It can't have been much fun in Cabinet last week.
When they might have hoped they would still be on a post-budget high, I imagine members slumped around the table, miffed at the fuss nasty media were creating over a piffling public servants' conference at Tongariro Lodge.
A transcript of such a meeting might have gone a little like this:
Head girl Helen calls them to order: I'd like some good ideas. Maryan, put your hand down. I have heard quite enough from you this week. And Michael, you look ridiculous - you will not be taking part in hoodie day - too many people already think you are robbing them blind.
Jolly Jim Anderton (eagerly): I reckon we should drug-test all secondary school kids and sickness and invalid beneficiaries.
Helen: No team, what about something to capture international headlines, the way that story about assault with a hedgehog did? I thought about apologising to the hedgehogs of the world, but that might look opportunistic.
I don't think we have time to introduce special hedgehog protection legislation to show we care.
Has anyone got anything which might excite the media?Pete Hodgson: Say the word and I'll repeat my 2005 funky chicken performance. (Groans clearly audible.)Annette King: Remember when we were clutching at straws after Don Brash's Orewa speech in 2004? I took a leaf out of Jenny Shipley's book and made an unrealistic announcement about breast screening.
I said we'd extend breast screening, even though we didn't have the capacity to do that at the time and the jury was still out on the value of screening women in their 40s.
That worked a treat. People have probably forgotten by now that it took yonks to cover the ages promised.
Actually, have we got it right yet? (General mumbling in the background.)David Cunliffe and Damien O'Connor (in unison): Health wins hearts.
Why don't we say we'll fast-track colorectal cancer screening? We'll be careful not to be specific.
We certainly won't mention money or tell anyone that it is likely to involve people having to gather samples of their faeces.
We'll acknowledge staffing issues, but put that problem back on the Ministry of Health . . . . (Shouts of acclamation all round.) Perhaps, since my husband died of bowel cancer about a decade ago while he was still in his 40s, I should be overjoyed at last week's announcement from the D-duo, but it worries me.
How is it there can be talk of fast-tracking when last September Dr John Childs, chief adviser cancer control with the ministry, was saying access to existing colonoscopy services from patients with symptoms was patchy and some district health boards, including Otago's, could not carry out surveillance of those with increased risk of the disease as seen as desirable in the 2004 national guidelines? He also spoke of the need for the development of standards for the provision of colonoscopy services.
This doesn't sound like a workforce anywhere near able to boldly take on a screening programme with all the quality issues involved.
Previous experience with screening programmes should tell us that it is important to get it right. It should not give false hope.
I was surprised to hear claims last week that the programme could save eight people a week. That would be a third of the 1200 deaths annually.
I am not sure on what basis such estimates were given - we don't know what age group would be involved in screening, nor what the support for screening would be.
My reading on the matter suggests that there is not randomised controlled trial evidence for the type of faecal occult blood test we seem to be leaning towards (FOBTi) but the test which has been trialled (FOBTg) may offer a 16% reduction in deaths over eight to 10 years.
It strikes me as optimistic to think using FOBTi might double that. Screening is about much more than having a test.
Among the many aspects are providing good information for those likely to participate (including a proper informed consent process), accurate pathology, readily available services for further investigation (and we know they are already inadequate for people with symptoms) and, if surgery and other follow-up is required, that needs to be easily accessed and timely, too.
Also, people have to want to take part in a programme. I suspect programme organisers will have a hard task there.
Bowel cancer, possibly because it is not a sexy subject, appears to have been largely ignored in public health campaigns.
Even though it is our second-highest cancer killer after lung cancer, can anyone remember a concerted effort alerting us to possible symptoms or telling us about things we might do to help reduce the risk of getting it?If Labour must use health to win brownie points, couldn't they find a reason why Pete doing the funky chicken again would be good for us all? Laughter is supposed to be the best medicine.
Elspeth McLean is a Dunedin writer.
