Archive for the ‘social psychology’ Category

For those concerned by proposed changes to Oz guidelines for Doctors re complementary medicine: what the proposed changes are

April 8, 2019

Actual proposed  Oz guidelines for doctors re complementary and unconventional medicine, from https://www.medicalboard.gov.au/News/Current-Consultations.aspx are copied in below.  Much of the concern seems to be from those who have not read them.  Read before worrying, then you will sound more sensible if you comment in the way described on the medicalboard.gov.au site.

The consultation is called

Public consultation on clearer regulation of medical practitioners who provide complementary and unconventional medicine and emerging treatments

Guidance for all registered medical practitioners

This section of the guidelines includes guidance for all registered medical practitioners including those doctors whose patients use complementary and unconventional medicine and emerging treatments, but who don’t themselves provide these treatments.

  1. Discussion with patients

The use of complementary and unconventional medicine and emerging treatments is increasing. It is therefore important that all medical practitioners are aware of these areas of practice and how they may affect their patients and impact other treatments, regardless of whether they themselves provide or recommend these treatments. There are resources available for medical practitioners when discussing complementary and unconventional medicine and emerging treatments with their patients.[1]

Good medical practice for all medical practitioners involves:

  • Asking your patients about their use of complementary and unconventional medicine and emerging treatments regardless of whether you provide or recommend these treatments.
  • Taking into consideration your patient’s use of complementary and unconventional medicine and emerging treatments when determining appropriate management for your patient.
  • Respecting your patient’s right to make informed decisions about their health and their right to choose complementary and unconventional medicine and emerging treatments.

 

 

Guidance for registered medical practitioners who provide complementary and unconventional medicine and emerging treatments

This section of the guidelines includes guidance for registered medical practitioners who provide complementary and unconventional medicine and emerging treatments.

  1. Knowledge and skills

Safe patient care relies on the medical practitioner having the knowledge and skills in the area of medicine in which they practise. This is both for the treatments being provided and the conditions for which patients seek treatment. This is particularly important where treatments may not be part of standard medical training, for alternative uses of conventional treatments and for new and emerging treatments that are continuously evolving.

Good medical practice for medical practitioners providing complementary and unconventional medicine and emerging treatments involves:

  • Ensuring you have current knowledge and skills for your scope of practice to ensure safe patient care.
  • Only offering treatments if you have the appropriate training, expertise and experience in both the treatment and the condition being treated.
  • Arranging appropriate and timely specialist referral, when indicated.
  • Undertaking necessary training if you intend to change your scope of practice to include complementary and unconventional medicine and emerging treatments.
  1. Conflicts of interest

Conflicts of interest can arise when providing complementary and unconventional medicine and emerging treatments. This is the case when there are high costs involved as well as because of the experimental and commercial aspects of some treatments.

Good medical practice for medical practitioners providing complementary and unconventional medicine and emerging treatments involves:

  • Always acting honestly and only in your patient’s best interests when providing complementary and unconventional medicine and emerging treatments.
  • Ensuring that you do not have a financial or commercial conflict of interest that may influence the advice and/or treatment that you give your patients.
  1. Informed consent

Patients have a right to know if the treatment they are being offered is not considered to be ‘conventional medicine’. They have the right to know the evidence for its efficacy and safe use.

Medical practitioners proposing complementary and unconventional medicine and emerging treatments must obtain informed consent from their patient. Good medical practice involves:

  • Providing your patient with enough information, preferably in written form, for them to make informed decisions about proposed assessments, investigations and treatments.
  • Providing your patient with clear information about:
    • the extent to which the assessment, investigation and treatment is consistent with conventional medicine and accepted by the medical profession or if it is considered alternative and/or experimental
    • the degree to which, and how, diagnostic investigations and tests have been formally evaluated and what is known about their reliability, safety and risks
    • the degree to which, and how, the proposed treatments have been formally evaluated or proven and what is known about their safety, side effects, risks, likely effectiveness and a realistic likelihood of benefit for the proposed use.
    • the range of possible outcomes, taking into consideration the patient’s expectations
    • the likely number of investigations and treatments required and the costs involved
    • other treatment options (including conventional treatments), their risks, likely benefits and efficacy based on the best current available information.
  • Ensuring that patients who may be vulnerable because of the serious and/or chronic nature of their condition and/or because conventional medicine has not been effective, are not exploited or unduly influenced.
  • Ensuring that information provided about complementary and unconventional medicine and emerging treatments does not create unrealistic patient expectations.
  • Informing your patient of their right to seek a second opinion regarding their treatment and options from another independent medical practitioner when proposing treatments that are complementary, unconventional or emerging.
  1. Assessment and diagnosis

