Friday, 10 June 2016

This Is A Serious Issue Which Needs A Higher Level Of Public Awareness.

This Is A Serious Issue Which Needs A Higher Level Of Public Awareness.

This appeared last week:

How to pick the good from the bad smartphone health apps

May 31, 2016 6.21am AEST

Carol Maher

National Heart Foundation Senior Research Fellow in Physical Activity, Sedentary Behaviour and Sleep, University of South Australia
With an estimated 100,000 health and fitness apps available on the two leading smartphone platforms, iOS and Android, it seems there is an app for everything – from tracking your bowel movements, to practising your pimple-popping technique.
However, a number of apps are starting to raise the ire of government regulators. Brain-training juggernaut Lumosity was recently fined US$2 million (A$2.7 million) for making unfounded claims that its app could improve work performance and delay the onset of Alzheimer’s.
“Ultimeyes”, a vision-training app touted to “turn back the clock on your vision” and reduce the need for glasses and contact lenses, was fined US$150,000 for misrepresenting scientific research and ordered to stop making deceptive marketing claims.
“MelApp” claimed to be able to assess melanoma on the basis of a photograph of the mole and some other inputted information, analysed using “patent protect, highly sophisticated mathematical algorithms and image pattern recognition technology”. The US Federal Trade Commission (FTC) found its claims lacked scientific evidence, leading to a hefty fine and strict instructions regarding future marketing.
To date, authorities have primarily pursued rogue health apps from a consumer rights perspective, on the basis of misleading advertising – that is, the apps claiming to do something when, in fact, they may be ineffective – rather than from a medical-safety perspective.
In the US, the Food and Drug Authority (FDA) is traditionally responsible for approving medical devices. However, apps that essentially allow a smartphone to become a medical device present a grey area. The FDA has issued guidelines, but compliance is primarily voluntary. Only a minuscule percentage of apps available in the Apple and Google Play stores have FDA approval.
Most apps that present themselves as substitute medical devices offer fine-print disclaimers, such as “not FDA cleared” and “for entertainment purposes”. This information is buried in the expandable description of the app on the app store, which most users will never read.
An interesting case in point is the hugely popular “Instant Blood Pressure” app, which has sold an estimated 148,000 copies. This app and others like it claim to read blood pressure – “no cuff required” (instead, the app supposedly uses the phone’s microphone pressed against the chest and a finger over the camera).
Independent testing published in March’s JAMA Internal Medicine found the app failed to identify high blood pressure in around 80% of true cases.
This is disturbing, considering such apps are likely to appeal to people with high blood pressure. It is conceivable that users could delay seeking medical attention on the basis of false normal-range readings, with potentially dire consequences.
So in this ever-expanding and largely unregulated app landscape, how can you go about distinguishing the good health apps from the bad?

1. Does the app use the phone’s built-in hardware to perform medical diagnoses?

Medical diagnostic equipment is highly specialised and specific, stringently tested and usually interpreted by skilled professionals. It’s therefore highly dubious that a smartphone app can match these diagnostic capabilities, based on the in-built microphone and camera, and interpretation by a commercial algorithm (which is typically unpublished and unproven).

2. Does the app use the phone’s in-built hardware to treat a medical condition?

While apps exist that claim to treat conditions such as pain, acne and seasonal affective disorder using smartphones’ vibrations and/or screen light (yes, really, and they’ve had thousands of paying downloads), such outputs lack scientific evidence and are extremely unlikely to be of therapeutic quality or intensity.

3. Is the app from a reputable source?

Affiliation with a reputable peak body, university or government department suggests the app is likely to be trustworthy. Beware, though, sneaky developers have been caught out inaccurately associating their app with leading universities (when, in fact, they simply studied there years earlier). Also, endorsement from obscure bodies shouldn’t convey confidence.

4. Does the app use self-help methods?

Self-monitoring, goal-setting and feedback are well-established techniques for boosting motivation and facilitating behaviour change. Such techniques are commonly offered in health apps and are likely to be useful for both people working on health goals that they wouldn’t normally see a doctor for (such as increasing fitness) and people self-managing a health condition in consultation with their doctor.

5. Does the app have bad reviews?

If reviews are bad, the app probably doesn’t work well, so give it a miss. However, good reviews aren’t necessarily a sign that an app is fundamentally trustworthy.

