$150,000cancerdrugthatsavedronwalkerapprovedforuseinaustraliaextranet.ama.com.au/sites/default/files/mediaclips/mediaclips...ref:...

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$150,000 cancer drug that saved Ron Walker approved for use in AustraliaAustralia has become the first country in theworld to register the cancer drug that formerMelbourne lord mayor Ron Walker creditswith saving his life. The Therapeutic GoodsAdministration has registered Keytruda fortreatment of patients with advanced melan-oma. The drug, which has not been listed onthe Pharmaceutical Benefits Scheme, is ex-

pected to cost about $150,000 a year. PeterMacCallum Cancer Centre’s Grant McArthursaid more than 1000 Australians battling ad-vanced melanoma each year could need thenew drug. ‘‘It is essential that these patientsare able to access Keytruda on the PBS assoon as possible,’’ Professor McArthur said.Australia has the highest rate of melanoma in

the world, with 31 people a day on averagediagnosed with the cancer. Clinical trials fun-ded by the manufacturer Merck found Key-truda was more effective than existing ad-vanced melanoma treatments. Results of thetrial, which involved 834 patients in 16 coun-tries were published this week in theNewEngland Journal ofMedicine. Craig Butt

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Companies, patient groups seek faster drug approvalDan Harrison

Patient groups are calling for

changes to fast track the approval

and subsidy of cancer medicines,

saying cancer sufferers haven’t got

time to wait for duplicate testing.

Consumer group Cancer Voices

Australia told a Senate inquiry

change was needed to ensure Aus-

tralians with cancer got the drugs

they needed in a timely manner.

‘‘Many of us can’t wait for the

years that our present approval

process takes, nor can we afford to

pay the full unsubsidised costs,’’

the organisation convener Sally

Crossing writes in its submission.

The group suggests Australia

make greater use of approvals by

trusted foreign regulators to speed

up access to medicines, and also

improve surveillance of drugs once

after they have reached the mar-

ket, to enable assessment of the

effectiveness of drugs in real life

use, as opposed to clinical trials.

In their submission, Cancer

Council Australia and the Clinical

Oncology Society of Australia ar-

gued evaluations between the

three bodies that consider new

drugs and medical services be bet-

ter co-ordinated to reduce delays.

It argued the Pharmaceutical

Benefits Advisory Committee,

which recommends which drugs

should be subsidised, needs to

adopt a more flexible approach to

evidence, and consider measures

other than survival data, such as

the response of a tumour to treat-

ment and the duration of time be-

fore the disease progresses.

‘‘Patients die waiting for longit-

udinal survival data to show a drug

is effective, even though other im-

portant evidence of efficacy has

been published,’’ the two organisa-

tions said in a joint submission.

The submission cited an analys-

is commissioned by the Cancer

Drugs Alliance, which showed the

average time between a cancer

medicine being approved by the

Therapeutic Goods Administra-

tion and it being listed on the Phar-

maceutical Benefits Scheme has

increased from 15 months to 31

months over the past decade.

In its submission, the Cancer

Drugs Alliance argued the ‘‘cost-

effectiveness criteria’’ used to de-

cide which medicines were subsid-

ised was out-dated and a newmod-

el should be adopted based on ‘‘an

assessment of value and quality’’.

Rare Cancers Australia ques-

tioned the relevance of the current

cost-effectiveness approach for

new medicines, which were in-

creasingly focused on small popu-

lations of patients.

‘‘The PBS has served Australia

NATAGE A009

well with its principle of ‘the

greatest good for the greatest

number’ but we need flexibility and

change if we are to expand its

reach to include the ‘greatest num-

ber of diseases’ be they rare or

common,’’ its submission says.

It said large clinical trials were

considered necessary to produce

quality evidence, butwith rare can-

cers it was often difficult to mount

trials on this scale.

The outgoing chair of the Phar-

maceutical Benefits Advisory

Committee, Suzanne Hill, told

Monday’s hearing the committee

was concerned that consumer per-

ceptions about the effectiveness of

many of the new drugs was not

supported by the evidence presen-

ted to the committee.

Many of us can’t waitfor the years that ourpresent approvalprocess takesCancer Voices Australia

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NSW wants GST on theagenda; Labor says no wayPhillip CooreyChief political correspondent

NSW Premier Mike Baird wants therate and coverage of the goods and ser-vices tax debated at a leaders' summitin July, but the Labor states ruled outbacking any change, casting doubt overplans to break the funding impasseover hospitals and schools.

While Mr Baird, a Liberal, told TheAustralian Financial Review that every-thing, GST included, should be on thetable at the retreat, the Labor states of

Queensland, Victoria and South Aus-tralia said other funding optionsshould be explored.

"Queensland under my leadershipdoes not support any change to thebase or rate of the GST, and if the issueis raised at future COAG meetings, menI will make that position crystal clear,"Queensland Premier ' AnnastaciaPalaszczuksaid.

