1. v
2015 Lobby Day
Policy Statement
Political Advocacy Committee
The UBC Medical
Undergraduate Society
Implementing a Transparent and Independent
Drug Assessment Procedure in British Columbia

2. 1
2015 Lobby Day Policy Statement
Implementing a Transparent and Independent Drug
Assessment Procedure in British Columbia
Policy Committee; UBC Political Advocacy Committee; on behalf of the UBC Medical
Undergraduate Society with support from the Canadian Federation of Medical Students
Introduction
As medical students and future physicians in British Columbia, we care deeply
about the health of our patients and by extension the health of the population. In order to
improve patient outcomes in everyday clinical practice, we depend strongly on sound
scientific evidence to model our clinical decision making. This is guided by various
scientific analyses from clinical trials to systemic reviews that make up the backbone of
EBM (Evidence Based Medicine). It dictates how physicians in modern medicine treat
patients supported with scientific evidence. The practice of Evidence Based Medicine is
paramount to ensuring that we deliver not only effective but safe healthcare to our patients.
With the ever expanding amount of scientific knowledge and growing complexities
of twenty-first century medical practice, clinicians depend strongly on independent review
groups that help us evaluate the overwhelming data published in scientific literature. By
vigorously analyzing and evaluating the science behind medical practice, these independent
review groups ensure the integrity and safety of medicines.
Our role as healthcare providers is to provide safe and effective healthcare. We want
to ensure that the best interests of our patients are protected from influence from private
industries and third parties. Thus, we strongly believe that review groups that perform
robust EBM practices should stay independent and maintain their neutrality. These review
groups that perform its work purely based on robust science require continued financial
support from policy makers and scientific support from clinicians. We as future healthcare
providers want to work together with our elected representatives in government to improve
the health of British Columbians. We present specific policy recommendations that will
help us achieve this goal.

3. 2
A recent survey showed that 95% of physicians and 92% of pharmacists in BC
reported a change in practice based on the research performed by the
Therapeutics Initiative
The Therapeutics Initiative
First established in 1994, the Therapeutics Initiative (TI) is part of the Faculty of
Medicine’s Department of Anaesthesiology, Pharmacology and Therapeutics at the
University of British Columbia. The TI performs research on the efficacy of
pharmaceuticals available in BC and helps health care professionals properly prescribe safe
and effective drugs for patients by informing health care professionals with updated
recommendations solely based on scientific evidence.
It is imperative that we have an independent drug review process without prejudice
from private industries, and the TI is instrumental in achieving this. The TI’s independent
drug review is free from influence from government, industry, or other organizations with
vested interest in pharmaceutical development or distribution. The TI evaluates policies and
educational interventions, monitors drug utilization, develops innovative research
methodology, and analyzes prescription drug safety and effectiveness. Additionally, the TI
is involved in healthcare education through Continuing Medical Education courses and
distribution of “Therapeutics Letters”. More than 12,000 practicing physicians and
pharmacists in BC, and 1000 other stakeholders and subscribers, receive these letters (1). A
recent survey showed that 95% of physicians and 92% of pharmacists in BC reported a
change in practice based on the research performed by the Therapeutics Initiative (2).
Given that most healthcare professionals have neither the time nor resources to conduct
independent research on the products they prescribe, an unbiased and publicly funded
pharmaceutical review body such as the TI is of utmost importance to ensure the safety of
patients in BC. It is unwise to allow healthcare professionals to receive product information
solely from industrial or government sources, given vested interests in profit or savings in
limited provincial funds.
Unfortunately, the TI’s funding from the BC government has been steadily
declining since 2008. The TI’s funding dropped from $1 Million to $850,000 in 2011, and
then to $550,000 in April 2012 (3). The TI also lost access to the BC government’s
provincial prescription drug data which limited the work that the TI carries out (4). The BC
government further suspended contracts with the TI in September 2012 and it was UBC
that replaced this deficit in order to keep it operational (4).
The decline in support for the TI was as a result of the Pharmaceutical Task Force
(PTF) instigated by the government. Unfortunately, members of the PTF included
influential people from the pharmaceutical industry. This conflict of interest from the PTF
cast the TI in a negative light, resulting in the decline in funding of the TI despite warnings
from various organizations (5). People rallied together to reinstate funding for the TI. The
British Medical Journal released an open letter to the BC government, urging it to restore
funding to the TI. Signatories of the open letter included Canadian Doctors for Medicare,
Public Health Association of British Columbia, Health Action International, and other
prominent healthcare organizations. In October 2013, the TI got a renewed contract that
gave the organization $550,000 per year.

