There is no good news when it comes to climate change

University of Colorado Boulder, Cooperative Institute for Research in Environmental Sciences, National Snow and Ice Data Center (NSIDC), media release, 5 February 2018:

Scientists find massive reserves of mercury hidden in permafrost

Researchers have discovered that thawing permafrost in the Northern Hemisphere stores twice as much mercury as the rest of the planet's soils, atmosphere, and oceans. The finding has significant implications for human health and ecosystems worldwide.

In a new study, scientists measured mercury concentrations in cores of frozen ground—or permafrost—from Alaska and used the data to estimate how much mercury has been trapped in Northern Hemisphere permafrost since the last Ice Age.

They found that Northern Hemisphere permafrost regions contain 1,656 gigagrams of mercury (32 million gallons, or enough to fill 50 Olympic-sized swimming pools), making them the largest known reservoir of mercury on the planet. This amount is nearly twice as much mercury as all soils outside of the northern permafrost region, the ocean, and the atmosphere combined.

The researchers also found that of the 1,656 gigagrams of mercury, 863 gigagrams lie in the surface layer of soil that freezes and thaws each year (27 Olympic-sized swimming pools), and 793 gigagrams are frozen in permafrost (23 Olympic-sized swimming pools).

"This implies permafrost regions contain roughly 10 times the total human mercury emissions over the last 30 years," said NSIDC scientist Kevin Schaefer, a co-author of the study published today in Geophysical Research Letters, a journal of the American Geophysical Union.

"Previous studies assumed little or no mercury in permafrost regions, but we find the opposite is true," Schaefer said. "This completely changes our view of how mercury moves through the land and ocean."

"This discovery is a game-changer," said Paul Schuster, a hydrologist at the U.S. Geological Survey in Boulder, Colorado and lead author of the study. "We've quantified a pool of mercury that had not been done previously with confidence, and the results have profound implications for better understanding the global mercury cycle."

​This diagram shows the modern mercury cycle with major reservoirs in white (gigagrams of mercury) and exchanges between reservoirs in black (gigagrams of mercury per year). Northern Hemisphere permafrost contains 863 gigagrams of mercury in the Active Layer, the layer of ground that is subject to annual thawing and freezing. About 793 gigagrams of mercury is found in Northern Hemisphere permafrost. Credit: Schuster et al./GRL/AGU. High-resolution image

Permafrost is permanently frozen ground and occurs in approximately 22.79 million square kilometers, or about 24 percent of the Northern Hemisphere land surface surrounding the Arctic ocean. 

Mercury naturally occurs in the Earth's crust and typically enters the atmosphere through volcanic eruptions. The element cycles between the atmosphere and ocean quickly. However, mercury deposited on land from the atmosphere binds with organic matter in plants. After the plants die, soil microbes eat the dead organic matter, releasing the mercury back into the atmosphere or water.

In permafrost regions, however, the organic matter gets buried by sediment before it decays and becomes frozen into permafrost. Once frozen, the decay of organic matter stops, and the mercury remains trapped for thousands of years unless liberated by permafrost thaw.

"As long as the permafrost remains frozen, the mercury will stay trapped in the soil," Schaefer said. Higher air temperatures due to climate change could thaw much of the existing permafrost, allowing the decay of organic matter to resume and releasing mercury that could affect Earth's ecosystems. The released mercury can accumulate in aquatic and terrestrial food chains and cause harmful neurological and reproductive effects on animals.

"Although measurement of the rate of permafrost thaw was not part of this study, the thawing permafrost provides a potential for mercury to be released—that's just physics." Schuster said.

Climate models predict a 30 to 90 percent reduction in permafrost by 2100, depending on actual fuel emissions.

The researchers determined the total amount of mercury locked up in permafrost using field measurements. Between 2004 and 2012, the study authors drilled 13 permafrost soil cores at various sites in Alaska and measured the total amounts of mercury and carbon in each core. They selected sites with a diverse array of soil characteristics to best represent permafrost found around the entire Northern Hemisphere.

These images show soil mercury content (in micrograms of mercury per square meter) in Northern Hemisphere permafrost zones for four soil layers: 0 to 30 centimeters, 0 to 100 centimeters, 0 to 300 centimeters, and permafrost. The permafrost map represents mercury bound to frozen organic matter below the active layer and above a depth of 300 centimeters. Credit: Schuster et al./GRL/AGU. High-resolution image

Schuster, Schaefer, and their colleagues found their measurements were consistent with published data on mercury in non-permafrost and permafrost soils from thousands of other sites worldwide. They used their observed values to calculate the total amount of mercury stored in permafrost in the Northern Hemisphere and to create a map of soil mercury concentrations in the region.

The researchers believe their study gives policymakers and scientists new numbers to work with and calibrate their models as they begin to study this new phenomenon in more detail. The researchers intend to release another study modeling the release of mercury from permafrost due to climate change.

