The 'Dispatched' Week in Review'- 13 February

Reflect on  Susan Ley’s legacy as a former health minister, especially the 2015 PBS Access and Sustainability Package. She was treated rudely and unfairly, and that meaningful ecosystem reform has since stalled. Critique Senate Estimates, noting that departmental witnesses were evasive and overly defensive, with patients largely absent from the conversation. The discussion expands to reform and the lack of patient rights. Also note the troubling political rhetoric about medical information and regulation. Close by teasing upcoming upgrades to the BPD website.

Transcript

Paul 0:08

Hello and welcome to the Dispatched Podcast. Week in review. It's Friday the 13th today. My name is Paul Cross. I'm delighted to be joined by my co-host Felicity McNeil, PSM, Chair of Better Access Australia. Hi Felicity.

Felicity 0:22

Hi, Paul. Are you superstitious?

Paul 0:25

Depends what happens. I might be retrospectively superstitious.

Felicity 0:28

I guess if you're in Susan Lee's camp, you'd think it was not a good day. And if you were in Angus's, you'd think it was a great one.

Paul 0:34

Maybe. You worked uh in the health department, she was minister.

Felicity 0:41

I certainly did. She's responsible for the PBS access and responsibility package.

Paul 0:48

Sustainability.

Felicity 0:50

Yes.

Paul 0:52

Six point six billion.

Felicity 0:54

Yes.

Paul 0:54

The biggest in history.

Felicity 0:56

Discounted copay's.

Paul 0:58

Discounted copay's.

Felicity 1:00

She changed the landscape.

Paul 1:01

Statutory price reductions in F1, breaking the link between pharmacy remuneration and pharmaceutical pricing. AHI fee.

Felicity 1:13

Yeah, and if you move aside from the the core area of interest of the listenership, you've also got the fact that she did the first ever all of community consultation on private health insurance, the biggest ever response to a Department of Health and Government request for information on their health products. She was also uh instrumental in educating the department on how to think differently about Aboriginal and Torres Strait Islander Health, coming back from working with not only Ken Wyatt, but visiting many communities and really instructing those in the bureaucracy to stop telling people how to do something and telling them what's wrong with them, particularly in their own experience of mental health and suicide, and not making it easier for local communities to give care to local communities in such a personalized area of health care. It's something that really struck me. Um that and the fact that she used to fly in and out on a small little plane.

Paul 2:20

She bought a new plane recently. I think it was a Cessna 180 or something. Yeah. It's quite nice. Plane makes sense for someone living in Albury. I think she was quite effective as Health Minister. I think she had some good people in the department at the time. I think the PBS Access and Sustainability Package, I think it was actually if you look at it from a system perspective, this is sort of the last system level changes. We haven't really had any reform appetite since then. I think she was treated absolutely disgracefully by Medicines Australia.

Felicity 3:09

Yeah, sexism gender issues was still really pro I mean, they are still today.

Paul 3:14

The way she was spoken to at the Medicines Australia Parliamentary Dinner.

Felicity 3:18

Oh yes, everyone else is minister, but but she's just Susan. Um absolutely. And I think some of the, you know, you'll have, you know, the death and blood of of dead people on your hands from other generations.

Paul 3:32

Yes, that was on biosimilar. On biosimilars. Biosimilars, but it were going to kill people, that's right.

Felicity 3:36

They were. Um but you know what, it wasn't exclusive to the industry that generated that high level of, I'm sorry, really sexist behaviour. Uh the way that she was treated by the finance minister and in particular the treasurer, when she came out and talked about the fact that the copies that she had inherited for the MBS and the PBS particularly, the five remember I was supposed to be increasing the PBS co-pays by five dollars and fifty cents, depending on the two levels, and she said this is not consistent with what we want to do, this is not going to work, I can't do this.

Paul 4:08

It was never going to get through the Senate anyway.

Felicity 4:10

And she just said it wasn't the right thing to do. And you know, Joe Hockey came out and publicly admonished her, made her do it, and of course, part of the reason for the six point six billion was to try and pay for that that we weren't successful, it had to continue. And when she was moved on, the first thing Greg Hunt was allowed to do, the boys were allowed to actually stop that.

Paul 4:28

So similar thing happened to Cape Patterson when she was replaced by Tony Abbott.

unknown 4:33

Yeah.

Paul 4:33

That was on Bog Billine, I think.

Felicity 4:36

Uh it's look, I just I don't want to make it about the sexism things, but I'm saying that you know things move on a little bit. But it does it does happen, and it did happen, and and there are t things at times that people colour about certain um ministers' decisions and what they do and then there's what they're made to do.

Paul 4:52

So yeah, it was a very interesting time for me, but I Well it was the last it was the last if you look at the state of the policy discussion, the ecosystem discussion in 2026, it's pretty tragic compared to what was happening in 2015. I mean, she was admonished I'm not gonna say who who the industry leader leader was at the time, but at that dinner, because she said, I need your ideas and that was in early 2015. Now, that's a minister saying, Hey, I need your help. Would you rather it be done the underhanded way, the way Greek Hunt did it in 2020? She actually invited all the stakeholders in and said, I I I want your ideas. She was very open, she was very transparent. It's the last time there was actually a sort of meaningful discussion about it, and it was it was achieved very, very quickly.

Felicity 5:49

It was actually 14th of February.

Paul 5:51

Yeah, and we all remember that let's not even talk about the train wreck of the say yes to the best PBS campaign. Uh but I just wanna you know, we're very good at forgetting the contribution of people. I think it's sad that she's retiring from politics because experience really matters, and she's been in the parliament for as long as some people have been on the PBSC.

