Indigenous health during Covid-19
Dr. Rachel Asiniwasis discusses the dermatological issues affecting northern Saskatchewan communities during the pandemic (700 words, 3 min)
PC Healthbiz Weekly is presented to you in cooperation with Peak Pharma Solutions
For Indigenous communities, which have had serious issues gaining access to healthcare services such as dermatology consultations prior to Covid-19, the pandemic has presented additional challenges for both the communities and the healthcare practitioners that serve them, according to Dr. Rachel Asiniwasis.
Dr. Asiniwasis is a dermatologist in Regina who also serves the rural and Indigenous communities throughout Saskatchewan.
“I think that there are many challenges that the pandemic has placed both on the communities and the healthcare practitioners,” Dr. Asiniwasis explained (photo below) on a recent episode of the NPC Podcast, a program for Pharma executives hosted by Peter Brenders. Brenders is the General Manager of BeiGene Canada. (Listen to the episode here.)
“Many practitioners have switched to virtual care and some remote communities do not necessarily have the best access to the internet or virtual care in general. I have some patients that do not have a phone and have a woodstove.”
While an increase in the availability of virtual care during the pandemic has been positive among some in general populations, teledermatology has presented challenges for Indigenous communities, said Dr. Asiniwasis.
“It is sometimes hard to manage or diagnose some conditions without seeing the patient in person,” she said. “Another thing is, let's say the community is on pandemic restrictions, and that they are only allowed to repeat their lab tests at certain times [so] the lab is not as accessible. If I'm using something like a traditional systemic immunosuppressant, such as methotrexate or cyclosporine for severe eczema or severe psoriasis, we are not able to get that lab work done as soon as we would like.
“[Additionally,] things such as PASI scores, a psoriasis area severity index, or EASI scores for eczema are hard to do virtually without bringing [the patient in] and doing a proper skin exam. Virtual care creates challenges for things such as getting the patient’s treatments covered, such as biologics. There is also the resource burden on the staff and administration for issues such as consenting people for virtual care, chasing them down if their picture is blurry, or you can't reach them. I think that the administrative burden has increased as well. It can be difficult from that end.”
Even before the pandemic, Indigenous communities were underserved with regard to dermatological care, according to Dr. Asiniwasis.
She noted Canadian Indigenous communities face unique health challenges that are often complex, interlinked and related to historical and social context. Some of the challenges are documented while others are not, Dr. Asiniwasis added.
Part of the problem in the remote communities is the high cost of basic skincare and hygiene products—prices are often inflated due to transportation costs. Additionally, there are issues with water, crowded housing and communicable disease.
“Putting all these things together, I think that we are starting to see some unique dermatological challenges in these communities,” Dr. Asiniwasis said. “There are top conditions that we are starting to see in literature, media and practitioner experience. There are common themes, and the top condition that [stems] from all of these issues put together, is eczema, uncontrolled eczema or atopic dermatitis.”
In her experience, Dr. Asiniwasis said the pediatric population had been especially affected by dermatological issues such as eczema due to the hereditary nature—factors such as filaggrin deficiency or genetic predispositions and the epidermal differentiation complex that may be passed on.
“Those with eczema have an increased risk for secondary skin infection based on their primary immune dysfunction and skin barrier dysfunction,” said Dr. Asiniwasis. “If the patient experiences other issues such as crowded housing or lack of access to certain basic skincare hygiene products or has concerns about clean water— it leads to chronic infections. It's quite shocking.”
The takeaway: In the future, Dr. Asiniwasis is working toward better educational sessions around Indigenous health that targets healthcare practitioners not just on the cultural safety issues but dermatology itself.
She said healthcare providers working with Indigenous communities need to be better educated on common dermatological conditions such as eczema, scabies, psoriasis and lice, as well as how to treat them.
“We need to improve research in Indigenous communities on skin disease just to open up that conversation because it is less represented than other organ system [conditions] such as diabetes,” Dr. Asiniwasis explained. “We need to also involve the communities in research. I think it's also important to know that the fee-for-service system is not always compatible with Indigenous health if there are complex issues."
Further reading: Dermatological help isn’t the only thing Indigenous communities need during the pandemic. According to a report by The Canadian Press, many Indigenous communities are struggling with mental illness and addictions in the wake of Covid-19. Story here.
YOUR HEALTHBIZ WEEK 04/13/21
Pfizer announced the U.S. FDA had extended the review of its experimental atopic dermatitis treatment, abrocitinib, by three months, Reuters reports. The U.S. drugmaker said the FDA’s decision on the treatment is now expected in the third quarter of this year. AbbVie’s Rinvoq and Eli Lilly’s Olumiant have also faced regulatory delays, the report notes. Pfizer’s abrocitinib was studied in adults and adolescents with moderate-to-severe atopic dermatitis.
