Decoding drug lobbyist rhetoric

DRUG BUST by Alan Cassels

• The people’s briefing note on prescription drugs

Dear new member of the Legislative Assembly:

• You’re likely facing a steep learning curve in getting used to your new job so I’d like to offer you some translation help. For free.

You can expect that, just as you are settling into your new office in the Legislature and getting comfortable running the government, a lobbyist working in the “Life Sciences” field – someone representing drug giants like Pfizer, Merck or GSK (GlaxoSmithKline) – will call you up and ask for a little meeting.

As an MLA, you are ultimately responsible to taxpayers for making many decisions, including decisions about spending about $1.2 billion per year of public money on drug products. Many people want to offer their services to help you with those decisions. For example, the GSK rep might come by to tell you how their drugs and vaccines “contribute benefits to patients and value to the sustainability of the healthcare system,” while the guy from Janssen will want to work with you to “identify treatment gaps and focus on ways through partnerships to improve health outcomes for British Columbians.” And then there’s the government relations person from Pfizer who will check in to brief you on “the pharmaceutical industry and/or Pfizer Canada’s business activities in the province, as well as learn more about your health policy priorities.” I know there are dozens of lobbyists who will start making these appointments to see you because that’s what they do. Such visits are recorded in the BC Government Lobbyist Registry and these quotes are directly from the registry.

The lobbyists will want to convince you of one thing: that, like you, they are there to serve the people of British Columbia and they want to make sure BC citizens have access to innovative, new medicines.

Please don’t be fooled. Despite the enticement of the pitch and the warm-n-fuzzy feeling that you and your new lobbyist friends are on the same team, I assure you, you are not. Your bosses (unlike theirs) are the electorate. Their bosses occupy corner offices in glass towers in Montreal or Mississauga, the franchise headquarters of Canada’s multinational drug industry and the Canadian bosses take orders from places like New York (Pfizer), London (GSK) and Whitehouse Station, New Jersey (Merck). You need to remember this fact when well-heeled lobbyists show up or when disease or consumer lobby groups ask to meet with you. If they are living partly off the avails of the “life sciences” industry (and many of them are), they will ultimately be working to please the CEOs in New York, London and New Jersey and not your voters.

So to help you in your new job, I’ve devised a handy interpretive codebook that may guide you through your discussions. Here are a few common topics you might face:

Investments in new medications

They will say: “Investing in new medications and vaccines improves our communities – because health innovations help save lives.”

Code for: “If you don’t agree to pay for the latest, greatest drugs produced by our labs, BC citizens will suffer.”

Only on rare occasions do the newest medicines and vaccines save lives and, at best, one in 10 new medicines offers significant benefits over and above existing drugs. But most independent research would indicate the additional costs needed to cover newer drugs –sometimes hundreds of times more than existing treatments – are almost never worth the added costs. But more importantly, being new they lack important safety data. York University professor Dr. Joel Lexchin has studied this situation intensely and says, “Almost 20% of new drugs approved in Canada between 1995 and 2010 were dangerous enough that they either acquired a serious safety warning or had to be removed from the market. Half of these serious safety problems turned up in the first three years after the drug was approved.” In other words, don’t set yourself up for being Vioxxed!

Investments in innovation

They will say: “Health innovation creates jobs, generates economic activity and eases the burden on our healthcare system…”

Code for: “Drug company research is a great way to create all those high-paying, high-tech jobs that feed the “knowledge economy.”

The implied threat is if you don’t pour more government money into BC’s universities and drug research labs, the companies will pull up stakes and move elsewhere. What they won’t tell you is that BC, with 13% of Canada’s population, only gets about 6% of the national expenditures on pharmaceutical research and development. In other words, the drug companies are spending less than half of what they should on generating sexy, high-paying jobs so for them to expect you to put up even more public money to subsidize the jobs that they are promising is a pretty bold, yet hypocritical statement.

Restrictive drug coverage

When they say: “BC PharmaCare’s ‘historical, and current approaches to listing decisions in BC have been unreasonably restrictive.’”

Code for: A “listing decision” is whether the government decides to pay for a treatment or not.

Historically, the BC government, acting under the influence of science and evidence, has been a bit tight-fisted and refused to pay for some so-called new and innovative drugs, like Vioxx. What they won’t tell you is that insisting on evidence and good independent drug evaluation (like those produced by groups like the Therapeutics Initiative) is not unreasonable, but an approach that has saved lives and money.

Transparency of drug coverage decisions

When they say: “We want ‘improved transparency and the enhanced deployment of a wider array of peer-respected specialized expertise.’”

Code for: “We want scientists that we have funded at the table when it comes to discussing the evidence around our wonderful, new drugs. If you don’t allow us to have our own people on the committees that make drug decisions, how will we be able to manipulate you into our way of thinking? We demand ‘transparency’ because that’s the best way we’ll be able to bias the process. Oh, so you have rules against conflicts-of-interest? How quaint.”

Disease management initiatives

When they say: “Innovative drug manufacturers have developed, or have been involved with, a number of disease management initiatives.”

Code for: “Look, don’t you want us to come in and provide a free diabetes or osteoporosis or Alzheimer’s program using our evidence? Then you better let us do things our way, which means putting our industry-friendly experts in place and engaging our industry-friendly disease groups so that they will work towards our marketing objectives. Basically, if you are nice to us, we’ll bring our programs to BC.”

Good corporate citizenship

They will say: “We are guided by a code of ethical practices, which has been a ‘tangible demonstration of Canada’s research-based pharmaceutical companies’ commitment to a relationship based on trust, openness and transparency with health-care providers.’”

Code for: (sotto voce) “Let’s not talk about our rap sheet, ok? Even though only four of the world’s biggest drug companies (GSK, Pfizer, Eli Lilly and Schering-Plough) have together paid some $10.5 billion (US) in financial penalties to the US government over the past two decades, that doesn’t mean we’re criminals.”

According to US consumer group Public Citizen, “The pharmaceutical industry now tops not only the defense industry, but all other industries in the total amount of fraud payments for actions against the [US] federal government under the False Claims Act.”

Look out for those watchwords: “partnership,” “transparency,” “shared goals” and “engagement.” These are loaded words, which imply you as an MLA and he (or she) as a drug lobbyist are on the same team. You are not.

Remember this: money has the ability to pollute even the most noble aspects of healthcare. Lobbyists provide a valuable service: to convey to you what the CEOs of multinational drug companies want. Remember that and use it to your advantage.

Good luck. You’ll need it.

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Alan Cassels is the author of Seeking Sickness: Medical Screening and the Misguided Hunt for Disease. Follow him on Twitter @AKECassels or www.alancassels.com