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Finance and Public Administration Legislation Committee

HARVEY, Dr Kenneth John, Adjunct Associate Professor, School of Public Health, La Trobe University

Committee met at 09:00

CHAIR ( Senator Polley ): I declare open this meeting of the Senate Finance and Public Administration Legislation Committee. This public hearing is for the committee's inquiry into the Therapeutic Goods Amendment (Pharmaceutical Transparency) Bill 2013. The full terms of reference are available on the committee's website.

I welcome Dr Ken Harvey. Information on parliamentary privilege and the protection of witnesses and evidence has been provided to you. The committee has your submission. I now invite you to make a short opening statement. At the conclusion of your remarks I will invite my Senate colleagues to put some questions to you.

Prof. Harvey : I am appearing on behalf of Choice, the Australian Consumers Association. I would like to start by giving some personal background about my interest in this matter. I am a Melbourne University medical graduate. After working in Papua New Guinea I took on postgraduate training in microbiology and infectious diseases. On returning to work at the Royal Melbourne Hospital in the mid-1970s I was confronted with the problem of antibiotic resistant organisms. Antibiotic resistant organisms are a reflection of antibiotic prescribing habits; therefore, I got interested in antibiotic prescribing by my colleagues. I can still remember a confrontation with a senior staff member when, having done an antibiotic audit, I said, 'I don't think you are prescribing antibiotics wisely.' They said, 'Who are you to tell me what to do?' That is not an unreasonable question.

The answer in the late 1970s was to collect together a group of specialists in Melbourne from different specialties and write a small booklet called Antibiotic Guidelines, which outlined cost-effective, evidence based treatment for common infections. Because germs change, drugs change and knowledge changes we have kept updating this booklet. It is now in its 14th edition and is available in both print and electronic forms.

Using this book we can now audit antibiotic use against peer consensus evidence based guidelines. We recommend older, narrower spectrum drugs where we can to keep newer antibiotics in reserve. But when we did audits we found that many of our colleagues were actually using the more expensive broader spectrum drugs as a first line. We did not teach that, but it was what was promoted by the pharmaceutical industry. 'You can't afford to be wrong,' they said, 'use E-mycin.' That got me interested in the forces at work on the pen that writes the script, especially the promotion activities of the pharmaceutical industry.

Since that time I have been a member of the expert group that formulated the World Health Organization ethical criteria for medicinal drug promotion. I have been involved in formulating the quality use of medicines policy of Australian drug policy. I have been a serial complainant about unethical promotion and have made a number of submissions to industry self-regulatory codes and government working parties on behalf of Choice and the Consumers Health Forum. It has been a frustrating process. While there has been some incremental improvement in codes over the years and individual behaviour has improved to some extent, there is a great need for more to be done.

There is increasing research that shows too close a relationship between health professionals and therapeutic goods companies can be detrimental to public health. For example, funding their travel and registration to attend conferences, payment for consultancies, company sponsored lectures, sitting on advisory boards—all of this can encourage conscious or unconscious reciprocation. The end result is uncritical uptake of newer, more expensive products and less well evaluated products and underutilisation of more cost-effective drugs and devices. There are significant cost and safety implications of this.

A recent editorial in the British Medical Journal reported that a US Senate finance committee investigation found that the medical device company Medtronic was heavily involved in drafting, editing and shaping the content of medical journal articles authored by its physician consultants, who were paid hundreds of millions of dollars by the company through royalties and consulting fees. The committee chair, Senator Max Baucus, said that Medtronic's actions had 'violated' patients' trust. The president of the North American Spine Society said:

If surgeons had known that the lead authors of the 13 original studies on InFuse had received payments ranging from $1.7m to $64m from Medtronic and that its marketing employees were co-authors and co-editors, would they have been as eager to use InFuse on their patients?

That is just the latest in a series of scandals that has cost the US therapeutic goods industry $15 billion worth of fines by the US justice department over the last few years. The most recent is a $3 billion fine of GlaxoSmithKline, who will be appearing before you later this morning. Prosecutors in this case said the company had tried to win over doctors by paying for trips to Jamaica and Bermuda, as well as spa treatments and hunting excursions. In response, the US Physician Payments Sunshine Act became operational earlier this year. It requires pharmaceutical and device companies to report to the Centers for Medicare and Medicaid Services all payments made to individual doctors and teaching hospitals that total more than US$100 a year. Companies must begin to collect this information by 1 August this year and report it by 31 March next year. It will be published on a public website by September next year.

