Vorsprung durch Technik

The Age, 29th December 2009

HOW odd. Cardinal Pell tells us that praying will cure cancer but not that it will cure poverty and hunger.

J. Cosmo Newbery, Burwood

Nigel Stewart Australia, Commentary cancer, catholicism, medical system, pell, prayer

The Age, 28th December, 2009

AS THE father of three home-born children, now healthy adults, I take issue with Dr Pieter Mourik’s slights against home-birthing (Letters, 26/12). His letter has a distinct whiff of vested interest. My children were born between 25 and 30 years ago in the country, outside Canberra.The support provided by the Canberra Home Birth Group was excellent. Expectant couples were initially counselled by a midwife and doctor, and those unsuited for health or psychological reasons for home birth were advised to have a conventional birth.

A close relationship was built with the midwife and doctor, as well as members of the home birth group. The births themselves went smoothly, in familiar surroundings, and not in the cold sterility of a hospital operating room.

As Dr Mourik should know, most births are normal, and do not require the intervention of an obstetrician. Unfortunately, too many members of the medical industry treat pregnancy as a pathological condition, requiring excessive servicing. One wonders why.

Mike Puleston, Brunswick

Nigel Stewart Australia, Commentary hospital, medical system, midwifery

The Age, 26th December 2009

Obstetricians left holding the baby

I AM not sure the majority of Victorian taxpayers will agree that $400,000 of their money is allocated for midwife-led home births is “fantastic” or “thrilling” (The Age, 23/12); the majority would consider this a misuse of public money.

This pilot is pandering to a vocal minority of midwives who want to do home births and the two or three women per thousand who are foolish enough to consider a home birth without immediate medical support.

For the Government to force this pilot on to a regional health service (as yet undecided) would be insensitive, particularly when no obstetrician I know in regional Victoria supports home birth.

Home birth in Australia is known to have increased risks for both the mother and her baby, particularly when delays in ambulance transport may be the difference between success and disaster. The obstetrician will always be the person who has to receive these disasters, not the Government.

Dr Pieter Mourik, Wodonga

Nigel Stewart Australia, Commentary home birth, medical system, midwifery

The Age, December 19th, 2009

Filtering the claims

I HAVE been a member of the Australian Computer Society for nearly 15 years. But the announcement of an honorary membership for Senator Conroy has made me terminate my membership. The plan for internet censorship shows a stunning lack of understanding of the relevant issues.

I have read the report on the trial of the filter system. The most important part is all of the things that the report does not say, like the size of the samples and the sites that were used in testing, which means that it is impossible to make any inference about load and scalability. Or that the reason that data traffic appeared in some cases to improve with the filter was because the comparison was between a filter with a ”cache” (local copies of material) versus an unfiltered system with no caching. This is an unfair comparison. The list goes on.

I’m retaining my membership in the System Administrators Guild, SAGE-AU. It, at least, understands the realities of the senator’s plans.

Don Gingrich, Ringwood

Nigel Stewart Australia

Reclaim ambition

The 40th anniversary of man’s landing on the moon commemorates a supreme achievement of collective will. However, the fact that we have been no further into space since the 1970s should prompt some reflection. Did something special mark that past generation? Have we lost something?

Perhaps the generation of people who made it happen had something special. This generation grew up in the Depression and through the Second World War. The formative years of astronauts Armstrong, Aldrin and Collins occurred when the community had to work together in a supreme effort to defeat threats to civilisation. Collectively, they succeeded.

Perhaps this experience imbued the decision makers of the 1960s with a will to make things happen.

Today we face similar challenges. But our near inertia of today, as compared with 40 years ago, as we face threats of pollution, climate change and overpopulation, seem to show we have lost that collective will that once helped us achieve the seemingly impossible. Maybe it’s time to reclaim our ambition.

Andrew Field, Camberwell

Nigel Stewart Australia, Commentary, Tech, USA Australia, opinion

Australian doctors claim they have a monopoly on “high-quality, evidence-based care”, with midwifery being unworthy of taxpayer funding.

