Parents told kids' homosexual talk should start at three

PARENTS should teach their children about gay relationships from the age of three or four, an expert says. But one family group says any attempt to normalise homosexuality is little more than a recruitment drive. Pop idol Anthony Callea, 24, this week announced he was gay, prompting a flood of support - and some shock - from fans.

Deakin University health and education lecturer Dr Maria Pallotta-Chiarolli said children as young as 13 were coming out. The author of When Our Children Come Out: How to support gay, lesbian, bisexual and transgendered young people, said parents should tell their children there was nothing wrong with same-sex relationships. That way, if they were gay, children would feel comfortable coming out to friends and family. She said that by contrast, families in which parents condemned homosexuality often struggled to cope.

Dr Pallotta-Chiarolli advises parents to raise the issue when children are three or four. She did not advocate raising the sexual aspect, just a simple explanation of male-male and female-female relationships.

Family Council of Victoria secretary Bill Muehlenberg said young children didn't need to know about homosexuality. He said just as you wouldn't tell children an adult was a heroin addict, you wouldn't tell them someone was gay. Mr Muehlenberg said attempts to educate children about homosexuality were little more than a recruitment drive.

Family First leader Senator Steve Fielding said it was inappropriate for parents to discuss such issues with three or four-year-olds. Focus on the Family CEO Andrew Boutros said children aged three to four were too young to hear about homosexuality. "We have concerns about whether a child aged three or four would be able to understand the concept of a gay relationship, let alone the moral issues associated," he said.

Melbourne-raised Nigel Giles, 41, who came out when he was about 20, agrees with Dr Pallotta-Chiarolli. Homosexuality wasn't discussed when he was a child, but his family was supportive. "If I'd grown up in a society where homosexuality wasn't demonised and marginalised, I wouldn't have had any problems. It's as simple as that," Mr Giles said.

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More vaccination needed?

Waning immunity after childhood vaccinations has prompted concerns we may need to better protect adults from disease

When you think chickenpox, do you imagine spotty but otherwise happy kids quarantined at home and amused with colouring books and hot drinks? If so, you may be surprised to learn that pneumonia, inflammation of the heart muscle and swelling of the brain (encephalitis) are all potential complications of this highly contagious disease, which causes 1500 hospitalisations and seven deaths in Australia each year.

Although it's a mostly mild illness in children, chickenpox - caused by the varicella zoster virus, one of the herpes family - can be nasty in adults, particularly the elderly, pregnant women, and other people with compromised immune systems. Since November 2005 a federal Government funded vaccine for varicella has been available free to all children aged 18 months (and at 10-13 years for non-immune children who haven't already been immunised). The problem is, no one is quite sure how long this protection lasts - estimates range from 10 to 20 years, or longer. It's a question that has significant implications as people age and become more susceptible to disease.

An editorial in the respected New England Journal of Medicine (2005;352(22):2344-6) suggested that mass childhood vaccination against chickenpox might ironically be leaving some people more vulnerable to the adult disease, which it said was "far more serious than childhood varicella usually is". And experts are also raising questions about waning post-vaccine immunity to other diseases. Not all vaccines offer lifelong protection and many of the newer ones have just not been around long enough for us to know how effective they are long-term. We know for example that immunity following a vaccination for pertussis - whooping cough - usually lasts only around five to 10 years.

Recently-released draft Australian immunisation guidelines are already suggesting that, contrary to current practice, children might need a second dose of chickenpox vaccine before 13 years of age, and receive their first dose six months earlier, to give them earlier and more sustained protection. "Waning immunity is often under-recognised," says Peter Eizenberg, a Melbourne GP who sits on several national immunisation committees. "It is an important issue in the community, particularly among the elderly, but not just the elderly. People get vaccinated and they forget that only a few of the vaccines give long-term immunity."

The NEJM recently revisited the topic, suggesting again that varicella vaccination could lead to a shift in the disease burden to older people (2007;356:1121-9). "Waning of immunity is of particular public health interest because it may result in increased susceptibility later in life, when the risk of severe complications may be greater than in childhood," the authors say.

