AusHealthIT Poll Number 800 – Results – 29 June 2025.

Here are the results of the recent poll.

Do You Believe Iran Can Survive Intact Having Found Itself In A Major War In The Middle-East With The US and Israel?

Yes                                                                     13 (54%)

No                                                                      11 (46%)

I Have No Idea                                                    0 (0%)

Total No. Of Votes: 24

A tiny majority reckons Iran has a future – many do not. A close-run thing as they say!

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

Not bad voter turnout – question must have been too easy. 

0 of 24 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.

This Is Really A Wonderful Australian Software Story! Pity About The Trolls

This appeared a few days ago:

Patent ‘trolls’ come for Canva as it prepares for share sales

Amelia McGuire Business reporter

Jun 22, 2025 – 8.00pm

Canva is being targeted by a Canadian serial litigant alleging the Australian design software giant has stolen its patents for an artificial intelligence voice generator that is now integrated into its platform.

Cedar Lane Technologies has made similar claims against hundreds of companies over the last five years including Amazon, Zoom and Huawei. Its lawyer, Isaac Rabicoff, has lodged separate patent claims against Canva in Texas on behalf of other companies over the last two months.

While Cedar Lane is regarded as a nuisance litigator – a California court found it had made “objectively frivolous and misleading arguments in defending their defective filings” in 2020 – it has had remarkable success in squeezing settlements and payments out of Silicon Valley giants.

The litigation comes as Canva rolls out a suite of AI tools, making a number of significant acquisitions in a bid to bolster its design software platform and attract more paying users. Last week, Canva said 25 million people or a 10th of its users were now paying, an increase of 5 million since September.

An increase in paying users is key for the company as it prepares for a long-awaited float. Canva confirmed on Sunday that it would facilitate a sale of employee and founder shares at the end of the year, as first revealed by The Australian Financial Review’s Street Talk column last week.

Secondary share sales are popular with mature private tech firms because they allow employees and investors to cash out instead of waiting for a public listing. Potential investors have been told the sale would amount to up to $US500 million ($773 million) worth of shares and would value Canva at $US37 billion, The Information reported at the weekend.

Canva’s peak valuation was $US40 billion at the height of the tech bubble in 2021, when interest rates were near zero and there was a lot of capital flowing into tech start-ups. Canva’s last share sale was in October when it said it had increased its valuation by $US6 billion to $US32 billon.

While Canva has not committed to a float, co-founder Cameron Adams said last week the company had been “IPO ready” for a long time. “It’ll happen when it makes sense but we’re not any closer to firming it up,” he said.

Canva’s platform is used for everything from marketing and sales presentations to educational audiobooks and YouTube clips, and the platform’s voice generator lets users add audio to projects using an AI-powered tool that draws from hundreds of voices.

In a five-page filing lodged with the District Court in Texas earlier this month, Cedar Lane claimed that Canva’s AI voice generator used the company’s “system, method and apparatus” for generating audio,

In response, Canva said the claims were baseless and “strongly opposed” them. “This kind of litigation misuses laws intended to support genuine creativity, instead using them to pressure companies into a quick settlement,” a Canva spokesman said. “Allowing actions like this to go unchallenged risks normalising a damaging trend across the broader industry, and we intend to vigorously defend ourselves.”

Patent litigation has been booming in the United States, often brought by companies with little public information disclosed.

Intel, for instance, was sued by VLSI Technologies in 2019, a semiconductor producer that has actually been defunct for decades. The new VLSI business, according to the Wall Street Journal, is backed by a New York-headquartered hedge fund, and tied up Intel in years of litigation.

Cedar Lane has been described in congressional hearings as a business whose main source of revenue is suing larger companies, a practice known as patent assertion. Such businesses are known by detractors as “patent trolls”.

Another of the firms suing Canva in the Texas courts, Hyperquery, has a similar business to Cedar Lane. In one week alone earlier this year, it launched litigation against another Australian-headquartered software giant, Atlassian, along with ByteDance and Sony. It is also suing Xero, the ASX-listed cloud-based accounting software business.

Here is the link:

https://www.afr.com/technology/patent-trolls-come-for-canva-as-it-prepares-for-share-sales-20250622-p5m9bg

I suppose these sort of commercial attempts at profiting on others hard work is just inevitable as in other areas of endeavour!

