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Friday, December 21, 2007

Holiday greetings, from Brian Day

Dr Brian Day, reluctant to take even a day off from his campaign for reform, managed to turn to doctors into a political treatise:

Everywhere, my messages have been received with enthusiasm. Well, perhaps not quite.

I remain a target of some critics for pointing out that change is occurring and that more is on the way, whether we like it or not. So be it. [...]

The refusal to consider change in the face of these facts doesn't make sense to me, and I will continue delivering that message long after my days as president are over.
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Monday, December 17, 2007

Ontario's top five healthcare problems

Ontario's Liberals may have won another majority mandate in this fall's election, but they've still got a boatload of healthcare battles left to fight, according to Michael Decter, the former chair of the Health Council of Canada and the Canadian Institute for Health Information.

In today's Peterborough Examiner, he enumerates Ontario's : chronic disease, effective regionalized administration, electronic records and prescribing, the doctor shortage, and wait times.

Despite the scope of the problems Mr Decter describes, he sounds like he's got at least a modicum of faith that the government, led by the team of Premier Dalton McGuinty and the "now-experienced" Health Minister George Smitherman (both pictured above, flanking Roy Romanow), have a chance to ameliorate some of the trouble areas.

Mr Decter, an , describes the five problems as:

Chronic Disease - We are living longer than our grandparents, but not in perfect health. Two million Canadians have diabetes, soon to be three million. Heart disease, arthritis and asthma afflict millions more. Our health services were designed decades ago to treat acute episodes of illness and injuries from accidents. We cannot sensibly or affordably treat chronic illness in our hospitals. We need a broader set of services and much more patient self-management to succeed.

Integrating Health Services
- Local Health Integration Networks, or LHINs, represent massive and needed realignment of decision-making in the health sector. The LHINs need to bring together community health services and hospitals services into a genuine system that is sensible and affordable. Vast numbers of hospital services could be more efficiently delivered in clinics. An excellent example is the success of the not-for-profit Kensington Clinic in reducing wait times for cataract surgery. Hospitals are likely to fiercely resist movement of dollars and services elsewhere. The LHINs will need to marshal evidence and public support to bring about necessary change.

Making Smart Systems Smarter - Smart Systems is the organization charged with bringing Ontarians modern, safe electronic health records and information management. Only recently has new leadership given this effort a chance of succeeding. This is a mission-critical challenge for the health system. Without electronic prescribing, thousands of Ontarians will continue to die from medication errors. Without electronic health records, patients will continue to receive slower and less informed care.

We Want More Doctors But We are Getting Family Health Teams - There is a large gap between how ordinary Ontarians frame their needs and how health policy types design reforms. Family doctors are in short supply and many will retire over the next two decades. Newly graduating doctors do not want the work-dominated lives of their solo-practice predecessors. The answer is larger teams with doctors, nurses, nurse practitioners, pharmacists and others. This essential reform needs a vast communication effort. Without popular support it will be drowned out in a chorus of voices simply demanding more doctors.

Extending Wait Times Reductions - Wait times for cataract surgery, heart surgery, hip and knee replacements and cancer surgery have gotten shorter. In term two it will be important to solve the overcrowding and waiting in emergency rooms. It will also be critical to move the techniques that have reduced wait times in specific areas to a more efficient, faster health system in total.

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Friday, December 14, 2007

Popular Ontario doctor killed in fire

Dr Lee Brown, of Windsor, Ontario (pictured right), in a fire at his home, after he reentered the house just as he and his wife were leaving.

Dr Brown was a 79-year-old family physician who worked both at his own practice and at Hotel-Dieu Grace Hospital, and still provided house calls to elderly patients.

His family said they believe he turned back in order to get dressed.

Dr Brown's colleagues had nothing but kind words for him, :

"He was the epitome of hard work and dedication," said [Dr. Anthony Glanz, the new president of the Essex County Medical Society], a cardiologist who worked with Brown at Hotel-Dieu. "He never seemed down. He was one of those doctors who always had a cheerful disposition. No matter what was going wrong, he always looked at the bright side."

[Dr. John] Greenaway said Brown would work 12 hours or more on weekdays and seven or eight hours on Saturday and Sunday,

"He never complained about the things that bothered most of us," said Greenaway, an on-call partner with Brown at Hotel-Dieu for the last decade. "He worked hard but always with good humour. He always did a good job and was always reliable. He was a wonderful guy. He was an inspiration to me and others younger than him."

He said Brown's passing will leave many patients without a doctor.

"It's going to take two people to replace him," said Greenaway. "Our problems are getting worse now. He was an amazing man. We've lost a real star."
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Thursday, December 13, 2007

Vancouver Island plans clean crack pipe program after new study shows need

Coinciding with the release of from the University of Victoria that found hepatitis C can be transmitted on shared crack pipes, the Vancouver Island Health Authority it will provide clean crack pipe mouthpieces and filters to addicts at needle exchange sites beginning April 1, 2008.

The pipe components will be available in Victoria, Nanaimo (whose town council an identical program), Campbell River and Courtenay, and elsewhere around the Island through the use of mobile units, medical officer of health Dr Murray Fyfe told CanWest News.

The decision is tantamount to a rejection of the recent trend in Canada that has seen Vancouver's Insite safe-injection site and to end that city's clean crack pipe program -- not to mention Prime Minister Stephen Harper's of the benefits of harm reduction. I wrote about the Prime Minister's opinion of harm reduction in September.

Stephen Harper's attitude about how society should treat drug addicts was outlined in a 2003 essay he wrote about the Left called "Rediscovering the Right Agenda," published in Report magazine:

"This descent into nihilism... leads to silliness such as moral neutrality on the use of marijuana or harder drugs mixed with its random moral crusades on tobacco. It explains the lack of moral censure on personal foibles of all kinds, extenuating even criminal behaviour with moral outrage at bourgeois society, which is then tangentially blamed for deviant behaviour."

[Dr Keith Martin, a Liberal MP from BC] says Mr Harper's position on substance abuse was the reason he opted not to join the newly formed Conservative Party, though he had been a member of the Canadian Alliance. "I suspect they see [substance abuse] as some kind of personal weakness — that people have a choice," says Dr Martin.
You can read the rest of Mr Harper's article online .


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Nuclear plant to resume producing isotopes

The temporary closure for repairs of the nuclear power plant at Chalk River, Ontario, has been put to an end with the Canadian Parliament's emergency legislation, Bill C-38.

Because the plant is responsible for producing the vast majority of radioisotopes used in diagnostic imaging around the world, the government has decided to permit the reopening of the plant despite the unfinished safety repairs.

Medical tests in the thousands by the time the Parliament passed Bill C-38 on Tuesday. The Senate ratified it today.

Here's :

News Release

December 13, 2007
For immediate release

Government Emergency Legislation Swiftly Ends Medical Isotope Crisis

OTTAWA - Cancer and cardiovascular patients across Canada and around the world received very good news as the Government's Bill C-38 was approved by the Senate and then received Royal Assent by the Governor General.

This Bill, introduced Tuesday by Minister of Natural Resources Gary Lunn and Health Minister Tony Clement and approved by the House of Commons, legislates the safe re-opening of the Chalk River nuclear plant. The Chalk River facility, which belongs to Atomic Energy Canada Limited, supplies more than half of the medical radioactive isotopes used around the globe in testing and treatment of cancer and cardiovascular disease. The unexpected extension of the shutdown of the Chalk River plant caused concern amongst medical professionals and patients who required this medical substance.

"Passage of this Bill into law is wonderful news for patients, their families and loved ones," said Health Minister Tony Clement. "Chalk River will be back up and running, producing medical isotopes, in seven to eight days instead of seven to eight weeks."

