18th Parliament · 2nd Session
The President (Senator the Hon. Gordon Brown) took the chair at 3 p.m., and read prayers.
page 1348
SenatorCRITCHLEY. - Can the Minister for Shipping and Fuel inform the Senate whether the report that major oil companies are pressing for an increase of the retail price of petrol is true? If so, and if the price increase is granted, will the Government consider offsetting the increase by means of an equivalent reduction of the petrol tax?
– I have read in the press that representations have been made to secure an increase of the price of petrol. As the honorable senator knows, prices control is now in the hands of the States. I do not think that the application for the increase has been successful yet, nor do I think that this Government will give consideration at present to any suggestion that a price increase should be offset by means of » reduction of petrol tax.
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– Will the PostmasterGeneral ascertain whether it is true, as reported in the Brisbane Sunday Mail of the 13th March, that the Labour party’s broadcasting station in Queensland, 4KQ, has announced that it will not accept advertising or propaganda material from other political bodies, and that it has made the announcement since the passing of the Australian Broadcasting Control Act which was to provide for equality of broadcasting opportunity?
– I have no knowledge of the report mentioned by the honorable senator, but if she will place the question on the notice-paper I shall make detailed inquiries and supply her with all relevant information.
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– On the 9th March, Senator Devlin asked the following questions : -
The answer to the honorable senator’s questions is as follows : -
The number of telephones installed in Victoria during the year ended the 3 let December, 1948, was 27,250. In common with the practice observed by other telephone administrations, a system has been adopted in Australia tinder which priority is allocated to applica tions for telephone services according to the extent to which the facilities are required in the interests of the community generally. Precedence is given to requests for services for essential organizations, such as government departments, public undertakings and medical, ambulance and hospital services. A measure of preference is extended to applications from ex-servicemen where the service is required for business purposes, and to cases where the facilities are needed because of serious illness or pregnancy.
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Assent to the following bills reported : -
Income Tax Bill 1949. Social Services Contribution Bill 1949. Entertainments Tax Bill 1949. Entertainments Tax Assessment Bill 1949.
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Transport Officers
– I preface a question to the Minister for Shipping and Fuel by reminding him that each House of the Parliament has a transport officer who arranges the transport of luggage on behalf of members and senators. The previous Senate transport officer had a utility truck that he used for this purpose. I understand that the House of Representatives transport officer uses his own motor car. Will the Minister consider the desirability of providing each of those officers with a utility truck to enable him to carry out his duties efficiently, particularly as the membership of the Parliament is to be increased in the near future?
– The transport of senators’ luggage comes within the province of the Usher of the Black Rod. I shall be glad to take the matter up with that officer, and to ascertain whether it is possible to improve this service. The transport of luggage of members of the House of Representatives is a matter entirely for that House, and I do not consider that it would be proper for me to make any representations in that connexion.
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– Has the attention of the Acting Attorney-General been drawn to the press report of a speech made yesterday by Mr. Justice Owen Dixon of the High Court of Australia,
In which he described members of the Federal Legislature, with the exception of the Leader of the Opposition in the House of Representatives, as either fools or seekers of publicity? Does the Minister not consider that this slur on the elected representatives of the people is an abuse by the learned justice of his high office? Will the Minister ask the Chief Justice of the High Court publicly to dissociate that institution from this outrageous attack by one of its members on the parliamentary institution?
– I have seen a press report somewhat in the terms indicated by the honorable senator, but whether His Honour, Mr. Justice Owen Dixon, has been correctly reported or not I do not know, and I shall suspend all judgment on the matter until I do know. However, even if His Honour did make that statement, I point out that he was speaking as an individual and not in exercise of his high judicial office. Certainly he could not be regarded as speaking for the High Court bench. Therefore, in the circumstances, I am not prepared to refer the statement to the Chief Justice of the High Court for action. I think that it has been completely proved that elevation from the bar to the bench of any court does not make a man an angel. He cannot dissociate himself from his religion, his politics, his general experience of life, and his whole outlook. However, I have not the faintest doubt whatever that every member of the judiciary does try to the limit of his power to be completely impartial. I do not know the circumstances in which the reported statement was made but I remind the Senate that there are informal occasions when even members of the High Court bench become men and not justices. Again I say that even if the report were correct, I should not regard the statement as one that I should take up officially with the Chief Justice of the High Court.
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– Can the Minister for Shipping and Fuel say whether the central executive of the Australian Labour party in New South Wales forwarded “How to Vote” cards to the Bourke
Branch of the Australian Labour party, directing Labour supporters to give their number two preferences to the Communist candidate in the Cobar by-election, and to place the Country party nominee, the only ex-serviceman candidate, last? If so, what explanation can the Minister offer for this action, in view of the Labour party’s expressed abhorrence of Communism ?
– Although I read a press report of a statement to that effect by Mr. Bruxner, of New South Wales, who is, I believe, a member of the Australian Country party, I am unable to vouch for the accuracy of the statement and I do not propose to make any comment upon it. I am not in any way personally responsible for the alleged decision concerning “ How to Vote “ cards, and the State executive of the Australian Labour party may not have been responsible. We do not know the basis for the report, and, in any event, the person who made the statement is just as irresponsible as are some sections of the press.
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– Has the Minister for Shipping and Fuel read the recent press report of a statement by Mr. L. P. Austin, Conciliation Commissioner, to the effect that the recent strike by crane drivers at Clyde Engineering Works implied that the Federated Union of Locomotive Engine-drivers and Firemen did not accept arbitration as a basis of negotiation between employer and employee? Did Mr. W. Lane, State secretary of the trade union mentioned, say, when commenting on Mr. Austin’s statement, that the arbitration system had failed to maintain decent standards of living for workers and that direct negotiations with employers or strike action were now the only alternative for trade unions? What comment has the Minister to offer on that statement?
– I have not seen the reported statement by Conciliation Commissioner Austin to the effect that a particular trade union did not accept arbitration, nor have I seen the report of an alleged comment by Mr. Lane that arbitration had failed and that the union concerned must now resort to direct negotiation with employers. With regard to that type of approach, if it were made by a particular union, or secretary, all that I say is that that is diametrically opposed to the policy of this Government and of the Australian Labour party. The present Australian Government stands very solidly for arbitration and conciliation in the settlement of industrial disputes. It does not for one moment believe that arbitration has failed. It gave a lot of thought to this matter in 1947 when it shifted the emphasis from arbitration to conciliation by the appointment of fifteen or sixteen conciliation commissioners, armed with specific powers in relation to the ordinary terms and conditions of employment, while leaving the main matters, such as the basic wage, females’ minimum rates, and recreation leave to the arbitration court itself. The new system has been under trial for approximately a year. It has made very real progress during that time. I repeat that this Government and the Australian Labour party stand very solidly for the preservation of arbitration and conciliation for the settlement of all industrial disputes. The Government believes that resort to the action suggested in the honorable senator’s question is the way to chaos and anarchy.
page 1351
– Has the Minister for Shipping and Fuel seen a recent press statement that the New Guard is becoming active again in New South Wales? Does the Minister know that a number of prominent members of the Opposition in the Parliament were, and probably still are, closely associated with that movement?
– I am not aware that the New Guard has become active again, and I have not seen the report referred to by the honorable senator. From information I have received with relation to the by-election in the New South Wales State electorate of Concord during the week-end, many limousines and other big motor cars were used to support the Liberal party candidate. If that is an indication of the activity of the New Guard, it is becoming very active.
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– Will the Minister representing the Minister for Information inform the Senate whether it is true thai the royal commission on the press in the United Kingdom has rejected almost al! of the charges of bad faith and undue political prejudice made against British newspapers? If so, will the Minister undertake to see that this information ibrought to the notice of the Minister fo> Information?
– It would appear that the Leader of the Opposition has been completely misled by press speculation about the result of the royal commission in the United Kingdom The Minister for Information is watching the situation even more closely than i.« Senator Cooper. The Minister desires to learn of the finding of that royal commission as soon as possible, and, depending on the result, he may suggest to the Australian Government that some action should be taken in this country with relation to the pres.I shall bring the honorable senator’ - question to the notice of the Minister for Information, and no doubt, if he seefit, he will reply direct.
– Has the Minister representing the Minister for Informs tion seen a statement in the Sydney Morning Herald of to-day that the Legislative Council in Fiji has passed a bil! which gives the Governor-in-Council power to order the publication of short factual statements on reports held to be incorrect or distorted, and that refusal by the proprietor of a newspaper to publish a correction will render him liable to a fine of £500 and six months imprisonment? In view of the past record of distortion and the publication of halftruths by sections of the Australian press during the last few years, will the Minister consider the advisability of similar legislation being enacted in this country?
– The honorable senator’s question is most interesting in view of the question just asked by the Leader of the Opposition. I have not seen the bill under which it is reported that the Legislative Council of Fiji will impose certain conditions upon the press in order to ensure some degree of fair reporting. I shall bring the question to the notice of the Minister for Information, who, I have no doubt, will find out whether the position is as the honorable senator has outlined it. Possibly, as the result of such an investigation, the Minister may put something else in his folder for reference when the report of the Royal Commission on the Press now sitting in England comes to hand; and he may deem it fit to take similar action.
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asked the Minister representing the Prime Minister, upon notice - 1.Is it a fact that 600 persons are employed at Australia House, London?
– The Prime Minister has supplied the following answer : -
The information is being collated and will be furnished to the honorable senator as soon is possible.
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asked the Minister representing the Minister for Works and Housing, upon notice -
– The Minister for Works and Housing has supplied the following answers: -
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asked the Minister representing the Minister for Air, upon notice -
– The Minister for Air has supplied the following answers : -
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asked the Minister representing the Minister for Works and Housing, upon notice -
– The Minister for Works and Housing has supplied the following answers: -
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Debate resumed from the 10th March (vide page 1248), on motion by Senator MoKenna -
That the bill be now read a second time.
– The original legislation dealing -with pharmaceutical benefits was introduced on the 4th June, 1947. The amending bill now before the Senate seeks to grant additional powers to the Government to enable it to force its free medicine scheme upon the medical profession. I should like to pay a tribute to the Minister for Health (Senator McKenna). With his usual courtesy, he presented a very convincing statement of the Government’s case in support of the bill. However, he will be ready to admit that it was purely and simply an ex parte statement. Any legislation that is designed to provide a reasonable service, which the people desire to have, will always have the support of the parties that I represent in this chamber, but there are important circumstances surrounding the free medicine scheme that need very careful investigation. The plan is a legacy that was left to the Minister for Health by his predecessors in office. He has had a difficult problem thrust upon him, and he is evidently making the best of a not very good case. There has been no evidence over the years of any substantial demand for a free medicine service. In fact, many people are opposed to the provision of the facilities for which the scheme provides. The Minister’s case is that the Government nas shown extreme moderation and toler ance in seeking to provide a free medical service for the community. The honorable senator carefully stated in his secondreading speech that he had approached the British Medical Association on many occasions and had done all that he possibly could have done to reach some agreement with it. The bill had been introduced, he said, only after the Government’s patience had been exhausted. But we must give some consideration to the other side of the case and try to obtain a picture of the situation as the British Medical Association sees it.
I regret that the Minister has endeavoured to state the background story of the disagreement in a way that implies that members of the medical profession are concerned only with their own selfish interests and are careless of the public welfare. I am led to make that statement by the terms of a letter that was sent by the Minister to the then president of the association, Sir Henry Newland, on the 24th December, 1948. In that letter, the Minister stated -
The primary concern of the Government ir for the health and welfare of the people.
That is the primary concern not only of the Minister and his colleagues, but also of every other honorable senator as well as every member of the British Medical Association. The Minister also stated in the letter -
Your letter makes it plain that the primary concern of your association is to contend for what it believes to be in the interests and for the convenience of its members.
He added -
Your association is grievously lacking in h sense of social responsibility.
That letter was most unfair, and it gave a completely untrue picture of the situation. In fairness to the medical profession generally, it may be said that every doctor, upon graduating, undertakes a life of public service with hours of work that are very much in excess of the 40-hour week. Every doctor devotes himself to the alleviation of the sufferings of humanity. Nevertheless, because doctors have dared to disagree with the Government about the method of implementing its free medicine scheme, they have been accused of looking after their own selfish interests. The Minister has said that there are about 6,000 doctors in Australia. To accuse the majority of them, or even a minority, of harbouring such a motive is distinctly unfair. The unfairness of the Minister’s letter was accentuated by the fact that it was written on the 24th December - a peculiar Christmas greeting to members of the medical profession. The bill has been very cleverly drafted, in my opinion, in order to extricate the Government from an extremely awkward situation in which it has landed itself.
Debate interrupted.
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– I desire to inform honorable senators that the Right Honorable The Earl of Listowel, Deputy Leader of the House of Lords, and Minister of State for Colonial Affairs in the United Kingdom Government, is within die precincts of the chamber. With the concurrence of honorable senators I shall invite him to take a seat on the floor of the Senate beside the President’s -hair.
Honorable Senators. - Hear, hear!
The Earl of Listowel thereupon filtered the chamber, and was seated accordingly
page 1354
Debate resumed.
– The present situation arises from the simple fact that the “ free medicine scheme “, as we know it, was ill-considered and was rightly described by the Tasmanian Labour Minister for Health, Dr. Turnbull, as “putting the cart before the horse “. The Minister, in his secondreading speech, referred to the initial objections raised by the British Medical Association. Those references, however, were entirely without relevance, as the objections were upheld by the High Court. We are concerned only with the position that has arisen since the granting of additional powers over public health to the Commonwealth at the referendum of 1946. We all agree that the health of the people is of immense importance. In fact, it is s paramount consideration. To obtain the maximum benefit under any health scheme it is essential to have the fullest co-operation and assistance of the medical profession. In New Zealand, where the co-operation of the medical profession has not been secured by the Government of that country over the years, a chaotic position has resulted. We have before us also the example of the United Kingdom. In that country, according to reports, doctors are overwhelmed with clerical work, and have to waste their time interviewing patients who come to them suffering from minor complaints for which, in ordinary circumstances, they would take a couple of aspros or some other simple remedy. Obviously the full co-operation, of the medical profession in Australia will not be achieved simply by passing this measure. In his secondreading speech the Minister gave no indication of the probable date of proclamation of the measure, but I gather that this may be deferred for some time. That will give the Minister and the Government an opportunity to make a new approach to the whole problem. The Minister has admitted that he has not received the co-operation that he desired from medical men. He will now have an opportunity to make a further attempt to secure that co-operation. I intend, later in my speech, to move an amendment aimed at se-curing further discussions on the pharmaceutical benefits scheme. I do not believe for one moment that an agreement between the Government and the British Medical Association on some method of implementing the scheme is impossible. Despite what the Minister has said about the noncooperative spirit of the British Medical Association, I shall show that, in the past, members of that organization co-operated generously with the Social Security Committee on matters which were of outstanding importance to the welfare and health of the people of this country. I was associated with the Social Security Committee during the whole of its investigations. The committee functioned most efficiently for five years. Amongst, other things, with the assistance of the British Medical Association, it made a survey of public health, medical and hospital services throughout the Commonwealth. The bulk of that work was undertaken by the Social Security Medical Planning Committee, the report of which, made on the 1st March, 1944, ia to be found in appendix A of the eighth report of the Social. Security Committee. As that report shows, the Social Security Medical Planning Committee inquired into many aspects of public health including a number of cervices that are beyond the scope of the bill now under discussion. One of the most important of those was maternal and child welfare. As I have said, I propose to move an amendment to the motion for the second reading of the bill. In the course of my speech I intend to show members of the Senate that the difficulty of which the Minister has spoken in securing the co-operation of the British Medical Association was overcome in relation to health measures which, to the general community, are more important than the free medicine scheme. I shall endeavour to prove to the Minister that the medical profession has not been so un-co-operative as he would have us believe, and that agreement has been reached with the association on many important aspects of health services, f believe that some plan similar to the 1944 scheme should be placed before the British Medical Association in order to obtain the complete co-operation of the doctors before any scheme is sought to be implemented. Members of the medical planning committee of the Joint Committee on Social Security interviewed members of the British Medical Association in Sydney in March, 1944, and discussed various matters with them, including particularly, maternal welfare. Paragraph 46 of the eighth interim report of the committee states -
We have been impressed by the -unanimity of opinion, in one matter, of those who have given evidence before the Social Security Committee, namely, with regard to the importance of maternal and child welfare in any comprehensive health scheme. It was inevitable that, in recording the Minutes of Evidence, the larger questions of medical and hospital services should have been more featured at some length ; actually, of individual indexed items of public health importance, references to maternal welfare and infant welfare appear more often than to any other subject.
The committee’s report stresses that one of our most urgent needs is the provision of more hospital beds, and emphasizes the necessity for introducing a plan of regionalization for country areas. Paragraph 161 of the report states -
The objective, so far as a medical health service in Australia is concerned, is to make available to every member of the community the best possible protective and corrective medical care; two further essentials are that the services within the area selected as a unit in the scheme must be properly correlated with others within and outside the area and that the personnel of the service must be adequate and available. None of these three pustulates is at present satisfied in any State of Australia.
Paragraph 167, which also deals with hospital services, states -
Apart from the general problem, therefore, there is a two-fold aspect: The cities, densely peopled, present the metropolitan aspect - they need regionalization by subdivision and correction of duplicated or overlapping facilities; the rural areas, sparsely populated and sprinkled with many small towns, villages, and railway sidings or outpost camps, call for regionalization by combination of facilities, the grouping of isolated units, and the provision of supplementary occasional ser vices and betterment of transport services.
Paragraph 169, which also deals with regionalization, refers to the lack of proper organization of existing facilities, and states -
To correct it would require the closest and most meticulous activity for an agreed measure of co-operation and would undoubtedly require to be achieved in stages over a period of years.
The provision of medical services in remote areas in the back country, which is a most pressing need, is dealt with in paragraph 207, which is as follows : -
For remote areas a voluntary full-time salaried or subsidized medical service under > limited term appointment, with improved hospital and transport services, including extended ambulance and flying doctor services, and facilities for consultant services is essential; such services to be established and extended as necessary.
Paragraph 227 relates to specialist practice, and the committee recommended that -
In respect of specialist facilities thenshould be a considerable planned extension of diagnostic provision. This should extend to every major country centre which is or be comes the basic centre for any regional service. Such aids should include (o) complete laboratory diagnostic facilities; and (6) radiological diagnostic facilities.
The provision of an experimental health service was discussed, and the committee recommended that the establishment of health services should be effected in cooperation with private medical practitioners. The British Medical Association agreed that private medical practitioners should work readily in experimental health services to be provided in metropolitan zones to serve areas containing a population of 15,000 people. The committee’s recommendation is contained in paragraph 253, which is as follows : -
We therefore recommend that experimental group-practice centres be set up at carefully selected places in Australia where different sets of conditions, different types of practice and different methods of payment for services might be tested fully for practicability - careful records being made of every aspect of each situation, in order that an ideal scheme might ultimately be formulated, sufficiently elastic to be applicable to the varying circumstances and conditions that operate in different parts of Australia.
– As late as last December, the British Medical Association wrote to the Government objecting strongly to the establishment of experimental and other health centres.
– I shall convince the Minister that he is wrong because I can prove that the arrangement was agreed to by the Federal Council of the British Medical Association. The association is not so difficult to deal with as the Minister has said. It agreed to practically every form of medical practice except free medicine, which was not even considered at that time. Other matters to which urgent attention could be given are an extension of the Flying Doctor and Air Ambulance services to the outback areas, and provision of facilities for post-graduate study by medical practitioners. These matters were given a lot of consideration. Paragraph 259 of the Eighth Interim Report of the Social Security Committee reads -
We consider there should be a post-war development of a series of aerial bases properly distributed in relation to selected major and minor centres, both city and rural, and pro viding -
“Flying doctor” services, including specialist services to the most remote and otherwise unstaffed areas; and
Air ambulance services from any area to the centre appropriate for specialized treatment in individual cases.
