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The future of depression treatment

The Canadian mental health landscape is changing fast. The rapidly accelerating pace of research and innovation over the last few decades has finally led to a comprehensive, system-wide review of the most common mental health problem: depression.

In October, a group of the country's top mental health experts, led by Canadian Mental Health Commission chair Michael Kirby, convened in Calgary to discuss depression. The result of the conference was an unprecedented consensus statement (PDF) from some of Canada's most influential policymakers, psychiatrists, family physicians and patients. The statement's recommendations on ways to improve the prevention, diagnosis and treatment of depression run the gamut from amendments to the Income Tax Act that would allow caregivers to write off expenses to the adoption by family physicians of a "stepped care" approach to treating cases of depression along a scale of severity, and lots more.

The scientific chair of the consensus conference, Dr Scott Patten (pictured left), a psychiatric epidemiologist at the University of Calgary, talked to Parkhurst Exchange about the latest research on depression, new thinking on effective clinical practices, and Britney Spears' breakdown.

To read my interview with Dr Patten in Parkhurst Exchange, .

What's in the news: Dec. 5 -- Liberals lead in Quebec election polls

A round-up of Canadian health news, from coast to coast to coast and beyond, for Friday, December 5.

QUEBEC ELECTION UPDATE: With just a few days remaining before the election on Monday, the Liberals have widened their lead in a new poll published in La Presse. The latest numbers give the Liberals a 45% share of the vote -- their largest in a year -- the Parti Québécois 29%, the ADQ 15%, Québec Solidaire 5% and the Green Party 6%. If those numbers turn out to be accurate, the Liberals will regain a majority in the National Assembly and the ADQ will lose a great many of the seats the party gained in last year's election and cede the job of the official opposition back to the PQ. PQ leader and ex-health minister Pauline Marois has been largely unable thus far to gain greater public support than her predecessor, who lost his job as the party leader after a poor showing in the 2007 election. [La Presse]

Just two weeks after celebrating the production of its five billionth vitamin A pill, the Micronutrient Initiative, a Canadian government-funded nonprofit set up to provide developing countries with vitamins to improve children's health, was praised to the skies by New York Times columnist Nicholas Kristof for its work -- particularly when it comes to the promotion of iodized salt. A lack of iodine during fetal development and during childhood and adult life causes permanent brain damage as well as goiters and other physical deformities. "Almost one-third of the world’s people don’t get enough iodine from food and water," Mr Kristof wrote. "An educated guess is that iodine deficiency results in a needless loss of more than 1 billion I.Q. points around the world... Yet the strategy hasn’t been fully put in place, partly because micronutrients have zero glamour. There are no starlets embracing iodine. And guess which country has taken the lead in this area by sponsoring the Micronutrient Initiative? Hint: It’s earnest and dull, just like micronutrients themselves. Ta-da — Canada!"

If the Liberal-NDP coalition government idea indeed comes to fruition, Dr Carolyn Bennett would be minister of health, according to the National Post's Don Martin, who was leaked a list of potential cabinet appointments.

AIDS PEI has run out of funding and may have to permanently discontinue its needle exchange program. Already, the program will be closed in January. It will not reopen unless new funding is found. "It would really be a big step backwards if the program could not be maintained," said Dr Lamont Sweet, Prince Edward Island's deputy chief health officer. The provincial health minister will meet with AIDS PEI to discuss the situation soon. [The Guardian (PEI)]

Now that it's been decided that Montreal's new French-language superhospital will be built downtown, where Saint-Luc Hospital currently stands, the details of the construction and the transition are making doctors anxious about how they will continue to see their Saint-Luc patients and maintain normal care. Plans are being drawn up now about what to do during the construction. "We've shown that to do the project in one phase is impossible," said Serge Leblanc, the interim director of the University of Montreal's teaching hospitals. "That would be insane." [La Presse]

A potentially problematic batch of the cancer drug Avastin is being blamed for causing eye inflammation in patients for whom ophthalmologists were prescribing the drug off-label for age-related macular degeneration (AMD). Avastin is less expensive than a similar drug approved for AMD, and is thought to be as effective. "Absolutely we do not recommend this," Roche Canada spokesperson Samantha Ouimet told the Canadian Press. "[Doctors] are taking it out of its [original] packaging, repackaging it and injecting it into people's eyes. This comes in a bag and it's meant for intravenous use for people with cancer."

