Interview with Jon Faine, ABC 774 3LO, Thursday 24 May 2001
Discussion - Dr Phelps responds to comments made by the Federal Health Minister about her qualifications and comments about cholesterol-lowering statins; moves to treat high cholesterol levels more aggressively; clinical decisions about patients being dictated by economics; poor relations between the Health Minister and the AMA; the AMA's independence from govt; reports that Federal Health Minister Michael Wooldridge may be seeking a new portfolio; replay of Dr Michael Wooldridge, Federal Health Minister (recorded early today)
FAINE: Earlier today, we heard on talkback from Frank in Seymour, who complained at what he understood to be a decision that was taken before and confirmed in the Budget by the Federal Government to make it more difficult for people in his situation, who he described as being dependent on a cholesterol-lowering medication, to continue to receive a Federal Government subsidy for the cost of that drug.
Frank told us about his cholesterol level and how even though he exercised and wasn't overweight and doesn't smoke, he still had too high a cholesterol reading and his doctor had put him on to a drug which lowered his cholesterol and the Federal Government subsidised it. It's called statins. And he wasn't happy that the subsidy was being withdrawn.
We got Dr Michael Wooldridge to speak to us about this issue and on the program earlier this morning he said that he thought Frank has got his wires crossed. And Frank and Dr Wooldridge engaged in a lively exchange.
Part of it involved Frank saying that he was relying for his concerns on information that had been put out into the public domain by the President of the AMA, Dr Kerryn Phelps.
Dr Phelps, good morning to you.
DR KERRYN PHELPS: Good morning, Jon.
FAINE: I'm not sure whether you've heard this yet or not, but here's what was said on this program earlier today about you by the Federal Health Minister, Dr Michael Wooldridge.
[Recording] DR MICHAEL WOOLDRIDGE: The majority of medical opinion is not with Dr Phelps, whose only qualification is in the media, not in any sort of specialist medical area. She is wrong on this. I was reading out of the book from the Pharmaceutical Benefits Advisory Committee, which is an independent expert scientific committee. In the end…
FAINE: Dr Wooldridge, I think Dr Kerryn Phelps does have qualifications in medicine as well as being a very persuasive media performer, as you are yourself. I think we should clear that up. She is a real doctor.
WOOLDRIDGE: Well, I'm making … yes, she is a doctor…
WOOLDRIDGE: …but she's wrong on this, she's dead wrong and- -
FAINE: What, you mean she disagrees with you on this?
WOOLDRIDGE: No, she disagrees with an independent scientific expert committee and she is spreading dangerous information that will worry people unnecessarily and she should be condemned for it [End recording]
FAINE: Dr Kerryn Phelps, that was Dr Michael Wooldridge, the Health Minister, talking about you on this program a short while ago.
I'm reluctant for the ABC to cop a writ over this. If Dr Wooldridge wants one, that's his business. But let's be absolutely clear on this, you are a fully qualified medical doctor?
PHELPS: Yes. My speciality is general practice, so I'm dealing with people who are concerned about their risk of heart disease every single day of the week.
FAINE: And your reaction then to what Dr Wooldridge said about you?
PHELPS: I think his comments are lamentable and my immediate reaction - which is already underway - is that I've referred his comments to my lawyers.
FAINE: Are you going to sue?
PHELPS: We are going to demand an apology and if an apology is not forthcoming we will take the next step.
This is unacceptable behaviour for a government minister and I think he would be much better placed to not be making personal attacks but to actually do something positive for the health system.
And this sort of commenting about an individual who is representing an association and representing the medical profession inn this country is very regrettable.
FAINE: At one level, yes, it's a spat between you and him personally. At another level though, is not Dr Wooldridge also passing comment on GPs as specialists, in that a general practitioner now is regarded as someone who specialised in general practice?
PHELPS: Yes, that's right. I actually sat my Fellowship exams in 1997; I didn't have to. I was grandfathered into vocational registration many years ago, but I felt that I wanted to upgrade my qualifications in the method that the young doctors coming through now have to do and I did the full exam program in '97 and attained my Fellowship, which is a specialist qualification.
FAINE: So is it a slur on GPs, who are specialist GPs, rather than just someone with nothing other than the basic qualification?
PHELPS: I think that doctors in training have the basic qualification and then they stream into various specialities, whether that be general practice or surgery, or internal medicine, psychiatry, dermatology and so forth. So I…
FAINE: Yes. He also says that you're spreading dangerous information and he says that point blank, on a point of medical treatment, you're wrong.
PHELPS: I think the information is only dangerous to the Government, frankly. I think it's certainly not dangerous for patients, who need to be aware that high levels of cholesterol do contribute to heart disease and that there is medication which is available, in conjunction of course with life style modifications, which will help to reduce statins.
Interestingly, the PBAC recommendations in the Pharmaceutical Benefits Scheme are in fact a bit behind the game in terms of when international thinking is on cholesterol-lowering and if you look at the recent National Institutes of Health Position statement on cholesterol-lowering, they actually recommend far more aggressive treatment of high cholesterol in order to reduce the toll from heart disease, which is the biggest killer in this country.
