Saturday, June 23, 2018

Weekly Overseas Health IT Links – 23rd June, 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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Could Artificial Intelligence Take the Art out of Medicine?

As health care becomes more complex, technological and data-driven, there’s a risk physicians will lose some of their autonomy
By Pamela E. Hepp on June 14, 2018
It has been said that the practice of medicine is both an art and a science. For example, different patients react differently to the same medication for the treatment of anxiety, and what works for one patient will not work for another. It can be a trial-and-error process to find the correct medication and optimum dosage. Why do side effects to medications or complications to treatments arise in some patients and not others? Every patient is unique, and the art of medicine is the component of the practice that addresses such uniqueness with compassion and care. Will artificial intelligence (AI) change all of that?
Of course, medicine is also a science, and health care is no stranger to technology. Health care is and has been for many years highly dependent upon technology, from x-ray machines and laboratory equipment; to more advanced medical equipment such as MRIs, ultrasounds and CT scanners; to systems that dispense medications within the hospital; to electronic medical records.
A hospital’s electronic health record may connect with the electronic health record of other hospitals and physicians to create a “health information exchange” (HIE), so that providers have access to all of a patient’s medical information regardless of where he or she may have been treated. The goal of providing access to a patient’s comprehensive medical information is to decrease medical errors as well as eliminate the provision of duplicate tests or procedures that may occur when a specialist may not have access to another provider’s records.
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HIT Think Why proposed CMS rule will re-energize info exchange

Published June 15 2018, 5:30pm EDT
Federal healthcare organizations such as CMS have spent billions of dollars over the years trying to bridge the gap between medical data and quality patient care with a “mesh” formed by interoperability requirements and data integration. Many government rules have been written to address the type of mesh needed, and many EHR companies have claimed to meet these government requirements and claim the throne of the ultimate mesh maker.
However, hospitals and clinics found the mesh contained many holes such as enabling hospitals to customize EHRs, but only if the EHR customers purchased the EHR systems for the manufacturers for millions of dollars that hospitals could ill afford. Also, there are issues such as proprietary connectivity to their own brands that left the hospitals’ other EHR systems to serve as dead-end data silos. Rules and solutions came and went, but few had any teeth until now.
To end the lack of interoperability morass and data duplication, the Department of Health and Human Services (HHS) issued 1,883 pages of proposed changes to Medicare and Medicaid. The changes rename the Merit-Based Incentive Payment System (MIPS) Advancing Care Information performance category to Promoting Interoperability (PI).
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Alphabet's DeepMind asked to explain business model for healthcare

Published June 15 2018, 5:02pm EDT
DeepMind, the artificial intelligence company owned by Alphabet, should explain how it intends to make money from its work with the U.K.’s National Health Service, a review panel appointed by the company concluded.
The panel also said DeepMind’s healthcare division needs to be more transparent about its relationship with the rest of the AI company, with Alphabet and with DeepMind sister company Google.
The public are likely to suspect that there must be an undisclosed profit motive or a hidden agenda without clarity about DeepMind Health’s business model, the panel wrote. “We do not believe this to be the case, but would urge DeepMind Health to be transparent about their business model, and their ability to stick to that without being overridden by Alphabet."
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Next-gen analytics: Here's what's coming in the future

Hospitals should expect orders of magnitude more data – but will also see emerging tools such as artificial intelligence and 5G connectivity helping to put both structured and unstructured information to work.
May 14, 2018 09:11 AM
The healthcare analytics market is booming and will be worth close to $54 billion worldwide by 2025, according to a March 2018 report from Grand View Research.
Given the need to achieve the Triple Aim, along with the rise of precision medicine and the move toward value-based care, data analytics have never been more important to healthcare provider organizations.
As the technology continues to grow and mature, here's the pressing question for healthcare and IT leaders: How will analytics tools evolve – and what should they expect to come next?
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The Sequoia Project updates patient matching framework

Written by Jessica Kim Cohen | June 13, 2018 |
The Sequoia Project, a nonprofit focused on healthcare interoperability, released an updated national framework for patient matching June 12.
The framework outlines best practices for patient matching between healthcare organizations and health information exchange partners. The recommendations for improved patient identity management were developed by the The Sequoia Project's Patient Identity Management Workgroup, which comprised stakeholders from academia, industry and government, through a multiyear effort. 
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This 30-second change to your computer settings is the easiest way to stop hackers

Published: June 13, 2018 11:16 a.m. ET

Experts claim you could save millions of dollars from potential hacks with one simple step

It takes less than one minute and can block many kinds of malware.

KariPaul

Reporter
With just a few clicks, you could better arm yourself against hackers and block advertisers from tracking you online.
Cybercrime is projected to cost the global economy more than $2 trillion a year by 2019 according to market analysts Juniper Research, and many of those scams start with phishing — tricking people into clicking on nefarious links through legitimate-looking emails.
An easy way to block these attacks: Change the Domain Name System (DNS) that your computer uses. Most computers connect to the DNS that’s automatically set by their internet service providers, but there are safer alternatives.
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AMA: Medical students, residents receive insufficient EHR training

Published June 14 2018, 7:24am EDT
Medical students and residents are not effectively using electronic health records because they continue to receive insufficient training on the systems as part of their formal professional education.
That’s the contention of the American Medical Association, whose policymaking body—AMA’s House of Delegates—met this week at its annual meeting and adopted a new policy that encourages medical schools and residency programs to “design clinical documentation and electronic health records (EHR) training that provides evaluative feedback regarding the value and effectiveness of the training, and, where necessary, make modifications to improve the training.”
In addition, the nation’s largest physician group wants to see medical schools and residency programs “provide clinical documentation and EHR training that can be evaluated and demonstrated as useful in clinical practice” and to “provide EHR professional development resources for faculty to assure appropriate modeling of EHR use during physician-patient interactions.”
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UCHealth to work with digital health companies to put tech into practice

Published June 14 2018, 7:32am EDT
UCHealth is planning to create an innovation center and work with medical technology start-up companies on artificial intelligence, big data, decision support, virtual health and wearables, among other technologies.
The nine-hospital Colorado delivery system, led by University of Colorado Hospital in Denver, seeks to build off its past experiences in working with innovative companies to improve the efficiency of operating rooms and the accuracy of medication prescribing. New efforts will include injecting new research and protocols into the electronic health records systems and using wearable devices to continuously monitor patient vital signs, executives say.
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Digital health must benefit patient safety

Written by Alojz Peterle on 14 June 2018 in Opinion
European policymakers must work towards better healthcare coordination and support while addressing preventable harm, writes Alojz Peterle MEP.
Patient safety is a major public health issue, with more than a quarter of EU citizens admitting to having an adverse experience while seeking healthcare and over half believing that patients might experience harm while in hospital care.
Unfortunately, there are grounds for such concerns. Every year an estimated 4.1 million patients acquire a healthcare associated infection in the EU and at least 37,000 die as a result.
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Special Report: Medicines Management

With national funding pledges to increase the uptake of e-prescribing in hospitals, digital medicines management is occupying a prominent place on the national agenda. But does that mean it can now finally hold a consistent place across NHS activity in local organisations? Jennifer Trueland investigates.
Digital medicines management seems to be front and centre of the national agenda at the moment. Hot on the heels of a Department of Health and Social Care review and an academic study into medication errors in England, in February health and social care secretary Jeremy Hunt announced £75 million to help NHS hospitals implement e-prescribing systems.
Some might say it’s about time. Although the technology has been around for years, and its benefits well rehearsed – reduced errors, improved patient safety and experience, financial and efficiency savings – uptake has remained gradual. The most recent Digital Health Intelligence clinical digital maturity index (CDMI) report showed 56% of trusts had gone electronic for outpatient prescribing, and 43% had for inpatient prescribing.
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Hospitals investing big in clinical communications as secure texting gains traction

Health system executives are convinced that mobile technology improves patient safety, but are looking for tools that feature robust security features, according to Black Book.
June 11, 2018 03:45 PM
Nearly all hospitals – 96 percent of them – are either budgeting for or already investing in comprehensive clinical communication platforms this year, according to a new report from Black Book Market Research.
C-suite IT decision-makers and frontline clinicians are united in their agreement that smart use of mobile devices makes for better patient safety and improved outcomes (90 and 94 percent of survey respondents, respectively) and the new study shows secure texting is fast-becoming the tool of choice for hospitals and practices.
Among 770 hospital professionals and 1,279 physician practices polled, the report showed respondents were looking for mobile technology that could do the most for patients while also maintaining sound cybersecurity.
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Next-gen data management: From FHIR APIs to AI to genomics, tech is changing fast

Hospitals should also expect Blockchain, patient experience and new iteration of vendor neutral archive capabilities to be available in the future.
June 13, 2018 09:36 AM
Healthcare data management technology is crucial to the interplay of information between IT systems, organizations and caregivers. The technology ensures that the right information is in the hands of the right person at the right time.
While data management tech is one of the basics of healthcare information and technology, it is by no means in an uninteresting position. In fact, there are many factors causing changes to the technology that healthcare CIOs will have to stay on top of in the years ahead.

