Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Friday, March 07, 2025

It Is Interesting To See How Divorce Is Evolving In Australia!

This interesting article appeared last week:

Divorce in Australia: What’s the ‘peak age’? And why are more long marriages ending?

Divorce in Australia is changing. Why are couples taking longer to call it quits?

Stephen Lunn

28 February, 2028

If you think sailing through the seven-year itch and beyond means you’ll be cosying up with your beloved til death do you part, think again.

The fact is Australian men and women are divorcing later and later in life, and 20-plus-year marriages make up a growing proportion of the nation’s divorces.

But don’t believe that old chestnut that half of all marriages end in divorce. It’s more likely around three in 10.

Overall, Australia’s divorce rate has been on a steady decline over the 50 years since no-fault divorce was introduced in the 1970s, but a deeper dive into the data offers a fascinating glimpse of how and why Australians are getting together and moving apart.

Divorces dive

Why has Australia’s divorce rate hit an all-time low?

According to the latest available Australian Bureau of Statistics data, it reached its lowest point in 2023, at 2.3 divorces per 1000 residents aged 16 and over. That’s almost half what it was in 1980.

It’s less a sign of growing domestic bliss than a reflection of society’s changing attitudes to marriage, says Australian Institute of Family Studies senior researcher Lixia Qu.

An increasing proportion of divorces in Australia involve marriages of 20 years or more, new research reveals.

“These days most couples live together before getting married – if they marry at all – which was unusual 50 years ago,” says Dr Qu, author of a new report Divorces in Australia, Facts and Figures 2024.

“Being able to ‘try before you buy’ was less of an option for young couples in the 1970s and earlier, due to stigma and societal expectations.”

Dr Qu says despite the declining number of divorces, relationships aren’t necessarily longer these days.

“In 2023, 83 per cent of couples had been living together before marriage, compared to just 16 per cent in 1975. Many couples separate without entering into marriage, which is not captured in the divorce statistics,” she says.

What is ‘peak’ divorce age?

The median age at divorce hasn’t been older since this data started to be collected in the 1970s. For men it is now 47.1 years and for women 44.1 years as at 2023, compared to 35.3 years for men and 32.7 years for women in 1980.

This is a different question from the most likely age to be divorced, which tends to coalesce around younger married people.

For married men it is between 25 and 29 and for married women it is highest at 24 and under, closely followed by the years from 25 to 29.

Younger people who have married at this age may have jumped in when their friends in relationships wait, or choose to live together.

Married or not, those in their 20s, especially their early and mid-20s, are still developing and maturing in various aspects of their life, including their communication with each other. There is also potentially financial pressure given they are still establishing themselves in their careers.

And at this age, uncoupling may be less emotionally complex given many will be able to do so without the complication of children.

All that said, the pattern of divorce across a couple of generations shows that those divorce rates among younger people, especially women, are dropping, while the rate among older people is increasing later in life.

The rise in divorce among 20+ year marriages

In 1980, marriages of less than five years’ duration made up more than 20 per cent of all divorces, but by 2023 that proportion had fallen to 11.7 per cent.

By contrast, 19.8 per cent of all divorces in 1980 involved marriages of 20 years or more, whereas in 2023 it was almost 30 per cent.

Overall, the median duration of a marriage that ends in divorce in Australia is between 12 and 13 years, an increase from 10 years in 1990.

“Compared to 40 or 50 years ago, more women have a degree of financial independence, and they also are more likely to be working, so this gives them more options in terms of staying in a marriage or not,” Dr Qu says.

“Women continue to be worse off than men after separation, with many having stepped back to part-time or no work during their children’s early lives, but often now there is at least some financial foundation to separate.

“Another reason is our longer life expectancy. People, even in long marriages, may feel there should be more to life. They may be looking ahead and thinking I don’t want to be unhappy for decades.

“More people in their 50s and 60s are still working full-time, still looking forward to much more life than perhaps the same people at that age half a century ago,” Dr Qu says.

So is there any sense that the HSC (or VCE) divorce is a real social trend?

Couples with children have an extra layer of complication when their marriage breaks down. About 47 per cent of divorces involve children under the age of 18.

Anecdotes abound of couples saying they’ll stick it out until their youngest finishes high school before separating. Whether this is a good thing for either the couple themselves, or the children, is open to question.

“I don’t have definitive data on the reason more people are leaving marriage after 20-something years, but people do worry about the impact of separation on their children, so along with those other factors around more financial independence for women and a sense that it is not too late to chase happiness, this theory does ring true.”

The AIFS report shows the proportion of divorces involving children under 18 has fallen from over 60 per cent in 1980 to about 47 per cent in 2023.

Are we out of love with marriage?

Apart from the post-Covid catch up of marriages, the marriage rate has continued a long-term decline as couples are increasingly willing to live together without a formal piece of paper.

