Our Government's Work Ethic

I'm blogging to you tonight from Georgetown, Kentucky, just north of Lexington, on my way down to Florida with the family.

We lost CBC somewhere near Toledo, but we've managed to keep the radio on a sequence of NPR stations, thus avoiding the canned pop music and right-wing talk that dominates the rest of the dial.

The big news down here, of course, is the health care bill passing in the U.S. Senate last night. While the question of whether or not this bill will actually improve health care remains unanswered, the point that caught my ear was this:

All 58 Democrats and the Senate's two independents held together early Monday against unanimous Republican opposition, providing the exact 60-40 margin needed to shut down a threatened GOP filibuster.

The vote came shortly after 1 a.m. with the nation's capital blanketed in snow, the unusual timing made necessary in order to get to a final vote by Christmas Eve presuming Republicans stretch out the debate as much as the rules allow.

Wow. I can't remember our MPs ever being late for dinner, let alone sticking it out into the wees.

No, our government is a little more laid back. Like those Conservative members of the Special Committee on Afghanistan who gave themselves an extra-long Christmas break, thanks to this note from Official Afghanistan Obstructionator Laurie Hawn:

Dear Ms. De Pape,

I am writing to inform the committee that Conservative Party members of the Special Committee on Canada's Mission in Afghanistan will not to be attending Tuesday's meeting called under Standing Order 106.4.

The Christmas and Holiday Season is a time to spend with family, friends, and loved ones. One would hope that only the most serious of emergencies should interfere with these moments.

There is presently nothing urgent needing study on the subject of Taleban prisoners. The alleged events in question took place over 3 years ago under two different Governments. Subsequently, Canada's prisoner policy was improved by the present Government and remains the "Gold standard" of our NATO allies.

Please pass this correspondence along to opposition members so they do not make unnecessary travel arrangements during this Christmas and Holiday season.

I would also like to wish yourself and all committee staff a Merry Christmas and Happy Holidays over the coming weeks.

Oddly enough, that reads exactly like the note my son forged last week to get out of school on Friday. Except his said "Social Studies" and not "Taliban Prisoners".

Orphan Drugs for Orphan Diseases: The Non-Profit Pharmaceutical Model

(This post was written for my two-hour blogathon for A Dare to Remember. Please sponsor me!)

Whenever I need a fresh injection of hope, I like to wander over to The Skoll Foundation. Partly because they always have great stories about innovative and inspiring people, and partly because.. well, I used to be friends with founder Jeff Skoll in high school. If only I'd known that my little slacker buddy was destined to become a billionaire philanthropist...

Anyway. One of the organizations funded by the Skoll Foundation is the Institute for OneWorld Health. Founded by pharmaceutical industry scientist Victoria G. Hale, OneWorld Health is a non-profit drug company.

You read that right: a non-profit drug company.

Will Uganda's New Anti-Gay Law Sabotage Anti-AIDS Efforts?

(This post was written for my two-hour blogathon for A Dare to Remember. Please sponsor me!)

Stephen Harper has joined Gordon Brown and other Commonwealth leaders in condemning Uganda's proposed new anti-homosexuality law, which would proscribe the death penalty for anyone engaging in a homosexual act in which one person has AIDS, and would also give harsh prison sentences to anyone publicly defending homosexuality or failing to report known homosexuals to the police.

“I did raise it directly with the president of Uganda and indicated Canada’s deep concern and strong opposition,” Mr. Harper announced at the conclusion of the 53-country meeting in Port of Spain, Trinidad.

“We deplore these kinds of measures. We find them inconsistent with frankly I think any reasonable understanding of human rights,” the prime minister said.

“I was very clear on that with the president of Uganda.”

Sadly, the Commonwealth appears somewhat divided on the issue, with some African and Caribbean leaders either quietly supporting the measure or dismissing it as "an internal matter".

Please sponsor me for 'A Dare To Remember'!

