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The globe has already warmed by more than one degree Celsius over pre-industrial levels and is on track to exceed two degrees by the end of the century. It doesn’t sound like a lot but this will have profound effects on human health with Australia being particularly vulnerable. Most obviously, Australia’s biggest cities will become furnaces in summer with a more than doubling of heat-related mortality. The rising temperatures will also increase frequency of the climate oscillations that delivered us record-breaking temperatures and bushfires in 2019-2020, followed by historic rains and floods last summer.  In this podcast we discuss the effects of this increasingly volatile climate on the health of Australians, from infectious disease to respiratory and even mental health. Professor Lynne Madden explains how the health system can become more resilient to these demands and what measures the RACP is asking Federal Government to commit to in preparation for this.  Find out more about the "Health Climate Future" campaign here.  Guest Prof Lynne Madden FAPHM (University of Notre Dame) ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Kauko’ and ‘Ikigai’ by Twelwe. Music courtesy of FreeMusicArchive includes ‘Nothing Else Matters’ by Mystery Mammal, ‘Namaste’ by Jason Shaw. Image credit; Jamie Kidston, Multimedia and Production Manager at Australian National University.Please visit the RACP website for a transcript and supporting references. RACP can claim CPD credits for listening via MyCPD. 
Immune checkpoint inhibitors have revolutionised care for patients with advanced melanoma and other cancers. These days around half of patients with unresectable metastatic melanoma can expect to live to five years after a regime of agents such as nivolumab and pembrolizumab. That’s up to ten times the survival rate of patients a decade ago, when the chaemotherapy Dacarbazine was the front-line treatment. Over half of these patients who respond to immune checkpoint inhibitors will go on to survive long-term but it’s still not possible to identify responders in advance. On top of this, some of the immune-related side-effects of therapy can be serious enough to require stopping therapy. Oncologist Matt Carlino explains how to approach the challenging conversations with patients about hopes around expectations for prognosis and quality of life. The risk-benefit equation becomes harder to balance when considering treatment for grade III or even grade II melanomas, as an adjuvant to surgery. Associate Professor Carlino also discusses the process of getting these new indications listed on the PBS, or how treatment can be funded when they are not. Guest Associate Professor Matteo Carlino FRACP (Westmead Hospital; Blacktown Hospital; Melanoma Institute Australia; University of Sydney)ProductionWritten and produced by Mic Cavazzini DPhil. Music courtesy of FreeMusicArchive includes ‘Headway’ and ‘Denouement’ by Kai Engel, ‘Tavern’ by Sergey Cheremisinov, ‘New Times’ by 4T Thieves. Music licenced from Epidemic Sound includes ‘Dusty Decks’ by Soul Single Serenade. Image licensed from Getty Images.Please visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening to the podcast and reading supporting resources. 
The core work of being a physician is demanding enough. But if you’re seeing patients come in day after day with ailments that have social determinants behind them, you may start to feel like Sisyphus; heaving that boulder up the hill only to have to start from the bottom every time it slips your grasp. Surely it would be better to change those socioeconomic drivers but where do you even begin? In fact, the three word mission statement of the RACP is Educate - Advocate – Innovate.  In this podcast, former General Manager of Policy and Advocacy, Patrick Tobin, explains how the College helps physicians put cases of health equity to those in power.  We hear from Kids off Nauru champion Dr Helen Young, and Dr Jin Russell explains how to harness social media to capture the attention of politicians and journalists. The interviews are drawn from an RACP-produced documentary called The Advocate's Journey hosted by Dr Robert Lethbridge. It is ever-more relevant given the high profile of public health in recent times. GuestsDr Rob Lethbridge FRACP (Perth Children’s Hospital)  Dr Helen Young FRACP (Royal North Shore Hospital; The Children’s Hospital at Westmead) Patrick TobinDr Jin Russell FRACP (Starship Children's Hospital; University of Auckland) ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Missing Memories’ by Christopher Moe Ditlevesen, ‘Kauko’ by Twelwe, ‘Full House Dusk’ by River Foxcroft and ‘No Show (Instrumental)’ by Penny Lane. Image licenced from Getty Images. Please visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening to the podcast and reading supporting resources. 
