ALAN CASSELS - DRUG COMPANIES DON'T CARE@Arts & Opinion

All that is required for evil to prevail
is for good men to do nothing.
Edmund Burke

Its products are iconic and its reputation among other drug companies legendary. Many of its sales managers are former military officers, driven, goal-oriented people, who know how to follow orders and 'take that hill.' Its executives are the type of people you want on your side because they know how to get things done in the face of carnage and adversity.

Yet Pfizer, the world’s biggest drug producer – an award-winning drug marketing genius with the biggest stable of blockbuster drugs on the planet – is currently on a very aggressive campaign to do more than sell drugs. It’s staking out new territory and investing in innovative ways to influence the people who make decisions about healthcare. Despite paying record-breaking fines last year for its criminal behaviour, Pfizer has proven that it is a company willing to boldly go where no other pharmaceutical company has gone before.

In Canada, it is clear to even casual observers that Pfizer is very publicly inserting itself into virtually every healthcare, medical research, patient advocacy and physician education organization in the country. It’s not like this form of bold public penetration hasn’t happened in the past (after all, we’re talking about the maker of Viagra) but this current level of activity seems emblematic of Pfizer’s immense size, power and influence in Canada.

In the past year, Pfizer managed to wangle an appointment for one of its top executives to the governing council of Canada’s premier health research agency: the Canadian Institutes of Health Research. It has declared that it intends to become a partner of choice with governments, universities and research institutions and it has launched numerous funding programs that will further colonize Canada’s cancer research establishment. It has had a surprising level of political influence over BC’s Liberal government; it has also established a new partnership with the Canadian Medical Association, which represents Canada’s 70,000 doctors who were recently on the receiving end of $780,000 new Pfizer dollars to help educate our physicians.

Some would call Pfizer’s strategies nothing more than smart business activity, evidence that the genius behind such drug blockbuster drugs as Lipitor, Viagra and Norvasc is doing exactly what companies need to do: increase shareholder value. Pfizer executives have consistently demonstrated that if you want to sell drugs, you need to be influencing audiences at every level of the market – especially physicians, researchers, policymakers, politicians, the public and media.

Pfizer’s competitors are, no doubt, in awe of this company’s activities over the past year, wondering if they too could be as bold and astute. Others might say Pfizer ingratiating itself into public institutions is like letting the money lenders into the temple and that we need a respectful distance between those who make money selling treatments and those who provide our healthcare. But those in the drug industry think differently.

The Prix Galien is said to be “the most prestigious award in the field of Canadian pharmaceutical research and innovation.” In 2009, judges named Pfizer’s new drug Champix, a smoking cessation product, as the most innovative of Canada’s drug research pipeline. (My first thought: if this is the best Canada’s drug industry can come up with, it is in even more trouble than I thought, but more on that later). Prix Galien Canada states that it wishes to “create bridges between the scientific community, industry and institutions.” Its spokesperson, Dr. Jacques Gagné, said, “We are proud to take part in this celebration of successes, victories and excellence.”

Hmm: “Success, victories and excellence?”

Do those words really capture what we are rewarding in drug companies? Are we really seeing the promotion of a scientific culture in which all citizens benefit? Private markets might be the most efficient way to invent and market new health products, but to have it run properly, we should think of the drug industry as a car – which only works with a functioning gas pedal 'and' a brake system. Without proper and acceptable government regulation oversight, it could well careen out of control.

It is clear that while 2009 was full of bad press for Pfizer, this last settlement was the fourth time in the last seven years it has been found guilty of breaking US laws and paying massive fines. These monetary penalties – the biggest ever – were particularly harsh, said the judge, emphasizing that Pfizer doesn’t seem to be able to learn from its past fines and penalties. He said in his judgment that Pfizer is starting to look a lot like a habitual offender and the financial penalties fully considered Pfizer’s 'recidivist' history.

Pfizer is not the only drug company that has been caught systematically instructing its sales people to push prescription drugs to doctors and patients far beyond their approved uses or charged with illegal promotion, bribery, faking data, price fixing and fraud. What happens is this: companies get caught. They get charged. They go free and do the same thing again. In the world of high stakes drug manufacturing, a mega fine is the cost of doing business.

We need governments willing to say: enough is enough. Enough infiltrating our research organizations with your money. Enough paying for our doctors’ education. Enough duping patients. And employees of companies who witness the wrongdoing need to say 'enough' before they quit in disgust. Me? My wish for the new year is for my phone to ring with a Pfizer whistleblower telling me he’s ready to hand over a box of company documents.

At the beginning of a new year, I think that we need to nurture the growing backlash, not against drug companies, but against those who run our public institutions who feel compelled to sell themselves out to the drug industry. In response to the Pfizer appointment to the CIHR, more than 4,000 people signed a petition protesting the appointment, including prominent researchers, ethicists and public policy experts. Throngs of angry voters must join them, willing to kick the moneylenders out of the temple.

After the CIHR Pfizer appointment, many people wrote letters to the Minister of Health asking, “What were you thinking?” Steven Lewis, a prominent health policy analyst in Saskatoon, saw this appointment as particularly sinister and wrote: “One is hard pressed to view the appointment as anything other than a deliberate provocation.”

And for evidence that doctors are queasy at the influence of ‘Big Pharma,’ an editorial in the Canadian Medical Association Journal last year argued that industry-funded CME (continuing medical education) is unacceptable and that a major overhaul is needed to erase industry influence. CMAJ’s editor, Dr. Paul Hebert, wrote, “We seem to have conveniently forgotten that the pharmaceutical industry is in business to make money, not to educate health professionals.”

The question I’m left with is this: Who in Canada can stop a criminal recidivist organization from taking over Canada’s healthcare system piece by piece?

While you ponder that and consider your own particular relationship to Pfizer, consider the following information about Champix, Pfizer’s award-winning innovative drug that could help you stop smoking. A bitter reminder that, like most drugs, pharma’s influence has side effects. The champion Champix has been linked to a wide range of injuries, including serious accidents and falls, potentially lethal cardiac rhythm disturbances, severe skin reactions, acute myocardial infarction, seizures, diabetes, psychosis, aggression and suicide.

All this to cure the disease of smoking. Innovative indeed.

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