Sunday, November 25

Amid the rejoicing, a note of caution

In all of last night's rejoicing, few took a look at the Senate voting. The count so far indicates Labor may run into trouble getting its legislation through the Federal Parliament.

This morning the ABC website is showing these results for the Senate. Adding those senators who did not have to face the electors this time around to the likely result for the half who did, we may end up with these Senate totals:

Liberal/National Coalition 37
Australian Labor Party 32
The Greens 5
Family First 1
Other 1

[The ABC warns that these figures are a guide. The final result may depend on "below the line" voting in individual states.]

Will the Greens always support Labor legislation? Will they demand too high a price, asking Rudd to welsh on election promises like approval for the Gunns pulp mill? Will Labor meet the Greens' expectations on climate change?

All parties face a high-stakes gamble, possibly within a few months, as they ponder whether to force a double-dissolution by having the Senate reject Labor's bills. Would electors rise in anger against the Coalition for its failure to accept their will so clearly expressed in the Reps elections. Or would the Opposition Leader, whoever may win the post, have persuaded electors that they'd made a mistake with Prime Minister Kevin Rudd?

Congrats to Antony Green and Kerry O'Brien, but the ABC did have some glitches

The ABC's election analyst Antony Green and its 7.30 Report presenter Kerry O'Brien did a first-class job from the tally room, along with Labor's Julia Gillard and the Libs' Nick Minchin.

Flicking around the channels, I was also impressed by the Nine Network's coverage.

The ABC did have some problems, with graphics refusing to come up as planned.

And someone stuffed up with the program guides. Days ago, ABC Television's promos said last night's news would be advanced to 5.30pm to allow its broadcast to cross to the tally room at 6pm. Newspaper program guides yesterday still showed bowls at 5pm and tally room at six – no mention of news. I checked the ABC program guide on its website just before 5pm yesterday, and it was showing the same erroneous information as the newspapers.

Forget the post-mortem, let's look to the future

I'd feel sorry for John Howard, except it's a word he understands only when it's applied to trivial issues. And in the past, Howard has had no compunction about trying to destroy the careers of people his conservative mates targeted for "political correctness".

And it's ironical that he suffered this humiliating defeat because he treated another of his assurances as a non-core promise.

You will recall that he often said he'd stay for as long as his party wanted him – surely an implied promise that he'd go when it didn't. But when, at the time of APEC, 70 per cent of his ministers said he should go, he went home to Janette, took her advice, and stayed.

That said, few could deny some respect and even admiration for Howard's determined fight against the odds.

But look to the future. I expect the Libs to spend two terms in Opposition before they will have rebuilt the party to give Rudd a run for his money in six years' time. Peter Costello today withdrew to pursue a career outside politics – probably a wise move. The electorate had already rejected him on a joint prime ministerial ticket, and his failure to challenge for the leadership earlier suggests he hasn't the ticker or the party support to lead the way back to government.

The times will suit Malcolm Turnbull, and it's great news for the Libs that he held his seat of Wentworth. Of the present mob, he's the only senior Lib who can take the party into the 21st century and possible re-election.

The one big problem he may face is that his foes will trawl back through all his deals and advisory roles in his years as a high-achieving merchant banker, seeking examples of his playing too aggressively or even bending the rules. Indeed, they're already doing it, to judge by the comments turning up on some of the online reports of his throwing his hat in the ring for the leadership.

Friday, November 23

Politics, a better Australia, and the pleasure of motor cycle riding

It seemed like a good idea at the time. To the friend who criticises me for anti-Liberal Party bias, I sent this email well over a week ago.

I may try one heavier piece before the election on Saturday week. Not so much party-political, but a list of what I'd like to see to make a better Australia. For me, I guess that would lead to a Labor vote, but perhaps you'd read the same list and say, yeah, that's what you'll get if you return the Coalition. It would still be somewhat biased, I suppose, but perhaps without the negativity you've seen in the past.

But what an extraordinarily difficult task it's proved to be. It's easy when you stick to labels like mateship – which Prime Minister John Howard once tried to have inserted into a preamble to the Australian Constitution – and fairness, which Howard, quite sincerely, has sometimes called a fundamental Australian value.

But what happens when you try to extend the ideal of tolerance and fairness to a celebration of the diverse foundations of Australian society?

What do you say of someone who attacks “political correctness” by sacking or publicly humiliating people with whom he disagrees? (I have in mind Dawn Casey from the National Museum and Federal Police Commissioner Mick Keelty after he agreed that Australia's joining the Iraq war had made us more of a target for terrorism – but I could draw up a much longer list.)

