Blessed by the Potato

During dinner tonight I had a bit of pain swallowing. It happens to me from time to time, usually a lump of food seems to go down funny, and then I get the hiccups if I don’t follow it quickly with a drink. Today though, that painful lump-in-my-throat feeling just wouldn’t go away (and in fact is still with me 8 hours later as I write this). The dull ache was a little painful, and every few minutes I’d get a more severe sharp pains that were quite intense just above my diaphragm, but only lasted for a few seconds.

After about two hours of that I started to get worried, so we packed up and headed to the hospital (since I was visiting Wayfare and her parents, we went to Marville-Stouffville). I was reasonably sure that I wasn’t having a heart attack, but I wasn’t completely, bet-my-life-on it sure, and at about two hours since the pain started, if it was a heart attack I was eating up my tPa intervention window. Plus, the pain had gone from vaguely annoying to grating, and I was hoping a doctor could make it stop.

There was next to no wait in the ER. The triage nurse saw me within a few minutes, though they took their time admitting me (I supposed they felt they could since my blood pressure was normal). I saw a nurse within about 25 minutes or so and got an ECG, which was normal. The doctor wasn’t hugely helpful, suggesting that I have some sort of spasms in my diaphragm or esophagus, and told me to take some Maalox and hope that it would settle down within a few hours. Wayfare, having some sense about her, asked “what if it doesn’t settle down in a few hours?” His response was essentially: “Meh.” It was a little disappointing: I was hoping they’d maybe do an ultrasound to see if they could see exactly what was spasming, and maybe give me a localized muscle relaxant or something…

So, we were discharged and left (I had some issues with the door: I remembered that on the other side it had a sensor and a big sign that said “do not touch handle”. There was a sensor on the inside too, and I waved my hand in front of it, but nothing happened. “Pull the handle” someone told me. Well, in hindsight: duh.

The pain got much worse after leaving, and continued to get worse over the next hour or so. I suspect taking the Maalox and then some of my dad’s Tylenol-1’s had set my esophagus off. Those few-second-long exceptionally painful spasms that sent me to the hospital when they were coming every minute or so started to happen every 10 seconds, and were lasting long enough to turn it into a nearly constant bought of pain. After nearly an hour of that it finally settled down and hurt less (maybe the Tylenol, maybe it just got tired). Now I’m back pretty much to where I started, and I’m really hoping I’ll be able to sleep through the night!

Vote-grabbing new measures is an unfortunate reality in the run-up to an election, and it seems to have affected the Ontario Liberals pretty hard this year. That said, a holiday in February is a great idea, one that’s been bounced around for years (if mostly just in the press as a filler story for February).

My recent bought of TV watching brought to my attention the new MedsCheck program from the Ontario government. The program allows anyone on more than 3 medications for chronic conditions to set up an appointment with their pharmacist to go over their prescriptions to make sure that there aren’t any potential bad interactions or confusion in the instructions, or any other ways that patient care could be improved. The visit is free (as free as any of our health care is — paid for by OHIP), and is paid out on a flat rate of 30 minutes (that is, the pharmacist gets $50 from OHIP per MedsCheck appointment, regardless of how long it actually takes). It sounds like a decent program that might help catch a few people who are on the road to “have a bad time”.

But then I remembered that I’m off to the eye doctor in a few weeks to have my biennial* eye exam, for which I will have to pay out of pocket (technically, my supplementary graduate student health insurance will pay for it, but then that means that I’ll have to pay more out of pocket for my lenses, since there’s a pretty small limit on the eye benefit). For a government that’s facing an election soon, that had to somewhat drastically cut back on OHIP benefits and introduce a health tax some years ago, I don’t really see this program as being a high priority. $50 million (note that I don’t know what time period the $50 million funding is for: per year, per 4-year budget cycle…) buys a lot of eye exams. As someone who’s had glasses since kindergarten and worries about what I would do with myself if I ever lost my vision (and I’ve had a number of close calls), I put much more importance on OHIP funding vision check-ups (even if they were only every five years) than on checking for drug interactions.

It might also be a waste, a duplication of resources. After all, many (all?) pharmacists already check your prescription record when you get a new prescription to make sure that there won’t be any complications, paid for as part of the dispensing fee. Of course, those checks may not reveal non-prescription drug/natural health product interactions, which may not appear on a list of prescriptions, but which may be revealed in an interview.