Some medical practitioners providing complementary and unconventional medicine and emerging treatments use diagnostic methods and tests that are not considered to be part of conventional medicine.

Good medical practice in the assessment and diagnosis of patients involves:

  • Ensuring the assessment and examination of your patient is comprehensive and considers all relevant information.
  • Ensuring that any recommendation for investigations or tests is based on the best current available information.
  • Performing and/or ordering any generally recognised diagnostic investigations and tests that would be reasonably expected for appropriate patient care.
  • Ensuring you consider appropriate differential diagnoses for each individual patient.
  • Ensuring that your diagnosis is supported by sound clinical judgement and informed by the best current available information.
  1. Treatment

Providing a treatment in the absence of an identified therapeutic need can unnecessarily expose a patient to risk of harm. Patient harm can also result if the provision of complementary and unconventional medicine and emerging treatments results in delays in accessing more appropriate treatments for the patient.

Good medical practice when providing complementary and unconventional medicine and emerging medicine involves:

  • Ensuring that you do not discourage the use of conventional treatment options when this is clinically appropriate.
  • Only recommending treatments where there is an identified therapeutic need, quality and safety can be reasonably assured and that have a reasonable expectation of clinical efficacy and benefit.
  • Ensuring that the provision of any complementary and unconventional medicine and emerging treatments comply with any relevant Therapeutic Goods Administration requirements.[2]
  1. Patient management

Good patient care is supported when there is good communication with, and coordination of care between, all treating practitioners. When the provider of complementary and unconventional medicine or emerging treatments does not have a role in the patient’s regular medical care it is important to ensure that there are measures in place for the coordination of care. Follow-up of patients is particularly important where treatment is provided that is experimental and/or part of a formal research clinical trial – both for the patient’s wellbeing and for the contribution to medical knowledge.

Good medical practice for the care of your patients to whom you are providing complementary and unconventional medicine and emerging treatments involves:

  • Documenting information including the diagnosis, treatment, efficacy, side-effects and known risks of interactions in the patient’s medical record.
  • Ensuring that you take responsibility for appropriate monitoring and follow-up of patients to whom you are providing complementary and unconventional and emerging treatments. This is even more important when you are providing experimental treatments.
  • Encouraging your patients to tell their other health practitioners about their use of complementary and unconventional medicine and emerging treatments.
  • With permission from your patient, communicating with their other treating doctors (if applicable). You should inform other treating medical practitioners of the investigations, the diagnoses, treatments, known risks of interactions and patient progress.
  • Reporting adverse events to the relevant authority to assist safety monitoring.
  1. Advertising

Some patients who seek complementary and unconventional medicine or emerging treatments may be vulnerable to advertising that may lead to unreasonable expectations. The advertising provisions in Section 133 of the National Law include that a regulated health service must not be advertised in a way that is false, misleading or deceptive or creates an unreasonable expectation of beneficial treatment.

Good medical practice when advertising complementary and unconventional medicine and emerging treatments involves:

  • Ensuring that all advertising material, including practice and practitioner websites, complies with the Board’s Guidelines for advertising of regulated health services, including the advertising requirements of section 133 of the National Law, of the Therapeutic Goods Administration and the Therapeutic Goods Advertising Code and of the Australian Competition and Consumer Commission.
  • Ensuring that you do not create the impression that you are a specialist in an area of practice that is not a recognised specialty.
  • Ensuring advertising material does not create unreasonable patient expectations of the benefits of the complementary and unconventional medicine and emerging treatments.
  1. Research and advancing knowledge

Innovation and research in new treatments is necessary to improve health outcomes. However, there must be protections in place for patients. Efforts to make advancements in treatments should not jeopardise patient safety.

