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Thursday, 29 April 1971

Senator GREENWOOD (VictoriaMinister for Health) - Senator Turnbullhas addressed himself to the motion for the first reading of the Pig Slaughter Levy Bill. Although his remarks have no relevance to that measure, he is entitled to do so by virtue of the generous Standing Orders of this place. He spoke at some length about his recent visit to the United Nations. On that aspect I wish to say nothing at all. But 1 do desire to reply to some of the matters to which he has referred in connection with the Department of Health.

The first point he raised - actually I am a little at a loss to appreciate the point that he was endeavouring to sustain - was that there should be some reporting to drug companies as to the reasons why their drugs are not regarded as safe or, I presume, as to why there are adverse reactions to those drugs, which are found by the Committee concerned. The committee which has a broad responsibility to consider the safety of drugs is the Australian Drug Evaluation Committee. That Committee is established under the Therapeutic Goods Regulations, and it has a wide and roving charter. It has an obligation to eval uate data on new drugs which are produced or proposed to be distributed in Australia. It also has the function of monitoring the adverse reactions .of drugs which are currently available.

This Committee is not a departmental committee. It is an independent committee established under the Regulations, without any departmental representation. Its members are eminent medical practitioners and pharmacologists. It is very important - I do not suggest for one moment that Senator Turnbull does not recognise the necessity for this Committee-

Senator TURNBULL (TASMANIA) - The Therapeutic Substances Committee is the one that deals with the matter I raised. I may have given you the wrong name.

Senator GREENWOOD - I note Senator Turnbull's comment. It adds point to the statement I made earlier, namely, that I lacked the ability to get the point that Senator Turnbull was endeavouring to make. As far as the Australian Drug Evaluation Committee is concerned, in the course of his remarks I sought some information in order to ascertain precisely what he was referring to; and the position is that this Committee does report to the various companies whose drugs are found to be unsafe or in respect of whose drugs adverse reactions are recorded. There is a general discussion, which takes place between the Committee and representatives of the drug companies concerned, as to why the Committee has reported adversely on the drug concerned.

I do not think it is a question of making these reports public, because to make them public would involve the Committee in controversy, it would raise an interest which possibly it is wiser not to raise and it might encourage experimentation, which is to be avoided.

Senator TURNBULL (TASMANIA) - You do not have to make them public.

Senator GREENWOOD - I appreciate that Senator Turnbull was not really urging that they be made public. But he was urging that something be done along the lines of the publicity that attended his efforts with regard to the Pharmaceutical Benefits Advisory Committee during the debate on the National Health Bill last year.

All I can say is that, if Senator Turnbull is concerned to produce a case that indicates clearly the committee to which he is referring and the disadvantages that he can adduce as flowing from present procedures, I certainly am prepared to have a took at it. But I say with all respect to him that I did not follow the point that he was endeavouring to make.

Senator TURNBULL (TASMANIA) - Your departmental officers should have told you that I had made a mistake. But they shut up; they did not say a word. That is what they are there for.

Senator GREENWOOD - I do not desire to respond to that interjection, except to say that by interjection 1 sought to elicit information and I was informed that the honourable senator was referring to the Drug Evaluation Committee. So I sought from the officers with me information about the Drug Evaluation Committee andI have been supplied with information which, as I understand the position, is not disputed by Senator Turnbull. However, I repent what I said earlier: In the area with which he is concerned, if he seeks to give me the information and the arguments he would use to support his case and to show a positive benefit, I certainly will be prepared to examine it.

The second aspect that Senator Turnbull raised was concerned with the problems under our national health scheme in relation to the supply of spectacles and the preceding consultations which are given by ophthalmologists and optometrists. It is a fact that if a person goes to an ophthalmologist, who is a specialist eye doctor, and as a result of a consultation obtains spectacles, he will not be able to recover, under the medical benefits segment of the national health scheme, any proportion of the cost of that consultation. Naturally, he is unable to recover Commonwealth Benefit for the cost of the spectacles.

