tag:theconversation.com,2011:/uk/topics/pathology-3046/articlesPathology – The Conversation2024-01-24T13:29:56Ztag:theconversation.com,2011:article/2189982024-01-24T13:29:56Z2024-01-24T13:29:56ZPictures have been teaching doctors medicine for centuries − a medical illustrator explains how<figure><img src="https://images.theconversation.com/files/565002/original/file-20231211-30-bxjrr5.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1524%2C1770&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Artists reveal what cannot be seen.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/internetarchivebookimages/17573010234">Henry Gray, Anthony Edwward Spitzka/Internet Archive via Flickr</a></span></figcaption></figure><p>“Medical illustrators draw what can’t be seen, watch what’s never been done, and tell thousands about it without saying a word.”</p>
<p>For decades, this slogan <a href="https://web.archive.org/web/20070203080223/http://www.ami.org/ECOMAMI/timssnet/common/tnt_frontpage.cfm">appeared on the website</a> and printed materials of the <a href="https://ami.org">Association of Medical Illustrators</a>. Although the association no longer uses this tag line, it’s still an accurate description of the profession.</p>
<p>As a <a href="https://www.rit.edu/directory/japfaa-james-perkins">practicing medical illustrator</a> for over 30 years, I draw what can’t be seen and watch what’s never been done on a daily basis. And I teach my students to do the same. </p>
<p>But what exactly does all of that mean, and how does it improve medicine?</p>
<h2>Tell thousands about it without saying a word</h2>
<p>You may have heard the adage, “A picture is worth a thousand words.” In that same vein, medical illustrators use pictures to teach complex scientific concepts. As the famed medical illustrator <a href="https://www.netterimages.com/artist-frank-h-netter.html">Frank H. Netter</a> once said, “(Pictures) eliminate the need for the lecturer or the author to translate what he has in his mind into words and for the listener or the student to translate those words back into a mental image.”</p>
<p>The use of illustrations to communicate medical information has a long history, dating back at least to <a href="https://doi.org/10.1002/(SICI)1098-2353(1999)12:2%3C120::AID-CA7%3E3.0.CO;2-V">ancient Egypt</a> and flourishing in the Renaissance. The work of 16th century anatomists <a href="https://doi.org/10.3389%2Ffnana.2019.00011">Giacomo Berengario da Carpi</a> and <a href="https://doi.org/10.5339%2Fgcsp.2015.66">Andreas Vesalius</a> set a precedent for the use of detailed illustrations to teach anatomy, a practice that continues to this day.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/564995/original/file-20231211-19-hqv8w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration depicting the musculature of the human body with text identifying each component" src="https://images.theconversation.com/files/564995/original/file-20231211-19-hqv8w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564995/original/file-20231211-19-hqv8w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=820&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564995/original/file-20231211-19-hqv8w6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=820&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564995/original/file-20231211-19-hqv8w6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=820&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564995/original/file-20231211-19-hqv8w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1031&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564995/original/file-20231211-19-hqv8w6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1031&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564995/original/file-20231211-19-hqv8w6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1031&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This is a page from Andreas Vesalius’ ‘Suorum de humani corporis fabrica librorum epitome.’</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/g6b6smge/images?id=w5d9ed8q">Andreas Vesalius/Wellcome Collection</a></span>
</figcaption>
</figure>
<p>The proliferation of illustrated anatomy atlases in the Renaissance coincided with the widespread acceptance of <a href="https://doi.org/10.5115%2Facb.2015.48.3.153">cadaver dissection</a>. The earliest known human dissections were performed in the third century BCE. The practice was prohibited throughout the Middle Ages but became common again in the 13th and 14th centuries. </p>
<p>By the 1500s, dissections, usually of executed criminals, had become public spectacles. The demand for bodies eventually outstripped the supply of executed convicts, leading to the unscrupulous practices of grave robbing and even murder.</p>
<p>In addition to depicting the location and features of an object such as an organ, illustrations proved essential in describing events happening over time, such as the progression of a disease or the steps in a surgical procedure. Generations of surgeons learned new procedures from meticulously illustrated surgical atlases. An early example of physiology illustration, William Harvey’s classic 17th century work on the circulation of blood, “<a href="https://library.si.edu/digital-library/book/exercitatioanat00harv">Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus</a>,” depicts the direction of blood flow through the veins of the forearm.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/564993/original/file-20231211-17-ppw1y6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration showing an arm gripping a pole with a tourniquet wrapped around the elbow." src="https://images.theconversation.com/files/564993/original/file-20231211-17-ppw1y6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564993/original/file-20231211-17-ppw1y6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=418&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564993/original/file-20231211-17-ppw1y6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=418&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564993/original/file-20231211-17-ppw1y6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=418&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564993/original/file-20231211-17-ppw1y6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=525&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564993/original/file-20231211-17-ppw1y6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=525&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564993/original/file-20231211-17-ppw1y6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=525&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This image from William Harvey’s ‘Exercitatio’ depicts the direction of normal blood circulation.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:William_Harvey_(1578-1657)_Venenbild.jpg">William Harvey/Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Nowadays, surgeons can practice a procedure hundreds of times <a href="https://theconversation.com/why-virtual-reality-wont-replace-cadavers-in-medical-school-67448">in virtual reality</a> before trying it on a real patient. Modern physiology and pathology texts include countless illustrations of the body, not just at the anatomical level but also the cellular and molecular. So valuable are these depictions of complex pathways and interactions that many science journals now require papers to include a <a href="https://doi.org/10.7759/cureus.45762">graphical abstract</a>, a single illustration that summarizes the content of each paper.</p>
<h2>Draw what can’t be seen</h2>
<p>Medical illustrators employ special tools and training to visualize things that are normally hidden from the naked eye. </p>
<p>All professionally trained medical illustrators <a href="https://ami.org/medical-illustration/enter-the-profession/careers">study human gross anatomy</a>, including dissecting a human cadaver, in order to visualize the internal structures of the body. When a cadaver isn’t readily available to serve as reference for an illustration, illustrators use <a href="https://doi.org/10.1148/rg.2018170088">medical imaging</a>, such as CT and MRI scans, and reconstruct the body in three dimensions.</p>
<p>At the cellular level, medical illustrators must understand how to use <a href="https://theconversation.com/seeing-what-the-naked-eye-cant-4-essential-reads-on-how-scientists-bring-the-microscopic-world-into-plain-sight-211666">microscopy techniques</a> in order to find references for accurate depictions of cellular structures. </p>
<p>Objects at the smallest scale – atoms and many molecules – are smaller than the wavelength of visible light. This means they are <a href="https://www.purdue.edu/uns/html4ever/1998/9804.Crystallography.html">below the theoretical limit</a> of what can be seen, even with the most powerful light microscope. So researchers experimentally determine the structures of molecules using techniques like <a href="https://chem.libretexts.org/Bookshelves/Analytical_Chemistry/Supplemental_Modules_(Analytical_Chemistry)/Instrumentation_and_Analysis/Diffraction_Scattering_Techniques/X-ray_Crystallography">X-ray crystallography</a> and <a href="https://chem.libretexts.org/Bookshelves/Organic_Chemistry/Supplemental_Modules_(Organic_Chemistry)/Spectroscopy/Nuclear_Magnetic_Resonance_Spectroscopy">nuclear magnetic resonance spectroscopy</a> instead. These techniques use X-rays or radio waves, respectively, to determine how atoms are arranged.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/564990/original/file-20231211-17-o2rq6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="CDC illustration of COVID-19 virus" src="https://images.theconversation.com/files/564990/original/file-20231211-17-o2rq6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564990/original/file-20231211-17-o2rq6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564990/original/file-20231211-17-o2rq6y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564990/original/file-20231211-17-o2rq6y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564990/original/file-20231211-17-o2rq6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=423&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564990/original/file-20231211-17-o2rq6y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=423&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564990/original/file-20231211-17-o2rq6y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=423&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This illustration, created by the Centers for Disease Control and Prevention, depicts the notorious spiked structure of the virus that causes COVID-19.</span>
<span class="attribution"><a class="source" href="https://phil.cdc.gov/Details.aspx?pid=23311">Alissa Eckert, MSMI; Dan Higgins, MAMS via CDC</a></span>
</figcaption>
</figure>
<p>Medical illustrators learn to locate and retrieve data on the structure of molecules from sites like the <a href="https://www.rcsb.org">RCSB Protein Databank</a>. They also use a host of visualization applications and software plug-ins to render these structures in 3D.</p>
<p>Medical illustrators Alissa Eckert and Dan Higgins at the U.S. Centers for Disease Control and Prevention used these techniques to create the famous <a href="https://phil.cdc.gov/Details.aspx?pid=23311">red-spiked coronavirus image</a> that went viral during the pandemic.</p>
<h2>Watch what’s never been done</h2>
<p>Obviously, you can’t really watch something that has never been done. But medical illustrators can help conceptualize new processes and techniques before they become a reality. </p>
<p>For example, they might illustrate how an experimental drug may theoretically work before it enters testing. Similarly, illustrations can be critically important in <a href="https://doi.org/10.7759%2Fcureus.40841">pre-surgical planning</a>, especially in complex cases.</p>
<p>My favorite example of the role of medical illustration in surgery is the separation of conjoined twins Abbigail and Isabelle Carlsen at the Mayo Clinic in 2006. Working from <a href="https://dl.acm.org/doi/10.1145/1401032.1401099">nearly 6,000 radiographic images</a>, the clinic’s medical illustrators produced five detailed illustrations of the twins’ anatomy. They even generated 3D-printed models of important structures, notably their shared liver. </p>
<p>The illustrations were critical in training a team of 70 surgeons, nurses and technicians involved in the case. They also served as a road map for the ultimately successful surgery, hung up on the walls of the operating theater during the procedure.</p>
<h2>Road to becoming a medical illustrator</h2>
<p>In order to draw what can’t be seen and watch what’s never been done, medical illustrators require specialized training. Most medical illustrators in North America are trained at <a href="https://ami.org/medical-illustration/enter-the-profession/education/graduate-programs">master’s programs</a> accredited by the Association of Medical Illustrators in conjunction with the Commission on Accreditation of Allied Health Education Programs. </p>
<p>Since the profession requires a strong understanding of the biomedical sciences, students accepted into these programs must have a <a href="https://ami.org/medical-illustration/enter-the-profession/education">strong science background</a> along with a portfolio demonstrating outstanding drawing skills. Students often have a double major in biology and art or a major in one area and minor in the other. </p>
<p>Once in the program, their science training continues with human gross anatomy and some combination of courses in neuroanatomy, embryology, histology, cell biology, pathology and immunology. Specialized courses in surgical observation and cellular and molecular visualization also include significant science content. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/7AEDUteTegw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Scientific illustrator Val Altounian of the journal Science walks viewers through her process.</span></figcaption>
</figure>
<p>Students receive extensive training in <a href="https://ami.org/medical-illustration/enter-the-profession/education">computer graphics</a>, including 2D digital illustration and animation, 3D computer modeling and animation, interactive media, virtual and augmented reality and educational game and mobile app design. Courses also emphasize the principles of design, including the use of color, layout and motion to create effective visuals. </p>
<p>Medical illustrators learn to <a href="https://www.wired.com/story/in-a-pandemic-medical-illustrators-made-science-accessible/">consider the educational level of their audience</a>, since their work may be used to educate patients – even kids – in addition to medical professionals. Illustrations made for a child recently diagnosed with leukemia would be very different from those aimed at the oncologist treating the disease.</p>
<p>After entering the workforce, many medical illustrators pursue optional board certification to become a <a href="https://www.ami.org/medical-illustration/board-certification">certified medical illustrator</a>, which recognizes professional competency and encourages continued learning. Continued certification requires 35 hours of continuing education every five years in the biomedical sciences, artistic techniques and business practices. </p>
<p>All of this education and training is essential to ensure that medical illustrators communicate complex scientific information with accuracy and clarity. I like to think of medical illustrators as teachers – they instruct with pictures.</p><img src="https://counter.theconversation.com/content/218998/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James A. Perkins is a Professional Member of the Association of Medical Illustrators. </span></em></p>From body snatching to Photoshop and virtual reality, the techniques of medical illustration have evolved. But its essential role in showing clinicians how to care for the body continues today.James A. Perkins, Distinguished Professor of Medical Illustration, Rochester Institute of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2160732023-11-13T00:17:00Z2023-11-13T00:17:00ZWorried about getting a blood test? 5 tips to make them easier (and still accurate)<figure><img src="https://images.theconversation.com/files/557028/original/file-20231101-25-xym2hd.jpg?ixlib=rb-1.1.0&rect=73%2C12%2C8106%2C5444&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-nurse-takes-venous-blood-test-2317705961">Shutterstock</a></span></figcaption></figure><p>Blood tests are a common medical procedure, offering valuable insights into a person’s health. Whether you’re getting a routine check-up, diagnosing a medical condition or monitoring treatment progress, understanding the process can make the experience more comfortable and effective. </p>
<p>For the majority of patients, blood collections are a minor inconvenience. Others may feel <a href="https://www.sciencedirect.com/science/article/abs/pii/S0887618506000041">uneasy and anxious</a>. </p>
<p>Preparation strategies can help get you through the procedure.</p>
<h2>How blood is collected</h2>
<p>During venipuncture (blood draw), the phlebotomist (blood collector) inserts a needle through the skin into a vein and a small amount of blood is collected and transferred into a test tube. </p>
<p>Tubes are sent to a laboratory, where the blood is analysed. A laboratory technician may count or examine cells and measure the levels of minerals/salts, enzymes, proteins or other substances in the sample. For some tests, blood plasma is separated out by spinning (centrifuging) the sample. Others pass a light beam through the sample to determine the amount of a chemical present.</p>
<p>For collection, the phlebotomist usually selects a vein in the crook of your elbow, where veins are readily accessible. Blood can also be drawn from veins in the wrists, fingers or heels. A tourniquet may be applied to restrict blood flow and make the chosen vein puff out. </p>
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<h2>Different tests require different preparation</h2>
<p>Before a blood test, the GP or health-care provider will give you specific instructions. </p>
<p>These may include fasting for up to 12 hours or temporarily discontinuing certain medications. </p>
<p>It is crucial to follow these guidelines meticulously as they can significantly impact the accuracy of your test results. For example, fasting is required before glucose (blood sugar) and lipids (blood fats) testing because blood sugar and cholesterol levels typically increase after a meal.</p>
<p>If the blood test requires fasting, you will be asked not to eat or drink (no tea, coffee, juice or alcohol) for about eight to 12 hours. Water is allowed but smoking should be avoided because it can increase <a href="https://diabetesjournals.org/care/article/19/2/112/19825/Acute-Effect-of-Cigarette-Smoking-on-Glucose">blood sugar, cholesterol and triglyceride levels</a>. </p>
<p>Generally, you will be asked to fast overnight and have the blood collection done in the morning. Fasting for longer than 15 hours could impact your results, too, by causing dehydration or the release of certain chemicals in the blood.</p>
<p>If you have diabetes, you must consult your doctor prior to fasting because it can increase the risk of hypoglycemia (low blood sugar) in people with type 1 diabetes. Most type 2 diabetics can safely fast before a blood test but there are some exceptions, such as people who are taking certain medications including insulin.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/557031/original/file-20231101-23-5b2fjt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="laboratory bench with a stand containing test tubes of blood. Gloved hand removes one" src="https://images.theconversation.com/files/557031/original/file-20231101-23-5b2fjt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/557031/original/file-20231101-23-5b2fjt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557031/original/file-20231101-23-5b2fjt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557031/original/file-20231101-23-5b2fjt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557031/original/file-20231101-23-5b2fjt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557031/original/file-20231101-23-5b2fjt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557031/original/file-20231101-23-5b2fjt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You may need to fast overnight before a blood test to ensure accuracy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/how-deal-blood-sample-1805240662">Shutterstock</a></span>
</figcaption>
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<h2>5 tips for a better blood test</h2>
<p>To improve your blood collection experience, consider these tips:</p>
<p><strong>1. Hydrate</strong></p>
<p>Drink plenty of water right up to 30 minutes before your appointment. Adequate hydration improves blood flow, making your veins more accessible. Avoid <a href="https://academic.oup.com/labmed/article/34/10/736/2657269">strenuous exercise</a> before your blood test, which can increase some blood parameters (such as liver function) while decreasing others (such as sodium).</p>
<p><strong>2. Loose clothing</strong></p>
<p>Wear clothing that allows easy access to your arms to ensure a less stressful procedure. </p>
<p><strong>3. Manage anxiety</strong></p>
<p>If the sight of blood or the procedure makes you anxious, look away while the needle is inserted and try to keep breathing normally. Distraction can help – virtual reality has been <a href="https://pubmed.ncbi.nlm.nih.gov/31889358/">trialled</a> to reduce needle anxiety in children. You could try bringing something to read or music to listen to. </p>
<p><strong>4. Know your risk of fainting</strong></p>
<p>If you’re prone to fainting, make sure to inform the phlebotomist when you arrive. You can have your blood drawn while lying down to minimise the risk of passing out and injury. Hydration helps maintain blood pressure and can also <a href="https://www.ahajournals.org/doi/10.1161/01.CIR.0000101966.24899.CB">reduce the risk</a> of fainting. </p>
<p><strong>5. Discuss difficult veins</strong></p>
<p>Some people have smaller or scarred veins, often due to repeated punctures, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989034/">chemotherapy</a> or blood thinner use. In such cases, venipuncture may require multiple attempts. It is important to talk to the phlebotomist if you feel discomfort or significant pain. A finger prick can be performed as an alternative for some tests, such as blood glucose levels. But other comprehensive tests require larger blood volume.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/557032/original/file-20231101-23-nw5diu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman holds glass of water" src="https://images.theconversation.com/files/557032/original/file-20231101-23-nw5diu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/557032/original/file-20231101-23-nw5diu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557032/original/file-20231101-23-nw5diu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557032/original/file-20231101-23-nw5diu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557032/original/file-20231101-23-nw5diu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557032/original/file-20231101-23-nw5diu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557032/original/file-20231101-23-nw5diu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Being well hydrated can help blood flow.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/healthy-beautiful-young-woman-holding-glass-1292227048">Shutterstock</a></span>
</figcaption>
</figure>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-can-go-wrong-in-the-blood-a-brief-overview-of-bleeding-clotting-and-cancer-76400">What can go wrong in the blood? A brief overview of bleeding, clotting and cancer</a>
</strong>
</em>
</p>
<hr>
<h2>Blood draws after lymph node removal</h2>
<p>Historically, there were concerns about drawing blood from an arm that had undergone lymph node removal. This was due to the risk of <a href="https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-pdq#:%7E:text=Lymphedema%20is%20the%20build%2Dup,the%20way%20that%20it%20should.">lymphedema</a>, a condition marked by fluid build-up in the affected arm. Lymph nodes may have been removed (<a href="https://www.ncbi.nlm.nih.gov/books/NBK564397/#:%7E:text=Lymph%20node%20dissection%2C%20also%20known,surgical%20management%20of%20malignant%20tumors.">lymphadenectomy</a>) for cancer diagnosis or treatment. </p>
<p>However, a <a href="https://ascopubs.org/doi/10.1200/JCO.2015.61.5948">2016 study</a> showed people who’ve had lymph nodes removed are not at a higher risk of developing lymphedema following blood draws, even when drawing blood from the affected arm.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-are-lymph-nodes-and-can-a-massage-really-improve-lymphatic-drainage-209334">What are lymph nodes? And can a massage really improve lymphatic drainage?</a>
</strong>
</em>
</p>
<hr>
<h2>After your blood test</h2>
<p>The whole blood test procedure usually lasts no more than a few minutes. Afterwards, you may be asked to apply gentle pressure over a clean dressing to aid clotting and reduce swelling.</p>
<p>If you do experience swelling, bruising or pain after a test, follow general first aid procedures to alleviate discomfort. These include applying ice to the site, resting the affected arm and, if needed, taking a pain killer. </p>
<p>It is usually recommended you do not do heavy lifting for a few hours after a blood draw. This is to prevent surges in blood flow that could prevent clotting where the blood was taken.</p><img src="https://counter.theconversation.com/content/216073/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sapha Shibeeb does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For the majority of patients, blood collections are not a problem, just a minor inconvenience. Others may feel uneasy and anxious about the process.Sapha Shibeeb, Senior lecturer in Laboratory Medicine , RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1968742023-02-14T13:27:07Z2023-02-14T13:27:07ZHow do blood tests work? Medical laboratory scientists explain the pathway from blood draw to diagnosis and treatment<figure><img src="https://images.theconversation.com/files/509538/original/file-20230210-16-9ds3x9.jpg?ixlib=rb-1.1.0&rect=15%2C0%2C2101%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pathology analyzes bodily fluids and tissues using a variety of methods.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-manipulating-blood-plasma-tubes-green-royalty-free-image/1404395240">Alvaro Lavin/Moment via Getty Images</a></span></figcaption></figure><p>Medical laboratory testing is the heartbeat of medicine. It provides critical data for physicians to diagnose and treat disease, <a href="https://doi.org/10.1093/labmed/lmaa098">dating back thousands of years</a>. Unfortunately, laboratory medicine as a field is poorly understood by both the public and health care communities. </p>
<p><a href="https://asm.org/Articles/2021/October/Using-Laboratory-Medicine-to-Support-Direct-Patien">Laboratory medicine</a>, also known as clinical pathology, is one of two main branches of pathology, or the study of the causes and effects of disease. Pathology covers many <a href="https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=85&contentid=P00955">laboratory areas</a>, such as blood banking and microbiology. Clinical pathology diagnoses a disease through laboratory analysis of body fluids such as blood, urine, feces and saliva. The other branch of pathology, <a href="https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/anatomical-pathology">anatomic pathology</a>, diagnoses a disease by examining body tissues.</p>
<p>We are <a href="https://scholar.google.com/citations?user=8XtvOZ8AAAAJ&hl=en">public health</a> and <a href="https://www.rushu.rush.edu/faculty/nicholas-moore-ms-mlsascpcm">medical laboratory</a> scientists who specialize in microbiology and infectious diseases. There are a lot of steps between when your doctor orders a blood test to establishing a diagnosis. From the bedside to the lab bench, here’s how laboratory testing works.</p>
<h2>It all starts with a specimen</h2>
<p>When you see a doctor, sometimes a physical exam and detailed medical history are enough for them to make a diagnosis, offer recommendations or prescribe medications for your condition. There are many instances, however, where your doctor may need additional information to make an accurate diagnosis. This information is often obtained from procedures like <a href="https://medlineplus.gov/ency/article/007451.htm">imaging scans</a> or <a href="https://doi.org/10.1309/LM4O4L0HHUTWWUDD">blood tests</a>.</p>
<p>The first step involves getting your blood drawn through a practice known as <a href="https://www.webmd.com/a-to-z-guides/what-is-phlebotomy">phlebotomy</a>. A health care professional, typically a phlebotomist or a nurse, inserts a needle into a vein to collect a blood specimen. </p>
<p>Multiple tubes of blood may be needed, as certain tests are only performed using certain types of blood specimens. For example, one test commonly used to <a href="https://www.nhlbi.nih.gov/health/anemia">diagnose anemia</a> requires blood to be collected in a chemical that prevents the blood from clotting. Patients being evaluated for a <a href="https://www.nhlbi.nih.gov/health/clotting-disorders">clotting disorder</a>, on the other hand, often have their blood collected in a tube containing another anticoagulant.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/509533/original/file-20230210-15-axvazu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Array of blood test tubes in a rack" src="https://images.theconversation.com/files/509533/original/file-20230210-15-axvazu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/509533/original/file-20230210-15-axvazu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509533/original/file-20230210-15-axvazu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509533/original/file-20230210-15-axvazu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509533/original/file-20230210-15-axvazu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509533/original/file-20230210-15-axvazu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509533/original/file-20230210-15-axvazu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Different tests require different types of blood specimens.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/rack-with-tubes-blood-samples-from-patients-for-royalty-free-image/1446655782">angelp/iStock via Getty Images Plus</a></span>
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<h2>Testing pathways</h2>
<p>Specimens then make their way to a clinical laboratory. Laboratories can be found within hospitals, reference labs or physician offices, or they can be located in a public health setting such as the Centers for Disease Control and Prevention or a state public health laboratory. In 2021, there were <a href="https://www.bls.gov/ooh/healthcare/clinical-laboratory-technologists-and-technicians.htm#tab-1">more than 329,000 laboratory professionals</a> working in the U.S. in <a href="https://www.cms.gov/regulations-and-guidance/legislation/clia#">more than 320,000 federally regulated laboratories</a>. An estimated <a href="https://www.cdc.gov/csels/dls/strengthening-clinical-labs.html">14 billion laboratory tests</a> are ordered annually in the U.S., on top of <a href="https://www.worldometers.info/coronavirus/#countries">over 1 billon COVID-19 tests</a> during the pandemic. With such a large volume of specimens to test and examine, various sections of a laboratory are automated. </p>
<p>Laboratory tests examine the biological, chemical and physical properties of the cells and molecules that make up a blood specimen. The first step is often to centrifuge a blood specimen into separate components. This divides the sample into one portion that contains solid components, such as cells, and another that contains liquid components and dissolved solutes, known as serum or plasma.</p>
<p>Analyzing the serum or plasma portion of a blood specimen measures the levels of different substances within the body. One of the most common is your blood sugar, or glucose concentration. For the doctors of <a href="https://www.cdc.gov/csels/dls/strengthening-clinical-labs.html">more than 37 million Americans with diabetes</a>, knowing how high their patient’s blood glucose is helps them establish a new diagnosis or ensure their condition is under control.</p>
<p>If your doctor suspects you have an infection, they will collect specimens to test for the presence of a pathogen. For example, they might collect a throat swab for strep throat or a urine sample for a urinary tract infection. Scientists incubate these samples to screen any organisms that grow and resemble pathogens of interest. They may perform additional testing to identify the microbe. Once an organism is identified, the <a href="https://deepdive.tips/index.php/2022/12/01/putting-a-face-on-clinical-laboratory-sciences-w-dr-rodney-rohde/">medical laboratory professional</a> can then test a variety of antimicrobial agents against it to inform your doctor what the best treatment would be against your infection.</p>