Good medical practice in the research and advancement of complementary and unconventional medicine and emerging treatments involves:

  • Ensuring that research involving complementary and unconventional medicine and emerging treatments complies with the National Health and Medical Research Council’s (NHMRC) current ‘Australian Code for the Responsible Conduct of Research’ and ‘National Statement on Ethical Conduct in Human Research’.
  • Where tests and treatments are experimental, being prepared to contribute to and share new knowledge with the profession.

Acknowledgements

The Board acknowledges the following organisations’ codes and guidelines, which helped inform the development of the Board’s draft guidelines:

  • Medical Council of New South Wales (2015) Complementary health care policy
  • Medical Council of New Zealand (2011) Statement on complementary and alternative medicine

Implementation date and review

These guidelines will take effect on <date>.

The Board will review these guidelines at least every five years.

[1] For example, National Health and Medical Research Council (NHMRC), Talking with your patients about Complementary Medicine – a Resource for Clinicians, 2014 and NHMRC, Stem Cell Treatments – A Quick Guide for Medical Practitioners, 2013

[2] For example, Therapeutic Goods Administration (TGA), Australian regulatory guidelines for complementary medicines, 2018 and TGA, Australian regulatory guidelines for biologicals, 2017.

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Basic Wage: We have gone backwards since 1907.

March 26, 2019

Oz Liberal Party are saying that we can’t afford Labor’s plan to set Fair Work’s guidelines to seek basic wage to keep single person out of poverty.  (Yes, our “independent arbiter” on minimum wage is independent, but it runs on rails laid by the government…)

Time for the general public in Oz and overseas to revisit the Harvester Decision 1907 (!)  :

As the Fair Work Commission’s website says:

In Ex parte H.V. McKay (the Harvester Decision), Justice Higgins of the Commonwealth Conciliation and Arbitration Court decided to determine what ‘fair and reasonable’ wages were using the following test:

I cannot think of any other standard appropriate than the normal needs of the average employee, regarded as a human being living in a civilised community. [p.3]

This became the basis of the national minimum wage system in Australia. It was a ‘living’ or ‘family’ wage, set at a level which would supposedly allow an unskilled labourer to support a wife and three children, to feed, house, and clothe them. By the 1920s it applied to over half of the Australian workforce. It became known as the ‘basic wage’. Additional amounts were paid to more skilled workers, for example an additional 3 shillings to a fitter or other tradesperson. These additional amounts were known as ‘margins’.

Our politicians are so proud of how we have “advanced” as a society. Well, let’s not go back to the high employment standards of 1907.  Compromise.  Don’t have the minimum be for a family of 2 adults and 3 children.  Let it be for a single adult, but have government support for dependants – covered by taking back some of the tax cuts we have had.  Have the Nation recognise that we need the children to be well-educated and healthy and happy if we are to continue as a strong nation.

Follow Justice Higgins: set the basic wage to cover at least housing, healthy food, medical costs (including dental and optical), power, water, clothes, footwear, furniture, rates, life insurance, savings in case of loss of employment, union dues, books and newspapers and NBN, public transport fares, school requisites, amusements and holidays, replacement of items such as refrigerators, domestic help, and any expenditure for unusual contingencies (e.g. too ill to work,  have to move house, death in family, etc.)

Yes, this means that Australia’s high rental and power costs should be figured in.

Seems weird that we have a high minimum wage by global standards but workers need more?

That’s what comes of letting private industry run vital services (Adam Smith would be horrified, and his works are the basis of many neocons’ theories!)  and also destroying the government-run provision of housing at controlled cost for low-income people.  With the perennial politicians’ bribes of lower taxes we have had the sale of infrastructure and the collapse of State Housing Commission support – with over a year’s wait for emergency housing as one result.  In North Metro Perth, 2018, the average wait was 166 weeks.  I therefore say that the private market’s prices for housing and power and internet must be factored into any calculation of unemployment and sickness benefits, as it should for the basic wage.

Politicians’ high incomes blind them to the reality of the effects of proposed taxation changes.

