School of Health Policy & Management Archives | Research & Innovation

Your walk says a lot about you, according to eHealth lecturers

fmaquito — Thu, 13 Oct 2011 08:00:00 +0000

The way you walk can say a lot about you, but until recently scientists could only study gait in a laboratory environment. With the latest advancements in sensory technology, all that has changed.

Join Professor William Gage, associate dean of research & innovation in the Faculty of Health (FoH) at 91��ɫ, and Professor Andrew Eckford of 91��ɫ’s Department of Computer Science & Engineering in the Faculty of Science & Engineering (FSE), for the launch of the eHealth Alliance brown bag lecture series. They will discuss the importance of accelerometers in studying the walking behaviour and interactions of participants in their natural environment.

Right: William Gage

The first eHealth Alliance lecture, “Wireless Accelerometers to Monitor Walking Activity and Behaviour”, will take place Thursday, Oct. 20, from 3 to 4pm at 402 Health, Nursing & Environmental Studies Building (HNES), Keele campus.

Gage and Eckford will also look at why these walking measurements are changing how scientists understand the activity levels of healthy individuals, and importantly, how illness and injury alter activity levels.

“We will describe the development our sensor system and contrast this development with other sensor systems in the literature; we will focus the application of our measurement system with healthy individuals, patients with stroke and patients with knee replacement,” says Gage, also a professor in the School of Kinesiology & Health Science, where he teaches a graduate level course in biomechanics and neuromuscular control of posture and gait.

Left: Andrew Eckford

Gage holds scientific appointments as an associate scientist in the Centre for Stroke Recovery at Sunnybrook Health Science Centre and as a scientist at Toronto Rehabilitation Institute. He is particularly interested in how balance and walking are affected by age, by joint disease, such as arthritis, and by stroke.

A graduate of the Royal Military College of Canada and the University of Toronto, Eckford has written many papers on wireless networking and has research interests in wearable wireless networks, as well as signal processing for biomechanics. He also holds an adjunct professorship at the University of Toronto.

The eHealth Alliance came about after some 30 faculty members from the School of Health Policy & Management, FoH, and the Department of Computer Science & Engineering, FSE, got together. They discussed the need for building a 91��ɫ alliance in e-health that would bring the two Faculties together with relevant 91��ɫ and external partners, such as industry leaders, 91��ɫ Region hospitals and the Central LHIN - Local Health Integration Network, says Professor Serban Dinca, undergraduate program director, coordinator of the Health Informatics Certificate in the School of Health Policy & Management and eHealth Alliance chair.

“The eHealth Alliance lecture series is the first step in coagulating the alliance and making connections with the industry,” says Dinca.

See the following list for upcoming eHealth Alliance lecture presenters:

Nov. 17 - Serban Dinca, undergraduate program director and coordinator of the Health Informatics Certificate in the School of Health Policy & Management, from 3 to 4pm at 402 HNES Building
Dec. 15 - Amir Asif, chair of the Department of Computer Science & Engineering, from 3 to 4pm at 3033 Computer Science & Engineering Building
Jan. 19 - Harvey Skinner, dean of the Faculty of Health, from 3 to 4pm at 402 HNES Building
Feb. 16 - Professor Farah Ahmad of the School of Health Policy & Management, from 3 to 4pm at 402 HNES Building

Republished courtesy of YFile– 91��ɫ’s daily e-bulletin.

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Professor Joel Lexchin co-authors study on free journals and costly or problematic drugs

fmaquito — Wed, 02 Mar 2011 10:00:00 +0000

Medical publications distributed freely to health professionals often promote drugs that are costly or have potential problems, says a new study warning that such practices could influence which drugs doctors prescribe, wrote :

Unlike medical publications that require paid subscriptions, free journals get most or all of their funding from pharmaceutical advertising.

A group of researchers keen to discover what effect industry ties have on the content of published medical journals conducted a detailed comparison of journals that are free, those that have some pharmaceutical advertising and subscription fees, and those that are subscription-only.