6. Might you put off seeing a doctor based on advice from the app?

Simply, don’t. While many apps contain sound medical information, they are no substitute for a consultation with a doctor. If you have a health concern, you should see a GP.
The landscape of smartphone health apps is quickly evolving, and regulators are struggling to keep pace. There are many outstanding apps to help people improve their health. My advice? Have fun experimenting with health and fitness apps – just be sure to bring along a healthy dose of common sense and scepticism.
And remember, an app does not put a doctor and specialist medical lab in your pocket.
Here is the link:
The view provided is rather confirmed by this article:

Medical apps prove tricky to regulate

Carmel Sparke | 31 May, 2016 | 
Most of us have smartphones jammed with apps that promise to improve our lives by tracking our sleep, finding the best coffee spots or, more annoyingly, reminding us it’s time to go for a run. 
Many are fun and entertaining, but some are for more serious medical purposes.
An estimated 165,000 medical apps are on offer that range from measuring blood pressure to helping manage conditions such as diabetes, asthma and mental health. 
While some are helpful, for the most part, this field of mobile personalised healthcare is untested, unregulated, possibly ungovernable and occasionally dangerous. 
A study by the University of NSW Black Dog Institute discovered that of the 120 suicide prevention apps they looked at, none provided comprehensive evidence-based support and some even contained dangerous advice. 
“Of greatest concern is the encouragement to engage in risky behaviours such as drugs and deliberate self-harm to manage a crisis,” said the researchers writing in PLOS One in April. 
Two years ago, US emergency specialist Dr Iltifat Husain, an expert in digital medicine, was highlighting the problem.
A review he carried out for the iMedicalApps website on a popular $3.99 blood pressure app, which used the iPhone’s camera and microphone to secure a reading, found it simply didn’t work. 
With clinical trials taking years to design, run and produce results, it seems that traditional scientific evaluation methods cannot keep pace with the speed of developments in digital health apps. 
“This lengthy process simply isn’t viable in the current app marketplace where the focus is on rapid delivery rather than proof of effect,” noted the Black Dog Institute researchers. 
More here:
Here is the link to the article.
More information
That we can have popular apps that simply do not work says it all - people need to be very careful with anything they download. The advice in the first article needs to be carefully considered and acted upon.
David.
Baca selengkapnya

Thursday, 9 June 2016

The Macro View - Budget, Election  And Health News Relevant To E-Health And Health In General.

The Macro View - Budget, Election And Health News Relevant To E-Health And Health In General.

June 09  Edition
With the Budget on May 3 now almost forgotten we are now off and rolling in the election campaign. We are seeing a lot of promises with Health from Labor with Medicare well and truly in focus. Also the traditional divide in areas of concern are being emphasised
As we move further into the campaign I am sure it will become more interesting - with the polls as tight as they are at present - and seemingly getting tighter, with some recent ones even suggesting Labor might win.
I also note concerns on economic growth,  the changes to superannuation as well as continuing cuts in other areas. It will be a while yet before it is clear just what the final outcomes of policy in both parties will be.
In the middle of the election campaign it is inevitable there is more commentary on the issue.
Globally there seems to be increasing worry  about the global economy.

Bill Gross: Get ready for an 'entirely different' market

Thursday, 2 Jun 2016 | 5:30 PM ET
Gross: Stellar returns of last 40 years won’t repeat - Janus portfolio manager Bill Gross discusses his investment playbook and outlook for the markets
Bill Gross has some bad news for investors.
In his June investment outlook released Thursday, the widely followed bond fund manager contended that bond and stock returns realized in the last 40 years are "a grey if not black swan event that cannot be repeated." Investors should not expect 7 percent returns on bonds or returns in the high single digits or double digits on stocks, Gross told CNBC on Thursday.
"The markets are entirely different and it would pay to travel to Mars as opposed to stay on Earth, because the returns here are very, very low," the manager of the Janus Capital Unconstrained Bond Fund, said on CNBC's "Power Lunch".
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Not sounding all that good…..

General Budget Issues.

Election 2016: Scott Morrison moves to head off economic growth fears

Date May 30, 2016 - 6:00PM

James Massola

Chief Political Reporter

Treasurer Scott Morrison has moved to pre-empt concerns about a potential slow-down in economic growth figures that will be released in Wednesday's national accounts.
And he has lashed Opposition Leader Bill Shorten's class warfare attack on a tax cut for big banks and big business in the Sunday night's election debate, describing it as a "retro ideological frolic" and cynical politics designed to play to the Labor base.
The Treasurer stressed he was not "commentating on the markets" but pointed out market expectations were that as the March 2015 growth figure of 0.9 per cent dropped out, it would be replaced by a figure of about 0.6 per cent growth for the March 2016 quarter and GDP growth of 2.7 per cent for the year to March, down from 3 per cent.
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  • May 30 2016 at 11:45 PM
  • Updated May 31 2016 at 7:45 AM

