Pr int Post Approved PP 299436/00041

C a n b e r r a D o c t o r i s p r o u d l y b r o u g h t t o y o u b y t h e A C T A M A

Volume 19, No. 3

Exciting new opportunityfor medical practices!

The AMA ACT in associationwith AMA Victoria and EssetAustralia are pleased to announcethe introduction of a training pro-gram to improve the skills ofhealth support staff. They havecombined under the trainingname of “Health Training Solut-ions” to bring these approvedcourses to your staff.

The AMA ACT, AMAVictoria and Esset Australia (aRegistered Training Organis-ation) have combined to providethe Certificate II in Health Supp-ort Services (Health Adminis-tration) and Certificate III inHealth Support Services (HealthAdministration) as well as aCertificate IV in Health Admin-istration and a Diploma of Pract-ice Management. The courses aredesigned to assist all health sup-port staff work effectively in amodern health workplace.

Units are completed in arange of areas, including� Patient records� Infection control� Senior first aid� Medical accounts� Confidentiality and privacy� Manual handling

Flexible course deliveryoptions to suit the needs of staffand the workplace:� On the job at your preferred

workplace, with course train-ers visiting each participantto complete the courserequirements and ensuretransfer of skills to the work-place

� Optional one day workshopsat AMA House in Barton

� Comprehensive health spe-cific print materials and staffsupport strategiesThe Health Support Services

stream is anticipated to becomethe accredited career pathway

and industry standard formedical and health supportstaff.

The courses are avail-able as recognition path-ways, offering experiencedsupport staff recognitionfor skills and knowledgedeveloped over manyyears of services.

Esset Australia is anationally registeredtraining organisation(RTO) registered underthe Australian QualityTraining Framework. Asan RTO, Esset Australiahas been audited andmeets Australian Gov-ernment educationalstandards.

A new federal gov-ernment initiative meansthat practice staff mayhave the cost of aCertificate II in HealthSupport Services(Health Administrat-ion) met in full by aWork Skills voucher.

To be eligible staffmust be:� Australian citizens� Aged over 25 years� Without Year 12 or

a qualification ator aboveCertificate IIFor practice man-

agement and supportstaff the vouchersprovide funded sup-port for the opportu-nity to up-skill incore areas of practicesupport in areassuch as:� Infection control� Occupational

health and safe-ty

� First aid� Managing chal-

lenging behav-iours

We are streamliningthe process for obtaininga Work Skills Voucher sopractices are aware of staffeligibility for fundingbefore committing toenrolment. Staff will needto provide evidence of eli-gibility criteria. Esset willnotify the Department ofEducation, Science andTraining, which will posteligibile employees thevoucher to give to the RTOto pay for their course.

This means that eligiblepractice staff can enrol in aCertificate II at no cost tothemselves or the practice.Some units from aCertificate II can be creditedtowards a Certificate III. Staffwishing to complete theCertificate III may also b eli-gible for funding if they havenot participated in formallyaccredited vocational educa-tion programs, such as TAFEcourses, in the last sevenyears.

Interested in reducingyour risk by up-skilling yourstaff via our training pro-grams? Contact Elizabeth on6270 5410 for further infor-mation or visit www. ama-act.com.au

Ask about the discountcost to AMA members whenyou speak to Elizabeth!

ACT

IssueThis

The year's most exciting social event

– page 11

Train your practice staff with the AMA ACT

Woden 6282 2888 Deakin 6214 1900 Tuggeranong 6293 2922 Civic 6247 5478 A member of the I-Med Network

Dr Jeremy Price | Dr Iain Stewart | Dr Suet Wan Chen | Dr Malcolm Thomson | Dr Fred Lomas | Dr Paul Sullivan | Dr Ann Harvey | Dr Robert Greenough

Are your patients over 70 and suffer from Osteoporosis?NCDI Woden now offers a FULLY REBATABLE Bone Mineral Density test for ALL patients over 70

(This program is fully funded by the Medicare Bulk Billing system)

BMD patient information brochures will be delivered to your practice shortly.BMD appointments available at:

Woden, phone: 6282 2888

Important

information

regarding the 2007

specialist directory inside.

Has it really beenone year?

It is now 12 months sincemy ACT AMA presidency beganand I can reflect with some satis-faction on the achievements thatthe ACT AMA branch and itscouncillors have been able toachieve, including:� promoting a positive image

of our great profession viathe “Do you want to praiseyour Doctor” poster, theFamily Doctor Week, theCanberra Doctor Award, andthe Medical StudentLeadership Award

� promoting good communityhealth care via the HEROESschool campaign, smokingreduction, pandemic plan-ning, antenatal shared careguidelines, workers compen-sation arrangements, agedcare facility services, crema-tion certificates, End of Lifeand Powers of Attorneydraft legislation, singleexpert witnesses and tortlaw reform

� promoting member benefitsvia the ACT AMA card withlocal partner businesses

� ongoing core industrial cam-paigns such as the very suc-cessful VMO pay rise, andour recent expansion intothe hospital scene withdirect industrial representa-tion for staff specialists. Thiswill become increasingly sig-nificant in the forthcomingyear with new contractnegotiations and the needfor a fiercely independentvoice that is not afraid tospeak out against the hospi-tal bureaucracy. We also suc-cessfully intervened onbehalf of medical students towin reduced parking fees.

� ongoing government influ-ence via regular meetingswith ACT Health, the HealthMinister, and HospitalCEOs.

� ongoing promotion of gen-eral practice and workforceissues

� support of the MedicalBenevolent Association via aCocktail evening

Canberra Medical BallI am very pleased to

announce ACT AMA’s involve-

ment in the inaugural CanberraMedical Ball to be held onSaturday 30th June, in collabo-ration with Canberra MedicalSociety and Medical Women’sSociety. I would particularly liketo acknowledge the willing par-ticipation of the respectivePresidents Drs Caroline Lukeand Jane Twin. The eveninglooks set to be a great socialoccasion, so get your ticketsearly to avoid disappointment.

Employment issuesACT AMA is excited to

announce that it will soon com-mence courses to train adminpractice staff. There is moreinformation on this in this edi-tion. We have also presentedinformation sessions on theimpact of WorkChoices legisla-tion and about to run a seminarin partnership with MinterEllison Lawyers on “contractorsor employees” – WorkChoicesand the Independent Cont-ractors Act.

Federal issuesMedia releases have includ-

ed smoke free cars, national

bowel screening, banning ofduty free cigarettes, nationalanaphylaxis strategy, safe drink-ing water, genetically modifiedfood safety, government super-annuation ethical investing, andalcohol health warning labelling.

The AMA National Conf-erence will be held at the end ofMay in Melbourne with DrHaikerwall stepping down afterhis very productive two-yearpresidency. We all eagerly awaitthe vote for the new presidentand executive team, to what hasbecome the premier advocacylobby group in Australia.

The next yearThe Federal election is

looming and health is definitelya core issue. I continue to bekeen to see a no-fault long termcare scheme for the catastrophi-cally injured. I look forward tobuilding on the good work thathas already been done, andplease don’t hesitate to contactme if there are burning issues.

If you are interested in serv-ing on one of our committees,please contact Christine on 62705410. Only AMA members need

apply, though. Your contributionwill be most welcome and youcan influence health policy inthe Territory through serving ona committee as many of yourcolleagues do now.Aged CareCommunity and Public Health“Canberra Doctor” editorialMedico-Legal and EthicsDoctor in Training ForumGeneral Practice ForumTobacco Task ForceInternational Medical GraduatesForumSalaried Specialists ForumVMO Forum

Owners of small ormedium sized healthcarepractices, like any busi-ness owners, need toborrow funds for a vari-ety of specific reasons –to upgrade equipment,improve the waitingroom, or to finance thepurchase of practicepremises etc.

Sometimes you want to bor-row funds to cover day to daybusiness expenses such as insur-ance, software, stationery, asso-ciation and professional devel-opment fees. Often the costsinvolved in these smaller pur-chases are not planned for.

Line of creditBorrowing money for

unforeseen business expenses isa common way for practice own-ers to protect their personal cashreserves.

If you are experiencing thepressure of a tight cashflow orwant funds ready for futurecashflow needs, a line of creditmay be the solution.

The benefit of a line of cred-it is that it gives you an opportu-nity to plan ahead for unfore-seen expenses by arranging easyaccess to money that you mayneed in the future.

Medfin – an Australianleader in finance for healthcareprofessionals, offers a line ofcredit for busy practitioners –Med-e-credit. A Medfin Med-e-credit account is simple to setup, just discuss the funds youwish to place at call with yourMedfin Finance Specialist and

after the funds are approved,your account is ready for use.