Being a pharmacist is a pretty thankless job: all the hassles of retail sales dealing face-to-face with customers, along with having to interpret the arcane scrawl of physicians (and their often incredible ability to make factor of 10 errors in dosing), being the last guardian of a wall full of narcotics in a world that is apparently full of druggies, all while having to take disgusting amounts of chemistry in university. Lately though, I don’t have much love of pharmacists. To the world on the other side of the counter, a big part of the job appears to be taking a piece of paper, turning around, grabbing a pre-packaged box of pills off the shelf, turning back around, putting it in a basket, and charging $14 for the service. That bitterness comes because of some of the arcane charges racked up: Wayfare, for instance, had a prescription for 4 months worth of a drug filled at Shoppers Drug Mart not too long ago, and was charged two dispensing fees: one for the first three-month bundle, and one for a 1-month bundle. Plus another two dispensing fees for the other two medications on the same scrip. That was, incidentally, the last time we went to Shoppers to get a prescription filled (though we still go there, since they’re a first-rate convenience store). I can’t remember the details exactly from when I had my kidney stone (partly because it was once again Wayfare dealing with the pharmacist, and partly because I was in the depths of a near-comatose state when she told me the story), but because of a miscalculation in the dosage from the resident at the hospital, the pharmacy wouldn’t fill my codeine prescription. Not even a single dose to get me through the night. There was some sort of desperate phone call made to the attending at UH to sort the whole matter out, made very reluctantly, if I remember the story right.

There are some good ones out there for sure, particularly the ones who helped my dad out a few years ago when his doctors were crazy and he needed new drugs every few weeks (it also helped that my mom was a nurse and was able to figure out the discrepancies between what the doctor said he was prescribing and what actually appeared on the pad after the pen flew over it). Hoping that they turned into one of the good ones, I asked an old friend what they thought about the MedsCheck program:

You need to look at the entire background before coming up to a decisive position.
The gov decided to cap the amount of money generic companies could charge for their products. They also eliminated the direct rebates that these companies used to pay pharmacies for using their products. All of a sudden pharmacies found themselves with a direct cut in income. This put more emphasis on increasing the number of prescriptions being dispensed without adjusting resources. This in turn reduced the amount of time spent per prescription.
The gov had to somehow offset this trend and thus, brought in the MedsCheck program. This program reimburses pharmacists for spending a set amount of focused time with each eligible patient.

This is actually mentioned in the CTV version of the report, but I didn’t really focus on it:

“But the new law also puts a squeeze on pharmacists because it reduces the amount of cash they can get from dispensing generic drugs…”

“While the government has taken out $277 million, this program only puts $50 million back in, he added.

The Transparent Drug System for Patients Act, passed last June, limited the promotional allowances pharmacists can collect from generic drug companies to 20 per cent of their cost, prompting some to warn dispensing fees would have to go up to keep pharmacies open.”

To introduce a new OHIP plan to try to offset the loss of revenue from another law is pretty messed up, and IMHO, not good health care policy. Of course, that’s the way politics works sometimes, but it does kind of stink. Especially since it doesn’t actually do that job very well ($50 million is a lot less than the $277 million quoted). I have to wonder though, if the pharmacies are losing money because the government eliminated the rebates from the drug companies, wouldn’t the lack of rebate lower the drug companies’ costs? Couldn’t they just lower the upfront price to the pharmacy instead of this rebate business? Looking briefly at the Transparent Drug System for Patients Act page from the government, it looks like the cap on generic payouts only affects patients in the Ontario Drug Benefit program (though limiting generics to 50% of the price of name brand drugs sounds fairly severe), and not mentioned is that the government is “Enforcing drug pricing compliance from manufacturers which will protect pharmacists from unauthorized price increases.” So while the government plans to save $277 million with the reforms, it doesn’t appear as though that’s all on the backs of the pharmacists (though cleaning up the rules on rebates may hurt the pharmacies’ bottom lines without being reflected as a savings for the government). I’m left wondering if the biggest negative impact was simply due to the suddenness of the change.

