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Thursday, 14 May 1970

Dr CASS (Maribyrnong) - I would like to discuss this Bill from the point of view of the quality of medical care and what it is we are seeking to do when we have a committee looking into the drugs that should be available under the national health scheme. Quite clearly the aim is to ensure that the drugs prescribed are the best available and, also, that some of the drugs, once accepted to be dangerous, or useless, whichever is probably more likely, are removed and no longer prescribed. I do not see this as a matter of opinion. I would even hesitate to say it should be based on clinical hunch or clinical judgement formed over a number of years without the backing of some clinical research. I say that because it is very easy for a busy doctor treating patients and not having very much time to pause and think or to analyse the results to remember the dramatic successes and completely forget the disasters. This has been shown often in many things ranging from recipes for treat:ng simple ailments up to the most complicated surgical procedures. The practitioner in that particular situation is convinced because he can recall certain dramatic events, particularly when a patient is saved, that his procedure is correct. But when one analyses the total of the results one reaches a different conclusion. I am not suggesting that this committee works solely on hunch. From what has been indicated the members of it might be the very sort of people I would want to have on it, but I think there is no harm in this sort of information being known.

I do not really feel that pressure from the drug firms would alter the situation one iota, if they are in fact the best people for the job, because their opinion should be based upon the sort of research work which the Americans are prepared to accept with their Food and Drugs Administration which goes into a very detailed analysis of all these aspects before anything is released for use by doctors and health authorities in America. After all1 it was the care of this body that prevented the thalidamide disasters there when, I am afraid, almost every other country in the world failed. I am a little unhappy the mechanics we have set up are not clear and explicit enough to ensure that we do not fall into the sort of error that occurred then. Perhaps our committee depends largely on what happens overseas. I suspect that is true because we spend singularly little on any sort of research, in including clinical research, and the correlation of data to allow proper judgment. I would not suggest that our proposal solve the problem anyway, but it is one small step towards bringing the whole deliberative mechanism out of the darkness so that it can be seen and criticised if need be. Perhaps better suggestions could be made as to how this committee could function. I hope I am making it clear that the aim of ensuring the highest possible standards requires a certain measure of public scrutiny, not secrecy. I am not trying to cast any doubts on the quality of the men involved. But they should be known. I think I am right in saying that the British have a counterpart committee and its members are known. They are in the main academics, and their results have to stand up to criticism by other academics. I think this is the way it should be. For this reason I think our suggestion needs some support. I am also prepared to concede that there may be a lot more suggestions which could be made to improve the standards of its function.

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