A group of British Columbia patients, backed by the provincial nursing union, is suing the BC government for allegedly failing to enforce its laws prohibiting private clinics.

An independent scientific review found that four out of 41 Tasers were more powerful than they were supposed to be, with some firing 50% more electrical current than they were designed to. "When you combine an increased current intensity with a dart that falls right over the heart for somebody who has cardio- vascular disease or other conditions, such as using drugs for example, it can all add up to a fatal issue," Pierre Savard, the University of Montreal engineer who designed tests, told the Canadian Press. The Taser corporation's VP of research countered that the excess electricity is not "relevant from a medical safety perspective."

A Newfoundland & Labrador task force recommended mandatory adverse-event and medical error reporting. [Task Force on Adverse Health Events]

Tom Daschle, Barack Obama's nominee for the job of Secretary of Health and Human Services and the man now charged with reforming the American health insurance system, wants Americans to hold "holiday-season house parties to brainstorm" about potential solutions. He said he'll stop in at one such party and consider the ideas generated.

Henry Gustav Molaison, the Connecticut man known to the world only as "HM" for years as one of the most famous neuroscience case studies in history, died earlier this week. After surgeons snipped off a piece of his hippocampus in 1953 to treat his epilepsy, which was caused by a trauma to his head as a child, HM developed an unusual form of amnesia in which he couldn't form any new memories whatsoever, but could still learn new tasks. The groundbreaking research conducted on him, which helped shape the modern understanding of memory, was mostly performed by McGill University's Brenda Milner, who still teaches neuroscience there. “He was a very gracious man, very patient, always willing to try these tasks I would give him,” she told the New York Times. “And yet every time I walked in the room, it was like we’d never met.” "He never recognized me, even if I'd been with him all day," Dr Milner told the Montreal Gazette. "He was always an extremely polite man. But I could pass him in the waiting room and he wouldn't bat an eyelid. If you ever said anything, he would just say, 'I'm sorry, I have a bit of trouble with my memory.'"

Ottawa obesity specialist Dr Yoni Freedhoff squares off against the local school system in a fight over weekly pizza and ice cream sandwich days for six-year-olds.

Alberta doctor blogger Liana, struggling through a hospital night shift, nearly passed out from exhaustion. She wants advice: how do you make it through the night shift?

Deirdre Bonnycastle, a clinical teaching development coordinator in the University of Saskatchewan's school of medicine, published a list of online resources physicians can use to stay up to date in their fields. [Medical Education Blog]

Don't forget to cast your second-round vote for the best Canadian health blog. The choices are: Ottawa Street Dental, Weighty Matters, Dr. Sharma's Obesity Notes, Marijke: Nurse turned writer, and Salted Lithium.

What's in the news: Dec. 4 -- Zimbabwe's healthcare crisis deepens

A round-up of Canadian health news, from coast to coast to coast and beyond, for Thursday, December 4.

Prime Minister Stephen Harper's request to suspend Parliament until January 26 was granted Thursday. His decision to ask for the time off was in response to the Liberal, NDP and Bloc Québécois threat to defeat the government in a confidence motion and then form a Liberal-NDP coalition under Stéphane Dion's temporary leadership to replace Mr Harper's Conservatives. There's no guarantee, of course, that this delay will change the opposition parties' minds; they could still topple the government when Parliament resumes meeting in January. Because of the October election and now this political wrangling, the severely shortened first sitting of our current Parliament has only seen the introduction of four proposed pieces of legislation by the government, none of which pertained to healthcare. Two private member's bills were introduced over the past few weeks -- , based on Jordan's Principle; and to allow people to take up to one year, paid, off work to care for an ill family member -- but nothing can move forwards until the House returns to work in late January, and even then only if the government manages to avoid being immediately defeated and all the bills die on the floor.

