June

24, 2015
Open letter to the Hon. Terry Lake Minister of Health for British Columbia
Introduction
We applaud the Minister of Health for considering mechanisms to get to the bottom
of the 2012 Ministry of Health firings. This is consistent with the Ministry of
Healths long-standing, growing commitment to evidence-based decision-making.

Our work, as well as that of many others in related programs that was stopped in
2012, was directly in support of evidence-based policymaking. Much was
specifically in response to the BC Auditor Generals 2006 review, Managing
PharmaCare, that called on the Ministry to produce more evidence of the
effectiveness of PharmaCare programs.

Mandate
The inquiry should seek to understand, and to remedy, how a painstakingly built
program to bring evidence to prescribing could be undone so quickly and, based on
the governments own public statements, mistakenly. It should recommend how to
restore public confidence that the government is fully engaged in ensuring the
safety and effectiveness of prescription medicines. It should provide the public
service with reassurance that evidence will be the basis for public policy and for
employment practices. We support an inquiry that determines its own initial and
emergent scope and terms of reference.

Independence
As human judgment is highly susceptible to bias, evidence-based decision-making
depends on reviews that are independent of financial and organizational influence.
Therefore, public confidence in government and public service morale depend on
this inquiry being independent.

It is our strong preference that the inquiry not be conducted by the Auditor General
or any other part of government, given that the Auditor General and many other
agencies of government were directly involved in the events that led to the 2012
firings. However, if the inquiry is conducted under the auspices of the Auditor
General, the inquiry should be stand-alone and as independent as possible. The
inquiry should report to the House and be mandated to release its report, without
redactions, to the public at the same time as it is provided to the House.

Evidence-Based
In order to allow the inquiry to gather evidence, it must have subpoena powers for
people and documents, the ability to retrieve deleted documents, and the authority
to take statements under oath.

The Minister said he feels constrained by the need to protect the privacy of
individuals who might be subject to the inquiry. We share his concern to protect
individual privacy and we support the BC Freedom of Information and Protection of
Privacy Act. Section 22(4) (e) of the Act excludes public servants, including us, from
privacy protection in matters concerning accountability for official actions.

June 24, 2015

Open letter to the Hon. Terry Lake Minister of Health for British Columbia
Details of Settlements
The Minister also expressed concern about revealing details of past settlements.
While those of us who settled our disputes with the government respect the
wording of our settlements, we recognize that an independent inquiry with
subpoena powers might require disclosure of those settlements for the purposes of
assessing adherence to due process. As a matter of principle, we have no objection
although this will need to be decided on a case-by-case basis and the government
may need to release some of us from confidentiality or other obligations.

Budget
The inquiry should have its own substantial budget that must provide for payment
of legal costs for anyone who has a legitimate interest in both the process and the
outcome of the inquiry.

Government has already spent over $5 million on the investigation and its
aftermath. We share concerns about additional costs. Consider, however, that the
long-run savings to government from redoubling its commitment to evidence-based
decision-making will undoubtedly far exceed the budget of the inquiry and make a
major contribution to evidence-based prescribing benefiting both public health and
the public purse. Our work included facilitating the Therapeutics Initiatives
unbiased reviews of evidence of drug effectiveness and safety that enabled BC
PharmaCare to improve prescribing safety and save over $100 million in the past 20
years by not covering drugs that were later confirmed in other jurisdictions to have
caused harm to patients and massive wastage of expenditures. The annual savings
to PharmaCare attributable to advice given by the Therapeutics Initiative even
before 2012 continues to exceed $5 million per year.

Summary
We believe that the strength of democracy depends on unbiased evidence, which
depends upon independent inquiry.

We call on the Minister to commission a thorough and independent inquiry.

Signed:

Ramsay Hamdi
Robert Hart
Linda Kayfish (sister of Roderick MacIsaac, deceased)
Dr. Malcolm Maclure
Ron Mattson
David Scott
Dr. Rebecca Warburton
Dr. William Warburton

Contact: Linda Kayfish lkayfish@gmail.com (email not for publication.)