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Thursday, September 27, 2007

To jab or not to jab: confusion reigns over HPV

On September 24, Quebec joined the march of other Canadian provinces to provide free HPV vaccinations to schoolgirls. Almost immediately, women's health activists there due to safety concerns. Health Minister Philippe Couillard the voluntary program is safe. "We are not doing this just because there is a company with the vaccine on the market (or) ... because other provinces are doing it. We're doing it because it is in the interest of public health," he said.

Quebec's HPV drama echoes what's been happening across the country and around the world. A group of Canadian public health researchers published a commentary in the CMAJ voicing their concerns that we don't know enough about safety and efficacy of the jab in kids to rush through the vast immunization program we're seeing.

One of the authors, Dr Abby Lippman, : “I couldn’t understand why there was suddenly such a rush to do this when cervical cancer only kills about 400 people a year in Canada, and most of them are dying because of lack of treatment. I couldn’t see anything like the sort of evidence one would expect to support a decision like this.”

MDs on the frontlines have expressed concerned that, in light of the confusion, we should wait for more data (read Waterloo family doctor Dr Neil Arya's editorial on the subject ). On the other hand, an of physicians revealed that two thirds of Canadian MDs think we shouldn't wait if we can prevent cervical cancer.

Meanwhile, presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy in Chicago showed that Gardasil appears to partially protect against 10 more HPV strains than was previously thought. These strains are responsible for 20% of cervical cancer lesions. The vaccine is currently indicated for strains 6, 11, 16 and 18.

One simply doesn't know what to think.

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Nurse slain by MD ex inquest begins

Creepy. Obnoxious. Abusive.

That's how thoracic surgeon Dr Craig Pearce his former colleague Dr Marc Daniel (right), the anesthetist who stabbed his ex girlfriend Lori Dupont (below) to death at their workplace, Windsor's Hotel-Dieu Grace Hospital, in November 2005.

Dr Pearce is testifying at the coroner's inquest into Ms Dupon's death. Dr Daniel killed himself soon after the murder with an overdose of narcotics he is thought to have stolen from his own OR.

A picture of a toxic working atmosphere is emerging from the testimonies. Dr Pearce - who tried desperately to save Ms Dupont's life after finding her in a pool of blood in a recovery room - testified: "There are a number of obnoxious people who work in the OR. But there's obnoxious and there's abusive."

Nurses at the hospital contend Hotel-DieuGrace has a culture of "physician dominance" where abusive MDs like Dr Daniel are allowed to thrive.

"It was a tragic situation," Dr Pearce testified. "I and a lot of people did everything we could to try to save Lori, and we're sad that it didn't turn out in a different way."

Read of the story when it happened.

Images: Windsor Star

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Thursday, September 20, 2007

Implanted RFID chips could cause cancer

That's the suggestion of a new investigation by .

And not only could the chips be linked to cancer in animals, but the FDA apparently did not consider any of the numerous studies that established that link when officials made the decision to approve the implants in humans on January 10, 2005.

And even further, the AP reports there's a whiff of something fishy in the air:

The FDA is overseen by the Department of Health and Human Services, which, at the time of VeriChip's approval, was headed by Tommy Thompson. Two weeks after the device's approval took effect on Jan. 10, 2005, Thompson left his Cabinet post, and within five months was a board member of VeriChip Corp. and Applied Digital Solutions. He was compensated in cash and stock options.

Thompson, until recently a candidate for the 2008 Republican presidential nomination, says he had no personal relationship with the company as the VeriChip was being evaluated, nor did he play any role in FDA's approval process of the RFID tag.

"I didn't even know VeriChip before I stepped down from the Department of Health and Human Services," he said in a telephone interview.
And, further still, the American Medical Association didn't acknowledge any of the animal-cancer studies in their "June report by the ethics committee [...] which touted the benefits of implantable RFID devices."
Had committee members reviewed the literature on cancer in chipped animals?

No, said Dr. Steven Stack, an AMA board member with knowledge of the committee's review.

Was the AMA aware of the studies?

No, he said.
The AP article goes on to detail the studies that link RFID implantation to cancer, at length.

The end of the AP story is priceless:
In a TV interview while still on the board, Thompson was explaining the benefits — and the ease — of being chipped when an interviewer interrupted:

"I'm sorry, sir. Did you just say you would get one implanted in your arm?"

"Absolutely," Thompson replied. "Without a doubt."

"No concerns at all?"

"No."

But to date, Thompson has yet to be chipped himself.
This news about a potential RFID-cancer link piqued my interest, so I sent an email to Amal Graafstra. I interviewed Amal earlier this year about his two RFID implants (one in each hand) for . (The photos to the right are of his hands.)

Amal pointed me to about the AP's work, that he published on . It's a fascinating examination of the cancer claim:
I really just don’t see the glass or the operation of the implant to be the cause. I feel it’s more than likely that it’s the anti-migration coating on the pet and human implants that are causing the cancerous cells surrounding the implant site. The implants I’ve got and other DIY people that have followed in my footsteps have do not have this coating. I purposely did not get implants with this coating because I wanted to be sure I could remove/replace mine should the need arise. Now I’m just that much more satisfied I chose not to get an “FDA approved human” or pet implant which have this coating.
To read the transcript of my interview with another body modification enthusiast, Quinn Norton, who has reported on body mods for Wired magazine and had a magnet inserted into her finger for a time, see .

