Eastern Lake Ontario Environmental Research Group 2000 (cont'd from eloerg.tripod.com/waupoos)

Oxycontin, 20 years on, letter to Globe, May 2017

Slide to Extinction, Chris Humphrey, letter to Globe, October 31, 2018
Peter Galbraith, FRCP, obituary, October 2017
White Pines on Death Bed, Bruce Bell, Intelligencer, July 17,2018
Thucydides Trap, letter to Globe, May 2018
Great Lakes toxics down, SUNY Oswego/Clarkson U, April 2018
Machine subversion of democracy, letter to Globe, April 2018
Air Pollution overrides Ancestral Genes, Globe, March 2018
Olympian Cathal Kelly, letter to Globe, March 2018
Environmentalists seeking unemployment, letter to Globe, February 2018
Less is more on Bike Lanes, National Post, January 2018
Tramadol, 10 years on, Globe and Mail, November 2017
White Stripes: Belleville bicycle lanes, letters, November 2017
Occupational Cancers, CCO research results, Globe and Mail, October 2017
Big Pharmoney and Canadian Drug Use Guidelines, Globe and Mail, June 21, 2017, Kelly Grant
Oxycontin, 20 years on, letter to Globe, May 2017
Lake Ontario wind turbines to remain on hold? Feb 2017
Obituary, Raold Serebrin, September 2016
Sartorial slip or signal? letter to Globe editor, October 2016
Weapons of mass distraction, letter to Globe editor, Oct 2016
Point O turbines 99% Down the Drain, CCSAGE, July 7, 2016
Point O turbines Dead and Damned, PECFN, July 6, 2016
Rabid diplomat, letter to Globe, May, 2016
More on bats: rabid rocker? letter to Globe, January 2016
Lighthouses of eastern Lake Ontario, new book by Marc Seguin, March 2016
Continuing corporate windpower malfeasance: Windstream and Trillium Corp, Feb 2016
Amherst Island: the next fine mess, Feb 2016
Valerie Langer: Thirty years of effort pays off on the B.C. coast, Feb 1,2016
Trillium log, 6th annual ELO expedtion, September 2015
Trillium Wind Corp intent on Spoliation of eastern Lake Ontario and Main Duck Isle, June 2015
Turtles rule? Ontario Court of Appeal Decision: Turtlegate, April 2015
Obituaries, Mary Terrance (Luke) Hill, January 2015; Valerie Ingrid (Hill) Kaldes, July 2015
Ontario Court of Appeal turtle hearing, December 2014
Trillium Log, 5th annual ELO expedition, September 2014
Planetary public health manifesto, The Lancet, March 2014
Ostrander Bioblitz, butterfly inventory walk, August 10, 2014
Victory at Cape Vincent: British Petroleum withdraws turbine proposal, February 2014
Stay of execution granted by Ontario Court of Appeal, March 2014
Never say die: Will the Court of Appeal let the Ostrander Phoenix fly free again? March 2014
Divisional Court ruling in Ostrander: turtles belly up, Trojan horses win, February 2014
Lafarge 2020, pushing the air envelope again, Hazardous waste as cement kiln fuel proposal, Jan2014
Another fine mess in Port Hope: municipal waste incinerator proposal, January 2014
Ostrander: fiasco, or snafu? you decide, December 2013
Ostrander rises again, Noli illegitimi carborundum, December 2013
British Petroleum backing off Cape Vincent after a decade of aggression? December 2013
Turbines best Bald Eagles in U.S law, December 2013
SARStock 10 years after, letter to editor, August 2003
Trillium log September 2013: Surfin' USA: Hanging Ten in a Hughes 29
ERT Post mortem: Garth Manning lets it all hang out, August 2013
ERT post mortem: Cheryl Anderson lets it all hang out, August 2013
ERT Post Mortem: Ian Dubin lets it all hang out, August 2013
Great Lakes United turns thirty, goes down, RIP GLU, July 29, 2013
ERT decision, Ostrander turns turtle, goes down, July 3, 2013
PECFN Thankyou, and Appeal for funds, July 6, 2013
Minister of Env on Lake Ontario Off shore wind turbine status, June 2013
Lake Ontario water level control plan, June 2013
Play by Play, Part II, APPEC Ostrander ERT Appeal, June 2013
Ostrander ERT June 2013, Appendix VI, an indirect cause of human morbidity and mortality ?
ELOERG Presentation to Ostrander ERT, Part II, Human Health, May 2013
The Dirty E-Word, Terry Sprague, Picton Gazette, April 2013
Toxics in Great Lakes Plastic Pollution, April 2013
Bill Evans on Birds and Wind farms, April 2013
Mayday, Naval Marine Archive, April 2013
Experimental Lakes Area, Kenora, Closing by Federal Gov't, March 2013
Fishing Lease Phase out on Prince Edward Point, March 2013
Windstream makes $1/2 Billion NAFTA claim, March 2013
Play by Play, PECFN Ostrander ERT Appeal, March 2013
Offshore Wind turbine moratorium 2 years later, The Star, Feb 2013
ELOERG ERT submission on Ostrander: Appendix V: Pushing the Envelope of the MoE SEV, Feb 2013
Wente on Wind and Bald Eagle mugging, Globe and Mail, February 2, 2013
Sprague on Wind and Bald Eagle mugging, Picton Gazette, Jan 25, 2013
Cry Me a River over a Few Bats: Submission to Env Review Tribunal, ELOERG, January 2013
Lake Ontario's Troubled Waters: U of Michigan GLEAM, January 2013
Letter to Minister of Environment re: Ostrander, January 2013
No Balm in Gilead: Ostrander IWT's as Trojan Horses, January 2013
Ostrander Turbines: another Christmas gift by the MoE, Dec 2012
Occupational carcinogens: Ontario Blue Collar breast cancer study, November 2012
Fresh water fish Extinctions, Scientific American,November 2012
Great Lakes Toxics revisited, November 2012
Frack the What ? November 2012
$ 2 1/4 Billion Trillium Power lawsuit knockback Appeal, November 2012
Canada Centre for Inland Waters decimated, October 2012
Birds, Bats, Turbines, and the Environmental Commissioner of Ontario, October 2012
Ecological public health, the 21st centurys big idea? British MedicalJournal Sept1,2012
Trillium log, Sept 2012
George Prevost, Saviour of the Canadas, 1812 - 1814. June 2012
The Victory at Picton: Bicentennial Conference on War of 1812-1814, Differing Perspectives, May 2012
Carleton Island and the 1812, letter to the Globe, October 2011
Queen's Fine Arts Department Succumbs, letter to Principal, December 2011
Mr. Kumar and the Super 30, November 2011
Letters, Articles and Projects from the Nineties
Alban Goddard Hill, web site manager