Felicity 6:15

Yeah, and she's been a great local member too, and I also owe her a lot during that time because say yes to the best PBS also included, you know, tell those unelected officials. And uh, you know what? It's not often that a minister turns around and says, How dare you threaten my my employees that way? That the departmental officials and she took a very strong stance and she didn't need to, because that's the job as far as I think.

Paul 6:41

It was it was actually it was it was disrespectful that campaign, and thankfully it was pulled very quickly. But Well, it was disrespectful, it was just dumb. There's just no history of I mean, because they're all ged up about the mining tax and how the mining industry the difference is that the m the mining industry is Australia's literal economic diamond.

Felicity 7:03

Yeah.

Paul 7:03

These are multinational pharmaceutical companies, and so just take a chill pill. And actually it might be worth remembering 2015 as we head into 2026.

Felicity 7:15

Let's let's let's talk about people who have been on the PPSC longer than let's talk about uh Senate estimates, additional estimates, I think it was yesterday. Yeah.

Paul 7:28

I just want to start by saying some of these officials are getting very cocky. They're very passive aggressive. Starting to Well, just the sarcasm in I I I I don't like it. I don't like it. And the chair of this committee is I'm not saying that we should become like the US congressional hearings where they're basically th threatening each other and talking over each other. But I did see Senator Rustin at some at some point yesterday actually told one official to check their tone.

Felicity 8:01

And so she should.

Paul 8:02

Yes. And it's disres it's very disrespectful of our elected representatives. This is a this is close to a judicial process. And the snarkiness and the the talking back and talking at and the patronizing responses. Just remember who you're serving would be my advice. It never used to be like that. It used to be really respectful.

Felicity 8:27

Yeah, and it also used I mean the great irony is that the senators are now being told that under no circumstances can they even question you, you know, your your response because that's bullying behaviour. The the sarcasm used to come from the other side. So the sarcasm used to come from the other side of the table where a senator you'd say something, yeah, right. I mean, we can all remember Senator Dean Atali, you know. Doesn't hurt to tell the truth, Miss McNeil. You know, the the game playings uh you know, having been at finance, Robert Ray, John Faulkner, uh Bromwin Bishop. It was Penny Wong. Yeah, Penny Warm. They they were very uh Katie Gallagher, um I've I've I've been grilled by many um Cormac, all sorts of people, depending whether they were in you know opposition or government. I mean, you know, Senator Ferrer, Vanti Wells and Senator McLucas were either lovely or ready to kill you, depending which time they thought they were going to be into um but but I didn't mind that. That was the job. The job of the Senate is to hold me to account and expect me to answer as truthfully as possible, alongside my job, which is also not to to actually you know drop the the government in it um and to to answer things in an appropriate way. But we have turned around to this area where everyone's so worried about the whole Rudd Gillard, Rudd years of bullying that you know that Prime Minister was a horrible bully. It's it's publicly known. But we've now got to this point in in my opinion. No, it's bullying me, in my opinion.

Paul 9:49

I'm just saying that for it to create defensibility. Thanks. Alrighty. Yeah, yeah. So it's all you gotta do. In my opinion, at the end of it, and it's protected. There we go.

Felicity 9:59

Ah, thank you. Welcome to the journalist versus the person that's gonna say. Uh but we've now moved to this area where the all the power vests in the departments, all the obfuscation, you know, even the fact that listening to Senator Rustin trying for the fourth time to get clarity on data for the MBS bulk billing initiatives, and it's just so rude. And I well no like you said, if you have have been a witness in in court, which I have, I'm telling you right now the barristers ain't that nice.

Paul 10:32

No, no, no. It was quite there were so many funny parts of the testimony given yesterday. So so the officials were moaning about the number of questions on notice they had to respond to. Well, stop taking them on notice. Come and be and pr be prepared to answer the question. Because the stuff that they take on notice is just ridiculous. It's almost like, well, uh Secretary, uh, what day is it today? Well, I'll have to take that on a note. I don't know if that with me, Senator, but I'll have to get back to you. I'll have to get back to you.

Felicity 11:07

And I don't think I can get back to you by the end of the day.

Paul 11:09

You can't, this is completely your doing because you refuse to answer questions. The other thing was we were when a certain first assistant secretary said about the department's relationship with the pharmaceutical benefits advisory committee. Oh, we don't uh give our opinion to the PBOC Senator. And then they gave six examples of where they give their opinion. Do you hear yourself? And then they said that I thought it was very interesting that when they were asked about the HTA review that there's this very subtle shift. I know they can't really talk about it, it's probably in the cabinet process now, a budget decision-making process, so that's not necessarily uh so they they were sort of saying we've been working on process improvements for ten years. And to which Senator Rustin said, Well, that's kind of the pro that's kind of the point, isn't it? You've been working on it for ten years. And then they hired they talked about the submission pathways, which we all know are actually about increasing cost recovery fees. And surprise, surprise, adding complexity doesn't lead to faster outcomes. Shock horror. I mean, you'd think these people were Warren Buffett. Then there was the well, actually, we are still working on a lot of process improvement, Senator. In fact, the two subcommittees of the PBAC recently m had a joint meeting. And I literally burst out laughing. Me too.

Felicity 12:30

So the drug utilization subcommittee and the economic subcommittee that used to meet sequentially, or sometimes you're roughly on the same day, are now as a pilot meeting together, even though there's not full overlap on the submissions that that they they look at. But yeah, if if that's the greatest process improvement, so how does that expedite the 17 weeks or the then the regoing or the churning and you must put in your notice beforehand? But I think the other than that being that's what's going to save us, and of course we know it's not. What I also found was of concern is getting on the record that those process improvements in 2018 was because the industry demanded them. This was their idea. Everything we've done is their idea, and everything we do has to be done with them because they asked for it, and everything we're doing right now is because they asked for it. And so anything that goes fast or slower is because of them. That that real undertone and uh the the joy, and I know you were you were citing from a book on free trade uh yesterday, and the failure to mention the word patient in the PBS. Yes, someone sent me that. Yes. That is exactly what happened yesterday. So when they talked about that process, the only person who mentioned a patient during that um discussion was Senator Rustin asking a question about patients, but everything was about the department blaming the industry about the process, and here's the process that we're all doing, and everybody has to agree to it. And I found that instructive.

Paul 14:03

This is this is where the Danger Will Robinson. Well, it's just devolved into this discussion between one group and another group, and patients are almost incidental to those conversations. When Senator Pocock was asking about biologics, pediatric access to biologics, and the fact that consumers patients will not have an opportunity to contribute ahead of the March PBAC meeting because it was put on the agenda so late. They basically said, Oh yes, but we met with patient groups regularly on this issue because it's been going for two years now, or however long it's been going for.

Felicity 14:38

We had correspondence. Everyone keeps complaining to the minister.

Paul 14:40

Yes, we but it's look look, I think that this to me is fundamentally the issue, and it's a frustration of mine. A lot of the questions and a lot of the discussions around this area of policy are so far from where they need to be. I I don't understand. I mean, the sort of sort of this idea about net PBS spending, okay, right? Yeah, the it's the easiest thing for the government to defeat. Because Mark Brother just has to say, Well, we have a long-standing commitment to list everything recommended by the Pharmaceutical Benefits Advisory Committee. These are the independent experts.

Felicity 15:16

As the first assistant secretary said.

Paul 15:18

Yes, so the government can agree to put in$20 billion to the PBS. But if the PBAC isn't reformed, and this is where the reform needs to take place. I don't know, I don't know what is so perfect about this committee that people won't even contemplate that maybe an institutional framework that hasn't changed for at least 30 years, which has members who've who've been part of the committee process for a quarter of a century, maybe it's time to take a look. You've only got to look at the history of any institution. Institutions are comprised of humans and human nature is what it is. The members of these HTA advisory committees, and I'm not just talking about the PBOC, they have no particular expertise. They're not uniquely brilliant. They have positional power. As much, if not more, expertise expertise resides outside of this framework as exists within it. But I don't know why we can't contemplate that maybe they're making mistakes. Maybe they're making serious mistakes.

Felicity 16:19

Well, as you know, at Better Access since we commenced in what's it, September 2020, and we put it as part of our submission to the novel technology inquiry. Remember that thing? It was going to change the world. Um and every budget application since.

Paul 16:35

I almost forgot. I just hadn't thought about that for a long time.

Felicity 16:38

No, whereas I think about it quite regularly. You know, atari, etc., is not appellable under the AAT or the ART to what you want to do. It's specifically exempt. And historically that's because people have gone, well, that's you know, big pharma and big medtech, and you know, this is a purchasing arrangement between them and the government. We don't want them always, you know, arguing and and pushing back on the PBAC recommendations and the the MSAC recommendations. So what we'll do is, you know, thanks to the you know USFTA, we'll have this, you know, independent review if you get a rejection. My issue that I have been arguing now for six years is that as a patient, because the system doesn't even contemplate me, when the PBAC decides that two years ago, or even though there's an application from a company for access to biologics for pediatric crones, and they go, nah, I'm not really sure we're not doing that, I have no right of appeal. There is nowhere for me to appeal. Whereas I should be able to, and this happens in the NGIS and in social services, if you do something that affects my individual access, then I have the right to appeal through a tribunal process. And we deny patients this. And as long as we keep doing this whole HDA process that's between government and the industry, which is purchase a provider, as long as, and you we heard it a lot on uh yesterday, this is about the population level, not about the patient, because that's how we make decisions, and we've got to look at the data at the population level.

Paul 18:25

That's how we avoid thinking about it seriously.

Felicity 18:28

And so fine, you want to do that, but as an individual patient, I need the right to appeal and to challenge your decisions. And when the department is more in control of the minister than the minister is in control of those things and isn't pushing back on those individual issues, then where do I go?

Paul 18:46

There's no mystery here. Illegal immigrants and convicted criminals have more rights than Australian patients denied access to trade. So so it's wrong. And we know why they won't do it. Because they'd lose. Because they would lose. That's that's exactly why they they don't do it. Now, is the AART one possible vehicle? Yes.

Felicity 19:08

Works for the TGA.

