May 30, 2008

The truth about diesel

Demand for diesel-powered cars is soaring. Australians bought more diesel cars in the first four months of this year than they did in the whole of 2005.

Sales this year are up 135 per cent on the same period last year and the latest figures show that almost 20 per cent of new vehicles sold this year are powered by diesel. In 2000, the figure was just 10 per cent.

However, the explosive growth is a double-edged sword.

The good news is that diesel-powered engines are more efficient than their petrol cousins and therefore emit less CO2 - the major contributor to global warming.

The bad news is that emissions from diesel engines are harmful to your health. That includes the latest generation of so-called "clean" diesels.

The Federal Government's Green Vehicle Guide, which ranks vehicles on their greenhouse gas and air pollution performance, doesn't have a single diesel vehicle in its top 50 list of low polluters.

Just one makes the top 150 and there are only five in the top 200 vehicles.

Jon Real, a spokesman for the Federal Department of Transport, which maintains the guide, says diesel cars are marked down because they have a "much more significant health effect".

He says diesels produce about the same amount of hydrocarbons as petrol but significantly more nitrogen oxides (NOx) - a precursor to smog - and particulate matter.

Air quality experts estimate that diesel engines produce particles at about 20 times the rate of petrol engines and it is those emissions that are bad for your health.

Particulate matter has been linked with thousands of deaths worldwide. Side effects range from cancer to respiratory and cardiovascular diseases. NOx have also been linked to serious health problems, including asthma, respiratory disease, infections and reduced lung function in children.

A recent NSW parliamentary inquiry into air quality found that motor vehicles produce 71 per cent of NOx emissions in Sydney and just under 20 per cent of particle pollution.

Real says particulate matter emissions carry a hefty weighting in the department's assessment of pollution effects from different vehicles. It's easy to see why.

The most recent figures from the Bureau of Transport and Regional Economics - for 2000 - put the annual death toll from vehicle exhaust pollution at between 900 and 2000 people - higher than the national road toll. It is also estimated to contribute to between 700 and 2050 asthma attacks in Australia each year.

May 29, 2008

Everyone wants to be agile

The last month I gave four public presentations with around 100-200 people each. I met with about twelve companies. At every occasion, I asked what really is new with agile. Here are typical unfiltered answers: "rapid iterations", "working software", "coping with change", "communication", "flexible", "adaptable", "eliminate waste", "accepting changes", "small iterations", "feature-driven", "continued integrations", "test driven development", "no documentation", "people before process", "adapt to change", "the name", "the team sets their own priority", "early stakeholder involvement".

An absolute majority, around 60%, said that agile is about iterations (or sprints to use the Scrum terminology). It is a bit disappointing that people don’t know that iterative development was introduced more than 25 years ago by Barry Boehm. He called it spiral development.

It is even more disappointing to hear that people think that Rational Unified Process (RUP) is not iterative, but based on the waterfall model. In fact, if you wanted to use RUP for waterfall development you would have to make a real effort to restructure RUP. We clearly said that everyone should move to iterations for the same reasons that people now like about agile: rapid, working software, change, flexible, risks, etc.

Given that around 60% think that agile is about iterations, and RUP was designed to support iterations, is RUP agile? My answer is that RUP can be applied in an agile way but RUP itself is not agile. Thus there need to be something more.

20% of the answers were about technical ideas such as feature-driven, test-driven, user stories, etc. However, none of these ideas would have created a revolution on their own.

10% of the answers were about light process -- light to understand, light to use and light on documentation. Now we start to come to the core of agile. I truly believe that in the past we have been too ambitious in describing process, in adopting too much process and in documentation. The reality is that even if people write a lot, very few people will ever read it. Thus the trend towards light will sustain. However, it is easy to be light. The trick is to be as light as possible but not lighter. I believe you will find our work on EssUP and EssWork new and fresh.

The last 10% were about how to work together daily, weekly, monthly, etc. It is about communication, people and teams, about how to organise teams, how to take decisions, how to protect the team from the outside. This is what we call social engineering. Agile has put the finger on the fact that we need highly motivated and competent people to be successful with software development. No process has ever developed software. It has always been done by people. We have of course always known this, but we have not pushed it as much. The focus on people is really what makes agile unique, and this is why agile originally broke through.

Now, it doesn’t really matter what people think agile is. Agile has become more of a philosophy. It appears that everything good is now agile. Thus it is not really easy to tell what agile is. However, one thing we know. Everyone will subscribe to being agile (as they should) so one day agile will go without saying.

Let me though make a cautious reservation. There is an obvious danger that as it continues, agile will be discredited because the concept is sometimes used as an excuse for doing shoddy work, for having no requirements, for developing whatever the developers feel like doing. This is not in the spirit of "true agility" but if it continues it will give agility a bad name.

