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recommended for PBS listing\nSeventy-nine medicines receiving a positive PBAC recommendation for listing in 2006 (42 medicines) and 2007 (37 medicines) were identified. Ten of these medicines had more than one application to the PBAC for use in different clinical conditions. Eight medicines were the subject of 50 or more news reports in the eligible time frame (2005–2008), 10 had 20–49 reports, 18 had 10–19 reports, 26 had \u003c10 reports and 17 medicines were not mentioned in any news report (see Appendix I). In total, 2664 stories relating to 62 medicines were identified.\nMedicines receiving greatest newspaper coverage were HPV vaccine (1230 stories), trastuzumab (410), pemetrexed (83), botulinum toxin (71), lapatinib (65), methylphenidate (57), atomoxetine (54), Tdap (tetanus, diphtheria and acellular pertussis) vaccine (53), infliximab (49), and rotavirus vaccine (45). The 18 medicines with 20 or more newspaper reports were mentioned in 2350 stories (88% of eligible articles). Nine of these 18 medicines cost more than AU$10,000 per course or year of treatment (see Table 1).\nTable 1 Medicines with \u003e20 newspaper articles (July 2005-June 2008) Abbreviations: NIP, National immunisation program; ADHD, Attention-deficient hyperactivity disorder; HPV, Human papillomavirus; Tdap, Tetanus, diphtheria, acellular pertussis.\n† Cost more than AUD$10,000 per year or course of treatment. Of the 18 highly reported medicines, six (33%) were treatments for cancer or other malignancies (docetaxel, imatinib, lapatinib, paclitaxel, pemetrexed, trastuzumab), three were vaccines (HPV, rotavirus, Tdap), two were used to manage Attention Deficit Hyperactivity Disorder (ADHD; methylphenidate, atomoxetine), and five were for severe, often debilitating chronic conditions (infliximab for Crohn’s disease and psoriatic arthritis, fentanyl for severe chronic pain, natalizumab for multiple sclerosis, ranibizumab for macular degeneration, sildenafil for pulmonary hypertension). Botulinum toxin reports in the eligible time period related almost exclusively to its cosmetic ‘Botox’ uses rather than its PBS listing for spasticity. Five of these 18 medicines (infliximab, docetaxel, fentanyl, methylphenidate, varenicline) were the subject of more than one PBS recommendation during the eligible study period increasing the opportunities for news reports for these drugs.\nTiming of these 2350 news reports in relation to PBAC meetings is shown in Table 1. Across these 18 medicines, 31% of the reports appeared in the 6 months prior to the PBAC meeting, 14% in the month of the meeting and 33% in the 6 months after the positive PBAC recommendation. For this same subset of 18 medicines, there were ≥3 mentions of the medicine in 38% of the stories, reference to the PBS in 37%, personal cost to the patient of the medicine in 24%, and overall cost to Government in 9% (Table 2). Personal cost in the absence of subsidy was mentioned most often for oncology medicines (docetaxel, lapatinib, pemetrexed, trastuzumab, 51% of stories for these medicines) and the monoclonal antibodies (infliximab, natalizumab, ranibizumab, trastuzumab, 52% of stories). Government subsidy (67.7%) and personal cost of the medicine (48.3%) were mentioned more frequently in the stories for the nine medicines costing more than AU$10,000 per course or year of treatment than overall. However, other high-cost medicines including bortezomib (7 stories) and dasatinib (1 story) received minimal media attention.\nTable 2 Content of newspaper articles † Cost more than AUD$10,000 per year or course of treatment.\n# Totals do not sum to 100% as an article may be included in more than one category. While there was no general trend to increased news reporting associated with PBAC meetings, some drugs did attract substantial media attention. We conducted additional qualitative analyses of reports for two medicines (infliximab for the treatment of Crohn’s disease and pemetrexed for mesothelioma) and one class of medicines (ADHD medicines, atomoxetine and methylphenidate).\n\nCase study – infliximab (5th application for PBAC listing)\nThere was a peak of reports in the month prior to the positive PBAC recommendation for subsidised use of infliximab in adult Crohn’s disease. In these articles, the case for infliximab was sometimes personalised with identifiable victims No joy for Sharron after $3000 magic pill rejected, [19]Jill Knox may have to remortgage her home, [20]Nicole O’Malley’s years of agony[21]. Patients were described as let down by the health system[20]and suffering needlessly[22]. Doctors were forced to offer second-best treatment to desperate people who deserve better[23].\nThere was active lobbying by the Australian Crohn’s and Colitis Association [24] specialist physicians and patients [25] (http://www.infliximab.org) and a petition of 25,000 signatures was delivered to Health Minister Tony Abbott demanding a listing of the drug [26].\nOne newspaper view before listing was that is unacceptable. Actually it is un-Australian. That’s not how we do things… a public campaign is the only chance[27]. After the positive recommendation, newspaper reports noted it was long overdue, [28] there was hip pocket relief, [29] and that it was close to winning a seven year battle[30]. The decision was described as a backflip following extensive lobbying, [30] commenting they’ve obviously listened to the public[31].