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Rx: A healthy dose of reason?

After a CBC News article reported that a man nearly died from his flu shot, hundreds of readers have commenced what amounts to an collective online panic attack.

CBC News reported Wednesday that Richard Ryan, a 44-year-old man from New Westminster, BC, was paralyzed for nearly five months and still remains ill as a result of Guillain-Barré syndrome, a serious autoimmune neurological disease that occurs very rarely as a side effect of the flu vaccine. Guillain-Barré occurs in around one in a million patients who receive the flu shot. But the rather alarmist headline read "B.C. man paralyzed after flu shot warns of risks."

In two days, the article has received over 300 comments written by CBC News readers. (Comments were posted both and , where the article was syndicated. The article itself also received from the Fox News website in the US.)

Predictably, remarks denouncing the vaccine have proliferated. "That is some scary, scary stuff," wrote one reader. "Thats almost as scary as the carrot juice that paralyzed that person last year. I will never drink carrot juice again. Nor will I take a flu shot. I heard that it has been linked to alzheimers." Another, under the pseudonym "skip the shot," claimed the risk of contracting Guillain-Barré syndrome from the vaccine is actually 100 times higher than it has typically been estimated. Many readers proclaimed their intention to decline vaccination in the future.

Keep in mind that a study last year by the Toronto-based Institute for Clinical Evaluative Sciences (ICES) reported that Canadian influenza vaccination rates, despite more than doubling since 1997, are still too low. And drops in other vaccination rates -- such as the MMR shot in Great Britain, after the now-disproved Dr Andrew Wakefield thimerosal/mercury scare -- have resulted in about potential epidemics of diseases like measles and mumps that could easily be prevented by immunization. Canadian MMR vaccination rates were only slightly lower than had been projected after the Wakefield warnings, the CMAJ has ; however, outbreaks of mumps in Canada have been traced back to the UK.

So, the question is: Did CBC News act responsibly by publicizing the story of one man whose case, according to a neurologist, is not representative and not making sufficiently clear the calculations and balancing of risks that have gone into developing public health and vaccination recommendations over the years? There's no denying the public has a right to know what is going on, but at some point the editorial decision-making process has to draw a line about what is newsworthy and what is sensationalist.

Photo: Shutterstock

What's in the news: Oct. 24 -- Goudge, apologies, and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Friday, October 24.

Only 55% of depressed Canadians receive treatment according to best-practices guidelines, according to a new analysis of national mental health data by a team of researchers from the University of Montreal. The proportion of people given appropriate treatment is even lower in rural regions and for patients who are treated by general practitioners.

The Ontario government introduced new legislation in response to Justice Stephen Goudge's report from the Inquiry into Pediatric Forensic Pathology in Ontario, apparently accepting all of Justice Goudge's recommendations. The law would create a specialized forensic pathology service in the province, an oversight council and a formalized complaints process. [news release] In response to the legislation yesterday afternoon, both opposition parties expressed support for the vast majority of the bill but brought up concerns about a clause that would strip the Minister of Community Safety of the authority to initiate a legal inquest into the death of a child. [Ontario Hansard] For more about the Goudge report, read our previous coverage: part one and part two.

My timing in musing on a snap election in Quebec yesterday was impeccable, it seems. Two ADQ opposition members have suddenly defected to the governing Liberals, making the possibility of a Liberal return to a majority all the more possible. [La Presse]

