conflicts of interest

Oct 28, 2011


Further to the recent discussions about the Medicines Australia sponsorship of The Australian’s series, the Health of the Nation…

Medicines Australia has now confirmed that as part of the arrangements with News Ltd, they have 20,000 copies of the Health of the Nation magazine to distribute.

A spokesman said: “We are distributing them among our 50 member companies, and have given about 750 to the Consumers Health Forum”.

This reinforces what a tremendous marketing coup the arrangement has been for Medicines Australia (as argued in comments at the bottom of this post).

Update, 2 Nov: I asked Clive Mathieson, editor of The Australian:

Q: Did you know that this was part of the deal with Medicines Australia? If so, did you have any concerns about how this would look for editorial independence (ie the sponsor of the series also being part of its distribution – an arrangement more common to advertising supplements).

Clive Mathieson: I was aware of that arrangement. It’s not uncommon for us – or other newspapers – to print extra copies of publications for commercial partners to distribute. The magazine was identical to the one that appeared in The Australian. And, as I have said before, Medicines Australia had zero input into the editorial direction of the magazine or its content.


Continue reading “The pharma industry is also distributing The Australian’s health series…”

climate change

Oct 28, 2011


Rural health issues are likely to be in the news thanks to a conference starting in Alice Springs today, hosted by the Rural Doctors Association of Australia (RDAA) and Australian College of Rural and Remote Medicine (ACRRM).

Perhaps any discussions about rural health should also be contemplating the impact of climate change – that’s the suggestion from a number of recent articles.

The Australian Journal of Rural Health has an editorial from the ANU’s Professor Tony McMichael, who writes that rural and remote communities can expect to feel the increasing brunt of human-induced climate change:

“… as global climate change progresses over coming decades, dust, smoke, flames, water and wind will impinge more damagingly on many of Australia’s rural and remote communities. Property, harvests, incomes, jobs and community vitality are at risk. More troubling, there are great risks to physical and, in particular, mental health.”

McMichael overviews four studies in the journal:

• A study of a community-development intervention in rural communities (the Rural Adversity Mental Health Program), which he says provides encouraging evidence that a combination of mental health literacy, enhanced social and service provider networking and activity, and education about coping with drought can engage whole communities in collective response to the threats posed by drought.

• A study evaluating the experiences of 150 older NSW farmers, which found that, although they faced the same drought-related pressures as their younger peers, their difficulties were compounded by the constraints of ageing, by seeming to fight a losing battle to cope with rapid social and agricultural changes (including the perceived high-handed imposition, by government, of new procedural demands on farmers), and by the draining experience of a pervasive sense of loss. As well, many were reluctant to use mental health services.

• A study investigating the experiences and feelings of young people, which found that many were worried about the social and economic impact of drought on their families, communities and futures. The study also revealed a need for a more coordinated support system within rural schools, more information about mental health and where to go for support for themselves and their friends – from people who really understand drought and rural circumstances.

• A study exploring the experiences, needs and wishes of Indigenous Australians in rural NSW, which found that the recent drought had adversely affected Aboriginal social and emotional well-being – by disrupting culture, exacerbating money pressures and causing a sense of loss, particularly in relation to the land.

(The journal and Wiley have kindly made the link to McMichael’s editorial freely available in response to a Croakey request but the other papers mentioned are subscriber only.)

Meanwhile, thanks to Medical Observer for allowing re-publication of this interview with Dr Rob Grenfell who has a first-hand understanding of the impact of natural catastrophes upon the health of individuals and communities.


Mental toll of climate change

Andrew Bracey writes:

Earlier this year, Victorian GP and public health physician Dr Rob Grenfell was asked  to contribute his observations and experiences about climate change and its impact on mental health to a landmark Climate Institute report. Continue reading “Climate change and rural health: a GP’s call for action, plus an update on recent studies”

conflicts of interest

Oct 28, 2011


Adam Cresswell, the health editor at The Australian, responds to recent comments at Crikey and Croakey, about the newspaper’s Health of the Nations series that was sponsored by Medicines Australia.

Adam Cresswell writes:

The most remarkable aspect of the criticisms of The Australian’s recent Health of the Nation series  is that few of the individuals making the comments seem to have read a word of it.