However, in Australia the government believes in self-regulation. Many consumer and health professional groups have argued that Medicines Australia and other industry associations should fully disclose payments to individual healthcare professionals. We did it in 2009, during the 16th revision of Medicines Australia's code, and again in 2012, during the 17th code revision. A petition supporting full disclosure, containing more than 450 signatures from health professionals and consumers, was sent to the ACCC during the authorisation process. I have appended that to my handout. Subsequently, Medicines Australia set up a transparency working group charged with incorporating similar disclosure procedures to the US. If the group's recommendations are adopted, member companies of Medicines Australia could start recording payments from the beginning of 2015, with public reporting expected in 2016.

In contrast, the Dutch are already reporting such transactions, and, as I have said, the US will report next year. The slow progress of Medicines Australia reminds me of St Augustine's famous prayer: 'O Lord, give me chastity and continence, but not yet.' Indeed, that has been Medicines Australia's slow progress. More importantly, while Medicines Australia members might take up the group's recommendations, there is no absolutely no compulsion on the other eight therapeutic goods industry associations to do so. Most importantly, nonmembers of industry associations escape any self-regulatory code, and they are often the worst offenders.

The bill currently before the Australian Senate would, like the US sunshine act, provide a compulsion to report, but, unlike the sunshine act, the Senate bill only applies to pharmaceutical companies and doctors. It also suggests that the payments be posted on a multitude of individual company websites, which would make it very difficult for consumers and health professionals to find out how much money an individual doctor or health professional was receiving. Regardless, the bill has stimulated important debate both in the media and elsewhere. Associate Professor Ian Haines and the Consumers Health Forum supported the bill in their submissions, but the majority of the submissions, which came from industry associations and pharmaceutical companies, opposed the bill and supported self-regulation, which reminds me of Paul Keating's quotation from Jack Lang: 'In the race of life, always back self-interest.' That, I believe, is behind the majority of those submissions.

As I say, there were several submissions supporting the bill, and Dr Mary Osborn and I also pointed out the limitations both of the bill and self-regulation and wanted broader debate about the mechanisms of ensuring ethical relationships between health professionals and therapeutic goods companies. A late submission from the Department of Health and Ageing reinforced the government's preference for self-regulation, but it failed to address its limitations. Both the AMA and DoHA's submissions cite the Health Practitioner Regulation National Law Act 2009, overseen by the Australian Health Practitioner Regulation Agency, AHPRA, and in particular its code of conduct for health professionals, which says, at 8.11.6:

Not asking for or accepting any inducement, gift or hospitality of more than trivial value, from companies that sell or market drugs or appliances that may affect, or be seen to affect, the way you prescribe for, treat or refer patients.

The AMA and DoHA should be asked about the apparent contradiction between this provision of the code and the $30 million to $45 million or more that health professionals receive from therapeutic goods companies every year for attending so-called educational events and hospitality. I could also expand on major problems I have found when complaints about health professionals' ethical conduct are referred to APRA.

In conclusion, self-regulation, I believe, cannot be effective unless legislation is introduced to make compliance with codes of conduct a condition of obtaining marketing approval for therapeutic goods. Four submissions—those of Medicines Australia, the Medical Technology Association and In Vitro Diagnostics and my own—reiterated the need for recommendation 5 of the Working Group on the Promotion of Therapeutic Products to be implemented: that is, each company that registers a product on the Australian Register of Therapeutic Goods should nominate a relevant industry code to which it agrees to adhere as a condition of registration. It is my understanding that there is a precedent for this, in that sponsors of prescription generic medicines must agree to comply with certain parts of the Medicines Australia code when they sign the TGA letter of marketing approval. I suggest that this matter be discussed with the DoHA witnesses when they appear later this morning. They could also be asked why they believe that yet another code-of-conduct advisory group dominated by self-interested stakeholders is likely to achieve a level playing field from nine disparate therapeutic goods industry associations, how on earth it can address the problems of nonmembers and how it will achieve the desired single public repository of transfer of values from all therapeutic goods companies to health professionals. I welcome questions on this matter.

CHAIR: Thank you very much, Dr Harvey.

Senator DI NATALE: Thanks very much, Dr Harvey. Let us perhaps start with one of the most important issues here—that is, why do we need a voluntary code or a regulated code? Why do we need a code at all? What is it about the interaction between the pharmaceutical industry and health professionals that is problematic?

