How to Acquire Antibiotics for Sale

In the old days, no one can acquire antibiotics for sale if they do not have a doctor’s prescription for it.   Most people of those ages do think that it is rightly appropriate to first have a doctor’s prescription or at least his recommendation in order for one to be allowed to get some antibiotics for sale to treat their ailments, but today, due to modern advancements in science, health and technology, this way of thinking is now being overlooked.  The way most of us think about antibiotics today is also different, too.  When we get a bacterial infection, we would usually want to get it treated right away, and that’s what antibiotics for sale without a prescription is all about.

You may be wondering, how can one acquire antibiotics for sale without a prescription by a doctor? If you live in the United States or any similar country, then most of the times it would be difficult for you to be able to buy some antibiotics for sale right at your local pharmacy’s counter.  In reality, there is a way on how to get some antibiotics for sale even without a doctor’s prescription on hand, and there are actually 4 ways: through a pet store, take a trip to Mexico, visit an oriental/ethnic market or convenience store, or you can buy antibiotics for sale via the Internet.

If you are already a pet lover or you have a pet at home, for example, a fish, then any pharmacist will say to you that human antibiotics are usually used to treat fish diseases, and you do not need a prescription just to buy antibiotics for your pet fish.  Some antibiotics for sale available at pet stores where you do not need a prescription are: ampicillin, erythromycin, tetracycline in either tablet or capsule form. Most people would think it’s not a great idea to take vet medicines; however, in chemical form, these drugs are actually the same as what you will get from a local pharmacy meant for human use. Read more…

What's in the news: September 19 -- Election talk, a Newfoundland fight and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Friday, September 19.

The Canadian Medical Association Journal has published the responses of all five major political parties to a list of 10 questions on healthcare. Read the CMAJ's overview here (PDF) and the responses to each question here (PDF).

The rift between the Newfoundland government and the province's medical association is larger than ever after Premier Danny Williams accused medical association president Rob Ritter of interfering unhelpfully in negotiations to keep disgruntled gynecological oncologists in the province.

New clinical practice guidelines released yesterday by the Canadian Diabetes Association urge doctors to identify and treat a condition known as "prediabetes," which can lead to full-blown diabetes. [Canadian Diabetes Association guidelines (PDF)]

Paracetamol (marketed as Tylenol) use in children might lead to asthma and several other conditions, report researchers in this week's asthma-themed issue of The Lancet.

Canada's healthcare protectionism violates NAFTA, claims businessman

For the first time ever, the Canadian government is facing a legal threat over the question of whether restrictions on foreign private investment in the healthcare sector are in violation of the North American Free Trade Agreement (NAFTA), Embassy magazine's Luke Eric Peterson reports in a column published yesterday.

Mr Peterson writes:

Successive governments—both Liberal and Conservative—have long insisted that Canadian trade negotiators succeeded in "grandfathering" medicare under the North American Free Trade Agreement. In other words, our health care system -— at least as it stood in 1994 when the NAFTA came into force —- is beyond the reach of foreign insurance companies and HMOs seeking to re-model it after the U.S. system.

What's less clear, however, is whether the ongoing flirtation by various provinces with greater private financing and delivery of certain forms of health care is slowly eroding Canada's legal defences.

At least one American citizen is keen to find out.
A lawsuit is being threatened by Melvin J Howard, the CEO of the Arizona-based Centurion Health Corporation, who spent five years and millions of dollars trying to build a $154-million private surgery clinic in British Columbia -- it was envisioned to be the largest such clinic in the country -- but he claims he was chased off by British Columbia cities' "politically motivated" zoning rules and bylaws because his business is American.

Mr Howard's case, as he lays it out on (he first threatened to sue under NAFTA as early as ), is based on the following logic:

1. Recent reforms in various Canadian provincial healthcare systems (including the Supreme Court of Canada's 2005 ruling in Chaoulli v Quebec) have created new private investment opportunities for Canadian businesses.

2. NAFTA dictates that American, Canadian and Mexican businesses must have equal opportunities in all three countries.

3. Centurion wasn't able to take advantage of the same opportunities some private Canadian companies have -- because, says Mr Howard, his business is based in the US.

Ergo: NAFTA violation.