Whatever happens we will one day get a new fashion. I can’t tell you what it will be but be sure of one thing: it will be smart, very smart.

Nick Higginbottom: Medical blunders injure one in 10

ONE in 10 public hospital patients has suffered a medical blunder, including having the wrong body part operated on and surgical instruments left inside them. In a report tabled in State Parliament, the Auditor-General yesterday slammed the Brumby Government for not properly monitoring medical mistakes, which cost taxpayers more than $500 million. Victoria is the only state in Australia that doesn't have a comprehensive monitoring system, and the report said it was unable to provide complete figures.

The Auditor-General's report Patient Safety in Public Hospitals estimated 135,000 patients had been exposed to medical mistakes, but concluded there could be more. Of these cases, 97 were labelled "sentinel events", which include "procedures involving the wrong patient or body part, retained instruments after surgery and death from a medication error". Health Minister Daniel Andrews said work had started on an appropriate monitoring system to be in place by 2010.

But Opposition health spokeswoman Helen Shardey said 2010 was too late for patients. "Despite a previous audit of patient safety in public hospitals in 2005 and a departmental review of quality and safety last year, there has been a distinct failure by the Government to implement all the recommendations," she said. Premier John Brumby yesterday defended the healthcare system and said it had improved in the key indicators of ulcers, superbug infections and deaths.

"That's not to say there aren't issues. We welcome the Auditor-General's report and we will be implementing his recommendations," he said.

May 24, 2008

ASIO chief urges business to look at IT security

Spy chief Paul O'Sullivan has urged business to assess its cyber security, saying individuals and nations are targeting the private sector in a bid to steal sensitive information.

"The widespread use of the internet in government and business presents opportunities for state agencies to gain covert access to information," Mr O'Sullivan told the Australia-Israel Chamber of Commerce in Sydney today.

"And a range of non-state actors - hackers, criminals and other foreign entities, acting independently or on behalf of groups, networks, or states - are engaged in nefarious cyber-activities, whether for profit, to cause damage, test for vulnerabilities or acquire sensitive information.

"Such actors are targeting business and government alike."

Mr O'Sullivan, the director-general of the Australian Security Intelligence Organisation (ASIO), warned the attacks were not always obvious.

He made particular mention of so-called trojan horse attacks where a seemingly innocuous piece of software is attached to an email and then makes its way into a computer network.

"The various IT-related devices - software, mobile phones, disks, thumb-drives, personal organisers, and so forth - all of which are now in common use - are also potential vectors for trojans.

May 23, 2008

Food for a rethink on allergies

AUSTRALIANS are the world's greatest hypochondriacs when it comes to food allergies, wrongly blaming their meals for everything from acne to headaches - and celebrities are often at fault, skin specialists said yesterday.

More than 10 per cent of adults claimed to suffer from some sort of food allergy, and most people blamed dairy and wheat for their ills, but less than 2 per cent had a true allergy, said Connie Katelaris, a professor of immunology and allergy at Campbelltown Hospital.

"These imagined food allergies are far more likely to be reported by women than by men," she said. "An individual often feels that they have control over their symptoms if they blame food."

Professor Katelaris, speaking at yesterday's annual scientific meeting of the Australasian College of Dermatologists, said most children grew out of their allergies by adulthood.

"About 97 per cent of those who had an allergy to dairy as children are no longer allergic as adults, while two-thirds of children grow out of their egg allergy and 20 per cent grow out of their allergy to peanuts."

A study of 250 doctors in Britain in 2006 found that 63 per cent had reported an increase in the number of patients claiming they had food allergies after the singers Geri Halliwell and Victoria Beckham and the actor Orlando Bloom announced they were sensitive to wheat and dairy products, while a poll of 1000 adults found more than 20 per cent had learnt of food intolerances and allergies from celebrity interviews, magazines and TV shows.

"I get quite frustrated by it," the secretary of the Australasian College of Dermatologists, Stephen Shumack, said yesterday. "People want to blame food for everything that is wrong with them when food allergies are actually very, very rare."

For those who really are allergic to certain foods, the tiniest amount can be life-threatening.

May 21, 2008

Alan Wood: Unbalanced remedy

WHATEVER the assertions to the contrary by Health Minister Nicola Roxon and Treasurer Wayne Swan, the unequivocal outcome of Labor's Medicare levy surcharge changes is to weaken the private health insurance system, raise premiums and increase pressure on the public health system.

Less clear is the extent to which Labor's ideological preference for the public health system will damage the private one. However, the Government's estimate that 485,000 Australians will drop their private health cover because of Labor's decision to substantially raise the income threshold for the Medicare surcharge looks like a serious underestimate.

