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Chapter 15

HLTHAGE 1AA3 Chapter Notes - Chapter 15: Health Care In Canada, Prescription Drug, Medical Device


Department
Health, Aging and Society
Course Code
HLTHAGE 1AA3
Professor
Elena Neiterman
Chapter
15

Page:
of 2
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 on it, pharmacists are free to dispense any company’s brand of a
particular drug
-they tend to recommend non-prescription drugs that will maximize their profit
The Pharmaceutical Industry:
-Canadian drug industry has been divided into domestically owned companies
-this industry is one of the more profitable manufacturing activities in Canada
-together, the pharmaceutical and medical device industries are the 5th largest in Canada and the
fastest-growing manufacturing industry
-the pharmaceutical industry is successful in maintaining its position as one of the most profitable
industries through a variety of strategies including:
The absence of a link between manufacturing cost and price
Chapter 15: The Medical-Industrial Complex
Patent protection
Competition and drug development focused on drugs with widespread potential for use rather
than drugs for rare conditions
Production of brand name rather than generic products
Drug distribution in less developed countries
The change in the availability of many drugs from prescription only to over-the-counter consumer
purchase
Advertising and providing select info to physicians and consumers
-3 distinct categories of pharmaceuticals:
In-patent drugs
Out-of-patent and generic drugs
Over-the-counter drugs
-many countries in the developing world face serious problems in relation to pharmaceuticals such as
lack of drugs
-sometimes one license in a country cannot be used in another
The Case of Thalidomide and DES & HRT:
-refer to page 394 onwards
Other Negative effects of the industry:
-it is a large set of industries causing ill health in another way
Issues in Drug Regulation:
-half the drugs now on the Canadian market have never passed modern tests regarding safety or
effectiveness
-even where regulations are in place in the industrialized world, substandard drugs are being marketed
and distributed overseas
-drugs companies seem to have a monopoly of the information available to doctors as well as on the
side effects of various drugs
Medical Devices and Bioengineering:
-profitable and growing industry
-except for devices to be used within the body, the government does not require evidence as to the
harm or benefit or the safety of medical devices