Buy Metronidazole and Treat Bacterial Issues

Bacterial infections and diseases can be gotten nearly everywhere.  There is really no way of telling when you can get an infection.  The best way in avoiding getting infected is by practicing proper sanitation and hygiene as well as having a healthy immune system.  Still, this is just to prevent usual infections from developing.  If you do get infected, you need to use antibiotics to properly eliminate the infection out of your system.  Buy metronidazole as this is considered by many as one of the most effective antibiotic drugs in the market today.

If you buy metronidazole, you are assured that you will be able to treat the bacterial infection you have developed.  However, you cannot buy metronidazole over-the-counter because you need a medical prescription to buy metronidazole.  Without any medical prescription, the pharmacist will not dispense and allow you to buy metronidazole.  These days, antibiotics have strictly become prescription drugs only due to the abuse that some people have done.  This is why if you were to have any type of bacterial disease, your only option in being able to buy metronidazole is to visit your doctor and have your issue diagnosed.  If your doctor believes you need to buy metronidazole as antibiotic treatment, you will be given prescription to buy metronidazole.

There are two ways to buy metronidazole.  You can buy metronidazole at your local pharmacy or you can buy metronidazole online.  A lot of people actually buy metronidazole online these days as they are able to get lots of savings.  The prices of metronidazole at online shops simply cannot be matched by a physical shop since online shops do not have to pay a lot of dues and permits just to be able to sell.  The low price of metronidazole is actually what draws most people who need to use metronidazole to buy metronidazole online. Read more…

Give up your holiday gifts for overseas medical aid

Two medical aid agencies -- the local branch of Médecins sans frontières (MSF) and Canadian Physicians for Aid and Relief (CPAR) -- are both encouraging Canadians to ask their friends and family to donate to humanitarian aid rather than give them gifts this holiday season.

More information on MSF's initiative is available , and more information on CPAR's is .

Worthwhile Canadian initiatives both, but there's one problem: telling your friends and relatives that you'd rather help malnourished children than get a new food processor is indisputably admirable. That's not the problem. The problem is that it's so admirable it's likely to make your friends and family feel guilty they're not doing the same thing. After all, they can't very well donate money to the charity of your choice and then expect you to show up on Christmas morning with a big gift-wrapped box for them, can they? This is an all-or-nothing kind of situation: either your entire gift-giving circle agrees to participate together -- thereby eliminating the one-sided guilt problem -- or you might want to just consider making your own donation directly.

What's in the news: Dec. 3 -- The WHO's new HIV treatment recommendations

WHO revises ART recommendations
This week, the World Health Organization issued new recommendations on anti-retroviral therapy for adult and adolescent HIV patients. The new recommendations are a major departure from what had previously been in place. For instance, the WHO is now advising that physicians begin ART when the patient is presympomatic, at a CD4 count of 350 cells per cubic milliliter rather than 200 cells per cubic milliliter. The 200 figure was included in WHO recommendations in 2006, but research over the last three years found that earlier ART showed large enough improvements in reducing morbidity to be worthwhile.

Some Canadian guidelines were ahead of the WHO's. In February 2009, the widely respected BC Centre for Excellence in HIV/AIDS recommended beginning ART before the CD4 count drops below 350 cells per cubic millileter. [ (PDF)]

Another important aspect of the new recommendations will likely not affect Canadian patients and their doctors: the WHO would like to see the anti-retroviral Stavudine phased out and replaced by drugs that cause fewer and less severe side effects. Stavudine is mainly used in the developing world. [Reuters] Zidovudine and Tenofovir are suggested as replacements for first-line therapy.

The new WHO recommendations also say that mother-to-infant disease transmission is best avoided by full-course ART rather than single-dose treatment. That recommendation was met with praise by the international AIDS Healthcare Foundation, which was eager to take credit for helping to push the WHO to make changes.