The actual numbers seem likely to be more than 700,000 and could be significantly higher, and the consequences of the change riskier and more damaging than the Rudd Government appreciates.

Looking across the world, what is rare and valuable about Australia's healthcare system is the balance we have achieved, by a fortuitous combination of good luck and policy intent, between the public and private provision of health care.

The balance is a delicate one, and in the 1990s the private health insurance system that is at the heart of the private provision of hospital and medical services suffered a crisis that could easily have led to the unravelling of the system, as the proportion of the population taking out private health insurance steadily declined.

Failure of the private system would have meant a crisis in the public system, already unable to cope with the demands being made on it. It was avoided as a result of intervention by the Howard government.

The private system is supported by three policy props introduced at the time: a tax surcharge of 1 per cent on top of the Medicare levy for those who do not have private health insurance, a 30 per cent government rebate of premiums for those who do, and age rating that progressively increases private health insurance premiums for those who enter the system after age 30.

Australia's public health system guarantees the universal availability of hospital care for all Australians.

It is not free, being paid for by taxation, including the Medicare levy, but is widely regarded as free as its services are provided at an effective cost of zero.

This leads to excessive demand for public hospital services and, because price signals are suppressed, it operates like the old Soviet Union by rationing access via queuing. No feasible amount of public funding will change this.

A crucial part of improving its operation is competition, and co-operation, with private sector health providers. The private system provides choice and acts as a shock absorber for the public system.

The private health insurance sector operates on the principle of community rating. Community rating means the cross-subsidisation of the sick and injured by the healthy.

Australia's system is not pure community rating because of the introduction of age-related rating, with its steadily increasing penalty for those who want to come into the system after age 30. This penalty peaks at 70 per cent for people who enter the system at age 65.

So what is the likely impact on our mixed public-private health system of the Rudd Government's decision to raise the Medicare surcharge threshold from an annual income of $50,000 to $100,000 for singles and $150,000 for families?

According to economist Ian Harper - who heads the Fair Pay Commission, is head of the Melbourne Business School's Centre for Business and Public Policy and has studied Australia's private health sector - there is no doubt it will take away one of the important supports for the private system by undermining community rating.

Harper notes that those leaving the system will overwhelmingly be the young and healthy. This means that increasingly the private health insurance funds will be faced with the problem of adverse selection.

Those who remain will comprise a higher proportion of the elderly and seriously ill, who have the strongest incentive to buy private health insurance. These are the highest cost members for a health insurance fund, and as the mix of fund members shifts towards them, premiums must inevitably increase.

The rising cost of insurance then drives more people out of the fund, and a vicious circle can emerge.

According to figures from the Australian Health Insurance Association, the private industry lobby, a large number of households fall below the old $50,000 income threshold for the surcharge but have private health insurance. It estimates 27 per cent of households that have private insurance - adding up to about 2.3 million policy holders - have an annual income below $48,000, and more than one million have an income below $24,000.

These are predominantly elderly households and individuals, significant numbers of whom may be forced out of the private system by rising premiums. And the story doesn't end there.

The Government argues that a lot of those who will drop out are the young and healthy, who have taken out private health cover purely because of the tax advantage from avoiding the surcharge and getting the premium rebate, and have limited cover they rarely use. It says this means the pressures on the public system as a result of people dropping private insurance will not be great.

There undoubtedly are a lot of tax arbitrageurs in the private system. But, even if the Government is right, it means the private health insurance system will lose many of those who provide the cross-subsidy from the healthy to the ill that is the central element of community rating.

The result will be further pressure on premiums and more adverse selection, with the young and healthy getting a free ride at the expense of the elderly and ill.

I am not suggesting this will lead to a collapse of the system because the 30 per cent tax rebate and the age rating of health insurance are still in place to attract people into private health insurance.

But it is an undermining of the private element of a mixed public-private system that will have significant costs for the elderly and the ill, and in terms of the increased pressure on the public system.

The Government's answer - that it plans to throw a lot of taxpayers' money at the public system - isn't persuasive. It can never satisfy the demand for more and better health care and will have to tackle the hard issues, such as hospital closures, that were swept aside in the election campaign last year.

There is no doubt the more competitive the private system is, the better all round for Australia's future healthcare provision.

Alan Wood: Unbalanced remedy

WHATEVER the assertions to the contrary by Health Minister Nicola Roxon and Treasurer Wayne Swan, the unequivocal outcome of Labor's Medicare levy surcharge changes is to weaken the private health insurance system, raise premiums and increase pressure on the public health system.

Less clear is the extent to which Labor's ideological preference for the public health system will damage the private one. However, the Government's estimate that 485,000 Australians will drop their private health cover because of Labor's decision to substantially raise the income threshold for the Medicare surcharge looks like a serious underestimate.

