Secondary prevention of osteoporosis in Australia: Analysis of government-dispensed prescription data

Background Osteoporosis is a common cause of disability and death in elderly men and women. Until 2007, Australian Government-subsidized use of oral bisphosphonates, raloxifene and calcitriol (1α,25-dihydroxycholecalciferol) was limited to secondary prevention (requiring x-ray evidence of previous low-trauma fracture). The cost to the Pharmaceutical Benefits Scheme was substantial (164 million Australian dollars in 2005/6). Objective To examine the dispensed prescriptions for oral bisphosphonates, raloxifene, calcitriol and two calcium products for the secondary prevention of osteoporosis (after previous low-trauma fracture) in the Australian population. Methods We analysed government data on prescriptions for oral bisphosphonates, raloxifene, calcitriol and two calcium products from 1995 to 2006, and by sex and age from 2002 to 2006. Prescription counts were converted to defined daily doses (DDD)/1000 population/day. This standardized drug utilization method used census population data, and adjusts for the effects of aging in the Australian population. Results Total bisphosphonate use increased 460% from 2.19 to 12.26 DDD/1000 population/day between June 2000 and June 2006. The proportion of total bisphosphonate use in June 2006 was 75.1% alendronate, 24.6% risedronate and 0.3% etidronate. Raloxifene use in June 2006 was 1.32 DDD/1000 population/day. The weekly forms of alendronate and risedronate, introduced in 2001 and 2003, respectively, were quickly adopted. Bisphosphonate use peaked at age 80–89 years in females and 85–94 years in males, with 3-fold higher use in females than in males. Conclusions Pharmaceutical intervention for osteoporosis in Australia is increasing with most use in the elderly, the population at greatest risk of fracture. However, fracture prevalence in this population is considerably higher than prescribing of effective anti-osteoporosis medications, representing a missed opportunity for the quality use of medicines.

Southern New England Social and Community Plan 2009 - Covering Local Government Authorities: Armidale Dumaresq, Guyra, Uralla and Walcha

The Southern New England (SNE) Social and Community Plan is a guide to collaborative, integrated planning involving the three spheres of government, the community and commercial sectors. The Plan is based on social justice principles such as: • Equity - fairness in resource distribution, particularly for those most in need • Access - fairer access for everyone to the economic resources and services essential to meeting their basic needs and improving their quality of life • Rights - recognition and promotion of civil rights • Participation - better opportunities for genuine participation and consultation about decisions affecting people's lives. The Plan is also aimed at improving the accountability of decision-makers, and should help the councils, in conjunction with their communities meet the state government's social justice commitments. Preparation of a social and community plan is required at least every five years, and as with most councils, Armidale Dumaresq Council (ADC) has produced two already, one in 1999 and one in 2004, following the amalgamation of the former Armidale City and Dumaresq Shire Councils in 2000. Those Councils formerly prepared their own Plans in 1999, based on shared consultancy work on a community profile. This is the first joint Southern New England Plan, featuring Armidale Dumaresq, Walcha, Uralla and Guyra Councils. This Social Plan has aimed to identify and address the needs of the local community by: • describing who makes up the community • summarising key priority issues • assessing the effectiveness of any previous plans • recommending strategic ways for council and other government and non-government agencies to met community needs.

Corporatizing the 'intellectual machinery' of government : the case of educational policy in Australia

This article analyses what it describes as the corporatization of the ‘intellectual machinery’ of government: the theories, knowledges, research and ‘know how’ utilized by political authorities to render the world thinkable, programmable and subject to intervention. Through an analysis of two key nodal points in national policy on teacher professional standards in Australia over the last decade, the article discloses a shift in the relation between expertise and politics. This is manifested, it is argued, in an increased reliance by policy authorities on corporatized forms of research produced by national and international private consulting firms, Think Tanks, and ‘policy entrepreneurs’ and a concomitant decrease in their reliance on free research produced largely by academics in institutions of higher education. The article seeks to account for this shift in terms of the ‘advanced liberal’ formula for rule which now characterizes government in contemporary Western polities.