<h2>Evolution of medical laboratory testing</h2>
<p>The <a href="https://doi.org/10.1093/clinchem/43.1.174">first hospital clinical laboratory in the U.S.</a> was established in 1894. Some of the methods <a href="https://deepdive.tips/index.php/2022/12/01/putting-a-face-on-clinical-laboratory-sciences-w-dr-rodney-rohde/">laboratory professionals</a> use to analyze samples have been in use for over a century. </p>
<p>One such staple, the <a href="https://www.ncbi.nlm.nih.gov/books/NBK562156/">Gram stain</a>, was introduced in 1882. It uses two different dyes and exploits differences in the bacterial cell wall to discriminate between two different groups of bacteria. This helps lab scientists identify the correct antimicrobial therapy to use against an infection.</p>
<p>Another commonly used technology, the <a href="https://doi.org/10.1002/cyto.a.24505">Coulter Principle</a>, was developed in the 1940s to identify and sort individual cells based on physical size and resistance to an electrical current. Medical laboratory professionals routinely use this technique to conduct <a href="https://medlineplus.gov/lab-tests/complete-blood-count-cbc/">complete blood count</a> tests, which measure unusual increases or decreases in the number of different types of blood cells that could provide insights into a disease or condition, such as cancer or sickle cell anemia.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/510360/original/file-20230215-28-e6jp0p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Medical laboratory professional holding blood tube" src="https://images.theconversation.com/files/510360/original/file-20230215-28-e6jp0p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510360/original/file-20230215-28-e6jp0p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510360/original/file-20230215-28-e6jp0p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510360/original/file-20230215-28-e6jp0p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510360/original/file-20230215-28-e6jp0p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510360/original/file-20230215-28-e6jp0p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510360/original/file-20230215-28-e6jp0p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Medical laboratory professionals use different techniques to analyze samples.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/feamle-scientist-preparing-a-blood-sample-for-royalty-free-image/1023297260">Westend61/Getty Images</a></span>
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<p>In 1986, scientists devised the <a href="https://www.nobelprize.org/prizes/chemistry/1993/mullis/facts/">Nobel Prize-winning</a> <a href="https://www.ncbi.nlm.nih.gov/probe/docs/techpcr/">polymerase chain reaction</a> method to amplify, or rapidly produce, multiple copies of the DNA of a pathogen present within a sample. PCR is widely used to diagnose infections, identify genetic disorders and monitor cancer progression.</p>
<p>An explosion of modern laboratory tools to research and diagnose disease followed PCR. To name a few of these cutting-edge tools, <a href="https://doi.org/10.1038/labinvest.2014.156">matrix-assisted laser desorption ionization, or MALDI</a>, is one of the most commonly used techniques to identify microbes that are difficult or impossible to culture. Genome editing and <a href="https://medlineplus.gov/genetics/understanding/genomicresearch/genomeediting/">CRISPR-Cas9</a> give scientists the ability to change an organism’s DNA, aiding in <a href="https://doi.org/10.1016/j.biopha.2021.111487">identifying pathogens and detecting dysfunctional genes</a> by adding, removing or altering genes of interest. <a href="https://theconversation.com/genomic-sequencing-heres-how-researchers-identify-omicron-and-other-covid-19-variants-172935">Next-generation sequencing</a> has become a powerful modern tool to determine the sequence of the genetic material in biological samples and has been extensively used to <a href="https://doi.org/10.3390%2Fijms12117861">identify variants</a> and wastewater surveillance of pathogens like the virus that causes COVID-19.</p>
<h2>Challenges and solutions</h2>
<p>One of the most critical challenges in laboratory medicine is <a href="https://doi.org/10.1309/LM4O4L0HHUTWWUDD">understanding and interpreting test results</a>, because errors can occur throughout the testing process. Specimens must be properly collected and transported to the lab for accurate results. Likewise, at-home tests need to be properly stored. Clinicians and patients need to take into account the chances of false positive or negative results by considering the <a href="https://theconversation.com/coronavirus-tests-are-pretty-accurate-but-far-from-perfect-136671">limitations of the test</a> alongside the patient’s individual case.</p>
<p>Collaboration between clinicians and medical laboratory professionals could help <a href="https://www.elsevier.com/connect/preventing-diagnostic-errors-by-uniting-the-clinical-laboratory-with-direct-patient-care">reduce errors</a> in diagnosis and treatment. Laboratory data can and often is extremely useful to patient care, but a holistic approach that takes into account a patient’s medical history, genetics and health habits, among other factors, is necessary for an accurate diagnosis and treatment. While powerful, a laboratory result should not be used in isolation. Clear and accurate communication on laboratory testing is critical for effective patient care.</p>
<p><em>A photo was replaced to more accurately reflect medical laboratory work</em></p><img src="https://counter.theconversation.com/content/196874/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rodney E. Rohde has received funding from the American Society of Clinical Pathologists, American Society for Clinical Laboratory Science, U.S. Department of Labor (OSHA), and other public and private entities/foundations. Rohde is affiliated with ASCP, ASCLS, ASM, and serves on several scientific advisory boards. See <a href="https://rodneyerohde.wp.txstate.edu/service/">https://rodneyerohde.wp.txstate.edu/service/</a>.</span></em></p><p class="fine-print"><em><span>Nicholas Moore previously received funding from Abbott Molecular, bioMerieux, and Cepheid for contracted research work related to the development of laboratory assays. Funds were paid directly to Rush University. Nicholas Moore is a volunteer with the American Society for Clinical Laboratory Science, the American Society for Clinical Pathology, the American Society for Microbiology, and the Clinical and Laboratory Standards Institute. He is a member of the editorial board of Clinical Microbiology Reviews and BMC Infectious Diseases.</span></em></p>Lab testing provides doctors with essential information to help them diagnose and treat disease. Here’s what happens behind the scenes after you roll up your sleeve for a blood draw.Rodney E. Rohde, Regents' Professor of Clinical Laboratory Science, Texas State UniversityNicholas Moore, Associate Professor of Medical Laboratory Science, Rush UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1692602021-10-21T01:45:22Z2021-10-21T01:45:22ZCOVID tests have made pathology companies big profits, but rapid tests are set to shake up the market<figure><img src="https://images.theconversation.com/files/427644/original/file-20211020-59335-xjmjyb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-protective-suit-taking-nasal-swab-1687321891">Shutterstock</a></span></figcaption></figure><p>Throughout the pandemic, Australians with a sniffle or other cold and flu symptoms have been encouraged to get a PCR test – a swab of their throat and the back of their nose, taken by a nurse or doctor. This is then sent to a pathology laboratory for analysis. </p>
<p>So far, a total of <a href="https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-case-numbers-and-statistics#tests-conducted-and-results">41.5 million COVID PCR tests</a> have been performed in Australia. Private companies that process the tests are paid a <a href="https://www.aph.gov.au/DocumentStore.ashx?id=cfbcd9ed-ffac-4c50-a91e-fd844f2c5fa2">Medicare rebate</a> of A$85 per test, up from A$28.65 at the start of the pandemic in March 2020. </p>
<p>Although pathology companies undoubtedly have high overhead costs, the sector has recorded massive profits as a consequence of COVID.</p>
<p>But with rapid antigen tests, which can be performed in the home without needing to be sent to a lab, pathology companies could see a drop-off in revenue. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/home-rapid-antigen-testing-is-on-its-way-but-we-need-to-make-sure-everyone-has-access-169362">Home rapid antigen testing is on its way. But we need to make sure everyone has access</a>
</strong>
</em>
</p>
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<h2>Who are the big players and how much profit did they make?</h2>
<p>Clinics and practitioners are generally aligned with a particular service provider: consumers don’t get to choose the particular provider.</p>
<p>The pathology sector involves a handful of <a href="https://theconversation.com/questioning-the-pathology-centre-goldrush-11108">very large</a> commercial groups operating nationally and often using multiple brand names as a result of takeovers. </p>
<p>The sector also includes much smaller commercial competitors and public sector operations within hospitals. </p>
<p>The large commercial groups typically require significant investment in infrastructure and specialist staff, alongside networks for collecting specimens for testing and communicating results to whoever ordered the test. </p>
<figure class="align-center ">
<img alt="Woman lowers her mask to get a COVID nose swab." src="https://images.theconversation.com/files/427652/original/file-20211020-20-5kn7os.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427652/original/file-20211020-20-5kn7os.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427652/original/file-20211020-20-5kn7os.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427652/original/file-20211020-20-5kn7os.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427652/original/file-20211020-20-5kn7os.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427652/original/file-20211020-20-5kn7os.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427652/original/file-20211020-20-5kn7os.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">COVID testing requires substantial infrastructure and logistics.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/smiling-girl-puts-face-mask-off-1934424008">Shutterstock</a></span>
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<p>There are potential efficiencies in scale: large groups might have more expertise, more capacity and better logistics. The profits are also likely to be higher.</p>
<p>In the 2020-21 financial year, one of the pathology giants, Sonic Healthcare, <a href="https://investors.sonichealthcare.com/DownloadFile.axd?file=/Report/ComNews/20210823/02410057.pdf">reported</a> a net profit growth of 149%, to A$1.3 billion, with a significant proportion of that from COVID testing. </p>
<p>The other market leader, Healius, today reported a <a href="https://www.healius.com.au/siteassets/healius-corporate/pdfs/asx-announcements/2021/asx_20210830_2256791.pdf">44% growth in revenue</a> in the September quarter, compared to 2020, driven by COVID testing and stronger than expected routine testing. </p>
<h2>How rapid testing could shake up the system</h2>
<p>The pathology industry’s dominance is likely to be eroded in coming decades by the emergence of rapid-testing “diagnostics on a stick” for a range of different illnesses. </p>
<p>These highly specialised low-cost and often disposable (use once and throw away) tools can be used in the home, GP clinic, or even venues such as pubs, clubs, restaurants and universities. </p>
<p>Rapid tests are similar to roadside alcohol testing or off-the-shelf pregnancy tests. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/rapid-antigen-tests-have-long-been-used-overseas-to-detect-covid-heres-what-australia-can-learn-168490">Rapid antigen tests have long been used overseas to detect COVID. Here's what Australia can learn</a>
</strong>
</em>
</p>
<hr>
<p>For COVID, rapid antigen tests take around 15 minutes and <a href="https://theconversation.com/home-rapid-antigen-testing-is-on-its-way-but-we-need-to-make-sure-everyone-has-access-169362">cost about A$8.50 to A$15</a>, but they don’t currently attract a Medicare rebate. </p>
<p>Rapid tests aren’t as accurate as PCR tests, which use high-end equipment and expertise in pathology labs, and are likely to miss some COVID cases. So rapid tests won’t replace PCR tests altogether but are likely to have an important role in testing people without symptoms.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/rapid-antigen-testing-isnt-perfect-but-it-could-be-a-useful-part-of-australias-covid-response-164873">Rapid antigen testing isn't perfect. But it could be a useful part of Australia's COVID response</a>
</strong>
</em>
</p>
<hr>
<h2>Why the delay?</h2>
<p>The Therapeutic Goods Administration (TGA) regulates medical devices, ranging from plastic gloves through to pacemakers, and is responsible for authorising new test equipment.</p>
<p>The TGA has been slow to authorise rapid testing tools for COVID. TGA head John Skerritt <a href="https://www.news.com.au/world/coronavirus/australia/tga-admits-delay-in-athome-testing-until-vax-rates-higher-was-deliberate/news-story/43626bc665945d721d532a9f62713a6c">told News.com</a> the regulator had been waiting for a signal from government about when it was an appropriate time to add rapid antigen tests into the mix. </p>
<p>That signal <a href="https://www.smh.com.au/politics/federal/additional-protection-of-home-covid-testing-expected-before-christmas-20210924-p58ugg.html">came in September</a>, with federal health minister Greg Hunt saying he wanted rapid tests to be made available as soon as the regulator had given them the all-clear. </p>
<p>The TGA is now assessing applications from manufacturers for rapid tests that can be used in the home, with the minister expecting these to become available from November.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1442784671297794052"}"></div></p>
<p>Slowness is, however, likely to please the big pathology groups, with their eyes on the bottom line and a sense that their world is going to change with advances in technology.</p>
<p>It’s also likely to please the <a href="https://www.rcpa.edu.au/News-and-Media-Releases/Media-Releases">Royal College of Pathologists of Australasia</a>, the professional body representing pathologists. </p>
<p>It has <a href="https://www.rcpa.edu.au/getattachment/f7af7c7f-e81c-426b-973f-8b627113eb3a/RCPA-updates-advice-surrounding-rapid-antigen-test.aspx">cautioned</a> about undue reliance on rapid tests. It has noted potential issues about accuracy, the handling of devices, and the need to capture data as the basis for effective public health responses when infection spreads across locations. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1311551467447152641"}"></div></p>
<p>The government has said rapid antigen tests will play a role in Australia’s COVID response going forward, but we’re yet to see exactly how this will work, who will have access, and at what cost. </p>
<p>But it’s clear we need more transparency about how these decisions are made.</p><img src="https://counter.theconversation.com/content/169260/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Baer Arnold is affiliated with Friends of Science in Medicine.</span></em></p>Pathology companies have recorded massive profits from COVID testing, with each PCR test attracting a Medicare rebate of A$85.Bruce Baer Arnold, Associate Professor, School of Law, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1698902021-10-15T16:15:47Z2021-10-15T16:15:47ZDeath in space: here’s what would happen to our bodies<figure><img src="https://images.theconversation.com/files/426677/original/file-20211015-30-1frhrda.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/s/photos/space">Nasa / Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>As space travel for recreational purposes is becoming a very real possibility, there could come a time when we are travelling to other planets for holidays, or perhaps even to live. Commercial space company Blue Origin has already started sending <a href="https://www.space.com/blue-origin-first-crewed-launch-four-world-records">paying customers</a> on sub-orbital flights. And Elon Musk hopes to start a <a href="https://www.cnbc.com/2021/04/23/elon-musk-aiming-for-mars-so-humanity-is-not-a-single-planet-species.html">base on Mars</a> with his firm SpaceX.</p>
<p>This means we need to start thinking about what it will be like to live in space – but also what will happen if someone dies there.</p>
<p>After death here on Earth the human body progresses through a number of stages of decomposition. These were described as early as 1247 in
Song Ci’s <a href="https://en.wikipedia.org/wiki/Collected_Cases_of_Injustice_Rectified">The Washing Away of Wrongs</a>, essentially the first forensic science handbook.</p>
<p>First the blood stops flowing and begins to pool as a result of gravity, a process known as livor mortis. Then the body cools to algor mortis, and the muscles stiffen due to uncontrolled build-up of calcium in the muscle fibres. This is the state of rigor mortis. Next enzymes, proteins which speed up chemical reactions, break down cell walls releasing their contents.</p>
<p>At the same time, the bacteria in our gut escape and spread throughout the body. They devour the soft tissues - putrefaction - and the gases they release cause the body to swell. Rigor mortis is undone as the muscles are destroyed, strong smells are emitted and the soft tissues are broken down.</p>
<p>These decomposition processes are the intrinsic factors, but there are also external factors which influence the process of decomposition, including temperature, insect activity, burying or wrapping a body, and the presence of fire or water.</p>
<p><a href="https://theconversation.com/scans-reveal-new-details-of-how-egyptian-pharaoh-met-a-violent-death-155171">Mummification</a>, the desiccation or drying out of the body, occurs in dry conditions which can be hot or cold.</p>
<p>In damp environments without oxygen, adipocere formation can occur, where the water can cause the breakdown of fats into a waxy material through the process of hydrolysis. This waxy coating can act as a barrier on top of the skin to protect and preserve it. </p>
<p>But in most cases, the soft tissues will ultimately disappear to reveal the skeleton. These hard tissues are much more resilient and can survive for thousands of years. </p>
<h2>Halting decomposition</h2>
<p>So, what about death in the final frontier? </p>
<p>Well, the different gravity seen on other planets will certainly impact the livor mortis stage, and the lack of gravity while floating in space would mean that blood would not pool.</p>
<p>Inside a spacesuit, rigor mortis would still occur since it is the result of the cessation of bodily functions. And bacteria from the gut would still devour the soft tissues. But these bacteria need oxygen to function properly and so limited supplies of air would significantly slow down the process.</p>
<p>Microbes from the soil also help decomposition, and so any planetary environment that inhibits microbial action, such as extreme dryness, improves the chances of soft tissue preserving. </p>
<p>Decomposition in conditions so different from the Earth’s environment means that external factors would be more complicated, such as with the skeleton. When we are alive, bone is a living material comprising both organic materials like blood vessels and collagen, and inorganic materials in a crystal structure. </p>
<p>Normally, the organic component will decompose, and so the skeletons we see in museums are mostly the inorganic remnants. But in very acidic soils, which we may find on other planets, the reverse can happen and the inorganic component can disappear leaving only the soft tissues. </p>
<p>On Earth the decomposition of human remains forms part of a balanced ecosystem where nutrients are recycled by living organisms, such as insects, microbes and even plants. Environments on different planets will not have evolved to make use of our bodies in the same efficient way. Insects and scavenging animals are not present on other planets in our system.</p>
<p>But the dry desert-like conditions of Mars might mean that the soft tissues dry out, and perhaps the windblown sediment would erode and damage the skeleton in a way that we see here on Earth.</p>
<figure class="align-center ">
<img alt="The dry rocky and sandy orange surface of Mars" src="https://images.theconversation.com/files/426689/original/file-20211015-7373-15mx7oc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/426689/original/file-20211015-7373-15mx7oc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=608&fit=crop&dpr=1 600w, https://images.theconversation.com/files/426689/original/file-20211015-7373-15mx7oc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=608&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/426689/original/file-20211015-7373-15mx7oc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=608&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/426689/original/file-20211015-7373-15mx7oc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=764&fit=crop&dpr=1 754w, https://images.theconversation.com/files/426689/original/file-20211015-7373-15mx7oc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=764&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/426689/original/file-20211015-7373-15mx7oc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=764&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The arid environment of Mars.</span>
<span class="attribution"><a class="source" href="https://pixabay.com/photos/mars-planet-surface-space-11604/">https://pixabay.com/users/wikiimages-1897</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>Temperature is also a key factor in decomposition. On the Moon, for example, <a href="https://www.bbc.com/future/article/20130920-how-cold-is-space-really">temperatures can range from 120°C to -170°C</a>. Bodies could therefore show signs of heat-induced change or freezing damage. </p>
<p>But I think it is likely that remains would still appear human as the full process of decomposition that we see here on Earth would not occur. Our bodies would be the “aliens” in space. Perhaps we would need to find a new form of funerary practice, which does not involve the high energy requirements of cremation or the digging of graves in a harsh inhospitable environment.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/william-shatner-oldest-astronaut-at-90-heres-how-space-tourism-could-affect-older-people-169548">William Shatner oldest astronaut at 90 – here's how space tourism could affect older people</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/169890/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Thompson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The vastly differing environment would need a whole new approach to disposing of dead bodies.Tim Thompson, Dean of Health & Life Sciences + Professor of Applied Biological Anthropology, Teesside UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1384082020-06-15T12:23:50Z2020-06-15T12:23:50ZWhat the archaeological record reveals about epidemics throughout history – and the human response to them<figure><img src="https://images.theconversation.com/files/341667/original/file-20200614-153862-12o8vrv.jpg?ixlib=rb-1.1.0&rect=121%2C23%2C3619%2C2594&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dead men do tell tales through their physical remains.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Italy-Uffizi-Ancient-Cemetery/49b445301cb148e29d0654254d397c18/2/0">AP Photo/Francesco Bellini</a></span></figcaption></figure><p>The previous pandemics to which people often compare COVID-19 – the <a href="https://theconversation.com/compare-the-flu-pandemic-of-1918-and-covid-19-with-caution-the-past-is-not-a-prediction-138895">influenza pandemic of 1918</a>, the <a href="https://theconversation.com/coronavirus-and-the-black-death-spread-of-misinformation-and-xenophobia-shows-we-havent-learned-from-our-past-132802">Black Death bubonic plague</a> (1342-1353), the <a href="https://www.newyorker.com/magazine/2020/04/06/pandemics-and-the-shape-of-human-history">Justinian plague</a> (541-542) – don’t seem that long ago to archaeologists. We’re used to thinking about people who lived many centuries or even millennia ago. Evidence found directly on skeletons shows that infectious diseases have been with us since our beginnings as a species.</p>
<p><a href="https://scholar.google.com/citations?user=HtKKK9AAAAAJ&hl=en">Bioarchaeologists</a> <a href="https://scholar.google.com/citations?user=pW_XmM4AAAAJ&hl=en&oi=ao">like</a> <a href="https://scholar.google.com/citations?user=MtpPBa4AAAAJ&hl=en&oi=ao">us</a> analyze skeletons to reveal more about how infectious diseases originated and spread in ancient times.</p>
<p>How did aspects of early people’s social behavior allow diseases to flourish? How did people try to care for the sick? How did individuals and entire societies modify behaviors to protect themselves and others?</p>
<p><a href="https://doi.org/10.1515/anre-2016-0001">Knowing these things</a> might help scientists understand why COVID-19 has wreaked such global devastation and what needs to be put in place before the next pandemic.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/338844/original/file-20200601-95024-11z243w.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/338844/original/file-20200601-95024-11z243w.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/338844/original/file-20200601-95024-11z243w.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/338844/original/file-20200601-95024-11z243w.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/338844/original/file-20200601-95024-11z243w.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/338844/original/file-20200601-95024-11z243w.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/338844/original/file-20200601-95024-11z243w.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/338844/original/file-20200601-95024-11z243w.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">These round lesions are pathognomonic signs of syphilis.</span>
<span class="attribution"><span class="source">Charlotte Roberts</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Clues about illnesses long ago</h2>
<p>How can bioarchaeologists possibly know these things, especially for early cultures that left no written record? Even in literate societies, <a href="https://southburnett.com.au/news2/2019/11/13/researchers-uncover-hidden-toll/">poorer and marginalized segments</a> were rarely written about.</p>
<p>In most archaeological settings, all that remains of our ancestors is the skeleton. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/341261/original/file-20200611-80750-47wdov.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/341261/original/file-20200611-80750-47wdov.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/341261/original/file-20200611-80750-47wdov.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341261/original/file-20200611-80750-47wdov.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341261/original/file-20200611-80750-47wdov.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341261/original/file-20200611-80750-47wdov.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341261/original/file-20200611-80750-47wdov.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341261/original/file-20200611-80750-47wdov.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Tuberculosis leaves telltale markings in the spine.</span>
<span class="attribution"><span class="source">Charlotte Roberts</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>For some infectious diseases, like <a href="https://www.dur.ac.uk/archaeology/research/projects/all/?mode=project&id=1036">syphilis</a>, <a href="https://www.dur.ac.uk/archaeology/research/projects/all/?mode=project&id=353">tuberculosis</a> and <a href="https://www.dur.ac.uk/archaeology/research/projects/all/?mode=project&id=279">leprosy</a>, the location, characteristics and distribution of marks on a skeleton’s bones can serve as distinctive “<a href="https://www.medicinenet.com/script/main/art.asp?articlekey=6386">pathognomonic</a>” indicators of the infection.</p>
<p>Most skeletal signs of disease are non-specific, though, meaning bioarchaeologists today can tell an individual was sick, but not with what disease. Some diseases never affect the skeleton at all, including plague and viral infections like HIV and COVID-19. And diseases that kill quickly don’t have enough time to leave a mark on victims’ bones.</p>
<p>To uncover evidence of specific diseases beyond obvious bone changes, bioarchaeologists use a variety of methods, often with the help of other specialists, like geneticists or parasitologists. For instance, analyzing soil collected in a grave from around a person’s pelvis can reveal the remains of <a href="https://doi.org/10.15184/aqy.2019.61">intestinal parasites</a>, such as tapeworms and round worms. Genetic analyses can also identify the <a href="https://www.dur.ac.uk/archaeology/research/projects/all/?mode=project&id=667">DNA of infectious pathogens</a> still clinging to ancient bones and teeth.</p>
<p>Bioarchaeologists can also estimate age at death based on how developed a youngster’s teeth and bones are, or how much an adult’s skeleton has degenerated over its lifespan. Then demographers help us draw age profiles for populations that died in epidemics. Most infectious diseases disproportionately affect those with the weakest immune systems, usually the very young and very old.</p>
<p>For instance, the Black Death was indiscriminate; <a href="https://www.americanscientist.org/article/the-bright-side-of-the-black-death">14th-century burial pits</a> contain the typical age distributions found in cemeteries we know were not for Black Death victims. In contrast, the 1918 flu pandemic was unusual in that it <a href="https://doi.org/10.1371/journal.pone.0069586">hit hardest those with the most robust immune systems</a>, that is, healthy young adults. COVID-19 today is also leaving a recognizable profile of those most likely to die from the disease, targeting <a href="https://www.bloomberg.com/opinion/articles/2020-05-07/comparing-coronavirus-deaths-by-age-with-flu-driving-fatalities">older and vulnerable people</a> and <a href="https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html">particular ethnic groups</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/341585/original/file-20200613-153827-mjcx87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/341585/original/file-20200613-153827-mjcx87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/341585/original/file-20200613-153827-mjcx87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=611&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341585/original/file-20200613-153827-mjcx87.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=611&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341585/original/file-20200613-153827-mjcx87.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=611&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341585/original/file-20200613-153827-mjcx87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=768&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341585/original/file-20200613-153827-mjcx87.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=768&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341585/original/file-20200613-153827-mjcx87.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=768&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ground penetrating radar shows mass graves from the small Aboriginal settlement of Cherbourg in Australia, where 490 out of 500 people were struck down by the 1918-1919 influenza pandemic, with about 90 deaths.</span>
<span class="attribution"><span class="source">Kelsey Lowe</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>We can find out what infections were around in the past through our ancestors’ remains, but what does this tell us about the bigger picture of the origin and evolution of infections? Archaeological clues can help researchers reconstruct aspects of socioeconomic organization, environment and technology. And we can study how variations in these risk factors caused diseases to vary across time, in different areas of the world and even among people living in the same societies.</p>
<h2>How infectious disease got its first foothold</h2>
<p>Human biology affects culture in complex ways. Culture influences biology, too, although it can be hard for our bodies to keep up with rapid cultural changes. For example, in the 20th century, highly processed fast food replaced a more balanced and healthy diet for many. Because the human body evolved and was <a href="https://global.oup.com/academic/product/mismatch-9780192806833?cc=us&lang=en&">designed for a different world</a>, this dietary switch resulted in a rise in diseases like diabetes, heart disease and obesity.</p>
