§ Motion made, and Question proposed, "That this House do new adjourn."—[Mr. Arthur Pearson.]
§ 11.15 p.m.
§ Sir John Mellor (Sutton Goldfield)
I am glad to have the opportunity of referring to the control of penicillin, because I know it is a matter which interests a large number of Members in this House and I know that some of them will desire to speak after me this evening, so I shall endeavour to be as brief as possible. Penicillin is controlled under Order No. 731 of 1946. Under that Order if anyone walks into a chemist's shop and says "Please sell me some penicillin," unless he tenders a medical prescription, he is guilty of a criminal offence for which he may be severely punished. Even at the time of a shortage of penicillin, to some of us that seemed to be rather a drastic provision, but there is now no longer any shortage of penicillin. Therefore, in 'my submission, the Order is now quite unjustified.
On 18th February I asked the Minister of Supply to state the production and the consumption of penicillin in the United Kingdom in January; the amount imported and exported during that month; and why the Control of Penicillin (No. r) Order, 1946, had not been revoked. The Parliamentary Secretary to the Ministry of Supply gave this written answer:225,387 mega units were produced and 85,000 exported. Figures of the quantities distributed to meet demand in January are not yet available, but we are satisfied that there is ample to meet all prescriptions. About 5 mega units were imported for experimental purposes. As regards the second part of the Question, I am advised by my right hon. Friend the Minister of Health that penicillin should be used only under expert supervision, and at his request my right hon. Friend is retaining the Control Orders until such time as other arrangements can he made."—[OFFICIAL REPORT, 18th February, 1947; Vol. 433, C. 166.]So it is clear that the ball has been passed by the Minister of Supply to the Minister of Health. In view of that answer, I wrote to both Ministries drawing attention to this forthcoming discussion. I received a letter from the Parliamentary Secretary to the Ministry of Health explaining to me that unfortunately owing to his being unwell he was unable to be present this evening. I am grateful for the courtesy of that reply, and I am sorry that the hon. Gentleman cannot be here. I am sure that the Parlia- 2030 mentary Secretary to the Ministry of Supply will be well able to answer for him. As I understand the position with regard to medical opinion generally in relation to penicillin, it is that penicillin is in no way harmful, but—and I do not want to under-estimate the importance of the "but"—the doctors also consider that if penicillin is continually used the body becomes so acclimatised to it that it becomes less susceptible to its beneficial qualities. The reaction of the body to penicillin tends to diminish with frequent use, though I do not think it is contended by the medical profession that any direct harm can come from the use of penicillin.
I think it can be said of many drugs that their continuous use would be undesirable, but that does not mean that their sale is in any way limited by legislation. We have, of course, the poisons dealt with in the Poisons Act, and opium and other narcotics of that character dealt with under the Dangerous Drugs Act. Under both these Acts the Home Secretary has power to make regulations restricting their distribution, but I am not aware that any legislation has yet been passed to restrict the sale of therapeutic substances which are not harmful. In my view, if my premises are correct, the continuance in force of this Order is therefore quite unjustified. Even assuming, for the purposes of argument, that it was desirable that some control over the distribution of penicillin should be retained, then, in my submission, the continuance in force of this Order is entirely the wrong way of doing it. This Order is made under Regulation 55, which is effected by virtue of the Supplies and Services Transitional Powers Act of 1945. That Act enables such regulations to have effect for the purpose of regulating supplies so as to ensure a sufficiency of supplies essential to the well-being of the community, their equitable distribution or their availability at fair prices. There is nothing at all to justify the use of an Order, made under these provisions, to enforce the medical opinion of the Ministry of Health.
This Order, which was no doubt quite properly made in the first instance to deal with a shortage of supply, is now being extended for an entirely different purpose in the interests of an entirely different Ministry from the one which made the Order. Far be it from me in any way to speak disrespectfully of medical opinion, 2031 indeed, I think we are wise when we hearken to medical opinion. But surely it is one thing to say that medical opinion should be respected, and quite a different thing to enforce it by law. I submit that the people of this country should be entirely free to follow medical opinion or to disregard it.
§ 11.23 p.m.
