Martyn Brown: The Rx-files—the truth is out there

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      If all goes according to plan, British Columbia’s new premier, John Horgan, should be sworn-in in time to attend the next meeting of Canada’s premiers in Edmonton, from July 17 to 19.

      It’s anyone’s guess what will be on their agenda, or which companies might be sponsoring that annual event.

      In my experience, those annual affairs were mostly a great excuse for a political gabfest, punctuated by extravagant feasts of local fare and lots of booze for the countless attending bureaucrats and politicians.

      Will any of Canada’s largest drug companies be among the private corporations that are helping to foot the bill for this year’s most expensive government party? I have no idea.

      But I do know they sure have given great gobs of money to governing parties, especially in B.C.’s "wild west".

      More importantly, everyone knows that public drug costs are through the roof.

      Rising drug prices and prescription costs are squeezing out funding for other health priorities, to say nothing of the financial burdens they are imposing on taxpayers. They are one of the many reasons why MSP premiums more than doubled under the Liberals.

      More importantly still, all those drugs are taking a health toll on Canadians who are being overprescribed or wrongly prescribed by drug-loving doctors.

      The premiers could do something about that, if they had a political backbone.

      They could commit to doing what the Obama administration did, when it introduced the Open Payments program, under the Affordable Care Act.

      That program mandates the public disclosure of all payments and funding from the pharmaceutical industry to physicians and teaching hospitals for things like research, clinical trials, gifts, meals, travel, speaking fees, honoraria for attending meetings, and compensation for advisory board memberships.

      Since the U.S. introduced its open payments program in 2013, other countries like Britain, France and Denmark have all followed suit. But not Canada.

      It is something that Canada’s Open Pharma campaign has long been calling for, to no avail.

      That campaign has also been pushing for the public release of clinical information about the safety and efficacy of drugs and medical devices by Health Canada, and for industry-funded research to be publicly accessible for re-analysis in academic journals and other platforms.

      One would think that with soaring drug costs, and with no end of stories about the disturbing trends in increased drug prescriptions, Canada’s health ministers would have long ago launched their own mandatory open payments regime.

      Nope. We are still stuck in the stone ages, thanks to a lack of political leadership by our governments.

      Last week, 10 of Canada’s largest drug companies voluntarily divulged that last year they spent about $48.3 million on payments to physicians and health-care organizations. Big deal. It was mostly a p.r. exercise in avoidance.

      Almost none of the information they released was of any earthly benefit.

      It didn’t name any of the doctors who received that money, perks, or benefits.

      It didn’t disclose how many physicians were paid in total by those drug companies.

      And it didn’t reveal the amounts those pharmaceutical firms shelled out for clinical trials aimed at proving the merits of their drugs, or at producing clinical practice guidelines.

      As such, the limited information those companies published with such great fanfare was pretty much useless.

      Plus, it was all over the map. Only four of the 10 companies provided figures for the entire 2016 year. One of them only released figures for three months.

      It is a scandalous racket that needs to stop, now.

      That much is evident from the excellent work of the CBC’s Kelly Crowe, who has illuminated some of the many tawdry practices that the pharmaceutical industry uses to influence drug research, guidelines, listings, and prescriptions. They should concern all Canadians.

      It’s safe to say those too-cozy funding relationships are pushing up health costs and fostering a pill-popping health treatment culture that is quietly supported by funding from the very companies that stand to profit from their supposed support of public health research efforts.

      The Globe and Mail’s Kelly Grant has also recently documented the conflicts of interest between drug companies and clinical practice guidelines. Her findings were appalling, but hardly surprising.

      They also highlighted the often insidious relationship that exists between those who are researching and writing those guidelines, and the large drug companies that fund them.

      Consider this nugget, for example, from Grant's report:

      "Nine drug makers, including the companies that make the antidepressants Prozac, Zoloft and Paxil, put up a total of $205,000, most of which went to cover flights, meals and Toronto hotel rooms for a meeting of the executive committee and to pay the salaries of two medical writers who helped research and draft the final guideline paper.

