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Category: Health

12/05/2022

What is Needed in Health

12 May 2022

Dr Stephen Duckett was an architect of Medicare and is one of our leading health policy experts. His opinion of what is needed for the health system has a lot of implied criticism of what has been happening, with excessive resources on late-stage treatments rather than prevention and early diagnosis, which comes in Primary Care.He speaks of the dis-cordination, cost shifting and political nature of decision-making.

He does not even mention the need to fix Medicare- saving it is not enough!

What I would do if I were the Minister for Health and Ageing in the next government

13/04/2022

Belated Federal Govt. Action on Vaping

13 April 2022
The Federal government has made statements to try to lessen vaping especially in children. Health Minister, Greg Hunt has made statements and asked for State help on the issue. This is only days before the Federal government goes into ‘Caretaker’ mode before the election, so can have no real effect. Hunt himself is retiring at the election. Perhaps he is doing his best, but he has been undermined by a determined ‘pro-vaping’ group within the Liberal government, which includes Trent Zimmerman, MP for North Sydney. (One might wonder whether the vaping groups are funding the major parties, as they have significant tobacco company ownership. Presumably this will come out eventually- too late to be relevant)
Vaping has been increasing due to the same sort of marketing that launched tobacco, making it exciting, sexy and rebellious. With the internet, social marketing and ‘social influencers able to be paid and target certain groups, this can happen much more under the radar than in former times. As my son commented recently, ‘People believe what their algorithm feeds them’. Older folk who are not fed the ads do not notice what is happening. But now even student correspondents are complaining that there is so much vaping that the school toilets are polluted.
As one Professor of Medicine commented on Radio National Life matters today, ‘We should not be comparing vaping to smoking, we should be comparing it to breathing fresh air’. Exactly.
There were two articles in the SMH this week, ‘Federal bid to stop children vaping’ by Dana Daniel on 7/4/22 and on 9/4/22 (below).
We can only hope that the vaping members lose their seats and that the new Labor government takes a much more active stance. It is late to act on this, but better late than never.

Greg Hunt urges state governments to stop vapes being sold to children

By Dana Daniel April 9 2022

Health Minister Greg Hunt has written to his state counterparts urging them to halt the illicit sale of e-cigarettes to children, but state health ministers want the federal government to stop them at the border.
Community concern is growing about e-cigarettes in schools as increasing numbers of teenagers take up vaping – despite state laws making it illegal to sell the devices to under-18s, regardless of whether they contain nicotine.
“I ask that you take active steps to enforce these laws by taking action against retailers contravening your laws, for example by selling NVPs to school children,” Mr Hunt wrote in the letter, seen by The Sydney Morning Herald and The Age.
Under Commonwealth law, it has been illegal to import liquid nicotine, unless prescribed by a GP as a smoking cessation aid, for the past six months.
But e-cigarettes and vape juices containing nicotine remain widely available through a black market both online and in retail stores and schools are grappling with an escalating problem.
Mr Hunt’s letter dated March 18 linked to a report in The Age about a five-year-old boy who was hospitalised with breathing difficulties after vaping with his brother and a seven-year-old classmate at school.
In that case, the vape was not alleged to have been sold to a child by a retailer, with the child’s father telling the ABC it belonged to another student’s mother.
Victorian Health Minister Martin Foley hit back on Friday, telling the Age and Herald: “We need more action from the Commonwealth to strengthen e-cigarette regulation at a national level – and we encourage the Morrison Government to get on with it.”
A spokeswoman for NSW Health Minister Brad Hazzard, who is recovering from COVID-19, said a national approach was needed to tackle vaping, which the state had formally requested “on multiple occasions, including during feedback on the new National Tobacco Strategy”.
“The federal government previously tried to get a uniform approach on e-cigarettes, but was met with opposition from supporters of vaping,” the spokeswoman said.
Mr Hazzard had already asked NSW Health to “step up its compliance action” before receiving Mr Hunt’s letter.
“Hopefully, it will be possible for federal compliance to be stepped up to minimise the importation of illegal vaping products.”
The federal health department is finalising the National Tobacco Strategy, a draft of which recommends new restrictions on “the marketing, availability and use of all e-cigarette components in Australia, regardless of their nicotine content”.
Australian Border Force Commissioner Michael Outram told a Senate estimates hearing in February that the ABF had not committed any additional resourcing to the detection and seizure of nicotine vaping products since the ban on importation without a prescription began last October.

08/04/2022

COVID19 Viral Shedding is unrelated to Symptom Severity

8 March 2022

A new, rather bold study involving health infected volunteers has shown that the severity of symptoms experienced is unrelated to how much virus is shed. In other words, even someone with minimal symptoms can shed and spread the virus a lot.

The bottom line of this is that people should wear masks to stop them spreading the virus.

Here is a cut-down version of the Nature Medicine article in Australian Doctor.

COVID-19 symptom severity ‘no indication’ of viral shedding

A world-first study offers insight into a key public health question about transmission, researchers say

4th April 2022 By Reuters Health

The world’s first ‘human challenge’ trial in which volunteers were deliberately exposed to SARS-CoV-2 has found that symptoms have no effect on how likely an infected person is to pass the infection on to others.

The UK study showed that among the 18 participants who developed COVID-19, the severity of symptoms, or whether they displayed symptoms at all, had nothing to do with the viral load in their airways.

Viral load was measured by a focus-forming assay (FFA) and quantitative polymerase chain reaction (qPCR) in the project led by Imperial College London and contract research company Open Orphan.

“There was no correlation between the amount of viral shedding by qPCR or FFA and symptom score,” the researchers said in Nature Medicine.

“Furthermore, our data clearly show that SARS-CoV-2 viral shedding occurs at high levels irrespective of symptom severity, thus explaining the high transmissibility of this infection and emphasising that symptom severity cannot be considered a surrogate for transmission risk in this disease.”

The trial exposed 36 healthy young adults without a history of infection or vaccination to the original SARS-CoV-2 strain of the virus and monitored them in a quarantined setting.

Since two volunteers were found to have had antibodies against the virus after all, they were excluded from the analysis.

Slightly more than half of them contracted the virus.

No serious adverse events occurred and the human challenge study model was shown to be safe and well tolerated in healthy young adults, the research team had said earlier this year.

“With virus present at significantly higher titres in the nose than the throat, these data provide clear evidence that emphasises the critical importance of wearing face coverings over the nose as well as the mouth,” the study team wrote.

A key unresolved question for public health had been whether transmission was less likely to occur during asymptomatic or mild infection compared to more severe disease, the researchers said.

More information: Nat Med 2022; 31 Mar.

08/04/2022

Bullshit Jobs

8 April 2022

The idea of bullshit jobs is not new. It comes from a book in 2018.

However, with employment supposedly doing well, largely because we have excluded guest workers due to Covid, it is worth looking at how many jobs are actually needed.

