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National’s cynical cancer policy announcement

Written By: - Date published: 10:59 am, July 30th, 2019 - 104 comments
Categories: health, national, same old national, Simon Bridges, Social issues, uncategorized - Tags:

So National’s big policy announcement was more money for cancer treatment.  Except there is none.

The proposal is to be funded out of existing health budgets.  The sector is already stretched with the opposition complaining about fiscal pressure on the sector.  From Stuff:

After months of refusing to release the figures, the Ministry of Health has published the latest financial reports of the 20 DHBs – and they make for grim reading. 

A sector-wide deficit of $207m has been posted, with every DHB now in the red. DHBs were forecasting a $372m deficit to June 30, which had deteriorated by $24.1m since the November, 2018 forecast.

Supporting documents also warned that if DHBs continued to spend to budget for the remainder of the year, or failed to achieve revenue targets, “a higher deficit than planned is expected”.

The proposal would also undermine Pharmac’s independence.  It is supposed to make those hard calls.  What funding should there be for glue ear which has significant life long effects on people compared to funding for people approaching the end of their lives.  These are not easy decisions.  Limiting Pharmac’s discretion is not helpful.

And the announcement has more than a hint of hypocrisy about it.  Because back in 2015 National disestablished Cancer Control New Zealand, an organisation with remarkably similar goals as the proposed agency.

Bridges has received some good press out of the announcement.  But he blew it in this interview last night.

The more things change, the more they stay the same.



104 comments on “National’s cynical cancer policy announcement”

  1. Sacha 1

    The proposal is to be funded out of existing health budgets.

    Not strictly true, to be fair. The proposed cancer agency is, but the extra $50m/yr for the drug companies is new. A good return for their lobbying efforts.

    The proposal would also undermine Pharmac’s independence.

    Exactly as intended. Cancer affects well-off families who vote, and the Nats would like to be able to reward that propensity directly rather than risk actual evidence about spending effectiveness favouring families with rheumatic fever, glue ear, respiratory infections and other diseases of the poor and brown.

    • Shadrach 1.1

      "Cancer affects well-off families who vote…"

      Cancer does not discriminate on the basis of wealth.  It is perhaps true to say that there is a deprivation gap in terms of survival rates (https://www.dailymail.co.uk/health/article-1060749/Gap-rich-poor-women-survive-breast-cancer-grows-disease-progresses.html).

      "…and the Nats would like to be able to reward that propensity directly rather than risk actual evidence about spending effectiveness favouring families with rheumatic fever, glue ear, respiratory infections and other diseases of the poor and brown."

      Wasn't it a National Government who introduced a program to reduce rates of rheumatic fever?  That had been particularly successful in the Maori population.  (https://www.health.govt.nz/our-work/diseases-and-conditions/rheumatic-fever/reducing-rheumatic-fever)

      • Sacha 1.1.1

        Cancer does not discriminate on the basis of wealth.

        Indeed. It affects both rich and poor, unlike the other conditions I mentioned.

        That had been particularly successful

        Not so.

        • Shadrach

          I provided a link that showed my actual claim, not your truncated misrepresentation, was indeed correct.

      • michelle 1.1.2

        no this failed 

          • Lucy

            From your data:

            "The rate is now almost at the level seen prior to the beginning of the Rheumatic Fever Prevention Programme (2009/10-2011/12) when there were 177 cases, a rate of 4.0 per 100,000.

            By 31 December 2018, rheumatic fever incidence in Māori had fallen by 34 percent from 2009/10–2011/12. There was a 46 percent increase in the incidence of rheumatic fever cases in Pacific people.

            The government has allocated $5 million per year until 2022 to these 11 DHBs so they can continue to deliver a balanced mix of rheumatic fever prevention activities to address rheumatic fever and reduce rheumatic fever rates."

            So initially the rate fell but even with sustained funding the incidence of rheumatic fever has risen again as it has increased in the Pacific populations. So the plan was too narrow focused and early gains have been eroded by lack of a credible policy that looks at all populations and risk factors, the main being not being able to take children with sore throats to the doctor.

            • Shadrach

              The data shows a discernible drop in rates amongst Maori.

              The data also shows that the sharp increase in incidence of RF has been arrested.

              And then there's this:

              "Some DHBs continue to make good progress in reducing rheumatic fever. DHBs that have made good progress in rheumatic fever prevention include Northland, Hauora Tairāwhiti, Lakes and Hawke’s Bay DHBs."

  2. Rosemary McDonald 2


    Clearly Bridges has, how shall I put it diplomatically…deficits.

    Your constant highlighting of his deficits and his obvious lack of credibility is becoming a bit of an embarrassment. You're preaching to the choir, and gloating over Bridges' latest foot in mouth episode makes you look petty.  And something of a bully.  I am not sure if you have been given the job of writing posts here on TS that incite yet another torrent of 'Isn't Bridges and idiot?!" comments as a distraction from other items in the media that would indicate all is not rosy and snuggly buggly on the Government benches, but it is sure looking that way.

    That out of the way, what both Bridges,Clark and every other  politician who has ever dived into the cancer pool as a way of garnering votes has completely overlooked is why there is no funding specifically earmarked for research into the causes of cancers and leukaemias.

    For a supposedly first world nation we have an alarmingly high rate of cancer.  We should be asking… why? To simply blame "genetics", "lifestyle", "smoking", "alcohol", "obesity" and other commonly cited 'causes' is a cop out….and distressing to those who live exemplary lives of abstinence and are still  stricken.

    So…my vote will go to the party who promises and makes it a 'first hundred days' policy to allocated at least as many dollars for research into cancer causes as is earmarked for research into cures.

    • Adrian 2.1

      There is shitloads of money going into cancer research and it is all finding much the same thing. The vast majority of cancers have an inherited genetic component exacerbated by lifestyle choices and surprisingly the remarkable efficiency of  our modern health system to keep us living longer. If you want to avoid most cancers die early. End of story. 

      • Rosemary McDonald 2.1.1

        Please….show me where the depository of such research can be found that states there are no other factors other than " inherited genetic component exacerbated by lifestyle choices …" that contribute to our high rates of cancers.

        The tell me where to find the depository of research that proves there is no relationship between our high and unregulated agrichemical use and our high rates of cancers and malignant neoplasms of lymphatic and haematopoietic tissue.