Dozens of Manitobans held a demonstration to protest the provincial government's failure to keep the emergency room open in the town of Virden. A shortage of emergency physicians has forced the government to close 19 emergency rooms.

Zimbabwe has declared a national health emergency in the wake of a cholera epidemic that has killed 563 and infected almost 12,000 people. "Our central hospitals are literally not functioning. Our staff is demotivated and we need your support to ensure that they start coming to work and our health system is revived," Health Minister Dr David Parirenyatwa said in a call for aid. [ (Zimbabwe)] The country's ongoing political crisis has put AIDS suffferers at increased risk. [ (Zimbabwe)] Also on Wednesday, Zimbabwean riot police attacked a group of doctors and nurses protesting the crises in the country's health system and economy, which have been precipitated by colossal government mismanagement and corruption. The protesters, who had wanted to present a petition at the ministry of health, issued a statement: "We are forced to work without basic health institutional needs like drugs, adequate water and sanitation, safe clothing gear, medical equipment and basic support services. Health workers can no longer afford to buy food and other basic goods and services." [ (UK)]

QUEBEC ELECTION UPDATE: ADQ opposition leader Mario Dumont accused Health Minister Yves Bolduc of promising better healthcare to ridings that vote Liberal in Monday's election. "I find that frankly dishonourable," said Mr Dumont. "Minister Bolduc is making an unpleasant link between how people vote in a democratic election and their ability to get access to improved healthcare." [La Presse]

A Quebec City hockey player was admitted to intensive care for nitrogen poisoning caused by a malfunctioning zamboni. Thirty-five other players and spectators also fell ill and were seen in hospitals or clinics as a result of the incident Sunday night, reported public health doctor Eric Prud'homme.

Driving behind a truck filled with chickens increases your risk of being infected with the antibiotic resistant strains of bacteria found in chicken feces, reported the Vancouver Sun's Pamela Fayerman, discussing a Johns Hopkins study in the Journal of Infection and Public Health. "This study confirms what my grandma used to say, that when you’ve got manure dust spraying, you don’t want to be breathing it in,” BC public health physician Gillian Arsenault told Ms Fayerman. “So if you’re driving behind something stinky, put more distance in between and put your windows up because you don’t want to be showered with bits of chicken feces."

Ms Fayerman, on her blog, Medicine Matters, recounted a recent instance in which NDP health critic Adrian Dix had to apologize to her after he provided her with incorrect information about a recent report on mental health hospital admissions. "Journalism 101," she called it, pointing out that the NDP is gearing up for next year's provincial election. "Check the math, consider the source."

At an Ottawa conference, physicians in Manitoba and Ontario expressed enthusiasm about physicians assistants (PAs). The doctors praised PAs for being effective, valuable additions to their practices and for helping them cut wait times.

Young doctors don't exercise nearly enough, a new British study showed. In fact, they exercise even less than the average Briton -- who already doesn't exercise nearly enough. Something must be done, the study's authors wrote: "This is very important, not only for the doctors' own health, but also for the health of the patients. Numerous studies have shown that students and consultant equivalent doctors who exercise are more likely to counsel their patients to exercise too."

Using instructions text-messaged to him by a colleague in London, Dr David Nott, a British vascular surgeon working for Doctors Without Borders in the Democratic Republic of the Congo, performed a difficult emergency surgery he had never attempted before on a fisherman who had been bitten by a hippopotamus. "Without the operation he would have died," Dr Nott said, "so I took a deap breath and I followed the instructions." [Agence France-Presse]

What's in the news: Dec. 3 -- Inuit healthcare a shambles: report

A round-up of Canadian health news, from coast to coast to coast and beyond, for Wednesday, December 3.

