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Health, Aging and Society
Elena Neiterman

Chapter 15: The Medical-Industrial Complex Drug Use: -drugs continue to be the fastest-growing category of health spending in the overall Canadian health system and the second largest, after that spent on hospitals -96% of Canadians have at least partial coverage for prescription drugs -approx. 58% of this is from private plans and 26% is from public or governmental expenditures; 10% comes from public provincial plans for exceptional circumstances, such as catastrophic diseases -the rapid increase in drug expenditures is the development of ‘me too’ drugs -the increase in drug expenditures is also due to aggressive advertising both to physicians and to consumers Rates of Drug Use and Patient Variables – Age, Gender, and Class: -drugs are frequently over prescribed in Canada -females are consistently heavier prescription drug users than males -those in the lower income groups spend a greater percentage of their incomes on prescription drugs All provinces have introduced drug programs to subsidize purchases by low-income families Physicians and Prescribing: -research has documented significant deficiencies in doctors knowledge about drugs -good prescribing by physicians involves maximizing effectiveness, minimizing risks, minimizing costs, and respecting the choices of patients -research has repeatedly confirmed the following correlations…the more frequently physicians saw drug sale representatives:  The more likely they were to use drugs even when not using drugs was the best option  The more often they sympathized with a ‘commercial’ view of the value of a given drug  The more likely they were to prescribe antibiotics inappropriately  The less likely they were to prescribe generically  The more likely they were to use more expensive medications when equally effective but less costly drugs were available -Pharmaceutical firms are a major source for doctors -another major source for doctors is the ‘Compendium of Pharmaceuticals and Specialities’ which is a Canadian Pharmaceutical Association publication -the latest influence on the prescribing habits of doctors is direct to consumer advertising Pharmacists: -approx. 26300 licensed pharmacists in Canada who are working -pharmacists do have some discretionary power when presented with a drug prescription: unless the physician has written no submission o
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