Steve Anthony: True Canadian Pharmacy

With dozens of prescription drugs unavailable and hundreds more on back order, pharmacists in Saskatchewan are scrambling to find alternative medications for patients.  worsening and there seems to be no end in sight, says Ray Joubert, registrar with the Saskatchewan College of Pharmacists. We need to solve it before something disastrous happens.

While the rest of Canada is suffering a moderate drug shortage,  experts say it doesnt compare to what going on in Saskatchewan. For almost a year, pharmacists there have been cutting pills in half, contacting multiple manufacturers and, when necessary, calling doctors to temporarily switch a patients medication because the supply of many prescriptions including tetracycline and certain strengths of vitamin B9 have dried up. Its especially hard for patients on complicated drug regimens, since alternatives cant always be found. Some patients, says Joubert, have gone without their meds.

Ontarios pharmacies are escalating their fight against the Liberal government by aggressively targeting the ridings of 25 MPPs.
For the most part, they are MPPs who are expected to face tight contests in the next provincial election  including several ministers. The aim, according to a source close to the pharmacies campaign, is to sow dissent among Dalton McGuintys caucus members.

If they are successful, the pharmacies ! hope the government will feel compelled to soften its plan to reduce prescription costs by eliminating professional allowances the large sums paid by generic manufacturers to stores in return for selling their products.

The drugstores are clearly sparing no expense. On Friday, a busload of about 50 pharmacy students departed Queens Park, aiming to make two stops in each of the 25 ridings.

Three separate flyers are being sent to every household in each of the constituencies  a total of about three million mailings. Each mentions the local MPP by name, charging that his or her prescription for your family is $750-million in cuts to frontline health care.

Robert Ross, an exercise physiologist at Queen’s. Impediments to greater use may include the time required, uncertainty about who should take the measurements, and a lack of familiarity with methods, Iglar suggested. That’s why waist circumference is important to watch for the 65 per cent of Canadians adults who are overweight or obese. A tape measure around the waist helps show who is at risk for heart disease beyond standard body-mass measurements, but not all family doctors are routinely using it. 94 centimetres (37 inches) for most men. For some reason, I never thought of it that way before, and it kind of gave me a visual as to ‘That can’t be good. Those risks explain why Canadian family doctors are encouraged to watch their patients’ waistlines. It might lead to lifestyle interventions at an earlier stage than with BMI alone. When your waist circumference is bigger, all that fat is around all your organs, said Grant Barber, who is participating in a study on weight loss through exercise at Queen’s University in Kingston, Ont. Scientists are learning more about how the deep abdominal fat that surrounds vital organs is worse than fat just beneath the skin in terms of risk of developing heart disease, Type 2 diabetes and other obesity-related illnesses.

Using waist circumference alongside BMI helps doctors, nurses, dietitians, kinesiologists and psychologists to tease out who is in greater need of weight-loss counselling, said Prof. It would put people potentially in a different risk category if their waist circumference was above the cutoff, said Dr. Research suggests that if the waist circumference climbs to more than 102 centimetres (40 inches) for most men or more than 88 centimetres (35 inches) for women then the risk of Type 2 diabetes, coronary heart disease, and other obesity-related illness also rises. Since a healthy diet and exercise can shrink the waist while weight stays the same, a smaller waist circumference may reflect health improvements from lifestyle changes that might otherwise be abandoned by those discouraged by numbers on the scale that barely budge, Ross said. 80 centimetres (31. 5 inches) for women. While it’s simple for doctors to wield a tape measure alongside their prescription pads, there is room to improve on their use of the tool, said Iglar, who developed the checklist. Karl Iglar, an associate professor of family medicine at the University of Toronto.

In 2007, waist circumference became part of a preventive care list for family doctors in Canada — a checklist for physicians to use during checkups for adults that also includes measures like colonoscopy and hepatitis B screening.

