Don't buy the snake oil

ChatBox AI image created by me

I generally stay out of the fray when it comes to commentary on politicking, so much of which is about as reliable as a snake-oil pitch.

But having caught Pierre Poilievre’s promise of addiction treatment for 50,000 Canadians, paid out of the money that will be saved when safe-supply programs are cut, I just can’t let that blatantly misleading statement stand unchallenged.

First, let’s start with safe supply. That’s the term used for when people are able to swap out their completely unregulated opioid-based street drugs for a prescription opioid from a health professional. It’s the most obvious immediate strategy to stop a toxic drug crisis that has killed 50,000+ Canadians – more than a quarter of them in BC - in the decade since the anesthetic fentanyl began dominating the street drug market.

That Poilievre actually thinks there’s enough money in the country’s teeny-weeny safe-supply response to pay for a major expansion of treatment beds and the cost of putting people into them for three, four or more times through – totally predictable with a relapsing health condition – well, that’s the first glaring sign that this promise is pure snake oil.

Here in BC, we have an estimated 100,000-125,000 people with opioid use disorder. A mere 4,600 of them are on the safe-supply program that BC launched at the start of the pandemic. That’s four per cent of the people who could actually benefit from safe supply.

Elsewhere in Canada, 10 other cities launched pilot safer-supply programs during the pandemic, nine of them in Ontario and one in Fredericton, NB. Federal funding ran out for most of them already.

In the few short years since, the mercurial public mood has shifted toward a view of safe supply as having “failed,” even though it actually barely got a start. So good luck grabbing all that big money invested in safe supply into treatment, Mr. Poilievre.

What really gets me with stuff like this is that a politician's comments are rarely challenged by reporters, leaving the public to assume that there really is some massive government investment in safe supply that can be transferred over to treatment.

I figure that whichever party ends up elected at the end of this month, we’ll get a few more treatment beds. That’s a good thing, because we really need them, along with government funding to support people accessing those beds without having to come up with tens of thousands of dollars multiple times to buy their way into a largely private system of care.

But any new beds will barely make a dint on the actual issues that are troubling the public - one of which is an unregulated drug supply managed in the shadows by international drug cartels that is killing their children, grandchildren, employees, partners, siblings and neighbours; and the other being a multi-faceted crisis of poverty, homelessness and mental illness manifesting ever more ferociously on the streets of our communities.

Substance use is definitely layered into that latter problem. But the main driver of the tragedy unfolding on our streets is poverty, mental illness and a housing crisis. Until we deal with those underlying causes, we’re going to be living with the soul-searing visibility of enormous suffering no matter how many treatment beds come into play.

Safe supply is an easy scapegoat for politicians, I suspect because we’ve been convinced over many decades to view the kind of drugs that end up on our streets as evil. BC’s tiny safe supply program was dealt a very hard blow recently when Premier David Eby got fussed about the supply being diverted into the illicit market, and withdrew people’s right to take their prescription drugs in the privacy of their own home.

Picture how that would go for whatever prescription drugs you might be taking, if suddenly you had to visit your local pharmacy twice a day, within their operating hours, to take your heart drugs, for instance, or use your asthma puffer.

Your job, your family time, your recreation activities – all of that would have to fit around getting yourself to the pharmacy twice a day, every day, to swallow your pills or inject your insulin in front of a health professional. How long would it take any of us to be looking for alternatives on the black market to spare us such misery?

Yes, diversion happens. An issue with safe supply is that it decrees what drugs you can swap onto, and fentanyl isn’t one of them. So some people on safe supply sell whatever drug they’ve been given to get the money for the fentanyl that they actually want.

You can look at that as a failure, I suppose. But toxic substances laced with unknown quantities of fentanyl and fentanyl analogs are now the No. 1 cause of death for British Columbians ages 10 to 59, exacting a massive impact on our collective productivity that is second only to cancer. What could possibly be a bigger failure than that?

So now let’s consider treatment as a “cure” for that failure, as Poilievre wants us to do.

First, the obvious: Many of the people dead in the toxic drug crisis weren’t in need of treatment. They were just average people using drugs for fun – not aberrant behaviour in a country where three-quarters of us consume alcohol regularly. They died because a toxic drug supply doesn’t differentiate between whether you’re a first-time user or an “addict.”

Then there’s also this tricky truth: Treatment for any chronic, relapsing condition is a long, hard slog. Whether it’s Type II diabetes, hypertension, or this thing we call addiction, 40-60 per cent of people will relapse after treatment. They will need many passes through treatment to reach a state of recovery, and some will never get there. Getting to where we need to be in terms of quick access to treatment is going to be expensive, just as it is for any other long-term health care interventions.