      • Jess NZ 2.1.2

        I think every government is going to struggle to fund expensive cancer treatments. We can't help our inherited genetic component but we can change our lifestyle choices, which have indeed to be shown to be the major cause of cancer progression. Cancer initiation (rogue cells) is almost universal – progression to death is variable, and the causes have already been widely studied in the most common cancers.

        This isn't a popular view for our primary industries, but both lab and clinical research shows if you want to increase your odds of avoiding dying from most cancers, don't die early, eat well which means lots of plants (and avoid much meat). From just one recent local report:

        "We found that this [plant-based] program may also slow, stop or reverse the progression of early-stage prostate cancer, as well as reverse the progression of type 2 diabetes.

        "Also, we found that it changed gene expression in over 500 genes in just three months, 'turning on' genes that protect against disease and 'turning off' genes that promote breast cancer, prostate cancer, inflammation and oxidative stress.'

        And much more detail at…


        '“Aotearoa New Zealand has one of the highest bowel cancer rates in the world; this study shows we could prevent some of these cancers by changing our diets, consuming less red and processed meat and alcohol, and more wholegrains,” says lead author Dr Kathryn Bradbury, a senior research fellow in the School of Population Health at the University of Auckland’s Faculty of Medical and Health Sciences.

        “Think less beer and bacon, more bran and brown bread.”


        Boring advice? Maybe. But already paid for and repeated in many similar countries. Please don’t jump on this as if I’m saying I don’t care about cancer research or those that this advice won’t help. I do. But research has already shown many cancers aren’t random mysteries we’re helpless against. And don’t fall for the ‘everything gives you cancer these days’ line either.

      • One Two 2.1.3

        ..and it is all finding much the same thing…

        Then perhaps much of the research is testing the wrong hypotheses.

        Perhaps the funding sources are a limiting constraint to much of the research.

      • reason 2.1.4

        carcinogen …. have you heard of them?

        5 mins 20 secs

      • Jess NZ 2.1.5

        'If these foods can slow the growth of cancer, why do so many people get cancer? How often do people get cancer due to their genetics, and how often is it because of lifestyle?

        Different studies tried to answer this important question.  One of the best is an excellent recent review by the MD Anderson Cancer Center at the University of Texas. The review analyzed the link between the agents/factors that cause cancer and the agents that prevent it. This review is based on more than 100 studies and trials done on this topic, so there’s a lot of information. We’ve summarized it for you in this infographic.'


        ‘The evidence indicates that of all cancer-related deaths, 30%-35% are linked to diet, 25%-30% are due to tobacco, 10%-20% are linked to obesity, about 15%-20% are due to infections, and the remaining percentages are due to other factors like radiation, alcohol consumption, stress, physical inactivity, environmental pollutants etc.


    • Incognito 2.2

      A friendly warning, people get banned for:

      1. Attributing hidden motivations to an Author (e.g. writing pieces for a third party or for money)
      2. Telling an Author what to write (e.g. don’t write about XYZ but about ABC)
      3. Abusing an Author (e.g. calling them petty or bully)
    • peterlepaysan 2.3

      Nobody, anywhere knows what causes cancers.

      A single small govt to announce this as policy is somewhat risky.

    • Drowsy M. Kram 2.4

      "To simply blame "genetics", "lifestyle", "smoking", "alcohol", "obesity" and other commonly cited 'causes' is a cop out….and distressing to those who live exemplary lives of abstinence and are still  stricken."

      Fair comment Rosemary, however we commoners can't yet abstain from our genetics.

      Age is likely the biggest single contributory factor to rates of cancer, dementia, and any number of disorders/diseases that are more common for those aged 75+.

      As the linked graph shows, UK incidence of cancer is close to zero up to the age of 24 years, 0.16% for ages 25 – 49, ~1% for ages 50 – 74 years, and ~2.5% for those 75+.

      "For most cancer types, incidence trends largely reflect changing prevalence of risk factors and improvements in diagnosis and data recording. Recent incidence trends are influenced by risk factor prevalence in years past, and trends by age group reflect risk factor exposure in birth cohorts."


      • Jess NZ 2.4.1

        Saying age is the risk factor is an almost meaningless truism, and it's true for pretty much any ailment you can mention, including balding:

        1) Cancers start as small groups of cells and take years to grow to life-threatening sizes or metastasize 

        2) Young people's immune systems fight cancer cells better than older people's.

        It doesn't take more research to present that. What's the use in knowing that?

        • Drowsy M. Kram

          Can lifestyle influence the rate at which collections of cancer cells "grow to life-threatening sizes or metastasize" – any population-based data?

          Also, is it well understood how "young people's immune systems fight cancer cells better than older people's"?  Is there anything we can do to maintain the efficiency of our immune systems as we age, or is it largely down to genetics?

          Cancer and immune systems – so much to discover.  Baldness research can wait.

          A few months ago Rosemary McDonald posted a link to TEDx talk about the health benefits that might accrue from improved training of the human immune system. Best to start early, and such training is not risk-free but then what is?

          "One of the most important things you can give her [your baby] is a live polio vaccine.  Let me explain why."

          • Jess NZ

            If you really wanted to know, you'd put the appropriate search terms into Google and find out what the expert consensus is. 

            There are heaps. This one even has a simple graphic for cancer causes.

            ‘The evidence indicates that of all cancer-related deaths, 30%-35% are linked to diet, 25%-30% are due to tobacco, 10%-20% are linked to obesity, about 15%-20% are due to infections, and the remaining percentages are due to other factors like radiation, alcohol consumption, stress, physical inactivity, environmental pollutants etc.’


            • Drowsy M. Kram

              Thanks for those links Jess – my questions and scientific curiosity are genuine.

          • Rosemary McDonald

            Drowsy M.Kram.  While the above Ted talk does say 'the best thing you can give her is a live polio vaccine..' that phrase is taken completely out of context.

            Hardly anyone here on TS will take the time to listen to the Good Doctor's entire speech.

            About how babies given the whole-cell diphtheria-tetanus-pertussis (DTP) vaccine in Guinea Bissau had a higher mortality rate than those who had not been given DTP. Especially the little girl babies.   https://www.ncbi.nlm.nih.gov/pubmed/29616207

            However, the babies who were given the live oral polio vaccine as well as the DTP had a slightly lower mortality rate….hence the 'the best thing you can give her is the live polio vaccine….'.  https://www.ncbi.nlm.nih.gov/pubmed/28188123

            And unfortunately, " Combined vaccination with DTP+MV+OPV may be detrimental for girls. "


            If only life could be as simple as saying….' "One of the most important things you can give her [your baby] is a live polio vaccine.  "

            • Mark

              btw, left a reply for you over at the daily blog

            • Drowsy M. Kram

              "Vaccines prevented at least 10 million deaths between 2010 and 2015, and many millions more lives were protected from illness."