Election 2016: Scott Morrison says economy too fragile for Labor return

Treasurer Scott Morrison is ramping up attacks on Labor's opposition to corporate tax cuts in anticipation figures this week will show economic growth slowed last quarter.
Speaking after profits from mining to manufacturing and property services tanked by almost 5 per cent in the March quarter - escalating concerns about the sustainability of share investor dividend expectations - Mr Morrison indicated Wednesday' s national accounts were likely to underscore the economy's fragility.
"This is a very sensitive time for the Australian economy," he said in an interview. "Wherever the figures land, the policy objective doesn't change - and that's about securing growth in this economy. You can't increase investment by taxing it more."
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Federal election 2016: Scott Morrison steps up company tax pitch

  • The Australian
  • 12:00AM May 31, 2016

David Uren

David Crowe

Treasurer Scott Morrison says he believed people were ‘very alive’ to the global challenges.
Scott Morrison has redoubled his argument for $48.2 billion in ­company tax cuts to ward off a business slowdown, as the ­government braces for weaker growth in tomorrow’s national ­accounts, intensifying the election fight with Labor over economic management.
The Treasurer expressed concern at a fall in company profits just as Labor stepped up its attack on the ambitious tax cuts for generating an economic gain that was too small and took too long to create more jobs. Labor Treasury spokesman Chris Bowen is blaming the Coalition for a 26 per cent fall in private investment since the last election and dismissing the company tax cut for adding “a tiny 0.1 per cent” to the nation’s economic output every year.
Mr Morrison took on critics of the tax cut by insisting the government would fight for “every inch of growth” and voters should not trust Labor or others who rejected a proven option to expand the economy. “I think we’re being very honest with people, I think we’re being incredibly honest,” he told The Australian. “We’re saying it’s a tough economy out there.”
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The reality of post-China resources boom is good, bad and ugly

May 31, 2016 10:00pm
Terry McCrann Herald Sun
THE trade and current account deficit figures yesterday and the GDP ones today will combine to lay out with brutal clarity our post-China resources boom reality. The good, the bad and the ugly.
They will also serve to emphatically reinforce the two-tier message that Treasurer Scott Morrison has been trying to get across since budget night — an effort, which he has stepped up this week in anticipation of these critical figures.
The first and in a broad sense the overlaying element of the message is the absolutely fundamental need to encourage business — small, big and wicked multinational all — to invest and keep investing in Australia. Not just for one year or even one decade, but for decades.
Business — again, whether big or small, local or foreign — needs two things fundamentally, to embark on such long-term financial commitments. The first is a welcoming investment environment; the second is some confidence in sustained stability of both government policy and political governance.
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  • Jun 1 2016 at 11:45 PM

Election 2016: Company tax cuts will struggle to pass Senate

The federal government's 10-year plan to cut the company tax rate to 25 per cent will struggle to pass the Senate if the Coalition wins the election, with all those likely to hold the balance of power opposed to some or all of the package.
As the government used better-than-expected economic growth numbers to argue the tax cuts were needed to shore up an underlying weakness in the domestic economy, the Greens confirmed their opposition to the entirety of the tax cuts with the release of costings by the Parliamentary Budget Office which estimated the cost of the cuts over a decade would be $51 billion.
While just $3 billion different from the $48.2 billion Treasury estimated for the government, Greens treasury spokesman Adam Bandt, who commissioned the PBO modelling, called it "a death blow to the argument that company tax cuts are affordable".
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Higher Australian household debt mounts to ‘unsustainable’ levels

  • The Australian
  • 12:00AM June 4, 2016

Adam Creighton

“If something cannot go on forever, it will stop,” said Herbert Stein, economic adviser to presidents Nixon and Ford. Stein was mocking concerns about the ­“unsustainable” US current ­account and budget deficits in the late 1980s. He had a point, both grew much larger.
Calling things unsustainable is often a cover for expressing disapproval for other reasons. The federal budget has been in surplus in fewer than 20 of the 116 years since Federation, so deficits are clearly sustainable. What isn’t sustainable is a rising stock of public debt (and interest payments) as a share of national income.
Both main political parties are rightly and routinely admonished for doing little to stem the rising tide of federal and state government debt, which has tripled to about 34 per cent of GDP over the past 10 years. But the spectacular ascent of private debt, which has doubled to about 160 per cent of GDP over the past 20 years, hasn’t rated a mention by either side of politics in this election.
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Health Budget Issues.