Or so claims Mr Howard. But Embassy's columnist, Mr Peterson, doesn't seem to be convinced yet. Though he writes that a healthcare-related NAFTA challenge has been a long time coming, he implies that this case isn't necessarily going to be the next softwood-lumber dust-up:
As someone who specializes in writing about these types of cross-border lawsuits, I should caution that not every such threat leads to an actual arbitration under the NAFTA. Moreover, even when arbitrations are launched, that doesn't always mean that investors can convince a panel of arbitrators that they have suffered breaches of NAFTA protections owed to them.

And at this stage there are more questions than answers about Mr. Howard's allegations.
At the end of August, Mr Howard and the Canadian government exchanged correspondence about setting up a consultation to discuss Mr Howard's claims. But with Prime Minister Stephen Harper clearly about to call an election at the end of August, Mr Howard said he would put a hold on talks until after the October 14 election is decided.

"At that time," , "Centurion will proceed [and] if after the consultations there appears to be no resolution we will move to go to arbitration."

Update, September 19: The largest labour union in Canada, the Canadian Union of Public Employees, is taking this matter very seriously. "For everyone who thought health care was safe from NAFTA, this is a reality check," said national president Paul Moist in a release. "The threat also exposes the serious risks that follow from the privatization schemes British Columbia and other provinces have allowed to creep into their health care systems. NAFTA threatens to transform that modest flow, if it is not immediately abated, into a torrent," said says Stephen Shrybman, a trade laywer.

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What's in the news: September 18 -- Tasers, the Wii Senior Olympics and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Thursday, September 18.

Nova Scotian medical examiner Dr Matthew Bowes has concluded his investigation into the 2007 death of schizophrenic Dartmouth resident Howard Hyde while he was in custody about 30 hours after police shot him with a Taser. His findings? Mr Hyde died of a "excited delirium," and his death was unrelated to the Taser shock and therefore accidental and in no way the liability of the police. But "excited delirium" is not a recognized medical condition; the American Civil Liberties Union has derided the use of the term as a way of "white-washing" the deaths of inmates, as National Review of Medicine article reported last fall.

Coincidentally, yesterday, another Canadian died after being Tasered by police while in custody, in Toronto. By one count, 23 Canadians have now died after being Tasered.

The government of New Brunswick has finally relented and agreed to review its policy limiting the number of doctor billing numbers that can be issued to certain geographical regions. The policy was intended to make sure enough doctors would be available to work in rural areas, but the medical community has long railed against the regulations.

Welcome to the Wii Senior Olympics! From September 27 to October 3, Toronto-area senior citizens will be competing for Nintendo supremacy in a grueling set of video game matches of virtual tennis, virtual golf, virtual bowling and the virtual triathlon of all three games. The competition is being held by Lifecare Operations, a long-term care company.

The Canadian Lung Association endorses the Conservative plan on cigarillos and tobacco, which would ban the sale of individual smokes and outlaw the use of kid-friendly flavourings like cotton candy and bubble gum. [Canadian Lung Association] [Canadian Press]

The federal minister of agriculture, Gerry Ritz, has apologized for making some rather unpleasant jokes about the Canadian listeriosis outbreak. [CBC News] Meanwhile, the Maple Leaf sanitizing plant in Toronto, which has been implicated in the spread of the bacteria, is set to reopen next week.

The College of Physicians and Surgeons of Ontario has removed a threat of disciplinary action from its draft policy warning doctors that they could face complaints from the Ontario Human Rights Commission if they refuse to perform any medical services because on religious or moral grounds. (Today the College will debate its draft policy in order to finalize it.) Margaret Somerville, the founding director of the McGill Centre for Medicine, Ethics and Law, expresses her support for doctors' freedom of conscience, and reports that Alberta's physician licensing body is considering the matter now.

An incentive program tested in four BC hospitals' emergency rooms was successful in reducing wait times.

Dr Keith Martin, a Liberal MP from British Columbia and a former physician, was exaggerating when he threatened to leave politics because of his frustration that getting anything done was so difficult. He's not going anywhere... so long as he keeps winning elections.

Bisexuals' mental healthcare needs are not being met, reports a new study from Toronto's Centre for Addiction and Mental Health. [CAMH]

To prevent the onset of heart disease, Dr Yoni Freedhoff, an Ottawa family doctor and obesity specialist, ate a whole bag of President's Choice Two-Bite Brownies.

