Open Pharma campaign is aimed at transparency in Physician’s relationship with drug industry


 Unethical marketing practices by the Pharma Industry

Open Pharma campaign is aimed at transparency
in Physician’s relationship with drug industry

President GSK Canada welcomes the move saying
“this is good but not good enough”

In Pakistan NBC Guidelines which takes care of all these things though
approved but have not yet been implemented by the regulatory agencies

KARACHI: At a time when public funding for research is fast declining, pharmaceutical industry is filling up this void. It makes billions of dollars investment in Research & Development every year and it also costs a lot to discover any new safe and effective molecule which is eventually marketed. However, there is also increasing concern about the cozy relationship between the Physicians and pharmaceutical industry which has given birth to lot of unethical marketing practices whereby the industry tries to influence the prescribing practices of healthcare professionals by offering “pricey dinners, alleged altering of studies besides physicians endorsement of drugs”. Doctors are often unaware of how they are influenced by taking gifts or money from the Pharma industry including travel grants.

In United States of America “Physicians Payment Sunshine Act” requires pharmaceutical companies to release details of payments to doctors and hospitals. In Canada Dr. Andrew Boozary a resident physician who is being supported by a team of distinguished medical personalities from the healthcare and Academia has initiated the Open Pharma campaign with the main objective of building public awareness forcing the health authorities to take action against unethical marketing practices by the pharmaceutical industry. According to Dr. Andrew Boozary “The interaction with industry is everywhere and a lot of progress has come from collaborating but if we continue to keep relationships in the dark, it will undermine the trust. Payments from the drug companies can be in the form of funding for research, fees for speeches or participation on advisory committees and coverage of travel expenses for participation in international functions. Organizations including hospital, universities and private medical clinics are also beneficiaries of funding of course some of it is philanthropic. There have been numerous controversies in Canada over perceived conflicts of interest because of payment relationships.”

It may be mentioned here that Federal Health Minister of Canada few weeks ago has ordered an independent review of Canada’s new prescription guidelines for opioids because of revelations that a doctor- who was part of a committee of medical experts who voted on whether to accept the guidelines had received financial compensation from companies that make and market opioids.

Open Pharma campaign, Boozary emphasizes is not “anti-Pharma” nor does it aim to ban industry involvement with the medical profession. It is about being open about relationship in the interest of upholding public confidence. The campaign has started bearing fruits as ten multinational pharmaceutical companies operating in Canada has agreed to publish aggregate data on payments to health-care-practitioners and organizations. Data to be released from June 20, 2017 will not be broken down into payments to individual doctors and organizations. Instead, each drug company will release on its website only three numbers which are total payments to healthcare professionals and organizations, payments to cover expenses related to travel to international meetings. GSK Canada is one of these ten companies but its President Paul Lirette says that this initiative falls short. “This is good but not good enough”. He has advised that Pharma industry would be wise to voluntarily take more action rather than risk being forced to by the Government.  “I would like to see disclosure of more detailed data. He also wants broader participation including from the other 35-brand-name drug companies under the umbrella of Innovative Medicines Canada, Ten Generic Drug companies and one hundred forty eight medical device manufactures and related companies.”

Open Pharma campaign in Canada has called upon the Canadian Government to mandate drug companies to be more transparent and publicly disclose clinical information on safety and efficacy of drugs and medical devices besides making industry funded research open access so that it is available for reanalysis in academic journals and other platforms. Canadian Medical Association had also passed a resolution five years ago asking the industry to make payments information publicly available. People are interested to know which physicians are involved in these relationships says Dr. Jeff Blackker Vice President of Medical Professionalism of Canadian Medical Association.  “It is not to say that these relationships are inherently evil or bad, it’s to say that we want to make sure that people understand the context”.

Dr. Howard Bauchner Editor-in-Chief of Journal of the American Medical Association (JAMA) says that “Overtime people have come to understand that conflicts of interest are real and are of concern. In a world of greater transparency, it was no longer a viable option not to reveal what payments were made. He has even devoted many Editorials on these issues.”

