Monday, January 18, 2016
Monday, November 30, 2015
Good for the economy while good for your health
Wednesday, November 4, 2015
Academics must cut the tentacles that threaten to strangle them
Mark Robertson’s reassurance that all is well in the world of academic publishing save for the occasional misunderstanding (HES, October 7) takes no account of widespread dissatisfaction within the research community, universities and academic libraries.Robertson asserts that Wiley, an international publisher for which he works, reported a profit of only 11 per cent most recently. Like any international company it is difficult to know from financial statements pertaining to activities in Australia what the overall profit was. For example, based on research for her PhD, Canadian academic Heather Morrison provided details of the enormous profits of several large scientific, technical and medical scholarly publishers.She quotes profits as a percentage of revenue for commercial STM publishers in 2010 or early 2011. These include Elsevier with profits of $1.5 billion on revenue of $3.4bn, or 36 per cent; Springer Science+Business Media, $636 million on revenue of $1.9bn (34 per cent); John Wiley & Sons, $106m on revenue of $253m (42 per cent); and the academic division of Informa with profits of $100m on revenues of $313m (32.4 per cent).Profits from academic publishing are immense, provoking widespread anger in universities, their libraries and research organisations. The Dutch government is in heavy conflict with Elsevier, a Dutch company, because of the huge payouts demanded for subscriptions to journals that it publishes. These are not minor misunderstandings but serious battles.The business strategy adopted by the major publishers of scientific and scholarly writing is brilliant.New knowledge generated from research is paid for from the public purse through research grants and academic salaries. Academics then give away their intellectual property to the publishers of their papers instead of licensing it. They then provide free peer review.While a portion of intellectual property could justifiably be assigned to publishers, new knowledge should quickly become available to the sponsoring public and it doesn’t. Instead, much essential free scientific water is bottled by publishers, then sold without compensation to the digger of the new well.Simple diagnostics, however, do not apply. The publishing companies have found in universities a hunger for numerical data to measure performance.The metrics of publication — how many times your paper has been cited and the prestige or impact factor of the journal you publish in — are used to judge you as an academic. Aggregated, the same metrics measure the performance of your institution.High-ranking universities attract more international fee-paying students. Academics acclaimed on these metrics gain promotion and preferred employment. Governments with no incentive to comprehend the complex social mission of universities beyond the publication metrics use them by default to determine university support. The system is closed and incestuous — and who can blame the publishers for making money from it?The plot thickens. Online publication has displaced print and accelerates the dissemination of new knowledge. Academic publishing has seen its share of shonky start-ups that have crashed and burned. The large established publishers have done deals with small academic associations and specialist journals that have kept their parents alive. The associations have found these arrangements to be financial havens and bless the publishers for their good fortune.The medical profession has passed this way before where the largesse of pharmaceutical companies has supported research and paid for conference travel. Publishers claim that when they take over the production of a journal they assure editorial independence. It is true that they take no interest in the content of the journal, and why should they? But independence of research workers suffers when their intellectual produce is commodified and sold as part of a commercial enterprise.The unfettered quest for new knowledge is crucial for innovation and progress. But academe and the research community have willingly embraced the octopus whose metric tentacles now threaten to strangle them.Assuming that Malcolm Turnbull is serious about innovation, which depends critically on new knowledge, the Prime Minister would do well to inquire into how new knowledge is made, or not made, freely available.Australia could lead the world by insisting on open access and the decommodification of all new knowledge.Now that would be innovative.Stephen Leeder is emeritus professor of public health and community medicine at the University of Sydney.
Published in The Australian November 4 2015
http://bit.ly/1MgQB01
Monday, October 19, 2015
Western Sydney is an amazing place with truly remarkable people providing health care.
WSLHD –
ANNUAL PUBLIC MEETING – 2015
WESTERN
SYDNEY – AMAZING PLACE!
Stephen
Leeder
Chair of the
WSLHD Board
I
add my acknowledgment to those already expressed of the original custodians of
the land and their elders past and present and I welcome people who identify as
Aboriginal people here today.