March 6, 2019

Most of the political claims around the Australian Labor Party’s franking credits tax plans talk about retirees. The pollies have missed the point – which is odd, as they probably own franked shares!  I guess they are just too wealthy to understand what happens to those on low incomes.

But why don’t journalists pick them up on it?

My understanding of shareholding is that shareholders are basically the company’s owners – each share being an equal “share” of the company.  In Australia the company pays tax on its profit to a maximum of 30%.  When the after-tax profits are shared out per share as dividend income to the owners, each has effectively paid that tax on that income. That tax per shareholding is the “franking credit.” For tax, both the dividend and the franking credit together make the shareholder’s income from owning part of the company.

The shareholder’s individual marginal tax rate may be more or less than the rate the company paid – if more, they pay the difference between what the company paid and their rate. If less, they get back the tax they have overpaid.

Consider a person who comes from a very Labor family.  He is single,  has lived quietly and bought shares instead of travelling and partying, and is now  effectively unemployable but too young to retire.  He cannot get unemployment benefits (“Newstart”) as he has paid off his home and has over $258,500 in assets outside the home.  His shares give him about $14,000 in franked dividends, with the franking credits of $6,000.  That is a total of about $385/week – $272 before franking credit refund  – and he gets by on that, nursing the $6,000 tax refund to get past unexpected expenses.  Newstart would be about $275 per week, according to the humanservices.gov.au website.

Under the proposed changes, he will have his effective income cut to $14,000 – cut by almost a third, to less than the  Newstart allowance he cannot get.  At the same time, a federal backbencher on the 2018 base salary of $207,100 a year with dividends of $14,000 will get the $6,000 back as a tax credit, suffering no change to income .

That makes him angry. And it has made me  angry too.

I feel that if Labor really cared about the battlers, it would not do this – if franking credits tax law must be messed with to stop wealthy family trusts and large superannuation holdings from getting big refunds, Labor should change the rules for large holdings, or say that only actual human individuals below median wage equivalent taxable income should get the credits back.  Or they should abandon the refunds altogether.  Not claim that the low income people who get taxed dividends “have not paid tax” and so shouldn’t get the franking credits refunded, insisting that they can only be used to pay tax due for other reasons.

I would like every journalist who has a pollie claim that the low income people who get franked dividends “have not paid tax” call them on that falsehood.

I would like every journalist who has a pollie talk about retirees and superannuation funds as being the only things affected by the proposed changes, or about “franking credits being returned to pensioners”,  do one thing:  ask the pollies “What about the many people who cannot get a pension or Newstart,  but have poverty-level incomes?”

The same could be asked of any who go on about “increasing support  for working families” (say, Liberals saying they will give tax cuts) – I know that many working families have only part-time or irregular work, end up barely taxable, and are not helped by tax cuts.

I think it is time pollies were put onto Newstart for their time in Parliament, to teach them how it feels.

Lies, damn lies, Same Sex Marriage and press responsibility

September 25, 2017

Should there be some requirement for “letters to the editor” to be fact-checked? What is the editorial responsibility if letters misrepresent the law?

Re—–
Subject: Editorial irresponsibility
Date: Sun, 24 Sep 2017 12:29:40 +0800

To: letters@sundaytimes.com.au

Dear Editor,

In “Your Say” 24 September, Leslie L Cummings suggested that same sex marriage imperils children, Andre Nel claimed that homophobic bullying is a “red herring,” and ID Smith claimed that legal marriage is required for access to IVF, artificial insemination, and adoption. As the “Indicative Survey” is being seen as a serious vote, and as anti-SSM speakers are verging on calls for children to be removed from same-sex couples, I feel it is irresponsible of your paper to print these letters without an associated factual article citing:

– the statistics which show greater psychological and physical
well-being in children raised by same-sex couples (the opponents of SSM generally cite stats from single-parent families to show ill-effects of lack of one gender in the house),

– recent reports of bullying at school of children of same-sex couples because their parents “shouldn’t have children” or are “unnatural,”

– statements of the legal situation in the various States of Australia, for example, lesbian couples can now start a family using IVF in every state and territory in Australia except the NT. 2014 Australian Census data indicate that 12% of same-sex couples have children (3 % of male couples.)

