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Ontario to force pharmaceutical companies to disclose money paid to doctors

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Ontario is planning to force pharmaceutical companies to divulge their payments to doctors, a major step toward transparency in the otherwise murky world of medical marketing in Canada.

Legislation the Liberals are expected to introduce on Wednesday would make Ontario the first province in which anyone could search a central online database to see if health-care providers or medical organizations have received money from the makers of drugs or medical devices.

Read more: The pressure of Big Pharma: Financial conflicts of interest common on medical guideline panels

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"This [proposed legislation] is about empowering patients and giving them tools and information so that they can make better, more informed decisions about their own health care," Ontario Health Minister Eric Hoskins said in an interview. "It's important to have this level of transparency and accountability. It creates even more confidence in our health-care system."

The information could allow patients to give more thought to accepting a prescription or to switch doctors if they feel their physicians have been unduly influenced by drug-company money. Others might use it to seek out practitioners who are involved with new treatments.

The legislation is loosely modelled on the Physician Payments Sunshine Act, a U.S. law that compels medical companies, including the big pharmaceutical players, to reveal how they compensate individual physicians for work such as delivering speeches, sitting on advisory boards, teaching continuing medical education classes and travelling to international medical conferences.

Australia, Japan and several European countries already have sunshine laws, but in Canada, information about payments to physicians and health-care organizations is shrouded in secrecy.

The Wynne government's legislation comes at a moment when Big Pharma's marketing tactics are under more scrutiny than ever, in part because of their role in the opioid crisis.

A study published last month in the American Journal of Public Health found that opioid makers paid more than $46-million (U.S.) to doctors in the United States between 2013 and 2015, with one in 12 U.S. physicians receiving payments.

The Trudeau government ordered an external review earlier this year of new opioid-prescribing guidelines after it emerged that one of the doctors who voted on the recommendations had received payments from opioid makers, information that would have been publicly available had Canada had its own open-payments law.

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The review concluded the opioid guidelines were scientifically sound, despite a flawed process for identifying potential conflicts of interest among panelists.

Dr. Hoskins said the proposed legislation will cast a wide net – one that would capture "transfers of value" made to 26 categories of regulated health professionals, including nurses and pharmacists, as well as to hospitals and other health-care organizations that might benefit from medical-industry largesse.

The onus to disclose the payments would be on the makers of brand-name drugs, generic drugs and medical devices that operate in Ontario, Dr. Hoskins said.

The question of a minimum cut-off for reporting – the United States uses $10 – would be sorted out in future regulations.

The earliest year for which companies would be expected to report is 2019, Dr. Hoskins added.

Andrew Boozary, the leader of Open Pharma, a group of high-profile doctors who have been calling for open-payments legislation in Canada, praised the Ontario government for taking the lead.

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However, he renewed his call for Ottawa to make disclosure rules national, which the Trudeau government has so far resisted.

(A spokesman for Ginette Petitpas Taylor, the new federal Health Minister, on Tuesday repeated her predecessor's position that the federal government, "will continue to look at ways to increase openness and transparency for Canadians.")

"There's been great leadership in Ontario to realize that this is an aching blind spot in our system and there needs to be action," Dr. Boozary said. "But hopefully this spurs action in other parts of the country and, hopefully, in Ottawa."

Dr. Hoskins said he, too, hopes Ontario's move will "inspire" his counterparts to pursue their own legislation.

The major medical-industry associations – which have not yet seen the proposed legislation – greeted the idea with a mix of cautious optimism and skepticism.

"We would like to work with the government and other stakeholders on the development of these new regulations, with a view to ensuring that they advance patient care, are practical, and are not excessively costly or burdensome for an already strained health-care system," Pamela Fralick, the president of Innovative Medicines Canada (IMC), said in an e-mailed statement. Her organization speaks for brand-name drug companies.

Brian Lewis, the president of Medical Devices Canada (MEDEC), which represents about 100 medical-technology companies, said his group "supports Ontario's objectives towards greater transparency in health care."

The pharmaceutical company GSK Canada, a member of IMC, was more full-throated in its support. "We're really happy with the news," said Annie Bourgault, the company's ethics and compliance officer.

GSK spent the past few years spearheading a voluntary disclosure effort that led to 10 brand-name pharmaceutical companies revealing in June that together they spent more than $48-million (Canadian) on payments to physicians and health-care organizations in 2016.

But releasing aggregate figures was roundly panned as meaningless, prompting the Ontario government to announce it would hold consultations over the summer on mandatory reporting.

Ms. Bourgault said GSK was especially pleased that the legislation would cover all companies that make patented medicines, generics and medical devices. "If that's how the legislation is framed, that's good news to us."

Joel Lexchin, a Toronto emergency-room doctor and York University researcher who recently published a book on the relationship between Big Pharma and Canadian doctors, said that when it comes to the "medical culture," Canada and the United States are very similar.

"In the United States, we know that payments are influencing what doctors do," Dr. Lexchin said. "There's no reason to believe that it's different here."

Opioid crisis is a ‘serious epidemic,’ Health Minister says (The Canadian Press)
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Kelly Grant is a health reporter with The Globe and Mail. More

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