Professor Lyn Gilbert, director of the Centre for Infectious Diseases and Microbiology at Westmead Hospital's Institute of Clinical Pathology and Medical Research, says the combination of mass childhood vaccination and waning immunity might see an increase in cases of shingles - a painful condition caused by the re-activation of the varicella zoster virus, which continues to lurk in nerve cells after a childhood infection. Shingles has its own set of complications. It can sometimes cause permanent, painful nerve damage and can actually transmit the chickenpox virus itself to people who aren't immune. "Shingles . . . is potentially a time bomb waiting to happen," Gilbert says.

The theory is that because mass childhood vaccination greatly reduces the amount of "wild" virus circulating in the community, it means that people's immunity to varicella is no longer being constantly "topped up" by re-exposure to it. "There is a very plausible model that suggests that if you reduce the incidence of infection in children through mass vaccination and older people are not exposed to wild virus, they are likely to have reactivations," Gilbert says. For the elderly, there may be hope of protection with a new shingles vaccine manufactured by drug giant Merck. Zostavax was licensed by the US Food and Drug Administration last year for use in people over 60. It's not yet available in Australia, but there are hopes that it soon will be.

Director of the National Centre for Immunisation Research and Surveillance professor Peter McIntyre says the vaccine would initially be used in the over-60s, but may in future be used for younger patients. Gilbert says in the long term, those vaccinated for varicella in childhood will probably require boosters as they age. But she says uncertainties over whether boosters are needed or not tend to muddy the waters on the true costs of a government funding of vaccines.

And funding of new vaccines doesn't come cheap. In the last financial year, the federal Government spent about $250 million on vaccines. Cabinet this week agreed to spend $124.4 million over five years to immunise babies against rotavirus, which hospitalises 10,000 children a year. Estimates are that this could save the health system some $30 million annually by preventing illnesses.

One disease where waning immunity issues pose a significant challenge is the highly infectious whooping cough (or pertussis), which is on the rise worldwide. It is less dangerous to adults than it is to young babies, for whom it can cause brain damage and even prove fatal. Adults can develop hernias and rib fractures from the coughing, but a particular problem in adults is that it might not be recognised as pertussis at all - missing an opportunity to limit transmission. Most babies are immunised against pertussis, but protection is not achieved until after the third dose at six months of age, so waning immunity to the vaccine and resulting infection in adults is putting these children at risk. "Pertussis is a number one problem," Eizenberg says. "It is in epidemic proportions . . . we have around 10,000 cases a year notified to the department of health and that probably under-represents the true numbers by 3-4 times because mild cases can be hard to diagnose but remain very infectious."

There's still uncertainty over how many pertussis boosters are needed, because the adult booster, called Boostrix, is only relatively new. While the federal Government funds Boostrix for 15 to 17-year-olds, there is no public funding for pertussis vaccination of older adults. Eizenberg would like to see national, publicly-funded routine immunisation with the combined diphtheria/tetanus/pertussis vaccine for all eligible 50-year-olds. The Australian Technical Advisory Group on Immunisation (ATAGI), which advises the federal government, is looking at whether there is a case to recommend a routine pertussis booster in middle age, a decision that would be a world first. "The unknown question is, how long will the vaccine last?" says ATAGI chairman professor Terry Nolan. "There is a possibility that progressive boosting will be needed to protect throughout life."

Another problem is measles, which in the 24 years from 1976 to 2000 caused nearly 100 deaths in Australia. While this figure is small, experts are still concerned. Small outbreaks continue to occur around the country and immunisation levels aren't as high as they could be, particularly in young adults who may not have been fully vaccinated in childhood. As for how long vaccine protection lasts, it has been thought that immunity was long term. But some experts believe that waning vaccine-induced immunity could become an issue. Introduced measles is a particular threat - from Australians who travel overseas."A classic situation is an unimmunised young Australian male, goes to Bali, picks it up there and comes back and infects all his mates," Gilbert says.

Experts say funding issues do make a difference to vaccine uptake and the battle to maintain levels of disease protection. "I think there is a culture amongst a lot of people that if a vaccine is not 'free' then it can't be important," Eizenberg says. This sort of attitude can make it hard for GPs to convince people who don't feel sick that they need a booster jab. McIntyre says although diphtheria/tetanus or diphtheria/tetanus/pertussis is recommended at age 50 (but not publicly funded), "the chances are most people don't do it". "We think most people don't get around to it and doctors forget to remind people and it's not free." Eizenberg says a national adult immunisation register could keep track of all vaccinations and trigger reminders.

