Life in Canada

People seem to be completely unaware that this is not just a US problem. Every country on the planet will be economically devastated if the US government does not start getting their act together. People living in China especially, Japan, UK, Canada, Germany and every other major economy better wake up to the fact that your governments (maybe not so much Canada) hold enormous amounts of US bonds and Treasuries, your economies run and function on it and a country like China is able to use US holding as a way to help in its GDP growth and to help in its massively growing debt burden. The US in for a world of hurt, think again dude everyone is in for a world of hurt yourself included.

The cost of prescription medicines used by millions of people every day is about to plummet.

The next 14 months will bring generic versions of seven of the world's 20 bestselling drugs, including the top two: cholesterol fighter Lipitor and blood thinner Plavix.

The magnitude of this wave of expiring drugs patents is unprecedented. Between now and 2016, blockbusters with about $255 billion in global annual sales are set to go off patent, notes EvaluatePharma Ltd., a London research firm. Generic competition will decimate sales of the brand-name drugs and slash the cost to patients and companies that provide health benefits.

Top drugs getting generic competition by September 2012 are taken by millions every day: Lipitor alone is taken by about 4.3 million Americans and Plavix by 1.4 million. Generic versions of big-selling drugs for blood pressure, asthma, diabetes, depression, high triglycerides, HIV and bipolar disorder also are coming by then.

The flood of generics will continue for the next decade or so, as about 120 brand-name prescription drugs lose market exclusivity, according to prescription benefit manager Medco Health Solutions Inc.

"My estimation is at least 15 per cent of the population is currently using one of the drugs whose patents will expire in 2011 or 2012," says Joel Owerbach, chief pharmacy officer for Excellus Blue Cross Blue Shield , which serves most of upstate New York.

Those patients, along with businesses and taxpayers who help pay for prescription drugs through corporate and government prescription plans, collectively will save a small fortune. That's because generic drugs typically cost 20 per cent to 80 per cent less than the brand names.

Doctors hope the lower prices will significantly reduce the number of people jeopardizing their health because they can't afford medicines they need.

Dr. Nieca Goldberg, director of The Women's Heart Program at NYU Langone Medical Center in Manhattan, worries about patients who are skipping checkups and halving pills to pare costs.

"You can pretty much tell by the numbers when I check the patient's blood pressure or cholesterol levels," that they've not taken their medications as often as prescribed, she says.

Even people with private insurance or Medicare aren't filling all their prescriptions, studies show, particularly for cancer drugs with copays of hundreds of dollars or more.

The new generics will slice copayments of those with insurance. For the uninsured, who have been paying full price, the savings will be much bigger.

Daly Powers, 25, an uninsured student who works two part-time jobs at low wages, says he often can't afford the $220 a month for his depression and attention deficit disorder pills. He couldn't buy either drug in June and says he's struggling with his Spanish class and his emotions. He looks forward to his antidepressant, Lexapro, going generic early next year.

"It'd make all the difference in the world," says Powers, of Bryan, Texas.

Generic medicines are chemically equivalent to the original brand-name drugs and work just as well for nearly all patients.

When a drug loses patent protection, often only one generic version is on sale for the first six months, so the price falls a little bit initially. Then, several other generic makers typically jump in, driving prices down dramatically.

Last year, the average generic prescription cost $72, versus $198 for the average brand-name drug, according to consulting firm Wolters Kluwer Pharma Solutions. Those figures average all prescriptions, from short-term to 90-day ones.

Average copayments last year were $6 for generics, compared with $24 for brand-name drugs given preferred status by an insurer and $35 for nonpreferred brands, according to IMS Health.

Among the drugs that recently went off patent, Protonix, for severe heartburn, now costs just $16 a month for the generic, versus about $170 for the brand name. And of the top sellers that soon will have competition, Lipitor retails for about $150 a month, Plavix costs almost $200 a month and blood pressure drug Diovan costs about $125 a month. For those with drug coverage, their out-of-pocket costs for each of those drugs could drop below $10 a month.

Jo Kelly, a retired social worker in Conklin, Mich., and her husband Ray, a retired railroad mechanic, each take Lipitor and two other brand-name medicines, plus some generic drugs. Both are 67, and they land in the Medicare prescription "doughnut hole," which means they must pay their drugs' full cost, by late summer or early fall each year. That pushes their monthly cost for Lipitor to about $95 each, and their combined monthly prescription cost to nearly $1,100.

Generic Lipitor should hit pharmacies Nov. 30 and cost them around $10 each a month.

"It would be a tremendous help for us financially," she says. "It would allow us to start going out to eat again."

For people with no prescription coverage, the coming savings on some drugs could be much bigger. Many discount retailers and grocery chains sell the most popular generics for $5 a month or less to draw in shoppers.

The impact of the coming wave of generics will be widespread — and swift.

Insurers use systems that make sure patients are switched to a generic the first day it's available. Many health plans require newly diagnosed patients to start out on generic medicines. And unless the doctor writes "brand only" on a prescription, if there's a generic available, that's almost always what the pharmacist dispenses.

