Dr Kerryn Phelps, AMA President - ABC Radio 702 2BL

30 May 2001

Blow out of the Pharmaceutical Benefits Scheme due to Celebrex and Zyban

SALLY LOANE: Well, the Federal Health Minister Doctor Michael Wooldridge was under pressure last night after revelations that the Commonwealth Drug Subsidy Scheme had blown out by $774 million as well as moves by the head of the AMA, Doctor Kerryn Phelps to sue him for defamation.

Now two drugs on the Pharmaceutical Benefits Scheme have contributed to the costs blowout, the arthritis drug Celebrex and the anti-smoking drug Zyban.

Joining me on the line, the Federal President of the AMA Kerry Phelps, Doctor Phelps, good morning.

KERRYN PHELPS: Good morning, Sally.

SALLY LOANE: Why are you suing Doctor Wooldridge?

KERRYN PHELPS: Well, I think that matter's in the hands of the legal profession now, so it's probably best I don't say too much, but I think it's reasonably obvious that the comments that were made about me were offensive to general practitioners in general and to me personally and we gave the Minister ample opportunity to apologist. I don't that anyone takes this sort of action in my capacity or in the capacity of the AMA lightly and we certainly reluctantly, but had no other options available to us when the Minister refused to apologise or withdraw his comments.

SALLY LOANE: His comments were essentially casting aspersions on your training?

KERRYN PHELPS: On my qualifications to be making comments about things like cholesterol lowering drugs and in general about the specialist qualification of being a general practitioner and I think that we're well past the time in history when general practitioners were not considered be specialists in general practice.

SALLY LOANE: Is the AMA suing Doctor Wooldridge, or is it you personally?

KERRYN PHELPS: It's the AMA on behalf of me, yes.

SALLY LOANE: There's no love lost between you and the Federal Health Minister, is there?

KERRYN PHELPS: It's been a difficult time, but we have continued to stick with the issues and to raise the issues that are of importance to the Australian people like - things like public hospital funding and what's happening with bulk filling and general practice and reviewing the Medical Benefits Schedule and Competition Policy and the decline of obstetricians around rural Australia because of medical indemnity costs rising and the need to review the whole system of medical negligence to ensure that we can continue to provide services.

These are the issues that have been highlighted by the AMA over the past 12 months and they do sometimes cause discomfort to Governments if they don't wish to move on them.

SALLY LOANE: There was quite a close relationship between the previous head of the AMA and Doctor Wooldridge, they went on several trips together around the country to look at issues like country doctors.

Did you go into this job thinking that you would not enjoy such a close relationship?

KERRYN PHELPS: I went into the job saying that I would be telling it like it is, that I would be saying exactly what patients and doctors wanted from the health system and to be indicating where we felt on a constructive basis, changes could be made.

And I must say that access and influence are two very different things and even though you might be going around on trips with the Minister and having lots of meetings, it doesn't necessarily mean you're getting anywhere.

SALLY LOANE: The Minister has called the AMA a militant trade union. This harps back to the days of Doctor Bruce Shepherd as head of the AMA.

Do you think it is like that? Do you think the atmosphere is as polarised as that?

KERRYN PHELPS: I certainly think that the attitude of doctors at the moment is one of anger and frustration.

I think militant is a bit of a dirty word and I don't think it should be readily applied to the medical profession.

But there's certainly a lot of anger and frustration. I have AMA members and non-members, doctors all over the country who are contacting us saying 'we can't get patients in for elective surgery, we've got ambulances doing laps of the block, not being able to get into emergency wards, we can't get our frail aged into aged care accommodation, we can't continue to keep our regional practices open because of the Medicare Benefits Schedule and the pathetic patient rebates'.

Patients are saying that their gaps are increasing, that they're having trouble getting access to services.

So, when you're faced with these sorts of dilemma's every day and doctors are letting us know how they're feeling, my responsibility is to make sure that their voices are heard.

SALLY LOANE: Are any of your members concerned that you are at war with the Minister?

KERRYN PHELPS: No, not at all. They are quite well aware that we tried to be as conciliatory as possible from the outset.

Now, you can be conciliatory and constructive without agreeing to absolutely everything. You can't just agree with everything if it contravenes your principles.

SALLY LOANE: This is a Federal Election year, of course, Kerryn Phelps and some people might say that it looks good for a Federal Health Minister to be having a war with the doctors, not always a popular group in the electorate, in election year, do you think that's behind this, part of it?

KERRYN PHELPS: Well, there have actually been statements attributed to the Minister where he said that it was good for the polls to actually bring on a fight with the AMA.

We've never sought a fight. We've sought constructive engagement and unfortunately, to take that attitude and to actually state that that's what your strategy is, that you're going to try and grind an organisation into the dust and take them on and the doctor, that kind of belligerent approach, I suppose, is I think very unfortunate.

And I don't think the public are buying it. I think that they're seeing that this is the stated strategy of the Minister and thinking well, why doesn't he sit down with my doctor and actually talk about what our concerns are.

SALLY LOANE: Kerryn Phelps, could you admit that you also have a confrontational style, that you did provoke, it seemed as though you provoked Doctor Wooldridge when you accused him of favouring his landlady, Kate Kurnell, when he gave here a job in general practice training. That was a shot over the bow.

KERRYN PHELPS: Well, I think that it would be fair to say that the General Practice Training and Education Board is probably one of the most important positions for General Practice future in Australia and my concern and the concern of my colleagues was that that contribution should be going to the person in Australia who would be most qualified to take that position.

