Reform efforts can struggle because they focus on health systems at their strongest point rather than their weakest. Framing is a pernicious tool used to justify delays and denials. We argue that the uptake of GLP-1 therapies in the US is delivering remarkable results, and that we need to apply the lessons from that experience in Australia, challenging institutional narratives and reframing the public debate to focus on public health benefits.

We discuss what could be a significant policy shift in PBS decision-making, with clinical judgement backed by what is a 'common sense' outcome. It could be a new precedent, but only if all stakeholders demand clarity on the criteria so that it can be applied more broadly. We also reflect on patient advocacy in New Zealand, where access has become a political issue and the focus of a significant discussion at this week's Valuing Life Summit in Wellington.

Has Senate Estimates devolved into an overly polite, time-sliced format that enables waffle, obfuscation, and endless questions taken on notice? Does this reflect weakened scrutiny? The responses provided revealed the truth of review processes, which aim to protect institutional power, blame outsiders for problems, and generally add complexity to existing problems. Few appear willing to say the quiet part out loud.

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We open by marking Yom Kippur and a frank discussion before pivoting to the US 'MFN' drug-pricing moves, what they could mean for Australia’s PBS, and why institutional rigidity in HTA persists and is worsening. Medical research funding rhetoric versus slow progress in PBS and health technology access, hospital funding and NDIS pressures, and the expansion of pharmacist prescribing, as well as the need for subsidised pharmacy services.

On the Dispatched Podcast this week, we reflect on the erosion of public confidence in health decision-making. Former Victorian Chief Health Officer Brett Sutton’s admission that some COVID-19 measures were not strictly evidence-based highlights the need for a Royal Commission, which would have compelled accountability and helped restore trust.

The discussion then turns to MSAC’s rejection of newborn screening for Pompe disease. Health Minister Mark Butler must intervene, not least because he has previously pledged support to affected families.

Looking abroad, Australia can look to New Zealand’s overhaul of Pharmac, particularly its decision to bring in external leadership and critics. It provides a model for cultural reform. In contrast, Australia’s system is mired in the same conversations among the same insiders.

The podcast closes on the Trump administration’s proposed 'Most Favored Nation' pharmaceutical pricing policy and the new 100 per cent tariff. The Albanese Government, they predicted, would adopt a wait-and-see approach, shaped by a long history of industry warnings about lost access to medicines that rarely materialised.

In this week’s episode, the Medical Services Advisory Committee’s rejection of adding Pompe disease to newborn blood spot screening is condemned. The decision is contemptuous, inhumane, and riddled with fabricated justifications based on made-up terms like 'parental hypervigilance'. Families’ lived experience highlights the devastating cost of delayed diagnosis. The committee ignored evidence, misused language, and hid behind flawed economic models while dismissing patients. Health Minister Mark Butler and the Prime Minister can show moral leadership and finally honour their promises of 'never again'.