Government grants - an abrogation or management of risks?

New public management (NPFM), with its hands-on, private sector-style performance measurement, output control, parsimonious use of resources, disaggreation of public sector units and greater competition in the public sector, has significantly affected charitable and nonprofit organisations delivering community services (Hood, 1991; Dunleavy, 1994; George & Wilding, 2002). The literature indicates that nonprofit organisations under NPM believe they are doing more for less: while administration is increasing, core costs are not being met; their dependence on government funding comes at the expense of other funding strategies; and there are concerns about proportionality and power asymmetries in the relationship (Kerr & Savelsberg, 2001; Powell & Dalton, 2011; Smith, 2002, p. 175; Morris, 1999, 2000a). Government agencies are under increased pressure to do more with less, demonstrate value for money, measure social outcomes, not merely outputs and minimise political risk (Grant, 2008; McGreogor-Lowndes, 2008). Government-community service organisation relationships are often viewed as 'uneasy alliances' characterised by the pressures that come with the parties' differing roles and expectations and the pressures that come with the parties' differing roles and expectations and the pressurs of funding and security (Productivity Commission, 2010, p. 308; McGregor-Lowndes, 2008, p. 45; Morris, 200a). Significant community services are now delivered to citizens through such relationships, often to the most disadvantaged in the community, and it is important for this to be achieved with equity, efficiently and effectively. On one level, the welfare state was seen as a 'risk management system' for the poor, with the state mitigating the risks of sickness, job loss and old age (Giddens, 1999) with the subsequent neoliberalist outlook shifting this risk back to households (Hacker, 2006). At the core of this risk shift are written contracts. Vincent-Jones (1999,2006) has mapped how NPM is characterised by the use of written contracts for all manner of relations; e.g., relgulation of dealings between government agencies, between individual citizens and the state, and the creation of quais-markets of service providers and infrastructure partners. We take this lens of contracts to examine where risk falls in relation to the outsourcing of community services. First we examine the concept of risk. We consider how risk might be managed and apportioned between governments and community serivce organisations (CSOs) in grant agreements, which are quasiy-market transactions at best. This is informed by insights from the law and economics literature. Then, standard grant agreements covering several years in two jurisdictions - Australia and the United Kingdom - are analysed, to establish the risk allocation between government and CSOs. This is placed in the context of the reform agenda in both jurisdictions. In Australia this context is th enonprofit reforms built around the creation of a national charities regulator, and red tape reduction. In the United Kingdom, the backdrop is the THird Way agenda with its compacts, succeed by Big Society in a climate of austerity. These 'case studies' inform a discussion about who is best placed to bear and manage the risks of community service provision on behalf of government. We conclude by identifying the lessons to be learned from our analysis and possible pathways for further scholarship.

Nonprofit Service Delivery for Government : Accountability Relationships and Mechanisms

When government purchases social services under contract from a nonprofit organisation, a clear accountability relationship is created. The NPO must give an account for the use of the funds and achievement of outcomes to the funder. This paper explores how accountability is enacted in two different types of funding relationships in Queensland. Support is found for the argument that different relationships have different approaches to accountability.

BIM - Implications for government (Case Study No. 5 [2004-032-A + Case study no. 5])

BIM as a suite of technologies has been enabled by the significant improvements in IT infrastructure, the capabilities of computer hardware and software, the increasing adoption of BIM, and the development of Industry Foundation Classes (IFC) which facilitate the sharing of information between firms. The report highlights the advantages of BIM, particularly the increased utility and speed, better data quality and enhanced fault finding in all construction phases. Additionally BIM promotes enhanced collaborations and visualisation of data mainly in the design and construction phase. There are a number of barriers to the effective implementation of BIM. These include, somewhat paradoxically, a single detailed model (which precludes scenarios and development of detailed alternative designs); the need for three different interoperability standards for effective implementation; added work for the designer which needs to be recognised and remunerated; the size and complexity of BIM, which requires significant investment in human capital to enable the realisation of its full potential. There are also a number of challenges to implementing BIM. The report has identified these as a range of issues concerning: IP, liability, risks and contracts, and the authenticity of users. Additionally, implementing BIM requires investment in new technology, skills training and development of news ways of collaboration. Finally, there are likely to be Trade Practices concerns as requiring certain technology owned by relatively few firms may limit

