MONOPOLY AND ANTI-MONOPOLY:

MEDICINE AND THE PUBLIC DOMAIN:

Considerable controversy has surrounded the idea of "intellectual property rights" in the so-called information age. This sort of monopoly is an obvious one, promoted by private interests, already powerful, and protected and advanced by government. Dozens, perhaps hundreds, of instances have arisen in past years where it was obvious that restricted access to information was detrimental to the public good, and campaigns demanding that free access, especially to research funded by public money, have been prominent in their opposition to restricted access, whether it be to genome sequences or to published scientific papers. See The Union for the Public Domain and IP Watch for more on this issue. Also the Against Monopoly site in our links section.

Down Toronto way there will be a panel discussion tomorrow, sponsored by Open Medicine, Canada's independent open source online medical journal. Here's the announcement. catch it if you can for some interesting ideas.

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Open Medicine presents:

The power of the public domain:

Can improving access to information transform global health?:

A panel discussion with: James Orbinski, Gavin Yamey & James Maskalyk

Tuesday, April 21, 2009

6:30 pm

Free (Donations welcome)

Leslie Dan Pharmacy Building

University of Toronto

144 College Street

Room B150

James Orbinski, MD, MA

James Orbinski is an associate professor at the University of Toronto and author of the national bestseller An Imperfect Offering. He was the International President of Médecins sans Frontières (MSF) in 1999 when it was awarded the Nobel Peace Prize, and co-founded Dignitas International, an organization focused on community-based care and prevention of HIV in the developing world.

James Maskalyk, MD

James Maskalyk is an associate editor of Open Medicine. He practises emergency medicine and is an assistant professor at the University of Toronto Faculty of Medicine. He is the author of the newly published book Six Months in Sudan, which chronicles his humanitarian work with Médecins sans Frontières in 2007.

Gavin Yamey, MD

Gavin Yamey is a senior editor of PLoS Medicine and consulting editor to PLoS Neglected Tropical Diseases. He has written extensively on global health, and has helped to train medical editors at workshops in Barcelona and Addis Ababa. He is on the editorial board of Health and Human Rights and was recently awarded a 2009 Kaiser Foundation Mini-Fellowship in Global Health Reporting.

For more information, please visit OpenMedicine.ca . You can also follow Open Medicine via identi.ca or twitter (openmedicine)

Please help us spread the word!

MEDICINE IN CANADA:

THE POOR GET LESS:

There's an interesting new article in the open publishing Canadian medical journal Open Medicine. The gist of the matter is a massive study on use of medicare in the province of British Columbia, and the conclusion is that, aside from visits to GPs, the lower your income the less service you receive from the medical system but the higher the eventual costs due to emergency in-hospital acre. Hardly astounding, but its nice to see it proved.

The following is the abstract of the article. To read the full article GO TO THIS LINK.

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Income-related inequities: Cross-sectional analyses of the use of medicare services in British Columbia in 1992 and 2002:
Kimberlyn M McGrail
ABSTRACT
Background: The primary demonstration of the principle of income-related equity in Canada is the provision of health care services based on need rather than ability to pay. Despite this principle, Canada, along with other OECD countries, exhibits income-related variations in the use of health care services. This paper extends previous analyses to include surgical day care, assesses changes in income-related equity between 1992 and 2002 in British Columbia and tests the feasibility of using administrative data for general equity analyses.
Methods: Data derive from the BC Linked Health Database and from a custom tabulation of income tax filer data provided by Statistics Canada. Cross-sectional analyses measure inequity in the probability and conditional use of services using concentration indices, which summarize health care services use for individuals ranked by income, after standardization for age, sex, region of residence and need for health care services.
Results: Small but systematic relationships were found between income and use of health care services for all types of services, with the exception of visits to general practitioners (GPs). Lower income is associated with greater conditional use of GPs and greater use of acute inpatient care. Higher income is associated with the greater use of specialist and surgical day care services; the latter inequity was found to grow substantially over time.
Conclusions: Deviations from equity deserve further investigation, especially because the use of day care surgery is continually expanding. For example, an understanding of the reasons for differential admission rates to acute and day surgery might provide insight as to whether community-based services could help shift some acute care use among lower income groups to surgical day care. It is possible to use administrative data to monitor income-related equity, and future research should take advantage of this possibility.

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THE STATE OF MEDICINE:

IS MEDICINE BECOMING CORRUPT:

The following item is taken from the BBC Science and Nature News website. Here in Canadaconcerns such as this have led to the creation of thge online medical journal Open Medicine where both health policy and clinical data are discussed in a atmosphere free of corporate and government interference. Go on over and have a kook.

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Sulston argues for open medicine
By Matt McGrath BBC science correspondent


A Nobel Prize-winning scientist has hit out at what he terms the "moral corruption" of the medical industry.

Britain's Sir John Sulston says that profits are taking precedence over the needs of patients, particularly in the developing world.

He was speaking at the launch of a new research institute into science, ethics and innovation.
Sir John shared the 2002 Nobel Prize for medicine for his work on the genetics controlling cell division.