Dip into funds as neededOnce your account is active

you can dip into the funds asneeded, up to the amount ofyour agreed limit. Funds do notneed to be used all at once – theycan be tapped into as required.

Medfin’s Med-e-credit boastsa competitive interest rate that isless expensive than most creditcards and overdraft facilities.And you only pay interest on theamount of money you havedrawn – not on the total limitthat is at your future disposal.Because your Med-e-creditaccount is for business purpos-es, interest payments are taxdeductible.

Med-e-credit customershave the flexibility to accesstheir funds according to their

preferred banking style. Theycan choose to speak to a cus-tomer service representative totransfer funds into their nomi-nated business account. Theyalso have the option of a tele-phone banking service andonline funds transfer.

With Medfin’s Med-e-credityou can save money with noannual fees. And you do notneed to offer security for thefacility – so your personal assets such as your family home or practice premises do not become entangled in the funds approval process.

If you need money up yoursleeve for future business expen-ses take a look into the productbenefits a line of credit facilityoffers.For more information on Medfin’sMed-e-credit contact your localMedfin Finance Specialist on1300 361 122.

ACT AMA President’s letter

Dr Andrew Foote.

2 Volume 19, No. 3

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3Volume 19, No. 3

In February 2006, I wrotean article about how the transi-tion to retirement rules, effec-tive from 1 July 2005, allowed amember to commence a super-annuation pension without hav-ing to retire. This was a flexibleand tax effective way to use yousuper fund at that point in time.Then came the May 2006 budg-et and the plan to simplifysuper. A key part of thesechanges was to eliminate tax onall benefits, lump sums and pen-sions, for those over 60.

From 1 July this year, forpeople still working beyond 55and particularly for those over60, the transition to retirementpension combined with salarysacrifice provides a significantopportunity. (From now on wewill call these pensions NCAP’sor “non-commutable allocatedpensions”.)

How does it work?The strategy works as follows:1) Salary sacrifice your wages

(for employed individuals)or make a deductible contri-bution (for self employed)up to $100,000 for thoseover 55 from 1/7/07

2) Commence a NCAP (up to10% p.a.) of the amount ofyour superannuationaccount (which will be taxfree for those over 60 from1/7/07)

The benefits are:1) Income tax savings:

Income/wages which wouldotherwise be taxed at yourmarginal tax rate (possibly ashigh as 46.5%) are beingtaxed as superannuationcontributions instead at 15%.

2) Pension income: As men-tioned, the pension incomewill not be taxed for thoseover 60 from 1/7/07. Forthose aged 55-60, the pen-sion income will be taxedbut will carry a 15% taxrebate.

3) Tax within the fundpayable by the trustee:The assets supporting thepension will also not betaxed where previouslythey were taxed at 15%.This tax saving is passedthrough to your memberaccount within the fund(for both DIY funds andpublic offer funds).

Is this too good to betrue?

A golden rule that hasserved financial advice providerswell when assessing risks is: “Ifit sounds too good to be true, isusually is!”. In this strategy youare effectively capping your topmarginal tax rate at 15%, as wellas eliminating tax within yoursuper fund. There is certainly anelement of “too good to be true”about this strategy. Let’s examinethe legislative risk:

ATO – media release NAT –2005/66: The ATO was asked toprovide comment on this strate-gy in Nov 2005. In this state-ment, the tax commissionerMichael Carmody, commented

“There has been some mediainterest recently in the promotionof this strategy. Arrangementsentered into in a straight forwardway are consistent with the oper-ation of the law, and we do not seegrounds for applying anti-avoid-ance rules.

“For example, an eligible per-son may take out a pension underthe transition to retirement rules.At the same time, that person mayengage in an effective salary sac-rifice arrangement and contributeto a complying superannuationfund for their own benefit.

“We would only be concernedwhere accessing the pension orundertaking the salary sacrificemay be artificial or contrived.”

It is important to note 2points:

1) This media release wasprior to the “plan to simplifysuperannuation”, and

2) The ATO has mentioned“artificial or contrived”arrangements withoutexplicitly detailing whatconstitutes such anarrangement.

Some comfortAnyone engaged in the

“plain vanilla” variety of thisstrategy as described in this arti-cle and in the media releaseabove, is almost certainly pro-tected by this statement. Forabsolute certainty a binding pri-vate ruling can be obtained.

If the ATO subsequentlychanges it’s view, (perhapsbecause of the changes in pen-sion taxation from 1 July),NCAP pensions are able berolled back into the accumula-tion stage of super at little or nocost.

The “transition to retire-ment” rules and the “plan tosimplify super” reforms havereceived overwhelming supportfrom both sides of government.The intent is to address the dras-tic underfunding of our retire-ment system as a result of popu-lation demographics and inade-quate current savings.

On that premise, it’s unlike-ly that strategies which encour-age use of superannuation willbe penalised.

More information The “plan to simplify super-

annuation” and the “transitionto retirement rules” are part of aconstant stream of changes tosuperannuation rules over thelast few years. Your adviser canhelp you understand what thechanges mean to you and canadvise you on the best course ofaction to suit your personal cir-cumstances. Copy supplied by Grant Alleyn,King Financial (see advert thispage)

A flexible (and now very tax effective)retirement

Assisting CanberraDoctors and their families too!The Medical Benevolent Association is an aid organisation which assists medical practitioners, their spouses and children during times of need.

The Association provides a counselling service andfinancial assistance and is available to every registeredmedical practitioner in NSW and the ACT.

The Association relies on donations to assist in caringfor the loved ones of your colleagues.

For further information please phone Mary Doughty on 02 9419 7062

There has been much mediainterest in this matter sinceProfessor Peter Collignon raisedthis matter in the public arena.There has also been a weigh-in tothe debate by water experts andpoliticians. The medical profes-sion has a unique opportunity tomake its views known and toadvocate caution on the basis ofpublic health impacts now andinto the future.

It is timely to report that theAMA Federal Council recentlyresolved:

The AMA recognises theimportance of safe drinkingwater for human health and sup-ports the recycling of water aslong as monitoring and rigoroustesting of the water is undertakento ensure its safety for humanconsumption.

That in light of this, allefforts must be made to reducedemand for water and encourageits more efficient and responsibleuse; and

That the AMA calls on allgovernments, councils andindustries to maximise their useof recycled water.

The AMA exists to, amongother things, promote andadvance the public health and itis both appropriate and timelythat this resolution be circulatedwidely in the light of the discus-sions being held in the ACT andgiven the contribution to thedebate by our own nationally andinternationally well-respectedauthority, Peter Collignon. Thehealth of the community dep-ends on informed, open androbust discussion before anypolitical decisions are taken.

In the light of the ongoingdrought conditions being experi-enced in Australia, this debate islikely to continue for some timeand it is important that for thehealth of us all that we get thisright. We would be pleased toconsider for publication any con-tribution you may wish to maketo this debate and influence thepolitical agenda, and we encour-age you to do so.

Following is a modified copyof the submission that PeterCollignon made to members ofthe ACT Legislative Assembly.

Peter Collignon, writes:Please note: These are my

personal views and do not neces-sarily reflect the opinions of theorganisations for whom I workor am associated. Many of thenecessary facts to have an in-formed public debate are surpris-ingly difficult to find (eg, envi-ronmental flows per year etc. Mysources for information and web-sites are given in the Postscript atthe conclusion of my article.

It is proposed in Canberra wewill recycle about 9 GL (9 billionlitres) of waste-water and thenpump this treated water backinto our reservoirs. It will then beused as part of our domesticwater supply, which includesdrinking water.

Removing sewage from our water was a significant public health improvement

One of our most significantpublic health improvements wasremoving sewage from watersupplies. Human waste containsnumerous viruses, bacteria, pro-tozoans and other microbes thatfrequently cause disease if ingest-ed. While our sewage will betreated so that it is “safe” todrink, the mechanisms beingproposed for this all have poten-tial problems with performance.Thus there is a strong possibilitythat at times we will contaminateour water supply with diseasecausing micro-organisms. Not necessary to recyclesewage in Canberra:unnecessary risk tohuman health

Worldwide there are locali-ties where there is no alternativebut to accept the risks associatedwith using recycled sewage.However, whenever possiblewhen we can avoid placing treat-ed sewage into drinking waterthis is hazard obviously desirableto avoid. In Canberra there is noreason to take this risk. The ACThas large volumes of unusedwater. Indeed it is a very large netexporter of water to NSW (onaverage about 471 GL per year).We also currently have one of thebest water supplies from a safetypoint of view in Australia (andprobably worldwide). Currentlyno human sewage enters ourdrinking water in our catch-ments. We are also very fortunate(and unique) in that minimaldomestic animal waste enters thewater supply because few farmsare in our catchments. Most ofour current Canberra water isgood enough to bottle! Can we make sewage“safe”?

