Transcript
Speaker: Hello and welcome to today's episode of Red Eye. I'm Jane Williams. On the podcast today, Lorraine Chisholm speaks with Dr. Joel Lection about the need for transparency about how much money Big Pharma gives to doctors and medical professionals in Canada.
Speaker: Most of us know that drug companies give payments to doctors and health professionals on a regular basis, with the aim of increasing the sales of their products. A veteran health researcher says Canadians need to know how much money Big Pharma gives healthcare providers, yet this information is not available.
Speaker: Joel Lectin says it's vital that the public knows that the choice of therapy is based on the patient's best interest and not on the interest of the company that makes the drug. Joel Lectin is Professor Emeritus of Health Policy and Management at York University, and he joins me now. Hello, Joel. Hi there. Glad to be with you. It's really good to talk with you again.
Speaker: What kinds of payments do we know that drug companies make to doctors and for what activities? So drug companies spend an awful lot of money trying to reach doctors and influence them. Not just doctors, though. They also have relationships with medical associations. So I'm or was an emergency physician.
Speaker: I'm a member of the Canadian Association of Emergency Physicians. My association has relationships with over 20 drug companies. We have no idea what those relationships are though because they're not made public. So it's healthcare professionals, it's medical associations, it's patient groups, it's hospitals. Drug companies spend an enormous amount of money
Speaker: The little that we know, and it is very little actually, is that from 2016 to 2022, 10 out of the 48 companies that are members of Innovative Medicines Canada
Speaker: Gave over two hundred million dollars to healthcare professionals and over two hundred million dollars to healthcare organizations so that's well over four hundred million dollars from less than a quarter of the membership of innovative medicines canada but we don't know
Speaker: what those payments were for, and we don't know to who they were because all we get are these gross amounts of money. So we don't know what individual doctors got money, what they got it for. We don't know whether or not medical associations got how much they got, what they got it for. All that kind of information is non -transparent.
Speaker: So presumably these aren't like, okay, here's a thousand dollars, prescribe more of my drug. So what is it that doctors or medical associations do that gets compensated for by these companies? Well, for individual doctors, there are a variety of things. So some doctors will be what are called key opinion leaders.
Speaker: These are people who are paid to go across Canada to give talks to other doctors. So you get paid for your travel expenses, your accommodation, and then you'll get a certain amount of money.
Speaker: to give those talks. Other doctors are on advisory boards for drug companies, so the drug company may say something like, we're going to be releasing a new drug to treat asthma and we'd like your opinion about how asthma is currently being treated.
Speaker: and how we should position our drug. So come to a meeting and we can talk about it. There is money spent on what are called drug dinners. So physicians get an invitation to go to a, to get a meal in a reasonably good restaurant. You get fed, you have some wine and then you listen to a talk sponsored by the drug company.
Speaker: Drug companies pay physicians to go to international meetings. You can't be, even if you're not a speaker, even if you're just a participant, you can, drug companies will pay you to go outside of the country to a meeting. So there are a variety of ways that drug companies spend their money on doctors. And that's not including the money that they pay their sales reps.
Speaker: These are the men and women who go from office to office talking to doctors about their products. And it also doesn't include the money that's spent on the samples, the free samples of medications that the drug companies leave behind when their sales reps go to doctor's offices. As far as medical associations go, that's even more of a black box
Speaker: All we know is that companies have relations with these medical associations. They will at their annual general meetings, they will pay for booths where they will promote their products.
Speaker: But beyond that, we really don't know what the money is, money is being used for. And we also don't know whether or not the medical associations have any kind of policies that govern the relationships with drug companies. I looked at this a couple of years ago in Canada and less than a quarter of the medical associations that have relations with drug companies
Speaker: had a public policy about how they were going to deal with those relationships. So what question should all this flow of money between the drug companies and medical professionals, what should it raise for us in terms of the influence these payments might have on doctors and more importantly on our treatments?
Speaker: Well, from information that's available in the United States, which does a much better job of transparency in this regard than we do, we know that if a drug company sponsors a meal of $20 or less, so $20 is about the cost of a quarter pounder
Speaker: French fries and a Coke at a McDonald's. A meal of that value will influence prescribing. If I go to a luncheon sponsored by Merck and Merck is promoting one of its drugs, we know that on average, I will prescribe more of that product
Speaker: after the lunch than I did before it. And we also know from other research that when doctors are influenced in their prescribing behavior by their relationships with drug companies, that that prescribing almost never gets better. Sometimes it doesn't change, but it frequently becomes worse.
Speaker: And by worse, I mean that doctors prescribe more expensive drugs. They prescribe drugs in larger quantities and they prescribe inappropriately. In other words, the wrong drug for the wrong reason for the wrong length of time. So these kinds of relationships between doctors and drug companies on average mean that patients get treated less appropriately.
