Wednesday Night #1414

T H E  R E P O R T

John Mavridis introduced his friend Jean  Lalonde, CEO of Pleio Health Support Systems, Inc.—which has pioneered a system for helping people with newly-diagnosed conditions to adhere to medication regimes.The original way in which Jean put together the initial concept of the company could be an inspiration to many start-ups seeking venture capital in these difficult credit times. With respect to credit, it seems that things are easing up somewhat in the U.S., at least in the experience of one  Wednesday Nighter, who has suddenly seen his credit line restored – and generously topped off – after months of fighting with his American bank to unfreeze it. Query: How much did his bank receive in the bailout? Bailout or not, isn’t it true that sooner or later banks will have to start lending again, or else they have lost their raison d’être?

The economy

Financial/business reporting  came in for sharp criticism, despite an upbeat report on an Ontario company that has converted its auto parts plant to one that manufactures mini-incinerators, and is thriving. Generally, reporters are poorly informed, and lacking depth in a specific field, fail to question the news items they report. Case in point: a reporter who states that there is good news because housing starts are up more than expected, without making clear that the predictions were abysmal. Our favorite economist also wonders whether allowance was made for seasonal adjustment in the construction industry, while pointing out that Canada’s size and regional diversity require that numbers be disaggregated to make any sense.  Although initial criticism was directed at financial reporting, it is equally applicable to medicine and any science or technology area. Is this because of ignorance, or a deliberate attempt to dumb-down the news to the lowest common denominator? In either case, the public is well served only by media (i.e. New York Times) that hire knowledgeable reporters and aim for a more intelligent audience.
Recovery?
There are a number of issues. The media empires are collapsing in the face of the e-business revolution, but there are also secular trends that must run their course. The steel business will never come back and neither will manufacturing. What will happen to the pulp & paper industry? How will the automotive industry survive all the reorganizations?  There is a constant change in the composition of business activity, but in a period of sharp decline, all difficulties are accelerated and we will have to wait to see how adaptable industries are. (The new GM-Segway attempt was greeted with derision by this WN audience – wheelchairs for the healthy.)
Chinese sovereign wealth funds are expecting an L-shaped recovery – as do many around the WN table. This may not be a long-term phenomenon; it could 3 months, 6 months; unlikely to be much longer unless the banking system is “messed up”;  sooner or later, inventory will be depleted and there will have to be an increase in economic activity.
Regarding the expanding money supply in the U.S., UK. and E.U. We’ll have to wait to see who moves, how fast, who reverses — a safe prediction is that exchange rates will be fairly mobile over the next few years. Is it possible that the U.S. and others are colluding to  increase the money supply in order to devalue the dollar  and reduce China’s hold on the U.S. economy? This would be a breach of IMF regulations. If, as some predict, there are only 4 major fixed currencies, that would have the same effect of devaluing the U.S. dollar. So does that mean the price of gold goes up?

