Search

Millions of Australians use the private health system every year. They should receive safe, high-quality, value-based care. However, poor policy and inadequate regulation of medical technology is driving low-value care at great expense to consumers and the broader health system. Key drivers include the Prescribed List of Medical Devices and Human Tissue, gaps in quality and safety controls for devices being used, and marketing and conflicts of interest. All of these should be addressed to reduce low-value care in Australia's private health system, so consumers are protected from harm and limited health budgets are used effectively. What is known about the topic? With health expenditure rising unsustainably, there is a growing focus on ways to reduce low-value care to improve health outcomes and eliminate unnecessary costs. What does this paper add? This paper details drivers of low-value care in Australia's private health system and recommendations to overcome them. Drivers include the Prescribed List of Medical Devices, gaps in safety and quality controls, and conflicts of interest and marketing. What are the implications for practitioners? These insights are relevant to clinicians, researchers, policymakers, consumers and health business leaders with an interest in low-value care. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

This paper explores the role of consensus statements in a risk society. It uses Beck's theory of risk to show that scientists have employed consensus statements in order to re-establish faith in science. Through analysing the goals of participants in consensus fora and comparing them to the fora processes, this paper considers how consensus statements and guidelines in public health can be viewed as remedies for the decline in expert trust experienced in the current risk society. To collect data, 25 interviews were undertaken with consensus panel participants from the USA, UK and Australia. Interviewees were from peak national agencies/commissioning agencies and were categorised as policymaker, practitioner and consumer stakeholders. Participants made recommendations for improving consensus processes in order to mitigate perceptions of risk. These were: (1) clearly stated goals; (2) robust, evidence-based and transparent processes of methodological development and participation/deliberation/decision-making; (3) diverse stakeholder representation, including increased consumer participation; (4) transparency about conflicts of interest; and, (5) robust, carefully worded recommendations. Poor-quality consensus statements can further entrench scepticism about the scientific enterprise. While consensus statements can be seen as a tool for moderating perceptions of risk, policymakers and scientists must ensure the integrity, strength and transparency of their research methods. This has the potential to facilitate policy, improve scientific accountability to the public and legitimise processes. While fostering greater trust is not a primary objective for scientists, an increase in legitimacy of process can be an important unintended consequence of improved quality consensus statements and an important antidote to the risk society. [ABSTRACT FROM AUTHOR]

Abstract: Aim: This paper reports on the findings from 6 focus groups conducted with Australian medical students. The focus groups sought students' perspectives on how the influence of commercial interests on medical practice and education could be managed. Method: We conducted 6 focus groups with medical students in New South Wales, Australia. Participants were recruited via student‐run medical society and faculty e‐mail lists. Forty‐nine students from 6 medical schools in New South Wales participated. The research team reflected on the extent to which students uncritically appealed to science in the abstract as a management solution for conflicts of interest. Data analysis was largely inductive, looking for uses of scientific terminology, EBM, and appeals to “science” in the management of COI and applied theoretical analyses of scientism. Results: The students in our study suggested that science and evidence‐based medicine, rather than ethics or professionalism, were the best tools to deal with undue influence and bias. This paper uses philosophy of science literature to critically examine these scientistic appeals to science and EBM as a means of managing the influence of pharmaceutical reps and commercial interests. We argue that a scientistic style of reasoning is reinforced through medical curricula and that students need to be made aware of the epistemological assumptions that underpin science, medicine, and EBM to address the ethical challenges associated with commercialised health care. Conclusion: More work is needed to structure medical curricula to reflect the complexities of practice and realities of science. However, curricula change alone will not sufficiently address issues associated with commercial interests in medicine. For real change to occur, there needs to be a broader social and professional debate about the ways in which medicine and industry interact, and structural changes that restrict or mitigate commercial influences in educational, research, and policy settings. [ABSTRACT FROM AUTHOR]