Learnings, case studies and guidelines for establishing shared and collaborative service delivery in the non-government sector: Evaluation of the Multi-Tenant Service Centre (MTSC) Pilots Project

This report presents learnings, case studies, guidelines and resources for non-government organisations that are planning to implement shared or collaborative arrangements with other agencies. It summarises results from an evaluation of the implementation phase of the Multi-Tenant Service Centre (MTSC) Pilots Project, which was completed in June 2008. This evaluation shows that developing and implementing shared and collaborative arrangements is a complex process that presents many risks, challenges and barriers to success, but can have many potential benefits for non government organisations. As this report makes clear, there is no ‘one size fits all’ approach to this process. The MTSC Pilots Project was conducted by the Department of Communities (DoC), Queensland Government, as part of its Strengthening Non-Government Organisations strategy. The objective of the MTSC Pilots initiative was to co-locate separate service providers in an appropriately located centre, operating with effective and transparent management, which enabled service providers to improve client services. Three MTSC consortiums in Mackay, Caboolture and Toowoomba were selected as the pilots over a four year period from 2006 – 2010.

Subtropical values and principles of subtropical design for the South East Queensland region : a report for the Office of Urban Management Queensland Government

The Office of Urban Management recognises that the values which characterise the SEQ region as 'subtropical' are important determinants of form in urban and regional planning. Subtropical values are those qualities on which our regional identity depends. A built environment which responds positively to these values is a critical ingredient for achieving a desirable future for the region. The Centre for Subtropical Design has undertaken this study to identify the particular set of values which characterises SEQ, and to translate theses values into design principals that will maintain and reinforce the value set. The principles not only apply to the overall balance between the natural environment and the built environment, but can be applied by local government authorities to guide local planning schemes and help shape specific built for outcomes.

Industry-government collaboration : Queensland's IT&T Strategy and the Information Industries Board

This paper presents a field study of the Queensland Information Technology and Telecommunications Industry Strategy (QITIS), and of the Information Industries Board (IIB), a joint industry-state government body established in 1992 to oversee the implementation of that strategy for the development of the IT&T Industry in Queensland. The aim of the study was to analyse differing stakeholder perspectives on the strategy and on its implementation by the IIB. The study forms part of a longer-term review which aims to develop methodologies for the selection of appropriate strategies for the IT&T Industry, and for the evaluation of outcomes of strategy.

Illuminative evaluation as a method applied to Australian Government policy borrowing and implementation in higher education

Any government deciding to invoke widespread change in its higher education sector through implementation of new policies impacts on every institution and all staff and students, often in both the time taken up and the heightened emotions caused. The central phenomenon that this study addresses is the process and consequences of policy changes in higher education in Australia. The aim of this article is to record the research design through the perspective (evaluation research), theoretical framework (program evaluation) and methods (content analysis, descriptive statistical analysis and bibliometric analysis) applied to the investigation of the 2003 federal government higher education reform package. This approach allows both the intended and unintended consequences arising from the policy implementation of three national initiatives focused on learning and teaching in higher education in Australia to surface. As a result, this program evaluation, also known in some disciplines as policy implementation analysis, will demonstrate the applicability of illuminative evaluation as a methodology and reinforce how program evaluation will assist and advise future government reform and policy implementation, and will serve as a legacy for future evaluative research.Any government deciding to invoke widespread change in its higher education sector through implementation of new policies impacts on every institution and all staff and students, often in both the time taken up and the heightened emotions caused. The central phenomenon that this study addresses is the process and consequences of policy changes in higher education in Australia. The aim of this article is to record the research design through the perspective (evaluation research), theoretical framework (program evaluation) and methods (content analysis, descriptive statistical analysis and bibliometric analysis) applied to the investigation of the 2003 federal government higher education reform package. This approach allows both the intended and unintended consequences arising from the policy implementation of three national initiatives focused on learning and teaching in higher education in Australia to surface. As a result, this program evaluation, also known in some disciplines as policy implementation analysis, will demonstrate the applicability of illuminative evaluation as a methodology and reinforce how program evaluation will assist and advise future government reform and policy implementation, and will serve as a legacy for future evaluative research.