Their findings, published on Monday in the Canadian Medical Association Journal, show that free journals are much more likely than other publications to display ads for new drugs that are more expensive than older, generic versions as well as drugs that are linked to some concerns over effectiveness.

But the researchers also discovered that free journals frequently print editorial content that directly recommends the drugs that are advertised in the journal.

“It’s pretty well drug company advertising,” said Joel Lexchin, a professor in the School of Health Policy & Management [Faculty of Health] at 91��ɫ in Toronto and one of the study’s authors. “These journals probably have a role in influencing prescribing behaviour.”

Republished courtesy of YFile – 91��ɫ’s daily e-bulletin.

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Poverty makes us sick; Professor Dennis Raphael says it should make us angry

fmaquito — Mon, 10 Jan 2011 10:00:00 +0000

The sky in Lawrence Heights is low and the horizon is as wide as it gets in the city; no skyscrapers here. Dennis Raphael and I were walking through the neighbourhood on a chilly day, wrote columnist :

He is a professor of health policy & management in 91��ɫ University’s Faculty of Health, and he is an observant guy. No skyscrapers?

“Downsview,” he said.

I should have known. The airport; incoming likes it low. But there are other features of the neighbourhood that are much more notable, in particular the overlapping of the maps of poverty, illness and crime.

What kind of poverty? Crushing. What kind of crime? You name it. How about illness?

Let’s talk diabetes. Everyone’s talking about it these days. The national public broadcaster even has a bunch of people eating lettuce and doing jumping jacks on TV.

Is it lifestyle? Fooey.

Raphael did a health study in a while back. His findings show that the correlation [of poverty and poor health] is not between the couch and the potato. “People who are poor don’t have the resources to be healthy. Diabetes is three or four times more likely to occur among poor people.”

He talked freely as we walked along. “We interviewed low-income people. We were struck, when we did the study, by how unable people were to access resources: the poor don’t go to ball games, to movies. They never spoke of recreation, of volunteering, of going out with friends.In other words, the poor have fewer ways to relieve their stress, and stress is a factor of the disease of diabetes, and I don’t know any poor people who are relaxed.

I was going to ask about other factors when he said something that is encouraging and ridiculous at once.

“People with life-threatening illnesses overwhelmingly say they get good health care. And most people on disability get free meds, diabetes test strips, monitors, feet and eye exams; and, overwhelmingly, they had public housing.” That’s the good news.

“But even with those pluses, we found that 72 per cent of the people we surveyed couldn’t afford the food they needed to be healthy.” He wasted no time in pointing out the irony: “The health care system will treat you fine if you keel over, but we won’t provide you with the resources you need to avoid getting sick.”

An easy fix?

“People are suffering, but I see little evidence that things are getting better.” I shivered, not from the cold. We passed a solid little building. He said, “The community health centre here is great. And the Community Care Access Centre is great.”

His proof?

“The people in our study knew about blood monitoring.” That, by the way, is a constant for diabetics. “And they knew about eating healthy food. But we found they didn’t have the money to afford the food they needed.”

That’s an outrage, or it ought to be.

I noted that some people seem to think that if you are fat, you are more prone to diabetes. Raphael hammered away at his original theme: “It isn’t whether you are fat, it’s whether you are poor.

“Countries that have low poverty rates are countries that give things like child care, tuition, decent social assistance.” These are countries where — surprise, surprise — people’s health is generally better.

“But in countries like ours, where there is a good chance of being poor, you don’t get those things — you don’t get universal child care; you don’t get good, solid employment insurance.”

Funny how we say we can’t afford first-rate social programs, and yet many of our neighbours haven’t got the money they need to be healthy. The dots ought to be easy to connect.

Raphael has published extensively about the , and the social determinants of health in Canada and internationally.

Posted by Elizabeth Monier-Williams, research communications officer, with files courtesy of YFile – 91��ɫ’s daily e-bulletin.