Letters to The Editor, The Age, 18th July 2009

Actuarial reality

PROPOSED legislation establishing a national registration scheme for health professionals does not outlaw home birthing. Rather, the Government has simply stated it will not provide indemnity for midwives working outside established clinical settings. This does not prevent midwives from seeking indemnity privately (as doctors have to do). The difficulty, of course, is that the cost of such insurance is likely to be prohibitive … an actuarial reality in keeping with the risks of home birth.

Hospital delivery is safe, not because it is done by doctors (most deliveries are conducted by a midwife), but because of the robust systems of clinical governance and access to a multidisciplinary team that underpin it.

Monica Dux asserts (Comment, 16/7) that to give birth at home is a fundamental right of all women, when really the right we should be fighting for is that of equitable access to high-quality, evidence-based care that will ensure the wellbeing of both mother and child.

Women should be free to make their own choice about childbirth, but this choice should not be inappropriately subsidised by the taxpayer.

Dr Sharon Monagle, Mordialloc

The AMA Submission to the Maternity Services Review makes various largely unsubstantiated frightening sounding claims, such as:

• Australia is one of the safest places in the world in which to give birth.  Australia’s maternal and perinatal death rates are lower than the majority of comparable countries.  Any reforms to maternity services must not lose sight of or jeopardise this excellent record.
• …absence of access to (medical) services means that mothers will not have the choice of epidural anaesthesia if required, will not have the choice of emergency caesarean section if required, and will not have the choice of their baby being assisted by a paediatrician if required.
• …real risks in morbidity and mortality outcomes…
• …there is a risk that Australian women will be made to feel that they are “lesser” women if they choose to have medical specialist and hospital care for their pregnancies and delivery.
• …in-home birthing by midwives is three times more likely to lead to perinatal mortality than conventional
  options even with the lowest risk pregnancies.
• … there was a statistically significant 4 fold overall increased risk of a baby dying during labour in a birth centre group overall and a 7 fold increased risk of dying in labour for babies of first time mothers in the birth centre group.

So suck it up ladies – you have no options because you’re not qualified.

Letters to The Editor, The Age, 17th July 2009

Delivering right care

MONICA Dux (Comment, 16/7), it is not only a matter of a woman’s right to choose, but also of society’s responsibility to either care for a family who has lost a mother through complications of a home delivery, and/or the considerable expense of looking after a baby with a cognitive defect as a result of a complicated or prolonged delivery.

As a country doctor who for 30 years has delivered about 1000 babies in NSW, Queensland and Norfolk Island, I can look back to a number of deliveries where everything pointed to an “uncomplicated” delivery, but problems developed during or after the delivery of the baby.

In a hospital, we always have full facilities at hand — blood for a severe and unexpected post-partum haemorrhage, or resuscitation equipment for a “flat” baby.  Not one mother’s or baby’s life has been lost or threatened as a consequence.

The same could not be said if the deliveries were home-based.

International studies do not support home deliveries; in fact they do the opposite. Certainly the British Government is supporting home births, but in a recent discussion with a friend, Eric Jauniaux, professor of obstetrics/gynaecology at the Middlesex and Royal Free hospitals in London, he pointed out that the Government has used a discredited report from just two years in the early 1990s to support their advice, simply as a huge cost-saving measure.

Well-conducted clinical studies from 1998-2008 show nearly a 10-fold increase in peri-natal and maternal mortality from home-based deliveries.

Dr Martin Panter, Kuranda, Queensland

Letters to The Editor, The Age, 19th July 2009

Home birth needs to go mainstream

I AM not quite sure what research Dr Martin Panter (Letters, 17/7) is referring to when he talks of “nearly a 10-fold increase in perinatal and maternal mortality from home-based deliveries”. Research of more than 600,000 births, published a few months ago in the British Journal of Obstetrics and Gynaecology, concluded that “planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system”.