Speaker: And that's a concern. It is definitely a concern. Now you referred to MC in Canada, which collects and dispenses some information about where money is spent. But where are the gaps there and what should we be seeing to have full transparency? So there are huge gaps. So
Speaker: Let's just look at the countries that do the best. And that's the United States. And it does the best for a number of reasons. First of all, these are not voluntary disclosures by drug companies. The US has legislation that requires any transfer of value of more than $10 to a physician be reported. So you have to report
Speaker: what the value was, either cash transfers or what the value of a meal was or something else, a gift. You also have to report the name of the physician who received that gift. You have to report what product that gift was related to.
Speaker: And then that information is all available in a public website. So you can look up and you can see, did Joel election get any money from a drug company last year? How much did he get? Which companies gave him that money? What were the products for? And was it cash? Did he get a gift? Did he get a vacation to Hawaii? All that kind of information.
Speaker: is available publicly in the United States. None of that information except for the gross amounts that 10 companies spent is available in Canada. It seems like the US system is a bit of a gold standard here. What about other countries? How does Canada compare to countries around the world as well? So there are some other European countries that
Speaker: also legislate disclosures, so France, Portugal, legislate disclosures. Most countries, and those are largely countries in Europe, Australia, New Zealand, rely on voluntary industry disclosures, but even those voluntary ones are more transparent than what we have in Canada. So you get
Speaker: Some places allow doctors to decline to have their names disclosed. Some places you don't have centralized register of information. You have to go from company to company to look at what they've disclosed. But all those countries do a better job than Canada. If you're looking at high income countries around the world,
Speaker: in terms of transparency and amount of information that's disclosed, Canada is at the bottom. Why is having a very transparent system important? What did the disclosure details tell us when they're more detailed and thorough? How can we use those to get better healthcare?
Speaker: Well, first of all, they they're a goldmine for researchers. So that's how we know what the influence of these payments are on the way the doctors prescribe because of the transparency of this information.
Speaker: But we can go beyond that and we can look at what kinds of policies are necessary to minimize the effects of the money that drug companies are giving to doctors. We can design new policies around that. So, for instance, in some places, they've instituted relatively strict
Speaker: regulations around contact between medical students and interns and residents with industry. We know that that has a positive effect. Once those people are out in independent practice, they're less likely to interact with drug companies
Speaker: They're less likely to believe the information that they get from drug companies. So that's one way of doing it or one thing that can be done with this kind of information. But beyond that, it also allows us to see that while transparency is necessary, it's not sufficient. So knowing how much money I got from a drug company is useful.
Speaker: But that's not going to necessarily change my behavior. And we need to go beyond just transparency. We need to look at things like, how do we restrict the contacts between doctors and drug companies? So some organizations don't allow drug companies to sponsor their
Speaker: their annual meetings, so the Ontario Family Physicians doesn't allow drug companies to participate in those meetings. In the United States, Kaiser Health, which is a large health maintenance organization on the US West Coast, doesn't allow their doctors
Speaker: to see drug company representatives while the doctors are working. So we know we need to do more than just have transparency, but transparency is the first step. How could we implement more transparency in Canada?
Speaker: Well, the Ontario government actually was going to duplicate what goes on in the United States. So, Ontario passed legislation that would have required the same level of disclosure as what we see in the United States.
Speaker: The Ontario legislation would have allowed even more disclosure. The US doesn't demand that drug companies disclose payments to patient groups. The Ontario legislation would have required that. But before the regulations that were necessary to put the legislation into practice were passed, Ontario had an election in 2018. The Conservatives came into power.
Speaker: and essentially killed that initiative. There was also some talk around 2019 -2020 that British Columbia might emulate what Ontario had proposed to do, but that fell by the wayside. The federal government has never shown any interest in doing anything about this.
Speaker: They've been lobbied about this on a number of occasions, but have never responded to those requests. And there's no indication that the liberals and especially the conservatives are willing or even interested to do something about this issue. Well, thank you very much for joining us and for shining a light on this issue. I think it's one that's really important.
Speaker: OK, well, I'm glad to do it. You know, I may be alone. Well, I'm not a lone voice on this. There are lots of other people who are lobbying about this. And I think that the more interest we get from the media, the more chance that something will happen in the future. Thanks so much, Joel. Thank you.
Speaker: I've been speaking with Dr. Joe election. He is professor emeritus of health policy and management at York University. His article on drug companies and their disclosure of payments to medical professionals can be found on the conversation .ca.
Speaker: The Red Eye Collective is based in Vancouver. You can check us out at coopradio .org slash redeye.
