Being a Resistance Fighter

On ANZAC Day, it’s important to remember the price our past generations of soldiers and their families paid for our freedom.  While we may not experience the ravages of war in Australia, we still face a bleak future as a result of a war that we fight every day, and on the front line, GP’s and pharmacists who every day, battle with the tide of sniffling masses  pleading, “Can I please have some antibiotics for this cold.”

We all know how it feels.  Your muscles ache, your nose feels like it is flowing like Niagara Falls.  Your throat is on fire.  You lurch between shivering under four blankets to sweating like you were in a sauna.  You would do anything to feel better.

A significant proportion of the population head to the pharmacist or naturopath and try whatever herbal treatment was last recommended by their facebook friends or the pharmacy assistant (which are usually unproven, or have been shown to be no better than placebo, but that’s another blog).  I see the people who feel that their cure lies in the miracle of antibiotics.

Antibiotics don’t seem like a miracle anymore.  But even as recently as the 1950’s, bacterial infections caused severe illness, and deaths were common.  With the discovery and adoption of penicillin, and the subsequent development of the armory of antimicrobials, we now see bacterial infections as trivial.  Antibiotics have become common place and they tend to be used as a panacea.

According to the Australia’s National Prescribing Service, the use of antibiotics in Australia is one of the highest per capita in the developed world.  The NPS says that “overuse and misuse of antibiotics has made it harder and harder to treat many bacterial infections. Antibiotics are losing their power against illness-causing bacteria.”

The NPS have recently launched a campaign to raise awareness of the growing concern of Antibiotic Resistance, which the WHO recently declared as ‘one of the greatest threats to human health today’.

While the ad is a bit pithy, the message is not.  You don’t need antibiotics for coughs and colds, which are usually caused by viruses.

The NPS says:

• Understand that antibiotics are only effective against bacteria and not viruses — colds, flu and most coughs are caused by viruses and will get better on their own.
• Treat your flu and cold symptoms and let your immune system fight the virus — antibiotics will not help you get better quickly, and may give you side effects such as diarrhoea and thrush.
• Don’t ask for antibiotics — instead ask your doctor about the best way to treat your symptoms.
• If you are prescribed antibiotics ask your doctor about the risks and benefits and always take them exactly as prescribed.
• Don’t take someone else’s antibiotics.
• Spread knowledge, not infections — encourage other people to join the fight against antibiotic resistance.

If you aren’t sure if you have an infection caused by a virus or a bacteria then see your GP.  They are the health professionals that are in the best position to examine you and advise the best course of action.  It may mean a script of antibiotics.  But nine times out of ten, all you’ll need will be a medical certificate, and a trip to the supermarket to get some paracetamol or ibuprofen.  If you have a favorite cold remedy, feel free to post a comment.

If you want more information on the NPS campaign to become a resistance fighter, you can get it here: http://www.nps.org.au/bemedicinewise/antibiotic_resistance

If you want to follow the NPS on Facebook, click here: Facebook

See the video: http://youtu.be/H1wwdE5abLk

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Why Diet Zealots Are Usually Wrong

I hate Diet Zealots.

You know, those people who tell you, “I lost blah blah pounds on the blah blah diet.  If only everyone was on the blah blah diet, then we wouldn’t have an obesity crisis.”  The also add when they see my generously rotund abdomen, “Why don’t you try it?” Grrrrr.

Its hard to argue against these people.  They hold unshakably to the belief in whichever diet worked for them because of their own attentional bias.  Usually they have tried for years to lose weight and have consistently failed.  So it is only natural that when they finally lose weight, their attention and belief systems are immovably focussed on their path to enlightenment.  It doesn’t help that some have the scientific acumen of a lab rat.  But of the many Diet Zealots that have come across my path, even the ones that have some scientific training find it hard to move beyond their cognitive anchoring to the program that finally worked for them.

But no matter what the French physician says in his book, or the woman who lost 200 pounds says on the TV, there is no magic ingredient or silver bullet in any of their diets.  If any diet brings about weight loss, there is only one fundamental reason.  It brings about a calorie imbalance, where more calories were used than consumed.  Nothing else.

The key point isn’t whether a diet can induce weight loss.  I can show you examples of people doing the dumbest things and still losing weight.  One guy ate nothing but potatoes for 60 days and in the process lost 21 pounds.  Even the cabbage-soup advocates say that you can lose 10 pounds in seven days.  Although I think I’d rather remain five kilos heavier than live on cabbage soup for a week.

The foundation to any diet is that it has to be healthy.  Because isn’t that the point, you go on a diet for your health.  There are a number of diets which sound good on the surface, and the guy selling his book will point to the thousands of people who may have genuinely lost weight on it.  But if it contributes to heart disease or colon cancer, then all it means is that you will fit better into your coffin.

The other consideration is whether the diet contributes to long term loss of fat.  Short term weight loss is always water weight and intracellular carbohydrates, then proteins from your muscle and bones.  Losing most of the weight in the first two weeks and then plateauing is actually going to be bad for you in the end.  Slow gradual weight loss over months to years is the best form of weight loss, because that usually represents fat loss, the sort of weight that you want to lose.  If you lose about two kilograms a month (or four to five pounds in the imperial) then you are on the right track.