Ontario's legislature spent a great deal of time on Tuesday debating the Apology Act, on its second reading. The Progressive Conservatives' justice critic first attempted -- without success -- to commandeer the discussion by insisting that the Liberals owed Ontarians an apology for destroying the manufacturing sector and losing jobs. Eventually, the debate got back on track and the PCs and the NDP both brought up very valid and interesting concerns about the legislation's potential effect in discouraging what may be worthwhile and meritorious lawsuits. The NDP also worried that protecting apologies from being introduced in court as admissions of liability could be potentially disastrous. One of the major complaints from both opposition parties was that debating the Apology Act while the economy crumbles is a demonstration of the government's misplaced priorities. Peter Kormos, who is leading the NDP's critique of the bill, proceeded to ramble on for about 40 minutes about the insurance industry lobby, OJ Simpson, Bill Clinton, George Burns, and lots, lots more. At one point, Liberal Tourism Minister Monique Smith tapped her watch to try to hurry Mr Kormos up. "Sister, I appreciate it very much," he responded. "I thank you, because I thought I'd exhausted my time. But she tapped her wristwatch and I looked and I've got 26 minutes." To which Ms Smith replied, "You've exhausted our time." Then he continued to talk, touching on the Geneva Convention, Zorro and the poor performance of the Maple Leafs so far this season. The bill has been forwarded to the justice committee for further debate, which -- if this week's show is anything to go by -- will probably not go quickly or easily. [Ontario Hansard]

Yellowknife's small Stanton Territorial Hospital has one case of necrotizing fasciitis. The infection has been contained, CBC News reported.

The current word is that Prime Minister Stephen Harper may announce his new cabinet as early as Monday.

Nearly half of US internists and rheumatologists prescribe placebos, according to a new study. Sixty-two percent believe giving placebos without disclosing they are not real drugs is "morally permissible." Earlier this year, after a similar study was published with similar results, the Canadian Medical Association's director of ethics questioned doctors' deception of patients.

Two of the United States' five highest-security biological laboratories do not meet a range of security measures, a Government Accountability Office report found.

An op-ed in the New York Times about the need for better data and evidence-based decision-making in the US healthcare sector would be mostly unremarkble, if it wasn't in large part about baseball and if it wasn't co-authored by Newt Gingrinch, John Kerry and Oakland Athletics general manager Billy Beane. "America’s health care system behaves like a hidebound, tradition-based ball club that chases after aging sluggers and plays by the old rules: we pay too much and get too little in return."

What happens to a shrew's skeleton if a person swallows the rodent whole? Find out in a new Annals of Improbable Research video clip.

Dr Richard Horton, the editor-in-chief of The Lancet, will speak at McGill University next Wednesday. [McGill]

Ontario doctors approve controversial contract

A majority of Ontario physicians voted in favour of approving a new contract with the provincial government, despite intense lobbying by critics of the deal in the one month that led up to last week’s vote.

Seventy-nine percent of Ontario Medical Association (OMA) voters approved the deal.

“I’m pleased that doctors have strongly endorsed this new contract,” OMA President Dr Ken Arnold said in . “Over the last four years doctors have been working harder to reduce wait times and improve access to care. This new agreement will build on that progress and help to further improve care for patients.”

According to the OMA, the contract provides for a 12.25% increase in doctors’ pay over four years. But an independent analysis by Canadian Medicine found that actual income will only rise by 10.25% because of the uneven weighting of the contract’s four stages. That means that the increase in ‘real’ income, or income adjusted for projected average Canadian inflation rates, is close to zero.

“I think this is worst contract,”said Dr Douglas Mark, the president of the largest dissenting group of doctors, the Coalition of Family Physicians of Ontario (COFP). “We don’t think it’s adequate.”

In the month between the contract’s tentative endorsement by the OMA’s board of directors and the referendum, the COFP repeatedly warned doctors about what it called the OMA’s “inaccuracies” in explaining the deal and urged voters to ignore the “scare tactics” employed to push them towards ratifying it. Voters may have grudgingly accepted the deal largely because Ontario physicians had been without a contract since the last agreement expired at the end of March. However, this year’s agreement passed with a greater margin of support from OMA members than did the last contract, in 2005, which was approved with 74% of the vote after an earlier version of that contract was rejected the previous year.

