Medical Research is a Matter of Economic Self Interest

Canadians face a seemingly insurmountable challenge. How are we going to cope with the cost of caring for a rapidly expanding aging population? Approximately 12 percent of Canadians are now over 65, but by 2030, that figure will have rocketed to nearly 25 percent of the population. Today there are approximately 8 people under age 65 for every one over, but by 2030 this is expected to change so that there will be only three people under 65 for each individual over that age. Of these, approximately 1.5 will be taxpayers paying the bill for themselves, their children, and each senior citizen.¹ Since our socialized health care is a pay-as-you-go system, these figures are cause for concern.

The significance of the increasing proportion of the population over 65 is compounded by the fact that per capita health care costs increase with age. Studies show that health care spending for those over 65 is 4.5 times greater than for those younger. Health care for those over 75 is even more costly, 6.7 times greater than for those under 65. The Urban Futures Institute has calculated that whereas today $59 of every $100 spent on health care is spent on the over 45 population, by 2035 this will have escalated to an astonishing $76 out of every $100 of Canada’s health spending.²

In Canada, much of the cost of health care is hidden because the money is taken from general revenue at both the federal and provincial levels. The amount that the federal government pays is concealed completely because it constitutes an unspecified part of the Canadian Health and Social Transfer (CHST). However, data from the Urban Futures Institute and elsewhere make it clear that the demographic shift to an older population brings with it an increase in health spending that may be unsustainable.

Changes must be made if those presently under 40 are to have the type of health care currently provided for seniors when they reach retirement. The system must begin to be funded in such a way that those under 65 start to pay for the care they will need when they are older. This can be done on an individual basis, or by sharing the responsibility through various types of insurance, or, most likely, as a combination of both.

Second, responsible planning for the future requires much more than just figuring out who is going to supply the money to pay the bills. The demand for services must be reduced, yet every- one’s access to high quality care must be maintained. This is probably more important than the issue of funding. The diseases associated with aging must be reduced so that the elderly are healthier and require less expensive care. This is achievable, but it involves much more than just convincing folks not to smoke, encouraging the obese to eat less, and giving prizes to everyone who diligently runs a few kilometres every day—though all these will help. It requires a concentrated effort to cure and prevent the painful, debilitating and expensive diseases that so often come with increased age. Diseases such as osteoporosis, diabetes, arthritis, coronary artery disease, Alzheimer’s Disease and many more must be eliminated from the human experience; this objective is achievable.

In January, two Toronto scientists, Dr. Josef Penninger and Dr. Young-Yun Kong published the results of ground-breaking research. They have discovered the cause of osteoporosis, one of the most devastating diseases of aging. Their research reveals that a gene triggers normal cells within the bone to start chewing healthy bones away, making them more vulnerable to fracture and collapse. Armed with this new experimental knowledge, scientists can begin to develop a mechanism to control the damaging activity, thereby potentially eliminating osteoporosis. Treating hip fractures alone costs over $400 million annually in Canada and it is estimated that soon osteoporosis will cost the Canadian health care system about $1 billion per year.³ With the number of elderly increasing rapidly, it is clear that Penninger’s and Young-Yun’s discovery has the potential to reduce health costs substantially.

In 1922, two other Toronto scientists made a discovery that changed life for millions of people. Banting and Best reported that insulin could be injected into dogs in order to control blood sugar levels. This was the dawn of a new age for the approximately 5 percent of the population who suffer from diabetes. Instead of facing an imminent and unpleasant death, those with this disease were able to lead near normal and productive lives for many years. However, insulin in its many sophisticated forms does not cure diabetes, but merely treats it. People with the disease gradually develop complications such as kidney failure, blindness, coronary artery disease leading to heart attack, and peripheral vascular disease, often requiring the amputation of one or both legs. These are unhappy and extremely expensive effects. Diabetes consumes $6 billion of the $76 billion Canadian health care budget (1997 spending); those most frequently afflicted are the elderly. But as with osteoporosis, recent genetic research indicates that scientists will likely unlock the secrets to curing, not just treating diabetes, within the next 10 years. That will be another 8 percent of the overall health care bill saved.

In Canada about 250,000 people suffer from dementia. Approximately 60 percent of these suffer from Alzheimer’s Disease. This cruel affliction gradually steals the minds of individuals from across the social spectrum. Sufferers eventually lose control of bodily functions and often must be institutionalized for months or years until they pass from this world. The dementing disorders cost the Canadian health care system about $3.9 billion per year.⁴ However, within the past two years a drug has come to market that slows the progress of Alzheimer’s Disease. Similarly, new and better drugs for the treatment of Parkinson’s disease are available. For the first time ever, medical scientists are beginning to understand the pathology that underlies many of the dementing illnesses of the elderly. This understanding is the first step toward treatment, then cure, and eventually prevention of these diseases.

Research into just the three diseases mentioned has the potential to reduce health costs by nearly 15 percent. The cure and prevention of many terrible diseases is within reach, but only if the research is conducted. If the research into osteoporosis, diabetes, Alzheimer’s Disease and coronary artery disease were to stop today, the disease patterns that we currently experience would remain unchanged, and our health care costs would continue to escalate to an unsustainable level over the next 25 years.

Research is needed to develop new drugs and new genetic pathways for controlling and preventing disease, for assessing the long-term effects of these new treatments, and to generally advance our quality of life. Research holds the promise of healthy, active, and intelligent lives for those in retirement. It has the potential to bring health care expenditures to an affordable level. If this research is not done, those presently under 40 face the possibility of unaffordable health care, an old age characterized by disease and debility, and possibly even a slow and painful demise.

Most of the advanced, high technology nations spend more per capita on medical research and development than does Canada. In fact, Austria, France, Japan, Switzerland, the UK, and the US all spend between 2 and 8 times more per capita than Canada.⁵ This country has become an international freeloader, hoping to spend little, and then reap the rewards of other countries’ spending and research. It is time we shouldered our share of the medical research burden. Canada must begin to create real incentives for the funding of medical research and development. After all, for those under 40, it is really just a matter of economic self-interest.

Notes

1R. Chawla, Statistics Canada, “Dependency Ratios,” Canadian Social Trends, Spring 1991.

2Urban Futures Institute, Healthy Choices: Demographics and Health Spending in Canada, 1980 to 2035, Vancouver, BC.

3Osteoporosis Society of BC website, “Osteoporosis—the facts.”

4Canadian Medical Association Journal, 1994, vol. 151, pp. 1457-64.

5OECD Health Data 98, Paris: OECD, 1998.

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Last Modified: Wednesday, October 20, 1999.