Paul 19:09

It w Yes, works for the TGA and the NDIS has its own version of the ART, I think, these days, or they've got a different super pathway. Super pathway. So I don't know why patients should be denied those rights, but we know exactly why. And we treat we treat this sort of framework as though it can't be touched, as though it's got to be put behind glass, like it's a museum piece. And so what we then end up doing is we get into the ridiculousness of the conversation yesterday where they're talking about oh, we've had a joint meeting of two subcommittees who discuss completely different issues. I don't know why they're I don't know the value of a meeting jointly, to be honest, but but because they usually meet day after the other, sequentially they could run each other, they've run each other. They literally run day each other, yeah, one day and then the next day. Yeah, so I don't if that's the big process improvement, then we're in big trouble. And I I thought they were essentially laying the defense for minimal change coming out of the HTA review. That's good so they started to point to well, we've already made we've already done a lot of stuff. Yeah. We've already we've already done a lot. And then when they said, Well, we're internationally comparable when it comes to timelines, and that wasn't picked up on because uh, well, then why do we need all these reforms and these prices improvements? And then the uh well, then we then we get the the lecture from the health department official about the commercial realities of operating a pharmaceutical company, and it wasn't that insightful. It's it's it's well obviously but but yes, the the the issue is not whether companies are making submissions, it's whether they're progressing those submissions. That's that's the critical point, and it's why it's perfectly reasonable for people to say, I'm not convinced that the PBAC is the right model. I'm not convinced. But all of these processes start with the PBAC will remain the primary body, and you're not allowed to touch it as if it's the bayou tapestry. You know, and and it is just to me, it's just ridiculous. And then people fall into this trap of saying, we need more money in the PBS. Yes, but we need more money in the PBS as a result of better decision making.

Felicity 21:12

We do, and we need more, you know, and we've we've commented on it publicly this week that and I've seen some various um articles on it too, but the risk shares are the things that really start to get get my goat and have uh You were quoted in that article. Yeah. But for the last five years, again, we've again at the Novel Technology Inquiry said exactly the same thing that this is a risk to chronic disease because the system has taken to going, you know what, we know that there's actually, you know, 200,000 women who suffer from migraine, but nah, we're just gonna we're gonna fund 50,000 of them and you're just gonna have to cop the rest of it. And we know that most people stay on a drug for two and a half years, but nah, we're only gonna allow for one and a half years, and we're gonna rely on the fact that the industry. We will just, you know, suck it up, princess, excuse the vernacular, and on we'll go. And what we're seeing more and more of is this absolutism about hard, fast caps, 100% rebates, and companies are just saying, no, we're not going to do this. We we we cannot do this anymore. And when you combine that then with the the pricing, and you know, I have a different view. Many companies come in too high to start with and to see what you know what will go, and sometimes they have to do it globally and locally. But even then, my my broader issue is this has all been about tinkering what we have, and that always makes it longer. And we've always said if you started with a a blank sheet of paper and said, So from ART registration, any device, diagnostic or medicine should be subsidized or available through the various subsidy forms within 100 days. If you put that as your target and then you engineered backwards, you would actually come up with a completely different system. And what concerns me is that people got this review, which you and I have both never wanted and thought was a really bad idea because it indoctrinates even further. It allows the system to blame those that asked for it for everything that's going wrong. And you ask for these higher costs, you ask for this more complex process, you ask for this, it allows for one or two examples of C, the exception is is perfect, so it's all working just perfectly. There's the rule, and patients miss out on and on, because we're genuinely not included.

Paul 23:30

Why can't we have a discussion about having a system that biases in favour of access? Like it does in the US. I mean I I don't I don't in fact, what we have a system is biases in favour of government. And I to me, from a social policy perspective, it it doesn't seem to make a lot of sense to me. I completely agree that if you started from scratch, would you have this system? If you're an ideological Marxist, yes, you probably would. You probably would. But that's that's that's the that's where this system came from. It came from this niche area of academic research in second second rate regional university and was taken advantage of by a government at the time who are worried about the cost of medicines and thought that people were getting scripts they didn't need. I mean that's basically how the system came about, and that's the system that's the system we've got to this day. And I I don't I don't know why we can't have a conversation that goes beyond technical inputs, processes, and joint meetings of subcommittees of people I don't even know. They're not visible to me. We don't know what they say, we don't even know really their the their their agenda and and what they're what they're working on. And these are the faceless people who determine in many cases whether we live and die. I like the Lily, the the Lily and Pfizer GMs quoted in that article this week, talking about access being catastrophically bad in Australia. I mean, that's the can we just have an honest conversation about it? Yeah, it's catastrophically bad. And if we're not gonna have a a discussion about the source of that, it is not a simple case. We've got to get the ecosystem, and that's I'll go back to Susan Lee. That that set of reforms in 2015 was an ecosystem reform.

Felicity 25:13

Yeah.

Paul 25:13

It was pharmacy, wholesalers, you had uh the generic off-pattern sector, you had the research-based sector. I was biotech involved in those discussions, I think. You had you had multiple reviews come out come out of that. You had the pharmacy review coming out of that. That was a really complex set of ecosystem-based reforms. We're not capable of that now. In fact, we can't even have an ecosystem-based conversation. And I it must be very hard for the minister, but I thought that was you know, estimates used to be really good to tune into because these these discussions were topical and they were interesting. And now we look, we even had the conversation about the Trump administration and MFN. And can I just say to the people in the industry can I just ask for some can we have some discipline in Canberra? I'm not talking about any association or anything. I'm talking about individual companies wandering around Canberra, putting all of these ideas out there about how to manage the risk of MFN. And of course they go to what do they go to? They go to these technical reforms.

unknown 26:27

Yeah.

Paul 26:27

That is ill discipline. It's a bad idea, and the government are going to look at that and go, Well, if that's your starting point. So as far as I can tell, the industry's already conceded the idea that Australia just has to pay more.

