Panaceia or Hygeia

immunize yourself against the pandemic of lifestyle diseases

Posts Tagged ‘Japan’

“Health” spending in Canada hits $172-billion, outpacing inflation

Posted by Colin Rose on November 14, 2008

Drugs now cost more than doctors and the cost is rising faster than inflation. Sooner or later this insanity has to end. Probably sooner. With a likely world-wide depression in the next few years there will be awakening awareness that most of those expensive branded drugs, such as Lipitor and Crestor, are for lifestyle diseases, like Type 2 diabetes, hypertension and atherosclerosis, related to junk food addiction which can be prevented and treated without drugs. But we need to take a $few billion of that $172 billion and put it into addiction research. Addictions of many kinds are at the root of most of the problems of developed capitalist democracies.

Note that Japan which spends per capita on its “health care” system only 38% of the USA and 70% of Canada has a longer life expectancy than either. Ergo, there is no relation between money spent on hospitals, drugs and doctors and life expectancy; if any, there is an inverse correlation. While everyone uses the term “health care” for the activities and effects of hospitals, drugs and doctors, these are really disease care. Some diseases can be cured but most can’t and in a high tech, fee-for-service medical system with an incentive only to do more, more people will be killed by the technology than saved by it.

Jeffrey Simpson in the Globe and Mail suggests as a solution to exponentially increasing costs more private “health” care. That will only increase the total cost as people with just spend more to support their addictions. Doctors in a fee-for-service regime will be only to happy to oblige. The only long-term solution I can see is to put all doctors on a salary. In such a system the driving incentive is to keep people healthy so doctors have less work to do. Paying doctors per disease is like paying firemen per fire. Would there be more or less fires? Would there be any incentive for fire departments to promote fire prevention? In a regime of totally salaried doctors costs would drop dramatically and the health of the population would markedly improve.


Health spending hits $172-billion, outpacing inflation
BY BRADLEY BOUZANE Canwest News Service
National Post
14 Nov 2008

OTTAWA  Health care in Canada will cost $172-billion this year, or nearly $5,200 for every person in the country, according to figures released yesterday by the Canadian Institute for Health Information. The independent statistical agency says that…read more…

