Welcome back to the Deep Dive. Today we're tackling
a really fascinating figure, someone whose career
journey takes us from the microscopic world of
immunology right through to the big picture of
national health policy. That's right. We're looking
at the life and work of John Michael Dwyer, an
Australian doctor, professor, and, well, a really...
Tireless public health advocate. Exactly. And
this isn't just about listing achievements. What
we want to do for you, the listener, is really
trace how a top clinical immunologist became
this major public voice. A voice really dedicated
to demanding rigor. fighting for evidence -based
medicine, and taking on misinformation and, frankly,
unproven practices. It's quite a transformation.
It really is. So we'll follow his path, starting
with some pretty cutting -edge research, actually,
at Yale University. And then right into the thick
of the AIDS crisis in the 80s. That experience
seems absolutely central. Definitely. And then
we'll see how that leads him into advocating
against health fraud, tackling pseudoscience,
even within universities and government policy.
It's quite the story arc. And I think the key
question running through it all, the thing we
really need to figure out, is how managing a
massive public health crisis like HIV AIDS, how
did that shape his conviction? His conviction
that you absolutely need both solid, rigorous
evidence and a respect for human rights to build
any kind of effective health system. Precisely.
That seems to be the thread connecting everything,
doesn't it? From the hospital wards to the halls
of parliament, decades later. Okay, so let's
lay the groundwork. Where did this all start?
He was born in Melbourne, 1939, but his medical
journey kicked off in Sydney. Yeah, University
of Sydney, got his medical degree, the MB. BS
back in 1964. Standard path initially. But he
didn't just stop there, did he? He pushed on
pretty quickly towards specialization. No, definitely
driven. By 1968, he'd earned his fellowship of
the Royal Australasian College of Physicians,
the FRACP. Which, for listeners, means he's gone
through significant extra training, passed tough
exams. He's a specialist physician now, operating
at a high level already. Right. But then comes
this. Well, this fork in the road. While he was
doing his residency work at St. Vincent's Hospital,
he landed a scholarship. From the Australian
Asthma Foundation. And this seems to be the moment,
just one year of research at the Garvin Institute.
Yeah, it was maybe just meant to supplement his
clinical work, but it completely changed his
direction. It sort of hooked him. Hooked him
on research. Exactly. It seems he realized that
understanding why the fundamental mechanisms
of disease was where he could make the biggest
difference, not just treating symptoms. So that
led him away from a purely clinical path. Pretty
much. He moved into academic research, ended
up at the Walter and Eliza Hall Institute in
Melbourne in 69, really digging into immunology.
And that led to his PhD. Yep. Finished in 72,
University of Melbourne. Clinical immunology
and the thesis title. It's quite telling, isn't
it? Cellular interactions with antigens in the
immune response. It sounds incredibly fundamental.
It is. He wasn't just looking at treatments.
He was down at the cellular level. figuring out
how the body's defense system actually works,
how it recognizes threats. And you can see how
that deep fundamental knowledge would become
his benchmark later on, right? Absolutely. If
you're going to claim something affects the immune
system, you'd better have evidence that stacks
up against that level of understanding. Yeah.
It kind of baked in an intolerance for claims
without solid data. That scientific grounding
then catapulted him overseas to the U .S. Yeah,
the American phase. A scholarship to Yale. And
he didn't just pop over for a year. He stayed
for 14 years, a really significant chunk of his
career. And it wasn't just any posting. He got
major recognition, didn't he? Oh, definitely.
Support from the Howard Hughes Medical Institute
pretty early on in 73. That's a huge deal. And
consistent funding from the NIH, the National
Institutes of Health. These are the big players
in U .S. medical research funding. They back
people they think are going to lead the field.
And he did. Climbed the academic ladder at Yale,
became professor of medicine and pediatrics.