Everyone needs something to do and a reasonable income to live on. The status of having a job relates generally to its perceived income, though there is some ‘doing good’ status associated with jobs like nursing despite their being chronically underpaid.

But technology replacing people has not brought the expected benefits because there seems no plan to spread the benefits evenly, or look at whether what is being done has any social utility. Many jobs that need doing are not done. Many people who want to work cannot, yet much energy and money is spent doing useless things.

I waste about 80% of my time as I treat Workers Comp and CTP injuries. About 20% of my time is deciding what treatment is needed, and about 80% filling in paperwork or writing reports to try to get the treatments paid for. On the other side there are a phalanx of clerks trying not to pay and to transfer the costs elsewhere. (i.e. to Private Health Insurance, Medicare or the patient themselves). Many doctors and lawyers also strive mightily in this unproductive area. The bottom line is that while the overheads of Medicare are about 4.5%, the overheads of CTP are close to 50%,; i.e half the money goes in processing or disputing claims or in profits for the companies indulging in this nonsense. And since many patients often cannot get the treatment or suffer long delays because of their efforts, it is a really bad use of human energy.

Someone needs to look hard at what we do and where the benefits go. Assuming that ‘the market’ will fix it is about as sensible as saying that ‘God’ will fix it, and is usually espoused with the same uncritical zeal.

Here is Wikipedia summary of the book:

In Bullshit Jobs, American anthropologist David Graeber posits that the productivity benefits of automation have not led to a 15-hour workweek, as predicted by economist John Maynard Keynes in 1930, but instead to “bullshit jobs”: “a form of paid employment that is so completely pointless, unnecessary, or pernicious that even the employee cannot justify its existence even though, as part of the conditions of employment, the employee feels obliged to pretend that this is not the case.”[1] While these jobs can offer good compensation and ample free time, Graeber holds that the pointlessness of the work grates at their humanity and creates a “profound psychological violence”.[1]

The author contends that more than half of societal work is pointless, both large parts of some jobs and, as he describes, five types of entirely pointless jobs:

flunkies, who serve to make their superiors feel important, e.g., receptionists, administrative assistants, door attendants, store greeters, makers of websites whose sites neglect ease of use and speed for looks;
goons, who act to harm or deceive others on behalf of their employer, e.g., lobbyists, corporate lawyers, telemarketers, public relations specialists, community managers;
duct tapers, who temporarily fix problems that could be fixed permanently, e.g., programmers repairing bloated code, airline desk staff who calm passengers whose bags do not arrive;
box tickers, who create the appearance that something useful is being done when it is not, e.g., survey administrators, in-house magazine journalists, corporate compliance officers, quality service managers;
taskmasters, who create extra work for those who do not need it, e.g., middle management, leadership professionals.[2][1]

Graeber argues that these jobs are largely in the private sector despite the idea that market competition would root out such inefficiencies. In companies, he concludes that the rise of service sector jobs owes less to economic need than to “managerial feudalism”, in which employers need underlings in order to feel important and maintain competitive status and power.[1][2] In society, he credits the Puritan-capitalist work ethic for making the labor of capitalism into religious duty: that workers did not reap advances in productivity as a reduced workday because, as a societal norm, they believe that work determines their self-worth, even as they find that work pointless. Graeber describes this cycle as “profound psychological violence”[2] and “a scar across our collective soul”.[3] Graeber suggests that one of the challenges to confronting our feelings about bullshit jobs is a lack of a behavioral script in much the same way that people are unsure of how to feel if they are the object of unrequited love. In turn, rather than correcting this system, Graeber writes, individuals attack those whose jobs are innately fulfilling.[3]

Graeber holds that work as a source of virtue is a recent idea, that work was disdained by the aristocracy in classical times, but inverted as virtuous through then-radical philosophers like John Locke. The Puritan idea of virtue through suffering justified the toil of the working classes as noble.[2] And so, Graeber continues, bullshit jobs justify contemporary patterns of living: that the pains of dull work are suitable justification for the ability to fulfill consumer desires, and that fulfilling those desires is indeed the reward for suffering through pointless work. Accordingly, over time, the prosperity extracted from technological advances has been reinvested into industry and consumer growth for its own sake rather than the purchase of additional leisure time from work.[1] Bullshit jobs also serve political ends, in which political parties are more concerned about having jobs than whether the jobs are fulfilling. In addition, he contends, populations occupied with busy work have less time to revolt.[3]

As a potential solution, Graeber suggests universal basic income, a livable benefit paid to all, without qualification, which would let people work at their leisure.[2] The author credits a natural human work cycle of cramming and slacking as the most productive way to work, as farmers, fishers, warriors, and novelists vary in the rigor of work based on the need for productivity, not the standard working hours, which can appear arbitrary when compared to cycles of productivity. Graeber contends that time not spent pursuing pointless work could instead be spent pursuing creative activities.[1]

25/03/2022

Vaping- the beginnings of a disease description

25/3/22

It seems that the tobacco industry has won the first major vaping battle. They have succeeded in getting their new product legal, and now they do not have to prove it is safe, the medical world has to prove it unsafe. Progressive elements of the medical profession are describing the diseases caused by vaping. Its progressive practitioners are also aware of the political aspects of vaping’s progress, though their power in this area is not great.

After my last article on vaping Anne Jones, who used to run ASH (Action on Smoking and Health,) sent me a significant lecture by Prof Andy Bush, from the Brompton Hospital. (Brompton is probably the most prestigious hospital for respiratory diseases in Britain).

The 45 minute lecture is quite medical/technical and as such quite hard going, but it is interesting in that it combines very detailed medical aspects with an astute analysis of the political and economic significance of vaping. As a student I was subjected to endless lectures on the harm of tobacco without any consideration of the political aspects of its political cause or prevention. As Prof Bush himself says, ‘Fool me once, shame on you. Fool me twice, shame on me’.

He points out the similarities between smoking and vaping, but also the differences. There is something of a nightmare of acronyms, so I will help where I can.

Currently vaping is being marketed using the same symbols of success as was used before tobacco had any restrictions on it, freedom, rebellion and glamour. The difference is that it now uses social media to market to CYPs (Children and Young People). BAT has spent a Billion pounds on social influencers. Although vaping is supposedly allowed to help people get off tobacco, the marketing to kids is to those who do not smoke anyway, so clearly it either a gateway drug to smoking or an entirely separate habit to be fostered and developed.

He points out that the tobacco industry has taken over the major vaping brands. VUSE is owned by RJR, who were R.J.Reynolds Tobacco. VYPE is owned by BAT, British-American Tobacco. BLU is now owned by Imperial Tobacco, and JUUL is now significantly owned by Altria, the new name for Philip Morris.

If that were not enough, one brand Puffit2 is owned by a company called Discreet Vape Company and the vaping device looks like a Ventolin inhaler! Philip Morris purchased Vectura, a British pharmaceutical company that manufactures respiratory drug delivery devices, in September 2021.