"Permafrost contains a huge amount of mercury," Schaefer said. "We need to know how much mercury will get released from thawing permafrost, when it will get released, and where."

-end-

Is the Turnbull Government spending veterans mental health funding wisely?

On the Line Limited state that it is a professional social health business that provides counselling support, anywhere and anytime, primarily via telephone, web chat and online support through the rather bluntly named  MensLine Australia, Suicide Call Back Service, SuicideLine Victoria, a Department of Defence All Hours Support Line After Hours Service and other geographically specific services.

On the Line Limited also provides tailored counselling services for corporate, member and community organisations.

According to its 2016-17 Annual Report On the Line Limited is doing very nicely thank you, with an income of over $11.3 million and $6.2m in new tenders, grants, and business opportunities.

However, it appears that this company may be falling down on the job……

The New Daily, 9 January 2018:

The government is refusing to reveal how often vulnerable veterans are unable to reach its crisis helpline for ex-service members in order to protect the bottom line of a private contractor, The New Daily can exclusively reveal.

The refusal comes as veterans’ advocates warn of a suicide epidemic among ex-service members, with support group Warrior’s Return estimating at least 84 veterans took their own lives in 2017.

The Department of Veterans Affairs claims that disclosing the call abandonment rates and wait times for the Veterans and Veterans Families Counselling Service would adversely impact the company that manages the service outside of normal business hours.

In response to a freedom of information request by The New Daily, the DVA said the disclosure would give the contractor’s business rivals information that could be used to out-compete the company.

The New Daily has appealed the decision on public interest grounds.

The DVA has awarded Melbourne-based company On the Line contracts worth at least $2 million to operate the after-hours counselling service since 2010, according to government procurement website AusTender.

The department also revealed to The New Daily that it does not collect data on the call abandonment rates and wait times for its regular hours service, which is managed in-house.

Doug Steley, an ex-service member who works with a number of veterans’ advocacy groups, said the department’s attitude was “totally unacceptable” and typical of its lack of transparency.

“Their service should be so excellent that they should be willing to boast about how good it is, and they should have absolutely no fear that a private contractor would be able to match the service to those who served Australia,” he said.

“There is no transparency in this department,” he added. “It operates on secrecy and hiding everything from the public.”

The DVA has faced repeated controversy over its treatment of veterans, with an official inquiry last year ruling it had failed to provide adequate support to 32-year-old Afghan war veteran Jesse Bird before he took his own life last June. In August, more than 100 people protested outside DVA headquarters in Melbourne to call for the establishment of a royal commission into the department’s failure to halt suicides among ex-service members.

Opposition spokeswoman for veterans’ affairs Amanda Rishworth accused the department of putting the welfare of a private firm above that of veterans.

“We expect DVA to act in the best interest of veterans – and not in the best interest of a private contractor,” Ms Rishworth told The New Daily.

“Labor thinks it is unacceptable that DVA is withholding any information that will provide greater transparency on services which directly affect those veterans and family members. It is also deeply concerning that DVA is not even collecting data on how the VVCS is performing during business hours.”

That 'very stable genius' in Washington DC has a few health issues

Well Donald John Trump had an official medical exam on 12 January 2018 and the spin began almost immediately.

First for media consumption he grew one inch taller reaching 6ft 3in in height and he became yugely healthy.

A more honest assessment is found in the written medical summary prepared by the senior naval doctor who examined him, Rear-Admiral Ronny L. Jackson.

This reveals that at 71 years of age, 75 inches or 6 foot 3 inches (190.5cm) tall and weighing 239 pounds or 17.07 stone (108.4kg) Trump has an estimated body mass index of between 29.9 to 30.9 BMI (when adjusted to height recorded on current drivers licence), which means he is at least 3 stone (19kg) over a healthy weight level.

Or to put it more baldly – he is obese.

His cholesterol level is too high even though he is taking medication, Crestor 10mg daily. 

He also takes Aspirin 81mg daily as a blood thinner for what has been describd as non-clinical coronary atherosclerosis and, uses an invermectin cream for acne rosacea.

The medication, Propecia 1mg daily, he takes for prevention of male pattern baldness is known to have a side effect of impotence or other sexual dysfunction in some individuals.

While the medication, Ambien, his doctor states he occasionally takes to help him sleep can lead to episodes of confusion, loss of coordination, balance problems, mood change, nasal irritation, dry mouth, sore throat and other possible side effects.

His diet is unhealthy and he gets insufficient physical exercise.

Trump underwent a basic cognitive test and his result score was 30 out of 30 points.

No psychiatric examination was included in the range of tests that have been made public.

The medical information Trump consented to release…….