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Professor Joel Lexchin: Health Canada should beef up drug-monitoring system

fmaquito — Mon, 06 Dec 2010 10:00:00 +0000

Health Canada did not pull a pain drug off the market until US officials made the decision to recall it, a move sparking criticism of the government's ability to act independently to protect the safety of Canadians from potentially dangerous medications, reported :

Health Canada and Paladin Labs Inc. announced a recall Wednesday of Darvon-N, the brand name of dextropropoxyphene, also known as propoxyphene, after new research showed the drug is linked to serious abnormal heart rhythms. The announcement came less than two weeks after the US Food and Drug Administration decided the drug should be removed from the market.

But widespread safety concerns about the drug have actually been around for decades, and prompted Britain and the European Union to ban Darvon-N amid fears it was linked to suicide and accidental overdose.

Joel Lexchin, a professor in 91��ɫ’s School of Health Policy & Management, said should have taken an active role with respect to Darvon-N, as well as other drugs. The department's follow-the-leader behaviour exposes major shortcomings and weaknesses in its drug monitoring capabilities, he said.

"This drug should have been off the market 30 years ago," Lexchin said in an interview Thursday. "Unfortunately, it took this long to get it off the market."

Health Canada should beef up its system for monitoring the safety of drugs as well as tracking the number of patients who experience serious side effects, he said.

Lexchin is a co-author of , which calls for sweeping improvements to drug safety in Canada.

Posted by Elizabeth Monier-Williams, research communications officer, with files courtesy of YFile– 91��ɫ’s daily e-bulletin.

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Diabetes crisis in Jane-Finch neighbourhood focus of 91��ɫ-led community forum on November 11

fmaquito — Thu, 11 Nov 2010 10:00:00 +0000

The high level of Type 2 diabetes in the Black Creek neighbourhood of northwest Toronto is imposing tremendous pain and suffering on a largely visible minority population, according to community health workers, researchers and educators who will meet Thursday at a community forum to begin developing an action plan to combat the disease.

91��ɫ's Health Leadership & Learning Network has partnered with the Black Creek Community Health Centre and the to bring members of the community together for the Diabetes: Perspectives for Action – Community Forum on Nov. 11, from 6 to 8pm at Westview Centennial Secondary School, 755 Oakdale Rd., North 91��ɫ.

Right: Maps of Toronto show the overlap between the areas of low income, visible minorities and the incidence of diabetes. Click maps to see interactive version. Courtesy of the Toronto Star

The forum will discuss the increasing incidence of Type 2 diabetes in the Jane-Finch neighbourhood, strategies to prevent it and community resources to improve the health of people living with the disease.

Income inequality is on the rise in Canada along with a parallel increase in diabetes mortality, especially in low-income neighbourhoods such as Jane-Finch, according to a recent 91��ɫ study that has been published online and will appear in an upcoming issue of the journal Health Policy.

Dennis Raphael, a professor in the School of Health Policy & Management at 91��ɫ and a co-author of the study, says it clearly shows that low income is associated with a higher risk of developing the disease, even when other risk factors such as obesity are taken into account. Separate maps of Toronto that show areas of low income, visible minorities and the incidence of diabetes clearly show the overlap between the three, says Raphael, who will speak first at the event.

Three representatives of the Black Creek Community Health Centre will speak about their work in the community. Community health worker Michelle Westin will discuss her experiences helping residents to identify and address issues related to diabetes prevention and management. Lisa Martin, a registered dietitian and certified diabetes educator, will speak about the importance of access to adequate resources in managing diabetes, as well as healthy lifestyle choices. Carla Da Mota, a diabetes nurse educator who has witnessed an increase in both the number of clients with diabetes and complications they experience due to poorly managed diabetes, will talk about her experiences in promoting prevention and management of the disease through education.

Professor Lesley Beagrie, associate dean, professional & global programs in 91��ɫ's Faculty of Health, will moderate the panel.

The Toronto District School Board has recently launched a Diabetes Awareness Strategy. Annie Appleby, superintendent of education for Ward 1 in the northwest part of Toronto – where the incidence of Type 2 Diabetes is at eight per cent – will speak about the schools' efforts to promote healthy choices and change the behaviours of staff, students, and even families.