ENDS (Electronic Nicotine Delivery Systems) (= vaping devices) deliver chemicals. Prof Bush points out these chemicals have no information publicly available about their nature and properties. 18 flavours have carcinogenic, tobacco-specific components and there are bacterial and fungal contaminants in a high percentage of vaping products. These contaminants may have their own ability to generate allergic lung diseases, which are similar to emphysema. In one case the nicotine was at 120% of the level stated on the pack.

Passive vaping is similar to passive smoking in that the non-vapers get similar levels of nicotine in their urine to passive smokers.

Vaping is not a gateway to smoking cessation and may even be a gateway to smoking. A study which compared nicotine replacement therapy to vaping showed that while 9% of nicotine replacement patients were off cigarettes after 6 months as opposed to 18% of people using vaping, 80% of the people who had used vaping were still vaping a year later (Hajek et al, NEJM 2019). If Buprion was used with nicotine replacement the quit rate was 25% at 6 months and 20% in a year. Varenicycline achieved 27% (Borelli and O’Connor NEJM 2019). Interestingly, if you pay people to quit, it is a better investment than the drugs!

Vaping has risen rapidly amongst American teens and is currently at 28% and the prevalence of smoking has stopped declining since the vaping rise started.

Prof Bush’s lecture states that the acute toxicity of vaping is actually worse than cigarettes. Researchers always do an immense amount of work, and doctors struggle to keep abreast of it. The effect has been measured on foetal lungs, levels of all kinds of proteins, cytokines, chemokines, enzymes, Cell functions, lung pathology, oxygenation levels and from many areas including broncho-alveolar lavage (BAL), (i.e. washing from lungs). Rat models have also been used to look at emphysema (poor little guys). It increases their alveolar (lung air sac) size and causes a fall in transcutaneous oxygen levels. This may be due to a lipoid pneumonia due to lipid (fats) being leached out of the lungs. The negative effects of e-cigarette vapour condensate on macrophages (the cells that fight infection) were similar with or without nicotine in the condensate. The condensate was also more toxic than the e-Cigarette liquid! (Scott, Thorax 2018).

Vaping has been shown to increase bacterial adherence to epithelial cells which increases susceptibility to infection. It also considerably worsens the effect of COVID infection.

There are case histories of a 16 year old previously healthy boy who was admitted urgently to an Emergency Dept with a lung disease so serious that he ended up on ECMO (Extra-Corporeal Membrane Oxygen- the artificial lung). He had only used OTC (Over the Counter) vaping products.

Prof Bush describes a new disease that has been called EVADI (E-cigarette Vaping Acute Lung Injury), though it would not be medicine if they were not arguing over the new name which some want to call EVALD (E-cigarette Vaping Acute Lung Disease).

Bush finally asks that the recommendations of FIRS, (Forum of International Respiratory Societies) be implemented:

ENDS (Electronic Nicotine Delivery Systems) should be considered as tobacco products and taxed and regulated as such.
Sales to CYPs (Children and Young People = minors) must be prohibited and this must be enforced.
All advertising and promotion should be regulated and made inaccessible to CYPs.
Flavourings increase rates of youth initiation, so should be banned in ENDS
Vaping should be prohibited in indoor locations, public parks, and places where children and youths are present.
While their health risks are increasingly recognised, more research is needed
Routine surveillance and surveys concerning combustible and electronic cigarette use should be carried out.

Prof Bush makes the point that they also need plain packaging and health warnings like tobacco products and says, ‘There is no chemical model that shows inhaling hot chemicals is a good idea. You show me the proof that it is harmless.’

We all need to lobby on this. Here is the video of the lecture: https://www.youtube.com/watch?app=desktop&v=yhdiIuz0ec4&fbclid=IwAR2ETBxTR8LD87Nmng54uo_w2xZ6vI7kRmYBqITPOv36R0

20/03/2022

The Smoke Screen Recurs.

20 March 2022

An article in the Good Weekend 19 March notes that screening services such as Netflix have a lot of smoking in their movies.

There was a lot of placement of smoking in movies for many years and in the 1920s and 30s there was more smoking in movies than in real life, which was probably not a coincidence.

Steve McQueen smoked in ‘Wanted: Dead or Alive’ and like Yul Brunner, Humphrey Bogart, Betty Grable, Paul Newman, and John Wayne was in the many Hollywood stars to die of lung cancer.

In the 1950s and 60s tobacco companies sponsored many TV programs, such as the ‘Jack Benny Show’ (comedy) and ‘Gunsmoke’. Walt Disney, Larry King, Moe Howard (3 Stooges), Larry Hagman (Dallas), Chuck Connors (The Rifleman) and Ed Sullivan were some of the TV stars to die of smoking-caused cancers. Some musicians to die were Nat King Cole, Dean Martin, Duke Ellington, George Harrison and Sammy Davis Jr.

The heath activists managed to get rid of tobacco advertising in Australia in 1976, but sponsorship, which was cheaper than actual advertising and got much more coverage lasted until after 2000. In the US activists drew attention to product placement in movies where brands were displayed or whole characters written to publicise smoking and fund movies. Product placement by tobacco was banned in Australia in 1992 and in the US in 1998, unless historical figures were known to smoke.

But now smoking in movies is rising again, and it seems to be worse in streaming services like Netflix. Smoking does not seem to be increasing yet, but with vaping acting as a new gateway to smoking, the battle ain’t over yet.

From the ashes: Smoking’s curious comeback on the silver screen

Once the epitome of Hollywood glamour, cigarettes were all but snuffed out in films and TV shows by the turn of the millennium. Now they’re making a comeback. Plot-driven or something more sinister?

By Tim Elliott Good Weekend March 18, 2022

Smoking has made a furtive, and somewhat puzzling, comeback in recent years, something one US veteran anti-tobacco activist says is not random: “Nothing in Hollywood happens by chance.”

When news broke, in mid-2021, that the cult turn of the millennium TV series Sex and the City was to return, the world’s entertainment media suffered a brief bout of tachycardia, the kind of hand-flapping hysteria that could reasonably be expected to herald the return of another well-known cult figure. The excitement was understandable. The new series, called And Just Like That, promised contemporary viewers everything that had made the original show so effortlessly watchable; cheeky humour, exceptional shoes and a non-threatening dose of prime-time friendly transgressiveness.

Yet there was one facet of And Just Like That which got special attention: one of the lead characters, Carrie Bradshaw (played by Sarah Jessica Parker), was smoking again. “Why, decades after she quit the habit, would Carrie return to it?” asked W magazine. A headline in New York magazine read: “And Just Like That … Carrie Is Smoking Again.” “Carrie’s smoking again!” the Daily Mail yelped.

