IGR-2015: Australia on-course to become the Cheap White Trash of Asia

Amanda Vanstone succinctly summarised the LNP worldview being pushed by Hockey's IGR.

 “The Rich aren’t to blame for being Rich, It’s Policy" (stupid)

Abbott/Hockey could balance the budget, increase Productivity, deflate housing prices and improve the 40-yr outlook with a low-cost, high-impact Policy: Reduce Tax Expenditures, the Treasury keeps tabs.

• $45B/yr is spent of Capital Gains exemptions on main residence. The USA doesn't do this, why do we?
• $30B/yr is spent on Superannuation tax discounts: the majority going to the top 10%. Equity suggests a cap.
• $5-6B/yr now goes on Negative Gearing. If you earn a Salary, you're not in Business, don't ask for business deductions.

Compare to $6.4B/yr for GST on Food and $3.9B/yr for GST on Education.

Which is fairer: $80B taxes lost for most wealthy or $10B for everyone?

There are massive structural problems with the Australian economy that aren’t mentioned in Hockey’s IGR, nor being raised by the ALP.
Anyone under 40 has to be deeply concerned for their financial future as a result.

According to the Government:

The Intergenerational Report is the social compact between the generations – with our children, grandchildren, parents, grandparents and each other.

Yet there is no mention of Housing, Housing Affordability, Rental or Mortgage Stress, First Home Buyer rates, or even Household Disposable Income.

The Hockey IGR is the biggest con-job is Australian Political History. The average working Australian is being shafted so badly, they can’t imagine the outcomes. It’s the Great Australian Dream, not Workchoices or Co-payments, that is “dead, buried and cremated”.

ISM/FoSiM: The irrelevance of more "Science" in Healthcare Reform

[Post moved to other blog.]

ISM (Institute of Science in Medicine) and their Australian "mini-me", FoSiM (Friends of Science in Medicine), are advocating a rather extreme version of Healthcare reform:

Medicalisation of all Healthcare, under the guise of advancing "Science in Medicine".

These extreme views are published in an ISM Policy paper on the Licensing of non-Medical Healthcare practitioners. They advocate changing world-wide statues/regulation to only allow "science-based" Healthcare (code for Only Medical Care) and finish with:

Unscientific practices in health care should further be targets of aggressive prosecution by regulatory authorities. [italics added]

They don't just want to wind the clock back to The Grand Old Days of the Fifties, but a whole Century. The authority they cite is the 1910 Carnegie Foundation report on Medical Education by Flexner.

Flexner tossed around a bunch of concepts, many more than the State Regulation of Medicine and Medical Schools on which ISM/FoSiM base their calls for increased Healthcare Regulation, a.k.a. "Science in Medicine", as the definitive solution to all the ills of all Healthcare Systems in the world.

In the second half of this piece, Flexner's original thesis and concepts are examined - and not wholly surprisingly they support the opposite position of ISM/FoSiM.

Firstly, What do the world's best experts in Healthcare Reform identify as the local and/or common challenges to Healthcare?

And, How do the proposals of ISM/FoSiM address these Medical Millennium Challenges?

Dr James is also quoted in a forum organised by his University, PANEL ON HEALTH CARE REFORM – FALL 2008, Continuum, Utah University.

This is what he has to say on the Challenges facing Healthcare around the world:

JAMES: Another point is that we’re getting exactly what we pay for. We tend to pay for procedures and rescue care, so we get lots of procedures and lots of rescue care. This is a key factor.

Another thing you need to know is that other countries have exactly the same problems. So don’t look for solutions in Europe. Don’t look for solutions in Canada.

I get a ton of those guys coming through visiting to see how care’s delivered in Utah, believe it or not, because they face exactly the same problems.

There’s a standard working list of the top five problems within health care, and nobody’s solved them.

Travel the world and it’s the same list of five things:

1. The first problem is variation in care on a geographic basis.
It’s so high that it’s impossible that all Americans are getting good care, even with full access.

2. The second biggest problem is high rates of care directly judged to be inappropriate.
This is where the medical risk treatment outweighed any potential benefit to the patient and we did it anyway . . . usually in a rescue setting.

3. The third problem is unacceptable rates of care-associated injury and death.
This is where the care delivered actively killed somebody, whose death was judged to be preventable upon review.

4. The fourth problem is that the system does it right only 55 percent of the time.
There are things that we know for a fact should be done every time but the system does right only 55 percent of the time.
Now, that’s better than zero, but it’s not nearly 95 percent or 98 percent, where it ought to be.

5. And the last one is that there’s at least 50 percent waste in the system.
This is non- value-adding from a patient’s perspective, and that’s where the opportunity exists.

Conclusion:

From the hard-data evidence presented by Dr James based on more than 3 decades of successful Healthcare Reform, we know:

• The ISM/FoSiM proposals address the least important, least useful areas of change. 

• Addressing Lifestyle Issues and Environment/Public Health would have six times the impact of attempting to improve "Health Care Delivery" through more "Science".  

• Even then, ISM/FoSiM are either vague or silent on just what benefits their proposals, if adopted, can deliver. If they want to turn Healthcare around the world inside out, with considerable disruption, cost and upheaval, then they need to first inform us of the exact benefits we can expect.

• The ISM/FoSiM proposals are irrelevant to the common "Top 5" Challenges faced by Healthcare Systems around the world: None benefit from more "Science", they are all about Quality of Care and Effectiveness of Delivery and Implementation.

• All successful and effective Healthcare Reform, since and including Flexner, has been Patient-centric. The ISM/FoSiM proposals aren't just wrong, but exactly the opposite of what is documented to have worked. Practitioner- and Profession-centric reforms, such as "More Science in Medicine" do not deliver better outcomes for Patients.

ISM/FoSiM consistently demand high-quality Evidence and rigorous Science from those in its sights, yet fail to apply the Scientific Method and their Rules of Evidence to their own proposals and assertions.

To be consistent and credible, ISM/FoSiM must:

• Meet the same standards of "Evidence", Research and adherence to the Scientific Method as they demand of others.
• Demonstrate and Quantify how more "Science" will improve Quality of Care, Patient Safety, Equity of Access and Systemic Waste and Cost-Effectiveness issues identified as "Top 5" Healthcare Reform Challenges by the leading experts in the field.
• First define their own "Top 5" Healthcare Challenges, and
• provide research backed by verifiable, hard-data on the Efficacy of their own proposals, their own favourite criticism of non-Medical Healthcare.

If ISM/FoSiM criticise the Effectiveness of non-Medical Healthcare, we must in turn ask them to demonstrate the Effectiveness of their own proposals. If they set Rules and Standards for others, they need to follow them themselves, even better, demonstrate by superior example.

---

The Flexner report doesn't just say "Regulation and Licensing is necessary" as ISM/FoSiM seems to think, it also says many things still relevant today:

• it asks for common standards and basic clinical education with laboratory practice,
• suggests the 'Best Practices' as used by the Europeans,
• says that Medicine is a Performance Discipline [my words] - that Theory and Practice/Experience together are needed by competent Professionals ("Head and Hands"),
• that Medicine is not primarily a commercial enterprise, but has a very large "Public Service" component, with a Duty of Care not just to individuals treated, but the larger Community,
• and explicitly recognises "all medical sects", and they be based on good clinical education.

