Doorstop Interview, Dr Mukesh Haikerwal: Voltaren, Private Operators of Public hospitals, Dr Suicides, Gold Card, Stem Cells

DR HAIKERWAL: The AMA certainly have problems about the availability of these groups of drugs - the anti-inflammatories - being available over the counter. This whole group of tablets have had problems associated with them. The problems include sore tummy and bleeding ulcers and so on. They also include damage to the kidneys.

But what we're hearing about today is an increased risk, or concerned risk about the blood being a bit more sticky. When the blood's a bit more sticky due to these tablets it causes an increased risk of heart-attack and an increased risk of stroke.

The increase of these is obviously more of a problem in people who have pre-existing heart disease, cholesterol problems, blood pressure and it's important that if they have a concern, they discuss that with their doctor.

Obviously the discussion is had at the time of prescribing and the discussion is had each time the medicine is reviewed for further treatment. We use this medication short-term when people have had a sporting injury or back pain and so on.

But of course it's used by significant numbers of people in Australia for chronic pain of arthritis. It's a very useful drug, because it reduces swelling and reduces pain.

But each time that we use these drugs, we have to understand there is a risk, and we've got to weigh up the risks with the benefits and that's a decision and discussion that's had each time.

Now the background risk, the risk that people face from the increased risk of heart-attack from these drugs is really quite small - maybe one or two per cent. And so the increased risk of this particular drug shown in this study, an increase of 40%, isn't an increase of 40% across the board. This is a risk of around one per cent extra.

So the risk of using Voltaren, or diclofenac, is not significant, but it's enough to have that discussion about whether to keep taking it, whether to substitute it for a different tablet or whether indeed it's actually safe to keep going with.

REPORTER: Where did the 40% come from then?

REPORTER: The TGA is looking at the situation at the moment, what's the likelihood of a recall, of a global recall or one in Australia?

DR HAIKERWAL: Certainly the FDA in the US hasn't put anything up today on their site and the TGA has got this ongoing investigation going on around the anti-inflammatory drugs.

The anti-inflammatory drugs included this group, non-steroidal anti-inflammatories including diclofenac and the COX-2s which include Vioxx, which of course was withdrawn, Celebrex which continues and Mobic.

So there are drugs there that are under the TGA's scrutiny. I don't think we need to get too concerned about it. There are very good, safe pain relievers that are out there, but we've got to put it into perspective.

If there is a pre-existing heart problem, or a pre-existing worry, then obviously we don't prescribe it or we prescribe it under great care. If there aren't those problems pre-existing, then we can continue to use the medications as is, obviously reviewing regularly and making sure the people aren't running into those problems - the problems including gut ache, bleeding and indeed heart problems.

REPORTER: Have there problems with things like that before?

REPORTER: Can you clarify the 40% please?

DR HAIKERWAL: Yes. The issue of 40% is very much from the study that was done. The study reviewed a whole heap of different studies out there from around the globe and it's showing that there may be a risk due to using Voltaren which increases somebody's risk of heart disease or stroke.

But that risk for an individual is not huge because it's already on a small risk. So people start off with a small risk of heart-attack or stroke anyway and by taking this medication it only increases the risk a very small amount.

REPORTER: Sorry, have there been concerns with it before?

DR HAIKERWAL: There are ongoing concerns with all these groups of tablets and in fact the product information captures that in the way in which the information sheet in the packets are actually written.

If you look on the various websites, there are warnings about the gut problems, about the kidney problems, about problems with asthmatics and indeed the problems of increased risk of heart-attack and stroke because there is a risk of the blood getting stickier and therefore causing all of those strokes and heart-attacks.

REPORTER: Can you confirm that the Voltaren gel or the ointment is not, is not something to be concerned about?

DR HAIKERWAL: Well there is a theoretical risk of increasing levels of diclofenac in the blood from skin absorption, but obviously the dose is very small compared to an oral dose.