"A blockbuster drug that goes off patent will lose 90 per cent of its revenue within 24 months. I've seen it happen in 12 months," says Ben Weintraub, a research director at Wolters Kluwer Pharma Solutions.

The looming revenue drop is changing the economics of the industry.

In the 1990s, big pharmaceutical companies were wildly successful at creating pills that millions of people take every day for common conditions, from heart disease and diabetes to osteoporosis and chronic pain. Double-digit quarterly profit increases became the norm.

But the patents on those blockbusters, which were filed years before the drugs went on sale, last for 20 years at most, and many expire soon.

In recent years, many drug companies have struggled to develop new blockbuster drugs. Pharmaceutical companies can save billions when they stop promoting drugs that have new generic rivals, and U.S. drug and biotech companies are still spending more than $65 billion a year on R&D.

The 20 new drug approvals in the U.S. this year, and other important ones expected in the next few years, eventually will help fill the revenue hole.

For now, brand-name drugmakers are scrambling to adjust for the billions in revenue that will soon be lost. Many raise prices 20 per cent or more over the last couple years before generics hit to maximize revenue. Some contract with generic drugmakers for "authorized generics," which give the brand-name company a portion of the generic sales.

Brand-name companies also are trimming research budgets, partnering with other companies to share drug development costs and shifting more manufacturing and patient testing to low-cost countries.

Pharmaceutical companies have cut about 10 per cent of U.S. jobs in four years, from a peak of about 297,000 to about 268,000, according to Labor Department data. Nearly two-thirds of the cuts came in the last 1 1/2 years, partly because of big mergers that were driven by the need to shore up pipelines and boost profit in the short term by slashing overlap.

Drug companies also are trying to stabilize future sales by putting more sales reps in emerging markets such as China and India, and diversifying into businesses that get little or no generic competition. Those include vaccines, diagnostic tests, veterinary medicines and consumer health products.

As the proportion of prescriptions filled with generic drugs jumped to 78 per cent in 2010, from 57 per cent in 2004, annual increases in prescription drug spending slowed, to just 4 per cent in 2010. According to the Generic Pharmaceutical Association, generics saved the U.S. health care system more than $824 billion from 2000 through 2009, and now save about $1 billion every three days.

The savings are only going to get greater as our overweight population ages. People who take their medicines regularly often avoid costly complications and hospitalizations, says AARP's policy chief, John Rother, bringing the system even bigger savings than the cheaper drugs.

In addition, many patients taking a particular brand-name drug will defect when a slightly older rival in the same class goes generic.

Global sales of Lipitor peaked at $12.9 billion in 2006, the year Zocor, an older drug in the statin class that reduces bad cholesterol, went generic. Lipitor sales then declined slowly but steadily to about $10.7 billion last year. That still makes Lipitor the biggest drug to go generic.

For patients, it's a godsend. Well maybe not for Canadians. I am sure the powers that be and always transparent, will find a way of even increasing the prices

In the meantime, once Lipitor and Plavix get generic competition his copayment will plunge from the current $1 per day for each.

"I will pay $16 for 90 days" for both, says Torok, who hopes to travel more. "It's a big deal for me on my income."

The B.C. premier promised that rioters will be brought to justice. But that won’t happen.

In the wake of Vancouver’s riots, B.C.’s populist Premier Christy Clark was quick to read the public pulse. “We will hold you responsible,” she said the morning after the mayhem. “You will not be able to hide behind your hoodie or your bandana.” A special team of experienced prosecutors, she said, would work with police to ensure swift, severe punishments for rioters—jail time, she made clear, sounding more like an Old West sheriff. The public roared its approval. The riots touched a raw nerve in Vancouver, where 19 of every 20 residents want the troublemakers prosecuted to the full extent of the law, according to a new poll by Angus Reid.

The reality of prosecuting the mess, however, will soon sink in. The premier is “out of touch with how our courts are operating,” Vancouver criminal defense lawyer Jason Tarnów tells Maclean’s. There is “no way” riot cases will get preferential treatment just because politicians are asking for it; that would be unconstitutional. Rioters will be processed by a justice system hobbled by judge, sheriff and prosecutorial shortages and a legal-aid system that no longer meets even basic needs, according to a recent report. “Justice will not be swift,” adds criminologist Robert Gordon, of Simon Fraser University. “This will be a long, drawn-out process.”

A week before the riot in fact, five Vancouver trials were ordered shut down after judges deemed courtrooms unsafe to proceed due to a shortage of sheriffs. More than 2,000 criminal cases, meanwhile, are at risk of being quashed over delays. In the past year, a range of cases, from drunk driving to drug dealing have been tossed because it took up to two years to get to trial. “It takes 12 to 18 months to get a single-day trial in Vancouver right now,” says criminal lawyer Michael Shapray. “What will happen if police suddenly lay 300 criminal charges? How are you going to find the judges, sheriffs and prosecutors for this?” In an eye-opening report released last fall, the provincial court warned that 17 new judges must be hired just to bring B.C. back to 2005 levels and slow the backlog. Instead, B.C.’s spring budget approved cuts totalling $14.5 million to the judiciary, court services and prosecution services. (In the wake of the riots, funding for sheriffs was quietly restored.)

