Drug company-funded guidelines in hospitals:

Dr Peter R Mansfield, Director of Healthy Skepticism, writes: Re. “Public hospital “guidelines” funded by drug maker” (yesterday, item 1). There are two main dangers arising from the NSW Health Department plan to use drug company-funded guidelines in its hospitals. The first is that it will lead to further erosion of public trust in the public hospital system. The second danger is that the guidelines may be biased and so cause harm. It is well known in drug marketing circles that sponsorship of guideline writing groups is often highly effective for increasing drug sales. Drug companies are rewarded with higher revenue whenever they do whatever it takes to persuade doctors. The opinion leaders who receive drug company sponsorship are usually highly intelligent people with the best of intentions who do not believe that they are vulnerable to bias. Paradoxically it is those 3 factors that make them most vulnerable to being infected with bias without them being aware of it. At a time when the medical profession is starting to wake up to the similarity between the harms caused by invisible infections of bacteria and the harm caused by invisible infections of bias it seems that the NSW Health Department are planning to take giant leap in the wrong direction.

Dr David More writes: I think Ray Moynihan might just have gone a little over the top here. My understanding is that a major problem right now is the under use of anti-coagulants in seriously ill and at risk patients rather than the other way around. Clinicians often forget to prescribe such medicines when there is a good evidence base they should. If the guidelines were created by a panel of experts independent of the drug company it is hard to see a problem. There is a risk with some of this commentary that there is confusion between what are clearly conflict of interest situations and when there are not. I do want to be alerted to genuine conflicts but this has the feel of a bit of “beat up” to me.

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Ange Kenos writes: Roy Moynihan’s article on how a major pharmaceutical company funded deliberations on what a hospital decided… is a shocking indictment on health care in NSW. But what makes me even angrier and also feeling much sicker is that this is NOT new. Over twenty five years ago I conducted the first tertiary study into medical complaints systems ever conducted in the Southern Hemisphere. I looked at the problems, concerns, issues and guess what – this was one of the matters way back then. Pharmaceutical companies giving all sorts of gifts – medical equipment, lab coats, desks, leather chairs, computers, and even holidays/ sorry study trips to doctors and senior medical students. This sort of improper behaviour must be stopped just as all doctors who send patients to their own private hospitals (i.e. they are co owners) must so declare themselves.

World Youth Day:

Shirley Colless writes: Re. “World Youth Day: An unholy fiasco in the making” (yesterday, item 14). Alarmed at the thought that as an OAP I might not be able to get out of Sydney on Countrylink during the weeklong Roman Catholic World Youth Day, I did a bit of checking. Seems the services should still be running but the seats are being commandeered, with block bookings coming in presumably from Parish Priests urging their flock to undertake the pilgrimage to the Emerald City. So unless the PPs are badly overestimating the numbers of the faithful who want to be seen under any circumstances in Sin City and, consequently, there are going to be a lot of Countrylink seats suddenly coming on to the market, then it looks as though those of us who want to make a pilgrimage in the opposite direction will have to pay what presumably will be totally exorbitant petrol prices to escape from Sodom and Gomorrah on the East Coast. After all, someone has to make some money out of this shindig.

John Goldbaum writes: The pilgrims won’t bring anything to our economy because they are a bunch of free-loaders. The federal and NSW governments are paying for them to party at our expense and their co-religionists are billeting them. There will be no hotel rooms booked, no restaurant meals and no shopping sprees for us Australians to cash in on. It’s a one-way street. They probably won’t even fly Qantas. Give me Mardi Gras any day. Post-Mardi Gras Australian travel has Cairns booming. Kevin Rudd is not the Manchurian candidate but the Italian mob masquerading as the NSW Government is certainly doing Rome’s bidding.

Food pricing:

Ted O’Brien writes: Re. “The crazy world of food pricing: a Crikey primer” (yesterday, item 23). Do not overlook the fact that the real cost of food is the price (over the counter) plus the subsidies (through taxes). Ever since the second world war some countries which experienced severe famine in those times and afterwards have applied heavy subsidies to the production of food, the most notable being Europe. The US has applied subsidies to defend its farmers against the low commodity prices which result from those European subsidies. These subsidies have depressed market prices. The current rise in food prices should not be assessed on the basis of last year’s price, but on the basis of last year’s real cost of production. If the current price surge results in the removal of subsidies, and it should, then the price should in future more closely reflect the real cost of production. This should be beneficial for everybody. Food will not really be costing more than it did. The new pricing regime should result in increased production, especially in Australia where subsidies have been minimal. Any subsidies should then be applied to supplying people in extraordinary need.