Some of my blogging colleagues from Canada's World and I are taking on 'A Dare to Remember' for the Stephen Lewis Foundation.

We have each pledged to blog for two hours straight (at least!) on global health issues before World AIDS Day on December 1st.* The result will (hopefully) be a week-long blog burst of compassion, support, and education about health issues around the globe - but we need someone to dare us first!

The money we raise will go directly to African grandmothers, children, and women – ordinary people who are doing extraordinary things to turn the tide of AIDS in Africa.

To donate online now, please select a donation amount from the "Sponsor Me" section on my Personal Page. It’s simple, fast and totally secure and will make such a difference to the incredible men and women transforming lives and restoring hope to communities in Africa.

So please dig deep and donate now.

Thank you!

* UPDATE: Time has once again gotten away from me, and I won't be able to put in my two hours until Sunday. But that just leaves more time for more people to sponsor me! I'm already up to $50 - let's bump that up, shall we?

I'll make you a deal - I'll make a commitment now to start blogging at 1:00 pm Sunday, and update the blog post live so you can watch my convoluted writing process in action. Now THAT'S worth a Dare!

Prescription Drug Ads Come to Canada

I saw something rather disturbing this evening: an ad talking about erectile dysfunction. Hardly an uncommon sight in itself - except this one was on a Canadian station. I believe it was CTV NewsChannel.

Unlike those endless, annoying American drug ads, this one didn't mention any specific drug - just informed the viewer that (apparently) 40% of men over 40 suffer from E.D. and referred them to a website: www.40over40.ca. But when you go to the website and dig through the fine print, you discover that the whole thing is the work of pharmaceutical giant Eli Lilly - makers of Cialis, an E.D. drug.

The whole thing is pretty subtle. After you get through all the information about how common E.D. is and rate your tumescence with their handy self-diagnostic tool, you get to a chart detailing the pros and cons of the three major oral treatments - with Cialis listed first, of course, and highlighting the fact that it's the only one you can take once a day. There's also a chart of the considerably less appealing non-oral treatments such as 'vacuum therapy' and 'transurethral insert'.

Still, it all seems pretty balanced. Right?



The trouble is, Eli Lilly has pulled this before - in England. Like Canada and almost everywhere else in the world, the U.K. doesn't allow 'Direct-to-Consumer Advertising' (DTCA) for prescription drugs. Ever. So Eli Lilly tried to sneak these '40 Over 40' ads through as 'disease awareness' campaigns.

The British weren't buying it.

Eli Lilly is to be reprimanded by the UK pharmaceutical industry watchdog for “unbalanced” promotion of its anti-erectile dysfunction drug Cialis, in violation of ethical rules.

The Prescription Medicines Code of Practice Authority has ruled that the US-based company “brought discredit” on the industry through a marketing campaign on television, the internet and in brochures in GP surgeries in the UK.

It said the company had presented information on its medicine that failed to cite the side-effects or risks, and in a way that would have encouraged patients to seek a prescription for Cialis.

The judgment, triggered by an FT article highlighting the campaign, is to be released shortly and has been accepted by Eli Lilly, which stopped using the criticised aspects of its campaign last month.

Interestingly, the British version of the campaign was even more subtle than the Canadian version. Prohibited from naming the drugs in question, they were listed only as Product A, Product B and Product C. Of course, those anonymous products were identified by name in the brochures supplied to doctors' offices by the company.

Canadian law is a bit more lax than that, and has unfortunately been getting even more lenient in recent years. Despite years of lobbbying by both the pharmaceutical industry and Canadian broadcasters, no actual changes to the law have been made. However, loopholes in the Canada Food and Drugs Act have led to an increasingly broad interpretation, as pointed out in this Canadian Medical Association Journal article:

There are 3 types of prescription drug advertisements aimed at the public: product claim advertisements, which include both the product name and specific therapeutic claims; reminder advertisements, which provide the name of a product without stating its use; and help-seeking advertisements, which inform consumers of new but unspecified treatment options for diseases or conditions. All 3 forms of advertising are permitted in the United States. In Canada, although all 3 forms appear to contravene the Food and Drugs Act, reminder advertisements and help-seeking advertisements are now everyday events in broadcast and print advertising, with little or no regulatory response.

