Category Archives: Health Sciences & Medicine

Providing prescription drug coverage

First, I should apologize. This is not a thoroughly thought-out scheme but I’m having one of those nights where my mind races and I need to produce something from all that idle thought.

Let’s say, for the sake of argument, that we want the government to pay for:

  1. All catastrophic drug costs (for example, beyond a certain percentage of income)
  2. Most costs for low-income families and individuals
  3. The costs of certain drug treatments with strong societal benefits (like HIV drugs)

Right now there is a complicated patchwork of programs in Ontario which aim to accomplish those goals, but navigating the bureaucracy can be a daunting task for a sick person who needs financial aid. When dealing with multiple programs, it is also possible there are holes in the safety net.

I propose we transform the OHIP cards into a sort of pharmaceutical credit card. A patient swipes her card at the pharmacy, the pharmacist transmits the OHIP ID and prescription cost to the Ministry of Health where a computer quickly calculates the subsidy, and that information is sent back to the pharmacy. Then the patient decides if she wants to fill the prescription, knowing the ultimate cost. If yes, the province pays the pharmacist up front and collects what it is owed by the patient later.

This way, we can reduce the paperwork and delay, get the drugs to the people who need them, and tie up the loose ends later. All that is accomplished with relatively little information: income, drug expenditures, and drug identity. The most difficult part would be rearranging the machinery of government, not operating the program.

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Eating cheaply, eating healthy

In high school, I thought home economics classes were a waste of time; they seemed to be vestigial remnants from the days when women could be homemakers, reduced to providing easy credits to dull students.

That I only discovered last year the function of the broil setting suggests my judgement was rash.

I mostly don’t mind cooking, but my everyday meals (as opposed to the occasional meals which double as recreational or social activities) are pretty spartan. Eggs, sandwiches, pasta, and ground beef are the staple of my diet. I can come up with any number of excuses (some lamer than others),  but I want to share some that are relevant to discussions of health/obesity and social justice – after the break.

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Because prevention isn’t working

It’s common sense that testing and treatment will reduce the severity of the AIDS epidemic, but you don’t embark on multi-million dollar public health initiatives without evidence.

Reported in the Washington Post:

A combination of universal voluntary HIV testing and immediate antiretroviral treatment (ART) following diagnosis of HIV infection could reduce HIV cases in a severe generalized epidemic by 95 percent within 10 years, a World Health Organization study finds.

In an accompanying comment on the study, Professor Geoffrey P. Garnett of Imperial College London, U.K., wrote that this type of HIV control strategy “would reflect public health at its best and its worst.”

“At its best, the strategy would prevent morbidity and mortality for the population, both through better treatment of the individual and reduced spread of HIV,” Garnett wrote. “At its worst, the strategy would involve over-testing, over-treatment, side-effects, resistance, and potentially reduced autonomy of the individual in their choices of care. The individual might gain no personal benefit from testing and early treatment, but they would benefit from protecting partners — and who could object to that, unless they were recklessly exposing others to infection?

“It is easy to see how enforced testing and treatment for the good of society would follow from such an argument. Partial success would lead to infection becoming concentrated in those with a high risk, with an increased danger of stigma and coercion,” Garnett wrote.

All other things being equal, it is better to treat the socioeconomic conditions which perpetuate HIV infections than to treat the virus itself. But in the meantime, poverty persists and we have relatively cheap and effective drugs for HIV/AIDS, so treatment is a decent stopgap effort.

Cut the ads, cut the fat: study

Discussions of obesity and overweight should always begin with the old aphorism “everything in moderation.”

There is nothing inherently wrong or evil about eating fast food; the trouble is in quantity. Too many hamburgers are unhealthy, and we need health to fulfil our other wants and needs in life. On the other hand, one could argue that someone who refuses to eat an occasional Big Mac is missing out on the good life, much like a teetotaler.

But we do have a quantity problem in many countries. We worry especially about children because they are innocents, not yet capable of making decisions and therefore not responsible for their actions. That responsibility falls with adults, primarily but not exclusively parents.

A study in this month’s Journal of Law & Economics (abstract only) concludes that childhood obesity in the US could be reduced by about 15% if companies like McDonalds could not advertise on television. Unfortunately, the study is only accessible for a fee and I can’t even get it through my university library yet. So there’s no way to know, until somebody knowledgeable passes judgement in the media or on a blog, if the study’s conclusions are valid.

I wouldn’t be surprised, if the study holds up to scrutiny, to see Ontario finally impose a ban on fast food advertising at least targeting children, if not adolescents and adults. It’s the kind of move the opens the government up to accusations of nany-statism, but I don’t think Premier McGuinty has a problem being our Nany Statist.

(more at CBC)

(photo credit)

Canadians: Teeth like Cambodians

Canada is a rich country with bad teeth. Worse, even, than the USA or UK.

The UK!

Gapminder lets you compare oral health and other variables across nations through the medium of neat flash charts.

Universal dental care, anyone?

I hear nothing

Am I disappointed? Yes.

[link] Screensaver reveals new test for synaesthesia – New Scientist

Pay Your Own Way

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Road pricing is back in the news as Metrolinx tries to fund transit improvements in the GTA. On the table are expressway tolls of 10 cents per kilometre. This would, according to the Globe and Mail, mean a one-way toll of $3.60 to get from Oakville to downtown Toronto.

This is a pretty good deal for motorists; GO riders pay $6.00 for the same trip.

While recognizing this is a good idea, we should hold off on implementing some or all of the tolls until certain significant improvements are made to transit. I know this is a chicken-and-egg problem, but the Yonge subway is at capacity during rush hour and GO has serious trouble arriving on-time. If we can’t fit people on the trains or get the trains to run on time it isn’t fair to punish them for hitting the highway.

And since we’re talking about road pricing, why not tolls on most of the 400-series highways? Ten cents per kilometre gets very pricey very quickly, but we might consider something similar to the New York State Thruway. Accordingly to my (shaky grasp of) math, it costs about 2.5 cents per kilometre between Buffalo and Albany. Applied to the length of the 401, a journey from Detroit to Montreal would set drivers back about $20. It isn’t a lot of money, but it is a reminder that driving has costs. You may not have to buy more gas when you get on the 401, but you always pay a small toll.

Gas taxes encourage people to use gasoline sparingly which is a worthy goal in this age of climate change. Getting people to leave their car – Hummer or Prius – at home is a part of that, but setting aside inconvenient truths, fewer cars on the road has independent merit. It isn’t healthy to spend hours on the road commuting between or across cities. Cars turn people into monsters. Highways destroy neighbourhoods.

The financial and psychological impacts of road pricing make it a useful tool for combating climate change, urban sprawl, and low standards of living.

[photo] “Toll booths” by vagrantant