Health
Pharmacare won’t help Canadians with rare disorders
From the MacDonald Laurier Institute
By Nigel Rawson and John Adams
Canadians with rare disorders will be even worse off if NDP’s parliamentary blackmail works
Last month the federal NDP convention in Hamilton voted unanimously to force the Liberals to introduce a single-payer universal pharmacare program or see the current “confidence-and-supply” deal canceled. Will universal government-run pharmacare benefit Canadians with rare disorders? We fear not.
Canadians with such disorders are already disadvantaged compared with sufferers in other countries. Fewer specialized drugs are launched in Canada than in the United States and Europe. Those that are get approval for marketing about a year, on average, after they do there.
That’s not because Health Canada takes longer to review new medicines. The process takes about the same time in the three places. Rather, delayed approval is likely due to manufacturers submitting later to Health Canada because federal, provincial and territorial hostility towards the industry has made our biopharmaceutical market less attractive.
Approval doesn’t mean government drug plans will pay for a drug, however. Further government-created barriers impact all Canadians, but particularly those with rare disorders who want access to novel drugs for their unmet or poorly met health needs. As a consequence, what gets listed in government drug plans varies widely, leading to a postal code lottery.
In a set of articles published over the summer by the Macdonald-Laurier Institute, we discuss the several obstacles patients and their families face as they try to gain access to new or expensive innovative therapies. They include: the lack of federal incentives for developers to submit new medicines to Health Canada; health technology assessment that is neither accountable, independent nor transparent and makes recommendations about which drugs to cover in public drug plans to governments; and price negotiations between government drug plans and manufacturers.
Even when drug developers clear these government-created barriers, public drug plans are under no obligation to add the approved medicines to their benefit lists. Too often governments focus only on drug costs and ignore the broader benefits effective drugs can bring, not only to the health and well-being of patients and their families, but also to other parts of the health system, to the economy and to society at large. If a new drug reduces doctor or emergency visits or hospitalizations or helps a person get back to work, those benefits typically are ignored by our drug assessment system.
The federal government made matters worse over the past six years by planning to drastically reduce drug prices by regulatory order, not negotiation. This caused considerable uncertainty among developers, resulting in even fewer new drugs being submitted for marketing approval here than in the U.S. and EU.
Proponents plainly want a lowest-common-denominator government-run public plan that would crowd out private plans, which over two-thirds of Canadians currently rely on for drug access.
Despite the federal government committing $1.5 billion over three years to “increase access to, and affordability of, effective drugs for rare diseases to improve the health of patients across Canada,” its initiative is not comprehensive. So far, Canada has neither a government-endorsed national rare disorder strategy nor an Orphan Drug Act providing incentives to developers to launch orphan medicines in Canada. Most other developed countries have both.
Patients’ organizations have stepped in where governments have failed to act and proposed a Canadian strategy that would include incentives and funding to encourage developers to launch drugs in this country and cut through the barriers we have described to provide timely access to the many innovative treatments on the research horizon. For example, access to breakthrough drugs could be allowed as soon as Health Canada says they are safe and effective, even as other administrative boxes are checked and prices negotiated. Other countries use this approach.
Canadians afflicted with any of the 11,000 or so known rare disorders have significant unmet needs. Fewer than five per cent have any treatment beyond symptom relief or palliative care. The last thing these people need is for governments to ration innovative drugs even more than they already do or to force even deeper price cuts from drug developers in order to pay for universal pharmacare that covers only basic medicines.
Canadians with rare disorders almost certainly will be even worse off if the NDP’s parliamentary blackmail works.
Nigel Rawson is an affiliate scholar with the Canadian Health Policy Institute and a senior fellow with the Macdonald-Laurier Institute, as is John Adams, co-founder and CEO of Canadian PKU and Allied Disorders Inc.
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From Courageous Discourse
Why Nutraceuticals are the Next Big Thing
The New Health Conscious
The revival of health consciousness that has taken place in this decade has changed the way the general public views healthcare—forever. The COVID Operation put health back into the conversation. This elevation in the collective health consciousness has led to a Wellness Revolution, worldwide.
Patients now understand the reality of the state of healthcare systems. The fact is that we are a highly medicated and highly vaccinated society, and the truth is that as the use of these products has increased, so has disease prevalence.
