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Are You Going to Use Finasteride for Hair Loss? Read This First

Sold in the market under the brand names Propecia and Proscar, finasteride is a medication that is intended to treat people who are suffering from hair loss.  In the early days, finasteride was just like other medications that were originally used to treat benign prostatic hypertrophy and prostate cancer. It turns out that patients who took finasteride for their prostate-related issues had experienced great results with it, along with a surprising bonus, and that is, the growth of hair.

Finasteride actually works by means of inhibiting or stopping type II 5-alpha reductase, the enzyme responsible for converting the hormone testosterone into dihydrotestosterone (DHT).  DHT, in turn, is the one responsible for losing one’s hair, resulting to baldness if not remedied.  Thus, simply put, the action of finasteride is to prevent the conversion of testosterone into DHT, and the end result would be the prevention of hair loss. This “favorable side effect” of preventing hair loss and promoting growth of new hair by finasteride is what made it famous in the pharmaceutical world, not by its primary use which is for treating benign prostatic hypertrophy and other prostate-related ailments. Read more…

What's in the news: Jun. 3 -- Mr Layton goes to Washington

Layton pitches health reform in US
NDP leader Jack Layton is in Washington, DC, this week to talk to Obama administration officials and American audiences about how to implement a universal healthcare system. "We know the Americans can't just simply adopt our model, walk it across the border and put it in place," he said. "But the principles of universality, of access and of insuring that health care's available to everybody, those kinds of principles are very much motivating the Obama administration."

American adoption of universal healthcare would dissuade some of Canada's healthcare critics, like former CMA president Dr Brian Day, said Mr Layton (left). "If Obama succeeds, it helps us hang onto our public health care system because they're [proponents of privatization] always chipping away at it, trying to say that we need to privatize." [Canadian Press] [Washington Times]

Update, Wednesday, June 3: You can read the full text of Mr Layton's speech this morning at the Woodrow Wilson Centre here.

Review Quebec breast cancer test errors: critics
Quebec Health Minister Dr Yves Bolduc last week tried to dismiss concerns that a new study by the Quebec Association of Pathologists proved that high test error rates meant that tests would have to be re-done. [Canadian Medicine]

Dr Bolduc began this week trying to play down the implications of the study and saying the story had been blown out of proportion when other medical experts suggested thousands of tests might need to be repeated. "That is totally false," he said. [Montreal Gazette]

Dr Bolduc said reporters had misinterpreted the study. "The experts have concluded that it is not true to say that a variation observed in the results in terms of quality means that there is the same variation in terms of wrong tests or inappropriate treatment." He also blasted Dr Gaétan Barrette, the president of the Federation of Medical Specialists of Quebec union, who had suggested the error rates were the result of government mismanagement of the healthcare system. "He's speaking for a union, he does not represent any professional association of quality," Dr Bolduc said. "You have to look at his credibility in that context." Dr Barrette told CBC News that Dr Bolduc's criticism was "outrageous." "Where did he do his medical training?" fumed Dr Barrette. [CBC News] He must have forgotten. Dr Bolduc received his MD from Université Laval, class of 1981.

But despite Dr Bolduc's pleas for calm, the controversy has grown. On Monday, the provincial College of Physicians and Surgeons called for a committee of experts to be set up to investigate the proper course of action. [Globe and Mail] On Tuesday, Dr Bolduc not only acquiesced but also announced that pathology tests would hereby be subjected to quality assurance, which they had not all been previously. [Ministry of Health and Social Services news release] The committee will make recommendations to him at the end of the week. [Montreal Gazette]

Things are looking grim for Dr Bolduc now. One of the Quebec Association of Pathologists researchers said some cancer tests will have to be repeated. [CTV News] And the opposition ADQ party is calling for Bolduc to resign because of this issue as well as prior problems it cited. [ADQ news release] Dr Amir Khadir, a Montreal infectious diseases specialist elected to the National Assembly last year, called on Dr Bolduc to stop delaying and confusing the public and instead get down to work right away to get to the bottom of the issue. [news release]

Isotope shortage begins to affect patients
Reports from across Canada tell of the test delays and cancellations doctors have been forced to make as a result of the radioisotope shortage caused by the shutdown for safety repairs at the Chalk River nuclear plant in eastern Ontario. The shortage is affecting doctors and their patients in Peterborough, Ontario, Quinte West, Ontario, Vancouver, Saskatoon, and elsewhere, and delayed exams are all but certain to be the norm in many regions.

The political fallout (please forgive the pun) from the Chalk River shutdown has continued to accumulate.

An editorial in the Toronto Star pointed out the contradictions inherent in the government's vastly different responses to the 2007 and the current Chalk River shutdowns. The 2007 shutdown, for three weeks, prompted the government to pass emergency legislation to permit the plant to open without the safety repairs that were recommended. Natural Resources Minister Gary Lunn said, "Had we not acted, people invariably would have died, since medical isotopes for serious cancer procedures were not available, and we could not let that happen." Now, with a minimum of three months of down time at Chalk River, Health Minister Leona Aglukkaq has said, "It's not a crisis." The Star concluded, "Stephen Harper's Conservative government is either dramatically underplaying the current medical isotope crisis or wildly overplayed the last one." [Toronto Star]

Trouble follows eHealth Ontario spending spree
Both opposition parties are calling for Ontario Health Minister David Caplan's resignation after revelations of profligate spending by the government's agency responsible for electronic health records, eHealth Ontario.

