Sunday, February 25, 2018

Talk About An Appalling IT Stuff-Up - I Really Feel For The Victims!

This story broke in the middle of last week.

Trainee doctors forced to resit exam after 'technical fault'

By Allie Coyne on Feb 20, 2018 6:22AM

First computer-based test failed, results voided.

Trainee doctors who sat a basic exam yesterday have had their results voided after a "technical fault" locked some students out of the second half of the test.
It was the first time the Royal Australasian College of Physicians (RACP)'s divisional written exam had been delivered online, managed by computer-based testing solutions provider Pearson Vue.
The medical college apologised to students for yesterday's technical error and said it had decided that all students would resit the exam - this time via pen and paper - "in order to be fair".
"We understand that some trainees have booked leave or holidays following today’s computer based test, and we are working as quickly as possible to reschedule a new exam," the RACP said in a statement.

"It is likely to be more than 24 hours before we can notify candidates of a new exam date."
The college said it had "explored all options" with Pearson Vue after the "unknown technical fault" locked a "significant" number of students out of the computer-based test and unable to complete the second part of the exam, but ultimately decided to call it off.
"The RACP is very disappointed that there has been a problem with today’s [exam], and we apologise to all trainee candidates for the distress caused," it said.
More here:
https://www.itnews.com.au/news/trainee-doctors-forced-to-resit-exam-after-technical-fault-485491
Harrowing reporting on the impact of the issue is found here:

Burnt-out doctors deeply distressed by botched high-stakes exam

Kate Aubusson, Jenny Noyes
Published: February 21 2018 - 9:32AM
Up to 1200 doctors are deeply distressed by the Royal Australian College of Physicians “appalling” handling of an IT meltdown that wiped out a crucial, high-stakes examination on Monday.
Senior physicians have raised serious concerns for the mental health and wellbeing of the registrars now forced to resit the test after months of gruelling study regimen, hospital workloads and personal sacrifice.
A technical fault abruptly shut down the basic training exam. The test cost each candidate $1800 to sit and is a requirement for doctors aspiring to specialise as physicians or paediatricians.
The college is facing mounting criticism from its membership, with calls for its president and others responsible for the incident to resign.
Several doctors who sat the botched exam spoke to Fairfax Media on condition of anonymity over concerns that speaking publicly could impact on their future careers.
As crowds of confused registrars poured out of exam centres across the country, many were crying inconsolably, visibly distressed and angry.
“It was just awful … complete chaos” one registrar said.
“There were a number of candidates sitting on kerbs crying ... no one [was] advising of what happens next.”
Several registrars described chaotic scenes long before the technical meltdown.
Lots more here:

Also included in a lot of subsequent coverage was commentary from some one who had sat the exam the year before:

Computer glitch in hardest exam of your life is unforgivable

Sanj Mudaliar
Published: February 21 2018 - 12:06PM
It’s hard to explain to someone outside the medical field what this examination means to those who sit it. The anguish that it can cause and the amount of time that candidates spend preparing.
After roughly 10 years of training and a lifetime of exams, the Royal Australian College of Physicians examination is the last written one you have to sit - and pass - on the road to becoming a fully fledged physician or paediatrician. It assesses your knowledge across all the medical specialties. It is the final hurdle, the finish line, what many see - correctly or incorrectly - as the point where they can stop striving for a life and start actually living one. Holidays, weddings, even births, have all been put on hold, planned around this last brutal test.
Which is why the 1200 or so junior doctors who had to abandon their attempts at the exam on Monday because of a computer glitch are so distressed.
The written exam consists of two papers -  a basic sciences and a clinical paper - and is held only once a year, on the same day nationwide. It takes 6.5 hours to complete, with a one-hour break, and covers two years' worth of study.  The written exam is like the hardest, broadest university-level final exam you have ever sat.  This year, for the first time, it was held in small venues across the country, with eight to 15 candidates per room, instead of in one central venue in each capital city.
Lots of annoyed rage found here:

Now in another life, in another time, I did a similar exam - (the Part 1 for the Anaesthetics Fellowship - which I passed on my first attempt much to my relieved amazement.) and I can say had my 4 hour exam suffered a similar fate there might have been enraged homicide ensue.

That these systems were not tested to within an inch of their life is simply unbelievable and unforgivable. My view is that the CEO of the College should resign - as simple as that - given the centrality of conducting these exams to the College’s role.

It is possible to ensure such important systems work and this should have been 100% ensured. It is really hard to understand how such a mission-critical system was not fully bullet-proof?

I feel for all the victims can I say!

David.

Saturday, February 24, 2018

Weekly Overseas Health IT Links – 24th February, 2018

Here are a few I came across last week.
Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
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Investment in e-health proposed under development plan

Previous estimates for electronic health record suggest it will cost up to €875 million

17 February, 2018
Digital health services will enable the right information about the right patients to be available securely in the right health care setting at the right time.
Investment in electronic health records and new IT systems will directly improve patient services and allow chronic disease to be managed at home and in the community, the new National Development Plan says.
The plan confirms proposals already announced by the Health Service Executive in recent years, which were also a feature of the Sl√°intecare report on reforming the health system.
It says ICT systems such as electronic prescribing and tele-health will “directly improve patient services allowing chronic disease to be managed in a more patient centred environment at community level including in patient’s homes”.
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Nokia starts review of digital health business, cuts jobs in Finland

Reuters Staff
HELSINKI (Reuters) - Finnish network gear maker Nokia has started a strategic review of its digital health business and announced more than 400 job cuts in its home country.
FILE PHOTO: Flags with the Nokia logo flutter at company's headquarters in Espoo, Finland, May 5, 2017. REUTERS/Ints Kalnins /File Photo
Digital health, part of Nokia Technologies unit, is one of the areas where the company had been looking for growth opportunities amid a tough market for its mainstay telecom network gear business.
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Roche to buy Flatiron Health for $1.9B

Feb 16, 2018 12:29pm
Roche has agreed to buy Flatiron Health for $1.9 billion. (Getty/Martin Barraud)
One of the world’s largest pharmaceutical companies has agreed to buy Flatiron Health, a health IT company founded by two former Google employees.
Switzerland-based Roche Group has agreed to pay $1.9 billion for the health IT company. The pharmaceutical and biotechnology company had already invested $200 million into Flatiron and owned 12.6% of the company.
The acquisition was first reported by CNBC and then confirmed in a joint announcement by the two companies.
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Special Report: Cybersecurity

The recent review of WannaCry attack by NHS England CIO has shone a bright light into NHS cyber defence deficiencies. With the General Data Protection Regulation coming into force this Spring, and an array of legacy Microsoft systems hitting their end of support status, just where do things stand now regarding cybersecurity strategy within the NHS? Davey Winder investigates.
According to the newly published review authored by Will Smart, chief information officer of NHS England, only 1 percent of NHS activity was directly impacted by WannaCry with 80 of the 236 hospital trusts affected, plus 595 of the 7,545 GP practices. However, the vulnerability of NHS infrastructure was laid bare for all to see.
An historic underinvestment in network security, unpatched legacy software and unpatchable hardware devices, were exposed; along with poor discipline and accountability at the highest levels within individual trusts.
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HHS wants to leverage data to track opioid prescribing

Published February 16 2018, 7:24am EST
President Trump’s proposed Fiscal Year 2019 budget for the Department of Health and Human Services would make combating the opioid epidemic one of the agency’s top priorities, including $10 billion in HHS funding to address the crisis.
As part of the effort, a proposal in the administration’s FY 2019 budget is to “require states to monitor high-risk billing activity to identify and remediate abnormal prescribing and utilization patterns that may indicate abuse in the Medicaid system,” HHS Secretary Alex Azar told members of Congress Thursday.
Rep. Michael Burgess, MD (R-Texas), chairman of the House Energy and Commerce Subcommittee on Health, agreed that the Centers for Medicare and Medicaid Services has a lot of data that could be used to “identify a practitioner who is writing an inordinate number of prescriptions.” Burgess added that this information is “actually knowable” within CMS databases.
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EMR alert may help physicians screen children for physical abuse, study suggests