For more information, visit the website.

Republished courtesy of YFile– 91��ɫ’s daily e-bulletin

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Professor Joel Lexchin's co-authored study finds doctors not immune to pharmaceutical promotion

fmaquito — Thu, 21 Oct 2010 08:00:00 +0000

Pharmaceutical promotion may cause doctors to prescribe more expensively, less appropriately and more often, according to a new study co-authored by physician and 91��ɫ Professor Joel Lexchin.

The findings, published Wednesday in the journal, PLoS Medicine, offer a broad look at the relationship between doctors’ prescribing habits and their exposure to information provided by drug companies. Researchers analyzed 58 separate studies of this phenomenon from Canada, the United States, Europe and Australia, dating from the 1960s.

Left: Joel Lexchin

“Many doctors claim they aren’t influenced by the information provided by pharmaceutical companies. Our research clearly shows that they are – and the influence is negative,” says Lexchin, a professor in the School of Health Policy & Management in 91��ɫ’s and an emergency physician in Toronto.

“Unfortunately, patients are the ones getting a raw deal. If doctors are inundated with advertising from brand- name companies, they are more likely to prescribe that brand name, regardless of whether it’s best for the patient.”

All but one of the studies suggested that exposure to promotional information was associated with lower prescribing quality; the one remaining study detected no association. Findings also show that promotional information led to more frequent prescribing; studies dealing with this correlation either showed a spike in prescribing or detected no association. Researchers also established a link between promotion and higher prescribing costs.

Lexchin says Canadian drug companies spend big money on marketing their products to physicians, to the detriment of other priorities such as research and development.

“In Canada, companies are estimated to be spending anywhere between $2.4 and $4.75 billion annually on promotion, one of the major reasons why spending on brand-name drugs was rising at a rate of just under 10 per cent annually until two years ago,” he says.

A limitation of the research is that most studies were observational in nature, meaning that the majority of physicians who participated were not randomly selected.

The researchers found no evidence that drug companies' promotional efforts improve prescribing behaviour in any way, but, says Lexchin, “that doesn’t entirely exclude the possibility that prescribing might sometimes be improved.” However, he adds, "As a precaution, we recommend that physicians avoid exposure to the information provided by pharmaceutical companies.”

The study, “Information from pharmaceutical companies and the quality, quantity and cost of physicians’ prescribing: a systematic review”, was led by Geoffrey Spurling, a professor at the University of Queensland, Brisbane, Australia. To read it, visit the website.

Republished courtesy of YFile– 91��ɫ’s daily e-bulletin

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Researchers creating international global rights-monitoring network for persons with disabilities

fmaquito — Wed, 29 Sep 2010 08:00:00 +0000

Disability Rights Promotion International provides innovative response to UN’s Convention on the Rights of Persons with Disabilities

If you pass a law to prevent discrimination against persons with disabilities, how do you know whether it’s being enforced, let alone making a difference?

Marcia Rioux (right), director of the 91��ɫ Institute for Health Research (YIHR) and professor in the Faculty of Health’s School of Health Policy & Management, is working internationally, particularly with countries with limited resources, to develop a unique and innovation solution for the reporting requirements set out in the United Nation’s .

The United Nations requires all governments that have ratified its Convention on the Rights of Persons with Disabilities − as Canada did on , 2010 − to provide information on the measures they have taken to integrate persons with disabilities into their societies. But this reporting is often limited to cataloguing laws, policies, and programs that may have little impact on the day-to-day lives of the people they’re intended to help.

Disability Rights Promotion International (DRPI), a multi-year international collaborative project, is establishing a global monitoring system to address disability discrimination. The research project, based in YIHR, is led by Rioux and Bengt Lindqvist − a former Cabinet Minister in Sweden, former UN Special Rapporteur on Disability, and long-time activist on disability rights. The team includes a group of 91��ɫ researchers and international colleagues who are creating a roadmap that will allow countries to evaluate their laws, policies and programs to comply with the United Nations’ standards.

