ZOOMER Magazine - - FRONT PAGE - By Wanda Mor­ris

MY SON, who has taken a few phi­los­o­phy cour­ses at uni­ver­sity, re­cently shared a clas­sic ethics prob­lem with me. In the Trol­ley Prob­lem, a ru­n­away trol­ley car­riage speeds down a track to­ward five peo­ple tied to its rails. You can throw a switch to di­vert the trol­ley to an­other track. But if you do, one per­son on the other track will be struck and killed.

For sim­plic­ity’s sake, there are only two choices:

1 Do noth­ing, and the ru­n­away trol­ley kills the five peo­ple on the main track.

2 Flip the switch and di­vert the trol­ley onto the side track, where it will kill one per­son.

I’m grate­ful I can leave this de­ci­sion to stu­dents of ethics. But the re­al­ity is that we or at least our gov­ern­ments make thorny eth­i­cal de­ci­sions like this ev­ery day.

Take the ex­am­ple of Stren­siq, a drug that treats hy­pophos­phata­sia (HPP), a rare ge­netic dis­or­der in­volv­ing ab­nor­mal bone devel­op­ment that is se­verely de­bil­i­tat­ing in chil­dren or adults and fa­tal in in­fants.

A drug trial of 11 chil­dren with HPP delivered mirac­u­lous-sound­ing re­sults. As chil­dren’s bones hard­ened, they be­gan crawl­ing, tak­ing ten­ta­tive steps or walk­ing.

So how does a feel-good story be­come a trol­ley prob­lem? It comes down to costs. An an­nual pre­scrip­tion for Stren­siq can cost $500,000 and reach $1 mil­lion, and it must be taken in­def­i­nitely to pre­vent symp­toms from re­turn­ing.

Ear­lier this year, the al­liance that ne­go­ti­ates drug prices for Ot­tawa and the prov­inces agreed to fund Stren­siq for those who be­gin tak­ing the drug be­fore they reach 18, not­ing that ev­i­dence is not strong enough to sup­port pay­ing for treat­ment start­ing later in life.

As fewer than 100 peo­ple in Canada have HPP, ap­proval of this drug won’t break the bank. But the de­ci­sion opens the door to fund­ing other high-cost med­i­ca­tions. And that means tough de­ci­sions will have to be made.

It is pos­si­ble for gov­ern­ments to get elected by promis­ing more ser­vices in ex­change for higher taxes, but it’s not an easy sell. In­stead, money spent on cer­tain pro­grams, whether im­proved tran­sit or more long-term care beds means fewer dol­lars avail­able to spend else­where.

There’s no ques­tion that in­vest­ing in high-cost drugs saves lives and im­proves qual­ity of liv­ing, but the eth­i­cal ques­tion re­mains: is this the best use of th­ese funds?

The difficulty in mak­ing th­ese de­ci­sions is likely one rea­son Canada, alone among all coun­tries with univer­sal health care, lacks univer­sal pharmacare. As of March 31, 2016, there were 10,946 unique drugs ap­proved for sale by Health Canada; no one is sug­gest­ing that even the most ro­bust of pharmacare pro­grams would cover all of them.

But fail­ing to in­tro­duce pharmacare is caus­ing real harm now. Ac­cord­ing to a July 2017 sur­vey of our mem­bers, eight per cent have con­sid­er­able or ex­treme difficulty fi­nanc­ing their med­i­ca­tions, while 25 per cent have some difficulty. In all, six per cent of CARP mem­bers re­ported not fill­ing a pre­scrip­tion in the past two years due to cost. Im­ple­ment­ing pharmacare means no one has to choose be­tween food, shelter and med­i­ca­tion. It also means pol­icy set­ters have to say no to drugs where they be­lieve ben­e­fits do not jus­tify costs.

Pharmacare ap­pears to be on the agenda once again. At the time of writ­ing, On­tario is in elec­tion mode: the NDP have com­mit­ted to pharmacare for all ages while the Lib­eral party would ex­tend their cur­rent pro­gram (which pro­vides free med­i­ca­tions to those un­der 18) to those who are 65 and older. The On­tario Pro­gres­sive Con­ser­va­tives have so far been silent as to whether they would re­tain, ex­pand or elim­i­nate cur­rent drug cov­er­age pro­grams.

In its re­cent bud­get, the fed­eral gov­ern­ment com­mit­ted to a na­tional di­a­logue on im­ple­ment­ing pharmacare, and the House of Commons Health Com­mit­tee re­cently is­sued a re­port rec­om­mend­ing the cre­ation of a sin­gle-payer, pub­licly funded pre­scrip­tion drug cov­er­age pro­gram for all Cana­di­ans.

If we want our gov­ern­ment to in­tro­duce univer­sal pharmacare and en­sure med­i­ca­tion is ac­ces­si­ble, af­ford­able and ap­pro­pri­ate for all Cana­di­ans, we must have the gov­ern­ment’s back when they an­a­lyze drug costs and ben­e­fits and make the tough de­ci­sions that will make pharmacare work. For more in­for­ma­tion, go to pharmacare.

Wanda Mor­ris is VP of Ad­vo­cacy at CARP and writes a weekly Post Me­dia col­umn “Grey Matters.” You can find them at

In a July poll of CARP mem­bers, 86 per cent agree or strongly agree that the same drugs should be cov­ered by provin­cial drug plans across Canada

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