Canadian Inuit receive far less healthcare than they need, a new Statistics Canada report showed. Self-rated health status has decreased since 2001, chronic disease incidence has risen, and 30% of Inuit children suffer "food insecurity," the report said. [Statistics Canada, The Daily] [Aboriginal Peoples Survey, 2006]

Here's some news that could have been plucked straight out of Orwell's bureaucratic dystopia or Pynchon's paranoid fever dreams... if it weren't true. An American company, UnitedHealth, is offering insurance for health insurance. That's right. You can now buy a plan to insure yourself for your future insurability. "This product is taking advantage of the lack of sensible health reform that could easily solve this problem,” said Families USA executive director Ron Pollack.

QUEBEC ELECTION UPDATE: There is a puzzling paradox in this year's campaign, writes Michel Corbeil of Le Soleil. Seventy percent of voters say the province's healthcare system hasn't gotten any better since Jean Charest's Liberals came to power in 2003, and over half of the people who believe the healthcare system has changed said it's changed for the worse. But in polls asking voters whom they trust to fix the healthcare system, Mr Charest comes out well ahead of any of his challengers. [Le Soleil] Health Minister Dr Yves Bolduc, campaigning for the Liberals in Trois-Rivières, on Monday said he would like to open two new medical schools in Quebec, one in Rimouski and one in Gatineau. The election is on Monday, December 8.

Facing a $7,000,000 budget deficit this coming year, Halifax's Capital Health regional authority plans to perform 1,000 fewer elective surgeries in 2009 than had been projected initially. Other budget cuts will include measures to reduce funding for furniture and small equipment, "maximize safe reuse of medical/surgical equipment," delay "needed" renovations," change the food offered to patients in hospitals, and move some late-night emergency surgeries out of smaller hospitals to Halifax's large Queen Elizabeth II.

Nova Scotia police acted correctly by Tasering a diabetic man suffering from hypoglycemia who was resisting paramedics trying to hook him up to an IV line.

Alberta's ombudsman, Gord Button, decided to look into complaints about patients whose claims for reimbursement through the provincial health ministry's out-of-province costs program were denied without a reasonable explanation. Mr Button's investigation was sparked by one woman's frustration at her $7,000 claim for her two daughters' experimental treatment in Chicago being denied because the ministry claimed similar treatments were available in Canada without specifying where or how that treatment could be found. The only study the woman had found in Canada that might have been appropriate had a two-year wait time.

Health Minister Ron Liepert's new plan for the future of Alberta's healthcare system, called "Vision 2020," has been blasted for being "short on details," reported the Canadian Press. "If this is 20-20 vision, then Minister Liepert had better get his eyes checked," Friends of Medicare director David Eggen, who also recently feuded with Mr Liepert over the disclosure of his name as a failed applicant for the provine's health governance board, said. "They fail to address what they are going to do beyond a series of generalizations," Mr Eggen said of the proposed reforms. "Any time I see the government talking about patient-focused funding, I see it as no more than buzz words for private facilities," commented Liberal health critic Hugh MacDonald. One hopes that Mr MacDonald will elaborate on that rather confusing claim at some point.

Health Canada has invested $8 million in pilot projects to test heat-alert systems in four Canadian cities. The systems would alert the elderly and emergency services about dangerous temperatures and ways to avoid heat-related health problems. But why did the National Post decide to run the subhead "'Absurd' waste" and include reactions from two climate-change skeptics and only one scientist who accepts that the evidence for climate change is "incontrovertible"?

Ontario Health Minister David Caplan has thrown his support behind an opposition proposal to create a new committee to develop a provincial mental health and addictions strategy, in what the Toronto Star calls "a rare show of Progressive Conservative-Liberal unity." "Mental health and addictions issues cut across all partisan lines," Mr Caplan told the newspaper. "If we can come together, we can come up with a strategy and way forward." The proposal, inspired Canadian mental health commissioner Michael Kirby's 2006 Out of the Shadows at Last report, will be officially introduced tomorrow by Progressive Conservative MPP Christine Elliott.

The rates of cesaerian section births and premature births rose signifantly over the past ten years, new statistics showed.