It does seem to be a paradox that under ahealth scheme which is designed, in its medical benefits segment, to ensure that the cost of the services of medical practitioners can be insured against there should be this exception. But I think it has been well established over the years that the reason for the exception - it has been in the National Health Act for a number of years - is that optometrists are engaged in the provision of spectacles and the performance of refractory work and it is largely to prevent the ophthalmologist from obtaining an advantage in a competitive field over the optometrist that this provision has been inserted.

Senator TURNBULL (TASMANIA) - You have been misadvised. The ophthalmologist is not paid for spectacles, only for ordering them.

Senator GREENWOOD - I appreciate the distinction which Senator Turnbull draws, but I do not think it affects the broad proposition I am making. These people are in competitive and comparable activities. If one was to receive a benefit, the other would be denied it. If the patient of an ophthalmologist was' granted a benefit the patient of an optometrist would be denied it. Patients would be discriminated against; similarly optometrists would be discriminated against. I appreciate the paradox which that position reveals. Nevertheless, it is an essential part of the present scheme pending the finalisation of the Government's review as to whether, and if so in what way, some assistance can be given for the ancillary fields, the paramedical fields not only of optometry but also physiotherapy, chiropractics and others.

The Nimmo Committee recommended consideration of a means whereby persons could insure themselves with respect to costs in the paramedical field. The Government has indicated that it is examining the matter. I am sure honourable senators will appreciate that it is a field of vast dimensions and that any review takes time. Ultimately the basic question to be faced is the cost of these provisions, and the Government's constant concern is to endeavour to keep down the costs to the patient and to the Government in all the complementary assistance it gives to help a patient to hold his medical bills at a level as low and reasonable as is possible.

The third point raised by Senator Turnbull related to the activities, or alleged lack of activities, on the part of the Government in taking action to cut down cigarette smoking. I repudiate, although surely it ought not to be necessary to do so, the allegation made by Senator Turnbull and. by others that the Government is in the pay of the tobacco companies.

Senator Kennelly - God forbid.

Senator GREENWOOD - It is very easy to make such glib assertions. I can imagine that if the Opposition was accused, because of a particular stance which it took, of being in the pay of a particular company or group which stood to benefit by what the Opposition was doing, it would legitimately take offence. I have heard offence taken in the Senate in . similar circumstances. J believe that if people are prepared to make a statement such as that made by Senator Turnbull and to. repeat and to reiterate it inside and outside Parliament, it ought to be nailed. I will nail such statements on .every occasion because there is absolutely no truth in . the imputation behind the statement that the Government in some way is being helped or financed by tobacco companies.

Senator TURNBULL (TASMANIA) - 1 apologise and accept your refutation, but tell us why the Government is not acting.

Senator GREENWOOD - 1 accept Senator Turnbull's statement, but I sense that a distinction needs to be recognised between the fact that there is a connection between cigarette smoking and lung cancer, heart disease and allied injuries to health, and the action which ought to be taken with regard to cutting down the risk that cigarette smokers undergo. These are separate fields. I said in the Senate yesterday in answer to a question that the advice of reputable medical people ought to be heeded and that as far as possible the greatest publicity should be given to the. statements of people who emphasise, establish and point to the risks which people run when smoking cigarettes. That is medical fact and I feel it should be given the widest publicity. Having made that fact known, and I do not believe that many Australians are unaware that they run the risk of injury to their health by smoking cigarettes, 1 believe it is up to the individual Australian to determine for himself what he will do. Whether a person smokes cigarettes is essentially a personal matter. It is a question of an individual's own responsibility and the way in which he discharges his obligation to himself and to those who are dependent upon him, whether he is prepared to run this risk.