This is particularly true of people who have been previously married. In 2023, 74 per cent of marriages were the first marriage of both partners, a percentage that has climbed since the early 2000s.

And forget what you’ve heard about a trend back to kids getting married younger these days. The data doesn’t lie, showing a steady increase in the age at which they enter their first marriage.

From 21 for women and 23 for men in the mid-1970s it now sits at 30.1 years for women and 31.4 years for men.

One of the main reasons is that sex before marriage is not as big a deal. Males and females still living in their parents homes are more likely to be able to sleep with each other without it being an issue.

And many more younger couples live together without being married. In fact, the 2021 Census data shows that people aged 25-29 were more likely to be living with a partner and not married than being married. For those living out of their parents’ home it was a pattern even more evident for those in their early 20s.

The delay in marriage may also be put down to men and women spending much more time in post-school education. More people in higher education for longer delays the start of paid jobs that is a critical part of the life course, often coming before marriage.

The high cost of housing also means young men and women are living with their parents longer, which again delays the start of those life-course decisions. This is not just behind the later median age of marriage, but also why the nation’s birthrate is at an all-time low.

The gender gap in median age at first marriage has narrowed in the past few decades from 2.3 years in 1980 to 1.3 years now.

And confirming Dr Qu’s “try before you buy” thesis, by 2023, 83 per cent of couples have lived together before getting married compared to just 23 per cent in 1979.

Here is the link:

https://www.theaustralian.com.au/health/relationships/divorce-in-australia-whats-the-peak-age-and-why-are-more-long-marriages-ending/news-story/e2fa610dcf410683c362edf8acdc95ea

I found this a fascinating collection of statistics and well worth a browse!

David.

 

Thursday, March 06, 2025

I Suspect We May Not Yet Realise Just How Alone Australia Is On The World Stage!

This appeared last week:

Zelensky, Trump clash in bitter Oval Office talks

Steve Holland, Nandita Bose and Jeff Mason

Updated Mar 1, 2025 – 11.22am, first published at 4.45am

Washington | Volodymyr Zelensky and Donald Trump clashed publicly at the White House, during which the Ukrainian leader was berated for being both disrespectful and not thankful enough to Trump and the US in general.

Plans to hold a signing ceremony between the two leaders on a resources’ agreement, demanded by Trump, were cancelled. A joint press conference also was cancelled. Zelensky was soon afterwards escorted to his vehicle by a protocol official.

The visit by Zelensky had been designed to help Ukraine convince the US not to side with Russian President Vladimir Putin, who ordered the invasion of Ukraine three years ago.

The meeting quickly devolved into a shouting match between Trump, vice president J.D. Vance and Zelensky. For his part, Trump insisted Zelensky was losing the war and said, “people are dying, you’re running low on soldiers”.

Trump then threatened to withdraw US support. “You’re either going to make a deal, or we’re out, and if we’re out, you’ll fight it out. I don’t think it’s going to be pretty,” Trump said.

“You don’t have the cards. Once we sign that deal, you’re in a much better position. But you’re not acting at all thankful, and that’s not a nice thing. I’ll be honest. That’s not a nice thing.”

Zelensky pushed back, openly challenging Trump over his softer approach toward Putin, urging him to “make no compromises with a killer”.

Trump stressed that Putin wants to make a deal. “You are gambling with World War Three,” Trump told Zelensky at one point, urging him to be more thankful.

Zelensky also pushed back on Trump’s claims that Ukrainian cities have been reduced to rubble by three years of war.

Former Russian president Dmitry Medvedev appeared to revel in the spectacle, writing on Telegram that Trump had delivered the “truth” to Zelensky and saying the Ukrainian leader had received a “brutal dressing down”. He called for military aid to Ukraine to be halted, something Moscow has long been pushing for.

Russian Foreign Ministry spokeswoman Maria Zakharova said it was a miracle that Trump and Vance had restrained themselves from hitting Zelensky.

Russia has long portrayed Zelensky as an unstable and self-obsessed US puppet who was used by the previous Biden administration to try to inflict a strategic defeat on Moscow by “fighting to the last Ukrainian”. Zelensky has rejected that characterisation.

Trump calls for ‘immediate’ ceasefire

Hours after the meeting with Zelensky, Trump said he wanted an “immediate” ceasefire between Russia and Ukraine, and warned Zelensky to make peace or lose American support.

“That was not a man that wanted to make peace,” Trump said to reporters before flying to Florida. He added, “I want a ceasefire now”.

Trump said he believed that Putin was ready for a peace deal.

Zelensky made an appearance on Fox News on Friday evening, in which he said his public spat with Trump and Vance was “not good for both sides”. But Zelensky said Trump needs to understand that Ukraine can’t change its attitudes toward Russia on a dime.

Zelensky added that Ukraine won’t enter peace talks with Russia until it has security guarantees against another offensive.

“It’s so sensitive for our people,” Zelensky said. “And they just want to hear that America (is) on our side, that America will stay with us. Not with Russia, with us. That’s it.”

