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Showing newest 21 of 42 posts from November 2007. Show older posts
Showing newest 21 of 42 posts from November 2007. Show older posts

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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CPSO carves out new cosmetic surgery rules

In response to mounting pressure to rein in the hundreds of GPs in the province who are doing largely unregulated cosmetic surgery procedures, the College of Physicians and Surgeons of Ontario (CPSO) today requiring cosmetic surgeons to undergo assessment.

The CPSO also released the results of a survey it conducted of 500 doctors who were performing cosmetic procedures. Sixteen have been placed under investigation for possible violations, and 20 doctors have been warned for failing to respond to the survey. (The CPSO refused to name them.)

The issue has been in the news lately because of the September death of 32-year-old Krista Stryland in Toronto during a liposuction operation performed by an FP named Behnaz Yazdanfar. NRM in our October 15 issue:

[...] Unlike plastic surgeons, in most of Canada doctors calling themselves cosmetic surgeons need no special licence to ply their trade.

Dr Yazdanfar's clinic didn't respond to NRM's request for an interview, but released a statement saying it wasn't operating out of bounds, but followed College guidelines on what treatments it was allowed to offer.

That claim seems to be true — and that's exactly the problem, say plastic surgeons. "The public may think that there's a universal level of education, training and experience, but in the area of cosmetic surgery there's no program or licence," says Dr David Kester, president of the Canadian Society for Aesthetic Plastic Surgery (CSAPS) and a BC plastic surgeon. "Anyone can do it if they can get into a clinic."

"A variety of names are used by cosmetic practitioners. It's confusing," agrees Dr Jeffrey Turnbull, president of the College of Physicians and Surgeons of Ontario. "When someone calls themselves a surgeon, people think they're a surgeon."
The regional coroner's office, under Dr James Edwards, is .

Update, November 20: for the lax standards on cosmetic surgery in Ontario squarely on the College of Physicians and Surgeons, citing years of "dithering" and failure to implement effective guidelines or enforce what guidelines did exist.

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Brainsuckers: a doctor's worst nightmare

Here's a new piece of medical slang you may not have heard before: brainsuckers.

That's how Dr Scott Haig describes the frustrating "medical googler" patients he sees, in published November 8 that has stirred up some controversy among patient advocates, reports the

Mary Shomon, who blogs about thyroid diseases at, says Dr Haig's article demonstrates why it's important patients are . She also notes that such patients are also called "petit papier patients," because they often bring in papers for their doctors to interpret.

Here's how begins:

We had never met, but as we talked on the phone I knew she was Googling me. The way she drew out her conjunctions, just a little, that was the tip off — stalling for time as new pages loaded. It was barely audible, but the soft click-click of the keyboard in the background confirmed it. Oh, well, it's the information age. Normally, she'd have to go through my staff first, but I gave her an appointment.

Susan was well spoken and in good shape, an attractive woman in her mid-40s. She had brought her three-year-old to my office, but was ignoring the little monster as he ripped up magazines, threw fish crackers and Cheerios, and stomped them into my rug. I tried to ignore him too, which was hard as he dribbled chocolate milk from his sippy cup all over my upholstered chairs. Eventually his screeching made conversation impossible. [...]

Meanwhile, Mom launched into me with a barrage of excruciatingly well-informed questions. I soon felt like throwing Cheerios at her too.

Susan had chosen me because she had researched my education, read a paper I had written, determined my university affiliation and knew where I lived. It was a little too much — as if she knew how stinky and snorey I was last Sunday morning. Yes, she was simply researching important aspects of her own health care. Yes, who your surgeon is certainly affects what your surgeon does. But I was unnerved by how she brandished her information, too personal and just too rude on our first meeting.

Every doctor knows patients like this. They're called "brainsuckers." By the time they come in, they've visited many other docs already — somehow unable to stick with any of them. They have many complaints, which rarely translate to hard findings on any objective tests. They talk a lot. I often wonder, while waiting for them to pause, if there are patients like this in poor, war-torn countries where the need for doctors is more dire.

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Feds "picking and choosing" which Agent Orange-related diseases they'll cover

An organization representing victims of Agent Orange poisoning from a New Brunswick military base says the federal government is , reports the Canadian Press.

The federal government's compensation offer was released in September, but excludes residents who claim the toxic herbicide caused their high blood pressure or AL amyloidosis.

The Agent Orange Association of Canada says the government is using a list of Agent Orange-associated conditions from a by the US Institute of Medicine in order to determine the extant of their coverage, rather than an , which includes the two conditions.

"It's not morally correct," [Agent Orange Association of Canada president Ken Dobbie] said in an interview from Ottawa.

"You can't just say, 'We're going to use an older list because it contains fewer diseases.' The science is showing us these two diseases have been accepted by the Institute of Medicine and they should be on our list for ex gratia payments to veterans and civilians."

Dobbie said Ottawa is "picking and choosing" to its benefit rather than the benefit of the people they are supposed to be helping.

The evidence for a link between the conditions and Agent Orange exposure is growing stronger
and stronger as more research is done. (See ,

The , worth a total of $96 million, proposes to give $20,000 apiece to residents who have a condition associated with Agent Orange and lived or worked at or near CFB Gagetown between 1966 and 1967. The chemical was sprayed as part of an American military testing program.

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The Poison Pita Pit

Medical officer Dr Byrna Warshawsky of Middlesex-London, Ontario is on the trail of the source of a new salmonella outbreak at the University of Western Ontario. The investigation has now spread beyond fast-food restaurant Pita Pit, which was initially the prime suspect.

Twenty-nine of the 42 cases reported in the past several weeks have been definitively linked to the Pita Pit, but the new cases appear to be connected to a school cafeteria's central kitchen, . (Another count -- from the same department, oddly -- puts the .) Five affected people have been hospitalized.

One student who fell ill after eating at Pita Pit :

Up until now, if you asked me where to dine, I would have praised the Pit through and through. Little did I know evil bacterial minions were invading my body and plotting to destroy my intestinal tract while I munched on my wrap.

By Monday, I was doubled over in pain. I won’t go into graphic depictions of the items expelled from my body that day – let’s just say Hostel couldn’t hold a candle to it.