Grey's Anatomy, the phenomenally popular hospital soap opera, partnered with the Kaiser Family Foundation to insert some information about HIV into the plot of their show. Kaiser researchers have now announced that viewers learned a surprisingly large amount about HIV from watching.

Do "doctor moms" suffer higher rates of pregnancy complications because of the physical demands of their work? The Boston Globe reports that Columbia University researchers are studying that question now, while other researchers look at the way expectant and new mothers are treated in the medical profession.

The latest edition of Health Wonk Review, a collection of the best recent blog entries on health policy, is online now.

On Friday, an interesting medical ethics conference comes to Edmonton: "Between a Rock and Hard Place: When Healthcare Providers Experience Moral Distress," the second iteration of the meeting held in Calgary in May. Hosted jointly by the College and Association of Registered Nurses of Alberta and Alberta's Provincial Health Ethics Network, the September 19 full-day conference will feature speakers from across Canada and the US. [more info]

What's in the news: September 17 -- Listeriosis blame, burns, budgies and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Wednesday, September 17.

The proposed agreement between the Ontario government and the province's physicians is flawed, Ontario NDP health critic France Gélinas tells NorthernLife.ca. But she doesn't believe the deal is bad because it doesn't pay doctors enough -- quite the opposite, in fact. "[A]s with the last agreement in 2005, physicians’ salaries are going up and promises of better access to care and reduced wait times are being made," she said. "But paying physicians more in 2005 did not improve access to care or reduce waiting lists - so why should it now?" Ms Gélinas decries the government's failure to link funding with real changes, instead pouring more money into an increasingly out-of-date fee-for-service model rather than community health centres, health promotion, chronic disease management and more funding for other providers.[NorthernLife.ca] In other news on the tentative Ontario deal, Ontario Medical Association president Dr Ken Arnold is refusing all interviews this week, Canadian Medicine has been informed.

Canadian researchers have made a major advance in oncolytic virotherapy, a cutting-edge area of research that seeks to use viruses to kill cancer cells. Scientists from Montreal and Ottawa report in the journal Proceedings of the National Academy of Sciences that another type of molecule, called histone deacetylase inhibitors or HDIs, can prime the cancer cells to be targetted by a virus that is harmless to normal human cells but fatal to cancer cells. Experiments have so far been limited to laboratory work, but human trials could begin within a year or two, McGill's lead researcher says. [McGill University]

Journalists in Sault Ste Marie, Ontario, were expelled from a meeting about the future of the region's healthcare.

The Canadian Medical Association Journal editorial board blames the Conservative government for dismantling the food-inspection system and allowing self-monitoring. The editors call for a public inquiry into the matter.

Canada's healthcare system doesn't compare favourably to those of most Western European nations, reports the Frontier Centre. Given all the other, similar discouraging studies we've heard over the years, this should come as no surprise.

Don't miss this excellent Toronto Star feature on bonding among severe burn victims, and how burn care works. [Toronto Star]

An update on the case of the Moorish-American parents who were arrested in Toronto after bringing their allegedly malnourished infant to the hospital but refusing treatment: the mother has been released on bail and the father is being held until his hearing tomorrow.

The controversial retired hockey player Eric Lindros donated $5 million to the London Health Sciences Centre, which the Canadian Press reports is believed to be the largest one-time charitable donation ever by a Canadian athlete. [Canadian Press]

A Canadian weight-loss supplement company, Wellnx Life Services, is being sued by customers in sixteen US states. [press release]

Canada becomes the first country in the world to approve the new anticoagulant rivaroxaban to prevent venous thromboembolic events (VTE) after hip and knee replacement surgeries. The once-daily pill has proven to have significant benefits over the current treatment, enoxarapin, with similar rates of side effects like bleeding. The drug's effects were demonstrated in a large trial (funded by Bayer) the results of which were published in The Lancet's July 5 issue. [ abstract] [ (subscription required)]

Prosthetic ears?!

A fascinating take on 23andMe, a DNA testing company, and the potential future of personalized medicine -- as well as social networking.