Written by Jessica Kim Cohen | February 13, 2018 | Print  | Email
A team of researchers from Children's Hospital of Pittsburgh of UPMC developed an EMR-based alert system to improve rates of screening for physical abuse among pediatric patients, according to a study published in the February issue of the Journal of the American Medical Informatics Association.
To develop the child physical abuse alert system, the researchers coded 30 age-specific "triggers" into the EMR at a freestanding pediatric hospital with a level 1 trauma center. These triggers would identify children under 2 years of age who were at risk for physical abuse.
Between October 2014 and April 2015, the system flagged 226 children as being at risk for physical abuse. The system ran in "silent mode" in the background of the EMR, meaning that while physicians were unaware of the system, study personnel received data on children who triggered an alert.
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4 study insights into physicians overriding decision support alerts in EHRs

Written by Jessica Kim Cohen | February 14, 2018 | Print  | Email
Clinical decision support alerts displayed in EHRs are associated with reduced incidence of medication errors and adverse drug events. However, a physician who inappropriately overrides one of these alerts may hinder their full potential to influence patient safety.
To evaluate this concern, a team of researchers analyzed 712 encounters from patients admitted to one of six intensive care units between July 2016 and April 2017, according to a study published in BMJ Quality & Safety. The researchers considered potential patient harm associated with medication-related CDS overrides for doses, drug allergies, drug interactions, and geriatric and renal alerts.Here are four insights from the study.
1. The researchers identified 2,448 overridden CDS alerts from 712 patient encounters. Of the 2,448 alerts, 81.6 percent of the alerts were appropriately overridden.
2. The researchers found more potential and definite adverse drug events following inappropriate overrides, compared to appropriate overrides.
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Report: Healthcare Way Behind other Major Sectors in Proper Cybersecurity Protocols

February 14, 2018
by Rajiv Leventhal
The healthcare industry is one of the lowest performing industries in terms of endpoint security, and the sector as a whole ranks near the bottom in cybersecurity strength compared to other major industries, according to a new report from New York City-based security risk company SecurityScorecard.
The report, "SecurityScorecard 2018 Healthcare Report: A Pulse on The Healthcare Industry's Cybersecurity Risks," pulls data from more than 1,200 healthcare companies. SecurityScorecard's research team analyzed information such as issue severity, industry-defined risk level, corporate peer performance, and more. The team's analysis revealed insights on how the healthcare industry performs compared to others, and specific areas of cybersecurity weakness within healthcare organizations.
Some of the report’s key insights include:
  • The healthcare industry ranks 15th when compared to 17 other major U.S. industries.
  • The healthcare industry is one of the lowest performing industries in terms of endpoint security, posing a threat to patient data and potentially patient lives.
  • Social engineering attacks continue to put patient data at risk.
  • 60 percent of the most common cybersecurity issues in the healthcare industry relate to poor patching cadence (which measures how quickly an organization applies an update that patches a security vulnerability).
  • All healthcare organizations struggled with patching cadence and network security.
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U.K. says Russia was behind Petya cyberattack that shut down Nuance, hospitals

Officials found the Russian military “was almost certainly responsible” for the massive global attack, and serves as a reminder that nation-state actors can impact even small organizations that weren’t the intended target.
February 15, 201812:33 PM
The hackers disguised the wiper malware, Petya, as ransomware in order to distract from its real purpose -- to destroy data.
The U.K. government has found the Russian government responsible for the global Petya cyberattack that shut down a wide range of major companies in June, including parts of FedEx, biopharma giant Merck, Nuance Communications and some U.S. health systems.
Officials specifically find the Russian military at fault.
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Bedrock for pop health success: physician buy-in

The best population health management program is built on data and supported by robust operations that can scale up to meet the organization’s needs.
February 15, 2018 10:46 AM
A good population health strategy requires physician engagement, C-suite involvement and the flexibility to be able to scale up to meet the organization’s needs, according to Renee Broadbent, associate vice president of Population Health Information Technology and Strategy for UMass Memorial Healthcare.
Broadbent’s role is to organize the data for the numerous hospitals and physician offices within the UMass system that may be located on the other end of state. Many are also in an accountable care organization. 
Only about 60 percent use the same electronic medical record, Epic, while the other 40 percent are in various EMRs.
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Blockchain not a panacea for managing health records, fed expert says

Published February 15 2018, 7:42am EST
While blockchain has a number of potentially promising healthcare applications, including the management of electronic health records, the technology has certain pitfalls that may inhibit its utility.
That’s the message delivered on Wednesday to lawmakers by Chris Jaikaran, a cybersecurity policy analyst in the Government and Finance Division at the Congressional Research Service.
Blockchain technology employs a data structure that can be time-stamped and signed using a private key to prevent tampering; many experts in the healthcare industry see the technology as a natural fit for managing the accountability, authentication, confidentiality and sharing of information.
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HIT Think Three keys to a multi-layer security strategy

Published February 14 2018, 5:30pm EST
User-based protections. As many as 68 percent of attacks are caused by internal users. Healthcare organizations have an even greater responsibility to educate and train their users, given the number of people who have access to sensitive information and the frequency with which that information is distributed. Prioritizing regular training, testing and education and requiring users to use complex passwords and two-factor authentication will help to limit unauthorized access and minimize the risk of a threat.
Contingency plans. Every effort must be made to block cyberattacks, but there must also be contingency plans in place to limit the scope and scale of the damage in the event a breach occurs. Abnormal traffic monitoring and refined network segmentation do just that. If a hacker is exporting data out of a system and into an independent server, then a spike in traffic results. Monitoring for these spikes enables a faster mitigation response, and networks that are properly segmented fundamentally limit the effects of an attack from spreading.
Even following these practices, organizations should consider using external audits to better assess their security strategy and look for the deeper gaps that may exist. In the U.S., the American Institute of Certified Public Accountants’ Service Organization Control 2 accreditation and SOC3 certification can help ensure that service organizations provide the appropriate controls for security, availability, integrity and confidentiality.
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The training of Dr. Robot: Data wave hits medical care

Feb 15, 2018 12:08pm
Artificial intelligence could help doctors recognize dangerous infections, but the use of algorithms in healthcare is still novel.
The technology used by Facebook, Google and Amazon to turn spoken language into text, recognize faces and target advertising could help doctors combat one of the deadliest killers in American hospitals.
Clostridium difficile, a deadly bacterium spread by physical contact with objects or infected people, thrives in hospitals, causing 453,000 cases a year and 29,000 deaths in the United States, according to a 2015 study in the New England Journal of Medicine. Traditional methods such as monitoring hygiene and warning signs often fail to stop the disease.
But what if it were possible to systematically target those most vulnerable to C-diff? Erica Shenoy, an infectious-disease specialist at Massachusetts General Hospital, and Jenna Wiens, a computer scientist and assistant professor of engineering at the University of Michigan, did just that when they created an algorithm to predict a patient’s risk of developing a C-diff infection, or CDI. Using patients’ vital signs and other health records, this method—still in an experimental phase—is something both researchers want to see integrated into hospital routines.
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The future of harvesting patient generated health data

The trickiest part is getting people to keep using the devices, even six months is a challenge.
February 13, 2018 03:32 PM
As remote monitoring becomes more and more popular providers are starting discussions about how to harvest and use the incoming data. But a serious challenge lies in how to synthesize data coming in from different sources. People have preferences — you might even go so far as to say there are “Fitbit people” and “Apple Watch people.”
What we are trying to do with these devices is collect non-episodic data. Apple watches, Fitbits, all of these devices capture it for you now,” said Ajay Mittal, associate director of IT at the American College of Cardiology. “Our top process was to harness this data that people are already using to support better outcomes.”
Mittal and the team at ACC ran a pilot study aimed at integrating non-episodic data, or data that wasn’t collected at a doctor’s appointment, into the providers system. The team then looked at whether these data points could help improve long-term outcomes.
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Precision medicine: Huge promise, but high health IT-related hurdles, too