Dr Harvey : Clearly, as I have pointed out in my submission and today, there are conflicts of interest between medical practitioners, health practitioners and therapeutic goods companies. In the push for marketing and getting market share, it is understandable that therapeutic goods companies would provide inducements, either overt or subtle, to try to influence the prescribing and use of therapeutic goods. And, as I pointed out, there is excellent evidence to show that that too-close relationship leads to unhealthy prescribing and also the use of devices that are inappropriate. We have had problems with metal-on-metal hip implants, for example, which had to be taken off the market. One of the reasons was, again, the too-close association of surgeons with therapeutic goods companies in which they lose objectivity—the desire to be the first to use something new rather than keep on using something that has been well proven. The evidence is clear. Many, particularly of those new devices, proved ultimately to have much higher failure rates than some of the older ones. Why did people jump on the bandwagon? Because there was pressure, inducements, subliminal or overt, to use those things—and, as I pointed out about Medtronic, large amounts of money paid by the companies to doctors and surgeons.

Senator DI NATALE: You have spoken in your opening statement and in your submission about some of the obvious conscious reciprocity, as you call it, that is at work here. Obviously, if somebody with a significant self-interest is involved in the publishing of research in a particular area, there is a conflict. But I am more interested in what you describe as subconscious influences. How do they work?

Dr Harvey : A lot of money is spent inviting health professionals to go to industry funded conferences, to attend conferences, some of which can be quite reasonable, in the sense that the speakers are independent. But in others of them the speakers come from the industry and they are provided with a set of company slides. The evidence clearly shows that company sponsored education is less objective. It is more inclined to promote the benefits of a product and minimise the adverse effects than independent information. And that is understandable.

Again, many of my colleagues would argue, 'Well, they'll accept everything from everyone and it all cancels out,' but it does not. Clearly research shows that health professionals that have the closest relationship with therapeutic goods companies are much more likely to prescribe expensive drugs and devices for which there is no good evidence. They are less likely to prescribe more cost-effective generic drugs. By definition, promotion by therapeutic goods companies only promotes the latest and the most expensive. There is very little promotion for more cost-effective older products—generic drugs, for example—and there is absolutely no promotion for non-drug alternatives, such as public health measures. So the weight of the information out there is biased against what we recommend in terms of cost-effective medical and therapeutic use through organisations such as Therapeutic Guidelines, to which I belong, and the National Prescribing Service, with which I have worked. There is an imbalance of information out there, produced by the excess promotional efforts of the industry. As you probably know, the industry spends twice as much money on promotion as on research. Regrettably, it is much more effective for a company to produce, for example, the 20th lipid-lowering drug and promote it extensively than to do genuine, good research on effective, needed disease remedies.

Senator DI NATALE: Different countries have different ways of dealing with this issue. Some have legislated; others have what you described as a co-regulatory approach. How does Australia compare to what is happening in other parts of the world?

Dr Harvey : It was 2009 when the US National Institutes of Health produced a seminal report on conflicts of interest. It was that that led ultimately to the US physicians payment act and also to the Dutch health minister getting involved in doing something similar. It is interesting that in Holland, again, the initial thrust—certainly by the industry—was for self-regulation, but I think it was accepted that that could not work. Again, the Dutch model is the co-regulatory one in which they have a foundation involving all the stakeholders, underpinned by the government. I think that co-regulatory model, as I say, is a useful one. It is fascinating that the US, which one would argue is the land of unrestrained private enterprise, has chosen to go down the path of legislation because again, regrettably, the evidence is that physicians and doctors will not disclose all the relationships they have; there is good evidence that they will not disclose voluntarily. Again, as I have said, I believe self-regulation is primarily self-serving, which is understandable.

Again, I think Australia is lagging behind. In 2009, in response to these things, many of us, including me, put it to the Medicines Australia code that we should be including disclosure of individual healthcare professionals. It was rejected. We put it up again last year. The compromise for Medicines Australia was, 'We'll have aggregate reporting,' which is absolutely meaningless—if you lump everything together, no-one knows what a doctor is having. But it was a nice gambit. Then, with pressure from the ACCC, they have a working party on transparency, of which I am a member. To be fair, I think the group has come up with sensible principles, including the fact that there should be a common database and transparency should apply to all therapeutic goods companies, not just pharmaceutical companies. But there are major questions still: what will happen about the non-members? Where will this database be housed? If it starts off with Medicines Australia, what happens if the Generic Medicines Industry Association or the Medical Technology Association join in? Do we really expect that Medicines Australia is going to fund or pay for the extra costs of handling other therapeutic goods industry associations' disclosures? And the fundamental question is: what about the non-members, which are the worst offenders? So with self-regulatory codes we have the good guys, to their credit, shooting themselves in the foot by having some constraints on their behaviour and the bad guys laughing all the way to the bank. There is nothing in the present government's submissions and support for self-regulation that is going to change this.