              Just my opinion Rosemary – I may be wrong. As the good Dr Benn makes abundantly clear, vaccines are not without risk.  And one reason that they are not without risk, and can never be completely without risk, is that scientific understanding of immune systems is partial.

              One of Dr Benn's key messages is that "vaccines [are] the largest untapped resource for improving health globally."  A more complete understanding of the immune system, and in particular the non-specific effects of live (attenuated) vaccines, and 'dead' (inactivated, subunit/conjugate, and toxoid) vaccines, will allow biomedical researchers and clinicians to tap into that resource.  An exciting prospect – good research is the key.

  3. Kat 3

    Good on you Mickey for highlighting the leader of the oppositions cynical dog whistling. He is at it again this morning over the PM's trip to Tokelau. Simon Bridges is the leader of the opposition and under our Westminster system of govt should be capable of competently leading the country, he is obviously not capable and never will be with his current attitude. 

    • Rosemary McDonald 3.1

      Good on you Mickey for highlighting the leader of the oppositions cynical dog whistling,

      But do you not ever get bored with mickysavage's constant dogwhistling at Bridges constant dogwhistling?

      • Kat 3.1.1

        I don't regard Mickey's posts on the leader of the opposition as dog whistling rather good running commentary and often entertaining. Lets face it we need to get some bang for the buck Bridges is being paid.

      • mac1 3.1.2

        How do you like Mr Bridges calling our PM a part-time PM?

        Am I an old cynic or am I hearing the dogwhistle to all mysogynists that a nursing mother cannot fulfil that role?

        Why does he say she is part-time? What evidence and why is he saying what he saying? I say mysogyny and the politics of denigration.

        • Rosemary McDonald

          mac1.   I would not even contemplate for a single second voting for National, Act, the Conservatives or the Maori Party, so why on Earth should I be interested in their opinion of the Prime Minister?  This is politics and it is expected that those with nothing better to do will draw attention to every little brain fart that the Opposition produces. I personally find it boring, and it distracts from what we should be doing which is holding the government of the day to account.

          Working mothers are the norm these days…have been for thirty years…so I do not see how anyone could take anyone making an issue of the fact she's a working mother seriously.  Pay these shit stirring dinosaurs no mind.

          We have much more important issues to worry about.

          Like this Current Mob spinning their wheels while trying to run damage control from loose cannon comms folk.


          • marty mars

            the 'current mob' are better than anything we've seen for years unless you're a shonKey fan

            1 : a large and disorderly crowd of people especially : one bent on riotous or destructive action. 2 informal : a large number of people a mob of shoppers clogged the aisles a team greeted by mobs of fans. 3 : a criminal set : gang especially, often capitalized : mafia sense 1 a member of the Mob a mob informant.

        • greywarshark


          I think you are right there.   An oily person as SB is, is ready for frying like an insect along with the rest of that fine brood.   Yuk.  Crispy for you today?

        • Jess NZ

          Bridges and Natz are trying to get the 'part-time' slogan to catch on and the idea that PM Ardern is trying to get a job at the UN now, not be PM. I've also heard "PR PM".

          It's nonsense. Like Clark, PM Ardern would be welcomed at UN anytime in the future on current merits, so why move away from NZ family now with a young child and also hamstring her party like Key did? 

      • woodart 3.1.3

        I get sick of your constant dogwhistling about mickys dog whistling about bridges dogwhistling. so, whats to be done? perhaps you should all be issued silent whistles so the rest of us can ignore you?problem solved?

        • Incognito

          You may not have seen my warning @ 2.2.

          Just to be very clear:

          We write here in our personal capacities and the opinions that are expressed on the blog are individual unless expressly stated otherwise (see the policy). We do not write on behalf of any organization.


      • ianmac 3.1.4

        Well Rosemary. Are you saying that Bridges should be free to say what he likes without any criticism? Are you a closet sympathiser for poor old Simon?

        I say every thing Simon says must be fact checked. Don't you? Well done Micky.

      • marty mars 3.1.5

        Micky doesn't dog whistle – I don't think you understand what that term means – bridges is utterly useless and that should be highlighted constantly imo otherwise some forget and begin to think he's cool or something

    • Shadrach 3.2

      The PM is in Tokelau on the taxpayers dime to visit Daddy.  It is a junket, in part to escape the pressures of dealing with issues on the home front.  Winston Peters, who seems to be handling things with his usual aplomb, is himself off overseas today, leaving Kelvin Davis in charge.  God help us all.

      • Enough is Enough 3.2.1

        Question time should be a doozy today with Kelvin answering on behalf of the PM

        • Shadrach

          Grant took over for Kelvin.  Grant was very shouty shouty today.  Probably sick of holding the PM's hand on all the real wok.

      • Psycho Milt 3.2.2

        The PM is in Tokelau on the taxpayers dime to visit Daddy.  It is a junket, in part to escape the pressures of dealing with issues on the home front.

        It must be so, because Shadrach has asserted it to be so.

      • Dukeofurl 3.2.3

        'The PM is in Tokelau on the taxpayers dime to visit Daddy

        The Tokelau Administrator is  either in Auckland or Apia and just visits like every one else.

        Key and  English both have made regular visits to the islands, and  both were made  honoary traditional chiefs

        Englishs wife has samoan ancestrty

  4. DirkDirkin 4

    Bridges,  in his speech about this deliberately ramped this up by saying it would be the end of people having to start Givealittle pages.  

    People start Givealittle pages because their meds cost $6000 per month,  so how will far will $50m stretch.  Especially when Keytruda and the other big cancer drug cost $54m

    This has been a hurredly put together policy

  5. Booker 5

    Good call. This proposal is a train wreck waiting to happen, and I’m genuinely concerned it could end up going ahead. People won’t see past the face value headlines or shallow media coverage, and the idea of “more money for cancer treatment” will sound like such a good thing, how could there be a downside?

    NZ desperately needs to take note of the history of the Cancer Drug Fund set up in the UK:

    “The Fund was introduced in 2011 by the then coalition government. And until 2016, it was used to pay for drugs that NICE had rejected or hadn’t reviewed, because there wasn’t strong evidence that they were effective enough to justify their cost. This meant many patients could be prescribed drugs that wouldn’t otherwise have been available, which was good news.

