June 24, 2015 Open letter to the Hon. Terry Lake Minister of Health for British Columbia

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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

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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.)