Therefore the doses that we use are as small as possible to maintain the maximal impact of pain relief, but you know there is a limited amount of absorption from the skin from an ointment.

REPORTER: Is it overreacting to talk about pulling anything with diclofenac including Voltaren from the market?

DR HAIKERWAL: It is a real overreaction. Voltaren, diclofenac has been in use for 20 plus years and it's one of the widest used anti-inflammatory drug in the world and used wisely, and used with good review and used at the minimum possible dose, it's a very good thing to continue to use if it helps your pain.

And people shouldn't get worried about it, but if they're concerned by this discussion, they should certainly have that discussion with their own doctor to put it into their own context.

You know, somebody that's pulled their back, who hasn't got a heart problem, it's not an issue. Somebody that's got rheumatoid arthritis with pre-existing heart disease may need to think twice about it.

REPORTER: Would you recommend an alternative?

DR HAIKERWAL: There are alternatives out there and it's important that that discussion is had again, based with the doctor's discussion with the patient because some things would be relevant and some things won't be for that person's individual needs.

REPORTER: Just on the issue of public hospitals and their administration, does the AMA have a position on whether or not they should be privatised?

DR HAIKERWAL: Oh look the public hospital system is a public hospital system. The discussion that we've seen overnight about having private people running the public hospital system I think is a bit of a side-show.

I think our public hospital system is currently grossly under-funded, not just for the ongoing functions of doing operations and seeing people that are unwell and looking after them, but also the infrastructure, the equipment and of course the personnel are under-resourced.

We need to make sure that if we're talking about the hospital functions, we've got to make sure that we get the right numbers of beds there to increase capacity and that we put the right number of people to look after people -- the population that comes into the hospitals.

REPORTER: The Opposition says that the Government is purely, or Mr Abbott is purely looking to profit at the patient's expense. What are your views on that?

DR HAIKERWAL: I don't think the motive is one of profit or anything to do with the patient's expense. The motive here is to say well, if you've put in a private management structure into a public hospital sector you'll get efficiencies.

You've actually got to fund the hospitals properly to get them to work first of all before you can even contemplate going down the road of privatising and saying you're going to turn a profit or turn any benefits from this sort of system.

REPORTER: So does Tony Abbott have a point that perhaps these hospitals will run more efficiently and waiting lists will be reduced as a result of private management?

DR HAIKERWAL: I think we have to look at the examples here in Victoria for instance of Latrobe Valley, of Mildura and indeed Werribee Mercy, they aren't exactly a bed of roses. So just by having a privatised scheme or just by having a charity running the hospital isn't going to resolve the underlying chronic under-funding and lack of capacity in the system.

REPORTER: What about stem cell research, can we move onto that? The Prime Minister is meeting a number of experts today, where do you think the - how do you think the debate is going? Has it reached an even level?

DR HAIKERWAL: No, look I think the debate around stem cells is really one that needs to really go through this learning process. I think that's what the Parliament is doing currently. They've had a group of people through yesterday, they've got another group of people through today.

What they need to do, is to understand the science and understand what's going on rather than go on knee-jerk reactions and on emotion. I think once people consider those various options, they will be able to make a good and reasonable choice.

REPORTER: So would you like to see a broader research?

DR HAIKERWAL: Research is there. Papers have been produced. The Lockhart Report is also one of the papers that has been put out there and that's what's being discussed.

I think what we need to do is to get the leaders in the field to be guiding our politicians, indeed the community in this discussion and indeed the Victorian Government and the Queensland Government have got a role here because they are very much protagonists for this.

To be able to lead the community to understand what it is that's being proposed, why it could be of benefit, what the pitfalls are and how they'll prevent those pitfalls from becoming reality.

REPORTER: Isn't it crucial then or do you think as some say, that it's offering false hope of breakthroughs?

DR HAIKERWAL: It's very early in the state of knowledge around stem cells to say whether it's going to be a great breakthrough or not. People say this is false hope, well if it turns out not to be a reasonable hope, then it is false.

