Australia now has a National Anti-Corruption Commission (NACC). Three cheers for that, and definitely not before time. In the first few days, over 300 complaints were submitted and the flow is not subsiding. Meanwhile, over the past few weeks, we have had news of an unbelievable scandal involving the massive international auditing firm, PWC. It seems the Federal Government contracted them to provide advice on how to formulate tax laws to prevent multinational companies hiding all their profits overseas and not paying tax. This is a huge problem, especially with the fossil fuel companies.
What happens is that a company, let's say the Blackheart Coal Company (BCC), mines coal and transports it to a port for export. Their total cost of mining the stuff and transporting it to the point where it drops into the ship is something like $100 per tonne. The current price of thermal coal here is $140/tonne, so you'd expect they'd be liable for tax on $40/tonne profit. Not so. They don't sell it to the final purchaser who pays that price. Instead, they sell it to a company in a tax haven like the Cook Islands or the British Virgin Islands, for $101/tonne. That way, they make very little profit and hardly have to pay tax. The second company then sells it on to the power or steel companies in Korea or China or wherever, who pay the full price, and the Cook Is. company, which is also owned by the parent of the Australian mining company, pockets the difference, except there is no tax to pay.
So the huge multinational audit firm, PWC, were asked to devise a way of dealing with this so the Government wasn't cheated of many billions of dollars of tax each year (international tax evasion is Very Big Money). So far so good, except it now seems that while PWC were charging the Federal Government untold millions for tax advice that any sensible person could provide free, they were busy selling that information to their international clients, who include many of the multinational mining companies that don't pay tax here. At first, PWC said it was only one rogue partner but it now seems there were 58 people in on it, as well as their many overseas connections. Is that corruption? It sure smells like it to me but the matter will go to the NACC to decide. At the same time, the OECD was pressuring the Labor Government in Canberra to weaken its legislation, which they did.
Continuing the theme, we've just had the decision of the New South Wales Independent Commission Against Corruption (ICAC) on their enquiry into the conduct of the former premier, Ms Gladys Berejiklian. After lengthy enquiries and even lengthier delays, they found she was guilty of "seriously corrupt conduct" but which wasn't quite illegal. Bearing in mind that she didn't make any money out of it, she comes across as a complete idiot and dupe of the people who did make the money. However, it hasn't cost her the post-parliamentary career that is now considered normal for all ex-pollies: earlier this year, she was appointed to the board of Optus, a major telecoms company, and they don't see reason to sack her.
And on Friday, we heard the decision of the inestimable Catherine Holmes SC after what is known as the Robodebt Royal Commission (a Royal Commission is the highest form of investigation in this country, with very extensive powers of subpoena). Robodebt was a scheme cooked up by the former (Liberal-National) government to screw money out of the undeserving, meaning people on unemployment benefits. After sitting through 3,000 hours of evidence and dredging through 10,000 exhibits, some of which were very long, Justice Holmes concluded the scheme was not just inherently unfair but was "cruel and crude," with devastating effects on the people least able to deal with it. Moreover, it was simply illegal, which everybody involved in setting it up and administering it (i.e. the government of the day and the highest levels of the Public Service) either knew or should have known. Her report, all 900 pages, has been made public. An addendum, recommending civil and criminal charges against unnamed persons, has gone to the Director of Public Prosecutions. We can but hope....
This comes on the back of the recent Royal Commissions into sexual abuse of children in care, the banking and insurance industries, the aged care industry, and the current Royal Commission into suicides in the military and veterans (I have submitted a lengthy report to this enquiry). And... we mustn't forget the saga of the recent defamation case involving the most highly decorated soldier in the country who didn't like being accused of murdering civilian prisoners in Afghanistan. The court found he probably had done and left him with (at least) $25million in legal costs.
Taken all round, it's starting to look as though the people we have entrusted to run the country according to the rule book have simply taken us for a ride. So with that scary thought lurking in the background, we turn (again) to the matter of psychiatry and psychotomimetics (yes, so am I). On March 14th, I posted a commentary on the rush approval job on using esketamine, and on May 2nd, reported on the excitement among psychiatrists in this country as we ready ourselves to become the first country in the world to approve MDMA and psilocybin for psychiatric treatment (if you can't access those files, email me). On Tuesday July 20th,the RANZCP will host a "Member webinar: Psychedelic-assisted therapy: A clinician’s perspective," i.e. the training will start after the drugs are released. At the risk of grinding more back teeth to a powder, I will watch it and report in due course.