How do you explain that some of the basic tenets of liberal thought are hard to find in the people and policies of the Liberal Party?

Classic writer's block. Awake about two, ideas fermenting but not formulating, check a few references from books beside the bed, make cups of tea, switch on computer, make more cups of tea, words still won't come.

If I get this wrong, perhaps I'll risk losing a friend. Just as important – perhaps even more important – I may risk something I rather pretentiously call intellectual or moral integrity. I don't want to be called a Howard-hater. I don't want to be defined by what I hate.

I want my friends and family to know me for positive values, and if I criticise the Howard Government, it's for its failure to carry forward those values, and I want my criticism to be fair, balanced and based on evidence.

On the road, the view is so much clearer (once you get round the lorries)

Finally, Merry is fed up. Fed up with my pacing through the house, sick of my opening and shutting the fridge door. She orders me to get on that motor cycle and don't come back till I settle down.

Up the F3, turn for Freemans Waterholes, Kurri Kurri and Maitland. Not a good choice – from before Freemans almost to Dungog, there are long delays at one section of roadworks after another, and processions of speeding trucks, semis or with dog trailers, carrying stone from the huge quarry at Martins Creek, then racing back for the next load.

When you're riding at five to ten kays over the limit anyway, there's something frightening about being tailgated by a Mack or Kenworth which wasn't even in your mirrors a few hundred metres back.

Almost as frightening is sipping a long black under the verandah of the Country Cafe in Paterson as the huge trucks come barrelling around the right-angled Post Office corner, so close you feel their slipstream.

On to Dungog. The roads are opening out, the country looks green. Dungog, as always, is an attractive town. At last I'm feeling on top of the world.

A beer and a hamburger in the Bank Hotel while I read the papers, and I feel able to return to the real world. Or is this closer to the real world, people moving around a pretty town set down in a scenic countryside, while politics and big-city society are artificial constructs which torment the human soul?

I'm still pondering this as I ride back through Clarencetown and Seaham, pausing for coffees at the Maccas McCafes at Raymond Terrace and the twin servos on the F3. In my mind, I begin to debate another issue of global importance: Who let Americans believe they know how to make coffee, and that it's OK to serve it in waxed cardboard cups?

Back at my keyboard, I still can't get the ideas together and put them into words. And now there is only one more sleep till we vote. What I think doesn't really matter – my few readers are unlikely to change their votes – but perhaps there are times when one should stand up and be counted.

I could list achievements of which John Howard can be proud – the GST, gun control, taking over water management of the Murray-Darling Basin, his closer relationships with Asian leaders (which seemed to defy his earlier rhetoric), and the fact that he and his tyro Treasurer managed to continue the economic boom for which the Paul Keating reforms had set the foundations.

I'm genuine. These are areas in which Howard's actions have given us a better Australia.

Or should I focus on his shortcomings. Do I need to list them? How long do you want this blog post to be?

Perhaps one should look beyond Saturday. If Kevin Rudd romps in with an overwhelming majority – as most disinterested (not uninterested!) commentators predict – will he run a good government which helps create a better Australia?

Many things make me hopeful. First, his standing up to the old Labor system which sees so many party hacks elevated to state and federal ministries as the result of factional wheeling and dealing. In the past, Labor leaders had the right to allot portfolios, but could not choose which people were to be ministers. Rudd should also have the right to choose the pool from which he will allot the portfolios.He can choose his Cabinet purely on merit.

Second, the hope that Rudd has the integrity to try to keep his promises, not sort them into core and non-core. That he will use his first term to review the aims and the strategies needed to carry this nation forward, and that after three years we will have the confidence to to re-elect him with a more progressive agenda.

Third, that he will wind back the politicisation of the Public Service, where incoming ministers push aside well-performing professional public servants to install political bedfellows as department heads (Labor's not blame-free – John Della Bosca did it in NSW when he became Education Minister).

And all those other hopes – that he will resume Paul Keating's economic and industrial relations reforms to allow further adaptation to the global economy, while still winding back the nastier provisions of AWAs, that he will reverse the trend to take welfare from the needy and hand it to the middle classes, that he will restore the role of secular public education, that he will continue to improve the superannuation system, and that he will maintain the American alliance without becoming a lickspittle to the neo-cons.

Turnbull facing Rudd – the nation will benefit

For the Liberals, I do hope they lose office. I hope the vote will show the party it has followed a leader who took too many wrong turns and betrayed our trust too often.

