Why Anne Ruston as health minister is bad for migraine

Today Scott Morrison announced that Anne Ruston, a South Australian Senator, will replace Greg Hunt as health minister, should the Coalition win the election.

I wrote previously on my political blog about how scary it was that we had a lame duck health minister, and a shadow health minister who clearly didn’t want the job.

Anne Ruston is worse. I happen to know the woman a little – she replaced my step-mother Mary Jo Fisher in the Senate. She’s a nice enough woman but not very bright. She’s certainly not very strong willed and does not possess the kind of mettle necessary to command the health portfolio. And, other than a partner that taught her how to play the PR game and basically got her into the seat, she doesn’t have much going for her at all.

She’s the perfect kind of person for an insecure narcissist like Morrison to promote, because she’s absolutely no threat to him.

Here’s the thing, the health world is at a significant crossroads. And the Department of Health is riddled with opinionated self-serving patient-haters that think they are doing a good job when they spend less on health care, without considering the costs to Australian’s health nor the long term costs to the nation of Australians being sick.

Greg Hunt, like many health ministers before him, managed to spend less on the PBS for five years straight while providing a greater number of drugs. The only way you do that is by helping fewer patients, and paying less for medications. Paying less for medications means choosing older cheaper drugs – that are less effective and have more side effects – over newer, better ones. Restricting patient numbers is achieved through cruel and unnecessary criteria.

In migraine land we know this very, very well. For those unfamiliar, let me recap.

We have amazing, life changing and life saving new medications, the first actually developed for the management of migraine. Two of four are on the PBS, but the government is only funding 10,000 patients – which means they are likely to be pulled by drug companies soon enough, and the government will blame ‘big bad pharma’, while health department officials giggle in glee about the millions they have ‘saved’. Of the other two, one is currently being considered for the PBS, and the other was rejected twice because that drug company refused to accept such an absurdly small patient number.

The drug that was refused twice, Aimovig, is the drug that I’m on. It costs me $695 a month. With no respite in sight. I’ve tried the two on the PBS, they have a different mechanism of action and didn’t work for me. It would be cheaper for me to move to the US and buy Obama Care or similar private insurance, and then pay a roughly $20 co-pay per month, than to stay here in Australia and be the victim of the patient-haters in the Australian Department of Health.

For those who benefit from Emgality and Ajovy, the two new meds that we did get on to the PBS after two years of relentless campaigning and the drug companies agreeing to be screwed to a 10,000 patient limit, these are the hurdles we must jump:

• Must be prescribed initially by a neurologist (wealthy and lucky people in big cities only please, rural and poor people should not expect universal health care!)
• You must have chronic migraine – defined as having at least 15 days a month – for at least 6 months (so you need to be completely debilitated for months before you can have medication that works)
• You must try and fail at least three older cheaper medications – all of which were not designed for migraine, don’t work very well, and have significant side effects – before you can be prescribed the new meds (so you need to be debilitated for at least a year, stack on some weight and lose your mind before you can have medication that works)
• You must not have a secondary condition called ‘medication overuse headache’, which is a persistent headache caused by taking acute medications for migraine attack more than 10-15 days per month. (Note the effect of the combination of requirements here: in order to qualify you have to have at least 15 migraine days per month, but can’t take symptom treating medications for 15 days per month… so you have to be in significant pain and discomfort a lot, for months, unable to do anything about it, before you can have the medication that works)

That’s how the patient haters in the Department of Health roll. They require you to be on your absolute knees, your life destroyed, your job/career gone and maybe your family too, and be able to afford a private neurologist or wait up to three years to access a public one, before they will deign to let you have access to effective medication… and they get the drug company to pay for most doses anyway. This is what our health department, that should be working for us, considers a good job.

I have called out the bullies in the Department of Health many times. I know exactly what happened with the screwed up negotiations for COVID-19 vaccines, because I’d watched the negotiations on Aimovig, Emgality and Ajovy be botched and bullied by the same procurement team just months earlier. The patient-haters in the Department of Health don’t actually care about your health, and are very happy for you to stay sick or die – they just like being bullies, and always getting their way.

Their bullying and power-obsessed culture is not limited to the way they treat patients or drug companies. The doctors get it too in the continued cutting back of medicare rebates and absurd conditions. I’m told the Medicare compliance unit has been trying to rival Centrelink’s work in spending more on compliance than benefits. The bullying of doctors of course is felt most keenly by patients, as the pain is passed on, and absolutely will not be fixed by the proposals of Labor to ‘protect’ this patient-hating bureaucracy.

Anne Ruston is on record as wanting to dismantle Medicare because it’s ‘not sustainable‘. I don’t think she actually holds that position, that’s just what she was told to say at a parliamentary hearing in 2015. And that’s the problem – she’s way too weak and way too thick for a portfolio like health, she’ll just do what she’s told to do. The self absorbed health department executives – whom I have heard in conferences and other public conversations refer to as elected leaders as temporary staff who will soon be gone – will walk all over the weak Anne Ruston. Which is, I’m sure, exactly why Scott Morrison and his mate, Health Secretary Brendan Murphy (of chief health officer during the pandemic fame) chose her as their puppet.

This is really, really bad for migraine. We already had an absolute mammoth battle to get either side of politics to stop thinking of migraine as a headache, and pay appropriate heed to the single largest cause of disability in this country (and indeed the world). To give us more than table scraps and limited access to medication, and in return reclaim some of the $36b a year that migraine costs the nation. With a limp-wristed puppet of a health minister like Anne Ruston, we have no chance of changing the conversation.

It’s really bad for everyone. 16 minutes after the Prime Minister met with the Governor General and called the election, the Department of Health published a list of people to be on an HTA review committee. HTA stands for ‘Health Technology Assessment’ – government speak for the review process that is used to decide what goes on the PBS or Medicare. The whole system is being reviewed as a result of the New Drugs inquiry (which I pushed for and gave evidence to) that found things weren’t working very well. Named as being on that committee is Peter Boxall, a known patient hating former senior public servant that recommended the abolition of the PBS in 2013, and Adriana Platona, a case-in-point example of a self-important patient-hating senior official from the department who delights in abusing patients, bullying drug companies, has lied to Senate Estimates about our migraine drugs and was apparently responsible for Greg Hunt calling us migraine advocates astroturf.

This country needs to wake up. We all need to stop being distracted by trivia and nonsense, and realise that there are moves afoot to dismantle the PBS. Labor just bangs on about Medicare and the tinkering they intend to do at the edges of a system that needs an overhaul – but NO ONE is paying attention to the fact that the PBS, the third leg of our not-really-universal health care system tripod that makes it possible for the primary (GPs) and acute (hospital) parts of the health system to function, is literally on the chopping block.

As this election goes forward I’m going to do my best to raise a whole heap of things that any reasonable government could commit to in order to improve the way we manage migraine… but step one would be give us a health minister with the spine and character necessary to stand up to the patient-hating Department of Health. That isn’t Anne Ruston. (It isn’t Mark Butler either.)