Here's the latest and greatest from blogs written by Canadian physicians:

In "A Bird's Eye View of Family Medicine," a retired Okotoks, Alberta, family physician, who ponders our country's health policy problems at What's Wrong with Healthcare?, writes:

Over the past four to five days I have noticed that my budgie bird, Jo-Jo, was becoming a “Star Gazer”. In medical terms, he was developing a torticollis. Now to appreciate the story, you should know that I inherited this bird from an elderly couple in my practice, when during a house-call, they asked if I would take Jo-Jo if anything ever happened to them. They said he liked me, and besides, their daughter had a cat. In a moment of insanity (my wife hated birds), I agreed. Some two years later both of these dear elderly folks passed on and I prayed that they told no-one of my promise. Unfortunately, the daughter showed up in my office a few days later with bird, bird cage, bird food, and various other bird paraphernalia. My wife was not pleased and I barely escaped the couch the first night.
The budgie's neck problem leads the author to a novel solution to the shortage of primary care providers in Canada, believe it or not. (I'll give you a hint: more money.)

Alberta Liberal leadership candidate and former public health physician David Swann on the environment and health: they're "two sides of the same coin," he says. [David Swann's Blog]

Dr Michelle Greiver dissects the debate on hosting electronic medical records locally vs remotely.

Speaking of electronic medical records, CanadianEMR just introduced its weighted medical records software rankings, vastly increasing the value of its already impressive user-rating system.


CMA issues healthcare challenge to political parties

In an open letter sent today to the leaders of the five largest political parties, Canadian Medical Association president Robert Ouellet (right) demands responses from each on the six most pressing healthcare problems facing the country today.

As well, Dr Ouellet asks each party to release their healthcare platform by September 29 at the latest so the public has time to weigh the different proposals before the election on October 14.

The CMA won't endorse anybody, but the party's platforms and their answers to the CMA's questionnaire will become part of the organization's Voter's Guide, to be published October 3 at .

The six healthcare problems that Dr Ouellet wants to know the party's positions on are:

- the doctor shortage
- mental health
- innovation and information technology
- access to prescription drugs
- health and the environment
- sustainability of the health care system
Before October 3, when the Voter's Guide will come out, the CMA is providing election coverage for physicians at .

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Electioneering

With the election campaign gearing up and the leaders hopping back and forth across the country in search of votes -- but with still only a few mentions of health policy thus far -- I decided it would be a good idea to find out when the major political parties' healthcare platforms would be available, to help plan our coverage. So I made a few calls.

The young man who answered the phone at the Liberals' media relations office had the answer at the ready: the full platform will be available on September 22 -- next Monday.

The Green Party informed me their platform comes out on September 17.

The NDP's media relations department couldn't give a specific date for the release, but they were very accommodating about putting my name on the list of reporters to be notified when the platform is published.

The Bloc Québécois, which doesn't really have any obligation to draft a full health platform beyond reiterating their mission to extract as much funding as possible from Ottawa, has already made public their . (Other than a timely section on food-safety inspections and a few other sensible but predictable concerns, healthcare doesn't play a terribly large role in the Bloc's platform.)

And the Conservative Party -- which has been with the for -- was not only unwilling to give me an idea of the date when their healthcare platform would be released. In addition, their media relations officer told me that there would be no point taking down my name and contact information, because the Prime Minister will be rolling out parts of the party's platform as the campaign progresses and I'll hear about it when he announces it. End of conversation.

What's in the news: September 16 -- Ranking the provinces, rural reluctance and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Tuesday, September 16.

The Frontier Centre for Public Policy, an independent think-tank based in Winnipeg, released its first Canada Health Consumer Index, which ranks the provinces' healthcare systems rank as follows:

1. Ontario
2. British Columbia
3. Nova Scotia
4. New Brunswick
5. Alberta
6. Prince Edward Island
7. Manitoba
8. Quebec
9. Saskatchewan
10. Newfoundland and Labrador
A short mention of the Frontier Centre study on the St John's Telegram's website has already attracted a number of angry comments, lambasting Newfoundland and Labrador premier Danny Williams. [Full study available as PDF from the ]

As Liberal leader Stéphane Dion's campaign continues to struggle, speaking at Dalhousie University's medical school (where Jack Layton announced elements of his proposed health human resources plan yesterday) Mr Dion this morning announced that his government would create a national catastrophic drug coverage plan. This is a promise Canadians have heard before from federal politicians -- and the premiers are all for it -- but still no progress has been made. [CBC News]