Sad that, but Canva is a great Australian story!

David.

Overall I Think Transparency With Surgical Outcomes Achieved Has To Be A Very Good Thing, But There Are Exceptions!

This appeared last week:

Safety in numbers: why honesty matters in medicine

Everyone thinks more openness in medicine is a good idea. And our world leading IVF and joint replacement projects are great examples. But information sharing doesn’t always produce better outcomes for doctors and patients.

Steve Robson

21 June, 2025

If you have any interest in health you’ve probably heard the word “transparency”. It now is inescapable and has been called for in everything from the cost of specialist visits and private health insurance, to the cost of health technology, and in healthcare outcomes.

Australia has two world-leading examples of transparency in healthcare – and a notable failure.

If you’re a patient what, exactly, is transparency and how can it make the medical treatment you receive better?

Transparency is all about making the healthcare system understandable not only for patients but also for doctors, healthcare workers, governments, indeed the whole community. It can involve everything from the costs of care to the outcomes of operations. Transparency guides good decision-making in your healthcare.

When transparency is missing it can be catastrophic. One terrible example was with the outcomes of heart surgery for British children in the 1990s at a hospital in Bristol, where the death rates were probably double that for England as a whole. Had the public and administrators had transparency around the hospital’s results it is possible that the lives of 35 children could have been saved.

A celebrated example of surgical transparency is Australia’s National Joint Replacement Registry. Well over 100,000 hip, knee and other joints are replaced in Australia every year. Our results are world-leading and this is due, in no small part, to the registry.

Surgeons complete information sheets about every joint replacement they perform, which includes information not only about the artificial joint itself but the age and health of the patient undergoing the procedure. This information is fed into a complex computer system for analysis and the results are made public. The process allows a careful matching of patient characteristics and devices, along with surgeon and hospital, to review the outcomes of this surgery.

When hip and knee replacement surgery was still in its infancy, problems with implants were relatively common, leading to the need for patients to go back to the operating theatre to have their implants removed and replaced – a potentially traumatic and resource-intensive process.

“Revision rates following primary joint replacement were pretty high,” explains orthopaedic surgeon Professor Paul Smith, the current clinical director of the registry. “With that burgeoning epidemic of prosthesis loosening and wear, people were conscious that they really needed to understand better which prostheses were actually performing and which weren’t.”

The registry was the brainchild of the Australian Orthopaedic Association, the peak body for orthopaedic surgeons. The leadership of the profession recognised the need for all surgeons to have unbiased and real-world information about the implants being placed in Australians’ knees and hips to avoid adverse outcomes.

This level of transparency was unprecedented in Australian healthcare and was embraced widely.

“We have 100 per cent of all joint replacement reported in Australia,” says Professor Smith with pride. “So there’s 100 per cent of surgeons who undertake joint replacement, and also 100 per cent of the hospitals with replacement occurring in them all engaged in the process.”

There is no legal obligation to participate in the registry – it is powered by the goodwill and passion of surgeons to offer their patients the best possible results of what are very big operations. Australians should be grateful for such an aid to transparency.

While the outcomes for patients of every single hip or knee implant can be individually tracked, the opposite was true for gynaecological mesh implants. This lack of transparency was uncovered during a Senate inquiry and related class action against the manufacturers of pelvic mesh.

The final report of the Senate inquiry found that, in contrast to the joint replacement registry, there was “no clear indication of how many women have had transvaginal mesh implants in Australia or how many women have experienced complications as there is no single source of information”.

This made the task of helping women who had experienced adverse outcomes – some lifelong – of mesh implants very challenging. It led the inquiry to recommend the “establishment of a registry for all high-risk implantable devices”.

What is notable about the Joint Replacement Registry is that it is entirely an initiative of surgeons and was not imposed by the government. Experience in the British National Health Service, much of it in the aftermath of the Bristol cardiac surgery disaster, suggests that government attempts to enforce transparency measures can be ham-fisted.

In his landmark book The Naked Surgeon – the power and peril of transparency in medicine, British cardiac surgeon Samer Nashef delved into the pitfalls of poorly thought-through transparency measures.

“The government decided to find ways of reducing costs by having expensive hospitals learn from cheaper ones,” he explained. The exercise began with heart surgery. Unfortunately, the economic analysis uncovered an important but perhaps unexpected truth.

