Money for Nothing (and the drugs for free)

Doctors’ relationships with drug company representatives have changed, say knowledgeable readers. But for better or worse?

A recently-unemployed friend of mine went into a Victoria walk-in clinic in June complaining about unease he couldn’t explain, and walked out with enough free packets of the antidepressant Cipralex and the stimulant Ritalin to last for weeks. If he liked these drugs, the doctor said, he should come back and get prescriptions for more. “It all happened so fast, in less than five minutes,” my friend said with both fascination and wariness.

I was working at the time on last issue’s article about the drug company sales representatives who fill our doctors’ shelves with free drug samples (“Meet Your Doctor’s Generous Friend,” Focus July/August 2013). My friend showed me his packets, each prominently stamped “Sample.” It seemed very coincidental. However, over the next several months coincidental encounters with Cipralex kept occurring, and I started to wonder how coincidental it really was.

Meanwhile, as damning as my article was of the relationships between drug companies, their sales representatives, and local medical doctors, Focus and I received only a few critical responses. That silence started making me feel like the reality was even worse than the article portrayed. Where were all the doctors declaring their independence from drug company money? Where were all the drug companies and reps declaring, “We’d never engage in those kinds of manipulative, corrupt activities”?

This month’s letter to the editor from a drug sales rep reflects one criticism we did hear: Bill’s and Sam’s stories of working as drug reps in Victoria and Vancouver from 1997-2009 were dated and things today are different. As some folks told it, today many local doctors know drug reps as responsible professionals who deliver samples and, if there’s any interaction, it’s a collaboration in patients’ best interests, period. However, my response was, even if practices in Victoria have changed, most doctors practising today will have been influenced by activities going on here as recently as four years ago, and going on elsewhere still today, and therefore Bill’s and Sam’s stories are still relevant.

This point would soon be even more robustly illustrated to me as I gradually learned about the corrupt international history of Cipralex and its enduring local legacy.

Read the rest at Focus online.

“Curiouser and Curiouser”

Ruling on BC Police Chiefs contradictory and confusing. (Originally published in Focus, July 2013)

In May, Acting Deputy Registrar of Lobbyists Jay Fedorak issued a decision that the BC Association of Chiefs of Police (BCACP) and Municipal Chiefs of Police (BCAMCP) do not need to register as political lobby groups under BC’s Lobbyists Registration Act. Unfortunately, rather than providing clarity, Fedorak’s reasoning has merely fuelled questions swirling around the secretive activities of our police chiefs.

Deputy Registrar of Lobbyists Mary Carlson launched an investigation of the two police chief associations in October after I reported my questions about the associations to her (see Focus, November 2012, and May 2013). The associations were claiming to be “private groups” exempt from BC’s freedom of information laws covering public bodies. However, I asked, if the associations are actually private groups, aren’t they legally required to be registered and tracked as lobby groups, since they do a lot of political lobbying? (Police chief associations in other provinces are registered lobby groups in their provinces.) One way or another, I reasoned, our police chief associations have to be accountable to some laws covering either public or private entities, surely?

Carlson was actively investigating the case for months. However, Carlson suddenly went on leave. Fedorak took over in April and quickly issued a surprising—and surprisingly brief—decision.

Fedorak didn’t grapple with any of the actual substantive issues of the case. Only a single item of evidence was cited in his analysis—a letter of defense from the BCACP President. Fedorak wrote that he agreed with the BCACP President that “when police chiefs are participating in [the BCACP and BCAMCP], they are not ceasing to act as federal and local government employees or police chiefs… [They are working] on behalf of their respective local governments or the RCMP.” Basically, Fedorak concluded that these associations are simply comprised of police chiefs performing their normal public duties as public servants for public bodies, and therefore are not required to be registered as lobby groups.

Okay…except this is a strange conclusion for a number of reasons. Fedorak did not even address the fact that both associations have continued claiming the exact opposite to Focus and to the Office of the Information and Privacy Commissioner (OIPC); that is, the police chiefs have continued claiming to us that they are “private” groups not subject to public freedom of information laws. Fedorak also did not address the fact that the BCACP as of January became a registered non-profit society, and have long had their own independent budget and a non-government employee. And Fedorak also did not address the fact that the OIPC in September made the determination that the BCACP and BCAMCP “are not a public body.”

And all of this is even more peculiar considering Fedorak’s regular job is OIPC Assistant Commissioner. He was appointed temporarily to the Office of the Registrar of Lobbyist’s by Elizabeth Denham, who technically oversees both independent offices in her role as both Registrar of Lobbyists and Information and Privacy Commissioner. So Fedorak surely knew that the OIPC had previously concluded that the BCACP and BCAMCP are not public bodies, even as he was concluding in his role as the Acting Deputy Registrar of Lobbyists that the associations essentially are public bodies. He also would have known, or should have known, that the BCACP has continued refusing, as a “private” group, to provide copies of its archives through freedom of information processes, even though Fedorak in his ruling seemingly suggests the BCACP has been openly releasing all documents.

BC Civil Liberties Association policy director Micheal Vonn comments, “You can’t be apples in this basket and oranges in this basket. You are either a public, or private, entity. Because all citizens’ rights in relation to you depend on this distinction…Transparency and accountability issues hinge on this.”