Genuinely concerned for my life by Tuesday morning, I booted it over to Student Health Services to speak with the docs. My physician greeted me with, “So you’ve got the runs, eh?”

Funny enough, he didn’t even ask me if I had been to Pita Pit lately. Of course, I visit the Pit at least once a week, so there’s no doubt in my mind the culprit was a delicious, but tainted, falafel.
The father of a girl who may have to sit out the rest of the semester is :
"She is no shape to go back. It knocked her for a loop."
According to the man, his daughter had been diagnosed with a "sensitive stomach." (Is that in the ICD-9?)

But last week when a London Free Press reporter showed up at the Pita Pit, one pre-med student was "munching away." "I didn't hear anything," said Breat Ghummar.

Image: (Doesn't the anthropomorphic pita look as though it's experiencing stomach pains?)

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Friday, November 16, 2007

Inhaled insulin gasps for breath

Despite the demise of the insulin inhaler Exubera last month due to disappointing sales, its developer, Nektar Therapeutics, is promising to revive the puffer.

Nektar has now regained the rights from Pfizer. They're planning improvements to the puffer (including making the apparatus less bulky) and are looking for a new partner to help them get it back on the market.

Meanwhile, the Exubera flap has cooled the ardour of other developers. reports that while Novo Nordisk A/S is moving ahead with plans to bring out its own insulin puffer, AERx, the launch will be delayed by a couple of years. "The market potential for inhaled insulin is significantly lower than expectations in recent years, but inhaled insulin is still part of the home turf of Novo, a diabetes specialist," noted Novo's CFO Jesper Brandgaard.

But others are forging valiantly ahead. Billionaire Alfred E Mann, CEO of MannKind Corporation, just announced he'll invest nearly $1 billion of his own money into the company to develop Technosphere Insulin, a lighter, cell-phone sized form of insulin inhaler, according to a .

Pharmaceutical giant , in clinical trials right now and hopes to have it market ready by 2010.

I reported on the , including the inhaled and sprayed formulations, in the latest issue of NRM.

Photo: Reuters/John Sommers

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Book launch marks National Medicare Week

This week is National Medicare Week, and the Canadian Health Coalition is celebrating with publication of a new book called Medicare: Facts, Myths, Problems, Promise.

The book is a collection of essays based on presentations given at the Coalition's , including speeches by Shirley Douglas, Monique Bégin, Roy Romanow and Stephen Lewis.

, Shirley Douglas said: "I encourage Prime Minister Harper and CMA president Dr. Brian Day to read this book and commit to working together to fix problems rather than using the problems as an excuse to go back to the days before Medicare - when doctors could charge whatever they wanted and care was rationed on the basis of ability to pay not need."

The book is being released in conjunction with the .

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Quebec ER bomb threat "a bad joke"

The Montreal Gazette :

Two men face possible charges after a bomb scare emptied the emergency room of a hospital in St. Hyacinthe yesterday. The men, described as being in their 20s, walked into the Honoré Mercier Hospital Centre just before 9 a.m. One of the men said they were going to "blow the place up" and left a travel bag on the floor, said Constable Ronald McInnis of the Sûreté du Québec. About 20 people, including 11 patients, were transferred to other parts of the hospital by staff and police. A bomb squad determined the bag did not contain any explosives. The pair were being questioned late yesterday afternoon. McInnis said he was not certain what charges they might face and said the incident appeared to be "a bad joke."

The Honoré-Mercier Hospital has had a rough year, having for poor cleaning that led to a deadly outbreak of C difficile. NRM reported on the infection control problems at Honoré-Mercier in and .

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Missed the World Toilet Summit 2007? We've got you covered

The , the annual conference of the -- the other WTO -- concluded on November 3. (This year's theme: "Toilets for all.")

Unfortunately, I didn't make it to the get-together; it was held halfway across the world in New Delhi.

But thankfully, Longwoods Publishing filed a report from the toilet meeting. is perhaps the least tongue-in-cheek, most serious article ever written on the World Toilet Summit. For that, I commode-- I mean, commend them. It is quite an accomplishment to have done so, especially given the photos on the conference's gallery, including the one shown above. (The text above the lit stove reads: "Human excreta based biogas being used as fuel.")

NRM wasn't able to wipe away the temptation to in 2004:

India's WTO member, Gramalaya, puts a more pressing spin on the issue than their British and American counterparts, working to improve sanitation and disease in desperately poor areas of India. Their mission includes the construction of public washrooms in needy areas. Gramalaya's work in the city of Tiruchirappalli has resulted in what their local billboard poignantly proclaims "India's first 100% Sanitised Slum — where open defecation is totally eschewed by the community."
In fairness, there are some serious issues that mustn't be (toilet)brushed aside here. The absence of sufficiently hygienic sanitation facilities in the developing world is to blame for the spread of disease and for millions of deaths worldwide, according to conference keynote speaker and founder of Indian toilet advocacy charity Sulabh International, Bindeshwar Pathak. (Check out Sulabh's .)

Another serious matter: Canada still isn't a member of the WTO! Concerned citizens are encouraged to write to their Members of Parliament and to Minister of Foreign Affairs Maxime Bernier to express their concern that Canada is flushing away an opportunity to participate in the global dialogue on toilets. (I'm joking but actually it would be very funny to write to Mr Bernier about toilets. Here's his email in case anyone is so inclined:

If, like me, you missed the World Toilet Summit this year, fear not -- you can still celebrate World Toilet Day on Monday, November 19.


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Alzheimer's love story captures public imagination

The of former US Supreme Court Judge Sandra Day O'Connor's Alzheimer's-afflicted husband John and a fellow nursing home patient named Kay tugged at the public's collective heart strings this week.

Justice O'Connor announced her retirement from the Supreme Court in 2005 to take care of her husband (pictured right with her in 1998), who was diagnosed with Alzheimer's 17 years ago.
Justice O'Connor is reportedly happy that her husband has found love again. He'd earlier been wracked by depression and suicidal thoughts. "Mom was thrilled that Dad was relaxed and happy and comfortable being here," their son Scott told Veronica Sanchez, the Arizona reporter who broke the story.
The story came out quite by accident, says Ms Sanchez. It was "dumb luck," she Poynter Online. "The director at Huger [Mr O'Connor's nursing home] told me she had two families willing to speak on camera but that only the sons would be doing the interviews. When I pressed to speak to the wife in question, that’s when I discovered the wife was Sandra Day O’Connor. I dropped the phone."