People using opioids are particularly vulnerable to dying during a relapse, as their tolerance falls significantly after a period of abstinence. Add in that little ongoing problem of a toxic drug supply - any hope of accessing safe supply during a relapse having evaporated under Poilievre’s plan - and it’s clear that expanding treatment alone will not get us out of this crisis.

And one more tricky truth: Treatment for this thing we call addiction is almost completely owned by the private sector – and increasingly, by multinational corporations and private-equity firms interested in consolidating many small community treatment centres into one big entity that will attract investors. (As is happening with veterinary services, lab services, mental health services, employment training, etc.)

Treatment for substance use problems is outside of the Canada Health Act. Private treatment centres are free to set their own rates and their own methods. If they report on their effectiveness at all, the data collection stops the moment a person leaves the centre. A person could relapse within hours of “graduating” and still be counted as a success.

The lack of transparency and absence of meaningful data collection leaves us with scarce knowledge to prove or disprove the effectiveness of any treatment approach. Nobody can actually say what’s working, or what happens once someone leaves a treatment facility in a state of abstinence and walks out into the big world where all their troubles await.

We simply don’t know how many times people relapse, because we don’t measure or track. We don’t know how long an individual stays abstinent after a round of treatment. There are no national standards for treatment. No followup.

So yes, let’s talk treatment. It’s a pillar of any health-care approach, as is access to regulated medications. But please don’t buy the snake oil.

Lessons from the UnitedHealthcare murder: Yes, CEOs, that's blood on your hands

Pixabay: Valentime AI

I was in Philadelphia visiting family last month when UnitedHealthcare CEO Brian Thompson was shot dead on a Manhattan street in a carefully planned execution. The instant roar of approval that united an otherwise starkly divided America in the days and weeks that followed has been a notable reminder that people are feeling a little done these days.

Like everyone who has written about Thompson’s murder, I want to stress that in no way do I condone street executions. I’m sorry that he got killed, and that a young man whose own path seemed quite promising felt compelled to take such drastic action.

At the same time, I’m awed by the powerful rage that the shooting brought out in people, and the major conversations it is sparking. (I, too, burn with fury at what the CEO class has gotten away with, though I’d like to think I’d never settle it with a gun.) The killing lit a fire under the issue of health-care claim denials in a way that a thousand of the most heart-breaking tales of life shattered by a claim denied could never do.

When terrible things are happening to ill people with no hope of seeing justice done, how can anyone be surprised when a CEO at one of the most prolific claim-denying companies ends up killed?

It’s no way to settle scores in a civil society. I really hope we don’t start murdering each other. But that’s not to deny the power of Luigi Mangione’s alleged bullets to open up an urgently needed public conversation in the U.S. on the brutal outcomes when people’s health is pitted against ruthless corporate profiteering.

The U.S. health care system is so profit-oriented that the first thing a typical American has to think about when they get sick or injured is how much it’s going to cost them. Polling by Gallup earlier this year found half of U.S. adults reporting it was difficult to afford health care costs.

One in four said they’d skipped or postponed needed health care in the previous 12 months because of the cost. Two-thirds said they went without care to escape the expense.

Until Thompson’s murder woke up the health insurance industry around just much they’re despised, one of United Healthcare’s competitors was busy setting new time limits in three states on how long a person could be under anesthesia before the insurance coverage would run out. (Anthem Blue Cross Blue Shield reversed that decision after Thompson’s death.)

A dozen years ago, my partner and I lived in Honduras for the better part of three years. Justice never got done officially in Honduras, which had a four per cent criminal conviction rate.

So it was rough justice in all directions at that time. People got killed in the street and at their homes for all kinds of reasons as citizens and gangs settled up debts, grudges and issues requiring vengence, rightly or wrongly. (But there was always a reason; Hondurans were completely baffled by the random gun violence going on in the US.) 

Honduras came to my mind immediately when I heard the news of Thompson’s death.

What CEOs feared in Honduras in our time there was kidnappings. Every now and then I’d imagine how it must have felt to be a CEO in Honduras, with your kids being driven to school by guys with guns and the constant threat of something scary happening to you or someone you loved. I’m sure it must feel deeply wrong for a person who considers themselves law-abiding to experience that.

But I really hope that the Manhattan killing prompts deep soul-searching among a class of business executives who have divorced themselves from the moral impact of their business decisions. If Thompson’s death impacts such decisions in the future because CEOs start worrying that they might get killed, that would not be a bad outcome.

There’s no arguing that corporations cause the rest of us harm routinely in the course of doing business. Our governments are helpless before them, compromised by their vast economic power and political donations, and not nearly smart enough to catch corporations out on all the ways they’ve figured out to maximize profits.

