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What's in the news: Dec. 12 -- Toronto MD in an extra-scandalous sex scandal

A round-up of Canadian health news, from coast to coast to coast and beyond, for Friday, December 12.

A Toronto-area bariatric surgeon has lost his licence to practise for sexual abuse involving four of his patients, including a bizarre situation in which he used illegal drugs and had a threesome with twin sisters, both of whom he had performed laparoscopic gastric band surgery on. "Every man’s fantasy is to have sex with twins," Dr Jacobo Joffe, who worked at Scarborough Grace Hospital, reportedly told the women. Dr Joffe pleaded "no contest" to the charges. In addition to losing his licence, he must pay over $40,000 in costs to the women as well as the regulatory body. "I went to him to help him make my life better, to help me transform," one of the four patients told a reporter. "He took advantage of that at a time when I was trusting... The worst pain is that I was seduced by my doctor." Three months ago, on the online forum ObesityHelp.com, one patient wrote "I believe in Dr. Joffe. Yes, I have heard the latest rumours and I have put them down to a desperate woman falling for her doctor just to be rejected. I have seen it before with another wonderful doctor that I had and I have heard about other women like her who have experienced unrequited love. Totally crazy! Don't believe everything you hear or read!"

The Alberta government, as well as other provincial governments, restricts private-sector involvement in healthcare to a much greater extent than it is required to by federal law, according to a new paper by University of Waterloo political scientist professor Gerard Boychuk, PhD. The paper, which reads like a blueprint for expanding private delivery and funding in healthcare, claimed that under the limits imposed by the Canada Health Act Alberta is not required to ban private delivery of services, nor is it required to prohibit doctors from working in both the public and private systems, nor does it have to outlaw private health insurance. [University of Calgary School of Policy Studies (PDF)] "I think it corrects that misperception that Alberta is a leader in encouraging private financing for health care," Dr Boychuk said of his study. Friends of Medicare director David Eggen countered, "There's a chasm between what the government would like to do and what Albertans are comfortable with and want to do."

A bad batch of cocaine, cut with an antibiotic, has made at least 10 BC residents ill.

Prodding patients with sarcastic comments might help identify which ones have frontotemporal dementia, an Australian study found.

Ohio State University plans to provide every medical student with an iPod Touch.

Dr Martina Scholtens was asked to examine her patients teeth with her stethoscope. So she did.

Chaoulli back in court, but this time it's to speak about a patient's death

Dr Jacques Chaoulli (right), the man whose Supreme Court case against the government of Quebec managed to overturn sections of the province's health insurance laws, spoke yesterday in court in front of a public inquiry into the January death of a 77-year-old in the waiting room of a Montreal walk-in clinic.

The man, who reportedly presented with an ankle injury before turning "purple" and having trouble breathing, wasn't asked why he was in the waiting room before he died in his seat; he was only told to sit down. Another patient in the waiting room resorted to calling 911 for instructions on giving CPR but a nurse told her not to touch him and soon thereafter Dr Chaoulli came out to examine him, decided he could not be resuscitated, and asked a nurse to call an ambulance. "I concluded that this patient must have been dead already a long enough time - I had no way of knowing how long - but long enough," he was in the Montreal Gazette. He declined to move the body out of the waiting room after the call was placed because he thought it was "the scene of a crime," he said.

"It was a really unusual event and the patients had an understandable reaction of distress, even of revolt," Dr Chaoulli said. A coroner will make recommendations in several months, after the inquiry hearings wrap up, the Le Journal de Montréal.

The clinic where this all occurred, Clinique médicale Viau, in St. Léonard, is one of several dozen Montreal "network-clinics," a new model of healthcare delivery initiated the same year Dr Chaoulli went to court to fight against private-healthcare restrictions. Network-clinics -- which "bridge the private and public sectors," as Dr Albert Benhaim, the Chair of the Network-Clinic Table, wrote in 2006 in DRMG Express, (PDF) published by the city of Montreal's health agency -- connect patients with doctors in both the public system and doctors who have opted out of the public system and charge their patients directly. Dr Chaoulli opted out of the public system years ago.