The love story closely echoes that told in the recent Canadian film , based on a short story by Alice Munro called “The Bear Came Over the Mountain.” In it, a husband must accept that his wife (played by Julie Christie and Gordon Pinsent, left) has fallen in love with a fellow Alzheimer's patient in her nursing home.
Such relationships are fairly common among demented patients. “It’s not uncommon at all for families and spouses to allow this to go on, because it sustains a person’s happiness,’’ Dr Richard Powers of the Alzheimer’s Foundation of America New York Times health blogger Tara Parker-Pope. “Those of us who have had this disease in our families know you just have to roll with these changes. Let them have a friend, if it buys them a day of happiness.’’

Images: ABC News, Capri Films
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Giller Prize winner Dr Vincent Lam in conversation

A student newspaper from the University of Toronto, The Strand, .

won the 2006 Giller Prize for his debut short story collection Bloodletting & Miraculous Cures.

Interviewer Moe Abbas's introduction isn't terribly promising ("To be honest with you, I didn't want to do this interview," it begins.) so skip ahead to read Dr Lam's thoughts on universal healthcare and the role of physicians in its defence:

I would rather go to a doctor whose ordering the tests just because they think it's the right test, and I would rather not be going to a doctor and have to think "gee, I know they're ordering it for me, but could they have more reasons to ordering this test? Is there some profit motive to this?"

As a patient I'd rather not think about that and just go to a doctor who's thinking only of my interests. And if that means that I live in a system where sometimes a CT scan is not available quite as quickly but nonetheless is available when it's needed then that to me, as a patient, that is a very worthy trade-off.
NRM in April 2006.


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Manitoba-Afghan med text story takes flight

Our about Manitoba-based Books With Wings has been by independent media outlet .

Founded by Winnipeg radiologist Dr Richard Gordon (pictured left with Afghan-Canadian colleague and BWW volunteer Dr Wassay Niazi), the Books With Wings project collects medical textbooks to help rebuild Afghanistan's war-ravaged medical libraries. Dr Niazi is currently in Afghanistan helping set up the country's epidemiology program.
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Thursday, November 15, 2007

Alberta pols take up doctors' cause against Bill 41

Alberta Legislative Assembly opposition members had strong words for the government yesterday afternoon during the second reading of the controversial Bill 41, which almost all health professions in the province oppose because they fear it will impinge on their self-regulation and independence. (For more on the Bill 41 debate, read .)

After Health Minister Dave Hancock spoke about the proposed legislation, the criticism began pouring forth. (To read the full text of the exchange, you can expand this post by clicking on the 'Read more' link below or by downloading .)

Liberal health critic Laurie Blakeman was first up to bat. Here are the highlights from her speech:

I think the second part of this, specifically what’s included in section 135 that’s being amended, is pernicious... This I think is an excessive reaction to the situations that arose. This is granting the minister an unwarranted extension of powers...

You know, we can find examples of where this very same government, these very same people – not 25 years ago, Mr. Speaker, not 40 years ago or 70 years ago, but this group of people – have made changes in other substantial pieces of conceptual legislation, and that resulted in them then coming back and using it, again, I would say, not for good but for evil.

What powers and what problem is being solved by this? I don’t think the minister was able to articulate exactly. It’s all sort of, “Well, maybe it’s this,” or “Maybe it’s that,” or “I could imagine possibly at some point in the future.” Uh-uh, uh-uh. That is not what legislation is for: some whimsical, magical, possible thing in the future. It has to be more concrete than that to
be giving itself such enormous power.

There also need to be checks and balances on power. Power corrupts. Absolute power corrupts absolutely. This government continues to give itself more and more intrusive powers into every aspect of our lives. That is inappropriate, and we the people have to curb that power.
Next up: NDP MLA Ray Martin.
Well, Mr. Speaker, it seems to me that this is sort of taking a sledgehammer to a nail.
Last but not least, Liberal MLA and pharmacist Mo Elsalhy.
... we were faced with a very difficult situation last year, Mr. Speaker: do we support a bill that has questionable parts, or do we oppose it? You try to amend it. You try to remove the offending parts, you try to stick to the good parts, and you try to move forward, but then the government responds by saying: “No. It’s take it all or leave it all.” This is a similar situation.
Click 'Read more' below to read the entire debate in the Alberta legislature yesterday.

You can read the online (PDF), and also the .

(The following is the full text of November 14 second reading of Bill 41, from )