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Public's "muted reaction" to Stronach story a sign of change: National Post

The Toronto Star's on Belinda Stronach's decision to have breast-cancer care in California rather than in Canada failed to cause much of a stir, the Star has admitted.

The acceptance of so many Canadians of Ms Stronach's choice is a sign of "the coming health revolution" when Canadians will cease to be prevented from leaving the public system if they want to spend their own money on healthcare, :

Last Friday, the left-leaning newspaper sought to goad its readers into righteous fury with a front-page story reporting that Liberal MP Belinda Stronach recently had sought treatment for breast cancer at a U.S. medical clinic. Ms. Stronach, who's become a political punching bag in recent years for a variety of unrelated reasons, clearly was being set up for a cascade of abuse and accusations of hypocrisy.

But that cascade never came. Instead, Star readers told the newspaper's editors to butt out. "Far from outrage, early reaction seems to be heavily on Stronach's side," a Star writer reported in a follow-up article. "Star readers, responding in a Web forum, were largely saying yesterday that it was no one's business where the Magna executive decided to pay for her own treatment outside Canada's medicare system. The Star's 'Speak Out' forum received comments such as: 'Good for Belinda,' and 'There's no issue,' and 'Please, please, please, leave her alone.' At least a couple of readers questioned the Star's judgment in making this front-page news."
You can read the Star's follow-ups on readers' reactions and .

For Canadian Medicine's earlier coverage of this story, see .

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Health Wonk Review: September 20, 2007

The , a collection of recent health-policy blog posts, is online now at .

Highlights include a series of entries about Hillary Clinton's health-insurance plan, a of a recent study debunking American myths about killer Canadian wait times, and news on a few interesting biotech companies' lawsuit struggles.

Canadian Medicine makes an appearance, with a nice introduction from author Joe Paduda:

here's a candidate for from a brand-spanking-new contributor to HWR - "Sex & drugs scandal rocks Adopt-A-Doc program". Yes, you can open this at the office...

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John Tory proposes more private delivery of publicly funded care

The two most salient points from John Tory's (pictured right) proposed health-insurance reform plan are to let Ontarians access private health clinics using their public insurance plan cards, and to let physicians work in both public and private clinics at the same time.

The London Free Press

While "fiercely committed" to the principles of the public health system, he said he believes private health-care delivery can end the suffering of people waiting for service.

Tory said the OHIP card would be needed to access such services and facilities, which wouldn't be able to charge more than OHIP pays.
The Globe and Mail says Tory's plan is from the religious-schools issue that has been hurting him in the polls heading into the October 10 election.

The Globe reports that the Liberals and NDP, of course, oppose Tory's ideas:
Liberal Health Minister George Smitherman said his party rejects the idea that for-profit delivery is the answer for health care.

There is a "tremendous body of evidence" that suggests the private delivery of health care will lead to poorer outcomes and the "cherry picking" of the easier, high-profit procedures by the private providers, he said.

"Hip surgery is not like having your toenail clipped," he said.The NDP also condemned the plan, saying Mr. Tory would "continue the McGuinty tradition of steering public dollars into private profit."
For more on the Ontario election and healthcare, see .

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Speaker didn't spread TB: public health officials

Andrew Speaker, the MDR-TB-positive Atlanta lawyer (pictured right) who flew back and forth across the Atlantic and attempted to sneak back into the US via Montreal, didn't infect any fellow passengers, .

The Public Health Agency of Canada identified and contacted the 29 people who were in that zone of potential infection on the Prague to Montreal flight. All but a few have completed the necessary two tests, an official of the agency confirmed.

"Based on the currently available information, there's no evidence of transmission on the flight," said Dr. Tom Wong, director of community acquired infections with the Public Health Agency of Canada.

"That's actually a welcome piece of news." [...]

While this is welcome news for Speaker's fellow passengers, it doesn't mean the saga is over, [Dr Mario Raviglione, head of the WHO's Stop TB program] said.

He said shortcomings in international guidelines that came to light during the Speaker case are being addressed by a working group. While the main principles - the guidance on testing people in the two rows on either side of an infected traveller, for instance - still hold, changes are needed to address actions countries should take when it is evident an infected person may have put others at risk.

"All the basic things will not change. But we want to expand on a few other points, to make it even clearer, if you like, to people what needs to be done in the case of a situation like that one," Raviglione said.

"It will define better what the responsibility of the public health authorities is and what WHO is, etc."

"Mr. Speaker was just the one that sounded, in a way, the alarm of what is going on," he added. "Sooner or later there will be a case like that that will fly again and so we have to be ready to try to contain the potential of transmissions to others."

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Making the link between pollution and health

Public concern about the health effects of pollution is gradually becoming a major political issue in Canada.

