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Ontario to force Big Pharma Disclosure

Bernnie Federko

TRIBE Member
Ontario to force pharmaceutical companies to divulge payments to doctors

Ontario is imposing financial transparency on pharmaceutical companies. Under proposed legislation, the province will force pharmaceutical companies to disclose their payments to doctors and medical organizations. The names and dollar figures will then be made public in an online database. The measure would allow patients, for example, to see whether their doctor has received money from a company whose medicine they are prescribing. The legislation is a first for Canadian province and follows the lead of the U.S. and other Western countries. The federal government has so far resisted calls to mandate disclosure rules on a national scale.
 
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praktik

TRIBE Member
I see this being both awesome and bad.

You will catch some seedy doctors. A few good doctors will get maligned and actually be ethically fine and making the appropriate recommendations.

Maybe that price is worth it?

Probably?

Just see a downside here that will likely impact a few people acutely.
 

praktik

TRIBE Member
More important IMO is Data Transparency. If this is handled then less worry about these doctor payments if it means a bit of a break on the promotion of drugs with questionable benefits, from this review of the excellent Bad Pharma: A Manifesto to fix the Pharmaceutical Industry:

Missing Data

Goldacre starts with missing data, the basis of his thesis and one of the most fundamental problems in medicine today. As I noted in a recent post on on clinical trials transparency, missing data compromises our evaluation of the evidence base, prevents science-based care, wastes resources, and ultimately, does a disservice to patients. If trials are conducted that don’t support efficacy claims, yet are never published, the evidence base becomes biased in favor of treatments and interventions. Goldacre summed up the issue concisely in a recent interview in The Economist:

If I were to run a study, and then just remove half of my data points so that my results looked much better, well, you would laugh in my face. It would be obvious to anyone that it was research misconduct. You might even call it fraud. And yet we tolerate the results of entire clinical trials—a huge proportion of them—being withheld from doctors and patients. In medicine, we rely on summaries of evidence, we collate the results from many different trials. So withholding the results of whole trials is exactly the same insult to the data as fraudulently deleting data points from within individual studies.​

There is ample evidence that the evidence base we are currently using in medicine is distorted exactly as Goldacre describes. However, the extent to which this has harmed our treatment evaluations is probably impossible to discern. Goldacre points out that this isn’t just pharma’s fault – research ethics boards, universities, regulators, and medical journals have all failed to follow-through on new standards for data transparency and access. Goldacre calls these “fake fixes”, such as the requirement from the world’s top medical journals to ensure that all published trials are registered before they commence – but the requirement isn’t subsequently enforced. These fake fixes extend to regulators who offer lip service on transparency, and even block access to the evidence they have used to determine if a drug should be approved for sale. Instead there is a “yes” or “no” decision, with little public sharing of the evaluation process and information considered. Goldacre makes an important point about regulatory decisions versus those made by health care professionals:

Contrary to what some regulators seem to think, a drugs is not either ‘good’ and therefore on the market or ‘bad’ and off it. A regulator makes a decision about whether it’s in the interests of the population as a whole that the drug should be available for use, at all ever – even if only is some very obscure circumstance, infrequently and cautiously. The bar is set pretty low, as we shall see, and lots of drugs that are on the market (in fact, the overwhelming majority) are hardly ever used.​

A doctor needs to use the same information as that available to the regulator in order to make a very different decision: is this the right drug for the patient in front of me right now? The simple fact that a drug is approved for prescription doesn’t mean it’s particularly good, or the best. In fact, there are complex decisions to be made in each clinical situation about which drug is best.

Goldacre concludes the chapter with an extended list of fixes, outlining ways to strengthen the checks and balances to ensure that the results of all human trials are made publicly available. Some are major policy issues, others are much more simple to implement. Would they improve transparency? Undoubtedly. Are these new issues? No. But the culture of complacency that exists in the health care system about this issue has so far been remarkably resistant to meaningful change.​
 

Bernnie Federko

TRIBE Member
Bruh, the skeezy shit that I personally know in the pharmaceutical sales game should be brought to light.

And in the finance world, conflict of interest by way of Tied Selling is regulated the fuck out of the game.

Why would it be acceptable in pharma sales and not pretty much everywhere else?

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praktik

TRIBE Member
Agree its a problem, but getting at data transparency helps undercut the game they're playing and gives other benefits besides - so I'm seeing multi-front approach. Financial transparency is, of course, a big deal and important too.

But also think some people will get targeted who don't deserve to based on line items in a report that don't actually mean, unless connected to other context, that the person is acting unethically.

Like I mentioned, I thought maybe the price would be worth it - but some innocents will be caught along with the Bad Apples.

For instance, activists on any number of issues will do FOIA requests and get information about "funding" and "emails" and its very easy to string a narrative together with just a few of these data points. Sometimes activitists take down deserving targets and shady characters. Sometimes they malign innocents based on fabricated narratives.
 
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kyfe

TRIBE Member
Agree its a problem, but getting at data transparency helps undercut the game they're playing and gives other benefits besides - so I'm seeing multi-front approach. Financial transparency is, of course, a big deal and important too.

But also think some people will get targeted who don't deserve to based on line items in a report that don't actually mean, unless connected to other context, that the person is acting unethically.

Like I mentioned, I thought maybe the price would be worth it - but some innocents will be caught along with the Bad Apples.

For instance, activists on any number of issues will do FOIA requests and get information about "funding" and "emails" and its very easy to string a narrative together with just a few of these data points. Sometimes activitists take down deserving targets and shady characters. Sometimes they malign innocents based on fabricated narratives.


they have the data and have been prosecuting some doctors on it presently. I think this is a good thing considering the overprescription of Oxy and other pharmasuticals. it is totally worth it as we already know who the doctors are that are overprescribing which can only be assumed as related to some type of monetary compensation. Now with full disclosure we can see how much some doctors are making at the sacrifice of their patients
 
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