APIs will decentralize data

The first next-generation feature of healthcare data management technology will be the decentralization of data through the incorporation of APIs into any technology at play within the health system, said Mark Vance, senior vice president of technology at Signet Accel, a data management technology vendor.
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Video Counseling Can "Upskill" PCPs, Bringing Specialty Knowledge to Rural Patients

Ryan Black
JUNE 12, 2018
There’s already ample evidence that telemedicine has great potential for improving outcomes and saving patients and healthcare organizations money. Saving lives, however, is a different proposition.
But not all telehealth is direct-to-patient. Video counseling for providers can act as a force multiplier for medical knowledge. And according to researchers from University of Michigan Medical School and the Ann Arbor Veterans’ Affairs Medical Center, such peer-to-peer videoconferencing might have helped survival rates among a cohort of more than 62,000 patients with liver disease.
Their new report, published in Hepatology, focused on a program called SCAN-ECHO, which stands for Specialty Care Access Network-Extension of Community Healthcare Outcome. The original ECHO program is a videoconferencing program first developed in New Mexico that works to “upskill” physicians by connecting them with specialists to inform care of patients with unique needs (rather than connecting a patient directly with a doctor via video).
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Pagers still a top communication tool in healthcare: 7 survey insights on hospital mobile strategies

Written by Julie Spitzer | June 12, 2018 |
Despite the popularity of smartphones and other mobile communication devices, many hospitals are still using pagers as a main mode of communication — especially among non-clinical care team members — according to a Spok survey.
For its annual "Mobile Strategies in Healthcare" report, Spok surveyed more than 300 healthcare professionals — 44 percent of whom were clinicians — about their organizations' mobile communication methods.
Here are seven survey insights:
1. The majority of respondents (57 percent) said their organization has a mobile strategy in place and 21 percent of them said their strategies have been in place for more than five years.
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Physical records were top target for hackers in Q1 — 8 statistics

Written by Angie Stewart | June 12, 2018 
Hackers breached protected health information most often through physical records in the first quarter of 2018, HIPAA Journal reports. 
Here were the top locations of breached PHI:
1. Paper/films: 18
2. Email: 16
3. Network server: 11
4. Laptop: 10
5. Electronic medical record: 9
6. Other portable electronic device: 9
7. Other: 7
8. Desktop computer: 6
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How CVS Health boosted specialty medication adherence with secure messaging, digital engagement

Jun 13, 2018 12:23pm
For the last year, CVS Health has been slowly integrating new digital tools to improve medication adherence for patients with serious conditions like cancer, cystic fibrosis and multiple sclerosis.
Using its mobile app, secure messaging and analytics, the retail pharmacy chain directed its efforts towards patients on specialty medications. By incorporating information from medication trials, CVS sends users customized alerts about potential side effects that coincide with the timing outlined in the clinical studies.
For example, if a cancer medication typically causes diarrhea three weeks into the regimen, the app times the alert at the three-week mark, and offers immediate access to a live care provider to answer additional questions, either through the app or on a phone call.
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Why a group of health systems just agreed to share precision medicine data with each other

Jun 13, 2018 3:02pm
If precision medicine is really going to be the panacea experts have promised, it'll be because health providers agreed to play nice with each other.
That's why Thomas D. Brown, M.D., executive director of the Swedish Cancer Institute in Seattle, said his organization jumped into a new Precision Medicine Countil convened by tech company Syapse. The council also includes Henry Ford Health System, Dignity Health, Catholic Health Initiatives, Aurora Health Care and the University of Miami Health System. 
Brown, whose institute is a part of Providence St. Joseph Health, said big-name providers that use similar technology systems will be central to building the massive and diverse data sets needed to allow researchers to find useful needles in the proverbial genomic haystack.
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New research shows up to 1,000 patients harmed by medical device breaches

Jun 13, 2018 2:48pm
As many as 1,000 patients suffered harm from medical devices hit by a cybersecurity attack, according to a new survey of executives of device manufacturers and provider organizations.
The survey, conducted by researchers at the University of California San Diego, is scheduled for publication in an academic journal. The results were announced by Christian Dameff, M.D., an emergency physician and clinical informatics researcher at UCSD at the HIMSS Healthcare Security Forum this week.
Of the 40 executives from some of the largest medical device vendors and provider organizations, two said 100-1,000 patients were harmed during an unreported adverse event associated with a medical device cybersecurity vulnerability.
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HIT Think 4 keys to successful health IT integration

Published June 13 2018, 5:52pm EDT
My career in medical informatics has spanned more than 15 years. During that time, I have witnessed innumerable changes in the processes, technology and people related to health IT solutions.
It used to be that the focus was almost entirely on clinician adoption, even if it adversely impacted outcomes and value. Clinicians and health systems were certain that they and their patients were unique, and process standardization and decreasing variations in care was only the dream of a few.
We certainly have come a long way from those early days. Today, most healthcare leaders are united around the belief in open, interoperable technology, and that standardization within an organization and across the industry is necessary if we are committed to improving the health outcomes of patients.
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Machine learning predicts dangerously low blood pressure during surgery

Published June 13 2018, 7:29am EDT
A machine learning algorithm is able to predict potentially dangerous low blood pressure that can occur during surgery by detecting subtle signs in routinely collected physiological data in surgical patients.
Dangerously low blood pressure—hypotension—can lead to complications such as postoperative heart attack, acute kidney injury and even death. The algorithm was able to accurately predict an intraoperative hypotensive event 15 minutes before it occurred in 84 percent of cases, 10 minutes before in 84 percent of cases, and five minutes before in 87 percent of cases.
Researchers leveraged two datasets to build and validate the predictive algorithm, based on recordings of the increase and decrease of blood pressure in the arteries during a heartbeat—including episodes of hypotension. For each heartbeat, they were able to derive 3,022 individual features from the arterial pressure waveforms, producing more than 2.6 million bits of information used to build the algorithm.
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Despite AI ethical concerns, IoT and smart sensor investments on rise new report finds

Most healthcare execs are planning to buy AI and IoT technology, but they'll need other capabilities and competencies to ensure they're safely deployed.
June 12, 2018 09:19 AM
It won't surprise you to know that artificial intelligence and the internet-of-things are suddenly big business. But as hospitals and health systems rush to incorporate these new technologies, many don't realize that they also need to be honing other capabilities and competencies – and sometimes buying complementary technologies – to ensure AI and IoT are well-deployed.
Accenture's new report, Digital Health Technology Vision 2018 finds that more than three-quarters of healthcare decision-makers surveyed say they're planning to invest in IoT and smart sensors in 2018. And more than half said they're shopping around for AI systems. The vast majority (86 percent) said they're looking for technology to help them harness data to drive automated decision-making.
At the same time, many are beginning to realize that the fundamental changes represented by AI demand more than just buying and installing a particular piece of software. More than 80 percent of execs said they're not ready for "societal and liability issues that will require them to explain their AI-based actions and decisions," according to the report.
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Radiologists find 13-button mouse useful for everyday tasks

Radiologists are completing more exams with fewer resources—thanks, in part, to new technology increasing personal efficiency.
When one institution gave radiologists a programmable 13-button mouse over a two-day period, many preferred non-conventional device over the conventional three-button variety, according to a study published in the Journal of Digital Imaging.
“In an era of decreasing radiologist reimbursement and increasing exam volume and complexity, it is imperative that radiologists explore multiple options to optimize workflow efficiency to meet the future demands of the specialty,” wrote lead author Kevin Denton, with the Department of Radiology at the University of Kansas Medical Center and colleagues.
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How Web-Based EHR Systems Save Community Hospitals Money

The flexible contracts that accompany some web-based EHR systems can fit a community hospital’s tight budget.

June 11, 2018 - More and more health IT companies are working to develop affordable EHR system offerings geared toward meeting the needs of small, rural, and community hospitals.
Enterprise health IT companies such as Epic and Cerner — which formerly catered almost exclusively to large hospitals and health systems — now offer deployment models and cost-efficient product packages better able to fit within the bounds of a small hospital-sized budget.
The advent of the web-based EHR system has allowed for even greater savings. Web-based EHR systems eliminate the need for cost-conscious hospitals to make upfront capital investments in new hardware or in-house storage systems.
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81% of healthcare execs say they're not prepared for potential social, liability issues of AI

Written by Jessica Kim Cohen | June 11, 2018 
As healthcare executives adopt artificial intelligence tools at an unprecedented scale, many have begun to realize they must prepare for the potential social or liability issues automated decision-making may create, according to an Accenture report.
For the report, the professional services company surveyed C-suite executives from 100 healthcare organizations about their firm's technology adoption and investment.
Here are five survey insights into how healthcare executives are adopting AI:
1. Fifty-three percent of executives plan to invest in AI systems, with 86 percent of respondents indicating their organizations use data to drive automated decision-making at an "unprecedented scale."
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One-third of healthcare CIOs 'still on the journey' to comply with GDPR privacy rules

Written by Jessica Kim Cohen | June 11, 2018 |
Roughly half of healthcare CIOs — 53 percent — indicated they would be 80 to 90 percent in compliance with the European Union's General Data Protection Regulation by May, according to a joint survey by IT outsourcing service provider Harvey Nash and professional services firm KPMG.
The EU's new data protection rules, which went into effect May 25, apply to anyone who handles European citizens' personal information, including addresses, credit card numbers, biometric data and other information that may be traced back to an individual. The law, which is stricter and broader than HIPAA, will affect businesses of all sizes worldwide that use European citizens' data in their services.
To assess IT leadership's preparedness for GDPR compliance, Harvey Nash and KPMG surveyed nearly 4,000 CIOs and technology leaders across 84 countries about their journey to meet the EU's new rules. Although the majority of healthcare respondents said they would be mostly prepared by May, only 14 percent expected to be completely in compliance.
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HIT Think 4 tips for retaining key IT staff talent

