PRESCRIPTION DRUGS, MENTAL HEALTH
AND SUBSTANCE USE
MISPRESCRIBING, OVERMEDICATION
AND USE OF BENZODIAZEPINES,
(TRANQUILLIZERS AND SLEEPING PILLS)
AND ANTIDEPRESSANTS IN
THE CANADIAN HEALTHCARE SYSTEM
Joan E. Gadsby
October 18, 2001
Public Hearing, Vancouver,
British Columbia, Canada
APPEARANCE/PRESENTATION TO THE CANADA
STANDING SENATE COMMITTEE ON
SOCIAL AFFAIRS/SCIENCE AND TECHNOLOGY ON THE
STATE OF THE CANADIAN HEALTHCARE SYSTEM
Committee Members;
I. By letter March 1, 2001 to the Committee Clerk, I provided considerable background information with attachments which I understand have been circulated to you regarding the above very significant health issue which I would like to briefly review - particularly the extent and significance of this problem on the lives of hundreds of thousands of Canadians and their families who have been seriously affected by the continued irresponsible prescribing and uninformed use of these legal drugs - a problem ten times the problem of illegal drugs.
(Please refer to March 1, 2001 letter and
II. Benzodiazepines - Time for Action and Accountability!
(also on website www.benzo.org.uk)
Benzodiazepine Problems known for over 2 decades by Health Canada/Doctors/ Pharmaceutical Companies but not to patients/consumers
4 Elements of the problem
Socio economic Impacts
Adverse Side Effects
Facts on Drugs and Benzodiazepines in Particular
Cognitive Impairment Research
Call to Action - Obstacles/Solutions - 14 Key recommended actions for systemic change requiring this Senate Committee's support/action. In addition, I updated a recommended resolution to the Canadian Government, October 9, 2001 which you also have been provided by fax entitled
III. Benzodiazepines - Responsible Prescribing and Informed Use Resolution to address this issue which my colleagues and I wholeheartedly support which I would like to read and for which I am urgently requesting the support/action of this Senate Committee.
IV. Next I would like to review Some Key Findings from my presentation this July to the World Assembly for Mental Health here in Vancouver which was attended by over 1000 delegates from around the world. This one page capsule summary is an important segue to my overall presentation at this World Conference (inclusive of the foregoing) and the following:
V. Responsible and Informed Use of Antidepressants - A Major Global Health Epidemic. Also provided to you by fax and on my home page at website www.benzo.org.uk. This detailed information includes:
A Global Perspective - Top 14 World Drug Markets/Dollars/Trends
World Drug Purchases - Central Nervous System Drugs
Trends in Prescription Drug Expenditures in the United States (2000) - The creation of markets by pharmaceutical companies/advertising
Annual Review of Prescribing and Diagnoses Trends - Canada (to March 2001) inclusive of antidepressants and benzodiazepines.
Responsible and Informed Use of Antidepressants - another serious World Wide concern calling for Action and Accountability - ongoing and increasing prescribing, adverse side effects, questionable effectiveness, inappropriate use.
Need for informed consumers/patients who give consent based on knowledge of adverse effects, contraindications, potential interactions and guidelines for appropriate use
Effects and Risks of Antidepressants and SSRI medications
Addiction/Chemical Dependency/Tolerance
Withdrawal Symptoms/Syndrome
Prescribing to Pregnant Women, Children
THE TRAGIC CONSEQUENCES!
All of the foregoing are even more important today with the recent terrorism activity in the United States of September 11 and the declaration of war against terrorists with doctors prescribing antidepressants and anxiety drugs at an alarming rate (according to recently published data) and drug companies "beefing up" advertising in all media for drugs to combat anxiety, depression, fear and insomnia.
In actual fact, prescription drug adverse reactions are the third leading cause of death in America affecting an estimated 200,000 people each year.
Bottom line -
A market driven billion dollar healthcare system lacking government accountability (politically and thorough the public service) - based on an outmoded "disease model" - perpetuated by too many doctors and their organizations who practice "turnstile medicine" also lacking accountability, and dependent on a chemical cocktail of drugs - heavily promoted by drug manufacturers who speak of "putting patients first" but whose prime objectives are increased sales and profits. What is needed is a wellness, health promotion and prevention healthcare model focused on healthy lifestyles including diet, exercise, meaningful patient/consumer support systems, the development of alternative coping skills, and the provision of insured/government coverage for alternative healthcare professionals' services and products.