It seems the Federal Government agrees in principle. In the last budget it allocated $1.2 million to explore redeveloping the Australian Childhood Immunisation Register into a whole-of-life register that included adult immunisation. Health Minister Tony Abbott is due to see a report on the concept some time this year. According to Gilbert, adult immunisation is becoming much more of an issue. "Increasingly, people are beginning to recognise better the burden of illness in older peo ple." But difficulties in reaching younger adults and unanswered questions about waning immunity means the cost-effectiveness of paying for immunisation programs from the public purse might be doubtful. It seems a big question for the future is, to whom should we give boosters, and can we afford it?

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Big NSW hospital in trouble

THE Royal North Shore Hospital is lurching towards another crisis, with a senior doctor resigning over serious problems with trauma surgery as the troubled hospital struggles to rein in its budget and maintain services. His resignation comes as the hospital's ability to manage elective surgery was again called into question by revelations yesterday that a woman booked to have fibroids removed had her operation cancelled twice on the day of surgery.

Over the past 10 years the surgeon, who does not want to be named, has written letter after letter, detailing a litany of complaints and cover-ups at the hospital, which he says has failed to properly investigate any of the incidents. "The system allows multiple problems to occur," his resignation letter says. "There is no one person who takes ownership of the problem and has the ability to affect any change for the good of those individual patients who are being harmed by the system." Obsessed by process at the expense of health care, the hospital gave medical and surgical units "untenable service goals with limited resources", he said. "We are exposed to a rotating door of middle managers who are servants to a paperwork process that hides the problem."

The final straw came when a patient arrived at the emergency department with a severe fracture and other complications but was refused access to theatre - and only received surgery five days later.

The resignation comes just two months after the Herald revealed that the hospital was facing another significant budget overrun, with an audit finding that $30 million of essential equipment needed to be bought. "North Shore is over-budget," admitted Phillipa Blakey, the director of clinical operations of Northern Sydney Central Coast Health. "It is not as over-budget as it has been in the past . and in terms of the area, we will break even at the financial year." She pointed to a fall in the rate of cancellations on the day of surgery from 18 per cent last July to 5 per cent last month, as well as a reduction in the number of people waiting longer than 12 months for surgery from 61 to seven in the past year. "It is a very busy hospital and it is getting busier by the day . And despite that the performance has improved a lot."

The chairman of the Royal Australasian College of Surgeons in NSW, Phil Truskett, said: "It is no different throughout metropolitan hospitals in NSW and if you want to get into rural and remote NSW it is much worse." A lack of infrastructure and funding was hampering access to operating theatres for acute cases, affecting the patients involved and those waiting for elective surgery, Dr Truskett said. "Acute surgery is done in the middle of the night when it should not be done - we need an appropriate process and method of managing acute care during the day."

The president of the Australian Medical Association in NSW, Andrew Keegan, said patient care was suffering because the system was being run to make the numbers look better. "If someone senior doesn't take responsibility for that patient then the quality of care is at risk," he said.

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The light way out

We want to feel we are doing something about global warming, but mere symbolism is alive and well

ABOUT dinnertime tonight, thousands of households have promised to turn off their electric lights for an hour as a symbol of their personal commitment to reduce the risk of climate change. Earth Hour is the brainchild of environment group WWF-Australia, which has joined forces with the Fairfax newspaper The Sydney Morning Herald -- but apparently not The Age in Melbourne -- for the latest in a series of feel-good campaigns pitched at engaging middle Australia on the hot issue in the environment debate. It's like a telethon where you don't have to donate money: all Sydneysiders are being asked to do is turn off their lights between 7.30pm and 8.30pm to "demonstrate how simple actions can make a world of difference if everyone takes part". The Australian Conservation Foundation has teamed with Channel7 for Lights Off Australia, which asks Australians on the first Wednesday of each month to turn off lights overnight that aren't needed.

Sydney's Earth Hour tonight is, by design, an act of mass symbolism. Separating genuine participants from those going out to dinner or watching the Sydney Swans, Waratahs or red-hot Rabbitohs may be more problematic. The emissions reductions from even half of Sydney going without lights for an hour will be almost indiscernible. WWF-Australia chief executive Greg Bourne has been campaigning for months to sell the event, and says its purpose is to sustain pressure on governments rather than deliver big cuts in emissions. If the idea is to galvanise public support, Earth Hour is already too late.