A number of methods arepurposed to make this recycledsewage “safe” but how many sys-tems work perfectly all the time?If membrane technology is used,how can we be sure that thesemembranes will be able toaccommodate the planned 24million litres of recycled waterthat they need to filter each day?

How will we know when thereare small tears in parts of themembranes? Bacteria are verysmall and unless the pore size ofthese membranes is < 0.2microns it is unlikely that all bac-teria will be removed. However ifthe pore size is so small, I find itdifficult to see how these mem-branes can satisfactorily workwithout being frequently blockedby larger waste material. Even ifsuch small pore sizes are used,this will still not remove viruses,which are much smaller.Membranes will also not removedrugs passed in urine and faecesthat are not broken down (suchas oestrogens).

A “reverse osmosis” processis also going to be used. But thereis a lack of details available toCanberra residents to see howeffective this system (which alsohas very high energy require-ments) may be in removing allviruses (and drugs). Ultravioletlight will also be used as an addi-tional sterilising agent. Howeverthis is far from an ideal disinfec-tant. There are many issues suchas time of exposure, susceptiblyof different microbes etc, for it towork. How can we be sure thatthis can handle 24 million litresof waste-water per day?

Safety monitoring is planned,presumably by culturing thewater and looking at coliformcounts. If coliforms (eg E. coli)are present in the treated waterthis implies faecal contamination(and thus a failure of the system).However, this type of monitoringhas problems. Around the worldnumerous outbreaks with watercontaminated with viruses andCryptosporidiosis, have occurreddespite low or zero coliformcounts. In addition these indica-tor bacteria take 1 or 2 days togrow and identify. There does notappear to be a plan for storing 2or 3 days of recycled water in atemporary reservoir. Presumablythe water will be pumped direct-ly back into our dams after treat-ment. This will mean that evenwhen we detect a failure with ourtreatment system, there will belittle we can do about it becausethe contaminated water willalready be in our dams. Howoften will this coliform testing bedone? -every half hour, hourly,daily or just weekly? If pressuremonitoring is going to be themain method used to assess anysystem failure, how will we knowif only small tears in the reverseosmosis or filtrations membraneshave occurred?Why take this backward step? Other better options

In Canberra we do not needto recycle our waste-water backinto our drinking water supply.The current proposal is for ini-tially 9 GL of water per year to berecycled into our dams. On aver-age however about 120 GL peryear has been released from ourdams into the rivers as environ-

mental flows (46 GL) and asspills (75 GL). Spills are whendams overflow – which hasoccurred frequently, even indroughts, with the Cotter dambecause of is low storage capaci-ty. In 2006 (our worst year onrecord) we still had 13 Gl thateither overflowed or was releasedfrom the Cotter dam. Thisreleased water is relatively “pris-tine” from an infection point ofview. Why not find ways to with-hold 9 GL of this water? Is thisnot a better option than pumpinguphill, 9 GL of very expensivelytreated waste-water upstreaminto our reservoirs when we can-not be assured it will always befree of harmful microbes?

In February 2006, the ChiefMinister announced the start of atransfer scheme commencing inDecember 2006 of 12 GL peryear from the Cotter reservoirs tothe Googong Dam. “This Schemetakes water that would otherwisespill over our dam walls, andmakes it available for consump-tion in the Canberra region”.This amount is larger than theproposed 9 GL volume of recy-cled water. Can’t more waterfrom the Cotter dams be trans-ferred if we still have a shortageof water in the Googong dam?Given on average 75 GL of water“spills” per year from our dams,surely the amount transferredcould be increased to say 20 GLper year and avoid the costs andrisks of recycling sewage into ourwater supply.

This current proposal torecycle sewage also does notseem to make environmentalsense. Effectively this will be put-ting 9 GL less water into ourwaterways. This is because 9 GLof water will be pumped backinto our reservoirs instead ofbeing released into our rivers asoccurs currently. We could reme-dy this by letting an extra 9 GLout of our dams and into therivers. That however wouldeffectively mean that there is no

net increase in the water supplyfor human use. If we did that wewill have spent maybe $150 mil-lion or more to process andpump water back into our dams,just to let the same amount ofwater out again! It makes neitherenvironmental nor economicsense. Reverse osmosis and pum-ping water uphill also requiresvery large amounts of energy andthus needless extra greenhousegas production.

Nearly all of the water that isreleased from ACT Dams as envi-ronmental flows plus naturalflows, move into the Murrum-bidgee River where it is then cap-tured just over the border in theBurrinjuck Dam (capacity 1,025GL) near Yass. Nearly all thewater in the Burrinjuck Dam isfor irrigation purposes, when it islet out for downstream users.One of the major uses of thiswater is for rice cultivation. In2001 (Australian Bureau ofStatistics), 1,924 GL was used forrice production in NSW/ACT.There is no rice production in theACT, which means all this wateris being used further downstreamin the Murrumbidgee river sys-tem. If the rice growers downriver from Canberra decreasedtheir water usage by just 1%, thatwould mean that there would beanother 19 GL available for therivers. This is more than doublethe amount that is proposed to besaved by recycling our waste-water in Canberra. It does notappear to make sense to spendhuge amounts of money recy-cling waste water and puttingthis water back into ourCanberra drinking water, whenat the same time we are releasing“pristine” water from these samedams for environmental flowsespecially when this releasedwater is effectively being usedmainly for irrigation purposesdownstream to produce waterintensive crops such as rice.

Currently with our presentwater restrictions Canberra resi-dents and businesses extractaround 50 GL per year from ourdams (and if there are no waterrestrictions about 65 GL peryear). Of this water, about 35 Glis recycled back into our riversafter it goes through tertiarytreatment processes. ThusCanberra residents currentlyrecycle about 70% of the waterthey use (much higher than anyother capital city). We on average

4 Volume 19, No. 3

DisclaimerThe Australian Capital TerritoryBranch of the Australian MedicalAssociation Limited shall not beresponsible in any manner what-soever to any person who relies,in whole or in part, on the con-tents of this publication unlessauthorised in writing by it.The comments or conclusion setout in this publication are not nec-essarily approved or endorsed bythe Australian Capital TerritoryBranch of the Australian MedicalAssociation Limited.

Recycled sewage in our water supply; a needless human health

Professor Peter Collignon.

Cotter dam.

5Volume 19, No. 3

Born 3 November 1926 Died 28 February 2007

Below is an edited version of theeulogy delivered by Hugh’s son,Finn at his funeral service recently.

Hugh Pratt passed away sud-denly last week. His passing wasan enormous shock to all whoknew him. He was so youthful,so fit and energetic. He lived anincredibly full and enjoyable lifeover his 80 years.

Hugh was born on 3November 1926 in PalmerstonNorth in New Zealand.

At about age seven, Hughspent an afternoon listening toan international health and foodexpert. It changed him for lifeand had a significant impact onhis future family. From thatyoung age, Hugh swore off whitebread, white flour, white sugar,foods with artificial colouringsand preservatives, smoking, andmany other things we now knoware harmful.

Hugh attended school at StGeorge’s Preparatory School andWanganui Collegiate School. Herelated to his children that hisyouth was all study, rugby andfreezing showers. In the mid-1940s, Hugh studied arts, lawand medicine at the Universityof Otago.

During World War 2, Hughattempted to join the NewZealand armed forces. Theywould not accept him, as he was16. According to his father,Hugh was not to be denied a

chance for adventure and, in hislate teens, he up and ran awayto sea. He joined the merchantnavy and sailed the world.

In the late 1940s, Hughmade his way to Australia wherehe continued his medical studiesat the University of Sydney. Hemaintained a long relationshipwith Sydney Uni: he was a clini-cal lecturer there for many years.

While in Sydney, Hugh mar-ried the great love of his life, abeautiful Scottish lass namedHelen Docherty. They marriedin May of 1949 and were togeth-er until Helen’s death in 1994.They had three children, Keren,Finn and Bente.

Hugh was awarded his Bach-elor of Medicine and Bachelor ofSurgery from the University ofSydney and University of Otagoin 1952 and 1953. Hugh contin-ued his practise of medicine rightup until the morning of his pass-ing. His children always knewHugh would never retire.

He worked as a medical offi-cer at the Greta and BonegillaImmigration Hospitals and as amedical officer or medical direc-tor at a whole range of missions,consulates and embassies for 25years. These included the CocosIslands, Austria, Denmark,Sweden, the United Kingdom,Yugoslavia, France, Papua NewGuinea and Malaysia.

