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ast month, Pricewaterhouse Coopers, an accounting and consulting company based in New York, published a report saying the global pharmaceutical market will double in value to $1.3 trillion by 2020. The report stated that warmer temperatures brought on by climate change will drive up rates of respiratory illness and infectious diseases and people in northern climes will begin to be exposed to malaria, cholera, diphtheria and dengue fever. Pharmaceuticals is not the only industry seeing new opportunities in the changing world maps of disease and demographics. For drug makers, global warming is just another fortunate market
doctors’ offices. The truth is, as a population, it is healthy people, not old people, who are disproportionately using more and more health services – more doctor visits, more tests and more drugs – and those costs are forever mounting. Here’s my favourite, new soundbite: It is not the aging of the population, but the gouging of the population that is causing health care systems to bleed red ink. Morris Barer, a health care economist at UBC, wrote over a decade ago that population aging is actually a very gradual phenomenon – more like a glacier than an avalanche – and that an aging population adds about one percent each year in total healthcare costs for all of us.
driver, sure to increase demand for more drugs, just like the perceived greying of the population has made many pharmaceutical investors feverish with delight. Here at home, BC politicians have seen much doom and gloom stemming from an “aging” demographic; during his watch, former Minister of Health Colin Hansen referred to the aging of the population as a “tsunami” and his colleague, MLA Katherine Whittred once introduced a new piece of legislation that she said would “… address the needs of BC’s growing and rapidly aging population.” Liberal MLA Ralph Sultan, whose name has graced these pages in the recent past, best sums up the gestalt of our times: “In 21st century medicine, we’ve come to respect three big health cost drivers: new technology, the proliferating pharmacy and increased consumer knowledge and expectations. However, it is longevity that now looms as the greatest cost driver of all.” Yup. We’re getting old and the health care bills of the aged are going to break the bank. Bad news for all of us, but the mother lode for those who sell health services and drugs. Colin, Katherine and Ralph are not unique, as other politicians around the world wring their hands at the coming tsunami. Problem is they’re blaming the wrong culprit. Simply put, the aging phenomenon is a myth. Canadian society is not going to go broke overnight due to rapidly aging people clogging up our hospitals and
Some tsunami. Yet the myth continues. If there is a lot of profit to be made in telling healthy people they’re sick, there’s even more political capital to be made in blaming aging boomers, rather than business opportunists, for the perceived problem of health care sustainability. Let’s not fault politicians for swallowing popular myths, but we can and should fault them for making health care funding decisions based on mythical thinking. Later this year, the BC government will make a major sea-change in its coverage of Alzheimer’s drugs, a decision that may cost BC taxpayers as much as $30 million per year. The cholinesterase inhibitors, the key drugs for Alzheimer’s disease – Aricept, Exelon and Reminyl – cost about $5 per pill. These drugs are covered in other provinces, but not in BC. This has had the drug-funded groups, the specialists and the manufacturers crying foul for more than a decade. It looks like the government is about to throw in the towel. Why BC has maintained its policy of non-coverage of Alzheimer’s drugs is an interesting question. The answer is complex, but let’s just say the “Left Coast” has a culture that may be marginally more successful at putting science ahead of lobbying. At least that’s what Minister of Health George Abbott alluded to in the legislature when asked about BC’s intransigence on Alzheimer’s drugs. “What we do in an evidencebased approach is look at the efficacy
of the pharmaceuticals themselves. We don’t respond to the efficacy of the lobbying behind the coverage of those pharmaceuticals,” he said. He went on to explain that BC will be “studying” the issue over the course of three years, to determine the effectiveness of these drugs in the “real world.” The key issue around any health care spending is knowing what you are buying. Unfortunately, the major Alzheimer’s drugs are next to useless for most people. They also have a number of adverse side effects that range from the merely unpleasant (nausea, vomiting and diarrhoea) to nasty (agitation, delirium and violence) to fatal (i.e. death). As if
the disease isn’t bad enough on its own. The effectiveness of Alzheimer’s drugs is measured by a patient’s score on a scale called the Alzheimer’s Disease Assessment Scale – Cognitive (ADAS-Cog) – which measures cognitive functioning. A patient taking one of the four Alzheimer’s drugs will score an average of 1.4 to 3.4 points better on the 70-point scale than those on placebo. Is this meaningful? Sounds like a washout to me. Dr. Todd Golde, a neuroscientist at the Mayo Clinic, was recently quoted in the National Post about the major Alzheimer’s drug trials: continued on p. 32
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