Felicity 26:41

Exactly. And, you know, I was picking up what you'd said, you know, in um the one of the articles this week, and I'll say it was Anne Harris, and her point was indeed of the 460 new medicines launched, launched internationally between 2012 and 2021, only 24% have been publicly funded on the Australian PBS. Now, that's a fairly shocking statistic for a country that has a very healthy GDP and a very healthy bank balance in general. And that did get traction up on the hill, but equally what is getting traction on the hill is that that's actually really not the problem. It's just if we give you shadow pricing, you'll be fine.

SPEAKER_01 27:25

Well.

Felicity 27:26

Like that that's the problem. You've got this really clear messaging that was starting to resonate, and now you've got these whole, it's actually not the system problem, but you think it is, it's just this little technicality tink that we have to do that's related to President Trump. And it's actually not. It's not related to the current policies in the US as well. That's kind of blowing up the sensitivity analysis. But these problems have been manifest in the country for a number of years and MFN is being applied in a completely wrong way, and the the Parliament is is hearing the message we do not want them to hear.

Paul 28:02

No, well, if Australia has to pay more, just pay more. What's the big deal? It's like no one's asking for your kidneys or anything. I mean, it's like we're not asking for organ donations. It's just if Australia has to pay more to ameliorate the risk of not getting access to medicines that people need, pay more. I mean, I I I don't know, I don't know what the big deal is, and I don't know what the challenge of arguing that is. Now, of course, the Australian government. See, I I wrote about this this week saying the Australian government is saying it's watching, it's watching, it's that's its negotiating position. It's not going to come out and say, well, if we have to pay more, we will. They're not going to say that because they're not even in a negotiation yet. And this is what a lot of people in the industry don't understand. You're not in a negotiation on MFN. So you don't need to concede. What I'll also say is that there is no history in this system of the industry securing beneficial outcomes, including for patients, based on direct engagement with the health bureaucracy. There is no history of it. When I say outcomes, I mean policy changes. You can argue F1, F2, but in the end the bigger beneficiary there was a government. But there is no history of it. The only history of positive change that is enduring 20 years later is the bilateral between Australia and the US. When the US government said, if you want access to some of our markets, you're gonna have to give our companies better access in Australia. So is the MFN opportunity? So I don't know why. One of the big things about that bilateral was we asked we wanted CPI justice pricing. Not unreasonable. Because it's all throughout the health system, even though health department officials at the time denied it, which we delightfully got to be proven wrong. But we knew we weren't gonna get it. We knew we were gonna get it. We knew we had no chance of getting it. We didn't concede it until the last day. So if if by going around Canberra and proposing some changes to supply chain payments and reshare arrangements, you are you've just conceded.

Felicity 30:19

Yes.

Paul 30:21

You've made a huge concession. Now people can say, oh no, we're still asking for higher prices. Well, what do you what do you are? It's just it's just the focus now needs to be on how do we get into a negotiated settlement on this. And before we get there, we do not concede a thing. And the I'm urging the industry leadership, please, please, stop, I'm begging you. Because ultimately, if we use MFN properly, I don't care where the change comes from, I don't care if it comes from Lagos or the Congo. I don't care where it comes from. If it's got to come from the US and there there is a history of that happening, then let it come from the from from the US. If that's how we're gonna get better access to medicines in Australia, thumbs up. Shame that we can't do it ourselves, but there's no history of us being able to do it ourselves.

Felicity 31:07

And I think it's really important because uh d did you watch the conversations with the Therapeutic Goods Administration with uh Senator Antic on pharmaceuticals?

Paul 31:18

No.

Felicity 31:19

Yeah, and I think this is it was it was quite um disturbing to to be honest. So, first of all, Senator Antic only thinks that farm prescription pharmaceuticals are ten billion a year in Australia. So I'm like, okay, good to know. Um doesn't doesn't quite understand what's going on there. But his prosecutorial nature was picking up a lot on the advertising of prescription medicines and how that is blocked and wanting that more tightly controlled. He would actually he was advocating why don't we do it for um over-the-counter materials and things, given that they're also owned by big pharma and big farmers ripping us off and big farmers trying to push up the prices and how dangerous it is for far for for for consumers to actually know anything about medicines. It led to a very robust discussion, the TGA talking how proud they are. They've been, you know, they investigated 13,000 issues last year and how they contact ISPs to stop people in Australia actually being able to link overseas to find out information about a pharmaceutical. I mean, I I'm sure you all talk about us. I, you know, some of the the the the only people apparently that can understand a medicine is a doctor, apparently. So, first of all, it's so offensive. I am so sick and tired of the infantilization of the, you know, you want to call me a consumer, and that's a derogatory term because you consumer, like I just want to, there's nothing more I want to do than take medicines because I'm sick. I am a patient when I take that and I want to be informed, and I find that most people are more informed about their health care than their GP and their specialist to start with. But why am I not allowed information? You want me to have transparent access to how much my specialist is going to charge, but you don't want me to know about the medicine that he might want me to take afterwards so I can have an open and robust conversation. But it was very disturbing about a 20-minute narrative about evil farmer, bad farmer, farmer trying to make people take medicines they don't need, farmer putting people's lives at risk because they, you know, they're going to try and ask for medicines that you know they shouldn't have. And what are we doing to clamp down on this outrageous cost in our health system from people wanting medicines that are actually, you know, they don't need. So there was a really dangerous narrative in there, and that was coming from a coalition senator. And I think when you look at that, you look at the MFN thing that's going on, you look at the the lack of consistent messaging. Like I loved the um eOPED piece this week because it was very clear. It set out a narrative. You can argue it and we can dispute it, but it's a it's a starting point, it's a clear position, and from there you can move forward. But I I think the industry's in trouble because if that much conversation is going on, then that's that's half the battle. If I if I'm in deep the department and I want to start arguing against you and your next strategic agreement, that Senator's making the point for me, and that means I can create a narrative and look like I'm actually responding to it rather than responding to the narrative, which is what Senator Rustin was talking about, which is patients are missing out on timely access to medicines.