... In 1996, a policy statement that set out to define the boundary between information dissemination and advertising suggested that Health Canada was ready to relax its interpretation of the Act.4 It stated that Health Canada "recognizes the importance to the pharmaceutical industry and to the general public of being able to disseminate and access nonpromotional information regarding drugs for human use." The effect of this statement was tacit approval of help-seeking advertisements for serious diseases. A policy paper released in November 2000 suggested an even more liberalized reinterpretation of the Act.5 It explicitly stated that help-seeking and reminder advertisements, but not product claim advertisements, were legal.

I guess it's surprising that we haven't seen even more of these ads, although I'm sure with the uncertain future of health care profits in the U.S. and all the whining the Canadian broadcasters have been doing over their financial situation lately, the pressure will only increase to have even more American-style ads hitting a TV screen near you.

I must say, though - the elephant is pretty cute.

(for all the many reasons why Direct-to-Consumer prescription drugs ads are worse than annoying - and especially bad for women - there's some great information here.)

Dr. Carolyn Bennett sets the record straight for the U.S. Senate

I was fortunate enough to hear Liberal MP Carolyn Bennett speak on health care and social infrastructure at a town hall forum here in Milton last week. I was tremendously impressed with her passion and her depth of knowledge and understanding on these issues.

So I was thrilled to hear that Dr. Bennett was in Washington this week testifying before the Special Senate Committee on Aging, explaining how the Canadian health care system works and how we manage equal or better outcomes than the U.S. while spending nearly a third less per capita.



Why Dr. Bennett was there and not our current Health Minister is a separate question.

There was a rather entertaining exchange between Dr. Bennett and Sen. Bob Corker in which Corker accused Canada and other countries of being "parasites" on U.S. pharmaceutical R&D:

"One of the things that has troubled me greatly about our system is the fact that we pay more for pharmaceuticals and devices than other countries, and yet it's not really our country so much that's the problem, it's the parasitic relationship that Canada and France and other countries have towards us," the Tennessee lawmaker told Carolyn Bennett.

"Meaning that you set prices and unfortunately all the innovation, all the technological breakthroughs, just about, take place in our country ... you benefit from us and we pay for that and I resent that."

...[Bennett] seemed puzzled by Corker's remarks, reminding him that drug pricing was a global concern, not something limited to Canada.

"It's the drug companies, sir, and they're multi-national -- it's nothing about the United States of America," Bennett told him.

Aside from the offensiveness of Corker's assumption that all the great medical innovations happen in the U.S. (uh... insulin? stem cells? remote surgery?), perhaps someone should remind Mr. Corker that the profit incentive in the U.S. system has meant that the vast bulk of R&D investment there goes towards drugs and procedures that serve the fat and wealthy West (Lipitor, Viagra, heartburn remedies, MRIs, gastric bypass) and nearly nothing towards treatments for the things that actually kill the most people in the world, like malaria, diarrhea and TB.

Video of the hearing can be found on the Committee viewer. Dr. Bennett starts her opening remarks at 41:06; questions start at 65:50, with her exchange with Sen. Corker at 71:55.

(I love what she's wearing, too!)

(cross-posted from Canada's World)

Kiefer Speaks! or... Spoke!

Yesss!! Tommy Douglas' grandson has finally done a PSA for U.S. health care reform!



I've said all along (although not, apparently, on my own blog) that Kiefer Sutherland would be the perfect spokesperson for U.S. health care reform - not only because of his family, but because Jack Bauer is the ultimate ass-kicking, terrorist-torturing hero of the right-wing. If they're going to listen to anyone, they've GOT to listen to Jack, right?

But wait a minute... I went looking for the full ad and ran across the original video - which was recorded three years ago as part of a Tommy Douglas tribute at the 2006 NDP Convention.

But no matter. It's too late. Kiefer Sutherland has been outed as (gasp) a Health Care-Loving Canadian Socialist! Now he'll HAVE to start speaking out.

Please. Kiefer. Call Rachel Maddow.

(H/T to Dammit Janet!)

The Wisdom of Roger Ebert

If you haven't been reading Roger Ebert's blog, you really, really should. When he started it a few years ago, he limited himself to discussing movie-related stuff, a policy he defended by insisting that nobody could possibly be interested in what he had to say about any other topic.

He was, of course, dead wrong.

These days, he blogs about everything from politics to evolution to the nature and meaning of existence. His perspective is profoundly coloured by the fact that he has come close to death more than once since enduring multiple surgeries for thyroid cancer, and has now permanently lost the power of speech due to the removal of much of his lower jaw. The result is the outpouring of a singular mind largely unable to communicate except through writing.

Good thing he's an exceptional writer.

I direct you to Roger Ebert's two latest posts on health care, not because they are necessarily superior to the rest but because they are typical and, as always, topical. The first he describes as an attempt to rationally and logically lay out the arguments in favour of universal health care and against hysterical nonsense like Sarah Palin's 'death panels'. The second is at once more specific (in that he addresses specific arguments by commenters on the first) and more emotional, as he speaks of how he considers universal health care a "moral imperative", especially in light of his own health issues.

Speaking of the many Canadians and other non-Americans who described their experiences after his first post, Ebert writes,

"What so many of these messages also made was an argument to morality. They were astonished that the United State is alone among all developed nations in refusing such coverage to its citizens. A Canadian wrote that it benefits his entire society that its citizens have access to universal care. By making preventative medicine freely available, it lowers the cost of chronic illness. By making early diagnosis possible, it prevents many diseases from reaching a fatal stage. By making mental health care and medication available to those who need it (and who are often unemployable), it avoids the American system where many such people are abandoned to the streets or to the care of their overtaxed families."

He might also have added the economic benefits of labour mobility, or of removing astronomical medical costs as a factor in law suits and court awards, thus reducing the overall cost of malpractice, auto, business, life, and other forms of insurance. And on and on.

The commenters on Roger's blog are shockingly civil and often equally eloquent, even when they disagree him or with each other. Here are two of the 300+ on today's post that amused me. The first is from a Canadian who took a job in the U.S. and suddenly had to think about health insurance:

"I took the job and never once asked about health care benefits because it wasn't even a question on my radar. It's like asking if there will be air in the room."

I love that line. And then there was this one from an earnest libertarian with no sense of irony:

"that doesn't mean that I'm close minded to the idea of Universal Health care, just as long as it's not forced on to the general public."

I read that and couldn't stop laughing.

Roger Ebert is, among other things, a sceptical and extremely enlightened Catholic, so it's not surprising that he ends this post with Matthew 25 which reads in part:

"Come, O blessed of my Father, inherit the kingdom prepared for you from the foundation of the world;
For I was hungry and you gave me food, I was thirsty and you gave me drink, I was a stranger and you welcomed me,
I was naked and you clothed me, I was sick and you visited me, I was in prison and you came to me...
Truly, I say to you, as you did it to one of the least of these my brethren, you did it to me."

Keep writing, Roger.

That Gun Guy in New Hampshire

A fascinating interview with the guy who showed up at Obama's health care Town Hall meeting loaded for bear and carrying a sign with a truncated version of the Jefferson quote about watering the tree of liberty with the blood of tyrants.

Visit msnbc.com for Breaking News, World News, and News about the Economy

Of course, as a Canadian my very first question is WHY ISN'T THIS GUY IN JAIL?!? Seriously - how is it the Secret Service wasn't all over his ass the second he was spotted within a mile of Obama carrying a loaded firearm?

Plus, I love that the guy voted for Ron Paul :)

Olbermann on Palin, Death Panels, and the Crazy, Crazy Right

Oh, you beautiful man...

