Healthier pill popping

 

DRUG BUST Alan Cassels

SURELY OUR economic calamity couldn’t have any positive health effects, could it?

As people lose their jobs and watch their assets, retirement savings and homes diminish in value, one might assume that it inevitably means a big negative on the balance sheets of our lives.

Not so fast, I say. Among the pharmaceutical-popping public, recessionary times may indeed have a silver lining. In fact, this recession may be good for both our health and our pocketbooks, especially if it forces us to reassess our frequently thoughtless, overzealous and often un-economical, legal drug habit.

You have to admit that we have been somewhat conditioned by the media to believe that spending less on healthcare means rationing, longer waits and less access to health services. But can throwing less money at the pharmaceutical industry translate into better access and shorter wait times for things that actually count? It could, but I admit such heretical thoughts are based on my perspective that pharmaceuticals really do reside in a special place inside the healthcare world.

For each drug on the market that is truly lifesaving, providing profound benefits and extending the quality and length of our lives, dozens more either don’t deliver the goods or worse, provide the opposite – more harm than benefit. And the money we’re spending on those treatments could be buying less health.

Suffice to say, one of the side effects of these belt-tightening times could be that we spend more energy figuring out what is really essential for people who are truly sick and then making sure the system doesn’t reward prescribing what is unnecessary or harmful. After all, what better time to eliminate fat than when we are collectively facing lean times?

One clue that there is perhaps too much excess in the world of prescription drugs might be found in the way society pays for pharmaceuticals. In Canada, drug coverage operates by the rule of thirds: about a third of our collective pharmaceutical tab is covered by the public purse (in our case, BC Pharmacare). A third is paid for by your private and typically employer-sponsored health benefit program. And finally, a third is paid for out of your own pocket.

Since you, the employee, are essentially paying for the private drug plan, let’s conclude that two-thirds of all prescription drug spending is essentially coming from your bank account. Yet unlike visits to a doctor or an occasional surgical visit or your trips to the hospital that are 100 percent paid for by the government, the way we pay for drugs makes them seem discretionary. After all, if they were really essential the government would pay for them, right?

This might seem simplistic, but addressing the question of whether or not we can afford things should start with us asking whether or not we need them in the first place. Deciding whether or not to fill your prescription shouldn’t depend on how much is in your wallet, but you should always ask the big questions: “Why am I taking this drug in the first place? Is this really necessary?”

There is considerable evidence that discretionary, prescription drug taking is widespread; far too many borderline hypertensive patients are prescribed the latest-greatest pill for their blood pressure. Far too many people worried about high cholesterol take statin drugs, even when those drugs make almost no difference to the quality and length of their lives. And far too many seniors are drugged silly by over energetic nurses preaching “compliance.” Name any major class of drugs today and you’ll find gross examples of those products being overused in otherwise healthy people – hence a lot of spending for drugs of no impact, at great financial cost to ourselves and our health system.

So with an economy going into the tank, what should we, as individuals, do? How about making ourselves more knowledgeable about what is actually happening when the doctor’s pen is poised over the prescription pad?

A sweet new book, Ten Questions You Must Ask Your Doctor (Greystone, 2009), written by crack Australian health journalists Ray Moynihan and Melissa Sweet, succinctly captures the types of questions you need to be armed with when you talk to your doctor. (Disclaimer time: I wrote a book called Selling Sickness with Moynihan four years ago and was asked to write the foreword to the Canadian edition of this book, but I have no financial ties to its success.) I said in my foreword that people should never challenge their physicians for sport, but they can become more involved in their own healthcare by asking their doctors some simple questions, such as, “Do I need this test, this screening program or this drug? What’s the evidence behind the treatment? Are there potential benefits and harms related to the treatment and what are my treatment options? Are there things I should do on my own to maintain and improve my health?” While this book goes beyond drugs, it could have easily gone by the slogan “Just say “know” to drugs.”

Books like this help consumers deconstruct what is being offered to them and compel them to seek out better answers to what’s on offer. Considering that a new prescription is often accompanied by new side effects, asking your doctor for the safest, most agreeable (for you) and most proven drug – likely cheaper, as well – won’t hurt either.

Hard questions about our health should not be placed solely on the shoulders of doctors, but should also be asked of health system officials. Do we need to be offering all healthcare options all the time to everyone? What is most essential and what is least essential? Are there rational ways to provide access in the grey areas? This needs to be part of a larger public debate that strives to maintain society’s overall level of health, albeit on less money.

It’s also time to involve the drug companies that are seeing their profits – except maybe profits for anti-anxiety or anti-depressant drugs – decline. Can we help them sustain reasonable markets by negotiating better prices? After all, if people and health systems can’t afford what the drug companies are asking for, there’s no market. Radical as it might seem, lowering a product’s cost to the consumer might actually improve a drug company’s bottom line because, at least for some drugs, excessive prices might be preventing people from filling their prescriptions. I call it “Pharmacy Sticker Shock” and who knows how often people say, “Nope, can’t afford it?”

But beyond cutting out unnecessary treatments or negotiating drug prices, people taking a prescription drug for perfectly rational reasons will need to ask a few other questions: “Are there generic drugs that can do the same thing? Do I need to be taking the dose I am taking? Can I take the drug on an as-needed basis?” This is especially true for people taking proton pump inhibitors – drugs like Losec, Pantaloc or Pariet for reflux and heartburn. Most patients may do well taking the drug every other day with no impact on their symptom control. Many could even control their symptoms with lower cost, generic or over the counter products too. Basically, you won’t know until you ask.

“Can I consider splitting pills?” is another question to ask. Pill splitting is a growing phenomenon based on the “flat pricing” of drugs like cholesterol-lowering statins, whereas the higher dosed drugs cost about the same as lower doses. For example, a month’s worth of 20 mg tablets of the statin Lipitor costs about $67 and the 40mg tablet costs about $72. Doctors who think the patient needs 20mg could prescribe the larger 40mg tablet and ask them to split it, taking half a pill each day. This one small action will save the patient almost $400 off their annual drug bill.

So go ahead and pick up a pill splitter for less than five dollars at a pharmacy and proceed to get twice the medication for the same price. Pill splitting is not appropriate for every person or every type of medication, but in the case of statins, splitting the pills is safe and economical.

A study published last summer showed that patients in BC are already cutting their own drug costs by splitting their statins. Even without widespread promotion of the practice, it is estimated that about five percent of BC’s statin users were splitting their pills, saving BC consumers (and private health plans and governments) about $2.3 million per year. Every year, British Columbians consume more than $140 million worth of cholesterol-lowering statins, an amount that has been growing steadily throughout the past decade. If everyone split their pills, we’d save an easy $50 million per year.

Not bad. One drug class. One intervention. Tons of money saved.