Such head-shaking suggested not just disapproval but bewilderment. The common consensus was that, thanks to decades of pressure from anti-tobacco groups, smoking in TV and films had all but disappeared. In fact, smoking has made a furtive, and somewhat puzzling, comeback in recent years. Agent Smith lights up in The Matrix Resurrections; Kate Winslet vapes in Mare of Easttown; and Christina Applegate’s character Jen sparks up in the woman buddy show, Dead to Me. There’s plenty of smoking in the Netflix series The Umbrella Academy and in Orange is the New Black, and also in Modern Family and Law & Order: SVU.

Sarah Jessica Parker’s character Carrie Bradshaw resumed her smoking habit in the latest Sex and the City series, And Just Like That.

The fug that all but envelops The Queen’s Gambit, which is set in the mid-1950s and ’60s in the US, could plausibly be excused: after all, in 1954 a full 45 per cent of Americans smoked, that country’s highest level. (Australia reached its peak – also 45 per cent – in 1960). But smoking is also popping up in contemporary films, and especially those aimed at kids: a 2019 report from the US Centres for Disease Control and Prevention (CDC) found that the number of times tobacco use appeared on-screen in PG-13 films jumped 120 per cent between 2010 and 2018.

So what’s going on? “It’s not totally clear, but we’ve got a few ideas,” says Professor Stanton Glantz, a veteran anti-tobacco activist and founder of Smoke Free Media at the University of California, San Francisco, which tracks the incidences of smoking in movies and video. “One thing for sure is, these are not random creative decisions. Nothing in Hollywood happens by chance.”

Cigarettes and movies have been inextricably linked for generations. Ever since the advent of the talkies, tobacco companies have understood the power of film to shape cultural norms. In the 1930s and ’40s, tobacco companies paid Hollywood stars to appear in cigarette ads and smoke on screen. In return, the studios received funding for film advertising. Some actors, including Joan Crawford and Carole Lombard, appeared smoking in posters that promoted both the film and the brand of cigarette.

In the 1950s and ’60s, tobacco companies shifted their focus to television, spending hundreds of millions of dollars sponsoring popular programs such as The Jack Benny Program and Gunsmoke. Steve McQueen smoked in Wanted: Dead or Alive. Peter Gunn smoked. Even the Flintstones smoked. In 1962, the American television network CBS assured tobacco companies that the TV set “is the greatest cigarette vending machine ever devised”.

In the early 1970s, however, regulators in the US and Australia began banning cigarette advertising on TV and radio, prompting the tobacco companies to turn their attention once more to the movies. Product placement became rife, with Big Tobacco paying millions to have its brands on screen.

In 1982, Superman II featured a classic fight scene in which Superman is thrown into a Marlboro truck by General Zod. In 1989, Philip Morris paid $US350,000 ($472,000) to have its Lark brand featured in the James Bond film Licence to Kill.

Some companies were literally throwing cigarettes at actors: in 1984, American Tobacco supplied more than $US5000 worth of cigarettes to the set of Beverly Hills Cop. “I do feel heartened at the increasing number of occasions when I go to a movie and see a pack of cigarettes in the hands of the leading lady,” Hamish Maxwell, then president of Philip Morris, told a marketing meeting in 1983, adding, “We must continue to exploit new opportunities to get cigarettes on screen and into the hands of smokers.”

Such marketing has been phenomenally powerful, not only at creating new smokers but at manipulating reality. “You often hear these days that, ‘Oh everyone smoked in the 1920s and 1930s,’ ” says Glantz. “But it turns out that people back then smoked less than they did 10 years ago. The reason people now think people smoked so much then is that the movies back then had so many people smoking.”

Paying for on-screen product placement was banned in Australia in 1992, and in 1998 in the US. By 2007, according to the CDC, smoking on screen was at an all-time low: virtually the only people you saw puffing away were historical figures whose persona was inseparable from their habit: Winston Churchill, Fidel Castro or King George VI in the 2010 film The King’s Speech, in which he’s frequently depicted lighting up as he struggles with his speech impediment.

But smoking soon rose from the ashes. According to the CDC, tobacco use in top-grossing movies jumped 57 per cent from 2010 to 2018. Meanwhile, in the real world, smoking rates in the US were going in the opposite direction, from 19.3 per cent in 2010 to 13.7 per cent in 2018. The CDC didn’t attempt to explain why there was more smoking in films, but it would be naive to think that Big Tobacco had simply walked away from the movies.

“If you see a pack of Marlboros on screen, someone would have had to approve that,” says Glantz. “It doesn’t get in there by accident. How exactly it gets there, we don’t really know at this stage. There are still product placement companies, but they all deny they work with Big Tobacco. But if you see smoke, there is a fire.” (A spokesman for Philip Morris in Australia said the company does not engage in product placement in movies or on television.)

Streaming services aren’t bound by regulatory agreements, which is how shows like The Umbrella Academy managed to include cigarettes in every scene of its latest season.

Streaming is a big part of the problem, according to Glantz. Every year the tobacco companies must certify to the US Federal Trade Commission that they haven’t paid for their product to be placed in movies, TV shows or video games. But the agreement doesn’t cover streaming content, the enormous quantity of which makes it all but impossible for anti-tobacco groups and regulators to monitor.

“The cynic in me says that tobacco ads have been so curtailed globally that the tobacco industry must have a role in it,” says Becky Freeman, associate professor of public health at the University of Sydney.

“But then, given how many productions are involved and the sheer number of people, it seems unlikely there would be big money changing hands without someone leaking about it.” Freeman believes it’s more likely that streaming services are using smoking “to stand out from the big budget movies, and to appear more ‘indie’.”

Some streaming services are more “indie” than others. Despite a pledge to limit smoking on screen, Netflix remains the worst offender. (According to the Truth Initiative, an American anti-smoking group, scenes involving smoking tripled in the latest season of its superhero series The Umbrella Academy, which managed to include tobacco in every scene.)

The major studios also have policies that aim to restrict the amount of on-screen smoking. The strictest is Disney, which banned it in 2007. Thus its 2021 film, Cruella, which features the ghoulish De Vil without her signature cigarette. But all of the studios – even Disney – make allowances for creative licence and historical accuracy.

Kate Winslet as Detective Sergeant Mare Sheehan vapes in the crime drama, Mare of Easttown.

“Smoking was so widespread in the 20th century that it would be inauthentic not to show it in a drama set in that period,” says novelist and screenwriter John Collee. Collee, whose credits include Master and Commander, Happy Feet and Hotel Mumbai, is writing an adaptation of Trent Dalton’s bestselling book, Boy Swallows Universe, which is set in Brisbane in the early 1980s among working-class criminals and journalists. As it happens, the movie will include a historical figure called Slim Halliday, who was a member of the Brisbane underworld and an enthusiastic smoker. (Spoiler alert: in the film, Halliday dies of lung cancer.)

The problem for groups like the Truth Initiative and Smoke Free Media is that smoking in movies often signifies recklessness, and being reckless is cool.

