Volume Ten, Number One   January 2005   www.columbiajournal.ca

YOUR HEALTH

Good minus bad equals?
Dr. Diane Forbes

This past month has brought some big developments on the health front. The First Ministers meetings on Health Care in September resulted in a 10-year agreement for funding from the Federal Government. This past week, Vioxx has been removed from the marketplace due to health concerns that were not seen in the original clinical trials. How do I see these two distinct news items as related? Well they both have to do with a balance of benefits.

Vioxx, when it entered the marketplace, was seen to be a vast improvement over prior non steroidal anti-inflammatory drugs such as ASA (aspirin) and its related drugs for the treatment of pain--predominantly from arthritic sources. The older classes of drugs are acidic, known to cause increased risk of bleeding in the stomach with long-term use at high doses. Vioxx and the other drugs of its type are known as Cox-2 inhibitors, and were found to be less harmful to the stomach lining over a prolonged use at doses required to lessen pain.

This benefit was found to be beneficial to many pain sufferers and Vioxx was a tremendously successful drug in the market place. But now, many years after its introduction, new studies have shown that it increases the risk of heart disease (heart attack) and stroke. There were hints that something wasn’t working as long as two years ago, but not until just this fall was there enough information to warrant a sudden action. And sudden it was. The reports of withdrawal followed shortly on the heels of release of the scientific findings of higher health risk from heart attack and stroke. These results were so important that the magazine that was to publish them posted them on the web two weeks earlier than their expected press date.

Merck has done the right thing is recalling this product. It is acting responsibly to a problem that was identified and later proven to be of great concern. As one of the largest drug recalls in history, this has been an expensive proposition for Merck. But the benefits to the company do not outweigh the negative benefits to patients.

So to the health care agreement from the First Ministers Meetings. Heralded as a great solution to our current national healthcare concerns, the agreement focuses on maintaining the Canada Health Act under specific parameters. The federal government has tried to increase accountability of the provinces for the increased flows of cash from Ottawa. It is requiring new measurement and reporting systems for waiting lists, increased training and inflow of health personnel, an increased commitment to home care and improved public health particularly for northern and remote communities.

But is this the panacea that it is presented as. Can we really expect that the political games of our first ministers will take a back seat to the health needs of Canadians? Unfortunately I suspect not.

We need to keep an eye on our provincial ministers, making sure that they carry out the components of the health accord that are good for the population. We cannot let them flex the agreement to such a way as to meet their own political interests. We need to hold them accountable for their agreement to meet with the accords contents. If not we need to sound an early warning.

As citizens, when we take action to alert the federal and provincial governments that they are not meeting our needs and their responsibilities. Eventually they have to show proof that they are in fact acting for us. If not, with time and focus they will be shown to not be supporting the interest of their constituents and will have to withdraw from their action or be removed by the electorate. When in trouble governments can act as quickly to put out a fire as anyone. And fortunately in the political spectrum we always have the power to assure that the benefits to the public outweigh benefits to the politicians (which are arguably a cost to the public). We do that by using our voice.