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.

General practice and the rise of chronic illness

Published in Australian Medicine 21 September 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:

“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.”²

Despite 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

Where has the medical home concept come from? According to Wikipedia, it was first articulated by the American Academy of Pediatrics in 1967 to offer co-ordinated care for children and their families, especially those with special needs.

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:

• There's no place like (a medical) home
• Home is where the heart is

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:

1. Oxford University Press blog 2015; Our habitat: one more etymology brought “home”; Anatoly Liberman.
2. Smithsonian magazine 2012; The definition of home; Verlyn Klinkenborg.

Published in Australian Doctor 28 September 2015

Dreaming of how things might be

Published in Australian Medicine 27 August 2015 http://bit.ly/1O4QDGR

Recent interview with ANU students about medical publishing.

Here is an interview with ANU students about medical publishing that may be of interest.
http://bit.ly/1EMOfz5

Gilead's Greed that Kills - Jeffrey Sachs - July 27 2015

Gilead's Greed that Kills

 Jeffrey Sachs

 

July, 27, 2015.

Gilead Sciences is an American pharmaceutical company driven by unquenchable greed. The company is causing hundreds of thousands of Americans with Hepatitis C to suffer unnecessarily and many of them to die as the result of its monopolistic practices, while public health programs face bankruptcy. Gilead CEO John C. Martin took home a reported $19 million last year in compensation--the spoils of untrammeled greed.

Hepatitis C is a global public health crisis, called a "viral time bomb" by the World Health Organization. 150 million people or more worldwide are estimated to be living with the disease. Untreated Hepatitis C can progress to cirrhosis, liver failure, and liver cancer. Every year, at least 700,000 people die from these complications--although HCV can be easily cured with just 12 weeks of medicines being sold by Gilead.

Gilead insists it is saving lives. It claims that it is a hero of innovation, bringing new wonder drugs to the market to cure Hepatitis C, an often-lethal disease that infects almost three million Americans and perhaps 80 million or more people worldwide. The company certainly could be a hero, but is the opposite today. Gilead is the main obstacle between tens of millions of very sick individuals and the medicine that could end their suffering and save their lives.

Gilead owns the monopoly patents on two life-saving Hepatitis C drugs, Solvadi and Harvoni. Gilead did not discover or develop these drugs, except for a brief and modest role at the end of the drug-approval process. Gilead bought these drugs from their discoverers and developers in 2011, after a decade-long discovery and development process, and just before the FDA licensed the drugs in 2013. It bought them with the knowledge that it would use its greed and lobbying power to rip off the American people and deprive people around the world of the benefits of these wonder drugs.

Gilead's gambit worked like this. The US Government funded most of the basic research for Sofosbuvir, the scientific name of the drug that underpins Gilead's two brand name drugs. Yet despite Sofosbuvir being discovered, developed, and tested through phase 2 clinical trials mainly with US Government funds, the government-funded scientist and some early investors took the patent rights. Their private company, Pharmasett, had invested less than $200 million in R&D. In truth, the US Government should own most of the intellectual property on Sofosbuvir, but under U.S. law and practices it is private investors who reap the rewards and taxpayers who bear the burden and the consequences.

Gilead paid Pharmasett $11 billion because it knew very well that it was about to rip off the American people and quickly recoup this sum and much more. Gilead announced that it would use its newly acquired monopoly rights to charge a whopping $84,000 per treatment for Solvadi (and $96,000 for Harvoni, a slightly different formulation), even though the actual production costs are estimated to be somewhere around $68 - $136. Gilead's markup over costs may be close to 1,000-to-1, probably a world record.

How did Gilead choose the price? It chose it for one reason: because it could get away with it. Washington allows this kind of abuse to occur, indeed insists upon it. Medicare is obliged -- in one of the most absurd policies of our era -- to accept whatever price a pharmaceutical company asks for its patent-protected medicines! The result is a level of drug prices that bear no resemblance whatsoever to the costs of production (including the R&D), or to the socially optimal drug pricing that would enable sick people to be cured of their illness.

Gilead says that $84,000 approximates the current last-ditch alternative (a liver transplant) but this is a ridiculous comparison; the new drug indeed allows people to be cured at a very low cost, so there is no reason to hark back to an out-of-date, ineffective approach that is too expensive for the vast majority of people suffering from the disease. Indeed, the taxpayers pay twice: first to fund the innovation, and second to feed a monopoly. From the company's point of view, soaking the taxpayer is the strategy; curing people is a sideshow at best.

By setting an outrageous retail price, Gilead tapped into federal spending on drugs under Medicare and Medicaid, and billed the US and the states for around $6 billion last year, something like $4 billion paid by Medicare and $2 billion paid by Medicaid, according to recent estimates. The federal and state governments therefore probably paid for more than half of the $10 billion that Gilead collected in revenues in the first year of sales, basically enough to recoup the purchase price in less than two years.

Given the monopoly price, tens of thousands of Americans and millions of people around the world infected with Hepatitis C are being told by their doctors, their health insurers, or Medicaid, that they don't "yet" qualify for Sofosbuvir because they are not yet sick enough. Their livers are not yet scarred enough. They are not yet dead enough. They should come back when they are nearly dead, if it's not too late.

Sofosbuvir could reach tens of millions of people worldwide if the drug were available at its true production cost (inclusive of R&D). At $500 per treatment, or even $1,000, millions of people around the world would be able to access this cure. But today, only a tiny fraction do, those who are covered by Medicare, Medicaid, or private insurance to pay $84,000 or some other astronomical price set by Gilead, or a sliver of people abroad who are lucky recipients of some specialized access program. Outside of the US, countries and patients must jump through so many burning hoops that access is fatally compromised, and the human right to health is fundamentally violated.

The end result is a continuing epidemic of Hepatitis C at the very moment that the disease could actually be eliminated or at least close to it. The New York Times has recently reported a new mass outbreak among IV-drug users, who are not able to gain access to treatment. These people are being left to die.

America has handed life and death decisions to corporate greed. Gilead is indeed the death panel that we were once warned about. Yet the Gilead death panel rations a life-saving cure not because it is too expensive to provide, but because it serves the interest of a patent-protected corporate monopoly. It is time for the US citizens to demand the intellectual property rights that US Government-backed science should give them; and for the Government to use rational price-setting to tame untrammeled corporate greed and the monopoly power created by a highly inefficient and unfair patent system.

 

Non-communicable disease: will we rise to the global challenge?



Published in Australian Medicine 6 July 2015 http://bit.ly/1J1Gma6