Bill 41
Health Professions Statutes Amendment Act, 2007
The Speaker: The hon. Minister of Health and Wellness.
Mr. Hancock: Thank you, Mr. Speaker. It’s my pleasure to
introduce for second reading Bill 41, the Health Professions Statutes
Amendment Act, 2007.
Bill 41 was referred to the standing policy committee after first
reading, and I’m pleased that the standing policy committee did
recommend to the House that we proceed with Bill 41.
Health care professionals play a very critical role in the health
care system, and in this province as in all provinces in the country
governance of health professions is done through regulatory
colleges. It’s a process that works well. Self-governance has served
us well and will continue to serve us well. Regulatory bodies
function independently of each other and the health system operators,
so there’s an issue of assurance that we need to deal with, hence
Bill 41. Government’s role is to provide that assurance to the public,
notwithstanding that we have self-regulated professions and that
those professions do operate in the best interests of the public, that
they do have the capacity to provide for the most part the governance
in the way of bylaws, codes of conduct, standards of practice.
The health care system is in fact becoming more and more
complex. We’re operating now where we have a stated policy of
government that we want to have health care professionals working
to the fullest extent of their capability, training, and expertise.
We’re working very diligently with health care professionals on
multidisciplinary teams, methods in which health care professionals,
different professions can practise collaboratively and collectively for
the better good of Albertans. So it’s important as we do that to make
sure that our codes of conduct, our ethical standards, and standards
of practice are synergized, that they work collaboratively together,
and that they are synchronized appropriately.
It’s also very important, as we have a range of health care
professionals working together not only at cross-profession but
within, if you want to call it, a range or a hierarchy of the profession,
that their standards of practice, codes of conduct, et cetera, work
together. So there’s a role for the government, the Minister of
Health in particular or through the Minister of Health, to work with
the professions to make sure that we have that kind of a collaborative
practice and that the codes of conduct, the standards of practice,
and the ethical standards are working in concert.
Now, earlier this year we had a very unfortunate circumstance
with respect to issues around infection prevention and control, which
has been discussed in this House before, so I won’t go into the
details on it. But coming out of that incident, I as Minister of
Health asked for a number of things to happen. One of the things
which we did was ask the health professions to respond with a
review of what they had in place with respect to infection prevention
and control standards, and we had a report on that, which was
released in August of this year.
While there are – and I want to say this – many very positive
things happening in the province by the professions in respect to
quality of care, infection prevention and control, there are gaps.
There are issues that need to be addressed. So it’s important when
that happens, when you see that, to work collaboratively, to
encourage the health professions to work both independently and to
work collaboratively with each other to make sure that those gaps
are filled.
But there is a responsibility as well on government. There’s a
responsibility on government to provide assurance to the public that
those gaps are being filled. So I want to be very clear that it’s not
my intention as minister and it’s not government’s intention, nor
would it be appropriate, for us to step in and do things with respect
to the standards of practice or the codes of conduct. In fact, many
of them, Mr. Speaker, are standards which are negotiated by the
professions with their sister and brother professions across the
country. It’s not that easy to step in and tinker with bylaws or
standards of practice or codes of conduct, but it is still fundamentally
important to be able to say to Albertans that the role of assurance
that government holds is there, is being fulfilled, and that we have
the capacity and we have the authority to do it if and when necessary.
With respect to Bill 41, then, I would just highlight that there are
four categories of amendments being proposed to the Health
Professions Act. The bill itself is called Health Professions Statutes
Amendment Act because the medical professions are not yet, in fact,
under the Health Professions Act. They’re still under their own act.
We anticipate the medical professions being brought in perhaps by
the spring. So it’s necessary to amend both acts in one circumstance.
Within Bill 41 there are four categories of amendments. The first
category of amendments provides, as I’ve been speaking about, for
greater accountability. Amendments are proposed to both the Health
Professions Act and the Medical Profession Act, and it’s really
around this ability of the minister – and I want to emphasize – in
extreme circumstance to be able to direct the profession to change
a code of conduct or bylaw or standard of practice. I say in extreme
circumstance because the expectation, the reality will be – it has to
be – that one would not make such a change unilaterally or, as some
have said in public discussion on this bill since its tabling in the
spring, on a whim.
This is not about taking away self-regulation. This is not about
defeating the very effective process of self-regulation of the
profession, but it is about re-establishing the ability of the government
to fulfill its role of assurance to the public.
It is about recognizing the complexity of the system and understanding
that health care professionals are working together not only,
as I say, in the hierarchy of the profession – in other words, nurse
practitioner, RN, LPN, nursing assistant or personal care attendant,
doctors, physicians’ assistants, whatever other subsequent professions
we might put in place there – but across professions, where
you have, such as they proved so effectively in the bone and joint
institute, the ability of health professionals to work together as a
team and work with others, with the technicians and other support
personnel, to make much more effective use of the health care
resources and much better use of patients’ time and provide a much
better outcome to patients by working collaboratively. But if they’re
going to work collaboratively, they have to work with an understanding
of a consistent set of ethical standards, of codes of conduct,
and standards of practice.
It’s government’s role because if there was ever a problem, people
wouldn’t go back to the profession about the problem. They’d come
to government. In a SARS pandemic, in a Walkerton situation, in
any of those, to use extreme examples, it’s not the individuals
involved – sure, they’re held accountable, but it’s not those individuals
that are expected to provide the assurance to the public. It’s
government that’s expected to provide the assurance, so it’s
necessary for government to have the tools to actually do that
It should be clear that while the amendments that we’re bringing
in in this first category are about authorizing the minister to give
direction to a health regulatory body to make, adopt, or amend
regulatory bodies’ bylaws, regulations, or standards of practice, it’s
to do so when there are gaps or inconsistencies. It’s to do so after
full discussion has happened, after you’ve gone through a process of
discussion, unless there’s an emergency. It’s to do so only if after
consultation, facilitation, mediation, and arbitration there needs to be
a mandate. It should be clear – and I want to make that clear on the
record – that this is not a first-in solution. This is a last-resort
The second category of amendments basically talk about strengthening
reporting on public health matters. Again, this comes out of
discussions we were already having but was highlighted by the
events this spring at East Central health, particularly at St. Joseph’s
hospital, and the necessity to make sure that there is a clear understanding
of the primacy of the Public Health Act and the requirement
on health care professionals to immediately report threats to public
health to a medical officer of health. That provision, that requirement
