Fury as Australia appoints former industry lobbyist to drugs watchdogBMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7283.383/a (Published 17 February 2001) Cite this as: BMJ 2001;322:383
All rapid responses
The spill of the Australian Pharmaceutical Benefits Advisory
Committee (PBAC) and the appointment of an industry representative are but
the latest initiatives of a neoliberal Howard government. Other examples
include a A$5 billion support package for the private health insurance
industry, the steady run-down of public hospitals and recently introduced
legislation that give business interests effective control of Australia's
food, health and safety regulatory body. With respect to the latter, it
appears that the Government is doing to the food regulator what it has
done to the PBAC.
The government’s actions have not gone unopposed. Media coverage has
been unprecedented, helped by ex-PBAC members who have courageously spoken
out about Ministerial and pharmaceutical industry perfidy. In addition,
there is an expanding coalition of people and organisations who are
protesting about the government's action, espousing alternative policies,
contributing to the public debate and are determined to make these issues
election issues. This protest can be tracked at: http://www-sph.health.latrobe.edu.au/PBAC/.
Neoliberal State governments have lost the last three Australian
State elections and a Federal election must be held by the end of this
year. Ultimately, the Australian people will determine whether these
changes to the PBAC remain.
Competing interests: No competing interests
The current furor in Australia over the Pharmaceutical Benefits Advisory Committee appointments and resignations appears to be another example of a problem aptly summarized by David Sackett as “When doing good conflicts with doing well”. Every country with any semblance of publicly funded health care is intensely worried about the rising costs of therapies. Those with adequate resources and expertise, including Australia and most provinces in Canada, believe that one of the most just and equitable approaches to the dilemma of rationing scarce financial resources is to rigorously evaluate the cost-effectiveness of therapies and reimburse accordingly. Australia is widely viewed as an international leader in this field of pharmacoeconomic evaluation for reimbursement and David Henry, in particular, is a highly respected clinical pharmacologist and international authority on this area of science.
This debacle and the personal attacks from the Minister of Health in Australia reinforce two key points which deserve further development. First, politicians are even more susceptible to organized lobbying efforts than clinicians (at least the latter should have critical appraisal training to rely on; politicians rarely have this). Economic considerations – e.g., a pharmaceutical industry’s promise of dollars invested and jobs created, although never factored into any public cost-effectiveness equation, often appears to be more important to political powers than providing life-saving and life-enhancing medications to all citizens. The answer to this issue is obvious: keep important regulatory activities free of political interference. Unfortunately this is easier said than done. Clearly further regulation is needed to ban the personal harassment exemplified by the Australian health minister’s ridicule of committee members and the legal threats that the pharmaceutical industry increasingly invoke to keep “doing well”.
Second, open adherence of all parties to clear conflict-of-interest rules, would at least make obvious the potential biases that committee members might represent. While the pharmaceutical industry is never suspected of being objective, health care consumers may not realize the extent of industry involvement of many clinicians and scientists providing recommendations and consultations to regulatory bodies. The appointment of a pharmaceutical industry representative to a formulary reimbursement committee, as was recommended by the Australian Minister, would contravene each of the many conflict of interest guidelines that I have witnessed over the years.
Anne M Holbrook,MD,PharmD,MSc,FRCPC
Director, Division of Clinical Pharmacology,
Centre for Evaluation of Medicines,
Competing interests: No competing interests