Last Friday's Council of AustralianGovernments meeting in Canberrafailed to resolve the fight started at lastContinued p4

From page 1NSW wants GST onagenda; Labor says no

year's federal budget when the Abbottgovernment cut $80 billion from fund-ing for schools and hospitals over thenext decade, a move designed to forcean agreement on changing the GST.

Prime Minister Tony Abbott, thepremiers and the chief ministersagreed at Friday's meeting to a specialleaders' retreat in July.

They declared that partisan politicsshould be cast aside for the next 16months because there would be noelections - state or federal - in thatperiod, providing a rare windowdevoid of hot-house partisan issues.

But before a venue or date has evenbeen finalised for the summit, the GSToption has been killed off.

Spokespeople for the South Austra-lian and Victorian governmentsechoed Ms Palaszczuk's sentiment

Mr Baird, who has called previouslyfor changes to the GST to be con-sidered, urged his counterparts tomake it part of the agenda at theretreat

"The Federation and Tax ReformWhite Papers are an important oppor-tunity to rethink the way we do busi-ness, and nothing should be off thetable," he said.

At the same time, Mr Baird does notbelieve the overall tax burden on peo-

ple should be increased, meaning hewould consider a change to the GST aspart of a broader reform.

Any chance of a change of heartfrom die ALP took a further hit onMonday when federal OppositionLeader Bill Shorten launched a cam-paign "to keep cost of living front andcentre of the political debate".

"Labor does not support increasingthe GST, nor do we support extendingit to some of the everyday items whichAustralians currently depend upon. Iinclude fresh food but... I also includeschool fees that parents pay," he said.

"Labor does not believe that theanswer to Australia's economic futurelies on putting up taxes for Australianswho don't earn a lot of money."

The conundrum caused by the $80billion cuts has developed a sense of

urgency as the states prepare to handdown their budgets in coming months.The impact of the cuts will start to besevere in the later years of the four-yearbudget cycle, making it difficult to planin the short-to-medium term.

On Friday, Mr Abbott said there wasno urgency because the cuts would notreally start to bite for three years.

In last year's budget, the federal gov-ernment, claiming it did not have themoney to provide the funding, said thecuts were aimed at "generatingmomentum for longer-term reforms tobe considered in the white paper on thereform of the federation and the whitepaper on the reforms of Australia's taxsystem".

The federal government has the solepower to change the rate or base of theGST, but Mr Abbott has said repeatedlyhe will make no changes without thebipartisan approval at a state and fed-

eral level.South Australian Premier Jay

Weatherill is proposing the federal gov-ernment find the funding through suchmeasures as limiting superannuationtax concessions, taxing multinationalprofit shifters, applying the GST toonline media downloads and purchaseof low-value of goods from overseas,and implementing a "Buffett rule"which would place a 35 per cent min-imum income tax on people earningover $300,000 a year.

The Buffett rule is being promotedby die left-wing think-tank, The Aus-tralia Institute, and modelling shows itcould raise $2.5 billion a year.

The Federation andTax Reform WhitePapers are animportantopportunity torethink the way wedo business, andnothing should be offthe table.NSW Premier Mike Baird

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The members of Labor's Cost of Living Committee: Terri Butler, Bill Shorten and Senator Sam Dastyari. PHOTO: DOM LORRIMER

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Spike in complaints against doctorsBy Phillip Thomson

Complaints about ACT surgeons andGPs have risen 66 per cent in threeyears as public records name severalCanberra health professionals withrestrictions, reprimands or suspen-sions.

Records kept by Australia’s healthindustry watchdog show a total of166 complaints were made aboutCanberra medical practitioners in2013-14, compared with 100 in2011-12.

These figures did not includecomplaints about other health pro-fessionals, such as dentists or nur-ses.

Australian Health PractitionerRegulation Agency records showBelconnen general practitionerJanardhana Naidu Bobba has beensuspended from practising but, asper AHPRA procedure, no reason for

the suspension or details of wherecomplaints originated from havebeen published.

Dr Bobba could not be contactedfor comment.

The regulator’s website says theMedical Board of Australia couldsuspend a practitioner’s registrationif it believed there was serious risk tothe health and safety of the publicfrom the practitioner’s continuedpractice and it was necessary toprotect the public from that risk.

Dr Bobba had previously beenunder restrictions while working atthe Belconnen Medical Centre.

In February, The Canberra Timesreported the ACT Civil and Adminis-trative Tribunal reprimanded DrNathem Al-Naser, the owner of theBelconnen Medical Centre, after hefailed to report a doctor heemployed, Maged Khalil, for havinga sexual relationship with a patient

during Medicare-billed consulta-tions. Dr Khalil, suspended for ashort time in 2013, was nowregistered to practise with no restric-tions and was based in NSW, AHPRArecords showed.

Among the doctors with voluntaryrestrictions, otherwise known as‘‘undertakings’’, which still allowed adoctor to practise but under certainlimitations to protect the public, wasPeter Asirvatham Subramaniam.

Dr Subramaniam, whose principalsuburb of practice was listed as

ki b i d f i

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Deakin, must be supervised for sixmonths by a senior and experiencedcardiothoracic surgeon.

He must submit himself to re-views every three months untildeemed ‘‘fully competent to under-take open cardiac surgery with

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cardiopulmonary bypass, and the establish-ment and maintenance of cardioplegia’’,according to AHPRA. Dr Subramaniam, whocould not be contacted for comment, mustnot do cardiac surgery as the principalsurgeon where that surgery includes or mayinclude or involve open cardiac surgery withcardiopulmonary bypass and the establish-ment and maintenance of cardioplegia.

Cardioplegia means temporarily anddeliberately stopping activities related to theheart during cardiac surgery.

Another doctor with restrictions wasSyeda Tazeena Tausif.

Last October, The Canberra Times repor-ted Dr Tausif had been suspended butrecords showed she had since regained herability to practise after a legal victory in theACT Civil and Administrative Tribunal.

Investigations of Dr Tausif’s misconductrevealed she prescribed opioids to patients

without proper approval for a period be-tween 2011 and 2012. Restrictions on DrTausif stop her prescribing schedule eightmedications unless specifically approved inwriting by the Medical Board of Australia oruntil such time as restrictions were lifted.Schedule eight drugs are prescription medi-cines with additional restrictions to reducemisuse or dependence, according to theACT Government. She also was undersupervision.

‘‘While so restricted, the respondentshould not consult with patients withcomplex pain needs, substance abuse issuesor patients who are known to be aggressiveor demanding,’’ AHPRA said.

Dr Tausif’s clinical notes would be subjectto one random audit by the medical boardand then audits at six-month intervals.

AHPRA said all restrictions would be liftedfrom Dr Tausif within two years of theconditions being placed on her.

She did not comment when contacted.

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Father calls for inquiry into death of country vetBy Scott Hannaford

The father of well-known Canberraregion vet Dr Ella Ormes Lichacz iscalling for an inquiry into whetherthe diabetes medication she wastaking may have contributed to hersudden death in March.

Dr Ormes Lichacz’s death has sentshockwaves through the ruralcommunities she served in andaround the ACT from her base atHall, with many friends and familyleft reeling by the unexpected deathof the otherwise healthy 28-year-old.Dr Ormes Lichacz, a type 1 diabetic,was known for her extraordinarystrength and ability to manage hercondition, but was found convulsingand slipping into a diabetic coma onMarch 24.

Her father, Wieslaw Lichacz, saidgiven her extensive medical training

and successful track record inmanaging her condition sincechildhood, it was extremely unlikelyshe had failed to take the appropriatedose and an investigation wasneeded to determine if the

medication she was taking or thespecial insulin delivery pen playedany role in her death.

Mr Lichacz said his daughter’sLevemir flexpen had been foundbeside her bed, and he hadimmediately tested it and others inher vehicle and found the dosageadministered to be incorrect, withsome doses well under the numberof units dialled up. His results are yetto be verified by an official testingauthority.

‘‘I’m going to be requesting acoroner’s inquest, because she wasfine. She cooked a good dinner forour friends before she went to bed,I’ve seen security footage [from thevet practice] showing her lifting 60kgbags down the driveway, laughingand having a good time .. . it was anormal day,’’ Mr Lichacz said.

‘‘From my tests [the insulin pens]

were delivering 50-70 per cent of theinsulin they should have been, andthe one at her bedside actuallydelivered zero, five times.’’

He also had concerns that thepreservative in the slow-actingLevemir may have not functionedcorrectly, affecting the timing of theinsulin’s release.

d k f fNovo Nordisk, manufacturers ofthe Levemir flexpen, has announcedthe phase-out of the product in somecountries, to be replaced with anewer design known as theFlextouch, although the phase-outwas not related to safety concerns.

The Therapeutic GoodsAdministration has received 38reports of adverse events up toJanuary 16 this year associated withLevemir flexpens and one report ofthe device malfunctioning.

‘‘There have been no reports of

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Continued Page 2

death where the person was usingLevemir. The product has not beenrecalled in Australia and the producthas been replaced by the sponsor inthe United States with a new type ofdelivery system. There have been norecent recalls or alerts issued forinsulin pens,’’ a TGA spokespersonsaid.

Due to the risk of infection and herwork with sick animals, Dr OrmesLichacz had not been able to monitorher blood sugar levels by pricking herfingertips, but Mr Lichacz said shehad become extremely skilled atjudging when her levels were too lowor high and he did not believe shewould have misjudged her levels.

Fellow vet at Hall Jan Spate, whohad known Dr Ormes Lichacz for

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Wieslaw Lichacz, the father of Hall vet Dr Ella Ormes Lichacz, below, with his daughter’s horse Shahlima. Dr Ormes Lichacz slipped into a diabetic coma onMarch 24. Main photo: MATT BEDFORD

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more than a decade, said she shared theconcerns that the matter needed to beinvestigated further.

‘‘I’ve known her since she was 14, andshe has always managed it very well. Itseems wrong that someone with herknowledge of what was going on shouldhave that happen,’’ Dr Spate said.