Including pharmacists and nurses in team-based management of patients' hypertension is a small amount more effective than leaving the care to just a physician, an Albertan trial demonstrated. Patients treated under the team-based model had 5.6 mm Hg lower systolic blood pressure after six months than patients treated by doctors alone.

Yesterday in the Ontario legislature, Progressive Conservative MPP Christine Elliott officially introduced her proposal to establish a new committee to create a provincial mental health and addictions strategy. [Legislative Assembly of Ontario]

Smart entrepreneurs stand to benefit from rising Canadian healthcare costs and the huge amount of inefficiency in the way the money is spent, declared PROFIT magazine. "Put these two realities of big money and inefficiencies together, and you have one rosy outlook," wrote Eleanor Beaton. The hardest part of healthcare-sector innovation? Doctors. That's according to one consultant quoted in the article, who said, "It’s a little like owning a GM plant, but with each worker on the line deciding which kind of car he or she wants to build on any given day."

Current therapies for deep venous thrombosis -- mainly blood thinners -- don't prevent patients from developing the "poorly understood, long-term complication" known as postthrombotic syndrome (PTS), reported McGill University researchers in last month's Annals of Internal Medicine. The researchers also found that PTS affects up to 43% of people who had cases of deep venous thrombosis. Their study also included research into predictors of which patients will develop PTS. "This suggests that physicians can predict if a patient is likely to develop chronic PTS as early as one month after DVT diagnosis," lead author Dr Susan Kahn said in a release. [news release]

This week's Grand Rounds, a collection of the best writing from the health blogs, is online.

PCP makes rats aggressive and less socially motivated, report a team of Canadian neuroscience researchers in a study published online ahead of print in Physiology & Behavior. Little surprise there, it seems to me.

A group from Dalhousie University published an article on how a novel like Kunal Basu's Racists -- in which a white infant and a black infant are raised on an island in a only-the-strongest-will-survive experiment to determine the superior race -- can serve as an important pedagogical tool in understanding the danger of the "biology is destiny" line of thought.

An addendum to yesterday's article on potential health ministers in a Liberal-NDP coalition government: Joël-Denis Bellavance, of La Presse, suggests Winnipeg NDP MP Judy Wasylycia-Leis could get the job. Ms Wasylycia-Leis has twice been the party's health critic and has sat on the Standing Committee on Health a number of times, but Mr Bellevance's thinking seems to be rooted mostly in her riding being located west of Toronto. [La Presse]

What's in the news: Dec. 2 -- Canadian poverty threatens health

A round-up of Canadian health news, from coast to coast to coast and beyond, for Tuesday, December 2.

Former Saskatchewan Premier Roy Romanow, who led a government commission on the Canadian healthcare system earlier this decade, appeared today in the opinion pages of the Toronto Star to urge Canada to improve public health by reducing poverty. While the stock markets have most thinkers enthralled with their dips and dives, it's nice to see some people still realize that the average person doesn't even own stock. The Wellesley Institute and the Community Social Planning Council of Toronto today released a report with much the same message: "Poverty is making us sick." "Contrary to some popular beliefs, poverty is making Canadians sick –- not simply lifestyle choices –- robbing hundreds of thousands of their health and leading to widespread preventable illness and creating huge costs for the health care system," the report says. Raising wages would contribute to improved public health, says the report. [ (PDF)]

The economic turmoil means job losses, which, because prescription drug insurance in provinces other than Quebec is mostly provided by employers, means that the unemployed not only lose their incomes but also their drug insurance plans. All the more reason, says the Canadian Health Coalition in a new report titled Life Before Pharmacare, to create a national pharmacare plan to make sure no one has to go without necessary medications. [ (PDF)]

Ontario hospitals face the largest budget cuts and restructuring since the administration of Mike Harris, a new report from the Ontario Health Coalition says. "The cuts we are seeing are disorganized, undemocratic and causing huge public backlash," said OHC director Natalie Mehra in a release. [news release]

On Tuesday, Ontario Attorney General Chris Bentley announced the start of a major legal and medical review of past cases involving "shaken baby syndrome." [Canadian Press] The review is one of the measures recommended by the Goudge report on the province's pediatric forensic pathology system, released October 1. [Canadian Medicine]

In a Toronto Star op/ed, Carol Goar bemoaned the continuing gender gap in healthcare.