Will this recession call upon more such ingenuity? I hope so. If it helps us put on our thinking caps and remove the waste from our prescription drug bill, it may well pay off in ways that allow us to reinvest those savings into things that count.

Alan Cassels is a drug policy researcher at the University of Victoria and author of The ABCs of Disease Mongering: An epidemic in 26 Letters.

cassels@uivic.ca

Veggies for vitality

NUTRISPEAK by Vesanto Melina

AT LAST we can celebrate spring and spend more time in BC’s beautiful outdoors. Here are some simple and/or collaborative meals to make when you return home. These and similar ideas are from Raising Vegetarian Children (J. Stepaniak and V. Melina, McGraw-Hill 2003). 

1. Create a spread of make-your-own tacos. Set out taco shells or tortillas, chopped lettuce, onion, tomatoes, sliced or mashed avocado, taco sauce and warmed, canned refried beans or pinto or kidney beans or crumbled veggie burgers. In some families, it works best to include a meat taco filling as well. As noted in Wikipedia, “The fact that a taco can be filled with practically anything that fits on a tortilla allows for its great versatility and variety.”
2. Have everyone make their own vegetable pizza (or their section of a bigger one). Start with a purchased whole-grain pizza crust or smaller pita breads. As toppings, set out bowls of pizza sauce, grated carrots, sliced mushrooms, olives and onions (red, yellow or white) and bell peppers (red, yellow or green). If you include veggie pepperoni slices, cover the slices with a little tomato sauce so they don’t dry out. You might top the pizza with raw baby spinach after baking and let it wilt slightly before serving.
3. Open a can of vegetarian chili or split pea soup. Add a fresh whole-grain bun and a carrot cut into strips.
4. Serve veggie burgers on whole-grain buns with all the fixings. If you like, serve these with oven-baked sweet potato wedges (instead of French fries).
5. Set out a salad bar. Provide bowls of salad greens, shredded or chopped vegetables, nuts and/or seeds, sprouts, cooked beans or cubes of marinated tofu, leftover cooked vegetables, avocado chunks and a couple of different dressings. Let everyone compose their salad just the way they like it.
6. Make a can of vegetable soup more hearty by adding some canned beans (such as black beans, chickpeas, pinto beans). Serve with whole-grain toast.
7. If kids (or adults) don’t eat vegetables at meals, set out a platter of vegetable sticks (carrots, celery, bell peppers) before a meal or as a snack, without saying a word. As an optional dip, many excellent flavours of hummus are now available from supermarket coolers.

Vesanto Melina is a dietitian and co-author of nutrition classics includingBecoming Vegetarian, Becoming Vegan, the Food Allergy Survival Guide andthe new Raw Food Revolution Diet. www.nutrispeak.com


Colourful kabobs

(Makes eight to nine 10-inch kabobs)
Kabobs are colourful, tasty and fun to make. They are welcome at a barbecue and you can make them any time by browning them under the broiler. Serve them on a bed of rice or in a pita pocket. Choose extra-firm tofu; it has been pressed to remove much of the water and holds its shape well on the 10-inch metal or bamboo skewer. Measurements are approximate.

• 1/2 pound extra-firm tofu, cut in 1/2-inch pieces
• 16 to 18 small mushrooms (1-1/2 ounces or 1 cup of pieces) 
• 1/2 red, green or yellow bell pepper, cut in 3/4- to 1-inch pieces
• 1 small zucchini, cut in slices 1/4-inch thick or 3/4-inch cubes
• 1/2 medium red or white onion, cut in 3/4 inch pieces
• 8 to 9 cherry tomatoes

Sweet and tangy marinade
(Makes about 1/2 cup)
• ¼ cup ketchup
• 2 Tbsp. balsamic vinegar
• 2 Tbsp. water
• 2 tsp. olive oil
• 1/4 to 1/2 tsp. crushed garlic (optional)

In a jar with a tight fitting lid, prepare marinade by stirring together ingredients. Add tofu, put on lid and toss so that pieces are covered. Marinate four to six hours or overnight in the refrigerator, tossing occasionally to coat all pieces. Starting and ending with the mushrooms, alternate pieces of tofu and one or other of the vegetables on the skewer, with a tomato midway along.

Under broiler:
Place kabobs on cookie sheet or roasting pan, baste with marinade and place six inches under broiler for 10 minutes, turning and basting with more marinade once. 

On barbecue or grill:
Baste with marinade, turning and basting with more marinade once. Remove when heated through and browned a little.

Fate of the world’s seeds

ON THE GARDEN PATH by Carolyn Herriot

IN THESE uncertain times, with global food security under threat from climate change, do you ever wonder who is in control of the world’s food seeds? While it isn’t reassuring news, it’s not surprising that the world’s largest agrochemical manufacturers are the seed industry giants. With people all over the world now growing more food, ownership of food seeds becomes an issue worthy of major consideration.

Monsanto, the world’s fifth largest agrochemical company, is the world’s biggest seed company. DuPont, the world’s sixth largest agrochemical company, is the world’s second biggest seed company. Syngenta, with 19 percent of the market share of agrochemicals, is the world’s third largest seed company. Bayer, holding the largest market share, is the world’s seventh biggest seed company. (Source:www.etcgroup.org/)

World’s top seed & pesticide firms:
company Sales US$ % market share
1. Bayer (Germany) $7,458m 19%
2. Syngenta (Switz.) $7,285m 19%
3. BASF (Germany) $4,297m 11%
4. Dow AgroSc (USA) $3,779m 10%
5. Monsanto (USA) $3,599m 9%
6. DuPont (USA) $2,369m 6%
(Source: www.agrow.com)

These companies are all gene giants so you’ll never be able to save any of their seeds and because most are being created for herbicide resistance, the worldwide market for agrochemicals is growing by 10 percent per year. This situation not only compromises our ability to feed ourselves, but the practice of applying ever increasing quantities of poisons to the soil borders on an insane war on nature.

A simple solution to this chemical fix lies in the ability to access open-pollinated seeds, produced by naturally occurring pollination, without human manipulation of the seed’s genetic makeup. Growing food with open-pollinated seeds means you can save seeds from the resulting plants, knowing they will provide the same food value and performance for future harvests. It’s what our forebears have been doing for thousands of years.

Unfortunately, only around two percent of food seeds today are open-pollinated and most are in the hands of a few small seed companies and grassroots seed saving organizations around the world.

The “glyphosate gap” is growing fast because at least 14 weed species on five continents have developed resistance due to massive applications of glyphosate. While BASF, Syngenta, Bayer, Dow and DuPont compete to fill the gap, farmers are employing more toxic chemicals to kill the resistant weeds. Agrochemical giants prefer to describe the resistance problem as a business opportunity. In the words of Syngenta’s Crop Science CEO, John Atki, “Resistance is healthy because we have to innovate.” I think resistance is imperative because we have to eat.