In this paper we report on the findings from six focus groups conducted with Australian medical students. The focus groups discussed students' perceptions of conflicts of interest and the influence of commercial values in health care and medical education. Our research revealed that students were aware of a number of structural influences that affected the medical education they received and that had the potential to shape their attitudes and practices as they progressed in becoming a doctor. We found that the pressures of educational workload and anticipated career trajectories tended to have an individualising effect that limited the perceived possibility of collective action and response to structural influences. We interpreted these findings through the lens of neoliberal governmentality to articulate the way commercial interests are negotiated and normalised by medical students. Based on these findings, we suggest that medical education should not only explicitly alert students to effects of political and commercial influences on the healthcare system, but also encourage the collective agency of students and strategies that do not place unrealistic expectations on individuals to effect structural change. [ABSTRACT FROM AUTHOR]

This paper analyses the issue of whether directors may use reliance on professional advice as a defence to a claim for breach of duty to exercise care, skill and diligence under common law or companies legislation in England and Australia. While England and Australia share the same common law tradition and have similar statutory provisions on the standard of care of directors, an English court generally regards a director as acting reasonably when he seeks advice from a qualified and independent professional adviser in a specialist matter within his expertise. In the absence of any conflict of interest, reliance is only unreasonable if the circumstances are so plain and obvious that no prudent person will rely on the advice. In contrast, recent Australian cases, particularly ASIC v Healey, ASIC v MacDonald and ASIC v Fortescue, restrict the circumstances in which directors can rely on professional advisers, even in specialist matters. This paper argues that the difference in approach between the two jurisdictions can be explained on two grounds. First, the Australian cases can be distinguished from the English cases because the former are special situations dealing with matters involving non-delegable duties of care imposed by legislation. Second, the potential outcomes of the breach of the duty of care differ in England and Australia, and this difference has a much deeper, substantive influence on the content of the standard of care. Contrary to academic suggestion, it is suggested that the Australian developments may not always be appropriate in determining the scope of the defence of reliance on professional advice in England. [ABSTRACT FROM AUTHOR]

While the concept of integrated marketing communications (IMC) is widely acknowledged in the literature, research on potential barriers to its implementation is relatively scarce. In particular, the possible significance of interagency politics and conflicts of interest has received little empirical consideration. This is perhaps somewhat surprising given the generally acknowledged proposition that marketing budgeting is largely a political process. This paper describes an exploratory study of leading Australian public companies and investigates the relationships between perceived agency politics, conflicts of interest and IMC orientation. The findings suggest that the salient conflict of interest is between advertising and public relations firms. The limitations are discussed and directions for future research offered. [ABSTRACT FROM AUTHOR]

Alcohol labelling laws and policy are contentious and highly politicized. Very few countries have been able to implement health warnings on alcohol labels due to complex legal and governance systems and coordinated industry lobbying. In 2020, Australia and New Zealand implemented a mandatory and evidence-based legal standard for pregnancy warning labels on alcohol products. This article discusses some of the challenges faced in achieving policy change and how these barriers were overcome by public health advocacy groups to build the evidence, counter industry conflicts of interest, consumer test health messages, mobilize community support and gather political support. Reflecting on the decades of ineffective regulation and politicization of this health issue, lessons for other countries include the importance of creating and maintaining relationships with decision makers and regularly updating them with evidence and recommendations, highlighting industry failures and tactics, building broad-based coalitions and sharing lived-experiences. [ABSTRACT FROM AUTHOR]

Community-based healthcare organisations manage competing, and often conflicting, priorities. These conflicts can arise from the multiple roles these organisations take up, and from the diverse range of stakeholders to whom they must be responsive. Often such conflicts may be titled conflicts of interest; however, what precisely constitutes such conflicts and what should be done about them is not always clear. Clarity about the duties owed by organisations and the roles they assume can help identify and manage some of these conflicts. Taking divisions of general practice in Australia as an example, this paper sets out to distinguish two main types of conflicts of interest, so that they may be more clearly identified and more effectively managed. [ABSTRACT FROM AUTHOR]