Note to listeners: Please consider joining the Podcast Editorial Group for 2022. Key responsibilities are to: (1) Discuss potential new podcast topics and prioritise them for development (2) For a chosen topic, suggest themes to explore and people to interview (3) Listen to audio drafts and provide feedback to the producer to improve it before publicationCorrespondence is conducted entirely via informal emails and the time commitment averages under 90 minutes per month. More information at https://www.racp.edu.au/podcast This episode is shared from the Essential Ethics podcast produced at the Royal Children's Hospital in Melbourne. It is presented by paediatric respiratory physician John Massie and clinical ethicist Lynn Gillam who are respectively the Clinical Lead and Academic Director of the Children's Bioethics Centre.In a series titled “Deciding with Children” they raise the following questions. When can a child be considered to have autonomy to make healthcare decisions for themselves? What intrinsic rights does a young patient have up to this age of so-called Gillick competence? How should responsibility for difficult decisions be shared between the patients, the parents and clinicians? And is it possible to minimise the moral injury when the wishes of the patient need to be over-ruled? For the full series go to rch.org.au/podcasts/essential-ethics. GuestsProf Lynn Gillam (Academic Director, Children’s Bioethics Centre, University of Melbourne) Prof John Massie FRACP (Royal Children’s Hospital Melbourne, University of Melbourne)Assoc Prof Clare Delany (Children’s Bioethics Centre, University of Melbourne) Assoc Prof Daryl Efron (Murdoch Children's Research Institute, University of Melbourne)ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Kryptonite’ by Blue Steel, ‘Going Undercover’, ‘I Have a Plan’, ‘See you Soon’ by Borrtex and ‘By the Harbor’ by Mhern. Image courtesy of Jin Han Tan at Flickr. Feedback on this episode was kindly provided by the following members of the Podcast Editorial Group.Please visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening to the podcast and reading supporting resources. 
This is the third podcast in a series about medical injury. First we talked about what victims of injury want to hear from the health system after such an event. And then we discussed the guilt and compromised professional identity that doctors might feel when they’ve been involved in a patient harm. We also heard how fear of medicolegal suits is a major obstacle to greater transparency. At least that’s the case in Australia, where litigation is virtually the only way for victims to get financial compensation for their hardship and ongoing care. New Zealand, by contrast, operates a no-fault compensation scheme where all such costs are born by the government, for harms from care that are relatively unpredictable. We’ll look at the advantages this system has, for patients and practitioners, but also at some of the issues that remain unresolved. Guests Associate Professor Marie Bismark FAFPHM (Melbourne School of Population and Global Health University of Melbourne). Associate Professor Katharine Wallis FRACGP FACRRM (Head, Primary Care Clinical Unit, University of Queensland) ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Circular’ by Silver Maple, ‘Into the Bone’ by Taylor Crane, ‘Heart of the River of the Sun’ by Lama House, ‘Disconnect’ by Gavin Luke, and ‘Five Below’ by Torii Wolf. Image licensed from Getty Images. Feedback on this episode was kindly provided by the following members of the Podcast Editorial Group; Loryn Einstein, Phillipa Wormald and Lisa Mounsey.Please visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening to the podcast and reading supporting resources. 
In the last episode we talked about what patients or their families want to hear after a iatrogenic injury. Despite best practice standards for open disclosure, this occurs far less often that it should. The reluctance from health practitioners to be more transparent is in part due to a misplaced fear of exposure to liability, but perhaps the greatest barrier to incident disclosure is culture of medicine itself. The historic tropes of the infallible physician and the heroic surgeon are still strong today. Though team-based practice has become the norm, many doctors find it hard to admit to a mistake, not just to patients and colleagues but even to themselves. This podcast explores the guilt that can come about from having caused harm, and the cognitive dissonance this creates in one’s professional identity as a healer.  Guests Associate Professor Stuart Lane  FCICM  (Nepean Hospital; FMH lead for Education, University of Sydney) Professor Simon Willcock FRACGP (Program Head of Primary Care and Wellbeing at Macquarie University; Clinical Program Head of Primary and Generalist Care, Wellbeing and Diagnostics at MQ Health)ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Far Away from Home’ by John Glossner, ‘Illusory Motion’ by Gavin Luke, ‘Heart of the River of the Sun’ by Lama House and ‘Struck By You’ by Seroa. Music courtesy of Free Music Archive includes ‘Harbor’ by Kai Engel. Image licensed from Getty Images. Additional voiceovers by Michael Pooley.Feedback on this episode was kindly provided by the following members of the Podcast Editorial Group; Li-Sza Tan, Saion Chaterjee, Vicka Poudyal, Paul Cooper, Rhiannon Mellor and Lisa Mounsey.Please visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening to the podcast and reading supporting resources. 