Night terrors are hereditary, a team of Quebec researchers reported in the December issue of Pediatrics.

Jordan's Principle, an effort to enshrine in law the illegality of denying medical care because of jurisdictional disputes, still has not been implemented in Canada, reports the Canadian Medical Association Journal. [CMAJ]

Forcing radiologists to look at a photograph of the person whose innards they are studying results in 80% more "incidental findings," such as discovering a serious problem unrelated to the problem the radiologist has been asked to look for, according to new research presented at a Chicago conference Tuesday.

Alberta's privacy commissioner issued a warning about proposed changes to the province's privacy laws regarding electronic health information. Worrisome changes, said Information and Privacy Commissioner Frank Work, include striking out the requirement for patient consent for doctors to transfer electronic health information, and the lack of clarity regarding the collection and use of patient information for research purposes.

Alberta's existing health privacy laws, along with those of British Columbia and the federal government, should follow the model of Ontario's, wrote lawyer Page Backman of Aird and Berlis LLP. Ontario is the only Canadian jurisdiction with a health information privacy and protection law that requires disclosure of a security broach to the people whose records were compromised.

The Alberta NDP wants a public inquiry into the provincial government's handling of a recent syphilis outbreak.

Journalist Alexander Gelfand explores the emerging field of pharmacogenetics (think of the relatively new testing now going on for warfarin dosing, abacavir hypersensitivity, and codeine metabolism speed in breastfeeding mothers). His excellent article, published in the December issue of The Walrus, dissects the underlying profit motives of pharmaceutical companies, and the inherent ethical and ethnic problems that researchers and doctors are encountering. Highly worth a read.

The Hospital for Sick Children, in Toronto, announced a new website to provide Canadians with information about children's health. [news release]

What would a Liberal-NDP coalition mean for health?

Well, it seems they're going through with it. The Liberals, New Democrats and Bloc Québécois have signed (PDF) to form a coalition government if the Conservatives are defeated in a non-confidence vote on Monday, December 8.

The agreement stipulates that Stéphane Dion would become Prime Minister until the Liberal Party chooses a new leader -- Dominic Leblanc, Michael Ignatieff or Bob Rae -- in May, who would then take over as PM.

But those of us who keep an eye on what the government has to say about healthcare are wondering what changes the deal could bring in health policy.

MINISTER OF HEALTH
The agreement would give the Liberals 12 of the 18 cabinet seats, and the NDP the other six. The finance ministry would be headed by a Liberal, but none of the others are promised to one party or the other in the deal.

So who would be named health minister in a Liberal-NDP coalition government? Of all the NDP MPs for the six cabinet positions they would be allotted -- Jack Layton, Thomas Mulcair, Joe Comartin, Libby Davies, Linda Duncan -- none have anywhere near the health policy experience of Liberals like Dr Carolyn Bennett or Ruby Dhalla, for instance. An educated guess probably places Ms Dhalla, a rising star in the Liberal caucus and a staunch supporter of Michael Ignatieff, who many expect to win the party's leadership race in May, as the most likely health minister. Other, more remote possibilities might be Dr Keith Martin, Ken Dryden or maybe even another rising star like Gerard Kennedy or Martha Hall Findlay, all of whom are good bets to receive cabinet posts.

Update, December 5: Dr Carolyn Bennett would become health minister, according to the National Post's Don Martin, who was leaked .

