Tuesday, February 26, 2008

Pleasant surprise

Although many have criticized the 2008 federal budget as boring and offering little of interest to taxpayers, I would argue that it is those very characteristics that makes it prudent especially considering the current economic environment. However, one exciting piece of the budget that was missed by many, but not by my favorite personal finance columnist, Rob Carrick at the Globe and Mail, is what is being called a TFSA or tax free savings account. It is like an RRSP for savings outside of retirement. For the breakdown of what it means and how it works, check out Canadian Capitalist and the article by Mr. Carrick.

Sunday, February 24, 2008

Smart idea

I came across this article by Stephen Brunt in the Globe and Mail and it has led me down the path toward a new obsession. Intelligence Squared U.S. is a spin off of the original Intelligence Squared, started in the United Kingdom, also home to the Oxford Union, the historical debating society at the university by the same name. The purpose of IQ2, as it is known, is to bring together intellectuals and have them publicly debate a controversial issue, like whether aid to Africa does more harm than good or whether America should be the world's policeman. While this is not new, both the format of the debate and the marketing of it are welcome.

First of all, the format: it is roughly based on the original Oxford debating style. At the beginning the moderator presents the resolution to be debated and introduces those arguing for and against the motion. The audience is given the opportunity to vote on the motion before hearing any arguments. Then each individual, alternating between each side, is given a chance to summarize their arguments. The brilliance is that they are the ONLY ones allowed to speak and do have their time limited and are cut off if they go over. After all presenters have spoken, the audience is able to ask questions which the moderator well, um, moderates, but the back and forth is fairly open. Finally the presenters are then allowed to close their arguments, once again time limited and on their own. At the end the audience again votes and the debaters get to see which side wins the day.

The marketing is great for us intellenerds too. You can download the podcasts from the National Public Radio website which is great. I listen to the bloody things while I run on my elliptical. My wife does not understand how I can have enough adrenalin to run for 30 minutes while listening to intellectual debates but it helps me keep both my mind and body healthy. Ah, what can I say...I'm a hopeless nerd?

Anyways, the real reason I love this stuff is that it gives me hope that debate can actually be civil and effective. Have you seen any leaders debates in Canada over the last 5 years? They are a disgrace to the art of debate. All that happens is the leaders shout at each other and dodge questions. It accomplishes nothing, changes no ones minds, and diminishes public trust in politicians and therefore public involvement in the democratic process. Can you imagine if they used the Oxford format for a leaders debate? The leaders would all shiver in their boots because they would actually have to formulate intellectual, effectual, and articulate arguments for their policy platforms and effective rebuttals to questions raised about their positions.

Of course, the TV networks host the debates, and intellectual discourse doesn't draw viewers. Or does it? The live debates of IQ2 U.S. sell out well in advance. Maybe there is more demand for this sort of thing than we think. I hope so.

Monday, February 18, 2008

Of interest

Just a quick note on something I came across. The results of a very interesting study were published in The American Journal of Public Health recently. Entitled "Characteristics of Recipients of Free Prescription Drug Samples", the study aimed to find out whether drug samples were serving the noble purpose put upon them by their staunchest defenders, the companies that give them out. That is, do those most in need most frequently receive drug samples, or the data point to a more nefarious motive behind free samples? This study seems to bear out the latter. Poor people were less likely than rich people to receive samples as were those without health insurance compared to those with health insurance. There you have it: free drug samples are not a benevolent public service provided by philanthropic pharmaceutical companies. Considering American pharmaceutical companies spend upwards of $16-billion a year on samples alone, it stands to reason that they are merely another arm of the massive marketing machine that aims only to sell more and more drugs.

Childhood bipolar disorder

This weekend there was an article in the Globe and Mail talking about the increasing prevalence of childhood bipolar disorder. The whole thing did not sit well with me, so below is a letter I sent to the editor in hopes it will be published. If not, at least you will read it!