The parents of an ill nine-month-old child, who was very underweight and suspected by staff Toronto's Hospital for Sick Children of being malnourished, were arrested yesterday after a week-long search across the city. The child was taken into the custody of the government's Children's Aid Society. It turns out the parents are members of a "religious sect" (The Globe and Mail was careful not to use the word "cult," for sensitivity reasons, one assumes) called the , which seeks to unite North American "Free Negroes" are really citizens of Morocco. "She's not an evil person and she's not a bad mother... We have the rights as Moorish-Americans not to succumb to institutionalized ways of healing ourselves," said her "spiritual leader" Grand Sheik Brother Kudjo Sut Tekh El.

An Ontario coroner's inquest began yesterday, to investigate the death of Jeffrey James. Mr James died at the Centre for Addiction & Mental Health in Toronto in 2005 after he was tied down to his bed for five days in a row because he had engaged in a "sexual act" in the hospital. Ontario's chief coroner has testified that Mr James died as a result of blood clots that reached his lungs, caused by his being tied down.

Acyclovir, long believed to be useless in HIV but effective in controlling the herpes virus, can actually attack HIV in patients with both that virus and herpes, according to a new study published in Cell Host and Microbe by an international team of researchers including one from McGill. [McGill University]

Saskatchewan's nurses' union has filed a Charter challenge against the province's essential services legislation, which was passed by the recently elected Saskatchewan Party majority government earlier this year.

A Quebec group advocating a provincial newborn hearing-screening program congratuled several Montreal hospitals on their decisions to begin screening programs, but urged the government to follow suit across Quebec. [Montreal Children's Hospital/McGill University]

Dr Trevor Theman, the registrar of the College of Physicians and Surgeons of Alberta, is nervous about this past summer's (PDF) by the Council of the Federation, the assembly of Canadian provincial premiers, on labour mobility for professionals including physicians. In the September issue of the College's newsletter, The Messenger, Dr Theman writes:
I am very concerned that the premiers’ direction addresses one social good, that of labor mobility, but ignores (and may destroy) another - that of ensuring we have physicians working in rural, remote and underserviced parts of Canada. [...]

What might happen if free, unfettered labor mobility is mandated? Well, Newfoundland, Saskatchewan, rural Manitoba and northern Alberta may find themselves with no (or significantly fewer) physicians. [ (PDF, page 3)]

The chemical found in many plastics, Bisphenol A (BPA), has deleterious health effects if it accumulates in humans, according to a new study published today in JAMA. Potential risks include heart disease, liver problems and diabetes. Canada has already restricted the use of BPA, labelling it a "toxic chemical" in April, but the United States has not done so yet.

New data from the DIRECT Program, described as "the first large-scale study program assessing the effect of treatment with an angiotensin receptor blocker (ARB) on the incidence and progression of diabetic eye complications," shows moderately positive signs on the potential benefits of prescribing the drug candesartan to Type 1 and Type 2 diabetics. Type 1 patients who had diabetic retinopathy at the start of the trial didn't get any help from the drug, but diabetics in the test group who had early signs of the disease or who hadn't yet contracted it saw up to one-third better outcomes than those in the placebo group. The study shows some promise for microvascular treatment solutions for diabetic retinopathy. Renowned Montreal General Hospital endocrinologist/internist Robert Gardiner is one of the international coordinators of the trial. The new data was presented last week at the European Association of the Study of Diabetes congress in Rome, and a full article is to come soon in The Lancet. [Takeda UK, AstraZeneca Canada, and others]

Remember the infamous Walter Reed Army Medical Center scandal by the Washington Post? Mother Jones magazine claims to have uncovered another military healthcare snafu: the Pentagon's $20-billion electronic medical records system, which now allegedly lies in shambles.

More details on the tentative Ontario doctors' pay agreement

Canadian Medicine has obtained a copy of today's message from Ontario Medical Association president Dr Ken Arnold to the association's members, announcing the endorsement of the tentative agreement with the government. Here it is, in full:

From: Ontario Medical Association
Sent: Mon 15/09/2008 09:52
To: ---------------
Subject: President's Update: Tentative Agreement Reached!

OMA President's Update


Volume 13, No. 24

September 15, 2008

Tentative Agreement Reached!


