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Archive for June, 2010

I’m fascinated by recent media articles celebrating Father’s Day and the things Dads do (or should do). One story I read was particularly moving – it described the Bruce Feeler story. The author cum founder of the Council of Dads. In it he describes how his life threatening illness put him in the delicate position of facing death and having to find surrogate ‘Dads’ for his twin daughters. He invited a half dozen of his friends and they all said yes to his invitation to help raise his daughters should he die. The story is important because it underscores the real need for a father and how this figures in the lives of children.

Having worked hard over the years to help raise awareness on the issue of access for non custodial parents – the greatest percentage being male, I helped to change the laws on custody and access for non-custodial parents in the mid-nineties and am proud to say that many Dads benefitted from this. The truth of the matter is that non custodial parents (mostly Dads) tend not to be not a fruitful part of the their children’s lives as a result of the turmoil of their marriage breakdown and then the emotional upset as a result of the battle between divorcing parents. The loss of Dad in these scenarios is often the case and the real losers are the children who are robbed of the benefit of Dad. I met a fellow the other day who will be doing business with us and his story was so sad. He painfully detailed the hardship of not being able to see his two boys. He made an interesting comment wherein he said that the ‘system’ (as he calls it – which is the courts and/or mediators) often makes mom the custodial parent and he described it that he moves out of the house and out of the children’s lives and mom is ok with that. “Just get rid of me”, he said, “they get on with life as if I was never there in the first place and they seem to think that’s ok – but it’s ripping my heart out”, he said.

It’s awful to hear stories like this, but there is help and there are good stories, I would venture to say.

Men have a hard time openly addressing the issues they have and face at the best of times. We’re not taught to emote well. Add in the pressure, stress and emotion of a family breakdown and it’s worse. It’s not good for the children of these situations either.

Another story that is equally moving is Dan Hill’s story in the National Post “Rallying Cry for Real Fathers”. In it he details is relationship with his own father and other strong father figures including CFL football legend Pinball Clemons , with whom I have had the honour of interacting over the years . What Hill’s essay outlines is the power of strong father figures. In any culture or race or economic situation – it’s important and necessary to have Dad as part of their children’s lives.

My wife and I talk about the importance of being a father often and my role in our children’s’ lives. Our children rush to the door every time I arrive from work, but in a few short years they may not even lift their heads to say hello when I come home. She and I want to make certain that doesn’t happen. Our vigilance in making sure that Dad is always present and a major force in their lives is what’s going to make the difference in our childrens’ lives.

At the writing of this blog, I am in Northern British Columbia with several dozen men at a remote fishing club. We are all fathers and there are two very important things that I have experienced here. There is a Dad who has brought his 13 year old son here to have a week of fishing with him for the boy’s birthday. This Dad has done this with his other sons when they turned 13 and it’s this Dad’s way of bonding with and being a major influence in his sons’ lives. The other interesting thing is that all the guides (men of course) have other professions that they do in the off season. Our guide, a macho stoic on the water, who can balance himself in 12 foot high waves while setting our deep sea reels on a 25 foot Boston whaler that I am sharing with two other men, is a gem. Dan is his name, he’s a grade three teacher in Nanaimo when he’s not a fishing guide from June to September way up here near Alaska. He’s a hero to me – the kind of hero that should be ‘lionized’ like Dan Hill has described in his essay. Dan talks openly about wanting to help shape the lives of young boys and girls who need a strong male leader in their classrooms.

Maybe a Council of Dads, more Dan Hills, Pinball Clemons’ and more Dan the fishing guides are what our fast moving society needs or maybe every family should take Father’s Day and reflect on Dad! The point is being a Dad is a privilege and one that should never be discounted, over-looked, treated casually, thrown away or denied – by Dad, Mom, ‘the system’ or anyone.

- Marc Kealey
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Pharmacy and integrated Health

Sunday, June 20, 2010 @ 06:06 PM

The regulations reflecting the revisions to the Transparent Drug System for Patients Act in Ontario have been approved by the government of Ontario and are now posted.
The reaction by pharmacy organizations was predictable. They hate what the government has done and in so doing, they want to hold patients (especially seniors and the chronically ill – as they say) hostage in the process.

Not surprisingly the business sections of major daily newspapers have reacted by issuing a reduced strike price for publicly traded pharmacy organizations and in some cases have downgraded some organizations to a “hold” on their stocks.

In all, it’s a bad start for the retail pharmacy guys who could have come out of this exercise as the real champions in an integrated health care system, currently en vogue worldwide.

As a frequent speaker across Canada on drug reform, I’ve heard from large and small organizations seeking to wade through the confusion on drug benefit plans and formulary management issues with real answers. The Ontario government has stated that it wants transparency on all drug prices plain and simple. It has passed the legislation to do that and posted the regulations that reflect it. The fight is now over! Or at least it should be. What is pharmacy doing? It’s threatening to cut back on services that make patients better. Not good.

