The sweet smell of transparency

Can a new government remove the stench of Big Pharma’s lobbying at the BC Legislature?

ONE THING I MOST REMEMBER about living in Asia 20 years ago was the ever-present smell of sewage. It was fairly subtle most of the time, but occasionally I would catch a powerful whiff of something rising from faulty plumbing or seeping up from the street drains. It’s the metaphor I think of when I consider politics here in BC, where every so often the stong scent of corruption wafts from the comingling of business and government.

But maybe that will all change if a breeze of transparency—in the form of campaign finance reform and limits to lobbying—starts to blow through Victoria. Getting big money out of the political system and changing the legislation that affects the behaviour of lobbyists could certainly help clear the air.

People who spend any time in the BC Legislature or work in the various ministries will tell you that lobbyists representing petroleum, real estate or pharmaceuticals (among others) roam the halls like they own the place. These “government relations” people (former MLAs among them) fill the calendars of our legislative members, snatching face-time to air their views and ensure the government maintains the “right” perspective on policies affecting their industry. Currently, other than being required to register that they are lobbying and who they might be lobbying, there is no way to find out who was actually lobbied or what was talked about.

The centrepiece of the new provincial government’s lobby reforms is a mere tweaking, a required two-year “cooling off” period where those leaving public office are prohibited from acting as lobbyists (this includes cabinet ministers, their political staff, and other senior people, down to the assistant deputy minister level). Lobbyists must also disclose the names of any staff person working in the minister or MLA’s office with whom they speak.

Dermod Travis with Integrity BC probably knows the activity of BC’s lobbyists better than almost anyone in the province. He is adamant that “we need checks and balances—knowing who was actually lobbied and what was discussed,” but unfortunately that information won’t be found in the BC Lobbyist Registry. Travis laments how close the relations can be between government and business, recalling a 2013 BC Chamber of Commerce private, $275-per-plate dinner with all of the Deputy Ministers. Participants (mostly lobbyists) paid to dine with the deputy of their choice. The Deputy Minister of Health at the time, Stephen Brown, was photographed with officials from Purdue Pharmaceuticals (famous makers of Oxycontin, believed to be the key gateway drug responsible for our opioid epidemic)—not exactly the kind of people you want to be glad-handing our senior bureaucrats.

So who is keeping an eye out for the public when it comes to pharmaceuticals? With BC Pharmacare spending upwards of $1.5 billion every year on public drug coverage, does this not make the BC Ministry of Health a prime target for drug lobbyists?

Let’s say you are a drug manufacturer producing many products you believe doctors should be prescribing. Your singular goal is driving profits and growing customers. You therefore put a very high priority on getting BC taxpayers to pay for your products; with over four million potential customers eligible for coverage through Pharmacare, government payors may mean the difference between success and failure. What complicates this is that you’re also competing with other companies who make similar products, and they want their drugs covered. Enter the lobbyists.

BC’s Lobbyist Registry is a good way to find out who has been registered to lobby for whom, and which ministers they wish to influence. In it are dozens of drug companies. Let’s choose one at random, starting with A: AstraZeneca Canada, a major pharmaceutical company making 50 or so drugs, not all of which are covered by Pharmacare. The diabetes drug exanatide, sold in two forms by AstraZeneca under the trade names Bydureon ($2,493 per year) and Byetta ($1,457 per year) are classed by Pharmacare as “non-benefits,” so if your doctor prescribes those drugs, there is a good chance you’re paying for them on your own, or hoping your employer’s health coverage will kick in. Brillinta (ticagrelor), another Astra product, is an antiplatelet drug used to prevent blood clotting, heart attacks and strokes. It used to be available for coverage through Pharmacare, but now it is not.

Drug companies like Astra are so profitable they can hire some of the best lobbyists (I mean, er, “government relations” people) around. If you are one of our newly-elected MLAs—and especially if you work in health, education, or economic development—expect to be on the sharp end of the lobbying activities of Big Pharma companies like Astra. On July 27, 2017, AstraZeneca Canada registered seven people as lobbyists in BC. Their “business or activity summary” on the BC Office of the Registrar of Lobbyists website says they focus on “Innovative Life Sciences/Economic Development Policies; Health as an Economic Generator of Wealth in British Columbia; and Health Policy/Reimbursement decisions.”

Let me translate: Even if Astra asserts that they “push the boundaries of science to deliver life-changing medicines” (according to their website), they are there to meet with our MLAs for business reasons. They will say their drug products might be beneficial to our economy, but the bottom line is to make sure taxpayers pay for Brillinta, Byetta, Bydureon and the dozens of other drugs they make.

In late September, the group tasked with assessing new cancer drugs in Canada (called the pan-Canadian Oncology Drug Review or pCODR) gave a positive “recommendation for the reimbursement of Lynparza® (olaparib).” Astra’s so-called “first-of-its-kind treatment for BRCA-mutated ovarian cancer” promises patients “improved progression-free survival.” Sounds great, and why wouldn’t you want the government to pay for that drug? As an MLA or a minister, it would be hard to say no to a drug that appears to help people suffering from what is often a fatal cancer.

We only know, broadly, what companies like Astra want from our politicians. Astra’s filing on the lobbyist registry says they are lobbying for “Information in support of provincial access and reimbursement of AstraZeneca’s medicines.” In other words, how do we get BC Pharmacare to pay for our drugs? Lobbyists have a financial incentive to paint their company’s products in the best possible light. (Some are even paid on contingency: If they earn their company positive cash flow from a policy decision, then ka-ching!)

BUT WHAT WILL OUR MLAs LEARN about the drugs they are asked to cover? Will they learn that Byetta (according to its product monograph) has been “associated with acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis?” Will they learn that there are lawsuits against the company suggesting that the link between Byetta and inflammation of the pancreas means the drug may actually cause pancreatic cancer? Will they learn that Astra may have submitted false data to the FDA to get Brillinta approved in the US, and is alleged to have omitted information regarding deaths and other adverse events associated with it? When it comes to olaparib, are there going to be any lobbyists telling Adrian Dix and his staff that if you look closely at the clinical trials, it actually made life worse for patients? (Its cost, if covered by the Province, will likely be in the millions.)

What’s the takeaway? Seven lobbyists from one company, multiplied by dozens of drug companies, against one health minister.

We need a stiff breeze of transparency blowing through the halls of the legislature, especially when it comes to the millions we spend on pharmaceuticals. There is some suggestion that recent reforms are only a first step. Maybe there will be, somewhere down the road, some real deodorizing acts that can freshen up the close, sweaty relations between drug lobbyists and those who decide on how to spend our health dollars.

The future, if we choose, could smell really great.

Alan Cassels is a Victoria writer and health researcher.  His most recent of four books is The Cochrane Collaboration: Medicine’s Best Kept Secret.