Sunday, July 19, 2009

The Grammar Nazi

I've known since day 1 that Sacha is smart as a whip. But he's demonstrated it more frequently since he started speaking. Now, it's official. You can't pass anything by this kid.

I noticed it first the other day when I was reading him his newest "favorite" story. It's about a St. Patrick's Day parade held by ants where they chase a green ant that is a leprechaun to hopefully snag some good luck. I was reading along and said, "'Green ant!' asked Grant." Sacha immediately interceded. "No, no. SAID. Not ASKED. SAID." Oh, yes, how silly of me. "Asked" is used in the next line. He's done this before where he knows a book so well that he'll correct you if you say it wrong. What came later though totally blew me away.

I was reading him a French book about a group of animals that each bring a different part to the party to help build a snowman. It became apparent to Sarah and me that whoever did the translation of this book into French didn't edit it very well because there are a few grammatical errors, one of which went unnoticed until our 3-year old grammar Nazi came along.

A little preamble is in order. In English, no matter whether you have one cat or numerous cats, you would still write "The cat places the carrot as the nose." OR "The cats place the carrot as the nose." The "place" changes to match the subject, but other than that, there is little change. In the case of French, the masculine definitive is "le" as in "the" but only when in reference to a masculine noun (English does not have this gender differentiation of nouns). If it is before a single subject like "chaton" (a single cat) it is "le chaton". If it is before a plural subject like "chatons" (two or more cats) it is "les chatons". You can see how the definitive changes its state to match the quantity of the subject.

So I had read the line "Les chatons place le carrotte pour le nez" numerous times without protests and without noticing anything. Then after correcting me on a few errors earlier on in the book (which I had made due to extreme fatigue) Sacha started to protest vehemently. Previously he had asked me to stop saying "chaton" because he preferred "chat" as he did not feel that this particular feline was worthy of being called a kitten (chaton). I thought that's what this particular protest was about so I said, "Oh, right "Les chats place le carrotte pour le nez"". "No, no, no, only one chat." Then I looked, and sure enough, there it was. The illustration only featured a single cat. Therefore, the phrase "les chats" is grammatically incorrect. And my 3-year old called me AND the editing staff of the book on it. Look out future teachers. You'd better be on your game!

Thursday, July 16, 2009

Seniors drug costs

In preparing for a presentation I'm doing at a local seniors home tomorrow, I had to research the upcoming changes to provincial drug coverage for seniors in Alberta. Basically, drug costs are rising, and the new changes will save THE GOVERNMENT $20-30 million per year, so you can imagine where the difference is going. Low income and mid-low-income seniors will benefit as the lowest income will pay nothing for prescriptions and the next step up will pay less. However, the mid-high income seniors will take on significantly more costs of drug therapy. At first, I thought this seemed rational, given that those more able to pay should bear more of the cost. But then I wondered whether this rule should apply to those who have served their country and communities for so long. Shouldn't WE be taking care of THEM and not vice versa by unloading our costs onto them? Then it got me thinking: which country has some of the highest health expenditures in the world? The United States. Who off loads most of their health spending onto citizens instead of covering it publicly? The United States.

I started to wonder whether we might be going about this the wrong way.

I dug up the comparative drug spending for all 20 OECD nations for the most recent years available, that being 2005. The United States has the highest per capita total expenditure on drugs of all 20 OECD nations. However, they have the second lowest % of that expenditure covered by public programs, second only to Mexico. The US only publicly funds 24% of all drug expenditures. The lowest developed Western nations in terms of total drug expenditure are Denmark, New Zealand, and Norway. Their public coverage of that cost ranges from 55.8-66.2%. Where is Canada? We have the second highest total expenditure and fourth LOWEST public expenditure. So much for universal healthcare.

Now, the thought entered my mind: is there any correlation between the following:

1. % of drug expenditures covered publicly and total drug expenditure
2. % of drug expenditures covered publicly and health system performance
3. % of total drug expenditures and health system performance

A presentation I came across concluded that public funding of healthcare does seem to improve health system performance but a good deal of this performance is tied to lifestyle choices and socioeconomic status as well. Furthermore, the WHO rankings of health care systems are contested by many respectable authorities, but they're all we've got for now. So let's test our theory.

1. The correlation is so close to 0, it might as well not exist. So based on the data I have, it looks like the amount of drugs that are covered publicly does not impact total drug spending. Thus, other factors must be at play like lack of price protection on marketed pharmaceuticals, lifestyle, etc. etc.

2. There seems to be a weak correlation that the less a country spends publicly on drugs, the more poorly their health system is ranked. But this certainly does not prove cause and effect and the relationship is weak.

3. Here a weak correlation would suggest a relationship between increased drug spending and increased health system performance. Again, no causation proved, but food for thought.

Taking all these together, it seems we may be headed in the wrong direction. It seems clear that there is no relationship between offloading drug costs to individuals and the eventual total drug costs of a society. And regardless of whether the government pays for them, those costs will be borne by someone. If it is individuals, they will then have less disposable income, meaning less money to "stimulate" the economy.

