In the hurly burly of everyday clinical practice and our responsibilities as P&T committee members, perhaps you missed two interesting follow-up articles that we could have taken from the pages of P&T itself. I would like to focus our readers’ attention on these issues and to reinforce some of the many take-home messages from the follow-ups. You might remember a commentary in P&T (September 2003) highlighting the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).1 Although our assessment of ALLHAT came under intense public scrutiny, my coauthors and I stand by our unbiased reassessment of the findings. Maybe you missed an important Letter to the Editor, published in JAMA, from the Institute for Clinical Evaluative Sciences in Toronto, Ontario, Canada.2 Peter Austin and colleagues studied the impact of the publication of the ALLHAT trial, which first appeared in JAMA on December 18, 2002.3 Let me quickly summarize the authors’ methods and the fascinating finding from their little research project. The Toronto team studied claims for antihypertensive agents that were submitted to the Ontario Drug Benefit Program from January 1, 1992, through April 30, 2003. This period covered prescriptions dispensed to all 1.3 million residents of Ontario who were older than 65 years of age (nicely mirroring our own Medicare population). For each month of the time period in question, the team determined the number of prescriptions filled for patients who had not had a prescription for any hypertensive agent in the previous year to establish the number of incident users of these agents. They also examined the proportion of new prescriptions within each of the four classes of these agents: the thiazide-type diuretics, the calcium-channel blockers, the angiotensin-conver ting enzyme (ACE) inhibitors, and the beta blockers. What did they find? Not surprisingly (to me), in the first four months following publication of ALLHAT, the relative market share of thiazide diuretics increased significantly, compared with the number predicted by the team’s special time series model. For each month in question, this figure was statistically significant (P < .001). In other words, during this period, the relative market share of the thiazide diuretics was statistically significant and that of the ACE-inhibitors and angiotensinreceptor blockers (ARBs) decreased. We all know that the thiazide diuretics, which are inexpensive and available in generic format, are one of the cornerstones of first-line antihypertensive therapy. I find it fascinating to see that prescriptions for diuretics gained market share at the expense of ACE-inhibitors and ARBs, both of which are newer, more expensive agents. In light of this fact, what is the main message? I believe that ALLHAT, the surrounding publicity,4 and our P&T article all contributed to a reassessment of practice behavior by clinicians. As Dr. Naylor pointed out in an accompanying JAMA editorial,5 we basi
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Pub Date : 2019-07-09DOI: 10.4324/9781351059114-11
J. Healey
This paper provides a theoretical discussion with point of departure in the case of Denmark of some of the theoretical issues concerning the relation liberal states may have to religion in general and religious minorities in particular. Liberal political philosophy has long taken for granted that liberal states have to be religiously neutral. The paper asks what a liberal state is with respect to religion and religious minorities if it is not a strictly religiously neutral state with full separation of church and state and of religion and politics. To illuminate this question, the paper investigates a particular case of an arguably reasonably liberal state, namely the Danish state,
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The Interview was first produced in its entirety at the 1993 Summerworks Festival in Toronto. This production was directed and drama turged by Mary Pat Mombourquette, with Tamara C. Bick as the sole performer, in August at the Tarragon Extra Space. Prior to this presentation, Ms Bick experimented with various monologues at the Theatre Resource Centre’s monthly Soirées. The essence of developing a play, in short segments, in front of a live audience, carries itself over to the completed play. Each scene is a story which can stand on its own or be part of a greater whole. The thread which binds the play together is the acknowledgement of its theatricality. Each scene begins with the illusion that the actor is going to step out of character. As the monologue develops however it becomes apparent that the actor has taken on another role. During performance, audience response was an integral part of the play’s structure. The spectator is not asked to suspend disbelief but to enter the spirit of the play. Mary Pat Mombowquette
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