And he headed up clinical immunology there for
seven years. That's right. So by the early 80s,
he's established himself as a, well, a global
authority in his field, based at a top institution
backed by serious funding. And that's right when
the world is about to face something completely
unprecedented. Yeah, this is where his academic
expertise crashes headfirst into a terrifying
reality. His time leading immunology at Yale.
It lines up perfectly with the emergence of AIDS.
The early 80s. Just think about it. Total mystery,
fear, panic, stigma. And he's right there at
the epicenter in the U .S. He wasn't just observing.
He was actively involved from the very beginning,
trying to understand this new disease. And not
just treating patients, though he did that too.
His research background was crucial. He was digging
into the mechanism. How was this virus actually
destroying the immune system? The source material
mentions his work on T8 cells specifically. Right.
T cells are like the generals of your immune
army. T8 cells, or cytotoxic T cells, are the
specialized soldiers that kill infected cells.
Understanding how HIV disrupted them was critical
to figuring out why the immune system collapsed
so catastrophically. So... You really needed
an immunologist like him with that deep cellular
understanding on the front lines. You absolutely
did. His work provided some of those early vital
clues about how the virus worked. But the need
wasn't just scientific, was it? No, the human
crisis was escalating. And in 1985, he comes
back to Australia. Bringing all that frontline
Yale experience with him, right when Australia
was grappling with its own rising fear and uncertainty
about AIDS. And he steps into massive roles,
not just one job, but several key leadership
positions at once. It's quite something. Professor
of medicine and head of the medical school at
UNSW. Plus, director of medicine at the big teaching
hospital complex, Prince Henry and Prince of
Wales. So he's leading medical education and
overseeing clinical care for a huge part of Sydney.
Yeah. Talk about pressure. And inevitably, HIV
AIDS remained his immediate focus back in Australia.
He was central in getting the early antiretroviral
drugs into use here. But the job quickly became
about more than just medicine, didn't it? The
fear, the panic. Oh, the moral panic was overwhelming.
That's why his role on the National Advisory
Committee on AIDS, Nick AIDS from 87, was so
important and so difficult. Because they were
recommending policies based on public health
evidence, but those policies flew in the face
of public fear. Exactly. Things like needle and
syringe exchange programs, even in prisons. and
arguing against segregating HID -positive prisoners.
Why were those things so controversial? Because
the public health logic, engage with reality,
reduce harm, prevent transmission, clashed with
the desire to punish or isolate. Segregating
prisoners, for instance, sounds tough, but it
drives the problem underground, increases risk.
Same with clean needles. And the government didn't
adopt those recommendations at the time. No.
Too politically unpopular. Too much fear, not
enough focus on evidence or, frankly, human rights.
And this is where Dwyer's core principle really
solidified. Which was? That effective public
health policy cannot be driven by fear or moral
judgment. It has to be grounded in evidence and
respect the rights of the people affected. Otherwise,
you alienate them and you lose control of the
epidemic. It just doesn't work. That principle
got tested in a very public, very painful way,
didn't it? The Charlene Spiteri case in 1989.
Oh, that's a powerful story. He was advising
the NSW health minister, Peter Collins, at the
time. And Spiteri, an HIV -positive sex worker,
was forcibly detained by the government. Yes,
despite Dwyer and others arguing strongly against
it. It was driven by media frenzy and public
pressure. The minister apparently felt he just
had to be seen to be being tough. So politics
trumps the medical and ethical advice. Completely.
And the awful irony for Dwyer. He was the senior
doctor whose unit was actually forced to hold
her. In a locked room. Against his professional
judgment. Against his ethical stance. Turning
his medical ward into a temporary prison cell,
essentially. Pretty much. And it blew up nationally,
featured on 60 Minutes. Imagine the impact that
had on him. It showed him in the starkest possible
terms that leadership in health meant fighting
political battles. Dealing with raw public emotion,
not just science. You can see how that experience
would... Well, change someone, harden their resolve,
perhaps. I think it had to be transformative.