Senator DI NATALE: You pointed in your submission to an example where a generic manufacturer engaged in some activity that was at the very least questionable. Can you just elaborate on that example and say whether they were in fact a participating member of their industry code.

Dr Harvey : No, they were not. Again, with the Generic Medicines Industry Association, as you are probably aware, there are a large number of new generic companies, particularly from India, coming in because it is an important market segment. Indeed, government policy is to stimulate the use, quite rightly, of generic, more cost-effective drugs. But the particular company concerned have not joined an industry association. They did not join the Generic Medicines Industry Association.

They were offering a substantial inducement of free stocks to pharmacists to preferentially dispense their product, which is against some of the principles—and, indeed, the letters of the law—in the Medicines Australia code and the GMiA code: thou shalt not induce a practitioner to influence their prescribing or dispensing of a particular drug. So a complaint was put in. The company concerned were asked if they would be happy with the GMiA adjudicating and, not surprisingly, they declined to have it heard. That is the problem with self-regulation of industry codes: those outside it are not touched at all.

Senator DI NATALE: Perhaps I will follow on from there. One of the statements that have come through again and again is that it is important to have a regulation that impacts on all health professionals. Why do we need to go beyond simply the issue of pharmaceuticals and doctors to other health professionals? Can you give me some evidence as to why that is necessary?

Dr Harvey : Clearly, I gave you the example of Medtronic. I mentioned the problems of metal-on-metal hip implants. Therapeutic devices are not costing us as much yet as pharmaceuticals, but clearly they are becoming much more important in an ageing population. Exactly the same commercial pressures are at work as they are with pharmaceuticals. I accept that, if you want to start somewhere, doctors and pharmaceutical companies are not a bad place to start, but why stop there when it has been accepted by the US that medical device companies should also be embraced? And, if you look at some of the figures on one of the handouts I gave you about promotional expenditure on hospitality and education, pharmacists are up there and nurses now—nurse prescribers—are up there, so all health professionals are important and all therapeutic goods companies. That principle has been accepted by the Medicines Australia Transparency Working Group. It has no power to implement it.

Senator DI NATALE: Thank you.

Senator RYAN: The example you referred to in your submission, which you were discussing with Senator Di Natale, I assume is the Ranbaxy example—

Dr Harvey : Yes.

Senator RYAN: That is not covered by this draft bill, which only refers to pharmaceutical companies and doctors, is it?

Dr Harvey : No, but I am making—

Senator RYAN: My concern here is about the bill. I just want to go to some of the underlying statements you made. Is one of the aims of your view on this to lower the level of expenditure that pharmaceutical companies spend on promotion? You have a long record of being critical of the industry for the relationship you mentioned earlier between the amount spent on promotion versus the amount spent on research. All those numbers are constantly in contest. Do you want the industry to spend less on promotion? Is an aim of the process you propose to be a sort of tool to try and bring that down?

Dr Harvey : I think the industry is wasting a lot of money on promotion, and I believe some of them would admit that themselves. We do have—as you are aware and the Department of Health and Ageing submission points out—now much better sources of independent information. When I was a lad, yes, I think the pharmaceutical industry did play a useful role, albeit somewhat biased, in providing information about new products. But now, in a recognition that there is a need for independent information and education, we have the Therapeutic Guidelines, and we have the National Prescribing Service. There is absolutely no need—and I note that Steve Hambleton, the President of the AMA, agreed—for a doctor or a health professional to attend pharmaceutical industry or therapeutic goods industry events to learn about how to use new products wisely, so why have so much money spent on it?

Senator RYAN: I take it that that is your view. Do you believe it is the role of us as legislators to legislate that particular objective? I understand if someone says that someone does not see a need to. I personally am reluctant to say that therefore I think I will try and prohibit it. Do you think that is something that we should be looking at—that, if the AMA or someone says there is no need to, we should be looking at making it more difficult?

Dr Harvey : That is not what I have said. Again, my own view is that self-regulation has a place, both for health professionals and for industry, and I think it should be the first cab off the rank, because it is basically trying to get its members—be they physicians, pharmacists or therapeutic goods industry people—to be aware of ethical conduct and to get some solidarity between them. But inevitably there will be some people, industry people and health professionals, that will not go along with that.