Misinformation has challenged the rollout of COVID-19 vaccination around the world. In 2021, professional bodies for several regulated occupations (including doctors and lawyers) initiated investigations into the conduct of members who engaged in vaccine misinformation, including on social media. This commentary discusses key controversies surrounding this novel disciplinary issue, with the focus on the legal profession in New Zealand and Australia. We consider the difficulties of defining "vaccine misinformation", differentiating between public and private social media use, giving proper scope to rights of free speech, and challenges in identifying financial conflicts of interest and unethical client solicitation practices (eg, profiting from spreading vaccine misinformation). The chilling effect upon freedom of expression when lawyers are disciplined for their social media posts that are deemed unscientific is discussed. [ABSTRACT FROM AUTHOR]

In Australia, there are over 20,000 financial advisers, with only 1% registered as independent financial advisers. This study investigates why there has been no significant transition to independent advising. The importance of the study is underlined by the substantial losses suffered by thousands of consumers from advice that has been found to be influenced by conflicts of interest. Using a qualitative technique, the study undertook exploratory semi-structured interviews among financial advisers. The study found that over 90% of privately owned advisers will not be transitioning to independent advising due to the belief that clients will not pay fees for insurance advice. The study finds strong evidence that the affordability of paying fees for insurance advice arguably outweighs the conflicts of interest associated with non-independent insurance advice. [ABSTRACT FROM AUTHOR]

Ralston et al highlight the ways that different actors in global nutrition governance conceptualise and frame the role of non-state actors in governance arrangements, including the potential for conflict of interest (COI) to undermine global health efforts. The authors argue that the World Health Organization (WHO) draft tool on managing COI in nutrition policy is an important innovation in global health, but that further research and refinement is needed for operationalising the management of COI with diverse actors in diverse contexts. In this commentary, reflecting on strategic framing and industry interference in policy-making, we argue for the urgent need for states and intergovernmental organisations to prevent alcohol industry interference in the development of national and global alcohol policy. We argue that policy incoherence remains a key barrier, where governments pursue health goals in the health sector while pursuing exports and market liberalisation of health harmful commodities in the trade sector. [ABSTRACT FROM AUTHOR]

In The Government and Copyright, John Gilchrist poses the following questions regarding government and the Copyright Act 1968: 'Should the government have a role as preserver of its own and privately owned copyright material? [...] How adequate is the present law to achieve this objective?' Similar questions could be applied to nineteenth-century Australia. As Government Printer, Thomas Richards oversaw the printing operations of the NSW Government Printing Office (GPO). When the Copyright Act 1879 (NSW) was enacted, Richards was appointed Registrar of Copyright and Office of Copyright Registry was situated at the GPO. Why was the government printer responsible for copyright, not the government or the libraries that oversaw legal deposit? Did Richards have the necessary resources? Was there a conflict of interest? This essay seeks to gauge the relationship between the GPO and the Copyright Act 1879 and the wider implications of copyright for nineteenth-century Australian print culture. [ABSTRACT FROM AUTHOR]