"The government responded to this situation with action that balanced safety issues at the Chalk River plant with the urgent need to resume the production of medical isotopes." said the Minister of Natural Resources, Gary Lunn. "With the swift adoption of Bill C-38, we have taken decisive and balanced action to protect the health and safety of Canadians."

You can read Bill C-38 online .

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Tuesday, December 11, 2007

Why you might want to vote for your doctor

Number of physicians in Paul Martin's Liberal minority government, 2003-2006: 4

Average rate of growth of the share of total federal funding represented by science and technology, in budgets 2004 and 2005: 3.85%

Number of physicians in Stephen Harper's Conservative minority government, 2006-2007: zero

Average rate of growth of the share of total federal funding represented by science and technology, in budgets 2006 and 2007: 0.5%

Sources: (PDF); ; (Liberal MPs/physicians: Keith Martin, Hedy Fry, Carolyn Bennett, Bernard Patry)

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The Rock goes digital

The Rock is going digital.

No, not that Rock (actor Dwayne Johnson, left, who is known mostly for his preening professional wrestling character).

Today's news, rather, concerns The Rock better known to Canadians as Newfoundland & Labrador.

The provincial government it has reached a rate of 95% of diagnostic images available digitally through a province-wide computerized diagnostic imaging system.

Plans for the province's Picture Archiving and Communications System (PACS) were announced last year. The system cost about $23 million, split by the province's Ministry of Health and the federal agency Canada Health Infoway. The system, according to today's press release, "allows diagnostic images such as X-rays, MRI, ultrasounds and CT scans to be captured, transmitted and stored digitally, and made available to clinicians regardless of where they are located or where the test was conducted."

The press release quotes Canada Health Infoway president Richard Alvarez:

"Achieving such widespread use of electronic digital imaging throughout Newfoundland and Labrador is an incredible achievement benefiting clinicians and especially their patients. Today's announcement means patients from remote areas can benefit from the advice of specialists located far away without the usual delays geography create. This is about increasing access, uncovering efficiencies, and improving access to quality care - regardless of where patiens live."
The Newfoundland release identifies the province as the second in Canada to adopt a province-wide PACS, but it inexplicably fails to mention which province was first: Prince Edward Island.

A couple of years ago, PEI officials were :
"We said, Maybe we can put together a province-wide project'," [Herman McQuaid, director of health informatics for the Department of Health and Social Services of Prince Edward Island] recalls. "The other Atlantic provinces had received some funding, too, but they were not able to complete the agenda."
It seems Newfoundland was up to the challenge, after all -- and PEI will have to stop boasting about its unique success in implementing a digital imaging system.

One aspect of the news that went without mention in today's Newfoundland announcement was the recent turmoil in the province's Eastern Health authority after several high-profile radiological imaging scandals were exposed over the course of the last year. ( about those in NRM's June 15 issue.) In PEI's case, part of the impetus behind the PACS initiative a few years back was to try to retain radiologists in the province and perhaps to attract new ones there. Those are ideas that likely seem very attractive to Newfoundland's health human resources department these days, given the problems the province has experienced in the field lately.

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Monday, December 10, 2007

BC woman files wait times lawsuit

Yet another Chaoulli-inspired lawsuit , this time in British Columbia.

Shirley Healey's legal action, as I reported , has been a long time in the making. When I spoke to some of the people involved in her case there was speculation the complaint might be resolved outside the courts, but that obviously hasn't come to pass.

I can still recall a despondent-sounding Kelowna, BC surgeon named Robert Ellett telling me about Ms Healey's mesenteric ischemia case: "Anyone with blocked arteries is not meant to wait six months to a year. I suggested that with the way things are in Canada, I would go to the States as well."

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Alberta passes Bill 41 despite doctors' pleas

In an last week, the Alberta legislature passed Bill 41, the dreaded legislation that empowers the Alberta government to take over some of the responsibilities of self-regulating professions' governing bodies in an emergency.

Physicians, nurses and pharmacists all opposed Bill 41 vehemently, as did both opposition parties. And although their protestations failed to kill the legislation, several amendments were passed to water down some of the powers granted to the government by the bill. They managed to eliminate the government's power to change professional bodies' codes of ethics, and they gained a stipulation that the Minister of Health must "consult" with the body before taking over its powers.

The Minister of Health, Dave Hancock, with the Edmonton Journal the day before the legislation was voted on.

The is available on the Alberta Legislative Assembly's website, as are the three amendments.

You can read about the events leading up to last week's decision to pass the bill by checking out the articles we've published on the subject over the past couple of months: "," and "."

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WHO punishes Times for embargo breach

The World Health Organization has suspended New York Times reporters' privileges to access embargoed media releases for two weeks after the newspaper mistakenly published a short note on an embargoed WHO release in late November.

The offending story, "," reads in full:

Improved routine immunization programs and huge national drives to give children a second dose of the inexpensive measles vaccine have contributed to a stunning 91 percent reduction in measles mortality across Africa, with deaths plunging to 36,000 last year from 396,000 in 2000, the World Health Organization and Unicef reported. Globally in that period, measles deaths fell 68 percent, to 242,000.
In response, the WHO sent out the following email to notify media of the Times' punishment:
Note for the Media WHO/36

30 November 2007


Please note that the New York Times has been suspended from the World Health Organization media distribution list for a period of two weeks, effective immediately, after breaking the embargo yesterday on a story from WHO and other partners.

The story in question, "Sharp drop in deaths from measles reported," appeared on the New York Times website after the reporter participated in an embargoed telebriefing.

After speaking to the reporter and assessing the circumstances surrounding the breach, WHO has decided that a two-week exclusion from our email list is a proportionate sanction. WHO communications staff have been asked not to brief any New York Times reporters during this period on any stories that are scheduled to be released through the WHO email distribution list.

WHO takes embargoes very seriously. Breaches are a violation of this code of honour among journalists and between reporters and their sources. The Organization will determine appropriate sanctions on a case-by-case basis.
Slate magazine's media critic, Jack Shafer, as "silly" and petty.

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Health news update

We here at Canadian Medicine have rounded up some of the most interesting recent health news. Keep reading for updates on schadenfreude, frog eating, the plague, noisy airports and more.

Web of lies
Youtube is rife with anti-vaccination messages, says .

"The green-eyed monster"
(Borat's cousin) on the brain correlates for schadenfreude and gloating. , published in Brain, has a wonderful title:
"The green-eyed monster and malicious joy: The neuroanatomical bases of envy and gloating (schadenfreude)."

Don't let it get you down
We knew severe depression was associated with bone damage and osteoporosis, but a new study found .

A heart-wrenching moral debate
The British allowing lesbian couples to have IVF, with no father. A new proposal would remove wording that requires fertility doctors to consider "the need of that child for a father." During the debate, one Lord had a heart attack and needed resuscitation from a fellow Lord surgeon.

Fundraiser extraordinaire
Liberal MP Belinda Stronach, recently treated for breast cancer herself, for breast cancer reconstructive surgery for the University Health Network.

Say what?
The noise people are exposed to from living near airports .

The straight dope, maybe
One marijuana joint is the equivalent -- in terms of lung damage -- of a whole pack of cigarettes, according to one . One blogger, at Med Journal Watch, , from New Zealand, that estimates the damage at about three to six cigarettes' worth.

Yum yum
A Chinese man solves his intestinal problems by . (Can this possibly be true? Another story, from China, ... Don't miss the photos.)

Gimme a (tax) break
The Canadian GST tax discriminates against publicly funded hospitals, clinics and other healthcare facilities, .

Killed by a dead mountain lion
An American biologist in early November in Arizona; he apparently contracted it from a mountain lion carcass.

Still hunting
Nazi doctor Aribert Heim , say authorities.

