Farcical play has serious side

If there was one fictional short story from the 19^th century that helped open discussion about mental health it would have to be the absurd yet powerfully clever Diary of a Madman by Russian author Nikolai Gogol.

Written in 1835, the story of a low-level public servant’s descent into insanity was ahead of its time and has proved to be an important sociological tool that helped psychologists more accurately diagnose schizophrenia in a time when such diseases were not widely studied.

Because it is one of the first accounts, albeit fictional, of schizophrenia, it emerged as an important reference tool for researchers and even today plays a vital role in the study of the history of the treatment of mental illness.

The story itself, however, is brilliant and engaging on every level.

Gogol’s masterpiece easily translates into a dark comedy perfectly designed for the stage.

And the good folk at Canberra’s intimate Street Theatre have done just that with it.

A short season of Diary of a Madman opens at the Street on June 2, playing through to June 16.

Award-winning actor PJ Williams portrays the protagonist Poprishchin, who slaves away in relative anonymity while yearning for his existence to be acknowledged – by his colleagues, his superiors and by a beautiful woman.

Written, and therefore acted, as diary entries, this narration of the life of the story’s hero (anti-hero) is filled with laughter, tragedy, rage and rapture. Originally set in St Petersburg at the time of the Tsar, it depicts alienation in society extremely well.

While Gogol’s story has long been recognised as a powerful dissection of mental disintegration, it was also hugely influential on a generation of writers who followed.

And if the Street Theatre is true to form, their production will be nothing short of outstanding.

Bookings and more information on (02) 6247 1223 or through www.thestreet.org.au

CHRIS JOHNSON

Photo by Shelly Higgs

Health Budget safe and steady

The AMA has labelled the 2018-19 Health Budget as “safe and steady”, but adds that it is notable as much for what is not to be found in it as it is for what is included.

Treasurer Scott Morrison has delivered a Federal Budget with an eye on the next federal election, promising tax relief for middle Australia, significant infrastructure investment and more funding for aged care.

On the health front, the establishment of a new 21^st century medical industry plan to create more jobs and support more medical research projects is a major commitment.

This Budget includes an extra $1.4 billion for listings on the PBS, including medicines to treat spinal muscular atrophy, breast cancer, refractory multiple myeloma, and relapsing-remitting multiple sclerosis, as well as a new medicine to prevent HIV.

The Government will also provide $154 million to promote active and healthy living, including $83 million to improve existing community sport facilities, and to expand support for the Sporting Schools and Local Sporting Champions programs.

It has dismissed a proposal for a single and separate Murray Darling Medical School, in favour of a network, in what Dr Gannon has described as a better approach

Mr Morrison said the plan was to get more doctors to where they are needed through a new workforce incentive program.

“This plan includes the establishment of a new network of five regional medical schools within the broader Murray Darling Region,” Mr Morrison said when delivering his Budget Address to Parliament on Tuesday.

Dr Gannon said many of the rural health initiatives outlined Budget are a direct response to AMA rural health policies and the AMA Budget Submission.

“We welcome the Government’s strong focus in this Budget on improving access to doctors in underserviced communities, particularly rural Australia,” Dr Gannon said.

“The evidence shows that selecting medical students with a rural background and providing high quality training in rural areas are the most effective policy measures to address workforce maldistribution.

“The decision to reject the proposal for a stand-alone Murray Darling Medical School, in favour of a network, is a better approach with the Government instead pursuing a policy that builds on existing infrastructure to create end-to-end medical school programs.

“However, while the Government has made a welcome commitment not to increase Commonwealth-supported medical school places, it has taken the unnecessary step of compensating medical schools with additional overseas full-fee paying places.

“This will not address community need, and instead simply waste precious resources.”

Dr Gannon said overall, the Government had delivered a safe and steady Health Budget, which outlines a broad range of initiatives across the health portfolio.

Necessary funding to aged care, mental health, rural health, the PBS, and medical research, were all welcome commitments.

“But some of the bigger reforms and the biggest challenges are yet to come,” he said.

“Due to a number of ongoing major reviews, this Budget is notable as much for what is not in it as for what is in it.

“The major reviews of the Medicare Benefits Schedule (MBS) and private health are not yet finalised, and the ensuing policies will be significant.

“We are pleased that indexation has been restored to general practice and other specialty consultations, but new and considerable investment in general practice is missing.

“Also, the signature primary care reform – Health Care Homes – did not rate a mention.”

