Wednesday, June 11, 2008

Sceptical Reflections on the BC Pharmaceutical Task Force

By Randall F. White, MD, FRCPC

9 June 2008

The BC minister of health, George Abbott, assembled a task force in 2007 to review policy on pharmaceutical coverage under the province’s PharmaCare program. According to the Web site, the program “subsidizes eligible prescription drugs and designated medical supplies, protecting British Columbians from high drug costs.” Abbott’s appointments to the panel surprised even cynics.

Adrian Dix, the opposition health critic, called the composition of the nine-member task force “highly debatable” because five of the members had ties to the pharmaceutical industry. It included Russell Williams, the president of Canada's Research-Based Pharmaceutical Companies, a leading industry lobbying group. The conflict of interest was glaring, yet aspects of the province’s decision-making that displease industry were open for review.

Most provinces turn to the Common Drug Review that for decisions about covering medications. For therapies that fall outside the Common Drug Review, BC has an independent review process called the Therapeutics Initiative (TI), which also provides education for clinicians on its Web site Therapeutics Initiative The TI review process has been praised for outcomes such as preventing widespread use of COX-2 inhibitors in BC, medications which turned out to have a poor risk/benefit ratio.

The task force released its report in April 2008, and just as critics expected, the recommendations lean hard on efforts to protect tax payers and public health at the expense of Big Pharma’s profits. The report concluded, without substantiation, that the TI is “widely regarded as being in need of either substantial revitalization or replacement.” The panel even recommended that the TI cease educational activities, suggesting that they have not been “unbiased and evidence based.”

In barely concealed contempt for the TI, which is housed at UBC and is explicitly designed to keep the evaluation process shielded from industry influence, the panel suggested a new process that includes “disease-specific experts.” Although experts have a lot to offer, the fact is that many are involved in research and education funded by Big Pharma: more conflict of interest. In an egregious example, Dr. Joseph Biederman, a renowned child psychiatrist and researcher at Harvard, was recently found to have concealed a large sum of pharma income New York Times

What about a government’s conflict of interest in inviting industry to craft public policy? Big Pharma spreads its money around, including to Abbott’s party, the BC Liberals. The Pharmaceutical Task Force illustrates how commercial interests influence health policy, and why Canadians should hesitate to allow commercialization of other aspects of the health care system. Once corporate interests are let in, their lobbyists want a say in whatever government does.

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