Feargal Quinn (Independent)

I thank the Minister of State for his coverage of what we are doing. I tabled amendment No. 17, which was not allowed and I have a confession to make in that regard. I knew when I was putting forward the amendment that it probably would be ruled out of order under the quaint rules by which we operate in this House. I persevered in submitting it because I got the strong impression in the debate two weeks ago that I was pushing an open door as far as the Minister and the Department were concerned. I believe strongly in this amendment and that there is a benefit to be had from it. It is my hope that the Minister will tell the House that he intends to take on board the intention of my amendment and perhaps reintroduce it on Report Stage.

Perhaps I may be allowed to recap on the case I made in the debate two weeks ago. The matter concerns the drugs doctors order and prescribe for their patients, which represent a large and growing cost of our overall health system because they are paid for by the State. Everybody, including the Minister and I, is concerned to ensure we get the best possible value for the money we spend. That is not the case currently because of the way drugs are prescribed. Very often the prescribing doctor has a choice between a well known and well advertised branded drug and a generic drug. In most cases the only significant difference between those two drugs is the cost. The branded drug invariably costs more than the generic one and can cost a multiple of the cost of the generic drug. Ultimately, the difference is paid by the taxpayer because the amount goes into the coffers of the big drug companies.

As I pointed out two weeks ago, I am not trying to to undermine the business model of the giant drug companies; they do a very useful job. I have no problem with them recouping the research costs they put into their drugs during the period the drugs are covered by the patent but when that patent protection expires, there is no reason the general public should continue paying for those drugs an amount that is vastly greater than the actual cost of producing the drugs because the patent and the research has been covered. Generics come into the picture when the patent protection expires. They do not have to carry the burden of recouping the research costs and therefore the prices at which they sold can be much closer to the cost of producing the drugs, which is much lower.

Understandably, the large drug companies do not see their revenues cut out in this way. They want to continue getting premium prices for what they have invested in but I spoke in the previous debate about their techniques for trying to ensure that happens. One is to keep making small and largely insignificant changes to the drugs they produce, which allows them to claim that the tweaked drug is new and improved but much of the time that is marketing bluff of which those of us in business are aware, as are consumers.

Another technique they use is to expose medical practitioners to a blitz of publicity pushing their wares. I am sure Senator Henry has had a great deal of experience of that in the past. That pressure is all one-sided. There is no corresponding marketing from the producers of the generic drugs because their cost structure does not allow for large spending on marketing. In fact, the whole concept of generics is that money is not spent on marketing.

Since speaking in the debate two weeks ago, I read an article in The New York Times on Monday of last week which spelled out in graphic detail one aspect of the marketing push in which the big drug companies indulge. According to that article, it is the practice of the drug companies in America to recruit sales representatives from the ranks of college cheerleaders. I thought that was fascinating. These are the girls who dance and wave pom-poms in front of the crowds at American football games. They encourage the team and the supporters. Apparently, the drug companies are not interested in the subject the potential sales representative studies at college. As one person quoted in the article stated:

Proven cheerleading skills suffice. Exaggerated motions, exaggerated smiles, exaggerated enthusiasm — they learn those things, and they can get people to do what they want.

That is a lovely quote worth remembering. I do not suggest that should happen in Ireland. For one reason I do not see it working but all Irish doctors will talk about the real pressure they come under from the big drug companies pushing them to use their products. The inevitable result is that we, the public, end up paying far more for many drugs than we need to pay to get the medical results we desire. In most cases it is the taxpayer who ends up paying the bill.

As the Minister readily acknowledged in the debate two week ago, we cannot force doctors to prescribe one type of drug over another. The freedom to choose a particular drug appears to be regarded as an important issue of clinical independence, which I understand. In the face of that I made a modest proposal which is encapsulated in the amendment we will not now discuss. I suggested that the Irish Medicines Board keep a register of those drugs for which there is a generic equivalent and update and publish that register via the Internet to medical professionals and also to pharmacists. The register would be a considered statement by an authoritative and respected body that there is no significant therapeutic difference between those drugs other than the price. It would put into the public domain the real truth about the drugs the doctor is choosing between — the generic or the branded one. It would be an admittedly small but useful counterweight to the marketing efforts of the big drug companies, which understandably seek to preserve their revenues. Therefore, the doctor would have a readily available reference, which he or she could quickly consult if in doubt or in need of information on whether there was a generic equivalent of the particular drug about to be prescribed.

Such a register as I am proposing could be established and maintained at a tiny cost. My amendment was turned down because of its cost implications but putting this information on a website would incur a small cost compared to the large amount that could be saved if the prescribing practice of doctors could be changed. I accept we cannot do so by compulsion but it does not mean we should not take every possible step to set out the facts of the matter before the medical professionals, both doctors and pharmacists.

For these reasons I look forward to hearing the Minister of State say the Government will adopt the intention of my failed amendment and act on my suggestion. I feel strongly on this matter as I know something about generics from the grocery business. The difference is that much research has been carried out in the area of prescribed drugs. Big drug companies must be refunded for that research. The concept is that we will continue to encourage them in their research but, once a patent has expired, a doctor could identify an alternative drug deemed by an authoritative source as being as good as a highly branded drug and prescribe the generic version. It is worthy of consideration. I was impressed by the Minister of State's words last week and I hope the matter will be considered.