Normally, when there's a change in B.C.'s health care, there's always a critic eager to tell the other side of the story. But when health minister George Abbott announced on July 11 B.C.'s funding for access to the breast cancer drug Herceptin, nary a contrary voice was heard among the kudos.

Part of the reason for the hush, explained Sharon Batt, a bioethics doctoral fellow at Dalhousie University, could be that drug companies fund Canada's supposedly independent patient advocacy groups, whose job is to speak out on behalf of Canadians.

"All we're hearing is that this is great, and that kind of bullshit," Batt told the Georgia Straight in a phone interview from Halifax. She characterized news coverage of the drug as "emotional", featuring women in tears. "It's not that it's [Herceptin is] not useful, but it's not a major advance."

There's reason to be wary of Herceptin, according to Batt. In a 2000 paper-presented at a York University biotechnology conference-that criticized the drug, Batt argued that the enormous cost to government health budgets of providing Herceptin, estimated at about $50,000 per patient, will cause other Canadians' care to be compromised. Plus, studies showing the long-term effectiveness of the drug, she said, have not been thoroughly reviewed.

Patient advocacy groups could point this out. But, according to Batt's analysis, along with Pharmawatch Canada and other organizations, some patient groups have become nothing more than part of a thinly veiled PR wing of the big pharmaceutical companies. That's why there's the uncritical hush, she said.

Pharmaceutical funding of health groups is not new news; in the U.S., criticism of the practice is widespread. Most Canadians, however, are unaware of how widely drug-company dollars are spread among local organizations.

It's quite common for Canadian pharmaceutical companies to fund health-oriented, nonprofit groups. For example, the B.C. Persons With Aids Walk for Life 2005, planned for September 25, is sponsored in part by pharmaceutical companies Shire BioChem, GlaxoSmithKlein, Bristol-Myers Squibb Canada, Boehringer Ingelheim, AnorMED, and Pfizer. Donations from Bristol-Myers Squibb Canada also reach the Positive Women's Network, the BC Centre for Excellence, Vancouver Native Health, and the Dr. Peter Centre in Vancouver. Pfizer Canada donates to the Rick Hansen Man in Motion Foundation, the Canadian Diabetes Association, and the Arthritis Society.

It's not that patient groups are morally bankrupt for taking the money-it's that there's only so much nonpharmaceutical funding out there from which they can draw.

The solution, according to Colleen Fuller, the chair of the Vancouver-based nonprofit industry watchdog PharmaWatch, is for the government to adequately fund advocacy groups so they don't have to rely on industry support. In the 1950s, when societies such as the Canadian Diabetes Association were established, advocates were needed to criticize government. Now, she said, they're needed even more to criticize multinational pharmaceutical companies.

What's a patient group to do if they don't receive any, or enough, government funding, though?

"They've [pharmaceuticals have] got lots of money, and if we can access it, we can provide a lot of services," Paul Lewand, the chair of BCPWA told the Straight in a phone interview from Vancouver. He said he is grateful to the pharmaceutical companies for the funding BCPWA receives. "But the downside is that we have to always be aware”¦The danger [of allowing them influence] is that we would no longer be providing true, unbiased health information."

Lewand knows all about this tension. Last year, the society rejected $30,000 in pharma-funding from Abbott Laboratories when the company jacked up the price of a protease inhibitor by 400 percent in the United States. The group only subsequently accepted the donation when the company later explained it made allowances for low-income Americans. He also notes that although pharmaceuticals are an important part of BCPWA's funding (between five and 10 percent; the government funds about 50 percent of the budget), pharmaceutical companies are not welcome to advertise in Living +, the nonprofit's magazine.

Even closer to the forefront of the debate is the B.C.?/?Yukon chapter of the Canadian Cancer Society. The nonprofit is the first CCS chapter in Canada to review its corporate donation policy, according to CEO Barbara Kaminsky. It's not only an issue of real conflict of interest but also of whether or not the public perceives the BCYCCS to be in conflict. Already, it has a policy against tobacco sponsorship; it may also in the future exclude companies that make unhealthy food, and perhaps even pharmaceuticals. So far, the BCYCCS only has a draft of its new policy, which it wouldn't share with the Straight.

The BCYCCS is partly funded by the provincial government to the tune of $1.1 million a year, and Kaminsky says government funding is a model that works well.

"I met with Gordon Campbell recently," Kaminsky told the Straight. "The premier said he had no problem with us being critics of his government. He said it's a difficult job, and we do it well. I thought that was heartening."

Still, compared with Breast Cancer Action Montreal, B.C. groups have a long way to go. In 2001, the advocacy group became one of the first health organizations in Canada to reject all pharmaceutical funding. The San Francisco chapter of BCA took the lead in establishing a no-pharmaceutical sponsorship policy. In addition, Women and Health Protection, a national umbrella coalition of health advocacy groups and activists, refuses pharmaceutical funding. Not so coincidentally, Herceptin-critical Batt is on the steering committee of WHP.

If traditional patient advocacy groups aren't taking a hard line on drugs such as Herceptin, Batt suggests a new grassroots approach: genome-jamming, named along the lines of Vancouver-based Adbusters' direct-action strategy called culture-jamming, which encourages creative public protest. She is frustrated that the underside of Canadian drug policies are so infrequently presented.

Because crying cancer patients on TV don't tell the whole story about the impact of health-care decisions, perhaps Batt's radical strategy of pharmaceutical critique would serve as a counterpoint.