It also contains an implicit commentary that demands:

• As part of good Professional conduct, the systematic elimination of Known Errors, Faults and Failures, ("To Err is Human", but repeating preventable mistakes is malpractice of the highest order) and
• From the Flexner principle of "licenses bear a uniform value":
• Continuing certification retesting of all license holders, not a lifetime grant of license.
• the adoption of practices that have been demonstrated to have value in assuring Professional competence and skills/knowledge currency at every point in time for all license holders. From Aviation, we know these techniques work:
• Frequent (2 monthly) "Check Pilot" assessment of the in-situ performance of every Practitioner,
• Simulator checks of "worst-case" situations. (Quarterly)

Why would we expect Medicine to have lower Quality and Practitioner Certification standards and processes than other fields? Heatlhcare should be the leader in Practice Efficacy, Quality, Safety and Cost-Effectiveness.

In conclusion, Flexner talks of Duties, Ethics and the need of the Medical Profession to guard against the corrupting effects of commerce. Exactly the same "Conflict of Interest" message that Arnold Relman and Marcia Angell started writing about in the New England Journal of Medicine in 1980.

Like the army, the police, or the social worker, the medical profession is supported for a benign, not a selfish, for a protective, not an exploiting, purpose.
The knell of the exploiting doctor has been sounded, just as the day of the freebooter and the soldier of fortune has passed away.

It's fitting to end with a quote from Arnold Relman ("A Drumbeat on Profit Takers"):

“It’s clear that if we go on practicing medicine the way we are now, we’re headed for disaster.”

If the things the best and brightest minds in the world of Medical Science are writing, researching and talking about, and have been doing so for 3 decades, are completely different to what ISM/FoSiM started advocating in 2009, then who should we give credence to?

My vote goes to the existing experts who can provide hard-data to back their stories, not mere puffery, exaggeration and "spin" as offered by ISM/FoSiM.

FoSiM: The local "mini-me" of Institute of Science in Medicine: Same Bull, different faces.

[Post moved to other blog.]

Dr Harriet Hall and her 26 "Founding Fellows" created the "Institute of Science in Medicine" [ISM] in mid-2009 as a "501(c)(3) organization for US federal tax purposes" registered in Colorado.

It self-describes as:

ISM is a non-profit educational organization dedicated to promoting high standards of science in all areas of medicine and public health.

and in PDF files includes:

Institute for Science in Medicine, Inc. (ISM) is an international, educational and public-policy institute, incorporated in the State of Colorado, and recognized as a 501(c)(3) organization for US federal tax purposes.

The local Australian variant, "Friends of Science in Medicine" [FoSiM] self-describes as:

 Our Association was formed at the end of 2011 out of concern about the increasing number of dubious interventions, not supported by credible scientific evidence, now on offer to Australians.

• Dr Hall appears in the first list of "Friends", January 2012.
• The "mini-me" relationship extends further with their DNS names:
• Dr Hall's group has the obvious website name:
• www.scienceinmedicine.org
• Where the local "mini-me" has a website name unrelated to it registered name, "Friends of Science in Medicine", but exactly congruent with being the local arm of ISM.
• www.scienceinmedicine.org.au 
• There is a test/development site at:
• www.loretta.fosim.org

Why does this matter?
If you read the first policy document of ISM [PDF] as a Declaration of Intent, it finishes with some very worrying 'Recommendations':

NEEDED POLICY

The world’s health care systems need to be rooted in a single, science-based standard of care for all practitioners.

Effective, reliable care can only be delivered by qualified professionals who practice within a consistent framework of scientific knowledge and standards.

Practitioners whose diagnoses, diagnostic methods, and therapies have no plausible basis in the scientific model of medicine should not be licensed by any government, nor should they be allowed to practice under any other regulatory scheme.

Any statute permitting such practices should be amended or repealed as necessary to achieve this policy.

Unscientific practices in health care should further be targets of aggressive prosecution by regulatory authorities.

 This unambiguous Declaration of Intent gives the ISM, and it's mini-me, FoSiM, a specific Agenda:

1. It is an explicit recognition that this is a Political not Academic or Scientific 'debate'. In no way are either of these bodies "Educational" or "about Science". They are only Political Lobby groups, yet aren't registered as such.
2. ISM/FoSiM want nothing less than making the practice of "Alternative" Medicines illegal ["change of statues"] and practitioners subject to "aggressive prosecution".
3. Who will judge what has, and has not, a "plausible basis in the scientific model of medicine"?
   • They don't define either "Science" or it antithesis, "Pseudo-Science", i.e. on the formal, strict basis for this rather extreme decision.
   • There seems to be no idea of Professions being able to defend themselves on any other grounds but an undefined "scientific model" and seemingly without means of Appeal or cause for Redress.
4. What isn't spelled out here, but is noted on the FoSiM site, is the assumed Dawkins Appropriation: anything ISM and their "mini-me"s decide is "Medicine" is automatically included in their Field of Practice. Which, by definition, makes that practice or technique now illegal for any other Profession to practice.

Given the extreme published position of ISM and the close alignment of ISM and its "mini-me", FoSiM, comments like this from Australian apologists strike me as ignorant, uninformed or disingenuous in the extreme:

Having an organisation like FSM to kick-start a public debate about the value of science in healthcare is invaluable. 

So to the extent that FSM can get the media and the general public thinking about how much they might value science as opposed to pseudoscience in their healthcare it can only be a good thing. That’s why I stopped sitting on the sidelines of the debate and signed up when I found out about them.

No, this is not a "debate", this is not something of little concern, an effort of well-intentioned, altruistic experts. It is anything but that.

ISM and their clones want any type of Healthcare they declare "not science" to be illegal, and practitioners "aggressively pursued". Once started, this is a very slippery slope.

Ultimately, internal Politics reliant on funding and 'connections' will determine what treatments are allowed and which will be deemed "unscientific".

The world of Medical Politics is already riven with such extreme dysfunction and violent internecine warfare that few outsiders understand how bad it is.

This campaign by ISM is hard-core Political Lobbying by the dominant Healthcare Profession for exclusive control of the domain.

They seem to not be happy with having captured over 99% of the Healthcare Dollar and now want everything, presumably in anticipation of making a grab for a much larger slice of our income.

After all, you wouldn't want to die from poor Medical care, would you?

Good Democracy needs Strong Media: What impact the Fairfax sackings?

Yesterday, Fairfax Media, the publishers of some of the oldest, most respected newspapers in Australia announced it would radically downsize and move its prime business on-line. More video, Lateline and a detailed timeline.

"The Fourth Estate" is a fundamental to strong Democracy - in Economics terms, it (notionally) provides "full/perfect information" for the Market. It's how the Public become informed of Things That Matter.

I posit that the "Golden Age" of Democracy of the 20th Century co-incided with a strong newspaper, newsreel and later "electronic media" culture:

• there is strong public demand for "information" coupled with a willingness to pay.
• "Fresh" news and stories are a competitive advantage: News 'Scoops' made money.
• Strong competition amongst providers for "fresh news" funded a lot of technology, a lot of research and stimulus to "look under every rock".
• Under this pressure, the News Cycle shrank from weeks, to days, to hours and minutes. Twitter with its 'news cycle of seconds' may be the end-game.

Media companies had a sound Business Model for around 100 years because they filled a fundamental human need: curiosity and concern.
They had worked out a great way to place a tax on that, far better than just paying for 'a' paper: advertising.

But is this Value Proposition of "Fresh News" dissolving in the New Media?

Newspapers used to be "News", i.e. the facts of {Who, What, Where, When, How and if known, Why}, not "Opinion" - the stuff that I'm writing.