John Halamka and Paul Cerrato sift through the hope and the hype of personally-tailored care, spotlighting to real-world success stories while not ignoring some significant potential pitfalls along the way.
February 13, 2018 03:42 PM
John Halamka (above) and Paul Cerrato to talk about some of the biggest obstacles holding back more widespread implementation of precision medicine at HIMSS18.
In their new book, Realizing the Promise of Precision Medicine, Paul Cerrato and John Halamka, MD, take a hard look at the potential for genomic discovery and technological advances set to cause a sea change in how healthcare is delivered.
"The goal of the precision medicine movement is to give clinicians and patients access to the kinds of information needed to create individually tailored programs to treat a variety of diseases and to ward off those that are preventable," they wrote. "To accomplish those twin goals will require the collection of far more data than clinicians now collect when they evaluate patients. It will require more sophisticated analytic tools to glean meaningful insights from the data collected. And equally important, it will require the public to become more engaged in its own care."
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FDA approves AI stroke application, signaling a shift in triage software oversight

Feb 14, 2018 12:00pm
Attorney Bradley Merrill Thompson says the FDA's latest approval shows the agency "seems to be warming to artificial intelligence used for triage." (FDA)
The Food and Drug Administration (FDA) approved an application that uses artificial intelligence to alert physicians of a potential stroke, signaling a notable shift in the way the agency reviews clinical decision support software used for triage.
The application, called Viz.AI Contact, uses an AI algorithm to analyze computed tomography (CT) scans and identify signs of a stroke in patients. The application notifies a neurovascular specialist via smartphone or tablet when it has identified a potential blockage in the brain, reducing the time it takes for a specialty provider to review the scans.
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FDA’s Scott Gottlieb wants to use funding boost to create a Center of Excellence on Digital Health

Feb 15, 2018 10:18am
The Food and Drug Administration plans to use a proposed $400 million boost in federal funding to focus on a range of innovative approaches to speed the approval of new medical devices and create a new center that would support digital health oversight and address cybersecurity concerns.
Overall, the FDA would receive an additional $473 million in discretionary spending under a budget proposal released by the Trump administration earlier this week, bringing the agency’s total to $3.25 billion in 2019. If that level of spending moves through Congress, the FDA plans to funnel about $400 million to promote innovation and competition, FDA Commissioner Scott Gottlieb, M.D., announced on Wednesday. That would include specific carve-outs planned for a new Center of Excellence on Digital Health and furthering the agency’s ability to use EHR data to evaluate medical devices.
The Center for Excellence on Digital Health would oversee a revamped regulatory paradigm created through the FDA’s new software precertification program launched with nine companies in September. But the center would also create a cybersecurity unit to “enhance its ability to coordinate device-specific responses to cybersecurity vulnerabilities and incidents.” Over the past several years, medical device cybersecurity has emerged as particular concern for industry and regulators.
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Trump budget eliminates AHRQ, makes major cuts to OCR, ONC

Published February 13 2018, 7:38am EST
President Trump on Monday released his proposed Fiscal Year 2019 budget for the Department of Health and Human Services, suggesting the elimination of funding for the Agency for Healthcare Research and Quality and slashing budgets for the Office of the National Coordinator for Health IT and HHS Office for Civil Rights.
Congress has traditionally ignored past White House budget proposals, but the plan does show the Trump administration‘s overall intentions for managing federal spending.
The FY 2019 HHS budget includes $256 million to consolidate the activities of AHRQ, which supports health services research addressing patient safety and healthcare quality as well as the application of HIT, into the National Institutes of Health—as the National Institute for Research on Safety and Quality (NIRSQ)—to eliminate duplication and redundancies.
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Azar: 'I Am a Big Supporter of Telehealth'

Steven Porter, February 15, 2018

The HHS secretary’s words of support coincide with a number of other promising signs for burgeoning acceptance and application of the technology.

During his third congressional hearing within 24 hours, Health and Human Services Secretary Alex Azar told lawmakers Thursday he’s looking forward to clearing reimbursement obstacles that have impeded the growth of telemedicine.
Azar, who’s been on the job two weeks, fielded questions from the House Energy and Commerce Committee, covering a wide range of issues facing the massive department.
Rep. Morgan Griffith, R-Va., asked specifically about how payments for telehealth services are handled currently and how they might be better handled in the future.


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AI just at the early stages of showing real results

Published February 09 2018, 7:16am EST
Artificial intelligence—a broad set of technologies that enable machines to mimic the human brain’s ability to process information, learn and adapt—holds potential in healthcare to improve patient outcomes and reduce costs, but it hasn’t yet been widely adopted in daily clinical practice.
However, some leading healthcare organizations, such as the Cleveland Clinic, Intermountain Healthcare and others, are beginning to build the infrastructure and data science capabilities to use AI to deliver clinical and financial benefits.
While some industries are using AI programs designed to recognize speech, written language or visual data or do problem-solving, health systems are gaining experience with machine learning, a subset of AI focused on finding patterns or relationships in data in an iterative, or learning, fashion. Early projects have demonstrated promising results.
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AAFP calls on feds to eliminate health IT utilization measures, focus on data blocking

Feb 12, 2018 10:23am
The nation’s leading association of family physicians is urging federal officials to eliminate health IT utilization measures, pare down documentation guidelines and instead focus their energy eliminating data blocking.
In a letter (PDF) to the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma and Donald Rucker, M.D., the top official at the Office of the National Coordinator for the Health IT(ONC), the American Academy of Family Physicians (AAFP) outlined ways in which the two agencies can ease the “crushing administrative and regulatory burden” that drives physicians out of practice.
The letter comes on the heels of an announcement that the organization plans to focus on administrative simplification, with medical record documentation listed among its four priorities.
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What’s propelling health IT spending in 2018?

Feb 7, 2018 at 12:26 PM
Value-based care initiatives are the biggest drivers of healthcare technology spending this year, according to a new survey from Damo Consulting.
Patient engagement and care management efforts came in as the number two drivers.
The Illinois-based healthcare advisory firm surveyed 38 individuals from global tech firms, population health management organizations, digital health companies, global management consulting firms and more. The majority of respondents were CEOs, heads of business or in sales/marketing roles.
Other key topics pushing health IT spending include enterprise digital transformation (47.37 percent of respondents), cybersecurity and ransomware (39.47 percent) and population health management (28.95 percent). M&A doesn’t appear to be as significant of a driver, as less than 11 percent of respondents selected it.
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Enjoy!
David.

Friday, February 23, 2018

Not Quite Digital Health But An Anti-Scientific Outrage Nevertheless!

This appeared last week:

Thank God, Australia is now licensed to ‘moisten intestines’ and ‘replenish the gates of vitality’

16/02/2018 Edwin Kruys

A while back I spoke with a politician who was very cross about the decision by the Therapeutic Goods Administration (TGA) to make codeine products no longer available without prescription. When I asked why, the answer was, “Codeine is great for jet lag, especially with a Scotch.”

Clearly there was some confusion here about the indication of (the painkiller) codeine, which can cause serious side effects, especially in combination with other drugs and alcohol.
An ‘indication’ is defined in the law as ‘the specific therapeutic use(s) of the goods.’ Confusion about indications of medications is common. For example, people often mistakenly believe that green snot is an indication for antibiotics or that back pain is an indication for diazepam (Valium).
And, just to be clear, codeine is not indicated for jet lag.

