Social Policy in Ontario

If you live in the United States, you can easily find out if your doctor receives payments from drug companies. Ditto if you live in Australia, Japan, the United Kingdom, France, Denmark and many other European countries.

But not Canada.

This country is seen as an international “laggard” when it comes to transparency about financial ties between the pharmaceutical industry and physicians.

But there is a growing chorus of voices demanding change in the name of quelling concerns about conflicts of interest in the marketing, prescription and study of drugs.

A new national campaign is being launched calling on the federal government to mandate public disclosure of all payments and transfers of value — for example, gifts and meals — from drug makers to doctors.

The Open Pharma campaign — spearheaded by resident physician Dr. Andrew Boozary and backed by some big names from the world of health care and academia — is seeking to build public awareness and momentum for federal action.

“The interaction with industry is everywhere and a lot of progress has come from collaborating,” Boozary said. “But if we continue to keep relationships in the dark, we will undermine trust.”

Payments from drug companies can be in the form of funding for research, fees for speeches or participation on advisory committees, and coverage of travel expenses for participation in international functions.

Organizations, including hospitals, universities and private medical clinics, are also beneficiaries of funding, some of it philanthropic.

There have been numerous controversies in Canada over perceived conflicts of interest because of payment relationships.

The most recent was three weeks ago when federal Health Minister Jane Philpott ordered an independent review of Canada’s new prescription guidelines for opioids because of revelations that a doctor — who was part of a committee of medical experts who voted on whether to accept the guidelines — had received financial compensation from companies that make and market opioids.

In recent years, Toronto Star investigations have exposed a number of questionable relationships between big pharma and doctors. Stories detailed industry funding of pricey dinners, alleged altering of studies, and physician endorsements of drugs.

Boozary emphasizes that the Open Pharma campaign is not “anti-pharma,” nor does it aim to ban industry involvement with the medical profession. It’s about being open about relationships in the interest of upholding public confidence.

The campaign is being launched on the eve of an initiative by the Canadian branches of 10 multinational drug companies to publish aggregate data on payments to health-care practitioners and organizations.

But the voluntary initiative has been criticized for not going far enough. Data to be released June 20 will not be broken down into payments to individual doctors and organizations. Instead, each drug company will release on its website only three numbers: total payments to health-care professionals and organizations, and payments to cover expenses related to travel to international meetings.

Even one participating drug company said the initiative falls short.

“This is good but not good enough,” said Paul Lirette, president of GSK Canada, adding that the industry would be wise to voluntarily take more action rather than risk being forced to by government.

Lirette said he would like to see disclosure of more detailed data. As well, he wants broader participation, including from the other 35 brand-name drug companies under the umbrella of Innovative Medicines Canada (IMC), 10 generic drug companies and 148 medical-device manufacturers and related companies.

The Open Pharma campaign also calls on Ottawa to mandate drug companies to be more transparent by:

• Publicly disclosing clinical information on safety and efficacy of drugs and medical devices.

• Making industry funded research open access so that it is available for reanalysis in academic journals and other platforms.

“Withholding data can mislead doctors and patients who need to make decisions based on best available evidence,” Boozary said. “And by ensuring data from patient trials are open and accessible, we can be more certain about the state of science when deciding treatment options.”

Andrew MacKendrick, press secretary to Philpott, said their office has asked Health Canada officials to look at what Ottawa can do to facilitate more transparency, given that provincial governments and health regulatory colleges also have some jurisdiction in the area.

In addition, MacKendrick points out that Health Canada recently issued a white paper for public consultation on the idea of disclosing clinical information on drugs and medical devices under consideration for government approval.

Members of the Open Pharma’s campaign’s advisory board include: Dr. Andreas Laupacis, executive director of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital; Adalsteinn Brown from the University of Toronto, where he serves as director of the Institute of Health Policy, Management and Evaluation, and the Dalla Lana Chair in Public Health Policy; Dr. Danielle Martin, a vice-president at Women’s College Hospital and a founder and a past chair of Canadian Doctors for Medicare; Toronto doctors David Juurlink and Nav Persaud, both of whom study the relationship between pharma and the medical profession and have raised questions about undeclared conflicts; and Dr. Ahmed Bayoumi, professor of medicine at U of T.

“Health systems larger and more complex than ours are already requiring disclosure of payments to physicians. . . . Conflict of interest is real, but the point is not to stop the payment to physicians, it is to make sure that these conflicts are identified and managed in the interests of patients,” Brown said.

The campaign is also supported by Joel Lexchin, a Toronto ER doctor and author of the newly released bookDoctors in Denial: Why big pharma and the Canadian medical profession are too close for comfort.

Doctors are often unaware of how they are influenced by taking gifts or money from industry, Lexchin said.

Five years ago, the Canadian Medical Association passed a resolution, calling on the industry to make payment information publicly available. Dr. Jeff Blackmer, CMA vice-president of medical professionalism, is pleased to finally see some movement:

“I think there is definitely public interest in knowing which physicians are involved in these relationships. It’s not to say that these relationships are inherently evil or bad, it’s to say that we want to make sure that people understand the context.”

Blackmer points out that public funding of research is on the decline and drug companies are filling a void.

The U.S. “Physician Payments Sunshine Act” requires pharmaceutical companies to release details of payments to doctors and hospitals.

“I think over time people have come to understand that conflicts of interest are real and are of concern. In a world of greater transparency, it was no longer a viable option not to reveal what the payments were,” said Dr. Howard Bauchner, editor-in-chief of the Journal of the American Medical Association, which has devoted many editorials to the issue.

ProPublica took the payment data and put it on an easily searchable database. The independent, non-profit news organization also cross-referenced it with prescriber data and found that doctors who receive payments as a group prescribe a higher percentage of brand-name drugs.

“Canada at the moment seems like it’s a laggard in this regard,” says ProPublic senior reporter Charles Ornstein. “The world is moving in the direction of providing patients with context about interactions between the pharmaceutical industry and doctors.”