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Address to 2015 Medical Graduates of the University of Adelaide

Presenter: Emeritus Professor Alastair MacLennan

 

Professor Randall Faull, Distinguished academics, medical graduates of 2015 and your proud and sometimes amazed relatives and friends,

It is a little daunting to be asked by the medical school to give such an important address at your commemoration ceremony because professionals wreak terrible retribution on their fellow professionals if they do not come up to expectations.

They tend to debase their victim.

For example, when doctors err,       they are deregistered

when lawyers err,     they are debarred

and when priests err ,     they are defrocked

However, I understand that when

Musicians err, they are decomposed

Clerks     are       defiled

Secret agents     are       despised

Traffic Wardens are       defined

Jockeys          are       derided

Cosmetic surgeons       are         defaced

Film stars         are       defamed

And Lawyers            are       debriefed

 

However, if I fail the Faculty

And if I fail as a Scottish Obstetrician will I be de-livered,

My haggis de-hydrated , my kilt de-pleated,

And whatever is under my kilt, de-pilated, de-mand and de-vitalised?

 

Well as an obstetrician and gynaecologist, with an interest in evolution, I was going to talk to you about Charles Darwin’s De-scent of Man but I

De-cided that it would be De-finitely Dangerous to stick to the DE words, so I would rather than talk about “ The Ascent of Man and Woman” in terms of the improvements in population health in the last two centuries. But now we are handing over the health of the nation to you graduates at a time when public health has the potential to deteriorate. I shall explain but let’s remember what has happened to date.

Charles Darwin would be amazed that since his death just 150 years ago, that men and women have evolved rapidly, from having an average of 18 pregnancies, with a very high infant and maternal mortality rate, to an average of 1.8 pregnancies with very low mortality.

– Over the same time, the average age of a mother’s first birth has moved from 17 to 30 years of age.

– Women’s life expectancy has increased from an average age of 41 in Darwin’s time, to an average age of 86 in 2015.

In Darwin’s day, women usually died rapidly, before the end of reproductive life, from haemorrhage and sepsis. But now women face a slow deterioration in health with an average of 9 disability years, in the care of others.

She dies from new diseases often associated with longevity, such as,

Cardiovascular Disease, Age related Cancers, Dementia or Hip Fracture.

Men have a shorter period of 6 disability years, before presumably – being shot by their wives!

What extraordinary evolution in such a short time.

We have a new way of life and a new way of death!

The rapid evolution and the ascent of mankind’s health are due mostly to major improvements in medical research, education and clinical practice.

But these huge changes in demographics are going to give you graduates, very different public health challenges from those faced by us on this stage.

 

When I was born there were 2 billion people on this earth and now there are 7 billion with an expectation of 11 billion in your life time.

The increasing overcrowding on our planet will bring you graduates political and health challenges such as more wars, mass starvation, mass migration, pan epidemics and reduced health budgets.

Despite the growing world population, mostly in underdeveloped countries, in developed countries such as Australia women are delaying pregnancy and are having less than 2 children per family with a projected average of 1.4 in Australia by the next decade.

It looks as if we are going to have more grandparents than grandchildren.

So the challenges for you Australian graduates will be population longevity and chronic disability.

 

Another problem today is the unabated challenge of non-evidence-based alternative medicine. The selling of “woo” to an unscientific public. You will need to practice evidence based medicine to overcome real health issues and not succumb to selling the worried well, nonsense based placebos that they think they need because Ricky Ponting and Oprah Winfrey promote them.

Professor David Gorski, a critic of alternative medicine, recently said

“When health fraud turned into ‘alternative medicine’ and then evolved into ‘complementary and alternative medicine’ and then reached its final form of ‘integrative medicine’ the language war was lost. That’s how quackery became accepted as main stream.”