Photo: Liam Maloney, National Review of Medicine

Criticism of the Ontario Medical Association continues unabated

The Coalition of Family Physicians of Ontario (COFP), which vehemently opposed the Ontario Medical Association's handling of this year's new contract with the provincial government, has not been dissuaded from its advocacy by the majority of Ontario doctors' approval of the contract.

The COFP's latest message to the province's family doctors, sent earlier this month, accuses the Ontario Medical Association of being too cozy with the government, calling its attempt to balance doctors' interests and the government's economic goals "conflicting allegiances."

The major issue, according to the COFP, is the OMA's utter failure to push the government to consider alternatives to the "unsustainable" Canadian model of universal healthcare. "Other provinces have already taken successful steps in this direction by allowing a limited two-tier approach to healthcare delivery and funding," COFP President Dr Douglas Mark wrote in his letter. "It is also the approach adopted by the rest of the Western industrialized nations, most of which have a more effective and equitable healthcare system than our own."

Here is the full text of the COFP's letter:

December 1, 2008

To All Ontario Family Physicians:

Healthcare in Ontario:
“Resources for some, some of the time”

There has never been a time in Canadian and Ontario medicine with as much potential for positive transformation as there is now. However, many of the changes in healthcare over the past few years have unfortunately been driven by the needs of government rather than those of patients or physicians. Providing adequate resources and care is becoming a scenario best summed up by the phrase: “Resources for some, some of the time”. This is hardly an acceptable arrangement – either for patients or physicians.

What needs to change? In our opinion, two things:

1) improved accountability by the Ontario Medical Association (OMA) to the physicians that it represents; and

2) the freedom to innovate and explore alternative ways of delivering healthcare in Ontario.

Obviously, these considerations transcend the concerns of family physicians alone, and are applicable to all physicians in Ontario. Allow us a few minutes of your time to explain further.

Improved accountability of the Ontario Medical Association to its members is an absolute necessity. While Ontario physicians are legally obliged to accept the OMA as its government-appointed representative body (Bill 8, the Commitment to the Future of Medicare Act, 2003), and are also obligated to pay the OMA dues (the Ontario Medical Association Dues Act, 1991), there now exists a “wait your turn” mentality when it comes to meeting the needs of various physician groups. In most other Canadian provinces, dues payable to physicians' professional associations are voluntary rather than mandatory. It is perhaps not surprising that, in the light of such built-in accountability, these provinces have fared significantly better in gaining compensation and resources for their members, while still achieving voluntary membership rates of about 95%.

Affected physicians in Ontario – whose needs remain unmet – have no recourse except to wait and hope that at some undetermined future date they will be dealt with fairly and equitably. Meanwhile, the OMA attempts to balance the interests of its members and those of government in a collaborative arrangement, in part because government assures the OMA’s ability to collect its dues. In good economic times this is an awkward predicament at best, with ill-defined or conflicting allegiances. It is expectedly a much less effective arrangement in recessionary times, as the stark new reality of deficit budgeting looms.

While continued government underfunding of healthcare undoubtedly contributes to the concerns of Ontario physicians and their patients, physicians are explicitly prevented by Bill 8 from exploring and innovating in order to create new ways of delivering and funding healthcare beyond the limited ways allowed by government. At the same time, other Canadian provinces are actively and successfully exploring sustainable alternatives – such as public-private partnerships, a two-tier approach and other creative solutions. The forced collaboration between physicians and government that was hailed as a solution to problems of sustainability in the ‘90s is now a major hindrance that prevents innovation.

Options beyond the government-mandated universal healthcare system are not discussed by the OMA, likely for fear of risking its collaborative relationship with the Ministry of Health and Long-Term Care (MOHLTC) and its attendant financial advantages. Instead, it seems to accept the current government agenda of requiring healthcare providers to bear the burden by tacitly accepting chronic underfunding and under-compensation by a cash-strapped provincial government driven by ideology rather than a realistic plan for sustainable healthcare.

So, how does this affect you?