‘‘Occasionally she’d come in afterworking all day and say, ‘I think I’ve gota bit of a low coming on’, you wouldn’tknow it to look at her, but she couldtell.

‘‘I’m a bit suspicious that the insulinwasn’t as good as it should have been, orthat it wasn’t giving the dose it shouldhave been. Yes it’s possible [that she gotit wrong] but I’d certainly like to see itinvestigated,’’ Dr Spate said.

A Novo Nordisk spokesperson said thecompany took its obligations to safety

extremely seriously and would fully co-operate with any coronial investigationinto the death. ‘‘The death of a youngwoman is a profoundly sad event, andour thoughts are with the family,’’ thespokesman said in a statement.

‘‘Novo Nordisk is committed to patientsafety and continuously monitors thesafety profiles of Levemir and FlexPen.Based on this monitoring, we have nogrounds to suspect that any of ourmarketed products would not functionas intended.’’ The spokesman said whilethe FlexTouch pens were being launchedin some countries in combination withnext generation insulin, they were notbeing launched in Australia at this time.

Mr Lichacz said he did not want toraise unnecessary alarm among otherdiabetics using Levemir.

‘‘But the important message is theyneed to check to make sure they aregetting the right dose,’’ he said.

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Dr Ormes Lichacz, who died in March, was known for her ability tomanage her diabetes.

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Delays atclinics cutit fine forflu seasonBy Henry Belot

Some northside residents arefacing waiting lists of up to sixweeks for vaccination appoint-ments at maternal and childhealth immunisation services.

The delays come as influenzaexperts warn that Canberrans haveonly six weeks to be vaccinateda g a i n s t i n f l u e n z a . T h egovernment-funded shot wasdelayed for modifications.

An ACT Health spokeswomansaid maternal and child healthservices were undertaking ‘‘a num-ber of strategies to address thecurrent waiting time on the north-side’’.

The northside nursing servicescan be accessed in Belconnen,Dickson, Florey, Gungahlin, Ngun-nawal and West Belconnen.

Influenza cases are known toincrease in June and peak in

h h l l l

August, which leaves little morethan a month before the beginningof the flu season.

‘‘The maternal and child healthimmunisation service is wellattended and this has led to longerwaits for appointments in thenorthside of Canberra [fourweeks], Gungahlin [six weeks]compared to just under a week onthe southside,’’ the spokeswomansaid. ‘‘Parents should plan theirchildren’s appointments well inadvance and keep these appoint-ments, especially for the whoop-ing cough vaccine, as childrenneed to keep up with their sched-uled vaccine dates.’’

On Monday, the government-funded influenza vaccine wasmade available under the NationalImmunisation Program after a rarechange to protect Australiansagainst a drift in the virus.

The southern hemisphere vac-i i h H N

cine now contains the H3N2strain, which led to a severeinfluenza season in the northernhemisphere and the late outbreakof influenza B in Europe.

Under the National Immunisa-tion Program the flu vaccine is freefor pregnant women, people agedover 65, Aboriginal and TorresStrait Islander people aged over 15,and anyone at serious risk.

There were almost 68,000 con-firmed cases of influenza through-out Australia last year comparedwith 28,312 in 2013 and 59,027 in2009. Dr Paul Van Buynder, adirector of the Influenza SpecialistGroup, said there were alreadymore influenza cases recorded thisyear than at this point in 2014.

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Ref:

Leaked report showsway forward in mental healthAustralia’s ‘system’ is weakest preciselywhere it should bestrongest, writes Sebastian Rosenberg.

TheReview intoMental

Health Services by the

NationalMentalHealth

Commission is the latest

addition tomore than 30 statutory

inquiries intomental health during

the past decade.

Rather than fixmental health,

Australia prefers to inquire into it.

Each inquiry confirms thatAustra-

lia’smental health systemcan best

be characterised as being in crisis.

Even this review, carefully crafted,

makes it clear that our approach to

mental health iswildly out of bal-

ance,with far toomany resources

directed to crisis response and far

too few to earlier intervention.

The focus of this reviewwas the

Commonwealth andwhat it could

do now to reformmental health

within existing funding. I amnot

sure this is tenable given thatmen-

tal health gets only about 5 per cent

of the total health budget but rep-

resents 13 per cent of the total bur-

den of disease.

However, the reviewdoes point

outwaste. One suggestionwas that

theCommonwealth redirect its fu-

ture funding away fromhospital

beds and towards community ser-

vices.Minister forHealth Sussan

Ley has already ruled this out and

someprofessional groups and oth-

ers have decried this as an attempt

to close beds. This is nonsense. A

national survey carried out in 2006

suggested that 43 per cent of all

hospital bedswere occupied by

peoplewhowould be better off in

other settings if those alternatives

were available.Wehave enough

beds already and in fact, resources

are beingwasted in this area.

The key pointmade by the re-

view is in relation to the stunted

nature of communitymental

health care inAustralia.We spend

only about a third the amount

spent inNewZealand on genuine

community-basedmental health

care. It is this type of care that is

critical toAustralia belatedly de-

veloping some alternatives to ex-

pensive and often traumatic

hospitalisation.