    But the Fund was also heavily criticised, including by us. There was no data collected on how well patients were doing on drugs paid for by the Fund, meaning it couldn’t help NICE make better decisions in future. And its costs also spiralled, with a massively overspent budget that ultimately led to the Fund being criticised for not delivering “meaningful value to patients or society”.”

    (from: https://scienceblog.cancerresearchuk.org/2018/12/14/the-new-cancer-drugs-fund-has-quietly-reached-a-significant-milestone/)

    I had been wondering what was going on with all the negative press from Radio New Zealand, particularly Guyon Espiner, about Pharmac recently. So much dubious journalism to unpack in that series. Now it seems that the Dirty Politics era links between National and the media never went away: get journalists to pummel out hit jobs on Pharmac, make it look like they’ve failed on funding (largely unproven or exorbitantly expensive) cancer treatments, then propose a “solution” which undermines the whole reason for having a subsidized medicines scheme in the first place and risks the same enormous budget blow out the UK had only 4 years ago.

    • Dukeofurl 5.1

      Not so much  media and national but media AND drug companies.

      Their interests merge – Drug companies to have  new  marginal  and highly expensive drugs paid from public health budget and media to have a 'supply of  stories that  are aimed for target demographics'

  6. infused 6

    reply button has gone…

    but I suspect our high cancer rates having something to do with our drinking and obesity rates.
    our bowel cancer rate is alarming… there really needs to be a serious look at why NZ stands out.

    • Jess NZ 6.1

      +100000 as above

      “Aotearoa New Zealand has one of the highest bowel cancer rates in the world; this study shows we could prevent some of these cancers by changing our diets, consuming less red and processed meat and alcohol, and more wholegrains,” says lead author Dr Kathryn Bradbury, a senior research fellow in the School of Population Health at the University of Auckland’s Faculty of Medical and Health Sciences.

      “Think less beer and bacon, more bran and brown bread.”


      • Psycho Milt 6.1.1

        He said a "serious" look.  The constant bullshit about the evils of red meat and alcohol vs the sacred cow of whole grains is a propaganda campaign by activists, not the result of scientific research. 

        EDIT: a friend of mine has been diagnosed with bowel cancer after a lifetime of “healthy” diet and has suffered incessant snooping about her food intake from people under the impression that cancer is a matter of dietary choices. I suggested her answers to the questions should consist of “Fuck you.”

        • Jess NZ

          Do you always rebut national scientific references that align with international studies and recommendations about health risks with tragic single anecdotes about 'healthy diets'? Seriously, I was expecting the 'my gran ate bacon every day and lived to 105' anecdote, but this is just as satisfying and effective. Those ‘snoopers’ are professionals following decades of scientific evidence.  

          Any REAL evidence about calling BS? Here is your chance to be taken seriously instead of being an emotion-based science denier.

          None of the science claims “Your healthy-eating friend will never get cancer.” The message is valuable info nonetheless.

          ‘Evidence shows that our risk for many types of cancer is related to diet, physical activity and weight. For some cancers, it is not yet possible to determine if these factors play a role. This does not mean such links do not exist, simply that more research is needed. AICR/WCRF reports examine the evidence linking diet, physical activity and weight to 17 cancer types using a rigorous and systematic process….

          AICR’S latest report on colorectal cancer found that eating fiber-rich foods, exercising regularly and maintaining a healthy weight can lower your risk. Eating high amounts of red and processed meat, drinking excess alcohol and carrying extra body fat were all linked to a higher risk.’


          • Psycho Milt

            Epidemiology that tries to establish dietary causes for illnesses has so far consisted of correlation=causation errors that are subsequently backed up with "evidence" consisting of confirmation bias.  That, rather than anecdote, is why I call it bullshit.  It's social science at best and achieves nothing beyond making people either neurotic about what they eat or cynical about health messaging. 

            • Firepig

              Agreed. Any study based on self-reported dietary intake or extrapolation from  rat and mice information should be looked at with suspicion. I taught students to critique published research papers and there are not many that really withstand scrutiny. 

            • McFlock

              Hey! It's not epidemiology's fault. Any research is only as reliable as its source data. And then the fecking media and industry come along and shit in the narrative, anyway.

              • Epidemiology's done a great job with infectious diseases.  Not convinced it's given us anything useful re dietary causes of illness though.  And yes, the reporting of this stuff in the media can only encourage cynicism.  

                • Jess NZ

                  And what's your accreditation so anyone should accept your dismissal of varying studies in many countries and the national organisations whose very existence is to examine the available data, lab, clinical, and epidemiological, and make recommendations to the public?

                  Don't get me wrong – I don't mind whether you personally decide to eat preventatively or laugh in the face of the odds. But I wonder how you see yourself as a superior expert.

                  • Booker

                    It’s okay to say that epidemiological studies have identified lifestyle factors that increase the risk of bowel cancer, but even people without those risk factors can still get cancer. So both points being made in this thread are correct: diet, exercise, smoking etc influences the risk of bowel cancer, but also people without those factors can be made to feel horrible if they a barrage of questions or insinuations about their lifestyle choices. They way those kinds of questions are framed and asked can have unintended consequences.

                    • Jess NZ

                      We know that looking both ways generally helps prevent most of us getting hit on the road. But even if you look both ways, you could still slip on oil and fall and get hit on the road. That would suck and be terrible luck.

                      Would you recommend NOT telling everyone to look both ways before crossing, so that those people who did, and some other factor made them get hit, didn’t feel resentful that they still got hit?

                  • No particular accreditation is needed to spot correlation = causation errors or confirmation bias.  

                    • Jess NZ

                      Yes, but to imply that peer reviewed studies from multiple accredited scientists in many countries in the specific field have ALL missed correlation=causation errors or confirmation bias that you see – that takes some independent support or it's BS.

                      I'm betting on BS, based on your posts so far. It's inconvenient to be told that your eating style could be harming you, so you've decided to be that skeptic.

                    • Jess NZ

                      'If these foods can slow the growth of cancer, why do so many people get cancer? How often do people get cancer due to their genetics, and how often is it because of lifestyle?

