The story begins in 2021 as a fifteen-year-old boy named Zachary "Zach" gets arrested for the first time for selling pot and gets sent to spend two months in juvenile detention. There, he meets an intriguing girl named Gabrielle, who appears to have a very strong connection with him. When Zach gets out, he realizes he's still got a lot of marijuana in his system and decides to use it to get high again. The government learns of the operation, and federal agents converge on the location to bust a major drug ring.
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The Drug Wars continues the story of Zach and Gabrielle as they attempt to navigate the world of drugs and organized crime while trying to work out their relationship. This book was one of my favorite novel releases of 2021, and I highly recommend it. It takes you into the dark world of the underground world of drug trafficking, which is a little different than what most story lines go with. However, it still has a great plot that kept me interested throughout and created many hours of reading pleasure.
Results: FcγRIIa-H131R was associated with an inferior response to treatment (ORG 0.67; 95%CI 0.46-0.97) and an additive mode of inheritance, with the genetic risk of heterozygotes assigned in the middle between high affinity (H/H) and lower affinity (R/R) genotypes. This effect was unrelated to risk stratification, as no association was documented for FcγRIIa-H131R variant with the international prognostic index (IPI) (ORG 1.02; 95%CI 0.79-1.31 for IPI 3-5 over 0-2). FcγRIIIa-V158F had no impact on treatment response but linkage disequilibrium and defective antibody-dependent cell-mediated cytotoxicity may have affected the outcome.
According to Tufts University political scientist Daniel W. Drezner, the Trump administration's desire to return relations with Mexico to the pre-NAFTA era are misguided. Drezner argued that NAFTA made it easier for Mexico to transform to a real democracy and become a country that views itself as North American. If Trump acts on many of the threats that he has made against Mexico, it is not inconceivable that Mexicans would turn to left-wing populist strongmen, as several South American countries have. At the very least, US-Mexico relations would worsen, with adverse implications for cooperation on border security, counterterrorism, drug-war operations, deportations and managing Central American migration.[85]
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Over the past year, we saw provinces and territories taking action, working hard to provide better prescription drug coverage, but we also concluded that the federal government can and should do more, working in partnership with provincial and territorial governments, to ensure all Canadians can access the medicines they need.
Throughout its work, the council benefited from extraordinary collaboration and input from provincial and territorial health ministers and senior officials. Health ministers, finance ministers, and in some cases premiers, readily shared their views with the council. Senior officials responsible for the management of public drug plans generously gave their time to engage with the council and the secretariat, and shared information that was critical in helping us understand the opportunities and challenges involved in moving forward with pharmacare.
We are also thankful for the candid conversations the council had with Indigenous leaders and peoples across the country. We recognize the unique and significant challenges facing Indigenous communities in Canada and wanted to ensure that your voices were heard as we developed our thinking on how national pharmacare could improve the accessibility and affordability of drugs for all Canadians.
There are other costs stemming from our patchwork approach to paying for drugs. Having so many public and private plans dilutes bargaining power. The cost of individual drugs is higher here than in other Organisation for Economic Co-operation and Development (OECD) countries and we spend more per person per year on prescription drugs than any other OECD country, with the exception of the United States and Switzerland.
National pharmacare would start with the creation of a Canadian drug agency (preliminary funding for an agency was announced in the 2019 federal budget). The new agency would be an arms-length organization, with strong patient representation, accountable to Canadians both directly and through the federal, provincial and territorial ministers of health. It would be governed collaboratively by the federal, provincial and territorial governments and would have patient representation on the board.
Over the subsequent five years, additional prescription drugs would be added to the national formulary as prices and supply arrangements are negotiated with manufacturers. The full, comprehensive national formulary would be in place no later than January 1, 2027.
There is strong evidence that user fees create barriers to access, whether in the form of copayments or deductibles. Research has shown they prevent people from taking their prescription drugs properly, or even at all. User fees are particularly hard on people with complex or chronic health problems and those with low incomes. Nevertheless, they are a standard feature of almost all drug coverage in Canada and abroad and we are recommending them, within strict limits: drugs on the essential medicines list would carry a copayment of $2, while all other drugs would have $5 copayments. People receiving social assistance, government disability benefits or the federal Guaranteed Income Supplement benefit would all be exempt from copayments, and no person or household would pay more than $100 per year.
No patient should face costs of this magnitude for any drug. That is why the council is recommending the Canadian government develop a formal national strategy for expensive drugs for rare diseases. We are also recommending the Canadian drug agency establish a distinct pathway for the consideration of expensive drugs for rare diseases, and a national expert panel to work with patients and their clinicians to determine which rare disease drugs should be funded for which patients. The national strategy, distinct process and funding for these specialized drugs should be in place in conjunction with the essential medicines list, beginning January 1, 2022.
The implementation and success of national pharmacare will not be possible without strong federal leadership and funding. The provinces and territories deserve credit for advancing prescription drug coverage in their respective jurisdictions. It is due to their hard work that we are not starting from scratch. In fact, provinces and territories have built a strong foundation upon which to build national pharmacare. For that reason, and conscious of divergent federal, provincial and territorial fiscal outlooks, the council is calling on the federal government to pay for the incremental cost of implementing national pharmacare.
We have estimated that it will cost an additional $3.5 billion in 2022 to launch national pharmacare starting with universal coverage for essential medicines. As the national formulary grows to cover a comprehensive list of drugs, we estimate that annual incremental costs will reach $15.3 billion in 2027. The council recognizes the very significant fiscal implications of this investment. But the issue is too important to ignore. Although national pharmacare requires a substantial investment of public funds, it will result in significant savings to Canadian families and lower the total amount being spent on prescription medications.
National pharmacare will save money as lower prices are negotiated for more drugs and as other cost-saving strategies are implemented. As early as 2022, when national pharmacare would cover essential medications, total spending on prescription drugs would be $300 million lower than without pharmacare. By 2027, total spending on prescription drugs would be $5 billion lower than it would be without national pharmacare.
Families and individuals will no longer face the postal code lottery, where access to prescribed drugs depends on which province or territory you reside in. And Canadians can rest assured knowing that their drug insurance travels with them, right across Canada.
National pharmacare will mean that employees and businesses no longer have to pay for expensive prescription drug coverage. The average business owner who provides drug benefits would save over $750 annually per employee. The average worker with workplace drug benefits would save over $100 per year in plan premiums. In addition, employees who pay hundreds or thousands of dollars per year in copayments, coinsurance or deductibles for themselves and their families would never pay more than $100 per household per year. No more coinsurance. No more annual or lifetime limits.
National pharmacare will provide businesses with much-needed relief from the high and growing cost of prescription drug insurance. Business owners will no longer have to worry about whether they can afford private drug coverage for their hardworking employees. They will have the financial room to offer other health benefits to their workers (for example, mental health and wellness services, physiotherapy, dental and vision care), to pass on the savings to their employees through higher wages, or to invest in their businesses. 2ff7e9595c
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