The reason that some hospitals were so “cost-effective” in treating complex heart problems was a simple one. “Many died on the operating table,” he wrote. “This is a very inexpensive pathway: it results in a short hospital stay, no intensive care bills, and no recovery costs.”

This is a significant lesson about transparency: include those providing care – and the patients receiving care – in planning any transparency measures. This is particularly true when either outcomes of procedures are considered or the costs of care are under the microscope.

Indeed, according to a review of transparency in the Journal of the American Medical Association, “public reporting of healthcare system performance is promoted as a means for enhancing the value of healthcare by improving quality and lowering costs … but little evidence of broad and sustained improvements”.

IVF treatment is another area where calls for transparency are being made. Yet Australia leads the world in this area with our newest large-scale transparency initiative – the Your IVF Success website.

While the Joint Replacement Registry aims to provide transparency for surgeons and hospitals, the IVF website is pitched squarely at patients – although the profession takes careful note of its findings.

“The Your IVF Success website was launched in 2021,” says Professor Georgina Chambers who runs the project. “It came about to improve transparency around assisting patients in getting independent information about IVF success rates.”

Long before the website was launched, Professor Chambers’ team collected information about IVF outcomes and provided a yearly academic report. “It’s the oldest IVF registry in the world and probably the most comprehensive,” says Professor Chambers.

The information in these reports was presented in a way that was difficult for patients to understand and was of little value in guiding choice. It was a very opaque transparency project.

IVF is performed at a similar rate as joint replacement, with well over 100,000 IVF procedures performed each year. As with the Joint Replacement Registry, the IVF website is not legislated and is run by the voluntary contributions of IVF doctors.

“Because it’s voluntary, I have to get consent from every single clinic to publish their results,” says Professor Chambers. “The way it works is that I give them their results – exactly what’s going to appear on their website for their clinic and benchmark it to the national average.”

Information from the IVF transparency website is only one factor in the way patients choose their doctors and clinics, Professor Chambers says.

“With public transparency … everybody interprets statistics so differently. They might think, oh yes, but that doesn’t relate to me or my doctors, or my friend got pregnant at that clinic so I want to go there.

“It’s just been overwhelmingly positively accepted by consumers. We get 40,000 people to the website every month. Now this just shows you the absolute hunger for information on the web because it affects just so many people.”

One of the important aspects of transparency on the IVF website is that it has strong input from consumers. “We have a consumer advisory group made up of seven people who have varying experiences of infertility, men and women who advise on everything on the website,” Professor Chambers says.

“It’s been absolutely made with consumer focus and was co-designed with them.”

The Your IVF Success website won the 2023 Research Australia Award for data innovation.

The Joint Replacement Registry now has a patient focus as well. “In the last decade it’s been recognised that one of the important outcome measures is not just how the device works, but what are the patient-related outcomes?” Professor Smith says.

“The registry started to collect patient-reported outcome measures in 2018 and this really provides another dimension.

The IVF website that began as a data project for doctors became more useful to patients. Picture: iStock

“While it was set up to ascertain device performance, it’s actually the patient we treat and we need to understand what patient outcomes are. The last decade has seen a growth in the importance of patient-reported outcome measures such as satisfaction, general health outcomes and outcomes related to the joint that’s operated on.”

Professor Chambers says that in its short history, her transparency website has supported ongoing improvements in IVF care. “The multiple birth weight has dropped to the lowest it’s ever been, so there is no indication that people are putting back more embryos to improve success rates,” she says.

“While it may not be due to your IVF Success website, every year – no matter how you cut the data – the success rate from IVF is increasing.”

Professor Smith acknowledges a similar effect of transparency from the Joint Replacement Registry on orthopaedic surgery. “It provides surgeons with a lot of information and an opportunity to look at where they can improve their practice,” he says.

“Surgeons do not want to be seen to be using devices which clearly have been identified as being poor. The registry has identified better-performing devices, and so surgeons will opt to use a better-performing device.”

Indeed, the Australian registry has identified devices that yield results so poor that it draws worldwide attention to them. “About 20 years ago the first one was identified and that resulted in that device being recalled worldwide,” says Professor Smith.

If Australia is to build further innovation in transparency, what are the keys to success?

