The Columbia Journal
P.O. Box 2633 MPO,
Vancouver, British Columbia,
Canada V6B 3W8
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.