– They would be improved under government control.
– Paragraph 261 reads -
The development of transceiver facilities should proceed equally in all areas thus serviced.
The parliamentary members of the Medical Planning Committee were : Mr. H. C. Barnard, M.P. (chairman) ; Senator W. J. Cooper, the Honorable F. H. Stewart, M.P., representing the Joint Committee on Social Security. The medical members were Sir Henry Newland, the then president of the British Medical Association; Sir Charles B. Blackburn, of Sydney, an eminent specialist, who is very closely associated with the British Medical Association; Dr. F. W. Simmons, representing the British Medical Association in Australia; Dr. F. McCallum, representing the Commonwealth Director-General of Health; Dr. Alan B. Lilley; Sir Raphael Cilento, representing the Social Security Medical Survey Committee ; Dr. J. G. Hunter, General Secretary of the British Medical Association in Australia, and Mr. Roy Rowe, Research Officer. On the medical side the representatives were men of high standing in the medical profession and in the British Medical Association. The report was agreed to unanimously. It was signed on the 1st March, 1944, by Mr. H. C. Barnard, chairman of the Joint Committee on Social Security, and Sir H. S. Newland, president, Federal Council of the British Medical Association in Australia, for and on behalf of the committee.
I have gone to some length to prove that the members of the British Medical Association are not so difficult and noncooperative as the Minister suggested in his second-reading speech. In that report the British Medical Association committed itself to health measures and medical measures in general of far more benefit to the community at large than those that are incorporated in this bill in regard to free medicine.
– Is their attitude cooperative with relation to pharmaceutical’ benefits ?
– The point I desire to make is that the members were prepared to co-operate with the Government in the wide and important sphere of positive health measures. The subject of free medicine was not submitted to the Social Security Committee for report. The matter at issue has to do not with the scheme, but rather with the way in which it shall be implemented. The Minister pointed out that there are three points on which the Federal Council of the British Medical Association cannot see eye to eye with the Government. They are (a) limitation of prescribing to a formulary; (b) the use of prescription forms; and (c) the penalty clauses applicable to doctors. Despite very long and protracted nego- tiations between the Government and the British Medical Association, a. deadlock has been reached on these matters. The Government has introduced this bill to overcome that deadlock by powers of compulsion. Clause 5 of the bill makes it obligatory for doctors to write prescriptions’ for medicines, the name or formula of which is contained in the Commonwealth Pharmaceutical Formulary, on government forms. Penality for nonobservance of this requirement is £50. In other words, the Government, having failed in conciliation, now proposes to re- sort to compulsion. That clause means virtually the regimentation, not only of the doctors, but also of the patients. By it, both the patient and the doctor are to be compelled to use government forms if the prescriptionprescribed is contained in. the Commonwealth formulary. Alot of social service legislation has been passed–
– With the honorable senator’s help!
– Yes, and probably alot more will be passed with my help–
– Then support this bill.
– This is the only legislation of a social nature that incorporates’ a clause of compulsion - compulsion to the recipient. I pointout that resort has not been had to compulsion with relation to age or widows’ pensions, child endowment, or any repatriation benefits.
– There is no comparison.
– The patient is at liberty to receive his or her treatment wherever desired. No person upon reaching the qualifying age is compelled to accept the age pension. However, both the doctor and his patient are to be compelled to accept the benefit provided under the measure. They are given no option in the matter. The only exception will, be when a doctor prescribes medicine none of the ingredients of which is contained in the Commonwealth Pharmaceutical Formulary. The Minister will probably reply, “ There is nothing in that objection, because the doctor is obliged to write on a prescription form supplied by the Commonwealth only when he prescribes medicines which are included in the formulary “. However, that provision cuts directly across adecision made by the International Labour Organization at its conference held in March, 1944. The recommendations of that body in respect of medical care included the following paragraph, which was reprintedin the eighthreportofthe Social Security Committee: -
Whereasit is nowdesirable to take further steps for the improvement and unification of medicalcare services, the extension of such services to all workers and their families, including, rural population and the selfemployed, and the elimination of inequitable anomalies, without prejudice to the rightof anybeneficiary of the medical care service who so desires, to arrange privately at his own expense for medical care.
Under this measure the patient will not begiven any option to say whether or not he wishes to receive medicine free of charge. That: provision is. also entirely atvariance with the will of the people as expressed at the referendum held in 1946.On thatoccasion the people approved the Government’s social services proposals, but they did not approve anyform of civil conscription. However,personsentitledtoreceivepharma ceutical benefits ares to be regimented underthismeasure. When introducing the Pharmaceutical Benefits Bill, onthe 4thJune,1947, the Minister stated -
Underthis bill there will be no compulsion ofmedical practitioners or pharmaceutical chemiststotakepart in the scheme.
– There is nocompulsion under this bill.
– That is not entirely correct, because under this measure the doctor will be subject to compulsion should he prescribe any medicine which is contained in the Commonwealth Pharmaceutical Formulary. The formulary includes a large number of prescriptions and uncompounded medicines which are in common use by the medical profession, and any doctor who prescribes such medicines will automatically be forced into the scheme. The Minister may say that the doctor is at liberty to prescribe medicines which are not contained in the formulary. However, he will admit that in the great majority of instances doctors prescribe medicines which are included in the formulary.
The proposals embodied in this measure are at variance with the Labour party’s avowed policy of conciliation and arbitration. Only this afternoon the Minister stated that the Labour party was proud of the fact that it had always adhered to that policy, and he added that his party always would adhere to it. The Government has passed several measures with the object of facilitating the settlement of industrial disputes. Under such legislation it has appointed conciliation commissioners who are empowered, in order to obviate strikes and dislocation of industry, to act speedily at the first sign of a dispute. The Government has also provided many amenities for workers engaged in the shipping, stevedoring and coal-mining industries. The Opposition parties have supported those measures, but, at the same time, we have criticized the Government for being too eager in its efforts to placate employees in those industries and the members of big industrial unions associated with other industries. All parties in the Parliament have striven to achieve peace in industry. However, it is noteworthy that in many instances the Government has failed to apply the penalty provisions of its industrial legislation to workers who have gone on strike and defied the law of the land. Yet it now proposes to penalize doctors by a fine of £50 if they do not conform with the provision that they shall write prescriptions on official forms. It is clear that the Government is not prepared to show towards members of the
British Medical Association the leniency which it has always displayed towards members of big industrial unions. It has not endeavoured to negotiate through a third party. In view of its professed espousal of the principle of conciliation and arbitration, it ought to give serious consideration to the provision of facilities for the doctors to state their case such as are provided for industrial workers. Their claims should he heard publicly so that people may hear both sides of the case instead of only the one side that the Minister stated in his second-reading speech.
Another great principle that has been observed by the medical profession through the ages is embodied in the relationship between patient and doctor. Up to the present, any confidence? exchanged between a doctor and a patient have been the concern only of those two persons. However, I assume that, under the Government’s scheme, some record: of the illnesses of patients and the methods of treatment prescribed would have to he kept. That would involve a third party. If such records are to he kept, secrecy can no longer be preserved between doctors and patients. I appreciate the assurances that were given by the Minister on this subject during hie second-reading speech, but they contrasted very emphatically with recent action that was taken by the Minister for the Army (Mr. Chambers) in the House of Representatives when he made public intimate details of the medical history of an ex-soldier.
– At the request of a member of the Opposition.
– The reason for the Minister’s action is not relevant to this discussion. I am dealing with principles. It has been done in one case, and it could be done again. I ask the Minister whether confidential information exchanged between a patient and hie doctor will be carefully safeguarded under the bill so that there shall be no opportunity for a third ‘party to have access to the patient’s medical history. It is evident that, if case details are to be made known to persons other than those who are directly concerned, the sanctity of the doctor-patient relationship will b* endangered.
In his criticism of the British Medical Association, the Minister said that only 117 of the 6,000 doctors in Australia had co-operated in the scheme and that, because approximately 3,000 doctors had refused to accept delivery of copies of the formulary and prescription forms, they could have no knowledge of the contents of the formulary.
– That would be correct, would it not?
– It was merely a hypothetical assumption. Nobody could confidently say that the statement was correct. I know, and the honorable senator knows, that the Government’s proposals for a free medicine scheme have !>een the subject of discussion by every branch of the British Medical Association in Australia. The mere fact that doctors have refused to accept parcels of forms does not mean that they have no knowledge of the contents of the formulary. Copies of the formulary are in the possession of other members of the profession. The Minister has pointed out that some thousands of doctors accepted delivery of parcels containing prescription forms and copies of the formulary. It would be very foolish to say that all of the 3,000 doctors who accepted delivery have locked the forms away and refused to show them to other members of their profession. It is obvious that this matter has been fully discussed by every medical practitioner in Australia. All doctors have full knowledge of the scheme and of the obligations that the Government proposes to impose upon them. Does the Minister suggest that those doctors who refused to accept the forms that were sent to them did not have an opportunity to vote within the association upon the question whether the scheme should be accepted or rejected or that, alternatively, they voted without knowing what they were voting upon? I doubt very much whether the scheme was rejected merely by the Federal Council of the British Vied ica! Association. I am sure that a vote was taken amongst all members in order to guide the council. In any case, 1 point out that executive committees of large industrial unions have not, up to the present, favoured the holding of secret ballots amongst members of their organisations before they declare strikes. Mem- bers of the Opposition in the Senate have consistently stressed the necessity for granting to rank and file members of trade unions the right to register their votes in secret ballots before being committed to strike action. I am sure that the right to express their views by ballot was granted to members of the British Medical Association before the Federal Council reached the present impasse with the Government.
I assume that the Government’s case in favour of the scheme has been developed upon the advice of officers of the Department of Health. The efficiency of those officers is not in question. Nevertheless, however efficient they may be in administration, many of them have had little experience of private medical practice. Some of them may have left thriving private practices in order to enter the government service, but most of them have not been engaged in private practice for many years. The 6,000 doctors who provide Australia’s medical services cannot all be entirely wrong. Some of them must be right. However, the Minister has told us that only 117 doctors of the 6,000 have accepted the manciples of the free medicine scheme. The doctors are educated men and women. Their profession is a very responsible one, which does not provide the extraordinarily profitable returns that can be gained in other walks of life.
– It is a fairly lucrative occupation.
– It may be lucrative for a few, but many doctors work much more than 40 hours a week. They are at the beck and call of the public for every hour of the 24 on every day of the week. It is wrong to suggest that such individuals are not anxious to provide the best possible health services for the people. They have devoted their lives to the promotion of health and the alleviation of suffering. It is unfair to say that they do not wish to give of their best. (Extension of time granted.] Their entire thought is of the service that they can give to the community.
– I do not think that anybody has disparaged their services to the community.
– The Minister perhaps did not disparage their services, but he alluded to them as being grievously lacking in a sense of social responsibility and being concerned only with their own interests. I do not agree with that statement in any respect. I have already notified my intention to move an amendment to the motion for the second reading of the bill.
I shall propose the amendment because I believe that the necessity for impartial adjudication by some competent authority of the dispute between the Government and the British Medical Association is emphasized by the fact that an entirely new form of departmental control has been decided upon. That new form of control is intended by the Government to apply both to the free medicine scheme and to the general medical services that are dealt with in the bill. Comprehensive evidence taken from witnesses throughout Australia by the former Social Security Committee of this Parliament made it very clear that such a form of control was highly undesirable for a service of the kind that is proposed by the Government. After mature consideration of this evidence, the Social Security Committee, in several reports, stressed the necessity for independent control of any medical or ancillary services, and recommended the appointment of a commission for that purpose. I therefore move -
That all words after “That” be left out, with a view to insert in lieu thereof the following words : - “ the Bill be withdrawn and referred for report to an independent tribunal mutually acceptable to the parties concerned “..
I take this action in the hope that the impasse that has been reached will be overcome. I have shown that in its dealings with the National Medical Planning Committee, the British Medical Association was not unreasonable. Ibelieve that by accepting this amendment the Government would be rendering a great service to the people who are most concerned with this measure - the general public. The taxpayers of Australia are paying a social services contribution and the community is entitled to a national health scheme. I am confident that with agreement between the Government and the medical profession, it will be possible to introduce an efficient health scheme.
.- The Leader of the Opposition (Senator Cooper) claims that in 1944 a certain committee investigating the need for various national health services received the co-operation of the British Medical Association. The honorable senator overlooked one fact. As the result of the deliberations and findings of that committee, the government of the day realized that it was not possible to legislate for public health services because the British Medical Association had already tested the constitutional powers of the Commonwealth in the High Court. Subsequently, a referendum on this matter was held and was carried by the requisite majority of citizens of Australia and a majority of the States. The Labour Government has since been endeavouring to implement the wishes of the electors as expressed at that referendum, but the British Medical Association has opposed the Government’s plans, and of course, in so doing, has opposed the will of the people of Australia. In this activity, the British Medical Association has been supported by the Opposition parties in this Parliament.
The Leader of the Opposition based his attack upon the fact that when this amending legislation becomes law, a doctor who fails to prescribe medicine on the form supplied by the Government will be liable to a penalty of £50. The honorable senator claimed that there was no demand for free medicine. Ihonestly believe, however, that if twenty of the leading doctors in Victoria were to notify the public that they were prepared to comply with the requirements of the Pharmaceutical Benefits Act by prescribing medicines on the specified forms, and so enable people to obtain medicine free of charge, not only the police but also the military forces would be required to control the crowds waiting outside their surgeries. Significantly, the Leader of the Opposition did not say one word about the need for the provision of free medicines to pensioners.
– They already get free medicine.
– They do not. Iinterviewmany age and invalid pensioners at my office and Senator Sheehain will vouch for the fact that oneday an old lady who cameto see us produced receipts for £20 worth of medicines that she had needed during the previous six months. I am sure that all honorable senators know of similar cases. But the medical profession is not concerned about providing free medicines to age pensioners or anybody else.
What is happening in other countries? The medical benefits scheme operating in Great Britain covers not only a free medical service, but also free dental and optical .services and free medicines. Why can that he done in the United Kingdom but not in this country? The answer is simple. The Parliament of Great Britain is not hampered by a written constitution. The British Medical Association challenged the Labour Government, but by foreshadowing legislation under which all premises occupied by medical men could be requisitioned, that Government defeated the challenge. The Leader of the Opposition said that, of more than 6,000 medical practitioners in Australia, 3,000 had not opened the envelopes containing notification of the commencement of the free medicine scheme. Are those men not sufficiently intelligent to determine for themselves whether the scheme is good or bad? The Leader of the Opposition complained about the injustice of fining a doctor £50 for failing to comply with this legislation; but this bill will become law, and I am sure that the honorable senator believes that the law should be upheld. I recall that before the principal act came into force members of the British Medical Association loudly proclaimed that they would ignore its provisions and challenge its validity in the High Court. We are constantly being asked why the Labour Government does not deal with people who flout Arbitration Court awards, but here we find honorable senators opposite supporting men who declare that they will break the law. What does the Opposition propose in regard to this measure? Only that there should he further delay, that there should be a re-examination of old records. No such investigation could alter the fact that the law of lie Commonwealth must be given effect. Not only is the Opposition hopeless in its approach to this matter, but also it is helpless. It has not one constructive suggestion to offer. What has been the history of social services schemes in this Parliament? The party to which the Leader of the Opposition belongs participated in an administration which did,, in fact, pass a social security measure - the National Health and Pensions Insurance Act. In preparing that legislation, the government of the day had the assistance of the best intellects of this country, and also brought men from overseas. What happened to that legislation? It passed through both Houses of the Parliament, but it was never proclaimed because, even then, the anti-Labour forces in this Parliament were hopeless. This Government is the only one that has ever given a workable social services scheme to the people of Australia. To-day the cost of living is high. We all know of people who are having the greatest difficulty in enjoying a reasonable standard of living, even while they remain in good health. I know of one young woman in Victoria who is dying from cancer. She was my typist when I was a member of the Melbourne Trades Hall Council. For the last three years her medicine bill has been not less than 25s. a week. Apparently, honorable senators opposite wish this state of affairs to continue, but Labour will not tolerate it any longer. Members of the Opposition parties and their supporters outside the Parliament may protest as much as they like, but the Government intends to put this legislation into operation. I remind the Senate that all governments protect the British Medical Association. If it were not for acts of Parliament in Great Britain, and in both the Commonwealth and States spheres in this country, a doctor’s job would not he worth fifty “ bob “ a week, because the profession would be inundated by “ quacks “ of all descriptions. Throughout the Commonwealth to-day are many overseas specialists who are not permitted to practise in this country because they have not qualified at its universities, I do not say that I disagree with the policy of members of the British Medical Association in this connexion. That is their prerogative, hut the prohibition affects highly qualified medical men who have practised with distinction in other countries. Why are they not permitted to practise here? Because it is illegal for them to do so. Let us consider for a moment what the Labour Government has done in regard to rehabilitation. The Commonwealth is spending many hundreds of thousands of pounds a year educating young men at the universities to fit them for membership of the medical profession in this country. It has also spent substantial sums in subsidizing university medical schools and hospitals thereby benefiting the medical profession considerably. In addition, State governments also have done a tremendous amount for that profession. It is obvious, therefore, that a profession whose members have received so much assistance from the Government should co-operate with the administration. Incidentally, no member of any administration, Commonwealth or State, has ever conducted with any organized body such protracted negotiations as has the Minister for Health (Senator McKenna) with the British Medical Association. Those negotiations have been conducted, on the Minister’s part, in a conciliatory and gentlemanly manner, as the reports of his conferences with the British Medical Association that have been issued from time to time prove. Nevertheless, the British Medical Association has stated that it will not co-operate with the Government. The Government must prevail in its dealings with all members of the community, whether they be coalminers, wharf-labourers, members of the medical profession or any other organized body. The National Government cannot permit individuals or groups of individuals to dictate to it. I am certain that with the exception of the medical profession, no organized body whose members had received 3,000 printed notices from the Government would have adopted the attitude displayed by the British Medical Association. Many members of that body did not have even the intellect or the courage to accept delivery of those notices. They hid behind their association, and the Government is perfectly right, therefore, in adopting the attitude which it now proposes to adopt with that body. Prominent members of the British Parliament who have visited this country recently have told us of the firmness displayed by the British Labour Government in carrying out its policy. I trust that the Australian Government will exhibit similar courage because, after all, it is not confronted with a task of the same magnitude as that which faced the present British Government.
I always listen attentively to the remarks made in the Senate by membersof the Opposition, and I paid particular attention to the speech made by the Leader of the Opposition (Senator Cooper) this afternoon. After hearing his speech I am convinced that the honorable senator knows that he has no sound, logical .objection to the bill, because no one could conscientiously object to the passage of a measure designed to provide free medicine and other vital health services for the community in accordance with the recommendations of the Social Security Committee. The Government proposes to provide not only special clinical and radiological services, including treatment for cancer, but also sera which are of such importance in relieving suffering. I remind honorable senators that penicillin and other life-saving drugs are already being manufactured by the Commonwealth in its laboratories, for which equipment and materials valued at £2,000,000 have been provided. The Commonwealth supplies all the money required for the manufacture of the drugs. Notwithstanding that, the British Medical Association assumes to itself the right to say to the sick, the poor and the afflicted : “ We will not prescribe the medicines that are necessary for the restoration of your health “. I point out that, after all, the Government is merely asking them to prescribe the drugs manufactured by the Commonwealth in its laboratories for the maintenance of health and the cure of sickness.
The Government has been accused of insincerity in not having given the British Medical Association another opportunity to co-operate with it. No section of the community has been given one-tenth of the opportunities that have been given to the British Medical Association to reach a satisfactory and amicable settlement. Although the Leader of the Opposition has fallen in behind the British Medical Association in objecting to the Government’s health scheme - probably because he has allowed himself to be influenced by some member of that association, who has told him that the general public do not want the scheme - point out to him that in dealings between doctors and patients, the doctors have all the advantages. For one thing, we do not go to a doctor while we are in good health ; it is only when we are ill that we visit him. It follows^ therefore, that when we consult them we are completely in their hands. If a doctor does not deign to say anything about free medicine when he prescribes for us, we cannot do much about it. Members of the British Medical Association have adopted the attitude, “ We are not going to lower our dignity by filling in forms “. What utter humbug I They fill in forms every day. They write prescriptions every day when they write prescriptions in a lodge book. Their attempt, therefore, to persuade the people that they will not join the scheme because it requires them to complete certain forms is so much sham and hyprocisy, and a deliberate attempt to mislead the electors. The Government has had no alternative but to insert a provision in the present measure to prevent them from escaping from their responsibilities. Of course, we realize that the British Medical Association will engage legal luminaries for an appeal to the High Court, and will expend thousands of pounds in an effort to defeat the present measure. However, I am confident that free medicine and free medical services will be provided in this country before long.
The Leader of the Opposition criticized the Government for its alleged lack of interest in organizing means for the prevention and treatment of certain diseases. However, he knows as well as I do, that the present Government has already appropriated £2,000,000 for the treatment of sufferers from tuberculosis, and he also knows that the Government proposes ultimately to expend a total of £40,000,000 for that purpose. One of the most important tasks that confronts any administration is the discharge of its obligation to provide proper social security, and the provision of free medicine is as important and as necessary as is the payment of age pensions, maternity allowances, child endowment, invalid and widows’ pensions. I remind members of the Opposition that the political interests which they represent advanced similar objections to the proposal to provide widows’ pensions when it was introduced as they now advance against the present measure. The Liberal party opposed widows’ pensions-
– Never.
– My word it did ! In Victoria we had to fight the Liberal party all the way in order to obtain payment of 10s. a week for widows, and even then the sons and daughters of widows had to pay that amount until a local police magistrate ordered it to be refunded to them. We do not want a repetition of the happenings of those times. Notwithstanding that the Opposition is fundamentally opposed to the Government on certain political principles, I suggest that it is the duty of any party in opposition to co-operate with the Government in enacting and improving such humane legislation as that now before us. I wholeheartedly commend the bill.
– A tremendous amount of propaganda has been disseminated concerning the pharmaceutical benefits scheme, and that propaganda has come, not from the Government, but from those who are opposed to the Labour movement. The Federal Council and the State councils of the British Medical Association have demonstrated that the members of those bodies are politically minded. It is also clear that the members of these councils have short memories. In opposing the implementation of the progressive and enlightened attempt of the present Government to implement an important part of its social security plan, on the ground that the operation of the pharmaceutical benefits scheme would require doctors to complete a large number of forms, they have apparently forgotten that during the depression, when the Commonwealth Government was not responsible for the provision of social services, the doctors not only filled in Government forms but, in addition, received a payment of 8d. in respect of every patient whom they attended. They had no hesitation then about filling- in forms in order to collect a payment of 8d.. There is, therefore, no real ground for their- objection.
I am pleased that the Leader of the Opposition (Senator Cooper) gave his blessing to the proposal to ‘provide free medicine for members of the community. At least, I assume that the honorable senator agrees with the Government concerning the necessity for providing free medicine, because otherwise I do not think that he would have moved his amendment for the scheme to be examined by a tribunal to be appointed for that purpose. Apparently, the honorable senator has forgotten that he has not been authorized by the British Medical Association to say that the members of that association will abide by any decision made by the. tribunal. It is of no use to submit the matter to a referee unless we are assured that the British Medical Association will abide by any decision of that referee. To date the council has not abided by even its own decisions. The reports of the Social Security Committee and other papers issued by the Department of Health show that whilst the British Medical Association agreed that in principle the scheme was good, it disagreed in certain respects with the methods proposed by the present Government to implement that policy. Certain negotiations took place, but entirely new issues were then raised by the association. Take, for instance, the formulary: It was stated that it was not wide enough in its scope, because it did not contain specific drugs. After the position was examined, however, it was found that the formulary did contain the specifics mentioned. It is unfortunate that the controllers of the Federal Council of the British Medical Association are drug-house addicts. In their prescriptions they prescribe medicine propounded by the drug houses. The greatest fight that is taking place now is with the drug houses of Australia that are associated with the Federal Council of the British Medical Association. The Government appointed experts to draw up the formulary. Although the Leader of the Opposition has said that they have not practised for years; I claim that some of them have practised continuously; Representatives- of thedrug houses in- this country considered particularly some of the items in the formulary and then, because the doctors would not be allowed to prescribe some proprietary compounds; there was a tremendous hullabaloo about the formulary. That is the position now with relation to pharmaceutical benefits. In some instances, also, that factor affects the provision of medical, attention by doctors. Further negotiations, took place with the Minister. He is indeed a very patient, man; he has been far more patient in connexion with this matter than I could have been. Had I been in. charge of tha matter I should long ago have told the doctors bluntly that, with the consent, of the people of this country; the Government is. the ruling power, and that they would have to obey the law. The Minister subsequently agreed to alter the formulary, and although they later reneged, the. Minister also agreed to accept some of their nominees. Now they say that they are not prepared to accept, the nominees. They have objected to the scheme right from the start. After they had conferred with the Minister he said that he was agreeable, to alter the Pharmaceutical Benefits Act to conform with particular requests brought forward by the Federal Council of the British Medical Association. Although, in the main, that has been done, the British Medical Association still, objects, and says that the Government has not sought its co-operation. I claim that everything possible in that direction has been done. The Minister has been faced with a Herculean task in trying to get the British Medical Association, to agree to the scheme in principle, and to co-operate with, the Government. After, the matter had been looked into from various aspects, the Federal Council of the British Medical Association submitted to the Minister a plan to enable the Government to institute the medical benefits scheme. Of course, in conference, the Minister had mentioned, to the association a number of methods of implementing this scheme. Although some of the methods that were suggested by the: Minister were summarily rejected by the British Medical Association, that association offered some comment with relation to four of the methods. They were : (a) payment by salary for medical services; (&) payment by capitation fee; (c) payment by a combination of salary and capitation fee; and (d) payment by “ fee for service “. The British Medical Association sent a long reply to the Minister. It ia not a private document, and can be obtained by any honorable senator. In that reply the Federal Council explained first why payment by salary was not practicable. It claimed that that would not be right; that quite a number of features of that system were wrong in the eyes of the British Medical Association. The Federal Council likewise rejected payment of a capitation fee. It pointed out that although that system applied to friendly societies, it did not work satisfactorily. It claimed that in any case this was a very limited scheme, which the Council did not favour. The Federal Council claimed that payment by a combination of capitation fee and salary would not he right, because of the anomalies associated with salaried officers and capitation payments. “With relation to the fourth method of payment of fee for service, the Federal Council said that although that scheme would not comply with the objective of the Government, it was the best scheme for that association. The relevant portion of the reply reads -
The fee-for-service method envisages the payment for each service rendered. The service might be a medical consultation or operation, an X-ray investigation or a pathological examination. Payment would be made in accordance with a Schedule of Fees drawn up for the purpose.
Yet the Federal Council of the British Medical Association is objecting to any kind of a schedule! -
This schedule would apply to all surgical operations, administration of anaesthetics, treatment of fractures and dislocations, X-ray and pathological examinations, maternity work, and physiotherapy. Where the services are performed by a specialist practising his specialty the schedule would be on a higher scale, such as satisfactorily operates in New Zealand in regard to X-ray and maternity services. . . . Abuse by the doctors could be stopped by making the patient pay part of the fee.
This is actually a suggestion by the British Medical Association -
This course, however, is contrary to government policy-
The British Medical Association knows of the government policy! - although strangely enough it operates satisfactorily in New Zealand in regard to X-ray benefits and is condoned by the Government in the “ Token System “ of payment by which the doctor charges the patient a fee per consultation and in addition sends that account to the fund for 7s. Cd. In the absence of the “ split fee “ check on abuses, adequate cooperation with the profession would solve the problem. . . .
The British Medical Association says first that the difficulty could be overcome by having a split-fee system, if it is the policy of the Government to co-operate with the British Medical Association, which absolutely refuses to co-operate in any shape or form and then proceeds -
The schedule would be the answer to- the “ bottomless pit “ charge against feeforservice in regard to these particular services. In a short time an average would be reached.
Why an average? So that the schedule can be fixed. Although the Federal Council of the British Medical Association has fought the National Government throughout, here is a suggestion from the Federal Council of that association relating to medical services. But let us consider what happened when the Government put that suggestion _ into operation. The Federal Council said, in effect, “We did not mean that; that is not quite correct “. But that was precisely the scheme that the council advocated in preference to the other schemes. Now the Federal Council says, in effect, “ You are doing wrong. You should have gone into some other phase of medicine and dealt first with age pensioners and other people who absolutely need it”. The Federal Council of the British Medical Association apparently forgot that those people were already provided for. Those people would be able to obtain free medicine merely by the doctors completing the Government forms. The doctors can supply medical treatment and free medicine to age pensioners now. All that is required is that they shall write the prescription on the Government form instead of on their own form. The doctors claim, however, that that would entail a large amount of clerical work. Nothing of the kind! No doubt many honorable senators have at times consulted doctors. Normally when a person consults a doctor, the doctor examines him and then refers to a book and writes a prescription on his prescription pad. The patient is then told to go to a chemist to obtain the mixture. Nothing more than that is involved in connexion. with the Government form for obtaining medicine. The antagonism of the medical profession has arisen because many of its members are opposed to this Labour Government. In thinking that they are on a “ winner “ they forget that this scheme took its rise as a result of a reference to the people of this country. I remind honorable senators that initially the medical benefits scheme was passed by this Parliament. It was subsequently found that the Government did not have the power to do the things that it desired to do. When the matter was referred to the people of this country by referendum, they gave the Government the necessary power. It is as a result of that referendum that the Government now seeks to implement these provisions. Yet the British Medical Association says, in effect, “ We are the Government. You are not the Government. There is no demand for it.” I point out that more than half of the people of this country who were entitled to vote voted in favour of the provision of such a scheme. Therefore, the demand does exist, particularly when the struggle before the High Court is remembered. The Leader of the Opposition now has the audacity to remind the Government that it believes in conciliation and arbitration. I should imagine that the Federal Council of the British Medical Association would pillory him for suggesting that it was an industrial body. Although I admit readily that the medical profession plays some part in the economy of this country. I cannot imagine that the members of the medical profession would be prepared tagree that they are industrialists merely because their association is an industrial association.
– Did I use those words ?
– No, but the honorable senator said that this matter should be submitted to arbitration because the Minister has said that he believes in arbitration and conciliation for the settlement of industrial disputes. The Government does believe in that policy, and it is in operation. If the suggestion of the Leader of the Opposition, that because this is an industrial dispute it should be submitted to arbitration, were adopted, doubtless the doctors would immediately say that they are professional men. Many of their numbers who are politically minded would walk on the other side of the street to avoid any inference that they were industrialists. There is no doubt about that.
– The honorable senator is waxing facetious.
– But, to-day, they urge that the issue should be submitted to some arbitrator because, they r-laim, it is a dispute. The great majority of the doctors are boycotting the Government. They are 6,000 strong, but I tell them now that they cannot dictate the policy of the Government. They shall be compelled to obey the law of the land. I do not hesitate to say that the rank and file of the members of the British Medical Association will obey the law. However, we can expect much litigation over this measure. I read a report in to-day’s press that the Federal Council of the British Medical Association intends to call for subscriptions to establish a fund to fight this legislation. I warn the doctors throughout Australia that there are “ hawks “ in thi9 country who want to get all the money they can, and if the doctors fight this legislation they will expend very large sums in the process. They should remember that they have not behind them the financial resources of the banks and financial institutions. I also warn them that should they meet with early success by beating the Government on one particular point, the Government will still pursue its objective; and so the fight and the expense will go on. The doctors would be wise to realize that their financial resources are not without limit, whereas the Government has unlimited funds. I again warn them to be very care*~,l about subscribing to any fund which may be established by the British Medical Association for the purpose of defeating the Government.
The Opposition parties describe this scheme as a “ free “ medicine scheme. No spokesman for the Government has described the benefits as “ free medicine “. However, the Opposition parties constantly use that phrase. The medicine to be supplied under this scheme cannot be described as “ free “ medicine. Certainly, patients will he able to procure medicine without paying for it over the counter, but, ultimately, the medicine is paid for out of the social services contributions of taxpayers. Under the new system a per-
Bon may go to a doctor and receive a prescription which includes medicines which are contained in the Commonwealth Pharmaceutical Formulary which has been drawn up by the Government’s medical experts. That formulary is not unalterable. As time goes on it will be widened to include all drugs whose efficacy has been proved in the treatment of diseases and complaints. The formulary as it stands at present is simply a starting point. Perhaps, opponents of the Government use the phrase “ free medicine “ because persons in the higher ranges of income pay more in social services contribution than do persons in the lower ranges of income. No means test is to he applied in respect of these benefits which are to be made available to all members of the community. The formulary includes medicines for the treatment of all kinds of diseases and complaints and the cost of such medicines is borne not directly by patients but indirectly through taxation.
Opponents of the Government’s proposals claim that this scheme will interfere with the doctor-patient relationship. That is not correct. As Senator Katz pointed out, people do not usually consult a medical practitioner, until they become ill. In that event they visit the doctor’s surgery and wait their turn for consultation. Should the doctor be the patient’s family doctor, he will be aware of the patient’s case history and after examination he will write out a prescription. The only change which will be effected under this measure will be that the doctor will be obliged to write his -prescription on an official form should the prescription in clude medicines contained in the Commonwealth Pharmaceutical Formulary. That alteration does not affect the doctorpatient relationship in any way whatever. However, opponents of the Government’s proposals claim that this scheme may detrimentally affect that relationship at some time in the future because the Government believes in the nationalization and socialization of medicine. Such terms are used as catch-cries in the hope of persuading the people to defeat the Government’s scheme. These proposals do not involve nationalization, socialization, compulsion or conscription of any thing or any one.
– Under this measure the doctor will be compelled to write his prescription on an official form.
– He will be obliged to do that only when he prescribes a medicine which is included in the Commonwealth Pharmaceutical Formulary.
– That is compulsion.
– If a parent does not send his child to school he is compelled to do so. That also can be called compulsion.
– The Pharmaceutical Benefits Bill which was passed in 1947 did not compel a doctor to write his prescription on a government form.
– In the meantime the Government has carried on negotiations with the British Medical Association but has failed to win the cooperation of that body. The doctors are still standing on their “ dig “. The great majority of them have decided to obey the instructions issued to them by the Federal Council of their association. The Government has introduced this measure because it has failed to win the cooperation of that band of political opponents of Labour. Nearly 3,000 of the doctors throughout Australia have accepted delivery of the Commonwealth Pharmaceutical Formulary, and the remainder will now be obliged to do likewise. Under this bill any doctor who prescribes a medicine which is included in the formulary and fails to write the prescription on the official form will break the law, and for such an offence he will become liable to he fined the sum of £50. I would fine any doctor who broke the law in that way at least £150, and, in addition, I would sentence him to imprisonment for three years.
– That will come later.
– No ; by this means we shall gradually win the cooperation of the great majority of doctors. In other instances persons who at first refused to co-operate with the Government have become quite enthusiastic about a procedure after they had been compelled to follow it. Once the rank-and-file members of the British Medical Association discover that their leaders have been lying to them, they will co-operate with the Government in this scheme. As yet the great majority of doctors do not realize that their leaders have not told them the truth about the formulary or that they have ‘been the victims of expedients employed by political opponents of Labour. That is the position. I trust that those doctors who have already accepted delivery of the formulary will study it. I admit that elderly doctors who have been accustomed to use the British Pharmacopoeia and certain hospital formularies, including, perhaps, the. Repatriation Department’s formulary, may be put to some inconvenience in having to ‘ study this new formulary. However, I have been informed by medical men that the average medical practitioner can readily get a grasp of it. It is true that some of the prescriptions in the formulary include proprietary line ingredients. I have been told that quite a number of doctors who have become accustomed to prescribing what I call “ drug-house “ drugs, cannot recognize the basic prescription for such drugs in the formulary. Such doctors have simply used the drug-house prescription. On one occasion a medical practitioner gave me a prescription which consisted of a dot and a figure and the name of a particular person. “When I took it to a chemist the latter simply took a bottle of medicine, a proprietary line, ofl his shelves and asked me whether I would accept that bottle immediately or whether I would prefer to have his own label put on the bottle. When I replied that the doctor said that the chemist would make up the prescription for me, the chemist said, “ This is it, but if I take off this label and put on my own label it will cost you ls. extra”. Many doctors merely prescribe proprietary lines. I am not suggesting that they get a “ cut “ in such instances, but, possibly, some of them do. That sort of thing could not happen if the doctors used the formulary. I know some doctors who have accepted the Government’s scheme and have used the formulary. The information that they have given to me has confirmed my view. However, I can also refer honorable senators to an independent source - dear old “granny” Melbourne Herald. Representatives of that journal made some inquiries from doctors who had been practising under the pharmaceutical benefits scheme since its inception. They said that the formulary was more comprehensive than had been admitted, and that it was intelligent and invaluable when properly studied. They claimed that they had greater freedom under the formulary than previously because they could now prescribe the best drugs available without considering whether or nol the patient could afford them. Outdoctor with a large practice in an industrial suburb said that he had found 994 prescriptions that he had needed within the formulary and only eight outside of it. Another doctor in a partnership in a Melbourne suburb said -
My partner and I have now used Government forms in more than 1,000 cases. This has covered the needs of more than 95 per cent, of our patients.
Another doctor quoted by the Melbourne Herald said -
You can find any drug in the British Pharmacopoeia in the formulary and it can he used within a range of doses but the drug is under its British Pharmacopoeia name not under the trade name by which many doctors recognize it.
That is the point to which 1 have directed my argument. That doctor’s statement continued -
As you use the formulary, daily you find new things in it which you did not know were there and many of these are quite expensive but therapeutically valuable.
Another doctor quoted by the Herald, who had been in practice “ since before some of his colleagues were born”, was reported to have said -
The formulary is a particularly intelligent job. Once you have got used to using it yon would not like to go back on it. Any doctor who has studied the British Pharmacopoeia will be delighted with this formulary. Now more than 90 per cent, of my patients are getting medicine, some of it quite expensive, at the taxpayers’ expense.
Those are the views and the judgments of practising doctors, who have studied the formulary and use it in their busy practices. I assure honorable senators that some doctors are exceedingly busy. The Leader of the Opposition has talked about the 40-hour week, but some of the doctors who have adopted the Government’s scheme know no limit to their working hours. There is no question of a 40-hour week. One of the doctors whom I know expends his energy and time without stint because he believes that his work is necessary for the public good. Such doctors affirm that the Government’s formulary provides for more than 95 per cent, of their patients’ needs.