The review sets a target to in-

crease the rate of access tomental

health care by 10 per cent each

year. This is criticalwhen overall

rates of access to care are poor in

relation to the general community

and abysmal in relation to young

people.While 75 per cent of all

mental illnessmanifests before the

age of 25, according to theAustrali-

anBureau of Statistics, only 13 per

cent of youngmenwhohad amen-

tal illness last year got any help.

Australia’smental health ‘‘system’’

isweakest preciselywhere it

should be strongest.

The review considers theCom-

monwealth’s BetterAccess Pro-

gram,which is nowcostingmore

than $12million aweek and grow-

ing. It finds significant inequity and

maldistribution of services under

this programand calls for better

targeting. A greater role for re-

gional planning is recommended,

though this ismademore difficult

with the advent of largePrimary

HealthNetworks instead of the

smallerMedicare Locals.

Terrible recent reporting on sui-

cide highlightsAustralia’s failure

to reduce the rate of suicide and

attempted suicide during the past

decade. The review’s suggestion to

focus a new suicide prevention

strategy across 12 designated re-

gionswould be awelcome change

from the desultory approach taken

to date.

Importantly, themeasures sug-

gested in the review reflectmat-

ters of interest to consumers and

their families, not just service and

systemnumbers. Issues of hous-

ing, employment and quality of life

are critical and poorly reported

but are vital to understanding

what itmeans to havemental ill-

ness in 21st-centuryAustralia.

After the reviewwas initially

leaked,Minister Ley put out a

press release blaming the previous

Labor government and setting up a

range of new committees and ad-

visory bodies under theCouncil of

AustralianGovernments (CoAG).

Australia tried usingCoAG to fix

mental health in 2006.While new

investmentsweremade, each state

and federal jurisdiction had com-

plete autonomy.A set of notionally

agreed prioritieswas a veneer for a

reality inwhich every government

invested in different services and

priorities. This perpetuated a situ-

ation inwhich the quality, type and

quantity ofmental health services

available varieswildly depending

onwhere you live. This latest re-

viewhas confirmed this approach

is unfair and inefficient.

Resources are limited and inad-

equate. Australia’s approach to a

mental health system is a crisis-

driven patchwork.MoreCoAG

committees are not the answer.

Communities understand the

depth of this crisis. They knowhow

vulnerable families are. The solu-

tion lies in properly resourcing

sustainedmental health reforms

throughout every region inAustra-

lia. Now.

SebastianRosenberg is a seniorlecturer,Mental Health Policy, BrainandMindResearch Institute,University of Sydney.

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A NATION RIDING THE JUNKIE EXPRESS

CARLEENFROST

Iwas nine years old when my localstate member was shot twice in thechest and left to die in the drivewayof his suburban, red brick home.

The death of anti-drugs cru-sader John Newman was the begin-ning of the end for the heroin epidemicthat plagued Cabramatta for much ofthe ’90s. It was an era that many whoremain have forgiven but not forgot-ten. A time when baby-faced gangs ran

the streets, crime was at an all-timehigh and addicts were quite literallydying in front of shocked passers-by inbroad daylight.

Not even the town’s MP, among themost esteemed office holders in thestate, was safe.

But despite the tragedy that wasCabramatta, the upside of the heroinepidemic for the rest of Australia wasthat this problem was largely con-tained to one lonely suburb in south-western Sydney.

In fact, it was such a centralisedproblem that it even had its own train

service — affectionately known as the“junkie express” — where the lostsouls of society would rattle into Cab-ramatta specifically to score cheap,good quality “harry” in the John Streetmall and smack out under a tree in anearby park.

It took the good part of a decade forthe suburb to come out of the otherside of the tornado that was the heroinepidemic and be reborn as a culturalmecca, a heartland for foodies.

Now we have a new epidemic onour hands — the ice epidemic.

And the problem with the ice epi-demic is that it hasn’t been containedto one suburb, a region or even a state.

It’s taking young professionals inthe cities, factory workers in the sub-urbs and farmers out in the bush —right across the country.

And sadly it’s consuming our kids.Some as young as eight are becomingheavily addicted to ice and in someshocking cases being recruited to sell iton the streets.

Many believe it’s history repeatingitself but on a much, much larger scale.

Already the ice epidemic is being

touted as one that is way beyond any-thing we have seen before. It’s a drugthat is far more addictive than heroin,making its victims a great deal more vi-olent and aggressive.

And if history tells us anything, it’sgoing to take a lot more than a few

press conferences to put this fire out.Already we have seen commit-

ments from Prime Minster Tony Ab-bott and Premier Mike Baird to helpstop ice infiltrating the nation. But it’sgoing to take all levels of governmentto work together with health depart-ments, rehabilitation facilities and not-for-profit groups to stop themanufacture and sale of the drug andhelp addicts recover what’s left of theirlives, if anything.

Because rather than tarnish onetown, ice might just leave a scar on ourentire nation.

