Canadian Rheumatology Association Meeting
by Elizabeth A. Tindall, MD
The annual Canadian Rheumatology Association meeting was held at Chateau Lake Louise in February 2002. The meetings consisted of didactic sessions, poster and plenary presentations as well as business meetings and pharmaceutical-sponsored symposia. I presented the ACR manpower and training projections to the group and attended their Board of Directors meeting, business meeting and Fellow presentations. There are certain similarities between Canada and the US with respect to low numbers of trainees and rheumatologists. Canada has approximately 270 rheumatologists for a population roughly the size of California, 32 million residents.
As far as recruiting trainees, Canada has an additional burden for rheumatologists in that many are forced to take general internal medicine call plus rheumatology call. In a survey from November 2001, 143 (270 members) CRA members answered a series of questions related to their call schedules. Seventy-eight percent of those respondents took “Rheumatology” call and twenty-nine percent took “Internal Medicine” call. Of those who participated in IM call, it was compulsory for 41% and by choice for 30 %. Rheumatologists who refused to take IM call were not allowed hospital staff privileges nor could they access the laboratory, radiology, outpatient or inpatient facilities of the local hospital for their patients. Canada’s practicing rheumatologists also face problems with severely restricted drug formularies and access to new therapies. In general, Canada is two years behind the US in drug approvals. Each Province has it’s own formulary and requirements for prior authorization of medications.
The Canadian Arthritis Bill of Rights was co-sponsored and endorsed by the Canadian Rheumatology Association, the Arthritis Society (www.arthritis.ca) and seventeen other “arthritis” oriented national groups. These groups include orthopedic surgeons, occupational therapists and patient organizations. It states the significant breakthrough in treatments for musculoskeletal diseases and the need for rheumatology patients to have access to these newer medications. In addition, the document lists the responsibilities that patients have in participating in their own health care. ORA reviewed this document and revised it to reflect the Oregon perspective.
On April 3, 2002, the Canadian Rheumatology Association (www.cra-scr.ca) released their Position Statement on the Use of Biologic Therapies for Rheumatoid Arthritis stating that Infliximab and Etanercept “offer significant benefit over conventional therapies and…it would be unethical to deny them to appropriate patients due to economic considerations.” Only two Provinces have allowed Anti-TNF therapies on their formulary; Saskatchewan with both agents and Ontario with restricted access. Quebec has refused to allow either drug on its formulary.
Just as ORA is adopting the Canadian Arthritis Bill of Rights, our organization may wish to develop a similar position statements for Biologic Therapies and COX-2 NSAIDs. For those ORA members who would like to participate in developing these position statements, please contact Cody Wasner.