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May 18: Opioid cascade. Plus other letters to the editor

Special to The Globe and Mail
Published Thursday, May 18, 2017 6:00AM EDT
Last updated Thursday, May 18, 2017 6:00AM EDT

Opioid cascade

Re Opioid Prescriptions Increasing In Ontario, Despite Crisis (May 17):

More than a $400,000 grant to McMaster University to tell us that doctors need to be careful prescribing opioids. I hope the doctors in Ontario writing more than nine million prescriptions a year to one in seven patients are listening!

Karen Phillips, Ancaster, Ont.


The problem of physician authors of national drug-use guidelines being in the thrall of drug houses has long been known, and applies not only to opiates but across the vast pharmaceutical menu (Doctor's Big Pharma Links Concerning, May 16).

Medical marijuana-use guidelines will be the next area to watch for this phenomenon.

We should, however, be thankful for small mercies: Apparently there was only one member of the recent opiate-use panel with financial ties to Big Pharma, compared to the 2010 version where fully one-third did, no doubt reflected in the liberal opiate-use guidelines that were published.

Most amazing throughout this 20-year debacle, which bore a flashing yellow light from the outset, was the silence of the provincial regulator.

Alban C. Goddard Hill, MD (retired), Belleville, Ont.


There seems to be a consensus that physician prescribing practices were responsible for the current problems that surround opioid use. The McMaster panel is advising on setting prescribing guidelines as one step toward protecting people in the future.

What about the people who were adversely affected and live with the excessive prescribing practices that date to the 1990s? Physicians were "misled" by Big Pharma? Is that explanation enough? End of discussion?

If so, patients have much to be concerned about with any number of drugs available to "naive" physicians.

Margaret Shaw, Toronto

May 17, Letter to Editor

Pain, gain: opioids

Re Doctor's Big Pharma Links "Concerning" (May 16): So Dr. Sol Stern was allowed to vote on a committee that sets that standards on opiate prescription for non-malignant pain because he has "no overt bias". So presumably the ordinary kind of bias was acceptable?