Summary of Physical Exam for President Trump, 12 January 2018 by clarencegirl on Scribd

https://www.scribd.com/document/369372192/Summary-of-Physical-Exam-for-President-Trump-12-January-2018

Forecasting a dangerous present and devastating future for Australia

“Background warming associated with anthropogenic climate change has seen Australian annual mean temperature increase by approximately 1.1 °C since 1910. Most of this warming has occurred since 1950.” [Australian Bureau of Meteorology, Annual Climate Statement 2017]

Bloomberg, 10 January 2018:

The road-melting heatwave that made Sydney the hottest place on Earth at the weekend may just be a taste of things to come. 

Temperatures in Australia are set to rise until around 2050 due to greenhouse gas emissions already in the atmosphere, according to the country’s weather bureau. 

“Australia is one country where you really can see the signal of global warming,” Karl Braganza, the Bureau of Meteorology’s head of climate monitoring, told reporters on a call. “We’ve locked the degree of warming in until mid-century and that means it’s likely that one of the next strong El Nino events in the coming decade or two will set a new record.”

Western Sydney touched 47.3 degrees Celsius (117 degrees Fahrenheit) on Sunday and 2017 was Australia’s third-hottest year on record. Heat and drought risk devastating crops in Australia, the world’s third-largest exporter of cotton where farm production is forecast to be worth A$59 billion ($46 billion) this financial year.

The Heat is On

Australia has had just one cooler-than-average year since 2005

Since 2005, Australia has notched up seven of its 10 warmest years, the weather bureau said in its annual climate statement.

More heatwaves could stress a power grid that’s struggled to cope with demand as people crank up air-conditioning during the scorching summer months.

Australian Bureau of Meteorology Annual Climate Statement 2017, issued January 2018.

Visible impacts in 2018.................

The Guardian, 9 January 2018:

More than 400 animals have died in one colony alone as temperatures soar above 47C, causing exhaustion and dehydration

Mounds of dead flying foxes in Campbelltown suburb of Sydney, Australia. Photograph: Facebook/Help Save the Wildlife and Bushlands in Campbelltown

Joining historic 'medical' research which looked at the incidence of legume anorexia amongst children comes a ground-breaking article 'The science behind "man flu"'

Following on the very successful research behind The Etiology and Treatment of Childhood first published sometime last century comes the British Medical Journal’s release of more recent research articulated in The science behind “man flu” (11 December 2017).

In which women find out that:

The concept of man flu, as commonly defined, is potentially unjust. Men may not be exaggerating symptoms but have weaker immune responses to viral respiratory viruses, leading to greater morbidity and mortality than seen in women. There are benefits to energy conservation when ill. Lying on the couch, not getting out of bed, or receiving assistance with activities of daily living could also be evolutionarily behaviours that protect against predators. Perhaps now is the time for male friendly spaces, equipped with enormous televisions and reclining chairs, to be set up where men can recover from the debilitating effects of man flu in safety and comfort.

Ah, the hardships of the male condition are manifold.

Turnbull Government's data retention privacy blunder just rolls on and on...

“If data can be re-identified with no more than SQL, there's no "if" about a leak, and the "when" is history.” [Journalist Richard Chirgwin, Twitter 18 December 2017]

“But why are medical records so attractive? Well, it turns out that there’s a metaphorical holiday feast of enticing data served up in your average health record. Family history, demographic data, insurance information, medications, etc. means there’s enough information to completely steal an individual’s identity and commit medication fraud, financial fraud, insurance fraud and a wide array of other crimes. When this very private, unchangeable information gets into the wrong hands, devastation can ensue.” [Robert Lord writing in Forbes, 15 December 2017]

First the Australian general public were told that patient data was well protected and data breaches wouldn't happen as a result of government's drive to collect, cross-match and retain as much information about each and every Australian citizen/permanent resident as possible.

Then when the inevitable day came where poor data security was laid bare - as the personal histories of 550,000 blood donors were placed on an insecure computer and accessed, as Medicare details began to be offered for sale on the Internet's dark web and Medicare itself became careless with its encryption -  the public was told in the first instance that misuse was unlikely, in the second instance that personal medical information couldn't be accessed and that patients couldn't really be individually identified in the third instance where a billion line encrypted data set was publicly released.

After that the Turnbull Government assured the population that it would create legislation which would make it illegal for anyone to de-encrypt anonymised data and create a Notifiable Data Breaches scheme.

We were all going to be safe once more in the arms of the Turnbull Government.

Now the cat is out of the bag, because that billion-line 30 year's worth of personal health information about est. 3 million people just won't stay in the back of the ministerial cupboard where Greg Hunt shoved it.

 [Fairfax journalist Ben Grubb, Twitter 18 December 2017]

The Sydney Morning Herald, 18 December 2017:

One in ten Australians' private health records have been unwittingly exposed by the Department of Health in an embarrassing blunder that includes potentially exposing if someone is on HIV medication, whether mothers have had terminations, or if mentally unwell people are seeing psychologists.