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Daily TelegraphTuesday 21/4/2015Page: 19Section: General NewsRegion: Sydney Circulation: 273,241Type: Capital City DailySize: 195.00 sq.cms.Frequency: MTWTFS-

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Drug companies and patientswant faster drug approvalDan Harrison

Patient groups are calling forchanges to fast track the approvaland subsidyof cancermedicines,saying cancer sufferers haven’t gottime towait for duplicate testing.

ConsumergroupCancerVoicesAustralia has told a Senate inquirythat changeswereneeded to ensureAustralianswith cancer got thedrugs theyneeded in a timelyman-ner. ‘‘Manyof us can’twait for theyears that our present approval pro-cess takes, nor canweafford to paythe full unsubsidised costs,’’ the or-ganisation’s convener, Sally Cross-ing,writes in its submission.

Thegroup suggestsAustraliamakegreater useof approvals bytrusted foreign regulators to speedupaccess tomedicines andalso im-prove surveillanceof drugs onceafter theyhave reached themarket,to enable assessment of the effect-iveness of drugs in real life use, asopposed to clinical trials.

TheCancer Council Australia andtheClinicalOncology Society of Aus-tralia arguedevaluations betweenthe threebodies that consider new

drugs andmedical services bebet-ter co-ordinated to reducedelays.

It argued thePharmaceutical Be-nefits AdvisoryCommittee,whichrecommendswhichdrugs should besubsidised, needs to adopt amoreflexible approach to evidence, andconsidermeasures other than sur-vival data, such as the responseof atumour to treatment and the timebefore thediseaseprogresses.

‘‘Patients diewaiting for long-itudinal survival data to showadrugis effective, even thoughother im-portant evidenceof efficacyhasbeenpublished,’’ the twoorganisa-tions said in a joint submission.

The submission said analysiscommissionedby theCancerDrugsAlliance showedaverage timebetweena cancermedicine beingapprovedby theTherapeuticGoods

Administration and it being listedonthePharmaceutical BenefitsSchemehasgrown from 15monthsto 31months in thepast decade.

TheCancerDrugsAlliance arguedthe ‘‘cost-effectiveness criteria’’used todecidewhichmedicineswere subsidisedwasout-dated andanewmodel should be adopted.

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Sydney Morning HeraldTuesday 21/4/2015Page: 7Section: General NewsRegion: Sydney Circulation: 114,634Type: Capital City DailySize: 138.00 sq.cms.Frequency: MTWTFS-

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Green light forlife-saving drug

1HERSD1 A007

Australia has become the first coun-try in theworld to register the can-cer drug that formerMelbourne lordmayorRonWalker creditswith sav-inghis life.

TheTherapeuticGoodsAdminis-trationhas registeredKeytruda fortreatment of patientswith advancedmelanoma. Thedrug,whichhas notbeen listedon thePharmaceuticalBenefits Scheme, is expected to costabout $150,000ayear. PeterMac-CallumCancerCentre’s GrantMcAr-thur saidmore than 1000Australi-ans battling advancedmelanomaeachyear could need thenewdrug.Australia has thehighest rate ofmelanoma in theworld,with 31 peo-ple a dayonaveragediagnosedwiththe cancer.

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Sydney Morning HeraldTuesday 21/4/2015Page: 7Section: General NewsRegion: Sydney Circulation: 114,634Type: Capital City DailySize: 44.00 sq.cms.Frequency: MTWTFS-

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Dowe love to have a beer with TonyAbbott?

WhenAustralians chewover a

pressing issue, nomatter

how serious or trivial, one

wordwill pop up sooner or

later. Be it domestic violence, intergenera-

tionalwelfare, racism, coward’s punches,

mental health, Indigenousdisadvantage,

homelessness, chronic disease or sporting

misbehaviour; the creativity of ourmusic,

art and literature; or our sense of humour

and sporting success: therewill be one com-

mondenominator in thedebate.Alcohol.

We shouldhardly be surprised, then, that

TonyAbbott has become the latestAustra-

lianprimeminister to skol a beer in public,

following the likes ofGoughWhitlam,Bob

HawkeandevenPaulKeating in anapo-

cryphal Labor electionposter claiming

‘‘leadership’’.

Somehavequestionedwhether it takes a

beer tomakeMrAbbottmorepalatable to

the averageperson.True, this nationhas

beendefinedbyothers – andhas often

defined itself – by the tolerance of alcohol.

Even theAnzac tradition is entwinedwith

alcohol, from the ‘‘gunfirebreakfast’’ that

often includes coffee lacedwith rum, to the

schooner or twowith oldmates after the

march to remember those lost, to thebeers

during two-upgames. Butwillmorepeople

be lured into binge-drinkingbecause ofMr

Abbott’s one-off drink amongagroupof

blokey footy players?

Not likely, unless youalso accept that

people drankmore light-beer shandies after

hehadone in 2010 or thatAustralians get up

at 4.30amto train for triathlons just to

followhis example.

There aremore important questions.

