Abstract
DEAR SIR
I was intrigued by Kausar and Safraz's claim that some Australian psychiatrists are being dishonest, in the interests of their patients, by misrepresenting the diagnosis of patients for whom they write authority prescriptions of atypical antipsychotics, in the belief that these drugs are the best and most appropriate treatment. 1 I was equally intrigued by Dr Lyndon's response, in which he clearly and correctly enunciates the facts concerning the regulation of access of these drugs 2 but, coincidentally, avoids the point at issue.
The point is that a large body of opinion supports the clinical practice documented by Kausar and Safraz and at least some Fellows are aggrieved that this use is unauthorized under the Pharmaceutical Benefits Scheme. Certainly, the wealthy can afford to pay full price for these drugs. But such luxuries are beyond the reach of the chronically mentally ill. There is no equity in this.
The rules governing the Pharmaceutical Benefits Advisory Committee (PBAC) were drawn up many years ago. They need revision. Realistically, drug companies are not going to spend the resources needed to obtain PBAC approval for uses that represent only niche markets. Also, the type of evidence the PBAC needs would be extremely difficult to obtain with many of the uses being envisaged. Indeed, the relevance to much of clinical practice of the — very narrow based — studies on which the PBAC relies, could be seriously questioned.
We are supposed to be interested in the welfare, and to promote the well-being, of those who suffer from mental illness. We should be working to ensure that they have access to the best possible treatments, at a cost that they can afford. Rather than a politically correct, reactive response to this issue, I would hope that this College (and other sister Colleges in which the members must experience the same types of frustration and behave dishonestly in the same way as some psychiatrists do) would take a positive, proactive stance and demand reform of the system.