“Collecting and reporting on evidence-based data forces governments to acknowledge that the challenges people with disabilities face are not just anecdotal,” says Rioux. “Our project allows evaluation to happen within the context of the experiences of people with disabilities to objectively measure where discrimination is now while developing and tracking solid trend data to determine if and how things are getting better.”

In September, the Africa Regional Monitoring Centre opened its doors in Kigali, Rwanda and will act as a focal point for disability monitoring and reporting in the region. Agreements with centres in Asia Pacific, Eastern Europe and Latin America are expected in the near future. The (SIDA) awarded the research team over $2 million in 2009 to open the four regional centres.

Each centre will act as a focal point for monitoring disability rights in that region, and will play a key role in empowering local people with disabilities to lead disability rights monitoring projects. “Regional monitoring is most sustainable when local people are involved since it puts long-term roots into the community,” says Rioux. “The vast majority of disabled people around the world face endemic poverty − many don’t have jobs or go to school or have basic literacy skills. Engaging people with disabilities to lead this process is a more holistic approach to addressing the challenges they face, both as individuals and a collective.”

When all four centres are operational, Rioux anticipates that hundreds of people with disabilities will be engaged in disability rights monitoring activities. The centres will host training on what disability means as a human right, how to collect data and conduct evidence-based research, and how to write and file human rights reports. Groundwork is also being laid to connect monitors with disabilities to other local rights-seeking groups, such as religious-based, race-based and gender-based, to get them coordinating their efforts together instead of separately.

"The Faculty of Health’s worldwide research aims to help people live healthier lives while co-creating rejuvenated health systems,” says Harvey Skinner, dean of Health. “Professor Rioux's research is an excellent example of how 91��ɫ University is on the front line of our increasingly complex, simultaneously global and local world."

Previous phases of this project focused on developing and piloting tools and methods to monitor disability rights. In 2006, the Social Sciences and Humanities Research Council of Canada ()’s Community-University Research Alliances program provided Rioux and her team with just under $1 million to fund Monitoring the Human Rights of People with Disabilities in Canada, which is currently in its last of five years.

In 2008, Rioux also received a two-year $40,000 grant from to research disability and social, economic and cultural rights. She has also received funding from the , and been invited to consult with governments and disabled persons associations around the globe to discuss disability rights. Recently, she and her team wrote the chapter on disability rights monitoring for the .

“Professor Rioux’s disability rights research reflects both the value 91��ɫ places on social justice and her expertise in leading large-scale collaborative research projects of international significance,” says Stan Shapson, vice-president research & innovation. “This type of knowledge mobilization is a crucial step in making governments more accountable for the social policies they set, and reflects the social input that’s possible when expertise is globally shared.”

By Elizabeth Monier-Williams, research communications officer.

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Professor Dennis Raphael: Getting sick is more about living conditions than lifestyle

fmaquito — Fri, 24 Sep 2010 08:00:00 +0000

What makes us sick? Is it genetics or lifestyle? Is it too many burgers, too much alcohol, not enough exercise? Not according to 91��ɫ Professor Dennis Raphael, who, like the fourth-century BC philosopher Plato, attributes poor health to living conditions. Things like income level and people’s access to food, housing, education, and health and social services, are what determines whether people are ill or healthy, he says.

That’s contrary to what most Canadians believe, says Raphael in his new book , which looks at who stays healthy, who gets sick and why. It’s written with the goal of educating the informed Canadian, as well as university students.

Most people think luck, treatment options and lifestyle choices shape whether they are healthy or not. After all, that is the current mantra – eating better and exercising will lead to a healthier existence – a mantra that Canadians have wholeheartedly internalized. But that’s only part of the equation, and not the biggest part, says Raphael, a professor in 91��ɫ's School of Health Policy & Management in the Faculty of Health.

“Decades of research and hundreds of studies in Canada and elsewhere tell a different story: the primary factors that shape the health and well-being of Canadians – the factors that will give us longer, better lives – are to be found not in those much-discussed areas, but rather in the actual living conditions that Canadians experience on a daily basis,” says Raphael in About Canada: Health and Illness.