Dryness in the triple burner

Unfortunately the Australian Government has just muddled the water by passing two bills in the Senate that allow manufacturers of vitamins, supplements and herbal complementary medicines to use a range of odd claims, such as ‘expel damp-heat in the bladder’, ‘moisten intestines’ and ‘cool blood heat’.
I have no idea what this means. The TGA’s new list of permitted indications is not based on scientific evidence.
RACGP President Bastian Seidel expressed concern about many of the indications. He said: “(…) phrases such as ‘moistens dryness in the triple burner’, ‘replenishes gate of vitality’ and ‘softens hardness’ have no place in any genuine healthcare situation. These types of claims are extremely misleading and could lead to significant harm for patients.”
More here with lots of outraged comments:

Here is a link to the list:


There has been a huge amount of commentary on this in mainstream media.

This is typical.

'Softens hardness': TGA under fire for health claim list that critics say endorses pseudoscience

Esther Han
Published: February 9 2018 - 12:15AM
Hundreds of bizarre health claims such as "tonifies kidney essence" and "opens body orifices" will be approved by the Therapeutic Goods Administration and appear on complementary medicine labels under new laws being pushed by the federal government, horrifying doctors.
In July last year, the TGA began developing a list of "permitted indications" that would restrict vitamin and herbal medicine companies to make only government-approved health claims on their products once the Therapeutic Goods Amendment bill passes.
Health groups were expecting a list of about 100 clinical indications, each backed with scientific evidence. Instead, it has ballooned to more than 1000 claims, most of which they say are misleading, potentially harmful and based on pseudoscience.
"The TGA held industry consultations and just lost the plot; it gave them a licence to deceive," said Allan Asher, a regulatory expert and former deputy chair of the Australian Competition and Consumer Commission.
"Everybody thought things would get better, but it's made things worse because the indications will be government-approved and government-required, and under product liability laws, if something is required by a government, it can't be found to be a hazardous product."
If the bill passes, complementary medicine companies will only be able to draw from the list of permitted indications (that is, claimed purpose or health benefit) when registering, and later labelling, their products. The list will be a legislative instrument.
The latest draft list contains innocuous items such as "relieves itchy eyes" and reassuringly shows the TGA has struck off dubious claims such as "helps increase hand to eye coordination", noting "remove - not plausible".
But critics claim 86 per cent of the 1019 indications are not supported by scientific evidence, including "softens hardness", "replenishes gate of vitality" and "moistens dryness in the triple burner".
"There's this yawning loophole where if you can't say that it's scientific, you can say there's evidence it's traditionally been used," said Mr Asher, chair of the TGA Complaints Resolution Panel, which will be scrapped under the bill.
"I'm worried consumers will think these traditional claims have some form of government imprimatur and are thus likely to be effective, when there is no such guarantee."
Two years ago, the National Health and Medical Research Council reviewed 225 research papers on homeopathy and concluded there was no good quality evidence to support the claim that homeopathy works better than a placebo.
Complementary medicines include vitamins, mineral and nutritional supplements, homeopathic, aromatherapy products and herbal medicines. Seven out of 10 Australians take some form of vitamin or supplement.
Dr Bastian Seidel, president of the Royal Australian College of General Practitioners (RACGP), said some of the indications were a dangerous mixture of "fiction and hope" and, at worst, could interact with pharmaceuticals and be harmful.
Lots more here:


All I can say is that the TGA are to be condemned for all this. There are better ways to allo use of non-scientific treatments without appearing to endorse them! Well said Edwin!

David.

Thursday, February 22, 2018

The Macro View – Health, Financial And Political News Relevant To E-Health And The Health Sector In General.

February 22, 2018 Edition.
In Trump world the big news is that the Special Prosecutor has indited 13 Russians with systematic interference with the US Election. Heaven knows where this goes from here but I suspect it won't end well for many people!
In OZ the Barnaby saga has reached escape velocity and who knows what will happen when it returns to Earth, as surely it must! Maybe by the time you read this we will know more.
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Here are a few other things I have noticed.
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Major Issues.

  • Feb 11 2018 at 11:24 AM

Volatility bets should not be available to retail investors

How much protection do people deserve when they venture into markets? After the longest period on record without a stock market sell-off — or "correction" — capital markets reminded last week that setting prices is painful.
It involves the interaction of greed and fear, with markets rising steadily, falling more suddenly, and overshooting in both directions as they go. It is a wasteful and expensive process, but it works. Paraphrasing Winston Churchill on democracy, a free capital market is the worst way to allocate capital — apart from all the others ever tried.
All that said, we should not be too relaxed about this equity market sell-off. It is unusual for markets to drop this quickly and violently from an all-time high. This 10 per cent fall took only nine trading days; London's Longview Economics reports that the S&P has never fallen so far so fast from a record high.
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So thanks, Captain Obvious. But what if the market is wrong?

Scott Phillips
Published: February 11 2018 - 9:07AM
The past week has been a tough one for many investors. The sudden, if inevitable, return of volatility woke many from their bullish slumber, as nervous traders tried to work out what to do - and whipsawing share prices were the result.
The cause, if you’ve been asleep for a week, was some stronger than expected employment, wages and inflation numbers in the United States, which were released last Friday night, our time.
All of a sudden, it seems, many in the market were confronted with what the rest of us had known was always obvious - that continued economic strength in the US would mean higher official interest rates (courtesy of the US Federal Reserve).
Yes, thanks, Captain Obvious.
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The price of your pizza, pad Thai or butter chicken depends on your postcode

Nigel Gladstone
Published: February 12 2018 - 2:49AM
Residents of the north shore and northern beaches of Sydney are paying up to twice as much for home delivered food as people in the south and west.
The highest prices, on average, for popular dishes such as pad Thai, a large Margherita pizza and Indian butter chicken curry were all found north of the bridge, a Herald analysis of Menulog data covering more than 3000 NSW restaurants found.
Generally, a Sydney restaurant will deliver to 12 or more suburbs, so the data reflects what is available for home delivery in a postcode - not what is delivered from a suburb. 
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With $30b in wealth, why is the Catholic Church struggling to pay for justice?

Ben Schneiders, Royce Millar, Chris Vedelago
Published: February 11 2018 - 7:00PM
After a lifetime contributing to the Catholic Church, Neil Ormerod could give no more.
Following a Sunday mass in 2014, the Australian Catholic University theology professor told his parish priest he no longer trusted the church to use its resources in a way Jesus Christ would approve.
The trigger for his rebellion was the Royal Commission into Institutional Responses to Child Sexual Abuse in 2014 - in particular, Cardinal George Pell’s testimony about the church’s brutal legal assault on John Ellis, a former altar boy abused by a priest in the 1970s.
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Australian power prices worse than banana republics

Cole Latimer
Published: February 11 2018 - 8:06PM
Australia has power prices worse than a third world country, a global renewable energy guru says.
"For a country that has a very high standard of living, stable economic situation and tremendous opportunities, it makes no sense at all for the price of power to be more than a banana republic," the Australian head of global renewable firm SunEnergy1, and part-time racecar driver, Kenny Habul said.
Speaking at the Bond Business Leaders Forum on the Gold Coast, Mr Habul said Australia needs to dramatically change its energy landscape in order to escape the energy price crisis, adding that there is a disconnect between Australian standards of living and electricity costs.
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Economists do little to promote bank competition

Ross Gittins
Published: February 12 2018 - 12:15AM
The royal commission into banking, whose public hearings start on Monday, won't get a lot of help from the Productivity Commission's report on competition within the sector. It's very limp-wristed.
The report's inability to deny the obvious - that competition in banking is weak, that the big four banks have considerable pricing power, abuse the trust of their customers and are excessively profitable – won it an enthusiastic reception from the media.
Trouble is, its distorted explanation of why competitive pressure is so weak and its unconvincing suggestions for fixing the problem. It offered one good (but oversold) proposal, one fatuous proposal (to abolish the four pillars policy because other laws made it "redundant") and a lot of fiddling round the edges.
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The three horsemen: Bonds, ETFs and the Vix