Carolyn Herriot is author of A Year on the Garden Path: A 52-Week Organic Gardening Guide. She grows her certified organic “Seeds of Victoria” at The Garden Path Centre where she blogs The New Victory Garden online.


Seed havens

BC Seeds, a FarmFolk/CityFolk project supporting BC’s organic seed growers. (www.bcseeds.org)

The Salt Spring Seed Sanctuary, learning centre and network, encourages local food and seed production, is committed to evaluating and maintaining records for all edible, medicinal and useful crops that can be grown in Canada. (www.saltspringseeds.com/catalog/seedsanctuary.htm)

The Sunshine Coast Seed Collective is developing education and resources, as well as a local seed registry and seed bank.

Seeds of Diversity is Canada’s grassroots seed saving network, where growers can find heritage varieties of “tried and true” seeds from their resource list of open-pollinated seed sources. I recommend that anyone starting to save food seeds should read the organization’s booklet How to Save Your own Vegetable Seeds. (Purchase through www.seeds.ca for $12).

There are now 40 Seedy Saturdays across Canada. Last month, the 7th Annual Qualicum Beach Seedy Saturday set a attendance record of 1,850 people, a 12% increase from last year. (www.seeds.ca/ev/events.php)

Sample seed data form

Location: neighbourhood, mini geoclimatic zone, &/or street address
Species: refers to common species name 
Variety: refers to common variety name
Isolation Distance: distance to other plants of same species, or description of method of isolation to prevent unwanted crossing
# Plants: number of parent plants grown, necessary to insure genetic diversity
History: seed source and unique characteristics

Forgive for good

A proven presciption for health and happiness

by Frederic Luskin, Ph.D.

I AM A SENIOR consultant for the Vaden Health Center at Stanford University where I teach people ways to manage their stress and to live lives of greater satisfaction. I do this to reduce their risk of disease and to help their bodies and minds remain strong and resilient. A funny thing happened to me in the midst of doing this work. I started to research the effect that forgiveness had on physical and emotional well being. Towards that end, I developed a simple process of teaching people to let go of the grudges and grievances they carried around. As I started to teach forgiveness, I discovered that an unexpectedly large number of people responded to this work with fascination, confusion, enthusiasm and mistrust. Almost no one knew for certain exactly what forgiveness was and why it might be useful to study.

My work as director of the Stanford Forgiveness Projects has shown that learning to forgive helps people hurt less, experience less anger, feel less stress and suffer less depression. My research also shows that, as people learn to forgive, they become more hopeful, optimistic and compassionate. As people learn to forgive, they become more forgiving in general, not just towards one particular person who did them wrong. Our research has also shown that forgiveness has physical health benefits.

People who learn to forgive report significantly fewer symptoms of stress, such as backache, muscle tension, dizziness, headaches and upset stomachs. In addition, people report improvements in appetite, sleep patterns, energy and general well being. Finally, one research project showed that angry people with high blood pressure showed a decrease in both anger and blood pressure when they learned to forgive.

If forgiveness is so good for us, why do so few of us choose to forgive when people hurt us? First, no one has taught us how to forgive. The religious traditions usually tell us to forgive, but do not offer the practical steps as to how. We live in a culture that prizes the expression of anger and resentment more than the peace of forgiveness. And most people are confused about what forgiveness is and what it is not. Because of this, too many do not take the opportunity to heal themselves, sometimes from great emotional pain and the physical consequences that result.

First, forgiving an offence such as an adulterous affair does not mean you condone the affair. I am reminded often that we can only forgive that which we know to be wrong. Your partner’s affair was wrong, but you do not have to suffer indefinitely because you were betrayed. Secondly, forgiveness in no way means you have to reconcile with someone who treated you badly. If you were the recipient of childhood abuse or are in a harsh relationship, you can forgive the offender and, as part of that choice, make the decision to end or limit contact. Forgiveness is primarily for creating your peace of mind. It is to create healing in your life and return you to a state where you can live capable again of love and trust.

Another misconception about forgiveness is that it depends on whether or not the abuser or lying person apologizes, wants you back or changes his/her ways. If another person’s poor behaviour was the determinant for your healing then the unkind and selfish people in your life would retain power over you indefinitely. Finally, you can forgive you ex-spouse for their insulting speech and even for abandoning you and your children… but forgiveness in no way means you do not take the ex to court to make sure your children get the support payments to which they are entitled. Forgiveness and justice are not the same. Forgiveness and reconciliation are not the same. Forgiveness and condoning are not the same.

What I have seen time and time again is that people have the capacity to make peace with their past. They regain their ability to trust and love and stop blaming other people for their emotional distress. They take more time to count their blessings and less to complain about what went wrong. They understand they need to look more at who they are becoming and less at what has happened. They grasp that each day they wake up with a fresh start no matter what happened to them yesterday. They learn to forgive and heal in both body and mind.

Nine steps to forgiveness
Forgive for Good

1. Know exactly how you feel about what happened and be able to articulate what about the situation is not OK. Then, tell a couple of trusted people about your experience.

2. Make a commitment to yourself to do what you have to do to feel better. Forgiveness is for you and not for anyone else. No one else even has to know about your decision.

3. Understand your goal. Forgiveness does not necessarily mean reconciliation with the person that upset you or condoning their action. What you are after is to find peace. Forgiveness can be defined as the “peace and understanding that come from blaming that which has hurt you less, taking the life experience less personally and changing your grievance story.”

4. Get the right perspective on what is happening. Recognize that your primary distress is coming from the hurt feelings, thoughts and physical upset you are suffering now, not what offended you or hurt you two minutes – or 10 years – ago.

5. At the moment you feel upset, practise the Positive Emotion Refocusing Technique, a simple stress management technique to soothe your body’s flight or fight response.

6. Give up expecting things from other people, or your life, that they do not choose to give you. Recognize the “unenforceable rules” you have for your health or how you or other people must behave. Remind yourself that you can hope for health, love, friendship and prosperity and work hard to get them. However, you will suffer if you demand these things occur when you do not have the power to make them happen.

7. Put your energy into looking for another way to get your positive goals met [other] than through the experience that has hurt you. I call this step finding your positive intention. Instead of mentally replaying your hurt, seek out new ways to get what you want.

8. Remember that a life well lived is your best revenge. Instead of focusing on your wounded feelings, and thereby giving the person who caused you pain power over you, learn to look for the love, beauty and kindness around you.

9. Amend your grievance story to remind you of the power you have to create a better story, one where you can let go of the need to be a victim.