Medical injury occurs at a rate of about 12 per cent of admissions, and errors without consequence at a higher rate still. According to Australian and New Zealand guidance documents, disclosure of error “is a patient right, anchored in professional ethics, considered good clinical practice, and is part of the care continuum.” But many practitioners are fearful of the medicolegal consequences of disclosure, or unsure about how to present the details of a challenging episode in care. In this podcast we hear how they can provide victims of adverse healthcare incidents with the comfort they seek. Guests Professor Rick Iedema (Director Centre for Team-Based Practice & Learning in Health Care, King’s College London) Professor Simon Willcock FRACGP (Program Head of Primary Care and Wellbeing at Macquarie University; Clinical Program Head of Primary and Generalist Care, Wellbeing and Diagnostics at MQ Health)ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Floating Kite by Tellsonic, ‘April Snow’ by Gavin Luke and ‘Five Below’ by Torii Wolf. Music courtesy of Free Music Archive includes ‘Cherry Blossom’ by Daddy Scrabble, ‘January’ by Kai Engel and ‘Remember the Archer’ by Scott Holmes. Image licensed from Getty Images. Additional voiceovers by Michael Pooley.Feedback on this episode was kindly provided by the following members of the Podcast Editorial Group; Loryn Einstein, Lisa Mounsey, Rhiannon Mellor, Nele Legge, Sern Wei Yeoh, Joseph Lee, Marion Leighton, Oliver Dillon, Ilana Ginges, Rosalynn Pszczola, Lucy Haggstrom, Paul Cooper, Atif Mohd Slim, Victoria Langton and Ellen Taylor.Please visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening to the podcast and reading supporting resources. 
There are many layers of public health interventions that can reduce the rate of transmission of the novel coronavirus. Social distancing, mask wearing, lockdowns and vaccines each nudge the reproduction number down. But you need all of them working together to make a significant impact, and that means you need the community on board. In this podcast we discuss the challenges and strategies around communicating public health messages to the public during a time of such high anxiety. Jessica Kaufman is a research fellow in the Vaccine Acceptance, Uptake and Policy Research Team at the Murdoch Children's Research Institute who presented her work to the RACP Congress in May. She outlined the principles and clarity, transparency and consistency that are needed to win the public’s trust when tough social restrictions need to be adhered to.    We also hear an interview with Professor Allen Cheng FRACP, who’s played this game harder than most. As Deputy Chief Health Officer of Victoria, he advised on implementation of the lockdown that brought Melbourne’s second wave to a halt after four long months. If being part of fun police wasn’t enough responsibility, he also co-chaired the COVID-19 Group at the Australian Technical Advisory Group on Immunisation which had to weigh up the suitability of the Astrazeneca vaccine as reports of rare side-effects and death were emerging in real time. He describes the fine balance between providing enough information for the public to be able to make informed decisions.Guests Dr Jessica Kaufman (Murdoch Children's Research Institute) Professor Allen Cheng FRACP (Alfred Health; Monash University; ATAGI; TGA)ProductionWritten and produced by Mic Cavazzini DPhil. Music courtesy of Free Music Archive includes ‘Passages’ and ‘Snowfall Intro’ by Kai Engel, ‘Become Death’ by Jahzarr. Music licenced from Epidemic Sound includes ‘Sunstorm’ by ELFL. Image licensed from Getty Images.  Feedback on this episode was kindly provided Frank Beard of the RACP COVID-19 Expert Advisory Group, and the members of the Podcast Editorial Group.Please visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening to the podcast and reading supporting resources. 