<p>From a paleoepidemiological perspective, the most significant event in our species’ history was the adoption of farming. <a href="https://www.khanacademy.org/humanities/world-history/world-history-beginnings/birth-agriculture-neolithic-revolution/v/how-did-agriculture-grow">Agriculture arose independently</a> in several places around the world beginning around 12,000 years ago.</p>
<p>Prior to this change, people lived as hunter-gatherers, with <a href="https://doi.org/10.1016/j.jas.2016.02.003">dogs as their only animal companions</a>. They were very active and had a well balanced, varied diet that was high in protein and fiber and low in calories and fat. These small groups experienced <a href="https://doi.org/10.1016/j.jas.2018.07.010">parasites</a>, <a href="https://doi.org/10.1016/j.ijpp.2017.01.004">bacterial infections</a> and <a href="https://www.nytimes.com/2016/10/18/science/first-boomerang-victim-australia.html">injuries</a> while hunting wild animals and occasionally fighting with one another. They also had to deal with <a href="https://doi.org/10.1016/j.jasrep.2018.03.019">dental problems</a>, including extreme wear, plaque and periodontal disease.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/341497/original/file-20200612-153832-7gh3c9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/341497/original/file-20200612-153832-7gh3c9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/341497/original/file-20200612-153832-7gh3c9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1387&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341497/original/file-20200612-153832-7gh3c9.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1387&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341497/original/file-20200612-153832-7gh3c9.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1387&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341497/original/file-20200612-153832-7gh3c9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1744&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341497/original/file-20200612-153832-7gh3c9.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1744&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341497/original/file-20200612-153832-7gh3c9.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1744&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A healed fracture of the lower leg bones from a person buried in Roman Winchester, England.</span>
<span class="attribution"><span class="source">Charlotte Roberts</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>One thing hunter-gatherers didn’t need to worry much about, however, was virulent infectious diseases that could move quickly from person to person throughout a large geographic region. Pathogens like the influenza virus were not able to effectively spread or even be maintained by small, mobile, and socially isolated populations.</p>
<p>The advent of agriculture resulted in larger, sedentary populations of people living in close proximity. New diseases could flourish in this new environment. The transition to agriculture was characterized by <a href="https://doi.org/10.1126/science.1208880">high childhood mortality</a>, in which approximately 30% or more of children died before the age of 5.</p>
<p>And for the first time in an evolutionary history spanning millions of years, different species of mammals and birds became intimate neighbors. Once people began to live with newly domesticated animals, they were brought into the life cycle of a new group of diseases – called <a href="https://www.who.int/topics/zoonoses/en/">zoonoses</a> – that previously had been limited to wild animals but could now jump into human beings.</p>
<p>Add to all this the stresses of poor sanitation and a deficient diet, as well as increased connections between distant communities through migration and trade especially between urban communities, and <a href="https://boydellandbrewer.com/urban-bodies-communal-health-in-late-medieval-english-towns-and-cities.html">epidemics of infectious disease</a> were able to take hold for the first time.</p>
<h2>Globalization of disease</h2>
<p>Later events in human history also resulted in major epidemiological transitions related to disease.</p>
<p>For more than 10,000 years, the people of Europe, the Middle East and Asia evolved along with particular zoonoses in their local environments. The animals people were in contact with varied from place to place. As people lived alongside particular animal species over long periods of time, a symbiosis could develop – as well as immune resistance to local zoonoses.</p>
<p>At the beginning of modern history, people from European empires also began traveling across the globe, taking with them a suite of “Old World” diseases that were devastating for groups who hadn’t evolved alongside them. Indigenous populations in <a href="https://australianstogether.org.au/discover/australian-history/colonisation/">Australia</a>, <a href="https://doi.org/10.4269/ajtmh.16-0169">the Pacific</a> and <a href="https://www.sciencemag.org/news/2015/06/how-europeans-brought-sickness-new-world">the Americas</a> had no biological familiarity with these new pathogens. Without immunity, one epidemic after another ravaged these groups. Mortality estimates range between 60-90%.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/341336/original/file-20200611-80778-1qo67z2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/341336/original/file-20200611-80778-1qo67z2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/341336/original/file-20200611-80778-1qo67z2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=753&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341336/original/file-20200611-80778-1qo67z2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=753&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341336/original/file-20200611-80778-1qo67z2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=753&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341336/original/file-20200611-80778-1qo67z2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=947&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341336/original/file-20200611-80778-1qo67z2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=947&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341336/original/file-20200611-80778-1qo67z2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=947&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">This skull of a person who lived more than 2,600 years ago in Peru shows evidence of a surgery, maybe to treat a head wound.</span>
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<p>The study of disease in skeletons, mummies and other remains of past people has played a critical role in reconstructing the origin and evolution of pandemics, but this work also provides evidence of <a href="https://www.nytimes.com/2012/12/18/science/ancient-bones-that-tell-a-story-of-compassion.html">compassion and care</a>, including medical interventions such as <a href="https://thereader.mitpress.mit.edu/hole-in-the-head-trepanation/">trepanation</a>, <a href="https://www.discovermagazine.com/planet-earth/13-000-year-old-fillings-prove-ancient-dentistry-was-brutal">dentistry</a>, <a href="https://theconversation.com/severed-limbs-and-wooden-feet-how-the-ancients-invented-prosthetics-77741">amputation and prostheses</a>,
<a href="https://www.history.com/news/ancient-medicines-from-shipwreck-shed-light-on-life-in-antiquity">herbal remedies</a> and <a href="https://www.forbes.com/sites/kristinakillgrove/2018/02/28/largest-collection-of-ancient-surgical-tools-was-found-here-not-at-pompeii/#5241f662317f">surgical instruments</a>.</p>
<p>Other evidence shows that people have often done their best to protect others, as well as themselves, from disease. Perhaps one of the most famous examples is the <a href="https://www.bbc.com/news/uk-england-derbyshire-51904810">English village of Eyam</a>, which made a self-sacrificing decision to isolate itself to prevent further spread of a plague from London in 1665.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/338847/original/file-20200601-95009-1t6jb06.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/338847/original/file-20200601-95009-1t6jb06.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/338847/original/file-20200601-95009-1t6jb06.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=389&fit=crop&dpr=1 600w, https://images.theconversation.com/files/338847/original/file-20200601-95009-1t6jb06.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=389&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/338847/original/file-20200601-95009-1t6jb06.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=389&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/338847/original/file-20200601-95009-1t6jb06.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=489&fit=crop&dpr=1 754w, https://images.theconversation.com/files/338847/original/file-20200601-95009-1t6jb06.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=489&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/338847/original/file-20200601-95009-1t6jb06.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=489&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A tuberculosis sanatorium in São Paulo, Brazil, in the late 1800s.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/ydhjdjb4">Wellcome Collection</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>In other eras, people with tuberculosis were placed in sanatoria, people with leprosy were admitted to specialized hospitals or segregated on islands or into remote areas, and urban dwellers fled cities when plagues came.</p>
<p>The archaeological and historical record are reminders that people have lived with infectious disease for millennia. Pathogens have helped shape civilization, and humans have been resilient in the face of such crises.</p><img src="https://counter.theconversation.com/content/138408/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Westaway receives funding from the Australian Research Council. </span></em></p><p class="fine-print"><em><span>Charlotte Roberts and Gabriel D. Wrobel do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People have lived with infectious disease throughout the millennia, with culture and biology influencing each other. Archaeologists decode the stories told by bones and what accompanies them.Charlotte Roberts, Professor of Archaeology, Durham UniversityGabriel D. Wrobel, Professor of Anthropology, Michigan State UniversityMichael Westaway, Australian Research Council Future Fellow, Archaeology, School of Social Science, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1314652020-02-14T03:31:59Z2020-02-14T03:31:59ZToday’s disease names are less catchy, but also less likely to cause stigma<p>What’s in a name? A lot when it comes to disease outbreaks, according to the recent communication from the World Health Organisation (WHO) on the previously named coronavirus. The virus will now be named <a href="https://www.sciencemag.org/news/2020/02/bit-chaotic-christening-new-coronavirus-and-its-disease-name-create-confusion">severe acute respiratory syndrome coronavirus 2</a> (SARS-CoV-2), and the disease named COVID-19.</p>
<p>While it has been noted that picking a name might not seem the <a href="https://www.theatlantic.com/science/archive/2020/01/the-virus-that-still-has-no-name/605893/">most pressing problem</a> in the middle of an outbreak, WHO chief Tedros Adhanom Ghebreyesus laid out the important considerations behind it in his announcement. Guidelines recommend avoiding “references to a specific geographical location, animal species or group of people,” he said, <a href="https://www.sbs.com.au/news/the-coronavirus-finally-has-an-official-name-here-s-how-it-was-chosen">adding</a> these measures aimed to prevent stigma.</p>
<p>The WHO renaming hopes to stymie racism and framing of COVID-19 as “<a href="https://www.heraldsun.com.au/news/national/brisbane-man-tested-for-deadly-chinese-virus/video/b544eb276770840073a49cea8268f501">the Chinese virus</a>”, that has come with reports of <a href="https://theconversation.com/coronavirus-fears-can-trigger-anti-chinese-prejudice-heres-how-schools-can-help-130945">discrimation</a>. </p>
<p>Unfortunately, there has not been a WHO pronouncement about inappropriate terminology to deflect the media from attaching the word “deadly” to whatever new virus is in their sights!</p>
<p>The new name is intended to represent a viral persona and the WHO correctly <a href="https://www.sciencealert.com/who-has-finally-named-the-deadly-coronavirus">points</a> to past experiences showing disease names can “stigmatise entire regions and ethnic groups”. When we look at the history of disease naming we can see plenty of unintended consequences, stigmatising or otherwise.</p>
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Read more:
<a href="https://theconversation.com/coronavirus-fears-can-trigger-anti-chinese-prejudice-heres-how-schools-can-help-130945">Coronavirus fears can trigger anti-Chinese prejudice. Here's how schools can help</a>
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<h2>The ‘Great Pox’: an exercise in re-branding</h2>
<p>In the 16th century “Pox” was a <a href="https://www.britannica.com/science/smallpox">generic name</a> for any frightening and unfamiliar health problem, particularly one that manifested with lesions on the human body. Pox (or “pocks” referring to the specific lesions) was a term often used interchangeably with “plague” as a population-terrifying word. </p>
<p>Both words came to carry a connotation of what or who the causes of the sickness might be. Less worthy people or “foreigners” were <a href="https://www.amazon.com/Greatest-Benefit-Mankind-Medical-Humanity/dp/0393319806">perennial favourites</a> as the guilty parties in the case of the pox, while rats were usually added to the mix in the case of plague. Nobody was very concerned about stigmatising the rats. </p>
<p>Sexually transmitted disease syphilis was originally called <a href="https://microbiologysociety.org/publication/past-issues/the-mobile-microbe/article/the-great-pox-mobile-microbe.html">The Great Pox</a> and referred to as a “venereal” affliction (luckily, you can’t really stigmatise Venus). It was also named variously the French or Italian or English disease, depending on which of these newly designated states you were at war with or just wished to gratuitously insult. </p>
<p>Italian physician <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631234/">Girolamo Fracastorio</a> (1484-1530) wrote a graphic poem about the disastrous physical effects of this disease on the young and beautiful. He named his “hero” <a href="https://www.npr.org/2011/05/27/136717683/science-diction-the-origin-of-the-word-syphilis">Syphilis</a>, thus providing another name for the contagion. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/315207/original/file-20200213-10976-xkmcna.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/315207/original/file-20200213-10976-xkmcna.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/315207/original/file-20200213-10976-xkmcna.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/315207/original/file-20200213-10976-xkmcna.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/315207/original/file-20200213-10976-xkmcna.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/315207/original/file-20200213-10976-xkmcna.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=563&fit=crop&dpr=1 754w, https://images.theconversation.com/files/315207/original/file-20200213-10976-xkmcna.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=563&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/315207/original/file-20200213-10976-xkmcna.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=563&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Hieronymus Fracastorius (Girolamo Fracastoro) shows the shepherd Syphilus and the hunter Ilceus a statue of Venus to warn them against the danger of infection.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/edzbqu78">Wellcome Trust</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
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<p>However, the use of the name “syphilis” for venereal disease was not common until the 19th century. By then it was no longer seen as a means to stigmatise attractive young men but rather as an acceptable name for a shameful social problem. </p>
<p>Those with long memories might acknowledge a year can be stigmatised by a disease just as easily as a geographic location. The year 1918 is associated with dread due to the outbreak of the Spanish Flu pandemic. Books have been published a century later with titles such as <a href="https://www.goodreads.com/book/show/37923457-pandemic-1918?from_search=true&qid=hGTEwUBIEU&rank=1">Pandemic 1918</a> and <a href="https://www.goodreads.com/book/show/18222767-a-death-struck-year?from_search=true&qid=e2uPYzII6p&rank=1">A Death Struck Year</a>. </p>
<h2>Microbe hunting</h2>
<p>An interlude of enthusiastic microbe hunting in the early 20th century had the counter-intuitive result of young ambitious, university-trained bacteriologists enthusiastically competing to get <a href="https://www.ncbi.nlm.nih.gov/pubmed/17788614">their names attached</a> to the “new” diseases.</p>
<p>Detected with then cutting-edge microscope equipment, <a href="https://www.cdc.gov/globalhealth/ntd/diseases/index.html">tropical diseases</a> were particularly popular, as distant but more exotic. African sleeping sickness, Yellow Fever, Buruli Ulcer, Chagas Disease, Dracunculiasis (Guinea Worm Disease), Schistosomiasis, Ebola, Yaws and others followed. </p>
<p>Meanwhile in New York the “disease” usually depicted as the archetypal example of stigmatising, was about to make its first media appearance. </p>
<p>The term GRID (<a href="https://www.nytimes.com/1982/05/11/science/new-homosexual-disorder-worries-health-officials.html">gay-related immune deficiency</a>) was used initially as a name to try to make sense of young gay men presenting at doctors’ surgeries or Emergency Rooms with collections of symptoms not usually seen in Western countries. </p>
<p>This name was <a href="https://www.avert.org/professionals/history-hiv-aids/overview">changed to AIDS</a> (acquired immune deficiency syndrome) when it was realised not just gay men were affected by compromised immune symptoms. Indeed, the <a href="https://www.youtube.com/watch?v=mSmaWEK_rD4">Grim Reaper</a> television commercials of the 1980s warned us that everyone from babies to the elderly was now at risk of this terrifying disease, but the stigmatising associated with GRID remained and the acronym AIDS did not protect the gay community from blame and rejection. </p>
<p>The WHO has developed guidelines to now be careful in their naming. Gone is the fear-mongering against pork products with <a href="https://www.cdc.gov/flu/swineflu/index.htm">swine flu</a>, first seen in Mexico in 2009; or people from Middle East, treated with suspicion after the naming of <a href="https://www.who.int/emergencies/mers-cov/en/">Middle East respiratory syndrome</a> in 2012.</p>
<p>Avian influenza was originally named <a href="https://www.ncbi.nlm.nih.gov/pubmed/18533261">fowl plague in 1878</a>, and when H5N1, or “bird flu” created major new outbreaks in 2004 and 2005 <a href="https://www.sciencedirect.com/topics/immunology-and-microbiology/influenza-a-virus-h5n1">millions of birds</a> were slaughtered – including many with no risk of carrying the disease.</p>
<h2>Fear is contagious</h2>
<p>Fear needs a name and naming suggests a response, but not always is the response acceptable to everyone. </p>
<p>Examining the past shows avoiding stigmatisation was not of primary importance in dealing with large outbreaks of disease. Rather, the search for scapegoats took precedence. </p>
<p>Now, in effect, a greater fear (of the worse effects of stigmatisation) is being used to combat and correct a medicalised fear. Can misinformation be minimised by the best non-stigmatisation efforts of the WHO? Only history will tell.</p>
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<p><em>Update: A previous version of this article referred to the virus as being named COVID-19. COVID-19 is the name of the disease. The virus itself is SARS-CoV-2.</em></p><img src="https://counter.theconversation.com/content/131465/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Hardy does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The official naming of COVID-19 has the tone of a committee decision. Historically, names for diseases have not been quite so well thought out and were more likely to offend.Susan Hardy, Honorary Lecturer, Arts & Social Sciences, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1228682020-01-21T19:03:40Z2020-01-21T19:03:40ZI’m taking antibiotics – how do I know I’ve been prescribed the right ones?<figure><img src="https://images.theconversation.com/files/311017/original/file-20200121-69543-del09s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Not all antibiotics kill all types of bacteria.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-sick-woman-holding-glass-water-1325841608">fizkes/Shutterstock</a></span></figcaption></figure><p>In the days before antibiotics, <a href="http://www.bbc.co.uk/newsbeat/article/34866829/life-before-antibiotics-and-maybe-life-after-an-antibiotic-apocalypse">deaths from bacterial infections</a> were common. Seemingly minor illnesses could escalate in severity, becoming deadly in a matter of hours or days. </p>
<p>These days, antibiotics can be life-savers. In the community, they’re <a href="https://theconversation.com/when-should-you-take-antibiotics-42751">commonly used</a> to treat bacterial infections of the lung, urinary tract, eye, throat, skin and gut. </p>
<p>But they’re not needed for <em>all</em> bacterial infections – many infections will resolve on their own without treatment. </p>
<p>And of course, antibiotics <a href="https://www.cdc.gov/features/antibioticuse/index.html">don’t treat viral infections</a> such as colds and flus, or fungal infections such as tinea or thrush. </p>
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Read more:
<a href="https://theconversation.com/when-should-you-take-antibiotics-42751">When should you take antibiotics?</a>
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<p>Even when antibiotics are necessary, they’re not a one-size-fits-all treatment: not all antibiotics kill all types of bacteria. </p>
<h2>What type of bacteria is causing the infection?</h2>
<p>If your doctor suspects you have a serious bacterial infection, they will often take a urine or blood test, or a swab to send to the pathologist. </p>
<p>At the lab, these tests aim to detect and identify the bacteria causing the infection. </p>
<p>Some methods only need to detect bacterial DNA. These DNA-based approaches are called “genotypic methods” and are quick and highly sensitive. </p>
<p>Other methods involve attempting to culture and isolate bacteria from the sample. This can take one to four days. </p>
<h2>What antibiotic can fight the infection?</h2>
<p>If antibiotic treatment is necessary, the isolated bacteria can be used in a second series of tests to help determine the right antibiotic for your infection. These are called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627445/">antimicrobial susceptibility tests</a>. </p>
<p>Like the tests that first detected the bacterium causing your infection, they can be done using DNA-based (genotypic) methods or by culturing the bacterium in the presence of various antibiotics and assessing what happens (phenotypic methods). </p>
<p>Genotypic tests tend to identify which antibiotics won’t work so they can be ruled out as treatment options; ruling out the ones that won’t work leaves the ones that <em>should</em> work.</p>
<p>For phenotypic tests, the bacterium is regrown in the presence of a range of antibiotics to see which one stops its growth. A range of concentrations of each antibiotic are often used in these tests.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/311018/original/file-20200121-69555-15dpssa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/311018/original/file-20200121-69555-15dpssa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/311018/original/file-20200121-69555-15dpssa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/311018/original/file-20200121-69555-15dpssa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/311018/original/file-20200121-69555-15dpssa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/311018/original/file-20200121-69555-15dpssa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/311018/original/file-20200121-69555-15dpssa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Testing can more accurately determine the right antibiotic for your infection.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-pharmacist-hand-holding-medicine-box-756231364">iviewfinder/Shutterstock</a></span>
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<h2>Why you sometimes get a script without testing</h2>
<p>Whichever tests are done, the results may not be available for a couple of days. In the meantime, your doctor will probably get you started on an antibiotic that is <em>most likely</em> to be effective. This is called empiric therapy and is the “best guess” treatment while they wait for test results.</p>
<p>Empiric antibiotic choice is based on the doctor’s prior experience with that type of infection, as well as clinical guidelines developed from evidence about that infection type, and ongoing surveillance data from the pathology lab about the types of bacteria generally causing that infection, and which antibiotics those bacteria are susceptible to.</p>
<p>When available, the test results will either confirm the initial choice, or influence the doctor’s decision to prescribe a different antibiotic. </p>
<p>Take urinary tract infections (UTIs), for example. Most are caused by <em>E. coli</em> and there are antibiotics that reliably treat these infections. </p>
<p>Data from the thousands of pathology tests performed each year on the <em>E. coli</em> from other people’s UTIs helps inform the doctor’s choice of empiric antibiotic for you, as do the clinical guidelines. </p>
<p>The doctor can therefore be reasonably confident in prescribing that antibiotic while you wait for the test results from your urine sample. You’ll either get better and need no further intervention, or you’ll come back to the doctor, by which time your test results should be available to fine-tune the choice of antibiotic.</p>
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Read more:
<a href="https://theconversation.com/health-check-im-taking-antibiotics-when-will-they-start-working-107528">Health Check: I’m taking antibiotics – when will they start working?</a>
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<h2>Why it’s important to get the right antibiotic</h2>
<p>Naturally, you want to receive an antibiotic that will effectively treat your infection. But what’s wrong with taking an antibiotic that does the job too well or, conversely, is ineffective?</p>
<p>Antibiotics that are too strong will not only clear your infection but will also kill other good bacteria, <a href="https://www.nature.com/articles/d42859-019-00019-x">disrupting your microbiome</a> and possibly causing other knock-on effects. </p>
<p>On the other hand, an ineffective antibiotic will not only fail to treat the infection adequately, it can still cause side effects and disrupt your microbiome.</p>
<p>A broader consideration for the judicious use of antibiotics is that overuse, or ineffective use, contributes unnecessarily to the development of antibiotic resistance. All antibiotic use <a href="https://www.researchgate.net/profile/Sara_Hernando-Amado/publication/335337005_Defining_and_combating_antibiotic_resistance_from_One_Health_and_Global-Health_perspectives/links/5d7123f4299bf1cb8088bd73/Defining-and-combating-antibiotic-resistance-from-One-Health-and-Global-Health-perspectives.pdf">promotes resistance</a> in other bacteria they come in contact with, so minimising and optimising their targeted use is important.</p>
<p>The right antibiotic choice for your infection is a complex decision that must often be made before key additional evidence to support the decision is available. </p>
<p>As test results become available, the treatment antibiotics may be refined, changed or even stopped. </p>
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Read more:
<a href="https://theconversation.com/we-can-reverse-antibiotic-resistance-in-australia-heres-how-sweden-is-doing-it-123081">We can reverse antibiotic resistance in Australia. Here's how Sweden is doing it</a>
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<img src="https://counter.theconversation.com/content/122868/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christine Carson receives funding from government, industry and philanthropic sources to conduct research on antimicrobial susceptibilty test methods. She is part of a research group commercialising a rapid test.</span></em></p>Antibiotics aren’t a one-size-fits-all treatment – the one you had last time might not work on the infection you have at the moment. So how do doctors determine which one is likely to work?Christine Carson, Senior Research Fellow, School of Biomedical Sciences, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1206312019-08-08T13:02:10Z2019-08-08T13:02:10ZAI could be our radiologists of the future, amid a healthcare staff crisis<figure><img src="https://images.theconversation.com/files/287367/original/file-20190808-144868-1qy07g9.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C870%2C579&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are more radiological scans than ever, but too few radiologists to interpret them.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Radiologist_interpreting_MRI.jpg">The Medical Futurist</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>It is <a href="https://www.bbc.co.uk/news/uk-scotland-north-east-orkney-shetland-44616538">almost 40 years since</a> a <a href="http://broughttolife.sciencemuseum.org.uk/broughttolife/objects/display?id=6765&image=1">full-body magnetic resonance imaging machine</a> was used for the first time to scan a patient and generate diagnostic-quality images. The <a href="https://iopscience.iop.org/article/10.1088/0031-9155/25/4/017/meta">scanner and signal processing methods</a> needed to produce an image were devised by a team of medical physicists including John Mallard, Jim Hutchinson, Bill Edelstein and Tom Redpath at the University of Aberdeen, leading to widespread use of the MRI scanner, now a ubiquitous tool in radiology departments across the world. </p>
<p>MRI was a game changer in medical diagnostics because it didn’t require exposure to ionising radiation (such as X-rays), and could generate images on multiple cross-sections of the body with superb definition of soft tissues. This allowed, for example, the direct visualisation of the spinal cord for the first time.</p>
<p>Most people today will have undergone an MRI or know somebody who has. Along with the other tools available to radiologists, MRI has become essential to confirm the extent of disease, identify whether the patient has responded to treatment, and to demonstrate complications and in some cases guide intervention.</p>
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Read more:
<a href="https://theconversation.com/obituary-professor-sir-peter-mansfield-whose-invention-of-the-mri-scanner-revolutionised-medicine-72815">Obituary: Professor Sir Peter Mansfield, whose invention of the MRI scanner revolutionised medicine</a>
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<p>But radiology has become a victim of its own success, with an exponential rise in the number of imaging examinations requested within increasingly complex healthcare systems that serve an ageing population. Demand outstrips the supply of radiographers and radiologists available to produce these scans in publicly-funded healthcare systems such as the NHS.</p>
<p>In Scotland, in particular, the <a href="https://www.rcr.ac.uk/system/files/publication/field_publication_files/clinical-radiology-uk-workforce-census-report-2018.pdf">number of consultant radiologists has flat-lined</a> over the past ten years, while the range and complexity of imaging methods grows with each generation of scanners. Radiologists are running in order to stand still, with even the most efficient departments outsourcing some of their workload to external agencies.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/287368/original/file-20190808-144862-my83g2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287368/original/file-20190808-144862-my83g2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287368/original/file-20190808-144862-my83g2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287368/original/file-20190808-144862-my83g2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287368/original/file-20190808-144862-my83g2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287368/original/file-20190808-144862-my83g2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287368/original/file-20190808-144862-my83g2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Interpreting the extraordinary detail from MRI scans is something that could be automated using AI.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/mgdtgd/3507973704">mgdtgd</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<h2>The potential and problems of AI</h2>
