In the high emotion surrounding the proposed reform of healthcare in the US, there have been serious allegations about the quality of care in other countries where socialized medicine is practised. With a mixture of horror and pity, Canada and the UK are held up as terrible warnings of what might happen to the US system. That makes the release of a new set of research findings particularly timely. While no-one doubts that every approach to healthcare has its strengths and weaknesses, these latest figures out of Canada make sobering reading. If the same problems are affecting the US, there should be a strong and immediate reaction.

The research focussed on some 110,000 women in Quebec. Their ages ranged from 15 to 45 and they were pregnant between 1998 and 2002. The research team analysed their prescription data and medical histories. An alarming trend emerged. Just over 6% of expectant mothers deliberately took drugs knowing there was a risk their unborn children would be damaged. These included a range of drugs used to treat anxiety disorders, depression, epilepsy and acne. When damage to the fetus was established, many of the women opted for an abortion. In fact, the abortion rate among these women was about 12% higher than the average. This is unfortunate because all these terminations are for avoidable damage to the fetus. It suggests two reforms are worth discussing. Should there be a change in the system for dispensing potentially hazardous drugs to women? The optimum would be a routine pregnancy test before any drug is prescribed that can cause fetal damage. Unfortunately, this would infringe a woman’s right to privacy and if a prescription was made conditional on a pregnancy test, this could be discriminatory and an infringement of human rights. Secondly, it may be evidence that women should be better educated in the risks of certain drugs. Given so many now buy their drugs online without a prescription, it is no longer sufficient to rely on doctors to act in a protective role. Women must take responsibility to protect themselves and take effective measures to prevent contraception unless actually planning a family.

In the case of acne, the main threat comes from accutane. The scientific evidence is clear. One in three women who take this drug during pregnancy give birth to damaged babies. That means actively preventing pregnancy if women plan to take this drug. This is a challenge for young, sexually active girls. The majority do not have the maturity and experience to accept the routine of contraception. Hence, in the US, the iPledge program imposes it on women as a precondition of accessing the drug. Women are required to go through a blood test before, during and after the course of treatment to ensure there is no realistic chance of conception. Unfortunately, the availability of accutane through online pharmacies undermines this preventative measure. This emphasises the need to improve education and ensure the number of babies with birth defects is kept to a minimum. As it is, the Canadian authorities now have proof of several thousand avoidable cases of birth defects every year from a range of drugs. Because the use of these drugs is normally beneficial, they cannot simply be withdrawn from the market. So it all comes down to better education.