Dr Gannon said the AMA supports the establishment of the Workforce Incentive Program, which will incorporate and expand on the existing Practice Nurse Incentive Program and the GP Rural Incentive Program.

“This new funding program will increase the support available for general practices to employ other health professionals, including non-dispensing pharmacists, as part of a GP-led team-based approach to care,” he said

“Good health policy is an investment, not a cost,” Dr Gannon said.

“We look forward to the finalisation of the private health and MBS reviews, and the reforms that will flow from those processes.

“We anticipate more significant health policy funding announcements ahead of the next election.”

CHRIS JOHNSON

[Correspondence] Port-of-Spain Declaration for global NCD prevention

As global health researchers who work on non-communicable diseases (NCDs) and global health diplomacy, we were delighted to see the prioritisation of and emphasis on a global commitment to tackle the epidemic of NCDs in the Comment1 by Sania Nishtar (Oct 21, p 1820). Nishtar suggests excellent strategies, such as a multi stakeholder structure to serve as a holistic platform, to enable transparency and accountability to negotiate policy space for NCDs. Nishtar also highlights that none of the more than 80 disease-specific partnerships that have been created holistically address NCDs, and that this requires a multisectoral, partnership-based solution.

[Correspondence] Associations of fats and carbohydrates with cardiovascular disease and mortality—PURE and simple?

Much has been said on the results from the Prospective Urban Rural Epidemiological (PURE) study by Mahshid Dehghan and colleagues.1 Data from 18 countries are represented, providing a valuable contribution to the body of prospective observational evidence. PURE is not the largest, most comprehensive, or longest running cohort study; however, the diverse sampling method is a valuable addition to nutrition epidemiology, should the PURE data be found usable.

[Correspondence] Partnering over the limit: The Global Fund’s brewing crisis

We strongly disagree with the recent comments from Peter Sands, the new executive director of The Global Fund to Fight AIDS, Tuberculosis and Malaria.1 In response to serious concerns from civil society,2 researchers,3 journals,4 and national representatives5,6 about The Global Fund’s partnership with Heineken, Sands states that “the global health community needs to engage the private sector more rather than less…Because if we really want to achieve the SDGs [Sustainable Development Goals] and build more resilient health systems, we need to partner with the private sector to leverage their resources and their capabilities to innovate.”1 This statement seems to reflect a corporate logic that engagement with industries—all industries, regardless of their products and effect—is both inevitable and beneficial in all areas.

OBITUARY

Neville Maurice Newman
9 July 1923 – 27 April 2018

Neville Newman was born in Sydney on July 9, 1923, to Horace and Ella Kate (Dids) Newman and spent his school years at Scots College, Sydney, where, in addition to this academic studies, he played rugby union and rowed for the School.

In 1941, aged 17, Neville was admitted to study Medicine at the University of Sydney and resided at St Andrew’s College, where he went on to be Treasurer and President of the student body and also Senior Student in 1945. 1941 was the first year of the war-time accelerated medical course, in which the clinical years were compressed by reducing the breaks between semesters. Neville therefore graduated in 1945 with MB BS with second class Honours, after spending his clinical years at Royal Prince Alfred Hospital (RPAH).

His preclinical years were punctuated by summer holidays spent in a Mills Bomb manufacturing facility or out in the country picking fruit. He also played rugby union for the University of Sydney, being awarded a Blue in 1943.

In 1946, Neville began his residency at RPAH. Then, after a short period as an assistant in general practice, he moved to a training position at the Royal Alexandra Hospital for Children. This was the beginning of a long career in Paediatrics.

On May 10, 1948, Neville married Peg Friend, a nurse he had met at RPAH and in 1949 they moved to London so that Neville could continue his paediatric training. After a series of jobs in the Middlesex group of hospitals and several training courses, Neville passed the Fellowship exam of the London Royal College of Physicians in 1951. He was then able to obtain a paediatric registrar position at the Hillingdon Hospital, Uxbridge.

With one small daughter and a son on the way, Peg and Neville decided to return to Australia in October 1952, moving to Hobart in May 1953 to join the private paediatric practice of Arch and John Millar. This was a demanding job, with office consultation during the day and home visits all over Hobart and surrounds, every evening and often on unpaved suburban streets. Two more daughters were born in Hobart.

In 1962, Neville was awarded a Fulbright Fellowship to Johns Hopkins Hospital, Baltimore, Maryland, USA, where he took part in a developmental study of children from birth to five years of age, with Dr Janet Hardy. The whole family went with him from May 1962 to September 1963.