New efforts to repair humanitarian drugs law
The federal parliament is considering a private member's bill that would reform the largely failed Canada's Access to Medicines Regime, which is intended to encourage Canadian pharmaceutical companies to provide low-cost drugs to African nations. The system as it currently exists has only been used once in five years when Rwanda purchased cheap anti-retroviral drugs. Bill C-393 was proposed by NDP health critic Judy Wasylycia-Leis.

Paul Martin, Dr James Orbinski, David Suzuki and other prominent Canadians signed an open letter circulated by the Canadian HIV/AIDS Legal Network asking the government to repair CAMR. [Toronto Star]

The bill passed second reading on Wednesday afternoon, with 143 MPs in favour and 127 against. More than a dozen Conservative MPs joined with the Bloc, NDP and the majority of the Liberal caucus to pass the bill on second reading. Health Minister Leona Aglukkaq voted no, as did Liberal Keith Martin, a former physician who has done extensive humanitarian work in Africa and in the field of international development. The bill will now be studied by the House committee on industry, science and technology before a final vote.

During the last discussion of the bill, at the end of November, several Conservative members explained their opposition. Bill C-393 "could have serious negative implications for continued pharmaceutical investment and growth in Canada," said Mike Lake, the parliamentary secretary to the minister of industry.

MDs accused of slowing progress on licensing foreign-trained docs
The latest development is that, in 2013, provincial medical regulatory bodies will be required by the government to assess the credentials of foreign-trained physicians within 12 months. But a number of other professions, including nurses and pharmacists, will do the same thing two years sooner.

"There are some of the major professional agencies -- let's make no bones about this -- who are less willing to co-operate, less willing to streamline the process and cut the red tape and reduce the processing time," said Immigration Minister Jason Kenney. Mr Kenney named physicians as one of those less cooperative groups, but no other professions. [Toronto Star]

The Canadian Medical Association immediately took issue with Mr Kenney's criticism, saying, "The medical profession has not been dragging its feet on the issue of foreign credentials - far from it. Medicine has had a national standard for licensure since 1992. It is currently about to pilot test a national assessment for international medical graduates [IMGs] and a national credential verification system has also been developed."

"[Until 2013 is] still a long time to wait, and there's a nasty backlog to clear up, but all the same this is a substantial accomplishment," wrote the Montreal Gazette in an editorial. "Things take time. As NDP MP Olivia Chow noted, better credential-verification for doctors will be of little use unless more intern positions are opened up. That's one example of what needs to be accomplished in the next couple of years if this reform is to be fully fruitful."

Many suspected H1N1 flu cases are just colds
Up to 75% of patients believed to be infected with the H1N1 flu may actually just have a cold. Lab test in Ontario found that fewer than one in four suspected H1N1 flu cases were actually the flu, and similar tests in BC yielded a figure of one in three.

"We have been notoriously inaccurate," Dr Michael Gardam, of Ontario's Agency for Health Protection and Promotion, told The Globe and Mail. "This year is very different because we are swabbing way more than we ever would and we are more accurate than we've ever been before – and it's still not very accurate." [Globe and Mail]

Ontario permits naturopaths to prescribe drugs
Follows the lead of some American states and British Columbia, Ontario legislators passed a bill earlier this week that will permit naturopaths to prescribe some substances. [Bill 179]

Which drugs they will be allowed to prescribe has not yet been determined, but a representative of the Ontario Association of Naturopathic Doctors (OAND) said that the organization hopes the government will follow the recommendations set out by the Health Professions Regulatory Advisory Council in a report in January 2009. Their list includes some hormones, natural enzymes, antibiotics, antifungals, one antiviral and several medicated topical creams. [ (PDF; see pp. 265-268)]

But Dr Suzanna Strasberg, the president of the Ontario Medical Association, told the Canadian Medical Association Journal last month, "We believe that the use of pharmaceuticals or synthetic drugs is completely outside naturopathy’s educational framework and scope of practice." [CMAJ (PDF)]

"We're not looking to take over the role of MDs," OAND policy director Michael Heitshu told Canadian Medicine. "Because a typical ND appointmen is 40 to 60 minutes, we have more time in the diagnostic process and can establish the kind of patient relationship that can find the causes of diseases and work on compliance issues."