After the Vietnam War, TV took over the immediate delivery of "News", as in "What's New(s)?".

Newspaper couldn't 'break' fresh stories because TV would always beat them with the 6PM or 10Pm bulletins, unless stories were non-obvious and required unusual research.

Newspapers found new niches with Opinion, Analysis and Entertainment and Informing (vs 'News' of delivering new facts).

Woodward and Bernstein's "Watergate" investigation happened precisely because:

• Post Vietnam, TV had taken over as "where Fresh Stories break" forcing the paper to "dig deeper" for stories,
• the Washington Post had the resources and editorial judgement and nerve to fund the research and publish the results "without fear or favour",
• "sources" respected the paper and its journalists enough to speak, with an implied contract that they'd be treated fairly and respectfully and their identity would be protected if needed, and
• the public trusted the facts were real, correct and checked, and trusted that any fraud, confabulation or misrepresentation would be outed and all those responsible would "suffer consequences".

The Washington Post had an owner that was interested and engaged, and would back their Editors and Journalists. The people on the coal-face trusted they would be defended if they told the truth and acted in Good Faith.

What evolved with News reporting was a delivery pipeline with well-known "rendezvous points", Trust, Respect, and "Reputation" that took decades to build and a moment to destroy, and diversity with competition.

Who kept the Media Honest? Their competitors!

Who prevented complacency, sloppiness and indolence? Their competitors!

And the Media, "the Fourth Estate", with its insatiable appetite for News and Fact, kept those in positions of power and trust, Politicians and Business leaders, accountable.

For a hundred years, the public could (mostly) trust what the papers said and trust them to hold those in power accountable on their behalf.

Without a vibrant, competitive and highly professional News Reporting disciple, this half of the democratic system dissolves...

In a Democracy, the citizenry has a duty to care, to actively maintain their Rights and hold those in positions of power to account. We're not going to see riots in the streets over this, it seems like an inevitable, and minor, business failure or restructure.

But what can and will replace a strong, free Press?

The Internet does Change Everything, but where's the business model that will fund good News Reporting? None has yet to emerge, and after ~15 years of "The InterWebs", if it was going to appear, it should be apparent.

Only for the brave? Doom and Gloom analysis of "USA Inc" + solutions.

This report, co-authored in early 2011 by Mary Meeker of KPCB (Kleiner, Perkins, Caulfied, Byers) the legendary Silicon Valley Venture Capital firm, is deeply challenging.
Long PDF and Short PDF available as well.

It's not your average "Doom & Gloom" report or "The Sky if Falling, all is lost, get to the Bunkers" shrill fear-mongering.

This is solid analysis backed by good research and unrelenting numbers.

These folks know their way around a balance sheet, their record speaks for itself. If you can't refute it, you have to believe and act on it.

The headlines for me are dual:

• If nothing changes, within 15 years the USA won't be able to pay its bills [like Greece and Spain], and
• these folks are very positive. They layout the strengths of the US Economy and its people and a game-plan for getting back into the black.

So, look at the video [43mins] and pull down one or more of the PDF's if you like, I'm not only suggesting that this is not something that everyone should read, but that people should carefully consider beforehand if they even want to read this. It's not said, but the GFC was just the beginning...

Be prepared to read some deeply disturbing and challenging data/analysis, I found it quite sobering.
The authors pointedly don't dwell on the negative outcomes or consequences inside the USA and for the rest of the world. There will be many commentators only too glad to bang that drum and instil "Fear, Uncertainty and Doubt" into a wider audience.

BUT, the whole reason Mary and her team spent a small fortune constructing this report, is they, the acknowledged experts in analysing the operations of any business, not only think there is hope, but think solutions are possible and achievable. This comes from a fundamentally positive 'frame'.

That they did the research, produced the analysis and published it, is a massive vote of confidence by some of the world's best financial minds in the resilience and capability of "USA Inc" and that solutions are within the grasp of Americans. The solutions may not be easy or palatable, but they are achievable.

This report is about Hope and Inspiration, don't lose sight of that when you read it.

Vote [1] Independent: Gillard vs Abbott - why we hate them both.

The last newspoll in May-2012 had Gillard and Abbott both with  disapproval ratings of ~60%.

Who cares about the approval ratings jiggling up and down a little with one or the other sneaking 'ahead' by a single point? It's all noise.

The BIG message here for these leaders and their parties is: the electorate hates you both, equally and with a passion. Almost the only folk still supporting either leader and party are the rusted-on faithful. The rest of us want "None of the Above".


This is why we have the hung Parliament, with the balance of power being held by Independents.

The Greens may be a safe bet "to keep the Bastards Honest" in the Senate, to borrow Don Chip's line, but intense disapproval of major parties will not translate into lower-house support for the Greens. They have yet to earn that support from the majority of voters.

There are around 500-days until Gillard has to go to the polls.

Is that enough time for strong independent candidates to declare themselves in all the lower house seats? I've no idea.

It would be so wonderful if Abbott or Gillard lost their seat to an Independent, in much the same way that the electorate of Bennelong "sent a message" when they replaced PM John Howard in 2007 with Maxine McKew. But only for a single term: The ALP got sent another message when she wasn't reelected.

We are in this "Tweedledee, Tweedledum" situation exactly because of all the "sophisticated" tools that political parties have used and refined over the years.

When Dr Gallup invented sampling theory for his PhD thesis and showed it comprehensively worked in the 1948 election of Truman, we embarked on this course towards "identical candidates and parties".

Simple survey techniques have been supplemented with frequent, targeted polls, "focus groups" and enhance with technology.

But the Political Party's analysis and use of this data to create "Perfect Candidates" and "Perfect Policies" has a monumental flaw: it can only tell you what to leave out, or not do, it cannot tell you what to do, what is missing.


A perfect example from my Industry, I.T., is Microsoft versus Apple:

Microsoft has products and a persona perfectly constructed from Opinion Polls and Focus Groups. Apple builds stuff it is passionate about, that springs from a clear well-expressed vision and worldview and is intentionally, not for everyone. 

Until 5 years ago, you would've said Microsoft had won hands down. Now Apple is so far ahead on all measures and Microsoft results so poor in absolute and relative terms, that there is simply no contest. The business press has called for the firing of the long-term Microsoft CEO and a set of commentators are now waiting for them to fail.

The lesson from MSFT v AAPL?

Pandering to the whims and desires of the masses and attempting to "never offend anyone" yields short-run benefits, but in the long-run guarantees all but the most faithful hate you with a passion. The majority of people will only buy and use your product if they have no other choice. Look at the share price and revenues since the 2007 launch of the iPhone... It had stopped being a contest before then, now the iPhone and iPad have "nailed shut the coffin" on Microsoft's business model.

Apple and Steve Jobs have, since the 1984 launch of the Macintosh, shown that they put Great Design ahead of everything else. Without Jobs in the company to solidly maintain this stance with upper management and the board, the company floundered, almost to the point of extinction.

When Jobs returned with the same core philosophy but now with the skills to profitably implement it, the turn-around of the company has been nothing short of amazing to those who don't understand the rule, and more than comforting to those who do understand this philosophy.

This is the "secret sauce" of Apple and Steve Jobs: Stay true to your deeply-held Beliefs.
Jobs' 2005 Commencement Address for Stanford says more.

You cannot "cut your way to success" in business, nor elsewise achieve greatness through appeasement, placating and being "politically correct" - newspeak for "never offend anyone". Being a reed that blows in the winds of opinion does not buy you friends, influence or respect.

