At least it wasn’t Beverley McLachlin. Apparently even Justin Trudeau thinks it would be a bit de trop to appoint a judge who sits on a Chinese court to investigate Chinese meddling in our electoral system. But admit it: her name at least crossed your mind when Trudeau promised that he would appoint an “eminent Canadian” to look into the matter.

Instead, we got David Johnston, and it doesn’t get much more eminent than that. The man was captain of the varsity hockey team at Harvard, for goodness sake. If we were the sort of country that still went in for honorific prefixes and postnominals, the plain Mr. Johnston would have a string of them as long as any Victorian colonial grandee.

Johnston was a genial and impeccably boring Governor General at a time when that was a welcome relief. Bland to the point of invisibility, he seemed determined not to be noticed. He even refused the historic uniform, opting instead to dress like the commodore of a suburban yacht club. 

Publicly, he rarely set a foot wrong, while privately he performed the less palatable duties of his office without complaint, schmoozing foreign dictators and paying Canada’s official respects at the funerals of the sort of head of state it would be awkward for the PM to honour. 

I don’t mean any of that churlishly. Johnston was an unsung diplomatic asset who reliably and effectively pressed Canada’s interests at the highest levels around the world in ways that most people in government never saw. His reports of his meetings were incisive and helpful.

It’s true that his record of investigative and regulatory appointments is rather more checkered. His exclusion of the Airbus payments to Karlheinz Schreiber from the scope of the Oliphant Commission’s terms of reference was at best a serious error in judgment. I’ll leave the “at worst” alternative to those who were there. 

More recently, he headed up the hapless Leaders’ Debates Commission that barred True North and Rebel Media from covering the 2019 leaders’ debates. The two news outlets had to rush to the Federal Court to overturn the decision, which the judge said was “lacking in discernible rationality and logic” and “neither justified nor intelligible.” 

Others have pointed to his involvement with the Pierre Elliott Trudeau Foundation as a problem, though that doesn’t bother me nearly as much as his advisory role with Deloitte, one of those global advisory firms that has raked in billions from government consulting (including in $172 million from the Government of Canada in 2021-22 alone, according to a Carleton University report) and has generally viewed the genocidal PRC as a gold mine rather than a global threat. 

But complaining about any of this, or any of Johnston’s other corporate and eleemosynary boards, commissions, panels, and advisory roles is beside the point: this is what it means to be an eminent Canadian. As soon as Trudeau uttered that dismal phrase, we knew what were in for. Frankly, Johnston is about as good as we could have hoped for, all things considered. 

The problem here is not Johnston, it’s the whole class, nay the very idea, of “eminent Canadians”—a phrase that means nothing outside Ottawa and a few corporate boardrooms in downtown Toronto and Montreal, but which means everything within that ambit. In those enclaves of faux leather chairs and sapless modern art, the answer to every problem is always the same: deploy the eminent Canadians! 

This is why their boards are stacked with them, and how we end up with paragraphs like this, which could be torn from the appendix of Peter C. Newman’s The Canadian Establishment:

Circles are small in Canadian business, and [BMO board chairman] Mr. Prichard and [BMO vice-chair] Mr. Lynch had every reason to be twisting arms on behalf of SNC-Lavalin, though the pair were in the Prime Minister’s office so often last fall they should have been allowed to choose the furniture. Mr. Prichard is also chair of law firm Torys, which is representing the Montreal-based engineering company. And along with his day job at BMO, Mr. Lynch is chair of the board of SNC-Lavalin. He’s also the former Clerk of the Privy Council, the country’s top civil servant.

When Lytton Strachey wrote his bitchy little book Eminent Victorians, he scandalized British society by aiming his iconoclasm at true giants of the previous age, figures still much better remembered than Strachey himself (the arc of history sometimes does bend toward justice). If the book has a legacy today, it is that it left the adjective “eminent” charged with faintly sardonic insinuation. Only in Canada, and even then only among a certain type of insular Laurentian Liberal, could the phrase “eminent Canadian” still be used unironically. 

