“Want to hear the joke about insulin?” goes the bleak gag about America’s drug prices. “You have to go to Canada to get it.”
But even that’s not an option anymore.
Pandemic travel restrictions have made Americans prisoners of their country. Even within North America, Mexico and Canada have closed thousands of kilometres of border to all but essential travel, roiling plans for vacation, work, and school. For cash-strapped Americans, it has also cut off access to medicines and health-care services that they can’t afford at home — at a time when money is tighter than ever.
Stephanie Boland’s nine-year-old son was diagnosed with diabetes in December. Travelling to Canada to fill his insulin prescription took a half-day’s drive from where they live in Brainerd, Minnesota, but it was worth it — the purchase was a simple, over-the-counter affair. One pack of injection pens, which would last several months, cost less than a hundred dollars, she says, compared to a list price of $530 at home.
As their son’s disease began to rewrite the routines of daily life, the Bolands planned to cross into Canada again to restock. Then the pandemic hit.
Boland, a masseuse, was forced to stop working. Her husband, a self-employed financial adviser, found his income hit by pandemic-related turbulence in the markets, too. Then their source for affordable insulin vanished behind a border that had never been closed before in the history of U.S.-Canada relations.
“We were going to make a trip north, one more trip in March, but then they closed the border,” she said.
BUYING INSULIN ABROAD
Only 1.5% of American adults who take prescription medications buy their drugs abroad, according to a June analysis by researchers at the University of Florida Gainesville, based on a 2015-2017 National Health Interview Survey.
But that’s still an estimated 2.3 million people.
Many medicines and medical services are cheaper in neighbouring Canada and Mexico, thanks to price controls and the power of the U.S. dollar. The difference is great enough that U.S. insurer PEHP, which covers Utah’s state employees, offers partially paid trips to Vancouver and Tijuana “to help you save money on your prescriptions.”
In popular Mexican resort towns like Cabo San Lucas on the West Coast, or Tulum on the East Coast, pharmacies, doctors and dentists targeting U.S. clientele dot the main drag, their prices on bright display. And the difference between those prices and the costs of the same drugs at U.S. pharmacies can mean life or death.
No drug is a better-known example of that calculus than insulin, a vital hormone in the body’s metabolism. Seven million American diabetics don’t produce it naturally — or not enough of it — and need to inject it throughout the day. Without it, dangerous levels of glucose build up in the blood, damaging organs and producing a painful stupor. In a worst case scenario, lack of insulin can kill within three days.
Americans have been going to Canada for insulin since scientists learned how to produce it in labs at the University of Toronto in 1921. One of the first patients to try it was an American: Elizabeth Hughes, the teenage daughter of then-U.S. Secretary of State Charles Evans Hughes.
“I’m so happy and elated,” she wrote in a letter to her mother from Canada, describing her first self-injection and the “enormous” meal she enjoyed afterward. Before crossing the border, the 15-year-old had managed her condition by starving herself — the only life-prolonging trick available to diabetics before insulin. Five feet tall, she weighed only 45 pounds.
A hundred years later, and after national soul-searching over the soaring cost of insulin, some Americans are still starving themselves. Daniel Carlisle, a Type 1 diabetic in Texas, has sometimes tried not to eat for days at a time, in an attempt to ration insulin. When he was 18 and short on cash, he even contemplated robbing a pharmacy, he says.
“I always do the math about how many days’ supply of insulin I have in the refrigerator,” the 60-year-old Texan says.
“That’s how I know my lifespan at that point. My lifespan is measured in exactly how many days’ worth of insulin I have in hand — plus three days.”
For the past three years, buying insulin in Mexico has brought Carlisle security.
His trips started with a split tooth in 2017. “I went to a dentist near where I live, and he said he could repair it for like $10,000,” says Carlisle, who is uninsured. “So I told him, ‘Look I can’t afford to send my kids to Harvard. Sure can’t afford to send yours.”
He tried to ignore his aching tooth, but at the urging of his family, eventually drove several hundred kilometres south from his home in Houston to the busy Mexican town of Nuevo Progreso.
“As soon as you come across the bridges, hawkers are saying “Need a dentist? Need a pharmacy? It’s just constant,” he says. First he got his tooth fixed — a root canal, bridge and crown altogether would end up costing him just $750. “The dentists aren’t marble palaces, but they’re clean,” he says.
Then he dipped into a pharmacy to ask the price of a vial of Humalog insulin, one of two kinds he takes. The answer: US$70. He checked the expiration date on the box, and then offered $20.
“You’ve got to negotiate!” he says. “I just tell them I’ll die without it and then they’ll lose a customer. They don’t put up a fuss.”