Being forced to implement a policy you know is
wrong and counterproductive. But even amidst
all that local turmoil, his commitment to fighting
AIDS globally continued. He founded the AIDS
Society of Asia and the Pacific. Yes, ASAP. And
that organization is still going strong, running
major international conferences, ICAP, across
the region. It shows this incredible capacity
to act on multiple fronts, even under intense
pressure. So after decades at the forefront of
clinical medicine and research, including that
intense period with AIDS, he retires from full
-time teaching in 2006, becomes emeritus professor
at UNSW. But retirement for him didn't mean,
you know, slowing down. It really marked a shift,
a pivot. From academic leader to... What? Full
-time advocate. Pretty much. His focus became
much broader championing evidence -based medicine
across the entire system and pushing for major
structural reform. And he had this quote about
why he felt compelled to do this. Yeah, it's
very telling. He said, as a doctor, I know that
even the most intelligent of us, faced with a
life -threatening situation, may suspend our
normal good judgment and be easily exploited.
So he saw a need to protect people not just from
disease, but from systemic failures and exploitation.
Exactly. He saw the vulnerability. And he turned
his attention squarely onto the structure of
Australian primary care. He was deeply critical
of it. What was his main criticism? Fundamentally,
that it was set up to treat sickness after it
happened rather than keeping people well. It
lacked the focus, the investment in preventative
strategies, especially for chronic lifestyle
-related diseases which were just exploding.
And that failure in primary care had knock -on
effects. Massive ones. He talked about his own
hospital, Prince of Wales, having to turn ambulances
away because the emergency department was constantly
choked. Why? What was filling up the ED? Often,
problems that should have been managed much earlier
in the community. Patients who couldn't get a
nursing home bed, people who couldn't afford
ongoing GP visits. The hospital became the disastrously
expensive safety net for a failing primary system.
It sounds like a system under incredible strain.
So what was his proposed solution? He championed
this idea called the medical home. What does
that involve? It's about moving away from the
solo GP model towards multidisciplinary teams.
Doctors, nurses, allied health professionals,
mental health experts, all working together in
primary care settings. And the focus shifts.
Completely. The focus becomes proactive, keeping
communities healthy, managing chronic conditions
effectively before they become acute crises that
land people in hospital. investing upstream,
basically. It makes logical sense, preventative
care to reduce the burden on expensive acute
care. Exactly. It echoes his AIDS experience,
too, doesn't it? You need a population -focused,
proactive strategy, not just reactive treatment.
But changing a whole system like that, that requires
serious political will. And that's what he realized
was missing. Around 2003, the federal and state
governments were locked in negotiations about
health funding. But what were they arguing about?
Hospital beds. Budgets. Pretty much just hospitals.
They were completely ignoring how hospitals depend
on everything else. Prevention, primary care,
mental health, aged care, indigenous health.
It was all siloed. So he saw a need to force
a broader conversation. Precisely. That's why
he founded the Australian Healthcare Reform Alliance,
AHCRA, in 2003. What was the goal of AHCRA? To
create a unified voice, to bring together all
the disparate groups who knew the system needed
fundamental change but weren't being heard individually.
to coordinate their message and put real informed
pressure on the politicians. And who was involved
in this alliance? It wasn't just doctors, was
it? No, that was the key. It was broad. The Australian
Medical Association, yes, but also the Nursing
Federation, Catholic Health Australia, the deans
of all the medical schools, specialist colleges,
consumer groups. a really powerful coalition.
So they could speak with one very loud voice
on the need for reform. And it worked pretty
quickly. AHCRA became recognized as a, quote,
powerful force. Government had to listen. They
were pushing for those fundamental changes to
structure and funding, pushing towards that more
integrated, preventative medical home model.
OK, so he's tackled the big structural issues
in the mainstream system with AHCRA, but then
he turns his attention outwards towards practices
outside conventional medicine. Yeah, towards
what he saw as a rising tide of health fraud,
dodgy cures and pseudoscience. This led to him
chairing a key committee in New South Wales back
in 2002. The Health Care Complaints and Consumer
Protection Advisory Committee. Quite a mouthful.
