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NATIONAL HEALTH CARE SPENDING TREND CANNOT BE SUSTAINED

Based on statistics from the Canadian Institute for Health Information (CIHI), if the trend of a 100% increase in total government spending on health care in the last decade (1999 to 2009) continues, the cost of health care to Canadians on a per capita basis in 2019 will be more than 5 times greater than it was in 1989.

The 2010 budgets of provincial/territorial governments reflect the projection that health care in Canada will cost each Canadian $11,000 by 2019. For example, the Government of Ontario has budgeted $42.6 billion for health care in the 2010/2011 fiscal year, which is 43% of every program dollar spent by the province. The Government of Alberta will be increasing provincial spending on health care services by 44% over 6 years, from $7.7 billion in 2009 to $11.1 billion in 2015.

"Hospitals" make up the largest component of Canada’s health care spending, but that percentage is declining. The CIHI reported that in 2008 Hospitals accounted for 28% of the health care spending, down from 40% in 1989. The second largest and fastest growing share of health care spending is with pharmaceuticals. “Prescription Drugs” accounted for 15% of health care spending in 2008, up from 7.6% in1989 when Prescription Drugs was the fifth largest area of spending behind Hospitals, Physicians, Other Institutions (e.g., nursing homes) and Dental/Vision Care Services.

THE COST OF HEALTH CARE WILL RISE SIGNIFICANTLY AS BABY BOOMERS AGE

Much of the growing health care costs in Canada are for aging baby boomers, born between 1946 and 1964, that are living with more years of obesity, arthritis and other chronic health conditions than any previous generation of aging adults. The unhealthy lifestyles of baby boomers have caused dramatic increases in health conditions such as adult-onset diabetes, heart disease and stroke. According to Dr. Ian Janssen, an epidemiologist in the School of Physical and Health Education at Queen’s University, 1 in 3 baby boomers are currently obese, compared to 1 in 4 Canadian seniors aged 65 to 74. His findings suggest that baby boomers may be the first to see a decline in their quality of life. Yet 80% of them think they will enjoy a longer life expectancy than previous generations and 58% think their weight has little or no effect on their health.

Without immediate health promotion interventions, the health care costs will rise significantly as baby boomers age. On February 8, 2010, for example, a report released by the Conference Board of Canada and the Heart and Stroke Foundation of Canada titled Canadian Heart Health Strategy: Risk Factors and Future Cost Implications, suggested that Canada could save a total of $76.4 billion between 2005 and 2020 if 5 targets were met:

• Decrease the prevalence of high blood pressure in adult Canadians age 18 to 74 by 32 per cent (from 22 per cent in 1992 to 15 per cent).
• Reduce the overall smoking rate by 25 per cent. In 2005, 14.9 per cent of females and 18.2 per cent of males smoked daily in Canada.
• Increase the proportion of Canadian children and adults eating at least five servings of fruit and vegetables per day by 20 per cent. Currently, 34 per cent of Canadians lack fruits and vegetables in their daily diet.
• Increase the proportion of Canadian children and adults who are physically active by 20 per cent. In 2005, almost half of Canadians age 12 and older were considered physically inactive.
• Decrease the rate of Canadian adults who are overweight and obese by 20 per cent. In 2005, the overall prevalence of obesity, defined as a body mass index of 30 or greater, in Canada was 14.2 per cent.

BIG PHARMA IS MISLEADING DOCTORS AND THE PUBLIC

Big chemical drug pharmaceutical companies (big pharma) are misleading doctors and the public about the efficacy and safety of many prescription drugs. The medical experts that seem to publish the most fraudulent information appear to be psychiatrists, particularly when it comes to sharing findings from clinical trials with popular antidepressants known as selective serotonin reuptake inhibitors (SSRIs), such as Paxil and Prozac – which generated an estimated $10 billion in worldwide sales for big pharma in 2008.