A vial of the same insulin in the U.S. has a list price of $274.70.
Since then, that’s the only place where he buys insulin, Carlisle says, and he’s never had a problem with its quality. But with the borders closed, he doesn’t expect be back any time soon.
A VAST GREY AREA
Pharmacy staff in several drugstores in border towns in both Canada and Mexico tell CNN that they’ve seen significant drops in foot traffic since their countries’ borders with the U.S. closed. Though American scofflaws have been accused of crossing into Mexico for nonessential errands, overall border crossings have plummeted.
One young man working at a pharmacy near Tijuana told CNN that business had fallen about 40% since the border closed. He asked to remain anonymous because he was not authorized to speak about the business.
Technically, bringing prescription drugs into the U.S. is illegal. But the U.S. Food and Drug Administration (FDA) has created a grey area for small amounts: Importation “might” be allowed, according to the agency’s website, if the medicine doesn’t exceed a three month supply.
Staff at Mark’s Marine Pharmacy in Vancouver, Canada, less than an hour’s drive from the U.S. border, typically fill hundreds of orders for U.S. customers each day, general manager Jordan Rosenblatt says, and rarely have any problem shipping it. With the borders closed, online ordering has spiked, he adds.
Reviews over the years on their Facebook page compare prices of all kinds of prescription drugs to those in the U.S., with commenters from as far as New Jersey and Texas. “They sell and send me my asthma inhalers at a price that is non-predatory, unlike here in the U.S. Happiest gal today! Thank you!” reads one.
But ordering online isn’t for everyone — there is always a risk that the medicine will be confiscated or that temperature-sensitive drugs like insulin could go bad waiting at customs or in U.S. Postal Service delays.
And as the frustrations of border closures highlight, foreign health systems make a poor fallback no matter how you access them.
“For any given individual in the short run, going to Canada is a decent solution, but it’s not a systemic solution,” says Dr. Vikas Saini, a Harvard-trained cardiologist and president of the Lown Institute, a nonpartisan health-care think tank.
U.S. President Donald Trump has called to allow larger scale importation from Canada, among a raft of recent proposals to reduce the prices of certain U.S. drugs. But that’s unlikely to make a dent in the U.S. market, Saini says: “Canada is a country of about 30 million people. It doesn’t have enough medication to provide all those prescriptions for the U.S. — a nation 10 times the size.”
Some Canadian health industry groups and patients agree. Since 2019, they’ve warned that Trump’s importation plan could lead to drug shortages for Canadians — a fear likely sharpened after witnessing global shortages of vital medical equipment in the early months of the COVID-19 pandemic.
A CRUMBLING ECONOMY
As the pandemic wears on, the options are dwindling for Americans who can’t afford to be sick in the United States — especially after the cratering economy erased nearly 13 million jobs, taking health insurance options with them.
Even at Canadian prices, some are struggling to pay for their prescriptions. “Recently, we’re hearing about all the financial issues of people laid off,” says Rosenblatt, the Vancouver pharmacy manager. “We have American customers that have been working with us for years, and under these circumstances, we’ve sent what they needed and we tell them, ‘Pay us when you can.'”
To make insulin more accessible, some U.S. states have pushed for price caps on copays. The three companies which control the U.S. insulin market offer discount plans, including new programs to which Americans who were financially impacted by the pandemic can apply for temporary access to cheaper or free insulin. And Walmart offers cheap insulin over the counter (though this is an older formulation that can make blood sugar management more complicated than newer, prescription versions.)
Yet many are still struggling — and not just the nearly 28 million Americans who don’t have health insurance, a number estimated by the Kaiser Family Foundation. Even Americans with health insurance, who benefit from negotiated prices that are lower than the list prices, sometimes still can’t afford all the costs of living with diabetes.
In Dayton, Ohio, Mindi Patterson’s family gets health insurance through her job as a Costco clerk. But even then, keeping up with the cost of insulin for both of her teenage sons and her husband is still a tightrope walk. “We have had to dig through the trash for (discarded) reservoirs from insulin pumps, when we haven’t had the money to buy the next bit of supplies,” she says.
“Right now I have a refill for (my son’s) insulin waiting, but I really don’t have the funds just yet to pick it up. So they’re holding onto it for me until payday,” she said.
Sabrina Renaud, a 22-year-old dietary aide in South Carolina, works fulltime at a hospital that offers health insurance to employees — but she earns about $1,300 per month after taxes, and says she simply can’t afford the deductible, premiums, and copays of the company plan and still make rent. “So I thought, I’m just going to have to wiggle through this without health insurance,” she says.