Ontario physicians have among the lowest fees in Canada, and the present contract will do little to change this. For example, after having been without a contract for six months, the negotiated 3% top up to our fees scheduled to take effect in October, 2008 has now been pushed back to February, 2009 as a lump sum payment – again with no retroactive penalties or interest. Add to this the scheduled 3.6% increase in OMA dues in the face of a delayed 3% fee top-up, and the deal doesn’t look so good at all, does it? We would not be surprised if further unilateral changes to the present deal appear in the near future.

We must stress that the Coalition of Family Physicians of Ontario recognizes the government’s inability to provide better funding, especially at a time of fiscal contraction. However, we also view this as an especially important time for encouraging major innovation and reform of an otherwise unsustainable healthcare system. With or without the OMA, this is the direction that we have chosen to pursue and promote in 2009.

Other provinces have already taken successful steps in this direction by allowing a limited two-tier approach to healthcare delivery and funding. It is also the approach adopted by the rest of the Western industrialized nations, most of which have a more effective and equitable healthcare system than our own. Leadership in this area has also been provided at the national level by the Canadian Medical Association, which has chosen to open a dialogue on having more privately-delivered services alongside a robust public system. The past and present CMA presidents, Dr. Day from British Columbia and Dr. Ouellet from Quebec, are both influential and outspoken advocates of exploring such options.

It is time for Ontario’s representative physician body to provide leadership in this direction – away from dependency, and towards more physician and patient empowerment – rather than serving short-sighted political agendas. Unfortunately, the OMA seems to be unable or unwilling to do this because of its close ties to government. To fill this void, we are presently forming alliances with other physician groups in Ontario, who are interested in reforming our healthcare system in new and exciting ways.

The present economic situation in Ontario necessitates new ways of looking at things in order to bring about true innovations in healthcare that will provide freedom of choice and better care to more patients in the long term. The Coalition of Family Physicians of Ontario will continue to support Ontario physicians as always, and invites you to join our efforts, as we move forward toward a compassionate, reasonable and sustainable healthcare system in 2009 and beyond.

Sincerely,

Douglas Mark MD, President
and the Board of the Coalition of Family Physicians of Ontario

P.S. We’ll have more to say about our future plans, as well as sharing the details of our spring conference with our members, in the weeks ahead!

The Ontario Medical Association has not responded publicly to the COFP's letter.

Contrary to the picture painted by the COFP, the OMA has had some complaints of its own about the provincial government's healthcare policies since the new contract was ratified in October. Last month, the OMA the decision to delay funding 50 new Family Health Teams by one year as a result of the budget's shortfall. At the same time, however, the government expanded its support for nurse practitioner-led clinics. "I'm disappointed to see the provincial government's delay in implementing 50 new Family Health Teams, while at the same time, expanding the number of nurse practitioner clinics," OMA President Dr Ken Arnold said in a release. "Not only does this model serve a small group of patients, but we have not seen any solid evidence proving its ability to provide high quality, cost-effective care."

Health Minister David Caplan was annoyed at the suggestion that the government had made the move to save money. "This is not a financial decision," he the Toronto Sun's Christina Blizzard. "It is one that provides better care and provides the kind of care that Ontarians wish to receive -- to be able to get access into the health care system -- this is another way to provide that."

What's in the news: Dec. 11 -- Inspectors will watch as Ontario docs work

A round-up of Canadian health news, from coast to coast to coast and beyond, for Thursday, December 11.

The Ontario government yesterday proposed new legislation to give health regulatory agencies, including the College of Physicians and Surgeons of Ontario (CPSO), the authority to directly observe health professionals performing medical procedures during an inspection. The proposal, which would amend existing regulations, came about partly as a result of the death of a woman who underwent surgery performed by a family physician who was using the at-the-time unregulated title of "cosmetic surgeon." [Bill 141 introduction] [Ministry of Health and Long Term Care news release] The proposed law received support from both the Progressive Conservative and the NDP, though NDP health critic France Gélinas said, "I must note that the college submitted a number of regulations and bylaw amendments to the ministry in March 2008, and it has taken nine months for the government to come back with this small amendment." The CPSO approved of the bill immediately. "We are extremely pleased that we will be able to deliver on our commitment to enhance patient safety in out-of-hospital facilities where invasive procedures are performed," said the college's new president, Dr Rayudu Koka, in a release. Dr Koka said more changes will be needed, however. [CPSO news release] The CPSO has not been let off the hook, though, for what some people say was its slow response to the problem of doctors being permitted to perform cosmetic surgeries without accreditation and use the "cosmetic surgeon" title.