‘You didn’t say thank you’

The White House clash undermined efforts by European leaders – from France and the UK this week – to convince Trump to provide security guarantees for Ukraine even if he has refused to deploy US soldiers on Ukrainian soil to maintain peace.

During the confrontation between Trump and Zelensky, Vance interjected that it was disrespectful of Zelensky to come to the Oval Office to litigate his position, a point Trump agreed with.

“You didn’t say thank you,” Vance said. Zelensky, raising his voice, responded: “I said a lot of times thank you to American people.”

Shortly after Zelensky left the White House, Trump posted on his social media site Truth Social that Zelensky “is not ready for peace”.

“I have determined that President Zelensky is not ready for Peace if America is involved, because he feels our involvement gives him a big advantage in negotiations. I don’t want advantage, I want PEACE. He disrespected the United States of America in its cherished Oval Office. He can come back when he is ready for Peace.”

Trump last week called Zelensky a “dictator”.

Zelensky repeatedly defended his nation, and its determination for a “lasting peace”, which he did again in a post on X following the White House meeting.

European leaders – including those from Germany, Poland, Spain, Norway, Sweden, the Czech Republic, Latvia, Lithuania and Moldova – rallied behind Zelensky in posts on X.

Moldova President Maia Sandu said: “The truth is simple. Russia invaded Ukraine. Russia is the aggressor. Ukraine defends its freedom—and ours. We stand with Ukraine.”

‘Better war, than shameful peace’

Ursula von der Leyen, president of the European Commission, posted: “Your dignity honours the bravery of the Ukrainian people. Be strong, be brave, be fearless. You are never alone, dear President @ZelenskyyUa. We will continue working with you for a just and lasting peace.”

French President Emmanuel Macron spoke by phone with Zelensky after he left the White House, the Élysée palace said. “We must ... respect those who have been fighting since the beginning,” Macron earlier told reporters in Portugal.

Just the word “wow” is how Oleksandr, 40, a Ukrainian military officer fighting in Russia’s Kursk region, responded to the footage of the argument.

“We still have a lot of work to be done,” he wrote. “Better war, than shameful peace.”

Earlier, Trump welcomed Zelensky on his arrival at the White House before they headed for talks, lunch and then a joint press conference where they were to sign the agreement.

“I hope I’m going to be remembered as a peacemaker,” Trump said.

Trump told Zelensky that his soldiers have been unbelievably brave and that the United States wants to see an end to the fighting and the money put to “different kinds of use like rebuilding”.

Trump has adopted a much less committed stance toward European security, a change in tone that has sent shockwaves across Europe and stoked fears in Kyiv and among its allies that it could be forced into a peace deal that favours Russia.

With files from AP, Washington Post

Reuters

Here is the link:

https://www.afr.com/world/europe/zelensky-trump-clash-in-bitter-oval-office-talks-20250301-p5lg31

With what has happened in the last week of so it is hard not to conclude that Donald Trump is not someone you would willingly trust to be in your corner and to me that means Australia needs to re-calibrate how we are going to proceed in the world!

We need to re-asses all our alliances and linkages and challenge all our old assumptions based on the “American Alliance” which is now defunct to a large degree. I would not trust Trump or Vance as far as I could throw them and I reckon Australia should plan accordingly – seeking to bolster alliances that we might be able to trust. The UK, Europe and India, as well as the friendly states closer, need a lot more work as do efforts to improve economic links with Asia and China. We ae more on our own than ever and we need to plan for this.

Anyone got other clever thoughts?  Scandinavia has some smart nations we should become more way friendly with I reckon! Ukraine also should be fostered!

We are on our own, the US cannot be relied upon, and we need to forge our own path I believe…

What do you think?

David.

Wednesday, March 05, 2025

Labor Is Going Pretty Hard On The Urgent Care Clinics. Too Soon To Tell How Useful They Are!

Labor seems to be convinced they are a “good thing”!

Here is the latest announcement…..

Labor vows $644m for additional 50 urgent care clinics if re-elected

By Paul Sakkal

March 1, 2025 — 10.30pm

Dozens more urgent care clinics will be built by the Albanese government if it is re-elected at the coming election, in a $644 million expansion of a scheme Labor regards as a big vote-winner.

Prime Minister Anthony Albanese is expected to call an election soon – with April 12 firming as a probable date – and on Sunday will add another plank to his health-focused agenda, taking Labor’s Medicare pledges over recent weeks to almost $10 billion.

Spending on the suburban and regional clinics, which Labor marginal seat MPs say have been politically popular as alternatives to hospitals, is also designed to sharpen Labor’s contrast with Peter Dutton, whom it is desperate to frame as a risk to public health funding ahead of what looms as a tight election.

Albanese said the 50 extra clinics would build on the 87 already opened this term, and that the new facilities would be constructed in 2025-26.