Psychotomimetics (drugs that mimic psychosis) as treatment; bringing ADHD to the masses; transcranial magnetic stimulation (TCMS); now transcranial direct current stimulation (TCdcS); deep brain stimulation (DBS); the local ECT industry bowls along cheerily, six times more productive than those sluggards in New Zealand; drugs, drugs and more drugs ... is there no end to the miracles flowing from psychiatry's cornucopia of surprises? Soon, there won't be any mentally-troubled people left, the last few in the country will be able to hold out to be paid by the psychiatrists clamouring to treat them.
Joking. As the rates of "treatment" go up, so too do the rates of suicide, and of people granted pensions for mental disability, and the number of workdays lost for mental reasons, and the total costs of treatment, and so on. What we are seeing is a feeding frenzy as psychiatrists flock into private practice and start advertising their wares to the unwary. And charging essentially what they like. If you would like a lifetime of subsidised amphetamines, all you have to do is pay the psychiatrist $2500 (or more) and Bob's your uncle, you've got the diagnosis and nobody will ever dare take it off you.
It has to be understood that private psychiatry has become an industry whose purpose is making money. That's true of all industries, of course, that's what industries do, but the point is that psychiatry is no longer a service. In the main, mainstream medicine is still a service, it exists to get people better (perchance to make a comfy living doing it). There are always a few money-grubbers, that's true of every avenue in life, but the psychiatric agenda is now being set by people whose primary motivation is using the government to expand their business models without limit.
In this context, it was surprising to see the July issue of the Australian and New Zealand Journal of Psychiatry carried two brief editorials on the approval process for MDMA (an amphetamine, commonly known as ecstasy, for PTSD) and psilocybin, which is derived from a wide range of fungi, mainly the Psilocybe, for "treatment-resistant depression" (both articles have open access). You may recall that the drugs can only be prescribed in conjunction with a process of psychotherapy. The first paper, The down-scheduling of MDMA and psilocybin(e): Too fast and too soon, by Dr Steve Kisely, of University of Qld Medical School, is important because he was asked by the Therapeutic Goods Administration (TGA) to lead an independent report on the use of these chemicals in psychiatry. The report recommended delaying any decisions pending further information. Surprisingly, the TGA ignored this expert opinion, apparently preferring to listen to some 3,500 private (non-technical) submissions, mainly organised by a group (Mind Medicine Australia, MMA) which is registered as a charity but functions as a lobby group.
The second paper should also carry weight as it was written by the only group in the country who are actually conducting research on these drugs in this country. Under the snappy title Why didn’t the TGA consult with Australian researchers and clinicians with experience in psilocybin-assisted psychotherapy for treatment-resistant major depressive disorder? the authors said: " ... it seems the TGA has yielded to pressure from the public and lobby groups to increase access to these experimental treatments, outside of clinical trials" (i.e. "with no evidence"). They concluded:
... many questions remain. These include (but are not limited to):
- what are the best models of psychotherapeutic care to be delivered alongside the psychedelic dosing?
- what is the long-term safety profile, especially in terms of psychological recovery and relapse? and
- how might we differentiate those patients who will benefit from those for whom it could actually be detrimental?
Until these questions have been addressed in empirical research, the decision to increase public access outside of clinical trials is questionable, if not concerning.
This is polite talk for "We don't actually know what we're doing." The drugs must be combined with psychotherapy. OK, what's that? What model, who's giving it and with what qualifications, for how long, what are the cut-off points, and if it doesn't work, who's responsible? It is a drug failure, or a failure of therapy?
But the real question is: What is the nature of depression that if biological treatment fails, you simply swap to psychological treatment and press on? For the past half-century of more, we have been subjected to a barrage of propaganda from the biological psychiatry industry telling us that all mental disorder is actually a physical disorder of the brain and should therefore be treated with either drugs or physical agents such as ECT. In this approach, talk is of no more benefit that trying to talk a patient out of having cancer. Suddenly, talk is back on the agenda, except psychiatrists have forgotten how to do that. There are very few psychiatrists in this country who have anything more than rudimentary skills in psychotherapy (CBT does not qualify). Moreover, none of them has a model of mental disorder anyway, but we all know that they'll make sure they get their cut of the huge fees that will be charged.
The closer you look, the worse the smell about this whole business. Did the TGA make a mistake in authorising these drugs, or did it give in to pressure from a self-declared pressure group? If the latter, what was the evidence that convinced the TGA to go against the proper advice (like, "Let's take this business very slowly")? Where is that evidence? If it's not available then suddenly, we're starting to think "There's something fishy going on here." That's why we have an NACC. Maybe we can start to hope that the day of backroom deals being stitched up to benefit a self-appointed few is over, but people have to be involved. If it isn't supported, the NACC itself will be stitched up.