Would Vonn call the decision of the Office of the Registrar of Lobbyist’s confusing, then? “Confusing is a fair characterization, but I think you want to go a little farther than that,” she answers. “We have a decision from another body [the OIPC] that comes to a completely contradictory conclusion. Not a different conclusion. Contradictory…This does not square. We need an umpire here to call this one, and we don’t have it at the moment.”

Interestingly, after a copy of a final communique with me about the case was emailed out to various parties, the Lobbyist Registrar’s contracted lawyer on the case, Frank Falzon, chose “reply to all” apparently accidentally. “I’m sure you’ll be hearing more on this issue,” Falzon wrote to Fedorak and another Registrar staff member.

Hmm, so apparently even the Registrar’s own lawyer doesn’t believe the case is as cut and dried as Fedorak’s decision made out?

I hope Mr Falzon is right; we at Focus would like to take all the outstanding questions about these police chief associations to a judicial review. Any lawyer out there who can offer pro-bono help?

Meet Your Doctor’s Generous Friend

Pharmaceutical companies have paid billions of dollars in fines in the US for giving bribes and kickbacks to doctors. Are their drug sales representatives behaving any differently in Victoria?

“Dinner and Yankee game with family. Talked about Paxil studies in children.” That note, written by a drug sales representative about his evening with a doctor and his family, was one of many records that forced GlaxoSmithKline (GSK) to pay a $3 billion fine to the U.S. government in 2012.

According to Public Citizen, since 1991, there have been 239 legal settlements between U.S. regulators and pharmaceutical companies adding up to $30.2 billion in penalties—a third of those in the past two years. Over half related to the kinds of activities that drug sales reps were doing in the GSK case: Reps promoted drugs with misleading information or for unapproved uses (the antidepressant Paxil carries government warnings against use in children), and gave doctors “expensive meals, weekend boondoggles, and lavish entertainment,” “trips to Bermuda and Jamaica, spa treatments and hunting trips,” and “cash payments” disguised as administrative reimbursements or consulting fees, all “to induce physicians to prescribe GSK’s drugs.”

The sheer scale of these cases is overwhelming, collectively involving dozens of multinationals, thousands of drug reps, and seemingly tens of thousands of doctors (although doctors have rarely been charged). And it shows no signs of abating, when such fines seem to be just the cost of doing business in a sector where profits rank with those of the oil and financial industries.

Notably, these same multinational pharmaceutical companies spend billions of dollars promoting the same drugs to Canadian doctors. And surveys show many Canadian doctors meet with reps monthly, weekly, or more often, regularly attend their educational events, and regard them as a primary source for information about newer drugs. Yet there’s never been any similar lawsuits in Canada. Do drug companies play nicer here, or are we just bigger dupes?

There are over 200 drug reps registered to visit Vancouver Island Health Authority facilities, and more visiting private doctors’ offices, but there’s no central tracking of what they’re doing. However, two former sales representatives who worked in Victoria and Vancouver for four different pharmaceutical companies agreed to interviews with Focus, and they make the case that most Canadians are dangerously in the dark. (Both men requested anonymity, which required removing identifying details of companies, drugs, and doctors.)

Read the rest at Focus online.

 

The Pharmacist of Film

Over 20 years, Bruce Saunders has built Movie Monday into one of Victoria’s most enduringly popular arts events.

 

The police looked uncomfortable the night they came to Movie Monday. We’d just watched Crisis Call, an absorbing, emotional documentary exploring often volatile, sometimes deadly encounters between Canadian police and people with severe mental health problems. After the film, host Bruce Saunders introduced us to two Greater Victoria police officers whom he’d invited to share their perspectives and answer audience questions.

One important point, though, in case you don’t know: The weekly film event Movie Monday takes place in a 100-seat theatre located at Royal Jubilee Hospital’s Eric Martin Pavilion, formerly the psychiatric hospital and today still home to various psychiatric services. Probably at least half the audience that night was comprised of people who had a mental health diagnosis or knew someone who had one, including Saunders himself, diagnosed as bipolar. The ensuing discussion revealed a lot about the challenges faced by all sides, but at times it understandably took provocative, tense turns.

Afterwards, one of the local police officers contacted the Vancouver Island Health Authority to complain that he’d felt “attacked” at the “poorly moderated” event. Rumblings circulated that VIHA might pull the plug on Movie Monday. Saunders anxiously contacted other audience members to write up their own observations of the evening; however, the most important letter came unsolicited: The other local police officer dropped Saunders an email saying he was recommending his department purchase the “excellent” documentary, and adding that he was impressed by Saunders’ “community-minded devotion” and felt “very good” about how “the police perspective was appreciated” by the Movie Monday audience.

“You don’t always have witnesses to your dealings with police,” says the 63-year-old Saunders to me with the kind of light-hearted smile that can only come years after things long since turned out okay. “Luckily for me, there were a lot of witnesses that night.”

Read the rest at Focus online.

Is the Law Catching Up to BC’s Police Chiefs?

The Office of the Information and Privacy Commissioner and the Registrar of Lobbyists are hot on their association’s trail. But a former BC police chief and solicitor general doubts they’ll ever be caught.

There’s one thing the police tell you never to do when they want to question you, right? Run. Running makes you look even more suspicious. So why do British Columbia’s chiefs of police keep running from me? Fortunately, I’ve gained some high-profile help in this now year-long chase. Read the rest at Focus online.