<p>Meanwhile, innovators in industry have seen the potential opportunities that artificial intelligence (AI) might bring to healthcare, particularly radiology and pathology which are based on digital images. Machine learning algorithms fed with large amounts of past diagnoses can generate new rules for classifying scans based on past examples. The approach of applying this technique to diagnostic scans is known as <a href="https://www.ncbi.nlm.nih.gov/pubmed/31080889">radiomics</a>. </p>
<p>A barrier to wider use is the <a href="https://www.ncbi.nlm.nih.gov/pubmed/30962048">lack of secure access to sensitive patient data</a> with which to develop and test AI models. Another is the public’s lack of trust of new methods – even though computerised decision-making in healthcare <a href="https://theconversation.com/ai-can-excel-at-medical-diagnosis-but-the-harder-task-is-to-win-hearts-and-minds-first-63782">dates as far back as the early 1970s</a>. Finally, there is the problem of <a href="https://www.tandfonline.com/doi/full/10.1080/17434440.2019.1610387">evaluating new methods based on real-world data</a>. </p>
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Read more:
<a href="https://theconversation.com/ai-can-excel-at-medical-diagnosis-but-the-harder-task-is-to-win-hearts-and-minds-first-63782">AI can excel at medical diagnosis, but the harder task is to win hearts and minds first</a>
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<p>We might ask whether we need artificial intelligence in patient care at all. But the power of these new techniques could offer huge opportunities. No matter how skilled, humans are subject to fatigue, boredom and regular interruptions, and these are when errors can occur.</p>
<p>Machines can work without tiring, but their ability to make intuitive decisions or rely on years of experience to recognise when an abnormality poses an urgent risk is unknown. Even without relying on artificial intelligence for complex matters, just using it for mundane tasks such as appointment booking, allocating staff and equipment, prioritising radiologists’ jobs, or incorporating data from health care records would free up clinicians’ time for other tasks.</p>
<h2>A testbed for future healthcare</h2>
<p>In the UK, <a href="https://www.abdn.ac.uk/news/12398/">iCAIRD</a>, the Industrial Centre for Artificial Intelligence Research in Digital Diagnostics, brings together experts from the Universities of Aberdeen, Edinburgh, Glasgow and St Andrews together with the NHS and industry partners such as Canon and Phillips in a £15m centre based in Glasgow.</p>
<p>Launched last year, the project will test how well artificial intelligence algorithms compare to human expertise by providing secure access to anonymised clinical data in areas including breast cancer screening, stroke diagnosis and treatment, chest X-rays from A&E, and cervical and <a href="https://www.nhs.uk/conditions/womb-cancer/">endometrial</a> cancer pathology. Using an established approach for secure access to anonymised images, reports and relevant clinical data, AI researchers will be able to develop and test their methods. iCAIRD will also create a national digital pathology database.</p>
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Read more:
<a href="https://theconversation.com/a-brain-scan-to-tell-if-youre-depressed-and-what-treatment-is-needed-75005">A brain scan to tell if you're depressed – and what treatment is needed</a>
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<p>Cancer care typically involves multidisciplinary team meetings between clinicians from different specialisms: in the same way, the aim at iCAIRD is that multiple artificial intelligence applications can be integrated to create an AI-based virtual multidisciplinary team meeting, where knowledge from radiology and pathology can direct <a href="https://www.ncbi.nlm.nih.gov/pubmed/31022746">personalised management of cancer patients</a>.</p>
<p>Just as new drugs must be properly evaluated before use, so must new artificial intelligence methods. We are fortunate to be able, through iCAIRD, to evaluate performance of these new algorithms with real-world data. It is clearly crucial to bring the public on this journey of evaluating AI as a potential solution.</p>
<p>Any new way of working is likely to come at a price – whether that is profit for the firms developing AI, just as the pharmaceutical industry profits from new drugs – or at a cost to the public in the loss of absolute patient data privacy. How to balance these and ensure good governance of AI in healthcare should be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521904/">a matter for public debate</a>, and not the role of a single sector, or a handful of companies.</p>
<p>Ultimately the benefits will be maximised if we, as healthcare staff, patients and members of the public, are involved in determining the direction of the journey. The responsibility lies with us all.</p><img src="https://counter.theconversation.com/content/120631/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alison Murray receives funding from Innovate UK, the European Commission, the Wellcome Trust, the Chief Scientist Office, the Scottish Funding Council (via the Scottish Imaging Network: A Platform of Scientific Excellence) and the University of Aberdeen.</span></em></p>Automated decision making has been around in healthcare since the 1970s, and now radiology is the new frontline where AI is being deployed.Alison Murray, Roland Sutton Professor and Chair of Radiology, University of AberdeenLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/995652019-03-27T16:16:44Z2019-03-27T16:16:44ZPrinciple behind Google’s April Fools’ pigeon prank proves more than a joke<figure><img src="https://images.theconversation.com/files/264444/original/file-20190318-28499-66kcrw.jpg?ixlib=rb-1.1.0&rect=513%2C2506%2C3294%2C2255&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Consider the wisdom of the flock.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/hPOFScEaZcA">Zac Ong/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p><a href="https://archive.google.com/pigeonrank/">Google’s 2002 April Fools’ Day joke</a> purportedly disclosed that its popular search engine was not actually powered by artificial intelligence, but instead by biological intelligence. Google had deployed bunches of birds, dubbed pigeon clusters, to calculate the relative value of web pages because they proved to be faster and more reliable than either human editors or digital computers.</p>
<p>The joke hinged on the silliness of the premise – but the scenario does have more than a bit of the factual mixed in with the fanciful.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/264443/original/file-20190318-28512-g4b3sl.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/264443/original/file-20190318-28512-g4b3sl.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/264443/original/file-20190318-28512-g4b3sl.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=354&fit=crop&dpr=1 600w, https://images.theconversation.com/files/264443/original/file-20190318-28512-g4b3sl.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=354&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/264443/original/file-20190318-28512-g4b3sl.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=354&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/264443/original/file-20190318-28512-g4b3sl.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=445&fit=crop&dpr=1 754w, https://images.theconversation.com/files/264443/original/file-20190318-28512-g4b3sl.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=445&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/264443/original/file-20190318-28512-g4b3sl.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=445&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A screenshot of Google’s explanation of how PigeonRank supposedly worked.</span>
<span class="attribution"><a class="source" href="https://archive.google.com/pigeonrank/">Google</a></span>
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<p>The prank had taken a page out of 20th-century behaviorist B. F. Skinner’s <a href="https://www.verywellmind.com/operant-conditioning-a2-2794863">operant conditioning</a> playbook by allegedly teaching pigeons to peck for a food reward whenever the birds detected a relevant search result.</p>
<p>It also adapted Victorian polymath Francis Galton’s <a href="https://doi.org/10.1038/075450a0">vox populi</a> – or the voice of the people – principle by purportedly putting the web search task to something of a vote. The more the flocks of pigeons pecked at a particular website, the higher it rose on the user’s results page. This so-called PigeonRank system thus rank-ordered a user’s search results in accord with the pecking order of Google’s suitably schooled birds.</p>
<p>More than a decade later, we integrated elements of this spoof into <a href="https://doi.org/10.1371/journal.pone.0141357">our own serious research project</a> using a real mini-flock of four pigeons. Our research team included <a href="https://health.ucdavis.edu/publish/providerbio/search/11653">a pathologist</a>, <a href="https://winshipcancer.emory.edu/bios/faculty/krupinski-elizabeth.html">a radiologist</a> and <a href="https://scholar.google.com/citations?user=SIl5WVYAAAAJ&hl=en">two experimental</a> <a href="https://scholar.google.com/citations?user=CiWDe9EAAAAJ&hl=en">psychologists</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/264174/original/file-20190315-28483-11dzk01.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/264174/original/file-20190315-28483-11dzk01.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/264174/original/file-20190315-28483-11dzk01.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=404&fit=crop&dpr=1 600w, https://images.theconversation.com/files/264174/original/file-20190315-28483-11dzk01.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=404&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/264174/original/file-20190315-28483-11dzk01.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=404&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/264174/original/file-20190315-28483-11dzk01.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=507&fit=crop&dpr=1 754w, https://images.theconversation.com/files/264174/original/file-20190315-28483-11dzk01.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=507&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/264174/original/file-20190315-28483-11dzk01.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=507&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The test chamber provided pigeons with an image to classify for the reward of a food pellet.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.1371/journal.pone.0141357">PLoS ONE 10(11): e0141357</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Exploiting the well-established <a href="http://crosstalk.cell.com/blog/pigeons-arent-just-rats-with-wings">visual and cognitive prowess of pigeons</a>, we taught our birds to peck either a blue or a yellow button on a computerized touchscreen in order to categorize pathology slides that depicted either benign or cancerous human breast tissue samples.</p>
<p>In each training session, we showed pigeons several slides of each type in random order on the touchscreen. Pigeons first had to peck the pathology slide multiple times – this step encouraged the birds to study them. Then the two report buttons popped up on each side of the tissue sample. If the tissue sample looked benign and the pigeons pecked the “benign” report button or if the presented tissue sample looked malignant and the pigeons pecked the “malignant” report button, then they received a food reward. However, if the pigeons chose the incorrect report button, then no food was given.</p>
<p>After two weeks of training, the pigeons attained accuracy levels ranging between 85 and 90 percent correct. Granted, this accomplishment falls short of their reading human text – although time will tell if that too is within <a href="https://doi.org/10.1073/pnas.1607870113">the ken of pigeons</a> – but the pigeons were quite able to make such highly accurate reports despite considerable variations in the magnification of the slide images.</p>
<p>We went on to test the pigeons with brand-new images to see if the birds could reliably transfer what they had learned; this is the key criterion for claiming that they’d learned a generalized concept of “benign/malignant tissue samples.” Accuracy to the familiar training samples averaged around 85 percent correct, and accuracy to the novel testing samples was nearly as high, averaging around 80 percent correct. This high level of transfer indicates that rote memorization alone cannot explain the pigeon’s categorization proficiency.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/264435/original/file-20190318-28487-14ykryc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/264435/original/file-20190318-28487-14ykryc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/264435/original/file-20190318-28487-14ykryc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=314&fit=crop&dpr=1 600w, https://images.theconversation.com/files/264435/original/file-20190318-28487-14ykryc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=314&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/264435/original/file-20190318-28487-14ykryc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=314&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/264435/original/file-20190318-28487-14ykryc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=395&fit=crop&dpr=1 754w, https://images.theconversation.com/files/264435/original/file-20190318-28487-14ykryc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=395&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/264435/original/file-20190318-28487-14ykryc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=395&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Pigeons were able to generalize the skill of classifying tissue samples.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.1371/journal.pone.0141357">PLoS ONE 10(11): e0141357</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Finally, we put Google’s PigeonRank proposal to the test. With an expanded set of breast tissue samples, we assessed the accuracy of each of four pigeons against the “wisdom of the flock,” a technique we termed “flock-sourcing.” To calculate these “flock” scores, we assigned each trial a score of 100 percent if three or four pigeons correctly responded, and we assigned a score of 50 percent if two pigeons correctly responded. Three or four pigeons never incorrectly responded.</p>
<p>The accuracy scores of the four individual pigeons were 73, 79, 81 and 85 percent correct. However, the accuracy score of the “flock” was 93 percent, thereby exceeding that of every individual bird. Pigeons <a href="http://news.mit.edu/2017/algorithm-better-wisdom-crowds-0125">thus join people</a> in evidencing better wisdom from crowds. Playing on Galton’s original term, you might call this vox columbae – or the voice-of-the-pigeons principle.</p>
<p>Although all of this may seem to be a bit of feathery fluff, over the past several years our report has resonated across several fields, going beyond pathology and radiology to include the burgeoning realm of artificial intelligence. It has been recognized in several articles including one <a href="https://www.newyorker.com/magazine/2017/04/03/ai-versus-md">quoting Geoff Hinton</a>, a key figure behind modern AI: “The role of radiologists will evolve from doing perceptual things that could probably be done by a highly trained pigeon to doing far more cognitive things.” In other words, machines may eventually be programmed to match what pigeons can do, leaving the more interesting and challenging tasks to humans.</p>
<p>What began as an elaborate April Fools’ prank has thus proved to be more than a joke. Never underestimate the brains of birds. They’re really <a href="https://www.activewild.com/bird-intelligence/">brainy beasts</a>.</p><img src="https://counter.theconversation.com/content/99565/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>After Google suggested PigeonRank was at the root of its search function, a group of researchers put a small flock of the birds to a different classification test in real life.Edward Wasserman, Professor of Experimental Psychology, University of IowaRichard Levenson, Professor of Pathology and Laboratory Medicine, University of California, DavisVictor Navarro, Graduate Student in Psychology, University of IowaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/936282018-03-22T10:36:04Z2018-03-22T10:36:04ZThe dinosaur that got away: how we diagnosed a 200-million-year-old infected predator bite<figure><img src="https://images.theconversation.com/files/211201/original/file-20180320-31602-nc28x0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Reconstruction of the bite wound affecting the shoulder of our herbivorous dinosaur.</span> <span class="attribution"><span class="source">Zongda Zhang/Lida Xing</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><blockquote>
<p>Nature, red in tooth and claw. </p>
</blockquote>
<p>When Tennyson published his poem <a href="http://www.online-literature.com/tennyson/718/">In Memoriam</a>, little did he know that this phrase from it would become so intimately associated with the process of Darwinian natural selection. Five little words which evoke the harsh evolutionary realities of competition for food, resources and life itself between predator and prey, the hunter and the hunted. </p>
<p>Now my colleagues and I, led by Lida Xing from the China University of Geosciences (Beijing), have <a href="http://www.nature.com/articles/s41598-018-23451-x">published evidence</a> of one lucky animal that got away – in this case, a herbivorous dinosaur from China. Our work highlights how the use of X-ray tomography – a rapidly developing technique in digital imaging – is revolutionising the study of the fossil record.</p>
<p>Our dinosaur is <em>Lufengosaurus huenei</em>, a Lower Jurassic sauropod, who would have lived 200-170m years ago in what is now Yunnan Province, China. <a href="http://www.prehistoric-wildlife.com/species/l/lufengosaurus.html"><em>Lufengosaurus</em></a> was a herbivore, around six metres in length and weighing a little under two tonnes. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/211351/original/file-20180321-165568-1tywk1n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/211351/original/file-20180321-165568-1tywk1n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=342&fit=crop&dpr=1 600w, https://images.theconversation.com/files/211351/original/file-20180321-165568-1tywk1n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=342&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/211351/original/file-20180321-165568-1tywk1n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=342&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/211351/original/file-20180321-165568-1tywk1n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=430&fit=crop&dpr=1 754w, https://images.theconversation.com/files/211351/original/file-20180321-165568-1tywk1n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=430&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/211351/original/file-20180321-165568-1tywk1n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=430&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Map showing the location of the dinosaur fossil discovery.</span>
<span class="attribution"><span class="source">Lida Xing</span></span>
</figcaption>
</figure>
<p>When the dinosaur was excavated in 1997, there was a pathological abnormality on one of the right ribs of the animal. Viewed from the side, there is a concave section of missing bone which cuts almost halfway through the rib. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/211346/original/file-20180321-165568-m5eei6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/211346/original/file-20180321-165568-m5eei6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/211346/original/file-20180321-165568-m5eei6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1138&fit=crop&dpr=1 600w, https://images.theconversation.com/files/211346/original/file-20180321-165568-m5eei6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1138&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/211346/original/file-20180321-165568-m5eei6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1138&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/211346/original/file-20180321-165568-m5eei6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1430&fit=crop&dpr=1 754w, https://images.theconversation.com/files/211346/original/file-20180321-165568-m5eei6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1430&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/211346/original/file-20180321-165568-m5eei6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1430&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The pathological rib of Lufengosaurus, showing the removal of a large area of bone.</span>
<span class="attribution"><span class="source">Lida Xing</span></span>
</figcaption>
</figure>
<p>The traditional approach in studying bone pathology is what is termed “morphoscopic evaluation”. This usually involves low powered magnification of the bone, but this would only image the external surface of the fossil. In the case of our rib, the lesion penetrated deep into the bone, so seeing the internal structure was needed for a diagnosis. </p>
<p>Now, 20 years after its initial discovery, we have used <a href="https://www.microphotonics.com/how-does-a-microct-scanner-work/">X-ray micro-computed tomography</a>, or micro-CT for short, to image the deep structures of our dinosaur.</p>
<h2>Seeing inside fossils</h2>
<p>Tomography (from the Greek <em>tomos</em> to slice, and <em>graphos</em> to write) is a non-invasive technique that has significant diagnostic advantages over conventional methods, allowing high-resolution slices and 3D images to be built up of internal structures without damaging the fossil.</p>
<p>Following micro-CT scanning, we reconstructed the cellular structure of the rib. In cross-section, there was clear evidence of both destructive changes and new bone formation which could not be observed from the outside. The pattern of these bone-destroying and bone-forming processes tells us that the disease process was both chronic (long-term) and active at the time of the animal’s death.</p>
<p>We diagnosed a process called osteomyelitis, which in this case had produced an abscess inside the bone. Osteomyelitis is a severe infection originating in the bone marrow, usually resulting from the introduction of pyogenic (pus-producing) bacteria into the bone. Pathogens enter the bone via the bloodstream, or through open wounds or fractures.</p>
<p>This is only the second case of osteomyelitis to be found in a sauropod dinosaur in the fossil record. The only other case comes from a <a href="https://www.researchgate.net/publication/308797156_The_first_evidence_of_osteomyelitis_in_a_sauropod_dinosaur">giant titanosaur from Argentina</a> who had a bacterial infection of the spine. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/211352/original/file-20180321-165577-1dduk9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/211352/original/file-20180321-165577-1dduk9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=610&fit=crop&dpr=1 600w, https://images.theconversation.com/files/211352/original/file-20180321-165577-1dduk9t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=610&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/211352/original/file-20180321-165577-1dduk9t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=610&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/211352/original/file-20180321-165577-1dduk9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=766&fit=crop&dpr=1 754w, https://images.theconversation.com/files/211352/original/file-20180321-165577-1dduk9t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=766&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/211352/original/file-20180321-165577-1dduk9t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=766&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Micro-computed tomography allowed us to produce surface renderings of the fossil in 3D (top row) and 2D X-ray slices through the rib (bottom row). These show areas of cellular reorganisation, bone destruction and bone formation indicative of ostemyelitis.</span>
<span class="attribution"><span class="source">Patrick Randolph-Quinney, UCLan</span></span>
</figcaption>
</figure>
<h2>Tooth and claw</h2>
<p>In this <em>Lufengosaurus</em> we also have the earliest recorded case of a bony abscess caused by osteomyelitis in the fossil record. </p>
<p>Given the shape of the lesion, and its position on the ribcage, we think that the infection may have been caused by a puncture wound from a bite. The teardrop shape suggests that the damage was produced by a tooth or claw, and is in keeping with evidence for predator bite trauma found elsewhere in the dinosaur fossil record.</p>
<p>The bacterial infection would have had a big impact on the life of the Yunnan dinosaur. Osteomyelitis is known to produce fever, fatigue, nausea and discomfort, and may send tracts of bacteria into the brain, accelerating death. We know that the dinosaur survived for some time with this infection, but this may have made it vulnerable to other diseases or unable to fend for itself in the long term.</p>
<p>What is exciting is that this case gives us evidence of interaction between a large plant-eating dinosaur (a sauropod) and one of the aggressive predators living at that time. We don’t just have evidence of disease but of behaviour between animals – between predator and prey at this deep period in prehistory. </p>
<p>We do not know which species of predator caused the bite, but the wound from the failed attack is a smoking gun. It is possible that <a href="http://www.prehistoric-wildlife.com/species/s/sinosaurus.html"><em>Sinosaurus</em></a>, a well-known predator found in Jurassic Yunnan, would have been able to attack <em>Lufengosaurus</em>.</p>
<h2>Virtual palaeontology</h2>
<p>This discovery was only made possible by the application of X-ray tomography (micro-CT). The first commercially available micro-CT scanner appeared in 1994, but it is only in the last decade that it has begun to be used in palaeontology, partly because of the cost of the equipment. Tomography is increasingly allowing us to understand processes such as trauma and infection in the fossil record at the cellular level. </p>
<p>This technology has opened up the fossil record, allowing palaeontologists to image and analyse the deep structure of fossils. This has enabled spectacular discoveries such as the <a href="https://www.sajs.co.za/article/view/3566">earliest hominin cancer</a> and the <a href="https://www.sajs.co.za/article/view/3562">earliest tumour</a>, the <a href="https://www.nature.com/articles/s41467-018-03296-8.pdf">flight pattern of Archaeoptryx</a>, or to <a href="https://www.sciencedirect.com/science/article/pii/S2095927318300331">rebuild an early bird trapped in amber</a>. It has also allowed us to <a href="https://www.sajs.co.za/article/view/3580">correct historical cases of pathological misdiagnosis</a> in fossils. </p>
<p>The resulting scans can be shared across the world, visualised and studied without the need to access the fossils directly. They can also be <a href="http://johnhawks.net/weblog/topics/metascience/open-access/benefits-data-brouwers-q-and-a-2015.html">3D printed</a>, both in their actual size or at any other scale that we require. </p>
<p>Who knows what spectacular discoveries await us using this technology, but it is clear that the future of <a href="https://www.theguardian.com/science/2016/mar/30/getting-under-a-fossils-skin-how-ct-scans-have-changed-palaeontology-dinosaur-lizard">palaeontological research is virtual</a>.</p><img src="https://counter.theconversation.com/content/93628/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patrick Randolph-Quinney does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research uses pathology in dinosaur bones to look at predator-prey interactions in the fossil record.Patrick Randolph-Quinney, Reader/Associate Professor in Biological and Forensic Anthropology, University of Central LancashireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/916082018-02-09T23:10:00Z2018-02-09T23:10:00ZCanada’s unsung female heroes of life sciences<figure><img src="https://images.theconversation.com/files/205770/original/file-20180209-51713-ighgwm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Former governor general David Johnston invests Toronto scientist Janet Rossant as a Companion of the Order of Canada during a ceremony at Rideau Hall in Ottawa in 2016. </span> <span class="attribution"><span class="source"> THE CANADIAN PRESS/Adrian Wyld</span></span></figcaption></figure><p><a href="http://www.un.org/en/events/women-and-girls-in-science-day/">International Day of Women and Girls in Science</a> is Feb. 11. To mark the occasion, let’s look back at some of Canada’s women life scientists. They’ve been pioneers in providing a foundation of knowledge through the sheer force of their world-class talent —going back more than a century. </p>
<p>Their legacy has established a knowledge foundation that represents the impact of real science. </p>
<p>Largely unknown by Canada’s decision-makers in government, industry and even the general public, their work is unheralded by ribbon-cutting ceremonies. Their relative obscurity in Canada, then and now, appears to be the preoccupation of how budgetary decisions are made as opposed to a consideration of talent and merit.</p>
<p>It’s high time to give them their due:</p>
<h2>Maud Menten</h2>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/205763/original/file-20180209-51716-1jnuap1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/205763/original/file-20180209-51716-1jnuap1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=982&fit=crop&dpr=1 600w, https://images.theconversation.com/files/205763/original/file-20180209-51716-1jnuap1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=982&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/205763/original/file-20180209-51716-1jnuap1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=982&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/205763/original/file-20180209-51716-1jnuap1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1234&fit=crop&dpr=1 754w, https://images.theconversation.com/files/205763/original/file-20180209-51716-1jnuap1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1234&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/205763/original/file-20180209-51716-1jnuap1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1234&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Maud Leonora Menten. Undated photo.</span>
<span class="attribution"><span class="source">(Smithsonian Institute)</span></span>
</figcaption>
</figure>
<p>At the turn of the century, University of Toronto medical graduate Maud Menten was barred from doing independent research in Canada as part of the accepted sexism of the day.</p>
<p>Her discovery in Berlin in 1913 provided the first insight into how chemical reactions in every cell of our body are regulated by enzymes. The discovery enabled enzymes to be purified, modified and targeted for drug therapy for disease. </p>
<p>Today enzymes serve as targets for about a third of all drugs in clinical use.
<br><br><br><br><br><br></p>
<h2>Maude Abbott</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/205765/original/file-20180209-51697-oprili.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/205765/original/file-20180209-51697-oprili.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=851&fit=crop&dpr=1 600w, https://images.theconversation.com/files/205765/original/file-20180209-51697-oprili.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=851&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/205765/original/file-20180209-51697-oprili.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=851&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/205765/original/file-20180209-51697-oprili.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1070&fit=crop&dpr=1 754w, https://images.theconversation.com/files/205765/original/file-20180209-51697-oprili.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1070&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/205765/original/file-20180209-51697-oprili.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1070&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Maude Abbott.</span>
<span class="attribution"><span class="source">McGill University</span></span>
</figcaption>
</figure>
<p>Maude Abbott was a world-renowned scholar, Bishop’s University medical graduate (1894) and a McGill University medical museum curator and pathology lecturer. </p>
<p>Her work in 1905 on congenital heart disease is critical to modern surgery. Abbott’s stunning pathology dissections are preserved today at the McGill Maude Abbott Medical Museum and remain unsurpassed to this day.
