Traditional Māori communities used medicines prepared by tohunga made from either fresh or dried plant materials. Common preparations included an infusion of flax root for constipation, koromiko leaves steeped in warm water to treat both diarrhoea and constipation; and kawakawa leaves for stomach upsets and toothache.
Early European inhabitants also used medicines prepared from plants, such as peppermint for digestive troubles, valerian for insomnia or opium for severe pain. These were obtained from local missionaries or from supplies held by visiting seamen. In the 1840s, European settlers were advised to bring their own medicines if they could.
Patent medicine was the common name used to describe trademarked medicinal preparations sold under particular brand names. They could be bought at fairs, in general stores and in some pharmacies without consulting a doctor. Initially they were expensive to import. By the second half of the 19th century, however, large numbers of these patent medicines were imported from the United States or Britain, which lowered the cost.
Chlorodyne, a popular patent medicine sold under various brand names in the 19th and early 20th centuries, contained ingredients like chloroform, morphine and extract of cannabis – a potent mix of highly addictive substances. It was often fatal when taken in large quantities, and was implicated in many accidental deaths and suicides during this period.
The labels usually gave no indication of the medicines’ contents (which were commercial secrets) but did make extravagant and often unfounded claims about their effectiveness. They were usually mixtures of mainly purgative plants, such as rhubarb and aloes, some with soap and ginger added. These had a laxative effect which may have been of some benefit to users. Many contained opium and a high alcohol content – sometimes as much as 40% – which eased pain and produced a sense of well-being. Even children were dosed with these medicines, occasionally with fatal results.
Patent medicines were popular because they were extensively, attractively and persuasively advertised in magazines and newspapers and through attractive trade or ‘show’ cards. Advertisements often included endorsements by doctors and were supported by testimonials from satisfied customers.
From the late 19th century, ready-made and fully-labelled medicines were manufactured by a growing number of international pharmaceutical companies. These medicines were developed after pharmacists and pharmacologists successfully isolated the individual active components of various plant extracts. The demand for these powerful medicines led to the development of large-scale manufacturing industries in Europe and the United States, and the creation of synthetic chemicals, including anaesthetics and analgesics (medicines that eliminate or reduce pain), such as aspirin.
The government attempted to regulate patent medicines at the beginning of the 20th century. Regulations issued in 1904 stated that bottles or boxes containing patent medicines were to be labelled in English with details of the ingredients they contained, together with the quantities of each ingredient.
Manufacturers said that they would not sell their products in New Zealand. Distributors and individuals who sold patent medicines claimed their businesses would fail and patients would suffer if the medicines were not available. These protests were successful and the regulations were revoked. Listing ingredients was not made compulsory until 1946.
Government attempts to introduce compulsory labelling of ingredients on patent medicine boxes and bottles was cause for concern to the Master Printers, Lithographers and Bookbinders’ Association. They believed that ‘printing and allied trades will be seriously affected, and much loss of employment by their workmen will result’ if the regulation was passed. If manufacturers stopped selling medicines they would not need printing services.
The Quackery Prevention Act 1908 made it an offence to publish a false statement about the efficacy of any medicine. However defendants could usually produce testimony that such remedies worked, so prosecutions were generally unsuccessful.
Māori healers were the target of the Tohunga Suppression Act 1907, which allowed the prosecution of any person ‘who misleads or attempts to mislead any Maori by professing or pretending to possess supernatural powers in the treatment or cure of any disease.’ Few successful prosecutions were brought.
The pharmaceutical industry expanded rapidly in the early 20th century as drugs were synthesised in the laboratory and manufactured in commercial quantities. They were sold to the public by doctors and pharmacists in easy-to-swallow formulations such as tablets and capsules. This meant that pharmacists were less involved in the preparation of medicines.
The potency of these new medicines prompted governments to pass laws to control their sale and use. The Dangerous Drugs Act 1927 attempted to control potentially addictive medicines. The Poisons Act 1934 identified medicines which could be harmful (though were not addictive). Such medicines could only be sold by a pharmacist if a registered doctor prescribed them.
