BC FORUM News

BC Liberals Undermine the Safety of Your Medicine Cabinet

By Bill Silvester and Colleen Fuller,
BCFORUM Directors

February, 2011 - The “Therapeutics Initiative” is the name of an organization that should be on the minds of every British Columbian. That’s because it already has or will have an impact on your life someday.

The TI, as its known, was set up in 1994 by the Department of Pharmacology and Therapeutics at the University of British Columbia to provide evidence-based and unbiased information about the effectiveness and safety of new prescription drugs. UBC received an annual grant of $1 million from the province that enabled the TI to conduct these assessments free of government or pharmaceutical influence. Described by the Globe and Mail as “a gem of Canadian public policy”, the TI has built an international reputation as a reliable and independent source of information about the drugs we – and our families – depend on when we are ill or have an on-going need for medicine.

The TI has also enabled Pharmacare to develop the Reference Drug Program that identifies a list of drugs providing similar benefits but at lower prices than other medicines in the same category. This is important in a world where most new drugs are costlier “me-too” versions of what is already on the market in generic form. Through Pharmacare’s Reference Drug Program, BC taxpayers have achieved the lowest per capita drug expenditures in Canada, about $700 per capita per year compared to a national average of $900. This program has saved almost $1 billion since it was introduced.

More importantly, the TI has played a significant role in improving our quality of care and potentially saving lives. Three examples, listed below, illustrate the role the Therapeutics Initiative has played in protecting the health and safety of British Columbians.

Vioxx

In 2002, the TI assessed the evidence for Vioxx, an anti-inflammatory medication used in the treatment of osteoarthritis and other chronic pain conditions, and concluded the risk of heart attacks and other harmful events outweighed any benefits associated with the painkiller. At the time, there were 21 other drugs in the same class as Vioxx. Consequently, Pharmacare did not decide to fund the drug and as a result, it was rarely used in BC. Two years later, Vioxx was pulled from the market, but not before it was linked to the deaths of 68,000 people in the United States alone. Experts estimate that the TI’s review of Vioxx saved 500 lives in British Columbia.

Avandia

This drug has been controversial since it was approved for the Canadian market in 2000 to treat Type 2 diabetes. When the TI reviewed the scientific evidence, it found that those who used Avandia experienced significant weight gain and an increase in the frequency of angina and heart attacks. At the time, there were 11 drugs available on the market to treat Type 2 diabetes, with Avandia and another drug in the same class, Actos, being among the most expensive. In 2005, Pharmacare decided to fund Avandia but only under special authority. Today, the US has placed serious restrictions on access to Avandia while Europe has suspended it from the market. These actions were due to the increased risk of heart attack and stroke.

Fosamax and Bextra

The TI also gave a thumbs down to the osteoporosis drug, Fosamax, now found to cause bone fractures in women, as well as Bextra, another arthritis drug pulled from the market in 2005 after it was linked to heart attack, stroke and other potentially life-threatening side effects.

The Therapeutics Initiative has served British Columbians well, surpassing all expectations, and has been copied in some form by other provinces. It has also served as a model for Canada’s Common Drug Review, earning the respect and admiration of drug safety experts around the world.

On November 26, 2010, the BC Liberal government announced they would discontinue funding for the Therapeutics Initiative, dismantling and contracting out the assessment work previously handled by the TI to “who knows”. They also announced a new drug approval process that allows drug companies to intervene at four different stages. Conflict of interest – which was eliminated in the TI’s reviews – now threatens to undermine the unbiased, objective drug assessments previously done by the Therapeutics Initiative. There is widespread speculation that one explanation lies in the major contributions by pharmaceutical companies to the BC Liberal Party (Times Colonist 2009).

If Therapeutics Initiative is allowed to die, British Columbians who rely on prescription drugs will face an increased risk of harm due to side effects. The objective assessments published by the TI will not be available to doctors so they know the drugs they are prescribing are safe and effective. Instead, they will have to rely on pharmaceutical drug reps whose job is to sell their products. British Columbians will pay more and be less safe.

Ten thousand Canadians die every year in hospital from adverse drug reactions as result of the proper use of prescription drugs. Many more die because of inappropriate use of medicine. We need the Therapeutics Initiative to warn us when drugs like Vioxx are being aggressively marketed. We are all vulnerable when powerful global corporations — Big Pharma — are pushing their drugs on an unsuspecting public.

What can we do?

You need to be angry about the move to dismantle the Therapeutics Initiative. If you have never approached your MLA before, this is the time to do it. This should not be a partisan issue; it affects the lives of us all regardless of political stripe. The Government’s decision to cut the funding for TI makes no sense financially or practically. Here’s what you can do about it:

• Write your MLA, with a copy to the Premier, the Minister of Health and the Official Opposition Health Critic to demand that core funding for the Therapeutics Initiative be re-established and increased.

• Tell your friends, family and neighbours to do the same.

• Write a letter to the editor of your local newspaper, and contact a reporter to ask him or her to write an article about the TI.

• Ask your union, church, community group to demand that core funding for the Therapeutics Initiative be re-established and increased.