Sunshine at last
The era of secret payments, gifts and benefits given to doctors and other health-care professionals by drug companies and medical device makers is coming to an end in Ontario, and not a moment too soon.
Health Minister Eric Hoskins introduced legislation on Wednesday that will compel those companies to publicly report cash payments, free dinners, trips and other benefits they dole out to provincially regulated health-care professionals and organizations, such as hospitals.
The information will go into a database that will be searchable by name so patients can, Hoskins said, “make better decisions about their own health care.”
Canada has lagged on this important issue behind countries such as the United States, Australia, Japan and many European nations that long ago set up transparency laws to shed light on the relationship between drug companies and doctors.
If the legislation is passed, Ontario would be leading the country in shining a spotlight on a practice that some worry influences doctors to prescribe a particular drug over an equal or better one. Worse, some critics believe it leads doctors to over-prescribe drugs, and over-diagnose illnesses in general, rather than focus on other measures that could improve a patient’s health, such as diet and exercise.
In fact, the current opioid crisis is blamed partly on the overprescribing of that medication by doctors whose patients then became addicts.
Still, the devil may be in the details. The legislation has been left purposefully vague on some points so they can be worked out through consultations and then carried out through regulations that are still to be written.
On the face of it, that’s fine. But Hoskins should make sure the intent of the legislation — to shed light on possible conflicts of interest — does not get watered down in the process.
For example, the legislation does not state what the threshold is for reporting.
In the U.S., for example, any cash or gift valued at over $10 must be reported. While $10 may seem too little to worry about, studies show that meals worth less than $20 can have an impact on a doctor’s prescribing habits. So the threshold here should be $10, too.
Nor does it spell out exactly how detailed the reporting must be. For example, should amounts paid to health-care professionals or organizations be itemized, so patients can see exactly what was given out — whether it was a cash for a service, a free trip to Europe for a conference or tickets to sporting events, for example? The particulars are important to see the overall picture.
Finally, the legislation raises the thorny question of whether healthcare professionals should even be getting their “education” on drugs and medical devices from manufacturers at fancy dinners and out-oftown conferences in the first place. While that isn’t dealt with in this legislation, it should be studied.
This legislation is a welcome effort to clean up what until now has been a too-cosy relationship between pharmaceutical and medical device companies and health-care professionals. But it’s just a start.