<br><br><br><br><br></p>
<h2>Brenda Milner</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/205766/original/file-20180209-51727-lj2w7b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/205766/original/file-20180209-51727-lj2w7b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/205766/original/file-20180209-51727-lj2w7b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/205766/original/file-20180209-51727-lj2w7b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/205766/original/file-20180209-51727-lj2w7b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/205766/original/file-20180209-51727-lj2w7b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/205766/original/file-20180209-51727-lj2w7b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dr. Brenda Milner is seen in the House of Commons among other laureates of the Canadian Medical Hall of Fame in February 2002.</span>
<span class="attribution"><span class="source">(CP PHOTO/Jonathan Hayward)</span></span>
</figcaption>
</figure>
<p>In the middle of the 20th century, McGill’s Brenda Milner, a renowned scholar and founder of the field of neuropsychology, discovered that memory in humans is multiple and stored in several different parts of the brain. </p>
<p>Her discoveries in 1957 led to better treatments for a variety of brain disorders including trauma, degenerative and psychiatric diseases.</p>
<h2>Annette Herscovics</h2>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/205768/original/file-20180209-51713-1yadvc9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/205768/original/file-20180209-51713-1yadvc9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=764&fit=crop&dpr=1 600w, https://images.theconversation.com/files/205768/original/file-20180209-51713-1yadvc9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=764&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/205768/original/file-20180209-51713-1yadvc9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=764&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/205768/original/file-20180209-51713-1yadvc9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=960&fit=crop&dpr=1 754w, https://images.theconversation.com/files/205768/original/file-20180209-51713-1yadvc9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=960&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/205768/original/file-20180209-51713-1yadvc9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=960&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Annette Herscovics.</span>
<span class="attribution"><span class="source">McGill University</span></span>
</figcaption>
</figure>
<p>At McGill, Annette Herscovics discovered in 1969 that thyroglobulin, a precursor to thyroid hormone, undergoes carbohydrate modifications.</p>
<p>This was one of the first discoveries of a class of proteins known today as “glycoproteins.” Carbohydrate addition to proteins is today known as the most abundant protein modification for all life forms on the planet. </p>
<p>At Harvard in 1974, Herscovics then discovered the exact mechanism for carbohydrate addition that is a universal mechanism for all organisms with nucleated cells. </p>
<p>Upon returning to McGill in 1981, she discovered how these modifications are relevant to human disease, including cancer. </p>
<h2>Rose Johnstone</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/205769/original/file-20180209-51703-f1d5bh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/205769/original/file-20180209-51703-f1d5bh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=870&fit=crop&dpr=1 600w, https://images.theconversation.com/files/205769/original/file-20180209-51703-f1d5bh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=870&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/205769/original/file-20180209-51703-f1d5bh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=870&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/205769/original/file-20180209-51703-f1d5bh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1093&fit=crop&dpr=1 754w, https://images.theconversation.com/files/205769/original/file-20180209-51703-f1d5bh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1093&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/205769/original/file-20180209-51703-f1d5bh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1093&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Rose Johnstone.</span>
<span class="attribution"><span class="source">McGill University</span></span>
</figcaption>
</figure>
<p>Herscovics’s PhD supervisor was Rose Johnstone, who made a monumental discovery at McGill in 1983. </p>
<p>She discovered exactly how red blood cells in our body are made from precursor cells through a previously unknown structure she named “exosomes.” </p>
<p>Exosomes are now recognized as a universal protein delivery mechanism used by all cells in our body. They’re actively studied by academics and industry for the understanding and treatment of cancer, autoimmune diseases and neurodegenerative diseases, including Alzheimer’s and Parkinson’s disease.</p>
<h2>Morag Park</h2>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/205771/original/file-20180209-51723-28jrdl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/205771/original/file-20180209-51723-28jrdl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/205771/original/file-20180209-51723-28jrdl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/205771/original/file-20180209-51723-28jrdl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/205771/original/file-20180209-51723-28jrdl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/205771/original/file-20180209-51723-28jrdl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/205771/original/file-20180209-51723-28jrdl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Morag Park.</span>
<span class="attribution"><span class="source">McGill University</span></span>
</figcaption>
</figure>
<p>At the U.S. National Cancer Institute in 1986, Morag Park’s work on mutant <a href="https://ghr.nlm.nih.gov/gene/MET">“MET” gene</a> association with several different cancers led to international prominence. </p>
<p>Today, Park is head of the McGill Cancer Research Centre, and has extended her discoveries to breast cancer and the importance of the surrounding normal cells in tumour progression.</p>
<h2>Janet Rossant</h2>
<p>Janet Rossant discovered the mechanisms used by embryos to generate organs and tissues with direct relevance to childhood diseases. </p>
<p>Her talent was first recognized at Brock University in 1977 and was followed by recruitment to the Lunenfeld Institute in Toronto. She was then director of the Research Institute of the Hospital for Sick Kids, and is now president and scientific director of the <a href="http://gairdner.org/">Gairdner Foundation.</a></p>
<h2>Mona Nemer</h2>
<p>Mona Nemer is currently Canada’s Chief Scientific Adviser discovered in Ottawa how genes that regulate the development of the heart help understand heart disease.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/205772/original/file-20180209-51719-1bd8ffd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/205772/original/file-20180209-51719-1bd8ffd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/205772/original/file-20180209-51719-1bd8ffd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/205772/original/file-20180209-51719-1bd8ffd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/205772/original/file-20180209-51719-1bd8ffd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/205772/original/file-20180209-51719-1bd8ffd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/205772/original/file-20180209-51719-1bd8ffd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dr. Mona Nemer is introduced as Canada’s new Chief Science Advisor on Parliament Hill in September 2017.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Sean Kilpatrick</span></span>
</figcaption>
</figure>
<h2>Nada Jabado</h2>
<p>The discoveries of <a href="http://www.thechildren.com/departments-and-staff/staff/nada-jabado-md-phd-pediatric-hemato-oncologist">Nada Jabado</a>, a McGill physician scientist and paediatric cancer specialist, focus on how proteins are modified in cancer via the epigenome that mark the DNA in our genes to change the function of the gene. </p>
<h2>Heidi McBride</h2>
<p>McGill cell biologist <a href="http://mcbridelab.org/about/">Heidi McBride</a> has made transformative discoveries on the role of mitochondria (the energy factory in our cells) in cancer and neurological diseases, including Parkinson’s disease.</p>
<h2>Freda Miller</h2>
<p><a href="http://www.sickkids.ca/AboutSickKids/Directory/People/M/Freda-Miller.html">Freda Miller</a> at the Hospital for Sick Kids in Toronto has deciphered the mechanisms used to generate neuronal circuits during development from a thin sheet of non-neuronal precursor cells.</p>
<h2>Anne Claude Gingras</h2>
<p><a href="http://www.lunenfeld.ca/researchers/gingras">Anne Claude Gingras</a> of the Lunenfeld-Tanenbaum Research Institute in Toronto is a specialist in “quantitative proteomics.” It’s led to enormous advances in our understanding of cell organization with direct application to disease.</p>
<h2>Andrews, Arrowsmith and Edwards</h2>
<p>Brenda Andrews, Cheryl Arrowsmith, and Elizabeth Edwards are internationally renowned for their discoveries at the University of Toronto. </p>
<p><a href="http://sites.utoronto.ca/andrewslab/">Andrews</a> defines the new field of systems biology to understand cell organization using robots and Artificial Intelligence and its application to disease. </p>
<p><a href="http://nmr.uhnres.utoronto.ca/arrowsmith/">Arrowsmith’s</a> discoveries focus on cellular protein structure resolved at the atomic level to understand how chemical modifications regulate gene expression and their relevance to disease. </p>
<p><a href="http://www.chem-eng.utoronto.ca/faculty-staff/faculty-members/elizabeth-a-edwards/">Edwards’</a> work on “bioaugmentation” through anaerobic microbes to detoxify environmental pollutants is of direct relevance to the nightmare of toxic industrial and municipal waste accumulation.</p>
<h2>Impressive display of talent</h2>
<p>Taken together, these discoveries represent an impressive display of talent for real science that rivals scientists anywhere in the world.</p>
<p>Whatever country recognizes and establishes a genuine priority to enable real science by talented women scientists, and helps them thrive in discovery research, will be rewarded enormously. </p>
<p>Discovery research institutes such as the Crick Institute in the U.K. gather the most talented scientists, men and women, early in their careers, when discoveries are usually made. That assures a critical mass and merit-based value system that then provides the best of the discovery researchers to go out to populate universities, research institutes and industry. </p>
<p>A Canadian model could — and should —focus on women scientists, since they now may be Canada’s most talented. And also its most undervalued.</p>
<hr>
<p><em>John Bergeron gratefully acknowledges Kathleen Dickson as co-author.</em></p><img src="https://counter.theconversation.com/content/91608/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Bergeron does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Canada’s female scientists are superstars in their fields yet most Canadians have never heard of them. On International Day for Women in Science, it’s time to give them the recognition they deserve.John Bergeron, Emeritus Robert Reford Professor and Professor of Medicine, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/785472017-06-08T16:31:39Z2017-06-08T16:31:39ZMajor change at work can trigger loss and grief. Organisations must accept this<figure><img src="https://images.theconversation.com/files/172723/original/file-20170607-11305-yeecef.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Employees are often unsettled by change in their organisations.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>There is hardly an organisation in the world – big or small – that doesn’t have to adapt to changing circumstances. The pace of development in technology, the quick pace at which new rivals come on the scene, even the rapid turnover of leaders, all require shifts in the way things are done.</p>
<p>But it’s never easy to steer people through change. And, inevitably, there’s resistance. So how can organisations manage it in a way that gets them the outcomes they want?</p>
<p>The default when things don’t go well is to blame employers for being resistant to change. This may be convenient, but it doesn’t deal with the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24362547">real issues</a>. </p>
<p>Over the last few decades organisations around the world have been pushed into large-scale changes, such as downsizing, outsourcing, mergers and acquisitions, or restructuring. The <a href="https://doi.org/10.1080/15416518.2015.1039637">success rate</a> in large scale changes is around 20%.</p>
<p>Change is inevitable. But forced change is emotionally more intimidating and disturbing than is generally assumed. This predisposes employees to be negative about it. What’s very often missing when organisations announce major change is that they don’t recognise this. In fact they should be concerned with issues such as loss, emotional trauma, grief and mourning.</p>
<p>Leaders, managers and change consultants have a great deal to learn about the ways in which employees experience change and the sense of loss they suffer. Change has little chance of success unless the severity of loss is acknowledged, grief is enfranchised and mourning is encouraged.</p>
<h2>Loss</h2>
<p>Work is central to many people’s lives and their identities. Therefore forced changes to jobs or work structures are <a href="http://www.emeraldinsight.com/doi/pdfplus/10.1108/eb028998">experienced</a> particularly intensely.</p>
<p>People become emotionally attached to things, the more important these things are, the more individuals want to hold onto them. The awareness of loss is therefore much more profound and creates more anxiety. </p>
<p>Any change involves some sort of loss. There are tangible losses like loss of income when a person is retrenched or downgraded. And there are abstract losses such as loss of control, status or self-worth.</p>
<p>For the most part, the deeply felt emotional losses are ignored when dealing with change or in debates about resistance to change. Most studies about corporate rationalisation, <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-6486.2006.00593.x/abstract">focus</a> mainly on costs and the performance of the survivors.</p>
<p>Where emotions from change are studied, the focus tends to be on the loss of a job. But the subjective losses and subsequent emotional experiences of individuals tend to be underplayed.</p>
<h2>Grieving</h2>
<p>Profound loss is associated with <a href="https://doi.org/10.1080/15325020902724198">grief</a> – a deep sorrow that causes piercing distress. Although the experience of grief is common, there are marked differences in how intensely and for how long people grieve. It’s more intense when there’s greater degree of attachment to what was lost. The rational size of the loss isn’t relevant – merely the emotional intensity with which the individual experiences the loss. </p>
<p>Organisations tend to be <a href="https://doi.org/10.1080/15325020902724198">indifferent</a> and reluctant to acknowledge the intensify of loss felt by individuals. Often demonstrating, or talking about emotions is taboo, and when it happens it’s interpreted as resistance to change. The indifference and carelessness of executives can compound the experience of emotional trauma. In the minds of many, grief is associated with weakness, cowardice or even hysterical exaggeration. </p>
<p>As a result, many employees fear that they’ll be seen as weaklings or disloyal if they show their hurt and pain. </p>
<p>When grieving is denied or discouraged, repression or suppression is the only alternative. This leads to individuals being unable to engage with change, and can even cause other pathologies. <a href="http://www.emeraldinsight.com/doi/full/10.1108/02683940010305289">Research</a> has shown that restructuring, especially downsizings, instils in affected people intense fear, anxiety, distrust, , perceptions of betrayal and rejection. These tend to transpire into lack of focus and higher rates of absenteeism and turnover. And <a href="http://www.emeraldinsight.com/doi/full/10.1108/02683940010305289">occupational injuries and illnesses</a> are much higher at workplaces that goes through transformations.</p>
<p>A <a href="https://www.researchgate.net/publication/285875563_Healing_emotional_trauma_in_organizations_An_OD_framework_and_case_study">study</a> titled “Healing emotional trauma in organizations” describes how a group of executives were negatively affected. This is after they went through a restructuring that logically should have caused no distress. But they were unable to look forward to plan their strategy as they remained stuck in emotional trauma of the restructuring.</p>
<h2>What can be done</h2>
<p>Executives can’t expect employees to leave their emotions at the door when they come to work. They must embrace people’s sense of loss and help them adapt to it if they want change to be successful. </p>
<p>Organisations must build systems that ensure grieving and mourning are allowed so that employees can heal and move on through and past the change. </p>
<p>To ease the pain that comes from change, loss and pain must be publicly acknowledged and mourned in the organisation. Sharing destigmatises the loss and grief as the bereaved employees find validation from peers and managers through their narratives. </p>
<p>This must happen in a safe space, without logical explanations, platitudes or superficial suggestions. In the <a href="https://www.researchgate.net/publication/285875563_Healing_emotional_trauma_in_organizations_An_OD_framework_and_case_study">case study</a>, a group of executives felt healed and prepared for the future after the opportunity to tell and share their stories. The anomaly is that nothing has changed rationally or logically to their situation, but psychologically they would be able to move on. </p>
<p>If safe and constructive environments are created, employees won’t find it necessary to vent their emotions in the passages, around the water cooler or in tea rooms.</p><img src="https://counter.theconversation.com/content/78547/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mias de Klerk does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many large scale organisational changes end up as failures most of the time employers are blamed for being resistant to change. This may be convenient, but it doesn’t deal with the real issues.Mias de Klerk, Professor: Organisational behaviour, human capital management, leadership development, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/773152017-05-09T10:57:01Z2017-05-09T10:57:01ZBudget 2017 sees Medicare rebate freeze slowly lifted and more funding for the NDIS: experts respond<figure><img src="https://images.theconversation.com/files/168539/original/file-20170509-11018-1upkul9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The future of the NDIS is seemingly secured in this federal budget.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p><em>As expected, the government has announced a progressive lifting of the Medicare rebate freeze. Together with removing the bulk-billing incentive for diagnostic imaging and pathology services, as well as an increase in the PBS co-payment and related changes, this will cost a total of A$2.2 billion over the forward estimates.</em></p>
<p><em>Other announcements include:</em></p>
<ul>
<li> <em>From July 1, 2019, an increase in the Medicare levy from 2% to 2.5% of taxable income, with the extra half a percent directed towards the NDIS</em></li>
<li><em>$1.2 billion for new and amended listings on the PBS, including more than $510 million for a new medicine for patients with chronic heart failure</em></li>
<li><em>a A$2.8 billion increase in hospitals funding over forward estimates</em></li>
<li><em>$115 million for mental health, including funding for rural telehealth psychological services, mental health research and suicide prevention</em></li>
<li><em>$1.4 billion for health research, including $65.9 million this year to help research into children’s cancer.</em></li>
</ul>
<p><em>All up, these commitments equate to A$10 billion.</em></p>
<h2>Medicare rebate freeze</h2>
<p><strong>Stephen Duckett, Health Program Director, Grattan Institute</strong></p>
<p>As foreshadowed in pre-budget leaks, the government is <a href="http://www.budget.gov.au/2017-18/content/glossies/overview/html/overview-07.htm">slowly unthawing the Medicare rebate freeze</a>, but at a snail’s pace. At a cost of A$1 billion over the forward estimates, indexation for Medicare items will be introduced in four stages, starting with bulk-billing incentives from July 1, 2017. </p>
<p>General practitioners and specialists will wait another year – until July 1, 2018 – for indexation to start up again for consultations, which make up the vast bulk of general practice revenue. Indexation for specialist and allied health consultations is slated to start from July 1, 2019. </p>
<p>Certain diagnostic imaging items (such as x-rays) will be the last cab off the rank. Indexation will start up again from July 1, 2020.</p>
<p>There is no mention of reintroducing indexation for pathology items. This may be due to the recognition that <a href="https://theconversation.com/blood-money-pathology-cuts-can-reduce-spending-without-compromising-health-54834">there is money to be saved in pathology</a>.</p>
<p>Regardless of the reaction of medical lobby groups, it is too early to tell whether this glacially slow reintroduction of indexation will be enough to keep bulk-billing rates at their current levels. Practice costs and income expectations of staff have not increased dramatically over the freeze period as the Consumer Price Index has been moving slowly. But each additional day of a freeze means costs and revenues fall further out of alignment.</p>
<p>The jury will be out for a while on whether reintroduction of indexation is enough to restore the Coalition’s tarnished Medicare credentials with voters. </p>
<p>Certainly, the slow phase-in may attract cynicism, with a legitimate perception the government is doing the minimum necessary and at the slowest pace to ensure the issue is off the agenda before a 2019 election.</p>
<p>There is no sign in the budget that the government has sought any trade-offs from the medical profession in exchange for the reintroduction of indexation, so we will have to wait to put in place <a href="https://theconversation.com/money-given-to-gps-from-ending-the-medicare-rebate-freeze-should-target-reform-76778">better foundations for primary care reform</a>.</p>
<h2>National Disability Insurance Scheme (NDIS)</h2>
<p><strong>Helen Dickinson, Associate Professor, Public Service Research Group, UNSW</strong></p>
<p>Since its inception, a number of bitter political battles have been fought over <a href="http://www.skynews.com.au/news/feature-2/2017/05/09/budget-to-fund-ndis-beyond-2019.html">how the National Disability Insurance Scheme should</a> be funded. Many have been nervous the current Productivity Commission <a href="http://www.pc.gov.au/inquiries/current/ndis-costs#draft">review</a> of the costs of the scheme could lead to a scaling back of the NDIS before it is fully operational.</p>
<p>The NDIS operates under a complex funding arrangement split between federal, state and territory governments. Until now it has been unclear where the federal component of this commitment will come from, and a significant gap was emerging from the middle of 2019.</p>
<p>Today’s budget <a href="http://www.budget.gov.au/2017-18/content/glossies/overview/html/overview-09.htm">promises to fill this funding gap</a>, in part through an increase by half a percentage point in the Medicare levy from 2% to 2.5% of taxable income. Of the revenue raised, one-fifth will be directed into the NDIS Savings Fund (a special account that will ensure federal cost commitments are met).</p>
<p>A commitment has also been made to provide funding to establish an independent NDIS quality and safeguards commission to oversee the delivery of quality and safe services for all NDIS participants. </p>
<p>This will have three core functions: regulation and registration of providers; complaints handling; and reviewing and reporting on restrictive practices. While such an agency will be welcomed by many, the devil will be in the detail as to whether it is possible to deliver this in practice.</p>
<h2>Generic Medicines</h2>
<p><strong>Chris Del Mar, Professor of Public Health, Bond University</strong></p>
<p>The government is <a href="http://www.budget.gov.au/2017-18/content/glossies/overview/html/overview-08.htm">set to save A$1.8 billion</a> over five years by extending or increasing the price reduction for medicines listed on the Pharmaceutical Benefits Scheme (PBS). </p>
<p>This will be achieved in part by encouraging doctors to prescribe generic medicines that name the active ingredient (as in “90 octane petrol”) rather than the brand name (as in “BP” or “Shell”). This has the effect of pharmaceutical companies selling the drug that is cheapest. </p>
<p>It doesn’t work for drugs still under patent (which allows only pharmaceutical companies holding the patent to negotiate a price, compensating them for the drug development costs). But when drugs come off patent, any other pharmaceutical company can manufacture the generic drug for the best price. </p>
<p>Some doctors worry different brands might have different effects, but there are very few examples of patients being harmed by this. Australia’s Therapeutic Drugs Administration (TGA) makes sure drugs are manufactured to tight standards. </p>
<p>However, many patients know their medications by the brand name rather than the generic name. This same problem can happen right now (when patients are prescribed the same drug with two or more different names when they are prescribed by GPs, hospitals, or specialists). </p>
<p>Doctors are already alert to ensuring that different drugs names do not confuse patients – the danger is that they take the same drug twice, thinking they are different drugs.</p>
<h2>Aged care</h2>
<p><strong>Michael Woods, Professor of Health Economics, University of Technology Sydney</strong></p>
<p>The government has held the line on restraining growth in funding to residential aged care providers in this budget by implementing its pre-announced indexation freeze for the year, and a partial freeze in 2018-19. </p>
<p>The freeze was in response to concerns some providers were wrongly over-claiming payments under the Aged Care Funding Instrument (ACFI). The instrument determines the level of funding the government pays to providers to care for their residents. </p>
<p>The government has stopped publishing its annual target number of ACFI audits, so any proposed changes in compliance activity are now unknown.</p>
<p>The long-awaited consolidation of the Home Care Packages (which aim to help ageing Australians remain at home for as long as they need) and entry-level support through the Commonwealth Home Support Program has been put off for another two years, until at least 2020-21. This will be disappointing to consumers as a more seamless set of support services will improve their ability to remain in the community.</p>
<p>A welcome initiative is the additional A$8.3 million for more home-based palliative care services, although this extra support is budgeted to end in 2019-20.</p>
<p>Overall, the biggest unanswered issue facing the government in aged care is the need to develop an evidence-based and sustainable funding regime for residential care. To date we have seen short-term budget fixes and the commissioning of opaque rushed research reports. </p>
<p>The health minister needs to step back and establish a proper policy review process that undertakes sound research and consults widely. The review needs to establish a set of core funding principles and model options that address the varying incentives of residents, providers and taxpayers. It needs to adopt the one that transparently empowers consumers, provides market competition and results in long-term sustainability and certainty.</p>
<h2>An inequitable budget</h2>
<p><strong>Elizabeth Savage, Professor of Health Economics, University of Technology Sydney</strong></p>
<p>The budget has increased the Medicare levy (from 2.0% to 2.5%). It also has removed of the 2% budget repair levy, which benefits individuals with taxable incomes above A$180,000. </p>
<p>In 2014-15, only 3% of taxpayers had taxable incomes above $180,000. By contrast, the Medicare levy increase affects almost all taxpayers. This is a tax increase designed to generate revenue to fund the NDIS. The Medicare levy is essentially a flat tax, except for those at the lowest end of the distribution of taxable income.</p>
<p>Revenue could have been raised more equitably by increasing marginal income tax rates for higher earners (including making the budget repair levy permanent) or lowering upper tax thresholds. </p>
<p><strong>What’s missing from the budget?</strong></p>
<p>The 30% <a href="https://theconversation.com/the-multi-billion-dollar-subsidy-for-private-health-insurance-isnt-worth-it-76446">subsidy for private health insurance</a> was introduced in 1999, and cost the budget A$2.1 billion in 2000-01. This cost has grown steadily and was estimated in the 2016-17 budget to be about A$7 billion for 2017-18. Despite high population coverage, consumers question whether private health insurance provides value for money.</p>
<p>There is abundant evidence the subsidy is an ineffective and costly policy, but it seems the politics keep reform of the subsidy in the too-hard basket.</p>