Visit msnbc.com for Breaking News, World News, and News about the Economy

Honestly, I watch what's been going on at these "Town Brawls" and I weep for America.

This was Wendell Potter's Epiphany

Remember Wendell Potter, the former health insurance industry executive and PR guy-turned-whistleblower? He was interviewed by the excellent Bill Moyers recently, and that interview was aired this week as part of a special episode on health care reform.

One of the things Potter talks about is an event he witnessed which rocked him to his core and eventually led him to quit his job and speak out against what these corporations have been doing all these years to prevent any sort of meaningful health care reform from gaining a toehold in the U.S. That event was a weekend-long free health care clinic run by a volunteer group of doctors, nurses, dentists and others called Remote Area Medical (RAM). They normally do this sort of thing in third world countries.

What Potter saw was hundreds of ordinary Americans streaming in from miles around and converging on a County Fairgrounds in rural Virginia in order to wait hours in the rain to see a doctor or a dentist in a tent or an animal stall. For many this now annual event is the only medical care they receive.

The Bill Moyers site has video of this year's 'health fair'. Thankfully no rain this time, but people arriving even the night before found over a thousand people in line before them. The stories they tell are heartbreaking - the images even more so.

Go watch.

If I were an American, I'd be dead

I decided to wade into the U.S. health care debate recently by making a diary entry on DailyKos, calling it "If I were an American, I'd be dead". It's a personal account of my experience with Canada's healthcare system for the benefit of our American friends. I'm not going to re-post the whole thing here - just wander over and read at your leisure.

The best and the worst thing about making that post was reading the comments from Americans dealing with their health care system. I was particularly struck by the story of one woman who defended the title of my post against someone who accused me of hyperbole. As it turned out, River (who has her own diary) has, like me, experienced kidney failure. She's not much older than me, in about the same income bracket. Or at least she was before all this.

Unlike me, however, River lives in the U.S. So when she started experiencing symptoms, she didn't go to the doctor right away because of the cost of co-pays and the fear of being declined. And so while my condition was caught in time (barely) to restore my kidneys to full function, hers failed completely and irreparably. And while I now lead a happy, healthy normal life, she is facing a lifetime of dialysis. Which probably won't be as long as you'd think, because she's about to hit the lifetime cap on her husband's medical insurance, at which point (as I understand it) she will be put on Medicare, which will only cover 80% of her dialysis. Unfortunately, even 20% of the cost of treatment is far beyond her means, so at that point she figures she'll be checking into a hospice to wait to die.

As for a kidney transplant, forget it. Not unless she wins the lottery - even if she could find a donor, which is twice as unlikely there than in Canada.

The most painful part of my little dialogue with River was when I jokingly suggested that Canada should have a "medical refugee" class of immigrants. She responded by begging me to check into this for her. She had looked into immigrating to Canada, but apparently someone in her medical and financial condition is not exactly the kind of person our Immigration Ministry is looking for as a Canadian citizen right now. It broke my heart to tell her that I'd just made it up, and that our current government isn't even letting our own citizens back into the country, let alone some sick indigent from the Greatest Country in the World.

I thought about River last night while watching 'Meeting of the Minds' on CNBC. They were having a round table discussion about health care with a pretty broad spectrum of people - a health insurance rep, a Democratic Governor, a Republican Senator, a cancer survivor, an AMA spokesman, a health clinic owner, etc. I found myself yelling at the TV a few times, but in general it was pretty enlightening.

The show helped me understand something that I really didn't before, and that is why so many supporters and opponents of U.S. health care reform keep insisting that America has "the best heath care in the world". I always assumed that they were merely delusional, but I think I get it now. You see, they aren't talking about "best" as you or I might define it, as in "the best outcomes for the greatest number of people". What they're talking about is Medical Miracles.