But I hope the loss is not so devastating it throws the party into turmoil, allowing hard-right extremists to take control. The Liberal Party's future lies in moderate and progressive policies and leadership.

Our parliamentary democracy requires a strong Opposition.

For that reason, I hope Malcolm Turnbull survives what looks like a close fight in the eastern Sydney electorate of Wentworth. In Opposition, the Liberal Party rump will not be bound by Howard's anointment of Peter Costello as his successor.

Turnbull could restore liberal values to the Liberal Party and pave the way for a return to the Government benches in as little as six years.

He has a brilliant mind, demonstrated in law, merchant banking and journalism. Before his political career took over, he espoused many progressive causes – republic, Australian flag, reconciliation, climate change. He could steal back the middle ground if Rudd disappoints.

Such a scenario – initially, Rudd as Prime Minister and Turnbull as Opposition Leader competing for the hearts and minds of moderate Australians – must give this nation a brighter future.

There. I think I've managed to wind up on a positive note. [Any readers disappointed at the lack of a full-on Howard-hating rant may get their fix here.]

Thursday, November 15

I'm chuffed at this rating

cash advance

One of the skills of a journalist should be clear, strong writing, and this rating delights me. It suggests I use language appropriate to the matters I like to discuss. Any simpler, like "primary school", and this blog couldn't get its ideas across. Any higher, like "university", and you could suggest I'm trying to show off.

It's the writing style you'll see in a newspaper which respects its readers' intelligence.

But I don't always get it right. After the previous post, a friend asked me to explain "exponential". And I'd been rather pleased at coming up with the phrase, "exponential explosion of emails".

Looking at that phrase again, I winced. If it's not tautology, it's damn close to it.

Tuesday, November 13

Kindness of a stranger and the voice of God

In the manner of these yarns passed around the world in an exponential explosion of emails, this has no provenance, no way to identify its author. Yet it seems authentic, and in the words of the friend who passed it on, it should bring a tear to the eye.

This is one of the kindest things I've ever experienced. I have no way to know who sent it, but there is a kind soul working in the dead letter office of the US postal service.

Our 14-year-old dog, Abbey, died last month. The day after she died, my four-year-old daughter Meredith was crying, and talking about how much she missed Abbey. She asked if we could write a letter to God so that when Abbey got to heaven, God would recognize her.

I told her that I thought we could . . . so she dictated these words:

Dear God,
Will you please take care of my dog?
She died yesterday and is with you in heaven.
I miss her very much.
I am happy that you let me have her as my dog even though she got sick.
I hope you will play with her.
She likes to play with balls and to swim.
I am sending a picture of her so when you see her you will know that she is my dog. I really miss her.
Love, Meredith.

We put the letter in an envelope with a picture of Abbey and Meredith and addressed it to God/Heaven. We put our return address on it. Then Meredith pasted several stamps on the front of the envelope because she said it would take lots of stamps to get the letter all the way to heaven. That afternoon she dropped it into the letter box at the post office. A few days later, she asked if God had received the letter yet. I told her that I thought He had.

Yesterday, there was a package wrapped in gold paper on our front porch addressed, "To Meredith" in an unfamiliar hand. Meredith opened it. Inside was a book by Mr. Rogers called, "When a Pet Dies." Taped to the inside front cover was the letter we had written to God in its opened envelope. On the opposite page was the picture of Abbey & Meredith and this note:

Dear Meredith,

Abbey arrived safely in heaven.
Having the picture was a big help. I recognised Abbey right away.
Abbey isn't sick anymore. Her spirit is here with me just like it stays in your heart. Abbey loved being your dog. Since we don't need our bodies in heaven, I don't have any pockets to keep your picture in, so I am sending it back to you in this little book for you to keep and have something to remember Abbey by.
Thank you for the beautiful letter and thank your mother for helping you write it and sending it to me. What a wonderful mother you have. I picked her especially for you. I send my blessings every day and remember that I love you very much.
By the way, I am wherever there is love.

Love, God.

Photo shows child embracing dog

Friday, November 9

Me and my prostate: An executive summary

Sometimes you can get too close to a topic. And that's what happened in my earlier post, the one which follows this.

I've been tossing around since the early hours wondering what to do about it. Surely it's too long? Does it say far more about my prostate than you really want to know? Is it boring?

And worse, does it fail to drive home arguments I believe to be important?

Yes, yes, yes and yes! Then, about 4am, the answer came to me. What I need is an executive summary.