Dr. Fred Luskin is the director of the Stanford University Forgiveness Projects, a renowned researcher, author and expert in forgiveness. He presents “Forgive for Good: 9 Steps to Forgiveness” at the Justice Institute of British Columbia (Theatre), New Westminster, BC, March 26, 9AM-3:30PM. Call 604-528-5590 or 1-877-528-5591to register

Back room drug deals

 

DRUG BUST Alan Cassels

“The very word ‘secrecy’ is repugnant in a free and open society and we are, as a people, inherently and historically opposed to secret societies, to secret oaths and to secret proceedings. ”

– John F. Kennedy

ARE YOU familiar with the line, “If you’ve nothing to hide, you have nothing to fear?” That’s the slogan often used to attack those who express concern about personal privacy – the ones who say they’re worried about the proliferation of surveillance cameras, databases and other data-collection devices that track us like bloodhounds, recording our every encounter with the legal, commercial, educational and medical systems. Where is all that information kept? How correct is it? Who is using it? Can it be used for purposes for other than which it was intended? Will it ever come back to haunt us even if we have “nothing to hide?” Scary thoughts indeed.

While personal privacy is an issue that gets a lot of attention, leading to a growing level of public concern about exactly how personal data are being used, there’s another side to the secrecy issue. And that’s the fact that many decisions, especially vital decisions that affect healthcare, are made in secret, not open to the sunlight of public scrutiny. Most people would find it astounding that, in Canada, millions are spent on healthcare decisions made behind closed doors. Even if these decisions are being made by well-meaning policy makers fully preoccupied with advancing the public interest, secretive decision-making, by its very nature, means there is no way for third parties to verify whether or not the public interest is best served.

One example on my radar, although details are sketchy, is the way different provincial drug plans cut deals with drug companies about listing their drugs. These so-called product listing agreements allow companies to get their new drugs on the formulary – the list of drugs the province will pay for – without having to reveal how much or how little they are paying the government. They also don’t have to reveal how much more patients and private insurers may have to pay outside the government plan for the same drug. The public may be getting a real steal on a certain product, which just might be providing incredible value for taxpayer money, but the name of the game is secrecy; no one is supposed to know.

Let’s say a company wants its new drug listed on the Ontario Drug Plan and it asks the Ontario government for a certain price. After negotiations about the number of doses and the number of patients likely to use the drug, the product will be listed. If the company sells more of the drug than it projected, it might be required to pay back some of those additional costs to government. These agreements may have research requirements built into them to better monitor how the drug is being used in the general population. This is all conjecture, of course, because the deals are made in secret. What actually happens within a product listing agreement is a big, black box and no one, except the government negotiators and the manufacturer, knows what kind of money the drug is costing the taxpayer or the consumers who are not covered by provincial plans.

Are these fair agreements? Should they be made in the open? That’s my default opinion, but without knowing the specifics of these deals, it’s necessary to withhold judgement. Hopefully, given all the pressure exerted on governments to keep costs down, such secret deals are actually resulting in maximum value for the dollar.

Let’s broaden this question and ask ourselves if we’d welcome governments secretly negotiating on our behalf for other public goods. Would we allow the building of a new Port Mann Bridge or a new Sea-to-Sky Highway to be negotiated in secret? What would we say if prospective builders got together with government officials and hammered out financial deals where the public couldn’t know how much money is changing hands?

Some say the secrecy is necessary because of the way the drug industry and the different public pharmacare programs are structured in Canada. For instance, Quebec has a “most favoured nation” clause that requires manufacturers to provide the Quebec government with the lowest price among all the provincial plans. Maybe doing deals in secret is the only way any other province can get the fairest price. It’s hard to tell, but a recent paper published by Aidan Hollis, an economist in Alberta, found that BC carried out a sole-sourcing contract with a drug company that involved secret rebates to Pharmacare. The problem he saw was that the alleged price reductions for Pharmacare recipients meant higher prices for everyone else not covered by Pharmacare. Hollis concluded: “A tendering process with secret rebates is not transparent, nor is it fair to impose high costs on those patients whose purchases are not covered by Pharmacare.”

“Transparent.” That’s the word that seems most antithetical to the word “secrecy” and one that pharmaceutical companies absolutely love to fling at governments for being secretive. In fact, if you’ve been listening to the comments from drug lobbyists and their favourite disease groups about public agencies that critically evaluate drugs – Canada’s Common Drug Review and UBC’s Therapeutics Initiative, for example – the word “transparency” is thrown down like a gauntlet. Why aren’t these organizations more “transparent” they ask?

Am I the only one to notice the faint whiff of hypocrisy when drug companies are cutting secret deals with provincial governments to list their drugs, even as they publicly demand transparency in government-sponsored analyses of new drugs?

The drug companies’ version of the word transparency is simple: these groups want to know who’s at the table and they want to know the name, rank and serial number of the key lobbying targets. They want to know which levers to work, hence demanding greater and greater transparency around the decisions governments make about drugs because the more opaque the decision-making process, the less chance the drug companies have of influencing governments’ decisions.

Fair enough, right? Yet these demands from the pharmaceutical industry lead to some hard questions regarding the industry’s offerings in terms of their own transparency. Sure, they are companies and companies need to keep secrets – proprietary information, ya know – and I can accept that. However, we in the public know almost nothing about what the industry is doing to influence healthcare decisions, such as how much they spend to influence physician prescribing.

Dr. Joel Lexchin, a Canadian expert in pharmaceutical policy and author of one of the best books on the drug industry in Canada –The Real Pushers, New Star Books, 1984 – has estimated that the drug industry in Canada today spends about $50,000 per doctor, per year, marketing its products to physicians, but we don’t know for sure. (With 6,000 practising doctors in BC, that’s about $300 million per year.) Do we know how the money is spent or to what extent it influences prescribing decisions? Of course not. All of that information is confidential, secret and non-transparent.

Another worrisome aspect of transparency relates to the way Health Canada respects drug manufacturers’ requests for confidentiality of unpublished data – that is, the company’s clinical data our regulator examines before it allows a drug to be sold in Canada. We researchers who are interested in what those data show –especially in terms of drug safety – can’t get them. That information is considered confidential and we can only see summaries of the data that support the approval of a drug.

Data on drug safety, data on what provinces pay for drugs and data on drug company spending to influence prescribing are certainly on my menu of what I think needs to be brought into the light of day under the banner of greater transparency.

Yet even while governments in Canada jump to satisfy the industry’s strident desire for greater transparency, they tend not to demand, in return, greater transparency for those things obviously in the public interest. At the very least, we would hope they would strike a balance so that the glare of transparency can shine on both public and private matters. However, the way the companies and governments currently deal with transparency issues reminds me of the slogan used to describe the recent spate of bailouts of private banks in the economic slowdown: “The privatization of benefits and socialization of costs and risks.”

Maybe our democratically elected governments need to say this to the drug companies: “We’ll give you transparency of our decision making processes when you provide us equal clarity on your business decisions. You can’t have us working in a glass house while you work in a batcave.”