\n\nCase study – pemetrexed (4th application for listing)\nThe story of pemetrexed (marketed as Alimta® in Australia) involved a very public face of a disease resulting from exposure to asbestos. Bernie Banton led the fight on behalf of workers and unions against James Hardie Industries for the establishment of an adequate compensation fund for victims of mesothelioma, only to find himself a victim of the disease.\nBefore the PBAC recommendation for listing (November 2007), patients were described as innocent victims: my only crime was to go to work[32], contracting a deadly disease through no fault of their own[33]. There were women affected many of whom probably did nothing more than wash their husbands’ asbestos coated overalls[34].\nArticles referred to deserving patients … one of the greatest injustices in Australian history that people who smoked voluntarily can get this drug on the PBS [subsidised for some lung cancers] but people with mesothelioma can’t[35]. A sense of entitlement was reflected in a comparison with other subsidised medicines why won’t the Government bankroll an effective cancer-fighting drug yet it spends millions of dollars a year providing methadone to more than 30,000 heroin addicts, [36]I paid tax all my working life…,[32] and it is not too much to ask that a Government …shows some commonsense compassion instead of callous, cold-blooded rationalism[37]. The Asbestos Disease Foundation noted it was appalling that we can spend so much money going to war and all sorts of other things but when it comes to the medicine and treatment of these tax-paying Australian people we just can find the sense and logic to provide the medicine as required[38].\nWhen politicians were challenged about the situation, responses referred to an independent, expert committee [PBAC],[39] and noting the need for companies to respect the processes for drug approvals for PBS listing[39].\nThere was active lobbying of PBAC and parliamentarians. The then Health Minister dismissed the delivery of a 17,000 signature petition from Bernie Banton as a publicity stunt, earning the ire of the media, and provoking the response that it was an unacceptable attack on a great Australian[40]. It resulted in prolonged media coverage around listing of the drug.\nThe positive decision to list on the PBS was reported as Bernie wins battle[41]. We found only one article that provided any detail on the PBAC decision: [the manufacturer] dropped the price [by 10%], changed the way it was packaged to reduce waste and cost and provided more data about how it improved patients’ quality of life[42].\nBernie Banton commented on possible political interference in the final decision: Tony Abbott [Health Minister] assured me there was no political interference in this decision but I would not have liked to have been him if the decision had gone the other way[43].\nThe reporting of the successful listing of pemetrexed was overshadowed by the death of Bernie Banton with tributes and the offer of a State funeral.\n\nCase study – atomoxetine and methylphenidate for ADHD\nIn contrast to the apparent support for listing of infliximab and pemetrexed in some newspaper reports, the discourse for the ADHD medicines often related to the dangers of the drug: deadly side to ADHD treatment,[44]when the costs of a well behaved child could be hallucinations or death[45]. Sometimes, the language of drugs of addiction and war was applied: Kids’ $10M ADHD habit; [46]kiddy-cocaine; [47,48]… a further 58 four-year-olds and 13 three-year-olds are also wandering the state like space cadets; [47]Australia’s dependency on ADHD drugs; [46] and New front opens on ADHD war[49].\nThere was also commentary implying the apparently reckless use of these drugs in very young children when perhaps better parenting and discipline were more appropriate: giving quick and careless prescribers the opportunity to prescribe a drug, [50]Prescribe discipline not drugs for children, [51]quick fix drugs to solve behavioural problems, [45]Has a normal childhood become a disorder?[52]. There was particular ire at their use in pre-school age children: Drugs for Toddlers? You must be kidding, [47] … you just don’t mess with the heads of babies, [47] and using mind-altering drugs… while still in nappies.[47]\nThe debate was fuelled by comments from politicians and members of the judiciary expressing their concerns about use of these drugs [53] that had created a generation of Ritalin kids who were committing violent crimes and coming before the courts[48]. It was noted that the Prime Minister was…very worried about the rate of prescribing of ADHD drugs; [54]….left open the possibility of a national enquiry into the ADHD epidemic[48].\nIn the view of one medical specialist …I think the numbers [of children prescribed the drugs] are not bad actually… we’re not doing such a bad job[47] (the figures follow the State Government’s ADHD review which found there was no overprescribing of drugs). So difficult was the environment that a specialist involved in developing guidelines for the use of these drugs described the task as a “contentious project”, noting “…there’s a high amount of emotional content from the media feeding into the politicians and presumably other dark forces are working in the background and the whole process has been put on hold” [55].\nReaders of some newspapers were invited to contribute their opinions on a complex social issue in simple yes/no polls: Does the issue concern you?[56]Should taxpayers be forced to subsidise ADHD drugs?[54]Should there be a Ritalin age limit?[57].\n"}