<p>From the budget speech and budget papers, it is not clear that there is any reform of the pricing of prostheses for private hospital patients. The Prostheses Listing Authority, the government regulator, sets minimum benefits for prostheses for private hospital inpatients. </p>
<p>The levels set are far higher than both prices in comparable overseas countries and those paid by public sector hospitals in Australia. Private hospitals are major beneficiaries when the regulated minimum benefits exceed the negotiated prices paid to suppliers. </p>
<p>Private health insurance premium increases are being driven by hospital benefits, of which 14.4% are for prostheses. In 2015, insurers paid out almost A$2 billion in hospital benefits for prostheses.</p>
<p>The previous health minister, Sussan Ley, raised prostheses reform as a priority, noting that insurers pay $26,000 more for a specific pacemaker for a private patient than a public patient ($43,000 compared with $17,000). It appears from early documentation that this problem has not been prioritised in this budget.</p><img src="https://counter.theconversation.com/content/77315/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grattan Institute began with contributions to its endowment of $15 million from each of the Federal and Victorian Governments. In order to safeguard its independence, Grattan Institute’s board controls this endowment. The funds are invested and Grattan uses the income to pursue its activities.</span></em></p><p class="fine-print"><em><span>Elizabeth Savage has received research funding from the Australian Research Council and the National Health and Medical Research Council. She has also undertaken commissioned research for the Australian Department of Health and Ageing.</span></em></p><p class="fine-print"><em><span>Chris Del Mar, Helen Dickinson, and Michael Woods do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Health announcements in the federal budget include a slow lifting of the Medicare rebate freeze, money for new medicines, and an increase in the Medicare levy to fund the NDIS.Stephen Duckett, Director, Health Program, Grattan InstituteChris Del Mar, Professor of Public Health, Bond UniversityElizabeth Savage, Professor of Health Economics, University of Technology SydneyHelen Dickinson, Associate Professor, Public Service Research Group, UNSW SydneyMichael Woods, Professor of Health Economics, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/749902017-04-25T19:53:56Z2017-04-25T19:53:56ZHealth Check: what can your doctor tell from your urine?<figure><img src="https://images.theconversation.com/files/165472/original/image-20170417-25894-1s7cmo9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Doctors can tell a lot about your health from your urine sample, if you take it properly.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/561894202?src=PWq8M1UaGBg3mpXxI5Dv-Q-1-15&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Doctors request a <a href="https://www.healthdirect.gov.au/urine-tests">urine test</a> to help diagnose and treat a range of conditions including <a href="http://kidney.org.au/health-professionals/detect/kidney-health-check">kidney disorders</a>, <a href="http://www.healthline.com/health/bilirubin-urine#overview1">liver problems</a>, <a href="http://www.diabetesqld.org.au/media/98723/diabetes_management.pdf">diabetes</a> and infections. Testing urine is also used to screen people for illicit <a href="https://www.nps.org.au/australian-prescriber/articles/urinary-drug-screening">drug use</a> and to test if a woman is <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-testing">pregnant</a>.</p>
<p>Urine can <a href="https://www.rcpa.edu.au/Library/Practising-Pathology/RCPA-Manual/Items/Pathology-Tests/U/Urinalysis">be tested</a> for particular proteins, sugars, hormones or other chemicals, certain bacteria and <a href="https://medlineplus.gov/ency/article/003583.htm">its acidity or alkalinity</a>.</p>
<p>Doctors can also tell a lot from how your urine <a href="https://theconversation.com/health-check-what-your-pee-and-poo-colour-says-about-your-health-59516">looks</a> and <a href="https://theconversation.com/from-the-sweet-taste-of-urine-to-mri-how-doctors-lost-their-senses-28905">smells</a>. For example dark urine could be a sign of dehydration; a cloudy appearance may suggest infection; if the urine is a reddish colour there may be blood in it; and a sweet smelling urine can be a sign of diabetes.</p>
<h2>Do I have an infection?</h2>
<p>The most common reason for analysing urine is to identify a bacterial infection in your urinary tract, your body’s drainage system for removing urine. Urinary tract infections are particularly common in women, affecting almost <a href="https://www.ncbi.nlm.nih.gov/pubmed/12601337">50%</a> in their lifetime.</p>
<p>Urine tests not only tell you if there’s an infection, they can identify the offending organism. That helps the doctor know how best to treat the infection, including prescribing the right type of antibiotic (one that particular microorganism is sensitive to).</p>
<p>At the GP, the first test uses a dipstick or strip test (sometimes called a rapid urine test). This involves dipping a specially treated plastic or paper strip into a urine sample collected in a sterile plastic pot. </p>
<p>The doctor compares the colour of the test strip with a chart of standard colours. If the strip test detects (is positive for) white blood cells (leucocytes), blood and/or chemicals called nitrites, infection is likely. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/165471/original/image-20170417-10077-1joicta.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/165471/original/image-20170417-10077-1joicta.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/165471/original/image-20170417-10077-1joicta.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/165471/original/image-20170417-10077-1joicta.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/165471/original/image-20170417-10077-1joicta.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/165471/original/image-20170417-10077-1joicta.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/165471/original/image-20170417-10077-1joicta.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/165471/original/image-20170417-10077-1joicta.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Your GP usually performs a quick dipstick test, where the colour of the test paper changes according to what the urine contains.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/438048715?src=PWq8M1UaGBg3mpXxI5Dv-Q-1-43&size=medium_jpg">from shutterstock.com</a></span>
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</figure>
<p>Then, the doctor sends off a sample of the urine to the laboratory for further testing. There, a laboratory technician can view it under a microscope to look for bacteria and cells. If the white cell count is above a baseline level, or if organisms are identified (and the patient has symptoms), an infection is very likely. </p>
<p>Further testing in the laboratory involves culturing the bacteria from the urine (by growing it in a special medium) and testing different antibiotics on it to see which one is most effective.</p>
<p>How your urine sample is handled in hospital may be different. Larger hospitals have a laboratory on site and patients will usually wait in the emergency department for the results of the laboratory microscopic evaluation. Doctors then start treatment with this extra information. </p>
<p>Patients sent home from the emergency department will still need to visit their GP for the final laboratory results, such as the antibiotic sensitivities. If you are admitted to hospital, treatment will start and may be modified once these results are known.</p>
<h2>Sterile samples are vital</h2>
<p>For any of these tests to be valid, the urine sample needs to be sterile (without contamination). To obtain a sterile sample in hospital, that might involve inserting a catheter (a tube that collects urine from the bladder) or a needle into the bladder (suprapubic aspiration). </p>
<p>But the most common method is by asking for a mid-stream urine sample (also known as clean-catch urine sample). This is when you urinate the first part of the urine stream into the toilet, collect the middle part of the stream in a sterile container, then empty the rest of the bladder into the toilet.</p>
<p>The idea is that the first discarded urine flushes out any bacteria or skin cells from the penis or vagina leaving the mid-stream sample as a truly representative sample to test.</p>
<h2>Instructions are often vague</h2>
<p>But many patients will recall being asked to provide a urine sample without adequate explanation of how to do it. They are simply handed a sample container and given directions to the toilet.</p>
<p>Without instruction patients may not know how to prepare their external genitalia. For women this involves parting the labia or lips of the vagina, while for men, this involves retracting the foreskin. </p>
<p>Nor are patients clearly advised how to provide the sample. As a result, they can contaminate the container and its lid by not washing their hands, and their sample often contains the first rather than mid-stream urine. </p>
<p>In these cases, what actually gets into the sample are contaminants; cells and bacteria from hands; or cells and bacteria from the lower part of the urinary tract and genitalia. </p>
<p>Unfortunately for women, their anatomy is more likely to result in more of this latter contamination. They void urine from the urethra (the tube from the bladder) and through a part of the vagina, while men most often void directly into the container.</p>
<h2>Why is a contaminant-free sample important?</h2>
<p>If the sample is contaminated there are various consequences. The laboratory will report contamination and advise the doctor to take care in interpreting results. However, a contaminated sample can result in incorrect diagnosis and incorrect or unnecessary treatment. </p>
<p>A new sample will probably be needed. This causes delays in diagnosis and treatment, potential anxiety to the patient and additional costs.</p>
<p>In our hospital, where the emergency department collects more than 1,000 mid-stream samples each month, women’s samples are contaminated over 40% of the time. In a <a href="http://jcp.bmj.com/content/69/10/921">recent trial</a> visual instructions in the form of cartoons were provided on how to collect the samples. </p>
<p>We paid particular attention to hand washing and collection technique. The number of contaminated samples was reduced <a href="http://jcp.bmj.com/content/69/10/921">by 15%</a>. This potentially could save upwards of 150 repeat tests a month and those instructions are now provided to all patients in the emergency department. </p>
<p>If you are unsure how to take a sterile sample, ask your doctor or nurse for more information. It can save you the time, inconvenience and worry of coming back for another sample.</p>
<hr>
<p><em>This article has been updated to clarify a woman’s anatomy.</em></p><img src="https://counter.theconversation.com/content/74990/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rob Eley received funding from Emergency Medicine Foundation for the study. </span></em></p><p class="fine-print"><em><span>Michael Sinnott receives funding from Queensland Emergency Medicine Research Foundation
Affiliations - I am co-founder of Qlicksmart Pty Ltd and Smartstream Pty Ltd</span></em></p>If you’re not sure why you need a urine test or the right way to collect a sample, here’s what you need to know.Rob Eley, Academic Research Manager, Princess Alexandra Hospital Southside Clinical Unit, The University of QueenslandMichael Sinnott, Adjunct Associate Professor, Faculty of Medicine, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/738292017-03-17T00:07:48Z2017-03-17T00:07:48ZWhat’s behind phantom cellphone buzzes?<figure><img src="https://images.theconversation.com/files/160993/original/image-20170315-5340-1n74g8s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">This is your brain on plugs.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/478917871?src=-ktPYA6l1Gi6QOxI8XWMDg-2-39&size=huge_jpg">'Brain' via www.shutterstock.com</a></span></figcaption></figure><p>Have you ever experienced a phantom phone call or text? You’re convinced that you felt your phone vibrate in your pocket, or that you heard your ring tone. But when you check your phone, no one actually tried to get in touch with you. </p>
<p>You then might plausibly wonder: “Is my phone acting up, or is it me?”</p>
<p>Well, it’s probably you, and it could be a sign of just how attached you’ve become to your phone. </p>
<p>At least you’re not alone. Over 80 percent of college students we surveyed <a href="http://www.sciencedirect.com/science/article/pii/S0747563217300171">have experienced it</a>. However, if it’s happening a lot – more than once a day – it could be a sign that you’re psychologically dependent on your cellphone.</p>
<p>There’s no question that cellphones are part of the social fabric in many parts of the world, and some people spend hours each day on their phones. Our research team recently found that most people will <a href="https://link.springer.com/article/10.1007/s41347-017-0012-8">fill their downtime</a> by fiddling with their phones. Others even do so in the middle of a conversation. And most people will check their phones <a href="https://link.springer.com/article/10.1007/s41347-017-0012-8">within 10 seconds</a> of getting in line for coffee or arriving at a destination. </p>
<p>Clinicians and researchers still debate whether excessive use of cellphones or other technology can constitute an addiction. <a href="http://onlinelibrary.wiley.com/doi/10.1111/appy.12164/abstract">It wasn’t included</a> in the latest update to the <a href="http://www.psychiatry.org/psychiatrists/practice/dsm">DSM-5</a>, the American Psychiatric Association’s definitive guide for classifying and diagnosing mental disorders.</p>
<p>But given <a href="https://www.nytimes.com/2017/03/13/health/teenagers-drugs-smartphones.html?_r=0">the ongoing debate</a>, we decided to see if phantom buzzes and rings could shed some light on the issue.</p>
<h2>A virtual drug?</h2>
<p>Addictions are pathological conditions in which people compulsively seek rewarding stimuli, despite the negative consequences. We often hear reports about how cellphone use can be problematic <a href="https://theconversation.com/she-phubbs-me-she-phubbs-me-not-smartphones-could-be-ruining-your-love-life-68463">for relationships</a> and <a href="https://sites.psu.edu/siowfa15/2015/09/16/are-cell-phones-ruining-our-social-skills/">for developing effective social skills</a>.</p>
<p>One of the features of addictions is that people become hypersensitive to cues related to the rewards they are craving. Whatever it is, they start to see it everywhere. (I had a college roommate who once thought that he saw a bee’s nest made out of cigarette butts hanging from the ceiling.)</p>
<p>So might people who crave the messages and notifications from their virtual social worlds do the same? Would they mistakenly interpret something they hear as a ring tone, their phone rubbing in their pocket as a vibrating alert or even think they see a notification on their phone screen – when, in reality, nothing is there?</p>
<h2>A human malfunction</h2>
<p>We decided to find out. <a href="http%3A%2F%2Fwww.amta.org.au%2Famta%2Fsite%2Famta%2Fdownloads%2Fpdfs.2005.web%2Fdr.phillips.monash.cyber.psychology.mar.05.pdf">From a tested survey measure of problematic cellphone use</a>, we pulled out items assessing psychological cellphone dependency. We also created questions about the frequency of experiencing phantom ringing, vibrations and notifications. We then administered an online survey to over 750 undergraduate students.</p>
<p>Those who scored higher on cellphone dependency – they more often used their phones to make themselves feel better, became irritable when they couldn’t use their phones and thought about using their phone when they weren’t on it – <a href="http://www.sciencedirect.com/science/article/pii/S0747563217300171">had more frequent phantom phone experiences</a>.</p>
<p>Cellphone manufacturers and phone service providers <a href="http://online.liebertpub.com/doi/10.1089/cyber.2015.0406">have assured us</a> that phantom phone experiences are not a problem with the technology. As <a href="https://en.wikipedia.org/wiki/HAL_9000">HAL 9000</a> might say, they are a product of “human error.”</p>
<p>So where, exactly, have we erred? We are in a brave new world of virtual socialization, and the psychological and social sciences can barely keep up with advances in the technology. </p>
<p>Phantom phone experiences may seem like a relatively small concern in our electronically connected age. But they raise the specter of how reliant we are on our phones – and how much influence phones have in our social lives. </p>
<p>How can we navigate the use of cellphones to maximize the benefits and minimize the hazards, whether it’s improving our own mental health or honing our live social skills? What other new technologies will change how we interact with others? </p>
<p>Our minds will continue to buzz with anticipation.</p><img src="https://counter.theconversation.com/content/73829/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel J. Kruger does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Have you ever checked your phone thinking you had felt it vibrate or heard it ring, only to see that no one tried to reach you? One researcher decided to study this phenomenon.Daniel J. Kruger, Research Assistant Professor, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/613602016-06-27T23:53:29Z2016-06-27T23:53:29ZElection FactCheck: has the Coalition cut bulk-billing for pathology and scans ‘to make patients pay more’?<blockquote>
<p>In their first term in office the Liberals … cut bulk-billing payments for pathology and diagnostic imaging to make patients pay more. – <strong>Shadow health minister Catherine King, <a href="http://www.catherineking.com.au/media/malcolm-cannot-be-trusted-on-medicare/">media release</a>, June 20, 2016.</strong></p>
</blockquote>
<p>The opposition has released political ads accusing the government of planning to privatise Medicare and warning of higher health costs in future – a campaign Prime Minister Malcolm Turnbull has <a href="http://www.news.com.au/national/federal-election/scare-campaign-could-hamper-attempts-to-boost-medicares-efficiency/news-story/fe9e1ae2b30ee2e2f8ec9aa817448579">called</a> “extraordinarily dishonest.” </p>
<p>As part of Labor’s Medicare campaign, shadow health minister Catherine King said that the government has “cut bulk-billing payments for pathology and diagnostic imaging to make patients pay more”. Incentives worth between $1.40 to $3.40 are paid direct to pathology service providers to encourage them to bulk-bill. </p>
<p>Is King right?</p>
<h2>Checking the source</h2>
<p>The Conversation asked Labor campaign media for sources to support Catherine King’s statement but did not hear back before deadline. </p>
<p>Health Minister Sussan Ley has <a href="http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2016-ley001.htm">argued</a> that bulk-billing incentives are not meant to be used to cross-subsidise other costs of doing business for <a href="https://theconversation.com/true-blood-cutting-through-confusion-about-pathology-cuts-55140">large companies</a> – some of which are owned by private equity firms – at a time when health care costs are growing.</p>
<h2>From ‘Don’t Kill Bulk Bill’ to a deal on rent</h2>
<p>In its December 2015 <a href="http://www.budget.gov.au/2015-16/content/myefo/download/MYEFO_2015-16_Final.pdf">Mid-Year Economic Fiscal Outlook</a>, the Coalition government announced a suite of bulk-billing changes aimed at saving $650 million over four years. It proposed removing bulk-billing incentives for pathology and diagnostic imaging services.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/127652/original/image-20160622-19786-1usxxbd.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/127652/original/image-20160622-19786-1usxxbd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/127652/original/image-20160622-19786-1usxxbd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=440&fit=crop&dpr=1 600w, https://images.theconversation.com/files/127652/original/image-20160622-19786-1usxxbd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=440&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/127652/original/image-20160622-19786-1usxxbd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=440&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/127652/original/image-20160622-19786-1usxxbd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=553&fit=crop&dpr=1 754w, https://images.theconversation.com/files/127652/original/image-20160622-19786-1usxxbd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=553&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/127652/original/image-20160622-19786-1usxxbd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=553&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="http://www.budget.gov.au/2015-16/content/myefo/download/MYEFO_2015-16_Final.pdf">MYEFO 2015-16</a></span>
</figcaption>
</figure>
<p>Pathology Australia, which includes big players such as Genea and Sonic Healthcare Group among its members, has been central to how this issue has unfolded. Pathology Australia says its member organisations perform a majority of pathology testing within the private sector.</p>
<p>Pathology Australia collected nearly 600,000 signatures for its “<a href="http://www.dontkillbulkbill.com/">Don’t Kill Bulk Bill</a>” campaign, which warned that patients would face expensive pap smears and other costly tests due to government’s removal of the bulk-billing incentive for pathology services.</p>
<p>In May, Pathology Australia <a href="http://www.pathologyaustralia.com.au/2016/05/13/patients-win-in-pathology-announcements/">closed</a> its Don’t Kill Bulk Bill campaign after striking a <a href="https://www.liberal.org.au/latest-news/2016/05/13/coalitions-plan-access-affordable-pathology-all-australians">deal</a> with the government, aimed at ensuring pathology service providers who co-located their collection rooms inside a GP’s building were charged “fair market value” rents.</p>
<p>The bulk-bill incentive removal is still going ahead, but the idea is that many pathology service providers may now be better able to absorb the cost if they’re getting a cheaper deal on rent – instead of passing the extra cost onto patients. </p>
<p>Nick Musgrave, president of Pathology Australia, told The Conversation that:</p>
<blockquote>
<p>Decisions regarding billing practices are made by individual pathology providers … The regulatory changes announced by the Coalition to control excessive rents for pathology collection rooms will enable providers to more readily maintain current billing practices as would the maintenance of current funding. In the absence of either of these measures, providers had indicated they would not have been able to maintain current high levels of bulk-billing.</p>
</blockquote>
<p>Musgrave said the deal to regulate rents for collection rooms will “more readily enable pathologists to maintain current billing practices” whether or not they are members of Pathology Australia. (You can read his full response <a href="http://theconversation.com/full-response-from-pathology-australia-61438">here</a>.)</p>
<p>But some other pathology service providers have said the deal with the government doesn’t take them into account.</p>
<h2>Not all pathologists</h2>
<p>Pathology is no longer a small industry, with the Sonic group reporting annual revenue of about <a href="http://www.sonichealthcare.com/about-us/corporate-overview/">$4 billion</a> – but not all businesses are on this scale.</p>
<p>Catholic Health Australia is one of the service providers that says the deal doesn’t take them into account. This group also represents pathology service providers, including many in regional and rural areas.</p>
<p>According to its spokesman:</p>
<blockquote>
<p>Independent and not-for-profit pathology providers may have to adopt co-payments simply in order for their services to remain viable … Turnbull’s deal with ‘the pathology sector’ was made without taking not-for-profit providers into account.</p>
</blockquote>
<p>The group said that the rents deal will:</p>
<blockquote>
<p>disproportionately assist the larger corporate providers and will not be sufficient to adequately offset the cuts imposed on smaller providers by removing the bulk-billing incentives.</p>
</blockquote>
<p>You can read Catholic Health Australia’s full comment <a href="http://theconversation.com/full-response-from-catholic-health-australia-61439">here</a>.</p>
<p>So, whether or not you’ll pay more for pathology tests after July 1 depends mostly on who owns that practice or pathology service provider, and whether they can afford to absorb the cost of the changes themselves or choose to pass on these costs to patients.</p>
<p>Labor has <a href="http://www.smh.com.au/federal-politics/federal-election-2016/federal-election-labor-promises-to-continue-funding-bulkbilling-incentives-for-pathology-radiology-20160618-gpmd3m.html">pledged</a> to reverse cuts to the Medicare Benefits Schedule pathology bulk-billing incentives – which it believes will improve access to bulk-billed pathology services, but would also drive up the cost to taxpayers. </p>
<p>Others, such as the Grattan Institute, <a href="http://grattan.edu.au/wp-content/uploads/2016/02/935-blood-money.pdf">argue that</a> there are ways save money in pathology, saying that:</p>
<blockquote>
<p>patient co-payments for tests should be abolished. Patients aren’t the real consumers of pathology tests – the doctors who order and use them are. </p>
</blockquote>
<h2>What about scans?</h2>
<p>The rents deal struck between the government and Pathology Australia doesn’t cover scans.</p>
<p>Australian Diagnostic Imaging Association (ADIA), which represents private providers of radiology services, <a href="http://www.adia.asn.au/public/3/system/newsAttachments/ADIA%20Pathology%20Deal%20Response%20May16.pdf">said</a> the rents deal was “cold comfort for the millions of patients needing vital radiology services”. </p>
<p>The government plans to remove bulk-billing incentive payments for radiology services in January 2017. However, ADIA has <a href="http://www.adia.asn.au/public/3/system/newsAttachments/050616_FINAL_ADIA%20welcomes%20Coalition%20commitment%20on%20access%20to%20diagnostic%20i%20....pdf">secured</a> a commitment from the government to “work with the diagnostic imaging sector on structural reforms to provide patients with certainty on affordable access to services”.</p>
<p>The review will happen before January 2017.</p>
<p>ADIA has also said that patient rebates for diagnostic imaging have been frozen since 1998, with patient gaps now averaging <a href="http://www.adia.asn.au/public/3/files/ADIA%20Rebate%20Response%2031May16.pdf">$100</a>, and has voiced concern that Labor’s pledge to reverse the decision to remove the bulk-billing incentive does not go far enough. Labor has said it will restore indexation in January 2017 to all services provided by GPs, allied health and other health practitioners and medical specialists – but that scans are not included.</p>
<p>ADIA has <a href="http://www.adia.asn.au/public/3/system/newsAttachments/100616%20ADIA%20calls%20Labor%20failure%20to%20index%20DI%20a%20broken%20promise%20on%20Medicare....pdf">called</a> on Labor to expand its indexation election promise to include diagnostic imaging service providers too.</p>
<h2>Verdict</h2>
<p>Catherine King was right to say that in its first term of office, the Coalition government cut bulk-billing payments for pathology and diagnostic imaging. That is scheduled to come into effect on July 1, 2016, for pathology services and in January 2017 for radiology services.</p>
<p>But the second part of her statement – “to make patients pay more” – didn’t tell the whole story. Pathology Australia’s deal with the government on rent regulation means some pathologists may be able to keep bulk-billing. Others, however, may not. </p>
<p>Whether or not patients will pay more as a result of the bulk-billing incentive removal depends on whether your pathology or radiology service provider passes on the cost to customers. <strong>– Helen Dickinson</strong></p>
<hr>
<h2>Review</h2>
<p>This is a sound FactCheck. I would further note that the Grattan Institute <a href="http://grattan.edu.au/wp-content/uploads/2016/02/935-blood-money.pdf">reports</a> that almost 99% of pathology tests for out-of-hospital patients are bulk-billed, an increase from 93% a decade ago.</p>
<p>St John of God, a large not-for-profit health group, is <a href="http://www.clinicallabs.com.au/media/1037/australian-clinical-labs-media-statement-22nd-june-2016.pdf">selling</a> its pathology operations to Clinical Labs. The removal of the bulk-billing incentive payment may have put them in a position where they would have passed increased costs onto patients. </p>
<p>The unmentioned driver behind the rising cost to the health budget of pathology bulk-billing is clinicians practising <a href="http://www.racgp.org.au/afp/2014/may/we-live-in-testing-times/">defensive medicine</a> – GPs and specialists reasonably ordering tests “to be sure” or “safe”, even where it may not be needed.<strong>– Bruce Baer Arnold</strong></p>
<hr>
<p><div class="callout"> Have you ever seen a “fact” worth checking? The Conversation’s FactCheck asks academic experts to test claims and see how true they are. We then ask a second academic to review an anonymous copy of the article. You can request a check at checkit@theconversation.edu.au. Please include the statement you would like us to check, the date it was made, and a link if possible.</div></p><img src="https://counter.theconversation.com/content/61360/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Dickinson receives funding from the federal Department of Health.
