This blog has been active daily for almost 20 years but in the last year readership and engagement has dropped off and comments have largely ceased!
With that being the situation - it is clearly time to do something else with my time.
So good luck to all! It has been fun...
Stay safe and well and good luck to all. Expect the occasional post when there is something that really needs a comment from me. Otherwise "thanks for all the fish!" (Douglas Adams)
David.
This appeared last week:
17 September 2025
By
Associate Professor Kees Nydam
I look forward to AI doing all the heavy lifting when it comes to the science of medicine, thereby allowing practitioners to return to the art.
Please join me on a trip into the future. It might sound a little like science fiction. Bear with me, as the future is circuitous.
The Human Genome Project was a landmark international research effort from 1990 to 2003. Following its completion, scientific inquiry shifted to the field of epigenetics. You could carry, for example, the gene for disease X, but the condition is not inevitable. Certain epigenetic triggers may need to be initiated first.
While scientific knowledge is iterative, currently there is a consensus that allostatic load in early life, plus the complex array of hormonal and other whole-body neuro-signalling, are critically involved in epigenetic trigger discharge. Hence the attention on the First 2000 Days.
One way of scoring allostatic load is the Adverse Childhood Experience (ACE) Score. While a high score does not absolutely predict mind-body “disease”, it significantly increases the odds. The ACE score sits between 0 and 10. A heightened burden of disease is set at scores of four or more. I work with patients who have scores of 8 to 10.
I am an addiction medicine specialist, working in the public sector. For my cohort, drugs were the solution, until they weren’t. Addiction for them is a secondary symptom of a more primary condition, early childhood trauma. Ironically, a traumatised child will get our sympathy, while that same child as an adult will provoke societal malevolence. Therein lies the paradox of stigma and the power of social network theory.
In the future, I predict that the Diagnostic Statistical Manual (DSM) and the International Classification of Disease (ICD) codes for mental, or brain conditions will evolve from their current categorical nature. Categorical coding is suited for a stocktaking, inventory or billing purpose. However, it provides little to enhance a deeper understanding of complex mental and behavioural disorder aetiology.
We are now seeing evidence of a gut-liver-brain-neuroendocrine axis. Substance use disorder, for instance, could just as well be named labelled a gut-liver-brain-neuroendocrine axis disorder. This does, of course, ignore the social network and larger environmental predisposing, precipitating and perpetuation factors. At any rate, the consequences of our new paradigm are that we can no longer differentiate between mind and body diseases.
If you accept that modern medicine began in the early 1900s, then the first 100 years were devoted to improving the medical response to acute emergencies.
In the future we will see a move away from acute “magic bullet cures” towards chronic disease management. This will require disinvesting in services at the bottom of the cliff and investing in services at the top of the cliff. In total the return on investment in illness care prohibits further outlay on a proverbial black hole.
We will still need to triage and initiate acute episodic “ambulance” treatments, but they have tended to consume all the oxygen in the room.
Only foolish doctors think they can save a life. At best we can prolong life. We aim to see how much difference we can make in the lives of others. At the micro level we can do this by including psycho-education in our care packages, at the macro level through advocacy.
The last 40 years have seen little shift in population health literacy rates. Around 60% of adult Australians have low health literacy, meaning they struggle to access, understand, appraise, and apply health information to make informed decisions about their health.
This lack of health literacy is a significant concern as it is linked to poorer health outcomes, increased hospitalisation rates, and a reduced ability for people to actively participate in their own care.
AI threatens to run rogue through the current workforce as we know it. If we do not know what the workforce needs will be, the best strategy is to retreat to an historical educational baseline. I refer to the dynamic duo of philosophy and rhetoric.
Philosophy teaches students how to think about thinking. Rhetoric teaches how to form an argument and, more importantly, how to spot a bad one. Combined they provide skills for critical thinking.
Most of our non-infectious chronic diseases are abetted by commercially motivated toxic propaganda, so sophisticated as to hoodwink the best of us.
To paraphrase Bertrand Russell, modern education was conceived more in terms of indoctrination by most schools than in terms of enlightenment. My own belief is that education must be subversive if it is to be meaningful. It should instil a desire to question and doubt. Without this the mere instruction to memorise information is empty. The attempt to enforce conventional mediocrity on the young is criminal.
The doctor-patient relationship needs to be replaced by a medical coach-person partnership. Often this will extend into addressing the underlying early allostatic load and ACE issues and navigating the propaganda swamping the environment.