“My advice would be that you’ve got to work with the industry as a collaboration,” says Professor Chambers. “You’ve got to abide by certain principles that respect patient and clinician autonomy. One of the key principles of transparency in an industry is that you don’t interfere, you don’t create any perverse incentives.”

This principle came out strongly in the NHS reforms. Dr Nashef has warned that ranking surgeons – without putting the work they do in broader context – puts patients at risk. To avoid looking bad in public “league tables”, surgeons may avoid operating on complex patients – often the ones who most need care.

“The greatest risk to the patient in the publication of league tables is that surgeons start to run away from high-risk surgery, and that is bad news indeed, especially if you are such a patient,” Dr Nashef writes.

What lessons can we learn from the successes – and failures – of transparency in the Australian healthcare system? The information provided must be put in context and be understandable by patients and it must not scare off doctors or hospitals from participating.

“You’ve got to get the senior thought leaders within the craft group behind the idea,” says Professor Smith. “It’s really got to be something that is led from the front. There has to be a champion group.”

Australia has some world-leading examples of transparency that are guiding patient choices and informing the best possible standards of healthcare. There is plenty of scope for more, but we must not make mistakes such as those of the NHS. Let the profession and patients, together, chart the pathway in transparency. That way all of us will benefit in the future.

Steve Robson is professor of obstetrics and gynaecology at the Australian National University and former president of the Australian Medical Association. He is a board member of the National Health and Medical Research Council and a co-author of research into outcomes of public and private maternity care.

Here is the link:

https://www.theaustralian.com.au/health/medical/safety-in-numbers-why-honesty-matters-in-medicine/news-story/29a1492f8950de50762016a174be977d

Making sure that surgical outcomes are reported fairly and reflect the difficulty and risk of surgical intervention need to be carefully designed to ensure the outcomes we seek are achieved. It is possible to put reporting systems together that are unfair and produce very poor overall outcomes and put patients at risk!

This is a situation where listening to as many experts as possible makes good sense, to get the system design correct and the answers found valid!

David.

This Is Not Good News by Any Stretch! Ukraine Needs To Be Freed Of This Jerk!

This appeared a few days ago:

Putin claims ‘whole of Ukraine is ours’ as forces near major city

The Russian president told attendees at a St. Petersburg conference that “wherever a Russian soldier steps foot, that’s ours”.

Ivan Nechepurenko

Updated Jun 22, 2025 – 10.17am, first published at Jun 21, 2025 – 5.29am

St. Petersburg, Russia | Russian President Vladimir Putin on Friday (Saturday AEST) doubled down on his justification for the war in Ukraine, claiming Russians and Ukrainians were one people and “in that sense, the whole of Ukraine is ours”.

Speaking at an annual economic conference in St. Petersburg, Russia, Putin did not rule out Russian forces taking control of the large Ukrainian city of Sumy. A Russian offensive in northern Ukraine has put its forces about 12 miles (20 kilometres) outside the city’s centre.

“We don’t have a goal to grab Sumy,” Putin said. “But I don’t exclude it in principle.”

“Wherever a Russian soldier steps foot, that’s ours,” he added.

Putin’s insistence on maintaining the offensive in Ukraine has come at a diplomatic cost. US President Donald Trump’s election last year gave Russia hope that it could restore economic and diplomatic ties with the United States while continuing to wage war in Ukraine, but Trump has become impatient with Russia’s insistence on continuing the war.

The Russian president made clear he had no intentions of soon ending the war. But it was less clear whether Putin, whose comments came in response to a question about his military’s ultimate goals in Ukraine, was suggesting that Russia would annex additional territory beyond the four Ukraine regions that it has already declared are officially part of Russia.

In peace talks, the Kremlin has insisted on formal recognition of sovereignty over those regions — one of several positions that are unacceptable to the Ukrainian government. But since those annexations, Russian forces have pushed into three additional regions.

On Friday, before Putin’s remarks, the Kremlin made its most direct statement yet acknowledging that improved relations with the US were tied to Russia’s willingness to the end the war.

“American diplomats believe that we need to directly tie the process of removing the irritants in bilateral relations with the settlement in Ukraine,” Dmitry Peskov, the Kremlin’s spokesperson, told reporters at the conference Friday.

Peskov reiterated the Kremlin’s position, which is that it wants to discuss relations with the United States separately from efforts to end the war in Ukraine.