The Minister announced some of the concessions that he had made to the Federal Council of the British Medical Association. For instance, he offered to widen the scope of the formulary by adding extensively to the number of drugs which could be added to the formulary ; by allowing two drugs instead of one, as at present, to be added to a formula from that list; and by allowing a choice of flavouring. I understand that the Federal Council of the association kicked up a deuce of a row about not being allowed to put flavouring in medicine. I have always been under the impression, perhaps wrongly, that if one gets something nasty from a doctor it cures more quickly than does anything that tastes sweet. At any rate, the Minister agreed to the use of flavouring substances and also offered to add, as a supplement to the formulary, drugs from a list submitted by the association, if they were not already included. I do not know whether the Federal Council has yet submitted that list. Perhaps the Minister will inform the Senate when he replies to the second-reading debate. The Federal Council also objected to certain penalties provided in regulations and kicked up a shindy about one that provided for a fine of £50. The objections were publicized in the Medical Journal. Representatives of the association in South Australia waited upon the Labour party organization in that State to protest against the regulations on the basis of that condensed and inaccurate condemnation of the Government. Afterwards, the Minister explained, both in the Senate and directly to representatives of the association, that the provision for a penalty of £50 applied only to doctors who compounded medicines in addition to prescribing them. Very few doctors compound medicines. Most of them send their prescriptions to chemists. The Minister also agreed to provide more attractive official prescription forms for use by doctors. Nevertheless, the association has shifted its ground again*
It is making a political fight of this issue, and it is going to lose the fight. It is trying to raise funds from its ownmembers, as a subterfuge, so that it will’ be able to say that doctors subscribed tothe coat of fighting the case against theGovernment. It will get funds for thefight, of course, but most of the money will come from people who are not members of the medical profession. It has’ made the fight a political one, and that is why I have been so impatient with it. The Minister has done a very good joh in continuing negotiations with the doctors for such a long period. His predecessor, Senator Fraser, also did a splendid job in trying to initiate the scheme during his term of office. The opposition to the proposal was tremendous, and it is still tremendous. I hope that doctors throughout Australia will put an end to the dispute by defying the Federal Council of their association and using the formulary. If they do so, there will be no need for the amendment submitted by the Leader of the Opposition, because they will all conform to the law of the land and at the same time will admit that they are put to no trouble in doing so. Furthermore, they will confer a great benefit upon people who need medicine.
The Leader of the Opposition said that the Labour party believed in arbitration and conciliation for the settlement of industrial disputes. In doing so, of course, he tacitly admitted that the disagreement between the British Medical Association and the Government was an industrial dispute. The honorable gentleman wants some third party to adjudicate upon the dispute. That, I contend, would be entirely wrong. There has been an insurrection by the Federal Council of the association, and the dispute is between that body and the Government. The sting of the proposal of the Leader of the Opposition is in its tail. He has moved that the bill be withdrawn and that it should not operate until mutual agreement is reached between the parties to the dispute. . How on earth could the Government arrive at a mutual agreement with the Federal Council of the British Medical Association? It is just not possible.
– What the Leader of the Opposition wants to do is to “ wipe “ the bill.
– Yes, of course. I am not prepared to “ wipe “ it or to spend one more minute negotiating with the Federal Council of the association. The Government should declare the law, and those who do not obey the law should be treated as I would be treated if I were haled before a magistrate for driving my motor car on the wrong side of the road. They should be made to pay the penalty for breaking the law. Who the deuce are these people that they should hold up the Government of the country after the electors have endorsed its desire to implement a plan for social security, including a pharmaceutical benefits scheme? Who are they that they should try to stop the wheels of progress ? They are a lot of incompetent insurrectionists. They are of the same school as those incompetent Communists that the Leader of the Opposition is always kicking up a row about. They are trying to upset the Government so that they may have their own way and dictate what the people should have after the people have made their wishes known. I hope that the Minister will go on with the- job and implement the scheme. I suppose that the dispute will come before the High Court, but the doctors will be fools if they carry it to that stage. The fight will cost them a tremendous amount of money. They would be better served if they co-operated in the scheme, irrespective of the attitude of the Federal Council of the British Medical Association. If they, did that they would show that the Government was right and that the council was wrong.
– I am happy indeed to speak in support of this bill to amend the Pharmaceutical Benefits Act. It is one of the most important measures that we have had to consider. It provides that the pharmaceutical benefits scheme, as originally proposed and as decided upon by the Government, shall be made law and that the people shall receive the benefits that the Government intends them to receive. The pharmaceutical benefits scheme is an important part of the Government’s social welfare plans, the completion of which will do much to ensure the economic security of the people of this country. One can only expect opposition to legislation of this kind from the anti-Labour forces in this Parliament. In a way, I am sorry that the Opposition in this chamber has not sufficient numerical strength to ensure a more lively debate. I am indeed sorry for the Leader of the Opposition (Senator Cooper). He made heavy weather of his task. The honor able senator referred to his association with the Social Security Committee, and from what I have heard of his activities while a member of that committee, the Senator Cooper of those days was behaving much more naturally than is the Senator Cooper of to-day, whom we have heard propounding the Liberal party and the Australian Country party interpretation of this Government’s legislation.
– He was not the Leader of the Opposition in those days.
– I see the point. Perhaps if he were not Leader of the Opposition in this chamber to-day and, by virtue of that office, compelled to lead the attack on this measure, he would be happy to remain silent. In the days of the Social Security Committee, the honorable senator expressed wholehearted sympathy with the Labour Government’s views on social welfare. It is interesting to recall some events in the history of the medical profession. Until early in the seventeenth century, medical treatment for almost any ailment was bloodletting. That was regarded as the cure for all diseases. About 1628, Harvey discovered that blood was pumped through the body by the action of the heart, but when he proclaimed his discovery, the medical men or witch doctors of those days were very annoyed indeed at him for tampering with their profession. In fact, so hostile was the attitude of medical men to advances in medical knowledge that I am convinced that had Harvey made his discovery perhaps 50 years earlier, he would have ‘been burned at the stake for witchcraft. History offers many examples of the manner in which the conservativeminded medical profession has striven to hinder the progress of medical research. I can remember when Louis Pasteur discovered that the process now known as pasteurization killed many germs and could minimize the spread of some diseases. Prom whom did the most violent opposition to that discovery come ? It came from the medical profession. So antagonistic were the doctors of those days that they would have shot Pasteur had they been able to do so with immunity. Whether their opposition was based upon the belief that discoveries such a3 that of Pasteur would lessen the amount of sickness in the world and so reduce their opportunities for extortion, I do not know. The discovery of anaesthetics is remembered by many people. At first the use of anaesthetics was hotly opposed by the British Medical Association. Doctors believed, apparently, that they should continue in the old “ saw-bones “ style, with the tourniquet and the knife. The use of anaesthetics became popular only after the then Prince of Wales, later King Edward VII., had undergone a successful operation at which an anaesthetic was used. Recent “ heresy hunts “ conducted by the British Medical Association include those associated with the activities of Sister Kenny and John Braund. Whilst those people may not have been able to achieve all that they claimed, they did achieve something. They should be encouraged to practise their arts. Medical research should be encouraged, provided that it is not detrimental to the community.
The Leader of the Opposition said that national health was a matter for the community. I agree with that wholeheartedly. And who represents the community? Are not members of this Parliament representatives of the community? Of course they are. Therefore, the welfare of the people is a matter for the Parliament, and the responsibility to safeguard the health of the nation rests upon whatever government is in office. No government has the right to shelve that responsibility. During the last century, a substantial contribution to the maintenance of good health standards has been made by the friendly societies. Until now they have shouldered a responsibility which rightly should have rested upon governments. I have the highest regard for the work that the friendly societies have done. I raise my hat to them; but we are taking another step in the march of progress. There is in office in this legislature a government that is prepared to shoulder all its responsibilities. That means that much of the work hitherto done so efficiently by friendly societies will be carried out by the Government. The need for the splendid heroic sacrifice and voluntary effort that have been characteristics of the work of friendly societies will no longer exist once this Government’s social security plans have been completed. The Leader of the Opposition has suggested another conference. There have been many conferences. I, for one, have believed for a long time that appeasement of the Federal Council of the British Medical Association has been a mistaken policy, but the constant insistence of the medical profession on conference after conference seems now to be to the Minister’s advantage. When the first formulary was- compiled - the predecessor of the present Minister for Social Services was then in office - it contained approximately 167 items. As the result of subsequent conferences sought by the British Medical Association, that number was increased to about 334. Since then, more conferences have been held in an effort to have other drugs and medicines included, with the result that, to-day, there are more than 600 items on the formulary. The object of the British Medical Association, of course, in pursuing these tactics, has been to break down the resistance of the Minister, but now we find that the greatly expanded formulary has strengthened the Minister’s position considerably because doctors will find it extremely difficult to prescribe any medicine that does not contain at least one of the 600 items specified in the formulary. The British
Medical Association has been hoist by its own petard. All that the Government need do now is to take a firm stand and make it mandatory, as is proposed in this legislation, for any doctor who prescribes a medicine containing a formulary item, to do so on the prescribed form. When the original Pharmaceutical Benefits Act was proclaimed, Dr. Hunter, who is the modern counterpart of the arch-priest of witch doctors in the olden days, instructed his followers that the letters sent by the Government announcing the inauguration of the pharmaceutical benefits scheme should be returned unopened. In many cases that was done.
Silting suspended from 5.58 to 8 p.m.
– At the suspension of the sitting I was discussing the high panjandrum of the medical profession, :and the Leader of the Opposition inquired lo which doctor I was referring. I agreed with him that the individual concerned was something of a “witch doctor That gentleman has only to utter an edict or wave a wand and the members of the British Medical Association jump to attention. It is against that individual, and not against the British Medical Association as a group of individuals, that I direct my remarks. I desire to emphasize now that any criticism of the members of the British Medical Association that I have occasion to make is not intended to apply to all the members of the medical profession in this country. For instance, my own family doctor is a man whom I admire. Unfortunately, we frequently argue because our political views do not coincide. He, like most members of his profession, is utterly conservative in his political views. In fact, I think that the doctors and the lawyers are the two most conservative groups in the community. The Leader of the Opposition said that the doctors were not un-co-operative. I join issue with him on that statement, and say that they are most un-co-operative. The Minister for Health has tried by every possible means to win their co-operation, and he has appeased them to a point that has disappointed - I almost said disgusted - supporters of the Government The intransigence of the British Medical Association has made it necessary for the Government to introduce the legislation now before us to amend the Pharmaceutical Benefits Act. Of course, members of the medical profession are conservative and un-co-operative not only in matters of local concern but also in international matters. During the war I met scores of doctors from overseas, many of whom had graduated with distinction through some of the finest medical institutions in Europe and America. However, in Australia they were treated like probationers by the British Medical Association and were required to spend several years in study in Australian universities. Many of them rebelled against such treatment and left Australia, and we have been deprived for ever of their very valuable services. Their exit from this country was due directly to the conservatism of the local members of the medical profession. As a whole members of that profession are not merely utterly conservative, but are also hopelessly backward. Before the dinner adjournment I pointed out that down the years from 1628, when Harvey first announced that human blood was circulated through the body by the action of the heart, to the present moment they have consistently opposed social progress. At the present time there is no doubt that they are dominated by their high priest or “ witch doctor who seems to “ run the show That individual also appears to be fascistminded.
The Leader of the Opposition wasted quite a lot of sympathy on the doctors when he dealt with the penal provisions of the bill which are intended to be applied to doctors who do not comply with the present act. Indeed, when he referred to the penal clauses his voice almost choked with sobs. He said that the present Government had never invoked the penal clauses of any legislation when it was confronted with opposition from industrialists. First of all, he said “ never “, and then, when he realized that he had based that assertion on false premises, he shifted his ground to say that it had not invoked penal provisions on many occasions. Apparently the honorable senator believes that the doctors and some other groups in the community should frame their own laws.
– The miners do.
– That is precisely what I object to about them. .They are simply a group in the community. The .first .responsibility of any administration is to look after the welfare, not of groups or sections, but of the whole community. In common with other members of the Australian Labour party, I deny to the miners or any group of individuals the right to usurp the functions of the Government. Unfortunately governments of the past have not always accented their responsibility to look after the welfare of the whole community. The provision of medicine and pharmaceutical services is a good example of that. Instead of previous administrations shouldering their responsibility to provide pharmaceutical benefits for the community, it was left to friendly societies and other humane organizations which have the welfare of the sick and the poor at heart to provide pharmaceutical services for those who could not afford to pay the very high prices charged for them.
One of the statements made by the Leader of the Opposition seemed to me rather strange, in the light of our knowledge of this subject and in view of the discussion that has taken place on the provision of pharmaceutical benefits. He said : “ Six thousand doctors cannot be wrong “. Of course, that statement is based on a false assumption, because 117 doctors are now co-operating with the Government in the pharmaceutical benefits scheme. However, the point I desire to make is that of the remaining doctors 3,200 did not read the communication which the Minister for Health had sent to them. They did not even open the envelopes in which his circular letter was contained. That is an indication of the power wielded by their “ witch doctor “, who has only to crack his whip for them to spring to attention. What sort of men are these 3,200 individuals who did not even read the communication that had been especially addressed to them by the Minister? Of course, members of the British Medical Association do not mind being referred to as law-breakers, but they are very concerned at the thought that they may be punished for breaking the law. The 3,200 doctors who returned unopened the communications which had been addressed to .them by tie Minister are virtually sheep who are following a bell wether. In this instance the bell Wether is named Hunter. I think that it is time that we brought them to heel.
As I ‘have said the Leader of the Opposition expressed a great deal of sympathy to the doctors and extolled their services to the community. He paid a special tribute to the services rendered by the Flying Doctor, Who visits remote parts of the hinterland at considerable risk to himself. We are all agreed tha’t the gentlemen who have operated the Flying Doctor service have performed a Wonderful service for the community. 1 shall disgress for a moment to mention that I was approached some time ago on behalf of the Flying Doctor service to use whatever influence I possess with the Minister for Air to obtain for the Flying Doctor service one of Hie disused aircraft that were formerly operated by the Royal Australian Air Force. The organizers of the Flying Doctor service Were prepared to pay a reasonable sum for the purchase of an aircraft. I point out that if the Government Were administering the medical and pharmaceutical services of the community there would be no need whatever for private individuals or organizations to go Cap in hand to the authorities in order to obtain aircraft or other requirements. A properly organized service would cater for the needs of sick people outback, and they would probably be provided for much more liberally than is possible under the present arrangement.
I do not intend my remarks to he taken as a criticism of all the members of the medical profession. Nevertheless, I have nothing but disgust for certain actions and comments of some members of that profession. The Leader of the Opposition, when referring to the penal clauses of the bill, mentioned adversely the coalminers. I recall that exactly 42 years ago I had occasion to visit a specialist in London, who Was also a titled gentleman. I went to him because I was suffering from a hernia. Of course, the surgical treatment of a hernia is regarded to-day more or less as a “ plumber’s job “ because the surgical technique was been perfected by long experience. However I went to the specialist because, at that time, it was necessary to obtain expert treatment for my complaint. At the time I was not prepared to undergo a surgical operation because, in company with 5,000 others, I was on strike against the premium bonus system which had been introduced at the works of Vickers, Son and Maxim at Erith, England. The surgeon said: “You had better go straight into the hospital “. I replied : “I am afraid that I cannot enter hospital for a week or so “. He said : “ Why can you not enter hospital now ? “ I said: “ I am out of work, because I am on strike with the other employees of Vickers, Son and Maxim “. He said : “ So you are one of the so-and-so fellows who are holding up industry! Do you know what I would like to do with you? “ I said: “I can guess”. Eventually, I underwent the operation and everything associated with it. I mention the incident now simply to illustrate the attitude adopted by prominent members of the medical profession towards industrialists. Whenever a strike occurs members of the medical profession generally, and other doctors with whom 1 am acquainted, are prepared almost to shoot the strikers. Possibly, the only reason that they do not do so is that they realize that certain “ penal clauses “ for murder would be invoked against them. However, they would certainly like to stand the strikers up against a wall and do away with them. That leads me to inquire into the attitude at present adopted by the doctors themselves. What are they doing? Not only are they on strike, but they have persuaded advocates, such as the Leader of the Opposition, to create a clamour about the penal clauses provided in this measure. I think that their attitude is absolutely ridiculous. Who amongst those of us who are parents, and have heard children crying because of toothache, does not feel inclined to take a revolver and shoot half a dozen doctors? I do not know how many honorable senators have felt that inclination, but I can assure theSenate that I have. Modern medical practice dates from Harvey’s discovery of the circulatory blood system in 1628, and, during that period, members of the medical profession have not been able to discover even how to ameliorate the pangs of children’s tooth ache. Of course, I may be wrong in uttering such criticism, and I may “ have the wrong slant” on the matter; nevertheless, the fact I have mentioned is, to me, an indication of the ignorance of members of the profession. On every occasion that a progressive social step has been suggested it has been opposed by the British Medical Association. I am glad, therefore, that the Government has determined to stiffen its attitude towards that body.
I listened with considerable pleasure and satisfaction to the second-reading speech made by the Minister for Health, who introduced this measure. The matter contained in that speech was properly compiled, and the speech itself was splendidly delivered. I envy the Minister the fact that his name will go down in history as the organizer of this measure. I realize that the British Medical Association will invoke all the legal aid it requires for its effort to defeat the measure, and it will also call upon all the other powerful resources at its command. However, I liken the efforts which it will undoubtedly make to an attempt to stem a torrent with a straw. I commend the bill and express my congratulations to the Minister on the manner in which he presented it. I can assure those who take the trouble to listen to his speech in reply that they will not be disappointed.
– During the debate on this measure the Leader of the Opposition (Senator Cooper) spoke with two voices, first as a member of the Social Security Committee, when he said that he agreed with the terms of the Pharmaceutical Benefits Act, and secondly when he had to obey that side of his nature that is subservient to those people who, for political reasons, wish to oppose and frustrate the policy of this democratically-elected Government. The opposition to this measure by the British Medical Association amounts to organized sabotage of legislation that has been passed by this chamber. In this instance the letters “B.M.A.” stand more for the “Beat McKenna Association “ than anything else. The British Medical Association seems to have only one idea, which is to defeat this measure and the national health scheme in general. It seeks to frustrate the attempts of this Government to improve the standard of living of the people of this country, which is the object of this measure. That the Leader of the Opposition should support the attitude of the British Medical Association is a very sad state of affairs, because as a member of the Social Security Committee, Senator Cooper made some constructive contributions. Were it not for political reasons I am sure that he would oppose, the attitude of the British Medical Association as whole-heartedly as do we on the Government side of the chamber. The attitude of the British Medical Association throughout has been to maintain a steady pressure against this Government merely because of its political colour. It is no tribute at all to the Leader of the Opposition that he should move an amendment seeking the appointment of an impartial body to inquire into this matter. We cannot forget the story behind the negotiations. la 1943 the previous Labour government decided that those members of the community who were sick and needed medical aid should be entitled to receive it without being burdened with the worry of payment. ‘Senator Fraser, who was then Minister for Health, invited the British Medical Association to shape, design, and fashion the Commonwealth formulary. Although the Government asked the British Medical Association to do that, the association declined the opportunity to submit a panel of names of people to do the job and cooperate. Bight from the start it has shown no signs of co-operation in connexion with this measure. The fact of the matter is that the British Medical Association has decided that it will not co-operate with a Labour Government. Nothing is more certain than that. Most of its submissions in respect of its objections to the original measure have been granted practically in toto. Every time that there have been negotiations between the Minister and the British Medical Association, a new crop of obstructions has been raised. To debate this matter on humanitarian lines is futile. Most people admit readily that a measure such as this is essential in connexion with modern society, and that when people are sick and need medicine they should be relieved of the burden of payment. But how far can a democracy and a democratic Government allow a small privileged section of the community to obstruct its path to progress? That is the issue at stake. I contend that had the doctors who are members of the British Medical Association been given an opportunity to form their own opinions on this matter, a greater measure of co-operation would have been forthcoming from them. However, right from the start they have been dominated by the Federal Council of the British Medical Association.
– Mostly by one person.
