Over the past two days a major health care summit has occurred in Ottawa at the Chateau Laurier Hotel. The summit, titled “A New Health Accord for All Canadians,” is a partnership between the Canada 2020 think tank and the Canadian Medical Association (CMA). This summit featured variety of stakeholders and speakers including senator Chantal Peticlerc, Dr. Granger Avery the president of the CMA, Dr. Gaétan Barrette the Quebec Minister of Health and Social Services, and Dr. Jane Philpott Canada’s Minister of Health. This summit comes at a pivotal point in the history of medicare with a new health accord being negotiated in coming months and an urgent need for national pharmacare (among many pressing topics).
So it comes as some surprise that when looking at this premier health summit the sponsors include a who’s who of the petrochemical, health insurance, banking and pharmaceutical lobby (colloquially big pharma). In particular, one of the sponsors listed is the Pharmaceutical Research and Manufacturers of America (PhRMA), the largest US pharmaceutical lobby group. When we say big pharma, this is generally who is referred to. For a think tank that calls itself independent, this seems like a conflict of interest. This isn’t to say that there were not independent speakers or important topics that were covered over the two days, but it points to a worrying trend of American corporate interests further creeping into our medicare (not to mention the negative relationship between pharmaceutical promotion and quality, quantity, and cost of physicians' prescribing). When one of the founders of Canada 2020 was questioned about this on twitter, his response to a fair question was pejorative (in fairness he did later apologize somewhat stating he was, “tired, cranky and surprised that we're being pre-judged by progressives!”)
Sadly, it doesn’t come as a surprise the Canadian Medical Association (CMA) is involved with the pharma lobby in co-hosting this health summit. The CMA has a long history of financial ties to big pharma and has in the past taken $780,000 from Pfizer Canada to fund the new "continuing medical education" (Two Pfizer staff members also sat on an administrative board during this time). Further the medical guidelines distributed by the CMA are largely written by authors with financial ties to big pharma. In a study of 350 authors from 28 of the written guidelines, 75% % of the documents had at least one author tied to big pharma; in 21.4 % of the guidelines all authors had a financial conflict of interest (FCOI) with drug companies.
Other groups who appear to be in involved include the Canadian pharmaceutical industry lobby group Innovative Medicines Canada (formerly Rx&D) as a facilitator for a panel delivering cost-effective home care. A Merck Canada executive was also involved in introducing & framing a framing another session. A representative from biopharma company Amgen was the moderator for a panel on the next health accord. Johnson & Johnson, and Amgen were also sponsor along with PhRMA. For those keeping track of the record for the US parent companies involved, Merck is well known for its deadly Vioxx scandal where it was made false or misleading safety claims and has paid out over US$6 billion in settlements. Johnson & Johnson has had to pay US$70 million to settle claims it bribed doctors in Greece, Poland and Romania to prescribe its medicines and, along with its subsidiaries, recently paid more than US$2.2 billion (one of the largest healthcare fraud settlements in US history) involving the drug Risperdal. Amgen was fined US$762m for illegally off-label illegal promotion of the drug Aranesp to cancer patients in a way that increased the likelihood of their deaths. Essentially, conferences like this are inviting the fox into the medicare henhouse.
But perhaps more worrying is the inclusion of PhRMA. In the US they have already spent a near-record $11.7 million in lobbying this year, and have spent nearly $150 million on lobbying since 2008 outspending powerful interests like defense contractors and the oil and gas industry. A recent Gallup poll of public opinion found drug makers are less popular than lawyers and oil companies, and just barely less hated than the federal government in the US (which is saying something). PhRMA which took in more than $200 million in member dues in 2014, and is expected to launch a major PR after the US election. Trying to shed the negative image incurred from industry price gouging scandals like those involving Turing and Valeant Pharmacueticals or the recent Purdue Pharma OxyContin nightmare or the Mylan EpiPen fiasco , PhRMA is planning large ad campaign (i.e. image makeover) in the US using a 5 year old boy and a woman with blood cancer to distance themselves from scandals. The drug industry overall has also spent $171 million on unbranded ads in the US so far this year, up 15 percent over the same period last year (last year drug makers spent a whopping $6 billion on branded and unbranded adds) Oddly, for a group trying to claim the companies that excessively price gouge are outliers, PhRMA recently added two drug companies to its roster (Jazz Pharmaceuticals and Horizon Pharmaceuticals) who have, “relied on excessive pricing to fuel their growth, while investing much less than other drug makers in research and development.” The list could go on, but the point is that this is industry group is extremely powerful and well financed; they will spend breathtaking amounts of money to, “shape policy debates to favour a pharmaceutical company’s profit maximization priorities and negatively impact public health objectives.”
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So again, does it make sense to have this group sponsor a conference on the future of Canadian health care?
It is also worth remembering that on the board of directors for PhRMA is John Lechleiter the Chairman, President, and CEO of Eli Lilly and Company. For those not familiar with this company, Eli Lilly is using the ISDS provisions in NAFTA to sue Canada for $500 million in damages, claiming the decision of the Canadian courts (at multiple levels) on two Lilly products (Strattera and Zyprexa) violated patent law obligations under NAFTA (for more detailed info see here or here). If Eli Lilly succeeds in the case, they will have found a way to override the Supreme Court of Canada and our right to make domestic policy for the benefit of the public. In essence, they are trying to use secretive and opaque ISDS tribunal to re-write Canada’s laws in the favour of their profits. As it stands, Canada has already incurred are $6.5 million dollars fighting this reckless NAFTA challenge.
In regard to Canada`s IP laws,the vice president of international affairs at PhRMA has commented, “PhRMA and its member companies operating in Canada are extremely concerned about Canada’s intellectual property environment... we believe that the seriousness of the IP violations in Canada demand particular focus by the US government to address this critical issue.” But it doesn`t stop there. Phrma has created astro-turf campaigns with names like `Protect Patents Protect Patents` to fight the promised utility doctrine (often called just the promise doctrine) which is at the heart of the Eli Lilly NAFTA challenge. Eli Lilly for their part uses their Lilly foundation, and endowment (whose assets come from the company) to donate huge funds to Canadain Pfink think tanks. While this dark money is difficult to track, Eli Lily is a long standing funder of the far-right Fraser Institute. It is believed they donated $325,000 to the institute in 2010, $600,000 in 2011, totalling $2,792,000 between 2001 and 2012. To the surprise of no one, this institute has published reports that are against the promise doctrine by an author who has worked for PhRMA in the past (strangely this little fact is not included on the FI bio page). As well, a former board member and now lifetime patron was a senior director at Pfizer.
So it stands to reason that the serious moral and ethical issues highlighted above are reason enough to not have the leader of Amiercan big pharma as sponsor at a Canadian health care summit. The reality is undue influence from the pharmaceutical industry often comes from groups accepting large amounts of money from them; it is now secret that when big pharma flexes its financial muscles, they frame the narrative and influence how health policy plays out through proxies. In the case of a summit to discuss the future of medicare in Canada, this amounts to an inherent conflict of interest (especially considering the history of PhRMA). Or as Dr. Peter Gotzsche, the Director of the Nordic Cochrane Center in Copenhagen, has highlighted, “Much of what the drug industry does fulfills the criteria for organized crime in US law... And they behave in many ways like the mafia does, they corrupt everyone they can corrupt, they have bought every type of person, even including ministers of health in some countries.”