Trevor Hancock: Opioid deaths are a massive ethical failure

The epidemic of opioid deaths that Alan Cassels wrote about last week (“Tackling causes of Canada’s opioid epidemic,” comment, May 10) is a particularly dramatic example of a larger problem. He noted that physicians “have been giving too many patients excessively powerful opioid medications to deal with modest pain.”

But the interesting question is: Why? Cassels traces their prescribing patterns to the marketing activities of the pharmaceutical industry.

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This is an issue that has concerned me for decades. As a family physician in the late 1970s, I refused to meet the numerous drug reps (let’s be blunt — drug pushers) from the pharmaceutical industry who did the rounds of physicians’ offices. They were slick, well-trained and persuasive. But while dressed up as “education,” their activities were simply attempts to get you to prescribe their product.

What your doctor prescribes should be based solely on the evidence, not the marketing spin of big pharma. This marketing can distort the evidence, thus doing a disservice to both patients and physicians. I took the position that the best information about the merits of these drugs was the impartial evidence reviews available through The Medical Letter and similar publications.

The Medical Letter describes itself as “a nonprofit organization that publishes critical appraisals of new prescription drugs and comparative reviews of drugs for common diseases,” and it has done so since 1959. It does not accept grants, donations or funding from anyone, does not accept advertising and does not sell reprints to industry for promotion.

In short, it is a highly ethical, independent, unbiased, science-based source of reliable information — and it should be all that physicians need.

So I propose that the various colleges that license physicians across Canada increase the licence fee so as to include a subscription to The Medical Letter or any similar resource. That way, we could be sure that all physicians had access to reliable information, and they would have no excuse for being unaware of the latest impartial evidence.

But the colleges need to go much further in re-establishing ethical control over physicians in their interactions with the pharmaceutical industry. To ensure that physicians base their decisions on the evidence, it should be declared unethical for physicians to meet with pharmaceutical-industry marketers. This would have numerous benefits in addition to preventing the highly biased and self-serving “education” of physicians by the industry.

First, physicians would not be wasting their time with these representatives. Second, as the drug reps would be laid off, the companies would save a pile of money that could be passed on in the form of lower drug costs. That should be coupled with a cessation of advertising, which is just as bad, and also very costly. The savings to patients, governments and health insurers would be considerable.

And of course, patients would be treated based on evidence alone, not on expensive and slick marketing, which should improve quality of care and patient safety.

Receiving any kind of reward (let’s be blunt — bribe) from the industry should also be considered unethical behaviour. In fact, the Canadian Medical Association’s 2007 guidelines on physicians’ interactions with industry are clear: “Practising physicians should not accept personal gifts of any significant monetary or other value from industry” — although “significant” is a slippery word that is hard to define, which is troubling.

And yet a Toronto Star investigative report published Feb. 16 described an “educational” event involving a three-course dinner with wine, followed by a presentation highlighting the sponsoring company’s product. The Star found that “drug companies routinely host and fund these dinners at upscale restaurants as training events for family doctors.”

So ask yourself: Would you want your doctor to be learning about the drugs they prescribe while enjoying a free meal from the manufacturer, or is that a gift that should be prohibited?

The marketing of pharmaceutical products to physicians, and the unhealthy consequences of that marketing, represents a profound ethical failure on the part of the medical profession, and especially the licensing bodies, to adequately police the profession’s interaction with the pharmaceutical industry. It is time they took strong action to protect us.

Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

thancock@uvic.ca

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