The label does, however, pair well with Johnston’s other new title of “special rapporteur.” Brent Cameron did a fine job in these pages explaining what exactly a “special rapporteur” is and what it might mean in this novel context, so I will skip the details. The short answer is that it’s a term borrowed from the dubious United Nations Human Rights Council for an expert appointed to assist them in their (sometimes not entirely spurious) human rights investigations. 

Cameron explained that, “[a]ssuming the use of the unconventional title isn’t some cynical messaging ploy” (which, for the record, is not an assumption that I am willing to grant), if the Trudeau government follows the UN’s example, the “special rapporteur” will be granted virtually unrestricted access to “interview all manner of individuals within the government, the opposition, the intelligence and law enforcement communities, academia, and any advocacy groups within the broader society.” This—and I don’t think I’m bursting anyone’s bubble here—is not going to happen. Even if it did, I doubt Johnston would find much that would surprise anyone.

And here we finally get to my own problem with the appointment. The eminently special David Johnston may be expert in many things, but he is not an expert in the areas relevant to this investigation. He is not an expert in foreign or domestic intelligence, he is not an expert in the political activities of the Chinese Communist Party, and—most importantly—he is not an expert in politics. 

If you want someone to investigate who has been tampering with the high table seating chart at Massey College, an eminent Canadian like Johnston is your man. No question. But the allegations of electoral interference that he is being tasked to investigating occurred at a rather less eminent level of our national politics, down in the murky world of riding nominations and municipal politics. 

These are shady places where, when you turn over a rock, you never know what is going to scurry out. I fear that Johnston will be lost as an outsider in the world of membership drives, volunteer recruitment, straw donors, and foreign-influenced diaspora politics, and will end up chasing shadows, half-truths, and will-o-the-whisp allegations down dead-end paper trails.

But if not Johnston, then who? Cameron’s suggestion of a retired judge or diplomat “from Britain, Australia, or New Zealand—jurisdictions that approximate Canada on multiple levels and utilize the Westminster system of government” is smart, though instead of a judge or diplomat, I’d have gone for a retired intelligence mandarin or ex-cabinet minister, someone with relevant experience of either foreign interference or coal-face politics. Anyone, really, who knows first-hand what to look for. Anyone, in other words, but an “eminent Canadian.”

In general we have too much governmental regulation and red tape. So why is Big Pharma an exception that needs more, not less regulation? The answer is their history of frequently unchecked greed and dishonesty.

As a physician, I prescribe medications every day and appreciate the remarkable impact that they have in treating diseases. Statins have dramatically reduced rates of heart attack. Diabetes drugs prolong and improve quality of life. Many more cancers can now be placed in remission or even cured. Arthritis drugs relieve pain and suffering. 

These drugs would not be available but for a tremendous expenditure of money and resources. In a free market, why shouldn’t Big Pharma recoup their costs and make a sizeable profit? Their argument is that new drugs should have enough patent protection to recover large development costs and we should recognize that few drugs that enter expensive clinical trials ever make it to market. As well, if we reduce drug profits, fewer venture capital dollars will be invested, resulting in less drug discovery. 

While these arguments have some validity, there is a troubling level of greed and conflict of interest that has affected drug research, marketing programs, and the schemes to extend patent protection and maintain high drug costs.

A recent paper in Nature indicated that global spending on prescription drugs in 2020 was expected to be $1.3 trillion, with $350 billion in the U.S. alone. The cost of cancer drugs in 2018 was estimated at $150 billion, increasing at more than 10 percent annually over the previous five years. Most new cancer drugs cost more than $100,000 per year for each patient in the U.S. alone. 

Greedy repricing of older drugs

Increased costs of drugs are not simply due to high development costs. Martin Shkreli is the poster boy for greed. As CEO of Turing Pharmaceuticals, he notoriously raised the price of Daraprim, an old drug used to treat parasitic infections such as in AIDS patients, from $13.50 to $750 per pill. His corporate greed in running the company resulted in him being sentenced to seven years in prison for fraud. He was also forced to pay a $64.4 million fine and barred from the pharmaceutical business for life. 

While he is an extreme example there are many other cases of old drugs becoming highly expensive without incremental producer cost.  

