Healthy Skepticism Library item: 8776

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Publication type: news

Cassels A.
Common Ground needed on drug pricing:
Victoria Times-Colonist 2007 Mar 8
http://www.canada.com/victoriatimescolonist/news/comment/story.html?id=c197f6b3-2af3-44c3-9f22-3ca1393cc60e

Full text:

Integrity a must in health care’s public consultation process

Two health conferences in Vancouver last month asked important questions: Can the public be meaningfully involved in developing and maintaining an overall vision for Canada’s health-care system?
 
And furthermore, what is the value of medicines?
 
These are both good questions, not just because the provincial government’s Conversation on Health is in full swing but because our answers will determine whether health care can be sustainable over the long-term or becomes increasingly divided between those who can pay and those who cannot.
 
It is hard to argue against taking the time to listen to citizens when shaping health policy, but there is a danger when those voices get co-opted by associations, disease or lobby groups funded by the pharmaceutical industry.
 
In my research those groups, while well meaning and a great support to many, often have agendas which are portrayed as being in the public interest, but aren’t.
 
In our book Selling Sickness, we used the term “Astroturf” to distinguish industry-funded health groups from real grassroots movements. Astroturf is green and looks like grass, but if you look beneath you find nothing that resembles roots.
 
Pharmaceutical companies, guided by public relations experts, seek to cultivate patient groups to build support not just for products, but ideas.
 
In B.C., we have a superb home-grown example in the “Better PharmaCare Coalition.” It’s composed of disease advocacy groups who, supported by pharmaceutical money, help reinforce the industry’s messages that citizens need more drugs, faster, and the government should pay for everything.
 
I was introduced to Astroturf groups more than a decade ago when a controversial PharmaCare policy called reference-based pricing was being introduced to B.C. This coalition sprang up out of nowhere to challenge Pharmacare’s new policy, fighting a pitched public relations battle using lobbyists and full-page newspaper ads demanding that the government “stay out of our medicine cabinets.”
 
I was administering a research project at the time trying to assess the impacts of such drug policies on B.C. seniors.
This public display of distaste for reference pricing contrasted with what we were hearing from the dozens of focus groups held with seniors around the province. They were telling us that reference pricing seemed rational.
 
With reference-based pricing, the government was trying to do what anyone does when faced with major purchasing decisions — comparison shop.
 
To these seniors, anyway, reference pricing showed good stewardship of public dollars. I remember one saying: “You mean the government wants to pay for the cheaper drug first? And we can still get the more expensive one if we need it? Well, that’s a no-brainer — who could be opposed to that?”
 
The Astroturf groups were opposed to that. And they still are.
 
But our focus groups actually tapped into genuine grassroots sentiment and provided opinions that weren’t twisted or shaped by buckets of pharma money.
 
We need to be reminded that these same Astroturf groups are attempting to insert their voices in the conversation on health.
 
Seniors especially are understandably worried about the sustainability of our health-care system. They want access to a range of drugs paid by Pharmacare, but they also question the value of medicine. I’ve found that B.C. seniors largely resent being ordered to swallow up to a dozen pills a day and spend their limited pensions on trying to afford them.
 
Astroturf patient groups have one thing in common: They consistently push for the government to cover the newest and most expensive treatments, ignoring the irrefutable fact that new drugs often replace drugs which are just as effective, often much cheaper and sometimes a lot safer.
 
In 2000, the blockbuster drugs Celebrex and Vioxx entered a crowded Canadian market of more than 20 arthritis drugs.
They were widely prescribed and taken by millions with no proof that they were more effective or safer than older therapies costing one-tenth as much.
 
Arthritis groups, funded in part by drug manufacturers, were at the forefront, lobbying for taxpayers to cover these drugs.
 
To what effect? Millions of people taking drugs that were more dangerous, increased risk of heart attacks and billions in wasted pharmaceutical spending.
 
What’s the solution? It’s not easy to ask patient and disease groups to kick their drug-funding habit, but they’ll have to if they want to be seen as credible.
 
If we want a sustainable system, everyone involved in making drug purchasing decisions — governments, doctors and especially patients — need to be on the same page pushing for public coverage for the most effective, safest and cheapest therapies that do the job.
 
Canadians are rightfully concerned about maintaining a health-care system that provides effective and affordable care.
Camouflaged patient groups don’t fool me any more and they shouldn’t fool the policy makers.
 
This is a question to the conversation on health organizers: How can the B.C. public be assured that the Astroturf groups haven’t invaded and contaminated the process and that the ‘real’ voices of B.C. citizens are being heard?
 
In other words, tell us you’re going to lift the grass and see if there are any roots.
 
Alan Cassels is a drug policy researcher at the University of Victoria and co-author of Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients.