This week I have co-signed a letter to the Health Minister regarding changes to men’s health. The changes occurred without consultation and with minimal warning. Most critically it affects men who are already approved for treatment.
The Hon Sussan Ley MP
Minister for Health
We are writing to call for a stay in the implementation of certain changes to the Pharmaceutical Benefits Schedule, due to come into force on April 1.
These particular changes relate to the prescribing of subsidised testosterone replacement to men under the Pharmaceutical Benefits Scheme.
They remove the capacity of General Practitioners to diagnose and initiate treatment for men presenting at their clinics with internationally recognised symptoms of androgen deficiency.
From April 1 the role of making diagnostic and prescriptive decisions in Australia under the PBS will pass to a range of specialists, emasculating General Practitioners from a meaningful role in the care of their male patients.
The changes also introduce a new lower level for the confirmation of androgen deficiency under the PBS through measurement of serum testosterone levels in a man’s blood, lowering the qualifying threshold from an already questionable low of 8nmols per litre to 6nmols.
This unheralded move sanctioned by the current Pharmaceutical Benefits Advisory Committee, none of whose members appear to have any practical experience in addressing male health issues, has raised serious questions with regard to the ethical and scientific validity of the changes and the integrity of the process by which they were arrived at.
However it is the absence of a grandfather clause in the imminent changes which would enable those already established on treatment under existing criteria to continue, which has raised the most concern. Amongst doctors with long standing experience of dealing with men in the real world of day to day clinical practice there is recognition that this is a serious issue.
It is this omission of a grandfather clause in particular which has prompted us to write to you calling for your urgent intervention.
There is a group of men in Australia for whom these changes are potentially life threatening and it is on their behalf that we urge you to intervene and order a stay on implantation pending an investigation. An investigation, not only into the rationale for the changes, the validity and relevance of any supporting and justifying evidence that was considered, the integrity of the process by which the changes came about, but also an investigation into the catastrophic and potentially tragic health outcomes for some men that will be set in motion next week – without any feedback mechanism in place by which this committee can be held accountable for the decisions it has made.
We believe that the effect of leaving out a grandfather clause in the upcoming PBS changes is potentially putting hundreds of Australian men into a life-threatening situation.
These are men in the lower socio economic bracket who genuinely will not be able to afford to continue their testosterone replacement treatment on private prescription and who will be denied treatment whilst they try to requalify under the new rules: an endeavour that could take months and which may not be successful in any case given the extreme nature of the new criteria.
For them the prospect is bleak, with the changes potentially plunging them back into a suicidal ideation that is a common symptom of androgen deficiency.
Sudden withdrawal of access to treatment will cause these men to crash to a worse condition than they were in when they first sought help.
If they were suicidal then, how are they going to react when their restored quality of life is suddenly ripped away from them, when all their previous distressing symptoms return with greater severity and they are looking down the barrel of this being the best they can expect for the rest of their lives?
If even one man takes his own life as a direct result of ill considered bureaucratic decisions where the potential harmful outcomes have clearly not been thought through, it will be one too many. The realistic prognosis is that the casualties will be many.
As Minister for Health you are in a position to prevent this serious error of judgement from taking place on your watch and we urge you to act.
What we are calling for at this stage, Minister, is a delay pending a thorough, unbiased and transparent investigation which does not solely rely on experts and academics already involved, who may have vested interests in the introduction of these changes: an investigation which canvasses feedback from those General Practitioners from all around Australia who have practical and actual experience in this area of men’s health at the coal face of clinical practice.
Surely Australian men who next week will find themselves in dire circumstances by virtue of bureaucratic decisions outside of their control, deserve a stay pending thorough investigation before and not after lives have been irrevocably lost.
Linda Byart AFRM Dr Joe Kosterich MBBS Jonathan Kester LCST MSPA PACAWA PACFA