March 26, 2014
The Globe and Mail
Dr. Andrew Boozary and Joel Lexchin
Ours can be an overly polite country. If the recent Senate spending scandal taught us anything, it’s the value of openness in financial relations. Our American neighbors have come to understand this (somewhat), and now believe that such transparency should not be confined to Congressmen or Wall Street. Lost in the rancor surrounding the Affordable Care Act is a piece of legislation that leans on transparency to enlighten and safeguard patients from conflicts of interest. It’s titled the Physician Payment Sunshine Act, and it’s a rather unapologetic take on a relationship Canada has been relatively bashful about.
By the end of this year, President Barack Obama’s Sunshine Act will have drug companies report virtually every transfer of value to doctors and academic hospitals. With payments of as little as $10 dollars to be listed on a public website, this marks a serious undertaking in the world’s most sophisticated pharmaceutical market.
So, why exactly is the government going through all this?
The idea is to have any financial biases in the physician’s office out in the open. This might help ensure that the most responsible decisions are being made for the patient – and the patient only. While doctors are hard pressed to believe that pens or souvlaki lunches can alter their own prescription patterns, there are numerous studies to suggest otherwise. And the issue is not just your physician’s own pen, it’s also pharma’s influence on the experts who set the standards of care. In a recent commentary for the Journal of the American Medical Association, Dr. John Ioannidis pointed out that over half of the panelists on the American Heart Association guideline committee had financial ties with industry – this for recommendations that could see more than one billion people taking statins by 2020. Factor in a projected $1-trillion worth of statin sales and it’s easy to see what’s at stake: people and profits.
The fact that such conflicts of interest may dilute evidence, or even taint the public’s trust, has spurred France, the United Kingdom and Denmark to follow suit with similar regulations. For many countries, pharma’s shroud of secrecy is no longer defensible.
Surely Canada’s publicly financed health care system is free of such competing interests? Much of the evidence isn’t so assuring.
A McGill professor has been formally reprimanded for signing her name to an article written by a professional writing firm that was hired by Wyeth (now part of Pfizer) to generate positive publicity for its hormone replacement therapy. When it comes to the financial interests among physicians who craft Canadian practice guidelines, a study in the British Medical Journal found close to 80 per cent declared conflicts of interest on the Canadian Cardiovascular Society and Canadian Diabetes Association. Potential conflicts are also rife at Canadian medical schools. Last summer, an analysis of the situation at all 17 schools across Canada found that the policy environment is generally lax; for instance, 12 of the schools either had no policy or permissive ones about their faculty engaging in speaking activities on behalf of drug companies. This gives us little reason to believe that patients are in the know when it comes to their own doctor’s involvement.
By enforcing calorie counts on all menus in restaurant chains, the Ontario government has shown that public disclosure is in. Transparency won’t be a panacea when it comes to medical industry relations, but it’s a requisite for boundaries that both patients and physicians can buy into.
To be sure, it will take strong provincial leadership to hold pharmaceutical companies to account. We are calling on the Ontario Ministry of Health to make disclosures of payments to doctors compulsory for any pharma companies with drugs listed on the Ontario Drug Benefit Program. By making this information publicly available on a website, it will no longer fall on the patient to ask whether their physician has been paid by drug makers. This is efficient from a taxpayer’s perspective as it would not involve spending much public money, while it also leverages the bulk buying of drugs to put patients directly in the centre of care.
Some critics have argued that the public wouldn’t be interested enough to visit such sites or know what to make of the information. The most recent numbers from the U.S. suggest this may not be true. Patients do seem to care about their physician’s financial motives, and a culture of openness might just help the lines of communication.
In Canada, it’s time we start betting on patients over pharma.
Andrew Boozary is the Editor-in-Chief of the Harvard Public Health Review and resident physician at the University of Toronto. Dr. Joel Lexchin teaches health policy at York University and works in the Emergency Department at the University Health Network. They have founded Open Pharma as a movement to empower patients and physicians through greater transparency with the drug industry.