The amount of spreading of false statements about the welfare of
children and the rights to adoption and parenting is nearing
vilification. I hope someone whose children are bullied, or whose house is vandalised, brings a case under the protective legislation.

FYI, I am in an over-30-year hetero relationship, and have 4 admirable adult children. So no homophobic hatemail, thanks.

What if Trump was literally being honest for once?

July 10, 2017

President Trump tweeted “Putin & I discussed forming an impenetrable Cyber Security unit so that election hacking, & many other negative things, will be guarded..” Consider the literal meaning (assume prescriptivist semantics apply) : Putin and Trump get an “impenetrable” unit protecting their election hacking etc from detection and publicity.

What if he is telling the truth this time? If hacking is being guarded, rather than guarded against?

When political activism is triggered by falsehoods, what do we do?

November 6, 2016
I was curious about the alleged blasphemy which had been reported as triggering violent protest in Indonesia – none of our local news services cited the inflammatory words.
A bit of googling found several sites saying that it was because a Christian Governor had had electoral opponents citing the Koran to say Islamic believers should not vote for a non-Muslim, and he had responded that the voters were being misled by the use of the Koran verse. More digging found:

According to sites including the Sydney Morning Herald, some Islamic groups had urged voters not to re-elect Ahok, citing verse 51 from the fifth sura or chapter of the Koran, al-Ma’ida, which some interpret as prohibiting Muslims from living under the leadership of a non-Muslim. It is often translated as:

“5:51 O ye who believe! take not the Jews and the Christians for your friends: They are but friends to each other. And he amongst you that turns to them is of them. Verily Allah guideth not a people unjust.”

Others say the scripture should be understood in its context – making allies a time of war – and not interpreted literally – its context excludes those who respect the ways and beliefs of Islam. e.g. http://www.answering-christianity.com/sami_zaatri/friends.htm and http://seekershub.org/ans-blog/2009/09/07/friendship-with-non-muslims-explaining-verse-551/

I wondered whether it was extreme sensitivity to allegations of anti-Muslim bias which led the newspaper and TV  reports I came across to avoid dealing with the misinterpretation of sacred words as a basis for violence. If so, it is a pity – much of the world’s politics is shaped by invincible ignorance or deliberate lies, and we really need some mechanism for dealing with that.

This is a serious topic which has not been addressed by our parties’ policies.  It is time we wrote to our representatives and called for legislative action to protect the ignorant from falsehoods in the political arena as well as in the commercial world.  Maybe even time to picket or pillory those who are caught out misleading the public.  If they should have known better, if they could have checked with reputable experts, if they chose to speak from ignorance while acting as demagogues – they are as culpable as if they had lied.

In this case it is worse than usual, as the protests could be used by those already nervously aware of the Koran’s approach to those who are not of the Christian or Jewish faiths (why not to be an active atheist or pagan in Indonesia or Dubai…) to fear that Muslims could be led to vote for radical candidates purely on the basis of their faith, and thus destabilise our political system.

What future for the average intelligence student? The problem with education “for employment”

July 10, 2016

Both our major political parties are talking about education to fit students for jobs in “the new economy.”  At the same time  Our Coalition Government wants to give Company Tax reductions to large businesses.  However, for large companies,  increased company profits invested in expansion tend to lead to job losses.

Not just from offshore subcontracting of labour to exploited workers with no leave entitlements, OH&S rights,  or superannuation. Consider  http://www.bbc.com/news/technology-36376966

It includes a quote from a former McDonald’s senior staffer : “It’s cheaper to buy a $35,000 robotic arm than it is to hire an employee who is inefficient, making $15 an hour bagging French fries.”

The main item in the article is that 60 000 (probably OH&S nightmare) jobs have gone because Chinese factories invested in technology not humans – even at their pay rates the robots are cheaper.