I look forward to AI doing all the heavy lifting when it comes to the science of medicine, thereby allowing practitioners to return to the art of medicine by improving the patient journey and addressing the intricate human context of the tasks at hand.
The early part of the 20th century had medical science search for the quick fix. A set and forget. This has never worked in chronic illness.
The American journalist HL Mencken had this to say about quick fixes: “Every complex problem has a solution which is simple, direct, plausible – and wrong.”
I foresee a future when doctors and patients alike, cease their fixation on “magic bullet cures” and focus more on the reality of lifestyle changes and lifelong self-care with a rejection of those parts of the material commercial world that make and keep us sick.
Associate Professor Kees Nydam was at various times an emergency physician and ED director in Wollongong, Campbeltown and Bundaberg. He continues to work as a senior specialist in addiction medicine and to teach medical students attending the University of Queensland, Rural Clinical School. He is also a poet and songwriter.
Here is the link:
https://www.medicalrepublic.com.au/ai-and-a-new-renaissance-in-medicine/119920
This is certainly a vision of medical practice, supported by AI, that could be both safer and richer than what we have now!
I wonder how long till it arrives?
David.
Concord is one of my local hospitals – so this is not good news!
Updated September 24, 2025 — 7.48pmfirst published at 6.35pm
A 92-year-old whose cancer diagnosis was delayed and a 13-year-old whose fracture was not identified for a year are among the patients affected by a backlog of more than 50,000 radiology scans at a Sydney hospital, a leaked government investigation has found.
In a sensitive report distributed to doctors at Concord Hospital this week, the NSW ombudsman found Sydney Local Health District was warned about issues with staffing and workload in the hospital’s radiology department years before the backlog threatened patient safety, but failed to respond to avert the crisis.
The NSW ombudsman found Sydney Local Health District failed to avert the crisis.Credit: James Brickwood, Chris Fowler
“The SLHD had ample warning, from as early as 2019, that a reporting backlog in radiology was accumulating, would worsen if not addressed and strategic intervention was required to manage the situation,” the report concluded. “Rather than proactively working in collaboration with the radiology department to address the issues, effective changes only took place after multiple resignations and external intervention.”
The scathing ombudsman’s report is another dramatic turn of events at Concord, where Health Minister Ryan Park was forced to intervene in July 2023 after the hospital’s medical staff won a vote of no confidence in health district chief executive Teresa Anderson, who left the job the following May.
It also highlights the challenges faced by a depleted healthcare workforce across the NSW health system dealing with an increased number and complexity of cases. Earlier this year at Westmead Hospital, for example, at least 21 patients had to wait up to 363 days for a cancer diagnosis due to the massive demand for endoscopies.
At the peak of the Concord backlog in the second half of 2023, the number of unreported radiology studies totalled 50,178 – 40 per cent of the total number of images reviewed by the department that year.
The vast majority of these were X-rays, leaving patients waiting an average of 131 days for results.
In one case, two incidents of delayed fracture diagnoses in a 12-year-old and a 14-year-old child were escalated to management in September 2022. In response, a new system was recommended to ensure chest and paediatric X-rays were prioritised and reported daily, but this was not implemented until May 2024. A new triage system took longer, coming into effect in August that year.
The health district argued in its submissions to the ombudsman it found only 14 “adverse incidents” affecting patients out of the 50,178 unreported scans, but the ombudsman noted the health district did not have a process for systematically identifying and addressing those risks until 2023 – “well into the backlog”.
Related Article
Exclusive
The Sydney hospital on its last warning
“Whilst the number of actual adverse incidents due to the backlog was relatively low, and certain actions, such as prioritising more complex imaging over X-rays, were put in place by the radiology department early on … the conduct of the Sydney Local Health District in responding to and managing the increasing backlog of radiology studies at Concord Hospital radiology was unreasonable,” the ombudsman said.
The ombudsman said multiple factors had driven the backlog, including increases in emergency presentations, an increase in the number of scans performed due to improvements in technology, and increased clinical workload for radiologists that took them away from reporting work.
These contributed to a 9 per cent increase in images assessed at Concord between 2012 and 2023, but the report noted the number of radiologists employed in the department decreased from 2019 to 2023.
This led the hospital’s director of medical services to warn management that most radiologists were “doing more than twice the workload that was recommended in the Australian literature”.
Related Article
Exclusive
‘It was hell’: Former Sydney hospital doctor speaks out
Instead of taking steps to recruit more radiologists, an executive took the extraordinary step of instigating an internal audit of the department due to allegations radiologists “were not working their required hours” – a claim the investigation found could not be substantiated.