– They were told that even if they held opinions different from those of the executive of the British Medical Association, it was expected of them that they should oppose the measure. Since 1943 there has been a series of meetings with a view to conciliation. When opposition was raised by the friendly societies in 1945, the act was amended. That was conciliation from another point of view. In every way possible this Government has tried to meet the people whose co-operation is essential for the successful operation of the Pharmaceutical Benefits Act. The Leader of the Opposition said that we need conciliation in connexion with this matter, but how much farther can we go with conciliation? The Minister for Health is the quintessence of reasonableness. In fact I do not know of any other man who would be as patient as he has been in dealing with this and other matters. As I have already said, in 1945 amendments were made to suit the purposes of the friendly societies. At that time it was plain that the social services of this country were in jeopardy, particularly after the British Medical Association had successfully challenged the legislation before the High Court. Conciliation was then invoked, and the majority of the people of Queensland, the State that Senator Cooper represents, and a majority of the people of the other States, were of the opinion that they should receive these social services.
– There was no opposition to it.
– I suggest that if the Leader of the Opposition were to carry out the wishes of the people that he represents he would support this measure. He has merely drawn red herrings across the trail for the purpose of frustrating the Government’s efforts and obstructing this legislation, because it has been introduced by a Labour government. He has said that conciliation should be introduced into this matter. Originally the British Medical Association objected to the use of the formulary, the constitution of the Formulary Committee, and the clause that provides a penalty for a doctor who prescribes under the scheme without making a personal examination of the patient. Right throughout the history of this scheme this Government has met representations of the British Medical Association, but that association continues to raise obstructions. The time has now arrived when this Government should know exactly where it stands. As an organization, the British Medical Association has set itself up as a pressure group whose members wield power far above their status in society. They are holding the people to ransom. Certain sections of our community are very much in need of the benefits that will be available to them under this measure, and by depriving the people of such benefits the British Medical Association is carrying out pressure tactics which should not be permitted. The introduction of this measure is the culmination of a series of conciliatory moves on the part of this Government in its dealings with the British Medical Association. After a long period of conciliation, however, that association has been found to be immovable. Had such obstructionist tactics been adopted by any other section of the community we should have heard loud cries from the Opposition and from the doctors to deal with it drastically. Its members would have been called Communists, which apparently is the term applied to every one who opposes any one else. It is indeed regrettable that this section of the community, which, has been assisted and sponsored by government institutions down the years, is now in such a position that it can hold other sections of the community to ransom. I consider that the doctors are lacking in a sense of social responsibility in this instance. It has been claimed that because the people have not organized themselves to make claims on the doctors, the people in general do not want these benefits. I point out, however, that usually it is not until people are sick that they seek medical attention. When people are sick they are incapable of organizing for themselves. The people do not know when they may become suddenly ill and require the assistance of responsible people. In this instance the Government is the responsible authority that seeks to ensure that when they are ill and cannot afford to purchase medicine, they will be able to obtain whatever is necessary to restore them to health. It has also been said that this measure seeks to provide something for nothing. It must not be forgotten that most of the knowledge that the doctors possess is as a result of experiments, and has been made available to them by people who have been very socially minded. We must remember that such famous people as Curie, Pasteur and Lister gave much valuable information to the medical profession for nothing. It is indeed a sad commentary on this generation of doctors that they are breaking the long tradition of the medical profession by seeking to withhold from the people something that they have the privilege to dispense for them, and to which the people are entitled. The story of medical research is a record of unselfish achievement in the interests of suffering humanity. The obstructionist attitude adopted by the British Medical Association in this matter sets a very bad precedent indeed in the medical profession. The Leader of the Opposition has submitted an amendment in which he proposes that an impartial body should be set up to arbitrate between the Government and the British Medical Association. However, as Senator O’Flaherty has pointed out, the honorable senator gave no indication whatever that the British Medical Association would be prepared to abide by the findings of such a body. Apparently, the amendment has been proposed merely to delay the passage of the measure, or in an attempt to> frustrate further the Government’s’ efforts; to implement this, scheme.
– The Minister stated that the measure will not be proclaimed for some, time;
-The measure will1 be1 proclaimed as- soon- as the Government finds it practicable, to do so. However, it is useless for the honorable senator to propose such an amendment when there is not even any likelihood of the British Medical Association being prepared to compromise in any way with the Government. When any section of the community endeavours to defy the law of the land to the disadvantage of another section of the community, the Government must implement the law. The Leader of the Opposition suggests that the Government should renew its negotiations with the British Medical Association. I remind him that over a long period the Government has made every effort to overcome the objections raised by the association, but, invariably, the Government’s efforts have been negatived by the British Medical Association. We are now convinced that it is useless for the Government to continue such negotiations. The matter has been brought to a head by the introduction, of this measure, after a delay of nearly six years. It is now clear that the time of the Government and of the Parliament should not be wasted further in attempts to conciliate the British Medical Association.
Many doctors agree that this is a good measure. Therefore, the Government would not be justified in tolerating any longer the “ tit-f or-tat “ methods of the British Medical Association. The Government must not yield to any pressure group in the community. This measure has everything to commend it and it has now been introduced only because of the failure of the Government negotiations with the British Medical Association. It it clear that the association is opposing the scheme purely for political reasons. No justification exists for the amendment of the Leader of the Opposition. This measure and the principal act are parts of a great charter which the Government envisages for the benefit of the people* as; a whole-. It. promised’ the> people that it would implement such- a charter,; These’ benefits will also, tend to. improve the. standard of living of the* community ‘by increasing the purchasing power of persons who are really in need! of this kind of assistance. The proposals, embodied in the measure are also a part of the Government’s charter to provide, full employment and to increase produc-tion. When people are relieved of the fear that; they will not, be- able to- afford! tha cost, they will he induced to seek medical assistance in the early stages of complaints’, audi diseases. Under such a system a greater proportion of people will be enabled to remain at their work benches for longer periods. I could deal with many other aspects of the Government’s proposals, but I shall not delay the Senate further. This measure would he endorsed by every humanitarian. I commend the Government for resisting the opposition of a political pressure group whose objective is to frustrate the policy of the Government and the will of the people.
– It is not very often that one is moved to pity for one’s political opponents, but when the Leader of the Opposition (Senator Cooper) was speaking I felt pity for him because it was clear that his opposition to the measure was only half-hearted. He introduced much extraneous matter. He commenced by admitting that the health of the community is of paramount importance. He stated that the Government should make a fresh approach to the British Medical Association in an effort to meet the objections raised by that body. However, as previous speakers have pointed out, the Government has been trying over a long period of years to conciliate the British Medical Association in order to obtain the co-operation of that body. The Leader of the Opposition said that he had no doubt that the formulary and the scheme generally had been fully considered by every individual doctor. That statement is not correct, because the Minister for Health (Senator McKenna), in his second-reading speech, said that the Federal Council of the British Medical Association had advised doctors right from the start to stay outside the scheme and to refuse to accept delivery of copies of the formulary and official prescription forms. Judging from the number of doctors who took that advice it is clear that practically 50 per cent, of medical practitioners throughout Australia have not even seen the formulary or the official prescription form. The Leader of the Opposition also contended that the Government’s case had been built up by departmental officers. Of course, it is not unusual for the Opposition parties to use that argument in an attempt to discredit Ministers. He also said that the public are most concerned about the Government’s attempt to implement this scheme. The doctors have not consulted the public upon the matter at all, although the people have shown in no uncertain manner that they support the scheme. The Leader of the Opposition also said that no body of patients had demanded these benefits from their medical advisers. As previous speakers have pointed out, no patient is in a position to argue with his medical adviser that he should have his prescription dispensed free of cost. In 90 per cent, of instances, patients approach their medical advisers with a certain degree of awe. The last thing a patient would do in the course of a consultation would be to argue with the doctor that he, or she, should enable a patient to have his, or her, prescription dispensed free of cost. The rank and file members of the British Medical Association have not been consulted by their leaders in this matter. A number of general practitioners have told me that they have not received any advice from the Federal Council of the association of the details of the scheme. The council has acted dictatorially. If trade unionists acted in a similar manner they would be branded as “ fifth-columnists “ and “ saboteurs”, and, no doubt, the Opposition parties would say their actions were dictated by Moscow. I believe that the vast majority of doctors throughout Australia would be quite prepared to co-operate with the Government in implementing this scheme were it not for the dictatorial attitude adopted by the Federal Council of their association. To-day’s Melbourne Sun publishes an article headed - “Three choices” for ddoctors, B.M.A. says: “War” Move.
Apparently, the British Medical Association in order to impose its will upon the Government is prepared to declare war on the Government. The article says -
Doctors under the amended Pharmaceutical Benefits Act would be faced with three choices, the general secretary of the British Medical Association (Dr. J. 6. Hunter) said to.night. These were: Acceptance of Government direction, breaking the law and jeopardizing patients’ lives. . . .
The Government has not attempted to direct the doctors. As the Minister pointed out, a doctor is completely free either to come into the scheme or stay outside it. A doctor who comes into it is not bound by the formulary if his conscience and medical judgment dictate the prescription of something that is outside it. The only thing that the Government insists upon is that if a prescription includes any medicine contained in the formulary the doctor must write the prescription on the official form. That provision is made in order to avoid the abuse of these benefits, and the possibility of forgeries 1< persons who attempt to obtain costly and dangerous drugs which they are not authorized to receive. It must be remembered that a person who obtains a prescription from a doctor in any city or town, can have that prescription made up in any other city or town in the Commonwealth. The second alternative the British Medical Association says is “ breaking the law “. That implies that rather than co-operate with the Government the association is prepared to break the law. The third alternative, which is somewhat astounding in its implications, is stated to be “jeopardizing patients’ lives “. The inference to be drawn from that statement is that unless the British Medical Association gets its way and the Government bows to it, the doctors would be obliged to jeopardize patients’ lives. The article continues -
A move will be made at the British Medical Association’s general meeting here next Sunday to launch a fund to challenge the validity of the amended act, if necessary. 1 contend, as do all right-thinking people, that the Government’s chief concern is for the welfare of the people. That is why it is determined to bring to fruition the scheme for which the bill provides. The doctors, in contrast, apparently have no concern for the people. They only want to get their own way. The welfare of the people is a subordinate consideration. The report continues -
In introducing the original bill, the Government’s spokesman had said : “ There will be no compulsion of medical practitioners or pharmaceutical chemists to take part in the scheme “.
The Minister pointed out in his secondreading speech that doctors will be completely free to come into the scheme or to stay out of it. Therefore, Dr. Hunter was absolutely wrong when he said, as reported -
But if the amending bill became law it would be impossible for individual doctors, if they wished to remain free of Government control, to prescribe any life-saving drug unless in so doing they were prepared to break the law.
That is another amazing statement. It implies that a doctor could not prescribe any drug not included in the formulary without breaking the law, whereas the truth is that doctors may prescribe outside of the formulary whenever they wish to do so. The only point upon which the Government insists is that any prescription from the formulary shall be written on an official form. The report goes on to say-
The provisions of the bill were so coercive and so strongly antagonistic to the people’s interests as patients that it might be doubted whether it would ever come into force, even if passed by Parliament, Dr. Hunter said.
There is little need to comment upon that statement. All reasonable persons will agree that the people should at least be allowed to decide whether or not they shall obtain free medicine under the Government’s scheme. If democracy means anything in this country, then the people, not the British Medical Association, have the right to state whether they shall have free medicine or not. The statement continues^ -
From time to time during the past twelve months, the British Medical Association had warned the people u rough the press of the unfavorable consequences of the Commonwealth Government’s health policy.
That also shows that, regardless of the expressed will of the people and the determination of their democratically elected Government, the association takes unto itself the authority to “ warn “ the people through the press of the consequences of this measure -
The people had heeded those warnings, and, accordingly, had shown little desire for the Government’s schemes.
That shows that the association is endeavouring to mislead the people by the use of organized propaganda through the press. No doubt it will also resort to the use of radio broadcasting to tell the people that they themselves do not want the scheme, even though they have not had the opportunity to benefit under it. The article in the Sun continues -
The Pharmaceutical Benefits Act already had been as much a failure as the National Health Service Act promised to be. At thin point it would have been wiser to have stopped and surveyed the whole ground again.
In spite of the protracted negotiations between the Government and the association in an effort to secure the co-operation of the doctors, Dr. Hunter makes the negative declaration that the whole scheme should be set aside so that the Government’s proposals could be studied again ! Dr. Hunter is also presumptuous enough to believe that he knows the views of rank and file members of the Labour party caucus. He said -
But in spite of doubts as to the wisdom of the scheme raised by the rank and file of caucus, whose constituents generally had supported the doctors, stand for freedom, the Government was proceeding by amending legislation to force doctors under its control.
That was a barefaced attempt to convince the people that there was dissension, or at least dissatisfaction, amongst members of the caucus concerning the implementation of the scheme.
– It was a deliberate lie.
– There is not the slightest opposition to the scheme from any member of the caucus. Every member is 100 per cent, behind the Government in its determination to implement this most necessary reform.
The Leader of the Opposition raised the hoary subject of the doctor-patient relationship. The Aunt Sally that he set up has been knocked down so often that it is scarcely necessary for me to deal with it now. The honorable gentleman has been told more than once that there is nothing in the bill that will interfere in the slightest degree with the relationship that now exists between patient and. doctor. The honorable senator made a very half-hearted and spineless attempt to justify the attitude of the British Medical Association. Had any trade union adopted a similar attitude towards any government scheme, its members would have been branded by the Opposition as Communists, fifth columnists, saboteurs and goodness knows what else. The Government has gone to the extreme limits of patience in its efforts to secure the happy and contented co-operation of the British Medical Association, but all of its appeals have fallen upon deaf ears. It is obvious that the association is still irrevocably opposed to the introduction of the scheme ,by this Labour government and that its opposition is entirely of a political character. That was made evident ‘by the instruction issued by the Federal Council of the association to its members to stay outside the scheme and not even accept the formularies or study the scheme. The nature of the resistance organized by the Federal Council is further emphasized by a letter that was sent on its behalf to all members. That letter contained the following statement : -
If any member is still unconvinced of the wisdom of the Federal Council’s attitude, it is nevertheless confidently hoped that his sense of loyalty to his fellow members will ensure that the 1st June will find the medical profession throughout Australia united against what the Federal Council considers as an utterly unjustifiable attempt to place every doctor in the Commonwealth under government control.
The Federal Council was quite prepared to invoke the loyalty of association members in order to secure their opposition to the scheme, even against their own inclinations.
The Labour party’s efforts to implement a widespread scheme of social services for the people of Australia have been going on since 1943. Honorable senators will recall that a pharmaceutical benefits scheme was introduced in 1945, but was challenged in the High Court by a section of vested interests in Victoria. The appeal was successful, and the legislation of 1945 was declared to be ultra vires the Constitution. But at the referendum in 1946 the people gave the Government an unmistakable mandate to implement its social services policy. Not only did they vote overwhelmingly in favour of that policy, but also they returned the Labour party to power with a record majority. There is no justifiable opposition to the free medicine scheme. The statements made on behalf of the British Medical Association about compulsion and coercion are contradicted by the bill itself. An examination of the measure shows that there is no provision for compulsion. The Government was elected by the people to give effect to the will of the people, not to obey the dictates of an organization such as the Federal Council of the British Medical Association. The people are entitled to the services for which the bill provides and for which they voted so overwhelmingly in 1946. We must not be thwarted by the Federal Council of the association. The will of the people must prevail. In all- of its propaganda against the scheme, the association has never referred to the welfare of patients. It has talked about the “freedom of the doctor”, which, according to its arguments, means the freedom of the doctor to prescribe on whatever form he wishes. The Government insists that prescriptions from the formulary must be written on government forms solely for the purpose of safeguarding the people from abuses of the scheme by certain individuals who- would be prepared to obtain expensive and dangerous drugs by forging doctors’ signatures on stolen letterheads. Under the system proposed by the Government, with numbered official forms, it will be possible to maintain proper control and supervision of the issue of drugs. However, the Government has gone out of its way in order to meet the wishes of the doctors. There is nothing to prevent a doctor from having his own name and address, &c, superimposed on the Government’s prescription form. The Federal Council of the British Medical Association is not concerned with the urgent needs of people like age pensioners who need medicine. Thousands of people throughout Australia, apart from pensioners, would be in a much better state of health than they are in to-day if they were able to benefit from the free medicine scheme. At present, many of them are not able to obtain adequate medical attention for ailments of a serious character. The Opposition has protested against the scheme, not as the result of the dictates of conscience and justice, but on behalf of the British Medical Association.
– Who told that to the honorable senator?
– We all know it. The Opposition has professed great faith in Gallup polls. As it is so certain of the efficacy of that method of testing public opinion, I refer it to the result of a Gallup poll recently conducted throughout Australia, which showed that 58 per cent, of the people were in favour of the free medicine scheme. In the light of that result, honorable senators opposite must concede that they state an untruth when they say that the people do not want free medicine. This Government was returned to office with an overwhelming majority and a mandate to implement social services, and it is determined to carry out the task for which it was elected. The people of this country have declared unequivocally at the polls that they want social services. This Government is not going to fall down on its job. It will not allow itself to be dictated to by any organization such as the council of the British Medical Association. If that body is to oppose the Government, then it must be dealt with as we would deal with any other organization or group of individuals which defied the law of this land. We are determined to implement the will of the people. The people have declared unmistakably that they want social services. Labour is determined, as it has always been during its term of office dating from 1941, to honour its undertakings to the people of this country, and we intend, therefore, that the people shall have what they deserve, =and what they have asked for.
– I agree whole-heartedly with everything that has been said in -condemnation of the political and professional opposition to the pharmaceutical benefits scheme. It is inevitable, of course, that in a change as momentous as that involved in this portion of the Gorvernment’s social services programme, there must be some interference in the lives of some individuals, and that of course will inevitably lead to criticism of the Government’s proposals. I pay a tribute to the persistency, tolerance and patience of the Minister for Health (Senator McKenna) in his negotiations with the British Medical Association. Events that have occurred since knowledge of the Government’s intention to give effect to the expressed will of the people became public property, have emphasized the Minister’s patience and tolerance, for which I commend him most sincerely. The Government’s intention to legislate for the benefit of the people has been criticized repeatedly in the press by interested parties, but, as I have said many times in this chamber, a government that does not regard the welfare and health of its people as its prime consideration, is not worthy of the name. I do not wish to be misunderstood. I have frequently expressed my appreciation of the great national work that is being done throughout Australia by individual members of the medical profession. I know that, at heart, they are just as good Australians, and just as charitable and loyal to their trust, as is any other section of the community. Senator O’Flaherty struck a new note when he mentioned the association between the drug houses and leading specialists and doctors. The honorable senator stated the position tersely and accurately. There is some overlapping of the interests of the medical profession and those of the purveyors of medicinal preparations, just as there are certain common interests among other commercial enterprises. I sincerely! trust that the apparent obstinancy of the British Medical Association will not persist. I refer specifically to the British Medical Association and not to the medical profession generally, because there are non-practising doctors throughout the Commonwealth who, in various governmental services and undertakings, are carrying out valuable national work. I hope that at a not far distant date, the main point of issue between the Government and the British Medical Association will be settled, and that the spirit of co-operation which the Government so earnestly seeks from medical men will be forthcoming.