British Columbia health authorities are owed around $20 million in medical bills, more than half of which is owed by tourists. "BC is not a destination that is in the habit of providing free health care for the rest of the world," Health Minister George Abbott was quoted as saying two years ago. Since then, five of the six health authorities saw the amounts owed to them grow. Some suggest that "maternity tourism" is to blame. That was the Montreal Gazette's take on things late last month. An editorial read, "... there is a systematic abuse of medicare here and the government, not MDs or hospitals, needs to find a solution, one that takes into account humanitarian needs but is also fair to doctors - and taxpayers."

Vitamin D deficiency in young women is both more prevalent and more harmful than had previously been thought, a new joint Canadian-American study found. Examining women aged 16 to 22, the study found that 59% didn't get enough vitamin D even though the research was conducted in sunny California. Vitamin D deficiency was associated with shorter height and greater weight, but not with lower bone mineral density. [ (PDF)] "“Clinicians need to identify vitamin D levels in younger adults who are at risk by using a simple and useful blood test," said co-author Dr Vicente Gilsanz in a release. He suggested that further research may determine that vitamin D supplements are indicated in young women. [McGill University Health Centre news release] In related news, the International Agency for Research on Cancer, a division of the WHO, said there's a need for a clinical trial to look at the connection between vitamin D and cancer.

There are significant medical problems associated with a baby being born between the 34th and 36th weeks of pregnancy, or during what is called the "late preterm" period, reported a new study in The Journal of Pediatrics. Such children -- who are being born more and more often these days because of the rising prevalence of IVF, early induced labour, and the trend towards delaying motherhood until later in life -- have a tripled rate of celebral palsy and are at a 25% increased risk of developmental delay. In an accompanying commentary, McGill's Dr Michael Kramer wrote that the study "fills an important gap in our knowledge." "Although the absolute risks are low for individual babies, they could become a public health problem because of the growing number of these births in the general population," he said in a release. [McGill University Health Centre news release] "At some point, with increasing technology and increasing intervention, we're going to be doing more harm than good," Dr Kramer told the Canadian Press. "I'm not saying we're there yet. But we need to keep an eye on this."

In response to a recent investigation of the variation in Taser guns' power output by the CBC, police forces across Canada are pulling similar models out of officers' hands. Taser International, however, said that the CBC's data was "scientifically flawed."

A new study in Nature, by researchers from the University of British Columbia, the US and Germany, identified a genetic mutation that causes 46% of the cases of uveal melanoma, the commonest type of eye cancer. [UBC news release]

An Ontario home-care company is facing criticism after two of its employees claimed to have failed to notice very serious signs of abuse in an elderly man whom they bathed every day.

The latest edition of the Health Wonk Review, a collection of the best recent health policy blogging, is online.

Canadian documentary on assisted suicide stirs up trouble in the UK

, a Canadian-made documentary that depicts the death of a British man by assisted suicide in Switzerland, is causing a kerfuffle on the other side of the Atlantic, where it airs for the first time tonight in the UK. "Britain in uproar," reported a .

The film, by the Oscar-winning director John Zaritsky, has already been shown in Canada at film festivals and even ran on television last month, on CTV, without causing a big fuss. But in England, the film has arrived at a time when assisted suicide is such a hot topic that The Suicide Tourist's broadcast was brought to the attention of Prime Minister Gordon Brown in Parliament. Mr Brown, who opposes legalizing assisted suicide, , "I hope broadcasters remember that they have a wider duty to the general public and of course it will be a matter for the television watchdogs when the broadcast is shown."

Are we Canadians more progressive? Or are we simply more complacent, and unwilling to debate enacting our own laws to legalize assisted suicide, as Bloc Québécois MP Francine Lalonde proposed earlier this year?

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What's in the news: Dec. 10 -- The end of "post-abortion syndrome"?

A round-up of Canadian health news, from coast to coast to coast and beyond, for Wednesday, December 10.