As was the case in the Canadian federal election, which fell in the middle of the OMA’s week-long polling, turnout for this year’s vote was very low. Only 34% of doctors cast a ballot -- far fewer than in past years, said Dr Mark. “Maybe doctors were too afraid with the economy turning the way it is to vote,” he said. “Some of them may have felt it was just not worth voting because they don’t think it’s going to make a difference.”

This year’s contract includes funding for a number of health policy initiatives as well as the physicians’ pay adjustments. The government pledged to fully fund 500 nursing positions in some physicians’ offices. Financial incentives will also be made available to physicians for treating diabetic patients, and for physicians who accept certain categories of unattached patients into their practice, including “complex/vulnerable” patients and mothers with newborns.

Another important commitment in the new contract is a promise from the government to pay 100% of the interest on medical residents’ student debt if they agree to practise in Ontario for a minimum of five years following graduation. Ninety percent of interns and residents who voted on the contract cast their vote in favour of approval, but their turnout was a paltry 15%. However, medical students, the majority of whose debt is still in front of them, voted 99% in favour of the contract, with an above-average 43% of eligible voters participating.

The deal also includes new funding models for geriatricians, geneticists, laboratory physicians and government-employed public health specialists.

One controversial aspect of the physicians’ pay aspect of the contract is the structuring of the raises. Half the increase will be distributed evenly across all medical specialties, while the other half will be allocated according to the government’s and the OMA’s priorities. Dr Mark has expressed serious concern with potentially inequitable raises given to certain doctors and not others. “Doctors are struggling in this province to keep things running in their practices. Now they’ll be faced with dealing with the economic reality, not just in terms of their own investments but in terms of how they are going to run their practices given that our increases are going to be so much in the air. Those who are facing leases that are going to be up for renewal in a short time, or looking at trying to hire more staff or giving their staff raises to help manage the volumes -- there’s so much stuff up in the air.”

Inequitable pay raises may create tension within the OMA, suggested Dr Mark. “There will be a number of docs trying to vie for those funds,” he said. “I think it’s going to create a lot of angst among doctors, even infighting, over these fees now. The process of finding out what the relative fee value should be has not been ironed out yet, and we have to trust the OMA to do that and do it right and be fair for all different doctors’ groups.”

Some OMA members also appeared apprehensive about that portion of the deal; the chairperson of the very large Section on General and Family Practice announced ahead of the vote that he would vote against the contract. Only 64% of GPs and FPs voted ‘yes’ on the contract -- well below the overall count of 79%.

Almost all OMA subsections voted ‘yes’ but several medical specialties voted overwhelmingly against the contract. Emergency physicians -- the third largest group of specialists in the province -- as well as hospitalists and nuclear medicine specialists all returned totals of at least 64% of members opposed to the agreement.

During the several weeks leading up to the vote, the COFP raised the question of whether the OMA deserved to be allowed to continue in its role as the sole government-recognized union permitted to negotiate on behalf of physicians. According to Dr Mark, the COFP could potentially begin an effort to convince members to leave the OMA en masse in order to undermine the OMA’s claim to represent all the province’s doctors. “That’s something we are still considering,” he said. “Over the next few weeks we are going to decide where our focus will be.”

Dr Arnold, the OMA president, took issue with the COFP’s broad criticism in a written statement to Canadian Medicine last week. “[T]he COFP has chosen to present a misleading analysis of the information in the agreement,” he wrote. Dr Arnold did not comment on the possibility of a COFP campaign to urge doctors to leave the OMA.

Illustration: Shutterstock

What's in the news: Oct. 23 -- Ontario deficit slows health plans

A round-up of Canadian health news, from coast to coast to coast and beyond, for Thursday, October 23.