If
western Sydney issued its own number plates, what might be the motto? South Australia has The Festival State.
But
look where that led. The grand prix used
to be held in Adelaide but was moved to Melbourne because in Adelaide the
drivers kept falling asleep.
No
risk of that here! The growth of western
Sydney is amazing! The increase in
population is amazing! The diversity of
our population is amazing – so many cultures to guide us and enrich our life if
we open to them and embrace difference!
The bonds among our citizens to one another area amazing as we see in
our hospitals and schools and sporting organisations, in social clubs and religious
groups! So how about Western Sydney: Amazing
Place!?
Just look around – this amazing building that enables Western Sydney University to train doctors and nurses was not here a decade ago. The new hospital building is amazing. Mt Druitt is changing and developing rehabilitation services in amazing ways. The Millennium Research Institute’s new building at Westmead won the Sulman prize for architecture this year. Pretty amazing! Auburn Hospital and its community services have developed amazingly with the stimulus of the University of Notre Dame Australia. Community health services are adapting to the needs of people with chronic problems to provide care and support. The development of the Primary Health Network, building on years of work with our general practitioners and WentWest, has been critically important and amazing.
Our
biggest challenge at Westmead is to ensure that the hundreds of millions of
dollars invested in the upcoming Westmead Precinct inspire our services to match
their efforts to the health needs of western Sydney in ten to 20 years’ time.
We
have had amazing support from our state politicians, especially Premier Mike
Baird and Minister Jillian Skinner. We have enjoyed steady backing from our local politicians – federal, state and
local government – as well. We now also
have a federal minister for health and a prime minister committed to innovation
and growth. The ministry of health
headquarters at North Sydney, especially Health Infrastructure, have been a huge
help on this campus, Mt Druitt and at Westmead as has the secretary, Dr Mary Foley.
None
of this would have been possible without the leadership from Danny O’Connor and
his amazing executive team.
Now
all of these amazing things will help make western Sydney an Australian leader in
health care. I’m also happy that we are
helping the Australian economy to grow.
I hope Mr Turnbull notices!
As
you can’t improve productivity without bright new ideas about better ways of
doing things, so research and education, which is where these ideas often
originate, are critical. We invest in both
alongside clinical care. We are members
of a new partnership with Children’s Hospital, our research institutes, the
local health districts of Sydney and North Sydney and the University of Sydney
to ensure that what comes out of research is rapidly applied to clinical
problems and that the research agenda makes sense to clinicians and the
community.
Sometimes
we’re told that we are a huge cost, but we could say that in fact we are a
really big investment. Think of the thousands of jobs we create. We are already
amazingly productive, especially when you see how we apply new technologies and
perform so much additional work each year at a highly efficient price.
But
our primary function is to care for people in need and to find practical and
feasible ways to assist our citizens to experience the best possible health.
This requires us to take hold of the hands of other social agencies such as
education, community services, transport, and planning to advocate for better
and safer environments, more walkways and parks in our suburbs, more community
interaction, fewer liquor outlets and easier access to fresh food. No other way exists to deal definitively with
the massive problem of diabetes.
We
have the motivation – it is one of our most impressive qualities – and it never
ceases to amaze me how dedicated and committed our staff is to our central
purpose of helping people who are sick and searching for preventive opportunities.
Yes,
we have challenges. We have a long way
to go in meeting the mental health needs of our population. Recent turmoil at
our Aboriginal Medical Service needs steady hands, cool minds, compassionate
hearts and deep involvement from our Aboriginal community to set straight. We
are working on bringing together all the care needed by people with multiple
chronic illnesses.
We
are humans, not robots or automatons, and so we make mistakes – occasionally
devastating – through ignorance or insensitivity or inattention or overload or prejudice.
These mistakes damage our patients and our staff. As a healing, caring organisation we do two
things in relation to those mistakes. First, to those we have hurt we seek to offer
support and our apology. Second, then we
set about to learn from our mistakes. We
seek constantly to improve the quality and safety of our organisation. Our
quality awards recognise people in our organisation who have excelled in this
pursuit.