The purported link between abortion and future mental health problems -- called "post-abortion syndrome" by some -- is largely a myth, suggested a new Johns Hopkins study in Contraception that demonstrated that the highest-quality studies on the question showed very few links while the lowest-quality studies tended to find correlation. "Despite unclear evidence on such a phenomenon, adverse mental health outcomes of abortion have been used as a rationale for policy-making," the authors wrote. "Based on the best available evidence, emotional harm should not be a factor in abortion policy," study author Vignetta Charles told Reuters. "If the goal is to help women, program and policy decisions should not distort science to advance political agendas." The debate is far from over, however. A relatively small University of Otago study, published in the British Journal of Psychiatry this month, concluded just the opposite as the Johns Hopkins study. The New Zealand study found that abortion is the cause of 1.5% to 5.5% of mental health disorders in the general population. It should be noted, though, that the study may be skewed by using a sample of patients from New Zealand, where the laws governing access to abortion are significantly more restrictive than those of most jurisdictions in the United States and Canada. As was true in Canada before the Supreme Court's 1988 Morgentaler decision and as is still the case in New Brunswick today, New Zealand women are permitted to get an abortion only if two physicians, one of whom must be an obstetrician, certify that the abortion is necessary to protect the woman's physical or mental health, or in cases of incest or fetal abnormality. And discussion continues in the pages of the Annals of Epidemiology about the effect of induced abortions on future pregnancy outcomes, particularly preterm births.

National Post columnist Jonathan Kay has also been thinking about abortion. In a recent column he argued that women who request abortions should be forced to look at ultrasound images of their fetuses. "It seems like a cruel exercise, but it also strikes me as morally necessary..." he wrote. "Over time, such a policy might also render a more humane society. It is no coincidence that monstrous crimes are most common under governments that deliberately shield their citizens from the moral consequences of their actions. In the Soviet Union, abortion was used as a means of birth control." The right to choose, he concluded, "means nothing if women don't also have a right to be informed."

Women taking diabetes drugs from of the class of thiazolidinediones (TZDs) for long periods of time are at more than double the risk of broken bones, a new study published in the Canadian Medical Association Journal found. The same problem didn't appear at all in men, but the study didn't determine why. "The relatively modest benefits of thiazolidinediones must be balanced against their significant long-term effects on bone and the cardiovascular system," concluded the study's authors in calling for regulatory agencies to "restrict the use of thiazolidinediones in women with diabetes who are at risk for fractures." [CMAJ (PDF)] An accompanying commentary by Dr Lorraine Lipscombe, of Toronto's Institute for Clinical Evaluative Sciences, pointed out also that besides raising fracture risk one of the TZDs, rostiglitazone, has also been shown to increase cardiovascular risks. "Therefore," she wrote, "the net benefit of thiazolidinedione therapy is unclear." [CMAJ editorial (PDF)] "I think there's genuine scientific consensus that these risks might really outweigh benefits in Type 2 diabetes," one of the study's authors, Dr Sonal Singh, told the Canadian Press.

All six health authorities in British Columbia will save a total of around $150 million by negotiating together to purchase supplies, Health Minister George Abbott said.

Nurses in PEI and the provincial government still can't come to a salary deal that both sides can agree on.

Kids come to pediatricians' offices with their parents. Adults see the doctor in private. But what about the people in between, the pre-teens and teens? Dr Perri Klass gave an inside look at the ambiguity pediatricians deal with when trying to decide whether to disclose to the parents something a teen tells them in confidence. What to do about the 13-year-old who drinks? The boy getting bullied?

The US Congress may take another crack at imposing limits on direct-to-consumer pharmaceutical advertising. A previous attempt failed last year.

What's in the news: Dec. 9 -- "War is for kids!"

A round-up of Canadian health news, from coast to coast to coast and beyond, for Tuesday, December 9.