These factors include whether people are wealthy or poor, employed or not, working conditions, access to quality education, health and social services, and the basics of food and affordable housing. These social determinants “are crucial factors in the health and well-being of Canadians,” he says.

“Contrary to the assumption that we have personal control over these factors, in most cases these living conditions are – for better or worse – imposed upon us in the normal course of everyday life.”

Left: Dennis Raphael

That’s in large part because of the policies, regulations and laws enacted by governments at all levels, which influence employment income, family benefits and social assistance, as well as the quality and availability of affordable housing, health and social services, and recreational opportunities. That includes “what happens when Canadians lose their jobs during economic downturns such as the one that Canada began experiencing in 2008,” says Raphael.

“Governments also determine whether our children have access to affordable and high-quality child care and better-quality schools, the working conditions that we experience, and whether as seniors we receive levels of public pensions that allow us to live in dignity.”

Raphael wants to see changes in public policy that will affect Canadians’ health in a positive way. Through About Canada: Health and Illness, he wants the average Canadian to understand the role social determinants play in shaping health and what can be done to improve the situation through better public policies.

Raphael is the editor of , co-editor of and author of . He served as an adviser to the California Newsreel documentary series and the Deveaux Babin Productions Canadian documentary .

By Sandra McLean, YFile writer

Republished courtesy of YFile – 91��ɫ’s daily e-bulletin.

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Grad student Gillian Parekh receives Human Rights Prize for research paper on international education systems

fmaquito — Fri, 10 Sep 2010 08:00:00 +0000

Despite good intentions, education systems can still succumb to the influence of flawed perceptions of meritocracy, says 91��ɫ PhD candidate Gillian Parekh (BEd '02, MA '09) in a recent winning paper. That means, in at least two parts of the world, governments' prioritization of economic returns can trump students' rights to equitable and quality educational opportunities.

Parekh is the winner of the inaugural Human Rights Prize for Master of Arts (MA) Major Research Paper in the Critical Disabilities Studies Program for her paper, "How Neoliberalism Impacts the Realization of Inclusive Education Both Internationally and Locally: A Study of Inclusive and Equitable Education Opportunities Within the Toronto District School Board". The award, created through donations from 91��ɫ Professors Marcia Rioux and Geoffrey Reaume of the School of Health Policy & Management in the Faculty of Health, was presented to Parekh on Tuesday. "It was an interesting paper to research," says Parekh.

Parekh earned her MA from 91��ɫ's Critical Disabilities Studies Program with an interest in international development and disability, as well as education.

Right: Gillian Parekh (left) being presented the 2010 Human Rights Prize

For her paper, Parekh initially looked at the connection between government prioritization of market ideologies and the subsequent waning commitment to inclusive practices, homing in on inclusive education policies under varying governments in South Africa. Although South Africa boasts of having highly progressive disability policies, over time the push for economic returns has taken precedence over the protection of the rights of students with disabilities, and segregated learning centres have been maintained and expanded.

"An analysis of the evolution of inclusive education policies from South Africa is documented to encapsulate a clear example of the hegemonic relationship between rights and market principles while the right to quality education for many hangs in the balance," says Parekh.

She then turned to the Toronto District School Board (TDSB) to see if the same was true here. She examined student demographics at 85 secondary schools and whether they correlated with the availability of specific programs and services. "Social factors such as poverty, disability, language and parental education are compared to increased or decreased access to programming and services that lead to future enhanced marketability for the student," she writes.

Although Parekh taught special education for several years at schools within the TDSB, the fourth-largest school district in North America, she was surprised by what she found. "Overall, the higher percentage of parents with a university education, the higher the likelihood their children would have access to elite programs within their public school. The higher the percentage of students from low income housing, as well as the higher the percentage of students using special education services, the fewer programs were offered at their school," says Parekh. She knows the TDSB has attempted to address issues of equity and continuously works to offer equitable services and programming to all students, however, the current state speaks to a much more powerful force at work.