HEALTH POLICY AGENDA
If a Liberal-NDP coalition indeed comes to power, what specific policy changes might we see in the health portfolio? A good guess is that, with a tenuous hold on power in an unusual and unprecedented government, few major changes can be expected. Some plausible moves that the coalition might be willing to attempt:

• Withdraw the legal appeal of the 2008 BC Supreme Court decision that stripped the federal government of control over Vancouver's safe-injection facility, Insite;
• grant temporary exemptions to federal drug laws to allow at least one heroin-assisted therapy clinic to open;
• revive the proposed Conservative law on tightening regulations on natural health products, which likely would have passed if Parliament hadn't been dissolved in September; and
  
• establish a Parliamentary committee to make recommendations on creating a national pharmacare program.

Given the billions of dollars already being proposed by the coalition for an economic stimulus plan, a broad investment in health human resources planning of the type promised by both the Liberals and the NDP during October's election campaign may not be in the cards for the moment.

It also seems unlikely that the number of penalties assessed to provinces for violations of the Canada Health Act would rise during what is now being called a full-blown recession.

What do you think? What would a Liberal-NDP coalition mean for the healthcare sector?

Photo:

What's in the news: Dec. 1 -- Alberta's blurry "Vision 2020" plan

A round-up of Canadian health news, from coast to coast to coast and beyond, for Monday, December 1.

Alberta Health Minister Ron Liepert introduced on Monday the outlines of his new action plan on health, dubbed "Vision 2020." The plan includes few concrete details. Several stated goals include reevaluating the types of care provided in hospitals that could be moved to community-based clinics; promoting greater use of telehealth services; allowing emergency medical technicians to do more; expanding interdisciplinary "team-based care" models, which have been popular in Ontario; creating a longterm information technology plan for the healthcare system; and making mental health services more accessible. "Bottom line is that we need to change the role of hospitals," he told CBC News. "By making more community-based health services available, overall wait times in hospitals will be reduced, but we have to be willing to change." "But there are few specifics in the plan and no dollar figures attached to any of the changes," the Canadian Press noted.

Just a few days before releasing his Vision 2020 plan, Mr Liepert made some rather awkward comments during a speech on the current economic problems and the healthcare system at the Canadian Club of Calgary. "Somehow we've got to get Albertans to accept more personal responsibility for their behaviour. I guess I'm hopeful that if people don't have the money to spend on Jolt and booze and everything else, maybe they won't become quite as addicted," he was quoted as saying in the Calgary Herald. Most uncomfortably, however, was the suggestion that citizens might accept a smaller role for government in healthcare as a budget-cutting measure. "We're going to have some tough decisions to make in the budget coming next year and I think people are going to start to say, 'OK, maybe government shouldn't be covering everything,'" he said.

Ontario is switching over to an organ donation system called "affirmative registration," in which only the intentions of people willing to donate are recorded in a database. People who do not want to donate or are not sure if they do will not have their preference recorded from now on; if the question comes up, the agency responsible for organ donation will ask their families what their preferences were. This system is anticipated to increase the number of organs available for donation. [news release] For more details on the new system, check the frequently asked questions on Trillium Gift of Life's website.

A new plan developed by the BC government largely in consultation with pharmaceutical companies appears to sideline the province's independent drug review body, the Therapeutics Initiative. "It's very, very disconcerting," NDP health critic Adrian Dix told The Tyee. [The Tyee] In July, Dr Randall F White warned in an opinion article in the National Review of Medicine that "unbiased drug review" was "under threat."

A new Ontario project named Rainbow Health Ontario, launched in conjunction with Sherbourne Health Centre, will function as a clearinghouse for resources and support for gay, lesbian, bisexual and transsexual health services. "This is a province-wide initiative that puts Ontario at the forefront with respect to LGBT health and equity in Canada and around the world," said Health Minister David Caplan in a release. Rainbow Health Ontario director Anna Travers said, "Despite significant improvements, LGBT people still face gaps and inequities in services. Many health care providers are uninformed about the specific health care issues of this community. RHO will help to fill that gap." George Smitherman, an openly gay MPP who served as the provincial health minister for five years until becoming the energy and infrastructure minister earlier this year, also attended the launch. In the release, he said, "Until now the LGBT community had no central place to access reliable information on health issues or services related to them." [news release]

Doctors and nurses should all get the flu shot, urged the chief public health officer of Canada, Dr David Butler-Jones.