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Wednesday, December 5, 2007

Concern grows as radioisotope-producing Ontario nuclear plant remains closed

after electrical repairs have forced the temporary closure of Chalk River, Ontario nuclear reactor that supplies two-thirds of the radioisotopes used for diagnostic imaging worldwide. Canadian medical tests are already being canceled, reports Reuters.

The reactor shutdown threatens to delay a substantial amount of medical tests around the world, a Canadian expert on radiopharmacy said. [...]

“This is a critical radioisotope that is used to produce radiopharmaceuticals to diagnose many types of diseases and, therefore, the impact is quite widespread and important for patients with all kinds of health conditions,” [said Raymond Reilly, a radiopharmacist and professor of pharmacy at the University of Toronto.]

The isotope is used in about 90 per cent of all imaging studies in nuclear medicine.

“It is basically the cornerstone of nuclear medicine in terms of diagnostic imaging,” Mr. Reilly said.

Andrew Ross, a nuclear medicine specialist in Halifax, Nova Scotia, told the Canadian Broadcasting Corp. he has already cancelled tests for 100 patients and expected to cancel 100 more next week.

It is difficult to predict how widespread the testing delays will be, however, as some supplies can be obtained from other sources, Mr. Reilly said, noting that European sites obtain their isotopes from a different supplier.
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Tuesday, December 4, 2007

Alberta DCA drug firm garners award

The University of Alberta-spinoff firm responsible for developing the controversial drug dichloroacetate (DCA) was at Bioalberta's annual meeting on November 28.

Cardiometabolics Inc, based in Edmonton, is studying the use of a type of DCA "as a potential therapy to improve heart function, surgical outcomes, patient quality of life and increase speed of recovery. The trial is being conducted at the University of Alberta Hospital in high risk geriatric patients following open heart surgery."

That research is taking place in parallel to another, more controversial study into DCA's anti-tumour effects.

Research from the University of Alberta spawned a spate of n-of-1 DCA trials in unsupervised metastatic cancer patients, , who worried that patients could be endangering themselves by buying the chemical online and trying it without a physician's help.

"He's a pest exterminator with a biology degree who's hired a chemist and is profiting from desperate people," said Dr Michelakis of in the Edmonton Sun back in the spring. "He is bypassing every regulatory principle that exists to ensure pharmaceuticals are safe and selling hope for money. It's horribly unethical."

DCA enthusiasts are, nevertheless, acquiring and imbibing the substance in greater and greater quantities; much discussion about methods of procuring and administering the drug is found on another site owned by Mr Tassano, .

At least two physicians in Canada -- Drs Akbar and Humaira Khan of Medicor Cancer Centres, in Toronto -- are , NRM reported this summer. "I'm pretty confident we're not harming anyone," Dr Akbar Khan told me at the time.

In the meantime, Cardiometabolics's DCA trials are still in its infancy. Health Canada approved a phase I and a phase II trial (PDF).

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CMA prez Day pulled strings to jump queues

Dr Brian Day has used personal connections to skip to the front of the wait list in order to get faster treatment for himself and for his daughter, :

When his five-year-old daughter's bone scan revealed a tumour that might be cancerous, the man who is now president of the Canadian Medical Association decided to jump the queue.

His wife, also a doctor, had taken their daughter into the emergency room of a Vancouver hospital after the little girl experienced a sudden pain in her leg, Dr. Brian Day recalled. The initial bone scan indicated a tumour, but couldn't reveal whether or not it was cancerous.

"The hospital said, 'We'll do a CT scan, bring her back next week,'" Dr. Day said. "To me, it's completely unacceptable, sending a mother home for six days not knowing whether her daughter has a malignant or a benign bone tumour. I made the phone call ... I made them do it that day." [...]

He admits that he himself used the system when he needed knee surgery, jumping a long queue to get the procedure done within a week by a surgeon who was also his friend.
See also NRM's two Q&As with Dr Day: , not long after he won the CMA presidential election, and is from September 30, 2007.

Photo: Lyle Stafford, NRM

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Airborne MDs terrified of emergencies

McGill's takes off tomorrow -- and not a moment too soon, it seems, given about doctors' fear of hearing the PA crackle, "Is there a doctor on board?"

The article begins with Dr Vincent Poirier, one of the course's creators, recounting a harrowing in-flight emergency:

Vincent Poirier was flying to central America on vacation when the page came over the airline PA system: a physician was urgently needed. Dr. Poirier had just finished medical school but was not yet licensed, so he decided to wait and see if someone else responded.

No one did and he finally, fearfully volunteered. The patient turned out to be a young girl suffering from anaphylactic shock. "If I hadn't done anything, she would have died," Dr. Poirier recalled. "She was wheezing, getting flushed, she was gasping for air."

He ended up saving her life, but his initial reluctance was typical of many physicians who, despite their expertise, react with trepidation to that sudden call to onbaord action.

To try to make the experience a little more comfortable, Dr. Poirier and a colleague at McGill University Health Centre have developed what they call the first continuing-education course in North America to teach physicians how to handle airline emergencies.
NRM recently wrote about in-flight emergencies and the rewards given to physicians by the airlines for providing their services -- or, more accurately, .

Dr Anna Carvalho, the course's co-creator alongside Dr Poirier, a couple months ago, as have a number of Canadian doctors. Most of them, unsurprisingly, have been with the gifts offered them by the airlines.

The movie poster above is from the 1980 disaster-movie parody Airplane!, which starred Saskatchwan-born, Northwest Territories-raised actor Leslie Nielsen as a physician named Dr Rumack. Here's one of the from the film:
Dr Rumack: Captain, how soon can you land?
Captain Oveur: I can't tell.
Dr Rumack: You can tell me. I'm a doctor.
Captain Oveur: No. I mean I'm just not sure.
Dr Rumack: Well, can't you take a guess?
Captain Oveur: Well, not for another two hours.
Dr Rumack: You can't take a guess for another two hours?
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Monday, December 3, 2007

Monday morning reading

To help you through this snowy Monday, Canadian Medicine's got a few interesting tidbits to share with you from around the web.

  • Doctors vs politicians: The Alberta Medical Association (along with the Canadian Medical Association, the College of Physicians and Surgeons of Alberta, the Professional Association of Residents of Alberta representing medical residents, the University of Alberta Medical Students' Association and Calgary Medical Students' Association) in Saturday's Edmonton Journal and Calgary Herald denouncing the Alberta government's proposed Bill 41, which would put a number of professional regulatory powers in the Minister of Health's hands.
  • The ratings are off the charts: A London, Ontario physician says she's "become obsessed" with comments posted about her on "I try to do my best every day and I appreciate positive comments. Negative comments kill me, they just break me apart," Dr Annette Richard told the London . After an anonymous user alleged she abandoned them after they were diagnosed with MS, she couldn't help but respond. (She's got a .)
  • Doping and hoping: Dr Maurice Duquette, the Quebec orthopedic surgeon who prescribed the performance-enhancing drug EPO to patients including cyclist Geneviève Jeanson, in front of the Supreme Court of Canada to withdraw his previous plea of 'guilty.' He had tried to change his plea on the day the Quebec College of Physicians and Surgeons judgment was to be announced in 2004, reports the Montreal Gazette.
  • On Friday in the House of Commons, the Conservatives got an earful from the NDP on , and from the Liberals on : "Is [the government] oblivious to how destructive its policies are or does it just not care how many Canadians will be hurt by its actions?" fumed Geoff Regan.
  • And now for something completely different... Is romance in your blood? Why does love evoke such strong feelings of obsession? "It is reasonable to hypothesise that [falling in love] must be mediated by a well-established biological process ... [We set out to] examine the relationship between the serotonin (5-HT) transporter, the state of being in love and obsessive-compulsive processes," Guardian correspondent and Annals of Improbable Research editor Marc Abrahams .
  • On the lighter side: "," by Blair Becker from the McSweeney's website.
    GAUNT: Listen, ever since I decided to subspecialize and take that residency in leechology, I have been raking in the livestock and cord wood. I've got a nice private practice in the hamlet out east and I bleed them all dry. [...] HASTINGS: Call me naive, but I truly believe that everyone deserves to be bled or sweated when they're at death's door, regardless of the feudal position they're born into.
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Thursday, November 29, 2007

Prescribing heroin to help heroin addicts

Preliminary results from a British harm reduction clinical trial on heroin users show that prescribing heroin to addicts reduces drug use and increases treatment program enrollment, .

