will be remembered as much for his warmth, generosity of spirit and dedication to his family as for his work in the fields of environmental epidemiology, public health and climate change science.

Professor McMichael, who died on 26 September 2014 at the age of 71 from complications related to influenza and pneumonia, was regarded as a leader of the pioneering generation of epidemiologists who brought the field to prominence in the 1970s and 1980s.

In his most recent publication for the MJA, Professor McMichael led a dozen prominent Australian medical practitioners and researchers as signatories to an open letter to the Prime Minister, urging action and inclusion on climate change (https://www.mja.com.au/journal/2014/201/5/open-letter-hon-tony-abbott-mp).

“I visited Tony in Canberra Hospital a week [before his death]”, wrote Professor Stephen Leeder, Editor-in-Chief of the MJA (http://blogs.crikey.com.au/croakey/2014/09/27/paying-tribute-to-professor-tony-mcmichael-one-of-the-worlds-public-health-champions). “We chatted about letters received at the MJA following publication of his (and colleagues’) open letter … One letter suggested that we were scurrilous fascists and another Russian socialist lackeys. He found this entertaining.

“He was an active writer on environmental matters … the lines were clearly drawn for his outstanding career in environmental epidemiology and public health.”

Professor Bruce Armstrong, currently working at the International Agency for Research on Cancer, said Professor McMichael was “a lovely, generous man”.

“He had always been concerned with trying to have an influence and make a difference in the world”, Professor Armstrong said. “I had the chance this year to work with him on a think tank on climate change and health. It was a wonderful opportunity to spend time with him, to see his influence on the people around him, and to experience the warmth and care of Tony.”

Professor Bob Douglas, from the National Centre for Epidemiology and Population Health (NCEPH) at the Australian National University, in delivering the eulogy, praised Professor McMichael’s “nurturing of future leaders”.

Professor McMichael worked at the University of North Carolina, the CSIRO Division of Human Nutrition, the University of Adelaide as Foundation Chair in Occupational and Environmental Health, the London School of Hygiene and Tropical Medicine, and the NCEPH as Director.

He was President of the Public Health Association of Australia in its early days, was a member of the National Better Health Commission, took a leading role in the Intergovernmental Panel on Climate Change and, with Professor Graham Vimpani, led research on lead poisoning that ultimately resulted in moves to lead-free petrol.

His 1993 book Planetary overload was considered groundbreaking. “Tony drew together the threads of research across multiple disciplines, arguing that the human species now faced a new threat to its health and perhaps to its survival”, Professor Douglas said.

Professor Colin Butler, one of Professor McMichael’s closest colleagues over the past two decades, wrote: “If we are to survive as an advanced, wise and compassionate species, the work of people like Tony McMichael will increasingly be recognised as fundamental to the shift that we are engaged in” (http://globalchangemusings.blogspot.com.au/2014/09/aj-tony-mcmichael-champion-for.html).

His early mentor and supervisor Dr Basil Hetzel, first Chief of the CSIRO Division of Human Nutrition, wrote that throughout his distinguished career, “Tony was a very popular figure, readily available to colleagues, research students and the community”.

Professor McMichael is survived by his wife Judith and two daughters, Celia and Anna.

In the fall, she draws inward
her thoughts her voice

pulled in. The sound of her
own beating heart, a quiet shh

of sound, grows slowly silent. The art
of loss so perfected, that mind

and memory will ease once again into
hibernation, burying roots in

deeper channels —

Is it winter that forgets her, or does
the body forget itself? At the last

its knot-spined trunk will exhale
the frozen air. Immersed in solitude

its thousand pores, will knit rings into
themselves and feather away the last

clinging leaves. And their absence,
fluttering in the air, will pulse

painfully, like a living thing.