So here's a first from Grumpy Old Journo. An executive summary:

  • Professor Simon Chapman, and many other researchers, believe prostate cancer screening isn't worthwhile.
  • The initial screening is unreliable. If abnormalities are found, the patient must have a biopsy to confirm diagnosis, and the biopsy procedure itself carries risks.
  • Even if a man has prostate cancer, he's probably going to die of something else first. Many men have prostate cancer when they die, but they've never had symptoms and it's not what killed them.
  • Treatment may end the patient's sex life and leave him wearing incontinence pads. Even if it does extend his life – and that's uncertain – his quality of life may be diminished.
  • However, screening may become valuable if better screening tests can be developed.

    Against that, I'd like to put a counter-argument based on my experience and my reading:

    • Despite their shortcomings, screening tests can indicate prostate cancer.
    • Follow-up biopsies do carry risks of infection and some pain, but they are valuable, not only in confirming a cancer diagnosis, but in calculating the aggressiveness of the cancer – is it likely to spread into lymph nodes and pelvic bones?
    • With this information, a guy (and his wife) can make sensible decisions about treatment options, including the option of no treatment. All specialists will explain the pros and cons
      of treatment they suggest and will offer booklets which set out that advice.
    • Professor Chapman's findings are based on statistical analysis of thousands of men. With sound evidence, good advice and sensible decisions, a guy could beat the odds.
    • Screening is the first step on the path which may lead you to a better outcome.
    Jesus wasn't talking about the prostate health of his listeners, of course, but you might find his words of value when you think about screening:

      "You shall know the truth, and the truth will set you free" [John 8:32]

      I've got the following links at the end of the next post, but to save your time, here they are again: Professor Chapman's article in the Sydney Morning Herald, and a long, detailed Wikipedia entry.

      Tuesday, November 6

      To screen or not to screen – a question for the mature male

      Newspaper clipping shows Sydney Morning Herald article by Professor Simon Chapman headed, Prostate screening not worth it

      Gee! Me against the Professor of Public Health at the University of Sydney. This should be a one-sided debate.

      But here goes. If you've dipped into this blogsite over the past year or so, you'll know I'm passionate in urging mature men to ask their doctor for a prostate cancer check. And although I've read Professor Chapman's article in Monday's Sydney Morning Herald – and was already familiar with the arguments he has put – I will not change my advocacy.

      The reason is simple. Early detection of prostate cancer, before any symptoms became apparent, may have saved my life. At the very least, it saved me from having to make decisions about more risky treatment of an aggressive cancer after it had spread further.

      I hope you'll bear with me. I'm trying to explain that screening is worthwhile for most mature men, provided the guy (and his wife and friends) understand its limitations.

      All treatment options – including non-treatment, ranging from "watchful waiting" to "no point worrying about it at your age" – have risks and shortcomings. What's the right treatment for one guy might be ill-advised for the next.

      As I've previously recorded, my wife Merry persuaded me to ask my GP for a prostate check (I've read that 80 per cent of men who do ask are yielding to their wives' nagging).

      The GP ordered a blood test for PSA – prostate-specific antigen – which came back a bit high. A digital rectal examination did not reveal any abnormalities, but then, not all prostate cancer can be detected with a probing finger.

      So first the doctor treated me with antibiotics. Perhaps I had a simple infection, or perhaps non-cancerous benign prostatic hyperplasia.

      The PSA continued to rise, so it was off to see a specialist urologist. After more examination, he performed a biopsy.

      The results came back – no cancer had been detected. Merry and I enjoyed a good bottle of wine that night.

      But follow-up tests showed an alarming leap in my PSA reading, and the urologist recommended another biopsy. If I remember right (I was zonked out with valium at the time), he told me he had taken 18 tissue samples, and the pathologist detected cancerous cells in just one.

      However, the pathologist gave the cancer a Gleason score of seven. Gleason scores rank the cancer's aggressiveness from a relatively benign two to an alarming ten, and seven is at the aggressive end.

      There is another vital score called staging – usually T1 through to T4, based on how far the cancer has spread. For me, there wasn't enough information to rank my cancer on what basically is a description.

      The urologist referred me to a radiation oncologist, who felt the cancer had already spread into my pelvic lymph nodes. (I know a little about lymph nodes because a surgeon had to remove those under my left arm after melanoma spread its cells – but that was more than 30 years ago.)

      After ultrasound and other imaging confirmed his opinion, we agreed radiation treatment would be appropriate. First, however, the radiation oncologist put me on a course of Androcur to stop my body's production of testosterone.