Petrol prices at the pump:

Ross Copeland writes: Re. “Gans: Where is the petrol price data?” (Yesterday, item 15). There seems to be a lot of misunderstanding about Fuel Watch, particularly when there is a focus on the average price for petrol. Fuel Watch is not about reducing the average price; it is about giving consumers readily accessible information on where they can buy the cheapest fuel in their area. The cheapest will by definition be less than the average and sometimes by a significant amount. Some people may not worry about buying the cheapest e.g. those with a company car and a fuel card, but for many of us price is the primary factor in deciding where to fill up. In WA you can get the listed price for this day or the next and be certain that when you get to the service station the price will be as posted. So look at what price people are actually paying, rather than the average.

Rudd’s child care plan:

Noel Hadjimichael writes: Re. “$11.9 billion per annum: costing Rudd’s child care plan” (yesterday, item 10). The announced one stop shop for mothers (read parents with kids) is a good idea that might be so simple that it will work. The old baby health centres of the 1950s and 1960s (generally a state government initiative with some federal money and council real estate) were quite a good idea in a more simple age. What is needed now is some real politic from Canberra: just get over the issue of the non-selection of the AMA President to the 2020 summit and offer her a co-chair to the health stream. Having someone in the tent (when big ideas are fished) is always better than having someone outside. Swallow the medicine for the sake of a win all round. If the Arts stream can have more than one chair, the health stream can have an extra co-chair. Commonsense dictates that the Summit should succeed on the health issues at least.

2020 Summit ideas:

Warren Driver writes: Re. “2020: My 200 words” (yesterday, item 5). Robert Manne’s “Your idea” piece for the 2020 summit was 262 words. May I suggest an edited version of his plea for greater involvement of parliamentary committees, debates and questions in the decision making process:

My idea;
More talk and less action.
Robert Manne,
academic who can’t count.

Let’s hope the 999 people are less verbose.

Harry Potter and the Intellectual Property Rights:

Mark Freeman writes: Re. “Harry Potter and the battle for free speech” (yesterday, item 20). Dear Crikey, once again we see the problematic nature of intellectual property rights in the realm of cultural works. The biggest problem is that IPR laws restrict access, such as in publishing rights splits between North America and the old British Empire or when books, films etc are out of print but you can’t copy, lend etc your copy to someone else. Also you can’t compare the protection of content to that of the physical forms used to make them. If I don’t want to pay for a particular word processor software or hardware printer there’s others to choose from that won’t affect my outcome much. But if I can’t access a particular cultural work, someone suggesting a similar one doesn’t cut it. Finally, in the Rowling case, what’s wrong with making a deal? If it does well so does she, if it’s the stinker she claims, it’ll sink of its own accord. All she’s doing is giving this guy publicity money can’t buy. Is there more to this than meets the eye?

Nick Evans writes: Charles Richardson should probably have taken a closer look at the facts of the Rowling case before sounding off – from court filings in the case 90% or so of the book appears to be direct quotes from the Harry Potter series, lifted without changing so much as a word here or there. There are quite a number of books of commentary and scholarship on the Harry Potter series out there, none of which have been the subject of legal action from Rowling’s camp – in fact, she was happy to allow the original website to remain, providing it wasn’t making money from her words. If I went through my Crikey archives, pulled out the “Best of Christian Kerr”, bound it up and tried to flog it without paying royalties to Kerr, and got smacked down by the courts, would Richardson be as outraged on my behalf? You don’t sell your words to a publisher, you sell the right to publish them, and that’s what is at stake here. Rowling won’t lose a cent either way in this case, but plenty of less wealthy authors might if it turns out that any publisher can take their works and repackage them up without paying for the right to do so.

Indigenous Australia:

Chris Hunter writes: Re. “Can we ever “close the gaps” in Indigenous outcomes?” (Yesterday, item 2). The problem with academic solutions is that they never leave the drawing board. My advice to any concerned white intellectuals is that they get off their ar-es, jump in their loaded trucks, head down to the local black fella camp and start redistributing “their” advantage. Christ, I’ve done it heaps of times over the years and will continue to do it till the day I die — because there won’t be any solutions before the day I die. Words neither clothe nor feed anyone. Can’t they work that out in Canberra?