Significant vitamins and hormones were identified by overseas researchers during this period. Insulin (used to treat diabetes) was first isolated in the early 1920s and vitamins A, B, C and D were synthesised from the 1930s. Oestrogen was used to treat menopausal symptoms, such as hot flushes, from the 1930s. The important antibiotic prontosil was discovered in 1932 and used to treat people suffering from bacterial infections. This signalled the beginning of the ‘therapeutic revolution’ – the transformation that made medicines more effective.
Until the 1940s most people had to pay for the medicines their doctor prescribed for them. Some belonged to friendly societies (credit unions), which owned some pharmacies, and for an annual charge could get subsidised medicines through these pharmacies.
In 1941 the government introduced the Pharmaceutical Benefits Scheme as part of comprehensive social security reform. The government began to fund medicines prescribed by doctors so people no longer had to pay pharmacists for their prescription medicines.
From the 1940s, pharmaceutical companies invested heavily in research. Many new and effective medicines were introduced. Over time these included penicillin (antibiotic), hydrocortisone (hormone), antidepressants, cardiovascular drugs such as medicines to lower blood pressure, tranquillisers, antipsychotics and contraceptive pills.
These new drugs replaced many older products. For example, the introduction of antibiotics meant that wounds and skin problems could be healed by swallowing a pill, reducing the need for traditional approaches like poultices.
The number of prescriptions dispensed increased greatly, as did the cost to the government. In 1943 the average person received 3.45 prescription items a year. This rose to 9.08 per year by 1986. Patient charges for prescription medicines were introduced in 1985 and increased in 1988, 1991 and 1992. By 1992 those on higher incomes were required to pay up to $20 per prescription item.
The introduction of effective new drugs led to public enthusiasm for modern medicine, but towards the end of the 20th century some people were more critical. From the 1970s the women’s health movement played a key role in stimulating debate about the safety of medicines and related products, particularly contraceptives. Alternative or complementary remedies became more popular. In the 1970s and 1980s the number of health-food shops selling vitamins and other nutritional supplements and homeopathic and naturopathic remedies grew substantially.
The government set up the Pharmaceuticals Management Agency (Pharmac) in 1993 to manage state expenditure on medicines. The agency negotiates with pharmaceutical manufacturers to reduce prices for particular medicines. It has a fixed budget to purchase medicines. The main functions of Pharmac are:
Pharmac’s purchasing strategies have been criticised by manufacturers and sometimes by patients and doctors. Manufacturers have argued that some highly effective new drugs are not available in New Zealand, and that the country does not contribute to the costs of research and development. Patients and doctors sometimes say their choice of medicines is constrained. There have also been debates about whether or not expensive new drugs should be subsidised if they benefit only a few people.
However, Pharmac has been very successful in reducing the cost of medicines. As a result, pharmaceutical expenditure in New Zealand is low and has not grown as fast as in many other OECD countries. In 2016/17 New Zealand spent $849.6 million, about $181 per person. New Zealand spends about 8.3% of its health budget on pharmaceuticals, compared to 12.1% in the UK and 17.5% in Canada. There is now widespread consensus that the Pharmac model works well and all major political parties support it.
The development of new, very expensive cancer treatments is challenging for governments and insurers who pay for medicines in many countries. In New Zealand there have recently been vigorous public debates about two medicines: Herceptin and Keytruda.
Herceptin (trastuzumab) is a treatment for a particular type of breast cancer. In 2007 Pharmac agreed to fund a nine-week course for people with early-stage breast cancer. This was based on an assessment of the costs and benefits of the drug, including the impact of long-term use on patients’ hearts. The Breast Cancer Advocacy Coalition led a public campaign for the funding of a 12-month course, as recommended in the UK. Eight women with breast cancer, the ‘Herceptin Heroines’, took Pharmac to court over the decision amid widespread public and media controversy. A National Party promise to fund 12 months of Herceptin was implemented after National won the 2008 election.