Why is insulin so expensive? It was discovered in Toronto in 1923, however, Frederick Banting declined to put his name on the patent and co-inventors Collip and Best sold the insulin patent to the University of Toronto for $1 so all could afford the lifesaving drug. Yet today in the U.S., a vial of insulin may cost $300 while it is only $30 to $40 in Canada. The answer is a combination of reformulation, expanded drug patents, and the inability of U.S. payers, unlike those in most of the rest of the world, to negotiate favourable drug pricing. Because of this many people have to forgo daily use and suffer the medical consequences of diabetic complications. 

A similar story relates to Mylan and their predatory pricing of EpiPens, critical for children and adults who need them to provide life-saving treatment for acute allergic reactions.

We need caps on price increases of older drugs that have more than recouped development costs.

How can drug prices be fair and price gouging avoided?

The Institute For Clinical and Economic Review (ICER) is a not-for-profit organization that determines the value of drugs based on need and performance. Other non-U.S. countries have value-based drug formularies and won’t approve drugs deemed not to be value for money. Such pricing schemes can determine fair profits for companies and preserve valuable health-care dollars for areas of greater need.

While greater use of generic drugs has reduced drug costs in most countries, a key driver of higher costs is the launch cost of expensive specialty drugs. These are used to treat complex or rarer diseases often with smaller markets. These drugs are often more expensive to produce and are harder to copy with generic formulations. Is their pricing fair? Let’s look at AbbVie which owns Humira a key drug in the treatment of inflammatory bowel disease and is the subject of a congressional probe for patent manipulation and price exploitation. The drug was launched in 2003 with a list price of $522 for a 40mg syringe.

The price has increased 27 times since the launch and now costs $2,984 a syringe, a 470 percent price increase. The drug cost was more recently tied to revenue targets and executive compensation, providing a corporate incentive for predatory pricing. Given sales of about $20 billion a year, it is hard to accept that the price increases are about recovering expensive development or production costs. 

Need for patent reform

Drug companies receive a fair number of years of patent protection to recoup costs and profit from their invention. All too often we now see minor tweaks made to extend a patent or “pay for delay” schemes used for payoffs to generic firms to delay their entry of cheaper copies into the market. Patents should not be extended for minor adjustments and pay for delay should be illegal. Other suggestions include faster approval of bio-similars which are the generic versions of hard-to-perfectly copy expensive biological drugs, in order to hasten their availability. 

Reduce conflicts of interest 

Currently, most expensive trials performed to demonstrate the safety and efficacy of new drugs are paid for by the sponsor company. While this is reasonable, the inherent conflict of interest in the reporting of these studies is unreasonable. The sponsor often has input into the study design, selection of participating recruitment sites, and manuscript preparation. Often they co-author the paper and most of the authors have declared conflicts of interest. Disclosure is voluntary and usually on the honour system. A study published in the Journal of General Medicine found that in 120 examined trials of new drugs, they discovered undeclared conflicts of interest in almost half the trials ranging from about $9,000 to $97,600 in author benefits.

There is concern that if authors don’t toe the party line and shade the discussion in favour of the drug, they will be excluded from future trials. Regulatory agencies need to be clear that sponsor input should be limited to trial funding and that there be no involvement in data analysis or manuscript preparation in order for the study to be used for drug approval. Journals need to impose serious consequences for authors who egregiously fail to report conflicts of interest. 

Penalize fraud 

It is shocking to discover that tens of billions of dollars have been imposed as drug companies’ penalties to settle fraud allegations. The penalties are to compensate for the promotion of unapproved indications, overbilling of service providers beyond negotiated pricing, kickbacks, and physician bribes. Billions of dollars have also been paid for patient harm resulting from promoting overprescribing of opioids and failure to prevent or disclose drug complications. Perhaps it is time to reduce executive compensation when criminal charges are settled and even to jail executives guilty of knowingly allowing serious patient harm. 

We need a dynamic free market to stimulate discovery and promote competition. Yet some sectors, such as the pharmaceutical business, enjoy a long-term monopoly on their drugs. Predatory pricing and greed all too often drive profit, with little compassion for the hardship it causes. When such a monopoly is abused, governments and regulators need to act vigorously and effectively to limit the abuse.