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Friday, 17 August, 2007

Alberta supermarket raises cash for DCA research

Strange but true: A Fairview, Alberta IGA supermarket is .

DCA has been a hot topic since January, when a University of Alberta researcher, cardiologist Dr Evangelos Michelakis, announced that the drug killed cancer tumours - at least in mice. To Dr Michelakis' dismay, desperate cancer patients - believing DCA to be a miracle cure - started . Some have been buying the drug online and using it without medical supervision, . Others have been prescribed the drug by doctors, as in the case of a husband and wife physician team in Toronto that .

The Alberta IGA wants to help DCA to go legit. :

The Freson IGA wants to help pay for the next stage of research.

“Cancer has affected at least someone we know. This drug could save lives,” said IGA manager Tom Dunlop.

Eight weeks ago, the store started a program where customers can donate their Smart Shopper cards. Each card is worth 50 cents and is matched by the store.

Since the program started two months ago, the grocery store has raised $900.

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Babes in (American) arms

Karen Jepp thought everything was all ready for her at Foothills Medical Centre in Calgary. After all, it's not like no one knew she was about to give birth to quadruplets.

But when her labour started she and her family were surprised to learn they'd be because Foothills didn't have enough beds for all four babies, reported the . Nor did any other NICU in Canada.

The miraculous identical quads (, reported the BBC) - named Autumn, Brooke, Calissa and Dahlia (pictured above, with their dad J P) - were all born healthy in a hospital in Montana. The babies were conceived without the aid of fertility treatments.

"We've had an awful couple of weeks. They've been really tough," Ms Jepps told the Globe and Mail. "We're in another country. We're just trying to get through the next few days. We need to get back home." The couple also has a two-year-old son, Simon.

Sending high-risk deliveries to the US has become increasingly common in Canadian hospitals.

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Thursday, 16 August, 2007

Nurses host SiCKO junket, drawing senior Grits, but no Tories

A group of senior federal and Ontario Liberal politicians were by the Registered Nurses' Association of Ontario (RNAO).

Federal opposition leader Stéphane Dion (left), Ontario deputy premier/health minister Mr Smitherman (right) and former Ontario MPP Gerard Kennedy got free tickets to the film from the nurses' association and then sat down to discuss Michael Moore's controversial project.

Prime Minister Stephen Harper and federal health minister Tony Clement - also on the invite list - were no-shows, RNAO executive director Doris Greenspun told the Toronto Sun.

The Toronto Sun :

Dion was careful to stay quiet during the wait-time segment and sat with perfect posture for Sicko's duration, but afterwards mentioned it when asked if he had any criticisms.
"We know that we have awful wait times in this country," Dion said. He said the system in Canada still needs work, even if it looks good against the U.S. model. [...]
Provincial Health Minister George Smitherman, watching in the row behind, laughed at some points before leaving halfway for other business.
Also in attendance was former Liberal leadership candidate Gerard Kennedy, who afterwards called the movie "effective propaganda" but, like Dion, said he enjoyed it.
The nurses hosted the screening and debate to remind politicians about the importance of protecting universal health care, but the Liberal Party's PR department put : "Mr. Dion's participation in the roundtable was aimed at soliciting the views of nurses on how best to address the challenges facing Canada's health care system."

calling the event an "unusual political stunt" and quoted Mr Dion saying the film's laudatory depiction of Canada's hospitals was "a bit rosy." "There are strong lobbies that would like to take us there," Mr Dion declared, "but they won't have the ear of the Liberal party."

The CP report dug deeper into Mr Dion's proclamation, however, asking whether Dr Brian Day's privatization-solves-wait-times-problems theory holds water:
Dion acknowledged that the private system must have a role in delivering some services - an opinion reinforced by a 2005 Supreme Court decision granting a Quebec doctor the right to provide private for some patients.

"We have to make sure people have speedy access to services while protecting universality (of coverage)," he said.
We hosted our own roundtable discussion of SiCKO in NRM .