The Kremlin has been hoping that a thaw with Washington would lead to the lifting of some economic sanctions, the return of some American companies, US investments in Russian natural resources and more leeway for Russia to assert its interests in former Soviet states.

Trump’s focus has shifted

At the same time, Putin has shown little interest in bending to US, European and Ukrainian demands to agree to a ceasefire in Ukraine, where his forces are on the offensive.

Trump had promised to end the war in Ukraine 24 hours after taking office, but efforts to mediate have been dogged by deep disagreements between the warring countries about what peace should look like.

After two direct meetings between Russian and Ukrainian representatives, the negotiations have led only to agreements to exchange prisoners of war and bodies of fallen soldiers.

Frustrated by the lack of progress, Trump has his diplomatic attention elsewhere, most recently the conflict between Iran and Israel, where he is considering whether to join the war on the side of Israel.

Meanwhile, Russian air assaults on Ukraine have intensified in recent weeks, dimming any hopes for a ceasefire. On Thursday night, Russia launched drone attacks on Odesa and Kharkiv, injuring 20 people and killing one person in Odesa, President Volodymyr Zelensky of Ukraine said on Facebook.

Peskov said Russia expected Russian and Ukrainian representatives to set a date for their third meeting next week, but that the Kremlin was determined to achieve its stated goals in Ukraine either diplomatically or militarily.

The talks between Russia and the United States on restoring bilateral ties have also been dragging. Despite multiple phone calls between Putin and Trump this year and at least four public meetings of Russian and American officials over the same period, nothing substantive has been achieved so far on that issue. The two countries’ diplomatic missions are still understaffed and some consulates are still shut.

There has also not been any tangible movement in terms of American companies returning to Russia or sanctions being lifted. The St. Petersburg conference, a yearly event promoted by the Kremlin as a magnet for Western businesses, has turned into a platform where Russian state companies showcase themselves. Again this year, no major American investors showed up and there was little sign of Western interest.

At the conference, Putin instructed government members that they cannot allow it to slip into “stagnation and even recession”.

“This cannot be allowed under any circumstances,” Putin said.

On Thursday, Russia’s economy minister said the country was on the verge of sliding into a recession, putting more pressure on its central bank to lower interest rates, which now are at 20 per cent.

This article originally appeared in The New York Times.

Here is the link:

https://www.afr.com/world/europe/whole-of-ukraine-is-ours-putin-muses-20250621-p5m96v

I really hope Putin’s advances can be reversed!

David.

It Looks Like We Are Heading For A Lot Of Instability In the Private Hospital Sector In NSW!

This appeared a few days ago:

Healthscope in limbo for up to a year as administrators extend auction

Max Mason Senior courts and crime reporter

Jun 20, 2025 – 8.00pm

The country’s second-largest private hospital operator could be left in limbo for a year after administrators of the collapsed Healthscope business won approval to extend negotiations with prospective buyers for months.

The company, handed to lenders by asset management giant Brookfield earlier this year, was placed into receivership last month as it buckled under $1.6 billion in debt owed to a syndicate of dozens of hedge funds and banks.

The administration process has created fears among state governments that the 37-hospital portfolio could be split up, with some of the weaker operations closing down, adding to the strain on public health systems.

KordaMentha, Healthscope’s administrators, have now sought an extension of time from the Federal Court so that McGrathNicol can undertake “an orderly and considered sale process designed to maximise value for Healthscope’s creditors and benefit key stakeholders”.

Healthscope, with 5000 beds and 19,000 staff, declined to comment.

“The sale process is complex because the Healthscope group operates its 37 hospitals through various arrangements, including several leases,” KordaMentha wrote in its submission to the court.

“The receivers may be required to negotiate new rental terms with these landlords to facilitate any sale of the business … Operating the Healthscope group business also requires engagement with state regulatory bodies in relation to hospital licenses, engagement with its heavily unionised workforce of nurses with 23 separate enterprise bargaining agreements, and continual engagement with major private hospital insurers.”

KordaMentha said the sale process had already attracted interest from several bidders, and it would be completed within the year. The Federal Court this week agreed to extend the timeline for a deal to June 30 next year.