Although
torn by events such as the recent Friday shooting in Parramatta and the
persistent problems that lie beneath the surface of that event, there is much about
the steady, humane concern of our district that heartens us. This is Carers’ Week throughout
Australia. Think of all the care given
by families and individuals in our
community to the thousands of people with disabling chronic illness and frail
older people and young people with disabilities. As I found in a research study in which we
interviewed people with chronic illness in western Sydney, family, neighbours
and friends provide most of the care and support these people receive.
Take
the response of our community to the possibility that additional refugees from
Syria may soon be offered a home with us.
Think of the community groups Professor Zelas has identified that have
quietly set about planning how they will help and what they will provide for
these weary people. Western Sydney – amazing
place? It can also be a place of amazing
grace.
There
are many items on our agenda for the coming year. With so much on we can easily lose sight of
our central function – helping those who are sick to get back to the maximum
level of health within their limits and helping shape the environment so that
is easier for all our citizens to make healthy choices.
Today
I am speaking on behalf of your board.
We are all immensely proud of our workforce – managers, maintenance
crews, volunteers, medical, and nursing, research, education and support staff. We admire your commitment, your humanity,
your proficiency, your professional investment in making our district such an
amazing place. The board knows also how
much we depend on the support of this fabulous community. In turn, we want to support you as best we
can.
So
on behalf of your board I say thank you for all you do with us, for us and for
the community of this amazing place called western Sydney.
Monday, September 28, 2015
Home is where the chart is
I thought molecular biology was complex until I recently ventured into the world of etymology in search of the origin of the word ‘home’.
If you share my interest in this topic, then please take a look at the Oxford University Press blog by Anatoly Lieberman1, a multilingual 78-year-old teacher of etymology, linguistics and folklore at the University of Minnesota.
He begins with a scholarly and intricate exploration of the words ‘house’ and ‘home’ by writing: “When it comes to origins, we know as little about home as we do about house.”
Perhaps because of the mystery surrounding the origin of the word home, it is powerful, and we need to be careful how we use it.
So, what does it mean?
As Verlyn Klinkenborg, an Iowan non-fiction writer of rural literary meditations, wrote in the Smithsonian magazine in 2012:
One such person said to me: “Frankly, I find the idea creepy. It seems to be appropriating an idea (home) that implies warmth and comfort and security to refer to a place where you go when you are ill, insecure and frightened.”
Related News:
The idea has since gathered support.
Now there is a list of qualities that medical home practices must demonstrate in order to be accredited. According to the rules, they must be places where each patient has their own doctor who leads a multidisciplinary team that can meet the individual needs of the patient.
High standards of quality and safety must be adhered to, and performance is formally assessed against these standards. Payment “appropriately recognises the added value provided to patients who have a patient-centred medical home”.
Put simply, the medical home is a place where a patient is known personally by name and history and where a team of health professionals, generally led by a GP, arranges and provides the patient with the care they need.
Related Opinion:
At its best, it is about knowing the patient, honouring their identity and knowing their unique health and illness profile and then building on that knowledge whenever a medical transaction takes place.
Going beyond the group practice, the medical home is designed to bring together professionals from different disciplines.
Yet, where a group practice adds in a nurse and other health professionals to meet patients’ needs, in a medical home (at least as formally defined and not as an indefinite and warmly fuzzy idea), these services are more formally organised and paid for.
This has special salience for people with multiple long-term problems, who make up around 30% of the general practice patient population. But we need to be careful because attractive concepts — such as co-ordinated care, which has been trialled here over recent decades — can be disappointing.
There are other issues too, such as the successful co-ordination of carer services, both in hospital and at home. This is a serious management task, and not many doctors have undergone the necessary training to take on this role.
Hospitals are in a relatively strong position because of their infrastructure and range of specialties. For a GP, matching this level of service is going to be extremely challenging, unless he or she has a back-up organisation, such as a group practice.