</span></em></p><p class="fine-print"><em><span>Bruce Baer Arnold does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Labor’s shadow health minister Catherine King, said that the government has “cut bulk-billing payments for pathology and diagnostic imaging to make patients pay more”. Is that right?Helen Dickinson, Associate Professor, Public Governance, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/613082016-06-22T20:12:08Z2016-06-22T20:12:08ZIs Medicare under threat? Making sense of the privatisation debate<p>Many Australians will go to the polls on July 2 believing the future of Medicare is at stake. In a sense it is – but not because of the government’s plans, now ditched under the heat of a campaign, to outsource IT functions. </p>
<p>The greater threats to our national public health system lie in the increasing role of consumer co-payments and the power of vested interests that stifle policy innovation in health. </p>
<h2>Mediscare campaign</h2>
<p>The Labor Party is heading into the election with its Medicare banner hoisted high. Labor promises that it alone can “save Medicare” from the incremental privatisation that higher co-payments and increased outsourcing may herald. </p>
<p>But while Labor’s claims about the need to defend universal health care from creeping co-payments are genuine and important, it is hard to accept the party’s recent claim that the <a href="http://www.health.gov.au/internet/ministers/publishing.nsf/Content/F565B4C4F57E4F7ECA257D2E0024CD32/$File/PD061.pdf">Liberals’ interest in outsourcing</a> claims and payment services for Medicare and the <a href="http://www.pbs.gov.au/pbs/home;jsessionid=1bf9hb5zm3zrn1162enbxdqdmf">Pharmaceutical Benefits Scheme</a> (PBS) is an existential threat to Medicare. </p>
<p>While any changes would <a href="http://www.afr.com/business/health/election-2016-no-reason-not-to-outsource-antique-medicare-payments-20160620-gpn9y3">need to be handled carefully</a>, in reality our antiquated system needs to be modernised in the most cost-effective way possible. </p>
<p>The public, though, is wary about how that modernisation occurs. An <a href="http://www.essentialvision.com.au/outsourcing-government-payments">Essential Report poll</a> conducted in February asked about the public’s attitude to outsourcing: </p>
<blockquote>
<p>It has been suggested that the government may outsource the administration and payment of Medicare, pharmaceutical and aged care benefits to the private sector. Would you approve or disapprove of this?</p>
</blockquote>
<p><strong>Public attitude to outsourcing of government payment systems, including Medicare, to the private sector</strong></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/127678/original/image-20160622-19754-1tml5sz.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/127678/original/image-20160622-19754-1tml5sz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/127678/original/image-20160622-19754-1tml5sz.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=303&fit=crop&dpr=1 600w, https://images.theconversation.com/files/127678/original/image-20160622-19754-1tml5sz.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=303&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/127678/original/image-20160622-19754-1tml5sz.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=303&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/127678/original/image-20160622-19754-1tml5sz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=381&fit=crop&dpr=1 754w, https://images.theconversation.com/files/127678/original/image-20160622-19754-1tml5sz.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=381&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/127678/original/image-20160622-19754-1tml5sz.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=381&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Grattan Institute</span></span>
</figcaption>
</figure>
<p>The answer was clear – the <a href="http://www.essentialvision.com.au/outsourcing-government-payments">public opposes outsourcing</a> but its opposition probably reflects the government’s failure to sell the idea rather than a settled view.</p>
<h2>Privatising service delivery has been ruled out</h2>
<p>The “Mediscare” campaign appears to have been effective, irrespective of its substance. Prime Minister Turnbull has now emphatically ruled out any outsourcing of Medicare services, <a href="https://www.liberal.org.au/latest-news/2016/06/20/press-conference-oran-park-nsw">stating that</a>: </p>
<blockquote>
<p>I am making a solemn commitment, an unequivocal commitment that every element of Medicare’s services will continue to be delivered by government. Full stop.</p>
</blockquote>
<p>Of course, Turnbull may forget this commitment soon after July 2. The dishonouring of pre-election commitments is a proud tradition on both sides of the aisle. Julia Gillard famously reneged on her vow to never introduce a carbon tax. Tony Abbott’s raft of <a href="http://www.smh.com.au/business/federal-budget/then-and-now-the-abbott-governments-broken-promises-20140514-zrcfr.html">broken election promises</a> exceed the word limit for this article. Voters will have to decide whether they believe this prime minister will be different. </p>
<p>Turnbull’s words may later be claimed to provide wiggle room, as the <a href="http://www.health.gov.au/internet/ministers/publishing.nsf/Content/F565B4C4F57E4F7ECA257D2E0024CD32/$File/PD061.pdf">original media release</a> also announced that the proposal “does not include the face-to-face services provided by Medicare”.</p>
<h2>Privatising funding is a greater threat</h2>
<p>Outsourcing is only one form of privatisation, and nowhere near the <a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9281493">most pernicious</a>. While privatisation of service delivery is now off the table, greater privatisation of funding (that is, the share of health costs met by private insurance or patient co-payments) is still very much on the cards. </p>
<p>The Liberals remain committed to a A$5 increase in <a href="https://theconversation.com/hidden-cost-of-increasing-drug-co-payment-poses-a-high-risk-37482">Pharmaceutical Benefits Scheme co-payments</a> – a zombie policy that has been stuck in the Senate since 2014. </p>
<p>Although the Coalition has given up on legislating its A$7 GP co-payment, its <a href="https://theconversation.com/confused-about-the-medicare-rebate-freeze-heres-what-you-need-to-know-59661">Medicare rebate freeze</a> is effectively designed to sneak it in through the back door. The freeze means that until 2020, doctors will be paid the same as they were in 2014. With a growing gap between income and costs, they will eventually pass the difference on to their patients.</p>
<p>Both policies, which Labor opposes, will have a real impact on the integrity of the public health system. </p>
<p>The underlying promise of Medicare is universal access to health services irrespective of a person’s age, illness or bank balance. While outsourcing IT systems or service provision may not affect this promise, the same is not true of co-payments. </p>
<p>Australia already has a very high level of <a href="http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Australian_healthcare">out-of-pocket costs</a>. Raising them further will have an immediate effect on the ability of <a href="http://grattan.edu.au/wp-content/uploads/2014/07/Grattan_Institute_submission_-_inquiry_on_out-of-pocket_costs_-_FINAL.pdf">people on a low-income to access the care they need</a>. </p>
<p>As skipped GP visits lead to an increasing number of avoidable hospital admissions, costs will rise rather than fall for the health system. </p>
<h2>Medicare needs evidence-based reform</h2>
<p>Medicare is vital to Australia’s social policy fabric. But in order to survive, it needs to be modernised, not preserved in aspic. </p>
<p>Over the past year, substantive ideas to increase the quality and sustainability of Medicare services have repeatedly gone down in flames. Poorly designed policies are being retained for the benefit of private providers, not patients. </p>
<p>Opportunities for <a href="https://grattan.edu.au/news/blood-money-pathology-cuts-can-reduce-spending-without-compromising-health/">improved sustainability</a> and service delivery have been put on the back burner because of fears of political campaigns by <a href="http://www.smh.com.au/federal-politics/political-opinion/the-pharmacy-guild-the-most-powerful-lobby-group-youve-never-heard-of-20150401-1mckxl.html">owners of pharmacies</a> and other providers. </p>
<p>Meanwhile, government backdowns have led to <a href="http://www.theaustralian.com.au/business/markets/pathology-shares-jump-on-government-backdown/news-story/b5d95baed6672b9a588d05b06cdb9522">share price rallies</a>, as we saw when Pathology Australia struck a deal with the government to abandon its <a href="http://www.dontkillbulkbill.com/">Don’t Kill Bulk Bill</a> campaign. </p>
<p>We need to remember that <a href="http://grattan.edu.au/wp-content/uploads/2014/12/14_15_StephenDucketStory_GMI.pdf">every dollar of health expenditure</a> is a dollar of some provider’s income. </p>
<p>The long-term solution to Medicare sustainability lies not in higher co-payments but in substantive reform. This includes investing in <a href="https://public-health.uq.edu.au/assessing-cost-effectiveness-ace-prevention-study">cost-effective prevention</a> and in a <a href="http://grattan.edu.au/report/chronic-failure-in-primary-care/">better designed primary care system</a> .</p><img src="https://counter.theconversation.com/content/61308/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Duckett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The greater threats to our national public health system lie in the increasing role of consumer co-payments and the power of vested interests that stifle policy innovation in health.Stephen Duckett, Director, Health Program, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/605682016-06-15T20:14:17Z2016-06-15T20:14:17ZHow Pathology Australia advocates for ‘patient care’ to achieve big corporate profits<figure><img src="https://images.theconversation.com/files/126652/original/image-20160615-22383-f3kyou.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pathology in Australia is big business.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-68481031/stock-photo-man-in-laboratory-in-during-blood-research.html?src=-d27yzJj8XtmHvnC0wZVXA-3-52">ariadna de raadt/Shutterstock</a></span></figcaption></figure><p><em>We see their spokespeople quoted in the papers and their ads on TV, but beyond that we know very little about how Australia’s lobby groups get what they want. This series shines a light on the strategies, political alignment and policy platforms of eight <a href="https://theconversation.com/au/topics/australian-lobby-groups">lobby groups that can influence this election</a>.</em></p>
<hr>
<p>Each time we go for a blood test to investigate or keep track of an illness, or have a tissue sample from a Pap test or suspicious mole sent off for analysis, the wheels of the pathology industry are put to work. </p>
<p>Pathology in Australia is <a href="https://theconversation.com/true-blood-cutting-through-confusion-about-pathology-cuts-55140">big business</a>. One company draws an <a href="http://www.sonichealthcare.com/about-us/corporate-overview/">annual revenue</a> of almost A$4 billion. And a proportion comes from the public purse, via Medicare rebates. </p>
<p>The industry features a handful of very large corporations – including giants <a href="http://www.sonichealthplus.com.au/about-us">Sonic</a> and <a href="http://www.primaryhealthcare.com.au/irm/content/company-overview.aspx?RID=299&RedirectCount=1">Primary Health Care</a> – that typically use multiple brands, giving a misleading sense of competition.</p>
<p>Other large groups operate on a commercial basis but have a religious and thus notionally not-for-profit orientation, such as the <a href="http://www.sjog.org.au/pathology1.aspx">St John of God group</a> in Western Australia. </p>
<p>There are also a shrinking number of smaller independent operators trying to occupy market niches or leverage personal relationships. </p>
<p>The industry doesn’t speak with one voice; different providers have competing interests. The key private sector industry body is <a href="http://www.pathologyaustralia.com.au/">Pathology Australia</a>. But it <a href="http://www.pathologyaustralia.com.au/about/">doesn’t represent</a> Primary Health Care or religious entities.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/126667/original/image-20160615-22398-xptmeh.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/126667/original/image-20160615-22398-xptmeh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/126667/original/image-20160615-22398-xptmeh.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=369&fit=crop&dpr=1 600w, https://images.theconversation.com/files/126667/original/image-20160615-22398-xptmeh.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=369&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/126667/original/image-20160615-22398-xptmeh.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=369&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/126667/original/image-20160615-22398-xptmeh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=464&fit=crop&dpr=1 754w, https://images.theconversation.com/files/126667/original/image-20160615-22398-xptmeh.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=464&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/126667/original/image-20160615-22398-xptmeh.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=464&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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</figure>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/126643/original/image-20160615-22408-jlvcyy.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/126643/original/image-20160615-22408-jlvcyy.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/126643/original/image-20160615-22408-jlvcyy.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=770&fit=crop&dpr=1 600w, https://images.theconversation.com/files/126643/original/image-20160615-22408-jlvcyy.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=770&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/126643/original/image-20160615-22408-jlvcyy.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=770&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/126643/original/image-20160615-22408-jlvcyy.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=967&fit=crop&dpr=1 754w, https://images.theconversation.com/files/126643/original/image-20160615-22408-jlvcyy.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=967&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/126643/original/image-20160615-22408-jlvcyy.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=967&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Pathology Australia’s Don’t Kill Bulk Bill campaign (screenshot).</span>
</figcaption>
</figure>
<h2>Threat to bulk billing</h2>
<p>If you visited a clinic to get a blood test or other service <a href="https://theconversation.com/blood-money-pathology-cuts-can-reduce-spending-without-compromising-health-54834">late last year or early this year</a>, you probably encountered Pathology Australia’s <a href="http://www.pathologyaustralia.com.au/2016/02/29/dont-kill-bulk-bill/">Don’t Kill Bulk Bill</a> posters and pamphlets encouraging you to contact your local MP or the health minister. </p>
<p>It was a traditional fear campaign that generated substantial public interest. The concern was that the government’s $1.40/$3.40 removal of the bulk-billing incentive for pathology services would lead to <a href="http://www.abc.net.au/news/2016-01-06/claims-over-$30-charge-for-pap-smears-false-minister-says/7070320">A$30 pap tests</a> and cause those with diabetes and other serious diseases to forgo important blood tests. </p>
<p>Such fees would only arise, however, if pathology companies didn’t absorb the small cuts, and decided instead to charge large co-payments. This seems unlikely, as patients could simply choose a provider that did bulk bill. </p>
<hr>
<p><em>Further reading:</em> <a href="https://theconversation.com/true-blood-cutting-through-confusion-about-pathology-cuts-55140">True blood: cutting through confusion about pathology cuts</a></p>
<hr>
<p>The Don’t Kill Bulk Bill campaign was <a href="http://www.businessinsider.com.au/healthcare-stocks-are-rallying-on-pathology-bulk-billing-deal-2016-5">promptly abandoned</a> in mid-May after Pathology Australia negotiated a <a href="https://www.liberal.org.au/latest-news/2016/05/13/coalitions-plan-access-affordable-pathology-all-australians">deal with the Coalition government</a>. This meant Pathology Australia’s members would maintain bulk billing. And the government would introduce regulation to stop general practitioners from charging pathology companies high rents for blood and tissue collection centres co-located within their clinics. </p>
<p>Sonic <a href="http://www.businessinsider.com.au/healthcare-stocks-are-rallying-on-pathology-bulk-billing-deal-2016-5">shares went up almost 5%</a> after deal was announced, signalling a win for Pathology Australia. And the government was able to dodge a bullet. </p>
<p>Patients are arguably the losers, being used as pawns in a campaign that claimed to be about patient care but was really about corporate profits. </p>
<h2>Why lobby about pathology?</h2>
<p>Like all lobby groups, Pathology Australia tries to persuade policymakers (officials and politicians) at the Commonwealth and state levels to “see things their way” when <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/pathqa">making rules</a> and funding decisions. That “seeing” might relate to pricing, as was the case in the Don’t Kill Bulk Bill campaign. </p>
<p>Other lobbying has gained less attention. The pathology industry has, for instance, attempted to convince the federal health department and the <a href="http://www.findlaw.com.au/articles/728/health-care-under-acccs-microscope.aspx">Australian Competition & Consumer Commission</a> (ACCC) that ongoing <a href="https://www.accc.gov.au/media-release/accc-will-review-sonic-healthcare%E2%80%99s-proposed-acquisition-of-adelaide-pathology-partners">consolidation</a> across the sector – which might otherwise be construed as anti-competitive activity – is acceptable because bigness results in the provision of high-quality services across Australia. </p>
<p>Such lobbying typically doesn’t take place in the public arena. Instead it’s the matter of meetings with ministerial advisers, unsolicited visits to backbench MPs and briefings of officials, sometimes leveraging cogent analyses such as the <a href="http://www.thecie.com.au/wp-content/uploads/2016/04/Economic-value-of-pathology_-Final-Report-April-2016.pdf">Centre for International Economics report</a> prepared for <a href="http://www.knowpathology.com.au">Pathology Awareness Australia</a>. </p>
<p>In parts of Australia, pathology lobbyists have attempted to privatise public pathology labs in public hospitals. The reasoning given is the sale would benefit a state treasury, remove the need for new investment, and improve service delivery. </p>
<p>This was the <a href="http://periodicdisclosures.aec.gov.au/Donor.aspx?SubmissionId=56&ClientId=33972">case in Tasmania</a>, where <a href="http://periodicdisclosures.aec.gov.au/Donor.aspx?SubmissionId=56&ClientId=33972">Pathology Australia</a> and individual pathology companies have donated to the local Liberal Party. Such donations don’t determine decisions but do, presumably, allow the donor to get the decision-maker’s ear. </p>
<h2>Conflicting voices</h2>
<p>If you look at Pathology Australia’s website, you won’t get much information about its war-chest or how it spends its funds to persuade the important people. Scrutinise reports from the leading private organisations, which presumably have had representatives doing the rounds in Canberra, and you similarly will not gain much useful data. </p>
<p>People who are not industry insiders are reliant on anecdotes about who talked to whom at industry dinners or who was seen in the foyer at the health department or the ACCC. </p>
<p>The public sector organisations are represented by <a href="http://publicpathology.org.au/">Public Pathology Australia</a>, established in 2001 as the National Coalition of Public Pathology. It is precluded from donating to political parties but can foster awareness. Its site is more informative.</p>
<p>Sitting alongside those bodies are the professional organisations that in essence represent the human capital – the clinicians and technicians who work in or around the industry. Those organisations include the <a href="https://www.rcpa.edu.au/">Royal College of Pathologists of Australasia</a>, with enough authority to gain a meeting with the minister, and entities such as the <a href="http://www.anzsbt.org.au/">Australia & New Zealand Society of Blood Transfusion</a>, <a href="https://www.aims.org.au/">Australian Institute of Medical Scientists</a> and <a href="http://www.cytology-asc.com/">Australian Society of Cytology</a>. </p>
<p>Such organisations do not have a major public profile. They arguably seek to stay out of the spotlight on the basis that soft power is best exercised through participation in departmental committees. Some of these are very opaque but still determine government policy.</p>
<p>Corporate priorities are not synonymous with national benefit. For a better discussion about health spending, we need greater transparency on the part of the minister, department and other bodies. Otherwise Australians risk being again used as pawns in the pathology game. </p>
<hr>
<p><em>Read the other articles in The Conversation’s Australian lobby groups series <a href="https://theconversation.com/au/topics/australian-lobby-groups">here</a>.</em></p><img src="https://counter.theconversation.com/content/60568/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Baer Arnold does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Pathology Australia promptly abandoned its Don’t Kill Bulk Bill campaign against cuts to bulk-billing incentives after doing a deal with the federal government.Bruce Baer Arnold, Assistant Professor, School of Law, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/594182016-05-13T13:25:57Z2016-05-13T13:25:57ZShorten wins first debate<p>The first debate of the election campaign, a “people’s forum” of 100 undecided voters in western Sydney that was a relatively free-flowing affair, saw Bill Shorten come out ahead.</p>
<p>After the encounter, 42 of the audience said they were more likely to vote for Shorten as a result of what they’d heard, 29 were more persuaded by Malcolm Turnbull, and 29 were undecided.</p>
<p>While everyone was polite this was an unpredictable environment for the contenders. The questions weren’t known even to Sky, which hosted the night. Turnbull and Shorten did not just have to be well prepared but also quick on their feet, to come back with responses to each other and to deal with some persistent follow-ups from moderator David Speers.</p>
<p>Shorten had previously done 25 of these forums and was comfortable in the setting. One of the questioners said later that Shorten seemed to be “talking more from the heart” while Turnbull was a “bit more standoffish”.</p>
<p>Shorten had good reflexes. When Turnbull expounded on the government’s childcare policy, he leapt in to point out that its implementation had just been delayed by a year, to 2018.</p>
<p>Not surprisingly, given this was western Sydney, the dozen questions were easier for Shorten because most of them played to his agenda more than to Turnbull’s.</p>
<p>Questioners were concerned with health and education, businesses outsourcing overseas at the expense of local jobs, superannuation – but not at the top end or the argument about retrospectivity – and whether there would be more privatisation.</p>
<p>Also notable was what didn’t get asked. Much of the election debate this week has concerned Labor’s asylum seeker policy, but boats did not rate a mention. Nor did climate change.</p>
<p>Shorten came across as traditional Labor, focused on the importance of services. But he was also anxious at every opportunity to say how he’d pay for them. He stressed that decisions were about priorities.</p>
<p>He was blunt when pressed on privatisation, saying “the privatisation tide has probably gone too far”. Turnbull said these days the issue was more of a live one at state level. When he was pushed on Australia Post and ASC Turnbull tended to faff around. Shorten jumped in to say that Australian Hearing should not be privatised.</p>
<p>Shorten came out ahead after a question about bank interest rates that quickly morphed into the issue of whether there should be a royal commission into the banks. Turnbull tried to be over-clever by referring to a Shorten article with the heading “Time to put the banks in the dock”. The “dock”, Turnbull pointed out, was where the criminal stood. The audience was obviously inclined to see the dock as a rather appropriate place for the banks.</p>
<p>Both leaders were firm in rejecting the proposition from one questioner that people should be able to access their superannuation for housing. Turnbull declared the purpose of superannuation was to provide for retirement; Shorten said “the nature of leadership” was that you couldn’t always tell people what they wanted to hear.</p>
<p>In the course of the forum both leaders produced some news on health policy. Turnbull announced the government had just settled its dispute with pathologists, who will continue to bulk bill for blood tests and the like.</p>
<p>The government decided late last year that from July 1 bulk-billing incentives paid to providers would be taken away. The deal struck with Pathology Australia, which represents the pathology companies, will reduce their rents in collection centres, rather than restore the bulk-billing incentive.</p>
<p>For his part Shorten, who has yet to unveil Labor’s health policy, indicated it would modify the government’s freeze on the Medicare patient rebate, which currently extends to 2020. The freeze, which affects most doctors, has been trenchantly attacked by the medical lobby, with an Australian Medical Association campaign due to start on Sunday.</p>
<p>People’s forums have only been going in recent elections. They are valuable because they get away from the controlled nature of many campaign events. It’s not yet clear how many debates there will be, but let’s hope there will be more of these forums, which give a chance for community engagement. They should, however, be broadcast on free-to-air TV, so they can be seen by a much wider audience. </p>
<iframe src="https://www.podbean.com/media/player/3b489-5f1958?from=yiiadmin" data-link="https://www.podbean.com/media/player/3b489-5f1958?from=yiiadmin" height="100" width="100%" frameborder="0" scrolling="no" data-name="pb-iframe-player"></iframe>
<iframe src="https://www.podbean.com/media/player/y4hyx-5f0a7e?from=yiiadmin" data-link="https://www.podbean.com/media/player/y4hyx-5f0a7e?from=yiiadmin" height="100" width="100%" frameborder="0" scrolling="no" data-name="pb-iframe-player"></iframe><img src="https://counter.theconversation.com/content/59418/count.gif" alt="The Conversation" width="1" height="1" />
The first debate of the election campaign, a “people’s forum” of 100 undecided voters in western Sydney that was a relatively free-flowing affair, saw Bill Shorten come out ahead. After the encounter…Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/551402016-03-01T00:26:54Z2016-03-01T00:26:54ZTrue blood: cutting through confusion about pathology cuts<figure><img src="https://images.theconversation.com/files/113184/original/image-20160229-4090-jjap8t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pathology is big business.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/thirteenofclubs/5457364149/">Thirteen Of Clubs/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>The <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pathology-aboutus-index.htm">pathology sector</a> in Australia is no longer a cottage industry. It is dominated by a handful of billion-dollar enterprises that analyse blood, tissue and other samples. These tests enable timely diagnosis of a range of illnesses and allow clinicians to optimise treatment by ensuring patients get the right mix of medications for specific conditions. </p>
<p>The sector uses advanced technology, involving high-cost specialist equipment rather than individual pathologists equipped with a microscope. It’s big business. The overall Sonic group, which includes one of the two leading services, last year <a href="http://www.sonichealthcare.com/media/95803/1463156.pdf">reported</a> annual revenue of more than A$4 billion.</p>
<p>As last week’s <a href="https://theconversation.com/blood-money-pathology-cuts-can-reduce-spending-without-compromising-health-54834">Grattan Institute report</a> and a new <a href="http://www.pathologyaustralia.com.au/2016/02/29/dont-kill-bulk-bill/">lobbying campaign</a> indicate, it’s also a sector full of confusion and controversy.</p>
<h2>Confusion and controversy</h2>
<p>The controversy comes from the <a href="http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/FlagPost/2015/December/Changes_to_bulk_billing_incentives">proposed removal</a> of bulk-billing incentives for pathology tests, announced in December. Critics claimed the changes will adversely affect the disadvantaged (who would be left out of pocket) or inhibit clinicians from ordering appropriate tests. </p>
<p>Health Minister Susan Ley <a href="http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2016-ley001.htm">responded</a> that Medicare exists to foster public health. It is not a gift from the taxpayer to pathology service providers. </p>
<p>Some of those providers are owned by private equity firms, some are listed companies such as <a href="http://www.sonichealthcare.com/about-us/corporate-overview.aspx">Sonic</a> and <a href="http://www.primaryhealthcare.com.au/irm/content/company-overview.aspx?RID=299">Primary</a>, and one – dominant in Western Australia – is the health services conglomerate <a href="http://www.sjog.org.au/pathology.aspx">St John of God</a>, a religious entity. </p>
<p>Controversy also reflects the regulation of the sector. Several major players operate internationally and have diversified. Some, for example, offer diagnostic imaging, medical software services, insurance, drug testing and paternity testing. Some are parts of conglomerates that include clinics and hospitals. </p>
<p>Canberra has taken a light-touch approach to regulation, on the basis that oligopoly (market domination by a small number of enterprises) results in economies of scale, administrative convenience (it’s easier for Canberra to deal with 50 rather than 5,000 players) and nationwide access to the tests that we take for granted. </p>
<p>Although bigness isn’t bad, it does raise concerns. The dominant players continue to acquire established businesses and market entrants, with occasional <a href="http://www.accc.gov.au/media-release/accc-will-review-sonic-healthcare%E2%80%99s-proposed-acquisition-of-adelaide-pathology-partners">push-back</a> by the national competition regulator. They have also engaged in incentive <a href="https://theconversation.com/questioning-the-pathology-centre-goldrush-11108">practices</a> that in other industries would raise eyebrows. </p>
<h2>Profits and services</h2>
<p>The sector is currently crying poor. The dominant players, however, continue to grow. </p>
<p>That growth is attributable to acquisitions and to a focus on cost reduction – offsetting fixed costs for premises, equipment and consumables through a scale that allows them to run tests continually. Insiders refer to ongoing reduction and casualisation of the overall workforce, alongside debt-servicing attributable to the cost of overseas expansion. </p>
<p>In thinking about conflicting claims, it is useful to remember that pathology services in the private sector are business, not philanthropy. In fiscal terms, they are good business: strong cash flows, respectable profits (<a href="http://www.afr.com/business/health/hospitals-and-gps/sonic-healthcare-profit-falls-6pc-to-363m-20150817-gj1e6r">A$363 million</a> and <a href="http://www.investopedia.com/terms/e/ebitda.asp">EBITDA</a> of 20% for Sonic last year) and positive signs for future growth.</p>
<p>It is also useful to remember that pap smears and other tests are not a luxury. They are social rather than specifically individual costs; they should be publicly funded. </p>
<p>Last week’s Grattan report <a href="https://grattan.edu.au/report/blood-money-paying-for-pathology-services/">argued</a> there was scope for reducing costs to the taxpayer without compromising quality. The savings are estimated at A$175 million a year. This wouldn’t cause the collapse of the dominant players but might deter new entrants.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/113302/original/image-20160301-4105-15buhv6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/113302/original/image-20160301-4105-15buhv6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/113302/original/image-20160301-4105-15buhv6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/113302/original/image-20160301-4105-15buhv6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/113302/original/image-20160301-4105-15buhv6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/113302/original/image-20160301-4105-15buhv6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/113302/original/image-20160301-4105-15buhv6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pathology tests such as pap smears aren’t a luxury and should be publicly funded.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-284516642/stock-photo-consultant-discussing-test-results-with-patient.html?src=pp-same_model-284516711-_7dcKHs7M2l2BCEw5GkZjA-4&ws=1">Monkey Business Images/Shutterstock</a></span>
