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Expensive medicine 'derailing' health care

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The national health budget is being derailed by expensive drugs and surgical practices that do not live up to their anticipated benefits, specialist doctors have argued.

Doctors working in cancer, kidney disease, intensive care and anaesthesia are developing a proposal to quarantine about 1 per cent of the Medicare budget to allow working clinicians to study the questions they deem most important in caring for patients.

The specialists are calling for new federal research funds to evaluate cheaper and simpler treatments not promoted by industry.

A meeting in May will precede a formal submission to the Federal Department of Health and Ageing, asking it to follow Britain in financing doctors and nurses to systematically monitor how patients respond to different styles of treatment and test their own ideas as a regular element of their work.

Director of anaesthesia and perioperative medicine at Melbourne's The Alfred Hospital, Paul Myles, said this type of research, ''gets completely swamped by pharmaceutical companies trying to investigate their wonder drugs, which are often very expensive''.

In one widely praised Australian trial, which the doctors will cite as evidence for the approach, intensive care specialists found ordinary saline solution worked just as well as expensive albumin for fluid replacement in critically ill people.

The director of the Division of Haematology and Medical Oncology at Melbourne's Peter MacCallum Cancer Centre, Professor John Zalcberg, said many clinical trials involved groups of patients most likely to respond well to the study treatment. But the treatment might be less effective in more typical patients.

Professor Zalcberg said it was important for the Government to pay for studies that directly compared alternative approaches, to ensure researchers could pursue an independent agenda even if it might undermine industry revenue.

A key question in cancer treatment was whether shorter courses of chemotherapy would work as well as longer courses already endorsed by industry-sponsored studies, Professor Zalcberg said.

But such trials, despite potential savings to the health budget, were ''not seen as innovative'', he said, and were unlikely to be funded under the usual competitive research grants process.

Chairman of the scientific committee of the Australasian Kidney Trials Network, Alan Cass, said Australia spent $1 billion a year treating kidney disease, ''and yet we don't have strong evidence about what form of dialysis gives the best outcomes. We have people advocating for daily dialysis rather then three times a week, and we don't have good evidence for that.''

A clinical research budget could be used not only to evaluate invasive treatments, Professor Cass said, but also to address broad questions such as the best way of providing care to patients in their own homes.

Medical Journal of Australia editor Annette Katelaris, the meeting's convenor, said, ''Clinical utility has to become one of the top reasons to allocate research dollars.''

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