cihi-canada-world-healthcare-cost
——————————————–

From the Globe and Mail, November 19, 2009

Listening to the sounds of health-care silence

JEFFREY SIMPSON

Where did health care go? Pollsters keep reporting that health care is the No. 1 issue for Canadians. We spend way more on it than on anything else. Yet, no one – well, almost no one – talks about it any more, at least not politically.
Sure, citizens recount their experiences with the system to each other. People who work in the system talk about it incessantly, health care being their world.
But as a public policy/political issue, health care has died. Died, despite the Canadian Institute for Health Information’s reporting last week that Canada will spend $172-billion this year on health, about 70 per cent from public sources. That works out to $5,170 per capita.
Health care gobbles up provincial (and federal) resources. It consumes 39 per cent of all provincial program expenditures – that is, spending on everything but  servicing the debt. In some provinces, health care’s share of program expenditures is 45 per cent. Soon, it will be 50 per cent and higher in all of them.
Health care consumed 7 per cent of the nation’s economic output in the mid-1970s, shortly after it was up and running. Now, it consumes 10.7 per cent. That share will keep on rising as the population ages, technology becomes more expensive, and demand grows.
No one knows how to stop the increase; in fact, large increases are hardwired into government spending plans. These increases are not improving the system, but they are keeping it from getting discernibly worse.
The Paul Martin government signed a deal with the provinces for a $41-billion transfer from Ottawa over 10 years starting in 2004-2005, with the transfer indexed yearly to 6 per cent. The Harper Conservatives, then in opposition, signed on to that deal and have never wavered.
Without that federal cash, provincial health-care plans would be struggling or imploding – or provinces would be forced to raise taxes or cut other services. As it is, their annual costs are rising by 4 per cent to 5 per cent after inflation. The federal cash keeps their systems afloat.
That’s one reason why silence surrounds the health-care debate. Caterwauling provinces can hardly complain about parsimonious Ottawa when such mighty rivers of federal cash are flowing their way. Similarly, almost complete silence reigns within federal politics, except for occasional election promises to spend  yet more money for provinces to hire more doctors. But with Ottawa already sending so much money to provincial capitals, these chirpings ring hollow.
It was cheap theatre for provinces to beat up on Ottawa when the federal government seemed to be rolling in dough. But after the Harper government spent the surplus it inherited by shovelling money to the provinces for the ‘fiscal imbalance,’ cut federal revenues through reductions to the GST and let spending proceed above the inflation rate, the surplus almost disappeared.
Now, with the economic tsunami upon us, the small surplus will head into deficit. Even if provinces clamoured for more health-care money, there wouldn’t be any.
The deeper reason for the silence is that no provincial government knows what to do about the system, except to keep it going, fiddle at the edges, try to improve administration here and there, negotiate the best collective bargaining agreements they can.
Nowhere in Canadian public affairs is the gap so wide between what those responsible for policy say and what they do. Privately, almost all of those responsible know that the spending increases are unsustainable and that some means must be found to allow more public services to be delivered privately.
Publicly, none of them dare say so.
Without that debate – and fear of public reaction keeps it closed – politicians spin their wheels, spend lots of money, patch the system, add something new here and there, and carry on.
The only idea for lowering the increase in health-care costs comes from those who claim, rightly, that the fastest-rising part of health-care budgets is the drug bill. Their answer: a national pharmaceutical plan integrated into medicare.
It might be recalled that, in 1997, Quebec introduced such a drug plan. It cost the treasury about $700-million that year. This year, the public cost will be $2.3-billion, a threefold increase in about a decade.

Posted in atherosclerosis, diabetes, diet, drugs, statins | Tagged: , , , , , , , , , , , , | 1 Comment »

REACH, “atherothrombosis”, and the marketing of Plavix

Posted by Colin Rose on June 23, 2007

An example of a “free” paper in a prominent medical journal reporting a study funded by industry.

Let’s examine what is behind this beneficence.

Disney World

The REACH type subject

REACH is an an acronym for REduction of Atherothrombosis for Continued Health. The term “atherothrombosis” was concocted by “industry” to market Plavix and has now infiltrated into the literature. This is a classic example of marketers inventing a disease for which their drug is the cure. The first and most lucrative was the invention of the disease,”dyslipidemia”, to market statins.

The web site, http://www.atherothrombosis.org, is funded by sanofi-aventis and Bristol-Myers Squibb who sell Plavix. Dr. Bhatt, an author of REACH, is prominent on the site. Here is a quote from the site by a Dr. Cannon:
————————-
Atherothrombosis vs atherosclerosis: Different diseases?

The patients were divided into those who had had a prior event versus those who had not. Interestingly, the patients who’d had a prior event each had about a 20% reduction in death, MI, stroke over the subsequent 2 ½ years in this otherwise pretty stable outpatient population. On the other hand, there was no benefit whatsoever in those who had coronary disease without a prior MI, or cerebrovasculardisease without prior stroke. So, in thinking about this, the question comes up: ‘Does this mean that the patients with a prior event are different?’ They’ve had a thrombotic event as part of their course of vascular disease. The question popped into my head: ‘Would this mean, potentially, that atherothrombosis might be a different disease than atherosclerosis?’

