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2015 Lobby Day

Policy Statement

Political Advocacy Committee

The UBC Medical

Undergraduate Society

Implementing a Transparent and Independent

Drug Assessment Procedure in British Columbia

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2015 Lobby Day Policy Statement

Implementing a Transparent and Independent Drug

Assessment Procedure in British Columbia

Policy Committee; UBC Political Advocacy Committee; on behalf of the UBC Medical

Undergraduate Society with support from the Canadian Federation of Medical Students

Introduction

As medical students and future physicians in British Columbia, we care deeply about the health of our patients and by extension the health of the population. In order to improve patient outcomes in everyday clinical practice, we depend strongly on sound scientific evidence to model our clinical decision making. This is guided by various scientific analyses from clinical trials to systemic reviews that make up the backbone of EBM (Evidence Based Medicine). It dictates how physicians in modern medicine treat patients supported with scientific evidence. The practice of Evidence Based Medicine is paramount to ensuring that we deliver not only effective but safe healthcare to our patients. With the ever expanding amount of scientific knowledge and growing complexities of twenty-first century medical practice, clinicians depend strongly on independent review groups that help us evaluate the overwhelming data published in scientific literature. By vigorously analyzing and evaluating the science behind medical practice, these independent review groups ensure the integrity and safety of medicines. Our role as healthcare providers is to provide safe and effective healthcare. We want to ensure that the best interests of our patients are protected from influence from private industries and third parties. Thus, we strongly believe that review groups that perform robust EBM practices should stay independent and maintain their neutrality. These review groups that perform its work purely based on robust science require continued financial support from policy makers and scientific support from clinicians. We as future healthcare providers want to work together with our elected representatives in government to improve the health of British Columbians. We present specific policy recommendations that will help us achieve this goal.

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A recent survey showed that 95% of physicians and 92% of pharmacists in BC

reported a change in practice based on the research performed by the

Therapeutics Initiative

The Therapeutics Initiative

First established in 1994, the Therapeutics Initiative (TI) is part of the Faculty of Medicine’s Department of Anaesthesiology, Pharmacology and Therapeutics at the University of British Columbia. The TI performs research on the efficacy of pharmaceuticals available in BC and helps health care professionals properly prescribe safe and effective drugs for patients by informing health care professionals with updated recommendations solely based on scientific evidence. It is imperative that we have an independent drug review process without prejudice from private industries, and the TI is instrumental in achieving this. The TI’s independent drug review is free from influence from government, industry, or other organizations with vested interest in pharmaceutical development or distribution. The TI evaluates policies and educational interventions, monitors drug utilization, develops innovative research methodology, and analyzes prescription drug safety and effectiveness. Additionally, the TI is involved in healthcare education through Continuing Medical Education courses and distribution of “Therapeutics Letters”. More than 12,000 practicing physicians and pharmacists in BC, and 1000 other stakeholders and subscribers, receive these letters (1). A recent survey showed that 95% of physicians and 92% of pharmacists in BC reported a change in practice based on the research performed by the Therapeutics Initiative (2). Given that most healthcare professionals have neither the time nor resources to conduct independent research on the products they prescribe, an unbiased and publicly funded pharmaceutical review body such as the TI is of utmost importance to ensure the safety of patients in BC. It is unwise to allow healthcare professionals to receive product information solely from industrial or government sources, given vested interests in profit or savings in limited provincial funds.

Unfortunately, the TI’s funding from the BC government has been steadily declining since 2008. The TI’s funding dropped from $1 Million to $850,000 in 2011, and then to $550,000 in April 2012 (3). The TI also lost access to the BC government’s provincial prescription drug data which limited the work that the TI carries out (4). The BC government further suspended contracts with the TI in September 2012 and it was UBC that replaced this deficit in order to keep it operational (4). The decline in support for the TI was as a result of the Pharmaceutical Task Force (PTF) instigated by the government. Unfortunately, members of the PTF included influential people from the pharmaceutical industry. This conflict of interest from the PTF cast the TI in a negative light, resulting in the decline in funding of the TI despite warnings from various organizations (5). People rallied together to reinstate funding for the TI. The British Medical Journal released an open letter to the BC government, urging it to restore funding to the TI. Signatories of the open letter included Canadian Doctors for Medicare, Public Health Association of British Columbia, Health Action International, and other prominent healthcare organizations. In October 2013, the TI got a renewed contract that gave the organization $550,000 per year.

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British Columbians spend $3.5 billion on pharmaceutical drugs every year

Supporting Evidence Based Medicine in British Columbia

Independent groups such as the TI require dependable and sustainable funding in order to perform EBM practices. Without this type of funding, we risk losing the unbiased voice in science to assist in the decision making of healthcare providers. We as future healthcare providers believe it is important to increase the support for independent drug analysis in BC.

