It's no secret Canada's pharmaceutical companies are lobbying hard to get the products they manufacture covered by provincial health plans.

They spend almost a billion dollars a year, trying to influence governments and doctors. Now, drug companies are trying a new strategy - targeting patients. And they're working through a network of organizations more trusted than themselves.

Among these patients' groups is the Cancer Advocacy Coalition. The group swept into the media spotlight in the fall of 2000 when it released a controversial study on cancer deaths. The coalition is advocating faster approval of costly cancer treatments. It also wants governments to cover expensive new drugs.

What the media did not report was where the group was getting its money from.

"Almost all of our money to date has come from pharmaceutical companies in Canada," Pat Kelly, one of the founders of the group told Marketplace.

The Coalition is not alone. These days almost every high profile disease advocacy group relies on the financial backing of the drug industry. That has some people worried these groups may be influenced by the corporate interests that pay their bills.

Barbara Mintzes tracks how pharmaceutical companies promote their products. She says cozying up to advocacy groups is the latest trend.

"They get much better credibility if a patient group comes out and says 'this is a good product,' rather than a manufacturer itself saying that the product they produced and that they'll gain from selling is a good product."

Mintzes stresses that disease advocacy groups do a lot of good work - and they're getting a lot less government money than they used to. Her concern is pharmaceutical giants may have a vested interested in handing over money to these groups.

Getting the message out effectively

A recent conference in Toronto lends some credence to that concern. People in the drug industry paid $1,500 to hear public relations experts explain that sales rise when drug companies develop partnerships with patient groups.

Speakers at the conference cited examples such as the OsteoBus, which toured the country urging women to get their bone mineral density tested. Sales for an expensive, controversial osteoporosis drug skyrocketed.

Delegates to the conference were told that patients and not industry types should be the spokespeople for new drugs.

Alan Cassels is a researcher and policy analyst investigating pharmaceutical practices. He attended the conference.

"The best way to advertise is to make your promotion not look like advertising - that's what one of the presenters said," Cassels told Marketplace. "And one of the ways you get your promotion to not look like advertising is to use...consumer groups to speak for you."

No one in the public relations industry would agree to do an on-camera interview for this story. But several did tell Marketplace over the telephone that they're busy matching drug companies with patient groups.

Donor dollars aren't enough: patient groups

The Arthritis Society has received almost $2-million dollars from pharmaceutical companies this year. Denis Morrice, the society's president, says that money has done a lot of good.

"We don't stand behind any single product or any single company," Morrice told Marketplace. "Two million of the four million people with arthritis take medication every single day to relieve pain. Why should these people not have access to the best possible medication?"

Recent national newspaper supplements carrying the Arthritis Society's logo extolled the virtues of two new drugs. Nowhere is it mentioned that the society gets money from the manufacturers of those products.

"The problem is, if the patient group is funded by a company that has an interest in getting that drug onto a provincial formulary, it's not a neutral unbiased source," said Barbara Mintzes.

Governments reluctant to cover all drugs

Governments are under intense lobbying pressure from well-heeled advocacy organizations. Increasingly, governments say, groups demand more coverage of expensive treatments - some of which may have questionable benefits.

Of 100 new drugs brought to market in Canada every year, about five are true therapeutic breakthroughs, according to Rick Hudson of BC's ministry of health. Paying for every drug the government is pressured to, he says, would take half a billion dollars from other healthcare areas.

"Do we take it from immunization programs?" Hudson asks. "Do we take it from our equipment for new hospitals? Do we take it from our budgets to hire nurses?"

Wendy Armstrong of the Consumer's Association of Canada says it's becoming impossible to recognize the difference between a legitimate group and "a drug company front."

"What needs to happen and it needs to happen very soon," Armstrong says, "is full disclosure of where these groups get their funding. And that should be available, and that should be required disclosure whenever a presentation is put on."

Others say patient groups that distribute pharmaceutical information should be governed by the same rules as drug companies. No publicizing a product before it's on the market and no making exaggerated claims. Health Canada says right now, there are no regulations governing these controversial partnerships - and because of limited resources, that will not change soon.

Meanwhile, the Cancer Advocacy Coalition has obtained more funding from a pharmaceutical company for a national newspaper campaign. The coalition wants politicians to spell out their commitment to cancer issues and drug approvals during the federal election.

The coalition says the ad campaign has nothing to do with the funding it has received. It simply wants to influence public and government opinion.