The question I was raising was whether it had been an independent and transparent process and I believe that that was a fair question to ask given the weight of this committee and its important to the future of my colleagues.

SALLY LOANE: So you don't believe that you have belligerent style as well?

KERRYN PHELPS: I think raising relevant questions and telling the truth is not a belligerent style and it may confront some people to face some truths, but I'm not concerned about that and I have very tremendous support for my colleagues for doing so.

This is not what I call confrontational. If someone can't actually be accountable and make sure that their processes are transparent and actually deal with the real issues even though they might be politically difficult - I don't have to agree with people in order to have a constructive relationship with them.

You never expect that in any kind of medico/political arena, but I do expect you to respect and I do expect -

SALLY LOANE: And you don't think you've got it from the Federal Health Minister?

KERRYN PHELPS: Well, I don't believe that I or my colleagues in the AMA have been treated with respect, no.

SALLY LOANE: Kerryn Phelps, what is the reason for this drug blowout, the Celebrex and the Zyban drug, there's also the anti-cholesterol drug as well. What do you think's behind it?

KERRYN PHELPS: Well, I think we need to look at the value of these drugs to the community. Now, I know for sure that there are a lot of elderly people just hanging out for the cox 2 inhibitors like Celebrex to come onto the market because they are suffering in pain, their standard painkillers were not really working terribly well for them and that they needed an anti-inflammatory to help them with their pain, but they couldn't take one of the existing broader range anti-inflammatories because it had with it, particularly for elder people, the risk of gut haemorrhage or stomach upset.

Now, there is no wonder that a drug that comes on the market that says it has far less risk of those side effects and will give relief to people was going to popular.

If you look at Zyban, now we also need to look well beyond, for a drug like Zyban, the current budget cycle.

I think we need to look at the number of people in this country who are desperately trying to give up smoking.

You don't go on a drug like Zyban until you've tried everything else and if it's not working and you simply can't stay off the cigarettes then you're going to need some assistance, so I would actually see the increased use of Zyban and the popularity of that medication as being good news.

SALLY LOANE: Should they stay on the PBS?

KERRYN PHELPS: Well, I think that that is really a budget and economic decision to be made and I think that clearly this is a subject that has come up over the last week, where we've seen a blurring of the boundaries between purely clinical guidelines and economic constraints and I think if we look at purely clinical guidelines then that is one point, but if you're looking at what the Government through the taxpayer is going to pay for those drugs then that's quite a separate argument and I think that it's important that we do keep the economic considerations in mind.

But once again I think it's important to look beyond the current budget cycle in doing that.

SALLY LOANE: I'm talking to Doctor Kerryn Phelps, the Federal President of the AMA on 702 ABC Sydney. Kerryn Phelps, should the Minister, should Doctor Wooldridge be going to the manufacturers, the pharmaceutical companies of - the ones that make Celebrex and Zyban and other drugs that are very expensive and asking them to reduce the cost?

KERRYN PHELPS: Well, I think what happens in the sort of economy that we have in Australia is that - and this is already happening, you're going to get other related drugs coming up and as their popularity increase, I guess, and as other competitors come onto the market then there will be some sort of price competition with them and I do think the price will come down of its own accord in that way.

So, I think that will take care of some of it, but certainly if there is a possibility of the cost of manufacture and production of the drugs without affecting quality, if that can come down in some way, then obviously that would be welcomed.

SALLY LOANE: Just finally, Kerry Phelps, will the AMA be fighting the Government on the hustings, on some of the issues that you've outlined this morning?

KERRYN PHELPS: I think the medical profession as a whole is going to be very politically active at this upcoming election.

It's not about fighting the Government, it's about educating all of our potential Members of Parliament and our current Members of Parliament in the real health issues and the things that are affecting doctors and the communities and making sure that in the leadup to the next election that health is the big election item and I believe it will be and that our MPs are going in there knowing what their doctors and the patients that they care for are thinking and feeling about the health fund, the health sector and that will be done in an organised way.

SALLY LOANE: Will you be fighting any marginal seats? Have you got a war chest of money to do this?

KERRYN PHELPS: Well, obviously if you're looking at an election coming up you'll put priority first and foremost into the marginal seats to make sure that those MPs are well and truly briefed right from the outset and so that they don't get any nasty surprises about what the medical profession is feeling and I think that communication is the key there and I do believe that once the MPs hear what we have to say and that's certainly been my experience, once they hear what you have to say and realise that what we're saying is in the public benefit and is quite reasonable, that they generally receive that information very well.

SALLY LOANE: Alight, so you'll be a political force then, come the election.

KERRYN PHELPS: I think the AMA's long been a political force and will continue to be and I think that doctors in talking to their patients are also a very strong political force.

Tens of thousands of doctors out there who are speaking to patients, millions of patients every year so, believe me the issue of what's happening in the medical system comes up all the time in conversation.

SALLY LOANE: Alright, Doctor Phelps we'll leave it there, thank you.

KERRYN PHELPS: Thank you.

SALLY LOANE: Kerryn Phelps, the Federal President of the AMA and we did put in calls, of course, this morning to Doctor Michael Wooldridge, the Federal Health Minister. He's not talking on either of these issues this morning, the PBS or the defamation action by Kerryn Phelps. He's decided to leave the running to his deputy, Doctor Grant Turnbling.

Ends

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