War Child Canada, the organization founded and led by Ontario physician Samantha Nutt, has started a provocative ad campaign ("War is for kids!" "Canadians trade indifference for action by donating weapons to minors in foreign countries") to draw attention to the problem of child soldiers worldwide and Canada's insufficient amount of international aid. [War Child Canada news release]

Alberta will pay for medication for a few dozen patients whose rare diseases require drugs that can cost hundreds of thousands of dollars per year. The government will begin coverage in April. Though the president of the Canadian Organization for Rare Disease was of the opinion that the program doesn't go far enough, 18-year-old Trevor Pare, who suffers from Pompe disease and is on the very expensive drug Myozyme, deemed the province's decision "awesome." "I think it's really sad that it's just for Alberta," his mother said. Meanwhile, in Ontario, Tory health critic Elizabeth Witmer begged Health Minister David Caplan to fund treatment for a Waterloo Pompe disease patient, Greg Troy. Mr Caplan's administration has twice rejected Mr Troy's special funding request, saying that the evidence is too scant to justify paying for Myozyme. There is no national program that covers such medications, known as "orphan drugs." "Canada, internationally, is known as the absolute worst country for orphan diseases," Canadian Organization for Rare Disorders president Durhane Wong-Rieger told The Globe and Mail.

British Columbia has recorded fewer deaths as a result of drug use so far in 2008 than it has in more than in any other single year in more than 15 years. No one was really sure why though. "It's very, very hard to make attribution about what it all means. It's very frustrating for researchers," Dr Thomas Kerr said. "It goes up and down a lot, and we really do not know why." Use of the safe-injection facility Insite and increased law enforcement shouldn't account for such a large change as has been seen, researchers said.

Older children of parents in polygynous marriages, or marriages of more than two people, have an increased risk of death as compared to older children of parents in monogamous marriages, according to new research by a sociologist at Queen's University.

Adults can receive half-doses of the flu vaccine without losing any of its effectiveness, a new in Archives of Internal Medicine showed. The authors sugggested, "Half-dose vaccination may be an effective strategy for healthy adults younger than 50 years in the setting of an influenza vaccine shortage."

Dr Michael Evans discussed the issue of whether doctors should be permitted to "cherry-pick" patients, or accept some and turn down others.

The US Food and Drug Administration rejected an application to label as a medical device, and therefore make insurable under public insurance plans, a product called the Palm Pistol, an "ergonomically innovative" one-bullet 9mm handgun designed to keep the elderly and the disabled safe.

A Chinese woman went deaf in one ear after her boyfriend kissed her too passionately, causing her eardrum to rupture. "While kissing is normally very safe, doctors advise people to proceed with caution," a local newspaper reported.

The weekly anthology of the best writing from the medical and health blogs, Grand Rounds, is online.

Left-wing MD elected as Quebec gives Liberals a majority

In yesterday's Quebec election, voters returned Jean Charest's Liberal Party to majority status in the legislature by a small margin, largely thanks to the epic collapse of the right-wing ADQ.

The election results marked a number of milestones. Turnout was the lowest since 1927; Mr Charest became the first Quebec premier in over 50 years to win a third mandate; and Mario Dumont, the only leader the ADQ has known, quit as head of the party after they lost 34 of the 41 seats they held going into the election.

But the most important milestone with regard to the future of the province's controversial healthcare debate was the election of the physician Amir Khadir (right) in the Montreal riding of Mercier as the first-ever representative elected from Québec solidaire, the left-wing, feminist, separatist party established in 2006.

The Montreal Gazette described his victory party last night :

Greeted with rock star adoration by the young, hip crowd, the outspoken Iranian-born physician hailed his victory and advances in a handful of other ridings as signs Quebecers are thirsting for a new political order – one where “the economy services society” rather than the other way around.

Dr Khadir, who moved to Quebec as a child, attended medical school in Montreal and went on to become a microbiologist and infectious-diseases specialist. He currently works at a hospital in the Montreal suburb of Lachenaie, and told Pierre Foglia of La Presse that he wants to keep working there one day out of fifteen. (An admirable goal, no doubt -- but we'll have to wait to find out whether it's really doable for an opposition member in a National Assembly held by only a slim majority.)

His medical experience extends far beyond the Montreal area. As a member of the humanitarian medical aid groups such as Médecins du monde, the group founded by a breakaway faction of Médecins sans frontières physicians including now-French Foreign Minister Dr Bernard Kouchner, Dr Khadir has worked in Iraq, Palestine, Zimbabwe, Afghanistan, Cuba, Nicaragua and India.

