Avanafil – Getting the Best out of ED Drug Characteristics

One of the things or condition that a man would really hate to have is erectile dysfunction.  Often time, this is a condition that makes a man not feel like a man because the main reason he is called a man to begin with is not useable.  Most men who suffer from this condition tend to keep it to themselves, mainly because it is an embarrassing condition to have.  Fortunately for men who have this condition these days, they have the internet to turn to regarding their problem. Read more…

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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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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Thinking of trying caterpillar fungus tonic? Think again

Perhaps somewhat unsurprisingly, you shouldn't take an herbal medication called Royal Medic No. 1 Chinese Caterpillar Fungus, according to released today.

Why shouldn't I eat Royal Medic No. 1 Chinese Caterpillar Fungus, you ask? After all, Utah State University's says "some people believe the caterpillar fungus cures tuberculosis, coughing, anemia, and back and knee pains," not to mention its supposed strength-enhancing, stress-reducing properties.

Well you might ask, dear reader. The product -- "a fruiting body produced by the fungus, Cordyceps sinesis, on dead caterpillars of the moth Hepilus fabricius" -- sounds appetizing indeed.

Health Canada's moratorium on the med, the warning explains, is due to "concerns about possible side-effects... due to microbial contamination."

Whew -- good thing Health Canada is on top of this one. Though, to be fair, they're a tad behind their counterparts: a paltry six months behind the , and a measly three and a half months behind the UK's .

Images: and

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Doctors' fashion faux pas

There's a lot to be said for first impressions, and a doctor decked out in cut-off jeans and an old Alma Mater T-shirt may not be making the right one on her patients.

"It's terribly important," Dr Jean Carruthers, a BC facial cosmetic surgeon, The Globe and Mail. "How you dress yourself will give [patients] cues on how you will take care of them."

Last month, to minimize the spread of germs (see the illustration, below, for a diagram of clothing infection-risk areas).

But beyond practical concerns, docs need to express their individuality through fashion, like everyone else, say experts -- so long as their manner of dress exhibits "precision, intelligence and maturity." As Andre Agassi , "Image is everything."


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The power of pointing out Powerpoint pap

Dr Kishore Visvanathan, the Saskatoon urologist whose Powerpoint exhaustion inspired my recent article in NRM, got from a science communication expert named , who is just doctors and other professionals with their presentation skills. She told Dr Visvanathan, in part:

It's like you enter a big messy kitchen with dirty dishes, pots, and pans stacked everywhere and someone asks you if you noticed the beautiful red design on the pie plate. Eventually you could find it among all the other dirty, stacked items and you could appreciate the beauty. However, wouldn't it have been better if the room was immaculately clean and the pie plate was prominently displayed on the counter?
Absolutely. Who doesn't like a clean pie plate? Or, for that matter, a clean Powerpoint?

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A doctor in Flanders fields

A Canadian physician, Lieutenant Colonel John McCrae, penned the poem that has since become the anthem of Remembrance Day:

In Flanders fields the poppies blow
Between the crosses, row on row,
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.
In Flanders fields the poppies blow

We are the Dead. Short days ago
We lived, felt dawn, saw sunset glow,
Loved, and were loved, and now we lie
In Flanders fields.

Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.

After a stint in the military in the Boer War, Dr McCrae became a pathologist at the Royal Victoria Hospital in Montreal, performed autopsies at the Montreal General Hospital and taught pathology and conducted medical research at McGill University and the University of Vermont. He published "In Flanders fields" anonymously in 1915, but his identity became known before long. Veterans Affairs Canada has devoted to Dr McCrae's life. The National Post published two years ago.

from another (less famous) piece of Dr McCrae's writing -- this one, published in the Journal of Experimental Medicine in 1900, has a less catchy title: "NOTES UPON THE AGGLUTINATIONS OBTAINED BY INTRAPERITONEAL INSERTION OF CELLOIDIN CAPSULES CONTAINING BACILLI AND UPON A MODE OF PREPARING SUCH CAPSULES."

1. Capsules made as described above allow dialysis, when placed in the peritoneal cavity.
2. The normal tissues, unstimulated, do not possess the power of causing agglutination; they do not require to be stimulated by the presence of the bacterial bodies, but will produce their share of the agglutinins when acted upon by the bacillary products.
3. Agglutination follows the insertion, in the peritoneal cavity, of "capsuled" bacilli; it gradually increases in degree, and on the removal of the capsule containing the bacilli, begins to disappear.
4. Varieties of bacilli, related closely in morphology and cultural reactions, do not, as a rule, produce serums which inter-agglutinate.
Say what you will about "In Flanders fields" -- aesthetically and without the context of its time and place of composition, it's not much of a poem -- but you have to concede this much: what a difference 15 years can make.