Cyberbullies reported difficulties with emotions, concentration, behaviour, or getting along with other people, psychiatric symptoms such as hyperactivity problems, conduct problems, frequently smoking or getting drunk, headaches and not feeling safe at school. Andre Sourander of Turku University and co-authors wrote. In total, 4. The Finnish study was funded by the country’s Pediatric Research Foundation and by the Finnish-Swedish Medical Association. 8 per cent of the participants were victims of cyberbullying, 7. The researchers’ definition of cyberbullying included aggressive, intentional, repeated acts using phones, computers or other electronic forms of contact. Traditional bullying typically occurs on school grounds, so victims are safe at least within their homes. S. 4 per cent were cyberbullies and 5. In 2008, a study commissioned by the Canadian Teachers’ Federation suggested that 34 per cent of Canadians surveyed knew of students in their community who had been targeted by cyberbullying in the past year, and almost one in 10 knew someone close to them who had been cyberbullied. The feeling of being unsafe is probably worse in cyberbullying compared with traditional bullying, Dr. In Tuesday’s issue of the Archives of General Psychiatry, researchers in Finland looked at the health reported by 2,215 Finnish teens in Grades 7 and 9 in 2008. Policy makers, educators, parents, and adolescents themselves should be aware of the potentially harmful effects of cyberbullying. Those who were both a cyberbully and cybervictim were linked to all of the above conditions, the researchers found. A U. 4 per cent were both victims and perpetrators of cyberbullying.

Rapid changes in technology, anonymity of the perpetrator and the potentially large audience make cyberbullying more complicated to prevent than traditional bullying, the researchers said. More research is also needed to look for any links between cyberbullying and later mental health distress, the study’s authors said. Of the respondents who said they had been victimized, one in four reported fear for their safety. The majority of victims who were repeatedly attacked online said they perceived a definite or severe amount of difficulty in their lives, ranging from headaches and physical pain to trouble sleeping. survey on internet use by those aged 10 to 17 suggested 12 per cent reported being aggressive to someone online, four per cent were targets of aggression and three per cent were both aggressors and targets. Future research is needed on whether antibullying policies, materials, interventions, and mobile telephone and internet user guidelines are effective for reducing cyberbullying, the study’s authors concluded. Both cyberbullies and their victims seem more likely to report physical and psychiatric symptoms than other teens, a Finnish study finds. With cyberbullying, victims are accessible 24 hours a day, seven days a week. Email, virtual chat rooms, mobile text messaging and discussion groups were all locations for cyberbullying, the study found.

In every instance, the published article made the drug look better than it would have. We cannot be certain that selective reporting was a decision made by employees of Pfizer and Parke-Davis, since the authors of the published reports included nonemployees, the researchers wrote. 3 billion US — including an unprecedented $1. According to the report, when a company-funded study’s primary finding wasn’t favorable, that result was usually buried  and something else positive was highlighted, without disclosing the switch. This results in harm. Sidney Wolfe, head of health research at consumer group Public Citizen, called it the first comprehensive look at studies in which a company and people working for it so maliciously manipulated the data to make a drug look more effective than it actually was. In eight of the 12 published studies, the main outcome listed in internal documents differs from the one later given in the published report. Experts believe most Neurontin sales were for off-label uses — the ones in the reviewed studies.

The documents used in the review were obtained by lawyers suing Pfizer for refunds on prescriptions paid for by insurers and consumers.
— Dr. The study descriptions also list their primary and secondary outcomes. By last year, Neurontin sales fell to $387 million US due to cheaper generic versions sold as gabapentin. gov, to be eligible for publication. Pfizer disputes the report’s conclusions, saying the company never attempted to mislead the medical community about the effectiveness of the drug for certain uses. While doctors can prescribe drugs for unapproved, or off-label uses, drug companies are legally barred from promoting their products for such uses. The report appears in Thursday’s New England Journal of Medicine. 2-billion US criminal fine — for illegally marketing other blockbuster drugs. In every instance, the published article made the drug look better than it would have, said Wolfe, a member of the Food and Drug Administration’s drug safety advisory committee. We believe the review suffers from significant bias, insufficient data, poor methodology, and cannot pass the threshold of credible scientific research, Pfizer said in a statement. Sales peaked at $2. But they don’t always seek approval for those new uses, particularly if the new findings aren’t convincing.