Faced with a projected $500-million deficit this coming year, Ontario's finance minister announced that it will slow down the hiring of 9,000 nurses in order to save $50 million. The nurses were supposed to be hired over four years; the new plan calls for them to be hired within five. Both major nursing groups in the province have criticized the decision, citing the pressing need for more nurses. Also, the introduction of 50 new family health teams will be deferred for a year, in order to shave $3 million off this year's budget. Even in Alberta, solidly in the black for over a decade, talk is beginning to turn to similar cutbacks. Is the credit crunch/recession/economic volatility situation going to put an even tighter squeeze on other provinces' health spending? That may be a dangerous precedent for governments that don't enjoy the same popular support that Ontario's Liberals have over the last several years; even Ontario, judging by today's news, is feeling pressure to reduce the impending public debt. A safe bet is that deficit spending will be necessary in a number of provinces over at least the next or two. Prince Edward Island is already doing so. Some economists have stated publicly that deficit spending will be better for the economy than program cuts. The federal government has already refused to consider deficit spending, Finance Minister Jim Flaherty announced recently.

Clopidogrel, a clot-prevention drug given to patients who have been fitted with arterial stents, used to be difficult to prescribe in Ontario; doctors needed to get special approval from the public health insurance plan to give the drug to a patient, and therefore only 35% of patients for whom it was indicated actually got the drug within 30 days. Then, a few years ago, the health insurance plan changed its policy and made it easier for doctors to prescribe clopidogrel. The number of patients who got the drug within the recommended time period more than doubled.

Infants put under anesthesia suffer from more developmental diseases, according to new research.

Quebec's ombudsman released a report that condemns one hospital's outsourcing of surgical work to a private clinic in Montreal. But the provincial government says the outsourcing will continue.

The prospect of a snap election in Quebec looms as the Liberals calculate their odds. This week's "contrived... theatrics" in the National Assembly could well be a sign of the writ being dropped sooner rather than later. An election this winter would be very different from the one held last year, in which the conservative ADQ party and its leader Mario Dumont allowed Jean Charest's Liberals to appear centrist on healthcare privatization. Many analysts have pointed out that the Liberal government has been anything but. The difference in a coming election is likely to be that the ADQ appears far weaker than it did in 2007, when it replaced the Parti Québécois as the official opposition. Since then, the Liberals and PQ have both gained in the polls. The new rumours come just a week after Mr Charest said he would this fall.

Toronto's medical officer released a report examining the effect of low income on health.

André Picard on some people's irrational hatred of Insite.

What's in the news: Oct. 22 -- RNs attacked, homeless care, and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Wednesday, October 22.

Nurses at Toronto's Centre for Addiction and Mental Health are sick and tired of being physically and verbally assaulted. The president of the Ontario Nurses' Association claimed there were 23 attacks against nurses there last month, including a sexual assault in one of the washrooms last week. The nurses' and public employees' unions are demanding better protection from the hospital. The Ministry of Labour should cover workplace violence under the Occupational Health and Safety Act, a union leader said.

British Columbia health authorities took steps to make it easier for patients to file complaints about healthcare delivery.

Dr Stephen Hwang received a much-deserved laudatory profile in The Globe and Mail about his universally admired work with the homeless, his research and his religious convictions.

Canadian asbestos producers were none too pleased about the high-profile drubbing they got in the Canadian Medical Association Journal and the national press over the last two days. Some claim the motive behind pushing Canada to ban asbestos exportation is in fact a business matter, not a health one.

Dr James Orbinski, a Toronto physician, university professor and the former international president of Doctors Without Borders, is shortlisted for the Governor-General's Literary Award for his memoir An Imperfect Offering: Humanitarian Action in the Twenty-First Century, which recounts his service in places such as Somalia, Rwanda, Kosovo and Afghanistan.

Is video game addiction a valid diagnosis? Not yet, according to the DSM-IV (though it's under review for the fifth revision now). Nevertheless, Dr Bruce Ballon at the Centre for Addiction and Mental Health has begun treating teens and young adults whose video game habits are adversely affecting their ability to live healthy lives and function normally. In a disturbing note, a 15-year-old Barrie, Ontario, boy named Brandon Crisp has been missing for nine days now; his mother blames his disappearance on Call of Duty 4, a war game, and police have hypothesized he may be attempting to survive on his own in the woods.

