by Alan Cassels
There are stark contrasts between the BC Liberals and the NDP
Let us say to the people not ‘How much have you got?’ but ‘How best can we serve you?’
– Dr. Norman Bethune
An election is looming and this may be one of the most crucial turning points in our province’s history. The market for prescription drugs is worth about $4 billion in annual spending in BC, and the way governments set policies around prescription drug approval, coverage and safety are vital to all of our futures. So the question is “Who do you trust?”
Below are six insights I’ve gathered over the last 23 years of watching provincial pharmaceutical policy, under both the NDP and Liberal governments. You may want to think of these when you step into the voting booth on May 9.
1. Evidence: When the NDP formed government in the early ‘90s, it was notable in how quickly they fostered a culture of evidence based policymaking at the Ministry of Health. They established an independent drug watchdog (UBC’s Therapeutics Initiative) and made sure science based decisions were going to undergird provincial drug coverage decisions. When the Liberals took power 16 years ago, they started to erode that base almost immediately, appointing drug industry lobbyists to oversee a panel on Pharmacare reform, sidelining the Therapeutics Initiative and ramping up the pharmaceutical industry’s involvement in drug coverage decisions. The quality of pharmaceutical governance under the BC Liberals, concerning approval, monitoring and safety of prescription drugs, has been an epic failure, and is the best way to explain why BC leads the country in opioid deaths.
2. Lobbying: Under the NDP, you almost never saw drug lobbyists wandering the halls of the Ministry of Health. Back in the ‘90s, the head of Pharmacare forbade his staff from meeting with them. The noticeable absence of pharmaceutical reps in the apparatus of government meant the ministry could get on with its job, unbefuddled by marketing messages and lobbying pressures. What a contrast to today where the BC Liberals have kicked open the door and invited industry officials, their experts and their funded patient reps right into the heart of government. The result? Even though the Liberals spout the aphorisms of evidence based policymaking, we can’t avoid watching a steady stream of often useless and expensive medicines being approved for coverage, and wasteful health spending decisions that may please Big Pharma’s lobbyist donors, but deliver little impact on public health.
3. Drug research: Under the NDP, BC established an internationally recognized cohort of independent drug policy researchers who studied changes in drug coverage policies, such as Reference-Based Pricing, which was responsible for eliminating much waste in the system. We studied the safety of drugs for acne (which cause birth defects), smoking cessation products (which cause psychiatric episodes) and drugs for ADHD (which are inappropriately prescribed), yet the message was loud and clear. The Liberals and their “partners” in the pharmaceutical industry didn’t want any independent research sullying their brands and most of that independent research was killed during the Health Ministry firing scandal in 2012. Meanwhile, millions in funding was ponied up for UBC’s Centre for Drug Research and Development designed to recycle our tax dollars into commercially viable products for private companies.
4. “Patient” groups: From the ‘90s onward, I remember seeing groups, such as the Osteoporosis Society, the BC Alzheimer’s Society and assorted astroturf patient groups, viciously attack the NDP. While patient groups can do good work for the diseases they represent, because so many of them are soaking in Big Pharma funding, they found allies in the Liberals. When the BC Liberals took office and warmly invited these patient groups into consultations and asked for their opinions about the latest pharmaceuticals, they were made to feel special. Sadly, the fine folks at BC Pharmacare who feel they are genuinely working in the public interest have been silently worn down by a steady stream of industry funded opinions and the drug-addled patient groups just make things worse.
5. Transparency: Under NDP premier Mike Harcourt, BC produced “model legislation for access to information,” according to the Vancouver Sun’s Vaughn Palmer. Palmer is certainly one who knows what a farce it is trying to access government documents through Freedom of Information (FOI). Hiding misdeeds from the public has become high art under the Liberals where politicians and bureaucrats routinely omit to write things down, use personal email or cell phones and “triple delete” to avoid anyone learning about government business. This corruption helps to partly explain why drug coverage decisions are often suspect and how the mysterious health firing scandal from 2012 remains the most expensive scandal in the BC Ministry of Health’s history.
BC’s Ombudsman may soon release his report on who called in the drone strike on the Health Ministry, resulting in the firing of eight drug safety researchers and millions of dollars of associated costs. Don’t tell me that the influence of pharmaceutical companies, many of which donate to the political BC Liberal Party, may not have wanted their products independently analyzed by those researchers. One of them, Rod MacIsaac, committed suicide before he could complete a study on Pfizer’s controversial smoking cessation drug. And yes, Pfizer, one of the world’s biggest pharmaceutical companies, has multiple ties to people within the BC Liberals. Quelle surprise!
6. Wastebusting: One thing I noticed under the BC NDP’s culture of evidence based drug decision-making was a commitment to reduce waste. Not all new prescription products coming to market (happening all the time) are going to be worthy of coverage. Paying for the most expensive newer medicines, which aren’t any more effective or safer than those currently covered, only benefits the manufacturers. The BC Liberals have eroded this culture of wastebusting, allowing itself to be swindled on million-dollar drug coverage decisions. Is this because they’ve spent too much time cozying up to the drug companies and listening to the entreaties of officials, lobbyists and patient groups? Suffice to say every dollar spent on a useless, unnecessary drug is a dollar that isn’t going to be used where it is actually needed in the healthcare system. The Liberals don’t get this, while the NDP, in my opinion, always did.
Finally, when it comes to elections and political discussion, we all need to talk about what underpins health coverage decisions. Is it the needs of manufacturers and their armies of lobbyists? A conservative estimate would say we waste about $10 billion per year on what are sometimes unnecessary, useless or potentially harmful medicines, diagnostic tests and procedures. Every single person working in the health system has seen this shameful waste, yet the independent analysis and research needed to keep people from taking harmful drugs or useless tests no longer exists under the Liberals.
If a new government were to start by eliminating the pharmaceutical corruption of our health decision making, we’d be able to spend millions more on what is actually needed: more affordable drugs, better care for seniors, thorough homecare, manageable childcare and getting serious about affordable housing in BC. Let’s be clear, Alan Cassels is not about sticking it to the pharmaceutical industry. I’m about defeating waste because much of the money we send to the drug companies isn’t being used where it needs to be.
The BC Liberals have, for the last 16 years, shown their capacity to be tainted by drug industry messages, lobbyists and donations. At the end of the day, we need clean, clear health decisions as urgently as we need clean, clear water.
That’s what I think, but what do you think? Visit my website www.alancassels.com and answer my survey. Or tweet me at @AKECassels and put this in the tweet: #healthcarewastebusting Tell me what we need to do to make BC’s drug coverage affordable and appropriate. We need a dialogue on avoiding waste and I need your voices.