DRUG BUST Alan Cassels

I offer you a parable – perhaps the parable of our time. Pull up a chair and start imagining. Imagine being a big group of very powerful and profitable companies whose main business is the manufacturing of pharmaceuticals. You are so influential that government ministers promptly return your calls. You keep some of the most powerful people within the legal and medical communities on your payroll. You invite yourself to lead government task forces and other agenda-setting activities and are considered so mighty that only fools would dare challenge your decrees. When it comes to leverage, you play a good game. You know how to force governments to have some “skin in the game” when it comes to paying the hefty costs of researching and developing your products. It’s not that you are a bully or anything; you are actually quite polite and congenial. Yet, at the same time, you and your members are very, very angry.

You are angry because not everyone considers the good products you produce and the good works conducted on your behalf by many of your favoured charities to be so special. Some even question whether your products are worth what you charge for them. Some even say they didn’t live up to their claims. Even worse, some believe your products make some people sicker. Those heretics might be small in number, but they are vocal. They constitute an unpleasant obstacle and prevent you from expanding your empire, blocking you from earning higher shareholder profits that are your due. With your great strength and wealth, some say you’re like Goliath because, in contrast to this pesky, nay-saying and ill-equipped David, you could easily overpower and smite him dead.

What makes you really angry is that this David’s skepticism could threaten to destroy other markets around the country. This sort of pesky impertinence could seriously harm your bottom line so you have to act, and act decisively.

This biblical parable is currently being played out right here in BC. Not in the full sheen of media lights, of course, but in the shadows and backrooms and offices of the legislature. In government ministries and universities. In halls redolent with the scent of power, prestige and privilege. The David and Goliath scenario could be an allegory for the forces of science against the forces of commerce, where we know David and his science don’t stand a chance.

It might be more accurate to call this particular BC-based David “evidence-based medicine.” Yet, in the eyes of Goliath, David is best characterized by the pharmaceutical industry’s pesky foe: UBC’s Therapeutics Initiative.

The world renowned Therapeutics Initiative (TI) was established by the BC provincial government in 1994 and planted at the Department of Pharmacology and Therapeutics at UBC. This group of researchers, university professors and experts in clinical research provides valuable analysis and insight into the value of pharmaceuticals. The TI has been involved in educating medical students and practising physicians in BC for nearly 15 years and has developed an international following. While it is often accused of setting BC government drug policy, its role is limited to examining, synthesizing and discussing the evidence around drugs. It has a “just the facts ma’am” approach to clinical research.

Sadly, most physicians, after formal training in medical school, will learn about new drugs mostly from pharmaceutical companies. These doctors urgently need a group like the TI, which can provide balanced and current assessments of new drugs. Drug companies maintain it is their job to convince physicians of the value of new drug products; they spend upwards of $3 billion per year doing just that, an amount larger than the collective budgets of all medical schools in Canada. The fact that TI maintains its distance from the drug companies is one of the true sources of Goliath’s anger: he is unable to influence the key agency that makes drug evidence available to BC physicians.

You can imagine Goliath’s anger when he examines drug expenditures across Canada and finds a huge “missing market” for drugs in BC, worth close to $500 million per year. On a per capita basis, if BC residents spent as much on drugs as people in Quebec and New Brunswick, our provincial drug bill would be about 50 percent higher than it is right now. It currently hovers around $1 billion per year.

In BC, the Therapeutics Initiative has strived to educate doctors about the relative prices (and therapeutic values) of new drugs and while some critics say it tends to favour older, cheaper drugs, its analyses ignore the pharmaceutical industry’s marketing pitches and zero in on what the evidence shows.

Goliaths from the drug world have been trying to slay the Davids of evidence-based medicine for years now, funding political parties, patient groups and specialists in order to build cases for the new drugs they will pitch to governments, physicians and patients. They supply money to universities and research institutes while claiming to politicians they are there to help “grow the knowledge economy.”

Despite how much we love our towers of higher learning, hang out at any of the world’s major universities these days and you will catch the unmistakeable whiff of commercialism, where plenty of Goliaths are cutting deals to divert publicly-funded, high-octane thinking into profitable and patentable products. Discussion of higher purposes and human fulfillment in universities is passé; the dominant theme is the drive for the respect and prestige that comes along with telling everyone we’re “Open for Business.”

If the government does away with the Therapeutics Initiative because of some sweetheart deal provided to UBC by Goliath, we should expect to see a body count. Wasn’t it the TI that sent out early alarm bells, asking physicians to pause before writing new prescriptions for drugs like Celebrex and Vioxx? Vioxx is likely responsible for more than 50,000 deaths in the US alone. I remember when the TI’s researchers were accused of being naysayers when they were asking physicians to be careful about prescribing this particular drug and to question the science behind the intense marketing.

Here in BC, there is growing evidence that Goliath is fortifying its battle with David by enticing UBC with lots of riches. There are rumours of buildings and bigger and well-equipped centres of research and drug discovery. The bribes have to be big because the payoff (half a billion dollars per year) is huge. Any government hoping to kill the TI and expecting a payoff should be asking not for a building worth a miserly $50 million, but rather for half a billion per year, every year to perpetuity. That’s what David is likely saving us.

BC is a strange province where the cosiness – a sort of chequebook diplomacy – between the current Liberal government and the drug companies that fund their election campaigns is well known. Last year, this cosiness translated into a BC government-appointed Pharmaceutical Task Force, staffed with drug industry lobbyists who produced a report so shoddy it’s an embarrassment to anyone involved. The major outcome of the report was the suggestion to scrap the Therapeutics Initiative.

The plot heats up when you recall that back in February of this year the UBC Centre for Drug Research and Development (CDRD) was named as a Centre of Excellence for Commercialization and Research (CECR). The Canadian government plans to kick in $15 million over five years to “accelerate the translation of health research into high value medicines.” Matching funds will come from BC taxpayers, funnelled through groups like the British Columbia Knowledge Development Fund and the British Columbia Innovation Council (BCIC). The latter describes itself as a ?one-stop point of access and support to high tech companies, educational institutions, technology industry awareness groups (including regional technology councils), federal science and technology agencies and university research labs.” Wow – sounds like a full-on marketing machine for BC high tech. Just what the doctor ordered.

Like most universities, UBC certainly has its own objectives and new pools of potential research money must seem awfully tempting. UBC’s president, Stephen Toope, is a world-respected advocate for human rights and the power of international law. He is one serious and uncompromising dude when it comes to speaking truth to power. But you have to ask yourself: Will Dr. Toope be able to speak truth to the Goliath at the gates of UBC?

It’s hard to say. What is certain is that the success of university presidents is usually measured by their ability to increase the university’s prestige, size, influence and wealth. And with large numbers of academics and researchers who measure their success by how much research funds they can absorb, Dr. Toope would certainly face a rabid faculty backlash if he questioned the flow of drug funds to UBC.

What a conundrum, eh?

You might think this biblical parable is too much of a stretch because in the real ‘modern’ world, the Goliaths almost always win. Well, thankfully we have a democracy and there is an election coming up. We can throw out the politics of rule by rude power. We can choose not to support a government that thumbs its nose at evidence-based medicine, one that encourages the drug companies rule the day. OR we could ask for something different. And that difference is something that may mean the choice of life or death for some of us.

Alan Cassels is a drug policy researcher at the University of Victoria a. He served with Stephen Toope as a UN Election Observer in the first all-race elections in South Africa in April, 1994.

cassels@uivic.ca