Hugh semi-settled down inCanberra in the mid-70s andpractised here for more than 30years. He was kind and gentle,

and loved helping people. Hedid have a cold stethoscope, Iam told.

This snap shot gives yousome idea of who Hugh Prattwas and what he was like.Personally, there were twothings about him I will alwaystreasure.

Hugh cared about peopleand went out of his way to helpthem whether professionally, as adoctor, or simply as a friend. Hewas always there for his family.

Looking back over HughPratt’s life, it is clear he lived itto the fullest extent possible. Hepursued his passions: medicineand travel; he contributed toAustralia’s development and thehealth of Canberra’s community– he made a difference; he wasan endearing character whotouched people’s lives; and hegave his family marvellousopportunities and supported usconstantly.Finn Pratt

VALE!Dr Hugh Bradbury Pratt

Dr Hugh Bradbury Pratt.

AMA President, Dr MukeshHaikerwal, said recently thatwar veterans would have im-proved access to general prac-tice medical services from 1May following the introductionof improved funding arrange-ments for the Local MedicalOfficer (LMO) scheme for vet-erans’ health care.

From 1 May, the Depart-ment of Veterans’ Affairs (DVA)will apply a single RepatriationMedical Fee Schedule for proce-dures and consultations.

In practical terms, thismeans that patients who seeGPs for specialist services suchas surgery and anaesthesia willnot be disadvantaged.

Up until now, the DVA Sch-edule has undervalued the roleof procedural GPs compared toother specialists when treatingveterans for the same care.

Dr Haikerwal said Depart-ment has responded to AMAconcerns about this anomaly by

moving quickly to ensure thatveterans treated by GPs aregiven better financial support.

“The increased funding willhelp keep GPs in the LMOScheme and may attract otherdoctors into the Scheme to pro-vide care for veterans.

“This decision is especiallysignificant for veteran patientsin rural areas, where rural GPsare often responsible for deliv-ering surgical care for veterans.

“The change builds on lastyear’s welcome funding boostfor veterans’ health care, whenthe major focus was on improv-ing access to specialist care.

“Now there is better accessto GP care as well.

“From May, there will alsobe more financial support forveteran consultations with GPs,further enhancing the value ofthe Gold Card for the many vet-erans who have served theircountry,” Dr Haikerwal said.

Veterans to getimproved access to GP care thanks to AMA

have inflows into our dams ofmore than 190 GL per year. Since2001 our inflows have beenseverely reduced to about a thirdof normal, however despite this,in every year except 2006, theinflows into our dams has stillexceeded 80 Gl per year (i.e.more than enough for ourdomestic consumption).

In my view this proposal torecycle sewage into our drinkingwater storage should not proceedin Canberra. Even during pro-longed droughts, we have hadample flows of much safer waterthat could be stored and used forhuman consumption. If we pro-ceed we will be creating a humanhealth hazard needlessly for ourpopulation at great financial costand without any obvious benefitsto our environment.Professor Peter Collignon Infectious Diseases Physician andMicrobiologistDirector Infectious Diseases Unitand Microbiology Department,The Canberra Hospital.Professor, School of ClinicalMedicine, Australian NationalUniversity.Postscript

The current total water availablein the ACT per year is 494 GL.Slightly more than half of this isreserved for environmental flows andjust under half (222 GL) is availablefor human usage if needed. In thepast the ACT has extracted 65 GL ofwater per year for human use but ofthis 35 GL is returned to the riversystem after processing. This meansthat there is a net usage of only 30 GL(of the 222 GL that is available forhuman use). In the last year (2006)our usage has dropped to 50 GL peryear, which means that the ACT isonly extracting 15 to 20 GL of water(this is the amount of water notreturned to the river system).

The ACT is a net exporter ofwater to NSW. On overage 368GL/year flows into the ACT fromNSW, via the Murrumbidgee River.However, 839 GL flows out of theACT, via the Murrumbidgee. Thismeans that the ACT exports 471 GLof water per year to NSW.

Large amounts of water arereleased from our dams each year asEnvironmental flows. On averagethis is 46 GL/year plus there isanother 75 GL/year that flows intothe rivers as spills. Thus currently onaverage the ACT from its reservoirsis putting 120 GL/year of water intoour rivers that could otherwise bestored in our dams (this is in com-parison to the net annual human useof water in ACT of about 20GL/year).

The ACT has storage capacity ifall the dams are full of about 200 GL.Currently about 50 GL/year is beingtaken out of that storage for humanuse (with 35 GL returned to therivers after processing). The averageannual environmental plus spillflows is 120 GL of which 45 GL is“released”. Between 50 to 65 GL ofwater is extracted for domestic con-sumption each year. Total about 100GL. Thus it appears that our damsreally only have about 2 years ofstorage capacity if full re theamounts on average that are current-ly released or used from the dams.

One of the major users of waterin Australia is rice cultivation. In2001 (Australian Bureau ofStatistics), 1,924 GL was used forrice production in NSW/ACT. Thenet use of water for human use peryear in Canberra for our 350,000people is 20GL. Thus one year’swater use for the rice productionthat occurs downstream fromCanberra is equal to 100 years use ofcurrent net domestic water use inCanberra.

The ACT is currently suffering amajor water inflow problem and anincrease in evaporation. However,there have been worse droughts thanis currently being experienced in theACT including the late 1800s, 1914,1944 and 1981-83. References and Sources

This source of information isreports from ACTEW 2004 Report,plus “The Need to Increase ACT’sWater Storage 2004 http://www.actew.com.au /FutureWaterOptions/Documents/assessmentReport.pdf

ActewAGL Water Facts and“Future Water Options for the ACTRegion in the 21st Century, http://www.actew.com.au/futurewaterop-tions/Reports.aspx

the Australian Bureau ofStatistics http://www.abs.gov.au/Ausstats/abs@.nsf/Previousproducts/4EB070C49861DA5DCA256F7200832FAE?opendocument

Burrinjuck Dam; http://www.tourism.net.au/articles/9051371

TRANSFER SCHEME LETSACT KEEP WATER OPTIONSOPEN. 15 February 2006. JonStanhope, Chief Minister, AustralianCapital Territory. http://www.chiefminister.act.gov.au/media.asp?id=24&media=1087&section=24&title=Media%20Release

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6 Volume 19, No. 3

eSHACT (Environment,Sustainability and HealthACT) is a group consist-ing of medical studentsfrom the ANU, academicstaff in medical researchand health professionalsin the ACT trying to pro-vide information to thehealth industry and med-ical professionals aboutthe ways they mightreduce their impact onthe environment in thework setting. You cannow visit the new web-site at www.eshact.net

The group was started by thefirst cohort of medical studentsto go through the ANU MedicalSchool and is run by medical stu-dents. It has two aims: � To Increase awareness about

effects of the environment onour health

� To reduce the effects of thehealth industry on our envi-ronmentThe website is the result of

hardwork by the students whichwill provide an easily accessiblesource of information for healthprofessionals about the environ-ment, sustainability and healthand medical student MadelaineHanson (ANUMS) will be pleas-ed to provide more information.

The launch was held recent-ly with Dr Helen Caldicott doing

the honours and featured speak-ers from the group and from thelocal indigenous community, aswell as a group of indigenousdancers.

Dr Caldicott received hermedical degree from theUniversity of Adelaide, shefounded the Cystic FibrosisClinic at the Adelaide Children'sHospital in 1975, was an instruc-tor in pediatrics at HarvardMedical School before resigningto work full time on the preven-tion of nuclear war.

Dr Caldicott co-founded thePhysicians for Social Respons-ibility in the USA, an organiza-tion of 23,000 doctors commit-ted to educating their colleaguesabout the dangers of nuclearpower, nuclear weapons andnuclear war and has helped startsimilar medical organizations inmany other countries. The inter-national umbrella group(International Physicians for thePrevention of Nuclear War) wonthe Nobel Peace Prize in 1985.She also founded the Women'sAction for Nuclear Disarma-ment. She is also the Founderand President of the NuclearPolicy Research Institute (NPRI).

Dr Caldicott has receivedmany prizes and awards for herwork, 19 honorary doctoraldegrees, and has been nominatedfor the Nobel Peace Prize. TheSmithsonian Institute has namedDr Caldicott as one of the mostinfluential women of the 20thCentury and she has been thesubject of several documentaries.She has written for five books,the most recent one is calledNuclear Power is Not the Answer(September 2006).

Dr Caldicott’s presentationoutlined the many adverse effects

that the health industry has onthe environment. She stated thatthe health sector is the secondbiggest emitter of greenhousegases in the built environmentafter commercial office buildings.