Alan Cassels is a drug policy researcher at the University of Victoria and author of The ABCs of Disease Mongering: An epidemic in 26 Letters.

cassels@uivic.ca

 

Veggies for vitality

NUTRISPEAK by Vesanto Melina

The scrumptious aroma of potatoes baking in the oven on a winter afternoon. Minestrone soup simmering, bringing an invitation from onion, garlic and herbs. The vibrant reds, greens and purples of a rainbow-hued salad. The explosion of flavour when you bite into an avocado and tomato sandwich.

If the word “vegetables” doesn’t conjure in your mind sensations of colour, fragrance, delicious flavour and bountiful health, it’s time to update your attitude about these amazing foods. When we have a savoury soup and salad for lunch, and build our dinner around veggies, we consume a wealth of vitamins, minerals and other nutritious compounds.

More than any other group of foods, vegetables have proven their worth as cancer fighters and as our powerful protectors. This is a great time to make the acquaintance of new members of this family of plant foods and also to discover what powerful allies they can be in supporting your health.

One of the best things that veggies have going for them is an abundance of protective phytochemicals (plant chemicals). These substances provide many of the colours that make the produce aisles so attractive and vibrant. Veggies also give you more bang for your buck, in terms of providing vitamins, minerals and protection against disease, per calorie and per mouthful, compared with any other group of foods.

The recipe shown is from our newest book, The Raw Food Revolution Diet*. This bean-free hummus has all the flavour of traditional Middle Eastern hummus and is full of nutrients, including bone-strengthening calcium. It’s tasty with raw veggies. To expand your horizons about which veggies you can eat raw, here are a few ideas: asparagus tips, broccoli florets, carrot sticks, cauliflower florets, celery sticks, cherry tomatoes, cucumber discs, green onions, green pea pods, jicama sticks, parsnip sticks, peppers (red, yellow and green), snow peas, zucchini strips or circles.

The Raw Food Diet Revolution

A trend that is sweeping North America is the raw foods movement. Some people are motivated by a concern about their bulging waistlines, others by the abundance of protective antioxidants and phytochemicals in plant foods. Many are inspired to increase their intake of uncooked veggies and fruits without adhering to an entirely raw diet. Are raw diets nutritionally adequate? What are the potential pitfalls? Are they good for children? Can a raw or mainly raw diet form the basis for a successful weight loss plan? I will be delivering a seminar entitled The Raw Food Diet Revolution at The Wellness Show. See information below.

Vesanto Melina delivers The Raw Food Diet Revolution seminar at The Wellness Show, Vancouver Convention & Exhibition Ctr, 999 Canada Place, Sun. Feb. 8, 12:30pm. Drop by the Book Publishing Company booth (620) and say hello.

www.thewellnessshow.com 
www.nutrispeak.com
*Authors: Cherie Soria, Brenda Davis and Vesanto Melina (The Book Publishing Company, 2008.)

Attend a free presentation by Vesanto, “Rx for Healthy Eating” in Langley’s Walnut Grove Library, Wed. Feb. 11 at 7 pm


Zucchini Hummus

Makes 1-2/3 cups (5 servings)
Serve hummus with raw veggies or as “Romaine Boats” on the inner leaves of a head of Romaine lettuce, topped with diced tomatoes and alfalfa sprouts.

1 small zucchini, peeled and chopped (1 cup/250 mL, firmly packed)
3 1/2 Tbsp. lemon juice
1 Tbsp. flaxseed oil or olive oil
1-4 cloves garlic
1 tsp. paprika
1 tsp. salt
1/4 tsp. ground cumin (optional)
1/8 tsp. cayenne
1/2 cup sesame tahini
1/3 cup sesame seeds, soaked 4 hours and drained

Place in a blender the zucchini, lemon juice, oil, garlic, paprika, salt, cumin (if using) and cayenne. Purée. Add tahini and sesame seeds and purée until perfectly smooth and creamy. Store in a glass jar or other covered container, refrigerated, for up to four days.

Note: This recipe can be made in a food processor, although the mixture will contain whole sesame seeds, rather than being smooth. Alternatively, you can replace the seeds with 1/3 cup more tahini plus a little water.

Vesanto Melina is a BC-registered dietitian and co-author of the following nutrition classics: Becoming Vegan, the Food Allergy Survival Guide andRaising Vegetarian Children
www.nutrispeak.com

Five-year food security plan

ON THE GARDEN PATH by Carolyn Herriot

I spent a full year searching for a property where I could grow as much of my own food as possible. From the moment I stepped foot on the land we bought, I started visualizing my new garden 10 years down the road. Amazingly, it only took five years to achieve year-round self-sufficiency in fruits and vegetables. Now I know that urban gardeners on Vancouver Island could achieve food security with their own five-year plan. It could look something like this:

Year one: edible landscaping. Year two: fruit and vegetable gardening. Year three: winter food gardening. Year four: seed saving for future harvests. Year five: four-season production using local seed banks.

We are beginning the ninth year on our property so I thought I’d share what we did on The Garden Path with you:

Amending the soil: With 15 feet of clay fill to work with, this was a no-brainer! How to change a cracked substrate with no earthworms into a fertile organic loam in a few months? First, Maverick Excavating came to break up the clay and then we mulched like mad, with what I refer to as “The Four Secrets of Successful Soil Building” – compost, manure, leaves and seaweed. By adding six-inch layers of these organic amendments in the fall, we were able to turn compacted clay into friable soil, with good tilth and teaming with earthworms by April the following year.

The best part is these organic soil amendments are free and freely available and are often regarded as waste. If urban gardeners linked with rural farmers and used their manure, we could easily solve a big waste disposal problem. If gardeners kept their leaves and fed them back to the soil, we would save a lot of money by the city not having to pick them up and we wouldn’t have to drive to the works yard to buy the leaves back as mulch. There’s a good joke here.

Building a greenhouse: I chose a glass and metal frame model, but there are other options. Due to erratic weather, I now grow seedlings for transplanting whenever possible. If you don’t have the luxury of a greenhouse, you can improvise with cold frames and cloches.

Designing the garden: Maverick Excavating dug up a 50 sq. ft. area, which was divided into four quadrants with a circular bed in the middle. This layout works well for crop rotations, which break the lifecycle of pests and diseases.

We grow food year round in the main garden because in our temperate climate there’s no need to leave beds empty from October to April; there are 50 varieties of different vegetables that can be harvested throughout winter.

The “Berry Walk”: I planted a 50-foot-long border with raspberries, blackcurrants, redcurrants, gooseberries and Josta berries, all of which were under-planted with “Totem” June-bearing strawberries. They thrive in the same conditions.

The fruit orchard: A small orchard of 10 trees was planted in the second year. Dwarf and semi-dwarf saplings of apple, pear, cherry and plum trees were planted 15-feet apart in two rows of five because I visualized an avenue of trees with a canopy of fruit, providing shade for summer banquets.

