You only need to know the name of one company — Purdue Pharma — to understand why transparency is needed in the financial dealings between drug manufacturers and doctors. Purdue sells OxyContin and other products prescribed for the treatment of pain, one of the most common symptoms physicians encounter. As the U.S. company acknowledged, Purdue misled doctors about the safety and effectiveness of OxyContin, fuelling a public health crisis that now claims the lives of some 30,000 North Americans annually.

In the seven years after OxyContin’s approval by the FDA in 1995, the company sponsored some 20,000 pain “education programs” in the United States at a cost of about $200 million. (OxyContin would eventually generate more than $35 billion in revenue.) The company employed a legion of sales representatives to promote its products, paying them bonuses averaging $70,000, with some earning upwards of $250,000. Purdue also spent huge amounts on “gifts” and “swag” for doctors, and distributed starter coupons entitling patients to their first OxyContin prescription free.

The company knew physicians, concerned about the risk of addiction, would be reluctant to prescribe opioids for chronic pain. Purdue reps were coached to tell doctors that, by virtue of its timed-release formulation, OxyContin would lead to addiction in less than 1 per cent of chronic pain patients. Doctors bought this message, even though the figure was based in part on a five-sentence research letter published in 1980 and not applicable to outpatients with chronic pain.

Purdue simultaneously engaged several “key opinion leaders” — most of them pain specialists — to tout OxyContin’s safety and effectiveness to the profession. Some ascended to prominent positions in national pain organizations that were themselves bankrolled in part by Purdue and other opioid manufacturers.

The OxyContin story is a particularly egregious example of what can happen at the pharma-physician interface. Companies don’t always use false information to “educate” doctors about their drugs, but they tend to selectively present information favouring their products. Doctors are free to do their own research, but the reality of medical practice is that few have the time.

That’s where the “gift relationship” between physicians and industry comes into play. When a drug company representative visits a physician’s office with a high-end lunch, tickets to a sporting event, or some other gift, the goal is not simply to promote a product. Rather, the goal is to build trust — sometimes, even friendship — so that physicians are more likely to accept what they’re told about the safety and effectiveness of not just one drug, but the next one too. When these same messages are heard at educational sessions at a fancy restaurant from a leading physician (who typically pockets $1,500 or more for each event), it’s his or her reputation that does the work, not the gifts.

How can we tackle the problem of undue industry influence over doctors’ prescribing? The United States has begun requiring companies to disclose, as a legal requirement, all “payments or transfers of value” to physicians exceeding $10. This information is freely searchable online by company, physician or drug. Some European countries have also recently implemented similar sunshine laws.

Seeing the writing on the wall, Canadian drug companies recently announced a voluntary sunshine initiative of their own. Unfortunately, what they’ve proposed is disingenuous and deceptive. Under the initiative, participating companies will report only aggregate amounts given to medical education, rather than how much money made its way to which doctors and why. It gives the illusion of transparency, while cloaking the money pocketed by individual physicians.

This initiative will not illuminate ties between drug companies and doctors, and it will not make doctors rethink their treatment decisions or relationships with Big Pharma. Nor will it allow patients to question what might be influencing their doctors’ prescribing.

Pharma’s voluntary initiative is a thinly veiled attempt to clean up its image. In reality, sunshine can only result if Canada’s Food and Drugs Act is amended to require individual drug manufacturers to disclose financial dealings with individual physicians. It’s time the Canadian medical profession and its provincial licensing bodies publicly supported reform of this sort. Otherwise, drug companies and their agents will continue to have undue influence on what doctors prescribe.

Matthew Herder is an associate professor at the Health Law Institute, Faculties of Medicine and Law, Dalhousie University. David Juurlink is Eaton Scholar and professor of medicine and health policy at the University of Toronto.