The actual numbers seem likely to be more than 700,000 and could be significantly higher, and the consequences of the change riskier and more damaging than the Rudd Government appreciates.

Looking across the world, what is rare and valuable about Australia's healthcare system is the balance we have achieved, by a fortuitous combination of good luck and policy intent, between the public and private provision of health care.

The balance is a delicate one, and in the 1990s the private health insurance system that is at the heart of the private provision of hospital and medical services suffered a crisis that could easily have led to the unravelling of the system, as the proportion of the population taking out private health insurance steadily declined.

Failure of the private system would have meant a crisis in the public system, already unable to cope with the demands being made on it. It was avoided as a result of intervention by the Howard government.

The private system is supported by three policy props introduced at the time: a tax surcharge of 1 per cent on top of the Medicare levy for those who do not have private health insurance, a 30 per cent government rebate of premiums for those who do, and age rating that progressively increases private health insurance premiums for those who enter the system after age 30.

Australia's public health system guarantees the universal availability of hospital care for all Australians.

It is not free, being paid for by taxation, including the Medicare levy, but is widely regarded as free as its services are provided at an effective cost of zero.

This leads to excessive demand for public hospital services and, because price signals are suppressed, it operates like the old Soviet Union by rationing access via queuing. No feasible amount of public funding will change this.

A crucial part of improving its operation is competition, and co-operation, with private sector health providers. The private system provides choice and acts as a shock absorber for the public system.

The private health insurance sector operates on the principle of community rating. Community rating means the cross-subsidisation of the sick and injured by the healthy.

Australia's system is not pure community rating because of the introduction of age-related rating, with its steadily increasing penalty for those who want to come into the system after age 30. This penalty peaks at 70 per cent for people who enter the system at age 65.

So what is the likely impact on our mixed public-private health system of the Rudd Government's decision to raise the Medicare surcharge threshold from an annual income of $50,000 to $100,000 for singles and $150,000 for families?

According to economist Ian Harper - who heads the Fair Pay Commission, is head of the Melbourne Business School's Centre for Business and Public Policy and has studied Australia's private health sector - there is no doubt it will take away one of the important supports for the private system by undermining community rating.

Harper notes that those leaving the system will overwhelmingly be the young and healthy. This means that increasingly the private health insurance funds will be faced with the problem of adverse selection.

Those who remain will comprise a higher proportion of the elderly and seriously ill, who have the strongest incentive to buy private health insurance. These are the highest cost members for a health insurance fund, and as the mix of fund members shifts towards them, premiums must inevitably increase.

The rising cost of insurance then drives more people out of the fund, and a vicious circle can emerge.

According to figures from the Australian Health Insurance Association, the private industry lobby, a large number of households fall below the old $50,000 income threshold for the surcharge but have private health insurance. It estimates 27 per cent of households that have private insurance - adding up to about 2.3 million policy holders - have an annual income below $48,000, and more than one million have an income below $24,000.

These are predominantly elderly households and individuals, significant numbers of whom may be forced out of the private system by rising premiums. And the story doesn't end there.

The Government argues that a lot of those who will drop out are the young and healthy, who have taken out private health cover purely because of the tax advantage from avoiding the surcharge and getting the premium rebate, and have limited cover they rarely use. It says this means the pressures on the public system as a result of people dropping private insurance will not be great.

There undoubtedly are a lot of tax arbitrageurs in the private system. But, even if the Government is right, it means the private health insurance system will lose many of those who provide the cross-subsidy from the healthy to the ill that is the central element of community rating.

The result will be further pressure on premiums and more adverse selection, with the young and healthy getting a free ride at the expense of the elderly and ill.

I am not suggesting this will lead to a collapse of the system because the 30 per cent tax rebate and the age rating of health insurance are still in place to attract people into private health insurance.

But it is an undermining of the private element of a mixed public-private system that will have significant costs for the elderly and the ill, and in terms of the increased pressure on the public system.

The Government's answer - that it plans to throw a lot of taxpayers' money at the public system - isn't persuasive. It can never satisfy the demand for more and better health care and will have to tackle the hard issues, such as hospital closures, that were swept aside in the election campaign last year.

There is no doubt the more competitive the private system is, the better all round for Australia's future healthcare provision.

May 20, 2008

Paramedic accused of ambulance rape

A paramedic digitally raped a drug-affected young woman in the back of an ambulance then asked as she was lying on a hospital bed if they could catch up later, a court has heard.

Simon Paul Howe, 33, was one of two paramedics who attended to the woman in Little Collins Street after she was escorted out of the Bubble nightclub by staff.

He is standing trial in the County Court after pleading not guilty to digital rape and indecent assault alleged to have taken place in the ambulance on the way to the Royal Melbourne Hospital about 6am on November 5, 2006.