4. 3
British Columbians spend $3.5 billion on pharmaceutical drugs every year
Supporting Evidence Based Medicine in British Columbia
Independent groups such as the TI require dependable and sustainable funding in
order to perform EBM practices. Without this type of funding, we risk losing the unbiased
voice in science to assist in the decision making of healthcare providers. We as future
healthcare providers believe it is important to increase the support for independent drug
analysis in BC.
In addition, by not investing in groups like the TI, we risk putting budgets at risk.
The cost of pharmaceuticals in BC is rising. BC taxpayers spend upwards of $1 billion
annually on pills purchased from PharmaCare Plans (6). In total, British Columbians spend
$3.5 billion on pharmaceutical drugs each year (6). PhamaCare spending increased around
30% since 2005 and the number of prescriptions increases by about 10% every year in BC.
Coupled with increasing drug prices, the Canadian Institute of Health Information predicts
even further increases in costs for the future (6). On the other hand, supporting the TI could
help the BC government and patients to save money. Reviews by auditor-generals in BC
credit the TI in keeping drug costs in BC low (7). The added cost-benefit of having an
independent drug analysis group will improve the efficiency of healthcare funding in
British Columbia. By advising coverage of safe and effective drugs, a streamlined
prescription system will aid provincial PharamaCare by increasing coverage protocol
efficiency and enhancing its bulk buying power. Without the TI’s review of drugs, costs
will continue to rise in BC, impacting the government, healthcare system, and patients.
Figure 1. Total Pharmaceutical Expenditures in British Columbia
Source: Canadian Institute for Health Information, 2013
Reviews by the Auditor General of BC found that the TI is a key player in
helping keep down drug costs in BC

5. 4
Most importantly, without the TI, we are risking the health of British Columbians.
The TI has been instrumental in improving the health of patients. Without independent
review of the safety and efficacy of new pharmaceutical drugs, patients may suffer from
potentially serious complications of some medications.
The efficacy of the TI has been well documented. Not only does the TI’s research
influence professional practice, it also prevents patient mortality. For example, the TI
successfully identified pharmaceuticals such as alendronate sodium (Fosamax),
rosiglitazone maleate (Avandia), donepezil (Aricept), rofecoxib (Vioxx), and valdecoxib
(Bextra) as having insufficient evidence to recommend routine prescription (2). Many of
these medications were later identified as having significant safety concerns. Vioxx and
Bextra were later withdrawn from the marketplace due to increased risk of myocardial
infarction (heart attack) and stroke. Vioxx in particular, was assessed to have caused
between 88,000 and 139,000 heart attacks while available in the North American
marketplace, 30 to 40% of which were fatal (8). The TI’s work helped to reduce Vioxx
prescription in BC compared to other provinces, and Vioxx was eventually pulled from the
market because of its serious side effects. These examples immediately highlight the patient
safety benefits to residents of BC provided by the early assessment from the TI.
Without an independent drug review body, drugs with potentially lethal side effects
may persist in the market to be taken by unsuspecting patients, harming BC citizens and
putting a greater strain on the healthcare system. We strongly believe that groups like the TI
provide benefit for patients, healthcare providers, and the government in the forms of
increased patient safety, unbiased healthcare information, and cost savings. To continue this
work in advancing the best interests of our patients, we strongly believe that the TI requires
dependable and sustainable funding to improve the health of British Columbians.
OUR PROPOSAL:
In summary, our recommendations on behalf of medical students in British
Columbia are the following:
1. Increase the support for independent pharmaceutical review groups in order to
create practice guidelines and prescribing recommendations based on evidence
based medicine:
a) Increase the Therapeutics Initiative’s funding to $2,000,000 per year.
b) Report on the current support structure of independent drug analysis
in British Columbia within the next fiscal quarter with specific
recommendations on its improvement.
2. Make a long term investment in funding educational programs for healthcare
professionals and patients in regards to evidence based medicine.
3. Maintain neutrality while increasing transparency of independent drug analysis
review groups in governmental organizations with no prejudice or bias from
private industries.

6. 5
References
1. Bassett K. (2006). Therapeutics Initiative - Role and Function. BCMJ, 48(4):163.
2. Silversides A. (2008). Highly lauded drug assessment program under attack. Can Med
Assoc J, 179(1):26–7.
3. The Centre for Health Services and Policy Research. (2013). The Canadian Rx Atlas.
Vancouver, The University of British Columbia.
4. VS editorial. (2013). Therapeutics Initiative has proven its worth. The Vancouver Sun.
Available from:
http://www.vancouversun.com/business/2035/Editorial+Therapeutics+Initiative+proven+w
orth/8336258/story.html
5. College of Physicians and Surgeons of British Columbia. (2014). Update from the
Prescription Review Program. Available from: https://www.cpsbc.ca/for-
physicians/college-connector/2014-V02-01/04
6. Canadian Institute for Health Information.(2013). National Health Expenditure Trends,
1975 to 2013. 17th edition. Available from:
https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC2400
7. Auditor General of British Columbia. (2006). Managing Pharmacare: Slow Progress
Towards Cost-effective Drug Use and a Sustainable Program. Ministry of Health.
8. FDA. (2015). Congress Questions Vioxx. PBS NewsHour. Available from:
http://www.pbs.org/newshour/bb/health-july-dec04-vioxx_11-18/
Authors:
David Kim, Sonja Babovic, Daljeet Chahal, Sam Minaker, Dennis Wang
Policy committee; UBC Political Advocacy Committee; on behalf of the UBC Medical
Undergraduate Society
Contacts:
David Kim, Policy Coordinator davidshkim@alumni.ubc.ca
David Klassen, PAC Chair david.klassen@alumni.ubc.ca
UBC Medical Undergraduate Society
Medical Student & Alumni Centre
2750 Heather Street
Vancouver, BC Canada V5Z 4M2
Web: mus.med.ubc.ca