The COVID-19 pandemic has brought to public attention, like never before, the work of public health physicians as well as epidemiologists, statisticians and computer modelers. The crisis also shown how hard it is to take decisions affecting the lives of millions when there is so little evidence to go on. Models of viral spread and interventions to mitigate these have become everyday discussion points, but few people understand how hard these are to put together. In this podcast we share expert talks that were presented at the RACP Congress in April and May. While they precede the latest developments of the delta strain and the National Plan to curb it by increasing vaccination rates, they clarify some of the first principles that go into creating these simulations, and the pressures of giving critical public health advice.Guests Professor Michael Baker FAFPHM (University of Otago)Professor Tony Blakely (Melbourne School of Population and Global Health, University of Melbourne) Professor Jodie McVernon FAFPHM (Director of Epidemiology, Doherty Institute) ProductionWritten and produced by Mic Cavazzini DPhil. Music courtesy of FreeMusic Archive includes, ‘Namaste’ by Jason Shaw, ‘Snowfall Intro’ by Kai Engel, ‘Become Death’ by Jahzarr, ‘The Time is Now’ by Borrtex. Music licenced from Epidemic Sound includes ‘Organic Textures’ by Johannes Bornlöf  and ‘Sunstorm’ by ELFL. Image licensed from Getty Images.  Feedback on this episode was kindly provided Frank Beard of the RACP COVID-19 Expert Advisory Group, and the following members of the Podcast Editorial Group; Rosalynn Pszczola, Seema Radhakrishnan, Duncan Austin, Sern Wei Yeoh, Paul Cooper, Adrienne Torda, Nele Legge, Keith Ooi, Lisa Mounsey, Marion Leighton, Stella Sarlos and Rhiannon Mellor. Please visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening to the podcast and reading supporting resources. 
In 2017, Victoria was the first state in Australia to pass voluntary assisted legislation and has been followed by Western Australia, Tasmania and now South Australia. Aotearoa-New Zealand passed its End-of-life Choice Bill two years ago and that will go live in November. This podcast draws on the experience of some very committed Victorian clinicians who share the lessons they've learned  over the last two years about practical implementation of VAD.The presenters were recorded at this year’s RACP Congress held in May. Palliative care physician Danielle Ko explained how Austin Health has prepared and supported its healthcare staff through this shift in practice. Palliative care Greg Mewett described the challenge of consulting remotely with patients in regional Victoria. Professor Paul Komesaroff reflected on some other points of friction in Victoria’s law as it stands and the practicalities of medical practice. And Professor James Howe talked of his work as a neurologist in a Catholic healthcare institution, and how tensions over assisted dying had been resolved. Guests  Dr Danielle Ko FRACGP FAChPM (Clinical Ethics Lead, Austin Health; VAD Review Board, Safercare Victoria)Dr Greg Mewett FRACGP FAChPM DRCOG (Ballarat Rural Health; Grampians Regional Palliative Care Team)Professor Paul Komesaroff FRACP (Alfred Hospital; Monash University)Adjunct Assoc Prof James Howe FRACP (VAD Review Board, Safercare Victoria)Dr George Laking FRACP (Auckland City Hospital; RACP President Aotearoa New Zealand)ProductionWritten and produced by Mic Cavazzini DPhil. Music courtesy of Epidemic Sound includes ‘Like Clockwork’, by Benjamin Kling, ‘September Skies’ by Silver Maple, ‘Mistranslations by Rand Aldo, ‘Elm Lake’ by Elm Lake, Finally B by ‘Twelwe. Image licensed from Getty Images.Feedback on this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Paul Cooper, Rhinnon Mellor, Loryn EinsteinPlease visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening to the podcast and reading supporting resources. 
Acute Kidney Injury makes a greater contribution to early mortality than acute myocardial infarction and it's been argued we should consider the concept of “kidney attack” to give it the weight that it deserves. But the presentation of kidney injury isn’t as overt or timely as a heart attack often is. While serum creatinine is a pretty good reporter of chronic impairment in kidney function it’s very insensitive to acute injury, so for two decades there’s been a concerted search for more proximal biomarkers of AKI. The three most promising candidates are neutrophil gelatinase‐associated lipocalin (NGAL), tissue inhibitor of metallo-proteinase 2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGBFP-7). Commercial assays for these exist that can predict moderate to severe AKI with a lead time of many hours in at-risk patients. But many questions remains as whether these are specific enough to be useful at point of care whether we have the interventions to respond to the information they provide, and what ‘false positives’ might indicate.Guest  Professor Rinaldo Bellomo AO FRACP FCICM FAHMS (Director of Research Intensive Care, Austin Hospital; University of Melbourne; Monash University). author of “Novel renal biomarkers of acute kidney injury and their implications” (2021) Internal Medicine Journal 51;3 pp316-318ProductionWritten and produced by Mic Cavazzini DPhil. Music courtesy of FreeMusicArchive includes ‘Downhill Racer’, by Blue Dot Sessions, ‘Making a Change’ by Lee Rosevere, ‘Fryeri’ by Kai Engel, ‘Subscribe to the New Internationalist’ by Tzara. Image licensed from Getty Images.Feedback on this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Vicka Poudyal, Paul Cooper, Rhiannon Mellor, Duncan Austin, Seema Radhakrishnan, Phillipa Wormald, Victoria Langton,  Oliver Dillon and Loryn Einstein.  Please visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening and additional reading. 
