Comparison of an aggressive (U.S.) and a less aggressive (Canadian) policy for cholesterol screening and treatment

Article Abstract:

In recent years, the United States has seen a concerted effort by organized medicine to promote education about cholesterol and its role in heart disease. This approach has included identifying people with high blood cholesterol levels, and treating, with either diet, drugs, or both, those who are perceived to have the greatest risk of heart disease. How much reduction in heart disease can be expected is still unknown. By contrast, in Canada, a far less aggressive approach to the treatment of high cholesterol is the norm. A statistical study was performed to determine the utility or disutility of an aggressive policy regarding the diagnosis and treatment of high cholesterol. Among the factors studied were the impact of labelling a person as 'sick' on the basis of a high blood cholesterol level, and the impact of regular medical check-ups, dietary changes, and drug therapy. If any negative value is assigned to these factors, a conservative approach, like that in Canada, is warranted. Adopting an aggressive approach to the treatment of high cholesterol is problematic, too, in that most studies of cholesterol-lowering efforts have focussed on middle-aged, white males, and the applicability of the results to women and other races is unknown. Aggressive treatment is also more expensive. Until further data on the effectiveness of cholesterol-lowering treatment are available, the Canadian approach, with its more conservative view, seems more justifiable, at least on the basis of statistical utility. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Social aspects, Medical policy, Health policy, Hypercholesterolemia, Medical protocols

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Effect of alpha-interferon treatment in patients with hepatitis B e antigen-positive chronic hepatitis B: a meta-analysis

Article Abstract:

Alpha-interferon may be an effective treatment for chronic hepatitis B virus (HBV) infection in individuals positive for hepatitis B e antigen (HBeAg). Some individuals can be carriers of HBV without developing active hepatitis. A study reviewed 15 articles in the medical literature that examined the use of alpha-interferon to treat chronic HBV infection in individuals positive for HBeAg and hepatitis B surface antigen (HBsAg). Individuals were treated between three and six months with alpha interferon and were followed between six and 12 months. Eight percent of the individuals treated with alpha interferon became negative for HBsAg, compared with 2% of those who were not treated with alpha interferon. Thirty-three percent of the individuals treated with alpha interferon became negative for HBeAg, compared with 12% of those who were not treated.

Health aspects, Drug therapy, Hepatitis B, Interferon alpha

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A survey of provider experiences and perceptions of preferential access to cardiovascular care in Ontario, Canada

Article Abstract:

Some Canadians are receiving preferential treatment for cardiovascular diseases even though their health care system is based on equal access for all. A survey of 788 Canadian family physicians, cardiologists, cardiac surgeons and hospital executives found that 80% of the doctors and 53% of the executives had arranged preferential treatment for some patients. Usually, this was reserved for politicians and other public figures, personal friends and family members, hospital board members and donors to hospital foundations.

Canada, Medical care, Science and technology policy, Ontario, Cardiac patients

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