Informally known as the Quack Watch Committee,
which tells you pretty much what its focus was.
Tightening the rules around wonder drugs and
miracle cures. Exactly. But what they found wasn't
just a few bad apples. It was systemic. The regulations,
the enforcement. They just weren't strong enough
to protect people. What were some of the specific
problems they identified? Well, first, the medical
boards often lacked the teeth, the power, or
maybe the will. to really clamp down on practitioners
promoting stuff that just didn't work. Okay,
what else? Advertising was a huge one. Claims
being made that had, as they put it, no basis
in reality. And the voluntary codes of conduct
that industries often rely on. Totally ineffective.
Basically useless. So self -regulation wasn't
working. Not at all. Then there was the issue
of training. Among alternative practitioners,
there was often a complete lack of standardized
training or advice. Consumers were left incredibly
vulnerable. without the basic protections you'd
expect. And the penalties for fraud. Often trivial.
Fines so small they were just the cost of doing
business, not a real deterrent. And what about
the official government watchdog, the TGA, the
Therapeutic Goods Administration? They found
the TGA was seriously under -resourced. It just
didn't have the capacity to be the effective
watchdog it needed to be. Which, again, creates
a low -risk environment for people selling dodgy
products. So the overall picture was pretty grim.
Lack of power, poor advertising standards, inconsistent
training, weak penalties, under -resourced regulator.
Yeah, a perfect storm, really. And their key
recommendation was about coordination, getting
all the different agencies, federal, state, consumer
protection, health complaints, TGA, to actually
work together. Stop the fraudsters falling through
the cracks between jurisdictions. This concern
about weak regulation then feeds into another
big issue for him, public money. Yes. He became
very focused, almost relentless, on the issue
of public funds effectively subsidizing unproven
therapies, particularly through tax rebates for
private health insurance extras. Why was that
such a big deal? Because taxpayer money was going
towards things that didn't work. And the scale
of it was shocking. He highlighted data showing
that between 2005 and 2015, the amount paid out
by private insurers for natural therapies jumped
by something like 345 percent. Wow. So public
policy was actually driving growth in this sector.
That was his argument. He was inadvertently propping
it up. Homeopathy was the classic example. Right.
The NHMRC, the National Health and Medical Research
Council, did that big review. Yeah. A massive,
comprehensive review of all the evidence worldwide.
And the conclusion was. Unequivocal. Homeopathy
is no more effective than a placebo. There's
just no reliable scientific evidence it works
for any condition. So Dwyer's response was? Logical.
If it doesn't work, why are we subsidizing it?
Stop the government financial support. Stop the
private health insurance rebates for it. Public
money should fund things that are proven to be
effective. Now, it's important to clarify here,
he wasn't necessarily anti -all. alternative
or complementary therapies, was he? No, not inherently.
His position was nuanced. He advocated for integrating
orthodox medicine with other approaches if, and
only if, Those other approaches had solid evidence
behind them. So evidence was the key criteria.
Always. He talked about wanting a converging
pathway, taking the best evidence -based elements
from different approaches, maybe mindfulness,
specific exercises, certain nutritional advice
backed by data, and incorporating them into unified
treatment plans, not keeping them as separate,
often conflicting systems. Okay, so he's identified
these deep systemic issues in policy, in regulation,
in funding. It seems like the next logical step
was to create a dedicated group to keep fighting
for that evidence -based approach. Exactly. In
2011, he was a key figure in founding Friends
of Science and Medicine, or FSM. He brought together
this group of prominent Australian doctors, scientists,
researchers. He was their first president, stayed
in that role until 2019. And their mission was
pretty straightforward, wasn't it? Crystal clear.
Their mission statement says it all. To emphasize
the importance of having health care in Australia
based upon evidence, scientifically sound research,
and established scientific knowledge. It's a
direct defense of the scientific method in health.