  • The Australian
  • 6:30AM February 12, 2018

Alan Kohler

Last week’s market sell-off prompts some thoughts about bonds, ETFs and the Vix.
Bonds
It seems fairly clear (but not certain, since nothing is certain) that bonds have entered a generational bear market.
Over 200 years or more, bonds have moved in long waves of 20-50 years. The greatest bond bear market in history was 1946-1980, as a result of the post-war boom and 1970s inflation, and the greatest bull market was from that peak in yields to July 2016 after Fed chairman Paul Volcker crushed inflation and the 2008 Great Recession killed it.
In 1980, a 10-year US bond was priced to yield 15 per cent, a rate only approached once before, in the panic of 1837. By mid 2016 the world’s most important interest rate had fallen to a low of 1.36 per cent.
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  • Updated Feb 12 2018 at 2:45 PM

Industry should have retirement products ready within 12 months

Superannuation funds should develop retirement strategies for their ageing members now rather than wait for the Coalition government to formulate its policy on comprehensive retirement income products, argues respected wealth industry veteran Jeremy Duffield.
Mr Duffield, the founder of Vanguard Australia, argued that the super industry had been too slow to create appropriate products and services for members in retirement to help ensure they did not run out of money or live too frugally.
Mr Duffield argued that funds would not need to come up with a single retirement product but could offer a range of products to meet the objectives of different member cohorts.
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Banking inquiry will counter 'moral hazard' inherent in Australian banks

Jessica Irvine
Published: February 12 2018 - 12:15AM
On level six of an unassuming office block at the "Paris-end" of Melbourne's CBD, the Turnbull government's much anticipated – but reluctantly embraced - banking royal commission kicked off today.
Former High Court justice Kenneth Hayne, has, as Commissioner, until September 30 to deliver his interim report, and until February 1 next year to deliver his final report and recommendations.
The race is on.
Already, unions say they have received more than 500 complaints of misconduct by the institutions under scrutiny, which include not only banks, but life insurers, superannuation companies, mortgage brokers and pay-day lenders.
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Ninety per cent of incarcerated youths have a brain disorder: study

Esther Han
Published: February 13 2018 - 10:16PM
Australian researchers say a shocking 90 per cent of young people in detention have at least one severe brain disorder and they hope their findings will act as a "catalyst for change" in the justice system.
The Telethon Kids Institute study of about 100 young people aged 10 to 17 incarcerated at Western Australia’s only youth detention facility, Banksia Hill Detention Centre, found 89 per cent had at least one area of severe neurodevelopmental impairment, such as problems with memory, cognition, motor skills or attention.
What they do is socially unacceptable but it’s arisen from a brain that isn’t working properly, and that underlying, innate difference of brain function has not been previously recognised nor understood,” Dr Raewyn Mutch, a paediatrician and one of the researchers, said.
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The three principles of reform done right

Chris Bowen
Published: February 13 2018 - 7:54PM
It would be understandable to be sceptical about the prospects for serious economic reform in Australia. A decade of a revolving-door prime ministership and stop-start policy arguments has led many people to conclude the reform machine is broken and the political class has let us down. Fair enough, but I am much more optimistic about the prospects of reform, if it is done right.
And reform is essential. Our 26 years of uninterrupted economic growth didn’t happen by accident and changes will be necessary to keep them going. Our budget won’t return to balance without tough decisions, and social mobility and economic equality won’t magically improve just by wishing it so.
So what is reform “done right”? What lessons are there from reforms that have succeeded and failed in recent years? I think there are three principles to seeing good reform through and they are the principles that have underpinned federal Labor’s approach to policy change since 2013.
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A modest proposal for better behaved banks

Peter Martin
Published: February 14 2018 - 6:03PM
Suddenly, banks are behaving nicely. They are no longer charging for the use of teller machines, the chief executive of the National Australia Bank took a day out of his $6.6 million a year job to sell copies of The Big Issue, and from this week it’ll be really, really easy to transfer funds. It’ll take seconds rather than days, and you won’t need to look up a BSB. You’ll be able to use a phone number or email address instead.
Could it get any better? Absolutely, and the route is spelt out in one of the submissions to the Productivity Commission’s inquiry into competition in the financial system, which is running in parallel with the banking industry royal commission.
The Productivity Commission has found that, notwithstanding the banks’ belated success in bringing service into the 21st century, they and their competitors aren’t particularly competitive. There’s half as many of them as there used to be in 1999. Instead of charging all their customers the best possible rate as competitive firms would, they charge their existing mortgage holders $66 to $87 a month more than new ones, in what amounts to a penalty for loyalty.
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Superannuation is where the gender pay gap really stings

Nick Dyrenfurth
Published: February 14 2018 - 8:20PM
More than 95 per cent of workers – 12 million Australians – hold superannuation accounts, double that of 20 years ago. We have built the fourth largest pool of savings globally in just 25 years.
Yet Australia’s population size and age profile pose significant challenges to our system. We are getting older and are having fewer children. If not addressed by policy makers, an ageing population may affect both economic growth and the viability of our retirement income system. We need as many taxpayers as possible to fund our aged pensions, or, preferably, maximise the super accounts of workers.
It is incumbent upon government to deal with other challenges to our retirement system. Non-payment of superannuation is rampant. Workers have been fleeced of $17 billion since 2009 - an average $2.81 billion every year between 2009 and 2015. Some businesses are reducing entitlements for workers who choose to make voluntary contributions through salary sacrificing. Government must prosecute a zero-tolerance approach towards employers who don’t pay super.
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CBA bans customers from using credit cards to buy bitcoin

Clancy Yeates
Published: February 14 2018 - 3:53PM
The Commonwealth Bank has banned its customers from buying bitcoin on credit cards after the recent plunge in the cryptocurrency's value, saying such purchases are no longer "appropriate."
The country's largest bank on Wednesday started sending text messages alerting affected customers to the ban, which follows similar action by large banks overseas in the wake of a more than 50 per cent plunge in bitcoin's value from last year's peaks.
The crackdown comes amid concern among banks overseas that further sharp falls in the price of bitcoin could leave some customers with large debts, creating extra risk for banks.
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APRA issues another warning on risky investor loans

Clancy Yeates
Published: February 14 2018 - 5:29PM
Banks would be forced to set aside more capital against mortgages to property investors and home buyers who are are only paying interest, under a new plan to counter risks in the home loan market.
The Australian Prudential Regulation Authority on Wednesday highlighted the risks to financial stability from the high level of property investor debt, in a paper setting out plans to make banks more resilient to potential housing shocks.
The latest warning, which follows last year's moves to cap new interest-only loans, follows a long-term rise in the popularity of property investment, amid strong house price growth and low interest rates.
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Plan to increase defence exports at odds with our peacekeeping role

Zac Rayson
Published: February 14 2018 - 3:35PM
The latest plank in the government's "jobs and growth" strategy - to turn Australia into one of the world's 10 biggest defence exporters in the next decade - takes the country down a path that is fundamentally at odds with our nation's values.
We have long pictured ourselves as a leader in our region, maintaining peace and a rules-based international order. From myriad projects supporting democracy, to our peacekeeping missions in the Solomon Islands, Timor-Leste and further afield, promoting peace and stability is a mission at the core of our Australian identity.
But the $3.8 billion defence export strategy announced by Prime Minister Malcolm Turnbull at the end of January puts our role as a peacekeeping nation at risk.
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Ominous warning for Sydney in Cape Town water crisis

Eamon Waterford
Published: February 15 2018 - 12:03AM
Within months, a city sitting on the same line of latitude as Sydney could become the first major metropolis in modern history to run out of water.
When Cape Town hits its projected "Day Zero", millions of taps will suddenly run dry. Schools, hospitals and other institutions will retain access to some water but households will be cut off completely.
Obviously Sydney enjoys a range of advantages over Cape Town.
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Government establishes ‘one-stop shop’ for small business financial services complaints