      The aim was to starve and shrink the cancer to make it a better target for radiation. But the drug achieved a much better result. PSA tests, imaging and digital examination all indicated the cancer had disappeared or was now insignificant.

      It may come back, of course, either as a new cancer or as a flare-up of a few cells which linger. Time will tell, but for now, and until I'm too old for it to matter, I'm happy to accept "watchful waiting" as my treatment option.

      The experience of just one guy – me – doesn't have much statistical significance when ranged against studies by medical and academic experts published in peer-reviewed journals. But it still matters to me, and I think it will help me make some worthwhile points.

      First, on screening itself: Understand what it can do, and what it can't. Initial screening may give false assurance that the guy does not have prostate cancer. But a good doctor today will use both PSA blood tests and a finger examination, although each technique is imperfect, and perhaps the doctor will also monitor changes over time.

      If those techniques lead to concern that cancer may be present in the prostate, it's time to see the urologist. Again, your family doctor – assuming you have one, and don't attend a medical centre where you're just a name on a computer – will be invaluable, suggesting specialists who are not only well regarded for their expertise, but who are also able to explain the diagnosis and treatment options to patients and wives who may be shocked and uncomprehending.

      Only one diagnostic tool can reliably confirm prostate cancer and measure its aggressiveness – a biopsy.

      But even a biopsy is not risk-free. Apart from the possibility of a false negative result such as I received, it also carries a risk of infection. To collect the tissue samples, a fine, hollow needle has to go through the rectum and into the prostate itself. The urologist will have prescribed strong antibiotics to suppress infection, and something like valium to calm the patient, but things can go wrong.

      After all this, however, you should know whether your prostate has cancer, how aggressive it is, and perhaps whether it's metastasising, scattering malignant cells to grow in your lymph nodes or in adjacent bones.

      All that's worth knowing, because it helps you make sensible decisions about what to do next.

      Indeed, it's vital to know about the full range of treatments you may be offered. How effective they may be, how significant are the risks, or even whether it would be better to have no treatment at all.

      Close to the prostate are nerves which control erection, bladder and anal functions, and radiation or surgical treatment may damage them. Some treatments make such damage probable, not just possible.

      Let's say you're about 60, healthy and active and enjoying good sex, and your prostate cancer is relatively low on the Gleason scale. Almost certainly, your wisest move is to do nothing, but let your doctors check from time to time – "watchful waiting".

      On the other hand, let's say you're over 80 and on to your second pacemaker. Treatment for prostate cancer probably won't prolong your life – you'll die first of something else – but it's likely to diminish the quality of your remaining years. Screening? Why bother?

      But between those extremes, what about guys like me? Late 60s, aggressive cancer already metastasising. I'm in reasonable health, and that cancer threatened to shorten my life and perhaps end it with pain. I'm satisfied screening and then treatment was my best option.

      However, Professor Chapman's views have strong support. Here's how Wikipedia reports on the issue (there's a link at the end of this post):

      Screening for prostate cancer is controversial because it is not clear if the benefits of screening outweigh the risks of follow-up diagnostic tests and cancer treatments.

      Prostate cancer is a slow-growing cancer, very common among older men. In fact, most prostate cancers never grow to the point where they cause symptoms, and most men with prostate cancer die of other causes before prostate cancer has an impact on their lives.

      The PSA screening test may detect these small cancers that would never become life threatening. Doing the PSA test in these men may lead to over-diagnosis, including additional testing and treatment. Follow-up tests, such as prostate biopsy, may cause pain, bleeding and infection.

      Prostate cancer treatments may cause urinary incontinence and erectile dysfunction.

      Therefore, it is essential that the risks and benefits of diagnostic procedures and treatment be carefully considered before PSA screening.

      And let's note the final words of Professor Chapman's article:

      What is urgently needed is a diagnostic test that will accurately predict those prostate cancers which will turn nasty. The tests we have now have poor reliability in that regard. Research funding into the development of such tests is vitally important.

      Forgive me for talking so much about my prostate. I know this post is long, and that I have a tendency to preach. But despite the flaws in prostate cancer diagnosis, I still believe screening is valuable for detecting cases such as mine. To get the full benefit, however, a guy needs to understand much more about the diagnostic tools and also the pros and cons of treatment options.

      The Wikipedia entry quoted above offers an excellent explanation of prostate cancer and the issues of diagnosis and treatment. And you can read Professor Chapman's article here.