Charles Ornstein, president of the US-based Association of Healthcare Journalists, does at least concede this. For most of the others, including Amanda Wilson, Wendy Lipworth and Gary Schwitzer, the omission is implicit in the points they make.

Does this matter? To borrow a phrase from Gary Schwitzer, you bet it does – for it allows a blurring of two quite separate issues.

On the one hand, there are the overall principles, and whether media organisations can insulate their coverage from the conflicts of interest such arrangements risk creating.

Secondly, there is the more specific question of whether the HOTN series did in fact pander to the commercial or other interests of the drug industry.

These questions appear to have been treated as one and the same. What results is a melange of speculative and unfounded commentary that wrongly implies The Australian and its journalists were either told what to write by Medicines Australia, or recognised on which side their bread was buttered and toed a corporate line without explicit instruction. These implications are completely false. Continue reading “Adam Cresswell responds to concerns about Medicines Australia’s deal with The Australian”


Oct 27, 2011


Just to let you know that Croakey (and the other Crikey blogs) will be offline for a while (down-time scheduled from 10pm tonight til 10am tomorrow) while some renovations are done on our “back-end”, as the IT people say…

global health

Oct 27, 2011


Meanwhile, while we’re on the subject of pharma-power (as per previous posts), the article below suggests that the US is attempting to use trade negotiations to influence medicines policy in Australia.

Dr Deborah Gleeson writes:

Leaked documents from the Trans Pacific Partnership (TPP) Agreement negotiations currently underway in Peru show the US is seeking to use the agreement to increase the monopoly rights of pharmaceutical companies and undermine the effectiveness of pharmaceutical reimbursement programs like Australia’s Pharmaceutical Benefits Scheme.

The TPP is a proposed regional trade agreement involving Australia, Brunei, Chile, Malaysia, New Zealand, Peru, Singapore, the United States and Vietnam.

The texts, leaked over the weekend, include an annex on ‘transparency and procedural fairness for healthcare technologies’ and extra provisions for an intellectual property rights chapter that was leaked in February this year.

The annex includes clauses that would undermine the ability of schemes like the PBS to set prices for medicines that are affordable to governments and consumers. Particularly concerning is a clause specifying that prices paid to drug companies must be based on ‘competitive market-derived prices in the Party’s territory’, or other benchmarks that ‘appropriately recognize the value’  of the patented product. Continue reading “US wants to give pharma more power over our medicines policy”

pharmaceutical industry

Oct 27, 2011


As mentioned at the previous post and in an article in today’s Crikey bulletin, the related issues of conflicts of interest and pharma marketing are a fertile field for investigation by researchers and journalists.

You can get some sense of this from the list of recent articles in this conflicts of interest document.

This compilation is from Healthy Skepticism, and is provided as a free email update service to journalists (worth signing up for in my book).


conflicts of interest

Oct 27, 2011


(Additional comments are being added to the bottom of this post as they land)

As you may have seen, The Australian has been running articles and video clips about health policy in a series called “Health of the Nation”, sponsored by The Australian Medicines Industry, an initiative of Medicines Australia.

The series culminated in a glossy, 24-page magazine published on the weekend that included feature articles, and advertorials and advertisements for the pharma industry.

I have written a news story for the BMJ raising concerns about the project (subscriber access only, let me know if you’d like a copy), and also a piece for today’s Crikey bulletin.

Below are comments on the arrangement from Medicines Australia, leaders in health journalism, researchers, and others.


Statement from Medicines Australia (provided for the BMJ story)

It’s important that the Australian public understands the contribution The Australian Medicines Industry makes to the health and wealth of the nation. Many Australians aren’t yet aware of that contribution.

That is why we want to have a conversation with the community and introduce ourselves as The Australian Medicines Industry.

This initiative is to ensure the Australian public has a better understanding of The Australian Medicines Industry and our contribution to the health and wealth of the nation, as a major employer, exporter and investor in local R&D.

Medicines Australia has a commercial agreement with News Ltd. The value of that agreement is commercial in confidence. The commercial agreement does not extend to any control or influence whatsoever over editorial generated by News Ltd journalists.