In 2016, the Supreme Court of Canada legalized medical assistance in dying in Canada. Similar to jurisdictions where this has been a more long-standing option for end-of-life care, the Supreme Court's decision in Canada included a caveat that no healthcare provider could be compelled to participate in medical assistance in dying. The Canadian Nurses Association, in alignment with numerous ethical guidelines for healthcare providers around the globe, maintains that nurses may opt out of participation in medical assistance in dying if they conscientiously object to this procedure. The realities of implementing medical assistance in dying are still unfolding. One area that has received little attention in the literature thus far is the ability of nurses who aid with, rather than administer, medical assistance in dying to conscientiously object. This is particularly significant in rural and remote areas of Canada where geographic dispersion and limited numbers of nursing staff create conditions that limit the ability to transfer care or call on a designated team. Exercising conscientious objection to medical assistance in dying in rural and remote areas, by way of policies developed with an urban focus, is one example of how the needs of rural nurses and patients may not be met, leading to issues of patient access to medical assistance in dying and retention of nursing staff. To illustrate the complexities of nurses' conscientious objection to medical assistance in dying in a rural setting, we apply an ethical decision-making framework to a hypothetical case scenario and discuss the potential consequences and implications for future policy. Realizing that conscientious objection may not be a viable option in a rural or remote context has implications for not only medical assistance in dying, but other ethically sensitive healthcare services as well. These considerations have implications for policy in other jurisdictions allowing or considering medically assisted deaths, as well as other rural and remote areas where nurses may face ethical dilemmas. [ABSTRACT FROM AUTHOR]

Conflicts of interest (COI) in health and medicine have been the source of considerable public and professional debate. Much of this debate has focused on financial, rather than non-financial COI, which is a significant lacuna because non-financial COI can be just as influential as financial COI. In an effort to explore the nature and effects of non-financial, as well as financial COI, we conducted semi-structured interviews with eleven Australian medical professionals regarding their experiences of, and attitudes towards, COI. We found that this group of medical professionals saw non-financial interests—most notably the pursuit of status and respect and the avoidance of stigma—as potentially conflicting with other important interests (such as patient care). [ABSTRACT FROM AUTHOR]

Purpose General Practitioners (GPs) play an important role in personal injury compensation systems yet system processes have been perceived as burdensome. Objectives were to (1) determine attitudes of Australian GPs on health benefits of return to work (RTW) after injury/illness and (2) identify associations between GP characteristics and agreement with issues surrounding treating compensable patients. Methods Cross-sectional postal survey of 423 Australian GPs to determine agreement with issues associated with compensable patients (including patient advocacy, conflicting opinions between GPs and compensation systems, fitness-for-work certification, and refusal to treat). Results The vast majority of GPs agreed there was a health benefit to early RTW. GPs with 16–20 years' experience had significantly higher odds of agreeing that the certificate of work capacity is the primary method of communication between RTW stakeholders (OR 2.36 [1.13–4.92]) than those with greater experience. 49% of GPs agreed they should be able to refuse to treat compensable patients. Female GPs had significantly lower odds (OR 0.60 [0.40–0.90]) of agreeing with right to refuse than male GPs, as did those from remote or regional practices (OR 0.43 [0.20–0.94]; OR 0.60 [0.39–0.92]) than GPs from urban practices. Conclusions Reducing administrative barriers identified by Australian GPs and improving communication with compensation systems will likely have a positive impact on their refusal to treat compensable patients. [ABSTRACT FROM AUTHOR]

In Australia, the growing assisted reproductive technologies (ART) industry has recently received some public criticism. Much of this criticism centres on the concern that doctors are increasingly motivated by profit, rather than patient interests. These concerns appear to suggest that the growing business of ART generates conflicts of interest (COI) for clinicians. While media reports may be rhetorically compelling, claims that ART practice is distorted by COI must be supported by empirical evidence. This preliminary study sought to engage with people involved with the ART industry and map out their concerns related to COI in ART. A small convenience sample of eight professionals was interviewed. Here, we present the major themes uncovered, including a richer understanding of the 'interests' of various parties involved in Australian ART. We then propose a strategy for how this topic could be constructively explored. [ABSTRACT FROM AUTHOR]

