Tuesday, November 23, 2010

Generic Drugs

I take three medications daily:  1. Lipitor, which reduces cholesterol which I produce internally; 2. Ezetrol, which reduces cholesterol which I absorb from food; 3. Cozaar, which lowers blood pressure.  The generic names for these medications are Atorvastatin, Ezetimibe, and Losartan.

They are not inexpensive.  A three month supply of each are $ 215.33 CAD; $ 166.10 CAD; and
$ 121.50 CAD.  Fortunately, I have Blue Cross extended health coverage, which pays 70% of the cost.

Lipitor has been the best selling drug in the world, producing revenue up to $ 12.7 billion USD for Pfizer annually.  The patent has expired, however, and yesterday my pharmacist informed me that the generic equivalent is available. The cost was reduced from $ 215.33 CAD to $ 91.29 CAD.

A curious thing is that the generic form of Lipitor will not be available in the United States for another year (November 2011).  Pfizer is concerned about losing revenue from its top money-maker and has been able to negotiate with the generic manufacturer to delay its introduction there.

Canada and most western countries have some type of government price control for drugs.  In Canada, the Patented Medicine Prices Review Board limits the prices that drug manufacturers may charge.  New patented drugs may not be priced above another drug providing similar therapy; or, if a new therapy, above the average of other countries.  The result is that Canadian patented drug prices are less than the international average and sometimes much less than in the U. S.    
New provincial regulations across Canada are also restricting the cost of generic drugs.  Ontario has announced that generic drugs may not cost more than 25% of the patented form.  BC is introducing a plan to limit the cost to 35%, down from 65%.

I sometimes see demonstrators in the U. S. with signs objecting to Canadian-styled "socialized medicine".  Of course, the Canadian system is not "socialized".  It is essentially a system of private practices, with a single payer and some government regulation. The Canadian health delivery system is not perfect, and is faced with rising costs, as are health systems in other countries.  In the area of keeping drug costs reasonable, however, it seems to be doing a better job than others.

Tuesday, November 16, 2010

Destructive Behaviour

In July, grandson and girl friend had their child taken by the grandson's parents, because of their continued drug use and neglect. Since then, Ministry of Children and Family Development has taken the toddler into care and a permanent placement with the grandparents is pending.  The biological parents do not contribute financially and have basically ceased any responsibility.

The girl friend has a history of addiction to methamphetamines.  This results in her being awake all night and asleep all day, unable to provide for her child's needs.  MCFD social workers have asked her to get treatment, but cannot force her to do it.  The response of the grandson and girl friend is denial, avoidance, and hostility. Although we've been careful not be accusatory and to be as supportive as we can, they now avoid us.

In April, the girl friend totaled their car in a four-car collision.  Both have lost their jobs.  They've lost supervised visiting rights with their child at the MCFD office, because they are unable to stay awake.   

Complicating this is that the girl friend's Mother is a drug user, as was her father, who died of drug use.  Instead of providing support for her daughter, the Mother also denies the drug use.  The daughter's response, "If I got treatment, my Mother wouldn't speak to me!"

Now the girl friend is pregnant again.  The downward spiral continues.

I don't think this story is very unusual.  A disturbing aspect is that it is generational.  Intervention is needed, but in our society, there is no one to provide it.  You are not required to be married to have children; or to accept direction; or to get treatment for your problems.  Eventually you lose your friends and family, your place to live, and your health.  This in a society which offers so much, but is unable to limit destructive behaviour.      


Tuesday, November 9, 2010

More Populism

The populist aversion to higher taxes, seen in the Tea Party phenomenon in the U. S., has its counterpart in British Columbia, with the public reaction to the Harmonized Sales Tax (HST), which has recently added  a 7% Provincial Sales Tax to previously untaxed items.  The most notable of these are probably restaurant meals, telephone and cable, and some personal services.

The BC Government maintains that the tax is revenue-neutral, being matched by offsetting business tax credits, which will be passed on to the public in lower prices and will encourage business investment in BC.   Nevertheless, opponents of the measure initiated a Province-wide petition campaign, and the issue is set for a referendum next September.  The Government has said that it will eliminate the tax if the referendum passes.

Premier Gordon Campbell's popularity has fallen so low that he has announced his intention to resign.  He has also announced Provincial income tax cuts to try to improve his party's approval rating.

Of course, no one likes to pay taxes.  We do like services, however, particularly when they are free, such as the BC Medical Services Plan, which provides doctor, hospital, and medical services in the Province. 

But "free" government services are not really free.  Someone, somewhere, has to pay, either by taxes, fees, or borrowing.  Charging additional fees for medical services is potentially asking for more populist rhetoric, opening up charges of a "two-tier" system, one for the prosperous, another for the low-income.

Unfortunately, the consequence of not being willing to support the cost of programs is longer wait times for medical services, more crowding in hospitals, more temporary classrooms, and fewer programs for students.

Both in Canada and the U. S., if they can't grow the economy, and don't want to pay taxes, eventually they'll have to decide which programs to cut.  In the current environment of harsh rhetoric, this will not be easy.        


Wednesday, November 3, 2010


In a democracy, political success often depends on an appeal to populism, or the wisdom, as well as the fears and prejudices, of the common man.  Yesterday, the American public switched some of their populist allegiance from the Democrats to the Republicans.  Congress is now split: the Republicans with a majority in  the House of Representatives; the Democrats with a majority in the Senate.

That the party that loses the last Presidential election recovers to make gains in the succeeding mid-term election, is not new.  It's easier to criticize from without than to actually govern.  This is particularly true when money is no object, and you're not held directly responsible for your campaign statements.

The general rationale for the Democratic losses is that the economy still has not recovered from the economic downturn of 2008.  While this was brought on by unregulated and dishonest banking practices of the Bush years, the pain has been felt primarily under Obama's tenure.

The Democrats have tried to do all the right things to revive the economy, at least according to the textbooks. When I was at University in the 1960's, we were taught that the Great Depression was caused by  Herbert Hoover attempting to balance the budget, when (according to Keynesian Theory) fiscal stimulus and deficit spending were needed. The great populist Franklin Roosevelt presumably was on the right track with new government programs to create jobs and stimulate recovery.  Today, opinion is divided on how successful he was.

In the 1970's, Milton Friedman popularized a theory that the Depression could have been avoided by lowering interest rates, instead of providing Government stimulus.  "Monetarism" removed some of criticism of capitalism, and, importantly, from the Republican point of view, some of Roosevelt's lustre.

The Obama administration has now tried both approaches, unprecedented stimulus and bailouts, and cutting interest rates to near zero.  Yet the economy has not responded as quickly as anyone would like.  You reap the consequences of events, even when you do all the "right" things.

Canada, as compared to the U. S., has not suffered the same economic downturn, partly because of a more regulated banking system; partly because its resource base has largely recovered.  It is not immune to populist pressures, however.  The Conservative federal government has refused to approve the purchase by Australian-based  BHP Billiton (the world's largest mining company) of  Potash Corporation of Saskatchewan (the world's largest Potash company).  Despite the fact that both operate internationally (most of the shareholders of Potash Corporation are probably not Canadian), that the Canadian Government claims to support free markets and to oppose government interference in private business, and that the sale would provide an economic stimulus to Canada, a surge of economic nationalism in the West and the potential loss of some seats in Parliament  has caused the Government to compromise its stated principles.  At least until it can figure out how to pacify the populist objections.