What does justice look like for people irreparably harmed by corporate actions? Right now, it looks like a CEO killed in cold blood and the lionizing of the young man charged with the murder.

The ongoing rage of the American people after the killing of Thompson has not abated. Expert after expert has weighed in with comments that are prefaced with their abhorrence of the murder, but follow with a big “…but on the other hand…” analysis contextualizing the public’s fury.

In a recent poll surveying 1,000 people in 50 states, a fifth said Thompson’s killer bore only a little or no responsibility at all for his death. Almost 70 per cent put the bulk of responsibility for the killing on the health-care insurance companies that deny claims.

But of course, Thompson wasn’t doing anything illegal when he ran his company hard on health-care claims. His shareholders and his big bosses might have loved him for it.

Yet millions of Americans have died, grown sicker or been bankrupted by the decisions of their health-care insurance providers. One study found that 36 per cent of the Americans surveyed had had at least one claim denied, and most of them had been denied multiple times.

What justice exists in such a system? Most companies would have an appeal process for individuals, but this 2023 ProPublica article says the appeal rate is one per cent. There’s court, but that’s money and time that few have. In truth, Americans have virtually no chance of justice against corporate decision-making around health care, yet their very lives are being ripped apart by the corporate direction being set by men like Thompson.

I could hear the hurt feelings in the voices of the CEOs quoted after Thompson’s death. Most sounded completely taken aback that people could hate them that much. It was as though their gilded life had shielded them from the harsh fact that yes, it WAS their fault that people were being killed, sickened and bankrupted by corporate policies and decisions under their direction.

That’s the takeaway that I hope lingers on in the reverberations that the murder has set off. CEOs need to internalize that when the corporation they run is routinely hurting people in order to create profit, they carry the burden of responsibility. The rule of law breaks down in societies where there is no hope of seeing justice done, and they should know that all eyes are ultimately going to be on them.

In one sense, Thompson was an innocent man that day he got murdered. But in another, he wasn’t. Let that be a cautionary tale to CEOs who still can’t see the connection between their executive actions and the mayhem on the ground.

Crazy-making cuts instantly increase government costs

The funny thing about the current government is that I often agree with what they say. It’s what they do that makes me crazy.
For instance, here’s the premier in an interview with the Times Colonist last week: "I think it's really important for people to understand that the costs of our health-care system are staggering, frankly.”
Indeed. Health eats up 42 cents of every dollar the government spends. Premier, you’ll get no argument from me on that.
But on the very day that Gordon Campbell was saying that, his government was preparing to eliminate birth-control options for women and men living in poverty, who will soon lose access to IUDs and condoms. It was taking away $50 glucometers from people on income assistance who have diabetes, needed to measure their blood sugar every day. It was cancelling funding for a little plastic adapter that makes it easier for people with asthma to use their inhalers.
And I’m left to wonder: Hey, guys, what the heck are you thinking? And how on Earth did your talk ever come to be quite so far away from your walk?
“Who did they consult? Certainly not a doctor I could ever imagine,” says Dr. Danica Gleave, a Cool Aid Health Centre physician who predicts dire repercussions from the health cuts to people on income assistance. “It just baffles me. These are people who have no backup, no other resources.”
Looks like they didn’t fly the plan past the provincial health officer, either. Asked this week about the cuts, Dr. Perry Kendall wondered whether a cost-benefit analysis had been done. “The impact should be monitored, as this may turn out to be counterproductive to health and budgets in the longer run,” he noted.
Hopefully a journalism teacher has latched onto the press release announcing the cuts. It’s a fine example of modern-day propaganda. (As was Budget 2010; there must be a new communications mandate that all bad things are to be restated as good.)
The headline: “Province protects services for low-income clients.” The opening paragraph: Changes will be implemented “in a manner that is fair to all British Columbians and supports children and families.” The cuts to birth control, glucometers and asthma adapters are needed to “ensure these programs will be available to meet the most medically essential needs of clients.”
Well, except for impoverished people in their fertile years, diabetics and asthmatics. And the ones who no longer qualify for “ready-made” orthotics - insoles, braces and the like, which have also been cut. Oh, and the ones with HIV, hanging onto their health with the help of $20 worth of bottled water every month.
Doctors at the Cool Aid centre typically prescribe IUDs to at least a dozen women on income assistance a week, says Gleave.
“We see all kinds of women who benefit from an IUD - sex workers, people with developmental disabilities, people who have behavioural issues that make it hard for them to be compliant with taking a pill every day. These cuts are being made on the backs of the most vulnerable people,” she says.
“The cuts will result in an increased number of unwanted pregnancies. It will increase emergency-room visits for people with asthma. Every diabetic needs to have a glucometer - it’s a huge safety issue for insulin-dependent people. We’re robbing Peter to pay Paul.”
There are no savings to be had by denying access to IUDs, says Island Sexual Health executive director Bobbi Turner.
“The IUD is the most cost-effective form of birth control out there. Something like the Copper T costs $60 and lasts three to five years,” says Turner. “IUDs are not part of the ‘compassion program’ that drug companies have to provide free birth-control pills to these women, so this change cuts off a really effective form of birth control.”
I tried to get Health Minister Kevin Falcon to talk to me about this, because it’s obvious that the cuts in Rich Coleman’s Ministry of Housing and Social Development will increase health costs almost immediately. But it appears the government doesn’t like to talk about such things, because I just ended up routed back to the MHSD communications staff.
Maybe I should try for Mary Polak next over at the Ministry of Children and Family Development. The cuts ultimately mean more kids in care for the women who end up pregnant. But she’s probably too distracted right now, what with the $12.3 million in community cuts already going on for non-aboriginal children and families served by her ministry.
Or maybe just straight to the top. Premier, do you really want to get a handle on health-care spending? You have to know you’re never going to get there this way.