to report, prevails over any of the confidentiality provisions in
the Health Professions Act, the Medical Profession Act, or any of the
other regulations or bylaws governing health professions. It must be
seen as paramount that the assurance of public health comes first,
and if there’s any question about the primacy of any of the various
acts or regulations or bylaws, the duty to report has priority.
The third category of amendments that are being brought forward
in Bill 41 deal with, in essence, the ability to provide support to
colleges. This also had some degree of concern being expressed by
members of the profession because you have, in fact, under the
Health Professions Act a structural regime that applies to all of the
colleges. But, in fact, one size doesn’t fit all. Although it was a
useful exercise, it’s a very important structure to have a Health
Professions Act and to have a standard organizational framework
and a process for public involvement and those sorts of things.
In fact, when you have newer professions, when you have
emerging professions, when you have some smaller professions that
perhaps do not have the capacity to carry out all the functions that
are required of a profession, there may be a need for support. It’s in
that vein that these amendments come forward, to say that in
appropriate circumstances there can be an administrator appointed
to perform a registrar function or to assist with a complaints director
or to do the conduct and competency committee functions, that, in
fact, these are helping provisions, but they also are fail-safe provisions.
You could appoint an administrator in a circumstance where
a profession fell on hard times and was not able to actually carry out
its functions.
So while the major professions, the ones that we’ve known and
loved for a long time – the College of Physicians and Surgeons;
CARNA, the College and Association of Registered Nurses; the
College of Pharmacists – are well-established, very strong professions,
one would not expect to see the need to use this provision with
respect to those professions. I can’t even imagine a circumstance
where that might come into effect. However, it might be very
important to be able to have these provisions with respect to
supporting a new or emerging profession.
Again, under our health workforce plan one of the things that we
want to try and accomplish is to have new and emerging professions
be able to come forward, be able to practise their profession in the
province and add to the health workforce in an appropriate way to
really, again, use the full skills that people might have, the education
that people might have to provide appropriate health outcomes for
The Standing Committee on Community Services recommended
imposing limits on the term of office for any person appointed as
administrator. The bill currently allows for a term of an administrator
to be set in the appointment. The intention is to help colleges
eventually operate without an administrator. I’m not anticipating an
amendment coming forward in that regard, but I wanted just to
highlight that that came out of the standing committee’s report.
The fourth and last category of amendments really provides for
greater clarity. Members will know that the Health Professions Act
came into effect a number of years ago. It has been our practice, as
we’ve learned and grown and as we’ve brought professions into the
act, to do amendments from time to time which, basically, update
and improve the act. So the changes in that category, for example,
deal with the responsibilities of employers and employees. Employees
must provide evidence to their employers of valid professional
registration. Employers must ensure that they employ the right
health professional for the right job. Those are the types of amendments
in that portion of the act.
Mr. Speaker, Bill 41 I would commend to the House. I would ask
the House for support. I think it’s a very important piece of
amending legislation which will provide the minister and the
government with the tools it needs to provide the assurance to the
public of Alberta not only, as we’ve now introduced in Bill 48, that
with respect to the regional health authorities there is a clear line of
authority in process and accountability but that with respect to health
professions there is a clear line of assurance and responsibility.
While we do delegate significant opportunities to professions to selfregulate
and responsibilities to professions to self-regulate, there is
still a role of assurance that government must have, and Bill 41
provides the tools.
It’s also important, as I said, because there needs to be a clear
indication – and this is the appropriate place for it – that whether
health professionals are practising on their own, in their own
practices, or whether they’re employed by or working within a
health authority, they have a duty as health professionals to report
any public health concern to the medical officer of health.
With those words, Mr. Speaker, I would ask for the support of the
House on Bill 41.
The Speaker: The hon. Member for Edmonton-Centre, followed by
the hon. Member for Edmonton-Beverly-Clareview. If a government
member would like to participate, kindly advise.
Ms Blakeman: Thank you very much, Mr. Speaker. Well, this is
one of these interesting bills that you see occasionally coming from
the government which has something good in it, and then that is
balanced by bad things in it. We were willing to support the
government in the amendments that they are proposing in Bill 41,
the Health Professions Statutes Amendment Act, in providing clarity
and certainty around the situation that arose specifically with the
College of Physicians and Surgeons in Vegreville in which there was
uncertainty about who was supposed to report to whom or even if
there was a requirement to do that. I am a fan of certainty, particularly
where public health is involved, so those amendments and the
section that contains those amendments I’m certainly willing to
support as the shadow minister for Health and Wellness.
I have not heard any complaints from any section of the health
professions or members of the public who weren’t supportive of this.
I think it helps everybody to know exactly what the expectations are
and that they’re laid out clearly: what are the lines of communication,
what is the timing around it, and who’s supposed to do it to
whom? That kind of clarity is very helpful.
We certainly had a scare around infection control both in
Lloydminster and Vegreville earlier this year. It scared a lot of us
and really brought into high relief the need to have those lines of
clarity and authority. Certainly, the Health Quality Council report,
from which flows much of the legislation that the minister has
referred to, was pointing that out. In addition, when we look at some
things like a pandemic preparation, as the minister alluded to at the
end of his remarks, that is one of the key ingredients. It is around
clear lines of communication and clarity of roles and responsibilities.
So the first section that appears in Bill 41 under Public Health Threat
and the changes that flow through the Health Professions Act and
others I think: we have no problem with that. That’s the good.
Now the bad. A number of members of the health profession took
advantage of the policy field committee public consultations to come
and present, and I’m glad that they did. They were able to get their
concerns well on the record. I may repeat some of those concerns,
but I think it’s important to have them laid out in this House.
I think the second part of this, specifically what’s included in
section 135 that’s being amended, is pernicious, the part that’s under
Part 8.1, Direction, Support and Variation, specifically the minister’s
direction under 135.1 and everything that follows after that. I know
that the College of Physicians and Surgeons really objects to this,
and frankly so do I. This I think is an excessive reaction to the
situations that arose. This is granting the minister an unwarranted
extension of powers, and it is unwarranted.
Further, it fundamentally challenges the concept of self-regulation,
and that is what we were trying to set up under the Health Professions
Act. We have these professions. They’re experts in their field.
We recognize their right, essentially, to self-regulate and that they
are the best people to be doing it. Then what we have is this overlay
from the minister that says: well, yeah, all of that’s true except if I
