“Old age is not for sissies,” said Bette Davis. Indeed, it is not, but the images from our childhood of what it meant to be “old” have changed dramatically. Of course, as I enter my 60th year, my perspective on what it means to be “old,” of necessity, shifts. As another popular aphorism, puts it “the hardest thing to decide is when middle age begins.” Thanks to advances in health care and a focus on healthy living, Canadians are living longer. And today’s senior has different issues and challenges than in our grandparents’ day. I see it every day, as my riding of Saanich-Gulf Islands is one of those with the highest proportion of older citizens. While so much in the mass media sees only the negatives of this aging demographic, there is much to celebrate.

The group Moses Znaimer calls “zoomers” are not abandoning their love of tennis or skiing. The aging population is increasingly embracing the benefits of staying involved, especially as they give back to community through the donations of thousands of hours of volunteer work.

That is, of course, not to deny the challenges. Today’s seniors want to know that pension and retirement savings are adequate to maintain an active lifestyle. The Green Party supports expansion of the Canada Pension Plan. CPP is sustainable and reliable. It is time to review whether RRSP is working as a vehicle. Evidence suggests its uptake is very limited, it has a large impact on government revenues and yet it seems to benefit primarily those Canadians who least need it.

Staying active is challenging in a car dominated culture. An aging population increases the need for convenient, accessible, mass transit. As it becomes less safe to drive at night, seniors want access to public transit.

The most extreme challenges of aging are experienced by seniors living in poverty, a disproportionate proportion of whom are women. While the percentage of seniors living in poverty dropped dramatically from a high of approximately 30 per cent in 1976, to a low of 4.7 per cent in 2007, the poverty rates for seniors have begun to move up once again5.8 per cent in 2008. We cannot be complacent about the economic struggles of our seniors.

Meanwhile, the widely-repeated claim that the growth in aging Canadians as a proportion of our population will drive up health-care costs is not supported by the evidence. Empirical evidence suggests that the aging population is not a major cause of increased costs. According to the Canadian Institute of Health Information: “Analyses of the drivers of increases in public sector health expenditures over the last decade showed that the contribution of aging has been relatively modest. To date, system-level cost drivers such as inflation and increased utilization have played bigger roles in health spending increases,” according to Health Care Cost Drivers: the facts, CIHI, November 2011.

The largest single driver for increased health-care costs is the rising cost of pharmaceutical drugs. We are all too often seeing evidence of over-prescription of drugs, and registration of drugs that actually will harm more people than they help. While seniors are wrongly seen as the reason for increasing health-care costs, the reality is that seniors are particularly vulnerable to the excess use of prescription drugs.

That is not to say that our health-care system is ready for an increase in the diseases of aging, particularly dementia and Alzheimer’s. We need to significantly improve supports for family members. So often a senior becomes the full-time caregiver for their spouse. Particularly, seniors of limited means lose any potential for enjoying life as they sacrifice for their partner. Better respite programs, better supports for home care, as well as more beds in long-term senior care facilities are needed, with supports from both federal and provincial governments.

We also need to have a conversation about the loss of basic rights experienced by seniors in care. One of the most shocking trends that I have uncovered since becoming an MP is the loss of basic human rights for seniors in residential care. Shockingly, I have heard dozens of stories of seniors being denied access to family members, being placed on drugs they do not want, and even being denied the right to go home to family members who would welcome them.

And lastly, we need to grasp the nettle of the thorny ethical problem of assisted suicide and the right to die with dignity. The solutions will not be simple because the problems are complex. Nevertheless, Canadians are demanding better answers. We need to engage in a respectful, informed discussion starting with a review of the various legal regimes in use around the world. We need to ensure that discussion is grounded in bioethics and premised on an acute awareness of the slippery slope of creating the impression that some human lives are worth more than others. What we must not do is to continue to ignore the suffering of well-informed, adult Canadians who wish to make a choice to die with dignity in their own country.

Originally printed in the Hill Times.

