Toronto, Canada (Toronto Star) May 18, 2006

Timid politicians block meaningful changes in the delivery of health care. The major preoccupation of all politicians is to get elected and then re-elected. Everything politicians do is measured in terms of how it affects their chances in upcoming elections.

Governments, both provincial and federal, are involved in many issues: softwood lumber, child care, taxation, tenant-landlord relations, etc. None of these is vital to the great majority of people most of the time.

Health care is different. Sterling Lyon, premier of Manitoba from 1977 to 1981, raised the fee for the Manitoba Health Plan and was soundly defeated in the next election after only one term, a lesson not lost on the other premiers.

Health care affects many people all the time and can, in an emergency, affect anyone at any time. It is an issue that usually is handled with extreme care and that in itself is a major problem. "Better to do nothing than to correct a situation in health care and create turmoil" seems to be the thinking.

We cannot ignore this issue. Drug costs have risen 140 per cent since 1997 and the government spends $3.4 billion on the drug benefit program. With the costs of medical and hospital care rising constantly and with new technologies available, a way must be found to change the system in order to incorporate new technologies while delivering standard care at a lower cost.

The entry point into the health-care system is the family doctor, who performs myriad tasks, some requiring considerable expertise but others that can be done by specially trained pharmacists and nurse practitioners.

These people could be allowed - under strict controls - to diagnose and prescribe treatment for specific illnesses. Even in some medical specialties there are areas where the job can be done by these professions. It goes without saying that these tasks would be performed for a lesser fee. Planning and implementation could be fine-tuned in northern Canada, where doctors are not found in great numbers.

Some doctors now routinely demand a visit to repeat a prescription. Having practised pharmacy for 40 years, it is my opinion that pharmacists could be assigned this job, under certain guidelines, which would save many office visits.

The research-based drug companies are constantly bringing out expensive new chemical agents. The problem is that some of these products are not much different than drugs currently in use at generic prices.

It is estimated that only one in 20 new drugs put on the market is a significant breakthrough. When a new drug comes out, pharmacists could advise doctors on what criterion should be used for abandoning the old therapy and getting on with the new. The money saved could be very significant.

You can rest assured that the medical profession and the research-based drug industry would be very unhappy with health care going in this direction.

But changes must be made in the delivery of health care. What is proposed in this article is now a fact, more or less, in some U.S. states, in Britain and even in some Canadian provinces.

Pharmacists and nurse practitioners involved in these changes (not necessarily everyone in the profession) would need extra training in diagnosis and prescribing.

A myth propagated by the medical profession is that its members are the only people capable of doing these tasks. That is not so and, in fact, many mistakes are made. It is believed that more than 20,000 Canadians die annually because of medical errors and about half of these deaths are due to the overuse or misuse of prescription drugs.

Under current rules, pharmacists today routinely prescribe medicines kept only in the dispensary and are very skilled in detecting mistakes in overdoses and drugs that should not be taken together.

A way has to be found to make the changes to the system that causes the least turmoil for the professions involved. But turmoil there will be, and the question is: Can the politicians take the heat?

Murray Rubin is a retired pharmacist and a former member of the Star's community editorial board.

Source: The Toronto Star