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Alberta law threatening doctors' self-regulation draws nearer

Alberta's Bill 41, the controversial proposed amendment to legislation governing the province's health professions, in nearly its original form.

Physicians are almost uniformly opposed to Bill 41 because of its Section 135, which would give the Minister of Health and Wellness the power to change the bylaws, standards of practice and codes of ethics of professional regulatory bodies, like the College of Physicians and Surgeons of Alberta.

The Standing Committee on Community Services (PDF) last Tuesday, November 6. The report suggests one minor change to Section 135: "The Committee recommends that the Minister consider imposing limits on the term of office for any person appointed as administrator." That single change is unlikely to appease critics of the legislation.

The bill is sure to encounter resistance in the Legislative Assembly upon second reading on Wednesday, November 14; the NDP and Liberals have both expressed opposition to elements of the proposed law. Minister of Health Dave Hancock (pictured above left) sounded alternately standoffish and conciliatory when he and I spoke a few weeks ago, first calling physicians' concerns "irrational" but later explaining that he would consider some of the College's proposed changes to Section 135.

You can read on the National Review of Medicine website.


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Calling all Canadian doctor bloggers

If you're a Canadian physician and you've got a blog, we want to know about it.

We're assembling a list of Canadian physician blogs (see sidebar, right) and we'd appreciate your help in expanding it if you either have a blog or you know about a blog you think we should add to our list.

You can let us know by responding to this post in the comments section or by emailing us at editors -at- nationalreviewofmedicine -dot- com.

Dr Charles Smith inquiry begins

Today is the into pediatric forensic pathology in Ontario, and by extension, Dr Charles Smith, the pathologist who stands accused of intentionally misrepresenting autopsy and medical test results on dead children and whose botched work was the impetus for the current inquiry.

The inquiry, led by Justice Stephen Goudge, is being held at the Ontario Court of Appeals. It's predicted to last about three months, with final recommendations to be submitted by Justice Goudge in April 2008. (The inquiry has , where you can watch a live video broadcast from the courtroom and read the transcript of the hearing.)

So far, the inquiry has published the (PDF). An excerpt from the paper by counsel Linda R Rothstein:

[...] our job is to critically scrutinize Dr. Smith’s work, but not to demonize him. Moreover, we cannot allow undue emphasis on his role to distract us from our systemic focus. As will become clear from the Overview Reports, in a number of the cases we will examine, Dr. Smith’s opinions were supported by others engaged in the complex and difficult task of pediatric death investigation.
Justice Goudge's opening statement is (PDF):
I emphasize again that this is a systemic inquiry. The examination of individual cases is important only as it helps identify systemic failings that must be addressed if public confidence in pediatric forensic pathology is to be restored and enhanced. This is reflected in the fact that the Commission is called the Inquiry into Pediatric Forensic Pathology in Ontario.
The systemic issues to which Justice Goudge and Ms Rothstein refer are enumerated in (PDF):
1. "ensuring that the highest quality pediatric forensic pathology is available to the criminal justice system"
2."how that pathology is fairly and effectively communicated to the criminal justice system"
3. how "the coroner, the hospital in which the pathology may be done, the police, the Crown, the defence, the child protection agencies and the families... can best assist in ensuring that sound pediatric forensic pathology is supplied to the criminal justice system
4. "to determine the best corrective measures that ought to be available... after the fact of inadequate pediatric forensic pathology"
The , read by lawyer Niels Ortved, has been published on The Globe and Mail's website:
As this inquiry commences and before any testimony is heard, Dr. Smith wishes to publicly acknowledge to the commission that in the 20 years that he performed autopsies at the direction of the Office of the Chief Coroner of Ontario, he made a number of mistakes for which he is truly sorry.

Dr. Smith sincerely regrets these mistakes and apologizes to all who may have been affected by his errors. Dr. Smith wishes to emphasize that any such mistakes were made honestly and without any intention to harm or obstruct the pediatric death investigations in which he was involved.

At all times, Dr. Smith endeavoured to use whatever knowledge and expertise he possessed to render accurate pathologic opinions. In retrospect, he understands that in some 20 cases which form the basis of this inquiry, his work, while to the best of his ability at the time, was simply not good enough in certain circumstances.

The inquiry is sure to be covered extensively in the media, not just in Ontario but nationally as well. In this morning's Globe and Mail, Kirk Makin asks, "" Mr Makin also unearths that a Maclean's reporter conducted with Dr Smith in 2001 in which he admits to interfering with judges and lawyers.

Toronto's CityNews of some of the cases where Dr Smith's conclusions have been either overturned or questioned.

The Toronto Star discusses the case's focus on , which treated suspects as though they had to prove their own innocence rather than the method embodied by the traditional 'innocent until proven guilty' dictum.

Former Star reporter Harold Levy is and prepping for a book on Dr Smith.

I wrote , in NRM.


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