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While in general we are living longer, there are worrying developments. Particularly disturbing is the numbers of illnesses and syndromes that afflict our children. If we were an animal species, looking at issues of population health, we would notice and worry that our young do not haveon a population basisthe state of health of earlier generations. Some have noted that the trend toward every generation being healthier than their parents is about to abruptly end. Industrialized countries have seen a rise in children’s cancer. One in five Canadian children has asthma. There is an epidemic of obesity in children. Rates of diabetes in our children have also gone up. And the rate of attention deficit disorder, autism, and mental retardation are on the rise.

Meanwhile, we are told the cost of health care will be driven up by the aging population. It turns out, that claim lacks empirical support. According to the Canadian Institute of Health Information:

“Analyses of the drivers of increases in public sector health expenditures over the last decade showed that the contribution of aging has been relatively modest. To date, system-level cost drivers such as inflation and increased utilization have played bigger roles in health spending increases.,” (Health Care Cost Drivers: the facts, CIHI, November 2011)

So what is driving up the costs of our health-care system?

Skyrocketing costs for pharmaceutical drugs have now eclipsed all other health care expenditures. Drugs are the fastest rising component in health-care costs. Pharmaceutical companies claim that the high pricesmany times more than the actual cost of manufacturing the drugare necessary to recover their investment in research and development. Recent studies from around the world have debunked this claim. (Light, et al, “Will lower drug prices jeopardize drug research: a policy fact sheet,” American Journal of Bioethics, 2004.)

The high mark-up on prescription drugs simply cannot be justified based on the investment in research. We are being ripped off by Big Pharma. But we may also be suffering more harm than benefit. The world-renowned Therapeutics Initiative at University of British Columbia operates as the Gold Standard of pharmaceutical reviews. It spotted problems with Vioxx, even as Health Canada approved the drug.

Its review of the data package from the manufacturers has saved B.C. lives and tens of thousands of dollars. One aspect of Therapeutics Initiative that makes it nearly unique is that it refuses any perks from the pharmaceutical industry. As I learned when visiting their centre at UBC, for every doctor in Canada, there are three drug salesmen, and there are many offers of conferences in exotic locations to better acquaint doctors with the prescription drugs on offer.

Meanwhile, the traditional way that governments deal with health-care, throwing more money to the provinces, is not achieving concrete results. The 2004 First Ministers Health Accord committed $41-billion to health care system improvements, including $5.5-billion over 10 years to reduce wait times. Benchmarks were established in December 2005 in five key health-care areas that have been prone to longer waiting times. So far, progress is mixed, even though reducing wait times was one of only five promises made by Stephen Harper in the 2006 campaign. That Health Accord is due to expire in 2014.

To get a handle on rising health-care costs, we should focus on drug costs, but we shouldn’t stop there. Here is a short list of where we should look:

1. Improving the bed to bureaucrat ratio (more beds; fewer bureaucrats). Special effort should be made to expand availability of lower cost long-term care and recuperation beds, leaving high-cost post-op beds available for people who really need them.
2. Creating a national pharmacare program with bulk buying of drugs at the federal level to provide at lower cost to provinces. Support the University of British Columbia Therapeutics Initiative and expand its approach to ensuring drugs are only registered if they do more good than harm, across Canada.
3. Focus on efficient use of resources. Not every patient needs every diagnostic test. This bioethics discussion has been growing in the medical literature. Avoiding waste is a sensible approach, but can be difficult to implement, (“From an Ethics of Rationing to an Ethics of Waste Avoidance,” New England Journal of Medicine, May 24, 2012).
4. Provide student loan forgiveness incentives for graduating doctors, nurses, paramedics and other health-care professionals who agree to staff rural facilities and family practice clinics where recruitment is currently a problem.
5. Enshrine a policy that seniors’ care must be provided in the communities where they or their families live.
6. Expand home support and home care programs and assisted-living services to support people with chronic care needs, including many seniors who wish to stay in their own homes and communities.
7. Ensure that the Canada Health Act is enforced. (i.e., the federal government cannot wash its hands of health care.)
8. Follow through on our commitment to a national Mental Health Strategy.
9. Expand our awareness and investment in prevention. Focus on nutrition. Restrict more carcinogenic, neurotoxic, and immune-suppressive substances. Ensure physical activity from pre-school through high school.