The woman, 23, who cannot be named, told the court she had snorted speed about 11.30pm the previous evening because "it wakes you up and gets you dancing" - but believed her drink was spiked with other drugs when she left it on a podium to hit the dancefloor with friends.

A blood test conducted by police after the woman reported the alleged rape revealed the presence of amphetamines (speed), methamphetamines (ice), and GHB in her blood. There were also traces of cannabis, which she admitted using a couple of days earlier.

Frugals show how to live the darn good life

FORGET the Fockers. Meet the Frugals.

This is the generation who were born in the 1920s and early 1930s and who are today aged over 76.

Unlike their consumerist and some say wastrel baby-boomer children, the Frugals are careful with their money.

In fact baby boomers love nothing more than one-upping each other with stories of how frugal their parents were.

And it's easy to see why the Frugals were so careful with their money. They were surrounded by catastrophe: their birth was preceded by the Great War and succeeded by the Great Depression.

These kids were hemmed in by disaster.

During their Depression-ravaged childhood the Frugals forged and honed the skills required to survive in a hostile world.

This training was put into good effect the following decade with the advent of war and war rationing.

Many Frugals were 30-something before their economic circumstances improved. But by then it was all too late; they were frugal by name and frugal by nature.

In an attempt to transfer Depression values into the hearts and minds of their baby-boomer children, the Frugals organised the handing down of clothes or mended them.

Socks were darned. Excuse me for a moment while I explain this novel concept to anyone born after 1980: to "darn" a sock means to patch it with a needle and woollen thread.

Get this, Generation Y, you don't throw stuff away because it's got a hole in it or because it's, like, totally unfashionable!

Frugals bought new clothes only when their old clothes could not be mended.

"Best" clothes were worn to church or on other special occasions.

All family members were drilled to turn off the light when leaving a room, not to save the environment from global warming but to save money.

The Frugals are our last link to the way Australia was before the advent of the modern consumer society.

Yet though many have accumulated a substantial asset base (centred on the family home), the Frugals remain quintessentially frugal.

The Frugals were never predisposed to the frippery of social groupings such as hippies, punks, dinks or yuppies.

Nor were the Frugals seduced by modern fads such as the boomer concept of jogging or the Gen-X invention of extreme sports.

Instead, the Frugals preferred spectator events such as the footy or the cricket.

It suited their lifestyle; why on earth would men who were hard at work with their bodies all day want to go jogging?

And that's why they also preferred meat and three veg for "tea" (meaning the evening meal) - salad and noodles just don't stick to the ribs of a working man. And all the better if topped off with jam roly-poly pudding for dessert.

Delicious.

Never into fashion, Frugal men wore their trousers where they were meant to be worn: just under the rib cage.

Frugal women invented the terry-towelling leisure suit in the 1970s and have ever since steadfastly refused to give it up.

Unlike their children, Frugals aren't motivated by money or status. They don't see the need to upgrade their appliances and they regard restaurants as outrageously expensive: "I could buy a week's groceries for the cost of one fancy-pants meal."

The one contribution that the Frugals have made to modern subculture is their invention of the life-form we now know and love as the grey nomad.

On retirement the Frugals hitched a caravan to their station wagon and "tootled off" around Australia. Isn't it odd: no other generation tootles anywhere.

Only Frugals tootle. Toot toot.

Baby boomers, on the other hand, were raised in less straitened times.

The good examples of thrift set by their parents were wasted on this lot.

After a brief flirtation with back-to-nature counter-culture in the early 1970s (perhaps inspired by their Sunbury rock concert camping experience) the boomers settled down and jumped on board the consumerist bandwagon.

And over the closing decades of the 20th century the Frugals looked on in disbelief as their baby-boomer children started buying 4WDs, building McMansions, taking lavish (meaning "aeroplane" as opposed to "caravan") holidays, and incessantly talking about investment properties.

Can these generations really have come from the same gene pool?

Apparently so. But just as the Frugals were born between great catastrophes, the boomers were born into an era of broadly rising prosperity.

So there you have the great boomer excuse for their rampant consumerism: "It's not our fault. The economy made us do it."

Australia's fast-dwindling Frugals are happy in retirement. They make little or no demand on the national budget because many (though by no means all) think they're rich on the pension.

Boomers, on the other hand, will not be so benign when they start retiring next decade. No matter how much money they have to retire on, it still won't be enough.

Stand by for the advent of the boomer-based "grumpy generation" in retirement.

And, unlike their Frugal parents, boomer retirees will have something to say about how they, as retirees, have been treated in each and every budget for two very long and very grumpy decades.

