Gillian Toole (Meath East, Independent)

Gabhaim buíochás leis an gCeann Comhairle, an Aire agus an Teachta Uí Ruairc. I thank Deputy O'Rourke for raising this most important issue. I thank the Minister of State for providing the Minister for Health's quite comprehensive briefing notes. I have only skimmed through them, but I will refer to them.

I have to state the obvious. We have an ageing and increasing population, with a rise in chronic diseases, new diseases and increasing reliance on health services, drug interventions and surgeries. All of this will come at a significant cost to the individual patient and, of equal importance, the State, from the perspective of reimbursement. If we look back to the foundation of medicine, which underpins all of our endeavours through health services and those working to deliver them, the Hippocratic oath is founded on the principle "First, do no harm". That persistent balance of risk and benefit has to be paramount in all decisions that we take. Everything must be patient focused from the outset.

If we take a business analogy, which is probably linked to our national focus on economics, economic development and GDP, as have said on many previous occasions, if we consider the well-being of our citizens, then as important as value for money and risk-benefit analysis are for fiscal prudence, they are of paramount importance for both the patient and the entity responsible for reimbursement - in this case, the State. The patient and the State must know that there is no bias in the system.

I have a couple of suggestions that may be helpful for today and for whatever the outcome or decision by Deputy O'Rourke is. If companies want to help to inform patients about health, they could perhaps pay into a central independent body, that could then give grants to people with a track record of giving evidence-based information to the public. As a pharmacist who no longer practises, I believe that any company running a disease awareness campaign should declare in its advertising that it is doing so because it is developing or marketing a product to treat that ailment. Similarly, all educational materials should bear the same declaration.

I will not go too deep into this because I struggle with it, despite having had to study some of it for a time. Difficult in all as they are to navigate, econometric models suggest - the evidence is there - that marketing has more influence on drug usage patterns than the publication of new evidence. Therefore, an in-depth exploration of the proposal is required. There has been a lot of information gathered over the past 30 years from the United Kingdom. It is quite weighty research.

I wish to mention the matter of voluntary self-regulation codes of practice. The very word "voluntary" must have a red ring around it. Disclosures can be made on the IPHA website. Even a simple review of the current processes, and possibly changing the description to "must" rather than "can", will instil confidence and contribute to transparency. I note that this method of voluntary disclosure is only mandatory for IPHA members. We are now in a space in this country where, because of shortages of product, there is the sourcing of many unlicensed or exempt medicinal products from companies that may not actually be members of IPHA. There may be gaps in information, but I am saying this purely to put it into context. I will go through the information after this debate.

Another example is that of the World Health Organization, WHO, and the World Health Assembly, WHA. The WHA is effectively the executive of the WHO. It was initially set up to be 100% funded by the member states. According to information from the WHA website, though, the funding is 84% from philanthropy and 16% from the member states currently. The philanthropic section has undeniable links to industry funding. There are different pathways. It has been that way for many years. There is an absolute need in that regard. It is beyond our scope, but on 19 May, we signed up to the WHO pandemic treaty, so there will be a connection between our national system and the WHO system. That is something that we also have to have on our radar in the context of Deputy O'Rourke's Bill.

At the end of the day, this is about getting the maximum benefit in a transparent fashion for the patient, first and foremost, and for us. We are moving towards a State-funded drug reimbursement scheme, which is to name only one of the devices used in the public and the private sectors. We are using the National Treatment Purchase Fund to avail of the private hospital system to help clear waiting lists. There is that inextricable link now between the public and private health services. The transparency of the sponsor must be to the forefront of our consciousness. We get the best outcome for the patient, but we should be fully conversant with all parties involved in achieving that outcome.

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