Green Party Leader Elizabeth May represents Saanich-Gulf Islands, B.C.
Originally printed in the Hill Times.

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Under Prime Minister Jean Chrétien, Parliament passed Canada’s Access to Medicines Regime (CAMR). The goal of the legislation was to ensure access to affordable generic drugs for illnesses such as AIDS, malaria and tuberculosis. Unfortunately, since it was passed in 2004, it has been used only once. The whole CAMR was so complex and snarled in red tape that it has been proven to be completely ineffective.

Now, under the leadership of NDP MP Hélène Laverdière (Laurier–Sainte-Marie), the bill is back with the new number C-398. It will come up for a vote on Wednesday, November 28 — the week in which this edition of Island Tides circulates.

The need for the bill is clear. Less than half of HIV-positive mothers receive the drugs that can prevent the transmission of HIV from mother to child. Similarly, of babies with HIV-positive mothers who themselves are born HIV-free, less than half receive treatment to prevent transmission from their mother.

The changes to the CAMR included in this new bill will not create any new costs for Canada. They are consistent with the WTO’s decision to exempt life-saving drugs to the developing world from the patent-protection rules of the Agreement on Trade-Related Aspects of Intellectual Property Rights. And it does not seem that the Canadian pharmaceutical industry will publicly object to the bill. One would hope its passage is assured.

Private members bills are supposed to be free of ‘party discipline,’ that seemingly benign concept which I believe is the enemy of democracy. Quite a lot of Conservatives in the House voted for C-393 when it passed. Now it seems some are losing their commitment to its passage. In one conversation, a Conservative who had previously voted for passage told me, ‘I have three pharmaceutical companies in my riding. What happens if a generic drug is sold leading to the stealing of patents?’

We are in a tough fight–I am talking to MPs in all parties; the Grandmothers to Grandmothers groups and other organizations—from Stephen Lewis Foundation to UNICEF—are working hard. I will do my best to get this much needed bill passed.

Saanich-Gulf Islands News Alert

I had meant to add more to this column and talk about the bill, but this evening, after votes, something amazing happened. I went to the reception of Parliamentarians hosted by Macleans magazine and the annual vote for MPawards. All of us get to vote. There are no suggested winners. I had an inkling something was up when Macleanssent a photographer to take pictures of me in the riding during the Remembrance Day week. There are a lot of categories—Hardest Working MP, Best Constituency MP, Most Collegial MP, most knowledgeable MP, and so on. I had thought I might be in the running for ‘hardest working.’

So here’s the shocker: in a prize based on how MPs voted, I was chosen for the top award—‘Parliamentarian of the Year’! I am the first woman to receive the award, the first British Columbia MP to have this honour, and certainly the first Green MP to win.

I am still a bit shocked, and it is hard to absorb that I am actually ‘Parliamentarian of the Year.’ Winning this proves what I have always said—that my friends and peers in the House of Commons do appreciate a respectful and non-partisan approach. Thank you, constituents of Saanich-Gulf Islands, for taking the chance of electing a Green MP. I want to share this honour with all citizens; Saanich-Gulf Islands is the constituency of the year.

Thank you!

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On October 2^nd, Elizabeth May, Leader of the Green Party of Canada and MP for Saanich-Gulf Islands, will take part in MIAW’s Breakfast on Parliament Hill. “Mental illness, like any other illness, requires a concerted national strategy for prevention and treatment. As MPs, we can help in bringing attention to this issue. There is still a stigma surrounding mental illness, but I believe initiatives such as MIAW create an opportunity for public discussion of mental health and mental illness, ” said May.

The Green Party promotes a comprehensive approach to mental health including:

• An increase transfer funding for non-institutionalized mental health patients including children and youth to provide adequate community-based support and outpatient and inpatient care by mental health practitioners, including in rural Canada where lack of facilities and trained professionals is acute;
• Support for a public health initiative to reduce the use of psychoactive drugs through better rehabilitation and prevention programs, especially for children;
• Requirements for greater involvement of people dealing with personal mental health problems in research planning, policy development, program evaluation, and other decisions that affect their lives and communities.