One iswhether it’s a bad look, especially

whenyoungboys see rolemodels linking

beer gameswith sporting success and,

notably,without necessarily any connection

withwomen.Another iswhetherMrAb-

bott’s approach to booze on this occasion

reduces the credibility ofwhat he – as

national leader andminister forwomen–

says about our alcohol culture.

Remember that nearly 28 per cent ofAus-

tralianmales over 18 drink enoughalcohol

everyday –more than two standarddrinks

– that their risk of alcohol-relateddiseases

suchas cancer andheart and liver disease

are tripled comparedwith thosewhodrink

less.About 10 per cent ofwomendrink at

this risky level, according to the latestNa-

tionalDrugStrategyHouseholdSurvey of

more than 28,000by theAustralian Insti-

tute ofHealth andWelfare.Alcohol, like it

was in thedays of rampantAustralianmate-

ship, to someextent remains at least in some

quarters an exclusivelymale thing.

AndwhileMrAbbott haswarned that

‘‘the bingedrinking culture . . . has become

all too prevalent amongyoungsters’’, his

government has also scrapped theAustrali-

anNational PreventiveHealthAgency amid

calls to stop taxpayer support for the

‘‘nanny state’’. Thegovernment also

stopped funding theAlcohol andDrugs

Council ofAustralia.

Instead,MrAbbott has urgedAustralians

to take greater personal responsibility.

After all, alcohol is legal and, subject to

limits onunderage drinking anddriving

under the influence, adults candecide for

themselves.

It is true thatmanydrinkers are respons-

ible for harming themselveswith alcohol.

But selfmedication formental health issues

is common too. So is peer pressure to drink

more.About eight in 10Australians drink

alcohol andweare rated in the top 20

nations as consumers of alcohol.

Crucially, heavydrinkers harmothers.

Families and children suffer. Communities

breakdown.Taxpayers subsidise thehealth

needs of drinkers aswell as their victims.

Society has aduty to step in to protect

those vulnerable to thedecisions of those

whoabuse alcohol. This is not nanny state-

ism. It is aboutmakingAustralia a place

wherehaving a fewdrinks ismostwelcome

but anti-social bingeing is not.

Fortunately, themessagemaybegetting

through.TheAIHWsurvey showsa statis-

tically significant reduction in lifetime risk

drinking amongmenandwomenbetween

2010 and2013.Measures of bingedrinking

amongmales and females aged 18-24have

dropped too.

Yet riskydrinking amongAustralians

over 40has changed little.One in 10Austra-

lians of all ages still drinks dangerously at

least once aweek.Andone in 12Australians

report being the victimof physical abuseby

someoneunder the influence of alcohol.

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Sydney Morning HeraldTuesday 21/4/2015Page: 16Section: EditorialsRegion: Sydney Circulation: 114,634Type: Capital City DailySize: 323.00 sq.cms.Frequency: MTWTFS-

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MrAbbott’s one-off beer-skollingwon’t

make theproblemanyworse.But hewould

dowell to take every opportunity to remind

Australians that a culture basedonboozy

blokes drinking to excess is not something

aboutwhichwe should boast or aproblem to

be treated lightly.

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Sydney Morning HeraldTuesday 21/4/2015Page: 16Section: EditorialsRegion: Sydney Circulation: 114,634Type: Capital City DailySize: 323.00 sq.cms.Frequency: MTWTFS-

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Push for aged-care tax reliefEXCLUSIVE

SID MAHERNATIONAL AFFAIRS EDITOR

Aged-care operators have askedstate governments for $653 mil-lion in payroll tax exemptions asthey seek to cover the effects ofcuts from last year’s federal bud-get.

The move comes amid fears inthe industry that investment re-turns are not big enough to backthe 76,000 extra aged-care bedsneeded by 2025 as an ageing popu-lation is expected to deliver asurge in the numbers of peopleneeding care.

Leading Age Services Australiachief executive Patrick Reid saidstates were being asked for con-cessions as they framed their bud-gets because the federalgovernment had cut the payrolltax offsets last year.

They had been granted in thepast to put the for-profit sector ona level playing field with the not-for-profit sector which is not re-quired to pay payroll tax.

But the federal governmentended the payment from Decem-ber 31, arguing payroll tax was inthe realm of the states and the sup-plement to aged-care operatorshad effectively been subsidisingthe states.

The move threatens to catch

the aged-care industry in anothertax battle between the states andthe federal government as pre-miers push Tony Abbott to restorehospitals and education funding.

Mr Reid said the industryneeded to attract $31 billion inextra investment over a decade tomeet the bed target.

“We are not going to reach thatinvestment level,’’ Mr Reid said.

His concerns are backed byPhilippa Lewis, chief executive ofSimavita, which provides techno-logy platforms to the aged-care in-dustry.

She said while more programs

were being put in place to keepageing people in their homes, thenumber of beds in aged-care facili-

ties would also need to rise dra-matically. “What people fail tounderstand about this whole issueof ageing is at the end of the daywhen you are very elderly, you willhave to often spend that last peri-od of your life in a facility so youcan’t stay home.”

“The extra beds in the systemwould not cover the demand,” shesaid.