Concessions on the regulations governing the Drug Act in Ontario have been made by government and I like to think that some of us whose voice for the effective role of pharmacist in integrated health care was heard – the role of pharmacist has been made more effective. I only hope that pharmacy can see this and cut back on the vitriol.
We still have a lot of work to do to encourage government in Ontario to increase the cognitive service fee they offer to pharmacists and we can start today by encouraging other governments in Canada to realize the ROI on effective pharmacist services to patients.

- Marc Kealey
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The Liberal NDP merger.

Wednesday, June 16, 2010 @ 08:06 AM

Ask any young person about politics and they’ll say don’t care! Better than that they might say, “don’t care, don’t give a shit”! This is a sad commentary on politics today.

The reason why fewer that 55% of Canadians bothered to vote in the last federal election and why more and more Canadians are voicing displeasure with the politicians is because they (the voters) feel helpless and unengaged.

I joined the Liberal Party when I was 14 years old. In the past 35 years, I have enjoyed the experience of fighting no fewer than 15 provincial and federal elections combined, 7 leadership conventions, two leadership reviews and myriad policy conferences. Suffice to say, I am a child of MY Party. The sad fact today is that it means a hill of beans.

My political mentor John Turner, for whom I worked, laments that the democratization of parliament is an issue second only to the bolstering of policies and ingratiation of Party faithful. These people own the Party, NOT the bunch of appointed flacks who serve the Leader of the Party. The recent private discussions that have been undertaken by old flacks in some secluded spots in Ottawa are a symptom of a larger problem for the Liberal Party how to re-engage Liberals or attract new ones.

Instead of a re-evaluation of this option, these wiley old timers seek to merge the oldest political brand in Canada with a left wing rump. Let’s face it the NDP will never assume power in Canada’s federal parliament, nor were they ever expected to – they were, however, a Party who’s philosophies and policies embraced that of a true perpetual opposition. Not so with the Liberals. This is a Party that bore most of the social policy reforms that have made Canada a tour de force internationally.

A discussion of a merger at this juncture should be taken for what it really is a cynical attempt to wrest power through mathematics. The Liberal Party on its own has neither the leadership nor the voter appeal at this point to become government. Perhaps a deal with the NDP to gain power now might be a possibility but ask Bob Rae if this benefitted him in Ontario in 1985.

The simple fact is this – the appointed flacks in the Leaders office, the unelected Senate members who claim to be the conscience of the Party, the advisors and consultants who skulk around Ottawa are NOT the Liberal Party. It is the hundreds of thousands of Party faithful across this great land who believe in the philosophies of Wilfrid Laurier, MacKenzie King, Louis St. Laurent, Mike Pearson, Pierre Trudeau, John Turner, Jean Chretien, Paul Martin and others. It is also the Party of great thinkers like Vincent Massey, Norman Lambert, Gordon Fogo, Gordon Dryden, Boyd Upper, Walter Gordon, James Scott, Keith Davey, Al Graham, Norm Macleod, Martin Connell, Maurice Sauvé, Paul Desrocher, Iona Campagnolo and many other great Liberal thinkers across Canada who have perfected the Liberal brand.

There is no cross road here, the silly talks about a merger should be outed for what they are a frustration at the current prospects of a Party in disarray, with little attraction from voters. If the attempt is to increase a paltry 25% voter approval for a leader no one wants – then following that logic, what does a Conservative PM do at 32% – who does he merge with???

Let¹s get smart all you Liberals say something!

- Marc Kealey
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The Waterloo worriers

Tuesday, June 15, 2010 @ 08:06 AM

I’m not shocked that the University of Waterloo Warrior Football team has caused a yearlong suspension over this recent steroid kerfuffle. Neither should any followers of Canadian University football.

Over the past several years, the increase in the talent and the style of play in CIAU football has increased enormously. Any casual observer of Canadian inter-scholastic football can see powerhouses emerging. Football mad fans in the province of Quebec love their teams in Laval and the Eastern Townships. Once horrible Ontario based teams (unfortunately like my alma mater U of W) are now becoming home to really good football players. New football stadiums are springing up and programs are getting better fan base here. The western teams have always had the support of their universities and fan base and we’ve seen a huge boon in Atlantic Canadian university football programs with those behemoths that play at St. Mary’s for example.

So, it’s little wonder that a scandal would eventually break – the stakes are high. Prospects for CFL drafts notwithstanding, many Canadian football players can see benefit in post graduate opportunities as a consequence of football in universities and potential professional playing opportunities in other leagues in the US and Europe post graduation.
Here’s the rub though, the football program at U of W, for example, is a costly venture for the university. The university doesn’t have the fan support or donor support that, say, McMaster University or Western or Queens have – so the prospect of the complete loss of the program at Waterloo could be a realization that may occur as a result of some idiotic players who decided on their own that enhancement by nefarious means might have worked. Wrong!