                      Different studies tried to answer this important question.  One of the best is an excellent recent review by the MD Anderson Cancer Center at the University of Texas. The review analyzed the link between the agents/factors that cause cancer and the agents that prevent it. This review is based on more than 100 studies and trials done on this topic, so there’s a lot of information. We’ve summarized it for you in this infographic.'
                      ‘The evidence indicates that of all cancer-related deaths, 30%-35% are linked to diet, 25%-30% are due to tobacco, 10%-20% are linked to obesity, about 15%-20% are due to infections, and the remaining percentages are due to other factors like radiation, alcohol consumption, stress, physical inactivity, environmental pollutants etc.’



                • McFlock

                  Heh. The one that immediately springs to mind is Takaki Kanehiro's work on beri-beri.

                  Saved millions.

                   Also spina bifida prevention.

                  My informal take is that part of the general problem now is that most of the major and clear solitary causes of conditions have largely been identified and minimised – e.g. tobacco use had something like a 90% attribution rate for lung cancers with a clear dose-response relationship available from self-reporting. Asbestos was a similar almost exclusive cause for some conditions.

                  These days one tries to narrow down a 10% attribution for something that occurs in 1:100000 people, with complex cause interactions and self reporting. That would take hundreds of studies over decades with maybe millions of participants. But pr folk want exposure and answers now.

                  • I think that's the problem. When you see something that talks about increases in relative risk of 10 – 30%, it's safer to assume it's effectively statistical noise.  That doesn't stop the PR types peddling "new study shows…" stories about it to the media.  

                    • McFlock

                      "Statistical noise" is a bit harsh (unless they bloody ended up data mining).

                      It's a bit like aircraft crashes: even the ones with a clear proximate cause (pilot suicide or the wing fell off) there are a number of factors that, had they worked optimally, would have by themselves prevented the crash: pilot's medical picked up depression, aircraft inspection detected the metal fatigue on a wing strut.

                      It's getting to be that way with cancer – there are a myriad of little steps to lower the odds of a cancer crash happening, but if you're alive long enough the odds increase that you'll get it. Just hope it's a not-so-serious one. But along with the crash prevention information, the ambulances at the crash site are getting better, too.

        • 7% of  sessile serrated adenomas are found in the population..  These are hereditary. (Our yougest is dealing with this)

          42% of these turn to bowel cancer.  So not all cancers are environmental or behavioural problems. 

          To avoid the cancer these are removed.  They are hard to spot as they appear as rough bowel folds.  Biopsies are needed to confirm them.

          There is more research into cancer world wide than most other conditions,   there is such a range of unrelated cancers, that causes are as numerous as the studies.

          Bridges is going for the "emotional underbelly" talking to cancer patients. 

           Micky is reporting on his behaviour,  and responses to interviews,  and drawing attention to the skills of Jack Tame in exposing Bridge's perfidy.  

    • woodart 6.2

      perhaps the 50mill should be wasted, er ,spent convincing people to eat less red meat and less processed meat. bridges constituency would really appreciate that(sarcasm alert). luckily the outrageous price of nz produced red meat is doing the job, so we will probably have less cancers because of market forces(law of unintended consequence).

    • Augustus 6.3

      Diesel fumes, agrochemicals to satisfy requirements from several continents at once, etc. 'lifestyle' is low hanging fruit.

  7. Adrian 7

    Rosemary, I did not say  "no other factors" do you just choose to read what you want to think is true.

    I said " the vast amount ", if you have read as widely as you claim you would also realise this to be true. It has long been known that melanoma for one unfairly favours  certain inherited skin types and the familial connections to bowel and similar cancers have been tracked for decades. I cannot quote you every article with these assertions because it would take weeks to collate. Do your own reading of proper peer reviewed research  papers from  credible universities and the like with an open mind rather than searching for only those that reinforce your views that you wish to be true.

    Anecdotage is and never has been a substitute for thorough reseach.

    • Rosemary McDonald 7.1

      Anecdotage is and never has been a substitute for thorough research.

      I agree.  That's why we need the research.  Let's begin with our overuse of agrichemicals which have an all pervasive influence.  Not only through lack of routine and regular residue testing for produce grown here for domestic sale (oh that we had the same standards for produce we are forced to buy as those demanded by, say, Japan) but also off target application that goes largely un- challenged.  How about we take a look at  occupational exposures ?

      If there ever was a call for more specific attention…you need to take a look at some of the odds ratios on page 19.

      • Adrian 7.1.1

        You are already starting off with an assumption that you know the cause of the so-called high rates of cancer. That is no way to conduct research because you will only find what you want and subconsciously reject evidence to the contrary. The first thing you are taught as a researcher is to leave your assumptions at the door and that is a lot harder to do than you would think.

        We do not even know if we have high rates. One anecdotal correlation that I have imagined up is that if a partner gets cancer, and this is without a shred of evidence of course, is that within a very short time the other partner will fall victim as well and not usually to the same type of cancer. Is it the stress? Or more likely it is age, all my cohort are ancient like me, or is it all my wild imaginings?

        • Rosemary McDonald

          Did you take a wee look at the link I provided? David McLean is a respected academic and he compiled that particular paper at the behest of ACC and Worksafe.

          My guess would be that further research would indicate that whatever some of those horticultural workers were exposed to that put the ORs so high could very well be coming through into the produce we eat.  And there is fuck all monitoring of this.

      • McFlock 7.1.2

        Let's begin with our overuse of agrichemicals which have an all pervasive influence.

        Agrichemicals. As in your comment above: 

        The tell me where to find the depository of research that proves there is no relationship between our high and unregulated agrichemical use and our high rates of cancers and malignant neoplasms of lymphatic and haematopoietic tissue.

        Even assuming a clear causal link, why would we start with a cancer well down the list of prevalence?

        Surely we'd start from the top down, e.g. breast, skin, digestive or genital cancers?

        • Rosemary McDonald

          Much as I would love to suspend all else on my to do list today and engage with you on this issue,sadly…and I'm seriously pissed about it…I am unable to download the file linked to on that MOH webpage.  The file with the nitty gritty I assume you are referring to.

          Are breast, skin, digestive or genital cancers top of the list?

          • McFlock

            Top of the list is digestive tract, with colorectal alone having a greater number than the lymphatic/hemowhatsits.

            But the other three groups also had greater incidence of new registrations in 2016 than whatever was allegedly caused by your agrichemicals.

