Did You Know ?

[Hazelgreen]

I recently joined the Canadian news outlet, Global News, as I came across an article by two of their reporters, Andrew Russell & Caryn Lieberman (Global News), dated August 19, 2019. The opening summary read as follows:

"The 10 largest pharmaceutical companies in Canada gave more than $151 million to doctors and hospitals across the country over the last two years. But unlike the U.S. and many European countries, Canada has no legislation compelling drug companies to reveal which health-care providers got money or what it was for.

Now, experts and medical researchers are calling for greater transparency around the millions of dollars shelled out each year, as multiple studies have shown that even small transfers of value can have an effect on how physicians prescribe certain drugs."

I guess I was too busy with my own diagnosis in 2019 to pay enough attention to the news, but I wondered how many of you were aware of this problem. Do those of you in other countries check whether your oncologists receive payments from drug companies? I fully realize that many physicians don't have the time, inclination, or statistical background to read research studies but I hate to think that their prescriptions are mostly influenced by what they are told by the drug reps who visit them.

Since we have socialized medicine in Canada, it is very important that those oncologists who serve on the provincial committees approving cancer medications form their recommendations solely on the basis of research findings.

[jersey-jazz]

You've highlighted a bad practice.However, how would one go about finding the answer to your the question?

[TammyCross]

Great point. In the US, how do we find out? -- As you know, I am on a clinical trial. Not too worried that my oncologist may be getting paid.. It is just a good thing. It also has brought in nurses to run the trial, and they are pretty good. Better than the regular nurses who work with the oncologist, as far as I can tell. (By "good," I mean can answer questions, seem to be knowledgeable.)

[jersey-jazz in reply to TammyCross]

Dear Tammycross--That's brilliant! I'm glad for you. It is always so reassuring to be around knowledgeable nurses and doctors. When we intersect with those kinds of professionals, we can relax and let it happen, let them be in charge of your health. Otherwise, we have to take charge and run the business.

[NPmary]

I live in the US when l Google doctors or check them out on hospital web sites l find this information easily. Thanks for sharing your thoughtful post. I have found most docs up front and honest about participation in research and objective in their analysis of research.Disclaimer: l used to work in health care and am aware that there have been unscrupulous fellows (but never personally aware of this in oncology).

[Hazelgreen]

Hi Sandra,In Saskatchewan, all staff salaries and payments over $50,000 are published in the annual report for the Saskatchewan Cancer Agency. Thus, I know that the Medical Professional Corporation my oncologist owns made $480,667 last year. Pfizer Canada received $3,062,500 while Novartis Canada (distributor of the ribociclib and letrozole I'm currently taking) wasn't listed so I guess that company isn't receiving $50,000.

Undoubtedly, many, if not most, physicians do not profit directly from big drug companies. I was not intending to cast aspersions on them all, or even the majority. I think those I'd be most concerned about are those who serve on the provincial committees approving cancer medications. There are less ethical types in all professions.

I am glad for you that your oncologist is a friend whom you admire. Mine isn't a friend but I like him well enough.

Regards,

Cindy

[Hazelgreen]

Hi Sandra,

I didn't mean to imply that the "the physicians that sit on the provincial committees are likely profiting" because I simply don't have a clue.

After reading your above response, I went to the site termed Pan-Canadian Oncology Drug Review (pCODR). It is said to be made up of individuals with "expertise in cancer drug therapy, drug evaluation and drug utilization, and patient members (for a lay perspective)". Its conflict of interest guidelines seem well laid out. I felt reassured that clearly the issues of concern are well recognized.

Given my interest in the cost of specific drugs, I copied several submitted economic evaluations from the pCODR website. Tamoxifen is by far the cheapest at $9.80 per 28-day course, followed by letrozole at $38.58, fulvestrant at $1165.79, ribociclib at $5332.95 / $6249.99, and palbociclib at $6250.02 all per 28-day cycle.

The two costs for ribociclib were dated March 19, 2020 and March 15, 2018. I assume there were additional negotiations to bring the cost down?

I didn't read any dates for drugs being added to specific provincial drug formularies. The BC drug manual dated its pages 2017 for palbociclib and 2018 for ribociclib for whatever that meant.

Cheers,

Cindy

[jersey-jazz in reply to Hazelgreen]

Ibrance was prescribed for me. I refused to take it because the woman on the phone told me that it was over $17,000 but that it was doable because the insurance companies pay the companay most of that and that it would only be $2,000 per month ,at the most, to me. And, where do the insurance companies get the finances to pay companies like the Ibrance company? Bingo! Our ever -increasing premiums cover their asses- ets.

[Hazelgreen in reply to jersey-jazz]

The Pan-Canadian Oncology Drug Review (pCODR) has the advantage of negotiating with the drug companies for all of Canada (except Quebec?) so presumably is talking about a much larger number of patients than individual insurance plans. Still, I wonder whether it "guarantees" a certain number of sales...

[AvidBooklover]

In the US, on the Sloan Kettering website they now have what the doctors are participating in, as far as trials or studies.

[Adele_Julia]

I am in the U.S. and would love to get my hands on the monthly list of new oncology medications. How do we go about that ? For example oral Faslodex or other breast cancer repeated drugs. ! Thoughts?

[Adele_Julia]

Great thank you !!!

[Hazelgreen]

I agree with the Canadian reporters in the 2019 article I mentioned above. Canada needs to pass "legislation compelling drug companies to reveal which health-care providers got money or what it was for". Given that Canadian taxpayers, not individual insurance companies, pay for the drugs Canadians use, it is socially responsible to know exactly what is happening.

Apparently, the US and Europe already have such legislation. If that is the case, the information should be in the quarterly or annual reports of the relevant branches of the drug companies in those countries.

I don't think it is necessarily wrong for individual physicians to contribute patient data to clinical trials or research studies. However, all details should be provided openly to all concerned. What needs to be prevented is physicians prescribing meds solely on the basis of what they are told during a golf game, for example, by a drug rep. (A psychiatrist I used to know thought it funny that drug reps treated him to course fees, etc.)