Mei-Khing Loo is a former practice manager whose 43-year-old obstetrician-gynaecologist husband of 21 years, Dr Yen-Yung Yap, died by suicide in 2020 while under investigation by the Australian Health Practitioner Regulation Agency (AHPRA). He left behind three young children. Another speaker intimately familiar with the case explained how Dr Yap had his livelihood destroyed for having delivered two babies by suction rather than forceps in Adelaide in 2015 and 2019.

There was no complaint to AHPRA, no litigation, no damage to the babies. In both cases ‘subgaleal haemorrhage’ was suspected but never diagnosed and the babies were discharged and went home within five days. An internal audit resulted in an AHPRA notification.

Four doctors who knew Dr Yap told his legal team that he had done nothing wrong in either birth. But the AHPRA-nominated expert (in gestational diabetes) claimed forceps should have been used and AHPRA imposed restrictions that effectively made it impossible for Dr Yap to continue his practice. ‘The ongoing harassment from AHPRA and the Medical Board will make me mentally and emotionally traumatised and professionally unable to care for my patients, and financially unable to care for our kids,’ he wrote in a letter to his wife shortly before his suicide. …

The pathology of regulatory excess is more widespread and generalised than just the medical sector. Because the conference was focussed narrowly on the misdeeds of AHPRA, there was no linkage made to the broader societal and political trends that have resulted in the growth of the administrative, surveillance, and regulatory state. Quasi-autonomous NGOs (Quangos) are supposedly independent bodies that are nevertheless set up, wholly or partly funded, and appointed by governments. They have been delegated some legislative and some judicial functions that circumvent the formal machinery of government and end up exercising de facto governmental powers without any responsibility for the consequences of their actions, no clear lines of accountability, and seemingly unanswerable to anyone.

Elected politicians and unelected judges alike have seen their powers shift to unelected and unaccountable technocrats. AHPRA is part of that institutional landscape. Australian doctors as a class are among the victims of that power grab. Many – but not nearly enough – brave souls who stood up to it and other organisations in the brotherhood of medical regulators paid a heavy price in the form of censure, deregistration, and loss of professional jobs and status.

The uncontrolled proliferation of Quangos has unmoored the state from its democratic anchor and made it distant from the people. Increasingly, the state neither reflects our needs and aspirations nor responds to our concerns. More and more people are waking up to the reality of the administrative state that has slowly but surely captured almost all key institutions and is stealthily strangulating democracy. This is a major explanation for the success of Nigel Farage’s Reform UK party in England’s local elections on 1 May.

Key to the reforms will be rebalancing the doctor-regulator relationship in the boardroom, on the one hand, and re-sacralising the doctor-patient relationship in the clinic, on the other. And establishing a better balance between patient safety, doctors’ rights and welfare, and regulatory reach. If the Leviathan is to be defeated, the resistance will have to be much more broad-based than each sector taking on bits of the state apparatus piecemeal.

The question addressed in this article to Australia’s medical regulator, as to whether the public health watchdog has been corrupted into a Big Pharma lapdog and drug enabler, is relevant for most countries. As in most areas in the current era, the United States has the heaviest normative weight and strongest gravitational pull of any country in the world. For better or worse, the presence of the likes of Robert F Kennedy, Jr, Jay Bhattacharya, Marty Makary, and Vinay Prasad in the top echelons of public health decision-making in Washington, DC is bound to have ripple effects in other countries in recalibrating the normative settling point of public health policy.