      "Of the 22 panelists who ultimately signed off on the paper—it was published in 2014 and is still among the 10 most-frequently accessed on the Canadian Medical Association’s database of 1,200 or so clinical practice guidelines—13 disclosed that they had received payments from the pharmaceutical industry in the past, one of them from 16 different companies."

      My question to soon-to-be-premier John Horgan is this: what are you going to do about this problem? Will you lead the way to fix it, as your party’s supporters would all hope?

      Action on open pharma was not a plank in any of B.C.’s provincial party platforms in the recent election. It should be a priority for the new NDP government.

      We sure can’t count on the federal Liberal government to tackle the issue. It has once again passed the buck.

      Canada’s health minister, Jane Philpott, has essentially said it is not her problem:

      "Obviously, as a family doctor, I understand the importance of Canadians being aware of the relationship that doctors have with pharmaceutical companies," she said. "But as it relates to the regulation of health professionals, this would be something I would leave to the jurisdiction of my provincial counterparts."

      What a cop-out. Obama, Trudeau’s not.

      Justin Trudeau and Health Minister Jane Philpott haven't demonstrated any interest in making pharmaceutical industry funding more transparent.
      Justin Trudeau

      Still, it begs the question, what are the premiers going to do fix the problem that Philpott and Trudeau are too timid to touch?

      In the States, thanks to the Open Payments program, we now know that some 1,455 U.S. drug companies gave over $7.3 billion last year to 618,000 doctors and to 1,111 teaching hospitals.

      If you lived down South, you could go online and find out exactly who gave what to whom. You could look up your doctor, or any doctor or teaching hospital, or any drug company, to see who paid the bills and pocketed the money.

      Yet in Canada, our politicians are essentially still protecting the drug companies’ secrecy.

      Why? What are they so afraid of?

      Are the drug companies really so powerful, or perhaps so politically important to the governing parties, that they are being left unregulated in Canada, while other countries have acted to hold them accountable?

      Parenthetically, it is worth noting as well that British Columbia has just lived through worst human resources scandal in its history, as the Ombudsman recently investigated and condemned, in the strongest possible terms.

      Eight government drug researchers were wrongly fired back in 2012, including Roderick MacIsaac, who was so distraught that he took his own life.

      In addition to acting upon all of the Ombudsman’s recommendations in response to that sordid episode and government cover-up, it would be fitting if premier Horgan committed to extending the value of transparency to the pharmaceutical industry.

      Let’s really shine a line on the Rx industry that so hated the province’s theurapeutic initiative, by publicly following the money that flows from the drug companies’ coffers to the ones who indirectly influence their profits, in offering their professional advice and services.

      Acting on the open pharma campaign should be at least one thing that Horgan and Alberta’s NDP premier Rachel Notley can agree upon.

      Indeed, all of Canada’s first ministers should commit to putting in place a mandatory public reporting program to expose the drug companies’ financial relationships with doctors and teaching hospitals, and to provide public access to industry-funded research.

      They should also commit to reviewing and standardizing the conflict of interest criteria that apply to drug research, guidelines, listings, and prescriptions.

      The opioid crisis that is killing so many Canadians should also provide new impetus for urgent action on that priority.

      As the open pharma campaign has highlighted, "national opioid guidelines underscore the uneven landscape of disclosure in our health system. Six of the thirteen members on the opioid expert advisory committee had ties to drug companies that manufacture narcotics. And while this should never disqualify opinion, the reporting of such conflicts was inconsistent with previous policies or procedures."

      The time for apologizing, delaying, and frustrating action on the Rx-files is long past.

      The truth is out there.

      Let’s see it, no matter how alien that concept might be to Canada’s wealthy drug companies, or to the vested interests that are afraid of that transparency.

      Martyn Brown was former B.C. premier Gordon Campbell’s long-serving chief of staff, the top strategic adviser to three provincial party leaders, and a former deputy minister of tourism, trade, and investment. He also served as the B.C. Liberals' public campaign director in 2001, 2005, and 2009, in addition to his other extensive campaign experience, and he was the principal author of four election platforms. Contact Brown at