Second opinion

Ain't no sunshine on Canadian doctors' conflicts of interest

Hello and happy Saturday! Here’s our roundup of the week’s interesting and eclectic news in health and medical science.

And a former drug addict provides a reality check for opioid experts

(Shutterstock/Nerthuz)

Hello and happy Saturday! Here's our roundup of the week's interesting and eclectic news in health and medical science.

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No Canadian sunshine on industry money to doctors

Almost half of doctors in the U.S. accept direct payments from industry, according to a paper in the Journal of the American Medical Association this week, part of an entire issue dedicated to the thorny problem of conflict of interest in medical science.

In a single year, U.S. drug and device makers paid $2.4 billion US to individual doctors and specialists. It's information collected from a searchable database that was established a few years ago under the U.S. Physician Payments Sunshine Act. That law forces U.S. industries to publicly disclose any payment or gift worth more than $10.

What about here in Canada? The risk of conflict of interest is real, but so far there's no legal sunshine to bring it to light.

"We like to think it's different in Canada," said Marc-André Gagnon, a pharmaceutical policy researcher at Carleton University. "But no, there's some real money at work in the health-care system when it comes to drug companies trying to influence the prescribing habits of doctors."

"It's been a recurrent problem for decades," said Bryn Williams-Jones, bioethics professor at the University of Montreal. "The pharmaceutical industry has used whatever leverage it can to create influence with health professionals who are then prescribing those medications."

Does it matter? Yes, according to the research. Study after study has shown that financial relationships with industry can change the kinds of drugs and treatments that a doctor prescribes.

The industry payments can take many forms. Some doctors are paid for every patient they sign up to participate in an industry drug study. Others are paid fees to attend seminars or give speeches at industry-funded conferences. Some receive money after writing articles or acting as industry consultants. Doctors also receive royalties and research grants from industry. And there are meals and gifts that are also considered payments under the U.S. law.

Dr. Joel Lexchin, an emergency room doctor and professor at York University, released a new book this week called Doctors in Denial, which explores the financial relationship between doctors and the pharmaceutical industry in Canada.

"It's very opaque," he told us, adding that he believes payments to doctors should be publicly disclosed and even linked to data about what drugs they prescribe.

Last year, Canada's pharmaceutical industry trade group, Innovations Medicines Canada, announced that some Canadian pharmaceutical firms will voluntarily disclose how much they give to Canadian doctors. A spokesperson told us it's set to happen on June 14.

But don't expect much detail. So far only 10 of the almost 50 member companies have joined the disclosure. And they're only planning to release one large number. There will be no details about which doctors got the money, how much they got, and why they were paid.

Gagnon said the voluntary disclosure is industry's way of avoiding a tough mandatory rule that forces it to disclose all payments to Canadian doctors.

"It's because they thought that it would be good for them to make sure nothing worse would be implemented."

The Canadian Medical Association told us it does not have a guidance policy for doctors when it comes to accepting industry payments.

Former drug user brings gritty experience to group writing new opioid guidelines

There were PhDs on one side, and medical doctors on the other. And in the middle of it all was Chris Cull, a former drug user.

"I'm not going to lie to you, it was an intimidating room to sit in when I first got there," he told CBC's Kas Roussy.

For the past two years, he sat at a committee table with clinicians, pain researchers, anesthesia specialists, and other experts with lots of letters behind their names. About 50 high profile experts were hammering out new guidelines for opioid use

Yet, the 32-year-old Ontario man was probably the best expert in the room. "I used to be a very bad opioid addict," he told Roussy. "I ended up turning to Percocet, which escalated in using 580 milligrams OxyContin a day for two years. And then I was on methadone for five years."

He didn't hold back as he described the horror of tapering off. If you go too quickly, it can trigger painful withdrawals.   

"It's like having the flu, but times 10. There's the vomiting, the diarrhea, the cold sweats." All grim details he shared with the committee, bringing a gritty reality to the theoretical considerations.

"It's important to discuss theories with somebody who's lived the reality."

Cull has been drug-free since 2014.

Canada's Good Samaritans now protected by law

It's safe to call for help at the scene of an overdose, now that a new federal law has gone into effect, protecting drug users from facing possession charges.

"This is an act that will save lives," Michael Parkinson told us. He's with the Waterloo Region Crime Prevention Council, which did research showing that in about half of the overdose cases they studied no one called 911, because they were too scared of police.

"If charges end up getting laid at the scene of an overdose, that story spreads like wildfire. And that puts a real chill on the community to call 911."

That's what happened in Oakville, Ont., in 2015, when police charged a man after he overdosed. They also charged the person who called 911.

"That story, I can tell you, spread throughout Ontario," said Parkinson. And he said there are cases where people have died from overdoses after witnesses failed to call for help.

Backbench MP Ron McKinnon from Port Coquitlam, B.C., decided someone had to do something, so he introduced a private member's bill that made it through the legislative system in record time.

Safe drug use activists and harm reduction workers are thrilled with the new law, especially because it includes protection for witnesses who might be in violation of parole conditions.  And they hope it will keep people at the scene, to assist with rescue breathing and other first aid until help arrives.

Now, the challenge is getting the word out that it's safe to stay at the scene of an overdose. "A law that nobody knows about is not much of a law," Parkinson told us.

Homeopathic products get rough ride in U.S. courts, but sit on Canadian shelves

In the litigious consumer environment of the U.S., makers of over-the-counter homeopathic products are getting sued.

Similasan Corporation, Swiss-based makers of about two dozen homeopathic remedies intended to treat everything from coughs and colds to anxiety, "computer eye," and "burn recovery" settled a class-action lawsuit and promises a refund to everyone who bought their products in the U.S. In their statement of claim, lawyers allege homeopathic products "are nothing more than placebos."

Homeopathy is an unproven theory that the cause of an ailment can also cure it and the more diluted the treatment the more powerful it is. For example, a highly diluted mixture containing poison ivy could be used to treat a poison ivy rash.

At least two of Similasan's cough syrups are sold in Canada. Another group of homeopathic products to treat colds and flu has also been challenged in U.S. courts. French homeopathic giant Boiron, faced with multiple class actions in the U.S., paid $5 million in settlements. Many of that company's products are still sold in Canada, with Health Canada approval.

Makers of mainstream pharmaceuticals aren't immune either. In March, Johnson & Johnson paid $5 million U.S. to settle accusations that it falsely advertised its baby bedtime products, including a bubble bath labelled as "clinically proven" to help babies sleep better. The same claim is still on the product sold in Canada.