If we circle back to thinking clinically, there are a lot of patients we see who are 80 years old who finally come in with evidence of angina and have diffuse atherosclerotic disease, but who have never had an MI or stroke; then there are other patients who come in at age 40 with a large anterior MI and just one atherosclerotic lesion on their cath. Those would seem to be two extremes: the atherosclerotic patient (the 80-year-old with diffuse disease) and the atherothrombotic patient (the person who comes in with an acute event). And, the difference in the benefit of dual antiplatelet therapy for the atherothrombotic patient makes perfect sense: you’re treating a thrombotic disease with an antithrombotic agent. This may give us insight into subcategorizing a little bit the disease process itself and targeting long-term therapies.
————————-

Readers should be made aware of the disclosure of Dr. McDermott, the editorialist:
—————–
Financial Disclosures: Dr McDermott reports that she has received honoraria from Bristol-Myers Squibb, Sanofi-Aventis, NicOx, and Otsuka Pharmaceutical, has served as a consultant for Hutchinson Technology, and is currently receiving support from research grants from the National Heart, Lung, and Blood Institute.
—————————————
Why couldn’t JAMA find an editorialist with no connection to “industry”, particularly the company funding the study which was editorialized?

If you wonder why this is a “free” publication just look at the disclosures and funding:
——————————-
Financial Disclosures: Dr Bhatt reports that he has received honoraria for consulting on scientific advisory boards from AstraZeneca, Bristol-Myers Squibb, Centocor, Eisai, Eli Lilly, GlaxoSmithKline, Millennium, Otsuka, Paringenix, PDL, Sanofi-Aventis, Schering Plough, The Medicines Company; honoraria for lectures from Bristol-Myers Squibb, Sanofi-Aventis, and The Medicines Company; and provided expert testimony regarding clopidogrel (the compensation was donated to a nonprofit organization). Dr Röther reports that he has received honoraria from Bristol-Myers Squibb and Sanofi-Aventis. Dr Steg reports that he has received honoraria from Bristol-Myers Squibb and Sanofi-Aventis and has received research grants from Sanofi-Aventis. Dr Steg reports having served as a member of the speakers’ bureau for Boehringer Ingelheim, Servier, GlaxoSmithKline, Merck, Sharp & Dohme, and Nycomed and also on a consultant ad board for AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Merck, Sharp & Dohme, Sanofi-Aventis, Servier, and Takeda. Dr Ohman reports that he has received research grants from Berlex, Sanofi-Aventis, Schering-Plough, Eli Lilly, Bristol-Myers Squibb, and Millennium. Dr Ohman reports that he has stock ownership in Medtronic, Savacor, and Response Biomedical and is a consultant for Invoise, Response Biomedical, Savacor, and Liposcience. Dr Hirsch reports that he has received research grants from Bristol-Myers Squibb and Sanofi-Aventis; honoraria from Sanofi-Aventis; and speaker’s bureau fees for Sanofi-Aventis. Dr Wilson reports that he has received a grant from Sanofi-Aventis. None of the other authors reported disclosures.

Funding/Support: The REACH Registry is sponsored by Sanofi-Aventis, Bristol-Myers Squibb, and the Waksman Foundation (Tokyo, Japan), who assisted with the design and conduct of the study and data collection.
———————————

Call me paranoid but I have a suspicion that the conclusion of the next paper from REACH will be that “dual anti-platelet” therapy (read ASA and Plavix) is underused. Thus the “reduction” in REACH.

But the sponsors may have shot themselves in their feet. The REACH data shows that in Japan the use of statins is about two-thirds and hypertensives one-half of the world average but Japanese all-cause mortality is 40% less than the world average. Also the Japanese used about the same “dual anti-platelet therapy” as the world average. So, total mortality has no relation to drug use of all types. This glaring paradox is nowhere mentioned in the paper or the editorial and I doubt most readers will look at the data themselves.

In the final analysis, what is the point in studying atherosclerosis in a population in which 80% are overweight or obese, 44% are diabetic, 82% are hypertensive and 16% are smoking? The causes of their atherosclerosis are obvious, food and/or tobacco addictions as we have known for many years.

If sanofi-aventis and Bristol-Myers Squibb really want to reduce “atherothrombosis” and improve health they should fund programs for fighting these addictions instead of doing more surveys to try to justify more drug sales. From their own data it is clear that drugs do not increase life expectancy.

Posted in atherosclerosis, coronary artery disease, diet, professionalism, Uncategorized | Tagged: , , , , , , , , , , , , , , , , , , | Leave a Comment »