Letters: Auckland caesarean rate soars

State Highway 16. Photo / Dean Purcell

The Herald continues to give coverage to the issue of access to childbirth by caesarean section at Auckland City Hospital for patients of private obstetricians.

The rate of C-section among these private patients — over 50 per cent — is more than double the rate among public patients, which is a similar public/private differential reported for Australia. It is also double the New Zealand (and UK) norm, and double the average recorded across all countries in the OECD.

The only countries that come close to this rate are all outside Europe — China, Turkey, Mexico and Chile — although some European countries such as Italy are high too. These countries tend to rely on fee-for-service payment, while doctors in our public system are generally paid by salary.

While some correspondents may present an elective caesarean section as a matter of individual choice, the figures suggest the consequences of such choices are out of line with national and international professional norms. And, according to your reports from DHB staff, the impact of the exercise of such choices by private patients on resource use like theatre time constrain the access of non-paying public patients to high-quality obstetric care.
Peter Davis, Emeritus Professor in Population Health and Social Science, Auckland.

Future proof now

The planners of the Penlink highway from the Whangaparāoa Peninsula say the two-lane bridge is "future proofed" so increasing two lanes to four will be easy.

But the harbour bridge SH1, Northwestern motorway SH16 and the Hobsonville bridge SH18 had to be increased with duplicate roadways, bridges (or bridge add-ons) at huge extra expense in far less time than envisaged.

Do planners think motorists who find the new Penlink jammed with vehicles will opt to use the old highway through Silverdale? Will it be too late to change once the Penlink congestion is evident? Also, better access to Whangaparāoa will attract more population with additional traffic, speeding the need for extra lanes.

Lastly, both accesses will channel traffic on to the SH1 motorway which is already hugely congested. Are there plans to add extra capacity to SH1? Perhaps it will hasten the need for a second harbour crossing. Surely future-proofing now would be the sensible option.
Robin McGrath, Forrest Hill.

Pathways to gangs

As Australia continues to send its criminal element to NZ and as homelessness escalates, it is only to be expected that the numbers joining gangs will rise.

Young people squeezed out of overcrowded homes tinged with sexual and domestic violence will seek accommodation, money and security of a "family" atmosphere which gangs can provide.

The Government must ramp up the building of houses to provide stability, security, better health, educational and job opportunities for children and youth who will be our future citizens. Transience and homelessness are sure pathways for youth joining gangs.
Marie Kaire, Whangārei.

Vaccine caution

We recently wrote a scientific article in a leading medical journal which featured prominently in a Herald news report.

Our article was not "rebuked" by the scientific adviser of the Ministry of Health. As part of the usual scholarly review process, the editor of the journal asked the ministry for comment. When one group raises questions about the work done by another, the latter is always given an opportunity to respond.

The article and the response are available for any reader.

The article seriously mischaracterises our views about Covid-19 vaccines. Our letter urges caution about the speed of the rollout of the Covid-19 vaccine, since historic vaccines for respiratory viruses, such as swine flu, have been associated with adverse effects. The associate editor of the British Medical Journal, Peter Doshi, has raised questions about the efficacy of current vaccines. None of them yet have evidence of success in reducing severe infection (hospital admission, ICU, or death) or interrupting transmission (person-to-person spread). At least, the trials could not test for these, given the compressed time-frame.

Developing and distributing these vaccines to seven billion people of the world is a non-trivial task.

This does not make the vaccines useless but does raise legitimate questions about basing our border policy on the effectiveness and wide availability of vaccines.

Finally, we caution against the types of ad hominem attacks reflected in this article. This is not the way to undertake either good science or good policy.

Simon Thornley, Ananish Chaudhuri, Gerhard Sundborn, Grant Schofield, Auckland.

School lockdowns

John Roughan (December 27 ) says schools should "probably have not locked down due to the selectivity of the virus". He forgets the ageing workforce, the Auckland Marist cluster, the closed rooms with air conditioners spreading the virus, the close proximity in overcrowded classrooms for 40 minutes to one hour. Anecdotal evidence shows masks will not be worn. These are ideal conditions to spread the micro droplets that evidence shows has spread the virus in less than two minutes overseas.

The gathering of up to 3200 students and up to 200 staff doesn't seem to concern him or the transport by bus or parents to and from school.

Schools cannot stay open without relievers (most of whom are ageing) and elderly teachers have the basic right to protect their health.

The parents voted with their feet and 25 per cent deserted the schools pre-lockdown in late March. It makes for highly stressful and practically impossible teaching when students are absent.

His suggestion shows a lack of empathy or consideration for the practicalities of running a school and of the mental health of their staff just to keep the "workers free of children" for business as usual. The effects of Covid on teachers should be studied.
Steve Russell, Hillcrest.

Sourpuss report

What envious sourpuss reporting on the Plumley bequest! Would you prefer he had lived a life of fast cars and faster women to grace your society blogs?

It may be that some perceived version of "fun" will not be had in the spending of this money, but there may be more genuine happiness achieved from its distribution on charitable and social services. Many of us who grew up in harder times retain frugal habits and this hardly deserves mocking.
Josephine Ellis, Meadowbank.

Pandemic omission

John Roughan says the pandemic responses by most countries were over reactions.

He criticises health authorities for using total infection and death rates to justify their actions and not putting them in perspective. But then uses that data to justify his view. However the biggest flaw is the sin of omission.

Prime Minister Jacinda Ardern reiterated recently that the main reason she decided to take quick and firm action on the pandemic was that, if infections took off, the hospital system would be swamped and fail. Most other countries had the same reasoning. Roughan does not cover this vital aspect.
Russell O Armitage, Hamilton.

Electricity probe needed

The unnecessary spillage by Meridian Energy cost the electricity consumer $70 million and resulted in 6000 tons of avoidable carbon emissions.

The Commerce Commission needs to investigate whether Meridian abused dominance in a part of the market or whether it acted in concert with other generators, whether other generators have also engaged in conduct with similar effect, whether there was any collusion, communication or reciprocal conduct between generators to keep prices high and whether there was collective gaming in the electricity market. Predatory conduct, cartels and corporate exploitation cannot be tolerated even when engaged in by Government-owned enterprises.

Those who lauded reform of the electricity industry and said that gouging was protected by the Kiwi golden share might also reflect. There is the need for serious action — and for it to be punitive if found to be appropriate.
John Collinge, St Mary's Bay.

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