Friday, November 30, 2007

King Rat

Just who is Brendan Nelson? Well let's see what he was like in 1994...

BMJ 1994;309:562 (3 September)


Focus: Sydney: The rise and rise of Brendan Nelson

S Chapman

Earlier this year a colleague returned to Sydney from what had promised to be a dull meeting of the Royal Australasian College of Physicians in Hobart, the drizzle soaked capital of Tasmania. But he beamed from ear to ear. His glee was at the oration given by Brendan Nelson, the 36 year old national president of the Australian Medical Association.

Nelson, a Tasmanian GP who wears a diamond earring, had torn into the medical profession for its sleepy social reform agenda. He berated them for shirking all the big public health debates other than those that were self serving. He urged them to use their knowledge, positions, and privilege to support the things that really mattered in their communities. At the end of his speech nearly all stood and applauded.

Nelson took over the AMA' presidency in 1993, after serving an apprenticeship to the affluent, avuncular orthopaedic surgeon Bruce Shepherd. During the 1993 federal election Shepherd campaigned on behalf of the (now deposed) Liberal leader, John Hewson, prompting Prime Minister Paul Keating to describe him as the "most ugly, most rapacious union leader" in Australia.

Nelson, in contrast, is from what the Labor party calls a "true believer" background. Grandson of a communist and son of a Labor loyalist he had been a Labor party member, but he resigned when he took up AMA politics so as to be seen as nonpartisan in his dealings.

Nelson has transformed the public face of AMA politics. Once seen as the guardian of medical privilege the AMA is now most often heard through Nelson's plain speaking about oppressed groups, reform, and bungling bureaucracy. The Australian media find him irresistible. While many in the Australian health system are mesmerised by the emperor's new clothes of the 1990s (health outcomes, customer focus, etc) Nelson speaks no nonsense talk about real health problems. In the past 12 months he has breathed life into debates about drug policy, euthanasia, homosexual law reform, environmentalism, immunisation, declining funding for medical research, and hotels supplying women with free drinks to attract hard drinking men. His most sustained efforts have been directed at Australia's appalling Aborginal health record, the health consequences of unemployment, and hounding the tobacco industry.

In August it was widely reported that Nelson would be forsaking medical politics for the popular variety. He confirmed that he had been approached by both main parties, and the main intrigue now focuses on which way he will jump. He remains tight lipped. The Liberal party in Australia has been out of power since 1983, and despite rhetoric about a new direction, remains bereft of leadership. Nelson would give the party a charisma transplant but at great risk of arousing Australian's suspicion of turncoats and political opportunists.

The Labor party keeps no seats warm for old comrades who "rat" on the party by leaving it. For some too Nelson remains tainted by his past association with Shepherd's overt support for the Liberals and by the abiding suspicion that the profile he gives to public health issues is a Trojan horse for the AMA's real business: the preservation of doctors' incomes.

But many suspect that Nelson's first duty is to social medicine - to the unemployed, Aboriginal health, the further humiliation of the tobacco industry - all subjects where the Liberal party has a weak record. These are issues where he is at his most animated. Those who know him find the public stand consonant with the private man. He has often said pragmatically that political change requires working from with in a major political party. Labor therefore seems most likely. If Nelson jumps into the desperate-for-talent Liberal boat he may just sink with it.

How prophetic. Nelson appears to become captain of one of the Titanic's lifeboats. He's now leader of a party so dumbstruck by defeat they've opted for a former union boss and Labor party member to lead their party. This is after having run a massive scare campaign on union bosses. There's a rumour that Nelson won because he wouldn't say sorry to Indigenous Australians while Turnbull would. If this ideological blind-spot is all that's holding the Liberal party together, it's going to be a long three years for them.