            • Rosemary McDonald

              They're not my agrichemicals….https://www.frontiersin.org/articles/10.3389/fpubh.2017.00273/full

              A Perspective Discussion on Rising Pesticide Levels and Colon Cancer Burden in Brazil

              Just one of many such papers discussing the link between colorectal cancers and pesticides.  Especially pesticide residues in food…

              From 2001 to 2007, this agency revealed that ~13% of food sources did not comply with the safety standards for human use. In 2009, 3,130 food samples were analyzed, revealing that 29% of them contained pesticides above safety levels. This means that 744 samples contained illegal pesticides (IP), 88 samples had pesticide concentration above the maximum residue level (MRL), while 75 other samples had either IP or pesticide levels higher than MRL. A similar scenario was repeated in 2010, in which banned pesticides were detected in 605 out of 694 contaminated food samples. Astonishingly, between 2011 and 2012, the same agency found that 36% of analyzed food samples were unsafe for humans. Specifically, 32% of unsafe food samples contained IP, 2.3% of them did not comply with MRL, and 1.9% had both irregular characteristics. The latest report (2013–2015) showed that 20% of analyzed food samples contained either prohibited pesticides or contamination levels above safety standards. While soy plantations, only in 2011, have used ~341.2 million liters of all 852.8 million liters of agrochemicals sprayed on Brazilian crops, Anvisa did not show any analysis for soy contamination by pesticides in its reports.

              • McFlock

                1: are there comparable levels of use and exposure in NZ?

                2: what % of lymph etc cancers are attributable to that exposure?

                3: how does this affect quality assurance practices in NZ (e.g. MPI testing of produce for chemical levels)?

  8. greywarshark 8

    Those part of the Deaf Community consider they must speak out for attention to their needs;  the needs of otherwise healthy people who are forced to wait years for operations.


    Ear, nose and throat surgeons say they are frustrated only 40 adults a year are funded to get implants which give them their hearing back.

    Two hundred people a year meet the criteria for the surgery to receive an implant, but the government currently funds 40 operations for adults nationally each year.

    This base figure hasn't changed for more than five years and surgeons say it needs to be tripled…

    Mrs Cleine was born able to hear, but she started to lose her hearing in her late teens. By her late 30s she was profoundly deaf.   "I could no longer use the telephone accurately, I couldn't participate in family dinners and family conversation. Going out with friends and socialising was extremely difficult. I could never understand what people were talking about, I was always behind the eight ball with the conversation….

    "It changed my life like you just couldn't believe," she said. "I can do things that I never would have thought possible. I can talk to my children freely, I've got another job. It's just opened up so many doors for me and has brought back the sparkle to my life."

    Further on deafness and how it can be overcome.

  9. Adrian 9

    Infused, ( damn reply button ) but do we even know if we have unusually high rates of certain cancers, with the probable exception of melanoma, and a few others,  which seems to be a pretty clear combination of very clear skies with little pollution meaning high UVs, marvellous weeks in summer sun as kids and a high proportion of northern European skin types.

    The rates may well be within reasonable variational parameters. Quesswork and anecdotal wondering needs to be verified by proper research.

    What I do know is that survival rates are hugely more advanced than only a decade ago, I have many friends who have lived on for much longer than I ever expected them to.

    The confounding factor in our rates of course is that they do leave us wide open to other cancers simply because of being compromised by being a survivor already. Maybe this is skewing the possibly wrongly believed "high rates " simply because of living a lot longer than previously. Its a complex one alright.

    • Maybe this is skewing the possibly wrongly believed "high rates " simply because of living a lot longer than previously.

      Yup.  Given that the death rate for Homo Sapiens is 100%, same as all the other critters, it's a given that reducing the incidence of any one cause of death increases the incidence of other causes.  The above may seem to be stating the obvious, but it's astonishing the number of people who report that [insert undesirable food/activity here] "increases your risk of death."

  10. Bearded Git 10

    The health budget is a tricky thing. 

    I've been diagnosed with a cataract in one eye that is significantly affecting my eyesight but, much to my surprise, my GP says it is not bad enough for me to get it fixed in the public health system.

    I am forced to go private-$4,500. This operation would cost perhaps $3,000 in the public health system (no profit/economies of scale). 

    The $50 million the Nats are proposing for cancer drugs (and the drug companies) would pay for nearly 17,000 cataract operations which would enhance the lives of 17,000 people if my experience is anything to go by.

    Or to put it another way one Keytruda patient costing $120,000 a year is worth 40 cataract operations. The life of one person possibly extended by one year so that 40 people have to walk around in a semi-blur.

    Tricky stuff…..of course if it was me with cancer….   

    • greywarshark 10.1

      Is it time for positive discrimination in health.     Eyes, hearing being given high priority, then mobility. Discrimination gets a bad name when it is applied either for or against Maori and the low income.  Your eye problem might be reviewed differently if you were in a different DHB, had a different GP etc.    So there is discrimination in all sorts of ways for those who should be considered entitled to better treatment.   Seeing and hearing and mobility are pretty important at all ages, and it would seem that there should be a priority order.  

      It seems to me that young people with cancer are struck at the unfairness of an early death, and old people with cancer draw on their unwritten guarantee of long life once at a time that approximated old age of the past – say just over 80, now wanting to squeeze the last drops out no matter the cost, especially to others needing public help.

      Cancer Agency – that is picking the cherries off the baked meats.   A whole new approach to being in the world is needed, one of gratitude and wonder about being here, and a recognition that we can't cling onto long lives in a crowded world.  Also one that is run on mean, selfish lines which refuse many of the young the basics of life, in an unloving way.  Attention to the wants of those who want a reliable, painless death when very old, very ill and terminally ill, on an individual basis, signed, sealed and nearly foolproof would be wise especially now, when disasters are going to happen.   At the end if there is a reversal of that decision, it would have to be cancelled I think.

      I have ageing people in my family 80s and 90s, and I wonder why we can't decide to go while we are still in comfort and can arrange our own affairs and rituals.   Why all this care and attention for a very aged person, and all the cost and discomfort, the equipment, the nursing, the cleaning, the decline, the uncertainty, the lack of wellbeing if not actual sickness, pain, collapse, and how long will it go on for, three, two, one year, months?  And the care, and who decides what and where;  there is a problem where an enduring power of attorney is held by one member of the family who is not performing the duty of care well.   Apparently the rest of the family have to stand back.  The whole thing can be quite traumatic, and often unnecessarily.


