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U.S. President Donald Trump holds a bilateral meeting with British Prime Minister Boris Johnson on the sidelines of the annual United Nations General Assembly in New York, on Sept. 24, 2019.

Jonathan Ernst/Reuters

Letters to the Editor should be exclusive to The Globe and Mail. Include your name, address and daytime phone number. Try to keep letters to fewer than 150 words. Letters may be edited for length and clarity. To submit a letter by e-mail, click here:

Thank god for science

Re ‘Let Us Pray’ Call Still Heeded Daily At Ontario Legislature (Dec. 23): I support the rights of people in Ontario to pray to their chosen god or gods, but that same right should also be afforded to the significant percentage of voters who believe there is no higher power.

I propose we devote equal time toward recognizing those who have made Ontario a better place – scientists, social workers, artists. How would the legislature change after hearing a brief reminder of the amazing work Sir Frederick Banting did in his lifetime, the successes of neurologist and astronaut Roberta Bondar or the global influence of Geoffrey Hinton on artificial intelligence? The list of inspirations goes on and on.

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That’s the positive, forward-thinking mindset I’d like our Ontario legislature to start with each morning.

David Sky Toronto

Up in the air

Re New Air Travel Rules Address Delays, Cancellations (Dec. 14) Minister of Transport Marc Garneau recently trumpeted new regulations designed to ensure the general public are “treated with fairness and respect” by all Canadian airline carriers. Regrettably, these regulations seem to provide more protection for the airlines than for the travelling public.

This seems especially so when compared to the rights of those travelling on European airlines, where compensation standards are much higher and strongly enforced. More improvements to Canadian standards will likely require a concerted effort from the travelling public demanding proper “fairness and respect” from our national airlines.

Nicholas Carson Halifax

Pharmacare thoughts

Re Should Ottawa Have A Say In Our Prescriptions? (Dec. 17): The arthritis community is in full support of any government policy directive to switch, or transition, all but the most vulnerable patients to biosimilars, because Health Canada and other leading regulators say it is safe and effective to do so.

What is being played out in the debate on pharmacare and biosimilars looks to me like a war over drugs and patent rules. Now that hundreds of peer-reviewed studies have found biosimilars to be safe, it seems some pharmaceutical companies that hold originating patents have turned to fear-based campaigns aimed at patient organizations, specialty physicians and patients themselves.

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A recent study in BMC Health Services Research found about $1-billion of unrealized savings by not implementing biosimilars policies for infliximab, filgrastim and insulin glargine between 2016 and 2018. Think about how much health care $1-billion could have provided over that same period: drugs for rare diseases, joint replacement wait-list reductions and improved models of care for chronic diseases, among other worthy expenditures.

Cheryl Koehn President, Arthritis Consumer Experts; Vancouver

I believe columnist André Picard is right that patients who are stable on medications should not be switched to biosimilars. The rest of the argument for universal pharmacare and biosimilars seems more problematic.

First, Ottawa has no role in what clinicians can prescribe; public drug plans are strictly provincial decisions.

Second, if Norway’s drug-spending policy is such a resounding success, why hasn’t its approach been widely adopted? In fact, other countries have used competitive bidding to drive down prices of both the originator and biosimilars, and are able to provide multiple options to clinicians and patients.

Third, the additional risk is that over time, with a monopoly, prices in a country could stagnate or rise; Norway’s solution has been to hold regular competitive bids and then switch everyone to the next cheapest biosimilar – not so good for patients on stable medications.

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Finally, there is the very real concern that driving prices too low could cause competitors to exit the market. This is often the situation with generic drugs today, with shortages owing to a lack of manufacturers.

Durhane Wong-Rieger President and CEO, Canadian Organization for Rare Disorders; Toronto

I believe universal pharmacare is a good policy for Canada. It could provide coverage for all while reining in soaring drug costs. But the Remicade/infliximab biosimilars case is an example of just how hard a sell this may be.

Substituting generic and biosimilar drugs will be a cornerstone of savings from pharmacare. The 60 per cent of Canadians with private drug plans are going to find that pharmacare often gives them less drug options than their current benefits – and they will be expected to pay higher taxes for the privilege. Stories of patients and physicians who disagree that “highly similar” substitutes are good enough will be likely to grab headlines as contemplation of pharmacare becomes more serious.

But as a reminder, Canada has chosen this path of universal coverage for hospital and doctor services. Without a doubt this has led to less choice than a fully private health-insurance system – such as in the United States – but with the same health outcomes delivered at a much lower cost. Most Canadians, it seems, see the trade-off as rational for those health services.

Hopefully, challenging patient stories aside, this big-picture thinking will transfer to pharmacare.

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Ryan Hoskins MD, North Vancouver

Open for business

Re Republicans’ Impeachment Deflections Are Bad For Ukrainian Business (Report on Business, Dec. 20): Contributor Michael Bociurkiw plays down corruption in Ukraine, noting that it ranked 120 out of 180 countries in the corruption-perceptions index by Transparency International. However, a top Ukraine foreign-policy goal is to join the European Union. In the same index, the lowest ranking EU country is Bulgaria at 77. For Ukraine to realistically have a chance at EU membership, it needs to address corruption.

This year, Ukraine has heard not just from U.S. politicians about corruption in its borders. Its own citizens spoke loudly about it in this year’s presidential election when Petro Poroshenko lost overwhelmingly to Volodymyr Zelensky, who had no political experience but was viewed as non-corrupt.

Bohdan Skrobach Toronto

B is for…

Re Empowered By TV: The Male Buffoon, From Don Cherry To Boris Johnson (Dec. 17): Boris Johnson has written numerous well-informed books, such as The Churchill Factor: How One Man Made History and The Dream of Rome, which depict complex and articulate historical reflections. In labelling him a buffoon, I believe columnist John Doyle spreads his net too widely, ensnaring a man who really does not deserve to be lumped in with the likes of Don Cherry and Donald Trump.

Paul Thiessen Vancouver

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Fresh new flavours

Re Ottawa To Ban E-cigarette Ads In Bid To Curb Teen Vaping (Dec. 20): Perhaps if e-cigarettes had been offered in flavours such as Brussels sprouts or charred liver, instead of mango and bubblegum, teenagers would have avoided them altogether.

Susan Fenwick Markham, Ont.

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