Renaud hasn’t seen a doctor to renew her insulin prescription in more than a year. Instead, every couple of months, she messages a woman she’s never met in real life, with a list of what she needs. So far, the life-saving supplies she needs keep turning up in the mail.
The woman, who asked to remain anonymous because redistributing prescription drugs is illegal, tells CNN that she has shipped insulin to hundreds of people over the years — an effort that she describes as a “necessary evil.” People from the U.S. and abroad send spare vials and injection pens to her, and she says she sends them for free to any American who asks for it.
“I personally do this, gosh, an average of four times per week,” she says.
“I could put out a tweet right now that someone needs (insulin brand) Humalog, and I’ll probably get 100 responses saying “I have extra,” from all over the country,” she says. “Folks are willing to pay $50 to overnight it to someone who’s in a really bad situation.”
She has even received large insulin donations from Canada.
AN INCREASINGLY BUSY ‘BLACK MARKET’
More than a dozen diabetic Americans interviewed for this article said they had participated in such an informal insulin exchange powered by social media, widely referred to as the “black market.” Organizers are nodes in the network, using their prominence on platforms like Twitter to connect people who have insulin to those who don’t.
“The FDA does not recommend sharing or reselling diabetic supplies, including insulin, due to concerns about the safety and efficacy of such resold or shared products,” an agency spokesman told CNN. But defenders of the network say they can’t stop, pointing to several deaths of diabetic Americans who rationed their insulin.
“We have been left with no other choice,” says emerging Minnesota politician Quinn Nystrom, whose campaign for Congress emphasizes affordable health care. A Type 1 diabetic herself, Nystrom helps distribute insulin donations and — before the pandemic — organized “caravans” to Canada to purchase insulin.
“Am I willing to break the law to keep American citizens alive? Yes,” she says.
Demand for black market insulin has spiked since the pandemic began, said another organizer in Colorado, who asked to remain anonymous due to the illegality of the work. In the last week of July alone, she facilitated $24,000 worth of insulin donations, she estimates.
“Prior to this whole COVID-19 crisis — let’s say just six months ago or eight months ago, I might hear about someone who needed insulin maybe once a month,” she says. “Fast-forward to now, when people are losing jobs: In the last seven days, I have heard from 15 different people who are almost out of insulin and have no way to afford their next purchase.”
Daniel Carlisle, the Houstonian, has sometimes donated some of his own supply to fellow diabetics in Houston and Dallas. “If someone died because they were lacking and I said I won’t share with you, well, I’ve got a real moral issue with that,” he says. “If you were living in Houston and needed some insulin, I would drive over and give you a vial.”
But he does have cash flow limits, he adds. And if he can’t restock in Nuevo Progreso soon, he’ll have to ask for help on the same black market he once gave to.
“Right now I’m looking at February. If I can’t make it to Mexico by then — and have the money to make the trip — I’ll be in trouble,” he says.
Canada reports more than 1,200 new coronavirus cases, 7 deaths – Global News
Winnipeg police say a woman has died and several other people have been injured in a collision involving a vehicle that was fleeing police.
The crash happened at about 1:30 p.m. Saturday in the area of Salter Street and Boyd Avenue, police said in a statement.
According to police, officers tried to pull over a vehicle for a traffic stop but the driver “took off at a high rate of speed.”
Seconds later, the vehicle hit another car in the nearby intersection of Andrews Street and Boyd Avenue.
Four people in the vehicle that was struck — including an infant and a child — were sent to hospital. A woman who was in that vehicle has died from her injuries, police said.
Two people from the vehicle that had fled police were also transported to hospital.
Police said most of the victims are in critical or serious condition.
The Independent Investigation Unit of Manitoba, which investigates serious incidents involving police, has been called to investigate.
© 2020 Global News, a division of Corus Entertainment Inc.
Canada's death toll could hit 16000 by the end of 2020, new modelling warns – CTV News
Canada could see as many as 16,000 COVID-19 deaths by the end of the year if current public safety measures don’t change, according to new modelling from the United States that has provided accurate assessments of the American death toll.
But a Canadian pandemic modelling expert says that, while anything is possible, the American model may not be capturing the whole picture in Canada.
The model from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington suggests Canada could see 16,214 deaths by Jan. 1 based on the current situation. If public safety mandates are loosened, such as physical distancing, the death toll could be even higher, hitting a projected 16,743 lives lost.
Universal masking in public spaces could curb those numbers and save thousands of lives, the model suggests, pointing to countries like Singapore that have successfully put in place masking protocols that are 95 per cent effective. Singapore has reported 27 deaths since the start of the pandemic.
If Canada were to successfully implement similar rules, the modelling predicts a death toll of 12,053.