Dear Colleague:

The OMA Board of Directors has unanimously endorsed a tentative four-year Physician Services Agreement with government. Our Negotiations Committee presented a proposal to the Board for review late last week. After very careful consideration, the Board has voted unanimously to approve the offer, and recommend it to members.

The purpose of this bulletin is to notify you that we have a proposed contract - we wanted to ensure that you hear it from the OMA first!

The fee component of the Tentative Agreement provides for a 12.25% increase in fees over the term of the Agreement. The amount available in each year for fee adjustments is as follows:

October 1, 2008 3%
October 1, 2009 2%
October 1, 2010 3%
September 1, 2011 4.25%

One-half of the fee adjustment will be allocated to each OHIP specialty on an equal percentage basis. The remaining half of the adjustment will be used to correct disparities in intersectional relativity. Non-fee-for-service physicians will receive an equivalent adjustment on payments for clinical services.

The Tentative Agreement also includes an additional $240 million in new ongoing program funding, and an additional $100 million in one-time incentive funds.

Program changes include:
  • $40 million to adjust Most Responsible Physician (MRP) care codes (C122, C123, C124, admission assessments, subsequent visits and hospital consultations).
  • $20 million in operation funding for changes or expansion of the Hospital On-Call Coverage (HOCC) program.
  • Up to 500 licensed nurses for eligible Patient Enrolment Model (PEM) physician groups.
  • $38 million to establish new, or enhance existing, non-fee-for-service contracts in infectious disease, genetics, public health, psychiatry and geriatrics.
  • Student interest relief and increases to the Clerkship Stipend.
  • $100 million LHIN Physician Collaboration Incentive Fund for physician groups who work together and in collaboration with other service providers in targeted areas of care.
(Complete details of the new program and incentive funds will be set out in the Executive Summary.)

The Tentative Agreement will deliver approximately $1 billion in new funding to Ontario physicians, including fee changes, alternate payment plans and programs.

This has been a difficult negotiation. Government took a very tough stance on a number of our priority issues. We maintained our strategic focus, and the OMA Negotiations Committee effectively advanced our position. Just recently, we achieved movement at the table that resulted in the current proposal.

We are now mobilizing to develop documents, arrange for member information sessions, and implement plans for a member referendum and special Council meeting. The legal team is finalizing the drafting of the contract.

All information will be posted in the Negotiations 2008 Member Resource Centre on the OMA website as soon as possible (https://www.oma.org/members/negotiations/). We will provide summary documents, a Q & A file, and frequent updates via the OMA e-mail and fax network. We expect the initial materials will be available Wednesday, September 17.

You will be hearing from us often. A schedule of member information sessions will be circulated to the profession. We are working to arrange as many meetings as possible to allow for face-to-face discussions about the proposal.

We will establish as many communications channels as we can to allow for members to get what you need to make an informed decision.

The Board anticipates that the member referendum will take place October 8-15. We are hoping to provide members the option to cast their vote either by telephone or online. A Special Meeting of Council will be held October 18.

On behalf of the Board, I want to thank all of our members for your patience and support throughout the negotiations process. I also want to thank the members of our Negotiations Committee for their diligence and commitment on behalf of the profession.

The Board is very pleased that we have achieved a Tentative Agreement that received unanimous endorsement. We will be bringing you all the information that you need to interpret the value of this proposal for your practice.


Dr. Ken Arnold
OMA President


Feedback public_affairs@oma.org

After long delay, Ontario MDs are offered a 12% raise

Five and a half months late, a proposed contract has finally emerged from the negotiations between the government of Ontario and the province's doctors.

According to by the Canadian Press today, the new contract would give Ontario's physicians a 12.25% raise over the next four years, plus an additional $350 million in special program funding.

The contract, however, must still be approved by the Ontario Medical Association's membership in an October 18 vote, and if past experience is any guide then there is no guarantee the OMA's members will approve the deal. During the last set of negotiations, in 2004 and 2005, doctors to endorse the first contract proposed by the government; the process to agree on a became heated and soured many Ontario physicians on then-Health Minister George Smitherman, who was transferred to the Ministry of Energy and Infrastructure in June.

Though the negotiations leading to today's proposal dragged on over a long period of time -- the previous contract expired on March 31 -- they haven't been as heated as 2004/2005 negotiations. The CP article notes that an OMA source called the process difficult and said the government took a "very tough stance."

