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[IP] diabetes treatment in alberta - globe and mail article

just for interest's sake...

Alberta agrees to pay for new diabetes treatment


Tuesday, August 27, 2002 - Page A7

The Edmonton transplant technique that has reversed diabetes in dozens of
patients is now being offered as a standard medical service in the province
where it was pioneered.

Alberta has decided that the success of the revolutionary treatment, known
internationally as the Edmonton Protocol, should be available to all
patients who could benefit and not just those few participating in a
research project.

The question is whether other provinces will agree. If not, patients outside
Alberta could be left to battle their home provinces to get them to cover
the costs of the $140,000 procedure, or come up with the funds themselves.

"We really don't want patients to get caught in the middle of this," said
James Shapiro, the 39-year-old University of Alberta Hospital surgeon
leading the program.

Alberta health officials will meet with other provinces in September. "We
hope we'll be able to get the other provinces to accept that it should be
reimbursed like other insured services," said Steve Buick, a spokesman for
the Capital Health Authority, which administers health services in the
Edmonton region.

Since the program first made headlines two years ago, 140 patients in
Canada, the United States and Europe have undergone the procedure in which
islet cells harvested from the pancreas tissue of cadavers are transplanted
into the livers of diabetes patients.

Those transplanted cells have allowed roughly 80 per cent of patients in the
trials to live insulin-free for at least one year so far, although they must
take a special cocktail of immunosuppressive drugs.

Four patients in the original Edmonton trials have remained insulin free for
three years, Dr. Shapiro said. Other patients require less insulin than they
did before the transplant.

"We're not treating it as a trial or a research program any more, but a
regular clinical service in our transplant program," Mr. Buick said. "Why
are we doing this? The simple answer is that it works, and we think it will
be cost-effective in the long run."

Each transplant, a speedy procedure in which the donor cells are injected
into the liver through a long, fine needle, costs $70,000. But most patients
need two procedures to boost their insulin levels. Alberta has agreed to
spend $5-million a year to cover the treatment costs for about 20 patients
and build a new lab to harvest islet cells from the donated pancreases.

The Edmonton team is writing to doctors across Canada asking them to refer
patients who may benefit, particularly those with severe Type 1 diabetes who
suffer wildly fluctuating insulin levels that leave them prone to fainting,
strokes, blindness, limb amputation and death.

"We are actively looking for new patients," said Dr. Shapiro. "It's a very
exciting transition to see this go from bench to bedside."

Alberta is unique in considering the technique ready as a regular service.

Three provinces, Ontario among them, have told patients who underwent the
procedure in Edmonton that they would not reimburse Alberta for providing a
treatment they consider to be experimental.

Some doctors remain cautious about the treatment, and Dr. Shapiro
acknowledged that no one knows the long-term effects of taking
immunosuppressant drugs to prevent patients from rejecting the tissue
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