Paul 34:29

Well Obviously that particular Senator spends far too much time on the internet. I wouldn't read all sorts of conspiracy theories.

Felicity 34:40

In your opinion.

Paul 34:41

Because and the idea that the TGA did the TGA actually say that they're contacting internet service providers.

Felicity 34:46

Yeah, they do and block it.

Paul 34:47

Well, it's not very effective.

Felicity 34:52

I mean, what?

Paul 34:53

It's just like what what world do these people live in?

Felicity 34:57

Oh, and he handed over an ad uh like an advertisement in the room and then gave a copy to the things and they said, Oh, we're not aware of this one, yes, and we'll have a look at it. Some companies were named, others weren't.

Paul 35:07

I just don't know why the TGA don't say senator, we have to live in the real world here.

Felicity 35:10

But they don't, they were really proud about how they do everything they can do. Oh, because they're medicine.

Paul 35:14

It's that that little religion that little religion that occupies the dark spaces of health regulation and health policy in Australia. That that that assumes that we're all idiots.

Felicity 35:23

Well, I found it quite hypocryphal because they were saying, well, of course we, you know, we we leave over-the-counters because, you know, on a danger level, that's not so bad. And so, you know, it's it's about the risk to the patient. I'm like, hang on, you're the same guys that have just stopped me being able to buy paracetamol in more than a pack of 20 and being charged four times the price for it because it's an over-the-counter medicine, and you decided that, you know, because of some things that had happened, then nobody should have access. So the inconsistency in their arguments is extraordinary.

Paul 35:51

I'm kind of of the view that well, they can regulate as much as they like. I mean, it's like tighten the regulations, knock yourself out. I mean, it's not gonna make the slightest difference. I mean, it's what what in what what form are they saying these regulations should take? How are they gonna regulate the AI platforms? How that how are they gonna do that? I mean, it's it's to me, it's it it amuses me no end that they think they can regulate away a problem via that is mostly transacted via a platform they are incapable of regulating.

Felicity 36:22

Well, they did talk a lot about how they are interacting with social media platforms and making them remove things.

Paul 36:27

So it's But this is this is one of those stupid things that bureaucrats do and bureaucracies do, where they have two examples and I've actually been it's like it's like when they say, Oh, we've just we've just seen 600,000 cigarettes coming in from China. It's like, yeah, what about the 600 million that came last week? They use these particular examples to try and highlight actions when we all know it's virtual.

Felicity 36:51

Yeah, well, you know, talking about 13,000 actions they've taken is is not insignificant.

Paul 36:56

What letters written?

Felicity 36:57

Look, I'm I'm not gonna get too much. I I I can't talk verbatim when I don't want to actually, you know, do them a disservice by by saying what they did or they didn't do correctly. And you know, I I encourage you all to actually just listen to the the the testimony. My broader point here is that I am more concerned about the the pushing up and the the counterfactual to his a group and patients saying we need better access and timely access to medicines and we're informed and we know that there's something out there and we can't get it, i.e. like a current cancer treatment or a chronic disease treatment, or heaven forbid a you know a GLP one for you know our obesity. And the equally strong argument that's coming back in now is well, that's because you're being brainwashed because there's direct communic you know communications and patients shouldn't be asking for these things, and this is this is the big farmer, and that language was used trying to drum up business, and yet we've got this bigger problem, we shouldn't be spending all this money on the earth's flat and moon landing shouldn't happen too.

Paul 37:53

I mean that I mean that that's that's pretty much what the world that these people occupy. How can a member of the Liberal Party, a Senate, an elected representative of the Liberal Party, be against individual agency? Look, my how how can they be in favour of more regulation that that imposes more restrictions on someone's ability to access information about their health care. That to me is fundamentally contradictory.

Felicity 38:24

I don't do not disagree with you. I'm only reporting what I had to sit through and just say, where has that come from? That got more ed that got more time in in estimates than the actual access to medicines in the the the next day. And that to me is just the point I'm trying to raise, which is that when I sit there doing my work with patients and I look at what's going up on in the parliament and the information that's flowing through to them, individual patient issues, like with Senator Pocock, we can get good traction on, we can get good support. Like senators and members are aware and they'll individually advocate on the individual patient basis. This broader discussion that's going on, which relies on how the industry approaches this now and into you know in these coming few months, you're already seeing this this murky space and these contradictory um positions come forward. And if the industry itself is not strong, ambitious, and clear, then at the moment we'll be gone. And meanwhile, we patients will try and work out another way to get access to medicine.

Paul 39:28

I say regulate away, and let's see, let's see how that how effective that is. That'll be about as effective as the$90 million spin on the new be a bomb website. To me. Well, but but it's just it's a it's a ridiculous discussion. And that's that's the point I'm I'm I'm getting to. So I presume that Senator Antic opposes the publication of the ARTG.

Felicity 39:54

I suppose so. I don't know.

Paul 39:56

I guess my my point is that Well, who's the biggest provider of medicines information in Australia?

Felicity 40:01

Oh no, no, he was supportive of that because they said they only want Australians to have the authoritative information from the ARTG. That's all we should be able to.

Paul 40:08

But the ARTG is all company information.

