Like Dr Ben Gray, in his letter in the 20 May 2005 issue of the Journal (http://www.nzma.org.nz/journal/118-1215/1481), we were surprised to see the Chair of the Researched Medicines Industry Association of New Zealand (RMI) given three editorial pages to give her views on PHARMAC.

We do remember Dr MacKay’s item in the September 1999 Medical Association Newsletter that she alludes to, and we responded to her criticisms at that time. We also remember that our response was modified without acknowledgement or our knowledge.

Dr MacKay portrays an image of a paternalistic and altruistic pharmaceutical industry. The reality is that pharmaceutical companies are businesses that have a primary responsibility to their shareholders.

A number of Dr MacKay’s assertions are simply wrong; indeed a number of them have been responded to before in the Journal by PHARMAC1–4 and others.5

PHARMAC is a Crown Entity charged with securing “for eligible people in need of pharmaceuticals, the best health outcomes that are reasonably achievable from pharmaceutical treatment and from within the amount of funding provided” (Section 47(a) New Zealand Public Health And Disability Act 2000). This objective will always create a tension when we are contracting with businesses that (quite rationally) seek to maximise profit.

It is not practical to reply in detail to Dr MacKay’s lengthy (1888 word) editorial in the Letters column of your journal. However, if we are invited we will submit an editorial.