StemCell Therapy

My New Democratic MLA, David Shepherd, was in the local paper Monday morning. Davids a pleasant fella, and I always feel awkward exposing Edmonton news items like worn-out ginch to a national audience, but he has presented an example of something that happens all across the country, all the time, and that ideally wouldnt, or shouldnt.

You see, there was a small protest at the Alberta legislature on Sunday. The hundred or so protesters were sufferers (and friends of sufferers) of inflammatory bowel disease Crohns and ulcerative colitis. The IBD patients recently received a letter from Janssen Inc., which makes one of the miracle drugs of our time, Remicade.

Remicade is a monoclonal antibody a mab, as your pharmacist would say to another pharmacist. This means its an ultra-complicated lab-designed molecule that is somewhat like a prosthesis for your immune system. Before Remicade, the old approach to IBD disorders was to wait until they became disabling or life-threatening, as opposed to just colossally inconvenient and painful, and then deluge them with steroids. With Remicade, many patients with severe IBD can live in remission indefinitely.

This is not cheap, which is why vis prescribed to only a fraction of those with IBD. Remicade is nonetheless the single largest prescription drug expense, by far, that the Alberta government has. In the year ending March 31, 2018, Alberta Health spent more than $80 million dispensing the drug to 2,535 patients.

You might expect that this situation would attract the attention of capitalism, and countless drug companies are indeed developing biosimilar alternatives to Remicade. Health Canada, acting more slowly than other developed countries, has approved a couple.

Biosimilars are drugs that have the same overall molecular structure as some reference drug and have been shown in the laboratory to target the same receptors in the body. Simple molecules dont attract imitators like these, but the mabs are (on the molecular scale) huge, intricate wads whose activity may not be perfectly understandable. Mabs were introduced because in-vitro laboratory drug creation using computer models and biological first principles got a lot better around the turn of the century. Biosimilar rivals, marketable for lower cost, exist for the same reason.

Remicade is the single largest prescription drug expense that the Alberta government has

So government drug plans have been itching to move patients onto cheaper biosimilars, or perhaps force discounts on Remicade. In British Columbia, the government a New Democratic government is currently in the process of switching everybody to biosimilars by fiat, with exceptional Special Authority approval (!) required for patients who prefer the name brand. Janssen wrote to Remicade patients when it learned that Alberta and Ontario were also eyeing their big Remicade bills.

Alberta hasnt decided whether to follow B.C.s guillotine approach. Theres a serious, evolving discussion about the evidence base for the biosimilars. It is fairly well established that patients can switch to one of the best biosimilars without risk, and that the biosimilars behave like the name brand within the immune system as far as any testing can show. But the empirical studies have been short in duration, and no one has been able to check what happens if doctors engage in multiple switching among biosimilar molecules.

This should not be a partisan conversation, but, well, if you are protesting on the legislature steps, your handmade sign is not going to read The magnitude of the nocebo effect is contested! The Sunday protest in Edmonton was led by a Crohns patient, Nick Arrand, who told the Journals Jonny Wakefield, The government should have no right to tell you what medications to take.

The story adds that Mr. Arrand is on his wifes insurance, so the government is not, in fact, telling him what medications to take. His insurer, one supposes, might eventually have something to say about it. Should he picket that companys headquarters if this happens? Or should he go bother Janssen about the price of Remicade? What would Bernie Sanders do?

For patients on government health plans, the government does decide what to pay for (if there were a punctuation mark meaning duh, it would go here), and it has no choice but to take cost into account, as an NDP-led government in idyllic B.C. has. This did not discourage MLA Shepherd from joining the Edmonton protest to denounce barbarous right-wing Alberta-government cost-chopping that might or might not happen. And which is, at root, a negotiation between Albertas public treasury and a constellation of drug manufacturers.

What would Bernie Sanders do?

Shepherd accused the Conservatives of intending to try to force their way into the doctor-patient relationship and force these individuals to switch onto new, unproven biosimilars. This is a curious departure from the official position of Crohns and Colitis Canada, which is that Biosimilars are a safe and effective treatment for people with Crohns disease and ulcerative colitis.

The charity, which receives funding from Janssen and organized the pro-Remicade demonstration, expresses concerns with non-medical switching of drugs for cost reasons alone. But it also concedes, quite explicitly, that in these here social democracies, none of us exists in a consecrated doctor-patient relationship without the presence of a third party footing the bill. Even when Bill Gates gets sick, he doesnt ask for the most expensive drug on principle.

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Continue reading here:
Colby Cosh: Barbarous right-wing cost-chopping ... pioneered by the B.C. NDP? - National Post

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