Next time you meet a Diet Zealot, be happy for them.  It’s hard to lose weight, no matter which diet they might be on, so congratulate them on their achievement.  But don’t feel you have to be converted.  Find what works for you, which is likely to be something a lot more simple than what the Diet Zealot has done.

(If you would like to compare the pros and cons of a number of the popular diets, I found this website in my research: http://health.usnews.com/best-diet/best-overall-diets I don’t know who their expert panel was, whether they were experts, or whether they were paid off.  But it’s the best comparison I have seen so far on the web.  If you have come across one better, let me know in the comments.)

Land of the Free – Chapter 4: There’s no place like home

Well, we’ve made it. I have now stepped foot in my living room, after completing a 30,000km round trip to the other side of the earth. The memories are many, but because of my early onset dementia, they are fading fast. But it was a really full on 17 days.

When one travels overseas, one receives the gift of perspective – I have been reminded about the good and bad things about living in Australia. For one, the coffee. Every day, every Australian should rise from their beds and thank God that we consume some of the best coffee in the world. American coffee is awful. I believe it’s made from silt dredged up from the bottom of a secret swamp, deep in the heart of southern Florida, mixed with a number of bitter herbs and goats urine, and boiled for 24 hours. The only reason I can think why Americans drink it is that it has healing properties. Anything tasting that bad must be good for you.

The other thing that I value is the feeling of (relative) safety here in Australia. LA gives me the creeps. Away from the tourist strips, I always had this foreboding, that someone was about to mug me for my wallet and my kidneys. It’s natural that one would have some anxiety when negotiating a new area, and if I was to settle somewhere in the US, that would probably pass. But since there is very little social security in the USA, and even worse health care if you don’t have insurance, the destitution seems a lot more visible.

It has also allowed me to see just how much Australians are subject to price gouging and taxation. The prices of almost everything in the US were ridiculously low compared to Australia. They were moaning in Hawaii that their gas prices were 445 US cents per gallon. Apparently their gas prices are expensive compared to the US mainland. And yet, 445 cents per gallon is equivalent to 117 cents per litre. In the taxi on the way home, I saw petrol prices at about 160 cents per litre near my house, and that is pre-carbon tax which is going to increase the price more. As I noted in my previous post, their alcohol is cheaper by a factor of 300%. The other product which I can compare directly with home was the price of a meal at McDonalds, known in finance circles as “the Big-Mac Index”. It was about $1 cheaper for a standard meal in the US, which is larger compared to the same meal in Australia.

The other thing about the US is tipping. I’m mixed on the whole tipping thing. It seems like a rort on the surface, a way for the service industry to make a couple of hundred dollars in tax-free cash a week. But on the other hand, it offers a way of direct reward for good service. I stayed in four different hotels on my travels. The three in the US had people there that were falling over themselves to help you. Carry your bags, get taxis for you, offer information. Sure, you would need to tip them, but I appreciated the service. When I arrived at the Holiday Inn at Sydney Airport, the front counter was like a ghost town. There was one person manning the front desk. No concierge, no people to help with the luggage. The one other person that was there when the taxi driver was dumping our bags in the middle of their driveway disappeared as soon as he saw 4 large suitcases that he might have to help with. Might as well put a big banner up at the airport: “Welcome to Australia, where we don’t give a sh*t.”

Griping aside, there are some other great benefits from being away from my office. The weather was fantastic. Other than the first day in LA with it’s cloudiness and sub-zero temperatures, the rest of the holiday was sunny and warm. I spend two weeks in blazing sunshine, which has been fantastic for my rickets. I think I’ve also lost about 5kg from all the walking that I had to do. So overall, a good break.

Well, I hope that these blogs haven’t bored you all to tears. You’ll have to wait until I save up enough money for my next holiday before you get any more, so a welcome break I’m sure. Until then, enjoy life, and God Bless America.

Land of the Free, Chapter 3 – Aloha!

Hawaii. A little cluster of eight islands in the middle of the north Pacific Ocean.  It is an eclectic mix of bustling US city complete with its clogged freeway system and homeless people, and of tropical island paradise with white beaches, palm trees and clear oceans that reflect the skies magnificent azure hue.

It has a rich polynesian heritage.  The local polynesian dialect is still spoken regularly, like an unofficial first language, and everyone greets you with a hearty “Aloha”.  I always thought that the whole aloha thing was just one of those annoying tourism gimmicks (like the nauseating “Have a magical day” that Disney people irritate you with).  But everyone says it – from the checkout chick at the supermarket to the guy serving at Maccas.

The kids had a little bit of trouble with the pronunciation though.

Me: “Aloha boys.”

Mr 7: “Hello-ha.”

Me: “What is the name of the island we’re on?”

Mr 5: “We’re staying at … Haw … ah … Ha-wee-wee.”

Me: “And the name of the city?”

Mr 7: “Hallelu-lu.”

Hawaii is truly a beautiful place, with some absolutely stunning natural features.  The beach at Waikiki is a pale, clean sandy beach where the clear shallow water reveals the schools of small fish swimming around your feet, and further out, the shoals of coral reef.  The clear water gradually gives way to the most amazing ocean, which looks like someone took a swatch of the most amazing shades of blue, then bled and blended them like a water colour, all the way to the cloudless horizon.

Turn around, and the mountain range looms above you, its sides covered with a lush carpet of rainforest, and its sharp ridges disappearing into the cumulus clouds that remain perpetually attracted to it.