Now, if it weren’t for the optics of health care funding lacking in other areas (and the still-stinging health care tax), I think this would be a great program. Heck, the government could even pick up the full cost of drugs and dispensing fees for Ontarians, and dental coverage while they’re at it, and take away the need for supplementary health insurance (the prevalence of which is kind of twisted in a country with universal health care), and I’d vote for it. But as it is, I don’t know what to make of this MedsCheck program.

Aside: I was going to use “biannual” but thought that might possibly mean twice a year, rather than once every two years. The dictionary indicated that was the case. So then I looked up “semiannual”… and found that it also meant twice a year… those can be some deceptive terms. Bimonthly apparently means both.

PS: If you want to leave a comment on this post, please be aware that nearly any word having to do with a pharmacy will land a comment in the spam filter, so it may take a while for me to clear the legit ones.

Toronto is hurting for money lately, and is considering all kinds of new ways to raise taxes or other revenues. One interesting proposal just announced yesterday by the CBC is to increase property taxes for big box stores and gas stations for promoting a “car culture”. This is a neat idea along the lines of a green party proposal (tax that which you want to have less of). It also makes some sense since gas stations can have leaks and runoff that can damage the soil they’re sited on, or get into the sewer systems, and they’re likely not paying their full share for those cleanups. AFAIK, gas is sold on a fairly tight margin, so I don’t know if this will spell doom for the gas stations within driving distance to the 905 (unless the 905 plays along too). The big box stores probably won’t even notice unless this is a really substantial tax hike, since property taxes don’t (again, AFAIK) make up a very large portion of retail markup.

In the end, while I think this is just as valid a way of choosing which properties to increase taxes on as any other (perhaps even preferred), I don’t really think it’s going to impact the number of big box stores or gas stations within Toronto, or really change our car culture. While we could possibly go through another doubling of gas prices, it doesn’t look like the high price of operating a car is enough of a deterrent to stop people from driving. To do that we would have to make it much easier than it currently is to get around without a car. And that would require not just more bus routes with more frequent service (including routes to get around your neighbourhood — it’s not too hard for a lot of people to get on a bus to the subway or GO station to get downtown, but it’s pretty tough to take a bus to the grocery store and back locally), but also much improved intercity rail or bus connections. It takes Wayfare something like 4-5 hours to get from London to Markham, with service only every two hours or so, while I can drive there in 2 any time I want. With that kind of disparity in service/convenience it’s no surprise that anyone who travelled outside the city with any kind of regularity would need a car, and once it’s in the driveway…

I was watching TV today — honest-to-goodness TV with commercials and everything. It’s been quite a while, since almost all the commercials I saw were new to me. A few that I thought were neat were political ones from a group called the Working Families Coalition. They were reminder ads, basically reminding us that we don’t want to go back to the days of the Conservatives, with four different ads about health care, education, poverty, and water/food safety. I liked them: they didn’t have that angry attack-ad feeling to them, and they weren’t too explicit in their Tory fear-mongering, but they did get the message across. Looking at their website, I can’t find much information about who they are, really. They don’t look to be a Liberal shell (while they’re anti-Tory, they’re not specifically pro-Liberal).

I’m a little surprised at how much support the Tories appear to be getting; I personally couldn’t even conceive of going back to a conservative-controlled Ontario. A lot of people are upset at McGuinty, especially about the health tax (though his last-minute pork barreling isn’t helping), but I don’t think the Liberals have been all that bad for Ontario. They haven’t been fantastic, but I hardly think we should be chasing them out with pitchforks and torches.

The Green Party may turn out to be a bit of a spoiler in this election, especially since they’re the only ones willing to change the status quo and scale back the catholic school funding. It is, perhaps, telling that the “working families” site has a link to the other parties but not the Greens, and that one of their supporting groups is the catholic school teachers association. Of course, it could also be that like so many others, they simply don’t see the Greens as a credible alternative since they haven’t yet had an elected member.

A bigger issue, one I hope I haven’t beaten to death already, is electoral reform. I just got in my mailbox a link to the now up-and-running voteformmp.ca, a site associated with Fair Vote Canada. A criticism of the site is that the “about MMP” section is quite vague, and you have to go to the PDFs in “campaign materials” to see what your ballot would look like under the new system. Remember to vote for the referendum on October 10, even if you wouldn’t ordinarily vote for your MPP!