The news is a positive sign for Canada's government-funded -- the North American Opiate Medication Initiative -- which is still recruiting patients in Vancouver and Montreal.

The 150-person British trial is ongoing, but the results to this point sound promising:
Trial leader Professor John Strang, of the National Addiction Centre, based at London's Institute of Psychiatry, told BBC News that about 40% of users had "quit their involvement with the street scene completely". "Of those who have continued, which obviously is a disappointment, it goes down from every day to about four days per month," he added. "Their crimes, for example, have gone from 40 a month to perhaps four crimes per month."

The study is being conducted in three locations: in London, Brighton and Darlington. And it's completely government funded, with the full ₤2.5 million kicked in by the Department of Health and the Home Office.

As for NAOMI, which costs $8.1 million, there's been little mention of the project in the news as of late.

But the current government's disdain for Vancouver's safe-injection site, Insite, doesn't bode well for NAOMI; both projects rely on exemptions from Section 56 of the federal Controlled Drugs and Substances Act in order to remain in operation. That's the exemption the Conservative government has been so reluctant to extend for very long in the case of Insite.

Giving them permanent status would violate Article Four of the (PDF), which reads:
The parties shall take such legislative and administrative measures as may be necessary:

a) To give effect to and carry out the provisions of this Convention within their own
b) To co-operate with other States in the execution of the provisions of this Convention; and
c) Subject to the provisions of this Convention, to limit exclusively to medical and
scientific purposes the production, manufacture, export, import, distribution of, trade in, use and possession of drugs.

Therefore, federal exemptions are required to run projects like Insite and NAOMI. But given the Conservative government's history and comments on harm reduction, and the veiled threats to close Insite, the prospects for these studies' futures aren't as bright as they once were. (NRM in September.)

And that's despite the fact that the evidence -- including the recent British report -- continues to show such initiatives are beneficial.

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Medical Hypotheses's far-out ideas

The journal (right) is almost certainly the strangest, most unpredictable medical journal in existence. (Closely followed by the ever-fascinating .)

Their recently published January-February 2008 contains some real bafflers.

The issue's , "Crick’s gossip test and Watson’s boredom principle: A pseudo-mathematical analysis of effort in scientific research," by editor-in-chief Bruce G Charlton, reports a
"bogus, but superficially-impressive" equation composed of "phony-variables":

Percentage likelihood of career success CS=(CP/G)–BQ×PoS×PS

where CP is the time spent gossiping about current project; G is the time spent gossiping about favourite topic; BQ is percentage of boring activities in CP; PoS is probability of solution of the problem; and PS is the percentage professional status of that branch of science as reflected in the proportionate funding, journal impact factors, number of jobs compared with the trendiest area.
And if that's not crazy enough for you, two Spanish researchers the correlation between the rates of mental illness and sunspots, based on data collected from Canada, the US and the UK.
In a hand, one can appreciate that the partial trends for insane person rate of Canada, USA and Ireland and the partial trend for group sunspot number are very similar during the period 1910–1960. However, the partial trend for insane person rate of England and Wales during the same period is very different (and it is decreasing in fact although we must point out a jump in the series around 1915). On the other hand, the partial trend for the group sunspot number during the period 1837–1910 was decreasing while the partial trend for insane person rate in all geographical sites was increasing.
Seems to me their hypothesis was wrong. But their assessment is more equivocal:
This result suggests that the mechanism that could relates [sic] the solar activity with mental illness is very complex and non-linear in the physical sense.
Another compelling paper was recently published online ahead of print. The abstract of "," by an American molecular radiobiologist, is worth reading in full:
Depression is a debilitating mood disorder that is among the top causes of disability worldwide. It can be characterized by a set of somatic, emotional, and behavioral symptoms, one of which is a high risk of suicide. This work presents a hypothesis that depression may be caused by the convergence of two factors: (A) A lifestyle that lacks certain physiological stressors that have been experienced by primates through millions of years of evolution, such as brief changes in body temperature (e.g. cold swim), and this lack of “thermal exercise” may cause inadequate functioning of the brain. (B) Genetic makeup that predisposes an individual to be affected by the above condition more seriously than other people.

To test the hypothesis, an approach to treating depression is proposed that consists of adapted cold showers (20 °C, 2–3 min, preceded by a 5-min gradual adaptation to make the procedure less shocking) performed once or twice daily. The proposed duration of treatment is several weeks to several months.

The following evidence appears to support the hypothesis: Exposure to cold is known to activate the sympathetic nervous system and increase the blood level of beta-endorphin and noradrenaline and to increase synaptic release of noradrenaline in the brain as well. Additionally, due to the high density of cold receptors in the skin, a cold shower is expected to send an overwhelming amount of electrical impulses from peripheral nerve endings to the brain, which could result in an anti-depressive effect. Practical testing by a statistically insignificant number of people, who did not have sufficient symptoms to be diagnosed with depression, showed that the cold hydrotherapy can relieve depressive symptoms rather effectively. The therapy was also found to have a significant analgesic effect and it does not appear to have noticeable side effects or cause dependence. In conclusion, wider and more rigorous studies would be needed to test the validity of the hypothesis.
Of course, these psuedo-studies aren't meant to be taken entirely seriously. But, as I wrote in early September, -- particularly when articles appear that purport to find links between Down syndrome patients and Asians.

Canada has some responsibility, for better or worse, for the genesis of Medical Hypotheses, as it turns out. The journal's founder, David F Horrobin, who is described as "an outspoken critic of the scientific process," began his crusade against the peer-review system in 1975 when he was a researcher and professor at the University of Montreal.

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Wednesday, November 28, 2007

Hep B and C found in exposed Alberta patients

An undisclosed number of patients exposed to improperly sterilized medical instruments at a rural Alberta hospital earlier this year .

But local medical officials say the rate of blood-borne infections among the exposed population are lower than the average rate in the general population, though they've refused to disclose details about the results of their testing -- including the actual number of patients who have been found to be infected, reports the Canadian Press.

The St Joseph's General Hospital in Vegreville, Alberta failed to clean medical equipment sufficiently over a period of four years, leading to a that has since sparked a government crackdown. The provincial government's latest efforts to improve infection-control accountability have included the introduction of Bill 41, which would give the Minister of Health the power to handpick administrators and rewrite the standards of practice and codes of ethics of health professionals' regulatory bodies like the College of Physicians and Surgeons of Alberta. (NRM in our November 15-30 issue.)

An initial estimate pegged the number of exposed patients at St Joseph's at 2,980; to 2,872. Nearly all of those patients -- 2,820, or 98% -- were contacted and offered testing, reports the Edmonton Journal. Just 1,850 agreed. But Dr Gerhard Benade, local medical officer, refused to divulge the number of positive test results. The cases are currently under review in Edmonton and definitive results of the testing likely won't be available until Dr Benade's final report, which is supposed to be published in February or March.

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Wonks and rounds

Grand Rounds, the weekly collection of the best of the medical blogs, is .

And the latest edition of the Health Wonk Review, a collection of the best health policy writing from blogs, is , at Health Care Renewal.