The arbour: In year three, we scoured the forest to build a 50-foot-long arbour for kiwis, grapes, climbing berries and thornless blackberries. The berries are very ornamental as they ripen from red to black.

Seed saving: Over the years, more garden beds were added for seed saving. Plants adapt to the conditions in which they grow, which is why using organic seed is best when you are an organic gardener. Local seeds also have an edge in that they become adapted to the local climate conditions.

Willows and bamboos: These are useful, renewable resources for the garden. In future years, the bamboos and willows I have been planting will provide material for obelisks, arbours, trellises, screens, fences and teepees.

The native edible plant walk: next on the list – I’ll keep you posted.

Carolyn Herriot is author of A Year on the Garden Path: A 52-Week Organic Gardening Guide. She grows her certified organic “Seeds of Victoria” at The Garden Path Centre where she blogs The New Victory Garden online.

Big pharma breaks the law and pays up

DRUG BUST Alan Cassels

“Drastic action is essential to preserve the integrity of medical science and practice and to justify public trust.”

– Journal of the American Medical Association

You can learn a lot about the effects of drugs and the actions of drug manufacturers by peering into a courtroom. When you hear what the companies themselves have to say, in sworn testimony, about their drugs or their marketing tactics, you realize that we in the general public really only have an iceberg tip’s worth of information about any drug on the market.

You can’t deny that courts of law can get at a certain purity of truth, which emerges from the wringer of the legal system.

Exhibit A to support this argument is a major lawsuit settled last month in the US against drug giant Eli Lilly. The company was ordered to pay $1.42-billion (US) to settle criminal and civil investigations. These charges stem from the way the drug manufacturer marketed its antipsychotic drug Zyprexa, (generic name olanzapine). Lilly executives explained that the key charge centred on how Lilly was advertising Zyprexa for ailments for which it was not approved.

A company trying to license its drug will come to the regulator with a series of claims of what its drug can do. It is only those claims deemed to be supported by sufficient evidence that get approved by the FDA or Health Canada. However, while drugs are licensed only to treat certain specific conditions, our doctors are free to prescribe any drug for any patient for whatever reason they see fit, approved or not approved. The issue of “approval” is important because a company can only market its drug for “approved” uses. In other words, if your drug is approved to treat toenail fungus, the sales reps can’t go pushing the drug for erectile dysfunction. That’s against the law.

Zyprexa belongs to a relatively new class of antipsychotic drugs approved to treat people suffering from schizophrenia and bipolar disorder. I thought, OK, there can’t be that many schizophrenics or people with bipolar out in society so antipsychotic drugs like Zyprexa wouldn’t have much of a market. I was wrong. Lilly has sold nearly $40 billion (US) worth of Zyprexa since it was approved in 1996, making it, in fact, one of the biggest-selling drugs in the world.

Many of us had sensed there had to be something illegal about the way the drug was being marketed, but we had to wait until the court documents revealed what was actually happening.

A huge blockbuster drug, approved only for the treatment of relatively uncommon diseases, was obviously being taken by millions of people – despite its known and fearful side effects (mainly weight gain and diabetes) and its documented life-threatening severe adverse effects, (heart attacks and strokes). So why was an antipsychotic like Zyprexa so widely used?

The answer is what we call “off-label promotion.” According to documents filed in U.S. District Court in Philadelphia, Lilly said it promoted Zyprexa for elderly people in the treatment of dementia, which is a use strictly not approved by Health Canada or the US Food and Drug Administration. The US attorney handling the case told a press conference, “Lilly completely ignored the law,” making “hundred of millions of dollars” from illegally promoting Zyprexa.

Here’s the main kicker: not only is the drug not approved to treat dementia in the elderly, but Health Canada has said that prescribing this drug to elderly people is something that should emphatically not be done due to the risk of strokes. Yet if you were to wander the halls of the average seniors home in Canada, you’d find as many as a quarter of the residents taking these drugs.

Exhibit B in my argument that the law courts are great places to look to expand our knowledge about drugs is the drug Neurontin (gabapentin). This drug will go down in the history books as being off the scale in terms of its off-label promotion. Neurontin was approved in the mid-1990s as an “add-on” therapy for what they call “partial complex seizures.” A small market, right? I mean, how many people suffer seizures and would therefore need drugs like Neurontin? Seems like a lot. By 2004, nearly $3 billion worth of the drug was being sold.

David Franklin, a whistleblower from Parke-Davis (later bought out by Pfizer, which marketed the drug), set the wheels in motion for a huge lawsuit that followed. The result was public access to some of the most complete court documents ever assembled around the aggressive, off-label marketing of a drug. In the passage below, Franklin relates what a Parke-Davis executive said to him and his fellow sales people:

“I want you out there every day selling Neurontin… We all know Neurontin’s not growing for adjunctive therapy, besides that’s not where the money is. Pain management, now that’s money. Monotherapy [for epilepsy], that’s money… We can’t wait for [physicians] to ask, we need [to] get out there and tell them up front. Dinner programs, CME [continuing medical education] programs, consultantships all work great but don’t forget the one-on-one. That’s where we need to be, holding their hand and whispering in their ear, Neurontin for pain, Neurontin for monotherapy, Neurontin for bipolar, Neurontin for everything. I don’t want to see a single patient coming off Neurontin before they’ve been up to at least 4800 mg/day. I don’t want to hear that safety crap either, have you tried Neurontin, every one of you should take one just to see there is nothing, it’s a great drug.” (From The Neurontin Legacy: Marketing through Misinformation and Manipulation by C. Seth Landefeld, M.D. and Michael A. Steinman, M.D., published in the New England Journal of Medicine, Jan. 9, 2009.)

It would become the mother of all court actions against illegal marketing by a company; the payouts were almost a billion dollars, at that time the biggest legal action ever taken against a drug company. The court documents reveal the whole gamut of tricks used to manipulate information: suppressing publications, training and using local doctors to serve as paid speakers for the drug, cultivating “thought leaders,” influencing academics with research grants, appointing people to “advisory boards” that worked to launder payments to physicians and lots and lots of “unrestricted educational grants” to do what was needed to sell this drug.

In an article in December’s New England Journal of Medicine, it was noted that the marketing of Neurontin was based on “the systematic use of deception and misinformation to create a biased evidence base and manipulate physicians’ beliefs and prescribing behaviours.”

The 8,000 pages of corporate documents now in the public domain reveal the tactics used by a company to create a multibillion-dollar blockbuster out of a drug that should have gone nowhere. These documents are available in a searchable digital library at the University of California in San Francisco. (www.dida.library.ucsf.edu). The class-action suit which followed also generated detailed testimony, searchable through the US Federal Judiciary’s Public Access to Court Electronic Records Service Center.

