|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
Enter subhead content here
The pressure of Big Pharma
A Globe and Mail analysis found financial conflicts of interest are commonplace in clinical practice guidelines. As 10
major Canadian pharmaceutical players prepare to release their total payments to physicians, some prominent doctors are dismissing
the limited disclosure as meaningless GETTY IMAGES/ISTOCKPHOTO
When the Anxiety Disorders Association of Canada set out to craft the official guidelines for managing anxiety, post-traumatic
stress and obsessive-compulsive disorders, the non-profit organization recruited six top psychiatrists to lead the effort.
Those psychiatrists, in turn, approached their contacts in the pharmaceutical industry with a request: Will your company
help pay for the development of our guidelines?
Nine drug makers, including the companies that make the antidepressants Prozac, Zoloft and Paxil, put up a total of $205,000,
most of which went to cover flights, meals and Toronto hotel rooms for a meeting of the executive committee and to pay the
salaries of two medical writers who helped research and draft the final guideline paper.
Of the 22 panelists who ultimately signed off on the paper – it was published in 2014 and is still among the
10 most-frequently accessed on the Canadian Medical Association’s database of 1,200 or so clinical practice guidelines
– 13 disclosed that they had received payments from the pharmaceutical industry in the past, one of them from 16
John Walker, the president of Anxiety Canada – as the association is now called – said the drug companies
who sponsored the guideline paper had no say whatsoever in its advice. But the Winnipeg psychologist, one of the nine panelists
who declared no financial ties to industry, acknowledged that the Big Pharma entanglements do not look good.
This chart show the relationship between panelists and pharmaceutical companies in the creation of one guideline
1 of the 22 panelists involved in the creation of the guideline had ties to 17 different pharmaceutical companies or other
The 36 pharmaceutical companies and other organizations from which the panelists received funding
St. Jude's Medical
Of the nine panelists who declared no financial conflicts, seven are psychologists, mental-health professionals who can’t
THE GLOBE AND MAIL, SOURCE: CANADIAN CLINICAL PRACTICE GUIDELINES FOR THE MANAGEMENT OF ANXIETY, POSTTRAUMATIC STRESS
AND OBSESSIVE-COMPULSIVE DISORDERS (PUBLISHED 2014)
“With all that funding from industry,” he said, “I think it’s something that
is reasonable for people to be concerned about for sure.”
Anxiety Canada’s 2014 paper is one of nine clinical practice guidelines, involving 212 panelists, that The Globe
and Mail analyzed in the wake of a controversy over new recommendations for prescribing opioids, the powerful painkillers
at the root of an epidemic of abuse and overdose deaths in Canada.
Federal Health Minister Jane Philpott ordered an external review of the opioid guidelines last month when it emerged that
a third of those involved in crafting the advice had received payments from opioid makers, including one doctor who voted
on the final recommendations despite the group’s promise to remain free of industry connections – a pledge
that was in itself unusual.
The Globe’s analysis found that financial conflicts of interest are commonplace on guideline committees. Forty-six
per cent of the panelists involved in the nine guideline documents reviewed by The Globe received some funding from companies
that might benefit from a positive mention of their drugs. In three cases, more than 75 per cent of the panelists declared
a conflict. In two, the guidelines were financed directly by the pharmaceutical industry.
Guideline panels play a particularly influential role in the practice of medicine. Front-line doctors usually don’t
have the time to evaluate hundreds of studies before deciding which treatments are best for their patients. They rely on guideline
panels to synthesize the information for them. Clinical practice guidelines have been used in medical malpractice cases to
determine whether doctors accused of harming their patients have deviated from the standards of care for their field.
Official clinical practice guidelines can also have a dramatic impact on how drugs are prescribed. A seemingly minor change
in the blood pressure or cholesterol levels at which medication is recommended could, for instance, result in million more
people taking anti-hypertensives or statins.
In Canada, there are no nationwide rules for how conflicts of interest should be divulged or what counts as a genuine
conflict, leaving guideline committees who want to protect the integrity of their recommendations to set their own standards.
The true reach of pharmaceutical dollars into the guidelines examined by The Globe could be deeper than it appears because
some of the committees only required doctors to disclose if they had received more than $5,000 or $10,000 from the industry.
And in the one case in which no conflicts were declared – a guideline on the diagnosis and treatment of dementia
aimed at family doctors – only the five main authors were asked to divulge their conflicts at the bottom of the
document – even though more than 30 physicians took part in the conference that led to the recommendations.