And did FSM gain much traction? Oh, absolutely.
Within a few years, they had over 1 ,000 supporters.
And these weren't just anyone. They included
Nobel Prize winners, several Australians of the
year, really high -profile, credible figures.
That gave them significant clout. Where did they
focus their efforts initially? What was the main
battleground? One of the biggest. and maybe most
controversial, was academia, the universities
themselves. Why universities? Dwyer and FSM were
deeply concerned about universities offering
courses in things like naturopathy, homeopathy,
traditional Chinese medicine, and teaching them
as if they were science -based health degrees.
often under the banner of health science. What
was the problem with that in their view? Several
things. They argued it was a misuse of public
funds, that it lowered the academic standards
and reputation of the university, and critically,
that it gave these practices a veneer of legitimacy
they hadn't earned through evidence. It misled
students and the public. And this ties into the
issue of professional registration too, right?
Yes, that was a crucial point. In Australia,
many alternative practitioners are registered
under the National Scheme, AHPRA. That's the
same body that registers your doctor, your dentist,
your nurse. So for the public, seeing that registration
implies a certain standard? Precisely. It gives
an appearance of respectability, as Dwyer put
it. But the catch is, for many of these alternative
fields, the registration requirements are different.
Because they're deemed low risk, the focus is
more on basic safety standards, maybe insurance.
rather than demanding rigorous proof that their
core therapies actually work. So registration
without proven efficacy. That was the concern.
It grants credibility without necessarily guaranteeing
effectiveness based on scientific evidence. Did
FSM get involved in specific university disputes
over this? Oh, yes. There was a well -publicized
instance where they organized about 34 prominent
Australians to write an open letter to Central
Queensland University. What was the issue there?
CQU was planning to expand its offerings in alternative
medicine, presenting them as science. The letter
argued this would diminish the academic reputation
and give credibility to pseudoscience. It was
a direct challenge. So they weren't afraid to
call out institutions directly. Did they also
look at commercial interests? Definitely. Dwyer
was quite critical of the pharmaceutical industry
itself. especially the big companies that also
sell homeopathic products or nutritional supplements
alongside their evidence -based medicines. Why
criticize that? Business is business, right?
His point was about integrity and mixed messages.
How can a company built on scientific research
simultaneously profit from selling things that
lack that same scientific basis? He suggested
pretty bluntly that commercial reasons dominate
those decisions, undermining their credibility.
Next to that case with Ken Harvey at La Trobe
University. That was another key moment FSM weighed
in on. Ken Harvey, another strong advocate for
evidence -based medicine, resigned from La Trobe.
Why did he resign? He was protesting because
a major vitamin company, Swiss, was funding a
research center at the university specifically
set up to study, well, Swiss's own products.
The potential for conflict of interest seems
pretty obvious there. Extremely. Dwyer and FSM
publicly supported Harvey. They questioned why
university resources were being used essentially
to validate products for a commercial sponsor,
potentially biasing the research outcomes, or
at least the perception of them. It highlighted
how these commercial pressures could compromise
scientific integrity even within respected academic
institutions. Given this incredibly active and,
let's face it, often controversial career spanning
decades, it's no surprise he received significant
formal recognition. No, not at all. Back in 1991,
he was made an officer of the Order of Australia,
the OA. That's a very high honor. The citation
specifically mentioned his service to public
health, particularly around infectious diseases,
obviously reflecting the AIDS work. And he holds
the emeritus professor title at UNSW, and there's
a lecture theater named after him at the Prince
of Wales Hospital. Right. Plus his medical fellowships,
FRACP in Australasia, and also a fellow of the
Royal College of Physicians of Ireland. Standard
high -level professional recognition. But there's
another kind of recognition that perhaps captures
the latter part of his career even better. You
mean the Skeptic Awards? Exactly. Named Skeptic
of the Year by the Australian skeptics way back
in 2000, and then won it again jointly in 2012
with the other founders of FSM. Yeah, that really
highlights his role as a public intellectual,
fighting for critical thinking, for rationality,
not just within medicine, but in the public sphere
generally. But as you said, when you take such
a strong, often uncompromising stance, especially
against things people believe in strongly or
things that are commercially successful, you're
going to attract criticism. Oh, absolutely. Controversy
is almost guaranteed. And while the criticism
was often aimed at FSM as an organization, it
definitely reflected the friction Dwyer himself
generated. Who were some of the critics? What
were their arguments? Well, Karen Phelps, for
example, she's a former president of the Australian
Medical Association and also someone who's been
quite supportive of integrating complementary
therapies. She described FSM pretty sharply.
