In 1998, a tobacco industry lobbyist John F. Scruggs coined the term “echo chamber” in a memo to his employer Philip Morris. The cigarette maker was seeking to undermine the scientific consensus on the health consequences of smoking and fend off further restrictions on the sale of its cancer-causing product.
If Philip Morris hoped to influence American legislators, the industry’s disinformation had to come not just from lobbyists but also from sources apparently removed from and independent of the tobacco corporations, Scruggs explained in his memo. “The more a particular view or piece of information ‘echoes’ or resonates through this group [of sources influential with policymakers], the greater its impact,” he wrote. Scruggs dubbed this “the ‘echo chamber’ approach to advocacy.”
The term “echo chamber” soon popped up in Big Pharma lobbyists’ vocabulary, which had long pursued strategies like the one outlined by Scruggs, as historian Edward Nik-Khah has shown. Indeed, Big Pharma and its allies have mastered the art of poisoning public debate over issues that might affect their interests. They do this through a network of seemingly independent policy institutes and research centres, which are in fact funded by the industry and often staffed by former – and in some cases, current – personnel.
Next week, the Council of Canadians is publishing an exposé on the “echo chamber” that Big Pharma has deployed to wage a disinformation war on pharmacare. In this excerpt of our research dossier, we trace how Big Pharma’s relationship with a host of Canadian think tanks opposed to public, single-payer pharmacare goes back decades.
As the debate on pharmacare has moved to centre stage following the introduction of the Pharmacare Act (bill C-64), this deeply compromised cast of characters and institutions are at it again – doing everything in their power to poison the public debate on pharmacare.
The Fraser Institute and Big Pharma’s cross-border fight against cheap drugs in the early 2000s
In 2003, the New York Times obtained confidential budget documents that revealed a $150 million game plan from the Pharmaceutical Research and Manufacturers of America (PhRMA) – the powerful industry lobby group – to fight price controls around the world, including in Canada. The goal, according to one document, was to generate an “intellectual echo chamber” of economists and other “thought leaders” speaking out against policies like drug price controls that could harm Big Pharma’s profits. The Fraser Institute appears to have played a key role in this campaign.
A key plank of Big Pharma’s plan was “subsidizing ‘like-minded organizations’ and paying economists to produce op-ed articles and monographs in response to critics,” the New York Times reported. Spending millions on support for research and policy organizations would serve “to build intellectual capital and generate a higher volume of messages from credible sources” sympathetic to the industry, according to the internal documents obtained by the Times.
The “echo chamber” strategy was clearly not limited to the United States. Canadian think tanks were given nearly $1.5 million to argue against drug price controls, to stem the flow of lower-price prescription drugs to customers in the U.S., and “to change the Canadian health care system,” the confidential documents indicated.
Big Pharma was troubled by Canada’s price controls on brand-name drugs, managed by the Patented Medicines Price Review Board (PMPRB), and the growth of online pharmacies selling lower-cost prescription drugs directly to American consumers. The immensely profitable U.S. market was threatened by “expanding government price controls abroad, resulting in politically unsustainable cross-border pricing differences” and “increasing availability of medicines from abroad via Internet sales,” as a memorandum for the PhRMA board put it.
While the Canadian recipients of PhRMA’s funding were not identified by the Times exposé, several think tanks dutifully churned out reports and op-eds reprising industry talking points in the following years – with the Fraser Institute leading the way.
For a think tank ostensibly committed to unfettered free trade between Canada and the U.S., the Fraser Institute’s output on drug reimportation in the early 2000s was impressive. Just months after the New York Times story broke, the Fraser Institute published a study titled “Canadian Prescriptions for American Patients Are Not the Solution.” Funding for this work (and many subsequent studies) came from “a number of research-based pharmaceutical companies,” though the Fraser Institute assured readers that this financial support had no impact on the integrity of its research.
Its author, the Fraser Institute’s Director of Pharmaceutical and Health Policy John H. Graham, received speaking fees from pharmaceutical companies for presenting at conferences and testifying at legislative proceedings. Graham wrote numerous op-eds in the Canadian media, arguing for banning online pharmacies, allowing direct-to-consumer advertising for prescription drugs, and against national pharmacare.
Graham’s successor on the drug policy file, Brett Skinner, would be equally prolific on topics of interest to Big Pharma. As Director of Pharmaceutical and Health Policy from 2004 to 2012, Skinner authored numerous Fraser Institute reports denouncing Americans’ use of online pharmacies to buy Canadian drugs at lower prices, which he maligned as a “black market trade in prescriptions drugs,” “prescription piracy,” and “theft of intellectual property.”
The Atlantic Institute for Market Studies (AIMS) was another free-market think tank that took an oddly hostile stance on cross-border trade in prescription drugs in these years. AIMS’ founder Brian Lee Crowley travelled regularly to the United States to argue against drug re-importation and to warn against any effort to replicate Canada’s weak system of drug price controls. “Basically, everybody loses, or at the very least nobody wins” when governments lower drug prices, Crowley told his American audiences.
In true echo chamber fashion, AIMS reports opposed to drug importation were brandished by PhRMA lobbyists in the U.S. in support of their position. AIMS was funded by PhRMA’s Canadian counterpart Rx&D (now known as Innovative Medicines Canada) and a host of pharmaceutical companies in the early 2000s, according to the think tank’s annual reports.
The Big Pharma echo chamber takes on pharmacare
What the leaked PhRMA memo revealed, Edward Nik-Khah argues, is that Big Pharma’s leading lobby group knew that “it could at a moment’s notice call upon a group of economists who could deliver a finely tuned message to achieve a political goal, and that they could be depended upon to do so because they had done so before.”
In similar fashion, Big Pharma is clearly working with many of the same individuals and institutions that constituted its Canadian echo chamber in the early 2000s to fight the Trudeau government’s hesitant moves towards a national pharmacare plan.
The Fraser Institute is staunchly opposed to public, single-payer pharmacare. It continues to receive funding from Big Pharma and employ experts with close ties to PhRMA and its member companies.
Brett Skinner, who left the Fraser Institute in 2012 after serving as its CEO for two years, is now head of a pharma-funded think tank, the Canadian Health Policy Institute. He established the organization while working as executive director of health and economic policy for Innovative Medicines Canada, Canada’s most powerful pharma lobby group. He regularly writes op-eds against single-payer pharmacare.
Brian Lee Crowley’s AIMS shut down as a separate organization in 2019 and was folded into the Fraser Institute. But Crowley’s privileged relationship with Big Pharma would carry over to the next think tank he would establish, the MacDonald-Laurier Institute. Its experts are some of the most vocal critics of single-payer pharmacare – and are similarly entangled in numerous conflicts of interest.
Nikolas Barry-Shaw
Nikolas is the Trade and Privatization Campaigner for the Council of Canadians and author of the book “Paved with Good Intentions.”