In comparing demographics between schools offering French immersion programs, what Parekh calls one of the board's most elite programs, and those schools providing vocational training, she found the difference in incidence of low income, special education and parental education staggering. When she looked at where schools providing vocational training were located, she discovered that they were largely running in Toronto's lowest income neighbourhoods, she says. Whereas French immersion programs were more likely to be found within schools in more affluent areas with greater numbers of parents having been to university.

Access to some programming was definitely related to geography, says Parekh. "The education system continues to sustain inequitable learning opportunities between social groups. Policies addressing the issues of inequity have not yet achieved fully inclusive or equitable educational opportunities for all." And that is true in both Toronto and South Africa.

Parekh largely holds the government accountable for continuing to move towards a private model of market ideology within its public school systems in which more advantaged students are met with greater opportunity

"What bothers me the most is that this disparity is often normalized. Not enough people think significant change is required," says Parekh. It comes down to erroneous thinking that certain people in society are more deserving of academic opportunities than others, she says.

Republished courtesy of YFile– 91��ɫ’s daily e-bulletin.

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Professor Joel Lexchin: Some Canadian drugs are overpriced before they are patented

fmaquito — Wed, 28 Jul 2010 08:00:00 +0000

Canada needs a new system for controlling drug prices that does not depend on whether or not a drug has received a patent, according to an article by 91��ɫ Professor Dr. Joel Lexchin.

Drug prices in Canada can be unregulated for years, a period during which companies may overprice the drugs and market them, says Lexchin, a professor in the School of Health Policy & Management in 91��ɫ’s and an emergency physician at the in Toronto.

Left: Dr. Joel Lexchin.

His commentary, “”, appears in the journal Open Medicine. It is based on new research which examined how many drugs in Canada are marketed before they are patented, whose prices are therefore not controlled by the federal Patented Medicine Prices Review Board. He also looked at the time period between marketing and patenting, and any excess revenue generated before those drug prices were regulated.

In total, 42 drugs were marketed between 2000 and 2008 before being patented, and complete data was available for 33 of those.

“Some of these drugs were potentially being marketed for weeks before they came under the jurisdiction of the review board and had their prices controlled, but some of them may have been marketed for years,” says Lexchin. “Only three of the 33 drugs were found to be overpriced, but the fact that one of the 33 drugs may have been marketed without price controls for more than seven years is troublesome.”

When drugs are finally patented, their prices are reviewed and if a drug is deemed to be overpriced, the review board can order a company to repay any excess revenue to the federal government. The problem is that if companies overprice their drugs, the drugs may not be added to provincial formularies such as the Ontario Drug Benefit Formulary. In Ontario, the government covers most drugs listed on the formulary for people who are eligible, so if a drug is not on the list, the cost will not be covered.

In addition, although excess revenue from the drugs is eventually recovered, it is paid to the federal government, not the provincial governments which fund drugs through their drug benefit schemes, or to private insurers or people who are paying the cost out-of-pocket, says Lexchin.

The best remedy for various problems caused by using patent status to regulate prices is simply to treat all drugs on the market equally and regulate all prices, he concludes.

More about Joel Lexchin

Dr. Joel Lexchin received his doctor of medicine from the University of Toronto in 1977 and for the past 22 years has been an emergency physician at the University Health Network. He is currently a professor in the School of Health Policy & Management at 91��ɫ and an associate professor in the Department of Family & Community Medicine at the University of Toronto.

From 1992 to 1994 he was a member of the Ontario Drug Quality & Therapeutics Committee and he was the chair of the Drugs & Pharmacotherapy Committee of the Ontario Medical Association from 1997-1999. He has been a consultant for the province of Ontario, various arms of the Canadian federal government, the World Health Organization, the government of New Zealand and the Australian National Prescribing Service.

He is the author or co-author of more than 90 peer-reviewed articles on topics such as physician prescribing behaviour, pharmaceutical patent issues, the drug approval process and prescription drug promotion. He is a co-author of and author of Drug Therapy for Emergency Physicians.

Republished courtesy of YFile– 91��ɫ’s daily e-bulletin.

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