A medical marijuana Compassion Centre opened today in Quebec City, run by the same man who started the Montreal store. [news release]

A Montreal woman pleaded guilty to making over 10,000 911 calls.

Albertans are worried about social-services and healthcare budget cuts as oil prices continue to drop to levels significantly below the provincial government's conservative estimates.

This week's edition of Grand Rounds, featuring the best of the health blogs, is online.

What's in the news: Oct. 21 -- Suicide, financial crisis, and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Tuesday, October 21.

A report by senior Ontario health policy analyst Ted Ball takes a gloomy view of government's ability to continue to fund healthcare as costs rise. Mr Ball also has some advice for people waiting to see if Health Minister David Caplan will institute major reforms: give it up. What's needed, says Mr Ball, is for Mr Caplan to push through the existing reforms that have not been fully instituted yet.

New national accreditation guidelines stipulate that hospitals and nursing homes must come up with suicide prevention and monitoring plans.

At 7am this morning, a patient at Toronto's Centre for Addiction and Mental Health found a woman dead on the hospital's lawn.

McMaster University has acquired the world's most powerful commercially available electron microscope -- the Hubble of the subatomic, they claim. The microscope will aid nanotechnology research.

Dr Dana Hansen, a former Canadian Medical Association president, has been elected to the position of president-elect of the World Medical Association. His term, beginning next year, will mark the first time a Canadian has headed the WMA since 1971. [CMA News]

In other World Medical Association news, the outgoing president, Iceland's Dr Jon Snaedal, warned in his valedictory address on Friday that the global financial crisis may result in medical responsibilities being shifted away from physicians to other (cheaper) health professionals. Such moves may be reasonable in some circumstances, he said, but doctors should be vigilant of situations that may arise where planning for major changes like these is insufficient.

Autistic children are difficult to manage. In many cases, autistic teenagers, however, are infinitely harder to deal with. An excellent article in this past Sunday's New York Times Magazine describes an experimental educational model that appears to be having a dramatic effect on the teens.

A group of Canadian researchers and policymakers met under the auspices of the Institute of Health Economics, in Edmonton, and produced a consensus statement on adult depression.

Mountain climbing at high altitudes causes neurological damage, reports a new study in this month's European Journal of Neurology.

Film about Canadian MD's oil-sands cancer warning on Oscar shortlist


A documentary about Dr John O'Connor, the Canadian physician who first sounded the alarm about the high rate of unusual cancers in First Nations people near the oil development fields in northern Alberta, has been .

Directed by US filmmaker Leslie Iwerks, Downstream takes a critical look at the Alberta oil-sands developments and the concomitant environmental health concerns.

Dr O'Connor, who lived in Alberta and regularly flew to the northern First Nations communities to treat patients, warned in 2006 of worryingly high rates of unusual cancers in the region near the new industrial developments. He was subsequently for professional misconduct, including alleged violations such as "engendering mistrust" and "raising undue alarm." The charges were laid by the provincial regulatory body, the College of Physicians and Surgeons of Alberta (CPSA), after a complaint was made by the federal government. The pressure from the case chased him from Alberta to a new home in Nova Scotia, where he now practises. He was of three of the four misconduct charges in January 2008. At the time, the charge of raising undue alarm was still open but Dr O'Connor was convinced it had become moot. (Reached by telephone on Monday, a CPSA representative declined to speak about Dr O'Connor's case, citing provincial privacy legislation related to professional complaints. Dr O'Connor could not be reached for comment.)*

Downstream's potential Oscar opportunity has received international attention, from to Los Angeles. According to Fort McMurray Today, upon seeing a short teaser for the film, Spike Lee , "Wow, that looks great." Dr O'Connor told Today he was pleased with the final product.