A report, published on Monday by Dr Chris Culnane, Dr Benjamin Rubinstein and Dr Vanessa Teague from the University of Melbourne's School of Computing and Information Systems, outlines how de-identified historical health data from the Australian Medicare Benefits Scheme (MBS) and the Pharmaceutical Benefits Scheme (PBS) released to the public in August 2016 can be re-identified using known information about the person to find their record.

The study reveals unique patient records matching the online public information of seven prominent Australians, including three (former or current) MPs and an AFL footballer. While a unique match may not always be accurate, Dr Rubinstein said there was the possibility to improve confidence by cross-referencing other data.

"Because only 10 per cent of Australians are included in the sample data, there can be a coincidental resemblance to someone who isn't included," he said.

"We can improve confidence by cross-referencing with a second dataset of population-wide billing frequencies. We can also examine uniqueness according to the characteristics of commercial datasets we know of, such as bank billing data."…….

Privacy analyst and Lockstep consultant Stephen Wilson said the breach damaged public confidence in health policy makers and data custodians.

"It's a huge breach of trust," he said.

"Promises of 'de-identification' and 'anonymisation' made by health officials, and ABS too in connection with census data releases, have been shown to be erroneous.

"The ability to re-identify patients from this sort of public release is frankly, in my view, catastrophic. Real dangers are posed to patients with socially difficult conditions.

"It beggars belief that any official would promise 'anonymity' any more. These promises cannot be kept."

Computer security researcher Troy Hunt said re-identification of anonymised records was attractive to researchers and nefarious parties alike.

"In this case, clearly more work needs to be done to protect individuals' identities,' he said. "My hope is that the government embraces responsible research like this and strives to improve confidentiality rather than penalise those seeking to report deficiencies such as this."

The federal Department of Health was notified about the issue December last year.

"The Department of Health takes this matter very seriously and had already referred this to the Privacy Commissioner," a Department of Health spokesperson told Fairfax Media......

Meanwhile, the Office of the Australian Information Commissioner, which houses Australia's privacy commissioner, said it was investigating the publication of the datasets.

"The investigation was opened under section 40(2) of the Australian Privacy Act 1988 (Privacy Act) in late September 2016 when the Department of Health notified the OAIC that the datasets were potentially vulnerable to re-identification," a spokesperson said.

"Given the investigation into the Medicare Benefits Scheme (MBS) and Pharmaceutical Benefits Scheme (PBS) datasets is ongoing, we are unable to comment on it further at this time.

However, the commissioner will make a public statement at the conclusion of the investigation."

The OAIC said it continued to work with Australian government agencies to enhance privacy protection in published datasets.....

U.S. court directs four American tobacco companies to publicly set the record straight on the dangers of their products

World Health Organisation (WHO), Statement, 29 November 2017:

GENEVA - In major victories for tobacco control efforts, four U.S. tobacco companies are publishing court-ordered “corrective statements” to set the record straight on the dangers of their products, while a major French bank has announced it will divest its interests in the tobacco industry.

Dr Douglas Bettcher, Director of WHO’s Prevention on Noncommunicable diseases department, says these moves reinforce to the world the need for accelerated action to protect people from tobacco.

“The tobacco control community has been saying for decades that tobacco kills, is addictive and that its manufacturers have known this, while profiting from the suffering of millions of their customers,” says Dr Bettcher. “But by being ordered by the courts to issue these corrective statements in American newspapers and on TV stations, the industry itself has been forced to come clean and acknowledge once and for all that its tobacco products kill.”

The publication of the corrective statements, which started 26 November 2017, follows a lawsuit filed by the U.S. Justice Department in 1999 under the Federal Racketeer Influenced and Corrupt Organizations law. The Federal Court first ordered tobacco companies to implement these corrective statement adverts in 2006, but years of tobacco industry appeals blocked their publication.

But last month, a U.S. court directed that four American companies, Philip Morris USA, R.J. Reynolds Tobacco, Lorillard and Altria, publish the corrective statements on the health effects of tobacco use, second-hand smoke, the false sale and advertising of low tar and light cigarettes as less harmful than regular cigarettes, that smoking and nicotine are highly addictive, and that they have designed cigarettes to enhance the delivery of nicotine.

The statements, appearing in advertisements paid for by the tobacco industry, were ordered to appear in more than 50 U.S. newspapers, as well as on American television stations.

Also, on 24 November, French bank BNP Paribas announced that it would stop its financing and investment activities related to tobacco companies, including producers, wholesalers and traders.

In its announcement, the bank acknowledged the efforts by WHO, and the focus of the WHO Framework Convention on Tobacco Control (WHO FCTC), to ensure people have access to the highest standard of health and “the importance of measures regarding the reduction of demand and supply in order to meet this objective.”

BNP is the latest financial institution to declare it is ending its association with the tobacco industry, including Axa SA and the Bank of New Zealand.

“The message we must take from all this is that the industry cannot be trusted, not now, and not in the future when it tries to market new products as less harmful, like heat not burn, and by funding new organizations that purport to be working for a smoke-free world,” says Dr Bettcher.