However, your degree in evidence-based Medicine and Surgery is a quality degree of which to be proud. But many Australian Universities and Colleges, but not to its great credit The University of Adelaide, have succumbed to the financial lure of running pseudo-scientific degree courses with very low entrance scores, in unproven therapies such as iridology, naturopathy, homeopathy, reflexology, kinesiology, healing touch, aromatherapy and chiropractic. A sub-group of chiropractors make unscientific and baseless claims that they can “adjust” and correct mythical and invisible “subluxations” that are magically connected to all types of organ dysfunction, and in particular childhood diseases, that can be cured by their magical adjustments. Some alternative practitioners are anti-vaccination decreasing the herd immunity of Australians. Polio and tuberculosis could return to our shores. You will need to compete against these alternative medicine graduates and their potential to give misinformation, delay effective therapies and sometimes cause serious adverse events such as stroke after neck manipulation.

You will also need to work against your elected government and its unwillingness to regulate both individual snake-oil salesmen and large Australian alternative medicine companies that push the extensive use of unnecessary vitamins or supplements. Australia’s political parties tacitly accept minimal regulation of alternative therapies and alternative therapists, because they accept huge donations from the alternative medicine industry.

Now I am not against the right of an informed public to use belief-based alternative therapies and therapists. Many in this audience will want to believe in them and I support their right to choose when given accurate information.

But, we should fight against the commercial purveyors of alternative therapies

who make false claims for their therapies they sell. The high and increasing use of alternative therapies is a testament only to widespread advertising and not to their efficacy and safety. Last month the New England Journal of Medicine recorded in the US, 23,000 hospital admissions per year for adverse events after the use of so called health supplements.

But don’t think that these will be your only battles against quackery after graduation. Your next King of Australia, Charles, is a fervent supporter of alternative medicine and it’s hocus pocus. Prince Charles helped fund the first chair of alternative medicine in Exeter, UK, and then had its chair, Professor Edzard Ernst, dismissed because Professor Ernst was evidence based and kept publishing that there was no good evidence to support any complementary therapy.

In Queen’s Square London, there is the very distinguished National Hospital for Neurology and Neurosurgery but it has no royal imprimatur. Next to it is The Royal Hospital – for Homeopathy, recently renamed the Royal Hospital for Integrative Medicine. You can’t integrate unscientific cods wallop with evidence-based medicine.

So you will have to stand up against Oprah Winfrey, Ricky Ponting, your government and your next king and forego your knighthood!

The degree you receive today, after 6 years of learning, has given you the ability to discriminate between nonsense, belief based commercial medicine, and on the other hand, scientifically evidence-based therapies that benefit the patient and not you. That very important piece of paper you will receive on this platform today is testimony that you can, and will, practice evidence-based medicine for the good of your patients.

Alternative practitioners do not have the exclusive license on empathy and compassion. You are very capable of that too, and you have therapeutic honesty. Sometimes you can offer no therapy but with sympathy and humanity explain why – and help them avoid the expensive, useless and potentially dangerous therapies offered by dubious “wellness institutes”.

The word “Wellness” is the badge of quackery!

So has the Ascent of Mankind’s Health peaked? Will it now decline?

Can you graduates meet these challenges?

Will Australia become a country of infertile, obese, infirm and insolvent geriatrics spending their last savings on gin seng and phytoestrogens, with few Australians young enough, to look after them?

Having met you, I have every faith that you will meet these challenges.

 

Graduates of 2015, ladies and gentlemen, thank you for letting me stir a little about the immense changes and improvements in medicine over the last two centuries and the challenges and dangers in the future which you have the chance to avert.

As you have taken it all in good humour, I shall finish in a similar vein to the way I began, by

 

REminding you, that

When we are successful in Research, we are REgarded, REwarded, REfunded, REcruited and REjuvenated.

But if our peers do not like what we REveal,

We are REdressed, REviled, REtrenched, REmoved and REtired.

Once again other professions are cruel to their peers who upset them

Nudes are REdressed

House agents are REleased

Cardiologists are REpulsed

Poets are REversed

Undertakers are REhearsed

And idiots are REminded.

I hope today that by working together, you graduates of this fine university can

with REgard and REspect for each other’s role and training,

REtain your REputations, and

REverse the REcent RElapse, REcession and Regression in Alternative Recidivism

So that YOU graduates of 2015 can continue   – The Ascent of MANKIND!

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