The Globe on drugs (1)

Today’s Globe and Mail features two excellent articles about drugs in Canada. The first makes some great points about what might be possible with a national pharmacare plan and how politics is getting in the way of doing the right thing. The second is about how profit-seeking by pharmaceutical companies is distorting the cost of treatment. In this case, doctors have found that a drug approved for one condition works for a related condition in a different part of the body, so now the company is trying to acquire a new monopoly so that they can charge ten times the price.

What is odd is that I really had to work to find these articles in the online edition, despite their presence on a full page in the print edition. Not on the main page, not in the headline index. I had to know what I was looking for and do a search. It is as if the Globe hid the articles so that the casual online reader would never come across them. So as a public service, RPE offers both articles here in their entirety.

First up, Andre Picard on the plight of the National Pharmaceuticals Strategy:

Bickering stalls national drug plan to cover catastrophes

In the 2004 federal-provincial Health Accord, Canadians were promised a National Pharmaceuticals Strategy, one whose cornerstone is a catastrophic drug plan.

With spending on prescription drugs at $20.6-billion and galloping upward at a rate of 12 per cent annually, the growing challenge posed by expensive new drugs for rare (and not-so-rare) diseases, and escalating concerns about drug safety and appropriate prescribing practices, getting a strategy in place is the most pressing issue in the health-care field.

However, two years after the accord, the NPS is still largely a good idea mired in a bureaucratic bog, and millions of Canadians are suffering unnecessarily — financially, physically and emotionally — as a result.

… Access to prescription drugs depends largely on where you live and where you work, not on need.At least 600,000 Canadians — almost all of them in Atlantic Canada — have no drug coverage at all. Another six million Canadians have inadequate drug coverage — basic treatments for common conditions such as diabetes pose a serious financial hardship, and treatment of conditions such as colon cancer or rare illnesses such as Gaucher’s disease is utterly unaffordable or inaccessible.

This yawning care gap is at odds with the principles of medicare and offends Canadian values.

The answer is to extend medicare guarantees beyond hospital and physician services to ensure universal timely access to safe and effective prescription drugs: in other words, pharmacare.

Politicians, largely for financial reasons, have shied away from this approach. Instead, they have embraced the notion of catastrophic drug coverage — placing a cap on how much Canadians pay out-of-pocket for prescription drugs.

… Implementing drug pricing and purchasing strategies to obtain the best prices for drugs and vaccines. Patented prescription drug prices are regulated in Canada. But if Canada also regulated non-patented prescription drugs (mostly generic drugs), the drug bill could be reduced by $1.5-billion a year;Strengthening the evaluation of real-world drug safety and effectiveness. A lot of drugs that look good in clinical trials don’t work nearly as well in the real world. Mr. Romanow recommended the creation of a National Drug Agency to do monitoring and to provide information to consumers, but little has been done in this area;

Broadening the practice of e-prescribing by developing electronic health records. Tracking prescriptions electronically can sharply reduce waste and help avoid dangerous adverse reactions, but e-prescribing remains a rarity;

Improving the prescribing behaviour of health professionals. No one likes to talk about it, but there is a lot of inappropriate prescribing going on: expensive drugs used when cheaper ones work fine, along with over-prescribing and under-prescribing of treatment for various conditions. Physicians, nurses and pharmacists with prescribing powers need access to good, impartial data; now, they are too dependent on pharmaceutical company bumpf.

The second story about profiteering in the pharmaceutical industry:

The blindness prevention few can afford

At $2,000 a monthly dose, Lucentis can reverse macular degeneration, but a cheaper, unproven alternative seems to do the same thing

A breakthrough drug that can successfully reverse the most common form of blindness in the elderly could hit Canadian pharmacy shelves as early as next year.

But breakthroughs don’t come cheaply, and this one could very well drive the already mounting cost of health care even higher.

In the United States, where Genentech’s Lucentis is already approved for use, it costs about $2,000 a dose and is required once a month for the rest of a patient’s life.

… While waiting for Lucentis to be approved by Health Canada, physicians such as Dr. Berger have been scrambling to find ways of salvaging their patients’ quickly diminishing eyesight.More than two million Canadians suffer from varying degrees of the macular degeneration but that number is expected to balloon rapidly as the oldest baby boomers turn 60.

They’ve found that using a cheaper alternative, already on the market in Canada, appears to do just as good a job as Lucentis when injected into the eye.

But that drug, Avastin, is approved to treat only colorectal cancer and is designed to prevent the growth of new blood vessels that feed tumours.

Incidentally, both drugs are manufactured by Genentech and have surprisingly similar molecular makeups.

“Basically, two Lucentises make one Avastin,” said David Wong, an assistant professor of ophthalmology at the University of Toronto, who has been prescribing the cancer drug off-label to his patients with the debilitating eye disease since last fall.

Many of his patients have been able to read three more lines on an eye chart after receiving a few doses of Avastin. (Off-label means that doctors can prescribe any approved medication for other purposes.)

“From what I’ve seen, [Avastin] works just as well as Lucentis, and is a fraction of the cost.”

A dose of Avastin for colorectal cancer can be bought for roughly $900 in Canada. Special pharmacies can divide it into as many as 20 parts.

After taking into account sterilization and packaging costs, the smaller dose of Avastin that can be injected into the eye could cost as little as $150 for the patient.

That is roughly 10 times cheaper than the expected cost for the same dosage of Lucentis.

The controversy highlights the struggle of pharmaceutical companies to achieve what they see as two equally essential priorities: making medical advances and turning a profit.

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