It came to light recently that the agency's CEO, Sarah Kramer, handed out $4.8 million in "sole-sourced" contracts, or contracts that were not opened up for bidding.

Subsequently, other expenses incurred at the agency became known. Ms Kramer's $380,000 salary; her $114,000 bonus; her $1,700/day executive assistant; $300/hour consultants who read newspaper articles, reviewed Ms Kramer's holiday voicemail greeting, and briefed her as she rode on the subway. [CBC News]

Sharing in the populist anger, the Toronto Star discovered expense claims for a $3.19 "dessert square" and a $1.65 Tim Hortons tea made by an eHealth consultant who was being paid $2,700/day.

Interim Tory leader Bob Runciman called eHealth a "rogue agency out of control." [Toronto Star]

In response to the criticism, eHealth Ontario has hired an independent consulting firm to perform an audit of its spending. [eHealth Ontario news release]

Hey, doctors: don't discriminate
In the current issue of the College of Physicians and Surgeons of Nova Scotia's quarterly magazine ALERT, the regulatory body reported an instance in which a physician allegedly refused to treat a pregnant patient because she had opted to take advantage of the recently introduced publicly funded midwifery system. Something is seriously wrong when regulators have to remind doctors, "Patients who are considering or who have chosen the services of a midwife expect and deserve to be treated in a non-discriminatory manner by their physicians." [College of Physicians and Surgeons of Nova Scotia ALERT]

Straining credulity
A very modern disease: cell-phone elbow. [CNN]

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  1. sharon3 June, 2009 9:24 AM

    A. RE:lest we forget:

    B. RE: Layton article

    issues/people worth watching related to political discussions on "universality" issues in health care ( some very interesting abstracts contained here)

    C. RE: Bolduc and the the " power to influence" of language

    in one word "meant" you have the mother of octuplets


    'high test error rates meant that tests would have to be re-done. '


    In considering a linkage between A. B. and C. ponder the many areas of life that( used to ) respond to " uninterrupted instruction " following a ? language with one interpretation to secure predictable, measurable results

    ( e.g. genetic codes; imprinting in animals;beliefs, codes and creeds )

    When these predictable elements of longstanding dependency in forming/undergirding the " everyday" are adjusted/altered by manipulation of their " core language" ....we end up with all sorts of " freakish new codes that do not harmonise with one another"

    The real question is:

    What language can create universality agreement... in expression.... in perpetuity.

    I predict it is not a language spoken by the mouth.

  2. sharon3 June, 2009 10:47 AM

    P.S. having said all of the aforementioned....... might ask... how does this affect the role of the physician?

    A- if you plan to be a significant player in the "civil" society approach and Global funding schemes for "defined medical" health care interventions you had best do the following:

    1. find out what the "civil society" definition entails

    2. find out why the "diagonal " approach might not have "skill specific" dependency

    3. interprete for funders how the internal structure of your practice fulfils the "diagonal approach" connected to (key)existing horizontal structures ( remember our discussion on "Z"?).

    Make your service the diagonal line by demonstrating how the vertical integration approach you presently have is the groundwork in terms of "knowledge/expertise/historical significance" .
    Physicians are still " the head that turns the body". Redefine how your practice is performed in something other than " a business plan"context.

    If you do, that diagonal line in the "Z" will fatten into filling the entire square with relevant, knowledgeable service delivery.

    Essentially your most valuable (but little used in primary care at present) is your capacity and skill as knowledge workers.

    Wake up!

  3. Sam Solomon3 June, 2009 3:25 PM

    I just updated the article to include a link to the full text of Mr Layton's speech this morning.

  4. sharon3 June, 2009 7:38 PM

    I guess there is some value in revisiting Mc Luhans tetrad (which can be applied to any medium including healthcare)

    Essentially he asks:

    What does the medium enhance?
    What does the medium make obsolete?
    What does the medium retrieve that had been obsolesced earlier?
    What does the medium flip into when pushed to extremes?

    What does the medium enhance?

    A- system dependency and failure to develop alternatives

    What does the medium make obsolete?

    A-self care knowledge

    What does the medium retrieve that had been obsolesced earlier?

    A- "ad hoc" development of service provision

    What does the medium flip into when pushed to extremes?

    A- a "harm reduction" perspective versus "prevention and rehab" complementing treatment protocols

    McLuhan saw the flip as getting exactly what you did not want.......hmmmmmm....

    60 years ago we had nurses treating patients both at the hospital...and in their own homes.

    60 years ago we had " cottage" hospitals in almost every community that stabilised the patient and Public Health followed up with home nursing care

    60 years ago people knew how to identify and treat a host of common ailments.....

    maybe...... that which is "old' will become new again?

    Ironically I am sitting here writing a paper entitled:

    'The Changing Role of Nurse in the context of "Community":
    Issues and trends impacting the role of Nursing in the development and delivery of community service programs '

    The difference being that nurses have been redefined and as primary community care unfolds.... they are in danger of extinction.

    Oh well..... so is the patient :(

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