§ 2.38 p.m.
§ Order of the Day for the Second Reading read.
§ LORD AMMON
On behalf of my noble friend the Earl of Listowel, I formally move the Second Reading of this Bill.
§ Moved, That the Bill be now read (Lord Ammon.)
§ THE EARL OF MUNSTER
My Lords, I would probably have withdrawn my remarks in view of what the noble Earl might have said. I see he has just arrived. I think it is a pity that we should let this Bill go through without some information from the Government as to what are the intents and purposes of the five clauses.
§ THE POSTMASTER-GENERAL (THE EARL OF LISTOWEL)
My Lords, I must apologize to your Lordships' House for not being here when the question was put. As a matter of fact, I was dealing with a point which a noble Lord intended to raise during the debate and which has only just reached me. The Object of this Bill, which is a Bill of some importance, can be put in a single sentence. It is to control the sale and supply to the public of penicillin or any substance with similar properties. The Bill will prevent such drugs and preparations reaching the public unless they are supplied or sold either by a properly qualified person—that is to say a doctor, a dentist or a veterinary surgeon—or by a chemist acting on a prescription drawn up by such a person.
I should like to explain briefly to the House why in our view this new drug should not be supplied to the public without the authority of a qualified practi- 402 tioner. To do this If must refer to some of the circumstances that have led up to the decision of the Government to introduce this Bill. At the present moment there are certain. restrictions on the sale of penicillin to the public, and these restrictions have been imposed by Orders made by the Minister of Supply under the Defence Regulations. These Orders were made at that time because the supply of penicillin was so limited that it could not be used whenever it was required, and might otherwise have been frittered away on uses not directly connected with the cure of serious illness. Since then. the production of this drug by manufacturers has steadily increased, and there is now sufficient quantity for all medical purposes at home, leaving a surplus over domestic requirements for export abroad. Therefore, there is no longer any justification for continuing to enforce Orders which were in fact authorized by Parliament to conserve a limited supply of this drug.
The question that has arisen is whether these Orders should he revoked forthwith, leaving penicillin to be bought and sold like most other articles in a chemist's shop quite freely- and without restriction: or whether it should be subjected to some. new form of statutory control. Before arriving at a final conclusion about this the Government decided to ask the advice of certain medical experts, the outstanding authorities in their own field. We wanted to know whether, in their opinion, the public could safely be allowed unrestricted access to penicillin. The experts consulted were Sir Alexander Fleming, the discoverer of penicillin who was awarded the Nobel Prize for Medicine in 1945 and whose name I have no doubt will be honoured among those who have clone most service in the struggle against pain and disease. In addition, there was Professor R. V. Christie, who is Professor of Medicine at the Medical School of St. Bartholomew's Hospital, Colonel L. W. Harrison, who- was Adviser on Venereal Diseases to the Minister of Health, and Sir Philip Panton who is an Adviser on Pathology to the Ministry of Health. All these eminent specialists shared the same view, and their unanimous opinion was that unrestricted access to penicillin would do a grave injury to public health. They maintained that this drug ought to be acquired and used by the ordinary citizen only on the advice 403 or instructions of a properly qualified practitioner.
This conclusion was based on their views about the dangers to which people would be exposed by the unrestricted sale of penicillin. The most serious of these dangers arises when a patient takes too small a quantity. This sort of amateur treatment causes noxious germs to lose their sensitivity to penicillin, with the result that the patient is likely to succumb to the next attack of any illness which might otherwise have responded to this treatment. The more indiscriminate the use of penicillin the greater, naturally, the danger becomes. These small doses give the body immunity from the curative effect of penicillin. People who acquire this immunity to penicillin—and this was a fact not known to me, although it may have been known to several of your Lordships—would not only be harming themselves, but would be a definite danger to their own families. A man can infect his wife and children with penicillin-resistant strains of organisms, thus making the evil more widespread among those he would naturally most wish to protect against it.
But if this is the most serious, it is not the only danger involved in the indiscriminate use of penicillin. Penicillin has been proved, if properly used, to be a most effective agency in the treatment of venereal diseases. The temptation to self-treatment, or to amateur treatment by others, to avoid exposing the patient to publicity, would be almost irresistible if penicillin could be obtained at any retail shop or store. But if it were used in cases of venereal disease for self-treatment or treatment under inexpert guidance the results would certainly be injurious to health. You would have cases in which a double infection of gonorrhœa and syphilis would be treated so as to mask the syphilis. You would also get cases of the superficial relief of both these diseases while the patient remained infected and liable to further outbreaks as soon as the temporary alleviation caused by the drugs had worn off. This, again, would add to the grave difficulty of preventing the spread of venereal diseases.
