Meeting Summary by Rachel McCready
Why does the Canadian public love to hate the pharmaceutical industry? And, more usefully, what the heck can we do about it?
That, acknowledged André Picard, public health reporter for The Globe and Mail, was the real subject of his presentation to the OPMA on November 2—not the simple counting exercise
André Picard, The Globe & Mail
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Calling on his access to the Canadian public and policy makers during more than 20 years as a health journalist, Picard reviewed several factors contributing to the public’s (dis)regard of our industry, followed by an intriguing suggestion for an approach toward a solution.
So here we have Ten Factors Contributing to the Canadian Public’s Disregard for the Pharmaceutical Industry:
1. Drugs are a huge and growing expense
In Canada, drugs are a $30 billion-a-year expenditure ($25 billion for Rx products). And it’s not just the number, but the growth of the number that freaks people out. In 1986, Picard recalls that Rx spending was $3 billion. A ten-fold increase in a little over 20 years is bound to make policy-makers nervous, especially when nothing else in public policy has grown at that rate.
2. We’re all rolling in dough (har har!)
There’s an assumption that drug companies are wildly profitable. (I know, I know. If you’ve read FirstWord—or a pink slip—lately, you would know better. But it seems that much of the Canadian public is a bit behind on their FirstWord updates.)
Picard says the impression remains that making drugs is like having a “license to print money.” The drugs people hear about, he says, are the blockbusters that sell millions of prescriptions each year. No one thinks about the massive investment it takes to make that pill, or the “many little drugs” that take the company years to develop, but only ever sell a few prescriptions. (Not to mention patent expiries).
3. Canada’s seniors are “a generation of junkies”
Canada’s consumption of prescription drugs is second only to the US, at about $900 per person, per year. This leaves the Canadian public with the impression that we’re an “over-medicated” society, says Picard. But is it as simple as “we take too many drugs?” No—it’s far more complicated than that: Picard points to a mix of over-use, under-use, and mis-use as the real story. But that’s subtle and complicated, and Picard notes that “subtlety is difficult to write about.” Instead, we hear stories about seniors, Canada’s “generation of junkies,” like Picard’s late mother who after a medication review had 12 of her 14 prescription medications thrown away.
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Yes, drugs can do harm (anyone who has sought to have a drug ad approved by the PAAB knows this all too well). But Picard says that, as a society, “we’ve lost track of the fact that risks do exist.” We may not like to talk about side effects, but Picard suggests that we ignore them at our peril. Better, he says, to be realistic about benefits and frank about side effects to maintain trust and avoid fallout when side effects do make the news.
He reminds us of the landmark Baker-Norton Report, which revealed that up to 24,000 Canadians die of medical adverse events each year, about half of which are drug-related. Though much of this harm is due more to the prescribing system than the drugs themselves, such reports fuel the fire directed at the pharmaceutical industry.
5. Our drug approval system doesn’t filter out “me too” drugs that add noise without adding value
The current system for drug approval in Canada is based on a positive review of evidence that a drug confers more benefit than harm. That’s it. What’s missing, says Picard, is the onus of demonstrating superiority versus an existing drug, or superior cost-effectiveness—a test built into approval processes in countries like Australia. Our system results in a lot of “me-too” drugs (new drugs that are superior to placebo, but not necessarily better or different than anything else on the market).
Picard sees these “me too” drugs as a cost-driver in the system, without adding a lot of value, giving reporters something scandalous to write about and further adding to the impression that we’re “peddling all this crap” at an unwitting Canadian public.
6. We can’t get access to drugs that would help us
The flip side of our Approve-All-Comers-That-Do-More-Good-Than-Harm system is that we’re slow to adopt, and even slower to pay for, new drugs that would, in fact, improve care. So, although we have stories about rampant increases in drug expenditures, we also have stories about Canadians not being able to access critical treatments.
Picard says that the lack of Pharmacare as part of Canada’s Medicare system isn’t rationally-based, but coincidentally-grandfathered: “We’re going to cover hospitals and doctors, but drugs aren’t necessarily in there because we didn’t write that in 1965.” And now, the fear that “Pharmacare would bankrupt the system” keeps the issue from being seriously considered.
7. Canadians don’t know that they’re getting a great deal
Perhaps due in part to barriers to access, there’s a pervasive impression that “drugs are expensive.” Notwithstanding what we know all too well about the challenges associated with getting a drug’s price approved in Canada, and that our resultingly low prices attract Americans like wedding crashers to a buffet, the impression that drugs are expensive remains.
