As Deputy O'Higgins said, the position is not quite the same now as it was. In relation to this establishment of an Irish pharmaceutical industry, I probably took the first steps myself in that I allowed the imposition of a tariff on Virol or something like that in order to allow a small industry in the midlands to be established. There is no comparison between a substance containing cod liver oil or malt and the substances we are dealing with. It is quite clear that this baby industry is likely to become a very much more powerful and substantial one and everybody wishes its well.
The Minister must not adopt the attitude that those of us who question it do so because we are anxious to see the continued importation of British, American, French or German drugs. I think we are able to make any substance or to carry on any craft, skill or profession as well as the people of any nation in the world. We have proved that; and I believe we could prove it in the case of a pharmaceutical industry, too. All I want to see is that the industry is given every possible chance of surviving in this its critical stage when it branches out into rather more important medicines, drugs and tablets.
It is for that reason that I think the suggestion of Deputy O'Higgins, and the suggestion of a number of responsible people, that a bureau of standards be established is a perfectly reasonable one. This suggestion is based on the assumption that the Irish pharmaceutical industry will extend, expand and grow. It is not a suggestion that has in mind the idea that it will collapse; on the contrary, it is an idea based on the assumption that the industry will expand. For that reason, we want to see the highest standards set and maintained.
The Minister seems to misunderstand the position a little in relation to the position of the medical profession. I do not think the average doctor gives a damn whether the drugs he prescribes are made in Hong Kong, Honolulu, Thurles or anywhere else. He is primarily concerned with whether they secure the end he has in mind, that is, the curing of the particular illness from which the patient is suffering. I do not think the Minister will be inundated with protests from the medical profession. On the contrary, I think the medical profession would much prefer that no great row was made about this whole question because they do not particularly want a change.
Deputy Dillon made a point in regard to drugs that are habitually used, that, on the one hand, a doctor has a belief in veganin, aspirin, some proprietary medical preparation, simple or complicated, which happens to work. He is conservative. He knows it is likely to work and that it has been tested and tried. He is likely to cling to that particular drug. On the other hand, the patient is also concerned in these things. It is quite an act on the part of a doctor to break a patient off a habit or a belief he happens to have in a particular drug. The doctor will not bother breaking that without some incentive.
Even if the Minister is to get the medical profession into his Department and ask them for their co-operation, I still think he will have a very hard job getting them to collaborate. There is a certain conservatism and a certain primitive belief — not really primitive, but a justified belief—that particular drugs will work and others will not. Why change horses when you are quite happy about getting the patient well? The Minister's job is a particularly difficult one, even taking the advice put forward to him with the best will in the world.
I do not think the Minister should take it that because the medical profession has not protested, everything is quite all right. It is not the doctor who pays for these drugs—he merely recommends them—it is the patient who pays for them. If the patient is given a prescription and goes to the chemist and finds that the price of the imported drug has increased by 10 per cent., 20 per cent. or whatever it is, the doctor is not really concerned because he has his fee. He merely says that the Minister for Industry and Commerce is trying to establish a new Irish industry and everything is more costly than it used to be. Generally speaking, the Department and the Government get the blame, but the main point is that it is the patient who pays and the cost of medicine is increased in that way. I think it is unnecessarily increased because there must be some way in which it could be established to the satisfaction of the medical profession that we can make these drugs here just as satisfactorily and efficiently as they can be made anywhere else and that the Irish trade could become established as being satisfactory and completely reliable in the production of medicines, tablets or drugs.
However, in present circumstances, I do not believe the Minister can give the medical profession any such guarantee. It is no good quoting the British Pharmacopoeia at them. Have the provisions and conditions as laid down in the British Pharmacopoeia been observed by the manufacturers? The manufacturers will say "Yes". The person distributing the diluted milk will not tell you he put water into it. For that reason, we have the food and drink regulations and health inspectors, some of whose functions are the periodic inspection and analysis of the different foods used for human consumption. These are some of the very good provisions of the 1947 Act, provisions which basically should be implemented in this Bill also.
There is no good in the Minister saying that officials have gone down to these factories, have looked at them and found that the premises are satisfactory and clean, and that the equipment is clean. That is neither here nor there. It is no use having first-class equipment and machinery and competent looking technicians turning out drugs which are not in fact made up to the formula laid down in the British Pharmacopoeia or which are in some way defective. The only way in which you can ensure they are not defective and that they are according to the detailed formula of the British Pharmacopoeia is by analysis. Going in and having a look at the factory and machinery is not a sufficient or satisfactory examination in this case.
For that reason, there is a most compelling case for the Minister to establish some form of independent and objective bureau of standards which can be above all of us—the profession, the public and the manufacturers — and consequently make certain statements which simply cannot be questioned because they are of scientific origin and therefore of great value.
If the Minister dismisses this whole idea of a bureau of standards, I do not think he can be serious in putting forward as a substitute that health inspectors and Department of Health officials should be satisfied with what they see. Why do other countries, on the Continent and elsewhere, not satisfy themselves with these devices if they are adequate for the protection of the public in relation to these various kinds of drugs?
It is a particularly difficult thing to assess the quality of effectiveness of drugs. If you have a drug which is defective in quality, the patient simply does not get better and it is important to try to keep control of the effectiveness of drugs. There is no good in saying to the doctors: "Keep your eyes on these things and, if they do not work, we shall know then that they are not up to the standards laid down by the British Pharmacopoeia." There are scientific methods to control the sale of drugs and these methods could be used properly only in a bureau of standards to test such drugs as biomycin, and the effectiveness of drugs on animals.
I personally appear to have very much more faith in an Irish pharmaceutical industry than the Minister because I hope it will become a very big industry which will eventually be in a position to export its products rather than that we should have to depend as at present, on other countries. Therefore, these steps should be taken so that we shall be able to offer to our own medical profession the evidence of analyses carried out by scientists, and be in a position to export to other countries that will probably be glad to trade with us, such as the Afro-Asian countries. When we take such steps and develop exports, we can export the drugs with absolute confidence that they are what they say they are on the label.
It is impossible, on the evidence put forward to us at the moment, to offer any such guarantee to the medical profession in our own country or, indeed, to that in any other country and, as a medical person, I could not consider switching with any serious drug. I am not talking about aspirins or anything like that, but it would be quite wrong, without the absolute certainty of a standard established by an independent authority on drugs, to switch in the treatment given by one drug now and possibly risk the life of an individual.
For that reason, the Minister should give serious consideration to the suggestion of establishing a bureau in relation to the distribution of drugs. I would also like to ask what is the position in regard to the Department of Health as regards the authority it exercises over the use of drugs in local authority hospitals and institutions of all kinds, through the Combined Purchasing Section of the Department of Local Government. Is there to be a re-consideration of the permitted drugs for use in these institutions? Is that list of drugs to be pruned and are imported drugs to be excluded and substituted by home-manufactured drugs and medicines?