“Four in five Australians will live within a 20-minute drive of a bulk-billed Medicare urgent care clinic once all Labor’s clinics are open,” Albanese said in a written statement.

Health Minister Mark Butler said: “You can’t trust [the Coalition] to keep them open”, setting up another test for Dutton after the opposition immediately backed Labor’s $8.5 billion free GP pledge last Sunday despite the budget being in structural deficit.

The adoption of such a big spending item displayed the political sensitivity of healthcare and the opposition’s eagerness to neutralise Labor’s attack, which carries echoes of the 2016 “Mediscare” campaign waged against Malcolm Turnbull. The line has particular potential to cut through because Peter Dutton was health minister when the Abbott government tried to create a GP co-payment.

Two senior opposition sources, not permitted to talk openly about shadow cabinet, said Dutton was preparing an expensive health policy of his own, making it easier to support Labor’s spending as the opposition struggles to find savings to bolster its budget bottom line. The $644 million clinic pitch was funded in December’s mid-year budget update, the government confirmed.

It is unclear, however, if the opposition will support the urgent care investment. The information contained in this story was provided by the government on an embargoed basis that prohibits questions being asked of non-government parties.

While the precise locations are yet to be finalised, 14 clinics would be opened in NSW at Bathurst, Bega, Burwood, Chatswood, Dee Why, Green Valley and surrounds, Maitland, Marrickville, Nowra, Rouse Hill, Shellharbour, Terrigal, Tweed Valley and Windsor.

Twelve would be built in Victoria at Bayside, Clifton Hill, Coburg, Diamond Creek and surrounds, Lilydale, Pakenham, Somerville, Stonnington, Sunshine, Torquay, Warrnambool and Warragul.

And in Queensland there would be new sites at Brisbane, Buderim, Burpengary, Cairns, Caloundra, Capalaba, Carindale, Gladstone, Greenslopes and surrounds, and Mackay.

Health and aged care is rated as the top issue for 7 per cent of voters, according to the latest Resolve Political Monitor, well behind the cost of living (53 per cent), but ahead of topics such as immigration (4 per cent) and similar to crime (9 per cent).

This masthead reported on January 1 that Labor would put bulk-billing and urgent care clinics at the centre of its campaign pitch.

Labor had a six-point lead on the Coalition on health policy in the Resolve poll in April last year, but this has turned into a three-point deficit as ratings of Labor’s performance in all areas have trended downward along with its level of core political support amid an inflation crisis.

Here is the link:

https://www.smh.com.au/politics/federal/labor-vows-644m-for-additional-50-urgent-care-clinics-if-re-elected-20250301-p5lg4p.html

It is interesting that Labor is increasingly not seen as totally credible with health service delivery as indicated in the article above – but it is hard to draw much from these findings. I am sure things will firm up when the election is called.

Recent commentary is not all that keen on the UCCs.

07 February 2025

Urgent Care Clinics aren’t showing their worth

By

Laura Woodrow

Medicare Urgent Care Clinics and the triple bulk billing incentives were central to the government’s campaign to support the health system. But are they working?

Potentially avoidable GP-type presentations to ED aren’t going down, but bulk billing rates are, according to this year’s Report on Government Services.

The federal government began rolling out Medicare Urgent Care Clinics from July 2023 , alongside a promise that they would ease the pressure on emergency departments.

But according to the 2025 Report on Government Services, released last night, GP-type presentations to EDs remained largely stagnant at 2.8 million between 2022-23 and 2023-24.

Potentially avoidable GP-type presentation to EDs had remained fairly consistent since 2014-15 but did rise to 3 million and 3.1 million during covid in 2021-22 and 2020-21 respectively.

Speaking to The Medical Republic, RACGP president Dr Michael Wright said that the data showed the MUCCs weren’t yet showing their worth.

“Importantly, [the data] show that the preventable hospitalisations have been pretty stable for the last decade, despite talk that there is increasing pressure on hospitals, these data don’t tend to reflect that,” he said.

“It also shows that the UCCs to date haven’t had an impact either.”

AMA president Dr Danielle McMullen agreed.

“It shows that UCCs haven’t necessarily reduced the demand on hospitals, and also that it’s really important that we don’t blame patients for where to go,” she told TMR

“Patients don’t always know what’s an emergency and what’s not.

“What we should be working together on is how to support patients to access the right care at the right time, and we know that investing in general practice to provide more urgent appointments and acute care within mainstream general practice helps maintain that continuity of care.

“We think would be a better investment than more urgent care centers.”

In late 2023, the government also introduced the triple bulk billing incentive.

This measure was explicitly targeted toward concession card holders and children, but there was hope that the extra funding would allow GPs to lower private fees across the board.

This has not borne out.

The national total expenditure per person on general practice did increase in real terms, from $440 in 2022-23 to $452 per person in 2023-24, taking inflation into account.

