Thursday, July 13, 2017

In a commentary in the Toronto Star, Prof. Trudo Lemmens and journalist and former U.S. Senate staffer Paul D. Thacker argue that Ontario and Canada needs to establish new rules to ensure payments by pharmaceutical companies not only to physicians and but also to all health-care providers, academic institutions, medical researchers, patient groups, PR agencies, professional societies, and media outlets ("Time for full transparency on pharmaceutical money," July 7, 2017).

Read the full commentary on the Toronto Star website, or below.

Time for full transparency on pharmaceutical money

By Trudo Lemmens and Paul D. Thacker

July 7, 2017

Ontario’s Minister of Health Eric Hoskins recently announced the government may oblige the pharmaceutical industry to disclose all payments to physicians. The initiative is long overdue, but to be effective, it must be broader, backed with adequate enforcement, significant penalties for those who break the law, and further conditions for payment transparency.

Sunshine rules only do so much. We must examine the damage done by industry-related financial conflicts of interests on health care, and restore integrity that wins back the public’s trust.

Physician sunshine rules address problems that have been extensively examined. Studies find that financial ties between doctors and industry lead to over-diagnosis of disease — a process called disease mongering — and over-prescription.

A recent analysis even found that the more money a doctor receives, the more likely that physician is to prescribe expensive brand name drugs. Pharmaceutical industry money has also been used to create marketing material that is cleverly disguised as medical research or educational tools, and to help skew how safety and efficacy data gets presented to the public.

Committees that evaluate drugs and medical devices or write prescribing guidelines are regularly stacked with physicians who have financial relationships with companies benefitting from committee decisions.

Inappropriate use of pharmaceuticals is a leading trigger of hospitalization in North America and causes more deaths each year than traffic accidents. The political pressure for Minister Hoskins’s initiative was sparked by the latest example of pharma corruption. North America’s opioid crisis largely results from opioid manufacturers funding physicians to act as their lobbyists and to push for more widespread prescription.

In 2010, the United States passed the Physician Payments Sunshine Act, forcing companies to disclose money and gifts they provide to doctors. France, Portugal and Slovakia enacted related laws. Other countries may follow suit. For years, Canadian commentators called upon governments to do the same, but many Canadians seem to believe that health-care corruption is an American phenomenon. In May 2015, we met with Minister Hoskins to provide lessons from the U.S. experience, and argued Ontario sunshine regulations should extend beyond the disclosure of physician payments.

Here is why. Industry funds physician education and helps create free medical textbooks that favour corporate products. These subtle forms of pay-for-play fill out industry’s marketing strategy that includes free lunches for residents and the funding of patient advocacy groups that lobby governments for drug and device approval and funding. Even medical journals are often beholden to industry interests, making money by selling reprints of industry-sponsored studies. Not all financial ties are so problematic, but transparency helps disentangle fraud from responsible corporate citizenship.

We recommend that Ontario and Canada adopt the French approach, which requires disclosure of industry contributions to all health-care providers, academic institutions, medical researchers, patient groups, PR agencies, professional societies, and media outlets. Provincial and federal governments in Canada should collaborate to ensure full transparency in health care. Partial transparency provides false assurance and creates complacency.

Will transparency work? The U.S. law has fairly strict penalties and reporting compliance to capture different types of transactions. Companies have to know that they are being watched and that they will feel it in their wallet if they try to evade the law. Canada must do the same, and even more.

Transparency is only a first step. As hidden payments come out of the shadows, it will be clearer why money in health care can be just as corrosive as it is in politics. A recent study examined a state sunshine law passed in the U.S. and found that, after payments to doctors became public, physicians began writing fewer prescriptions. This reaction makes sense because American doctors have become leery of becoming too cozy with pharmaceutical companies. The U.S. government has fined companies billions when they were caught in behavior that sunshine rules aim to curb, and in some instances, physicians have been prosecuted.

Despite similar problems and practices here in Canada, rules are enforced much more timidly. Health Canada, health professions regulatory colleges, and academic institutions rarely sanction industry, physicians and researchers after they are caught in questionable activities.

If we want to address the pharmaceutical industry’s influence on our health-care system, it’s time to pass new rules to shine a light on these practices that harm patients and increase health-care costs. A more transparent process will force leaders to stop ignoring corrosive behavior.