Published June 12 2018, 5:39pm EDT
While recruiting in-demand IT professionals is difficult, the real challenge is figuring out how to retain those professionals. It’s not an easy problem to solve, but it’s possible and worth it when adding up just how much high turnover can cost a healthcare organization.
In the tech industry, it’s rare to see employees stay with one organization longer than two years. Consider these four HIT professional retention tips as helpful insights into the minds of your most valuable employees.
To get essential software, app or web development talent, HIT executives most likely must consider the average salary ranges, benefit plans and additional incentives competitors were offering for the developer roles they wanted to fill. This research shouldn't end once the position is filled.
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Groups seek to develop atrial fibrillation decision tools

Published June 12 2018, 5:33pm EDT
The Patient-Centered Outcomes Research Institute and the American Heart Association have teamed to build a new research center to create or refine “decision aid tools,” a type of decision support, to help patients with atrial fibrillation more easily make choices on their treatment options with their physicians.
Two decision aid support tools are being developed—the first is for patients with atrial fibrillation to use on their own before an office visit, with the second tool to be used with the doctor during the visit.
“Shared decision making tools can be very useful in helping patients, their families and their clinicians better understand and discuss how to balance the benefits and risks of their treatment options,” says Joe Selby, MD, an executive director at PCORI.
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Apple Health Records API owes much to FHIR standard

Published June 11 2018, 7:15am EDT
Apple’s new Health Records API—offered to developers to help them create apps for better disease management, medication tracking and nutrition planning—would not be possible without HL7’s Fast Healthcare Interoperability Resources standard.
So said Jason Morely, software engineer on the Apple health team, during the company’s 2018 Worldwide Developers Conference held last week in San Jose. At the event, the company announced the availability of the Health Records API, enabling developers to access healthcare data and “work with it,” resulting in the creation of apps that empower patients.
 “Users interact with multiple healthcare institutions over the course of their lives—and, these are often running different electronic health record systems that don’t always represent data in the same way,” Morely pointed out. “This makes interoperability incredibly difficult.”
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Most Clinical Trial Participants Support Health Data Sharing

New research shows 93 percent of clinical trial participants are willing to support health data sharing for a variety of uses.

June 08, 2018 - The vast majority of clinical trial participants approve of health data sharing among researchers as long as the appropriate safeguards are in place, according to new findings in the New England Journal of Medicine (NEJM).
Despite the high number of patient EHRs compromised in healthcare data breaches in 2018, few patients have reservations about allowing university scientists or for-profit companies to access their health data.
According to Mello et al., only 8 percent of a total number of 771 surveyed clinical trial participants feel the potential negative consequences of data sharing outweigh the benefits.
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CMS: Medicaid programs can fund opioid-related health IT enhancements through HITECH

Jun 11, 2018 4:02pm
Federal funding is available to state Medicaid programs to enhance the use of technology to help states manage the opioid crisis, according to new guidance from the Centers for Medicare & Medicaid Services (CMS).
Much of that funding is already available through existing legislation, the agency said. The guidance also encourages Medicaid program directors to use telehealth and telepsychiatry to coordinate care for patients with substance abuse disorder.
In a letter (PDF) to state Medicaid directors, Tim Hill, acting director of the Center for Medicaid and CHIP Services, said the CMS doesn’t need to approve telehealth coverage changes for opioid treatment unless the state elects to cover telehealth encounters differently than in-person visits.
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6 key criteria for selecting business analytics tools

Published June 11 2018, 7:32am EDT
Key capabilities needed in business analytics tools
The adoption of business analytics doubled between 2013 and 2016, according to the BARC Research and Eckerson Group study, “BI and Data Management in the Cloud: Issues and Trends.” The most popular tools are those that are designed to improve data exploration, including visual discovery. Additional factors that differentiate cutting-edge business analytics tools include extensive support for dashboard reporting (mentioned by 76 percent of respondents), ad-hoc analysis and exploration (noted by 57 percent) and dashboard authoring (55 percent). Dozens of new analytics tools are released every year, making it difficult to select the best choice for any organization. Blogger Louis Columbus of SelectHub aims to simplify the process by identifying six key criteria to use in making a selection.
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Latvian Association of Family Physicians issues call not to vote for Greens/Farmers and their health care policy

RIGA - The Latvian Association of Family Physicians at the meeting on Friday supported a call not to vote for the Union of Greens and Farmers and the bloc's healthcare policy.
The association's president, Sarmite Veide, told LETA that the family physicians thought that Health Minister Anda Caksa (Greens/Farmers), Prime Minister Maris Kucinskis (Greens/Farmers) and the political bloc they represented would reduce the health care system to shambles, leaving "doctors and patients staring at broken pieces".
The family physicians agreed to re-assess performance of the e-health system in July. As long as the functions of issuing e-sick notes and e-prescriptions did not work properly (namely, if it took physicians more than 30 seconds to issue one of those electronic documents), the family physicians will not be using other functions of the e-system. Moreover, they will abstaining from use of the e-health system one day a week.
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Enjoy!
David.

Friday, June 22, 2018

Some Interesting Questions Worth Thinking About Around AI In Healthcare.

This appeared a few days ago.

Could Artificial Intelligence Take the Art out of Medicine?

As health care becomes more complex, technological and data-driven, there’s a risk physicians will lose some of their autonomy
By Pamela E. Hepp on June 14, 2018
It has been said that the practice of medicine is both an art and a science. For example, different patients react differently to the same medication for the treatment of anxiety, and what works for one patient will not work for another. It can be a trial-and-error process to find the correct medication and optimum dosage. Why do side effects to medications or complications to treatments arise in some patients and not others? Every patient is unique, and the art of medicine is the component of the practice that addresses such uniqueness with compassion and care. Will artificial intelligence (AI) change all of that?
Of course, medicine is also a science, and health care is no stranger to technology. Health care is and has been for many years highly dependent upon technology, from x-ray machines and laboratory equipment; to more advanced medical equipment such as MRIs, ultrasounds and CT scanners; to systems that dispense medications within the hospital; to electronic medical records.
A hospital’s electronic health record may connect with the electronic health record of other hospitals and physicians to create a “health information exchange” (HIE), so that providers have access to all of a patient’s medical information regardless of where he or she may have been treated. The goal of providing access to a patient’s comprehensive medical information is to decrease medical errors as well as eliminate the provision of duplicate tests or procedures that may occur when a specialist may not have access to another provider’s records.
Access to all of that information, however, is creating an information overload for many physicians—yet under the current reimbursement system, where providers are paid a set fee per patient encounter or procedure, providers are being pressured to see more patients in a given day, thereby having less time to spend on any given case. Similarly, hospitals are paid a set amount for the entire hospital stay for a specific patient diagnosis. Accordingly, hospitals are incentivized to discharge patients much quicker than they once did.
Lots more here:
This is a fascinating post, written from a legal perspective, that raises all the issues of liability, responsibility, regulation and complexity associated with the use of AI in support of care delivery.
We have already had a taste of the problem with ‘alert fatigue’ from clinical decision support systems (CDS) but as the complexity and capabilities of AI improve it is clear things are going to become that much harder and more tricky.
How responsibility and blame will be apportioned when things go wrong using systems that the users don’t fully understand is an interesting and open question.
Well worth a browse and a think about.
David.

Thursday, June 21, 2018

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

June 21, 2018 Edition.
After last week it is hard to be sure just what comes next other than there seems to be more and more sabre rattling on trade with China, Canada and the EU. It is more than possible this ends badly.
In OZ we have a fevered 2 weeks of parliament and the Royal Commission starts up next week in Brisbane – so lots of headlines to cope with there!
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Here are a few other things I have noticed.
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Major Issues.

Economists: male, upper class, out of touch

By ROSS GITTINS
10 June 2018 — 6:27pm
Could there ever be a shortage of economists? And if there were, would that be a bad thing?
At the risk of being drummed out of the economists’ union, it wouldn’t be a big worry of mine.
What I do find of concern is the decline in the number of students studying economics at school and university, as outlined by the Reserve Bank’s Dr  Jacqui Dwyer in a recent speech.
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Odds shorten on a Turnbull backflip to a spring poll

By Mark Kenny National affairs editor
9 June 2018 — 4:43pm
Labor is quietly preparing for a spring election, despite Malcolm Turnbull's continued assurances of a 2019 poll.
Sources confirm the Opposition has recently stepped up its internal processes for completing policy documents, finalising candidates, and mapping out its media buys.
The flurry of activity reflects Labor's hard-headed assessment of the electoral landscape spearheaded by a particular wariness about the super-Saturday byelections on July 28.
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Security bill will muzzle human rights activists

By Claire O’Rourke
11 June 2018 — 12:05am
In this era of so-called “fake news”, civil society plays a critical role in holding governments to account.
And yet, with Labor capitulating to the government on the proposed National Security Legislation Amendment (Espionage and Foreign Interference) Bill, it may soon become a crime to hold the Australian government to account on its human rights record. The truth itself would not be a defence.
By joining regimes around the world in passing new, restrictive laws attempting to suffocate civil society under pretexts of "treason" and "security", the opposition and government are lurching towards authoritarianism.
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In Australia's relentless culture wars, Tony Abbott strikes again

By Tony Walker
10 June 2018 — 11:52pm
Nothing, it seems, stirs the blood of the country’s cultural warriors more than an argument about academic license or press freedom if it’s not favourably disposed to their side.
One is tempted to ask what would these mavens of "political incorrectness" do without academia and the ABC to rail against; although it might be observed that one person’s political correctness is another person’s political incorrectness.
Take the question of whether the Australian National University should have accepted money from a private body to establish a course in Western civilisation, aimed at educating a new generation in the foundations of our own society in the broader sense.
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Special forces case could forge new legal territory, experts say