In addition, by not investing in groups like the TI, we risk putting budgets at risk. The cost of pharmaceuticals in BC is rising. BC taxpayers spend upwards of $1 billion annually on pills purchased from PharmaCare Plans (6). In total, British Columbians spend $3.5 billion on pharmaceutical drugs each year (6). PhamaCare spending increased around 30% since 2005 and the number of prescriptions increases by about 10% every year in BC. Coupled with increasing drug prices, the Canadian Institute of Health Information predicts even further increases in costs for the future (6). On the other hand, supporting the TI could help the BC government and patients to save money. Reviews by auditor-generals in BC credit the TI in keeping drug costs in BC low (7). The added cost-benefit of having an independent drug analysis group will improve the efficiency of healthcare funding in British Columbia. By advising coverage of safe and effective drugs, a streamlined prescription system will aid provincial PharamaCare by increasing coverage protocol efficiency and enhancing its bulk buying power. Without the TI’s review of drugs, costs will continue to rise in BC, impacting the government, healthcare system, and patients.

Figure 1. Total Pharmaceutical Expenditures in British Columbia Source: Canadian Institute for Health Information, 2013

Reviews by the Auditor General of BC found that the TI is a key player in

helping keep down drug costs in BC

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Most importantly, without the TI, we are risking the health of British Columbians. The TI has been instrumental in improving the health of patients. Without independent review of the safety and efficacy of new pharmaceutical drugs, patients may suffer from potentially serious complications of some medications.

The efficacy of the TI has been well documented. Not only does the TI’s research influence professional practice, it also prevents patient mortality. For example, the TI successfully identified pharmaceuticals such as alendronate sodium (Fosamax), rosiglitazone maleate (Avandia), donepezil (Aricept), rofecoxib (Vioxx), and valdecoxib (Bextra) as having insufficient evidence to recommend routine prescription (2). Many of these medications were later identified as having significant safety concerns. Vioxx and Bextra were later withdrawn from the marketplace due to increased risk of myocardial infarction (heart attack) and stroke. Vioxx in particular, was assessed to have caused between 88,000 and 139,000 heart attacks while available in the North American marketplace, 30 to 40% of which were fatal (8). The TI’s work helped to reduce Vioxx prescription in BC compared to other provinces, and Vioxx was eventually pulled from the market because of its serious side effects. These examples immediately highlight the patient safety benefits to residents of BC provided by the early assessment from the TI. Without an independent drug review body, drugs with potentially lethal side effects may persist in the market to be taken by unsuspecting patients, harming BC citizens and putting a greater strain on the healthcare system. We strongly believe that groups like the TI provide benefit for patients, healthcare providers, and the government in the forms of increased patient safety, unbiased healthcare information, and cost savings. To continue this work in advancing the best interests of our patients, we strongly believe that the TI requires dependable and sustainable funding to improve the health of British Columbians.

OUR PROPOSAL:

In summary, our recommendations on behalf of medical students in British

Columbia are the following:

1. Increase the support for independent pharmaceutical review groups in order to

create practice guidelines and prescribing recommendations based on evidence

based medicine:

a) Increase the Therapeutics Initiative’s funding to $2,000,000 per year.

b) Report on the current support structure of independent drug analysis

in British Columbia within the next fiscal quarter with specific

recommendations on its improvement.

2. Make a long term investment in funding educational programs for healthcare

professionals and patients in regards to evidence based medicine.

3. Maintain neutrality while increasing transparency of independent drug analysis

review groups in governmental organizations with no prejudice or bias from

private industries.

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References

1. Bassett K. (2006). Therapeutics Initiative - Role and Function. BCMJ, 48(4):163. 2. Silversides A. (2008). Highly lauded drug assessment program under attack. Can Med Assoc J, 179(1):26–7. 3. The Centre for Health Services and Policy Research. (2013). The Canadian Rx Atlas. Vancouver, The University of British Columbia.

4. VS editorial. (2013). Therapeutics Initiative has proven its worth. The Vancouver Sun. Available from: http://www.vancouversun.com/business/2035/Editorial+Therapeutics+Initiative+proven+worth/8336258/story.html 5. College of Physicians and Surgeons of British Columbia. (2014). Update from the Prescription Review Program. Available from: https://www.cpsbc.ca/for-physicians/college-connector/2014-V02-01/04 6. Canadian Institute for Health Information.(2013). National Health Expenditure Trends, 1975 to 2013. 17th edition. Available from: https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC2400 7. Auditor General of British Columbia. (2006). Managing Pharmacare: Slow Progress

Towards Cost-effective Drug Use and a Sustainable Program. Ministry of Health. 8. FDA. (2015). Congress Questions Vioxx. PBS NewsHour. Available from: http://www.pbs.org/newshour/bb/health-july-dec04-vioxx_11-18/

Authors:

David Kim, Sonja Babovic, Daljeet Chahal, Sam Minaker, Dennis Wang Policy committee; UBC Political Advocacy Committee; on behalf of the UBC Medical

Undergraduate Society

Contacts:

David Kim, Policy Coordinator davidshkim@alumni.ubc.ca David Klassen, PAC Chair david.klassen@alumni.ubc.ca

UBC Medical Undergraduate Society Medical Student & Alumni Centre

2750 Heather Street Vancouver, BC Canada V5Z 4M2

Web: mus.med.ubc.ca