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Archive for October, 2019
09 Oct

Racing: Snowden raiders snare prizes as in form Dunn lands Caulfield treble

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By a long neck: Mark Zahra riding Redzel, right, defeats Nicholas Hall riding Under the Louvre, second left, in race 5 of the Resimax Stakes at Caulfield Racecourse on Saturday, August 27. Photo: Vince CaligiuriThere are few shrewder judges around than Peter Snowden – as his stable’s strike rate regularly attests – so when the Sydney based handler brings a couple of horses south for a tilt at two valuable support races on the first group 1 day of the new racing season, it’s probably worth paying attention.
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Punters who did so and combined the pair would have enjoyed a healthy profit after Redzel scored in the group 3 Resimax Stakes at $5.50 and Defcon followed up 35 minutes later in the HDF McNeil Stakes at the longer odds of $7.50, producing a double which paid around 40/1.

The McNeil is often a decent pointer to the Caulfield Guineas later in the spring – the likes of Starspangled Banner and Bel Esprit have done the double in the past 16 years – but Snowden does not entertain such aspirations for Defcon.

The McNeil winner was the second leg of a treble for jockey of the moment Dwayne Dunn, who won the Scobie Breasley Medal, the jockeys’ Brownlow equivalent, earlier in the week but Snowden believes he is purely and simply a sprinter.

His main Melbourne target this spring will be the group 1 Coolmore Stakes on Derby Day, when he could clash with his stable mate Capitalist.

A son of Choisir, Defcon adapted quickly to the Melbourne way of going and showed commendable courage to accelerate through a narrow gap and quickly put away his field, beating the $4.80 favourite and last start winner Highland Beat by a length and a quarter,  with the fast finishing Wazzenme ($10) third a half-head away.

“He gave it a great ride,” said the trainer of Dunn’s effort. “Everything we asked he did … to the horse’s credit first time here he railed perfectly and took a needle eye opening and showed that customary 300-metre dash that he has. It’s brutal, it will win him more races than he will lose by them.

“If you can hold him up until that last little bit, it takes a good one to get by him. I am positive that he can improve off that. The Danehill (a group 2 sprint at Flemington) looks perfect for him in a couple of weeks’ time.”

A little knowledge may be a dangerous thing sometimes, but on other occasions it can make a huge difference.

Mark Zahra has ridden group 1 winner Under the Louvre on nine occasions – in races or trials – in the past 18 months, so if any jockey knows the capabilities of the Robert Smerdon trained Stradbroke winner it is Zahra.

On Saturday he was aboard the front-running Redzel ($5.50)  in the group 3 Resimax Stakes at Caulfield, with rival Nick Hall on Under the Louvre. The latter was sent off as the $3.70 favourite at his first start since his win in the big Brisbane feature, where he had been partnered by Dwayne Dunn.

Zahra knew he would have to set the right fractions and then leave enough in the tank to sustain what would be a determined late charge from the favourite, and he did it to perfection, scoring by a long neck.

“I knew he (Under the Louvre) always gets a fair way back. I didn’t have eyes in the back of my head, but late on I was starting to wonder, where is he. I just had enough left in the tank. Pete’s advice was spot on, he knew his horse and that helped me to win the race.”

Dunn stretched his lead at the top of the jockey’s list with the treble, begun earlier in the day on the David Hayes trained He’s Our Rokki ($7) who took out the Cattanach’s Jewellers Handicap over 1400 metres for the Hayes/Dabernig combination and completed in the last race with a swooping win on Ocean Embers ($4.40 favourite) in the Ladbrokes Cockram Stakes, a group 3 event for fillies and mares.

The latter was the first group race triumph for young trainer Shea Eden and she is a progressive sort who has now won three of her last four starts.

There was also a black type  success for Stuart Webb and Kate Mallyon, who teamed up with the front-running Great Esteem to take out the listed Heatherlie Handicap, a race that often provides clues to the middle distance contests later in the spring.

Great Esteem was well rated in the lead by Mallyon and had enough in reserve to hold off favourite Tom Melbourne ($4), who had chased her throughout. It was a race where backmarkers never had a sniff, as the third placed Longeron ($8) had been in the same spot throughout the race as well.