There is one further danger which I think I ought to mention. The Government had been advised that the indiscriminate use of penicillin may also lead 404 to such conditions as dermatitis and ulcers of the mouth. I have described the dangers in detail because I think your Lordships would require such justification for a statutory control. It is to meet all these dangers that the Government have decided to ask the approval of Parliament for the present Bill. In no way other than by legislation, in our view, can the use of penicillin be effectively controlled once the Orders made by the Minister of Supply, which everyone agrees are no longer justified, have been revoked.
Your Lordships will observe that the controls in this Bill are strictly limited to the supply of certain drugs to members of the public. There is to be no interference with the wholesale trade in these drugs and preparations, with their supply to doctors and surgeons, to hospitals and nursing homes, to bodies doing medical research, or to Government Departments. It is at the point where they pass into the hands of the public that the real danger arises, and it is at that point only that the Bill subjects any one to the irksome restrictions of statutory control. The Government are just as anxious as members of the Opposition, as any member of your Lordships' House, to avoid controls in this as in any other field and, if they have to be applied, to make them as few and as limited in scope as possible.
I will conclude by running very briefly through the provisions of the Bill. Clause r sets out restrictions on the sale and supply of penicillin and other substances with similar properties to which the Act applies. It also provides exemption from such restrictions in all cases where these drugs can change hands without prejudice to health. Subsection 3 of this clause provides that the same prescription shall not be used more than once, or after three months, unless the person signing it directs otherwise. This will prevent the misuse of prescriptions to build up an unauthorized supply of penicillin. Clause 2 applies the Bill to penicillin and to such other substances as may be prescribed in regulations made by the appropriate Ministers, after consultation with the Medical Research Council. Clause 3 deals with offences and penalties under the Bill, Clauses 4 and 5 are definition clauses, and Clause 6 gives the short title of the Bill.
I am sure the House will agree that this Bill, which raises no controversial issue, is sound in principle, because it sets out 405 to safeguard the public from the misuse of some of the most recent and remarkable discoveries of medical science. 1 hope your Lordships will assist the Government by giving it as quick a passage to another place as is consistent with careful consideration of the form and detail of its provisions. This would be a valuable service to the public, because we are not in a position to revoke the Orders made by the Minister of Supply until this Bill has been approved by both Houses of Parliament and passed into law.
§ 2.49 p.m.
My Lords, I am sure your Lordships would wish me to congratulate toy noble friend on the very concise and clear way in which he has explained this Bill, which has rightly been described by the noble Earl, Lord Munster, as important. I agree that it is an important Bill. I rise only to point out that there is a loophole in it. I have this on very high authority. I am fortunate enough to enjoy the friendship of Sir Alexander Fleming, and I know something of the work he and his team of scientists put in during the early years of the war. It resulted in the successful discovery of this remarkable substance. I have been in touch with Sir Alexander Fleming, who was consulted by the Government on this Bill, as mentioned by my noble friend, and also one of his colleagues, Dr. E. W. Fish, with regard to the actual terms of the Bill which your Lordships are now considering. I think I can do no better than read short passages from two letters which I have on this subject from Dr. Fish, one of these two eminent scientists who has consulted Sir Alexander Fleming. One letter stated:There is one danger which this Bill does not cover. If penicillin lozenges for the mouth may be prescribed in any quantity the practitioner thinks fit, there may be a large number of people who will give prescriptions for perhaps too at a time, and if their patients use them, possibly spasmodically, for some chronic complaint such as tonsilitis, or even a tendency to dental caries, the mouth and throat of such a person would be an idet.1 breeding ground for the resistant strain of streptococcus which might infect somebody else and prove fatal.My noble friend explained this in describing the Bill, and I am pointing out on the authority I have mentioned, that there is a loophole in the case of the 406 penicillin lozenge. The letter goes on to say:I do not see how this could be prevented, except through the medical Press pointing out the danger. One could, of course, limit the permitted sale of lozenges to some two dozen at any one time, or on any one prescription, but it would be difficult in factories where the nurse hands them out. I believe, under the doctor's orders, and Fleming felt, perhaps more strongly than I did, that no attempt should be made to go farther than the present Bill provides.I have a further suggestion which was contained in a letter I received subsequently, and which I have not had time to send to my noble friend as I received it only this morning. It reads:I should be Inclined myself to put the point in this way: that it is important that not more than (say) two dozen tablets be dispensed (not prescribed) to any one person without further authority from the practitioner (medical, dental, veterinary). If that is done, there could he no offence.That is the suggestion. Would it be possible to amend the Bill in such a way as to strengthen it in the terms proposed, so that no more than a limited number of tablets could be dispensed at any one time to the ordinary patient? I suggest to your Lordships that that is an important point, raised by two men to whom we owe a great deal because of their discoveries. I might say, in passing, that I was very glad to be one of the guinea pigs and to allow certain experiments to be carried out on myself in the early stages of their researches. They did me good, I am glad to say. I therefore have a personal interest in this matter, as well as a public one, but it is in the public interest that I would venture to suggest to my noble friend that this point might be looked into. If it is found possible to strengthen the Bill in the direction suggested I gather that it will allay certain doubts and fears.