By David Wroe
11 June 2018 — 7:30pm
Military legal experts say any prosecutions following the inquiry into some special forces soldiers’ conduct in Afghanistan would enter new legal territory for Australia and would face challenges establishing sufficient evidence.
David Letts, a former naval officer who now heads the Australian National University’s military law program, said the closest previous comparison in Australia was the charging of two Australian commandos after the death of five children in Afghanistan.
Those charges were dropped by the Director of Military Prosecutions before it went to a court-martial.
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The dark side of personal data and why it pays to care about it

By Nigel Gladstone
11 June 2018 — 11:53pm
A ''renaissance man'' who started a billion-dollar technology company is aiming to enlighten the "dark side" of data and change how the internet pays for the stuff we put in our brains.
Jim McKelvey is an engineer, author and the co-founder of Square, a company worth more than $20 billion that allows credit cards to be accepted as payment on a smartphone. He is also a master glass artist, works for the Federal Reserve as an independent director in St Louis, founded a non-profit organisation called LaunchCode, and is building a new "business-model stack” for the media industry.
In Sydney last month to talk about the "dark side of data", Mr McKelvey spoke to the Herald about why personal data matters - "it can be ransomed for bitcoin" - and the risk from people "drowning in data", and losing control of their information.
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Time to judge our wars in Iraq and Afghanistan

By Travers McLeod
11 June 2018 — 11:12pm
 “We will never forget that 100 years ago a young and brave nation on the other side of the world made history by writing our history. Lest we forget.”
So ended French Prime Minister Edouard Philippe’s tribute to the Anzacs in April this year at the opening of the Sir John Monash Centre at Villers-Bretonneux.
Compare this to what a former Afghan refugee who calls Australia home wrote after Fairfax Media reported our special forces may have committed war crimes in Afghanistan.
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Clouds over world economy 'getting darker by the day'

12 June 2018 — 1:01pm
IMF managing director Christine Lagarde says the risks to the global economy are rising as major industrial nations sharpen threats of a trade war.
"The clouds on the horizon that we have signalled about six months ago are getting darker by the day - and, I was going to say, by the weekend," Ms Lagarde said at a news conference in Berlin on Monday.
Her remarks follow a chaotic two-day meeting of the Group of Seven in which US President Donald Trump shocked fellow leaders with his disregard for US allies. After leaving the summit early, Mr Trump tweeted he was pulling US support from a joint statement and he accused the host, Canadian Prime Minister Justin Trudeau, of being weak and dishonest.
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  • Updated Jun 12 2018 at 11:00 PM

Retirement incomes: how does Australia stack up?

by David Knox
How does Australia fare globally when it comes to retirement incomes?
Our superannuation savings framework is often highlighted as a long-term success of the decisions made in the 1980s and 1990s. Yet the latest OECD numbers show that the system is not delivering an acceptable level of retirement income across all wage earners.
When compared with 10 other countries with similar economies, Australia's results are skewed.
Odd as it may seem, Australia's wealthiest and the very poorest are doing well from our compulsory superannuation system. But average wage earners are not. This incongruity means that the system is far from perfect.
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The small improvements that could deliver a big boost to our wellbeing

By Matt Wade
12 June 2018 — 7:13pm
Australia is back at the “top of the global leader board”. That’s how Treasurer Scott Morrison framed things when official economic growth figures last week showed gross domestic product expanded by 1 per cent in the first three months of the year, the best quarterly result in six years.
But a few days earlier another gauge of national performance, for exactly the same period, told a very different story.
NAB’s Australian Wellbeing Index dropped for the third successive quarter to the lowest mark since it began five years ago.
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Blocking foreign meddling in our affairs

13 June 2018 — 12:05am
The resignation of former Senator Sam Dastyari late last year got Labor out of a tight political spot but solved none of the underlying problems that had led Mr Dastyari into strife in the first place. They are problems that go to the heart of the way countries seek to influence each other's internal affairs in the digital age.
Mr Dastyari's undoing came after a joint Fairfax Media-ABC investigation revealed startling new details of the "soft power" exerted over our political system by China's Communist Party. That reporting showed how vulnerable our system is to the distortions of lobbying, often accompanied by political donations, by agents of foreign governments – without the usual diplomatic formalities and all done far away from the glare of media or public scrutiny.
And the challenges do not end there. In the digital age, as the 2016 US election showed, foreign powers can cause havoc during election campaigns by exploiting the anonymity of the internet to seed division, misunderstanding and "fake news".
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  • Jun 13 2018 at 11:12 AM

Sydney's housing bubble deflates as loans revisit GFC declines

by Michael Heath and Garfield Reynolds
Australia's east-coast property bubble is showing signs of deflating at a faster clip as home-lending data recorded the longest losing streak in almost a decade.
Housing finance fell 1.4 per cent in April, the fifth straight monthly drop and the longest stretch of declines since September 2008, when Lehman Brothers collapsed and a month before the Reserve Bank of Australia slashed its key interest rate by a per centage point.
The downturn is most prominent in Sydney where prices slid 4.2 per cent in May from a year earlier, when they were rising at an annual pace of 17 per cent. Sales at auctions have slumped to the lowest since early 2016 in Australia's biggest city, with only around half of properties successfully selling.
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  • Jun 13 2018 at 1:20 PM

RBA governor Philip Lowe warns weak wages may see inflation fall short of target

Reserve Bank of Australia governor Philip Lowe has warned the current pace of wages growth is not compatible with his goal of keeping inflation at 2.5 per cent, is eroding the nation's "sense of shared prosperity," and makes much-needed productivity enhancing economic reforms more difficult to achieve.
Reiterating that the Reserve Bank expects wages growth will gather pace as unemployment falls, Dr Lowe said a return to a world where wage increases start "with a 3 rather than a 2 is both possible and desirable".
"This is not a call for a sudden jump in wages growth from current rates to 3-point-something. Rather, we will be better off if this increase takes place steadily over time as the economy improves."
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  • Jun 13 2018 at 4:30 PM

Is an Australian financial crisis on the cards?

Household leverage may have peaked, house prices are falling, and credit conditions are tightening. The combination of the three should have all of us asking: what next?
The question is crucial because Australia is one of the few economies to have increased its debt burden since the global financial crisis. Household debt to GDP has tailed off a touch of late, but sits at record highs of around 120 per cent. The next nearest is Canada, at 100 per cent. We also have one of the highest household debt-to-income ratios in the world: 190 per cent. Five years ago it was 160 per cent.
"Economic history shows that there is usually a consequence of a prolonged period of rapidly rising debt, the only question is: how bad will the consequence be", Capital Economics chief Australia economist Paul Dales writes in a provocatively titled new report "Is a financial crisis looming?".
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Pink tax versus blue tax: the case for taxing women lightly

By Peter Martin
13 June 2018 — 7:41pm
If women were to be taxed differently to men, it wouldn’t be the first time.
Treasurer Scott Morrison says the idea is absurd.
“You don’t fill out pink forms and blue forms on your tax return. It doesn’t look at what your gender is any more than it looks at whether you are left-handed or right-handed,” he said last week.
He even said, wrongly, that Labor has been suggesting it.
But such a move has happened before.
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Ramsay Centre controversy a high-stakes affair

By John Warhurst
13 June 2018 — 10:00pm
The controversy surrounding the rejection by the Australian National University of the proposal by the Ramsay Centre for a large private donation to support a new area of study in Western Civilizations has become the subject of hostile newspaper editorials and assertive current affairs interviews of the ANU Vice-Chancellor, Brian Schmidt. Even the Prime Minister has got into the act.
Another ANU entity, the Centre for Arab and Islamic Studies, has been dragged into the furore, as have other institutes and donors elsewhere in the Australian university system, such as China’s Confucius Institutes. The ANU, not for the first time, has felt compelled to defend the Centre for Arab and Islamic Studies and indirectly its director, Professor Amin Saikal.
This is a high-stakes affair. The players could hardly be more prominent. On one side the Ramsay Centre’s funds come from a bequest by the late health care industry billionaire Paul Ramsay. Its public spokesman is Australia’s second-longest serving prime minister, John Howard. Behind Howard, tossing political hand-grenades, is another former prime minister, Tony Abbott.
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Brian Schmidt: At the end of the day, it's a matter of principle

By Brian Schmidt
7 June 2018 — 5:56pm
The news came yesterday that Australian National University remains ranked by QS as No. 1 in Australia and in the top 25 universities in the world. We take this global reputation seriously – one that is built on the basis of academic autonomy and free academic inquiry.
The ANU has declined donations in the past and will again where we are unable to meet the donor's wishes within our normal practices. It is right that we explore opportunities openly and in good faith, but it is also right that we let prospective donors know when we cannot provide them with what they want.
Our decision to end negotiations with the Ramsay Centre for Western Civilization has attracted a great deal of interest. In this case, the prospective donor sought a level of influence over our curriculum and staffing that went beyond what any other donor has been granted, and was inconsistent with academic autonomy.
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  • Updated Jun 14 2018 at 11:23 AM

This is why productivity growth has slowed so much

We live in an age judged to be one of exciting technological change, but our national accounts tell us that productivity is almost stagnant. Is the slowdown or the innovation an illusion? If not, what might explain the puzzle?
The slowdown, if true, matters. As Paul Krugman, also a Nobel laureate, argued, "Productivity isn't everything, but in the long run it is almost everything." Improvements in standards of living depend almost entirely on rising output per worker.
The productivity slowdown is a major explanation for the stagnation in real incomes and the pressure for fiscal austerity in high-income countries. Gene Grossman of Princeton and three co-authors even argue that the marked slowdown in the growth of incomes per head also explains the decline in labour's share of national income in wealthy countries.
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Zombie alert! Fed and ECB's next moves could expose the living dead