decide that it isn’t. So I would argue that this sort of thing fundamentally
challenges that whole concept of self-regulation and all the
other things that fall under that new Health Professions Act.
It’s all about self-regulation. They’ve made every possible health
profession conform to that by setting up a college, an association, a
series of criteria for meeting standards in the profession, for selfregulating
on discipline procedures, on training, on ongoing, lifelong
evaluation of professional qualifications and practice. We’ve done
all of this work to set this up. We’ve been operating under that
assumption. It’s worked pretty well for us so far, and now we have
this overlay where the minister can basically interject himself into
any component and for no good reason. The reasons that the
minister has laid out are not good enough, not to make that kind of
a change in what we have in a system that’s working pretty well for
us, not perfectly but, you know, pretty well.
I think there are a number of possibilities that arise out of a change
like that. For example, how keen will the pressure be to capitulate
on a negotiation in another area to avoid having the minister decide
that this is such an enormous case that they’re going to have to
invoke these powers and come in? Pretty strong. I can speak from
experience on that one. The not-for-profit sector in this province has
been under enormous pressure to be careful, not to make too much
noise, not to distress the government by pushing too hard on certain
advocacy things because they held all the money strings in a lot of
[The Deputy Speaker in the chair]
I think we can look not too far in the province for other examples
where the government has not played ball on this kind of thing and
where there is a coercion factor that comes into play. You know
what? Sometimes that’s our own fault, Mr. Speaker. Sometimes we
self-censor. Sometimes we make choices about our organizations or
our companies in fear of some sort of interference from the government
because they have the power to do it. Okay. That’s our fault.
We shouldn’t have self-censored ourselves or made decisions based
on that. But you know what? We do it because of fear. We do it
because the government has already given itself the power to
interfere with us. That’s what’s wrong with the whole second
section of what’s anticipated in this act, in Bill 41.
The minister says: oh, we’re not really going to use these powers;
you know, this is just really for an unanticipated extreme emergency.
Well, you know what? If the powers are not to be used, they should
not be legislated. The government surely has another way to deal
with this problem. If this extreme, far-reaching, highly unlikely
situation is ever going to arise, then they have a number of other
tools at their disposal. This makes it too easy, and it’s too darn
I think we’ve seen a couple of other examples where we have
major conceptual legislation that gets adjusted a bit by this government
and as a result other things happen that, I hope, were not
anticipated, but perhaps they were. You know, the idea of collective
bargaining that got tinkered with when the government in negotiating
with CNRL changed the division 8 labour code. That has now
allowed for changes in master agreements. So there’s an example of
where they gave themselves the power. They changed something
that was conceptual legislation, and then they’ve gone back and used
it not for good but for evil, I would argue, if I may paraphrase, Mr.
Where is another example? Well, that would be around the
confined feedlot operators, where they tinkered with it and allowed
those to be closer to things like schools and communities. You
know, we can find examples of where this very same government,
these very same people – not 25 years ago, Mr. Speaker, not 40
years ago or 70 years ago, but this group of people – have made
changes in other substantial pieces of conceptual legislation, and that
resulted in them then coming back and using it, again, I would say,
not for good but for evil.
What underlying problem is being solved by the changes that the
minister would like to see in this legislation? Again I’m not talking
about the beginning part, about the public health, about that clarity.
I’m talking about the other sections, where the minister is now able
to go in and arbitrarily change regulation power and a number of
other powers that are delegated now or are allowed to be evoked by
self-regulatory organizations. What powers and what problem is
being solved by this? I don’t think the minister was able to articulate
exactly. It’s all sort of, “Well, maybe it’s this,” or “Maybe it’s that,”
or “I could imagine possibly at some point in the future.” Uh-uh,
uh-uh. That is not what legislation is for: some whimsical, magical,
possible thing in the future. It has to be more concrete than that to
be giving itself such enormous power.
If it’s not a problem that’s being solved, then what policy issue is
being addressed through this? Again, I can’t see what policy issue
is being addressed. What policy issue needed to be advocated that’s
now being addressed by the minister giving himself powers to be
able to go in and arbitrarily change self-regulatory groups? Again,
that can’t be answered.
I heard the minister say: well, this was being done for what if or
role of assurance. Well, again that brings up the issues of trust. This
government continues to give itself very expansive powers, especially
through regulations, which are not open to scrutiny by this
Assembly. The discussions and reasons behind it do not appear in
Hansard. They’re not streamed through live audio or through live
video streaming on the Internet. The citizens and the members of
the opposition have no ability to scrutinize the government on why
they arrived at those particular decisions. It’s behind closed doors,
and for the kind of changes that are being anticipated here, that is
There are a couple of things really wrong around those issues of
trust. There are issues around transparency and accountability.
What kind of report back do we get if the minister decides that he
wants to come in and do this? What sort of accountability and
transparency do we the public or members of the opposition in this
House on behalf of the public get to have to scrutinize when the
minister decides to do this? It’s not there, Mr. Speaker, and that is
There also need to be checks and balances on power. Power
corrupts. Absolute power corrupts absolutely. This government
continues to give itself more and more intrusive powers into every
aspect of our lives. That is inappropriate, and we the people have to
curb that power. That’s part of the push back that citizens should
have against a government. They should be able to advocate to keep
the government in check, and so is it the role of the opposition to do
I will not support this legislation as it stands. As I said at the
beginning, I’m more than willing to support the public health
concerns that were being addressed because of the confusion that
arose over those situations that started with St. Joe’s hospital and
then moved beyond that last spring. But the second part of what’s
anticipated in this legislation is inappropriate. It’s more than that.
It is pernicious. I don’t trust this government with that kind of
power. I’m not willing to give them that kind of power if I can’t
trust them with it. I have enough examples in front of me of where
that government took that kind of power before and then did things
that were against the tenor of what was expected out of that, and I
feel they misused and abused that. I don’t think it’s appropriate to
do that.
An Hon. Member: Do you have some examples?
Ms Blakeman: I gave the two examples, if the member was
listening. He’s welcome to check with Hansard.
I won’t support it because this is being made unilaterally. I don’t
like it being made through regs, which this government tends to do.
There are other opportunities for the government to react to pandemic
situations. This kind of power should be used only as a last
resort, and I don’t see anything on the horizon that would justify the
minister giving himself and the government that kind of power at
this point in time.
I will look at amendments for this, but I do not think what’s being
anticipated here is appropriate in any way, shape, or form.
Thank you.
The Deputy Speaker: The hon. Member for Edmonton-Beverly-
Mr. Martin: Well, thank you very much, Mr. Speaker. I’m glad to
participate in debate on Bill 41, the Health Professions Statutes