Senator RYAN: There are also some people that break the law, too. Law does not stop some people misbehaving. It means there might be a bigger penalty if we catch them.

Dr Harvey : But it is useful to have legislation and law as a backstop. Can I give you an example.

Senator RYAN: We only have very limited time for questions. I take your point on that.

Dr Harvey : I am saying I want both.

Senator RYAN: I accept your point that the promotion of marketers, advertisers and representatives is to promote the use of a product. I accept your point that there is obvious bias in that, because that is the whole point of it. But do you accept that there can be bias from people who some might people might claim are independent? I am referring to people who write therapeutic guidelines. Despite all best endeavours, we know that people are sometimes more likely to tend to defend their own work than to be open to criticism of it. They constantly evolve due to awareness of new knowledge. That is the scientific process. Do you think that representatives of government appointed bodies, funded by government—and government has an incentive in rationing and limiting expenditure—are capable of bias in the opposite direction?

Dr Harvey : Over the years it has been accepted that there are conflicts of interest on both sides, as you have pointed out. There are now very stringent mechanisms in place—in terms of both the therapeutic guidelines where I work and the guidelines of the National Health and Medical Research Council—to make sure that there is declaration of all interests and that if there is potential conflict the person involved leaves the room. The other important thing is that it is accepted that the best wisdom comes from a group of disparate specialists, working on evidence, having to justify what they are recommending to each other and being well aware of conflicts of interest—and kicking people out of the room if there are those. I think we do that well in Australia and I would defy you to point out new, additional therapeutic guidelines where there is bias.

Senator RYAN: I agree with you—generally, the conflict of interest processes that every organisation goes through are done well. That is a process issue. But people naturally defend their own work. Research shows that often they are more inclined to do that than they are open to new ideas. We have processes in place, such as those that you outlined, to constantly challenge that. But the fact that therapeutic guidelines change and develop as new evidence and knowledge becomes available is a sign in itself that there is not one true answer upon which we can always rely, that constant challenge and contest is important. The NPS, when it has been funded, has had attached to it not tied grants but the idea that it will save a certain amount of money. Does that not also potentially create a conflict of interest?

Dr Harvey : My view is that to set up the National Prescribing Service with a specific charter to save money on the PBS was not sensible. It came from the fact that there are a lot of overt expenses—prescribing that is too expensive. We know that quality use of medicines can reduce the amount of inappropriate and expensive drugs prescribe. But, equally well, we know that there is underutilisation of effective therapies, like anti-hypertensive therapy and diabetes therapy. To the credit of the NPS, they have pushed quality use of medicines, even if that has meant pushing greater use of drugs and tackling the problem of compliance—many people with chronic diseases do not continue to take their drugs. They have pushed that as much as they have pushed, for example, restraining the excessive use of antibiotics, which both wastes money and is a public health disaster from the point of view of producing resistant organisms. My view is that, looking at the activities of the NPS, they have been as objective and rational as you would like.

Senator RYAN: I think they have done a reasonable job too. I am not as aware of the last few years as I have been of previous years. If you think it is not possible, that is fine. But bias, particularly unconscious bias, is just as possible with those who seek to save money as it is with those who seek to sell the product, is it not?

Dr Harvey : I personally disagree. I think the mechanisms we have set up of multiple people declaring conflicts of interest and arguing exactly those points out makes the process as good as it can be. I am not saying it is perfect all the time, but it is certainly a damn sight better than an opinion leader from the pharmaceutical industry having been flown overseas and coming back with a set of company slides and purporting to give an independent education. It is much better than that.

Senator RYAN: I am not challenging the point you make about that, but surely it is just as much of a problem if a body or a person has been given money by the government, which goes through a budget process, and that is explicitly or implicitly associated with cost constraint in the use of medicine, which usually applies to the chronic population medicines and the acute ones, which may be things like antihypertensives and drugs for the control of diabetes or cholesterol or whatever. I am surprised that you come to the situation with the preconceived view and do not see that the same evidence might drive a different answer from someone else.

Dr Harvey : I am a public health physician. There is never going to be enough money to expend on every drug. That is why we have a Pharmaceutical Benefits Scheme driven by rational cost effectiveness. That is why those of us in this game try to push the public agenda rather than doing everything possible for a patient. Should we be spending $100,000 on cancer therapy to give someone two weeks extra of life or should we be putting that money into immunisation? These are the questions that people like us and people on the committee, as you are talking about, have to grapple with. I do not believe they are biased. I believe they make judgements in the best interests of the community.