What did she say? She called FSM an ultra -conservative
group with an alarming and far -reaching agenda.
They actually debated publicly about what level
of evidence should be required before universities
teach something or doctors recommend it. So a
fundamental disagreement about the threshold
for evidence. Exactly. Phelps seemed concerned
that FSM's strict insistence on things like large
randomized controlled trials might unfairly dismiss
therapies that patients find helpful, even if
they don't fit that specific evidence model neatly.
She sort of painted them as wanting to shut down
anything outside a narrow definition of science.
Right, a clash of philosophies there. Was there
pushback from the complementary medicine research
community, too? Yes. John Wardle, who's a prominent
figure in complementary and integrative medicine
research in Australia, had a pretty memorable
description of FSM. Which was? He called them
the new poster child for CAM, complementary,
and alternative medicine conspiracy theorists.
Wow, that's strong language. What does that imply?
It suggests that... From the perspective of some
in the cam field, FSM wasn't just advocating
for evidence but actively campaigning against
them, perhaps unfairly, maybe driven by an inherent
bias against anything non -Orthodox. It frames
FSM as antagonists, as obstacles. So you have
this real tension. FSM sees itself as defending
scientific integrity, while some opponents see
them as intolerant gatekeepers trying to delegitimize
anything outside the mainstream. That's pretty
much the core conflict, isn't it? His entire
later career really was spent navigating that
difficult line, constantly pushing for verifiable
evidence, whether it was popular, politically
convenient or commercially profitable or not.
Hashtag tag outro. So looking back at John Dwyer's
career, it's this remarkable journey, isn't it?
From the intricate world of cellular immunology,
fighting HIV in the lab and clinic. Yeah, where
the science was literally life and death. Right
through to these huge system level battles, fighting
for structural reform and health care with HCRA.
And then that very public fight against misinformation
and pseudoscience with FSM. It's a lifelong commitment
to evidence played out on vastly different scales.
It really is. Yeah. And I think his career offers
a kind of model. maybe, for how experts can engage
publicly using that deep scientific authority,
not just for research papers, but to provide
moral and political leadership on really complex,
messy issues. Like managing pandemics or deciding
how health care should be funded or what should
be taught in universities. Exactly. The common
thread, the takeaway for you listening, has to
be the absolute non -negotiable need for critical
thinking in health. Whether you're facing a global
virus or just trying to decide if a supplement
claim stacks up, that rigorous questioning approach
is vital. And throughout our discussion, we've
seen these recurring vulnerabilities in the system,
haven't we? We have. Financial pressures keep
cropping up. Think about the insurance rebates
potentially propping up unproven therapies. Or
corporate sponsorship may be influencing research
agendas at universities. Even our most trusted
institutions aren't immune to these pressures.
Which leaves us with a really important question
to ponder, doesn't it? We rely on experts like
Dwyer, on regulators, on universities to maintain
standards. But what's our role in this? What
role do we as citizens, as health consumers,
have in demanding transparency and demanding
evidence? That's the critical point. Where do
we draw the line between respecting personal
choice when it comes to health and upholding
public safety or ensuring responsible use of
public funds when those choices involve treatments
lacking solid proof? It's a tough balance to
strike. Definitely something to think about.
Thank you for joining us for this deep dive.