By Stephen Bartholomeusz
Updated14 June 2018 — 1:04
When the history of the global economy post-crisis is written, this week might be seen to have provided a significant moment - and one not necessarily universally positive.
At face value, the US Federal Reserve board's decision to raise the federal funds rate by 25 basis points -- the second increase this year and the sixth since late 2015 – is an endorsement of the strength of the US economy and the progress in normalising US monetary policy.
The Fed flagged another rate rise later this year and, by a slender majority, indicated there might even be a fourth. With US GDP growth pushing towards 3 per cent, the unemployment rate falling below 4 per cent and inflation around 2 per cent it signalled the trajectory of rates is steepening.
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Brace yourself: Why the fallout from the next GFC will be much worse

By Satyajit Das
13 June 2018 — 10:18am
No one can predict how bad the next financial crisis will be. What's certain, though, is that a lack of liquidity will make the fallout much worse.
Holders of shares, currencies and commodities need trading liquidity so they can adjust positions, raise cash to meet redemptions, reduce their risk, or limit losses. Yet they seem to anticipate more liquidity than there actually is.
Outside of a few stocks, major currencies and some government securities that trade consistently in large volumes, few instruments are truly liquid. High trading volumes and low bid-offer spreads [low differences between the highest price a buyer is ready to pay and the lowest price a seller is willing to accept] are misleading. Earlier this month, as political chaos gripped Italy, volumes shrank and the bid-offer spread tripled with alarming speed.
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On the down Lowe: it's workers who will experience the real penalties

By Jenna Price
Updated15 June 2018 — 7:32amfirst published 14 June 2018 — 10:00pm
Here are two oppositional forces at work: the governor of the Reserve Bank Philip Lowe with a reprise of the song he has been singing since last year; and the latest round of cut to penalty rates which begins on July 1.
What's he singing?
He's singing Pink Floyd's Another Brick in the Wall, an anthem about alienation. Not exactly. He is a bit too reserved (ahem) for that. But the themes are more or less the same. We need higher wage growth for a happier Australia (yeah, I'm paraphrasing but only a little).
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Employment comes off the boil — now for the NDIS factor

  • The Australian
  • 12:00AM June 15, 2018

Judith Sloan

Yesterday’s labour force figures were really not much to crow about, even though the Prime Minister gave it his best shot. The rate of employment growth is clearly slowing after the bumper year that was 2017.
The number of employed people increased by only 12,000 in May and the fall in the rate of unemployment — from 5.6 per cent to 5.4 per cent — reflected a drop in the participation rate. For the year to May, overall employment grew 2.6 per cent, but note that the population is growing at the rate of 1.6 per cent.
Full-time employment actually fell almost 21,000 (in seasonally adjusted terms) last month whereas part-time employment rose nearly 33,000. In 2017, three-quarters of new jobs over the calendar year were full-time.
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Evolutions in Growth, Trade and Geopolitics

PIMCO’s Global Advisory Board discusses the outlook for major economies and geopolitical developments.
By Global Advisory Board June 2018
The six members of PIMCO’s Global Advisory Board, a team of world-renowned macroeconomic thinkers and former policymakers, recently joined the discussion at PIMCO’s annual Secular Forum, where they addressed critical factors likely to shape the global economy over the three- to five-year horizon. The board’s insights constitute a valuable input into PIMCO’s investment process. The discussion below is distilled from their far-ranging conversation.

Q: What is the outlook for U.S. growth, business sentiment and monetary policy over the secular horizon?

A: Tailwinds supporting continued U.S. growth, at least over the early part of the secular timeframe, include the synchronized global recovery, accommodative financial conditions, tax reform, the regulatory environment and the fiscal policy impulse. Demographics are a drag on growth, but over time we could see productivity begin to improve.
“If tightening financial conditions do some of the Fed’s work for it, then it doesn’t have to be quite as aggressive on short rates.”
- Ben Bernanke
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Trump triggers talk of Australia going nuclear

By Peter Hartcher
16 June 2018 — 12:16am
Should Australia develop its own nuclear weapons? It seems an outlandishly radical thought for such a safe country to consider. But a former adviser to Malcolm Turnbull and Julie Bishop thinks it's an idea whose time is fast approaching.
In his book Why Australia Slept, launched this week, Peter Hendy says that Australia needs to consider nuclear weapons because "if we could financially afford them, [they] would secure an even more independent foreign policy" for the country.
Hendy, a former Liberal federal MP, former head of the Australian Chamber of Commerce and Industry and now a consultant, is not the first to raise this delicate subject. The way things are going he won't be the last.
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Australian dollar could slump to 'mid-60s', says Vimal Gor

By Matthew Burgess & Ruth Carson
16 June 2018 — 7:11am
A Sydney-based fund manager that profited from the selloff in Turkey's bonds and currency last month now expects a slump closer to home, as a stronger greenback weighs on the Australian dollar.
The Aussie may fall more than 10 per cent to the "mid-60s" US cents in 12 months, said Vimal Gor, head of income and fixed interest at Pendal Group, at a conference. A hawkish Federal Reserve will continue raising rates "until something breaks," while its Australian counterpart stands pat, he said.
"The US is the only country that's genuinely hiking rates, so the interest-rate differential story is giving a huge tailwind to the dollar," Tim Hext, a portfolio manager in Gor's team, said separately.
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The $2.7 trillion question: why trade wars do matter

By Mark Gongloff
16 June 2018 — 10:22am
An old Wall Street saw says "Buy on the sound of cannons, sell on the sound of trumpets," meaning stock traders see wars as buying opportunities. The story may be different if those cannons are aimed at their wallets, however.
Until recently, President Donald Trump's waving of the trade-war stick at China and various allies has generally elicited stock-market yawns. But Trump's new tariffs on Chinese goods today may have been a hot pot of coffee. China fired back with massive tariffs of its own, and Trump has threatened to retaliate for China's retaliation.
Suddenly the trade wars seem to matter a bit more to stocks; the S&P 500 fell about one per cent before recovering at the end of the day. And trade wars matter in some quarters more than others.
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What doors would a 'Western Civilisation' degree open?

By Richard Denniss
16 June 2018 — 8:54am
It’s not that long ago that right wing politicians saw arts degrees as an expensive indulgence that distracted universities from the real task of training the next generation of accountants and marketing executives. But these days John Howard, Tony Abbott and Malcolm Turnbull all think that an education in ‘Western Civilisation’, albeit a privately funded one, is the most important thing a university can provide.
Amongst all of the fire and fury about the Australian National University’s decision to decline an offer of private funding for a course in Western Civilisation, a couple of key questions are yet to be asked. The first is simply, what job would a student of Western Civilisation be qualified to do?
After 20 years of neoliberalism, most universities now define themselves by their ability to design undergraduate courses that the employees of tomorrow will need. Course titles, curriculum content and even assessment tasks are all designed to signal to students and employers that graduates are ‘job ready’. But has anyone ever heard of a skills shortage for those well versed in Greek literature?
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Elderly Australians pressed by adult children to sell, move out

  • The Australian
  • 12:00AM June 16, 2018

Luke Griffiths

As the dream of home ownership becomes less achievable for the young, older Australians are increasingly under pressure from their children to hand over their wealth, Age Discrimination Commissioner Kay Patterson says.
Dr Patterson, a Howard government health minister, said this form of “elder abuse” was ­expected to escalate as the population aged and house prices rose.
“People are living much longer, so those who might have expected an inheritance aren’t getting it when they think they deserve it … leading to so-called ‘inheritance impatience’,” she said.
  • Updated Jun 15 2018 at 11:00 PM

A five-point plan to right Australian foreign policy

"We should be smart" may not sound like a sophisticated strategy for Australia in a world where international relations are taking on hallucinatory colours, but it's the way to go.
The sight of a US President condemning the leader of Canada, America's closest ally, as "weak" and "dishonest" and a couple of days later embracing a brutal, murderous dictator who was threatening to attack American cities with nuclear missiles is, let's face it, surreal.
It forms the backdrop to advice from Australian foreign policy veterans that Australia must be "positively alert" and "agile and imaginative". This doesn't sound like what jargon-meisters call "an integrated policy" but, hey, these aren't the sort of times where the old rules apply.
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Liberal Party members call to sell ABC nothing but 'pure self-indulgence'

By David Crowe
16 June 2018 — 8:14pm
Liberal Party federal president Nick Greiner had some good advice for his colleagues on Friday night but they struggled to remember it on Saturday morning.
“I think in some ways, across the party, we’ve occasionally been lazy and self-indulgent when we put our own internal tiffs, our internal arguments, over the wellbeing of the party overall,” he said.
The Liberal Party’s peak council has voted almost 2:1 to privatise the ABC, but the treasurer says there are 'no plans'.
Greiner urged party members to put aside divisions in order to focus on what really matters – the big ideas needed to win the election and govern the country.
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Australia vulnerable to 'full-blown trade war' as US-China tension deepens

By Eryk Bagshaw
16 June 2018 — 4:57pm
Australia is overexposed to a full-blown trade war between the US and China, business leaders have warned, as the Trump administration increases sanctions on Chinese products.
The Turnbull government moved quickly to put itself at the front of negotiations on Saturday after it was revealed a 25 per cent tariff on $US50 billion ($67 billion) worth of 1102 Chinese imports would take effect from July 6.
Foreign Minster Julie Bishop urged the world's two largest economies to take their dispute to the World Trade Organisation before it hit global standards of living and economic growth.
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ABC won't be sold despite Liberal vote

Treasurer Scott Morrison says there are no plans to privatise the ABC despite calls from Liberal rank-and-file members to sell it off.
Australian Associated Press June 16, 20182:31pm
The ABC will not be privatised despite rank-and-file Liberal members calling on the government to sell off the national broadcaster's city operations.
The Liberal federal council passed a motion with a two-to-one majority calling on the coalition to sell off the ABC, except for in regional areas.
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Real conservatives do not wear rose-coloured glasses

  • The Australian
  • 12:00AM June 16, 2018

Peter Van Onselen

The term conservative has been hijacked by right-of-centre activists who, frankly, do not qualify for its ideological camp. The worst part about this is the profoundly adverse effect it is having on the broader right’s ­capacity to win political arguments and convince mainstream voters of the merits of their ideological positioning.
“Liberals” aren’t much better, but their failure is generally a lack of policy courage rather than ideological understanding. Liberalism also needs to decouple itself from neo-liberalism, but that’s a complicated topic for another day.
Conservatism is a worthy world view. The concept of defending institutions and pressure-testing ideas before change is adopted can be prudent. Equally, liberalism is a valuable ideo­logical construct. Embracing the importance and the value of the market, alongside the usefulness of protecting liberties and personal freedoms, is something Australia needs.
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Financial Royal Commission Issues.