These job losses are not just the semi-literate jobs.  Consider the rise in expert systems, even self-reprogramming learning systems: the first white-collar job robots are already here, even doing work for lawyers: https://www.washingtonpost.com/news/innovations/wp/2016/05/16/meet-ross-the-newly-hired-legal-robot/

The students know about this.  They know that machine intelligence researchers are even starting to find ways to program the machines for creativity.
(see John Gero on Creativity emergence and evolution in design concepts and framework
and  https://www.jwtintelligence.com/2016/06/cannes-2016-creativity-and-machine-learning/  )

So why should the less bright and less creative struggle to learn the basics, if they are told education is “to get a job” and they know they are headed for love on the dole?   (Read Greenwood’s book, or at least a detailed review, if you haven’t come across a film or play adaptation yet )

It is time for the meme of “education to be fit for work” to die.  Move to “education to get tools to make more fun and happiness, or dodge trouble.”  Start classes in “Learning something new without a teacher’s help, and demonstrating it to others,” “Comparing and testing health benefit claims,”  “Bullshit detection,” “website reliability testing,” “effective complaints,” “Dealing with Bureaucracy 1:  Completing a basic tax return so you don’t pay your refund to an accountant,” and  “Dealing with Bureaucracy 2:  Complying with Dole paperwork requirements.”

Of course, you may end up with a lot of activists trying to improve the Nation because they realise that the  current socio-economic system is the source of much unhappiness.  They may even realise that money is just another social construct – and not a good one – and demand a world run on social obligation instead.
Would that be so bad?

Cruz Iowa “big victory”?

February 7, 2016

https://www.washingtonpost.com/news/the-fix/wp/2016/02/02/ted-cruzs-interminably-long-iowa-victory-speech-annotated/  said “Ted Cruz won a big victory Monday night at the Iowa caucuses.”   Most Australian media had American talking heads referring to a clear victory and Donald Trump coming second, with little talk of Rubio.

From http://www.iowacaucus.biz/, Marco Rubio took 23.1 per cent, Mr Trump 24.3 per cent and Mr Cruz 27.7 per cent of the vote.

Less than a 5% difference?  In polling terms, that’s experimental error.  In USA political terms, at the start of the long chain of preliminaries in  other – less farm-based – States, this is neck-and-neck.

I think the media have not done a good job of reporting here.  We have the right to feel insulted, and the responsibility to wonder about their hidden agendas.

 

I

What is normal?

January 27, 2015

This was left in a caravan park in the 1950’s, earlier provenance unknown, but the hairstyles date it.

My, how culture changes: we are no longer allowed to see the range of shapes as normal, let alone have images of them or names for them except on unsavoury internet sites. Some may object to the descriptive lables, but I think they are rather poetic.

In these days of Barbies, airbrushing, and boob-jobs it could be a valuable health-ed and art resource.  Imagine comic-books with the full range depicted…

 

Dismissing Freud – baby and bathwater time.

January 6, 2015

According to university student reports, Psychology students are now taught to dismiss Freud – that is, if they are even introduced to his name.  I see three problems with this,  Firstly, they lose the good bits such as  the concept of “Freudian Slips.”  Secondly, they miss the historical perspective – which can inform a properly sceptical view of current theories.  Thirdly, they miss the anthropological perspective, the link between the theories and the culture in which they were developed (for example, penis envy and castrtion fears in a society where men have social power and freedom of movement and body details are a taboo topic, what a surprise….)

The third point is a sad loss in our increasingly multicultural society:  If a woman seeks mental health support and comes of a very patriarchal and female-restricting society, would current approaches help her fit the social rôle her family expects, and would the health professionals be sufficiently aware of the problem to even consider offering culturally sensitive counselling?  I have the uncomfortable feeling that old-style Freudian would be more fitting for some groups – not just Muslim, consider  http://blogs.forward.com/sisterhood-blog/127114/why-jewish-women-are-wearing-burqas/ and assault on non-compliant http://failedmessiah.typepad.com/failed_messiahcom/2014/03/haredi-modesty-assault-woman-beaten-up-by-haredi-man-in-beit-shemesh-over-skirt-length-678.html

– our underlying WEIRD cultural  assumptions will challenge these families should they migrate here.

Should people be offered the option of psychiatric help to fit in with their sub-culture’s expectations for their rôle, rather than to achieve full mental health as our culture defines it?  To what extent would a Freudian approach help?