Amendment Act, 2007. You know, some of the bill is, I suppose,
absolutely necessary. We learn things as we go along, and the bill
aims to provide for greater accountability to Albertans about the
consistency of health care standards of practice, require the reporting
of public health issues despite any other confidentiality in the
respective acts, and provide for professions to be regulated in the
Health Professions Act.
Now, Mr. Speaker, as the previous speaker said, most of that’s
desirable, and certainly we learned things recently by what happened
in east-central Alberta. But I think the other part of the bill, that we
all know is the most controversial part, is that the minister gains new
power to intervene in professional bodies. I notice that the minister
said that one of the purposes of this act was to increase collaboration
between the various health professions. He’s done that indirectly
because I think he has almost all the associations against him in
section 135. They all seem to be of one mind about that, so I think
there is an amount of collaboration going on, probably not the kind
that the minister wanted. We notice, I think, right across the board
that the College of Physicians and Surgeons, CARNA, the pharmacists
all strongly opposed to the new section, section 135, which
creates new powers for the minister to intervene in the affairs of
what are supposedly self-governing bodies. I know this was brought
forward to the policy field committee, but they decided, I think
unfortunately, to not recommend any substantive changes to section
Now, I’ve listened to the minister. I wasn’t on the committee, but
I believe he said to the policy field committee that, really, this is just
a what if, sort of, and he can’t imagine – I heard him say today – for
whatever reason that he would ever interfere with the established
professional bodies such as the pharmacists, physicians, surgeons,
nurses, and others, but maybe there are some emerging health
professions that may need some help. Well, Mr. Speaker, it seems
to me that this is sort of taking a sledgehammer to a nail. If there are
some particular smaller professions that are coming that need help,
surely there’s a way around it to put it into regulation that that’s who
we’re to deal with, but to say that you take a broad approach and say
that for all the health professions the minister has the right to
intervene seems to me to be overkill.
As the previous speaker said, the minister said that he can’t
imagine ever having to do that. Well, why would we legislate it if
you can’t imagine us ever doing it? I mean, that just doesn’t make
a lot of sense to me. What could be a good bill we’ve now got in a
controversy here with the minister. I know the minister himself is
from a profession that’s self-governing. I can imagine the outcry
within that group of professionals if this sort of bill was coming
forward. In the legal profession they’d be as angry as the other
groups are, Mr. Speaker.
Last night in this Assembly I recall debating Bill 24, the Real
Estate Amendment Act, 2007. Interestingly enough, in that
particular bill dealing with mortgage brokers – we were supposedly
dealing with mortgage fraud – we were actually opening it up to
more self-governance so that they can deal with these problems
within the real estate industry. The next day, Mr. Speaker, we have
a bill here dealing with established professions that have been
around forever, and now we’re taking away some of their rights.
That just doesn’t make a lot of sense with two different bills that
we’re debating right here in this Legislature.
You know, I say to the minister that I would have thought one
would have wanted to be particularly careful when we’re dealing
with this. As I say, the collaboration, the groups – he’s got the
message, I’m sure, about section 135. So you’ve taken a good bill
and learned from it, and now we have this controversy, unnecessarily,
I would say, in terms of taking away rights of the professions.
That doesn’t make much sense to me, Mr. Speaker, because these
are precisely the groups that we want to have on board on this
Now, I notice – and I’d like to come to this – why we have to do
this. The minister was good enough to brief us about a bill that’s
coming forward, Bill 48, the Health Facilities Accountability
Statutes Amendment Act, 2007, and he alluded to the problems with
infection control in Vegreville, in east-central Alberta. This
particular bill, Bill 48, seems to me to be solving his problems, Mr.
Speaker, because he’s working, correctly – and I believe it’s a good
bill – on accountability. Obviously, the minister is accountable
Then the health regions. We’ve laid that out in Bill 48. It seems
to me that there’s where the minister has the power to do the things
that he needs to do. So why would we be taking this bill and
messing around with the professions when we don’t need to, Mr.
Speaker? I just come back to what the minister said. He said that
it’s basically there for emerging professions. Well, surely you can
put in some guidelines and that without going and saying: well, it
may be down the way that I need to interfere in the professions that
have been operating in this province for a long time. I really do say
to the minister: imagine in the legal profession, that he’s in, if a
similar bill like this came forward, what the outcry would be. He
knows very well what that outcry would be, and they’d probably be
even more vociferous, because they’re used to being in court, than
the doctors and everybody else, I can imagine.
You know, if I may just quote from a letter sent recently to Mr.
Hancock, that was delivered to all of us, from PARA, the Professional
Association of Residents of Alberta. I think they put it very
well. They talk about co-operation. I’ll just quote the one paragraph:
as resident physicians we have witnessed an era of productive
collaboration between the Alberta government and its physicians;
introducing legislation which may undermine the ability of Alberta’s
physicians to regulate themselves risks making the province a less
attractive environment for new physicians deciding where to
That’s an important point, Mr. Speaker, because we’re all in
competition for health workers right across Canada, around the
world, for that matter, and they’re saying that this may have a
detrimental effect, especially getting new young physicians. It says:
resident physicians value sound discussion and good evidence from
a broad perspective to implement codes of ethics, regulations,
bylaws, and practices. I think they’re offering their hands out and
saying, “We’ll help whatever way we can.” They’re saying: “Why
are we doing basically this? We’ve had a good round of collaboration
with the government.” They’re praising the government; they
just don’t understand the purpose of this.
Mr. Speaker, as I say, most of the bill is an important part of
accountability and certainly, when we bring it in with Bill 48,
absolutely a necessity, as we’ve learned in east-central Alberta. But
I’d just say to the minister and to this government: why would we
undermine a good working relationship with established health
professionals that we need to make it a sound health care system by
even saying that we may need this power somewhere down the line,
that we may need it? As I say, the minister hasn’t given us a good
reason why he would interfere within the self-governance model of
these established professions. He said, you know, that emerging
professions may need help. Well, it seems to me that you can deal
with that rather than what you’re doing here. I think it’s a major
mistake, and it detracts from the good parts of the bill, and it
certainly detracts from the bill that the minister brought that the minister brought forward
I’d just, with all due respect to the minister, say that I think we
don’t have a Senate here, but sober second thought – well, that’s
always a misnomer in the Senate. We need some sober second
thought here by the minister and the government, and I would hope
that they would take a look at this before it comes back in Committee
of the Whole.
Thank you, Mr. Speaker.
The Deputy Speaker: Hon. members, Standing Order 29(2)(a) is
available for any questions or comments.
Seeing none, the hon. Member for Edmonton-McClung.
Mr. Elsalhy: Thank you, Mr. Speaker, for this opportunity to rise
and speak on Bill 41, the Health Professions Statutes Amendment
Act, 2007. I have to start by saying that this is a new phase in
democracy in this province because this is one of four bills which
