Issue 40 / 27 October 2014

ON an ordinary November day in 1975, the deputy principal of my suburban primary school burst into the classroom to loudly announce: “The Governor-General has sacked the Prime Minister”.

His excitement caught on: about half the class erupted in a rowdy cheer, while the rest sat silently exchanging meaningful glances. I expected to witness furious table thumping rather than cheering at home that night, and I was not wrong.

Politics can divide us but with the death of Gough Whitlam last week it’s been amazing to see how memories of his vision, intellect, optimism and sheer determination have managed to transcend politics to inspire almost everyone.

One often repeated Whitlam quote is his instruction to his supporters on the day of his dismissal to, “Maintain your rage and enthusiasm …”.

While this was said in the context of his ill fated ambition to return to power, it is an anthem by which some people live their lives. One of the great pleasures of being a medical editor is being able to provide a platform for the rage and enthusiasm of those who use these two emotions productively to change behaviour and improve health.

Recently in MJA InSight, we have seen plenty of “rage and enthusiasm” from both contributors and readers, with our articles on Medicare, thrombolysis, pharmaceutical representatives and homeopathy.  

InSight contributors also hold passionate views about medical professionalism. In a comment this week, emergency physician Sue Ieraci says doctors’ tendency to “blame and shame” each other for missing diagnoses needs to stop, as it is causing waste and harming patients.

One news story looks at another difficult professional issue: the rare but daunting dilemma of coming into conflict with a patient’s family members in making decisions about end-of-life care. An article published online in the MJA outlining how the courts view disputes about futility was the springboard for this story.

US-based epidemiologist, John Ioannidis, has spent the past decade raging (very politely) against the “sloppy science” that forms the evidence base for medical practice. In her blog, Jane McCredie refers to a recent article by Ioannidis, which begins with a startling calculation that about 85% of research resources are wasted. Two of the problems Ioannidis cites are apparent in our news stories this week.

Another news story relates to data sharing, with the need to define the benefits, risks and costs of percutaneous transcatheter aortic valve replacement (TAVI).  

An Australian study has just been published showing good results with TAVI in patients in whom conventional valve replacement surgery would be moderately or prohibitively risky. However, as the Medical Services Advisory Committee considers whether Medicare should fund the procedure, InSight learned that some centres have been reluctant to share their data, claiming it is “commercial in confidence”.

Our other news story underscores the problem of fragmented, short-term research into new drugs, which leads to delayed recognition of rare or unusual adverse effects. A US study has tried to quantify the occurrence of impulse control disorders in patients taking dopamine agonists but, as in Australia, obtaining this information relies on discretionary reports, meaning that the estimates are likely to be imprecise.

Lack of confidence in the evidence base for practice is an increasingly strident theme in the medical literature. In his article Ioannidis goes beyond the rage to suggest strategies for improvement.

If we applied these strategies to our research efforts they could well be as transformative as some of the Whitlam reforms that the nation has been reflecting on for the past week.

In the meantime, I salute those of you whose rage and enthusiasm is manifested in a passion to improve health. Keep up the good work and remember you’ll always be welcome in MJA InSight.


Dr Ruth Armstrong is the medical editor of MJA InSight. Find her on Twitter: @DrRuthInSight

14 thoughts on “Ruth Armstrong: Gough effect

  1. Dr Roger BURGESS says:

    Much has been written about the so-called Whitlam “reforms”, but nothing about how he bankrupted our country prompting the famous statement from one of his own, Paul Keeting, that Australia had effectively become a”banana republic”. His cabinet was a circus who would not know how to run the proverbial chook raffle. Witness the Kemlani scandal. Then you had such luniaries as Al Grassby, Jim Cairns, Junie Morossi etc ad nauseam,  all milling around in the Labor trough to get a turn to suck at the Labor teat. To this day, Labor governments are of the opinion that you can hand out all this largess/effective bribes to the populace and retain power, don’t worry that the money is all on bankcard. The collective sigh of relief when Sir John Kerr sacked the bloke, was palpable in ALL levels of our society. Note Ruth, if you will, the landslide against Labor in the election, held immediately after the dismissal. Republicans also please note this vital safety valve in our constitution. Without a G-G, how would we, for example, be able to handle another Mark Latham, who came within a whisker of running our fair country! Gough Whitlam this Gough Whitlam that. Gee that was a terrific reform when he gave our indigenous brothers the right to drink alcohol, even in their reservations. Terric one that was! Oh, and what about Papua-New Guinea’s independance. That was a terrific move in the right direction for them, as you can hear from the rascals who virtually run the country. 


  2. Dr Andrew Orr says:

    Many said Whitlam’s arrival gave us “self confidence”. Hard to better Greg Sheridan , from “The Australian” 22/10/14 :  ” Of what does the Whitlam-induced ‘self-confidence’ consist ? It is merely the self congratulatory humbug of the baby boomers who loved Whitlam because he took much of their moral dereliction and narcissistic self-obsession nad turned it into approved public policy”      Amen !!

  3. John Parkinson says:

    Would these medical crtics of Gouigh Whitlam really want Medicare abolished?  If so, let them have the hide to say so.





    Staunch your bleeding heart for a minute and listen, John Parkinson.  I said abolish Medicare NOT abolish helping those who are unable to access health care due to infirmity or penury.  Just because we want to help pensioners and the disadvantaged does not mean the entire country must push in front of those same needy people to claw for their “free” entitlements.

  5. Michael Fearnside says:

    It is strange to read such an editorial comment as this exhorting us to “rage” about problems in the health sector  in the manner that Gough Whitlam urged Australians to “maintain the rage”. For the record, Mr Whitlam was thrown out of office by the Australian public, not the Governor General. Venom and hatred to maintain anger, Ruth, are no way to work through health sector problems. Thoughtful analysis and reasoned argument,supported by data are what is required, qualities singularly lacking in Mr Whitlam and his government.  And for you, John Parkinson, Mr Whitlam established Medibank, not Medicare which were entirely different entities.

  6. John Parkinson says:

    Yes, Michael Fearnside, the scheme set up by the Whitlam government was indeed called Medibank.  It was, however, not truly a different entity from the present Medicare  –  into which it evolved.  Medibank Private is the separate entity.  As for bleeding hearts, George Quittner, mine must run in the family.  The obituary of my great-grandfather, RRS Bowker, who ended his career as an eye surgeon, records “His services were freely given to the sick regardless of pecuniary remuneration and the gratuitous performance of a cataract operation would at all times claim his attention in preference to seeing any number of paying patients.”

    That was in 1903.  Would you really like to see the sick poor still depending on charity?  Bleeding hearts eventually run dry.  It is the proper task of a government “by and for the people” to attend to its people’s health.   

  7. ruth says:

    Reply to Michael Fearnside

    Thank you for your comments about “rage”. I agree it’s a very strong term and I did think quite a bit about whether (independently of who said it) there is a place for rage in our efforts to improve health and healthcare. For the purposes of this column I saw the combination of rage and enthusiasm as a passionate belief to see things change, and sustained effort to change them. As an editor, I have seen have seen this combination in people writing about diverse issues — be they clinical or related to public health. I apologise if you find the term “rage” too strong. As you say, anger alone achieves nothing but channeled the right way it can be invigorating. Hatred (directed towards a person) is, I believe, always destructive .

  8. Dr Maureen Fitzsimon says:

    True. Whitlam did too much, in too little time, and overspent. However, he imbued in me an agenda  for social justice. He did so much for women, too. Up until his time, a young pregnant woman was often forced to give up her child, due to impoverishment. Of course, the single mothers’ pension has had negatives, but the heartache of wrenching a child from it’s mother is a huge, lifelong, agony before Whitlam, . If parents could only afford to send one child to University, it was often the male child. When Whitlam was sacked, I heard a fellow medical student state, to his privately schooled male friends: ” ” Thank God for that. Now we can get rid of the lower classes and women in medicine” . Well this lower class , state school educated female , has worked much, much, longer hours than he , or any of his cohorts, so , I  think, Whitlam’s investment in me has been well repaid. 

  9. John Bishop says:


    Australia is a capitalist society,not a socialist entity.The role of government is to manage the economy.President Bill Clinton,put it succinctly”it’s the economy,stupid”

    Comrade Whitlam ,whom I once met was charming and charismatic,but was economically naive.We are still paying 

    both economically and socially for his naïveté.I refer you to the book “False Promises”,by Dr Lucy Sullivan,Windrush Press,2012,which outlines the deleterious changes to Australian society as recorded by the Australian Bureau of Statistics as result of the changes wrought onto the Australian public by the Whitlam government of the day.The role of government is to manage the economy,the role of the Medical Press is to present  medical information,not gushing advocacy for a past politician.

    Please do not turn the MJA into a watered down  medical version  of  the Women’s Weekly.



  10. P Morris says:

    Gough Whitlam’s abiding passion was to nationalise or socialse the whole medical profession.  See his chapter on health in his 1997 book ‘Abiding Interests’.  It arose from his Fabian socialist philosophy of excoriating private practice and anything resembling it from medicine in Australia.  Medbank 1974 (not Medibank Private) was the first step in this process.   Salaried GPs at community health centres was the next step – although ultimately a failure.  Interesting how this idea was revisited by Kevin Rudd as GP superclinics in 2007 – but this time no salaries for the GPs just Medicare bulk billed item numbers! – and probably they wil ultimately come to a similar fate.  The current situation of a mixed public and private system of medical practice in Australia is due to the determined opposition of the profession to the objectionable aspects of the socialist agenda in medical practice championed by Gough Whitlam.  Gough Whitlam had good sides and bad sides, no one is perfect.  On all accounts he was a loving husband and good father to his children and his descendents.  We celebrate his life but think at this time ot the loss his family is experiencing – our condolences go to them.

  11. Dr Greg Mewett says:

    Oh dear! The anti-Whitlam naysayers have been brought back to life by Ruth’s interesting commentary. I heard Greg Sheridan last week on John Faine’s ABC 774 radio program spill his anti-Gough vitriol under the guise of “truth and balance”! He is hardly a font of rational opinion on Labor history or social-justice issues. History has, of course, judged the Whitlam Government as a fraught, frantic and often impetuous administration but that should not take away from the many positive social reforms set on track by Whitlam et al. His vision, intellect and strong leadership have been recognised by prominent folk from both sides of the political fence. Time for some of your respondents to take a cold shower, I reckon!

  12. Sue Ieraci says:

    Thanks for the article, Ruth. Many valid comments in response, but, for me, the fixable economic costs were more than worth the introduction of universal health care and a generation of free tertiary education. For my migrant family, progress from primary to tertiary education in one generation, without having to hock the family home. Many post-war migrant families have benefitted in the same way. Thanks, Gough, for the window of opportunity. The professions are richer today for that time.

  13. Peter Bradley says:

    I also regret the negative and condemnatory attitude many appear to have towards Gough.  I was living in NZ at the time, and there was an interesting parallel going on between the two contries.  Both had had a long period of (very) conservative Government, with the end result things were a long way from where people felt they should be in terms of enlightened attitudes, health, education and the Viet Nam war.  Then Labor swept to power, under Whitlam here in 1972 – in NZ under Norman Kirk, who was also a large figure of a man, both in stature and personality.  Both brought a breath of fresh air in terms of some idealist and altruistic thinking re changes to try and make society a better, fairer place.  Sadly both crashed and burned.  Gough because of lack of ability in his rank and file support – he was an ideas man, not a bean-counter – he needed others to do that for him, and they failed him.  Norman Kirk was brought down by untimely death from a pulmonary embolus after DVT from a knee injury or operation, if memory serves.  His major legacy was the launch of the ACC – Accident Compensation Corporation – the equivalent to the amalgamation of Workers Compensation and the Permanent Disability & Compensation Scheme we are still waiting for here.  I still think it was one of the best and most forward-looking pieces of social legislation enacted in my lifetime.  We have all been reminded what Whitlam helped set in motion.  The job is not yet done.  I just wish they’d get on with the PDCS above.  It’s already 30 years late as it is.

  14. Greg Hockings says:

    I was a medical student during the Whitlam period and participated in a public demonstration in support of Whitlam after his dismissal in 1975, as I viewed it as undemocratic. However my views have evolved over the years.  I vividly remember Bill Hayden, the architect of Medbank, stating publically that he wanted to see all medical practitioners riding bicycles rather than driving expensive motor vehicles.  I recall how shaken my father, a combat veteran from WW2, was after being verbally abused and sworn at by Rex Connor, the then Minister for Mines and Energy, after being summonsed to a meeting in Canberra in his capacity as company secretary of an Australian mining company with multi-national ownership.  History may be written by the victors, but what has been attributed to Whtlam is not always accurate. Yes, he abolished tertiary education fees, but many of us who matriculated back then were awarded commonwealth university scholarships and so did not have to pay fees in  any case. Yes, he pulled Australia out of the Vietnam war, but a staged withdrawl was already proceeding under the previous government, and Whitlam left our Vietnamese allies behind to face brutal communist retribution. I suggest that some of your correspondents and editors remove the stars from their eyes and check their facts before granting Whitlam sainthood.

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