Maybe we have to rethink our whole approach to controlling costs. Also in the process of researching this presentation, I came across a study that showed that if used properly, pharmacists could save the Canadian healthcare system $103 million a year. That's just one member in the healthcare team. Think of what we could accomplish if we restructured our system to fully utilize the skills of each of our allied health professionals, with the patient in the centre of the team? Think what we could accomplish if instead of only pushing pharmacotherapy we also focussed on healthy living and preventative medicine? Think what we could accomplish if instead of always thinking about dollars and cents, the government put some consideration into the greater factors at play in rising drug costs? Think what we could accomplish if for a moment our legislators and administrators would do just that....think.

Friday, July 3, 2009

Stark contrast

I drive through a beautiful part of the Peace River valley every morning on my way to work. It is a little flood plain set against the hills of the valley in which lies a farmers field, lush forest, abundant wildlife, and a small residential development that, although within city limits, looks akin to country living. In the fall and winter the field is crawling with deer and the occasional moose. In the spring, it is a collection of roadside creeks channeling the spring runoff into the mighty Peace. And when summer comes, it really pops. There is a plethora of wild roses growing along the road that just recently bloomed. The boreal forest abutting the fields is lush with greenery. So it was with some confusion that I read the articles in the Globe and Mail about the catastrophic drought affecting most of Alberta right now, including the Peace River region. If all I had to rely on was my visual input during the day, I wouldn't believe it. But I talk to my parents, still devoted, hard-working farmers, and I read the data. Large swaths of Alberta have received less than 40% of average precipitation in the last 60 days. Peace River has received only 40-60% of average precipitation.

But why do my eyes deceive me? As I drive through this valley every day, all I can see is the lush green forest. However, I noticed something today. Although the farmer's field of canola looks healthy at first glance, a closer look reveals that the stems are sparsely placed and that the vibrant yellow flower of the canola plant is already in bloom. The end of June? That's not right. How could it be in bloom? The drought. And many fields up here look like this. So it got me to wandering about the abundant greenery adjacent to the field. It was a stark contrast. Amidst this environmental devastation that ranks this June as the driest on Canadian records, this forest thrives. How is this possible?

I don't know enough about industrial agriculture to claim that it is a failure as a Western experiment. But the whole contrast got me wondering. Numerous seedlings germinated in this forest during this horrible drought. The canopy is full of leaves and the wild roses are chalk full of beautiful pink flowers blooming right when they're supposed to. All this with no synthetic fertilizers, herbicides, or pesticides. So is industrial agriculture inefficient? Does it make the very products it grows and sells susceptible to destruction?

What I have found doesn't look good. Consider a forest: it is a self-sustaining ecosystem. If done right, agriculture should at least be sustainable, if not self-sustainable. However, studies have shown over the last many years that the energy efficiency of our food system has drastically declined. The energy output-energy input ratio has gone from around 100 in pre-industrial societies (that is we get 100 calories of food energy out for every 1 calorie of energy put in) to less than 1 in today's agricultural system. And that doesn't even include the transportation of our food which brings this ratio much lower. For example, iceberg lettuce was included in one detailed study that showed we need to put 127 calories IN to produce and ship to source 1 calorie of iceberg lettuce to the consumer. Johns Hopkins University estimates that the average input for 1 calorie of North American food is 3 calories.

How about the farms and crops themselves? A study done in 1989 by the National Research Council concluded that "Well-managed alternative farming systems nearly always use less synthetic chemical pesticides, fertilizers, and antibiotics per unit of production than conventional farms. Reduced use of these inputs lowers production costs and lessens agriculture’s potential for adverse environmental and health effects without decreasing and in some cases increasing per acre crop yields and the productivity of livestock management systems.” The article goes on to state that various studies and agricultural experts have concluded that "small farms almost always produce far more agricultural output per unit area than larger farms...[that] smaller farm sizes are 2 to 10 times more productive per unit acre than larger ones...[that] the smallest farms surveyed in the study, those of 27 acres or less, are more than ten times as productive (in dollar output per acre) than large farms (6,000 acres or more), and extremely small farms (4 acres or less) can be over a hundred times as productive."

Finally, the practice of monoculture, row-on-row planting increases the susceptibility of the crop to environmental calamities like drought and, what farmers are now expecting is the next kick coming to Alberta, grasshoppers. According to the Union of Concerned Scientists, the Southern Corn Leaf Blight in 1970 destroyed 60% of the US corn crop. That was almost 40 years ago now, and already it demonstrates the dangers of monoculture farming.

Is it time for us to reconsider our modern agricultural system? I don't know, but it's certainly got me thinking. Any thoughts?

No surprises here

After watching my own waistline balloon ever since meeting my wife, I was completely unsurprised when I read this study. Apparently, "living with a romantic partner for 1 year or more increased the likelihood of incident obesity by up to 3-fold compared to single/dating individuals. This risk became even stronger for couples who lived together more than 2 years." News flash!