Dr Kerryn Phelps, AMA President with Leon Byner, Radio 5AA

PHELPS: Good morning Leon.

BYNER: What do you think of this scheme where doctors will be financially rewarded for prescribing fewer or generic drugs?

PHELPS: Oh I think it's important to point out that it's not doctors themselves who are proposed to benefit from this particular scheme - it's the Divisions of General Practice which is an umbrella organisation that is community-based - and I think that we would need to see whether there was any evidence that a scheme like this had any benefit to patient care. At this stage I don't believe that that's been demonstrated.

BYNER: Do you believe that generic drugs, in general, are as good as other brands that are prescribed?

PHELPS: Not necessarily so, and not necessarily the other way. Unfortunately there is not always exact comparison between a generic and a brand name and I think it's important if people are stabilised on a particular medication that they are able to maintain themselves on that particular medication - and particularly for people who are elderly and on a number of different types of drugs - we need to avoid confusion also if people are accustomed to taking a pill of a particular size and shape on a particular time of day.

This is especially important where people are on multiple drugs - they might be on five or six different medications - I think it's important that they are familiar with their medication, that they're on the medication that is best for them, not the one that's cheapest.

BYNER: So Kerryn where do we sit with this now? I mean is this going to, I mean, my view is because my pharmacist told me that generic drugs are okay but of course it depends on the ones you pick as you've just said. Knowing this, does this not compromise the effective care between a doctor and a patient - giving a financial incentive if you like, albeit not directly but indirectly - to prescribe less or generic?

PHELPS: Yes I mean our belief is that the relationship between the doctor and the patient must take precedence and the doctor can really only do what they believe is in the best interests of the patient.

We obviously bear in mind, not only the cost to the patient, but to the system, of any decisions that we make, and if we can be, have it demonstrated to us by evidence that a less expensive alternative is better for a patient, then doctors are the first to embrace that change. But to simply impose a change on the basis of a budget bottom line, is not something that I think my colleagues would accept.

BYNER: Alright. So what do you suggest the public do about this?

PHELPS: I think the public need to contact their local members of parliament and let them know how they feel about it. They need to talk to their doctors about how any changes of this nature might affect them. I think it's important that people regularly review their medications and to see whether there are any non-drug alternatives or just as effective, less expensive alternatives for them.

But if the medication that is best for them is more expensive, I think that people who are sick, who are disadvantaged in our community must have the safety net of the Pharmaceutical Benefits Scheme.

BYNER: Are doctors over prescribing?

PHELPS: Look I think doctors have had enough of being scapegoated for the blow out in the Pharmaceutical Benefits Scheme, and using the word 'over prescribing' is really scapegoating doctors.

There are lots of different reasons why the PBS has blown out. If you just look at last year, there was a 19 per cent increase - most of that was in two drugs that were heavily marketed by pharmaceutical companies - that is Celebrex and Zyban - Celebrex for arthritis, Zyban for quitting smoking.

Now there was an enormous peak in activity of prescribing of Zyban because patients were demanding it, because they'd heard about it, because of all the hype that was generated by the pharmaceutical company.

So if we can make sure that doctors are first and foremost informed of the evidence about medications and their appropriate place in prescribing, then we do what believe is in the patient's best interests.

But I think we also need to look at the generation of demand for these so-called trendy drugs and make sure that they are as effective as their hype makes out.

BYNER: So really, in a sense, this is very perverse Kerryn, because what we're saying also is that the policy where drug companies can go direct to the public and advertise - cutting out the middle man - and then they go and demand it from the doctor, where he or she's in a more I suppose favourable position to prescribe it because the patient demands it, that policy in itself has been partly responsible for the blow out.

PHELPS: question, and I think that's one area that we can certainly look at in terms of reducing unrealistic demands for medication. Obviously people are looking for hope that a medication will help them better than the drug that they're currently taking or better than the measures that they're currently taking to relieve their distress or their disease problem.

But if that evidence is not there, then I think it's important that doctors are able to say to people 'look I don't believe that this more expensive medication or this change of your medication is in your best interest', but the doctors have to have that information first before there is any marketing direct to consumers.

BYNER: Alright. What's the AMA's next move now?

PHELPS: Well we've put a position paper to government. They're well aware of our concerns. I think that we'll really continue to state what we believe should happen, and that is that the government needs to sit down with the medical profession and work out what - on an evidence basis - is an appropriate way to manage the blow out in costs of the Pharmaceutical Benefits Scheme.

We're very happy to work constructively with government on this. I think that the Australian people need to have a say in it, and I think that we need to really look at the broader issues here.

And, for example, we're not just looking at what's good for this year's bottom line. We're looking at savings, by keeping people well, over maybe the next couple of decades. If we can prevent a stroke, prevent heart disease, prevent illnesses currently preventable - not only by medication but by non-medication means - we'll do all that we can to achieve that. But the Pharmaceutical Benefits Scheme should be there as a partner supporting that end, and I don't want for the medical profession to have to be fighting the government on expenditure for what is a very valuable scheme.

BYNER: Kerryn thanks for joining us this morning. That's the Federal President of the AMA, Kerryn Phelps.

Ends