Research prepared for LASAby the Centre for InternationalEconomics consultancy said thetax change had opened up an in-vestment gap in the for-profit sec-tor.

In NSW alone the number ofpeople aged 80 to 84 is forecast togrow by 3.8 per cent a year and the

number above 85 will grow by3.1 per cent to 2030.

The CIE report warns that thecost to NSW public hospitals ofaged people being diverted to ahospital bed rather than a residen-tial aged-care facility would be be-tween $10m and $30m a year.

Assistant Minister for SocialServices Mitch Fifield said thepayroll tax supplement had effec-tively been an uncapped, indirecttransfer of revenue from the Aus-tralian government to the statesand territories.

“Put differently, it was theequivalent of the Australian gov-ernment providing an exemptionto state and territory taxes.

“The level of government that

has responsibility for a particulartax base should have responsibil-ity not only for its application, butany exemptions, including thoserelating to issues of competitiveneutrality.”

The government was alsomoving to boost funding to en-courage new facilities.

He said from July 1 last year,newly built and significantly re-furbished residential aged-careservices attracted a higher level of

accommodation supplement paidfor residents with low means.

Since the supplement becameavailable on July 1 last year justover 200 services had applied andbeen approved for the higheraccommodation supplement.

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The AustralianTuesday 21/4/2015Page: 2Section: General NewsRegion: Australia Circulation: 104,774Type: NationalSize: 249.00 sq.cms.Frequency: MTWTF

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6WAYSTO DEAL WITHDEPRESSION AT WORK

In any given year, one million Australians suffer from depression, but for many their working life must go on regardless. David Smiedt discovers how to ease the burden

1FACE THE TRUTHWe all have crappy days at work, but depression can’t be

tackled unless it’s acknowledged. Beyondblue says depression is a combination of behaviour (such as a lack of productivity), feelings (such as lack of self-confidence), thoughts (“I’m really bad at my

job”) and physical symptoms (such as constant tiredness).

2TO TELL OR NOT TO TELLType the following address

into your browser and then bookmark it: headsup.org.au

This program is the result of the Federal Government’s Mentally Healthy Workplace Alliance, as undiagnosed depression leads to more than six million working days lost in Australia each year.

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Sunday TasmanianSunday 19/4/2015Page: 13Section: Body and SoulRegion: Hobart Circulation: 42,645Type: Capital City DailySize: 720.00 sq.cms.Frequency: ------S

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One of the most useful tools here is an interactive pro/con list, focusing on whether you should raise the issue of your depression at work. One pro is: “I’ve been missing deadlines and my work hasn’t been to my usual standard. I’d rather people knew about my condition than having them think I was slacking off – they’re more likely to be understanding.”

On the other hand, you may prefer to remain silent, due to a con such as: “I’m worried that my boss will think differently about my ability and potential, and it could affect my career prospects.”

Either way, it can help to have both sides of the debate presented in this way.

3FIND SOMEONE YOU TRUSTShould you decide to raise

the subject, there are myriad ways to do so. Many people find that having just one trusted colleague to rely on in tough times provides enough support. Others may prefer implementing a more formal approach through their company’s human resources department, or their manager. Bear in mind, though, that you can’t retract something once it’s said, and you don’t have to share your entire story. Often a rundown of your diagnosis and symptoms

will get the point across without you having to relay any traumatic experiences. It’s also a good idea to jot down how you’re going to describe your feelings, and why you’re sharing them before having this conversation, so you don’t panic in the moment.

4KNOW YOUR RIGHTSThe Heads Up program

says that if you’re suffering from depression, “your employer must

make changes, or ‘reasonable adjustments’ to support you, providing you’re able to carry out the core requirements of the job”.

With the diminishing stigma of mental health issues, it’s gradually being recognised that this is more than merely a legal obligation. On a purely business level, research by PricewaterhouseCoopers has found that for every dollar spent on creating a mentally healthy workplace, a company can expect $2.30 in benefits in return.

5TAKE RESPONSIBILITYChallenging depression in

the workplace – either on an individual or company-wide level – takes courage. And you’ll find it’s often contagious, with colleagues expressing support or revealing their own experiences. That said, while a company has some obligation to do the right thing by you (and others, because you’re almost certainly not alone), you have a role to play, too. Just speaking up isn’t enough. You need to think about what parts of the job you find most stressful, and how these can be tailored to your needs while allowing you to make a meaningful contribution.

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COMBAT STRESS

Stress is depression’s ugly cousin. By taking care of

the former at work, you can better manage the latter. To do this, be mindful

of your day by always taking a lunch break, during which you enjoy some green space,

and making healthy food choices. In the fight against workplace depression, it can also help to do exercise before or after work and to prioritise the day’s

tasks in the morning, rather

6

than responding to every email straight away.

SEEK COUNSEL Professional psychological counselling can be a major help for people who are dealing with depression. If arranged through your GP, a course of treatment sessions can be subsidised through Medicare (a session of 30-50 minutes costs from about $15 after the rebate). Some workplaces also offer free and confidential counselling services to their employees.

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