Wednesday, April 6, 2011

Autism | The Browser

Leading academics, and parents with their own personal experiences of autism, discuss what best to read on the disorder. Accompanied by a selection of must-read articles.

Monday, April 4, 2011

The cost of drugs: breaking the bank to stay alive - The Globe and Mail

Julie Easley had just graduated from the University of New Brunswick when she was diagnosed with Hodgkin's lymphoma. She was 23 and broke – with exactly $9 in her bank account.

Thankfully, in Canada, her medical care was free of charge – or so she thought.

In fact, while physician visits and in-hospital care like chemotherapy are covered by medicare, Ms. Easley soon learned that the essential medication she needed to take out-of-hospital was not.

"It was a shock to me that I had to pay for cancer treatment. That's not how it's supposed to be in Canada."

Drug therapies have become an essential part of treatment for many ailments, but costs of the latest and most advanced treatments have soared. The response from public health plans has been uneven and often inadequate.

Ms. Easley had no private drug insurance and New Brunswick has no publicly funded drug plan for those saddled with big drug bills.

Friends held fundraisers, she scrounged anti-nausea medication ($23 a pill) from other patients and she took out personal loans to pay for the prescription for filgrastim (brand name Neupogen), a drug to treat the side effects of chemo that staves off deadly infections ($1,600 a month).

When her cancer treatment was done, Ms. Easley was $26,000 in debt. Twelve years later: "I'm all clear of cancer, but I'm still paying for my cancer treatment."

Katharina Kovacs Burns of the Best Medicines Coalition, an alliance of consumer groups and patients, said the "system of drug coverage we have now is unfair, it's unethical and it makes no sense."

She said Canada desperately needs a national catastrophic drug plan because too many patients are suffering undue financial hardship.

There are currently 19 public drug plans (mostly for seniors and those on social assistance) and 1,000 private drug plans in Canada. Yet, many Canadians – three million by some estimates – still don't have sufficient coverage for "catastrophic" drug costs, which are defined as anywhere from 2 per cent to 10 per cent of family income.

"Drug coverage in Canada been described as a patchwork and the quilt has some gaping holes in it," said Steve Morgan, associate director of the Centre for Health Services and Policy Research at the University of British Columbia in Vancouver.

About 40 per cent of Canadians have private drug insurance (about half of those have catastrophic coverage), 40 per cent have public health insurance (with big differences in deductibles and co-payments) and 20 per cent have no coverage and have to pay for drugs out-of-pocket.

Ultimately, coverage depends on where people live and where they work. Young, self-employed, and middle-income earners in smaller provinces are the most vulnerable.

Consider this: A person with a $20,000 annual drug bill – not unusual for a cancer patient or someone with a chronic condition like rheumatoid arthritis – would pay nothing in the Northwest Territories, roughly $1,500 in Quebec, $8,000 in Saskatchewan and $20,000 in Prince Edward Island.

"If this was the standard for medicare – for physician and hospital services – there would be a revolt in this country," Dr. Morgan said. "It's hard to believe we tolerate this situation."

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Sunday, April 3, 2011

Doctors Go Far Afield to Battle Epidemics -

MASHAI, Lesotho — At a clinic in the mountains, reached only by crossing a churning river in a rowboat, Dr. Paul Young, a pediatrician raised in the housing projects of Savannah, Ga., soothed a fussy baby. She stared at him, fascinated, as he made soft popping sounds with his lips and listened to her heart through a stethoscope.

"I used to be afraid to look at the babies' test results," he said after examining a bunch of children, who were born healthy despite having H.I.V.-positive mothers. "But now, most of them are negative."

Dr. Young, 33, and the nurses he trained here have persuaded many pregnant women to get tested and take the drugs that prevent them from passing the disease to their newborns. It is all part of a charitable effort he joined in 2008 for $40,000 a year and the chance to work in this AIDS-afflicted country, which has just one pediatrician in its entire government health system.

"If this was the last thing I did, if this was the only job I ever had in life, I would have served my purpose," he said.

Dr. Young represents the surging interest of young Americans in combating the deadly epidemics ravaging the world's poorest countries, fueled in part by the billions of dollars that the American government, the Bill & Melinda Gates Foundation and other organizations have poured into international health in recent years.

Across sub-Saharan Africa, an extreme shortage of health workers remains a critical barrier to fighting illness. The region bears a quarter of the world's burden of disease, but has only 3 percent of its health care workers, according to the World Health Organization.

Public health experts say efforts like the one involving Dr. Young have proved particularly useful on a continent that sorely needs pediatricians, surgeons and other specialists to train African doctors and nurses in the field.

And demand for such opportunities is rising. More than 70 universities in the United States and Canada now offer formal academic programs in global health, most of them developed in just the past five years, according to the Consortium of Universities for Global Health.

"Today's students really want to make a difference in the world," said Michael H. Merson, director of Duke University's Global Health Institute. "They have a passion for sacrifice and service. It reminds me of the '60s."

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