Drugmakers often test drugs for additional conditions and publicize the results. Arthur Caplan, director of the University of Pennsylvania’s Center for Bioethics, called the report one of the most ethically disturbing papers I’ve read in some time and an indication that people have been playing fast and loose with studies, particularly industry ones. epilepsy drug found that reporting of the results was often misleading, indicating the medicine worked better than internal company documents showed. Medical journals in recent years have required that studies be listed on a federal website, called ClinicalTrials. Its potential side-effects include suicidal tendencies and depression. In half the cases, a new primary outcome was substituted and in others, the original main outcome was instead reported as a secondary measure or wasn’t disclosed at all. One of the report’s authors is an expert witness for the plaintiffs; another has received fees from the lawyers. The studies were published in medical journals or presented at conferences, mostly over the last decade. Wolfe said there should be bigger fines and jail terms for manipulating study data, plus tougher rules for studies being published in journals. Dr. For the new review, the researchers examined 20 patient studies funded by New York-based Pfizer and its Parke-Davis unit on use of Neurontin for preventing migraines or treating nerve pain or bipolar disorder. The lawyers, who are seeking class action status for the cases, claim Pfizer concealed evidence the epilepsy drug Neurontin didn’t work for those unapproved uses, including nerve pain, migraines and bipolar disorder. Caplan said the FDA should have the power to audit industry drug studies. That move was made partly to make it harder for industry to hide studies on products that don’t pan out and only publish those with good results. Analysis of a dozen published studies testing possible new uses for a Pfizer Inc. The report, by researchers at the University of California at San Francisco and the Johns Hopkins Bloomberg School of Public Health comes two months after Pfizer was fined a record $2. Pfizer said it now has 1,245 company-sponsored studies listed on the website.

Neurontin was approved by the FDA a decade ago for treating seizures and later for pain caused by shingles — but not for other conditions. The authors cited some limitations to their review, including not knowing who made the changes. 7 billion US in 2004, when Pfizer paid $430 million US in government fines to settle allegations it improperly marketed the epilepsy drug for unapproved uses.

Hundreds of natural health products could disappear from store shelves next spring because of a Health Canada backlog in approving licences, warns the Canadian Health Food Association.
We’re at a critical stage, said Carl Carter, director of regulatory affairs and policy development for the CHFA.
The biggest concern we have at this point is the standards of evidence Health Canada has been requesting for products’ efficacy, he told CBC News.
!–more– Firms that make and sell natural health products are not opposed to being regulated. In fact, they welcome the Health Canada stamp of approval, said Carter. However, he said the pendulum has swung too far in terms of proving that a drug works.

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When the blockbuster heart pill Norvasc lost its patent protection earlier this year, generic manufacturers couldn’t wait to get into the lucrative market for Canada’s third top-selling prescription drug, predicting they could save patients $180-million a year with their cheaper copies.
But the Saskatchewan government has just awarded its first contract for a generic version of the medicine to a generic branch of Pfizer, the pharmaceutical giant !–more– that makes Norvasc itself, feeding concerns that such tendering systems will become the norm and inadvertently leave Canadians paying much more for prescription drugs.
Pfizer lost a drawn-out court battle recently to try to keep its patent-protection in force longer and delay any generic competition for another year.
Like other brand-name companies, though, the world’s largest pharma firm sometimes enters the generic market when its drugs go off patent, and its GenMed division offered Saskatchewan’s drug plan the lowest price among the eight competitors that started selling copies of Norvasc when the patent expired last week.