The contentious issue ofnuclear power came up as an ex-ample of how the environmentcan severely impact on our heal-th. Dr Caldicott went through thelifecycle of nuclear power fromthe mining of uranium to the out-flow of coolant from reactors.Every stage of the process wasshown to produce dangerousradiation. Dr Caldicott explainedto the audience made of up pri-marily of interested public, med-ical students and medical practi-tioners exactly how each radioac-tive isotope damages human tis-sues and DNA.

This medical science per-spective has been missing fromthe general media debate onnuclear power and is an exampleof the informed debate thateSHACT is trying to foster. Thewebsite is far from one-sidedthough. On the new websitethere is already an article writtenby ANU medical student HungTran opposing Dr Caldicott’spoint of view.

Other speakers included DrDavid Carpenter from ANUGreen and Mr Duncan Smithfrom the Wiradjuri Echos.

Dr Carpenter gave manyexamples of how the ANU is theleading university in Australia ifnot the world when it comes tosustainability.

The Wiradjuri Echos enter-tained the audience with indige-nous dancing and the uniquelyAustralia perspective of theeffects of the changing environ-ment on indigenous Australia.

eSHACT website launched by Dr Helen Caldicott

The Gift of GivingIt is an inherent giftthat we all, as humanbeings possess – thegift of giving. We giveclothes, food andmoney to those lessfortunate, and what wereceive in return issomething muchgreater, the knowledgethat somewhere, insomeone’s life, we havemade a difference. Onesuch difference mayhave been initiated bya recent decision ofmine in the rural townof Goulburn.

As a firm believer in worldpeace and equality, I havealways desired to sponsor achild. As a medical student liv-ing for the first time away fromhome, I now only have a taste ofthe financial burden life maypose. Another human being inneed, helpless in their owncommunity, cannot compare toany seemingly minor stresses Ihave faced in my lifetime. Thegift of money towards easingtheir afflictions of hunger anddisease was and is unfortunate-ly not an option for me.Unaware of the great good thatI could do, the donation ofmoney remained a distant wish.

In my eyes, blood donorsalways seemed so courageous,it was someone I never thoughtI would be, but always admired.Now, as a future medical profes-sional, I have come to the reali-sation that the gift of blood ismore than just admirable, it iscrucial. I learnt of this first handwhen I finally decided to donateblood during the second yearvisit to Goulburn, a decisionwhich would inevitably becomeroutine to me for the rest of myliving days.

A selfless act such as donat-ing blood should come naturalto a doctor, but does it? Shouldsuch a harmless moral act ofaltruism be compulsory for allmedical professionals? After all,the presence of certain infec-

tions exist as regulatory draw-backs to prohibit medical stu-dents from placing others atrisk within a medical facility.Are these limitations not thesame as those deferring blooddonors? Why has it proven sodifficult to recruit blood donorsin Australia? Why aren’t moreof these medical students orindeed medical professionals? Amere 469,000 donors currentlyexist in Australia, a numberwhich I highly doubt representsthose truly eligible. Thethought of such a simple proce-dure having the potential to aidin the treatment of cancer, heartdisease, burns and accident vic-tims, to name a few, is phenom-enal. Yet to become a qualifiedmedical practitioner, life-savingsurgery is currently not feasible,and so it seems the least I coulddo is donate a small part ofmyself I can survive without tothose who cannot.

Dating back to Hippocrates,ethical principles pertaining tomedical practice have shapedthe way in which doctors dealwith their patients. The modernrevision of this oath wasinevitable, as many actions for-bidden, including abortion andeuthanasia, have proved to besomewhat controversial. Thereis however little, if none at all,controversy associated withblood donation, with its bene-fits far outweighing any risks.The resources are plentiful,what is lacking remainsunknown. Is it an issue of self-ishness in giving away a“unique” entity of oneself? Oris it the fear of losing a part ofoneself that cannot beregained? For a professionrevolving around saving lives,donating blood or blood com-ponents should be mandatory.

If a single blood donationcan save three lives, imaginewhat a lifetime of donations canachieve. The power to save livesis not exclusive to the medicalprofession, but intrinsic to allethically and morally groundedindividuals seeking a more ful-filling existence. Anyone can besuccessful and aim to uncoverthe true meaning of life, but topreserve a gift as precious aslife, is irreplaceable.Copy supplied by AlayneMoreira, ANU medical student(year 3)

The ANU Rural Medical(Students) Society (ARMS) suc-cessfully hosted 'Bushdance07'.The Yarralumla woolshed onlyneeded a little hay to give thevenue a classic country settingand atmosphere.

Approximately 160 medical students,doctors, family and friends had a fantastictime bootscooting around, cracking openpinyatas and generally being merry tosome country beats.

A spit roast dinner went down wellwith the crowd and gave them energy todance late into the night. Some studentseven had sore legs the next day as well assore heads!Thankyou to all that came along and gotexcited about rural medicine.

Feedback and thanksfrom our medical students

• Your exclusive local AMA Travel Service office• View travel specials at www.amatravel.com.au• Exclusive American Express Cardmember offers• Top service for travel anywhere, anytime

7Volume 19, No. 3

Medfin, one of Australia's leadingfinanciers for healthcare profes-sionals is offering a new serviceto healthcare practioners.

From 1st May you can visitwww.Medfin.com.auhttp://www.Medfin.com.au and buy orsell second hand dental or medicalequipment. And the good news is thatthere's no cost involved. Simply followthe prompts and your online, equipmentclassified advertisement is ready forposting on this popular site.

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A News Magazinefor all Doctors

in theCanberra Region

ISSN 13118X25Published by the ACT Branchof the AMA Ltd42 Macquarie St Barton(PO Box 560, Curtin ACT 2605)

Editorial:Christine BrillPh 6270 5410 – Fax 6273 0455

Typesetting:DFS Design GraphixPO Box 580, Mitchell ACT 2911Ph/Fax 6238 0864

Editorial Committee:Dr Ian Pryor – Chair/EditorDr Jo-Anne BensonDr Keith BarnesMrs Christine Brill –Production ManagerDr Ray CookDr John DonovanDr Jeffrey LooiDr Tracy SohDr Peter WilkinsMs Gemma DashwoodMr Stefan Baku

Advertising:Lucy BoomPh 6270 5410 – Fax 6273 0455Email accounts@ama-act.com.au

Copy is preferred by Email to execofficer@ama-act.com.au oron disk in IBM “Microsoft Word” orRTF format, with graphics in TIFF,EPS or JPEG format.

Next edition of Canberra Doctor –May 2007

JACKmail delivers for the AMAJACKmail was official-ly launched on the 2ndMarch 2007 by MsKaty Gallagher, ACTMinister for Disabilityand CommunityServices.

The AMA has become themost recent business to enjoythe professional and reliablemail delivery service: JACK-mail. Courier, Jackson West,and his driver/support worker,

Jamie, collect the AMA’s mailfrom the Curtin post office anddeliver it to the AMA office inBarton.

Jackson has a profoundintellectual disability and autismdue to a unique chromosomeabnormality. The business wascreated by Jackson’s parents toemploy Jackson part-time andhas been designed around hisskills and loves. JACKmail deliv-ers tender documents, courierssmall items between businessesand collects mail from postoffice boxes and delivers it tobusinesses.

JACKmail givesJackson the opportunity to:� be employed and earn an

income� contribute to his community � meet many small business

owners, operators, employ-ees and customers

� have a busy, active andinteresting life

� be an ambassador for peo-ple with a disability His mother, Sally Richards,

says, “Jackson graduated fromBlack Mountain School at theend of 2006 and in this newstage of his life, post-school, hehas much to offer. However, we

live in a society that oftenrefuses to acknowledge thecontribution people with a dis-ability can make. We wanted toensure that Jackson was a fulland contributing member ofhis community and henceJACKmail was developed.”

JACKmail has 13 business-es as clients and is looking formore in the inner south. If youwould like to engage JACKmailto pick-up and deliver yourmail or courier small itemswithin the Canberra region,phone 02 62810974 (office),0421 455 913 (mobile) oremail sally@jacksonwest.org

To find out more about Jacksonvisit www.jacksonwest.orgAMA ACT office manager, Linda McHugh with Jack.

8 Volume 19, No. 3

NOTICE BOARD “Notice Board” is a new feature of “Canberra Doctor”You are invited to submit your entry for this free service. Notices will be limited to 200 words and must contain contact details. Notices should be sent to

execofficer@ama-act.com.au and headed “NOTICE BOARD”. Written reports of the meeting following the event are also encouraged.

