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This is part two of a two part series with Dr. Mike Murphy. On episode one, we took a deep dive into the relationship between the healthcare system and the pharmaceutical industry.
We examined the incentives for a for-profit system that does not necessarily value overall patient health outcomes in the wider social context. Check out episode one if you haven't already.
In the second half of our conversation, we talk about psychedelics. There's a lot of chatter, excitement, and what you may call hype with the emerging studies on psychedelic therapies.
On this episode, we continue to take a sceptical eye on this new field of medicine, cognisant of the risks of falling into the same trap as conventional pharmaceutical silver bullets. We discuss states of consciousness, potential benefits and harms of new therapies, and the need for safeguards during times of significant change.
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As doctors, we rely on the pharmaceutical industry to produce medications, from everyday paracetamol to advanced targeted cancer therapies. The industry faces constant pressure to innovate and create profit for shareholders, while governments face pressure to approve and fund these medicines from patients and clinicians.
What we are seeing is a rise in medicines spending. People are living longer, with more disease and requiring more medications. The newer medicines are costing exponentially more while sometimes providing only small incremental benefit when compared to older and cheaper medicines.
When we only have a limited pot of resources to fund our healthcare system, we need to start asking the question of how effective is this spend and who seeks to benefit? And if we continue promoting a sickness system that is heavily reliant on pharmaceutical silver bullets, will we create a happier, healthier nation?
Joining me on this episode is Dr Mike Murphy, an emergency doctor, and clinical director of medicinal cannabis clinic, Cannaplus. Having been involved in clinical trials, Mike understands the costs, process and drivers of developing new drugs. Together we unpack the complicated relationship doctors have with big Pharma as well as holding a hopeful but sceptical eye on emerging psychedelic therapies.
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Modern day living values universal individual freedom and rights. This has helped open the doors to many great things like individual reproductive choices, same sex marriage and a focus on tackling discrimination against immutable characteristics.
But what are the trade-offs?
I have this growing feeling that we no longer have communities, at least not ones that are robust, intergenerational and will last the test of time. By valuing the successes of individuals, by judging the success of countries based on GDP, the value of families, connected communities and strong relationships are lost in the calculation.
We are living in strange times where much of the conversation is on what divides us, not on what unites us. We are stronger and more productive as a united community if we have shared goals, values and visions.
To talk more about economics, productivity and the social contract, on this episode we have ex-Productivity Commissioner and long time economist Ganesh Nana.
When we talk about health, education, housing, and environment, it is time we take a long-term, intergenerational approach. In times of widespread nihilism about the future, now, more than ever we need hope. We need hope that things will improve and we need action to make it happen.
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As doctors, we carry an enormous amount of risk; sometimes, we quite literally hold people's lives in our hands.
Under these extraordinary circumstances, with increasing expectations and limited health resources, it's no wonder the pressures on our health workforce are sky-high, making hospitals an even less welcoming place for both patients and healthcare workers. It makes you question whether empathy training is truly effective when the system itself isn't designed to enable empathy.
If we want a sustainable healthcare service, perhaps it's time we have some uncomfortable conversations about how we're going to get there. Just because we can do something, does it mean we should? Is it time to collectively re-prioritise our attention and focus given the limited resources we have?
In this episode, I bring you Dr Heidi Baker. When I first started in paediatrics, I wanted to be just like Heidi when I grew up. In this conversation, we discuss the changing landscape of healthcare provision, training, and the responsibility we have to future generations. Heidi has been a role model and mentor for me over the years, and I'm so grateful to now call her my friend.
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This is Revolving Door Syndrome, and I am Dr Nina Su.
Everywhere you look, the statistics tell a story of Maori doing worse. Of Maori struggling, of Maori poverty.
While these statistics are true, it fails to tell the whole story. On this episode of Revolving Door Syndrome, I sat down with Boris Sokratov AKA the Bulgarian Maori to talk about how we can shift the narrative.
Much of the conversation perpetuates low expectations and reinforces dependency when in reality there is plenty for Maori to be proud of. Not only do we need to build a society where every child can succeed regardless of class, colour or creed, we need to have expectations that every child will succeed.