The main artery of Waikiki is Kalakaua Avenue, which is a clean, vibrant, high-end restaurant and retail strip.  Louis Vuitton, Victorias Secret, Prada … there are a lot of different ways in which you can spend your money.  If you keep going west, you will eventually end up in Ala Moana, which is a very very large, open-air shopping centre with many of the same brands.

If you would prefer cheap alcohol, cigarettes and souvenirs then head to the nearest ABC store.  You won’t have far to go.  The ABC stores are everywhere.  There are literally 60 or 70 of them in the mile or so around Waikiki.  They outnumber McDonalds about 30 to 1.  They stock almost everything.  Groceries, snack foods, lots and lots of souvenirs, tacky Hawaiian shirts, and really really cheap alcohol and cigarettes.  Like, 1.75L bottles of Smirnoff Vodka for $US25.  In Australia, that same volume of spirits would cost about $70.   The story from the tour guides is that the chain is owned buy a japanese family, who named it ABC as an abbreviation for “A Better Convenience”.  The locals have a number of other possible abbreviations – Aloha Brings Customers, Alcohol Bric-a-brac Cigarettes, Another Bottle of Cognac, A Bunch of Crap, just to name a few.

The Hawaiian diet is unique.  This little island consumes the largest amount of spam in the world.  They serve spam with breakfast in McDonalds.  They have cook books entirely  dedicated to spam.  They have macadamia nuts with spam flavored coating.  The tour guide said they even have a festival where they close part of the main street of Waikiki for a festival of spam cooking.  If they ever took Iron Chef to Hawaii, their key ingredient would be spam.  Cue Monty Python sketch here.

The other key ingredient to combine with the spam is, not surprisingly, pineapple.  Again, they like to serve everything with pineapple, or pineapple juice.  Every time I ordered a meal from McDonalds, they gave me a cup of pineapple pieces with it.  Mr 5 ate a couple of them, but I had four left over in the fridge when I left.  I must admit, it does go well in Mai Tais, but other than that, I really didn’t share their pineapple fetish.

The dress code is pretty much anything you feel like.  High end restaurants will let you in wearing T-shirts, shorts and sandals.  Gaudy Hawaiian shirts are the standard uniform for everyone in hotels, transportation and tours.  On the beach, as long as you have some form of material covering your delicate parts, no one cares.  There are exceptions of course.  One middle aged, unattractive Indian lady decided to wear a white, relatively see-through G-string Bikini.  When she emerged from the water, there wasn’t much left to the imagination.  And worse yet, she sauntered up the beach, blithely oblivious to the wave of nausea that she was creating, found her towel, and then bent over for about five minutes while she scrounged around in her handbag looking for her sunglasses.  Oh please madam, put it away, this is a family beach.  Now, I have seen my fair share of buttocks in my time as a doctor, from the aesthetically pleasing to the downright ugly.  Even so, there was something particularly hideous about this view, and yet, like a doe staring into the headlights of the on-coming semi-trailer, I strangely couldn’t look away.  I should have.  I’m now scarred for life.

Over all, I enjoyed Hawaii so much more than the rest of the trip.  We did pay through the nose to get high end accommodation, a condo 35 floors above and directly across from the beach at Waikiki, but having a bedroom and bathroom to ourselves was absolute gold.  We will definitely be coming back – to explore the rest of Oahu, and to try and get across to Maui or the big island of Hawaii.

I’d recommend coming if you can.  Before I came to Hawaii I thought it would be just like the Gold Coast. While there are definitely some similar elements, the Gold Coast doesn’t come with a stunning mountain range just behind the beach, coral or the clear water that allows you to see it, and it certainly doesn’t come with magnificent sunsets over the ocean that I witnessed at a Luau the other night.

I might come back to the keyboard when I get home, to sum up a few things but for now, mahalo, aloha, and God bless America.

Land of the Free – Chapter 2: My Magical Week

Disney World.  Every child’s dream.  A place where dreams come true … unless of course you are that child’s parents.  In which case, your dreams of having a quiet, relaxing week of rest and tranquility will become your worst nightmare!

You will queue for everything.  You will stand in line for an hour to ride something that will last 30 seconds.  Between each queue, you will walk a mile and a half, through a swarm of people, wheelchairs, strollers and tourists trying to take photos of everything, including wheelchairs and strollers.

To rub in a bit more salt, all the park attendants look at you with big cheesy smiles and say, “Have a magical day!” I sure will, but only after I get over this incredibly strong urge to stuff this large pair of mouse ears down your throat.

In fairness, our travel agent did book us for Disney on the week that coincided with the US Spring Break, in which three quarters of the US population descend on Florida, with most of them going to Disney World.

After three days of leisurely mornings, arriving at the park by 10am, only to discover that 500,000 people had beaten us to it, we figured that we would turn up at park opening.  This meant very long days.  But it was the only way to get the jump on the 500,000 people.  We got more done in the first two hours before the crowds arrived that we did the rest of the day.  Consequently, our last three days was much more enjoyable than our first.

I don’t have the space to give you a blow-by-blow description of everything we did.  But the highlights … They had a few shows that used a technology that allowed the animated characters on the movie screen to interact live with the audience.  Like “Crush the Turtle, Under The Sea” show at Epcot, where Crush, the turtle from Finding Nemo, had conversations with the kids in the front section, answered questions from the audience, and even produced fart bubbles on cue (the Monsters Inc Laugh Floor at the Magic Kingdom was very similar).