Dr Michael Gannon named new Australian Medical Association president

Date May 29, 2016 - 2:41PM

Jane Lee

Legal affairs, health and science reporter

The Australian Medical Association's new president has vowed to repair the group's relationship with government, which he says has been partly damaged by speaking out on asylum seekers.
Western Australian obstetrician and gynaecologist Dr Michael Gannon -  who counts Coalition MPs among his friends - pledged to work "constructively" with whichever party formed government, shortly after he won the association's election at its national conference in Canberra on Sunday. 
The doctors' union has lobbied against a range of Coalition policies under outgoing president Associate Professor Brian Owler, including its failed $7 GP co-payment and abandoned hospital funding formula. It recently launched a public campaign against the Turnbull government's extended freeze on Medicare rebates to 2020, warning patients this could lead to GPs charging a co-payment of up to $20.
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AMA seeks to close political wounds with election of Michael Gannon as president

May 29, 2016 12:54pm
Sue Dunlevy National Health Reporter News Corp Australia Network
IT’S precisely the medical relief the Prime Minister needed — the doctors’ lobby has elected a new president who says he wants to work more closely with the Federal Government.
As the Royal Australian College of General Practitioners today launches television ads against the six-year freeze on Medicare rebates, its sister organisation the Australian Medical Association has elected a new president who has boasted of his close relationship with Coalition ministers.
West Australian obstetrician Michael Gannon told News Corp Australia earlier this year he wants to the AMA to work more closely with the government and said he thought the previous AMA leadership was too lefty.
Dr Gannon is a personal friend of Assistant Minister for Health Ken Wyatt and says he knows Finance Minister Mathias Cormann socially and he wants the AMA needs to rebuild its relationship with the Coalition Government.
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'GPs are at breaking point': new AMA president vows to fight Medicare freeze

Michael Gannon, who had previously said the AMA was becoming too left wing, says the six-year freeze is ‘unfair’ and ‘wrong’
The new AMA president, Dr Michael Gannon, says the freeze on indexation for Medicare rebates until 2019-20, announced in the budget, reflects ‘continued under-investment in general practice’. Photograph: Mick Tsikas/EPA
The new head of the Australian Medical Association has said fighting the Coalition’s “unfair” and “wrong” six-year Medicare freeze is his highest priority in his new post.
West Australian obstetrician Dr Michael Gannon, appointed to a two-year term as AMA president at the organisation’s national conference on Sunday, said general practitioners could not endure more restrictions imposed upon their working conditions.
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Labor prescribes healthcare reform

The Opposition Labor Party has promised to establish an Australian Healthcare Reform Commission to guide the continuous improvement of the nation’s healthcare system if elected at the 2 July Federal poll.
Opposition Spokesperson on Health, Catherine King announced the plan, saying a new Centre for Medicare and Healthcare System Innovation would also be established to develop, trial, evaluate and implement new payment and service delivery models to reduce health expenditure while improving the quality and safety of care.
“Much like the successful National Health and Hospitals Commission, the new Commission will have a key advisory role,” Ms King said.
“It will investigate, develop and evaluate proposed changes to Australia’s health system, and advise Governments — including State and Territory governments — on these changes.”
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Federal election 2016: doctor glut to blow out Medicare costs

  • The Australian
  • 12:00AM June 1, 2016

Adam Creighton

Growth in GP numbers of ­almost 50 per cent over the past decade — 2.5 times population growth — has undermined doctors’ ability to charge fees above the Medicare Benefits Schedule.
A growing glut of doctors has forced GPs to “chase patients” and pushed bulk-billing rates to record highs, leaving Medicare vulnerable to overuse that will add to its projected cost blowout of more than $35 billion within a decade.
Growth in GP numbers of ­almost 50 per cent over the past decade — 2.5 times population growth — has undermined doctors’ ability to charge fees above the Medicare Benefits Schedule, according to Australian Population Research Institute analysis.
The findings cast doubt on Labor’s and doctors’ claims that the Coalition’s plan to freeze the MBS for a further two years until 2020, to save $925 million, would hit bulk-billing rates. “There are so many GPs seeking patients that few could risk charging a co-payment because patients would go around the corner to a competitor who bulk bills,” said report author Bob Birrell. “Oversupply is the cause of escalation of GP costs that the Coalition is trying to curtail. But freezing the rebate is just a Band-Aid.”
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Soaring demand for after-hours GPs ‘open to abuse’

  • The Australian
  • 12:00AM June 3, 2016

Sean Parnell

Growth in “urgent” after-hours home doctor visits has prompted a leading provider to call for greater monitoring to prevent operators ripping off Medicare or allowing patients to abuse the ­system.
The number of services — funded through higher than normal Medicare rebates and usually bulk-billed — has doubled in just four years, from 733,685 in 2010-2011 to 1,475,547 last financial year, when it cost Medicare about $200 million.
Non-urgent after-hours visits increased in the same period, ­albeit only to 310,948, whereas standard-hours home visits declined, from 1,288,377 to 1,176,724, continuing a downward trend.
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Superannuation Issues.