Recently, Boris was diagnosed with a rare neuroendocrine cancer and is currently undergoing treatment. He shares with me his thoughts on life's purpose and the value of service to others.
Boris came from humble beginnings but has become a serial businessman as well as being a driving force for social good with setting up I Am Hope, Brown Buttabean Motivation and The Nutter's Club Radio show. He assures me that he won't let cancer get in the way of achieving his goals, it's just sped up his timeline a little.
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Why in this age of hyper connectivity and social media are we lonelier than ever? Regardless of race, gender, sexuality, or class, mental health for young people is getting worse. Not only do we see it in self-reported surveys, we see it in hospital presentations for eating disorders, self harm, intentional overdose and suicide attempts.
The Harvard Study of Adult Development found that the greatest impact on happiness, health, and longevity wasn't money, social class, or even healthcare access. It was the strength of our relationships.
Consider how much time you spend with your friends, your family, your spouse and conversely how much time you spend scrolling social media accounts.
We've lost so much community and undervalued the power of strong relationships. If you think this affects you, how much do you think it affects kids?
The process of forming relationships, through rupture and repair is critical to the healthy development and success of our children. But if we deprive them of the necessary unstructured, unsupervised device-free play, they will struggle to develop critical thinking and the ability to overcome conflict and adversity.
Joining me on this episode is Dr Emma Woodward. She shares her wisdom as a Child Psychologist and specialist in trauma informed care as well as her learnings as a mother to four sons.
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Falling literacy rates are a concern in New Zealand and developed countries around the world.
The future generations of New Zealanders are based on the early foundations we set in childhood. But if we don't get literacy right, how can we expect children to one day become global leaders in health, education and science?
Strong literacy skills are for everyone, not just for those who can afford private tuition. How we teach in public education and how we encourage behaviours in the home environment can make a world of difference to children in even the poorest most disadvantaged communities.
Even how we frame disadvantage can have its harms. Can we really improve disparities with the widely disseminated deficit mindset of low expectations?
Joining me on this episode is Dr Melissa Derby of Ngāti Ranginui. She is a Senior Lecturer at the Waikato University, Director of the Early Years Research Centre and part of the ministerial advisory group to the minister for education.
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Food waste affects our growers, sellers and our wallets.
It affects our farmers who try to grow food that meets strict beauty standards.
It affects our shrinking household budgets where wasted food is as good as money down the drain.
It affects our environment where wasted food decomposing in landfill contributes to our greenhouse gas emissions and climate change.
All of this while food insecurity is becoming a problem for more and more families in New Zealand
Joining me on this episode of Revolving Door Syndrome are my two guests Kaitlin Dawson and Iain Lees-Galloway. Through New Zealand Food Waste Champions, Kaitlin helps businesses achieve both environmental and economic sustainability through reducing over-production of food. Iain heads Aotearoa Food Rescue Alliance, a network of food rescue organisations taking this extra food and distributing to communities and families who can better use it than our landfills.
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Widespread, free and quality education has lifted the masses out of poverty. Or at least that's what it used to do.
Access to a quality curriculum with teachers who are supported to teach are important factors to get children interested in education.
However, what we are seeing is teachers are increasingly unsupported and overworked. They are having to pick up the pieces for children who are in difficult social situations outside of the school's control. We have rising material child poverty and dire rates of school attendance. These are big problems that require innovation, investment and prioritisation.
One of the programs out there attempting to shift the dial is Lalanga toolbox, created by Lesieli and Daniel Oliver.
Lalanga seeks to take the load off of teachers and provide a quality curriculum that is culturally appropriate for their Maori and Pasifika community. Lalanga is about showing children their potential, inspiring high aspirations and making education into the most powerful tool for success.
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Trust in government and trust in the media are the bedrocks of a working democracy.
True democracy requires the freedoms of speech and expression to allow individuals and the media to hold our government to account.
However an AUT research report found that trust in mainstream media has plummeted to 33% while three quarters of people actively avoid reading the news. There are accusations that the mainstream media are biased in their reporting, telling people what to think rather than reporting on the facts.
Governments of all stripes are increasingly using urgency to pass legislation. How can we expect people to trust in governments that bypass the usual checks and balances?
For a society to continue to achieve progress and prosperity, we need to get better at working together with people of different perspectives and points of view. We need to find our common goals and shared visions.
Joining me today is Tim Wilson, a seasoned journalist whose work has been featured in The New York Times and The Guardian. He was the former US correspondent for One news and a roaming reporter on Seven Sharp. Today, he is the director of the Maxim Institute think tank.
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Let's talk about sex.
Sex education has been a particularly divisive topic, yet hasn't really had the quality debate about what good sex education should look like.
I get it. People probably have very mixed experiences on how sex education was delivered to them by their schools or their parents. Some people feel squeamish about delivering sex education to their own kids and some are concerned about what is being taught in schools. There's so much confusion from parents, teachers and policymakers because there is such a huge variation in what schools can choose to teach.
However, sex education is something we need to get right.
While young people are having less sex than before, the research shows they are having more dangerous sex. They are less likely to use protection and more likely to engage in rough sex. Young people are also more likely to have been exposed to porn at a younger age, much of it rough and non-consensual. Could this be purely correlation or causation?
The stakes are high. It's the welfare of our children we are talking about. We must balance the urge to bubble wrap our children with the need to teach them skills to stay safe on their own. Because newsflash - you won't always be around to protect them.
Joining me on this podcast is Jo Robertson, experienced sex therapist, parenting expert and sex education teacher.
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As the saying goes, an ounce of prevention is worth a pound of cure.
And in the context of our health system, prevention looks like a strong primary care service that’s focused on keeping you healthy and out of the emergency department. The problem is though, Primary Care, as we know it, is broken.
Our current funding model has driven GP practices to the brink of insolvency. Many are forced to close down or are selling out to profit driven corporates, who want to make your sickness work for their shareholders. By overenrolling patients and pushing doctors to see more people in a day, we will see a two tier Primary health care service beginning to form. Where the days of knowing your local GP might be reserved for those that can afford the premium service.
And at the same time, our fascination with medical specialists has relegated the humble medical generalist to the bottom of the pile. Fewer and fewer doctors are interested in pursuing pathways in generalist fields and instead are opting for more lucrative, but highly niche specialties. We know how important primary care is for keeping people healthy, but why aren’t we prioritising it? It seems like we have things backwards.
On the latest episode of Revolving Door Syndrome, I kōrero with the energetic power duo that is Dr Marcia Walker (Whakatōhea/Ngāti Porou) and Dr Buzz Burrell. Both passionate about the power of primary care, brimming with real ideas about how we can tackle these issues head on.
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Cults have come and gone but for the survivors, the trauma remains. Most every day people think that they'd be immune to a cult and could never fall for something as silly as a cult.
The reality is that anyone can end up falling into a cult willingly or unwillingly whether as an adult or child. It is important that we equip ourselves with the skills to identify cult-like behaviours before we fall into the worst kind of echo chamber of groupthink.
This is a reminder for us to not take freedom of expression and freedom of speech for granted. We must extend our empathy to survivors and people who are still in these cults where informed concept becomes a foreign concept.
Joining me on this episode is Dr Caroline Ansley where we deep dive into the cultiverse and learn about the madness of groupthink and coercive control.
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How have we ended up in both a housing and productivity crisis?
Why can't we seem to just get on with maintaining and building more housing and infrastructure?
Why does it feel like inequality is getting worse, not better?
Joining me on this episode of Revolving Door is Sam Stubbs, founder and CEO of simplicity, a not-for-profit kiwisaver and investment provider.
Late stage capitalism and an economy based on selling houses to each other is failing our younger generations. I ask Sam if it is possible to make capitalism work better for our young people. Us millenials and zoomers are struggling to get on the housing ladder. How easy is it to hold down a job when your landlord sells up your home? How easy is it for kids to get good education if they keep having to move schools? What effects will the stress of housing insecurity have on our health outcomes?