This discredits the entire exercise, an observation that is supported by the fact that there is little difference between the 2010 standards and the new ones. The drug manufacturer's drastic mistake of promoting high doses of narcotic medication for non-cancer pain and portraying the sustained release formulations as being safer, as Purdue did in the case of OxyContin, had particularly dire consequences here in Southwestern Ontario, where we now have twice the incidence of accidental overdose deaths caused by its products.

Such opiates, apart from being minimally effective in the treatment of several conditions that they were promoted for, such as uncomplicated chronic back pain and fibromyalgia, actually enhance the patient's perception of pain. Thus we have created a new class of patient who, stranded on high doses of opiate, needs to go through a detoxification process before we can find out whether he or she is getting any pain relief at all that might begin to justify the life-threatening risks that accompany their treatment.

All those with conflicts of interest should have been excluded from McMaster's task force so that more radical recommendations could have been adopted in order to address the current crisis. Better training for doctors in opiate management involving lower doses and higher ethical standards are long overdue.

Tony Hammer, MD, addictions medicine, Windsor, Ont.

Health Minister orders review of opioid guidelines after conflict-of-interest revelations

Karen Howlett

The Globe and Mail
Published Thursday, May 18, 2017 5:52PM EDT
Last updated Thursday, May 18, 2017 6:36PM EDT

Health Minister Jane Philpott has ordered a government agency to review new national standards for prescribing opioids to determine whether they are "tainted" amid revelations that one third of the individuals who crafted the measures have financial ties to the pharmaceutical industry.

Dr. Philpott has also asked McMaster University, which developed the new prescribing standards, for an assessment of the process it used to manage conflicts of interest.

"It is very important to make sure that the guidelines are not tainted by the influence of industry," Dr. Philpott said in an interview on Thursday. "As stewards of the public purse, we need to make sure that we are supporting the development of guidelines that we would have no reason to believe have been influenced by commercial interests."

Of the 28 medical experts, academics and patient advocates assembled by McMaster to revise the standards, nine have received remuneration from drug companies, including the pharmaceutical giant whose pain pill triggered Canada's deadly opioid epidemic, according to declaration forms posted on the school's website.

Dr. Philpott has asked the Canadian Institutes of Health Research, a federal research agency, to assemble a panel of experts to assess whether they are satisfied with the "rigour" that went into developing the new standards and whether doctors can "safely" use them to prescribe opioids.

The announcement follows a story in The Globe and Mail revealing that officials at McMaster did not honour a pledge to exclude medical experts who receive income from drug companies from voting on the standards.

Sol Stern, a family doctor in Oakville, Ont., and one of 13 panel members who voted on the standards, has been a paid speaker and advisory board member for four drug companies.

In addition, a Globe review of all the declarations reveals that others involved on a panel of medical experts who did not vote on the standards also have ties to the drug industry.

McMaster received $618,248 from Health Canada to update existing guidelines that were out of date with research showing the risks associated with opioids are substantial and the benefits uncertain. The 2010 guidelines were aimed at addressing the root cause of the epidemic: the overprescribing of prescription painkillers. But the guidelines did little to reverse practices developed two decades ago, when doctors began prescribing opioids to relieve moderate to severe pain as pharmaceutical companies promoted their benefits. Canada remains the worlds's second highest per capita user of prescription painkillers.

"We are confident in the guideline and its recommendations and look forward to sharing a full account as requested" said Jason Busse, an associate professor at McMaster's department of anesthesia and co-lead of the group that drafted the guidelines.

Opioid panel chair admits conflict-of-interest lapse

Karen Howlett
The Globe and Mail
Published Friday, May 19, 2017 9:29PM EDT
Last updated Friday, May 19, 2017 9:58PM EDT

McMaster University says it did not follow proper procedures for reviewing financial conflicts of panel members who crafted new national standards for prescribing opioids.

In a letter to federal Health Minister Jane Philpott, the chair of the steering committee assigned to develop the guidelines apologized for errors that were made but said the measures are "sound" and "unbiased".

As a result of not properly following the administrative process for reviewing the conflict-of-interest forms, the letter says, a voting panel member's financial ties to drug companies were not brought to the steering committee's attention until after the recommendations had been completed.

