Episode 31: Medicines safety, health literacy and the National Medicines Policy in a pandemic world

Voiceover:

Welcome to the NPS MedicineWise podcast, helping health professionals stay up-to-date with the latest news and evidence about medicines and medical tests.

Steve Morris:

Yeah. Hello, I'm Steve Morris, CEO of NPS MedicineWise, and welcome again to the NPS MedicineWise podcast. And today I have a repeat offender with me, Professor Andrew McLachlan from the University of Sydney. Hi, Andrew.

Andrew McLachlan

G’day, Steve.

Steve Morris:

I think this is your third appearance on our podcast series.

Andrew McLachlan

I did one with you and also Australian Prescriber as well.

Steve Morris:

Yeah, that's right. That's right. Well, thank you again for taking the time. Look, we just want to have a bit of a chat around a number of QUM issues, including National Medicines Policy, medicine safety and health literacy. So just to kick off, obviously, as you'd be aware, recently it was announced there'd be a commencement or perhaps a recommencement of the review of the National Medicines Policy, which was originally announced way back in October 2019. And it's due now to begin in August 2021. And what we know of the review so far is that there will be a stakeholder consultation process and a call for public submissions to support the review. So, I suppose, Andrew, the first question I have is, why should our listeners remotely care about the National Medicines Policy?

Andrew McLachlan

You're right, Steve, as always. It's a good question because talking about policy is certainly a great sedative and can even be a laxative at times. But look, having said that, National Medicines Policy has been in place for over 20 years and really does provide the overarching framework for many things we do every day in healthcare and really about the fabric of how we make decisions.

So, it also sets out, of course, what Australians can expect from medicines and healthcare. So that's about affordable access to medicines that are high-quality, safe and effective from a viable and responsible medicines industry. And of course, when we use a medicine aligning with all those QUM principles that we see the benefits and avoid the harms.

Steve Morris:

Yeah. So, would you encourage some of our listeners to consider making a submission or to encourage other people to make a submission?

Andrew McLachlan

Look, I would. And you mentioned the idea of stakeholders, and stakeholder consultations are a critical part of it because at the very core of the National Medicines Policy are the people, the healthcare consumers. And around that, of course, are the healthcare professionals that are looking after for them. And when we look at our broader medicine system, a lot has changed in the last 20 years about the type of medicines, the type of system that we're in and even, of course, things like the cost of medicines and even consumers and how they think about medicines, which has been probably changed forever by COVID. So that new context becomes very, very important when it comes to reshaping what that National Medicines Policy should look like in the future.

Steve Morris:

And if you don't respond, you can't influence, Andrew.

Andrew McLachlan

That's right. You've got to be at the table to be part of the conversation. I think that's an important message.

Steve Morris:

Yeah. And just picking on something you mentioned around COVID, obviously you published an article in the Australian Prescriber back in February 2020, which you called National Medicines Policy 201, a vision for the future. And that, strangely enough, was recorded pre-COVID.

Andrew McLachlan

It was.

Steve Morris:

So, what's changed because of COVID and how you think the health system's adapted during that period?

Andrew McLachlan

Yeah. So maybe when I think about that article, which was kinda timely, much of what we wrote with Parisa Aslani I think is still valid. But some things certainly have changed, and actually some have come to pass. So maybe I'll touch on three things that are relevant from that particular article.

So, one thing we touched on there was the idea of pharmaceutical nationalism, and we've seen this play out with COVID. And there's been calls, of course, in the media for Australia to retain or to develop its sovereign capability in medicines manufacturing. And we've seen that, of course, in vaccine development, but it equally applies to many essential medicines.

The other one is to have secure and robust supply chains to ensure that Australians can actually get the medicines they need. So, medicine shortages is a continuing emerging theme, and this was really emphasized, of course, during COVID. So that's one.

We've already touched on the idea of health literacy, and I think the last 18 months have really changed forever the way people think about medicines and the common parlance around drug development, around side effects of medicines.

Imagine talking to your mom about mRNA vaccines and what they do. These are things that have really changed the discourse around medicines as health interventions and, of course, the importance of science when it comes to making decisions in public policy. The number of people who seem to be experts on different aspects of viral spread is really quite amazing.

And the very last one, which I think is interesting, is the role of the medicines industry, the pharmaceutical industry. And really this has been highlighted as very, very important in bringing medicines to market that the world needs. And of course, now the names of companies like Pfizer, AstraZeneca, Moderna, Johnson & Johnson and CSL, of course, are on the lips of people.

And what I really think is interesting about this common conversation is that people no longer use the word vaccine. They say things like I had my Pfizer this morning, or I'm having my AstraZeneca next week. So those are three areas of ability to make medicines here in Australia and access them, health literacy and of course the medicines industry, I think are three things that certainly have changed or really ramped up since we wrote our article.

Steve Morris:

Yeah, absolutely right, Andrew. Look, I never thought in a million years I'd have a conversation with my own father for 20 minutes about how he believed he received a superior vaccine to me and quoting literature papers and what he'd read over a long period of time. So, I think it has fundamentally changed that kind of discourse around medicines, which in many ways can be a positive thing.

Andrew McLachlan

Of course. I think also just on that, your father, obviously a notable scholar and a person who dives into the literature, it's really important to appreciate as well, now more than ever, at our fingertips related to these vaccines. For example, there's all the clinical trials, which were very robustly and rigorously assessed, so we have a lot of confidence in them. But now at the end of April, it was estimated there are 600 million people who received vaccines for COVID. And of course, most of those have been tracked around efficacy and safety.

There's a really good article coming out in the Medical Journal of Australia soon, David Henry, it's online early now. David Henry and team looked at the real-world evidence. And this is a really important area of understanding. Not only does it work from a clinical trial, but does it work in practice? And that new dimension is now very front-of-mind when it comes to translating, is there a difference between the vaccines? And I saw from that article there's not when it comes to preventing serious harm and illness. There may be some subtle variations between them, but all of them are substantially better than most vaccines that we've ever had really used therapeutically previously.

Steve Morris:

Yeah. Look, and just to pick on that whole health literacy issue, Andrew, what you've described is obviously conversations occurring about side effects and risks and harms and benefits of medicines, which probably never happened to this degree in the past, so potentially a good thing for health literacy and public awareness. But how do we make sure we make the most of this opportunity to really do more around health literacy and public awareness?

Andrew McLachlan

Yeah. Steve, what worries me the most about this development and trend, and you really put your finger on it, is the lack of balance, especially in some sections of the media. And I really think healthcare professionals have a vital role to really lead the conversation with balanced information. And for me, this comes down to a couple of elements in many ways.

First of all, we're encouraging people to ask their healthcare professional, doctor or pharmacist. We also have to make sure healthcare professionals expect to be asked and want to be asked about providing information. And we think about the mantra of shared decision-making, which is best practice when it comes to QUM. It's really that idea of no decision about me without me.

So, when it comes to communicating harms and benefits, the healthcare professional needs to be up-to-date. And I just spoke about the real-world evidence which continues to emerge. We need to know the most current evidence and information. So, we do have to follow that. And then it probably starts by understanding and addressing an individual's concerns. So rather than just a download of info, understand what they already know and try and address any major concerns and then use a format that's accessible to them.

So, it might be some people want numbers. They want quantitative data. Others like graphics. There's some really good apps out there as well which allow people to fiddle around and say, "What if?" as well. And then comparative examples, and we've seen quite a few of these in the media where people have said comparing this to other types of activities.

I suppose the last thing I'd say around this is that it's very important we don't dismiss concerns, but we listen to them and try and respond in a balanced way, not only about the possible harms, but also help people appreciate the benefits, not just to them directly, but to the broader community. And that's very relevant when it comes to vaccines.

Steve Morris:

So, what you're saying Andrew is it's incumbent on many of our listeners and health professionals per se to do what they can to try and explain risk, just in the context of the understanding of that individual consumer and patient.

Andrew McLachlan

Yeah, that's right. So, we know that there's a whole range of health literacy and understanding that people have in the community. Of course, add on to that people different culturally and linguistically diverse backgrounds and then all sorts of levels of understanding and misconceptions. So, I find it better, and certainly when we're training pharmacists, we talk about topping up information and correcting misunderstandings rather than necessarily just doing a data dump or download. And that's obviously tailoring the message for that individual to understand better.