Issue addressed Christian churches have historically undertaken welfare and community service activities to practise faith and increase their relevance to communities. However, the church in Australia has received little attention from health promotion practitioners and researchers. The objective of this qualitative study was to explore the barriers and challenges that affect church engagement in health promotion to assist practitioners' understanding of the potential for these civil society organisations to play a role in health promotion programs and partnerships. Methods The research was based on interviews with five directors of church-affiliated organisations and with the church leaders (ministers, pastors, priests) of 30 churches in urban and rural Victoria. Analysis was iterative using open, axial and thematic coding. Results The challenges to church involvement in health promotion, as articulated by church leaders, fell under the themes of the social context of churches and the attributes of congregations. Major issues raised were perceived relevance, mistrust, contested agendas, discordant values within congregations, and risk management. Conclusion Although churches may take a different stance to health promotion agencies on a range of social and health issues, many have experience addressing social disadvantage and are prepared to commit resources to meet the needs of people outside their congregations. However, several factors inhibit the engagement of churches in health promotion including perceived irrelevance and community mistrust, agendas of conversion and values that conflict with health promotion. So what? Churches have a history of addressing social determinants of health such as housing, employment and food security. Deeper understanding of the challenges and barriers church leaders experience in undertaking health promotion work will facilitate more realistic and effective engagement by practitioners with these organisations. [ABSTRACT FROM AUTHOR]

Politicians and policy makers routinely engage with lobbyists and see them as crucial agents in the political process. But how much do we really know about the Australian lobby system? Although there are a range of reviews of lobby regulation schemes and discussions about the work of lobbyists, a comprehensive contemporary picture of the commercial lobbying system in Australia is missing. Using data from the 'federal lobby register', this article sets out to map the commercial lobbying scene at the national level. Using this as a backdrop, the article goes on to discuss what questions this raises and how we might develop a deeper understanding of the commercial lobbying system in Australia. [ABSTRACT FROM AUTHOR]

The conception of the doctor-patient relationship under Australian law has followed British common law tradition whereby the relationship is founded in a contractual exchange. By contrast, this article presents a rationale and framework for an alternative model-a 'Trust Model'-for implementation into law to more accurately reflect the contemporary therapeutic dynamic. The framework has four elements: (i) an assumption that professional conflicts (actual or perceived) with patient safety, motivated by financial or personal interests, should be avoided; (ii) an onus on doctors to disclose these conflicts; (iii) a proposed mechanism to contend with instances where doctors choose not to disclose; and (iv) sanctions for non-compliance with the regime. [ABSTRACT FROM AUTHOR]

Background:A national Personally Controlled Electronic Health Record (PCEHR) system was made available across Australia in July 2012. While the technical, policy, and commercial aspects of the new Australian PCEHR system were examined thoroughly by the National E-Health Transition Authority in developing the new e-health record system, little attention was given to examining the related ethical implications of PCEHR advances. This article reports on ethical concerns about the new Australian electronic health record system identified by expert stakeholders.Methods:A qualitative study using semistructured interviews with a purposive sample of key informants from Melbourne, Canberra, Brisbane, and Sydney with expert knowledge about electronic health records was conducted. The 12 participants represented a range of health and other professionals, research, policy, and consumer/patient groups.Results:Major themes identified were the importance of privacy safeguards at implementation and in future PCEHR uses, the appropriate uses of PCEHR data in research, unique ethical challenges around children and adolescents with PCEHRs, conflicting stakeholder interests around record access and use, and cultural diversity and engagement.Conclusions:The technical, policy, and commercial aspects of the new Australian PCEHR system have been examined thoroughly to date. A greater focus is needed on the ethical implications of PCEHR advances. A continuing failure to address ethical issues in the national implementation and utilization of the PCEHR could limit its uptake and success in Australia, and is also not without risks to the future participants of such a system. [ABSTRACT FROM PUBLISHER]