History aside, smoking holds a strong stylistic appeal in cinema, which, says Collee, uses a “Freudian kind of dream language, where some things signify other things”. In Mad Men, the popular series about hard-living advertising executives in 1960s New York, smoking stands in as moral commentary, a metaphor for lead character Don Draper’s shadowy past and heedless chauvinism.

In the 1999 movie, Fight Club, Brad Pitt’s character, a poisonously disillusioned soap salesman named Tyler Durden, smokes so greedily it’s as if he’s eating the cigarette. “His smoking is like saying, ‘Here is a guy who doesn’t much care for his own survival,’ ” Collee says.

In Mad Men, smoking stands in as moral commentary, a metaphor for lead character Don Draper’s shadowy past and heedless chauvinism.

The problem for groups like the Truth Initiative and Smoke Free Media is that smoking in movies often signifies recklessness, and being reckless is cool. The bottom line, says Collee, who worked as a doctor before becoming a writer, “is that, unlike a public health announcement, a drama is essentially non-didactic. To a certain extent, you have to trust your audience to discriminate between a good thing and a bad thing.”

In the 2012 Judd Apatow film, This is 40, the lead female character, Debbie (played by Leslie Mann), has a sneaky smoking habit, puffing away near the bins out the back of her house. When her teenage daughter Sadie discovers her, Debbie is aghast and promises to give up. Like Debbie, today’s filmmakers have been busted smoking. Like Debbie, they have promised to give up. Like Debbie, their heart’s not in it.

Everyone has different ideas about how to fix the problem. India tried to ban all smoking scenes in Bollywood movies in 2005, but failed thanks in part to opposition from the creative community, which argued that it would curb artistic freedom. Instead, all scenes involving smoking are now accompanied by a caption at the bottom of the screen warning viewers that “Smoking is injurious to health”. In Thailand, meanwhile, the act of smoking and cigarette packs are pixelated.

Stan Glantz has long advocated, unsuccessfully, to have all movies with smoking scenes rated R. But prominent Australian anti-tobacco campaigner Simon Chapman believes this would be a mistake, not only because it’s unfeasible (would a minor character smoking one cigarette trigger an R-rating? What about scenes that depict smoking negatively? And what 15-year-old kid takes notice of movie ratings anyway?), but also because having health advocates dictate the content of movies is a really bad idea. “This kind of approach just seems a bit North Korea to me,” he says.

Some of the most memorable anti-smoking messages have come from within the film industry itself. In 1985, the actor Yul Brynner, who had been a smoker since the age of 12 and was then dying of lung cancer, appeared on Good Morning America, imploring the viewers: “Whatever you, just don’t smoke.”

Some of the smoking scenes in The Queen’s Gambit may not have had quite the effect Big Tobacco was hoping for.

Then there is the hit series The Queen’s Gambit, in which sassy chess prodigy Beth Harmon (Anya Taylor-Joy) rises up the chess world while battling booze and drugs. In one scene, Harmon, hitting rock bottom, stumbles around her house, hopelessly hungover, a cigarette dangling from her lips. She heads to the fridge and grabs a beer, then dances around the kitchen to Shocking Blue’s Venus.

As the song hits full stride – “A goddess on a mountain top, was burning like a silver flame” – Harmon twirls, cigarette in hand, smoke in her hair, and promptly pukes in the sink. Not quite the product placement Big Tobacco might have hoped for.

18/03/2022

Vaping is Now Endemic

18 March 2022

It gives me no pleasure to say that vaping is endemic, or that I told you so.

I spent 20 years more or less full time trying to get smoke-free air, which equated to fighting the tobacco industry, who were dedicated to selling as much tobacco as was possible with no regards for its health effects.

As I attended endless conferences at my own expense, there were parallel better funded conferences on the Quit issue, where a second tier of anti-smoking professionals went to conferences on nicotine replacement strategies.

Some of them ran Quit clinics on the model that people would come to them saying “I have a tobacco addiction problem, please help me wean off nicotine”. The Health Dept. set up and funded quite a number of these clinics. The tobacco industry did not object as they made little difference to the number of people who smoked or the ubiquitousness of the habit, and allowed the government to say that it was doing something, avoid doing something more useful and continue to get the tobacco industry’s political donations. As an enthusiastic smoking activist, I visited these clinics. I was always warmly welcomed by the health promotion staff running them who were always up to date on the latest tobacco control literature and happy to talk. It took me a while and some direct questioning to realise that the model was flawed; very few people came to the clinics and the staff were well read because they did not have much else to do. Eventually the government stopped funding them.

When the activists had reduced the credibility of the tobacco industry to laughing stock, and the deliberately long contracts of the sponsored sports and other apologists had run out, we managed to get rid of the advertising sponsorships and get smoke free air (with a generous definition of ‘outdoors’ to allow smoking in poker machine areas in pubs to keep the money engine ticking over). This was in 2000.

The vaping technology was being improved as part of this parallel Quit universe, and its medical protagonists were grateful that there was less tobacco use and hoped that the world would perceive their Quit efforts as the last stage in mopping up the smokers remaining, and they could take more of the limelight. Seeing the whole world from a Quit smoking perspective and possibly having attended a few well-funded conferences, they concluded that vaping would be good for quitting, and because it was much less harmful than burning leaves, it was a step in the right direction. The assumption that the only use of vaping was to get smokers to quit was naïve in the extreme. Some of the vape makers are the same companies that were happy to sell cigarettes, and now there are as many people starting smoking from vaping as leaving smoking for vaping.

But the key to vaping is that it is a new consumer product, with the potential to do immense public heath harm and to make massive profits. The economic engine is in place, the government apathy continues helped by the naïve abovementioned Quit doctors.

In the fight against tobacco, the fact that the ubiquitous ads affected children was self-evident, but like everything in the tobacco wars had to be proved, so a study was done which showed that the brand preference of kids was not the same as adults, but the brands chosen by kids were the ones most advertised.

But now marketing is much more sophisticated. Social media allows targeting by age, gender, location and even personal opinions and preferences. So kids can be reached without adults even being aware, and this is what has happened. Vaping has become ubiquitous, just as we were achieving a smoke-free generation. Now vaping will have to be shown to be harmful, rather than have to be shown to be safe. So the research will take years, be denied by its industry protagonists, and be subject to the venal indolence of the political process. Inhaling solvents with random additives is likely to be harmful, but this of course is not ‘proof’. The industry should have had to prove it was safe before it being released, but because the Quit people allowed tobacco to be the bar that it had to beat, it became legal without scrutiny, and now has become ubiquitous without being noticed.

I was therefore not happy but not surprised to read a schoolkid talking about vaping, and sadly he was also realistic enough to assume that the government was not likely to be of much help. Here is his article.

