Pharmaceutical companies in Canada should be forced to reveal their payments to individual doctors, according to a new campaign backed by some prominent physicians and researchers who say this country has fallen behind its peers when it comes to health-care transparency.
The founders of the "Open Pharma" campaign, launched this week, say Canadian patients should be able to check an online database to see whether their doctors have received funding from the drug industry, as patients can already do in the United States, Australia and several European countries.
"Canada is lagging behind," said Joel Lexchin, a Toronto emergency-room doctor and York University researcher who recently published a book on the cozy relationship between Big Pharma and Canadian doctors. "But it's not just a question of doing something that other countries are doing – it's the benefits that you get out of it."
Dr. Lexchin, who is part of the 12-member advisory board of Open Pharma, said the rich data made available through the Physician Payments Sunshine Act in the U.S. since 2014 has allowed researchers to elucidate how industry money can influence physicians' prescribing behaviour.
Bringing drug-industry payments out of the shadows could also help prevent a repeat of a recent debacle over opioid guidelines, the group argues.
Health Minister Jane Philpott ordered an external review of Canada's new official guidelines on how the powerful painkillers should be used in chronic pain cases after The Globe and Mail revealed that a doctor who had a vote on the final version had financial ties to the pharmaceutical industry. A third of the individuals who crafted the guidelines also had ties to the industry.
Open Pharma's call comes as the Canadian branches of 10 large pharmaceutical companies prepare to voluntarily release the total amounts they paid to health-care providers and health-care organizations, such as hospitals and universities, last year. But the drug makers won't reveal their payments to individual doctors when they post the information to their websites on June 20.
"I think it's meaningless," said Andrew Boozary, a resident physician at St. Michael's Hospital in Toronto. "You have this big aggregate number. What does that mean for the patient who's sitting in front of their physician?"
Dr. Boozary, who is also a visiting scientist at Harvard's School of Public Health and a former adviser to Ontario's Ministry of Health and Long-Term Care, is leading the Open Pharma effort.
Among the other medical heavyweights on the group's board are Danielle Martin, a family doctor at Toronto's Women's College Hospital whose book Better Now: Six Big Ideas to Improve Health Care for All Canadians was published earlier this year; Joshua Tepper, the president of Health Quality Ontario, an agency that advises the province on improving the health-care system; and Andreas Laupacis, the executive director of the Li Ka Shing Knowledge Institute at St. Michael's Hospital.
Innovative Medicines Canada (IMC), which represents brand-name drug companies, concedes that the June 20 disclosure is simply a first step and far from a "perfect" one.
Only 10 of IMC's 45 member companies agreed to take part: AbbVie Corporation; Amgen Canada Inc.; Bristol-Myers Squibb Canada Inc.; Eli Lilly Canada Inc.; Gilead Sciences Canada Inc.; GlaxoSmithKline Inc.; Roche Canada; Merck Canada Inc.; Novartis Pharmaceuticals Canada Inc.; and Purdue Pharma Canada.
Chrisoula Nikidis, vice-president of ethics, integrity and governance at IMC, said the participating companies decided to publish aggregate totals in part because the doctors they consulted informally balked at having their payment information released. The U.S. legislation makes it mandatory.
"I'm personally not a fan of the piece of legislation that's taken place in the U.S. I've seen it, I've studied it," Ms. Nikidis said. "I'm not sure of the usefulness of capturing, you know, $3 cups of coffee … I think we've done well self-regulating here. I'm proud of this first step we've taken." (The U.S. legislation requires disclosure of payments more than $10.)
The Canadian Medical Association, meanwhile, says physicians favour more transparency. The CMA, which represents doctors across the country, passed a resolution in 2012 calling on pharmaceutical companies to disclose their payments to doctors.
"[The resolution] shows that, very clearly, physicians and the profession are ready for this type of information to be made public," said Jeff Blackmer, the CMA's vice-president for medical professionalism. "We don't feel like we have anything to hide."
Andrew MacKendrick, a spokesman for Dr. Philpott, said that while financial transparency in medicine is best left to the provincial and territorial governments, "We always remain open to new approaches to increase transparency for Canadians."