Yesterday the Climate Institute issued the latest in a series of reports on the attitude of Australians to climate change policy. Its survey of 1000 people last weekend claims 80per cent support for a government plan to cut greenhouse pollution with enforceable targets for 2020 and 2050. The report, which neatly sidesteps issues related to the cost of such reforms, also says Australians understand climate change is already happening and are particularly concerned about water resources and the impact of water restrictions.

This follows the release of a global survey by the Lowy Institute this month, revealing widespread agreement among communities across the world that climate change is a pressing problem. Twelve countries, including Australia, were asked whether steps should be taken to address climate change, and all but one of them favoured action. Australia reported the largest majority in favour of measures to combat global warming (92 per cent). "But awareness is not action," Bourne says. "Awareness and action is what really matters. The Government has been aware of these issues for a long time, and ... have taken very little action, even though their rhetoric says they have taken a lot."

Bourne defends the highly symbolic campaign, rejecting the idea that it risks trivialising the scale and complexity of the multi-trillion-dollar global economic and technological challenge by simply encouraging people to switch off their lights. "People know intuitively that changing a light bulb helps, but it doesn't do it. "They require governments to lead, they are demanding of government and business to lead," he says.

For about 1.5 billion people on the planet, every hour is Earth Hour. And that's at the heart of the problem. Astonishing economic growth in China and now India is dragging millions out of poverty, giving them electricity and water, and in the process adding incrementally to the release of greenhouse gases. China is expected to become the largest emitter of greenhouse gases by the end of the decade. Emissions from developing economies are nearly equal to those from developed economies, and bigger if you include land clearing.

Accelerated retro-fitting of the world's energy supply while simultaneously developing and installing new technologies is a mind-boggling exercise. For Australia the problem is magnified: our economy is still highly dependent on low-cost fossil fuels. The economic pain implicit in such a reform program has the late-moving Howard Government wincing as it rolls out a suite of symbolic measures to buy time until it can find a policy pathway that can neutralise the issue in the lead-up to this year's election. First it was a ban on incandescent light bulbs; this week it's a $200million, five-year plan to help developing countries slow land clearing, said to contribute about 20 per cent of greenhouse emissions.

Wentworth Group of Concerned Scientists spokesman Peter Cosier says such initiatives are always welcome, but attempts by developed countries during the past two decades to curb land clearing have not been particularly effective. "This will not end the clearing of tropical forests," he tells Inquirer. "That will still continue. The question is at what rate and at what scale."

This reminds us that poverty is a key enemy of the environment. The head of the University of Melbourne's school of forests and ecosystems, Rod Keenan, says such measures can merely shift land clearing to other countries without the right institutional structures to create incentives in the developing world. "The challenge is going to be in the implementation. While many people have tried to tackle the issues around sustainable forest management and illegal logging over the past 10 to 20 years, the impact of those activities has generally been pretty small," he says.

Federal Labor leader Kevin Rudd is equally happy to stick with symbolism for now, as he tries to retain his early high ground on climate change while not spooking business by locking in expensive and unworkable solutions. This week he offered to upgrade the solar cells rebate scheme for households, one of the most symbolic, expensive and inequitable subsidies in the climate change space. Existing technology comes at a starting price of $12,000 per household less a partial rebate, with a 12 to 15-year payback in power savings, and as such household solar panels using existing photovoltaic technology remain an indulgence rather than a serious solution. But better technology may be on the way.

Federal Labor's climate change summit with the states in Canberra today will be a full house, with strong attendance from industry, science and the environmental movement. While gathering such a broad church is a political coup, keeping them in the same tent may be more problematic. It's hard to see how either Rudd or Opposition environment spokesman Peter Garrett can reconcile the deep concerns of the coal and metals processing industries with the aspirations of the Wilderness Society or the Australia Institute.

Labor will be encouraged that all sections of the policy spectrum see it increasingly as a serious player and potential post-November government. But, like a meeting of the Hatfields and McCoys, keeping these fiercely opposing sides from derailing the symbolism of consensus building that Rudd is hoping to create may prove more difficult. Rudd is already working hard to open up Labor's existing three mines policy at next month's national conference. Climate change may yet become a more thorny challenge for his leadership and credibility with middle Australia, which might be happy to turn its lights off for an hour, but is unlikely to have much appetite for policies that risk keeping them off.

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