Article about Canadian guidelines on proton pump inhibitors was misleading

Editor—I am writing because AstraZeneca Canada objects to the fact that the BMJ did not ask the company for comment before publishing Shuchman's news article on guidelines about the prescription of proton pump inhibitors in Canada.¹ The article misleads readers on several counts.

Firstly, Shuchman writes of a letter that AstraZeneca sent to Dr Anne Holbrook; the letter was sent two years ago to Dr Holbrook as the chair of a government committee. The government of Ontario responded in April 1998 on her behalf and provided assurances that these guidelines would not contravene the Federal Food and Drugs Act.

Secondly, the guidelines have never been published by the government and to the best of our knowledge are currently being reviewed and updated.

Thirdly, AstraZeneca provided the committee with scientific information refuting the draft guidelines but did not receive any response to these concerns.

AstraZeneca Canada is not pursuing legal action against any doctor. AstraZeneca believes in, and champions the appropriate use of, all of its products. We support patient access to cost effective drugs that provide the best available treatment, freedom of product choice, and independent evaluations–provided such evaluations are based on sound, peer reviewed scientific evidence.

AstraZeneca has never prevented any doctor or researcher from publishing or communicating the results of their studies. It has a passionate interest in–and a long history of supporting–independent, peer reviewed research that leads to the development of beneficial products for Canadians and patients around the world.

Two years ago we believed the provincial government might accept the draft recommendations from the Ontario Gastrointestinal Guideline Development Committee and implement drug class substitution in Ontario. In our view, this would contravene federal legislation. Health Canada has the primary responsibility to determine the safety and efficacy of prescription pharmaceutical products. For gastrointestinal illnesses there are three products in this class of drugs. Each product is a different chemical entity. Omeprazole has been approved by Health Canada for more indications than the other two products, and the drugs in this class are not “the same.”

We have spoken to Dr Holbrook and apologised for misdirecting the letter through her, as chair of the advisory committee, instead of sending it to the ministry. We have also discussed our differences in the assessment of proton pump inhibitors by the committee and wish to move forward in the spirit of scientific debate.