Healthscope is now run by former Qantas executive Tino La Spina. Last month, The Australian Financial Review revealed he had told staff and doctors in a frank exchange that Bupa, a major British health insurer interested in the business, would buy Healthscope “over my dead body”.

Healthscope and Bupa clashed last year after the British fund resisted pressure from Brookfield to increase how much it paid for its members’ care. Bupa has appointed advisers to look at the assets, the Financial Review’s Street Talk column has previously reported.

Healthscope has received 10 indicative offers from private hospital operators, including Ramsay Health Care.

Health Minister Mark Butler has ruled out a government bailout of Healthscope despite the risk that some of its hospitals could stop admitting patients if a buyer for the whole business cannot be found.

The Albanese government has also flagged that it would be less receptive to offshore private equity ownership than the previous Coalition government, which approved the 2019 sale of Healthscope to Brookfield.

Brookfield took on large amounts of debt to acquire Healthscope following a bidding war for the operator at a time when hospital valuations had soared. As part of the buyout, it sold 22 properties for $2.5 billion before leasing them back at rents it now says were well above market rates.

Healthscope also faces the loss of one of its largest facilities, Sydney’s Northern Beaches Hospital, in an escalating dispute with the NSW government.

“The government must be able to act decisively to avoid a prolonged dispute for members of the Northern Beaches community, staff working at the hospital and for NSW taxpayers,” NSW Treasurer Daniel Mookhey said.

Here is the link:

https://www.afr.com/companies/healthcare-and-fitness/healthscope-in-limbo-for-up-to-a-year-as-administrators-extend-auction-20250620-p5m92l

It is difficult to see that we will see this issue fixed soon – given the long -standing issues this hospital has and the issues with operating a hospital of this complexity.

It would be good if the State-Government took it over for a few years, got it up to scratch and then put back in the private sector when stabilized! Or they could just add it to the public hospital sector – which might not be a bad idea.

David.

It Looks Like We Are In For A Few Pretty Unstable Weeks As The Iranian Situation Plays Out!

This appeared a few hours ago:

Analysis:

Trump was holding back on Iran. Then he took a phone call

The Islamic Republic has become a lot weaker recently, and the US president and Benjamin Netanyahu know it. Both gave victorious press conferences on Saturday.

Jessica Gardner United States correspondent

Updated Jun 22, 2025 – 2.41pm, first published at 2.34pm

Washington | Last Thursday, US President Donald Trump gave himself a two-week option on bombing Iran, but by Saturday evening (Sunday AEST), the job was done.

What changed in those 48 hours? Was Trump handed new intelligence? Did Iran rebuff his fortnight window to negotiate? Did he finally snap over the Trump Always Chickens Out label?

His reasons for drawing the US into another war in the Middle East are perhaps many. He certainly didn’t give a detailed explanation in his brief address to the nation, warning instead of more attacks if Iran didn’t “make peace”. But what is known is that he received a tense phone call beforehand from Benjamin Netanyahu.

US media reported that Trump, Vice President J.D. Vance and Defence Secretary Pete Hegseth spoke with Israel’s prime minister, along with Defence Minister Israel Katz and military chief Eyal Zamir.

Israel was incensed that Trump could waste the opportunity to move against Iran’s crown jewel nuclear sites by giving it more time.

At the behest of Israel, probably angering voters (and some Republicans) who supported his promise to end US entanglement far from home, and very likely sparking Iranian retaliations, Trump made his move.

Iran is a repressive regime that holds little regard for the hopes, dreams and freedom of its 92 million citizens. Its rulers have pledged to destroy Israel and have threatened “death to America”. All of this has been true for decades.

The difference now is that Iran has been significantly weakened. The most recent barrage from Israel, which caught it unaware, wiped out top-ranking military and science personnel. And the regional militias Iran funds in Lebanon, Gaza and Yemen have been cut down by Israel’s unflinching attacks over the past 18 months, which have also led to widespread civilian deaths.

Iran’s stocks are down, and Trump and Netanyahu know it. Both gave victorious press conferences on Saturday night.

Nuclear weapons intelligence

The other factor that has changed, but accounts vary, is how far away Iran was from possessing a nuclear weapon. “If not stopped, Iran could produce a nuclear weapon in a very short time,” Netanyahu said on June 13 after Israel’s first strikes. “It could be a year. It could be within a few months.”