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09 Oct

Melbourne’s APCR Australia Prostate Cancer Centre accused of Medicare fraud

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Professor Tony Costello AM. Photo: Jessica ShapiroA prominent Melbourne cancer clinic is being investigated for alleged Medicare fraud and potentially ripping off state government hospital funding.
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The Victorian Department of Health and the Royal Melbourne Hospital have commissioned independent reviews of the APCR Australia Prostate Cancer Centre – a private clinic for men with prostate concerns and other urological conditions.

The centre has been accused of “double dipping” from federal and state health funding for patients, who are sometimes referred there by the Royal Melbourne Hospital under a patient-sharing agreement.

The centre’s clinical director Professor Tony Costello AM has described the allegations as “scurrilous” and “defamatory” and said audits of its billing would show no wrongdoing.

Concerns have been raised that some staff who work for both the centre and the hospital are billing Medicare at the same time they are receiving payment from the hospital, where Professor Costello is also head of urology.

There are also allegations Professor Costello has been using junior doctors paid for by the public hospital for private work.

Professor Costello rejected these claims and said the centre had been funded by philanthropy and appropriately by Medicare for patient care.

The investigations are likely to interest many specialist doctors who work in both public and private hospitals, and who sometimes treat patients paid for by private sources in government-funded public hospitals.

While these doctors often find themselves juggling work with the two groups of patients, they can only bill Medicare when a patient is being treated privately. That is, the patient is either paying for their own care or using their private health insurance.

A spokesman for the Victorian Department of Health and Human Services said it had commissioned Ernst & Young to review “the governance and patient referral pathways between the Melbourne Health urology unit and the APCR Australia Prostate Cancer Centre”.

“The review has been triggered by a range of concerns raised internally at Melbourne Health,” the spokesman said.

“The review will investigate whether the operation of the private urology clinic … is within the terms of the existing service agreement between Melbourne Health and APCR Australia Prostate Cancer Centre; and specifically whether the billing arrangements for patients referred from Melbourne Health to APCR Australia Prostate Cancer Centre comply with the required Medicare guidelines”.

A statement from Melbourne Health which runs the Royal Melbourne Hospital said it was taking the issues seriously and had asked a specialist legal firm, Health Legal, to “work through a number of administrative and governance issues such as referral processes, branding and scope of work”.

“In response to ongoing, expanded concern about these administrative and governance issues, and to ensure processes occur in line with the service agreement, Melbourne Health recently commissioned an external specialist review … The review, being undertaken by Health Legal, will ensure a timely resolution of these issues,” the statement said.

“We have confidence in the current process we are undertaking and we are committed to learning and implementing the recommendations from the external review.”

The APCR Australia Prostate Cancer Centre was set up last year by Professor Costello in collaboration with the Royal Melbourne Hospital where he and several of the centre’s staff work.

It received charitable donations through Australian Prostate Cancer Research, kicked along by a $6000-a-head dinner for 70 men hosted by broadcaster Eddie McGuire. The night raised more than $650,000.

Professor Costello said the idea was that a multidisciplinary clinic would be set up for men without private health insurance so they could be seen within about two weeks of referral, rather than waiting months for an appointment at the Royal Melbourne Hospital.

He said the clinic bulk-bills patients through Medicare for consultations with GPs, urologists, and other health professionals so patients don’t face out-of-pocket costs.

GPs can refer patients directly to the centre, however if a patient’s GP refers them to the Royal Melbourne Hospital to see a urologist, they are also given an option to go the centre.

Ordinarily, when patients are referred by their GPs to public hospitals to see specialists, those consultations take place in the hospital and are paid for by the public hospital, which are mostly funded by state governments – not Medicare, which is paid for by the federal government.

Professor Costello said if people attending the centre needed surgery or radiation treatment they could be put on the waiting list for the Royal Melbourne or Peter MacCallum Cancer Centre in the same way as they would if they had never visited the centre and went straight to the public hospitals instead.

Or, he said, they can choose to use their private health insurance, or pay one of the doctors privately for care in a private hospital.