Dover Financial shuts up shop

By Mathew Dunckley & Sarah Danckert
10 June 2018 — 2:05pm
Financial planning group Dover Financial Advisers has abruptly pulled the pin on its advice services just weeks after its founder collapsed on the stand at the Hayne royal commission.
Dover Financial, based in the Melbourne suburb of Cheltenham, is one of the 10 biggest financial planning outfits in Australia and has more than 400 planners operating under its licence around the country.
Industry sources have confirmed that Dover wrote to its planner network on Friday telling them to cease offering new advice immediately, putting an estimated 50,000 clients in limbo.
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'Read email thoroughly, it contains unhappy news': Dover shuts down

By Mathew Dunckley & Sarah Danckert
10 June 2018 — 2:05pm
Financial planning group Dover Financial Advisers has abruptly pulled the pin on its advice services just weeks after its founder collapsed on the stand at the Hayne royal commission.
Dover Financial, based in the Melbourne suburb of Cheltenham, is one of the 10 biggest financial planning outfits in Australia and has more than 400 planners operating under its licence around the country.
Fairfax Media has obtained an email Dover's owner Terry McMaster wrote to the company's network of planners on Friday telling them to cease offering new advice immediately as the corporate watchdog was going to remove its licence, putting an estimated 50,000 clients in limbo.
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'If you can't trust your kids' - bank chief warns on small biz loans

By Clancy Yeates
11 June 2018 — 12:00am
Raising banks' threshold for small business lending from $3 million to $5 million would risk forcing up interest rates and restricting the supply of credit, Bendigo and Adelaide Bank chief executive Mike Hirst warns.
With business banking practices under the microscope, Mr Hirst said that if banks classify loans worth up to $5 million as small business lending - as the corporate regulator has backed - it could exacerbate the long-held complaint of small businesses: that it is too hard to get credit.
 “I’d be concerned for funding availability to small business. Without knowing how it will all play out, I’m wondering whether or not it means more expensive lending for small business and less of it,” he said in an interview with Fairfax Media.
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  • Jun 11 2018 at 9:33 AM

Dover Financial Planning shutdown puts $4 billion of client's money in limbo

An estimated $4 billion of clients' funds and 10,000 customers could now be in limbo after financial planning group Dover Financial Advisers abruptly closed down just weeks after its owner collapsed while testifying at the banking royal commission.
The Melbourne-based company is one of the country's 10 largest largest financial planning businesses with more than 400 advisers and about 260 practices across the country.
On Friday, owner Terry McMaster wrote to Dover advisers telling them they were no longer able to provide new financial advice under the company's Australian Financial Services Licence (AFSL).
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  • Jun 11 2018 at 11:11 AM

Sean Fenton: Beware the Royal Commission effect

by Sean Fenton
Revelations at the Royal Commission into Misconduct in the Banking, Superannuation and Financial Services Industry have impacted many stocks, but the focus on responsible lending across the banking sector has the potential to drive wider ranging economic impacts.
The Australian housing market has already been softening following moves by APRA to limit interest–only lending in an effort to contain runaway house prices.
The tightening in credit availability and repricing of mortgages by the banks has seen a decline in auction clearance rates and house prices in nearly all capital cities.
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What I learned … James Kirby, Alan Kohler and Richard Gluyas on the banking royal commission

  • The Deal
  • 10:00AM June 12, 2018
Don’t miss a special edition of The Deal magazine in The Australian this Friday, in which we’ll reveal Australia’s Top 50 Financial Advisers. And in a special sneak peek from this week’s magazine, The Australian’s Alan Kohler, Richard Gluyas and James Kirby comment on the fallout from the royal commission into banking and financial services and reveal what they’ve learned.
Alan Kohler
What I’ve learnt from the royal commission is that things are worse than I thought in the financial services industry. I’ve known for years that the use of financial advisers as sales people — that it’s the distribution arm of the wealth management industry — was continuing despite the efforts of the ALP through the Future of Financial Advice legislation, in which commissions were banned and advisers were required to act in the best interests of clients, and which remains despite the efforts of the Coalition to gut it. I thought at the time that more would be needed than FoFA, and that the switch to “fee for service” instead of sales commissions was a fig leaf.
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Call to warn parents over guaranteeing kids' loans

By Clancy Yeates
14 June 2018 — 9:41pm
Banks would have to bluntly warn parents planning to guarantee their children's business debts that they risk losing their home, and that many small businesses end up failing, under proposals to the royal commission.
After the commission last month delved into parental guarantees of business loans, Bank of Queensland (BoQ),  Legal Aid NSW and the Finance Sector Union (FSU) backed changes to ensure guarantors were making informed decisions when putting their home on the line.
However, the major banks are resisting further change, arguing current laws and the industry's revamped code of conduct give guarantors enough protection, with one suggesting further change could make it harder to get a loan.
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National Budget Issues.

$500,000 wind farm experts provided no advice in two years

By Nicole Hasham
11 June 2018 — 4:35pm
A $500,000 scientific committee created by the Coalition government to monitor the health effects of wind turbines held one face-to-face meeting in two years, failed to provide any official advice and had its work repeatedly rejected by research journals.
Documents also show that while the federal environment department’s budget has declined steadily under the Coalition, bureaucrats have splashed out on travel, treadmills and office refurbishments.
The Independent Scientific Committee on Wind Turbines was established in October 2015, fulfilling a commitment by the previous Abbott administration.
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Flat income tax rate will limit people 'gaming the system': research finds

By Eryk Bagshaw
12 June 2018 — 6:13pm
Eliminating the second highest tax bracket would help "wipe out bunching" and reduce endemic levels of legal tax avoidance, one of Australia's leading tax experts says, in comments that are likely to be seized on by the Turnbull government to help push their $144 billion income tax package through a resistant Parliament.
An analysis of 160 million Australian tax records between 1999 and 2014 has found six times the expected number of taxpayers hovering just below the 37 per cent tax bracket.
The phenomenon -  known as "bunching" - suggests taxpayers or their agents are deliberately structuring their affairs to avoid falling into a higher tax rate.
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Weaker jobs growth puts wage boost in doubt

By Peter Martin
14 June 2018 — 5:02pm
Jobs growth has slid dramatically, with new employment figures showing only 95,900 extra workers employed during the past six months, down from 208,000 employed in the previous six months.
It came as the Westpac Melbourne Institute index of unemployment expectations ticked up in May, undoing the improvement since December.
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Everyone pays the energy price

By David Crowe
15 June 2018 — 12:15am
Australians are learning daily of the full venality of a banking industry that has cheated customers, flouted regulators and created a market where nobody can be sure who is pocketing a hidden fee from their savings.
The testimony at the banking royal commission has shamed an entire industry and jolted politicians into planning tougher measures, with a natural focus on one sector alone.
But are financial advisers the only ones who take a cut as they pass consumers through a byzantine industry? The energy business is making all the same mistakes – and building a political timebomb for whoever takes power in Canberra at the next election.
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Josh Frydenberg issues blunt warning to energy retailers

  • The Australian
  • 9:24AM June 15, 2018

Rick Morton

Energy retailers will see “more intervention” from the federal government if they don’t sort out major issues with the market such as prices and reliability, Josh Frydenberg says.
The Energy Minister issued a blunt warning to the sector this morning after the release of a new report from the Australian Energy Market Commission which shows public trust in retailers has hit record lows.
“My message to the retailers is unless they get prices down and they pick up their act, you will see more intervention because that is what the public will demand of their political leaders,” Mr Frydenberg told ABC Radio National.
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Health Budget Issues.

Are out-of-pocket medical costs out of control?