Stereotypes getting in way of good care for seniors

This is a column about my mom, and the crazy things that can happen when you take ill at 83.
My mother is a retired nurse who has done everything right in terms of looking after her health all these years. Despite mobility challenges since being hit by a car in a crosswalk seven years ago, she’s still very much a “tough old broad,” as a friend once described her.
But as our family has now come to see, in the eyes of our depersonalized and harried health-care system, she’s just Old Person No. 347,050 on a very long list. And from what she’s been hearing from her friends, that’s just how it is once you cross some invisible line into old age.
She has no chronic health conditions. She isn’t on any long-term medication. Up until two months ago, she was travelling, cooking dinner for one friend or another virtually every night she was home, and was an active, engaged community volunteer.
Then we went on a family holiday to Tofino in June. She got too much sun one day and went to bed feeling sick. Perhaps she slept too heavily on her bad arm - the accident left her with a broken shoulder and severe limitations in the use of her right arm. At any rate, she awoke the next day with major pain in her arm.
It’s been one strange ride ever since, starting with the prescription drug she was given to reduce inflammation - which lived up to its potential to cause “a general feeling of illness” as one of its side-effects.
By the time she figured that out and quit the drug, she’d developed blood-sugar problems and was showing diabetes-like symptoms. (With any luck, that was a side-effect of the drug as well, because they’ve since stopped.)
And wouldn’t you know it, my mother’s trusted family doctor retired just as all of this got underway. That put her into the care of the doctor who’d just bought the practice.
They’d never met before my mother came in about the pain in her arm. The physician knew nothing of the vigorous, active woman my mother had been just a few days earlier, and didn’t bother to ask. I’m guessing the doctor just saw a tired, sick 83-year-old with a bum shoulder - one who had yet to come to grips with her pain and illness as the byproducts of aging.
OK, I get that. So does my mom. She recognizes that she’s in the countdown. She won’t be looking for medical heroics when her time comes.
But there’s a fine line between expecting people to accept the aging process and relegating them to assembly-line care that presumes they’ll soon be dead anyway. That’s how it has felt for my mother these past two months.
Her saga was complicated by a much-anticipated cruise to Alaska in early July, which she desperately wanted to go on. The x-ray of her shoulder found nothing untoward and the doctors didn’t seem too interested in exploring the issue further, so she mustered her strength to go on the cruise. She still didn’t know whether the diabetes-like problems she’d experienced were a reaction to the anti-inflammatory she’d taken, but figured results from the blood-sugar tests would be ready when she returned.
And they were. But by then she’d caught some terrible flu-like thing that had morphed into a secondary bronchial infection, as had her sister on the final days of the cruise. (Could it be swine flu? My mother is on Day 21 of what she describes as the worst illness of her life, and nobody has even suggested she be tested for it.)
So the bronchial infection was the more pressing issue by the time she got home. In B.C., you’re only allowed one health concern per visit these days when you go to the doctor, which meant her doctor listened to her chest but then refused to review her blood-sugar results until a later appointment.
Her active life has ground to a halt over the past two months. Depression crept in. Fortunately, all those friends she cooks for have come through for her. And the really good news is that so much time has passed since her arm first started to hurt that the original problem appears to have resolved itself. I think she’s going to be fine.
I wouldn’t say the system failed her; she got drugs, tests and an x-ray. But all of it came grudgingly, as if done just to silence a frail old lady who hadn’t come to grips with her own mortality. Come on, docs - look past those aging bodies to the people who are still very much alive inside them.