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p But as of Tuesday, three new groups were eligible for the H1N1 vaccine:
As of Tuesday, Nova Scotia had received 207,400 doses of H1N1 vaccine and about 15 per cent of the population has been inoculated. Dr. Once the vaccine was restricted to only priority high-risk groups, the company offered to give the vaccine back but was turned down, said Derek Estabrook, vice-president of marketing for Farmers Dairy. Vaccination clinics in the province !–more– are closed for Remembrance Day, though flu assessment centres are still open. Ultimately, all Nova Scotians are at some risk, so while it’s not following our current rules, they were given the vaccine under a different set of rules and we just need to keep using it, Strang said. It’s far better they just keep using it than just have it sit in the fridge unused. Robert Strang, Nova Scotia chief public health officer
The company requested the doses weeks before the current restrictions were put in place, when the Department of Health allowed big employers to look after the vaccination of their own staff. Robert Strang, the province’s chief public health officer, said it’s a matter of quality control, and the dairy company did the right thing by using the doses. A major dairy company serving Atlantic Canada did nothing wrong in immunizing employees against swine flu even though they weren’t a priority group, Nova Scotia public health officials say. Estabrook said the company was told there was no guarantee the doses had been kept at the proper temperature. —Dr. Nova Scotia narrowed the list of people who can get the shot to only priority groups because of a Canada-wide vaccine shortfall. About 100 Farmers Dairy employees in Hammonds Plains and Truro received the H1N1 shot on Monday, including those outside the announced high-risk categories. Strang said it could take until February before all Nova Scotians have access to the vaccine. Health said that they could not take it back and that we should use our best judgment and administer it from there, he said.

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p Regina General Hospital is $1. When the lab is in place, the region hopes it will be able to recruit more specialists to diagnose and treat such patients. The lab would fill an urgent need in southern Saskatchewan, the foundation says. The donation, aimed at establishing an electrophysiology lab at the hospital, was announced Thursday by the Kinsmen Telemiracle Foundation. The new lab will diagnose and treat arrhythmias, which are life-threatening !–more– abnormal heart rhythms. Currently, arrhythmia patients in south Saskatchewan are given medication — considered an inadequate treatment — or are sent out of province for treatment, the health region says. Last year, around 700 patients were admitted to the Regina Qu’Appelle Health Region for atrial fibrillation, the most common type of arrhythmia. 25 million closer to building a laboratory to help people with heart rhythm disorders. Electrophysiology concerns problems related to electrical activity of the heart. George Garbe, the section head of cardiology for the health region, said in a release. Heart rhythm abnormalities are a major cause of death and disability in heart patients, Dr.

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p News of the pending amendment, to be introduced when the health-care reform bill makes it to the Senate floor, has alarmed some Canadian observers who fear re-importation could lead to shortage of drugs in Canada. law, only pharmaceutical companies are allowed to import prescription drugs approved by the Food and Drug Administration into the United States. Consequently, Dorgan has long maintained, Americans pay higher prices for prescription drugs !–more– than anywhere else in the world. Bennett herself raised that concern in her testimony on Wednesday.
My goal over time is for us not to pay more than you, because you set prices and cause us to pay more when we’re doing all the innovation, Corker added. S. S. Drug companies import more than US $40 billion in drugs into the United States, while drug wholesalers and consumers are shut out of the global marketplace. Please don’t think that you can import cheap drugs from Canada … it will last us about 36 days, she told Corker. Dorgan will introduce an amendment to the health-care reform legislation currently before the Senate finance committee that would legalize so-called re-importation. He replied: That’s a silly way of dealing with it. Under current U. It’s the drug companies, sir, and they’re multinational — it’s nothing about the United States of America, she told him. In essence, the Canadian government and its citizens are taking advantage of our citizens by virtue of setting prices that are lower than competitive prices. 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. … You benefit from us, and we pay for that, and I resent that. The panel, chaired by Democratic Sen. Democratic senator Byron Dorgan from North Dakota is preparing to make a legislative push in the days to come that would legally allow Americans to buy cheaper Canadian drugs. Their debate comes as U. Senate committee. Herb Kohl and including newly minted Sen. She seemed puzzled by Corker’s remarks, reminding him that drug pricing was a global concern, not part of a plot by Canada.
Canada benefits financially from America’s role as a world leader in medical advances, Republican Senator Bob Corker charged in an exchange with a Liberal MP as she testified before a U. S. An American legislator called Canada parasitic on Wednesday for siphoning U. Al Franken, was examining how successful health-care systems keep their costs low while maintaining quality care. dollars to Canada with low prescription drug prices while his country does all the innovation.
Bennett, a family doctor and one-time minister of state for public health, was one of five people testifying before the Senate special committee on aging. Meaning that you set prices and unfortunately all the innovation, all the technological breakthroughs, just about, take place in our country. S.

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