I do not believe that government can ban successfully the smoking of cigarettes or the sale of cigarettes. I do not believe that government by any device with regard to advertising could succeed in stopping people from smoking, because if people want to smoke they will smoke. I think that people in the education field should be concerned to make Australians, aware of the risks they run by smoking cigarettes. I hope that publicity will be given to statements such as those made last week by Professor Nossal, and that on all possible occasions publicity will be given to - the statements of people who, by virtue of their authority and eminence in the field in which they practice, can point to the connection between cigarette smoking and the diseases that flow from it.

In the sense that Senator Turnbull here today has taken advantage of the Pig Slaughter Levy Bill to raise this matter, I hope that what he says will be heeded, but I do not accept that what he says with regard' to the necessary or desirable means of trying to stop people smoking is at all a logical or necessary consequence from the initial points he raised. If the evil of cigarette smoking is as great as Senator Turnbull says it is, one might suppose that the effective course is to prohibit smoking, or the sale of cigarettes. Yet that is not the argument raised by Senator Turnbull and it is not the argument raised by those concerned in this field. It is argued that an intermediate step should be taken, that a warning label should be placed on cigarette packets. On that view the Government has indicated that for the Australian Capital Territory it will be prepared to enact that legislation when the States which have agreed to it have enacted similar legislation in their own States. It would be pointless for the Commonwealth to act in the A.C.T. when the major sources of supply and distribution are outside the Territory.

Another suggestion of an intermediate character is that a ban should be placed on cigarette advertising on television. I would have thought that the only reason people could properly advance in support of that argument is the one advanced by Senator Turnbull - that other countries in the world have done so, particularly the United States of America. I am surprised by the way in which people castigate the Government for slavishly following United States policy on this and that issue, whether it is true or not. But on this issue they urge with all the determination they have that we must follow what the United States is doing. I hope that there is more consistency and more study of the desirability of some of the proposals that have been advanced than has been given to the question of banning cigarette advertising. It is a complex matter. I repeat what I have said before. It is not a question only of whether a ban will be effective, as the rights of individuals are also involved, as is the revenue which the Government derives.

I sense that the aspect of personal responsibility is fundamental to this question. The basic premise upon which Senator Turnbull and others rest their case that cigarette advertising on television should be banned is the risk that a person runs by smoking cigarettes. I suggest to him that more people die from injuries received in road accidents than die as a result of lung cancer or other diseases which can be attributed to cigarette smoking. An extension of the argument used by Senator Turnbull is that people should not ride in or drive motor cars as the risk of injury or death is much greater if they do. How a person drives a car is a matter of personal responsibility because he knows that he can risk damage and harm to others as well as harm to himself.

Senator Prowse - Does the honourable senator think that is a fair analogy? One situation is a certainty and another is problematical.

Senator GREENWOOD - I cannot see the distinction which Senator Prowse draws. This matter gets back essentially to one of personal responsibility. In the case of a motor car it is personal responsibility affecting not only oneself but also others. In the case of a person who smokes cigarettes it is a personal responsibility peculiar to himself. I have not yet heard of a person through his craving for cigarettes involving others in any anti-social conduct.

Senator Rae - Is it not a question of encouraging the taking of a personal risk?

Senator GREENWOOD - I sense, possibly following what Senator Rae is pointing to, that the main area in which activity should be undertaken is health education. Education in the schools is, I think, doing a tremendous amount to inform people of the hazards of smoking. I believe that is where the real effort should be made. The Education Departments in the States are doing that. I feel it is a large question. As Senator Turnbull was inclined to pass over any real connection between the sort of remedies he was urging and the type of risk which he acknowledged existed I thought it was appropriate to make some points which I hope have some relevance to what he said. This is an area in which there is a constant study and in which government activity has been concerned to try to cut down the activity of the cigarette companies which advertise where that advertising can affect younger people. I trust that in due course I shall be able to make an announcementabout the voluntary code which the companies and the television stations haveaccepted with regard to. cigarette advertising. In terms of argument I do not see the. point which has been made by Senator Turnbull, that there is a need for a total banning of cigarette advertising.

Debate (on motion by Senator Cavanagh) adjourned.

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