This is why Australian voters don't just dislike, but actively hate, the major parties, their leaders and their policies:
 they don't have the guts and gumption to strongly state their message and stick with it.
If you have real, strongly-held beliefs, you will have a whole raft of people disagree with you, but they will admire and respect you for it and given the choice, grudgingly allow you to get on with it.

Voters know too well that the party hacks they vote for locally will, when given the choice between the interests of their own electorate and "the party", consistently not put the interests of their constituents first.
So why vote for someone that won't stand up for you and your interests when it counts???

This is exactly why strong, capable Independents are being increasingly elected.

Voters know that Bob "mad hatter" Katter will fight to the death for them. He might hold a bunch of crazy and unimplementable views, but he is passionate about his electorate and volubly so. Love him or hate him, you have to respect his passion, his work ethic and commitment to his constituents: this is real Public Service, putting others interests ahead of your own.

So this is why my recommendation for the 2013 Federal election is:

Vote [1] Independent.

Because if you don't vote the bastards out, nobody else can.

If you don't have a strong, capable Independent standing in your Electorate?

You still have many avenues to make your views known, though there are few I can write about.

Just be sure when you do share your views and attempt to influence others, that you don't fall foul of the Electoral Act.

You cannot advocate that people don't vote nor that they vote 'informal', especially not that they avoid being on the electoral rolls. We are a Democracy and this entails a duty to care, it relies on your active engagement, not passive acceptance of the Status Quo and wishy-washy 'statements' that waste your vote.

Voting is compulsory in Australia (we're such an apathetic lot and seemingly love to obey authority!) and failing to vote for a good reason attracts a $25 fine. The penalties for advocating others not vote are considerably harsher and more onerous (court appearance, not a fine, possibly criminal offence) than an individual failing to vote.
To be clear: I support everyone casting a vote, this is fundamental to maintaining our Democracy.

IIRC, Somewhere around 4-6% of registered voters don't cast ballots on the day. I've no idea, nor any interest in finding out, if or where the reasons for not participating in the cornerstone of our Democratic process are tabulated.

Update 10-Jun-2012: The Financial Review has estimates that 20% [~3MM] eligible voters "choose not to vote". 2.88MM of 14.09MM people:

• 1.20MM not on the roll,
• 0.95MM don't turn up to vote (and face the fine)
• 0.73MM don't cast a formal vote

 To create change, you have to vote.

Think about it and make your vote count in 2013.

The Budget, The Promise, The Dividend

Australia is about to pass a pivotal milestone:
 the last Federal ALP budget to run full-term for perhaps a decade.

It is already notorious because of the commitment Kevin Rudd made in 2008 that this budget would be in Surplus and the Coalition's constant carping and criticism about the ALP's "incompetence" in every area, including financial management. The clamour from economics commentators that it is not just unnecessary, but unwise, is just part of the lead-up to this event.

So, my comments on why we are getting, The Surplus We Had to Have.


The Budget

With the Australian Federal Budget under a week away, the ALP is attempting to bring down a Surplus, seemingly only for Political reasons.

We'll only know the result in 18 months, at which point, believing current trends, the Coalition will be in power and will pick a figure that:
a) makes their case that the ALP were "incompetent at everything" and
b) uses the usual rhetoric of "the situation was much worse than we were led to believe, we have to make much deeper cuts and reduce or defer some or all of our promises".

I can't add to the debate over the economic pros and cons of "The Surplus we had to have", but can point to a deeper set of concerns.


The Promise

The Rudd/Gillard governments backed themselves into a corner a number of times by making unwarranted unequivocal statements (e.g. "there will be no tax on carbon" and "we will have a surplus in 2012/13").

But leaders before have done exactly this, or made outrageous gaffs, and not felt the same need to Keep The Promise. The current ALP leaders are holding themselves to their statements and in this, having the Opposition pursue them on their promises.

• Hawke: "No child (need/will) live in poverty by 1990".
• Keating: "The recession we had to have" and "Banana Republic".
• Howard: "That wasn't a 'core' promise".

This could be the result of a generational change. All Prime Ministers up to and including Howard (e.g. Whitlam, Fraser, Hawke, Keating) literally had to have "town hall meetings" and learn to deal with hecklers without the assistance of microphones, effectively what every stand-up comedian has to learn.

Younger ALP leaders, Latham, Rudd and Gillard, differ in two important ways:

• they've had limited experience dealing with hecklers and antagonistic crowds (think of the difference between TV-only comedians and stand-ups), and
• they joined the Party Machine (or the Union movement) almost straight from school. Unlike Ben Chifley, who had a career as an engine driver before moving into paid politics.

There are other effects, such as the logical/absurdist extension of Sampling Theory and Statistical analysis of surveys invented by Gallup and used in 1936 to predict FDR's upset election.

This 'surplus', head-line or underlying, real or faked, is entirely for Political reasons, and as such is an "own goal" for the ALP. At the very least, they've shown they are inflexibly wed to any and all their policy statements and can't see a way around themselves to "adapt, improvise, overcome" in response to changing circumstances and needs.

But the real concern for every elector/taxpayer is the overwhelming message from both major parties:

Politics trumps Public Good. They don't care what harm they cause in the pursuit of a short-term political advantage or goal.

This is our future, our jobs, our money they're playing with so cavalierly. There is no "Government Money" to spend, only taxpayers wages.


The (Efficiency) Dividend

[My previous piece on the "Triple Whammy" effects of waste in I.T. is useful background for this.]

Keating introduced the Efficiency Dividend, or really Automatic Budget Reduction, to Federal Government in 1986. Notionally, it was a systematic attempt for Departments and Agencies to be forced to realise, and hand back, the productivity gains due to Technology, I.T./I.C.T. particularly.

Which is fine sounding until you pick apart the assumptions and implementation.

I was caught up in the first I.T. Recession in Australia, at the end of 1990. Westpac laid off 500 contractors (for the abandoned project CS90) at Christmas. It was 1994 before Computing and I.T. graduates were back to 100% employment. For a while, a Chemistry or Geology graduate had a better chance of finding work in their field - very different to the industry cries beforehand of "we have a staff shortage crisis" and "I.T. it's a job for life".

That first I.T. Recession was because all the low-hanging fruit was picked: all Australian businesses and Government Agencies had hired more I.T. staff to automate their back-office functions and replace (low-level) clerical staff.

In 1990/1, I.T. staff were cut, just like all other staff.

Why is this problematic? Consider these three related points:

• If this was 1965 and government Agencies had to supply all now current services, would we ever have an unemployment problem? [How many people would it take for Centrelink, ATO, Medicare, etc to do their work and handle 800,000 unemployed?]
• I.T., like Marketing, is an intangible and an indirect cost. We do them both for a Business Benefit. But we don't measure, report or analyse I.T. benefits.
• I.T. is a Cognitive Amplifier. We use it to automate business processes and increase staff productivity. Rough estimates suggest a 10-100 times 'amplification'.

The Keating Efficiency Dividend is recognising all three points:  from all the money invested in Federal Government I.T. Systems, rather large savings should have been realised.

The workload, and notionally the workforce, of many or most Federal Government Agencies should scale with population size - growing at a long-term average of 1.5%. [18M in 1996, five times the 1901 size]

But after 30+ years of I.T. Automation, for the Public Service to have only achieved a 1% total savings either suggests:

• gross incompetence in either failed or unproductive/irrelevant projects,
• management fakery in reallocating savings to increasing empires, or
• an increased level of service, either numbers served or complexity and number of services provided.