Famous Canadian environmentalist / scientist / reporter David Suzuki (right) delivered a lecture on Tuesday this week at the Canadian Public Health Association conference in Ottawa entitled "Our environment is our health."

On the same day, the David Suzuki Foundation released a report, "," calling for broad reform of Canadian environmental-protection legislation in order to prevent disease. (Read the full report , as a PDF.) Here's an overview of the report:

Unlike nearly every other industrialized country, Canada has no coordinated environmental health strategy. As a result, Canada's current patchwork approach to the most serious environmental hazards threatens the health and well-being of every Canadian [...]

"The good news is that we can prevent the majority of the adverse environmental effects on our health, but we require an all-encompassing effort from federal, provincial, territorial and municipal governments to catch up and solve these problems," [report author and environmental lawyer David Boyd] says.

Currently, many Canadian health and environment laws and policies are weaker than corresponding laws in other nations. For example:
  • Canada does not have legally binding national standards for air quality and drinking water quality;
  • Canada permits the use of pesticides that other countries have banned for health and environmental reasons;
  • Compared to other nations, Canada allows higher levels of pesticide residues on our food;
  • Canada has completely failed to regulate some toxic substances such as polybrominated diphenyl ethers (PBDEs), phthalates, and polycyclic aromatic hydrocarbons (PAHs); and,
  • Canada has weaker regulations for toxic substances such as radon, lead, mercury, arsenic, and asbestos.
And it's not just David Suzuki who's onto this. In New Brunswick, where the is , a to investigate the relationship between proximity to industrial/pesticide pollution and asthma, allergies, neuro-developmental disorders, cancer and endocrine-related disorders. Another community in the province, Grand Lake, is of an insufficient response to unhealthy pollution.

, released around the time of the group's August annual meeting, showed 27% of Canadians say they have an illness that is attributable to environmental degradation.

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Wednesday, September 19, 2007

Quebec's "Chaoulli" law is bad for Quebecers: Prémont

Two years after the Supreme Court ruled on the Chaoulli case, and a year after Quebec's Bill 33 was passed in response to it, École nationale d’administration publique Law professor Marie-Claude Prémont (pictured right) still hasn't run out of things to say about the matter. This month, she submitted a (PDF) to the Health Law Journal analyzing the effects of the Chaoulli decision:

The Quebec government’s response to the Chaoulli Supreme Court decision regarding unreasonable wait times and private health insurance has been to introduce guaranteed wait time limits for certain health care services. In this paper I examine two documents: the White Paper (Guaranteeing Access: Meeting the Challenges of Equity, Efficiency and Quality), and Bill 33, passed and assented in December 2006. An analysis of these documents shows that the government is suggesting not one but two separate guarantee mechanisms quite different from one another: a public guarantee on the one hand and a public-private guarantee on the other.

The first one, the public guarantee, is for all practical purposes already in place, even if not in those terms, for tertiary cardiology and radiation oncology services. Results of the use of this mechanism in the past few years have shown dramatic improvement to access to care. I welcome the expansion of the public guarantee for health care services in Quebec.

However, the Quebec proposal also introduces a second type of guarantee, the public-private one, about which I express strong reservations. This guarantee is linked to staunch conservative ideology, as found in Canada and elsewhere, and it is part and parcel of the introduction of private health insurance for medical and hospital services, as well as contracting-out public services to private for-profit enterprises. Its main impact over the medium to long term will be the support of the legalization and expansion of private surgical facilities and, more broadly, the implementation of a parallel system of private medical and hospital care in Quebec. The public interest of Quebecers is poorly served by such an initiative.

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Quebec City man's kidney for sale

If you want to illegally sell your kidney, it's probably best not to :

Saying he is "flat broke" because of the court battle, which killed his reputation as a legitimate and competent provider of offshore financial services, [Quebec City businessman Jean Bédard] is eligible to qualify for legal aid but is unable to find a lawyer willing to take his case.

After being granted a delay by the courts last month to find a solution, he said he came up with the idea of selling one of his two kidneys to raise funds. [...]

"I've heard that a guy was paid $2.5 million for a kidney," said Bédard, a 44-year-old bachelor with no children who says he is in good health. "I don't smoke or drink or do drugs, (so) my kidneys must be in pretty good shape." [...]

But kidney experts think Bédard might have trouble with his money-raising scheme.

According to Marlene Shoucair, director of national communications for the Canadian Kidney Foundation, it is illegal to sell any organ for transplant in Canada.

Whoops.

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How (not) to protect Canadians' private health information

The , which comes to Montreal from September 25 to 28, will play host to US Secretary of Homeland Security Michael Chertoff, pictured below, who will appear as a guest speaker at the gathering of data-privacy officers. He makes a rather odd choice for a speaker at such a conference, given his own views on information privacy.

The USA Patriot Act, which he co-wrote in 2002, permits the US government to , , and -- all without proving probable cause and obtaining a court-issued warrant first. The US-based Medical Library Association has .