Authored by Hugo Wilcken
DOCTORS’ fees have once again been in the news, following a recent Four Corners report that put a brutal spotlight on the huge out-of-pocket medical expenses some patients pay.
Take, for example, the case of John Dunn, a privately insured patient in need of surgery after a diagnosis of aggressive prostate cancer. John wound up with a bill of $25 000, an eye-watering $18 000 of which was out-of-pocket expenses, after Medicare and private health fund rebates. Most of this went to his GP-referred surgeon, who charged $16 000. But there were also fees for the anaesthetist (over $3000), the biopsy ($1600), the magnetic resonance imaging ($450) and sundry other expenses.
“It shocks you,” Mr Dunn told Four Corners. “You live in this world where you have Medicare, a universal health fund, and you’ve got a private health fund, you’re paying in substantial fees, and lo and behold, you’re 18 grand out of pocket when you have one operation.”
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Breast cancer the most expensive for patients, say researchers

  • The Australian
  • 12:00AM June 11, 2018

Sean Parnell

People diagnosed with breast cancer are left with the highest out-of-pocket costs of any cancers treated in Australia, according to a study highlighting the inconsistency and lack of transparency in healthcare bills.
In the latest Medical Journal of Australia, associate professor Louisa Gordon and colleagues from QIMR Berghofer Medical Research Institute in Brisbane detail out-of-pocket cancer treatment costs.
The researchers kept records on 452 patients who were diagnosed with one of five major cancers between November 2010 and November 2011. Analysing all consultations, tests, imaging, procedures and pharmaceuticals billed through Medicare, they discovered the highest median out-of-pocket costs over a two-year period was for breast cancer ($4192) followed by prostate cancer ($3175). Both have higher surgical fees, including the controversial use of robotics in prostate cancer cases. The lowest median out-of-pocket cost was for lung cancer ($1078), which also has a lower survival rate. Yet lung cancer had the highest median provider fees — $22,011, just above breast cancer with $21,581. The median proportion of fees covered by Medicare was 63 per cent — ranging from 51 per cent for prostate cancer to 89 per cent for lung cancer — however, the results may be skewed by the fact more patients were covered by insurance than the national average.
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Hospitals cover excess to tempt sick to go private

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

Sean Parnell

State-run public hospitals are spending tens of millions of dollars a year on insurance excess payments for patients to bill the much larger cost of treatment to their health fund.
The likely scale of the excess payments, revealed only after a Right to Information search in Queensland, emerges amid a ­debate over private patients in public hospitals and the challenge of rising health costs.
In recent years, public hospitals have ramped up their private billing, which insurers complain is a $1.1 billion cost-shift that pushes up insurance premiums and threatens the balance in the health system. While public hospitals are obliged to provide treatment to Australian citizens without charge, and cannot compel health fund members to use their insurance, they make private billing more attractive by paying the excess so there are no out-of-pocket costs for the patient.
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Push to get health services out of hospitals, into the home

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

Sean Parnell

A quiet revolution is under way in the health system, with government and insurance funders looking to shift more services — such as chemotherapy, dialysis, rehabilitation, mental health and palliative care — out of high-cost hospitals and into the community or home.
The debate over rising health costs, especially in the private sector, has brought a renewed emphasis on new models of service delivery and major reforms are now likely. This may prove controversial, however, with some providers financially dependent on maintaining the status quo, and concerns that cost-cutting may compromise the quality of care.
In the public-hospital sector, the Independent Hospital Pricing Authority on Tuesday flagged more work on funding different models, following the success of a Victorian chronic disease program aimed at reducing avoidable hospital visits.
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‘Stuffed mental health set-up needs review’

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

Rick Morton

The country’s “mental health archi­tecture is stuffed” and should be reviewed by the Productivity Commission after years of ­rewarding activity instead of outcomes, a mental health commissioner says.
Ian Hickie, a member of the federal government’s National Mental Health Commission, told a conference in Canberra yesterday that successive governments had “increased access of care ­rather than quality of care”, which had ultimately led to ­poorer outcomes.
“I’m one of these people that says the Uberisation of mental health is going to happen because I actually don’t think we can fix the system we have,” Professor Hickie said.
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Rising prices for medical specialists

  • The Australian
  • 12:00AM June 15, 2018

Sean Parnell

Out-of-pocket costs for specialist services are growing at a rate of 5.5 per cent each year, according to analysts who are unable to predict whether the surge in medical graduates, or proposed transparency measures, will provide patients with any relief.
An ANZ Melbourne Institute report found significant variation in bulk-billing rates and out-of-pocket expenses by, and within, specialties.
Similar ­variation was evident in specialist earnings, with ortho­pedic surgery the highest and 2.4 times that of the lowest, endocrinology.
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Push on for supplies of local plasma to supplement imports

  • The Australian
  • 1:00AM June 16, 2018

Sean Parnell

Blood plasma from US and European donors — many of whom are paid for their contributions — has become increasingly vital to the health system, despite Australia’s long-held policy of self-sufficiency through voluntary donations.
National Blood Authority figures suggest more than half of Australia’s immunoglobulin stocks soon will come from overseas, with clinical ­demand constantly exceeding local donor supply. In 2016-17, 44 per cent of immunoglobulin was purchased from overseas companies, with that expected to become a maj­ority this year.
Immunoglobulin is used in different forms to treat conditions where immune replacement or immune modulation therapy is required, and also in cases of severe blood loss. Sourcing and supplying such plasma products takes up half of the NBA’s $1 billion-plus government-funded budget, with costs rising from $205.2 million to $504.6m across the past 14 years.
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International Issues.

  • Jun 10 2018 at 11:30 AM

Donald Trump throws G7 into disarray with tweets attacking Justin Trudeau

Lashing out at the longtime US ally and northern neighbour, President Donald Trump tweeted that Canadian Prime Minister Justin Trudeau is "dishonest & weak" and that the US was pulling back its endorsement of the G7 summit's communique in part because of what he called Trudeau's "false statements" at a news conference.
In an extraordinary set of tweets aboard Air Force One, on its way to Singapore for Tuesday's summit with North Korea's Kim Jong Un, Trump threw the G7 summit into disarray Saturday and threatened to escalate his trade war just as Canada released the G7's official communique.
Its statement took a generally positive view of the leaders' positions on trade matters while acknowledging tensions with the US.
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  • Jun 11 2018 at 8:35 AM

Donald Trump scolds US friends, embraces foes in show of strength to Kim Jong-un

For friends and foes of the United States, Donald Trump is rewriting history before our eyes.
Astonishingly, the disruptive US president on the weekend condemned Canada's Prime Minister Justin Trudeau as "very dishonest and weak", en route to a historic summit with North Korea's tyrannical leader.
After pouring scorn on America's democratic neighbour and defying other Western allies, Trump will try to make nice with oppressive dictator Kim Jong-un to try to convince North Korea to forfeit its nuclear weapons.
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  • Jun 11 2018 at 7:02 AM

Germany's Angela Merkel says Donald Trump's G7 tweets were 'depressing'

by Michael Nienaber
​Europe will implement countermeasures against US tariffs on steel and aluminium just like Canada, German Chancellor Angela Merkel said on Sunday, voicing regret about President Donald Trump's abrupt decision to withdraw support for a G7 communique.
Trump's announcement on Twitter, after leaving the Group of Seven summit in Canada early, that he was backing out of the joint communiqué torpedoed what appeared to be a fragile consensus on a trade dispute between Washington and its top allies.
"The withdrawal, so to speak, via tweet is of course ... sobering and a bit depressing," Merkel said in an ARD television interview following the G7 summit.
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Trump baffles as he divides - but Russia inclination offers a clue

By Nick O’Malley
10 June 2018 — 3:53pm
Donald Trump went into the G7 meeting in Canada declaring that Russia should be readmitted to the group despite its annexation of the Crimean Peninsula and left it tweeting insults at his host, Canadian Prime Minister Justin Trudeau.
Sometime between taking off from Canada and landing in Crete to refuel, Trump made the decision not to sign the G7’s joint communique.
The US President threw the G7’s efforts to show a united front into disarray after he became angry with Canadian Prime Minister Justin Trudeau.
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  • Updated Jun 11 2018 at 8:03 AM

How Donald Trump plays loose with the truth on trade - putting him in the wrong

by Hope Yen and Josh Boak
He is using some goosey numbers to rationalise his aggressive rhetoric on trade, disregarding strong points in US competitiveness to paint a dark portrait of a world taking advantage of his country.
Conversely, he's glossing over aspects of the economy that don't support his faulty contention that it's the best it's ever been. The complexities of health care for veterans are also set aside as he hails a new era in the Department of Veterans Affairs' system.
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China’s Master Plan: A Global Military Threat

From the East China Sea to Africa, Beijing is flexing its muscles. 
by Hal Brands
June 11, 2018, 12:00 AM GMT+10
 (This is the first in a series of columns on China's effort to supplant the U.S. as the world's pre-eminent geopolitical power.)

I wrote a
column recently about how a longstanding assumption of America’s China policy -- that economic integration between the two countries is an unalloyed good -- has now been overtaken by events. But this isn’t the only area in which China’s rise is forcing a re-evaluation of old beliefs.
Now, as the first in a series of columns on this phenomenon that Bloomberg Opinion will publish in the coming days, I'll delve into another issue with enormous implications for U.S.-China relations and American interests: the rise of China as a more globally oriented military power.
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  • Updated Jun 11 2018 at 11:00 PM

A special place in hell for those who start trade wars

The world is now seeing the full extent of Donald Trump's crazy brave foreign policy: first he abuses his allies at a G7 meeting in Quebec, preposterously suggesting that Russia be readmitted into a forum designed for economic superpowers, before welching on a deal he had agreed to sign. Then he jets off to Singapore for a landmark summit with North Korean dictator Kim Jong-un, where he claims that he will know "within the first minute" if Mr Kim is serious about denuclearising the hermit kingdom.
In Quebec, the Americans had reluctantly agreed to sign a joint statement including the words that "we strive to reduce tariff barriers, non-tariff barriers and subsidies". That agreement came even after Mr Trump slammed minor tariffs on US good as "ridiculous and unacceptable" and promised to end a situation where the US is "like a piggy bank that everybody is robbing" while defending aluminium and steel tariffs he himself has imposed. As the photo in today's world section shows, the other G7 leaders, such as Emmanuel Macron, Angela Merkel and Shinzo Abe, encouragingly stood up against Mr Trump's protectionist instincts, and sought to change his mind.
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  • Updated Jun 11 2018 at 7:00 PM