Steve Morris:

Yeah, that's right. And look, maybe one final question on National Medicines or reflection on National Medicines Policy. It is unique to Australia, isn't it? As far as I'm aware, having that kind of policy in place.

Andrew McLachlan

Actually, the World Health Organization has really led this internationally, and there's been a big move for many countries around the world to take on National Medicines Policy. How it's embedded in our health system, I think, is quite unique. And if you read the budget papers, another great read, if you're looking for something interesting to do on a Saturday, work your way through the budget papers each time the budget comes out. The funding for healthcare is directly linked to our National Medicines Policy, but many countries around the world have a policy, and actually many have crafted their policy, particularly in the Asia-Pac region on the Australian policy.

Steve Morris:

Thanks for that, Andrew. I'm just going to change tack slightly and maybe talk about a broader issue of medicine safety.

Andrew McLachlan

Sure.

Steve Morris:

Look, a week or so ago at the end of June, there was a report from the Medicine Safety Forum, which was set up to inform Australia's 10th National Health Priority Area. And that was published by a consortia of leading medicine safety experts, including MedicineWise and the University of Sydney, Monash University, Consumer Health Forum, PSA, and SHPA. And the report really endorses, well, and calls for action to turn the tide on unsafe medicine use to better protect Australians against preventable harm. So how do we turn that tide, Andrew? What's the key message from that report?

Andrew McLachlan

Yeah. So, this report really was that bringing together the minds and experience of multiple stakeholders, and as you say, it's people from across the sector. I was lucky enough with the Monash University to lead the write-up of that report and bring together some of those insights. So to cut to the chase, there are about 10 recommendations that are embedded there, and really they focused on systems issues that can address preventable harms from medicines. And they included particularly garnering the experience of consumers, which hasn't always been in the discourse around medication safety.

There was a call for setting up medication safety targets, measuring things that matter, quality indicators so that we can track them over time, and also benchmarking to make comparisons. I think the other part of this was better targeting of medicines we know to be at high risk and individuals, people who are most vulnerable and the situations they find themselves in. And much of that aligns with the World Health Organization's Global Patient Safety Challenge, Medication Without Harm. And that sets the laudable target of reducing preventable harm to medicines by 50% over five years.

So this is a really important document, which I think will feed very nicely into the National Medicines Policy review that we've started talking about today, but it also put consumers right back in the heart of this conversation. And I think that's something that we're really proud of.

Steve Morris:

Yeah. So, Andrew, strategically, we've got the focus on the 10th National Health Priority Medicines Safety, the review of the National Medicines Policy. So yeah, a real opportunity for people to try and be involved and influence future focus and strategic action.

Andrew McLachlan

Yeah, most definitely.

Steve Morris:

Thanks again, Andrew, for participating. I've got one final question for you related to risk. What is the risk of England losing to the Ukraine in two days' time?

Andrew McLachlan

Well, usually what I do there is I gather some evidence and information from a credible expert such as yourself. I know that you normally do a Bayesian analysis of all of the goal-scoring opportunities over the last 50 matches. I'm not sure if you want to share those results now or save them for another podcast, but I know, like you, I'll be watching with white knuckles of excitement. There's been so many great matches in the Euro already, and I'm sure there's more to come. And go, England.

Steve Morris:

Yeah. My prediction is two- nil, and by the time that this podcast is released, the game will have been played. So we'll see whether my prediction is accurate. But yeah, thanks again for your time, Andrew.

Andrew McLachlan

My pleasure. Thanks very much.

Steve Morris:

Okay. Yeah. Thanks for listening. And look, I'd just like to take this opportunity to say this is my last podcast as CEO of NPS MedicineWise. I'm moving on, but look, I've really enjoyed doing these podcasts, and I hope you've enjoyed listening to them. And look, it is a really opportune time to raise and discuss issues around National Medicines Policy and medicines issues. I think there's a real opportunity to improve outcomes for consumers relating to the quality of medicines. And it is really incumbent on all of us to do what we can. And hopefully I'll still be involved in medicines in some way, but I encourage you all to do what you can in the role that you have to improve outcomes for consumers related to QUM. Okay. I hope you have enjoyed listening. Goodbye.

Voiceover:

For more information about the safe and wise use of medicines, visit the NPS MedicineWise website at nps.org.au.