Mississauga, Ont.’s BeiGene announced the launch of zanubrutinib in Canada to treat adult patients with Waldenström’s macroglobulinemia (WM). Zanubrutinib was authorized for sale by Health Canada in this indication on March 1, 2021. The Canadian approval of zanubrutinib was based on efficacy results from the Phase 3 ASPEN clinical trial, a randomized, open-label, multicenter trial (NCT03053440) that evaluated zanubrutinib compared to ibrutinib in patients with relapsed/refractory (R/R) or treatment-naïve (TN) WM who harbour a MYD88 mutation (MYD88MUT). In the ASPEN trial, zanubrutinib demonstrated a numerically higher partial response (VGPR) rate and a favourable safety profile over ibrutinib.
According to a Reuters report, Eli Lilly and Incyte’s rheumatoid arthritis drug baricitinib did not meet the main goal of preventing progression to mechanical ventilation in hospitalized Covid-19 patients in a late-stage study. Patients receiving baricitinib were 2.7 per cent less likely than those receiving standard of care to progress to ventilation, which was not statistically significant, the data showed. The U.S. FDA has granted Baricitinib emergency use authorization combined with remdesivir for Covid-19 patients requiring supplemental oxygen.
UPCOMING NATIONAL PHARMA CONGRESS WEBINARS
The National Pharma Congress Spring Webinar is scheduled for Wednesday, May 12, 2021, and the Summer Webinar is scheduled for Tuesday, June 22, 2021. Be sure to watch the NPC HealthBiz Weekly for updates on the event.
CANADIAN HEALTHCARE MARKETING HALL OF FAME
The Canadian Healthcare Marketing Hall of Fame awards were established in 2002 to honour healthcare marketers who have contributed to our avocation and are an inspiration to others.
More than 100 honourees have been selected during the past 18 years. In the selection committee's view, they stand for a representative cross-section of the qualities that make our business unique and fulfilling. Each week, NPC Healthbiz Weekly will acknowledge one past Hall of Fame Honouree.
2019 Inductee
Brian Canestraro
Intercept Pharmaceuticals Inc.
Toronto
Editor’s note: Brian has been the General Manager of Intercept Pharmaceuticals since 2015 - a role he currently holds.
Brian Canestraro knew he wanted to build a life sciences career and was determined to get into the pharmaceutical industry. His persistence eventually paid off. After graduating from Western university, Canestraro frequently visited the Zeneca Pharmaceuticals offices with the hopes of finding employment.
“I can remember putting on my suit every Thursday and visiting the HR manager at Zeneca. I was determined to get my foot in the door and must have done this for months until Julie baker called me up and said, ‘Listen, we’re finally expanding.’ She gave me the number of their district sales manager and the rest is history. I think she was happy not to have me bother her anymore.”
Following his Honours Degree in Kinesiology at Western, Canestraro chose to earn his master’s in business administration from the University of Leicester.
In 2005, Canestraro joined Gilead Sciences Canada Inc. He successfully took on a variety of roles over his 10 years at Gilead. There, Canestraro met two individuals who played a significant role in shaping his leadership style: Gilead General manager, Ed Gudaitis and executive Vice president, Jim Meyers.
“Ed was the first memorable leadership figure that I worked closely with on a day-to-day basis and someone I learned a lot from,” Canestraro said. “[Meyers] had an executive presence and a way about him that made you feel like the Canadian affiliate mattered, and that your personal contributions mattered to the broader business.”
“Those were two people that left a lasting impression on me and shaped my own leadership skill set.”
Canestraro moved into his current role as General manager at Intercept pharma Canada in June, 2015. Intercept wanted someone to build their Canadian operations. Canestraro was able to take key experiences learned over the course of his time at Gilead with him to his new role.
Building, and leading, Intercept from start-up to successful Canadian entity has produced some of the more memorable moments of Canestraro’s 20+ years in the pharma industry.
“Leading Intercept from the very beginning stage of establishing the Canadian commercial entity, building the organization, launching our first product, and achieving rapid market access has been really fulfilling, especially now that I can look back almost three years post-launch with Canada representing one of the top performing affiliates in the Intercept world—I’m really proud of that,” Canestraro said.
Reflecting on his time in the industry, Canestraro says his key message for young individuals pursuing a career in the pharmaceutical industry is to be patient and take the time to build a breadth of skill sets that will provide the versatility needed to manage change and add value across key functions, instead of rushing too quickly to chase a title.
“Our industry is constantly undergoing change,” Canestraro said. “People who invest the time to build a breadth of experience will be best positioned to make a lasting impact throughout their careers.”
NEXT WEEK
The 04/20 edition of NPC Healthbiz Weekly will feature Jim Shea, General Manager of the Council for Continuing Pharmaceutical Education, speaking about sales reps and the effect of Covid-19 on continuing education in the pharma industry. It’s easy to get your no-charge subscription and have the issue sent to your phone or inbox each Tuesday at 6:00 a.m. sharp.
Stay safe, stay sure, and stay on your game. We’ll see you again next Tuesday.