Submission for the Queensland Government Parliamentary Inquiry into personal health promotion interventions using telephone and web-based technologies

Telephone and web-based technologies such as SMS, smartphone apps, gamification, online/mobile games, online quizzes and tools can be used in personal health interventions in two ways: health promotion or social marketing. In response to the Queensland government's call for submissions to the parliamentary inquiry, a social marketing and design submission from four of the faculties at Queensland University of Technology was submitted. There appears to be a great deal of confusion in government circles about the terms ‘social marketing’ and ‘health promotion’ and often they are used interchangeably when they are actually significantly different approaches. Social marketing is the science and practice of behaviour change and involves goods and services that offer a value proposition, and which incentivises citizens to change their behaviour voluntarily. However, social marketing is often mistakenly used to describe advertising and communication or social media marketing. This submission contains an overview of how technology interventions need to be implemented to be successful, provides examples of the evidence that telephone and web-based interventions can effectively influence public health outcome. This submission poses seven critical factors.

Submission to KPMG review of the Federal Government Initiative to “analyse dementia program and services funded by the Department of Social Services"

The comments I make are based on my nearly twenty years involvement in the dementia cause at both a national and international level. In preparation, I read two papers namely the Ministerial Dementia Forum – Option Paper produced by KPMG Management Consultants (2014) and Analysis of Dementia Programmes and Services Funded by the Department of Social Services: Conversation Starter prepared by KPMG as a preparation document for those attending a workshop in Brisbane on April 22nd 2015. Dementia is a complex “syndrome” and as is often said, “when you meet one person with dementia, you have met one” meaning that no two persons with dementia are the same. Even in dementia care, Australia is a “lucky country” and there is much to be said for the quality and diversity of dementia care available for people living with dementia. Despite this, I agree with the many views expressed in the material I read that there is scope for improvement, especially in the way that services are coordinated. In saying that, I do not purport to have all the solutions nor claim to have the knowledge required to comment on all the programs covered by this review. If I appear to be a “biased” advocate for Alzheimer’s Australia across the States and Territories, it is because I have seen constant evidence of ordinary people doing extraordinary things with inadequate resources. Dementia care is not cheap and if those funding dementia services are primarily only interested in economic outcomes and benefits, the real purpose of this consultation will be defeated. In addition, nowhere in the material I have read is there any recognition that in many instances program funding is a complex mix of government (at all levels) and private funding. This makes reviewing those programs more complex and less able to be coordinated at a Departmental level. It goes without saying therefore that the Federal Government is not” the only player in this game”. Of all those participating in this review, Alzheimer’s Australia is best placed to comment on programs as it is more connected to people living with dementia and has probably the best record of consulting with them. It would appear however that their role has been reduced to that of a “bit player”. Without wanting to be critical, the Forum Report which deals with the comments made at a gathering of 70 individuals and organisations, only three (3) or 4.28% were actual carers of people living with dementia. Even if it is argued that a number of organisations present represented consumers, the percentage goes up only marginally to 8.57% which is hardly an endorsement of the forum being “consumer driven”. The predominance of those present were service providers, each with their own agenda and each seeking advantage for their “business”. The final point I want to make before commenting on more specific, program related issues, is that many programs being reviewed have a much longer history than is reflected in the material I have read. Their growth and development was pioneered by Alzheimer’s Australia organisations across the country often with no government funding. Attempts to bring about better coordination of programs were often at the behest of Alzheimer’s Australia but in the main were ignored. The opportunity to now put this right is long overdue.

