Ontario recently took a historic step as the first province in Canada to introduce legislation that would shine a light on interactions between drug companies and prescribers. The use of the term “historic” here is not hyperbole, since the extent of payments by the pharmaceutical industry to individual physicians in Canada has never been known.
Other countries, such as the United States and France, have been making such information public for a few years now. But Ontario’s bill would provide a wider scope of transparency by including payments to prescribers of all sorts — not just doctors — into the mix, and even including payments from medical device companies.
British Columbia also appears to be taking a serious look at following suit. And while we applaud these steps, they could set up separate registries with absolutely no information for the public in other parts of the country. What Canada really needs is a publicly accessible national registry of such payments, similar to the one in the United States.
Pharmaceutical and medical device companies dole out payments to physicians for a variety of purposes, including consulting, speaking engagements, meals for continuing medical education events, and the operation of clinical trials. The call for transparency here is not meant to demonize prescribers who interact with the drug industry, but rather to ensure that any biases, whether conscious or not, are out in the open. And while the rationale for such transparency is universal across the country, it runs the risk of being embraced in typically uneven Canadian fashion.
Patients ultimately bear the cost of these payments in the prices they pay for their drugs. When pharmaceutical companies provide physicians with meals, gifts, travel, or direct payments, it is with the intent of influencing prescribing. And when doctors get such information from drug companies, the overwhelming majority of evidence suggests that prescribing gets more expensive, more frequent, and sometimes less appropriate. When physicians or researchers give talks at conferences, educational rounds, and the like, they are expected to list any possible conflicts of interests. Shouldn’t such disclosure be the minimum standard for all Canadians?
Since Canadians pay more for medications than citizens of almost any other country aside from the United States, it is important to track national spending on marketing so we can test the claims made by pharmaceutical companies that high drug prices are needed to support research and development. To do so properly, we need information from across the country, not just from one or two provinces.
Duplicating registries in each jurisdiction would only add to administrative costs — we would need thirteen online databases instead of one —and there’s no guarantee that these registries would collect the same type of data.
Payments that pharmaceutical companies make to health care providers is an issue that needs transparency across Canada. Although health care is administered by provinces and territories, the federal government could take the initiative to coordinate changes across the country. In the United States, individual states have vastly different approaches to health care but they are all subject to the Physician Payments Sunshine Act that gave rise to an online database of physician gifts and payments. Regardless of the regulatory mechanism, Canadian jurisdictions should be able to agree on a common approach to a national registry.
The Canadian federal government could also work with the provinces and territories to make transparency for physician gifts and payments compulsory in every jurisdiction. Such a change may have widespread support. The Canadian Medical Association and the College of Family Physicians of Canada have both endorsed further disclosure of some kind. Perhaps surprisingly, several large pharmaceutical companies are also in favor. The main missing ingredient seems to be political will.
The Trudeau government campaigned on the principles of openness and transparency. With the release of the new health mandate letter, which referenced “increasing transparency in the marketing and promotion of therapies,” there may indeed be cause for optimism. But just to be sure, we are calling on the federal government to make a national sunshine act an item for discussion at this month’s meeting of federal, provincial, and territorial ministers of health.
This is an opportunity for Ginette Petitpas Taylor, the new federal minister of health, to demonstrate leadership on a policy issue that no objective assessor can oppose because it puts the best interests of patients before those of pharmaceutical companies.
Given where our neighbors are on this issue, it’s surely well past time.
Nav Persaud is a physician and associate scientist at St. Michael’s Hospital in Toronto and assistant professor at the University of Toronto. Joel Lexchin is an emergency physician at the University Health Network in Toronto. David Juurlink is head of the division of clinical pharmacology and toxicology at the University of Toronto. Andrew S. Boozary is a resident physician at the University of Toronto and founding editor of the Harvard Public Health Review. They are all advisory board members of Open Pharma, a national campaign in Canada to make public all industry payments directed towards individual prescribers.
This article was updated to reflect contributions by David Juurlink.