The Royal College of Obstetricians and Gynaecologists, in response, said it supported home births for low-risk pregnancies, provided there were appropriate infrastructure and resources.

Home birth is a legitimate choice for women. The Australian maternity system needs to promote this choice by providing the appropriate infrastructure and resources. Ignoring the fact that some women will choose to birth at home will not make it go away. We need to acknowledge this, and provide access to home births as a mainstream option.

Debbie Slater, vice-chairwoman, Childbirth Australia, Churchlands, WA

Nigel Stewart Australia, Commentary

I also hope that recent incidents do not reflect a general resentment of Indians in particular.  With education being a significant export earner, governments and universities have a significant incentive to inject their own spin, rather than insight.

In Letters to The Editor, The Age, June 3rd, 2009

Thugs don’t think

I COMMEND Akash Arora’s article (Comment, 2/6) and agree that it is general violence by street thugs that is the problem, not racism. It is incorrect to typecast Australia as more racist than any other nation. It is dangerous to get distracted by a supposed race issue.

Rather than focus on higher penalties, money needs to be spent on transport security and supervision of public areas, with a broad crackdown on violence. The thugs don’t generally think of consequences. They hardly think at all. They simply pick on anyone who is weaker or not part of their tribe.

Chris Peters, Eltham

Nigel Stewart Australia, Commentary Australia, higher education, india, racism

Letters to The Editor, The Age.

Believers – or not?

SO 54 per cent of Australians believe Jesus rose from the dead. I am astonished that the percentage is so high. What surprises me even more is that these numbers have not translated into more people following Jesus.

If the resurrection of Jesus Christ happened in history, something I am convinced of, how is it that so many Australians believe it is irrelevant to everyday life? It’s like believing in the discovery of penicillin and yet refusing to use it.

Pastor Murray Campbell, Mentone

Nigel Stewart Australia, Commentary Australia, illogical, relevant, religion

A recent ABC Background Briefing radio documentary looks at the role of MBA education in the current financial crisis: MBA: Mostly bloody awful.

What we taught were very simplified and not necessarily accurate models of human behaviour, that over time become self-fulfilling. And so there was this model that in fact by basically being self-interested to an extreme, that was the appropriate way to behave and act. And what that does over time, because this is not an innocent exercise, it actually over time because it is a professional school, comes to shape the identity of those individuals. That is, they begin to see themselves in those views. And one of the consequences of that is that if you look with respect to executive compensation for example, and the incentives around that, the view becomes that I actually have to be compensated to do the job I was hired for, and on top of that you have to bribe me with stock options to make sure I do that job. In no other occupation or profession is that part of the modus operandi.

Nigel Stewart Australia, Commentary, USA business, education, leadership, mba, podcast

Letters to The Editor, The Age:

No problems with atheists after all

CATHERINE Deveny (Metropolis, 23/2) seems to have formed a view of APN Outdoor based on incorrect information. APN Outdoor has run ads for a diverse range of religious organisations. We always have and will continue to work with religious and non-religious groups.

When the Atheist Foundation came to us in November, we welcomed its business. APN Outdoor recommended a range of roadside advertising sites. However, the AFA specifically wanted bus panels.

Bus, or “transit”, advertising sites are public property, owned by state bus authorities. These are regulated differently from private property. One regulation is that any advertisement, religious or otherwise, that may offend the community or represent an individual point of view is not permitted.

Deveny was right on the toing and froing. We went backwards and forwards trying to help the AFA find a creative line that would meet its needs and still fall within the regulations. We also presented the foundation with equally impactful outdoor advertising options on which it could advertise without changing its ads at all. For starters, there are 2200 premium roadside billboards in Australia that can be used for maximum impact. We were happy to work with the foundation then and we’re still happy to work with it now.

Paul McBeth, general manager — marketing, APN Outdoor, Ultimo, NSW

Nigel Stewart Australia, Commentary advertising, APN, atheism, Australia