Not a well thought out proposal
My hometown Hamilton, Ontario has been receiving continent wide attention for a unique proposal put forward at city council to make it mandatory for restaurants and shopping mall food courts to be equipped with epinephrine auto injectors. On its face it may seem like a good idea but when you
break down the numbers the chance of a Hamilton family benefitting from this
program are about the same as their chance of winning a 6/49 lottery scheme. At the same
time restaurant owners will be required to throw $280.00 in the trash each year.
There are proven anaphylaxis prevention strategies that could be implemented
with $150,000 that would be far more effective at preventing life threatening
events.
Prior to Sabrina’s Law (Jan 1, 2006) paediatric death
triggered by food allergies was very rare in Ontario, less than 1 per year from
1986-2000. Since Sabrina there were no reported deaths in the province from 2004
until the tragic 2013 event in Burlington, that’s one in 10 years across
the entire province, population 13.5 million. That equates to about one event every
250 years in a city of half a million residents. The majority of children that are
anaphylactic to a known allergen are identified and their parents are
responsible for insuring that they are protected from both known triggers and
lethal reactions when they occur. The chance that a potentially lethal
anaphylactic event involving a child will occur in a Hamilton restaurant in the
next 10 years, and the only available epinephrine is the auto-injector supplied
by the restaurant are slim and none, and Slim is out of town. The chance that one of
these auto-injectors will be used to save a child’s life during a two year trial
period is microscopic.
The financial burden on restaurant owners is not
insignificant. Auto-injectors cost $140.00, each restaurant will need to
purchase two, a 15mg dose for smaller patients and a 30 mg does for larger
patients. Staff must be trained and program integrity must be maintained. Every year the two injectors must be safely disposed of and then
replaced at a cost of $280.00. In the current economic climate it hardly seems
fair to ask a small businessman to burn at least three hundred dollars a year on a program that has no evidence base to support its potential efficacy. If the city gives the restaurateurs a break and picks up the $150,000 annual tab for throwing this medicine in the trash, the cost will be borne by ratepayers.
An interesting sidebar to this discussion is the retail
price of epinephrine auto-injectors. When a dose of epinephrine is drawn up at a hospital or
in the back of an ambulance it costs taxpayers less than 50 cents, which includes the medicine, the syringe and the
needle. The pharmaceutical companies that sell epinephrine on the retail market
are taking advantage of parent’s vulnerability and marking the product up 14,000
percent. Auto-injectors could be sold
for $20.00 and the Pharma’s would still make money. It begs the question, who
would benefit most from this policy?
If the cost of the program is $150,000 per year, as
suggested by a local Councillor on national radio, what
alternative strategies could be funded with that money? Are there strategies
that would provide greater protection from severe allergic reactions for
Hamilton children? Is it possible to fund auto-injectors for low income
families? Is it possible to require restaurants to provide diners with a list of
ingredients that they use that are on the list of known food allergens?
Is it possible to require restaurants, especially those with outdoor seating, to
take steps to reduce the presence of stinging insects – wasps, hornets, bees? Is
it possible to invest in free anaphylaxis awareness education for parents and
caregivers, including seminars and online training tools? Is it possible to
reduce wait times for children that have had a mild to moderate reaction to an
allergen to see a specialist and get tested?
All five of these suggestions could
be funded with $150,000 per year with money left over and I’m sure that people
far smarter than me could come up with a list of five even better
suggestions on how to prevent and respond to anaphylactic reactions.
