Saladin,
Thanks for the enthusiastic feedback that you've finally been diagnosed with CH after 10 years... I know the feeling... It took me 4 years... It's also good to hear that your new neurologist prescribed textbook classic standards of care medications for this disorder…. Too bad he was unwilling to honor your request for the 25-Hydroxyvitmain D lab test…
Your post got me thinking so I did a little research… I think I found a couple possible sources of your neurologist's reluctance to order the 25-Hydroxyvitmain D test for you.
It appears that Canada's government run health care and social medicine system has run into a bit of a bureaucratic cost saving snag…
In October of 2010, it seems the provincial Ministry of Health in Ontario began mulling over a proposal from its medical advisory committee to eliminate most of the discretion doctors have in asking for the $50 vitamin D tests and have them paid by the province.
The bureaucrats and bean counters in the medical advisory committee came to a conclusion that Ontario physicians were prescribing far too many tests for vitamin D… i.e., the lab test for serum 25(OH)D and the provincial bill was roughly $37.5 M for the vitamin D tests performed so far that year by public medical labs…
Moreover, the province estimated that if vitamin D testing continues to grow at current rates, the expense might top $150-million by 2012, up from $38-million last year… so proposed a reduction in vitamin D testing back to 2004 levels… roughly 30,000 a year for Ontario…
It also appears the Canadian Agency for Drugs and Technologies in Health (CADTH), who provides decision-makers with the evidence, analysis, advice, and recommendations they require to make informed decisions in health care, also decided the costs associated with vitamin D testing were growing too rapidly. They commissioned a study report, based on a limited literature search and on personal communications with Canadian health care officials, that concluded in Feb 2011, essentially suggesting a limit on vitamin D testing. For reference, in Quebec, the ~ $50 fees for this test conducted in private laboratories are paid for by the patient and reimbursed by medical insurance plans.
Meanwhile, the mainstream medical community views epidemiology as a weak form of evidence and remains skeptical about the dramatic claims for vitamin D because they have not been confirmed by major clinical trials, the gold standard for evaluating drugs. “The [medical] literature is replete with megavitamin therapies for this, that and the other thing which, in fact, at the end of the day, have not borne out,” Dr. Shragge, a government type observed.
So here's the conundrum… Doctors are unwilling to prescribe the lab tests for vitamin D, i.e., 25(OH)D or 25-Hydroxyvitamin D, or treat many common disorders with vitamin D3 supplements until gold standard studies (randomized, placebo controlled, double blind), have been conducted to confirm the safety and efficacy of vitamin D3 in treating these disorders… nor are any of them willing to sign up to lead a study on vitamin D3 as a preventative for the many disorders in which it could actually help improve the outcome… Moreover, because too many physicians are unwilling to prescribe this lab test, too many of us will never know if we're vitamin D3 deficient… If they did order this test and the results came back indicating a deficiency, physicians would be bound by ethics to treat this deficiency… so they don't order the test…
Let's try to put all this in perspective… on a cost basis… using the cluster headache disorder as an example…
If a neurologist prescribed the leading standards of care cluster headache medications, (Pred taper - $50, verapamil 240 mg/day X 60 days – $105, sumatriptan succinate injections 9/month X 2 months - $550, oxygen therapy for 60 days - $200), it would come to a rough order magnitude average cost of $15 a day or $900 for the average two-month cluster headache annual cycle… You'll likely get these same medications prescribed for your next cycle and the one following that…
Meanwhile, the annual cost of the 10,000 IU/day vitamin D3, 500 mg/day calcium and cofactor minerals needed to prevent your cluster headaches comes to roughly $100.
You do the math… Even at 70% efficacy… and that's a low estimate, the cost savings for the treatment of Canada's episodic cluster headache sufferers would be $6,427,000 a year.
Here's how I arrived at that figure… Using a CH prevalence of one tenth of one percent and a population of Canada estimated at 34,108,752 by the World Bank, that works out to 30,600 CH'ers of whom 75% are likely episodic and only half of them are being treated… that works out to 11,475 episodic CH'ers being treated for this disorder in Canada at an annual cost of $10,327,500 Canadian Dollars…
Treating 70% of these 11,475 episodic CH'ers with vitamin D3, calcium and the cofactors comes to $802,250/year… Treating that same 11,475 CH'ers with the standards of care prescription medications costs $7,229,250/year… for a difference of $6,427,000/year.
Fortunately, not all of Canada's Provincial medical care systems are run by narrow-minded bean counting bureaucrats… Fraser Health, who manages residential care facilities for the elderly folks in British Colombia, is offering free prophylactic vitamin D to residents of their residential care facilities…
This is not a benevolent outreach by bean counting bureaucrats… It's smart thinking by a for profit corporate leaders and mangers who finally realized an ounce of prevention is far less costly than a pound of cure…
Fraser Health’s new vitamin D protocol calls for 20,000 IU weekly dosage of vitamin D, which is an adequate, safe and effective dosage for older adults living in residential care facilities. Those with hypercalcaemia and severe renal failure will be excluded. Residents can opt out of the protocol if they do not want to participate. The protocol will be initiated by the physician within the first six weeks of a resident moving into a residential care facility.
The vitamin D protocol will cost Fraser Health less than $20,000 per year, whereas the cost of treating a single hip fracture resulting from a fall ranges from $18,000 – $30,000. Compared to the potential benefits, the cost of providing a safe and effective dose of vitamin D is very low at less than $2.00 per month per resident.
Fraser Health is the first health authority in Canada to implement a vitamin D protocol in residential care facilities.
“The new vitamin D protocol being implemented at residential care facilities across Fraser Health is a positive step in helping our seniors stay active and independent,” said Dr. Nigel Murray, CEO of Fraser Health. “We know that seniors with fall-related injuries tend to stay in hospital twice as long as seniors hospitalized for all other reasons. This protocol will help to decrease falls and keep seniors in their own homes.”
“Based on recent analysis of the effect of vitamin D on falls, it’s estimated that vitamin D supplements can prevent between 10-25% of falls that currently happen in residential care facilities,” said Fabio Feldman, manager of seniors falls and prevention.
As your neighbors to the South, we're not too far behind you in the wonderful world of having all our healthcare being managed and provided by government socialized medicine… That's where bean-counting bureaucrats decide what the medical treatments you get instead of a physician…
As you know, the Marxist trained community organizer occupying our Nation's most expensive public housing at 1600 Pennsylvania Av. in Washington DC and the politburo at the Capitol used fuzzy math and Chicago thug tactics to pass the unconstitutional Obamacare legislation…
In fact, our early entry into social medicine, a.k.a. Medicare, has already decided old people with CH just need to suffer rather than be treated according to the prevailing standards of care for cluster headache and other trigeminal autonomic neuralgias…
Bureaucrats and bean-counters at the Centers for Medicare and Medicaid Services (CMS), decided that covering the cost of oxygen therapy for Medicare beneficiaries suffering from cluster headache was just too expensive so they denied coverage…
As if that wasn't enough of a health care cost savings… the bean-counting bureaucrats have also decided to cut funding for supplemental oxygen for our Nation's 1,047,000 Medicare beneficiaries suffering from COPD…
As you can see from the CMS 5-Year spend plan for oxygen and oxygen contents, these clever bureaucrats will have cut funding for home oxygen to 1,047,000 Medicare beneficiaries suffering from COPD from $1.7 Billion in 2009 to $51.6 Million by 2014…. That's a 97% cut in funding for home oxygen therapy…
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It appears these bean-counting bureaucrats may be suffering from low blood oxygen content to the brain as their actuarial acumen has failed to account for an additional 3 million baby boomers joining the Medicare ranks every year… and a good 40% of them smoked so are likely COPD inclined…
Sorry this got so long winded… but it sure makes you think twice who you'll vote for in the next election…
Take care,
V/R, Batch
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