During this year in Baltimore, Neville developed his love for newborn babies. He was able to bring back with him a specialised three-way tap which allowed efficient exchange transfusion of babies with jaundice due to Rhesus incompatibility. For these exchange transfusions, Neville perfected the cannulisation of the umbilical vein.

On his return to Hobart, Neville began to specialise in Neonatology, attending most of the caesarean sections and multiple births.

In 1964, he was appointed Senior Paediatrician at the Royal Hobart Hospital (RHH), a practice which included neonatology and paediatric oncology. However, not long after this, John Millar retired. This meant that Neville was left as the sole paediatrician in Southern Tasmania until Dr Graham Bury arrived in Hobart in 1975 to set up a second paediatric practice.

In 1975, Neville was appointed as Senior Lecturer at the University of Tasmania and began his research into Sudden Infant Death Syndrome (SIDS) together with Drs David Megirian and John Sherry.

In 1980, Neville retired from private practice to become the Inaugural Director of the Neonatal Intensive Care Unit in the Queen Alexandra Division of the RHH, a position he held until his retirement in December 1989. During this time Neville continued his research into SIDS and in 1992 was awarded an Advance Australia Award for outstanding contribution to Medical Research into Sudden Infant Death Syndrome.

In retirement, Neville continued his interest in Medicine and was made a life member of the Tasmanian Branch of the Australian Medical Association.

Neville was lovingly cared for in the later years of his life by his family and in 2015 moved into St Andrew’s Village, Hughes, ACT. He died peacefully at on April 27, 2018, aged 94.

Neville was a leader and innovator in Neonatology, a researcher and a wonderful father. His service to the community was immense. He will be sadly missed.

By Jane Twin B Med Sc, MBBS, FRCPA
(Dr Newman’s daughter)

[Editorial] Making more of multimorbidity: an emerging priority

Multimorbidity would seem a relatively straightforward term, denoting multiple medical conditions within a single patient. Yet an Academy of Medical Sciences report, Multimorbidity: a priority for global health research, published in April, 2018, suggests that competing definitions in the medical literature have impeded research and improvements in patient care. The report recommends that a path forward must include a standardised definition that can be incorporated into research agendas to identify the evidence gaps and to inform the organisation of health-care systems globally.

[Correspondence] Prevention of dementia by targeting risk factors

The report by Gill Livingston and colleagues (Dec 16, 2017 p 2673)1 is a valuable collation of a large body of medical research evidence that aims to combat the dementia epidemic, the greatest global challenge for health and social care in the 21st century. One of the key messages of the Commission is the need to be ambitious in terms of prevention. Using population attributable fractions (PAF), the authors estimate that as much as 35% of dementia cases could be prevented by targeting nine modifiable risk factors.

Mapping the cost of health-related work incapacity

A Federal Government statutory authority is releasing new research that estimates the scale and cost of health-related work incapacity in Australia. And it looks at opportunities to improve the situation.

Comcare, the Government’s compensation insurer and work health and safety regulator, late last year established an innovative public-private initiative known as the Collaborative Partnership to Improve Work Participation.

It is focused on aligning the various sectors of Australia’s work disability system to deliver better outcomes for people with temporary or permanent physical or mental health conditions.

The Partnership includes the Australasian Faculty of Occupational and Environmental Medicine (AFOEM), the Departments of Social Services and Jobs and Small Business, the ACTU, the Insurance Council of Australia, insurer EML and experts Lucy Brogden, Chair of the National Mental Health Commission, and consulting Professor Niki Ellis.

AFOEM is leading work to strengthen the role of GPs in improving return to work outcomes for injured and ill workers – including helping GPs prescribe work as part of recovery.

Through a range of projects, the Partnership is working across sectors including workers’ compensation, life insurance, superannuation, disability support and employment services to improve disability employment and return to work rates for people experiencing work incapacity through illness and injury.

It is also the first time all the major compensation and benefit systems have been examined together to identify the flow of people through them, how the systems interact, and where they can be improved to deliver better health and productivity outcomes.

The Partnership commissioned Monash University to undertake the research. The resulting report The Cross Sector Project Mapping Australian Systems of Income Support for People with Health-Related Work Incapacity is now being released.

The study considered data and services across the systems that support people to work – workers’ compensation, disability support, veterans’ compensation, superannuation, life insurance and motor accident compensation.

Among other things, the study found that 786,000 Australians who were unable to work due to ill health, injury or disability received some form of income support in 2015-16.

Also, about $18 billion was spent on some form of income support in that year.

