Reti ShaneDr SHANE RETI (National): Thank you Madam Chair. The National Party will not support direct-to-consumer advertising in this bill. Supplementary Order Paper (SOP) 372 in my name amends the Therapeutic Products BillNew Zealand and the United States are the only two countries to allow full direct-to-consumer advertising of prescription medicines (DTCA-PM). All other jurisdictions have determined that the harms to public health of such advertising are of such sufficient magnitude to override the protections in their bill of rights - equivalent legislation. Providers describe inappropriate advertising pressure arising from DTCA and patient expectations to prescribe. They describe how direct-to-consumer advertising - driven pressure on prescribers promotes inappropriate prescribing expensive substitution and rapid uptake of new medicines before full safety data are known. Examples are cited where large numbers of patients have been harmed as a result. This SOP will bring our regulatory framework back into line with international best practice.Active campaigning against direct-to-consumer advertising for more than two decades has been led by consumer advocacy groups such as Consumer NZ and the public health and primary care sector. An open letter in the past week from the New Zealand Council of Medical Colleges has been signed by several hundred distinguished leaders in health and science academics researchers and health practitioners together with leading patient and consumer advocates. Taking these factors into account this SOP seeks to prohibit direct-to-consumer advertising of prescription medicines for human use in New Zealand.I want to describe some of the issues with direct-to-consumer advertising that have been raised by specialists in the past week in particular—not just in the past week in an open letter from the Council of Medical Colleges that has been provided in the past week signed by luminaries as I have said. It's actually been a discussion over several decades. Here are the concerns of some of our most senior and most experienced clinicians and advocacy groups. Direct-to-consumer advertising is prohibited almost everywhere else in the OECD. Direct-to-consumer advertising is inconsistent with efforts to improve New Zealanders' health literacy—and I'll abbreviate direct-to-consumer advertising with DTCA". DTCA targets the most vulnerable. DTCA leads to increased costs for the health system. DTCA leads to inappropriate prescribing and overtreatment. DTCA leads to iatrogenic harm. DTCA puts the doctor-patient relationship at risk. DTCA regulation options are flawed. DTCA does not provide patients with useful information. And finally DTCA perpetuates power imbalance in pharmaceutical companies' favour.We understand the balance of patient information versus prescriber manipulation. New Zealand Bill of Rights Act - type issues were raised in select committee with no backing whatsoever from Crown Law to substantiate them. And similar bill of rights legislation in the EU by way of one example has not provided remedy. It is currently banned in the EU. The mechanism we propose in this SOP is elegant and 20 words. It's just 20 words. It's the line that says "notwithstanding that advertising to the general public of medicinal products which are only available on medical prescription (DTCA-PM) is prohibited." And we've borrowed that particular phrase that particular wording from the EU so that we know that we are consistent with international best practice. It's no epiphany that's sprung into our head overnight; we're using well-established international wording here.The mechanism we propose here is elegant. The Minister does or has generated an SOP which pushes this issue to regulations at some time in the future. We think that is weak and we think that does not address the issue. This is the bill; now's the time. Now's the time to make a statement on direct-to-consumer advertising. You're either in the camp for direct-to-consumer advertising or you're out. We are out. Instead of millions of dollars in advertising and manipulating prescribers maybe those millions of dollars that pharmaceuticals spend could be spent on reducing the price of pharmaceuticals to the most vulnerable. We would contend that is the best place for this sort of funding which we know is in the millions.As a prescriber myself I've faced and confronted—and you deal with it; it's part of your day to day—patients arriving with expectations that they've seen from the television around what is the best preparation for them. You spend a considerable amount of time explaining why maybe not. Very occasionally it might be; most of the time it's not. That's time that could be better spent with other patients actually. You can offer other alternatives and I would come back to the point that the millions of dollars that pharmaceuticals spend on direct-to-consumer advertising would be much better used reducing the price of their products to the most vulnerable."