Mr 7 really enjoyed the Buzz Lightyear ride, and when he went back on it the second time, managed to max out the score somehow.  Future sniper.  Mr 5, on the other hand, has discovered his love of roller coasters.  “Star Tours” is a ride at Hollywood Studios.  It is a virtual reality 3D ride which simulates an out-of-control galactic shuttle, which flies through battles, planets, and cityscapes.
Mr 5: “Woo Hoo! That was fun!  I want to do that again.”
Me: “Oohh, that was nauseating.  You can go back on that with Mummy.”

On one of our days at Magic Kingdom, S made us go on the “It’s a Small World” ride.  In summary, it was five minutes of intense psychological suffering.  Imagine a slow boat ride through a warehouse through of tacky robotic puppets (like the puppets that did the “Welcome to Duloc” song in Shrek 1) all singing “It’s a small world after all”.  You can understand my anguish.

The “Nemo, Live on Stage Musical” at the Animal Kingdom was brilliant, 45 minute, full musical production, which was a clever combination of the human actors singing and dancing with the Nemo character puppets.

Our last stop in Florida was Legoland.  Legoland is another theme park, but filled with Lego sculptures.  Some of them are enormous.  Most of them are very creative and well done.  They have an entire section of the park dedicated to Lego replicas of famous International cityscapes that are significant to Americans (ie: cityscapes only from America).  At the end of the day, the boys bought as many Lego sets as we could fit into our suitcases.  Overall, not as well run as the Disney theme parks, but still good, and when they add the water park in May 2012, it will make Legoland worth the 45 minute trip from Orlando.

So, having done 7 theme parks in 7 days, I have lived to tell the tale, and I am not planning on going anywhere near another one for about 7 years.

I will hopefully update before leaving Hawaii, but for now, God bless America.

Land of the Free, Part 1: City of Angels

America.

The land of the free. The home of the brave.

The last time I travelled to the US, I was unencumbered. I was free to go and get coffee, or go to the bathroom any time I wanted. I had a rather quiet trip over the Pacific.

This time, eight years and two pregnancies later, things were somewhat more complicated. It is only when you are confined to a single row of seats in a small hollow tube with two small children that you realize just how big the Pacific Ocean is. I did tell the children that if they didn’t do exactly as the flight crew or I told them, the hostesses would hit the button for the ejector seat and they would be launched out of the plane. I think they bought it. They were certainly well behaved for most of the flight. Mr 5 was amazing, he slept most of the way. Mr 7, well, he had his moments but was able to be entertained most of the way but the LCD screen in front of him, with as many games, tv shows and movies that he could watch.

After surviving the ordeal that was the trans-Pacific crossing, we arrived in the US. Standing in line, waiting to get through customs, S decided to vomit everywhere. All over her clothes. All over the floor. She managed to miss the customs officials, which was lucky. I didn’t fancy the prospect of another 12 hours back to Australia.

When we got out of the airport we quickly realized that we may not have packed properly. Los Angeles was all of 8 degrees, we were in shirts and shorts. The shuttle driver was short one seat in the van, so rather than dying of hypothermia, I decided to ride, literally, on the edge of my seat. Crammed like sardines in the back of the over-crowded van, S decided to vomit again. Thank God that Customs now make you pack all of your liquids in those plastic resealable bags. They came in very handy . Still, I triple-tipped the driver for making his van smell like S’s stomach contents. The hotel did manage to get us into the room earlier than the usual check in time, but I would have too if I’d had to watch S vomit another two times while in their lobby. I’m still not sure of the exact cause of her hyperemesis. Qantas service isn’t great but we did eat the same things and I was fine. Maybe America is nauseating, although we seemed to have adjusted. Maybe it was jet lag, although she had more sleep than I did.

Anyhow, the boys and I left S in bed, and headed to Hollywood! The day had warmed up remarkably – by that time it was a balmy 11 degrees, and the kids still were only wearing t-shirts and shorts. We found the closest vendor of tourist clothes and bought the warmest thing I could find them. Hence the “I (heart) LA” jumpers that they are now wearing everywhere, that you’ll see in all the photos. Cheesy, tacky, but warm nonetheless.

Once we found the nearest indoor restaurant and warmed up for 30 minutes, we braved the crowds of Hollywood Boulevard. The kids got to see Mann’s Chinese Theatre, the Walk of Fame, and were accosted by several failed actors who roam the strip, hoping that discerning tourists will take pity on them and pose for photos, or that Chinese tourists will believe that they are the real thing and pay for their autograph. They also got to see the Hollywood sign when the fog finally cleared enough.

By about 1pm local time, the kids were wasted. It was about 5 am Brisbane time, and I’m surprised that they weren’t delirious. On the return trip back to the hotel, the cab driver appeared to be a Ukrainian immigrant with tuberculosis. And we stopped at a set of traffic lights where a clearly deranged woman was vigorously fondling her breasts and laughing with the voices in her head. American healthcare, the best in the world.

We got to the hotel about 3pm, and we slept. And slept. And slept.  At one point S woke me up, saying, “Its 7am. Gee I slept well.”
“Is it 7am, or 7pm?”  It was still half light outside, and I knew I’d slept well, but not for 15 hours straight. “What does the phone say?”
“Oh, 19:00. It is 7pm. Oh well, I’m still going to have a shower, then I’ll go back to bed.”
Goddamned jet-lag.