Since research and development is so expensive, a new tactic used by pharmaceutical companies to increase revenue is to 'invent' medical conditions or to 'redefine' an existing medical condition so that existing drugs are used more frequently. The most glaring example of this is pre-menstrual dysphoric disorder. Similar to childhood bipolar disorder, it is a condition nonexistent in Europe and although it is recognized as a psychiatric disease in the diagnostic manual used by North American psychiatrists, it is not considered as a disease by the World Health Organization International Classification of Diseases. Is this happening here? Joseph Biederman, mentioned in this article as a supporter of this new diagnosis, has received research support from or served on a speaker's bureau or advisory board of fourteen drug companies. As for the Canadian Attention Deficit/Hyperactivity Disorder Alliance Resource, questions should be asked about their main sources of sponsorship. The only three sponsors listed on their website are Eli Lilly, Janssen-Ortho, and Shire. Lilly makes Strattera, a popular ADHD drug and one being pushed for use in another "new" disease, adult ADHD. Janssen-Ortho makes Concerta, one of the top selling forms of methylphenidate, previously known only as Ritalin. Shire makes Adderall XR, another ADHD drug. The bottom line is that psychiatry is a field into which the tendrils of pharma penetrate deeply. Careful when searching for information in this field as a layperson. When all else fails, look to Europe for guidance. For some reason they seem to be immune to this whole mess.

What do you think of this issue? Is Childhood Bipolar Disorder a legitimate condition? Does Pharma have too much influence on disease definitions? Have your say by leaving a comment.

Thursday, February 14, 2008

Putty

Without going into details, of the 18 months I have been with my current employer, this week surely ranks as the worst. Long story short, a physician we deal with made a real bonehead decision and caused astronomical chaos and headaches. So it was with great pleasure I witnessed the development of a new habit in our son.

When I come home from work all of my worries melt away because I get to see my beautiful wife and my incredible son. This week was no exception, except now Sacha does this thing that turns my heart into putty. When I walk in the door I can hear him running around being silly. I say "Hello?" and all of a sudden all is still and quiet. Sarah, in French, says "Who's here?". I then here frantic footsteps bounding toward the door. When Sacha comes around the corner and sees daddy in the porch he smiles from ear to ear, falls on the floor in a heap of pure joy and does what can only be described as an epileptic happy dance. It is so adorable. It is like he is just so excited to see me that the only way he can truly express his excitement is by aimlessly flailing his body about in a fit of glee.

The stress and chaos of even the worst day would not stand a chance against such a profuse display of love.

Monday, February 11, 2008

A lost art

I am one who mourns the loss of public speech as an art form. I cannot attest to the rousing recitations of days past by such masters as John F. Kennedy, Martin Luther King Jr., Pierre Trudeau, and others as they were before my time. But apparently there was a time where leaders were elected not by how many dollars they promised to the electorate but by how much hope they inspired in those voting for them. I sometimes find it hard to believe, but do long for such a time to return.

Roy MacGregor, one of the best Globe and Mail columnists, reports that Ed Stelmach, the incumbent Alberta premier aiming to maintain his party's 37 year rule in an upcoming election, can "pull boredom out of thin air". You can call Honest Ed a lot of things, but charismatic he is not and inspire a crowd he cannot. And then there is Stephen Harper, the Canadian prime minister who, besides being a control freak couldn't speak his way out of a wet paper bag. And the misery doesn't stop at those in power. St├ęphane Dion, the federal Liberal party leader is barely functional in one official language and I have been told he is not much more inspiring in his mother tongue.

But you move down south and you have emerging a new movement that treats intelligent discourse and inspiring oration as noble pursuits. I think it all started for me when I saw Keith Olbermann lambaste George W. Bush on national television. Then I read about Intelligence Squared US, a series of public debates broadcast on National Public Radio that deals with major issues and pits those for and against each motion in a sophisticated debate style taken from the Oxford Union.

And then you have the new guy: Barack Obama. He has inspired comparisons to JFK. His relative youth and inexperience has more or less been forgotten by the American electorate due to his ability to speak publicly and uplift all those listening. He has not only brought back public speaking as an art form (even going so far as to resurrect soapbox style town halls) but he has given Americans reason to hope and redefined the American Dream in modern terms. His speaking ability is so profound that many Americans have decided not to closely analyze some of his policy stances, for good or bad.

As Rick Mercer stated, the inspiring nature of Barack's speaking style has gotten young people involved in the chaotic and disastrous process that is the American presidential primary system. Here in Canada, with its relatively simple electoral process, young people have all but checked out. And I cannot blame them. Have you seen what is up on offer of late? I can only hope that soon a gifted speaker will emerge on the Canadian political scene and bring this lost art back north of the 49th. Maybe then my peers will find reason to get involved in the democratic process. Here's hoping Rex Murphy will decide to run for PM. Go Rex!

Sunday, February 10, 2008

What's there to lose?

You may notice my new widget at the top of the blog. It is a plug for Kiva, a charitable organization that I have just discovered and thought more people should know about.

Kiva works on the principles of microcredit. You may recall reading about microcredit in 2006. That is when the founder of a major microcredit organization, Muhammad Yunus, was given the Nobel Peace Prize for advancing the concept of microcredit.

Essentially, microcredit is the provision of small loans to entrepreneurs in third world countries to help them finance their businesses. Through provision of these small loans, these entrepreneurs are able to grow their enterprises and lift themselves out of abject poverty.

So where does Kiva come in? Think about it: if you were inclined to lend your money to a third world entrepreneur how would you go about finding one? Furthermore, consider all of the potential barriers to getting your cash to that person and than getting it back in repayment. It is just too much to consider and so the idea would never take off. Plus, the big financial institutions are not going to get involved because the amounts involved are just too small and they consider such borrowers to be much too high risk.

Kiva basically connects lenders (you and me) with entrepreneurs and facilitates the transfer of money. The entrepreneurs register with local microcredit organizations who then partner with Kiva. The entrepreneurs are screened so as to ensure maximum probability of repayment. Their businesses, personal profile, and fundraising goals are all listed on Kiva.org. If you find someone you think will benefit from your cash you can lend them as little as $25. It is all done online through PayPal (who waive their normal fees in this case).

Once the contributions from you and other lenders around the world reach the goal, the money is then given to the entrepreneur by the microcredit organization. The repayment agreement then starts. So in the case of the Azerbaijani man I lent $25 to grow his hardware store, he has 10 months to pay back the $1500 he received in total and each month he is supposed to pay back a portion of that. The credit organization does require the borrower to pay them interest, the specific percentage of which is stated in each organization's profile on Kiva.org. However, as a lender, you do not get to charge interest. It is just too legally complex. But you do get all your principal back. When it is repaid you can choose to then give it to another entrepreneur or withdraw it.

Brilliant right? But what if the borrower defaults on the loan? Well in the case of Kiva, if an entrepreneur you lend to defaults, you are just plain unlucky. They've lent over $25 million since inception and the default rate is only 0.14%. That is pretty good. Human nature won the day with me though, so I decided that $25 was a good start to test the waters.

Anyways, thought people would be interested in this. What do you think of the idea?

Much too smart

As reported by my beautiful wife Mrs. Mustard, we celebrated Mass last evening with other married couples who are celebrating a significant anniversary this year (that being any anniversary ending in 0 or 5 or any past 50). I'm not sure if the whole event brought to light how grateful she is that I wake up with Sacha EVERY morning and let her sleep until 8, but my wife decided to try and get up with him to let me sleep in.

You see, Sacha feels it is unacceptable for Mommy to get up with him, because she is home all day every day, while Daddy is only home all day two days a week. So he has previously fought any notion of forgoing his daddytime with fierce determination. But Mommy had a plan. She told him that it was only Mommy this morning, implying that maybe Daddy was already at work.

At first it seemed he had been tricked and I could actually sleep past 6:30am. But then he saw my watch and ring lying around and pointed them out to mommy, implying that their presence suggested discordance with the story he'd been told. Exhibit B: my boots. If daddy's boots are in the porch, how can he possibly be at work? Hmmm. I'm not sure what the last straw was, but it was likely one of the many pieces of paternal paraphernalia strewn about the house suggesting to Sacha that if they were here, I must be as well.

Down he went out of mommy's hands and made a beeline straight to the bedroom door. He started knocking ever so politely, upon which the door opened and he realized that his suspicions were correct. There lay daddy in bed, basking in the glory of a sleep that lasted until 8am, even if its potential length had been truncated by a brilliant toddler.

Thursday, February 7, 2008

Dear Ed: Call in the Norwegians

With an election set for March 3 in my home province of Alberta, I'm settling in to election mode. Unfortunately for me I cannot vote, because I am currently a resident of inferior Ontario. Boo. Oh well. At least I can comment from the sidelines.

First of all, I must be realistic and relinquish any hopes that my dear New Democrats will make many gains. A friend of my wife, Duane Petluk, is running in Little Bow. In 2004 the Alberta Alliance, Social Credit Party, and Separation Party all got more votes than the NDP. Ouch. And with all likelihood, although they may lose some ground, the Tories will maintain majority power.

So I am left appealing to Ed Stelmach, who as a farmer of Ukrainian descent must have inherent frugality.

Dear Ed: (we farmers prefer informal greetings)

I am concerned with your handling of the oil sands boom. With reserves second only to those of Saudi Arabia, and its placement within a stable Western democracy, the oil from Alberta is coveted the world over. And with oil prices at historic highs, Alberta has never been more wealthy. But what are we doing with all this wealth? We are squandering it on short term solutions, vote buying, and cockeyed gimmicks. Why not take a page from the Norwegians book?

"Frugal Norway", as the Globe and Mail calls them, have not only found a way to benefit from their North Sea oil riches, but they have also prevented these riches from causing excessive inflationary pressures at home, something at which Alberta is failing miserably. The service industry cannot find workers, and prices are through the roof, thanks to our monolithic economy.

The Norwegians are brighter. They created the "oil fund", a massive $370 billion government pension fund surpassed in value only by the Japanese government pension fund and Chinese foreign exchange reserve fund, both worth around $1 trillion. When this fund makes investment decisions, be they based on financial or ethical principles, the business world sits up and takes notes.

Where does it all come from? Every oil company drilling Norwegian oil must give 78% of their profits to the fund. That makes your small increase in royalties paid to Alberta seem amateur. But the real genius lies in what they do with the money.

The fund holds enough money to give each Norwegian $75 000 (in comparison, the Alberta Heritage Fund has a paltry $4500 per person). So they could do like the Alaskans or the Albertans and dole out "prosperity" cheques. But those crafty Scandinavians created the Management Rule, the guiding principle behind management of the oil fund. First of all, the Norwegian government must save 96% of that money paid by the oil companies. NONE of that can be touched until all the oil is gone. Now that's saving for a rainy day! But it doesn't matter because all of that money is invested in Norway anyway, right?

Dead wrong. Unlike isolationist Alberta, longing for Eastern bastards to freeze in the dark, Norway has made it a mandate of the oil fund that not a single cent shall be invested within the country. Have they gone mad, you say? Not at all. Not investing the money created by oil in Norway means the oil boom barely impacts the Norwegian economy, at least not negatively.

When the Dutch discovered oil, the ensuing economic boom actually caused massive inflation and job loss. A similar experience in Britain left the economy in shambles. Alberta is well on its way down this road. But in Norway, due to their genius economic planning, the non-oil sector is currently growing at a healthy 7% per year, outperforming oil and gas exports even! They've planned AND diversified their economy.

But the taxes....ohhhh, the taxes. Yes Ed, Norwegians pay some of the highest taxes in the world. However, their ability to plan ahead, spend and save smart, and work collaboratively as legislators, instead of wasting time hurling epithets across the legislature, means Norwegians have some of the highest disposable incomes of any people (even the poor share the wealth). Only 2 percent of their people are unemployed and their quality of life ratings put Canada to shame.

So if you think for a second that the "invisible hand" of market forces will guide Alberta to everlasting prosperity, think again. The rich resource upon which our great province sits must be extracted under the guidance of enlightened leadership. A true leader will aim for wealth while responsibly protecting the natural beauty of the land we are all proud to call home. A true leader will ensure that this wealth benefits all Albertans, not just the oil executives and very rich. And a true leader will realize that this resource is for the benefit of future generations and aim to secure their prosperity.

It won't be easy. You will likely pay a great political price to exercise true leadership. But in the end, all Albertans, present and future, will remember you for doing so.

So do it now Ed, call in the Norwegians and learn some lessons. And then show us all what you're made of.

Your homesick friend,

Pharmadaddy

Wednesday, February 6, 2008

Losing sleep

The official verdict has been rendered: Heath Ledger died from an overdose of prescription medications. The Globe and Mail reports that Ledger died "as the result of acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam and doxylamine”. If Mr. Ledger was receiving all of those medications legitimately from one physician and one pharmacy, some questions need to be asked. If, however, he was obtaining these medications "on the street" as is often the case with prescription drug abuse, then it only serves to add heft to the warnings of the medical community against illicit use of these medications.

