Strengthening Bank Regulation: OSFI's Contingent Capital Plan

Bank failures around the world during the recent financial crisis put taxpayers on the hook for trillions of dollars in government backstopping. In future, requiring banks to issue contingent capital, which would convert from debt to equity when banks run into trouble, is one way to help avoid that happening again, and limit taxpayer costs if it does, according to this paper. The author makes the case for contingent capital, critiques the current federal proposal, and makes recommendations for design that would help stave off disaster for banks, not hasten their demise.Financial Services, bank failures, contingent capital, Office of the Superintendent of Financial Institutions (OSFT)

The Canadian Experience with Counterfeiting

Counterfeiting poses a significant public policy issue because of the important role that paper money plays in Canada's payments system. Yet the threat of counterfeiting in all economies has increased markedly in the past decade as a result of technological advances to photocopiers and computer printers. An appropriate pubic policy response is thus necessary to maintain the public's continued confidence in the national currency. To assess the threat from counterfeiting, including possible loss of confidence in the currency, estimating the stock of counterfeits circulating is necessary. In this article, Chant proposes a composite method of detecting counterfeits as an effective alternative to existing methods and offers estimates of the extent of counterfeiting Canadian currency for 2001. An Addendum to the article summarizes Chant's methods and updates the calculations to 2003.

Keeping the Genie in the Bottle: Grading the Regulation of Canadian Financial Institutions

The Canadian financial sector made it through the recent global credit crisis in better shape than most. Still the government undertook extraordinary measures to support the soundness of Canadian financial institutions. Fortunately, Canadians learned the lessons of the world banking crisis at lower cost than others. They may not be so lucky the next time. Canada’s approach to regulation includes many features that have been effective in insulating its financial sector from major shocks. Its principles-based approach has proven more adaptable to emerging financial innovations than the rules-based approaches as adopted in the U.S. By favouring permission over prohibition, it has allowed beneficial financial innovations to thrive, while leaving regulators able to step in when innovations appear harmful to the stability of the system. On the whole, Canada’s regulatory approach is, put simply, simpler and reduces the costs of compliance and enforcement. Significantly, it has remained immune from the toxic political influences that overshadow U.S. regulation. None of this guarantees that the Canadian approach to regulation is fail-proof. The Canadian financial sector has a few large banks – some with assets ranging up to 50% of GDP – who could be categorized as “too big to fail.” Deposit insurance rates remain low and insurer’s reserves are not sufficient to shield the Canadian public from the costs of institutional failure. Despite the good job in fostering a stable environment, Canadian regulators must still face a number of issues. Each financial crisis is different and future crises are always over the horizon. Success in avoiding the brunt of the last crisis does not guarantee that Canadian financial institutions will escape unscathed from the next one. Also, fast paced innovation puts regulators in a continual game of catch-up. The rapid growth of shadow banks and over-the-counter derivatives contributed to the last crisis and the issues they raise have yet to be resolved. Finally, the success of international efforts to reverse “too big to fail” by allowing troubled financial institutions to fail safely cannot be assured. It requires authorities to close failing institutions promptly but history suggests that delay may appeal to regulators. They may hope that an institution, if given time, can recover. They may also fear fuelling a financial crisis by repeating the distress unleashed by the failures in the last crisis. With no chance for a trial run, regulators may be forced to bailout failing institutions in the heat of a crisis. To prevent such an outcome, regulators must strengthen measures to ensure that major institutions are too safe to fail

A Canadian Critical Care Trials Group project in collaboration with the international forum for acute care trialists - Collaborative H1N1 Adjuvant Treatment pilot trial (CHAT): study protocol and design of a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Swine origin influenza A/H1N1 infection (H1N1) emerged in early 2009 and rapidly spread to humans. For most infected individuals, symptoms were mild and self-limited; however, a small number developed a more severe clinical syndrome characterized by profound respiratory failure with hospital mortality ranging from 10 to 30%. While supportive care and neuraminidase inhibitors are the main treatment for influenza, data from observational and interventional studies suggest that the course of influenza can be favorably influenced by agents not classically considered as influenza treatments. Multiple observational studies have suggested that HMGCoA reductase inhibitors (statins) can exert a class effect in attenuating inflammation. The Collaborative H1N1 Adjuvant Treatment (CHAT) Pilot Trial sought to investigate the feasibility of conducting a trial during a global pandemic in critically ill patients with H1N1 with the goal of informing the design of a larger trial powered to determine impact of statins on important outcomes.</p> <p>Methods/Design</p> <p>A multi-national, pilot randomized controlled trial (RCT) of once daily enteral rosuvastatin versus matched placebo administered for 14 days for the treatment of critically ill patients with suspected, probable or confirmed H1N1 infection. We propose to randomize 80 critically ill adults with a moderate to high index of suspicion for H1N1 infection who require mechanical ventilation and have received antiviral therapy for ≤ 72 hours. Site investigators, research coordinators and clinical pharmacists will be blinded to treatment assignment. Only research pharmacy staff will be aware of treatment assignment. We propose several approaches to informed consent including a priori consent from the substitute decision maker (SDM), waived and deferred consent. The primary outcome of the CHAT trial is the proportion of eligible patients enrolled in the study. Secondary outcomes will evaluate adherence to medication administration regimens, the proportion of primary and secondary endpoints collected, the number of patients receiving open-label statins, consent withdrawals and the effect of approved consent models on recruitment rates.</p> <p>Discussion</p> <p>Several aspects of study design including the need to include central randomization, preserve allocation concealment, ensure study blinding compare to a matched placebo and the use novel consent models pose challenges to investigators conducting pandemic research. Moreover, study implementation requires that trial design be pragmatic and initiated in a short time period amidst uncertainty regarding the scope and duration of the pandemic.</p> <p>Trial Registration Number</p> <p><a href="http://www.controlled-trials.com/ISRCTN45190901">ISRCTN45190901</a></p

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden