Dear Editor

Rawson and Adams (2023) are certainly entitled to express their views about the lead and response articles by Sirrs et al. (2023a; 2023b). Their entitlement comes with a responsibility to accurately and comprehensively state their conflicts of interest (COI) so that readers can assess whether their arguments may be influenced by other interests.

In their “Letter to the Editor” (Rawson and Adams 2023), I believe that the declaration of COI that they provided was not complete for the following reasons: Adams personally declared receiving payments from Aptatek Biosciences (, which produces medical technology that helps diagnose phenylketonuria, a rare metabolic disease. Rawson reported receiving payments from AbbVie, which makes a product that treats hidradenitis suppurativa (, which is considered a rare skin disease (Khattak and Zahid 2020).

Conflict of Interest

In 2019–2022, Joel Lexchin received payments for writing briefs on the role of promotion in generating prescriptions fortwo legal firms. He is a member of the Foundation Board of Health Action International and the board of Canadian Doctors for Medicare. He receives royalties from the University of Toronto Press and James Lorimer & Company Ltd., for books he has written.

About the Author

Joel Lexchin, MD, Professor Emeritus, School of Health Policy and Management, York University, Associate Professor, Faculty of Medicine, University of Toronto Toronto, ON


Khattak, J.I. and U. Zahid. 2020. Hidradenitis Suppurativa, a Rare Skin Disease. Journal of the Pakistan Medical Association 70(2): 348–50. doi:10.5455/JPMA.5213.

Rawson, N.S. and J. Adams. 2023. Canadians Need Improved Access to Drugs for Rare Diseases, Not More Denial. Healthcare Papers 21(2): 4–10. doi:10.12927/hcpap.2023.27112.

Sirrs, S., H. Anderson, B. Jiwani, L.D. Lynd, E. Lun, B. Nakagawa et al. 2023a. Expensive Drugs for Rare Diseases in Canada: What Value and at What Cost? Healthcare Papers 21(1): 10–28. doi:10.12927/hcpap.2023.26992.

Sirrs, S., H. Anderson, B. Jiwani, E. Lun, B. Nakagawa, D. Regier et al. 2023b. Expensive Drugs for Rare Diseases in Canada: Time for Action Everywhere and by Everyone. Healthcare Papers 21(1): 74–80. doi:10.12927/hcpap.2023.27000.