I too often see multiple benzodiazepines (BZDs), a drug class of which diazepam, temazepam, and alprazolam are members, prescribed by physicians. There is no good reason to do this and is exceedingly dangerous. BZDs are safe if used properly but very dangerous when used in combination with excessive alcohol, other sedating drugs (like those mentioned above), each other, or illicit substances. The fact that Mr. Ledger was on THREE is very unfortunate. As well, he was on two very potent opioid painkillers (morphine-like drugs), hydrocodone and oxycodone. Using two different formulations of one opioid is common in chronic pain, but using these two drugs together, given their addictive and potentially dangerous properties, suggests they were being used non-therapeutically, which is increasingly common. These combined with three BZDs is a cocktail incompatible with life.

But how does one get addicted to sleep and pain medications? The causes of the ever increasing abuse of prescription painkillers and sleep aids is multi-factorial. However, the pharmaceutical industry is partially to blame. As it is in their best financial interests, they work very hard to market pharmacotherapy as the best option for treatment of insomnia. They go further to inflate the prevalence of insomnia, a tactic brilliantly documented in Selling Sickness: How the World's Biggest Pharmaceutical Companies are Turning Us All Into Patients.

The fear and frenzy the Ledger story caused amidst the sleep aid using public led to many calls to the American Academy of Sleep Medicine. Thankfully, they used this as an opportunity to reiterate their guidelines on the treatment of insomnia, which include warnings against combining these medications and advice to use behavioral treatments in some cases to treat insomnia. (As a side note, insomnia in and of itself is rare; insomnia is most often a symptom of some underlying condition so treatment with sleep aids should be short lived while the underlying cause is addressed).

Unfortunately, such balanced statements cannot possibly compete against the juggernaut that is pharmaceutical marketing. If you need evidence as to this, check out PharmedOut and PerxInfo. PharmedOut has links to videos of drug reps discussing their sneaky tactics as well as links to objective drug information. PerxInfo is a site created by the US state attorneys general. The money for the program comes from Pfizer, but not in the form you'd think. They paid a $430 million USD settlement after the US Food and Drug Administration charged them with promoting their drug Neurontin for unapproved uses. This happens more than you might think.

The New York Times reported last week that Eli Lilly is considering settling with federal prosecutors by paying a $1 billion fine. That's almost a third of their annual profit, so what could they have done to deserve this? Turns out company documents show that they were actively promoting their blockbuster antipsychotic Zyprexa for unapproved uses from 2000-2003.

Not in Canada you say? Biovail, a Canadian pharmaceutical company, revealed it is being investigated by a US grand jury for improper marketing of its drug Cardizem LA. They were paying doctors in the US $1000 if they prescribed the drug. Even doctor's office managers got $150.

What about companies pushing sleep meds and painkillers? In July 2007, PurduePharma, makers of Oxycontin (oxycodone, which Ledger was taking), one of the most addictive painkillers on the market and an extremely popular street drug, was fined over $600m by US courts. This was for misleading physicians and the public about the addictive nature of the drug, even going so far as to claim that it was barely addicting at all, and certainly no more than other painkillers, which is a load.

And finally we get to the National Sleep Foundation. This organization aims to "educate" the public on the prevalence of sleep problems and their consequences. The .org domain would lead one to believe that the NSF is a benevolent charitable organization, as would the calls for donations. Bruno Maddox reports in Discover magazine that while the NSF does receive funding from individual donations, the majority actually comes from pharmaceutical companies, which would explain why one of their stated objectives is "educating" healthcare professionals. In the 2007 fiscal year, the NSF received $2.4m in funding. Of that, at least $1.6m came from pharmaceutical companies, most or all of which manufacturer medications used for sleep. Of course, this money is then used not only to "educate" but to give research grants under the guise of a benign foundation. And we all know that research grants from pharmaceutical companies have no bearing on research results.

Which all goes to show, in my long winded manner, that you should always assess the risks of any medication, seek out OBJECTIVE information, and NEVER, EVER use prescription medications that were not prescribed to you by a licensed healthcare practitioner. Just because they are marketed pharmaceuticals, doesn't mean they are safe to get off the street. Oh, and next time your doctor wants to try you on "the latest greatest thing" he heard about from his drug rep, politely decline his offer and stick with what is working.