The admissions by the U.S. tobacco companies that its products kill and are designed for addiction should strengthen national tobacco control efforts, including implementation by governments of commitments in the WHO FCTC.

To assist in country-level implementation of the WHO FCTC, WHO has introduced the MPOWER package of technical measures and resources, each of which reflects one or more of the demand reduction provisions of the Convention.

These include monitoring tobacco use and the impact of prevention policies; protecting people from tobacco smoke by introducing smoke-free public and workplaces; offering people help to quit tobacco use; warning about the dangers of tobacco use, including by implementing graphic health warnings and plain packaging; enforcing bans on tobacco advertising, promotion and sponsorship; and raising excise taxes on tobacco.

Australians with lower incomes are dying sooner from potentially preventable diseases than their wealthier counterparts

The Conversation, 28 November 2017:

Australians with lower incomes are dying sooner from potentially preventable diseases than their wealthier counterparts, according to our new report.

Australia’s Health Tracker by Socioeconomic Status, released today, tracks health risk factors, disease and premature death by socioeconomic status. It shows that over the past four years, 49,227 more people on lower incomes have died from chronic diseases – such as diabetes, heart disease and cancer – before the age of 75 than those on higher incomes.

A steady job or being engaged in the community is important to good health. Australia’s unemployment rate is low, but this hides low workforce participation, and a serious problem with underemployment. Casual workers are often not getting enough hours, and more and more Australians are employed on short-term contracts.

There’s a vicious feedback loop – if your health is struggling, it’s harder to build your wealth. If you’re unable to work as much as you want, you can’t build your wealth, so it’s much tougher to improve your health.

Our team tracked health risk factors, disease and premature death by socioeconomic status, which measures people’s access to material and social resources as well as their ability to participate in society. We’ve measured in quintiles – with one fifth of the population in each quintile.

We developed health targets and indicators based on the World Health Organisation’s 2025 targets to improve health around the globe.

The good news is that for many of the indicators, the most advantaged in the community have already reached the targets.

The bad news is that poor health is not just an issue affecting the most vulnerable in our community, it significantly affects the second-lowest quintile as well. Almost ten million Australians with low incomes have much greater risks of developing preventable chronic diseases, and of dying from these earlier than other Australians.

Read the rest of the article here.

Have our expectations in relation to medical treatment risen steadily or is NSW health service delivery getting worse?

The Sydney Morning Herald, 24 November 2017:

The Health Care Complaints Commission's annual report shows it was hit with 6319 complaints, which largely related to questionable treatments, misconduct and poor communication…..

Complaints surge

The NSW Health Care Complaints Commission was hit with 6,319 complaints in 2016-17 - leading to a 132 per cent growth in complaints over the past decade.

Health Care Complaints Commission Annual Report 2016-17:

Prosecuting complaints

The Commission referred 198 investigations to its Legal Division, compared with 139 in the previous year. This is an increase of 42.4%.

In the same period, the Director of Proceedings made 104 determinations whether or not to prosecute a complaint, 76 of which recommended prosecution before NCAT and 20 before a Professional Standards Committee. In eight complaints, the Director of Proceedings determined not to prosecute…..

The overall success rate of prosecutions before Professional Standards Committees and NCAT was 96.2%.

In 2016-17, the registration of 38 health practitioners was cancelled or disqualified. Three practitioners were suspended and had conditions placed on their registration. A further 31 health practitioners had conditions placed on their registration and were reprimanded or cautioned……

The proportions of complaints for each category of health service provider have remained consistent during the period. Individual health practitioners continue to make up the highest proportion of all complaints. Over the period 2012-13 to 2016-17 an average of 62.5% were about registered health practitioners, 35.1% of complaints received were about health organisations, and 2.4% were about non-registered health practitioners and practitioners whose registration status was unknown…..

Can anyone believe anything Australian Human Services Minister Alan Tudge and his motley crew say?

The New Daily,  21 November 2017:

The Department of Human Services flagged the illegal sale of Medicare details on the dark web almost a fortnight before the illicit trade was exposed in a bombshell media report, The New Daily can exclusively reveal.

Internal emails, obtained under freedom of information laws, reveal that department officials discussed the security issue as early as June 22 – nearly two weeks before revelations that Medicare numbers were being sold online.

On July 4, The Guardian revealed that a dark web vendor was advertising the sale of any Australian’s Medicare number for the bitcoin equivalent of just $22 after exploiting a government system vulnerability.

In the wake of the revelations, Human Services Minister Alan Tudge said that he and his department had only learned of the illicit trade when contacted by a Guardian journalist on July 3.

However, high-priority correspondence within DHS shows that senior officials discussed the trade on the dark net, which is only accessible through a customised browser, nearly two weeks before it made the news.

On June 22, Rhonda Morris, national manager for serious non-compliance, raised the issue with Kate Buggy, national manager for internal fraud control and investigations, and Mark Withnell, general manager of business integrity, as well as several unnamed officials.