Federal election 2016: Turnbull takes sting out of super

  • The Australian
  • 12:00AM May 30, 2016

David Crowe

Sid Maher

A clash over superannuation sharpened the election fight last night as Malcolm Turnbull promised voters there would be no further changes to the system after the controversial reforms in this month’s budget while Bill Shorten attacked the “poison” of retrospective tax laws.
Mr Turnbull used a televised debate with Mr Shorten to assure Australians that a Coalition government would not go beyond the super tax increases now before the public, while attempting to highlight sweeteners in the package that help women and those on low incomes.
In a debate that lacked fireworks and showed both men relying on prepared lines, the two leaders refused to accept that the other would have a mandate in power — highlighting the risk of a deadlock in the Senate under a Coalition or a Labor election ­victory.
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Coalition blind to superannuation debacle

  • The Australian
  • 12:00AM June 1, 2016

Glenda Korporaal

Watching Foreign Minister Julie Bishop’s grilling on Neil Mitchell’s program on radio 3AW yesterday on the Coalition’s proposed superannuation changes was painful.
It was patently clear that one of the government’s most senior and experienced members did not know what the transition to retirement scheme was and did not understand the impact of the proposed $1.6 million cap on
tax-free super.
Challenged on the fact that many more people would be affected by the sweeping super changes proposed on budget night than the 4 per cent the Treasurer declared, Bishop could only answer that this was the number given to her by the Treasury in a “briefing”.
Several weeks after the budget it is clear that senior members of the government either don’t know or don’t want to know the true impact of the changes on super.
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Super stoush could cost Coalition the election

  • The Australian
  • 10:57AM June 1, 2016

Robert Gottliebsen

One of the great dangers that governments in Australia face is that many in Treasury hate superannuation and don’t have a deep understanding of how it works in the lives of ordinary Australians.
Accordingly, the department led Treasurer Scott Morrison into claiming that only 4 per cent of Australians would be affected by the superannuation changes proposed in the budget.
The first person who can loosely be described as being ‘on the government’s side’ to raise the alarm was Tony Abbott’s former chief of staff Peta Credlin. She emphatically told Andrew Bolt that once the public understood the superannuation changes, the government would be forced to modify them as the election approached.
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Federal election 2016: Kelly O’Dwyer explains superannuation

  • The Australian
  • 9:57AM June 1, 2016

Rachel Baxendale

Assistant Treasurer and Minister for Small Business Kelly O'Dwyer is delighted to explain the Coalition’s superannuation policy.
Assistant Treasurer Kelly O’Dwyer has declined to directly comment on Peta Credlin’s declaration that she has been “completely absent from the campaign” and has not articulated the government’s superannuation policy sufficiently.
Ms O’Dwyer said she was not going to “commentate on a commentator”, but that she was delighted to be on ABC RN Breakfast radio earlier this morning.
“This is the first invitation I’ve received to be on your show to talk about superannuation, and I’ve actually been spending a lot of time travelling around the country talking to people about our small business tax cuts and superannuation policy,” Ms O’Dwyer told host Fran Kelly.
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  • Jun 1 2016 at 5:42 PM

Election 2016: Super tangle ensnares the government

Malcolm Turnbull won't be happy his enthusiasm about an economy in transition is being overwhelmed by arguments about "transition to retirement" and the government's other changes to superannuation.
So instead of being able to celebrate better than expected growth figures as confirming its "economic plan", Coalition messaging keeps being diverted by the antagonism, mainly from its own supporters, to its plan for super.
That leaves the Treasurer and the Prime Minister belatedly trying to refine their big super sell to emphasise such changes will help pay for those who will supposedly benefit from making the system "fairer".  
According to the government's list, that includes women with more flexible arrangements, lower income earners who get a tax credit and people over 65 who can now keep contributing.
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  • Jun 1 2016 at 6:36 PM

Not just wealthy hit by pension crackdown, say super experts

Superannuation experts warn a planned crackdown on transition-to-retirement pensions will hurt middle-income savers and burden the industry. 
Transition-to-retirement pensions are in the spotlight after Foreign Minister Julie Bishop was unable to explain incoming changes to the scheme during a radio interview with 3AW's Neil Mitchell his week. 
The scheme was designed to allow individuals aged 56-65 to wind back their work hours while maintaining their income levels. Under the current system transition-to-retirement pensions are tax free, but the government has said it will levy a 15 per cent tax on the earnings from July 1, 2017.
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Superannuation changes 'confusing seniors'

June 2, 20168:28am
AAP
Seniors are confused - and some are outraged - at the federal government's superannuation changes.
The issue has been put in the spotlight with some coalition MPs admitting they are receiving concerns from voters and will be seeking further consultation on the budget measures should they win the July 2 election.
"We accept that there is a need for some reform ... but I don't think it has been well sold and that's really fed into this whole area of people now resisting, I suspect, the importance of reform," National Seniors Australia chief executive Michael O'Neill told ABC radio.
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A fix for the Coalition’s super mess