Bill 179 has stirred up a great deal of controversy, particularly among opinion columnists and bloggers, but it is now law and all that remains is to see what exactly the Ontario government will grant naturopaths the authority to prescribe.

Astro-doc Robert Thirsk is back on earth
Dr Robert Thirsk, the physician-cum-astronaut who just spent the last six months living on the International Space Station, has returned to the surface of this planet.

"The end of my Station sojourn is bittersweet. I will miss the challenge of living in space," wrote Dr Thirsk from the ISS before his departure. "On every day of this expedition, some task has pushed my capabilities to a limit. Most of all, I will miss my wonderful crewmates. We had a special synergy."

Dr Thirsk landed safely in Kazakhstan in a Russian capsule on Tuesday.

Fibre consumption linked to healthy weight
Protein, fat and carbohydrate consumption are not directly tied to obesity. But eating more calories and eating less fibre are. That's according to data from the Canadian Community Health Survey. [Globe and Mail]

U de M researchers forced to rethink porn study
University of Montreal researchers were forced to change the research project they originally set out to do -- to compare porn-watching men to non-porn-watching men -- when they discovered that the latter did not seem to exist. [ (This link contains fairly explicit sexual imagery)]

Tory MP praises scarcity of Saskatoon abortion services
After news broke last month that Saskatoon women were forced to leave the city to find a physician to perform abortions, Conservative MP Maurice Vellacott, who is the co-chair of the House of Commons' Pro-Life Caucus, announced he was proud that local doctors had reduced the availability of abortion services in the city. Toronto Star columnist Antonia Zerbisias takes him to task and bemoans the fact that neither the Prime Minister nor his minister of state for the status of women were willing to speak out against Mr Vellacott.

New Brunswicker sees surfeit of Canadian doctors in future
After reading the recent news that the number of doctors in Canada grew faster than did the population over the last five years, Fredericton Daily Gleaner columnist Jo-Ann Fellows wrote a piece titled "Canada is heading towards an oversupply of physicians."

Ms Fellows's column is an ominous reminder of the same kind of dangerous thinking that brought us the infamous 1991 Barer-Stoddard report [ (PDF)] that led to governments' disastrous decisions in the 90s to reduce the number of training spots available for medical students and interns.

For a more in-depth look at how many doctors Canada will have in the future, you may want to look at this 2007 Canadian Medical Association analysis, which includes a number of different projections based on various factors. [ (PDF)]

Vancouver MD dies in plane crash
Dr Kerry Telford, her six-month-old daughter, and four other people were killed when a float plane they were on crashed into the water near Saturna Island, BC.

What really really killed Jane Austen?
It wasn't Addison's disease -- it was tuberculosis that she caught from a cow. So says a new explanation published in the British journal Medical Humanities. In February 2008, Canadian Medicine asked you, our readers, what you thought killed Ms Austen. Addison's disease came in first in our poll; Hodgkin's second. Tuberculosis was tied for 9th in our poll, tied with syphilis, out of 12 options. Writer's cramp got more votes than tuberculosis. [Canadian Medicine]

Photo:

Will temporary phone-consult billing codes ever be made permanent?

At the beginning of October, in recognition of the strain that this fall's return of the H1N1 flu would put on its physicians, British Columbia offered the medical community a gift: PG13705. That's the billing code that pays doctors $14.74 for dispensing advice on the pandemic flu to their patients via telephone.

The fee has proven popular. In the first month it was made available to doctors, the provincial insurance plan paid 16,785 claims for PG13705. That's a quarter of a million dollars for that billing code alone, and that was largely before the H1N1 flu really came surging back around the beginning of November.

But just as the government giveth, the government can taketh away. When it's decided it's no longer needed to support doctors dealing with flu patients, PG13705 will disappear "at the declaration of the Provincial Health Officer."

I asked Dr Bonnie Henry, the BC Centre for Disease Control’s director of Public Health Emergency Management, about health administrators' take on the future of paid phone consults. She was one of the people who recommended the creation of PG13705, and although she wasn't ready to recommend that phone consults become permanent features of the billing structure, she didn't rule out the idea. My with her appeared in the November issue of Parkhurst Exchange magazine.