Vaping, a constant craving for too many of my school friends

Ari Katz, High school student

March 15, 2022, Sydney Morning Herald p19

It started as a novelty, a bit of harmless fun. The snap, crackle and pop of each nicotine-fuelled hit was exciting, enticing. The headspin was a new experience. We felt rebellious, revolutionary, cool. Vapes then started appearing at parties, the beach, the cinema.

But when friends started vaping regularly in the bathrooms at school, it became clear this device – resembling a coloured pen, bright and slim (concealing the fusion of wires, batteries and chemical compounds) – was here to stay.

During assessment-intensive periods at school, vapes act as a coping mechanism, a seemingly indispensable form of stress relief. Is this really the way we want our youth to be dealing with the challenges life throws at them?

The highly addictive, flavour-filled substances in vapes are engineered by profit-hungry foreign manufacturers who, I fear, pay little attention to the long-term health implications of their product.

What began as youthful self-discovery and experimentation has descended into a state of unfettered addiction among the adolescents – boys and girls – I know, some as young as 12. This is because vapes are too accessible, too easy. For me, having seen this obsessive relationship with vaping in all types of peers, including those who excel in sport or academic work, the extent of the issue becomes overwhelmingly clear. Vape addiction does not discriminate – everyone is susceptible.

So why should you care?

A Victorian father is warning parents about the dangers of having vapes near children after his son was hospitalised with what are believed to be the effects of smoking one.

The full negative health implications of vaping are as yet unknown. But the concern is that the recurrent inhalation of chemicals will do significant damage to the underdeveloped lungs and brains of teen vapers. However, from my perspective, far worse is the impact that this dependency and incessant craving has on the mental and social wellbeing of my peers. Teen brains aren’t prepared for the burden of addiction.

We know adults are largely oblivious to the scale of the problem, so how can we ask for help when we know the first reaction of the unprepared parent is likely to be a reprimand rather than a helping hand?

The cognitive dissonance of knowing vaping is harmful, while not being able to stop, is taxing on the mental wellbeing of adolescents. We have little experience of addiction and are not taught to deal with it. We know it’s harmful, we know it’s toxic, but we can’t stop.

Vaping is no longer a fad; the fun has been over for months now. From what I can see in my circle, few people who vape actually want to vape.

Government education campaigns will be largely impotent against the vape culture because addiction, by nature, does not just end by the push of a button. It takes personalised support, resources and encouragement to curb the dependency. Where is all this when we need it?

Vulnerable, developing brains are suffering at the hands of an insidious device, yet this challenge is only now starting to receive attention.

Seeing friends and peers suffer is shattering. This is Australia’s future we are talking about.

Ari Katz is a high school student in Sydney’s Eastern Suburbs

24/02/2022

Loneliness and its solutions

25 February 2022

I sometimes watch Foreign Correspondent on ABC TV and by chance on 15/2/21 I came across this excellent programme on loneliness in Japan.

The ABC correspondent there looks at loneliness in the Japanese population from older folk dying alone, to younger people simply withdrawing from society.

Some of the older ones had no family or jobs. Some of the younger ones were so pressured to succeed and felt that they had failed, so simply withdrew from society. It seems that the pressure on kids all to be CEOs is an absurd and unachievable objective.

I am not sure that the situation in Australia is as bad, but I thought about some of my patients and could think of half a dozen immediately. With some of them , I am one of the only two or three people in the world they have any contact with, their relationships are tenuous.

None of them started with mental health problems. Here are some examples:

A 60 year old man worked for a security company looking after an insurance company. He was doing surveillance for them, but it took over his life as he was contacted 24 hours a day for various crises. Case management employees having conscience over what they were doing had to be rescued from self-harm in the toilets. Enraged claimants with refused claims threatened to blow up the company offices with cans of petrol. He saw staff high-fiveing as some claimant got a derisory settlement when they deserved and needed a lot more. It went on like this for years. When he said that he could not do this anymore he was treated as badly as any of the people he had dealt with. He told me this story, and I had hoped that with his considerable management skills and experience, he could be put into a less stressful position. But he deteriorated. Everything reminds him of the corruption of the world. He is estranged from his wife and they communicate with post-it notes on the frig. He goes for a walk at 11 at night so he will not have to speak to people in the street. One son has stuck by him and visits daily, and will build him a self-contained unit in his new home.

Another patient is a 62 year old ethnic taxi driver who was so badly bashed 11 years ago by a gang stealing his takings that he lost an eye, has never worked again and never recovered mentally or physically. He was divorced; lives alone and sometimes will not even answer the phone.

One is a 42 year old foreign student who came to study theology, wanting to become a pastor. Her English is not great. She is a trifle unworldly, and thought that the world is basically kind and people look after each other. She had a casual job in a motel and her boss asked her to move a bed down the stairs between floors. She said it was too heavy and she could not, but he threatened to sack her. She did it and got an injury to two discs in her back. She was frightened to have surgery, so was in agony for a couple of years and eventually agreed. She had minimal surgery, which was not successful. The insurer decided that she was not complying with what they wanted so refused to pay her. She was effectively broke and homeless, so an old lady from her church offered her a bed and food. But she lives a long way away and up a drive that is hard for my patient to walk up. She was effectively trapped. As a foreign person she did not even have Medicare for the minimal psychological help it offers (6 visits a year). Her mental health deteriorated and she shunned all outside contact, and would not even answer the phone. She has gone home to her family- I can only hope she improves there.

One is a 39 year old from a religious and teetotal family with a high sense of ethics. He was a top salesman of a computer company and became aware that they were ripping off some customers. He drew this to management’s attention, but they declined to do anything and he was labelled a whistleblower. Management supported him by putting out an email asking that he be supported for his mental health issues. He felt that this ostracisation was the end of his career, because he had asked them to behave ethically. He was certain that no one in his tight top group will now employ him, so he withdrew and started to drink to lessen the pain. His family then rejected him because of the drinking and his sales friends are estranged also. The psychologist gives him Cognitive Behavioural Therapy exercises and I try to get him to drink less and somewhat ironically counsel him that you cannot withdraw from the world merely because the baddies generally win. He lives alone, answers the phone and is just able to do his own shopping, but is not improving much.

These are just some examples that I know. Coasting home as GP at least keeps you in contact with life. The point is that many people have broken lives, but just keep living. None of these examples have done anything wrong themselves. Is a sense of ethics a mental illness?

As everyone has to ‘look after themselves’ in a consumer-oriented society, more people will fall through the cracks, especially as the gap between rich and poor is enlarged by pork barrelling which puts resources into areas that need them less, tax breaks for the rich, subsidies for private schools and private health insurance, derisory welfare payments, and insurers allowed simply to refuse to pay without penalty.