This week Canadian Medicine appears in both. In the former, our piece on London, Ontario's is cited; in the latter, our entry on the of outsourcing the collection of uninsured billings.

Thanks to Dr Tess Termulo and Dr Roy Poses for hosting the anthologies.

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Canada's greatest medical research

Canada has produced a disproportionately large number of major biomedical breakthroughs, and a new report released today exhaustively catalogues the best of the best.

The new report, called "" (PDF), includes a (very long) list of the top medical discoveries made in Canadian academic hospitals.

You probably knew about Dr Frederick Banting's discovery of insulin, but you're sure to be surprised at some of the high-profile research mentioned in the report, like robot surgeons, music therapy for the physically disabled, induced hypothermia for heart surgery patients and "cobalt bombs," to name a few of the most interesting items.

Download the PDF above or click 'Read more' to check out the list.

1877 Introduction of sterilized cotton wool swabs in test tubes, which reduces contamination. (McGill University Health Centre Research Institute — Montreal, Quebec)

1907 First bronchoscopy performed. (McGill University Health Centre Research Institute — Montreal, Quebec)

1908 Installation of the first milk pasteurization plant in Canada, 30 years before it becomes mandatory. This all but eliminates diseases transmitted by unpasteurized milk like tuberculosis, salmonella, and e.coli. Pasteurization dramatically decreases infant mortality in Canada. (The Hospital for Sick Children — Toronto, Ontario)

1912 First surgical treatment of tuberculosis. (McGill University Health Centre Research Institute — Montreal, Quebec)

1922 First clinical use of insulin for diabetes in human patients. (University Health Network — Toronto, Ontario)

1930 Development of a new infant cereal that later becomes famous internationally as “pablum.” This fortified cereal (the first of its kind) significantly reduces death from malnutrition. (The Hospital for Sick Children — Toronto, Ontario)

1933 First excision of the entire lung performed (pneumonectomy). (McGill University Health Centre Research Institute — Montreal, Quebec)

1939 Invention of the corneal splitting knife (still standard in surgery to reduce pressure in glaucoma). (McGill University Health Centre Research Institute — Montreal, Quebec)

1948 Development of the first artificial kidney machine. (Lawson Health Research Institute — London, Ontario)

1948 First 25 million electron-volt beta-tron to be established in any university or hospital — calibration takes nine months. The electron-volt beta-tron is used for cancer research and to improve treatment accuracy. (Saskatoon Health Region — Saskatoon, Saskatchewan)

1950 Introduction of lumpectomy for treatment of breast cancer. Lumpectomy is a surgical procedure designed to remove a discrete lump (usually a tumour, benign or otherwise) from an affected woman or man’s breast. (University Health Network — Toronto, Ontario)

1950 Use of total body cooling as a method of making heart surgery safer. (University Health Network — Toronto, Ontario)

1950 First neuro-surgical treatment of epilepsy performed. (McGill University Health Centre Research Institute — Montreal, Quebec)

1951 First use worldwide of calibrated cobalt-60 for cancer radiotherapy treatment. (Saskatoon Health Region — Saskatoon, Saskatchewan)

1951 First “cobalt bomb” in the world used to deliver radiation therapy to cancer patients. (Lawson Health Research Institute — London, Ontario)

1952 First use of a device that determines whether or not a patient’s thyroid is cancerous through the use of radioactive iodine. (Saskatoon Health Region — Saskatoon, Saskatchewan)

1956 Major breakthrough in virology by discovering that positive strand Ribonucleic Acid (RNA) could be infectious. (Capital Health/University of Alberta — Edmonton, Alberta)

1957 Invention of the artificial cell for application in medicine and biotechnology. It was thought that artificial cells could one day be used as a partial substitute for human cells and organs. (McGill University Health Centre Research Institute — Montreal, Quebec)

1958 World first surgical treatment on cerebral aneurysms. (Lawson Health Research Institute — London, Ontario)

1960 Implementation of genetic screening programs for hereditary metabolic diseases in newborns. (McGill University Health Centre Research Institute — Montreal, Quebec)

1960 First implanted mammary artery into the heart wall in order to restore functionality of the heart. (McGill University Health Centre Research Institute — Montreal, Quebec)

1961 Discovery of blood-forming stem cells enabling bone marrow transplants. (University Health Network — Toronto, Ontario)

1963 The first widely successful surgery to correct the birth defect known as “Blue Babies” is performed. Before this procedure, this condition used to kill 9 out of 10 patients in their first year. (The Hospital for Sick Children — Toronto, Ontario)

1965 First artificial knee joint in the world created. (McGill University Health Centre Research Institute — Montreal, Quebec)

1969 Discovery of a carcino-embryonic antigen, a tumour marker for cancer. (McGill University Health Centre Research Institute — Montreal, Quebec)

1970 Discovery that hereditary metabolic diseases could be treated with vitamins. (McGill University Health Centre Research Institute — Montreal, Quebec)

1971 Developed the world’s first paediatric electric prosthetic arm. (Bloorview Kids Rehab – Toronto, Ontario)

1975 Development of software used worldwide for 20 years to control radiation therapy. (University Health Network—Toronto, Ontario)

1976 Identification of P-glycoprotein as a major cause of cancer drug resistance. (University Health Network — Toronto, Ontario)

1978 Developed the internationally-recognized AeroChamber, a medical device used to administer aerosolized medication for patients with asthma. This device continues to be used in practice around the world. (St. Joseph’s Healthcare – Hamilton, Ontario)

1979 Invention of a radically different ventilator (now used worldwide) that gently “shakes” oxygen into the lungs of children with severe lung disease, sparing many of them painful lung bypass procedures. (The Hospital for Sick Children — Toronto, Ontario)

1979 Development of “Continuous Passive Motion” (CPM), a revolutionary treatment for injured or diseased joints. Before this treatment, patients with damaged cartilage had to be totally immobilized. CPM is such an improvement that it is now being used in 17,500 hospitals in more than 77 countries worldwide. (The Hospital for Sick Children — Toronto, Ontario)

1980 Initial studies using real time ultrasounds and detailing biological factors affecting human fetal behavioral activity and breathing movements. (Lawson Health Research Institute — London, Ontario)

1981 World-first heart operation to correct a life-threatening heart condition known as right ventricular dysphasia. (Lawson Health Research Institute — London, Ontario)

1983 Successful single lung transplant. Lung transplants extend life expectancy and enhance the quality of life for end-stage pulmonary patients. (University Health Network — Toronto, Ontario)

1983 The Department of Nuclear Medicine becomes first to use a special imaging agent to diagnose Parkinson’s disease. Called [18] F6-fluorodopa PET, the chemical was produced by Hamilton Health Sciences and is now used worldwide. (Hamilton Health Sciences/McMaster University – Hamilton, Ontario)

1984 Discovery and cloning of the T-Cell receptor genes, significant in the field of immunology. (University Health Network — Toronto, Ontario)

1986 Discovery of the SH2 domain, which controls the ability of proteins to interact with other SH2 containing proteins and thereby direct the function of enzymes involved in transmitting cellular signals. This finding has revolutionized our understanding of how proteins form, signaling pathways inside cells. It is already informing research to control these pathways in diseased cells — the basis for novel therapies. (Mount Sinai Hospital — Toronto, Ontario)

1986 Developed first predictive testing for late onset genetic diseases (Huntington Disease). (Provincial Health Services Authority – Vancouver, British Columbia)

1987 First aortic valve replacement in the world using the Toronto Heart Valve, which is now used worldwide. (University Health Network — Toronto, Ontario)

1987 World’s first pacemaker cardioverter defibrillator is implanted. (Lawson Health Research Institute — London, Ontario)