He is well known for his commitment to public medicine and his opposition to the privatisation of scientific information.

Eight years ago he led the fight to keep the data being derived from the Human Genome Project open and free to any scientist who wanted to use it.

'Fair access'
He says there is now great concern among researchers about private companies patenting genes and genetic tests. He is also concerned about the misuse of information, and what he terms "disease mongering".

He is taking these concerns over the direction that science and medicine are going in, onto a broader stage.

Sir John is to be the chairman of a new UK-based institute that will research the ethical questions raised by science and innovation.

He wants the group to try to provide ground rules and guidance on issues such as the patenting of genes, and how people in developing countries have fair access to medicines.
Sir John believes that our current systems place the needs of shareholders ahead of the needs of patients.

Treaty requirement
The Nobel Laureate told the BBC: "Some people would say it is not corrupt because it is not illegal, and that is true; but I consider that advertising a medicine that doesn't make clear any disadvantages of the medicine, or, in fact, the fact that most people don't need this particular medicine - I would cite, for example, anti-depressants which are hugely oversold, especially in America. This is the sort of thing I mean by corruption. It's not legal corruption; it's moral corruption."

According to Sir John, the world is at a crisis point in terms of getting medicines to sick people, particularly in the developing world.

He says that the world needs an international biomedical treaty to iron out issues over patents and intellectual property.

Sir John is setting up the Institute for Science, Ethics and Innovation with the bioethicist John Harris.

The institute is staging a one-day conference on Saturday called Who Owns Science?

FROM 'OPEN MEDICINE':

NEW PRESCRIPTIONS FOR NEGLECTED DISEASES:

BY JAMES MASKALYK

The online journal Open Medicine has been mentioned previously on these pages. It is basically an alternative medical journal, alternative in format and concept rather than in subject matter. Publication is online and access to its pages is free to anyone registering. The journal was started by ex-members of the Canadian Medical Association Journal after many were fired or quit following a dispute involving editorial freedom and undue outside influence on the journal's contents. Since its inception back in April of this year Open Medicine has posted many new articles, focusing very much on "progressive medicine" with its social ramifications.

A recent article 'New Prescriptions for Neglected Diseases' by James Maskalyk of the medicine faculty at the University of Toronto. has caught my eye. The author discusses the disparity between the availability of medicines in the rich world versus their scarcity in poorer counties with emphasis on Chagas Disease. Not only does Maskalyk point out the glaring disparity, but he also presents some practical solutions to the problem, many of which are now in progress. He talks about the Drugs for Neglected Diseases Initiative and the Pan American Health Organization. He mentions how two researchers in the United Kingdom have done an end run around the patent protection schemes of Big Pharma by formulating a slightly chemically modified form of a therapeutic drug and then patenting it as a new drug while at the same time making its production free to manufacturers in poor countries. The world's only non-profit drug manufacturer, The Institute for OneWorld Health, also in the UK is mentioned as well. This outfit presently has drugs under development for both Chagas Disease and for visceral Leishmaniasis.

All told a very interesting and practical read. Go on over to Open Medicine to see this and many other fine items.

ANNOUNCING 'OPEN MEDICINE':

Beginning in 2001 with an article calling for the decriminalization of possession of small amounts of marijuana for personal use there was a "running dispute" between the editorial board of the Canadian Medical Association Journal and the executive of the CMA. This dispute escalated in 2002 with criticism of an emergency room in Quebec and in Nov, 2005 became more acrimonious when the journal attempted to survey the practice of some pharmacists asking women for their name, address and "sexual history !!!!! before handing over "Plan B", an "over the counter" emergency contraception drug. The Canadian Pharmacists association rose to the defense of the tiny minority of its members and complained citing "privacy concerns" (Molly Note: It seems that some people are totally incapable of shame). The CMA agreed with the CPhA and interfered with the journal's publication of the article. In February 2006 a CMAJ article critical of Health Minister Tony Clement's stand on privatization is replaced by the CMA with more more supportive of the Minister. The same month the CMA begins the firings of the editorial staff of its journal.As time goes on more and more staff resign from the journal. The fired and resigned staff of the journal gains the support of such publications as The Lancet and The New England Journal of Medicine, and the International Council of science Editors criticizes the CMA for its interference in editorial independence. As of May 3rd, 2006 the National Press Club in Ottawa awarded two fired editors of the CMAJ the year's "World Press Freedom Award".

NOW the former editors of the CMAJ have announced the launch of a new "open-access" journal titled 'Open Medicine'.This effort has been joined by a great number of medical editors, not just in Canada but across the world. The articles will be "open access" ie open to the public for free, but all articles will be peer reviewed for quality. The new journal will "be independent of medical society affiliations and will not accept pharmaceutical or medical devise advertising". The new journal will feature not just research articles but will also attempt "to promote international dialogue and collaboration of health issues".

To see what this is all about and to register to receive the journal's email alerts go to http://www.openmedicine.ca

Molly