Roche Products Pty Limited v National Drugs and Poisons Schedule Committee
[2007] FCA 1352
At a glance
Source factsCourt
Federal Court of Australia
Decision date
2007-08-30
Before
Branson J
Source
Original judgment source is linked above.
Judgment (17 paragraphs)
BACKGROUND FACTS 42 As mentioned above, orlistat has been included in Schedule 3 of the Poisons Standard since 1 May 2004. At the 43rd meeting of the Committee, which was held on 22-23 February 2005, consideration was given to including orlistat in Appendix H. However, the Committee at that time decided against the inclusion of orlistat in Appendix H. The record of reasons of the meeting records the outcome of the consideration in the following way: The Committee did not support the inclusion of orlistat in Appendix H of the SUSDP. The Committee noted the available data in the clinical trials setting using orlistat for weight loss resulted in modest efficacy and reduced long‑term efficacy. Members were concerned that omission of this information in advertising campaigns could potentially create a consumer demand based on unrealistic expectations of the product's effectiveness. 43 The above decision was confirmed by the Committee at its 44th meeting held on 21-23 June 2005. The record of reasons of this meeting records that the Committee remained concerned that branded advertising of orlistat would convey an inappropriate public health message that pharmacotherapy is the first-line treatment for obesity or overweight conditions and could expose the public to unnecessary risks. Additionally, the Committee considered that such advertising could increase consumer expectations and make them less likely to accept advice from pharmacists. 44 After its June 2005 meeting, the Committee received a new submission from Roche seeking the inclusion of orlistat in Appendix H. That submission was considered by the Committee at its 46th meeting held on 21-23 February 2006. The record of reasons of this meeting records the outcome of its consideration in the following way: The Committee agreed to include orlistat in Appendix H on the grounds of potential public health benefit. The Committee noted additional information on post-marketing surveillance study, media survey and consumer/market research, as well as the experience gained by pharmacists on screening and consulting patients on the suitability of orlistat for other [conditions]. The Committee also believed that the newly amended TGAC [Therapeutic Goods Advertising Code] which has been strengthened with regards to the advertising of weight loss products shall [sic] ensure responsible and appropriate [branded] advertising of the orlistat product … by the sponsor. 45 The Committee considered post-meeting comments received in relation to the above decision at the 47th meeting which was held on 20-22 June 2006. After noting that those comments were supportive of the decision, it confirmed the decision to include orlistat in Appendix H on the ground of potential public health benefit. 46 The 48th meeting of the Committee was held on 10-12 October 2006. Orlistat was again on the agenda; on this occasion for the purpose of enabling the Committee to consider "the current media attention on the direct to consumer advertising". The agenda paper on this item reported: There has been recent media coverage on the advertising of Xenical during the television programme Australian Idol. Both the Australian Medical Association (AMA) and the Australian Consumers Association (ACA) have criticised the advertising of Xenical during prime time TV. The AMA has stated that advertising Xenical direct to consumers gives a misleading message and that it is a medication that shouldn't be allowed to be advertised direct to consumer. The AMA have also commented that the decision to allow direct to consumer advertising needs to be reviewed, as must the decision allowing orlistat to be available without prescription. The ACA believes that the advertising campaign is in breach of the TGAC. Their argument is that the code prohibits the advertising of pharmaceuticals to people under the age of 18 and the core audience for the Australian Idol program is girls in the 13‑17 year age group. The ACA also express concern that the advertisements for Xenical send the message to young women that taking a pill is a solution to weight problems rather than undertaking a balanced diet and exercise regimen. 47 The record of reasons of the 48th meeting of the Committee records the following outcome concerning orlistat: After discussion, the Committee agreed to foreshadow consideration of the current Appendix H listing of orlistat at the February 2007 NDPSC Meeting in order to give interested parties the opportunity to put forward submissions on the issue. Post meeting, the Chair decided to also bring consideration of orlistat's current Schedule 3 status to the Committee for consideration at the February 2007 NDPSC meeting. 48 A notice was published in the Gazette concerning the February 2007 meeting of the Committee as required by reg 42ZCU. The notice advised that the scheduling of orlistat would be under consideration and that the closing day for submissions was 24 January 2007. 49 The agenda paper concerning orlistat prepared for the 49th meeting of the Committee, which was held in February 2007, was lengthy. It reviewed the scheduling history of orlistat and also the circumstances giving rise to the decision to reconsider the scheduling status of orlistat. It summarised submissions received concerning the agenda item, including those from Roche and the Australian Consumers Association ("ACA") respectively. It set out the findings of the Complaints Resolution Panel ("CRP") on the complaint made by the ACA concerning Roche's advertising of Xenical during the television program Australian Idol on 19 October 2006. It noted that a number of submissions had been received supporting the continued Schedule 3 and Appendix H listing of orlistat on the basis of public health need; others had been received supporting the Schedule 3 listing of orlistat; and yet others supporting the retention of orlistat in Appendix H. It also noted that submissions had been received opposing the inclusion of orlistat in Appendix H and that the Australian Medical Association (AMA) had provided a submission calling for orlistat to be withdrawn as a Schedule 3 substance. The Pharmacy Guild of Australia (PGA) had put forward a proposal to strengthen the Standard for the Uniform Scheduling of Drugs and Poisons (SUSDP) regulations regarding the advertising of Schedule 3 substances. 50 The agenda paper identified the following options: OPTION 1. THE COMMITTEE AGREES THAT DUE TO THE EMERGING CONCERNS REGARDING INAPPROPRIATE USE OF THE SUBSTANCE, TO INCLUDE ORLISTAT IN SCHEDULE 4 OF THE SUSDP AND, AS A CONSEQUENCE, REMOVE IT FROM APPENDIX H OF THE SUSDP. Schedule 4 - Amend entry ORLISTAT OPTION 2. THE COMMITTEE AGREES THAT THE CURRENT SCHEDULING OF ORLISTAT REMAINS APPROPRIATE BUT DUE TO THE POTENTIAL FOR DIRECT TO CONSUMER ADVERTISING TO BE MISUNDERSTOOD BY CONSUMERS THAT ORLISTAT BE REMOVED FROM APPENDIX H OF THE SUSDP. Appendix H - Delete entry Orlistat OPTION 3. THE COMMITTEE AGREES THAT THE CURRENT SCHEDULING OF ORLISTAT REMAINS APPROPRIATE BUT THAT THE CURRENT REGULATIONS IN PART 3 OF THE SUSDP REQUIRE REVISION. OPTION 4. THE COMMITTEE AGREES THAT THE CURRENT SCHEDULING OF ORLISTAT REMAINS APPROPRIATE. 51 An extract from a transcript of the 49th meeting of the Committee was received in evidence on this application. It reveals that the Committee discussed the above options. One Committee member is recorded as saying: … just in the interests of transparency, I'd just like to state that the advice from my department is that I should vote against Schedule 3 and Appendix H listing. Another member is recorded as saying: I have voting instructions as well. It is agreed that each of the above members was a jurisdictional member. 52 When a vote was taken on Option 1 that option was defeated. The Chair is then recorded as saying: Therefore, Option 2, that the committee agrees that the current scheduling of orlistat remains appropriate but, due to the potential for direct to consumer advertising to be misunderstood by consumers, that orlistat be removed from Appendix H and the SUSDP. Those in favour? You'll just need to put your hands up and we'll just count. Those against? Okay. And State and Territories in favour? [counting] for. And against? So that is carried which means that the Appendix H listing for orlistat be removed. It remains in Schedule 3. 53 Shortly thereafter a member of the Committee is recorded as expressing concern that the Committee might be understood to have approved a survey undertaken by the ACA concerning pharmacy performance. Another member is recorded as questioning the appropriateness of the wording of Option 2. 54 The Secretary is then recorded as saying: That's not going to be the final wording - the outcome. 55 Immediately thereafter the Chair is recorded as saying: Yes, I think - the criteria for including the Schedule 3 substance in Appendix H - matters that we would consider are the potential for public health benefit - I would have thought that that was the primary issue that we would refer to in our decision - and the likelihood of advertising of the substance leading to inappropriate patterns of medication use - I would have thought that that was another key point. The other things we need to take into consideration are the wider regulatory system through the Advertising Code and therapeutic goods registration process, whether the application may result in the advertising of goods for an indication other than those included in the ARTG - and we've clearly seen evidence of that - the responsibility of pharmacists to be actively involved in the supply of substances included in Schedule 3, available CMI [ie consumer medicine information], the level of patient education necessary to ensure correct use, and the desire of consumers to manage their own medication. 56 The record of reasons for the 49th meeting of the Committee records the decision concerning orlistat in the following terms: While acknowledging the importance of the obesity problem in Australia, the Committee decided that, on balance, there was insufficient public health benefit associated with allowing direct-to-consumer advertising of orlistat. Orlistat is currently only indicated for use in a relatively small group of patients with serious and significant weight problems (those with a Body Mass Index (BMI) greater than 27 with other serious diseases, or those with a BMI greater than 30), not for the general population who might wish to manage more minor weight issues. The Committee noted the advice from professionals and consumers that direct-to-consumer advertising increased pressure on pharmacists to provide orlistat to consumers. This in turn had the potential to result in inappropriate patterns of use, in patients for whom orlistat was neither indicated nor appropriate. By retaining it in Schedule 3, the Committee has ensured that orlistat remains available for appropriate patients with professional advice from pharmacists. Appendix H - Amendment Orlistat - Delete entry 57 The 50th meeting of the Committee was held on 26-28 June 2007. Orlistat was on the agenda for the purpose of considering public submissions on the February 2007 decision to remove orlistat from Appendix H. The agenda paper noted that 33 form letters had been received from pharmacists who supported the Appendix H listing of orlistat. These were in addition to another 607 form letters that were received as part of the post-meeting submission made by the PGA. The paper also summarised a further submission from Roche, which called for the Appendix H listing of orlistat to be reinstated, and a submission from the Australian Self Medication Industry which also supported reinstatement. The paper additionally noted that the PGA had reiterated its opposition to the removal of orlistat from Appendix H and that the Pharmaceutical Society of Australia ("PSA") had made a submission after the deadline for submissions that opposed the listing of orlistat in Appendix H. 58 The Committee decided to affirm the February 2007 decision. Its reasons for the decision are set out in [68] below.