The agreement arose out of meetings between News Ltd and Medicines Australia which recognised common interests.   Continue reading “Concerns raised about pharma-sponsored health journalism at The Australian”

Health inequalities

Oct 26, 2011


A vision for Aboriginal and Islander health reform in Queensland was recently launched at Qld Parliament House, with the support of the Minister for Aboriginal and Torres Strait Island Partnerships, Curtis Pitt.

In the article below, Selwyn Button, CEO of the Qld Aboriginal & Islander Health Council, explains some of the background to A Blueprint for Aboriginal and Islander Health Reform in Queensland, including the national health reform agenda’s blind spots around Indigenous health.

Button also outlines the key elements of the document, including a call for the National Health Performance Authority to have a specific focus on Indigenous health, and for governance mechanisms to oversee the local impact of national reform upon Aboriginal and Torres Strait Islander people.

The document also calls for the community controlled sector to develop better ways of working together and ensuring the sector’s capacity to respond collectively to health reform implementation.

The document clearly has Queensland as its focus, but it may also have some useful leads for other jurisdictions.



How can we ensure that health reform promotes Aboriginal and Islander health?

Selwyn Button writes:

The Blueprint has been a culmination of activities that have taken place over the last 12 months in the community controlled health services sector in Qld, and represents a significant shift in the mindsets of community controlled organisations nationally.

Firstly, it must be mentioned that the Blueprint was developed not only from community controlled desire, but also necessity, as there remains very little detail about how national health reform policy changes will ultimately affect the health and well being of Aboriginal and Torres Strait Islander people.

Rather than waiting for someone else to come up with the solutions, the Qld community controlled sector, through its membership and participating communities, provided direct input to QAIHC about what these should look like. Continue reading “How can health reform help Aboriginal and Islander health: a practical vision”

global health

Oct 26, 2011


With the European financial crisis in the headlines, let’s not forget that these are important matters for peoples’ health, as well as the world’s bank balances.

A US study tracking people older than 50, published last week in the American Journal of Public Health underlines the link between financial stress and health. It found those who had fallen behind in mortgage payments were also more likely to suffer a deterioration in health than those who had kept up their payments.

You can read the abstract here (pay for full paper). In this report on the study from Science Daily, one of the researchers suggests that the housing crisis in the US may be making health disparities worse. No surprises there.

(As an aside, the researchers used the unfortunate terms “mortgage delinquents” and “nondelinquents” to describe those who who had been unable or able to keep up their payments).

Meanwhile, in the article republished below from The Conversation, Professor Stephen Leeder, a Director of the Menzies Centre for Health Policy at the University of Sydney, examines the state of health services and public health in Greece in the wake of economic crisis there.

Leeder reminds us of the sensitivity of health and health care to financial and economic fortune, and observes: “Health, like goodwill, takes a long time to establish and can be lost quickly.”

But will the peoples’ health be a top-of-mind issue for the world’s financial and political powerbrokers?


Financial crisis takes toll on Greece’s health

Stephen Leeder writes:

Another round of violent protests erupted in Greece last week, following the latest austerity cuts to public service jobs and pay. Meanwhile, the creeping consequences of austerity measures are beginning to show, with the nation facing a sharp increase in suicides and restrictions on access to health care. Continue reading “The financial crisis and what it means for peoples’ health”


Oct 25, 2011


(Nov 23: see update at bottom of post)

What are the strengths and limitations of eHealth technologies in primary health care?

Olga Anikeeva at the Primary Health Care Research and Information Service is drafting a “research round-up”  about the use of eHealth technologies such as electronic health records, decision support systems and e-prescribing software by primary health care providers in Australia.

If you’ve an interest or expertise in the area, and can spare a few minutes – please have a look at her draft below and send your feedback by November 3 (contact details are at the bottom of the post).





eHealth aims to improve the quality and safety of Australia’s health system byintroducing a more efficient way to collect and share information such as prescriptions and test results.1 The primary health care sector could benefit substantially from thewidespread use of eHealth technologies.2 The National E-Health Transition Authority is currently working with numerous stakeholders, including GPs and allied health professionals to develop an eHealth uptake plan.2 This RESEARCH ROUNDup focuses on the use of eHealth technologies in primary health care, by exploring the benefits and current limitations of a number of eHealth tools. Continue reading “Your thoughts on the good and bad of eHealth in primary health care?”

adverse events

Oct 25, 2011


Continuing a series of regular updates of health and medical reading at The Conversation

Thanks to Reema Rattan for providing this summary, which covers articles about the safety of vitamin supplements, health financing, humane approaches to preventing crime, disability services, ghostwriting of research articles, patenting of stem cell inventions, and the latest legal developments in the Vioxx case.


