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Thursday, 11 June 1970

Dr EVERINGHAM (Capricornia) - The Minister's reasons are not acceptable to the Opposition. We maintain the carefully considered position we took up when this amendment was first moved in this place and in another place. The Minister's reasons are not new although he has now elaborated slightly on them. First of all, he said that this amendment would place added burdens on the members of the Pharmaceutical Benefits Advisory Committee if they were required to give specific reasons for excluding a drug from the pharmaceutical benefits list. What are those added burdens? The first is that the Committee would have to commit to writing succinctly in a report to this Parliament the scientific and medical grounds on which it refused the inclusion of the drug. The second burden the Minister referred to, only in an oblique fashion, was that it would be a deterrent to people accepting a position on the Committee if they knew that this report was to come before the Parliament.

The Minister has said that there is room for discussion about drugs excluded from the list to take place in the medical journals. Let us take a specific example. Let us assume that the drug called phenylbutazone, which is a popular drug for use in rheumatic and joint conditions, has been excluded from the list. This has occurred. Questions would then be asked in this Parliament, the reasons for the exclusion would be given, the drug would later be added to the list but no reasons would be given for this despite the fact that the reasons for its exclusion in the first place and as reported to this Parliament still existed. Let us further suppose that the reasons given were that this drug was a dangerous drug and must be used with care. I confidently submit - anybody with commonsense will agree - that that was not the true reason or the drug would never have been restored to the list at a later date. All that I, the Opposition and the Senate ask is that the sensible, true, scientific, medical reason be made public.

Mr Whittorn - Nonsense.

Dr EVERINGHAM - Nonsense? What is the amendment seeking? I shall read what the Opposition is seeking:

When the Committee recommends that drugs and medicinal preparations should not be made available as pharmaceutical benefits ... the reasons for the recommendations, shall be laid before each House of the Parliament within 14 sitting days . . .

The honourable member can call that nonsense if he wishes but I think it is perfectly fair. I ask him: Is a scientific reason nonsense? The Minister said that exclusions could be debated in medical journals. That is true. But the debates in the medical journals can speculate only as to the reasons in the minds of the advisers on the Committee for the exclusion of a drug. Such speculation is quite fruitless because there is no way of asking the people on the Committee. That the Government has accepted the first part of the amendment requiring names and qualifications to be published is a step forward and virtually an admission by the Government that this should be done. The amendment provides: The names and the qualifications of those persons appointed under the foregoing provisions shall be published in the 'Gazette'.

Honourable members will recall that when we first suggested this amendment in this place the Government said it would be intolerable because people would never go on a committee if their names and their qualifications were made public and people could get at them. We said quite rightly that most of the important drug firms, who are the ones who really want to get at these officers and to influence them to change the drug list, already have found out who they are. So the Minister has not made a very major concession to the drug firms by saying that their names shall be published. But I submit that he has made a concession in this House, to the Senate, to this Opposition and to the people who are saying; We should know not only their names but also their reasons as reasonable, scientific and experienced medical men. If these reasons are not forthcoming we can only assume that the Government has some reason for hiding them*.

The Minister says that if these reasons were published it would cause needless concern and loss of confidence among patients. I would just like him to have a look at his files some time and look at the correspondence he has received concerning the exclusions of drugs from this pharmaceutical benefits list. I would like him to analyse it and ascertain the percentage of those letters that are showing confidence and preventing the concern of patients. I would submit that this very secrecy is causing their concern. If anything has caused that loss of confidence it is the very secrecy of these reasons for excluding drugs from this list. The only way to restore this confidence and to remove that concern is for the patients to be assured that these things have, been thrashed out in the light of day and not by people selected by the Government in secrecy to make secret decisions under the influence of officers of the Minister's Department. These officers can go along and say, and I am sure that this is what happens, although Ministers of Health consistently have denied it: 'You know this is rather an expensive drug. The bil'l is rising every year. Doctors are a little inclined to prescribe this a bit freely. Be very careful how freely you place this in the hands of doctors. If you must really put it on the free list, hedge it around with a few restrictions. Make it available only to pensioners.' That was done with this same drug - phenylbutazone.

After it had been denied to everybody there was such an outcry from pensioners who suffered from these joint conditions that it was placed back on the list, for pensioners only. It was still a dangerous drug. The reason the Minister had given was still there. It was a dangerous drug and should be used carefully; but of course such care does not have to be taken with pensioners because they cannot afford to pay for a private prescription. It had to be made free for them. The Minister's reason does not ring true. It does not jibe with the facts It is inadequate. We stand by our original contention. We stand by the amendment from the Senate, that the whole of the Senate's recommendations should be accepted by this House and that when the committee recommends that a drug should not be made available, the reasons shall be laid before the Parliament within 14 sitting days. This is a reasonable, humane and democratic request. Any man on that advisory committee who is worth his salt will not use this as an excuse to resign. In fact, it will be an incentive to a man of honour to go on and justify his decisions as to which drugs are made available to the public of Australia.

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