§ Mr. John Lewis (Bolton)
I am sure the House is very grateful to the hon. Baronet for raising this matter tonight. I am in rather the same difficulty as that in which he found himself. Neither of us is a medical man, and in this discussion we are basing quite a lot of what we have to say upon the advice of experts who know more than we do about it. If I understand the hon. Member's argument, it is that because penicillin is plentiful and readily available —a situation which is a distinct change from the previous years when it had to be carefully used because of the shortage—any person who desires it should have the facility of going into a chemist's shop and buying penicillin and using it, without a doctor's prescription. I think that in this case we must examine the way in which penicillin may be efficaciously used. No one would say that this drug which has proved to be one of the greatest boons to mankind should be used indiscriminately, because there are parts of the world where it could at present be employed with great advantage to the people living there, and I think that if there is any surplus of a pharmaceutical or a therapeutic product of this kind, that surplus should be made available to those who most need it. But we must bear in mind that this drug can only be used with effect by injection. That means that any person who proposes to use it without a medical certificate has to get a hypodermic syringe and give himself injections and I think no medical man in this House would be happy if he knew that a patient, without instructions and advice was injecting himself with whatever amount of penicillin he thought fit there is quite a lot of danger in sticking a needle into one's flesh and in any case, the medical men would like to be assured that the interests they have in giving injections are not interfered with. I think it has been argued by the hon. Member opposite that penicillin can be given in other forms and that one can buy penicillin tablets of 500 units each without a doctor's certificate, in any 2032 chemist's shop. I hope the hon. Gentle man who is to reply tonight is aware that this is an utter waste of penicillin these tablets of 500 units each, have not the slightest effect.
§ Sir J. Mellor
Is the hon. Gentleman not going to mention other methods of application—penicillin cream. for example?
§ Mr. J. Lewis
I am glad the hon. Baronet has mentioned that. I was coming to the question of creams being used in cases in dermatology, but that is not a panacea for all ills. In some cases such as stefflacocus, streptococus, and pneumococus, it may have produced some very wonderful results. We do not know definitely yet, whether if one continues to use penicillin indiscriminately, one does not build up a penicillin resistance strain so that after a time it will have no effect at all. The medical authorities are not all of that opinion. In any case this valuable drug should not be wasted and I hope the hon. Gentleman who is to reply ill make investigations, in co-operation with his colleague the Minister of Health, who I am pleased to see sitting on the Front Bench tonight, to find whether these tablets of 500 units are in pharmaceutical practice proving profitable and whether it is proposed to go on selling them when the manufacturers themselves know they are not of the slightest use. I have contacted a director of a firm which is one of the largest manufacturers of penicillin, and he has assured me that these tablets are of no use.
We must bear in mind that penicillin is an unstable compound. It is not possible to keep these tablets for very long. They must he kept under special conditions in refrigerators. If we are to let everyone go into a shop, without a prescription of any kind, and buy whatever penicillin they think is necessary for maintaining their health, I feel the effectiveness of this drug will be lost completely. If we allow it to be used in that way it would create a precedent. There people who are now entitled to buy insulin on a doctor's prescription would feel that they also should not need a doctor's prescription. The hon. Member's point is that this is not a dangerous drug and that therefore it should be available without control. Insulin is not a dangerous drug but it is in short supply and it is still thought necessary to exercise some control. I 2033 hope my hon. Friend will deal with this question of the waste of penicillin and will promise to make an investigation into its indiscriminate use.
§ 11.31 p.m.
§ Wing-Commander Roland Robinson (Blackpool, South)
There is no doubt that the discovery of penicillin by one of our own countrymen and its subsequent commercial development by the Americans, represent a great advance in medical science. I thought the Joint Parliamentary Secretary to the Ministry of Supply was right when, in June last, he said it was one of the most potent cures known for certain diseases. Our desire on this side of the House is to be quite sure that adequate supplies are available to the general public, so that they can get the benefit it offers. I hope the hon. Gentleman will not take everything said by the hon. Member for Bolton (Mr. J. Lewis) too seriously. There are other ways of taking penicillin than injection. I remember when I was in America, I had a bad throat and I cured it by chewing two tablets of penicillin chewing gum. It has been said that penicillin can cure a very wide range of diseases, from sore throat to venereal disease, and that it can thus help unfortunate children who suffer through no fault of their own. Here we have a great opportunity to launch a public health campaign to help our people. We can do much for them.
§ Mr. J. Lewis
Is the hon. and gallant Member suggesting that people should treat themselves for venereal disease?
§ Wing-Commander Robinson
I did not say that at any time. I said we wanted to ensure that penicillin was as freely available as possible to meet public needs. I have not the slightest thought that we should cut out the medical profession, where injections are needed. I would urge on the Minister the opportunity he has here to launch a campaign for public health. I am afraid this has not so far been done. It is all wrong that whenever penicillin is discussed, the matter has to be dealt with by the Ministry of Supply rather than by the Ministry of Health. I am afraid we are using penicillin as a pawn in the export drive. The Ministry of Supply and the Board of Trade are trying to use it to get hard currency, when they might well use it at home to improve the health of the people. The 2034 Joint Parliamentary Secretary, when he spoke last June, said we were exporting more than we were using at home. I am anxious to, know if we are maintaining these restrictions on penicillin, and seeking to narrow its use here so that we can export it in competition with our American friends who have done so much in its devolpment. Let us encourage the Minister of Health to launch a great health campaign. Let us use it at home, and I am sure it will pay far greater dividends than we can obtain from the small quantity of hard currency which we get by export. We have an opportunity of doing good; let us take it.
§ 11.35 p.m.