1988 Researchers solve the structure of rennin, a key enzyme in the kidney that plays a role in the development of high blood pressure. (Capital Health/University of Alberta — Edmonton, Alberta)

1988 World’s first successful liver/small bowel transplant is performed. (Lawson Health Research Institute — London, Ontario)

1989 Researchers develop sputum induction techniques and sputum cell analysis. Research on nasal mucosa suggested ways in which the cellular response to antigen challenge might be studied in bronchial mucosa and sputum. (Firestone Institute for Respiratory at St. Joseph’s Healthcare – Hamilton, Ontario)

1989 Development of the first oral treatment for hepatitis B, resulting in the drug Lamivudine. (Capital Health/University of Alberta — Edmonton, Alberta)

1989 Discovery of the gene which, when defective, causes cystic fibrosis, the most fatal genetic disease of Canadian children today. (The Hospital for Sick Children — Toronto, Ontario)

1990 First measure of neurotransmitter concentration in schizophrenics by Magnetic Resonance Spectroscopy (MRS). MRS allows scientists and doctors to measure chemicals within the body and brain without removing tissue or blood samples and without using dangerous radioactive “tracers.” It is therefore safe and can be used repeatedly on the patient without any ill effects. (Lawson Health Research Institute — London, Ontario)

1991 Publication of the first paper demonstrating that treatment of obstructive sleep apnea by nasal continuous positive airway pressure (CPAP) in patients with congestive heart failure improves cardiac function and symptoms of heart failure. This discovery has major implications because it suggests that obstructive sleep apnea contributes to the development and progression of congestive heart failure. (Toronto Rehabilitation Institute — Toronto, Ontario)

1992 Discovery of the first gene responsible for Fanconi anemia. Fanconi anemia (FA) is a rare genetic disease that affects children and adults from all ethnic backgrounds. FA is characterized by short stature, skeletal anomalies, increased incidence of solid tumors and leukemias, bone marrow failure (aplastic anemia), and cellular sensitivity to DNA-damaging agents such as mitomycin C. (Hospital for Sick Children — Toronto, Ontario)

1993 Researchers demonstrate that mouse embryonic stem cells are capable of supporting the entire embryonic development and in fact creating completely cell cultured derived mice. (Mount Sinai Hospital — Toronto, Ontario)

1993 Discovery of a novel gene associated with Lou-Gehrig’s disease. (McGill University Health Centre Research Institute — Montreal, Quebec)

1994 World’s first three-dimensional (3-D) ultrasound-guided cryosurgery. (Lawson Health Research Institute – London, Ontario)

1994 Solved the 30-year old puzzle of why so many people suffer an allergic reaction when they receive a blood transfusion. (Hamilton Health Sciences/McMaster University – Hamilton, Ontario)

1995 First physical map of the human genome created. (McGill University Health Centre Research Institute — Montreal, Quebec)

1995 Discovery of the gene associated with localized muscular dystrophy. (McGill University Health Centre Research Institute — Montreal, Quebec)

1996 Identification of a human blood cell that regenerates the entire blood system. This discovery enabled the development of new treatments for blood diseases such as leukemia, thalassemia and sickle cell anemia. (Hospital for Sick Children — Toronto, Ontario)

1996 Identification of a gene that causes colon cancer. Colorectal cancer is the second leading cause of cancer-related deaths among Canadians. (Hospital for Sick Children — Toronto, Ontario)

1998 Developed the first trophoblast stem cells – the precursors of cells that form the placenta. Since the placenta is critical for a successful pregnancy, this discovery will have a major impact on research to understand and ultimately prevent pregnancy complications resulting from a failure in normal placental function. (Mount Sinai Hospital — Toronto, Ontario)

1998 Discovery of the first gene that causes Lafora disease, one of the most severe forms of teenageonset epilepsy. (Hospital for Sick Children — Toronto, Ontario)

1999 First islet transplant under the Edmonton protocol for Type I diabetes. Islet transplantation had been performed under other protocols; however, the Edmonton protocol produced unprecedented levels of success in the field of islet transplantation. (Capital Health/University of Alberta — Edmonton, Alberta)

1999 World’s first closed chest robotic-assisted beating heart coronary artery bypass graft conducted. (Lawson Health Research Institute — London, Ontario)

1999 Identification of ABCA-1 gene – key regulator of HDL concentrations in humans. (Provincial Health Services Authority/BC Children’s Hospital – Vancouver, British Columbia)

2000 Discovery of the mechanism of formation of amyloid, the basis of Alzheimer’s and other diseases, and the subsequent development of drugs to treat this. (Kingston General Hospital — Kingston, Ontario)

2001 Discovery of a clinical rule that may reduce use of unnecessary x-rays for low-risk neck injuries and could aid in reducing use of imaging tests in alert and stable patients. (Ottawa Health Research Institute — Ottawa, Ontario)

2001 Development of the first animal model for Hepatitis C in mice, using transplanted human cells, providing a convenient way to test new treatments for Hepatitis C. (Capital Health/University of Alberta — Edmonton, Alberta)

2001 Tissue factor is a cell surface membrane protein involved in the initiation of blood clotting. Overexpression or increased activation of tissue factor can increase the risk of cardiovascular disease. The research group demonstrated that overexpression of GRP78 (a protein), can block the coagulant activity of tissue factor in human cells. These studies are important because they have identified a relevant cellular factor that can mediate tissue factor activity. (Hamilton Health Sciences Centre — Hamilton, Ontario)

2001 Identified the emerging role that albuminuria as an important risk factor for both kidney and heart disease. (Hamilton Health Sciences/McMaster University – Hamilton, Ontario)

2002 Introduction of revolutionary medication doses for depression and schizophrenia through positron emission tomography (PET) technology. (Centre for Addiction and Mental Health — Toronto, Ontario)

2002 Creation of a simple system to generate T-cells in a Petri dish. T-cells are a vital component of the immune system that orchestrate, regulate and coordinate the overall immune response. This discovery provided a method to create model systems to study the genetics and molecular biology of T-cell development and points to future clinical therapies for people whose immune systems have been destroyed, for example, by HIV or toxic cancer therapies. (Sunnybrook & Women’s Research Institute — Toronto, Ontario)

2002 Discovery that a type of self-destructing “suicide cell” activity, previously believed to only be detrimental, is in fact necessary for the proper formation of muscle tissue. (Ottawa Health Research Institute — Ottawa, Ontario)

2002 Pioneered the use of Botulinum Toxin A to reduce upper limb spasticity in children with cerebral palsy. (Bloorview Kids Rehab – Toronto, Ontario)

2003 Discovery of a molecular marker to diagnose hepatocellular carcinoma (HCC), the most common type of liver cancer. HCC is usually asymptomatic at early stages, and has great propensity for invasion, making it difficult to treat. A test was developed for the early diagnosis of HCC, which could also be useful for the screening of individuals that are at high risk for developing this disease, such as people chronically infected with Hepatitis B and C. (Sunnybrook & Women’s Research Institute — Toronto, Ontario)

2003 Researchers discover a way to make the immune system specifically recognize infectious prions, proteins that cause brain-wasting diseases like mad cow disease and Creutzfeldt–Jakob disease, its human equivalent. This discovery paves the way for the development of diagnostic tools, immunotherapy and a vaccine. (Sunnybrook & Women’s Research Institute — Toronto, Ontario)

2003 Major international clinical trial provides first alternative treatment to taxol for preventing breast cancer recurrence in survivors five years post diagnosis. (University Health Network — Toronto, Ontario)

2003 Compilation of the complete DNA sequence of chromosome 7. Researchers decode nearly all of the genes on this medically important portion of the human genome. Chromosome 7 contains 1,455 genes, some of which, when altered, cause diseases such as cystic fibrosis, leukemia and autism. (Hospital for Sick Children — Toronto, Ontario)

2003 Study makes it easier to identify patients with deep vein thrombosis (DVT), providing faster diagnosis and significant savings to the health care system. (Ottawa Health Research Institute — Ottawa, Ontario)

2003 Performed the world’s first deep brain stimulation for depression, causing depression that was previously treatment-resistant to go into remission. (University Health Network — Toronto, Ontario)

2003 Identification of a cancer stem cell responsible for brain tumors. This discovery may change how this deadly condition is studied and treated in the future. (Hospital for Sick Children — Toronto, Ontario)

2003 Linkage of maternal folic acid intake to a decrease in neuroblastoma, a deadly childhood cancer. (Hospital for Sick Children — Toronto, Ontario)

2003 Performed the world’s first hospital-to-hospital telerobotic assisted surgery on a patient more than 400 kilometres away. During the procedure, they completed a Nissen Fundoplication on a 66-year old patient located at North Bay General Hospital from St. Joseph’s telerobotics suite in Hamilton, Ontario. (St. Joseph’s Healthcare – Hamilton, Ontario).

