Feargal Quinn (Independent)

I wish to share my time with Senator Ross. I welcome the Minister to the House and the explanations she has given on this issue.

When I came into this House 15 years ago I decided that I would examine all proposed legislation from the customer's point of view. I want to look at the present problem from a slightly wider angle than we have become used to over the last few weeks.

I am a fan of the tasks that pharmacists do. I see them as fulfilling an important and necessary role in the overall health service. In a situation where the primary health care provided by doctors is hopelessly inadequate, pharmacists serve as a kind of auxiliary troop in the fight against ill health. At community level they are an important part of the health care team and could play an even more important role.

However, while I am a fan of the task of pharmacists and their general role, I am much less of a fan of the pharmacists themselves. To be more precise, I am not in favour of the way they have defended their vested interests in recent years against the more general interests of the community the Minister described so well earlier. Their policy all along has been blatantly protectionist, and in a rapidly changing world they have tried their hardest to defend the indefensible.

In the current dispute the mark-ups pharmacists enjoy in dispensing medicines are undoubtedly excessive, and I fully support the Health Service Executive in its efforts to reduce them. However, I have not always been much of a fan of the HSE, either generally or in the way it appears to have handled this dispute. The HSE deserves at least some of the blame for the situation we find ourselves in today. The fact that it has the right on its side does not give it licence to behave unreasonably in its negotiations.

Having called down a plague on both houses in this dispute, I will now try to widen the issue. The mark-up by pharmacists is not the only issue that affects the excessive cost of drugs in this country. There are at least three other factors that the HSE should be paying attention to and which, until I heard the Minister speak earlier, I thought it was ignoring.

The first factor is the use of its buying power against the prices demanded by the drug multinationals. As a retailer I am very aware of the clout created by being a big customer. I had intended suggesting to the Minister that she should get together with other countries — she has indicated she has got together with nine of them — to be able to negotiate in a better way than we have done previously. I was pleased to hear that.

The second factor is the greater use of generic drugs. These are drugs on which royalties do not have to be paid because their original patents have expired. The drug multinationals are past masters at making tiny and inconsequential changes to their drugs just as the patents are about to expire. They ally that with pressure on doctors to prescribe the new drugs rather than switch to the much cheaper but just as effective generic drugs. Since the medical profession has shown itself incapable of addressing this problem, the time has now come to deal with it at national level, probably by way of legislation.

The third urgent issue also involves curbing the doctor's traditionally unfettered freedom to prescribe whatever he or she likes. It has become clear in recent years that we have a serious problem in over-prescribing by doctors, largely created by the expectations of patients. It is notable, for instance, that the average number of drugs prescribed to medical card patients, who can visit the doctor as often as they like, is considerably higher than the average number of drugs prescribed to private patients. That has very serious cost implications for the health service but it is not the most important reason over-prescription must be stopped as a matter of urgency. The more drugs that are prescribed, especially of antibiotics, the more resistant the patient's body becomes to them. I understand the staggering increase in the prevalence of the MRSA bug in our hospitals in recent years has been attributed to the general over-prescribing of antibiotics by general practitioners.

I welcome the Minister's contribution to the debate. The row between the HSE and the pharmacists will no doubt sort itself out in the coming weeks. The Minister has shone a beam of light on an area I had not quite understood until today. It will help bring this dispute to a conclusion.