People keep telling me I look so skinny,
and although they say it as an observation, I take it
as a compliment, like a medal made of orchids
I can pin to my chest, like a creamy silk dress to drape
myself in, I take it like a Pulitzer Prize,
like I’ve done something worth doing, I dance
half-naked, alone in my room, sun rays beaming from
my armpits and the ridges of my ribs, my light
touching everyone I know, falling deeper
in love with the world the smaller I become in it,
though most days I’m not actually touching anyone,
because actually touching most people requires all the effort
it takes me to breathe for a day, and probably most people
won’t find me beautiful, really, not in that wholesome
curvy honey way, not like a stallion or arctic
wolf, but more like a spider people study in awe, like an accident
on the side of the road you have to
slow down and watch, to see if there are stretchers, white sheets or blood,
if body parts are hanging out of windows, if anyone’s standing
with their face in their hands, having a worse day than you,
and if I get any thinner, people will start to look at me
and feel sad, and I’ll take it
like a martyr, like a lover, I’ll let you stare at me, say yes,
I’m a wreck, yes, I know suffering, yes,
I am dying too.

You didn’t know what to do with the wisdom teeth
so you saved them for a while
for nothing, or what to think of the ganglion cyst —
smooth, benign — they removed
from the wrist just above the pulse. And then
there was the first biopsy
of the cervix, a plug the size of a pencil eraser
they said, and that mole
you’d had all your life they of a sudden called
suspicious, and the nuisance
the gall bladder became, and the thyroid gland.
But it is the tumour
in the gut that gets everyone’s attention
its slow, mute explosion
in the liver. This time, you are the anatomy
lesson, your surgery
a sharper degree of difficulty. Starched
bleached, their names newly
stitched on crisp lapels, the medical students
file in and listen;
they write things down. They observe the operation;
there is a quiz, a test;
you are the exam; what they can access of you
theatre — now — in the surround —;
you are the text, the close reading and radical
revision, the offensive
part lifted out and taken away in a pan
fetus-like — that kind
of measure, that kind of heft. Only they can tell you
when you return to them
what you can live without, what regenerates
and on hearing it
you feel a lightening, the way a snake must
on slipping through its discarded
mouth into another year, or, knowing nothing
of a year, into time itself.

This Enlightening, Alarming and depressing book deserves a wide readership among doctors but also among politicians, health administrators, and drug and medical device regulators. While there is no shortage of books that have sought to expose the misconduct of the pharmaceutical industry (one thinks of the books of Braithwaite, Kassirer, Angell, Moynihan and Goldacre), I finished this book with the feeling that things are getting worse and not better.

The author is a Danish physician with expertise in clinical trials and statistics, and previous experience working in the pharmaceutical industry. He understands the need to substantiate the allegations he makes and provides extensive publicly available documentation covering at least 30 pharmaceutical companies. The book is well written and well planned, with 22 chapters, each addressing discrete issues. This makes it easy to read and his arguments easy to follow.

His criticisms of the industry are wideranging. In the early chapters, the author identifies fraudulent conduct by several big companies, many involving settlements of billions of dollars, and convincingly compares this conduct with the modus operandi of crime syndicates. Subsequent chapters address themes such as the impotence of drug regulators, lack of efficacy of many new drugs, concealment of clinical trial data including serious adverse effects, conflicts of interest at medical journals, alleged corruptive influence of drug company money, marketing disguised as clinical trials, creation of “new” diseases, and his desire to bust industry myths. He also addresses industry exaggeration of the cost of developing new drugs, abuses of the rights of research participants, diminishing clinician input into trial design, conduct and reporting, and conflicted positions of clinicians who collaborate with industry and are paid in their roles as key opinion leaders.

The author seeks to identify root causes of these problems and blames in particular the dominance of the industry marketing arm in company management. He also highlights ineffectual regulation because many governments now expect regulators to survive on industry funding. Finally, the book proffers several thoughtful suggestions for change, only two of which (improved access to data from all clinical trials and disclosure of industry payments to doctors) are likely to become widespread in the near future. Overall, this book is a must-read for all doctors in clinical practice.