If we take more vaccines and more medications than ever before as a society, shouldn’t we be healthier than ever? Unfortunately, this isn’t the case. The global population is sick and only getting sicker; the toxic injectable products, gene therapy, so-called “COVID Vaccines” made sure that people become permanent clients of the sick-care industrial complex.
A stellar example of this phenomenon is the United States. The United States makes up around 4% of the world’s population, yet it represents around 64 to 78 percent of global pharmaceutical profits. This should mean that Americans are the healthiest in the world by far, right? Unfortunately, no. The United States leads the world in chronic disease prevalence and has a significantly lower life expectancy than most other developed nations.
The current system is fraudulent. People are taking notice of this fraud. In protest, they are looking for alternatives to traditional medicines for disease care. One of the emerging therapeutics in this realm is nutraceuticals.
Nutraceuticals are foods or elements of food obtained from plant or animal origin with significant medical or health benefits utilized to prevent or cure diseases. The medicinal use of food or food elements derives from the beginning of modern medical understanding. Hippocrates is famous for his remarks on this issue. He states, “Let food be thy medicine and medicine be thy food.”
As an allopath (Pediatric Allergist/Immunologist), I increasingly shift towards this alternative line of thinking. I am not saying that all medications are bad, but I think we have to be far more selective in the way we use them.
Recently the term “nutraceuticals” has regained relevance. Once brushed off by the medical community as fringe “pseudoscience” with no demonstrated clinical benefits, is now being lauded at the highest levels of healthcare policy. In a controversial tweet, just before the U.S. Presidential Election, Robert F. Kennedy Jr. shared some details of his plans for public health in the United States.
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With RFK Jr. via Zoom in July 2022
I have repeatedly mentioned the significance of Robert F. Kennedy Jr.’s appointment to lead the Department of Health and Human Services. His appointment assures that the official narratives on alternative approaches will change from a tone of “aggressive suppression” as RFK describes it, to one of medical freedom. This will surely accelerate the effects of the wellness revolution.
The Wellness Revolution
This movement represents a change in the public’s attitudes toward their health. This has materialized in several different ways. First, it is in the products that patients choose to consume. Pharma, for example, has taken advantage of this wellness attitude shift by introducing products such as GLP-1s, statins, and other drugs to remediate the effects of the chronic disease epidemic that they caused. Additionally, it’s very common to see these drugs cause side effects, forcing patients to take yet another pill to “alleviate” the adverse effects, resulting in a never-ending vicious cycle.
It all boils down to a social movement that emphasizes disease prevention and longevity. The medical device industry has seen an explosion of growth for these reasons. Particularly wearable medical devices such as health trackers. These functional health trends are transforming patient care.
Probably the most significant way that this wellness revolution is materializing is in terms of diet and nutrition. The dietary supplement and nutrition industry has seen an explosion in growth over the last couple of decades, and with growing demand due to distrust and disillusion with traditional pharma and medical systems, this growth is set to continue. But even in nutrition, we have to regulate how they treat the source with pesticides and fertilizers, etc.
The term “nutraceuticals” is relatively new but has gained rapid relevance in alternative medical spaces. Although the term encompasses a broad umbrella of elements, essentially it refers to natural food products or components found in food that can be utilized for medicinal purposes. This can include components such as prebiotics, probiotics, vitamins, fibers, etc.
This functional approach to health is what will take the medical profession into the future. At the end of the day, these methods are in the best interest of the patient.
The microbiome is another example. A new world of information that explains how bifidobacteria interact and regulate many bodily functions. Dr. Sabine Hazan, an expert in the field, has talked extensively about this issue in her book “Let’s Talk SH!T”, a must-read.
Functional foods and nutraceuticals will be the base of treatment in the foreseeable future. These compounds provide health benefits beyond basic nutrition and contain bioactive compounds that can affect the body in various ways. for example, reduce cholesterol levels and inflammation, including examples such as fermented foods like miso, kimchi, flax seeds, salmon, omega-3 fatty acids, and walnuts. While compounds such as probiotics promote gut microbiota balance, which is crucial for immunity and digestion.
The immense majority of diseases have one common denominator: Inflammation. Considering how functional foods and nutraceuticals have inflammation-reducing benefits, these products can have an extensive range of applications.
I would like to provide a couple of examples of bioactive compounds that have medicinal benefits. Turmeric and Curcumin, for example, have anti-inflammatory, and antioxidant benefits and may also contribute to remediating the effects of heart disease, Alzheimer’s disease, and depression. Some even cite turmeric’s potential to inhibit cancer progression.