This increase did not align with an overall drop in costs to patients or an overall increase in bulk billing.

Dr Wright said the small increase in per person funding “was better than a decrease” but it followed a considerable drop over recent years, with 2022-23 seeing the lowest per-person expenditure for a decade.

“There is a small increase here, and that reflects the impact of the tripling of the bulk billing incentives which did help some GPs to continue to bulk bill more concession card holders and pensioners, but we need more than those incentives to support access to care to all Australians,” he said.

“We definitely need to do a lot more to reinvest in Medicare and provide greater support for general practice.

“All Australians deserve affordable access to general practice.”

Despite the triple bulk billing injection, bulk billing has continued to decline overall.

In 2023-24, 47.7% of patients were fully bulk billed, a decrease from 51.7% in 2022-23.

“It just shows that we need to focus not only on supporting bulk billing, but we also need to decrease out of pocket costs for patients who aren’t being bulk billed. That requires a more comprehensive investment in Medicare rebates,” said Dr Wright.

Over 2023-24, the average out-of-pocket costs for a patient to see a GP sat at $45, preceded allied health, $68, and specialists, $117.

High costs caused 8.8% of respondents who needed to see a GP to delay or forgo appointments, the highest proportion since 2014-15.

This continued a year-on-year increase since 2020-21, when the proportion was 2.4%.

Around 8% of respondents delayed filling or did not fill a prescription due to costs, which was also the highest proportion recorded since 2014-15, continuing a year-by-year increase from 4.4% in 2020-21.

In total over the last financial year, 77.3% of non-referred GP services were bulk billed, and 28.7% of specialist services.

In terms of the workforce, the number of GPs per 100,000 people dropped by almost 5% between 2022 and 2023.

It now sits at 109.7, leaving 39,449 GPs in total across the nation, 29,215 of whom are on a full-time equivalent basis.

“Nationally in 2023, the number of FTE GPs per 100,000 people decreased as remoteness increased (111.8 GPs per 100,000 people in major cities compared to 87.3 GPs per 100,000 people in outer regional, remote and very remote areas),” read the report.

Dr Wright said this showed the need for more GPs in communities and across Australia.

“It’s a concern that the GP numbers are dropping, when we’ve never needed [GPs] more… with our aging population, a growing population, more people living with chronic health conditions,” he said.

“We really need to increase access to GP services, which involves training more GPs, and we need to make care more affordable for patients, and that involves increasing the medical Medicare rebates.”

In terms of workforce sustainability, in 2023 26.6% of full time GPs were aged 60 years or older, compared to 1.5% who were less than 30 years of age.

“This is the equal highest proportion of GPs aged 60 years or older and the equal lowest proportion of GPs who were less than 30 years old across the reported nine-year time series (equal with 2022),” read the report.

The proportion of GPs who exited the GP workforce in 2023 was 1.4% nationally.

Here is the link:

https://www.medicalrepublic.com.au/urgent-care-clinics-arent-showing-their-worth/114334

It looks like it is not yet totally clear just what value will flow from the UCCs. While politically they sound good we have yet to see them in place for long enough to know a final verdict on how well they work.

As people get used to them clearer answers may emerge – but not before the election I am pretty sure!

David.

Tuesday, March 04, 2025

The New England Journal Of Medicine Comments On The Trump Administration....

 This appeared recently:

Order out of Chaos

Author: Eric J. Rubin, M.D., Ph.D. Author Info & Affiliations

Published March 3, 2025

DOI: 10.1056/NEJMe2502874

Copyright © 2025

The young woman and her husband were terrified. Her first pregnancy had been difficult, although she had eventually given birth to a healthy boy. But she’d had two subsequent miscarriages. Now, despite another rocky course, she’d carried a baby almost to full term. But something was very wrong. The obstetrician and nurse spoke quietly to each other while the woman’s contractions continued. When the baby was finally delivered, he was pale and swollen. The obstetrician offered him to the mother to hold while the baby took his last few breaths.

This is the story my parents told me about my brother Alan. My mother was Rh-negative, while my father was Rh-positive. As a medical student, I put it together — my birth had induced antibodies to Rhesus factor, and Alan had developed immune hemolytic disease of the newborn. It is a disease of largely historical significance that is now almost completely preventable with the administration of RhoD immune globulin. Unfortunately, this agent came almost a decade too late for Alan.

But it did come, an early product of a new and substantial investment in medical research. Its development has been followed by multiple miracles — the transformation of childhood leukemias into curable diseases, immunotherapy for some tumors even when they are widely metastatic, and the restoration of normal function in many people with cystic fibrosis, to name just a few of many breakthroughs. And this research has been an enormous economic engine for the United States, generating tens of billions of dollars annually and more than 400,000 jobs. It’s difficult to imagine an investment that has paid more dividends, both in bettering the health of Americans and in making the United States the global leader in life science — which is why the current administration’s seemingly random assault on scientific research is so puzzling.