Caleb Triscari / Thursday, February 15, 2018

Small businesses will soon have access to a new financial complaints authority, with the federal Parliament this week successfully passing legislation to establish the Australian Financial Complaints Authority (AFCA).
The Treasury Laws Amendment (Putting Consumers First – Establishment of the Australian Financial Complaints Authority) Bill, passed the Senate on Wednesday.
The AFCA will be an amalgamation of the Financial Ombudsman Service (FOS), the Credit and Investments Ombudsman (CIO) and the Superannuation Complaints Tribunal (SCT) and will hear complaints around products and services offered by financial firms, such as bank loans, insurance and superannuation.
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Putting tax cuts before budget is 'problematic'

  • 11:03 AM 18/2/2018
Lowe has jumped into the debate on corporate tax cuts in a big way.
He says Donald Trump's tax cuts are 'very problematic' because they blow out the budget deficit and Australia should not go the same way.
He says that over the next six years US budget deficits will average 5 percent of GDP even though unemployment is low and the economy is strong.
"That's very problematic and if we were to go down the direction of having lower corporate tax rates it is really important that it does not come at the expense of higher budget deficits."
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The Aussie wasn’t meant to be this way

Michael Pascoe
Published: February 15 2018 - 6:43PM
It wasn’t meant to be like this. Rising US interest rates while ours remained steady were supposed to result in a weaker Australian dollar against a stronger greenback, supporting our exporters and helping import a little inflation.
Instead, we have a stubbornly strong Aussie and a weaker greenback even as the outlook for American rate increases is faster and further.
Specifically, indications of higher American inflation (and therefore higher interest rates) were supposed to weaken the Aussie. Instead, it was the greenback that went down overnight.
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RBA more relaxed on housing, next rate move some way off

Matt Wade
Published: February 16 2018 - 10:01AM
The Reserve Bank governor, Philip Lowe, says the next move in interest rates is likely to be up rather than down, although that change is still some way off.
The timing of any rate hike will depend on further reductions in the unemployment rate and how quickly the inflation rate climbs from its current low levels, Dr Lowe told a parliamentary committee in Sydney on Friday.
In Australia, the pick-up in inflation was expected to be “only gradual”.
Dr Lowe did not see a “strong case for a near-term adjustment in monetary policy” but eventually the need to keep interest rates at the current historic low of 1.5 per cent would dissipate.
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When the next financial crisis hits, there will be little the RBA can do about it

John Hewson
Published: February 15 2018 - 2:58PM
What if governments and policy authorities are unable to handle the next global financial crisis? Indeed, what if their declared strategy of  “normalising” interest rates actually triggers the next GFC and leaves them powerless to respond?
Rather than deal with its structural causes, the response of authorities to the last crisis 10 years ago was to flood the world with liquidity – key central banks launched QE (quantitative easing) and aggressive bond-buying programs which pushed interest rates down to near zero, even negative, levels, and then held them there, supported by all sorts of budgetary injections to avoid a recession or stimulate growth and/or to bail out certain financial institutions and companies. All this has now been magnified by massive (and unparalleled) leverage, with grossly overvalued stock and bond markets.
Of course, it should also be recognised that the GFC was itself essentially created by excess liquidity; Federal Reserve chairman Alan Greenspan held US rates too low, for too long, causing a global quest for yield, resulting in a mountain of debt that was built on the securitisation and financial engineering of high risk sub-prime housing loans and other securities.
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Banking royal commission: be thankful our banks were better than the rest of the West's

Crispin Hull
Published: February 17 2018 - 12:15AM
Now that the banking royal commission is under way, it's a good time to reflect on the Australian financial system over the past decade and be grateful that we're kicking the banks while they're up, not down. Far better to have obscenely profitable banks than grotesquely bankrupt ones.
The popular mythology is that Australia was saved from the great recession of 2008 by prime minister Kevin Rudd and treasurer Wayne Swan following Treasury advice to increase public spending and to get cash into people's hands.
But that's only part of the story. Remember, the US government did a similar thing, pushing $700 billion into the economy, but it didn't save the US from recession. Similarly with Britain.
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Royal commission chief Kenneth Hayne should break up banks

  • The Australian
  • 12:00AM February 17, 2018
  • Alan Kohler
The Royal Commission into Misconduct in the Banking, Superannuation and Financial Services Industry got off to an innovative start in December with commissioner Kenneth Hayne asking his class to set out their misconduct in 50 pages or less, quick smart.
Right then, what have you been up to? Come on you lot, I haven’t got all year. Out with it!” (Arms folded, foot tapping.)
All responded with their 50 pages, on time, but some of the essays were not up to scratch.
You there, what do you call this?” he said this week. “I asked you to specify the nature, extent and effect of your misconduct, but you just listed the nasty things you did, you disgusting bank. Not good enough!”
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National Budget Issues.

Wages growth is worse than the headlines claim

Michael Pascoe
Published: February 11 2018 - 8:58AM
For once the headlines have been underplaying bad news. That stubbornly weak wage price index (WPI)? The reality is worse.
The Reserve Bank's quarterly statement on monetary policy, released on Friday, highlights two broader and arguably better wages measures that are tracking lower than the low WPI.
And the RBA, like much of the rest of the world, remains uncertain about when and how the trend might change, clinging somewhat hopefully to the old economic textbook explanations while acknowledging the world has changed.
The bank does have a hot tip on how to get a decent pay rise: change employer.
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Why both Turnbull and Shorten are lying to us about the budget fix

Shane Wright, Economics Editor | The West Australian
Monday, 12 February 2018 10:20AM
The Turnbull Government and Shorten Opposition are lying to you, me and the fence post over their long-term plans to get the Budget back into shape.
The lie is laid out in the Government’s own Budget papers and in the Opposition’s promises.
And it’s time they were both called out.
The starting point is the current Budget deficit which, this year, is likely to be about $20 billion. A similar-sized deficit is expected next year.
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Labor considers company tax reform after budget returns to surplus

Eryk Bagshaw
Published: February 13 2018 - 11:04AM
Labor has been accused of "hypocrisy" by Treasurer Scott Morrison after the opposition indicated a shift in its stance on company tax reform - if it is able to win the election and get the budget back into surplus.
The opposition has spent the past year arguing big business did not deserve a bonus and campaigning strongly against the Turnbull government's proposal to cut tax for all companies to 25 per cent, but Tuesday marked the first time the party said it would consider business tax reform in the latest round of debate.
Shadow treasurer Chris Bowen said his focus remained returning the budget to balance in an effort to place Labor as sensible economic managers, traditionally a Coalition strong suit, as it moves towards an election footing.
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  • Updated Feb 16 2018 at 5:04 PM

RBA head Philip Lowe rings alarm over Trump inflation threat

The first rate hike from the RBA probably will not be before year-end. Louie Douvis
Reserve Bank of Australia governor Philip Lowe has slammed as "very problematic" the inflationary forces being unleashed by Donald Trump's unprecedented borrowing surge to fund company tax cuts, saying they are landing on a US economy already running at full tilt.
Over three hours of politically sensitive testimony before a House of Representatives committee, Dr Lowe lamented the global shift toward lower company taxes, arguing that if every country joined the race downwards the economic benefits would only be shortlived.

Markets can 'turn against you'

Dr Lowe warned that financial markets "can turn against you" fast if governments overreach in borrowing to fund tax cuts, warning the Coalition government against blowing its planned return to surplus by 2020-21.
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Health Budget Issues.