The Globe’s analysis illuminates the pervasiveness of industry ties to Canada’s medical community,
especially among the top-flight researchers and “key opinion leaders” who often sit on important guideline
Pharmaceutical companies pay doctors to deliver speeches, act as consultants, teach continuing medical-education courses,
fly to conferences and spearhead clinical trials, among other services.
However, in Canada, these specific industry payments to doctors are shrouded in secrecy – unlike in the United
States, where the Physician Payments Sunshine Act compels companies to divulge all payments of $10 or more to doctors. The
U.S. legislation has generated a rich trove of data, allowing researchers to learn that gifts as small as a free meal can
influence physicians’ prescribing behaviour.
“People will always deny that they’re influenced by conflicts that they may have. Those denials are
often quite sincere,” said Joel Lexchin, a Toronto emergency physician and the author of a recent book on the cozy
relationship between Big Pharma and Canadian doctors.
“I’m not accusing doctors of being bribed. But they may still be influenced – and that will
influence the kind of recommendations that they make.”
On Tuesday, the Canadian branches of 10 major pharmaceutical players are expected to reveal the total amount they paid
in 2016 to doctors and health-care organizations in this country, but some prominent physicians behind the new “Open
Pharma” campaign for greater transparency are already dismissing the release of aggregate figures as a meaningless
Those doctors – including Dr. Lexchin – are urging the federal and provincial governments to step
in and force drug companies to reveal their specific payments to physicians.
That’s a call the Canadian Medical Association, which represents doctors across the country, already supports.
When it comes to guideline panels, Jeff Blackmer, the CMA’s vice-president for medical professionalism, said
it would be “ideal” for conflicted doctors to be prohibited from voting on final recommendations, although
he conceded that could be difficult given Big Pharma’s pervasive influence.
“You may have someone who’s a real leading expert, who’s been sponsored for a couple of
very important studies, and you have to decide: Do you disqualify that person?” Dr. Blackmer said. “It’s
not a black-and-white issue. Ideally, you would have a completely clean sheet with no one who has ever taken a penny from
industry. In reality, that can be difficult.”
In its analysis, The Globe tried to pick guidelines published in the past five years for a wide variety of medical conditions:
hypertension, acne, attention-deficit hyperactivity disorder in children, anxiety and related disorders, dementia, two types
of cancer, rheumatoid arthritis and chronic hepatitis C.
Funding of medical guidelines by the
CHRONIC HEPATITIS C
An update on the management of chronic hepatitis C: 2015
consensus guidelines from the Canadian Association for the
Study of the Liver
panelists who received funding from
the pharmaceutical industry*
Management of Acne: Canadian clinical practice guideline.
Canadian Rheumatology Association Recommendations for
Pharmacological Management of Rheumatoid Arthritis with
Traditional and Biologic Disease-modifying Antirheumatic
Drugs. (published 2012)
Canadian clinical practice guidelines for the management of
anxiety, posttraumatic stress and obsessive-compulsive
disorders (published 2014)
Hypertension Canada’s 2017 Guidelines for Diagnosis, Risk
Assessment, Prevention and Treatment of Hypertension in
Bone Health and Bone-targeted therapies for prostate cancer,
Cancer Care Ontario. (published 2016)
Canadian Guidelines on Pharmacotherapy for Disruptive and
Aggressive Behaviour in Children and Adolescents with
Attention-Deficit Hyperactivity Disorder, Oppositional Defiant
Disorder, or Conduct Disorder (published 2015)
Adjuvant systemic chemotherapy for Stage II and III colon
cancer following complete resection, Cancer Care Ontario
Fourth Canadian Consensus Conference on the Diagnosis and
Treatment of Dementia, recommendations for family
physicians (published 2014)
*In some cases, panelists who declared a conflict of interest
were prohibited from voting on the final recommendations.
THE GLOBE AND MAIL, SOURCE: THE CANADIAN MEDICAL
The Globe interviewed representatives from all the committees by phone or e-mail, but it did not contact all the individual
In the case of the Canadian Association for the Study of the Liver (CASL,) a professional organization of liver-disease
researchers and doctors, all five of the authors of its 2015 update on the management of chronic hepatitis C disclosed receiving
money from drug companies, including the makers of direct-acting antivirals, a new generation of drugs that can cure the liver-damaging
virus in about three months but can cost tens of thousands of dollars per patient. (The real prices of the drugs are secret,
but they are believed to have come down considerably after the federal-provincial-territorial alliance that negotiates confidential
drug prices on behalf of public drug plans reached a deal on the new drugs in February.)
The guideline authors, all of whom are considered top experts in their field, received their payments for consulting,
giving speeches or conducting research, according to the disclosures made at the bottom of their guideline paper.