Professor Costello said he was proud of the centre, which was not seeking to make a profit. To the contrary, he said it was making a loss.

The complaints include allegations about inappropriate billing of Medicare; use of other private radiology and pathology companies instead of the Royal Melbourne’s publicly funded service; and criticism that a female patient was referred by the Royal Melbourne to the centre even though it primarily targets men.

Professor Costello rejected all of these claims and said both he and the centre, which was backed by funding raised through Australian Prostate Cancer Research, were not doing anything wrong.

He said any pathology and radiology done from the centre was bulk-billed so patients did not face out-of-pocket costs and that while some women did visit the centre, none had reported feeling uncomfortable.

The leading urologist said although some people had accused him of charging high fees for his private robotic surgery, he believed he charged fairly and that some criticism of him was motivated by professional jealousy.

“I’ve got nothing to hide,” he said.

Got a tip about health system billing? Let us know. 

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09 Oct

Bioethicist calls for a ban on doctors’ conscientious objection

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Biothics professor Julian Savulescu says doctors in the public system should be banned from conscientiously refusing to perform procedures. Photo: Michael RaynerDoctors working in the public system should be banned from refusing to perform certain procedures, such as abortions, because of their religious beliefs, a leading bioethicist will argue in Brisbane next week.
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Oxford-based Australian bioethicist Julian Savulescu will make the argument at a public lecture at the Queensland University of Technology’s Australian Centre for Health Law Research next Tuesday.

In his lecture, Professor Savulescu will also argue doctors and health professionals should only enter medical specialities in which their values would not be in conflict with routine legal medical procedures.

“When a medical procedure, or one which doctors have a monopoly over, is desired by the patient, in the patient’s interests, and is a legal and reasonable use of limited resources, then that procedure ought to be provided by doctors,” he said.

“There is no place for conscientious objection at the bedside in these circumstances.”

ACHLR co-director Lindy Willmott said Professor Savulescu’s lecture was timely, given Queensland Parliamentary Inquiry into Laws Governing Termination of Pregnancy in Queensland, the report of which was due to be released on Friday.

“What is essential is that doctors’ personal values don’t compromise patients’ access to medical care, and the health of women who seek or urgently require a termination,” Professor Willmott said.

“The safety and wellbeing of women in those situations should be the paramount concern and priority.”

Situations in which conscientious objections could be made by health workers included euthanasia and the withdrawal of treatment, contraception, sterilisation, and abortion.

Comment was sought from the Australian Medical Association, which has a stated position on conscientious objection.

“Doctors (medical practitioners) are entitled to have their own personal beliefs and values, as are all members of society,” the AMA policy statement says.

“There may be times, however, where a doctor’s personal beliefs conflict with their peer-based professional practice.

“A doctor who makes a conscientious objection to providing, or participating, in certain treatments or procedures should make every effort in a timely manner to minimise the disruption in the delivery of health care and ensuing burden on colleagues.

“The doctor needs to take whatever steps are necessary to ensure the patient’s access to care is not impeded.”

Professor Savulescu’s free public lecture will be held at QUT’s Gardens Point campus, in the level 10 Gibson Room at Z Block on Tuesday at 5.30pm.

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09 Oct

Teen pregnancy program had a reverse effect: study

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The simulators replicate the sleeping and feeding patterns of a baby. Photo: Supplied The Bachelor Australia contestants with their baby simulators. Photo: Ten
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They’re the baby robots that ruined the social lives of high school students in every teen TV show for the past two decades.

Just last week, in The Bachelor Australia, Richie Strahan deployed the screaming dolls to test the parenting prowess of his bevy of beauties.

But a baby simulator program aimed at preventing teenage pregnancies may in fact do just the opposite, an Australian study shows.

The gurgling dolls may have inadvertently made teen motherhood too appealing, with many students doting on their electronic progeny and enjoying the attention that came with it, the researchers said.

Schoolgirls asked to care for the baby bots were more likely to become pregnant in their teens, found the first randomised controlled trial that tracked whether participants became pregnant.

