Contributing to discussion, open to debate
While PHARMAC’s staff and independent advisers draw heavily on medical peer-reviewed literature in their decision making, they are also prolific contributors to the literature themselves.
That is born of a desire to draw on the agency’s experience and data to inform the work of clinicians and public health practitioners both here and around the world.
From its early days, PHARMAC staff were submitting articles, letters and editorials to esteemed journals including BMJ, The Lancet, JAMA, New England Journal of Medicine and Pharmacoeconomics.
The agency’s strongest presence, unsurprisingly, has been in the New Zealand Medical Journal, which is published by the New Zealand Medical Association and has a proud publication history stretching back to 1887.
PHARMAC authors feature in dozens of NZMJ articles from the past 25 years. Indeed, PHARMAC has an arrangement with the New Zealand Medical Association to provide free access on the internet to NZMJ articles with PHARMAC authors.
This is a commitment to open access publishing that reinforces PHARMAC’s statutory objective, “to secure for eligible people in need of pharmaceuticals the best health outcomes that are reasonably achievable from pharmaceutical treatment and from within the amount of funding provided”.
The peer-reviewed literature, letters and editorials span all aspects of PHARMAC’s operations – from decisions about funding of statins, to the impact of direct-to-consumer advertising on health consumers, to explanations of the PHARMAC model itself.
One name features prominently as an author or co-author on dozens of PHARMAC-related papers – Scott Metcalfe. The public health physician and PHARMAC’s Chief Adviser, Population Medicine has been with the agency as a staff member or contractor for 23 years.
Metcalfe’s name can often be found alongside those of PHARMAC chief executives, PTAC members and academics, on a wide range of articles fastidiously researched and well articulated.
In 2002 Metcalfe, Matthew Brougham and Wayne McNee were writing in HealthcarePapers, offering words of advice to health sector leaders in other countries struggling with crippling pharmaceutical costs.
“If you want to avoid bankruptcy, first you have to know what you can afford to spend,” they wrote.
“From our observations as a public agency responsible for setting drug subsidies in New Zealand, operating within a budget constraint may better help to achieve many of the desired outcomes.”
Often PHARMAC will add to the primary research base, as it did in 2014 when it used data from the Pharmaceuticals Collection administrative claims database, to measure how the use by diabetics of blood glucose test strips funded by PHARMAC compared with published guidelines.
Often, the medical literature is also used to defend and justify PHARMAC processes and decision making. The agency has taken a proactive stance in engaging with its critics, correcting misinformation and offering insights into its processes.
Wrote Metcalfe, Peter Moodie and Wayne McNee in a 2003 NZMJ article responding to criticism of PHARMAC’s approach to funding statins in the late 1990s:
“Our perspectives differ, but we do agree on the desirability of open and vigorous debate.”
PHARMAC’s funding decisions are regularly contentious. But a commitment to informed discussion and regular contributions to the medical literature have won the agency respect, even from its strongest critics.
Last updated: 13 September 2018