Vitamin supplements: more harm than help?

By Ian Chapman, Associate Professor and Senior Specialist Endocrinologist at The University of Adelaide

A study published in the Archives of Internal Medicine has investigated the link between taking dietary supplements and an increase risk of death in older women. Continue reading “Latest health and medical news from The Conversation”

complementary medicines

Oct 23, 2011


We’ve already heard buckets of criticism of the deal between the Pharmacy Guild and Blackmores, which would have seen pharmacists prompted to promote Blackmores products as “companions” to certain popular medications.

In the article below (first published in Medical Observer), Dr Ken Harvey, Adjunct Senior Lecturer, School of Public Health at La Trobe University, looks at some of the broader issues involved.

He calls on the TGA to provide information about whether specific complementary medicines have been evaluated, and for the National Prescribing Service or similar groups to provide more independent information about evidence-based complementary products that have not been registered.

(Update: On 26 October, a related article, from Carol Bennett of the Consumers Health Forum, was added to the bottom of this post).


A call for independent information about complementary products

Ken Harvey writes:

The Pharmacy Guild says its deal to promote Blackmores complementary medicines (CMs) has been withdrawn in view of “media reporting of the endorsement which was ill-informed and inflammatory”.

My own view is that the deal itself was ill-informed and inflammatory. It involved an undisclosed payment by Blackmores to enable GuildCare dispensing software to prompt pharmacists entering prescriptions to on-sell Blackmores “Companion” products.

The four Guild-endorsed Blackmores products were a probiotic to be promoted with antibiotics, zinc with blood pressure drugs, coenzyme Q10 with vitamin D3 for statins and magnesium with proton pump inhibitors.

The National Prescribing Service (NPS) and others have pointed out that there is no good evidence to support the routine use of these supplements with the prescription drugs targeted.

In addition, this practice would unnecessarily add to the “medication burden” experienced by many patients taking multiple drugs, including compliance difficulties, increased cost and potential drug interactions.

Finally, it presents ethical problems for GuildCare (who were recommending one brand only) and for individual pharmacists (who would benefit financially if they went along with prompts that may not be in their patient’s best interest).

Several polls have shown that the deal diminished the standing of pharmacists in the eyes of consumers and medical practitioners. Continue reading “Consumers need much better information about complementary medicines”

environmental health

Oct 21, 2011


Emeritus Professor Bob Douglas writes:

Earlier this month in Geelong, I attended a National Summit on “Transforming Australia”. This was a three-day meeting of 60 invited activists from various civil society groups around Australia.

We were united by a common concern that Australia will not be able to deal effectively with the problems that now confront the human world without transformative change in the way we manage our institutions, and especially our economy.

The firm view of this group was that simply tinkering around the edges of “business as usual” is a formula for national catastrophe. The starting point for most of the participants was that we must urgently transform our governance, our economy and our culture in ways that will permit our descendants to live within the limits of nature’s economy.

Australia’s political system is largely ignoring the seriousness of the gathering storm that includes climate change, peak oil, disastrous loss of ecosystems, increasing world hunger and inequity and continuing growth in the human population.

It is currently incapable of addressing these issues because it is being corrupted by the special interests of the status quo. If our children are to survive to a ripe old age we must transform our political institutions, including especially the way they are funded.

The Geelong Summit was the 5th meeting I have attended on this topic in the past 18 months. The Transform-Australia movement is still in its infancy but it is a growing network of thinkers, researchers, environmentalists and social policy activists.

The summit was an opportunity for sharing understanding and assets and to explore together, the process of building a radically new way of thinking about Australia’s future. Continue reading “Why we need to transform Australia: leading public health expert”

Health inequalities

Oct 21, 2011


Predictably, the international conference on the social determinants of health held in Brazil this week failed to generate widespread media interest – even though related issues were in the news thanks to the globalisation of the Wall Street sit-in movement.