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It is in this sense that “life sciences” has become a hot commodity. While the Harper Conservatives seem allergic to any kind of science to monitor and expand our knowledge of life on earth—whether fresh water ecosystems (through the killing of federal support for the world-renowned Experimental Lakes Area), the nature of polar atmospheric chemistry in terms of ozone and greenhouse gases (through the closing of the Polar Environmental Atmospheric Research Laboratory), the build up of toxic chemicals in marine mammals (shutting down the DFO marine contaminants program), to name a few, pressing for the commercial advantage of the global pharmaceutical industry is a “life science” Mr. Harper likes.

When contemplating the proposed, and now fast-tracked, Canada-European Union Comprehensive Economic Trade Agreement (CETA), many Canadians are concerned with the reality that the agreement will assist the pharmaceutical industry in retaining patent protection longer, undercutting generic drugs and driving up prices for critical medicines.

Trade agreements still masquerade as though they were about trade. Little wonder. They still get away with being described as “trade agreements.”   The term “trade agreement” should be reserved for agreements, like the 1947 General Agreement on Tariffs and Trade (GATT); one of the last agreements actually about trade in goods. Ever since the Uruguay Round of the GATT, leading to the creation of the World Trade Organization, agreements have shifted from the focus on elimination of tariffs and other barriers to trade in goods, to the greater economic integration of national economies in the interest of corporate profits. And the shifting of balance away from national policies designed to improve the health of a domestic economy to assisting transnational corporations in deriving ever-higher profits is well demonstrated in the CETA provisions to aid Big Pharma.

While Canadians bemoan the “health-care crisis,” the single fastest rising component of health care is the cost of pharmaceutical drugs. The costs are “justified” by claims that the pharmaceutical industry invests an enormous amount in research that can only be captured through drug prices that far exceed the actual cost of production of the drugs in question. That allegation is false. Recent studies from around the world have debunked this claim. (Light, et al., “Will lower drug prices jeopardize drug research: a policy fact sheet,” American Journal of Bioethics, 2004.)

Meanwhile, the regulation of pharmaceutical products is failing Canadians. The excellent work by the Therapeutics Initiative at University of British Columbia is well worth replicating across Canada (www.ti.ubc.ca). Using an objective, evidence-based approach, the Therapeutics Initiative (TI) has saved lives and dollars by advising the B.C. government of drugs, approved by Health Canada, which, in their assessment, posed more risks than benefits. Due to the TI assessment, British Columbia did not approve Vioxx or cholinesterase inhibitors for Alzheimer’s patients. In fact, the TI approach was so successful that it was targeted by Big Pharma and pressure was brought to bear on the B.C. government to cease its funding.

This is not the time to abandon scientific rigour when it comes to pharmaceuticals. It is one of the largest corporate profit-centres on the planet, and its ethics are not squeaky clean. GlaxoSmithKline agreed in July to plead guilty to fraud and to pay $3-billion in the United States for illegal promotion of Paxil in what is the largest settlement ever with Big Pharma.

Giving the pharmaceutical industry more power to drive up drug costs faster is not in the public interest—not in Canada and not in Europe. The fact that we are in the midst of negotiations operating on the assumption that this is a worthy policy goal is evidence of just how unhinged the public good has become from public policy.

While discussing life sciences, we need to bring to bear actual evidence-based science in the interest of protecting life. What a novel approach.

Elizabeth May is the Leader of the Green Party of Canada and Member of Parliament for Saanich-Gulf Islands.
Originally printed in the Hill Times.

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The Canadian Diabetes Association advocates that no Canadian should spend more than 3% of their total after tax earnings on necessary prescribed medications and other treatments. This is a good principle to support.

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“It is equally common sense for our health care system to place greater emphasis on preventing disease and promoting healthy lifestyles. This is the best way to sustain our health care system over the longer term. Keeping people well, rather than treating them when they are sick, is common sense.”

– Roy Romanow, Future of Health Care in Canada, 2002

Governments keep telling Canadians how they are going to “fix” the health care system. Yet many problems are actually getting worse, including longer wait-lists for diagnosis and surgery, over-crowded emergency rooms, and increasing shortages of family doctors.