So far Canada has reported 9,256 deaths from COVID-19 and more than 150,000 cases. Prime Minister Justin Trudeau warned earlier this week that the country is at the beginning of a second wave of infections as he urged Canadians to take public health guidance seriously.
Quebec is leading the country with new cases of COVID-19. On Saturday, the province reported another 698 cases, the highest daily infection numbers since May.
Dionne Aleman, an associate professor at the University of Toronto who specializes in mathematical models for pandemic prediction, said the IHME model is “simplistic” and does not account for regional differences across the country.
While a second wave of COVID-19 infections has started, Aleman points out that deaths are not in a second wave. COVID-19 deaths in Canada peaked in April and May, when more than 100 people died in connection with the virus daily. Those numbers have remained much lower in recent months, with five deaths reported on Friday.
“The fact that deaths are not tracking with infections as they did in the first wave indicates that vulnerable individuals are taking more precautions to protect themselves now, and it is reasonable to assume those precautions will continue as the second wave gets worse. This model does not account for the fact that some people are behaving differently from others, and thus, the projected deaths are likely overstated,” Aleman told CTVNews.ca on Saturday over email.
The latest modelling by the Public Health Agency of Canada does not offer predictions to the end of the year, but suggests that, based on current rates, the death toll could steadily rise to 9,300 lives lost by Oct. 2.
The IMHE modelling has proven to be accurate. Earlier this year, the model predicted that the U.S. would hit 200,000 deaths in September, a grim milestone that happened earlier this week. Now, the model predicts the U.S. death toll will nearly double by the end of the year, reaching 371,509 by Jan. 1.
The IMHE model also predicts daily infections — a number that includes people who aren’t tested for COVID-19 — could hit more than 19,000 by the end of the year.
Aleman said it’s important to remember that, even if a person doesn’t die from COVID-19, the consequences of getting sick can be serious.
“There are numerous examples of otherwise healthy individuals with severe reactions to COVID taking several weeks and even months to recover, and there are indications that there could be long-term health consequences,” she said.
“We should view these projections of exponential infection increase with great concern, and we as individuals should take every reasonable precaution to stem this increase before it is too far out of control. Wearing masks is easy and effective, and we should do it.”
Infections may be on the upswing, but Canada’s Chief Public Health Officer Dr. Theresa Tam said Saturday that limiting personal contacts as much as possible can help once again flatten the curve. She encouraged Canadians to take time this weekend to chat with loved ones about how to keep their bubbles safer.
“Even if people attending an event are part of your extended family, as has been the case with some of these private gathering outbreaks, it doesn’t mean they are not infected, even if no one appears to be unwell,” Tam said in a statement.
“Despite the very real concern of a large resurgence in areas where the virus is escalating, there is still reason to be optimistic that we can get things back to the slow burn.”
B.C. university launches 1st peace and reconciliation centre in Canada – CBC.ca
The University of the Fraser Valley hopes its new Peace and Reconciliation Centre (PARC) — which the school says is the first of its kind in Canada — will help contribute to a more equitable society.
Professor Keith Carlson, the centre’s chair, said institutions like universities and governments can often reinforce unequal power structures by excluding knowledge and experience from historically-marginalized communities.
The PARC was established to counter that by “bringing new voices to the table,” he told Margaret Gallagher, guest host of CBC’s On the Coast on Thursday.
Aside from collaborating with academic departments like Peace and Conflict Studies, the PARC will offer funding and scholarships to students and faculty, as well as community members not affiliated with UFV “who are looking for partners and allies to change the world,” said Carlson.
The Abbotsford-based university says it has received substantial funding from the Oikodome Foundation, a local Christian charity.
UFV launched the PARC Thursday with a virtual event featuring speeches from Steven Point, the first-ever Indigenous chancellor of UBC, and former Ontario Premier Bob Rae, now Canada’s ambassador to the United Nations.
Jacqueline Nolte, dean of UFV’s college of arts, said the university envisions the PARC as a hub for constructive dialogue, research and creative expression aimed at building trust among diverse communities.
“We will facilitate deep listening and mediation such that all people will feel heard and acknowledged,” she said in a news release.
The scope of the centre won’t be narrow.
Along with relations between Indigenous people and settlers, Carlson said the centre could address everything from domestic violence to interfaith conflicts in the Middle East and Ireland.
Carlson, who holds the Canada Research Chair in Indigenous and community-engaged history, echoed Nolte’s words.
“What we’re saying [is] that we value Indigenous ways of knowing,” Carlson said.
“The structures that underlie racism need to be dismantled so that everybody in this country […] will be able to enjoy all the privileges that anybody who’s of European descent [has].”
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