I am writing this in support of the position taken by Dr Bebb and his colleagues (The drug review process in BC: A critique. BCMJ 2001; 43(2):86-87) with respect to the Therapeutics Initiative (TI).
TI was propounded as an independent body free of any governmental or commercial biases. As it has evolved in recent years it has become clear that it is no longer fulfilling its mandate.
The cited debacle over zopiclone is a clear-cut example of how TI has become biased by its connections with government. The documented evidence about zopiclone is that it is in a major fashion far less liable to be of addictive potential and has very much fewer in the ways of cognitive side effects in senior patients. Yet TI agreed with Pharmacare that, because of reasons of cost, benzodiazepines of considerable addictive potential were preferable as benefits under the scheme.
For similar reasons TI opposed the coverage of donepezil hydrochloride for patients with dementia despite the more than 1000 international references of its therapeutic efficacy. Nor did TI point out that for donepezil to work properly it required 2000 units of vitamin E per day.
Commercial bias? TI has lent its standing to the advocacy of statin drugs (ß-hydroxy-ß-methyl-glutaryl coenzyme-A inhibitors) for the management of cholesterol-related conditions, even though these drugs are exceedingly costly and have no long-term demonstrated value. There is nothing which statin drugs can do which niacin has not been shown to do as well, if not better, for very much lower cost and for a demonstrated value of more than 11/2 decades. Worse, TI has lent tacit support to the concealment of the most important adverse reaction of the statin drugs, the progressive deficiency of ubiquinone in the oxidative phosphorylation pathway in mitochondria.
These are but three examples among a sorry list of many others.
I supported TI when it was first formed and had great hopes that it would fulfill its mandate. In some cases it has done so, and all credit to it.
However I do have to agree with Bebb, et al., that it has come time for the actions of TI to come under serious scrutiny by the medical profession in this province.
—Erik T. Paterson, MB
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