Eco-crime and freshwater

The unsustainable and exploitative use of one of the most important but scarce resources on the planet - freshwater - continues to create conflict and human dislocation on a grand scale. Instead of witnessing nation-states adopting more equitable and efficient conservation strategies, powerful corporations are permitted to privatise and monopolise diminishing water reservoirs based on flawed neo-liberal assumptions and market models of the ‘global good’. The commodification of water has enabled corporate monopolies and corrupt states to exploit a fundamental human right, and in the process have created new forms of criminality. In recent years, affluent industrialised nations have experienced violent rioting as protestors express opposition to government ‘freshwater taxes’ and to corporate investors seeking to privatise drinking water. These water conflicts have included unprecedented clashes with police and deaths of innocent civilians in South Africa (BBC News, 2014a); the United Nations intervention in Detroit USA after weeks of public protest (Burns, 2014); and the hundreds of thousands of people protesting in Ireland (BBC News, 2014,b; Irish Times 2015). Subsequently, the commodification of freshwater has become a criminological issue for water-abundant rich states, as well as for the highly indebted water-scarce nations.

The empire of cancer: Gene patents and cancer voices

In his book, The Emperor of All Maladies, Siddhartha Mukherjee writes a history of cancer — "It is a chronicle of an ancient disease — once a clandestine, 'whispered-about' illness — that has metamorphosed into a lethal shape-shifting entity imbued with such penetrating metaphorical, medical, scientific, and political potency that cancer is often described as the defining plague of our generation." Increasingly, an important theme in the history of cancer is the role of law, particularly in the field of intellectual property law. It is striking that a number of contemporary policy debates over intellectual property and public health have concerned cancer research, diagnosis, and treatment. In the area of access to essential medicines, there has been much debate over Novartis’ patent application in respect of Glivec, a treatment for leukaemia. India’s Supreme Court held that the Swiss company’s patent application violated a safeguard provision in India’s patent law designed to stop evergreening. In the field of tobacco control, the Australian Government introduced plain packaging for tobacco products in order to address the health burdens associated with the tobacco epidemic. This regime was successfully defended in the High Court of Australia. In the area of intellectual property and biotechnology, there have been significant disputes over the Utah biotechnology company Myriad Genetics and its patents in respect of genetic testing for BRCA1 and BRCA2, which are related to breast cancer and ovarian cancer. The Federal Court of Australia handed down a decision on the validity of Myriad Genetics’ patent in respect of genetic testing for BRCA1 in February 2013. The Supreme Court of the United States heard a challenge to the validity of Myriad Genetics’ patents in this area in April 2013, and handed down a judgment in July 2013. Such disputes have involved tensions between intellectual property rights, and public health. This article focuses upon one of these important test cases involving intellectual property, public health, and cancer research. In June 2010, Cancer Voices Australia and Yvonne D’Arcy brought an action in the Federal Court of Australia against the validity of a BRCA1 patent — held by Myriad Genetics Inc, the Centre de Recherche du Chul, the Cancer Institute of Japan and Genetic Technologies Limited. Yvonne D’Arcy — a Brisbane woman who has had treatment for breast cancer — maintained: "I believe that what they are doing is morally and ethically corrupt and that big companies should not control any parts of the human body." She observed: "For my daughter, I've had her have [sic] mammograms, etc, because of me but I would still like her to be able to have the test to see if the mutation gene is in there from me." The applicants made the following arguments: "Genes and the information represented by human gene sequences are products of nature universally present in each individual, and the information content of a human gene sequence is fixed. Genetic variations or mutations are products of nature. The isolation of the BRCA1 gene mutation from the human body constitutes no more than a medical or scientific discovery of a naturally occurring phenomenon and does not give rise to a patentable invention." The applicants also argued that "the alleged invention is not a patentable invention in that, so far as claimed in claims 1–3, it is not a manner of manufacture within the meaning of s 6 of the Statute of Monopolies". The applicants suggested that "the alleged invention is a mere discovery". Moreover, the applicants contended that "the alleged invention of each of claims 1-3 is not a patentable invention because they are claims for biological processes for the generation of human beings". The applicants, though, later dropped the