At one point around 2am, Mr 5 woke up, and promptly vomited all over the toilet floor.  America – nauseating.  Luckily I slept through that one, so poor S had to deal with that.  When we did all finally manage to surface about 8am local time, we certainly felt better.  The day outside was a beautiful one, clear sunny skies … and a freezing south-easterly wind, cyclonic at times, that even the locals were finding a bit too much to handle.  We donned whatever warm clothes we had again (cheesy, tacky “I (heart) LA” jumpers) and headed to Universal Studios.

Overall Universal was good. The kids loved the Animal Show.  Mr 7 had mini-meltdowns every time we went to a new show because “It might be scary”.  Honestly, what would give him that idea?  It certainly wouldn’t have been the fact that we took them on the tour first up, complete with the all-new “King-Kong in 4D” segment, which had us flailing around inside the carriage as it jolted and jerked us earthquake-style, while the screens either side had T-rexes and a giant ape attacking us.  Honestly, I don’t know why they would have been scared?  Ok, that part aside, they did enjoy the rest of the day, it just took them more to convince them they weren’t going to die each time we went to a new show.

We’re now on our way to Florida, where the temperature says that it is a tropical 32 degrees, so we can finally ditch the jumpers.  I will update after a few days at Disney, and add some more photos as well.  Till then, God Bless America!

The hidden secrets of Queensland Health

I swore on the Bible once.

I was giving a statement at a lawyers office, for evidence to be submitted in a trial.  I was taken aback when they pulled out a Bible, and asked if I wanted to swear on it.  I’ve probably seen too many episodes of Matlock, so I associated the process with Hollywood, not our modern legal system.  I never thought I’d be doing it myself.

I swore that I would “tell the truth, the whole truth and nothing but the truth, so help me God.”

Anna Bligh would like Queenslanders to believe during the current election campaign that she is telling the truth.  And in a way, I’m sure she is.  Like when she said that Queensland has the lowest operating waiting lists of all state health departments (http://bit.ly/zQGVbs).  Sure, it’s probably technically correct.  But could she swear on the Bible about the QHealth elective surgery waiting times?  Is she speaking the whole truth, and nothing but the truth?

The AMA Queensland doesn’t think so.  Professor Richard Kidd told the media, “The Premier lied when she said that we had the shortest waiting lists.”

The article went on,

“Dr Kidd said public hospitals were returning thousands of referral letters to general practitioners telling them they could not see their patients in a timely way.
“Those patients don’t get counted on the waiting list,” he said.
Dr Kidd said other patients languished for many years before getting an appointment to a public hospital specialist for assessment, making up the so-called “waiting list to get on the waiting list”.
“We need to talk about the waiting list, the waiting list for the waiting list and the I’m never going to get onto the waiting list, waiting list,” he said.”

Rarely do I agree with the AMA.  By and large, I have found them like an old broken air-conditioner – chewing up lots of resources, making lots of noise, and producing nothing but hot air.  But Richard Kidd publicly confirmed things about Queensland Health that the average Queensland voter wouldn’t hear about.

As a GP on Brisbane’s northside, I struggle with patients every day to find a timely solution to their health needs.  Getting them into the Royal Brisbane or Prince Charles Hospitals are not timely options.  Only the absolutely emergent will get seen within a few days.  Most of my patients would wait 12 months to 18 months depending on the severity and the specialty required.  As Professor Kidd pointed out, most of these people languish on the specialist outpatients waiting list, the so-called “waiting list for the waiting list”.

But even then, it isn’t so much the waiting times that irritate me, but the tricks that the bureaucrats play to keep thinning the numbers.  Like sending letters out to patients asking if they still want to stay on the waiting list.  If the patient doesn’t respond within 7 days, they are taken off the list.  Or 18 month audits of the waiting list that GP’s are expected to complete and return, with the same aim in mind, to thin out the waiting list numbers.   I had to do two of those for one patient I can recall, who suffered for more than two years on the ENT waiting list for the RBH, almost completely deaf while I waited for a specialist to give me advice on how best to manage his condition.

Or, as Professor Kidd also said, I get letters back from the hospitals stating that they will not accept my referrals because my patients will not get seen in a timely manner.  In other words, “we don’t want to see them at all”.  But some people have no other option.  They can’t afford to go to private specialists.  Or, like the children on the long, long wait for speech therapy services, there aren’t enough private practitioners around.

When services are provided, Queensland Health now uses federal funding by bulk-billing Medicare for services rendered.  While that may seem like a win-win for the hospital and the patient, the hundreds of millions of dollars that Queensland Health sucks from the Medicare system is money that could be put towards better General Practice and primary health care – money that could be spent on trying to keep people out of the hospital system in the first place.

When I left the public hospital system in early 2004, I already felt that the system was starting to spiral out of control.  And nothing in the last eight years of Labour government has convinced me that it is getting any better.  If anything, the holes in the error-riddled system binding Queensland Health together have become large and numerous, like an old sponge.  If Campbell Newman wins this election, he will have a tough job on his hands.

If Anna Bligh wins this election, God help us all.  There will certainly be lots of swearing, but not on the Bible.

On Poetry and Purpose

Ephesians 2 – http://bit.ly/ruEci

I’ve written before about how were are like Gods Masterpieces.  Remember, Psalm 139 says that you are God’s masterpiece, a one-off, unique creation that inspires reverence and admiration for God.