The 13- to 15-year-old girls enrolled in the Virtual Infant Parenting Program (VIP) were twice as likely to give birth in their teens than girls who had no intervention (8 per cent versus 4 per cent), found the trial involving 1567 students from 57 schools in Western Australia.

When it came to pregnancies, 17 per cent of the schoolgirls given the dolls got pregnant versus 11 per cent among controls, according to the research paper published in the international journal The Lanceton Friday.

Girls who were given the baby bots were also more likely to have an abortion (9 per cent) in their teens compared with their counterparts (6 per cent), found the study that followed participants until the age of 20. The researchers linked the data collection to abortion clinics and hospital records.

Schoolgirls were given the baby simulators to care for over a weekend as part of the VIP program designed by the Telethon Kids Institute researchers.

The baby simulators – which cost roughly $1200 each – replicate the sleeping and feeding patterns of a baby. They cry when they need to be fed, burped, rocked or changed. They detect and report any mishandling, the length of crying time, the number of changes and general care.

Girls enrolled in the VIP program also attend education sessions delivered by nurses that cover pregnancy, good nutrition, the financial costs of having a baby, sexual health, contraception and respectful relationships.

They also watch a documentary featuring teenage mothers talking about their experiences.

“The risk of pregnancy is actually increased compared to girls who didn’t take part in the intervention,” said lead author Dr Sally Brinkman, a senior research fellow at the Telethon Kids Institute.

“We don’t know what the actual mechanism is as to why the program failed. There are a few different theories out there,” Dr Brinkman said.

The problem may have been that the programs were just too appealing to the schoolgirls.

“Anecdotally, a lot of the students really enjoyed the program … there was a lot of positivity around the program, so it didn’t really work in putting the kids off,” Dr Brinkman said.

The students got quite a lot of positive attention from family and even strangers on the street and they went about their weekends toting the electronic dolls.

“It was quite an intense experience for the students and perhaps that’s why they really liked it,” Dr Brinkman said

But the program did not present teen pregnancy in a positive light.

“What we tried to do was to present the reality of what it would be like to be a teen mother,” Dr Brinkman said.

“We definitely were not saying you can’t become a teenage mother. We didn’t want to demonise that, but the intention was clearly behind the program to increase contraceptive use and if you were going to have a baby to do it in a healthy way, and part of doing it in a healthy way was to delay,” she said.

This season’s The Bachelor Australia pitted contestants against each other in a baby simulator competition last week. The women were forced to prove what good mothers they could be to the plastic automaton as they vied for Strahan’s affection.

But the baby bots were designed for a very different reason.

Australia ranks sixth highest in teenage pregnancy rates among OECD countries.

It is understood between 1800 and 2000 Australian schools had the simulators, though they are mainly used for early childhood education programs.

The program was adapted from the US program “Baby Think It Over” by Realityworks. Similar programs are used in 89 countries, and are expanding into low- and middle-income countries.

Despite their popularity, there is little evidence of their effectiveness, the authors said.

“Evidence now suggests they do not have the desired long-term effect of reducing teenage pregnancy. These interventions are likely to be an ineffective use of public resources for pregnancy prevention,” Dr Brinkman said.

She questioned whether such an individualised approach was needed considering the gradual decline in teenage pregnancies in Australia overall.

Realityworks chief executive Timmothy Boettcher said the baby simulators were extremely effective in parenting education programs and to deter teen pregnancy when used in conjunction with the company’s curriculum.

“I am flattered that people are looking at new ways to use parts of our product, with things like different curricula for different purposes and measuring the outcomes, again flattering,” Mr Boettcher said. “It, however, is not the same as using the product we sell in the way we provide it.”

The simulators were currently used by more than 40,000 institutions worldwide, he said.

Dr Julie Quinlivan at the University of Notre Dame said one reason the intervention failed was that parenthood takes “two to tango”.

“The intervention was directed at teenage girls and neglects the fathers,” she wrote in an accompanying editorial in the Lancet.

Teenage girls idealised parenthood, and interventions needed to start in primary school, especially for children who faced “adversity in early childhood”, she said.