Home users want ISPs to do more, survey finds

AusCERT general manager, Graham Ingram, said the decision to conduct the survey reflects a significant increase in the targeting of client computers, such as home PCs in particular.

"We see the gap as being the client and home users and understanding the environment there," said Ingram. "We've change tack; our focus is now on the gap."

Conducted by Nielsen, the survey of 1001 adult representatives from all Australian States and Territories found that confidence is high among Australian Internet users when it comes to managing the security of their home PC.

68 percent of survey respondents said they were confident or very confident about the task.

However, further analysis found that many home Internet users do not fully understand the capabilities of security technologies, which may affect their confidence level.

For example, 46 percent held incorrect assumptions about what protection SSL provides online, which could give them a false sense of security about what they do online.

"When we talk about data in transit, SSL does provide very good protection," said Kathryn Kerr, AusCERT’s manager for analysis and assessments.

"But what alot of people do not realise is that if one of those computers in the communication is compromised, then the attacker can see what the user can see because the data is captured before it's encrypted," she said.

Meanwhile, 23 percent of 1001 surveyed admitted that their home PCs had been infected with malware.

Additionally, 71 percent of the malware victims were infected with one or two pieces of malware during the last 12 months, a trend likely to continue as malware volumes continue to double or triple year on year.

“With this information, we can focus more on areas where understanding is limited or poor and help better address those areas, while reinforcing the good security practices they already understand well," said Kerr.

She added: “For anyone in the business of raising awareness about security issues among home Internet users, the results are very useful."

Furthermore, the survey found that Internet users want ISPs to be more pro-active in helping them recover from computer attacks.

AusCERT's Graham Ingram noted that this result was both “surprising and pleasing because it means that home Internet users are supportive of a layered or defence in-depth approach to security.”

Surprisingly, home users don’t mind if their Internet service is disrupted in order to control a malicious attack.

Sixty-one percent support ISPs limiting their access to the Internet if the ISP became aware their computers had become infected with serious forms of malware.

“In these cases it is not in the home Internet users’ interests, nor the interests of the Internet community more generally to allow these computers to connect to the Internet until they have been repaired,” said Ingram.

“Users can only do so much, and sometimes even their best efforts fail. Hence it is helpful if ISPs are able to step in and, in a responsible way, limit users’ access to those web sites, such as Windows Update and others as appropriate, to allow them to recover without causing the home Internet users or others more harm," he said.

Finally, the survey found that 57 percent of people didn't use anti-phishing tools. Kerr said, "when we asked why, 33 percent of those didn't know what phishing was."

May 18, 2008

Voice recognition software can tell if you're chucking a sickie

Employers are turning to voice recognition software to crack down on unnecessary sick leave. Britain's Daily Mail reports that some companies are using a new generation of voice analysis systems to detect whether someone is lying when they call in sick. It said that a trial in north-west London, saved the borough of Harrow approximately £420,000 ($A871,000) in false benefit claims.

One of the systems currently being used is called Voice Risk Analysis, developed by a software company Digilog. Software listens to the caller's voice to detect changes that suggest they are under pressure or lying, and alerts the person taking the call.
It is estimated that nearly one in eight sick days are not genuine, costing the UK economy £13 billion ($A27 billion) a year.

According to an Australian Bureau of Statistics survey in 2003, the rate of absenteeism among workers in Australia, shows a marked difference between the public and private sector. During a two-week period, 9.5 per cent of public sector workers were off sick or injured from work, compared with 6.1 per cent of private sector workers.

Ambulance shake-up 'robs Peter to pay Paul'

A REVAMP of the state's ambulance services, touted as putting more paramedics on the road, will result in cuts to services in many parts of Melbourne, the ambulance union claims.

Minutes of a meeting of Metropolitan Ambulance Service managers, obtained by The Sunday Age, show that of the 16 mobile intensive care ambulance (MICA) units that now treat the city's most complex and demanding cases — such as shootings, stabbings and road trauma victims — 10 will either have their operating time halved to 12 hours a day or become a "single responder unit," staffed by one paramedic in a passenger vehicle. A full MICA unit usually is two paramedics and a stretcher vehicle.

The plan was outlined in a meeting of MICA team managers on April 23, the day after the State Government announced a $185.7 million boost to Victoria's ambulance services. That will fund new MICA units at Werribee, Boronia and Eltham North, and new single responder units at Nunawading, Chelsea and Hillside.

But the minutes of the meeting reveal the new services will come at the cost of service reductions at existing MICA units. The units in Brunswick, Prahran, Ivanhoe, Box Hill, Frankston, Dandenong, Laverton North and Bundoora will be replaced with single responder units, which will be based with regular ambulances, while MICA units in Clayton and Footscray will become "peak period" units that will operate only during the busiest 12 hours of the day.

