Pharmaceutical companies will have to reveal in detail the payments they make to patient-advocacy groups and professional medical societies in Ontario as part of the province's efforts to pull back the curtain on money in medicine.
The lack of transparency has meant that health charities and non-profits have had no mandatory obligation to reveal which companies are funding them and in what amounts.
Right now, Canadian patient-advocacy groups can disclose as much or as little as they like about the donations they receive from drug or device makers. Some make detailed disclosures on their websites; most do little more than putting the names or logos of their industry sponsors online.
In draft regulations posted on Wednesday, the Ontario government laid out how the health-sector transparency law it passed last year will work, including listing the 31 categories of funding recipients who will be covered by the new disclosure system, the first of its kind in Canada. These changes will allow anyone to search the name of a health charity or non-profit in an online database to access funding information.
The news that patient groups and doctors' associations will fall under Ontario's legislation comes less than two weeks after a U.S. Senate report revealed that five major opioid makers gave more than US$10-million to third-party advocacy groups and physicians affiliated with them over a five-year period.
The U.S. patient groups often parroted the industry's goals, lobbying against prescribing restrictions for the powerful painkillers at the root of the opioid-overdose epidemic, according to the report from Missouri Senator Claire McCaskill.
Andrew Boozary, a resident physician at the University of Toronto and the leader of the pro-transparency group Open Pharma, said that right now "we just don't know" how the pharmaceutical industry funds such third-party groups in Canada.
"That's where, hopefully, this law is able to unveil some of that so there will be a better understanding of what the interaction actually is," Dr. Boozary said.
Durhane Wong-Rieger, the president of the Canadian Organization for Rare Disorders (CORD,) a national network of patient-advocacy groups, said she has "no problem" with revealing the specifics of CORD's funding, as long as the administrative burden of reporting the information is not placed on small non-profits such as those she represents.
The Ontario law places the onus for reporting payments on the drug and medical-device makers, not the recipients of funding.
"We're happy to disclose fully," Dr. Wong-Rieger said. "To me, this is actually going to make very little difference in terms of what it is that we do."
Along with individual doctors and patient groups, the other categories of funding recipients listed in the draft regulations include: all regulated health professionals, including nurses and pharmacists; universities; hospitals; long-term care homes; family-health teams; regulatory colleges; and medical labs, among others.
The health-sector transparency law that Ontario's Liberal government adopted last year is loosely modelled on the Physician Payments Sunshine Act, a U.S. law that compels the makers of drugs and medical devices to reveal how they compensate individual physicians for work such as delivering speeches, sitting on advisory boards, teaching continuing medical-education classes and travelling to international medical conferences.
Australia, Japan and several European countries already have sunshine laws, but in Canada, information about payments to physicians and health-care organizations is shrouded in secrecy.
Ontario's draft regulations posted on Wednesday set $10 as the minimum threshold for disclosing payments, the same cutoff as the U.S. law.
The regulations, which are open for public comment until April 5, also exempt drug samples from the reporting requirements.
Joel Lexchin, a Toronto emergency-room doctor and York University researcher who recently published a book on the relationship between Big Pharma and Canadian doctors, said he disagrees with leaving drug samples out.
"I have problems with that. That's an inducement to doctors to use the company's products in the future," Dr. Lexchin said. "I think that the retail value of the samples should be included [in the reporting requirement]."
But Dr. Boozary countered that drug samples are worthy of an exemption because they can be an important source of free medication for patients who cannot afford to pay for their prescriptions.
Dr. Boozary said a much bigger concern is the fact that Ontario is alone in legislating transparency in health-sector payments.
The federal government has so far rebuffed calls to follow Ontario's lead and make disclosures national.
The first year for which drug companies and device makers who operate in Ontario will be required to collect and, ultimately, disclose their payment details, is 2019.
A searchable database of payment information is expected to be online in the fall of 2020.
Companies that repeatedly refuse to adhere to the new rules could face fines of up to $100,000 for every day they fail to comply.