In a later email on July 3, Mr Withnell apparently connected The Guardian’s inquiries to the department’s earlier discussions on the issue, writing to colleagues: “This is the one I was mentioning last week.”

It is unclear exactly what DHS knew about the sale of Medicare details on the dark web prior to July’s media report.

Citing exemptions related to law enforcement and criminal investigations, the department redacted most of the content of the emails released to The New Daily.

It refused to release numerous other related emails entirely.

A DHS spokesman denied the department had knowledge of a specific breach in June and said its internal discussions had only related to general matters……

In September, DHS told the Senate that as many as 165 people may have had their Medicare numbers sold to unknown parties, although there had been no unauthorised access of any Australian’s health records.

Last month, a seperate review commissioned by the department recommended beefing up the authentication procedures required to access the online database used by healthcare professionals.

Although the AFP is continuing to investigate the source of the breach, the government has said it was likely the result of “traditional criminal activity” rather than a cyber attack.

In February, DHS was embroiled in controversy after it released the personal information of a Centrelink recipient to a journalist in order to diffuse claims she made in the media.

Indigenous Health 2017: "We are failing because the government is focusing only on the tipping point of suicide when we need to be looking at the causal narrative also"

IndigenousX, September 2017:

The Australian Bureau of Statistics has today released its 2016 Causes of Death data which includes annual national suicide information. Analysis provided by Mindframe revealed that 162 (119 male, 43 female) Aboriginal and Torres Strait Islander people died by suicide, which is slightly higher than the 152 recorded in 2015.

Suicide was the 5th leading cause of death for Aboriginal and Torres Strait Islander peoples across NSW, QLD, SA, WA and NT, compared to the 15th leading cause of death for non-Indigenous people in these states. In these states, the standardised death rate for Aboriginal and Torres Strait Islander peoples (23.8 per 100,000) was more than twice the non-Indigenous rate (11.4 per 100,000).

Limited data is available for VIC, TAS and the ACT due to relatively small numbers in comparison to the other states.

According to Gerry Georgatos, a suicide prevention researcher and prison reform advocate, the data fails to take into account deaths classified as “Other”, which are often through drug or alcohol use, overdose or misadventure. The data, if it truly reflected the reality on the ground, would depict the real number as 1 in 10 Indigenous deaths is by suicide, not 1 in 18 as the national data suggests.

Georgatos says: “We are failing because the government is focusing only on the tipping point of suicide when we need to be looking at the causal narrative also. The causal narrative, of course is the deep, deep poverty and inequality.” He says that the government is doing next to nothing to address the fact that there is gross inequality not only between Indigenous and non-Indigenous, but even within Indigenous communities themselves.

“We need to not only address suicide and trauma, but we need to give people something to live for by lifting them out of entrenched poverty and support them through addressing their trauma with treatment from a place of opportunity,” he says.

Georgatos is of the view that the systemic failures are translating as clear toxic racism: “When you see remote non-Indigenous communities provided with services and infrastructure, but Indigenous communities a mere 50km away with nothing – it is a clear indication that racism is at play.”

Georgatos says that the crisis is not improving, as many governmental advisers and stakeholders tend to suggest, but worsening with children as young as 9-years-old taking their life through suicide, as well as countless others experiencing depression and suicidal ideation. He believes that we do Indigenous people a disservice if we continue with the falsehoods of improvement……

Read full article here.

More wheels are falling off the Turnbull Government train

BuzzFeed News, 14 September 2017:

Australia's immigration detention regime is facing a crisis in healthcare staffing following the resignation of the surgeon-general of the Australian Border Force (ABF), and the departure of three senior medical staff on Nauru.

Rumours have circulated online for several days that the surgeon-general of the ABF, Dr John Brayley, who oversees the healthcare of asylum seekers in immigration detention, had resigned.

BuzzFeed News has now confirmed that the surgeon-general resigned last week. A senior immigration department source confirmed his resignation, although the department has declined to comment.

Brayley's department email now has an indefinite out-of-office message. His phone has been switched off and is no longer receiving voicemail. His Linkedin profile has also recently removed his position as surgeon-general as his current occupation.

Brayley's resignation comes at a difficult time for the department. The ABF is continuing to face allegations of medical treatment failures at detention centres. A whistleblower on Nauru recently warned that pregnant women on Nauru were being denied terminations.

The department is also facing further internal changes in the lead up to the creation of the new Home Affairs department that will see the ABF merge with agencies including the Australian Federal Police and Australian Security Intelligence Organisation.

Brayley's position — and extensive background in medicine — placed him uniquely to manage healthcare matters in the department and recommend appropriate clinical care for asylum seekers. But his position as surgeon-general also made him a focal point for criticism. He routinely received correspondence from advocates about asylum seeker healthcare matters.

Any decent federal government with an ounce of compassion would end this terrible situation on Manus and Nauru islands.

