Concocted war on drug industry another Wag the Dog

BC Liberals can’t afford a real war against Pharma so they’ll fake one

 

DRUG BUST by Alan Cassels

• In the 1997 political satire film Wag the Dog, Anne Heche, playing an advisor to the US president, turns to Robert De Niro, another presidential aide and whispers, “We can’t afford a war.” De Niro waves his hand and replies confidently, “We’re going to have the ‘appearance’ of a war.”

The two are on a plane enroute to Los Angeles to recruit a famous Hollywood producer, played by Dustin Hoffman, whom they convince to work for them in constructing a fictional war. The sitting president of the US is caught up in a sex scandal 11 days before an election and, to distract the public’s attention, his advisers concoct a war with Albania. The De Niro character lays it out to Hoffman, waving his hands like a conductor: “It’s not a war, it’s a pageant. We need a theme, a song, some visuals. It’s a pageant.” The ensuing drama is ripe with scintillating satire, showing how craftily political operatives can manipulate the public’s attention and otherwise shape a narrative that can have a huge influence on world events – and elections.

How does this have anything to do with pharmaceuticals and drug policy?

Well, I found myself riffing on Wag the Dog when I saw a mini skirmish erupting between the BC Ministry of Health and the association of the Canadian brand-name drug industry known as Innovative Medicines Canada. This pageant included predictable talking points from astroturf activists and lobbyists berating the BC government and our Minister of Health while exhibiting unconvincing fearlessness.

If this was a war, I’d seen it before. But back then it was the real deal. In the mid 1990s, a newly elected NDP government in BC brought in one of the most radical and profit threatening changes the drug industry had ever seen in North America – at a time when ministries of health were embracing this new thing called Evidence-Based Medicine, where groups like the Oxford-based Centre for Evidence-Based Medicine, the Cochrane Collaboration and BC’s Therapeutics Initiative were being established. Basing policy on evidence instead of expert opinion allowed BC policymakers to consider Reference-Based Pricing to help reign in runaway drug costs.

Reference pricing was so simple a school child could understand it: if there was a bunch of products in a class of drugs that generally worked the same way – were ‘therapeutically equivalent’ – the government would pay for the cheapest one, the ‘reference’ drug. If you wanted a more expensive drug, you paid the difference. If the cheaper reference drug didn’t work for you, your doctor could ask PharmaCare for “Special Authority” and 95% of the time they were approved. The policy was a no-brainer and mirrored how many people shop: if there is no qualitative difference between competing products, why not buy the cheapest one?

By the end of the 1990s, Reference Pricing in BC covered five drug classes, including drugs for arthritis, ulcers, angina and blood pressure. Independent evaluations carried out by researchers found the policy saved the BC taxpayer about $44 million the first year in full operation, with no adverse impacts on health. With a provincial drug budget just over $400 million, this was a serious saving, yet the ensuing war between the BC government and the drug companies was a full-on, knock’em out fight.

For weeks, full-page ads ran in the Vancouver Sun and the Globe and Mail, paid for by the Pharmaceutical Manufacturers’ Association of Canada and the Canadian Association of Retired Persons. They featured a sorry looking senior helplessly staring into her medicine cabinet under the headline, “The Provincial Government wants to change your medication.” The Ministry responded in the press with its own ads and the media went crazy covering the story. One Vancouver Sun headline read, “Minister condemns drug manufacturers. Greedy multinational firms trying to terrorize British Columbians.”

Documenting this as a researcher was like getting a PhD in pharmaco-political propaganda. The BC Liberals listened to the lobbyists’ propaganda and promised to get rid of Reference Pricing if elected, which they were in 2001, helped by hundreds of thousands of Pharma money. After taking power, the Liberals commissioned several evaluations of the policy, which showed it was a great way to save money in the drug budget. Yet the policy was never expanded. We researchers knew of other drugs taxpayers were paying far more for than they needed to, yet the BC Liberals refused to expand Reference Pricing. The next class of drugs to be referenced – the cholesterol-lowering statins – was a big-ticket item when most of them were still under patent. Referencing them back in the 1990’s would have saved BC about $50 million per year. The Liberals refusing to implement this policy capable of saving $50 million a year for 16 years is an $800 million gift to the pharmaceutical industry. No wonder the drug companies were such avid donors to the BC Liberal party.

In the intervening years, other pro-Pharma policies under a BC Liberal government were shockingly generous to drug companies. In 2003, the Liberals created what they called “Fair PharmaCare,” which tied a citizen’s drug coverage to their income, proving to be a $100 million per year bonanza to the drug companies, right out of the pockets of BC citizens. Instead of ‘managing’ drug cost growth, the Liberals took the cowardly way out: shifting the cost growth onto consumers.

Perhaps the most blatant gift to Big Pharma was a 2007 commissioned review of PharmaCare designed to formulate recommendations on reform. The resulting Pharmaceutical Task Force was so stacked with drug industry executives and cronies, the recommendations were ridiculously generous to the drug companies. And then in 2012, we had the PharmaCare firing scandal, which destroyed the government’s own capacity to carry out proper drug safety research in this province, another massive gift to Big Pharma.

Fast forward to 2016 and an election looming; what do we see? The Liberals, to demonstrate how tough they are, dust off Reference Pricing, in the spirit of a wag-the- dog gimmick. This distraction is supposed to extend Reference Pricing to statins, angiotensin receptor blockers (for high blood pressure) and PPIs (proton pump inhibitors) for heartburn, but the savings, touted to be $9 million per year, are a drop in the bucket.

The drug industry has also played its dutiful part in this charade by launching a lobbying campaign asking BC citizens to write their MLA, the Premier and the Health Minister to complain they are being denied access to “world class” drugs. Astroturf activists in BC’s Pharma-funded Better PharmaCare Coalition are also pretending outrage and have weighed in on the debate too.

Terry Lake, our Minister of Health, told the Tyee he’s not a victim of lobbying by pharmaceutical companies. Really? Sorry, Terry, your whole government over the past 15 years has shown itself to be easily lobbied by the drug industry. We’ll know you’re serious about controlling drug costs when we see full-page attack ads in the Vancouver Sun. Until then, it’s a pageant.

A concocted war on the drug industry surely benefits the BC Liberal Party, which is desperate to prove it’s not in the pockets of the pharmaceutical industry. Historically, the drug companies that make up Innovative Medicines Canada are among the Liberals’ biggest donors. They are getting the government policies on pharmaceutical policy that they have bought.

I wonder what would happen if the Ministry brought in real, serious drug cost control policies such as halting the overprescribing of antipsychotic and diabetes drugs and oodles of other unsafe, and often useless, treatments? A government serious about playing hardball with the drug companies could probably save $300 million or more a year in BC and here’s the kicker: the health of the population would likely improve!

Just like in Wag the Dog, maybe the BC Liberals know they can’t afford a real war so they’ll just fake one.

Come election time, I’m hoping BC citizens can tell the difference between a government that has the cojones to take on the drug industry and one that is only faking it.

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Alan Cassels is a drug policy researcher in Victoria and the author of the new book called The Cochrane Collaboration: Medicine’s Best Kept Secret.