People need basic support with universal housing and universal health case. They need jobs or at least occupations and an adequate income to survive. And we need outreach and support services that can be called upon.
When people say, ‘There are not enough jobs’, they are taking nonsense. Anyone can think of many worthwhile things that need doing. And there are plenty of people who would be happy to do them. The problem is that in a world where nothing can be done that does not make a profit, a lot of things that need doing are not done. That is where the policy change are needed. We cannot simply look at the money and see to what level existing activities can be maintained. We need to look at what needs to be done, and then work out how to achieve it. We need to decide that everyone has a right to live and those who have a good life will live in a better society if everyone can share at least a basic quality of life. There has to be recognition that the ability to be profitable need not be the overwhelming criterion for what is done. Tax may go up, but if there is real re-think of priorities, it is not likely to be all that much.

The link to the ABC program that initiated this tirade is below.
https://iview.abc.net.au/show/foreign-correspondent/series/2022/video/NC2210H002S00

16/01/2022

Djokovic goes to Gaol or exile while Hillsong goes Scott-Free.

16 January 2022

Today Novax Djokovic is in Court trying to stop Immigration Minister Alex Hawke deporting him before the Australian Open Tennis starts tomorrow. For those who don’t follow tennis and have been sleeping under a rock, he is the number one seed and if he wins, he will be the first player to win 21 Grand Slam tournaments and as such, the Greatest tennis player Of All Time (GOAT).

Last time he went to Court he won, because the issue was whether the government or Djokovic had done the wrong thing in the visa application process. He won with costs and the government was heavily criticised by the Court (not to mention the rest of the world).

This time is different. Minister Alex Hawke, a young ambitious religious Conservative right-wing numbers man has excluded him in that he is a danger to the population from an infectious point of view, and because he is known to be anti-vaxx and will give publicity to that view. The Court decision is totally stacked the Government’s way because it only has to decide whether the Minister has the power to do this, and the legislation is written so that he would have this power and the meddlesome courts could not interfere. So what is likely to happen is that the government’s position will be upheld, Djokovic will be deported and Australia’s appalling immigration policies will be seen for the arbitrary farce that they are- beyond the rule of law.

The fact that ATAGI (Aust. Technical Advisory Group on Immigration) said that previous infection within the last 6 months could be a reason for vaccination exemption, that Djokovic had had such an infection and that a blind medical panel said that he was safe to come has been ignored. (‘Blind’ in the sense that the panel did not know the name of the person whose file they were reviewing). The point is that he is very unlikely to infect anyone, not to mention the fact that the virus has already escaped and there are few preventive measures in place. Anyone in Australia can fly into Melbourne and go to the tennis with no tests of anything and case numbers of omicron set new records every day. Djokovic has not trumpeted his anti-vaxx views, though one could argue that these are already well known. There is a whole industry telling us what famous people do and think, and that was before the anti-vaxx lobby.

Djokovic is not as popular as the ever-smooth Federer or the rougher battler Nadal, but his public image seems that he is a nice guy, if occasionally misunderstood and pretty ruthless in his quest for the top. Darker mumblings about his unsportsmanlike use of injury rules and mind games have surfaced from a few columnists recently, and one might wonder why. But this is all irrelevant. The government is excluding him ostensibly because he is a risk of infection (absolutely minimal), or that he will stir anti-vaxx sentiment (where the controversy has already done more for the anti-vax cause than his winning of the Australian Open would ever have done).

The real reason is that this government wants to look tough on border control and quarantine, having made a complete mess of the COVID epidemic, with outbreaks due to ‘careless’ border policy, (were there Hillsong groups on the Ruby Princess?), lack of purchase of vaccine, poor management of aged care facilities, and now a ‘let ‘er rip’ policy supposedly to help the economy. Today’s Sun Herald front page announces that ‘71% want Djokovic sent home’. So some hairy-chested populism is the order of the day.

On page 6 of the same Sun Herald (see below) NSW Police decided not to fine Hillsong church after videos were seen of people singing and dancing at a Hunter Valley religious camp. NSW State Health Minister Brad Hazzard is quoted as saying that the singing and dancing ban does not apply to religious groups, though it does apply to recreation facilities, nightclubs etc. Presumably a religious recreation camp is OK, but a non-religious one is a big problem. The fact that the same article notes NSW had 48,768 new cases, 2,576 in hospital, 193 in ICU and 20 deaths yesterday presumably is also irrelevant.

Is it relevant that Scott Morrison and Alex Hawke are members of Hillsong and NSW Health Minister Brad Hazzard is in the same Liberal party?

Craig Kelly has called Djokovic a ‘political prisoner’, and for once I agree with him.

If the Court agrees to deport Djokovic because the Minister said so and they cannot appeal it, it will show the world the arbitrariness of Australia’s immigration laws and the government may win a populist victory at the cost of further damage to our international reputation.

As a tennis follower who saw the US Open final, I am of the opinion that Medvedev will beat Djokovic in the tennis if they play, but it looks as though political stupidity has game, set and match.

Hillsong let off as NSW posts 48,768 new cases and 20 deaths
Sally Rawsthorne, Sun Herald, 16 January 2022
NSW has recorded 48,768 new COVID-19 cases and 20 deaths on the third day positive rapid antigen tests are included in the daily infection numbers.Of the new cases, 21,748 were self-reported from at-home tests and 27,020 were from PCR testing.There are 2576 people in hospital with the virus, of whom 193 are in intensive care units. Eleven men and nine women have died from COVID-19 in the past 24 hours.Yesterday, police confirmed they had decided not to issue a fine to Hillsong church for a camp in the Hunter Valley, after videos of attendees singing and dancing without masks sparked public outrage.‘‘NSW Police have attended an event in the Newcastle area and spoken with organisers. Following discussions with organisers and after consultation with NSW Health, no infringement will be issued,’’ said police in a statement.‘‘Event organisers are aware of their obligations under the Public Health Orders, and NSW Police will continue to ensure ongoing compliance.’’NSW’s Public Health Order prohibits singing and dancing at music festivals, hospitality venues, nightclubs, entertainment facilities and major recreation facilities.Health Minister Brad Hazzard said while the order does not apply to religious services, it does apply to major recreation facilities, which is defined as a ‘‘building or place used for large-scale sporting or recreation activities that are attended by large numbers of people, whether regularly or periodically’’.‘‘This event is clearly in breach of both the spirit and intent of the order, which is in place to help keep the community safe,’’ he said.Hillsong said the camp differed from music festivals and the organisation was committed to a COVID-safe plan.‘‘Our camps involve primarily outdoor recreational activities including sports and games. We follow strict COVID procedures and adhere to government guidelines,’’ it said.‘‘Outdoor Christian services are held during the camp but these are only a small part of the program.’’It said the video of attendees singing and dancing represented ‘‘only a small part of each service’’.Yesterday, the state government announced its rent regulation would be extended by another two months to March 2022. ‘‘Small business is the engine room of our economy and we need to make sure we support impacted businesses through this latest Omicron wave,’’ NSW Treasurer Matt Kean said. ‘‘With staff shortages and reduced foot traffic, many businesses are struggling at the moment but the ability to negotiate rent will give them a buffer so they can keep the lights on now and recover more quickly.’’Business tenants can access rent relief if they have an annual turnover of less than $5 million. Rent relief has the same eligibility criteria as the discontinued JobSaver and Micro-business Grant programs.It comes as almost 1000 NSW Health workers have resigned or been sacked after refusing to be vaccinated against COVID-19, placing further pressure on the hospital system that has seen coronavirus patient admissions almost triple within a fortnight. As hospitals and general practices are overwhelmed with surging cases and almost 6000 healthcare workers are isolated across NSW due to COVID-19 exposure, the state’s health department on Friday confirmed 995 of its 170,000-strong workforce had resigned or been stood down after refusing the vaccine.