PARKHURST EXCHANGE: Logic would say that if having a billing code for phone consults works during a pandemic to deal with people coming in with infectious diseases, wouldn’t it also work not during a pandemic?
BONNIE HENRY: Maybe. [Laughs] I don’t know about that. We would have to look at it how it would be used. But I do think for getting through this it’s a very important piece to help us manage this without putting clinicians at risk.
PE: I ask because I think many physicians would like to have the option to bill for phone calls occasionally.
BH: Yeah, and we do so much by phone we don’t get paid for. Look at lawyers, for example. Talk to your lawyer for ten minutes on the phone and you get billed for it. [Laughs] But, you know, part of it is built into other fee codes. I think there’s a lot of potential for abuse, but clinicians are professionals and should be trusted to use things appropriately. I’m a little on the fence. I do know that this time I was one of the people that advocated for this because we know there are going to be a lot more people infected than usual with influenza this year, and this is one really important strategy to help clinicians be able to cope with that and to help protect our communities.
Ontario followed suit at the end of last month, creating three new fee codes for phone consults: K080, K081 and K082. K080 refers to health-advice calls of 10 minutes or less, and pays $11.00. K081 refers to health-advice calls of longer durations, or to mental health consults of 10-16 minutes, and pays $27.55. K082 refers to half-hour mental health consults, and pays $55.05 per half hour.

One thing that distinguishes the Ontario fee codes from BC's PG13705 is that the Ontario codes aren't restricted to use for H1N1 flu patients, which gives doctors more flexibility in deciding how to run their practice. For instance, a family physician whose waiting room is teeming with suspected influenza cases might decide it's safer to speak to non-urgent flu-free patients by phone, if their care can be reasonably delivered that way. In a statement on November 2, OMA President Dr Suzanne Strasberg explained that the new codes are "designed to alleviate some of the pressures on the health care system. The intent is for doctors to confer with patients over the phone thereby reducing the contact between patients who have the flu and those who do not, while still being able to speak with their doctor about other health concerns."

Ontario physicians were also able to bill for phone consults during the 2003 Toronto SARS outbreak. At the moment, the Ontario Medical Association's current contract with the provincial government doesn't include any permanent fee codes for phone consults, and the mandate for the next set of negotiations hasn't been established yet. K080, K081 and K082 are all temporary codes, like BC's PG13705, and will expire either at the Minister of Health's discretion or after twelve months.

The British Columbia Medical Association begins negotiations in a few months on a collective agreement to replace the current one, which expires March 31, 2012. Although the union and other physicians' groups have asked the government for a permanent phone-consult billing code in the past, Canadian Medicine is told that, at the moment, the BCMA's tariff committee has "no plans at this time to do that" in its upcoming negotiations.

Is there are any chance one or more of the provincial governments might see how useful the phone consults are proving to be and decide to keep them permanently in a limited capacity -- perhaps similar to the current usage, in which the consults will only be compensated when there's a safety reason not to bring a patient into your office?

That remains to be seen.

UPDATE, Dec. 2: Canadian Medicine neglected to mention that Alberta also introduced a special H1N1-flu-related phone-consult billing code this fall, on October 30. Theirs is numbered 03.01AD and pays $20. More information on the Alberta fee code is available .

Photo: Shutterstock

What's in the news: Nov. 30 -- "Dismantle" Canadian health system, Sarah Palin urges

Sarah Palin generously offers health-policy advice to Canadians
"Canada needs to dismantle its public health-care system and allow private enterprise to get involved and turn a profit." That's what former Alaska governor Sarah Palin told "Marg Delahunty," the Mary Walsh character from This Hour Has 22 Minutes in a recent ambush Ms Walsh staged at a Palin book-signing.

Unfortunately, Ms Palin wasn't in on the joke: she was serious.