Gilead Sciences Canada, Merck Canada and Bristol-Myers Squibb Canada – the three makers of direct-acting antivirals
who inked the February pricing deal – provided payments of one kind or another to every member of the panel, with
one minor exception. (Merck provided payments to only four of the five doctors.)
As CASL president Rick Schreiber pointed out, the hepatitis C guidelines were not funded by the industry, nor is CASL
itself. The group also recently set up a guideline committee that will act at arm’s length from the association
and will evaluate potential conflicts of interest before deciding who should be allowed to sit on future guideline panels.
“We’re trying to take as many steps as possible to ensure the highest ethical standards for guidelines,”
said Dr. Schreiber, a professor of pediatrics at the University of British Columbia and the director of the B.C. pediatric
liver-transplant program. “We think we have ethical standards [already,] but we’re putting all these things
The Canadian Rheumatology Association is another group whose guideline developers are awash in financial conflicts of
interest, although the guideline itself was funded by a Canadian Institutes of Health Research grant, not the industry.
Twelve of the 16 panelists who crafted the association’s 2012 recommendations for the pharmacological management
of rheumatoid arthritis disclosed that they had received more than $10,000 in “ honoraria” from the pharmaceutical
industry in the three years before the document was published.
Of the four members who declared they were conflict-free, two were patient advocates, one was a family doctor and another
was a researcher. The rest were rheumatologists – specialists in a field that has undergone a sea change in the
past two decades thanks to the rise of a pricey new class of biologic medicines called disease-modifying antirheumatic drugs,
or DMARDs, which can put the autoimmune disorder into remission.
The two most expensive and widely used drugs in the category, Remicade and Humira, cost on average $27,300 and $15,800
a year, respectively, according to the federal body that regulates drug prices in Canada. Sales of DMARDs, which are also
used to treat other conditions, almost doubled between 2010 and 2015. They now account for more than 10 per cent of all public
drug-plan spending in the country.
The Canadian Rheumatology Association said by e-mail that it is taking a fresh look at its conflict-of-interest policy.
“Excluding people based on very strict criteria may exclude many experts, and impact the quality of the guideline.
This is traditionally why we’ve chosen disclosure of [conflicts of interest] rather than exclusion. However, we
are currently reviewing our [conflict-of-interest] policies.”
Many of the guideline representatives who spoke to The Globe expressed concern that automatically excluding all the physicians
who have received money from the pharmaceutical industry would leave guideline committees without critical expertise, particularly
in niche specialties.
“Within a small group like this, it’s very difficult to find dermatologists in Canada who have not
had some dealings with industry,” said Jerry Tan, a Windsor dermatologist and the co-chair of a panel that produced
the Canadian clinical practice guideline on the management of acne.
Dr. Tan was one of the 10 doctors on the panel who divulged receiving payments from the pharmaceutical industry. Only
one of the panelists had not. The acne guideline was directly funded with about $120,000 from five drug companies, according
to Dr. Tan, who himself has worked as an adviser, consultant or clinical investigator for nine different companies, according
to the disclosure published at the bottom of the guideline.
However, he said that he and his co-chair were “very conscious of the risk of bias and of how conflict of interest
might be construed” as they led the guideline process. They solicited funds from between 15 and 20 companies, then
kept the identity of the five funders secret from the rest of the panel and recused themselves from all voting.
Several other guideline committees have also tried to erect safeguards that would allow conflicted doctors to share their
knowledge without unduly influencing the final recommendations.
In the case of Hypertension Canada, for example, just over half of the 80 doctors involved in the 2017 guidelines for
managing high blood pressure declared a conflict of some sort with industry.
But the non-profit organization keeps Big Pharma’s influence in check by barring all panelists from voting on
sections of the guideline in which their potential conflicts of interest might come into play. It also has a central review
committee comprised of methodological experts with no industry affiliations.
Cancer Care Ontario, a government agency that produced two of the guidelines reviewed by The Globe, does not allow conflicted
physicians to chair its guideline panels. It also leaves the final word on its recommendations to an approval panel with no
For Daniel Gorman, a psychiatrist at the Hospital for Sick Children in Toronto who helped to craft the Canadian guidelines
related to attention-deficit hyperactivity disorder in children, the influence of the pharmaceutical industry remains a “big
problem.” He was one of nine members of the panel who received no payments from industry. Three others declared
He is skeptical of his counterparts who say Big Pharma’s financial influence can be difficult to escape.
“Is it hard to avoid getting into relationships where they’re actually paying you to do research or
give talks?” Dr. Gorman said. “That’s not difficult. You just say no.”
Enter supporting content here
Eastern Lake Ontario Environmental Research Group