When Americans extol the virtues of American health care, they talk about technology like MRIs and PET scans. They talk about the baby who received heart surgery in utero, or the woman with the exotic tumour that was excised with robotic lasers directed by a surgeon halfway across the country. They talk about extraordinary drugs that can treat AIDS and lower cholesterol and cure cancer and give you a hard on at age 90.

This is what they mean by "the best", and this is what they are afraid they're going to be losing if they bring in any form of public health care.

I can almost sympathize with that. Almost. But even aside from my instinct to question why an entire nation should suffer for the sake of the .5% of the population who might benefit from such treatments and can afford to make use of them - I have to wonder why such a trade-off should even occur, and why having a public health care option would grind such research to a halt.

The argument is that these technical and pharmacological innovations are only made possible by the huge profits reaped by the health care industry. Unfortunately, the application of capitalist incentives to medical research tends to favour the Prozacs and the Lap-Bands over the cancer drugs and the exotic surgeries. And of course they have to sell those drugs and procedures aggressively in order to profit from them, which means spending millions on those annoying direct-to-consumer ads so people will try to convince their doctors that they're sick and get them to sign off on drugs and treatments that they may or may not need.

There was a lot of talk about market incentives in this particular discussion - where they are now and where they should be. There was a surprising amount of consensus that the British system of paying doctors more when their patients quit smoking or have lower cholesterol puts the incentives in the right place, whereas the current system of giving doctors the financial incentive to prescribe as many unnecessary tests, procedures and drugs as they can think up without actually making their patients more healthy... not so much.

That sounds like the kind of thing that could help Canada's own health care system become more cost effective while improving outcomes. But for the Americans, I'm afraid most of the schemes and alternatives proposed by the health industry advocates amount to cosmetic surgery on a dying patient.

It's already apparent that razing the whole mess to the ground and starting fresh is neither feasible nor desirable. Their current system is just too firmly locked into everything from social security to union contracts to be simply done away with all at once. More's the pity. But that reality doesn't preclude an incremental transformation of the sort Obama is proposing.

For River's sake, I just hope those increments are big enough to lead them somewhere significantly better than the status quo. The stakes could not be higher.

Blowing the Whistle on the U.S. Health Insurance Industry

There's an extraordinary interview with former CIGNA executive Wendell Potter on 'Democracy Now!' this week. Potter spent twenty years working for the health care industry, and up until a few months ago was the chief spokesperson and PR pointman for health insurance giant CIGNA. He even developed and launched the industry's counterattack against Michael Moore and his documentary, 'Sicko'.

But when Potter saw his industry using the same talking points and scare tactics against President Obama's health care plan that they had used to destroy Hillary Clinton's efforts at reform back in the '90s, he knew he couldn't do it any more.

The interview is a fascinating look at the tactics used by the U.S. for-profit insurance industry to discredit anyone who would suggest having a public health care system - even a watered-down, parallel system to their own. And a single-payer system like we have here? That, according to Potter, is the industry's worst nightmare.

Well, the game plan is based on scare tactics. And, of course, the thing they fear most is that the country will at some point gravitate toward a single-payer plan. That’s the ultimate fear that they have. But currently—and they know that right now that is not something that’s on the legislative table. And they’ve been very successful in making sure that it isn’t. They fear even the public insurance option that’s being proposed, that was part of President Obama’s campaign platform, his healthcare platform. And they’ll pull out all the stops they can to defeat that.

Towards the end of the interview, Potter does a fair job of explaining Canada's health care system to an American audience used to having the bejeesus scared out of them about the evils of Canadian socialism ("Do you want a Government bureaucrat standing between you and your doctor?"). That fear has been generated largely by third-party ads using people like Dr. Brian Day, who has his own reasons for promoting private health care.

Happily, people like Wendell Potter are pulling back the curtain and exposing the health care industry's use of the same sorts of lies and PR tactics the tobacco industry used so effectively for so long. It's a long interview but well worth listening to and/or reading in full. Especially if we start seeing those same tactics being deployed here in Canada.