Are banks and insurance companies misusing personal health information and medical files?

“After an insured has made a claim against their policy, the insurer obtains access to and reviews the insured’s medical records. PIAC has seen instances of insurers obtaining an insured’s complete medical history, including from doctors that treated the insured during childhood, before deciding a claim.

PIAC has found that insurers often rely on matters ‘discovered’ during the review of the insured’s medical records to allege that the insured has breached their duty of disclosure.

Often the conclusions drawn by the insurer from the insured’s medical record about their experiences of mental health are inconsistent with the insured’s medical record and the opinions of their treating medical practitioners.

PIAC has represented individuals who have had a policy avoided because the insurer has relied on medical records to impute a medical condition that either did not exist or that the insured did not know existed at the time of applying for insurance.

In PIAC’s experience, it appears that consumers are being disadvantaged by the reforms to the remedies available to insurers (as set out above), or at the very least, are not seeing any benefits flowing from the increased flexibility.” [Public Interest Advocacy Centre, 18 November 2016]

Parliament of Australia, Inquiry into the life insurance industry:

On 14 September 2016, the Senate referred an inquiry into the life insurance industry to the Joint Parliamentary Committee on Corporations and Financial Services for report by 30 June 2017.

The committee welcomes individual stories that may identify widespread issues and recommendations for reform. The committee is not able to investigate or resolve individual disputes.

If you make adverse comment about people in your submission, the committee may reject such evidence or offer a right of reply.

Submissions close on 18 November 2016.

On 29 March 2017, the Senate extended the reporting date from 30 June 2017 to 31 October 2017.

Submissions received by the Committee can be found here.

ABC News, 8 September 2017:

Doctors are pushing back against insurance companies asking them to send them their patients' entire health records as they make decisions about life insurance.

"I am very alarmed that there might be tens of thousands of people's entire health record across the country now stored with insurance companies," Labor Senator Deborah O'Neil told Parliament's joint committee on corporations and financial services.

Edwin Kruys from the Royal Australian College of General Practitioners told the committee doctors do not believe it is appropriate to send entire files to insurance companies.

"It contains information that is often not relevant to the claim, it is all sorts of information that patients have shared with their doctor over the years and they may not even remember what they have shared," Dr Kruys said.

Anne Trimmer from the Australian Medical Association (AMA) told the committee it is challenging for a doctor to determine which parts of a file are relevant.

"And you overlay that with doctors who are time poor with busy practices, it is really hard to make the determination of what is really relevant," she said.

Helen Troup who is managing director of the Commonwealth Bank's Life Insurance arm, CommInsure, told their insurance customers agreed to let doctors provide the files.

"We do get a full authority," Ms Troup said.

She said the company keeps the files but could not say how many it had.

"Our claims principle is to ask for information that is relevant to the claim assessment," she said.

But she said it sometimes meant the company received the full file.

"We of course take due care with that information," Ms Troup said.

But Dr Kruys said he did not take a tick in a box on a form as true consent from his patients to hand over their records, so he contacted them and checked.

He told the committee that they often then withdrew that consent and he would instead send a much more specific report.

Associate Professor Stephen Bradshaw of the Medical Board of Australia told the committee that the request for medical records could come months or years after the doctor had seen the patient.

Retirement, bereavement, change in home situation, infrequent contact with family and friends, and social isolation leading to an increase in alcohol consumption by older people

British Medical Journal, Substance misuse in older people, 22 August 2017:

Baby boomers are the population at highest risk

Developed countries have seen substantial increases in longevity over the past 20 years, contributing to a global demographic shift. The number of older people (aged over 50) experiencing problems from substance misuse is also growing rapidly, with the numbers receiving treatment expected to treble in the United States and double in Europe by 2020.1

In both the UK and Australia, risky drinking is declining, except among people aged 50 years and older.23 There is also a strong upward trend for episodic heavy drinking in this age group. This generational trend is not restricted to alcohol. In Australia, the largest percentage increase in drug misuse between 2013 and 2016 was among people aged 60 and over, with this age group mainly misusing prescription drugs. However, people over 50 also have higher rates than younger age groups for both past year and lifetime illicit drug misuse (notably cannabis).4

Of additional concern is the increasing proportion of women drinking in later life, particularly those whose alcohol consumption is triggered by life events such as retirement, bereavement, change in home situation, infrequent contact with family and friends, and social isolation. The rise of alcohol misuse in "baby boomers" (people born between 1946 and 1964) has also been noted in Asian countries.5

Older people with substance misuse show different characteristics but most fall into one of three groups: maintainers (unchanged lifetime patterns), survivors (long term problem users), and reactors (later uptake or increased patterns). The distinction is important because each requires different assessment, intervention, and treatment regimens.6

With alcohol being the most common substance of misuse among older people, underdetection of alcohol problems is of immediate concern. Alcohol misuse in the older population may increase further as baby boomers get older because of their more liberal views towards, and higher use of, alcohol. A lack of sound alcohol screening to detect risky drinking may result in a greater need for treatment, longer duration of treatment, heavier use of ambulance services, and higher rates of hospital admission.