The raft of executive orders issued by this administration and the judicial responses to them have been dizzying, and chaos seems to reign. Collectively, these actions have crippled many of the institutions we rely on to promote and improve health. The National Institutes of Health (NIH) is a jewel, and the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) set the international standard for monitoring health and maintaining safety. The President’s Emergency Plan for AIDS Relief (PEPFAR) has by itself saved millions of lives. And even more innovation comes from externally funded university and hospital labs. Already, as funding is disrupted and funding decisions suspended, many people have lost their jobs, new hiring is frozen, patients are losing access to life-saving treatments, and research is being interrupted, sometimes with tragic and expensive consequences. Research studies, once stopped, cannot necessarily be restarted. And the longer this chaos persists, the greater the damage will be.

The editors of the Journal are clinicians, researchers, and patients. We strive to care for anyone who needs help, we write and review grants, and we serve on federal advisory committees. We join our colleagues in celebrating every new and exciting medical insight that can lead to longer and healthier lives (even when the findings are published elsewhere). In other words, we are members of the same communities as our readers and authors, and today we share their pain and their concerns about the threats to health.

What can we do to counter the current chaos? At the least, we can try to maintain order. In our roles as editors, this means continuing to do what we think makes a difference: publishing the highest-quality research, analysis, opinion, and educational content that can improve patient health. We are proud of our communities, and we seek to provide a platform where authors can speak out, even when topics are controversial.

I never met Alan. But I hope that the research continues that will allow others to meet their future family members.

Notes

This editorial was published on March 3, 2025, at NEJM.org.

Disclosure forms provided by the author are available with the full text of this editorial at NEJM.org.

Supplementary Material

Disclosure Forms (nejme2502874_disclosures.pdf)

Here is the link:

https://www.nejm.org/doi/full/10.1056/NEJMe2502874?query=RP 

Heaven help us all. They have collectively "slipped their moorings"

David.

 

 

It Looks Like Department Of Health Wowsers Have Forced Continued Smoking By Not Encouraging Substitutes That Actually Work!

This appeared last week:

Opinion

Our vaping delusions have gone up in smoke. The Kiwis have a better idea

By Dr Colin Mendelsohn

March 2, 2025 — 5.00am

A landmark study published in the journal Addiction has revealed that the smoking rate in New Zealand fell twice as fast as in Australia between 2016 and 2023. Over this seven-year period, NZ’s adult daily smoking rate plummeted by an astonishing 10 per cent per year, from 14.5 per cent to 6.8 per cent. In contrast, Australia’s smoking rate declined by only 5 per cent per year, from 12.2 per cent to 8.3 per cent.

NZ now boasts a lower smoking rate than Australia for the first time. The key difference? They have embraced vaping nicotine as a legitimate harm-reduction tool, while Australia has stuck to an outdated, prohibitionist model. NZ smokers have easy access to a wide range of regulated vaping products and flavours. Vapes are sold as adult consumer products from licensed retailers – just like cigarettes and alcohol. This aligns with policies in the UK, the US and Canada, where vaping is supported as a harm-reduction strategy rather than seen as a public health threat.

Australia, on the other hand, has taken a highly restrictive, medicalised approach designed to deter youth vaping. Here, legal vapes are available only through pharmacies, often requiring a doctor’s prescription. Most flavours are banned. However, enforcement efforts have largely failed to curb the booming black market.

The result? NZ’s more pragmatic approach is accelerating the decline in smoking, while Australia’s restrictive policies are leaving smokers behind.

One of the most overlooked benefits of vaping is its potential to reduce health disparities. The study found that smoking prevalence in NZ’s poorest communities fell three times faster than in Australia (12 per cent per year versus 4 per cent). Similarly, smoking rates among NZ’s Maori population declined at almost three times the rate of Indigenous Australians (16 per cent v 6 per cent). This rapid fall wasn’t random – it closely correlated with rising vaping rates in these groups.

People from disadvantaged backgrounds have historically had high smoking rates and greater difficulty quitting. But in NZ, they are now quitting smoking even faster than the general population, reversing decades of entrenched inequality in tobacco-related harm.

Youth vaping rose more sharply in NZ, reaching 10 per cent daily vaping in 2023 compared with just 3 per cent in Australia. However, most of this rise occurred before regulations were introduced in 2021. More recent data show youth vaping declined to 8.7 per cent in 2024. While youth vaping remains a concern, it is important to note that it is associated with a decline in youth smoking. In 2023, only 1.2 per cent of youths in NZ smoked daily.

Critics argue that increased youth vaping could lead to a resurgence in smoking, yet the data contradicts this claim. Despite the higher levels of youth vaping in NZ, daily youth smoking has fallen to record lows – just 1.2 per cent in 2023. Rather than acting as a “gateway” to smoking, vaping appears to be diverting young people away from more harmful, combustible tobacco.