"These errors should not have occurred and we apologize that they did," Gordon Guyatt, a professor in McMaster's faculty of health science and chair of the steering committee, says in the letter. "We are reviewing our administrative policies and practices to ensure that errors of this type do not occur again."

Dr. Philpott has ordered a federal agency to conduct an independent review to ensure the scientific foundation of the guidelines are not "tainted by the influence of industry," she said. She has also asked McMaster for a full account of the process for determining who got to vote on the guidelines and how conflicts of interest were managed.

The Health Minister's intervention on Thursday followed a story in The Globe and Mail revealing that McMaster officials did not honour a pledge to exclude medical experts who receive income from drug companies from voting on the standards.

A further review by The Globe of declarations for all 28 medical experts, academics and patient advocates who worked on the guidelines reveals that nine have received remuneration from drug companies, including Purdue Pharma, the pharmaceutical giant whose pain pill triggered Canada's deadly opioid epidemic. Two of the nine voted on the guidelines and seven did not.

McMaster received $618,248 from Health Canada to revise prescribing guidelines that were last updated in 2010 and out of step with research showing that the risks associated with opioids are substantial and the benefits uncertain. In its application for federal funding to update the guidelines, McMaster,s Michael G. DeGroote National Pain Centre said "the key to developing conflict-free recommendations" is requiring panel members who vote on the standards to have no financial ties to the pharmaceutical industry.

However, one of the 15 panel members who voted on the guidelines, Sol Stern, a family doctor in Oakville, Ont., has been a paid speaker and advisory board member for four drug companies, including Purdue, according to his declaration form posted on McMaster's website.

The guidelines took two years to develop. All 28 individuals who worked on them were required to submit two declarations of conflicts in December, 2015, and January, 2017 and the steering committee was to review them.

Jason Busse, an associate professor in McMaster's department of anesthesia and a member of the steering committee, told The Globe the committee made an exception for Dr. Stern because his industry-sponsored talks took a "balanced approach" to opioids. Dr. Stern "reassured us he had no overt bias either strongly in favour or strongly opposed to opioids for chronic pain."

On Friday, Dr. Busse declined to clarify when exactly the steering committee learned about Dr. Stern's financial conflicts and referred questions from The Globe to Susan Emigh, McMaster's director of public relations. Ms. Emigh referred The Globe to Dr. Guyatt's letter.

The notes section of Dr. Stern's declaration, intended for internal McMaster use, is blank. On declarations for every other member of the voting panel, by contrast, that section is filled out, saying the steering committee "perceives no significant" financial conflicts that preclude the individual from participating.

The notes sections for seven other individuals who declared industry conflicts say: "Acknowledged potential financial and non financial COI" and approved to participate as a non-voting member on the expert committee.

A patient advocate on the voting panel also disclosed consulting work for a drug company, but the steering committee said his activities "are judged not to be significant."

Globe editorial

Globe editorial: How to end Canada's biggest public health emergency

The Globe and Mail
Published Monday, May 22, 2017 6:00PM EDT
Last updated Monday, May 22, 2017 6:00PM EDT


In 2015, more Canadians were killed by opioid-related overdoses than lost their lives at the height of the HIV/AIDS epidemic. In 1995, at the peak of that earlier public-health disaster, 1,764 Canadians were killed by the blood-borne virus. The latest estimates are that opioids claimed the lives of more than 2,000 Canadians in 2015.

And all indications are that the death toll is rising, not falling.

Part of the problem may have to do with this: Doctors are not just prescribing opioids, but prescribing them widely and liberally. For example, the number of prescriptions for opioids and their derivatives increased five per cent in Ontario over the three years ending 2015-16. Last year, Ontario doctors wrote 9.1 million orders for opioid painkillers.

A recent article in Annals of Surgery, an American medical journal, summed up the situation tactfully, describing doctors, and surgeons in particular, as "unwittingly enablers of addiction, abuse and overdosage." Addiction to illicit opioids often begins with licit prescriptions.

It's why new medical guidelines for fentanyl, hydromorphone and other opioids were issued this month. They suggest using opioids as a treatment of last resort and call for smaller doses.

However, when it comes to opioids, many physicians find themselves ensnared in the appearance of conflicts-of-interest, extending even to the new guidelines. Last week, a Globe and Mail review of the 28 medical experts, academics and patient advocates who worked on them found that nine have received remuneration from drug companies, including Purdue Pharma, the pharmaceutical giant whose pain pill triggered Canada's deadly opioid epidemic. Two of the nine voted on the guidelines and seven did not.

Meanwhile, frontline doctors find themselves in an unenviable position. These drugs are not prescribed without reason. A 2011 study published in the academic journal Pain Research and Management estimated that a staggering one in five Canadian adults suffers from some form of chronic pain.

A commentary in the same CMAJ issue that unveiled the new prescription guidelines identified another area that demands closer attention,"a less well-publicized problem of undertreated chronic pain."

To that end, the authors outline the case for a national chronic pain strategy to improve the perennially poor access to specialized clinics and treatments. The idea is not without merit.

But no effort to confront or assuage the opioid epidemic can succeed without knowing who is prescribing what, to whom, and in what quantities.

Those previously mentioned figures on Ontario's volume of prescriptions, from the province's narcotics monitoring system, are eyebrow-raising. But the number of prescriptions filled doesn't tell anything close to the whole story.

Was each dose appropriate? What proportion was diverted to friends, family or the street? How much free-floating pain medication sits unused in medicine cabinets across the country? How many prescriptions were issued but not filled?

Canada's invisible painkiller epidemic is at least a couple of decades old and we don't have good answers to those questions.

Given the scope and depth of the human catastrophe at hand, the lack of surveillance data is frankly shocking. The situation is all the more surprising when you consider the urgent and overwhelming response to recent public health emergencies involving infectious disease or food-borne illnesses, SARS, avian flu, listeriosis.

Where are the daily updates on opioid overdoses and deaths? Where is the all-out response?

Federal Health Minister Jane Philpott needs to do more. But Ottawa is catching up with a decade of ground lost under a Harper government that saw opioids as a law-enforcement problem, rather than a public-health issue.

It's long past time to dispense with that unhelpful fiction. We need to get tough on addiction, not addicts. Nobody volunteered to have their lives ruined by addiction.

Eleven months ago, Ottawa announced $40 million to fund a national e-prescribing program. It aims to ensure that doctors are ordering the minimum quantity necessary, while reducing dosing errors, eliminating forgery concerns, and providing tighter control of medication that's often diverted to the streets.

It's a complicated, multijurisdictional effort, and though trial runs are slated for Alberta and Ontario this summer, it won't be fully operational until mid-2018 at the earliest.

Opioid strategies and action plans, like the one adopted last winter by Ottawa and the provinces, are laudable and important.

But this big of an emergency demands big, course-changing action. Canadians, already among the world's top per capita consumers of opioids, can no longer wait.


May 23: Power over pipelines. Plus other letters to the editor

Special to The Globe and Mail
Published Tuesday, May 23, 2017 6:00AM EDT
Last updated Tuesday, May 23, 2017 6:00AM EDT

Doctors are at risk of inappropriate use of prescription drugs because the pharmaceutical industry has inserted itself into the guideline process?

Say it ain't so.

I hate to say it, but this is hardly front-page news. We have known about tainted and drug-addled drug-prescribing guidelines for years. Some of us have even written books on this and other tactics. The pharmaceutical industry's many-tentacled minions have been able to insert themselves into almost every corner of medicine.

If the minister thinks the opioid guidelines are tainted, she should try taking a look at the diabetes or osteoporosis guidelines around the world, so steeped are they in the tincture of pharmaceutical funding it takes dozens of pages to list the contributors and their many conflicts of interest with pharmaceutical manufacturers.

We need clean, clear health information as urgently as we need clean, clear water. Allowing the drug companies to "educate" doctors on prescribing continues to befoul prescribing and sicken the population.

Alan Cassels, drug policy researcher, co-author, Selling Sickness: How The World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients; University of Victoria


Ontario opioid overdose deaths climb in first half of 2016

Karen Howlett

TORONTO The Globe and Mail
Published Wednesday, May 24, 2017 1:36PM EDT
Last updated Wednesday, May 24, 2017 8:16PM EDT

The number of people who died of opioid overdoses in Ontario jumped 11 per cent in the first six months of 2016, according to new figures showing that the epidemic is rapidly moving east from Western Canada.

Ontario has not been hit as hard as British Columbia, the epicentre of the crisis where fatal overdoses spiked 80 per cent between 2015 and 2016. But the spread to Ontario is happening quickly, with at least 412 people dying of opioid overdoses in the first six months of 2016, compared with 371 in the same period of 2015.