Day surgery can ‘save millions if spared red tape’

  • The Australian
  • 8:02PM February 11, 2018

Sean Parnell

Day surgery providers argue they are the “future of elective surgery” in Australia and can keep costs down if they are not strangled by government red tape and caught up in disputes between doctors and health insurers.
The Australian earlier revealed at that insurers were spending almost $700 million a year on common hospital procedures and treatments that could be performed as day surgery, in doctors’ rooms or in the hospital at a fraction of the cost.
The Royal Australian and New Zealand College of Ophthalmologists recommends intravitreal injections be performed in day surgery unless there are clinical reasons for hospital admission, yet Bupa has calculated the cost to insurers of eye injections in hospital at $44m a year.
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Obesity crisis hits Australia's maternity wards

Aisha Dow
Published: February 12 2018 - 12:05AM
Australia’s obesity crisis is hitting the nation's maternity wards, with a significant proportion of serious pregnancy complications and trauma caused by women’s excess weight, new research has found.
The study published in The Medical Journal of Australia has analysed data from more than 42,500 first-time mothers and found a major increase in the number of pregnant women who are overweight or obese.
Researchers believe that if overweight or obese women had moved down one BMI (body mass index) category, 7.1 per cent of all stillbirths, 3.8 per cent of fetal abnormalities, 6.8 per cent of post-partum haemorrhages and 8.5 per cent of caesarean deliveries of all deliveries could have been avoided.
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Colleges call for an end to health waste

  • The Australian
  • 12:00AM February 13, 2018

Sean Parnell

Sarah-Jane Tasker

Senior specialists at two influential health organisations have called on their peers to help insurers, governments and ­patients keep costs down, amid concerns over unnecessary and wasteful procedures.
The Weekend Australian revealed that insurers were spending almost $700 million a year on common hospital procedures or care that could be performed as day surgery, in doctors’ rooms or in the home at a fraction of the cost. This is contributing to rising insurance premiums.
The Royal Australian and New Zealand College of ­Ophthalmologists recommends intra­vitreal injections be performed in doctor’s rooms unless there are clinical reasons for ­hospital admission, yet Bupa has ­calculated the cost to insurers of eye injections in hospital at $44m a year.
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Location rules locked in

Certainty and stability” ensured, Guild believes as bill passes both houses  

The National Health Amendment (Pharmaceutical Benefits – Budget and Other Measures) Bill 2017 has now passed through the Senate,
In the words of the Pharmacy Guild of Australia the bill provides “much needed certainty and stability for Australia’s 5700 community pharmacy small businesses”.
Among other measures, the bill abolishes the sunset clause of the Pharmacy Location Rules, ensuring that the rules do not automatically expire at the end of the Sixth Community Pharmacy Agreement in June 2020.
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More Australians dispose of health insurance because of rising premiums

Esther Han
Published: February 14 2018 - 12:01AM
 More than 12,000 Australians ditched their hospital cover in the three months to last December, new figures show, as a separate survey suggests the key reason was they felt it wasn't worth the money.
Fresh quarterly data from the Australian Prudential Regulation Authority shows the percentage of Australians with hospital cover fell 0.2 percentage points in the December quarter to 45.6 per cent - the lowest in seven years.
Meanwhile, a new survey by consumer group Choice has found 70 per cent of Australians who don't have health insurance say it's because it's too expensive.
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Private health insurance is a con job

Ross Gittins
Published: February 14 2018 - 12:05AM
You won't believe it, but my birthday was on Tuesday and I got a present from the federal government. I also got a card from my state member, sending his "very best wishes" for reaching such an "important milestone" in my life.
I almost wrote back asking him to alert the Queen to be standing by in 30 years' time. Instead, my ever-sceptical mind told me the pollies have awarded themselves privileged access to the private information we're obliged to give the electoral commission.
So, what was my fabulous federal birthday present? Apparently, I'm now so ancient and infirm I get a bigger private health insurance tax rebate.
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Funding cuts threaten flying doctor services

  • The Australian
  • 12:00AM February 14, 2018

Michael McKenna

The Royal Flying Doctor Service has warned it will be forced to abandon some of its health work in rural Australia unless the federal government reinstates funding cuts made last year.
The Turnbull government’s budget-repair measures slashed $10.2 million in funding from the RFDS this financial year in a move the 90-year-old organisation says can no longer be sustained without cutting services.
Corporate and private donors covered some of the shortfall from the budget cut — which reduced commonwealth funding to $57m — with the RFDS also using cash out of reserves normally used to buy aircraft.
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Health waste: spinal fusion added to list

  • The Australian
  • 12:00AM February 14, 2018

Sean Parnell

Sarah-Jane Tasker

Spinal fusion for unexplained back pain will today be put on the list of unnecessary, wasteful and risky medical procedures, promising patients more clarity over their options and potentially saving the health system tens of millions of dollar a year.
The move comes after The Australian revealed health insurers had nominated a reduction in spinal fusion surgery as one of the doctor-led responses required to contain the rising costs that are driving up premiums. Even a 20 per cent reduction in hospital cases would save the industry $60 million a year, with flow-on savings for members.
The Australian Prudential Regulation Authority has warned that insurers are “under duress” and more work needs to be done to reduce costs and stabilise the industry. Its latest figures, ­released yesterday, showed the proportion of Australians with hospital cover had fallen again, to 45.6 per cent, the lowest rate since mid-2011.
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Healthscope boss in swipe at insurers over costs of clinical care

  • The Australian
  • 1:40PM February 15, 2018
  • Sarah-Jane Tasker
The head of private hospital group Healthscope, Gordon Ballantyne, has argued health insurers are not the best judge of where clinical care should be delivered, adding there is no such thing as “low-value care”.
The Healthscope chief executive made the comments after reporting a 12.8 per cent dip in first-half profit to $77.5 million, with an “adverse patient case mix” fuelled by a strong flu season impacting the result.
Shares in Healthscope (HSO) were today trading lower on the back of the financial result, down 3.4 per cent at $1.80
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Veil of secrecy leaves Australian patients in the dark

Stephen Duckett
Published: February 15 2018 - 3:20PM
One in four patients who stay overnight in an Australian hospital will have something go wrong,  but a veil of secrecy hangs over which hospitals – and which doctors – have higher rates of complications and which are safety leaders.
The Grattan Institute has also found that a patient’s risk of developing a complication also varies dramatically depending on which hospital they go to. While researching our report All complications should count: Using data to make hospitals safer, we found that in some cases, the additional risk at the worst-performing hospitals can be four times higher than at the best performers.
Safety statistics are collected for both public and private hospitals but they are kept secret, not just from patients but also from doctors and hospitals, who should be able to access this information to see how they are performing compared to their peers – and to learn from those who do things best.
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Health insurance gains buoy Medibank profit

Published: February 16 2018 - 9:04AM
Medibank Private has lifted half-year profit nearly 6 per cent, but cost pressures on consumers have kept growth in health insurance premium revenue to less than 2 per cent.
The health insurer booked a $245.6 million profit in the six months to December 31, thanks to improved operating profit in health insurance and Medibank Health businesses offsetting lower earnings from investments.
The company's shares rose as much as 4.8 per cent to $3.185 in early trade - their biggest intraday percentage gain since late August.
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An old age overspent on health

Not all old people can stay in their own homes and there will be demand for more nursing home facilities.
Australia spends more than 10 per cent of its gross domestic product on health. The federal government, the state and territory governments and individuals are contributing to the total spend of close to $200 billion a year.
Australia is not the highest spender on health, or the lowest. The US is an outlier when it comes to spending, at more than 17 per cent of GDP, but there are plenty of countries that spend more than Australia — France, Germany, Canada and the Nordic countries. Britain spends a little less while other examples of low spenders include Israel, South Korea, Greece (not surprisingly) and Hungary.
While it is true that overall spending on health in Australia has slowed in recent times — in the year ending 2015-16, for instance, spending rose by only 3.6 per cent, which is well below the 10-year average of 4.7 per cent — the pressures of an ageing ­population have only just begun to emerge.
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Medibank to return $20m to customers as a ‘loyalty bonus’

  • The Australian
  • 8:42AM February 16, 2018
  • Sarah-Jane Tasker
Australian health insurance giant Medibank has pledged to return $20 million to its customers after recording a 5.9 per cent jump in profit to $245.6 million.
Craig Drummond, chief executive of the Australian-listed health insurer (MPL), announced today that the company was launching a “priority” program for its customers, to formally recognise and thank customers who had been with Medibank for 10 years or more.
To mark the launch of this program, we are pleased to announce a $20m one-off loyalty bonus to our Medibank customers in June this year, starting with our priority customers,” Mr Drummond said.
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The unhealthy portion of Medibank premiums not spent on health

Michael Pascoe
Published: February 16 2018 - 12:07PM
There are different ways of looking at Medibank’s first-half profit announced this morning.
Let’s consider two of them:
The market sees a 1.8 per cent rise in premium income to $3.2 billion and total revenue of $3.5 billion, yielding a sweet 5.9 per cent rise in net profit to $245.6 million with the interim dividend up 4.8 per cent to 5.5 cents a share, fully franked.
The rise in claims (what Medibank paid out to customers) was held down to 1.3 per cent at $2.6 billion. The gross health insurance profit (premiums minus claims) was $550.5 million, a gross margin of 17.3 per cent. The management expense ratio eased from 8.9 per cent to 8.6 per cent.
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International Issues.

In the US, white supremacists have infiltrated police and military to get weapons training

Matthew Hall
Published: February 11 2018 - 2:40PM
New York: Law enforcement, the military, and politics in the United States have been infiltrated by white supremacists, who use it to recruit others and gain paramilitary training.
The claim, by a former neo-Nazi skinhead who now works as an anti-racist activist, is supported by internal reports on local policing by the Federal Bureau of Investigation, the top domestic law enforcement agency in the US.
Christian Picciolini, a 44-year-old, award-winning activist from Chicago who now works to deradicalise racist extremists, says members of his former neo-Nazi gang pursued careers with police departments, joined the military, or ran for political office.
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'International Space Station for sale': NASA documents reveal Trump selloff plan

Christian Davenport
Published: February 12 2018 - 8:12AM
Washington: The Trump administration wants to turn the International Space Station (ISS) into a kind of orbiting real estate venture run not by the government, but by private industry.
The White House plans to stop funding for the station after 2024, ending direct federal support of the orbiting laboratory. But it does not intend to abandon it altogether, and is working on a transition plan that could turn the station over to the private sector, according to an internal NASA document obtained by The Washington Post.
"The decision to end direct federal support for the ISS in 2025 does not imply that the platform itself will be deorbited at that time – it is possible that industry could continue to operate certain elements or capabilities of the ISS as part of a future commercial platform," the document states.
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Trudeau holds firm as Duterte vows to end Canada and US arms buys

Clarissa Batino & Andreo Calonzo
Published: February 11 2018 - 6:30PM
Canadian Prime Minister Justin Trudeau is undeterred by Philippine President Rodrigo Duterte's vow to end military purchases from countries including the US and Canada that impose conditions on how the weaponry is used, standing by his country's review of a helicopter sale.
"The statements that have been coming out of the Philippines on the potential or possible uses of those helicopters have given us cause to need to follow up on that, and that's exactly what we're doing," Trudeau said Saturday in Los Angeles, during a visit with the city's mayor.
Trudeau responded after Duterte on Friday said he's scrapping the acquisition of 16 Canadian Bell helicopters.
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OxyContin maker to stop promoting opioids to doctors

Published: February 11 2018 - 11:48AM
OxyContin maker Purdue Pharma LP said that it has cut its sales force in half and will stop promoting opioids to doctors following widespread criticism of the ways that drugmakers market addictive painkillers.
The drugmaker said it will inform doctors on Monday that its sales representatives will no longer visit their offices to discuss its opioid products. It will now have about 200 sales representatives, Purdue said.
"We have restructured and significantly reduced our commercial operation and will no longer be promoting opioids to prescribers," the Stamford, Connecticut-based company said in a statement.
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The risks of Trump’s pump-priming policies

  • The Australian
  • 12:13PM February 13, 2018
The Trump administration’s budget “request’’, issued overnight, points to soaring US government deficits and debt. That should be sounding an alert for overly-indebted corporates and households around the world.
While the proposals will probably be reshaped by Congress, the overall direction of economic policy in the US is clear.
Trump is pursuing a supercharged growth strategy (he sees no reason, reportedly, why the US economy can’t grow at 6 per cent) that will see the US produce a deficit of close to $US1 trillion this year and more than $US1 trillion in 2019. US government debt, now just above $US20 trillion, is expected to reach $US30 trillion within a decade.
With the US economy growing quite strongly and unemployment at 4.1 per cent, the Trump tax cuts and infrastructure and defence spending agendas represent the priming of a pump that was already functioning at full capacity.
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Israeli police recommend indictment of Netanyahu on corruption charges

Loveday Morris and Ruth Eglash
Published: February 14 2018 - 6:44AM
Jerusalem: Israeli Prime Minister Benjamin Netanyahu should be indicted in two corruption cases, police recommended on Tuesday, ramping up pressure on the leader who has served more than a decade in office.
After months of investigations, Israeli police handed over their recommendations to Israeli Attorney General Avichai Mandelblit on Tuesday evening.
Netanyahu maintained his innocence in a televised address to the nation on Tuesday night.
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A whirlwind envelops the White House, and the revolving door spins

Peter Baker
Published: February 14 2018 - 3:11AM
Washington: The doors at the White House have been swinging a lot lately. A deputy chief of staff moved on. A speechwriter resigned. The associate attorney general stepped down. The chief of staff offered to quit. And that was just Friday.
All of that came after the departure of Rob Porter, the White House staff secretary who cleared out his office last week amid accusations of spousal abuse. The White House had overlooked reported problems with his security clearance last year in part, officials said, because of a reluctance to lose yet another senior aide, particularly one seen as so professional and reliable.
More than a year into his administration, President Donald Trump is presiding over a staff in turmoil, one with a 34 per cent turnover rate, higher than any White House in decades. He has struggled to fill openings, unwilling to hire Republicans he considers disloyal and unable to entice Republicans who consider him unstable. Those who do come to work for him often do not last long, burning out from a volatile, sometimes cutthroat environment exacerbated by tweets and subpoenas.
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South Africa's President Jacob Zuma resigns 'with immediate effect'

Published: February 15 2018 - 11:59AM
  South African President Jacob Zuma resigned on Wednesday, bringing an end to his scandal-marred tenure and leaving the nation's leadership in the hands of the ruling African National Congress's new leader, Cyril Ramaphosa.
"The ANC should never be divided in my name," Zuma said in a 30-minute farewell address to the nation.
"I have therefore come to the decision to resign as the president of the republic with immediate effect," he said.
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Former Playmate alleges she had affair with Donald Trump

Brent Lang
Published: February 17 2018 - 3:48AM
US President Donald Trump engaged in elaborate efforts to cover his tracks while engaging in multiple extramarital affairs, according to Ronan Farrow's latest blockbuster report in the New Yorker.
The story relies heavily on the firsthand account of Karen McDougal, a former Playmate of the Year, who recounts her consensual affair with the President before he was elected.
The White House called the report "fake news," its default response to unflattering stories.
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Russia indictments present new reality for Trump crying ‘hoax’

Michael Shear
Published: February 17 2018 - 8:29AM
Washington: In November, President Donald Trump told reporters that he believed Russian President Vladimir Putin when he vigorously denied having meddled in the 2016 presidential election, an allegation that Trump has repeatedly called a hoax.
"Every time he sees me he says I didn't do that, and I really believe that when he tells me that, he means it," Trump said at the time.
On Friday, Robert Mueller, the special counsel, indicted 13 Russian nationals and described a vast, sophisticated Russian operation to interfere in the election, delivering to Trump the kind of evidence that the president has long sought to dismiss as political attacks from his rivals.
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Trump's top security adviser says Russian meddling 'incontrovertible'

Tracy Wilkinson
Published: February 18 2018 - 4:27AM
National security adviser HR McMaster said on Saturday that evidence of Russian interference in the 2016 US election was "now really incontrovertible" after indictment of 13 Russian individuals and three companies.
Speaking at an international security conference in Munich, Germany, McMaster lent credence to a widening scandal that President Donald Trump has routinely dismissed as a hoax.
"The evidence is now really incontrovertible and available in the public domain," McMaster said. The US was becoming "more and more adept at tracing the origins of this espionage and subversion," he said.

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I look forward to comments on all this!
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David.