13/01/2022

NDIS- An Unsuccessful Privatisation of the Welfare System

13 January 2022

I was never in favour of the National Disability Insurance System as I saw it as a defacto privatisation and reliance on a ‘market’ which would have another layer of assessors, who may or may not get it right in a single interview, the award of ‘packages’ of money which may or may not be enough and/or may or may not be wisely spend. The greatest problem was that as a ’market’ it would be always liable to have glossy marketing to vulnerable families, with services delivered as cheaply as possible, by unqualified people and profits skimmed off. The government coffers were topped up by increasing the Medicare levy, which just ensured that the private sector was given huge amounts of public money.

When I was in the NSW Parliament’s Social Issues Committee which looked at the issue, a key problem was that there was no actual numbers of what the needs were for disability services. There were two ways of calculating it. The first was to add up all the people on benefits on the assumption that everyone who needed benefits was getting them. The other way was to ask the Australian Institute of Health and Welfare (AIHW), the government-funded research body what percentage of the population had a disability and multiply that percentage by the population. Their answer was many multiples of those on welfare, presumably either because their relatives or support networks were looking after their problems, or there was unmet need.

It seemed obvious that:

There would be a huge increase in demand when more resources were (at least in theory) available
There would be a lot of bureaucracy that would waste a lot of money
Those actually doing the job and who knew the needs at a practical level would have less control so the decision making would worsen
There would be a lot of profiteering
Disability workers would face a race to the bottom in pay and conditions.

It might be noted that NDIS cuts out when you are 65, so the whole process restarts with recipients having to apply for a Disability Support Pension (DSP). The current government has boasted that it is putting only a third as many people on the DSP as formerly. My experience was that when the NSW government stopped all Workers Comp payments after 5 years, many people who had been on this support for 5 year at least had to apply for the DSP. Figures were rubbery as the NSW government did not want to know how many people were simply tipped off income support, but the best estimate was that about 20% got the DSP and the rest had to go on Jobseeker. I wrote a lot of detailed medical reports for people who were still unable to get the DSP, and then the government wrote to me and said that I could only charge a very modest Medicare amount to write such reports, so presumably doctors will not be able to take much time on them. I cannot write them in the time that the allowance pays. I had one patient who was 61, ethnic, unskilled and illiterate in English who had been on compensation for a back injury 13 years and was carer for an invalid wife and was refused the DSP despite my best efforts and put into the ‘mutual obligation’ multiple job application system.

But to get back to the NDIS itself, I recently chanced across this article recently from an old issue of Green Left Weekly- a personal story. It seems very credible.

My view is the NDIS needs to be abolished, but it will be very hard to rebuild a public welfare support system against a well-funded and established private lobby that is making a fortune and has at least one major party ready to undo any efforts in this direction.

NDIS is also making life harder for disability workers

Janine Brown, Melbourne, February 8, 2019, Green Left Weekly Issue 1208

I am employed as a disability support worker by a council and, since the introduction of the National Disability Insurance Scheme (NDIS), I will soon lose my job. This is my story.

I am in transition to becoming “self-employed” with an ABN (Australian Business Number), which makes me a small business, and enables me to sign individual contracts with each client.

The other alternative was to become an employee of a private company that has contracts with NDIS clients.

From these two bad choices, I decided to go with the former.

We have been told that NDIS will be much better for hundreds of thousands of Australians. But is it?

Once families receive NDIS funding, it is their responsibility to make the choices for their child or adult family member and manage their finances over a 12-month period.

The idea that they are in control of the life choices of their family member may sound appealing. But the stress levels rise with the amount of bookkeeping required and when it is difficult to clearly define their needs.

Parents are encouraged to employ an advisor, but that person is paid for by the funding for their family member. That NDIS planner will recommend “one of theirs”, someone who will ask many questions and tick many boxes but who doesn’t really know the needs and interests of the person concerned.

I was once supporting a child at home when the NDIS planner was interviewing his parents. One of the questions was “Do you own your home?” I invited the planner to meet the child but she declined, saying it wasn’t necessary.

As much as I agree with giving parents options in choosing a carer for their child, the options being presented are often inadequate to the task at hand.

By privatising the disability sector, many people are obtaining an ABN (which is easy to do online) and presenting themselves as a qualified support worker. They do not need background checks and parents who search online for support workers only see promotional material.

I am qualified and have many years of experience, but l am now in competition with an untrained person who is willing to provide “services” at a cheaper rate. They call it business. I call it a dangerous rort.

NDIS has also meant that our work is now casual: we no longer have permanent employment with leave benefits, superannuation and union support.

A few weeks ago a parent asked me to do a buddy shift with a potential new carer as she lives near the client. Having a carer nearby is appealing for parents who may need to call on you at the last minute.

l agreed to do the shadow shift. I found that the inexperienced carer had no idea about the work responsibilities or the safety measures. She had no knowledge about supporting someone who is non-verbal with behavioural difficulties, who needs support in all aspects of daily life. She appeared to be more interested in the times of shifts, rather than the child’s needs.

It is easy to be blinded by the NDIS marketing, but just as the privatisation of the aged care sector has led to cuts in staff, quality meals and wound management, the same is true for the disAbility sector.

There are also many grey areas concerning the care of people with a disability.

Statistics show that as the number of people being diagnosed with autism (done by general practioners) has increased in the past few years. This adds to the NDIS budget.

As a result, NDIS bureaucrats are thinking of using “their people” to make the diagnosis. If this happens, we can expect a decline in the numbers of people being diagnosed with autism and many who need support will not be eligible for funding for appropriate services.

Another grey area concerns supporting people transitioning from childhood to adulthood, and teaching them to become more independent.

It is sometimes possible to teach a person to take public transport to an activity. However, it becomes a crisis situation when the bus/tram/train is late or cancelled and the person has lost all points of reference and they have to navigate replacement measures.

The NDIS planner may have ticked a box for someone to take public transport to an activity when things are going well, but an unexpected or crisis situation which causes the person anxiety is not factored into the plan.

It is imperative that we continue to support vulnerable people in our community. We must not be blinded by the NDIS hype when the reality is vastly different.

www.greenleft.org.au/content/ndis-also-making-life-harder-disability-workers