FAINE: Well, that's your response, but I must say there's a certain common sense and some strength to what Dr Wooldridge says. If I've got to choose between a GP, even one who's gone through the College of GPs procedure, and a specialist body, wouldn't most of us trust the specialist rather than the GP first?
PHELPS: Yes. But you're talking about a political body, not an independent medical body. An independent medical body like the Hearth Foundation, or the National Institutes of Health in the United States, are the ones who are looking at … you know, let's talk to the cardiologists, what are they saying about cholesterol-lowering? And what they're saying is that, yes, diet and lifestyle are extremely important, but where a patient needs a statin and, in fact, the threshold for putting people on statins has been lowered, not raised, as the government is doing with this budget move.
If we are looking at independent cardiological opinion from around the world, they are putting people on statins at much lower levels of cholesterol and treating people much more aggressively who have high cholesterol levels.
FAINE: All right. There's a bigger issue at stake here then than just another boil-over between you and Michael Wooldridge, or the AMA and the Government, lifting it above the personal, and that is whether or not the treatment of patients in Australia for a medical condition is in some way being dictated by economic decisions taken in the context of the budget.
PHELPS: That, I think, encapsulates our entire point, that clinical decisions based on what is best for the patient are being affected by political and economic imperatives.
And you have to bear in mind that the committees that recommend to the government about what should be subsidised are … always have to balance economic realities and economic imperatives and political imperatives with clinical data. And what I'm talking about is what the clinicians of this world are saying about cholesterol and cholesterol-lowering drugs, not what a committee which has to bear in mind expenditure is also thinking.
And it's only expenditure for this budget cycle. We're not talking about the expenditure on people who may well develop heart disease because they were not treated aggressively for their cholesterol problem 10 or 20 years down the track.
FAINE: Dr Phelps, this must represent a new low in relations between the Health Minister and the AMA, this personal attack on you by the Health Minister. Does it make it hard for the AMA, for you to work with him in future?
PHELPS: Well, the Minister has indicated quite clearly that he's not interested in working with any group that criticises him in any way and, in fact, we have steadfastly attempted not to make any personal criticisms of the Minister whatsoever but to concentrate entirely on policy. We much prefer to play the game and in the most appropriate and upfront way and that is to look at the issues and to comment upon the issues in a constructive way based on what is best for the health of Australians.
FAINE: But he's questioned your credibility as a medical specialist, as a doctor. He's questioned your judgment. He's said you're plain wrong. He says you're spreading damaging information.
PHELPS: Well, unfortunately, I think the Minister has probably picked on the wrong person to make that sort of personal attack.
FAINE: But where do you go from here working with the Federal Government?
PHELPS: We work with the Federal Government, but around and above Dr Wooldridge, because he really … he doesn't like to deal with groups that don't agree with him, or who actually make any sort of criticisms of him. And that's fairly well known.
And the AMA, of course, is an independent voice for Australia's doctors and will not just tell the Minister what he wants to hear. We are financially independent of government and we are philosophically independent of party politics and I think sometimes for politicians that's a very confusing mixture.
FAINE: When you say he's picked on the wrong person, why are you the wrong person, you're the Federal President of the AMA?
PHELPS: I'm not going to take it lying down.
FAINE: You're going to sue him, is that what you're saying.
PHELPS: I've already referred it to my lawyers and I will be expecting an apology by the end of the working day and if I don't have that apology, then the lawyers will have taken instructions.
FAINE: Well, I suppose that does represent a new low then in relations between the AMA and the Federal Government.
I then went on after discussing statins and cholesterol drugs with Dr Wooldridge to ask him whether he was sick of being the Health Minister. There were some reports of some suggestions that came from his office that he was looking for a new portfolio if the Howard Government were returned to office.
Do you want to comment on that?
PHELPS: Well, there are very strong indications that Dr Wooldridge is not going to be the Health Minister after the next election whatever the result and I think for many medical practitioners that can't come soon enough.
FAINE: Who would you prefer to have as a Health Minister if the Liberal Party are returned to office?
PHELPS: I think that's an internal matter for the Liberal Party and for the Coalition. I would be, you know, very happy to make comments along those lines once the Minister has announced that he's not going to continue as Health Minister. But I think it will depend on who is interested and qualified to take on that role.
FAINE: Thank you for your time this morning.
PHELPS: Thank you, Jon.
FAINE: And I hope … I mean, I'm wary and protective of the role of the ABC in this. If there's a matter between you and Dr Wooldridge that arose from this program, we certainly don't want to be the meat in the sandwich.
PHELPS: I heard what you had to say and I think that you took steps to modify the comments very substantially and I thank you for that.
FAINE: Dr Kerryn Phelps, the Federal President of the AMA, responding to Dr Michael Woodridge, the Federal Health Minister, on this program about an hour or so ago.