Alternative isotope sources
Accelerator-driven photo-fission could be used to generate molybdenum-99 to meet medical demand in Canada and abroad, concluded a task force struck to explore alternatives to medical-isotope production following controversies surrounding the 51-year-old National Research Universal reactor and the cancellation of its replacement with a pair of flawed Multipurpose Applied Physics Lattice Experiment reactors (CMAJ 2008;178[5]: 536-8, CMAJ 2008;178[6]:668 and CMAJ 2008;178[13]:1648).
The Canadian reactor was again in the news in December 2008, when a planned shutdown that was extended 2 days coincided with a shortage of medical isotopes in Canada resulting in many medical and diagnostic procedures being cancelled. An Atomic Energy of Canada Ltd. spokesman told media that the shortage stemmed from the shutdown of European nuclear reactors.
The new proposal calls for the use of high-energy photons to split natural or depleted uranium (rather than the weapons-grade uranium used in the Chalk River reactor) to generate molybdenum-99 for processing by US firms into technetium-99m, the isotope used in clinics. Canada lacks the processing capacity and its market is too small for any one to consider building such a generator, the report states.
Because such machines can be turned on and off and have lower decommissioning costs, they're an “attractive” option, states the task force report Making Medical Isotopes (http://admin.triumf.ca/facility/5yp/comm/Report-vPREPUB.pdf).
The Task Force on Alternatives for Medical-Isotope production, convened by the TRI-University Meson Facility and the University of British Columbia, with the support of the federal department of Natural Resources, also issued several cautionary notes.
“Several laboratory experiments are needed to establish efficiencies, equivalency of products, reliability of operation, and capacity,” it states.
There are also major technical hurdles, such the lack of a “conceptual design of a U-238 target system for efficient photo-fission and dissipation of the generated thermal power.”
As well, a 1-beam 2–3-megawatt machine would be needed to generate supply for 5%–7% of the North American market, and 6 would be needed if Canada was to maintain its 30%–50% stake.
The National Research Reactor produces about half of the world's medical isotope supply and all isotopes used in the roughly 1.5 million nuclear medicine procedures undertaken in Canada annually.
Canada would also need to obtain regulatory approval for accelerator-generated isotopes, and build the facilities at a cost of $50 million to $125 million apiece, depending on the technologies chosen.
There would also be $50 million for capital costs associated with the production cycles, including “the manufacturer of targets for irradiation, storage of radioactive waste from target processing, and hot-cell to recover and refine mo-99.” — Wayne Kondro, CMAJ
Lack of competition
Public drug plans, businesses and individual payers could reap savings of up to $800 million a year if there were more competition in the sale of generic drugs, according to a federal Competition Bureau report.
The bulk of potential savings — up to $600 million — could be reaped by businesses, private drug plans and individuals who pay out of pocket, states the report, Benefiting from Generic Drug Competition in Canada: The Way Forward, which was released Nov. 25, 2008.
But public plans could cut costs by $200 million a year, which would be available for reinvestment in the health care system. Potential savings would mount as more drugs come off patent protection, according to the report, which outlines strategies for increasing competition.
An earlier report from the bureau found that although there is generic drug competition in Canada at the pharmacy level, savings from rebates and allowances were not being passed on to customers. Ontario's 2006 Transparent Drug System for Patients Act lowered the cost of generic drugs for both the Ontario public drug plan and, effectively, Quebec's plan. But with the exception of Quebec, private payers did not benefit, according to the report (www.competitionbureau.gc.ca/epic/site/cb-bc.nsf/en/02754e.html).
Since the Act was passed, some brand name drug companies have lowered prices to compete with generics. Prescription drugs are the second-largest health care cost in Canada (accounting for $19 billion in 2007), and from 2006–2007 generic drug expenditures alone increased by 20% to $4.1 billion, the report states. — Ann Silversides, CMAJ
Midwest medicinal marijuana
The state of Michigan has become the 14th in the United States, and the first in the American Midwest, to approve the use of marijuana for registered patients with debilitating medical conditions.
The proposition allows for medicinal marijuana use by patients suffering from cancer, glaucoma, HIV/AIDS, hepatitis C and other conditions approved by the Michigan Department of Community Health, which has been given until March 2009 to establish a program for registering users, who will berestricted to 2.5 ounces of marijuana and 12 plants, which must be kept within locked facilities.
“This represents a thundering rejection of the draconian and unscientific policies of the last 10 years,” says Bruce Mirken, director of communications for the Marijuana Policy Project, a Washington, District of Columbia advocacy group for marijuana use. “One in 4 Americans now lives in a state that approves medical marijuana.”
The other states that have passed such laws are Alaska, California, Colorado, Hawaii, Maine, Maryland, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont and Washington. — Lesley Ananny, Ottawa, Ont.
Bamako call to action
National governments have been urged to allocate 2% of the budgets of their health ministries to research under a “call to action” issued by the Global Ministerial Forum on Research for Health held in Bamako, Mali, from Nov. 17–19, 2008.
In a bid to establish targets for increasing investment in health research, representatives from 53 of the 69 participating nations that inked the Call to Action in Bamako, Mali, also urged that at least 5% of all health-related developmental assistance funding should be ticketed for health research, (www.tropika.net/svc/specials/bamako2008/call-for-action/call).
Signatories to the call to action also urged that the research investments should be “determined by national and regional agendas and priorities, with due attention to gender and equity considerations” and that more attention be paid to research that “addresses the health challenges that disproportionately affect, the poor, marginalized and disadvantaged.”
Among other measures urged was the establishment of Nov. 18 each year as a “World Day of Research for Health” and ministerial gatherings every 4 years to discuss progress. A similar Call for Action was issued from the Global Ministerial Summit on Health Research held in Mexico in 2004. — Wayne Kondro, CMAJ