Ambulance Employees Australia, which is negotiating with the Government over a new paramedics' enterprise bargaining agreement, said the Ringwood MICA unit would also be downgraded, resulting in a net loss of eight 24-hour MICA units from Melbourne.

"By spreading these single responders, they may reduce some response times, but we say it reduces service because you're reducing the potential of delivering the optimum level of care," said union general secretary Steve McGhie.

He said if working alone, MICA paramedics were unable to perform critical procedures such as rapid sequence induction, where a patient is placed in an induced coma and a tube placed down their throat.

One MICA paramedic, who declined to be identified, told The Sunday Age: "It's a false economy. What they need is a hospital, not a sedan. They're treating the clock and not the patient."

May 13, 2008

Hospital report card shows delays

A damning new report card on Victoria's hospitals shows failures in emergency treatment times and elective surgery. The Your Hospitals Report shows the state government failed to meet six of its nine key performance targets in the six months from July to December last year. While all patients needing resuscitation were treated on time in emergency departments, other urgent patients waited longer.

One in four category two patients, who may be in very severe pain, with severe breathing difficulties or major fractures, was made to wait longer than the desired time. One-third of the category three patients, with moderately severe blood loss or persistent vomiting, was made to wait too long. Urgent elective surgery patients were treated on time, but only 75 per cent of semi-urgent patients were seen in clinically appropriate times.

Also, hospitals were on bypass 3.7 per cent of the time, above the statewide target of three per cent. Victorian Health Minister Daniel Andrews said patient care was never compromised. He blamed larger-than-expected rises in patients presenting with flu or gastro over winter, as well as industrial action by nurses in October.

A step from Medicare to mediocre

THE Rudd Government is trumpeting that it has saved 2.4 million people from paying a Medicare surcharge. In fact, only 465,000 people paid the surcharge and each one of them could have avoided it by taking out private health insurance. If up to one million people now give up their private cover, as experts predict they will, Kevin Rudd will be directly responsible for a massive blow-out in public hospital waiting lists.

Sick people already wait for hours in public hospital emergency departments, despite the big increase in bulk-billing since 2003. Older people still wait months for elective surgery, despite a 16 per cent real increase in federal funding for state-run public hospitals under the present healthcare agreements. People tempted to thank Rudd for a tax cut won't be so grateful when they wait even longer for a hospital bed.

The Medicare surcharge is designed to ensure that people with higher incomes make a greater contribution to health costs. Fewer people covered by the surcharge means less money invested in the health system. At present, a family on $100,000 a year takes out private health insurance or pays an extra $1000 to Medicare. Most families in this situation have private insurance, which means that they don't compete with poorer people for elective surgery in public hospitals or can contribute to public hospital revenue by electing to be treated as private patients. Under the Rudd Government's announced changes, these families will have much less incentive to be privately insured.

Many will drop out, especially because they also face higher grocery and petrol prices and higher interest rates since the Government's election.

Health analyst Andrew Goodsall says the initial effect of the Government's changes could be that 400,000 people drop out of private health insurance. Because the dropouts will mostly be younger and less costly to treat, Goodsall expects a disproportionate drop in profitability, perhaps a 10 per cent hike in premiums, and one million people ultimately losing private health cover. As a result, not only will more people be totally reliant on overstretched public hospitals but there could be a cascading effect on the viability of the private health system, which has been painstakingly restored since 1996.

May 12, 2008

Arlene Weintraub: Physician, Reveal Thyself

A group of researchers at Duke University scoured more than 700 studies on heart stents published in medical journals over the course of a year, and were shocked to discover two huge omissions. First, 83% of the papers failed to disclose whether the authors were paid consultants for the companies that made the products they wrote about.

Perhaps more surprising, 72% of articles describing clinical trials and other research-related matters didn't identify who funded the research. The Duke paper, published May 7 in the online journal PLoS One, raises fresh questions about the ever-growing financial ties between doctors and companies, and the adequacy with which those relationships are communicated to the public.

Doctors who study drugs and medical devices often get financial support from the companies that make those products. It's a symbiotic and important partnership, especially as federal funding for medical research dries up (BusinessWeek, 5/8/08). But in the past few years, the medical community has become increasingly concerned that some physicians who author studies about products could be biased by the money they get from industry. That may prompt them to downplay dangerous side effects, critics say, or simply not publish studies that come to negative conclusions about experimental products.
Tougher Policies After Vioxx

In the wake of the controversy surrounding Vioxx—the Merck (MRK) arthritis pill that was pulled from the market in 2004 after it was linked to heart attacks and strokes—publications such as the New England Journal of Medicine and The Journal of the American Medical Assn. (JAMA) toughened policies requiring authors to disclose financial ties to industry. The idea was that such transparency would allow doctors, patients, regulators, and insurance companies to see the studies in light of their backers, and decide for themselves how serious the potential for bias might be.