Another public controversy surrounded Keytruda (pembrolizumab). In 2015 Pharmac refused to fund Keytruda to treat melanoma because of its very high cost and because strong evidence for its effectiveness was lacking. This led to media coverage and lobbying by patients and doctors. In 2016 Pharmac received an application for funding for a competitor drug, and after negotiations with both companies and further evidence from clinical trials, in mid-2016 both drugs became funded for melanoma. Controversy about funding for Keytruda to treat other types of cancer was ongoing in 2018.
Medsafe, a business unit of the Ministry of Health, is responsible for the regulation of therapeutic products (medicines and medical devices) in New Zealand. Its activities are governed by the Medicines Act 1981 and the Medicines Regulations 1984. Medsafe’s functions include:
It is possible to purchase prescription-only medicines from overseas suppliers without a prescription by using the internet. Medsafe carries out border control to intercept these medicines.
Medicines tend to become more accessible over time, but there are exceptions. Pseudoephedrine, a popular over-the-counter remedy for blocked noses and sinuses, was reclassified as a prescription medicine in 2009 because of its use in the manufacture of the illegal Class A drug, methamphetamine or ‘P’.
Prescription charges were reduced substantially between 2002 and 2007 as part of the Labour-led government’s Primary Health Care Strategy, which aimed to make primary care (provided by a GP or public health nurse) more affordable. By 2013 most people paid $5 per prescription item for most medicines. In 2018 free prescriptions were provided for children under 14.
In the 2000s the New Zealand and Australian governments proposed establishing a trans-Tasman agency to assess the quality and safety of pharmaceutical and natural medicines. It was argued that New Zealand was not large enough to effectively and quickly assess new medicines.
Critics of this proposal argued that businesses manufacturing natural products would suffer, and that people who used these products would not be able to buy them as easily as in the past. In 2007 the government decided it did not have enough support to pass the necessary legislation, and the agency was not established. The production of natural and traditional products continued to be governed by the Dietary Supplements Regulations 1985 or the Medicines Act 1981, neither of which were considered by the industry to be appropriate models.
The National-led government in association with the Green Party began planning a new regulatory scheme in 2009 and consulted widely with consumers, suppliers, importers, manufacturers and practitioners. The regulatory impact statement released by the Ministry of Health in June 2011 noted that there was insufficient information available regarding the number and turnover of natural products in the New Zealand market to enable the Ministry to determine the probable cost of such regulations on the industry. Nevertheless, the Natural Health and Supplementary Products Bill (later the Natural Health Products Bill) was introduced into Parliament in September 2011 and submissions sought from all potentially interested parties. Following the second Reading of the (amended) Bill in 2013, further submissions were sought, up until 7 May 2017.
Natural Products New Zealand, which represented most major local manufacturers and practitioners, had expressed some concerns about the contents of the initial Bill but supported its revised form, believing it to be of benefit to consumers, the natural product sector and the wider New Zealand economy. Their view was disputed by the New Zealand Health Trust, which launched a media campaign to discredit the Bill, claiming that it would limit consumer choice and seriously damage the New Zealand natural products industry. These claims were countered by Natural Products New Zealand, which identified and publicised the 'misunderstanding and misinformation' being promoted.1 Nevertheless, the third and final reading of the Bill, which was to have been held before the September 2017 election, was delayed. The Bill had not been reinstated by the new Government as of 2018.
Davis, Peter., ed. For health or profit? Medicine, the pharmaceutical industry and the state in New Zealand. Auckland: Oxford University Press, 1992.
Leibrich, J., J. Hickling and G. Pitt, In search of well-being: exploratory research in complementary therapies. Wellington: Department of Health, 1988.
‘Pink pills for pale people’ in Coney, Sandra, ed. Standing in the sunshine: a history of New Zealand women since they won the vote. Auckland: Penguin, 1993, pp. 94-95.
Riley, Murdoch. Maori healing and herbal. Paraparaumu: Viking Sevenseas, 1994.