One exception was this piece from Time Magazine, How Economic Inequality Is (Literally) Making Us Sick, which begins:

Imagine there was one changeable factor that affected virtually every measure of a country’s health — including life expectancy, crime rates, addiction, obesity, infant mortality, stroke, academic achievement, happiness and even overall prosperity. Indeed, this factor actually exists.

It’s called economic inequality. A growing body of research suggests that such inequality — more so than income or absolute wealth alone — has a profound influence on a population’s health, in every socioeconomic group from rich to middle class to poor.

Meanwhile, Fran Baum, professor of public health at Flinders University and one of an Australian contingent at the Rio conference, has thrown down a challenge to the WHO in an article at BMJ Group Blogs, expressing her disappointment with its work in this area.

Baum says the background paper prepared by the WHO for the Rio conference failed to advance the agenda set by the Commission on the Social Determinants of Health, or CSDH (on which Baum was a commissioner).

“It certainly does not set a clear agenda for future action by the WHO,” she wrote. Continue reading “Has the WHO lost the plot, when it comes to tackling the social determinants of health?”

Earlier this year, Croakey ran a series of articles examining the potential for physician assistants to extend the capacity of health services in under-served areas, particularly rural and remote Australia.

In the article below, Sharon Barnwell and Allan Forde provide an update – and a reminder that if you know someone who might be a candidate for PA training, applications are now open for the James Cook University course…


Despite some setbacks, momentum is gathering for the physician assistant role

By Sharon Barnwell and Allan Forde

Last time we wrote for this blog, we talked about the reasons James Cook University decided to implement a physician assistant (PA) program.

JCU had embraced the potential for an alternative to the one-doctor rural town and was pushing ahead developing the program, recruiting PAs from the United States and regularly consulting PA educational institutions and Queensland Health.

Spirits were high, with the University of Queensland’s first cohort almost completing their course and other universities considering implementing a similar course.

Queensland and South Australia had both run independently evaluated pilot programs, which were found to have more than reasonable potential.

Since then, however, the outlook in Australia for PAs has been less than clear – the University of Queensland’s program will be dismantling their course after the second cohort graduates in June 2012, and the PA model appears a political casualty in Queensland and South Australia, partially due to entrenched opposition from a few powerful organisations fearful of change.

It may seem that physician assistants have become the irrelevant victims of a negative media campaign even before they’ve gotten off the ground… But JCU does not buy this and continues to move forward in the development of a PA course. Continue reading “Physician assistants: an update on the policy, politics and state-of-play”

Media-related issues

Oct 21, 2011


The Centre for Obesity, Diabetes and Cardiovascular Disease at the University of Sydney held a symposium last week on the use of mobile, social media and Web technologies in healthcare delivery and health communications.

I noticed that Carolyn Der Vartanian, a researcher and active member of the Health Care and Social Media in Australia and New Zealand twitter chat group, was tweeting from the symposium, and asked if she would mind also writing about it for Croakey readers.

Her report, below, also cites tweets from other #hcsmanz and Croakey contributors.

Meanwhile, those with an interest in this burgeoning field will have a chance to hear from one of its international pioneers at a Sax Institute forum in Sydney on November 9. Lee Aase is director of the Mayo Clinic Center for Social Media (which this week held a Social Media Summit).

According to the Sax forum blurb, the Mayo centre is committed to using social media’s “revolutionary tools to spread knowledge and encourage collaboration among providers, improving health care quality everywhere”.


A glimpse into the future of social media and healthcare

Carolyn Der Vartanian writes:

The Centre for Obesity, Diabetes and Cardiovascular Disease symposium heard presentations from a variety of faculties and disciplines, including sociology, information technologies, the humanities and electrical engineering – reflecting the broad impact of emerging communication technologies on all aspects of health.

Robert Steele, the symposium Chair and Professor of Health Informatics’ stressed that the future of communication and technology is indeed mobile as by 2012 six billion people will have mobile phones.   Continue reading “Social media and healthcare: recent news and developments”

climate change

Oct 19, 2011


Richard Smith, a leader in international public health, has been tweeting about the conference held in London earlier this week on the health and security implications of climate change, as previously mentioned.