Canadians' medical records may be at risk, too. Where Canadian medical record-keeping is outsourced to American companies -- as it has already been in BC with the US company Maximus (see , , and especially , and read the BC privacy commissioner's analysis ), for instance -- it could be argued that those records will fall under the provisions of the Patriot Act.

In some cases, however, Mr Chertoff has instead been a vigorous defender of information privacy -- such as when he to divulge details about conversations he may or may not have had with the CIA about the legality of various torture methods (which he also refused to discuss) when he testified before the Senate in 2005.

It will be very, very interesting to find out what Mr Chertoff has to contribute to this kind of conference.


*Update, October 2: Michael Geist, Canada Research Chair in Internet and E-commerce Law, . The title of Geist's article gives you a hint as to his assessment of Chertoff's views: "The End of Privacy?"

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Will the aging population bankrupt medicare? No, it won't

Japan's aging population is beginning to put a strain on the country's healthcare system, . There, seniors' care now accounts for 40% of all health spending. And the trend is projected to continue: as the world's longest-living people, 40% of Japanese will be 65 or older by 2055.

Japan's elderly health costs crisis appears to be the real thing -- unlike the one allegedly underway in Canada, (PDF).

Marc Lee, the author of the report, :

"There's a notion in the public that as the baby-boom generation recedes into retirement years, this is going to push health-care costs over the cliff, but it's not true."
The study concludes that the effect of aging on healthcare costs will be no greater than a 1% increase in spending per year over the next 40 years. That amount is easily manageable, Dr Lee says. The nominal growth of the Canadian economy has been 5.4% per year over the past 20 years, and Dr Lee predicts that the current state of the healthcare system can be maintained with increased spending of about 4.4%.

The CCPA study may sound a bit unbelievable given the excited protests of Canadian governments citing the "unsustainability" of the current system and the need to supplement it with public-private partnerships/user fees/private insurers/increased private delivery of care/all of the above. But the logical conclusion, based on the results of the CCPA study, is to realize that governments have been dishonest in their assessments.

In fact, a 2005 CIHI study found nearly the same result as the new CCPA report. I wrote about that in February in relation to British Columbia's projection of out-of-control health spending in the future, when I asked "" (Hence the Chicken Little illustration above.)

Canadian Medicine when a UBC economist named Robert Evans published a working paper that similarly debunked BC's desperate claims.

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Monday, September 17, 2007

"Dr Profit" is nothing more than a capitalist running dog: socialists

The world's socialists, not entirely surprisingly, :

In August of this year, Dr. Brian Day, an unabashed proponent of the privatization of the Canadian health care system, began a one-year term as president of the Canadian Medical Association (CMA), an organization comprising some 60,000 doctors across Canada. The arrival of Day—who had been nicknamed “Dr. Profit” by supporters of Canada’s universal public health insurance program—has received the fervent support of a Canadian ruling elite eager to intensify the assault on Medicare and to expand the market for private, for-profit health services.

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Physicians, economists and pirates. Oh my!

In a short article on the New York Times Freakonomics blog about , Stephen J Dubner quotes from a book by Stephen Talty called , which details the remuneration and recruitment models common among pirate physicians:

Skilled tradesmen were well compensated: The carpenter who’d be responsible for fixing any breaches of the hull from cannonballs or storm damage was often paid 150 pieces of eight; the surgeon and his “chest of medicaments” got 250. Men of both professions were so sought after that pirates would sometimes attack merchant ships just to steal away their shipwright or doctor, who was then forced into piracy.
The most famous pirate physician is undoubtedly Dr James Ferguson, a Scot in Samuel Bellamy's employ who sailed on the Whydah, which sank in 1717 near Massachusetts. :

As a man of science, Dr. Ferguson would have wanted us to stick to the facts. But they're pretty sparse in his case. We know he was Scottish; we know he tended the sick and wounded in Samuel Bellamy's pirate crew.

At least he tried to. A ship's surgeon had few supplies and none of the antibiotics we count on today. So when something got infected, the answer was often just to cut it off. The surgeon grasped the limb tightly, since the wide-awake patient wasn't likely to sit still. Then he cut as quickly as he could and cauterized the stump with a red-hot ax.

But there may have been more to Dr. Ferguson. Many of Scotland's citizens were unenthusiastic about King George I, who'd been imported from Germany. Some even launched a rebellion in 1715, and the good doctor may have been part of it. If so, turning pirate might have been his way of escaping punishment when the revolt failed.

A Google search for pirate doctors unearths a handful of truly strange items:
  • US journalist Paul Davidson's imaginary job as : "... in pirate psychology school, they teach you to be honest, generous and that if someone crosses you that you must push them into shark-infested waters before they can do it again."
  • A rather crude and not very funny joke that begins ""
  • An Oklahoma City mother recalls her two boys' game of : "the Pirate Doctor says things like, ‘Arrr, ye be having a broken arm there, lassie! I’ll be puttin’ a bandage on that there! Arr!’"
  • A frightening story about a November 2005 incident in which Rossland, BC surgeon Steve McVicar and another BC doctor and his wife were (you can also hear a , in a Real Audio file):

Five pirates boarded the sailboat and held Dr. Steve McVicar and his friends – a Vancouver Island doctor and his wife – at gunpoint while they looted the 13-metre vessel.