But the issue isn’t solely administrative. Although this will surely go down as the world’s best documented riot, some of the hundreds of thousands of photos submitted anonymously to police may be inadmissable as evidence. “In court, you have to be able to call a witness who took the video or picture,” says Shapray. The photo of the so-called “kissing couple” offers a perfect example of how deceptive a picture can be without video evidence or witness testimony. Was it staged? What were they doing? News sites buzzed until the couple was identified.

Further, we may be putting too much faith in facial-recognition software: it was designed to sift through well-lit, frontal, ID-quality images, not dark, grainy cellphone photos. Brock Anton, who became an Internet meme after bragging about his alleged exploits on Facebook—apparently admitting to burning a police car and assaulting an officer—may next become an example of someone who gets off scot free, unless credible witnesses come forward to testify, says Shapray.

Precedent offers little comfort to outraged citizens. Of the more than 1,100 people held over the Toronto G20 weekend last summer, only 317 were ever charged. And of those, 58 per cent had their charges withdrawn, stayed or dismissed. The rioters who took part in Vancouver’s violent anti-Olympic protest last year have all, meanwhile, escaped criminal punishment.

Still, some rioters are receiving punishment far worse than anything the courts might dole out for their crimes. Robert Snelgrove, 24, was captured on film walking out of Sears with a handful of face creams. The next day, the Coquitlam, B.C., native—then fully sober and utterly mortified—turned himself in, and returned the stolen items. No charges were laid. Police took a statement and sent him home. But the Internet mob, who’d pasted his image to shaming sites, was just getting going. By evening, he’d been identified and his cell number and work address were posted online. Then came the messages: “Die scumbag,” plus a rash of homophobic insults. (Snelgrove is gay.)

The mob was relentless. “It was message after message”—voice, text and Facebook messages, says Snelgrove. For the first three days he didn’t eat anything. “I felt sick. I felt too ashamed to go outside.” Customers called his manager to complain, and he was suspended without pay, and expects to be fired.

In a world where a reference check begins with a Google search, the mob has given many students and young adults a life sentence. There is a reason, however slow and unwieldy, that the administration of justice has been delegated to the state. Internet justice, unlike the real kind, is swift and severe—and not necessarily right or fair.

Perhaps the anti- monarchists in Quebec should read this...again

Quebec Native Women recognizes the Prime Minister's official apology concerning the genocidal experience of Aboriginal people in the history of the Residential School system. While the apology to Aboriginal peoples is long overdue it is contradicted by the oppressive policies of the Indian
Act.

The heinous crimes committed against Aboriginal children who were victims and survivors of the Residential School experience must be dealt with beyond mere apologies and monetary compensation.

The damages to our languages, well-being, social and political structures, and sexuality caused by Residential School, demands attention. The policy of assimilation through the Residential Schools system constituted a war against an identifiable group of people.

And while we commend the Canadian Government on the creation of a Truth and Reconciliation Commission we cannot ignore the Auditor General's recent report substantiating that budgets for child welfare agencies in Canada continue to focus the majority of their efforts on the placement of Aboriginal children outside their communities and Nations. This type of
practice is reminiscent of the Residential School policy.

Consequently, the Canadian Government must acknowledge that Residential School was an act of genocide; a crime against humanity. Apologies may be recognized but they are not necessarily accompanied by forgiveness as no
nation or groups have ever been forgiven for their acts of genocide.

In order for this apology to be considered genuine, more efforts must be undertaken to correct current oppressive measures under the Indian Act that prevent Indigenous peoples from prospering socially, culturally, politically and economically.

The actions of the Canadian Government in opposing the United Nations Declaration on the Rights of Indigenous Peoples makes the apology feel hollow. Their opposition to the UNDRIP perpetuates the insidious, archaic Indian Act that continues to discriminate and deny Aboriginal nations their rights. The facts and arguments reflecting the manner in which the
Canadian Government continues to undermine the rights of Indigenous peoples, can be found in Amnesty International?s 2008 Annual Report.

We therefore urge the Government of Canada to adequately fund Indigenous languages in a manner that is equivalent to the support given to the French and English languages; to adequately consult Aboriginal peoples in good faith on legislation that addresses issues such as matrimonial real property, Bill C-21, Bill C-47; Bill C-30 and to eliminate the sexual discrimination that exists under Section 6 of the Indian Act.

In order for Aboriginal communities to emerge from the negative impacts of colonization they must have access to their lands and resources; they must have the opportunities to build strong and healthy nations by taking to task the social and economic problems whose roots are firmly based in colonization.

Canada has established itself as a rich and prosperous country at the expense and blood of Aboriginal peoples. And while we may recognize the Government?s admission of guilt, the fact remains that many obstacles must be removed in order to give meaning to the spirit and intent of their apology.

- Ellen Gabriel, President, Québec Native Women's Association