But the qualities that define your uniqueness and inspire the awe and reverence for God are not limited to your physical beauty.  The are woven into the very fabric of your life and destiny.  The purpose that God has for you is also unique, and the Bible reveals that it is just as carefully crafted.

Ephesians 2:10 is a verse that is very powerful, and unfortunately has become a bit cliche.  This verse still triggers nightmarish memories of Rick Warren in Hawaiian shirts for me, after I did the “Purpose Driven Life” series a few years ago.  Whatever context you have heard this verse in, I want to look at it afresh and put it in a different light.

It says, “For we are God’s workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do.”  Without delving any deeper, the verse is still very powerful.  It tells me that we have a God-given purpose, to do good, and these were set out for us in advance, before we were even born.

If something was created for a purpose, then the very act of its creation was purposeful.  In other words, God made us specifically for certain tasks, so he designed us. He did not throw a few limbs and some skin together and hoped for the best.  Our life is not a conglomeration of random chance.  If I were to make a  knife, I would have to shape it specifically with the correct dimensions, make it pointed, make it sharp.  I can’t just pour some molten metal on the floor and hope it comes out straight or sharp.  Whatever your purpose in life, you are meant to be what you are.

If we dig a little deeper into the original greek language, the meaning of the verse becomes even clearer.  ‘Workmanship’ in the greek is poiema from which we get our english word ‘poem’.  We are not a meaningless jumble of letters that makes no sense. We are a beautifully crafted blend of rhythm, harmony and meaning.  You are a sonnet from the mouth of God.

Following in this vein, the next word ‘created’ is the word ktizo which refers to God creating the worlds, or to form or shape, literally “to transform completely.”  Like a potter taking a lump of clay and completely transforming it into a ceramic vase, so when God spoke you into being, you were expertly crafted into the symphony of shape, colour, texture and depth that makes you unique.

The next phrase, ‘to do good works’, are the words agathos ergon, literally a ‘good, pleasant, useful or distinguished occupation’.  These works are not just sporadic, but they are a lifestyle.  I am a doctor, not just when I walk into my office in the morning, but all the time.  You can’t clock on and off from your calling either.

‘Prepared in advance’ is the word proetoimazo, a compound word made up of pro, meaning ‘before’ and hetoimazo, to ‘make everything ready’.  Like getting the table set and the meal cooked before your dinner party guests arrive, God prepared your calling.  It is ready to go, all you need to do is to step into it.  So why isn’t everyone functioning in their calling?

The next greek word, peripateo, is translated in the NIV as ‘for us to do’, but in the King James, ‘we should walk in them’.  It is used in the subjunctive sense – a form which the action is not certain but dependent on the action of another.  So God is not compelling you to walk in them, but they are ready when you are.

There was a custom in the ancient Middle East where a traveling King would send out an advance team to clear the road of debris, and repair it, and make it passable for his entourage to journey without obstacles.  God has prepared the road for you already.  But God isn’t going to make us walk on it – that’s up to us.  We often want to walk on the roads of other people but we have been specifically designed to travel on our road.  Like driving a sports car on a rough hewn dirt-road, or a four-wheel-drive on a race track, being on the wrong road is frustrating and hard work.  We need to find our own road.

How do you find your road then?  You know, I don’t think we actually find the road, but that God shows it to us.  When God called Abram from Haran in Genesis 12, He said “Get up and leave, go to a land that I will show you”.  You have to be travelling first, and God will open your eyes to the road when you are approaching it.

I said earlier that the purpose that God created us for is unique.  But our unique purpose is derived first and foremost from our common purpose.  The preceding verses of Ephesians 2 says, “All of us also lived among them at one time, gratifying the cravings of our sinful nature and following its desires and thoughts. Like the rest, we were by nature objects of wrath. But because of his great love for us, God, who is rich in mercy, made us alive with Christ even when we were dead in transgressions—it is by grace you have been saved. And God raised us up with Christ and seated us with him in the heavenly realms in Christ Jesus, in order that in the coming ages he might show the incomparable riches of his grace, expressed in his kindness to us in Christ Jesus. For it is by grace you have been saved, through faith—and this not from yourselves, it is the gift of God— not by works, so that no one can boast.” (v3-9)

It is because of the grace of God, and only because of his grace, that we are saved.  It is not because of anything we have done.  But the incomparable riches have given us all a purpose – to be made alive in Christ and join him in the heavenly realms so he can show the incomparable riches of his grace, expressed in his kindness.  It is only when we know him intimately that ministry and calling are worthwhile.  Moses said to God, “If your Presence does not go with us, do not send us up from here.” (Exodus 33:15).  You can be in the promised land, but without the presence of God it will never be enough.  And Jesus himself would rather relationship than just service and sacrament.  In Matthew 7 he said, “Not everyone who calls out to me, ‘Lord! Lord!’ will enter the Kingdom of Heaven. Only those who actually do the will of my Father in heaven will enter. On judgment day many will say to me, ‘Lord! Lord! We prophesied in your name and cast out demons in your name and performed many miracles in your name.’ But I will reply, ‘I never knew you. Get away from me, you who break God’s laws.’”