Photo of Mr Dion:
Photo of Mr Smitherman:

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Wednesday, 15 August, 2007

New CMA prez Dr Brian Day already making waves

Dr Brian Day doesn't become president of the Canadian Medical Association until next week, but he's already stirring up controversy.

On Monday, he told the Toronto Star -- a task that he believes, as he likes to repeat loudly and often, is best accomplished by introducing an accountability clause to the Canada Health Act and allowing patients to seek care in the private sector if wait-times benchmarks aren't met.

Prime Minister Stephen Harper, since his election last year, appears to have changed his opinion on this debate; he used to advocate greater involvement of the private sector much like Dr Day does now, but after he arrived in Ottawa he has become (outwardly, at least) a more ardent defender of healthcare. The same is true of health minister Tony Clement who seems to be trying to shed his "Two-Tier Tony" nickname.

"[Mr Harper] doesn't understand the financing of the healthcare system," Dr Day scoffed.

Dr Day also appears in this week's edition of the CMAJ, in a friendly interview with Wayne Kondro entitled "." In the space of several hundred words, Dr Day manages to turn a biographical interview into a mouthpiece for two of his pet projects: patient-focused funding (see Canadian Medicine's ) and private delivery of healthcare.

NRM featured Brian Day on the cover last November in a Q&A called "." He talked about taking the same bus as the Beatles when they were schoolboys, his father's murder, and hanging out with Fidel Castro.


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Tuesday, 14 August, 2007

Hollywood tackles anesthesia screw-ups

In , a Hollywood film slated to be released soon, Vancouver-born actor Hayden Christensen (right) plays a young husband who regains consciousness during open-heart surgery but is unable to move or talk.

"Anesthesiologists are not looking forward to [Awake] coming out at all," . People have become aware of the possibility, he says, and now worry about going under the knife.

Patients' fears, reports the Star, are not entirely unfounded: post-traumatic stress from the experience has led to a myriad of effects, ranging from depression to suicide. In the Star article, one victim recounts her horror when she came to during eye surgery but couldn't warn the doctors. Ms Carol Weirher says her experience left her afraid to sleep or lie down. She spends her nights in a chair, napping for 90 minutes at a time.

Her ordeal prompted her to start the , and she is now fighting to have monitoring devices installed in operating rooms. The device measures brain waves and alerts anesthesiologists when the patient is not completely sedated. It costs between $4,000 and $5,000; only a few are currently available in Canada.

Episodes of intra-operative awareness while under general anesthesia are reported by one or two of every 1,000 patients, writes University of Toronto physiologist Beverley Orser, in . Most end up going back under, but a few stay conscious enough to feel every cut, pull and tug, yet are too paralyzed by the anesthetic to do anything about it.

An Australian study published in 2005 in the journal Anesthesia & Analgesia found -- as much as four times higher than previously reported rates in adults.

Photo: Awake film still,

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Google Health details leaked

Some details about Google's top-secret health project, codename "Weaver," are .

The project (see the sample screenshot below) appears to be a sort of EMR for patients, to keep track of treatments, medications, conditions and doctors' appointments. Questions remain about how the information is intended to be put to use, including whether doctors would be able to access patients' files or if patients could send files or reports to their doctors. (The New York Times as well earlier this week.)

Last November, Google VP of Engineering Adam Bosworth :

"[People] need the medical information that is out there and available to be organized and made accessible to all... Health information should be easier to access and organize, especially in ways that make it as simple as possible to find the information that is most relevant to a specific patient’s needs.”
One EMR competitor wrote in a blog comment :
There is something else behind this vanilla data entry application. The functionality represented in these screenflows should not take 1 year and 2 months.

I expect something bigger than just this. It's either the tip of the proverbial iceberg, or Goog has not been giving it the attention it deserves.
Another blog commenter is wary, however: "Kiss HIPAA goodbye! Hello, Big Brother!!!" (HIPAA is the American equivalent of Canada's .)

