Editor’s Note
This article examines the ethical concerns surrounding undisclosed financial relationships between physicians and pharmaceutical companies, highlighting a specific case in Canada. It raises important questions about transparency and potential conflicts of interest in medical practice.
Experts warn that payments from drug companies to doctors — through speaking fees, research grants and other sorts of funding — might create conflicts of interest that could influence a physician’s decisions about how to treat their patients.
By invitation only, 300 Canadian doctors have a chance to earn $6,600 on top of their usual public health-care fees by taking part in some research.
Here’s what they have to do: sign up 12 high-risk heart patients, see each of them three times as part of normal practice, and fill out forms describing what drugs were prescribed.
The doctors get an additional $500 for attending a three-hour information session about the research. It’s called the Guidelines Oriented Approach to Lipid Lowering (GOAL). And it is one example of how doctors receive money from outside the public system, often from the pharmaceutical industry.
GOAL is funded by Amgen, a pharmaceutical company. But it’s being conducted by a private research organization called the Canadian Heart Research Centre, which is chaired by Dr. Anatoly Langer. He designed the program and applied to Amgen for funding.
GOAL’s objective is to monitor whether doctors are following new guidelines when treating high-risk heart patients whose LDL cholesterol (so-called “bad” cholesterol) remains high despite taking commonly prescribed cholesterol-lowering drugs, called statins.
— Dr. Todd Anderson
If doctors follow the guidelines, they could put patients on additional drugs, potentially including a new one made by Amgen, called Repatha, which costs about $8,000 per year and is not covered by public drug plans.
Apart from the funding, Langer says Amgen has no further involvement in the program. The research is approved by independent ethics review boards, and the fees to the doctors are modest by industry standards, he says.
The company calls GOAL an “investigator initiated study” conducted by independent researchers.
“Amgen only supports these studies following a medical review to determine scientific merit,” the company said in a statement to CBC News. It referred all questions to Langer.
Langer calls GOAL a “natural interest for all parties” because it reminds physicians to practise according to the guidelines, which are set by a committee of the Canadian Cardiovascular Society (CSS) to recommend best practices when it comes to lowering lipids.
But a closer look at that committee is another example of the financial relationships that exist between Canada’s doctors and the pharmaceutical industry.
Almost everyone on the 22-member committee received money from Amgen or other pharmaceutical companies.* Only two received no funding.
Yet according to the committee’s own rules, no one with conflicts is allowed to vote on its recommendations.
So how did they manage the voting? The honour system. Each person made his or her own decision about whether they had a conflict of interest.
Across Canada, doctors are paid to sit on drug company advisory committees and to give industry-funded talks to other doctors. They also receive funding for research and are frequently asked to enrol patients in trials to test new drugs. The higher their profile, the more likely they are to receive industry funding.
Prof. Matthew Herder of Dalhousie University says many leading cardiologists at Canadian universities have received money for giving talks, sponsored by the drug industry, to other doctors.
Herder reviewed the industry relationships among leading cardiologists at Canadian universities and found many had received money for giving industry-sponsored talks to other doctors.
The issue made headlines recently, after Health Minister Jane Philpott ordered an independent review of new opioid guidelines because one member of that committee that voted on recommendations had received fees from Purdue Pharma and other companies that make opioid drugs, even though no one with any industry ties was supposed to vote.