Senator STEPHENS: Dr Harvey, I just want to go back to your submission, if I may. First of all, you quoted in your submission the complaint about Ranbaxy. Are you aware of other breaches of that industry code that you could advise the committee on?

Dr Harvey : If you look at the Generic Medicines Industry Association submission, I think they say that there have been three recent complaints about companies that have not been able to be charged because they were not members. I have not got that entirely clear in my head, but it was certainly something along those lines.

Senator STEPHENS: That is exactly what my question was going to be. I was going to ask, 'How many cases have been referred and how many investigations have been declined?'

Dr Harvey : I will just say again that complaints are the tip of the iceberg. I put in complaints. It is a frustrating and really non-productive exercise. I do it mainly because of my past association with the world health business. It takes a lot of time to put in a well-argued complaint. Often it does not get up. For example, recently there was one to Medicines Australia that a pharmacist colleague put in. It did not get up, but we appealed. I had to go to Sydney at my own expense to appear before the appeal committee of Medicines Australia. It was well argued and that got up. The company got a $40,000 fine, which is not much for a company. I had the expenses of going to Sydney and giving up half a day. Why on earth would anyone complain? Most people who complain are fellow therapeutic goods companies who complain because they think someone is interfering with their market share. If they are all doing it, no-one is going to complain.

Senator STEPHENS: Fair enough! Just going back to your submission again, you quoted the submissions from several consumer and health professional groups to the 2010 position paper and the response of the working group in March 2011 where the submitters recommended:

… one Code, one efficient complaint (and appeal) system and one set of effective sanctions applicable to all therapeutic claims and promotional activities regardless of the industry sector, media or target. This was to be administered by an independent Therapeutic Goods Promotion Agency …

Those suggestions were rejected by the industry members of the working party who preferred to keep their individual codes. Going back one step, would taking up those kinds of recommendations address some of your concerns?

Dr Harvey : In my view that is the best way to proceed. It is the Dutch way. It is accepting that everyone has got responsibility—all the stakeholders; it is not just industry. It should not just be an industry code. What pisses me off quite candidly about putting in submissions to industry codes is that you can put in all these submissions—and they increasingly have been quite generous in having consumer workshops and inviting other people to make submissions—but at the end of the day it is the industry and only the industry that decides what gets up. Inevitably, most of the suggestions we put do not get up.

The benefit of the coregulatory model is that the codes—I believe an industry code and health professional codes—should have all stakeholders involved. The government should involve all stakeholders. The revision should involve all stakeholders. You leave it to the industry and, yes, they will listen but they will reject and go slow. Again, the Dutch model is where we all come together—as we have in several working parties—and the government has said that their preference is industry self-regulation. If the industry people who have the numbers say not unreasonably, 'We want to keep our own code, thank you' then you are not going to solve this problem.

With a bit of stimulus from senators, for example, these ideas could well be given life. To some extent, as I see it, this was behind the bill that we are talking about. My own view is that it could go further and it could embrace a self-regulatory model as well as having the regulatory model there as a backstop. That would be my preference—not all my colleagues would agree; not all my consumer colleagues, obviously, or health professional colleagues would agree. For many years involved in the game—and, again, this is a principle of Australian Medicine's policy that it should be a partnership and that we should all be working together acknowledging that there are disparate objectives but, ultimately, the health of the community is better if we can work together.

Senator STEPHENS: You make reference to the codes of conduct of the advisory committee chaired by Professor Lloyd Sampson and, at the time of making the submission, you said currently you can find no information about its activities. I just wondered if anything had happened since the establishment of this inquiry.

Dr Harvey : To me this is yet another advisory committee set-up. We had our working party on therapeutic promotion which was set up and made recommendations. This new committee as I understand it is to look—there is a budget of money—at progressing certain recommendations. I have talked to the Consumer Health Forum representative on that first meeting. Nothing has happened. It is an advisory committee and it is dominated by industry—one consumer rep.

I regret I have not got a lot of faith that it will produce anything more than committees and working parties in the past. I accept Lloyd will challenge people to do something but, ultimately, they do not have to.

CHAIR: Any further questions? Dr Harvey, you asked to have tabled your opening statement and a couple of other documents. Is it the wish of the committee that the documents be accepted as evidence? There being no objection, it is so ordered. Not only do we thank you for your submission but also for the time obviously taken as always to submit to these inquiries. We appreciate that and for making yourself available this morning. Thank you very much.