argument that the patent claims related to biological processes for the generation of human beings. In February 2013, Nicholas J of the Federal Court of Australia considered the case brought by Cancer Voices Australia and Yvonne D’Arcy against Myriad Genetics. The judge presented the issues in the case, as follows: "The issue that arises in this case is of considerable importance. It relates to the patentability of genes, or gene sequences, and the practice of 'gene patenting'. Briefly stated, the issue to be decided is whether under the Patents Act 1990 (Cth) a valid patent may be granted for a claim that covers naturally occurring nucleic acid — either deoxyribonucleic acid (DNA) or ribonucleic acid (RNA) — that has been 'isolated'". In this context, the word "isolated" implies that naturally occurring nucleic acid found in the cells of the human body, whether it be DNA or RNA, has been removed from the cellular environment in which it naturally exists and separated from other cellular components also found there. The genes found in the human body are made of nucleic acid. The particular gene with which the patent in suit is concerned (BRCA1) is a human breast and ovarian cancer disposing gene. Various mutations that may be present in this gene have been linked to various forms of cancer including breast cancer and ovarian cancer.' The judge held in this particular case that Myriad Genetics’ patent claims were a "manner of manufacture" under s 6 of the Statute of Monopolies and s 18(1)(a) of the Patents Act 1990 (Cth). The matter is currently under appeal in the Full Court of the Federal Court of Australia. This article interprets the dispute over Myriad Genetics in light of the scholarly work of Nobel Laureate Professor Joseph Stiglitz on inequality. Such work has significant explanatory power in the context of intellectual property and biotechnology. First, Stiglitz has contended that "societal inequality was a result not just of the laws of economics, but also of how we shape the economy — through politics, including through almost every aspect of our legal system". Stiglitz is concerned that "our intellectual property regime … contributes needlessly to the gravest form of inequality." He maintains: "The right to life should not be contingent on the ability to pay." Second, Stiglitz worries that "some of the most iniquitous aspects of inequality creation within our economic system are a result of 'rent-seeking': profits, and inequality, generated by manipulating social or political conditions to get a larger share of the economic pie, rather than increasing the size of that pie". He observes that "the most iniquitous aspect of this wealth appropriation arises when the wealth that goes to the top comes at the expense of the bottom." Third, Stiglitz comments: "When the legal regime governing intellectual property rights is designed poorly, it facilitates rent-seeking" and "the result is that there is actually less innovation and more inequality." He is concerned that intellectual property regimes "create monopoly rents that impede access to health both create inequality and hamper growth more generally." Finally, Stiglitz has recommended: "Government-financed research, foundations, and the prize system … are alternatives, with major advantages, and without the inequality-increasing disadvantages of the current intellectual property rights system.’" This article provides a critical analysis of the Australian litigation and debate surrounding Myriad Genetics’ patents in respect of genetic testing for BRCA1. First, it considers the ruling of Nicholas J in the Federal Court of Australia that Myriad Genetics’ patent was a manner of manufacture as it related to an artificially created state of affairs, and not mere products of nature. Second, it examines the policy debate over gene patents in Australia, and its relevance to the litigation involving Myriad Genetics. Third, it examines comparative law, and contrasts the ruling by Nicholas J in the Federal Court of Australia with developments in the United States, Canada, and the European Union. Fourth, this piece considers the reaction to the decision of Nicholas at first instance in Australia. Fifth, the article assesses the prospects of an appeal to the Full Federal Court of Australia over the Myriad Genetics’ patents. Finally, this article observes that, whatever happens in respect of litigation against Myriad Genetics, there remains controversy over Genetic Technologies Limited. The Melbourne firm has been aggressively licensing and enforcing its related patents on non-coding DNA and genomic mapping.

Insolvency specialists and government enquiries: A unique opportunity to contribute to the public good

This lecture addresses the contribution of research by insolvency specialists to the development of insolvency law and practice, in particular to the (re-)design of insolvency systems. It draws on examples from Australia of government enquiries to reform insolvency law as well as other areas of law with which it intersects. It comments on the role that insolvency specialists can play in such policy debates – not only insolvency academics but also scholarly practitioners – for the public good.