Health
As mentioned in tonight’s invitation, life expectancy has risen dramatically in Canada and in the developed world; we are benefiting from the epidemiological studies of the 1950s; nutrition, hygiene, housing, improved; major breakthroughs in bacteriology (disease control).
Studies of “Blue Zones”  (Sardinia, Costa Rica, etc) may also give clues to increased life expectancy.
Adoption of evidence-based medicine, using the tools now available to evaluate effects and that analyzes the quality of research projects/reports and looks for specific effects is increasingly important.
Compliance (following prescriptions) is essential for medicines to work; this is where the work of Pleio is very important.
Obesity, especially among the young, is a huge concern – they are bombarded with advertising for snack and high cholesterol foods in all the media they watch.
Pharmacogenomics (medicine tailored to the individual’s profile) will be in wide use with 5-10 years.
Recently, the use of checklists in areas such as surgery and infection control has delivered remarkable results, greatly reducing morbidity and mortality. Studies show a new checklist developed by the World Health Organization may reduce complications and death from surgery by as much as one-third. It is patterned after similar checklists used by airline pilots to ensure flight safety, and, while it is not a new concept, the WHO list is more structured and detailed.
Local issues
A major problem here is the lack of primary care physicians. Some have had excellent experiences with CLSCs; however while these clinics undeniably serve a useful function, they can only conduct specific case analysis, not a full spectrum check-up, which everyone should have ‘at least once’.
With so many joggers, walkers and runners today, a little-considered municipal planning issue is the slope of sidewalks, which can severely affect the rate of hip displacements.
Health insurance and medicare
What is the likelihood of significant healthcare reform in the U.S. since Obama may have used up large amounts of both goodwill and money on the financial crisis? The Obama plan is based on private insurance, subsidized by the government and fully paid for the poor. Everyone will have to have insurance.
Governments – whether in Canada or elsewhere – must inform the population about what precisely is covered by government healthcare plans and what is not, so that the individual can make provisions for complementary insurance, i.e. voluntary group health insurance. A cancer drug like herbitux can be extremely expensive and not covered in Ontario;  if patients can afford to go to the U.S., there is no reason to stop them.   When Canada’s Medicare system was set up, it was to be universal, but that was in terms of access and not delivery – – not all medication at all times at all costs. And today there are now many items  that are no longer covered.  In  the current economic climate, is it likely that Medicare will entirely disappear? Entirely – no – it is too fundamental to Canadian beliefs, but benefits are likely to diminish. Little known fact: anyone who has worked for the government in any capacity and for any length of time is entitled to private group health insurance for such things as prescription drugs, semi-private rooms, physiotherapy, etc. In many western European nations, a combination of public and private insurance works well – total health costs as a portion of GDP are lower than here and people appear to receive better service. BUT, the idea of parallel public and private systems is accepted in those countries, whereas the Canadian culture does not accept two-tiered service.  It should also be remembered that doctors in those countries do not declare their full private incomes and therefore avoid the taxes that our Canadian doctors pay. A numer of Americans and Canadians are turning to India for low-cost, high quality medical procedures; in fact overtures have been made to Great Britain’s NHS to send patients to India for a fraction of the cost. Overall, Canada needs to improve its efficiency – estimated at 60% today -to 80%. In any debate over the advantages – and remuneration – of  the U.S. healthcare system, the astranomical costs of medical malpractice insurance must not be overlooked. Furthermore, malpractice suits are subject to the jury system in the U.S. , while in Canada litigation is brought before an individual judge — and most cases are settled out of court.
The population’s health and increased longevity are not only a function of the healthcare system – other factors include nutrition, exercise [air and water quality].
In conclusion
The medical profession has been around for over 2000 years and one may assume that many – or all practitioners received some recompense for their services.  How much good they did in return until about 100 years ago is debatable (think of surgery practiced aboard naval ships under sail].  The question of  Rolls Royce service for all is insurmountable. Volunteer participation in a group plan is likely to be subject to negative selectivity, so it should be mandatory and that too is a huge problem. The good news is that there is more to discuss.

The market
The market has reached the point at which the bearishness has reached a point at which a counter move is called for. The first 15-day period after the first quarter is significant. The first quarter was dreadful, so the market should pull back, but once it has done that,  in our technical analyst’s view, the end of April to the second half  of May should be a better market. An indication of the bearishness of sentiment is the success of the annual Sprott “A Night with the Bears“. We are in a secular bear market which means that from 2007 – 2014, there will be economically driven downward pressure on the market but ‘in between’ there will be some cyclical upward movement. Bargain hunting may happen, but all clients should have stop-loss strategies.

Monique Jérôme-Forget has been rapidly and smoothly replaced as Quebec Minister of Finance by Raymond Bachand will retain the Economic Development portfolio as well. The timing of her resignation and imminent departure for Mexico raise some questions. One answer may well be that she has been designated the scapegoat for the Caisse débacle. No doubt we will hear more soon.