This is the third and final part of our series on gendered medicine. We step back and look at the way that health care and research are funded. It’s been said that the health needs of women are undervalued by our existing fee-for-service model, down to individual item numbers in the Medicare Benefits Schedule. There’s also evidence that disease predominantly experienced by female patients receive less research investment. Is this blatant sexism or a symptom of other structural imbalance? And what do we do about it? Guest  Dr Zoe Wainer BMBS, PhD, MPH (Director of Clinical Governance, BUPA)ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Lullaby’ by OOy, ‘Cocktail’ by Major Tweaks, ‘Soul Single Serenade’ by Dusty Decks, ‘Elm Lake’ by Elm Lake, ‘Kauko’ by Twelve, ‘Fugent’ by Lupus Nocte. Voice acting by Ai Leen Quah. Image by Claudius Vesalius courtesy of Wikimedia Commons. Feedback on this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Ilana Ginges, Sern Wei Yeoh, Lucy Haggstrom, Nele Legge, Ketih Ooi, Adrienne Torda, Li-Zsa Tan, Loryn Einstein, Vicka Poudyal, Rhiannon Mellor, Rosalynn Pszczola. Other reviewers include Dr Lucy Mitchell and Rebecca Lewis, Elyce Pyzhov, Michelle Daley, Cristiana Palmieri PhD and Dr Anna Sidis DCP. Please visit the RACP website for a transcript and embedded citations. Fellows of the College can claim CPD credits for listening and additional reading. 
Gender can be considered a social determinant of health, in the different pressures and expectations it puts on women and men. For example, the taboos around menstruation are so profound that many young women are dangerously naïve about their own reproductive health. Meanwhile, endometriosis, chronic fatigue syndrome, and other conditions associated with chronic pain have a stigma around them that means self-reports are often not taken seriously by health professionals. Historic notions of hysteria have a more profound impact on medical thinking than we might imagine, and in this podcast we ask what can be done to erase these. GuestGabrielle Jackson (Associate News Editor Guardian Australia, Author Pain and Prejudice)  ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Elm Lake’ by Elm Lake, ‘Soul Single Serenade’ by Dusty Decks, ‘Desert Hideout’ by Christopher Moe Ditlevsen, ‘September Skies’ by Silver Maple, ‘Fugent’ by Lupus Nocte. Image licenced from Getty Images. Voice acting by Paul Curtis. Feedback on this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Ilana Ginges, Sern Wei Yeoh, Lucy Haggstrom, Nele Legge, Ketih Ooi, Adrienne Torda, Li-Zsa Tan, Loryn Einstein, Vicka Poudyal, Rhiannon Mellor, Rosalynn Pszczola. Other reviewers include Dr Lucy Mitchell and Rebecca Lewis, Elyce Pyzhov, Michelle Daley, Cristiana Palmieri PhD and Dr Anna Sidis DCP.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  
This is the fourth and final part in our series on Global Health Security. Australia’s Indo-Pacific Centre for Health Security was launched in 2017 to provide development assistance to health services as far-flung as Fiji, Cambodia and Timor L’este. Its mission is always tailored to the needs of the partner government. In Indonesia it has provided training to the veterinary sector to foster antimicrobial stewardship. The 2020 COVID-19 pandemic was a sudden shock to the development agenda and has forced a rapid redeployment of resources. Since recording this interview there has been an additional $500 million dollar commitment to fund doses of COVID-19 vaccine and technical assistance to the Pacific and Southeast Asia. GuestsRobin Davies (Head of Centre, Indo-Pacific Centre for Health Security)Dr Stephanie Williams AFPHM (Australia's Ambassador for Regional Health Security, Indo-Pacific Centre for Health Security)ProductionWritten and produced by Mic Cavazzini. Music courtesy of Free Music Archive includes ‘Cast in Wicker’ and ‘the Zepplin’ by Blue Dot Sessions, ‘Linger’ by David Szezstay and ‘Dormir’ by Monplaisir. Photo by Lazslo Mates licenced from Shutterstock. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  
We traditionally think of cardiovascular disease as a man’s problem, but it’s the leading cause of death for women as well as men in most of the industrialized world. Despite great advances in the management of heart disease in recent years, women are still not getting the same quality of care as men. Readmissions and mortality following an acute myocardial infarction at least two times higher in women as they are in men.  Put simply, cardiovascular disease is better understood in men, the presentations and diagnosis occur more promptly, and therapies are more consistently delivered to male patients. In this episode we explore the subtle biases at every stage that nudge male and female patients down different health pathways and result in gendered health outcomes. Guest Associate Professor Sarah Zaman FRACP (Westmead Hospital, University of Sydney)Production Written and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Dew’ and ‘Vargtimmen’ by Da Sein, ‘Spring’ by Cora Zea, ‘Missing Memories’ by Christopher Moe Ditlevsen and ‘Feels Like I’m Going Crazy’ by Tigeblood Jewel. Image licenced from Getty Images. Editorial feedback for this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Sern Wei Yeoh, Joseph Lee, Phillipa Wormald, Rhiannon Mellor,  Seema Radhakrishnan, Atif Mohd Slim and Li-Sza Tan. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  
In this episode we present some provocative solutions to problems presented in the previous two stories.We heard about pharmaceutical patents, and how embedded intellectual property law is in global trade relations. There’s this fundamental assumption that innovation occurs thanks only to the vigour of the private sector and the plucky entrepreneur. It’s even been said that financialized capitalism is “the greatest engine of progress ever seen.” But the reality is that shiny smartphones and targeted drugs wouldn’t exist without massive government spending on research. It’s public money that funds the riskiest stages of development, before private enterprise takes these products to market with the benefit of monopoly pricing. Dr Owain Williams and Associate Professor Peter Hill argue that states can demand more control over the outputs and pricing of drug and vaccine research, and that the current intellectual property regime is not the only way to stimulate innovation. In the second part Associate Professor Adam Kamradt-Scott talks about the lessons learned and not learned from pandemic modelling in past years. He also makes the case for establishing an Australian Centre for Disease Control with standalone jurisdiction, to cut through some of the conflict we’ve seen in recent months between state and federal leaders.  GuestsDr Owain Williams (University of Leeds) Associate Professor Peter Hill AFPHM (University of Queensland)Associate Professor Adam Kamradt-Scott (University of Sydney, United States Studies Centre)Production Written and produced by Mic Cavazzini DPhil. Music courtesy of Free Music Archive includes ‘Cherry Blossom’ by Daddy Scrabble, ‘Sunstorm’ by ELFL, ‘Mister S’ by Tortue Super Sonic and ‘Club Crunk for Monkeys’ by Kromatic. Image licenced from Getty Images. Editorial feedback for this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Sern Wei Yeoh, Leah Krischock, Saion Chaterjee, Priya Garg, Victoria Langton and Joseph Lee.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  
This is part 2 in our series on global public health and focuses on the impact of intellectual property laws on the development and distribution of pharmaceuticals. The COVID-19 pandemic has stimulated a frenzy of vaccine development never seen before, but also examples of hoarding, price hikes and vaccine nationalism. The crisis has brought together scores of governments, manufactures and philanthropic organisations to pool research outcomes and patents, but the response from big pharma has been mixed. We’ll discuss where the IP rules have come from and where exceptions are sometimes made for public health emergencies. We also discuss how pooled procurement mechanisms and advanced market commitments can help get drugs and vaccines to populations in developing countries and whether COVID-19 can prompt a permanent change to the existing IP regime.Guests Dr Owain Williams (University of Leeds) Associate Professor Peter Hill AFPHM (University of Queensland) Dr Deborah Gleeson (La Trobe University) Production Written and produced by Mic Cavazzini. Music courtesy of Free Music Archive includes ‘Let Us Overcome’ by Tayler Watts, ‘Passages’, ‘Global Warming’ and ‘Salue’ by Kai Engel, ‘Electro Cool’ by 4T Thieves, ‘Capgras’ by Ben Carey and ‘Sunstorm’ by ELFL. Image licenced from Getty Images. Editorial feedback for this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Sern Wei Yeoh, Leah Krischock, Saion Chaterjee, Priya Garg, Victoria Langton and Joseph LeePlease visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  
During the COVID-19 crisis there has been some criticism of the World Health Organisation as to whether it declared a pandemic soon enough or covered up for China’s failings. But few commentators have explained the role and responsibilities it shares with its member states in dealing with a pandemic. A prototype of the International Health Regulations were conceived during the cholera epidemics of the mid 1800s, and but the most current version of the IHR was formalised in 2005 in response to SARS. Associate Professor Adam Kamradt-Scott has documented the political and social factors that have accompanied the implementation of the IHR. In this podcast we consider how the unprecedented scale of the current pandemic and the mixed response from member states has challenged the viability of the WHO.GuestsAssociate Professor Adam Kamradt-Scott (University of Sydney, United States Studies Centre) Production Written and produced by Mic Cavazzini. Music courtesy of Free Music Archive includes ‘Amsterdam’ by LASERS , ‘Capgras’ by Ben Carey and ‘Let Us Overcome’ by Tayler Watts. Image licenced from Getty Images. Editorial feedback for this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group;  Rosalynn Pszczola, Li-Zsa Tan, Michael Herd, Sern Wei Yeoh, Oliver Dillon, Priya Garg, Ilana Ginges, Duncan Austin, Saion Chaterjee, Leah Krishchock and Lisa Mounsey Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  
In episode 59 we shared a sampler of the Essential Ethics podcast from the Children's Bioethics Centre, at the Royal Children’s Hospital, Melbourne. A couple of cases studies were presented to help us define “the Zone of Parental Discretion” – a space in which decision-making about a child’s medical care is conceded to parents even if it’s not optimal clinical management.Today’s thought experiments come from the oncology department. First, we’re asked to consider when an adolescent should be permitted to make autonomous decisions about their health, even if these would lead to worse clinical outcomes. How does a clinical team decide whether to accept this wish or to override it?    In the second case study, the final outcome has already been determined by an incurable brain tumour. A 14 year old girl has been diagnosed with a high grade medulloblastoma. Therapy has little chance of cure but around 30% of patients have their life prolonged by 2 or 3 years but comes with disabling side effects. The parents want to bypass recommended treatment and try prayer and natural therapies instead . Does this terminal prognosis broaden the zone of parental discretion, and how can the clinical team help the family with the terrible choices they have to make? GuestsProf John Massie FRACP (Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute)Associate Professor Clare Delany (Children’s Bioethics Centre, University of Melbourne)Diane Hanna FRACP (Royal Children’s Hospital, Melbourne, Walter and Eliza Hall Institute of Medical Research)Kanika Bhatia FRACP (Royal Children’s Hospital, Melbourne)Molly Williams FRACP, FAChPM (Royal Children’s Hospital, Melbourne) ProductionWritten and produced by Mic Cavazzini. Music courtesy of Free Music Archive includes ‘A Path Unwinding’ , ‘The Air Escaping’ and ‘Vittoro’ by Blue Dot Sessions. Image licenced from Shutterstock.Editorial feedback for this episode was kindly provided by members of the RACP’s Podcast Editorial Group; Lisa Mounsey. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  
In the previous episode we discussed the presentations and screening of delirium, as well as the risk factors. Just as important as these medical and iatrogenic precipitants are a host of environmental triggers that are highly modifiable. Anything that contributes to a person’s disorientation and discomfort can increase the likelihood of a delirium episode. While a lot of these factors are compounded in elderly and frail patients, it’s important not to be fatalistic. Delirium can be reversed in a majority of patients by non-pharmacological means. There are no medications indicated for treatment anywhere in the world. Psychtropic drugs should only be considered in patients experiencing severe distress intractable by other means as they are associated with many adverse side effects.GuestsAdam KwokProfessor Meera Agar FRACP FAChPM (Liverpool Hospital, UTS) Professor Gideon Caplan FRACP (Director of Geriatric Medicine, Prince of Wales Hospital, UNSW)  ProductionWritten and produced by Mic Cavazzini. Music courtesy of Free Music Archive includes  ‘See You Soon’ by Borrtex, ‘Remember the Archer’ by Scott Holmes, ‘John Stockton Slow Drag’ by Chris Zabriskie, ‘Tam814’ by LJ Kruzer and ‘Listen, Lisbon’ by Loch Lomond. Picture licenced from Getty Images.Editorial feedback for this episode was kindly provided by members of the RACP’s Podcast Editorial Group; Sern Wei Yeoh, Seema Radhakrishnan, Phillipa Wormald, Duncan Austin, Joseph Lee, Adrienne Torda,  Marion Leighton, Oliver Dillon, Atif Slim, Andrew Whyte, Rhiannon Mellor.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  
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