Professional sports with high rates of concussion have become increasingly concerned about the long-term effects of multiple head injuries. In this context, return-to-play decisions about concussion generate considerable ethical tensions for sports physicians. Team doctors clearly have an obligation to the welfare of their patient (the injured athlete) but they also have an obligation to their employer (the team), whose primary interest is typically success through winning. At times, a team's interest in winning may not accord with the welfare of an injured player, particularly when it comes to decisions about returning to play after injury. Australia's two most popular professional football codes-rugby league and Australian Rules football-have adopted guidelines that prohibit concussed players from continuing to play on the same day. I suggest that conflicts of interest between doctors, patients, and teams may present a substantial obstacle to the proper adherence of concussion guidelines. Concussion management guidelines implemented by a sport's governing body do not necessarily remove or resolve conflicts of interest in the doctor-patient-team triad. The instigation of a concussion exclusion rule appears to add a fourth party to this triad (the National Rugby League or the Australian Football League). In some instances, when conflicts of interest among stakeholders are ignored or insufficiently managed, they may facilitate attempts at circumventing concussion management guidelines to the detriment of player welfare. [ABSTRACT FROM AUTHOR]

The article addresses the debate over the conflict of interest involving doctors' selling products to patients. According to the provisions of the Health Practitioner Regulation National Law, medical merchandising involves a prima-facie conflict of interest. The Australian Medical Association (AMA) recommends that physicians avoid being affiliated with pharmaceutical firms if the nature of the relationship impacts their practice in an inappropriate manner.

Upon winning the 1996 election, John Howard became the first Australian prime minister to codify his understanding of individual ministerial responsibility by publishing A Guide on Key Elements of Ministerial Responsibility. This article examines how this ministerial code of conduct was applied to significant allegations of ministerial impropriety that occurred during the 1996–2007 Howard era, and highlights the relationship between the media, the Prime Minister's response and the ultimate outcome. It finds that Howard's early rigorous application of the Guide to allegations of conflicts of interest involved political pain and instigated its decline. Howard retreated, redefined ministerial responsibility as requiring deliberate wrongdoing and raised the threshold required for a minister's dismissal. His inability to firmly apply the Guide to instances of ministerial misconduct betrays the traditional view that ministers are responsible for their own actions. The contemporary practice is that ministers do not resign for departmental failures for which they are not personally responsible, irrespective of the gravity of that wrongdoing. [ABSTRACT FROM AUTHOR]

The prospects of engaging police unions in a process of police reform is conditioned by the political context and organisational culture that characterises those unions. Understanding the historical formation of unions and the changing nature of their aspirations and interests is critical to appreciating such prospects. The history of Australian police unions, long established and privileged by high levels of acceptance in their political environment, suggests the need for optimism about police union engagement in police reform to be balanced by a realism about the limitations imposed by their primary purpose, to serve the interests of their members. [ABSTRACT FROM AUTHOR]

Purpose - To show how conflicts of interest and disingenuous investment research at the end of the 1990s stock market bubble occurred in Australia as well as the USA and Western Europe Design/methodology/approach - Reviews the role of research analysts in major securities firms and conflicts of interest such as analyzing and evaluating a company for investment purposes, while seeking the investment banking business of the same company. Provides a case study of how an investment banking firm dealt with a provider of internet search services in both a research and an investment banking capacity. Investigates and evaluates the regulations and guidelines developed and introduced by the Australian regulatory bodies (Australian Stock Exchange (ASX) and Australian Securities and Investment Commission (ABIC)) and the Australian Government to deal with potential conflicts of interest that could affect the objectivity and independence of analyst research Findings - There were examples of conflicts of interest and fraudulent stock recommendations in Australia that rivaled the worst examples in the USA and Western Europe Originality/value - A reminder of fraudulent investment research practices during the stock market bubble and the potential for conflicts of interest between research and investment banking functions within the same firm. [ABSTRACT FROM AUTHOR]