A new Canadian Institute for Health Information report showed the ratio of women to men on the rise in all of the health professions. Among family physicians, 56% under the age of 40 are female, whereas just 16% over the age of 60 are, indicating that a huge change in the profession's gender balance is already well underway. CIHI report on Canadian physicians "Women continue to dominate in nursing, physiotherapy and occupational therapy, and their ranks are increasing in male-dominated health-care professions [such as pharmacy and medicine]," wrote the Canadian Press. Canadian Medical Association President Dr Robert Ouellet was unnerved by one of the new report's findings. "The fact that the average age within our profession has been rising for the past decade tells us that the number of retirements is going to increase - and increase rapidly - in the coming decade. We have to prepare for that," he said in a release.

A new service will soon be offered at the fertility clinic in Toronto's Mount Sinai Hospital, reported The Globe and Mail's Hayley Mick: help for HIV-positive parents to conceive.

A new Fraser Institute report compared Canada's healthcare system to the mixed public-private ones of European countries. According to the group's analysis of the data, Canada spends more than almost any other country in the world with a universal healthcare system, but doesn't see better outcomes. "Groups opposing reform here in Canada often resort to fear-mongering and suggestions that Canada will end up with an American-style health care system. But those groups are behind the times," said Fraser Institute director of health system performance studies Nadeem Esmail. "They don’t seem to realize that throughout Europe, Asia, and elsewhere in the developed world, nations have built efficient, high-functioning health care systems by blending public and private health care. It’s time for Canada to do the same." [ (PDF)]

Nicolas Bédard, a doctor in Outaouais, Quebec, has managed to recruit doctors to take a pay cut to work at his clinic because he offers excellent work conditions. His experience should serve as a lesson to politicians looking to improve their physician recruitment and retention strategies, he says. [Le Droit]

Canadian social justice activist Stephen Lewis demanded that Canada honour its responsibility to protect the citizens of the Democratic Republic of the Congo who are being killed and displaced by the ongoing civil war at an alarming rate. "It's the silence from Canada that is absolutely revolting," Mr Lewis said. Congolese women, in particular, are in danger because of the widespread incidence of rape as a military tactic. He spoke in Toronto recently with The Vagina Monologues author Eve Ensler and Congolese gynecologist Denis Mukwege, a winner of a 2008 United Nations Human Rights Award who runs a hospital in eastern Congo where he treats women attacked and raped in the war. "This is the worst kind of war one can imagine," Dr Mukwege said. "Because it's beyond the idea of a classical war where soldiers and armies are fighting each other. Now, the battlefield has changed to the bodies of women. It's a war on women's bodies."

In the latest Toronto-based Joint Centre for Bioethics newsletter, Faiza Rab and Bob Parke describe a representative case that demonstrates the ethical problems in end-of-life care when a patient has an implantable cardioverter defibrillator, or ICD, designed to shock a patient's heart back into an acceptable rhythm in case of a serious problem. In the case they describe, a patient, named Mike, learned that an ICD can temporarily prevent people from dying when they're ready to go, resulting in a painful series of shocks before one's demise. He asked his doctor to remove the device, but the doctor refused, "erroneously believing that he would be guilty of directly causing his patient's death." [ (PDF)]

Online doctor rating websites like RateMDs, which has become very popular in Canada, are a load of garbage, wrote Dr Kent Sepkowicz in Slate. His main complaint was that there were hardly any reviews for most of the doctors he looked up -- including himself. So he decided to add some of his own. Lo and behold, Dr Sepkowicz has some great ratings online now.

Men in management positions derive prestige and command respect as a result of their girth, a pair of University of Calgary researchers found in a new study. Their research asked why class status and BMI were associated with one another in men.

Doctors in Switzerland will be permitted to prescribe heroin to addicts after voters elected to legalize the practice in a referendum.