Number of monthly opioid-related cases in Ontario

Emergency department visits/Hospitalizations/Deaths

Number of monthly opioid-related cases in Ontario

Share this chart:


"The numbers are definitely increasing and are definitely alarming," said Ontario Health Minister Eric Hoskins.

Related: Prescriptions for painkillers still rising in Canada despite opioid

Read more: How a little-known patent sparked Canada's opioid crisis

In an effort to help policy makers and health-care workers in Ontario better understand the scope of the problem, Dr. Hoskins unveiled an online surveillance system on Wednesday. The interactive opioid tracker makes a wide range of data publicly available, including the number of deaths, hospitalizations and emergency department visits from drug overdoses dating back to 2003.

It will be a few more months, however, before Ontario has anything close to real-time tracking of fatalities from opioids, including illicit fentanyl. The Office of the Chief Coroner has built a new centralized electronic database to house information on opioid-related deaths. The office began adding all death investigation cases as of May 1 to the database, which captures information such as the victim's age, sex, geographic location of death and type of drugs involved.

Chief Coroner Dirk Huyer said at the news conference that it should take about three months to compile preliminary findings on each case.

Meanwhile, the death figures released on Wednesday likely underestimate the problem. In Waterloo Region alone, 28 people died in the first four months of this year from suspected opioid overdoses, compared with just 24 in all of 2015; figures for 2016 are not yet available.

While illicit fentanyl is behind a surge in overdose deaths across Canada in recent years, Dr. Hoskins said the problem dates back to the introduction of the prescription painkiller OxyContin in the mid-1990s. Marketing by OxyContin maker Purdue Pharma "erroneously gave confidence" to doctors that opioids were safe to prescribe for pain relief, Dr. Hoskins said. "There is no question that has dramatically impacted the number of Ontarians and Canadians who utilize opioids," he said, adding that Canada is the world's second-highest per-capita user of prescription opioids.

Police and public-health officials across Ontario have complained that the lack of up-to-date statistics on the toll from opioids have left them struggling to track the scale of the problem.

Federal Health Minister Jane Philpott has also expressed frustration with those provinces and territories that have not provided data in the midst of a public-health crisis.

In British Columbia, the Coroners Service releases monthly reports on overdose deaths. Overdose deaths from opioids climbed 66 per cent in the first three months of this year in B.C., compared with 2016.

Ontario's Coroners Office has been working hard to catch up with British Columbia. Dr. Huyer said in a recent interview that his office is speeding up investigations by capturing any information related to drugs at the beginning of a probe, rather than waiting until it is complete to determine that opioids were involved.

All information on a drug investigation will be housed in the new centralized database. Under the old system, by contrast, information on opioid-related fatalities existed in individual case files, making it difficult to systematically review cases and analyze trends.

Dr. Huyer said much of the information about the toll opioids are taking already exists in his office but under the old system someone had to manually go through case files to extract the information.

With the new database, he said, his office will be able to readily look for trends, such as how many people die of opioid overdoses in a certain geographic region.


Doctors should have to publicly disclose ties to drug industry: experts

Karen Howlett

The Globe and Mail
Published Monday, May 29, 2017 3:12PM EDT
Last updated Monday, May 29, 2017 3:54PM EDT

The controversy swirling around new national standards for prescribing opioids could have been avoided if Canada had laws requiring doctors to publicly disclose their financial ties to the drug industry, experts say.

The new guidelines developed by McMaster University take aim at an epidemic of addiction and accidental deaths resulting from powerful narcotic painkillers. The guidelines had not been updated since 2010, leaving them out of date with evidence showing that the risks associated with prescription opioids are substantial and the benefits uncertain. Canada ranks as the world’s second-biggest consumer of prescription opioids, after the United States.

The Globe and Mail has reported that a third of the individuals who crafted the guidelines have financial ties to the pharmaceutical industry. These conflicts of interest did not come to light until McMaster posted declarations-of-interest forms on its website on May 8, the same day the guidelines were published in the Canadian Medical Association Journal. Federal Health Minister Jane Philpott has ordered an independent review to ensure that the scientific foundation of the guidelines are not “tainted by the influence of industry.”