I love my football at Waterloo, I love the program and the coaches are extraordinarily dedicated to the craft. Let’s hope this year on the sidelines gives pause to players to manage their skill through legitimate means and not off the street – or that’s where they’ll stay.

- Marc Kealey
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Major media outlets have covered the legislative process quite fairly over the past few months as the government of Ontario has moved to stabilize drug prices in Canada’s biggest province.  Nothing new here, the costs of public sector formularies have been increasing at anywhere between 5% to 15% annually.  When I was CEO of the Ontario Pharmacists’ Association, I implored the Board at the time to work with government and insisted that we play the Pharmacist as health care provider card when tackling the issues associated with the original reform brought in by the McGuinty Liberals in 2006.  The tack we took was to demonstrate the value of pharmacists and the work they do in community pharmacy, long term care pharmacy, specialty pharmacy and hospitals across the province.

The initial legislative framework (Bill 102) had taken draconian and, frankly, chaos inducing steps to transform the drug program in Ontario. The steps we took in 2006 to counter these moves proved fruitful and beneficial to pharmacy and pharmacists.  In fact, the initial financial impact of Bill 102 was some $680 million dollars out of pharmacy.  Our efforts at Ontario Pharmacists’ Association, at the time, was to appeal to the issue of fairness, integration in healthcare, a new reimbursement model and the use of collaborative efforts such as Information Technology to increase competition among pharmacies.  Our efforts paid off and instead of the initial $680 million dollar hit, we got back in programs and other concessions some $450 million dollars.  The unintended consequence of these efforts was the establishment of a two-tiered drug pricing regime that has taken hold across the country.   This means that private sector plans would pay more for the exact same drug and services as provided to public sector plan members (ODB for example).

In the ensuing years after Bill 102 was passed as the Transparent Drug System for Patients Act (TDSPA), the government has moved to integrate pharmacists into their health teams with minimal uptake from the pharmacy sector.   The Meds Check program which was announced coincidentally to the TDSPA was supposed to provide some $50 million dollars to pharmacists to provide extra service to patients on their drug regimens.  The program was initially a success, but pharmacy more or less blew it off in many parts of the province.  The Pharmacy Council, which was also announced in the TDSPA has now become a joke.

In the ensuing years since the TDSPA was made law, there have been charges laid against pharmacies, wholesalers and manufacturers for fudging required reporting to the Ontario Public Drug Program’s Executive Officer. The Canadian Association of Change Drug Stores (CACDS), which is the de-facto negotiating body for pharmacy, or the Ontario Pharmacists’ Association have barely attempted to licit potential models that could benefit patients and the customers they serve with ways to improve the  drug system. This  noted, quarter after quarter publicly traded pharmacy
organizations have seen average double digit profits  this in an era of economic austerity.

The trouble is that patients, plan members, formulary designers and public drug plan providers remained afflicted with cost increases. In the TDSPA there is a provision that the government will review the Act every 2 years.  Last summer (2009) the then Minister of Health in Ontario announced a review of the TDSPA.  Stakeholders were invited to provide their views on how to better the system.

Many stakeholders took the process seriously.  It was sad to see that pharmacy did not. When the government moved to enact legislation in 2010, it seemed to take pharmacy by surprise and they reacted with faux indignation. In fact, had they been more engaged , more attuned to the needs and wants of the patients and customers they purport to cherish, they world not have used them as pawns in this massive game of chess that they have lost so publicly.

The latest polls have suggested that Ontarians overwhelming (some 93%) support the government’s initiative. So enough bitching.  Here’s the deal  pharmacy should stop immediately their diatribes on how they will be forced to make very difficult choices “as they evaluate the level of care they provide to all patients, especially seniors and the chronically ill”.  It is sad to see that THIS rhetoric would be their response rather than engaging the public in a dialogue about an increase in cognitive services fees.

The government has announced some $100 million dollars in cognitive service fees with an additional amount for Meds Check and diabetes management.  In an era where medical models of treatment are becoming teams (like a Family Health Team) pharmacists can and should integrate themselves into these models.  This could prompt a call for an additional, say, $300 to $400 million in cognitive services fees.  Who’s leading these pharmacy organizations? They seem to have hit every stupid button and made asses of themselves throughout this whole process.  The sad reality here is that instead of looking to modernize an antiquated drug distribution process and embracing the trend of integrated healthcare, these pharmacy organization seem to think that the patients and consumers and shareholders they purport to care about are treated like lemmings and  will, unfortunately, continue to fight  to their own bitter end.

- Marc Kealey
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