      If you have children and there is a flood, it would hurt to leave the elderly and frail if you only had room for the children in your vehicle.   But the elderly are putting their needs at the end of their lives, before those of the young who should have a chance to live for a while if not as long as the old.   We will have to be more thoughtful of others.   In the meantime I will go on looking after my relatives when needed.    That's what I'll be doing this year if I am well myself.

      • Firepig 10.1.1

        My husband, 75 (is that old?), would have happily gone just before dementia stole his mind and body, but who is to say when that is and how he should be dispatched? I cared for him as long as it was safe but now we fund his full time care ourselves – no burden on the state (until last year when he was given his first pharmaceuticals) and he will linger on for years at our expense. There's no easy answer.

        A niece and a friend (30+ and 40) both have lung cancer despite being non-smoking and being otherwise healthy. They both have a gene mutation that predisposes them to lung cancer at an early age and they and their families have funded the expensive drugs that have been helpful in giving them some remission. One has a teenage daughter. Should they have just been left to suffer? Again, no easy answer as to who lives and dies.

        • greywarshark

          Yes Firepig I agree.   I think age should come into it though.    The young ones should have a certain time with family, friends I think that is fair and should be funded –  but how long?   It would be better for the individual to have thoughts on this rather than a blanket law.    Maybe there could be a grant for alleviating drugs and when that was used up then the end time would come closer for a date and arrangements.   It might be that part of the pact for the state providing drugs for people with proved genetic likelihood, would be that child-bearing would have to be foregone.   That would be a reasonable expectation.

          As for dementia.   It is very hard looking after the person as the body does its servant business so dutifully, while the mind is elsewhere.    And of course there might be wandering off down the street, the river, an attempt to go somewhere and putting on familiar clothes in unusual ways.  Your husband did not sign any agreement, it has taken so long to get the matter considered intelligently, and he may now linger on for years.   It is good that you have shared care of some sort. It is sad to see the person fade in mind, and think of all the things they have said and done.    Sometime they will find the connection to get the brain working again, or better.

          And if you can get some help from the state to make life easier for you and it doesn't mean some constraint on his present home location, the system has been set up to help and should be open to support you in some way.

          I have thought about the practice to follow but have not looked at the various brochures and books but must do so fairly soon.  While lucid, the person could sign approval to cross over or die, I think of it as managed demise.  The partner or family, could be trusted to do what was right when appropriate, after a proper legal set of actions had taken place, the will, looking out insurances, settling accounts, preparing letters to distant family and telling near family etc.   Then the partner could decide to let the person go when the time seemed right.   The pact and trust between them would give strength.   Family who could cope could come around, and those who couldn't would get their letter written earlier by the person saying goodbye with kindness, love and regret.  The aim would be to have a quiet demise – if the person was disturbed in their mind at the time, it would need to be cancelled and reconsidered for the future.    It may take time to carry out properly.   I know of others who have planned their death, and carried it out with others beside them.     I am not ready yet, I have to do my part in caring for others in my family who are aged in the next few years, as they also do for others near and dear who are sorely missed.

    • mac1 10.2

      “Tricky stuff…..of course if it was me with cancer…”

      Wise observation, Bearded Git.

       I was diagnosed two weeks ago for the recurrence of a cancer which showed first symptoms four weeks ago. I have already seen my GP, a specialist oncologist and had the procedure to discover the actual tumour, am due for a  scan on Monday and scheduled for a resection of the tumour in September. There is a delay there as the oncologist is off on holiday and his replacement needs a little time to fit in. 

      Ask whether I think this treatment is timely I would say yes. Ask me if I want it done tomorrow and I'd also say yes.

      This will be my fourth treatment for cancer under successive governments over ten years. Each time the treatment provided by our health system has been exemplary.

      I am not happy to see arguments being raised about treatment being necessarily age related. This baby boomer entitlement, greedy oldies, pampered beneficiaries is too often being raised recently.

      That issue was raised in the substantive post above. "What funding should there be for glue ear which has significant life long effects on people compared to funding for people approaching the end of their lives.  These are not easy decisions."

      Indeed they are not, as you say too, BG. And what is not good is to see these hard decisions about expenditure on the quality and length of people's lives being made a political football.

      The Cancer Society explains that what Bridges is advocating will fund two or three treatments only. Where is the real debate as to what our health care really costs and where the funding for it is? 

      That of course includes taxation. How much responsibility sheets home to those thousands who dodge taxation to the extent of billions of dollars annually?

      Do those tax dodgers and deniers actually understand the social cost of their theft?

      Do the purveyors of cancer causing products and lifestyles acknowledge their complicity?

      Finally, considering some of the ideas being advanced here, there are many causes of cancer.

      My specialist commented that my bladder tumour might be the result of radiation therapy for my prostate cancer which was needed  because the prostatectomy was unsuccessful at finding all the cancer!

      Discussion about the possible causes and especially pronouncing on who is more deserving of full treatment based on age, moral delinquency or supposed life style choices is itself fraught.

      • greywarshark 10.2.1

        Talking about being age related can't be put off.    There are so many people now living to 90.    The rates for dementia start going up after 80. People over 70 have had a good life, with experiences enough to make decisions about everything.    The idea that the old can accept the changes that give them extended old age but can't think about the ramifications of that implies that people become like children as they age, not true.   It's like sex – out there, all round us, but no one wants to talk about it.    And when they don't it doesn't go away.     So age is important, it is separate from moral delinquency and if it comes through life style choices, then again it is something that people can think through.    We have the information, the education, the brains to think with and there should be regular meetings about ageing and what we can do in society, for our families and for society, and for pleasure and meditation and enjoyment as elders, or kick up our heels also.   But we are not children, we can think and talk about it, we aren't white haired old doddery couch sitters and retirement home buyer investments.

      • All the best mac 1.  

        • Bearded Git

          I'll second that PB. 

          Wonderful answers to my post above-I hope the pollies are reading this thread.

  11. Louis 11

    Keep posting your articles Mickysavage, theyre good reads and are not petty at all. Youre the main reason I visit the site.

  12. Cinny 12

    Jack Tame totally owned simon on Q+A last night, it's well worth a watch if you missed it.

  13. ianmac 13

    Jack's best interview of Bridges. First journalist who actually tried to dig into the Cancer scam. Pity Bridges became angry to have to explain the superficial plan. Q&A at its better show:

  14. Jum 14

    A few decades ago, I remembered a radio item about a person with altzeimers being refused kidney dialysis treatment.  There ended any pretence that ethical well-being of patients was more important than money.