If we can't get housing right, can we really solve any of our other problems?
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When we talk about addressing the mental health issues in society, we often hear that if only we had more psychologists, more psychiatrists, more psychotherapists and counsellors, we'd be able to fix the problem. Hamish William's is a host of NewstalkZB's show, The Nutters Club. He has a different perspective on the issue, given that every Sunday night he listens to real stories from real people facing very real mental health challenges around the country. For his listeners, The Nutters Club has become a beacon of hope and a network of support forged through the airwaves. We kōrero about building communities that become self supporting and self healing. Hamish also explores his own experience as a step father and the challenges faced with raising a teenage son in the age of Andrew Tate and the Manosphere.
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Imagine a future where healthcare looks more like the tiers of a Netflix subscription. Where if you can afford it, your premium, gold-plated health service gets you your own personal family doctor. Meanwhile, those on the ‘free tier’ still get access to healthcare, but it’s delivered via algorithm and internet. In the eyes of Melissa Clark-Reynolds, this could one day be a reality. An Officer of the New Zealand Order of Merit, a futurist and a company director. Melissa is a thought leader and a game changer always at the edge of technological innovations. She uses her experiences and knowledge about human behaviour and technology to guide companies and people to a better future.
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Healthcare services around the world are reeling from the consequences of a pandemic. We have news media and social media that are full of discontent with the provision of these core services and we hear the word crisis so regularly, sometimes it's easy to forget what normal is
So much of our healthcare system is devoted to the treatment of disease, rather than wellbeing and prevention. So much so that we are seeing our hospitals full of patients with worsening amenable disease with ultimately worse health outcomes.
Joining me today is Dr David Galler, retired intensive care doctor, health leader and author of the book Things That Matter to talk about his experiences in the intensive care unit. He shares with us his insights of working both as a clinician with our sickest people as well as the difficulties of trying to drive change as a leader within the bureuacracy. If we only focus on improving our treatments, will we continue to chase our own tails by refusing to focus on the real drivers of poor health?
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Can we fix our mental health epidemic with a drastic change in what we eat? That's the question posed by Professor Julia Rucklidge. She's a psychologist and the director of the Mental Health and Nutrition Research Group at the University of Canterbury. Her research has focused on the impact of nutrition on brain metabolism, gut microbiome and how our mental health is directly tied to the gut-brain axis. We kōrero with Julia about the findings of her studies and expose the barriers she's faced challenging the status quo, with Scientific institutes unwilling to publish and promote research on the basis that it questions the existing treatments.
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The issues of health, education and welfare can often feel intangible and immovable. Despite feeling like we are slipping backwards on these issues, we often look to the government, expecting them to drive change. Yet, in our focus on government as an omnipotent force, we might overlook the organic source of change at the grassroots. Charities, NGOs and Community organisations often serve as the safety net for the most vulnerable among us. However, they struggle due to insufficient funding, resources, and the means to measure their impact. Social Investment is an initiative that aims to promote and resource the grassroots programs that are working. Joining me to talk more about this is former Prime Minister of New Zealand, Sir Bill English. Today his organisation Impact Lab helps charities and NGOs better measure the impact they have. You might notice that the audio quality of this episode isn’t up to our usual standard. Unfortunately we had some issues with the recording and have had to do our best with a backup. So please bear with us, we promise it’s a conversation worth listening to.
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Top of mind for Nzers, according to the media, is youth crime and ram raids. But when I speak to most people, there’s a deeper understanding that crime is just a symptom of broader societal dissonance. The risk factors for a life of crime and incarceration are well studied and well known, yet it feels like we haven't figured out how to prevent it yet. Or at least we haven't accepted that we need to keep doing the interventions that work and stop doing the interventions that don't. On this episode I'm joined by Sully Paea, Member of the New Zealand order of Merit for his services to youth work. He's an iconic fixture in Otara who has not only seen it all, but lived it.
- Se mer