So by all means, let’s discuss the medical home as a way to provide better personalised, stitched-up care. But let’s be careful: powerful words misused have a habit of coming back to bite you. Beware of overpromising and trampling on sacred ground.
Professor Leeder is Emeritus Professor at the Menzies Centre for Health Policy at the University of Sydney.
References:
If you share my interest in this topic, then please take a look at the Oxford University Press blog by Anatoly Lieberman1, a multilingual 78-year-old teacher of etymology, linguistics and folklore at the University of Minnesota.
He begins with a scholarly and intricate exploration of the words ‘house’ and ‘home’ by writing: “When it comes to origins, we know as little about home as we do about house.”
Perhaps because of the mystery surrounding the origin of the word home, it is powerful, and we need to be careful how we use it.
So, what does it mean?
As Verlyn Klinkenborg, an Iowan non-fiction writer of rural literary meditations, wrote in the Smithsonian magazine in 2012:
“Our psychological habitat is shaped by … the magnetic property of home: the way it aligns everything around us. Perhaps you remember a moment, coming home from a trip, when the house you call home looked, for a moment, like just another house on a street full of houses. For a fraction of a second, you could see your home as a stranger might see it. But then the illusion faded, and your house became home again. That, I think, is one of the most basic meanings of home — a place we can never see with a stranger’s eyes for more than a moment.”2Despite the word having such an uncertain origin and complex meaning, there’s currently much discussion within general practice about the idea of the ‘medical home’, which is portrayed as an attractive place, not to be confused with a nursing home or an institution for the residential care of people with severe disabilities. But not everyone with whom I have spoken likes the concept.
One such person said to me: “Frankly, I find the idea creepy. It seems to be appropriating an idea (home) that implies warmth and comfort and security to refer to a place where you go when you are ill, insecure and frightened.”
Related News:
- CDM items tied to 'medical home' under RACGP plan
- Primary embraces 'medical home' model
- Govt launches discussion on future of general practice
The idea has since gathered support.
Now there is a list of qualities that medical home practices must demonstrate in order to be accredited. According to the rules, they must be places where each patient has their own doctor who leads a multidisciplinary team that can meet the individual needs of the patient.
High standards of quality and safety must be adhered to, and performance is formally assessed against these standards. Payment “appropriately recognises the added value provided to patients who have a patient-centred medical home”.
Put simply, the medical home is a place where a patient is known personally by name and history and where a team of health professionals, generally led by a GP, arranges and provides the patient with the care they need.
Related Opinion:
At its best, it is about knowing the patient, honouring their identity and knowing their unique health and illness profile and then building on that knowledge whenever a medical transaction takes place.
Going beyond the group practice, the medical home is designed to bring together professionals from different disciplines.
Yet, where a group practice adds in a nurse and other health professionals to meet patients’ needs, in a medical home (at least as formally defined and not as an indefinite and warmly fuzzy idea), these services are more formally organised and paid for.
This has special salience for people with multiple long-term problems, who make up around 30% of the general practice patient population. But we need to be careful because attractive concepts — such as co-ordinated care, which has been trialled here over recent decades — can be disappointing.
There are other issues too, such as the successful co-ordination of carer services, both in hospital and at home. This is a serious management task, and not many doctors have undergone the necessary training to take on this role.
Hospitals are in a relatively strong position because of their infrastructure and range of specialties. For a GP, matching this level of service is going to be extremely challenging, unless he or she has a back-up organisation, such as a group practice.
So by all means, let’s discuss the medical home as a way to provide better personalised, stitched-up care. But let’s be careful: powerful words misused have a habit of coming back to bite you. Beware of overpromising and trampling on sacred ground.
Professor Leeder is Emeritus Professor at the Menzies Centre for Health Policy at the University of Sydney.
References:
- Oxford University Press blog 2015; Our habitat: one more etymology brought “home”; Anatoly Liberman.
- Smithsonian magazine 2012; The definition of home; Verlyn Klinkenborg.
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