McVicar says the trio had been watching a DVD in the cockpit when the pirates attacked, with the sound of the movie covering their approach.

Speaking with Rick Cluff on CBC Radio's The Early Edition, he said the three B.C. sailors were tied up and threatened with guns.

McVicar says they tried not to resist or look their captors in the eyes.

"I knew that any second I could be gone from this life. I think my family would have a hard time with that," he said.

"We were fairly calm, but we knew we were in an extremely dangerous situation, you know, I just think that for those 20 minutes of hell."


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Canadian scientists battle Congo Ebola

Three National Microbiology Laboratory scientists from Winnipeg are :

Three Canadian scientists will be based in Luebo in the affected area and approximately 10 kilometres north of Kampungu, where Medecins Sans Frontieres (Doctors without Borders) have established their base, Kelly Keith, a spokesperson for the Winnipeg laboratory, confirmed Sunday.

Keith said the Canadian team will be comprised of Dr. Heinz Feldmann, laboratory technician Allen Grolla and Dr. Gary Kobinger. Feldmann is an expert on viral hemorrhagic fevers such as Ebola and the related Marburg virus; Feldmann and Grolla spent weeks in Angola in 2005 helping to contain a large Marburg outbreak there.

The three will bring a small mobile laboratory developed by staff of the National Microbiology Laboratory which can operate with limited resources. They will serve as part of a joint team made up of experts from the U.S. Centers for Disease Control in Atlanta and the Public Health Agency of Canada. (The Winnipeg lab is part of the agency.)
(Read the for more information.)

In February 2001, there was . Dr Douglas MacPherson, a tropical medicine specialist, ordered . It turned out the woman didn't have Ebola and made a full recovery, but Dr MacPherson told the CMAJ he was .

To read up on Ebola, check out .

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Friday, September 14, 2007

The weirdest medical experiments in history

A new book, , by Alex Boese, lists some of the strangest medical experiments ever performed.

Here's the publisher's description:

When Tusko the Elephant woke in his pen at the Lincoln Park Zoo on the morning of August 3, 1962, little did he know that he was about to become the test subject in an experiment to determine what happens to an elephant given a massive dose of LSD. In Elephants on Acid, Alex Boese reveals to readers the results of not only this scientific trial but of scores of other outrageous, amusing, and provocative experiments found in the files of modern science.

Why can’t people tickle themselves? Would the average dog summon help in an emergency? Will babies instinctually pick a well-balanced diet? Is it possible to restore life to the dead? Read Elephants on Acid and find out!
of some of the weirdest and most shocking:
  • The Initiation of Heterosexual Behavior in a Homosexual Male
  • Heartbeat At Death
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The Dawson College shooting, one year later

Montreal hospital trauma staff of September 13, 2006, when Kimveer Gill shot 20 Dawson College CEGEP students, one fatally, before being shot by police and then killing himself.

Le docteur Tarek Razek, chef du département de traumatologie, parle de «chaos organisé» pour décrire la situation dans la salle d'urgence ce jour-là. «Au début, ce n'était pas clair. Combien y aurait-il de victimes? Tout ce qu'on savait, c'est qu'on faisait face à des blessures multiples par balles», dit-il.

Sa formation en traumatologie à Philadelphie l'a habitué à ce type de traumatisme. Parmi les 11 victimes reçues à l'Hôpital général, trois l'inquiétaient particulièrement, dont Leslie Maforsky qui a reçu deux balles à la tête. [...]

Encore aujourd'hui, il est surpris de voir qu'ils s'en sont tous sortis aussi bien. «Le fait que ce soit des jeunes les a sûrement aidés à récupérer. Pour certains, c'est incroyable de voir leur récupération face à des blessures aussi graves», dit-il.
Another physician, Bernard Bernardin, insisting humbly he didn't deserve recognition, said the successful response to the tragedy .

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Belinda Stronach seeks cancer care in US

When Liberal MP Belinda Stronach (right) needed a mastectomy and breast reconstruction following her breast cancer diagnosis earlier this year, she headed to California. Her choice of US private care over Canadian public care was :

It is unusual for a federal politician to travel outside Canada for private medical treatment, especially given the hallowed status of the Canadian, publicly financed healthcare system in the realm of political debate.
But her spokesperson insisted her decision "had nothing to do with her confidence – or lack of it – in Canada's cancer-treatment facilities or public health care." He continued:
"In fact, Belinda thinks very highly of the Canadian health-care system, and uses it when needed for herself and her children, as do all Canadians. As well, her family has clearly demonstrated that support. [...]

"This was about a specific health-care procedure, unrelated to any views about the quality of Canadian health care, a decision based on medical advice and a referral from her Toronto physicians, and just one part of several areas of treatment. Belinda has nothing but praise for the community of health-care professionals in Toronto who supported and treated her throughout the last six months."
The Star story is , with American readers thrilled to hear of Canada's healthcare struggles.

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Thursday, September 13, 2007

Sex & drugs scandal rocks Adopt-A-Doc program

A doctor brought to London, ON via the city's $20,000 Adopt-A-Doc subsidy program with the College of Physicians and Surgeons of Ontario that will see him avoid a sexual abuse and narcotics inquiry in exchange for giving up his medical licence and promising to never practise again in any jurisdiction.

Dr Robert Axford-Gatley practised in London until 2004, when he left for Toronto at his wife's behest. There, he worked in cosmetic medicine. (In , he offers Botox and collagen lip treatments: "Want lips like Angelina Jolie's?") But, reports the London Free Press, his marriage fell apart and he struggled financially. He in December 2005 after receiving a $20,000 grant to facilitate the move.

Now, after allegations of sexual abuse of patients and improper prescribing, including of narcotics, Dr Axford-Gatley has managed to strike a deal to avoid a public airing of the charges. Why would the College agree to make such a deal?

In the case of Axford-Gatley, the college obtained more from the agreement than it would have been able to impose if it had investigated and prosecuted his case, [College spokesperson Kathryn] Clarke said.

"We could effectively take someone out of practice in Ontario but we have no authority to take someone out of practice elsewhere. He has agreed not to practise elsewhere," she said.
Despite Ms Clarke's reasoning, it remains to be seen how the people of London feel about an agreement that shoves allegations of sexual abuse under the rug.

Meanwhile, London mayor Anne Marie DeCicco-Best is trying to recoup part of the city's investment in the Adopt-A-Doc payments:
[DeCicco-Best] said the city sent Axford-Gatley a letter in August requesting he pay back a portion of the Adopt-A-Doc grant. There has been no response, she said.

"If he doesn't respond shortly we will have to look at what our next steps are," the mayor said.
The truth about Dr Axford-Gatley's reason for resigning, which he actually did in July, hadn't come out until now. The London Free Press had he "got burned out."

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Wednesday, September 12, 2007

Canada's new research policy a "victory for open access"

Michael Geist, the Canada Research Chair of Internet and E-commerce Law at the University of Ottawa, gives two thumbs up to the new CIHR open access policy in a published in the Toronto Star and The Tyee.

The new policy - the first of its kind for Ottawa's three major research granting institutions that dole out hundreds of millions of dollars each year - will revolutionize access to health research by mandating that thousands of articles published each year be made freely available online to a global audience.

This marks an important step in the "open access" movement in Canada, which had been falling behind peer institutions in the United States, Europe, and Australia. It also places heightened pressure on the publishing industry to adapt their policies to permit greater access to publicly-funded research.
Despite his paean to the open access policy, Mr Geist, careful reader that he is, has nevertheless discovered a loophole that could allow staid publishers to undermine the new effort:
The policy is not iron-clad since publication in an online repository is conditional on the appropriate permission from the publisher. Accordingly, a researcher does not violate the grant requirements by not posting their work if a publisher refuses to grant them permission to do so. This leaves publishers with a measure of control...
You can read , if you're so inclined, on the CIHR website. Or just stick to , if you prefer.

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Clinical practice guidelines? Who needs 'em?

There's no shortage of clinical practice guidelines available to Canadian physicians, but it seems nobody's paying them any mind. A reports that many clinical practice guidelines haven't had the desired effect on actual clinical practice.

The CMA Handbook on Clinical Practice Guidelines therefore spends as much as a third of the space in its new edition focusing on uptake strategies, commonly called "knowledge translation" methods.

The message, in short: read the guidelines.

The book is available free to CMA members online or in print form.

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Tuesday, September 11, 2007

US Guantanamo MDs 'complicit in torture'

A letter signed by 260 doctors, scientists and professors, , draws a parallel between the work of American physicians in the Guantanamo prison and the actions of South African physicians during apartheid who forged records to cover up the murder of activist Steve Biko.

The resolution of the Biko case was instrumental in the rehabilitation of the South African Medical and Dental Council and the Medical Association of South Africa, which had been subject to boycotts during the apartheid years. The failure of the US regulatory authorities to act is damaging the reputation of US military medicine. No health-care worker in the War on Terror has been charged or convicted of any significant offence despite numerous instances documented including fraudulent record keeping on detainees who have died as a result of failed interrogations. We suspect that the doctors in Guantanamo and elsewhere have made the same mistake as [South African physician Benjamin Tucker, one of the two doctors who forged Biko's records] who, in 1991, in expressing remorse and seeking reinstatement, said “I had gradually lost the fearless independence…and become too closely identified with the organs of the State, especially the Police force…I have come to realise that a medical practitioner's first responsibility is the wellbeing of his patient, and that a medical practitioner cannot subordinate his patient's interest to extraneous considerations.”

The attitude of the US medical establishment appears to be one of “See no evil, hear no evil, speak no evil”.
Of the (PDF), just one is from Canada: , PhD (right), who is actually not Canadian, but German. Dr Schuklenk is a professor of Philosophy at Queen’s University and was appointed in June to hold the Ontario Research Chair in Bioethics. He's also the co-editor-in-chief of Bioethics. You can read his very interesting blog . Although he hasn't yet touched on the Guantanamo letter, he did write last month about a case in he has dubbed .

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Monday, September 10, 2007

Ontario's toxic politicians

The leaders of the major political parties in Ontario are , reports Environmental Defence.

John Tory (pictured right) is the most polluted, with 44 substances present in his body. Howard Hampton (left) came in second with 42, and Dalton McGuinty (centre) had 41. The Canadian Press collected the :

"I'm confident, based on discussions I've had, that people living in northern Ontario - who think the air would be pristine and subject to far fewer smog days - also have toxins in their blood," McGuinty said.

"I don't think you can live in an industrialized environment at the beginning of the 21st century and not have ingested, in one form or another, toxins."

Experts tested the politicians for 70 pollutants and detected 46, including many that are associated with cancer, developmental problems, respiratory illnesses, nervous system damage and hormone disruption.

"This is a very stark lesson to everyone that, no matter who you are, where you live or what you do, toxins are in all of us," Tory said in a statement.

Hampton commended Environmental Defence for its research and said he was "alarmed" by his results.

"It makes me concerned about the health of everyone else in Ontario," he said in a statement.
You can read the at the Environmental Defence website (PDF).

Photo:

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Are health wikis useful?

if patient-generated health wikis are beneficial (or even safe):

Patients who live with chronic diseases such as epilepsy often know more about them than their doctors, contends Daniel Hoch, a professor at Harvard Medical School who helped to found BrainTalk. Many doctors, he says, “don't get the wisdom of crowds.” But he thinks the combined knowledge of a crowd of his patients would be far greater than his own. A wiki capturing the knowledge of, say, 300 epileptics could be invaluable not only to others with epilepsy, but also to the medical professionals who care for them.
Following that line of reasoning, wouldn't the collective wisdom of 300 epilepsy specialist physicians be even better, then? Some doctors (including Dr Melissa Hershberg, who was ) are already working along those lines with a project called .

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"A connoisseur of medical argot"

The Wall Street Journal Health Blog recently featured Dr Adam Fox, a British pediatric allergist, as .

Dr Fox's crowning achievement -- the one that earned him the WSJ distinction -- is not is research into the increasing prevalence of child nut allergies, but rather his delightfully unusual glossary of doctor slang, published in Ethics and Behaviour in 2003 to accompany a paper he co-authored about the role of slang in a clinical setting.

The WSJ lists some of the highlights of the 200-plus terms Dr Fox identified:

GPO - Good for Parts Only
HAIRY PSALMS - Haven’t Any Idea Regarding Your Patient, Send a Lot More Serum
LOBNH - Lights on But Nobody Home
TEETH - Tried Everything Else, Try Homeopathy
UBI - Unexplained Beer Injury
The BBC enumerated some a few years ago:
NFN - Normal for Norfolk
GROLIES - Guardian Reader Of Low Intelligence in Ethnic Skirt
CTD - Circling the Drain
GLM - Good-Looking Mum
TTFO - An impolite way to say "Told To Go Away" (The doctor told the judge it meant "To take fluids orally," Dr Fox says.)
CNS-QNS - Central Nervous System-Quantity Not Sufficient
Pumpkin positive - "A penlight shone into the patient's mouth would encounter a brain so small that the whole head would light up"
DBI - Dirt Bag Index ("Multiply the number of tattoos with the number of missing teeth to give an estimate of the number of days since the patient last bathed")
Digging for Worms - varicose vein surgery
Departure lounge - geriatric ward
You can find hundreds of other, equally outrageous terms online (see , or , or .)

According to the WSJ, Dr Fox is concerned that these examples of inventive, colourful, descriptive language are disappearng:
Fox laments that slang is “a dying art.” Even as he acknowledges slang can be derogatory, he says it can be useful. Slang is easily remembered, descriptive and saves time. Also, as he wrote in his paper, the humor that make slang catchy “is a potential way of coping with some of the unpleasantness of dealing with human bodily functions, suffering and death on a daily basis.”
But insurance companies are also concerned. Apparently it doesn't reflect well on a doctor's character to have to explain such offensive, insensitive phrases to malpractice jurors.

NRM covered Dr Fox's important research into offensive slang .

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Wednesday, September 5, 2007

Quads' Montana birth give Americans ammo

When the Calgary Health Region , they probably didn't expect to invite the kind of razzing they've brought upon not only the Calgary hospital system, but also the Canadian healthcare system as a whole.

The Canadian Press provides a round-up of :

  • "We've heard much talk about Canada's `free' health-care system, glorified in Michael Moore's documentary Sicko. But the birth of the Jepp sisters are case in point that Canada's medical system is as flawed as ours, just on the other end. As our congressmen debate the future of our health-care system, we urge them to keep cases such as the Jepps' in mind." - Great Falls Tribune
  • "I'm sure Canadians like their health system. Just remember, though, that Canada's backup system is in Montana. Great Falls has enough neonatal units to handle quadruple births and a `universal health' nation doesn't." - Charleston (West Virginia) Daily Mail
  • "Canadians love their health care – in Montana. [...] Universal health care is a pretty edifice to cover the ugly reality of rationing treatment within a bureaucratic monstrosity. Great testimony for single-payer health care: Can't handle a C-section, can't find any room at neonatal intensive care units, has to fly mothers in labour to a small town in the savage land of only half-governmentalized care just so they can bear children." - Milwaukee Journal Sentinel
  • "More proof socialized health care doesn't work." - Powerline News blog
  • "The precious gift of American citizenship comes to the Jepp quads because there were no hospital facilities anywhere in Canada able to handle four neonatal intensive care babies. Not in Calgary, a city over a million people, the wealthiest in Canada, or anywhere else in Canada. However, Great Falls, a city of well under 100,000 people, apparently had no problem." - Blue Zeus blog

The Calgary Health Region made a rather meek protest in the CP article: "They don't have all the facts and information, obviously," said Don Stewart.

Jack Goldberg of the Canadian lobby group Friends of Medicare put it better: "I think we need to appreciate that it's because of our publicly insured system that this couple was able to get access to a hugely expensive service in the United States that may very well be denied to tens of millions of Americans. So even what happened there is a point in favour of our system – that these people were able to get there."

---

In a rather surreal twist, the quadruplets have also attracted the attention of none other than Art Garfunkel. The proceeds from , both part of the Jepp father's company's Green Planet Concert Series, .

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Tuesday, September 4, 2007

US cancer patient woos Canadian gents - for medicare

"Assertive, adventurous 52-year-old woman, living with incurable cancer, would like to meet a marriage-minded Canadian gent who is a cancer survivor or living with the disease."
That's how Jeanne Sather's , published last week on her blog , begins. Ms Sather (right), a former journalist for Newsweek and Reuters, decided to look for a Canadian husband in order to join the ranks of those whose healthcare is provided by the government.

Ms Sather, a Seattle resident, pays about $20,000 annually for her medical insurance and other costs. A move to Vancouver, with a Canadian spouse, would solve her health-cost problems, she says. Her ad continues:
Me: Writer, artist, teacher, well-known cancer blogger. Mother of two almost-grown sons (22 and 17). Vegetarian (but you don’t have to be). Loves animals (two large dogs and three cats), gardening, house projects. The beach. Books. Travel. Financially solvent except for absurdly expensive health insurance premiums and medical costs. Dislikes: Pink ribbons, chemotherapy, and unsolicited advice.

You: Age 45 to about 57. Canadian citizen living in Vancouver, B.C., or willing to relocate there. Cancer patient or survivor. Open-minded. Bit of a risk taker. Warm hearted but not clinging. Bald OK.

I’m not looking for a caretaker, and you shouldn’t be either. I am looking for a lover and new best friend.
The approach may be a tad unorthodox, but Ms Sather's no beggar -- she told the Victoria Times-Colonist that : she's got to fall in love with the man. So, don't forget to send along a snapshot:
Contact: jeanne.sather@gmail.com with photo.
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Bad science in Medical Hypotheses

The Guardian's "Bad Science" correspondent Ben Goldacre recently to an article published in the journal called "Down subjects and Oriental population share several specific attitudes and characteristic:"

You'd be right to experience a shudder of nervousness at the title alone, since this is an academic journal, from 2007, and not 1866 when John Langdon Down wrote his classic "Observations on the Ethnic Classification of Idiots". [...]

Flash forward to 2007 - I think that's where we are - to two Italian doctors. They offer their theory that the parallels between Down syndrome and "oriental" people go beyond this fleeting facial similarity.
Here's the doctors' proof for the connection:
  • "Down subjects adore having several dishes displayed on the table, and have a propensity for food which is rich in monosodium glutamate."
  • "The tendencies of Down subjects to carry out recreative-rehabilitative activities, such as embroidery, wicker-working, ceramics, book-binding, etc., that is renowned, remind [us of] the Chinese hand-crafts, which need a notable ability, such as Chinese vases, or the use of chopsticks employed for eating by Asiatic populations."
  • "Down persons during waiting periods, when they get tired of standing up straight, crouch, squatting down, reminding us of the 'squatting' position ... They remain in this position for several minutes and only to rest themselves. This position is the same taken by the Vietnamese, the Thai, the Cambodian, the Chinese, while they are waiting at a bus stop, for instance, or while they are chatting."
  • "There is another pose taken by Down subjects while they are sitting on a chair: they sit with their legs crossed while they are eating, writing, watching TV, as the Oriental peoples do."
Generally medical journals publish articles that are based in what those of us in journalism refer to as "facts" and "data" -- but not this one, apparently.

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Alberta won't follow Ontario's lead on pharma-policy

Health Minister Dave Hancock (right) tells the Calgary Herald that although Alberta needs a drug-costs reform plan, he :

"We're looking at other models across the country. I'm not satisfied the Ontario model will do the trick."
He says possible solutions include expanding the bulk-buying strategy (agreed upon with BC recently) and reducing the price of generics.

Alberta's reforms could be implemented as early as this fall, reports the Herald.

For some background on Bill 102, see , when the law came into effect.

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