*Update, October 29: The charge of raising undue alarm still stands, as far as Dr O'Connor knows, he said in a phone interview from his office in Nova Scotia. "I haven't heard from them [the College of Physicians and Surgeons of Alberta] since December 5 of 2007," he said. He maintains the allegation is bogus. "There is definitely no undue alarm -- there is no alarm at all," he explains. "The chiefs are saying, 'We have been crying out for decades.' They are calling it 'due concern' not 'undue alarm.' I am puzzled to say the least."

Photo:

What's in the news: Oct. 20 -- Asbestos, manslaughter, and more

A round-up of Canadian health news, from coast to coast to coast and beyond, for Monday, October 20.

Canada's efforts to stymie international trade restrictions on carcinogenic asbestos are "shameful and wrong," declares the Canadian Medical Association Journal in an editorial to be published tomorrow. A great deal of asbestos is mined in Quebec -- there's even a town named Asbestos in the south of the province -- but 95% is exported and very little is actually used in Canada, according to the Globe and Mail. "In 2006, at the last round of the talks," the newspaper reported, "Canada successfully led a group of countries including Iran, Zimbabwe and Kyrgyzstan in stopping the action. Canada was the only advanced Western country to take such a position."

The federal government has filed its claim in the appeal of the May 2008 decision by a BC judge that Vancouver's safe-injection clinic, Insite, cannot legally be shut down by Ottawa. "The issue of whether supervised-injection sites are good public policy is not a matter for the courts," the documents say, according to the Canadian Press. "This is no more justifiable than requiring an exception from the law of theft from kleptomaniacs, or an exception from the impaired driving laws for alcoholics... Treating addicts with sensitivity on sentencing may be good policy, but giving them a free pass from conviction is not." The appeal will be heard in April.

The outbreak of C difficile in a Regina hospital's neonatal intensive care unit is over.

Doctors at Mt Sinai Hospital in Toronto announced a new, much less invasive method of reversing a vasectomy. The new technique, tested on 10 patients successfully, only requires a tiny incision and doesn't even necessitate the use of a scalpel. The researchers haven't determined yet whether the new technique will make surgical recoveries safer or faster.

A Montreal naturopath was charged with manslaughter after an elderly patient died the day following an intravenous "mineral treatment." The naturopath, Mitra Javanmardi, is being defended by one of the city's top lawyers, Julius Grey. Ms Javanmardi is out on bail but her practice has been restricted during the trial. "The fact that she's not allowed to do what she used to do is for the protection of the public," said the crown prosecutor. "And I hope the public will know what they cannot do, the naturopath, because they are not doctors and that's important." Ms Javanmardi had some legal trouble in the 80s in regards to her professional title. The case is already making the rounds online: one blog, which refers to naturopathy as "just another face of fascism," mentioned Ms Javanmardi's case beneath an illustration of a duck in the crosshairs and the words "QUACK KILLS."

Alberta's new funding for midwife-assisted births might translate into more unsafe deliveries outside hospitals, worries the Calgary Herald in an editorial.

A reporter with the Regina Leader-Post, a week after writing about emergency care, suddenly found herself rushing off to the emergency room after her husband broke his pelvis in a skydiving accident. She provides a list of "hospital etiquette" that she's learned.

Brushing your teeth with an electric brush and special toothpaste doesn't convey any particular health benefits as compared to using a regular toothbrush and regular toothpaste, reports a Dalhousie University periodontal researcher.

China, which largely abandoned its national public healthcare system in the 1980s, plans to reverse course and return to universal healthcare by 2020. The country will cover 90% of the population under a public insurance plan over the next two years. The plan -- developed in consultation with the World Health Organization, the World Bank, public health experts and the consulting firm McKinsey & Co., which was also used by the government of Alberta this year -- is not finalized, and is now the subject of a great deal of public debate as some analysts have criticized the lack of specific planning.

Pfizer's former global patents director, Alan Hesketh, was sentence to 6.5 years in prison for possessing and distributing child pornography.