The following international examples of misleading information have tremendous influence on doctor education and the mental health system in Canada:

• In July 2006, the British Medical Journal published an article written by Dr. David Healy, a psychiatrist at Cardiff University in Wales and Director of the North Wales School of Psychological Medicine, which demonstrated, from a meta-analysis of several years of data from clinical trials with Prozac, Paxil and other SSRIs, that important negative data was withheld by psychiatrists and manufacturers of SSRIs when it was presented to scientific advisory groups of the U.S. Food and Drug Administration (FDA), and that many scientists did not report negative findings about the potentially lethal side effects of these popular antidepressants in peer-reviewed medical journal articles.

• In hundreds of reports and articles published in peer-reviewed medical journals over the last several years, Dr. Charles Nemeroff, former Chair of Psychiatry at Emory University and now Chair of the Department of Psychiatry and Behavioral Sciences at the University of Miami, did not present negative findings about the potentially lethal side effects of Paxil. According to the New York Times, In 2008, Dr. Nemeroff disclosed to Emory University officials that he was paid less than $35,000 by GlaxoSmithKline (GSK), the manufacturer of Paxil, from 2000 to 2006 while conducting U.S. Government funded clinical trials on Paxil. He actually received more than $960,000 from GSK during this period:

• In 2005, the British Medical Journal reported that Eli Lilly, manufacturer of the antidepressant Prozac, had data from 1988 indicating that patients on Prozac, the only SSRI on the market at the time, were far more likely to attempt suicide and show hostility than patients on other antidepressants and that the company attempted to minimize public awareness of the potentially lethal side effects. The 1988 leaked internal document from Eli Lilly showed that 3.7 percent of patients attempted suicide on this new SSRI at a rate more than 12 times greater than patients on any of four other commonly used antidepressants. The document, which cited clinical trials of 14,198 patients on Prozac, also indicated that 2.3 percent of users suffered acute psychosis while on the drug, more than double the next-highest rate of patients using another antidepressant.

• More than 10,000 pages of Eli Lilly internal documents were unsealed and made public on May 1, 2009 as the result of lawsuits by insurers and pension funds to demonstrate that Eli Lilly officials wrote medical journal articles that exaggerated the effectiveness of the antipsychotic drug Zyprexa and then encouraged psychiatrists and doctors to put their names on the articles, a practice called “ghostwriting”. According to Dr. Carl Elliot, a bioethicist at the University of Minnesota, the unethical use of “ghostwriters” by drugmakers has created a huge body of literature that doctors and the public cannot trust.

• In a January 2009 article in the journal Psychotherapy and Psychosomatics, Dr. Glen Spielmans, associate professor in psychology at Metropolitan State University in Saint John, Minnesota, reported that of the 43 articles published in peer-reviewed medical journals about the new SSRI Cymbalta, manufactured by Eli Lilly, 2 particular findings from the same clinical trial were reported in 33 of them. The 2 findings suggest that patients benefit by switching to Cymbalta from other antidepressants. This practice, known as “salami slicing”, is considered unethical because it makes a drug appear to have much more scientific support than is warranted. According to many scientists, a particular finding from one clinical trial should only appear in one medical article.

• In a meta-analysis of randomized placebo-controlled clinical trials of antidepressants approved by the Food and Drug Administration  (FDA) that was published in the January 6, 2010 issue of the Journal of the American Medical Association, Dr. Robert DeRubeis of the University of Pennsylvania stated that of the 164 million prescriptions of antidepressants dispensed worldwide in 2008, drugs manufactured by big chemical drug pharmaceutical companies (big pharma) such as Paxil and Prozac are no more effective than a placebo (sugar pill) at treating more than 70% of depression sufferers and reported that antidepressants are only effective with a small percentage of the 3 out of 10 people who suffer from major depression. The researchers suggested that doctors should consider non-drug options such as exercise when treating depression, particularly mild and moderate depression.

The unethical, and possibly illegal, activities do not stop with scientists and big pharma. On December 16, 2004, for example, the Los Angeles Times reported that Louisiana Republican Congressman W. J. “Billy” Tauzin was leaving congress and his $158,100 a year salary to become President of Pharmaceutical Research and Manufacturers of America (a national lobby group) on January 3, 2005 for reportedly $2.5 million. As a congressman, Billy Tauzin had jurisdiction over the U.S. pharmaceutical industry as Chairman of the Energy and Commerce Committee.