The state of our health is getting worse, too. One in five Canadian children now have asthma. Almost half of us face cancer at some time in our lives. There is an epidemic of obesity in adults and children, and along with this comes known increased risk factor for cardiovascular diseases, hypertension, diabetes, and other serious health risks. Close to one million Canadians have been diagnosed with Multiple Chemical Sensitivities. Skyrocketing costs for pharmaceutical drugs have now eclipsed all other health care expenditures. (Drugs are, in fact, the fastest rising component in health care costs.)

Throwing more money to the provinces, as has been done by the last two governments, is not achieving concrete results. The 2004 First Ministers Health Accord (http://bit.ly/2004accord) committed $41 billion to health care system improvements, including $5.5 billion over 10 years to reduce wait times. Benchmarks were established in December 2005 in five key health care areas that have been prone to longer waiting times. So far, progress is mixed, even though reducing wait times was one of only five promises made by Stephen Harper in the 2006 campaign. This Health Accord expires in 2014.

As pressure built on Prime Minister Stephen Harper to set out the plan for federal-provincial negotiation of a renewed Health Accord, the Conservatives made a bold move. Finance Minister Jim Flaherty met with the provincial ministers in December 2011 and presented a “take it or leave it” offer.

The federal government has set out a financial formula until 2024. The current 6% per year increase will continue from $30 billion in 2013-14 growing to $38 billion by 2018-19. At that point, the funding formula for federal transfers to the provinces would shift to being tied to the rate of economic growth in each province. (The actual rate is called “nominal GDP,” a measure of GDP plus inflation.) BC Finance Minister Kevin Falcon was pleased with the certainty, while most provincial ministers were angry with the unilateral nature of the federal “offer.”

What I find most troubling is that the federal offer is also “no strings attached.” In other words, the federal government is washing its hands of insisting on national health care standards. Former Saskatchewan Premier and head of the 2002 Royal Commission on Health Care, Roy Romanow, expressed his concern that the federal “no strings attached” approach was “potentially dangerous for the future of Medicare in Canada.” (“Provinces get more autonomy to drive health care reform,” Globe and Mail, December 21, 2011.)

Where all players in health care expected that as the 2014 Health Accord reached its expiration date, there would be a transparent process to negotiate standards and goals in health care, the federal government has walked away from the process, leaving its money on the table.

In This Issue…

• Did You Know…
• What is the Single-Fastest Increasing Cost to the Health Care System?
• Riding Redistribution
• The Need for a National Mental Health Strategy
• Bill C-442: A National Lyme Disease Strategy
• What is Wrong With Moving to a Two-Tier Health Care System?
• Is the Aging Population Causing the Big Increase in Health Care Costs?
• What is the Role of the Federal Government?
• Queen Elizabeth II Diamond Jubilee Medal Award Ceremony
• Results from MarchNewsletter Survey
• Your Opinion Matters!
• Elizabeth May’s Health Care Solutions
• Does Spending More Money Solve Health Care Problems?
• Focus on Prevention – “An ounce of prevention is worth a pound of cure”

The post Summer 2012 Newsletter — Focus on Health appeared first on Elizabeth May.

The member spoke about pharmaceutical drugs and their prices. Has the official opposition looked at the efficacy and the inadequacies of registration for prescription drugs. Recently it was drawn to my attention, through a therapeutics initiative in British Columbia, that 150,000 North Americans die every year using prescription drugs as prescribed, that we are not using enough of an evidence-based approach and that we should be concerned about seniors being overmedicated.

I wonder if the hon. member has a view on this.

Glenn Thibeault: Mr. Speaker, in relation to the specifics, it would be best to defer that to the critic for health in our party.

However, in relation to overmedication of seniors and some of the problems that we are seeing when it relates to seniors, I believe one of our colleagues from the Conservative bench wrote a book about the subject. I have also had the opportunity of working in the field of supporting individuals with developmental handicaps who were also seniors. What we have seen in many instances is overmedication and the over-medication results in them going to the hospital.

I spoke earlier about those costs and the implication that those costs have on our health care system. If we actually had a national pharmacare program, those dollars could be saved so that we could ensure that seniors have more money in their pockets, because that is the motion that we are speaking to today.

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