    I was appalled at the time.  Now I realise that profit is the end goal of so many political and private entities and the cynical use of New Zealanders' personal suffering is a political tool.  I note National tried to introduce user pays to much of health, which Labour then reversed.

    When first john key with his cynical pre 2008 election promise to help with breast cancer sufferers to access a yet unproven treatment and now simon bridges with his new action on cancer processes enters the chattering classes of media, I realise how revolting politics has become.  Media should be ashamed of its bowing to money.

    The end goal for national is privatisation of our health system..  They were working on that through degrading our infrastructure to a degree where they could state it was beyond repair and seek to bring in private partnerships to muddy our publicly owned systems.  Thanks to NZ First and Labour that has been halted.

    We need to force that privatisation profit-oriented thinking out of health, education, transport, etc.

    New Zealand and New Zealanders are so much better than that.

    • greywarshark 14.1

      People who have utopian ideas that are totally unrelated to real life like this are why I dislike consensus except for deciding where to for coffee.

      • Jum 14.1.1

        G, you can call it utopian if you like.  I just see NZ's future under privatisation as a world like below, where staff are forced to beg for an 82p pay rise.  The British NHS is a public good, yet privatised parts are making high profits from the public purse and not passing it on.


        ' We are hospital support staff working for Compass in St Helens, Blackpool and Liverpool NHS Trusts. We keep hospitals clean, cook for patients and keep them safe.

        Compass made £1.7bn in profit last year alone, we refuse to accept that they can’t afford an 82p pay rise for the lowest paid staff in the NHS.

        We are paid over £1000 less per year and have worse terms & conditions than some of our colleagues who do the same jobs. That's why we are standing together for fair pay and fair treatment.

        #ONENHS, nobody left out. '

  15. Jum 15

    G, as for your previous posts on cancer; I've had it.  2/3 likely to get it back.  Treatment taken because my children were too young.  That is no longer the case.  There is now no need for me to take treatment again.  As the body ages, we should take the hint and stop hanging on.

    Cancer treatment should go to young mothers (young solo fathers) automatically and a special funding channel, outside the Pharmac protocol, to fund special drug treatments as required.

    • Jum,  hang on to the 33% healthy,  and keep positive.  Greywarshark has his opinions as do you.  Yours are equally valid,  and I notice you don't accuse dissenters as being mental defectives who believe in utopia. He doesn’t believe in democracy if he doesn’t go with the majority? “Except to buy coffee!!” Wow!! lol lol

      • Jum 15.1.1

        Thanks, Patricia, but it hasn’t shown up for a while now, so my great care under our ‘utopian freeish’ health system is probably the reason why.
        Also, I prefer tea to coffee so G and I are never going to agree! 🙂

        • greywarshark

          PB An example of how you fail to understand what you are reading.  You said:  He doesn’t believe in democracy if he doesn’t go with the majority?

          I said :  People who have utopian ideas that are totally unrelated to real life like this are why I dislike consensus except for deciding where to for coffee.

          Please note that: Consensus is not a majority opinion, it is a total agreement without any dissent.   And interestingly enough, it often doesn't reflect democracy, as there is often a dominant group who will pressure others to drop their own hesitations and questions and vote with the loudest or most forceful and emotional section.

          And where did I say 'mental defectives' as in: I notice you don't accuse dissenters as being mental defectives who believe in utopia.

          I did say that people with utopian ideas are not in touch with real life.  I think your comments are an example of how difficult it is to have objective discussions, looking at archived knowledge and drawing on personal experience and informed anecdotes.    Perhaps we need to have classes in critical thinking to avoid talking around each other.  If each person in a meeting has a different idea of what has been said  and further discussed, it cannot be said to be a 'meeting of minds'.

          • Jum

            Really G, if people don't have utopian ideals, how can NZers ever drag themselves up from their base instincts of personal greed.  Political ideologies were probably perfect; unfortunately people got involved.

            • greywarshark

              A level of pragmatism is required Jum.   Utopians tend not to have that in their considerations.    I know I have been involved with them, and fallen into that trap myself.   Just remembering Murphys Law is what is needed to bring one round to a sensible position.*

              *Murphy's laws origin. Murphy's Law ("If anything can go wrong, it will") was born at Edwards Air Force Base in 1949 at North Base. It was named after Capt. Edward A. Murphy, an engineer working on Air Force Project MX981, (a project) designed to see how much sudden deceleration a person can stand in a crash.


              The idea is to work for the best possible outcome, in the amount of time available with the resources that one can count on and beg if there are over-runs.

              • Jum

                That's what I like about The Standard; there's always something to learn from the posters – aka Murphy's Law origin.  But, utopia pragmatism?- nah.  I'm a total utopia believer G.  Without that belief I couldn't continue to believe in the progress of the evolution of mankind, which is pretty shit at the mo. 

  16. greywarshark 16

    Jum   I noted what you said about young mothers and think that would be a good point to start off discussion about what treatment is available and who needs it first in the priority list.   It would be good if people could come together in groups and talk these things out with the government, considering that if everything can't be provided, what is fair to request from the government and how it should be provided with a priority list.

    Yours sounds as if it has gone away.  Hopefully a good diet and limited stress,  and healthy lifestyle with adequate sleep (which seems important – confusing that there is both too much and too little showing up as not good) will mean fun and positivity being at the forefront all your life.

    • Jum 16.1

      Oh dear, I hope I didn't sound like some sad old case just waiting for Godot. Probably another 15 years ahead.  The 2/3 hasn't come back yet.  I just wanted to make it clear I know what cancer is and how to approach it personally.  I am politically fit to fight on for my utopian goals, G.

      For anyone needing fun I recommend Black Books and Morecambe and Wise.  Death, preserving life, and how to deal with either should never be a taboo subject.  I agree on debating everything – cancer, abortion, euthenasia.  Nothing should be exempt.

      That's what I tried to say. 

      As for me as long as I have projects of importance to complete, nothing will remove me.  Look out greed!

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  • Another Green win as climate change considerations inserted into the RMA
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  • New Navy vessel Aotearoa to arrive in New Zealand
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  • Racing Industry Bill passes third reading
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  • New Zealand First MP Mark Patterson selected as candidate for Taieri
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  • Ground-breaking on NZ Post depot
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  • Fleeing drivers hit new record-high yet again
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  • Speech to Labour Party Congress 2020
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