John Crown (Independent)
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These are very important hearings and I thank the participants. I raised an issue in the earlier session in regard to the possibility that companies had been lobbying our Government, alleging that domestic purchasing policies for the tiny, infinitesimally small by international standards, Irish market in some way influences the siting of manufacturing plants in Ireland. I said I believed this was nonsense. It took me a few minutes to find the reference but it was reported by Martin Wall in The Irish Timesin December 2012 that high level representations had been made by Mr. Lechleiter from Lilly and Mr. Weldon from Johnson & Johnson, among others, to An Taoiseach, suggesting that if we did not get our act together and prescribe expensive branded products, they may think about where they put their investment for jobs, which is nonsense. We all know that investment for jobs is based almost entirely on corporation tax and almost nothing else, except a good workforce.

The reasons the market fails here are complex and Professor Dunne's contribution has been very helpful. We have a big cultural job to do on people, patients, pharmacists, doctors and purchasers in terms of being quite willing to move to generic drugs, if generic drugs have passed their analysis and have been approved. If at that stage anybody has any reason to believe one of them is less effective, they should then report it to the authorities and ask for repeat testing. It is surprising how rare that is. One never hears of that happening. The products, in general, are quite good.

I prescribe some horrendously expensive cancer drugs and I made the decision a few years ago to try to save money wherever possible by prescribing generic cancer drugs but one encounters a lot of opposition from patients who repeatedly ask why they cannot have the particular anti-breast cancer tablet they have been taking for years. I tell them they can have it but that they should know the generic one works just as well and it is a lot cheaper. We have a job on our hands and our profession has failed a little bit in that regard.

Another part of the problem is that I do not believe the HSE is very good at purchasing. It does not run the organisation like a business but rather like a bureaucracy. One of the ways a bureaucracy deals with budget overruns is to try to delay spending and that is why we have waiting lists for beds, for operations and for clinics. It is also one of the reasons we have delayed approval of products. If one can put extra hurdles in the way of the approval of a product and get it into next year's budget as opposed to this year's one, it helps one, at a time of great constraints in a health service, to meet that panic-stricken budgetary deadline that one has to meet the next time.

Gardasil, the cervical cancer vaccine, was originally unearthed before the financial meltdown and a correct decision was made to approve it. A decision was then made, when we really got into the real horrors of constraint in 2008, that it would not be purchased. However, a year or two years later, it was purchased, following what was alleged by the authorities to have been a robust negotiating process. I happen to know that no tender was ever asked for either of those drugs at the time of the original rejection.The decision was made on the list price that one could get on MIMS for a vial of the drug which was never going to be the price a whole country, which might be vaccinating 30,000 to 40,000 young girls per annum, would be charged.

I have a question for Mr. Gallagher. We hear a lot about the need for indigenous industry. It was my impression that we had a number of Irish entrepreneur-driven generic houses in this country, which were quite big leaders in the field of generic medicines. I may have my eye off this particular radar screen but I get the sense that is no longer the case and that most of what we have now is an increasing concentration of generic manufacturing in the hands of an ever smaller number of increasingly massive organisations. Would this be a mischaracterisation? Is there something we could do at a public policy level to foster and encourage the redevelopment of an indigenous generic manufacturing sector?