But we don't know what's happened: what staff productivity or organisational efficiencies have been realised?

This is a massive management and reporting failure on behalf of the permanent Public Service, but an even greater failure of governance and insight on behalf of the Parliament they report to.

This leads to another set of points:

• Not all Government Agencies can achieve the same efficiencies as their workload and workforce are dependant on different factors,
• Different areas within Agencies cannot be expected to yield the same "efficiency gains" for the same reasons, their inherent workload scales from different factors, and
• "Percent maximum potential efficiency" is not calculated nor taken into account. The past improvement by individual Agencies, and the future savings possible, are seen as irrelevant.

The Productivity Commission [2004] reported that ICT was still the single largest factor driving (staff) productivity growth, yet there appears no intensive study of the APS (Australian Public Service) to which it has special access and interest, nor does there seem to be a recognition or refutation of this is Agency management practice.

If investing in I.T./I.C.T. is still the most cost-effective way of improving productivity, and hence of meeting the Efficiency Dividend, why are any Government Agencies apply the full 4% 'dividend' across all their organisational units?

If I.T./I.C.T investment is judged as not improving productivity, where is the evidence?
Pointing to a glaring omission of all Government Agency Annual Reports. Although they all have detailed reporting against "Key Outcome Areas", there are no output metrics.

Productivity is a measure of Output per unit of Input. Within the APS reporting schemes and managerial system/requirements, only Inputs (staff numbers and on-costs) are measured. Failing to even notice this gap, let alone address it, seems to me to be another monumental failure of the APS's management and culture.

Politicians, as managers of the APS, make decisions/directions are unpredictable, capricious and irrational. This is simply the nature of the beast. Politics is the Art of the Possible.

Which means senior managers in the APS have to deal with this insane world.

Down the organisation structures, staff never learn to relate their time input into economic value output. The simple cost/benefit equation at the heart of every business transaction that any 16-yo at MacDonald's learns is missing: wages have to be paid for.

This has led to an incredible blind-spot within the Public Service, resulting in systemic management and reporting failures such as not defining and collecting/reporting staff output data so year-on-year Productivity can be tracked.

What we can absolutely say about the 4% (1.5%+2.5%) Swan/Gillard Efficiency Dividend:

• it should not be evenly applied across all Agencies, but has to be because the necessary management data is missing.
• it should not be evenly applied within Agencies because the necessary data is missing.
• without evidence, APS managers are blindly acting. Should they be investing in more I.T./I.C.T. or reducing I.T. staff/budgets more than 4%?
• There will be uneven and disproportionate effects on the delivery of Government services.

Just because Politicians live in an extreme world is no excuse that they don't properly fulfil their Fiduciary Duty towards their constituents - the people who've entrusted to them their future livelihoods and living standard.

We, as taxpayers and electors, need to be demanding a much higher standard of management and governance from the Politicians representing us.

Is there any reason that the Public Service is not the best organised, best managed and provably most productive and efficient/effective organisation in the country? Why should the Public Service be less than the definitive model of good management and good governance? The standard that every organisation is judged by.

The only reason is that we haven't held our Politicians accountable for their performance.

We have let them get away with putting their interests ahead of what they are elected and paid to do:  husband the public purse, the taxpayer dollar, for the best possible outcomes and sustained benefits to the citizenry.

First, Do no harm: Patient Safety and the central fallacy of the "Friends of Science in Medicine" position.

[Post moved to other blog.]

"First, Do no harm"... Or so the Hippocratic Oath is presumed to begin.

The Dwyer/Marron "Friends of Science in Medicine" campaign against the teaching, insurance/reimbursement-for and ultimately practice of Alternative Therapies and Medicines of which they, and they alone, do not approve, is based on a central fallacy:

People are much safer being treated by the Medical Establishment not using Alternative Therapies and Medicines, but exactly the reverse is true. 

This debate is "all about Evidence", as in hard-data, but Patient Safety and Quality of Care must be examined first before any debate on Effectiveness can even be started.

The flip-side is the erroneous logic that "Good Science" is somehow causally linked to "Good Patient Care", but FoSiM ignore the Golden Rule of Execution: 

Science and Knowledge don't deliver outcomes, Practice does.

Before the Dwyer/Marron group can argue against any Therapy, Treatment or Medicine, by its own strict rules ("there must always be very strong Evidence"), it must:

Show us the Data! 

Where is their Evidence, the "Good Science" they want from everyone else, to demand any changes?

The worst logical trick and intellectual swindle played by the Dwyer/Marron group is their conflation and confusion of terms:

• A slew of unrelated practices are strung together in one long line of gibberish, with no distinction between recognised, well-controlled modalities and others, with all presumed to be 'equivalent'.
  If the Dwyer/Marron group cannot, or will not, distinguish between a piece of crud and a gem, what relevance or vracity do their arguments have?

• In Australia, there is a trivial and essential differentiator between all Medical Therapies, Practices and Medicines:
  • Is there a AHPRA Registration Board? and hence
  • Do Practitioners have a Medicare Provider Number?
  
  The failure of the Dwyer/Marron group to make this simple and essential distinction invalidates all their arguments, just who are they vociferously and ferociously objecting to?

• For the Dwyer/Marron group to disagree with Government Policy and Processes is their Democratic right.
  For them to not understand the way these decisions and processes are changed is via Lobbying and the Political process is both ludicrous and naive.

Whilst the Dwyer/Marron group and their FoSiM purport a wish "to foster Good Science in Medicine", their actions and statements belie a rabid bigotry, bias and prejudice.

Even in their Constitutions' statement of Object, they don't define or elaborate on their terms:

• "Good Science" is a vague, ill-defind term. To quote Shakespeare's Macbeth:
  "it is a tale told by an idiot, full of sound and fury, signifying nothing".

• There are "scientific methodologies" (hypotheses, test, result) and "(apparently) good or valid studies/experiments" with "strong evidence", but "Good Science" is at best a lay-person's term, not something any Professional in the field would use.

• Likewise, "Medicine" is a broad church...
  There is no definition ever offered for FoSiM's frequently used acronym, "CAM", presumably "Complementary and Alternative Medicine". This has some mysterious meaning only known to the Inner Sanctum of the Dwyer/Marron group. I expect it falls in the category of "I know it when I see it", a throughly undisciplined, non-rigourous and unscientific methodology - because it is inexact, ill-defined and non-repeatable.

Where does the Richard Dawkins comment that "there is only medicine that works" leave the Dwyer/Marron definition of "CAM"?

Invalid and irrelevant, like the rest of their bluster, assertion, dogma and prejudice parading as "the opinion of experts", because they can provide no test or Evidence to show, as Dawkins says, "what works and what doesn't".

The very real risk they face with their simplistic and naive thinking is that if they ever construct testable definitions, then a good deal of their own Establishment Medicine would be found wanting.

It comes down to this:

The Dwyer/Marron group have no documented process or methodology to define the Alternative Therapies and Medicines of which they, and they alone, do not approve. They have a loose, informal, self-referential definition: "Good Science, it's what we say it is".

They are self-appointed experts and judges, without credentials, special expertise or relevant experience, who are presuming to force their opinions, biases and prejudices upon the rest of us.

Whenever they cry "Show us The Evidence" or "That's not Good Science", all they are displaying is their own ignorance, ineptitude and biases.

Friends of Science in Medicine: Hypocritical call to action

[Post moved to other blog.]