I think the body of Christ is like a tree.  A branch is not much good unless it is attached to the trunk, and the whole tree is dead unless that is connected to the roots and they are in the ground.  We have to have to be rooted into an intimate relationship with God, sharing in common with the trunk of the church, and only then can we branch off into our individual calling.  Every leaf is different, in shape, in colour, in pattern and texture.  But they are all the same in that they must be connected to the trunk and the roots to remain alive.

So, we are God’s poem, a sonnet of grace and beauty, each with a path that God has prepared for our travels.  Connect with him, make sure he is first in all aspects of your life.  Then he will show you your calling, your individual purpose in life that he has planned for you.  It is only then that you will be truly fulfilled, and live life abundantly.

Originally published May 2009

On MRI Scans And Freedom Of Speech

I broke my elbow once.  It was a complicated fracture that only partially restricted my movement, and in fact, I initially thought it was just a bad sprain.  After seeing my orthopaedic surgeon, I diligently went to have an MRI done to see exactly what was going on.  MRI machines aren’t the most comfortable things, and in my case I had to be in a particular position, laying face down with my arm straight out in front of me, Superman style.  And I had to be perfectly still.

Sure, easy … right?  For the first minute I was fine.  After the second minute, my fingers were tingling.  Five minutes into the twenty-minute scan, my entire arm went numb.  By the time the scan was over, I was experiencing phantom limb movement where my brain was telling me that my arm was free-floating in space, even though it was laying dormant and lifeless on the bed in front of me.  What was really weird was that I couldn’t lift my arm.  I had to use my other hand to pick it up and carry it with me when I got off the bed.  And that made it harder to walk straight, because my body was used to both arms moving freely to walk straight.

In recent months, Senator Brown has vociferously pushed for media regulation, especially of what he refers to as “hate media” (http://www.youtube.com/watch?v=OydmiPg6j9M).  Of course, by “hate media” he means every newspaper and journalist that would dare to question Greens policy.

In recent days he went further, suggesting that individual journalists should be licensed.  “It’s time the crown licensed the press,” Senator Brown said, before later calling for “some point of reference” to pull up both journalists and proprietors “who do the wrong thing in their tracks” (http://www.theaustralian.com.au/business/media/brown-calls-for-state-control-of-media-and-licences-for-journos/story-e6frg996-1226156424790).

But who decides exactly what the standards for journalism should be?  Who can claim to be the sole arbiter of truth, and thus able to set firm, objective boundaries that the media can operate within?

Perhaps it should be the Judiciary?  Except that the reputation of Judges as objective respecters of fact must be called into question by the most recent judgement of Justice Bromberg in the Federal Court.  In handing down his verdict that journalist Andrew Bolt breached the Racial Discrimination Act, Justice Bromberg pronounced that Bolt used language which was not “moderate or temperate but often strong and emphatic” and contained “a liberal use of sarcasm and mockery”.  Justice Bromberg commented: “Language of that kind has a heightened capacity to convey implications beyond the literal meaning of the words utilised. It is language which invites the reader to not only read the lines, but to also read between the lines.” (Media Watch Dog Issue 114, http://www.thesydneyinstitute.com.au/media-watch-dog/).  As columnist Tim Blair astutely noted, “Reading between the lines of Bromberg’s ruling, Bolt seems to have been condemned for a form of thought crime.  We’ve now witnessed a legal procedure about race involving racial differences nobody could see and words nobody could read.” (http://www.dailytelegraph.com.au/news/opinion/blank-spaces-between-the-lines/story-e6frezz0-1226156284507)

Perhaps we can trust the Greens themselves to be an impartial arbiter?  Except that they have already shown that they are thin-skinned and insular.  I refer not only to Senator Browns “hate media” comments, but also to the deputy-leader of the Greens, Senator Christine Milne.  She told ABC TV’s Q&A program on the 25th of July 2011, “The Murdoch press has been running a very strong campaign against action on climate change … The bias is extreme, in The Australian in particular … We’ll also have a look at a range of other issues, including who are fit and proper people into whether we need that test into people to be running media outlets. It’s time we had a good inquiry and certainly bias is certainly going to be one of the things that’s certainly to be looked at.”  It is well and good to look at media bias, but can we be guaranteed that such an inquiry will give the same attention to left wing media bias?  Indeed, can a government review process ever be truly unbiased?

But even more fundamental is the issue of freedom of speech.  In 1948 the United Nations General Assembly adopted the Universal Declaration of Human Rights (UDHR).  Article 19 affirms the right to free speech: “Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers.”

On the 10th of December 1998 the Australian Government pledged to give wholehearted support to the principles enshrined in the Declaration.  However, such a freedom is not wholly enshrined by the the Australian constitution, and indeed, no parliament has moved to enact the freedom of speech articles into Australian law (http://www.aph.gov.au/library/pubs/rn/2001-02/02rn42.htm).

Yet free speech remains one of democracies most powerful and fundamental principles.  Indeed, without the ability for any society to openly debate any topic, the sustainability of the growth in knowledge comes under threat.