Watch the This Hour segment here:



Women behind majority of growth in physician workforce
It may be hard to tell in practice, but Canada has more doctors now than we did five years ago -- quite a few more. The precise number: 8% more, which is almost twice as fast a growth rate as our population experienced over that period.

Even more remarkable than that is the fact that, from 2004 to 2008, the number of male doctors grew 3.8% while the number of female doctors grew an incredible 16.3%. [CIHI report: Supply, distribution and migration of Canadian physicians, 2008] [CIHI news release]

Saskatchewan ditches heli-ambulance plan
Sure, a helicopter air-ambulance service out of Saskatoon and Regina sounded good, and, yeah, it was a Saskatchewan Party campaign promise in the run-up to their 2007 election win.

But then they got the estimate: $42.4 million in start-up costs and $9 million per year thereafter. And that's when Saskatchewan Health Minister Don McMorris decided changed his mind. "It isn't a priority as our government moves forward, at least for the next couple years," he said.

The province does, however, still operate an airplane ambulance service out of Saskatoon, Regina and Prince Albert.

Quebec and France near deal on mutual recognition of qualifications
After signing a deal on April 2 this year to allow Ontario physicians to work in Quebec without going through endless paperwork and testing, and vice versa, the province of Quebec is set to sign a similar agreement with France.

"Pour ce qui est du recrutement en France de professionnels de la santé, le Québec compte sur plusieurs atouts de taille, outre le partage de la même langue," said Health Minister Dr Yves Bolduc in a statement released Friday. "Les formations professionnelles ont une qualité équivalente, et il existe des liens étroits entre les universités et les établissements de santé du Québec et de la France. Enfin, nous profitons d'un avantage concurrentiel sous l'angle de la rémunération des médecins."

The agreement will also apply to pharmacists, midwives and dentists; Dr Bolduc plans to add nurses to the deal in July 2010. [ (French only)]

Out-of-province OHIP coverage requests almost triple over five years
The number of applications made to the Ontario public insurance plan for procedures provided outside the province has risen from 4,775 in a one year period from 2004-2005 to 12,393 in 2008, costing the province $127.9 million last year. That increase is largely attributable to DNA testing for genetic conditions that could predispose patients to diseases -- a service performed in American laboratories because it is not offered in Ontario. Health Minister Deb Mathews said she hopes the province will begin to offer DNA testing next spring, however.

Requests for bariatric surgery also increased dramatically, with around five times as many received in 2008 as were received in 2004-2005. The government already announced a plan earlier this year, involving $75 million in new funding, to try to address the demand for bariatric surgery.

NB will create electronic records for prescriptions
New Brunswick hopes to have an electronic records system set up by early 2011 to monitor prescriptions given to patients. Part of the impetus for the effort is the difficulty in preventing drug-seeking patients from obtaining narcotics prescriptions from multiple physicians without the physicians realizing what is happening.

Heparin doses get smaller
Heparin units are going to be made 10% weaker. There will be a transition period of two years in Canada when both the old and new strengths will be available. [Health Canada Information Update]

Transgender option on Ontario school vaccine form sparks anger
In Algoma, in northern Ontario, public health officials sent students home with H1N1-flu-vaccination permission slips that included a question asking for the student's gender. The options: male, female, or "other; unknown; transgender." A trustee of the region's Huron-Superior Catholic District School Board and the conservative advocacy group LifeSiteNews have taken issue with the officials' decision to allow students to be identified as they see fit.

Ukrainian pols exaggerate H1N1 flu pandemic to improve election chances
The woman currently leading the pack to become the next president of Ukraine in the January 17 elections may have intentionally made the country's struggle to keep the H1N1 flu pandemic under control seem far more dire than it actually is.

"We had to create a phantom and then have a white knight riding in to save the day," Taras Berezovets, a senior campaign adviser for the party of Ukrainian presidential candidate Yulia Tymoshenko, admitted to a reporter.

As heated as the debate on the Canadian government's response to the H1N1 flu pandemic has been in the House of Commons, the opposition parties haven't even come close to the level of exaggeration that's been seen in Ukraine.