Update: 17-Jul-2012: There is now considerable blowback from the Medical Community towards Dwyer and his "little Friends". The MJA [Medical Journal of Australia, behind a paywall] of 16-Jul had multiple articles on this topic.

From a report on the Editorial and associated articles.

Professor Stephen Myers, SCU [Southern Cross University]:

“the real benefit of an appropriately mentored and approved university education is the exposure of students to the biomedical sciences, epidemiology and population health, differential diagnosis, safe
practice and critical appraisal."

Professor Paul Komesaroff, Monash University, on MacLennan's MJA in editorial in March-2012:

“exceed the boundaries of reasoned debate and risk compromising the values that FSM claims to support”.

Professor Komesaroff:

"while there was now an extensive evidence base in relation to complementary therapies, the concept of evidence-based medicine was highly contested and debated within Western medicine itself." 

"It is not appropriate for doctors or scientists with a particular view of medicine to impose those views on the whole community; rather, they should respect the rights of individuals to choose the approach to health care they feel is suitable for them." 

“It is important that those who seek to be friends of science do not inadvertently become its enemies. We call on the members of FSM to revise their tactics and instead support open, respectful dialogue in the great spirit and tradition of science itself”

---

In writing an inadvertently long piece on the Irrelevance of Marron and Dwyer's "Friends of Science in Medicine", I had to reflect on what what a convincing "short version" would be. Here's an attempt:

• Dwyer, as a respected and long-serving medico, has to be aware of the estimated 18-35,000 preventable deaths in Australian Hospitals each and every year. [1995 QAHCS report, disputed.]
• He must also be aware of the lack of good data on Adverse Events (AE) and Iatrogenic Injuries.
• Similarly, the extra $2B/year estimated additional cost of treating AE's in hospitals.
• He should also be aware of Dr Brent James reports (2001) from Intermountain Health, Utah, that only "3.5% (of patient injuries) resulted because of a human error" and from the APSF report on Iatrogenic Injuries (2001)  "The causes of iatrogenic injury appear to be systemic".
• There is also a 2004 report on the effects and additional preventable deaths from overcrowding in Accident and Emergency. 

All of which could be used to suggest by Dwyer and friends:

Australian Medicine and Hospitals do very well in the face of insurmountable odds and lack of Political will and funding. [A justification used by AMA President Rosanna Capolingua in 2008, below.]

Only it isn't so...

Compare the complete lack of an Evidence Base for Patient Outcomes for Australians and any coherent, credible, co-ordinated plan to address this with the UK's Civil Aviation Authority's current Safety Plan. 

Secondly, Dr Brent James reported a 20% reduction in costs by reducing Patient Injuries through a "Do it Right, First Time" approach to Quality. This corresponds with the 2002 results from Ehsani, Jackson and Duckett. As Berwick suggests, organisational change is required to address systemic issues. Unless the system is changed, results won't change.

The CAA's Safety Plan [excerpted below] conspicuously shares a feature unknown in Australian Medical literature and seemingly in Hospital improvement plans: The Most Important Problems List.

The CAA has its "Significant Seven" and Dr James his "Bg Six List".
These seem unknown and unreported in Australian Hospitals and Health Department Plans and Operations.

Where this line of reasoning leads to:

After 50 years of large jet aircraft being used in Commercial Aviation, 'we' know exactly what has to be done to economically achieve good, reliable and safe Public Services, so why isn't this approach being advocated and adopted by Medicos and Hospitals?

From Dr. James, we also know that it is cheaper to fix systemic issues through a "Get it Right First Time" Quality approach, so after more than a decade of being known in Australia is this not being done?

How many "Adverse Events" are there in the Australian Hospital system? We don't know.
But the best evidence available is that they are not reducing. [below]
The most conservative estimates, "Sentinel Events", counts around 270 adverse events/year.
The QAHCS report estimated 18,000, the difference being direct, provable causality.
While the Australian Doctors Fund (ADF) would like us to use the American UTCOS report figure of 3.3 times less, of ~5,500 per year.

From Dr. James definitive work, the number of patient injuries is around 30 times the number of Adverse Events reported, reasonably 165,000 per year.

So why isn't Prof. Dwyer advocating and campaigning for the Medical Profession in Australia to adopt known, effective Evidence-Based Systems for itself preventing thousands of deaths, eliminating hundreds of thousands of injuries and reducing needless waste, rather than what appears to be a distracting side-show of "look at all those Bad Guys over there!".

This is the nub of his hypocrisy: Everyone else is doing it wrong, but we are beyond reproach.

Rudd versus Gillard: Everyone loses.

A copy of a letter I sent today to my local ALP senator.

---

Dear Senator,

Not sure if you care what one of your constituents thinks about your internal party matters, but here goes.

Julia Gillard is, IMO:

• a competent legislator,
• a good administrator, and
• outstanding at achieving 'meeting of minds'
• negotiating with many competing parties,
• with conflicting aims and differing agendas, and
• hence achieving legislative aims in a hung parliament.

Her record of accomplishment in the actual business of government is, again, very good, doubly so in that it's a hung parliament. Not 'revolutionary' like Whitlam and his many reforms, not 'breakthrough' like Keating floating the dollar (because we aren't in those times), but solid important stuff that matters now and matters for the future - balancing the budget, creating the next century's infrastructure and improving our intellectual competency and competitiveness.

So what's wrong that she doesn't have the 60-70% voter approval rating that she should have??

There is a serious disconnect between what Gillard does and her perceived performance in the electorate. It's worth at least 30-40% in her approval rating, IMO.

I have no idea why this is so. My best guess is that it is somehow related to the advisers around her in the PMO.
 [PMO = Prime Ministers Office, her personal unit staffed by her vs Dept. of Prime Minister and Cabinet, a normal Public Service Agency]

Howard had Arthur Sinodinos and together they made a formidable team, unbeatable for a decade. Proving the point that Great Leaders have Great Teams around them. But that's speculation on my part.

What Gillard is experiencing (approval vs performance gap) seems to me to be the political equivalent of business' "glass ceiling".

Women work incredibly hard, are exceptionally competent and do very good work but regularly get overlooked for promotion by their managers. I've personally worked with a number of mid-level Managers in the Public Service who've been trapped this way, but never were any of them men.

This can't be blamed solely on bias, nor solely on "Men do this to us".
Part of the effect, at least, has to be something in the way that Women approach work and promotion. A side-effect of this is that Women Entrepreneurs coming from this group are hugely successful in the plethora of small businesses they create.

There's such a weight of evidence about this 'overlooked for promotion' effect that I'm surprised it hasn't been studied extensively and that 'remediation' courses/training aren't available for it.

None of which might help Ms Gillard right now :-(

But this is my attempt at explaining why one of our most competent and apparently most broadly knowledgeable and informed political leaders isn't getting due recognition from her 'employers', the electorate.

---

Rudd:
Plays well to the public and sprouts lots of great sounding stuff.
Unfortunately, has proven to have very limited ability to 'execute'.

Or to sell difficult decisions.

After 3-4 attempts to get up Carbon pricing legislation, he quite rightly said, "enough time wasted on this now, we'll  defer it until after the next election when we should have better upper house numbers".

If he'd been up against Nelson or Turnbull (whom I'd call 'reasonable men'), that would've been the end of the matter...

But Abbot creamed Rudd, and easily so, quickly bringing him down.

Abbot has beaten two Labor leaders - Rudd lost office and Gillard didn't win the unloseable election.
But Abbot doesn't understand there's a difference between beating an opponent and winning over them.