THE INVITATION

In honor of World Health Day it seems like a good idea to reflect on medical and health-related topics, taking a slight respite from the economic health of the world, although that surely will be raised.Coincidentally, our favourite B.C. doctor, Alexandra Tcheremenska, and husband James are celebrating the first anniversary of the West Wing of Wednesday Night this week. A BIG BRAVO to our sibling. It is maintaining a very high standard.
The focus of WHD is on making hospitals safe in emergencies – maybe we should be more worried about keeping patients safe in emergency rooms? The problems of our ERs were highlighted today by CBC Radio, while the Gazette decided to give the headlines to the state of the mega hospitals. We wonder, will they really improve our health? On the other hand, there is much progress to be thankful for, again according to the Gazette that tells us about Life-prolonging advances in virtually every field of medicine, illustrated by the story of an amazing recovery by a stroke victim. In 1980-82, the life expectancy for a boy born in Canada was 72, for a girl 79. By 2005, it had jumped to 78 for men, 82.7 for women, and it will increase, thanks to the work of Dr. Siegried Hekinmi of McGill, who it seems practices on worms (once considered more as the ultimate terminators of our bodies).Many diseases that were prevalent when we were young have been eliminated, more – like forms of cancer – are being effectively treated and still others, like polio and drug-resistant TB are receiving attention and important funding from philanthropic organizations like the Gates Foundation. There are still many problems, particularly in the developing world, but the outlook is encouraging; with focus on education, clean water and sanitation – and the elimination of mosquitoes , much can and will be accomplished. Which is a good thing given that Quebec will likely lose more doctors with the increased mobility afforded by the new agreement between the Colleges of Quebec and Ontario. So, perhaps we should rename WHD Be-VERY-NICE-TO-YOUR-DOCTOR Day.Yes, yes, there must be tidbits on economic health, especially the week after the G20 tossed trillions of dollars around – mostly at the IMF – if not with gay abandon, then with a seeming enthusiasm. Sarkozy’s hissy fit quickly wore off, Stephen Harper distinguished himself by missing the official photo and in the end came a gloomy appraisal from Foreign Policy: Near-term promise and longer-term trouble , but rave reviews about the fashions statements of the WAGSReviews of the Obama administration’s attempts to fix the economy are not so happy. Geithner Bank Plan Faces New Wave Of Criticism Two weeks after being introduced, Timothy Geithner’s bank rescue plan is facing a new round of withering criticism from economists who say the proposal is likely to produce major losses for taxpayers as banks and investors game the system. Jeffrey Sachs: The Geithner-Summers Plan is Even Worse Than We Thought and he quotes the earlier piece by Joseph Stiglitz, Obama’s Ersatz Capitalism that Tony Deutsch had called to our attention, noting, “The best writing I have seen on this topic so far.”

In the run-up to the G20, we missed this dismaying item from Robert Scheer:
“In for a Penny, In for $2.98 Trillion” — The good news on the government’s “No Banker Left Behind” program is that according to the special inspector general’s report on Tuesday, the total handout to date is still less than 3 trillion dollars. It’s only 2.98 trillion to be precise, an amount six times greater than will be spent by federal, state and local governments this year on educating the 50 million American children in elementary and secondary schools.

This is NOT turning into a cheery bulletin, such as we like to issue from time-to-time. More worrying pieces follow:

We are all, of course, watching the tragic news surrounding the earthquake in central Italy  but far more worrisome is the aftermath of the Korean rocket launch and the [not unexpected] failure of the UN Security Council to reach a consensus on what to do. As foretold at Wednesday Night, Ukraine is hard hit by the recession.

Environment & energy developments
The Wilkins Ice Shelf in Antarctic set to collapse after ice bridge breaks for the first time in recorded history.
It was holding in place an ice shelf half the size of Scotland.
Then comes this surprising news: Oil Companies Loath to Follow Obama’s Green Lead

Something to cheer about
But, hey there is some justice in the world: Alberto Fujimori has been sentenced to 25 years in jail for ordering killings and kidnappings by security forces, and the intrepid Iraqi  ‘shoe-thrower’ had his sentence reduced.
Finally, Sophie, the castaway dog returns home after four months on a remote island – great story!