The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.
Letters to the Editor
Editor, I would like to commend Dr Nisselle and Australian Prescriber for the editorial 'Signing the script' (Aust Prescr 2004;27:108-9), which raised awareness of the responsibilities that medical practitioners assume when they prescribe on the Pharmaceutical Benefits Scheme (PBS). Unfortunately, the 1973 legislation Dr Nisselle quoted relates to Medicare rather than pharmaceutical benefits.
The relevant legislation is found in regulation 19B of the National Health (Pharmaceutical Benefits) Regulations 1960. This states that it is an offence to write a prescription bearing the letters 'PBS' when it is not a PBS prescription. A prescriber who prescribes a medication under the PBS for a condition which falls outside the PBS indications may be committing a criminal offence under the National Health Act 1953. The relevant legislation is found in Paragraph 103(5)(g) of the National Health Act 1953 and states that a person shall not:
by means of impersonation, a false or misleading statement or a fraudulent device, obtain, or by any of those means aid or abet another person to obtain, a pharmaceutical benefit or a payment in respect of the supply of a pharmaceutical benefit;
A prescriber acting in this manner may also be referred to a Professional Services Review Committee to determine whether or not they have engaged in inappropriate practice.
PBS Compliance Branch
Health Insurance Commission
Editor, Dr Nisselle reminds us that a judge can imprison us, under current legislation, for making therapeutically effective and cost-effective treatment decisions.1 There are instances with 'SPs' where deeming that as 'criminal fraud' is both irrational and unacceptable.
Experienced professionals tend not to respond to threatening behaviour, even when it originates from official bodies that accord themselves the status of 'authorities'. Some categories of rules, and laws, can only ever aspire to be guidelines. The proportions that are neither enforced, nor monitored, attest to that historical reality. The legislation has never been systematically enforced for many SPs during its 30-year existence. Draconian threats of imprisonment and fines are counter-productive and one suspects they have diminished respect for, and co-operation with, those 'authorities'. Few doctors in our town would be available for consultations if the regulations were enforced.
Education may change doctors' behaviour. Unfortunately the situation has evolved where an undue portion of doctors' knowledge about drugs emanates from drug companies. Authorities have lessened their funding and leadership roles; it might be preferable to balance the drug company billions spent on advertising with more non-partisan funding and leadership, rather than the threats in the legislation. Drug representatives take doctors to dinner, not to prison; they have (sadly) achieved greater influence over the profession.
Pioneer Valley Private Hospital
- Gillman PK. Mirtazapine: not a dual action antidepressant? Aust N Z J Psychiatry 2004;38:266-7. .