Unelected figures:

Walt Hawtin writes: Re. “Richard Farmer’s political bite-sized meaty chunks” (yesterday, item 11). Richard Farmer’s comments on the role of Governor-General, and his hope that we do not “… have an unelected figure telling the nation what it should do”, sound valid enough. But I’d be disappointed if the voices of mature and considered individuals who are currently (and formerly) in public life, like Governors-General, former PMs, High Court Judges, are silenced because they are “unelected” and therefore not qualified to influence public opinion, and therefore public policy. Frankly, if Kevin Rudd has the courage to call 1,000 people together to generate some new insights and ideas for his government, he can certainly handle someone like Sir Gus Nossal having a crack at him over research funding, for example. As a society, we gain enormous intellectual value from experienced, mature people such as Malcolm Fraser, or Quentin Bryce, or Michael Kirby, when they feel it is important enough to publicly comment on issues that concern them. Firstly, it is a courageous act. Secondly, it provokes debate. And finally, it is usually driven by genuine and transparent motives. Elected politicians and professional commentators are usually commenting for less apparent reasons. So, as long as the media are smart enough to report on relevant comments from this country’s intellectual jewels, then the majority of Australians would certainly prefer to hear from them.

Letters to the editor:

Terry Sedgwick writes: “Crikey displays a lack of judgment in publishing an item that actually reveals nothing except someone doing her job properly. If only others at The Age performed their tasks so conscientiously.” So says Gideon Haigh (yesterday, comments). Doing the letters editor job properly involves congratulating colleague Jim Schembri on his good work. “I enjoyed your piece this morning and was hoping it would p-ss off a few film-makers enough to generate a good debate.” Yep, the mark of a good piece is its capacity to fulfil the letters editor’s wish of p-ssing off people to generate letters debates. The letters editor apparently loves the smell of burning confection in the morning. Yep, the assassination of Franz Ferdinand Karl Giuermo Anikò Strezpek Belschwitz Mòric Pinche Bálint Szilveszter Gömpi Maurice Bzoch János Frajkor Ludwig van Haverbeke Josef von Habsburg-Lothringe (yep, that was his full name) by Gavrilo Princip at Sarajevo p-ssed off quite a few people and generated a stirring debate between 1914 and 1918.

Bloody Malcolm:

Gracie Daniel writes: Re. Crikey’s subject line. I have been waiting patiently for that joke to unravel for days now. Hilarious. A bloody mary is traditionally a hangover drink when you have foggy memories of your former hour of power from the night before… uncanny the similarities; it is almost life imitating art (if you can call tomato juice, vodka and celery art).

Final word: Religion and cults:

Jason Ives writes: William Schultink (yesterday, comments) seeks to clarify the difference between religions and cults, but as an ignorant atheist I grow more confused. Schultink writes: “a religion has a basic set of beliefs that everyone in that religion adheres to”, while cults “are groups that have grown out of a certain religion, but do not hold to its basic tenets.” In the case of Christianity, belief in Jesus Christ as the Son of God is cited as the distinguishing factor. Presumably this is why Schultink holds that Senator Fielding’s “religion” is not an extremist cult. Does this mean that the polygamist Fundamentalist Church of Jesus Christ of Latter Day Saints is a religion? After all, its adherents believe Jesus to be the Son of God, as do those of Mormonism, more broadly. Or are these guys an extremist cult? Forgive my confusion, but from where I sit, “cult” seems to be the label that one religion attaches to another it doesn’t like. However, they’re all the same to me.

David Menere writes: I searched without success for confirmation of the novel definition Willem Schultink produced in an effort to extricate himself from his attempt to identify Senator Fielding’s evangelical beliefs as part of mainstream Christianity- until I found a reference under “cult” in Wikipedia that noted that “conservative Christian authors, especially evangelical Protestants, define a cult as a religion which claims to be in conformance with Biblical truth yet deviates from it.” That might explain it. For the rest of the world though, a cult is still a system of religious worship directed at a particular entity or object.

Richard Lawson write: Re. Willem Schultink (yesterday, comments). The confusion between religions and cults is irresolvable (“I’m in a religion, you’re in a cult”), however by Schultink’s own definition isn’t Christianity just an unusually successful Judaic cult, or is there some sort of statute of limitation?

Send your comments, corrections, clarifications and c*ck-ups to [email protected] . Preference will be given to comments that are short and succinct: maximum length is 200 words (we reserve the right to edit comments for length). Please include your full name – we won’t publish comments anonymously unless there is a very good reason.

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