Reassessing Malcolm Fraser

Overview: Malcolm Fraser, Australia’s 22nd Prime Minister, died on 20 March 2015 aged 84. This Strategic Insights, drawn from posts on ASPI’s blog The Strategist, examines Fraser’s foreign policy record as well as his approach to defence policy making and his evolving attitude to the US alliance. Fraser reorganised Australia’s defence establishment and the 1976 defence white paper foreshadowed the move towards the defence of Australia strategy adopted by the Labor government in the 1980’s. Fraser’s strong commitment to human rights and his support for the Commonwealth as a useful multilateral forum were enduring features of his prime ministership

Reviews and contestability: new directions for Defence

Overview: The First Principles Review of Defence is arguably the most significant review of the defence establishment since the 1973 re-organisation led by Sir Arthur Tange. This Strategic Insights brings together a series of contributions to ASPI’s blog The Strategist written by ten experts with long experience and broad knowledge of Australia’s defence bureaucracy. They bring a wealth of different perspectives and point to significant challenges ahead for Defence if the reforms proposed by the First Principles Review are to succeed

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Book Review: Radio Happy Isles: media and politics at play in the Pacific

No abstract availabl

Australia confronts its Pacific taboo: Pacific workers

stimulate a stressed private sector

The South Pacific Islands: policy taboos, popular amnesia and political failure

This paper was originally presented as part of the Menzies Research Centre Lecture Series: Australian Security in the 21st Century. Here the well-known Australian journalist Graeme Dobell argues that Australia should accept its unique role in the Pacific as a great gift, not a burden. We should abandon the strangely defensive posture we have adopted from the day the South Pacific Forum was created. It is time for Australia to lead

The strange saga of Speights siege in Suva

No abstract availabl