Australia’s restrictive approach has backfired in another way – by fuelling an out-of-control and increasingly violent black market. Today, more than 90 per cent of vaping products sold in Australia come from illicit sources with no safety standards and easy access for youth. New Zealand, with its well-regulated retail market, has no significant black market activity.

Vaping is an effective and widely used aid for quitting smoking. New Zealand’s adult daily vaping rate in 2023 was nearly three times higher than in Australia (9.7 per cent v 3.5 per cent) and the decline in smoking rates mirrors this difference. Of course, this study is “cross-sectional”, meaning it tracks population trends rather than following individuals and cannot definitively prove vaping was the cause of the rapid fall in NZ smoking. However, after examining multiple possible explanations, researchers found no other credible factor to explain this dramatic decline.

If vaping is the key driver of this success, as appears likely, then Australia’s current approach isn’t just failing, it’s costing lives.

A more liberal, consumer-driven model – similar to that of NZ – could accelerate the decline in smoking, reduce the health gap for disadvantaged and Indigenous communities and diminish the harms from an unregulated black market. The solution isn’t to ban vaping or to try to restrict it into obscurity. It’s to regulate it sensibly – encouraging smokers to switch while implementing reasonable safeguards to protect youth. NZ has shown us what works. It’s time we paid attention.

Dr Colin Mendelsohn is an academic, researcher and clinician who has worked in smoking cessation and tobacco harm reduction for more than 40 years. He is a co-author of a study in the journal Addiction comparing smoking and vaping rates in Australia and New Zealand. He says he has never received funding from e-cigarette or tobacco companies. He was an unpaid board member of the Australian Tobacco Harm Reduction Association, a registered health promotion charity, from October 2017 to January 2021. ATHRA accepted unconditional seed funding from the vape retail industry to become established. That funding ceased in 2019.

Here is the link:

https://www.smh.com.au/national/our-vaping-delusions-have-gone-up-in-smoke-the-kiwis-have-a-better-idea-20250217-p5lctj.html

Time for the Canberra bureaucrats to get on board with what has been shown to work “across the ditch” I reckon!

I worry at just how long it seems to take to have good ideas implemented and start saving lives as observed in this case!

David.

Sunday, March 02, 2025

I Find This A Pretty Cautionary Tale That Needs To Be More Widely Understood!

This appeared a few days ago:

Jess’ mum drank a small amount of alcohol before she knew she was pregnant – the damage had been done.

By Wendy Tuohy

March 1, 2025 — 7.00pm

Jessica Birch knows that you might not be able to detect the mark left by alcohol on her as a developing baby simply by looking at her face.

You would need to be informed of the “sentinel” signs of the often-undetected condition fetal alcohol spectrum disorder to pick up the subtle changes caused by exposure in the womb to alcohol before her mother even knew she was pregnant.

The skin between her nose and mouth, known as the philtrum, is long and unusually smooth, she explains, and her upper lip is “thin”.

“You have a flat mid-face and bridge of the nose and forehead,” Birch says. The bridge of her nose and middle plane of her face are also flatter than normal, and “you might have folds on the eye or smaller eye openings”.

“Had I not been exposed to the alcohol, it’s likely that my face would have looked a little bit different,” she says.

The condition left other imprints on her life, too. As a child, “I had a lot of issues managing mood and emotional regulation and quite a lot of neurological symptoms”, Birch says.

“My mum definitely identified these things and sought out specialist help; however, I was told, and she was constantly told, these things were behavioural and I would grow out of them.”

Instead, her symptoms worsened and were compounded with childhood anxiety, then depression in her teens. She developed tachycardia – an irregular heartbeat – and as she approached young adulthood, she struggled with cognitive tasks, and to manage her life.

By the age of 22, Birch had developed a cluster of symptoms of physical illness, and despite seeing “a myriad of specialists”, she experienced malaise so intense that she could not leave the house.

“I completely deteriorated to the point where I was bedridden with malnutrition and chronic fatigue, and my mum became very scared for my safety and physical health,” she says.

It was only when her mother saw a 2015 episode of the ABC program Four Corners called “Hidden Harm”, about young people living with fetal alcohol spectrum disorder (known as FASD), that she realised what had happened to her daughter.

She collected information and screening material for the disorder and presented it to Birch: “After I read those documents, I burst into tears, and we just cried together because I knew it was absolutely FASD I was dealing with,” Birch says.

At 33, and after years of struggling to get a diagnosis that encompassed all of Birch’s symptoms, she was diagnosed with “FASD with sentinel facial features”. It was caused by the small amount of alcohol her mother had consumed before she even knew she was pregnant.

‘My story is a very common one, and it’s not because my mother struggled with alcohol use disorder … it does not take a lot.’

Jessica Birch, who lives with the symptoms of FASD

“My story is a very common one, and it’s not because my mother struggled with alcohol use disorder; she was on the contraceptive pill when she became pregnant with me,” Birch says.