</figcaption>
</figure>
<p>An <a href="https://theconversation.com/can-medicare-sustain-the-health-of-our-ageing-population-49579">ageing</a> population and ongoing shift to high-tech medicine, especially in the treatment of some intractable conditions, mean we can look forward to more (although not necessarily better) tests in future. </p>
<p>Those tests are potentially clinically useful but, as importantly, are a reflection of defensive medicine. Clinicians will seek to comply with practice norms and minimise liability by ordering tests that provide clues to the treatment of complex conditions, or the adjustment of regimes involving multiple medications that potentially conflict with each other. </p>
<p>Treatment has moved on from the era when it was sufficient to prescribe only a single pill: we might now have a therapeutic regime involving medications for blood pressure, depression, diabetes, cancer and eczema.</p>
<h2>What do we want from the sector?</h2>
<p>For real reform in this sector, we first need to revisit the <a href="https://theconversation.com/harper-makes-case-for-competition-overhaul-experts-react-39582">Harper Review</a>, the experience of outsourcing in Victoria and the Department of Health’s 2011 pathology services discussion paper.</p>
<p>The ACCC should forbid further acquisitions by Sonic and Primary. Their shareholders will squeal; the government should stand firm, foster competition but take a more considered approach to bulk billing. </p>
<p>More inventively, the national and state/territory governments should take a hard-headed look at proposals for outsourcing (or privatisation) of pathology services that public hospitals provide. Privatisation is likely to both reduce overall costs and reinforce the oligopoly. </p>
<p>Will privatisation necessarily foster better public health and lower costs? We don’t know. It’s time for a Productivity Commission inquiry into the sector. </p>
<p>More broadly, we need an informed national discussion about pathology services and health priorities. These services are too important to be left to health and treasury department economists, lobbyists and the executives of the dominant service providers. </p>
<p>Health Minister Ley, in contrast to her predecessor, Peter Dutton, has made a useful start. So has the Grattan report. Now we need to think about markets, expectations and sharing.</p><img src="https://counter.theconversation.com/content/55140/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Baer Arnold does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The pathology sector in Australia is no longer a cottage industry. It is dominated by a handful of billion-dollar enterprises that analyse blood, tissue and other samples.Bruce Baer Arnold, Assistant Professor, School of Law, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/548342016-02-21T19:02:44Z2016-02-21T19:02:44ZBlood money: pathology cuts can reduce spending without compromising health<figure><img src="https://images.theconversation.com/files/112034/original/image-20160218-1264-hy6gi6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More than three in every four Medicare-billed pathology tests are analysed by one of two big corporations: Sonic Healthcare and Primary Health Care.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-371602273/stock-photo-nurse-collecting-a-blood-from-a-patient.html?src=0TcOiQ0DCgrrETgH0IhSXw-7-9">Soda_O2/Shutterstock</a></span></figcaption></figure><p>The <a href="http://www.budget.gov.au/2015-16/content/myefo/html/index.htm">Mid-Year Economic and Fiscal Outlook</a> (MYEFO) set the cat among the pathology pigeons late last year. One of the government’s flagged changes, estimated to save around A$100 million a year, was <a href="https://theconversation.com/myefo-2015-at-a-glance-52298">to abolish</a> the bulk-billing incentive Labor introduced in 2009. </p>
<p>The industry mobilised, threatening to charge consumers significant out-of-pocket co-payments for pathology tests for blood, tissue and other bodily fluids. The threatened increases were well in excess of the A$1.40 to A$3.40 cut to the bulk-billing incentive, which companies received for not charging patients out-of-pocket charges. </p>
<p>A campaign was organised, focusing on the <a href="http://www.mamamia.com.au/medicare-pap-smears-not-free/">increased cost of pap smears</a>. It included a <a href="https://www.change.org/p/health-minister-susan-ley-keep-pap-smears-and-pathology-services-free">petition</a> supported by more than 200,000 people. </p>
<p>Health Minister Sussan Ley escalated her rhetoric, pointing out that Medicare was not <a href="http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2016-ley001.htm">designed</a> to be a guaranteed bankable revenue for corporations, nor a taxpayer-funded payment to cross-subsidise pathology companies for other costs of doing business. </p>
<p>The minister noted:</p>
<blockquote>
<p>… complaints from stock exchange-listed pathology companies about this MYEFO decision have revolved around impacts on ‘shareholders’ – not patients – exposing what is really motivating these criticisms.</p>
</blockquote>
<p>The MYEFO-induced furore about bulk billing provides context for a wider “root and branch” review of pathology payments. As the Grattan Institute’s report, <a href="http://grattan.edu.au/home/health/">Blood Money</a>, published today, shows, there is money to be saved in pathology. This can be done in ways that don’t affect patient access to needed tests.</p>
<h2>Industry profit</h2>
<p>The Blood Money report addresses several questions. First, why is bulk billing on the agenda for pathology tests at all? All out-of-hospital pathology tests should be bulk-billed. </p>
<p>There should be no “incentive” for pathology corporations to bulk-bill. Rather, bulk-billing should be a requirement to participate in this market. </p>
<p>The place of co-payments in health care is highly contested. Those who argue for co-payments say they help to reduce demand, particularly for frivolous use of health care. </p>
<p>But consumers almost never initiate pathology services. Professionals order tests to assist them to make a diagnosis or to track a patient’s condition. In those circumstances, there is no theoretical argument to use financial disincentives for consumers, in the form of co-payments, to limit demand. </p>
<p>Industry consolidation and technological advances have completely reshaped the pathology industry over recent decades. But the way governments pay for pathology services hasn’t kept up. </p>
<p>Fee-for-service was originally a way for individual consumers to pay their medical practitioner for professional services. Health insurance then evolved to provide insurance for those costs. Medicare, when it was introduced, followed the same model. </p>
<p>But what was suitable for cottage-industry medical practice is not necessarily appropriate as a payment system for big corporations. More than three in every four Medicare-billed pathology tests are analysed by one of two big corporations: <a href="http://www.asx.com.au/asx/research/company.do#!/SHL">Sonic Healthcare</a> and <a href="http://www.asx.com.au/asx/research/company.do#!/PRy">Primary Health Care</a>. Both companies suffered a share price drop when the MYEFO cuts were announced.</p>
<p>Many parts of the pathology schedule are now highly automated. The large corporations benefit from economies of scale as the costs of an additional test to run through an analyser are trivial. But Medicare pays the same for the tests processed by the machine for the thousandth patient as it does for the first.</p>
<h2>Same service, lower costs</h2>
<p>A <a href="https://ama.com.au/sites/default/files/documents/Final_Discussion_Paper_Review_of_Pathology_Services_1_March_2011.pdf">2011 discussion paper</a> on pathology funding proposed that Medicare negotiate with providers to share the benefits of technological change by discounting the schedule for high volumes by, say, 5%. The Commonwealth Department of Health should dust off this paper and use it as a basis for proper commercial negotiations with the big pathology corporations. </p>
<p>The bulk-billing incentives should be in the mix as well. Serious negotiations of that kind would save taxpayers about A$175 million per year; A$100 million from bulk-billing incentives, the balance from a 5% trim.</p>
<p>The government should also consider going to tender for the right to bill Medicare for out-of-hospital pathology. In other words, companies would bid to be involved in the out-of-hospital pathology market by offering to provide tests at particular prices. </p>
<p>The tender specification might incorporate provisions that the price to be paid by government goes down after a particular number of tests is performed. </p>
<p>A pilot scheme of tendering should be established in Victoria for 2017, with the scheme allowing for multiple successful winning bids to ensure continued competition in the pathology marketplace. Tenders could be rolled out in other states after an evaluation of the Victorian experience.</p>
<p>Tendering should generate greater savings than the 5% trim. </p>
<p>Tendering introduces price competition into the pathology market. Rather than companies responding to a government-regulated price, they would have to specify the prices at which they think they can operate. If a company bids at too high a price, they may not be among the group of successful tenderers. </p>
<p>The <a href="https://ama.com.au/sites/default/files/documents/Final_Discussion_Paper_Review_of_Pathology_Services_1_March_2011.pdf">2011 pathology discussion paper notes</a> strong savings from other departments tendering pathology services: </p>
<ul>
<li><p>Victoria has tendered out most of its regional
public pathology services for more than 20 years. Negotiated prices are 65-75% of Medicare fees, equating to a 10-20% saving.</p></li>
<li><p>Defence tendered pathology services for military personnel. It settled at 80% of Medicare fees, without patient initiation fees. This was equivalent to a 5% discount. </p></li>
</ul>
<p>Neither paid the equivalent of a bulk-billing incentive. Further savings, on top of a negotiated trim, could therefore be achievable.</p>
<p>There are savings to be made in pathology payments and they should come from narrowing the margins of profitable corporations, not from cutting services to the ill and vulnerable. </p>
<p>In a time of increasing deficits, the government must prioritise reforms that reduce spending without compromising the health of Australians. Pathology payment reform provides an opportunity to do this – an opportunity that should not be missed.</p><img src="https://counter.theconversation.com/content/54834/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Duckett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Industry consolidation and technological advances have completely reshaped the pathology industry over recent decades. But the way governments pay for pathology services hasn’t kept up.Stephen Duckett, Director, Health Program, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/255572014-04-16T05:19:10Z2014-04-16T05:19:10ZScreenagers face troubling addictions from an early age<figure><img src="https://images.theconversation.com/files/46465/original/57y3k2qy-1397562521.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Early exposure can lead to addiction.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/celinesphotographer/4751630027">Brit.</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>In 1997, Douglas Rushkoff boldly predicted the emergence a new caste of tech-literate adolescents. He argued that the children of his day would soon blossom into <a href="http://www.spikemagazine.com/0297rush.php">“screenagers”</a>, endowed with effortless advantages over their parents, having been raised from birth on a diet of computers and micro-chipped devices.</p>
<p>Fast-forward to 2014: the screenagers have come of age in a world ruled by Twitter and Candy Crush Saga. A substantial body of evidence addresses the ways in which media saturation shapes the identities of children and adolescents.</p>
<p>While there are clear benefits to maturing as a digital native, a number of experts are concerned about the physical and psychological health of our screenagers.</p>
<h2>The perils of media-immersion</h2>
<p>There are <a href="http://drmarkgriffiths.wordpress.com/2014/01/10/no-time-for-the-crime-excessive-adolescent-video-game-playing-social-networking-and-crime-reduction/">advantages of tech-literacy from an early age</a> such as gaining IT skills that will serve you well in the future but there are risks too.</p>
<p>Aside from the dangers of social isolation and physical inactivity, there are also dangers that come not directly from any IT medium itself, but what happens when children are exposed to them. The ability to access pornography or gamble online throws up all kinds of issues when children are involved. </p>
<p>Particularly insidious are “foot-in-the-door” products which, combined with big data marketing techniques, specifically target adolescents and stimulate pathological behaviour. For example, a number of free Facebook games, including Zynga Poker and Slotomania, <a href="http://www.rightcasino.com/news/mark-griffiths-social-gambling/">normalise gambling</a> and divorce the thrill of playing from the consequences of losing. The player gets to experience the highs of winning but because there is no money involved, they don’t suffer any real life consequences when they lose. This poses a major risk and could lead to problem gambling in adolescence.</p>
<p>Other freemium app and internet games also carry a risk factor for pathological behaviour. So-called “casual games” such as Flappy Bird, Bejeweled and Candy Crush Saga use <a href="https://theconversation.com/flappy-bird-obsession-is-not-necessarily-an-addiction-22638">behavioural conditioning techniques</a> to keep players invested for long stretches, which may inhibit the <a href="While%20the%20advantages%20of%20internet%20use%20far%20outweigh%20the%20disadvantages,%20children%20and%20adolescents%20need%20educating%20about%20the%20potential%20risks%20of%20excessive%20risks%20and%20life%20online">social development</a> of youngsters.</p>
<p>And even if we don’t buy into the moral panic so often spread by the media, there is evidence to suggest that sustained access to pornography can have detrimental effects on young people.</p>
<p>Mental health website <a href="http://psychcentral.com/lib/teens-and-internet-pornography/0002812">Psych Central</a> reports that not only is pornography easy to stumble across online (with search terms like “toy” often throwing up adult images) repeated exposure can be over-stimulating and potentially addictive for young people.</p>
<p>According to the site, “Cybersex addiction functions in a similar way to any other addiction, leading to a cycle of preoccupation, compulsion, acting out, isolation, self-absorption, shame and depression as well as distorted views of real relationships and intimacy.”</p>
<p>Most susceptible to compulsive porn viewing are teens with limited parental support, which also correlates with unsupervised web access.</p>
<h2>New addictions</h2>
<p>While the addictiveness of certain activities is reasonably well established, the more general concept of “media addiction” in young people is harder to pin down.</p>
<p>For a start, it isn’t easy to <a href="http://drmarkgriffiths.wordpress.com/2011/11/29/behavioural-addictions-can-be-just-as-serious-as-drug-addictions/">define addiction</a> as it applies to any activity, even traditional problems such as gambling. So when it comes to new technologies and services, the picture becomes more confused. </p>
<p>It is tempting to discuss “media addiction” as a catch-all term for spending too much time online but there are so many opportunities for digital natives to engage in harmful activities that we ought to think in more detail about the problems that can arise for them.</p>
<p>While we might group people together as “Facebook addicts”, for example, there may well be a big difference between someone who spends an unhealthy amount of time growing virtual tomatoes on Farmville and another who might be pathologically engrossed in instant messaging.</p>
<h2>Starting young</h2>
<p>These phenomena are disconcerting enough on their own but we also need to address the fact that for today’s youngsters, the process of media immersion often begins in very early childhood.</p>
<p>Last year, campaign group Common Sense Media and electronics company VTech carried out a survey of <a href="http://www.commonsensemedia.org/research/zero-to-eight-childrens-media-use-in-america-2013/key-finding-1%3A-young-kids%27-mobile-access-dramatically-higher">1,463 parents with children aged under eight in the US</a> and found 75% had access to smart devices. This was up from 52% in 2011. This suggests that by the time they hit their teens, there is a high probability that young children will be active participants in global information networks.</p>
<p>Whereas children of the 1990s were raised on a diet of discontinuous digital media (MTV and 16-bit gaming), the next wave of screenagers will hold multiple social media accounts, exposing them to all the hazards this level of connectivity implies.</p>
<p>From underage users viewing gambling as a source of wealth to adolescents whose formative sexuality is filtered through internet porn, the influence of media-immersion on developing minds is disquieting.</p>
<p>One can only imagine the mental state of young people when a universe of information, temptations and perils can be carried around in their pocket. While it’s obvious that internet-use carries huge advantages for young people, they also need to be educated about the dangers before addictions develop.</p><img src="https://counter.theconversation.com/content/25557/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Mark Griffiths has received research funding from a wide range of organizations including the Economic and Social Research Council, the British Academy and the Responsibility in Gambling Trust. He has also carried out consultancy for numerous gaming companies in the area of social responsibility and responsible gaming.</span></em></p><p class="fine-print"><em><span>Joseph Attard does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In 1997, Douglas Rushkoff boldly predicted the emergence a new caste of tech-literate adolescents. He argued that the children of his day would soon blossom into “screenagers”, endowed with effortless…Joseph Attard, Film Studies PhD Researcher, King's College LondonMark Griffiths, Director of the International Gaming Research Unit and Professor of Gambling Studies, Nottingham Trent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/165942013-07-31T13:52:55Z2013-07-31T13:52:55ZPostcode lottery plays out in death as well as life<figure><img src="https://images.theconversation.com/files/28447/original/59yqxsbw-1375275880.jpg?ixlib=rb-1.1.0&rect=162%2C4%2C856%2C676&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We can't cheat death, but can it cheat us?</span> <span class="attribution"><span class="source">MTSOfan</span></span></figcaption></figure><p>Whether your death is reported to the coroner or not depends hugely on where you live (or died) and whether you are a man or a woman, as does the verdict on the cause of your death. </p>
<p>These were the <a href="http://jcp.bmj.com/content/early/2013/07/05/jclinpath-2013-201640.abstract">preliminary findings of a study</a> we conducted into death reporting to, and decision making by, coroners in England and Wales between 2001-2010.</p>
<h2>Reporting deaths to Coroners</h2>
<p>Not all deaths are reported to a coroner by a doctor. But there are a number of <a href="https://www.gov.uk/after-a-death/when-a-death-is-reported-to-a-coroner">reasons when they are</a>. These include when the cause of death is unknown;
the death was violent, unnatural, sudden or explained; or if the person who died wasn’t seen by the doctor who signed the medical certificate within 14 days before or after they died. </p>
<p>In the 1950’s, fewer than 20% of registered deaths were reported to a coroner. This figure is now 46%. And it varies significantly between regions. We found reporting rates ranged from 12% of registered deaths in one jurisdiction to 87% in another. </p>
<h2>Differences between jurisdictions</h2>
<p>Reporting rates were stable over the 10-year period we studied and there weren’t obvious geographical or demographic explanations for the variation. This means that differences must come down to a combination of local demography, a high number of suicides in a particular area for example, or local practice, where a coroner might favour a particular verdict over another.</p>
<p>Three quarters of the 114 coroner jurisdictions in England and Wales had death reporting rates of between 33% and 57%; 11 had less than 33% and 17 had reporting rates of 57% and above.</p>
<p>When these findings were placed on a map, there was an inverse relationship between geographically larger jurisdiction areas and lower reporting rates - so if you live in a larger urban area, rather than a more rural one, your death is more likely to be reported. </p>
<p>It’s unsurprising that highly populated areas should report more deaths, but population size doesn’t seem to make a difference to the rate (percentage) of reporting. For example, the two coroner jurisdictions with the highest populations - Essex & Thurrock and North London - had reporting rates of 36% to 59% respectively.</p>
<p>But the more deprived an area is, the higher the rate of reporting. This potentially throws up an interesting insight into health inequalities - this demographic is likely to be less well known to GPs, who are then less able to certify a death. </p>
<p>But it’s still not the full picture: significant differences were found between Blackburn and Manchester North, areas with similar levels of deprivation. </p>
<p>Potential links with crime rates are a current focus, such as whether reporting rates and the levels of gang violence and gun crime in an area are related.</p>
<h2>Inquest verdicts</h2>
<p><a href="http://www.yourrights.org.uk/yourrights/rights-of-the-bereaved/investigations-into-deaths/verdicts.shtml">Inquest verdicts</a> are another area with wide variation. The average post mortem rate for 2010 was 46%, but varied locally from 20% to 66%. What’s surprising is that in areas where a greater proportion of registered deaths were reported there were proportionately less post mortems.</p>
<p>Verdict types - for example, accident/misadventure or natural causes - also vary. For unnatural deaths, men were statistically over-represented in industrial disease and suicide verdicts while women were over-represented in narrative verdicts (where the coroner doesn’t reach a verdict but lays out the facts of the case) and accidents.</p>
<p>The variation suggests that verdict patterns are more a product of an individual coroner’s decision-making style than local patterns of death.</p>
<p>Even jurisdictions with similar overall case loads reported very different verdict profiles. Of course, there’s a link with reporting patterns. For example, a coroner who records fewer natural causes verdicts may be one whose guidance influences decisions by local doctors when certifying a death.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/28438/original/tjp6gghn-1375267812.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/28438/original/tjp6gghn-1375267812.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=350&fit=crop&dpr=1 600w, https://images.theconversation.com/files/28438/original/tjp6gghn-1375267812.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=350&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/28438/original/tjp6gghn-1375267812.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=350&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/28438/original/tjp6gghn-1375267812.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=440&fit=crop&dpr=1 754w, https://images.theconversation.com/files/28438/original/tjp6gghn-1375267812.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=440&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/28438/original/tjp6gghn-1375267812.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=440&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Share of the six main coroner verdicts in England and Wales in 2011.</span>
<span class="attribution"><span class="source">Jason Roach</span></span>
</figcaption>
</figure>
<h2>Is it a man thing?</h2>
<p>When we analysed data according to sex, just under a half (49%) of male deaths were reported to a coroner compared with 39% if female.</p>
<p>On average, a man’s death was 26% more likely to be reported to the coroner.</p>
<p>However, we mustn’t jump to any firm conclusions just yet. For example, since women die later than men, it would be crucial to know age-specific reporting rates, for which there is currently no readily available data. </p>
<p>It may also give us an insight into different health habits between men and women. For example it could be that many men don’t attend doctor’s surgeries on a regular basis so their recorded medical histories are considerably shorter and their cause of death possibly less certain. But we don’t know.</p>
<p>But gender differences continue. There were proportionately fewer inquests for women. For men, 16% of all deaths reported to coroners between 2001-2010 proceeded to inquest while for women that figure was 8%.</p>
<p>Once at inquest, verdicts of natural causes were recorded more often for women (28%) than for men (22%). So, fewer women were reported to the coroner, fewer women proceeded to inquest and fewer women at inquest were considered to have died unnaturally. </p>
<p>The analysis suggests that some coroners may be more “gendered” in their approach to inquest verdicts, that is they are consistently more likely to favour a particular verdict when dealing with a death.</p>
<p>These statistics provide us with an interesting snapshot of health. But to see the true picture we need to analyse further data on age, crime, and gender. It could be that further analysis throws up yet more information on the different health habits between men and women, or potential problems in the system that need to be addressed. </p><img src="https://counter.theconversation.com/content/16594/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Whether your death is reported to the coroner or not depends hugely on where you live (or died) and whether you are a man or a woman, as does the verdict on the cause of your death. These were the preliminary…Jason Roach, Reader in Crime and Policing, University of HuddersfieldMaxwell McLean, Former Detective Chief Superintendent and PhD Student, University of HuddersfieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/111082012-12-18T19:47:00Z2012-12-18T19:47:00ZQuestioning the pathology centre goldrush<figure><img src="https://images.theconversation.com/files/18644/original/4yfhrnnh-1355369516.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A deregulated pathology services industry is in the sights of the Federal Government.</span> <span class="attribution"><span class="source">Flickr/joebeone</span></span></figcaption></figure><p>The Australian Government is looking – very quietly – at <a href="https://theconversation.com/small-step-for-transparency-in-medicine-but-what-about-pathology-8767">pathology payola</a>.</p>
<p>Pathology services in Australia are big business, reflecting the shift from the days when your kindly family physician – the one who did house-calls in midwinter without complaint and omitted to charge the poor – placed a blood sample on a slide, peered into his microscope and invariably come up with the right diagnosis. In 2012 Dr Finlay and Dr Kildare are long gone.</p>
<p>Pathology is now a matter of multi-million dollar laboratories relying on economies of scale and drawing on samples provided by medical practices across a region or even a state. </p>
<p>Those practices may be large, for example involving 20 or more specialists and general practitioners, and may form part of multi-practice groups, which is what you’d expect in an era of increasingly corporatised medicine. They typically aren’t controlled by the pathology services. </p>
<p>Some of those services are overtly commercial, driven by “medical entrepreneurs” and private equity. Others generate substantial revenue but are badged as religious organisations and perceived as non-commercial.</p>
<p>The services rely on medical practices providing them with blood, tissue and other samples for testing. (Consumers typically can’t go direct to a testing service or specify that a medical practice sends that patient’s sample to a service of the consumer’s choice.) </p>
<p>The services compete in an oligopolistic market, seeking to persuade practices to supply samples on an ongoing and frequent basis, consistent with economies of sale. Practices typically affiliate with a specific service; a decision to switch from one service provider can result in job losses and lower share prices for listed providers. Persuasion is not necessarily because a particular service provider delivers more accurate results on a faster basis. (Rigorous technical accreditation means there’s consistency in service delivery.)</p>
<p>Affiliation instead reflects service providers offering incentives to the practices. Those incentives centre on leasing space within the practices. That space often consists of a square metre of carpet or reception counter. The payment for the space is, however, significant. In some practices it’s equivalent to leasing prime Tokyo real estate during the 1980s Japanese property bubble. Leasing costs are of course passed on to individual consumers and the taxpayer, given that pathology services are ultimately funded by public/private health insurance schemes and patients rather than by general practitioners and specialists. </p>
<p>Leasing for what the industry characterises as “collection centres” is a nice earner for the medical practices. Paying for collection centres is a cost of operating a major pathology service. In the absence of a prohibition by the Government the providers understandably keep paying the payola to the medical practices. Canberra is aware of the leasing payments through reporting by the pathology services but hasn’t acted.</p>
<p>The national government <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pathology-aboutus-index.htm">shapes</a> the pathology market by recognition of particular tests, <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/health-npaac-docs-apcc.htm">standards</a> and rules for the overall market. The service providers thus need to grapple with expectations about a commercial return on capital, the Australian Pathology Funding Agreement (<a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/Pathology">PFA</a>) and demands by practices for payment. </p>
<p>In 2010 the Government deregulated the number of collection centres that could be operated by any pathology service. The expectation was that deregulation would lead to greater competition and thus greater efficiency. Critics however forecast that costs would rise, with practitioners cashing in on a “collection centre land grab” or “gold rush” and the larger service providers reinforcing market dominance at the expense of smaller competitors. </p>
<p>Those fears appear to have been justified, with at least one entrant in Victoria (Pathology Services Pty Ltd) being bought out by an industry major. Deutsche Bank <a href="http://www.theaustralian.com.au/business/companies/deregulation-causes-bloodletting-among-small-pathology-players/story-fn91v9q3-1226129289925">estimated</a> margins fell by 20% after a 60% increase in the number of collection centres. Good news for practices, bad news for the overall health system.</p>
<p>There has been little publicity about the review, scheduled for completion in April next year. It involves the Treasury, Department of Health & Ageing, Department of Human Services, Department of Finance & Administration and non-government signatories to the PFA. </p>
<p>Commencement of the review has been marked by warnings from pathology service leaders such as <a href="http://www.afr.com/p/business/companies/hands_off_pathology_warns_bateman_XPxIMnHl3HNPBCJwAe1IUK">Ed Bateman</a> against further regulation. That’s presumably because re-regulation, as with any regulation, is perceived as bad in principle. It’s probably also because the leading businesses can cope with lower margins and are averse to the uncertainty or disruption associated with any change.</p>
<p>From a public policy perspective what’s disappointing about the review is the lack of information about what’s going on, reinforcing fears about regulatory capture. Australia’s ageing population means health costs will inevitably rise. The review is a lost opportunity for politicians, officials and industry figures to articulate how the health system works and why particular decisions are being made. </p>
<p>If nothing else, optimism about deregulation appears to have been misplaced. We should be asking hard questions about the performance of the people who authorised the land grab. They’re the same people who’ll be making other fundamental decisions about services in health markets. </p><img src="https://counter.theconversation.com/content/11108/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Baer Arnold does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Australian Government is looking – very quietly – at pathology payola. Pathology services in Australia are big business, reflecting the shift from the days when your kindly family physician – the one…Bruce Baer Arnold, Assistant Professor, School of Law, University of CanberraLicensed as Creative Commons – attribution, no derivatives.