Coming to the situation in Pakistan, unethical marketing practices and bribing the healthcare professionals in different forms is on the rise. Pharma industry all over the world sponsors Continuing Medical Education activities, medical conferences, seminars and symposia and it won’t be an exaggeration to say that without this financial support most of the academic activities in health sector will come to a standstill. The Pharma industry’s help and support in all such academic activities needs to be commended and appreciated but the problem arises when thin line of professional ethics is crossed. Many of the conference organizes demand millions of rupees for organizing conferences at Five Star Hotels. Can a poor country like Pakistan afford all this? It is desirable to organize all such academic activities at medical institutions which will reduce the conference expenditures to great extent.

Surgical course for Colorectal Diseases and Course on Endocrine Diseases organized by the Dept. of Surgery at JPMC Karachi for the last many years is a shining example of this pharma industry relationship with the medical profession. Eminent Master Trainers from Europe and United States are invited every year. The course is attended by hundreds of junior and senior surgeons from all over the country. It has a working tea and working lunch and it is sponsored by the pharma industry. The venue is the Najmuddin Auditorium at JPMC built through donations by an NGO run by Prof. Hassan Aziz, the noted Neuro Physician. Surgical week for Colorectal Diseases was initiated by Prof. Surgeon Mumtaz Maher and now it is being successfully continued by Surgeon Shamim Qureshi, Surgeon Naseem Baloch and their teams. There is no Registration Fee. Master Trainers coming from overseas also enjoy their visit and have always been full of praise of Pakistan’s hospitality which only proves that one need not host such functions at Five Star Hotels.

Even if due to some security concern, an international event has to be organized at a Five Star Hotel, the organizers can minimize the expenditures by limiting it to the registered participants only ensuring that it does not turn into a social get together of doctors with their families. Family members and friends who are most often invited to such occasions should not be allowed restricting the participation to only registered delegates. The tradition of offering mementoes to everyone, expensive conference bags should be done away with. Instead, the organizers should help residents, postgraduates encouraging their participation. Those young researchers and postgraduates who present papers or participate in poster competition should be offered travel grants. Health RAB an entity founded by one of the national pharmaceutical companies has recently started offering lucrative prizes to young researchers which is indeed commendable and it should be followed by other companies as well. Some saner physicians within the medical profession have already supported moves to uphold professional ethics and urging the conference organizers in Pakistan to be content with the willing participation of the pharmaceutical industry rather than demanding Millions of rupees in donations on one pretext or the other which comes in the category of “Bhatta Collection”.

National Bioethics Committee constituted by Government of Pakistan had taken up all these issues and in its comprehensive Guidelines on Physicians Interaction with Pharma Trade and Industry has come up with very useful, practical guidelines, suggestions keeping in view the local conditions. This has already been approved by the Government of Pakistan as well as by Pakistan Medical & Dental Council but as usually happens in Pakistan, its implementation is still awaited though the Guidelines were approved more than four years ago. These Guidelines also suggest the Pharma Industry to publish details of its financial assistance to the medical profession on its website while the professional specialty organizations and all those organizing such academic activities sponsored by the Pharma Trade and Industry are also required to publish these details on their websites and get its accounts audited every year. Those failing to comply with this should be barred from receiving any funding from the pharma trade and industry.

Members of the Open Pharma’s campaign’s advisory board include: Dr. Andreas Laupacis, Executive Director of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital; Adalsteinn Brown from the University of Toronto, where he serves as director of the Institute of Health Policy, Management and Evaluation, and the Dalla Lana Chair in Public Health Policy; Dr. Danielle Martin, a vice-president at Women’s College Hospital and a founder and a past chair of Canadian Doctors for Medicare; Toronto doctors David Juurlink and Nav Persaud, both of whom study the relationship between pharma and the medical profession and have raised questions about undeclared conflicts; and Dr. Ahmed Bayoumi, Professor of Medicine at University of Toronto.

The campaign is also supported by Joel Lexchin, a Toronto ER doctor and author of the newly released book Doctors in Denial: Why big pharma and the Canadian medical profession are too close for comfort.

For more details about Open Pharma Campaign in Canada visit