Evan Doran

Disease Mongering Is Now Part of the Global Health Debate

Ray Moynihan and colleagues, who organized the worlds first international conference on disease mongering in 2006, discuss its subsequent impact.

Patient co-payments and use of prescription medicines

Objective: To investigate how prescription co‐payments influence the medicine use of Australian patients.

Disease mongering: expanding the boundaries of treatable disease

Traditionally, the promotional activities of medical industries have been product specific. In recent years, however, there have been examples where companies have worked through partnerships, which have included clinicians, to expand the boundaries of treatable disorders. The main motivation appears to be to increase sales of commercial products. The term ‘disease mongering’ has been applied to these activities. Whereas some disease awareness programmes may bring benefits in the form of improved recognition and management of disorders, the presence of strong commercial interests probably distorts the traditional processes by which treatable diseases have been defined. This can result in individual patients being exposed to potential harms, with little expectation of benefit and will place an unwarranted burden on the publicly funded health‐care system. None of this can happen without the collaboration of the medical profession that needs to be aware of the risks of becoming involved in commercially supported ‘consensus’ groups that are reviewing the definition and management of diseases.

Attitudes of physicians and public to pharmaceutical industry ‘gifts’

Background: Few studies have reported the attitudes of both individual doctors and members of the public toward the appropriateness of ‘gifts’ from pharmaceutical companies.

Australian Pharmaceutical Policy: Price Control, Equity, and Drug Innovation in Australia

This paper outlines the increasing salience of drug “innovation” in the debate for reform of Australias pharmaceutical policy, particularly change to Australias price control mechanisms. The pharmaceutical industry has consistently criticised the central role of price control in Australias pharmaceutical regulatory regime as an impediment to drug innovation and industry growth. Despite ambivalent or contrary evidence on the impact of price control on drug innovation, this criticism, and the appeals for reform it supports, appear to be increasingly influential in directing pharmaceutical policy. This is particularly evident in the implementation of the Australia/United States Free Trade Agreement, which has led to a weakening of the historical process of evidence-based reference pricing in Australia. Should drug innovation come to dominate Australian pharmaceutical policy, there is the potential to precipitate a devaluing of the current public orientation of regulation and diminish equitable access to affordable pharmaceuticals. The manner in which trade policy has effectively undermined a publicly funded pharmaceutical benefits scheme has clear implications for many countries that maintain such programmes.

Dilemmas in the compassionate supply of investigational cancer drugs

In Australia, patients who want to access medicines that are not yet approved have only two options: to enrol in a clinical trial if they are eligible, or obtain their medicine through ‘compassionate supply’, which is provided at the discretion of the manufacturer. In this article, we explore ethical issues associated with the provision of oncology medicines that are still in development, either prior to regulatory approval or government reimbursement.

The affordability of prescription medicines in Australia: Are copayments and safety net thresholds too high?

OBJECTIVE To create and report survey-based indicators of the affordability of prescription medicines for patients in Australia. METHOD A cross-sectional study of 1502 randomly selected participants in the Hunter Region of NSW, were interviewed by telephone. MAIN OUTCOME MEASURE The self-reported financial burden of obtaining prescription medicines. RESULTS Data collection was completed with a response rate of 59.0%. Participants who had received and filled at least one prescription medicine in the previous 3 months, and eligible for analysis (n=952), were asked to self-report the level of financial burden from obtaining these medicines. Extreme and heavy financial burdens were reported by 2.1% and 6.8% of participants, respectively. A moderate level of burden was experienced by a further 19.5%. Low burden was recorded for participants who said that their prescription medicines presented either a slight burden (29.0%) or were no burden at all (42.6%). CONCLUSION A substantial minority of participants who had obtained prescription medicines in the 3 months prior to survey experienced a level of financial burden from the cost of these medicines that was reported as being moderate to extreme.

Part of the fabric and mostly right: an ethnography of ethics in clinical practice.

Objectives: To describe how ethics is practised in a health care setting, and to ascertain whether there was interest in establishing clinical ethics support services.

Pharmaceutical benefits scheme policy: confused and tough on patients.

The 2005–2006 Commonwealth Budget contained several measures that are likely to have an effect on the availability and affordability of prescription medicines. For the second time in 2005, patients were asked to pay more for the medicines that their doctors prescribe for them. In January 2005, the Federal Government, with the acquiescence of the Labour Party, increased prescription copayment for general users to a maximum of

Mixed method integrative review exploring nurses’ recognition and response to unsafe practice

28.60. The 2005–2006 budget raised the safety net eligibility threshold by an additional two prescriptions (52 to 54). General patients and/or their families have to spend