How much off-label prescribing happens? About 20 percent of drugs in the US are written to treat a condition for which the drug was not approved, according to a 2006 study published in the Archives of Internal Medicine.

What’s a patient to do in all of this? For starters, ask your doctor, “Is this drug you are about to prescribe me actually “approved” for the condition or disease for which I would take it? It might be best to first try the proven, standard and “approved” therapies.”

Clearly, we shouldn’t have to wait for the courts to tell us what is happening behind the scenes about how drugs are being used. Better research and regulation on how drugs are actually being used in the market (and what kinds of effects they have) are needed.

In Canada, a group of academics and health policymakers have been trying for several years to make the case that Canada needed better ways to research and assess the safety and effectiveness of drugs as they are used in the “real world.” In mid-January, Canada’s new Health Minister Leona Aglukkaq announced that the government was committing $32 million over four years to create a research network to “enhance national capacity for research on the safety and effectiveness of drugs used by Canadians.” This is about the best news on the drug safety front we’ve seen in a long time.

We shouldn’t have to rely on the courts to provide independent, unbiased evidence to help answer important questions about the drugs we take every day. Publicly funded research that is free from pharmaceutical industry influences will help a lot. The new $32 million is hardly what you’d calldrastic action on the drug safety front, seeing as this represents about 1/1,000th of Canada’s annual drug bill, but it could be a step in the right direction. There is no doubt that the time has come to start creating systems to ensure safe and effective use of drugs in Canada.

There is no use waiting until the courts have their say.

Alan Cassels is a drug policy researcher at the University of Victoria.

He uncovers the world of cancer screening in a two-part radio documentary, You are Pre-Diseased, airing on CBC IDEAS at 9:05 pm, February 12 and 19. Mark your calendars.

cassels@uivic.ca

The heights of the fall

by Shakti Mhi

Dedicated to Daniel, who was there for me with his whole being.

My body was in motion, falling 30 feet down. As I fell, time didn’t slow down; it simply stopped. Maybe because I fell at the speed of light, or when you take off from your usual orbit, the laws of nature cease to exist.

As I was in the air, I was very clear and relaxed. I thought, “Is this going to be the end?” I felt a bit disappointed as I was in the middle of teaching a yoga teacher training program and I had a few things to do in my life. I didn’t resist the fall with my body; I let my body fall like a heavy pillow and I hit the rock on the ground. The impact was incredible; bones and flesh hitting the ground at a speed that is only meant for diving birds. I lost my breath but not my consciousness. I watched my body in its stillness; no air moved in or out. I knew at this moment I was entering a new era of my existence, but I wasn’t sure if it was in the form of death or a new kind of life.

I wondered if the reason I was not breathing was because one of my ribs had pierced my lung. I decided to gather all the energy that was left in my broken body and force a deep inhale into my shocked lungs. There is a good reason why in Zen it says, “If you are aware of your breath, you are aware of the moment.” I guess the last time I had been forced to inhale so intensely was when I was born. I felt so much joy when my lungs started to move, vacuuming the air in.

The aftermath

I knew my spine was broken and my next thought was, “Am I paralyzed?” I searched for my toes, but it wasn’t easy to map them in my brain. I was determined to find the group of muscles responsible for moving my toes. I did and when they moved, I was in bliss. I checked my legs and was thrilled to feel them moving. My left hand was lying beside me with no life in it. Broken bones were exposed to the air covered with a jungle of dark mud. I thought of the long journey before me. I was on a small island off the main coast of Thailand that had no medical facilities and the only way back was on a tiny boat on a stormy ocean. Honouring my practice, I knew there was only one way for me to go through the ordeal: being in the moment.

Lying on the ground, waiting for an emergency team to arrive, I had to restrain my mind from leaving the moment and wildly galloping into the unbounded desert of fears, doubts, worries and the replay of moments that had past. I needed to be 100 percent focused, tuned in and crystal clear. I couldn’t afford to lose any energy by letting my mind wander outside of the moment.

People carried me from the jungle to the beach and the pain was unbearable. I knew if I identified with the pain it would swallow me alive and I would lose consciousness. So I started to say loudly, “I am not this body and this pain is not me.” I kept repeating it as a mantra until I established a state were I was fully able to watch the pain, knowing it was in my body and knowing that it was not me. It helped me to manage the pain as a separate thing from my self. When I was informed that it would take some time for the speedboat to arrive, I started to chant like there would be no tomorrow. I chanted so loudly that people started to move towards the beach thinking maybe there was a Satsang going on. I couldn’t understand where this powerful voice came from in my broken, bleeding body. But I didn’t care; my intense chanting established life in my injured body by evoking Prana and circulating it in my physical and energy bodies.

And the journey began – endless moments of awareness, bliss and gratitude for being alive. When I arrived at the hospital a few hours later, I was informed that it would take another six hours for the surgeon to fly in from Bangkok. I asked Daniel to remove the big clock from the wall across from my bed, as I needed to bend time to my own terms to survive the long wait. The next thing I heard was the surgeon explaining how serious the injury was. He suggested surgery for my spine. I went within my self and came back with an assertive command not to touch my spine, just to care for my hand. They respected my wish, but didn’t support it.

What made this experience so powerful and spiritual is that I was forced to immerse fully into the moment and move beyond space and time, move beyond all concepts of pain and pleasure, of good and bad. I experienced each moment as it was.

Another significant aspect of my injury was watching the power of the mind when it was guided with intuition

Illustration © Mahesh14

and cleared of all fears. My mind and I decided not to let any predictable diagnoses and bad news from the medical staff stop us from being creative in our dance of healing. Meditation, visualization, loud affirmations and tons of humour were my yoga practice, day and night. I was talking to my body and guiding it gently as it found its way back to a place of balance and health. I refused to remain on morphine and instead exercised changing the concept of pain into pleasure; after all, it is only a concept.

Long distance healing

Because we are all connected to each other on the energy level, healing from a distance works powerfully. Immediately following my event, many people in Thailand, including teachers, students, yogis and friends, meditated and sent me powerful energy to encourage rapid healing. The news travelled quickly from India to Vancouver and beyond and wonderful people sent me more and more energy. Lying in my hospital room, I felt strong vibrations moving along my spine, aware of a beautiful gold colour, healing my broken bones. Even though I was isolated, I felt connected to an ocean of high frequency vibrations. I could physically feel streams of energy entering my body. I owe my rapid healing to all the people that sent this wonderful, loving energy. Sometimes the energy felt so intense, I burst into tears of bliss and gratitude. Thank you all.

Shakti Mhi is the author of The Enigma of Self-Realization and founder of Prana Yoga College International.

www.pranayoga.com

Less is more: make it your new mantra

DRUG BUST Alan Cassels

If you listen closely to the pleas of health advocates and patient groups, those who push for better treatments for specific diseases, such as Alzheimer’s, cancer, arthritis or heart disease, there is a common refrain. That refrain, summed up in a word, is “More.”