Medical Association for Prevention of War

Presents

Music As Peace WorkSaturday 5th May 2007

atCanberra Baptist ChurchCurrie Crescent Kingston

A family friendly festival of music and danceBring food to share for a buffet meal

Tea, coffee and cold drinks will be provided(It is an alcohol free venue)

Live music provided by ACT Doctors, their families and friendsDinner and music start at 6:00 pm

Donations of up to $50 would be appreciatedTickets at the door or from Graeme or Rosie

Enquiries:Graeme Thomson 0419271714

Rosie Yuille 62477090musicaspeacework@hotmail.com

A seminar for members and their practice managers

Another member benefit!Non-members are welcome to attend. Cost $100 (no refunds).

To check out the benefits of membership visit www.ama-act.com.au or www.ama.com.au

Pandemic planning“ready reserve”

AMA ACT co-ordinating a listof doctors willing to assist inan emergency.

Have you returned your Form yet?

You will have received a letterfrom AMA ACT President, DrAndrew Foote, inviting you toindicate your willingness to beconsidered part of a “readyreserve” medical workforce inthe event of an influenza pan-demic. The response from theprofession has been amazing.Thank you to all of those whohave returned their forms.

If you have not indicated thatyou are willing to be consideredas part of this emergency work-force please do so as soon as pos-sible by returning the form to fax6273 0455 or by post to PO Box560 Curtin ACT 2605. If you didnot receive an “invitation”,please contact Christine on62790 5410 or by email to exe-cofficer@ama-act.com.au

Just to remind: this is an expres-sion of interest only and will notbe taken as binding upon you toprovide assistance. The AMAACT will not make the informa-tion available to any third partywithout your consent. It is togauge whether or not we willhave a “ready reserve” of medicalpractitioners to support our gen-eral practitioners so that theyand the general public will becared for.

Medicare easyclaim seminar series!

Mr Andy Ozolins, industri-al officer at the AMA ACT, willbe visiting The CanberraHospital on Monday 7 Maybetween 10.00am and 2.00 pmand is available for consultationwith salaried members.

The AMA ACT is commit-ted to providing an industrialadvice and advocacy service toits salaried members and if youhave an issue you would like todiscuss with Mr Ozolins, pleasecontact the secretariat on 62705410 for an appointment.

Further dates for visits toTCH will be advertised on theAMA website in the near future.

Conversations betweenmembers and Andy will beregarded as confidential.

As this is a member service,inquiries regarding member-ship can be made to Elizabethon 670 5410 or by emailingmembership@ama-act.com.au

A list of the benefits ofmembership is available atwww.ama-act.com.au and www.ama.com.au

In association with MedicareAustralia, the AMA ACT ispleased to offer a series of twoseminars on the soon-to-beintroduced electronic billclaiming.As reported in the last editionof “Canberra Doctor” the newelectronic Medicare claimingwill be available in mid 2007which will enable a totallypaperless process for you andyour patients. For furtherinformation see the article onpage 9 of the March edition.To hear how this will work inyour practice you, and your

key practice staff, are invited toattend either of the two semi-nars on offer to be held in theTheatre in the Clinical ServicesBuilding, Calvary John James,Strickland Crescent, Deakin.� Wednesday 6 June� Thursday 7 June� 7.00 pm to 8.00 pm withrefreshments from 6.30 pm.RSVP essential to Linda on6270 5410 or by email to reception@ama-act.com.auwith names of those attendingby COB Monday 4 June.Preference given to AMA mem-bers and their staff.

A new service for salaried members!The AMA ACTs industrial advice and advocacy service

is coming to a workplace near you!Another exclusive benefit for members!

Are your staff “employees” or“independent contractors”?

If you thought this was a sim-ple question, you might be sur-prised to learn that the answermay not be so simple.With the introduction of thenew Federal IndependentContractors Act, it is timely thatemploying members are briefedon its provisions. Members needto know who is an employeeand covered by WorkChoicesand who is a contractor andcovered by the new Act.In association with MinterEllison Lawyers, the AMAACT invites you to a seminarto be held at Minter Ellison,25 National Circuit, Forrest

on Tuesday 14 May com-mencing at 7.00 pm with lightrefreshments.The seminar will commence at7.30 pm and conclude atapproximately 8.30 pm. As theultimate responsibility foremployment matters rests withthe practice principal, they andtheir practice managers areencouraged to attend.As a service to members there isno charge for their attendance,and for all others there is a costof $100 to be paid by creditcard at the time of registering.Registrations can be made toLinda at 6270 5410 or by emailto reception@ama-act.com.auby COB Thursday 10 May

Dixon, Jane and Broom,Dorothy H. (Eds):

The 7 Deadly Sins of Obesity(How the modern world is

making us fat): UNSW PressSydney 2007. 228 pp (+ xii).

All but four of the elevencontributors to this thought-provoking volume, includingboth editors, are current or pre-vious staff of the NationalCentre for Epidemiology andPublic Health. Three of theremainder are Canberra-basedacademics and the final contrib-utor is a strategic advisor to theAustralian Greens and formerchief of staff to Senator NatashaStott Despoja. They bring aneclectic range of backgroundresearch interests to the task ofexplaining Australia’s balloon-ing collective waistline, andmost have published previouslyin areas of health, economics ornutrition.

The central conceit of thisbook postulates replacement ofThomas Aquinas’s C13 theolog-ical list identifying ‘the sevendeadly sins’ (pride, covetous-ness, lust, anger, gluttony, envyand sloth) with a new C21 psy-chosocial list centred on select-ed contemporary factors heldresponsible for producing themuch-discussed modern ‘epi-demic’ of obesity and over-weight. After dismissingAquinas’s list as irrelevant toproduction of an ever tubbierAustralian population (evengluttony and sloth are excused),the editors identify the ‘topseven explanations for changesin physical activity and foodconsumption patterns duringthe past 50 years’.� increased use of conven-

ience and pre-preparedfoods

� increasing ‘busyness’ andlack of discretionary time

� altered family dynamics� sedentarisation of leisure

activities� escalating reliance on per-

sonal motor vehicles

� aggressive mar-keting of food-stuffs

� changingknowledge, atti-tudes and prac-tices concerningphysical activityFrom this start-

ing point, individualcontributors thenpresent their chapter-length disquisitions ona series of less elegant-ly titled ‘modern sins ofthe environment’*, pos-tulating a causal chainfor determinants of obe-sity, focussing on socie-tal rather than individualresponses.

Changes > socioeco-nomic, > cumulative >individual > BMI & insocial gender & age- expo-sures to dietary & healthtrends related practicesobesogenic physical outcomesenvironment activity, behav-iours.

* The new listing is as fol-lows.� The codified environment

(how the economy feedsobesity)

� The harried environment (istime pressure making usfat?)

� The pressured parentingenvironment (parents aspiggy in the middle)

� The technological environ-ment (digital technologiesor space to play [up] andbelong

� The car-reliant environment(the vehicle that drives obe-sity)

� The market environment(formula for fatness)

� The environment of com-peting authorities (saturatedwith choice)Readers familiar with Prof-

essor Broom’s earlier work insociology will not be disap-pointed by her summative finalchapters (with collaboration byother contributors) on ‘Unequal

society, unhealthy weight’and a ‘Conclusion’ calling for‘multiple synergistic actions bynumerous actors’ (includinggovernments, employers,unions, marketers and individu-als). Overall, this is a well-rea-soned and accessible account ofmultiple (but not all) factorsimplicated in the national accre-tion of avoirdupois. Exculpationof individual “Norms” and attri-bution of most blame to politi-cal and social factors may com-fort some, but the work lacksbalance due to this. BeforeAquinas, philosophers and the-ologians enunciated the doc-trine that free will is a necessarypre-condition for sin: ‘the devilmade me do it’ rang as hollowthen as claims today that ‘I / mykids are only fat due to TVadvertising’. However, the bookdoes present a persuasive casefor its postulate, and blueprintfor remedial action, assisted bycopious references and a com-prehensive index.Peter S. Wilkins(Peter Wilkins is a member of theAMA ACT Council and CanberraDoctor editorial committee.)

9Volume 19, No. 3

BOOK REVIEW

Sportsmed ACTwelcomes Sports Doctor,Dr Gus Oon to the team

Gus consults atSuite 9b National Capital Private Hospital

and Suite 9 Calvary Clinic

Appointments for both sites may be made on

6247 7222

ACT

For further information contact Elizabeth on 6270 5410

1 0 Volume 19, No. 3

On 2 June, CapitalPathology will cele-brate the ten-yearanniversary of theopening of its purposebuilt laboratory inDeakin. While beingthe focus of these cele-brations, the buildingis also currently under-going extensive reno-vation and refurbish-ment for the next stageof its role as the hub ofCapital Pathology.