Academic and medical experts said the controversy highlights the need for more transparency on conflicts of interest in the medical community. Requiring doctors to publicly disclose remuneration from drug companies would allow the public to assess whether those financial relationships might have influenced their recommendations, said Matthew Herder, director of Dalhousie University’s Health Law Institute and an associate professor in the faculties of law and medicine.

“If we’re in the dark about the existence of those relationships, you can’t factor that into your analysis of their research or their recommendations,” Prof. Herder said. “From my point of view, there’s no reason why we wouldn’t want that transparency.”

Disclosure is mandatory for drug companies and doctors in many countries, leaving Canada a laggard internationally. The Physician Payments Sunshine Act in the United States, passed as part of the Obama government’s health reforms, requires drug and medical device companies to release details of payments they make to doctors and teaching hospitals for such things as speaking fees, research, travel and meals. The information is publicly available on Open Payments, a searchable federal database.

The database shows that one doctor received payments totalling $694,333 (U.S.) in 2015, including $10.20 for food and a beverage from one company and $2,450 in consulting fees from another company. Companies made about $2-billion in general payments to 618,000 doctors in the United States each year between 2013 and 2015, in addition to another $600-million a year to teaching hospitals, according to ProPublica, an investigative news organization. General payments cover promotional speaking, consulting meals, travel, gifts and royalties but not research.

Other countries, including France, the United Kingdom, Denmark and Portugal, have enacted similar sunshine laws as part of a global move toward greater transparency. In Canada, by contrast, the public has no idea how much money drug companies have doled out to doctors. Medical journals in Canada typically disclose whether authors of research papers have conflicts of interest, but not how much drug companies have paid them.

Nav Persaud, a family doctor at Toronto’s St. Michael’s Hospital who helped craft the new standards for prescribing opioids, said he did not learn that many others at the table had financial conflicts of interest until after the standards were publicly released.

“This problem could have been prevented if we had a sunshine act,” Dr. Persaud said. “If these conflicts were publicly declared, it would have been clear to everyone who had conflicts.”

Nine of the 28 medical experts, academics and patient advocates who crafted the prescribing guidelines received remuneration from drug companies, including Purdue Pharma, the pharmaceutical giant whose pain pill triggered Canada’s deadly opioid epidemic. Sol Stern, a family doctor in Oakville, Ont., who voted on the guidelines, has been a paid speaker and advisory board member for four drug companies, including OxyContin maker Purdue.

The financial conflicts should have been disclosed at the beginning of the process, said Joel Lexchin, a professor emeritus at York University’s faculty of health who has studied the prevalence of industry influence on medical guidelines in Canada, which doctors rely on for the best available clinical evidence.

The American Society of Interventional Pain Physicians, which also recently unveiled new guidelines for prescribing opioids, had panel members declare any conflicts of interest within the previous five years, which were distributed at the introductory meeting, according to the journal Pain Physician. Individuals with potential conflicts could not participate in the discussion or preparation of the guidelines but they could remain on the panel.

The Michael G. DeGroote National Pain Centre at McMaster received $618,248 from Health Canada to revise the Canadian guidelines it originally developed in 2010. The revisions took two years. University officials pledged in the application for funding to Health Canada that panel members would be asked to declare conflicts of interest within the past five years and that no one with financial ties to the drug industry would be allowed to vote on the guidelines. However, McMaster did not honour those pledges: panel members were asked to declare conflicts in the previous 24 months and Dr. Stern was allowed to vote on the guidelines, despite his financial conflicts.

Susan Emigh, director of public relations at McMaster, said in an e-mail to The Globe that the university follows the Canadian requirements for disclosing conflicts of interest. On the prescribing guidelines, however, the steering committee assigned to develop them did not become aware of Dr. Stern’s conflicts until after panel members had voted, due to an “administrative error,” she said.

Gordon Guyatt, a professor in McMaster’s faculty of health science and chair of the steering committee, has written to Dr. Philpott apologizing for not properly following the administrative procedures for reviewing conflict-of-interest declarations.

Jason Busse, an associate professor at McMaster’s department of anesthesia and co-lead of the committee that drafted the guidelines, has told The Globe Dr. Stern voted the same way on every recommendation as other panel members. He also said it was an “oversight” not to expand the timeline for declaring conflicts to five years.

A Health Canada spokeswoman said the provinces and territories have primary responsibility for health care, so it would be up to them to develop an equivalent of a sunshine act in Canada.