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Monday, 13 August, 2007

Doc's email results in paralysis, lawsuit

, however innocuous and casual the conversation may seem, writes New York healthcare attorney Lee Johnson in Medical Economics. Consider this case:

In one case, an interventional radiologist gave advice to a 65-year-old woman who had selected the "contact us" option on the practice's website. The woman had written that her doctor recommended a vertebroplasty because radiographs of the lumbar spine showed diffuse osteoporosis and a collapsed third lumbar vertebra. The radiologist responded that he, too, recommended the procedure. An orthopedic surgeon performed the vertebroplasty, complications ensued, and the patient became paraplegic. The resulting lawsuit alleged that the radiologist had "negligently advised" the woman to undergo vertebroplasty "without conducting physical examination and medical testing that would have disclosed the presence of metastatic cancer." [...]
Ultimately, the interventional radiologist mentioned earlier dodged a bullet when the plaintiff's attorney decided his case would be stronger if he focused exclusively on the orthopedic surgeon.
But the lesson remains: When advice is offered via e-mail, a duty may be created and there will be a written record of how that duty was discharged.

I wrote about in NRM in June. Liability issues are legion, Bill Pascal, the CMA's chief technology officer, told me, but he said there's an even more serious explanation for Canadian physicians' reluctance to use email with their patients:
There are very few doctors that are emailing with their patients for one simple reason: most docs are under a fee-for-service structure, and they cant be compensated for providing care through any channel -- patients have to go into the office. The issue is that we don’t have the policies in place that allow [email communications] and encourage it.

I do know [remuneration for email has been discussed] in some of the negotiations between the divisions in the CMA, the 12 regional associations. It is through those levels that negotiations of what gets paid for and not paid for through fee-for-service is negotiated. Up until now, things through the e-channel, as I call it, are not built in. Even telehealth is usually not covered under fee-for-service -- just for people on a salaried basis. One of the things we are looking at now is if we can start to utilize the e-channel in a way that supports care and in a way that doctors and institutions can get compensated for.

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Doctors' self-regulation is dangerous: André Picard

The Globe and Mail public health reporter (left) argued in a recent column that .

In the piece, Mr Picard provides less-than-compelling evidence that there is indeed a need for a change in regulatory methodology. His sample size? One.

"The failings of Jocelyne Genest, a family doctor and surgeon in Sainte-Agathe-des-Monts, Que., are eye-popping.

"According to testimony before a disciplinary panel of the Collège des médecins du Québec, among other things, she:

"Performed a sigmoidectomy (a removal of part of the colon) though she was not qualified to do so. Before the operation, Dr. Genest looked up the procedure on the Internet. Not surprisingly, surgery went badly and dragged on for 12 hours, putting the patient at risk for brain damage;

"Failed to install a chest drain in a patient suffering from emphysema who was being transferred to another hospital, even though she was told to do so by an emergency room doctor, again putting a life at risk;

"Administered 'massive, unprecedented and unjustified' doses of morphine to a terminally ill patient - at the request of a family member, not the patient himself - until he died."

Incidentally, the fact introduced two paragraphs later -- that Dr Genest had her license to practise revoked by the College -- doesn't satisfy Mr Picard because she's still permitted to work as a surgical assistant.

Based on the single example, the column concludes:
"Right now, we have an inappropriate tolerance for aberrant conduct and deviant practice, and a culture of deference for doctors that serves us poorly.

"Good doctors make for safer patients. And that is why we must spare no effort in weeding out the bad doctors."

Other, more egregious miscarriages of justice abound in the medical profession. In the UK, one need look no further than the case of (right) and the through the 80s and 90s. In Canada, the public was scandalized to learn of .

Inquiries and investigations into all three incidents have been exhaustive. The British system has been significantly reformed since then, and , albeit in a somewhat "watered-down" form compared to what some have proposed.

First photo:
Second photo:

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