Felicity 40:10

I know. I guess, like I said, it wasn't actually about that. What I'm trying to raise is that that when I'm listening from a policy level and an advocacy level and where patients sit in the middle of all this, I'm like my patients are losing out either way.

Paul 40:24

It surprises me because I would have thought COVID is an example of where so-called public experts and authorities prove themselves to be completely untrustworthy.

Felicity 40:36

Well, this senator was also very concerned about the insistence on um certain vaccinations and the misrepresentation of the hooping cough prevalence in Australia too.

Paul 40:46

So he's a RFK guy.

Felicity 40:48

Yeah.

Paul 40:50

Anyway, okay. Yeah. Well, as I say, I look forward to the TGA or the health department that in which the TGA resides. Well, Mike Butler, he was asked about this two weeks ago, and he said, Yeah, well, we can regulate this form of media, but we can't regulate this form of media. It's just not it's not practical, and it it just disappoints me that the the TGA become a cheer a cheer squad for such stupid ideas. That that, oh yes, we write to ISPs. It's like, really? Do you write to the ones who are promoting cholesterol, lower, and margarine? And that thing that helps your blood circulation that you sit on? Do you write do you write to those people? I mean, it's just crazy that the proven product, the product for which there is most evidence, everyone else is allowed to communicate about it. You know, I've held this view for a very long time because I understand that the internet has been around since 1991. And and it's it's ridiculous that we have to live in this claimed vacuum when in c in fact there's information all around. And again, it it is the public health public policy mindset that we're all too stupid to be able to take responsibility for ourselves.

Felicity 42:03

I agree, and like I said, um I'm in a very similar um area of support for you on this one, which is that inf information is important to patients and it's not a it's not a CMI health literacy, something more um substantial and good.

Paul 42:17

What is happening in the South Australian Liberal Party? Did you see that thing, their shadow health minister in South Australia had a go at pharmacy?

SPEAKER_01 42:25

Yeah.

Paul 42:26

What are you doing? I mean, I know they were speaking to the doctor crowd, so I don't know where they got carried away. But to see the pharmacy guild attacking a liberal health spokesman are you crazy? I've seen everything now. I mean, I I don't know whether I told you I went to a fundraiser many, many years ago. It was Tony when Tony Abbott was health minister. And it was actually in Canberra, it was just one of those classic fundraisers with the minister with like 12 people there, and the guild were well represented, of course. And Tony Abbott went, you know, you introduce everyone. Everyone introduces themselves, and Tony Abbott said you couldn't do this now because you'd be cancelled, but he said, I'd just like to acknowledge the traditional owners of Liberal Party of Australia, the pharmacy guild.

SPEAKER_01 43:17

It's very funny.

Felicity 43:26

And it's ridiculous. I mean, this is the future of healthcare. We're we've all moved on, we all understand that our pro the primary point of care these days is actually the pharmacist. The GP is the coordinator of our care and now a conduit between the pharmacist and the specialist. Like we we have changed the way we need to access. And the the importance of having, you know, and this is in particular for you know urinary tract infections, uh, which is something that, you know, women have to deal with a lot. And, you know, you wait, it always happens on the Saturday, and you've got to wait for three days and then you've got to do this, and it's It's a r it's actually couldn't be quite dangerous. But it was it was it was a shock. I I I don't I'm with you. I actually almost thought it was like could it be the first of April early? Is this like a fake news?

Paul 44:12

Yes, it was. I was qu I was really shocked by it as well. I would have thought doctors would have bigger problems than pharmacy taking their jobs. I I I think the government employed doctors who were taking their jobs are the problem, plus them wanted to reinterpret section fifty one of the Constitution and start capping fees. Exactly. I would have thought that's a much bigger problem than than pharmacists being able to dispense or or uh diagnose and prescribe a couple of things. Because nurse pre that nurse practitioner law is obviously going to go through the parliament, despite some very stupid amendments being proposed, uh including the Schedule Eight stuff. But but yeah, I was I I thought that was what is going on. And then you've got this guy doing the RFK junior.

Felicity 45:01

There was some very I thought Parliament Yeah, I mean he he he also went after the you know the pregnant people and pulled out a pregnancy test, you know, why can't I get pregnant?

Paul 45:13

Okay. Yeah. Did you see hey did you see Jane Hume, who's now the deputy leader of the Liberal Party, and the thing about condoms in the women's bathroom at Parliament? I sure did. She's quite funny because I I mean I followed her stuff on the desk, the$20,000 desk that's now in storage.

Felicity 45:31

Yes.

Paul 45:32

I don't know if you saw photos of it, it just looked like a going to IKEA. It looks like a schnumpflugli or whatever they call those things at ICAE.

Felicity 45:40

I love that you even know that there might be a name like that.

Paul 45:42

I've been to you know I went to IKEA once, but I actually went three times. No, it was many, many years ago, but I didn't I wanna I w I think I was buying a desk, but I didn't realise it was like five different boxes.

Felicity 45:54

Oh. So You get the box, go home, yeah.

Paul 45:59

There's another box, and then I went, oh, there's another box. And then I had to put the thing together.

Felicity 46:03

Yeah.

Paul 46:04

So anyway, so it was very funny, wasn't it, where she said there's there's condoms in the women's bathroom at the gym. But not in the men's.

Felicity 46:13

Not in the men's and then the the the department officials all the same responding and said, Yes, but isn't it great that you know women are taking control of of their social health? And she said, Well, how about the men do too?

Paul 46:26

It wasn't a great response by I think there was uh the minister, wasn't it? It was very funny.

Felicity 46:32

It is a weird thing, isn't it? I just love the conversation you have to have with your colleagues. So she's coming out of the gym, maybe it was to talk to Angus Taylor ahead of this week. And does it hey Angus? Don't take this the wrong way. But do you have condoms in your bathroom? I mean, that's the conversation.

Paul 46:47

That's a that's an awkward conversation. Well, I'm not gonna say because I don't want to be reported to HR.

Felicity 46:53

Exactly. But how did we decide to work it up? Because you know, it is that that absurdity of it, but um particularly Parliament House and all the recent history. Well, you're not allowed to do that up there anymore, remember? Malcolm Temple changed the rules.

Paul 47:06

Malcolm Temple speaking to infantilizing people. Anyway.

Felicity 47:10

So I I guess if you're heading out and I don't know what you do at the gym, but already.

Paul 47:14

Yeah, so uh look, it was uh interesting week.

SPEAKER_01 47:20

Yeah.

Paul 47:21

Uh I thought the Susan Lee's resignation from Parliament is a moment to reflect on her achievements as health minister. And she did she did have them. And it was the last ecosystem reform of the PBS. And so it's worth thinking about that and acknowledging it because often there's nothing more ex than an ex-health minister, and they tend to be forgotten pretty quickly. But I thought I thought she achieved a lot in her I think she was in it for two years.

Felicity 47:58

She did, and she did a lot in um you know, and um obviously she was in environment as well, too, and things. And she was I liked her because uh for many reasons. I think she's a very decent person.

Paul 48:09

She's a really nice person.

Felicity 48:10

And very principled. Her her issue about being can consumer focused, patient focused was was very genuine. And what I also loved, because I had the opportunity to work for both a um liberal minister and a national minister, and understanding that that difference of a of a liberal representative in a rural election.

Paul 48:31

Oh, the night the nat hated, Susan, because that was Tim Fisher's outside.

Felicity 48:35

Yeah, but I guess the reflection she gave me, which was the if I choose to live here and things, I can't make everything perfect and possible. That that is sometimes the horse trade, just like I don't have to do two hours sitting in George Street trying to get past a tram that's broken down again, and I have I don't have that problem when I I live in the you know the electorate of Farah. But I also understand that when I choose to live here, it cannot be the same standards of services all the time, and specialist services as I get elsewhere in in the main cities. And how how do we just it doesn't have to be perfect, but we need to get the balance a little bit better and we need to make it a little bit more affordable for and easier for people in rural and remote Australia to access that quality of care. And it was it was a good learning for me just because to as a as an official you're always trying to find the balance because people want everything and then people want to give nothing, and it was a a very good time for me to sort of say, Well, what is the experience and how much can we move it and and shift the dial a little bit? And you know, and she also really still does have a really wicked sense of humour, so you know.

Paul 49:45

She was uh yeah, she was always nice to talk to. She gave me a couple of lifts over the years too, which was nice. You know, you should be at an event and she said, Where are you going? I said, I'm going, yeah, I'll give you a lift. So that was that was very nice. So she was very a really nice, nice person, and we have to remember her achievements. I think she took the leadership at a really difficult time. And a lot of the stuff that's going inside the coalition now probably should have happened three years ago, and it didn't. And that was probably a mistake. But uh let's see what happens. Albury is a very nice town. Albury Donga. It's got to be. The two towns are very, really nice, and if if you haven't visited them, they're definitely worth a visit. If you drive into Melbourne, for example, it's always a good stop for a night in all in Albury, because the industry, the agriculture around there has done really, really well in in recent years. So yeah.

Felicity 50:39

Lovely place.

Paul 50:40

So I'm not quite sure how to introduce this subject, but you know I'm making some changes to m my websites.

Felicity 50:47

I do.

Paul 50:49

I'm not gonna describe them just yet, but I just want to let everyone know that in the next week or two uh there's gonna be some changes made.

Felicity 51:02

That's exciting. We should have a poll on what people think it's gonna be. That's what we should do. I want to do that.

Paul 51:07

We're gonna introduce the Bassett section.

Felicity 51:09

I'll put a survey monkey to monkey out. People can vote for what they think is coming. I think we should.

Paul 51:14

Well, I I I think it's gonna be pretty cool. It's just in a beta testing phase at the moment, but it's going to greatly enhance the utility of the site for people. And I'm looking forward to that. And there'll be some visual changes, and that that I'm quite I'm quite excited about it. It hasn't been cheap. But but uh and when I say it hasn't been cheap, I'm say it's been very expensive. But but it's something that I've always tried to do is to invest in the platform to make it better for the users. And that that's the principle that's at play here. So keep an eye out, everyone. It might happen sooner than we expect, but uh, you know, it's an IT project.

Felicity 52:15

Yeah, on time, on budget against specified objectives. There's my gateway years coming into. No, it's very exciting. I've I've had you talk a little about it. I've said nothing to anyone, but um I I think your listeners should be and your readership should be um very excited to see what's coming. But I say, I'll put out the you've got to vote on what you think it might actually be. And it's not a dedicated F1 site for me that you can link to the dedicated site to my dogs.

Paul 52:45

You are not asleep. Uh Felicity, thank you. Uh thanks to all the listeners. We really like the feedback. Drop us a review or any questions or suggestions. Happy to take them on board or at least consider them. Um, but thanks, thanks for the for the feedback. We really do appreciate it. And uh we look forward to speaking to everyone next week.

Felicity 53:10

Thanks for watching. Thanks, Paul.