This research sheds new light on how many Australians have health conditions that impact their ability to work, and the cost for employers, Government and insurers. The numbers include 155,000 people in workers’ compensation and 469,000 people in social security.

Researchers also produced a conceptual map of Australia’s income support systems, showing the volumes of people, the types of income support they receive and how they might move through the various systems.

“These findings mark the first step in establishing an evidence base in a critical area of public health and social policy,” Comcare CEO Jennifer Taylor said.

“It gives us a basis for improving Australia’s service delivery model for supporting people with work-related injury or disability in their return to work.

“Australia’s benefit and compensation systems are siloed and operate with little reference to each other. There’s growing recognition that what happens in one system impacts others, and the costs often just shift between the systems.

“Considering the sectors as a whole rather than as independent systems will lead to a better understanding of how they operate in relation to each other, how they connect and where gaps or tensions exist.

“It’s clear that taking a cross-system view and a collaborative approach gives us a platform to design and trial new service offerings. We have significant opportunities to improve health and productivity for a very large number of working age Australians.”

Monash University’s Insurance Work and Health Group, led by Professor Alex Collie, was asked to develop a high-level system map of the current Australian service delivery model for supporting people with a work-related injury or disability in their return to work. The project also analysed and mapped system-related data and data gaps.

The project scope included investigating five categories of services: return to work services; healthcare and treatment; job finding or employment services; functional support services; and case management services.

The Monash team mapped 10 major systems of income support in Australia: employer provided entitlements; workers’ compensation (short tail and long tail schemes); motor vehicle accident compensation (lump sum and statutory benefits); life insurance (income protection and total and permanent disability schemes); defence and veterans’ compensation and pensions; superannuation; and social security.

The report estimated the number of people accessing income support and associated costs from each of the systems during 2015-16 and identified opportunities for improvements in the various systems.

Potential improvements include information and data sharing to provide greater understanding of the systems of income support; and better aligning service models – particularly through reforming GP certification and work capacity assessment – to reduce overlap and improve service delivery.

The Collaborative Partnership is considering these recommendations and working towards addressing the opportunities for change. Members are already examining ways to improve data sharing between the various compensation and benefit systems to get a better understanding of how they interact and how they can work together more effectively.

CHRIS JOHNSON

The Cross Sector Project report can be found on the Partnership’s website: http://www.comcare.gov.au/collaborativepartnership

PICTURE: Comcare CEO Jennifer Taylor launching the Collaborative Partnership to Improve Work Participation.

Doctors invited to subscribe to new Olive Wellness Institute

A new online resource promoting the health attributes of extra virgin olive oil has been launched to coincide with the latest international findings of the benefits of a Mediterranean diet.

The world-first Olive Wellness Institute aims to build awareness of olive products through the gathering, sharing and promotion of credible, evidence-based information pertaining to their nutrition, and health and wellness benefits.

The Institute, which is sponsored by olive company Boundary Blend Limited, is asking doctors to subscribe to its free online research source.

Professor Catherine Itsiopoulos, Head of the School of Allied Health at La Trobe University, chairs the Olive Wellness Institute’s (OWI) advisory panel.

“Given the abundant misinformation on the health benefits of foods, ingredients and supplements, a collaborative organisation like the OWI will offer healthcare professionals, scientists, academics and members of the general public, invaluable access to evidence-based information about extra virgin olive oil (EVOO) and other olive products,” she said.

“I have been researching the impact of the Mediterranean diet for more than 20 years, and EVOO forms the basis of the dietary advice I provide to patients with heart disease, diabetes and other chronic diseases.”

Prof Itsiopoulos is currently conducting a trial which aims to demonstrate the positive effects of the Mediterranean diet on patients with coronary heart disease.

A new research review, published last month in the Journals of Gerontology and titled The Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms, highlights the anti-inflammatory and antioxidant properties of phytochemicals found in EVOO.

Conducted by US and Italian geriatric and nutritional research scientists, the review discusses the role played by EVOO and the Mediterranean diet in trying to reduce the risk of stroke, Type 2 diabetes, peripheral artery disease and breast cancer.

Subscription to the olive wellness community is free via the OWI website: www.olivewellnessinstitute.org.

Subscribers can access:

Regularly updated news and articles relating to olive nutrition, health and wellness.
An easily searchable and comprehensive olive science database featuring prominent recent research findings.
An expert library listing designed to facilitate queries and research collaboration.
A list of relevant olive events worldwide.

New subscribers can also download a free olive health and wellness e-book, containing comprehensive information about the history and science behind olive products.

CHRIS JOHNSON