Some of the biggest names in Canadian medicine are calling on Ottawa to use the power it already has under the Patent Act to force drug companies to reveal their payments to doctors.
The idea is laid out in a letter to Health Minister Jane Philpott from 17 physicians and other health-policy leaders, all of whom argue that the federal government could usher in a new era of drug-industry openness simply by tweaking regulations that are already under review.
"It is long past time for Canada to follow the lead of other developed nations in bringing transparency to the financial dealings between pharmaceutical companies and prescribers," the letters says. "The rationale is clear and the machinery already exists for its implementation."
Signatories to the letter include David Naylor, the former president of the University of Toronto; Catherine Zahn, the current chief executive of the country's largest mental-health and addictions hospital; Brian Goldman, a Toronto emergency-room doctor and the host of the CBC radio show White Coat, Black Art; Christopher Simpson, vice-dean of the medical school at Queen's University in Kingston and a past president of the Canadian Medical Association; and Andrew Boozary, a resident physician who leads a pro-transparency campaign called Open Pharma.
The group's proposal comes at a time when Big Pharma's payments to doctors are under more scrutiny then ever, in part because of the role they played in exacerbating the opioid crisis.
Just this week, a study published in the American Journal of Public Health found that opioid makers spent more than $46-million on payments to doctors in the United States between 2013 and 2015. One in 12 U.S. physicians received the payments, most often in the form of speakers' fees or "honoraria."
The authors of the study gleaned their conclusions from a public database created under the Physician Payments Sunshine Act, a U.S. law that compels drug companies to report all payments of more than $10 to doctors by name. Canada has no such law.
"The reality is, we're not privy to that data [in Canada]," Dr. Boozary said.
A spokesman for Dr. Philpott said on Thursday that she intends to look into the group's ideas, and that her government remains "open to new approaches to increase transparency for Canadians."
But in the past, Dr. Philpott has also said the file would be best left to the provinces, which have jurisdiction over health care.
Ontario is already looking at stepping in: Eric Hoskins, the province's Health Minister, launched consultations on a potential new open-payments law earlier this summer.
The authors of the letter praised Ontario for taking the lead, but they warned that a patchwork of provincial rules could undermine the goal of transparency.
"Delegating this to the provinces and territories is asking for failure," said David Juurlink, the head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto and another signatory to the letter. "The only way to give this initiative teeth is to focus on the companies that write the cheques."
The letter argues the best way to do that is through the Patented Medicines Prices Review Board (PMPRB), a federal body that has statutory authority over "the costs of making and marketing" brand-name medicines.
The board, which is a creature of the Patent Act, happens to be in the midst of its first regulatory overhaul in three decades.
"The window of opportunity to amend the regulations is right now," said Amir Attaran, a professor in the faculties of law and medicine at the University of Ottawa who helped craft the legal argument in the letter. He also signed it.
The letter suggests that the PMPRB's regulations could be amended to require that brand-name drug makers report "the date, amount, and purpose of any contribution, whether in cash or in kind, given to each person in Canada authorized to prescribe the medicine or to each health-care institution, society and organization."
New regulations could also exclude payments below a certain amount – the letter floats $25 as a possible cut-off – and set "meaningful penalties," for patentees who refuse to comply.
One possible drawback to using the PMPRB to enforce transparency is that it would leave out the makers of generic drugs and medical devices, neither of which are governed by the board, said Annie Bourgault, the ethics and compliance officer for GSK Canada.
"We need to look at multiple solutions that would be made in Canada and that would include the entire health-care system," she said.
However, Ms. Bourgault said she believes mandatory disclosure of some kind is necessary, a conclusion she reached after GSK spent more than two years leading a voluntary disclosure effort that was roundly criticized as meaningless. Only 10 companies took part and none divulged specific payments to doctors.
Innovative Medicines Canada, which represents brand-name drug makers, declined to comment on the letter.
Dr. Goldman, who has spoken publicly about why he used to accept payments from opioid makers and no longer does, said Canadian action on Big Pharma transparency is long overdue.
"It's well known that payments to physicians influence their behaviour – their own prescribing practices and what they recommend to colleagues in paid speeches," he said by e-mail. "In the interests of transparency, patients and the public have a right to know about those payments."