Highlights of this issue

Differences in provincial drug plans and out-of-pocket expenses

In this comparative study using simulated patient scenarios to represent various sociodemographic backgrounds, Demers and colleagues found marked variation across provinces in the burden of prescription drug costs borne by the patient. The authors advocate for a national pharmaceutical strategy to address these inequities. In a related commentary, Dhalla and Laupacis argue for greater transparency in how drug approval and reimbursement decisions are made. In another commentary, Tierney, Manns and colleagues describe how the Common Drug Review of the Canadian Agency for Drugs and Technologies in Health operates.

See pages 405, 428 and 432

Restricted access to clopidogrel and mortality after stent implantation

Clopidogrel has been shown to reduce mortality after coronary stent implantation. In this population-based retrospective cohort study involving 13 633 patients in Quebec, Sheehy and colleagues investigated the effect of the provincial drug plan's restrictive access on patient prescription filling and on all-cause mortality after stenting. They report that the restricted-access policy was associated with a delay filling clopidogrel prescriptions and patients not filling their prescriptions. These outcomes were associated with an increase in mortality. In a related commentary, Suissa examines potential sources of bias in this study and cautions clinicians in interpreting these findings.

See pages 413 and 425

Availability of emergency contraception after deregulation

In 2005 the emergency contraception formulation of levonorgestrel (Plan B) became available in Canada from pharmacists without a prescription. In this longitudinal survey of randomly selected pharmacies in Ontario, Dunn and colleagues found a significant increase in the availability of Plan B and widespread willingness to dispense it following the regulatory change.

See page 423

Protecting Canadian travellers

In a guest editorial, Keystone discusses the increasing burden of travel-related illnesses among Canadians and argues that the unwillingness of provincial health plans to cover pre-travel consultations and vaccinations is preventing many of the most vulnerable individuals from receiving appropriate preventive care.

See page 373

Practice

In this Teaching Case Report, Kapadia and Bassett describe the case of a 24-year-old woman with 22q11.2 deletion syndrome and discuss the difficulties in describing this syndrome (page 391).

In Interesting Images, Singh and colleagues provide images suggesting horseshoe lung in a 14-year-old boy, but their diagnosis revealed something different (page 394).

In the Clinical Quiz column, readers are asked to determine the cause of leg pains, clubbing of digits and lung mass in a 43-year-old woman (page 395).

Leptospirosis is a zoonotic bacterial disease that is becoming more prevalent in Canada. In 2 Public Health articles, Prescott and Brown discuss this disease from the perspectives of a family physician and a veterinarian. They encourage physicians to be aware of the danger that this disease poses to humans (pages 397 and 399).