Open Pharma campaign puts pressure on drug industry to reveal payments to doctors \l "


Special to The Globe and Mail
Published Friday, Jun. 09, 2017 7:29PM EDT

Pharmaceutical companies in Canada should be forced to reveal their payments to individual doctors, according to a new campaign backed by some prominent physicians and researchers who say this country has fallen behind its peers when it comes to health-care transparency.

The founders of the “Open Pharma” campaign, launched this week, say Canadian patients should be able to check an online database to see whether their doctors have received funding from the drug industry, as patients can already do in the United States, Australia and several European countries.

“Canada is lagging behind,” said Joel Lexchin, a Toronto emergency-room doctor and York University researcher who recently published a book on the cozy relationship between Big Pharma and Canadian doctors. “But it’s not just a question of doing something that other countries are doing – it’s the benefits that you get out of it.”

Dr. Lexchin, who is part of the 12-member advisory board of Open Pharma, said the rich data made available through the Physician Payments Sunshine Act in the U.S. since 2014 has allowed researchers to elucidate how industry money can influence physicians’ prescribing behaviour.

Bringing drug-industry payments out of the shadows could also help prevent a repeat of a recent debacle over opioid guidelines, the group argues.

Health Minister Jane Philpott ordered an external review of Canada’s new official guidelines on how the powerful painkillers should be used in chronic pain cases after The Globe and Mail revealed that a doctor who had a vote on the final version had financial ties to the pharmaceutical industry. A third of the individuals who crafted the guidelines also had ties to the industry.

Open Pharma’s call comes as the Canadian branches of 10 large pharmaceutical companies prepare to voluntarily release the total amounts they paid to health-care providers and health-care organizations, such as hospitals and universities, last year. But the drug makers won’t reveal their payments to individual doctors when they post the information to their websites on June 20.

“I think it’s meaningless,” said Andrew Boozary, a resident physician at St. Michael’s Hospital in Toronto. “You have this big aggregate number. What does that mean for the patient who’s sitting in front of their physician?”

Dr. Boozary, who is also a visiting scientist at Harvard’s School of Public Health and a former adviser to Ontario’s Ministry of Health and Long-Term Care, is leading the Open Pharma effort.

Among the other medical heavyweights on the group’s board are Danielle Martin, a family doctor at Toronto’s Women’s College Hospital whose book Better Now: Six Big Ideas to Improve Health Care for All Canadians was published earlier this year; Joshua Tepper, the president of Health Quality Ontario, an agency that advises the province on improving the health-care system; and Andreas Laupacis, the executive director of the Li Ka Shing Knowledge Institute at St. Michael’s Hospital.

Innovative Medicines Canada (IMC), which represents brand-name drug companies, concedes that the June 20 disclosure is simply a first step and far from a “perfect” one.
Only 10 of IMC’s 45 member companies agreed to take part: AbbVie Corporation; Amgen Canada Inc.; Bristol-Myers Squibb Canada Inc.; Eli Lilly Canada Inc.; Gilead Sciences Canada Inc.; GlaxoSmithKline Inc.; Roche Canada; Merck Canada Inc.; Novartis Pharmaceuticals Canada Inc.; and Purdue Pharma Canada.

Chrisoula Nikidis, vice-president of ethics, integrity and governance at IMC, said the participating companies decided to publish aggregate totals in part because the doctors they consulted informally balked at having their payment information released. The U.S. legislation makes it mandatory.

“I’m personally not a fan of the piece of legislation that’s taken place in the U.S. I’ve seen it, I’ve studied it,” Ms. Nikidis said. “I’m not sure of the usefulness of capturing, you know, $3 cups of coffee … I think we’ve done well self-regulating here. I’m proud of this first step we’ve taken.” (The U.S. legislation requires disclosure of payments more than $10.)

The Canadian Medical Association, meanwhile, says physicians favour more transparency. The CMA, which represents doctors across the country, passed a resolution in 2012 calling on pharmaceutical companies to disclose their payments to doctors.

“[The resolution] shows that, very clearly, physicians and the profession are ready for this type of information to be made public,” said Jeff Blackmer, the CMA’s vice-president for medical professionalism. “We don’t feel like we have anything to hide.”

Andrew MacKendrick, a spokesman for Dr. Philpott, said that while financial transparency in medicine is best left to the provincial and territorial governments, “We always remain open to new approaches to increase transparency for Canadians.”

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Eastern Lake Ontario Environmental Research Group