In the swirl of drama surrounding mass firings at B.C.'s health ministry, a critical fact has gone unnoticed. The strongest drug-management program in the country has been all but wiped out, and the damage may never be repaired.
Five employees in the ministry's Pharmaceutical Services Division have been dismissed, and three researchers with crossover appointments at the University of Victoria have been suspended without pay or had their contracts terminated.
Nothing like this has ever happened in Canada. Nearly all of the ministry staff were respected, long-term employees. Dr. Malcolm Maclure, one of the university researchers suspended, is an adjunct professor at Harvard with an international reputation.
Much of the public concern has focused on the vague explanations for these firings. Several of the workers say they have no idea why they were let go. At a minimum, the government's communication effort has been woefully inadequate.
But this wasn't just a cleanout of some dust-filled back room. The ministry has gutted an essential front-line service.
In Canada, the federal government is theoretically responsible for licensing pharmaceutical products. But in practice, most provinces carry out their own assessment to decide if new drugs are safe or cost-effective.
In B.C., two groups handle this responsibility. One is an independent watchdog agency at the University of British Columbia called the Therapeutics Initiative.
But the province withdrew its funds last year, and staff have been given layoff notices.
The second line of defence lay with the ministry researchers who have just been fired or suspended. When the axe fell, they were investigating an Alzheimer's medication, an anti-psychotic drug used on children and a preparation intended to help smokers give up the habit.
At a stroke, both components of the drug-review apparatus have been crippled. Who will do this work now?
If the question is left up to drug companies, the answer is, no one will. This kind of research is fiercely opposed by the industry.
They take the view that once Health Canada has granted a licence, that is the end of the matter. It was a decade-long campaign by the industry that got the Therapeutics Initiative killed. And there are numerous instances around the country where the industry has used its clout to stifle similar research.
Yet B.C.'s drug-evaluation process is widely recognized as enormously successful. B.C. spends less on medications than other provinces, because our drug researchers weed out marginal performers.
And several times in the last decade, researchers here have given warnings that saved lives. The anti-inflammatory drug Vioxx caused thousands of deaths worldwide before it was withdrawn in 2004.
But B.C. drug researchers saw this danger from the outset, and kept Vioxx on the sidelines. Their insight saved scores of lives.
How is this essential task to be performed, when the government shows so little commitment to it?
It may indeed be the case that the minister of health, Dr. Margaret MacDiarmid, has evidence that necessitated these firings. In that event, she would be well-advised to demonstrate, at least in general terms, the nature of her case. For the treatment she is dispensing has all but killed the patient.
Moreover, actions like these make waves. Fairly or otherwise, the message is that taking on the drug industry in B.C. is now fatal to one's career.
In short, there are much bigger issues at stake here than indiscretions, real or alleged. The question is how to rebuild a credible drug-assessment program, once the dust has settled.
The minister and her predecessors have proved adept at dismantling structures that took decades to build. We will watch with interest to see how she goes about the task of reconstruction.
© Copyright 2013