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While we support this legislation, we also strongly support the Ontario government advocating at the national level. All Ontarians, and indeed all Canadians, need a safe and affordable national pharmacare program that would provide equal access to prescription drugs, be publicly funded and controlled, and cover essential drug costs. While provincial governments pay the costs of provincial drug plans and have some regulatory powers, many regulatory powers still rest with the federal government. We hope the Ontario government will play a leadership role in advocating for a national formulary, an independent agency with more rigorous practices for drug approval, patent reform, post-marketing safety monitoring, enhanced controls on drug company advertising, and other measures that would improve our drug regulation regime. And we support a national pharmacare program. The Chair: Thank you, Mr. Freeman. We have a minute or so, beginning with the third party. Ms. Martel: Thank you for being here today. At the bottom of your page 2, I believe, you talk about announcements that are not actually in the bill: the patient representatives in the drug evaluation process and the Citizens' Council. Of course, you're right, they're not in the bill, so one does question the government's priority on this or attachment to this. If those don't appear in the bill, what would be your concerns with respect to the legislation and citizen participation? Mr. Freeman: If those don't actually appear in the bill, especially the patient and citizen representatives, then we don't see why you would have a citizens' committee. They obviously have to be far removed from the drug industry, period. We don't need any influence from the drug companies on that committee. But I believe if that committee and the patient and citizen representatives aren't there, then we have a problem with-- The Chair: Thank you. To the government side. Mr. Peterson: Thank you very much for the presentation. You argue for a national pharmacare system. In Ontario right now, our plan costs about $3.2 billion a year. We would have to spend about $6.4 billion if we wanted to put that across the board. We put in the health care tax, a levy that caused a huge cry amongst everyone about people having to pay and be more accountable for their health care costs. If we increased our taxes to pay for this and tried not to run a deficit, this would force us to tax everyone again almost more than the equivalent of what we've already taxed them. Do you see this as being at all workable for a government to even attempt, to be able to afford a national plan and put it on the backs of current taxpayers? Mr. Freeman: I believe it is. You mentioned the Ontario health tax, but now we're talking about spreading those costs out over, because plaquenil.

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Between 2000 and 2005, the number of stimulant pills sold per child has more than doubled in quebec, according to figures by ims health canada, which tracks prescription trends and irbesartan. From inspection of the results of the survey, the following conclusions are reached: Public sector procurement of medicines in Kuwait appears to be effective and efficient although the reliance on some innovator brands does not seem necessary. Medicines in the private sector are `expensive' in terms of their MPRs calculated with reference to MSH prices and were about twice the corresponding PBS prices on average, suggesting that they are priced higher than is justified. There is a wide range in the MPRs for individual medicines which cannot be explained by simple variation in production and transportation costs. Some medicines including generic products ; would be unaffordable to low-wage nonKuwaiti government workers if they had to purchase them from private retail pharmacies. There is limited generic penetration of the private health sector and generic medicine prices are not significantly lower than the innovator brands, even when multiple generic products are available. Prices of medicines in Kuwait are comparable to a small selection of countries but there is wide variability which calls into question the pricing setting practices of pharmaceutical companies in addition to the customs duties, taxes and margins applied to medicines internationally. There is insufficient data using this methodology to comment on the prices of medicines in Kuwait compared to similar countries in the region or beyond. The openness in medicine pricing in Kuwait and the price regulations to prevent overcharging for medicines is to be commended, but the process could be abused by pharmaceutical companies through practices such as transfer pricing and suitable checks and balances e.g. reference pricing, should be introduced. The potential benefits of generic medicines on national and private out-of-pocket pharmaceutical expenditure are not fully realised in Kuwait. In one study, one third of non-white medical students report hearing racial slurs in medical school.[274] Reported in the article, "Perceptions of Racism by Black Medical Students Attending White Medical Schools, " while only over a half of the students interviewed experienced racism during their high school and college education, 30 out of 31 reported racist experiences in medical school. Twenty-nine of them, "spoke of suppressing anger or being in a state of shock at the environment they found."[275]. Onstrated that the intraventricular administration of NGF increases the ChAT activity in the basal forebrain of neonatal rats Mobley et al., 1989 ; . In adult animals NGF promotes neurotransmitter synthesis by enhancement of ChAT in BF cholinergic neurons Williams et al., 1989; Dekker et al., 1992 ; , probably at both the transcriptional and posttranslational level. NGF action on neurons exerted by regulation of nuclear gene expression is well established e.g. Lorenzi et al., 1992 ; . In addition, increased ChAT expression after NGF treatment correlated with age Williams, 1991 ; . Our data together with the previous reports raise the interesting possibility that availability of NGF plays a critical role in maintenance of phenotype fate of the NGF responsive cholinergic neurons during aging. It seems possible, that following nerve growth factor administration ChAT enzyme levels are reexpressed or increased. Moreover, the present study demonstrated that NGF can restore not only the ChAT expression in BF cholinergic neurons but also their cholinergic projection to the cortex, as shown by AChE histochemical measurement. In untreated aged rats, a number of network of AChE-positive cortical fibers was markedly reduced in the cortical areas. However, after administration of NGF the pattern of cortical AChE activity resembled that of young rats. Therefore, we conclude that, in aged rats, the cholinergic cells are not dying or becoming atrophic but rather are in a quiescent state. The observation that infusion of NGF reverses the quiescent state of cholinergic neurons might suggest that a local deficit of the trophic factor is, at least, partly responsible for deterioration of cholinergic phenotype and cortical projection of those neurons. However, there is no consistent loss of NGF or NGF mRNA during aging or in dementia of Alzheimer's type Hellweg & Hartung, 1990; Hellweg et al., 1990 ; . It is possible that impairment with age of axonal transport, as observed in peripheral Caselli et al., 1999; Lopez et al., 1998; Ma et al., 2000 ; and.

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