§ 2.53 p.m.
My Lords, I do not wish to take up much of your Lordships' time, for I think that the noble Earl who introduced the Bill has dealt with the medical side so extremely well that there is practically nothing for me to do except to confirm entirely what he says. I am satisfied that the medical profession will welcome this Bill very heartily. There is, I think, one danger which the noble Earl has not mentioned and which has occurred to me, though I am not sure it has actually arisen. I understand that certain firms who make cosmetics of vari- 407 ous sorts are seeking to increase the sales of some of their goods by calling attention to the fact that they contain penicillin. Because of this they charge a greatly enhanced price. In fact, the preparations in question contain such a minute quantity of penicillin as to be completely valueless. But the public is gulled into buying a very expensive and practically worthless preparation, and this is calculated to bring penicillin into considerable disrepute, since, as a result, people may not be so anxious to be treated by their doctors with this valuable drug.
With regard to what the noble Lord, Lord Strabolgi has said, I was not clear whether his remarks about penicillin lozenges applied also to penicillin snuff. That is a thing which can be bought and which is very good indeed for the aftereffects of colds and catarrh and that sort of malady. It does not seem to me that if, as I understand is the case, this stuff is safe, there is the same reason for restriction of the sale to a limited amount on each prescription. I am under the impression that penicillin snuff tends, in a short space of time, to lose its properties and become valueless. If that is true, it does seem rather hard to make a patient go back to his doctor for a prescription for a fresh supply of penicillin snuff each time he catches a cold, when it could be made possible for him to get a repeat supply on the prescription which was given him originally. That is the one criticism which I have to make with regard to what I am sure will prove a very valuable Bill.
§ 2.55 p.m.
§ THE EARL OF MUNSTER
My Lords, I rise only to say that We on these Benches support the Second Reading of this Bill. There is just one question which I would like to ask the noble Earl. Clause 2 of the Bill begins in this way:The substances to which this Act applies are penicillin and such other anti-microbial organic substances produced by living organisms as may be prescribed by regulations….I wonder if the noble Earl can tell us what are those other organic substances which can be prescribed by Regulations of four Government Departments, for, as he himself has rightly said, this is only one further irksome Government restriction on the public at large. I am not clear what are these substances referred 408 to, unless, of course, they refer to Clause I (i) of the Bill. I should be grateful if the noble Earl can enlighten me with regard to the meaning of those words.
§ THE EARL OF LISTOWEL
My Lords, let me first say that I am extremely grateful to all the noble Lords who have spoken and to the House generally for the support that has been given to the Second Reading of this Bill. I thank the noble Lord, Lord Amulree for what he said, and I think that his point about the sale of what might be called "pseudo-penicillin "preparations by chemists is an additional argument—and one which did not occur to me—in support of the Bill. In reply to the noble Lord, Lord Strabolgi, may I say that I believe he would agree that the responsibility for not prescribing too large a quantity of penicillin tablets at one time is a responsibility that falls upon the medical profession, rather than one for the Government to enforce by Statute. The appropriate measures will no doubt be taken by doctors, and do not fall to be included in any Statute. I have no doubt that those responsible will read very carefully the report of what the noble Lord has said, and will also be impressed by the authorities whom he quoted in his support.
I realize that the noble Earl, Lord Munster, has raised a point of importance. Of course, we are dealing with substances which are still very largely in an experimental stage from the point of view of medical knowledge. Penicillin is only the first of a series of new substances on which experiments are being carried out. The most advanced of these preparations at the present moment, apart from penicillin, is streptomycin, on which the Medical Research Council are now conducting tests. The Government did consider—and the noble Lord has rightly drawn attention to it—whether or not streptomycin should be specifically mentioned in the Bill as a substance to he similarly controlled, but they came to the conclusion that too little was known about its properties for them to take this course. That is why the proper procedure, in our view, is for Regulations to be made under the Bill, when it is proved, in accordance with the tests made in the laboratories, that a certain substance has the same properties as penicillin and will, therefore, have the same effects on the public when prescribed by doctors or bought in shops. I have answered 409 questions raised by noble Lords to the best of my ability, and I hope to their satisfaction.
§ On Question, Bill read 2a, and committed to a Committee of the Whole House.