This post was written by Alan Cassels and first appeared in Focus magazine online in early March. The full version is here. Alan was one of the creators of the Selling Sickness, or disease mongering idea. His recent book is “Seeking Sickness: Medical Screening and the Misguided Hunt for Disease.” There is an editorial comment below.
A year ago this month – March 28, 2012, to be exact. British Colomubia’s office of the auditor general told the B.C. Ministry of Health about a complaint someone made about the way contracts were being awarded and how research was being conducted within the ministry’s Pharmaceutical Services Division (PSD).
It’s time the public had some answers since this is not just a personal tale of intrigue and tragedy for those involved – but a story that has directly affected the way we assess and monitor pharmaceutical drugs in British Columbia (B.C.), the rest of Canada and the rest of the World.
Here’s what we do know in a nutshell: Pharmaceutical Services Division (PSD) is in charge of paying for medications for B.C. citizens, medications that cost about $100 million per month, the fastest growing budget in the ministry. At the time, there was a small evaluation unit within PSD – a staff of half a dozen economists and data analysts plus one position shared by two academic researchers, for facilitating drug evaluations by outside researchers. These weren’t lightweight researchers: both had PhDs, one was a world-leading Harvard-trained epidemiologist and the other a health economist.
The unit’s job was to help design and sponsor evaluations to determine if drugs paid for by B.C. Pharmacare were effective and safe. In the course of this work, the evaluations might show that some medications are ineffective or worse: they might sometimes kill or injure people.
The Ministry of Health started investigating the complaint in April 2012 by conducting staff interviews and reviewing contracts. The ministry said the formal investigation was initiated to “examine financial controls, contracting, data management and employee/contractor relationships.”
Then a handful of employees were sent letters saying they were suspended without pay, but not told the specific reasons why. Other researchers had their data access suspended. Contractors were fired and contracts cancelled.
In June, while the province’s minister of health was announcing nearly $40 million in new drug research money for B.C. at a large biotechnology conference in Boston, his staff back in Victoria were carrying out what some called a “Kafkaesque” series of interrogations. People were on trial, not knowing the charges or who was doing the accusing.
All drug safety evaluations carried out by the Therapeutics Initiative (TI) were halted. Funded by the provincial government, the TI has been providing an independent voice on pharmaceuticals since the mid-1990s and has gained an international reputation for its meticulous and thorough drug reviews.
Without these reviews, many commonly used drugs, such as those for cholesterol-lowering, heartburn, smoking cessation or stroke prevention were left with no monitoring activities.
In early September, the day after her appointment as minister of health, Dr. Margaret MacDiarmid and her deputy minister Graham Whitmarsh, called a news conference in the legislature. They announced that four employees had already been fired and three more were suspended without pay. They didn’t name the employees and the explanations made vague and confusing references to privacy concerns, inappropriate conduct and potential conflicts of interest.
Two others were fired later. The seventh in the unit has sued for constructive dismissal. One of the fired employees, a co-op student, had three days left in his term. He wasn’t able to complete his PhD – an evaluation of smoking cessation drugs – because the government cut off his access to data. And he’ll never complete it. He’s dead. (His death is still under investigation by the coroner.) Some of the fired employees are working through their unions to address their grievances or have brought suits against the government.
In media reports, the minister was “deeply troubled” and let it be known that the RCMP had been called. As the months rolled by, no one could say what was happening. No one knew, and/or no one would talk. Despite intense media curiosity, secrecy continues to be the order of the day.
When I asked for confirmation of the people doing the investigation, the ministry spokesperson wrote: “We have not and will not confirm any of the individuals involved in this investigation.” Calls to the coroner and the RCMP are answered in the same way: “An investigation is underway.”
Independent observers of this situation are stunned. There has never been a scandal like this in B.C. A big part of our provincial drug safety evaluation apparatus has ground to a halt, and so things must be very serious. But no one is saying what is really going on.
With polling day imminent, voters deserve to know one thing: What sort of crimes did these employees do to warrant the near total shutdown of drug safety evaluation in British Columbia? Canadians have lost a valuable source of drug safety information from B.C., so we all want to know – what exactly is going on?
Editorial Comment by David Healy
“Voters deserve to know” – but will they get to hear? Alan’s article appeared in Focus Online. We are in a world where there is a real McCarthyism in American medicine with publishers scared to publish, doctors scared to make connections happening right in front of their own eyes, and even government health departments becoming a threat to the wellbeing of citizens. This is why it is increasingly important to generate independent data in forums such as RxISK.org.
Harper’s publisher John MacArthur recently wrote: “You should be greatly concerned by the notion that press freedom nowadays hangs not by a stout cord between publisher and reader, but rather by a more tenuous thread connecting advertisers and the media.” And he would know: Pfizer withdrew “between $400,000 and a million dollars” worth of ads from Harper’s because of an unflattering piece on depression medication. His magazine got by, but MacArthur is quick to point out that many others wouldn’t survive such a blow.
In contrast, when on December 7th 1959, the most famous hearings on the Drug Industry, the Kefauver Hearings began, the front pages of American newspapers the following day were full of headlines about mark-ups of 1000% on the prices of drugs, and they later carried stories about fraudulent advertising and a range of sleazy marketing techniques. All of Kefauver’s team were surprised. They had held comparable hearings on price-fixing in other industries but had not received any coverage. One of them noted that:
“at some times the press is more free than at others. The crucial point in this case was that ethical drug companies don’t advertise prescription products directly to the layman through newspapers. That meant that since there was no pressure from advertisers, the papers could report whatever they wanted to“.