I propose to treat the subject-matter of this legislation from an entirely different viewpoint from that taken by other honorable senators. I feel sure that after I have revealed to the Senate the mass of information that I have gleaned on this subject even Opposition senators, and perhaps the press, will realize how interwoven are its various aspects, and how important the whole matter is to the welfare of any nation. Quite enough has been said by supporters of this measure about the hostility of the British Medical Association and the press to the pharmaceutical benefits scheme. I have long contended that in any country in which the system of responsible government operates, the utmost cooperation is essential between medical men, the dispensers of drugs, and the government, in the national interest. After all, it is the responsibility of every government to care for its people, and this nation, young as it is, is not different from older civilizations which have perished because of the lack of the co-operation that I have mentioned. I have with me, through the generosity and kindness of some of my friends whoare interested in this momentous legislation, a copy of the report of the royal commission on secret drugs, cures, and foods which was ordered to be printed by the House ofRepresentatives on the 8th August, 1907. I propose to read extracts from the report and when I have done so, I shall ask honorable senators to consider whether the position is very much different to-day from what it was at the time the report was made. The report is most comprehensive. The royal commissioner was appointed to inquire into the following matters: -
Although in some respects, and probably as a result of this most damning report and subsequent legislative enactments, there has been some slight improvement in the position, even a cursory inquiry reveals that the very people whom the report condemned, are continuing their activities with the same persistence and effrontery as were so much in evidence when the commission conducted its investigations. I remind the Senate that the Australian taxpayer subsidizes the education of medical men by maintaining universities and other institutions of learning. On that score alone therefore doctors owe some responsibility to the country that has made it possible for them to practise their profession. Some of the matters to which I shall refer are not pleasant, but they are of such importance not only to the people of the Commonwealth, but throughout the world that I shall not shirk from repeating them. AgainI stress the necessity for cooperation between the Government and the learned men of the medical profession, many members of which are not engaged in private practice, but, because of their Christian sense of duty to the nation, are doing such magnificent work on the preventive rather than the curative aspect of disease. Honorable senators may be astonished to find that views such as those so forcibly expressed in this report, were held even as far back as 1907. I ask honorable senators to bear with me while I read extracts from the royal commission’s report and then to ask themselves honestly whether the position to-day has greatly improved. The report states : -
The practice of interferences with the sexual function is so common, and the knowledge of it so universal that it would be thinnest hypocrisy upon the part of any grown persons to pretend that modesty may be shocked at considering its causes and consequences.
Is that not one of the greatest scourges in this land to-day? Yet its effects could be overcome substantially by close cooperation between the medical profession, drugs manufacturers, and a government which had the interests of its people at heart. The report continues -
The Lancet, of June, 1008, page 1839 remarks -
A most able and veracious physician has truly asserted that “ quackery has destroyed more in this country (Great Britain) than the sword, famine, and pestilence united,” and never was there a period in the history of the British medicine at which the force and truth of this1 opinion was more obvious than this day.
The point I wish to make is that in spite of the revelations made in this report the position to-day is not much better, at least in those countries of the world which have a predominately white population. I have no knowledge of the prevalence of this abomination in other countries. Referring to the statement in the Lancet, the royal commission’s report states -
In our life-time, some of us have seen three wars, others two. The quotation that I have made shows that this is no new-found abomination. The report continues -
And amongst the perversions that our sins and the neglect of our rulers have brought upon us, the Lancet would surely include unnatural interference with racial production.
I turn now to another paragraph from the report of the royal commission. Throughout the British Empire to-day there is a cry for more population. More than ever, Australia needs an increase of population, but particularly we want Australian-horn citizens. The aim of this Government, through its social services programme, is to improve social conditions in this country and to raise living standards. To this end, it has introduced such social services as maternity allowances, and child endowment, both of which were unknown when the report of the royal commissioner was made. The report was presented to the Deakin Government in 1907. It proves conclusively that for many years the Australian Labour party has consistently sought to safeguard the vital interests of the community. Labour has no apology to make for the introduction of the present measure. In fact, members of that party were astounded at the obstinate and obstructionist attitude adopted by the conservative interests who are endeavouring to frustrate our efforts to improve social conditions. It is essential that we should view the present measure in proper perspective. I turn again to the report, and from it I shall quote a passage which applies with equal force to the present period. The passage is as follows : -
It becomes necessary for ns to preserve equilibrium of judgment regarding this phase of what is called civilization. It is impossible to state the case shortly and an exhaustive statement would be interminable.
The prevention of the curse referred to is the responsibility of the Government, and the obligation of the medical profession to the Government is inescapable. The report continues -
To those who recognize the family as a divine institution, to those who quote in any language the words of the Founder of Christian civilization, Sinite parvulos venire ad me, such practices are inadmissible - indeed they are abomination. This “ limitation of families “, which is absolutely apart from, and in essence distinguished from, celibacy, abstinence, continence or any kind of self-control, is the annihilating carcinoma which is breaking down the tissues of living nations.
I point out that the economic condition to which the Leader of the Opposition desires us to revert is of the kind referred to in that passage. The honorable senator also supports the refusal of members of the medical profession to co-operate with the Government-
– I am asking the Government to co-operate with members of the medical profession.
– The Leader of the Opposition, who has just interjected, has had approximately a quarter of a century’s experience in the Parliament and during that period he has had more opportunity for study than I have had. Nevertheless, when a progressive social measure such as the present is proposed he prefers to bury his head in the sand like an ostrich. He was a member of the Social Security Committee, but the views that he expressed to that committee are not identical with those that he has expressed to-night. In the circumstances I think that his interjection was rather unfortunate. It ill becomes him to suggest that the Government should make any further effort to conciliate members of the medical profession. In any event, what more co-operation does he suggest could have been offered to the profession than that which has been offered by the Minister for Health?
– Why does the honorable senator not listen to the case for the doctors?
The DEPUTY PRESIDENT.Order! Senator Critchley will address himself to the subject before the chair.
– I want to be fair to the Leader of the Opposition, and if I have done him any injustice I apologize. However, I could not refrain from commenting on the almost childish suggestion that he made in his interjection. The report from which I was quoting continues-
We find alao that the practices and habits which the doctrines of limitation inculcate tend to undermine the morality of the people, to loosen the bonds of religion, and to obliterate the influence of those higher sentiments and sanctions for conduct with which the development of high national character has ever been associated.
How true is that comment even to-day I Possibly, it is even truer of the condition of affairs to-day, when such a pernicious system is practised more frequently than ever before. If wc cannot correct that abuse by obtaining the ready co-operation of the learned, professional members of the medical fraternity, who, in the main, abhor and detest the practices referred to in the report, what hope has the community of stamping them out? I do not want to be misunderstood. Not for a moment do I include the overwhelming majority of doctors in my criticism of certain members of the medical profession. I point out, however, that if members of that profession would co-operate enthusiastically with the Government a great deal could be accomplished to inculcate in the minds of the people a sense of economic security, a higher moral standard, and, above all, a return to practical Christianity. The present Government has done more to improve the economic conditions of the people generally than any previous administration did.
Another portion of the report refers to a matter which, in my opinion, is interwoven with the problem that confronts the present Government. I refer to the advertising of patent medicines and proprietary lines. The report is founded on evidence tendered in the courts of law. including criminal trials at which individuals who pedalled drugs were convicted of murder. The report also contains an analysis of the dope used in some of the proprietary preparations. Incidentally, a number of the popular medicines that are advertised throughout the world to-day were being extensively advertised in those days. The relevant portion of the report shows that the ingredients of some of the most common patent medicines are as follows : -
Holloway’s Pills - :aloes, jalap, ginger and myrrh made into a mass with mucilage; might give rise to dangerous systems if given to young children, or to persons debilitated by age or disease.
Holloway’s Ointment - fresh butter, beeswax, yellow resin, vinegar of cantharides, Canada balsam, expressed oil of mace, and balsam of Peru or liquid storax. It is said, that “ no two samples are precisely the same colour or consistence “.
St. Jacob’s Oil - largely used for the relief of pain, contains turpentine and aconitine
Warner’s Safe Cure was found on analysis to. contain in each bottle, extract of Lycopus virginicus 20 grammes, extract Hepatica IS grammes, extract of Gaultheria (wintergreen ) i gramme, nitre 2$ grammes, alcohol 80 grammes, and glycerine 4& grammes, the rest being water. Lycopus virginicus is the bugleweed of the United States. As more than half a century has elapsed since medical virtues were ascribed to it, and as they have up to now failed to receive, recognition, ii may be assumed that they are not of. a very high order. Hepatica is the common liverwort, respecting which it is stated in the National Dispensatory that: “Its medical value is very small, and hardly entitles it toa place in the Materia Medica ”.
Beecham’s Pills - Aloes, ginger and soap.
Bile Beans - -Cascara rhubarb, liquorice, oil of peppermint, coated with gelatine.
Cockle’s Pills and Barclay’s Pills - Aloes, colocynth, and rhubarb
Carter’s Little Liver Pills - -Podophyllin (one-eighth of a grain) and aloes eoe. (onethird grain) in each pill.
Holloway’s Pills - Aloes, rhubarb, saffron,, glauber salt, and pepper.
Koko - Borax, glycerine and rose-water.
Harlene - Glycerine, alcohol, ammonia, andnil of cassia.
I have mentioned those particular preparations because they are still advertised. According to the report of the royal commission patent medicines which contained’ injurious drugs were responsible for as many deaths as any epidemic which had” attacked the community. Then, as now, the press found it highly profitable to accept advertisements for patent medicines and quack nostrums. Because poor- people cannot afford to consult doctors and pay the high prices charged to dispense prescriptions they are the natural prey of the manufacturers of those preparations. Since the first duty of the Government is to protect all sections of the community, the present Government would be failing in its duty if it did not make some effort to provide medical and pharmaceutical services for those who cannot afford to pay the high fees at present charged for those services. Incidentally, it is interesting to notice that more than 40 years ago a journal, The Australasian Traveller, published by the Commercial Travellers Association, contained an announcement that it refused to advertise preparations that claimed to cure cancer, consumption, organic diseases, diseases of the nervous system, female complaints and other disabilities. Incidentally, an examination of the advertisements which appear in the current press will convince any one that very little improvement has taken place in the ethics of the press proprietors since 1907. Certainly legislation has been introduced in this country which requires pharmaceutical preparations to conform to certain standards. However, those standards are intended not so much to improve the efficacy of pharmaceutical preparations as to insure that they do not contain ingredients that are known poisons. The report goes on to state -
Yet no falsehood is too shameless, no promise too palpable a trap to be refused currency in the advertisement columns of some of the best-known journals, and it is noteworthy that among the worst offenders in this respect are newspapers and magazines which enjoy with certain classes of the community a high reputation for accuracy and bona fides. Regard being had to the lavish expenditure which is bestowed upon advertising some quackeries, it is obvious that those who take toll of the advertisers are participators in the proceeds of this sinister traffic. There have been, it is to be feared, flagrant cases in which an extravagant advertisement has been the price of corrupt silence or even of venal praise on the part of the press.
Unfortunately, many of the conditions of which the royal commissioner complained 40 years ago, still persist. Only by obtaining the effective co-operation of the medical profession can the Government discharge properly its obligation to the community to prohibit the continuance of such practices as those mentioned in the report. It may astonish honorable senators to learn that the manufacturers and distributors of many patent medicines have had to survive numerous actions at law. Most of the actions were not concerned with the contents of the preparations but with the identity of the manufacturers. Because of the ridiculous claims made by many manufacturers, some of whom claimed that their preparations would cure anything from a wooden leg to a wall eye, it became necessary to insist that a manufacturer of patent medicines should disclose his identity. Some preparations that are still on sale have been the subject of considerable litigation, and many of them have had a most unsavoury past. I am thinking at the moment of “Dr. William’s Pink Pills,” “ Dr. Astbury’s Purple Pills,” and “ Bile Beans “. This is a most interesting portion of the report -
The healing professions, surgical and medical, back of them the medical press with the devoted pathologists, toxicologists and men of scientific research, arc clear of blame in this matter. Their protest has been loud and long. They submit to the obloquy which the lay press in its advertising columns heaps upon them every day; they carry the burden in public hospitals of those sickened or mortally injured by secret drugs, all the time that they see the cash successes of the brazen charlatans who cause the mischief.
It cannot be denied that two of the greatest curses which affect this country are those to which I have referred. It is astounding that in this country as far back as the 8th August, 1907, during the days of Alfred Deakin, a report of such damning proportions was submitted to the Australian legislature. Whilst it is to the everlasting disgrace of successive Federal and State parliaments that the regard for human life has not been made more evident by legislative action, it is to the everlasting credit of this Labour Government, whose years in office have been comparatively short, that this legislation has been introduced. The Government has endeavoured to implement this legislation by all peaceful means possible, to give legislative enactment to the wishes of the people as expressed in the referendum, but at long last it has been forced to take this action. I repeat that this Government is playing a part in eliminating these nefarious practices which have damned this land in the past, in common with every other part of the world. I support the bill.
– This bill proposes to amend the Pharmaceutical Benefits Act 1947 in several ways. The principal amendment is that contained in clause 5, which reads - (1.) After section seven of the Principal Act the following section is inserted: - “ 7a. Except as prescribed, a medical practitioner shall not write a prescription for the supply to a person entitled to receive pharmaceutical benefits -
Penalty: Fifty pounds.”. (2.) The section inserted in the Principal Act by this section shall come into operation on a date to be fixed by Proclamation.
This proposed amendment of the principal act has been brought about as a result of the long period which has elapsed since the inception of the idea of providing pharmaceutical benefits for the people of this country. Although in 1943 the then Minister for Health in this Parliament requested the British Medical Association to submit a panel of names for selection for the formulary committee, it did not do so. The history of negotiations since then shows that the British Medical Association has in no way attempted to cooperate with either the previous Minister for Health, Senator Eraser, or the present Minister for Health (Senator McKenna) in relation to making available to the people of this country the pharmaceutical benefits to which they are entitled. At the referendum of 1946, the people of Australia requested that pharmaceutical benefits should be made available to them. Yet to-day the Leader of the Opposition (Senator Cooper) pleaded on behalf of the British Medical Association, that the Government had not sufficiently negotiated with the Federal Council of that body, and that at this stage the Government should continue to negotiate. To try to give effect to his desire in that direction he moved an amendment that the bill should bo withdrawn and referred to an impartial tribunal, mutually acceptable to both parties. In view of the time that has expired in relation to the negotiations I think that the Leader of the Opposition must be a sublime optimist to visualize even the possibility of the Federal Council of the British Medical Association agreeing mutually to any body negotiating in this manner. That Council has taken upon itself the right to dictate to the elected representatives of the people of this country. They are attempting to emulate the example of the British Medical Association in the United Kingdom where the Labour Government has instituted a system of social security in which provision is made for medical, dental, and other benefits for the citizens of that country. A fight was put up by the British Medical Association in the United Kingdom in respect of the determination of the British Labour Government to do something in the interests of the people. In the United Kingdom the majority of the members of the British Medical Association have fallen in with the Government, and the result is that certain benefits now apply in that country. The medical association in Great Britain is doing its best to see that the system inaugurated there has a chance of succeeding. In this country, however, whatever this Government attempts to do to provide pharmaceutical benefits for the people, is opposed by the Federal Council of the British Medical Association. Bearing in mind the snide remarks about what this Government has done in regard to industrial disputations in this country, when such a situation develops the only thing for a Government to do is to decide to allow nobody to dictate to it. Under both Federal and State laws provision is made for the conduct and settlement of industrial disputation by courts of conciliation and arbitration. Those courts have a responsibility to determine an industrial disputation wherever it arises. The Federal Council of the British Medical Association is determined that it will not play ball with the Government of this country. I submit that the proposal submitted by the Leader of the Opposition is simply ludicrous. I honestly believe that Senator Cooper moved the amendment “with his tongue in his cheek. Can he guarantee that the British Medical Association would be prepared to mutually agree to some outside body determining the difference that exists between itself and this Government? Has the time arrived when the Government has to submit to some outside body to decide whether its policy is right or wrong? If there is anything wrong with what this Government intends to do with relation to pharmaceutical benefits, the members of the medical profession of this country have their legal redress. There is no need for me to endeavour to show the Leader of the Opposition the way out. The people of this country have asked this Government to do something, and since 1943 the Government has endeavoured to reach agreement with the British Medical Association. Instead of keeping this promise of settlement, which could easily have been agreed to in 19441 or 1945, we find that to-day, according to the Daily Mirror, Dr. J. G. Hunter, the general secretary of the Federal Council of the British Medical Association, is reported to have made this statement - “ If this amending bill becomes law, it will be impossible for the individual doctor if he wishes to remain free of Government control, to prescribe any life-saving drug for his patients, unless in doing so he is prepared to break the law,” said Dr. Hunter.
That statement was made deliberately with the object of creating a fear complex among the people. It implies that lifesaving drugs may not be made available under this scheme and, that consequently, patients will succumb to their complaints. I propose to review some of the correspondence which passed between the Minister for Health and Sir Henry S. Newland the then president of the Federal Council of the British Medical Association, in the course of negotiations between the Government and the association. On the 6th September, 1948, the Minister wrote as follows: -
I welcome your advice to the effect that your Council now accepts the general principle that the people of Australia should receive pharmaceutical benefits without charge.
To that degree, no difference of opinion exists between the Government and the Federal Council of the British Medical Association. However, differences arose with respect to prescription forms. The Minister in his letter to Sir Henry, wrote -
Your Council has agreed that prescription forms should be of uniform size, be prepared in duplicate, and bear the name and address of both the patient and the doctor. The only question outstanding is whether the forms should be the doctors’ private forms or Government forms.
The question now at issue is whether the doctors should be allowed to write their prescriptions on their own private forms or be obliged to write them on a government form. The Minister in his letter stated -
Documents upon which prescriptions for pharmaceutical benefits are written are. when passed to chemists, documents of entitlement io the receipt of money from the Commonwealth for the provision of pharmaceutical benefits to the estimated total of at least £2.000,000 per annum.
I emphasize that point because it has generally been lost sight of. Prescriptions are documents of entitlement to pharmaceutical benefits amounting to £2,000,000 annually, but the doctors desire to prescribe on their own forms instead of on official forms. Is it preferable to allow doctors to use their own forms when, in many instances, they must prescribe dangerous drugs? The way would thus be left open to forgeries whereas the use of government prescription forms would obviate that possibility and would protect the interests of the taxpayers who have to foot the bill for these benefits. The use of a government form would be of great assistance to chemists because forgeries on the prescription forms of individual doctors would be difficult to detect. The Federal Council of the British Medical Association does not appear to have given very careful consideration to those points. The Minister in his summary of the Government’s main objections to private forms included the following point -
Use of doctors’ private prescription forms would involve detailed examination of each one of about 20,000,000 prescriptions per annum and would entail the employment of a large staff of trained chemists, who are not available in any case, to check and cost prescriptions. The Government’s scheme requires a staff of 134, inclusive of only seventeen chemists. The proposal of your Council would need staff and accommodation at least six times greater than those required for the Government’s scheme.
Surely it is to the credit of the Government that it should endeavour to obviate the employment of unnecessary staff in the handling of over 20,000,000 prescription forms annually. One can visualize the great difficulty that would be involved in costing so many prescriptions written on the private forms of medical practitioners. Those forms would be of different sizes and layout. Furthermore, the fact must be borne in mind that a prescription written by a doctor, say, in Perth, could be made up by a chemist in Brisbane. Chemists would be better able to guard against forgeries if all prescriptions were written on official forms. The majority of doctors are not aware of the contents of the Commonwealth Pharmaceutical Formulary. Instead of the members’ of the British Medical Association directing their Federal Council, the reverse would appear to be the position. It has been suggested that the 117 doctors who are cooperating in the Government’s scheme are regarded by the Federal Council of the British Medical Association as “ scabs “. However, whilst there are approximately 6,000 doctors throughout Australia, over 3,000 of them have not seen the Commonwealth Pharmaceutical Formulary because, at the behest of their Federal Council, they have refused to accept delivery of copies of it. The Minister has assured us that the formulary meets the requirements of approximately 95 per cent, of prescriptions issued by doctors to-day, and, in addition, it includes the life-saving drugs. Much has been said about interference with the doctor-patient relationship. Each doctor is free to determine what he shall prescribe for his patient. The provision that should his prescription include any medicine contained in the Commonwealth Pharmaceutical Formulary he shall write it on a government form, does not interfere in any way with the doctor-patient relationship. The Government’s only purpose is to ensure that persons entitled to pharmaceutical benefits shall receive them without charge. It is about time that the medical profession as a whole realized that the Federal Council of the British Medical Association, by the attitude it has adopted in this matter, is depriving thousands of people of the right to obtain medicine without charge. Age pensioners of whom there are over 300,000 in this country are obliged to pay for medicine simply because the great majority of doctors refuse to write their prescriptions on an official form. Such an attitude cannot be justified.