A cultural review announced in July 2023, after the Herald revealed the backlog of 50,000 scans, found this audit of their working hours had resulted in “a number of the state’s most experienced and highly regarded radiologists leaving the public health system”.
While the health district said at the time it was actively recruiting for two full-time radiologists, the ombudsman noted the recruitment and retention rates on offer were lower than the state average.
The backlog had been reduced to 217 studies older than four weeks by September last year.
A health district spokesperson said they were unable to comment on individual patients due to privacy considerations, but open disclosure was provided to all affected patients and their families.
“Radiology images are often reviewed by clinicians as soon as they become available, even where a formal report has not yet been produced, to inform safe and timely treatment and care,” the spokesperson said.
Here is the link:
I wonder what is the root cause of the problems here – other than money - and if the separation from the Commonwealth system still has some unresolved problems?
I am sure locals can let us know!
David.
This appeared a day of so ago.
PM to set out plans for compulsory ‘Brit card’ but faces opposition from civil liberty groups over privacy concerns
Fri 26 Sep 2025 17.53 AEST
Digital ID cards present “an enormous opportunity” for the UK, Keir Starmer has said, as the government braces for a civil liberties row over the proposals.
The prime minister will set out the measures on Friday morning at a conference on how progressive politicians can tackle the problems facing the UK, including addressing voter concerns around immigration.
The proposals for a “Brit card” would require legislation and are already facing opposition from civil liberty groups concerned about privacy.
Addressing those concerns, the culture secretary, Lisa Nandy, said the government had “no intention of pursuing a dystopian mess”.
Speaking on Friday, Starmer said: “I know working people are worried about the level of illegal migration into this country. A secure border and controlled migration are reasonable demands, and this government is listening and delivering.
“Digital ID is an enormous opportunity for the UK. It will make it tougher to work illegally in this country, making our borders more secure.
“And it will also offer ordinary citizens countless benefits, like being able to prove your identity to access key services swiftly – rather than hunting around for an old utility bill.”
The prime minister, writing in the Telegraph, said Labour had shied away previously from addressing concerns over immigration and that it was now “essential” to tackle “every aspect of the problem of illegal immigration”.
He argued that it was possible to be concerned about immigration while rejecting Reform UK’s “toxic” approach.
“There is no doubt that for years leftwing parties, including my own, did shy away from people’s concerns around illegal immigration,” he wrote.
Civil liberties groups reacted with concern over the proposals. Silkie Carlo, the director of Big Brother Watch, said digital IDs would turn the UK into a “checkpoint society that is wholly unBritish”.
“Digital IDs would do absolutely nothing to deter small boats but would make Britain less free, creating a domestic mass surveillance infrastructure that will likely sprawl from citizenship to benefits, tax, health, possibly even internet data and more,” Carlo said.
“Incredibly sensitive information about each and every one of us would be hoarded by the state and vulnerable to cyber-attacks.
“Starmer has no mandate to force the population to carry digital IDs and millions of us will simply not do it. The cost to the public purse will likely run into the billions, much like Blair’s failed scheme, but the cost to our freedoms would be even more serious. He is making an enormous mistake and should drop the plans sooner rather than later.”
Nigel Farage’s Reform UK called the plans a “cynical ploy” designed to “fool” voters into thinking something is being done about immigration, while the Conservative leader, Kemi Badenoch, dismissed the plans as a “gimmick that will do nothing to stop the boats”.
The Guardian revealed in June that Downing Street was exploring proposals for a digital ID card to crack down on illegal migration, rogue landlords and exploitative work.
The idea came from a Labour Together paper given to the No 10 policy unit proposing a Brit Card, which it claimed could help avoid another Windrush scandal.
The thinktank also said it would help reduce vast numbers of visa overstayers, saying half of those whose asylum claims were turned down over the past 14 years were probably still in the UK.
It proposed a free, secure digital ID, stored on a person’s smartphone using a planned gov.uk Wallet app, rebranded as the Brit Card app. That could then be verified by employers, immigration, banks and landlords using free software.
Under the possible plans, the technology is expected to be built on the government’s existing “One Login” infrastructure, which allows citizens to access about 50 government services, from applying for a job as a teacher to using a lasting power of attorney.
Here is the link:
If the UK goes ahead and there is not too much of an outcry, expect Albo to be the next cab off the rank!
They know they want to do it!
David.