I believe that knowledge in its broadest sense is like a plumb line.  Within human civilization, knowledge within any discipline or relating to any particular topic goes through fundamental changes as each opposing side is allowed to freely add their input.  Some of these changes are seismic in proportion, the “paradigm shift”, while others are infinitesimal.  A paradigm shift pushes the plumb-bob off on a tangent, and the swing of the plumb-line in its journey back to it’s central point is representative of the course that knowledge takes as each school of thought around that topic or discipline has input into it.  If left to it’s natural course, the oscillating plumb-line regains its equilibrium around the central position, and similarly, if the process of intellectual exchange is left unhindered, the truth within the discipline is revealed.  Such a process relies on the unimpeded action of gravity on the plumb-bob and the knowledge equivalent relies on the free exchange of ideas, unimpeded by political interference within the scientific or philosophical debate.  Once the scientific process is corrupted, or debate stifled, the plumb-bob of knowledge remains skewed off course, artificially held away from its true centre.  We must hold on to the freedom to share our opinions.  It is the only way that human kind will ever discover true knowledge.

I do not agree with most liberal commentary.  But it is essential for ultimate truth to be revealed.  The same must go for conservative commentary as well.  Both sides are needed for balance – like my body’s left and right arms after my MRI.  Or your left and right legs.  If recent legal precedent remains unchallenged, or politicians on the extreme left such as Senators Brown and Milne have their way, we will have the socio-political version of a stroke, and as a country, we will be rendered lame.  Like it or not, journalists, writers, and indeed all Australians, need to be able to speak without fear so our country remains racing, not limping into our future.

Dr Oz: Disempowering women everywhere

This is a public service announcement.  If you see an e-mail circulating about demanding a thyroid guard for a mammogram, ignore it.

Dr Oz, the TV talk-show doctor, is obviously a smart guy.  Depending on how much you believe wikipedia, Dr Oz graduated from Harvard, then went on to obtain a joint MD and MBA in 1986.  He specialised as a cardiothoracic surgeon.  So the man is talented.

But sometimes even the smartest people make errors.  During a show on thyroid cancer, Dr Oz asserted that thyroid cancer was caused in part by the radiation dose received to the thyroid from mammograms, and that all women should ask for thyroid shields (a lead apron for your neck) when having a mammogram.

Misinformation behaves like a viral infection.  The mistruth infects the trust of a small group of people, and the idea spreads quickly through their social networks, disrupting and destroying the confidence that had established itself in the community.

Anecdotally, a number of women have presented for their mammogram, asking for their thyroid shield.  And when told they’re not routinely used, they have cancelled their mammograms in a huff, complaining that the screening service was obviously deficient.

For Oz, it’s all about a patients rights.  “Mammography makes a ton of sense, but you have the right to ask for a thyroid guard,” he said. “This is only going to happen if you make it happen. If you don’t ask those tough questions, there isn’t going to be any change. But if you do ask them, you have the power to make us doctors adjust to you and customize your care.”

That’s great for a TV show sign off, leaving the audience with the warm fuzzy glow of empowerment.  But true empowerment isn’t just turning up to a doctor and demanding things Dr Oz or Google said were essential to life, just as good medical care isn’t the doctor smiling at you condescendingly, while giving you a script without any explanation.  Empowerment is getting the best information from your doctor and working on a way of tailoring that information to your particular needs.

The converse to the empowerment principle is caustic.  Giving the wrong information is disempowering, because every choice stemming from the wrong information is still wrong.  While he probably had the best intention, Dr Oz’s mistruth still results in potential harm to thousands of women.

When it comes to mammograms, the radiation dose to the breast is still low by X-ray standards.  The scatter that would be absorbed by the thyroid would only be a small fraction of this already low dose.  In a follow up show, experts in breast health told Oz that the radiation dose exposure to the thyroid gland after 40 years of annual mammograms would be less than the background radiation received by sitting in a television studio for 60 minutes.

The American College of Radiology and Society of Breast Imaging quantified the effects of this scatter as increasing the thyroid cancer risk by one in 17 million women.  According to those statistics, you’d have more chance of winning the lottery.

Even if thyroid cancer was significantly affected by mammography, the overall risk of thyroid cancer is smaller than breast cancer.  Thyroid cancer in women has an incidence of 16.3 per 100,000 women.  Breast cancer incidence is 124 per 100,000 women, and sadly, 24 per 100,000 women died from breast cancer.  So breast cancer is eight times more likely than thyroid cancer.  And the number of women dying from breast cancer is higher than the total numbers of thyroid cancers being diagnosed.  So having a mammogram is more likely to save your life rather than to end it.

You may agree at this point that the risk is very low.  But why not just use the thyroid shield anyway?  Even if the risk is microscopic, reducing it further would still of benefit, right?  Well, not really, since the breast tissue fans out from the main “mound” of the body of the breast.  Some breast tissue extends up to the collar bones and the armpit, and tumours in this peripheral part of the breast tissue would be obscured by wearing a thyroid guard.  So its possible to actually increase the risk of harm by wearing a thyroid shield.

For women living in Australia, the current guidelines are that women over 40 can have mammograms every two years, through their state-based breast screening clinic.  For Queensland women, this is BreastScreen Queensland.  It is also beneficial to have a breast examination done by your GP at regular intervals, and the easiest way to do this is to have a breast check done with your pap smear.

For more information, Queensland Health issued a statement regarding the thyroid scare: http://www.health.qld.gov.au/news/media_releases/qhthryoidcancer0415.pdf

A brochure from the American Thyroid Association discusses thyroid cancer in more detail: http://www.thyroid.org/patients/brochures/ThyroidCancer_brochure.pdf

So, have regular mammograms, don’t ask for a thyroid shield, and if you see the e-mail about Dr Oz, just delete it.