B.C.'s pharmaceutical watchdog marks 25 years of advising doctors, government

As a busy family physician and assistant professor at the University of British Columbia, Dr. Rita McCracken is often flooded with information about new treatments for her patients. 

"I regularly feel completely overwhelmed in my clinical practice," McCracken said. "I feel like I might miss something and that the stakes are really high."

Hundreds of studies on new pharmaceutical treatments get published every day. Not only does McCracken not have time to read them all, she doesn't have time to sift through the details to separate fact from fiction. 

As a physician and a researcher, McCracken wants to know if new drug treatments will actually be useful to her patients or if the results may have been biased by researchers with ties to the pharmaceutical companies that manufacture those drugs. 

"There are a lot of benefits for people from pharmaceutical drugs," she said. "However many benefits are oversold, the quantity of benefit is misperceived. And also there's a very poor articulation of the possible harms associated with drugs." 

Key government influencer

Over the years, McCracken has learned to turn to trusted sources for information. 

Friday morning, she shared that knowledge with her peers at the Therapeutics Initiative conference in Vancouver. McCracken is the co-chair of the initiative's quality prescribing working group.

The University of British Columbia-based Therapeutics Initiative was created by Mike Harcourt's NDP govermnent in 1994 when the provincial government felt it needed independent advice about which drugs to pay for.

The initiative still gets about $2 million of its funding from the province, as well as funds from research grants. 

At its conference this weekend, the initiative is celebrating 25 years of practice. It still advises the province and also physicians across B.C., mainly in the form of newsletters that critically examine new drug treatments and research.

To avoid any conflicts of interest, the initiative forbids its key members from working with any drug manufacturers.

Ensuring value

Alan Cassels, the initiative's director of communications, has worked with the group on and off since it started. 

"PharmaCare in British Columbia is probably better than any other province in the country in terms of making sure that, when they pay for drugs, there's value," Cassels said from the basement of Robson Square, where the conference was taking place.

Cassels says the Therapeutics Initiative is one of only a handful of similar institutions across the country, and one of only a few dozen around the world. 

About a third of physicians in B.C. have regular and frequent contact with pharmaceutical companies, he says, adding that research has shown that those who do are the most likely to prescribe unnecessary or potentially harmful medication. 

Not all on board

Not all doctors are on board with the initiative's work.

Psychiatrist Dr. Diane McIntosh, who recently wrote the book This is Depression, says work by the Therapeutics Initiative has kept specialists like her from treating patients with the latest medication.

"We need to have a strong pharma industry in this country if we're going to change the world of mental illness," McIntosh said over the phone.

"If we don't have innovation, if we don't have research and development, we will not have new treatments." 

McIntosh says she doesn't think the province should continue to fund the Therapeutics Initiative because, in her view, it spreads misinformation based on inaccurate, cherry-picked data that's inconsistent with Canadian clinical practice guidelines. 

She says she admits without shame that she works with several pharmaceutical companies, either giving talks or sitting on advisory boards, because she wants to help find new treatments for severe mental illnesses.

'Still a huge need'

But Cassels says more needs to be done, not less, to ensure patients in B.C. get adequate treatment that isn't hyped by drug makers.

Cassels would like to see a system like the U.S Sunshine Act which forces doctors to disclose any money or items of value they have received from manufacturers of drugs and medical devices. 

"There's still a huge need for us to deconstruct the medical marketing and certainly the sort of promotional messages that come around new pharmaceuticals," he said.

"It's really important that doctors get access to unbiased assessments of those drugs."