But if there is some hope there, then maybe that's a discussion we have to have. Is it the sort of hope that we want to be able to give people and follow through on or is it not?

So this is where the discussion needs to be based on what the science is, based on leading the community to understand what's going before the community then holds a discussion, before society makes a commitment to say, yes we think this is the right way to go, or no, we don't want to go there because these are the dangers.

REPORTER: Do you think that's happening or do you think there are extremes on, there's extremes coming out?

DR HAIKERWAL: We see with any debates around reproductive health, whether it's IVF in the past 20 odd years ago or whether it's around contraceptives and the morning after pill or whether we're talking about the RU406 discussion, there are always extreme views on both sides.

People are very entitled to have their view and to hold to it, but at the end of the day, the community needs to understand what the pros and cons of each of these concepts are and then be lead and guided into a decision made by the Parliament hearings, based on facts, not emotions.

REPORTER: Just on Voltaren once more, it has been known to be the footballers' friend. Could it now be a friend and a foe at the same time?

DR HAIKERWAL: Oh used in short courses for things like strains after footballing injuries and other sporting injuries it's still a very useful group of drugs, the anti-inflammatories, of which Voltaren is one of the biggest selling world-wide.

I think we need to be careful about long term use and we need to be careful about the sizes of the dosing that we have. If we are using these sorts of medications, it's a very difficult decision to make based on the pros and the cons, you've got to balance those up and make sure that people are comfortable and also monitored.

REPORTER: Can I ask you about the $600 million commitment to veterans' health care? What are your thoughts on that?

DR HAIKERWAL: Veterans have a Gold Card Scheme which gives them good health care services based on the significant contribution they've made by putting their lives on the line in the service of the country.

The Veterans Scheme, the Gold Card Scheme is falling way behind in terms of the benefits it offered veterans. This is a significant injection by Minister Billson, the Veterans Affairs Minister and the Prime Minister to ensuring that veterans have good access to health care services during the course of any illness they may have.

REPORTER: Just with the Voltaren, surely it's a blow to the thousands of people who got off Vioxx and were referred to Voltaren?

DR HAIKERWAL: Obviously people change their medications based on what their needs are and what's available out there and if they've moved from one tablet to another they may well have to move yet again.

That's what keeping up to pace with the science is all about and that's what keeping up to speed with new research is all about. If we find ways of doing things and keeping people safe, that's what we need to do.

REPORTER: Are you happy with Minister Billson's $600 million commitment? Is that enough?

DR HAIKERWAL: This is a significant step by Minister Billson to improve the health of Veterans across the country. We hope this will increase their access and there is a significant commitment by Government in this area.

Obviously there will be a need to look at things like indexation so that we don't fall back behind the eight ball in due course, but I think this is a very significant contribution.

REPORTER: Just on another issue again, this media report this morning focusing on the two suicides of young doctors - can you, do you think that's a problem and are hospitals doing enough to cut the hours they're working?

DR HAIKERWAL: The tragic suicide of two of our younger colleagues is an example of a stress that doctors in training face on a daily basis and it's important that they have ways of dealing with that.

In Victoria there's a Victorian Doctors Health Program which is very, very much a caring way of dealing with these sorts of issues that people might have.

Despite the AMA's safe working campaign and the AMA's safe rostering campaign, there continue to be exorbitant numbers of hours worked by doctors in the health care system and that's wrong.

We need to make sure we bring to book the authorities, the hospitals that make people work long hours and often unrostered and unpaid overtime.

I think it's important that we look at the problems of suicide, which is a significant problem in the medical community and certainly that's what we're doing is to see how we can take, stop this being a problem within our community.

REPORTER: It seems terrible to me to have a doctors' shortage, but then also a system that sees them commit suicide as well.

DR HAIKERWAL: Obviously the suicide of anybody in the caring professions is something we need to avoid, they need to have support in what's a very stressful, a very emotionally taxing career, so they get support so they don't feel that that's the only recourse that they have.

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