Most pertinently for his new job in government is his membership in a Quebec advocacy group known as the Coalition of Doctors for Social Justice. The group has in recent years emerged as one of the province's loudest groups opposing what it sees as, at a minimum, the Liberal government's failure to protect the public healthcare system from encroaching privatization caused by chronic funding and staffing shortfalls, or, worse, as the government's sometimes active though subtle encouragement of medicare privatization, as in the case of the post-Chaoulli .

Québec solidaire's reflects Dr Khadir's thinking on the subject: he has called for banning all forms of private healthcare for medically necessary services, increased funding for prevention, and a huge expansion of the public insurance plan's coverage that would include a number of delisted services including dentistry, optometry and psychotherapy. Of course, with only one party member elected to the National Assembly, those goals won't be realized as Dr Khadir might like them to be. But given his background and his campaign's focus on the healthcare system and its continuing problems, Quebecers should expect to hear a lot of his criticism of the government's work on the health portfolio. In this campaign video, Dr Khadir outlined his thinking on healthcare with a didactic presentation (in French) on a whiteboard:

           

Dr Khadir's radical approach to the healthcare system, by virtue of being so far left, might permit the PQ to shift its position to the left in response. "It’s the job of the left to move the center,” as the Montreal-born left-wing journalist Naomi Klein said in this month. “Get out there and say some crazy stuff! And then, suddenly, it’ll seem more reasonable for politicians to take riskier positions.”

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What's in the news: Dec. 8 -- Vancouver's invisible Asian drug addicts

A round-up of Canadian health news, from coast to coast to coast and beyond, for Monday, December 8.

Reporter Kate Allen described the invisible population of drug-addicted Asians in Vancouver. "They're not visible in mainstream services, but it's a huge problem. That's even understating it," Tomiye Ishida, an outreach worker and recovering addict, told Ms Allen. "There were some people [the ASIA drug outreach team] connected with on the street who hadn't talked to anybody in weeks because they didn't know anybody who spoke their language. You probably can't even imagine how limited their knowledge of resources is." UBC's Thomas Kerr, one of Canada's top addictions researchers, said, "The reality is, we don't have enough treatment for anybody, let alone making ethnicity-specific treatment, which is unfortunate. There is certainly a need for it, but we don't have it."

Patients are more comfortable and less frightened by medical conditions when doctors call them by their conversational name (excessive sweatiness, for instance) rather than their medical name (hyperhidrosis), a new study from McMaster University showed. "A simple switch in terminology can result in a real bias in perception," said grad student Meredith Young, who co-authored the study, which appears online today in the journal Public Library of Science ONE. "These findings have implications for many areas, including medical communication with the public, corporate advertising and public policy." [news release]

Everyone should be given access to stimulants and other drugs that enhance cognition, said a highly controversial commentary published in Nature that compares drug use for healthy adults to "exercise, nutrition and sleep, as well as instruction and reading" as a reasonable and viable method of improving one's intellectual ability. "I would be the first in line if safe and effective drugs were developed that trumped caffeine," one of the authors told the Associated Press. But the Minnesota Center for Bioethics's Leigh Turner commented, "It's a nice puff piece for selling medications for people who don't have an illness of any kind." Readers are discussing the article , and the Knight Science Journalism Tracker collected a handful of stories on the subject. Medical ethics reporter Stuart Laidlaw also covered the Nature paper.

The city of Windsor, Ontario, has managed to recruit several dozen doctors from the United States. The doctors have been enticed largely by the marked difference in the amount of insurance paperwork required in Canada's single-payer system.

New studies are investigating whether amphetamines might help cure cocaine addicts.

Dr Dave Williams, the Canadian physician, researcher and astronaut, will deliver the first of an 11-part series of lectures on medicine in extreme environments. Dr Williams will speak tomorrow night at McMaster University, in Hamilton, Ontario. [news release]

Dr David Greenberg, the star of the television show Doctor in the House, analyzed the hit TV shows House and Grey's Anatomy with Edmonton Sun reporter Bill Harris.