Pill Wars.

Poison-pen letters. Lawsuits. Trash talking. The sort of thing you'd expect from the World Wrestling Federation, but not among senior members of Canada's medical community. But, some very messy disputes have made the front pages recently involving relationships between pharmaceutical companies and physicians.

At Toronto's Hospital for Sick Children, Dr. Nancy Olivieri and a couple of colleagues have been the targets of a smear campaign. Dr. Olivieri, a world-renowned expert on blood, headed up a team of physicians that was contracted to carry out clinical trials of a new drug developed to control a serious blood disorder. The trials were partly paid for by Apotex Inc., the company that developed and manufactured the drug called L1.

By 1995, Dr. Olivieri was convinced that L1 was ineffective. She told Apotex about her findings and the drug company threatened to sue her if she made them public. Dr. Olivieri, who expected that the hospital would support her, did go public. But, the management of the Hospital for Sick Children failed to back up Dr. Olivieri; letters were written by a senior colleague characterizing her as a liar and a thief and one of her fellow researchers as a "pig."

The story went international. The CBS newsmagazine 60 Minutes covered it, and caught the president of Apotex calling Dr. Olivieri "Nuts," when he thought the cameras were not rolling.

The whole episode has unleashed a debate about the ethics of medical research funding. Apotex had earlier made a gift of $20 million to the University of Toronto, which is affiliated with the Hospital for Sick Children. Michael Valpy, writing in the Globe and Mail in 1998, summed up the ethical dilemma: "There is ... the perception that Nancy Olivieri was hung out to dry, and children were put at risk, because the hospital and university were too hungry for Apotex's good will and, more to the point, its cash."

This problem increases as governments pull out of funding research and private enterprise moves in. Scientists are becoming concerned that the only research that will be funded is that from which companies can make a profit.

Nobel Prize-winning chemist, Dr. John Polanyi, asks an interesting question: "Just think of what we'd know today about smoking if the tobacco companies had funded all the research."

As if to underscore the point, Dr. Anne Holbrook ran into serious trouble at Hamilton's St. Joseph's Hospital. In 1998, she was threatened with a lawsuit by the pharmaceutical company AstraZeneca PLC. Dr. Holbrook had studied a number of stomach ulcer and heartburn medications for effectiveness. She found that Losec, AstraZeneca's best-selling product and among the five most prescribed drugs in the world, was very effective. However, Losec is expensive at $3 a pill, and Dr. Holbrook said two other cheaper drugs could be substituted for it.

A decision of this sort could cost AstraZeneca hundreds of millions of dollars, hence the threatened lawsuit. Such threats, and actual lawsuits, are part of a growing trend on the part of drug companies. Researchers such as Drs. Olivieri and Holbrook are put in a difficult position. If the research they do doesn't turn out the way the company that funds it wants it to, they have a dilemma. Do you remain silent and risk harm to patients or do you go public and risk being sued into bankruptcy?

FACT FILE

In 1999, Canada's Medical Research Council said it had received only five requests to fund research into alternative therapies in its 40-year history. However, according to a 1997 Fraser Institute study, 73% of Canadians say they have used at least one alternative therapy at some time in their lives.