Although most out patientshave their pathology specimenscollected in collection centresthroughout ACT and sur-rounding NSW, the laboratoryis the centre of the extensivecourier and electronic networkthat links doctors and otherhealth professionals from hos-pitals, nursing homes and sur-geries with the pathologists,scientists and other staff ofCapital Pathology. The labora-tory is also the testing site forblood and other specimenssuch as tissue specimens andcytology specimens such as Papsmears and Fine Needle Aspir-ates which are all processedand reported on site.

In some ways there seem tohave been massive changessince the laboratory was com-missioned in 1997, particularlyin regard to information tech-nology and connectivity. Forexample, it is hard to remem-ber a time when cameras werenot a standard feature ofmobile phones, but they weredeveloped only in 1997. Also itseems hard to remember howwe functioned when less than5% of businesses had a websiteand less than 16% of business-es had internet access; howev-er that was the case in Aust-ralia in 1997.

Similarly, in diagnosticpathology, 10 years has broughtmany changes in areas ofgrowth, knowledge and tech-nological advances.

In areas of instrumenta-tion, technology and workflow, a scientist who worked inthe lab in 1997 would barelyrecognise their role and envi-ronment today.

Then the laboratory was di-vided into small esoteric dep-artments of haematology, bio-chemistry and serology, wheremuch of the testing includedmanual steps. Now most of thetesting is incorporated onto

automated testing platformsthat have made these separate“departments” largely obsolete.This means that general chem-istry, hormones, tumour mark-ers, therapeutic drugs andserology for HIV/ hepatitis test-ing are done very quickly andaccurately on highly automat-ed, integrated machines thateliminate much manual han-dling and the potential errorsassociated with manual testing.

Increased automation hasalso allowed efficiencies thathave enabled pathology labora-tories to absorb the spirallingcost of labour, instrumentationand reagents during a timewhen HIC benefits for patholo-gy items have been static forover 20 years.

Changes in technologyhave allowed a broader range oftesting to be done cost effec-tively and quickly. For examplethe introduction of polymerasechain reaction (PCR) technolo-gy means that modern patholo-gy laboratories routinely pro-vide testing for a wide range ofinfectious diseases such asChlamydia, gonococcus, Bord-etella pertussis, cat scratchfever, herpes, varicella andCMV. As well as this, advancesin the last ten years in PCRtechnology now allow us to testfor haemochromatosis genes,factor V Leiden and prothrom-bin gene (thrombotic riskassessment) as well as cysticfibrosis. Apart from assistingclinicians with testing that waspreviously not routinely avail-able; PCR technology has oftenled to better accuracy andspecificity, and faster availabili-ty of results. PCR testing hasproven performance on a widerange of specimen types, andthis has enabled testing on eas-ily collected specimens whichcan avoid the need for an inva-sive procedure, for exampleChlamydia PCR testing on afirst void urine rather than oncervical swab.

Ten years has also seen hugeadvances in prenatal testing,where first trimester biochem-istry combined with imaging ofnuchal fold thickness allowsearly detection of Down’s syn-drome and neural tube defects.Previous investigations werelimited to second trimesterscreening using biochemistryalone, and offered a risk assess-ment of lower sensitivity com-pared with the novel combinedfirst trimeter screening.

In 1997, most laboratoriesassessed the possibility of myo-cardial damage through assaysof cardiac enzymes (CK, AST,and LDH). Now troponins are

the test of choice, as they are amore specific and sensitivemarker of myocardial damage.

The laboratory investigationof Coeliac disease has pro-gressed enormously over tenyears, testing initially for gliadinantibodies, then endomysial andnow TTG (Tissue Transglutam-inase) antibodies which are nowthe test of choice.

In 1997, surgeries and hos-pitals filed hard copy pathologyreports, and the concept of“paperless” surgeries seemedvery futuristic. However, thewhole area of information han-

dling, sharing and storage haschanged significantly in tenyears. As the population growsand ages, and modern medicinebecomes more sophisticated,the amount of data generatedand handled by pathology labo-ratories has grown enormously.There have been significantdevelopments in informationtechnology enabling better pro-tection of data from inadver-tent or deliberate damage andquicker, more efficient, directtransfer of results to referringdoctors using either securedial-in via Fetch or encryptedemail via Argus and secure webbased lookup via Webster. Thenext stage of this excitingphase of development willinvolve electronic requesttransmission and this is cur-rently being tested. The chang-es in information technologyhave been instrumental indecreasing the incidence ofdata loss and increasing thespeed of result availability.

In histology there havebeen major advances since1997 in the area of immunohis-tochemical staining and flowcytometry for better diagnosisof tumours and other diseasesand this has led to quantumchanges in the understanding,diagnosis, treatment and prog-nosis for patients with manytypes of lymphoma and othertumours. These advances have

also influenced patient out-comes by predicting suitabilityfor various treatment options,such as Her 2 receptor chro-mogenic in situ hybridisation(CISH) testing to assess breastcancer patients for suitabilityfor Herceptin therapy.

In the field of cytology, thecervical Pap smear has under-gone further refinementthrough the acceptance of liq-uid based testing that wasbeing trialled in Australia at thetime of the opening of theCapital Pathology laboratory.An advantage of liquid based

testing is that high risk sub-types of HPV can be tested foron the same sample, allowingfor better counselling and fol-low up of at risk women.

So, particularly in areasrelated to technological devel-opments, 1997 seems a longtime ago.

However, possibly as a signof my own aging, things thathappened 10 years ago seemvery immediate in humanterms. 1997 was the year of theCanberra Hospital implosionand the tragic death of KatieBender on 13 July. I remembervery clearly the Thredbo disas-ter on 30 July. I find it hard tobelieve that Princess Di,Mother Teresa and MichaelHutchence have been dead forten years. In politics, Tony Blairwas elected Prime Minister ofGreat Britain and John Howardwas still the prime Minister ofAustralia.

When Capital Pathologymoved into its new Deakin lab-oratory, the practice employedapproximately 120 people. Upuntil that time we were calledBarratt and Smith & Moranafter the merge of those 2 longestablished practices and in1997 we were still dealing withsome of the operational andinterpersonal consequences ofthat merge.

Now we have close to threehundred people working withus and Capital Pathology hasthe privilege of being thelargest community based path-ology practice in our region.The number of patients that wehelp clinicians investigate, treatand monitor has almost tripledsince the laboratory was com-missioned.

In conclusion, technologyhas changed a great deal in thelast ten years. However, thepeople of Capital Pathologyremain focused on their role of“helping doctors help patientsby providing specialist patholo-gy services”.

Our pathologists, scien-tists, technicians, collectors,couriers and support staff takegreat pride in being part of thelargest specialist medical prac-tice in our region.

On behalf of all of the peo-ple of Capital Pathology, Iwould like to thank the mem-bers of the Canberra medicalcommunity for their supportover the last ten years. Wevery much look forward toworking with you to improvethe health of our patients andour whole community formany years to come.Copy supplied by: Dr GloriaArmellin, CEO, CapitalPathology

Capital Pathology– Looking back on 10 years of growth and development

View of the Laboratory and staff.

Staff at Capital Pathology.

A potted history of theAMA and what itstands for!

The AMA was originally theBritish Medical Association inAustralia and in the 1960s theAustralian Medical Associationwas created. Of course, theBMA/AMA transition meansthat some State AMAs have cel-ebrated very proudly, theirCentenaries.

Up until 1981, the AMAACT was a local association ofthe AMA NSW (ACT MedicalAssociation) and became anentity in its own right as theCapital Territory Group of theAMA. Under the Constitution ofthe Federal AMA, Branch statuswas conferred on those State/Territory organisations with 500or more members and withBranch status the organisationalso received representation atthe AMA Federal Council.Following the review of theAssociation by Sir RobertCotton in 1988, both the ACT

and the NT were granted“Branch” status and receivedrepresentation on the expandedFederal Council. “Branches”have now evolved as AMA –NSW etc and in due course, wetoo will change our name toAMA – ACT to reflect thechanges to the Federal AMAConstitution and to mirror theState AMA organisations.

The AMA ACT is governedby a Board of twelve directors(Council) elected by their peers.The Council has a dedicatedplace for a representative ofmedical students – appointed byAMSA – and for a representativeof doctors in training. All otherBoard positions are elected fromwithin the general membership.Each Council has striven toensure it represents the wholeprofession and being such adiverse profession, this is oftenchallenging.