We need more drugs. We need more CT or MRI machines. We need more doctors. We need more specialists. We need more access to everything. More. More. More.

And then add the requests for more of everything that supports a decent quality of life. Advocates for the homeless make pleas for more affordable rental housing. AIDs advocates make a very strong case for government-supported safe injection sites. Seniors advocates make demands for more assisted living complexes to support seniors in their frail years. More. More. More. The advocates often feel like their pleas are mere cries in the wilderness.

If you are a health bureaucrat, policymaker or politician, you probably spend a lot of time listening to the competing groups stating their case for More, More, More. You may spend much of your workday trying to satisfy the needs of those who are asking for more. And choosing to make more of one thing accessible to one group inevitably means money that is not going towards a competing claim. After all, there is a limited supply of tax dollars to go around.

The sense of a limited supply of money brings a level of discipline to the way government doles out our collective wealth. Yet I believe it’s occasionally worth putting aside those decisions for a moment and stepping back to take a look at the big picture at the way we manage all our collective resources, of which healthcare is only a single slice.

At the beginning of the year, let’s ask ourselves, “What kind of show are we humans running here on this planet?” Our planet consists of nearly unimaginable health extremes. The poorest billion people on Earth live on less than a dollar a day, a level of deprivation that necessitates being dominated by the issue of survival. More than 25,000 children under five die every day from the most easily preventable diseases: diarrhoea, parasites, malnutrition and malaria. This one billion people lack even the most basic components of health and improving their chances of survival depends on their getting more of almost everything: clean water, decent clothing, adequate shelter, basic healthcare, income, peace and democracy. Even a little more of any of these simple things would produce a huge impact on the lives of these people.

At the other end of the spectrum, where the majority of Canadians live, are another billion or so people for whom survival is almost a foreign concept. These people can easily think of more ways to spend our collective wealth. Nearly half of our provincial budgets are allocated for healthcare and still there is a belief in scarcity – a belief that we need more drugs, more machines, more specialists and more doctors to solve our woes.

That’s not to say that a lot of our collective health spending couldn’t be better managed. There’s good evidence that the way we organize healthcare is so chaotic and irrational that we overspend and underspend in areas that have nothing to do with rationality and equity. What I see at this extreme rich end of the rich spectrum is an absurd level of obsession with avoidance of death at any cost and a collective self-absorption to fight an unwinnable war. Supporting this war is a belief that prophylactic medicine – medicine at any cost, and often against the dictates of evidence, rationality or even common sense – presents nothing but positive contributions to our health. Here we see people plunking down $2,500 to buy a full body CT scan, convinced that it’ll give them the edge they need to save them from the inevitable. Many more get tested and treated, poked and prodded, diagnosed, medicated, swabbed, jabbed, cut and eviscerated, to an extent that sometimes seems quite laughable if it wasn’t so regrettable.

Some beliefs are decidedly bad for your health. Let’s examine some of the more absurd of those beliefs, shall we?

Brand name means better healthcare: How about the belief that brand name drugs are always better than generic drugs? This singular idiocy means that we Canadians collectively spend $2 billion more on drugs than is necessary every year. Don’t tell me we can’t afford to meet even the most minimal levels of foreign aid befitting of a developed country when we allow this lunacy to continue. Buying a patent-protected drug when a cheaper generic exists is a tax on the uninformed. If you believe that a patented treatment always infers some kind of clinical advantage over the unpatented stuff, you should probably be forced to pay for your beliefs. And please don’t expect the taxpayer to pay for your foolishness.

Screen early, screen often: Another absurd belief that many of us have is that it’s a great idea to screen healthy people for disease. Yet screening healthy people can involve insidious and uncounted harms and it is expensive and often terribly unnecessary. There may be dozens of cancer screening programs out there, but only three – count’em three – types of screening programs for cancer have sufficient scientific evidence for authorities to recommend them for the whole population. What are they? Breast screening (mammography) for women over 50, cervical cancer screening (the pap test) and colorectal cancer screening (fecal occult blood test). All the others that we hear about – full body screening, lung cancer screening, PSA or prostate screening, other organ screening, heart screening, (angiography) etc, etc. – are not recommended even though they are heavily marketed and promoted through both the media and private clinics.

Government is protecting us from drug marketing and screening scams:Sadly, that one is wrong too. In Canada, despite all the marketing of both screening and drugs, there is minimal consumer protection from the blatant fear-mongering advertisements you see asking you to take a drug or come on down to the local private clinic for a full body or heart or lung scan. Colleges of Physicians, Health Canada regulators and other professional organizations point at each other when asked who should be minding the store. Even if you believe in minimal government control over your life, you could not disagree with the need for some state involvement overlooking the advertising and marketing of health care products and devices that could hurt you.

Screening and newer drugs are always of incredible benefit: Sadly, this is wrong too. Both the provision of new drugs and preventative health screening are highly controversial because the actual benefit for most people is very small. A new cholesterol-lowering drug might prevent one percent of people taking it from having a heart attack in the next five years. With mammography screening, we’d have to screen 1,000 women with X-ray mammograms every two years for 10 years to prevent about three deaths (compared to a similar group of women not screened). This level of screening will cause about 200 women to experience further investigation (because something suspicious was “found” on their mammogram) or a biopsy. Those women would face the anxiety of having a diagnosis of breast cancer that turned out to be false. It’s very hard to counter the “look early, act early” mantra when it comes to cancer screening, the underlying thought being that if you can find it early, you have a better chance of living.

I think it is time we re-examine our healthcare beliefs. Maybe we need to make a pledge to consider a “less is more” mantra towards health spending. We only need look at the level of per capita health spending in the US, which is more than twice the rate of other industrialized countries, to remind ourselves it’s how we organize healthcare that counts, not how much we spend.

Major advances in world health could be achieved if we collectively took care of everyone’s basic needs – why not start with homelessness in our own cities? – and then worked to ensure we don’t let our collective and irrational health beliefs hold us hostage.

The reason that over-treatment and over-diagnosis are such important subjects to us rich one billion is not just because the excesses of medicine can adversely affect our health, but because such appalling excesses leave so many of our fellow citizens behind.

A civilized society is measured not by how well it takes care of its most privileged citizens, but how well it takes care of those who have nothing. Why not pledge that in this New Year, we work to create a rising tide that lifts all boats, not just those of us who live on yachts?

Alan Cassels is a drug policy researcher at the University of Victoria.

He uncovers the world of cancer screening in a two-part radio documentary, You are Pre-Diseased, airing on CBC IDEAS at 9:05 pm, February 12 and 19. Mark your calendars.

cassels@uivic.ca