Here are some of his tweets (for those without the time or inclination to wade the T-verse). The Twitter tag is #healthandsecurity.

Continue reading “Richard Smith: tweeting the news on climate change, health and security”

climate change

Oct 18, 2011


“Climate change poses an immediate, growing and grave threat to the health and security of people in both developed and developing countries around the globe.

“Climate change leads to more frequent and extreme weather events and to conditions that favour the spread of infectious diseases. Rising sea levels, floods and droughts cause loss of habitat, water and food shortages, and threats to livelihood. These trigger conflict within and between countries.

“Humanitarian crises will further burden military resources through the need for rescue missions and aid. Mass migration will also increase, triggered by both environmental stress and conflict, thus leading to serious further security issues. It will often not be possible to adapt meaningfully to these changes, and the economic cost will be enormous.

“As in medicine, prevention is the best solution.”

This is the introduction to a statement issued yesterday from a conference in London on the health and security implications of climate change. It was held at BMA (British Medical Association) House and convened by the BMJ.

It stands in such stark contrast to the focus of so much of the public debate in Australia since the House of Reps passed the carbon tax legislation last week. Continue reading “Climate change is an “immediate, growing and grave threat” to health and security”

conflicts of interest

Oct 14, 2011


It seems we are in the midst of a veritable outbreak of reports raising concerns about conflicts of interest in health and medicine.

Guideline developers under scrutiny

The BMJ has published a study investigating financial conflicts of interest among members of panels producing clinical practice guidelines in the US and Canada on screening and/or treatment for hyperlipidaemia or diabetes between 2000 and 2010.

The results are freely available but in a nutshell, 52 per cent of panel members had conflicts, of which 138 were declared and 12 were undeclared.

Panel members from government sponsored guidelines were less likely to have conflicts of interest compared with guidelines sponsored by non-government sources (15/92 (16%) v 135/196 (69%).

Many of the panel chairs had financial conflicts of interest.

The researchers concluded: Organisations that produce guidelines should minimise conflicts of interest among panel members to ensure the credibility and evidence based nature of the guidelines’ content.

Calls for cultural and legislative change

In a related editorial, Edwin Gale, emeritus professor of diabetic medicine from Southmead Hospital, Bristol, argues for a change of culture in medicine:

“It has been said that ‘it is difficult to get a man to understand something when his salary depends upon his not understanding it,’ and the medical profession has been slow to understand the importance of conflicts of interest….What is needed is a change of culture in which serving two masters becomes as socially unacceptable as smoking a cigarette…” Continue reading “Conflicts of interest in health and medicine: calls for a culture change”

Health inequalities

Oct 14, 2011


New Matilda recently reported on a backlash against Federal Government plans to extend income management (here is the Government’s explanation of how it will work at Bankstown in south-western Sydney).

The Public Health Association of Australia (PHAA) has added its weight to concerns about compulsory income management schemes.

At its annual conference last month, the PHAA resolved to develop a position statement for endorsement out of session by the Board to oppose population-level compulsory income management schemes.

Since then, the PHAA has been working on a more detailed position statement, as per the media release below, issued today:

PHAA statement

Delegates at the Public Health Association of Australia’s (PHAA) Annual Conference have passed a resolution opposing population level compulsory income management schemes.  “Compulsory income management for Aboriginal people discriminates and disempowers individuals and leaves them with insufficient resources to manage their own lives,” said PHAA Vice President Vanessa Lee.

“Indigenous Affairs Minister Jenny Macklin recently stated that the Federal Government is considering three models of voluntary and compulsory income management in the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands of South Australia. Income management initiatives currently in place in other states are being monitored and evaluation has not been completed – an assessment is due early in the New Year.  PHAA strongly opposes the blanket roll out of a compulsory scheme,” said Ms Lee.

“PHAA believes an intervention to quarantine welfare payments and allow families to buy food should only be implemented on a voluntary basis, as determined through a comprehensive engagement process with affected individuals, and as a last resort,” Ms Lee explained. Continue reading “Public health experts take a stand against compulsory income management”