The secretariat is locatedwithin AMA House in Bartonand is the respository for theold minute books of the previ-ous incarnations of what is nowthe AMA ACT. They make

interesting reading now that thecigarette and pipe tobaccosmells have largely disappeared– reflecting the mobile nature ofthe position of Secretary. I’mtold the early archival materiallived in one good doctors’garage for a quite a time.

Today the AMA ACT contin-ues to build on the foundationslaid down by a succession ofCouncils and invites member-ship from all members of the pro-fession in order to keep a strongand united voice to fight for theindependence of the professionand to advocate for patients. It’smission is to support doctorsserving their communities andeverything it does is measuredagainst this objective.

Like all associations itevolves to keep pace with thedemands its members placeupon it and to ensure it canadvocate for the profession on arange of matters which affects it.

Membership applicationforms can be downloaded fromwww.ama-act.com.au or can beobtained by phoning 6270 5410.

The Canberra Medical Soc-iety was founded in the late1950's by a number of eminentdoctors in town as an apoliticalorganization that aimed to fostersocial contact between the variedarms of medicine in the A.C.T. Atthat stage there were privatepractitioners, Commonwealthdoctors, military medical officersand medical researchers at theJohn Curtin School of MedicalResearch. Among the activemembers of the Society in itsearly years were Dr MarcusFaunce, (Honorary Physician tothe Governor General and Prime

Minister), Professor FrankFenner (Director of the JohnCurtin School of MedicalResearch and winner of the JapanPrize for his work in eradicatingsmallpox) and Brian Furness(Physician and later ANUMedical Officer). The societywould meet every few months fora meal, usually at the ANU

College and listen to a guestspeaker. This tradition continuedinto the 1990's when it unfortu-nately fell into a period of inac-tivity.

In 2000 it was resuscitatedwith the main aim of facilitatingthe social interaction betweenthe diverse groups of medicalpractitioners and their partners.In recent times an annual benev-olent function has increasinglybecome a focus with successfulprojects to support the ACTBushfire Appeal (with AMAACT), The Tiwi Island mammo-gram initiative and theYuendemu eye surgery project. Inthe last two years we have held afree Welcome BBQ for all newstudents and doctors to Canberraand this has been a highly suc-cessful event to inform theCanberra medical community ofour vision and mission:

VisionTo be an organization which

unites the entire ACT regionmedical community via socialand benevolent functions.

MissionTo identify and welcome all

doctors and their partners arriv-ing and living in the ACT regionvia periodic gatherings for thepurposes of support and friend-ship.

We encourage all doctors tocontact us via the website withcomments and suggestions forfuture events www.canberramed-icalsociety.com (no .au at end)

The idea of a Medical Ballhas flourished this year and weare pleased to be co-hosting theinaugural Canberra Medical Ballwith the MWS (ACT andSouthern region) and the AMAACT for what will be one of thebest social events of the year!Dr Caroline Luke, President, CMS

1 1Volume 19, No. 3

The Medical Women’s Socie-ty of the ACT and Region is agroup with the aim of fosteringcommunication between medicalwomen, both in the ACT and inthe surrounding NSW towns.Our members live and work asfar away as Crookwell and theSapphire coast and we cater forall ages. We have a strong link tothe ANU Medical School, withstudent representatives fromeach year on our committee. Thestudent membership is free,while we ask $60.00 as an annu-

al membership for the qualifiedmembers, to pay for costs and forthe affiliation fees for the Aust-ralian Federation of MedicalWomen.

The Society has several roles. Firstly we are a networking

group. The members have differ-ent needs, such as women newlyarrived in the region wanting tomeet other women with similarinterests and make to makefriends. There is a Medical Wom-en’s Playgroup, which meets atirregular intervals at Black Moun-

tain Peninsula. We are GPs, spe-cialists and registrars working inhospitals, private practice and inadministration.

We meet five times a year atvarious venues, with differentthemes, but usually associatedwith dinner or cocktails.

One of our gatherings is adesignated fundraising dinner,where we specifically aim to raisemoney for a charity related towomen’s and children’s health.

We have a role in studentsupport and mentoring.Through our student committeemembers we have been madeaware of certain problems andhave been able to supportmorally and practically.

In addition, the local MedicalWomen’s Societies are affiliatedwith the Australian Federationof Medical Women, which is inturn affiliated with MedicalWomen International. Australia,at the present, holds theSecretariat of MWI and as such

influences policy with organiza-tions such as the WHO. InAustralia, we have members onnational women’s lobby groups,particularly in relationship towomen’s health.

We always welcome newmembers. To join, go to www.amfw.org.au and follow thelinks to the ACT.Jane TwinPresidentMedical Women’s Society of theACT and Region

Australian Medical Association – ACT

Medical Womens’ society

Canberra Medical Society

1 2 Volume 19, No. 3

Dr. P.M.V. Mutton

colposcopy & laserendoscopic surgery

specialist gynaecologytreatment of prolapse

Dr. P.M.V. MuttonMBBS, FRCOG, FRANZCOG

for prompt, personalisedand

experienced care

6273 310239 GREY STREET DEAKIN ACT 2600

FAX 6273 3002EMAIL drmutton@bigpond.net.au

� Subspecialist in female urinary incontinence and prolapse

� Advanced laparoscopic surgery� Urodynamics, ultrasound, colposcopy

phone: 6253 3399www.canberracuresclinic.com.au

OBSTETRICIAN,GYNAECOLOGIST

& UROGYNAECOLOGIST

needed for very busymodern family practicewith attached PathologyProvider. Flexible hours,no A/Hrs and goodconditions to rightcandidate.

Phone Jamison Medical Clinic,Macquarie – 6251 2300 or visit

www.jamisonmedicalclinic.com.au

VRG

P

CONSULTATIONSUITE

Suit Specialist or Allied Health

Adjacent to GP andPathology

0407 011 737

GP POSITIONAvailable F/T or P/T

Fully computerised modern spacious rooms. Flexible hours.Evenings optional. Private billing. Nurse onsite.

0407 011 737

GP Position availableBega Valley Medical Practice

~ Modern family practice in Bega township~ Computerised / fully accredited / Practice Nurse

~ Flexible hours and conditions~ Choice of Country or Coastal lifestyle

Telephone: 02 6492 3333 Dr Duncan MacKinnon

PRACTICEMANAGER

required forNorthside.

Please send CV toPO Box 9457

DEAKIN ACT 2600

FEMALE GPinvited to join accredited family practice in North

Canberra. Flexible hours, private billing, no after hours

or weekends. Good remuneration with

guaranteed minimum.Please phone 6248 7005

GP WANTEDTo join friendly practice

with practice nurse Weston Creek

Sessions or full-timeContact 6288 5000 | 6288 8139

Kevin Gow | Tracey Baker

CHAPMANMEDICAL PRACTICEVRGP

position available in computerised and accredited General

Practice in Woden area, adjacent imaging,

pathology, pharmacy.

Ph: (02) 6282 1516

A/Professor Jeffrey LooiMBBS(Syd) FRANZCP MRACMA

Consultant Neuropsychiatrist

Specialising in:Anxiety & Mood Disorders,

Dementia & Cognitive Disorders,Geriatric Psychiatry & Neuropsychiatry

Is relocating his Private Practicefrom May 2007 to:

Lyneham Professional Centre5/2 Montford Cres, Lyneham ACT 2602Phone: 6248-6614 | Fax: 6248 7277

Canberra Wollongong Gosford Newcastle Sydney

Pregnancy Termination• Private & individual treatment• Consultation, ultrasound & counselling prior to procedure• Only a 2 hour visit• 24 hour on call advice• Mirena/IUD insertion with sedation 6-8 weeks post TOP• D & C for incomplete miscarriage

All Hours 6299 5559

Crawford Street Medical ClinicP/T or F/T GP wanted to join largefriendly practice in Queanbeyan.GP owned centre established for

nearly 50 years. Purpose built facilitywith on-site pathology. Enjoy the

benefits of working in a group environment whilst retaining the

ethos of family practice.Above average remuneration.

For more information please contact PM on 0438 812 651

• Purpose Built centre• Four colleagues

• Interest in travel medicine a bonus• Fully computerised

• Practice Nurse on site• Sat mornings optional

Part Time or Full Time GPwanted for

Dickson Medical & Travel Clinic

Contact principal 0407 206 365or practice manager 0438 812 651

Full time/part time VR GP wanted for busymodern practice in Jerrabomberra.

Only 15 min from CBD. Fully accredited and computerised, privatebilling. Practice Nurse support. No after hours. Opportunities todevelop special interest.

Would also suit GP registrars. Contact Bernard on 02 6299 8892or email bernard_leung@optusnet.com.au