  • The Australian
  • 9:38AM June 2, 2016

Robert Gottliebsen

From what I am hearing, the protests from Coalition members over changes to superannuation are far more vicious and widespread than what is being described in the media.
And so they should be.
The Coalition is still telling half-truths and untruths about some of the changes it proposes to make to super.
Indeed, almost every time a minister speaks on the subject the government digs a deeper superannuation hole.
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Impacts of the 2016 Budget superannuation measures

2 June 2016 Industry Expert |
Catherine Chivers looks at the key changes and potential Budget 2016 impacts on superannuation and taxation of small businesses.
On Tuesday 3 May 2016, Treasurer Morrison handed down his inaugural Federal Budget plan which was focussed on "growing jobs and supporting small business sustainably".
From a financial planning perspective, key measures involve changes to superannuation and taxation of small businesses. As expected, there will be a mixed series of impacts for clients, especially within the superannuation space.
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I look forward to comments on all this!
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David.
Baca selengkapnya
Oh Dear! It Seems Another State Health System Is Running Into Implementation Problems.

Oh Dear! It Seems Another State Health System Is Running Into Implementation Problems.

This appeared last week:

Doctors warn of budget blowout due to dodgy software program at Cairns Hospital

May 29, 2016 5:00am
Daniel Bateman The Cairns Post
SENIOR doctors have warned of a budget crisis developing at Cairns Hospital, with health bosses asking them to no longer use pens, and to switch off lights in unused rooms.
The Cairns and Hinterland Hospital and Health Service has confirmed it is facing a “modest” deficit by the end of the financial year, forecasting a shortfall of about $6 million.
However the Far North Queensland Senior Medical Staff Association has warned unless the health service’s new electronic medical records system is fixed – claiming it is a major contributor to the hospital’s financial woes – then a much larger budget blackhole could emerge.
Cairns has been one of two pilot sites in Queensland for the rollout of the software program, Digital Hospital, an Integrated Electronic Medical Record (iEMR) system.
The program removes the need for paper records and charts, allowing staff to see patient information across a number of wards and facilities.
Dr Sean McManus, vice- president of the medical staff association, said Digital Hospital was too unreliable, and therefore creating a lot of stress for clinical staff, distracting them from patient care.
He said hospital funding was dependent on accurate reporting of clinical activity like surgery and clinical visits, which was being jeopardised by the new software program.
“The effect it is having on work, ward rounds and clinics is it now takes significantly longer,’’ he said.
“Medical records are not readily available under the new system. Yes, it is accessible from multiple locations, but you can’t always access it.
“The ability to report on the work that is done in order to get more funding has been problematic.”
More here:
This all sounds rather like what we have already seen in Victoria, SA and to some extent in NSW.
As Mark Twain allegedly said - History seldom repeats but it does rhyme!
David.
Baca selengkapnya

Wednesday, 8 June 2016

Transparency International Reports on Massive Corruption in the Pharmaceutical Sector - Media Hardly Notices

Transparency International Reports on Massive Corruption in the Pharmaceutical Sector - Media Hardly Notices

Health Care Corruption as a Taboo Topic

Transparency International (TI) defines corruption as

Abuse of entrusted power for private gain

In 2006, TI published a report on health care corruption, which asserted that corruption is widespread throughout the world, serious, and causes severe harm to patients and society.

the scale of corruption is vast in both rich and poor countries.

Also,

Corruption might mean the difference between life and death for those in need of urgent care. It is invariably the poor in society who are affected most by corruption because they often cannot afford bribes or private health care. But corruption in the richest parts of the world also has its costs.

The report did not get much attention.  Since then, health care corruption has been nearly a taboo topic in the US.  When health care corruption is discussed in English speaking developed countries, it is almost always in terms of a problem that affects benighted less developed countries.  On Health Care Renewal, we have repeatedly asserted that health care corruption is a big problem in all countries, including the US, but the topic remains anechoic.

Yet somehow, a substantial minority of US citizens, 43%, seemed to believe that corruption is an important problem in US health care, according to a TI survey published in 2013 (look here).  But that survey was largely ignored in the media and health care and medical scholarly literature in the developed world, and when it was discussed, it was again in terms of results in less developed countries.  Health Care Renewal was practically the only source of coverage in the US of the survey's results.

Transparency International's New Report on Corruption in the Pharmaceutical Sector

Now Transparency International (TI) has tried, and Health Care Reenewal will try again.  In June, 2016 Transparency International published a new report entittled

Corruption in the Pharmaceutical Sector

The report's executive summary states:

Within the health sector, pharmaceuticals stands out as sub-sector that is particularly prone to corruption. There are abundant examples globally that display how corruption in the pharmaceutical sector endangers positive health outcomes.

