More to health than hospitals, Mr Rudd

It’s been widely reported that one of Kevin Rudd’s first moves as Prime Minister elect was to send all Labor MPs back to school. Under instructions to visit one government and one non-government school in their electorates over two days, the MPs will test the waters of Labor’s Education Revolution.
Specifically, the plan to put a computer on the desk of every year 9 to 12 student, and the increased emphasis of trades education in schools will be on the agenda of meetings at schools today, as MPs prepare to report back to the partyroom tomorrow.
To his credit, Mr Rudd has wasted no time, although it does seem a big call to expect MPs and schools to think through such weighty issues in such a limited time. It’s also not clear how much input he’s inviting from state education departments, who might be thought to know a thing or two about the issues at stake.
So when it comes to firming up the party’s health policy, I’m hoping for a more considered approach, as well as one that recognises hospitals are not the only component of our health system. Mr Rudd has announced he will meet with premiers within three months to discuss health, but he must be careful.
It’s an understandable trap for young players with an ER mentality to equate the health system with busy hospitals and big machines. Hospitals may well be at the pointy end of the system, as well as generating most of the scary headlines feared by politicians, but the majority of health care takes place in primary, not secondary, care. Good evidence now exists to show that it’s accessible, high quality primary that has most influence over the state of the nation’s health.
Encouragingly, Labor has promised to develop a long-awaited National Primary Health Care Policy, but on the other hand has already announced GP clinics which may not be in the best interests of patients if they fragment care.
So please Mr Rudd, remember two things when it’s health’s turn.
Take it slowly. When sending out the troops to gather information, allow more than two days.
And please don’t focus on hospitals alone. Sit in with GPs and private specialists, outpatient mental health units, and boarding houses where the mentally ill sit alone smoking themselves to death.
Otherwise, you’re going to get a very warped view of what Australians need and what they’re getting.

Large shoes to fill for new health minister

A few Saturday nights ago I saw Don’s Party for the first time and realised I’d totally misunderstood what it was about for the last thirty something years. With election night 1969 the setting for the play, I was keen to see it because of the political similarities between the two elections, mainly a feeling that Labor could snatch victory from a longstanding Liberal government.
Boy, was I wrong. Williamson’s play was much more about personal rather than party politics, especially the social context of the times, predominantly boorish men who thought feminism was just a good excuse to get a bit of skirt.
The two election parties I attended last Saturday night were both much more like those I’d expected Don’s to be, except of course for the outcome.
But while Saturday’s landslide election settled the big question, there are still questions and debates aplenty.
For a start, who will be our next Health Minister? There’s still no clear indication Nicola Roxon will get the spot, and while I might not make many friends saying this, Tony will be a hard act to follow.
Sure he wore his Catholicism too much on his sleeve. His comments that it didn’t matter if hospital boards further distanced hospitals from primary care because GPs could deal with it didn’t sit well with me either.
On the other hand, his handling of the indemnity crisis, early funding of the cervical cancer vaccine in international terms, and some financial wins for GPs, such as the 100% rebate for GPs, can’t be ignored.
And according to the SMH today, he was often rolled in cabinet, so maybe he was trying to do more.
However, while he says he’s sad not to continue in the role, I’m not sure I believe him. Those in the know have told me the last year or so saw him looking increasingly distracted, but at least unlike many of his predecessors, Liberal and Labor, he seemed to not dislike doctors.

Male menopause confirmed a myth

I have to admit I’m a skeptic. Not in general, but about the male menopause, sometimes called the “andropause”, “male climacteric” or even the “viropause”. More recently, even more names have emerged, including “late onset hypogonadism” and “partial androgen deficiency in older men” (PADAM).
I’ve just read a study and editorial that’s only confirmed my skepticism.
Acknowledging that “menopause in women is an unquestionable condition caused by ovarian failure, with a number of symptoms related to decreased sex steroid production, hot flushes being the most common symptom”, the researchers go on to postulate a male climacteric, whereby age-related decreases in testosterone in men can develop a clinically relevant hormonal deficit.
Of course, the symptoms of male menopause would be subtle, the authors say, and its recognition could be obscured by normal ageing. Convenient really.
And another thing. Call me old-fashioned but I’d always considered the journal Menopause was aimed at doctors gynaecologists, and am not so sure this group is interested in aging men, unless they are one.
Anyway, in a nutshell, the Swedish study found that in men aged 55 to 75, symptoms thought perhaps due to androgen deficiency, including low libido, lack of energy, decreased strength, loss of height and less strong erections, were generally not associated with blood testosterone concentrations.
You’d think this finding would put a significant dent in the researchers’ confidence in the existence of the syndrome.
But in the words of a brilliant editorial in the journal, the issue has been repeatedly examined and shows little evidence of life. “It is now time for a decent burial.”
According to the editorial, the current researchers “describe the syndrome as a natural consequence of ageing”. “What is surprising is the need to revisit the body after so many death certificates have been issued”, it says. “What concerns us is the despondency produced by the results”, the editorial says in response to the following statement by the authors – “Unfortunately, and in line with others, we could not find any connection between those symptoms and circulating androgen levels”.
One can only speculate why researchers are so attached to this syndrome, which smacks of a me-too mentality, just like men who claim they have labour pains.
I suppose there’s money to be made by some drug companies if doctors are allowed, or even encouraged, to prescribe androgens for men without identified androgen deficiencies.
Maybe researchers in this area are so entrenched, their careers depend on it.
Whatever the reason, surely we’re at a point where there are more worthy targets of research.
Menopause 2007; 14; 999-1005.
Menopause 2007; 14; 973 - 5.