For the record

Parliament adopts Jordan's principle

In an altogether rare demonstration of legislative unanimity, Parliament voted to adopt what has come to be called “Jordan's Principle” in resolving healthcare disputes involving First Nations children.

Although not legally binding, the principle advocated by the First Nations Child and Family Caring Society of Canada and 400 other organizations, and embodied in New Democrat Member of Parliament Jean Crowder's (Nanaimo-Cowichan) private member's motion calls on governments to adopt a “child first” approach to resolving jurisdictional disputes involving the care of children like 4-year-old Jordan River Anderson. As governments squabbled over who was financially responsible for Jordan's care, he languished and eventually died of a rare neuromuscular disorder while living in a Winnipeg hosptial, far removed from his family and home on the Norway House Cree Nation reserve.

CMAJ threw its weight behind the legislation last August in an editorial urging that the medical needs of First Nations' children be the prime consideration in such intergovernmental disputes. If governments “ignore Jordan's Principle and entangle themselves in financial or jurisdictional battles first, the governments deserve to be sued,” stated the editorial (CMAJ 2007;177[4]: 321).

A recent study indicated that as many as 400 Aboriginal children annually are caught in similar disputes.

The final vote in Parliament? 262-0.

Ontario fails to adequately monitor public drug provision

Overbilling by pharmacies and lax medication practices at long-term care facilities were among findings in the annual report of Ontario's spending watchdog.

Ontario fails to adequately monitor pharmacies in their provision of drugs for seniors, welfare recipients, the disabled and others eligible for assistance under various programs, Auditor-General Jim McCarter stated in his 2007 report on government spending.

McCarter's review found that more than 30% of claims exceeded Ontario Drug Formulary prices by more than 100%. In 1 case, a pharmacy's claim exceeded the formulary price by 12 500%, so the Ministry of Health and Long-Term Care paid nearly $2400 for a claim that should have cost less than $20. In another instance, a pharmacy made 300 claims in 5 months for 1 ineligible individual. Less than 3% of pharmacies are inspected. Selecting 1 for review, McCarter found that it claimed $270 000 in overpayments, including $240 000 for invalid dispensing fees.

The report also raised major concerns about medication management practices at long-term-care homes, including failure to obtain informed consent from patients for the use of new medications, inadequate reporting of medication errors and inadequate processes to ensure that medications that approach their expiry date are removed.

Among the findings was that “91% of the 18 000 level-1 alerts (which warn of a drug combination that is clearly contraindicated and should not be dispensed of administered) generated by pharmacy computer were overridden and the drugs dispensed to residents of 421 long-term-care homes.”

Parliament's remarkable isotope fiasco

It is difficult to imagine how Parliament, when it resumes this week, could possibly top the level of spectacle that characterized its final week of pre-Christmas sittings. It featured the mudslinging antics of former prime minister Brian Mulroney and Karlheinz Schreiber, as well as government passage of emergency legislation to override the safety concerns of Canada's nuclear watchdog and reopen the nuclear reactor that produces isotopes for medical imaging.

The Chalk River reactor purportedly produces two-thirds of the world's supply of techtinium. Image by: Photos.com

In the latter instance, there was absolutely no shortage of grandstanding: Prime Minister Stephen Harper accused Canadian Nuclear Safety Commission President Linda Keen of being little more than a Liberal Party shill determined to compromise the health of Canadian patients by denying them access to radioisotopes used in diagnostic tests.

Meanwhile, the crown corporation Atomic Energy of Canada, which operates the Chalk River, Ontario, reactor, was revealed as a manager that flat out ignored the conditions of its licence by essentially refusing to connect 2 coolant pumps to an emergency power backup.

As hospitals struggled to cope with isotope shortages (or at a minimum, were unable or unwilling to invest in more expensive isotopes produced abroad) and patient backlogs began mounting, it also became painfully apparent that the government lacked a national backup plan to obtain isotopes in the event of shutdown or mishap (e.g., fire, earthquake) at Chalk River, which apparently supplies over one-half of the world's technetium.

Almost entirely lost in the brouhaha was any element of discussion of the balance between acceptable levels of nuclear risk and the health risks, and consequences, accruing for Canadians from a shortage of isotopes.

WHO speaks out on global health challenges

The follwing is an excerpt from the 2007 David E. Barmes Global Health Lecture, delivered by Dr. Margaret Chan, director-general of the World Health Organization, in which she advanced the arguments that the world's ability to handle health challenges rests upon the capacity of local health system infrastructure.

“Industrialization of food production, globalization of the food supply and its distribution and marketing channels mean that all of us are increasingly eating similar unhealthy diets. With the massive move to cities, lifestyles are increasingly sedentary. Obesity has gone global.

Chronic diseases, long considered the companions of affluent societies, have changed places. They now impose their heaviest burden on low-and middle-income countries. Here is 1 example. In Cambodia, a least developed country, 1 in 10 adults now has diabetes and 1 in 4 adults has hypertension.

The rise of chronic diseases and the demands of chronic care are placing an almost unbearable strain on health systems. The costs for impoverished households can be catastrophic. In part of rural China, for example, 30%–50% of poor farmers cite ill health or the costs of chronic care as the root cause for their poverty.

Two conclusions are obvious. If we want better health to work as a poverty reduction strategy, we must reach the poor. If we want health to reduce poverty, we cannot let the costs of health care drive impoverished households even deeper into poverty.

Public health has been given a big push forward, but it is still an uphill climb. Here is the reality. Interventions and money will have only a limited impact in the absence of adequate delivery systems.”