2003 Developed a genetically modified vaccine that can completely prevent the recurrence of metastatic breast cancer through genetically altered cells that only destroy cancer cells. (Hamilton Health Sciences/McMaster University – Hamilton, Ontario)

2003 Developed first draft DNA sequence for coronavirus implicated as cause of SARS (Provincial Health Services Authority/BC Cancer Agency, Genome Sciences Centre – Vancouver, British Columbia)

2003 Found that the vast majority of heart attacks can be predicted by nine easily measurable factors that are the same in virtually every region and ethnic group worldwide. (Hamilton Health Sciences/McMaster University – Hamilton, Ontario)

2004 Performed the world’s first simulated underwater surgery during the NASA Extreme Environment Mission Operation (NEEMO 7). During the 10-day NEEMO 7 Mission, they successfully telementored the NEEMO7 crew through various surgical simulations from their base in the underwater Aquarius habitat located 19 metres below the surface off the coast of Key largo, Florida. (St. Joseph’s Healthcare – Hamilton, Ontario)

2004 Development of StemBase, a database of gene expression data from DNA micro array experiments on samples from human and mouse stem cells and their derivatives. This growing resource is used to find genes whose activity is related to stem cells. (Ottawa Health Research Institute — Ottawa, Ontario)

2004 Discovery of the apelin receptor and design of an analogue that can interfere with and block the actions of apelin, in order to decipher its role in the brain. (Centre for Addiction and Mental Health — Toronto, Ontario)

2004 Discovery of over 70 novel human receptor genes; many of which, together with their chemical activators, mediate unique functions in the brain and are being targeted for drug design. (Centre for Addiction and Mental Health — Toronto, Ontario)

2004 In the first large, multi-centre clinical trial of its kind, researchers provided evidence to suggest that artery grafts from the forearm should be used in place of vein grafts from the leg in heart bypass surgery because radial arteries have significantly higher graft patency over one year. Graft patency, a measure of whether the bypass remains open enough to permit efficient blood flow, is critical to success after surgery. (Sunnybrook & Women’s Research Institute — Toronto, Ontario)

2004 A research team finds magnetic resonance imaging detects more breast cancer tumors, earlier, compared with mammography, ultrasound or clinical examination in women with the BRCA1 and BRCA2 genes. This finding offers hope to genetically at-risk women, and gives them an alternative to removing both breasts. (Sunnybrook & Women’s Research Institute — Toronto, Ontario)

2004 World’s first use of beads of palladium, a low-dose radioactive material, to treat women with breast cancer on an outpatient basis. This therapy holds the promise of eliminating anguishing side effects and considerably enhancing the women’s quality of life. (Sunnybrook & Women’s Research Institute — Toronto, Ontario)

2004 Demonstration of an association between pediatric multiple sclerosis (MS) and the Epstein-Barr virus, indicating that exposure to the virus at a certain time in childhood may be an important environmental trigger for the development of MS. (Hospital for Sick Children — Toronto, Ontario)

2004 Developed a virtual instrument that allows children with physical disabilities to make music (both therapeutic and recreational applications of the software – which is licensed in 7 countries around the world). (Bloorview Kids Rehab – Toronto, Ontario)

2005 Developed the world’s first upper respiratory viral panel test that can accurately identify all respiratory viruses including various flu strains including H5N1 and the SARS Coronavirus. (St. Joseph’s Healthcare – Hamilton, Ontario)

2005 In the first trial of its kind in the world, researchers begin treating prostate cancer using a 3-D image-guided radiation therapy device that was developed in Canada. This non-surgical technique allows oncologists to visualize the exact position of the target and deliver precise external beam radiation therapy. (Sunnybrook & Women’s Research Institute — Toronto, Ontario)

2005 Key discovery in Type-1 Diabetes proves the repair process is present within the pancreas during disease development. Understanding the repair process could be the key to successful treatment. (Ottawa Health Research Institute — Ottawa, Ontario)

2005 Study determines that a specific enzyme, known as pro-protein convertase 4 (PC4) may be responsible for fetal growth restriction, the second leading cause of infant mortality in the developed world. Knowledge may lead to screening for the defective enzyme early in the pregnancy and provide the ability to monitor the pregnancy more closely. (Ottawa Health Research Institute — Ottawa, Ontario)

2005 Scientists show that early surgical removal of the spleen combined with antiangiogenic therapy, which arrests the growth of tumour-feeding blood vessels, may stop the progression of leukemia. (Sunnybrook & Women’s Research Institute — Toronto, Ontario)

2005 Using neuropsychological testing, researchers accurately predict which study participants will develop Alzheimer’s disease within five and 10 years. Previous studies were able to predict Alzheimer’s only for shorter periods of time; other studies showed predictions for 10 and even 15 years, but these did not indicate the predictive accuracy of the tests. (Sunnybrook & Women’s Research Institute — Toronto, Ontario)

2005 Identified novel mutations in the gene that causes Rett Syndrome. The discovery is now licenced as a test for the disorder and is available to the public. (Centre for Addiction and Mental Health — Toronto, Ontario)

2005 Initiation of first human clinical gene therapy trials for lipoprotein lipase deficiency. (Provincial Health Services Authority/BC Children’s Hospital – Vancouver, British Columbia)

2006 Discovery of the precise molecular chain of events that initiates the wide-scale immune destruction of “super bug” infections such as flesh-eating disease, toxic shock syndrome and severe food poisoning. (Robarts Research Institute — London, Ontario)

2006 Implantation of an antibody-coated stent into the first human patient. The invention of the antibody-coated stent reduces restenosis and prevents blood clots from occurring. (St. Michael’s Hospital — Toronto, Ontario)

2006 World’s first clinical trial to combine gene and cell therapy to treat a cardiovascular disorder. The PHACeT (Pulmonary Hypertension: Assessment of Cell Therapy) trial will assess the use of adult stem-like cells called endothelial progenitor cells (EPC) for the treatment of pulmonary hypertension. (St. Michael’s Hospital — Toronto, Ontario)

2006 First demonstration that children with cystic fibrosis have choline deficiency. Provision of choline improves redox balance and methyl transfer capacity in humans. (Provincial Health Services Authority/BC Children’s Hospital – Vancouver, British Columbia)

2006 First demonstration that dietary omega-3 fatty acid deficiency impairs neurogenesis in vivo (Provincial Health Services Authority/BC Children’s Hospital – Vancouver, British Columbia)

2006 First curative therapy for Huntington Disease in a mouse model (Provincial Health Services Authority/BC Children’s Hospital, Vancouver, British Columbia)

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Friday, November 23, 2007

Outsourced medical billing and privacy law

The Toronto Star today with the relatively new practice of physicians outsourcing their billing for providing uninsured services, like filling out forms and giving advice over the phone.