“By the time a child reaches secondary education, the traumatised brain might have already evolved towards a desire for early childbearing to address subconscious evolutionary fears,” she said.

Successful programs needed to invest early in vulnerable children from disadvantaged backgrounds.

“We cannot afford the quick fix, especially when it doesn’t work,” she said.

The study authors conceded that the control cohort tended to have higher education and higher socio-economic status, but after adjusting for these factors they found no difference in their findings.

Another potential limitation of the study was the low participation rate, with only 45 per cent of eligible students enrolled in the control group and 58 per cent in the intervention group. The study did not measure miscarriage rates.

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09 Oct

Breast cancer patients could be spared chemotherapy with new genetic test, study shows

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A Mammaprint microarray showing the biopsy results of low risk (top) and high risk (bottom) breast cancer tumours. Photo: SuppliedIt’s a gruelling decision every breast cancer patient and their doctor must consider: do we need to start chemotherapy, or could we spare you the ravages of the toxic, yet potentially life-saving treatment?
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A genetic test could see thousands of Australian women with early-stage breast cancer safely avoid chemotherapy, a landmark trial shows.

Based the genetic profile of their tumours, nearly half of women (46 per cent) with early-stage breast cancer who are at high clinical risk of the cancer returning may not require chemo, found one of the largest and most robust studies of genetic testing published.

The trial investigated whether the test (dubbed MammaPrint in Europe and Australia) could identify which patients had a low genetic risk of their cancer re-emerging among women in the early stages of the most common type of breast cancer: HER2 negative tumours.

Researchers screened more than 6600 patients and found 1550 had a high clinical risk, but low genetic risk, of their cancer returning.

Women deemed to have a high clinical risk of recurrence are usually treated with chemo.

The researchers randomly assigned these women to chemo treatment or no chemo after their first-line treatments (surgery, hormone therapy and radiation).

After five years, 94.4 per cent of the women who did not receive chemo had no distant metastasis; their cancer hadn’t spread, found the study published in the New England Journal of Medicine on Thursday.

There was only 1.5 percentage points that separated them from the women who did receive chemo, with 95.9 per cent of these patients showing no distant metastasis at the five-year mark.

“We found that chemotherapy with its toxic effects could be avoided in these patients,” the authors concluded. They plan to follow the women for another five years to document their ongoing survival rates.

“Given these findings, approximately 46 per cent of women with breast cancer who are at high clinical risk might not require chemotherapy, they said.

The risks from certain types of chemo increase with the patient’s age. The risk of leukemia is about 0.5 per cent to 1 per cent, and the heart risk can reach 4 per cent or 5 per cent in older women, Dr Freedman said.

Australian oncologist Associate Professor Guy Hingston – who pioneered access to MammaPrint for Australian women – recommended all Australian women who were about to undergo chemo should check with their oncologist to see if they would benefit from the test.

Between 4000 and 5000 Australian women diagnosed with breast cancer every year would be eligible for the test. The study results suggest roughly 2000 to 2500 women could be spared chemo every year.

“We now live and work in a different world of breast cancer management. Women already shattered with a new diagnosis of breast cancer, should not needlessly be put through chemotherapy, if genomically their cancer can be shown to have a low risk of recurrence,” Associate Professor Hingston said.

“As a medical profession, we are here to help women, not hurt them, and this form of genomic testing is a great step forward in our ability to more accurately target treatment and provide personalised cancer therapy.”

But MammaPrint is not universally accessible. Australian samples are sent to Los Angeles for testing and come with an out of pocket cost of roughly $5500 in Australia.

The medical services advisory committee is assessing an application for government funding.

A sobering editorial published alongside the study findings warned the trial was not the final proof that chemotherapy could be tossed aside for this group of patients.

“The immediate question for many observers is this: Was withholding chemotherapy in such patients actually safe?” wrote Drs Clifford Hudis and Maura Dickler at the Memorial Sloan Kettering Cancer Center, New York.

“[A] difference of 1.5 percentage points, if real, might mean more to one patient than to another.

“What doctors and their patients do with the results of such testing will be highly individualised — and will inevitably be finessed by the findings from future studies,” they wrote.

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