Province of B.C. stalls drug reviews
For 18 years, the Therapeutics Initiative at UBC has been providing unbiased information about prescription drugs. With no funding from the pharmaceutical industry, pharmacologists and physicians have been compiling evidence on a wide range of important issues related to various medicines.
The information is condensed into easy-to-read letters, which are distributed to doctors, pharmacists, researchers, and provincial bureaucrats in charge of the pharmaceutical services division.
In early 2010, for example, the Therapeutics Initiative released the results of its research into the use of antidepressants by pregnant women.
“There is no evidence that SSRIs in pregnancy improve maternal or infant health, and substantive evidence that they pose a risk to the fetus,” the letter stated. “Thus the harms exceed the benefits in this setting. Non-drug options such as cognitive behavioural therapy or psychotherapy are also unproven, but do not carry a risk to the fetus. The common argument of their lack of availability is not relevant for this relatively small, high priority population. If a woman wants to stop SSRIs in pregnancy, it is best to taper the dose over at least 1 week to minimize withdrawal symptoms. Exercise, social support, sleep hygiene and good nutrition are important for all pregnant women, including those with symptoms of depression.”
Last year, it released a letter about people with Type 2 diabetes self-monitoring their blood-sugar levels. It was deemed “very costly” in noninsulin-treated patients. Moreover, it “has not been shown to improve outcomes that matter to patients: mortality, morbidity or quality of life”.
One of the Therapeutics Initiative’s most notable achievements came several years ago when three of its letters questioned a federally approved group of nonsteroidal, anti-inflammatory drugs used to treat osteoarthritis. Patients who took these so-called COX-2 inhibitors—including Vioxx—were more likely to suffer heart attacks than those who stuck to an older medication. Vioxx was pulled off the market.
Dr. Ken Bassett, the comanaging director of the Therapeutics Initiative, told the Georgia Straight by phone that B.C. was one of the last provinces to list COX-2 inhibitors under its PharmaCare plan. And even then, he added, these drugs were prescribed at half the rate of Ontario, which likely saved lives.
“It was very much a powerful partnership that allowed people in the ministry and people making these funding decisions to make these very difficult, very controversial, and very challenging decisions not to fund a drug that virtually the rest of the world—almost—was rallying to fund because it was seen as very favourable,” Bassett said.
Despite this success, the B.C. government recently cut off the Therapeutics Initiative’s access to provincial prescription-drug data without disclosing the reason, according to Bassett. “We just received notification from the university—it was originally a letter from the ministry—notifying that we need to suspend activities under our contributory agreement,” he said.
Bassett bluntly stated that the job of the Therapeutics Initiative is to clarify the state of scientific evidence and provide reports, but that has been jeopardized by the government’s action. “It will mean that we’ll have more difficulty in actually continuing to do our independent drug reviews,” he noted.
Last month, the B.C. Ministry of Health fired five employees and suspended two others in connection with data-management practices involving its employees and drug researchers. Health Minister Margaret MacDiarmid announced in early September that all work on contracts linked to “drug and evidence development” was suspended and that the policy would be tightened for contracts with universities. The government’s news release named UBC and the University of Victoria.
The Ministry of Health has refused to reveal if these actions had anything to do with the Therapeutics Initiative. Bassett said that UBC, which has been acting on its behalf, has not been able to clarify anything. But he has trouble seeing how his group could be connected to the issue involving the ministry dismissals.
“We don’t actually download data,” Bassett emphasized. “Our group goes and uses data on the ministry’s mainframe—and the interface is all anonymized data.…All we know is it has made it not possible for our group to continue our work. That is the main issue.”