Outsourcing the responsibility for billing the "block fees" for such services to a growing industry of private firms is now becoming for Canadians doctors to get paid for doing hundreds of hours of unremunerated work per year, but is it legal?

*Update, Monday, November 26: On Saturday, the Ontario Information and Privacy Commissioner announced she will investigate the information-privacy concerns about uninsured billing agencies, and the College of Physicians and Surgeons of Ontario said it too will look into the matter. Ontario NDP leader Howard Hampton is pushing for a ban on block fees. at the Waterloo Record.

The Star's article explains that many of the letters mailed to patients by one firm, Healthscreen Solutions, in order to explain the block fee service, are designed to appear to be mailed directly from the physicians, and don't inform patients that a third party is involved in the transaction:

The letters imply that patients signing up for the plan are communicating only with their doctors. In fact, their personal information, including financial and other personal details from the doctor's file, are going to a company that handles $1.5 billion a year in billing and other services for 5,000 doctors. [...]

Privacy experts say the packages raise questions about transparency.

Fair information practices, the principles that underpin privacy laws across North America, say individuals should know who is collecting their personal data, where it's going and how it will be used.
But that principle, for better or worse, is not enshrined in Canadian privacy legislation. For an explanation, I defer to Richard Owens and Francois van Vuuren the Toronto-based law firm and their discussion of the legalities of outsourcing private information processing, :
PIPEDA [] requires consent for the collection, use or disclosure of personal information unless one of the exceptions in PIPEDA applies.

The most important exception in PIPEDA to the requirement for data subject consent to a disclosure for outsourcing purposes is Principle 4.1.3 of Schedule 1 to PIPEDA, which provides:
  • an organization is responsible for personal information in its possession or custody, including information that has been transferred to a third party for processing. The organization shall use contractual or other means to provide a comparable level of protection while the information is being processed by a third party.
The Office of the Privacy Commissioner of Canada (Canadian Commissioner), has stated that no consent by the data subjects involved is required for a transfer under Principle 4.1.3, provided the processor only uses the personal information for the purpose that it is transferred and the requirements of Principle 4.1.3 are met. It perhaps bears note that only "processing" services qualify for an exemption under Principle 4.1.3. The term "processing" is undefined. It is worth noting that the ability to transfer data implied by Principle 4.1.3 is just that, an implication, and that it is a bit at odds with the more straightforward prohibitions in the statute itself.
It would seem, then, that although some people might prefer Canadian law to require disclosure and consent in cases of outsourced information processing, no such protection currently exists.

That's probably why the Star wasn't able to drum up much interest from the Ontario government:
The Ontario Information and Privacy Commissioner's office says it can't comment without full details about how Healthscreen operates and how the province's Personal Health Information Protection Act might apply.

But spokesperson Bob Spence said that "if anyone believes their personal health information has been inappropriately collected, used or disclosed, they can file a privacy complaint with our office."

Health Minister George Smitherman said he keeps a "very, very watchful eye" on the issue of block fees. If questions are being raised about disclosure to patients, he said he'd consider reviewing the issue.
The only hope for change is the ongoing Industry Canada review into PIPEDA reform. It was recently announced that the issue would be opened to public consultation, but a seems to indicate that outsourcing is not being considered for reform.

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Thursday, November 22, 2007

Taser toll keeps rising

, bringing the death toll to 19 since 2001, according to Amnesty International figures. Four of those deaths happened in the last two months.

The latest death took place November 22 in a Nova Scotia jail. A 45-year-old man was Tasered once or twice during what police call a "violent" struggle as he was being booked at the Central NS Correctional Facility in Dartmouth following an arrest for assault. "But then he went into medical distress, was taken to hospital where he was cleared and released to police and sent to jail [Wednesday]," said Halifax Regional Police Deputy Chief Tony Burbridge. He died 30 hours later back at the jail.

[UPDATE 4:44PM: Halifax police have not yet released the name of the man who died, but his sister (pictured above from a family photo) Ms Hyde said her brother suffered from mental health problems.]

Although the RCMP said it would review its Taser use after the death of Polish immigrant Robert Dziekanski at Vancouver Airport - which has scandalized people around the world - another two BC Tasering cases have emerged in the last week.

. Police also pepper sprayed and batoned the man who was behaving "erratically" in a store.

Yesterday, officials at BC's Northern Health Authority officials revealed that on November 14, the same day the video of Mr Dziekanski's death became public.

The Ottawa Citizen this list of Taser related deaths in Canada:

Robert Dziekanski, 40, in the Vancouver Airport in October.
Quilem Registre, 39, in Montreal after being stopped by police on suspicion of drunk driving, also in October.
Claudio Castagnetta, 32, who died in Quebec City on Sept. 20 two days after being Tasered.

Jason Dean, 28 in Red Deer while running from police in August.

Alesandro Fiacco, 33 in Edmonton, arrested while wandering into traffic in December.
James Foldi, 39, of Beamsville, Ont. while being arrested for breaking and entering in July.
Paul Sheldon Saulnier, 42, while being restrained by police in Digby N.S. in July.
Gurmeet Sandhu, 41, of Surrey B.C., while being restrained during a domestic dispute in June.
Kevin Geldart, 34, in Moncton, N.B. in May during an altercation with police in a bar.

Samuel Truscott, 43, of Kingston, Ont. was tasered by police during arrest. His death was ruled a drug overdose.
Jerry Knight, 29, a semi-pro boxer was tasered by police at a Mississauga motel in July after complaints he had become violent.
Robert Bagnell, 54, while in custody of the Vancouver police in June. He had cocaine in his system.
Peter Lamonday, 33, while being restrained by police in London, Ont. in May.
Roman Andreichikov, 25, high on cocaine and being restrained by Vancouver police also in May.
Perry Ronald, 28, while being restrained by Edmonton police after jumping from a window in March.

Clark Whitehouse, 34, tried to flee the Whitehorse RCMP after being stopped in traffic in September.
Clayton Alvin Willey, 33, of Prince George was also high on cocaine when tasered by police while trespassing in July.
Terry Hanna, 51, was tasered by Burnaby RCMP in April during a break and enter. Cocaine was also involved.
NRM in its latest issue.

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Tuesday, November 20, 2007

Grand Rounds 4:09 is online

A , the weekly collection of the best offerings from medical bloggers, is online today, featuring Canadian Medicine's .

This week's edition is hosted by Enrico, the blogger and music enthusiast. His Grand Rounds includes audio clips from Aaron Copland, George Gershwin, Samuel Barber and others.

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Monday, November 19, 2007

Quebec joins the call for hospital funding reform

Dr Jean-Bernard Trudeau, the president of the Quebec Medical Association, that the province consider implementing service-based funding in its hospitals, echoing the calls for reform that Dr Brian Day has been shouting from the rooftops for over a year.

It is interesting to note that hospital funding in Quebec - the primary expenditure in our health-care system - is not very realistic. A hospital's budget is still very largely allocated on a historical basis, determined by the budget from the previous year.

This funding model creates some major adverse effects. Patients are seen as an expense. Rationing becomes a management method.

Why not introduce market forces that promote competition among public institutions? A recent OECD report (Toward High-Performing Health Systems, 2004) observed that these forces reduce the cost of hospital services even when they are administered primarily by the state.

The Quebec Medical Association advocates public patient-focused funding. In other words, clinicians and managers should see patients as a source of revenues, and not as a source of expenditure. Hospitals should be financed according to the services and care that are actually dispensed. The money should follow the patient, so to speak.

It is clear - and this is supported by experience in Europe - that such a funding mechanism would increase the system's production capacity.

Dr Day outlined the case for service-based funding .
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