were referred to the newly formed standing policy field committees
– I know, Mr. Speaker, that you and I together sat on one of them,
the Standing Committee on Government Services; this is the other
one, Community Services – which is really a direction that I like and
I commend. We know that members from both sides of the House
approached this exercise with open minds, and I know that for the
most part it did pay off. I was more than pleased with the cooperation
and the progress that we experienced in Government
Services, and I’m sure that was the case as well in Community
Now, Bill 41 as proposed by the minister has good parts and
questionable parts. When we’re amending the Health Professions
Act to require immediate notification of the medical officer of health
by a health professional, a college employee, an officer, or an agent
of any threat to public health, well, that’s okay. I think that is good
in terms of, you know, public safety and in terms of reaction times
and in terms of being quick on our feet to respond to an emergency
or to a threat, so I don’t see any reason to oppose this particular part
of the bill.
But as my hon. colleague for Edmonton-Centre mentioned, it has
become more the tradition and the custom of this government to
lump good things with bad things, and I’m going to remind the
House that this was the case last year when we were talking about
Bill 20, the changes we did to the privacy legislation. We had some
good components, which everybody agreed to, components that
strengthened protection of personal information, components that
made it difficult for personal information to be misused or abused,
but then we also had components from the government which made
government operations more secretive and added another layer of
concealment to, you know, government decisions and blocked access
to government information and so on.
So we were faced with a very difficult situation last year, Mr.
Speaker: do we support a bill that has questionable parts, or do we
oppose it? You try to amend it. You try to remove the offending
parts, you try to stick to the good parts, and you try to move forward,
but then the government responds by saying: “No. It’s take it all or
leave it all.” This is a similar situation.
I mentioned the positive component. The negative component
here would be the part that amends the Health Professions Act and
the Medical Profession Act to give the minister that extra power, that
added power, the concentration of power in the hands of one person,
to either replace the functions of the entity that’s in question – take
the College of Physicians and Surgeons, for example – or direct a
college to adopt certain bylaws, regulations, or standards.
Now, as the minister explained in his opening remarks, the
College of Physicians and Surgeons, the college of pharmacy,
nursing, and so on and so forth, all of these entities, are long
standing. They are strong in their mandates, they are strong in their
history and tradition, and we don’t have many complaints against
them. We don’t have many troubles with these agencies or entities.
So why are we doing this now?
Definitely the concerns that were heard in the committee, from my
brief scan of their transcripts and from talking to members of the
Official Opposition that sat on that committee, regarding changes to
existing medical health professions’ self-governance were definitely
the more pronounced concerns, the concerns that were heard the
Now, I think that this is in reaction to the crisis in Lloydminster,
for example, and in similar situations with respect to infection
control and things like sterilization and things like this. Responsibility
for these situations rests with the health regions, and I have to
mention, Mr. Speaker, on the record that I would have much rather
seen health regions continue to be elected, but what’s behind us is
behind us. They are now appointed. Anyway, they are ultimately
responsible for what goes on in the facilities in their immediate
Then I would like to see a strengthened central monitoring role for
the ministry of health to have that oversight capacity, that oversight
function centrally, that basically they would look after sterilization.
They would look after equipment. They would look after most of
these things. That would then hopefully alleviate the concern that
maybe the health regions are to blame. I don’t want to be pointing
blame, and I don’t think the minister is trying to do this here. But I
think he’s trying to react very forcefully. I think, you know, that cooperation
with the health regions and maybe having that central
monitoring function would alleviate that concern, and he doesn’t
have to really intervene in this fashion.
The committee received submissions, Mr. Speaker. They received
written as well as in-person submissions, oral submissions. Again,
sort of the uniform reaction, the most received feedback was: what
are we trying to do here? The most important question was one
given by the College of Physicians and Surgeons, and I don’t think
they’ve received an answer yet: “What problem is being addressed?
What is this legislative change attempting to do?”
Now, when we take a professional organization that has been there
in some cases even longer than the government – I actually attended
the centennial celebration of the Law Society. This Law Society
was here before the province became a province. Similarly, I would
bet you that the College of Physicians and Surgeons, the college of
pharmacy have been here for decades and decades, some of them
before the province even became a province. Now we’re telling
them: you cannot continue to do what you do because we know
better. I think this would be classified, in my book at least, as shortsighted.
I think it would be too much government, and we know that
too much government is not necessarily better. Sometimes we enter
into places that we shouldn’t, and we venture into new places that
maybe we should stay away from.
The other question I had. I know this is second reading, Mr.
Speaker, so I’m talking to the essence of the bill. I’m talking to the
basics of the bill, which is about the recommendation from the
committee to the minister to impose limits on the term of office for
an appointed administrator. Is the minister leaning towards that? Is
he going in that direction? I need to maybe hear from him as to his
rationale, what good he’s hoping to achieve, and what problems,
again, we are trying to fix or address. Appointed administrators: you
know, I would classify them as employees. They’re basically there
to do a job. Have we heard anything that maybe advises us or tells
us that maybe two terms is enough because the longer they stay, they
lose their effectiveness or there are mistakes made or certain things
that maybe we don’t like to see?
I need to know the rationale and if, in fact, the minister is leaning
towards that, if he’s going to accept that recommendation from the
committee. I’m not necessarily against it. Don’t get me wrong, Mr.
Speaker. I just need the clarity to make up my own mind whether,
in fact, this is something I am going to be willing to support.
In terms of the minister using public interest as his trigger, who is
going to define public interest? Is that interpretation or that opinion
going to be one that the minister exercises himself? When we have
situations where public interest is the focal point, the deciding factor,
who’s going to make that decision? Again, I don’t think it should
rest in the hands of just one person because too much power
concentrated in one person’s hands is not necessarily the way I’d
like our government to be going. Subjectivity and sometimes
settling scores or personal agendas might get in the way of being
objective and being a good manager.
I can go on and on, but I realize this is second reading, and I want
to give the opportunity to other members of the House to put their
thoughts on record and put their comments and questions on record
so that we can all gain a better understanding. If we’re forced to
have the situation where we take it all or leave it all, I have to tell
you, Mr. Speaker, that I am probably going to oppose Bill 41 unless
the offending sections are removed, and I’m hoping that this would
happen in Committee of the Whole.
Thank you for the opportunity.
The Deputy Speaker: Hon. members, Standing Order (29)(2)(a) is
The hon. Member for Peace River.
Mr. Oberle: Mr. Speaker, at this time I’d like to move that we
adjourn debate on Bill 41.

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