Pharmacare Fact Sheet #1
What's the deal?
The business of developing cures and treatments for disease is fraught with contradictions. Its raison d’être is to help people. But being so highly valued — it attracts both those who want to help and those who are greedy
Most Canadians probably have a vision of pharmaceutical research as being at arm’s length from the corporations that will eventually produce and market the drugs that result from their investigations. They would be shocked to learn that this is not necessarily the case, and that regulations controlling this relationship are lax.
Increasingly, pharmaceutical companies are controlling the process of developing new drugs from start to finish. The problem, according to a group of academics is that the public interest is not being served under this regime. Nor is public health.
In a document entitled Tales from the other drug war, released by the Centre for Health Services and Policy Research (CHS&P) at the University of British Columbia last year, they explore how drugs are developed, researched, regulated and approved for distribution in Canada.
Advances in medicine in recent history have been phenomenal. Diseases that used to kill people on a regular basis either have been almost wiped out or are managed so that people now live long and useful lives.
But there are still many diseases out there that have no cure or treatment.
Most medical researchers want to leave a lasting contribution and help those who are sick.
Pharmaceutical research is a magnet to those who simply want to make a lot of money. If a drug is developed that will help people be well, it will sell. Guaranteed.
But the problem, according to the papers prepared for Tales from the other drug war, is that in Canada pharmaceutical companies almost completely dominate the country’s clinical research business.
There are such prodigious amounts of money involved that often test results will be swept under the rug if it means a drug will not be approved.
Pharmaceutical companies are powerful enough to ensure that favourable results make it to the public eye and unfavourable results are suppressed.
Researchers are put into the position of deciding to “blow the whistle” when it may mean losing a research grant — maybe for a very long time.
That is what happened to a blood specialist at Toronto’s Hospital for Sick Children. Nancy Olivieri first reported favourable results for a drug used to treat a genetically transmitted blood disorder. But three years later, when she had data on long-term effects of the drug, she reported that there was actually no benefit at all for those treated with the drug.
The drug company which had funded her research did not want to hear that. She found herself being threatened with legal action if she publicly presented or published the negative results.
Olivieri had done what many researchers do — signed a letter in advance of doing the research giving the company control over any communications about her research. But she followed her hospital’s ethical guidelines and informed her patients and colleagues about her findings.
The drug company dropped her as the key researcher on the project and stopped the drug trial at her hospital. Then they appropriated all her data and — without her consent — published the results as favourable.
Pharmaceutical companies are not adverse to taking an existing drug, making minor changes, patenting it and marketing it as a major innovation or creating a market.
Ken Bassett, one of the document’s authors, cites the example of bone marrow tests for women. “The testing technology is, in effect, a marketing test,” he says. Once determined that she is at risk of osteoporosis, a woman is generally put on a drug treatment, when exercise and diet are perhaps better ways to combat this disease.
And pharmaceutical companies sometimes deliberately apply data collected from one segment of the population and apply it to another. Studies done on middle-aged men which found strong links between high cholesterol levels and heart disease created a market for cholesterol-lowering drugs.
Random tests were never done on women, but their doctors prescribe these drugs to them anyway.
The importance of diet was recognized early in the research, but it has been shoved aside by a sophisticated media campaign, according to Isabelle Savoie, another of the document’s authors. “By the early 1980s, nearly two-thirds of the American population was aware of the reported role of dietary cholesterol in coronary heart disease and of the reported importance of reducing dietary fat intake as a means of controlling cholesterol,” she writes.
Pharmaceutical lobby groups waged a media campaign that shifted the public perception significantly and by the late 1980s a large percentage of the population had been prescribed a lipid-lowering drug.
That Canada’s Health Protection Branch is loosening its control on pharmaceutical research and marketing does not bode well for the public good, either.
And the pharmaceutical industry wants the government to remove even more regulations, as well as minimize arrival time for new drugs on the market.
The authors of Tales think this is a bad idea. Regulations controlling peer review processes, advertising, evaluation of drug trials, post-marketing surveillance, the role of patient/disease groups and access to the full scope of information to government, the public and the research community should be tightened up, not loosened, they say.
Researchers need to act in a collective manner and develop their own ethical guidelines. Union members will recognize the advantage of this arrangement. An independent agency to oversee the protection of public health in Canada is needed, one that has the power to conduct independent audits. Pharmaceutical companies should not be permitted to make unlimited profits at the cost of the public’s health and well-being.
In B.C., prescription drugs form a substantial part of the health care budget, and Pharmacare is an easy target for the government when it starts to make cuts. We could end up paying more money and more often for drugs which may not even be necessary.
Buy me, try me, say drug ads
No longer content to limit their advertising dollars to publications aimed at the medical profession, pharmaceutical manufacturers are now going straight to the patient/consumer. Direct advertising of pharmaceutical products is banned everywhere except in the United States and New Zealand.
In Canada, drug companies have been permitted to advertise the price of prescription drugs along with the name of the drug, but that’s all.
Recently, however, Health Canada conceded some ground to pharmaceutical manufacturers who want to reach the public.
Picture this: A middle-aged woman talks confidentially to the camera about how she used to be so depressed. But now she feels better. Scene changes to the woman affectionately cuddling her husband, both smiling contentedly. “I’m so happy I found my way out,” she says. Fade out and voice-over, “Brought to you by Miracle Drug X.”
In Canada the ad is still not allowed to say, “Miracle Drug X cured my depression. You should use it, too.”
But the public gets the not-so-subtle message loud and clear.
Health care professionals are concerned about this trend. Australian doctor Peter Mansfield has seen what happens in New Zealand when pharmaceutical companies are allowed to advertise directly to consumers. He says that patients start insisting on the drugs from their doctor.
“When prescription drugs are marketed directly to consumers,” he told a Times Colonist reporter last June, “You get a much higher demand for them. Meanwhile, they’re typically the drugs that we know the least about.”
And they are very often more expensive than other comparable drugs.
Prescription drugs — which are subsidized in B.C. — form a huge chunk of the province’s health care budget. Too much spent on prescription drugs will route money away from other parts of the health care budget.
Only stockholders’ pocket books are ensured of better health with increased drug advertising.
Who is covered by Pharmacare?
ALL BRITISH COLUMBIANS AUTOMATICALLY QUALIFY qualify for Pharmacare coverage by registering with the Medical Services Plan of British Columbia (MSP).
THE COVERAGE FOR THIS PLAN is based on the total eligible expenses of a family, rather than on an individual basis. The current annual deductible for universal Pharmacare is $800. When the total expenses for eligible prescription drugs and other benefits for a family have reached this annual deductible, Pharmacare will automatically cover 70 per cent of the cost of any further eligible benefit items. Once a family has paid a total of $2,000 in costs recognized by Pharmacare, any further costs in that year are covered 100 per cent.
RESIDENTS OF B.C. WHO ARE 65 YEARS OR OLDER are covered for 100 per cent of the cost of prescription drugs. Seniors cover the costs of pharmacists’ dispensing fees until they have reached a maximum of $200 per year, at which time Pharmacare covers the full cost.
FULL PAYMENT FOR PHARMACARE BENEFITS are made on behalf of the following groups:
- residents of licensed care facilities within the province, regardless of age or financial situation;
- individuals who hold a valid Human Resources Medical Benefits program care card and their dependents.
AIDS DRUGS ARE AVAILABLE free of charge through St. Paul’s Hospital.