Symphony No.41 in C major “Jupiter” K551
Symphony No.40 in G minor K550

Wiener Philharmoniker – Leonard Bernstein

Symphony No.38 in D major “Prague” K504
Symphony No.39 in E flat major K543

Wiener Philharmoniker – James Levine

Symphony No.25 in G minor K183
Symphony No. 29 in D major K201
Symphony No.35 in D major “Haffner” K385

The English Concert – Trevor Pinnock

Symphony No.101 in D major “The Clock” Hob. I.101
Symphony No. 104 in D major “London” Hob. I.104

London Philharmonic Orchestra – Eugen Jochum

Symphony No.88 in G major Hob. I.88
Symphony No. 94 in G major “Surprise” Hob. I.94

Wiener Philharmoniker – Leonard Bernstein

Symphony No. 39 in G minor Hob. I:39
Symphony No.48 in C major “Maria Theresia” Hob I:48
Symphony No.49 in F minor “La passione” Hob:149

The English Concert – Trevor Pinnock

Giovanni Battista Sammartini – Sinfonia in A major J-C 62 – Arcadia Ensemble – Kevin Mallon

Johann Stamitz – Sinfonia in D major op.3 No.2 – The Academy of Ancient Music – Christopher Hogwood

Carl Ditters von Dittersdorf – Sinfonia in A minor – Cammerata Bern – Thomas Furi

Johann Christian Bach – Sinfonia in F major op.3 no.5 – Academy of St. Martin-in-the-Fields – Sir Neville Marrriner

Carl Philipp Emanuel Bach – Sinfonia in D major Wq 183 no.1 – Munchener Bach-Orchester – Karl Richter

Somebody clever really needs to do a satirical version of “It’s been a great year! Thanks for being part of it.”
It could include images from selected highlights such as civil war in the Ukraine, ISIS, Syria, Gaza, Ebola, Pakistani children slaughter, Boko Haram, Martin Place Siege, Cairns children, North Korean hackers, climate change deniers, legless South African murderers, Malaysian airlines x 2 (X-file), US school shootings, etc, etc, etc.
There would be no shortage of ‪#‎hashtagged‬ memes to accompany the slide set.
At the end we can say we really are lucky to have had a good year.
Sorry, I’ll restart my medication now.

The draft guidelines for prostate cancer screening in Australia are currently out for comment.

These are interesting guidelines as they seem to pursue a different strategy to the breast, cervical and colorectal cancer screening programs. Although, obviously, nobody is coerced to participate in these programs, the underlying principle is population screening. The prostate guidelines consciously shift the focus to one of autonomy or more specifically informed choice guided by decision support processes or the use of decision aids.

The main evidence used to justify PSA screening is a trial that demonstrates an an absolute reduction of 0.1 deaths per 1000 person years. This translates into inviting to screening 1055 men, detecting 37 cancers and preventing 1 death due to prostate cancer. This may be associated with both unnecessary biopsies due to false positive PSA and also potentially unnecessary and expensive treatments. Many men won’t die of their prostate cancer but will still undergo treatments that may results in urinary and sexual dysfunction.

So PSA screening is controversial – the solution is to let the consumer decide. This all depends on successful implementation of evidence that support the use of decision support aids with men contemplating prostate cancer screening. Whilst I agree implementation of such decision support is important the arch cynic in me is doubtful about this approach unless it is adequately supported – something that might change the whole cost-effectiveness of the approach. The guideline itself points out the barriers to use of decision aids such as poor uptake to date, the time required and the training needed. It also doesn’t mention what would be considered the consensus messages…..are we talking absolute or relative risks here?

Within a week of the guidelines being published the Federal Government announced a revision of its’ copayment program. If implemented general practice will need to work out how to incorporate decision support in a cost-effective manner. If you were really doing it properly you might actually need two sessions with the GP – a short and a long appointment. Will this really be an incentive for GPs or will they just sign the pathology request? At least they will get CME points for having attended a training session.

There are other issues not being addressed by this disease specific guideline. The PSA screening moment is a moment to address other primary preventative issues like smoking, alcohol and other drug use, cardiovascular risk, bowel cancer screening, etc, etc. The prostate screening decision could be bundled with other health interventions for complete care.

The cost of care after the diagnosis of prostate cancer is also not addressed. Currently it is fashionable to offer robotic prostate cancer surgery, largely in private facilities. The price of these procedures can be very expensive with relatively marginal improvements compared to open procedures – mostly in relation to length of stay and acute complications rather than differences in late complications and cancer outcomes. Price variation and outcomes of practitioners should be published in order to get the best value from the guidelines and subsequent decisions about treatment.

I support informed decision making and patient autonomy but when we inform the patients we better add the disclaimer up-front that we can’t actually decide ourselves (based on the current evidence) what is the right thing to do.

The program tonight:

Marius Flothuis – Cantus Amoris
Richard Strauss – Oboe Concerto played by Alexei Ogrintchouk
Dimitri Shostakovich Symphony No.5 in D minor, Op. 47

I was last at the Concertgebouw 20 years ago. I’ve discovered that like all other galleries and museums I’ve visited in recent times, both in Europe and the US, that you need to install a surrounding glass reception centre or cover the central courtyard in a glass structure to enclose the building….preferably you get an architect to do it but I.M Pei isn’t always available. The Concertgebouw is no exception. The other big change since i was last here was that there was no indoor smoking. Even the marijuana cafes one has to step outside if you want tobacco (so I’m told).

The Flothuis was an excellent and moving piece to start the program and of sentimental resonance for the band as he was a former music director.

The concerto and encore were played with great theatrics and drew a deserved standing ovation as did the Shostakovich. The conductor was awesome. Sitting in the North Balcony and looking over the podium from a 20-30 degree angle one could see all of the upper body and many of the facial gestures. There was fist pumping for the brusque basso military rhythms and and the baton was abandoned for fine hand movements in sections featuring the wood wind.

It must be a prerequisite that a conductor of the RCO must learn to bounce down the stairs from the second level to the podium and up again. He got his exercise and was clearly drenched in perspiration as he disappeared into the green room adjacent to the North Balcony as I exited into the rain of Amsterdam.