"The main challenge in our work is getting to the truth," says Wright.
"It's been estimated that about 90 per cent of the published
literature is biased by economic interests."

http://www.publicaffairs.ubc.ca/ubcreports/2004/04dec02/trust.html

UBC Reports | Vol. 50 | No. 11 |  Dec. 2, 2004
Can We Trust the Drug Companies?
The Therapeutics Initiative is working to get reliable data to doctors
and patients

By Hilary Thomson

Imagine you are a 75-year-old woman who has been taking a daily drug
to relieve arthritis pain. You're shocked to learn the drug just got
pulled off the market worldwide and you wonder if you can trust your
doctor to know what's safe.

With the recall in September 2004 of Vioxx®, a top-selling arthritis
pain medication that was found to increase cardiovascular problems,
and a U.S. Congressional hearing into how the drug's safety was
evaluated, a UBC initiative dedicated to disseminating evidence about
drug therapies couldn't be more relevant.

Under the direction of Jim Wright, a professor in the departments of
pharmacology & therapeutics, and medicine, the Therapeutics Initiative
(TI) has been providing physicians and pharmacists with up-to-date
evidence on the effectiveness of prescription drugs for 10 years.
"
In fact, the current issue of the group's newsletter, Therapeutics
Letter, (which has a circulation of 10,000) addresses the storm of
uncertainty surrounding the class of drugs called COX-2s. Used to
treat inflammation, the class includes Vioxx® and Celebrex®.

The newsletter focuses on COX-2's product monographs -- legal
documents written by drug companies to list pertinent data, including
potential benefits and harms. The newsletter reported that the
monographs do not adequately inform of harms and that they provide
insufficient information as to whether COX-2s increase myocardial
infarction or other cardiovascular events.

"We've been looking at this class of drugs for several years now,"
says Wright, a faculty member since 1977. "Our work nearly always
surrounds medications, like these ones, that are widely prescribed but
which have uncertain therapeutic value. Our efforts frequently put us
at odds with drug companies."

Started in 1994 with a five-year annual grant of $540,000 from B.C.'s
Ministry of Health (MOH), the TI is now operating on a three-year, $1
million per annum grant from MOH. The group reviews evidence of
effectiveness for drugs prescribed for everything from male pattern
baldness to depression in children and adolescents, and is one of only
a handful of such groups in Canada.

In addition to provincial work, TI members also complete one-quarter
to one-third of the federal government's common drug reviews, a
year-old process overseen by the Canadian Coordinating Office for
Health Technology Assessment.

"The main challenge in our work is getting to the truth," says Wright.
"It's been estimated that about 90 per cent of the published
literature is biased by economic interests."

Dr. Warren Bell, a general practitioner in Salmon Arm, B.C., says he
uses the newsletter "for clarifying and interpreting the relentless
propaganda of the drug industry" and adds that he has formed a number
of prescribing practices directly out of the pages of the letter.

The largest working group in the TI is the drug assessment group,
headed by Ken Bassett, a faculty member in the department of family
practice and the Centre for Health Services and Policy Research at
UBC.

Some of the 30 assessments completed annually are triggered by new
drug submissions to PharmaCare, the province's drug subsidy program.
TI researchers review the submissions, evaluate evidence of the drug's
therapeutic advantage and report back to government and, in a
summarized fashion, to practitioners via the newsletter. Physicians
and pharmacists also learn of critically appraised evidence through
annual drug therapy courses and numerous interactive seminars.

The TI's evaluation group measures the impact of these education
efforts on prescribing patterns and assesses how drugs are being used.
It also uses provincial health databases to learn the impact of drug
prescribing patterns on patient health outcomes.

A challenge for the group is a perception that the TI may not be
independent from the provincial government's interest in decreasing
costs of PharmaCare. Wright counters by saying that TI reviews and
reports to government don't include cost data and are limited to
evidence of drug benefits and harms derived from clinical trials.
PharmaCare includes TI reports as just one of the pieces of
information it uses to make funding decisions, he adds.

Internationally, many TI members are actively involved in the Cochrane
Collaboration. Named for Archie Cochrane, a British medical
researcher, epidemiologist and advocate of rigorous reviews of health
intervention evidence, the collaboration is an international
organization dedicated to making available reviews of the effects of
health-care treatments and therapies.

Wright says it's currently not possible for groups like the TI and the
Cochrane Collaboration to get complete data from all clinical trials
conducted worldwide. However, he does have a vision for greater access
to reliable and unbiased data.

"What's needed is to get more people involved in Cochrane, better
access to data from all clinical trials, more systematic reviews
published and more countries providing universal free access to the
Cochrane resource," he says.

Many countries, such as Australia, Finland, Ireland and England, make
the Cochrane Library's resources available without charge. In Canada,
however, only one province -- Saskatchewan -- has paid for the
licence. The federal government has balked at a $500,000 annual fee
that would make the library freely accessible to all Canadians, says
Wright.

For more information on the TI, visit www.ti.ubc.ca.
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Last reviewed 01-Dec-2004

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