What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Thursday, February 02, 2006

Pharmaceuticals, or "Pick Your Poison"

One of the significant blows to controlling the costs of pharmaceuticals was the decision to decrease the patent times for new drugs. I have read that the pharmaceutical industry spends 32 billion dollars annually on new drugs and biologics. This is independent of government (taxpayer financed) research and thus must be recaptured in some way by the pharmaceutical companies plus a reasonable profit needs to be made. By reducing the time for these companies to recapture their costs, the government has guaranteed that new medicines coming out will be considerably more expensive. To compound this problem, no stipulations were put in place that controlled the price of generic drugs, therefore a generic could come on the market at 40% less than the patented drug, but perhaps it should have been 500% less.
It is estimated that one in 10,000 compounds investigated by the pharmaceutical industry becomes a new drug. Approximately 20% of new drugs presented to the U.S Food and Drug Administration progress through clinical trials and are approved for marketing. Generics have none of these costs so tell me how they can possibly be charging the prices they do.
Another problem that exists is preventative measures today, and their costs, are absorbed by the political party that is in power at the time, but the benefits are not realized for years down the road, and by then some other political party is likely in power. Can we really look for solutions under the Canadian System when there is such a conflict of interest? The problems in designing an efficient health care system in Canada are primarily political, not medical. Our federal government transfers money to provinces and then gets votes by slamming the provincial governments and the job that they are doing. Meanwhile the provincial governments claim they are being under-funded. It is my opinion there needs to be a better delineation of responsibilities and as much as possible, conflict of interest should be avoided and appropriate responsibility assigned.
I think there are several areas that the federal government could take direct responsibility for cost:
1) Aspects of health that are impacted by international factors such as pandemics,
2) Financing of immunizations that would have universal applications to all Canadians,
3) A basic pharmaceutical coverage program.
The above does not mean that provinces and other insurers would be exempted from supplementing coverage for pharmaceuticals, but at least the federal government would have its feet to the fire for rising hard costs of the basic package. Further, I feel an independent federal body, appointed by the provinces, should decide on the medications to be included. This on the surface seems strange, but why would a federal agency look at ways of expanding their costs if it meant savings in acute care and long term care which are provincial responsibilities. On the other hand, in order for pharmaceuticals to be marketed in Canada under a federal plan, negotiations would have to take place with competing pharmaceutical companies, and as a consequence significant savings through bulk buying (and federal controls) could be realized.
By now some people will be raising the usual issues of “rich people will get better medication”. This type of paranoid thinking has done incredible damage to Canadians from a health perspective. Our objectives should not be to have available the most expensive drug to everyone. It should be how do we provide everyone with the medication that will treat the illness in the time frame in which it should be treated(is most beneficial)?
A new blood pressure drug may be shown to be 10% more effective but is 30% more costly. Meanwhile, we know that 40% of patients over a certain age group are not aware that they have high blood pressure and another 20% are inadequately treated. We know that high blood pressure is a more significant contributor to strokes and heart attacks than is smoking. Where should societies priorities lay? What methodologies have been put in place by government to find the people who need to be treated for their high blood pressure or to encourage better follow up and control of those who are being treated? The only efforts I have seen are by communities (being able to get your blood pressure taken at fire halls---very cost effective) and by private industry. Drug stores have blood pressure machines on site and pharmaceutical companies encourage people to have their blood pressure checked----obviously in an effort to increase business. But at least an attempt is being made to get the people to treatment that need to get to treatment. It is time we stopped being paranoid about a few people that MAY have a marginal advantage by having a more expensive pill and address the issue of all the people who need intervention and are either not identified or have no access to very acceptable treatments. Can we count on governments to lead the way in this regard when it certainly will increase cost in the short term with the benefits down the road, possibly under a different administration. It’s called conflict of interest and improvement will only be seen when the system is changed. In my opinion we are far too concerned about equal access to the best drug (efficacy-the effectiveness of interventions) and not nearly concerned enough about (fidelity-the application of interventions). More on this tomorrow.


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