§ Dr. Santo Jeger (St. Pancras, Southeast)
Whenever a new drug is discovered and achieves a fair proportion of cures, the public at once gets the idea that it is a cure-all, and one is faced immediately with a demand from the public for an indiscriminate supply of it for all sorts of purposes for which it is no use whatever. That is one of the reasons why the supply of penicillin should be controlled. It is true that the main method of therapeutic application is by injection. But there are other ways of giving penicillin—first, inhalation, and secondly, by lozenges. But there has been considerable correspondence in the medical Press recently on certain deleterious effects following the use of lozenges. The hon. Member who spoke last mentioned venereal disease, as a disease which can easily be made to yield to the application of penicillin. I would not like to treat myself with penicillin for venereal disease without being subjected to the proper tests, both before and after the treatment. I think it would be a most dangerous proceeding, and one which would be likely to lead to great distress.
§ Wing-Commander Robinson
I did not say, at any time, that it should be done without the advice and care of a doctor. I made this plain in answer to an interjection by the hon. Member for Bolton (Mr. J. Lewis).
§ Dr. Jeger
I was under the impression that the sole purpose of those who initiated this discussion was to argue that penicillin should be used without medical supervision. When a doctor issues a prescription, he does not just order a supply of the drug. The prescription consists of two parts, the first being a recipe for the drug, 2035 and the second, the method of application of the drug. There are instructions on the prescription which will be repeated on the package handed to the patient, or to the person who collects the drug, so that the patient may know the proper way to use it. In my view, the supply of penicillin must be controlled, first, because we have not got unlimited quantities of it, and secondly, because its use must still be medically controlled.
§ 11.38 p.m.
§ The Joint Parliamentary Secretary to the Ministry of Supply (Mr. Leonard)
The hon. Member who introduced the matter prefaced his remarks by saying that he was glad to have the opportunity of doing so. I welcome the opportunity of giving him a reply, which I propose to restrain within the few minutes now available to me. I shall not weary the House with details with regard to the advantages of deep culture as against the early method of surface culture but I would say that there is now no serious risk of supplies being insufficient to meet requirements in this country for medical and dental and veterinary requirements. With regard to the latter category, I was questioned about it on the last occasion when this matter was raised in the House and I gave an assurance then than it would not be ruled out, when supplies of penicillin were sufficient. Supplies being sufficient, we have no hesitation about including the veterinary category.
It may interest the House to know that, in January, 85,000 mega units were exported. I make reference to this not to support the view of the hon. and gallant Member opposite, who thought that there was 'some inclination on the part of this country to restrain the use of penicillin here, so that it could be exported, but in order to support the contention that there is ample penicillin available in this country, and that in the circumstances we think it should be made available for export. The reason for the Control Order was the need, while penicillin was in short supply, to ensure that those limited supplies were not frittered away on trivial uses, but having said that, it was always recognised that there might be reasons for controlling its sale and distribution on purely medical grounds, a point which I think I mentioned when this matter was dis- 2036 cussed last June. I will not go into details because of the support I have received from my hon. Friends who have spoken from this side of the House, but I stated then that when penicillin became available in greater measure the policy of control would be reviewed. This we have kept in view and we have only adopted the attitude we have because of the considerable risks on supply grounds, namely, that if we removed control too early no one could forecast the expansion of the demand and we might find ourselves short of penicillin for important medicinal uses.
May I also give what I am advised has been the experience in America? They started with control and that control was lifted, but because of what transpired after the lifting of control it was deemed to be in the national interest to reimpose it. I put that in in order to support the attitude we adopt. Now, however, I am glad to be able to say that the supply position in this country is so much improved that on supply grounds alone it would no longer be necessary to retain control over distribution. I notice that my hon. Friend said "Far be it from me to be disrespectful of medical opinion," and may I say, "Far be it from me to disregard medical opinion. My right hon. Friend the Minister of Health has been advised by eminent medical experts—including Sir Alexander Fleming, who is pre-eminent in this matter—that there would be considerable danger in the uncontrolled use of penicillin, and it should not be permitted. This is a very specialised problem and I do not propose to enter into it, but I am advised that there is a real danger to patients and to others by the creation of a strain of organisms resistant to penicillin treatment, if I may choose a formula different from that used by the hon. Member who introduced this matter. This aspect of the matter is well recognised and therefore, as has already been stated by the hon. Member who opened the Debate, we still stand by the reply given to him on 18th February that he has referred to, when he was informed that my right hon. Friend the Minister of Health requested my right hon. Friend the Minister of Supply to retain the Control Orders in force until such time as other arrangements could be made. That still stands.
However, I think the House will be pleased to learn that a draft Bill has been 2037 prepared to control the sale and supply of penicillin other than by Order. I cannot anticipate what that might mean, but I think it should give surely to the hon. Gentleman who introduced this discussion tonight that the matter is well within the 2038 notice of the Government, and with that I think he ought to be satisfied.
§ Question put, and agreed to.
§ Adjourned accordingly at Sixteen Minutes to Twelve o'clock.