In my humble opinion, the report is particularly significant in that it classifies as corrupt various kinds of activities that occur within the pharmaceutical sector (and also in other parts of health care) which are often discussed publicly as anything from standard operating procedure through unfortunate errors to unethical behavior. These include many activities which we have frequently discussed on Health Care Renewal. For example,

Manipulation of Clinical Research

We have frequently discussed how pharmaceutical companies, and biotechnology, medical device, and other health care companies and organizations, may manipulate clinical research to enhance the likelihood that is results will favor their products and marketing goals, even if the results are biased, inaccurate, could mislead physicians and patients, and ultimately harm patients.  The TI report included: 

As pharmaceutical companies rely on gaining market entry in order to recoup R&D costs, when there is a lack of oversight in clinical trial data publication a conflict of interest exists in which a pharmaceutical company may have an incentive to manipulate clinical trial data. When clinical trial data is manipulated medical literature can become biased with positive findings fabricated, positive findings exaggerated or negative results hidden. This can result in inadequate prescribing patterns because HCPs rely on clinical trial data to make decisions on which medicines to use to treat patients.

Suppression of Clinical Research

We have frequently discussed how health care organizations (as above) may outright suppress clinical research when the results fail to support their interests.  The TI report included:

Transparency and access to information through mandatory clinical trial registration, sanctions for not registering results or providing clinical trial information, and the publication of both positive and negative results are commonly discussed as helpful tools to curb corruption. With the European Medicines Agency (EMA) as a notable positive exception, public agencies and authorities do not require R&D-based pharmaceutical companies to make their raw data publicly available, making it impossible to verify whether the reported results are accurate. Based on laws and regulations clinical trial data is considered to be proprietary information, which allows pharmaceutical companies to conceal important data from the public domain.

Manipulation of the Dissemination of Clinical Research

We have frequently discussed how health care organizations may manipulate the dissemination of clinical research, through various forms of publications, presentations, courses, media summaries, etc, to favor their products and marketing goals, even if the results are misleading and could harm patients.  For example, a while back we discussed the problem of "ghost-written" articles appearing in scholarly journals. The TI report included:

The practice of ghostwriting is also a risk with clinical trials. Ghostwriting involves the writing of clinical trial publications by industry and then having a highly esteemed researcher pass these findings off as their own without disclosing their actual involvement with the authorship of the article. It is a common practice, particularly in industry led trials. Ghostwriting is done to increase the prestige and reputation of the findings, while simultaneously researchers are able to improve their reputation, which can lead to promotions. Clearly this practice can result in inaccurate results being published.

Deceptive Marketing

We have frequently discussed how marketing of pharmaceuticals (and nearly everything else in health care) may be deceptive, favoring companies' products and services, but again misleading health care professionals and patients, and ultimately risking patient harm.  In the extreme, pharmaceutical companies (and other health care organizations) may resort to bribes or kickbacks.  The TI report included:

There are several methods for a corrupt pharmaceutical company to unethically market its medicines. At its most simple a pharmaceutical company can bribe a HCP directly with payments so its medicines are more likely to be prescribed. More abstrusely individuals may include a pharmaceutical company’s medicine on the national list that is reimbursed by public funds, in return for an indirect bribe by being sent to inappropriate holiday destinations for lavish conferences.

Corrupt marketing practices also include pharmaceutical companies providing misleading information regarding the safety and efficacy of a medicine to influence doctors’ prescribing habits and encouraging off-label, unlicensed use to increase sales.

Other Topics

Finally, the report mentions such issues as the revolving door, regulatory capture, etc, etc, etc

A Striking, and Strikingly Anechoic Report

Again, while the report summarizes information that is likely familiar to most Health Care Renewal readers, what is striking is that it describes manipulation of clinical research, suppression of clinical research, manipulation of dissemination of clinical research, and deceptive marketing as corruption.  That is a sentiment rarely heard in the US, and one that appears nearly taboo.  

Demonstrating the strength of the taboo, this striking report has gotten almost no attention in the media or scholarly medical and health care literature in the developed English-speaking countries.  Let me note the important exceptions, however.

I learned of the report from a brief news item from the BMJ, the prestigious UK journal that seems most at the forefront of championing the integrity of medical and health care research.(1)  The only substantial news article I could find on the report was also from the UK, in the Independent.  Its sub-title is worth repeating:

Transparency International says corruption is making a few rich and wrecking the health of some of the world's poorest people

Also, there were brief articles in Reuters, and in (web-only) FiercePharma.  That is about it so far.