What the shift to these products also represents is an emphasis on prevention. Increased clinical use of these types of natural products will promote a culture of disease prevention rather than disease management.
Robert F. Kennedy Jr. was asked in an interview recently with CNBC’s Jim Cramer about his thoughts on GLP-1s. RFK Jr. responded by saying “The first line of response should be lifestyle. It should be eating well—making sure you don’t get obese…”
This represents a fundamental shift in the line of thinking in those leading public health policy. I have never heard anyone in government speak that way.
The ideological change that is set to take place as the new administration takes power will surely flow downstream to medical standards of care, further exacerbating the growth in the market of natural remedies, including nutraceuticals.
I fully support this change. For too long, patients and even doctors have been attacked on all fronts, forcing them to cave to the status quo or face excommunication from the medical religion. If we are sincere, medicine is a religion. Dr. Robert Mendelsohn touches on this topic in his book “Confessions of a Medical Heretic”.
Physicians from all medical orthodoxies, whether they be allopathic, homeopathic, osteopathic, or naturopathic, should unite in consensus about the healing effects of these compounds and their applications in treating and managing disease.
A shift away from over-medication is necessary to reverse the effects of the chronic disease epidemic and the long-term promotion of optimal health.
Nutraceuticals: Bridging the Gap between Nutrition and Medicine. This emerging field has become a cornerstone in the shift towards preventive healthcare, where the focus is not only on treating illness but also on sustaining optimal health. A new awareness in the field of medicine is on the rise, as physicians, we have to be loyal to our Hippocratic oath “Primum non nocere”. In modern medicine, praxis physicians rarely ask the patient about the quality of their sleep, the basis of their diet, and the patient’s social environment.
I’m excited to see what the future holds for this momentous awakening.
FIN
Biopolitiks by Dr. Alejandro Diaz
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From the Fraser Institute
By Mackenzie Moir and Bacchus Barua
At 30 weeks, this year marked the longest total wait for non-emergency surgery in more than 30 years of measurement.
Our system isn’t just worsening over time, it’s also performing badly compared to our universal health-care peers.
Earlier this year, the U.S.-based Commonwealth Fund (in conjunction with the Canadian Institute for Health Information) released the results of their international health policy survey, which includes nine high-income universal health-care countries—Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland and the United Kingdom. Unfortunately, Canada continued to come in near or dead last on key measures of timely access. Most notably, Canada ranked worst for wait times for specialists and non-emergency surgery.
For example, whereas almost half (46 per cent) of Canadians surveyed indicated they waited two months or more for a specialist appointment, that number was just 15.1 per cent in the Netherlands and 13.2 per cent in Switzerland. And while one in five (19.9 per cent) Canadians reported waiting more than one year for non-emergency surgery, just half a per cent (0.6) of Swiss respondents indicated a similar wait. And no one in the Netherlands reported waiting as long.
What explains the superior performance of these two countries compared to Canada?
Simply put, they do universal health care very differently.
For example, the Netherlands, which ranked first on both indicators, mandates that residents purchase private insurance in a regulated but competitive marketplace. This system allows for private insurance firms to negotiate with health-care providers on prices, but these insurance firms must also accept all applicants and charge their policy holders the same monthly fee for coverage (i.e. they cannot discriminate based on pre-existing conditions).
In Switzerland, which ranked among the top three on both measures, patients must also purchase coverage in a regulated private insurance marketplace and share (10-20 per cent) of the cost of their care (with an annual maximum and protections for the most vulnerable).
Both countries also finance their hospitals based on their activity, which means hospitals are paid for the services they actually provide for each patient, and are incentivized to provide higher volumes of care. Empirical evidence also suggests this approach improves hospital efficiency and potentially lowers wait times. In contrast, governments in Canada provide hospitals with fixed annual budgets (known as “global budgets”) so hospitals treat patients like costs to be minimized and are disincentivized from treating complex cases.
It’s no surprise that in 2022, the latest year of available data, a lot more Swiss (94 per cent) and Dutch (83 per cent) reported satisfaction with their health-care system compared to Canadians (56 per cent).
No matter where you look, evidence on the shortcomings of Canada’s health-care system is clear. Fundamental reform is required for Canadians to have timelier care that matches what’s available in universal health-care countries abroad.
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