“She did not know she was pregnant until around the start of the second trimester, and by that stage the damage was done. And it does not take a lot.”

She wants the alcohol industry to be held to greater account, and wants women to have more information on the true risks alcohol poses.

New research by the Murdoch Children’s Research Institute has revealed that even though the children studied who had been exposed to low levels of alcohol in the womb did not show obvious physical, behavioural or cognitive signs, “characteristic changes in the face … persisted until at least six to eight years of age”.

Researcher Evi Muggli said the study, published in JAMA Pediatrics, showed that although changes might not be observable at a clinical level, “we saw changes at a biological level”.

The study, involving Monash, Melbourne and Sydney universities and scientists in Oxford and Belgium, used highly specialised 3D imaging and analysis to examine the faces of children who had been exposed to low to moderate levels of alcohol in utero compared with those who hadn’t.

The team found “consistent changes in the shape of the eyes and nose” of those who had. The changes were similar “regardless of whether they were exposed to alcohol in only the first trimester or continued through the pregnancy”.

There was no clear link between the level of alcohol exposure and the degree of facial change, and Muggli said many factors, including timing of alcohol consumption, the mother’s alcohol metabolism and genetics, could also influence how much alcohol reaches the baby and its effect.

The study should provide some reassurance to mothers who had consumed some alcohol in the first couple of weeks of pregnancy, Muggli said, because it did not find developmental difficulties in the children. But it also demonstrated that any alcohol consumption can leave a trace detectable with imaging.

“What we’ve established is that because of the physical biological effect alcohol has, it is definitely a teratogeen – a chemical that interrupts fetal development,” she said.

“But unlike certain types of drugs, like thalidomide, it is not easy to establish a cause and effect relationship [between exposure and corresponding harms], it is not a linear relationship.”

Muggli said the research should arm educated women who are aware there is a lack of strong evidence linking low alcohol consumption with harm with the understanding that “it does something to the fetus during their development, so why would you take that risk when the stakes are so high?”

Louise Gray, specialist adviser for NOFASD Australia, said the research was significant because it showed that even in the absence of harm that meets diagnostic criteria for FASD, “it does not mean there is no effect from prenatal alcohol exposure”.

“It’s really important for women to understand that if there’s any possibility you may become pregnant, you shouldn’t be consuming alcohol. That’s the safest way to ensure there won’t be any changes,” she says.

Caterina Giorgi, chief executive of the Foundation for Alcohol Research and Education, says the study reinforced the need for pregnancy warnings on alcohol packaging. These were mandated in 2020, and manufacturers were given a three-year transition period in which to introduce them.

“A recent study analysing uptake found the products least likely to carry warnings are spirits and wine, which are more likely to be consumed in the age group where women are most likely to have a baby,” Giorgi says.

It found only 50 per cent of spirit labels and 65 per cent of wine labels had had warnings added so far.

Jessica Birch, who is on the advisory group at NOFASD Australia and who speaks “loudly and proudly” about her experience to try to help other women understand alcohol’s potential harms, said that receiving her diagnosis had changed her life profoundly for the better.

“It has allowed me to shift all the internalisation, the blame, the comparing, the self-loathing, the depression and stuckness that happens when you live with this and allowed me to not only access support and understand myself, but I can heal.”

If you have questions about FASD or would like to speak to someone confidentially the NOFASD helpline is 1800 860 613.

Here is the link:

https://www.smh.com.au/national/jess-mum-drank-a-small-amount-of-alcohol-before-she-knew-she-was-pregnant-the-damage-had-been-done-20250226-p5lf7a.html

This is a pretty sobering (sorry) tale that makes it clear that damage is being done to many children because of ignorance of just how little drinking can have life-long consequences for children.

What I get from this is that basically women who are at risk of pregnancy should not drink and that blokes should take “no” for an answer and not try to push grog on anyone!

How we can educate both women and blokes as to the risks is way above my pay grade but pushing drinks on women between 12 and 50 is clearly just not on and needs to be avoided.

Sorry to be a wowser but alcohol is just too dangerous to women in the child-bearing age range unless pregnancy is just not in any way possible!!! We do not take the risk(s) seriously enough I suspect…..

We all need to be considerate and respectful of each other in this!

I sure would not want any level of foetal damage on my conscience!

David.

AusHealthIT Poll Number 783 – Results – 2 March 2025.

Here are the results of the poll.

Should Australians Be Concerned At The Passage Of 3 Chinese Warships Along Our Eastern Coast?

Yes                                                                   10 (34%)

No                                                                    19 (66%)

I Have No Idea                                                  0 (0%)

Total No. Of Votes: 29

An interesting outcome with a decent majority wanting a pretty relaxed approach to the warship visits!

Any insights on the poll are welcome, as a comment, as usual!

Fair voter turnout. 

0 of 29 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many thanks to all those who voted! 

David.