The report itself suggests why it has been so anechoic, just like nearly every other attempt to expose health care corruption to public discussion.  Essentially, there is so much money to be made through pharmaceutical (and by implication, other health care corruption) that the corrupt have the money, power, and resources to protect their wealth accumulation by keeping it obscure.  In the TI Report itself,

However, strong control over key processes combined with huge resources and big profits to be made make the pharmaceutical industry particularly vulnerable to corruption. Pharmaceutical companies have the opportunity to use their influence and resources to exploit weak governance structures and divert policy and institutions away from public health objectives and towards their own profit maximising interests.

Keep in mind that the money made from corruption does not just go to innocent peoples' retirement funds that are invested in pharmaceutical stocks.  It predominantly goes to top corporate executives and managers, and their cronies who preside over the corrupt practices.


I might as well repeat myself once again.  As I wrote in 2015,

If we are not willing to even talk about health care corruption, how will we ever challenge it? 

So to repeat an ending to one of my previous posts on health care corruption....  if we really want to reform health care, in the little time we may have before our health care bubble bursts, we will need to take strong action against health care corruption.  Such action will really disturb the insiders within large health care organizations who have gotten rich from their organizations' misbehavior, and thus taking such action will require some courage.  Yet such action cannot begin until we acknowledge and freely discuss the problem.  The first step against health care corruption is to be able to say or write the words, health care corruption.

Reference

1.  Torjesen I.  Group calls for more to be done to tackle corruption in the pharmaceutical industry. BMJ 2016;353:i3099. Link here.
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The UK Finds That Personal Health Records Are Pretty Much Useless. What A Surprise!

The UK Finds That Personal Health Records Are Pretty Much Useless. What A Surprise!

This appeared last week:

PHRs struggling to gain traction and show benefits - review

Ben Heather
2 June 2016
Attempts to create a personal health records suffer from a “lack of quantifiable benefits” and some schemes face an uncertain future if new funding is not found.
A wide ranging review of PHRs, carried out by the Royal College of Physicians’ Health Informatics Unit and funded by NHS England, found that attempts to put more health information in the hands of patients remain at a “relatively low level of maturity.”
It also found that while organisations that had set up PHR projects claimed they had led to meaningful improvements - from fewer hospitalisations to cost savings – these were mostly “assumptions or anecdotal.”
“Many of the case study sites had invested in PHRs on the basis that they are ‘a good thing’, but with little evidence of quantified benefits,” a report released this week says. “The lack of a viable business case could slow further developments and make existing PHRs unsustainable.”
Professor Jeremy Wyatt, who leads the Health Informatics Unit, said there was a clear desire from the public to get more involved in managing their health; but not yet the capacity for providers to deliver.
“Personal health records are a tool that can facilitate this, but at present are only available to restricted groups of patients,” he said. “The evidence shows that more work is required to develop and improve the user experience.”
The report defines personal health records as “a digital tool that helps people to maintain their health and manage their care”; most often by enabling them to access their health record, carry out transactional services, and communicate with medical staff.
Rolling out PHRs across the country is part of the National Information Board’s ‘Personalised Health and Care 2020’ framework to drive improved use of digital technology in healthcare; and some large acute and mental health trusts have invested in developing them.
Lots more here:
Here is the link to the report:
Here are the summary recommendations:

Key recommendations

  • There is little information available on the usage of PHRs in the UK, but it appears that the number of both individual users and organisational users is low.
  • Although it seems self-evident that patients and service users should have access to their electronic records, how they can do that is currently unclear, as are what data they want to see or which functions they are able to carry out using their PHR.
  • At best, there is only anecdotal information on PHR benefits, with little concrete evidence, and funding tends to be short term.
  • Where a PHR is used, it tends to be for a very specific purpose with a very specific user base.
  • Commonly identified success factors in the adoption of PHRs were: health/care professionals encouraging patients; good communications through multiple channels; support for users at the start (e.g. demonstrating use of PHR).
  • It is vital that patients and health/social care professionals are active participants in the design, implementation and appraisal of PHRs.
  • The implementation of PHRs has tended to focus on enhancing information sharing and communication. The failure to fully utilise PHRs for health service improvement projects may mean that potential improvements in cost-efficiency and effectiveness are not being realised.
  • Further research should seek to understand what patients require from PHRs, along with exploring and piloting projects that utilise the features available within a PHR to deliver health or social care in innovative ways.
  • With the anticipated greater use, functionality and complexity of PHRs, sufficient attention must be paid to the design and user interface of these systems to ensure ease of use by, and benefits for, all sectors of the community.
-----  End Summary.
There is little reason to think that things are any different in Australia and this all goes to show just how evidence free the PCEHR / myHR is!
David.
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