And statistics like “in Canada, 52% of prescriptions are for brand-name drugs, but brands account for 82% of drug costs” don’t help, creating the impression that brand-name drugs are over-priced, and generics are the good citizens willing to help a brother out.
8. Generics are seen as the heroes of the industry
Picard says the fact that brand-name drugs cost more than generics shouldn’t be surprising. After all, it costs more to develop brand drugs than generics, and brand companies don’t “cherry-pick the profitable ones.” But the public perception remains that “generics are cheap, and brand names are expensive.” And generic companies have created a system of access to patients through pharmacists, well-oiled by “professional allowances,” and implicitly endorsed—a public policy that Picard describes as “odd,” yet deeply engrained in the status quo.
9. The most profitable drugs are often the silliest
When you’re explaining what you do to someone you’ve just met, how often does Viagra come up in the conversation? Part of the problem, says Picard, is that the less-critical drugs, the “Viagras and Rogaines” of the world, are the ones the public knows about, contributing to a general sense that the pharmaceutical industry isn’t making an important contribution to society. (Certain among my male associates of a certain age may disagree, but I digress…)
10. “Pseudopharma” is trashing the legit industry… and we’re taking it lying down
So, who is fuelling this impression that the pharmaceutical industry is greedy and not to be trusted? Picard points to certain culprits from the industry I’ll call “pseudopharma”—purveyors of untested and unregulated “health” products who make unsubstantiated claims for their own products while arguing that “Big Pharma” is out to medicate us all into our graves—and fighting the battle best where it matters most these days: cyberspace.
It’s the pseudopharma industry, says Picard, that perpetuates the conspiracy theories about the pharma industry that he is exposed to on a daily basis in his work as a health journalist. (An example that recently crossed Picard’s desk: “H1N1 was created in a lab so the pharmaceutical industry could sell vaccines.” This is what we’re dealing with.)
Of course, there will always be conspiracy theorists, but as Picard says, the problem begins when
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How will evolving public policy change the way the Canadian public relates to the pharmaceutical industry?
Public policy governing the pharmaceutical industry is slowly changing, and Picard points to the UBC-issued document, Toward a National Pharmaceutical Strategy—with its recommendations such as strengthening the Common Drug Review process, investing in electronic medical records, and establishing an independent agency for drug safety—as the shape of things to come.
Surely, the guiding principles in this document will contribute to a changing reputation for the pharmaceutical industry over the years to come, but change will be gradual and largely out of the industry’s control. Picard doesn’t advocate waiting, though, and he offers a suggestion to spruce up our own backyard in the meantime.
Have you driven a research-based pharmaceutical lately?
Why does everybody pick on the pharmaceutical industry? Partly because it’s easy: Picard describes the pharmaceutical industry as a “big, fat, juicy target that doesn’t fight back.”
He points to automakers, which he, an “obsessive pedestrian,” describes as among the most “murderous” of industries, as a contrasting model. The auto industry, he says, has been massively successful in establishing itself as a boon to society—a fundamental backbone to the economy. Picard points to recent government bailouts as evidence of its success in establishing itself as critical to North American culture.
Learning to play the media game
Where to begin? For starters, Picard says we need to be trickier and more aggressive than we’re used to being, like the auto industry, which “goes after its opponents with both fists.” Canadian Pharma, suggests Picard, should take a similar stance if it wants to play the media game to its advantage.
Feel-good industry-sponsored ads featuring “cute kids cured of cancer” aren’t going to cut it. Instead, we need to take advantage of the fact that “in media, we write about negative stuff.” Picard suggests calling out the negatives of our detractors to draw attention to our own positives – a play that would be more tantalizing to the bad-news-feeding media.
Would a campaign drawing attention to the unsubstantiated claims and lack of regulation in the pseudopharma industry draw attention to the rigour applied to legit pharma? There’s only one way to find out…
They would like us if they knew us
Ultimately, Picard says that most Canadians would appreciate the pharmaceutical industry far more if they understood it better. Why wouldn’t they? We make lifesaving and life-improving treatments that are proven to work; we employ thousands of Canadians; and we support health research and education.
The trick will be to engage the Canadian public, media, and policy-makers enough to motivate them to get to know us.
So, is “pharma” a 4-letter word? Only if we “#@!*ing” let it be.
About the Author
Rachel McCready is Creative Director at CPC Healthcare Communications. She can be reached at rmccready@cpchealthcare.com