A Rudd vs Abbot election will be another debacle for the ALP.
As would currently, a Gillard vs Abbot election.

---

I talk to my friends, most of whom like me have been voting since Whitlam or before and cover a spectrum of political persuasions, and we all would like to vote "None of the Above" if the next election is between Abbot and either Rudd or Gillard.

The consensus is: "Not ALP, not Liberal, Not Greens, but WHO?"

And many wish we could vote for Independents as gutsy as Windsor and Oakeshott, or a little less wild-eyed than Wilke. Katter is just plain crazy, but so one-eyed pro-QLD his electorate must love him.

---

If I was in your shoes, I wouldn't know which potential Leader could get the ALP over the line at the next election - at least not against Abbot.

Gillard doesn't sell herself well enough to the electorate and has been kicking far too many 'own goals' recently, and Rudd is like week old fish, flashy but well past its Use By.

Crean was leader for a time, but the "Anyone But Crean" sentiment is still strong.

There are many other fine people serving in Parliament who, in time, might make outstanding leaders - but anyone contesting and deposing  an incumbent ALP Prime Minister for the second time, no matter how good or well respected, will be hated by the electorate, just for the act.

If the ALP was in Opposition, this would all be moot. We, the electors, expect there to be jockeying amongst the contenders for 'a shot at the title' (to use a boxing analogy, appropriate for Abbot).

But the electorate, wrongly, presume "we vote for the Prime Minister", as I saw stated in a voxpop last night.
That's a direct outcome of Australian political parties succumbing to the 'Presidential style' of campaigning and government.
We aren't the USA...

While a single, strong 'all-powerful' leader is an easier sell to the electorate, this situation we find ourselves in is its inevitable conclusion.

Why are all these unpleasant stories and opinions about Rudd and his poor performance/personality only coming out only now? Why not when they were happening?

Because the Parliamentary wing of the ALP collectively and consciously created and maintained the fiction of "one good all-powerful leader", possibly telling itself that "Disunity is Death" (the flip-side of "Workers, United, can never be Defeated").

Being caught out in "the Big Lie" is also "political Death".  The electorate are just finding out about being sold "the Big Lie" and are NOT at all happy about it.

As Richo said, "Politicians Lie" (that's what they are forced to do by our Political and Media System).
We, the electorate know that, but don't expect/condone such monumental constructs, hence the massive rebound effect.

You'd think that the way to cut this Gordian Knot is for Gillard, not Rudd, to revert to Radical Honesty.

There'd be an immediate backlash for sure, but it would completely destabilise and confuse Abbot.
And given time, might win over a bunch of the disenchanted electorate.

It also needs Open, Honest, Transparent comment/opinion from inside the rest of the Cabinet and potentially the Caucus.

There's a time for a rigidly controlled, disciplined "single message", and perhaps a time for close-to-genuine Honesty.

For evidence, I offer Bob Hawke. A hard-drinking womanising larakin if ever there was one, that we still applaud because he can scoff down a beer faster than most.
He was forgiven these indiscretions by the public because he announced them, unlike the damaging backroom succession deal with Keating, or the unfulfilled Howard/Costello agreement, reported to the public by others.

If the Liberal party can get behind a good Leader, someone besides Abbot who thinks constant whining is a strategy, before the next election then the ALP, if it doesn't do something very different, could well be in the wilderness for another generation.

But I don't expect changes like that in Politics, just like I don't expect a fuchsia Airborne porcine division to swing by here. [A squadron of Pink Flying Pigs]

---

All the best in whatever happens.

regards
steve jenkin

--
Steve Jenkin, Info Tech, Systems and Design Specialist.
0412 786 915 (+61 412 786 915)
PO Box 48, Kippax ACT 2615, AUSTRALIA

stevej098@gmail.com http://members.tip.net.au/~sjenkin

Friends of Science in Medicine: Irrelevant and Inconsequential?

[Post moved to other blog.]

Peter Jean, Health Reporter for the Canberra Times, wrote a good piece (clear, informative, balanced) about FoSiM, Sunday 19th Feb, 2012: "Accessing the Alternatives".

In researching a follow-on piece to Peter Jeans', I took 4,500 words of notes - without covering anywhere near the number of topics I wanted to bring together. I wrestled with:

a) how to meaningfully condense such a wide field, and

b) Just what is the story here?

The crux of my dismay and discomfort with FoSiM, Marron and Dwyer is their outrageous attack on a relatively benign and low-impact Healthcare Services ("Complementary and Alternative Medicine" [CAM]), whilst ignoring massive, real and pervasive fundamental problems with mainstream Medical Healthcare.

FoSiM, Marron and Dwyer are asking us to shutdown and prevent from practicing those who account for under 1% of Medical fatalities and errors, whilst comprehensively ignoring the major problems. What is going on here???

Loretta Marron, CEO and the apparent Power behind the Throne, is the medical equivalent of Pauline Hanson: industrious, opinionated, loud, self-promoting - and ultimately mostly irrelevant.

Prof. Dwyer and his other "Executives" are all well-known, reputable medical scientists and academics with an axe to grind. It appears they are upset that they don't control or regulate every aspect of Medicine, mainstream and Alternative. Appearing so very "50's" and "Doctor knows Best".

Plus you'd have to wonder if like "One Nation", people of the calibre of David Oldfield will move in and use FoSiM to further their own careers, pursue their own aims/agendas, damaging organisational credibility and undermining their goals.

Some observations on the FoSiM goals:

1. Any call for Science in Medicine is fraught for mainstream medical practitioners. If the spotlight is turned on them and they are required to provide Evidence of Competency themselves, even expected to practice "Real" Quality, their life will get much more difficult.
    
2. This appears solely to be a turf war. Since the 1950's Doctors have lost their high-standing in the community and automatic respect from the public. Doctors have lost the unquestioning confidence of the public, who decided to look elsewhere for compassionate, engaged care.
    
3. This is mostly about money. Doctors don't practice solely for the love of it. GP's are small businesses who collectively try to both defend their income and look for ways to increase it.
   If this aspect isn't acknowledged and discussed openly, the whole debate will become very murky indeed.
    
4. There is a real problem under all this: vulnerable people are conned all the time. They want to believe in miracles, snake-oil and panaceas and resist all attempts to be warned or enlightened.
   This isn't a recent phenomena, nor confined to Medicine of any description.
   FoSiM appears to be advocating for a unilateral approach: Ban the Bad Guys (practitioners).
   The 1920's "Prohibition" in the USA and the current "War on Drugs" shows that you can't just legislate problems away. This simplistic approach of FoSiM will not work - there is overwhelming evidence of this, which makes you wonder what sort of 'Scientists' these folks are.
    
5. The Internet is a searchlight that illuminates dark corners everywhere.
   FoSiM should be calling for a definitive on-line wikipedia-style 'register', not registration, of all Health Practitioners. It would allow the relatives and friends of people entrapped by shonks of any kind (including AHPRA registered and certified) to uncover warning signs and to warn-off others.
    
6. Mainstream Medicine gets a "free pass" from the ACCC with their business model.
   They don't have to refund the cost of "failing to provide the service advertised" as does every other retail business.
   If Doctors wish to enforce Accountability on others, they should be prepared to give up their privileged position and join the rest of us in ordinary business.
    
7. What s Loretta Marron's motivation? I cannot understand her complaining and campaigning about other people's problems when she is not a Healthcare Practitioner of any type.
   Only in movies and comic books do people need "Super Heroes" to look after them and defend them from the ranged Forces of Evil. Adults in the real world need Information, Training and Support - not being "stood up for" by some self-appointed 'guardian'.
   There is a word for this in law-enforcement: Vigilante.
    
8. Loretta Marron, interview on 4BC and her constant untested accusations of "voodoo and witchcraft", seemingly against all CAM (as MP3). Love her or hate her, you need to hear the lady in her natural element. I found it hugely ironic that she was preening herself over being the first person ever to be recipient of dual "Australian Sceptic of the Year" awards (2007, 2011) - an self-appointed organisation built on judging others and requiring evidence but the antithesis of "open and transparent" themselves. All while she threw nothing but untested, unproven accusations and innuendo around. One standard for her, another for everyone else...

Queensland Public Hospitals Commission of Inquiry, 2005:

While the site for the Davies Queensland Public Hospitals Commission of Inquiry is still on-line, that for its immediate predecessor, Morris' Bundaberg Hospital Commission of Inquiry is not, existing only in The Internet Archive.

Initially I was going to start this piece with this bunch of aphorisms relevant to FoSiM and their performance and bias:

• "by their actions you will know them"
• "ends must match the means"
• "first remove the log from your own eye"

While these are still relevant and appropriate, indicating that FoSiM, Marron and Dwyer are being driven by a hidden agenda, I was derailed by the next thought:

Just how Professional are Mainstream Medical Practitioners? (could they really withstand a serious Inquiry?)
For example Jayant Patel (JMP), "Doctor Death" of Bundaberg.

Reading the ~550 pages of the Davies Inquiry report I was struck by many things:

• The only reason there was ever an Inquiry is that a single nurse, Toni Hoffman, sacrificed her career by whistle-blowing. Otherwise none of this would have happened, raising the question: "How many incidents like this had happened previously without comment?"
• Although Patel's "Mortality and Morbidity" statistics implicated him in 30 or more deaths, the legal system requires proof of causality. Hence he was only prosecuted for a small number of cases.
• Jayant Patel was by far not the only "renegade" practitioner identified by the Inquiry, nor the only person whom the Inquiry made recommendations about.
• There were multiple other hospital districts found to be delivering unsafe care to patients. This is further evidence of wide-scale, systemic failures in Queensland Health.
• There were serious systemic problems within Queensland Health, including its treatment of local medical graduates and GP's (as VMO's, Visiting Medical Officers).
• These origins of these problems is complex and due to Political, Public Service Administration and Medical Profession issues - going back 30-40 years.

• Margaret Cunneen SC, in "The Patel Case – Implications for the Medical Profession (Medico-Legal Society of NSW, 2010), points out:
• Queensland has a "Criminal Code of Law" which made the criminal prosecution of JMP possible.
• Patel, and any doctor acting maliciously, could not be charged with a criminal offence in NSW and most other Australian jurisdictions.
• Cunneen says little has changed in NSW in over a century:
  She reviewed an 1893 case of a person practicing as a doctor, but not legally qualified. He failed to deliver a baby, causing it severe injuries and death - but the charges were dismissed because the man had no case to answer under the law then, or now.
• Cunneen, a senior prosecutor, says:
  "because of this expectation that doctors will not do something maliciously against a patient, that they will only make a mistake which may or may not be civil negligence."
• There have been no calls by the Australian Medical Profession to address these problems of Jurisdiction, consistent Medical Board judgements or malicious injury by doctors.

• In late 2011, Premier Anna Bligh "dismantled" Queensland Health following a $16M fraud. Five years after the Davies Inquiry, it seems there has been little change or improvement.

There is overwhelming evidence that Queensland Health has had pervasive, systemic problems for decades. Is that Politically acceptable or a proper use of Public Monies?

The most critical question is:

What has fundamentally changed so that any of this could not happen again, that these lives lost and unnecessary injury inflicted has not been in vain? [Nothing?]

My rubric for Professionals:

Is there ever a reason for any Professional to repeat, or allow, a known Error, Fault or Failure?

By this test, Aviation professionals and technicians, at least here in Oz, are overwhelming more Professional that every registered Doctor. Part of the proof lies in the Open and Transparent collection and reporting of critical outcome data.

The lack of demonstrated improvement, in fact the universal absence of critical outcome data, for Hospitals, GP's and specialists suggests a fundamental, systemic failure within Australian Mainstream Medical practice.

That's something definitely worthy of FoSiM, Marron and Dwyer's time and attention, and demonstrably of massive benefit to Australia.

---

"A primer on leading the improvement of systems"
Donald M Berwick. BMJ VOLUME 312 9 MARCH 1996
Institute for Healthcare Improvement,Boston, MA 02215,USA
Donald M Berwick, president and Chief Executive Officer.

Learning points:

• Not all change is improvement, but all improvement is change.
• Real improvement comes from changing systems, not changing within systems.
• To make improvements we must be clear about what we are trying to accomplish, how we will know that a change has led to improvement, and what change we can make that will result in an improvement.
• The more specific the aim, the more likely the improvement; armies do not take all hills at once.
• Concentrate on meeting the needs of patients rather than the needs of organisations.
• Measurement is best used for learning rather than for selection, reward, or punishment.
• Measurement helps to know whether innovations should be kept, changed, or rejected;
• to understand causes; and
• to clarify aims.
• Effective leaders challenge the status quo both by insisting that the current system cannot remain and by offering clear ideas about superior alternatives.
• Educating people and providing incentives are familiar but not very effective ways of achieving improvement.
• Most work systems leave too litle time for reflection on work.
• You win the Tour de France not by planning for years for the perfect first bicycle ride but by constantly making small improvements.

THE CENTRAL LAW OF IMPROVEMENT

Not all change is improvement, but all improvement is change.

The relation derives from what I will call the central law of improvement:

every system is perfectly designed to achieve the results it achieves.

The central law reframes performance from a matter of effort to a matter of design.

The central law of improvement implies that better or worse "performance" cannot be obtained from a system of work merely on demand. [Therefore Inquiries and Political directives that mandate change without organisational redesign are doomed to failure. This is confirmed by the outcomes we've seen.]

The Real Deal on Not-for-Profit enterprises

Philip Greenspun in a piece on Early Retirement neatly summarises my experience with a multitude of Not-for-Profits...

Non-profit organizations exist to provide their staff with great jobs and the fun of making decisions and spending money.

The folks who work at a non-profit organization are very interested in drawing a salary higher than their skills and working hours would command at a for-profit enterprise subject to competition.

They are not especially interested in efficiency or accomplishment.

If you've come from the commercial world, in which McDonald's must be ruthlessly efficient for fear of being destroyed by Burger King, working with or in the typical non-profit organization will likely drive you to insanity.

Funnily enough, this aspect, nor the consequential intense internal politiking, doesn't appear in the definitive book on the subject, The The Complete Guide to Nonprofit Management by Smith, Bucklin & Associates.

The Complete Nuts-and-Bolts Guide to Managing Today's Bottom-Line Oriented Nonprofit Organizations

This significantly revised and expanded Second Edition of the highly popular how-to book identifies and addresses the unique concerns of nonprofit organizations. Cutting through the morass of mere theory, the experts at Smith, Bucklin & Associates, Inc., a leading nonprofit management firm, get right to actual practice with dozens of real-world examples and case studies, and up-to-date, vital, "combat-tested" strategies and techniques for dealing with virtually every nonprofit business management issue, including:
* The daily role of boards of directors
* Fund development and marketing
* Public and government relations
* Educational programs and certification
* Information services
* Human resources management
* Using the Internet