But the Duke study suggests the quest for transparency has failed. Aside from the revelation that most authors are ignoring journals' disclosure rules, the study suggests the disclosures themselves may be suspect.

The researchers zeroed in on the 170 or so authors, out of a total of 2,985, who fulfilled their duty to disclose in the journal articles, which were published in 2006. By doing informal Internet searches, they discovered that some of the physicians who said they had no conflicts of interest in fact served on the advisory boards of companies that make stents. One person co-founded a stent company. (The Duke paper doesn't name individual doctors.) Of the 75 authors who disclosed relationships with companies, only two did so consistently; the rest named their corporate sponsors in some journals but not others.

Lead author Kevin Weinfurt of the Duke Clinical Research Institute says journal editors are as much to blame as authors are for the lack of transparency. "These journals should be doing better" at policing their disclosure rules, he says. "We hope this is a wake-up call."
The Companies Respond

Disclosure guidelines are set by the journals, and they're completely voluntary. Some federal legislators have proposed mandating a national database that would list all doctors' financial ties to companies, but so far those efforts have stalled.

The study also reveals just how deeply corporate interests have infiltrated medical research. The top funding sources named in the disclosures that the Duke researchers found were stentmakers Johnson & Johnson (JNJ), Boston Scientific (BSX), and Medtronic (MDT), as well as drugmakers Bristol-Myers Squibb (BMY) and Sanofi-Aventis (SNY). Those last two companies co-market the blood thinner Plavix, which is widely prescribed to stent patients.

May 10, 2008

Trick or treatment? The truth about homeopathy

Once upon a time, doctors had little patience with the claims made for alternative medicines. In recent years, however, the climate has changed dramatically. It is now politically correct to have an open mind about such matters; ‘the patient knows best’ or ‘it worked for me’ seem to be the new mantras.

While this may be a reasonable approach to some of the more plausible aspects of alternative medicine, such as herbal medicine, we believe it cannot apply across the board. Some of these ‘alternatives’ are based on obsolete or metaphysical concepts of human biology and physiology that have to be described as absurd. Proponents of such concepts will not subject their interventions to scientific scrutiny, suggesting that the mere attempt of critical evaluation is sufficient to chase the healing process away. An open mind, it is widely held, is an essential precondition for any scientific inquiry – yet we believe there are limits to this principle.
Homeopathy

Homeopathy is amongst the worst examples of faith-based medicine that wins shrill support from celebrities and other powerful lobbies in place of a genuine and humble wish to explore the limits of our knowledge using the scientific method. Homeopathy is based on the like-cures-like principle (‘Similia similibus curentur’) and the concept of the memory of water.

The like-cures-like principle holds that, if a substance causes certain symptoms in healthy volunteers (like onions cause a runny nose), then this substance constitutes an effective treatment for conditions associated with those symptoms – so, for example, a homeopathic remedy from onion cures a common cold. The second principle posits that serial dilution in combination with vigorous shaking of a substance (homeopaths call this ‘potentation’) does not render that substance less but more powerful. Thus the most ‘potent’ homeopathic medicines are so highly diluted that they do not contain a single molecule of the original substance. These axioms are not only out of line with scientific facts – they are also directly opposed to them. If homeopathy is correct, much of physics, chemistry and pharmacology must be incorrect.

To have an open mind about homeopathy or similarly implausible forms of alternative medicine – for example, Bach Flower remedies, iridology, spiritual healing or crystal therapy – is therefore not an option. After many years of considering these subjects, we have come to the conclusion that a belief in these forms of alternative medicine exceeds the tolerance of an open mind. We should start from the premise that homeopathy and similarly irrational treatments cannot work, and that, until proven otherwise, any positive evidence simply reflects publication bias or design flaws. If not, we must believe that water has a selective memory, recalling the 1x 10 molecule of the mother tincture in favour of the multitude of molecules that are likely to be present in concentrations orders of magnitude greater.

So far homeopathy has failed to demonstrate efficacy in independently replicated randomised clinical trials (RCTs) and systematic reviews of well-designed studies (1). Homeopathic physicians seem to clutch on to the straws of poorly designed or underpowered studies to retain their credibility, or they claim that the RCT is an inappropriate methodology to assess their belief system in the name of postmodern relativism (2). We are certain that no kind of evidence would persuade homeopathic evangelists of their self-delusion. Yet we challenge them to design a methodologically sound trial, which, if negative, should give rise to a serious debate about ending homeopathic treatments. This is not a double standard; both of us have been involved in studies that have challenged our favoured remedies and the practice of our specific disciplines.