The Cubillo and Gunner hearing in the Federal Court of Australia possessed enormous historical, political and moral significance. The applicants' suit against the Commonwealth argued that having been removed they were then wrongfully detained, that government breached its statutory and fiduciary duties and duty of care, and the Commonwealth was responsible for the injuries and damages they incurred as a result of their removal and detention. They sought monetary compensation and exemplary damages. In response the Commonwealth government sought to have the case for damages dismissed on a variety of grounds. From the perspective of the plaintiffs, the case had the potential to set an important precedent. From the Commonwealth's perspective a lot was at stake. Beyond the financial costs, the government's reputation was at risk. The Cubillo–Gunner action tested the Australian legal system's capacity to deal justly with a critical range of moral, historical and political issues raised by the ‘stolen generations’. In his judgment delivered on 11 August 2000, O'Loughlin J dismissed each of the claims for damages by Lorna Cubillo and Peter Gunner. In this article attention is given to aspects of the case that have not yet received due consideration. It is argued here the Commonwealth government had an overriding resolve to win the Cubillo–Gunner case, which sat incongruously with the principle and practice of the federal government as a ‘model litigant’. I consider whether the Commonwealth breached those standards in respect to three central elements of the model litigant standards — namely (1) the exercise of proportionate power, (2) the over-reliance on technical defences, and (3) a proper regard for accepting a responsibility to administer justice and fair play. I ask whether the appointment of Meagher as the Commonwealth's leading counsel was in the public interest? The case is put that Meagher had a conflict of interest relating to his own biography which connected to the HREOC report on the ‘stolen generations’ in general and the Cubillo–Gunner case in particular. Meager is the son of a man deeply implicated in the politics of Aboriginal affairs during the period under question. (Meagher's father was Chairman of the Aborigines Welfare Board and Minister for Aboriginal Affairs in Victoria until 1972.) Meagher junior was by his own public admission concerned about the findings of the HREOC report and its implications for his father's reputation. He felt it dishonoured his father's name while also sullying the standing of his father's contemporaries. Meagher indicated he believed the case must not be allowed to set a precedent. The public evidence on display in these comments reflects a hostility towards child removal policies which raises questions about the suitability of Meagher's appointment as counsel. As Meagher himself pointed out, he wondered whether his involvement in the case was ‘inappropriate for counsel’ and ‘possibly contrary to the client's interest’, but later decided it was not. His appointment raises questions about the Commonwealth's conformity to the model litigant standards. [ABSTRACT FROM AUTHOR]

The author expresses his views on how a fair review can be done for medical research grants in Australia. The author says that the National Health and Medical Research Council (NHMRC) gives priority to management of conflicts of interest; and confidentiality is also important for the review system. The author says that the grant review panel should have members with diverse skills, who have expertise for the grants being reviewed.

The scandals of the 1980s, extending into the 1990s, came as a profound shock to Australians and New Zealanders. Both countries have prided themselves -- somewhat smugly and naively -- on being open, fair and honest societies. So it was very disillusioning to see both corruption and gross dereliction of duty exposed in virtually every sphere of public life. Perhaps the most positive outcome, however, amidst an almost daily diet of amazing revelations, has been the ability of the 'system' -- and especially the judiciary and the media -- to expose and deal with corruption even at the highest level. Following an extensive survey and literature review, it is clear that there is now widespread awareness of the need for reform in many areas of public administration, corporate governance and professional behaviour. However, a continuing cause for concern is the lack of leadership in identifying and addressing complex ethical dilemmas, particularly in the areas of conflict of interest and disclosure. Feedback from professional bodies, industry associations and university business schools indicates slow but uneven progress in ethics education. While several ethic centres and prominent individual ethicists have introduced innovative programs and given ethical issues greater prominence in the media, narrow vocationalism still takes precedence over personal values in the business and management curriculum. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Compassionate access anti-tumour necrosis factor-α therapy for ulcerative colitis in Australia: the benefits to patients" by S.P. Costello in a 2015 issue. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Attitudes of Australian Emergency Department Clinicians Toward Organ and Tissue Donation: An Analysis of Cultural and Religious Influences" by T. J. Weiland, C. H. Marck, G. A. Jelinek et al., which appeared in the September 2013 issue.