Iran was “weeks away” from creating a nuclear weapon, Trump said on June 18, without offering any evidence.

In March, Trump’s national intelligence director, Tulsi Gabbard, told Congress that Iran’s stockpile of enriched uranium was “at its highest levels” and “unprecedented for a state without nuclear weapons”. But she also said US intelligence suggested Iran had not decided to build a nuclear bomb.

Trump, on June 21, said that she was “wrong”.

The International Atomic Energy Agency said in May that Iran had amassed enough uranium enriched to potentially make nine nuclear bombs if it undertook further enrichment. But the watchdog also noted its monitoring efforts had been hamstrung by Iran’s refusal to co-operate.

While Trump danced around the prospect of an attack in the past week, some pundits mused on the similarities with George W. Bush’s invasion of Iraq. That deadly military intervention was in response to incorrect intelligence that Iraq possessed weapons of mass destruction.

Iran has been conducting clandestine nuclear enrichment operations since the 1990s, which the regime has assured were for energy production, even if much of the globe did not trust it. The most troubling facility was Fordow, located deep in a mountainside reachable only by US-owned bunker-busting bombs, and the right fighter jets to carry them.

In his Saturday night address following the strikes, Trump said Fordow, and two other sites, Natanz and Isfahan, had been “obliterated”. That will make it challenging to ascertain exactly what was going on deep underground and cloud the basis for the operation.

What we know for sure is that this is not the end.

Trump did not shy away from that in his Saturday address. “Remember, there are many targets left,” he said. “Tonight’s was the most difficult of them all, by far, and perhaps the most lethal. But if peace does not come quickly, we’ll go after those other targets with precision, speed and skill.”

Trump may characterise these operations as a simple in-and-out, but by joining the Middle East’s latest conflict, he has lit a match in one of the globe’s most combustible regions.

After styling himself as a peacemaker who was more interested in ending wars than starting them, the unpredictable president has escalated one.

Here is the link:

https://www.afr.com/world/middle-east/trump-was-holding-back-on-iran-then-he-took-a-phone-call-20250622-p5m9b8

So here we are in the middle of another war in the Middle-East:

I fear no good can come from all this and it really is time for everyone to stand back and take a few deep breaths! The implications of all this could be pretty bad if we don't work to settle things down, and fast!

Peace has to be re-established ASAP.

Let us see how it plays out in the next few days:

David.

AusHealthIT Poll Number 799 – Results – 22 June 2025.

Here are the results of the recent poll.

Do You Think There Is A Significant Risk Of The Israel / Iran Conflict Getting Out Of Control And Resulting In A Major Conflict?

Yes                                                                     18 (67%)

No                                                                        9 (33%)

I Have No Idea                                                    0 (0%)

Total No. Of Votes: 27

Clearly an overall majority think the risk for major conflict is real as we now see happening!

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

Not bad voter turnout – question must have been too easy. 

0 of 27 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.

A Update To Screening Approaches For Prostate Cancer. An Update After Almost A Decade.

This appeared last week:

16 June 2025

Prostate cancer screening gets revamp

By Laura Andronicos

But not everyone agrees with the recommendations, which would significantly change how GPs screen and treat patients.

---

The draft 2025 clinical guidelines for the early detection of prostate cancer have been released and some changes have sparked a strong response from the RACGP. 

The Prostate Cancer Foundation of Australia (PCFA) is replacing the current 2016 version and changing who is screened and when, who is offered active surveillance or definitive treatment, and removing biopsy as the primary test following an elevated PSA, among other things. 

“We need these new guidelines, because much has changed over the last decade in the diagnosis of prostate cancer,” said Dr Brett Montgomery, RACGP representative on the guidelines steering committee. 

He said many GPs found it challenging to counsel patients about early detection of prostate cancer, but the update will provide clear guidance about PSA testing and interpreting results, including flowcharts of action points that are easy to read and implement. 

The guideline includes new risk factors, with particular focus on recognising Aboriginal and Torres Strait Islander males as a priority population due to worse survival outcomes than the general Australian population. 

There were no specific recommendations for this population in the previous guideline, but now PSA testing is recommended every two years from the age of 40. The PCFA highlighted this as a world-first recommendation. 

Dr Montgomery told TMR that the recommendation to offer testing to males aged 50-69 is still what is best supported by evidence. However, the update offers support for starting screening earlier for people at increased risk. 