UPDATE, 4pm: The Ontario Ministry of Health and Long-Term Care has issued their press release on the tentative agreement. Health Minister David Caplan is quoted as saying: "This agreement will allow us to continue moving forward by focusing on our top priorities: improving access to family care and reducing wait times."

UPDATE, 5pm: A 12.25% raise over four years may sound generous, but there's another way of looking at that figure. The average annual raise promised in the proposed contract amounts to 3.0625%. Compare that to the Canadian inflation rate as reported by Statistics Canada for the last two months data are available: a 3.1% inflation rate in June 2008, and a 3.4% inflation rate in July 2008. The nation's inflation rate is variable, of course, but consider the fact that over the last four years Canada's average inflation rate has been 2.48% -- not far from the 3.0625% raise proposed today. If one assumes that inflation rates over the next four years -- the term of the new Ontario agreement -- remain as they have been over the past four, then Ontario doctors will be getting an inflation-adjusted pay hike of just 0.5825%.

What's in the news: September 15 -- Religion, suicide, addictive energy drinks and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Monday, September 15.

Healthcare will be a major issue in this week #2 of the federal election campaign, pledges Canadian Medical Association president Robert Ouellet. Voters go to the polls on October 14. [ (PEI)]

The Ontario Medical Association is taking a stand against a draft policy by the College of Physicians and Surgeons of Ontario that would warn doctors that changes to the functioning of the province's Human Rights Commission may mean that doctors will no longer be able to refuse to provide certain types of medical services (such as abortion referrals) on religious or moral grounds. According to the OMA, the document should note that doctors' "right to freedom of religion is protected under the Charter of Rights and Freedoms."

Newfoundland and Labrador's three gynecological oncologists won't be leaving quite yet. The province's only three such specialists warned that because of poor working conditions they would be leaving on October 7, but that date has now been pushed back to December 15 at the earliest because of delays in notifying patients of their imminent departures.

Newfoundland and Labrador faces other problems as well: physicians are complaining that the lack of operating-room time is "a very desperate situation."

The hospital centre affiliated with the University of Montreal -- CHUM -- is outsourcing all its ophthalmology work to the private sector.

Garou, the Quebec pop singer, has proposed creating a $100-million private health clinic across the street from the site where the planned CHUM French-language Montreal "superhospital" is supposed to be built (assuming all the parties end up agreeing on the site).

Canadian Family Physician looks at physician suicide in "The wounded healer." [CFP] Read the National Review of Medicine's 2007 article on the same subject.

The Archbishop of Montreal, Jean-Claude Turcotte, has returned his Order of Canada medal in protest of the award being given to Dr Henry Morgentaler earlier this year. Dr Morgentaler is largely responsible for the full decriminalization of abortion in Canada, in 1988.

Last week, an LA Times blog that US Republic Party vice-presidential candidate Sarah Palin's much-publicized decision not to abort her son Trig, who was given a prenatal diagnosis of Down syndrome, may reduce the number of Down syndrome abortions -- which would be a negative development, according to Society of Obstetricians and Gynecologists of Canada executive VP Dr André Lalonde. However, the Times was after it became clear that Dr Lalonde (who was quickly vilified all over the internet) was actually saying that he worried Ms Palin's decision could influence the decisions of mothers who are not prepared for the challenges of raising a Down syndrome-afflicted child. Read the original quotes from Dr Lalonde in .

The RCMP has charged an unnamed North Battleford, Saskatchewan, physician with "counselling to commit drug trafficking." The doctor is set to appear in court tomorrow.

Energy drinks should be banned in PEI, says the president of the Medical Society of Prince Edward Island, Dr William Scantlebury. A New Brunswick neurologist says a ban on sales of energy drinks to children across Canada would be prudent. [Moncton ]

Check out the new information-technology handbook published by the Canadian Medical Association.

A Toronto-based physician and researcher from the Centre for Addiction & Mental Health has traced the neurotransmitter levels involved in seasonal affective disorder. The study is published in this month's Archives of General Psychiatry.

Novelist Jennifer Egan explores the "bipolar puzzle" in children, in an excellent article in yesterday's New York Times Magazine.

Asteroid 84928 is hereby named Oliversacks.