– Some doctors prescribe free of charge for patients who are pensioners.
– Pensioners receive their medicine free of charge only when their prescriptions are made up at public hospitals. I know of many age pensioners who have been, obliged to pay for medicine simply because their doctors refused to write their prescriptions on the government form. Thus, many people are being deprived of the right to receive pharmaceutical benefits although in many instances they contribute towards the cost of such benefits through social services contributions. The Government must now stand up to the British Medical Association. It must not allow any section of the community to determine its policy. Such a state of affairs would not be tolerated by any government regardless of its party political affiliations.
– The doctors are engaging in a bad sort of a strike.
– We have heard much about fifth columnists. I have always regarded the members of the medical profession as men of more than average intelligence with a mentality perhaps beyond the average and able to deal adequately and competently with matters affecting themselves in their avocation. But it seems to me now that until they are rebuffed they will continue to carry on as the Federal Council of their association directs. Therefore, if we effect some reorientation of their attitude in regard to that council we shall accomplish something desirable. I consider that the Government has been too lenient in permitting the introduction of this essential benefit to be delayed.
– Six years next month!
– Yes. It has been claimed that there has been no public outcry for the provision of free medicine, but that is not correct. The Labour movement in Western Australia had to be restrained from making public protests against the non-application of the benefits scheme. At the request of the Minister for Health, who did not want to embarrass the members of the medical profession, it agreed not to make its protest. The Minister wanted to give them every possible opportunity to achieve a genuine and just settlement of the disagreement between the Government and themselves. The absence of a strong public demand for pharmaceutical benefits is simply due to the fact that the Minister requested that action be withheld for the time being. I am sure that the introduction of this amending legislation will bring forth a great burst of public support for the scheme throughout Australia. Although [ have every respect for the Leader of the Opposition, I could not help thinking that he endeavoured to side-track the whole issue when he made lengthy references to reports of the former Social Security Committee in connexion with various schemes for medical services that were considered by that body from time to time. The honorable gentleman said that a deadlock had been reached between the Government and the British Medical Association and that it was to be overcome by compulsion. I disagree with that statement. The Government is taking the only course open to it in the circumstances that have arisen. The British Medical Association, through its Federal Council, has refused to play ball with the Government and to give the people the benefits that they desire and are entitled to receive. In that situation the Government’ must either govern or get out.
– It is with a sense of grave regret that I speak in connexion with this amending bill. I regret that a bill of this nature should be presented to the Parliament. Much has been said by the Leader of the Opposition (Senator Cooper), and much more will be said by my colleagues’ in the House of Represen tatives, about that sacred obligation that exists between patient and doctor and I do not propose to dwell upon it. But I want to record here and now my protest against the action of the Government in forcing freedom-loving Australians who have the misfortune to be ill to accept hand-outs of medicine whether they like it or not. Has the Government given adequate consideration to the feelings of people who may not want to accept the scheme but may prefer to get their medicine in the usual way instead of having to get a prescription for an issue of free medicine from the chemist? Has the Government considered the corrosive effect that such a system will have upon the selfrespect of. many people? I agree very sincerely with the remarks made by the Leader of the Opposition about the lack of wisdom and justice in applying compulsion to the medical profession. But does the Government realize that, in turn, it is also applying compulsion to the people of Australia to make them accept free medicine? One of the features of the scheme that was not discussed by the Minister for Health (Senator McKenna) is the question, whether the people want the service or not. It is not made optional. I stress that fact.
If the bill provided that doctors must use the official prescription form when requested to do so by their patients, we should have the opportunity to learn the number of forms that were requested and their percentage of. the total number - of forms used. However, instead of including such a provision, the Government has said, in effect, to thedoctors of. Australia, “ You must issue the official form whether the patient wants it or not “. That is compulsion. It forces the people to accept free medicine whether they want to do so or not. Is this scheme for the benefit of all of the people of. Australia? That is a point that we must consider very seriously. I was interested’ recently to read a report of arbitration proceedings in which some railway employees were involved. It was pointed out during the case that the men were provided with uniforms, free travel to and from work, free holiday travel and.’ various other perquisites of that kind which represented an addition of about 15s. a week each to their wages. I remind] honorable senators that those men were liable to pay income tax and social services contribution only on their wages. Here we have an instance of privileges attached to real wages which make them very much higher in value than they at first appear. Now, in addition, everybody is to have free medicine compulsorily. There will certainly be fewer chemists’ bills with which to qualify for relief from income tax, but if this trend goes on and on, as appears likely, a time may come when wages will be received merely for living expenses and we shall have travel vouchers, holiday vouchers, family endowment vouchers, hospital vouchers and medicine vouchers, and the word “free” will have less and less significance because the cost of all such things will have to be provided from taxes. In the final analysis, the consumer, otherwise the worker, will pay for those things through taxes and the high cost of living.
The Minister will probably say to me that the Government is establishing a nation-wide friendly society and is making membership compulsory through forced contributions to the National Welfare Fund, and that the bill will compel doctors to take part in the scheme under conditions that will make certain medicines a charge against the fund. However, there is very much more in the proposal than that. Membership of a lodge is entirely voluntary, and members choose the lodges to which they belong for the sake of the benefits that suit their particular cases. A man is free to select his lodge as he wishes, and a doctor is free to decide which lodge he will work for according to’ his personal tastes. But now every doctor throughout the length and breadth of the land is to become a compulsory lodge doctor, or its equivalent, and must prescribe free medicine under certain conditions. Fortunately I am able to buy my own medicine. But, under this bill, am I to be compelled to accept free medicine?
– The honorable senator can pay for it if she likes.
– No. Under the bill I will he compelled to take free medicine. But there is more in the scheme than that. Am I and other Australians to be gradually conditioned to become dependants of the Government? Am I to be gradually accustomed to accepting this and that and the other benefits from the Government until government benefits play such a large part in my life that I become fearful of the Government and therefore docile? I should prefer independence to being reduced to that state in which one is fearful and docile. This bill will force an unwilling people to accept unwanted government benefit’s. It represents a step towards “ pauperization “ of the people. We on this side of the .Senate believe sincerely in legislation for the community to provide for the care of the aged, the invalid and the widowed.
– The Liberals do not believe in that.
– We have said on many occasions that we believe in those things. But, even in extending benefits to people of such deserving classes, the Government imposes a means test and carefully excludes from community benefits those who, because of their thrift and ability, have been able to make some provision for their needs in old age or adversity. It is also necessary and desirable for the community as a whole to bear the cost of caring for the mentally ill in institutions and for others who are sorely afflicted. But I affirm that it is not necessary to provide free medicine for the 80 per cent, of our people who are freedom-loving Australians, who have good jobs and draw wages regularly, and who are so fiercely independent that they do not want to accept free medicine. Yet this bill will force them to accept it. That is my interpretation of the measure. For the average healthy, clear-thinking, skilled Australian who is caring for his family and is willing to accept the responsibility to continue to do so, to be forced to accept free medicine as he will be under this bill, will be just one step further on the road to serfdom. When T first read the measure, it reminded me of a story of an orator on the Yarra bank. When a question was asked by an interjector, the orator said, “Brother, when the day of freedom comes you too will do as you are told “. Truly, the Australian people are being forced to do as they are told. Whether- they want it or not, from the day that this bill becomes law, they will get their dose of free medicine. Thus, they will become further dependent upon, and not masters of, the Government. That is quite wrong. Therefore, I oppose the hill.
– The Leader of the Opposition (Senator Cooper), in moving an amendment to the motion for the second reading of this measure, suggested that the Government should further negotiate with the British Medical Association. Already the Government and the Minister have shown the greatest tolerance in their negotiations with the British Medical Association. The Leader of the Opposition and Senator Rankin have made a comparison between the treatment of industrial workers under arbitration procedure, and the treatment of the British Medical Association by the Government in connexion with this legislation. Apparently both honorable senators have forgotten that one of the main features of industrial arbitration is that persons resisting the law must obey the law before negotiations for the settlement of any dispute will be opened by the court: Therefore, if the suggestion that Opposition senators have made to-day is to be taken seriously - I do not believe for a moment that they wish it to be taken seriously because I am sure that once again they are indulging only in delaying tactics - I suggest that members of the British Medical Association should first obey the law, and then negotiate to remove from it any feature that they consider to be either prejudicial to the operation of the scheme or inimical to their own interests. I am convinced that, in its negotiations with the Minister, the Federal Council of the British Medical Association has had as its last consideration, the welfare of the people of this country, who, I consider, are entitled to and certainly want the benefits of free medicine and other social services. Opposition speakers have said repeatedly that the Australian public does not want those services, but an analysis of the voting figures at the referendum held on the 28 th March, 1946, shows that whereas 1,927,148 elec tors voted against the Government’s social services proposals, 2,297,934 voted in favour of them. That is a clear indication of the will of the people of this country that the Government should proceed with its social services programme. Let us trace the negotiations between the Government and the British Medical Association to ascertain whether there is any real foundation for the accusation by the Opposition that full consideration has not been given to the British Medical Association in formulating the pharmaceutical benefits scheme. In 1943, the then Minister for Health, Senator Fraser, approached the British Medical Association and requested it to submit to him a panel of names from which he would make selections for appointment to a committee which was to frame the formulary to be used under the pharmaceutical benefits scheme The British Medical Association declined to accede to the Government’s request. Apparently, it did not want to have any hand in drawing up the formulary. Yet the Government is urged to take the medical profession into its confidence. Clearly, that has been done, but the medical profession has resisted the Government throughout. The association was not prepared to co-operate in the scheme at its very introduction. In 1945, after further negotiations, in the course of which every encouragement was given to the British Medical Association to co-operate and to obey the law, the Victorian Council of the association challenged the Pharmaceutical Benefits Act in the High Court. That was in 1945. The court held that the act was beyond the powers of the Commonwealth. It will be seen that, despite the British Medical Association’s professed belief in -the necessity for a pharmaceutical benefits scheme, it has consistently fought the Government’s proposal to introduce such a scheme. The referendum was held in September,. 1946, with the results that I have already mentioned. The people of Australia stated their attitude quite definitely. In 1947, a further conference was held with the Federal Council of the British Medical Association. Adequate opportunity was given for a full discussion of any aspect of the proposed scheme that membersof the association considered to beinimicaltotheirinterests,orpre- judicial tothepublic.The representa- tivesofthe British Medical Association, however,couldnotraiseany objections thatthe Government was not prepared to meet. Obviously its objection was to the use of a formulary at all.However,I remind the Senate that throughout the waraformulary,notnearlysocompre- hensive as that provided under the pharmaceutical benefits scheme, was used in alltheservices.Theformularysub- mittedto the council was most comprehensive, but, obviously, the medical profession wants to have nothing to do with it at all. When the constitution of a formulary committee to revise the formulary was again suggested, there wasno co-operation from the ‘British MedicalAssociation.Clearly,theasso- ciation wasnotanxioustoprotectthe healthofthepeople.TheBritishMedi- calAssociationcouldnotfindverymuch fault with the formulary, but objection wastakentosection22oftheact,which prescribed a penalty of £50 or three months’ imprisonment for any doctor who prescribed for a person without examininghimasapatient.Ithadbeen found that in the initial operation of the NewZealandscheme,thispernicious practicehadprevailed.However,itwas __cededthattheBritishMedicalAsso- ciation bad some sound arguments on this subject. Itwas pointed out that, in certain circumstances, a doctor might, through sheer necessity, have to prescribe for a patient whomhe could not possibly examine. For instance, a doctor might be out in the back-blocks and be unable to reach a patient. In such circumstances, hewould have touse his initiative, make his diagnosis from the facts conveyed to him by telephone or by letter, and prescribe a medicine. The Government conceded that the British Medical Association had some basis for its objection, and the relevant portion of the bill was modified considerably. Did that produce any more evidence of co-operation? No. Further negotiations took place. On the 7th July, 1947, the Minister invited the British Medical Association to appoint representatives to confer with three medical officers on all proposals contained in the bill. On the 8th September - after a considerable lapse of time - the
Ministerreceivedareplyfromtheasso- ciation rejecting his offer. Yet, the Opposition in this chamber claims that thewishes of the British Medical Association have not been considered ! The Leader of the Opposition has suggested that the British Medical Association should be given the same opportunities that are given to industrialworkers when they go on strike. If any industrial worker disobeyed thelaw for as long a period as the British Medical Association has been defying the Government, he would be instructed to return to work,or his organizationwould be deregistered by the court andwould have noindustrial standing as aunion. In industry compulsory conferences arecalled and heavy fines are imposed for disobedienceoforders of the court. That apparently iswhat Opposition senators, in their ignorance, suggest should be done to theBritish Medical Association. Perhaps they are right. In 1947., the Social Services Consolidation Act was passed, and the entire scheme was amended. Provision was madefor the formulary -committee to consist predominantly of medical men. There were to be only two pharmacists out of seven members. At the Melbourne conference, the Minister invited the Federal Council of theBritish Medical Association to submit a panel of names of doctors for appointment to the formulary committee. The invitation was rejected. In 1947, section 22 of the act to which objection had been taken previously was eliminated completely. So, in that respect at least,the wishes of the BritishMedical Association were met completely. There wasto be no compulsion on its members. In May, 1948, it was announced that the pharmaceutical benefits schemewould come into operation on the 1stJuly. The Council of the British Medical Association advised doctors to refuse acceptance of the forms and formulary, and requested them not to use the formulary. Thatwas clear evidence of the intention of the British Medical Association to resist the scheme in its entirety and tokeep its members ignorant of the Government’s proposals. To-day, quite a number of medical men are prepared to co-operate in the scheme. In fact,some are already co-operating. I am reliably informed that theTasmanian branch of the British Medical Association is prepared to co-operate, but that the Federal Council will not permit it to do so. A similar state of affairs exists in other parts of the Commonwealth, although perhaps not to the same degree as in Tasmania. On the 26th May, 1948, the Minister wrote to the Federal Council of the British Medical Association offering to discuss any aspects of the operation of the scheme or the regulations to which exception could be taken. That offer was refused. It is, therefore, futile for the Opposition to argue that the Government could do any more to encourage the British Medical Association to carry out the law and so to give to the people of this country a health service which they themselves have sought. The Leader of the Opposition implied that the national health scheme in Great Britain had not been a success. However, Br. Abercrombie, a prominent medical man in England, who visited this country recently, made an interesting statement when he arrived in Perth. Dr. Abercrombie is not a supporter of the Labour Government in Great Britain, and he was not out here on any government mission. He was not drawing any payment for expenses from the British Government. He said, however, that he had to admit that the medical scheme in Great Britain had been a tremendous success. He said that persons who receive treatment under proper medical direction are usually better citizens than those who, because of poverty or some other reason, cannot avail themselves of proper medical treatment and rely on quack nostrums and proprietary lines. It is well known that people who have suffered from relatively minor ailments have developed chronic conditions and serious complaints because of their failure to obtain proper medical attention and also because of the injurious effects of some forms of self-treatment. The Government’s medical and pharmaceutical medical scheme envisages that patients shall be in continuous contact with their doctors. Senator Rankin mentioned what she termed the “ sacred relationship “ that exists between doctor and patient, and said that that relationship might be interfered with. Let me assure the honorable senator that the patient will be permitted to choose his or her own doctor, and that a doctor can prescribe or treat the patient in any way at all. Furthermore, the Minister for Health (Senator McKenna) pointed out in the course of his second-reading speech -
A doctor who comes into the scheme is not bound by the formulary if his conscience and medical training dictate the prescription of something that is outside the formulary.
Members of the medical ‘profession will have a free hand. They can prescribe anything that their conscience and medical training suggest. When the scheme is implemented many more citizens will be able to share the “ sacred relationship “ to which Senator Rankin referred.
The attitude displayed by the Government towards individual doctors has been consistently forbearing. After all, the Government has no quarrel with the doctors. It does not seek to impress upon the people that the medical profession is not providing a great service for the community. Unfortunately, that service is, in very many instances, confined to persons who can afford to pay the high fees and charges associated with illness, whereas, the indigent sections of the community - and I point out that very few people to-day are depending upon charity for their existence- do not receive the medical attention that they require. The Government has determined that they shall in future receive free medical and pharmaceutical services. At the same time I emphasize that no one will be compelled to accept free medicine. The suggestion to the contrary advanced by the Opposition is ridiculous, particularly when that suggestion is coupled with mention of age and invalid benefits. Senator Rankin, when addressing herself to this aspect of the matter, used the term “free medicine”. Members and supporters of the Government speak of “ pharmaceutical benefits “ which is an entirely different thing. The honorable senator suggested that the Government should remove the means test applied to determine the eligibility of applicants for age and invalid pensions. Of course, that has nothing whatever to do with the provision of pharmaceutical benefits, but
I point out that even if the means test were removed from applicants for pensions the Government could not compel people of independent mind to accept pensions. Of course, in any event, it is utter rot to suggest that people who refused to accept pensions or free medical services would be prosecuted. Those who do not desire to avail themselves of free pharmaceutical services can simply pay the charge involved to the pharmacist, who will endorse the dispensed prescription “ paid by patient “, and there will be no more to it. Similarly, if the means lest were removed from the pensions scheme any one who did not want to receive a pension would be free to reject it. There is, therefore, no interference with the freedom of the people. Of course, what the Opposition really objects to is the provision in the bill to compel doctors - and we might as well be frank and use the word “ compel “ - to use prescribed forms for any prescription that is covered by the formulary. Doctors will be quite free to use their own forms for drugs that are not included in the formulary. If only one ingredient of the prescription is not included in the formulary a doctor is entitled to use his own prescription form. If a doctor proposed to prescribe a mixture from the formulary, and the patient objected or requested the doctor to prescribe something else, he would be interfering with the freedom of the doctor to prescribe for him.
I think that the present Government has been most tolerant and forbearing in this matter. If it had wanted to attack individual doctors it could simply have issued to the public forms which would have entitled them, on presentation to a doctor, to receive free treatment, and the doctor would then have been placed in the embarrassing position that he would have had to supply a prescription, in opposition to the attitude of the British Medical Association, or deny to people something to which they were legally entitled. It is interesting to review briefly the attitude adopted by the British Medical Association throughout the negotiations that have taken place. For some time it objected to the formulary, with which it endeavoured to find fault on the ground that certain drugs and specifics were not included. It wa# pointed out by the Government that the formulary did include those drugs, which were shown under their proper pharmaceutical nomenclature, which was noi recognized by members of the British Medical Association, who apparently knew the drugs only by their proprietary names. Then members of the British Medical Association advanced the argument that they could not employ certain syrups in the prescriptions because no provision was made for different flavours. One doctor preferred to use an orange flavouring, whilst another preferred cloves. The doctors got their way abou syrups, and they can now prescribe any flavouring they like. Actually the only real difficulty is the fear that has been aroused in certain quarters that the proper application of the formulary will result in the elimination of the competition provided by patent medicines and quack remedies of the kind referred to by Senator Critchley. After the pharmaceutical benefits scheme has been operating properly many of the patent medicines will inevitably go off the market. People will no longer be tempted to buy them because they cannot afford to incur the expense of consulting a doctor and having a prescription dispensed. I support the measure wholeheartedly, and I hope that the British Medical Association will yet offer the co-operation about which the Opposition has said such a great deal. I hope that that co-operation will be achieved in the same manner as the great majority of successful industrial agreements in this country have been achieved, namely, by negotiation and agreement between the parties concerned. It is highly desirable that the proposed scheme should be implemented by co-operative rather than by compulsive action. I support the bill, which is absolutely necessary, and I shall support the Government whole-heartedly in giving effect to legislation that would have been operating to-day but for the attempts made by members of the Opposition to frustrate it.
– The bill before the Senate is a simple measure, which seeks to amend the Pharmaceutical Benefits Act 1947 in order to enable that legislation to become effective. Certainly, the Leader of the Opposition (Senator Cooper) has proposed an amendment that the measure should be withdrawn until such time as the Government has had further consultation with the British Medical Association. However, I dismiss the proposed amendment because, in presenting it to the Senate, the Leader of the Opposition in no way indicated that he had the support of the British Medical Association. Had the honorable senator been able to assure the Senate that he spoke authoritatively for the Federal Council of the British Medical Association, and intimated that that body desired that further consultation should take place, the position would have been entirely different. In the course of his second-reading speech the Minister for Health (Senator McKenna) - drew the attention of the Senate to the fact that for a considerable period he had used his utmost endeavours to obtain the cooperation of the Federal Council of the British Medical Association. He also mentioned that as far back as 1943 his predecessor, Senator Fraser, endeavoured to arrive at an agreement with the British Medical Association in order to introduce a pharmaceutical benefits scheme, and pointed out that Senator Fraser had been no more successful than he himself had been. I think that that fact indicates conclusively that in proposing his amendment the Leader of the Opposition was simply acting in accordance with the dictum that it is the duty of the Opposition to oppose. I am convinced that the honorable senator would have preferred to give his blessing to a measure which he realizes is in the interests of the community.
During the discussions between the Government and the British Medical Association a great deal of extraneous matter was introduced by Dr. Hunter, the secretary of the federal council of that body. If when the present bill was read a first time and the Council became aware of the amendments to the 1947 legislation proposed in the measure, it had attacked the merits of the bill one might have been persuaded that there was some merit in its objections. I realize that amongst members of the medical profession there is a considerable difference of opinion about the first steps that should be taken by the Government to implement a national health scheme. In every country in which it has been suggested that the health of the people is a matter that should concern the national government, differences of opinion have arisen concerning the first steps that should be taken. Some hold the opinion that instead of providing pharmaceutical benefits, governments should endeavour to provide funds to erect hospitals, establish diagnostic centres and provide other facilities. That is a matter for debate. If in the early stages of the negotiations between the Government and the British Medical Association, when it became apparent that the present Government was determined to introduce a national health scheme, which had been part of its policy for many years, the British Medical Association had said to the Government: “ Whilst we believe that health is a national consideration, we believe that you are going about it the wrong way, and that instead of commencing at one particular point you should begin at another “, such an attitude would have commended serious consideration. It would then have been apparent that they had the health of the people at heart. Let us consider the latest statement of Dr. Hunter as published in the Melbourne Sun, which was presented to the Senate earlier in this debate by Senator Sandford. It is evident from that statement that it would not matter whether the amendment were carried or not, or what the Government did to meet the wishes of the doctors. Dr. Hunter and those associated with him on the Federal Council of the British Medical Association would never agree. Amongst other things Dr. Hunter is reported to have said -
From time to time during the past 12 months the British Medical Association has warned the people, through the press, of ths unfavorable consequences of the Commonwealth Government’s health policy. The people had heeded those warnings and accordingly had shown little desire for the Government’s schemes.
Honorable senators may guess what opportunity the people have had to express an opinion about the merits or demerits of the Government’s health scheme. For the scheme to work it is necessary that the members of the British Medical Association should take part in it. They have been invited as free citizens to come into the scheme, and have been told time and time again that there is no compulsion, that if they desire to be members of the organization well and good, but if they do not desire to be part and parcel of the organization they can keep out. Let us analyse the attitude of the executive of the association. It professes to believe that the people do not desire the scheme, and that its members, if they understood what the scheme really is, would stay out of it, hut before the printed formularies or the prescribed forms on which prescriptions were to be written had left the Government Printer, the executive said to the members of the British Medical Association, in effect, “ Don’t you dare read that formulary. Don’t you dare handle those prescriptions. Don’t allow the postman to place them in your letterbox, but if he does, send them back immediately.” That is the kind of thing that children would do when playing games. Senator Rankin and sections of the press have suggested that the Government is about to coerce somebody. Those of us who have had any experience over the years of attempts made by friendly societies, industrial groups, and others who wished to improve their conditions to negotiate with the British Medical Association, know full well that the Federal Council of that organization has denied the doctors the right to make a decision of their own. In the struggle that took place between the friendly societies in Victoria some years ago and the British Medical Association, all of the coercive power possessed by that federal organization was used to deny to its members the right to decide for themselves whether the fees and the conditions offered by the friendly societies were acceptable to them as individuals. Some of the members of the British Medical Association had the temerity to break away from their organization. There was a similar happening on the coal-fields of New South Wales, when the Australian Medical Association was formed by certain doctors who were prepared to enter into an agreement with the coalminers in order to become their medical advisers. But this council that to-day talks about freedom issued a manifesto that if any members of the British Medical Association broke away, no brother practitioner would associate himself with them. Even if a patient were dying on the side of the road, the member of that organization would be bound, by that decision of the British Medical Association, to refuse to assist a non-member of the association to save life. That is indicative of the strength of this organization. Because of its strength it issued the edict that no member should read the formulary. Despite that, some members of the association talk glibly as though they know all about this scheme. Of course, they know nothing about it, and the Federal Council of the British Medical Association will not allow them to read the formulary, for fear that if the members become conversant with what is contained in it, and what is expected of them, they will break away and come into the scheme.
– What about a secret ballot?
– Our friends opposite, and those people outside who are supporting the action of the British Medical Association contend that trade unions which are not satisfied with awards that have been made, or conditions under which their members labour, before deciding upon direct action should submit to a secret ballot. That presupposes that the members of the union or organization that was about to engage in a secret ballot would at least know something of the question on which they were to vote. But the executive of the British Medical Association will not allow the members of that organization to become conversant with the problem.
– This matter has been discussed in every branch of the British Medical Association in Australia.
– Many doctors sent the formularies back. Years ago. Senator Fraser, when Minister for Health, tried to get the British Medical Association to “ play ball “ about a health scheme, but that body would have nothing to do with it. He asked that association to send along its most highly trained specialists to help to draw up a formulary, but it would not do so. Therefore, it is out of sheer cussedness that it refuses to take part in these negotiations. It is now intended that approximately 3,000 doctors who returned their mail matter to the Minister for Health unopened, shall in the future be called upon to have a look at it, because, as has already been pointed out, if they prescribe some drug, appliance or other ingredient contained in the formulary, to which the people are entitled free, that must be done on the prescribed form. Many thousands of diabetics will be pleased to receive their insulin free. Quite a number of other people suffering from chronic complaints, particularly age and invalid pensioners, will also be pleased to be able to receive their medicine free. .Senator Rankin has suggested that doctors usually prescribe for people in the last-mentioned category free of charge. I have no doubt, that some doctors with humanitarian principles would do so. Only the other day a medical friend of mine told me that he would be quite pleased if, over the years, he had received an average of 5s. from each patient that he attended. That is an individual approach to this matter, and the Government has no quarrel with many doctors who evince humanitarianism when practising in industrial centres. Of course, there is no hard and fast rule that a doctor shall prescribe free. I remind honorable senators who have referred to the sacred rights of doctors and patients that if the Government’s health scheme were in operation a doctor would be able to do far more for his patient than he does to-day. Let us consider the thoughts of a humanitarian doctor who visits the home of the not-too-well-off. The doctor may be called in to attend to a patient who is suffering from a serious malady. He can readily sum-up the financial position of the occupants of the home. He may consider that he should prescribe a certain drug for the patient, but he knows that the patient would not be able to afford to pay for that drug. Of course, li is service is only the first service. Under this measure, all that the doctor need do i.= to diagnose the complaint, for which. under another scheme, he will receive half of his fee. Until that other scheme operates, however, he cannot be sure that he will receive any part of his fee, because he has to depend upon the ability of his patient to pay. He knows that after writing a prescription on his own form, the patient must then take the prescription to a chemist to be made up, and find the cash necessary to pay for it over the counter. Consequently, the doctor has to decide whether he should prescribe certain drugs which he believes would be most effective or whether he should prescribe a cheaper substitute. Owing to the patient’s financial position, and the fact that the patient will have to pay cash for the prescription, as a result of which the doctor may not be paid his fee, the medical man may decide on a prescription involving, a rninimum of expense. If this scheme were operating, however, the doctor would entertain no such fear. He could approach such a case, saying, “I have diagnosed his complaint. What are the best drugs contained in this formulary, to treat that complaint?” As they are enumerated, the doctor will be able readily to decide on an appropriate prescription. The patient can then be assured that he receives, subsequently, from the chemist the drugs that are most beneficial to him. It has been suggested that some important drugs have not yet been included in the formulary. If that be so, why does not the British Medical Association nominate its experts to be members of the formulary committee? The Minister has sought the association’s help on many occasions. The offer is open to the association to-night to nominate its best representatives to the formulary committee and the Government ha9 decided that any drug which the committee so recommends will be included in the formulary. I cannot comprehend why a body such as the Federal Council of the British Medical Association seems to be living in the face of world thought in respect of health and medical problems. Reverting to the reported statement by Dr. Hunter that he had warned the people through the press of the unfavorable consequences of the Government’s health policy, I ask: What is the Government’s health policy?
The Minister, in a statement which he made on the 25th February last outlining the Government’s health proposals, said -
There are three major, correlated lines of approach to the solution of the health problems of Australia. They are, in order of ultimate importance: (1) Preventive medicine;
curative measures; and (3) relief to the individual from the financial burden imposed by ill-health. The Federal Government, in its approach to the health problem, has made three types of proposal. They are, again in order of ultimate importance: (1) The provision of a national health service; (2) the medical benefits scheme within that wider service; and
the pharmaceutical benefits scheme. Of these three proposals, the first, the national health service, is primarily concerned with the educational, preventive and curative aspects related to the national health. The medical benefits scheme and the pharmaceutical benefits scheme, though they do not disregard the curative, and on some degree the preventive, aspects, are concerned primarily with relief of the financial burden on those, of the community in ill-health.
Briefly, that is the scheme with which Dr. Hunter says that the Federal Council of the British Medical Association warned the people to have nothing whatever to do. Let us see what is happening in other parts of the world. In the literary supplement of the Melbourne Age of the 5th March last I read a review of a book written by Professor Ryle who is associated with the Departments of Social Medicine which have been established at the Universities of Oxford, Birmingham, Edinburgh and Durham. The article, which is entitled, “ Aims of Medical Practice - Importance of Quality of Health ‘ “ was written by Dr. H. A. Sissons, of London, reads -
The manner in which the aims of medical practice are undergoing alteration is outlined by Professor J. A. Ryle in “Changing discipline” (Oxford University Press) - a volume which is an arresting and stimulating account nf his views on the social aspects of medicine.
To-day there is a growing realization that the “ quality of health “ of the whole community is a matter of the highest importance, and as an adaptation to this outlook medicine is placing increasing emphasis on the maintenance and improvement of health, as opposed to its more established task, the treatment of existing disease.
The change is a slow one, but its progress is shown by the way in which “ public health “, not long ago almost entirely restricted to the study and prevention of infectious diseases, is reaching out more and more into the sphere of the social sciences and demonstrating the importance of social factors, such as economic circumstance, domestic environment, occupation, nutrition and education, in the causation of a wide variety of diseases. “Social Medicine”.
For some years there has been a general feeling that the ideas developed in this extension of the subject, to which the name “ Social Medicine “, is becoming attached, should pay a greater part in the training of doctors. Thus, in Great Britain since the war, departments of social medicine have been established in the Universities of Oxford, Birmingham, Edinburgh and Durham.
Professor Ryle is in charge of the Oxford University’s Institute of Social Medicine, which was the first of these departments to be set up, and as an illustration of the increasing influence of social medicine, he traces for us the origin and development of this Oxford school.
The idea of a Chair in Social Medicine was first mooted in 1039, when Sir Arthur MacNalty, formerly Chief Medical Officer in the Ministry of Health, addressed a memorandum on the subject to the Oxford University Court. In 1943, the experiment, as it was then regarded, took shape with Professor Kyle’s appointment as Director of the newly established Institute.
Subsequent years have seen the provision of offices and the recruitment of a staff now numbering IS persons, including seven doctors, with statisticians, technical and clerical assistants, and the operators of a mechanicallyequipped records bureau. The Institute has been active in many fields of investigation, and its teaching work has developed to include the official University course in social medicine and public health.
In giving us a picture of social medicine at. work, Professor Ryle tells us how, a century ago, William Farr pioneered the field of mortality studies by his examinations of the information lodged with the newly-established Registrar-General’s office. He shows us very vividly how the application of statistical considerations to such data - an important part of the raw material of social medicine - is used to gain insight into the ultimate social causes of disease. Not only does this “ social postmortem “ demonstrate how clearly disease goes hand in hand with poverty, but “it reveals the operation of diverse social factors in the causation of a variety of individual diseases, such as pulmonary tuberculosis, peptic ulcer, coronary disease and skin cancer.
Types of Investigation.
In many types of investigation information restricted to mortality figures is inadequate, and Professor Ryle goes on to show the value of more detailed first-hand studies of health and disease in human communities. He stresses the importance of such “ group studies “ carried out, not on hospitalized patients, but on apparently healthy “ populations “, whether these be schools, factories or groups of service personnel.
Accurate estimates of the normal range of variation of human form and function can thus be made, and the beginnings of illhealth related to slight departures from these normal standards. Above all, social medicine can, id this way, develop a more dynamic concept of “ health “ as applied to the community.
In this type of investigation team work becomes essentia], and Professor Ryle is able to show how- the necessary background for collaboration between physicians, statisticians and medical social workers can be provided by a university department of social medicine.
He provides illustrations from the work of the Oxford Institute, as it concerns child health, the study of occupational illnesses and industrial accidents, and its surveys of health among university students. In all these fields lie shows how medicine, looking out beyond
Kick humanity, is concentrating more and more on the promotion of health.
The author shows how the investigations of social medicine, by pointing out causes of early preventable mortality, can play a part in offsetting some of the problems of a diminishing birth rate. In concluding the book with a consideration of the way in which the activities he has been describing can influence social planning and medical practice, Professor Ryle puts forward a strong plea for more frequent discussions both public and private, on these matters. It is his hope that by this means social medicine will be able to make its fullest contribution to human wellbeing.
Honorable senators who heard the Minister’s second-reading speech and know the details of the Government’s health scheme are aware that every word of that article can be applied to the scheme under which the Government proposes to set up schools for the training of doctors and nurses and to investigate the causes and effects ‘of disease. Legislation for the implementation of that scheme has already been placed on the statu te-book. Yet Dr. Hunter has the temerity to say that twelve months ago the British Medical Association warned the people through the -press of its unfavorable consequences. The Australian Government in evolving the scheme it has placed before the people is in very good company. I am at a loss to understand why the British Medical Association will not “ play ball “ with the Government. Are the members of the Federal Council of that body afraid that as the result of new developments in medicine and of the discussions for the extension of which Professor Ryle is pleading, the people will abandon their old idea of the medical practitioner wracking’ his ‘brains to determine what he should prescribe for his patient? Does that body adopt its present attitude because it believes that as the result of discussions of that kind the people are beginning to realize that already formularies have. been provided much in the same way as ready reckoners have been provided for mathematical calculations? Do doctors fear that the old idea of the medical practitioner as a sort of witch doctor operating in an atmosphere of mystery is likely to be abandoned ? Such an attitude is groundless. It has been said that the British Medical Association is opposing this scheme because it has been introduced by a Labour government. I do not accept that view. I believe that if an antiLabour government were to introduce a national health scheme the British Medical Association would oppose it. Progressive ideas must necessarily developslowly. That fact has been demonstrated by the experiences of the pioneers in the medical world. In the past the average doctor automatically opposed new discoveries in medicines. Therefore, the Government is not surprised that the medical profession now opposes its progressive health legislation. We know that doctors are rather conservative. Whenever a new cure comes on to the market they like to test it thoroughly before prescribing it generally. However, such conservatism can be carried too far although, at first glance, it might appear to be praiseworthy in the medical profession. We do not suggest that every newly discovered drug must ipso facto he included in the formulary. We give the doctors the right to decide whether such drugs should he admitted or not. Nevertheless, they have refused to play ball, and the Government, very reluctantly, has been forced to introduce tha measure that is now before the Senate. Even so, the Government will’ not enforce its provisions as soon as it has been passed by the Parliament. It will not come into operation until the day on which it receives the Royal assent. That again shows the desire of the Government to secure the co-operation ‘of the Federal Council of the British Medical Association. Could any Government be more patient and more tolerant than this Government has been? I hope that, as the result of the passing of this legislation, the British Medical Association will sea fit to play its part in developing the scheme which the Government has introduced for the benefit of the people. Why does the Government want to have such schemes? The answer is simply that it wants to eradicate the scourges that are in our midst. For instance, it has decided that £20,000,000 will be spent in the fight against tuberculosis at the rate of £2,000,000 a year for the next ten years. Is that decision in accordance with Dr. Hunter’s “warning” to the public about the inefficiency of the Government’s scheme? I deeply regret that an eminent medical man, Sir Sidney Sewell, passed from our midst a few days ago. That humane gentleman fought for years to eradicate tuberculosis. Day by day, year after year, he endeavoured to awaken the people of Australia and their governments to the necessity for combating the scourge. Many times he was forced to tell how his efforts had been thwarted because of lack of funds for the work in which he was engaged. At last Australia has a Government that is prepared to build hospitals and do everything else that is possible for a government to do in order to destroy the evil thing which attacks our people. It is greatly to be regretted that Sir Sidney Sewell died before the plans of the Government had been fully developed. I am sure that he would have found no cause for complaint in days to come on account of lack of funds for the work in which he was engaged at the time of his death. If the Federal Council of the British Medical Association would only agree to co-operate with the Government, it would find that the Government is prepared to give it facilities to assist the work of the great profession which it represents so that doctors could do for humanity those things to which lip service has been paid in this chamber to-day. When this bill has been passed, I hope that there will be a change of heart in that section of the community whose work is vital to the effective prosecution of the Government’s schemes for the health of the people.
Senator McKENWA (Tasmania - Minister for Health and Minister for Social to the amendment only at this stage, and I ask leave to continue my remarks at a later date.
Leave granted; debate adjourned.
page 1400
The following papers were pre sented : -
Commonwealth Public Service Act - Appointments - Department -
Civil Aviation - R. P. Hansen, A. B. McFarlane, W. L. Milne.
External Affairs - P. B. Cooper, R. N. Hamilton, G. M. Hooker, D. J. Home, M. L. Johnston, M. McPheraon. D. R. G. Packer, A. R. Parsons.
Defence (Transitional Provisions) Act - National Security (Industrial Property) Regulations -
Orders - Inventions and designs (9).
Lands Acquisition Act - Land acquired for -
Lighthouse purposes - Cape Jaffa, South Australia.
Postal purposes -
Binalong, New South Wales.
Mooroopna, Victoria.
Senate adjourned at 11.21 pan.
Cite as: Australia, Senate, Debates, 15 March 1949, viewed 22 October 2017, <http://historichansard.net/senate/1949/19490315_senate_18_201/>.