Two systematic reviews of both descriptive and analytical trials found that treatment programmes adapted for older people with substance misuse were associated with better outcomes than programmes aimed at all age groups.78 Age adapted programmes resulted in less severe addiction, higher rates of abstinence, improved health status, and better aftercare. Assessment, treatment, and recovery plans require careful consideration of age specific clinical needs. Professionals need to consider the possibility of coexisting mental disorders such as cognitive impairment and depression (dual diagnosis), as well as complex physical presentations that may include the presence of pain, insomnia, or the non-medical use of prescription drugs. Older people with dual diagnosis use both inpatient and outpatient services more frequently than those with substance misuse alone.9 The management of substance use in older people can also be influenced by mental capacity, which may change with the onset of cognitive impairment.

Future healthcare for older people with substance misuse will continue to present challenges for service delivery, particularly with the growing influence of baby boomers. Some of the recommendations from the 2011 Royal College of Psychiatrists' report on substance misuse in older people (Our Invisible Addicts),10 such as examining safe drinking limits for older people, developing age specific skills in the assessment and treatment of substance misuse, and adapting services have been incorporated into an information guide for clinical practice.11 In the United States, the importance of better education for clinicians has already been noted.12 In the UK, a revision of Our Invisible Addicts is under way.

The baby boomer population also brings challenges to the diagnostic process, given the complexity of clinical presentations. Clinicians will need improved knowledge and skills in assessing and treating older people at risk of misuse of opiate prescription drugs, cannabis, and, increasingly, gabapentinoid drugs used to treat neuropathic pain and anxiety.13

Guidance for service commissioners has begun to acknowledge the needs of older people with substance misuse, particularly in the context of dual diagnosis.14 The Drink Wise Age Well project in the UK has also started to evaluate interventions for alcohol misuse in older people.15 But there remains an urgent need for better drug treatments for older people with substance misuse, more widespread training, and above all a stronger evidence base for both prevention and treatment.

The clinical complexity of older adults with substance misuse demands new solutions to a rapidly growing problem. So far, there has been little sign of a coordinated international approach to integrated care.

References

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Australian Institute of Health and Welfare. National Drug Strategy Household Survey (NDSHS) 2016: key findings. 2017.http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/key-findings

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Nicholas R, Roche AM. Grey matters. Preventing and responding to alcohol and other drug problems among older Australians. Information Sheet 3. The silver tsunami: the impact of Australia's ageing population.National Centre for Education and Training on Addiction, Flinders University, 2014, http://nceta.flinders.edu.au/files/7014/1679/1083/EN559.pdf.

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Moy I, Crome P, Crome I, Fisher M. Systematic and narrative review of treatment for older people with substance problems. Eur Geriatr Med2011;358:212-36. doi:10.1016/j.eurger.2011.06.004.

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Bhatia U, Nadkarni A, Murthy P, et al. Recent advances in treatment for older people with substance use problems: An updated systematic and narrative review. Eur Geriatr Med2015;358:580-6. doi:10.1016/j.eurger.2015.07.001.

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Bartels SJ, Coakley EH, Zubritsky C, et al. PRISM-E Investigators. Improving access to geriatric mental health services: a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use. Am J Psychiatry2004;358:1455-62. https://doi.org/10.1176/appi.ajp.161.8.1455.doi:10.1176/appi.ajp.161.8.1455 pmid:15285973.

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Royal College of Psychiatrists. Our invisible addicts: first report of the older persons' substance misuse working group of the Royal College of Psychiatrists. 2011. http://www.rcpsych.ac.uk/files/pdfversion/cr165.pdf

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Rao RT, Crome I, Crome P. Substance Misuse in Older People: an Information Guide. Cross Faculty Report FR/OA/A)/01.The Royal College of Psychiatrists, 2015,https://www.rcpsych.ac.uk/pdf/Substance%20misuse%20in%20Older%20People_an%20information%20guide.pdf

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De Jong CAJ, Goodair C, Crome I, et al. Substance misuse education for physicians: why older people are important. Yale J Biol Med2016;358:97-103. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4797843pmid:27505022.

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Evoy KE, Morrison MD, Saklad SR. Abuse and misuse of pregabalin and gabapentin. Drugs2017;358:403-26.doi:10.1007/s40265-017-0700-x pmid:28144823.

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Public Health England. Better care for people with co-occurring mental health, and alcohol and drug use conditions. 2017.https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/625809/Co-occurring_mental_health_and_alcohol_drug_use_conditions.pdf

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Drink Wise Age Well. Impact report. 2016. http://www.drinkwiseagewell.org.uk/wp-content/uploads/2016/11/DWAW_AR16-LoResSpreads2.pdf