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Thursday, 14 May 1970

Dr EVERINGHAM (Capricornia) - I move:

That the following new clause be inserted in the Bill: "46a. Section 101 of the Principal Act is amended by inserting after sub-section (2b) the following sub-section: - (2c.) Parliament shall be advised of the names and qualifications of those persons appointed under the foregoing provisions.'.".

This is asking that we in this Parliament be informed of the personnel and the qualifications of the people who are appointed to the Pharmaceutical Benefits Advisory Committee. The main function of this Committee is to advise the Minister for Health on those items which shall be included as subsidised prescriptions or as free medicine for pensioners. There are one or two other categories such as free doctors' bag supplies and certain hospital items. The important group of course is the general pharmaceutical benefits which are available to anyone on a doctor's prescription if that prescription is in accordance with the Act and those benefits available to pensioners.

When the Labor Party introduced a medical scheme with a schedule it was thrown out on various technicalities, including the fact that the High Court of Australia ruled that it was conscription to require doctors to use a government form. Shortly after, of course, the Earle Page scheme came in. It purported to provide life saving and disease preventing drugs on prescription free, but not the wide range that the Labor Government had proposed. Since then the Government has made a magnaminous gesture by saying that it will cover 90% of the cost of doctors' prescriptions provided that the patient pays the first 50c of each prescription. That 90% has proved to be wrong. It is probably nearer to 85% of prescriptions that are now covered under the pharmaceutical benefits laws.

The point to whichI want particularly to address myself is the conditions under which these drugs are made available. First of all, there is a maximum quantity which may be put on any one prescription, and this maximum quantity is set in a way that no Minister for Health has ever made clear. Well over 12 months ago I suggested to the Minister for Health (Dr Forbes) that a full 5-day course of antibiotics should be available on 1 prescription, as was recommended in the prescribers journal provided to every doctor by the Government. I am glad to say that this provision has been implemented after a delay of many months. But if we look at the sort of drugs that are available in a far bigger supply - a supply that will last for a month with perhaps a repeat for another couple of months - in many cases we will find that they are the cheaper drugs. The expensive ones are limited. The more expensive of these are further restricted as to which disease they will be approved for, and the written authority of the State Director of the Commonwealth Department of Health is required before some of these drugs can be made available. With some more expensive ones the doctor even has to make extensive clinical notes available just to indicate why this drug should be made available free. I am not saying that there is not a case for doctors to justify in some way expensive prescribing. What I am saying is that if this sort of policing is to go on it will create genuine hardship in some cases.

Because of the short time that is available to us in this guillotined debate I can refer to only 1 case. It is the case of a child whose life was at stake because there was only 1 antibiotic available for a case of pneumonia. The child specialist in charge of the case, who was qualified and registered in the State of Queensland, had to make out a case for prescribing this drug. Without being given any reasons for the decision and without having any right of appeal against it, he was refused permission to prescribe it as a pharmaceutical benefit. The parents of the child, who could ill afford to pay for the drug and who really should have had their child in a public hospital if the specialist had been available there, had to pay several hundred dollars for this one drug to treat this fairly long and critical illness. The child was saved and I have no doubt that the parents are very thankful that this happened and were willing to pay this money. But why should they have had to pay it?

There should be some way by which people can have access to this Committee and see on what criteria it decides that a drug is put on the subsidised list. They should be able to see the Director of the

Department of Health in the State and ascertain his criteria for denying people this drug as a free drug. It should be on the basis of the trust that occurs everywhere else in the medical profession that the people concerned in the case consult with each other. It should not be done by means of forms sent through the post with a oneway decision coming to the doctor attending the patient.

There are precedents for this. For instance, some States have a consultant service available to doctors over the telephone for obstetric emergencies. The State finances this and makes this sort of two-way consultation available free. That is the sort of thing that should occur if one intervenes between a doctor with his clinical judgment and the patient. There should be no form filling and posting. There should be immediate consultation so that this can be done. The doctor should not be put to the expense of making trunk line calls in a case of this kind, to pinpoint specifically the reason for listing drugs by the Pharmaceutical Benefist Advisory Committee; their names and qualifications should be published.

Because of the guillotine I can talk about only 1 drug, phenylbutazone. That drug has been on and off the various lists over the years in a way that makes one wonder whether the Committee members really know their clinical work. On the first occasion that butazolidin was removed from the pharmaceutical benefits list the then Minister for Health said, in answer to a question, that it was a very dangerous drug. We know that it is dangerous and ought to be used carefully and with discretion. The drug was not banned. No new restrictions we're placed on the prescribing of it. The only restriction was that a patient who needed the drug had to pay the full cost instead of the 5s for what was the arbitrarily set maximum quantity. Subsequently, while the same Minister for Health was in office, the drug was put back onto the free list for pensioners only. If that Minister was genuine and if his advisers were genuine in giving him that reason one can only assume that it does not matter how dangerous a drug is for a pensioner; it matters only for the patient who has to pay for it. He must pay the full price in order to safeguard himself from the dangers, of that drug.

This is no way in which to run a good quality, sound medical profession. The public should know who the members of the Advisory Committee are. They should be prepared to stand and be counted and discuss their decisions just as any other advisory committee does. We do not find engineers hiding behind anonymous panels. We do not have any other professional people doing this. The names of the directors-general of health are made public. We on this side of the House maintain that all such advisers should be prepared to stand and be counted. It has been said that they must be protected from the brainwashing of the drug firms. This is not so. All of us in the medical profession are subjected to this brainwashing. What is more, most of the big drug firms know the names of the members anyway.

The CHAIRMAN (Mr Lucock - Order! The honourable member's time has expired.

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