“They offer some cautious flexibility in the age of starting and stopping testing: allowing doctors to respect patient choice in testing from age 40 or beyond age 70 in people who are keen and relatively well, even though evidence of benefit in these age groups is much more slender,” he said. 

However, the RACGP expressed “major concerns” with the move, saying the disparity in mortality rates for Aboriginal and Torres Strait Islander people was likely due to access to and engagement with health systems. 

“The evidence cited in the draft guideline shows no significant difference in the age of diagnosis or spread of disease at diagnosis in Aboriginal and Torres Strait Islander men,” said Professor Mark Morgan, chair of the RACGP expert committee. 

“Therefore, while they are a priority population, the RACGP is concerned this approach may lead to more unintentional harms, such as false positive PSA tests and overdiagnosis.” 

For Aboriginal and Torres Strait Islander men aged 40-49, a PSA of 1.0μg/L or greater, or a PSA of 2.0μg/L or greater for men aged 50-69, would prompt a repeat test within three months. These age and PSA ranges also apply to other risk factors that were not identified in the 2016 guideline, such as black males of sub-Saharan ancestry, males with a BRCA2 gene mutation and a family history of prostate cancer. 

Family history specifically refers toas a brother diagnosed with prostate cancer, a father diagnosed with prostate cancer before the age of 65 and/or two or more second degree relatives who died of prostate cancer. The draft suggests that these risk factors can more than double the risk of an individual dying from prostate cancer. 

The RACGP recommended including men who take exogenous anabolic steroids as a risk factor, not because they’re at a higher risk of prostate cancer but because these medications may stimulate prostate cancer growth. 

There are also proposed changes to who should be offered active surveillance.  

The PCFA recommends reducing the PSA threshold from 20μg/L to 10μg/L and requiring a PSAD of 0.15μg/L/mL or less, an MRI PI-RADS of 3 or less and a clinical stage of T1-T2a. All criteria must be met to offer active surveillance.  

The previous guideline did not advise testing men over the age of 70, but the new guideline aims to reverse that, recommending testing based on clinical assessment rather than age alone.  

The RACGP asked for clarification, suggesting that clinical assessment should be clearly defined and include life expectancy, comorbidities, and patient values and preferences. 

It also recommended adding guidance for GPs on making a shared decision to discontinue testing in healthy men aged 70 and over with a PSA less than 1.5μg/L, as these individuals were unlikely to benefit from further screening. 

“A problem in the past has been that only a tiny proportion of participants have their life saved through early detection. And these benefits have needed to be weighed against the hazards of prostate screening, including overdiagnosis,” said Dr Montgomery. 

He said that for every 1000 people getting tested, they see around one life being saved after 11 years, two after 16 years, and perhaps four after 25 years and 14 after 40 years. These numbers were outlined in the RACGP submission, which cautioned potential overdiagnosis from the expansion of screening recommendations.  

The previous guideline had a lot of criteria for offering definitive treatment, but the update suggests that it only requires either pathological progression detected from a biopsy or based on patient preference.  

Under the new guidelines, biopsy will no longer be considered the primary testing approach after an elevated PSA. mpMRI is now the preferred first diagnostic test following a raised PSA result and will determine if a biopsy is required.  

Ultrasound-guided transperineal approach is now the preferred biopsy method to reduce infection risk, as opposed to transrectal. The optimal number of cores for targeted biopsy have been reduced from 21-24 to a minimum of 3-4. 

 The RACGP recommended the development of a national registry for prostate cancer screening be considered by the PCFA.  

“This will help avoid duplication of testing for patients who see multiple providers, as a central system will capture people who move to a different GP and/or clinic, and allow GPs to undertake the recalls and reminders for screening,” they wrote. 

They also suggested providing a clear list of changes to screening tests, such as the removal of the free-to-total ratio. 

“I would like to see the development of resources that help GPs to work with their patients to weigh the good things and the bad things about testing so that patients can reach a decision on testing that is in keeping with their own values,” Dr Montgomery said. 

“I know that good people are working on such a resource now.” 

This article was updated to include comments by Dr Montgomery.

Here is the link:

https://www.medicalrepublic.com.au/prostate-cancer-screening-gets-revamp/117609

A useful summary of the current recommended approach.

David.