We all have a right to be concerned! Many millions of dollars are repetitively spent on Standing Committees on Health, Royal Commissions including the current Romanow Commission and Senate Hearings which end up in oblivion. Please do not let this happen with your deliberations. Canadians are counting on you!
Ladies and Gentlemen; The Time for Action and Accountability is Now!
As Senator Lucie Pépin stated in the Senate October 2, 2000 "tragedies such as the one I have experienced must never be repeated". Fortunately I escaped with my life - but $2 million in lost income and assets to date. 20-year-old Christina Constable who died in May 2000 in Abbotsford BC did not. In the 2 month period prior to her death, Christina was prescribed at least a dozen different drugs - including 5 benzodiazepines, 4 antidepressants and 3 antipsychotics. This tragic situation is often repeated in Canada's healthcare system.
This needless devastation of people's lives and their families continues every day in Canada with the continued irresponsible prescribing and uninformed use of benzodiazepines and antidepressants.
To summarize, my specific recommendations and those of my colleagues to this Senate Committee are:
Support/Action/Funding for implementation of my Call to Action - Obstacles/Solutions - 14 key recommendations for much overdue systemic change in the Canadian Healthcare System dated March 2000
Support for my resolution to the Canadian Government dated October 9, 2001 (page 2)
Implementation of the recommendations of the Coroner's Inquest in Ontario in March/April of this year into the death of 15 year old Vanessa Young
These very significant recommendations for Health Canada, the pharmaceutical industry and the doctors' regulatory bodies, the Colleges of Physicians and Surgeons and the College of Family Physicians, responsible for continuing medical education of doctors and the Canadian Medical Association in particular, are not new in respect to drug safety effectiveness and appropriate drug utilization.
They parallel and reiterate my own Call to Action Plan inclusive of the dire need for a national and accountable adverse drug reporting system and a more effective communications and information delivery system for prescription drugs. Quality Healthcare for consumers/patients must be paramount.
For additional comments, input, recommendations re your committee's Volume Four - Issues and Options report on The Health of Canadians - The Federal Role, please refer to Appendix A below.
Joan E. Gadsby
President
Project Leader/Consultant - National Strategic Action Plan - Responsible Prescribing and Informed use of Benzodiazepines and Antidepressants - A Health Promotion and Wellness Initiative.
Vice President, International Benzodiazepines Awareness Network (whose mandate is EARS - education, awareness, research and support).
Author of Internationally endorsed Book "Addiction By Prescription" and Co Executive Producer television documentary "Our Pill Epidemic" - the Shocking Story of a Society Hooked on Drugs.
Note: Materials faxed/provided previously for Senate Committee members include:
March 1, 2001 - letter with attachments to Committee clerk
July 24, 2001 - presentation to World Assembly for Mental Health (17 pages) plus Key Findings
October 9, 2001 - Healthcare recommended resolution to Canadian Government (2 pages)
July 30, 2001 letter to Health Minister Allan Rock from Women's Addiction Foundation
5 letters of support re need for strategic action plan - health promotion and wellness initiative on responsible prescribing and informed use (national, provincial, regional)
Information re my internationally endorsed book "Addiction By Prescription"
Information re my television documentary "Our Pill Epidemic" - the Shocking Story of a Society Hooked on Drugs
May 14, 2001 - National news story "To Hell and Back" which appeared in 8 Southam newspapers.
October 1, 2000 letter to Prime Minister Jean Chrétien with July 2000 proposal to Health Canada.
Most of the above are on website www.benzo.org.uk
APPENDIX A
The Health of Canadians
- The Federal Role
ADDITIONAL COMMENTS, INPUT & RECOMMENDATIONS RE
VOLUME FOUR ISSUES AND OPTIONS INTERIM REPORT
OF THE STANDING SENATE OF CANADA COMMITTEE
ON SOCIAL AFFAIRS, SCIENCE AND TECHNOLOGY
Public Hearing, Vancouver,
British Columbia, Canada
October 18, 2001
APPEARANCE/PRESENTATION TO THE CANADA
STANDING SENATE COMMITTEE ON
SOCIAL AFFAIRS/SCIENCE AND TECHNOLOGY ON THE
STATE OF THE CANADIAN HEALTHCARE SYSTEM
Agree, that the Canadian Healthcare system is "sick" and needs major reform to be quality healthcare, effective, efficient and sustainable.
Agree, that the role of the federal government should be to encourage and promote healthy lifestyles and the prevention of illness - particularly iatrogenic or doctor induced illness from prescription drugs and medical treatment (WHO research results indicate that 33% of diseases today are caused by medical treatments inclusive of inappropriate prescribing).
Millions of dollars can be saved in the Canadian healthcare system with short and long range benefits by redirecting funds to health promotion and wellness initiatives. For every $1 expended, research shows that $8 - $12 can be saved and the quality of life of Canadians significantly improved.
A major "mindset" change is urgently needed amongst politicians, bureaucrats and healthcare service providers to make Canada's healthcare system responsive to consumer/patient needs.
Agree, there should be no more "passing of the buck" or abdication of responsibility from the Federal Department of Health to the Provincial Ministries of Health.
Systemic change is urgently needed in the healthcare delivery system to make it less market driven by pharmaceutical companies and to ensure greater accountability of doctors and other healthcare service organizations and providers.
Lack of accountability by the Federal Department of Health historically and currently, whose mandate is the health and safety of Canadians - with responsibility for the regulation of prescription drugs - approvals and protection of the public from health hazards in the sale and use of prescription drugs including adverse drug reactions, monitoring, reporting and post market surveillance! Full public disclosure is mandatory.
Disagree with the expansion of services for prescription drugs as this relates to Central Nervous System drugs - already the largest therapeutic category of drug expenditures (34% in British Columbia).
Lack of proper prescribing and utilization of prescription drugs as a factor in steadily increasing drug costs and total health care spending (the second largest category after hospitals) is conspicuously missing. There is an urgent need for a national drug utilization information and communications system, published guidelines, usage and prescribing protocols and patterns to ensure safe drug decisions.
There is a significant need for more business skills and "out of the box" thinking in the management and operation of the healthcare delivery system not the "same old, same old".
Primary care needs to be majorly reformed away from "turnstile medicine" and the payment of a fee for services for doctors where "through put" - numbers of patients processed - (mostly with prescription drugs) is the basis of remuneration and not always quality healthcare. It should be inclusive of a multi disciplinary approach, greater responsibility allocated to the nursing profession; other healthcare service providers and non medical professionals such as psychologists.
Strongly support the need for a Patient's Bill of Rights i.e. 11 points as outlined on page 46. - Informed consent is crucial today where historically patients have trusted their doctors "to do no harm".
Support, the need for an independent National Health Care Quality Council.
Support, the need for an independent Citizens' Council on Quality Health Care.
Health care system needs to be client/patient focussed.
Advertising of prescription drugs in medical journals is a question of ethics and needs to be controlled and regulated by an independent public body assessing truth of claims, content, suitability etc with objective agreed upon criteria.
Direct to consumer advertising to expand markets or to create consumer demand needs to be regulated and controlled by an independent public body which sets advertising dollar restrictions, principles and criteria. Promotional dollars of drug companies can be best utilized in sponsoring public awareness forums and health promotion initiatives on appropriate prescribing and use of drugs. Pamphlets, product labelling and inserts detailing uses, side effects, contraindications etc. supported by research can be useful educational tools for doctors and patients.
Control of clinical trials and research funding by pharmaceutical companies who have a vested interest in results, needs to be publicly regulated by an independent body including the publishing of findings in medical journals.
All Universities, Hospitals and Healthcare Centres in receipt of drug company funding for research and programs need to publicly disclose same including all doctors, academic researchers and others whose professional integrity must be paramount in their work/research findings.
Need for ongoing continuing education of doctors on adverse drug effects, clinical guidelines, evidence based research, medical protocols and standards of care must be enforced by doctors' regulatory bodies and medical organizations.
Need to discontinue the payment of millions of taxpayers' dollars to the CMPA (Canadian Medical Protection Association) for liability insurance coverage for doctors against medical malpractice lawsuits unless a similar Legal Action Fund is provided for consumers/patients as Plaintiffs.
Healthcare related research projects including health promotion research projects funded by the Federal Government (e.g. Health Transition Fund, Canadian Institute of Health Research etc) need to be inclusive of other professional disciplines and consumers who can also be adequately compensated for their services in addition to traditional academic researchers and medical/healthcare professionals.
The results of healthcare research projects funded by the Federal Government need to be properly evaluated in terms of outcomes, improvements in the healthcare delivery system impact on doctors' practices and prescribing habits, impact on consumers/patients and be made readily available to the public and disseminated widely.
Leadership, commitment and action are all needed to "fix" Canada's healthcare system and all stakeholders must be involved working together to make a difference.
Joan E. Gadsby · October 18, 2001
Market-Media International Corp.
4507 Cedarcrest Ave., North Vancouver, BC, V7R 3R2, Canada
Phone: (604) 987-6064 Fax: (604) 987-6063
Email Joan E. Gadsby
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