Costs of Australia's relationship with China are adding up

Even if it's not yet publicly spelled out, there's a growing difference of opinion between Australia's political and business leadership over China.
Australian business leaders are alarmed about the potential impact on Chinese trade and investment due to the ratcheting up of public tension between China and Australia. Australian political leaders are more worried about the potential impact on national security unless they are willing to risk Chinese ire, including some form of economic retaliation.
These contrasting viewpoints are only becoming more obvious as the Australian government presses ahead with legislation aimed at espionage and foreign interference. Naturally, the government insists its bills are not targeting China but all foreign governments attempting to influence Australian democratic processes.
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Pimco predicts recession in the US

  • The Australian
  • 12:00AM June 12, 2018

Adam Creighton

The head of fixed income at ­global bond giant Pimco, ­Andrew Balls, foresees “rude awakenings” over the next few years, including a recession in the US as populist challenges thwart prospects for trade.
Mr Balls said increased “populist risks”, from Italy to Turkey and Argentina, would occur in an environment where central banks, keen to withdraw their stimulus, have less scope to suppress any increase in financial volatility.
“Through most of my life free trade was something of a cornerstone. Clearly that is under threat, and you have political and populist challenges,” Mr Balls told The Australian.
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  • Updated Jun 12 2018 at 11:00 PM

Donald Trump and Kim Jong-Un: From war threats to best friends in just 14 months

'The world will see a major change': Kim
As Donald Trump and Kim Jong-un signed their "historic" agreement – standing side-by-side against a backdrop of North Korean and American flags – the US President said the summit went "better than anybody could have expected".
While the meeting was certainly unexpected and historic, it will take a long time to determine how well it actually went.
The agreement is a starting point but will depend on follow-through from two unpredictable and self-serving world leaders.
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Three reasons why the Singapore summit had to happen

By Sam Roggeveen
12 June 2018 — 11:35pm
President Trump has a special talent for keeping his political opponents in a near-constant state of frenzy. The fact that he even agreed to yesterday’s summit in Singapore was read by his critics as a terrible affront to America’s Asian allies. Donald Trump’s weekend Twitter outburst against another ally, Canadian Prime Minister Justin Trudeau, was the latest outrage, dutifully blown out of all proportion by the media and on social media.
But the critics who say Trump is destroying America’s alliances give him too much credit. And by focusing on the President, they imply that these alliances can return to "normal" when he leaves office. Yes, Trump is doing a lot of unnecessary damage, but the fraying of America’s alliance network pre-dates Trump, and will survive him.
Something like yesterday's Singapore summit had to happen. There are three reasons why.
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Robert Mueller warns of active Russian meddling, seeks disclosure lid

13 June 2018 — 6:16am
Washington: US Special Counsel Robert Mueller warned that Russian intelligence services have active "interference operations" in the US and asked a judge to limit the pretrial evidence provided to a Russian firm indicted over meddling in the 2016 election.
Mueller asked a federal judge in Washington for an order that would protect the handover of voluminous evidence to lawyers for Concord Management and Consulting LLC, one of three companies and 13 Russian nationals charged in a February indictment. They are accused of producing propaganda, posing as US activists and posting political content on social media as so-called trolls to encourage strife in the US.
The threat of public or unauthorised disclosure of evidence would help foreign intelligence services, particularly in Russia, in "future operations against the United States," Mueller's prosecutors wrote in a filing on Tuesday.
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Trump blasts media as America's 'biggest enemy' for North Korea coverage

By John Wagner
13 June 2018 — 9:15pm
Washington: President Donald Trump posted a series of tweets about his meeting with North Korean leader Kim Jong-Un as he arrived back in Washington, blasting the media as "our country's biggest enemy" for its coverage of the historic summit and claiming there is no longer a nuclear threat.
He said that North Korea is no longer the United States' most dangerous problem, as President Barack Obama had characterised it upon leaving office.
President Donald Trump made a sweeping pronouncement upon returning to Washington, saying there is no nuclear threat from North Korea.
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I'll rejoice in Trump's triumph when Kim opens his gulags to scrutiny

By Michael Kirby
13 June 2018 — 4:07pm
Back in 1949, at my local public school in Sydney, my teacher gave everyone in the class a copy of the Universal Declaration of Human Rights.
It had been adopted in the previous December by the General Assembly of the United Nations, with an Australian, Dr HV Evatt, as president of the Assembly. But the chair of the committee that  drafted the declaration was an American, Eleanor Roosevelt, widow of FDR.
She was an internationalist. A humanitarian. A great lady. Our teacher told my class that, unless the world could uphold the declaration, we would go on killing each other. Especially now, with the advent of the atomic bombs that had been used on Hiroshima and Nagasaki just a few years earlier.
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Why Wall Street isn't freaking out about Trump

By Barry Ritholtz
14 June 2018 — 7:14am
Ominous headlines have dominated the news since Donald Trump was elected president. A parade of unprecedented events, ranging from trade wars to mind-bending changes in the western alliances, have many on edge.
But not investors.
If there is a single question that I have heard more than any other during the past few months, it is: "How are markets so blasé about the endless threats to financial stability and order from the president?"
Many theories are tossed around. Some resonate more than others. What follows is a short summary of why markets haven't freaked out over the ongoing spectacle of what used to be called market-moving news, but today merely is the state of the world.
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  • Updated Jun 14 2018 at 6:00 PM

Gerrymandering stacks US mid-term elections against Democrats

by Michael Tomasky
A decade ago, when the Republican Party was paying the price for the various cataclysms brought on by the George W. Bush presidency – the shockingly inadequate response to Hurricane Katrina, the ill effects of the Iraq War, the great economic meltdown – the Democratic Party reached its post-Great Society zenith. It nominated and elected the country's first African-American president – and he won decisively, against an admired war hero. It sent 60 senators to Washington, which it hadn't done in 40 years.
It also sent 257 representatives to the House, its highest number since before the Gingrich Revolution of 1994. Its governors sat in 28 executive mansions, including in such improbable states as Tennessee, Kansas, Oklahoma and Wyoming.
Then came the rise of the Tea Party and the calamitous 2010 elections. The Republicans' net gain of 63 seats in the House of Representatives, giving them control over that chamber after a four-year hiatus, swallowed most of the headlines (the party also had a net gain of six Senate seats). The Democrats, as President Barack Obama put it, took a "shellacking".
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'Let's not underestimate the impact': IMF sends warning on Trump's tariffs

By Lindsay Dunsmuir
15 June 2018 — 5:24am
The International Monetary Fund warned on Thursday that US President Donald Trump's new import tariffs threaten to undermine the global trading system, prompt retaliation by other countries and damage the US economy.
"Let us not understate the macroeconomic impact," IMF Director Christine Lagarde said, saying the tariffs will have a larger economic toll if they prompt retaliation from trading partners like Canada and Germany.
The IMF, in a review of US economic policy, also took a much less optimistic view on America's economic growth potential than that of the Trump administration.
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  • Jun 15 2018 at 11:06 AM

Donald Trump's America: The rogue superpower

by Robert Kagan
Since the end of the Cold War, it has widely been assumed that US foreign policy would follow one of two courses: Either the United States would continue as primary defender of the international order it created after World War II, or it would pull back from overseas commitments, shed global responsibilities, turn inward and begin transitioning to a post-American world. The second approach was where US foreign policy seemed headed under President Barack Obama, and most saw the election of Donald Trump as another step toward withdrawal.
It turns out there was a third option: the United States as rogue superpower, neither isolationist nor internationalist, neither withdrawing nor in decline, but active, powerful and entirely out for itself. In recent months, on trade, Iran, NATO defence spending and perhaps even North Korea, Trump has shown that a president willing to throw off the moral, ideological and strategic constraints that limited US action in the past can bend this intractable world to his will, at least for a while.
Trump is not merely neglecting the liberal world order; he is milking it for narrow gain, rapidly destroying the trust and sense of common purpose that have held it together and prevented international chaos for seven decades. The successes he is scoring – if they are successes – derive from his willingness to do what past presidents have refused to do: exploit the great disparities of power built into the postwar order, at the expense of the United States' allies and partners.
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Pulling down the house

By Nicholas Stuart
16 June 2018 — 12:00am
For the past seventy years, slowly and carefully, the nations of the world have been putting together a robust framework of international relations. The key concept has always been emphasising stability and avoiding risk. Now, within a week, Donald Trump's done his best to demolish that entire structure.
Even before the meeting ended Trump was giving media interviews to proclaim it a “remarkable success”.
The US President had a simple – some would say simplistic – narrative. According to this he went to Singapore, sat down with Kim Jong Un, and obtained an agreement to denuclearise the Korean peninsula, something no other person had been able to achieve since the end of the war.
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A trade war looms as Trump slaps tariffs on 1102 Chinese imports

By Christopher Rugaber
16 June 2018 — 5:09am
Washington: President Donald Trump has brought the world's two biggest economies to the brink of a trade war by announcing a 25 per cent tariff on up to $US50 billion in Chinese imports to take effect July 6.
Beijing quickly responded that it would retaliate with penalties of the same scale on American goods.
The latest round of trade talks between the US and China ended with China warning that all progress between the two economic superpowers could be lost if the US pushes ahead with trade sanctions, including tariffs.
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Curious link between world peace and gender equality

By Matt Wade
17 June 2018 — 12:00am
Whatever comes of Donald Trump and Kim Jong Un’s curious get-together in Singapore it brought a welcome focus: peace.
If the optimists are right the meeting has paved the way for "major disarmament" on the Korean peninsula over the next few years.
But, even if that happens, how much more peaceful would the world really be?
Sadly, not that much.
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I look forward to comments on all this!
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David.